plueme/wizJson huggingface dataset:
At present, The Pharmacy council has launched the notification on Guidelines for Telepharmacy, with some additional details required to be stated for the setting of continuous and efficient operating in telepharmacy, while conforming current changes of society and technology. This study aimed to conduct the standard of telepharmacy and guidelines for pharmaceutical care and to develop data architecture which supports and facilitates the operating of telepharmacy. This study was designed in accordance with development research, in which it was divided into 2 phases. The first phase, literature review was done from guideline/standard of practice of foreign references and acceptable standard transportation requirements which was primarily analyzed for the suitability in consistency of context. Team on synthesis research has drafted the guideline of telepharmacy and guidelines for pharmaceutical care. Summary of the guidelines was obtained according to the group discussions of stakeholders and opinions from pharmacists. In the second phase, the draft of data architecture for supporting the telepharmacy was conducted in accordance with information from phase I. Additional suggestions from stakeholders were obtained, prior to the summary of data architecture. Phase I study result provided the basic guideline for telepharmacy that was consisted of minimum dataset (composing of patients’ information, prescription, dispensing, pharmaceutical care service, and drug transportation); the basic guideline for telepharmacy (in which it contained 8 components i.e., location, customer service approach, information technology, transportation, etc.); and guidelines for pharmaceutical care (including prescription analysis and pre-dispensing for remote prescription, drug transportation, and remote counseling. The result of phase II study provided the draft of data architecture using HL7-FHIR for standard messaging and standardizing the database which contributes to the data exchange among organizations and leads further to better outcome in patient care. Finally, this study proposed the Pharmacy Council of Thailand to implement the guidelines, standard data set, and capacity building for community pharmacist on telepharmacy service.
Background: Thailand is among the 30 countries with high tuberculosis (TB) prevalence. Cases of TB in Secondary schools have been reported and aggregated adolescents in school are at risk of TB transmission. Children with latent TB may develop TB diseases later on. Nevertheless, studies of TB diseases and latent TB prevalence in schoolchildren in Thailand are scarce. Method: We did an observational cross-sectional study in Secondary school children grade 7-12 in a school in Bangkok and a school in another province of Thailand. We used the Symptoms scoring questionnaire developed by the Bureau of Tuberculosis and Chest radiography to screen for pulmonary TB to identify the TB prevalence. And we used tuberculin skin test (TST) at a 10 mm. cut-off to identify latent TB infection in grade 7 students. Also, 80 students were undergone QuantiFERON® TB Gold (QFT) blood test together with TST. Furthermore, we did a survey on knowledge, attitude, and practice (KAP) of TB in school among personnel of the 2 schools using a structured questionnaire. Results: A total of 1,005 from 5,113 students from 2 schools were enrolled, 496 from Nawaminthrachinuthit Bodindecha School in Bangkok and 509 from Chonburi Sukkhabot School in Chonburi province. Three hundred and fifty-four, 176, 154, 176, 141, and 153 students were from Grade 1, 2, 3, 4, 5, and 6 respectively. The mean age was 14.6±1.8 years. Forty-six and 21.8 percent had the household incomes of 20,000-40,000 and less than 20,000 Thai Baht per month. Twelve percent had the history of TB exposure in the past. The screening with Symptoms scoring questionnaire and chest radiography revealed no TB disease in this survey. Meanwhile, 270 first grade students were screened for latent TB and 13 were positive, resulted in latent TB prevalence of 4.8% (95% Confidence Interval (CI), 2.3-7.4%) Of them, none developed TB disease during the 1-year follow-up. The TST at 10 mm. cut-off had the sensitivity 50% (95% CI 6.8-98.2) and specificity 98.7 (95% CI, 92.9-100%) compared to QFT. Furthermore, the results of KAP survey among the school personnel showed lower percentage (11-39%) of correct answers to knowledge of TB symptoms in children, transmission, and prevention of TB in community. Most personnel had positive attitude to learn about TB and help students to receive treatment (78-99%). However, 55% tended to separate students with TB from others even the students already receiving treatment and 29% would not be a personal tutor for students with TB after the treatment. Conclusion: The prevalence of TB disease and latent TB in Thai school children is not high. The routine TB screening in Thailand may target other population groups with higher TB rate. However, the protocol for reporting and investigation should be put forward for schoolchildren who develop TB diseases along with school personnel education on TB transmission and prevention.
Concurrent use of rifampicin (RIF) and dolutegravir (DTG) reduces DTG exposure, thus, DTG 50 mg twice-daily is currently recommended. Food increased DTG concentrations in healthy volunteers by 33 – 66%. We therefore investigated the effect of RIF on DTG exposure when dosed at 50 mg once daily with food, which would be more convenient than 50 mg twice daily in resource limited settings, where generic fixed dosed combination of TDF/ 3TC/DTG (TLD) is widely available. Method: We conducted a single-center, randomized control trial study in Bangkok, Thailand to evaluate efficacy, safety and pharmacokinetics of dolutegravir 50 mg once daily with food versus dolutegravir 50 mg twice daily in HIV/TB co-infected patients receiving rifampin based antituberculosis therapy. TB/HIV coinfected adults, ART naïve, stable on RIF containing regimen for drug-susceptible TB were randomly assigned to receive DTG 50 mg OD with food (study arm; TLD 1 pill/day) or DTG 50 mg twice-daily (control arm; TLD 1 pill plus additional DTG). Intensive PK was scheduled at week 4. Blood samples were collected pre-dose, 1, 2, 4, 6, 8, 12, and 24-hour post-dose (by study arm). HIV-RNA, liver and renal function tests were monitored. DTG concentrations were determined by validated LC-MS/MS. PK parameters were estimated (nonparametric; WinNonLin). The primary endpoint was DTG geometric mean ratios (GMRs) of DTG 50 mg QD vs DTG 50 mg BID (90%CI) and percent of participants with DTG minimum concentrations (Cmin) above the required protein-adjusted 90% inhibitory concentration (IC90) of 0.064 μg/mL. Results: Totally 20 study arm and 20 control arm participants completed PK analysis. The majority were male (87.5%); with median age 35.6 years, and median body weight 57.5 kg. At baseline, median CD4 was 170 (IQR 45.5-302) cells/μL and median HIV RNA was 4.96 (IQR 4.23-5.61) log10 copies/mL; 43% had HIV-RNA> 100,000 copies/mL. GMR (90%CI) maximum concentration (Cmax) and area under curve (AUC0-τ) not within the bioequivalence range of 0.8-1.25: 0.84 (0.57-1.25) and 1.07 (0.72-1.59), respectively (Table 1). Cmin GMR was 0.3 (0.18-0.49); however, the geometric means in both arms were above the required IC90: 0.18 (0.11-0.28) in study arm and 0.59 (0.44-0.79) in control arm. At week 12, 83% and 83% of participants in study arm and control arm, respectively had HIV-RNA <50 copies/mL. At week 24, 83% and 100% of participants in study arm and control arm, respectively had HIV-RNA <50 copies/mL Both arms were well-tolerated. Conclusion: Although there were substantial reductions in DTG concentrations when co-administered with RIF, Cmin levels were mostly above the protein-binding-adjusted IC90 of 0.064 μg/mL and majority of participants had high efficacy and >85% had VL suppression at week 12 and 24. Dolutegravir based ART can be used safely with rifampin based antituberculosis.
Migration is a global phenomenon. Thailand is currently the destination country with the largest population of migrant workers in ASEAN. Urbanization has attracted large numbers of migrants to cities and/or metropolis. Three main urban health challenges are infectious disease outbreaks due to overcrowded housing, chronic NCDs due to unhealthy urban lifestyle, and accidental injuries due to work risks. The Urban Migrant Health Survey and Enhancing Private Sector Role in Migrant Health System Development research project aims to develop the health service system that meet the health needs of migrant workers in urban areas, and promote the participation of private sector. The research methodology was a combination of quantitative and qualitative with documentary research. It consists of an assessment of migrant workers' health problems in Bangkok Metropolitan region, interviews, focus groups, and literature review. The data collection include face-to-face surveys from 432 migrant workers, 54 entrepreneurs and 81 health service providers, interviews with 20 migrant workers, 49 entrepreneurs, 3 health service providers, and 3 government officials, as well as 3 focus group meetings among expert and 2 future scenario meetings among entrepreneurs. Literature review emphasizes on six building block of migrant health system in developed countries and Bangkok Metropolitan. The documentary research findings are that the core idea underlying established migrant health system in developed countries is allocating migrant health rights according to their level of economic and social participation. Two major obstacles of migrant health system in Thai metropolis are the lack of migrant health policy in urban development policy and bias towards migrant workers in policy processes and health service provision. Therefore, it is necessary to tackle both by establish the share vision of an urban health system integrating migrant workers and promote the paradigm shift towards migrant workers integration as a participant in the urban economic and social development. In parallel, policies on proactive health service provision to cover dense urban migrant communities and health finance that covers all groups of migrant workers are introduced. These are supported by systematic management of migrant health database management system and enhancing the participation level of employers and migrants in the inclusive urban health system development.
Cancer is a major cause of death in Thailand. Apart from surgery, chemotherapy, radiation, and hormonal therapy, cancer immunotherapy became the most promising treatment in the era. Immune checkpoint inhibitors (ICIs) act as immune stimulators to reactivate exhausted T cells to harness cancer cells. Programmed cell death protein 1 (PD-1) is the most potent immune checkpoint molecule, and PD-1-targeted ICIs have been approved by the U.S. FDA for cancer immunotherapy for over 30 indications. In Thailand, ICIs need to be imported for cancer treatment, and the cost of this drug is very expensive, and most cancer patients cannot access this kind of therapy. So, the development of this drug in our country is urgently needed to make it cheaper and increase the chance of patients to access the treatment. This study successfully developed a novel humanized anti-PD-1 monoclonal antibody (humanized anti-PD-1 CUSB1936) using mouse hybridoma technology and characterized its physicochemical and biological properties. The result showed that the humanized anti-PD-1 CUSB1936 could bind to PD-1 protein with high affinity in the sub-nanomolar range and neutralize the PD1/PD-L1 interaction with EC50 values 375.2 - 613.5 ng/mL. In addition, the anti-PD-1 CUSB1936 VH3+VL2 variant could induce T cell activation via IFN-gamma and IL-2 secretion in vitro better than the benchmark antibodies (Keytruda and Opdivo). Then, the anti-PD-1 CUSB1936 VH3+VL2 variant was transiently expressed using the Expi293 expression system. The purified anti-PD-1 CUSB1936 VH3+VL2 variant was then characterized and evaluated in vivo anti-tumor activity in MC38/hPD1 allograft mice model. The results exhibited that the anti-PD-1 CUSB1936 VH3+VL2 variant at 10 mg/kg could significantly inhibit tumor growth compared with IgG antibody control and showed similar antitumor efficacy compared with benchmark antibody. These findings prove that the anti-PD-1 CUSB1936 VH3+VL2 variant exhibits high anti-tumor efficiency and could be further developed as a novel PD-1 targeted ICI in Thailand.
Utility value is an important outcome for cost-utility analysis (CUA). The EQ-5D is used to elicit the utility values for economic analyses recommended by the Thai health technology assessment guideline. Therefore, this literature review was to establish the dataset of utility values for Thai patients with liver, lung, colorectal, breast, cervical, ovarian and hematologic cancers in various stages in Thailand.
This study reviewed all relevant studies by searching international databases such as PubMed and Scopus, and national databases including health intervention and technology assessment program (HITAP), health systems research institute (HSRI) and Thai LIS-Thailibrary integrated system (ThaiLIS) Study was included if 1) report utility values for Thai cancer patients and 2) identify the type of instruments used to elicit utility values. Moreover, quality scoring and assessment were performed for all included studies based on the adapted National Heart, Lung and Blood Institute guideline.
Of total 4,432 studies identified, 30 studies were included for literature review. Utility values were elicited from direct methods (Standard gamble; n=3 and mixed direct methods: Standard gamble, Time-trade off and Visual analog scale; n=1), indirect methods (n=14), mixed direct and indirect methods (n=3), mapping techniques (n=3), indirect method and retrieved from published papers (n=3) and unidentified methods (n=3). Within indirect methods, the EQ-5D questionnaire (n=17) was used in which the EQ-5D-3L (n=13) was the most frequently used. However, none of the included studies reported the psychometric performance of the instruments used to elicit the utility values.
This review establishes the dataset of utility values for Thai cancer patients with various stages. Both direct (SG, TTO and VAS) and indirect methods are used to elicit the utility values. The utility values decline in patients with metastatic stage (Stage IV) compared to the earlier-stage (Stage I-II). However, the utility values are mostly the result from chemotherapy or surgery for cancer treatment, so the utility values is directly uncomparable among the included studies. Therefore, further studies investigating the differences of utility values derived from direct and indirect methods among Thai patient cancers with various stages should be encouraged. Furthermore, the EQ-5D-5L with hybrid model should be used to elicit the utility values for economic analyses based on Thai health technology assessment guideline.
Background The Coronavirus disease (COVID-19) pandemic was emerged in 2020 and continue to third wave in 2021. Social measures and personal preventive measures were rolled out, which includes COVID-19 vaccine allocation and distribution strategy. This study aims to assess public adherence to personal preventive measures and perception of COVID-19 vaccine. The findings will further communicate and translate into policy recommendations.
Methodology Online survey was performed by Google Forms service and communicate through the village health volunteers channel throughout the country. Sampling method was the convenient sampling. Questionnaires were adjusted around every two week throughout the survey period from 15 February to 15 August 2021, with the total of 12 questionnaires sets. The analysis was performed by STATA software.
Results Total 422,479 respondents were included in this survey and around 79.4% was female with an average age of 46 years old. Majority of the respondents were graduated in high school or lower level (80%) and were in the argricultural field (38%). Respondents were euqlly distributed in all health regions. Wearing face mask was the highest compliance behaviour, while avoid touching face, nose, eyes and mouth received the least compliance. Overall personal protective behaviours were still high of around 91.1% in the 1-15 August 2021 survey period. In the latest survey period found that vaccine acceptance in the 15-59 years old was higher than the 60 years old and above group of 73.0% and 61.0%, respectively. Correlation analysis revealed positive correlation between higher risk perception and vaccine willingness of adjusted OR 3.45 (95% CI 3.38-3.53, p value < 0.001). Infodemic data revealed that public still misperceive about vaccine management system and some may still misunderstood about vaccine effectiveness. However, around 70% of the respondents reported that information from media has no effect on their decisions.
Conclusion The public still compliant with personal protective behaviours, especially when the epidemic has not subside. Willingness to vaccinate was influent by media at some level, however, the most affected factor was own risk perception. Therefore, the government shall monitor and control the infodemic situation and establish vaccine literacy with social measures concurrently
Background and Rationale: Acute ischemic stroke is a major public health problem in Thailand. Treatment decisions are based on the national clinical practice guideline (CPG). However, the guidelines are in the form of publications or pdf files, generating several barriers to implementation. Adopting clinical decision support (CDS) technology will increase practice effectiveness. This study intends to develop web application-based stroke guideline for physicians and teams in health care area 7. Methodology: Health professional team from health care area 7 convene for a discussion. We determine clinical practice gaps based on Thai CPG, develop a web application, evaluate user satisfaction, and track key performance indicators (KPI) after using the web application. The project has a one-year operating period. Results: This study structures guideline suggestions and converts evidence synthesis into executable knowledge for web applications via a multilayer framework (https://strokenetwork.kku.ac.th). The National Institute of Health Stroke Scale (NIHSS) is used to classify stroke subtypes. It is a clinical decision support (CDS) tool that assists physicians in making treatment decisions. CPG was separated according to the hospital's potential level. A list of hospitals consists of details necessary to assist physicians in planning patient referrals. The satisfaction of the health care teams was assessed. The CPG for health care area 7 in web application is appropriate: 40% strongly suitable, 60% suitable. NIHSS assessment are appropriate: 40% strongly suitable, 53% suitable. Easy to understand and convenient to use: 20% strongly agree, 40% agree. Web application will benefit actual clinical practice: 13% strongly agree, 73% agree. The KPI for stroke patient treatment at Srinagarind hospital demonstrated that specific indicators have potentially improved after the web application's implementation: increase of stroke fast track notification rate, increased rate of receiving intravenous thrombolytics, decreased rate of intracerebral hemorrhage with death post intravenous thrombolytics, shorter duration of receiving intravenous thrombolytics, increase proportion of patient with improved outcome, and decreased time of hospitalization. Conclusion and discussion: We demonstrate how to develop web application for physicians and healthcare teams. The web application guideline was appropriate, simple to understand, and easy to use. There are numerous potentially improved KPI. Web apps should benefit health care teams and have ability to improve in the future.
Background: Breast and ovarian cancers are common cancers in female. In Thailand, breast cancer is the most common type of cancer and ovarian cancer is identified at 6th rank in female. BRCA1/BRCA2 are the most common types of hereditary cancer. The prognosis of woman who inherited mutations in the BRCA1/BRCA2 genes could be predicted; as the group with high risk of developing breast cancer (80%) and ovarian cancer (15-40%) in their life time. The detection of germline BRCA1/BRCA2 could lend the opportunity for offering choices of prophylactic treatments. Moreover, recent advance in development of technique for detecting BRCA1/BRCA2 with a lower price raises the question whether this intervention is affordable at the national level in Thai context. Method: The objectives of this study were to evaluate the cost-utility of testing for BRCA1/BRCA2 followed by preventive interventions compared to no genetic test in both high-risk breast cancer patients and their first-degree relatives and to estimate government budget impact using an economic model. A Markov model was used to estimate relevant costs and health outcomes using a lifetime horizon from the societal perspective for Thai healthcare system. Direct medical and non-medical costs were included. Health outcome was quality adjusted life years (QALYs). The results were presented as incremental cost effectiveness ratio (ICER) in Thai baht per QALY gained. One-way sensitivity and probabilistic sensitivity analyses were performed to investigate effects of model variable uncertainties on the results. Results: The results of this study showed that genetic testing for BRCA1/BRCA2 in high-risk breast cancer patients who should be screened for the BRCA1/BRCA2 gene mutations followed by preventive intervention was cost-effectiveness when compare with no genetic testing. The ICER of this intervention was 18,591 Baht/QALY gained which accounted as cost effective based on current willingness to pay (WTP) threshold in Thailand (160,000 Baht/QALY gained). Moreover, offering genetic testing in first-degree relatives of patients with BRCA1/BRCA2 gene mutations was found to be dominant and a cost-saving option compared to no genetic testing. The estimated five years budget impact is approximately 1,011 million Thai baht at BRCA1/BRCA2 testing cost of 21,340 baht. Policy recommendation: The results of this study suggested that providing BRCA1/BRCA2 genetic testing in high-risk breast cancer patients who should be screened for the BRCA1/BRCA2 gene mutations and first-degree relatives of patients with BRCA1/BRCA2 gene mutations detected should include in the National benefit package in Thailand.