PSU Medical Journal

Frailty in Elderly Undergoing Cardiac Surgery

Nichakan Rewurai — 2024-12-18

Currently, there is a growing population of elderly individuals with frailty who require cardiac surgery. Frail patients experience significantly higher rates of postoperative complications, in-hospital mortality, and prolonged stays in the ICU and hospital compared to those without frailty. Therefore, preoperative assessment of frailty is deemed essential for timely diagnosis and comprehensive care planning. This article has compiled knowledge on assessing frailty before surgery, as well as caring for patients with frailty throughout the preoperative, perioperative, and postoperative phases of cardiac surgery. This knowledge aims to improve the care of elderly individuals with frailty undergoing cardiac surgery.

Delayed Detection and Immediate Repair of Iatrogenic Ureteral Injury in Laparoscopic Anterior Resection with Partial Cystectomy: Lessons Learned

Thanat Tantinam — 2024-12-18

Objective: This video intends to illustrate the pitfalls during laparoscopic anterior resection with partial cystectomy, causing ureteral injury, and why a delayed detection occurred.
Material and Methods: A 72-year-old male with T4 rectosigmoid colon cancer involving the bladder underwent laparoscopic anterior resection with partial cystectomy. Postoperatively, urinary leakage raised concern for bladder leakage, prompting conservative management for 2 weeks. Persistent leakage led to further investigation. A CT scan with cystography revealed an iatrogenic left ureteral injury without bladder leakage. The patient immediately underwent repair in the third postoperative week. This video highlights the operative challenges encountered during our review.
Results: The diagnosis of ureteral injury was initially obscured by the suspicion of bladder leakage following a partial cystectomy. The delayed diagnosis occurred due to the initiation of conservative management. After detecting the injury, the patient immediately underwent left ureteric re-implantation and experienced an uneventful discharge in the second postoperative week. A video review revealed challenging aspects that could provide vulnerable insights for future procedures.
Conclusion: During concomitant partial cystectomy, the ureters must be identified clearly. The suspicion of bladder leakage post-cystectomy can obscure iatrogenic ureteral injury. Delayed diagnosis of ureteral injury can be promptly repaired in cases where the preceding operation utilizes a laparoscopic approach, which is associated with less intraabdominal adhesion.

The Rising Heat: Climate Change and the Future of Health in Thailand

Puttisak Puttawibul — 2024-12-18

Reviewer Acknowledgement, 2024

Puttisak Puttawibul — 2024-12-18

Innovative Design and Practical Reflections on Teaching Ideological and Political Aspects of ‘Pharmacoeconomics’ in the Digital Era

Zaixian Yang — 2024-12-18

Objective: This study examines the innovative design and practical application of ideological and political (IP) teaching in the Pharmaceutical Economics course in a digitally evolving educational landscape. It seeks to effectively integrate IP education into the curriculum, enhance the synergy between disciplinary and IP education, and foster students’ holistic skills and social responsibility.
Material and Methods: The research began with a literature review to identify the unique characteristics of the “Pharmaceutical Economics” course and the theoretical underpinnings of IP teaching in a digital context. It then employed empirical analysis, using specific teaching cases to compare the outcomes and challenges of innovative versus traditional teaching methods. Finally, feedback from students and teachers was gathered through interviews and surveys to provide deep insights into the practical implementation of these methods.
Results: Findings indicated that leveraging online platforms and digital resources enhances the diversity and engagement of “Pharmaceutical Economics” teaching. Integrating IP education into professional instruction not only helps students link theory with practice, enhancing their overall qualities and skills, but also improves the relevance and effectiveness of IP education. Nonetheless, challenges persist; including the selection and use of digital resources, the impact of blended learning, and the fairness and accuracy of evaluations.
Conclusion: Digital teaching opens new avenues for incorporating IP education in “Pharmaceutical Economics”. Careful strategic and methodological choices are required to ensure the pedagogical rigor and effectiveness of IP education. Future research may explore the transformation of teacher roles in digital environments, the empowerment of student agencies, and the seamless integration of online and offline teaching modalities.

Clinical Utility of Fasting Plasma Glucose and Hemoglobin A1C (HbA1C) for the Prediction of Type 2 Diabetes Mellitus Diagnosed by Oral Glucose Tolerance Testing in Cirrhotic Patients with Impaired Fasting Plasma Glucose

Chanin Chareesil — 2024-12-18

Objective: Use of fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) levels has been ineffective in diagnosing diabetes in cirrhotic patients. The aim of this study was to determine the prevalence and optimal cut-off levels of FPG and HbA1c for effective prediction of type 2 diabetes mellitus (T2DM) as definitely diagnosed by the 75-gram oral glucose tolerance test (75-g OGTT) in cirrhotic patients with impaired fasting plasma glucose (IFG).
Material and Methods: This single-center, cross-sectional study conducted in Nan Hospital included cirrhotic patients with IFG that were diagnosed as T2DM or non-T2DM via 75-g OGTT. The clinical factors associated with the presence of T2DM were investigated using univariate and multivariate regression models.
Results: T2DM was diagnosed according to 75-g OGTT in 55 of the 103 participants (53.40%); impaired glucose tolerance (IGT) was diagnosed in 22.33%, and normal OGTT results were found in 24.27%. An FPG level of ≥104.5 mg/dL and an HbA1c level of ≥5.25% were found to be the optimal cut-off levels for the prediction of T2DM. The FPG level had a sensitivity of 76.4%, 95% confidence interval (CI) [63.0%, 86.8%], and a specificity of 37.5%; 95% CI [24.0%, 52.6%]. HbA1c levels had a sensitivity of 67.3%; 95% CI [53.3%, 79.3%] and a specificity of 37.5%; 95% CI [24.0%, 52.6%]. Hepatitis C virus (HCV) infection, high Child-Pugh score, and high level of FPG before the 75-g OGTT testing were significantly associated with T2DM.
Conclusion: More than half of the cirrhotic patients with IFG had T2DM diagnosed by 75-g OGTT. An FPG level of ≥104.5 mg/dL and an HbA1c level of ≥5.25% were found to be the optimal cut-off levels for the prediction of the presence of T2DM in those with cirrhosis and IFG.

Factors Affecting Effectiveness of Patient Care Process through Lean Management in the Recovery Room of Songklanagarind Hospital: A Retrospective Cohort Study

Maliwan Oearsakul — 2024-12-18

Objective: To determine the effectiveness and factors influencing the extension of time in the Lean patient care process in the recovery rooms of Songklanagarind Hospital.
Material and Methods: This retrospective study involved inpatients aged 15-60 years, ASA class I-II, receiving general anesthesia between January and December 2020, with a total of 2,004 cases. The patient care process utilized the Lean management concept, which was developed in the previous study and is currently employed as a cultural framework. Data were collected using a modified record form from the previous study.
Results: Found cost-effectiveness with a median total lead time (TLT) for the caring process of 45 minutes. Specifically, 19.6% of patients had a TLT of ≤30 minutes, 57.8% had a TLT of ≤45 minutes, and 42.2% had a TLT of >45 minutes. The initial oxygen use was 30.2%, reducing oxygen usage costs by 272,805 baht per year. In terms of safety effectiveness, the incidence of respiratory complications in the recovery room and within 24 hours after discharge to the ward was found to be 8.8% and 2.9%, respectively. Factors affecting cost-effectiveness were surgical site, initial oxygen use, respiratory complications, nausea-vomiting, shivering, other complications in the recovery room, and pain.
Conclusion: The Lean concept is applicable to continue adjusting healthcare work processes to reduce waste, save costs, and increase work productivity within the standards of quality and safe organization.

Comparative Effectiveness of Blended Teaching Models with Micro-Teaching Assistants in Clinical Pharmacokinetics Education

Zhang Xiaofang — 2024-12-18

Objective: This study aimed to evaluate the effectiveness of micro-teaching assistants within a hybrid online-offline teaching framework in the context of clinical pharmacokinetics education.
Material and Methods: A total of 320 clinical pharmacy students participated, with 143 students from earlier cohorts forming the control group and 177 students from the 2019 and 2020 batches comprising of the observation group. Traditional teaching methodologies instructed the control group, while the observation group benefited from a novel, blended teaching approach incorporating micro-teaching assistants. The evaluation criteria encompassed theoretical knowledge acquisition, practical skill development, pass rates, and score distribution.
Results: This investigation into clinical pharmacokinetics education demonstrates the superiority of a blended teaching model, enhanced by micro-teaching assistants, over traditional methodologies. The observation group, utilizing this approach, displayed a significant 15% increase in theoretical knowledge scores, maintained high practical skill levels, alongside achieving a 94.9% pass rate, markedly surpassing the control group’s 91.6%. Feedback from students corroborated the model’s effectiveness, with satisfaction scores exceeding 4.8 out of 5; despite potential respondent bias. Notably, the application of micro-teaching assistants was most pronounced in Pharmacology, highlighting its value in teaching complex theoretical content, and advocating for expanded use in medical education.
Conclusion: This study concludes that the integration of micro-teaching assistants into blended teaching strategies for clinical pharmacokinetics significantly improves educational outcomes. This approach not only facilitates a more effective learning environment but also underscores the potential of innovative pedagogical tools in enhancing student performance, and comprehension in complex subjects.