Vajira Medical Journal: Journal of Urban Medicine

371-380

Authors: Jutartip Koonsiripaiboon, Supapan Tantracheewathorn

Background: The advanced neonatal care improved survival of preterm and very low birth weight (VLBW) infants. However, complications of prematurity increased especially osteopenia of prematurity which caused long-term effects to these infants. Objective: To determine prevalence and risk factors of osteopenia of prematurity in VLBW infants. Methods: Retrospective descriptive study was conducted at Vajira Hospital. Medical records and x-rays of infants, whose birth weight was less than 1,500 grams and admitted more than 8 weeks from January 2014 to May 2019, were reviewed. Results: Eighty VLBW infants were enrolled. Prevalenceofosteopeniaof prematurity in VLBW infants was 12.5%. Factors associated with osteopenia of prematurity were long duration of nothing per oral, long duration to full enteral feeding, necrotizing enterocolitis (NEC), duration of total parenteral nutrition, duration of use medication (furosemide, aminophylline) and length of hospital stay. After using logistic regression analysis, only three factors including NPO time, duration tofull enteral feeding and the presenceof NEC were significant. The presenceof NEC was the most related risk factor (OR12.40, 95% CI 1.81-84.77). Infants withosteopenia received less energy, calcium and phosphorus than those without osteopenia. Conclusions: The prevalence of osteopenia of prematurity in VLBW infants at Faculty of Medicine Vajira Hospital was 12.5%. Factors associated with osteopenia of prematurity were long duration of nothing per oral, long duration to full enteral feeding and presence of NEC.

389-396

Authors: Kanokpan Ngammuk, Konlawij Trongtrakul, Areeya Jirathananuwat

Sepsis is one of the major cause of mortality for critically ill patients. Therefore, nursing competencies are imperative to keep patients’ safety and decrease loss of organs, including to further survival. Objective: To compare nursing competencies before and after based on nursing practice guideline for sepsis patients. Methods: This study was a one group quasi-experimental research on 20 registered nurses who worked at surgical intensive care unit in November 1, 2018 to January 31, 2019. The guideline was conducted through research utilization consisted of three steps. Initially, to determine an appropriate nursing practice guideline and patient sepsis assessment by using qSOFA and SOFA score. Secondly, to implement three period of interventions resulting to an organs failure assessment based various scenarios. Lastly, to evaluate the scores difference before and after development of nursing practice guideline. Data were analyzed by frequencies, percentages, means, and standard deviations. Comparative analysis of means scores using Repeated Measure ANOVA was also applied to the study. Results: The average age of 20 registered nurses were 28.1 years. Most of them were females and single with average 6.0 years of work experience. The score after using nursing practice guideline for critical sepsis patients revealed significantly higher scores as compared before the guideline were developed at p-value less than 0.001. Conclusion: Nursing practice guideline and patient sepsis assessment could influence the increment of competencies among registered nurses in simulation situation. However, these guidelines should be used in practical work, evaluated and monitored continuously including application to another intensive care unit. Consequently, the guideline for critical sepsis will stay in similar direction.

411-418

Authors: Vimon Yanpanich, Chatnapa Duangdee, Jittima Kunsombat

Objective: This study aims to assess the quality control performance in clinical chemistry using sigma metrics and to compare sigma metrics after quality control improvements. Methods: This study collected %CV data from IQC and % Bias from the EQA results derived from performance evaluation using sigma metrics. The obtained data were used to identify the cause for tests with low-sigma metrics and to improve quality. All results were used to conduct comparative studies. Results: Twenty-five tests were used to improve the quality control using the sigma metrics. It was discovered that 19 tests before the quality control improvements were included in the world class performance (≥ 6-sigma) and excellent performance (≥ 5-sigma) criteria which can be used in the rules of 13s, (N = 2, R = 1) and 13s/22s, /R4s (N =2, R=1) respectively. After quality control improvement, tests with the world class and excellent performance was increased to 22 included; glucose, creatinine, uric acid, cholesterol, triglyceride, HDL, LDL, total protein, AST, ALT, ALP, CPK, LDH, amylase, GGT, magnesium, BUN, albumin, total bilirubin, calcium, phosphorous and potassium. There was only 1 test with <4-sigma, chloride, that was applied the maximum QC 13s / 2 of 32s / R4s / 31s / 8x (N = 2, R = 4) Conclusion: The Cobas 6000 automatic analyzer (model C501) at the Clinical Chemistry Laboratory of Tropical Medicine Hospital has an excellent diagnostic performance with a high level of six-sigma which makes it possible to choose the suitable quality control rules for testing programs. Beneficially, six-sigma provides cost saving, convenience, and easy to apply. Moreover, using sigma matric helped to reduce the clinical testing workload. However, laboratory worker must follow the all test items. In addition, the training program recognizing of six-sigma is important. Therefore, staff should have knowledge and competence to select quality control rules and interpret the control result.

313-324

Authors: Somkiat Wongsuriyanan, Kitiporn Sriamornrattanakul

Objective: To describe and evaluate the patency rate of superficial temporal artery-middle cerebral artery (STA-MCA) bypass for treatment of patients with cerebrovascular diseases and brain tumors at Vajira Hospital. Methods: This was a retrospective descriptive study in patients with cerebrovascular diseases and brain tumors who received STA-MCA bypass at Faculty of Medicine Vajira Hospital between May 2015 and September 2019. Type of diseases, bypass techniques (single or double bypass) and bypass patency were collected from medical records. The surgical techniques and one illustrative case were also described. Results: Thirty-three patients received STA-MCA bypass for 37 operations and 55 anastomoses. Operations with single bypass and double bypass were 51.4 and 48.6%, respectively. The most common indication for STA-MCA bypass was intracranial aneurysms (37.8%). Patency rate were 94.6% and 92.7% for number of operations and anastomoses respectively. For single bypass, patency rate was 89.5%. In cases of double bypass, patency rate were 100% and 94.4% for number of operations and anastomoses respectively. Conclusion: With our knowledge, this study is the research that report the highest number of STA-MCA bypass procedure and is the first issue to study the patency rate of STA-MCA bypass in Thailand. STA-MCA bypass has a high patency rate in immediate period (within 48 hours) after surgery, especially for double bypass.

333-344

Authors: Chitima Kulchanarat, Kornanong Yuenyongchaiwat

Objective: Heart failure has been associated with sarcopenia; however, no systematic review was reported regarding the prevalence and the association of sarcopenia in heart failure. Therefore, the study aimed to systematically review the prevalence and factors associated with sarcopenia in heart failure. Methods: The literature searched on both international databases e.g., The Cochrane Library, Science Direct, PubMed and Scopus from 2007 to October 2019 in English language journals. The inclusion criteria were cross sectional study or cohort studies. Participants were 18 years and older who had diagnosed heart failure and sarcopenia. Kappa score was used to measure the agreement of two independent reviewers and National institute of health was used to test the quality assessment of observational cohort and cross-sectional studies. Results: A total of 258 studies, six studies were included in this review. A total number of the participants was 1,936. Most of the participants were > 65 years old (66.7%). The prevalence of sarcopenia in heart failure was 19.5%-36%. Age, male gender, lower body mass index and low physical activity were associated with sarcopenia in heart failure patients. Conclusion: The high prevalence of sarcopenia was observed in patients with heart failure. However, gender, age, body mass index and physical activity were associated with sarcopenia.

357-364

Authors: Piyawadee Ngamdee, Wongpun Limpaseni, Petch Rawdaree

Objective: The purpose of this research is to study elderly health promotion methods, assessed health promotion programs and recommend action plan of elderly club to the relevant department. Study design: Descriptive research Methods: We assess the health promotion model of the elderly club by using the CIPP model. Data were collected from 3 specific study groups that participated in the activities through interviews and questionnaires. The 3 specific study groups consist of 11 Rewadee zone 1 elderly club committee members, 60 elderly people and 56 elderly relatives. Results: The health promotion of the elderly club is assessed in 4 aspects, namely context, input, process and productivity. In context aspect, the objective of establishing an elderly club is suitable for problems and needs in the community. The elderly and people in community have a place to exercise and have the most expectation in health. In input aspect, the health promotion of the elderly has supporting factors such as knowledgeable personnel, sufficient budget and equipment. The committee structure is clear as according to the regulations of the elderly association of Thailand. In terms of processes, the most of activities of elderly club set by the public health center 4, Nonthaburi municipality are distributed thoroughly and on time. In productivity aspect, the elderly who participated in the activities are able to perform daily activities better, good quality of life without financial problems and are satisfied with club. The elderly club has 3 main activities, including social activities, health activities and activities for public benefit. Conclusions: the elderly club are clearly useful in terms of promoting elderly health. The government should support the establishment of elderly club in the community to proceed continuously and efferently.

235-242

Authors: Basmon Manomaipiboon, Surin Assawawitoontip, Sudsri Kokaewichain, Bhorn-ake Manasvanich

Introduction: Advance care planning should ideally be discussed with every geriatric patient in the ambulatory settings. However, only a small percentage of geriatric patients have had the discussion with their providers. We hypothesized that an educational video intervention would better promote interest compared to verbal advice alone. Objectives: To compare the levels of interest in advance care planning between the educational video interventional group and the control group at the geriatric clinic. Methods: Older adults aged 60 years and older who visited the clinic between November and December 2018 were enrolled and randomized into 2 groups. The intervention group was shown an 8-min video with verbal advice while the control group received standardized verbal advice. Participants were administered a Likert scale questionnaire after the intervention. The primary outcome was the proportion of participants who expressed interests in completing an advance directive. Results: Of the 110 enrolled participants [55 in intervention group and 55 in controls: mean age was 67 years, and most of them were female (83%)]. There was no difference in the baseline characteristics between the two groups including age, sex, education, marital status, income, and health status. Ninety eight percent of the participants in video group expressed interests to complete an advance care plan, whereas only 67% of the control group did (P<0.001). Conclusion: An educational video significantly increased awareness and interests among geriatric clinic patients compared to verbal education alone.

255-262

Authors: Nut Boontawan, Wanjak Pongsittisak

Background: Chronic kidney disease (CKD) is a major public health problem worldwide, particularly in Thailand. Several studies have recommended limiting protein and sodium intake with the benefit of delaying kidney deterioration. Hence, dietary counseling is recommended for CKD patients. We aimed to explore and compare the effects of intensive dietary counseling (In-counseling) and standard dietary counseling (Sd-counselling) for controlling protein and sodium intake. Methods: The present study was an open-labeled randomized control trial. The participants were stage III – IV CKD patients who were stable on their current treatment. The Id-counseling group received 30-minute monthly lessons with advice on dietary intake. The Sd-counseling group received the usual standard of care. The outcomes were daily protein intake (DPI) and 24-hour urinary sodium (UNa) at two months. Results: Twenty CKD patients were divided into two groups of 10 participants each. Baseline characteristics were similar in both groups, except there were more CKD stage 4 patients in Sd-counselling group (3 vs 1 participant). The three most common comorbidities were hypertension (80%), dyslipidemia (70%) and diabetes mellitus (50%). Baseline DPI and 24-hour UNa were similar in both groups. After 2 months, the DPI of the In-counseling group achieved greater target-control than Sd-counseling. There was a trend to decrease 24-hour UNa between before and after counseling in In-counseling group. However, the DPI and 24-hour UNa at the end of the study was not statistically significant. Conclusion: Although our study did not show significant benefit from In-counselling, it might be due to a small sample size and short time period. There was, however, some trend showing a benefit of In-counselling. A larger scale randomized controlled trial should be conducted to explore this benefit.

275-286

Authors: Chantaka Supiyaphun, Puncharut Preechaharn

Objective: To determine knowledge and behavior of contact lens wear in medical students and medical residents in Vajira hospital. Methods: A cross-sectional study using questionnaire was conducted among medical students and medical residents who wore contact lenses within the recent one year in Vajira hospital. Results: A total of 660 (480 of medical students and 180 of residents) were recruited in this study. Twenty-four percent in medical student group and 17% in resident group wore contact lens in recent one year. The majority was female in both groups (79.3% and 80.6%, respectively). The average age was 21.4 years in medical student group and 27.8 years in resident group. The main reason for wearing contact lens is visual correction (67.3%). Approximately sixty percent in both groups wore monthly soft contact lens following by daily disposable lens (43.5%). Six improper contact lens compliance and care practices were reported as sleeping with their lens (22.6%), swimming with lens (26.5%), topping off lens storage solution (20.0%), not cleaning lens case daily (57.7%), prolonged wear over replacing schedule (18.4%) and no rubbing and rinsing (33.7%). Seventy-three percent in medical student group and 48.4% in residency group were classified as good behavior. The prevalence of good contact lens behavior in medical students were significantly higher than that of medical resident (p=0.013). However, the majority of participants in both groups were categorized in good knowledge (p=0.297). In all participants, we found statistical significant different between behavior and knowledge (p=0.001) Conclusion: The majority of participants in both groups have good knowledge. However, medical student group has better behavior in contact lens wear and care compare with medical resident group.

297-310

Authors: Chanika Maenchantrarath, Daranee Nutalai, Worada Samosornsuk, Prirayapak Sakoonwatanyoo

Objective: This research aimed to identify the yeasts from the clinical specimens by comparing MALDI-TOF MS using extended direct transfer technique (EDT-MALDI) and the conventional method. Methods: This study was a retrospective cohort. The samples were the 557 yeasts isolated from the clinical specimens in the Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand by comparing between the EDT-MALDI and the conventional method. The data were analyzed by using McNemar Test. Moreover, the unit cost and the turnaround time of the both methods were calculated. The other data such as age, sex, wards, types of the specimens and the prevalence of the species of yeasts, were collected and analyzed. Results: The result showed that the EDT-MALDI can identify the yeast isolates into the species level more accurately than the conventional method at 100% and 93.2%, respectively. The conventional method was limited for correctly identification of Trichosporon asahii, Cryptococcus neoformans, some non-albicans Candida, Magnusiomyces capitatus, and Candida rugosa. However, both methods were not significantly different from each other. Even though the threshold score of the EDT-MALDI was reduced from ≥ 2 to ≥ 1.7, this will increase the acceptable results without effect to specificity, accuracy, and reliability in the species level. The EDT-MALDI was faster than the conventional method for at least 24 hours. Moreover, the unit cost of EDT-MALDI is lower than the conventional method (68 baht/test and 116 baht/test, respectively). In this data, the elderly female admitted to the hospital were the most patients who found yeast in specimens. Candida albicans (54.04%) were the most isolated species, followed by Candida tropicalis (26.21%). Conclusion: The EDT-MALDI was a suitable method for the yeast identification in the routine laboratory because it was provided a shorter time of analysis, obtained reliable results and less expensive unit cost.

165-172

Authors: Thunwipa Tuscharoenporn, Pahsuvudn Kongsin, Busaba Supawatttanabodee, Piyasak Vitayaburananont

Objective: To determine the effectiveness of 400-mg celecoxib after elective cesarean delivery. Methods: In this randomized double blinded controlled trial, 110 full-term pregnant women aged between 20-40 years old who were scheduled for elective cesarean delivery between May 2018 and November 2018 were enrolled. A total of 110 participants were randomly assigned equally into 2 groups to receive celecoxib or placebo. All patients from both groups received meperidine under PCA after operation. Pain score was measured 3 times with 2 different states: 6, 12 and 24 hour at rest and upon movement. Results: The overall pain score in each time point between PCA meperidine plus celecoxib and PCA meperidine plus placebo was significantly different (p-value = 0.004). The use of meperidine at 24 hours in the group of PCA meperidine plus celecoxib was not significantly different from the group of PCA meperidine plus placebo (p-value =0.058) Conclusion: Celecoxib could relieve post-operative pain after cesarean delivery statistic significantly.

181-192

Authors: Mason Porramatikul, Thiti Meeopartmongkon, Boonsakdi Lorpipatana, Chalerm Chaiwatcharaporn, Tossaporn Yimlamai

Objective: To compare the peak force and vibration at tennis racket grip between different dampers and different tennis ball impact locations. Methods: The peak force and vibration was measured at tennis rackets grips between 4 different damping conditions which were no damper, button damper, rubber band damper and worm damper. Tennis balls were served using a tennis strike-simulating machine with speed 32m/s. The peak force were recorded from a wireless force transducer attached to the grip during four locations on string bed: center, above center, below center, and off-axis. Vibration was calculated form time domian using Fourier transform. Results: At a below center impact location, the button damper yielded a 10% reduction in some harmonic of the racket’s vibration from 191.7 ± 2.6 Hz to 172.9 ± 2.8 Hz (p =0.001), the rubber band damper yielded a 8% reduction from 191.7 ± 2.6 Hz to 176.8 ± 4.4 Hz (p = 0.005), whereas the worm damper yielded a 7% reduction from 191.7 ± 2.6 Hz to 178.8 ± 3.8 Hz (p = 0.011). No significant effect of damper types on the vibration with the others impacts location. These dampers did not reduce the impact force at the grip regardless of the location. Conclusion: Damper reduced the racket’s vibration when the ball impacts a below center position.

205-212

Authors: Sirichan Chunhakan, Prirayapak Sakoonwatanyoo, Jedniphat Intrapongpan, Chavit Pryngam, Pootipong Wongveerasin, Monai Kanchanasinith, Sitthisak Phupungtamakoon, Suwansingh Chawla, Akkasil Pinchumponsang

Objective: To comparison of knowledge regarding vitamin D in non-healthcare personnel of Faculty of Medicine Vajira Hospital, Navamindradhiraj University between the lecture-based group and the edutainment with lecture group. Methods: This quasi-experimental research collected data from 39 non-healthcare personnel of the Faculty of Medicine, Vajira Hospital (male 6 persons, female 33 persons). They were divided into two groups: one group was provided lecture knowledge only and another group was provided knowledge in a lecture style combined with edutainment. The questionnaire was used to study knowledge about vitamin D before entering and after joining the activity. Results: The mean score before and after giving knowledge of the lecture-based group was 5.71 and 7.41 respectively, while the average score before and after giving knowledge of the edutainment with lecture group was 5.86 and 7.68 respectively. We found that both knowledge scores before and after giving knowledge were not statistically significantly different between the lecture-based group and the edutainment with lecture group (p = 0.777 and p = 0.586, respectively). While the post-knowledge scores were significantly higher than before giving knowledge in both groups (p = 0.002 and p <0.001, respectively). Conclusion: Both forms of education were successful. On the other hand, edutainment combined with lectures did not help to increase the knowledge of volunteers over the lecture alone. Therefore, lectures could be done alone for providing knowledge to save time and budget.

223-234

Authors: Thaunyapa Iniana, Wongpun Limpaseni

Objectives: 1) To study the management process of stalls and the market operation in Bang Khae District 2) To study problems and obstacles in managing the stalls by Bangkok Metropolitan Administration 3) To present the development guidelines for stalls in Bangkok in the future. Methods: The study employed questionaires by stakeholders including 6 Ban khae District officers. 83 hawkers from temporary stalls in front of outbound Bang Khae market, 65 traders in the Bang Khae shopping center market, Bang Khae New Market and Saeng Fah Ha Pae Market, as well as 35 shoppers and pedestrians. Results: It was found that stall traders were willing to move to locations provided by the Bangkok Metropolitan Administration because there was only a moderate fee and there were few other choices. The motivation was there were markets that can accommodate stall traders and they were legal stalls. The driving force were buyers support the relocation of the stalls and the city prohibited roadside stalls. Resistance were traders were attached to the old location, the prohibition of stalls was not enforced strictly and traders were looking for support from local politicians. The suggestion is there should be a firm policy to prohibit roadside stalls since traders already had alternative locations. If relocation of roadside stalls into the market is successful, it will be a case study for other areas. Supporting measures by the government may include initial capital with cheap interest rate, charging no rental fee but only water and electricity. Conclusion: It can be concluded that it is highly feasible to relocate the stalls to a proper location provided by the city.

85-96

Authors: Athaphon Kerdaunsuksri, Puritat Sangtongpanichakull

Objective: This research determined the foundations of personal and social support factors associated with self - care behaviors of older adults in the elderly club at Ratchaphiphat Hospital, Medical Service Department of the Bangkok Metropolitan Administration, Bangkok, Thailand. Methods: A Cross - sectional study design was conducted in 247 elderly person from March 1, 2017 to July 28, 2017. Data were collected by interview. The instrument was the questionnaire was developed by the researcher that qualified by the expertise improving content validity and reliability was test by using Cronbachs’alpha coefficients was more confidence 0.70 consists of 3 parts (general characteristics, social support factors and self-care behavior of people). Descriptive statistics were applied to describe general characteristics and point biserial correlation coefficient. Results: Research result was summarized among 247 persons who were in the elderly club, Ratchaphiphat Hospital as follows: General characteristics: Three - fourths of the participants were female 175 women (70.9%), aged between 70-75 years were 65 persons (26.6%), 165 persons (66.8%) had underlying diseases, marital status was 132 persons (53.2%), the elementary graduated were the common education level [89 persons (36.6%)], there were 150 persons (62%) had no occupation, most of them earn 1,001-5,000 baht per month were 65 persons (41.4%) Social support factors: The social support factors of the participants was related to the elderly self-care behaviors that was statistically significant of <0.01. Self-care behaviors: The self-care behaviors were high level at X = 4.08 SD±0.601 Conclusion: The Factors were statistically significant difference in personal factors, social support factors, and self-care behaviors of the participants including disease factor which correlated to positive self-care behaviors at a moderate level.

109-116

Authors: Vasin Chotivanich, Pinyaphan Putkham

Background: Vitamin D is important in the absorption of calcium in the gastrointestinal tract. It plays role in promoting the accumulation of calcium in the bones and muscles. Major resources of vitamin D are in the diet, such as liver, fish, salmon, and eel. Vitamin D-synthesis through the skin is activated by sunlight. Even though Thailand is located near the equator, between latitudes 5 ° 40 ‘N - 20 ° 30’ N sunlight, there is a report about the situation of vitamin D deficiency in the country. NCCN recommended that patients receiving aromatase inhibitors get vitamin D and calcium supplements. These results provided the data of vitamin D and calcium levels in Thai postmenopausal patients. The prescription for vitamin D and calcium supplements should be given. in those patients who received aromatase inhibitor. Objective: To study the prevalence of vitamin D deficiency and calcium in postmenopausal women in the urban areas. Methods: A cross-sectional, descriptive study was conducted in the postmenopausal patients without underlying diseases related to gastrointestinal absorption in Vajira Hospital. The information about the underlying disease, age, sex, menopausal period, serum calcium, and serum 25 – hydroxyvitamin D was collected and analyzed by statistical software (SPSS version 18). Outcome: Postmenopausal women according to the National Comprehensive Cancer Network criteria in the urban areas have a low level of serum calcium and serum 25-hydroxyvitamin D. The supplements of Vitamin D and calcium in these patients are necessary. Results: 107 cases of postmenopausal women were recruited. They are postmenopausal women aged 52-90 years old. The mean serum 25 –hydroxyvitamin D level among the postmenopausal women was 17.05 ng/mL and mean serum calcium level was 8.4 mg/dL. The prevalence of vitamin D deficiency and calcium deficiency in postmenopausal women was 93 percent and 63 percent, respectively. Conclusion: There is a high prevalence of vitamin D deficiency and calcium deficiency among postmenopausal urban women. This study supports the guideline of the National Comprehensive Cancer Network to supplement calcium and vitamin D for all patients who received aromatase inhibitor.

125-132

Authors: Piyasak Vitayaburananont, Pruchwilai Nuchpramool

Objectives: To assess level of pain intensity (Numerical Rating Scale) in patients who underwent elective general surgery, colorectal surgery, urological surgery, ENT surgery, plastic surgery and orthopedic surgery at recovery room, arrival to ward, 4th, 8th, 16th, 32nd and 48th hour post-operatively using pre-printed post-operative pain order prescribed by surgeon. Secondary outcome is to study the incidence of serious adverse events after administering opioid such as deep sedation (Sedation Score=3) or respiratory depression (Respiratory rate <10/min) during using this pre-printed post-operative pain order protocol. Study design: Descriptive study Subject: Data was obtained during January to March, 2017 with sample size of 370 patients. Methods: Personal and clinical information, types of surgery, anesthetic techniques and pain score at recovery room, arrival to ward, 4th, 8th, 16th, 32nd and 48th hour post-operatively were collected for analysis. Using descriptive statistics such as frequency, percentage, mean and standard deviation. Main outcome measures : Pain score at various time interval during 48 hours post-operative period. Results : From 370 participants, 187 male patients (50.54%), median age was 54.3 ±14.82 years and 183 female patients (49.46%), median age was 55.5 ±14.96 years. Patients’ mean pain score at recovery room was 3.94 ±4.31, arrival to ward was 3.06 ±2.89, 4th hour post-operatively was 3.03 ±2.62, 8th hour post-operatively was 3.11 ±2.50, 16th hour post-operatively was 2.58 ±2.28, 24th hour post-operatively was 2.31 ±2.12, 32nd hour post-operatively was 1.89 ±2.10 and 48th hour post-operatively was 1.25 ±1.61 respectively. And during this study we found no incidence of serious complications regarding using opioid such as deep sedation or respiratory depression. Conclusion : Patients who were prescribed post-operative pain order using pre-printed order by surgeon for elective general surgery, colorectal surgery, urological surgery, ENT surgery, plastic surgery and orthopedic surgery had mean pain score at recovery room 3.94 ±4.31, arrival to ward 3.06 ±2.89, 4th hour post-operatively 3.03 ±2.62, 8th hour post-operatively 3.11 ±2.50, 16th hour post-operatively 2.58 ±2.28, 24th hour post-operatively 2.31 ±2.12, 32nd hour post-operatively 1.89 ±2.10 and 48th hour post-operatively 1.25 ±1.61 respectively. And we found no incidence of serious complications regarding opioid administration for pain relief. Thus we support the usage of pre-printed post-operative pain order prescribed by surgeon in the hospital.

145-158

Authors: Nithikoon Aksorn, Ittisak Subrungruang, Lakhanawan Charoensuk, Picha Suwannahitatorn, Thanyaros Sinsophonphap, Sutiwat Poonyakariyakorn, Teeradon Karndee, Pannawat Arunotong, Parnrada Juicharoen, Warunyoo Prasitnok

Objective: To determine the prevalence of parasitic infection and health risk behaviors among Buddhist monks Methods: Thirty-six stool samples were collected from monks fromWat Thewarat Kunchon Worawihan, Wat Ratchapha Tikaram Worawihan, Wat Prasat Bunyawat and Wat Bot Samsen. All stool samples were microscopically examined using simple smear and formalin-ethyl acetate concentration technique (FECT). The information regarding health risk behaviors associated to parasitic infection was assessed using questionnaires. Data were analyzed using descriptive statistics. Results: The prevalence of parasitic infection was 5.55% comprised the pathogenic protozoan Giardia intestinalis (2.78%) and non-pathogenic protozoan Entamoeba coli (2.78%). Helminth infection was not found. Regarding the health risk behaviors associated to parasitic infection, most of the participants have never had eaten raw or undercooked fish (97.06%), salt-fermented fish (63.64%), raw or undercooked pork (90.62%) and raw or undercooked beef (87.50%). Concerning preventive behaviors, more than half always wore shoes when going outside the temple (69.44%), almost all of them drink bottled water (90.91%), majority of them wash their hands sometimes before eating (66.66%), always washing hands after defecation (69.44%) and after touching pets or stray animals (62.5%). Regarding prevention of the spread behaviors, all monks used sanitary latrine (100%) but the knowledge about parasitic infection was only moderate (51.43%). Most of the participants have never had their stool examination for parasitic infection (91.7%) and more than half (62.86%) have never had anthelmintics. Conclusion: Although the prevalence of parasite infections among monks is low but the risk behaviors of parasitic infection is still apprehensive. Therefore, monks should be encouraged to enhance healthcare knowledge for health risk reduction including promote appropriate hygiene for the prevention of parasitic infection. These results can be applied for health care planning and promoting the health of monks in the community in the future.