Journal of Nakornping Hospital

Comparative analysis of clinical outcomes in very low birth weight infants with respiratory distress syndrome: surfactant replacement using INSURE technique versus Conventional method at Nakornping Hospital

Kanmalee Jenjarat — Mon, 22 Jan 2024 00:00:00 +0700

Introduction: Administering surfactant to preterm infants with respiratory distress syndrome (RDS) using the INSURE method presents advantages over conventional techniques. However, practical limitations persist concerning personnel and resources.

Objectives: The study aimed to compare clinical outcomes between preterm infants weighing less than 1,500 grams with RDS, who received surfactant via INSURE versus conventional methods and to examine the success rate of extubation after surfactant administration via INSURE.

Research Methodology: This retrospective study involved reviewing medical records of preterm infants weighing less than 1,500 grams, experiencing RDS, and receiving surfactant between October 1, 2019, and September 30, 2022. Statistical analysis for main outcomes included Gaussian regression or Logistic regression models based on data characteristics, complemented by inverse propensity score weighting adjustments.

Results: Among the 280 eligible infants, 240 had RDS, and 194 (80.8%) received surfactant - 157 (80.9%) via conventional methods and 37 (19.1%) via INSURE. Both groups exhibited no significant differences in demographics, delivery methods, maternal age, intrapartum antibiotic prophylaxis, or Intrapartum complications. However, the conventional group displayed lower birth weight, gestational age, inborn rate, Apgar score, pregnancy-induced hypertension, and antenatal steroid use. After inverse propensity weighting adjustment, the INSURE group showed significantly lower rates of severe BPD or mortality (OR 0.39, 95% CI 0.16-0.96, p=0.041), ventilator-associated pneumonia (OR 0.26, 95% CI 0.07 – 0.94, p=0.041), and retinopathy of prematurity stage 3 or higher (OR 0.10, 95% CI 0.06 – 0.18, p <0.001) compared to the conventional group. Successful extubation after surfactant administration in the INSURE group was observed in 29 cases (78.4%), while success rate in extremely low birth weight infants was 71.4%. In fail extubation group had higher incidence of patent ductus arteriosus (100%, p=0.006) compared to successful extubation (44.8%).

Conclusion: Administering surfactant via INSURE in a regional hospital setting yields favorable outcomes for extremely low birth weight preterm infants, reducing significant complications. Further development is essential to enhance accessibility.

Risk factor of COVID-19 infection among prisoners in Chiang Mai Center Prison

Titikarn Na Pan — Sat, 10 Feb 2024 00:00:00 +0700

Background: COVID-19 disease (COVID-19) is an emerging infectious disease caused by the 2019 novel coronavirus. It has spread and infected many people around the world. COVID-19 infection in prisons with limited living space and a large population: studying the factors affecting COVID-19 infection can help in preventing and controlling the infection.

Objective: The aim of this study was to determine the factors affecting COVID-19 infection among prisoners in Chiang Mai Central Prison.

Method: A retrospective study collected data from a male prison center during January 1st, 2021, to December 31st, 2022, among 400 inmates at Chiang Mai Central Prison aged 18 years and over, using simple random sampling. The data were analyzed using logistic regression analysis.

Results: The sample size was 400, and 342 were infected with COVID-19 (85.5 %). Factors in age group, number of COVID-19 vaccinations received, participation in daily activities, and cleaning of residences found that there were differences between groups infected with and not infected with COVID-19. The multivariable logistic regression analysis revealed that receiving 2 doses of the COVID-19 vaccine (Adjusted OR = 20.312, 95% CI 4.464 - 92.418), attending daily activities (Adjusted OR = 4.261, 95% CI 2.217 - 8.187), and cleaning the residence area less than four times per month (Adjusted OR = 2.917, 95% CI 1.501 - 5.669) significantly contribute to COVID-19 infection in Chiang Mai Central Prison (p-value < 0.05).

Conclusion: Promoting vaccinations for inmates in the prison and educating in performing self-defense measures in congested populations such as settlement sanitation can be accounted for measures against COVID-19.

Prevalence and factors affecting anemia among patients with chronic heart failure with reduced or mildly reduced ejection fraction, Samutsakorn Hospital

Prichapol Thantassanee, Satit Janwanishstaporn — Tue, 20 Feb 2024 00:00:00 +0700

Background: Anemia is one of major co-morbidities in patients with chronic heart failure with reduced and mildly reduced ejection fraction (HFrEF & HFmrEF) and may deteriorate patients with these conditions.

Objective: To analyze and compare prevalence and factors affect anemia in patients with chronic HFrEF & HFmrEF categorises based on New York Heart Association (NYHA) functional class 1-2 with NYHA functional class 3-4.

Methods: This was a retrospective chart review with consecutive data collection of patients diagnosed with chronic HFrEF & HFmrEF in Samutsakorn Hospital during 1^st July 2021 – 31^st December 2022. Patients included in this study must receive hemoglobin level test and had documented of follow up data after initial treatment. A multivariable logistic regression model was used to determine the factors affecting the effect of anemia in these patients, and the results of analysis were presented with an odds ratio and 95% confidence interval.

Results: A total of 391 patients were met an inclusion criterion in this study. The prevalence of anemia in patients with chronic HFrEF and HFmrEF was 52%. Only 15 % of patients in our study received iron study and serum ferritin testing. Patients with chronic HFrEF and HFmrEF with NYHA class 3-4 had a prevalence of anemia at 71.95 %, significantly more than NYHA class 1-2, which was 46.92% (p < 0.001). NYHA class 3-4 (Adj.OR 2.32, 95%CI: 1.22-4.43, p = 0.010), female (Adj.OR 2.38, 95%CI: 1.37-4.14, p = 0.002), low BMI (Adj.OR 4.71, 95%CI: 1.64-13.57, p = 0.004), diabetes mellitus (Adj.OR 2.44, 95%CI: 1.42-4.17, p = 0.001) and serum creatinine (Adj.OR 2.08, 95%CI: 1.37-3.15, p = 0.006) were predictive factors associated with anemia in patients with chronic HFrEF & HFmrEF. Whereas low DBP (Adj.OR 0.97, 95%CI: 0.96-0.99, p = 0.006) was less likely to be associated with anemia in patients with chronic HFrEF & HFmrEF.

Conclusion: Anemia has significant higher prevalence in chronic HFrEF & HFmrEF patients with a worsening functional class. Thus, identification of the etiology and treatment of anemia are needed in these patients.

Factors associated with the infection among tuberculosis and COVID-19 patients at Nakornping Hospital, Chiangmai Province

Orasa Munkarn, Saiyud Moolphate, Samart Jaitae — Wed, 13 Mar 2024 00:00:00 +0700

This research was a retrospective cohort research aimed at investigating the prevalence and factors associated with co-infection of tuberculosis and COVID-19 in tuberculosis patients registered for treatment at Nakornping Hospital in Chiang Mai. The study population consisted of tuberculosis patients who were registered for treatment at the hospital from January 2024 to September 2025, totaling 388 individuals. Data collection involved extracting patient demographic information and co-infection status from the Thai National Tuberculosis Data Reporting System and COVID-19 patient information from the Epid-CM Dashboard. Binary logistic regression analysis was employed to identify factors related to the co-infection of tuberculosis and COVID-19.

Results: The research found that out of the 388 tuberculosis patients, 258 (66.5%) were male, and 130 (33.5%) were female, with an average age of 49.24±17.95 years. Pulmonary tuberculosis was diagnosed in 281 patients (72.4%), while extrapulmonary tuberculosis was diagnosed in 107 patients (27.6%). Co-infection with tuberculosis and COVID-19 was observed in 16 cases (4.12%). Factors significantly associated with co-infection included the type of treatment coverage and patient registration status. Patients covered by social security (Adjusted Odds Ratio 5.17, 95% CI: 1.15-23.38) or government/civil servant healthcare schemes (Adjusted Odds Ratio 6.81, 95% CI: 1.20-38.53) were more likely to be co-infected compared to those with comprehensive health coverage. Additionally, patients who had previously registered as return or retreatment cases after treatment interruption due to medication non-adherence (Adjusted Odds Ratio 7.24, 95% CI: 1.69-30.97) were significantly more prone to co-infection compared to new cases.

Conclusion: Emphasizing knowledge dissemination and self-care guidelines for patients covered by social security, government/civil servant healthcare schemes, and those returning for retreatment after medication interruption may contribute to preventing co-infection of tuberculosis and COVID-19.

A retrospective study comparing the size of deep leg veins under normal condition, acute thrombosis, and chronic thrombosis using ultrasound in patients with suspected thrombosis at Phra Phutthabat Hospital, Saraburi Province

Patsorn Suksukon — Thu, 14 Mar 2024 00:00:00 +0700

Introduction: Acute deep vein thrombosis of the leg is a common occurrence. An ultrasound examination of the deep veins of the legs is used to assess vascular collapse. Acute deep vein thrombosis cannot be excluded in cases with chronic thrombotic conditions. Additional diagnostic criteria are needed based on the size and the affected vein.

Objectives: To compare the average diameters of deep veins and accompanying arteries in the legs at the exact location under normal conditions, acute thrombosis, and chronic thrombosis in patients with suspected thrombosis by using ultrasound.

Methods: This study is a retrospective descriptive analysis conducted on patients with suspected leg thrombosis who underwent ultrasound examinations at Phra Phutthabat Hospital between January 1, 2017, and July 31, 2023, using the Envision imaging. The patients were categorized into three groups: those exhibiting normal conditions, acute thrombosis, and chronic thrombosis, with each group comprising 49 cases.

Results: The majority of the population in this study was female at 55.10%, the mean age of 60.43±15.25 years, BMI 42.16±8.74 kg/m², and 104 (70.75%) underlying diseases. The difference in the mean diameter of the deep veins in the legs between normal and acute thrombosis of CFV was 1.76 mm (95% CI 0.91-2.60) p<0.001, SFV was 1.20 mm (95% CI 0.55-1.86) p<0.001, popliteal vein was 1.47 mm (95% CI 0.83-2.11) p<0.001, between normal condition and chronic thrombosis of CFV was 1.66 mm (95% CI 0.94-2.38) p<0.001, popliteal vein was 0.70 mm (95% CI 0.27-1.13) p=0.001, and between acute thrombosis and chronic thrombosis of CFV was 3.42 mm (95% CI 2.84-4.01) p<0.001, SFV was 1.62 mm (95% CI 1.02-2.23) p<0.001, popliteal vein was 2.18 mm (95% CI 1.60-2.76) p <0.001. The artery's diameter at the exact location was the only SFA that was different among the 3 groups.

Conclusion: The size of the deep veins of the legs in acute and chronic thrombotic conditions differs from normal conditions, which can be used to diagnose. This study found limitations of ultrasound examination. If a collapsed vein that is not entirely attached is found, other information should be included in the diagnosis.

Prevalence and associated factors of physical frailty in elderly patients at Geriatric Clinic, Nakornping Hospital

Nicharee Samniang — Wed, 20 Mar 2024 00:00:00 +0700

Comprehending the various declining conditions of the elderly is of paramount importance in providing quality care. One common condition found in the elderly population is frailty, which specifically refers to physical frailty. Physical frailty significantly impacts the incidence of illness, mortality, and treatment outcomes in various diseases.

Objective: The aim of this research is to study the prevalence and associated factors of physical frailty in elderly patients.

Study Method: This is cross-sectional analytic study. Data was collected at Geriatric Clinic, Nakornping Hospital between September 2022 to January, 2023 in elderly patients by using FRAIL scale questionnaire. The data was analyzed into frequency, percentage, compared the proportion by Chi-Square, and analyzed the associated factors by multivariable logistic regression analysis.

Result: A study included 190 participants, with females constituting the majority (68.95%). The age distribution revealed that aged at 70–79 years old category was44.74%, followed by 60–69 years olds (39.47%) and those 80 years or older (15.79%). In terms of weight status, overweight was the most prevalent category (61.05%), followed by normal weight (29.47%) and underweight (9.47%). The prevalence of physical frailty in elderly patients was 46.32 %, and statistically significant associated factors with physical frailty were age increasing (AOR 3.4, 95% CI 1.10-10.50), history of hospitalization in previous year (AOR 3.4, 95% CI 1.10-10.50), drinking caffeine (AOR 0.34, 95% CI 0.13-0.85), risk of malnutrition (AOR 6.00, 95% CI 1.20-30.06), depression (AOR 5.32, 95% CI 1.54-18.30), and social frailty (AOR 11.98, 95% CI 2.31-62.21)

Conclusion: This study found a high prevalence of physical frailty in older adults. Factors associated with physical frailty included increasing age, history of hospitalization in previous year, caffeine consumption, nutritional status, depression, and social frailty. Therefore, planning for care and prevention in this group is important.

The effects of using multi-system trauma care nursing practices in Accident and Emergency Department, Lamphun Hospital

Nichanan Siwichai — Wed, 03 Apr 2024 00:00:00 +0700

Objectives: To compare knowledge and satisfaction of nurses before and after implementing multi-system trauma care nursing practices and outcomes of multi-system trauma patients at the Accident and Emergency department, Lamphun Hospital.

Methodology: It was quasi-experimental research conducted during January to June 2023. The sample group comprised 25 nurses and 43 patients before using the guideline, and 20 patients after using the guideline for multi-system trauma care nursing practices at the Accident and Emergency department of Lamphun Hospital. The research tools included multi-system trauma care nursing practices, knowledge assessment form, nursing practice assessment form, nurse satisfaction assessment form, and patient record forms. Data were analyzed using T-tests and Fisher’s exact test.

Results: A total of 25 nurses participated. Most of them were female (84.0%) and aged between 31 and 40 years (44.0%). All had a bachelor's degree, 48.0% had working experience in accident and emergency work less than 5 years, and 76.0% had never received specialized training for accident and emergency patients. Evaluation before and after using the guidelines for nursing knowledge scores in caring for multi-system trauma patients averaged 13.70 ± 2.28 and 18.20 ± 2.00, respectively (p < 0.001). Correct scores in nursing practice in caring for multi-system trauma patients increased from 72.0% to 92.0% (p < 0.001). Nurses expressed a high level of satisfaction with the use of the guidelines (mean ± SD = 4.04 ± 0.41). Regarding patient care results, it was found that the average time of patients being evaluated and prepared for surgery within 60 minutes before using the guidelines was 68.13 ± 40.85 minutes, which was reduced to an average of 48.10 ± 16.60 minutes after using the guidelines (p < 0.039). The mortality rate for multi-system injury patients before implementing the guidelines was 16.3%, and after implementing the guidelines, it decreased to 5.0% (p < 0.042).

Conclusion: The study has shown that this practice guideline helps to develop knowledge and nursing practice in caring for patients with multi-system injuries, resulting in increased satisfaction among nurses, reduced time to prepare for operations, and ultimately a decrease in mortality. Active implementing the guideline should be warranted the patients outcome.

The development of nursing supervision program model for the first-line manager based towards patient safety in the intensive care nursing department, Lamphun Hospital

Sriwan Ruangwattana, Pornthana Kaewkhumpa, Oratai Thummapok — Sat, 20 Apr 2024 00:00:00 +0700

Background: Nursing supervision of first-level manager based towards patient safety is an important aspect of nursing administration to develop professional standards and quality of nursing.

Objective: To develop and evaluate the implementation of nursing supervision program model for the first-line manager based towards patient safety in the Intensive Care Nursing Department, Lamphun Hospital

Methodology: This study was a research and development. The research was conducted from November 2022 – September 2023. The sample size consisted of 25 first-line manager based and 54 registered nurse. The tools for implementing the research, including nursing supervision program model for the first-line manager based towards patient safety and (2) Tools for data collection, including Assessment forms for first-line manager based consist of personal records, knowledge assessments, and skill assessments and assessment forms for registered nurses, consisting of personal records and satisfaction assessments. Quantitative data were analyzed using descriptive and inferential statistics, including Paired Samples t-test and Fisher's exact probability test.

Results: Nursing supervision program model for the first-line manager based towards patient safety to develop in accordance with proctor nursing supervision conceptual framework and the concept of patient safety of the Institute of Healthcare Quality Assurance, it consists of 3 activities such as formative clinical supervision, restorative clinical supervision and normative clinical supervision. The results of the implementation of the model showed that after the use of the junior management model, there was an average score of knowledge (mean+SD=13.88±1.16, p<0.001) and nursing supervision skills for patient safety have increased statistically significantly. (mean+SD=4.07±0.28, p<0.001) Registered nurses who receive supervision have a high level of satisfaction with the nursing supervision of junior management to patient safety. (mean+SD=4.06+0.42) and after using the incidence pattern of unplan extubations, medication administration discrepancies, urinary tract infections from urinary catheterization and Ventilator Associated pneumonia statistically significant decrease (p<0.05).

Conclusion: The developed model helps to improve the knowledge and nursing supervision skills of the first-line manager based. Satisfy registered nurses who receive supervision and help reduce incidents related to patient safety. Therefore, nursing administrators at all levels should be encouraged to adopt this model of clinical supervision to help develop clinical supervision knowledge for junior nursing administrators appropriately.

The effectiveness of nursing care plan in discharge planning for elderly patients with hip fractures who have undergone surgery, Orthopedic Department, Lamphun Hospital

Siriporn Khunchum — Wed, 24 Apr 2024 00:00:00 +0700

Objectives: To compare the ability to perform daily activities of elderly hip fracture patients who have undergone surgery before and after discharge from the hospital, using a nursing care plan in discharge planning for elderly patients with hip fractures, and to assess the satisfaction of registered nurses when using the care plan.

Methodology: It was quasi-experimental research conducted during April to May 2023. The sample group consisted of 24 registered nurses and 35 elderly hip fracture patients who had undergone surgery. Research tools used include: nursing care plan in discharge planning for elderly patients with hip fractures who have undergone surgery. data collecting tools, and Barthel’s activities assessment. Analyze quantitative data using descriptive and inferential statistics.

Results: The sample group of elderly patients with hip fractures who underwent surgery, predominantly female at 92.3%, had an average age of 75.31 ± 8.75 years. Approximately 57.1% had primary education or its equivalent, while 42.9% had a normal body mass index. Additionally, 80.0% had their siblings as their primary caregivers, and 65.7% had comorbidities. Before admission to the hospital, the majority of the sample group relied entirely on others for their activities of daily living, at 65.7%, which reduced to 5.7% after implementing the care plan. The average scores for activities such as eating, personal care, transferring from bed to chair, using the toilet, moving within the house, dressing, climbing stairs, and bathing significantly increased before discharge with statistical significance. The majority of professional nurses were highly satisfied with the implemented care plan, at 66.7%.

Conclusion: Nursing care plans in discharge planning for elderly patients with hip fractures who underwent surgery have contributed to significantly improving the functional abilities of these patients before hospital discharge.