Krabi Medical Journal

Development of a Home-Based Stroke Care Network through Collaboration of Family Physician Teams and the Community, Nuea Khlong Hospital, Krabi Province

Natthaphon Hemthanon — Tue, 30 Jun 2026 00:00:00 +0700

Stroke patients require continuous monitoring, care, and rehabilitation to ensure an optimal quality of life. This mixed-methods research aimed to develop a home-based stroke care network model through the collaboration of Family Care Teams and the community at Nuea Khlong Hospital, Krabi Province. The study employed a four-stage action process: planning, action, observation, and reflection. Qualitative data were gathered via in-depth interviews and focus groups. Quantitative data were collected from 90 caregivers with at least three months of experience, selected through random drawing. The research instruments demonstrated content validity and reliability scores of 0.98 and 0.99. Data analysis included descriptive statistics, Wilcoxon signed-ranks Test, and McNemar Test. The results led to the development of the "5I Model for Participatory Home-Based Stroke Care." Following implementation: 1) activities of daily living (ADL) scores significantly increased to a median of 72 (IQR = 65–81, p < 0.05) 2) disability levels significantly decreased to a median of 72 (IQR = 65–81, p < 0.05) 3) patients were free from complications rate reached 98.89%(p < 0.05) and 4) the non-readmission rate reached 97.78% (p < 0.05). In conclusion, establishing a collaborative network between FCTs and the community effectively enhances home-based care efficiency, reduces complications, and promotes a sustainable quality of life for both patients and caregivers within the local context.

Comparison of Spinal anesthesia with General Anesthesia on the Postoperative Pain Score in Patients undergoing elective Abdominal Hysterectomy :A retrospective study

Natthaporn Harungsri, Pinanong Rattanapathumwong — Tue, 30 Jun 2026 00:00:00 +0700

Objective: To compare the postoperative pain score between spinal anesthesia and general anesthesia in patients undergoing elective abdominal hysterectomy at Ranong hospital.

Material and Method: This study retrospectively reviewed 100 medical records of patients who received abdominal hysterectomy between 1 January 2022 and 31 December 2024 at Ranong Hospital. Data collection included patient demographics, duration of surgery, intraoperative blood loss, postoperative complications, length of hospital stay and costs of hospital admission. Assessment of postoperative pain, using NRS (Numerical rating scale), was measured at Post-Anesthesia Care Unit and at 2, 4, 6, 12 and 24 postoperative hours. Descriptive data analysis was employed using various statistical methods, including mean, standard deviation, frequency, and percentage. Independent T-test and Chi-square test were used to compare difference between 2 groups, p-value < 0.05 was considered significant.

Results: There were no difference between 2 groups in term of demographics, duration of surgery, intraoperative blood loss and length of hospital stay. Mean NRS pain score was significantly lower in spinal anesthesia group at Post-Anesthesia Care Unit and at 2, 6, 12 postoperative hours. Additionally, the cost of hospital admission was significant lower in spinal anesthesia group.

Conclusion: Spinal anesthesia provides lower postoperative pain as compared to the general anesthesia in patients undergoing abdominal hysterectomy.

Nursing Care of Patients with Late Postpartum Hemorrhage Complicated by Shock : A Case Study

Woranuch Kaewdee — Fri, 30 Jan 2026 00:00:00 +0700

การพยาบาลผู้ป่วยจิตเภทที่มีโรคร่วม: กรณีศึกษา

waraporn Thongprung — Mon, 11 May 2026 00:00:00 +0700

Objective: To report a case of a patient with schizophrenia complicated by comorbid substance use, recurrent relapse, and community-based management.

Methods: A case review was conducted based on medical records, with coordination among the multidisciplinary healthcare team, local administrative authorities, and police agencies to support patient care and community safety.

Results of the study: The patient was a 45-year-old Thai male diagnosed with schizophrenia for 13 years. He had a history of poor treatment adherence, frequent missed appointments, and concurrent substance use, resulting in seven relapse episodes. The patient had previously experienced suicidal ideation and attempted self-harm. He was admitted to the hospital due to exacerbation of symptoms, including increased irritability, talking to himself, and visual hallucinations. During hospitalization, psychiatric medications were administered, and behavioral restriction was implemented during periods of severe agitation and aggression.

After symptom stabilization, the patient was discharged with a long-acting injectable antipsychotic (Fluphenazine 50 mg intramuscularly once monthly), oral Perphenazine, and Trihexyphenidyl, with scheduled follow-up appointments. Following discharge, intermittent methamphetamine use was reported; however, urine testing for methamphetamine was negative. The patient continued to exhibit verbal aggression toward his parents but did not display physical violence. No auditory hallucinations were reported, sleep quality improved, and the patient was maintained on Perphenazine and Trihexyphenidyl for ongoing outpatient management.

Conclusion: In patients with schizophrenia and comorbid conditions, poor medication adherence, missed follow-up appointments, substance use, inadequate social support, and maladaptive coping strategies are significant factors associated with recurrent relapse. Therefore, effective management should adopt an integrated and holistic approach, addressing both biological and psychosocial dimensions, while promoting the active involvement of families, community networks, and relevant agencies. Such an approach is essential to enhance continuity of care, reduce relapse risk, and improve long-term quality of life.

Nursing Care for Schizophrenic Patients with Violent Behavior from Amphetamine Use: Case Studies

Suwanna Srinim — Tue, 30 Jun 2026 00:00:00 +0700

Objective : To compare the nursing care provided to two case studies of schizophrenic patients exhibiting violent behavior resulting from amphetamine use, and to utilize the findings as a clinical guideline for enhancing the efficiency of nursing interventions for this patient population.

Methodology : This study is a comparative case study of two schizophrenic patients with violent behavior induced by amphetamine use, who were admitted to the Ruam Jai Ward at Krabi Hospital between October 2023 and September 2024. Data were collected from medical records and analyzed by comparing the two cases through the application of the nursing process.

Results : The first case was a 29-year-old Thai male with a 6-year history of schizophrenia, complicated by methamphetamine and kratom use. Following methamphetamine consumption, he exhibited aggression, auditory hallucinations, and delirium, leading to the assault of a neighbor and destruction of property. After receiving care based on the clinical nursing practice guidelines for Serious Mental Illness with High Risk of Violence (SMI-V), there was no recurrence of violent behavior or complications from substance and psychiatric medication use, and his psychotic symptoms improved. The second case was a 39-year-old Thai male with a 15-year history of schizophrenia, co-occurring with the use of methamphetamine, kratom, and cannabis. Post-methamphetamine use, he presented with delirium, agitation, hallucinations, and a hostile gaze, leading to the assault of his brother-in-law and property damage. While managed under the SMI-V guidelines, he experienced complications from long-term substance abuse, including rhabdomyolysis, and developed acute dystonia due to the central nervous system depressant effects of multiple psychiatric medications, alongside amphetamine withdrawal. These conditions required intensive physical and mental health care, resulting in a prolonged hospital stay. Although both cases presented with psychiatric emergencies and violent behavior induced by amphetamine use, they differed significantly in disease severity, complications, and the complexity of problems, necessitating distinct nursing interventions.

Conclusion : Medical treatment combined with holistic nursing care ensured that both cases received individualized crisis management across all phases, including admission for aggressive behavior, stabilization, and pre-discharge. The care was guided by the protocols for Serious Mental Illness with High Risk of Violence (SMI-V) induced by amphetamine use. Discharge planning involved active caregiver participation to facilitate the patients' successful reintegration into their families and communities. Effective nursing processes were implemented, ranging from risk assessment and timely crisis intervention to rehabilitation aimed at preventing relapse. This included proactive care, close monitoring of vital signs and complications, and functional rehabilitation to enhance self-care abilities. Family readiness was prioritized through humanized counseling, emphasizing compassion and love. Caregivers played a vital role in ensuring treatment adherence, reducing aggressive behaviors, and preventing re-hospitalization. Furthermore, a multidisciplinary approach and community involvement were essential in providing continuous and sustainable care.