Siriraj Medical Journal

Impact of Social Determinants of Health on Postoperative Health-Related Quality of Life Among Patients Undergoing Colorectal Cancer Surgery

2025-02-02T10:55:06+07:00

Objective: This study aimed to investigate the predictive effects of social determinants of health—specifically financial status, neighborhood environment, body mass index, anxiety, and family support—on the health-related quality of life (HRQoL) among patients undergoing colorectal cancer (CRC) surgery.

Materials and Methods: A cross-sectional study was conducted with patients who underwent elective colorectal surgery and were in the postoperative period of one month in a super-tertiary hospital in Thailand. Data were collected using questionnaires and analyzed with descriptive statistics, one-way ANOVA, Pearson correlation, and multiple regression analysis.

Results: A total of 130 patients were enrolled, with 71 patients (54.6%) having fewer complications. Patients who have undergone CRC surgery had an average HRQoL score of 111.9 ± 11.9. Notably, the HRQoL after surgery was higher than before, reflecting an increase of 78.5%. The significant predictive factors of HRQoL were financial status (β = 0.56, p < 0.001), followed by anxiety (β = –0.172, p = 0.011), body mass index (β = 0.171, p = 0.008), and family support (β = 0.15, p = 0.022).

Conclusion: Nurses should develop practice guidelines to promote HRQoL in postoperative CRC patients after discharge by screening financial status, body mass index, anxiety, and family support. These guidelines should serve as a framework for planning ongoing care for patients and their families once they return home, ensuring that their physical, emotional, and social needs are effectively addressed during their recovery process.

In Vitro Comparison of the Mechanical and Optical Characteristics of the Storz Flex-XC1 Singleuse Ureteroscope and the Storz Flex-XC Reusable Flexible Ureteroscope

2025-01-18T14:15:32+07:00

Objective: This study compared the mechanical and optical characteristics of the Storz Flex-XC1 single-use ureteroscope and the Storz Flex-XC reusable flexible ureteroscope. The mechanical parameters comprised the upward/downward deflection, loop diameter, and irrigation flow rate. The optical parameters were image resolution and color representation.

Materials and Methods: We conducted an in vitro evaluation of two Karl Storz flexible ureteroscopes. Specifically, we examined the Storz Flex-XC1 single-use and Storz Flex-XC reusable scopes for upward/downward deflection angles, loop diameter, irrigation flow rates, image resolution, and color representation. The Storz Professional Image Enhancement System was also applied.

Results: The Storz Flex-XC reusable ureteroscope achieved greater upward/downward deflection angles than did the Storz Flex-XC1 single-use ureteroscope when a 200 μm laser or a 1.9 Fr tipless basket was used, with mean differences of 1.9°‒2.2° and 2.3°‒5.6°, respectively. No clinically significant difference in loop diameter was found. The Storz Flex reusable scope achieved a higher irrigation flow rate with an empty working channel (mean difference of 2.25 ml/min). Both scopes demonstrated identical image resolutions in air and in a normal saline solution, but the Storz Flex single-use device showed superior color representation.

Conclusion: The Storz Flex-XC reusable flexible ureteroscope displayed slight advantages in terms of the deflection angle and irrigation flow rate. The Storz Flex-XC1 single-use flexible ureteroscope offered improved color representation and marginally better resolution in saline.

The Role of Intraprostatic Injection of Epinephrine in Reducing Perioperative Blood Loss during Transurethral Resection of the Prostate (TURP) in Patients with Benign Prostatic Hyperplasia (BPH): A Systematic Review & Meta-Analysis

2025-01-14T19:44:34+07:00

Objective: This systematic review and meta-analysis aims to evaluate the effectiveness of intraprostatic epinephrine injections in reducing perioperative blood loss during TURP for BPH.

Materials and Methods: A systematic review and meta-analysis were conducted by searching the PubMed, EBSCO, and Cochrane databases up to September 2024. Randomized controlled trials (RCTs) and observational studies involving the use of intraprostatic epinephrine during TURP were included. The primary outcome assessed was perioperative blood loss, while secondary outcomes included hemoglobin changes, resected tissue volume, and resection time. Data analysis was performed using Review Manager 5.4 software.

Results: A total of 185 patients from three RCTs and one comparative retrospective study were included in the systematic review. Among these, 144 patients from the RCTs were included in the meta-analysis. Intraprostatic epinephrine was associated with a significant reduction in hemoglobin decline (mean difference [MD]: 0.52 g/dL, p = 0.0002) and shorter resection time (MD: -10.57 minutes, p = 0.01). However, no significant differences were observed in perioperative blood loss (MD: -96.58 mL, p = 0.36) or the volume of resected tissue (MD: 3.71 g, p = 0.46).

Conclusion: Intraprostatic epinephrine injections during TURP effectively reduce hemoglobin loss and resection time, improving surgical efficiency. However, no significant effects were observed on total perioperative blood loss or tissue volume resected. Variability in surgical techniques and patient factors likely contributed to inconsistent outcomes, underscoring the need for standardized protocols in future research.

Assessing Dysphagia in Head and Neck Cancer Patients: Validation and Cultural Adaptation of the Thai M.D. Anderson Dysphagia Inventory (TH-MDADI)

2025-01-02T11:41:11+07:00

Objective: The validation study of the Thai version of the M.D. Anderson Dysphagia Inventory (TH-MDADI) addresses a critical gap in head and neck cancer (HNC) care in Thailand. At leading institutions like Siriraj Hospital, patient-reported outcomes have been historically neglected, with care primarily focusing on routine medical services. This study aimed to validate the TH-MDADI to enhance dysphagia assessment and promote patient centered care.

Materials and Methods: In this longitudinal prospective study, 66 HNC patients completed the TH-MDADI and SF-36 at baseline, pre-treatment, and post-treatment at Siriraj Hospital. Psychometric properties were evaluated, including internal consistency (Cronbach’s α), test-retest reliability (intraclass correlation coefficient, ICC), convergent and discriminant validity (correlations with SF-36 domains), and responsiveness (standardized response mean, SRM).

Results: The TH-MDADI demonstrated excellent internal consistency (Cronbach’s α = 0.93) and test-retest reliability (ICC = 0.92, 95% CI: 0.88–0.96). Strong correlations with related SF-36 domains (r = 0.64-0.74, p < 0.001) established convergent validity, while weak correlations with unrelated domains confirmed discriminant validity. High responsiveness to change post-treatment was observed, particularly in the Global (SRM = 3.83) and Emotional (SRM = 3.17) subscales.

Conclusion: The TH-MDADI demonstrates robust psychometric properties, establishing its value as a reliable tool for assessing dysphagia-related quality of life in Thai HNC patients. This validation represents a significant advancement in Thai cancer care, addressing the historical neglect of patient-reported outcomes. By providing clinicians with a validated assessment instrument, this study promotes a more systematic, patient-centered approach to HNC treatment in Thailand.

Incidence of Tympanic Membrane Perforation Affected by Intratympanic Steroid Injection: A Retrospective Review

2025-01-15T07:17:03+07:00

Objective: This study aims to determine the incidence of persistent tympanic membrane perforation following intratympanic steroid injection and to identify potential factors associated with delayed healing. Additionally, it aims to estimate the time required for perforation closure in prolonged cases to avoid unnecessary interventions.

Materials and Methods: Data from patients who underwent intratympanic steroid injections were reviewed. The primary outcome was the incidence of tympanic membrane perforation lasting beyond four weeks post-injection. Secondary outcomes included identifying factors affecting healing duration and closure time in prolonged cases.

Results: Of 295 ears treated between March 2018 and March 2021, 3.39% (10/295) experienced persistent perforation at four weeks. Of these, 1.69% (5/295) required intervention, while the rest healed spontaneously. The median closure time was 12 weeks. All patients with persistent perforation were female. No statistically significant differences were found between groups. Hearing recovery was achieved in 29.1% (74/254) of patients with sudden sensorineural hearing loss. Younger age and non-profound hearing loss were favorable prognostic factors.

Conclusion: The incidence of perforation in this study is lower than previously reported but consistent with other literature. Intratympanic steroid injections remain beneficial, outweighing the risks of complications.