Research Medical Journal

[2026-01-26] Bilateral Third Nerve Palsies Secondary to Pituitary Apoplexy: A Case Report

Suntaree Thitiwichienlert — 2026-01-26

Background: Bilateral third cranial nerve palsies resulting from pituitary apoplexy with bilateral lateral expansion compressing bilateral third cranial nerves at the cavernous sinuses walls are uncommon.

Case Presentation: A 31-year-old healthy male complained of an acute severe headache, bilateral ptosis, and binocular horizontal diplopia for about 4 days. Eye examinations revealed incomplete ptosis, partial limitation of supraduction, infraduction, complete limitation of adduction, and dilated pupils in both eyes associated with bitemporal hemianopia. A brain computerized tomography (CT) scan with contrast revealed an intra- and suprasellar pituitary mass. Brain magnetic resonance imaging (MRI) reported a heterogenous mass measuring 3.0 × 3.1 × 3.8 cm involving the sphenoid sinus, sella turcica, and suprasellar cistern. Hormonal workup revealed the first diagnosis of type 2 diabetes mellitus, hyperprolactinemia, central hypothyroidism, and hypogonadotropic hypogonadism. The patient received hormonal supplements and the tumor was successfully treated by endoscopic surgery. Pathological confirmation of pituitary hemorrhage was found. All ocular and neurological deficits were completely resolved within 6 months postsurgery. Follow-up MRIs at 3 months and 1 year showed no residual tumor; however, hypogonadotropic hypogonadism and postoperative diabetes insipidus persisted for 4 months.

Conclusions: Localization of the third cranial nerve palsy was significant in determining the possibility of a lesion and detecting an emergency condition causing potential life-threatening complications. Most cases of third cranial nerve palsy from pituitary tumors effect one side, but this case is unusual because it involved both sides, showing a rare pattern of tumor growth and compression.

[2026-01-26] Laparoscopic Vesicovaginal Fistula Repair: 2 Cases From Chaophrayayommarat Hospital

Pongpak Pinyoboon — 2026-01-26

Background: Vesicovaginal fistula (VVF) is a distressing complication most commonly resulting from gynecologic surgeries, particularly abdominal hysterectomy. Laparoscopic repair offers a minimally invasive alternative to open surgery, providing favorable outcomes and quicker recovery.

Case Presentation: This report presented 2 cases of posthysterectomy VVF managed at a provincial hospital. The first case was a 39-year-old woman who developed persistent urinary leakage one month after abdominal hysterectomy. Imaging revealed a 3-mm fistula near the left ureteric orifice, and cystoscopy showed a 1 cm defect. The second case was a 45-year-old woman who presented with leakage 16 months posthysterectomy and intraoperative bladder repair. Imaging and cystoscopy confirmed a 6-mm midline fistula. Both patients underwent laparoscopic transabdominal VVF repair using the O’Conor technique. Key surgical steps included cystotomy, layered closure with nonoverlapping sutures, and omental interposition. Ureteral stenting was used to prevent injury, and Foley catheters were left for 2 weeks postoperatively. Both surgeries were completed successfully without major complications. Operative times were approximately 4 hours. Blood loss was minimal. Patients were discharged within 3-5 days, and followed-up at 1, 3, and 6 months which confirmed complete continence and improved quality of life.

Conclusions: Laparoscopic VVF repair is a feasible technique to minimize postoperative pain and length of hospital stay, as well as enhance access to quality of care and reduce the burden of referral to tertiary centers.

[2026-01-26] Conventional vs Combination of Conventional and Digital Approaches to Prosthetic Rehabilitation of Orbital Defect: Case Report

Nuntaporn Rojanasakul — 2026-01-26

Background: Presently, the digital impression and fabrication techniques for maxillofacial prostheses have been introduced. The efficient, easy and accessible one was created, selected, performed and compared with the conventional one.

Case Presentation: Prosthetic reconstructions were performed in a large and unfavorable facial defect, involving left orbital and intimately surrounding structures, with 2 different approaches: conventional approach vs combinational approach. One-month and 6-month follow-up visits were conducted. The results revealed that the combined technique overcame the conventional one in term of patients’ comfort, risk of trauma, laboratory workload, mold accuracy and split mold fabrication, whereas, the inferior appearance of skin texture from the scan powder and the layer lines on the printed mold surface was noticeable.

Conclusions: Digital technique can be utilized to support, replace and even outperform conventional technique in certain steps of maxillofacial prosthesis fabrication which decreases workload and increases patient satisfaction.

[2026-01-29] Development of Care Guidelines for Type 2 Diabetes Remission and Prevention of Recurrence in the Mueang District Health Service Network, Surat Thani, Thailand

Punyanuch Kongsanae — 2026-01-29

Background: Achieving type 2 diabetes remission has emerged as a critical therapeutic goal, shifting the focus from mere disease control to reversing the condition. Although remission is clinically achievable through intensive lifestyle modification, the success rates in routine primary care remain low. A significant gap exists regarding context-specific care guidelines suitable for urban health service networks, where socioeconomic constraints make sustaining behavioral changes particularly challenging.

Objectives: To investigate the current situation and barriers to diabetes remission, develop context-specific care guidelines, and evaluate their effectiveness in terms of clinical outcomes and patient satisfaction.

Methods: This study used an action research design conducted in 3 phases. Phase 1 involved a detailed situational assessment of diabetes-related issues within the target population. In Phase 2 practice guidelines were developed by identifying specific areas requiring attention based on Phase 1 findings. Phase 3 evaluated the guidelines by measuring clinical outcomes and patient satisfaction. Participants included 124 medical records and 10 key stakeholders for the situational analysis (Phase 1) and 12 pilot patients for the implementation phase (Phase 2). Instruments included medical record recording forms, semi-structured interview guidelines, clinical follow-up records, and a questionnaire on patient satisfaction.

Results: The situational analysis in Phase 1 identified major diabetes-related challenges, specifically time constraints due to urban employment and a lack of family support, alongside distinct gaps in existing care protocols. Consequently, context-specific guidelines featuring digital monitoring and community support were developed. The implementation of these guidelines demonstrated their effectiveness in practice. Repeated-measures analysis of variance revealed significant reductions in body weight (F = 23.65, P < .001) and finger-prick glucose (F = 21.95, P < .001). Additionally, HbA_1c levels significantly decreased (mean difference = 0.78, P < .001), and patient satisfaction significantly increased (P = .046). Based on these findings, urban health networks should integrate flexible digital tools and community-based support systems to overcome socioeconomic barriers and effectively promote diabetes remission.

Conclusions: This study demonstrates a coherent action research process where context-specific interventions effectively address identified urban barriers, leading to successful outcomes of diabetes remission.

[2026-01-28] Surgeon Satisfaction With Anesthesia Services at Srinagarind Hospital: A Comparison With Data From 7 Years Ago

Jiranuwat Kaewhan — 2026-01-28

Background: Surgeon satisfaction with anesthesia services is a critical quality indicator that drives multidisciplinary improvement in perioperative care.

Objective: To assess current satisfaction levels and compare improvements over a 7-year period.

Methods: This prospective, descriptive study was conducted between May 2024 and July 2024 at Srinagarind Hospital. This study surveyed 41 surgeons (faculty physicians, residents, and staff physicians) across multiple departments using a validated questionnaire covering preoperative, intraoperative, postoperative recovery room, and ward-based anesthesia services. Satisfaction was measured using a 4-point Likert scale and compared with the 2016-2017 baseline data from 102 surgeons.

Results: Response rate was 100% (41/41). Overall satisfaction scores ranged from 3.56 to 3.98 (very high satisfaction). The highest satisfaction areas included: fasting guidelines, anesthesia initiation timing, and postoperative patient visits (mean [SD], 3.95 [0.22], 3.98 [0.16], and 3.97 [0.16], respectively). Compared with 2016-2017, significant improvements were observed in coordination systems (mean [SD], 3.46 [0.57] to 3.95 [0.22]; P < .001), emergency scheduling (mean [SD], 3.42 [0.64] to 3.88 [0.33]; P < .01), and sign-in cooperation (mean [SD], 3.53 [0.59] to 3.90 [0.30]; P < .01). Areas for improvement included preoperative coordination communication and glucose loading protocols (mean [SD], 3.63 [0.49] and 3.60 [0.59], respectively).

Conclusions: Surgeon satisfaction with anesthesia services at Srinagarind Hospital consistently demonstrated high levels, with marked improvements over 7 years, particularly in coordination systems and safety protocols. A continued focus on communication and evidence-based preoperative protocols will further improve multidisciplinary collaboration.

[2026-01-28] Cost-Effectiveness of Carbetocin vs Oxytocin for Preventing Postpartum Hemorrhage in Women at High Risk for Postpartum Hemorrhage Undergoing Cesarean Section at Buddhachinaraj Phitsanulok Hospital

Boonchai Nakariyakul — 2026-01-28

Background: Postpartum hemorrhage (PPH) is a serious and dangerous complication following a cesarean section that carries a significant risk of bleeding and can result in shock or death.

Objective: To compare the cost-effectiveness of 100 mg of carbetocin with that of 10 units of oxytocin for the prevention of PPH in women at high risk for PPH undergoing cesarean section.

Methods: A decision tree model was used to assess cost-effectiveness from societal and payer perspectives over a one-year time horizon, using a 3% discount rate and data from hospital records and published studies. Robustness was evaluated using with one-way and probabilistic sensitivity analyses.

Results: From the societal perspective, carbetocin demonstrated a cost saving of ฿828.16 ($25.18) and yielded an incremental gain of 0.04 quality-adjusted life years (QALYs). In contrast, the payer’s perspective revealed an additional cost of ฿632.69, with an incremental cost-effectiveness ratio of ฿14 243.20 ($433.14) per QALY gained. Carbetocin was notably more effective in preventing severe PPH, with a prevention rate of 44.4% compared with 16.3% observed with oxytocin. Sensitivity analysis identified treatment response as the most influential factor in the economic model.

Conclusions: Carbetocin is a cost saving and clinically effective option for managing PPH in women at high-risk for PPH undergoing cesarean section. Its performance remains within the acceptable willingness-to-pay threshold established by Thai context (฿160 000 per QALY), making it a viable candidate for broader policy inclusion.

[2026-01-28] Assessment of Pharmacist Prescription Screening Processes Using Eye Tracking Technology: A Mixed-Method Pilot Study

Ladawan Siriluck — 2026-01-28

Background: Accurate medication dispensing is essential for patient safety. Electronic prescription (EP) systems are effective because they support the cognitive functions of pharmacists. Eye tracking provides rapid, objective insights into the visual attention and cognitive engagement of pharmacists interacting with EP interfaces, offering details unmatched by other methods.

Objective: To assess prescription screening practice of pharmacists by analyzing their visual attention (fixation duration, scanpath length, and heatmaps) and cognitive engagement (qualitative responses and error detection) with EP systems using eye-tracking technology.

Methods: Ten hospital pharmacists reviewed 2 medication error scenarios using eye tracking with the Tobii Eye Tracker 4C. The interface mimicked routine hospital software, allowing free review with no time limits. Participants recorded subjective responses after identifying errors, while software logs captured their visual attention patterns (eg, fixations, scanpaths, and heatmaps) and qualitative responses to assess cognitive engagement.

Results: Ten pharmacists participated, including 5 seniors with an average of 9.4 years of hospital experience and 5 juniors with an average of 3 years. A quantitative analysis of heatmaps revealed that senior pharmacists adopt a comprehensive approach, integrating clinical data and medication details, whereas junior pharmacists primarily focus on medication names and doses. A qualitative analysis of participant responses revealed that senior pharmacists demonstrated broader attention patterns during prescription review, facilitating faster, more holistic decision-making. Although most participants correctly identified dosing errors, few participants detected interactions or duplications. These results suggest that experience influences visual focus and accuracy in prescription screening, thereby informing targeted training strategies.

Conclusions: Heatmap data revealed that senior pharmacists conducted more comprehensive reviews, with longer fixations correlating with higher accuracy. Most dosing errors were identified, and interactions and duplications were often overlooked because of over-reliance on EP tools and limited clinical judgment. These outcomes indicate the need for targeted pharmacy interventions, including enhanced clinical reasoning training and improved EP interface design for better drug interaction detection.

[2026-01-28] Comparison of Initial Absolute Monocyte Counts in 7-Day Recovery vs Nonrecovery Neutrophil Counts After Chemotherapy in Patients With Solid Organ Malignancy

Jittranoot Leelasawat — 2026-01-28

Background: Neutropenia following chemotherapy is a common side effect that often delays treatment cycles, potentially affecting therapeutic outcomes in patients with cancer. Studies suggest that baseline monocyte count may predict neutrophil recovery after chemotherapy, aiding in better treatment planning.

Objective: To investigate the association between the initial monocyte count on the day of neutropenia and neutrophil recovery on day 7. Patients were categorized into 2 groups: recovery (absolute neutrophil count [ANC] ≥ 1500 cells/µL) and nonrecovery (ANC < 1500 cells/µL).

Methods: A retrospective cohort study was conducted at Chonburi Hospital, and the records of patients with solid organ malignancy who received chemotherapy from 1 January 2022 to 31 August 2023, were analyzed. Patients with neutropenia on chemotherapy day were included in the study. The initial monocyte count was compared between patients who recovered on day 7 and those who did not. Predictive power was assessed using the area under the receiver operating characteristic curve (AUROC).

Results: Of 42 patients, 29 (69.04%) achieved neutrophil recovery. The initial monocyte count was significantly higher in the recovery group than in the nonrecovery group (mean [SD], 422.97 [144.66] vs 272.00 [82.13] cells/µL; P = .001). An initial monocyte count of ≥ 375 cells/µL was identified as a predictive threshold for recovery, with an AUROC of 0.803, sensitivity of 58.6%, and specificity of 100%.

Conclusions: The initial monocyte count significantly differs between patients who recover and those who do not. A threshold of ≥ 375 cells/µL accurately predicts neutrophil recovery on day 7, potentially optimizing chemotherapy scheduling.

[2026-01-28] Beyond Basic Skills – Exploring the Informatics Competency of Clinical Nurses in Vietnam: A Single-Center Study

Hoang Thi Minh Hau — 2026-01-28

Background: Informatics competency is essential for nurses in the digital health era. However, there is limited evidence regarding the informatics skills of Vietnamese clinical nurses. As healthcare systems increasingly adopt electronic health records and data-driven decision-making, it is expected that nurses will integrate informatics into their daily practice. Understanding current competency levels is critical to guide educations, training, and policy development.

Objectives: To assess the self-perceived informatics competency of clinical nurses and identify associated demographic and experiential factors.

Methods: A cross-sectional survey was conducted using the Canadian Nurse Informatics Competency Assessment Scale. The instrument evaluates 4 domains: basic information and communications technology (ICT) skills, information and knowledge management, ICT use in patient care delivery, and professional and regulatory accountability. The scale has demonstrated good validity and reliability in previous studies, and the Vietnamese version showed excellent internal consistency in pilot testing. Data were analyzed using descriptive statistics and ordinal logistic regression.

Results: A total of 175 clinical nurses participated in this study. The overall mean (SD) informatics competency score was 2.43 (0.49), indicating a moderate level of competency. The highest subscale score was in professional and regulatory accountability (mean 2.51), and the lowest score was in information and knowledge management (mean 2.36). Age, formal informatics education, frequency of social media use, and computer experience were significantly associated with competency level (P < .05).

Conclusions: Vietnamese clinical nurses demonstrated moderate informatics competency, with key influencing factors identified. Targeted training and integration of informatics education into nursing curricula and professional development are recommended to enhance digital readiness in healthcare settings.

[2026-01-26] Effect of Positive Psychological Capital and Self-Management Model Interventions on Pain and Functional Difficulty in Persons With Osteoarthritis

Jeerawan Pangsan — 2026-01-26

Background: Osteoarthritis is a prevalent global health challenge, particularly among the elderly, and leads to significant physical disability, emotional distress, and socioeconomic burden. Effective interventions addressing these multifaceted effects are limited, especially in patients with severe knee osteoarthritis awaiting a surgical intervention. This study was guided by 2 theoretical frameworks: the positive psychological capital (PsyCap) theory, which focuses on enhancing psychological resilience, motivation, and coping strategies; and the self-management model, which emphasizes goal setting, symptom tracking, and adherence to self-care behaviors.

Objectives: To evaluate the effectiveness of a novel intervention integrating PsyCap theory and self-management model strategies to enhance self-care behavior, alleviate pain, and reduce mobility difficulties among patients with severe knee osteoarthritis (Kellgren-Lawrence grades 3-4).

Methods: A quasi-experimental pretest-posttest design was used between May and July 2023 at the outpatient surgery department of a university hospital. A total of 34 patients with primary knee osteoarthritis were randomly assigned into experimental (n = 17) and control (n = 17) groups. The experimental group received a self-care behavior enhancement program integrating PsyCap and self-management principles. Outcomes were assessed at 3 time points: baseline, postintervention (4 weeks), and follow-up (12 weeks). Statistical analyses included descriptive statistics and 2-way repeated measures analysis of variance (ANOVA) to examine within- and between-group effects over time.

Results: Compared to the control group, the experimental group demonstrated significant improvements in self-care behaviors (F[1,32] = 24.982; P < .001; η² = 0.438), with significant time-group interaction effects (F[1.374,43.960] = 38.581; P < .001; η² = 0.547). Additionally, pain and mobility difficulties significantly decreased in the experimental group (F[1.640,52.473] = 42.261; P < .001; η² = 0.569), whereas no significant changes were observed in the control group.

Conclusions: Integrating PsyCap theory and the self-management model significantly improved self-care behavior and reduced pain and mobility difficulty in patients with severe knee osteoarthritis awaiting surgery. These benefits were sustained over 12 weeks.

[2026-01-26] Effects of a Health Literacy Enhancement Programs for COVID-19 Prevention on Health Literacy and COVID-19 Preventive Behaviors Among Caregivers of Dependent Older People

Phisit Yuyong — 2026-01-26

Background: Older people with dependent conditions are highly vulnerable to COVID-19 due to exposure to respiratory droplets from talking, coughing, sneezing, or close contact with caregivers.

Objectives: To evaluate the effectiveness of a health literacy enhancement program on caregivers' health literacy and preventive behaviors.

Methods: This quasi-experimental study was conducted in Phak Hai district, Phra Nakhon Si Ayutthaya province, from September 2023 to January 2024. The study included 50 caregivers selected through simple random sampling and divided into the experimental group (n = 25) and control groups (n = 25). The experimental group participated in an 8-week COVID-19 prevention program based on Nutbeam's health literacy framework, while the control group received standard care. The instruments used for data collection included 3 components: a personal information questionnaire; the COVID-19 Health Literacy Questionnaire (content validity index [CVI] = 0.88, Cronbach a = 0.84); and the COVID-19 Preventive Behavior Questionnaire (CVI = 0.88, Cronbach a = 0.76). Statistical tests included t tests, the Wilcoxon signed rank test, the Mann-Whitney U test, and analyses of covariance (ANCOVA).

Results: The experimental group achieved significantly higher postintervention health literacy scores compared to their preintervention scores and the control group (P < .05). Improvements were observed in accessing information, decision-making, and health behavior changes (P < .05). Also, postintervention preventive behavior scores of the experimental group were significantly higher in the control group, even after adjusting for baseline differences (P < .05).

Conclusions: This study has reinforced the importance of health literacy programs in effectively empowering caregivers to prevent COVID-19. Primary healthcare units should implement this program to better protect dependent older people from COVID-19.

[2026-01-26] Nursing Students' Perceptions of Spiritual Care Competency: A Qualitative Study

Yuttachai Chaiyasit — 2026-01-26

Background: Spiritual care is a crucial component of holistic nursing practice, as it addresses patients' emotional, psychological, and existential well-being. Nursing students play a vital role in providing spiritual support, yet their competencies in this area remain underexplored.

Objective: To explore nursing students' perceptions of their competencies in providing spiritual care to patients.

Methods: A descriptive qualitative research design was employed in this study. Ten fourth-year nursing students from the Faculty of Nursing at Ubon Ratchathani Rajabhat University were selected using purposive sampling and snowball techniques. Data were collected through in-depth interviews conducted between December 2024 and January 2025. The research instruments included a semi-structured interview guide, field notes, observational tools, and the researcher’s reflective journal. Content analysis was used to analyze the data.

Results: The findings revealed that nursing students perceived their spiritual care competencies as encompassing 3 key areas: 1) assessing and diagnosing spiritual issues; 2) planning and implementing spiritual care, which included: maintaining a positive attitude and respecting patients’ spiritual beliefs, communication and counseling, empathy and compassion, encouraging patients to practice their faith and beliefs, and referring patients to spiritual care specialists; and 3) evaluating spiritual care practices.

Conclusions: While nursing students show confidence in certain aspects of spiritual care, the study highlights the need for enhanced training. Integrating comprehensive spiritual care education and practical experiences into the curriculum, along with support from spiritual care professionals, is essential for strengthening students' competencies.

[2026-01-26] Exploring Kratom Use in High-Prevalence Areas of Southern Thailand: Attitudes, Knowledge, and Consumption Patterns – A Mixed-Methods Study

Tasanee Khunthong — 2026-01-26

Background: Kratom (Mitragyna speciosa), a tropical tree native to Southeast Asia, has traditionally been used in Thailand for medicinal and recreational purposes. Although recently legalized for medicinal use, concerns remain regarding its safety and potential for abuse.

Objectives: To investigate kratom consumption patterns and identify demographic, behavioral, and cognitive predictors of current and harmful use in high-prevalence rural communities in southern Thailand.

Methods: A cross-sectional study was conducted among 169 participants from southern Thai communities with high kratom use. A structured questionnaire assessed demographics, attitudes, knowledge, and usage patterns. Harmful use was defined as consumption of more than 20 leaves per day. Multiple logistic regression analysis identified predictors of current and harmful use.

Results: Among participants, 45 (26.6%) were current users, and of those 22 (48.9%) met the criteria for harmful use. Predictors of current use included younger age (adjusted OR [AOR], 0.97; 95% CI, 0.94-0.99), tobacco use (AOR, 16.12; 95% CI, 5.01-51.86), poor mental health (AOR, 8.8; 95% CI, 2.2-35.16), and favorable attitudes toward kratom (AOR, 1.12 per point; 95% CI, 1.06-1.18). Harmful use was associated with long-term consumption (AOR, 10.54; 95% CI, 1.01-109.9), boiling as the method of use (AOR, 80.96; 95% CI, 4.98-1315.6), and lower knowledge scores (AOR, 17.8; 95% CI, 1.57-201.68).

Conclusions: Current and harmful kratom use are linked to specific demographic and behavioral factors. These findings support the need for targeted public health education and regulation in high-risk communities.

[2026-01-26] Pleural Fluid Volume for Cytological Diagnosis of Malignancy: How Much Is Optimum

Jirasit Lualon — 2026-01-26

Background: Pleural fluid cytology is essential for evaluating effusions and detecting atypical and malignant cells. However, the optimal fluid volume for accurate diagnosis remains unclear.

Objective: To determine the optimal pleural fluid volume for detecting atypical to malignant cells by analyzing diagnostic yield across different volume groups.

Methods: This retrospective study analyzed pleural fluid samples collected between 2020 and 2021, correlating to cases with confirmed malignancy in pleural cavities. Samples were categorized into volume groups and classified using the International System for Serous Fluid Cytopathology: nondiagnostic (ND), negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM), and malignant (MAL).

Results: Of 1794 pleural fluid samples, the detection rates of atypical to malignant cells in the samples were < 25 mL (35.87%), 25-49 mL (40.77%), 50-74 mL (45.38%), 75-99 mL (37.89%), 100-249 mL (29.67%), 250-499 mL (21.99%), and ³ 500 mL (40.97%). Considering the samples with evidence of pleural involvement by malignancy (n = 497), detection rates of atypical to malignant cells in the samples were < 25 mL (83.72%), 25-49 mL (91.67%), 50-74 mL (90.41%), 75-99 mL (93.33%), 100-249 mL (72.06%), 250-499 mL (44.17%), and ³ 500 mL (82.14%). The proportion of AUS and SFM categories among the atypical and malignant samples were low (< 20%) in the 50-74 mL and 75-99 mL volume groups.

Conclusions: Intermediate volumes (50-100 mL) provide adequate cellular material while maintaining manageable sample processing. Implementing this volume range in clinical practice may enhance diagnostic accuracy.

[2026-01-26] Factors Associated With Transitional Stress Among Relatives During Transferring Critically Ill Patients From ICU-to-Ward

Wei Wei Cai — 2026-01-26

Background: The intensive care unit (ICU) provides effective care for critically ill patients and can significantly reduce mortality rates. However, ICU hospitalization is not only a crisis for patients, but also for their relatives, who often experience high levels of transitional stress. This stress can negatively impact their ability to provide loving care to the patient after the transfer to a general ward.

Objectives: To describe the level of transitional stress and determine the relationship between uncertainty, hope, and preparedness with transitional stress among relatives during transferring critically ill patients from ICU-to-Ward.

Methods: This study used a descriptive correlational cross-sectional research design. A total of 112 participants were recruited during December 2022 to September 2023 by selecting participants randomly, following the inclusion criteria. The research instruments included a demographic questionnaire, the Herth Hope Index, the Family Relocation Stress Scale, the Care Preparedness Scale, and the Parents’ Perception of Uncertainty in Illness Scale-Family Member. The reliability of the scales was 0.87, 0.88, 0.82, and 0.86, respectively. Descriptive statistics and Pearson product moment correlation were used to perform data analysis.

Results: The mean (SD) score of transitional stress was 36.5 (6.2), indicating a moderate level of stress. Uncertainty was positively correlated with transitional stress (r = 0.75, P < .001). However, hope and preparedness were negatively correlated with transitional stress (r = -0.40, P < .001; r = -0.44, P < .001 respectively).

Conclusions: Clinical nurses should develop nursing interventions to reduce transitional stress among a patient’s relatives by promoting their preparedness and hope, and communicate effectively to reduce the relatives’ uncertainty about the patient’s illness.

[2026-01-26] Intraoperative Anxiety and Its Associated Factors Among Patients Undergoing Conscious Surgery for Closed-Leg Fracture

Xue Zhang — 2026-01-26

Background: Patients undergoing open reduction and internal fixation surgery frequently opt for spinal anesthesia, which preserves intraoperative consciousness. This conscious state may trigger significant anxiety during surgical procedures. Despite the clinical relevance of this phenomenon, intraoperative anxiety among conscious patients remains under-recognized in Chinese surgical populations. Many scholars have conducted extensive research on preoperative and postoperative anxiety levels. However, a study on the level of intraoperative anxiety and its’ related factors is still lacking. This knowledge gap motivated the current investigation.

Objectives: To examine the level of intraoperative anxiety and the relationship between gender, age, waiting time, surgical time and intraoperative anxiety among patients with closed-leg fracture undergoing conscious surgery.

Methods: A total of 112 participants were recruited during February 2025 to April 2025 by selecting samples as per the inclusion criteria and using random sampling. Research instruments include the demographic questionnaire and the Visual Analog Scale for Anxiety (VAS-A). Data were analyzed using descriptive statistics, the independent t test, and the Pearson correlation coefficient.

Results: The mean (SD) intraoperative anxiety was 6.3 (2.2), which indicates a clinically-relevant level of anxiety. There was a significant difference in the experience of intraoperative anxiety between female and male patients (t = -3.92, P < .001). Age, waiting time, and surgical time had a positive correlation with intraoperative anxiety among the patients undergoing conscious surgery (r = 0.221, P < .05; r = 0.307, r = 0.346, P < .001, respectively).

Conclusions: The findings provide a reference for healthcare providers to better understand the factors contributing to intraoperative anxiety of patients with closed-leg fracture undergoing conscious surgery, allowing for early identification of high-risk individuals, and targeted interventions, thereby preventing and alleviating intraoperative anxiety, reducing anxiety-related physiological response, minimizing complication risk, and promoting postoperative recovery.

[2026-01-26] Vitamin D Deficiency and Bone Turnover in People Living With HIV Switching to Tenofovir Disoproxil Fumarate/Lamivudine/Dolutegravir Versus Continuing Nonnucleoside Reverse Transcriptase Inhibitor or Protease Inhibitor Regimens in Thailand

Pakawas Praisarnti — 2026-01-26

Background: People living with HIV (PLWH) frequently have low bone mineral density, with vitamin D deficiency as a key risk factor. Recently, World Health Organization (WHO) and Thai national HIV guidelines recommend dolutegravir as first-line therapy, replacing nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen.

Objectives: To compare vitamin D levels and bone changes in PLWH switching from NNRTI- or boosted protease inhibitor (PI)-containing regimens to DTG-based therapy versus those continuing NNRTI- or PI-based therapy.

Methods: This post hoc analysis used data from a randomized controlled trial (2020-2022) at Suddhavej Hospital, a university-affiliated tertiary care hospital in Maha Sarakham, Thailand. PLWH aged 18 years or older without virologic failure were randomized to either continue current NNRTI/boosted PI-containing combined antiretroviral therapy (control group, CG) or switch to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TDF/3TC/DTG) (switch group, SG). The primary outcome was vitamin D deficiency at 48 weeks; secondary outcomes assessing changes in bone metabolism markers.

Results: Thirty-nine patients completed follow-up (20 CG, 19 SG). After 48 weeks, vitamin D deficiency prevalence increased in both groups (CG: 15% to 35%; SG: 15.8% to 31.6%) with no significant difference (P = .905). Osteocalcin increased in SG but decreased in CG (P = .036). Beta-crosslaps increased in both groups (P = .461 between groups). Procollagen type 1 amino-terminal propeptide showed a nonsignificant decrease in both (P = .960).

Conclusions: Switching to TDF/3TC/DTG had minimal impact on vitamin D status but was associated with increased osteocalcin, suggesting a possible positive effect on bone formation. No significant differences were seen in bone resorption or other formation markers.

[2026-01-26] Effectiveness of a Hypothermia Prevention Guideline in Adult Patients Undergoing General Anesthesia at Srinagarind Hospital

Wilawan Somdee — 2026-01-26

Background: Perioperative hypothermia (POH), associated with various complications, has a reported incidence ranging from 30% to 70%. A previous incidence of 31% at Srinagarind Hospital prompted the development and implementation of a copyrighted clinical practice guideline (CPG) for the prevention and management of hypothermia in adults.

Objective: To assess the effectiveness and user satisfaction of this CPG.

Methods: This retrospective descriptive study included adult patients undergoing general anesthesia, with or without regional anesthesia, at Srinagarind Hospital between 1 January 2023, and 30 April 2023. POH was defined as a core temperature below 36 °C. Following induction, all patients received forced-air warming using either upper-body warming (UBW) or lower-body warming (LBW) blankets, depending on the surgical procedure and patient position. Body temperature was recorded every 15 minutes for up to 120 minutes. Postoperative satisfaction with the CPG was assessed among patients and anesthesia nurses.

Results: A total of 356 patients, predominantly male with the American Society of Anesthesiologists (ASA) classifications I-II, were enrolled. Sixty-seven patients (18.8%) developed POH. Patients receiving LBW tended to experience POH more frequently than those receiving UBW, although the difference was not statistically significant (P = .444). No patient's temperature fell below 35.5 °C. High satisfaction with CPG implementation was reported by both patients (99.4%) and anesthesia nurses (100%).

Conclusions: Implementation of a CPG emphasizing forced-air warming effectively reduced the incidence of POH in adult patients. The CPG demonstrated high satisfaction among both patients and anesthesia nursing staff.

[2026-01-26] Pressure Asymmetries and Low Back Pain in Pregnancy: A Smart Insole-Based Analysis

Jennara Wongpalee — 2026-01-26

Background: Low back pain is a common condition affecting pregnant women that arises from hormonal and biomechanical changes that alter posture, gait, and balance. Traditional studies focus on general biomechanical adaptations, often neglecting dynamic plantar pressure changes, left-right foot asymmetries, and their link to low back pain.

Objectives: To study the effects of plantar pressure analysis on walking and balance, and to explore the relationship between plantar pressure and low back pain in pregnant women.

Methods: This was a cross-sectional study of 85 pregnant women recruited through simple random sampling and participated in a 10-meter walk test using SuraSole insoles to collect plantar pressure data across eight-foot zones. Data were analyzed using descriptive statistics, paired t test assessed plantar pressure differences between the left and right feet in the pregnant women, and Pearson correlation, paired measurements, and relationships involving continuous variables.The Scheffe’ method was used to test the mean of each pair of means. The relationship between low back pain and plantar pressure using a multiple linear regression analysis.

Results: Pregnant women exhibited significantly higher plantar pressure in the forefoot and heel zones (P < .05). Pregnant participants showed significantly greater plantar pressure in the left heel, medial forefoot, and medial midfoot than the right side (P < .01), reflecting left-side dominance. Plantar pressure positively correlated with gestational age and body mass index. Heel pressure was strongly associated with lower back pain, while toe and forefoot zones showed weaker correlations.

Conclusions: Pregnancy affects plantar pressure distribution and foot asymmetry. Increased plantar pressure, particularly in the heel zone, strongly correlates with low back pain. Left-right foot asymmetries in the pregnant women emphasize the need for targeted interventions, such as improving gait mechanics and suitable shoes and promoting walking exercises to reduce low back pain during pregnancy.

[2026-01-26] Psychometric Testing of the Thai Version of the Short-Form Practice Environment Scale of the Nursing Work Index Among Nurses Within the Thai Social Context

Vachira Posai — 2026-01-26

Background: A standardized assessment of the nursing practice environment is essential as a foundation for planning and implementing improvements that enhance the suitability and efficiency of nurses’ work settings. While comprehensive evaluations provide valuable insights, they can be resource-intensive, particularly in settings with limited capacity. The Practice Environment Scale of the Nursing Work Index (PES-NWI) is a widely validated instrument for assessing nursing work environments, and its short-form version, the PES-5, was developed to reduce respondent burden. Adapting the PES-5 to the Thai context ensures cultural and organizational appropriateness, thereby enhancing its applicability and utility in Thai healthcare settings.

Objectives: To translate the PES-5 into Thai and assess its psychometric properties among Thai nurses.

Methods: A cross-sectional design was employed. The PES-5 was translated into Thai using a systematic forward and backward translation process to ensure conceptual and linguistic equivalence. Data were collected from 250 full-time registered nurses working in public hospitals under Thailand’s Ministry of Public Health via an online survey. Psychometric evaluation was conducted using Rasch model analysis, performed with Jamovi software (version 2.6.26). Internal consistency was assessed using Cronbach a and item-total correlation. Rasch analysis was used to examine item fit, response category functioning, and person separation reliability.

Results: The Thai version (T-PES-5) demonstrated excellent content validity (S-CVI = 1.00). Rasch analysis showed acceptable Infit and Outfit statistics (0.81-1.24 and 0.79-1.31, respectively), indicating good item fit. Cronbach a was 0.73, reflecting satisfactory internal consistency. The Wright map revealed a well-balanced item difficulty distribution with no evidence of floor or ceiling effects.

Conclusions: The T-PES-5 is a psychometrically sound instrument for evaluating the nursing practice environment in Thailand. Its brevity and validity make it particularly suitable for large-scale assessments in public healthcare settings, supporting efforts to improve work environments and, ultimately, patient care quality.

[2026-01-26] Child and/or Guardian Satisfaction With Pediatric Anesthesia Services and Understanding of Enhanced Recovery After Surgery Protocols at Srinagarind Hospital

Duangned Litu — 2026-01-26

Background: Pediatric anesthesia presents unique challenges requiring specialized expertise in managing both patient care and parental anxiety. Patient satisfaction has become a crucial quality indicator in anesthesia services, with satisfaction rates varying from 78% to over 95%. Enhanced recovery after surgery (ERAS) protocols have shown improved perioperative outcomes, but require significant patient education. However, most studies have been conducted in Western settings, with limited data from Southeast Asian healthcare contexts.

Objectives: To assess satisfaction with pediatric anesthesia care among children and their guardians at Srinagarind Hospital, while also evaluating their understanding of ERAS protocols.

Methods: A descriptive cross-sectional study collected data from 103 children/guardians between September 2024 to October 2024 using questionnaires with 4-point Likert scales. High satisfaction or understanding was defined as scores 3 to 4, and low satisfaction or understanding as 1 to 2.

Results: Respondents were predominantly female (87.4%) and aged 31 to 40 years (43.7%). General anesthesia was used in 94.2% of cases. Full satisfaction (100%) was reported for preoperative, intraoperative, and postanesthesia care unit services, with mean (SD) overall satisfaction scores of 3.96 (0.05), 3.99 (0.01), and 3.99 (0.01), respectively. Ward follow-up satisfaction reached 96.8%, with mean (SD) overall satisfaction scores of 3.88 (0.01). ERAS protocol understanding varied, with mean (SD) overall understanding score of 3.07 (0.79); high for fasting guidelines (99.0%), low for thrombosis prophylaxis (22.3%), and smoking cessation (23.3%).

Conclusions: While child/guardian satisfaction with anesthesia services was excellent, particularly during perioperative periods, targeted improvements in ERAS education are recommended, especially regarding thrombosis prophylaxis and lifestyle modifications.

[2026-01-26] Incidence and Types of Cardiac Arrhythmias Detected by Telemetry Monitoring in Hospitalized Patients at a Tertiary Care Hospital

Sopita Areerob — 2026-01-26

Background: Cardiac arrhythmia constitutes a significant clinical complication among hospitalized patients, with elevated prevalence in individuals presenting with underlying cardiovascular pathology. Continuous telemetry monitoring provides real-time electrocardiographic surveillance, facilitating prompt arrhythmia detection and therapeutic intervention. Despite widespread clinical implementation globally, Thailand lacks standardized hospital guidelines governing telemetry monitoring utilization.

Objective: To determine the incidence, classification, and morphological characteristics of cardiac arrhythmias in patients subjected to continuous telemetry surveillance at a tertiary medical hospital in Thailand.

Methods: A cross-sectional study was conducted at Ramathibodi Hospital. The study comprised 331 hospitalized patients aged 18 years or older who received telemetry monitoring between June 2022 and December 2022. Clinical data were systematically extracted from electronic health records and subjected to descriptive statistical analysis.

Results: Among 331 monitored patients, cardiac arrhythmias were documented in 212 patients (64.05%). According to the American Heart Association classification criteria, most patients were categorized as class II (118 of 212 patients, 55.60%). Out of the 387 detected episodes, premature ventricular contractions constituted the most frequently observed arrhythmic pattern (34.37%), followed by premature atrial contraction (19.90%) and atrial fibrillation (15.76%). Conservative clinical observation represented the predominant management approach (41.69%). Hospital discharge constituted the primary indication for telemetry monitoring discontinuation (59.21%).

Conclusions: This study demonstrated a substantial incidence of cardiac arrhythmias under continuous telemetry surveillance, with premature ventricular contractions representing the most prevalent finding. These findings underscore the clinical utility of telemetry monitoring in hospitalized patients and support the development of standardized monitoring protocols in Thai healthcare hospitals.

[2026-01-26] Incidence and Factors Related to Reintubation After Planned Extubation in Patients Receiving General Anesthesia in Srinagarind Hospital

Krittiya Wanphon — 2026-01-26

Background: Reintubation after planned extubation (RAP) is associated with adverse outcomes. Understanding the incidence and related factors can reduce complications and improve outcomes.

Objectives: To identify the incidence, related factors, causes, and outcomes of RAP in patients undergoing general anesthesia (GA).

Methods: This retrospective descriptive study was done at the Srinagarind Hospital. After screening incident reports from January 2022 to June 2024, an RAP, which is defined as an intubation conducted within 24 hours after surgery was identified. The primary outcome was the incidence of RAP. The secondary outcomes were the characteristics, causes, and outcomes. Logistic regression analysis was used to identify the factors related to poor long-term outcomes.

Results: The incidence of RAP was 8.59 per 10 000 GA (40/46 543 patients). The incidence per 10 000 GA was higher among male (12.08), the elderly (22.80), patients with an American Society of Anesthesiologists (ASA) classification of 4 (24.72), patients with respiratory disease (63.09), and individuals undergoing hepatobiliary surgery (26.90). Most RAP (50%) occurred in the postanesthesia care unit. The most common indications for RAP were hypoxemia (32.5%), altered consciousness (25%), and airway obstruction (20%). RAP was primarily attributed to patient factor (65%). Male gender was associated with an odds ratio of 0.11 for poor long-term outcomes (95% CI, 0.02-0.51; P = .005).

Conclusions: RAP occurred at a lower rate than previously reported. Incidence of RAP was high among males, the elderly, classified as ASA 4, preexisting respiratory diseases, and hepatobiliary surgery. The major cause of RAP was related to patient-related factors.

[2026-01-26] Factors Associated With Homework Adherence in Cognitive Behavioral Therapy

Paniccha Chaikawin — 2026-01-26

Background:Homework is a central component of cognitive behavioral therapy (CBT), promoting the application of therapeutic skills in daily life. However, adherence to homework varies and may be influenced by multiple factors, particularly among young people.

Objectives: To identify factors associated with homework adherence in CBT, and to examine these factors specifically in young people.

Methods: A cross-sectional descriptive study was conducted with 79 clients receiving CBT through the “Therapist Volunteers” project or the outpatient psychiatry clinic at Ramathibodi Hospital, along with 47 therapists. Data were collected from January 2024 to September 2024. Measures included the Working Alliance Inventory - Short Revised (WAI-SR), the Situational Motivation Scale (SIMS), SCORE-15, Homework Rating Scale II (HRS-II), Homework Compliance Scale (HCS), and Clinical Global Impression - Improvement Scale (CGI-I). Descriptive and inferential statistics, including multiple regression analysis, were used.

Results: The mean age of participants was 26.06 years; 82.3% were female. Therapeutic alliance, intrinsic motivation, and identified regulation were significantly associated with homework adherence (P < .05). Among young people, therapeutic alliance, identified regulation, and therapist experience were positively associated with homework adherence. Both self-reported homework adherence and therapist-rated completion were significantly correlated with clinical improvement (P < .01).

Conclusions: A strong therapeutic alliance, along with intrinsic motivation and identified regulation, play crucial roles in enhancing homework adherence and clinical outcomes in CBT. For young people, therapist experience and tailored support strategies may further strengthen treatment engagement.

[2026-01-26] Comparing Diagnostic Criteria for Noise-Induced Hearing Loss in Hospital Personnel: Age Adjustments With ISO 7029-2017

Pitchaya Chevasutho — 2026-01-26

Background: Noise-induced hearing loss (NIHL) is a prevalent occupational health concern, especially in high-noise industries. Despite various diagnostic methods, no universally accepted gold standard for diagnosing NIHL exists. Age adjustments, which are an unresolved issue, vary across proposed standards. Comparing diagnostic criteria is vital for improving early detection and prevention strategies.

Objective: To compare different NIHL diagnostic methods, assessing the impact of age adjustments on hearing threshold interpretations in hospital personnel.

Methods: A retrospective study was conducted, analyzing audiometric data from hospital personnel in a hearing conservation program (HCP) using multiple diagnostic criteria, including the National Institute for Occupational Safety and Health (NIOSH) and the Occupational Safety and Health Administration (OSHA) threshold shift criteria, the Coles, Lutman, and Buffin (CLB) method with OSHA age-adjustment table, and ISO 7029-2017 values. NIHL quantification was performed using various averages and age-associated hearing loss (AAHL) values.

Results: A total of 108 participants (71.30% male; mean age 43.92 years) were included. The mean duration of employment was 12.80 years. Based on OSHA Standard Threshold Shift (OSTS), 9.26% of participants had NIHL, while NIOSH Significant Threshold Shift (NSTS) identified 35.19%. Coles' bulge analysis revealed varied NIHL prevalence of 28.70% using OSHA Table F-1/F-2, and 46.30% with ISO 7029-2017. Mean hearing thresholds (average of 0.5 kHz, 1 kHz, 2 kHz, 3 kHz) were 23.02 dB (OSHA AAHL) and 20.90 dB (ISO 7029-2017), compared to 41.22 dB and 50.56 dB when 4 kHz was included.

Conclusions: NIHL diagnosis remains complex due to the lack of a definitive standard. Diagnostic criteria and age adjustment methods influence prevalence estimates, highlighting the need for further research to enhance NIHL assessment for more effective prevention strategies.

[2026-01-26] A Qualitative Study Exploring COVID-19 Vaccine Hesitancy and Refusal Among Unvaccinated Patients Visiting Family Physicians in Bangkok, Thailand

Veerachai Sachdev — 2026-01-26

Background: Vaccine hesitancy and refusal are critical barriers to achieving herd immunity against COVID-19. Despite widespread vaccine availability nationwide, some people remain unvaccinated.

Objective: To explore reasons for COVID-19 vaccine hesitancy and refusal among unvaccinated patients visiting family physicians at the Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital.

Methods: A qualitative study collected data using in-depth semi-structured telephone interviews between 24 March 2022 and 16 June 2022. All recruited participants had never received COVID-19 vaccination and were registered patients at the Family Medicine outpatient clinic, Ramathibodi Hospital. The interviews were conducted in Thai, digitally recorded, and transcribed verbatim. They were reviewed for accuracy and analyzed using thematic analysis.

Results: Thirteen participants, aged 55 to 83 years, were interviewed. Four themes were identified: 1) fear of vaccination, particularly concerns about side effects; 2) vaccine safety and effectiveness, safety and efficacy concerns, and perceptions of vaccines as "emergency vaccines"; 3) health information, especially negative vaccine/health content from social media and mainstream news; and 4) personal health beliefs, including reliance on self-care, hygiene, and Thai herbal medicine as alternatives. Most participants (92%) stated they would continue refusing vaccination despite availability.

Conclusions: Vaccine hesitancy and refusal were driven by fear of side effects, personal beliefs, and exposure to negative health information. Therefore, it is strongly recommended that health sectors develop a knowledge management platform to disseminate evidence-based health information that is widely accessible. This would enable patients to make well-informed and autonomous decisions.

[2026-01-26] Factors Affecting Melioidosis Prevention Behaviors Among People in the Area of Health Zone 10, Ubon Ratchathani

Sitang Philom — 2026-01-26

Background: The number of melioidosis cases in Thailand rose from approximately 3500 in 2022 to more than 4000 in 2023, with provinces in Health Zone 10 experiencing the highest incidence.

Objective: To investigate the factors influencing the melioidosis prevention behaviors of the population in the Health Zone 10 area of Ubon Ratchathani province.

Methods: This cross‑sectional analytic study included 352 adults (≥ 45 years) selected by multistage sampling. Data were collected using a validated questionnaire and analyzed using descriptive statistics and binary logistic regression.

Results: Most of the participants were female farmers (65.90%); 66.8% had nonrisk preventive behaviors, whereas 33.2% were in the risk group. Compared with the age group of 45-55 years, it was found that those aged ≥ 66 years had a significantly lower chance of having inappropriate disease prevention behaviors (adjusted odds ratio [AOR], 0.10; P = .003). Regarding educational level, it was found that the group with completed primary education had a significantly lower chance of having inappropriate disease prevention behaviors (AOR, 0.02; P < .001) than the group with less than primary education. The group with secondary education had a significantly lower chance (AOR, 0.02; P < .001). Regarding occupation, using agriculture (rice farming and gardening) as the reference group, the animal husbandry group was significantly more likely to engage in inappropriate disease prevention behaviors (AOR, 7.91; P = .027). Other occupations also had a significantly higher chance than the reference group (AOR, 13.67; P < .001). Regarding knowledge about melioidosis, those with high knowledge were significantly less likely to engage in inappropriate disease prevention behaviors (AOR, 0.10; P < .001) than those with low knowledge.

Conclusions: Factors associated with disease prevention behaviors included age, education level, occupation, knowledge about melioidosis, and certain health literacy.

[2026-01-26] Integrated Training Program in Lifestyle Medicine and Health Literacy for Diabetes Coaches: A Research and Development Study in Community-Based Prediabetes Management

Kridsada Sirichaisit — 2026-01-26

Background: Prediabetes significantly increases risk for type 2 diabetes mellitus (DM) and cardiovascular disease. Lifestyle modification represents the most effective preventive approach but requires strong health literacy and self-management skills for sustainable implementation in community settings.

Objectives: To develop and evaluate an integrated training program combining lifestyle medicine and health literacy for DM coaches in managing prediabetes within Thai communities. This evaluated whether intensive coach training could produce superior outcomes and assessed peer coaches' effectiveness in delivering lifestyle interventions.

Methods: This 12-month research and development study following the ADDIE framework was conducted across 7 provinces in northeastern Thailand. A total of 4998 participants with prediabetes were enrolled: 1127 trained as DM coaches through an intensive 2-day training which integrated lifestyle medicine, health literacy, and coaching techniques while implementing personal lifestyle modifications. The other 3871 received peer coaching from trained coaches. Primary outcomes included fasting blood glucose (FBG), blood pressure (BP), anthropometrics, body composition, knowledge, and lifestyle medicine scores. Linear mixed model (LMM) analysis assessed within-group changes and between-group differences as rates of change over time.

Results: Both groups demonstrated significant improvements in all parameters (P < .001). The DM coach group achieved substantial reductions in FBG (-8.4 mg/dL), body weight (-0.8 kg), systolic BP (-1.5 mmHg), and diastolic BP (-2.0 mmHg). LMM analysis revealed superior daily improvements in diastolic BP (-0.012 mmHg/day, P = .020) in the coach group. Knowledge scores improved by 4.5 points and coaching skills by 1.6 points in the coach group.

Conclusions: The integrated DM coach training program effectively improved clinical outcomes, knowledge, and lifestyle practices. This community-based approach offers a promising, scalable strategy for DM prevention in resource-limited settings.

[2026-01-26] The Role and Impact of Artificial Intelligence in Shaping Resident Doctor Education

Witthawin Sae-Lee — 2026-01-26

Artificial intelligence (AI) holds immense potential to transform resident doctor education by offering personalized, adaptive learning experiences and enhancing clinical skill development. Drawing from a literature search of key academic databases for articles published between 2018 and 2024, this review explores the current applications, benefits, challenges, and future directions of AI integration into residency training programs. AI facilitates structured curriculum design, enabling customized pathways based on individual resident needs and performance data. It enhances mentorship and monitoring through virtual tutors, improved accessibility, and data-rich workplace-based assessments, while complementing traditional human oversight. AI-driven simulations provide safe environments for procedural practice with immediate, objective feedback, showing promise in specialties like radiology, dermatology, and ophthalmology. However, significant challenges remain, including the need for robust validation, addressing risks of over-reliance that may hinder critical thinking, managing medicolegal concerns, ensuring faculty development, and meeting infrastructure requirements. Concerns about AI's impact on the job market also influence residents. Successfully leveraging AI requires addressing these challenges through further research, developing ethical guidelines, and integrating AI literacy throughout medical training to prepare future physicians effectively.