Hospitals In Southern Thailand Research Articles

The Effect of a Nurse-Led Family Involvement Program on Anxiety and Depression in Patients with Advanced-Stage Hepatocellular Carcinoma.

Psychological distress is commonly reported in patients with advanced cancer. Family is considered a psychological supporter for patients during their cancer journey. This study aimed to examine the effect of a nurse-led family involvement program on anxiety and depression in patients with advanced hepatocellular cancer. This is a quasi-experimental study with a two-group, pre-post-test design. Forty-eight participants were recruited at a male medical ward in a university hospital in Southern Thailand, and assigned to either the experimental or the control group. The experimental group received the nurse-led family involvement program, while the control group received only conventional care. Instruments included a demographic data form, clinical data form, and the Hospital Anxiety and Depression Scale. Data analyses were performed using descriptive statistics, chi-square, Fisher's exact test, and t-test. The results revealed that the mean scores of anxiety and depression in the experimental group at post-test were significantly lower than on the pretest and significantly lower than those of the control group. The results indicate that a nurse-led family involvement program has a short-term effect on the reduction of anxiety and depression in male patients with advanced HCC. The program can be useful for nurses to encourage family caregivers to engage in patient care during hospitalization.

SG-APSIC1048: Lean management dressing set of service unit at Pattani Hospital

Background: Pattani Hospital in southern Thailand has 540 beds and a network of 22 family clinical practice and community locations and 13 primary-care hospitals. We care for patients and soldiers who have wounds from guns and bombs of varying wound size. The central sterilization services department (CSSD) prepares dressing sets with 1 size dressing procedures. Objectives: We sought to improve the sizing of dressing sets within Pattani Hospital and network, to reduce preparation time to ≤3 minutes per set, and to reduce the cost of dressing sets by 8,000 Thai baht (US $240) per month. Methods: We convened a problem-solving meeting to address the sizes of dressing sets in the hospital. We decided that 3 sizes were needed (small, medium, and large) following the size of the wound. We performed a pilot project and evaluated its progress every 2 months. Results: Unique dressing sets were used in 68.18% of cases before the intervention and 88.5% after the sizing changes. Time to prepare the dressing sets decreased from 3 minutes to 1 minute per set. The intervention reduced the costs related to dressing sets from 39,952.50 Thai baht (US $1,194) per month to 25,641 baht (US $766) per month. Furthermore, infectious waste was reduced from 31.8 kg per day to 7.99 kg per day. Conclusions: Multiple sizes of dressing sets were prepared for use with wounds of varying size. The CSSD prepared the dressing sets using medical supplies such as gauze, cotton, and top gauze. This project reduced waste and improved cost-effectiveness, and this procedure will be extended to other care facilities in our network.

Risk of thrombosis in essential thrombocythemia according to three prediction models: an external validation study.

Thrombosis is a major complication of essential thrombocythemia (ET). There are three well-known prediction models for thrombotic risk in ET patients. However, only few external validation studies for the performance of these models in Asian populations have been conducted. Thus, we aimed to evaluate the performance of these models for predicting the risk of thrombosis in Thai patients with ET. We retrospectively evaluated the clinical characteristics and thrombotic risk of 149 Thai ET patients in a university hospital in Southern Thailand between 2002 and 2019. Thrombotic risk variables were evaluated using Cox proportional hazard regression. The Brier score, calibration plot, and Harrel concordance index (C-index) were used to evaluate the performance of the three models. With a median follow-up of 5.2 years, there were a total of 28 thrombotic events in 26 patients. Age > 60 years was a significant prognostic factor for thrombosis in the multivariate Cox regression analysis. The Brier scores were 0.251, 0.273, and 0.276 in the conventional, IPSET-thrombosis, and revised IPSET-thrombosis models, respectively. The conventional model had optimal calibration and good discrimination (C-index, 0.67; 95%CI:0.55-0.79). The IPSET thrombosis (C-index 0.33; 95%CI:0.20-0.49) and revised IPSET thrombosis (C-index 0.31; 95%CI:0.18-0.44) models showed poor discrimination. The conventional model, which is based on age and history of thrombosis, is the best model to predict thrombotic risk in Thai ET patients. Further studies with a larger number of patients with thrombotic events are needed to validate the IPSET-thrombosis and revised IPSET-thrombosis models.

Factors Associated with Mortality among Patients with Colorectal Cancer at the Secondary Care Hospital in Southern Thailand: Hospital-Based Retrospective Cohort Study.

Globally and in Thailand, the incidence of colorectal cancer (CRC) is third-ranked behind lung and breast cancer, respectively. This hospital-based retrospective cohort study aimed to determine factors associated with mortality among patients with CRC. This study was performed by using the secondary data of the cancer registry among patients with CRC registered in Phatthalung Hospital. Two hundred twenty-eight patients with CRC were diagnosed and followed up from January 2014 to December 2018. Multiple logistic regression analysis was used to analyze factors associated with mortality among subjects with CRC. The results revealed that the proportion of mortality among subjects with CRC was 50.44% (115 cases) at six months of following up. Subjects who had an increasing age every ten years (adjusted odds ratio [ORadj] = 1.40, 95 percent confidence interval [95% CI]: 1.09-1.80) were diagnosed with CRC at stage 3 (2.64, 1.19-5.84) and at stage 4 (11.63, 2.69-50.15) more likely to die. Also, subjects who received a combination of chemotherapy and radiotherapy treatment (3.44, 1.20-9.85), combination treatment of surgery, and postoperative care (2.46, 1.22-4.94) were more likely to die. Subjects who had not had surgery treatment were more likely to die (35.00, 7.44-168.27). In conclusion, factors such as the age of patients, stage of CRC, and treatment were associated with mortality among patients with CRC. Hence, medical and health professionals should consider these factors according to the treatment and optimization in patients with CRC.

Effects of diets containing synbiotics on the gut microbiota of critically ill septic patients: a pilot randomized controlled trial

The effects of synbiotics on gut microbiota have not been thoroughly clarified in critically ill patients with sepsis. In this present study, we aimed to evaluate the effects of synbiotics in a commercial diet on the gut microbiota of mechanically ventilated septic patients. This double-blind, randomized controlled clinical trial was conducted on septic patients under mechanical ventilation in a university-affiliated hospital in southern Thailand from February 2019 to March 2021. The patients were randomly divided into 2 groups stratified by sepsis stages and given commercial enteral feeding with synbiotics or standard commercial feeding for 7 days. The primary outcome was fecal microbial diversity measured as alpha and beta diversity. The secondary outcomes included ventilator-associated pneumonia, nosocomial diarrhea, ventilator days, length of hospital stay, and mortality. Twenty-four patients, 12 on a synbiotic diet and 12 on a non-synbiotic diet, completed this study. On day 3 of feeding, no significant difference was observed in their alpha fecal microbial diversity. However, significantly greater beta diversity was observed in the non-synbiotics group compared with the synbiotic group (Bray Curtis distance, p = 0.001; Jaccard’s distance, p = 0.001; unweighted UniFrac, p = 0.001; weighted UniFrac, p = 0.029). The secondary outcomes were not significantly different between the two groups. In critically ill septic patients, feeding with a commercial diet containing synbiotics did not significantly improve fecal microbial diversity. Due to the small sample size, further study is required.

Persistent Asthma at School Age: Associated Factors in Preschool Children with Asthma.

Most patients with childhood asthma present their first symptoms at preschool age. Identifying modifiable risks and protective factors at an early age may help develop asthma prevention and control strategies. This study aimed to identify factors at preschool age that are associated with persistent asthma at school age. This retrospective observational study included preschool children with asthma from 2015 to 2020 at a university hospital in Southern Thailand. In total, 189 eligible participants (70.9% boys; median age, 7.6 [6.7, 8.5] years) were included. Wheeze characteristics included early transient wheeze, persistent wheeze, and late-onset wheeze that accounted for 55%, 27.5%, and 19.5% of the patients, respectively. Approximately 20% of the participants had persistent asthma. Breastfeeding was a protective factor (odds ratio [OR] 0.4 [0.2, 0.9], p = 0.04). The modifiable risk factors were siblings living in the same household (OR 2.6 [1.1, 6.2], p = 0.02) and residence in an industrial area (OR 3.8 [1.4, 10.5], p = 0.009). Additionally, presence of allergic rhinitis was associated with an increased risk of persistent asthma at school age (OR 3.6 [1.6, 8.2], p = 0.002). Early therapeutic interventions targeting modifiable factors provide a window of opportunity to prevent persistent asthma at school age.

Effectiveness of a Nurse-led Program to Enhance Self-efficacy of Pregnant Adolescents and Reduce their Fear of Childbirth: A Randomized Controlled Trial

Fear of childbirth is a common feeling experienced by pregnant women, and it can occur before, during, or after childbirth. Intense fear has a detrimental effect on physical and psychological statuses of the pregnant women. The aim of this randomized controlled trial was to examine the effectiveness of a nurse-led program together with the mobile phone application to enhance pregnant adolescents’ childbirth self-efficacy and reduce their fear of childbirth. The sample was pregnant adolescents receiving antenatal care in a regional hospital in Southern Thailand. Using the minimization procedure, pregnant adolescents were assigned to either an experimental group receiving the program (n = 64) or a control group receiving routine care (n = 64). The instruments used for data collection consisted of a demographic characteristics form, the Fear of Childbirth in the Third Trimester Questionnaire, and the Thai Childbirth Self-Efficacy Inventory. Data were analyzed using descriptive statistics, paired t-test, and independent t-test. The results showed that after completion of the intervention program, the participants in the experimental group had a significantly higher mean score on childbirth self-efficacy and lower fear of childbirth than before the intervention. When comparing the two groups after completion of the program, results showed a significantly higher childbirth self-efficacy mean score, and lower fear of childbirth mean score in the experimental group than those in the control group. The results indicate that application of childbirth self-efficacy enhancement program can increase self-efficacy and reduce fear of childbirth in pregnant adolescents. Therefore, it is a promising program for caring pregnant adolescents but needs to be tested with other samples before implementation in practice.

Model of Factors Influencing Health-Related Quality of Life among Thais with Colorectal Cancer and a Permanent Colostomy

Enhancing health-related quality of life among colorectal cancer survivors with a colostomy has become a significant concern for healthcare professionals. An understanding of factors involved in this condition and treatment, and how these work to affect the health-related quality of life of cancer survivors is a foundation for developing effective interventions. This cross-sectional study aimed to develop and test a health-related quality of life model among people with colorectal cancer and a permanent colostomy. Data were collected from 232 Thais with colorectal cancer and a permanent colostomy from six tertiary hospitals in southern Thailand by using seven instruments, including the Demographic and Health-related Data Form, the Social Support Questionnaire, the Bowel Function Inventory-Colorectal Surgery, the Center for Epidemiologic Studies Depression Scale, the Body Image Scale, the Chula ADL Index, and the Quality of Life Index-Cancer version III. Descriptive statistics and structural equation modeling were used for analyzing the data. The results indicated that the final model fitted with the empirical data and explained 72% of the variance in health-related quality of life. Three factors, carcinoembryonic antigen, gender, and age, had an indirect effect on health-related quality of life through different paths. Six factors, religion, social support, bowel symptoms, depressive symptoms, body image disturbance, and functional status, had both direct and indirect effects on health-related quality of life, with body image disturbance being the strongest effect. Nurses and other health professionals can use the findings of this study to design a comprehensive intervention to improve the quality of life for this group of patients. Such an intervention needs to target all the factors of this study, especially improving body image, functional status, and social support, and managing bowel and depressive symptoms. This intervention should be further tested in clinical practice.

Are Technical Skills Assessed Using Medical Knowledge Associated with Non-technical Skill Knowledge in Anaesthesia Resident Training?

Objective: We examined the association between midterm examinations and anaesthetists’ non-technical skills (ANTS) knowledge using multiple choice questions (MCQs) for anaesthesia training.
 Materials and Methods: A prospective cross-sectional study was implemented based on two cohort studies conducted in November 2017 and November 2019 at the university hospital in southern Thailand. Each cohort consisted of MCQs, short answer questions (SAQs), objective structured clinical examinations (OSCEs), and MCQs after ANTS simulation workshops during the midterm examinations. The main exposure variable was the midterm examination (MCQs/ SAQs/ OSCEs) whereas the ANTS MCQs were the outcome. The potential predictors were the residents’ role, sex, PGY (1-3), and competency. Associations between midterm examinations and ANTS MCQ scores were analysed using Pearson’s correlation coefficients (r) and multivariate linear regression analysis, and presented as beta coefficient (β) and 95% confidence limit (CL).
 Results: Forty-eight anaesthesia residents were recruited for the study. After adjusting for PGY, knowledge score, and attitude evaluated by the staff, OSCE was found to be significantly associated with the pretest ANTS scores (β [95% CL]= 1.02 (0.06, 1.98)) and MCQ scores were significantly associated with the posttest ANTS scores (β [95% CL]= 0.14 (0.04, 0.24)). SAQ scores had negative associations with the pretest (β [95% CL]=-0.11 (-0.21, -0.01)) and posttest (β [95% CL]=-0.16 (-0.27, -0.05)) ANTS scores. It was found that there was a significant relationship between midterm examinations and posttest ANTS scores (r=0.52).
 Conclusion: Technical skills using OSCE and midterm MCQ examination scores were associated with non-technical skill knowledge in anaesthesia training.

Delayed pre-hospital time in acute coronary syndrome patients and associated factors in a hospital in Southern Thailand

Background: Acute coronary syndrome (ACS) is currently the leading cause of morbidity and mortality worldwide. The prognosis of ACS treatment outcome depends on the speed of reperfusion after a heart attack; wherein, one of the associated factors is pre-hospital time.

Inferior Clinical Outcomes of Pediatric Rhabdomyosarcoma in Thailand: A 16-Year Experience in a Single Tertiary Institution.

There is limited data available on the treatment outcomes of pediatric rhabdomyosarcoma (RMS) in Asian populations. Therefore, we aimed to review the baseline characteristics, clinical outcomes, and prognostic factors in children with RMS from Thailand. The data of children under 15 years of age diagnosed with RMS between 2003 and 2019 from a large tertiary hospital in Southern Thailand were retrospectively reviewed. Descriptive statistics were utilized to describe the clinical characteristics. The Kaplan-Meier method was utilized to estimate survival. Cox proportional hazards regression analysis was utilized to determine prognostic factors that affect survival. A total of 42 children RMS were included in this study. The median age at diagnosis was 6.4 years (IQR, 2.4-10.2). Among these patients, 11 (26%) were older than 10 years, and 13 (31%) presented with metastatic disease at diagnosis. The 5-year overall survival (OS) rate was 39% for all children. Age greater than 10 years (hazard ratio (HR): 3.3, 95% CI: 1.2-9.2) and metastatic disease at diagnosis (hazard ratio (HR): 2.8, 95% CI: 1.1-7.5) were independently associated with poorer survival. The 3-year OS for children with metastatic disease (stage IV) was 15% (95% CI: 4.3-55). The percentage of metastatic disease in our cohort was higher than that in previous reports and may have contributed to a poorer outcome. Age greater than 10 years and metastatic disease at diagnosis were noted as adverse prognostic factors.

Psychometric evaluation of the Thai version of the Self-Care of Coronary Heart Disease Inventory Version 3.

Engaging in self-care is an important aspect of the prevention and management of coronary heart disease (CHD), the leading cause of premature death in Thailand. As no validated tool exists to measure self-care in Thai people with CHD, we translated and examined the psychometric properties of the Self-Care of Coronary Heart Disease Inventory Version 3 (SC-CHDI-V3) in a Thai population. The SC-CHDI-V3 was translated into Thai using the standard forward and backward translation procedure for self-care instruments. A cross-sectional design was used to examine the psychometric properties of the Thai version of the SC-CHDI-V3 in 250 patients with confirmed CHD in a tertiary hospital in southern Thailand. Cronbach's alpha and McDonald's omega coefficients were used to assess internal consistency, and confirmatory factor analysis was performed to assess construct validity. The Thai version of the SC-CHDI-V3 demonstrated acceptable internal consistency (Cronbach's alpha and McDonald's omega coefficients of each scale ranged from 0.821 to 0.910). Reliability estimates were adequate for each scale (range 0.863-0.906). Confirmatory factor analysis supported the original factor structure of the instrument, with good fit indices for all three scales (comparative fit index = 0.996-1.000; root mean square error of approximation = <0.001-0.040). The Thai version of the SC-CHDI-V3 appears to be a valid and reliable instrument for measuring engagement in self-care maintenance, self-care monitoring, and self-care management among Thai people with CHD.

HBV seroprevalence and liver fibrosis status among population born before national immunization in Southern Thailand: Findings from a health check-up program.

Hepatitis B virus (HBV) infection is the leading cause of liver-related death worldwide, particularly in Asia. Patients with either current or past HBV infection are at risk of cirrhosis and hepatocellular carcinoma (HCC). Here, we investigated the HBV seroprevalence in residents of southern Thailand born before the national vaccination program. A cross-sectional study of individuals born before the nationwide HBV vaccination program who sought check-up programs which included HBV serology and abdominal ultrasound at a tertiary care hospital in southern Thailand from 2019 to 2020 was conducted. HBV serology, cirrhosis and liver fibrosis status (determined by ultrasonography and FIB-4), and clinical notes regarding management following HBsAg+ detection were obtained. Of 1,690 eligible individuals, the overall prevalence of HBsAg+ and HBsAg-antiHBc+, indicating current and past HBV infections, were 2.9% and 27.8%, respectively. Among current HBV patients, 87.8% were unaware of their infection. Cirrhosis was found in 8.2%, 1.1%, and 0.3% of patients with current, past, and no HBV infection, respectively (p<0.001). One-fourth of past HBV patients had FIB-4≥1.45, which indicated indeterminate or significant liver fibrosis, which may increase the risk of HCC. The prevalence of HBsAg+ in Southern Thailand was 2.9%, and that of past infection (HBsAg-antiHBc+) was 27.8%. Patients with current and past HBV infection have an increased risk of cirrhosis and significant liver fibrosis. Most current HBV patients were unaware of their infection. Identifying patients with current and past HBV infection who are at risk for HCC and linking them to a cascade of care is necessary to reduce the burden of HBV-related liver diseases in Thailand.

Progression time of de novo metastases in relation to castration resistant prostate cancer at a tertiary care hospital in Southern Thailand

Objective: Androgen deprivation therapy (ADT) is often the treatment of choice in metastatic prostate cancer patients. However, there is currently an insufficiency of biomarker-related data that can be used in order to predict how the disease would respond to ADT. In this study we evaluated the clinical response to ADT, including factors which are affecting the progression of the disease into castration-resistant prostate cancer (CRPC) in patients with de novo metastatic prostate cancer. Materials and Methods: This retrospective study incorporated patients with metastatic prostate cancer who received ADT at our center from January 2008 to December 2019. Baseline characteristics, mode of ADT, prostate-specific antigen (PSA), blood chemistry, Gleason score (GS) grade group, location, and the number of metastases were analyzed. The risk factors affecting the progression of the disease were identified. Results: Data from 125 patients were included in the study. One hundred patients (80%) were classified as suffering from high volume metastatic prostate cancer and six patients (6%) with visceral metastasis. Baseline PSA in high volume and low volume metastatic prostate cancer were defined as 500 ng/ml and 215.1 ng/ ml respectively. Eighty-one patients (64.8%) received a gonadotrophin-releasing hormone (GnRH) agonist while 42 patients (33.6%) underwent bilateral orchi- ectomy. Time to CRPC in high and low volume metastasis was 12 months and 23 months respectively. Patients with Alkaline Phosphatase (ALP) ≥350 U/L had 8.5 months to CRPC while patients with ALP &lt;350 U/L had 15 months. High GS grade group (3-5), short time to PSA nadir (&lt;6 months), PSA nadir level (≥ 2 ng/ ml), and serum ALP ≥350 U/L were independent factors associated with shorter time to CRPC. Conclusion: The clinical management of metastatic prostate cancer is challenging; the main aims of treatment are to prolong overall survival whilst maintaining quality of life. Patients with aggressive tumors, high volume metastasis, short time to nadir (TTN), high PSA nadir level, and high ALP level were independent factors associated with shorter time to CRPC.

The related factors to the re-thrombosis of hemodialysis arteriovenous graft after endovascular salvage.

Only a few issues of the related factors to hemodialysis access dysfunction have been evaluated, and the effects of antiplatelets to improve the patency of hemodialysis access remained controversial. Hence, this study aimed to determine the related factors to the re-thrombosis of arteriovenous grafts (AVGs) after endovascular treatment. This retrospective study was conducted at a university-affiliated teaching hospital in Southern Thailand. All patients who underwent hemodialysis with thrombosed AVG, who had pharmacomechanical thrombolysis from January 2016 to December 2018, were enrolled. Post-intervention primary patency was analyzed by the Kaplan-Meier method, and the related factors to the re-thrombosis of AVG were evaluated using logistic regression. A total of 157 patients with thrombosed hemodialysis AVG were enrolled. The most common graft location and configuration was a forearm loop graft (65%). Post-intervention primary patency rate at 1, 3, and 6 months were 79.0%, 67.1%, and 54.0%, respectively. Diabetes mellitus (DM) was a significant related factor for re-thrombosis (hazard ratio [HR], 1.89; 95% confidence interval [CI], 1.20-2.98; p = 0.006). A single antiplatelet after the procedure was a protective factor for re-thrombosis (HR, 0.58; 95% CI, 0.38-0.89; p = 0.013). The median post-intervention primary patency was 15.7 months in the group of single antiplatelet usage, which was better than that of the non-antiplatelet group (p = 0.012). DM and antiplatelet usage were significant related factors to the re-thrombosis of hemodialysis AVG after endovascular salvage.

Antimicrobial resistance in Staphylococcus pseudintermedius on the environmental surfaces of a recently constructed veterinary hospital in Southern Thailand.

Background and Aim:Staphylococcus pseudintermedius is a zoonotic bacterium commonly found in animals, especially dogs. These bacteria can survive on environmental surfaces for several months. The infection of S. pseudintermedius from the environment is possible, but properly cleaning surface objects can prevent it. This study aimed to investigate the prevalence of methicillin-resistant S. pseudintermedius (MRSP) in the environment of a recently constructed veterinary hospital in Southern Thailand, where we hypothesized that the prevalence of MRSP might be very low.Materials and Methods:At three different time points, 150 samples were collected from different environmental surfaces and wastewater across the veterinary hospital. The collection was done after the hospital’s cleaning. Bacteria were purified in the culture before being identified as species by biochemical tests and polymerase chain reaction (PCR). Next, the antimicrobial-resistant profile was performed using an automated system (Vitek 2). Finally, the antimicrobial resistance genes were identified using PCR.Results:Fifteen colonies of S. pseudintermedius were isolated from the surfaces of eight floors, four tables, two chairs, and one rebreathing tube. Fourteen colonies (93.3%) were multidrug-resistant (MDR) and carried the blaZ gene (93.3%). The majority of colonies were resistant to benzylpenicillin (93.3%), cefovecin (93.3%), ceftiofur (93.3%), kanamycin (93.3%), and neomycin (93.3%). Notably, only four colonies (26.7%) were methicillin-susceptible S. pseudintermedius, whereas 11 colonies (73.3%) were MRSP and carried both the mecA and blaZ genes. Five MRSP (45.5%) were resistant to at least 14 antimicrobial drugs, represented as extensively drug-resistant (XDR) bacteria. Ten of eleven MRSP (90.9%) were Staphylococcal chromosomal mec type V, while another displayed untypeable. Despite the routine and extensive cleaning with detergent and disinfectant, MRSP isolates were still detectable.Conclusion:Many isolates of MRSP were found in this veterinary hospital. Almost all of them were MDR, and nearly half were XDR, posing a threat to animals and humans. In addition, the current hospital cleaning procedure proved ineffective. Future research should be conducted to determine the bacterial biofilm properties and bacterial sensitivity to certain detergents and disinfectants.

Minimal effective dose of ultrasound-guided rectus sheath block to reduce oral analgesic requirement after ambulatory laparoscopic tubal resection: a randomized controlled superiority trial

BackgroundThe effective dose during ultrasound-guided rectus sheath block (URSB) for reducing pain after laparoscopic tubal ligation is reported to be 100 mg of 0.25% bupivacaine. We examined the minimal effective dose of 0.25% bupivacaine for URSB on oral analgesic requirement after ambulatory single-port laparoscopic tubal resection.MethodsA prospective, randomized controlled, superiority trial was conducted among patients who had been scheduled for ambulatory laparoscopic tubal resection between September 2015 and January 2019 at a tertiary care hospital in southern Thailand. Anesthesia was induced following protocol. The intervention group was allocated to receive a bilateral URSB using 10 ml of 0.25% bupivacaine on either side after intubation (total 50 mg) while the control group did not receive the sham block. Patients and assessors were blinded to the study intervention. All patients received a multimodal analgesia regimen as follows: fentanyl and ketorolac intraoperatively and fentanyl and oral acetaminophen at the post-anesthetic care unit. Postoperative oral analgesic requirement (acetaminophen and/or ibuprofen) at home was the primary outcome. Postoperative time to first analgesic requirement, oral analgesia (acetaminophen/ibuprofen), and pain score at 6 and 24 h were accessed via telephone interviews. Percentage, effect size (ES), and 95% confidence interval (CI) were presented.ResultsA total of 66 out of 79 eligible patients were analyzed (32 intervention, 34 control). Intraoperative fentanyl consumption was significantly lower in the intervention group (ES [95% CI]: 0.58 [0.08, 1.07] mcg, p = 0.022). Time to first oral analgesia in the intervention group was significantly longer than that of the control group (ES [95% CI]: 0.66 [0.14, 1.16] h, p = 0.012). The proportion of oral analgesia requirement at 24 h after surgery in the control group was significantly higher than that in the intervention group (97% vs 75%, p = 0.012). Pain scores at 6 and 24 h were similar in both groups although slightly lower in the intervention group (ES [95% CI]: 0.22 [−0.26, 0.71], p = 0.368 and 0.33 [−0.16, 0.81], p = 0.184, respectively).ConclusionA dose of 0.25% bupivacaine 50 mg for URSB reduced the oral analgesic requirement at 24 h and prolonged the time to first analgesic requirement after ambulatory laparoscopic tubal resection.Trial registrationThaiclinicaltrials.orgTCTR20150921002. Registered on 18 September 2015

The Association between Urinary Malondialdehyde and Obesity

Background: Malondialdehyde (MDA) is end-product of polyunsaturated fatty acid. Studies have highlighted MDA as a biomarker of whole-body oxidative stress. Objective: To explore the association between urinary MDA and obesity status. Materials and Methods: The present research was performed as a cross-sectional study at the Primary Care Unit of a tertiary care university hospital in southern Thailand. Data were collected via questionnaire, medical records, and urinary MDA sample measured with high-performance liquid chromatography. Data were analyzed by R program version 4.0.0. Results: One hundred fifteen participants comprised of 57 obese and 58 non-obese patients were included in the present study. The means of body mass indexes (BMIs) were 27.5±2.3 versus 21.9±1.7 kg/m² in obese and non-obese group, respectively. The median of urinary MDA among obese was significantly higher than in non-obese participants at 5.7 (6.0) versus 3.6 (3.9) μg/mL, (p=0.016). Additionally, the urinary MDA in central obesity at 5.8 (5.9) μg/mL was higher than normal waist circumference at 3.5 (3.8) μg/mL, (p=0.009). Conclusion: Urinary MDA was significantly higher in the obesity and central obesity group than the lower or normal BMI and waist circumference group. Obesity could be an essential factor promoting the body’s oxidative stress. Since oxidative stress is well known to be involved in the causes of lifestyle-related or chronic diseases, this specific biomarker can be used to detect and monitor the development of these diseases. Keywords: Biomarker; Malondialdehyde; Obesity; Oxidative stress; Urinary MDA

COVID-19 Vaccine Acceptance and Associated Factors among Unvaccinated Workers at a Tertiary Hospital in Southern Thailand.

BackgroundHospital workers are at high risk of COVID-19 infection which is now vaccine-preventable. However, vaccine refusals also occur among hospital workers, but the associated factors have not been described.ObjectivesTo describe: (1) the level of COVID-19 vaccine acceptance, and; (2) the extent that history of pre-pandemic vaccine hesitancy and health beliefs regarding COVID-19 were associated with COVID-19 vaccine acceptance among workers at a tertiary hospital in southern Thailand.MethodsWe conducted a cross-sectional study using a paper-based self-administered questionnaire at a tertiary hospital in south Thailand in April 2021 and used multivariable logistic regression to identify psychological-behavioral factors associated with vaccine acceptance.ResultsOf 359 workers invited to participate, 226 participants returned the questionnaires, 67% of whom reported willingness to accept the vaccine. Vaccine acceptance was associated with perceived severity of disease (Adjusted OR = 2.07, 95% CI = 1.04, 4.10), perceived harm from non-vaccination (Adjusted OR = 2.51, 95% CI = 1.27, 4.96), and lower expectation of vaccine efficacy (Adjusted OR = 3.80, 95% CI = 1.87, 7.71).ConclusionMost workers in this study were willing to accept the COVID-19 vaccine, and such acceptance was associated with components of the health belief model. However, the cross-sectional study design did not allow causal inference, and study data were all self-reported with no probing of the responses. These limitations should be considered as caveats in the interpretation of the study findings.

Predictors of Health-Related Quality of Life in Children with Cyanotic Heart Disease Who Underwent Palliative and Total Repair

Background: Studies on predictors of health-related quality of life (HRQOL) in pediatric patients with cyanotic heart disease who are waiting for the next stage and those who have undergone total repair are scarce. Therefore, we aimed to identify such predictors in children who received the modified Blalock–Taussig shunt (MBTS) and those who underwent total repair. Methods: In this historical cohort and concurrent follow-up study, data of children who underwent MBTS at the age of 0–3 years between January 2005 and December 2016 at a super-tertiary care hospital in Southern Thailand were obtained. Children who were alive in December 2017 were recruited to evaluate the quality of life at least 1 year after their operation. Between January and December 2018, the “Pediatric Quality of Life Inventory 4.0 Generic Core Scales” with both child self-report and parent proxy-report scores were used to examine the HRQOL. Multivariate linear regression analysis was performed to identify independent predictors of HRQOL. Beta-coefficient (β) and 95% confidence intervals (95% CIs) were calculated and considered statistically significant at p