Royal Thai Navy Medical Journal

Hyperbaric Oxygen Therapy for Avascular Necrosis of the Femoral Head: A Comprehensive Review and Treatment Perspective

2025-12-24T09:48:10+07:00

            Avascular necrosis (AVN) of the femoral head is a progressive orthopedic condition marked by bone tissue death due to impaired blood supply. It predominantly affects young and middle-aged adults and can result in femoral head collapse, joint degeneration, and functional disability if left untreated. Conventional therapies, including pharmacological agents and surgical interventions, often fail to prevent disease progression or restore joint integrity, especially in advanced stages. This review aims to provide a comprehensive overview of AVN pathophysiology, clinical presentation, and classification systems, while critically evaluating the emerging role of hyperbaric oxygen therapy (HBO₂T) as an adjunct or alternative treatment. A structured literature review was conducted to synthesize clinical evidence from observational studies, randomized controlled trials (RCTs), case reports, and systematic reviews assessing the efficacy and mechanisms of HBO₂T in treating AVN of the femoral head.
            The results showed that HBO₂T enhanced oxygen delivery to ischemic bone, stimulated angiogenesis, reduced inflammation and marrow edema, and promoted osteoblast activity–mechanisms directly addressing AVN pathogenesis. Clinical studies consistently report improvements in pain, function, radiographic outcomes, and a delayed need for surgical intervention, particularly when HBO₂T is initiated in early disease stages. Despite growing global support, HBO₂T research in Thailand remains limited due to funding constraints, despite an increasing pool of trained specialists.
         In conclusion, HBO₂T represents a promising, biologically sound treatment for early-stage femoral head AVN. Its inclusion in clinical protocols may significantly improve patient outcomes and reduce the need for invasive procedures. Larger multicenter RCTs and investment in local research infrastructure are crucial to establish standardized treatment guidelines and expand access, particularly in resource-limited settings.

Preventive Technician Training Course

2025-12-24T10:00:41+07:00

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Editorial

2025-12-24T10:15:44+07:00

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Effects of a Discharge Planning Program on Knowledge, Self-Care Behavior, and Hospital Readmission Rate after Discharge of the Patients with Stroke

2025-12-23T14:35:35+07:00

This quasi-experimental research aimed to examine the effects of the IDEAL model discharge planning program for stroke patients by comparing knowledge, self-care behavior, hospital readmission rates after discharge, and satisfaction with the program to those of conventional discharge planning. The sample consisted of two groups: (1) 60 ischemic stroke patients admitted to the hospital, divided into an experimental group who received the IDEAL model discharge planning program (30 patients), and a control group who received conventional discharge planning (30 patients); and (2) 15 professional nurses. The research instruments included the IDEAL model discharge planning program for stroke patients, a teaching plan and stroke knowledge manual, a form for recording personal data and evaluating patients’ self-care behavior, a stroke knowledge assessment form, and a satisfaction assessment form for both patients and nurses. All research instruments were validated for content accuracy by three experts. Data were analyzed using descriptive statistics and independent sample t-tests. The research findings indicated that:
1. Ischemic stroke patients who received the IDEAL model program had higher knowledge and self-care behaviors than those who received conventional discharge planning, with statistical significance at the .05 level.
2. Ischemic stroke patients who received the IDEAL model program had a lower hospital readmission rate after discharge than patients who received conventional discharge planning.
3. Ischemic stroke patients and professional nurses were more satisfied with the IDEAL model program than with conventional discharge planning.

Factors Related to Medication Adherence of Patients with Neuromyelitis Optica Spectrum Disorder

2025-12-23T14:58:31+07:00

This descriptive research aimed to investigate the relationships between various factors, consisting of disease and medication knowledge, ability to perform activities of daily living, number of oral medications taken per day, family support, and trust in the healthcare team, and medication adherence among patients with Neuromyelitis Optica Spectrum Disorder (NMOSD). The study was guided by the World Health Organization’s Multidimensional Adherence Model. The sample consisted of 100 purposively selected NMOSD patients attending the neurology outpatient clinic at a tertiary hospital in Bangkok. The research tools included a screening instrument consisted of the 6-item cognitive impairment test; and data collection instruments consisted of the following: (1) general demographic data form, (2) medication adherence questionnaire, (3) medication factors assessment form, (4) patient’s knowledge questionnaire on NMOSD and medication use, (5) functional assessment for activities of daily living, (6) family APGAR questionnaire, and (7) trust in the health team questionnaire. Data collection was conducted from December 2022 to February 2023. Descriptive statistics, chi-square tests, and Fisher’s exact tests were used for data analysis.
The results revealed that 96% of the participants were female, aged between 22 and 79 years, with a mean age of 49 years (SD = 11.96). The medication adherence rate among participants was 56%. Statistically significant associations were found between medication adherence and disease and medication knowledge (χ² = 37.543, p < .01), ability to perform daily activities (χ² = 19.7, p < .01), number of medications taken per day (χ² = 4.694, p < .05), and family support (χ² = 17.473, p < .01). No significant association was observed between trust in the healthcare team and medication adherence. Odds ratio (OR) analysis indicated that participants with good knowledge of the the disease and medication were 23 times more likely to adhere to medication compared to those with low to moderate knowledge (OR = 23.4, 95% CI = 7.71 - 71.021). Those with good ability in daily activities were 7 times more likely to adhere than those with low to moderate ability to perform daily activities (OR = 7.28, 95% CI = 2.997 - 17.28). Those taking 1 - 5 tablets per day were 2.7 times more likely to adhere than those taking more than 5 tablets (OR = 2.79, 95% CI = 1.181 - 6.604), and those with high family support were 17 times more likely to adhere than those with moderate support (OR = 17, 95% CI = 3.658 - 79.002). Based on these findings, nurses should play a proactive role in enhancing mutual understanding between patients and their families to support consistent medication adherence. Additionally, programs should be implemented to promote daily functioning, provide ongoing education about the disease, and emphasize the benefits of regular medication intake.

A Study of the Situation of Chronic Kidney Disease in the Community and Strategies to Delay Its Progression from Chronic Non-Communicable Diseases Based on the Perspectives of Participants in Community-Based NCD Screening

2025-12-23T21:02:32+07:00

            This mixed-methods study aimed to explore the perspectives of stakeholders involved in community-based screening for non-communicable diseases (NCDs) regarding the situation of chronic kidney disease (CKD) and strategies to slow its progression. Forty participants were selected through multi-stage random sampling from four primary healthcare units in Khon Kaen Province. The quantitative component used a questionnaire assessing perceptions of CKD in the community, with a content validity index of 1.00 and a Cronbach’s alpha of 0.97. The qualitative component involved focus group discussions guided by semi-structured questions and supported by field notes. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed through content analysis.
            The study revealed that, overall, stakeholders involved in the screening of non-communicable diseases (NCDs) in the community demonstrated a high level of awareness regarding the issues and current situation of chronic kidney disease (CKD), with a mean score of 4.23 (SD = 0.75). When considering specific aspects, the highest level of awareness was found in the area of CKD progression management strategies (Mean = 4.63, SD = 0.50), while awareness regarding the self-care behaviors of NCD patients was also high but exhibited the lowest mean score among the dimensions assessed (Mean = 3.98, SD = 0.86).
            From the perspective of the stakeholders, the underlying causes of CKD in the community included personal factors among NCD patients—such as lack of treatment adherence and poor dietary control—as well as social factors, including culturally ingrained cooking practices and the absence of caregivers. Effective management strategies for slowing CKD progression among NCD patients comprised educational promotion activities, the provision of clear and practical guidelines, and active community participation. The findings of this study provide essential information for developing a health literacy promotion model tailored to NCD patients, with the aim of preventing or delaying CKD progression in the future

The Effects of Self-Management Program on Postpartum Stress and Flatulence in Primiparous Mothers after Cesarean Section

2025-12-23T21:27:48+07:00

The purposes of this research were to study the effects of a self-management program on postpartum stress and flatulence in primiparous mothers after cesarean section. The instruments used in the experiment consisted of the self-management program, and four sets of data collection tools as follows: (1) Personal information record form; (2) Self-management behavior assessment form; (3) Stress assessment form; and (4) Flatulence assessment form. The self-management behavior assessment and the flatulence assessment form were reviewed for content validity by 3 experts with Content Validity Index (CVI) of 1. The reliability of self-management behavior assessment form, the stress assessment form and the flatulence assessment form were tested with a sample of 10 people using Cronbach’s alpha coefficient yielding values of 0.77, 0.86 and 0.74, respectively. The data were analyzed using frequency, percentage, mean, standard deviation and independent t-test.
The results of the study were as follows: primiparous mothers after cesarean section in the experimental group who received self-management program had significantly better behavior than the control group who received care according to hospital standards (t = -3.15, p < .01). The stress and flatulence in the experimental group were significantly lower than the control group (t = 2.31, p < .05) and (t = 3.23, p < .01), respectively. In addition, when comparing the stress level of primiparous mothers after cesarean section before and after receiving the self-management program, it was found that after the experiment, their stress significantly decreased, (t = 4.82, p < .01).

The Relationship between Pain Management, Pain scores and Patient Satisfaction among Musculoskeletal Injury Patients from Accidents in the Emergency Department of Somdech Phra Pinklao Hospital

2025-12-23T21:46:41+07:00

Pain is a common symptom frequently encountered in emergency departments, especially among patients suffering from musculoskeletal injuries caused by accidents, which are increasingly prevalent. Despite this, pain management approaches remain inconsistent, resulting in some patients receiving inadequate care and potentially affecting the quality of treatment and patient satisfaction. Somdech Phra Pinklao Hospital has one of the highest numbers of such cases in its emergency department, highlighting the need for effective pain management strategies tailored to patient needs. This study aimed to investigate the relationship between pain management, pain scores, and patient satisfaction, as well as to compare satisfaction levels between patients whose pain decreased and those whose pain remained unchanged after receiving treatment. A cross-sectional analytical study was conducted involving 155 patients with pain scores of 4 or above due to musculoskeletal injuries. Pain management methods included pharmacological interventions (opioids and non-opioids) and non-pharmacological interventions (local anesthesia and immobilization). Data were obtained from medical records and a 12-item satisfaction questionnaire. Univariable and multivariable linear regression analyses were used to assess relationships between pain management and outcomes. The Mann–Whitney U test was applied to compare satisfaction scores between groups. The findings revealed that opioid use and immobilization were significantly associated with reduced pain levels (95% CI: -2.296, -0.164; p < .05 and 95% CI: 0.25, 1.86; p < .05, respectively). However, no significant association was found between pain management methods and overall patient satisfaction, and there was no significant difference in satisfaction between patients whose pain levels decreased and those whose pain did not. In summary, opioid administration and immobilization play an important role in pain reduction, but reduced pain does not necessarily lead to greater patient satisfaction. Other influencing factors should be considered when evaluating patient satisfaction with pain management.

Factors Predicting Cervical Cancer Screening Behavior of Bangkok Metropolis Women

2025-12-23T21:58:02+07:00

This cross-sectional descriptive study aimed to identify the factors influencing cervical cancer screening behaviors among women residing in the Bangkok metropolitan area, using the PRECEDE-PROCEED model as the conceptual framework. A total of 424 participants were recruited from six administrative districts of Bangkok. Data were collected through a self-administered questionnaire that assessed predisposing, enabling, and reinforcing factors. Instruments used in this study included the Perceived Susceptibility of the Cervical Cancer Questionnaire, the Perceived Severity of the Cervical Cancer Questionnaire, the Perceived Benefits of the Cervical Cancer Questionnaire, the Access to Cervical Cancer Screening Services Questionnaire, the Perceived Policy on Cervical Cancer Screening Questionnaire, and the Social Support Questionnaire. All instruments were validated by 3 experts and the Cronbach’s alpha coefficients were 0.73, 0.78, 0.75, 0.69, 0.69, and 0.87, respectively. Descriptive statistics, the chi-square test, and binary logistic regression were employed for data analysis.
The results showed that most of the participants demonstrated inappropriate screening cervical screening behaviors, accounting for 54.48percent. Significant predictors of cervical cancer screening behaviors included education level, perceived benefits of cervical cancer screening, accessibility to cervical cancer screening services, and social support.
Public health professionals, including physicians and nurses, who are tasked with advocating for cervical cancer screening, should consider these factors when designing initiatives to raise awareness about the benefits of screening. Additionally, campaigns should aim to engage family members-such as husbands, children, and siblings-in encouraging and supporting women to participate in screening. Furthermore, the government should play a critical role in endorsing policies and improve women's access to cervical cancer screening services

The Effects of the Elderly Care for Frailty Prevention Program on Perceived Self-efficacy and Behaviors to Prevent and Delay of Frailty Progression in Elderly Patients

2025-12-23T22:13:13+07:00

This quasi-experimental research with a two-group pretest-posttest design aimed to investigate the effects of the Elderly Care for Frailty Prevention Program or “Sung Wai Pong Gan Praw Bahng Program” on perceived self-efficacy and behaviors to prevent and delay frailty progression among elderly patients. The participants were elderly patients receiving treatment at the Accident and Emergency Department of Srinagarind Hospital, who met the inclusion criteria: 22 patients in the experimental group and 23 patients in the control group. The research instruments were: (1) the Sung Wai Pong Gan Praw Bahng Program, (2) the perceived self-efficacy scale, (3) the preventive behaviors and delaying frailty in elderly patients questionnaire, (4) a manual for preventing and delaying frailty progression, and (5) a video media about exercise for preventing and delaying frailty progression. All five instruments were tested for content validity and the CVI values were 1, 0.93, 0.96, 0.96 and 1 respectively. Regarding the reliability, the Cronbach’s alpha coefficient values were 0.93 and 0.92. The experimental group received the program “Sung Wai Pong Gan Praw Bahng”, developed based on the self-efficacy theory, while the control group received standard nursing care. Data were collected before and after the experiment using the self-efficacy scale and the preventive behaviors and delaying frailty in elderly patients questionnaire and were analyzed by descriptive statistics, independent t-test and paired t-test.
The study results indicated that after receiving the program, the experimental group’s perceived self-efficacy scores were significantly higher than both the control group (t = 3.167) and their pre-experiment scores (t = 4.499). Additionally, the experimental group showed significantly higher scores in behaviors to prevent and delay frailty compared to the control group (t = 10.292) and their pre-experiment scores (t = 8.953) (p < .05). Based on these findings, it is recommended that nurses involved in elderly patient care incorporate this program into their practice in managing older adults across different disease groups.

Factors Associated with Health-Related Quality of Life in Persons with Type 2 Diabetes Mellitus during the Coronavirus-19 Pandemic in Upper Southern Region

2025-12-23T23:04:43+07:00

The purposes of this correlation research were: (1) to study the health-related quality of life of people with type 2 diabetes during the COVID-19 epidemic, and (2) to examine the relationship between selected factors, including body mass index, fasting blood sugar levels, lifestyle changes, social support, medication adherence, access to health services and the health-related quality of life of people with type 2 diabetes during the COVID-19 epidemic. The sample consisted of 235 adult patients with type 2 diabetes from the outpatient department of secondary hospitals and above under the Ministry of Public Health in Health Region 11, Upper Southern Region. The study was conducted between December 2023 and April 2024 using a multi-stage sampling strategy. Research instruments included a record form of patients’ demographic data, disease-specific quality of life measures, lifestyle changes, social support, medication adherence, and access to health services. The reliability coefficients for these instruments were 0.85, 0.83, 0.82, 0.86, and 0.81, respectively. The data analysis included descriptive quantitative statistics (frequency, mean, percentage, and standard deviation), and Pearson’s correlation.
The major findings were as follows: (1) The quality of life of individuals with type 2 diabetes during the COVID-19 pandemic, categorized by dimensions of quality of life, was found to be high in all aspects: diabetes control (Mean = 63.01, SD = 8.33); anxiety (Mean = 21.02, SD = 2.57); social burden (Mean = 28.09, SD = 3.18); sexual function (Mean = 20.36, SD = 1.18); and vitality (Mean = 90.85, SD = 6.89). (2) Factors associated with the quality of life of individuals with type 2 diabetes during the COVID-19 pandemic found that lifestyle changes and medication adherence showed a low positive correlation with quality of life, statistically significant at the .05 level (r = .28, .28, respectively) while social support and access to health services exhibited a moderate positive correlation, statistically significant at the .05 level (r = .37, .35, respectively). Body mass index and fasting blood sugar levels showed no correlation with the health-related quality of life of individuals with type 2 diabetes during the COVID-19 pandemic.

Experience in Enhancing Self-Awareness through Reflection among Nursing Students in Psychiatric and Mental Health Nursing Practicum

2025-12-24T03:46:35+07:00

This qualitative research aimed to explore the experiences of enhancing self-awareness through reflection among nursing students in the Psychiatric and Mental Health Nursing Practicum.The target group consisted of 12 third-year nursing students who were purposively selected while undertaking the practicum. Data were collected using a personal information questionnaire and in-depth interviews guided by semi-structured questions. Content analysis was conducted following Colaizzi’s method. The findings revealed that nursing students developed self-awareness through self-reflection in three main themes: 1) experiencing positive energy, personal growth, and inner transformation; 2) developing self-understanding as a foundation for understanding and empathizing with others; and 3) identifying pathways for personal and professional development in life and nursing practice. Educational institutions and relevant stakeholders should support nursing students in cultivating self-awareness through reflection, which can enhance their well-being and promote effective and continuous learning.

The Empowerment Process of Caregivers in Promoting Early Childhood Development: A Community in a Northern Province of Thailand

2025-12-24T04:07:51+07:00

This study aimed to analyze the empowerment process of caregivers in promoting early childhood development, focusing on a case study of a community in a northern province of Thailand. The research employed a descriptive qualitative methodology, using in-depth interviews with 20 elderly caregivers of early childhood children who were purposively selected based on criteria relevant to the study. Qualitative data were analyzed using content analysis. The findings regarding the empowerment process of caregivers revealed four main aspects: (1) Awareness of the situation—Elderly caregivers had diverse reasons for taking on the caregiving role. Most felt unprepared for the responsibility but accepted it due to a lack of alternatives, love, and emotional attachment to the children. In terms of promoting child development, some caregivers did not fully understand the importance of developmental assessments; (2) Critical reflection—Most caregivers were unaware of their role in assessing child development, often believing this responsibility belonged to medical professionals or teachers. Many lacked confidence in their abilities to support child development and relied heavily on others for developmental assessments; (3) Decision-Making on practical approaches—Some caregivers made efforts to learn from others or requested training from professionals. They expressed a need for educational materials that are easy to understand to support their caregiving role; and (4) Maintaining effective practices—This was achievable only when caregivers received appropriate support. The study highlighted that the empowerment process for caregivers in intergenerational families required both knowledge enhancement and external support. These elements were essential to build caregivers’ confidence and enable them to effectively promote early childhood development.

The Effect of Self-efficacy Enhancement Program Using LINE Application on Blood Pressure Level among Persons with Hypertension

2025-12-24T04:26:48+07:00

The purpose of this quasi-experimental, pre- and post-experimental study was to determine the effect of self-efficacy enhancement program using LINE application on blood pressure levels among persons with hypertension. The sample consisted of 56 hypertension patients aged 40 years and older, both male and female who received antihypertensive medication at outpatients clinic of at King Chulalongkorn Memorial Hospital. The control group (n = 28) and experimental group (n = 28) were matched by gender, age, and type of medication. The experimental group attended the eight-week self-efficacy enhancement program using LINE application focusing on blood pressure level, while the control group received conventional care. The instruments used for collecting data were the socio-demographic questionnaire and blood pressure levels, and the experimental control instrument was the health behavior record form with Cronbach’s alpha coefficient of 0.85. Data were analyzed using descriptive statistics and t-test with significance level at .05. The results revealed that the mean scores of systolic and diastolic blood pressure level among persons with hypertension after attending the program were significantly lower than before attending the program (t = 4.75, df = 27, p < .05; t = 2.54, df = 27, p < .05). The mean score of systolic and diastolic blood pressure in experimental group who attended the program were significantly lower than the control group (t = 3.24, df = 54, p < .05, t = 2.77, df = 54, p < .05).

The Results of the Development of a Knowledge Media for People at Risk of Community-Acquired Sepsis by through Network Participation in Kok Sa-at Subdistrict, Mueang District, Udon Thani Province

2025-12-24T04:40:45+07:00

This action research aimed to analyze the situation, develop educational media, and evaluate the use of knowledge media for people at risk of community-acquired sepsis. The study was conducted from December 2023 to October 2024. The research areas were selected specifically based on the highest morbidity and mortality rates in 2022. The sample group was selected through purposive sampling, totaling 457 people. The research tool consisted of educational media for people at risk of sepsis in the community through network participation. Data were collected using in-depth interview questions, group discussions, and a community-based public knowledge test on sepsis. The IOC value of the instrument was 0.67 - 1. The community-based public knowledge test on sepsis had a Kuder-Richardson reliability of 0.78. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using content analysis.
The results showed: (1) Most community-acquired sepsis were found in the elderly, those with underlying diseases, regular alcohol consumption, and poor personal hygiene practices. The cause was that when experiencing pain in the body, a wound, and a fever, they waited to observe the symptoms, thinking that it was a minor illness. Some people treated themselves with herbal plants, folk medicine, or bought medicine to take on their own. They sought treatment only when symptoms became severe. Most infections were from wounds and the digestive tract. Prevention included teaching how to wash hands before eating, eating freshly cooked food, cleaning wounds correctly, avoid buying medicine for self treatment, and entering the treatment system immediately when suspecting community-acquired sepsis; (2) The knowledge media consisted of severity, meaning, causes, symptoms and prevention, decision-making to enter the healthcare system, and details in the QR Code; (3) Using educational media for the sepsis risk group after 4 months of implementation showed that the sample group was able to take care of their health, reduce the mortality of sepsis from 38.18 percent to 17.86 percent, and reduce the mortality of severe sepsis/septic shock from 52 percent to 22.22 percent.
Conclusion: The development of knowledge media for people at risk of community-acquired sepsis through network participation, enabled people to take care of their health and decide to enter the medical treatment system, thereby reducing the mortality rate in the community.

Ecological Model Factors Associated with the Presence of 20 Functional Permanent Teeth and 4 Functional Occluding Pairs among Older Adults in Bangrak Subdistrict, Mueang District, Trang Province

2025-12-24T08:43:28+07:00

            This cross-sectional descriptive study aimed to examine the presence of at least 20 functional permanent teeth and four functional posterior occluding pairs, as well as to assess the relationship between factors within an ecological model: intrapersonal factor, interpersonal factor, organizational factor, community and public policy factors, and the presence of at least 20 functional permanent teeth and four functional posterior occluding pairs in older adults in Bangrak Subdistrict, Mueang District, Trang Province. The sample consisted of 270 individuals, collected by proportion estimation with a known population and two stage random sampling method. Data were collected through oral health examinations and interviews in June 2024. Statistical analyses included descriptive statistics, including frequency, percentage, mean, standard deviation, minimum, and maximum values. Inferential statistics included binary logistic regression at a significance level of .05.
            The results showed that 30.74% of participants had at least 20 functional permanent teeth and four functional posterior occluding pairs. Ecological model factors significantly associated with this outcome (p < .05) included individual-level factors such as age (p < .001), income (p = .02), and perceived oral health issues related to difficulties in eating or chewing (p < 0.001), as well as difficulties in speaking or pronunciation (p < .001). Organizational-level factors included the presence of public health volunteers providing dietary guidance to prevent dental caries (p = .04).
            Therefore, it is recommended to promote oral health care for the population before they reach old age to reduce tooth loss and ensure that dental restoration, including prosthetic replacements for lost natural teeth, is accessible.

Cultural Adaptation in the U.S.: A Case Study of a Thai Naval Attaché’s Cross-Cultural Experiences

2025-12-24T09:03:25+07:00

In an era of increased global mobility, understanding effective cultural adaptation processes has become essential in various fields, including the military. Thai naval attachés, like other foreign diplomats, must build and maintain relationships with individuals who often have diverse beliefs, practices, and cultural attitudes. This requires a high level of sensitivity, adaptability, and strong communication skills in order to navigate their roles effectively. This study, grounded in a narrative inquiry approach, aimed to examine the linguistic and cultural challenges encountered by a Thai naval attaché while navigating his social and professional life in the United States. Additionally, it sought to identify the strategies employed to bridge cultural differences and facilitate successful integration into the host environment. A semi-structured interview was utilized to capture the attaché's narratives, which were then analyzed using content analysis consisting of four stages: compilation, decontextualization, recontextualization, and categorization.
The findings revealed that cross-cultural adaptation is a complex and ongoing process. It involves overcoming challenges such as societal divides, language barriers, racial discrimination, and unfamiliar social norms. This process requires an open mind, a proactive approach to bridging cultural differences, and a commitment to continuous learning through cultural immersion. Additionally, cultural adaptation does not necessitate full assimilation but rather calls for a balance between maintaining one’s cultural identity while embracing aspects of the host culture. The findings also underlined the importance of cultural knowledge, adaptability, as well as the need to challenge cultural stereotypes. This study provides valuable insights for individuals and training institutions engaged in global interactions by offering guidance and developing more effective strategies for adaptation and fostering meaningful interactions in diverse environments.

Comparative Study on the Effectiveness of the CROW-65, MEWS, and 4C Mortality Score in Predicting In-Hospital Mortality among COVID-19 Patients Treated with High-Flow Nasal Cannula

2025-12-24T09:12:44+07:00

            The purpose of this retrospective cross-sectional study was to compare the effectiveness of the CROW-65, Modified Early Warning Score (MEWS), and 4C Mortality Score in predicting in-hospital mortality among COVID-19 patients treated with high-flow nasal cannula (HFNC). Data were collected from medical records of 144 COVID-19 patients with acute hypoxemic respiratory failure who were treated with HFNC at Somdech Phra Pinklao Hospital between November 1, 2020, and October 31, 2021. The research instruments included a demographic and clinical data record form, pre-HFNC treatment data, and HFNC treatment data. Descriptive statistics were used to analyze general patient characteristics. The effectiveness of the CROW-65, MEWS, and 4C Mortality Score in predicting in-hospital mortality was compared using area under curve (AUC), sensitivity, specificity, and accuracy.
            Results showed that the 4C Mortality Score was highly suitable for predicting the mortality rate of COVID-19 patients (AUC = 0.862), followed by CROW-65 at a good level (AUC = 0.748), and MEWS at a satisfactory level (AUC = 0.694). When considering the appropriate cut-off point, the 4C Mortality Score with a cut-off value of 13 demonstrated the highest Youden's index (0.551), with a sensitivity of 76.3, specificity of 78.8, and accuracy of 77.8. The CROW-65 Score, with a cut-off value of 11 and 12, showed the highest Youden’s index (0.381), with a sensitivity of 74.6, specificity of 63.5, and accuracy of 68.1. The MEWS Score, with a cut-off value of 4, yielded the highest Youden's index (0.293), with a sensitivity of 45.8, specificity of 83.5, and accuracy of 68.1.
            The results of this study indicate that the 4C Mortality Score is the most appropriate tool for predicting in-hospital mortality among COVID-19 patients treated with HFNC. It can be used by healthcare professionals as a guideline for clinical decision-making to enhance efficiency in treatment prioritization and optimal allocation of medical resources.