Hua Hin Medical Journal

Factor Affecting Intracranial Hemorrhage in Ischemic Stroke Patient after Receiving Intravenous rt-PA in Hua Hin Hospital

pichaporn surawongsin — 2024-12-31

Background: The incident of ischemic stroke in Thailand is increasing and leading to higher morbidity and mortality. The standard treatment of ischemic stroke onset lease than 4.5 hours is intravenous thrombolytic or IV rt-PA. The most serious complication of IV rt-PA is intracranial hemorrhage that is resulting to more disability and death of ischemic stroke patient.

Objective: This research attempts to find out factor associated with increasing risk of intracranial bleeding after receiving IV rt-PA in ischemic stroke patient at Hua Hin Hospital.

Method: This study is retrospective analytical study. The data are collected from medical records of patients who diagnosed with acute ischemic stroke and receiving IV rt-PA during the period from 1 January 2020 to 31 December 2022. The data are analyzed by Logistic regression analysis.

Results: A total number of ischemic stroke patient who receiving IV rt-PA is 84 and the incident of intracranial hemorrhage is 15 or 17.85%. The factor that we comparing are sex, age, underlying disease, atrial fibrillation, using of antiplatelet and anticoagulant, blood pressure, NIHSS score, onset to rt-PA, creatinine, blood sugar, coagulogram, platelet count. The factor associated with intracranial hemorrhage is platelet number (adj.OR 15.94, 95%CI 1.84 - 138.18, P=0.012). The factor that possibly be associated are NIHSS score more than 13 (adj.OR 3.24, 95%CI 0.86 - 12.15, P=0.082), time onset to rt-PA more than 210 min (adj.OR 2.61, 95%CI 0.68 - 10.07, P=0.164).

Conclusion: The Factor affecting intracranial hemorrhage in ischemic stroke patient after receiving intravenous rt-PA in Hua Hin Hospital is platelet level.

Effects of Educating by Digital Media Combined with Communication via Social Media on Knowledge, Health Behavior and Blood Pressure of Hypertensive Patients at Outpatient Department, Phrae Hospital

Mallika Vienghok — 2025-02-13

Background: Hypertension is a continually increasing health problem, and lead to severe complication or death If blood pressure levels cannot be controlled. Providing health education leads to modified health behavior and blood pressure levels control for outpatients has several limitations. Therefore, the researcher conducted studied effects of educating by digital media combined with communication via social media on knowledge, health behavior and blood pressure of hypertensive patients at outpatient department, Phrae Hospital as a guideline for developing providing health education for hypertensive patients and other patient groups.

Objective: To study the effects of digital media education combined with social media communication on knowledge, health behaviors, and blood pressure levels among hypertensive patients at the outpatient department of Phrae Hospital.

Method: This research is a quasi-experimental pretest-posttest comparison group designed, 56 hypertensive patients at outpatient department, Phrae Hospital, divided into an experimental and comparison group of 28 people each. The experimental group received education through digital media combined with social media communication, while the comparison group received through standard methods. Data were collected using hypertension knowledge assessment form with CVI and KR-20 values of 0.87 and 0.81, health behavior assessment form based on the 3E 2S principles, with CVI and Cronbach's alpha coefficient values of 0.90 and 0.85, and blood pressure self - records form. Data were analyzed with chi-square test, paired t-test, Wilcoxon sign-ranks test, and Mann - Whitney U test.

Results: After receiving digital media education combined with social media communication, the experimental group had higher scores in hypertension knowledge and health behaviors compared to before the intervention, and higher health behavior scores than the comparison group with statistical significance at the .001 level. However, there was no significant difference in hypertension knowledge between the two groups (p >.05). Furthermore, the experimental group showed lower blood pressure levels than pre-intervention with statistical significance at the .001 level, while the comparison group showed no significant difference in blood pressure levels before and after the intervention.

Conclusion: Digital media education combined with social media communication improves hypertension knowledge, health behaviors, and blood pressure control in hypertensive patients more effectively than traditional education methods.

Comparison of Success Rates between Ultrasound-guided Intercostobrachial and Medial Brachial Cutaneous Nerve Blocks and Ultrasound-guided Subcutaneous Infiltration in Upper Limb Surgery Patients, A Randomized Controlled Trial

Donpicha Woonprasert — 2024-12-31

Background: The intercostobrachial and medial brachial cutaneous nerves can be anesthetized to block sensation in the inner upper arm either through subcutaneous infiltration or direct nerve injection. However, there have been no studies comparing the success rates between ultrasound-guided selective nerve block and subcutaneous infiltration for anesthetizing these nerves.

Objective: To compare the success rate of numbness at the inner upper arm between ultrasound-guided intercostobrachial and medial brachial cutaneous nerves block and ultrasound-guided subcutaneous infiltration in upper limb surgery patients. Additionally, the onset time of anesthesia between the two techniques was evaluated.

Methods: This randomized single-blinded controlled trial was conducted on 18 patients undergoing upper limb surgery at Samut Sakhon Hospital. Patients were selected based on specific criteria and randomly divided into two groups, each with 9 participants. General demographic data were collected. Sensory testing of the inner upper arm at 4 locations was conducted every 5 minutes for a total of 20 minutes after the injection. The number of patients experiencing numbness after local anesthetic injection was compared using the Chi-square test.

Result: The success rate of the intercostobrachial and medial brachial cutaneous nerve block group was 88.9% [95%CI 51.8, 99.7], which was higher than the subcutaneous infiltration group (66.7% [95%CI 29.9, 92.5]), although the difference was not statistically significant (P=0.257). However, the onset time for complete numbness at all four locations was significantly faster in the nerve block group (P<0.05). In the nerve block group, 87.5% of patients achieved complete numbness within 0-5 minutes, compared to 33.3% in the subcutaneous infiltration group.

Conclusion: The ultrasound-guided intercostobrachial and medial brachial cutaneous nerve block tended to have a higher success rate and faster onset of anesthesia compared to subcutaneous infiltration.

The Effects of a Cardiac Rehabilitation Program on Ischemic Heart Disease Patients after Stent Placement at Hua Hin Hospital, Prachuap Khirikrun Province

napaporn sangsanga — 2024-12-31

Background: Myocardial infarction is a leading cause of death globally, including in Thailand, where it ranks as the second leading cause of mortality. The trend of deaths due to myocardial infarction continues to rise each year, making it a major public health issue. Currently, the treatment of coronary artery disease with coronary stent implantation is considered an effective and widely accepted method. It is known for high efficiency, minimal complications, and favorable outcomes. After treatment, it takes time to help the heart muscle recover, allowing the heart to function efficiently again. Most patients who experience complications do so due to a lack of knowledge about proper self-care, cardiac rehabilitation after receiving a stent, and education on appropriate exercise and daily activities. These factors can help reduce complications and improve the body's functional abilities.

Objective: To compare knowledge before and after receiving the cardiac rehabilitation program, assess physical fitness using the 6-Minute Walk Test (6 MWT), and evaluate satisfaction with the cardiac rehabilitation program.

Method: The preliminary experimental research design (pre-experimental research) using a one-group pretest-posttest design was conducted. The sample consisted of patients with acute myocardial infarction who had undergone percutaneous coronary intervention with stent placement. The participants included both male and female patients aged between 18 to 65 years, who were hospitalized at Hua Hin Hospital. A purposive sampling method was used to select 30 participants. The research instruments included two parts: 1) various assessment forms and 2) a cardiac rehabilitation program. The program was designed in accordance with the ethical standards for human research. The content validity was determined to be 0.97, the Index of Inter-Object Congruence (IOC) was 0.97, and the reliability was 0.75. The data were analyzed using descriptive statistics and inferential statistics (Paired sample t-test).

Results: 1. Personal information: The majority of patients with coronary artery disease who underwent stent insertion were male, with 22 individuals (73.3%), compared to 8 females (26.7%). The average age was 55.8 years (S.D. 8.53), with 80% of the patients being between 50-65 years old. Most were married (80%). In terms of education, 43.3% had completed only primary school. The majority had a monthly income between 5,001-10,000 Baht (33.3%) and were employed as laborers (43.3%). Additionally, 56.7% had underlying health conditions, and 39.9% had a BMI between 18.6-22.9. 2. The patients showed a statistically significant increase in knowledge before and after receiving the cardiac rehabilitation program (P<0.05). 3. The physical fitness, as assessed by the 6-minute walk test (6MWT), significantly improved (p<0.05), with an average distance of 214.23 ± 31.44 meters before and after.4. The satisfaction with the heart rehabilitation program at a high level (= 2.88)

Conclusion: Patients with ischemic heart disease who received stent placement at Hua Hin Hospital in Prachuap Khiri Khan Province showed significant improvement in knowledge and physical fitness following the cardiac rehabilitation program, with statistical significance at the 0.05 level. Additionally, they reported a high level of satisfaction with the cardiac rehabilitation program (=3.00)

Result of The Heart Failure Clinic at Nakhon Chai Si Hospital, NakhonPathom Province

Sapol Theerawattanawit — 2024-12-31

Background: Patients hospitalized with acute heart failure had high heart failure re-hospitalization rate. The previous studies showed that the heart failure clinic with multidisciplinary team can reduce heart failure re-hospitalization.

Objective: To evaluate the effect of the heart failure clinic on 30-day heart failure re-hospitalization after patients were admitted with acute heart failure at Nakhon Chai Si Hospital.

Methods: In this retrospective cohort study, the data were collected from the medical record of patients who were hospitalized with acute heart failure at Nakhon Chai Si Hospital, Thailand from October 2022 to December 2023 and were followed up at the outpatient clinic. The patients were assigned to the heart failure clinic with multidisciplinary team which is composed of physicians, nurse, pharmacists and nutritionists or the general clinic which physicians are the main practitioners.

Results: There were 144 patients in this study. 64 patients were followed up at the heart failure clinic. 80 patients were followed up at the general clinic. The mean age was 67.9 years. 34.7 percents of patients were male. There were 6 patients (9.4%) in the heart failure clinic group were re-hospitalized with recurrent heart failure at 30 day, while there were 21 patients (26.2%) in the general clinic group (p=0.010). There were 12 patients (18.8%) in the heart failure clinic group were re-hospitalized with any causes at 30 day, while there were 29 patients (36.2%) in the general clinic group (p=0.021). In univariate analyses, the 30-day heart failure re-hospitalization was lower in the heart failure clinic group (odd ratio [OR] 0.291, 95% confidence interval [CI] 0.109-0.772, p=0.013). In multivariate analyses, the 30-day heart failure re-hospitalization was also lower in the heart failure clinic group (OR 0.217, 95% CI 0.071-0.669, p= 0.008).

Conclusion: The heart failure clinic with multidisciplinary team in patients who were hospitalized with acute heart failure can reduce both 30-day heart failure re-hospitalization and 30-day re-hospitalization.

Evaluation of the Surveillance System and Management of Arthritis in Sexually Transmitted Infection Patients Aged 15-24 at Samut Prakan Hospital, Thailand, 2023

Seksit Sangiamsak — 2024-12-31

Background: Syphilis remains a significant public health concern among adolescents and young adults, particularly in the 15-24 age group. Arthritis is a complication that can affect patients' quality of life. Evaluating the surveillance system and analyzing the management of Arthritis symptoms in syphilis patients is crucial for developing improved care and prevention strategies.

Objective: To evaluate the surveillance system for Arthritis symptoms in sexually transmitted infection patients aged 15-24 years and to analyze the management and diagnosis of Arthritis symptoms in syphilis patients of the same age group at Samut Prakan Hospital.

Method: This descriptive study involved reviewing medical records of 97 syphilis patients aged 15-24 years in 2023 and conducting in-depth interviews with 13 stakeholders involved in the surveillance system. Data were analyzed using descriptive statistics and content analysis. Both quantitative and qualitative characteristics of the surveillance system were assessed, along with an analysis of the diagnosis process and management of Arthritis symptoms.

Results: The surveillance system showed a sensitivity of 37.11% and a positive predictive value of 100%. Data quality was 100% complete and accurate, with 91.67% timeliness. Correct diagnosis of Arthritis symptoms was achieved in 72.0% of cases. Pain medication and antibiotics were used in 100% of cases, with rehabilitation therapy in 87.6%. The surveillance system was found to be user-friendly, flexible, and stable, but issues were identified regarding access to certain data and delays in modifying information in the medical record system.

Conclusion: The surveillance system demonstrates high accuracy but low sensitivity. The diagnosis and treatment of Arthritis symptoms in syphilis patients are effective, but there is room for improvement. Enhancements to the surveillance system, development of diagnostic and treatment guidelines, and education of medical personnel are recommended to improve the care of syphilis patients with Arthritis symptoms.