Enhance dynamic wedge verification by using electronic portal imaging device

Objectives The purpose of this study was to verify the 80% enhanced dynamic wedge (EDW) beam profile using an electronic portal imaging device (EPID). Methods This study investigated symmetric and asymmetric field sizes using a 6 MV photon beam. Verification of the wedge output factor with an 80% beam profile was performed by comparing EPID measurements and treatment planning systems (TPS) calculations in both symmetric and asymmetric field sizes at different wedge angles (15, 30, 45, and 60 degrees). Results For the symmetric field size, the average difference between the measured and calculated beam profile was less than 2% (range 0.57-1.12%). For the asymmetric field size, the difference was also less than 2% (range 0.3-0.52%). Conclusion This study indicates that EPID can be used to verify the 80% enhanced dynamic wedge beam profile at different field sizes and wedge angles. The difference in beam profiles was less than 2% which is in accordance with AAPM TG no.142 recommendations.

Risk factors and severity of acute liver injury in non-chronic liver disease and chronic liver disease patients

Objectives To study factors related to acute liver injury and compare the severity and risk of those factors in patients with and without chronic liver disease. Methods This cross-sectional study of 323 patients admitted to Somdejphrajaotaksin Maharaj Hospital between 1 January and 30 September 2019, analyzing data collected on the clinical background, signs and symptoms, and laboratory results of those patients. Results Of the 323 patients in the study, 188 did not have chronic liver disease (58.2%) and 135 had chronic liver disease (41.8%). Risk factors for acute liver injury in the chronic liver disease group included bacterial infection (33.3%) and spontaneous bacterial peritonitis (4.4%), much significantly higher than the rates in the no chronic disease group. However, the risk factors excessive consumption of alcohol (30.3%) and dengue infection (11.2%) in the no chronic liver disease group were significantly higher than in the chronic disease group. Both groups had a high incidence of disease severity as well as a high incidence of complications and mortality, although the mortality rate was higher in the chronic liver disease group (15.0% vs. 6.9%). Conclusions The types and frequencies of risk factors for acute liver injury in patients with chronic liver disease and those with no chronic liver disease groups are different. The incidence of bacterial infection and spontaneous bacterial peritonitis is higher in patients with chronic liver disease. The incidence of excessive alcohol consumption and dengue infection is much higher in patients without chronic liver disease. Both groups have high levels of disease severity, complications and mortality. Sepsis is the major cause of mortality, especially in patients with chronic liver disease.

Process and outcome of management for orthopedic patients with sepsis

Objectives To analyze the management process and outcomes of orthopedic patients diagnosed with sepsis. Methods This retrospective descriptive study included the medical records 275 orthopedics patients with sepsis from January 2017 to December 2019. Data collection was done using the Management Situation for Orthopedic Patients with Sepsis Record Form. Descriptive statistics were used for data analysis. Results Within 3 hours after being diagnosed with sepsis, the following management process occurred: 82.90% of the samples had blood collected for culturing before antibiotic administration, 31.27% received broad-spectrum antibiotics, 15.63% had serum lactate measurement and the 50.00% of the patients requiring fluid resuscitation (n=56) received initial fluid resuscitation. Within 6 hours following diagnosis, the 32.07% of the sample requiring vasopressors (n=53) received them. Of the patients in the study, 13.18% developed septic shock and the overall mortality rate was 18.19% (n=50). Conclusions There are opportunities for improvement of the management process for orthopedic patients with sepsis. Improvements in the quality of the management process could lead to better outcomes.

Measles outbreaks among health workers in a university hospital admission ward in Northeastern Thailand in 2019: reflections on the occupational health management system

Objectives This study examined a measles outbreak among health workers in a university hospital admission ward and details of the existing occupational health management system. Methods Secondary data was obtained from two sources: 1) from the Occupational Health and Safety Office outbreak investigation report a post-exposure immunity evaluation which is completed after a measles, mumps, or rubella outbreak and 2) from the medical records of the individual cases. In addition, the Occupational Health and Safety Office guidelines were reviewed and a descriptive epidemiological investigation was conducted. Results A total of 75 health workers in the university hospital admissions ward who were potentially exposed were included in the study, of whom three were diagnosable as measles based on a positive immunoglobulin M (IgM) test. The three health workers who were identified as confirmed cases were nursing assistants; two worked in the admissions ward 4A, and one worked in the cardiac care unit. We found evidence that a propagated source caused the outbreak. The occupational health management system in the hospital at that time had only exposure and post-exposure protocols, but no pre-exposure protocol. Conclusion None of the health workers who were diagnosable as measles had been examined for measles immunity during their pre-placement health examination. The occupational health management system should revise the policy for ensuring the immunity to measles of health workers before allowing them to begin work and conducting a respirator fit test before using an N95 respirator.

Age estimation in the Thai male population using epiphyseal union of the medial clavicle

Objectives To study the relationship between the union of the epiphyseal plate of the medial clavicle and age in the Thai male population. Methods Age-at-death estimation was evaluated from clavicles obtained from 200 cadavers of Thai males aged between 11 and 35 years. After soft tissue removal, the fusion status of the medial clavicular epiphysis was classified using a morphological classification. Stages of the epiphyseal union were categorized as follows: 1) nonunion with no epiphyses, 2) nonunion with separate epiphyses, 3) partial union, and 4) complete union. Results The stage of development of the epiphyseal union increased with age. The nonunion stage was found in indivi-duals up to 22 years old. Complete epiphyseal union was found as early as age 22. Partial union was found in individuals 19-26 years old. Conclusions The stage of the epiphyseal union of the medial clavicle in Thai males is related to age. We recommend using complete union (stage 4) of epiphyseal development to indicate age more than 22 years and nonunion (stage 1 and 2) to represent age less than 22 years in Thai males.

Shunt occlusion in neonates with congenital heart disease undergoing systemic-to-pulmonary shunt surgery in the Neonatal Intensive Care Unit, Maharaj Nakorn Chiang Mai Hospital

Objectives To study occlusion of shunts and related factors in neonates after systemic-to-pulmonary shunt surgery. Methods This retrospective descriptive study reviewed the medical records of neonates in the Neonatal Intensive Care Unit who underwent a systemic-to-pulmonary shunt operation at Maharaj Nakorn Chiang Mai Hospital between January 1, 2011 and December 31, 2016. Patient characteristics and operative data were collected. Demographic data and incidence of shunt occlusion were analyzed using descriptive statistics. Factors associated with shunt occlusion were identified using Fisher’s exact test and the Mann-Whitney U test. Results Seventy-five newborns were enrolled in the study, of whom 39 (52.0%) were female. The average birth weight was 2,711.1 grams, and the average gestational age was 37.6 weeks. The number of newborns with TOF or TOF/IVS was equal to those with PA/IVS (34.7%). Sixty neonates (80%) underwent Modified Blalock Taussig shunt surgery, most (57.3%) with a 3.5 Fr. diameter shunt. The average weight at surgery was 2,898.9 grams, and the average age at surgery was 17.6 days. Anticoagulant and anti-platelet medication was used with almost all the neonates following surgery (96.0% and 93.3%, respectively). The incidence of shunt occlusion was 22.7% (17 neonates). Complete occlusion was found in 11 neonates. In-hospital shunt occlusion occurred in 10 neonates as well as in 7 neonates after discharge from the hospital. The overall mortality rate was 14.7%. Congenital heart disease diagnosis and gestational age were significantly associated with shunt occlusion (p = 0.02 and p = 0.01, respectively). Conclusion The study results can be used to provide develop guidelines for treatment of neonates with complex heart disease and low gestational age as well as nursing care guidelines for the prevention of blockage of the shunt in neonates undergoing a systemic-to-pulmonary shunt operation due to hospitalization in a hospital.

Self-management activities and diabetes control of diabetic patients in Muang district, Nan province

Objectives To evaluate the prevalence of uncontrolled diabetes and diabetic self-care activities in type 2 diabetic patients in Muang District, Nan Province and to explore the association between self-care activities and glycemic control. Methods Participants were interviewed for general information, self-care activities and self-efficacy. Self-care activities in diabetic patients were assessed using the Summary Diabetes Self-Care Activities (SDSCA) questionnaire. Hemoglobin A1c (HbA1c) was collected to evaluate glycemic control. The data was analyzed using logistic regression analysis. Results Of 222 patients, more than half (56.76%) had poor glycemic control. Using multivariate regression analysis, lower SDSCA scores in diet and foot care activities were found to be associated with poor glycemic control (adjusted odds ratio = 2.29, p < 0.001 and adjusted odds ratio = 1.52, respectively; p-value 0.022). Conclusion The majority of the diabetic patients had poor glycemic control. Healthy diet is an important factor in good glycemic control. The association between foot care activity and glycemic control may not be straight forward; however, good foot care may represent adherence to prescribed diabetes treatment and appropriate life-style modification.

Development of wound management record form for traumatic persons in Emergency Department, Maharaj Nakorn Chiang Mai Hospital

Objectives To develop a wound management record form for traumatic patients in the emergency department and to explore the feasibility of using the form to record wound management of traumatic patients in an emergency department. Methods This developmental study used the National Health and Medical Research Council’s Guide to the Development of Clinical Practice Guideline (1999) as the research framework for development of the record form. The form was tested for feasibility by 20 emergency nurses who recorded wound management for 70 trauma patients who also completed a Wound Management Record Form Feasibility Questionnaire. The data were analyzed using descriptive statistics. Results The Wound Management Record Form developed was a one-page paper form which includes a checklist, standard abbreviations, a full-body anatomical picture for recording location, and space for additional information. The form includes five components: wound assessment, wound cleansing, wound closure and dressing, antibiotics and vaccination, and follow-up. Evaluation of use of the form found the completeness of components 1-5 to be 88.57, 82.86, 90.00, 81.43, and 82.86 percent, respectively. The majority of participating nurses either agreed or strongly agreed that the form was easy and convenient, precise and valid, appropriate as a wound management record for the emergency department, and saved time in recording information. The majority felt the form to be effective and feasible for use in an emergency department. Conclusion The Developed Wound Management Record Form is both appropriate and feasible for use in emergency departments.

A research synthesis of quasi and experimental studies about palliative care nursing in Thailand

Objectives The objective of the study was to synthesize existing quantitative evidence on palliative care intervention among patients with various types of illness in Thailand. Methods A synthesis of quasi and experimental studies published between 2010-2020 was conducted. The sample included theses and research articles that focused on nursing therapeutic therapeutic nursing. programs and which utilized a quasi or experimental study design. The main research instrument was a coding sheet developed by the researchers to record characteristics of the studies that met the inclusion criteria. Data were analyzed by frequency and percentage Results The study found seven studies that were included in literature reviews. Of the seven studies, one was classified as level 2.B and other six were classified as level 2.C. The outcomes of these existing nursing therapeutic programs specific focuses of the therapeutic nursing studies were quality of life (2 studies, 28.5%), symptom management in patients with advanced cancer (1 study, 14.3%), measurement of palliative care behavior (1 study, 14.3%), measurement of self-adaptation (1 study, 14.3%), measurement of quality of nursing care (1 study, 14.3%), and perceived symptom distress and quality of care (1 study, 14.3%). There were four types of interventions for caring patients and families during periods of palliative care: structured information programs, concrete nursing care programs, teaching and counseling programs, and family participation programs. Conclusion The findings of this study could be utilized as empirical evidence in developing clinical practice guidelines for patients in need of palliative care related to the patients’ health problems, symptoms, and needs.

Effects of different forms of communication on knowledge, attitudes and practices related to antibiotics smart use by undergraduate students in different faculties

Objectives To investigate correlations among different forms of communications and the knowledge, attitudes and practices of undergraduate students related to antibiotics smart use. Methods Correlations of knowledges, attitudes, and practices regarding antibiotics and different forms of communications among third year students of three faculties, Associated Medical Sciences (AMS), Engineering (ENG) and Economics (ECON), were computed using a questionnaire and Spearman’s rank correlation coefficient analysis. Results The highest correct knowledge and practices scores were exhibited by AMS students: 3.17 ± 1.12 (p < 0.001) and 4.08 ± 0.67 (p = 0.001), respectively. Gender, the only personal factor, was significantly correlated with negative attitudes and practices among Engineering and Economics students. Correct knowledge scores were significantly correlated with the method of communication. Only weak relationships were found with communication from medical practitioners among AMS and Engineering students, r = 0.278 (p = 0.004); and r = 0.295 (p < 0.001). Correlations were also weak for radio, television, and print media among the Engineering students, r = 0.287, (p = 0.003). A moderate relationship was found with communication from the internet in Engineering students, r=0.311 (p < 0.001), health posters or brochures, and family or close friends of the AMS students, r =0.329, (p = 0.001), and r = 0.305, (p = 0.001), respectively. Other correlations were not statistically significant. Conclusion Antibiotics Smart Use (ASU) is an innovative model to promote the rational use of medicines, fight against the irrational use of antibiotics, and counteract antimicrobial resistance. The present study revealed that the information regarding antibiotics smart use provided via various forms of communications should be provided to improve the knowledge, attitude, and practice regarding antibiotics smart use among undergraduate students