plueme/wizJson huggingface dataset:
This action research aimed to develop the community-based cardiac rehabilitation (CR) model for patients with post myocardial infarction, Muang Roi-Et district, Roi-Et province. Participants consisted of post myocardial infarction patients, caregivers, community leaders, stakeholders, and multidisciplinary teams. The study processes followed three phases: 1) situational analysis 2) development and 3) evaluation. Research instruments included in-depth interview questions, questions for a focused group discussion, field note record, after action review record form, readmission record form, six-minute walk test record form, questionnaires of Duke Activity Status Index, questionnaires of Thai Depression Inventory, and questionnaires of The Revised Illness Perception. The data were analyzed using percentage, mean, standard deviation, logistic regression analysis, one way repeated measure ANOVA, inductive content analysis and deductive content analysis. Results: 1) Readmission rate was found at 35.8%. Needs for the development were identified in five dimensions: community participation in the CR, promoting the self-efficacy of patients in the CR, enhancing the capacity of a caregiver network in the community, continuing care, and care coordination between hospital and community 2) the development process consisted of four steps: building awareness and the development needs, building up caring and managing team, a pilot study for the development in a health-promoting hospital model, and expanding networks for the CR in community to other health-promoting hospitals 3) outcomes of the development were as follows. The care network in community, environments and facilities, guidelines, and innovations that contributed to the CR were improved. Health outcome of the patients were improved including (a) the readmission rate in four months decreased from 35.8% to 10% (b) After hospital discharge in 1 week, 1 months, and 4 months, the six-minute walk test and the illness perception scores were significantly differences (F=51.458, p<.001; F=27.092, p<.001, respectively). 100% of patients had an improvement in functional status outcomes, and no patients had depression. The results indicate that the developed model contributes to improving the CR resulting in patients’ better health
Neuromuscular diseases (NMD) are chronic non-communicable disorder mostly caused by genetic abnormality. NMD are considered rare and their treatments are mainly supportive treatment. Genetic-based therapy is a promising specific treatment for the diseases. However, most of them are still in clinical trial phase 2, 3 and expected to be costly and not available in the very near future. We aimed to conduct systematic review of the medical treatments for NMD including repurposing drugs and genetic-based therapy in order to identify best available treatments and prepare for commercial genetic-based therapy. The outcomes of the study are systematic review of the treatments for NMD and a meta-analysis of genetic-based therapy as well as cost of illness in Duchenne Muscular Dystrophy that are expected to shape the treatment guideline in medical practice and contribute the regulation of national drug list.
The global spreading of Coronavirus Disease 2019 (COVID-19) started in late 2019 and still last until today. Globally, more than 30 million people infected and nearly million people died from COVID-19. This emerging infectious disease creates massive impacts to not only health but also social, wellbeing and economic. Tackling with the pandemic, we require multisectoral collaboration across sectors. This study set the aim with “Reclining Infection, Reducing Morbidity and Avoiding Mortality of COVID-19”. In order to achieve this aim, the study 7 strategic areas for Thailand to cope with the outbreak; 1) situation and trend, 2) social measures, 3) public health measures, 4) health system response, 5) research & development, 6) communication and 7) governance. Each strategic area covers situation analysis, measures/interventions implemented, gaps and recommendations. This strategic framework can be applied at national and provincial levels.
Antibiotic-resistant bacterial infections are a major problem at the national level, especially for patients admitted to hospitals. Additionally, patients with infections have a high mortality rate, prolonged length of hospital stay, and high hospital cost. The most common concerned gram-negative bacteria as the major problem is Acetobacter baumannii and Enterobacteriaceae, particularly the strain which is resistant to carbapenam antibiotics. Objectives To study the clinical and molecular epidemiology of carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae in the lower southern hospital network as well as spatiotemporal analysis of these two species from clinical specimens and from screening in patients with systemic survey as well as from the hospital environments in each hospital and in the hospital network. To measure the efficacy of infection control strategies based on the investigational data. Methods To collect the specimens of carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae from clinical practices and surveillance and do the laboratory to identify molecular strain of those specimen. Clinical data was used to analyzed the factors influencing mortality as well as probability for colonization of those bacteria. Clinical and non-clinical outcomes were compared between the patient with colonization and those without colonization. Molecular data and demographic data was used to performed spatio-temporal analysis. The number of the patients infected with these two bacteria was compared before and after intervention. Results From February 2019 to July 2019, there is the distribution of both bacteria every hospital in the network as well as in the whole of network with identically detection of molecular closeness and spatio-temporal relation. The infection due to both bacteria had relatively high mortality and unfavorable economic burden. Factors influencing mortality is Acute Physiology and Chronic Health Evaluation II (APACHE II) score and appropriate empirical antibiotics. Among of the patients with colonization of these two bacteria, unfavorable clinical outcomes and particularly high hospital costs were identified. The significantly associated factors influencing colonization is previous use of antibiotics, particularly carbapenems even the short duration of administration. The number of cases infected with carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae were significantly decreased after implement of infection control measures based on the finding from surveillance data. Conclusion Systematic control of the use of antibiotics is sufficient to reduce the infection due to carbapenem-resistant Acetobacter baumannii and Enterobacteriaceae. Measures for screening patients before admission is potentially necessary supplementary measures.
The increase of older persons accompanying with increasing chronic diseases resulted in high demand for long term care services. To meet the needs of dependent elderly, integration between social care and health cares are needed and that health workforce should be adequate in term of number, distribution, skill, and motivation. This study thus aimed to forecast health workforce requirements and supply as well as develop policy recommendations to address health workforce challenges for long term care services. Secondary data and primary data from surveys and in-depth interview were used. Sample size for self-administered questionnaires comprised 51 representatives and 331 health workforce from long term care facilities, 130 care managers, and 271 care givers. In additional, 42 concerned stakeholders were interviewed. The results showed that, in term of number, the requirements of health professional and care givers are likely to meet the supply in 2026, except those of nurses, social workers and care managers. Other health workforce challenges concerned with distribution, skill and motivation. Health workforce were poorly distributed to long term care and primary care services, skills to look after long term care were inadequate especially those of care givers, and turnover rate of care givers were high particularly at institutional care. To address health workforce challenges for the long- term care services, Thailand should increase the production of health workforce professional and care givers in relation to number and skills. In additional, increase motivation in order to retain them in the system is in need.
Background: Based on national and international guidelines (Kidney Disease Outcomes Quality Initiative-K DOQI) in patients with end staged renal disease, arteriovenous access (AVA) creation without history of central venous catheter (CVC) insertion is the recommended approach, but in Thailand, most hemodialysis patients had experiences of CVC insertion beforehand. Underestimation of consequences of such approach in our patients and medical personnel, might be a cause. Therefore, we aimed to develop the protocol that can improve the outcomes. Methods: Expressed Protocol in Thailand (EPT) was formulated. EPT was composed of: 1) patients who did not have any experience of CVC insertion before AVA creation, 2) patients almost used vein for AVA creation, 3) AVA was under good surveillance after operation. This study plan followed up in 24 months, but this report compared and illustrated the outcome between EPT and non-EPT patients in the 24 months. The outcome included the rate of maturation, AVA complications, central vein stenosis, sepsis, major adverse cardiovascular event (MACE), and the score of Quality of life by SF-36. Results: There were 100 EPT patients and 101 non EPT patients. EPT group had lower cumulative rate of AVA infection (EPT: 0% vs non EPT 7.53%, p = 0.038) than those in non EPT. Also 11.9% in non EPT patients had history of CVC sepsis. Also EPT group had lower rates of central vein stenosis (EPT: 4.34% vs non EPT 11.11%, p = 0.047), than those in non EPT group. However there was no significant difference in the rates of maturation, AVA complications, and cardiovascular morbidity/mortality including MACE between two groups. The score in the Physical Functioning and General Mental Health in EPT group was significantly better than those in non EPT group during 6-18 month. Conclusion: EPT patients had a trend toward lower rates of AVA infection and central vein stenosis, and better quality of life score in terms of Physical Function and General Mental Health than those non EPT patients. Therefore the EPT approach should be recommended more and more in Thailand.
Peripheral arterial disease (PAD) is commonly caused by atherosclerosis. PAD is one of the major health problems in the modern society. Most patients who suffer from diabetes mellitus type II tend to suffer also from a severe PAD complication, i.e., critical limb ischemia (CLI). The main therapeutic approach for CLI is either surgical debridement or endovascular revascularization in order to improve blood flow to the affected body area, like extremity. However, approximately 20-30% of patients with CLI are not able to receive vascular or endovascular procedures and amputation appears to be the only option. This is to say that CLI patients have a relatively high tendency to have their afflicted body parts removed and the mortality rate of this group of patients is also high. With severe obstruction of blood flow, type II diabetic patients often have their limb loss from debridement. To search for the new therapeutic option of PAD/CLI, most of the researchers are focusing on progenitor cells, which were identified as a potential new therapeutic option to induce therapeutic angiogenesis. Recently, cell-based therapy for treating CLI has been introduced. Several studies show that the cell-based therapy for vascular regenerations is safe and effective. Especially, the new culture medium called culture medium which able to enhance quality and quantity mononuclear cell. The recent study reveals the efficacy of QQMNC in angiogenesis and vasculogenesis function already. This study was conducted to further investigate the efficacy and safety in animal model. The QQMNCs were injected to the critical ischemic limb mice model at the site of occlusion intramuscularly, then, the blood perfusion was assessed by using Laser doppler image scan. In this study, the group of nude mice which was injected with QQMNC show a promising angiogenesis and vaslucogenesis significantly while the group of PBMNC injection was not. The PBMNC injection group show gangrene and finally lost their limb. This study show the efficacy and safety in animal model which will pave the way to the next phase of the study about applying this method of QQMNC for treating in critical limb ischemic patient.
This retrospective research is aimed at; to study the situation, results of performance based compensation and analyze factors influencing the compensation according to the performance of service units under the Ministry of Public Health. The qualitative study was performed on group discussion committees (Focus group) involving in performance – based compensation, In-depth interviewing with health personnel. Moreover, the quantitative study was hold in this research which are the secondary data from related documents, data analyzation from various institutes. Including, the financial and accounting information form the hospitals that under Office of the Permanent Secretary, Ministry of Public Health, Health Data Center information, performant - base compensation scoring, human resources information and others. The results explore that Pay for Performance (P4P) is not a burden situation. Rather, it is an administrative tool that affects to the quality development of the hospital. Various hospitals pay for their performance less than the limits set by the Ministry of Health. P4P arrearage was found in many hospitals doe to financial liquidity. The compensation received by each profession in each hospital varies from person to person. P4P can be a drive for tangible outcomes clearly. The management of the P4P has an influence on the success of the P4P payment. It should be integrated P4P system with the hospital accreditation system and routine works development.
This study aimed at describing an investigation of a confirmed coronavirus disease 2019 (COVID-19) case in Chonburi, Thailand. He was the first imported case of COVID-19 from Europe to Thailand. The case was an Italian expatriate working in Chonburi. He left for Italy on 14 February 2020 and returned to Thailand on 1 March 2020. At the port of entry, he passed the temperature scan. The following day, he developed upper respiratory symptoms. The providers at a private hospital performed nasopharyngeal swab (NPS) and throat swab (TS). On 3 March 2020, positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were reported. Subsequently, he was referred to Chonburi Regional Hospital. The investigation team of the Department of Disease Control (DDC), Ministry of Public Health (MoPH), could identify 75 contact persons. Of these 75, 56 were classified as high-risk. Of these 56, 40 were tested for NPS and TS and all were found negative for SARS-CoV-2 infection. The rest 16 contacts could not be reached at the time of investigation but their name list was submitted to the incident commander (IC) and the Immigration Bureau for further tracing. Later, the investigation team found that none of these 16 contacts became positive. Another important discovery from this investigation was that a number of healthcare workers were counted as high-risk contacts due to improper use of personal protective equipment (PPE). The report of this investigation raised the concern for proper PPE application amongst healthcare workers to the Emergency Operating Center (EOC) of the MoPH. Outcomes from this event in combination with other events alike were fed into policy decision making process of the MoPH. The MoPH later launched a message to emphasize the importance of proper PPE application amongst healthcare providers to minimize the number of high-risk healthcare-worker contacts who would be subject to a 14-day quarantine. In addition, the MoPH also underpinned that the self-quarantine measure must be strictly enforced to mitigate the risk of wider disease spreading.
Background and Rationale: An implementation research on integrated people-centered primary care has developed protocols and piloted new care processes to patients with diabetes and hypertension in 20 primary care clusters (PCCs) in Thailand. This study was conducted after 4 months of implementation aiming to assess care process provided by the piloted PCCs compared with other types of health facilities within the same district. Methodology: A survey of providers’ opinion on care process provided by themselves was conducted. Samples were all health workers providing care to patients with diabetes and hypertension in 4 types of health facilities in 20 districts, these included 301 piloted PCCs, 240 PCCs outside the project, 172 hospital non-communicable disease clinics, and 351 non-PCC health centers. A self-assessment form developed by the researchers was employed. The form covered 5 care process components: patient-provider relationships, shared care plan, health information system, self-management support, continuity of care and coordination including organizational supports. Data analysis was done using ANOVA test and the least significant difference test. Results: People working in piloted PCCs reported high mean scores on patient-provider relationships, shared care plan, health information system, self-management support, and continuity of care and coordination as 6.3, 6.1, 6.7, 5.9 and 6.3 respectively. Mean scores of all dimensions of the piloted PCCs were significantly higher than those of other types of health facilities (p-value < 0.05). Conclusion and discussion: The piloted PCCs reported highest integrated people-centered care to patients with diabetes and hypertension compared with all other types of health facilities. However, the self-management support got the lowest score that needed further strengthening. Further research on implementation outcomes was proposed including capacity building of staff on essential skills in providing integrated people-centered care.
Background & Rationale: Duplicate medication is irrational drug use that can cause adverse drug events to patients and wasteful health expenditure. There have been a limited number of studies on duplicate prescribing in Thailand. The objective of this study was to develop a computer software to prevent therapeutic duplicate prescription and to determine its effects in Mahasarakham Hospital. Methodology: This research and development comprised three parts. Part 1 described characteristics and magnitudes of duplicate drug prescribing in the hospital using electronic database of 12 drug groups (39 drug items) during 1 October 2018 – 30 September 2019. Part 2 developed a computer software based on results of part 1 and implemented the software in November 2019. Part 3 examined effects of the software by comparing proportions of duplicate drug prescriptions during, before (November 2017 – April 2018) and after software implementation (November 2019 – April 2020). Results: Of total 218,179 prescriptions, 818 duplicates (0.37%) were found, of which 576 (0.26%) were duplicate medication at the same therapeutic groups and 242 (0.11%) at the same drug item. Moreover, 530 duplicates (0.24%) were detected in the same prescription and 288 duplicates (0.13%) detected in the same patient. The highest duplicate medication rate was found in the gastric secretion inhibitors group (378/36,495 prescriptions, 1.04%), followed by antihistamine (130/13,433 prescriptions, 0.97%) and NSAIDs (184/29,783 prescriptions, 0.62%). These duplicates costed around 19,740 – 79,591 baht/year. The software detected any duplicate medications prescribed in the same therapeutic drug, same patient and same day and alert prescribers/ pharmacists for clarification. After software implementation, the duplicate drug prescribing decreased significantly from 0.27% (266/100,367 prescriptions) to 0.08% (75/95,350 prescriptions) or a 70.3% reduction (OR 0.296, 95%CI: 0.226-0.384, p < 0.001). The excess healthcare cost declined by 4,098 – 18,360 baht/6 months or 8,196 – 36,720 baht/year. Conclusion: The developed computer software was effective in preventing duplicate prescription and reducing unnecessary healthcare cost. Future studies should determine duplicate drug prescription and prevention program at national level to support rational drug use and reduce healthcare cost in Thailand.
The cross-sectional survey research was conducted to study the situation of employment of retired nurses in hospitals under the Permanent Secretary Office of the Ministry of Public Health. The data on employment of retired nurses were surveyed from regional hospitals, general hospitals and community hospitals during fiscal year 2019-2020. The results show that there were 31 of 116 regional and general hospitals (26.7%) that employed retired nurses in 2019. In the fiscal year 2020, there were 28 hospitals (24.1%) that employed 162 retired nurses. For community hospitals, 20 of 780 hospitals (2.6%) employed 32 retired nurses in 2019 and reduced to 18 hospitals employing 20 retired nurses in 2020. Hospitals in the central and the eastern regions had the highest employments of retired nurses. There were 2 types of job characteristics (nursing work and non-nursing work such as health information management and health record). The pattern of employment was either full-time or part-time. Many payment arrangements were reported, such as daily payment (at a rate of 600-800 baht a day), monthly payment, and performance compensation. However, all payments were based on the regulations of the Ministry of Public Health. As for community hospitals, 20 hospitals employed 32 retired nurses (2.6%) in 2019, and reduced to only 18 hospitals employing 20 nurses (2.3 %) in 2020. During the fiscal year 2019-2020, hospitals in the central and the eastern regions (Health Region 4, 5 and 6) reported the highest employment rate than other regions. Regarding the 2 types of employment: 1) the nursing work employment was reported at the outpatient department, inpatient wards, special clinics and antenatal care clinics, accident and emergency department, central dispensing unit, breast feeding clinic, orthopedic department, primary and community care unit, and diabetes clinic. 2) The non-nursing work employment was reported in other departments such as in the medical records audit, the outreach health check unit, the patient complaint services, the health insurance center, and the public relations. The monthly payment was approximately 13,000-20,000 baht a month. The time-based payments varied as 100 baht an hour for working in the central supply unit, 80 baht an hour for other units, 450-600 baht a day for the patient complaint services, and the public relations, respectively. The results revealed the situation of employment of retired nurses, the characteristics and the patterns of employment. These results should be useful for policy development on human resource planning. Moreover, employment of retired nurses at different levels of health sectors should be further researched.