University Hospital In Bangkok Research Articles

Factors influencing prehospital delay time among patients with peripheral arterial occlusive disease

Only one-third of patients with peripheral arterial occlusive disease (PAOD) seek medical care after perceiving the symptoms of PAOD, and most PAOD patients only visit the physician when they develop ulceration and gangrene. Delay can result in lower extremity amputation and death within three years. The aim of this study was to predict prehospital delay time from sociodemographic characteristics and clinical characteristics, social support, knowledge about PAOD, depression and fear, and treatment-seeking behaviors among patients with PAOD. Data were collected in three university hospitals in Bangkok, Thailand. A sample of 212 patients with PAOD who were newly diagnosed or diagnosed within the preceding four months was recruited into the study. Questionnaires and interviewing were used to collect data. Stepwise multiple regression analysis was performed to identify the factors influencing prehospital delay time. Significant determinants of prolonged prehospital delay time were male gender, low monthly income (less than 10,000 Thai baht or 213 Euros), high level of perceived social support, and several treatment seeking behaviors. Depression, high level of fear, and self-pay of medical expenses were associated with short prehospital delay time. Overall, the model explained 41.0% of the variance in prehospital delay time. Clinicians need to develop intervention programs and national campaigns to increase knowledge about PAOD among patients in these high risk groups.

Chikungunya outbreak in Bueng Kan Province, Thailand, 2013.

Chikungunya outbreak in Bueng Kan Province, Thailand, 2013.

Use of the CRUSADE Bleeding Risk Score in the Prediction of Major Bleeding for Patients with Acute Coronary Syndrome Receiving Enoxaparin in Thailand

CRUSADE risk score stands out as a simple-to-use bleeding risk model. However, its use is still doubtful for Thai population. The aim of this study was to assess the prognostic value of CRUSADE in predicting risk of major bleeding among Thai patients with acute coronary syndrome (ACS) receiving enoxaparin. A retrospective cohort study was performed using patients with ACS who were hospitalised at a university hospital in Bangkok between 2006 and 2009 and had received enoxaparin. The CRUSADE risk score was calculated. The model validation was tested by using C statistic and Hosmer-Lemeshow goodness-of-fit. The overall incidence of major bleeding was 18.3%. Median CRUSADE score for entire study population, unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI), and ST elevation myocardial infarction (STEMI) were 49, 47, 53, and 39, respectively. Hosmer-Lemeshow goodness of fit revealed no statistical significance in all groups. The CRUSADE model demonstrated a satisfactory discriminatory capacity for the entire study population (C = 0.688), UA (C = 0.591), NSTEMI (C = 0.693), and STEMI groups (C = 0.736). Across the ACS spectrum, CRUSADE risk score was able to estimate in-hospital major bleeding of Thai patients with ACS who received treatment with enoxaparin. The application of these results in Thailand may be helpful in the identification of patients at high bleeding risk and also may lead to implementation of appropriate prevention.

Effects of maternal iodine supplementation during pregnancy and lactation on iodine status and neonatal thyroid-stimulating hormone.

To determine the iodine status in pregnant and lactating women, as well as neonatal thyroid-stimulating hormone (TSH) concentration. Pregnant women cared at our hospital, the University Hospital in Bangkok, had routinely received 200 μg iodine tablet daily since October 2010. Urinary iodine concentrations (UICs) of 1508 pregnant and 87 lactating women and 76 offspring and breast milk iodine concentration (BMIC) (n=57) were measured. Cord serum TSH levels from hypothyroidism screening were analyzed. Median UIC levels of pregnant and lactating women were 170.6 and 138.0 μg l(-1), respectively. Median BMIC and infants' UIC at 2-month postpartum in iodine-supplemented group were higher than the respective values of non-supplemented group. Median cord serum TSH level obtained before iodine supplementation (n=8332) was higher than that obtained after supplementation (n=5181; 7.3 vs 5.2 mU l(-1)). Maternal iodine supplementation improved iodine nutrition in their breast-fed offspring. A trend toward declining in cord serum TSH values after iodine supplementation indicates improvement of iodine status during pregnancy.

High-Value, Cost-Conscious Care

Letters15 January 2013High-Value, Cost-Conscious CareVichai Atichartakarn, MDVichai Atichartakarn, MDFrom Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-158-2-201301150-00026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:I mostly agree with Smith and colleagues' recent article (1). As a faculty member of a university hospital in Bangkok, I am aware that we are facing the same problem of skyrocketing medical care costs, which in my opinion are due mostly to us, the medical care providers. Because my colleagues and I work in a country with limited resources, it is even more crucial that we tackle this problem effectively. There are 2 parts of medical care cost: diagnostic and therapeutic. I will discuss only the first part, because I believe that it applies everywhere.To ...Reference1. Smith CD; Alliance for Academic Internal Medicine-American College of Physicians High Value. Teaching high-value, cost-conscious care to residents: the Alliance for Academic Internal Medicine-American College of Physicians Curriculum. Ann Intern Med. 2012;157:284-6. [PMID: 22777503] AbstractGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoTeaching High-Value, Cost-Conscious Care to Residents: The Alliance for Academic Internal Medicine–American College of Physicians Curriculum Cynthia D. Smith and High-Value, Cost-Conscious Care Cynthia D. Smith High-Value, Cost-Conscious Care Barry Kisloff Metrics 15 January 2013Volume 158, Issue 2Page: 143KeywordsConflicts of interestResearch laboratories ePublished: 15 January 2013 Issue Published: 15 January 2013 CopyrightCopyright © 2013 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...

Validity of two point-of-care glucometers in the diagnosis of neonatal hypoglycemia

To estimate validity of two point of care glucometers for the diagnosis of neonatal hypoglycemia and to determine the glucometers cut off values for which standard laboratory confirmatory test are no longer needed. Prospective study. A tertiary care, university hospital in Bangkok, Thailand. The study included 180 blood specimens from 166 high risk neonates aged between 1-24 hours. On average, most of the blood glucose read-outs from the Nova StatStrip and SureStep were higher than laboratory plasma glucose throughout the glucose range with mean differences (SD) of 11.2 (8.4) mg/dL and 13.7 (6.8) mg/dL, respectively. Sensitivity of Nova StatStrip and SureStep were 62% and 53.3%, respectively. Specificity and positive predictive value of both glucometers were 100%. Negative predictive values of both glucometers were approximately 85%. The cut-off levels with 100% negative predictive values were 63 mg/dL and 62 mg/dL for Nova StatStrip and SureStep, respectively. None of the glucometers in this study has sufficient validity to replace laboratory testing in diagnosing hypoglycemia. Confirmatory plasma glucose for diagnosis of hypoglycemia is needed when POC readings are between 39 and 63 mg/dL for Nova StatStrip and between 39 and 62 mg/dL for SureStep.

Thai Families’ Caring Practices for Infants with Congenital Heart Disease prior to Cardiac Surgery

This focused ethnographic study aimed at exploring how the Thai socio- cultural context influenced the perceptions and practices of Thai families caring for infants, 3 months to 17 months, with symptomatic, acyanotic or cyanotic, congenital heart disease (CHD), prior to cardiac Purposive sampling was used to recruit twelve parents and two family members, from eight families, who brought their infant with a CHD, to two university hospitals in Bangkok. Data were collected through in-depth interviews, participant observations and field notes, from September 2006 to October 2007, and analyzed through use of content analysis. Family care practices were characterized by the phrase: doing our best to get our child ready for surgery. Families understood their infants may not survive and would be difficult to care for. All the infants required pharmacological management, followed by surgery, and needed weight gain and strength to withstand and recover from Families prevented their children from getting worse, as well as managed their respective infant's care under significant constraints. Findings indicated the families' perceptions and practices were influenced by the socio-cultural contexts, which included Buddhist teachings, cultural beliefs, financial constraints, hospital services, and support from family members and significant others. The results provided health professionals with an understanding of perspectives and practices of Thai families providing care, prior to surgery, for infants with CHD, and highlighted the context-dependent nature of family care and need for new and creative ways to provide culturally congruent professional care.

Spiritual care provided by Thai nurses in intensive care units

The aim of this study was to explore how Thai nurses in intensive care units of a university hospital in Bangkok provided spiritual care to their patients. The function of nursing is to promote health, prevent illness, restore health and alleviate suffering. An holistic approach to this promotion includes spirituality. An explorative qualitative study was used. Thirty Thai nurses, selected through purposive sampling with the snowball technique, participated voluntarily. Semi-structured interviews with open-ended questions were carried out, taped-recorded, transcribed verbatim and subjected to content analysis. Five themes related to the provision of spiritual care emerged: giving mental support, facilitating religious rituals and cultural beliefs, communicating with patients and patients' families, assessing the spiritual needs of patients and showing respect and facilitating family participation in care. Several ways of improving the spiritual care were suggested by the nurses. Spirituality was an important part of the care for the nurses when meeting the needs of their patients and the patients' families. Therefore, nursing education should enhance nurses' understanding and awareness of spiritual issues and prepare them to respond to human spiritual needs. Nurses should consider spirituality as an important component of holistic care. During their professional career, they should expand their knowledge and understanding of spirituality and develop tools for assessment of spiritual needs.

Efficacy and Safety of Curcuma domestica Extracts in Patients with Knee Osteoarthritis

The objective of this study was to determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement in patients with knee osteoarthritis. The design and setting were a randomized controlled study at a university hospital in Bangkok, Thailand. One-hundred and seven (107) patients with primary knee osteoarthritis (OA) with pain score of > or =5 were randomized to receive ibuprofen 800 mg per day or C. domestica extracts 2 g per day for 6 weeks. The main outcomes were improvement in pain on level walking, pain on stairs, and functions of knee assessed by time spent during 100-m walk and going up and down a flight of stairs. The adverse events were also recorded. Fifty-two (52) and 55 patients were randomized to C. domestica extracts and ibuprofen groups, respectively. Baseline characteristics of the patients in both groups were not different. The mean scores of the aforementioned outcomes at weeks 0, 2, 4, and 6 were significantly improved when compared with the baseline values in both groups. There was no difference in those parameters between the patients receiving ibuprofen and C. domestica extracts, except pain on stairs (p = 0.016). No significant difference of adverse events between both groups was found (33.3% versus 44.2%, p = 0.36 in C. domestica extracts and ibuprofen groups, respectively). C. domestica extracts seem to be similarly efficacious and safe as ibuprofen for the treatment of knee OA.

Predictors of anxiety symptoms in the gynecological outpatient setting: The Thai experience

Objective. To examine the prevalence and predictors of anxiety in women attending a gynecological outpatient service. Method. A total of 271 women who came to a gynecological outpatient clinic at a large university hospital in Bangkok, Thailand, were asked to complete the state sub-scale of the Spielberger State-Trait Anxiety Index (STAI) and a questionnaire to obtain demographic, medical and gynecological information as well as a questionnaire to assess social support. A cutoff score of ≥ 46 on the STAI was considered to indicate the presence of moderate–severe anxiety. Result. One hundred (36.9%) subjects met criteria for anxiety. Anxious women were more likely to be young and to have had an abortion at an earlier age. They were more likely to reside in rural Thailand, report perception of low social support, present with abnormal vaginal discharge and to have a greater number of gynecological symptoms than non-anxious women. Additionally, anxious women were less likely to have knowledge about their diagnosis compared to non-anxious women. Conclusion. Clinically meaningful levels of anxiety are common among women attending an outpatient gynecological clinic. Awareness of risk factors for anxiety in these women will aid medical personnel in identifying those in need of additional support and/or mental health services.

Increased alanine aminotransferase level and future risk of type 2 diabetes and impaired fasting glucose among the employees in a university hospital in Thailand

Aim The purpose of this study was to determine the association between baseline alanine aminotransferase (ALT) levels, and future risk of impaired fasting glucose and type 2 diabetes among the employees of a university hospital in Bangkok, Thailand. Methods Totally, 2370 and 1619 workers without diabetes and impaired fasting glucose (IFG) at baseline, respectively, who were 35 years or older were followed during 2001–2005. Diagnosis of IFG and type 2 diabetes was based on the fasting plasma glucose levels of 100–125 and greater or equal to 126 mg/dl, respectively. Results Higher baseline ALT levels were associated with future diabetes risk in an obvious dose-response manner (the OR [95% CI] for the groups with baseline ALT of 17–22, 23–38, and greater than 38 mg/dl comparing to the group with baseline ALT of 1–16 mg/dl were 4.75 [1.25–18.10], 6.14 [1.54–24.45], and 7.19 [1.32–39.16], respectively). Magnitude of association were even higher among those with existing IFG at baseline. The association patterns were consistent for both genders. Concerning the IFG risk, while those who developed IFG had significantly higher baseline ALT levels than those who remained normal at the end of follow-up period, further analyses did not show that baseline ALT was significantly associated with future IFG risk. Conclusion Present study provided supporting evidence from a cohort of Asian subjects about the ALT and future type 2 diabetes risk.

Clinical Presentations of Newly Diagnosed HIV-Infected Patients at a University Hospital in Bangkok, Thailand

Epidemiology and clinical features of newly diagnosed HIV-infected patients vary and depend on period of time and geographical area. A retrospective review was conducted in adults with positive HIV antibody testing between January and December 2006 at a university hospital setting. Prevalence of HIV infection was 1.0%. There were 221 patients with a median age of 35.5 (range, 15.8-72.3) years, and 57% were males. The most common risk of HIV acquisition was heterosexual (63.8%). The most common reason for HIV testing was preoperative screening (41.2%). Of all, 52.9%, 37.1%, and 10% were diagnosed as AIDS, asymptomatic, and symptomatic patients, respectively. Median CD4 count at HIV diagnosis was 260 (range, 6-1284) cells/mm(3). AIDS-defining illnesses were found in 35.7%. Overall mortality rate was 1.8%. More than half of newly diagnosed HIV-infected patients have advanced HIV disease and are unaware of their HIV status. These results reflect inadequate education of HIV risks and voluntary HIV testing in Thailand.

Randomized Controlled Trial and Meta-analysis of Oral Decontamination with 2% Chlorhexidine Solution for the Prevention of Ventilator-Associated Pneumonia

To determine the effectiveness of oral decontamination with 2% chlorhexidine solution for the prevention of ventilator-associated pneumonia (VAP). Randomized controlled trial and meta-analysis. A tertiary care university hospital in Bangkok, Thailand. Adult patients who received mechanical ventilation and who were hospitalized in intensive care units and general medical wards. The patients were randomized to receive oral decontamination with 2% chlorhexidine solution or normal saline solution 4 times per day until their endotracheal tubes were removed. The outcome measures were the development of VAP and oropharyngeal colonization with gram-negative bacilli. Meta-analysis was performed by combining the results of the present study with those from another randomized controlled trial that also used a 2% chlorhexidine formulation for oral decontamination. The characteristics of the patients in the chlorhexidine group (n=102) and the normal saline group (n=105) were not significantly different. The incidence of VAP in the chlorhexidine group was 4.9% (5 of 102), and the incidence in the normal saline group was 11.4% (12 of 105) (P=.08). The rate of VAP in the chlorhexidine group was 7 episodes per 1,000 ventilator-days, and the rate in the normal saline group was 21 episodes per 1,000 ventilator-days (P=.04). Irritation of the oral mucosa was observed in 10 (9.8%) of the patients in the chlorhexidine group and in 1 (0.9%) of the patients in the normal saline group (P=.001). Oropharyngeal colonization with gram-negative bacilli was either reduced or delayed in the chlorhexidine group. Overall mortality of the patients did not differ significantly between the groups. Meta-analysis of 2 randomized controlled trials revealed an overall relative risk of VAP for patients in the chlorhexidine group of 0.53 (95% confidence interval, 0.31-0.90; P=.02). Oral decontamination with 2% chlorhexidine solution is an effective and safe method for preventing VAP in patients who receive mechanical ventilation.

Incidence and predictors of abnormal fasting plasma glucose among the university hospital employees in Thailand

The purposes of this study were to determine the incidence rates and predictors of type 2 diabetes and impaired fasting plasma glucose (IFG) among the employees of a university hospital in Bangkok, Thailand. Totally 2370 and 1619 workers without diabetes and IFG at baseline, respectively, who were +35 years old were followed up during 2001–2005. Type 2 diabetes incidence rates (95% CI) were 13.6 (8.4–22.3) and 6.4 (4.5–9.1) per 1000 PYs, respectively, for men and women, while those of the IFG were 37.8 (26.3–54.4) and 23.6 (19.3–29.0) per 1000 PYs, respectively, for both genders. Baseline FBS predicted future IFG risk even at the levels as low as 63–70 mg/dl. The OR (95% CI) of IFG for those with baseline FPG of 63–70, 71–80, and >80 mg/dl—compared to those with baseline FPG ≤62 mg/dl—were 2.51 (1.12–5.64), 5.39 (2.51–11.56), and 8.30 (3.67–18.75), respectively. Future diabetes risk was observed only in those with baseline FPG of 96 mg/dl or higher, with the OR (95% CI) of 6.0 (2.29–15.75). In conclusion, baseline FPG even at the level as low as 63–70 mg/dl predicts future IFG risk among a hospital employee group in Thailand, while increased diabetes risk was found only in those at the FBS level of ≥96 mg/dl.

A Bedside Prediction-Scoring Model for Late-Onset Neonatal Sepsis

Insufficient tools for bedside prediction of late-onset neonatal sepsis (LNS) initiated this study. The objective was to develop and validate a simple prediction-scoring model for LNS defined as culture-proven sepsis occurring 72 hours after birth. The study was performed at a university hospital in Bangkok. The derivation phase included medical records of 1870 neonates, randomly selected from 9347 records of neonates who had been hospitalized for >72 hours during 1998 to 2000, of which 1824 records were available. In all, 100 neonates were clinically suspected of sepsis and 17 had proven LNS. The validation phase included 73 neonates suspected of having sepsis during July 2002 to June 2003 and 25 who had LNS. Weighted coefficients from Cox's proportional hazards model and receiver-operating-characteristic (ROC) curve analysis were used. The incidence density of LNS was 17/11355 (1.5/1000) person-days. A scoring model was developed and consisted of the following: hypotension (score 4), abnormal body temperature (score 3), respiratory insufficiency (score 2), neutrophil band form fraction >1% (score 2), platelet count <150 x 10(3)/microl (score 2), and umbilical venous catheterization (1 to 7 or >7 days; score 2 or 4). The area under the ROC curves for prediction of LNS in a neonate suspected of sepsis in each of the two phases was 0.85 and 0.80, respectively (p=0.436). The mean probabilities of LNS were approximately 0.10 (low risk) for scores from 0 to 3; 0.50 (intermediate risk) for scores from 4 to 6; and 0.70 (high risk) for scores > or =7. A simple prediction-scoring model for LNS was developed. Validation of the scores suggested good diagnostic performance.

Impact of an Educational Program on Antibiotic Use in a Tertiary Care Hospital in a Developing Country

A multi-cross-sectional study was conducted in a 2000-bed tertiary care university hospital in Bangkok, Thailand, from September 1993 to May 1994 to assess the effectiveness of an educational program on the use of antibiotics. Data on the study covered antibiotic usage both in-patients and out-patients. Data were collected for a 24-hour period every 2 weeks for 7 days for each 3-month period. The target population were residents, general practitioners, and sixth-year medical students. The educational program provided information derived from the data of inappropriate use of antibiotics during the pre-intervention period and guidelines on the use of antibiotics which were agreed to by a concensus among the faculty in all clinical departments. The study revealed: (1) the prevalence of antibiotic use and the cost of antibiotics during post-intervention period was significantly decreased by 20%; (2) the use of antibiotic prophylaxis for obstetrics patients and patients undergoing cataract surgery decreased significantly; (3) there was a shift from second or third generation cephalosporins to cefazolin for surgical prophylaxis; (4) the duration of perioperative antibiotic prophylaxis was reduced to under 2 days; (5) there was a shift from netilmicin or amikacin to gentamicin for the treatment of community acquired infection; and (6) the mortality, median length of hospital stay, and nosocomial infection rate among the patients who received antibiotics during the post-intervention period were not significantly different from those during the pre-intervention period. These results suggest that this educational program comprising information feedback and antibiotic usage guidelines was effective in improving antibiotic use at this tertiary care university hospital in Thailand.

Clinical and immunological features of human immunodeficiency virus infection in patients from Bangkok, Thailand.

To assess the association between the CD4 count and clinical diseases in a cohort of Thai patients. In all, 1902 patients who presented with human immunodeficiency virus (HIV) infection at the Chulalongkorn University Hospital in Bangkok were investigated. At the time of presentation 295 (15.5%) patients had acquired immunodeficiency syndrome (AIDS) and there was a highly significant tendency for lower CD4 counts in this group (median 67/mm3) than in patients free of AIDS (median 369/mm3). A total of 757 patients had data available on follow-up and were free of AIDS at the first visit. During a median follow-up of 0.9 years, 110 developed AIDS or AIDS-related death (12.2/100 person years). Subjects with CD4 count < 200/mm3 at initial visit showed over a ninefold increase in risk of developing AIDS compared to subjects with levels > or = 500/mm3 (relative risk [RR] = 9.1; 95% CI: 5.4-16.0). The rate/100 person years was 47.1 compared with 6.0 in subjects with levels > or = 500/mm3. After adjusting for initial CD4 count, homosexual men showed over a twofold increase in risk of developing AIDS compared to heterosexuals (RR = 2.4; 95% CI: 1.6-4.4) and intravenous drug users (IVDU) showed nearly a twofold increase (RR = 1.8; 95% CI: 0.9-3.9). The increased risk in homosexual men persisted even after further adjustment for clinical stage (RR = 2.2; 95% CI: 1.3-3.7) but the increased risk in IVDU was attenuated (RR = 1.5; 95% CI: 0.7-3.2) although it remained increased albeit non-significantly. Men tended to progress faster to AIDS than women but the difference was not significant. However, the faster progression in homosexual men was seen even when compared to heterosexual men only. The rate of progression of AIDS according to CD4 count group at baseline in this Thai cohort is broadly comparable with Western cohorts. It appears that heterosexuals in Thailand show slower progression to AIDS than homosexual men.

Review: collected materials and records of HIV/AIDS prevalence and the contemporary social changes in Thailand.

The first AIDS case in Thailand was reported in 1984: a bisexual 28-year-old male who had been in the US. By 1989 about 40% of brothel prostitutes in northern Thailand were HIV infected. HIV infection since spread rapidly into the general population. The National Blood Center of the Thai Red Cross Society began screening donated blood for HIV in 1986. As of May 31 1994 there were 7457 cumulative AIDS cases. Some key factors of the sociocultural background in Thailand that facilitated the HIV/AIDS epidemic included the lack of a compulsory and common system to control behavior focus on individual rather than community rapid economic development during 1970-1989 high rate of population migration from rural areas to Bangkok international tourism and the concurrent development of the sex industry intravenous drug use and acceptability of prostitution as an occupation among peasants in the north. Since 1989 a serosurvey of 21-year-old conscripts is conducted twice a year. The HIV infection rate is consistently higher among conscripts from northern Thailand. Around 50% of new HIV cases are women. HIV is spreading to their infants. Thailand has two HIV-1 subtypes distinct from those found in other regions of the world. During 1993-1994 at an AIDS clinic of Chulalongkorn University Hospital in Bangkok most patients (86%) acquired HIV infection through heterosexual intercourse. 47% had clinical AIDS. The most common symptoms were oral lesions and generalized lymphadenopathy. A study of all blood donors at a public hospital in Bangkok found a rate of window-period donors of 23.6/100000 donors. AIDS vaccines will be field tested in Thailand in 1995. The Japan International Cooperation Agency is working with the Thai government to prevent and control HIV/AIDS.

Perception of pain and management in a hospital in I hailantl.

After winning the American Medical International Nurse Scholarship Award in 1990, the author went to the Chulalongkorn University Hospital in Bangkok to study how the nurses in the surgical intensive care unit manage patients in acute pain.