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.