Chiangrai Medical Journal

Prevalence and predictors of normal coronary arteries in patients undergoing coronary angiography

2025-03-10T13:52:50+07:00

BACKGROUND: Coronary angiography (CAG) is a gold standard procedure for diagnosing coronary artery disease (CAD), despite its invasiveness and potential complications. Proper patient selection can minimize over investigation, thus reducing the risk of complications, cost, and the burden on the medical team.

OBJECTIVE: This study aims to assess the prevalence of normal coronary arteries in patients undergoing coronary angiography and to identify factors which predict normal coronary arteries.

METHODS: A retrospective observational cross-sectional study was conducted on patients aged over 18 years who underwent elective coronary angiography at Chiangrai Prachanukroh hospital between January 1st and December 31st, 2023.

RESULTS: Among the 122 patients undergoing elective CAG, 61.5% being male and having a mean age of 63.5 years, with 36.1% exhibited normal coronary arteries. Factors significantly associated with normal CAG results included female gender (adjusted OR 6.20; 95% CI 2.03-18.94, p= 0.001), age under 60 years (adjusted OR 3.08; 95% CI 1.07-8.85, p= 0.037), dilated cardiomyopathy (adjusted OR 14.64; 95% CI 2.90-73.94, p= 0.001), and absence of dyslipidemia (adjusted OR 5.27; 95% CI 1.54-18, p= 0.008).

CONCLUSIONS AND RECOMMENDATIONS: In patients undergoing elective CAG, female gender, age under 60 years, presence of dilated cardiomyopathy, and absence of hyperlipidemia were factors associated with normal coronary arteries. Non-invasive diagnostic methods should be considered to reduce unnecessary CAG, minimizing risks to patients and alleviating the burden on healthcare personnel.

Evaluation of the development of a Home ward care system for diabetic patients with hyperglycemia without acute complications through the application of medical technology: A case study at Phan hospital, Chiang Rai province

2025-02-18T13:22:05+07:00

BACKGROUND: Diabetes mellitus is a chronic disease with an increasing prevalence, leading to a growing number of hospital admissions. In response, a home-based inpatient care model has been developed, supported by a multidisciplinary health team in collaboration with families and communities. This approach aims to meet the essential treatment needs of patients while reducing inpatient bed occupancy rates within the healthcare system.

OBJECTIVE: To evaluate the outcomes of developing a Home ward care system for diabetic patients with hyperglycemia without acute complications, through the application of medical technology at Phan Hospital, Chiang Rai province.

METHODS: The evaluation research studied 9 personnel from Phan Hospital and a sample of 235 diabetic patients receiving “Home ward” care at Phan Hospital, Chiang Rai province, between October 1, 2023, and September 30, 2024. The evaluation was conducted using the CIPP Model framework, which consists of four aspects: context, input, process, and product. Research tools included personal questionnaires based on the CIPP Model and diabetic patient satisfaction surveys. Clinical outcomes were evaluated based on data recorded in the HOSxP system and the DMS Home ward system. The collected data were analyzed by using descriptive and inferential statistics.

RESULTS: It was found that (1) Context: The implementation was consistent with the hospital’s policies and the current public health issues. (2) Input Factors: There was support from management at all levels, including medical technology, personnel, and equipment (3) Development Process: The Chronic Care Model with its six components was applied. (4) Product Evaluation: The overall evaluation revealed that the average score across all dimensions was at a high level (𝑥̅ =4.30, S.D.=0.54). The diabetic patients reported the highest level of satisfaction with the service system (𝑥̅ =4.56, S.D.=0.61). In terms of clinical outcomes, the mean capillary blood glucose level (DTX) of diabetic patients before and after discharge from the Home ward program decreased significantly (p<0.001). Similarly, the mean glycated hemoglobin (HbA1c) levels at either 3 months or 6 months after discharge also showed a statistically significant reduction (p<0.001). When comparing data from 2023 to 2024, the incidence of acute complications among diabetic patients decreased from 3.93% to 2.63%, and the bed occupancy rate declined from 84.56% to 78.25%.

CONCLUSIONS AND RECOMMENDATIONS: Home-based inpatient care has been shown to improve clinical outcomes among patients with diabetes mellitus by reducing hospital bed occupancy and minimizing complications. It is recommended that the Home ward model be integrated into primary healthcare services to enhance the continuity and sustainability of care for patients with chronic illnesses through a collaborative, community-based approach.

Development of a surveillance system for monitoring contrast media-related adverse events in patients undergoing coronary angiography

2025-06-27T19:37:14+07:00

BACKGROUND: Contrast media have been developed for use in coronary angiography, which is a procedure for diagnosing coronary artery disease. However, some patients may experience adverse reactions, such as contrast media allergy and contrast media associated with acute kidney injury. Therefore, the development of a safety monitoring system is essential for surveillance, analysis, follow-up, and implementation of risk strategies to enhance patient safety.

OBJECTIVE: To develop a surveillance system for monitoring contrast media-related adverse events in patients undergoing coronary angiography, and to evaluate its effects on patients and healthcare professionals’ opinions.

METHODS: This study was an action research project based on the conceptual framework of Kemmis and McTaggart. It aims to develop a surveillance system for adverse reactions to contrast media in patients undergoing coronary angiography at Chiangrai Prachanukroh Hospital. The implemented development system was evaluated both in terms of patient safety and the opinions of research participants. This study was conducted between 1 December 2024 to 30 June 2025.

RESULTS: In the developed system, pharmacists assumed an additional role in conducting risk assessments and monitoring patients for adverse reactions to contrast media following coronary angiography. After the system’s development, a total of 62 patients were enrolled, and 2 cases experienced contrast media adverse reactions (3.23%), of which 1.61% had delayed adverse reactions with moderate severity. Contrast media associated with acute kidney injury were found in 1.61 percent of patients. The mean opinion score after development was significantly higher than that before development (mean difference = – 0.35; 95% CI: – 0.92 to – 0.17; p=0.002).

CONCLUSIONS AND RECOMMENDATIONS: Systematic surveillance for contrast media-related adverse events in patients undergoing coronary angiography can reduce potential risks and provide a more comprehensive understanding of the incidence of adverse reactions. Therefore, the system should be applied and expanded to include patients receiving contrast media for other procedures and those receiving other high-risk medications.

Characteristics and behaviors of pre-exposure prophylaxis (PrEP) use among men who have sex with men in Chiang Rai province

2025-06-09T13:04:10+07:00

BACKGROUND: Pre-exposure prophylaxis (PrEP) is an HIV prevention strategy that involves administering antiretroviral medication to individuals who are not yet infected with the virus, particularly among men who have sex with men (MSM), a high-risk population. Continuous monitoring of PrEP usage behaviors is essential.

OBJECTIVE: To examine the characteristics and usage behaviors of PrEP among MSM in Chiang Rai province.

METHODS: This descriptive cross-sectional study collected data from 188 participants between
1 August to 31 October 2024 using a snowball sampling technique. Data were gathered through
a questionnaire validated for content and reliability (CVI=0.94, Cronbach’s Alpha=0.92). Descriptive statistics, including frequencies and percentages, were used to analyze general information,
PrEP usage characteristics, and behaviors.

RESULTS: Among the participants, 140 individuals (74.47%) reported using daily oral PrEP. Of these, 90 % adhered to a daily regimen, and 65 % had never missed a dose. The remaining 48 participants (25.53%) used event-driven PrEP; within the past three months, 79.17% adhered to the 2-1-1 dosing schedule. Regarding condom use while on PrEP, 39.89% of the total sample (n=188) reported consistent condom use. In terms of overall PrEP usage behavior, 141 participants (75.00%) demonstrated good adherence, while 47 (25 %) exhibited moderate adherence, and none were classified as having poor adherence.

CONCLUSIONS AND RECOMMENDATIONS: It is recommended to continue promoting knowledge, understanding, and access to PrEP services, as well as supporting correct and consistent medication behaviors. These efforts can help reduce HIV infection rates among high-risk populations and sustainably contribute to the goal of ending the AIDS epidemic at the provincial level.

Seasonal and associated factors of stroke in Mueang Chiang Rai: A 3-year retrospective medical record review

2025-03-22T20:23:48+07:00

BACKGROUND: Previous studies have shown that colder seasons are associated with the occurrence of hemorrhagic stroke (HS), which has a poorer prognosis than ischemic stroke (IS). HS is associated with hypertension, smoking, and alcohol consumption. However, no study in Chiang Rai has focused on the relationship between seasonal variation and stroke subtype. This study aims to explore this association to improve understanding of related risk factors and to inform effective strategies for health promotion and stroke prevention.

OBJECTIVE: To compare the influence of seasonal variations and other contributing factors on the incidence of stroke in Mueang, Chiang Rai.

METHODS: A retrospective cross-sectional study was conducted using hospital records (ICD-10: I60-I66) from January 1, 2020, to December 31, 2022. Descriptive statistics were used to present patient characteristics, while multivariable logistic regression analysis examined associations between stroke subtype and risk factors. A significance level of p<0.05 was considered.

RESULTS: Patients under 65 years, hypertension, and alcohol consumption were significantly associated with HS compared to IS, with AORs of 1.64 (95% CI 1.17–2.32, p=0.005), 4.11 (95% CI 2.83–5.98, p<0.001), and 1.47 (95% CI 1.00–2.16, p=0.048), respectively. However, no significant association was found between stroke subtype and seasonal variation.

CONCLUSIONS AND RECOMMENDATIONS: There was no significant association between stroke occurrence and seasonal variation. However, age under 65 years, hypertension, and alcohol consumption were associated with HS compared to IS. Future studies should analyze monthly stroke incidence and consider additional environmental factors, such as average monthly temperature and air pollution, to better understand seasonal and other relevant risk factors for stroke.

The effectiveness of eyelid spa in dry eyes and Meibomian gland disease in eye clinic Dararassamee hospital

2025-02-11T15:02:51+07:00

BACKGROUND: Dry eye disease, Meibomian gland dysfunction (MGD), and blepharitis are common ophthalmological conditions frequently encountered in outpatient departments. Patients often present with symptoms such as eye irritation, redness, tearing, excessive eye mucus, or, in severe cases, complications like conjunctivitis, styes, or keratitis. Meibomian gland disease involves the occlusion of sebaceous glands in the eyelids, leading to an unstable lipid layer in the tear film. This instability causes increased tear evaporation, resulting in a condition known as evaporative dry eye. Eyelid care typically includes warm compresses and cleaning the eyelid margin to unblock the Meibomian glands. Gentle compression can help release the occluded meibum, improving gland function.

OBJECTIVE: To evaluate the effectiveness of eyelid spa treatments in reducing symptoms of dry eye disease and blepharitis at the Eye Clinic of Dararassamee Hospital.

METHODS: This retrospective quasi-experimental study included 59 patients diagnosed with dry eye disease and blepharitis who underwent eyelid spa treatments between January 1 and December 31, 2024. Data were collected from two sources: (1) therapy activities from the hospital database to calculate treatment costs and (2) quality-of-life assessments using the Dry Eye-Related Quality-of-Life Score (DEQS-Th) questionnaire. Statistical analysis was performed using the STATA18 program.

RESULTS: The study found that patients received an average of four eyelid spa treatments per case, resulting in statistically significant improvements in quality of life and satisfaction related to eye disease (p<0.001). Most patients' treatment regimens became simpler, requiring fewer medications and significantly reducing treatment costs (p=0.020 and <0.001).

CONCLUSIONS AND RECOMMENDATIONS: Eyelid spa treatments effectively reduce the severity of dry eye disease and Meibomian gland dysfunction, improve patients' quality of life, and decrease treatment costs.

Factors associated with hypoglycemia in patients with type 2 diabetes treated with insulin at Wiang Pa Pao hospital: A 5-year review

2025-03-24T13:58:30+07:00

BACKGROUND: Hypoglycemia in diabetic patients can be severe and even life-threatening. It is a significant cause of fear among patients using diabetes medications, leading to poor glycemic control and subsequent complications.

OBJECTIVE: To identify risk factors for hypoglycemia requiring hospitalization in type 2 diabetic patients treated with insulin injections at Wiang Pa Pao hospital.

METHODS: This is a retrospective case control study conducted over five years. Data were analyzed using t-test and chi-square test, and multiple logistic regression analysis was used to identify associated factors with backward elimination for variable selection.

RESULTS: From 2019 to 2023, 248 patients were hospitalized due to drug induce hypoglycemia.
The factors reducing the risk of hypoglycemia include, female (AOR 0.508, 95% CI 0.36-0.84, p=0.005), education level of high school or above (AOR 0.246, 95% CI 1.12-0.49, p<0.001), BMI greater than 18.5 kg/m² (AOR 0.334, 95% CI 0.90-20.38, p=0.001), hyperlipidemia (AOR 0.435, 95% CI = 0.27-0.69, p<0.001) and renal complications (AOR 0.143, 95% CI = 0.03-0.52, p=0.004). The factors increasing the risk of hypoglycemia include, hypertension (AOR 2.37, 95% CI 1.38-4.06, p=0.002), cerebrovascular complications (AOR 2.329, 95% CI 1.03-5.24, p=0.041), Aspart (NovoMix) INJ 300IU/3mL (AOR 4.98, 95% CI 2.00-12.38, p=0.001).

CONCLUSIONS AND RECOMMENDATIONS: The factors associated with hypoglycemia include gender, education level, BMI, hypertension, hyperlipidemia, renal complications, and the use of Aspart (NovoMix) INJ 300IU/3mL. Patients with these risk factors should be closely monitored and given appropriate guidance.

Efficacy of telling blood test with a trend graph to decrease levels of HbA1c and direct LDL in diabetes patients

2025-03-10T14:07:57+07:00

BACKGROUND: Uncontrolled diabetes is a significant contributor to high annual mortality rates. In Thailand, physicians typically inform patients of their HbA1c and direct LDL levels through verbal communication. However, a review of the literature found no clinical trials comparing the effectiveness of traditional verbal communication and trend graph communication in reducing HbA1c and direct LDL levels among patients with diabetes.

OBJECTIVE: To compare the efficacy of traditional verbal communication versus trend graph communication in conveying blood test results for reducing HbA1c and direct LDL levels in patients with type 2 diabetes.

METHODS: Patients with type 2 diabetes mellitus at subdistrict health promoting hospital in Chiang Rai were randomized in an open-label design into two groups: a control group that received blood test results through traditional verbal communication and an intervention groupthat received blood test results through trend graph communication. Each group will receive treatment and be provided with their blood test results twice: on the first day of study enrollment and at the 3-month follow-up. HbA1c and direct LDL levels will be monitored at 3 and 6 months after the study begins. The efficacy will be compared within and between groups using the mean differences in blood test results from 0 to 3 months and from 0 to 6 months, analyzed with paired t-test and independent t-test.

RESULTS: A total of 120 patients were included, and 98 patients met the criteria. The baseline characteristics, including initial HbA1c and direct LDL levels, were not statistically different between the two groups. At the end of 6 months, the mean differences in the reduction of HbA1cand direct LDL between the trend graph communication group and the traditional verbal communication group were not statistically significant [HbA1c: mean difference -0.04 (95% CI -0.25 to 0.16), p=0.661; direct LDL: mean difference 4.33 (95% CI -4.76 to 13.41), p=0.347]. However, within the trend graph communication group, HbA1clevels showed a statistically significant reduction from baseline [mean change -0.14 (95% CI -0.25 to -0.04), p=0.010].

CONCLUSIONS AND RECOMMENDATIONS: Both groups were able to reduce HbA1c and direct LDL levels over 6 months, with no significant difference in efficacy. However, trend graph communication demonstrated a slightly greater reduction in HbA1clevels. This approach may serve as an additional tool to support patients with type 2 diabetes in better managing their HbA1c and direct LDL levels.

The impact of BRCA gene mutation screening in individuals with indications for genetic testing: A descriptive study at Nan hospital

2025-06-29T09:51:14+07:00

BACKGROUND: Breast cancer incidence has been increasing annually and remains a leading cause of premature mortality. Inherited mutations in the BRCA1 and BRCA2 genes are among the key genetic causes. Genetic screening can help identify individuals at high risk, enabling early monitoring and potential risk reduction. In Thailand, the Ministry of Public Health and the National Health Security Office have supported BRCA testing for high-risk patients and their direct relatives, aiming to enhance surveillance and reduce breast cancer incidence.

OBJECTIVE: To study the effect of BRCA gene mutation screening in individuals with indications for genetic testing.

METHODS: This study was a descriptive study conducted on a group of 125 individuals with indications for genetic testing of BRCA1 and BRCA2 mutations who received treatment at Nan Hospital. The participants underwent laboratory testing through genetic sequencing using next-generation sequencing (NGS) from August 2024 to January 2025. Data were analyzed for frequency, percentage, and mean values.

RESULTS: A total of 125 individuals with indications for genetic testing were included in the study, comprising 122 females and 3 males. The average age was 51.88±11.76 years. Of these, 116 cases were breast cancer patients and 9 cases were first-degree relatives. Among the breast cancer group, two declined BRCA testing, while 114 (98.28%) underwent mutation screening. Results showed no mutation in 90 cases (78.95%), variants of uncertain significance in 16 cases (14.04%), and pathogenic mutations in 8 cases (7.02%), equally distributed between BRCA1 (n=4) and BRCA2 (n=4). Among the relatives, 6 underwent testing, with two carriers of BRCA1 mutations were subsequently diagnosed with breast cancer

CONCLUSIONS AND RECOMMENDATIONS: Genetic screening is valuable for detecting abnormalities even in the absence of symptoms. Therefore, studying genetic counseling and exploring the factors influencing the decision to undergo or decline testing, both in patients and their direct relatives, is essential.

Development of a community-based tuberculosis care model by the health network of Chiangrai Prachanukroh hospital

2025-05-22T13:59:13+07:00

BACKGROUND: Tuberculosis patients have treatment success rates below the standard, with high rates of treatment default and mortality due to delayed treatment, lack of awareness, and limited community participation.

OBJECTIVE: To develop a community-based tuberculosis care model through the health network of Chiangrai Prachanukroh Hospital and evaluate its outcomes using the holistic care concept and evidence-based practice.

METHODS: The study consisted of four phases: 1) focus group discussions to analyze data, 2) development of the tuberculosis care model, 3) capacity building of the network and implementation of the model, and 4) outcome evaluation. Purposive sampling was used, included 20 health network members and 103 tuberculosis patients in each group registered for treatment at Chiangrai Prachanukroh Hospital before and after the model development. The study was conducted from December 2023 to October 2024. Data were collected using problem-solving summaries from focus groups, patient record forms, care outcomes, household contact screenings, socioeconomic support, and health network satisfaction surveys. Data were analyzed using descriptive statistics, Chi-square tests, and t-tests.

RESULTS: The community-based tuberculosis care model consists of home visits, screening of household contacts, and social and financial support. Implementation of the model led to increased treatment success rates, decreased mortality rates, and no treatment defaults; however, these differences were not statistically significant (p=0.082, 0.530, and 0.121). The network demonstrated increased satisfaction in terms of knowledge, referral processes, information coverage, and consultation (p<0.001). Home visits were conducted according to the model, with 100% timeliness and 89.36% coverage, which was lower due to patient deaths before treatment completion. Screening of household contacts and provision of social and financial support also increased.

CONCLUSIONS AND RECOMMENDATIONS: The developed community-based tuberculosis care model is appropriate for managing tuberculosis patients in the community. It enhances the quality of nursing care and leads to improved patient treatment outcomes. It is recommended that tuberculosis screening be further strengthened in high-risk chronic disease groups to ensure comprehensive coverage, as mortality remains high among patients with severe symptoms who enter tuberculosis treatment late.

The effects of a self-management program on reducing hypertension among patients with chronic kidney disease undergoing hemodialysis

2025-04-04T09:47:51+07:00

BACKGROUND: Hypertension in patients with chronic kidney disease (CKD) undergoing hemodialysis is a significant health concern, as it increases the risk of stroke and myocardial infarction. It also negatively impacts patients' quality of life and contributes to long-term complications.

OBJECTIVE: To assess the impact of a self-management program designed to mitigate hypertension in individuals with CKD receiving hemodialysis.

METHODS: This quasi-experimental study employed a one-group pretest-posttest design to investigate the effects of a self-management program on reducing hypertension in patients with CKD undergoing hemodialysis. The study spans from December 14, 2023, to April 30, 2024, and includes a sample of 30 patients. Descriptive statistics were used to summarize participants’ general characteristics. The paired t-test was applied to compare mean scores of self-management behaviors and hypertension-related knowledge before and after the program, while changes in blood pressure were analyzed using the Wilcoxon matched-pairs signed rank test.

RESULTS: After participation in the self-management program, patients with CKD receiving hemodialysis exhibited a considerable increase in self-management behaviors and knowledge of blood pressure control. They were significantly different from the original (47.90±3.41 v.s. 65.90±2.22, p<0.001 and 7.53±1.19 v.s.10.83±1.26, p<0.001, respectively). And average systolic pressure and diastolic pressure decreased significantly from before the experiment (155.87±6.34 v.s. 150.40±8.54, p<0.001 and 79.23±6.76 v.s. 77.10±5.12, p=0.028, respectively).

CONCLUSIONS AND RECOMMENDATIONS: The self-management program successfully diminished the number of individuals with CKD receiving hemodialysis who frequently had hypertension. The standardization of the program in nursing care for this patient demographic is advised to enhance self-management behaviors, regulate hypertension, mitigate the risk of complications, and ultimately improve the patients’ quality of life.