Buddhachinaraj Medical Journal

Editor’s Note

NanThiya Tanthachun — Fri, 07 Aug 2020 00:00:00 +0700

Workplace Violence with Stress and Quality of Life among Healthcare Workers in a Tertiary Care Hospital

Kannika Winapa, Pokin Sakarinkhu — Fri, 07 Aug 2020 00:00:00 +0700

Medical workplace violence is the one of occupational hazard which brings physical and psychological
harms such as stress, depression and poor well-being. The purpose of this cross-sectional study was
to assess the relevance of workplace violence to stress and quality of life among healthcare workers (HCW).
The data were collected from October 2018 to February 2019 by using Medical Workplace Violence (MWPV)
Questionnaire, Stress Test Questionnaire (ST-5) and World Health Organization-Five Well-Being Index
(Thai version) in 645 volunteers of HCW. Data was analyzed with statistics program and presented as
frequency, percentage, mean and standard deviation. The relevance of workplace violence to stress and
quality of life was analyzed with the Pearson chi-square test, determining a confidence level of 95% CI,
not straddling 1.The results from 645 HCW showed that the prevalence of MWPV was 28.7%. Verbal
violence, bullying, physical violence and sexual harassment accounted for 26.4%, 5.7%, 2.0% and 0.2%
respectively. The majority of HCW had low stress level at 58.5%, while fair well-being group showed at 80.3%.
HCW who had experienced at least one of workplace violence incident in one year had risk of stress
(ST5 > 7) 4.56 times (95% CI 2.935-7.081) compared with non-experienced group. Furthermore, risk of
poor well-being (WHO5 < 13) 1.88 times (95% CI 1.24-2.88) compared with the group who had never been
violenced. In conclusion, HCW who have been exposed to violence are at risk of stress and poor health which
can contribute to mental health problems. It is important to manage violence prevention in the workplace.

Depression in People Living with HIV/AIDS (PLWHA) Receiving Antiviral Regimens

Jaruwan Diewsurin — Mon, 17 Aug 2020 00:00:00 +0700

People living with HIV/AIDS (PLWHA) should receive antiretroviral therapy (ART) due to long life
expectancy. Rilpivirine (RPV), one of the commonly used ARTs, can cause depression as a side effect.
This study aim was to determine depression risk comparison between PLWHA receiving RPV-containing
regimen and other regimens. A cross-section study compared the prevalence of depression in both groups
by using 9Q questionnaire. Between 1 January-30 April 2020, 336 patients were enrolled in this study.
Mean age was 39.5 years and 201 patients (59.8%) were male. Duration of HIV infection was 7.42 years.
There were 96 patients received RPV-containing regimen and 240 patients received other regimens.
The median 9Q in RPV-containing regimen group was two scores and other regimens group was three scores
(p = 0.252). The prevalence of depression was 20.7% (score ≥ 7). Associated risk factors were age ≤ 35
years (adj OR 2.01, 95% CI 1.14-3.57, p = 0.016), history of tuberculosis infection (adj OR 2.02, 95% CI
1.01-4.05, p = 0.046). Depression is common in PLWHA who receiving ART therefore 9Q questionnaire
should be assessed in all patients especially for patients age ≤ 35 years or history of tuberculosis infection
for depression treatment to improve their quality of life.

Tumor Delineation with SUV 2.5 for 18F-FDG PET in Lung Cancer

Jiraporn Khamhang, Patsuree Cheebsumon — Mon, 17 Aug 2020 00:00:00 +0700

The most common cause of cancer death is lung cancer. Recently, 18F-FDG PET/CT has been
an important tool of target volume delineation in radiotherapy treatment planning. The objective of this
retrospective study was to assess target volume delineation obtained by SUV 2.5 for 18F-FDG PET images
of 18 lung cancer patients, admitted from December 2011 to December 2016. Primary tumor volumes
obtained by SUV 2.5 were delineated. Tumor volume, equivalent sphere diameter and disc similarity
coefficient were calculated. Values of median, mean and standard deviation were presented. All values were
compared with manually delineation of radiation oncologist, by using Wilcoxon signed rank test and paired
t test, correlation reported by Pearson correlation coefficient (r), with statistically significant at 0.05 level.
Results showed that median of tumor volume obtained by SUV 2.5 was 41.21 cubic centimeter that was
smaller than manually delineation, which was 51.59 cubic centimeter (p = 0.002). Good correlation was
presented (r = 0.929). In addition, median of equivalent sphere diameter obtained by SUV 2.5 and manually
delineation were 4.29 and 4.83 centimeter, respectively (p = 0.006). Good correlation was showed (r = 0.952).
Median of disc similarity coefficient was 0.57. In conclusion, tumor volume and equivalent sphere diameter
of SUV 2.5 delineation are small than manually delineation with high correlation.

Short-term Outcomes between Laparoscopic and Open Colorectal Cancer Surgery in Elderly Patients by General Surgeons

Yannapon Tansuke, Rathaporn Tungpean — Mon, 17 Aug 2020 00:00:00 +0700

Colorectal cancer is one of the main malignant tumors threatening human health and common in
elderly patients. Laparoscopy is widely used to approach this kind of disease. This study aimed to compare
the short-term outcomes of laparoscopic versus open surgery in elderly patients with colorectal cancer by
general surgeon team. From August 2017 to October 2019, patients with colorectal cancer older than 60 years
old operated at Buddhachinaraj Phitsanulok Hospital were included in this study. The medical records from
a total 47 patients who underwent surgery for colorectal cancer were retrospectively analyzed. Median age
in the laparoscopic group (n = 17) was 73.0 years, and in the open group (n = 30) was 68 years (p = 0.033).
The patients who underwent laparoscopic surgery showed significant advantages compared with those
who underwent open surgery, faster postoperative bowel function recovery (p = 0.003), shorter lengths of
post-operative hospital stay (p = 0.002). However, laparoscopic surgery resulted in a longer operating
time compare with open surgery (p < 0.001). Open surgery resulted in more incisional infections more than
laparoscopic surgery (p = 0.014). There were no significant differences between groups for intra-operative
complication. In conclusion, laparoscopic colorectal surgery has advantages over open surgery with respect
to short-term clinical results in elderly patients.

Factors Associated to Job Stress among Officers in a General Hospital

Worakan Thaomor — Mon, 17 Aug 2020 00:00:00 +0700

This descriptive research was conducted to investigate factors associated with job stress among
922 officers working in a general hospital. Research instruments were questionnaires, covering different
significant aspects including personal information, occupational factors, and job stress measure survey
based on Karasek's Demand-Control Model. Associations among factors were analyzed by chi-square test.
It was found that 19.5% of officers have job stress in high-stress group. External factors related to work
stress were: ages, income, economic status, family burdens, activities to relieve stress. While internal
factors were: work sectors, working experiences, shift works, holidays, working seven consecutive days
a week, long working hours, the job that requires direct contact with the patient, factors that cause stress
during work (supervisors, lower-level associates, workload and rewards), workloads (treatment/patient
nursing, procedural work, coordination work, evaluation and quality work), job security, social support,
and workplace hazards were significantly related to job stress. The result of this study can be applied
for preventing, monitoring, and providing assistance to officers with high-stress risk groups, increasing
social support, especially from supervisors and colleagues, increasing welfare as well as improving the
environment in the hospital in order to reduce stress caused by officers' work in hospital.

Transperitoneal Laparoscopic Adrenalectomy

Wasana Khampiwmar — Mon, 17 Aug 2020 00:00:00 +0700

Laparoscopic adrenalectomy has become the procedure of choice to treat small adrenal mass.
The laparoscopic adrenalectomy has been further enhanced in medical schools, universities, or private
hospitals in Bangkok, it is not well-known in regional hospitals and other general hospitals. The objectives of
this research were to demonstrate the experiences and results of the laparoscopic adrenalectomy that
performed at Buddhachinaraj Phitsanulok Hospital. A review of the medical records was performed for
126 cases of patients who underwent the adrenalectomy during April 2009 to July 2019. Data were
presented as frequency, percentage, mean, standard deviation and median. Comparison of data between
two groups with chi-square, Mann Whitney U, independent t and Fisher’s exact tests with statistically
significant at 0.05 level. Patients in 126 cases had laparoscopic adrenalectomy 107 cases (by researcher)
and normal surgery 19 cases (by urosurgeons, including researcher). Patient underwent laparoscopic
adrenalectomy appeared to achieve superior results in terms of blood loss, hospital stay. The conversion rate
to open surgery was 2.8%. Complications during surgery in laparoscopic surgery were significantly lower than
those with large open surgery. No mortality case detected. Thus, laparoscopic adrenal surgery in this study
are effective, safe, reduced blood loss, shortened the length of hospitalization, quick recovery and no
mortality case.

Hepatocellular Carcinoma in Cirrhotic Liver: CT Findings and AFP Association

Siriphat Olankitcharoen, Smith Kerdsin, Kittisak Olankitcharoen — Mon, 17 Aug 2020 00:00:00 +0700

Most liver cancer diagnosis currently uses computed tomography (CT) with the alpha-fetoprotein
(AFP) level, but there is no study of the relationship between the AFP level and liver cancer CT. The purpose
of this study was to determine CT findings characterization of HCC and association with AFP level.
Two hundred and one patients with diagnosis of malignant of liver according to ICD10 (C220, C221 and
C229) were reviewed between June 2015 and April 2019 at Somdejphrajaotaksin Maharaj Hospital.
Seventy-two patients were met the CT diagnosis of HCC criteria with cirrhosis findings. Cases divided into
three groups: Group one with low AFP level (< 20 IU/ml), Group two with moderate AFP level (20-400 IU/ml)
and Group three with high AFP level (> 400 IU/ml). Of these, there were 19 (26.4%), 21 (29.2%) and
32 patients (44.4%) in Groups one, two and three, respectively. CT findings of HCC (location, margin,
heterogeneous enhancement, fat component) were no significant association with AFP levels. HCC patients
with high AFP level tended to have greater tumor size, tumor number, portal vein thrombosis, positive lymph
nodes and rupture of tumor. But even among low AFP level, extrahepatic metastasis was found up to 10.5%
(overall 13.8%). In conclusion, AFP is useful for prognostic indicator, but it is not a reliable indicator in the
early detection in patients with HCC.

Results of Rehabilitation Service for Sub-acute Stroke Patients between IPD-based, OPD-based and Home-based Service

Suphatha Phutrit — Mon, 17 Aug 2020 00:00:00 +0700

Rehabilitation increases the quality of life for patients. The objective of this quasi-experiment
research was to compare intermediate rehabilitation service for sub-acute stroke patients in Rehabilitation
Medicine Department of Srisangwornsukhothai Hospital. The rehabilitation service was divided into IPD-based,
OPD-based and home-based program. Effectiveness was assessed as gain of function on Barthel index (BI)
assessment. The study was conducted between January to August, 2019. The sample were selected
by purposive sampling with 27 persons and divided the patients into three groups according to type of
rehabilitation services. Data were presented as frequency, percentage, average, standard deviation and
median (Q1, Q3) and compared the BI scores before and after in each group with Wilcoxon signed rank
test with statistically significant at 0.05 level. The results showed that patients receiving all three types of
rehabilitation services after having three months of rehabilitation had a significantly increased BI score.
Complications were found only in the home-based. In conclusion, intermediate rehabilitation services in all
three forms allow patients to perform more daily activities, all rehabilitation service leads to better outcome.

Modified Ultrafiltration Circuit Versus Simplified Ultrafiltration Circuit in Cardiac Surgery

Anuchit Manin — Mon, 17 Aug 2020 00:00:00 +0700

Naresuan University Hospital has designed a new modified ultrafiltration circuit, but the effect on
patients has not been studied. The objective of this retrospective study was to compare the effectiveness
of using ultrafiltration circuit in patients undergoing open-heart surgery between group of 55 people using
the modified ultrafiltration circuit and group of 55 people using simplified ultrafiltration circuit from January,
2015 to December, 2016. Data were analyzed with chi-square, independent t, and Mann Whitney U tests.
The results showed that personal data and clinical data were not different, except for the type of acquired
heart surgery in group used the modified ultrafiltration circuit has a number of isolated CABG surgery patients
more than group used the simplified ultrafiltration circuit with statistically significant. As for surgical data, fluid
removal, and fluid requirement data, postoperative data and postoperative complications were not different,
but the modified ultrafiltration circuit has the advantage of being easy to install, cheap and suitable for
both pediatric and adult patients, reduce the risk of air embolism. There are many ultrafiltration circuit
techniques, it is important to choose the right method of ultrafiltration circuit on the right patient for the
greatest benefit to the patient.

Prosthodontic Treatment of a Patient with Anterior Hyperfunction Syndrome

Chalermsak Jindadumrongwech — Mon, 17 Aug 2020 00:00:00 +0700

Anterior hyperfunction syndrome (or combination syndrome) commonly occurs in patient wearing
a complete maxillary denture, opposing a mandibular distal extension removable partial denture. The manifestation
includes flabby tissue in the anterior part of the maxillary ridge, overgrowth of maxillary tuberosities,
tilting of the occlusal plane and resorption in mandibular distal extension area. All of these effects render
prosthetic treatment more difficult, and although it is preferable to use dental implants for functional support,
complex cases still require conventional prosthetic treatments for medical or financial reasons. This clinical
report presented the prosthetic rehabilitation of a patient exhibiting anterior hyperfunction syndrome.
After 12 months of follow-up revealed no any changes in posterior support, and the patient's functional was
satisfied.

Posterior Sub-axial Cervical Spine, Lateral Mass Screw Fixation Techniques

Adisak Tanpun — Mon, 17 Aug 2020 00:00:00 +0700

Screw reconstruction of the posterior sub-axial cervical spine is a common procedure in spinal
surgery. This article reviews surgical techniques for the lateral mass, which are commonly used in surgery.
By conclusion the technique, steps in each technique are illustrated with pictures for easy insertion of the
screws, entrances, corners and lines of each technique such as Roy-Camille, Louis, Magerl, Anderson,
An and Riew techniques, including a modified technique for C7 lateral mass fixation. This article describes
each surgical method and surgical procedure so that the surgeon can select the appropriate technique
for each patient in order to achieve a successful operation with minimal complications.