Krabi Medical Journal

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.

Computed Tomography imaging predictors of hemorrhagic transformation in stroke patients treated with intravenous thrombolytic drug in Krabi hospital

Chanakan Boonmanee — Tue, 07 Jul 2026 00:00:00 +0700

Background: Hemorrhagic Transformation is a significant complication following thrombolytic therapy in acute ischemic stroke patients, associated with disability and mortality. Early risk prediction is crucial for treatment planning and improving patient outcomes.

Objective: To identify CT imaging predictors associated with Hemorrhagic Transformation in acute ischemic stroke patients treated with intravenous thrombolysis (rt-PA), determine the incidence of Hemorrhagic Transformation, and evaluate the predictive performance of Early Ischemic CT Signs.

Methods: A retrospective cohort study was conducted among 170 acute ischemic stroke patients treated with rt-PA at Krabi Hospital, between January 2021 and February 2025. Baseline Non-contrast Computed Tomography (NCCT) was reviewed for Early Ischemic CT Signs prior to treatment. Hemorrhagic transformation was classified according to the European Cooperative Acute Stroke Study II (ECASS II) criteria. Associations between imaging findings and Hemorrhagic Transformation were analyzed using Firth’s bias-reduced logistic regression. Predictive performance was assessed using receiver operating characteristic (ROC) analysis.

Results: Hemorrhagic Transformation occurred in 12.9% of patients, while the in-hospital mortality rate was 8.8%. In univariable analyses, several Early Ischemic CT Signs were significantly associated with Hemorrhagic Transformation. After adjustment for potential confounders, Loss of Insular Ribbon remained the only independent predictor of Hemorrhagic Transformation (Adjusted OR 15.45, 95% CI 2.73–87.32; p=0.002). ROC analysis demonstrated that Loss of Insular Ribbon had the highest predictive performance, with an area under the ROC curve (AuROC) of 0.70 (95% CI 0.57–0.83), specificity of 89.9%, and a NPV of 92.4%.

Conclusion: Loss of Insular Ribbon on pretreatment NCCT was independently associated with hemorrhagic transformation following intravenous thrombolysis and showed the highest predictive performance among the evaluated imaging markers. These findings support the use of Early Ischemic CT Signs for risk stratification and post-thrombolysis monitoring, particularly in resource-limited settings where NCCT remains the primary imaging modality.

The The Effects of Using Guidelines for Caring Pregnant Women with Gestational Diabetes, Thachang Hospital, Suratthani Province.

Duangduan nuyim, Wannaphon Innimit — Tue, 07 Jul 2026 00:00:00 +0700

This study aimed to develop and evaluate a care guideline for pregnant women with gestational diabetes mellitus (GDM), focusing on its effects on nurses’ knowledge, practical skills, and satisfaction, as well as the clinical characteristics of pregnant women with GDM. The participants included 6 professional nurses working in the obstetric unit and 40 pregnant women diagnosed with GDM. The research instruments consisted of an evidence-based care guideline, a knowledge test, a skill assessment form, a satisfaction questionnaire, and a clinical data record form. Data were analyzed using descriptive statistics and paired t-test.

Results showed that after implementation of the care guideline, nurses’ knowledge scores significantly increased from 7.83 (SD = 1.17) to 12.67 (SD = 1.03) (t = 29.00, p = .001). Similarly, practical skill scores significantly increased from 12.50 (SD = 1.05) to 19.00 (SD = 0.89) (t = 13.00, p = .001). Nurses’ overall satisfaction with the guideline was rated at a high level. Regarding the clinical characteristics of pregnant women, 62.5% had fasting blood glucose levels below 95 mg/dL, whereas 70.0% had 1-hour postprandial blood glucose levels of 140 mg/dL or higher. In addition, 45.0% had a pre-pregnancy body mass index of 27 kg/m² or above.

Conclusion: The developed care guideline improved nurses’ knowledge, practical skills, and satisfaction, and promoted systematic nursing care for pregnant women with GDM. The clinical findings suggest the need for continuous monitoring of postprandial blood glucose and individualized care to support better glycemic control among pregnant women with GDM.

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.

The Development of Nursing Care Model for Prevention of Ventilator associated pneumonia in the Department of Internal Medicine, Krabi Hospital

jutarwadee Wongsombat — Tue, 07 Jul 2026 00:00:00 +0700

การวิจัยครั้งนี้เป็นการวิจัยและพัฒนา มีวัตถุประสงค์เพื่อ 1) ศึกษาปัจจัยที่มีผลต่อการพยาบาลเพื่อป้องกันการเกิดปอดอักเสบจากการใช้เครื่องช่วยหายใจ 2) พัฒนารูปแบบการพยาบาล ฯ และ 3) ศึกษาประสิทธิผลของการพัฒนารูปแบบการพยาบาล ฯ โดยใช้กรอบแนวคิดทฤษฎีเชิงระบบของ Donabedian (2003) เป็นแนวทางในการพัฒนารูปแบบ โดยแบ่งการศึกษาเป็น 3 ระยะ ได้แก่ ระยะศึกษาโครงสร้าง ระยะดำเนินการตามกระบวนการ และระยะประเมินผลลัพธ์ ร่วมกับ การพยาบาลเพื่อป้องกันการเกิดปอดอักเสบจากการใช้เครื่องช่วยหายใจ ได้แก่ การหย่าเครื่องช่วยหายใจ การล้างมือ การยกศีรษะสูง และการดูดเสมหะในปากก่อนการดูดเสมหะในท่อช่วยหายใจ การเปลี่ยนระบบสายเครื่องช่วยหายใจ การทำความสะอาดช่องปาก และการส่งเสริม/กระตุ้นให้ผู้ป่วยเคลื่อนไหวและให้ได้รับสารอาหารทางระบบทางเดินอาหารเมื่อผู้ป่วยพร้อม กลุ่มตัวอย่าง แบ่งเป็น 2 กลุ่มคือ กลุ่มที่ 1 ผู้ป่วยหอผู้ป่วยอายุรกรรมชาย และอายุรกรรมหญิง ที่ได้รับการรักษาโดยใส่ท่อช่วยหายใจต่อกับเครื่องช่วยหายใจ จำนวนหอผู้ป่วยละ 44 คน รวม 88 คน กลุ่มที่ 2 คือ พยาบาลที่ปฏิบัติงานในหอผู้ป่วย อายุรกรรมชาย และอายุรกรรมหญิง คัดเลือกแบบเจาะจงและสมัครใจเข้าร่วมโครงการ จำนวนหอผู้ป่วยละ 19 คน รวม 38 คน หยิบฉลากได้หมายเลข 1 เป็นกลุ่มทดลองและ 2 เป็นกลุ่มควบคุม ระยะเวลาศึกษา 3 เดือน

ผลการศึกษา พบว่าพยาบาลวิชาชีพ มีคะแนนความรู้ก่อนการทดลองระหว่างกลุ่มทดลองและกลุ่มควบคุม ไม่แตกต่างกันอย่างมีนัยสำคัญทางสถิติ (p>.05) กล่าวคือ ทั้ง 2 กลุ่มมีระดับความรู้พื้นฐานใกล้เคียงกัน คะแนนความรู้หลังการทดลองมีค่าเฉลี่ยสูงกว่าก่อนการทดลองอย่างมีนัยสำคัญทางสถิติ (t=-4.652, p=.001) การปฏิบัติตามรูปแบบการพยาบาล ฯ ในระดับสูง ระหว่างร้อยละ 84.1-100 ความพึงพอใจต่อรูปแบบการพยาบาล ฯ ในระดับมากที่สุด โดยค่าคะแนนเฉลี่ยรายข้ออยู่ในช่วง 4.68-4.95 ส่วนผู้ป่วยพบว่า การเกิดปอดอักเสบระหว่างกลุ่มทดลองกับกลุ่มควบคุมแตกต่างกันอย่างมีนัยสำคัญทางสถิติที่ระดับ .05 อย่างไรก็ตามเมื่อพิจารณาด้วย Fisher’s Exact Test พบว่าไม่มีนัยสำคัญทางสถิติ (p=.058) แต่มีแนวโน้มไปในทิศทางเดียวกัน ค่าเฉลี่ยระยะเวลาการใช้เครื่องช่วยหายใจระหว่างกลุ่มทดลองกับกลุ่มควบคุมแตกต่างกันอย่างมีนัยสำคัญทางสถิติ (t=-3.692, df=63.033, p=.001) โดยกลุ่มควบคุมมีค่าเฉลี่ยสูงกว่ากลุ่มทดลอง และค่าเฉลี่ยจำนวนวันนอนพักรักษาตัวในโรงพยาบาลระหว่างกลุ่มทดลองกับกลุ่มควบคุมแตกต่างกันอย่างมีนัยสำคัญทางสถิติ (t=-3.069, df=86, p=.003) โดยกลุ่มควบคุมมีค่าเฉลี่ยสูงกว่ากลุ่มทดลอง

Effects of online learning program based on Ganye's learning concept on online media awareness and knowledge about unwanted pregnancy prevention among late adolescents

Tue, 07 Jul 2026 00:00:00 +0700

This quasi-experimental research aimed to study online media awareness and knowledge about unwanted pregnancy prevention among late adolescents in Surat Thani Province. The population consisted of late adolescents studying at the tertiary level, aged 18-20 years. The sample group consisted of 60 first-year students at Boromarajonani College of Nursing, Surat Thani. The experimental tool was the online learning program based on Ganye's concept was examined for content validity by three experts, with a congruence index of 0.67. and a questionnaire on online media awareness and knowledge about unwanted pregnancy prevention among late adolescents. They were tested with a sample of 45 people. The reliability of the questionnaire, Cronbach's alpha coefficient, was 0.84 and the reliability of the test (KR-21) was 0.82.Data analysis was performed using mean and paired t-test statistics comparing before-after and independent t-test statistics comparing between experimental and control groups. The research results found of the experimental group's online media awareness had a mean score of 4.34, standard deviation 0.37, Online media in defense confirmed on preventing unwanted pregnancy had a mean score of 3.70, standard deviation 0.41 and after the experiment, the mean score was 4.62, standard deviation 0.36. Knowledge on preventing unwanted pregnancy, before the experiment, mean score 10.23 After the experiment, the average score was 16.20, the difference in scores was 5.97. The control group, before the experiment, the average score was 9.90. After the experiment, the average score was 10.77, the difference in scores was 0.87.

Development of a Medication Reconciliation Model to Enhance Patient Safety Among Chronic Disease Patients at Ao Luk Hospital, Krabi Province

jularat puaknian — Fri, 03 Jul 2026 00:00:00 +0700

Medication reconciliation is a process that prevents medication errors and enhances safety for patients with chronic diseases. This research and development aimed to develop a medication reconciliation model and evaluate its effectiveness in improving medication safety in patients with chronic diseases at Ao Luk Hospital, Krabi Province. The study was conducted in three phases: 1. Situation analysis, studying 30 personnel and 2,665 chronic disease patient records. 2. Development of a medication coordination model in collaboration with a multidisciplinary team, including training, designing forms linked to the medical record system, and establishing standard operating procedures. 3. Pilot testing and continuous follow-up for 5 months, studying 30 personnel and 2,714 chronic disease patients. Data were analyzed using descriptive statistics, content analysis, and paired t-test.

Results: In phase 1, personnel had low to moderate knowledge and attitudes towards medication reconciliation, and the medication error rate was 2.74%. In phase 2, a medication reconciliation model was developed that covers three stages of care: initial patient admission, during care, and before discharge. This model was developed through practical training and on-the-job instruction. Learning from case studies in Phase 3, following the implementation of the model, showed a statistically significant increase (p < 0.001) in the knowledge and attitudes of personnel. Satisfaction was at a high level, the medication error rate decreased from 2.74% to 0.18%, and the completeness of the forms increased to 96.7%. In conclusion, the developed medication reconciliation model is clearly effective in reducing medication errors and increasing the safety of patients with chronic diseases, and can be applied in community hospitals.

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

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

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.

วัคซีนสำหรับผู้ใหญ่

suppamas Punchey — Tue, 30 Jun 2026 00:00:00 +0700