Siriraj Medical Journal

Standardized Medical Photographic Imaging of Patients: A Proposed Guideline

Kawitsara Eambunnapong — 2025-11-01

Medical photographic imaging plays an essential role in the diagnosis, treatment planning, and follow-up care of patients. Medical photographic imaging also plays a vital role in supporting academic/instructional and research documentation and materials. Therefore, to ensure high-quality, reliable, and consistent medical photographic imaging, standardized guidelines for photographing medical patients are needed. Based on a synthesis of relevant published documents, we hypothesized that medical photographic imaging standards can be divided into the following three key domains: 1) characteristics of; 2) essential elements of; and, 3) standardized process of producing good medical photographic imaging. Establishing and consolidating these standards into a medical photographic
imaging guideline for medical clinicians, researchers, and educators will improve the usefulness and consistency of photographic communication of medical patient information. Accordingly, the aim of this study was to establish a medical photographic imaging guideline for use by any subset involved in human patient healthcare, including clinicians, medical imaging specialists, researchers, teachers/students, human healthcare manufacturers/publishers, and government health policy organizations. Moreover, acceptance and establishment of the proposed medical photographic imaging guideline will facilitate and promote improved communication of medical information internationally, making comparisons of treatment and research outcomes more accurate, consistent, and systematic.
The proposed medical photographic imaging guideline represents an important advancement in medical knowledge, including how medical photographic imaging is learned, used, and communicated in clinical practice.

Endovascular Versus Open Repair for Symptomatic, Non-Ruptured Abdominal Aortic Aneurysms: A Retrospective Cohort Study

Wanchai Chinchalongporn — 2025-11-01

Objective: To compare perioperative organ morbidity, 30-day mortality, and 5-year overall survival following endovascular aneurysm repair (EVAR) versus open surgical repair (OSR) for symptomatic, non-ruptured abdominal aortic aneurysm (SnAAA).

Materials and Methods: We retrospectively reviewed 140 consecutive patients treated for SnAAA between 2010 and 2020 (EVAR n=111, OSR n=29). The primary endpoint was 30-day all-cause mortality; secondary endpoints included perioperative complications and 5-year survival. Due to extreme baseline imbalances (62.2% unfit in EVAR vs 6.9% in OSR) and limited sample size, multivariable adjustment was used instead of propensity score methods.

Results: Thirty-day mortality was 1.8% in the EVAR group and 3.4% in the OSR group (p=0.504, Fisher’s exact test). EVAR was associated with an 88% reduction in perioperative organ complications (adjusted OR 0.12, 95% CI 0.03-0.47, p=0.003), including a significant reduction in respiratory failure (2.7% vs 13.8%, OR 0.17, 95% CI 0.04-0.83, p=0.034). EVAR also resulted in shorter operative time (median 150 vs 265 minutes, p<0.001), reduced blood loss (200 vs 1,800 mL, p<0.001), and shorter hospital stay (7 vs 11 days, p<0.001). Five-year survival analysis revealed no significant difference between groups (log-rank p=0.193; adjusted HR 1.09, 95% CI 0.42-2.85, p=0.857).

Conclusions: Despite being performed in a higher-risk cohort, EVAR provided significant protection against organ complications without compromising long-term survival compared to OSR. These findings support EVAR as the preferred approach for unfit patients with SnAAA, while both strategies remain appropriate options for fit patients.

Validity and Reliability of the Multiple-Mini Interview (MMI) in Medical Student Selection: A Comparison of Onsite and Online Platforms

Cherdsak Iramaneerat — 2025-11-01

Objective: The objective of this study was to compare the administration of Multiple-Mini Interview (MMI) between the online and onsite platforms, in terms of validity evidence.

Materials and Methods: We retrospectively reviewed records of past MMI scores, examination materials, and participant questionnaire responses over a six-year period at the Faculty of Medicine Siriraj Hospital, Mahidol University. A total of eight MMI administrations were included, four onsite and four online. Validity evidence was assessed based on three key sources: test content, response processes, and internal structure.

Results: Over six years, eight MMIs were conducted, with 237 out of 340 candidates admitted to a medical school. Content analysis of the test specification tables indicated that both onsite and online platforms adequately addressed similar objectives. Participant satisfaction ratings were comparable between onsite and online MMIs. Qualitative analysis revealed minor issues in a few stations regarding clarity of instructions and scoring criteria. Additionally, some online MMI stations showed discrepancies between task time requirements and allotted time, and more technical issues were also reported. Score analysis showed that both highest and average scores from online MMIs were slightly lower than those from onsite MMIs. However, both formats yielded moderately reliable test scores (Cronbach’s Alpha of 0.49 - 0.51).

Conclusion: The online MMI is a viable alternative to the traditional onsite MMI. Both platforms effectively covered the same assessment objectives, yielded comparable reliability and participant satisfaction.

The Efficacy of Oral Risperidone Solution to Reduce the Incidence and Severity of Postoperative Delirium After Vascular Surgery: A Randomized Controlled Trial

Varit Rangsaritwutikul — 2025-10-01

Objective: To determine the efficacy of the preoperative oral solution of risperidone in preventing Postoperative delirium (POD) and reducing the severity of POD in patients with geriatric vascular disease.

Materials and Methods: Randomized, double-blind, placebo controlled trial. A total of 140 elderly patients scheduled for vascular surgery were enrolled and randomly assigned to either the risperidone group (0.5 mg oral solution of risperidone within 1 hour before surgery) or the placebo group.

Results: POD was assessed daily using the DSM-5 criteria, and its severity was measured with the Delirium Rating Scale (DRS) for the first three days after surgery. The incidence and severity of POD were compared between the two groups. Potential side effects of risperidone, and the length of hospital stay were also recorded. There were no statistical differences in demographic data between the two groups. The incidence of POD was 10.6% compared to 21.2 % in the intervention group without statistical significance (p-value=0.096). However, the severity of POD, measured by the DRS, was significantly lower in the risperidone group (2.0 vs. 6.0, p value=0.025). The length of hospital stay did not show significant differences between the two groups.

Conclusions: The overall incidence of POD in this study without intervention was 21.2%. Preoperative administration of oral risperidone (0.5mg) reduced the severity of POD, but did not affect the incidence of POD or the length of hospital stay in this population.

Lidocaine Spray versus Other Forms for Local Anesthesia in Upper Gastrointestinal Endoscopy: A Systematic Review and Meta-analysis

Theerada Chandee — 2025-10-01

Objective: To evaluate the effectiveness of various lidocaine forms compared to the traditional spray during esophagogastroduodenoscopy (EGD).

Materials and Methods: We searched PubMed, Scopus, EMBASE, the Cochrane Central Register of Controlled Trials, CENTRAL, Web of Science Core Collection, World Health Organization, International Clinical Trials Registry Platform, and ClinicalTrials.gov databases in December 2022. Selection criteria were randomized controlled trials comparing lidocaine spray with other forms of pharyngeal anesthesia. Outcomes of interest included ease of instrumentation, participants’ satisfaction scores, tolerance scores, pain, endoscopist’s satisfaction scores, and procedural time.

Results: We included 13 trials with 3,711 participants. The quality of trials was poor. Lidocaine spray provided better ease of instrumentation (risk ratio (RR) 1.19, 95% confidence intervals (CI)1.06,1.34; I2 = 66%; very low certainty of evidence), decreased participants’ pain (mean difference (MD) 0.38, 95% CI 0.25,0.5; I2 = 92%; very low certainty of evidence), and shorter procedural time (MD 0.22, 95% CI 0.10,0.35; I2 = 13%; low certainty of evidence). However, spray had lower participants’ highest satisfaction scores (RR 0.83, 95% CI 0.76,0.92; I2 = 62%; very low certainty of evidence), participants’ mean satisfaction scores (MD -0.61, 95% CI -0.29,-0.04; I2 = 92%; very low certainty of evidence), participants’ tolerance scores (RR 0.83, 95% CI 0.71,0.97; I2 = 0%; low certainty of evidence), and endoscopist’s satisfaction scores (MD -0.33, 95% CI -0.45,-0.21; I2 = 94%; very low certainty of evidence).

Conclusion: Evidence suggests that lidocaine spray may improve the ease of EGD instrumentation, although limitations in trial quality warrant cautious interpretation.