Tertiary Hospital In Thailand Research Articles

Effect of Installation of Alcohol Gel Dispensers and Behavioral Nudges on Behavioral Drivers for Hand Hygiene: A Quasi-Experimental Study at a Tertiary Hospital during the COVID-19 Pandemic

Objective: To compare the level of hand hygiene behavioral drivers before and after installation of alcohol gel dispensers and behavioral nudges among outpatients and visitors at a tertiary hospital in Thailand during the coronavirus disease 2019 (COVID-19) pandemic.Material and Methods: A quasi-experimental study was conducted among outpatients and visitors in June 2020. We installed 12 alcohol gel dispensers with signs serving as behavioral nudges at a tertiary hospital in the Internal Medicine Outpatient Department (OPD), Surgery OPD, and the Pharmacy. We trained enumerators to interview outpatients and visitors regarding their behavioral drivers (beliefs about COVID-19 and hand hygiene based on the health belief model, plus handwashing social norms). We analyzed data using descriptive statistics.Results: Enumerators recruited 206 participants in the pre-intervention phase (refusal rate = 37.6%) and 219 participants in the post-intervention phase (refusal rate = 32.2%). There were significant differences between the pre-intervention and post-intervention phases with regard to self-efficacy for hand hygiene (92.0% vs. 100%, respectively), perceived lack of barriers to hand hygiene with alcohol (93.2% vs. 98.2%, respectively), and the proportion of participants who reported that hand hygiene had become a habit (7.5 vs. 18.8%, respectively). Reports of other domains of health beliefs (perceived severity of COVID-19, perceived benefits of handwashing) were homogeneous in both periods.Conclusion: We found differences in perceived lack of barriers and reported habit of hand hygiene but while self-efficacy was homogeneous in both periods. Issues regarding selection bias, construct validity, and generalizability may limit the usefulness of the study data. Caveats should be considered in the interpretation of the study findings.

Emergence of Multi-Drug Resistance and Its Association With Uncommon Serotypes of Streptococcus agalactiae Isolated From Non-neonatal Patients in Thailand.

Group B streptococcus (GBS) or Streptococcus agalactiae is an opportunistic pathogen that causes serious illness in newborns, pregnant women, and adults. However, insufficient detection methods and disease prevention programs have contributed to an increase in the incidence and fatality rates associated with this pathogen in non-neonatal patients. This study aimed to investigate factors of the observed increased incidence by investigation of serotype distribution, virulence factors, and antimicrobial susceptibility patterns from invasive GBS disease among non-neonatal patients in Thailand. During 2017–2018, a total of 109 S. agalactiae isolates were collected from non-pregnant patients. There were 62 males and 47 females, with an average age of 63.5 years (range: 20 – 96). Serotypes were determined by latex agglutination assay and multiplex polymerase chain reaction (PCR)-based assay. Among those isolates, seven virulence genes (rib, bca, pavA, lmb, scpB, cylE, and cfb) were detected by PCR amplification, and were determined for their susceptibility to 20 antimicrobial agents using a SensititreTM Streptococcus species STP6F AST plate. Among the study isolates, serotype III was predominant (52.3%), followed by serotype V and serotype VI (13.8% for each), serotype Ib (11.9%), and other serotypes (8.2%). Of the seven virulence genes, pavA was found in 67.0%. Except for one, there were no significant differences in virulence genes between serotype III and non-serotype III. Study isolates showed an overall rate of non-susceptibility to penicillin, the first-line antibiotic, of only 0.9%, whereas the resistance rates measured in tetracycline, clindamycin, azithromycin, and erythromycin were 41.3, 22.0, 22.0, and 22.0%, respectively. Strains that were resistant to all four of those drugs were significantly associated with non-serotype III (p < 0.001). Using multi-locus sequence typing (MLST), 40.0% of the four-drug-resistant isolates belonged to serotype VI/ST1, followed by serotype Ib/ST1 (35.0%). Cluster analysis with global GBS isolates suggested that the multiple drug-resistant isolates to be strongly associated with the clonal complex (CC) 1 (p < 0.001). Compared to the 2014 study of 210 invasive GBS isolates conducted in 12 tertiary hospitals in Thailand, the proportion of serotype III has dramatically dropped from nearly 90% to about 50%. This suggests that resistances to the second-line antibiotics for GBS might be the selective pressure causing the high prevalence of non-serotype III isolates.

Factors associated with bleeding outcome of non-vitamin K antagonist oral anticoagulants at a tertiary hospital in Thailand

This retrospective descriptive study aimed to evaluate the factors influencing bleeding in patients who received non-vitamin K antagonist oral anticoagulants (NOACs) at Phramongkutklao Hospital, Bangkok, Thailand, from January 2015 to February 2019. A total of 416 patients were included in the study. The median age was 73 years, and the median weight was 66.4 kg. NOACs were prescribed for stroke prevention in nonvalvular atrial fibrillation in the majority of the patients. Hypertension, dyslipidemia, and diabetes mellitus were respectively found in 76.2%, 59.9%, and 29.8% of the patients. Among the patients, 126 (30.3%) received dabigatran, 179 (43.0%) received rivaroxaban, 109 (26.2%) received apixaban, and 2 (9.4%) received edoxaban. Bleeding occurred in 39 patients (9.4%), including 22 (5.3%) in the rivaroxaban group, 12 (2.9%) in the dabigatran group, and 5 (1.2%) in the apixaban group. The most common bleeding type was minor bleeding. Age and previous bleeding history were factors that appeared to influence the increased bleeding outcome of NOACs. Therefore, healthcare providers should prescribe NOACs with care and closely monitor bleeding events in the elderly and patients with prior bleeding history.

Assessment of the Health-Promoting Behaviors of Hospitalized Patients with Non-Communicable Diseases During the Second Wave of COVID-19.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has affected the health-related behaviors of patients with non-communicable diseases (NCDs). Thus, the factors predicting the health-promoting behaviors (HPBs) of hospitalized patients with NCDs during the second wave of COVID-19 should be examined.ObjectiveThe aims of this study were to determine the relationships among the patients’ characteristics, perceived self-efficacy, social support, perception of the benefits of and barriers, and HPBs, and to determine the predictive factors of HPBs among hospitalized patients with NCDs during the second wave of COVID-19.Patients and MethodsThe study had a cross-sectional predictive correlational design and included 250 patients with NCDs 18 years of age or older hospitalized in a tertiary hospital in Thailand. Descriptive statistics, the chi-square test, the Pearson’s correlation coefficient, and stepwise multiple linear regression were used for data analysis.ResultsMost of the participants had a cardiovascular disease (34.0%). Followed by diabetes (28.8%), cancer (11.2%), hypertension (10.0%), heart disease (9.6%), or chronic obstructive pulmonary disease (6.4%) and had a moderate level of overall HPBs (M = 106.09; SD = 4.66). Among the six components of the HPBs, the participants achieved the moderate levels in nutrition, interpersonal relations, spiritual growth, and stress management, and low levels in physical-activity and health responsibility. The patients’ perception of the benefits and barriers to the adoption of HPBs and perceived self-efficacy and social support were able to predict their HPBs, accounting for approximately 38.0% of the variance of such behaviors.ConclusionOn the basis of our study’s results, we suggest that researchers, multidisciplinary teams, the government, and policymakers establish effective interventions, guidelines, and policies for the development of HPBs to prevent and control the spread of COVID-19 particularly among patients with NCDs, and to improve their capacity for high-quality and continuing self-care.

Neonatal multidrug-resistant bacterial meningitis: a 29-year study from a tertiary hospital in Thailand.

This study aimed to compare the risks and case fatality rate (CFR) between neonatal multidrug-resistant (MDR) and non-MDR meningitis. a secondary analysis of a case-control studies in a Thai neonatal intensive care unit between 1990 and 2018 was performed. The pathogenic organisms causing neonatal meningitis were Staphylococcus aureus, Enterococcus spp., Enterobacteriaceae, Acinetobacter spp., and Pseudomonas aeruginosa. A MDR organism was defined as an isolate that was non-susceptible to at least 1 agent in at least 3 antimicrobial categories. The multivariate regression was analyzed for MDR and non-MDR samples of neonatal meningitis. Over a period of 29 years, the number of neonatal MDR and non-MDR meningitis cases were 17 and 21, respectively. The medians (interquartile ranges) of gestational age, birthweight and onset of meningitis were 35 (29.5-38) weeks, 1,945 (1,218-2,859) grams and 6.5 (2.8-17.9) days, respectively. The most common organism was Acinetobacter baumannii (32%). By multivariate analysis, neonates who had MDR meningitis were more likely to have a lower Apgar score at 5 minutes (adjusted odds ratio: 95% confidence intervals = 0.66 [0.44-0.99], p = 0.04). The crude CFR of neonatal meningitis was 32%. Non-survivors in MDR meningitis (58.8%) were significantly higher than non-MDR meningitis (9.5%, p = 0.004). The most common pathogen in non-survivors was carbapenem-resistant Acinetobacter baumannii. Neonatal MDR meningitis has an association with lower APGAR scores, and higher CFR as well as Acinetobacter baumannii. Multifaceted infection prevention, and control programs for MDR organisms are crucial, and must be strictly implemented in high MDR areas.

Determinants and Outcomes of Mortality among Extremely Preterm Infants From a Tertiary Hospital in Thailand: 15-Year Experience

Objective: It remains unclear if changes in neonatal care have resulted in better outcomes for extremely preterm infants (EPTs). This study was to evaluate neonatal mortality and morbidity in EPTs.Material and Methods: A retrospective cohort study of EPTs at a gestational age (GA) ≤28 weeks, who were admitted to the neonatal intensive care unit between January 2004 and December 2018. The study was divided into 2 periods, from 2004-2010 and 2011-2018. The likelihood ratio test in Multiple Cox regression models were used to determine adjusted hazard ratios (aHR) for differences in mortality among the two periods.Results: A total of 188 EPTs were enrolled. The overall median (interquartile range), GA and birth weight of the enrolled infants were 26 (25, 27) weeks and 780 (667, 875) g, respectively. The mortality rate was 66/188 (35.1%). The mortality rate between 2004-2010 and 2011-2018 decreased from 44.6% to 32.8%, but was not statistically significant (p-value=0.170). Multiple Cox regression analysis of mortality rate demonstrated statistical significance with infants of 23-24 and 25-26 weeks GA VS 27-28 weeks GA [aHR 3.85, 95% confidence interval (CI) (1.95, 7.58), p-value&lt;0.010] and [aHR 1.92, 95% CI (1.09, 3.35), p-value&lt;0.010], respectively. Pregnancy complications [aHR 2.24, 95% CI (0.96, 5.24), p-value=0.040)] and EPTs intubated VS early CPAP at birth [aHR 2.41, 95% CI (1.36, 4.25), p-value&lt;0.010] were statistically significant.Conclusion: The mortality rate of EPTs decreased with advancing GA. Prenatal care of pregnancy complications and improving care practices might reduce the mortality rate.

Clinical Outcomes of Children Diagnosed Dengue-Associated Acute Liver Failure with or without N-Acetylcysteine Treatment: A Retrospective Cohort Study.

N-acetylcysteine (NAC) has been shown to prevent hepatic damage and improve microcirculatory blood flow and oxygen delivery to the tissue. Previous studies have proposed the benefit of NAC in dengue-associated acute liver failure (ALF). However, most studies are descriptive and lack comparison between groups. We aimed to compare the ALF resolution rate and mortality rate of those who received and did not receive NAC treatment. A retrospective cohort study was conducted among children aged <15 years who were diagnosed with dengue-associated ALF at a tertiary hospital in Thailand, between January 2002 and July 2019. Demographic and clinical information were collected. Main outcomes were ALF resolution and mortality rate. Thirty-three patients were included of which 16 received NAC treatment (48.5%). Mean ages were 8.5 years (SD 3.7) and mean onset of ALF was 6.3 days (SD 1.6) after onset of fever. The grading of hepatic encephalopathy (HE) and organ failure was not significantly different between the two groups. In the NAC group, 13/16 children were prescribed 100 mg/kg/day of NAC until INR <2 without HE or <1.5 with HE. NAC was initiated 1.1 days (SD 0.3) after the ALF diagnosis. The NAC group showed a higher rate of ALF resolution (75% vs. 53% in the non-NAC group, p = 0.34) with a lower mortality rate (31% vs. 53%, p = 0.36). Side effects of NAC were not found. NAC may be beneficial in dengue-associated pediatric ALF. Further well-designed randomized control trials should be carried out.

Identifying the barriers to universal cervical length screening for preterm birth prevention at a tertiary hospital in Thailand (patient's perspectives): implementation research.

To identify patient perspectives of barriers to cervical length screening to prevent preterm births. In Phase I of this prospective descriptive implementation study, 40 pregnant women of up to 24week gestation were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was subsequently administered to 400 participants in Phase III. Most participants (74.3%) realised preterm babies have complications and high care costs (53%). They recognised that premature-birth risk identification enables appropriate pregnancy care (93.8%), but they were unaware that cervical length measurements indicate the risk (59.5%). The participants who were aware wanted to be examined (63.5%) because of concern about preterm birth (95.8%). Husbands were reported to influence decision-making about screening (81.3%) and subsequent treatment (42.5%). If the associated costs were subsidised, the majority of participants (67.3%) would undergo screening. Physicians do not explain ways to prevent preterm births. Government policy on preventing preterm births is not well established. Screening and treatment costs are major barriers. Thai Clinical Trials Registry (TCTR) number: TCTR20190813003.

The implementation of TORS for head and neck surgery in Thailand

Transoral robotic surgery (TORS) is a novel surgical treatment of head and neck cancers, mainly for limited tumor in oropharynx and supraglottis. Despite the major advantage of favorable postoperative functional outcomes, many obstacles exist during the implementation of TORS, especially in a country where financial resources are modest. We demonstrated our experience of initiating this sophisticated technology at the largest tertiary hospital in Thailand. A retrospective review study was conducted in patients with benign or malignant lesions during 2014-2020 at Siriraj Hospital. Different periods of operation time between initial and subsequent cases were compared to evaluate learning-curve improvement. A total of 36 patients underwent TORS, with median follow-up time of 18months. The average time of room set-up, anesthesia, and positioning was 37 ± 14, 13 ± 7, and 15 ± 7min, respectively. Whilst, the average robotic procedure time and total time in room were 44 ± 19 and 118 ± 31min, consecutively. There was no significant difference in any time interval, except the set-up time between initial and subsequent cases. The worthwhile utilization of TORS could be administered cost-effectively despite the complicated and daunting implementation of TORS. Whilst, meticulous planning and sufficient training prior to the initiation of TORS can favorably shorten the learning curve of operative staffs in the TORS team.

Outcome Comparison between Video Assisted Thoracoscopic Surgery and Open Thoracotomy on Primary Spontaneous Pneumothorax in a Tertiary Hospital in Thailand

Objective: To assess recurrence, complication after surgery, hospital stay, and cost-effective in primary spontaneous pneumothorax (PSP) patients of Thai urban population that underwent video assisted thoracoscopic surgery (VATS) and open thoracotomy (OT). Materials and Methods: The present study was a retrospective cohort between 2006 and 2019. Seventy-five patients were diagnosed as PSP. All medical records were collected from Vajira Hospital. All various factors were analyzed to evaluate an outcome between the two groups. Results: Fifty-four patients were treated by VATS, whereas 21 patients were treated by OT. The mean follow-up time was 26 months. There was no difference in term of gender, indication of surgery, and cost during hospital stay between the two groups. Length of hospital stay were shorter in VATS groups (9.5 days versus 15 days, p=0.006). The operative time was longer and more blood loss in OT groups compared to VATS groups (180 minutes versus 70 minutes, p&lt;0.001 and 100 mL versus 30 mL, p&lt;0.001). In post-operative outcome, there was no difference in terms of recurrence, pneumonia, and re-operation. Conclusion: VATS is associated with shorter length of hospital stay and less blood loss with no difference of cost effective, recurrence, and post-operative outcome in PSP patients. Keywords: Video assisted thoracoscopic surgery, Pneumothorax, Open thoracotomy

Safety of Preoperative Low-Molecular-Weight Heparin in Patients Who Underwent Hepatectomy

Background: Although international guidelines advocate preoperative venous thromboembolism (VTE) chemoprophylaxis for hepatectomy, there are still safety concerns. Methods: We conducted a medical chart review of patients who underwent hepatectomy from 2016 to 2020 in a tertiary hospital in Thailand. Our center has applied preoperative chemoprophylaxis protocols with low-molecular-weight heparin (LMWH) since 2018. The rates of post-hepatectomy hemorrhage (PHH) were compared between patients receiving and those not receiving preoperative LMWH. Results: Of 204 patients who underwent hepatectomy, 186 were eligible for the analysis. Moreover, 48% were included in the LMWH group. Major hepatectomies accounted for approximately 50% in both LMWH and No-LMWH groups. The overall PHH rate was 3.8% and was not different between the LMWH (4.4%) and No-LMWH groups (3.1%). PHH was significantly associated with intraoperative blood transfusion > 2 units and post-hepatectomy liver failure. Postoperative VTE developed in 0.5% of patients. Conclusion: No association between PHH and preoperative VTE prophylaxis for hepatectomies was found. Although half of patients in this study underwent major hepatectomies, the PPH rate was low. A single dose of preoperative LMWH plus mechanical thromboprophylaxis may be appropriate in populations with low incidence of VTE. Funding Information: None. Declaration of Interests: None. Ethics Approval Statement: This study was approved by the Prince of Songkla University Hospital Ethics Committee (approval no. REC. 63443101).

Behavioral drivers and observation of face covering use during the COVID-19 pandemic among outpatients and visitors at a tertiary hospital in Thailand.

BACKGROUND:Use of face covering may help prevent COVID-19 transmission. However, there is a lack of data on behavioral drivers of face covering use and compliance to mandatory face covering policy at health facilities. This study aimed to describe behavioral drivers and observed face covering use among outpatients and visitors at a tertiary hospital in Southern Thailand during the COVID-19 pandemic.MATERIALS AND METHODS:We conducted a hospital-based, cross-sectional study in June 2020. We developed, pilot-tested and finalized an interview questionnaire in Thai. We also developed a structured observation questionnaire. Two trained enumerators recruited outpatients and visitors at the hospital's internal medicine outpatient department (OPD), surgery OPD, and the pharmacy using the convenience sampling. Another enumerator conducted structured observation of face covering use among outpatients and visitors when interviews were not taking place. We analyzed the data using the descriptive statistics.RESULTS:A total of 206 persons that our interview enumerators approached agreed to participate (n = 206; response rate = 62.4%). Nearly all participants stated that the use of face covering was beneficial in preventing COVID-19 infection from others and preventing others from being infected (94.0% and 98.0%, respectively). Common barriers included inconvenience in breathing and speaking (19.7%) and pain at the ears (9.6%). Structured observation of 408 outpatients and visitors showed that nearly everyone (>99%) had a face covering on their person, most of whom (94.6%) covered both their nose and mouth.CONCLUSION:We found near-universal perceived benefits and compliance, but variations in perceived barriers, cues, and social norms for the use of face coverings. The findings of this study can inform future intervention programs on face covering use promotion.

1165. Epidemiology, management and outcomes of fungal keratitis: A single center study from tertiary hospital in Thailand

BackgroundFungal keratitis is known as an important cause of sight threatening infection worldwide. Variation of clinical characteristics and treatment have been observed among different geographic regions. Currently, clinical data of fungal keratitis in South East Asia remain scarce.MethodsA retrospective single study was conducted at King Chulalongkorn Memorial Hospital in Thailand. Medical records of patient with diagnosis of fungal keratitis between January 2016 and December 2018 were reviewed. Cases were identified using ICD-10 code. Data on demographics, clinical presentations, investigations and outcomes were collected. Mycological diagnosis was made in patients who had clinical presentation compatible with fungal keratitis and positive fungal detection in clinical specimen.ResultsDuring study period, fungal keratitis was diagnosed in 59 pts including 31 by mycological and 28 by clinical diagnosis. KOH preparation of corneal scraping was positive in 19 of 53 pts (35.8%). Culture from cornea, aqueous and vitreous yielded positive result in 18 of 53 (33.9%), 2 of 14 (14.3%), respectively. ITS sequence analysis was positive in 7 of 15 (46.7%) from cornea, 1 of 6 (16.7%) from aqueous and 2 of 2 (100%) from vitreous. Culture and molecular detection from clinical specimens provided additional mycological diagnosis in 8 and 5 cases with negative KOH preparation. Fusarium was the most common pathogen (33%) followed by Paecilomyces (9.7%), Aspergillus (6.4%), Candida (6.4%). Ten patients (32.2%) had only positive KOH preparation. All patients received treatment with topical antifungal agent, while 38 pts (64%) required systemic, 24 pts (40.7%) received intrastromal, 22 pts (37.2%) received intracameral and 3 pts (5.1%) received intravitreal antifungal therapy. Operation was performed in 21 pts (35.6%) which 6 (28.5%) required evisceration. Twenty-three patients (39%) had visual improvement after complete treatment.ConclusionFungal keratitis is not an uncommon disease. Fusarium was the most common etiologic agent similar to study from other region. Unfavorable outcomes were observed in majority of cases. Appropriate fungal culture and molecular detection from clinical specimens can be considered as they may increase diagnostic yield in some patients.Disclosures All Authors: No reported disclosures

Risk factors and outcomes of Candidemia caused by non-albicans Candidain a tertiary hospital in Thailand

Background: Candidemia is an important cause of severe sepsis in critically ill patients. The incidence of candidemia increased dramatically worldwide and the etiologic Candidaspecieshas been shifted from Candida albicans to non- albicans Candida. Candida tropicalisis highly prevalent in Asia. The risk factors and clinical outcomes in patients who had blood stream infection from non-albicans Candida is still unclear. Methods and materials: This is a retrospective review of medical records of patients with candidemia hospitalized at Siriraj Hospital, Thailand, from January 2016 to December 2017. Clinical characteristics, risk factors, treatment outcomes and antifungal susceptibility were analyzed. Results: A total of 156 patients were enrolled, 54.6% were male and the median age was 68 years. The underlying conditions included diabetes mellitus (32.1%), chronic cardiac disease (28.2%), chronic kidney disease (26.9%) and hematologic malignancies (21.2%). Candidaspecies isolated from patients’ blood were C. tropicalis (49.4%), C. albicans (28.8%), C. glabrata (16.7%) and C. parapsilosis (5.1%). Fluconazole resistance was significantly increased in C. tropicalis (37.8%) and C. albicans (14.3%). When compared with C. albicanscandidemia, no independent factor was found to be associated with non-albicans Candida candidemia. There was no significant difference in mortality rate between non-albicans Candida and C. albicanscandidemia [OR=1.35 (0.64–2.85)]. From multivariate analysis, when compared with C. albicanscandidemia, the independent factors associated with C. tropicaliscandidemia were chronic liver disease [OR = 11.39 (1.38–94.02)], neutropenia [OR = 4.31 (1.34–13.87)] and male gender [OR = 2.34 (1.04–5.29)]. Conclusion: In candidemic patients,chronic liver disease, neutropenia and male gender were associated with C. tropicalisrather than C. albicansinfection. Considering a higher fluconazole resistance in C. tropicalis, fluconazole should not be used for empirical antifungal treatment in such patients.

Effects of thiamine on vasopressor requirements in patients with septic shock: a prospective randomized controlled trial

BackgroundThiamine, an essential vitamin for aerobic metabolism and glutathione cycling, may decrease the effects of critical illnesses. The objective of this study was to determine whether intravenous thiamine administration can reduce vasopressor requirements in patients with septic shock.MethodsThis study was a prospective randomized double-blind placebo-controlled trial. We included adult patients with septic shock who required a vasopressor within 1–24 h after admission between March 2018 and January 2019 at a tertiary hospital in Thailand. Patients were divided into two groups: those who received 200 mg thiamine or those receiving a placebo every 12 h for 7 days or until hospital discharge. The primary outcome was the number of vasopressor-free days over 7 days. The pre-defined sample size was 31 patients per group, and the study was terminated early due to difficult recruitment.ResultsSixty-two patients were screened and 50 patients were finally enrolled in the study, 25 in each group. There was no difference in the primary outcome of vasopressor-free days within the 7-day period between the thiamine and placebo groups (mean: 4.9 days (1.9) vs. 4.0 days (2.7), p = 0.197, mean difference − 0.9, 95% CI (− 2.9 to 0.5)). However, the reductions in lactate (p = 0.024) and in the vasopressor dependency index (p = 0.02) at 24 h were greater among subjects who received thiamine repletion vs. the placebo. No statistically significant difference was observed in SOFA scores within 7 days, vasopressor dependency index within 4 days and 7 days, or 28-day mortality.ConclusionsThiamine was not associated to a significant reduction in vasopressor-free days over 7-days in comparison to placebo in patients with septic shock. Administration of thiamine could be associated with a reduction in vasopressor dependency index and lactate level within 24 h. The study is limited by early stopping and low sample size.Trial registrationTCTR, TCTR20180310001. Registered 8 March 2018, http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsearch&smenu=fulltext&task=search&task2=view1&id=3330.

Situational analysis on the recovery of patients who have undergone major abdominal surgery.

AimTo analyse the recovery situation of patients who underwent abdominal surgery.DesignA descriptive study.MethodThis study was conducted among 50 participants: 15 postoperative patients, 16 caregivers, 2 surgeons and 17 nurses in a tertiary hospital in Thailand. The state of patients’ recovery after undergoing major abdominal surgery was analysed using Donabedian's approach.ResultsThe findings showed that hospitals and some organizations do not have a clear policy about clinical care to help patients recover after undergoing major surgery or to prevent the risk of complications following major abdominal surgery. In addition, there were no clinical practice guidelines in use in each ward. Each ward should have a set of guidelines and procedures for assisting with patient recovery. The procedures should be based on nursing care. It is necessary to have a coordinated multidisciplinary care guideline to use with other health professionals to promote the recovery of patients.

Insight into Molecular Epidemiology, Antimicrobial Resistance, and Virulence Genes of Extensively Drug-Resistant Acinetobacter baumannii in Thailand.

Extensively drug-resistant Acinetobacter baumannii (XDR-AB) is a major threat to public health worldwide. A retrospective study for 27 XDR-AB isolates from four tertiary hospitals in Thailand was conducted. Beta-lactamase and virulence genes were characterized by PCR. The blaADC, blaOXA-51, and blaOXA-23 were detected in all isolates, whereas blaPER-1 and blaNDM-1 genes were present in 7.4% and 3.7% of isolates. All isolates had virulence genes, including genes in iron acquisition system, biofilm formation and secretion systems. The plasmids in XDR-AB belonged to GR2 (100%), GR6 (40.7%), and GR1 (7.4%). Multilocus sequence typing sequence types (STs) were further investigated. The data demonstrated that XDR-AB isolates had nine STs: ST195 (n = 4), ST208 (n = 4), ST368 (n = 1), ST451 (n = 5), ST457 (n = 2), ST1947 (n = 1), ST1166 (n = 7), including two novel STs namely ST1682 (n = 2) and ST1684 (n = 1). We observed that the majority ST1166 (25.9%) was associated with the prevalence of GR2 and GR6 plasmids and traU virulence gene. Genome-based single nucleotide polymorphism phylogenetic analysis of the isolates with two novel ST types indicated that the two isolates belonged to the international clone II (IC2) within the same cluster. In conclusion, our data showed the dissemination of XDR-AB isolates harbored virulence genes and antibiotic resistance genes among four hospitals in Thailand. The results highlighted the difficulty posed for the empirical treatment of the patients with the A. baumannii infection.

Vascular Complications from Coronary Angiography/Percutaneous Coronary Intervention: Comparing Day Case Patients and Inpatients in a Tertiary Hospital in Thailand: A Retrospective Cohort Stud

Objective: To compare the incidence along with risk factors of vascular complications between patients having undergone Coronary angiography/Percutaneous Coronary Interventions (CAG/PCIs); as day cases and those as inpatients. Material and Methods: Our study is a retrospective cohort study. We performed a retrospective chart review of the patients, visiting a heart center of the hospital from October, 2014 to September, 2018. We included patients of a minimum 18 years of age, who had undergone CAG/PCIs. Excluded patients were those who had been referred from other hospitals. The main outcomes were vascular complications defined as: (1) bleeding with significant blood loss during the procedure. (2) Hematoma within 1 month after the procedure. Wilcoxon’s rank sum and chi-squared test were used to assess the risk factors. Results: Of all 784 patients having undergone CAG/PCI, 387 were day cases and 397 were inpatients. Only 12 cases developed vascular complications. The incidence of vascular complications was not significantly different between either day case; whose incidence was 1.3% (95% confidence interval (CI), 0.72-1.87), and inpatients; whose incidence was 1.8% (95% CI, 1.10-2.42). We found that the risk factors of vascular complications were percutaneous coronary intervention, and using a vascular closure device to remove the introducer sheath. Conclusion: Performing CAG/PCI as day cases did not increase the risks of complications post-procedure, as compare to the inpatients. However, due to the small numbers of patients with complications future studies with more patients are needed to ensure the safety of day case CAG/PCI. Patients undergoing PCI, or patients with vascular closure devices used should be closely observed before discharge.

Quality of life for type II diabetes mellitus patients in a suburban tertiary hospital in Thailand

PurposeThe purposes of this paper were to assess the quality of life (QoL) in patients with type II diabetes mellitus (DM) in a suburban tertiary hospital and determine the factors that affect the QoL including individual characteristics, health factors, self-care behaviors and social support.Design/methodology/approachThis study was a cross-sectional study among DM type II cases being treated in a suburban tertiary hospital in Thailand. Data were collected by personal interview from 188 patients in 2018. Diabetes-39 was administered to assess QoL.Findings54.3 percent of patients had good QoL. Total score of QoL was moderate which found an average score of 216.0 ± 41.0, 46.8% had moderate level in self-care behaviors and 56.4 percent had moderate level in social support. The factors associated with QoL in patients were cerebrovascular disease (Fisher = 7.2, p = 0.01), self-care behaviors (rs = 0.191, p = 0.008) and social support (rs = 0.229, p = 0.002).Originality/valueHealth care system ought to develop a policy driven to improve the QoL in DM type II patients by encouraging self-care behaviors and social support for DM type II patients.

Quality of Life and Burden of Lung Cancer Patients’ Caregivers: A Cross-Sectional Study from Southern Thailand

Objective: To measure the Quality of Life (QoL) and Caregiver Burden Scale (CBS) of lung cancer patients’ caregivers and assess the associated factors. Material and Methods: This was a cross-sectional study. We interviewed lung cancer patients and their caregivers who were visiting the outpatient department of a tertiary hospital in Thailand. QoL was measured by the World Health Organization Quality of Life-BREF-THAI. CBS was measured by Zarit’s burden interview. The data were collected using the KoBoToolbox application. Multivariate ordinal logistic regression was used to assess associations between caregivers’ QoL and CBS with the dependent variables, including patient and caregiver factors. Results: Two hundred and four patients and 202 caregivers were included in the study. The only caregivers factor associated with lower QoL was younger age [odds ratio (OR)=0.33, 95% confidence interval (CI): 0.11-0.95)] while factors associated with better QoL were income (OR=3.91, 95% CI: 1.13-14.50) and being a child of the patient (OR=3.24, 95% CI: 1.02-11.30). The main caregivers factor associated with a lower CBS was being Muslim (OR=0.16, 95% CI: 0.05-0.52), and the main factor associated with a higher CBS was income (OR=6.12, 95% CI: 1.66-23.75). The patients factors affecting CBS were female (OR=0.36, 95% CI: 0.17-0.71), Barthel’s activity daily living (ADL) index (OR= 7.42, 95% CI: 1.99-28.65), and ≥2 years looking after a patient (OR=0.40, 95% CI: 0.18-0.88). Conclusion: The factors affecting caregivers’ QoL and CBS were their patients’ ADL and years with disease. Training on caring patients to maintain the patients’ ADL for caregivers should be provided. Health authorities should provide opportunities for patients to share their experience on how they live and cope with the symptoms of lung cancer.