Journal of Nakornping Hospital

Comparative analysis of complications associated with percutaneous nephrostomy: suction tubes versus pigtail catheters

Suthee Netithanakun — Thu, 02 Jan 2025 00:00:00 +0700

Background: Percutaneous nephrostomy (PCN) is a common treatment for urinary tract obstruction, with the pigtail catheter being the standard choice. Due to cost considerations, some urologists use suction tubes instead. This study aimed to compare the rates of dislodgement, obstruction and febrile urinary tract infection (UTI) between pigtail and suction tube nephrostomy catheters.

Materials and Methods: This retrospective cohort study analyzed data from patients who underwent PCN at Phayao Hospital from January 2018 to September 2022. Included patients had a PCN tube in place for more than 30 days. Data collected included catheter type (suction tube or pigtail catheter), the length of time between catheter changes, and the occurrence of dislodgement, obstruction and febrile UTI.

Results: A total of 429 cases were reviewed. Among them, 83.9% used suction tube catheters, while 16.1% used pigtail catheters. The mean time between catheter changes was 31.1 (±10.8) days for suction tubes and 94.6 (±26.6) days for pigtail catheters. The suction tube group had significantly higher rates of dislodgement (IRR=7.43, p=0.021), obstruction (IRR=12.14, p=0.016) and overall complications (IRR=9.39, p=0.001) compared to the pigtail catheter group. However, no significant difference was found in febrile UTI rates (IRR=13.34, p=0.123).

Conclusion: Suction tube nephrostomy catheters have higher rates of dislodgement, obstruction and overall complications compared to pigtail catheters.

Reducing healthcare costs through early palliative care in terminal cancer: Evidence from a retrospective cohort study

Winita Wajatieng — Tue, 21 Jan 2025 00:00:00 +0700

Introduction: Palliative care focuses on improving the quality of life for patients and their families, particularly for those with terminal cancer. Early initiation of palliative care could reduce unnecessary medical services and healthcare costs.

Objective: This study aimed to evaluate the impact of early palliative care on healthcare costs for end-stage cancer patients and compare healthcare utilization between patients receiving early palliative care and those who did not.

Methods: A retrospective cohort study was conducted using medical records of all cancer decedents at Nakornping Hospital between January 2016 and December 2023. Data were analyzed using descriptive statistics, and differences between groups were tested using t-tests, Chi-square tests, Kruskal-Wallis tests, and ANOVA.

Results: A total of 880 patients were included, with 67.95% not receiving palliative care, 28.75% receiving late palliative care, and 3.3% receiving early palliative care. The group receiving early-stage palliative care had the lowest utilization of healthcare services in the last month of life, with a median hospital stay of 5 days (IQR 3-10; p = 0.005) and the lowest inpatient costs at 29,068 Baht (IQR 15,436-60,240; p = 0.030). Daily healthcare costs decreased to 809 THB/day (IQR 433.48–1,143.09; p < 0.001) with early palliative care. Consultation from palliative care teams significantly reduced unnecessary interventions, such as intubation, surgery, and chemotherapy, particularly in patients receiving late palliative care (p<0.001).

Conclusion: Early palliative care can reduce healthcare utilization and costs during the last month of life and daily expenses for terminal cancer patients. Palliative care consultations also reduce unnecessary procedures in patients receiving late palliative care.

Effects of self-regulation program on volume overload control in end-stage renal disease patients undergoing peritoneal dialysis at Nakornping Hospital

Thu, 20 Feb 2025 00:00:00 +0700

Background: Volume overload is a significant complication in end-stage renal disease (ESRD) patients undergoing peritoneal dialysis (PD), often leading to unplanned hospital readmissions. Self-regulation programs can effectively promote behavioral changes and help control volume overload.

Objective: To compare mean scores of knowledges, self-efficacy, outcome expectations, and sodium and fluid consumption behaviors between experimental and control groups before and after program participation, and to compare the incidence of volume overload between the two groups post-intervention.

Methods: A quasi-experimental study was conducted on 80 ESRD patients undergoing PD at the Peritoneal Dialysis Clinic, Nakornping Hospital, from November 2023 to February 2024. Participants were selected based on inclusion and exclusion criteria. Research instruments included: 1) A 9-week self-regulation program for volume overload control in ESRD patients on PD, 2) A patient handbook "Kidney Care Without Edema”3) Self-monitoring records for sodium and fluid intake, and 4) Educational slide presentations on volume overload control. Data was analyzed using descriptive statistics, frequency, percentage, and chi-square tests.

Results: The study included experimental and control groups (40 patients each). In the experimental group, 55.0% were male, compared to 42.5% in the control group. Most participants were over 60 years old (62.5% and 70.0%), had sufficient but no savings income (50.0% and 67.5%), were primarily cared for by their children (32.5% and 45.0%), and had primary education (60.0% and 35.0%). High peritoneal transport status was found in 47.5% and 62.5% of participants respectively. Post-intervention, the experimental group showed significant improvements in mean knowledge scores (from 7.07±1.98 to 8.67±2.89, p<0.001), self-efficacy (from 57.57±15.59 to 66.10±12.68, p=0.016), and sodium and fluid consumption behaviors (from 41.47±5.11 to 42.72±4.23, p=0.039 and from 6.40±1.26 to 6.85±0.58, p=0.006). The experimental group demonstrated significantly higher knowledge scores than the control group (8.67±2.89 vs 7.85±2.85, p=0.020). The experimental group showed 75% lower risk of volume overload compared to the control group, though not statistically significant (IRR = 0.25, 95% CI 0.005-2.526, p=0.219).

Conclusion: This self-regulation program shows potential in controlling volume overload in ESRD patients undergoing peritoneal dialysis.

Effects of self-management programs on knowledge self-management behavior and interdialytic weight gain in patients end-stage chronic kidney disease receiving hemodialysis at Nakornping hospital

Piyaluck Pingkum, Nongruk Srinuanyai , Wiparat Benja — Wed, 12 Mar 2025 00:00:00 +0700

Introduction: Chronic kidney disease is a global public health problem. Interdialytic weight gain is common in patients with end-stage chronic kidney disease undergoing kidney replacement therapy through hemodialysis. Therefore, good patient self-management is an important part.

Objective: To study the effects of self-management programs on knowledge self-management behavior and interdialytic weight gain in patients end-stage chronic kidney disease receiving hemodialysis.

Study Method: This quasi-experimental research aimed to study a self-management program to control interdialytic weight gain in patients end-stage chronic kidney disease receiving hemodialysis. The study was conducted between December 1, 2023 and January 31, 2024 at the hemodialysis unit, Nakornping Hospital. The sample consisted of patients end-stage chronic kidney disease receiving hemodialysis. The purposive sampling of 21 people was selected. Data were analyzed using statistics of numbers, percentages, means, and standard deviations. Compare knowledge to control interdialytic weight gain, food and water consumption behavior and daily body weight loss before and after the experiment. A paired samples t-test was employed to analyze the statistical significance of these comparisons.

Results: The total of 21 participants had an average age of 64.67 ± 12.93 years, with 61.90% being male. Hypertension was a comorbidity in 48.38% of the participants. A majority (57.10%) had been undergoing hemodialysis for 1–5 years, and 66.70% had hemodialysis sessions twice per week. Post-program assessments revealed significant improvements in knowledge about fluid overload management, with the mean score increasing from 19.09 ± 4.73 to 22.62 ± 1.86 (p = 0.001). Dietary and fluid intake behavior scores improved from 51.38 ± 6.05 to 58.24 ± 6.22 (p = 0.001). Additionally, average daily weight reduction decreased from 3.66 ± 1.49 to 2.23 ± 0.94 kg (p < 0.001).

Conclusions: Integrating the self-management program into their routine work enables the provision of accurate knowledge and guidance to patients, fostering an improved quality of life. Thus, promoting the program can contribute to its broader adoption in general practice.

The relationship between risk management and work motivation of personnel in Nakornping Hospital

Pissmai Sakunna — Fri, 14 Mar 2025 00:00:00 +0700

Introduction: Risk management is about focusing on the relationship between strategies in the context of mission, vision and core values by linking business strategies and objectives to risks, which will help organizations plan risk management throughout the organization to focus on creating better value for the organization.

Objective: To study the relationship between risk management and motivation of personnel in Nakornping Hospital

Methods: A cross-sectional study was conducted between December 2023 and February 2024 using questionnaires on personal factors, risk management in work performance, and work motivation among personnel in all work groups at Nakornping Hospital. A stratified random sampling method was used based on job positions, with a total of 347 participants. Data were analyzed using descriptive statistics, inferential statistics, and Pearson’s correlation coefficient.

Results: A total of 347 participants, the majority were female (73.50%). The age distribution was as follows: 41-50 years (34.60%) and 31-40 years (33.40%). Most participants were government officers (56.48%), followed by Ministry of Public Health employees (33.40%). The majority held a bachelor's degree (64.80%). Most had work experience of 11-15 years (39.20%) and 6-10 years (27.10%). A large proportion (55.90%) belonged to the nursing service group. Additionally, 70.30% had never received risk management training.

The overall risk management level of personnel working at Nakornping Hospital was high (Mean ± SD = 3.76 ± 0.37), covering aspects such as control activities, risk assessment, situation identification, monitoring and evaluation, information and communication, internal environment, and objective setting, respectively.

Regarding work motivation, both motivational and supportive factors were at a high level (Mean ± SD = 3.85 ± 0.31 and 3.88 ± 0.28, respectively). Risk management was found to have a significant positive correlation with work motivation among hospital personnel (r = 0.644, p < 0.001).

Conclusion: This hospital-based study, involving personnel with mostly 6-15 years of experience, found high levels of risk management and work motivation, with a strong positive correlation. Therefore, effective risk management plays a vital role in enhancing motivation among hospital staff.

The situation of detecting COVID-19 virus variants and clinical symptoms of infected patients at Nakornping Hospital, Chiang Mai during 2021–2023

Patcharaporn Tariyo — Sun, 16 Mar 2025 00:00:00 +0700

Background: Coronavirus disease 2019, caused by the SARS-CoV-2 virus, has a variable incubation period and severity of infection, depending on the virus's mutations. Infected individuals may experience no symptoms or only mild symptoms, while others may develop severe symptoms, potentially leading to death.

Objective: This study aimed to investigate the SARS-CoV-2 strains, trends in clinical symptoms, and severity levels among individuals infected with various strains circulating in Chiang Mai Province.

Method: A retrospective analysis of medical records, laboratory databases, and information systems for 357 COVID-19 patients with confirmed variant identification and documented symptom histories at Nakornping Hospital from June 2021 to August 2023.

Results: The Alpha variant of COVID-19 was detected before June 2021 and disappeared by November 2021. The Delta variant emerged in June 2021 and disappeared by May 2022. The Omicron variant was first detected in December 2021 and remains present to date. When analyzing symptoms, the five most common symptoms among infected individuals were fever (45%), cough (43%), sore throat (33%), headache (18%), and runny nose (18%). Patients infected with the Omicron variant exhibited more severe symptoms compared to those with the Alpha and Delta variants, with mortality rates of 26.8%, 9%, and 9%, respectively. Additionally, the Omicron variant has undergone mutations resulting in subvariants with varying severity based on mutation sites. The BA.2 subvariant was particularly severe, with a high mortality rate of 34%. Over time, the Omicron variant continued to mutate, especially in the latter part of 2023, during which the number of COVID-19 infections detected decreased.

Conclusion: Alpha, Delta, and Omicron strains were identified as spreading in Chiang Mai province. Most infected individuals experienced symptoms such as fever, cough, headache, runny nose, and sore throat. The BA.2 substrains of Omicron were associated with a higher risk of death compared to other strains.

Efficacy and safety of percutaneous nephrolithotomy using the Triangular technique, accessing the upper pole of the kidney through a subcostal incision for urinary tract stone removal

Prapon Piamanant — Mon, 17 Mar 2025 00:00:00 +0700

This study aimed to evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) using the triangular technique with upper pole renal access through a subcostal incision.

Methods: A retrospective cohort study was conducted on patients diagnosed with kidney stones who underwent treatment at Nakornping Hospital between January 28, 2020, and December 12, 2023. The study focused on patients who underwent percutaneous nephrolithotomy (PCNL) using the Triangular technique, in which access was gained through the upper pole of the kidney via an incision below the costal margin. Data were collected on stone-free rates, pleural injury, postoperative blood transfusion, postoperative fever, length of hospital stay, and operative time. Descriptive statistics were used for data analysis, and stone-free rates were compared using logistic regression.

Results: A total of 106 patients met the inclusion criteria, of whom 69 (65.1%) were male. The mean age was 55.83 ± 11.76 years, with an average body mass index (BMI) of 24.48 ± 3.88 kg/m². The mean stone surface area was 905.16 ± 553.17 mm². The average operative time for PCNL was 51.31 ± 4.44 minutes, and the mean length of hospital stay was 6.05 ± 1.93 days. The stone-free rate, defined as complete stone clearance or residual fragments ≤4 mm, was 73%. Postoperative complications occurred in 13 patients (12.26%), with no cases of pleural injury. Factors associated with incomplete stone clearance included a stone surface area of ≥800 mm² (OR 6.747, 95% CI 2.304–19.757, p < 0.001) and a Guy’s Stone Score (GSS) of 4 (OR 6.00, 95% CI 2.312–15.574, p < 0.001).

Conclusion: PCNL using the triangular technique with upper pole renal access through a subcostal incision is an effective and safe surgical method for renal stone removal. The procedure demonstrated high efficacy, no pleural injuries, and acceptable complication rates.

Impact of transportation by Helicopter Emergency Medical Services (HEMS) to 24-hours mortality in severe traumatic brain injury

Wed, 26 Mar 2025 00:00:00 +0700

Introduction: Patients with severe traumatic brain injury are currently transported via Helicopter Emergency Medical Services (HEMS) to provide early, specific treatment, reduce the time spent caring for patients outside the hospital, and decrease mortality.

Objective: The primary objective of this study was to determine the 24-hour mortality rate, while the secondary objectives were to assess the in-hospital mortality rate within 14 days, time to activation at the trauma center, and time to activation for emergency neurosurgery, comparing transportation by HEMS and Ground Emergency Medical Services (GEMS).

Study Method: This was a retrospective observational cohort study conducted at Nakornping Hospital from July 1st, 2017, to April 31st, 2023. The eligibility criteria included patients aged 18 years or older with severe traumatic brain injury who were transferred from a referring hospital to a receiving hospital more than 2 hours away by ambulance. Baseline characteristics, 24-hour mortality, in-hospital mortality within 14 days, and transport times in the HEMS and GEMS groups were collected. Statistical analyses were performed using multivariable logistic regression analysis.

Results: Two hundred and twenty patients were enrolled in this study. HEMS transported 40 patients, and GEMS transported 180 patients. The 24-hour mortality in the HEMS group compared with the GEMS group was not significantly different (7.5% vs. 5.56%, respectively; odds ratio 1.38, 95% CI: 0.36–5.26, p-value=0.638). However, in-hospital mortality in the HEMS group was significantly higher than in the GEMS group (30.00% vs. 11.11%, respectively; odds ratio 3.43, 95% CI: 1.51–7.79, p-value=0.003). The result of the study regarding the time to activation at the trauma center showed that HEMS was significantly faster than GEMS (158±68.5 minutes vs. 194.5±69.5 minutes, respectively; odds ratio 0.98, 95% CI: 0.97–0.99, p-value<0.001). Additionally, the time to activation for emergency neurosurgery in HEMS was also significantly shorter than in GEMS (307±69 minutes vs. 330±120 minutes, respectively; odds ratio 0.99, 95% CI: 0.98–0.99, p-value=0.045).

Conclusions: In severe traumatic brain Injury, secondary mission HEMS decreased transport time and time to emergency neurosurgery in distant hospital compared to GEMS but did not reduce 24-hour mortality rates and in-hospital mortality within 14 days.

Factors associated with sustained prehospital return of spontaneous circulation after out-of-hospital cardiac arrest at Nakornping Hospital

Hatairat Chantarapromkul, Waratsuda Samuthtai — Thu, 27 Mar 2025 00:00:00 +0700

Introduction: Out-of-hospital cardiac arrest (OHCA) is an emergency medical condition, which needs advanced cardiac life support. However, there has been a lack of consensus to determine the factors related to the outcome.

Objectives: This study aimed to identify the factors associated with sustained prehospital return of spontaneous circulation (sustained PROSC) after OHCA.

Methods: This is a retrospective prognostic study conducted at Nakornping Hospital. Data were collected from the medical records of OHCA patients between January 1, 2020, and December 31, 2023. The inclusion criteria were patients aged 18 years or older who experienced out-of-hospital cardiac arrest, were transported by advanced medical response units, and were later admitted to the emergency department. The exclusion criteria included patients with a do-not-attempt-resuscitation (DNAR) order, individuals whose cardiac arrest resulted from trauma, those who received emergency medical care via air transport (sky doctor), patients showing post-mortem changes from the outset, and individuals treated in the emergency departments of other hospitals. Factors associated with sustained PROSC following OHCA were analyzed using logistic regression. Data analysis was performed using descriptive and logistic regression analysis.

Results: A total of 266 patients were included in the study. The participants had an average age of 64.1 ± 16.9 years. There were 104 patients (39.1%) who had sustained PROSC. Mean response time was 13.3 ± 6.1 minutes. In multivariable analysis age over 60 years (Adjusted Odd Ratio 1.94; 95%CI: 1.05-3.56, p=0.033) and bedridden patients (Adjusted OR: 11.91; 95%CI: 2.58-54.97, p=0.002) were factors associate sustain PROSC.

Conclusion: Age over 60 years and bedridden were significantly associated with sustained PROSC after OHCA. Therefore, the emergency medical system should be adapted and developed effective protocol to handle patients experiencing OHCA and gain the success rates of resuscitation in our hospital.

The effect of early diuretic therapy in the Emergency Department on clinical outcomes in patients hospitalized with acute heart failure

Haruetai Wongnang, Waratsuda Samuthtai — Tue, 01 Apr 2025 00:00:00 +0700

Introduction Acute heart failure (AHF) is a common condition among individuals who need medical attention at the emergency department (ED). The mainstay treatment of acute heart failure is diuretic therapy. Early intravenous (IV) diuretics may rapidly improve symptoms and clinical outcomes.

Objectives The study explored the effect of door-to-diuretics (D2D) time on mortality and other clinical outcomes in patients hospitalized with AHF.

Method A retrospective cohort study was conducted at Nakornping Hospital, using data from the hospital’s database center to evaluate the association between D2D time and all-cause in-hospital mortality as the primary outcome. Patients hospitalized with AHF and treated with IV diuretics within 24 hours of ED arrival between January 1, 2020, and September 30, 2022, were included, targeting a calculated sample size of 726. After applying the predefined exclusion criteria, eligible patients were categorized into an early treatment group (D2D time ≤60 minutes) and a non-early treatment group (D2D time >60 minutes).

Results A final analysis of 750 patients, the median D2D time was 65 minutes (IQR 43.75-108). Of the total number of patients, 343 (45.7%) were in the early treatment group, while 407 (54.3%) were in the non-early treatment group. All-cause in-hospital mortality was 16 cases (4.7%) and 24 cases (5.9%) respectively (p = 0.454). In a subgroup analysis for triage level 1, there was a trend toward a lower mortality rate in the early treatment group (11 out of 221, 5.0%) compared to the non-early treatment group (18 out of 165, 10.9%), p = 0.029.

Conclusion In summary, early IV diuretic therapy showed no significant mortality benefit but suggested a trend toward lower mortality in severe cases. Further research is needed to confirm and explore its potential benefits in AHF management.

Quality of life and associated factors in transfusion-dependent thalassemia children in Nakornping hospital

Wed, 02 Apr 2025 00:00:00 +0700

Introduction: Thalassemia is a chronic hemolytic anemia caused by abnormalities of hemoglobin production. The severity varies depending on the type of the disease. In severe cases, patients require regular blood transfusions to alleviate symptoms such as severe anemia, enlarged liver and spleen and growth retardation. These can affect daily life and impact physical, mental, and social well-being.

Objectives: To study quality of life and associated factors in pediatric patients with transfusion-dependent thalassemia at Nakornping Hospital.

Methodology: A cross-sectional analytical study collected data from 70 children diagnosed with transfusion-dependent thalassemia, aged 2-15 years, and their caregivers, who attended the one-day blood transfusion service at the Pediatrics Department, Nakornping Hospital, between March 2-24, 2023. Data were collected using a general characteristics questionnaire and the Thai version of the Pediatric Quality of Life Inventory™ (PedsQL™) to assess quality of life across four domains. Patients over 4 years old completed the questionnaire themselves, while caregivers answered for those under 4. A depression screening tool was used for both patients and caregivers. Descriptive statistics were used for data analysis, and factors related to quality of life were analyzed using multivariable linear regression.

Results: The pediatric patients with transfusion-dependent thalassemia were mostly male (51.43%) and aged 8–12 years, with β-thalassemia/E disease being the most prevalent (55.7%). Most required blood transfusions every < 4 weeks (80%), had iron levels ≥ 2,500 ng/ml (44.29%), and received iron chelation therapy (94.29%). The average quality of life score across all 4 domains was 89.24±11.84, indicating a good quality of life. The highest score was in the social domain (93.43±13.15), followed by emotional (91.57±14.20), physical (89.51±13.30), and the lowest in the school domain (79.00±14.82). Depression was the only factor significantly associated with quality of life.

Conclusion: The overall quality of life score was high but the school domain had the lowest score. Depression was a significantly factor related to the quality of life. Developing the blood transfusion service during holidays to reduce school absences, assessing mental health, and school support systems for sick children will help improve quality of life.

The effectiveness of ondansetron compared to a placebo for preventing shivering in orthopedic surgery patients at Sanpatong Hospital: A double-blind randomized controlled trial

Ularat Sarassamit — Sun, 20 Apr 2025 00:00:00 +0700

Shivering is a common side effect of spinal anesthesia, increasing oxygen consumption, elevating cardiovascular risk, and potentially causing hypoxia. This study aimed to compare the incidence of shivering following spinal anesthesia for hip surgery between intravenous ondansetron and a placebo.

Methods: A parallel-group, double-blind, randomized controlled trial (RCT) was conducted in patients undergoing hip surgery under spinal anesthesia. Participants were aged 20–90 years, classified as ASA ≤ III, and afebrile. Exclusion criteria included admission body temperature <36.0°C or >37.8°C, hemodynamic instability, cardiac arrhythmia, aortic stenosis, or surgery duration >180 minutes. The study was conducted at Sanpatong Hospital from December 2023 to October 2024. A total of 232 patients were randomly assigned via computer-generated simple randomization to either the control group (0.9%NaCl 4 mL) or the intervention group (ondansetron 8 mg) administered intravenously. Patients, medical personnel, and outcome assessors were blinded.

Results: Of the 232 patients enrolled, 116 were assigned to the ondansetron group and 116 to the placebo group. After excluding 20 patients, 105 patients in the ondansetron group and 107 in the placebo group were analyzed. The proportion of male participants was 33.6% in the ondansetron group and 22.9% in the placebo group. The mean age was 72.99 ± 12.39 years in the ondansetron group and 71.69 ± 13.55 years in the placebo group. The mean BMI was 21.02 ± 3.82 kg/m² and 21.8 ± 4.58 kg/m², respectively. Baseline temperature was 36.71 ± 0.41°C in the ondansetron group and 36.76 ± 0.34°C in the placebo group. The only significant difference was in spinal anesthesia duration, which was shorter in the ondansetron group (105.00 ± 31.59 min) compared to the placebo group (120.95 ± 35.49 min, p = 0.001). Shivering occurred in 17.8% of the ondansetron group and 41.9% of the placebo group, with a difference of 24.15% (95% CI: -36.04, -12.25; p < 0.001). Hypotension was also less frequent in the ondansetron group (27.36%, p < 0.001). No other significant adverse effects were observed.

Conclusion: In patients undergoing hip surgery, intravenous ondansetron (8 mg) was effective in reducing the incidence of post-spinal anesthesia shivering (PSAS).