Journal of Nakornping Hospital

Integrative medicine in the treatment of depression in perimenopausal women: A narrative review

Nicharee Samniang — 2024-11-04

Depression is one of the most prevalent symptoms experienced by women during the perimenopausal stage, which occurs due to fluctuations in female sex hormones, typically between the ages of 45 and 60. The primary treatment is antidepressants, which often cause side effects such as dizziness, nausea, fatigue, reduced libido, weight gain, and higher recurrence and discontinuation rates. As a result, integrative medicine, which includes alternative treatments, offers an additional option that may help reduce depression and mitigate treatment side effects.

Objective: To summarize data or empirical evidence on integrative medicine in the treatment of depression in perimenopausal women.

Literature Review Methodology: The study involved searching for research data on integrative medicine in the treatment of depression in perimenopausal women and conducting a literature review using databases such as PubMed, Google Scholar, and Science Direct. The keywords used for the search included 'perimenopausal depression' and 'management,' 'treatment,' or 'integrative' (including 'diet,' 'supplement,' 'herbal,' 'exercise,' or 'cognitive behavior therapy') in English-language studies from 2018 to 2024. Out of 299 studies, 23 were selected for their content relevance and included in this review."

Literature Review Results: Several studies included in this review demonstrated positive outcomes for using integrative medicine approaches to treat depression in perimenopausal women, including Traditional Chinese Medicine, acupuncture, and electroacupuncture, as well as activities like mindfulness training and physical exercise. Other approaches, such as time management training, health counseling, and the consumption of natural compounds like phytoestrogens and omega-3 fatty acids, along with the use of non-estrogen synthetic steroids, may help reduce depression but still lack sufficient evidence. The use of synthetic selective estrogen receptor modulators and natural compounds like cannabis also lacks sufficient evidence for their benefits in treating depression in perimenopausal women.

Conclusion: Integrative medicine offers an alternative option for treating depression in perimenopausal women, as it may be more effective and safer than using antidepressants alone. Treatment should be tailored to each patient and monitored closely.

Recurrence rate and factors associated with ovarian endometrioma recurrence following laparoscopic ovarian cystectomy

Yada Thongyou — 2024-07-05

Introduction: Recurrence of ovarian endometrioma following laparoscopic ovarian cystectomy can be caused by many factors. In patients with high risk factors for recurrent endometrioma, close monitoring and appropriate postoperative treatment may be required to prevent recurrence.

Objectives: To determine the recurrence rate, cumulative recurrence rate and factors associated with recurrent ovarian endometrioma after laparoscopic ovarian cystectomy.

Research methodology: A retrospective cohort study was conducted. Data were collected from the medical records of patients diagnosed with ovarian endometrioma who underwent laparoscopic ovarian cystectomy and had pathologically confirmed endometriosis at Nakornping Hospital from January 2013 to June 2023.

Results: Of the 75 patients, with a median follow-up duration of 7 months, 9 experienced recurrent ovarian endometrioma, while 66 did not. The recurrence rate was 12%. The cumulative recurrence rates at 6, 12, and 24 months were 6.37%, 19.7%, and 19.7%, respectively. Factors evaluated included age, BMI, nulliparity, size and laterality of the cyst, symptoms, associated diseases, revised American Society for Reproductive Medicine (rASRM) stage, pre-operative and post-operative hormonal treatment, and post-operative pregnancy. No associations were found with factors related to recurrent ovarian endometrioma. Pelvic endometriosis appeared to be a contributing factor associated with recurrent ovarian endometrioma (Adj. HR 11.96, 95% CI 0.97-146.51, p=0.052).

Conclusion: The patient factors studied were not associated with the recurrence of ovarian endometrioma following laparoscopic ovarian cystectomy. Therefore, extending the follow-up period and increasing the study population will help to further evaluate these factors.

Efficiency of enhancement program of trade creditors management accounting system for individual

Boonga Promcampa — 2024-07-17

Background: The problem with Lamphun Hospital's trade accounts payable management system is that it is not as efficient as it should be. The process of recognizing debt accounts is delayed, and accounts payable information is not current, which affects the hospital's financial information and prevents it from accurately reflecting the true financial status. Conducting studies to identify issues in work operations and establishing a good operating system will result in further increasing the efficiency of the accounts payable management system.

Objective: To evaluate the efficiency of the individual trade accounts payable management system

Method: A action research was conducted by setting operational guidelines to improve the efficiency of the individual trade accounts payable management system among the parcel work group, other work groups that act like the parcels accounting work group, the accounting work group, and the finance group. This study was carried out at Lamphun Hospital from October 1, 2020, to September 30, 2022. The study results before and after implementing these operations were compared.

Results: Establishing work guidelines for use between related work groups was well accepted. As a result, the overall percentage of delays in individual trade accounts payable management per month decreased on average by 1.71 percent before implementation (statistically significant) (P = 0.035). After implementation, in the 12th and 24th months, a trend showed a decrease of 1.83 percent (statistically significant) (P < 0.031). After the 24th month, the rate of delay decreased by 0.65 percent (statistically significant) (P < 0.012). This resulted in a reduction in delays of individual trade accounts payable management from 36.39 percent in October 2020 to 9.31 percent in the fiscal year 2022.

Conclusion: The study indicates that the operational guidelines can improve the efficiency of the individual trade accounts payable management system. As a result, debt account information will be recognized faster by trade creditors, and information on the financial status of Lamphun Hospital will be complete and accurate.

Risk management and performance efficiency of personnel in Nakornping Hospital

Yuthapong Promsena — 2024-07-18

This was quantitative research conducted in February 2024 at Nakornping Hospital. The objectives were to: 1) study risk management in Nakornping Hospital, 2) study the efficiency of staff performance, 3) study risk management of personnel classified by personal factors, 4) study the relationship between risk management and the efficiency of staff performance, and 5) identify problems and suggestions for risk management. Data was collected using questionnaires. The population used in this research was 2,404 personnels of Nakornping Hospital, a sample group of 343 people., selected through stratified sampling. Data analysis was performed using descriptive statistics such as frequency, percentage, mean, and standard deviation. Hypothesis testing was conducted using inferential statistics including T-test analysis, One-way ANOVA, and Pearson correlation coefficient analysis.

Results: The majority of the participants were female (73.76%), and 30.61% were aged between 41 and 50 years. Most participants had a bachelor's degree (66.76%), had worked for over 21 years (34.11%), were civil servants (66.76%), and held professional positions (55.69%). Overall, opinions on risk management were rated at a very high level (mean±SD 3.70±0.73), with the highest score for risk management policy setting (mean±SD 3.79±0.80). The overall performance efficiency of Nakornping Hospital staff was also rated very high (mean±SD 3.91±0.65), with work time management being the highest-rated aspect (mean±SD 3.94±0.71). There were no significant differences in risk management opinions based on gender and education level. However, significant differences were found in risk management opinions based on age, duration of work, personnel type, and job position (p < 0.05). Risk management had a very high positive correlation with staff performance efficiency (r = 0.709, p < 0.001).

Conclusion: Effective hospital risk management is crucial for enhancing the efficiency of personnel performance. Suggestions and recommendations from this study are important for planning, analyzing, and continuously monitoring risk management. This, in turn, contributes to organizational development and the successful achievement of the hospital's goals.

Prevalence and factors associated with anemia in pregnant women attending their first antenatal care visit

Thitiporn Lertjitgaroon — 2024-08-02

Introduction: Anemia is a common problem in pregnant women. Various factors affecting the development of anemia have been reported in different studies. However, there are no reports of factors associated with anemia in pregnant women from Chiang Dao Hospital. This study can help in developing care models for pregnant women with anemia.

Objectives: This study aimed to investigate prevalence and factors associated with anemia in pregnant women attending their first antenatal care visit.

Research methodology: A cross-sectional descriptive study was conducted on pregnant women who had their first antenatal care visits at the antenatal room of Chiang Dao Hospital and sub-district health-promoting hospitals in Chiang Mai province. Data were collected through face-to-face interviews using a structured questionnaire from January to April 2023. Demographic data, obstetric history, and knowledge about anemia in pregnant women were recorded. Laboratory records included hemoglobin, serum ferritin, and hemoglobin typing. Data were analyzed using frequency, percentage, mean, standard deviation, the Exact Probability Test, and multivariable logistic regression.

Results: A total of 211 pregnant women participated, with a mean age of 27.75 ± 7.39 years. The mean hemoglobin value was 12.14 ± 1.44 g/dl. There were 31 cases of anemia (14.7%). Among these cases, 29% were iron deficiency, 12.9% had the HbE trait, 12.9% had the beta thalassemia trait, 3.23% had homozygous HbE, and 3.23% had HbH disease. Statistically significant factors associated with anemia in pregnant women were an age of 35 years or more (Adj. OR 0.30, 95% CI 0.06-0.56), having the first antenatal care visit in the third trimester (Adj. OR 0.04, 95% CI 0.01-0.24), and the level of knowledge about the causes and diagnosis of anemia (Adj. OR 0.58, 95% CI 0.39-0.90).

Conclusion: Factors associated with reduced anemia in pregnant women included being 35 years of age or older, having the first antenatal care visit in the third trimester, and having a higher level of knowledge about the causes and diagnosis of anemia.

Exploring the correlation between body mass index and severity of COVID-19 in adult patients at Nakornping Hospital, Chiang Mai Province

Waratsuda Samuthtai — 2024-08-05

Background: Body mass index (BMI) has been identified as a significant risk factor associated with the severity of coronavirus disease 2019 (COVID-19).

Objectives: This study aims to determine the BMI threshold that accurately predicts the severity of COVID-19 infection. Additionally, it explores the relationship between BMI, age, comorbidities, and disease severity at Nakornping Hospital, Chiang Mai.

Methods: A retrospective cohort study was conducted, including all COVID-19 patients aged 15 years or more, diagnosed with real-time PCR, and hospitalized between January 1, 2020, and May 25, 2021.

Results: The study comprised 195 patients, revealing that individuals with a BMI ranging from 26 to 29.99 and those with a BMI over 30 kg/m² had a higher likelihood of experiencing severe COVID-19 infection in 2019. The adjusted risk ratios for these BMI categories were 1.35 (95% CI 1.351-1.352) and 3.03 (95% CI 2.101-4.373), respectively, with a p-value of less than 0.001. Additionally, individuals with a BMI of 30 or above, along with age and chronic kidney disease, were identified as contributors to the increased severity of COVID-19.

Conclusion: Patients with a BMI of 30 kg/m² or above, advanced age, and chronic kidney disease are factors contributing to the severity of coronavirus infection. Notably, individuals with a BMI above 26 and age over 40 were found to be better predictors of severity compared to those with a BMI over 30 and age over 60.

Prevalence and factors associated with hearing loss in pediatric beta-thalassemia patients receiving blood transfusion and iron-chelation therapy

Chaiwat Songsermpanyakul — 2024-08-18

Introduction: Thalassemia is one of the most common inherited blood disorders worldwide. Hearing loss is more frequently observed in pediatric thalassemia patients receiving blood transfusions and iron chelation therapy compared to normal children. Studies on risk factors for hearing loss have not yet reached definitive conclusions. Identifying the factors associated with hearing loss in this patient group will help guide the development of appropriate treatment plans for pediatric beta-thalassemia patients undergoing iron chelation therapy in the future.
Objectives: To investigate the prevalence and factors associated with hearing loss in pediatric thalassemia patients who receiving blood transfusions and iron-chelation therapy.
Methods: This research was a retrospective cross-sectional analytical study conducted on patients receiving treatment at Nakornping hospital. Data were collected from medical records between January 1, 2021 and December 31, 2022. Inclusion criteria included patients diagnosed with beta-thalassemia (ICD10: D56.1) under 15 years of age, receiving iron-chelation therapy, and undergoing annual examinations, including blood ferritin levels and audiometry.
Results : Of the 96 patients, 24 experienced hearing loss. Patients with Beta thalassemia/Hemoglobin E exhibited a trend towards increased hearing loss compared to those with Beta thalassemia Major ([AOR 4.57, 95% CI 0.97-21.60, p=0.055). Additionally, deferasirox use was associated with a higher risk of hearing loss compared to deferiprone (AOR 3.38, 95% CI 1.02-11.18, p=0.046). However, receiver operating characteristic (ROC) curve analysis revealed a modest accuracy of 69.21% (95% CI: 59.53-78.90), indicating poor predictive performance. Consequently, despite statistically significant findings, the current predictive model may not be sufficiently robust for clinical implementation.
Conclusion: This study suggests potential recommendations for monitoring hearing impairments in children receiving deferasirox, particularly those with Beta thalassemia/Hemoglobin E who require regular blood transfusions. However, the study was limited by its small sample size and lack of longitudinal data. Future studies with larger sample sizes and longitudinal data are necessary to confirm the findings of this study.

Visual outcomes and surgical efficiency in cataract surgery: a comparison of extracapsular cataract extraction and phacoemulsification techniques at Sri Sangwan Hospital, Mae Hong Son Province, Thailand

Piyada Pholnongluang — 2024-08-26

Introduction: Cataracts are the primary cause of blindness in the Thai population, significantly affecting quality of life and the country's economy. Cataracts predominantly affect the elderly. Cataract surgery and intraocular lens implantation are crucial in enhancing visual capacity and reducing blindness caused by cataracts.

Objectives: To study the efficacy of cataract surgery using extracapsular cataract extraction (ECCE) compared to phacoemulsification (Phaco) at Srisangwal Hospital in Mae Hong Son Province.

Research methodology: This research employed a prospective study with a non-randomised design, comparing participants undergoing cataract surgery with ECCE and Phaco techniques at Srisangwal Hospital. Participants were recruited by purposive sampling consisted of 34 participants in each group. Data were collected from June 1 to December 31, 2023. Data analysis was performed using independent t-tests and Chi-square tests with SPSS version 26.

Results: The study included 68 cataract patients (34 in the ECCE group and 34 in the Phaco group), aged between 71-80 years and 61-70 years, with proportions of 33.8% and 32.3%, respectively. The gender distribution was 47.1% male and 52.9% female, with 50% undergoing right eye surgery. All participants in both groups had severe visual loss or worse before surgery. Postoperative visual acuity comparisons showed that the Phaco group had significantly better visual outcomes than the ECCE group at 1 day, 1 week, 4 weeks, and 8 weeks post-surgery, with statistical significance at p=0.004, p<0.001, p<0.001, and p=0.001, respectively.

Conclusion: Phacoemulsification is more effective than extracapsular cataract extraction for cataract surgery. Appropriate screening for cataract surgery should be considered to reduce cataract-related blindness and improve vision and quality of life.

Prevalence and predictive factors associated readmission within 30 days in palliative care at Doisaket hospital

Tiwa Intawong — 2024-08-31

Introduction: Palliative care is an important responsibility of family physicians. The care of terminal patients who are re-hospitalized within 30 days increases treatment costs, complication rates, hospital bed occupancy, and the likelihood of an unpeaceful death.

Objectives: This study employed a retrospective data collection design, involving a review of the medical records of palliative care patients (ICD-10: Z515) at Doisaket Hospital between October 1, 2022, and September 30, 2023. The study focused on the first hospital admission and all causes of readmission.

Research methodology: This study employed a retrospective data collection design, involving a review of the medical records of palliative care patients (ICD-10: Z515) at Doisaket Hospital between October 1, 2022, and September 30, 2023. The study focused on the first hospital admission and all causes of readmission.

Results: Among the 159 palliative care patients in this study, 55 patients (34.5%) were readmitted within 30 days. There were no significant differences between the groups in terms of gender, age, marital status, education, or diagnosis. Factors were significantly associated with readmission within 30 days included the absence of an advance care plan (AOR = 0.34, 95% CI 0.13 - 0.86, p = 0.023), the presence of a psychiatric disease (AOR = 2.98, 95% CI 1.01 - 8.76, p = 0.047), and caregiver burden (AOR = 12.18, 95% CI 3.46 - 42.86, p < 0.001).

Conclusion: To reduce the rate of readmission within 30 days, palliative care should include advance care planning, early screening and treatment of psychiatric diseases, and the screening and management of caregiver burden.

Conventional complete denture and implant retained overdenture PRK integrated line OA for follow up: A case report

Jiravadee Chaiyaprasith — 2024-09-12

Loss of all natural teeth in a patient results in the need for complete dentures. The limitations of full dentures may arise from the condition of the alveolar ridge, the function of the masticatory muscles, the function of perioral muscle, patient adaptation, and their experience with denture, all these factors affect denture retention. Denture retention impacts masticatory function and improves the patient's quality of life, including confidence in speech and social interaction. Enhancing denture retention can be achieved by using implant-supported dentures, where implants are placed in the lower denture to increase stability, thus improving masticatory function and speech confidence, ultimately enhancing the patient's quality of life compared to conventional complete dentures.

This report was a case study of a patient who received both complete dentures and PRK implant-supported dentures to improve denture retention and patient functionality, monitored via the Line OA system. The patient, a 72-year-old male with chewing difficulties, a history of severe periodontitis, and an edentulous ridge, required a well-fitting denture for effective masticatory function. The patient received treatment with complete dentures and PRK implant-supported dentures and was monitored through the Line OA system. At the final treatment visit, the patient expressed satisfaction with the dentures and was able to chew a variety of foods confidently.

In summary, the combination of complete dentures and PRK implant-supported dentures is a complex procedure. This report demonstrates the successful outcome of using PRK implants to enhance denture retention and functionality, suggesting its potential for wider application and as an option for patients.

Effect of using medical cannabis clinic services in palliative care patients at MaeOn Hospital, MaeOn District, Chiang Mai Province

Sommit Singjai — 2024-09-15

Objective: To study effect of using medical cannabis in palliative care patients at MaeOn hospital MaeOn district ChiangMai province.

Methodology: This was a quasi-experimental study with a non-random, purposive sampling method. The sample consisted of 36 cancer patients in palliative care who received treatment at Mae On Hospital, Mae On District, Chiang Mai Province, from October 3, 2022, to June 30, 2023. The participants were divided into an experimental group, which received treatment with a cannabis-containing formula at the medical cannabis clinic, and a control group, which received treatment with a conventional medicine formula. Data collection tools included a palliative care patient information record and the Edmonton Symptom Assessment System (ESAS) for quality of life assessment. Data were analzed using descriptive statistics and comparisons between groups were made using the Mann-Whitney U test, and Wilcoxon Signed Ranks Test.

Results: The study results showed that in the experimental group of 18 participants, 44% were male, with an average age of 65.78 ± 10.63 years and an average cancer duration of 2.44 ± 1.72 years. In the control group, also with 18 participants, 50% were male, with an average age of 63.28 ± 12.85 years and an average cancer duration of 1.94 ± 1.39 years. After the experiment, the average quality of life score in the control group was 16.39 ± 6.32 points, compared to 10.67 ± 4.60 points in the experimental group, with a statistically significant difference (p=0.006). Additionally, the difference in average quality of life scores before and after the experiment was 1.00 ± 2.14 points in the control group and 7.83 ± 4.09 points in the experimental group, also showing a statistically significant difference (p<0.001).

Conclusion: Medical cannabis can improve quality of life in palliative care. Therefore, this is another an alternative treatment for palliative care patients.

Effectiveness of metformin prescription practices guideline to prevent metformin associated lactic acidosis in a diabetic patient at the Somdejphrajoataksin Maharaj Hospital

Sitthi Fakthongyoo — 2024-11-04

Objective: To study the effectiveness of metformin prescription practices guideline to prevent metformin associated lactic acidosis (MALA) in diabetic patients at Somdejphrajoataksin Maharaj Hospital

Methodology: This study was an interrupt time study that selected all type 2 diabetes patients receiving metformin from the outpatient department of the Somdejphrajoataksin Maharaj Hospital from January 1, 2023 to December 31, 2023. The research tools were metformin prescription practices to prevent MALA, compilation of data using medication error record form, drug-related adverse events record form. Data was analyzed by frequency, percentage, and Chi’s square test.

Results: The studies were 3,671 patients. Before using the metformin prescription practices guideline there were 1,654 unreasonably prescriptions (13.75%) and after using the guideline, there were 109 unreasonably prescriptions (0.82%), that was a significantly reduced unreasonably prescriptions (p=0.001). Incidence of MALA after using the guideline was significantly lower than before using the guideline (p = 0.002). There were 30 (0.89%) MALA incidents and reduced to 12 (0.33%) after using the guideline.

Conclusion: The metformin prescription practices guideline can reduce the number of prescriptions that were unreasonably prescribed, as well as statistically significantly reduce the incidence of MALA occurrences.

A development of dental caries prevention program in kindergarten in Phayao Province

Prasit Wongsupa — 2024-11-14

Background: Dental caries in primary teeth is a significant global issue. Preschool children have a high prevalence of dental caries, as seen in data from Phayao Province.

Objective: To develop and evaluate the effectiveness of a dental caries prevention program in child care centers in Phayao Province.

Methods: This was a research and development (R&D) study conducted over a 6-month period during 25 January – 10 June 2024 in 12 child care centers, Phayao province. The participants were children aged 2-5 years. The experimental group, consisting of 125 children, received preventive dental care, including fluoride varnish and probiotic milk tablets, toothbrushing skill training, oral health promotion, and capacity building for oral health care by parents and caregivers. The control group, also consisting of 125 children, received standard care. All participants were evaluated for toothbrushing behavior, plaque index, and dental caries status. Data were analyzed using frequency, percentage, chi-square, and t-tests.

Results: After 6 months, a total of 221 children remained in the study, with an average age of 3.02 ± 0.60 years. Of these, 115 were boys (52.00%). The experimental group consisted of 109 children (49.32%), while the control group had 112 children (50.68%). The evaluation results showed that, compared to the control group, the experimental group had lower mean number of dental caries (2.55 ± 3.77 vs. 3.50 ± 4.16 teeth per person, p = 0.073), a lower mean plaque index (0.68 ± 0.26 vs. 0.98 ± 0.36, p < 0.001), and a higher mean of toothbrushing (2.11 ± 0.63 vs. 1.78 ± 0.65 times per day, p < 0.001). The experimental group also had a lower average snack consumption (1.41 ± 1.80 vs. 1.89 ± 1.69 times per week, p = 0.041) and parents showed a higher level of knowledge (8.74 ± 1.12 vs. 7.44 ± 1.60 points, p < 0.001).

Conclusion: The dental caries prevention program in child care centers effectively reduced new caries in the experimental group compared to the control group. It also resulted in a lower plaque index and increased frequency of toothbrushing.