Vajira Medical Journal: Journal of Urban Medicine

173-186

Authors: Suttipong Pearpleum, Yutthana Apichatbutr

Background: Driving pressure is associated with mortality in patients with acute respiratory distress syndrome (ARDS). However, whether driving pressure is associated with outcomes in mechanically ventilated patients without ARDS is unknown. Objective: This study primarily aimed to determine the association between driving pressure and severe lung injury (lung injury score ≥ 2.5). The secondary outcomes were to determine the cutoff point of driving pressure associated with severe lung injury and compare patient mortality between severe and non-severe lung injury score in mechanically ventilated patients without ARDS. Methods: Mechanically ventilated patients without ARDS admitted in the intensive care unit (ICU) of Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, between 2018 and 2020 were enrolled. Baseline characteristics including sex, age, diagnosis, sedative drug, and lung mechanic from the ventilator were recorded. Moreover, the patients’ driving pressure [plateau pressure–positive end expiratory pressure (PEEP)] and lung injury score were obtained. Multivariable logistic regression analysis was performed to determine associations between driving pressure and patient lung severity with lung injury score. The mechanically ventilated patients without ARDS were categorized according to lung injury score ≥ 2.5; then, a severe form of the area under the receiver operating characteristic (AuROC), as a dependent outcome, was observed to determine the association between driving pressure and severe lung injury. The optimal cutoff point of driving pressure that determined severe lung injury was calculated by Youden’s index. Result: In total, 155 mechanically ventilated patients without ARDS were enrolled. Overall mortality was 28.3%. Driving pressure was associated with severe lung injury (OR, 1.28; 95% CI, 1.15–1.42; p-value <0.001). A good discriminative ability of driving pressure to determine severe lung injury was noted (AuROC = 0.859; 95%CI, 0.768–0.950). The optimal cutoff point of driving pressure indicating severe lung injury was 16 cmH2O with, 89.5% sensitivity (95% CI, 66.9–98.7), 75% specificity (95% CI, 66.9–82.0), 33.3% positive predictive value (95% CI, 20.8–47.9), and 98.1% negative predictive value (95% CI, 93.2–99.8). Conclusion: In mechanically ventilated patients without ARDS, increased driving pressure was associated with severe lung injury. A driving pressure >16 cmH2O was associated with severe lung injury.

197-210

Authors: Charnwat Chuantantikamol, Petch Rawdaree

Background: Currently, the prevalence of congestive heart failure in type 2 diabetes mellitus (T2DM) worldwide is increasing continuously. However, risks and incidence of hospital readmission due to congestive heart failure in T2DM are no conclusion. Therefore, this study aimed to evaluate risks of hospital due to congestive heart failure in T2DM patients. Methods: A matched case-control study was conducted to discover risks of hospitalization because of congestive heart failure (CHF) in T2DM patients at Vajira Hospital. Clinical and laboratory data from medical record of diabetic patients hospitalized due to CHF, defined as a case, from 1st January, 2560 BE to 31st December, 2561 BE and T2DM patients who had no history of CHF which age and sex matched, defined as a control, were retrieved from hospital database. Univariate and multivariate analysis controlling for confounders were conducted to identify risk factors for hospitalization from CHF. Results: Among the 180 subjects the average age was 68.38 years and 50% was female. Ninety subjects who had heart failure were recruited as cases (50%) and others 90 subjects without heart failure were in control group. All of the cases were diagnosed congestive heart failure by Framingham criteria. Most of cases had heart failure with preserved ejection fraction (51.9%) and 22.2% were readmission due to heart failure. Risk factors for congestive heart failure in T2DM subjects were Body Mass Index (BMI) (OR = 1.18, 95%CI = 1.03-1.36, p-value = 0.02) but protective factor is statin (OR=0.03, 95%CI = 0.0001-0.71, p-value = 0.03) Conclusions: The risk of hospitalization for heart failure patients with type 2 diabetes mellitus is BMI and protective factor is statin. There was 22.2% of the subjects readmitted due to CHF and smoking is a risk factor for the readmission.

221-234

Authors: Pornertai Rattanamaytanon, Prasit Leewattanapat

Objective: To compared Fracture Risk Assessment Tool (FRAX) score in previous hip fracture patients with type 2 diabetes and non-diabetes patients and to ascertain accuracy of FRAX whether using Rheumatoid Arthritis (RA) substitution of diabetes. Methods: A retrospective study from medical record in patients aged 50 to 100 years with previous osteoporotic hip fracture in Vajira hospital between January 1st, 2014 to January 31st, 2019. Comparing mean of FRAX score between type 2 diabetes and non-diabetes group. Results: A total of 288 participants with previous osteoporotic hip fracture were included in the study, type 2 diabetes (T2DM) 144 patients (50.88%) and non-diabetic 139 patients (49.12%). The significant lower FRAX score between diabetic and control group was observed for both major osteoporotic (MOF) 6.68±4.66 vs. 8.53±5.26, p = 0.02 and hip fracture (HF) 2.42±2.69 vs. 3.96±3.71, p<0.01 respectively. Adjusted FRAX by substitution RA input for diabetes, the fracture risk estimates in both groups were approximately (MOF 9.09±6.32 vs. 8.53±5.26, p = 0.412 and HF 3.87±4.05 vs. 3.96±3.71, p = 0.888) Conclusions: The FRAX tool underestimated fracture risk in T2DM compared to non-diabetes patients. The introduction of a correction factor by selecting RA as equivalent variable for T2DM resulted in mean FRAX values no longer significant to those without diabetes subjects which can improve the performance of the FRAX prediction.

245-252

Authors: Panjit Phothong, Waraporn Somwong, Kongkaew Younboonhlim, Porntipa Kwanraj, Sompit Suvanboon

Objective: To assess nursing factors affecting the solution of dengue hemorrhagic fever patients. Methods: This research was descriptive research by collecting retrospective data from medical records. We studied dengue patients who were admitted to the wards in the Hospital for Tropical Medicine, Mahidol University .To record in case record form . Total 250 patients consisted of 125 DF patients and 125 DHF / DSS patients selected by Hospital number with an even number ending. Data collected from 1 January 2013 to 31 December 2017 from medical record. Results: Among 250 patients, there were 125 cases (50%) in the DF group, 115 (46%) in the DHF group, and 10 (4%) in the DSS group. 53.3 % of patients were female with overall mean age 28 years. Most patients (86.0%) were Thai, Burmese (10%), Lao (2.4%). Nursing Practice up to 99.5% of care could be managed by nurses such as vital sign monitoring, providing supporting care, etc. Only 0.5% of care must be managed by doctors, such as rise in hematocrit, and severely abnormal vital signs, or hepatic encephalopathy. Conclusion: The result of this study showed nurses were able to provide nursing practice to patients in due time, causing no complications and patients can go home as scheduled. Therefore, nurses play an important role in elementary evaluating the symptoms of patients and providing nursing care closely.

95-106

Authors: Pasistha Termworasin, Dissajee Lumbiganon, Chattip Prueksapraopong

Background: Road traffic accident is one of the leading causes of death in children. Appropriate car seat use can reduce the severity of injuries. Objective: The aims of this study were to collect information on car seat use and to compare the knowledge of parents of preschoolers in Bangkok regarding road traffic safety for children including car seat use before and after receiving car seat brochure by using pretest and posttest questionnaires. Methods: The pretest questionnaires were sent out to parents of preschoolers in 3 randomly selected schools and were collected 3 days later. Thereafter, the car seat brochures and the posttest questionnaires were sent to the parents and the questionnaires was collected back after 2 weeks. Results: Of the 309 parents, 254 (82.2%) completed the pretests and 135 (43.7%) of them also completed the posttest questionnaires. Among 254 parents, most of them were female. All of them knew about car seat, mostly from the internet (73.2%) and relatives (40.6%). Among 233 parents who used car to take their children to school, 82.0% had ever used car seat but only 21.5% of them always used it. The most important reason for not using car seat was children’s refusal. The overall score of knowledge about car seat increased after receiving car seat brochure. Conclusions: This study demonstrated that very few parents used car seat for every ride of their young children. Car seat brochure may increase knowledge but more strategies are needed to improve car seat use for child passenger safety.

117-126

Authors: Natthapong Hongku, Pruk Chaiyakrit, Chaipipath Senwiruch

Objective: To demonstrate the varus correction angle after performing the medial tibial reduction osteotomy and tibia component undersizing and lateralization techniques for correcting varus deformity in computer-assisted and cruciate-retaining total knee arthroplasty. Methods: Cadaveric study included 5 bodies (10 knee joints) using total knee arthroplasty surgery assessing the varus correction angle, degree, medial and lateral gap measurement of knee joint during the different angles. Then, medial tibial reduction osteotomy and tibia component undersizing and lateralization were performed by 3 and 6 mm and all parameters were measured. Results: The varus correction angles after 3 and 6 mm medial tibial reduction osteotomy were 2.00 and 2.93 degrees respectively. The medial gap increased 1.5 mm after 3 mm medial tibial reduction osteotomy tibia component undersizing and lateralization in full extension knee position. Conclusions: Medial tibial reduction osteotomy and tibia component undersizing and lateralization were used to correct the varus deformity in total knee arthroplasty. The average of the varus correction angle was only 0.6 degrees per 1 mm of bone cut, therefore, this technique should not recommend to be used alone for severe varus deformity knee.

135-142

Authors: Wanthanachai Rotchomphu, Wisit Kasetsermwiriya

Background: Advances in surgical techniques and appropriate perioperative management has decreased the mortality rate of pancreaticoduodenectomy less than 5 percent. However, postoperative pancreatic fistula is the most serious and life-threatening condition with the incidence rate at 27% for conventional reconstruction. A newly modified technique in Japan Kakita pancreaticojejunostomy has been reported that it reduces postoperative pancreatic fistula; however there were only few reports of this technique outside Japan. This study aimed to compare rate of pancreatic leakage between the new technique and conventional pancreaticojejunostomy after pancreaticoduodenectomy in Thai patients. Methods: Data of 25 consecutive patients with periampullary cancer and benign conditions (e.g. chronic pancreatitis) who underwent pancreaticoduodenectomy at Vajira hospital from 2005 to 2015 were reviewed. Postoperative results of fifteen patients who underwent conventional pancreaticojejunostomy (group A) were compared with ten patients who underwent modified Kakita pancreaticojejunostomy (group B). The primary outcome measure was the rate of postoperative pancreatic fistula (POPF) and secondary outcomes included; operative data, postoperative morbidity, mortality and evaluation of the risk factors of pancreatic leakage. Results: There were no differences in clinicopathological characteristics and postoperative morbidity between two groups. Overall, the leakage rate was 32% (8/25). The pancreatic leakage in group A was 50 % (5/10) while the leakage rate in group B was 20% (3/15), p=0.194. Duration of hospital stay in group A was 39 days (17-66 days) and in group B was 28 days (21.5-46.5 days); p = 0.824. All of the complications could be managed by conservative measures. Intraoperative blood loss was a risk factor for leakage (1500 ml vs. 750 ml, p = 0.038). The leakage caused delayed gastric emptying (3 vs. 0, p = 0.24) and prolonged hospital stay (72.5 days vs. 25.5 days, p< 0.0001). Conclusion : This retrospective single-center study showed that duct-to-mucosa anastomosis by modified Kakita technique was a safe procedure.

153-164

Authors: Nitaya Srichamnong, Anchalee Jantapo

Objectives: The objectives of this research aim at comparing the way of life and potential of the older person in a community, Nonthaburi Province. Methods: This study was a descriptive research. The samples were 98 elders in the community using Krejcie and Morgan sample size table and simple random sampling method. The statistics used for data analysis were percentage, arithmetic mean, standard deviation, and one - way ANOVA. Results: The finding revealed that overall of health behaviors was in a moderate level (x̄ = 2.30, SD = 0.20), consisting of having food (x̄ = 2.30, SD = 0.20), no alcohol drinking (x̄ = 1.55, SD = 0.71), and visiting doctor regularly (x̄ = 2.35, SD = 0.22). Sleep and exercise were in a good level (x̄ = 2.56, SD = 0.51 and x̄ = 2.53, SD = 0.53, respectively). Lifestyle in moderate level were relationships with family and community. As for spiritual growth, it was in a good level (x̄ = 2.63, SD = 0.36). The potential of the older person was a moderate level (x̄ =1.84, SD = 0.35). where as the ability to using computers was in a low level (x̄ =1.38, SD = 0.53). When compared health behaviors and potentials of the older person, their basic learning skills, work, income, and health condition were not significantly different. (P> .05). Conclusion: The lifestyle of health behavior and potential of the older person were a moderate level. Older person with different potentials found that health behaviors were not significantly different.

1-12

Authors: Yutthana Apichatbutr

Introduction: The coronavirus outbreak which has spread across the world resulting in a significant shortage of the N 95 type of medical mask. For this reason, the University of Navamindradhiraj jointly developed a medical mask made from silicone type N 99 (Silicone Mask Respirator N 99) that filters more than 99% of bacteria and viruses. This research shows the study of respiratory physiology and the impact of using N 99 silicone mask in general volunteers. Methods: A prospective study was carried out by 20 volunteers breathing through a HEPA filter fitted with a silicone N 99 mask doing routine work and testing for breathing through volumetric capnography every 1 hour until at the end of 3-hours. The required measurements were measured dead space volume (Vd), dead space volume / tidal volume (Vd / Vt), end- tidal CO2 (EtCO2), alveolar CO2, oxygen saturation, airway resistance and a satisfaction questionnaire after all studies were performed. Results: Total 20 subjects were eight males and twelve females, mean age was 31 years (SD), mean body mass index was 21.60 ± 2.23 kg / m2 and no underlying disease. Volumetric capnography was used to calculate the respiratory parameters. With silicone N 99, the average dead space volume increased 27.57 ± 7.57 ml( p=0.001). The mean proportion of dead space volume / tidal volume before and after wearing the N 99 silicone mask was 0.22 ± 0.03 and 0.25 ± 0.03 respectively, with 0.03 increments (p = 0.011). End- tidal CO2 measurements before and after wearing the N 99 silicone mask were found to be 35.35 ± 2.32 mmHg and 36.71 ± 2.25 mmHg (p = 0.054). When calculating alveolar CO2 before and after wearing silicone N 99 was 32.94 ± 3.06 mmHg and 34.52 ± 2.64 mmHg respectively (p = 0.085). Respiratory resistance measurements before and after wearing the N 99 silicone mask was 2.53 ± 0.37 cmH2O/L/sec and 4.14 ± 0.8 cmH2O/L/sec increased by 1.53 ± 0.72 cmH2O/L/sec (p <0.001). The oxygenation value before and after using the mask is normal (p = 0.355). According to the user satisfaction questionnaire, there was no headache in the volunteers. Respiration heat and stinging, irritation, sweating, odor, scores were 1-2 points (not at all uncomfortable to a little uncomfortable), and masked communication and mask tightening were scored 2-3 points range (a little uncomfortable to moderately uncomfortable). Conclusion: When the silicone mask N 99 was continuously used for while it has shown that respiratory dead space and resistance were increased statistically significant but results of oxygenation and carbon dioxide levels were typical throughout use. It is therefore safe to use the N 99 silicone mask.

27-36

Authors: Kanoknan Somnuk, Kulrut Saytichai, Kittipong Ounkeaw, Rungnapha Siriphonphaibool, Arnon Thongkonghan

Objective: To study prevalence and factors related to metabolic syndrome in personnel of Somdejphrajaotaksinmaharaj Hospital Method: This was a descriptive research. The sample was 805 personnel of Somdejphrajaotaksinmaharaj hospital who received annual health checks up in2019.The data were collected from medical records and questionnaire which included general characteristics and personal behavioral factors. Descriptive statistics and inferential statistics were used. Univariate analysis and multiple logistic regressions were used for identifying risk factors and presenting adjusted odds ratio (ORadj). Results: The results showed that the prevalence of metabolic syndrome was 15.80% among Somdejphrajaotaksinmaharaj hospital personnel. The statistically significant factors related to the metabolic syndrome by using the univariate were the gender, age, disease, smoking, alcohol drinking and exercise frequency (p<0.05). Male were found to at risk of metabolic syndrome 3.10 times (95% CI: 1.71-5.63) more than female. Over 45 years of age were found to at risk of metabolic syndrome 2.35 times (95% CI: 1.27-4.33) more than lower than 45 years. Underlying diseases were found to at risk of metabolic syndrome 5.65 times (95% CI: 3.05-10.45) more than absence of underlying diseases. Smoking were found to at risk of metabolic syndrome 2.24 times (95% CI:1.05-4.78) more than non-smoking. Alcohols drinking were found to at risk of metabolic syndrome1.93times(95%CI:1.11-3.37)more than non-alcohols drinking. Exercise frequency lower than 3 day were found to at risk of metabolic syndrome 0.45 times (95% CI: 0.26-0.78) more than exercise frequency over 3 day. The factors related to the metabolic syndrome by using the multiple logistic regressions were gender, disease and exercise frequency (p<0.05). Male were found to at risk of metabolic syndrome 0.39 times (95% CI: 0.19-0.95) more than female. Underlying diseases were found to at risk of metabolic syndrome 0.20 times (95% CI: 0.10-0.39) more than absence of underlying diseases. Exercise frequency lower than 3 day were found to at risk of metabolic syndrome 1.34 times (95% CI: 0.70-2.55) more than exercise frequency over 3 day. Conclusion: This research showed the prevalence and factors related to metabolic syndrome of the personnel of Somdejphrajaotaksinmaharaj Hospital. This finding can be useful to plan the prevention and the treatment program in the future.

45-60

Authors: Sirinapa Saneemanomai, Suwat Srisuwannanukorn

Objectives: This study aimed to evaluate the sensitivity and specificity of the Thai versions of Scales for Outcomes in Parkinson’s Disease-Nighttime Sleep (SCOPA-NS) and Modified Parkinson’s Disease Sleep Scale (MPDSS) test for patients with Parkinson’s disease in comparison with the Pittsburgh Sleep Quality Index (PSQI) test. Methods: This cross-sectional study enrolled patients with Parkinson’s disease who sought treatment at the OPD department, Division of Neurology, Faculty of Medicine Vajira Hospital. The study was conducted from 1 March 2019 to 31 December 2019. Volunteers completed Thai SCOPA-NS and MPDSS sleep tests to obtain the sensitivity and specificity of each test, which was then compared with the PSQI test. Results: Of the 216 volunteers, 200 met the study criteria. To evaluate nighttime sleep, SCOPA-NS test and MPDSS test in Thai language were used. The prevalence rates of sleep disorders in volunteers using the SCOPA-NS test and MPDSS test were 62.5% (95% confidence interval [CI] 55.4–69.2) and 52.5% (95% CI 45.3–59.6), respectively. Youden’s index (1− (sensitivity + specificity)) was used to find the optimal cut-off points by comparing it with the PSQI test. SCOPA-NS test has a sensitivity of 83.1% (95%CI 75.3–89.2), specificity of 71.1% (95% CI 59.5–80.9), positive predictive value (PPV) of 82.4% (95% CI 74.6–88.6), and negative predictive value (NPV) of 72% (95% CI 60.4–81.8), whereas the MPDSS test has a sensitivity of 71.8% (95% CI 63.0–79.5), specificity of 78.9% (95% CI 68.1–87.5), PPV of 84.8% (95% CI 76.4–91.0), and NPV of 63.2% (95% CI 52.6–72.8). The volunteers preferred doing the SCOPA-NS test than the MPDSS test with preference rates of 65.5% and 34.5%, respectively. Conclusion: Thai SCOPA-NS test has higher sensitivity but lower specificity than the MPDSS test. However, patients significantly prefer doing the Thai SCOPA-NS test than the MPDSS test. Both tests can be used to evaluate patients with Parkinson’s disease at comparable accuracy. However, Thai SCOPA-NS test took shorter test, and patients with Parkinson’s disease prefer this test. We recommend using Thai SCOPA-NS in screening for sleep disorder in this patient population.

73-82

Authors: Krittima Phochanasomboon

Objectives: To study the outcomes of pharmaceutical care in the area of drug related problems, problem causes, intervention methods, intervention outcome and inhaler technique in the asthma and chronic obstructive pulmonary disease (COPD) patients. Methods: This study was retrospectively descriptive study in patients diagnosed with asthma and COPD who receives the first prescription of new inhaler device from the out-patient department of Faculty of Medicine Vajira Hospital, Navamindradhiraj University between January 1, 2014 to December 31, 2018. Each patient received pharmaceutical care during the treatment of asthma and COPD. The outcomes were analyzed by descriptive statistics. Results: There were 538 patients in this study, (282 females, 52.42%, and 257 males, 47.78%). This study identified 402 drug related problems (DRPs) in 311 patients (57.81%) with an average of 1.32 + 0.69 DRPs per patient. The most frequent problems were insufficient drug treatment [331 problems (82.34%)]. Most common causes were prescribing error (missing of necessary information) 219 causes (54.48%). The highest problem solving action was the change of drug prescription which was 235 times (58.46%). Pharmaceutical care interventions could resolve 395 problems (98.26%). From evaluation of inhaler technique, the most common misuse inhaler device by the patients were Respimat, Turbuhaler, Breezhaler, HandiHaler, Pressurized Metered-Dose Inhalers and Accuhaler, respectively. Conclusion: The pharmaceutical care in this study was found to be effective to identify and solve the problems relating to drug use, which can assist the patients to use their medications appropriately.

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.