Journal of Nakornping Hospital

Factors influencing survival in patients with non-acetaminophen acute liver failure receiving continuous intravenous N-acetylcysteine

2025-11-21T08:54:35+07:00

Background: The management of acute liver failure (ALF), particularly non-acetaminophen induced acute liver failure (NAI-ALF), presents a significant challenge in healthcare settings where liver transplantation facilities are limited. Understanding the factors that contribute to the successful use of continuous intravenous N-acetylcysteine (IV NAC) could be crucial for optimizing treatment strategies and improving patient survival rates.

Objective: This study aimed to identify the factors associated with the 21-day survival rate of NAI-ALF patients who received continuous IV NAC at hospital with limited liver transplantation capabilities.

Methods: This retrospective cohort study was conducted at Nakornping hospital from January 1, 2022, to December 31, 2024. Data were collected from the medical records of all NAI-ALF patients who received IV NAC and had been followed up for 21-day survival outcome.

Results: Out of 198 patients with acute liver failure (ALF) who received IV NAC, 74 met the inclusion criteria (37.37%). Of these, 50 (67.57%) were male, a median age was 44 years (IQR 34-62) and HE grades III-IV were observed in 16 patients (21.62%). The primary etiology of ALF was drug or toxin-induced (n = 33, 44.59%). The median duration of IV NAC administration was 96 hours (IQR 24 - 192). The overall 21-day survival rate was 56.75%. Non-serious adverse drug events occurred in 3 events (4.41%). Analysis revealed that only factor associated with improved survival was continuous IV NAC administration ≥ 72 hours (AOR = 19.573, 95% CI 4.509 - 84.961, p < 0.001). Factors associated with reduced survival were NAI-ALF caused by viral hepatitis infection (AOR = 0.098, 95% CI 0.012 - 0.774, p = 0.028) and requirement for mechanical ventilation (AOR = 0.176, 95% CI 0.043-0.713, p = 0.015).

Conclusion: In hospital settings where liver transplantation is unavailable, the administration of continuous intravenous N-acetylcysteine (IV NAC) for more than 72 hours may serve as a crucial strategy to improve survival rate in patients with Non-Acetaminophen Induced Acute Liver Failure (NAI-ALF). This approach is particularly effective in patients whose conditions have not yet progressed to a critical stage.

Unit costs of medical student training in the clinical years: A cross-sectional study

2026-04-21T10:26:08+07:00

Background and Objectives: Medical Education Centers in hospitals under the Ministry of Public Health (MOPH) have the crucial mission of training clinical medical students, including the 6th-year medical students from other institutions undergoing rotational training. However, there is no existing study on the costs incurred in this specific context. This research aims to study the unit cost of medical student training at the Medical Education Center, Lampang Hospital, and to estimate the training cost of Year 6 medical students undergoing rotational training from other institutions.

Methods: This was a cross-sectional survey study, collecting data on training cost of clinical medical student training at Lampang Hospital during the 2024 academic year between June 2024 to May 2025 in 145 clinical medical students and estimated 1 – 30 medical students on rotational training from other medical schools included into the analysis. The study estimated the accounting cost using a standard costing method. The cost analysis was based on empirical costing approach, together with the requirement from the medical curriculum, from the societal perspective. The cost assessment framework divided costs into two main groups: 1) training costs and 2) administrative costs.

Results: The unit cost of training for Year 4-6 medical students was 248,979.06 Baht per person per year. The three highest cost categories were operating costs (26.4%), stipends/compensation (21.8%), and materials and equipment (14.6%), respectively. For the estimated unit cost of rotational training for Year 6 medical students from other medical schools, with group sizes ranging from 1 to 30 students, the unit cost was between 4,500 – 6,000 Baht per person per week, with the average cost per person decreasing as the number of students increased.

Conclusion: The cost data obtained provides empirical evidence reflecting the financial burden of the training center. This information can be effectively utilized for budget planning and setting training subsidies that align with the actual costs incurred, thereby promoting the sustainability of the physician production system in MOPH hospitals.

Standard versus delayed PPCI timing in Efficacy and major adverse cardiac Events in early-Diagnosed STEMI — The SPEED-STEMI Study

2026-04-16T15:06:13+07:00

Background: Primary percutaneous coronary intervention (PPCI) is the standard treatment for ST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset. However, the clinical benefit of achieving a diagnosis-to-PCI time ≤ 120 minutes, compared with delayed PCI within this period, remains uncertain for 30-day outcomes.

Objectives: To compare 30-day major adverse cardiac events (death, recurrent myocardial infarction, and heart failure) between early (≤ 120 minutes) and delayed (> 120 minutes) primary PCI in early-presenting STEMI

Methods: This single-center retrospective cohort study used data from the Nakornping Hospital STEMI Registry. Patients with STEMI presenting within 12 hours of symptom onset between October 1, 2024, and September 30, 2025, were included. Patients were stratified into early (≤ 120 minutes) and delayed (> 120 minutes) PPCI groups. The primary endpoint was 30-day major adverse cardiac events, defined as a composite of all-cause mortality, recurrent myocardial infarction, and heart failure.

Results: Among 210 early presenting STEMI patients, 137 (65.2%) were male, the mean age was 63.5 (± 12.2) years, and baseline characteristics were generally well balanced between the study groups. However, the delayed PPCI group exhibited a significantly higher prevalence of pre-existing coronary artery disease (20.4% vs. 9.8%, P = 0.036) and a higher trend of chronic kidney disease (15.7% vs. 6.9%, P = 0.052). Regarding clinical outcomes, the 30-day MACE rate was 11.9 % in the early PCI group compared to 19.0 % in the delayed group but not statistically significant (adjusted RR 1.30, 95% CI 0.68–2.48, p= 0.420). Notably, while a favorable trend toward lower all-cause mortality was observed in the early PPCI group (6.9% vs. 15.2%, P = 0.068), the incidences of recurrent myocardial infarction and heart failure remained comparable in both groups.

Conclusion: In early-presenter STEMI, achieving a standard or early PPCI time demonstrates a clinically meaningful, though not statistically significant, trend toward reduced 30-day mortality and major adverse cardiac events. These findings support the continued optimization of regional fast-track systems to ensure timely reperfusion for improved patient outcomes.

The relative effectiveness of high-dose influenza vaccine compared with standard-dose influenza vaccine in elderly during the one-year period after vaccination at Nakornping Hospital during 2023 - 2025: A retrospective crossover study

2025-11-28T12:51:25+07:00

Background: Influenza is a significant public health concern and imposes a considerable disease burden among older adults. Age-related immunosenescence limits immune responses to standard-dose influenza vaccines. High-dose influenza vaccines (HD-IV) were developed to enhance protection, but real-world evidence in the Thai setting remains limited.

Objectives: To compare the effectiveness of high-dose influenza vaccine (HD-IV), standard-dose influenza vaccine (SD-IV), and no vaccination over a 1-year period in preventing medically attended respiratory illness among older adults.

Methods: A retrospective crossover cohort study was conducted using medical records of elderly individuals (≥65 years) who had received HD-IV between July 2024 and February 2025. Influenza infection rate, OPD and IPD visit rates for respiratory illnesses in the post-vaccination period were compared with those from the corresponding period one year earlier in the same individuals, during which SD-IV or no vaccination had been received. Adjusted incidence rate ratios were estimated using multilevel mixed-effects Poisson regression

Results: A total of 628 participants were included. Within the 1-year post-vaccination period, the OPD visit rates for respiratory illnesses in the HD-IV and SD-IV groups were 92.74 and 253.07 per 1,000 person-years, respectively. HD-IV significantly reduced OPD visit rates compared to SD-IV (adjusted IRR = 0.37, 95% CI: 0.18–0.76, p = 0.006) and no vaccination (adjusted IRR = 0.52, 95% CI: 0.28–0.94, p = 0.031). No significant differences were observed for inpatient admissions or laboratory-confirmed influenza infection.

Conclusion: HD-IV demonstrated superior effectiveness over SD-IV and no vaccination in reducing outpatient visits for respiratory illness among older adults in Nakornping Hospital. It serves as an effective alternative for reducing healthcare resource utilization in high-risk populations; however, further studies are needed to confirm its long-term impact on more severe outcomes.

Development of quality nursing care system using evidence-based practice for acute ST-elevation myocardial infarction (STEMI) patients in Chiang Mai provincial network

2026-04-11T15:09:06+07:00

Background: The critical care of patients with ST-elevation myocardial infarction (STEMI) requires prompt, precise, and evidence-based services to reduce complications and improve survival outcomes.

Objectives: To develop and evaluate the outcomes of an evidence-based nursing service system integrated with relationship-based care for critically ill STEMI patients.

Methods: This research and development study was conducted at Nakornping Hospital from February 2022 to January 2023, comprising four phases: situational analysis through focus group discussions; system development through a participatory process involving CCU nurses, patient, family and a multidisciplinary team; system implementation in the cardiac intensive care unit using a quasi-experimental pre–post comparative design with professional nurses and STEMI patients as samples; and quality evaluation through reflective focus group discussions. Data were analyzed using descriptive statistics, Chi-square, independent t-test, and paired t-test, while qualitative data were analyzed using content analysis.

Results: The developed system comprised four core components: a service access management and referral network system for Chiang Mai Province; a nurse competency development system; evidence-based nursing practice guidelines for the CCU; and a cardiac rehabilitation system integrated with discharge planning and continuity of care. Following implementation, nurses demonstrated statistically significant improvements in competency and knowledge, and reported the highest level of satisfaction with the system. The rate of streptokinase administration within 30 minutes increased to 30 cases (96.77%), and the rate of primary PCI completion within 120 minutes increased to 22 cases (70.96%). Mortality rate declined significantly to 1 case (3.23%) (p = 0.047). Patients also demonstrated improved self-care knowledge and reported a high level of quality of life.

Conclusion: The developed nursing service system effectively enhanced nurse competency, reduced time to service access, decreased complications and mortality, and contributed to improved patient quality of life.