Lampang Medical Journal

Results of Developing a Liver Fluke Participatory-Prevention Model in Wang Ta Mua Subdistrict, Mueang District, Nakhon Phanom Province

Wachareeporn Natungmuan — 2024-05-17

Background: Liver fluke infection is a major cause of cholangiocarcinoma and a health problem in the northeastern region of Thailand. In Mueang District, the prevalence of liver fluke infection ranks among the top three highest districts in Nakhon Phanom province.
Objective: To study the outcomes of a developed model for liver fluke prevention through community participation in Wang Ta Mua Subdistrict, Mueang District, Nakhon Phanom Province.
Material and methods: This action research study was conducted with 61 participants, including village health volunteers, public health officers, teachers, monks, a villager representative, a village headman, a subdistrict headman, and members of the Subdistrict Administrative Organization, as well as 33 villagers who had concurrent liver fluke infections. The study consisted of ten operating steps: 1) problem analysis; 2) preparation of action plans; 3) educational activities; 4) disease prevention campaign activities; 5) creating a cooperation network; 6) monitoring infected villagers; 7) conducting a papaya salad cooking and market survey to ensure it was free from raw fermented fish; 8) setting community preventive measures; 9) monitoring, supervising, and evaluating the activities; and 10) exchanging and sharing knowledge. Data were collected using questionnaires, interviews, and observations and were analyzed using descriptive statistics, paired t-tests, and content analysis.
Results: After finishing the model, the target group had significantly higher levels of knowledge, attitudes, behaviors, and participation in liver fluke prevention (p<0.001). The success factors might be explained by the connection between network partners and the unity of people in the community, leading to the participation and mutual acceptance of those involved in all steps of development.
Conclusion: The development of a liver fluke participatory-prevention model in Wang Ta Mua Subdistrict could significantly increase the levels of knowledge, attitudes, behaviors, and participation in disease prevention. The community could create a participatory plan to address the problem using a more systematic operating model.

Results of the Health Literacy Program for Pregnant Women in Borabue Hospital, Borabue District, Mahasarakham Province

Sirinapa Samlee — 2024-07-03

Background: Pregnancy poses risks to pregnant women, which can be reduced by enhancing health literacy. This strategy promotes the acquisition of knowledge, positive attitudes, and motivation for engaging in correct and suitable self-care behaviors.
Objective: To evaluate the outcomes of the program designed to enhance health literacy among pregnant women at Borabue Hospital, which includes the development of six skills: access, cognition, communication, decisionmaking, self-management, and media literacy.
Material and methods: A quasi-experimental research study, employing a one-group, before-and-after design, was conducted among 30 pregnant women who had their first visit at the ANC clinic in Borabue Hospital between July and November 2023. The participants attended the program three times, which included two weeks after the first antenatal care (ANC) visit (focusing on functional health literacy), at a gestational age (GA) of 15 weeks (emphasizing interactive health literacy), and at a GA of 20 weeks (concentrating on critical health literacy). Data were collected before program participation and at 26 weeks of GA using questionnaires and blood exams. The health knowledge scores, health literacy scores, self-care behavioral scores, and hematocrit levels were compared using the paired t-test.
Results: The mean age was 28.0±1.9 years (range 17–38). Fifty percent of the participants (15 cases) are experiencing their second pregnancy (range 1–3), and the average GA at the first ANC visit was 8.5±0.9 weeks (range 7–10). After completing the program, the women achieved higher average scores in terms of health knowledge (12.8±1.4 vs 9.6±1.4 points, p=0.001), health literacy (4.2±0.8 vs 2.9±0.8 points, p<0.001), self-care behavior (4.1±0.8 vs 2.9±0.7 points, p<0.001), and hematocrit levels (38.7±3.0% vs 33.8±2.5%, p<0.001).
Conclusion: The health literacy program for pregnant woman at Borabue Hospital could enhance the literacy skills of newly pregnant women, enabling proper self-care behaviors and increasing hematocrit levels.

Quality Improvement of Nursing Services for Colorectal Cancer Patients Undergoing Minimally Invasive Surgery in the Operating Room at Lampang Hospital

Patcharee Ruekchan — 2024-08-09

Background: Improving the quality of nursing services for patients undergoing minimally invasive colorectal cancer surgery is an important goal for developing nursing services that ensure patient safety and prevent operative complications.
Objective: To develop a quality nursing care model for colorectal cancer patients undergoing minimally invasive surgery, and to evaluate the nursing outcomes resulting from the implementation of this quality care model in the operating room of Lampang Hospital.
Material and methods: This research and development study utilized the Donabedian model of quality service development to achieve high-quality care. The study involved registered nurses providing care for colorectal cancer patients undergoing minimally invasive surgery in four units: the outpatient department of general surgery, the male surgical ward, the female surgical ward, and the general surgery operating room. The study was conducted from June to November 2023. The instruments used included in-depth interview guides, focus group discussion guidelines, knowledge tests, evaluation forms for the implementation of the development model, and satisfaction surveys regarding the development model.
Results: A total of 51 registered nurses analyzed the incidence of adverse events from surgical procedures using incident report forms. They collaboratively designed and developed a quality care model. Upon implementation and knowledge testing, it was found that the average knowledge scores regarding colorectal cancer, its treatment, and surgery significantly increased after using the new model. The average nursing care scores for colorectal cancer patients also significantly increased in the preoperative and postoperative phases. The average scores for
preventing surgical complications did not show a significant difference post-implementation. However, the average scores for managing surgical instruments, including patient positioning, surgical team positioning, and the preparation of surgical instruments, significantly increased. The average preoperative nursing skill scores for colorectal cancer patients significantly increased, as did the intraoperative nursing skill scores. There was no significant difference in the average scores for surgical instrument management skills. The average postoperative nursing skill scores for colorectal cancer patients significantly increased. Service provider satisfaction had an average score of 4.9, and there were no postoperative complications among the patients.
Conclusion: The application of the Donabedian model in developing the quality of nursing care for colorectal cancer patients undergoing minimally invasive surgery resulted in an effective development model. Nurses involved gained knowledge, skills, and satisfaction from using this model, which in turn ensured patient safety and the absence of postoperative complications.

Outcomes of Hip Fracture Surgery in Elderly Patients with High American Society of Anesthesiologists Physical Status: a Comparison of Surgery Within 72 Hours Versus After 72 Hours

Natee Tanasubsinn — 2024-08-09

Background: Expedited hip fracture surgery in elderly patients can reduce complications and 1-year mortality. However, there is limited research on the clinical outcomes of expedited surgery in patients with high American Society of Anesthesiologists (ASA) physical status (classes III-IV).
Objective: To evaluate the outcomes of expedited surgery within 72 hours in terms of length of hospital stay, complications, and mortality in elderly hip fracture patients with high ASA physical status, compared to surgeries performed after 72 hours.
Material and methods: A retrospective cohort study was conducted among ASA class III-IV patients aged 60 years and above, who underwent hip fracture surgery at Chiang Rai Prachanukroh Hospital from October 2019 to September 2021. Data were compared between the group that underwent surgery within 72 hours (expedited group) and the group that underwent surgery after 72 hours (delayed group) in terms of length of hospital stay, 30-day post-operative complications and mortality, and 1-year mortality.
Results: A total of 345 patients were enrolled in the study, with a mean age of 77.4±8.1 years. Most of the patients were female (248 cases, 71.9%), had extra-articular fractures (241 cases, 69.9%), and were treated with internal fixation (227 cases, 65.8%). There were 198 patients (57.4%) in the expedited group with an average waiting time of 38±17 hours, and 147 patients (42.6%) in the delayed group with an average waiting time of 159±69 hours. Complications were found in 32 cases (16.2%) in the expedited group and 20 cases (13.6%) in the delayed group. The most common complication was a urinary tract infection. The 30-day mortality rate was 1.7% (6 cases), all due to pneumonia. The 1-year mortality rate was 3.8% (13 cases). There were no significant differences between the two groups in terms of complications, readmission rate, and mortality rate. However, expedited surgery significantly reduced the length of hospital stay (p<0.001).
Conclusion: Expediting surgery in elderly patients with high ASA physical status significantly reduced hospitalization time, without significant differences in complication, re-admission, and mortality rates

Results of Femoral Offset and Leg Length in Bipolar Hip Hemiarthroplasty Pre-operatively Planned Using Digital Templating in the Keynote Program: a Retrospective Study

Siripong Tahwang — 2024-08-09

Background: When performing bipolar hemiarthroplasty (BHA) for femoral neck fractures (FNF), it is crucial to restore the femoral offset (FO) and leg length to match those of the normal contralateral leg. This is achieved through preoperative templating. A technique using a digital template, incorporating computer systems and the Keynote program on an iPhone, has been developed. However, the outcomes of using this digital template in BHA patients have not yet been studied.
Objective: To compare FO and leg length between the operated leg and the contralateral normal leg in FNF patients who underwent BHA surgery, using a digital template in the Keynote program for preoperative planning.
Material and methods: A retrospective cohort study among 101 elderly patients with FNF who underwent BHA at Lampang Hospital from January 2019 to March 2024. Preoperative templating was performed using the Keynote program on an iPhone or iPad, which included digital images of femoral prosthesis templates in the background of each slide. Postoperative leg length discrepancy (LLD) and FO difference were measured on X-ray images. Data were analyzed using descriptive statistics. Comparisons were made between the group with LLD within the range of -6 mm to 6 mm and the group with LLD outside this range, as well as between the group with FO difference within the range of -5 mm to 5 mm and the group with FO difference outside this range. The consistency of measurements was analyzed for both intra-rater and inter-rater reliability.
Results: The mean age of the patients was 77.9 years (SD 6.4, range 63−92), with the majority being female (86 patients, 84.2%). The direct lateral approach was used in 53 patients (52.5%), and the posterolateral approach was used in 48 patients (47.5%). Most of the femoral prostheses used were cemented (63.4%) and standard offset (75.3%). Radiographic measurements showed a median LLD of 0.0 mm (IQR -0.2, 3.6). Ninety-two patients (91.1%) had an LLD within the range of -6 mm to 6 mm. The mean FO difference was 0.9 mm (SD 2.5), with 94 patients (93.1%) having an FO difference within the range of -5 mm to 5 mm. Comparative analysis between groups revealed no factors associated with having an LLD within the range of -6 mm to 6 mm or an FO difference within the range of -5 mm to 5 mm. The intra-rater and inter-rater reliability had ICC values of 0.93 and 0.90, respectively
Conclusion: Using digital templates in the Keynote program for preoperative planning of BHA was highly effective in ensuring equal leg length and femoral offset. About 91−93% of patients achieve acceptable differences in these measurements.