Research Medical Journal

Laparoscopic Vesicovaginal Fistula Repair: 2 Cases From Chaophrayayommarat Hospital

Pongpak Pinyoboon — Mon, 26 Jan 2026 00:00:00 +0700

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.

Conventional vs Combination of Conventional and Digital Approaches to Prosthetic Rehabilitation of Orbital Defect: Case Report

Nuntaporn Rojanasakul — Mon, 26 Jan 2026 00:00:00 +0700

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.

Comparing Diagnostic Criteria for Noise-Induced Hearing Loss in Hospital Personnel: Age Adjustments With ISO 7029-2017

Pitchaya Chevasutho — Mon, 26 Jan 2026 00:00:00 +0700

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.

Factors Affecting Melioidosis Prevention Behaviors Among People in the Area of Health Zone 10, Ubon Ratchathani

Sitang Philom, Kulchaya Loyha, Supaporn Chaigarun — Mon, 26 Jan 2026 00:00:00 +0700

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.

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

Veerachai Sachdev, Paichit Inpanya, Ekkachai Petchlorlian — Mon, 26 Jan 2026 00:00:00 +0700

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.

Factors Associated With Homework Adherence in Cognitive Behavioral Therapy

Mon, 26 Jan 2026 00:00:00 +0700

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.

Surgeon Satisfaction With Anesthesia Services at Srinagarind Hospital: A Comparison With Data From 7 Years Ago

Wed, 28 Jan 2026 00:00:00 +0700

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

Objectives: 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.

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

Kridsada Sirichaisit — Mon, 26 Jan 2026 00:00:00 +0700

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.