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คู่มือปฏิบัติงาน การกำหนดสิทธิ์การเข้าใช้งานของแพทย์ในโรงพยาบาลศิริราชบนระบบ eHIS
(2565) สิทธี สามกองงาม
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High-velocity nasal insufflation with oxygen assist module versus conventional high-velocity nasal insufflation after extubation: an open-label randomized crossover study
(2025-01-24) Visuthisakchai S.; Lersritwimanmaen P.; Rittayamai N.; Visuthisakchai S.; Mahidol University
Background: The current technology of high-velocity nasal insufflation (HVNI) can be equipped with an oxygen assist module (OAM) that continuously monitors and automatically adjusts the inspired oxygen fraction (FiO2) to maintain oxygen saturation by pulse oximetry (SpO2) within the target range. This study aimed to evaluate the use of HVNI with OAM compared to conventional HVNI in patients after endotracheal extubation. Methods: This randomized crossover study enrolled 16 mechanically ventilated subjects who were ready to wean. The subjects were randomized to protocol A (HVNI with OAM for 60 min, followed by conventional HVNI for another 60 min) or protocol B (conventional HVNI for 60 min, followed by HVNI with OAM for another 60 min) after extubation. In HVNI with OAM, the target SpO2 was set at 94% with a range of 92-98%, temperature of 37 °C and flow rate of 40 L/min. In the conventional HVNI group, the attending physician adjusted the FiO2 to maintain an SpO2 of at least 94%. The primary outcome was the time in the SpO2 range between the two groups. The secondary outcomes included FiO2, transcutaneous carbon dioxide pressure (PtcCO2), respiratory rate oxygenation (ROX) index, and hemodynamic variables. Results: HVNI with OAM significantly maintained SpO2 within the target range compared to conventional HVNI [99.4% (97.4-99.8%) vs. 5.3% (1.5-68.1%); P=0.001]. The use of FiO2 was significantly lower and the ROX index was significantly higher at the end of the study in the HVNI with OAM group than in the conventional HVNI group [0.22 (0.21-0.25) vs. 0.40 (0.40-0.40); P=0.001 and 22.26 (15.94-26.46) vs. 13.01 (10.72-14.66); P=0.001, respectively]. No differences in breathing frequency, PtcCO2 or hemodynamic variables were observed between the two groups. Conclusions: HVNI with OAM can maintain SpO2 within the target range while using a lower FiO2 and providing a higher ROX index than conventional HVNI in patients after extubation. Trial Registration: This study was registered in the Thai Clinical Trial Registry (TCTR20220801007) before the inclusion of the first patient.
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The effect of additional proprioceptive neuromuscular facilitation (PNF) training on functional hop test in cerebral palsy athletes: a pilot clinical trial
(2024-01-01) Al Hazmy A.; Andriati; Wardani N.K.; Indriani D.; Azizah A.N.; Al Hazmy A.; Mahidol University
Introductions. This study investigates the effects of additional proprioceptive neuromuscular facilitation (PNF) training on functional hop test in cerebral palsy athletes. Methods. This is a pilot randomized controlled trial study. The subjects were professional cerebral palsy athletes from National Paralympic Indonesia, 24 athletes aged 18-40 years divided into two groups (n = 12). The interventional group received 2 times per week resistance training and additional PNF training 3 times per week, and the control group underwent resistance training program only 2 times per week for 4 weeks on both legs. This study measured several variables, including age, body weight, body height, and body mass index. We measured functional hop test before and after 4 weeks of intervention by single hop test, triple hop test, crossover hop test in dominant and non-dominant legs. Results. There was a significant increase in the hop distance of the intervention group in the single hop test on the dominant side (p = 0.000) and non-dominant side (p = 0.000), triple hop test on the dominant side and non-dominant side (p = 0.000), crossover hop test on the dominant side (p = 0.000) and non-dominant side (p = 0.000). In the control group, there was also significant increase in hop distance on single hop test non-dominant (p = 0.007), triple hop test dominant (p = 0.011), triple hop test non-dominant (p = 0.026), crossover hop test dominant (p = 0.006), non-dominant crossover hop test (p = 0.003). There was no significant difference in the jump distance between the two groups on both sides of the leg, but there was a significant difference in the difference in the increase in jump distance between the two groups. Conclusion. There were better results of functional hop test in cerebral palsy athletes with the additional PNF training.
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Short- and Long-Term Outcomes of Patients Who Underwent the Arterial Switch Operation at Siriraj Hospital—Thailand’s Largest National Tertiary Referral Center
(2025-01-01) Hannarong J.; Tocharoenchok T.; Sriyoschati S.; Thongcharoen P.; Tantiwongkosri K.; Nitiyarom E.; Subtaweesin T.; Hannarong J.; Mahidol University
Objective: The aim of this study was to assess the short- and long-term outcomes of patients who underwent the arterial switch operation (ASO) at Siriraj Hospital in Thailand, and to identify postoperative complications and factors that significantly affect patient survival. Materials and Methods: We retrospectively studied all patients with dextro-transposition of the great arteries and anatomic variants who underwent the ASO from January 1995 to December 2020. Twenty-year overall survival and 15-year freedom from reoperation/reintervention were estimated using the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were used to identify factors independently associated with 30-day mortality. Results: Of the 171 patients included, there were 116 males (67.84%). The median (minimum, maximum) age at operation was 33.5 (3-4,499) days, and the median (minimum, maximum) bodyweight was 3.4 (2.2-44.9) kg. Most patients (115/171, 67.25%) had an intact ventricular septum, whereas 48/171 (28.07%), had ventricular septal defects. The typical coronary anatomic pattern (1LCx-2R) was found in 120 patients (70.1%). Early mortality was 8.7% ± 4.4%, and there was no late death up to 20 years postoperatively with a median follow-up of five years. Fifteen-year freedom from reoperation or reintervention was 85.7%. Atypical coronary pattern was an independent factor for survival with an adjusted hazard ratio of 5.1 (95% confidence interval: 1.22-21.4; P =.026). Conclusions: The results of this study revealed excellent short- and long-term outcomes of the ASO at our center. Atypical coronary anatomy was found to be the only factor that independently predicted 30-day mortality.
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The relationship between stress, social support, and quality of life among spouses of patients at the end-of-life stage in Thailand: A correlational study
(2025-01-01) Thawonphat R.; Junda T.; Sumdaengrit B.; Thawonphat R.; Mahidol University
Background: Non-communicable diseases have become a leading global health challenge, with mortality rates steadily rising. Insufficient patient care can worsen chronic illness, often placing significant caregiving responsibilities on the patient’s spouse. In some cases, spouses may need to leave their jobs to provide full-time care, especially during the end-of-life stage. Spousal caregivers often face emotionally distressing circumstances while caring for their loved ones, which can lead to elevated stress levels. However, research indicates that adequate social support can improve caregivers’ quality of life, reducing some of the burdens associated with end-of-life care. Objectives: This study aimed to assess and analyze the relationships between stress, social support, and quality of life experienced by spousal caregivers in Thailand, guided by Lazarus and Folkman’s (1984) Stress and Coping Theory. Methods: A correlational descriptive study design was used. The study was conducted with 84 spouses of patients in the end-of-life stage at a university hospital between October 2021 and March 2022. Data were collected using a questionnaire covering stress, social support, and quality of life and analyzed using Pearson’s Product Moment and Spearman Rank Correlation Coefficients. Results: The majority of spouses were women aged between 31 and 83 years (Mean = 61.24, SD = 10.42). The mean stress level was 6.40 (SD = 1.62), the mean social support was 55.07 (SD = 9.06), and the mean quality of life was 94.69 (SD = 10.04). There was no significant correlation between social support and stress (r = -0.098, p = 0.373). However, stress was negatively correlated with quality of life (r = -0.299, p = 0.006), and social support was positively related to quality of life (r = 0.219, p = 0.045). Conclusion: Spousal caregivers of patients at the end-of-life stage experienced varying levels of stress, social support, and quality of life. While no significant relationship was found between social support and stress, stress negatively impacted quality of life, while higher social support was associated with improved quality of life. Healthcare providers, especially nurses, should assess and address the stress, social support, and overall well-being of spousal caregivers to enhance their quality of life.