Royal Thai Navy Medical Journal

Underwater Medicine Technician Curriculum

2025-04-16T00:33:08+07:00

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Editorial

2025-04-01T09:19:54+07:00

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Sea Sickness in Seafarers: Associated Factors and Preventive Strategies

2025-04-16T00:01:35+07:00

Sea sickness is a common health problem that significantly affects seafarers in the commercial shipping industry worldwide. This review aimed to synthesize the knowledge on sea sickness in seafarers, covering key issues such as prevalence, associated factors, impacts and prevention strategies.
The prevalence of sea sickness in seafarers varied depending on the situation. In calm seas, the incidence was approximately 25 to 30 percent, and increased to 50 to 90 percent in rough seas. In addition, a study of Icelandic seafarers found the incidence to be as high as 80 percent. The etiology is attributed to the sensory conflict hypothesis, which posits a discrepancy between the body's perceived movement and environmental, arising from conflicting signals received by the eyes, inner ears, and proprioceptive system. Factors related to sea sickness included personal factors, work factors, and environmental factors. The effects of sea sickness affected crew members both physically and mentally, as well as their work efficiency. It was found that more than 50 percent were unable to work to their full potential. Sea sickness is a major problem that affects the quality of life and productivity of seafarers. However, it can be prevented or alleviated through a variety of measures, from basic preventive measures, appropriate medication, diet, to physical training. Understanding and implementing these preventive measures correctly can help reduce sea sickness and improve seafarers’ performance on board.

Hyperbaric Oxygen Therapy for the Prevention and Treatment of Delayed Neurological Sequelae after Carbon Monoxide Poisoning

2025-04-16T00:12:36+07:00

Carbon monoxide (CO) poisoning remains a prevalent medical emergency with potentially fatal outcomes. Long-term neurological consequences, known as delayed neurological sequelae (DNS), may manifest several days to weeks following the acute exposure. Hyperbaric oxygen (HBO₂) has appeared as a valuable intervention in severe cases, enhancing the CO dissociation from hemoglobin and aiding tissue oxygenation. Recent case studies and clinical reports suggest that HBO₂ not only reduces the severity of acute CO poisoning but also plays a critical role in preventing and treating DNS, leading to improvements in neurocognitive function. The article aims to describe DNS and discuss the demonstrated benefits of HBO₂ in the treatment and prevention of neurological sequelae, emphasizing its potential to enhance recovery and reduce long-term neurological damage.

Home-based Palliative Care for Patients with Terminal Cancer

2025-04-16T00:23:36+07:00

Home-based palliative care for patients with terminal cancer is a crucial approach that aims to promote quality of life during the final stage of illness. By providing care in a familiar setting, it fosters a sense of psychological security and reduces anxiety. This type of care focuses on alleviating suffering through a combination of methods, such as holistic care, interdisciplinary teamwork, family-centered care, community support, and the integration of medical treatment with palliative care. In order for this approach to be truly effective, various management and support measures are crucial: offering education to families and communities to address misunderstandings about discontinuing treatment, enhancing communication skills among healthcare professionals in critical situations, distributing medical resources and equipment to remote areas, involving communities and local agencies, and establishing policies and health insurance systems that comprehensively support palliative care. These factors collectively facilitate improved patient outcomes, ease the burden on families, and reduce overcrowding in hospitals. However, there remain obstacles that warrant further attention, including resource allocation, access to services, telehealth infrastructure, support systems, and cooperation between the public and private sectors. By integrating efforts from multiple stakeholders and conducting continuous evaluations, home-based palliative care can more effectively achieve its goal of enhancing the quality of life for patients with terminal cancer.

Comparison of Material and Profit Costs of Surgical Consumables and Outcomes between Laparoscopic and Open Inguinal Hernia Repair

2025-04-15T16:06:32+07:00

               This study aimed to compare the material and profit costs of surgical consumables, the frequency of postoperative intravenous painkiller usage within 48 hours, and complications within 12 months following both laparoscopic and open inguinal hernia repairs. A retrospective study design was employed using secondary data analysis from medical records, including 159 total inguinal hernia repair cases. Of these, 54 cases involved laparoscopic techniques, and 105 cases involved open surgeries at Pattani Hospital between July 2022 and December 2023. The data were analyzed using descriptive statistics.
            The results showed that the material costs for laparoscopic inguinal hernia repair was significantly higher than open surgery (6,420 and 2,554 Baht/case, respectively). Furthermore, the profit margin for consumable materials in laparoscopic hernia repair was also significantly higher than in open surgery (9,274 and 6,924 Baht/case, respectively). The frequency of postoperative intravenous painkiller usage were not different for both techniques (p = .636). Postoperative complications were not different between laparoscopic and open inguinal repairs.
            In conclusions, laparoscopic inguinal hernia surgery uses more expensive materials compared to open surgery, it can also yield higher net profits per case. Post-operative pain and complication are comparable. However, choosing the surgical method, factors such as the patient's condition, the surgeon's expertise, and the availability of equipment at each hospital should be considered.

The Effect of Health Promotion Program Using Smart Phone Line Application on Allergic Rhinitis Exacerbation Prevention Behaviors in Caregivers of School-age Children with Allergic Rhinitis

2025-04-15T20:11:14+07:00

This quasi-experimental research was a comparative group, pretest, and posttest design. The objective was to examine the effect of health promotion program using the LINE smart phone application on allergic rhinitis exacerbation prevention behaviors in caregivers of school-age children with allergic rhinitis aged 6 - 12 who received services at the Allergy Clinic of King Chulalongkorn Memorial Hospital, Thai Red Cross Society. The study involved 60 participants, divided into two groups of 30 caregivers each. The experimental group received the health promotion program using the LINE smart phone application, designed based on Pender's model, while the control group received routine nursing care. The study was conducted using questionnaires to assess perceived benefits, perceived barriers, and self-efficacy regarding behaviors. The prevention behaviors of allergic rhinitis symptom exacerbation was evaluated using a specific behavior questionnaire. All instruments demonstrated acceptable content validity and reliability. Data were analyzed using descriptive statistics and t-tests.
The research findings indicated that caregivers of children with allergic rhinitis who received the health promotion program using the LINE smart phone application exhibited significantly higher allergic rhinitis exacerbation prevention behaviors compared to before receiving the program (t = 7.68, p < .05). Additionally, it was found that caregivers in the experimental group showed significantly higher allergic rhinitis exacerbation prevention behaviors than those who received routine nursing care (t = -4.25, p < .05).

The Development of Predictive Models for Pneumonia in Chest X-ray Images Using Statistical Analysis

2025-04-15T20:32:33+07:00

This experimental research aimed to develop predictive models for pneumonia in chest X-ray images using statistical analysis. A total of 640 images were retrospective collected from October 1, 2021 - September 30, 2022 and were divided into 320 pneumonia images and 320 normal chest images. Subsequently, 192 images were randomly selected for training data and 128 images for testing data. A region of interest (ROI) of 20 x 20 pixels was drawn on the training data images, and statistical data were measured using ImageJ. The statistical analysis 9 values which included mean gray value, standard deviation, modal gray value, minimum gray level, maximum gray level, integrated density, median, skewness, and kurtosis. We compared the difference between pneumonia and normal chest images using Independent Sample t-test or Mann-Whitney U-test. We found that 8 statistical average values of pneumonia chest images were significantly higher than normal chest images (p < 0.001) except skewness. Predictive performances of 8 statistical values showed sensitivity, specificity, and accuracy of 64.06 - 94.53, 71.09 - 96.09, and 67.58 - 95.31, respectively and the total integrated density was the highest predictive performances. The 8 statistical values can predict pneumonia chest x-ray images. However, all chest x-ray images should be approved by radiologists.

Development of a UV-C Disinfection Chamber for Coronavirus Elimination

2025-04-15T20:49:03+07:00

            The COVID-19 pandemic has significantly impacted the health of the Thai population, with some individuals experiencing prolonged symptoms post-infection. The use of UV-C light can be applied to clean medical equipment after use, especially for devices that have limitations regarding heat and moisture during steam sterilization, which could otherwise cause damage to certain types of equipment.
               This study aimed to develop a sterilization chamber and evaluate its effectiveness in eliminating the coronavirus from medical equipment using ultraviolet-C (UV-C) radiation. The chamber is constructed from transparent acrylic, measuring 32.60 cm in width, 33.60 cm in height, and 27.60 cm in depth. It is equipped with a 6-watt UV-C lamp. To evaluate its efficacy, radiation levels were measured at five positions within the chamber, including the collection of samples for screening from medical devices.
            The results showed UV-C radiation measurements of 266.60, 268.30, 270.30, 273 and 276.10, all within the 245 - 285 nm wavelength range, at an intensity of 260 W/cm², with a distance of 11.96 cm from the source. The usage time was 21 seconds, and the results were negative, indicating no detection of the coronavirus.
            In conclusion, this study validates the UV-C wavelength range of 245 - 285 nm as an effective standard for virus inactivation. The UV-C sterilization chamber developed in this study effectively inactivates coronavirus, an RNA-structured virus, and can also be used against other microorganisms, including various viruses, bacteria, and fungi, when operated within this UV-C wavelength range.

Predisposing Factors of Ketoacidosis in Type 2 Diabetes Patients Using Sodium-Glucose Co-Transporter 2 Inhibitors: A Multicenter Case-Control Study

2025-04-15T21:11:22+07:00

This retrospective, multicenter case-control study is designed to investigate type 2 diabetes mellitus (T2DM) patients treated with sodium-glucose co-transporter-2 (SGLT-2) inhibitors at King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, and Rajavithi Hospital between October 1, 2014, and April 30, 2024. The aims were to identify predisposing factors associated with the occurrence of diabetic ketoacidosis (DKA) in Thai T2DM patients receiving SGLT-2 inhibitors and to analyze the type and severity of DKA episodes. Descriptive statistics were employed to analyze general data, while univariate and multivariate logistic regression analyses were conducted to assess predisposing factors. Group comparisons were performed using the Chi-square test, Fisher's exact test, independent t-test, and Mann-Whitney U test. Statistical significance was set at p < .05.
The study population consisted of 310 patients, divided into a study group comprising 62 patients who experienced DKA (prevalence rate: 1.37% during the study period) and a control group comprising 248 patients who did not develop DKA. Statistically significant predisposing factors for DKA included infection (Adjusted OR = 28.31, p < .001), recent insulin dosage reduction within the last month (Adjusted OR = 5.58, p < .001), and a history of DKA within the past year (Adjusted OR = 8.76, p = .038). Among DKA cases, the proportion of hyperglycemic diabetic ketoacidosis (HDKA) (54.84%) exceeded that of euglycemic diabetic ketoacidosis (EuDKA) (45.16%). Most DKA cases were of mild severity (46.77%), followed by moderate (27.42%) and severe cases (25.81%). The findings revealed that infection, recent insulin dosage reduction within the last month, and a history of DKA within the past year in T2DM patients treated with SGLT-2 inhibitors are predisposing factors to DKA. To reduce the risk of DKA and enhance the safety of SGLT-2 inhibitor therapy, targeted counseling regarding medication management during illness, close monitoring of their condition, and tailored therapeutic adjustments are recommended.

The Effects of Nutritional Self-management Promotion Program on Fatigue among Breast Cancer Patients Receiving Radiotherapy at Nakornping Hospital

2025-04-15T21:25:55+07:00

            This quasi-experimental research aimed to study the effects of a nutritional self-management promotion program on the fatigue condition of cancer patients being treated with radiotherapy. The samples consisted of 60 cancer patients receiving radiotherapy at Nakornping hospital selected by inclusion criteria. They were assigned into an experimental group and a control group by simple random sampling with thirty patients in each group. Whilst the subjects in the control group received standard care, those in the experimental group underwent a nutritional self-management promotion program. The data were collected during November 2023 to January 2024. The instruments used to collect data included a personal data questionnaire, a disease and treatment information questionnaire, and a fatigue questionnaire. The experimental instruments consisted of the self-management promotion program, handbook, and a record book of self-management. The reliability of fatigue questionnaire was 0.97, tested by Cronbach’s alpha coefficient. Data were analyzed by using descriptive statistics, Chi-square, independent t-test and dependent t-test.
            The results of this study revealed that after receiving the nutritional self-management promotion program, the fatigue level of the experimental group decreased significantly (t = 4.52, p = .000), compared to the level prior to the program. In addition, the experimental group’s fatigue level was significantly lower than that of the control group (t = 13.86, p = .000).
            The findings of this study indicate the effectiveness of the nutritional self-management promotion program in promoting nutritious behaviors among breast cancer patients receiving radiotherapy which resulted in reduced fatigue.

Results of Receiving Food According to the RTA Nutritional Program Prototype on Body Composition Changes among Conscripts in Conscript Training Course

2025-04-15T21:50:39+07:00

This quasi-experimental study aimed to examine the nutritional value received by conscripts and the changes in body composition resulting from a diet determined by the RTA Nutritional Program Prototype. The study divided 1,600 conscripts into two groups of 800 each, across 16 conscripts training units overseen by 8 hospitals in 4 army regions. Data on the nutritional value received by the conscripts were collected using the RTA Nutritional Program, based on the standard manual database from the Department of Health, Ministry of Public Health. General information about the conscripts and data on changes in body composition were collected using the Shaper SF-959 body composition analyzer, which has an accuracy rate of 99.99%. Data analysis used descriptive statistics and t-tests. The study found that the conscripts received adequate nutritional value and there were significant statistical changes in the average body composition before and after the experiment at the .05 level, including body fat percentage, body water content, muscle mass, and bone mass. Significant statistical differences in the average body composition between the experimental and control groups at the .05 level were also observed in body fat percentage, muscle mass, and body weight.

The Effect of Perceived Sufficient Milk Supply and Milk Volume Promotion Program after Discharge on Exclusive Breastfeeding Rate at 4 Weeks Postpartum in First-time Mother

2025-04-15T22:07:24+07:00

Breast milk is the best food for babies. The World Health Organization recommends exclusive breastfeeding for six months, but most mothers stop breastfeeding in the first month after giving birth due to their concerns about milk supply. This quasi-experimental research aimed to study the effect of a perceived sufficient milk supply and milk volume promoting program after discharge on exclusive breastfeeding rate at four weeks postpartum in first-time mothers. The samples consisted of 43 postpartum mothers. Participants were divided into a control group of 22 participants and an experimental group of 21 participants. The control group received usual care while the experimental group received usual care combined with the program, which consisted of (1) promoting confidence in correct breastfeeding, (2) creating confidence in milk supply, (3) assessing and solving breastfeeding problems, and (4) breastfeeding following up and counseling. Instruments used in data collection included a data recording form and an exclusive breastfeeding interview form. Data were analyzed using descriptive statistics, t-test statistics, chi-square statistics, Fisher’s exact test statistics, and Z test.
The research found that the experimental group had a significantly higher rate of exclusive breastfeeding than the control group (Z = -8.04, p = .000). Suggestions for promoting continued breastfeeding include training mothers to be confident in holding their babies to the breast correctly, understanding infant cues, and how to assess sufficient milk supply, and having a monitoring system that can be used for follow ups to help mothers with breastfeeding during the first month.

Effects of SMART PLUS Program on Basic Life Support Competency among Village Health Volunteers in Uttaradit Province

2025-04-15T22:40:55+07:00

This study aimed to: (1) examine the effects of SMART PLUS program on basic life support knowledge, skills, and confidence among village health volunteers in Uttaradit province; (2) compare the effectiveness between SMART PLUS program and traditional training methods; and (3) study factors affecting program effectiveness. A randomized controlled trial was conducted with 190 village health volunteers, equally divided into intervention and control groups. Research instruments demonstrated high content validity (CVI = 0.92), reliability of knowledge test (KR-20 = 0.85), confidence scale (Cronbach's alpha = 0.91), and inter-rater reliability of skill assessment (ICC = 0.88). Data were analyzed using repeated measures ANOVA and multivariate multiple regression. Results showed that the intervention group had significantly higher scores in knowledge, skills, and confidence compared to the control group both immediately post-intervention and at 6-month follow-up (p < .001). Factors influencing program effectiveness, in order of effect size, were frequency of application use (Partial η² = 0.316), education level (Partial η² = 0.258), village health volunteer experience (Partial η² = 0.188), and age (Partial η² = 0.144). This study demonstrates that the SMART PLUS program is effective in enhancing basic life support competency among village health volunteers and supports the continued use of technology in training.

Factors Influencing Adherence to Inhaled Corticosteroids in Patients with Asthma

2025-04-15T23:11:21+07:00

A cross-sectional study design aimed to examine the influence of age, gender, inhaler technique, knowledge of drug use, smoking, depression, and asthma control on inhaled corticosteroid adherence in patients with asthma. The sample consisted of 164 asthmatic participants, diagnosed by lung function test, aged 18 years or above, both males and females, with normal cognitive function (GP-COG score of 9 for patients aged 60 years or over), ability to communicate in Thai, no other lung diseases, no psychiatric disorders, and no comorbidity with severe symptoms. Data were collected at the Asthma Clinic, a super-tertiary hospital in Bangkok. The research instruments comprised a personal information questionnaire and health record, an inhaled medication adherence questionnaire, an inhaler technique assessment, an inhaled corticosteroid knowledge questionnaire, the Center for Epidemiologic Studies Depression Scale (CES-D), and an asthma control assessment form based on the Global Initiative for Asthma (GINA) criteria. The reliability of the questionnaires was assessed by Cronbach's alpha coefficient, equal to 0.89 for the inhaled medication adherence questionnaire, 0.73 for the inhaled corticosteroid knowledge questionnaire, 0.78 for the CES-D, and 0.74 for the asthma control assessment as determined by the Kuder-Richardson. Descriptive statistics and the logistic regression enter method were used to analyze the data.
The results showed that 69.51% of participants were female, with an average age of 63.82 (SD = 12.82); 61.7% adhered to inhaled corticosteroids. Age, gender, inhaler technique, knowledge of inhaled corticosteroids, smoking, depression, and disease control were not correlated and could not predict adherence to inhaled corticosteroids. Only depression and asthma control could predict adherence to inhaled corticosteroids (OR = 2.30, 95% CI: 1.02 - 5.18, p = .04; and OR = 3.00, 95% CI: 1.44 - 6.21, p = .01, respectively). Depression management and support for patients to control asthma will help patients adhere to inhaled corticosteroids, so nurses should assess patients' depression and provide information on the risk factors, and management that can lead to increased adherence to inhaled corticosteroids.

Factors Related to Quality of Life among Elderly-dependency Caregivers Living in Bangkok Metropolitan

2025-04-15T23:27:43+07:00

            This study was a cross-sectional descriptive research aimed to examine the quality of life and factors related to the quality of life among caregivers of dependent elderly living in the Bangkok metropolitan area by applying the PRECEDE-PROCEED model as a conceptual framework. The subjects were 232 caregivers of dependent elderly which were selected by multi-stage sampling. Data were collected through interviews between October and November 2023, guided by a questionnaire consisting of 7 parts, including personal data, caregiving burden measurement, depression scale, resilience scale, health service access assessment, social support scale and quality of life. The content validity index ranged from 0.80 to 1, and the reliability of the questionnaires ranged between 0.78 and 0.89. The data were analyzed using descriptive statistics, Pearson's correlation coefficient, and stepwise multiple regression analysis.
            The results revealed that most of the samples had a moderate level of quality of life (53.9%). Factors were correlated with the quality of life among caregivers of dependent elderly living in the Bangkok metropolitan including predisposing factors: income, health status, caregiving burden, depression, and resilience; enabling factors: health service; and reinforcing factors: social support. When performing stepwise multiple regression, income, health status, caregiving burden, resilience, access to health services and social support can jointly predict about 49.7% of the variance in the quality of life among caregivers of dependent elderly living in the Bangkok metropolitan area.
            According to the findings, recommendations include that the government and public health organization of Bangkok metropolitan area should provide welfare assistance, support healthcare education, enhance caregivers' adaptability for better health, ensure access to quality health services, and create social support network to improve the quality of life of caregivers of dependent elderly.

Relationship between Adaptive Leadership, Work Excitement and Job Burnout among Certified Registered Nurse Anesthetists, Southern Thailand

2025-04-15T23:42:41+07:00

            The purposes of this descriptive correlation research were to study: (1) the level of the nurse anesthetists’ job burnout, the level of the chief nurses’ adaptive leadership in anesthesia units and the level of nurse anesthetists’ work-excitement; (2) the correlation between the chief nurses’ adaptive leadership in anesthesia units and the nurse anesthetists’ job burnout; and (3) the correlation between the nurse anesthetists’ work-excitement and the nurse anesthetists’ job burnout. The sample consisted of 120 nurse anesthetists in Southern Thailand, with data collected from April 10 to May 20, 2024. Questionnaires were used which comprised 4 sections: demographic data, job burnout, adaptive leadership of chief nurses, and work-excitement. The questionnaires were tested for validity and reliability. The validity of the second, third and fourth sections were 0.96, 0.92 and 0.98, and the reliability of the second, third and fourth sections were 0.94, 0.98 and 0.94, respectively. Data were analyzed using frequency, percentage, mean, standard deviation, and Pearson’s product moment correlation coefficient.
            The results showed that: (1) the level of the nurse anesthetists’ job burnout, the level of the chief nurses’ adaptive leadership in anesthesia units and the level of nurse anesthetists’ work-excitement were as follows: the mean total score of the nurse anesthetists’ job burnout was at a low level (Mean = 2.50, SD = 0.46), the mean total score of the chief nurses’ adaptive leadership in anesthesia units was at a medium level (Mean = 3.01, SD = 0.99) and the mean total score of nurse anesthetists’ work-excitement was at a high level (Mean = 3.56, SD = 0.99); (2) the relationship of the chief nurses’ adaptive leadership in anesthesia units and the nurse anesthetists’ job burnout showed a statistically significant negative correlation at a medium level (r = -.53, p < .01); and (3) the relationship of nurse anesthetists’ work-excitement and nurse anesthetists’ job burnout showed statistically significant negative correlation at a low level (r = -.30, p < .01).
            These results can be used as a guideline to improve human resource management, and to find ways to prevent and reduce the nurse anesthetist’s job burnout in organizations.