PSU Medical Journal

Academic Capitalism: Standing on the Shoulder of a Giant - and Playing the Giant’s Racing Game?

Surasak Sangkhathat — 2024-04-23

Vulvar Paget Disease

Pakhanan Dankamak — 2024-04-23

Vulvar Paget disease (VPD) is a rare and difficult-to-diagnose condition that can be associated with other types of cancer, such as urinary tract cancer and gastrointestinal tract cancer. Accurate and thorough diagnosis is essential. The main treatment for VPD is surgery, although alternative treatments are available in cases for which surgery is not feasible. These alternative treatments include radiation therapy, topical medications, and chemotherapy for advanced and disseminated cases. Due to the recurrent nature of VPD, continuous monitoring and follow-up are necessary. This article aimed to gather and explore information about VPD. The article includes the etiology of the disease, clinical characteristics, pathological features, various investigations, current treatment options for VPD.

Pancreatic Fistula after Pancreatoduodenectomy: Evaluation of Different Surgical Techniques

Monwadee Chaiyakul — 2024-02-13

Postoperative pancreatic fistula (POPF) is one of the most fatal complications of pancreatoduodenectomy. POPF is caused by leakage of pancreatic juice from the pancreatic anastomosis into the abdomen, leading to intra-abdominal complications, such as severe surgical site infections, significant postoperative hemorrhage and multi-organ failure. Many risk factors for POPF have been identified, including patient and surgical technique factors. Our objective was to review the literature on surgical techniques to prevent POPF after pancreatoduodenectomy. Pancreatogastrostomy (PG) has the same incidence of POPF as pancreatojejunostomy (PJ). For PJ anastomosis, the interrupted suture and Blumgart technique also had the same rate of POPF. For soft pancreas it was shown that invagination was better than duct-to-mucosa anastomosis to prevent the POPF. However, a pancreatic duct stent cannot decrease the rate of POPF over the non-stent group. Intraperitoneal drainage cannot prevent POPF, however, it can detect POPF more than the non-drain group. Laparoscopic PD (LPD) and robotic-assisted PD (RAPD) were comparable in rates of POPF with open PD. Overall, no conclusion has been reached regarding the best surgical technique. In any individual case, the surgical technique should be selected based on the surgeon’s experience in reducing the incidence of POPF, and other complications.

Hard-to-Heal Wounds

Atthawit Mongkornwong — 2024-01-18

A hard-to-heal wound or chronic wound is a wound that fails to heal in an expected time due to disruption of the normal healing process. Commonly encountered chronic wounds are those occurring in patients with diabetes, long-standing pressure injuries, and venous diseases. If not treated properly, a chronic wound might be complicated with infection, threatening limb loss, and serious psychological impacts. This review addresses the concepts of chronic wound management, emphasizing the TIMERS principle. Care for specific types of wounds and modern dressing materials used in chronic wound care are also discussed.

Epidemiology, Seasonal Variability, and Factors Associated with Increased Mortality in Patients with Acute Appendicitis in Thailand: A Study Using Data from the National Health Security Office

Natthapon Khongcharoen — 2024-04-23

Objective: The study aimed to study the spatiotemporal distribution of acute appendicitis in Thailand, using a reimbursement dataset from the National Health Security Office, and also analyze for mortality and factors associated with mortality after an appendectomy.
Material and Methods: The study used data mining to analyze a reimbursement data set from the Thailand National Health Security Office (NHSO), focusing on the diagnosis of acute appendicitis (K35.2-K35.9). The analysis looked for the incidence trend and seasonal variation of the incidence. The study also analyzed mortality and factors associated with the mortality. A prediction model for mortality was constructed using a decision tree.
Results: During the 4 fiscal years of the study period, from October 2016 - September 2020, a total of 287,449 individuals were diagnosed with acute appendicitis, and 272,850 appendectomies were performed, which gave an annual incidence (AI) of 10.8/10,000 person-years. The peak age incidence was in the second decade of life, which had an age-specific AI of 28.4/10,000 person-years. Using a multiplicative model of time series detrending and a decomposition model and a seasonal variation of acute appendicitis, with the highest incidence from May to October, linear regression showed a significant correlation between the incidence of appendicitis and precipitation (r2=0.28, p-value<0.001). The AI of appendicitis was declining and showed an especially large decline in the year 2020, when the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic began. The overall mortality was 2.3%. A significantly higher mortality rate was found in cases with extreme age (pediatric or geriatric), those with co-morbidities (diabetes, hypertension, dyslipidemia, chronic pulmonary disease, chronic kidney disease), and those with complications, especially generalized peritonitis, sepsis, and acute kidney injury. A decision-tree prediction model suggested that sepsis and renal complication were key nodes determining mortality risk in pediatric and geriatric appendicitis.
Conclusion: A mortality risk from appendicitis remains in Thai patients, especially the elderly with co-morbidities and those with generalized peritonitis, sepsis, or renal complications. Early diagnosis and improvement in perioperative care in the extreme age groups might improve the mortality figure.

Empathy Levels and Burnout in Medical Students: An Analytic Cross-Sectional Study in a Thai University Hospital

Aimorn Jiraphan — 2024-04-23

Objective: In medical education, empathy is an essential element of professionalism; however, medical students are sometimes advised to limit empathy. Excessive empathy might be linked to burnout and trigger negative consequences such as low mood and quality of life. Due to limited data regarding the association between empathy and burnout, this study aimed to examine the relationship between levels of empathy and burnout with their respective subscales, among medical students.
Material and Methods: This cross-sectional study was conducted at the clinical level of medical students currently undergoing medical training at the Faculty of Medicine, Prince of Songkla University, at the end of the 2020 academic year. Medical students aged more than 20 years who completed the questionnaires were included. The questionnaires comprised 1) demographic data, 2) The Toronto Empathy Questionnaire, 3) The Maslach Burnout Inventory (Thai version), and 4) The Thai Mental Health Indicator-15. Associations between empathy and burnout including emotional exhaustion, depersonalisation, and personal accomplishment subscales were investigated using linear regression analysis.
Results: From the three-year clinical level, 91.9% (466 of 507) of medical students completed the questionnaires, with a mean age of 23.1±1.4 years. In the linear regression analyses, empathy scores were positively associated with emotional exhaustion and negatively associated with depersonalisation and low personal accomplishment (Adjusted coefficient 0.18 (0.02, 0.33), -0.09 (-0.18, -0.01), and -0.42 (-0.52, -0.31), respectively). Among the empathy subscales, altruism was significantly correlated with personal accomplishment (r=-0.41, p-value<0.001).
Conclusion: The study revealed a negative correlation between empathy and overall burnout. While a high level of empathy was found to prevent depersonalisation and enhance personal accomplishment, it did not significantly hinder the emotional exhaustion associated with burnout. Empathy, particularly altruism, was related to personal accomplishments. Our findings suggest that empathy is a crucial determinant of burnout prevention; therefore, optimal levels of empathy should be taught to medical students during medical training to prevent emotional exhaustion. However, the evaluation of further causal explanations is recommended.