PSU Medical Journal

Development of a Modified Work Ability Index for Nurses

2026-04-17T16:36:34+07:00

Objective: This study investigated the components of the work ability index among registered nurses in the inpatient departments of a tertiary university hospital in Southern Thailand. The Work Ability Index was modified from the original version by Orawan et al.
Material and Methods: Data were collected from 374 nurses. Participants were recruited using a multi-stage sampling method. Data were collected using a psychosocial risk questionnaire, a job satisfaction questionnaire, and the work ability index questionnaire. Exploratory factor analysis with oblique rotation (Oblimin) was employed to extract and identify components.
Results: Five components of the work ability index for nurses in the inpatient department, accounting for 46% of the variance, were described by 47 variables. These components are as follows: Component 1, Organizational Management and Support, described by 27 indicators, explaining 21% of the variance; Component 2, Workload and Pressure, described by 7 indicators, explaining 7% of the variance; Component 3, Peer Support, described by 4 indicators, explaining 6% of the variance; Component 4, Management and Decision-Making, described by 5 indicators, explaining 6% of the variance; and, Component 5, Supervisor Support, described by 4 indicators, explaining 6% of the variance.
Conclusion: The findings suggest that the developed tool can be applied to assess work ability among nurses in the Thai context. Deficiencies in work ability may serve as early warning signals for implementing the appropriate interventions to reduce the risk of adverse work outcomes and potential turnover.

Development of an Automated ICD Coding System for Outpatients at Songklanagarind Hospital: A Retrospective Study

2026-04-17T16:36:32+07:00

Objective: To develop and evaluate the performance of an automatic disease and procedure coding system for outpatients at Songklanagarind Hospital using rule-based techniques. This system aims to address the problem of payment rejections from health funds due to errors in disease and procedure coding.
Material and Methods: This retrospective study utilized 49,497 outpatient visit summaries from Songklanagarind Hospital in 2023 that did not meet the payment conditions set by health funds, as evaluated by the hospital information system (HIS). Data were divided into a training dataset (24,748 records) and an evaluation dataset (24,749 records). The automatic coding system was developed using rule-based techniques, comprising disease code databases, procedure code databases, a rule repository, and a matching rules engine. System performance was assessed using Spearman’s rank correlation coefficient, confusion matrix, accuracy, sensitivity, false positive rate (FPR), and area under the curve (AUC).
Results: The system achieved an accuracy of 84.42%, a sensitivity of 65.53%, and an AUC of 81.74%. Spearman’s rho was 0.8517, indicating high concordance between codes assigned by the automatic system and those assigned by experts. The system was able to assign 57,870 codes out of a total of 117,295 codes, To ensure the record is not rejected or subjected to reimbursement delays exceeding 50% of the total medical expenses (specifically for cases that do not meet the payment criteria of the health insurance fund, as assessed by the hospital information system [HIS]).
Conclusion: The rule-based automated disease and procedure coding system demonstrates high performance, effectively reducing workload, increasing efficiency, and minimizing coding errors. It is suitable as an assistive tool for coding outpatient cases, particularly when processing large volumes of data.

Clinical and Polysomnographic Phenotypes of Obstructive Sleep Apnea in Non-Obese Versus Obese Patients

2026-04-17T16:36:29+07:00

Objective: This study aimed to compare clinical and polysomnographic features between obese and non-obese obstructive sleep apnea (OSA) patients.
Material and Methods: This retrospective cohort study included: adult patients having undergone type I polysomnography; from 2017 until 2022. Participants were categorized as: obese (body mass index [BMI] ≥30 kg/m²) and non-obese (BMI <30 kg/m²). Clinical features and sleep study parameters were compared. Correlation analyses were performed to assess any relationships between apnea hypopnea index (AHI) and body weight, BMI and neck circumference (NC). The diagnostic performance of STOP-Bang in obese individuals was additionally investigated.
Results: There were 573 patients; of which 359 (62.7%) were obese and 214 (37.3%) were non-obese. The prevalence of OSA and OSAS were 94.9% and 38.9%, respectively, increasing with BMI. Obese patients were significantly younger and had higher BMI, neck and waist circumferences, STOP-Bang and Epworth sleepiness scale, and more frequent symptoms; such as fatigue and choking. Polysomnographic findings revealed that obese patients had higher AHI, oxygen desaturation index (ODI) and T90, lower minimum SpO₂, and shorter total sleep time. NC showed a modest correlation with AHI (r=0.442, p-value<0.001). In obese patients, a STOP-Bang score ≥3 yielded 80.3% sensitivity and 62.5% specificity for detecting OSA.
Conclusions: Obesity markedly increases OSA severity, correlating strongly with higher AHI and more pronounced clinical and polysomnographic abnormalities. NC is the predictor of OSA severity, and a STOP-Bang of ≥3 has an acceptable performance in identifying OSA in obese patients.

Laparoscopic Liver Resection in Ruptured Hepatocellular Carcinoma [with Video]

2026-04-17T16:36:26+07:00

Laparoscopic liver resection (LLR) has emerged as a valuable treatment option for managing ruptured hepatocellular carcinoma (HCC). As surgery is one curative treatment of HCC in selected patients, LLR offers advantages over open liver resection (OLR) in terms of reduced blood loss, shorter hospital stays, and comparable postoperative outcomes. While LLR is feasible for non-ruptured HCC, its role in resections of ruptured HCC remains a controversial issue. The primary and secondary aims of this article were to review the current role of LLR, and provide patient selection criteria for ruptured HCC. To date, only 10 cases with good postoperative outcomes have been reported in patients having undergone LLR for ruptured HCC. Patient selection is crucial, along with individualized assessment; based on hemodynamic status, tumor burden and liver function, to guide treatment decisions. In highly selected patients with ruptured tumor, LLR in an experienced center can provide a minimally invasive alternative to OLR; leading to improved patient outcomes. As current evidence relies exclusively on minor hepatectomy case series, further studies are necessary to refine indications and optimize outcomes in this specific context.

Critical Line of Safety Guided Decision Making for Laparoscopic Subtotal Cholecystectomy in Difficult Gallbladder Surgery

2026-04-17T16:36:24+07:00

Objective: This article proposes incorporating the critical line of safety (CLS) as an anatomical and decision-making landmark to guide a safe laparoscopic cholecystectomy (LC); especially when critical view of safety (CVS) cannot be achieved.
Material and Methods: The CLS is defined as the caudocranial line running along the lateral edge of the hepatoduodenal ligament that extends from the duodenum to the cystic-hilar plate junction. Two key rules are emphasized: (1) no structure medial to the CLS should be divided and (2) dissection beyond the CLS should be avoided or performed with awareness of potential thermal injury. If completing total cholecystectomy requires resection beyond the CLS, this represents the “inflection point” to stop and perform a laparoscopic subtotal cholecystectomy.
Results: In difficult cholecystectomy, the key decision is to stop before bile duct injury (BDI) occurs. In cases of unattainable CVS, the CLS helps the surgeon identify the extrahepatic bile duct and thereby facilitates safe dissection. When difficult anatomy is combined with failure to achieve CVS, CLS-guided decision-making provides a foundation basis for the surgeon to recognize the inflection point and stop attempting total cholecystectomy.
Conclusion: CLS-guided decision-making provides an objective and anatomical reference for identifying the safe limit of dissection and determining when to terminate attempts at total cholecystectomy. Incorporating this landmark into standard practice may enhance surgical awareness, reduce perception bias, and prevent BDI. Further clinical validation is warranted to establish the role of CLS in safe LC.

Surgical Perspective of the Post-Flood Situation in Songkhla

2026-04-17T16:36:22+07:00