PSU Medical Journal

Modified Fundus First Technique for Laparoscopic Cholecystectomy

Kanittha Sakolprakaikit — 2026-08-21

Laparoscopic cholecystectomy (LC) is the standard treatment for gallstone disease and acute cholecystitis. However, bile duct and vascular injuries remain serious complications, particularly in patients with severe inflammation, dense adhesions or anatomical variations; wherein, obtaining the critical view of safety (CVS) can be challenging. Hence, the fundus-first technique is commonly employed as a bailout strategy in difficult cases; nevertheless, severe injuries have been reported due to dissection in incorrect planes and excessive proximity to the hepatic hilum.
This article introduces the concept of a modified fundus-first technique. It combines limited dissection of the hepatocystic triangle, so as to establish safe anatomical reference points with controlled fundus-down gallbladder dissection along the appropriate surgical plane. This approach aims to enhance procedural safety in cases where conventional infundibular dissection is not feasible. Additionally, key anatomical landmarks, limitations of the CVS, and important technical precautions are reviewed to provide practical guidance for minimizing the risk of bile duct injury during LC.

Enteral Nutrition in Traumatic Patients: Essential for Achieving Optimal Recovery Outcomes

Patdanai Khongsakool — 2026-08-21

Post-traumatic physiological changes result in distinct energy metabolism patterns during each phase of recovery. More injury necessitates increased nutritional support, specifically earliest possible nutrition support in addition to elevated caloric and protein intake. The specific nutrition supplementation for each phase for individual patients may be a crucial aspect of post-traumatic care. Enteral nutrition (EN) is preferred over parenteral nutrition (PN), if no contraindication exists; as it stimulates immunity and avoids the need for invasive procedures. Monitoring clinical signs and gastric residual volume (GRV) together for feeding intolerance is essential to prevent complications. However, although open abdomen after damage control surgery can be encountered in traumatic patients, EN remains an option provided it is carefully managed to replace protein lost from exudative content; thereby, facilitating recovery.

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

Saranee Supornpipat — 2026-09-02

This Correction relates to the following article:
Saranee Supornpipat and Phongsak Dandecha. Development of an Automated ICD Coding System for Outpatients at Songklanagarind Hospital: A Retrospective Study. PSU Med J 2026;6(1):15-24. https://doi.org/10.31584/psumj.2026281538

URL: https://he01.tci-thaijo.org/index.php/PSUMJ/article/view/281538

CONTENT OF CORRECTION
An extraneous and unrelated segment of English text was found remaining in the main body of the article on page 17, within the passage discussing “the development of automated systems to assist in disease and procedure coding represents an important approach to addressing issues that have arisen. Over the past decade, the academic field has proposed various methods for developing automated coding systems, ranging from machine learning techniques to deep learning⁵ insurance claim processing and research. The current scenario of assigning codes is a manual process which is very expensive, time-consuming and error prone. In recent years, many researchers have studied the use of natural language processing (NLP),” which has been revised to read: “The development of automated systems to assist in disease and procedure coding represents an important approach to addressing issues that have arisen. Over the past decade, the academic field has proposed various methods for developing automated coding systems, ranging from machine learning techniques to deep learning⁵”

Additionally, the English Running Title in the header on pages 17, 19, 21, and 23 has been corrected from “Development of a Modified Work Ability Index for Nurses” to “Automated ICD Coding in Outpatients”.

We confirm that this correction does not alter the core content or the scientific results reported in the study.

The editorial office sincerely regrets the error.

Durable Resolution of Refractory Corrosive-Induced Pyloric Stenosis Treated with Endoscopic Balloon Dilatation and Intralesional Triamcinolone Injection: A Case Report

Kanittha Sakolprakaikit — 2026-08-21

Corrosive ingestion may result in severe gastrointestinal injury and subsequent benign pyloric stenosis. Although endoscopic balloon dilatation is considered first-line therapy, recurrence is common because of fibrotic scar remodeling. We report a young adult with corrosive-induced pyloric stenosis who developed progressive gastric outlet obstruction and severe malnutrition. Despite multiple sessions of endoscopic balloon dilatation and temporary stent placement, recurrent stenosis occurred. The patient subsequently underwent balloon dilatation combined with intralesional triamcinolone injection. Following two sessions of steroid-augmented dilatation, sustained clinical improvement was achieved. The patient resumed oral intake, gained weight, and follow-up endoscopy demonstrated complete resolution of the stricture. Intralesional steroid injection may be an effective adjunct to balloon dilatation in selected patients with refractory benign pyloric stenosis, potentially avoiding surgical intervention.

Quality Improvement in Neurosurgical Practice: Future Directions

Thara Tunthanathip — 2026-08-21

Quality improvement (QI) has become an essential component of modern neurosurgical practice due to the increasing complexity, high-risk nature, and multidisciplinary demands of neurosurgical care. Contemporary QI frameworks extend beyond technical surgical performance and increasingly emphasize patient safety, system reliability, patient-centered outcomes, and continuous organizational learning. Neurosurgical QI has shifted to the integration of system-based approaches, with measurable outcomes, risk reduction, process redesign, and data-based continuous improvement.
Advanced clinical analytics, digital transformation, and artificial intelligence (AI) are expected to significantly influence future neurosurgical quality systems. Clinical and operational data can be used in AI applications for improved risk prediction, workflow optimization, complication prevention, and resource allocation. In parallel, image-based AI and computer vision solutions using computed tomography, magnetic resonance imaging, and real-time surgical data could help with detection, classification, segmentation, anatomical recognition, and surgical workflow analysis. In the future, AI-powered platforms could be developed that combine clinical and imaging information for predictive monitoring and real-time decision-making.
Future directions in neurosurgical QI will likely include learning health systems, real-time quality monitoring, patient-reported outcomes, multidisciplinary collaboration, and system-based safety approaches. However, successful implementation requires careful attention to ethical governance, transparency, algorithmic bias, clinician oversight, and healthcare equity. The vision of neurosurgical quality improvement is to develop safer, more reliable, equitable, and patient-centered care systems for patients with complex neurological diseases.

Association between Adverse Childhood Experiences and Prevalent Depressive Symptoms among Secondary School Students in Thailand

Jarusrawee La-ongnual — 2026-08-21

Objective: To describe the prevalence of Adverse Childhood Experiences (ACEs) and its association with prevalent depression among Thailand secondary school students.
Material and Methods: We analyzed data from the 5th National School Survey on Alcohol, Tobacco, Substance Use and Health-Risk Behaviors. Univariate descriptive statistics to present general information regarding the sample; such as age, gender, social, economic, and family characteristics and prevalence of ACEs and depressive symptoms was used. Bivariable descriptive statistics and regression analyses assessing extent and association between ACEs and depression was used.
Results: From 23,659 students participating in the survey (n=23,659), there were 7,131 that answered questions regarding ACEs. Students having had experienced at least one ACE had significantly higher odds of prevalent depression compared to those without any adverse experiences (32% vs. 8%; Adjusted OR=4.65; 95% CI=3.94, 5.49). The more types of adverse experiences, the greater the odds of depression; i.e., results suggested a linear relationship between number of ACEs and likelihood of depression.
Conclusion: Significant association between ACEs and prevalent depression among Thailand secondary school students was found, indicating a linear relationship. However, issues; including question comprehension and providing inaccurate answers could have led to under- or over-reporting of ACEs or depressive symptoms. Future studies should consider methods to potentially reduce errors; including conducting face-to-face interviews or online surveys.

Effect of Listening to Intraoperative Hemispheric Synchronized Sounds on Postoperative Cognitive Function after Coronary Artery Bypass Graft Surgery: A Randomized Controlled Trial

Wirat Wasinwong — 2026-08-21

Objective: This study aimed to evaluate the effect of listening to hemispheric synchronized sounds during surgery on postoperative cognitive function, delirium, and pain scores in patients undergoing coronary artery bypass graft (CABG) surgery.
Material and Methods: This prospective, randomized study was conducted in Songklanagarind Hospital; from February 2021 to December 2022. A total of 70 patients having undergone CABG surgery, were divided into two groups: the “music” group (37 patients) and the control group (33 patients). In the operating room, all patients wore headphones connected to an MP3 player; hemispherical synchronization sounds were played in the music group, beginning immediately after sedation and continuing until the end of surgery. No sounds were played in the control group. Preoperative and postoperative Mini-Mental State Examination (MMSE), Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) 7, and Verbal Numerical Rating Scale pain scores were evaluated in all patients in the first 24 hr after extubation.
Results: Preoperative MMSE scores (26 [interquartile range, IQR: 24,28] vs. 27 [IQR: 23,29], p-value=0.78), postoperative MMSE scores (27 [IQR: 23,29] vs. 27 [IQR: 24,29], p-value=0.42), and CAM-ICU 7 scores (0 [0,1] vs. 0 [0,1], p-value=0.69) did not differ between the control and music groups. However, the maximum pain score (7.6 [1.2] vs. 5 [1.3], p-value<0.001) and postoperative opioid consumption (61.1 [11.8] vs. 31.9 [11.3], p-value<0.001) were higher in the control group than in the music group.
Conclusion: Listening to hemispheric synchronized sounds during an operation did not affect postoperative cognitive dysfunction and delirium. However, music therapy decreased the level of pain and the need for analgesic drug intake postoperatively.

Synergistic Governance of Research Integrity and Mentorship under the PI System: A “Co-construction” Model for Pharmacy Education

Jian Yang — 2026-08-21

Objective: This study aims to dissect the institutional mechanisms of mentorship alienation under the Principal Investigator (PI) system in pharmacy education and to propose a systemic governance model for research integrity. The transition to the PI system, while boosting innovation, has inadvertently induced a “Pressure Cascade” that strains the traditional educational bond. This systemic pressure often rationalizes Questionable Research Practices (QRPs), which directly threaten the reliability of pharmaceutical research and national bio-security.
Material and Methods: As a theoretical analysis and policy perspective, this study integrates Social Learning Theory and Ethical Leadership Theory to deconstruct the mechanisms of ethical erosion and the “knowledge-behavior gap” within the laboratory microcosm. Furthermore, an institutional analysis is utilized to examine the structural constraints imposed by the PI system, specifically the invasion of instrumental rationality and the formation of an interest-bound community under rigid Key Performance Indicators (KPIs).
Results: Our analysis reveals that the PI system often forces supervisors to prioritize task leadership over explicit ethical management, resulting in a deficit of the “Moral Manager” dimension. To address this root cause, we developed the “Mentorship Co-construction” (Dao-Xue-Gong-Jian) model, which shifts the paradigm from unilateral supervision to systemic co-governance. The model synergizes three dimensions: 1) reconstructing bilateral subjectivity by establishing “Bilateral Integrity Pacts” at entry; 2) integrating ethics into the daily scientific process through the “Glass Box” protocol for routine data auditing and normalizing negative results; and 3) providing ecological support by decoupling tenure reviews from purely quantitative metrics and establishing an independent Ombudsperson System.
Conclusion: Safeguarding research integrity in the PI era demands a systemic reconstruction of the mentorship ecosystem. The “Co-construction” model offers a sustainable path to harmonize high-efficiency scientific production with high-standard ethical cultivation, ensuring the reliability of pharmaceutical research.