Chaiyaphum Medical Journal

Nursing care for Septic shock at the Emergency Department: Case Study

Atchara kwuanyuen — Fri, 28 Jun 2024 00:00:00 +0700

Objective: This case study aims to investigate the nursing care of patients with sepsis shock.

Methodology: This is a case study of patients with sepsis and septic shock at the Emergency Department of Chaiyaphum Hospital on December 8, 2023. Data were collected from patient histories and relatives, physical examinations, observations, and patient medical records. Data analysis was conducted based on pathology, sign and symptoms, and treatment. Patient assessment uses the Modified Early Warning Score (MEWS) to determine nursing diagnoses, provide nursing care, and evaluate outcomes.

Result: A 60-year-old Thai female patient with underlying conditions of diabetes, hypertension, and hyperlipidemia presented with abdominal pain, bloating, diarrhea, nausea, vomiting, and fatigue. She was referred from a community hospital and diagnosed with infective diarrhea with sepsis and septic shock. The patient's critical condition was assessed using the MEWS. The nursing problems identified during the critical stage were: 1) decreased peripheral tissue perfusion due to shock; and 2) altered elimination patterns due to gastrointestinal infection. She received nursing care according to the nursing process and treatment according to the Clinical Practice Guidelines for Patients with Sepsis (MHALBIS).

Conclusion: The patient received treatment according to the Clinical Practice Guidelines for patients with sepsis (MHALBIS) and professional standards. After recovery from the critical stage, the patient's condition was stable. The medical doctor considered continuing treatment in the medical intensive care unit. Following treatment, the patient responded well and was discharged home on December 15, 2023, after
a total of 8 days of care.

Factors related to the treatment of internal fixation in patients with intertrochanteric femur fractures

Supavit Chulapakorn — Fri, 28 Jun 2024 00:00:00 +0700

Reasons and objectives: To investigate the factors affecting the treatment outcomes of patients with intertrochanteric of femur fracture.

Method: A case-control study was conducted using secondary data from 130 patients aged 50 years and older who had intertrochanteric of femur fracture and were treated with internal fixation surgery between 2020 and 2023 at Pakchong Nana Hospital. The relationship between variables was analyzed using multiple logistic regression.

Results: More than half (61.5%) of the 130 patients had a non-excellent outcome (Harris Hip Score: HHS < 90), while 38.5% had an excellent outcome (HHS ≥ 90). The most common fracture patterns in both groups were AO31-A2.2, AO31-A2.3, and AO31-A1.2. There was no statistically significant difference in fracture patterns between the two groups. Multivariate analysis revealed that the presence of comorbidities (OR_Adjusted = 2.04; 95% CI: 1.29, 3.23) and prolonged surgery (OR_Adjusted= 1.32; 95% CI: 1.03, 1.70) were associated with non-excellent outcomes.

Conclusion: The presence of comorbidities and prolonged surgery adversely affect treatment outcomes in patients with proximal femur fractures. Strategies to reduce the risk before surgery should focus on three areas: patient preparation, risk assessment for physicians, and the development of screening systems.

Persistent Pulmonary Hypertension of the Newborn at Chaiyaphum Hospital Hospital

Supannigar Yangai — Fri, 28 Jun 2024 00:00:00 +0700

Introduction : Persistent Pulmonary Hypertension of the Newborn (PPHN) is serious condition in neonates resulting in high morbidity and mortality

Objectives : To identify the proportion and mortality-related risk factors of Persistent Pulmonary Hypertension of the Newborn (PPHN) at Chaiyaphum hospital.

Methods : This study employs a cross-sectional study. The author obtained data from the medical records of infants with PPHN admitted to Chaiyaphum Hospital, between 1^st October 2020 to 30^th September 2023. Then, the author analyzed descriptive statistics, independent t-test, Z-test for proportion, and conditional logistic regression.

Results : There were 48 PPHN neonates over the course of the four-year study. The proportion was 1.76:1,000 live births. The male : female ratio was 1.66 :1. The mean gestational age was 37.38 + 2.57 weeks. The mean birth weight 2,974 + 726.16 grams. The PPHN mortality rate was 37.5 % (95% CI: 24.0, 51.2) with the highest rate in 2021. The survival group had a longer length of stay (mean diff.=27.43; 95% CI: 17.27, 37.60) and a longer duration of ventilator support (mean diff. = 8.03; 95% CI: 0.56, 15.51), which was associated with the administration of Norepinephrine used (prop. diff. = 32.5; 95% CI: 6.7, 58.2). Male neonates. (OR_Adjusted = 8.97; 95% CI: 1.61, 50.04) have a higher risk of mortality in PPHN than neonates with birth weight < 2,500 grams (OR_Adjusted = 15.16; 95% CI: 1.66, 138.08)

Conclusions : The frequency of PPHN in infant is low. The mortality rate in infants is about one in every three, with congenital pneumonia from birth being the leading cause. High-risk factors for mortality are male newborns and infants weighing less than 2,500 grams.

Effect of Digital platform to FMC (First Medical Contact) to refer out for primary PCI/fibrinolytic among ST-segment elevation myocardial infarction patients in Chaiyaphum province

Aphirak Pussawiro — Fri, 28 Jun 2024 00:00:00 +0700

Background: Patients with acute ST-segment elevation myocardial infarction (STEMI) require prompt treatment within 60 minutes to reduce mortality rates.

Objective: To compare the time taken for each step in the treatment of STEMI patients between using a digital platform and manual recording.

Method: A cross-sectional study using secondary data from 512 STEMI patients. Patients were divided into two groups: manual recording (n = 243, November 2021 – October 2022) and digital platform recording (Google form, n = 269, November 2022 – October 2023). Data were collected from admission to diagnosis confirmation, including 6 steps. Data were analyzed using repeated measure ANOVA.

Result: The manual recording group had an average data recording time of 162.20 minutes, while the Google Forms group had an average of 150.92 minutes. Manual recording took the longest time in the step from Confirm diagnosis to Refer out (81.26 minutes; 95% CI: 75.83, 86.69), followed by the step from EKG to diagnosis (47.70 minutes; 95% CI: 42.28, 53.13). Similarly, Google Forms took 61.92 minutes (95% CI: 56.76, 67.07) and 22.02 minutes (95% CI: 16.86, 27.17), respectively. Overall, Google Forms took significantly less time than manual recording (p-value < 0.001). The steps with the greatest difference were EKG to diagnosis (Mean diff. = 25.69; 95% CI: 18.20, 33.17), followed by Confirm diagnosis to Refer out (Mean diff. = 19.34; 95% CI: 11.85, 26.82). There was no statistically significant difference between the two methods in the step from admission to EKG (Mean diff. = 4.91; 95% CI: -2.57, 12.39).

Conclusions: The development of a digital platform can reduce the time to treatment for STEMI patients. However, this method does not yet meet the target of less than 60 minutes. Further development to reduce unnecessary processes and connect devices to the digital platform is a direction that should be promoted in the future.

HIV Viral Load Monitoring after Antiretroviral Therapy initiation and Four Follow-up Visits over Three Years.

Waurawoot Mata — Fri, 28 Jun 2024 00:00:00 +0700

The Thai HIV treatment program aims to reduce HIV viral load to below 200 copies/mL in 95% of treated patients by 2030. This study investigated viral load dynamics in 230 patients after initiating antiretroviral therapy (ART). Viral load was measured using the Abbott Realtime m2000 system at four time points over three year: 6 months, 1 year, 2 years, and 3 years. Data were analyzed using descriptive statistics and Pearson’s correlation.

The study sample comprised 230 HIV-positive individuals receiving ART and completing all four viral load monitoring visits (6 months, 1 year, 2 years, and 3 years). This constitutes 82.7% of all monitored patients. The majority were male (53.%) with an average age of 44.62 years. At the follow-up (3 years), 96.1% of patients achieved undetectable viral load (< 40 copies/mL), while 2.2% had viral load between 40 and 1,000 copies/mL, and 1.7% had viral load > 1,000 copies/mL. Overall, the proportion of patients achieving undetectable viral load increase from 58.5% at 6 months to 96.1% at 3 years. Additionally, a strong positive correlation (Pearson’s corr. = 0.598) was observe between viral load and log values obtained using the Abbott Realtime m2000 system. Among patients with persisted detectable viral load (> 40 copies/mL), non-adherence to ART was identified as a major factor, citing family issues and transportation difficulties as barriers to consistent medication use.

HIV/AIDS patients receiving antiretroviral therapy and completing follow-up visits demonstrate a favorable trend towards reducing viral load. The outcomes observed in the sample group (82.7%) are close to the target value (95.0%). However, with the remaining time, efforts will be focused on proactive advocacy campaigns and case management to achieve the set goals.

The post-surgery recurrence rate of oral cancer and influencing factors at Chaiyaphum Hospital.

Phennapa Wongsricha — Fri, 28 Jun 2024 00:00:00 +0700

Objective : To evaluate treatment outcomes for oral cancer patients at Chaiyaphum Hospital, focusing on recurrence rates, 5-year recurrence-free survival rates, and potential factors influencing disease recurrence.

Design : This is a retrospective cohort study of patients with oral cancer who underwent surgery at Chaiyaphum Hospital between January 2018 and March 2023.

Result : A total 50 patients were included in the study. Most were male (64.0%) with a mean age of 64.8 years. The most common tumor sites were the tongue (48.0%), followed by the lip (40.0%) and the floor of the mouth (12.0%). Most patients (88.0%) underwent surgery within 30 days of diagnosis. Thirty-eight percent of patients had stage II disease. There were 12 recurrences, resulting in a recurrence rate of 18 per 100 person-years (95% CI:10.17- 31.56). The recurrence-free survival (RFS) rates at 1, 2 and 5 years were 73.8%, 69.9% and 58.3%, respectively. In multivariate analysis, a positive resection margin of less than 5 mm and post-operative radiation were found to be independent predictors of recurrence (HR_Adjusted = 13.54; 95% CI 2.79-65.63, p < 0.001 and HR_Adjusted= 3.78; 95% CI 1.16-12.31, p = 0.02, respectively).

Conclusion : The study findings highlight the importance of achieving a negative surgical margin in oral cancer resection to reduce the risk of recurrence. This implies the need for continuous skill development among surgeons and close patient follow-up for recurrence surveillance, especially in patients who have received radiation therapy. Further research is also needed to identify additional factors influencing recurrence over extended follow-up periods with a larger sample size.

Risk factors associated with Postpartum Hemorrhage in PhuKhiao Chaloem Prakiat Hospital Chaiyaphum Province

Othanee Suwanmalee — Fri, 28 Jun 2024 00:00:00 +0700

This research is a case-control study aimed to investigating the prevalence and risk factors of early postpartum hemorrhage in pregnant women who delivered at Phu Khiao Chalerm Phra Kiat Hospital between January 1, 2022, and December 31, 2023. The study included 508 participants, selected through sampling from medical records and birth registers. Data was collected using a pregnancy data recording tool, which had a reliability score of 0.85. Descriptive statistics and multiple logistic regression were used for analysis.

The results show that 71 pregnant women have early postpartum hemorrhage, representing a prevalence of 14 percent. Of these, 63.4% of cases are classified as minor postpartum hemorrhage. Risk factors associated with postpartum hemorrhage included maternal anemia (adj. OR=3.25; 95% CI: 1.29, 8.18), higher than normal birth weight (adj. OR=12: 3.57, 45.62), placental abnormalities (adj. OR=8.31; 95% CI: 2.14, 32.24), tear of stitches level 3 and above (adj. OR=32.43; 95% CI: 5.20, 202.49), prolonged first stage of labor (adj.OR = 4.29; 95% CI: 2.03, 9.03) and prolonged third stage of labor (adj.OR=17.46; 95% CI: 2.98, 102.42). These factors collectively predict a 32.3 percent likelihood of early postpartum hemorrhage. Additionally, having a higher than normal body mass index before pregnancy was associated with a 72% lower risk of postpartum hemorrhage compared to having a normal pre-pregnancy body mass index.

Postpartum hemorrhage depends on many factors. Focusing on screening, and risk factors since in the pregnancy phase will be surveillance and treatment before the occurrence of abnormalities in pregnant women.

Cost Analysis and Cost Recovery Ratio of Radiology Services at Mahasarakham Hospital, in Fiscal Year 2023

Sarawut Suphrawitchayanon — Fri, 28 Jun 2024 00:00:00 +0700

Introduction: MahaSarakham Hospital Has developed radiology services using technology for storing and transmitting medical image data. including digital radiography technology. The goal is to reduce the cost of radiology services.

Objectives: To study the total cost, unit cost of service, and cost recovery ratio of radiology services.

Research Methodology: This is a descriptive study using cost and revenue data from the Radiology Department of Mahasarakham Hospital between October 1, 2022 and September 30, 2023. The cost data includes labor, materials, investments, and the number of services. Data were analyzed using descriptive statistics.

Results: The total cost was 21,066,409.63 baht, with the proportion of labor costs, capital costs, and material costs being 69.5%, 21.0%, and 9.5%, respectively. Considering the activities, general X-ray had the highest total cost of 8,140,287.46 baht, while quality control, medical image storage, and delivery had the lowest total cost of 709,615.14 baht. When considering the unit cost for each activity, general X-ray (Bone survey, Elbow, Forearm, Hand, Humerus, Wrist) had the lowest unit cost of 44.63 baht, while unit cost of two special X-ray activities that exceeded the charge rate: Cystogram and Voiding Cysto-Urethrogram.

The highest cost recovery ratio was general X-ray at 3.62 times, while the lowest was for special X-ray at 1.20 times. When considering only material costs. It was found that the highest recovery ratio for material costs was 76.09 times in mobile x-ray, followed by 54.35, 14.14, 4.45 times in general X-ray, ultrasound X-ray, and special X-ray, respectively.

Submission: 10 January 2024

Publication: 19 June 2024

Submission: 10 January 2024

Publication: 19 June 2024

Conclusion: The majority of the cost was labor, and general X-ray was the most frequently used activity, resulting in the highest total cost. Additionally, it was found that special X-ray has activities that unit costhigher than the charge rate. However, the overall radiology service there was a profitable payback rate in almost every activity.

Factors Associated with HbA1c Levels of Type 2 Diabetes Patients in Nong Bua Daneng Hospital, Chaiyaphum Province

Yuttachai Phungan — Fri, 28 Jun 2024 00:00:00 +0700

Objective: To investigate the factors associated with Hba1c levels in type 2 diabetes patients receiving treatment and follow-up at Nongbuadaeng hospital.

Methods: A cross-sectional study was conducted using patient records from January to December 2023. The sample size was 3,800 patients. Data were analyzed using descriptive statistics and Spearman’s rank correlation.

Result: The majority of the patients were female (70.6%) and aged between 40-59 years (40.1%). The prevalence of obesity (BMI ≥ 30) was 84.5%. Additionally, 56.5% of the patients had high blood pressure (SBP 120-139), 65.0% had fasting blood sugar (FBS) >125 mg/dL, and 85.3% had HbA1c ≥ 6.5 mg%. Spearman's rank correlation analysis revealed a weak negative correlation between age and HbA1c levels (r = -18.9%), indicating that younger patients may have higher HbA1c levels. A moderate positive correlation was found between FBS and HbA1c levels (r = 40.2%).

Conclusion: The study findings suggest that the type 2 diabetic patients in this study are at high risk of developing complications due to elevated BMI, blood pressure, FBS, and HbA1c levels. Further research on in-depth analysis of high-risk groups, the impact of complications, and the development of individualized patient care strategies could be potential solutions to address these issues.

Factors Affecting Falls in The Elderly in Huiyae Sup-District Nongbuarawae District Chaiyaphum Province

Rumpueng Jaratsuriyasakul — Fri, 28 Jun 2024 00:00:00 +0700

Falls are a major problem among older adults. This cross-sectional study aimed to investigate the factors associated with falls in older adults in Huai Yae Sub-district, Nongbua Rahewe District, Chaiyaphum Province. A sample of 274 people was collected using questionnaires and data were analyzed using descriptive statistics and multiple logistic regression.

The results showed a prevalence of falls in older adults of 35.0% (95% CI: 29.4, 41.0). Most (79.2%) falls were first-time falls, and more than half (52.1%) were caused by tripping over oneself. These falls mostly occurred at home (66.7%). Analysis of the relationship between falls and other factors showed that having difficulty walking (OR_(Adjusted)= 2.85; 95% CI: 1.48, 5.47), having cognitive impairment (OR_(Adjusted) = 1.91; 95% CI: 1.001, 3.65), and wearing inappropriate shoes (OR_(Adjusted) = 3.44; 95% CI: 1.21, 9.80) increased the risk of falls in older adults. On the other hand, poor vision (OR_(Adjusted) = 0.54; 95% CI: 0.27, 1.09), the absence of handrails in the bathroom (OR_(Adjusted) = 0.15; 95% CI: 0.03, 0.71), and the use of slippery carpets that are not attached to the floor (OR = 0.16; 95% CI: 0.06, 0.41) or non-slip mats (OR_(Adjusted) = 0.05; 95% CI: 0.004, 0.58) did not increase the risk of falls, but rather increased caution against such risks.

Falls in older adults are still a worrying problem. Understanding the causes and prevention can help reduce the risk. Promoting muscle strength, adapting the environment, and having regular health checks for older adults may be appropriate ways to address this issue.