Thammasat University Research Articles

Factors Associated with Knowledge, Attitudes, and Practices of Personnel to Use Objective and Key Results (OKRs) in Thammasat University Hospital

Background: Objective and key results (OKRs) was a strategic tool to drive the organization to achieve a goal. Goals are concomitant and come from leaders and personnel. Most hospital management studies are conducted in a qualitative approach. Objective: To evaluate the association of knowledge, attitudes, practices, personal factor (PF), and perceived organizational support (POS) of OKRs in quantitative approach. Materials and Methods: The present study was a descriptive study conducted at Thammasat University Hospital (TUH), Pathum Thani, Thailand between March and April 2024. Participants were TUH personnel. Self-filling questionnaires were applied and signed written informed consent after thoroughly counselled. Questionnaires consisted of POS, knowledge, attitudes, and practices questions. PF was also collected. Results: Two hundred and twenty-one participants were recruited. Most participant (192 out of 221) were female. Three-quarters (149 out of 221) of the participants had more than ten years’ experience. Eighty-six percent (192 out of 221) of the participants had an educational level equal to or higher than bachelor. Mean knowledge, attitudes, and practices of participants were 9.5±0.6, 3.9±0.4, and 3.7±0.4, respectively. PF was not associated with POS and practices. Hospital personnel with more than 20 years seniority had OKRs’ knowledge less than those less than 10 years seniority (b= –0.21, p=0.04). Monthly income and work experience were significantly positive and negative associated with attitudes at b=0.17 and –0.15, respectively. POS was not associated with attitudes and knowledge. Practice was associated with POS, with statistical significance (b=0.20, p<0.001). Conclusion: OKRs knowledge decreased with work experience. Attitude was associated with high monthly income and reverse associated with work experience. POS was significantly associated with the practice. There was no association between PF and practice, PF and POS, POS and attitude, and POS and knowledge. This study provided guidelines for recognizing organizational support in implementing OKRs and improving processes to ensure efficiency and staff involvement. Management should establish clear policies involving personnel at all levels.

Prevalence and risk factors of Acinetobacter baumannii infection in Pediatric Intensive Care Unit at Thammasat University Hospital

Prevalence and risk factors of Acinetobacter baumannii infection in Pediatric Intensive Care Unit at Thammasat University Hospital

Prevalence of Vitamin D Deficiency in Patients with Fatigue and Neuropsychiatric Symptoms of Long COVID and its Correlation with Symptom Severity

Background: Despite the potential role of vitamin D in the acute phase of COVID-19, studies on its prevalence and association with long COVID severity are limited, leaving the relationship between vitamin D levels and long COVID symptoms unclear. Aim: The objective of this study was to investigate the prevalence of vitamin D deficiency in patients with fatigue or neuropsychiatric symptoms of long COVID and its correlation with the severity of symptoms. Methods: A cross-sectional, single-center study was conducted at Thammasat University Hospital, Thailand. The study recruited participants between the ages of 18 and 60 years who had received a diagnosis of COVID-19 and had at least one long COVID symptom, including fatigue or neuropsychiatric symptoms. Vitamin D level was collected, and clinical severity was assessed using the Chalder Fatigue Scale [CFQ-11], Depression, Anxiety and Stress Scale-21 Items [DASS-21], Pittsburgh Sleep Quality Index [PSQI], Addenbrooke's Cognitive Examination III [ACE], and Trail Making Test A & B [TMT-A and TMT-B]. Results: A total of 82 patients were recruited; most were female [78%], with a mean age of 34.2 years. Most participants had a vitamin D deficiency [<20 ng/mL, 73.2%], accounting for 23.2% vitamin D insufficiency [20-30 ng/mL], and 3.6% had an adequate vitamin D level. Only gender was associated with vitamin D levels. Multivariable analysis demonstrated that the vitamin D level was not correlated with all clinical outcomes, including total CFQ, total DASS, DASS depression, DASS anxiety, total PSQI, total ACE score, and total TMT scores. Conclusion: The prevalence of vitamin D insufficiency and deficiency was high in patients with long COVID, with female gender serving as predictors of lower vitamin D levels. However, no associations were found between vitamin D level and fatigue syndrome, depression, anxiety, sleep problems, or cognitive function.

Long COVID at 3 and 6 months after covid-19 infection in Thailand.

"Long COVID", which describes a diverse set of symptoms or conditions that persist or develop after four weeks from the onset of initial SARS-CoV-2 infection has been introduced. However, the true prevalence varies worldwide. This study aimed to determine the point prevalence and clinical characteristics of long COVID at three and six months after acute COVID-19 infection in Thailand. Methods All adult patients who were diagnosed with COVID-19 by positive nasopharyngeal RT-PCR for SARS-CoV-2 at Thammasat University Hospital between October and December 2021 were recruited and followed for long COVID symptoms by telephone interviews at 3 and 6 months after an acute infection. Among 1,400 eligible COVID-19 cases, interviews were complete for 1,129 and 932 individuals at 3 and 6 months, respectively. Of those, 431 and 314 reported at least one symptom consistent with long COVID. The point prevalence was 38.2% (95% confidence interval: 35.3-41.1%) and 33.7% (95% confidence interval: 30.7-36.7%) respectively. Female gender, disease severity, and symptomatic acute infection were identified as independent risk factors. Conclusion Based on the reported symptoms, long COVID is commonly observed either at 3 or 6 months in our study.

Correlation between handgrip strength and air trapping in patients with stable chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) often presents with dyspnea resulting from the condition of air trapping, assessed by lung volume measurement studies. This study aimed to investigate the relationship between handgrip strength (HGS) and air trapping in COPD patients. Cross-sectional research was conducted in COPD patients at Thammasat University Hospital, Thailand between May 2022 and December 2023. HGS was assessed using the Jamar® Smart Hand Dynamometer, and air trapping was measured using a body plethysmograph. Air trapping was defined as a ratio of residual volume (RV) to total lung capacity (TLC) greater than 40%. Receiver operator characteristic (ROC) curves, sensitivity, and specificity values were calculated to determine the optimal cutoff value of HGS for predicting air trapping. A total of 72 patients (90.3% male) were included, with an average age of 72.4±9.7 years. The body mass index was 23.5±4.3 kg/m2. The smoking history was 23.2±14.8 pack-years. Common comorbidities included hypertension (36.1%) and diabetes (22.2%). Post-bronchodilator forced expiratory volume in 1 second (FEV1) was 72.1%±21.2%. Air trapping was found in 55.6%. A negative correlation was found between HGS and RV/TLC (R=-0.399, P=0.001). The best cutoff value for HGS to predict air trapping was 28.3 kg, with 71.9% sensitivity and 65.0% specificity. The area under the ROC curve for identifying air trapping was 0.681 (95% CI: 0.554 to 0.808, P=0.009). Air trapping is common in COPD patients, and HGS is significantly correlated with air trapping. Thus, HGS may serve as an alternative tool for assessing air trapping.

Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis.

Acute ischemic stroke (AIS) retains a notable stance in global disease burden, with thrombolysis via recombinant tissue plasminogen activator (rtPA) serving as a viable management approach, albeit with variable outcomes and the potential for complications like hemorrhagic transformation (HT). The platelet-to-neutrophil ratio (P/NR) has been considered for its potential prognostic value in AIS, yet its capacity to predict outcomes following rtPA administration demands further exploration. To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients. Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed. The relationship between P/NR and clinical outcomes [early neurological deterioration (E-ND), HT, delayed ND (D-ND), and 3-mo outcomes] was scrutinized. Notable variables, such as age, diabetes, and stroke history, exhibited statistical disparities when comparing patients with and without E-ND, HT, D-ND, and 3-mo outcomes. P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3% sensitivity and a 52.5% specificity for 90-d outcomes. P/NR prognostic accuracy was statistically significant for 90-d outcomes [area under the curve (AUC) = 0.562], D-ND (AUC = 0.584), and HT (AUC = 0.607). P/NR demonstrated an association with adverse 3-mo clinical outcomes, HT, and D-ND in AIS patients post-rtPA administration, indicating its potential as a predictive tool for complications and prognoses. This infers that a diminished P/NR may serve as a novel prognostic indicator, assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy.

Transforming Academic Libraries into Hubs of Innovation and Entrepreneurship: A Case Study of a New Library Model

In a data-driven era, academic libraries must evolve beyond traditional roles as spaces for reading and storing information resources to become platforms promoting learning, research, innovation, future skills, and entrepreneurship. Based on the triple helix model of innovation, this paper highlights the new library model in a case study aimed at transforming traditional academic library services into enterprising, innovation-driven activities. For over ninety years, Thammasat University Library has been located on Rattanakosin Island, an historical area of Thailand. More recently, the library business model has evolved to meet modern needs. This qualitative research uses a case study to explore library strategies to create space meeting requirements of diverse user groups: students, faculty, staff, alumni, businesspeople and the community, including older residents. Service innovations responding to user demands are prioritized by drawing on the expertise of librarians. These changes generate new revenue for the library and enhance the space design and use through the Life Space concept. Co-working spaces, learning areas, inspirational corners, and performance venues make the library a platform for inspiring creativity, learning, life enhancement, and business ventures. The Thammasat University Library has also become an innovative bridge linking university research with small and medium-sized enterprises (SMEs), facilitating knowledge transfer and research commercialization. These findings may serve as guidelines for academic libraries seeking to adapt the Library of Life approach to be centres catering to readers of all generations and stations in life.

Effect of Informative Cesarean Delivery Operative Steps Video on Maternal Anxiety Level: A Randomized Controlled Trial

Background Cesarean section is the most common obstetric procedure performed. This can lead to maternal anxiety, which is a significant contributor to postpartum depression. This can adversely affect pregnant women both mentally and emotionally, negatively impacting their well-being and family bonding. The aim of this study was to evaluate the effect of the addition of an informative cesarean section operative steps video on the maternal anxiety score compared with standard pre-cesarean section care. Methods This randomized controlled trial was conducted at Thammasat University Hospital, Thailand, between April and September 2023. Pregnant women who underwent their first cesarean section were allocated to two groups: intervention and control groups. Participants in the intervention group were required to watch a 5-minute informative video that elaborately described the process from pre-operative steps until post-operative care on the day scheduled for cesarean delivery. All participants received the same routine pre-operative and post-operative care. The State-Trait Anxiety Inventory (STAI) was used to measure both populations on two occasions: the day of scheduled cesarean delivery and postpartum day 1. Results A total of 178 women were recruited. The demographic and obstetric characteristics were similar between the two groups. The pre-operative STAI scores of the intervention and control groups were 42.9 and 44.1 points, respectively, with no significant difference. However, the post-operative anxiety score showed a significant decline in the intervention group compared to that in the control group (p = 0.002). Moreover, most of the participants in the intervention group showed a low level of anxiety after the operation, while half of the control group remained at a moderate to high level score. Conclusions The provision of an informative educational video before cesarean delivery is a powerful tool that significantly reduces cesarean operative anxiety and improves health outcomes. Thai Clinical Trials Registry on the 28 March 2023 (TCTR20230328001).

Dexamethasone and Lidocaine Effects in 24 hours Post Cesarean Pain Reduction under Spinal Anesthesia: A Randomized Controlled Trial

Objective: This study aimed to compare the efficacy of additional local infiltration of dexamethasone and lidocaine among post-cesarean parturient underwent spinal anesthesia compared to the control group. Materials and Methods: This randomized controlled trial was conducted at Thammasat University Hospital, Thailand, between June and November 2022. Singleton pregnant women who underwent cesarean delivery were randomized into 3 groups: dexamethasone (D), lidocaine (L), and control groups (C). Before skin closure, D, L and C group received infiltration of 16 mg of dexamethasone, 2% lidocaine with adrenaline and none, respectively. A visual analog scale (VAS, 0-10) was used for the evaluation of post-cesarean pain at two, four, six, eight, twelve, and twenty-four hours. VAS, demographic, and obstetric data were collected for analysis. Additional opioid was recorded for secondary outcome. Results: A total of 279 participants were recruited and divided into 3 groups. Half of the participants (151/279) were nulliparity. Other demographics were similar. Subjects in the D group had lower moderate to severe pain after 6 hours onwards and less additional opioid requirement compared to the C and L groups significantly. Subjects in the L group had lower moderate to severe pain than the C group at 4 hours after surgery. Postoperative complications were comparable among the groups. Conclusion: Local dexamethasone infiltration could reduce and prolong post-cesarean pain relief within 24 hours after cesarean delivery.

Comparison of the Cost Effectiveness of Orthognathic Surgery Treatment Between Orthodontic-first and Surgery-first Approaches in the Surgical Phase in Thammasat University Hospital

Objectives: This retrospective cohort study aims to evaluate the costs and advantages of the surgical phase of the surgery-first approach (SFA) versus the orthodontic-first approach (OFA). Methods: Orthognathic surgery has been described as having two concepts: an orthodontic-first approach and a surgery-first approach. However, there was no consensus on which group has the best cost effectiveness in the surgical treatment phase. In total, 70 patients were treated; half of the patients were treated via the SFA, and another half were treated via the OFA. The information collected included operation cost, operation time, total hospital cost, and length of hospitalization. Effectiveness was determined by quality of life, which was measured with the Orthognathic Quality of Life Questionnaire Thai Version (OQLQ) before and then 6 months after treatment. The cost effectiveness was assessed with an incremental cost effectiveness ratio (ICER) and an incremental time effectiveness ratio (ITER). Results: The results indicated the intervention cost and time of SFA were slightly higher but more effective than those of OFA. However, the operation cost (p=0.375), operation time (p=0.556), total hospital cost (p=0.363), and length of hospitalization (p=0.643) and OQLQ scores (p=0.344) of both groups were not significantly different. Conclusions: The intervention cost and time of SFA were slightly higher but more effective than those of OFA. Depending on the result of this study, SFA treatment planning was a good choice for orthognathic treatment.

Is the rate of extremely climate-intensifying rainfall for Bangkok severely propagating into flooding?

ABSTRACT The present paper assesses whether the extremely climate-intensifying rate (i.e., 14%/°C) for maximum rainfall in Bangkok is severely propagating into flooding. The impact evaluation involves the development of a flooding assessment method for a drainage system (DS) representative of the capital and the application of the developed procedure to assess the interested effect of the DS on its flooding. Considering the DS of Thammasat University (DS-TU) as the typical DS for the city, the popular storm water management model (SWMM) is then used for developing the dynamic simulation method against the most critical flooding condition of the DS-TU. Applying this SWMM for impact assessment of the intense rainfall rate has indicated that the rising temperature in excess of 2 °C would cause the gradient to severely propagate into the flooding because of the rapid increase in its associated peak, volume and duration properties. The propagated flooding has been shown to be further escalated, as a result of the clogging in the DS-TU. The clogging height that exceeded the 30% threshold of the full openings would intensify the volume and duration properties increasingly.

The association between histopathological growth patterns with tumor budding and poorly differentiated clusters in colorectal liver metastasis treated with preoperative systemic therapy.

The liver's unique cellular structure makes it a frequent site for metastatic cancer. In colorectal liver metastasis (CRLM), surgical resection is essential for long-term survival. Histopathological growth patterns (HGPs) in CRLM, including desmoplastic and nondesmoplastic patterns, provide critical prognostic information. Tumor budding (TB) and poorly differentiated clusters (PDCs), indicators of aggressive cancer behavior, are evaluated using standardized histological scoring systems and are linked to epithelial-mesenchymal transition. This study explored the correlation between HGPs, TB, and PDCs in CRLM. Archived data from Thammasat University Hospital, including resected CRLM specimens, were analyzed. This study evaluated 51 CRLM resection specimens treated with preoperative systemic therapy, finding most to be nondesmoplastic with low TB and grade 1 PDC. Desmoplastic growth was significantly more prevalent in cases receiving preoperative chemotherapy than those that did not. Higher 3-year mortality was noted in nondesmoplastic groups and those with higher TB and tumor regression grade (TRG) scores. Significant correlations were observed between HGPs, TB, and PDCs, despite challenges in assessing these parameters due to issues with noncancer cells, extracellular mucin, bile ductular proliferation, and retraction artifacts. This study underscores the prognostic significance of HGPs, TB, PDCs, and TRG scores in CRLM, highlighting the need for precise histopathological evaluation for more accurate prognostic implications.

Effects of electroacupuncture on cognitive symptoms in major depressive disorder: a pilot study and randomized controlled trial

Objectives To investigate the impact of electroacupuncture on cognitive function, quality of life (QoL), and depression severity in patients with major depressive disorder (MDD). Methods This double-blinded randomized controlled trial included 60 participants aged 18-55 with cognitive symptoms related to MDD at Thammasat University Hospital. Participants were divided into two groups: the electroacupuncture group combined with standard antidepressant treatment (EG; n=30) and the control group receiving standard care with placebo acupuncture (CG; n=30). The study assessed 1) executive functions using the Trail making test- B and Stroop Color and Word Test, 2) delayed recall, and 3) subjective cognitive complaint and Quality of life (QoL) using WHODAS 2.0. Depressive symptoms were measured using the Thai version of the Patient Health Questionnaire (PHQ-9). Baseline and post-intervention assessments were conducted over 10 weeks. Mann-Whitney U test analyzed treatment effects by comparing median differences between groups. Results Both groups exhibited similar demographics and cognitive traits. Cognitive improvement was observed in both groups at the endpoint. Intention-to-treat analysis revealed significantly higher median scores for subjective cognitive complaints in the EG compared to the CG (EG: Median = 5.5, CG: Median = 0.0, p=0.049). No serious side effects were identified from either electroacupuncture or placebo acupuncture. Conclusions Electroacupuncture improved subjective complaints in MDD patients with cognitive symptoms, but did not show effects on specific cognitive functions, QoL, or depressive symptoms. This study provides initial evidence supporting the potential of electroacupuncture in MDD patients with cognitive symptoms, suggesting opportunities for further research. Trial registration NCT06239740, February 2, 2024, ClinicalTrials.gov.

Effects of dynamic versus static parameter-guided fluid resuscitation in patients with sepsis: A randomized controlled trial.

Fluid resuscitation is an essential component for sepsis treatment. Although several studies demonstrated that dynamic variables were more accurate than static variables for prediction of fluid responsiveness, fluid resuscitation guidance by dynamic variables is not standard for treatment. The objectives were to determine the effects of dynamic inferior vena cava (IVC)-guided versus (vs.) static central venous pressure (CVP)-guided fluid resuscitation in septic patients on mortality; and others, i.e., resuscitation targets, shock duration, fluid and vasopressor amount, invasive respiratory support, length of stay and adverse events. A single-blind randomized controlled trial was conducted at Thammasat University Hospital between August 2016 and April 2020. Septic patients were stratified by acute physiologic and chronic health evaluation II (APACHEII) <25 or ≥25 and randomized by blocks of 2 and 4 to fluid resuscitation guidance by dynamic IVC or static CVP. Of 124 patients enrolled, 62 were randomized to each group, and one of each was excluded from mortality analysis. Baseline characteristics were comparable. The 30-day mortality rates between dynamic IVC vs. static CVP groups were not different (34.4% vs. 45.9%, p=0.196). Relative risk for 30-day mortality of dynamic IVC group was 0.8 (95%CI=0.5-1.2, p=0.201). Different outcomes were median (interquartile range) of shock duration (0.8 (0.4-1.6) vs. 1.5 (1.1-3.1) days, p=0.001) and norepinephrine (NE) dose (6.8 (3.9-17.8) vs. 16.1 (7.6-53.6) milligrams, p=0.008 and 0.1 (0.1-0.3) vs. 0.3 (0.1-0.8) milligram⋅kilogram -1, p=0.017). Others were not different. Dynamic IVC-guided fluid resuscitation does not affect mortality of septic patients. However, this may reduce shock duration and NE dose, compared with static CVP guidance.

Effects of electroacupuncture on cognitive symptoms in major depressive disorder: a pilot study and randomized controlled trial

Objectives To investigate the impact of electroacupuncture on cognitive function, quality of life (QoL), and depression severity in patients with major depressive disorder (MDD). Methods This double-blinded randomized controlled trial included 60 participants aged 18-55 with cognitive symptoms related to MDD at Thammasat University Hospital. Participants were divided into two groups: the electroacupuncture group combined with standard antidepressant treatment (EG; n=30) and the control group receiving standard care with placebo acupuncture (CG; n=30). The study assessed 1) executive functions using the Trail making test- B and Stroop Color and Word Test, 2) delayed recall, and 3) subjective cognitive complaint and Quality of life (QoL) using WHODAS 2.0. Depressive symptoms were measured using the Thai version of the Patient Health Questionnaire (PHQ-9). Baseline and post-intervention assessments were conducted over 10 weeks. Mann-Whitney U test analyzed treatment effects by comparing median differences between groups. Results Both groups exhibited similar demographics and cognitive traits. Cognitive improvement was observed in both groups at the endpoint. Intention-to-treat analysis revealed significantly higher median scores for subjective cognitive complaints in the EG compared to the CG (EG: Median = 5.5, CG: Median = 0.0, p=0.049). No serious side effects were identified from either electroacupuncture or placebo acupuncture. Conclusions Electroacupuncture improved subjective complaints in MDD patients with cognitive symptoms, but did not show effects on specific cognitive functions, QoL, or depressive symptoms. This study provides initial evidence supporting the potential of electroacupuncture in MDD patients with cognitive symptoms, suggesting opportunities for further research. Trial registration NCT06239740, February 2, 2024, ClinicalTrials.gov.

A machine learning-based protocol to support visual tree assessment and risk of failure classification on a university campus

Tree failure risk assessment involves visually evaluating trees by considering three essential factors: identifying potential targets that may be affected if the tree falls, assessing the potential consequences of the fall, and determining the likelihood of tree failure. This assessment was used to evaluate the safety of trees in a study area at Thammasat University Rangsit Center, Thailand. In two priority-selected areas for tree risk management, 3659 trees representing 139 species were assessed, and to understand the spatial patterns of tree health conditions and risks, the study employed a GIS-based mapping methodology to manage tree inventory and analyze the spatial patterns of tree health conditions and risks. A decision tree protocol based on the chi-squared automatic interaction detector (CHAID) algorithm, which employs machine learning, was used to evaluate the risk of tree failure. Our study successfully identified seven variables that are crucial in assessing the risk of tree failure. According to the findings, the overall accuracy rate of failure risk classification was 87.35 %, and of all the trees evaluated, 280 trees (7.65 % of the total) representing 34 different species were at high risk. It is recommended to start the assessment process by evaluating important variables such as tree cavities, pest infestations, mechanical damage, dead branches, and epicormic growth. Machine learning protocols, integrated with GIS, are shown to be effective, spatially-explicit, decision-support tools for detecting tree failure potential and assessing risk ratings. Application of these tools improves tree risk management practices.

Effect of Informative Cesarean Delivery Operative Steps Video on Maternal Anxiety Level: A Randomized Controlled Trial

Background Cesarean section is the most common obstetric procedure performed. This can lead to maternal anxiety, which is a significant contributor to postpartum depression. This can adversely affect pregnant women both mentally and emotionally, negatively impacting their well-being and family bonding. The aim of this study was to evaluate the effect of the addition of an informative cesarean section operative steps video on the maternal anxiety score compared with standard pre-cesarean section care. Methods This randomized controlled trial was conducted at Thammasat University Hospital, Thailand, between April and September 2023. Pregnant women who underwent their first cesarean section were allocated to two groups: intervention and control groups. Participants in the intervention group were required to watch a 5-minute informative video that elaborately described the process from pre-operative steps until post-operative care on the day scheduled for cesarean delivery. All participants received the same routine pre-operative and post-operative care. The State-Trait Anxiety Inventory (STAI) was used to measure both populations on two occasions: the day of scheduled cesarean delivery and postpartum day 1. Results A total of 178 women were recruited. The demographic and obstetric characteristics were similar between the two groups. The pre-operative STAI scores of the intervention and control groups were 42.9 and 44.1 points, respectively, with no significant difference. However, the post-operative anxiety score showed a significant decline in the intervention group compared to that in the control group (p = 0.002). Moreover, most of the participants in the intervention group showed a low level of anxiety after the operation, while half of the control group remained at a moderate to high level score. Conclusions The provision of an informative educational video before cesarean delivery is a powerful tool that significantly reduces cesarean operative anxiety and improves health outcomes. Thai Clinical Trials Registry on the 28 March 2023 (TCTR20230328001).

Distribution of Foot Arch Type and Associated Symptoms in Medical Students at Faculty of Medicine, Thammasat University

Objective: To determine the distribution of foot arch type, associated symptoms, and factors associated with moderate to severe pain Materials and Methods: The cross-sectional study was collected data from 5th year medical students, Faculty of Medicine, Thammasat University in academic year 2020. The distribution of foot arch type used the footprint and classified by Harris imprint index (HII), Chippaux-Smirak index (CSI), Staheli index (SI). The associated symptoms were collected into pain and tightness. Pain score was rated by the volunteer using numeric rating scale (NRS) at each foot/leg separately. Results: A total of ninety-eight medical students (196 feet) were recruited and analyzed. The distribution of foot arch type by HII, CSI and SI were 1) bilateral normal arched feet: 42.9%, 67.3%, 54.1% 2) bilateral pes planus: 8.2%, 12.2%, 21.4% 3) bilateral pes cavus: 25.5%, 6.1%, 5.1% 4) unilateral pes planus: 2%, 9.2%,15.3% 5) unilateral pes cavus: 21.4%, 5.1%, 4.1%, respectively. The most commonly associated symptom of pes planus was midfoot pain (17%) while pes cavus and normal arched foot were hindfoot pain (22.4% and 17.3%). The factor associated with moderate to severe pain was BMI ≥ 23 kg/m2 (OR = 3.23, 95%CI 1.63 - 6.41, p-value = 0.001). Conclusion: Bilateral normal arched feet were mostly found. Midfoot pain in pes planus and hindfoot pain in pes cavus and normal arched foot were the greatest symptoms. BMI was a risk factor.

Preface

Proceeding of the 4th International Conference on Environmental Technology and Innovations (ICETI 2023) Dear Colleagues, We are delighted to present the proceedings of the 4th International Conference on Environmental Technology and Innovations (ICETI 2023), which was part of the IOP Conference Series: Earth and Environmental Science. This event was a collaborative effort involving several prestigious institutions: Ton Duc Thang University, National Cheng Kung University, and Cheng Shiu University in Taiwan; Thammasat University in Thailand; Universiti Sains Malaysia; and Nagaoka and Hokkaido Universities in Japan. ICETI 2023 served as a multidisciplinary platform for experts from academia, industry, and research to discuss and share advancements in Environmental science and technology, Sustainable development and conservation of natural resources, Technologies for adapting to climate change, and Occupational health and safety engineering. The conference proceedings feature a series of peer-reviewed articles that uphold our discussions' high scientific standards and integrity, highlighting our authors’ significant contributions towards innovative practices and policy development in environmental stewardship. We extend our heartfelt thanks to the editorial board and reviewers, whose meticulous work guaranteed the quality of these proceedings. Their expertise was crucial to the success of this publication. We are also grateful to our keynote speakers and all participants for their invaluable insights and contributions, which greatly enriched our conference. Their diverse perspectives and experiences are essential in advancing our sustainable future agenda. Special thanks go to the conference organizers and the support staff at Ton Duc Thang University for their unwavering commitment and effort in making this conference a success. We trust that the insights shared at ICETI 2023 will inspire ongoing research and collaboration within our community. As we look forward to future conferences, we remain committed to advancing the field of environmental technology and innovation. Together, we can continue to make significant strides towards a sustainable and prosperous future for all. Editorial Board Members of the ICETI 2023 - The Manuscript Section for the IOP List of Conference Proceedings is available in the pdf.

Effects of dynamic versus static parameter-guided fluid resuscitation in patients with sepsis: A randomized controlled trial

Background Fluid resuscitation is an essential component for sepsis treatment. Although several studies demonstrated that dynamic variables were more accurate than static variables for prediction of fluid responsiveness, fluid resuscitation guidance by dynamic variables is not standard for treatment. The objectives were to determine the effects of dynamic inferior vena cava (IVC)-guided versus (vs.) static central venous pressure (CVP)-guided fluid resuscitation in septic patients on mortality; and others, i.e., resuscitation targets, shock duration, fluid and vasopressor amount, invasive respiratory support, length of stay and adverse events. Methods A single-blind randomized controlled trial was conducted at Thammasat University Hospital between August 2016 and April 2020. Septic patients were stratified by acute physiologic and chronic health evaluation II (APACHE II) &lt;25 or ≥25 and randomized by blocks of 2 and 4 to fluid resuscitation guidance by dynamic IVC or static CVP. Results Of 124 patients enrolled, 62 were randomized to each group, and one of each was excluded from mortality analysis. Baseline characteristics were comparable. The 30-day mortality rates between dynamic IVC vs. static CVP groups were not different (34.4% vs. 45.9%, p=0.196). Relative risk for 30-day mortality of dynamic IVC group was 0.8 (95%CI=0.5-1.2, p=0.201). Different outcomes were median (interquartile range) of shock duration (0.8 (0.4-1.6) vs. 1.5 (1.1-3.1) days, p=0.001) and norepinephrine (NE) dose (6.8 (3.9–17.8) vs. 16.1 (7.6–53.6) milligrams, p=0.008 and 0.1 (0.1-0.3) vs. 0.3 (0.1-0.8) milligram⋅kilogram−1, p=0.017). Others were not different. Conclusions Dynamic IVC-guided fluid resuscitation does not affect mortality of septic patients. However, this may reduce shock duration and NE dose, compared with static CVP guidance.