Teaching Hospital In Bangkok Research Articles

Psychometric Properties of The Thai Version of the Nurses’ Intention to Participate in Advance Care Planning Instrument

Advance care planning is an essential process in healthcare that necessitates active participation from all involved professionals, particularly nurses. However, in Thailand, nurse involvement in ACP is limited. Assessment of nurses’ intention to participate inadvance care planning is necessary to organize training courses to improve their participation in this critical event. However, there is no tool to evaluate Thai nurses’ intention to participate in Advance care planning. Thus, we selected the Health Professionals’ Experience and Attitudes Questionnaire on Advance Care Planning to culturally adapt and validate it in the Thai context. We achieved this through a five-step process: (1) standard translation procedures, including forward translation, reconciliation, and back-translation; (2) item refinement through an expert panel; (3) conducting content validity and cognitive interviews; and (4) confirmation of the first culturally adapted tool by the expert panel on the factors. The panel of experts suggested adding the knowledge dimension and changing the name to the Nurses’ Intention to Participate in Advance Care Planning and (5) The Thai version was tested for validity and reliability using confirmatory factor analysis, average variance extracted, and the Fornell–Larcker criteria matrix, Cronbach’s α, and composite reliability. The final version achieved from testing with 260 registered nurses from a teaching hospital in Bangkok is comprised of 20 items distributed across five key dimensions, namely ‘intention,’ ‘attitude,’ ‘subjective norm,’ ‘perceived behavioral control,’ and ‘knowledge,’ demonstrating an excellent model fit, strong composite reliability, and robust internal consistency. This newly adapted tool is a resource for policymakers and nurse educators designing targeted training courses to enhance nurses’ competency in advance care planning. However, before this tool is widely implemented, it would be beneficial to test it further across diverse groups of nursing professionals.

Thai-version Migraine Disability Assessment (MIDAS) questionnaire: concurrent validity, test-retest reliability, internal consistency, and factors predictive for migraine-related disability.

A Thai-version of the Migraine Specific Quality of Life Questionnaire (MSQ 2.1) is available, but a qualified questionnaire used specifically for disability assessment was not available. The most relevant practical disability assessment tested during this study was the Migraine Disability Assessment (MIDAS) Questionnaire. To test the concurrent validity, test-retest reliability, and internal consistency of a Thai-version MIDAS questionnaire, and factors to predict disability in people with migraine. We conducted the present prospective study at a tertiary care teaching hospital in Bangkok. The original English MIDAS Questionnaire was translated into Thai with back-translation into English and the language equivalence was assessed. The Thai-version MIDAS Questionnaire was tested for concurrent validity, test-retest reliability, and internal consistency, and factors including duration of migraine history, migraine characteristics, and comorbidity were assessed for the ability to predict migraine-related disability of migraineurs. Of the 58 participants, 31 were eligible to be included. The validity of the Thai-version questionnaire between the MIDAS total score and the mean headache severity (question B), the mean pain duration per attack, and the mean pain numerical rating scale (NRS) score were moderately correlated with a Spearman correlation coefficient range 0.42-0.58. The test-retest reliability of MIDAS grade had a weighted κ of 0.66, and for individual questions of the MIDAS total score, questions A and B assessed by intraclass correlation coefficients ranged 0.89-0.98. The internal consistency had a Cronbach α of 0.98. The mean pain NRS score in the past 3 months was an independent predictive factor for migraine-related disability. The Thai-version MIDAS Questionnaire has moderate concurrent validity, acceptable internal consistency, and excellent test-retest reliability. It would be helpful to assess clinical outcomes. Future study with a standardized translation process for the Thai-version questionnaire and a larger sample size is warranted to confirm internal consistency and determine all probable predictive factors for migraine-related disability.

Family Function in Pediatric Liver Transplant Recipients Residing In a Developing Country

BackgroundPediatric liver transplantation (LT) can affect recipients’ family function; however, inconsistent results between studies exist, and data from developing nations are sparse. We aimed to evaluate family function and identify factors associated with suboptimal function in pediatric LT recipients. MethodsA cross-sectional study was performed at a teaching hospital in Bangkok, Thailand between May 2018 and December 2018. We included the families of children aged 2 to 18 years who underwent LT for at least 1 year. Chulalongkorn Family Inventory (CFI) was used to evaluate the family function in these children comparing with families of healthy children. Family function was interpreted from the total CFI score and characterized as dysfunctional, normal-functioned, and well-functioned. ResultsWe enrolled families of 82 LT recipients and 72 healthy children. LT recipients had median age of 7.4 (interquartile range: 4.5-10.3) years. Eighteen children (22%) had a single parent, and at least one unemployed parent was reported in 25%. Most (96%) had well-functioned families, and none had a dysfunctional family. Furthermore, the total score was not significantly different between families of LT and healthy children (P = .95). LT families had a higher score in problem-solving (P < .01) and lower score in the affective involvement and general functioning dimension (P < .01 and .02, respectively). Among the LT children, postoperative bile leakage was associated with lower overall family function score. ConclusionsEven though most recipients had good family function, physicians should pay close attention to specific aspects of family function, especially in children with certain postoperative complications.

Disaster preparedness among Thai elderly emergency department patients: a survey of patients\u2019 perspective

BackgroundIn disaster situations, the elderly are considered to be a particularly vulnerable population. Preparedness is the key to reduce post-disaster damage. There is limited research in middle-income countries on how well elderly emergency department (ED) patients are prepared for disaster situations. The objective of this study was to determine the attitudes and behavior of elderly ED patients toward disaster preparedness.MethodsThis study was a cross-sectional face-to-face survey at one urban teaching hospital in Bangkok, Thailand between August 1st and September 30th, 2016. Patients aged 60 and older who presented to the ED were included to this study. We excluded patients who had severe dementia [defined as Short Portable Mental State Questionnaires (SPMSQ) > 8], were unable to speak Thai, had severe trauma and/or needed immediate resuscitation. The survey instruction was adapted from previous disaster surveys. This study was approved by the Vajira Institutional Review Board (IRB).ResultsA total of 243 patients were enrolled. Most of them were female [154 patients (63.4%)]. The median age was 72 [Interquartile range (IQR) 66–81] years and the most common underlying diseases were hypertension [148 patients (60.9%)] and diabetes [108 patients (44.4%)]. The majority of patients [172 patients (72.4%)] reported that they had had some teaching about disaster knowledge from a healthcare provider and had experienced a disaster [138 patients (56.8%)]. While 175/197 (81.8%) patients who had underlying diseases reported that they had a medication supply for disaster situations, only 61 (25.1%) patients had an emergency toolbox for disasters. Most patients (159, 65.4%) did not know the emergency telephone number, and 133 (54.7%) patients reported transportation limitations.ConclusionsWhile most Thai elderly ED patients reported having a medication supply for disaster situations, many lacked comprehensive plans for a disaster situation. Work needs to be done to improve the quality of preparedness in disaster situations among elderly patients. Future research should focus on preparedness knowledge regarding evacuation, and shelter/residence for older patients.

Prevalence and factors associated with one-year mortality of infectious diseases among elderly emergency department patients in a middle-income country

BackgroundThis study aimed to determine the prevalence of infectious diseases and risk factors for one-year mortality in elderly emergency department (ED) patients.MethodsA retrospective cohort study of patients aged 65 and over who visited the ED of one urban teaching hospital in Bangkok, Thailand and who were diagnosed with infectious diseases between 1 January 2016 and 30 June 2016.ResultsThere were 463 elderly patients who visited ED with infectious diseases, accounting for 14.5% (463/3,196) of all elderly patients’ visits. The most common diseases diagnosed by emergency physicians (EPs) were pneumonia [151 (32.6%) patients] followed by pyelonephritis [107 (23.1%) patients] and intestinal infection [53 (11.4%) patients]. Moreover, 286 (61.8%) patients were admitted during the study period. The in-hospital mortality rate was 22.7%. 181 (39.1%) patients died within 1 year. Our multivariate analysis showed that age 85 years and older [odds ratio (OR) = 1.89; 95% confidence interval (CI): 1.36–2.63], Charlson Co-morbidity Index score ≥ 5 (OR = 3.51; 95% CI2.14–5.77), lactate ≥4 mmol/l (OR = 2.66;95% CI 1.32–5.38), quick Sequential Organ Failure Assessment (qSOFA) score ≥ 2 (OR = 5.46; 95% CI 2.94–10.12), and platelet count < 100,000 cells/mm3 (OR = 3.19; 95% CI 1.15–8.83) were associated with 1-year mortality.ConclusionsIn one middle-income country, infectious diseases account for 14.5% of elderly ED patients. Almost two-thirds of patients presenting to ED with infection are admitted to hospital. One-third of elderly ED patients with infection died within 1 year. Age ≥ 85 years, Charlson Co-morbidity Index score ≥ 5, lactate ≥4 mmol/l, qSOFA score ≥ 2, and platelet count < 100,000 cells/mm3 predicted 1-year mortality rate.

Characteristics and risk factors for antituberculosis drug-induced liver injury in a cohort of patients with cirrhosis in a tertiary referral university teaching hospital in Thailand

Abstract Background Cirrhotic patients are susceptible to drug toxicity, which presents frequently with antituberculosis drug (ATD) treatment. Previous studies of ATD-induced liver injury (ATDILI) in cirrhotics have been limited to patients with early-stage cirrhosis. Objectives To describe characteristics and determine risk factors for ATDILI in cirrhotic patients. Methods We included 64 cirrhotic patients treated with ATDs between 2006 and 2016 in a tertiary referral university teaching hospital in Bangkok, Thailand. Cirrhosis was diagnosed by radiological features, including small-sized nodular liver and/or caudate lobe hypertrophy or evidence of portal hypertension (collateral vessels, varices, and/or splenomegaly). Clinical information was retrospectively abstracted. Characteristics of patients with ATDILI vs. those without ATDILI were compared. Results Six (9.4%) patients developed ATDILI with the median duration from ATD initiation of 14 days (range: 6–66). All the 6 patients who developed ATDILI received 3 hepatotoxic ATDs (isoniazid, rifampin, and pyrazinamide) and had Child–Turcotte–Pugh class B cirrhosis. The patients with ATDILI were found to have a higher percentage of human immunodeficiency virus (HIV) infection than patients without ATDILI (50% vs. 8.6%; P = 0.02). Conclusions Cirrhotic patients, particularly those with underlying HIV infection, are at risk of developing ATDILI. Pyrazinamide should be used cautiously in cirrhotic patients due to the significantly increased risk of ATIDLI. This study supports the current recommendation for the use of ATD in patients with cirrhosis; however, the ATD regimen should be carefully selected, particularly for cirrhotic patients with HIV infection.

Incidence of Newly Diagnosed Tuberculosis among Healthcare Workers in a Teaching Hospital, Thailand.

Background:Data on the incidence of new onset tuberculosis (TB) infection among healthcare workers (HCWs) in Thailand was scarce and not current.Objectives:To determine the incidence of TB, as well as the impact of TB on HCWs in a teaching hospital in Bangkok, Thailand.Methods:A time series cross-sectional study was conducted at Ramathibodi Hospital, Bangkok, Thailand. It was a teaching hospital with 9,562 employees. Medical records of personnel with TB infection between October 1st, 2010 and September 30th, 2015 were reviewed to determine the newly diagnosed TB infection. The personnel who were treated in fiscal year 2015 were interviewed about work-related issues, health status and the impact of TB.Findings:In five years, 109 personnel were diagnosed with new onset TB disease. The infection rates were 2.04, 1.97, 2.85, 2.53, and 1.35 per 1,000 persons in 2011, 2012, 2013, 2014, and 2015, respectively. The most prevalent type of TB infection was pulmonary TB. The infection rate in males was higher than in females. Pharmacists had the highest proportion of infected personnel. The second highest rate of infection was in support staff related to patient care. Twenty personnel were interviewed. Most of them worked in patient care units with central-type air-conditioning system without negative-pressure rooms for TB patients. Contracting TB had an impact on productivity at work, health (physically, mentally and socially) and incomes.Conclusions:Ramathibodi HCWs had higher rate of TB infection than the general Thai population, but the incidence was noted to be decreasing from 2013 to 2015. HCWs suffered from the impact of TB on their lives in multiple ways. Due to the adverse impact of TB on the health and welfare of its employees, hospital administration should apply effective preventive measures and develop a compensation system for HCWs infected with TB.

Self-efficacy, social support, and quality of life among primary family-member caregivers of patients with cancer in Thailand

PurposeIn Thailand, most patients with cancer primarily receive in-home care from their family members. However, information regarding the quality of life (QoL) of the primary family-member caregivers is scarce. The purpose of this paper is to assess primary family-member caregivers’ QoL and its association with self-efficacy and social support using a Thai version of the Caregiver Quality of Life Index-Cancer (CQOLC).Design/methodology/approachThis hospital-based cross-sectional study was performed at a teaching hospital in Bangkok. Questionnaires were administered to 178 primary family-member caregivers of patients with cancer between June 2015 and July 2016, and their QoL was measured using a Thai translation of the CQOLC made by the research team. Hierarchical multiple regression analyses were performed using SPSS software (version 18).FindingsApproximately 79.8 percent of primary family-member caregivers were female, 86.0 percent were 18-51 years old. In total, 52.8 percent reported having a good QoL, 60.1 percent reported a moderate level of perceived self-efficacy, and 56.7 percent reported a high level of perceived social support for providing care. Primary family-member caregivers, who provided care for male cancer patients and were co-responsible for covering the patient’s cost of care, had a lower level of perceived self-efficacy and perceived social support. They also reported having poorer QoL. The patients’ characteristics were more strongly associated with the family-member caregivers’ QoL, than the family-member caregivers’ characteristics, perceived self-efficacy, and perceived social support.Originality/valueApproximately 50 percent of primary family-member caregivers reported having a good QoL. Healthcare providers should incorporate the self-efficacy concept to help improve primary family caregiver’s self-efficacy to provide care to patients with cancer, especially for individuals who are caring for male patients, and provide counseling for primary family-member caregivers regarding ways to obtain the necessary social and financial support to improve their QoL.

Medication nonadherence in elderly patients in a Thai geriatric clinic

Abstract Background: Medication nonadherence is common in elderly patients and is a major cause of morbidity. However, it is not well-described in the literature and to our knowledge has never been studied in Thais. Objective: To investigate the extent, causes, and contributing factors of medication nonadherence in older patients in a geriatric clinic. Material and Methods: We conducted a cross-sectional study at Siriraj Hospital, a university teaching hospital in Bangkok. We assessed baseline demographic data, comorbid diseases, Thai Mental State Examination (TMSE), functional status (basic and basic activities of daily living), type and number of medications used, and medication adherence. Results: There were 153 participants in this study. Medication nonadherence, in the administration of prescribed drugs only, was found in 34% of the participants. Nonadherence to administration of prescribed drugs and to the advice regarding over-the-counter drugs was 42.5%. Nonadherence to the administration of prescribed drugs and to the advice regarding over-the-counter drugs, and herbal and dietary supplements was 54.9%. Three most common causes of medication nonadherence were misunderstanding or lack of the knowledge (25.6%), the development of adverse drug events (18.9%), and because of a suggestion by a friend or family member (16.2%). Conclusion: Medication nonadherence is common in elderly Thais attending geriatric clinics. We recommend clinicians be aware of this problem and develop a system to improve medication adherence. The clarification of reasons for prescribing is crucial. We recommend emphasis on educating patients, family members, and the public about the risk of nonadherence and of using nonprescribed medications.

Pediatric invasive pneumococcal disease in a teaching hospital in Bangkok

Background: Increased problems with drug-resistant Streptococcus pneumoniae (SP) and the dearth of epidemiologic and clinical information on invasive pneumococcal disease in children in Asia formed the basis for this study. Methods: A periodic retrospective review of the records of 0–15-year-old patients was conducted at a teaching Hospital in Bangkok, during 1971–2000. Results: Infections with penicillin-non-susceptible SP (PNSSP) strains rapidly increased after they first appeared in 1988, and they accounted for 71% (29/41) of the total cases during 1996–2000. Of 137 patients, 74% were <60 months old, and 66% had an underlying condition. Infections included: bacteremia without focus 51; pneumonia 38; meningitis 35; peritonitis 13; and bone/joint infection 2. Two patients had two foci of infection. Eight of 10 episodes in patients with AIDS were bacteremic pneumonia. Median ages (range) in months for patients with and without an underlying condition were 24 (1–174) and 10 (0–160); and for the patients without an underlying condition they were: pneumonia 23 (4–156); bacteremia without focus 12 (0–160); and meningitis 7 (2–156). Case-fatality rates were 18% and 2% for patients with and without an underlying condition. The study also examined factors associated with PNSSP infection and death. During 1991–2000,74% (43/58) of the total cases occurred from November to April, which are dry months. Conclusions: This study population contained a high proportion with both an underlying condition and infection with PNSSP, and a moderately low proportion with bacteremia without focus. The disease was two to three times more common in dry months than in rainy months.

Effect of immediate neonatal zidovudine on prevention of vertical transmission of human immunodeficiency virus type 1

Objectives: To describe the effects of various short zidovudine (ZDV) prophylactic regimens on vertical transmission of human immunodeficiency virus type 1 (HIV-1) infection, especially the effect of immediate neonatal ZDV prophylaxis. Materials and Methods: The study included children of HIV-1-infected mothers who were born at a teaching hospital in Bangkok. The ZDV prophylaxis regimens varied by time periods that included: (1) no ZDV (1991–1996); (2) antenatal oral ZDV, 250 mg given twice a day starting at 34 to 36 weeks' gestation and continued until labor (1995–1998); (3) antenatal oral ZDV plus immediate neonatal oral ZDV, 6 mg/0.6 mL/dose started within the first 2 hours after birth and continued at 6-hour intervals for 4 to 6 weeks (1997–1998); and (4) intrapartum intravenous ZDV given in addition to regimen 3 (1998–1999). Neonatal ZDV was administered within 2 hours after birth in 95% of the neonates. Results: In a cohort of 136 children born at least 9 months before the analysis date, the HIV-1 vertical infection rates were: (1) no ZDV, 11 of 48 (22.9%, 95% confidence interval [Cl] = 12.0–37.3); (2) late antenatal ZDV, 10 of 47 (21.3%, 95% Cl = 10.7–35.7); (3) late antenatal ZDV plus immediate neonatal ZDV, 0 of 28 (0%, 95% Cl = 0–12.3); (4) late antenatal, intrapartum intravenous ZDV, plus immediate neonatal ZDV, 0 of 13 (0%, 95% Cl = 0–24.7). An estimated 0% (95% Cl = 0–8.6) of the infants who received immediate neonatal ZDV with or without intrapartum ZDV were infected, as compared with 22.1% (95% Cl = 14.2–31.8 ) of those who received no ZDV or only late antenatal ZDV (P < 0.001). Conclusion: The results of this study suggests high protective effect of immediate administration of neonatal ZDV. Perinatal components of antiretroviral prophylaxis provided the best results for protecting against vertical HIV-1 transmission.

Donation deferral criteria for human immunodeficiency virus positivity among blood donors in northern Thailand.

The purpose of this study was to develop human immunodeficiency virus (HIV) infection donation deferral criteria for blood donors in an HIV-epidemic area of northern Thailand, where the predominant means of transmission of HIV is through heterosexual contact. In a preliminary study, 2242 blood donors were interviewed, and their blood was tested for HIV antibodies between September 1993 and April 1994. The risk factors associated with HIV positivity were identified. Criteria to identify HIV-positive persons on the basis of a logistic equation were developed and applied to another group of 5769 prospective blood donors. A multivariate analysis showed the following odds ratios (OR) for traits that were independently associated with HIV positivity: younger age (OR = 0.93 for each additional year of age), male gender (OR = 2.41), having no more than a primary school education (OR = 2.00), being in the military (OR = 1.78), being unsure of one's own blood safety (OR = 2.00), history of injecting drug use (OR = 5.36), diagnosis of syphilis or positive syphilis serologic test in the past 12 months (OR = 2.67), and genital ulcer in the past 12 months (OR = 4.56). On the basis of the model, with a limit of <10 percent loss of uninfected donors, predicted probabilities of HIV positivity alone or of markers of infection with HIV, hepatitis B virus, or Treponema pallidum were calculated. With a cutoff of 6.5-percent estimated probability of HIV infection, derived from the logistic equation, the donor deferral criteria have 33.6-percent sensitivity and 8.3-percent positive predictive value for HIV positivity and 15.5-percent sensitivity and 18.4-percent positive predictive value for markers of infection with one of the three pathogens. The proposed donor deferral system provides a more flexible, sensitive, and predictive tool for averting donation by those who, though HIV antibody-negative, are at a higher risk of being infected with HIV.

Dog-bite injuries at a Bangkok teaching hospital

Thailand has a large domestic and stray dog population and Buddhist cultural beliefs encourage feeding and protection of stray animals. Dog bites are common injuries encountered in emergency rooms throughout the country. A prospective study of such bites seen at a teaching hospital in Bangkok revealed that: (1) dog bites represent 5.3% of injuries seen in the emergency room; (2) the majority occur on the street, are inflicated by stray dogs and are interpreted by the victim as unprovoked. Children and teenagers account for 55% of the victims. The lower extremities (54%) and upper extremities (20%) were the most common sites for bites. 9% of patients were bitten on the face or head. In addition to pain, risk of infection (approximately 13%) and the significant cost of caring for these injuries, victims often experienced prolonged anxiety because of to the generally known risk of rabies in Thailand. Due to the high cost of imported immune globulins and vaccines, rabies exposures are not always managed optimally in Asia.

An outbreak of Salmonella urbana infection in neonatal nurseries

An outbreak of neonatal infection with Salmonella urbana in three neonatal wards of a teaching hospital in Bangkok, Thailand is described. The outbreak lasted for 5 days. Fifty-seven neonates had gastrointestinal infection, 37 had diarrhoea, and three had bacteraemia. The attack rates were 43% for infection, 29% for diarrhoea, and 2·3%for bacteraemia. Epidemiological evaluation suggested that a contaminated wash basin in the labour nursery was the source of infection. Delay in controlling this outbreak occurred because the staff assumed that person-to-person transmission was the mode of spread, thus ignoring epidemiological data that would have led to the identification of the source of infection.

Pattern of Antibiotic Use in Medical Wards of a University Hospital, Bangkok, Thailand

Inappropriate use of antimicrobial agents has been found to be common in various parts of the world, but there have been few studies in developing countries. In Siriraj Hospital, Mahidol University, the largest university Hospital in Thailand, a study was performed to estimate the appropriateness of the use of antimicrobial drugs. Each of the nine medical wards was sampled in random order, and daily surveillance of all patients over two 2-week periods identified 307 of the total 690 patients to have been prescribed an antibiotic. In only 27 of the 307 patients was the use of antibiotics entirely appropriate. The main problem was the use without evidence of infection (in 110 of the 307 patients), which we estimate would result in the loss for the hospital of approximately $40,000 (U.S.) each year on the medical wards alone. The choice of antimicrobial agents and pharmacokinetic considerations were also inappropriate. Use of expensive drugs where cheaper ones were available, however, was not frequent (71 of the 655 prescriptions). Attempts to rectify antimicrobial misutilization, based on the results of this study, can be focused specifically at improving clinical recognition of infectious disease by education. The pattern of antimicrobial use in a university teaching hospital in Bangkok, Thailand, reflects a high proportion of misuse. The need for rationalization of antimicrobial use is urgent.

Increasing resistance to trimethoprim-sulfamethoxazole among isolates of Escherichia coli in developing countries.

Resistance of Escherichia coli to trimethoprim (TMP)-sulfamethoxazole remains at 3%-8% at many medical centers within the United States. In this study a 44% resistance rate was observed among E. coli isolated at a pediatric hospital in Santiago, Chile, and a 40% resistance rate at a general teaching hospital in Bangkok, Thailand. Most isolates were from urinary tract infections and showed high-level resistance (minimal inhibitory concentration of TMP greater than 1,000 micrograms/ml). Nineteen of 35 isolates tested transferred resistance to TMP; most cotransferred resistance to streptomycin and sulfonamides. Dihydrofolate reductase type I was detected by gene probing in 14 of 35 strains. Subsequent investigations in Brazil, Honduras, and Costa Rica revealed that this high rate of resistance was not an isolated phenomenon.