Royal Thai Army Medical Journal

The The Impact of Social Participation on Dementia Risk Reduction

Ong-on Prajankett — 2024-12-29

Dementia, a debilitating syndrome characterized by progressive memory, cognitive, and behavior-psychological decline, is rapidly emerging as a major global health concern.
With an aging population, the number of individuals diagnosed with dementia is projected to
rise significantly in the coming decades. While certain risk factors, such as age and genetics, are unmodifiable, recent research increasingly emphasizes the importance of modifiable factors in reducing dementia risk. Among these, social participation is gaining significant attention for their potential to protect cognitive health. This article delves into this promising connection, exploring the potential mechanisms through which social participation may exert its protective effects. We examine research evidence from various studies that demonstrate the link between social connectedness and a lower risk of dementia. Additionally, we provide practical examples of how individuals can increase their social participation. Finally, we discuss the crucial role that healthcare professionals can play in promoting social participation for their patients, outlining guideline and recommending social activities, and supporting community programs that cater to the needs of people in the community. By highlighting the protective power of social connections and advocating for increased social participation, this article aims to contribute to the development of effective strategies for reducing dementia risk and promoting cognitive well-being.

Risk Factors and Managing Pre-diabetes for Health Personnel

Apinya Indhraratana — 2024-12-29

Pre-diabetes is a condition that affects the destruction of small and large blood vessels due to elevated blood sugar levels, which causes complications or risks of diseases similar to diabetes. The main purpose of caring for people with pre-diabetes is risk factor control, preventing and delaying the onset of diabetes Including prevention of heart disease and various complications. This article reviews meaning and importance of pre-diabetes, health risks that occurred from pre-diabetes, risk factors leading to pre-diabetes, and guidelines for managing people with pre-diabetes such as health screening, health examination, lifestyles modification, and strategies for health care providers to successfully implement the guidelines for preventing pre-diabetes.

Idiopathic Sudden Sensorineural Hearing Loss

Pimrada Potipimpanon — 2024-12-29

Sudden sensorineural hearing loss (SSNHL) is characterized by a rapid or abrupt decrease in hearing ability, typically occurring within a 72-hour period. Its annual prevalence is estimated to range from 5 to 27 cases per 100,000 individuals.¹ More than 90% of this illness is idiopathic, which implies fewer than 10% attributed to identifiable factors. This condition is urgent since early diagnosis allows for earlier treatment initiation, leading to improved outcomes and enhanced quality of life for patients. Numerous studies have been conducted in the past and have continued to advance up to this day. The authors are aware of the necessity of evidence-based practice and attempt to synthesize available data from reliable databases that could provide both physicians and patients with useful information on treatment choices.

Using CIPP Model for Summer Course Development: Case study in Musculoskeletal system

Natcha Lorsuwannarat — 2024-12-29

Background: During the past three consecutive years, it has been found that a significant number of students did not pass the minimum passing criteria in the Musculoskeletal System I subject and had to retake the exam each year. In most educational institutions in Thailand, the use of the CIPP model is primarily for evaluating the outcomes of teaching and learning.

However, this study has expanded the application of the CIPP model in curriculum development planning to improve the effectiveness of managing summer courses aimed at meeting the minimal knowledge requirements. Methods: The pilot study and cross-sectional descriptive study were conducted by analysing the four aspects of the CIPP model, which are context, input, process, and product. It is used as a foundation for problem-solving, curriculum development planning, and selecting appropriate learning methods to provide students in need of remedial and developmental education with sufficient knowledge in essential and necessary physical science topics to advance in higher-level studies, particularly in the fields of surgery, rehabilitation medicine, and otolaryngology. Data was collected through questionnaires and collaborative discussions, followed by statistical analysis. Results: The data obtained from clinical instructors, preclinical instructors, 2^nd-year, and 5^th-year medical students, totaling 161 individuals, were used to determine the teaching topics and suitable learning formats for the remedial summer course for medical students. For the product evaluation, curriculum appropriateness was rated at the highest level (5.00/5.00), while student performance and competency were rated at a high level (4.19/5.00). Conclusion: The CIPP model can be effectively used in the planning, development, and problem-solving of curriculum by considering the aptitude and attitude of the learners. It also takes into account the feedback from instructors and the requirements of clinical faculty.

A comparative outcome of infrainguinal vessel endovascular intervention by intravascular ultrasound-guided (IVUS) versus angiography-guided in chronic limb-threatening ischemia at Phramongkutklao hospital

Chanarat chokchaisamut — 2024-12-29

A comparative outcome of infrainguinal vessel endovascular intervention by intravascular ultrasound-guided (IVUS) versus angiography-guided in chronic limb-threatening ischemia at Phramongkutklao hospital

Objective : Chronic limb-threatening ischemia make many patients loss limbs world wild. Treatment strategy for this disease is important. The endovascular treatment-first strategy (EVT) are prefer.Today, intravascular ultrasound was developed for evaluation more vessel pathology detail. It give more information during endovascular surgery. The aims of study is to prove outcome of intravascular ultrasound (IVUS) guide endovascular intervention comparison with angiographic guide endovascular intervention in chronic limb-threatening ischemia at Phramongkutklao hospital.

Method : Single center, retrospective cohort study was created. Data were collected since January 2018 to December 2022. The data of chronic limb-threatening ischemia patients who were operated by endovascular surgery were collected. Then separate into 2 group, The control group is angiographic guide endovascular intervention and the study group is IVUS guide endovascular intervention. Major adverse limb events (MALE) in 6 month and major adverse cardiac events (MACE) in 30 days are primary outcome of this study.

Result : 98 limb of 90 patients were included. Angiographic guide endovascular intervention is 69 limb. And IVUS guide endovascular intervention is 29 limb. They were not difference in patient baseline characteristic and severity of disease. Overall technical success rates are 100%. After calculate by Chi-Square Tests, 6 month MALE are equal in both group ( angiography 20.3% vs IVUS 20.7%; p=0.964). Similar in 30 day MACE, the result are not difference in both group ( angiography 8.7% vs IVUS 10.3%; p=0.796)

Conclusion : IVUS guide endovascular intervention do not increase limb salvage rate than angiographic guide in short term outcome. Other benefit of this imaging technique such as post angioplasty dissection detection rate and accurately stent size selection must be study more in large population.

EFFECT OF A SELF-REGULATION PROGRAM WITH POSITIVE REINFORCEMENT ON PARTICIPATION WORK BEHAVIOR BASED ON PDCA OF NURSES WORKING IN HOSPITAL QUALITY ASSURANCE

Phanumas Intrarakamhaeng — 2024-12-29

This study aimed to examine the effects of a self-regulation program combined with positive reinforcement on PDCA-based work participation behaviors among hospital quality assurance nurses. The sample consisted of professional nurses working in a military hospital, selected through stratified random sampling and randomly assigned to either an experimental group (n = 32) or a control group (n = 32). The self-regulation program with positive reinforcement comprised three main stages and five activities conducted over eight weeks. Data analysis employed descriptive statistics, independent t-tests, and paired t-tests.

The results showed that the experimental group, after participating in the program, had significantly higher PDCA-based work participation scores compared to the control group (t = 5.73, p < 0.05), with an average score of 5.03 (SD = 0.78) compared to 4.77 (SD = 0.23) for the control group. Additionally, the experimental group demonstrated significantly higher post-program participation scores compared to their pre-program scores (t = 6.39, p < 0.05), with post-program scores averaging 5.03 (SD = 0.07) compared to 4.78 (SD = 0.26) pre-program.

These findings suggest that this program is a viable tool for hospital administrators to implement in enhancing the work behaviors of staff within their organizations.

Incidence and Risk Factors Associated with Thrombosis at Presentation of Polycythemia Vera (PV)

Tanapun Thamgrang — 2024-12-29

Background

Polycythemia vera (PV) thromboembolism has a significant impact on morbidity and mortality, with a variety of risk factors.

Aims

To evaluate the incidence of thrombosis in PV patients, identify associated risk factors, and assess clinical outcomes, including thrombosis-free survival and overall survival (OS).

Methods

Data from Phramongkutklao Hospital (January 2000 to November 2023) were retrospectively analyzed. Patients diagnosed with PV (WHO 2022 criteria) were included, and demographic information, cardiovascular risk factors, thrombotic events, and laboratory data were collected.

Results

We enrolled 190 patients (73.68% male) with a mean age of 60.94±13.83 years and a median follow-up period of 3.13 years. Of these, 65.79% were classified as ELN high-risk. Thrombosis occurred in 67 patients (35.26%) either before or at PV diagnosis, with predominantly arterial. Key cardiovascular risk factors included hypertension (75.79%), dyslipidemia (56.84%), diabetes mellitus (50%), and smoking (34.74%). The JAK2^V617F mutation was present in 73.16%. Mean hemoglobin was 18.08±1.84 g/dL; median WBC and platelet counts were 11,270/mm³ (IQR: 8,200-16,600) and 387,000/mm³ (IQR: 245,000-611,000), respectively. Multivariable analysis identified age ≥60 years (aOR 2.30; 95% CI: 1.21-4.38), female (aOR 1.60; 95% CI: 0.80-3.19), and WBC >11,000/mm³ (aOR 1.81; 95% CI: 0.96-3.41) as factors associated with thrombosis either before or at PV diagnosis. Post-diagnosis thrombosis occurred in 8.95%, with a 10-year cumulative incidence of 19.53%. Thrombosis-free survival and overall survival (OS) at 10 years were lower in the thrombosis group either before or at diagnosis group, at 59.65% vs. 76.71% (p=0.2037) and 67.06% vs. 87.54% (p=0.027), respectively.

Conclusions

The incidence of thrombosis occurring either before or at the time of PV diagnosis is consistent with findings from previous studies. Among the factors analyzed, age ≥60 years is the only statistically significant risk factor.

Editoral

sarawut ่jindarat — 2024-12-29

Coexistence of IgA Nephropathy and ANCA-Associated Vasculitis in an HIV Infected Patient: A Case Report

kulachon leelasiri — 2024-12-29

This case report presents a rare and complex scenario involving the coexistence of HIV infection, immunoglobulin A nephropathy (IgAN), and anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis in a 40-year-old female. The patient, with a 4-year history of HIV, had been on consistent antiretroviral therapy and had a CD4 count of 374 cells per cubic millimeter. She presented with hematuria and rapidly declining renal function. The diagnosis was confirmed through kidney biopsy, revealing both IgA deposition and features of ANCA-associated vasculitis. The patient was successfully treated with a combination of high-dose corticosteroids and cyclophosphamide, leading to the stabilization of her renal function. This case underscores the challenges of managing such conditions, particularly in the context of an immunocompromised state, and highlights the importance of early recognition and timely intervention.