Hua Hin Medical Journal

Upper gastro-intestinal hemorrhage in patients with coronary stenting & double antiplatelet therapy (DAPT) administration beyond 1 year at Ratchaburi hospital

Atinan Wasuwat — 2025-04-30

Background: During COVID-19 worldwide pandemic, hundreds of patients whom managed with coronary stenting regard to various indication were scheduled to be followed up & treated by groups of non-cardiologist physicians, many of them were administrated with double anti-platelet therapy (DAPT) strategy, most of them were administrated with DAPT beyond one year, some of them were discontinued DAPT inappropriately due to lack of competency of non-cardiologists to use accepted criteria worldwide (such as DAPT scores which recommended by ACC/AHA) for appropriate DAPT discontinuation in those patients.

Objective: This study purpose is to study whether administration of extended double anti-platelet therapy (DAPT) causes higher incidence of upper gastro-intestinal hemorrhage then standard DAPT in patient with coronary stenting and to calculate duration from drug initiation to events.

Methods: This retrospective cohort study is conducted in patients who receive both standard DAPT & extended DAPT in consecutive fashion and explore incidence of upper gastro-intestinal hemorrhage and measure duration from date of drug initiation to date of first events.

Results: Among 342 patients (average follow up duration 21 months) there were no differences in baseline characteristics (age, sex, co-morbidity, concomitant drugs use, echocardiographic/angiographic data). Incidence of upper gastro-intestinal hemorrhage in patients with standard DAPT was lower than those with extended DAPT (4.8% versus 9.7% respectively) with hazard ratio 0.46 (statistically significant).

Conclusion: Patients with extended DAPT have higher incidence of upper gastro-intestinal hemorrhage than patients who take standard DAPT with statistically significance.

Factors Associated with Cerebral Vasospasm in Patients with Subarachnoid Hemorrhage Due to Ruptured Intracranial Aneurysm

Sarun Jotikasthira — 2025-04-30

Background: Subarachnoid hemorrhage (SAH) due to ruptured cerebral aneurysm is commonly complicated by cerebral vasospasm. Investigating its causes and modern treatment approaches is essential for selecting the most appropriate management strategies.

Objective: To identify factors associated with cerebral vasospasm in patients with subarachnoid hemorrhage from ruptured intracranial aneurysms.

Method: This quantitative, retrospective study was conducted using medical records. The sample included 55 patients diagnosed with cerebral vasospasm following subarachnoid hemorrhage from ruptured intracranial aneurysms at Hua Hin Hospital. Statistical methods used included percentage, frequency distribution, and multiple logistic regression analysis.

Results: Patient factors significantly associated with cerebral vasospasm included Hunt and Hess grade 3 or 4, WFNS grade 4 or 5, Modified Fisher grade 3 or 4, Glasgow Coma Scale motor response (M4 or M5), and presence of intracerebral hemorrhage.

Conclusion: Cerebral vasospasm was significantly associated with the following clinical factors: Hunt and Hess grade 3 or 4, WFNS grade 4 or 5, Modified Fisher grade 3 or 4, GCS motor score of M4 or M5, and intracerebral hemorrhage.

A Comparative Study of The Association between The Waiting Time for Appendectomy and Occurrence of Appendicitis Complications

Pothchara Tanchvalit — 2025-04-30

Background: Currently, there are research studies collecting data on delayed appendectomy compared to the group undergoing urgent surgery to study the effects of delayed surgery. The majority found no statistically significant difference. In addition, The World Journal of Emergency Surgery published the Jerusalem guidelines for appendicitis, which state that appendectomy for uncomplicated appendicitis within 24 hours does not differ in the occurrence of complications. (QoE: 1B) Therefore, it is possible to study the appropriate waiting time for planning appendectomy treatment, reducing the burden of emergency surgery, and increasing treatment options for appendicitis.

Objective: To compare appendectomy outcomes at Hua Hin Hospital, dividing patients into groups based on the time after diagnosis: those who underwent surgery within 1 hour, 1-6 hours, 6-12 hours, and after 12 hours, to study the effect on the occurrence of complications.

Methods: This is a retrospective study collecting data from patients diagnosed with appendicitis at Hua Hin Hospital from January 1, 2021, to December 31, 2023, totaling 839 cases. Descriptive statistics were used, and for continuous data, statistical tests were used, including the Chi-square test, One-way ANOVA, Kruskal-Wallis test, Binary logistic regression, Poisson regression, Mann-Whitney U test, and Spearman rho correlation.

Results: The waiting time for appendectomy in the groups operated within 1 hour, 1-6 hours, and 6-12 hours showed no statistically significant difference in the occurrence of complications. However, the group operated after 12 hours had a statistically significant reduction in the chance of developing gangrenous appendicitis and ruptured appendicitis at the 0.05 level (Multivariable analysis). The effect of surgical waiting time on the occurrence of abscess and phlegmon was found to be statistically insignificant (P>0.05)

Conclusion: The waiting time for appendectomy in the groups operated within 1 hour, 1-6 hours, and 6-12 hours showed no statistically significant difference in the occurrence of complications, which is consistent with previous research.However, this study found that the group operated after 12 hours had a lower chance of developing gangrenous appendicitis and ruptured appendicitis compared to the group operating within 1 hour.

Development of a Physical Therapy Guideline for Elderly Patients After Hip Fracture Surgery Undergoing Intermediate Rehabilitation at Hua Hin Hospital

Nattanun Saetang — 2025-04-30

Background: Hip fractures are a significant global public health issue, particularly among the elderly with osteoporosis, which increases the risk of falls and fractures. Over the past decade, the incidence of hip fractures in the elderly has risen by 30.4%, with a higher prevalence in women than men. Effective treatment for hip fractures includes surgical interventions such as internal fixation or hip replacement. Postoperative rehabilitation through physical therapy is crucial for helping patients regain functional independence. However, some patients experience delays in continuing physical therapy after discharge due to the need for physician referrals or transportation difficulties. Recognizing the importance of continuous care, this study aimed to develop a structured physical therapy guideline for elderly patients after hip fracture surgery undergoing intermediate rehabilitation, ensuring a systematic and coordinated approach among multidisciplinary teams.

Objective: To develop a systematic physical therapy guideline for elderly patients after hip fracture surgery undergoing intermediate rehabilitation at Hua Hin Hospital.

Methods: This study employed both qualitative and quantitative research methods. The study involved 7 content experts and 9 physical therapists from Hua Hin Hospital. The research instruments included a content validity assessment of the guideline, a satisfaction survey for physical therapists, and an in-depth interview with experts and physical therapists. The content validity of the guideline was evaluated using the Item-Content Validity Index (I-CVI) and Scale-Content Validity Index (S-CVI). Data analysis included frequency, percentage, and mean for general information, while qualitative data were analyzed using content analysis.

Results: The content validity assessment by experts indicated a high level of validity (I-CVI=0.87, S-CVI = 0.87). Additionally, all physical therapists expressed complete satisfaction with the developed guideline (100%).

Conclusion: The physiotherapy guidelines for elderly patients after hip fracture surgery undergoing mid-term rehabilitation at Hua Hin Hospital are academically sound. Practitioners can correctly follow the guidelines in a consistent manner, resulting in a systematic and continuous rehabilitation process for patients.

Development of Guidelines for The Control of Carbapenem - Resistant Enterobacteriaceae Drug Resistance in Pathumthani Hospital

Prapaporn Thumkaew — 2025-04-30

Background: Currently, antimicrobial-resistant bacteria pose a significant global public health problems, including Thailand. The number of patients infected with antimicrobial-resistant bacteria continue to increase annually, complicating treatment as stronger and more effective antibiotics are required, which in turn increases healthcare costs. Patients also need to stay in the hospital longer, which may lead to complications and increased risk of death. Carbapenem antibiotics are commonly used for treating hospital-acquired infections due to their high efficacy. However, as Enterobacteriaceae bacteria begin to develop carbapenem resistance, there is a growing concern that in the future, effective antibiotics for treating severe hospital infections may become unavailable.

Objective: The objective of this study was to assess the situation of Carbapenem-Resistant Enterobacteriaceae (CRE) infections in patients admitted to hospital and to develop strategies for controlling CRE infections in Pathumthani Hospital.

Methods: This study was a retrospective descriptive study involving patients admitted to Pathumthani Hospital between 2022 and 2024 who had bacterial cultures performed from various specimens and underwent testing for antimicrobial resistance genes. The data were analyzed to develop infection control guidelines.

Results: A total of 18,154 cases of Enterobacteriaceae bacteria were identified, with 2,161 cases of CRE, representing 32.25%, 33.82%, and 33.92% annually, respectively. CRE infections mostly caused issues in the respiratory system. The five most significant pathogens were Klebsiella pneumoniae (46.00%), Escherichia coli (38.72%), Klebsiella ozanae (6.91%), Enterobacter cloacae (5.63%), and Klebsiella aerogenes (2.73%). Males were more frequently affected than females, and the majority of affected patients were over 60 years old, accounting for 1,433 cases. The department with the highest incidence of CRE infections was the internal medicine department. Antibiotic susceptibility testing revealed that CRE was resistant to carbapenem antibiotics but still sensitive to amikacin. Gene testing showed that 68.75% of Escherichia coli isolates carried the blaNDM gene, and 80% of Klebsiella pneumoniae isolates carried the blaOXA48-like gene.

Conclusion: CRE infections in Pathumthani Hospital present a significant challenge that requires ongoing control and surveillance. Raising awareness and strict adherence to infection control protocols by all staff members are essential to enable the infection control committee to review processes and implement effective preventions and control measures.

Factors Related to the Performance of Village Health Volunteers to Operate Health Management Village in Samut Sakhon Province

Kanyanon Lumlert — 2025-04-30

Background: The development of health management village is a crucial approach to promoting community participation in their own healthcare. It aims to empower communities to think, set goals, manage, and continuously evaluate the outcomes of health initiatives. This is achieved through the leadership of Village Health Volunteers (VHVs), who drive operations with community involvement.

Objectives: To investigate the factors associated with the performance of Village Health Volunteers (VHVs) to Operate Health Management Village in Samut Sakhon Province.

Methods: This descriptive study was conducted among 400 Village Health Volunteers (VHVs) in Samut Sakhon Province with at least one year of experience in their VHV role. Participants were selected using simple random sampling. Data were collected through a questionnaire adapted from the Department of Health Service Support, Ministry of Public Health. The collected data were analyzed using descriptive statistics, including mean, percentage, standard deviation, Chi-square test, Cronbach’s alpha coefficient and Pearson's correlation coefficient. Statistical significance was set at p < 0.05

Results: The study found that most of the group were female (81.75%), with an average age of 56.55 years, married (52.50%), had completed primary school (49.25%), were Buddhist (99.75%), and worked in agriculture (30.25%). They had an average family income of 13,274 baht/month, and they had been a VHV for 5-10 years (26.75%), able to use smartphones for work (94.75%), and had received regular training from public health officials (99.75%). Overall knowledge of health managed village operations was high, as was the overall level of psychosocial factors. Analysis of the relationship between various factors and health managed village operations of VHVs in Samut Sakhon Province revealed a statistically significant relationship between personal factors (duration of VHV service, age, education level, and training from health officials) and overall psychosocial factors, and health managed village operations. Examination of the sub-factors of psychosocial factors revealed a statistically significant relationship between all factors and VHV health managed village operations, except for positive perception of others. Social support had the highest correlation, followed by influence over others, relationships with others, and job satisfaction, respectively.

Conclusion: Factors related to the performance of village health volunteers to operate health management village in Samut Sakhon Province include duration of VHV service, age, education level, training, social support, influence over others, relationships with others, and job satisfaction.

Recommendations: Government organizations have a fantastic opportunity to support personnel development by encouraging knowledge and work skills, facilitating exchange of experiences and listening to opinions that benefit the organization. This creates a fantastic learning process and a great way to pass on knowledge from generation to generation. It's such an important strategy for taking care of people to ensure good health, as well as building morale, encouragement, pride and acceptance from society, local communities and families of public health volunteers. The goal is to develop the public health service system and create cooperation among the public sector in taking care of good health sustainably.

Factors Affecting Satisfaction in Using Health Services at Primary Care Units and Network of Primary Care Units in Prachuap Khiri Khan Province

Supachai Sarapaiwanit — 2025-04-30

Background: Primary health care units or networks of primary health care units are considered "levers" in the health system that will make Thai people healthy. This is considered an important mission of the Ministry of Public Health. Therefore, it is essential to measure service quality, which directly affects the feelings of service recipients about the primary care unit and the primary care network, whether positively or negatively. Service satisfaction is the feeling or attitude of the service user after receiving the service or during the service, achieving the goal or receiving a service that matches what the service user expected. To achieve continuous and sustainable development of the health service system.

Objective: This research aimed to study the factors affecting the satisfaction in using health services at primary care units and primary care unit networks (PCU/NPCU) in Prachuap Khiri Khan Province.

Method: The research is descriptive research. The sample group was people aged 18-60 years living in the areas under the responsibility of 23 primary care units and primary care unit networks (PCU/NPCU) By accidental sampling, 460 people were recruited. The research was conducted from July 2024 to February 2025. The research instrument was a questionnaire divided into 3 parts: Part 1: general information; Part 2:expectations for the quality of health services; Part 3:satisfaction with using health services. Data were analyzed using frequency, percentage, mean, standard deviation, Pearson's product moment correlation coefficient and and stepwise multiple regression analysis.

Results: The results of the research found that most of the sample groups had a high level of satisfaction in using health services overall ( =3.88, S.D.= 0.77). When considering each aspect, it was found that they were most satisfied with proactive services ( =4.07, S.D.=0.79), followed by networking and participation ( =3.97, S.D.=0.81), continuous services ( =3.80, S.D.=0.81), and information and consultation services for the public ( = 3.73, S.D.=0.92). Factors affecting satisfaction in using health services at primary care units and primary care unit networks (PCU/NPCU) were statistically significant at the 0.05 level with a multiple correlation coefficient (R) of 0.856 and able to predict satisfaction at 73.2 percent, namely, the expectation of service tangibility can predict satisfaction in using the service at the highest level The regression coefficients in the form of raw scores (b) and regression coefficients in the form of standard scores (Beta) were 0.653 and 0.619, respectively, followed by expectations of response, attitude, expression or interaction with service recipients and age and in terms of information and knowledge recommendations, satisfaction in using the service can be predicted with regression coefficients in the form of raw scores (b) and regression coefficients in the form of standard scores (Beta) of 0.133 and 0.143, -0.007 and -0.093, and 0.117 and 0.118, respectively.

Conclusion: the research results can be applied to all sub-district health promotion hospitals in Prachuap Khiri Khan Province. Administrators should give importance to service quality, especially in terms of service tangibility, response, attitude, expression, or interaction with service recipients and in terms of providing information and knowledge to assure service recipients, there is sufficient and clean parking and service areas, medical equipment and sufficient personnel providing services equally and equally without discrimination on the basis of age, whether they are the elderly, children or the disabled, to increase satisfaction.