Buddhachinaraj Medical Journal

เปิดใจบรรณาธิการ

NanThiya Tanthachun — Mon, 01 Jun 2020 00:00:00 +0700

Appropriate Antibiotic Use for Acute Diarrhea among Outpatients in Urban Primary Care Units

Dusida Tooprakai — Mon, 01 Jun 2020 00:00:00 +0700

The use of antibiotics have been unreasonably high in practice and this has led to adverseconsequences such as an increased antibiotic resistance rate and an increased cost of treatment. This study aimed to explore the prevalence of antibiotic use in treating acute diarrhea among outpatients at urban primary care units of Lampang Hospital. A cross-sectional study was conducted to assess antibiotic use among outpatients from January to December 2016. Information from electronic medical records, including medical history, physical examination, and laboratory testing, were reviewed to examine the appropriateness of antibiotic use. The association between appropriate antibiotic prescription and certain covariates were assessed, including patients' age group, gender and length of physicians' clinical experience. From 1,127 patient visits, approximately 71.3% of patients were 15-59 years of age. Appropriate use of antibiotics was documented in 64.9% of these patients. Evidence indicated an association between appropriate use of antibiotic prescription and the length of the doctors' experience. Evidence from this study suggests that there remains a problem concerning the inappropriate use of antibiotic treatment. Interventions, such as developing a system to advocate continuing medical education and appropriate antibiotic use are recommended with the goal of reducing antibiotic resistance and promoting efficient healthcare resources

Development of an Action Learning Program for Perioperative Nurses in Nursing Care for Patients undergoing Mitral Valve Surgery

Tippawan Sripipatanakul, Suwannee Sroisong, Sutipa Jaisamuk — Mon, 01 Jun 2020 00:00:00 +0700

The perioperative nurse is an important personnel in taking care of surgical patients. The objective of this research and development study aimed to develop an Action Learning (AL) program for perioperative nurses in nursing care of patients undergoing mitral valve surgery at Buddhachinaraj Phitsanulok Hospital. The participants constituted six nurses in heart surgery team, six trainee nurses, and sixty patients undergoing mitral valve surgery. The study consisted of four phases and the results showed that: Phase I: Situation analysis as follows insufficient workforce of nurses in heart surgery team, lack of knowledge and skill of caring the patient, and lack of application about nursing process. Phase II: Program development which consisted of 5 steps: 1) preparation, 2) learning to solve problem, 3) action, 4) evaluation, and 5) learning reflection. Phase III: Program testing the results revealed that score of knowledge and ability in caring the patient through the preoperative, intraoperative and postoperative phase after using the program were statistically significant higher than before the program. Furthermore, score of ability of application in nursing process after using the program was also statistically significant higher than before the program. The last phase: Outcomes indicated that the suitability of the program was at high level and the number of nurses in heart surgery team increased six persons. Moreover, nurses’ satisfaction were at good level and patients’ satisfaction in caring were in excellent level. In addition, incidents in calling nurses to assist the heart surgery team was reduced from 25 to 5 times (80%). Conclusion, this AL program can enhance knowledge, capability, and application nursing process for the patients undergoing mitral value surgery more than before using the program. Thus, the institution should organize training workshop to regularly enhance skills of staff. Futhermore, other departments which are similarly complicated surgery should repeatedly do this program to keep patients safe from complications.

Variety of Lip Print Codes in a Thai Population

Thanawat Sukantawanid, Karnda Mekjaidee, Chaturong Kanchai — Mon, 01 Jun 2020 00:00:00 +0700

Collections of lip prints from evidence for DNA analysis are the best method to match with suspected persons. In cases with many suspected persons, this method becomes more expensive. This study had an interest in a variety of lip print codes to screen different suspected persons before being further submitted for DNA testing. The study population was 50 Thai volunteer men and women living in Chiang Mai during October 2018. The lip prints were collected by using cello tape applied to lips that were painted by plain red color lipstick then scanned to a digital file. Each lip print picture was divided into six parts and labeled with codes A to F as referenced from a study by Suzuki and Tsuchihashi. The results determined that the pattern code of whole lips had 98 codes while the upper lip showed only 63 codes and the lower lip revealed 50 codes. The evaluation utilizing inter-rater reliability by Landis and Koch indicated the value of kappa was 0.645 (substantial level). Finally, lip print codes can screen suspected persons prior to submission for DNA analysis.

Attitude of Clinical Clerkship Medical Students towards Learning Method of Medical Ethics in Obstetrics and Gynecology

Patcharada Amatyakul — Mon, 01 Jun 2020 00:00:00 +0700

Teaching medical ethics is a challenging topic in medical curriculum. It is difficult to teach students to achieve confidence and be able to apply knowledge in the real situation. This survey aimed at evaluating attitudes towards learning method of medical ethics in Obstetrics and Gynecology while studying in the Department of Obstetrics and Gynecology in Naresuan University Hospital. Ethics in OB & GYN about medical errors and disclosure were taught with case-based approach and small group discussion. Medical students' attitudes towards learning method and the preferable characteristics of medical teachers who should teach ethics were evaluated by a questionnaire and opened-end questions. The results showed that 98.5% of medical students agreed that small group discussion highly impacted on their learning process better than conventional lectures. The preferably important characteristics of medical ethic-teachers were: optimal experience in academic working and teaching, good listener, and good role model for students. In conclusion, a case-based with problem-oriented scenario can stimulate students' critical and reasonable thinking. The appropriate characteristics of medical teachers has highly positive impact on medical students' attitudes and learning environment

Building a Learning Organization for Primary Care Units using Constructivist Theory

Pokin Sakarinkhul — Mon, 01 Jun 2020 00:00:00 +0700

The concept of a learning organization is used in implementing primary care units to achieve collaborative processes. Personnel who have taken real action, review their own knowledge until finding appropriate knowledge in contextual services is the refore important. This mixed methods research aimed to understand building a Learning Organization for Primary Care Units using Constructivist theory from Lamphun's experiences. The data was collected by using 1) score of learning organization assessment questionnaires in 54 primary health care personnel 2) semi-structured deep interviews about the activities related to constructivist theory from six personnel who have been involved in project improvement. The study period was July 2018-May 2019. Data were presented in frequency, percentage, mean and standard deviation. Data were compared before and after joining this program with the paired t-test with statistic significant level at 0.05. For the interview data, the content analysis was based on triangular content. The study found that learning improvement project could increase all dimension of learning organization score with significantly statistic (except dimension 3) and the highest in dimension 5 (Empowerment). In conclusion, lesson learned from peers, teams/groups storytelling, task achieving, state their view and ask what other thinks are important activities in the project that consistent with Constructivist theory

Prevalence of Peri-implant Mucositis and Peri-implantitis in Implant-retained Mandibular Overdenture

Sirichai Tantrakoolcharoen — Mon, 01 Jun 2020 00:00:00 +0700

Seniors up to one in fourth are necessary to wear implants, which have common complications:
inflammation of the mucous tissue surrounding the implants and the tissue surrounding the implants.
The aim of this descriptive study was to evaluate the prevalence of peri-implant mucositis and peri-implantitis
in implant-retained mandibular overdenture after a 8-9 years follow-up period. The twenty four-fully
edentulous patients underwent implant-retained mandibular overdenture surgery in Dental Department,
Lampang Hospital, were recalled for clinical and radiographic examination after functional loading for
8-9 years. The prevalence of peri-implant mucositis and peri-implantitis were analyzed following the
consensus of the third Periodontology Thailand Workshop. Data were presented as fequancy and
percentage. The results of this study found that prevalence of peri-implant mucositis was 28.3%, and of
the implant and peri-implantitis occurred in 39.1% of the implant. The average marginal bone loss was
3.28 mm. after functional loading for 8-9 years. In conclusion, peri-implant mucositis and peri-implantitis
are the most common biological complications in implant-retained mandibular overdenture of the fully
edentulous patients

The Results of Promoting Program for the Use of Clinical Practice Guidelines in Oral Health Care on Nurses' Practices and Oral Health of Intubated Patients in Surgical Care Unit

Somsri Panploy, Wongduan Suwannakeeree, Nichakarn Songthai — Mon, 01 Jun 2020 00:00:00 +0700

Oral endotracheal intubation to save the patient's life affects oral health of patients. The purpose
of this quasi-experimental research was to explore the results of the promoting program for the use
of clinical practice guidelines on nurses' practices and oral health of intubated patients. The sample
consisted of 12 nurses and 50 intubated patients in the Male Surgical Ward 2 at Buddhachinaraj Phitsanulok
Hospital. This sample group of nurses received the promoting program for the use of clinical practice
guidelines, based on Diffusion of Innovation Theory proposed by Rogers. In this study, the research
instruments were the observation form for oral health care of nurses and oral health assessment form
for intubated patients. Data were presented in frequency, percentage, mean, median values and compared
data with McNemar test, chi-square test, exact probability test, Mann-Whitney U test, and Wilcoxon
signed rank test with statistic significant level at 0.05.The research duration was from August 2018 to
February 2020.The results showed that,the number of correct practice activities of professional nurses
after receiving the program was greater than the first receiving the program with statistical significance
in all groups. Oral health of intubated patients on 2nd and 5th day or the day that the airway was removed
after receiving the program and the oral health of intubated patients after receiving the program on day 2nd
and the first day, day 5th or the day that the airway was removed and the first day and day 5th or the day that
the airway was removed and day 2nd was better than before using the program statistical significance.
This study shows that the promoting program for the use of clinical practice guidelines on nurses' practices
and oral health of intubated patients can improve the correct practices of registered nurses and the oral
health of intubated patients.

Efficacy and Safety of Turmeric in Prevention of Lupus Flare in Chloroquine or Hydroxychloroquine Withdrawing Patients

Angkana Norasetthada — Mon, 01 Jun 2020 00:00:00 +0700

Systemic lupus erythematosus is an perspective autoimmune, multisystemic inflammatory disease.
Chloroquine or hydroxychloroquine and anti-inflammatory drugs are used for treatment. When disease
is remission, anti-inflammatory drugs are stop, only the chloroquine or hydroxychloroquine is used to
prevent lupus flare. Retinopathy is related to the cumulative dose of both drugs leading to drug withdrawing
in some of lupus patients. Turmeric has anti-inflammatory effects similar to hydroxychloroquine, but there
is no used for lupus flare. This study conducted a double-blind randomized control study to assess
the efficacy and safety of turmeric compare with placebo in prevention of lupus flare in Buddhachinaraj
Phitsanulok Hospital. Twenty-nine, stable disease for at least 3 months and both drugs withdrawing patients
were randomized into two groups with patients receiving turmeric (750 mg/d) and placebo for 52 weeks.
The primary endpoint was changing in SLEDAI every 12 weeks. The secondary endpoint was defined:
severe exacerbation, increased or doubling prednisolone dosage > 0.5 mg/kg/day, adding immunosuppressive
drugs and admission due to severe disease flare. Patients in turmeric group showed statistically
significant lower SLEDAI, 1.8-fold prevented mild to moderate disease flare, 1.6-fold prevented severe
disease flare. Patients in turmeric group had two times greater chance of suviving from crisis than a placebo
group (24/12 weeks). Turmeric treatment did not related with any adverse events. This study provides
the efficacy and safety of turmeric in prevention of lupus flare in chloroquine or hydroxychloroquine
withdrawing patients, and highlights the need for future large-scale trials to validate these findings.

Survival Factors of Trauma Patients in Trauma Fast Track

Anake Supap — Mon, 01 Jun 2020 00:00:00 +0700

Trauma is one of the leading causes of death which several factors impact survivability. This
retrospective cross-sectional study aimed to analyze the association between factors in fast-track trauma
patients who visit the Emergency Department (ED), Buddhachinaraj Phitsanulok Hospital between April 2017
to July 2019. The sampling criteria included penetrating injury of the chest or abdomen with unstable
vital signs, vascular injury with active bleeding, or blunt injury of the chest or abdomen with unstable vital
signs and/or positive FAST results. The sample size was done by a 80% power analysis method and 288
patients were included. The data were collected via document detailing factors and outcomes of the
treatment. The data were analyzed by chi-square and Fisher's exact test with statistically significant level
at 0.05. The results showed probability of survival, mode of arrival, mechanism of injury and treatment
were statistically significant difference to survivability; but neither gender, age, time to surgery nor time to
refer provided the difference. In conclusion, to improve survivability, the assessment and referral system and
quality of care should be improved and standardized.

Full Mouth Rehabilitation of the Patient with Severely Worn Dentition: A Case Report

Danai Pornsathapant — Mon, 01 Jun 2020 00:00:00 +0700

The main functions of posterior teeth are for mastication and maintaining vertical dimension.
Extractions of posterior teeth will likely lead to the loss of vertical dimension, which will in turn cause severe
wear of anterior teeth. This case report described the treatment of a 72-year-old male, who had losses
of posterior teeth and vertical dimension. The treatment consisted of two stages. First, acrylic removable
partial dentures were used to increase vertical dimension. Second, after compatibility of the new vertical
dimension had been confirmed, interim fixed restoration and permanent reconstruction were initiated
The follow-up check showed that satisfactory clinical results, including improved masticating function
and aesthetics, were achieved by the restoration of vertical dimension

Kidney Transplantation: "Non-wasted Organ" with Community Participation

Nataya Kamsawang, Supaporn Sudnongbua — Mon, 01 Jun 2020 00:00:00 +0700

Kidney Transplantation (KT) is the best treatment for end stage renal disease (ERSD) patients.
Nowadays there are many ESRD patients waiting for donated kidneys, some patients had waited as long as
22 years. The recipients, the patients undergoing KT could feel that they have a new life after operation
and all process are successfully done in the hospital. More importantly, all recipients should follow the
doctor's advice strictly when they return to their home, such as lifelong taking immunosuppressive drugs.
If the recipients do not take medication regularly, the transplanted kidney will be rejected and become
"wasted organ". This will cause chronic kidney disease in the recipients again. Promotion of good self-care
is necessary for the recipients. Moreover, care giver and communities should participate and support them.
The community participation is very important in prevention of wasted organ. This article provides the
opinion and suggestion of the community participation in self-care among kidney transplantation recipients
that includes the situation of kidney transplantation, definition, type, level and the suggestion of community
participation. It would be useful to improve self-care for KT recipients and prevent wasted organs. Patients
have good health and better quality of life of the recipients