Ramathibodi Medical Journal

Integrating Standardized Patients to Enhance Practical Training in Health Sciences

Thunchanok Leetheera — 2025-03-28

In the past, classroom lectures and laboratory instruction using mannequins in simulated settings constituted the main modes of instruction in health science institutions. This approach encouraged students to see, understand, touch, and connect different concepts and principles, bridging theory with practice. It enabled them to develop skills, apply these skills in real-life situations, boost their confidence, and make informed clinical decisions. The traditional teaching methods for preparing students for practical training serve as models. However, despite modern technological advancements, these methods still face limitations in fostering interaction, communication, and emotional expression. In fact, communication between service providers and service recipients is important and indispensable, particularly in areas such as psychiatric care, history-taking for disease diagnosis and health counseling. As a result, learners may not develop communication skills or be able to interact with service recipients, potentially leading to ineffective decision-making in practice. Therefore, using standardized patients offers an effective alternative to developing students’ skills. The purpose of this article is to present a comprehensive approach to teaching and learning with standardized patients at every stage of simulation-based education. It includes the characteristics of standardized patients, along with the advantages and limitations from individual and organizational policy perspectives, providing guidelines for preparing health science students for practical training in the future. However, the use of standardized patients in the teaching and learning process requires preparation by the department, teachers, students, and the standardized patients themselves. This preparation is essential to achieve learning objectives and maximize the efficiency of teaching and learning in simulated situations.

Correlation Between Thrombotic Parameter D-Dimer and Disease Severity in Patients Infected With SARS-CoV-2 in Da Nang City, Vietnam

Thuy Thi Le — 2025-03-28

Background: The COVID-19 pandemic posed a significant healthcare crisis due to the emergence of acute respiratory infections, leading to severe complications such as thrombosis. Meanwhile, the D-dimer index serves as a dependable routine diagnostic marker for thrombosis. Therefore, it is hypothesized that D-dimer could serve as a potential prognostic marker for COVID-19 infection.

Objective: To assess the association between D-dimer levels and the severity of COVID-19 among patients in the Vietnamese central coastal region.

Methods: A retrospective cross-sectional study was conducted at Da Nang Hospital for Pulmonary Diseases and its satellites on patients admitted for COVID-19 from September 2021 to April 2022. Clinical data were analyzed using the chi-square test. The receiver operating characteristic (ROC) curve was used to determine the best cut-off for D-dimer levels that differentiate between mild and severe cases amongst COVID-19 positive patients.

Results: This study comprised of 205 confirmed COVID-19 patients (mean [SD] age, 66.71 [18.80] years). The participants were divided into 2 groups based on their D-dimer levels: those with D-dimer levels greater than 500 µg/L or less than 500 µg/L. The median D-dimer level of each group were 1507.50 µg/L and 302 µg/L, respectively. Patient age and a history of diabetes correlated with D-dimer elevation in COVID-19 patients. The ROC curve indicated that D-dimer of greater than 638 µg/L was associated with severe disease (sensitivity 80%, specificity 90.8%, area under the curve [AUC] = 0.900).

Conclusions: Elevated D-dimer levels was associated with more severe instances of COVID-19 with levels exceeding 638 µg/L demonstrating high sensitivity and specificity.

A Study of Anxiety Levels Among Parents of Children With Hearing Impairment Before and After Receiving Auditory Intervention at Ramathibodi Hospital

Rada Dara — 2025-03-28

Background: Hearing loss in children impacts their communication ability and daily living. Research has shown a correlation between hearing loss in children and parent’s mental health problems. Although anxiety is a common mental health problem globally, few studies have examined anxiety levels among parents of children with hearing impairments.

Objective: To evaluate anxiety levels among parents of children with hearing impairments before and after children received auditory interventions.

Methods: The study recruited 35 parents of children with hearing impairments who received auditory interventions at Ramathibodi Hospital. Parental anxiety levels were evaluated using STAI Form Y-1 (Thai version), supplemented with structured interviews. Parental anxiety levels before and after children received the intervention were compared using paired t tests, and content analysis was used to analyze qualitative data from structured interviews.

Results: Most participants were female parents of children with bilateral sensorineural hearing loss (SNHL) using hearing aids (mean age; parents = 41 years, and children = 6 years). The results showed a significant decrease in parental anxiety levels after children received an auditory intervention. Consistent with previous literature, parental anxiety levels were reduced after children received auditory interventions. Reduction in parental anxiety might be associated with a better understanding of children’s hearing status, treatment plans, and improvements in children’s speech and language development.

Conclusions: This study suggests that appropriate auditory interventions reduce parental anxiety. The interventions should be carefully planned to support children’s development and parents’ mental well-being.

A Comparison of a Healthy Thai Diet and Contemporary Thai Diet on Health Indices in Individuals With Noncommunicable Diseases: A Randomized Controlled Trial

Sant Chaiyodsilp — 2025-03-28

Background: Studies have suggested that dietary patterns emphasizing low-fat, plant-based foods like vegetarian, Mediterranean, and Dietary Approaches to Stop Hypertension (DASH) diets reduce noncommunicable disease risk.

Objectives: To compare the effects of a Healthy Thai Diet (HTD) and a Contemporary Thai Diet (CTD) on body mass index (BMI), blood pressure, cholesterol, and glycemia. The HTD is characterized by low-fat, plant-based Thai food that substitutes animal products with plant-based ingredients while maintaining traditional seasonings (eg, fish sauce, shrimp paste, and coconut milk).

Methods: Individuals exhibiting at least 1 abnormal health index (BMI, blood pressure, low-density lipoprotein cholesterol [LDL-C], fasting blood sugar [FBS]) or undergoing chronic disease treatment were randomly assigned to the HTD (n = 30) orCTD (n = 32) for 12 weeks. Health indices were measured at baseline and at week 12. Statistical analyses included paired t tests for within-group comparisons and student’s t tests for between-group comparisons.

Results: After 12 weeks, the HTD group experienced significant weight loss (-3.03 kg vs 0.43 kg in CTD, P < .01), particularly in participants with BMI greater or equal to 23 kg/m² (-3.99 kg vs 0.04 kg, P < .01). Systolic blood pressure dropped significantly in the HTD (-17.4 mmHg vs -6.3 mmHg in CTD, P = .05), especially in those with initial readings greater or equal to 140 mmHg (-32 mmHg vs -12 mmHg, P = .01). LDL-C decreased notably in the HTD (-34.1 mg/dL vs -12.9 mg/dL in CTD, P < .05). Participants with type 2 diabetes in the HTD were able to reduce or discontinue medications while maintaining stable glycemic control. Significant changes in gut microbial abundance and improvement in estimated glomerular filtration rate (eGFR) (P < .05) were observed in the HTD.

Conclusions: These results suggest that the HTD may be a promising dietary intervention for managing obesity, hypertension, dyslipidemia, and type 2 diabetes in Thailand.

A Synthesis of Clinical Research From Mahidol University 2019-2023

Chaninart Suriyalungga — 2025-03-28

Background: Strategic research funding is a potential avenue for financial support. Consequently, the synthesis of previous clinical research projects was conducted to explore the possibility of receiving funds.

Objective: To synthesize the clinical research projects of Mahidol University.

Methods: Research data synthesis was performed on clinical research projects in the database of the Research Management and Development Division, Mahidol University, covering the fiscal year 2019-2023. This synthesis was based on the strategic research funding of Thailand for the years 2023-2027 and the announcement of funding from the Program Management Unit (PMU) for the fiscal year 2023-2024. The results are reported by type classification, quantity, and percentage.

Results: Clinical trial research conducted by Mahidol University during fiscal years 2019-2023, which met the criteria of the program for strategic research funding and qualified for the PMU’s announcement of research funding in the fiscal year 2023-2024, were as follows: 1) vaccine development and production, F1 (S1P1), 43 projects (81.13%); 2) development and production of advanced therapy medicinal products, F2 (S1P1), 15 projects (23.44%); 3) genomics and precision medicine, N1 (S1P1), 17 projects (94.44%); 4) development and production of medicines and herbal extracts, N2 (S1P1), 430 projects (97.28%); and 5) national epidemics and emerging diseases, N15 (S2P10), 11 projects (40.74%).

Conclusions: Clinical trial research according to the program of strategic research funding and eligible for PMU was arranged in descending order as follows: N2 (S1P1), N1 (S1P1), F1 (S1P1), N15 (S2P10), and F2 (S1P1).

The Impact of Disclosing Sponsored Marketing to Children: A Pilot Randomized Controlled Trial

Prakasit Wannapaschaiyong — 2025-03-28

Background:Early primary school children (ages 6-8 years) often struggle to recognize advertising content and understand its persuasive intent, particularly in digital media. With increasing exposure to sponsored content on platforms, such as YouTube, there is a critical need for effective methods to enhance children’s advertising literacy.

Objective: To evaluate the impact of child-specific advertising disclosure on advertising literacy among children aged 6 to 8 years.

Methods: This pilot randomized controlled trial, 43 primary school children in Thailand were randomly assigned to control or intervention groups. The intervention group viewed a 10-second disclosure stating, “This person received money to use the product in this content,” before watching a mock YouTube unboxing video. Advertising literacy was assessed via questionnaires at baseline, immediately postintervention, and at 3-month follow-up.

Results: Among 43 participants (51.6% female, mean age 7.31 years), the control group demonstrated a significant decrease in overall advertising literacy scores from pretest to posttest (P = .049), driven by reduced brand recognition, source recognition, and understanding of selling intent. In contrast, the intervention group maintained their advertising literacy (P = .110), with a stable understanding of persuasive intent and a trend toward improved understanding of selling intent. Scores remained consistent from the posttest to 3-month follow-up in both groups.

Conclusions: Child-inspired advertising disclosure prevented a decline in advertising literacy, particularly for persuasive and selling intent components. These findings suggest that customized disclosures may enhance young children’s recognition of advertising commercial motives.