Journal of Nakornping Hospital

The effectiveness of double loop Ethibond figure of eight sutures in distal third clavicular fractures in Nakornping Hospital: A pilot study

Nopparat Rujiwattanapong — 2025-11-14

Introduction: Treatment of distal third clavicular fractures does not yet have a standard surgical method. The use of metal or suture materials is limited in that it requires repeated surgery to remove the metal or material. There is evidence showing the good efficacy of using new techniques with non-metallic materials (Ethibond).

Objectives: To evaluate the effectiveness of using new techniques with non-metallic materials (Ethibond) in distal third clavicular fractures.

Methods: A pilot study was conducted on patients with distal third clavicular fractures who were admitted to Nakornping Hospital between August 1, 2021, and July 31, 2023. A total of 22 patients underwent clavicle fixation surgery with a new technique of Ethibond to coracoclavicular- stabilization. Primary outcomes included union rate and time-to-union, while secondary outcomes were coracoclavicular (C-C) distance, shoulder range of motion, DASH score, VAS score measured at weeks 2, 6, 12, and 24. Complications, and adverse events were also evaluated. Data were analyzed with descriptive statistics and mixed effect models comparing average scores of outcomes with baseline at week 0.

Results: Of 22 patients, 15 males (68.2%), the mean age was 43.64±13.61 years. Fifteen cases (68.2%) had surgery on their right shoulder, nine patients (40.9%) were loss-of-follow-up. Among 13 patients followed, all (100%) had a clinical union, with a time-to-union of 12 weeks, and a radiographic union with a total of 13 cases from all who showed up for X-ray (100%). VAS score and DASH score were equal to 0 at 12 weeks after surgery. Range of motion, flexion, extension, abduction, adduction, internal rotation and external rotation, CC-distance improved significantly 2 weeks onwards after surgery. No complications or adverse events were observed.

Conclusion: A new technique with non-metallic materials (Ethibond) in distal third clavicular fractures was found to be effective in all outcomes. Patients can return to normal activities within 12 weeks. Therefore, it could be applied as a treatment of choice in the future.

Effects of a self-care promotion program on the success of one day surgery and vascular thrill at 30 days post-operative in patients undergoing arteriovenous anastomosis at Mae Sot Hospital

Duangbhorn Prasertnoi — 2025-11-14

Introduction: Arteriovenous anastomosis surgery for hemodialysis is essential for patients with end-stage renal disease undergoing renal replacement therapy. A self-care promotion program for patients undergoing vascular access surgery, provided by operating room nurses, may enhance surgical success rates.

Objectives: To investigate the success rate of one day vascular access surgery, vascular patency 30 days post-surgery, and patient satisfaction in the self-care promotion program group.

Methods: A quasi-experimental study with a historical control group was conducted among patients undergoing single-day vascular access surgery for hemodialysis at Mae Sot Hospital, Tak Province. The experimental and control groups were matched on a 1:1 ratio. The control group data were collected retrospectively under standard care, while the experimental group data were collected from August 2024 to January 2025, included a self-care promotion program, instructional guidelines, and educational video materials. Data were analyzed using descriptive statistics, frequencies, percentages, and inferential statistics including chi-square test, exact probability test, Wilcoxon-Mann-Whitney test, and multivariate binary regression analysis.

Results: A total of 60 patients met the study criteria, with 30 in the control group and 30 in the experimental group. Baseline characteristics were comparable. The success rate of single-day vascular access surgery in the experimental group was 100%, not significantly higher than the control group (93.33%; p=0.492). Vascular patency at 30 days post-surgery was also higher in the experimental group (99.67% vs. 70.00%, p=0.012). Multivariable regression analysis was adjusted for differences in age, educational level, history of vascular surgery, hemoglobin levels, diabetes mellitus status, postoperative caregiver support, preoperative waiting time, duration of surgery, and surgical site, indicated that the experimental group had a 23.27% improvement in vascular patency (RD 23.27, 95%CI 9.55-39.99, p=0.001). Patient satisfaction in the experimental group was rated as very high.

Conclusion: The self-care promotion program increased the success rate of single-day vascular access surgery and improved vascular patency at 30 days post-surgery. Given the high patient satisfaction, the program should be considered for continued implementation in healthcare settings.

24-hour survival prediction of initial blood pH for non-traumatic out-of-hospital cardiac arrest patients in the Emergency Department of Nakornping Hospital

Khanaphorn Kunpradit — 2025-11-14

Background: A major reduction in tissue perfusion during cardiac arrest can lead to metabolic acidosis, which causes a decrease in blood pH. Blood gas analysis, as one of the cardiopulmonary resuscitation parameters, may be effective in predicting ROSC and 24-hour survival.

Objectives: This study aims to investigate the associations between the initial blood pH during ongoing cardiopulmonary resuscitation of out-of-hospital cardiac arrest (OHCA) patients and the likelihood of return of spontaneous circulation (ROSC) and 24-hour survival.

Methods: Patients with OHCA who more than 15 years old were enrolled in this prospective observational cohort study. From October 2020 to August 2021, data from Nakornping Hospital's emergency department was collected, including the sex, age, date and time, pre-hospital CPR duration, witness arrest, cardiac origin, bystander CPR, shockable rhythm and initial blood pH.

Results: A total of 79 patients with out-of-hospital cardiac arrest (OHCA) were included. Univariable logistic regression analysis revealed several factors significantly associated with return of spontaneous circulation (ROSC), including prehospital chest compression duration ≥20 minutes compared to 0 minutes (Odds Ratio [OR] 6.9; 95% Confidence Interval [CI] 2.11–22.57; p 0.001), initiation of chest compression by a bystander (OR 0.26; p 0.021), and initial blood pH ≥ 7.0 (OR 3.75; 95% CI 1.46–9.64; p 0.006). Factors associated with 24-hour survival included prehospital chest compression duration of 1–19 minutes and ≥20 minutes (OR 8.86 and 13.12; 95% CI 1.66–47.20 and 2.54–67.61; p 0.011 and 0.002, respectively), as well as initial blood pH ≥6.8, ≥6.9, and ≥7.0 (OR 11.35, 4.88, and 5.56; 95% CI 1.42–90.73, 1.46–16.28, and 1.85–16.66; p 0.022, 0.010, and 0.002, respectively). However, multivariable analysis identified only one statistically significant factor: prehospital chest compression duration of 1–19 minutes and ≥20 minutes, which remained independently associated with 24-hour survival (AOR 6.48, 95% CI 1.12–37.41 and AOR and 8.03, 95% CI1.28–50.19; p 0.037 and 0.026, respectively).

Conclusions: From this study, the association between the Initial blood pH and the likelihood of ROSC and 24-hour survival was inconclusive. Further research is needed.

Serum lactate and hospital mortality in emergency critical care: A prospective cohort study

Saran Intapibool — 2025-11-14

Background and objectives: Serum lactate is one of the biomarkers that indicate tissue hypoperfusion in compensated shock. In recent years, serum lactate testing has become more common among critically ill patients presenting to the emergency department (ED). This research aimed to investigate the association between serum lactate levels and both mortality and clinical deterioration in critically ill patients.

Methods: This was an observational prospective cohort study of critically ill patients. Hospitalized patients aged ≥18 years who were triaged as MOPH ED level 1 or 2 at the Emergency Department of Nakornping Hospital between January 1 and April 30, 2020, were included. Patients were excluded if they had traumatic injuries, were pregnant, were referred from other hospitals without a serum lactate level, refused admission against medical advice, died in the ED, or met criteria for the Stroke/STEMI fast track. Patients were stratified by initial venous lactate levels into three groups: low (<2 mmol/L), intermediate (2–4 mmol/L), and high (>4 mmol/L). Statistical analysis was performed using multivariable exponential risk regression to predict in-hospital mortality for each group.

Results: A total of 379 patients were included in the study. In-hospital mortality was observed in 17 patients (12.5%) in the normal lactate group, 21 patients (14.2%) in the intermediate group, and 36 patients (37.9%) in the markedly elevated lactate group. After adjusting for variables that significantly differed between groups—such as gender, age over 60 years, systolic blood pressure below 90 mmHg, presence of infection, and underlying diseases—patients in the markedly elevated lactate group (>4 mmol/L) had a 2.77 times higher risk of mortality (95% CI: 1.68–4.55, p < 0.001) compared to those in the normal lactate group (<2 mmol/L), (Adjusted RR 2.77, 95% CI 1.68-4.55, p-value<0.001).

Conclusion: High serum lactate levels are strongly associated with increased in-hospital mortality in critically ill patients. Early lactate measurement may help identify high-risk individuals and guide timely, targeted emergency interventions.

Factors associated with malaria prevention behaviors among residents in the border area Mae Ramat District, Tak Province

Phaibun Chiraphatthakun — 2025-11-21

Introduction: Malaria continues to pose a significant public health threat in Thailand, particularly in border areas such as Tak Province.

Objective: This study aimed to determine the factors associated with malaria prevention behavior among residents in the border area of Thailand.

Methods: A cross-sectional study was conducted among residents aged 18 years and older in Khane Chue Subdistrict, Thailand during June 25 to August 9, 2025. Data collection utilized an interviewer-administered, validated questionnaire to assess demographics, knowledge, health beliefs, and preventive behaviors. Associations were examined using the Chi-square test, Fisher's exact test, and multivariate logistic regression.

Results: Among the 250 participants, 74% were female, 76.8% were married, and 89.2% had low income. Nearly half (47.2%) reported a personal history of malaria. Overall, 66.8% exhibited good prevention behaviors. Education level was significantly associated with prevention behavior. In the multivariable analysis, moderate and high perceived barriers were strongly associated with poor prevention behavior (AOR = 3.89 for moderate, 95% CI: 1.32–11.48, p = 0.014; AOR = 3.01 for high, 95% CI: 1.59–5.69, p = 0.001). Additionally, moderate perceived benefits were associated with poor prevention behavior compared to high perceived benefits (AOR = 2.19, 95% CI: 1.21–3.97, p = 0.010).

Conclusion: Even though a large proportion of residents in the border area had good malaria prevention behavior, targeted interventions should focus on reducing barriers and reinforcing the benefits of preventive measures. Health education and the promotion of community-based interventions are strongly recommended for health authorities to support malaria prevention efforts.

Factors associated with one-year mortality and rehospitalization in patients hospitalized with acute heart failureat Sansai Hospital, Chiang Mai: A retrospective study

Khanittha Pongsiri — 2025-11-21

Background: Acute heart failure is a major public health problem associated with high mortality and readmission rates, particularly in community hospitals with limited resources. The identification of clinical factors associated with adverse outcomes is crucial for planning appropriate patient care and reducing mortality.

Objective: To identify clinical factors associated with in-hospital mortality, one-year mortality, and one-year rehospitalization among patients with acute heart failure admitted to Sansai Hospital, Chiang Mai.

Methods: This retrospective study included 196 patients hospitalized with acute heart failure between January 1 and December 31, 2022 in Sansai Hospital. Clinical characteristics and outcomes were analyzed using univariable and multivariable logistic regression to assess factors associated with mortality and rehospitalization within one year.

Results: Among 196 patients admitted with acute heart failure, 61.7% were female, with a mean age of 69.5 ± 14.6 years. The most common comorbidities were hypertension (51.5%) and diabetes mellitus (39.8%). The in-hospital mortality rate was 9.1% (18 patients), and when including post-discharge deaths within one year, the overall one-year mortality rate was 45.9% (90 patients). The one-year rehospitalization rate was 68.8% (135 patients). In multivariable analysis, factors significantly associated with overall mortality included older age (Adjusted OR 1.03, 95% CI 1.01–1.05, p = 0.003), underweight (BMI <18.5) (Adjusted OR 2.54, 95% CI 1.08–5.95, p = 0.032), and anemia (Hb <10 g/dL) (Adjusted OR 2.62, 95% CI 1.12–6.10, p = 0.026). For rehospitalization, anemia (Hb <10 g/dL) (Adjusted OR 2.11, 95% CI 0.94–4.76, p = 0.071) and underweight (BMI <18.5) (Adjusted OR 1.96, 95% CI 0.88–4.35, p = 0.095) showed a trend toward being associated risk factors.

Conclusion: Patients with acute heart failure in Sansai Hospital experienced higher mortality and rehospitalization rates than those reported in previous national and international studies. Key predictive factors included older age, underweight, and anemia. These findings highlight the need for structured post-discharge follow-up programs, such as dedicated heart failure clinics, to improve long-term outcomes.

A study on the use of the FRAX® tool to assess the prevalence and associated factors of fracture risk among older adults in the Outpatient Department of Nakornping Hospital, Chiang Mai

Muchshima Kitisri — 2025-11-21

Objective: This study aimed to investigate the prevalence and factors associated with high fracture risk scores of within 10 years using the FRAX assessment tool in the outpatient department of Nakornping Hospital, Chiang Mai Province.

Method: This study was cross-sectional research. Data were collected through interviews from older adults aged 60 years and over who were visited at the orthopedic outpatient clinic, Nakornping hospital between November 1, 2024, and January 31, 2025, with a total of 283 participants. Convenience sampling was used according to the inclusion criteria. The questionnaire used for interviews consisted of personal information and the fracture assessment using the FRAX^® tool. Data were analyzed using descriptive statistics and binary logistic regression analysis.

Results: Among all 283 participants, the majority were female (73.1%), with a mean age of 70.18 ± 7.22 years and a body mass index (BMI) greater than 23 kg/m² (55.1%). Most participants were non-smokers (94.7%) and exercise less than 30 minutes (85.2%). Among this number, 135 participants (47.7%) had FRAX score ≥ 3, indicating a high risk of fracture within 10 years. Factors associated with FRAX scores for high fracture risk were statistically significant, including female gender (adj. OR 13.97, 95% CI 5.74–33.96), age 70 years or older (adj. OR 11.42, 95% CI 5.70–22.88), and a BMI of 23 kg/m²or higher (adj. OR 0.15, 95% CI 0.08–0.31).

Conclusion: In this study, older adults assessed using the FRAX^® tool were found to have a high 10-year risk of fractures. Statistically significant risk factors included being female, aged over 70, and having a body mass index (BMI) above 23 kg/m²