Lampang Medical Journal

Waiting Time to Chemotherapy in Obstructed Metastatic Colorectal Cancer: Comparative Analysis of 3 Surgical Procedures

Prawaet Sangwanloy — Mon, 22 Aug 2022 00:00:00 +0700

Background: Surgical treatments in obstructed metastatic colorectal cancer (CRC) include primary resection with anastomosis, loop colostomy and
Hartmann’s procedure. Recovery of these surgeries should not delay the conversion chemotherapy for bridging to metastectomy that improve the survival time.

Objective: To compare the postoperative waiting time for chemotherapy, length of stay, complication, and survival time between 3 groups of surgical procedures in obstructed metastatic CRC.

Material and methods: A retrospective cohort study was conducted among 50 patients with obstructed metastatic CRC who underwent surgery and received chemotherapy in Nan Hospital from 2011 to 2020. Length of stay, waiting time for chemotherapy, and survival time were compared between 3 surgical procedures using one-way ANOVA and Kruskal-Wallis test.

Results: The mean age was 62.4 years (SD 10.2, range 45−85) and 32 cases were male. Most of CRC located at rectum (34%), descending colon (26%) and sigmoid colon (18%). Metastatic sites were liver (74%) and lung (40%). Surgeries included 24 cases of primary resection with anastomosis, 19 cases of loop colostomy and 7 cases of Hartmann’s procedure. Length of stay were averaged 11.0 days (SD 4.4), 7.3 days (SD 2.9) and 7.7 days (SD 2.4) respectively (p=0.002). The mean waiting time for chemotherapy was 25.3 days (SD 6.6) in anastomosis group, 29.8 days (SD 14.1) in loop colostomy and 23.0 days (SD 27.4) in Hartmann’s procedure (p=0.416). The median survival time were 372 days (IQR 256, 661), 373 days (IQR 338, 545) and 657 days (IQR 245, 786) respectively (p=0.874). There were 1 case of sepsis and 1 case of surgical site infection in the anastomosis group, and 1 case of respiratory failure in loop colostomy group.

Conclusion: Primary resection with anastomosis in obstructed metastatic CRC did not delay the waiting time for conversion chemotherapy, compared with loop colostomy or Hartmann’s procedure.

Defining Threshold Value of 50-g Glucose Challenge Test to Diagnose Gestational Diabetes Mellitus in At-risk Women

Patthamaphorn Chongcharoen, Supitcha Sassanarakkit — Mon, 22 Aug 2022 00:00:00 +0700

Background: Gestational diabetes mellitus (GDM) is usually screened by the 50-g glucose challenge test (GCT) and subsequently confirmed its
diagnosis with the 100-g oral glucose tolerance test (100-g OGTT). The very-high glucose level obtained from the 50-g GCT test may be valid
to diagnose GDM and discard the unnecessary 100-g OGTT test.

Objective: To define the threshold value of 50-g GCT using for diagnosis of GDM in the diabetic at-risk pregnant women.

Materials and methods: A diagnostic research was conducted among 552 pregnant women who had ≥1 risk of GDM and received 50-g GCT
in Lampang Hospital between January 2019 and September 2021. In case of blood sugar ≥140 mg/dl, the 100-g OGTT was implemented and
interpreted according to Carpenter & Coustan criteria to diagnose GDM. The results 50-g GCT were categorized with 10 mg/dL increment and
analyzed to define the cut-off value for GDM diagnosis.

Results: The mean age was 31.0 years (SD 5.7) and 407 women (73.7%) were multigravida. Most of 50-g GCT performed at gestational age ≥24
weeks (64.3%). GDM were diagnosed in 178 cases (32.2%) with the 100-g OGTT using Carpenter & Coustan criteria. At the cut-off value of 50-g GCT
≥210 mg/dl, GDM could be diagnosed in 100% of cases. Both specificity and positive predictive value were 100%.

Conclusion: In pregnant woman who has at least 1 risk factor and blood level of 50-g GCT ≥210 mg/dl, diagnosis of GDM could be made without
confirmation by the 100-g OGTT.

Incidence of Flare in Patients with Rheumatoid Arthritis after Tapering Conventional Synthetic Disease-Modifying Antirheumatic Drugs

Ampond Pitipakorn — Mon, 22 Aug 2022 00:00:00 +0700

Background: Conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) are used in rheumatoid arthritis (RA) to achieve a
remission or low disease activity at least 6 months. Thereafter, drug de-escalation is initiated to obtain the sustained drug free remission De-escalation of csDMARDs is a major cause of disease flare.

Objective: To determine an incidence rate of flare in patients with RA after csDMARDs tapering and the risk factors of flare.

Material and method: A retrospective cohort study was conducted among RA patients treated in Lampang Hospital with disease remission
or low disease activity at least 6 months and received csDMARDs de-escalation during January 2015 – March 2020. The event of first flare within 1 year after drug tapering was monitored. Data were compared between
the flare and non-flare groups. Risk factor of disease flare was analyzed using univariate regression analysis.

Results: Among 88 patients who underwent csDMARDs tapering, 17 patients (19.3%) had disease flare at the average of 202 days (SD 79). The median time of csDMARDs treatment before drug de-escalation in the flare group was shorter than the non-flare group (1 [IQR 1,2] year vs 2 [IQR 1,4] year, p=0.027). Longer duration of csDMARDs treatment before
drug de-escalation tended to decrease the risk of disease flare (OR 0.67, 95%CI 0.44−1.01, p=0.056), similarly with receiving ≥3 items of csDMARDs (OR 0.29, 95%CI 0.08−1.11, p=0.071)

Conclusion: The incidence of flare in patients with RA after tapering csDMARDs within one year was 19.3%. Longer duration of csDMARDs
treatment and receiving ≥3 items of csDMARDs before drug de-escalation tended to decrease the risk of disease flare.

Effectiveness of Pain Control in Total Knee Arthroplasty between Different Anesthetic Techniques in Phrae Hospital

Sawika Pinyo — Mon, 22 Aug 2022 00:00:00 +0700

Background: Anesthetic techniques in total knee arthroplasty (TKA) include general anesthesia (GA), spinal anesthesia (SA), adductor canal block (ACB), periarticular infiltration (PAI) and SA combined with intrathecal morphine (SA+MO). There is diversity of utilizing these techniques.

Objective: To evaluate the efficacy of postoperative pain control and walking ability between different anesthetic techniques used in TKA.

Material and method: A retrospective analytical study was conducted among 153 patients receiving TKA during August 2018 – July 2019 under 5 different anesthetic techniques; group 1: SA+ACB 55 cases, group 2: SA+PAI 13 cases, group 3: SA+MO 63 cases, group 4: GA+PAI/ACB 9 cases and group 5: GA 13 cases. Postoperative pain score at 2, 24, 48 hours and ability to walk with walker within 48 hours were compared between groups.

Result: The mean 2-hrs pain score in GA group was 4.5 (SD 2.2), significantly higher than group 1−4. The average 24-hrs pain score in GA group was 4.3 (SD 2.0), significantly higher than group 1, 3 and 4. At 48 hours, the mean pain
score in GA group (3.5, SD 1.3) was higher than SA+ACB (2.6, SD 0.9, p=0.035) and GA+PAI/ACB group (2.1, SD 0.6, p=0.012). The pain scores in group 1−4 were not significantly different, no matter when assessed at 2, 24 or 48 hours. Percentages of patients with satisfied walking ability in SA+ACB and SA+PAI groups were higher than those of GA+PAI/ACB and GA groups (92.7% and 92.3% vs 55.6% and 53.8% respectively, p=0.002)

Conclusion: Using PAI or ACB, combined with either SA or GA provided similar effectiveness of postoperative pain control in TKA, and not different from SA+ MO. Combination of these techniques had better results than using GA alone.

Use of Experiential Learning Theory to Develop a Skill Training Program for Operating Room Nurses in Off-pump Coronary Artery Bypass Surgery

Wipada Suprasuwankul, Kedsaraporn Udkunta, Boonsap Sakboon — Mon, 22 Aug 2022 00:00:00 +0700

Background: Empowering competency of cardiovascular operating room (OR) nurse is important and takes several months for training, leading to the personnel shortage.

Objective: To develop a training program for OR nurse assisting off-pump coronary artery bypass (OPCAB) surgery by the experiential learning theory in Lampang Hospital and evaluate its outcomes.

Materials and Methods: Research and development of training program for OR nurse was obtained during March to July 2021 in patients underwent OPCAB. Three trainers (above-5-years experienced cardiovascular OR nurses) and
8 trainee nurses participated this program. Trainees’ knowledge, competency and satisfaction were evaluated.

Results: The mean age of trainees was 25.1 years and OR experience was 2.3 years. After finishing 4-weeks training period, they could prepare and deliver surgical instruments at average of 2.5 days (SD 1.3) by supervision and 3.5 days
(SD 2.1) without supervision. All trainees passed the competency evaluation with a mean score of 94.9 (SD 5.5). Knowledge score improved form 72.9 (SD 8.6) to 90.0 (SD 7.4, (p<0.001). They were satisfied with the program at a
score of 79.5 (SD 6.9). No surgical site infection, posture injuries and residue in the surgical patient were observed.

Conclusion: This experiential learning program could improve the nursing knowledge and skills for assisting the OPCAB surgery. It could shorten the training period and satisfy the trainees without increasing the patients’
adverse events.