plueme/wizJson huggingface dataset:
Background & Rationale: Extended length of stay (LOS) in the emergency department (ED) affects LOS in hospital, increased mortality and increased hospital resource uses. Knowing factors affecting extended ED LOS should lead to improved patient’s quality of care. Methodology: The study design was a retrospective analytical study in ED at Maharaj Nakorn Chiang Mai Hospital between January 2018 to June 2019 by collecting data from the electronic medical records. Data collection included factors expected to extend ED LOS 6 hours and longer by using multivariable logistics regression. Result: A total of 330 patients of whom 165 with ED LOS ≥ 6 hours were eligible. The risk factor for staying 6 hours and longer in the ED was having urine investigation (adjusted odds ratio [aOR] 3.43, 95% CI 2.05-5.73, p < 0.01). Moreover, patients in the evening and night shifts observed a shorter ED LOS compared to the day shift (aOR 0.26, 95% CI 0.15-0.47, p < 0.01 and aOR 0.40, 95% CI 0.21-0.77, p < 0.01, respectively). For patient presentation to ED, the refer-in patients had a shorter ED LOS compared to the walk-in patients (aOR 0.33, 95% CI 0.15-0.70, p < 0.01). Conclusion: The factors extending ED LOS ≥ 6 hours included urine investigation process and the day shift. Refer-in patients were likely to have a shortened ED LOS.
Organ transplantation is the treatment in patients with organ failure where kidney is the organ with the highest rate of transplantation in Thailand. Despite 50 years of an advancement in transplant surgical techniques and post-transplantation care, long-term kidney graft survival is not changed. One of the factor would be that the HLA matching technique used is polymerase chain reaction-sequence specific oligonucleotide (PCR-SSO, Luminex®) which has intermediate resolution for detecting variations in HLA gene. We conducted a HLA sequencing of 330 kidney transplant donors and recipients using Long-Read Single Molecule Real-Time (SMRT) Sequencing and observed the significant association of HLA long-read mismatch score to any type of rejection at 1 year post transplantation and any episode of graft rejection from transplantation to year 2021. This association was better than HLA Luminex mismatch score calculated with PCR-SSO technique. The HLA long-read sequencing information obtained from this study can be used as a reference allele for Thai population. There should be more population sequenced with HLA-long read technique to enhance robustness of the reference database. A prospective multicenter study comparing allocation of donor-recipients with HLA Luminex score versus HLA long-read score is warranted to evaluate outcomes such as death or allograft failure which were not be able to assessed in this study.
The sequential embedded mixed-method research consisted of two phases. 1) The qualitative phase is aimed to explore the situation, experience, problems, and barriers of the family pharmacists in primary care cluster. Focus group discussion was conducted in 24 pharmacists working in the primary care unit (PCU) distributed in 7 provinces of the health region, in January 2020 and April 2021. Average period of working experience was 5.6±5.0 years, and eight of them were full-time pharmacists working in the PCU. Findings of content analysis comprised three main themes: pharmacist roles; related factors from policies, colleagues, and the pharmacist; and the resolution of common drug-related problems (DRPs). Four roles of pharmacists were health services at the PCU, home health care, pharmaceutical management, and consumer protection. The patients’ care barriers were a limitation of the health information connection and information access from the PCU. Part-time working in the PCU limited the pharmacist’s roles; however, updated medication knowledge promoted the pharmacists for effective home health care with the team. In addition, local organizations also supported in home health care and the consumer protection. Communication skills, solving DRPs skill and working experience led the pharmacists to providing effective resolutions of DRPs. 2) The prospective, longitudinal quasi-experimental study was performed as quantitative phase. Data collection in 1,471 hypertensive patients for continuously three visits at the PCU in 2020. This aims to examine DRPs, blood pressure, and physician acceptance of pharmacists’ resolution change over the study including factors affecting DRPs resolutions. 379 DRPs were identified and the highest DRP was 164 non-adherence problems. Following the pharmaceutical care, all DRPs and non-adherence were significantly decreased by 3 2 .4% (X2(2)=46.78, p<0.001), and 61.0% (X2(2)=98.60, p<0.001), respectively. Blood pressure was unchanged. Physician acceptance of pharmacists’ resolution were 77.8%, 70.3% and 68.4%, at visit 0, 1 and 2 respectively. Factor affecting non-adherence resolution was physician acceptance of pharmacists’ intervention (rs=0.18, p=0.020). The family pharmacists can reduce DRPs in patients with hypertension. The relevant factor of DRPs resolution was teamwork due to working experience and skills of pharmacists. There should then be increasing experience and related skills through short course training for pharmacists.
Development of rapid diagnostic tests are a fundamental component for an effective public health system. At present, the availability of rapid diagnostic test and equipment quality in Thailand still insufficient. In this study, we aimed to develop the smartphone-controlled electrochemical sensor operated via Near Field Communication (NFC) as portable devices for screening test. This study used the electrochemical gas sensor to detect blood alcohol concentration from breath sample. For hepatitis B detection kit, the operating system was composed of a card-sized electrochemical NFC tag sensor integrated with a smartphone and antibody-modified electrode with gold nanoparticles to provide high sensitivity and β-cyclodextrin (β-CD). The modification and immobilization processes were verified by electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV). The electrochemical immunosensor was then used to quantify Hepatitis B surface antigen (HBsAg) by measuring the current-time response obtained from amperometric detection. The current from the Fe(CN)63-/4- redox couple was measured before and after addition of HBsAg. A resistance-based lateral flow immunosensor diagnosis device (R-LFI) that integrated NFC with portable smartphone for L. interrogans detection in clinical samples. The performance of R-LFI sensor was evaluated using recombinant LipL32 (rLipL32), L. interrogans, and clinical samples. The results showed that the performance of the smartphone-based breath alcohol sensor was acceptable (SD ≤ 1.4mg%). Under optimal conditions, a linear calibration curve and a limit of detection for HBsAg were found to be 10-200 μg/mL and 0.17 μg/mL, respectively. The R-LFI device exhibited linear responses toward rLipL32 protein in phosphate buffer and L. interrogans spiked in healthy human serum samples within concentration ranging from 1 to 100 ng (limit of detection, LOD: 0.16 ng). This platform is sensitive, specific, simple, label-free, and requires small sample volume. These desirable features make it particularly suitable for resource-poor settings. However, these device improvement needs to be studied for commercial use in the future.
Astrocytoma can be found to develop malignancy in 9-23 percent that is significantly associated with poor prognosis. From a literature review, lack of evidence mentioned about risk factors associated with malignant transformation. The study objectives were 1. to identify factors associated with malignant transformation 2. To identify the prognosis of astrocytoma that developed malignant transformation according to biomarkers. Method The present study was a retrospective cohort study and the study population was patients who were diagnosed with low-grade astrocytoma. The processes of the study comprised 4 processes as follows: 1. investigation of the candidate genes from fresh frozen tissue 2. Investigation of candidate gene mutations 3. survival analysis 4. nomogram development. Results Following whole-genome sequencing, IDH 1 and IDH 2 mutations were candidate genes. In 90 patients, IDH 1 and IDH 2 mutations were found in 12.2% and 10%, respectively. Malignant transformation was associated with a short survival time (log-rank test, p=0.006). Factors associated with malignant transformation were a supratentorial tumor, midline shift of more than 1 cm, the extent of resection, and IDH 1 mutations following multivariable analysis. Therefore, a nomogram was developed for predicting malignant transformation. Conclusion Malignant transformation was significantly associated with poor prognosis; therefore, a close follow-up strategy should be applied in high-risk patients.
This study had investigated contaminants and control of antimicrobial-resistant microorganisms (AMR) from hospitals and pig farms. In the study of pig farms, the questionnaire survey was conducted at four farms nearby the surface water body in Prachinburi province. It shows that 50% of the farms use antibiotics for disease prevention and treatment, while that 50% mix antibiotics with feed. The commonly used antibiotics are Amoxycillin (100%), Enrofloxacin (50%), and colistin (25%). The residual antibiotics found during the rainy season were Amoxycillin (54%), Florfenicol (14%), and Tiamulin (13%), of which the concentrations were significantly higher than those found during the summer season (P<0.05). The detection of antibiotic resistance among 143 isolates of E. coli, 29% was in pig manure, 36% in wastewater, and 33% in treated water. Nevertheless, the antibiotics that those isolates were found more than 50% resistant against were Ampicillin (90%), Florfenicol (67%), and Tetracycline (66%), 13% of ESBL. None was of Imipenem resistance. The resistant genes of E. coli were found higher for beta-lactamase followed by Tetracycline (tetA, tetB) and Aminoglycoside (aadA1, aadA2, aadB), while no mcr1 gene showed in all samples. The probability that microorganisms having identical genes of 1 pair (100%) and 80% similarity was about 20%. The study of treatment efficacy of activated sludge (AS) wastewater treatment plant of Chao Phraya Abhaibhubejhr hospital revealed 68-69% removals of basic pollutants, and 20-100% removals of 13 types of antibiotics. A similar AMR population (60-100%) to 20 antibiotics of E. coli, K. pneumoniae, and A. baumannii appeared in wastewater and the AS effluent. The study of pilot-scale membrane bioreactor (MBR) operated without excess sludge wastage in hospital wastewater treatment revealed 79-100% removals of basic pollutants and 32-100% removals of antibiotics. The MBR could effectively remove microorganisms (100%). Antimicrobial resistant test in the MBR sludge revealed higher percentages of sensitive colonies, especially those of K. pneumoniae and A. baumannii >80% were sensitive to 75-85% of tested antibiotics. The 1-2 log reduction of antibiotic resistance genes (ARGs) in the influent with 106-1010 copies/ml by the MBR had been achieved. The use of post-chlorination and ozonation slightly improved in removals of ARGs.
This study is a documentary research and aimed to study and review the contents of international cooperation frameworks at global, regional and national levels concerning issues on migration management and health care provision for migrant workers and cross-national populations and health collaboration frameworks between Thailand and Mekong sub-region countries, especially Cambodia, Lao PDR and Myanmar as well as mechanisms for implementation, coordination, monitoring and evaluation of the international cooperation frameworks. Results of the study revealed that global and regional international cooperation frameworks, with selected criteria mentioned above, have provided concepts and guiding principles for migration management and promotion of migrant and refugee health, which are harmoniously interlinked and aimed to realize the sustainable development goals (SDGs) that facilitate orderly, safe, regular and responsible migration and mobility of people (SDG target 10.7) and ensure healthy lives and promote well-being for all at all ages (SDG goal 3) including achieve universal health coverage (SDG target 3.8). The concepts and guiding principles can be applied by member countries as guidelines for dealing with problems and issues related to migrant workers and cross-national populations or can be used as conceptual frameworks for developing additional agreements to address the issues with countries of mutual interests. Since health management for migrant workers cannot be carried out alone by one country, collaboration and cooperation among the countries of origin or the sending countries and countries of destination or receiving countries are required. As movement of migrant workers can provide both positive and negative impacts on the economic development of countries and the region, integration of migrant health management as a public health issue of international cooperation in existing regional economic cooperation frameworks, such as ACMECS and GMS will help mobilize resources and efforts from member countries to address this issue in more effective and concrete ways, thus, makes the migration to be a positive impact for the overall economic development of the member countries and the region. Recommendations for better dealing with the challenges on provision of health services for migrants and cross-border population have been emphasized on the development of health and health-related policies to solve the obstacles at national level, such as to integrate primary care services or community-based health care provided at migrant community health centers with support and assistance of migrant health workers and migrant health volunteers to be a part of existing universal health insurance system for migrant workers and cross-border population, and the development of bilateral and multilateral international cooperation to mobilize efforts and collaboration in order to reduce negative impacts to the overall economic and social development of the region.
The project, Health Service design in Primary care under situation Covid - 19 diseases Study case of district Yarang, Pattani Province., aimed to stimulate health personnel to recognize the importance of primary health care system and to design their own service delivery responding to unique context complexity at local level in the southern part of Thailand. The project consists of 2 processes as followed. 1) Self-review of Pattani’s health personnel in primary care system to respond to recommended procedures regarding the COVID - 19 epidemic control in communities. The procedures were based on the WHO primary care framework, a framework with community network partners and the analysis of the complexity of the epidemic situation. There has been a response to the government policies and agreements at the area level in order to achieve 3 goals, namely 1) Safety of personnel and provider, 2) Strong community for disease management, and 3) Effective disease control. As a result, target personnel could understand the complexity of the problems and be motivated to develop health service to respond problems that arise. At the same time, the researcher realized that the policy imperative to the main responsible agencies at the national level. There should be preparation and readiness of the whole structure, specific budgets and personnel to cope with future outbreaks and response to chronic disease problems that may require a different management approach. 2) Target personnel development for new health service design by using “Design Thinking” process. The result of the development was a new working design and service system responding to complex health problems at the local level in 4 issues: 1) Anemia problem in pregnant women, 2) Expanding the services access to vulnerable groups, 3) The development of rehabilitation service for stroke patients (Intermediate care), and 4) The development of health service systems for uncontrolled hypertension and diabetes patients. Regarding the new delivery processes design, it was found that the health personnel placed greater emphasis on the primary health care system and the patients were more confident about receiving the service, as evidenced by the co-rehabilitation of 21 stroke patients revealed that 18 patients (85.71%) had increased ADL levels and improved clinical outcomes in a sample of 22 pregnant women with anemia were able to manage the problem in 14 cases (66.66%) without anemia. In addition, all four services were prepared in order to response to the potential recurrent of COVID-19 epidemic in Pattani.
Molecular subtyping of muscle-invasive bladder cancer (MIBC) predicts disease progression and treatment response. However, present subtyping techniques are based primarily on transcriptomic analysis, which is relatively expensive. Subtype classification of protein levels by immunohistochemistry (IHC) are more affordable and feasible to perform in a general pathology laboratory. Recent data demonstrated that GATA3, CK20, CK5/6, and CK14 protein levels were correlated with MIBC molecular subtypes. We aimed to evaluate the correlation of those IHC markers with survival outcomes after radical cystectomy in Thai patients. Moreover, we aim to evaluate molecular subtypings by mRNA expression analysis. We evaluated the IHC-based subtypes in MIBC, as classified by GATA3, CK20, CK5/6, and CK14 expression in 132 MIBC patients who underwent radical cystectomy followed by adjuvant chemotherapy (2008–2016). All individual markers and clinicopathological parameters were analyzed against treatment outcomes after radical cystectomy and some selected tissues were sent for whole transcriptome sequencing and clustering from mRNA expression. The result showed that the mean patient age was 65.6 years, and the male to female ratio was 6.8:1. Positive IHC expression rates of GATA3, CK20, CK5/6, and CK14 were 80.3%, 50.8%, 42.4%, and 28.0%, respectively. The 5-year overall survival (OS) was 27.0% (95% confidence interval (CI) 19.6%–35.0%). Only GATA3 and CK5/6 were significantly associated with survival outcome (log-rank p-values = 0.004 and 0.02). GATA3 and CK5/6 were then used to establish subtypes, which were luminal (GATA+ and CK5/6−, 38.6%), basal (GATA− and CK5/6+, 12.9%), mixed (GATA+ and CK5/6+, 37.9%), and double-negative (GATA− and CK5/6−, 10.6%). Patients with the mixed subtype had a significantly better 5-year OS at 42.8%, whereas patients with the double-negative subtype had the worst prognosis among the four groups (5-year OS 7.14%). In the multivariable analysis, lymph node status and subtype independently predicted survival probability. The double-negative subtype had a hazard ratio of 3.29 (95% CI 1.71–6.32). In conclusion, subtyping using GATA3 and CK5/6 was applicable in MIBCs, and patients with the double-negative subtype were at the highest risk and may require more intensive therapy and mRNA subtyping by mRNA expression must showed the significant relationship with survival rate.
The outbreak of Coronavirus disease 2019 (COVID-19) has a massive impact on health and well-being in all populations especially the vulnerable populations. Due to their vulnerability and limited opportunity to access health services, vulnerable populations have a greater health risk compared with other populations. Despite existing universal health insurance for all populations in Thailand including Universal Health Coverage Scheme (UCS), Civil Servant Medical Benefit Scheme (CSMBS), Social Security Scheme (SSS), and Health Insurance Card Scheme (HICS) for migrant workers and their dependents, there remain some uninsured populations. Therefore, this study aimed to provide policy recommendations to improve the health systems for vulnerable populations in Thailand during the COVID-19 pandemic. Both quantitative and qualitative studies were performed. Firstly, the situation of access to health services among vulnerable populations in Thailand during COVID-19 was studied by using the hospital service records of the Ministry of Public Health (MOPH) (43 folders), a secondary data, from National Health Security Office (NHSO) from January 2020 to June 2021. Secondly, document review regarding access to health services for vulnerable population. s. Lastly, in-depth interviews and focus group discussions on relevant stakeholders were performed to develop recommendations for improving health services for vulnerable populations. In this regard, a total of 39 participants including policymakers, staff responsible for taking care of vulnerable populations, and vulnerable populations were selected by purposive sampling and snowball sampling. The findings demonstrated that vulnerable populations the COVID-19 screening test utilised by vulnerable populations accounted for approximately 1,154,355 records (included all insurance schemes) during January 2020 – June 2021. Focused only on the UCS, there were COVID-19 screening tests in total 939,444 times. The number of visits of vulnerable people receiving COVID-19 tests and treatment in both outpatient (OP) and inpatient (IP) care was about 9,288. The number of deaths of vulnerable populations due to COVID-19 was 216.