Tertiary Care Hospital In Thailand Research Articles

Outcomes of advanced and recurrent cervical cancer treated with cisplatin and generic topotecan: retrospective analysis in a tertiary care hospital in Thailand

Retrospective evaluation of the outcome of stage IVB, recurrent or persistent cervical cancer treated with cisplatin and generic topotecan (CT) in a tertiary care hospital in Thailand. The medical records of patients treated with CT regimen at Chiang Mai University Hospital between January 2005 and December 2007 were reviewed and analyzed. The treatment protocol consisted of IV topotecan 0.75 mg/m(2) on days 1, 2, and 3; combined with cisplatin 50 mg/m(2) IV on day 1 and repeated every 21 days until progression or unacceptable toxicity for a maximum of 6 cycles. The outcomes were evaluated based on the response rate, progression free survival (PFS), and overall survival (OS) by using the World Health Organization criteria. The adverse effects of the treatments were also determined. Twenty-one cervical cancer patients received the CT regimen. The tumor response rate was 28.6%. The median PFS and OS was 4 and 11 months, respectively. With 87 cycles of chemotherapy, the most common grade 3 & 4 hematologic toxicity was neutropenia (57.9%). Advanced and recurrent cervical cancer patients treated with cisplatin and generic topotecan had a favorable outcome with manageable toxicity.

Using a Collaborative to Reduce Ventilator-Associated Pneumonia in Thailand

Ventilator-associated pneumonia (VAP) is a serious nosocomial infection, leading to high mortality and high costs of treatment in developed and limited-resource countries. A collaborative quality improvement (QI) project was conducted in 18 secondary and tertiary care hospitals in Thailand to address the problem. The project, conducted between February 2004 and May 2005, entailed three face-to-face meetings--two national workshops and two regional workshops (each conducted twice). Education on VAP prevention, including guidelines and the ventilator bundle, was conducted for intensive care unit staff and all relevant personnel. The collaborative's effectiveness was assessed by VAP rate, a self-administered questionnaire, and face-to-face interviews. Within 12 months, the pooled VAP rate decreased from 13.3 to 8.3 per 1,000 ventilator-days. The costs of antibiotic treatment for VAP decreased by more than one half. More than 80% of interviewed participants reported that the QI method could be applied effectively in their organization. VAP surveillance during this project revealed a gradual reduction of the VAP rate. The project's relative overall success appears to reflect, as reported elsewhere, a well-organized program, support from hospital administrators, and workshop leaders' presentation of proven QI methods and clinical interventions.

Effectiveness of Education and an Antibiotic-Control Program in a Tertiary Care Hospital in Thailand

We conducted a study to evaluate the impact of education and an antibiotic-control program on antibiotic-prescribing practices, antibiotic consumption, antimicrobial resistance, and cost of antibiotics in a tertiary care hospital in Thailand. A study of the year before and the year after the intervention was performed. Inpatient antibiotic prescriptions were prospectively observed. Demographic characteristics, hospital unit, indication for antibiotic prescription, appropriateness of antibiotic use, reasons for inappropriate antibiotic use, antibiotic consumption (i.e., the rate of antibiotic use), bacterial resistance, and antibiotic cost data were collected. Interventions included education, introduction of an antibiogram, use of antibiotic prescription forms, and prescribing controls. After the intervention, there was a 24% reduction in the rate of antibiotic prescription (640 vs. 400 prescriptions/1000 admissions; P<.001). The incidence of inappropriate antibiotic use was significantly reduced (42% vs. 20%; P<.001). A sustained reduction in antibiotic use was observed (R2=0.692; P<.001). Rates of use of third-generation cephalosporins (31 vs. 18 defined daily doses [DDDs]/1000 patient-days; P<.001) and glycopeptides (3.2 vs. 2.4 DDDs/1000 patient-days; P=.002) were significantly reduced. Rates of use of cefazolin (3.5 vs. 8.2 DDDs/1000 patient-days; P<.001) and fluoroquinolones (0.68 vs. 1.15 DDDs/1000 patient-days; P<.001) increased. There were no significant changes for other antibiotic classes. Significant reductions in the incidence of infections due to methicillin-resistant Staphylococcus aureus (48% vs. 33.5%; P<.001), extended-spectrum beta -lactamase-producing Escherichia coli (33% vs. 21%; P<.001), extended-spectrum beta -lactamase-producing Klebsiella pneumoniae (30% vs. 20%; P<.001), and third-generation cephalosporin-resistant Acinetobacter baumanii (27% vs. 19%; P<.001) were also observed. Total costs saving were USD 32,231 during the study period. Education and an antibiotic-control program constituted an effective and cost-saving strategy to optimize antibiotic use in a tertiary care center in Thailand.

Implementation of clinical practice guidelines for upper respiratory infection in Thailand

Objective: To determine the effectiveness of implementing clinical practice guidelines (CPG) on antibiotic prescribing for adults with upper respiratory infection (URI) in terms of the changes in diagnosis and prevalence and patterns of antibiotic prescribing. Methods: The CPG on antibiotic treatments for adults with URI published in the Annals of Internal Medicine 2001; 134: 479–52 were considered to be of high quality and applicable to Thai patients. A one-page clinical practice protocol in Thai was prepared from these guidelines. The dissemination strategy provided CPG and clinical practice protocol to 12 general practitioners in Siriraj Social Security Program in Bangkok during interactive educational meetings in April 2001. The information on 837 URI episodes from January to March (pre-CPG phase) and 774 URI episodes during May to July (post-CPG phase) were extracted from the patients’ medical records. Telephone follow up for patients without antibiotics in the post-CPG phase was also attempted. Results: Changes in the post-CPG period included (1) The diagnosis of URI was used less frequently whereas the diagnosis of common cold, pharyngitis and acute bronchitis were used more frequently ( p<0.05). (2) Antibiotic use fell from 74.0% to 44.1% ( p<0.001). (3) Fewer prescriptions for amoxicillin, roxithromycin, co-trimoxazole and doxycycline, and more for penicillin V ( p<0.05). Patients ( n=97) not given antibiotics reported recovery in 83.5% and improvement in 16.5%. Conclusion: A locally prepared clinical practice protocol based on US CPG for appropriate antibiotic use for URI combined with interactive educational meetings is effective in promoting appropriate diagnosis and antibiotic therapy in an ambulatory setting in a tertiary care hospital in Thailand.

Skin flora of patients in Thailand

Background: Studies taken from different hospitalized patient populations, environments, and geographic regions reveal differences in the numbers and species of organisms colonizing the skin. Our aim was to determine the types and amounts of skin flora, and examine the factors associated with variations in microbial skin flora in patients in Thailand. Method: We studied 350 outpatients and 500 inpatients at Siriraj Hospital in Bangkok, Thailand. The skin at the forearm and the sternum of each patient was cultured by contact plate technique. Results: The number of skin flora colony-forming units (CFUs) were correlated to the site of sampling. There was a significant correlation of CFUs between samples from the forearm and the sternum in patients who were hospitalized (r = 0.6; P <.001) and in outpatients (r = 0.5; P <.001). The numbers of micro-organisms on the sternum was significantly greater than the number cultured from the forearm for all patients. Inpatients had significantly more organisms on the the forearm and sternum compared with outpatients. High counts (CFUs > 600) were found more frequently in patients who were hospitalized; had chronic obstructive pulmonary disease, diabetes mellitus, or autoimmune diseases; and were undergoing operation and receiving antibiotics. Acinetobacter spp and methicillin-resistant Staphyloccoccus aureus were found more frequently in patients who were hospitalized. Conclusion: Skin flora of patients in tertiary care hospitals in Thailand has higher CFUs, and A baumannii is prevalent, especially in patients who are hospitalized. (Am J Infect Control 2003;31:80-4.)