Royal Thai Air Force Medical Gazette

Nurse’s Role: The Nurse Case Manager in Empowering Patients Facing Diabetes Burnout

Kaewrin Pengsalud — 2025-12-29

Diabetes management presents a continuously escalating global health challenge. Beyond the physical demands of management, patients frequently encounter significant emotional and psychological burdens, which can lead to “diabetes burnout”—a condition distinct from general depression. This state manifests across three primary dimensions: emotional exhaustion, depersonalization or cynicism towards self-care, and a diminished sense of personal accomplishment in managing the disease. Various factors contribute to burnout, including the overwhelming burden of self-management, unrealistic expectations, complications and fear, insufficient social support, and co-occurring emotional and mental health issues. Burnout directly compromises glycemic control, increases the risk of complications, and significantly erodes patients’ quality of life. This article emphasizes the pivotal role of the “nurse case manager” in addressing diabetes burnout. Utilizing a holistic care approach, nurses coordinate with multidisciplinary teams and employ proactive and reactive strategies to provide individualized support. Key techniques employed by nurses include Motivational Interviewing (MI) and OARS skills (Open-ended questions, Affirmations, Reflections, Summarization) to foster patient awareness and promote sustainable behavioral changes. The article also presents case examples demonstrating the success of nurse case managers in helping patients re-engage with their self-care. Furthermore, routine screening for diabetes distress and depression is crucial, and when severe symptoms are identified, patients should be referred to mental health specialists.

The Development of The Mother-To-Infant Attachment Questionnaire (MIAQ) For Newborns’ Mothers Admitted to The Neonatal Intensive Care Unit (NICU)

Chananchita Chunko — 2025-12-29

This developmental study aimed to develop the Mother-to-Infant Attachment Questionnaire (MIAQ) and to assess its appropriateness and basic measurement qualities for evaluating maternal attachment among mothers whose newborns were admitted to a Neonatal Intensive Care Unit (NICU). The research was conducted in two phases: (1) questionnaire development and content validation by five experts, and (2) preliminary testing with 30 mothers selected through convenience sampling based on pre-defined criteria. The results showed that the developed questionnaire demonstrated high content validity and acceptable reliability, with a Cronbach’s alpha coefficient of 0.88 for all 26 items. The alpha coefficients when each item was deleted ranged from 0.87 to 0.88, and item-total correlations ranged from 0.30 to 0.58. The MIAQ was found to be appropriate for contexts where mothers are unable to provide continuous care for their infants, such as in NICU settings with time and health-related constraints. By reflecting maternal perceptions and emotions directly, this tool can offer preliminary insight into maternal-infant attachment and provide a foundation for supporting early bonding between mothers and their newborns.

The Effect of Integrated Anticipatory Pleasure Skills Training Program on Anhedonia of Persons with Major Depressive Disorder

Prapaluk Sanlom — 2025-12-29

This quasi-experimental research employed a two-group pretest-posttest design and aimed to examine the effect of integrated anticipatory pleasure skills training program on anhedonia of persons with major depressive disorder. The sample consisted of 64 male and female patients aged between 20 and 59 years who were receiving outpatient treatment at the psychiatric clinic of a tertiary hospital in Bangkok. Participants were randomly assigned to either the experimental group or the control group, with 32 individuals in each group. The experimental group received the integrated anticipatory pleasure skills training program, while the control group received standard nursing care. Research instruments included The Integrated Anticipatory Pleasure Skills Training program, the Anhedonia Assessment Scale and the Temporal Experience Pleasure Scale (for intervention monitoring). All instruments were validated for content validity by experts. The content validity index (CVI) of the Anhedonia Assessment Scale and the Temporal Experience Pleasure Scale were 1.00 and 0.98, respectively. The reliability coefficients (Cronbach’s alpha) were 0.94 and 0.87, respectively. Data were analyzed using descriptive statistics, paired t-tests, and independent t-tests.

The results revealed that the mean anhedonia score of patients with major depressive disorder in the experimental group significantly decreased after participating in the integrated anticipatory pleasure skills training program (p<0.05). Additionally, the mean anhedonia score of the experimental group after participating in the integrated anticipatory pleasure skills training program was significantly lower than that of the control group (p<0.05). These findings indicated that the nursing intervention involving integrated anticipatory pleasure skills training can effectively reduce anhedonia in patients with major depressive disorder.

The results revealed that the mean anhedonia score of patients with major depressive disorder in the experimental group significantly decreased after participating in the integrated anticipatory pleasure skills training program (p < .05). Additionally, the mean anhedonia score of the experimental group after participating in the integrated anticipatory pleasure skills training program was significantly lower than that of the control group (p < .05). These findings indicate that the nursing intervention involving integrated anticipatory pleasure skills training can effectively reduce anhedonia in patients with major depressive disorder.

Symptom Experiences and Quality of Life in Early Surgical Menopause Women

Nutchaya Sa-ngaareekul — 2025-12-29

This prospective descriptive study focused on the symptoms experienced and quality of life in early surgical menopause women. The Symptom Management Model (Dodd et al., 2001) was used as a research framework. The sample consisted of 52 women who had surgical menopause and were receiving outpatient services at Siriraj Hospital. Data were collected during August 2023 to April 2024 through 3-time follow-ups, 10-14 days, 4-8 weeks, and 12-16 weeks after surgery. Research instruments included a personal and health data recording form, a symptom experience questionnaire, and quality of life of menopausal women (Thai MENQOL). Data were analyzed using descriptive statistics.

The research results found that the 5 common symptoms for all 3-time follow-ups were hot flashes, night sweats, insomnia, dry skin, and irritability. During 10-14 days after surgery, the severity of almost all symptoms was low. The severity of most symptoms was gradually increase during 4-8 weeks after surgery and were in moderate levels during 12-16 weeks after surgery. As for the quality of life of women with surgical menopause, it was found that autonomic nervous system symptoms had the highest impact on quality of life in all 3 periods. Symptoms that had the greatest impact on quality of life in the period 10-14 days 4-8 weeks and 12-16 weeks after surgery were bloating, insomnia and hot flashes, respectively. The results provide data for improving health care for women undergoing surgical menopause.

Selected Factors Related to Patient Activation Among Ischemic Stroke Patients

Rattasiri Kamkem — 2025-12-29

Background: Ischemic stroke is a chronic condition that requires complex and continuous care. In the recovery process, patients play a central role not only as care recipients but as active participants in their own rehabilitation. Low levels of patient activation have been associated with increased disease severity and higher rates of hospital readmission. Patient activation is closely related to health behaviors among individuals with ischemic stroke.

Objectives: The purpose of this study was to investigate the level of patient activation among patients with ischemic stroke and to study the relationships between selected factors including age, perceived health status, self-efficacy, social support, comorbid conditions, and depression with patient activation.

Methods: This descriptive correlational study included a sample of 104 patients with ischemic stroke who had completed the acute phase of treatment for at least two weeks. Participants were between 18 and 59 years of age and received care at the outpatient department of three tertiary hospitals. The sample was selected using simple random sampling. The research instruments included a personal information questionnaire, the Perceived Health Status Scale, the Self-Efficacy in Self-Care Scale, the Social Support Questionnaire, the Comorbidity Index, the Depression Scale, and the Patient Activation Measure (PAM).

Results: The majority of participants with ischemic stroke demonstrated a high level of patient activation (Level 4), indicating their ability to adopt new health behaviors and maintain them even under pressure, accounting for 96.2%. Statistically significant positive correlations were found between patient activation and perceived health status (r=0.46, p<0.001), as well as self-efficacy (r =0.50, p<0.001). In contrast, comorbid conditions (r=-0.34, p<0.001) and depression (r=-0.27, p=0.004) were significantly and negatively correlated with patient activation. No significant correlations were found between patient activation and age (r=0.02, p=0.635) or social support (r=0.17, p=0.074)

Conclusion: The findings of this study indicate that perceived health status, self-efficacy, depression, and comorbid conditions are significantly associated with patient activation in self-care among individuals with ischemic stroke. In contrast, age and social support were not found to be associated with patient activation.

Quality of Care Management among Persons with Multiple Trauma at Emergency Department in a Tertiary Care Hospital under the Ministry of Public Health

์Niramon Phawet — 2025-12-29

This descriptive research aimed to study the quality of care for multiple trauma patients in the emergency and accident department using the Donabedian model as a conceptual framework. The sample consisted of 83 medical records of multiple trauma patients and 32 professional nurses. The data collection tools were divided into three aspects: structure, process, and outcome. Data were analyzed using descriptive statistics and inferential statistics with the Mann-Whitney U test.

The results showed that, in terms of patient characteristics, the majority were male, with an average age of 38.52 years (SD=14.94), and most injuries resulted from traffic accidents. Regarding healthcare providers, most nurses were female, with an average age of 32.19 years (SD=1.40), held a bachelor’s degree (96.88 %), and had an average work experience of 8.28 years (SD=7.68). Overall, their knowledge of multiple trauma patient care was at a high level (62.50 %), and there was no significant difference in knowledge of care management among persons with multiple trauma between those who had attended specialized training and those who had not (p>0.05).

For the process of care, during the pre-hospital care phase, emergency response teams took less than 2 minutes to respond, and patients had a Glasgow Coma Score (GCS) of <8 (58.62 %). In the in-hospital care phase, (100 %) received activated fast track trauma protocols, and approximately half did not experience hemorrhagic shock. In the definitive care phase, most patients underwent surgery within 30 minutes (63.64 %) and were transferred to critical care units, with an average emergency room stay of 290.83 minutes (SD=153.02).

In terms of outcomes, 89.15 % of patients survived. Among those with a low probability of survival (Ps<0.25), 77.78 % died, while 16.67 % of patients in the preventable death group (Ps 0.51-0.74) did not survive. The findings reflect a certain level of quality in the care provided to multiple trauma patients. However, further development of care protocols is recommended to improve the survival rates of patients whose deaths could potentially be prevented.

Study of the Mini-Thanyarak Service Model in Thailand

Meena Choojai — 2025-12-29

This research aims to conduct a developmental evaluation to assess the efficiency and improve the service model of Mini-Thanyarak facilities in Thailand. The study identified a total of 147 service establishments with 1,844 beds, comprising 112 intermediate care facilities and 35 long-term care facilities. Health District 10 demonstrated the highest service capacity with 254 beds, while Health District 3 had the least at 23 beds. In intermediate care, there were 2,298 service users, equating to a service rate of 220.96%, whereas long-term care recorded 340 users, with a service rate of 42.29 %. The majority of patients were found to be using methamphetamines (1,802 individuals), particularly in Health District 8, which had the highest number of service recipients at 376. The evaluation identified significant risks associated with service delivery, including unauthorized exits from facilities and altercations among patients. Additionally, a lack of resources and shortages of specialized personnel were critical limitations. Various training programs for staff were noted, emphasizing holistic rehabilitation activities for physical, mental, and social recovery, with a treatment duration of 1 to 3 months. The assessment results indicated budget constraints and limited facility capacity, recommending increased investment in infrastructure, personnel, and technology to enhance the quality of patient rehabilitation.

The Effect of Family Resilience Enhancement Program Through Mobile Applications on Amphetamine Consumption in Adolescents with Amphetamine Dependence Receiving Outpatient Treatment

Supawadee Cheumeerang — 2025-12-29

This study is a quasi-experimental two-group repeated measures design. The objectives were to compare: 1) amphetamine consumption in adolescents with amphetamine dependence on who received multidimensional family therapy program (MDFT) measured at pre-test (t1), at end of the intervention (t2), and 2) amphetamine consumption in adolescents with amphetamine dependence on who received

multidimensional family therapy program (MDFT) measured at t1, t2 and t3. The sample consisted of 50 adolescents with amphetamine dependence who met the inclusion criteria and received services at the outpatient of Princess Mother National Institute of Drug Abuse Treatment Institute: PMNIDAT. They were matched pairs with scores on severity of dependence and parents’ marital status, then randomly assigned to the experimental and control groups, which received regular care. Research instruments for relationship assessment. All instruments were verified for content validity by 5 professional experts. Pearson Correlation reported the reliability of the 2nd instrument as 0.91, and the 3rd instrument had a Cronbach’s Alpha Coefficient reliability of 0.91. Descriptive statistics, repeated measures analysis of variance (Repeat ANOVA), and Planned comparisons were used in data analysis.

The study found that adolescents addicted to methamphetamine who participated in the family-based intervention program delivered via a mobile application (experimental group) showed significantly greater improvement in their resistance to methamphetamine addiction compared to the control group, both before and immediately after the intervention (P<0.001). Specifically, the results were statistically significant for the experimental group (P<0.001) and the control group (P<0.002).

After two weeks of receiving the family-based anti-methamphetamine empowerment program via a mobile application, the resistance scores of adolescents in the control group were found to be higher than those in the experimental group; however, the difference was not statistically significant (P<0.273).

Prevalence of Refractive Error Among Kindergarten Level 3 at Rittiyawannalai Kindergarten School

Wanlikar Pattama — 2025-12-29

The visual acuity and refractive error screening project was initiated for kindergarten level 3 at Rittiyawannalai Kindergarten School by the Department of Ophthalmology, Bhumibol Adulyadej Hospital, Directorate of Medical Services, Royal Thai Air Force. The primary objective of this project was to screen for and identify visual abnormalities among these children. Screening results were provided to parents to ensure that children with abnormal visual findings could receive prompt and appropriate treatment, thereby preventing the development of amblyopia (lazy eye). Furthermore, this proactive medical initiative aims to improve the delivery of early ophthalmic care, allowing children to achieve normal or near-normal visual function. During the 5-year implementation period (2016-2024), a total of 1,584 children were screened. Among these, 141 children were found to have visual abnormalities that warranted further examination by an ophthalmologist. Of those referred, 16 children were diagnosed with specific ocular diseases at the Ophthalmology Clinic, Bhumibol Adulyadej Hospital. The diagnoses were as follows myopia 4 cases, hyperopia with astigmatism 4 cases, astigmatism 4 cases, hemangioma 1 case, epiblepharon 1 case, exotropia divergence concomitant strabismus 1 case. Left-eye amblyopia 1 case which was associated with unilateral hyperopia in the left eye and astigmatism in both eyes. The astigmatic error was morepronounced in the left eye.
This project facilitated timely diagnosis and treatment, contributing to improved visual outcomes and overall quality of life for the affected children.

A Proof-of-Concept Study for an Intradermal Dose-Sparing Strategy: Non-Inferior Immunogenicity and Improved Systemic Tolerability of Fractional-Dose ChAdOx1-S SARS-CoV-2 Vaccine Compared to Intramuscular Administration

Sumit Ariyawongsakul — 2025-12-29

Background: The global shortage of SARS-CoV-2 vaccines and the necessity for repeated booster doses highlight an urgent need for dose-sparing strategies. The intradermal (ID) route, leveraging the skin’s rich immune network, is highly attractive due to the high density of antigen-presenting cells (APCs) in the dermis, offering the potential to induce a robust immune response with a reduced antigen dose. This study was conducted to establish a Proof-of-Concept (PoC) for the feasibility of an ID fractional dose strategy.

Objective: This study aimed to establish a proof-of-concept for an ID dose-sparing strategy. Primary

objectives were to evaluate the safety, tolerability, and immunogenicity of a fractional ID dose (0.1 mL,

1 x 1010 viral particles) compared to the standard IM dose (0.5 mL, 5 x1010 viral particles) as a booster in healthy adults.

Methods: This was a comparative, prospective, open-label, volunteer-controlled trial. Healthy adults (18-60 years old) who had previously completed a two-dose regimen of inactivated SARS-CoV-2 vaccine (Sinovac) were assigned to receive the ChAdOx1-S vaccine as a 3^rd dose booster. The IM full dose group received 0.5 mL, 5 x 1010 vp, while the ID fractional dose group received 0.1 mL, 1 x 1010 vp. Safety, tolerability, and immunogenicity (Anti-S RBD antibody titers, converted to BAU/mL) were evaluated at Day 0 and Day 14 post-vaccination.

Results: A total of 60 volunteers were included. The Geometric Mean Titer (GMT) of Anti-S RBD antibodies was 10,203 BAU/mL (95%CI: 7,698 to 13,524) in the ID group and 10,337 BAU/mL (95%CI: 8,078 to 13,225) in the IM group. The GMT ratio (ID/IM) was 0.99 (95%CI: 0.77 to 1.27), which exceeded the pre-specified non-inferiority margin (0.67), demonstrating statistical non-inferiority of the fractional ID dose. The ID group demonstrated a favorable safety profile with significantly lower incidence of systemic adverse events (AEs) (e.g., Myalgia 10 % vs. 40 %, Headache 5 % vs. 30 %) compared to the IM group. Local reactions like erythema (91 % vs. 11.1 %) and swelling (72 % vs. 11.1 %) were more common with ID administration.

No serious adverse events were reported.

Conclusion: The ID administration of a one-fifth fractional dose of the ChAdOx1-S vaccine produces a robust, non-inferior immune response with a superior systemic safety profile. This study establishes a vital PoC for a Dose-Sparing strategy using viral vector vaccines. Beyond vaccine scarcity, the demonstrated efficiency of the ID route holds vast potential for future application in anti-cancer immunotherapy, specifically with personalized cancer vaccines.