Srinagarind Medical Journal

Knowledge, Dietary Behavior, and Health Status in Hemodialysis Patients following an Application-based Self-management Model

2026-04-22T14:28:04+07:00

Background and objectives: Self-management plays a crucial role in maintaining fluid and electrolyte balance among patients with end-stage kidney disease undergoing hemodialysis. However, education provided in dialysis units is often episodic and may be insufficient to support sustained behavioral change. This study aimed to assess changes in knowledge, dietary behavior, and clinical parameters including blood pressure and serum electrolyte levels following the implementation of an integrated application-based self-management model in hemodialysis patients.

Methods: A quasi-experimental one-group pretest–posttest study was conducted in five hemodialysis units in Maha Sarakham Province. Ninety-nine patients with end-stage kidney disease participated in a 4-week application-based self-management program, which included educational content, behavior tracking, and two-way communication with healthcare providers. Pre–post differences were analyzed using paired t-tests.

Results: After the intervention, knowledge scores related to fluid and nutrition significantly increased (p<0.001) from 8.43±1.67 to 9.11±1.22 (p<0.001) and 7.23±1.67 to 8.44±1.22 (p<0.001) accordingly. The mean self-care behavior score improved from 10.34±2.29 to 13.36±1.64 (p<0.001). While the frequency of salty food consumption during breakfast and lunch decreased significantly from 8.40±18.10 to 5.00±14.40 and 13.90±23.00 to 8.10±17.90. However, no statistically significant changes were observed in blood pressure or serum electrolyte levels, both of which remained within clinically acceptable ranges.

Conclusions: The application-based self-management model was associated with improvements in knowledge and self-care behaviors among hemodialysis patients, although no short-term changes in clinical parameters were observed. These findings suggest the potential role of digital health tools in supporting continuous care in real-world settings. Further studies with controlled designs and longer follow-up periods are warranted to confirm these findings.

Prognostic Factors for Prolonged Length of Stay in Hip Fracture Patients: A Retrospective Cohort Study at Mae Sot Hospital

2026-04-01T16:13:37+07:00

Background and objectives: Hip fracture in older adults is associated with substantial morbidity, mortality, and healthcare utilization. Prolonged hospital length of stay (LOS) after hip fracture surgery is clinically important because it may reflect delayed recovery, increase resource use, and be associated with poorer outcomes. However, evidence on potentially modifiable predictors of prolonged LOS in general hospitals in Thailand remains limited. This study aimed to identify prognostic factors associated with prolonged hospital LOS in elderly patients undergoing hip fracture surgery at Mae Sot Hospital. Secondary objectives were to evaluate the association of prolonged LOS with hospitalization cost and 1-year mortality.

Methods: This retrospective cohort study included patients aged 60 years or older who underwent surgery for hip fracture at Mae Sot Hospital between January 2018 and December 2023. Prolonged LOS was defined as a hospital stay of more than 10 days. Demographic, clinical, perioperative, and rehabilitation-related variables were analyzed. Univariable and multivariable regression analyses were performed to identify factors associated with prolonged LOS. Additional analyses were conducted to examine the association of prolonged LOS with hospitalization cost and 1-year mortality.

Results: A total of 223 patients were included. Delayed surgery of more than 3 days was independently associated with prolonged LOS, whereas early rehabilitation was associated with a reduced likelihood of prolonged LOS. Prolonged LOS was also associated with increased hospitalization cost. In univariable analysis, prolonged LOS was associated with higher 1-year mortality.

Conclusions: In this general hospital setting, delayed surgery and lack of early rehabilitation were important factors associated with prolonged hospitalization after hip fracture surgery. Prolonged LOS was also associated with higher hospitalization cost and worse 1-year survival. These findings support efforts to improve early surgical access and timely postoperative rehabilitation in elderly hip fracture care.

Association Between Hypomagnesemia and Albuminuria in CKD Patients

2026-04-16T10:41:10+07:00

Background and objective: Hypomagnesemia is common in patients with chronic kidney disease (CKD) and may increase cardiovascular risk. Albuminuria is an important marker of CKD severity and is also associated with cardiovascular outcomes. However, evidence regarding the association between hypomagnesemia and albuminuria in CKD remains limited. This study aimed to investigate the association between hypomagnesemia and albuminuria in patients with CKD, and to evaluate the relationship between fractional excretion of magnesium (FEMg) and albuminuria.

Methods: A cross-sectional study was conducted among CKD patients attending the CKD clinic at Thasala Hospital between December 2025 and January 2026. Participants were classified into hypomagnesemia (serum Mg < 1.7 mg/dL) and normomagnesemia groups. Albuminuria was defined as UACR > 30 mg/g. Clinical characteristics and laboratory parameters were compared between groups. Factors associated with hypomagnesemia were assessed using univariate and multivariable analyses. ROC curve analysis was performed to determine the optimal cut-off values of UACR for discriminating hypomagnesemia, and of serum magnesesium and FEMg for discriminating ablumminuria.

Results: A total of 131 patients were included (median age 69 years; 51.9% female). Albuminuria was present in 69 patients (52.7%), and hypomagnesemia was observed in 35 patients (26.7%). In multivariable analysis, albuminuria was independently associated with hypomagnesemia (OR_adj = 3.65, 95% CI 2.46–5.25; p < 0.001). Lower estimated glomerular filtration rate (eGFR) (OR_adj = 1.09, 95% CI 1.02–1.18; p = 0.017) and longer CKD duration (OR_adj = 1.01, 95% CI 1.00–1.02; p = 0.011) were also significantly associated with hypomagnesemia. ROC curve analysis identified an optimal UACR cut-off of 80.0 mg/g for discriminating hypomagnesemia (AUC = 0.857), a serum magnesium cut-off of < 1.60 mg/dL for discriminating albuminuria (AUC = 0.743), and an optimal FEMg cut-off of 8.36% for discriminating albuminuria (AUC = 0.743).

Conclusions: Albuminuria was independently associated with hypomagnesemia in patients with CKD. Lower eGFR and longer CKD duration were also associated with hypomagnesemia.

Prevalence and Associated Factors of Anesthesia-related Complications in Patients Undergoing One-day Colonoscopy under the Colorectal Cancer Screening Program at Crown Prince Kranuan Hospital

2026-04-08T09:36:16+07:00

Background and objective: Colorectal cancer (CRC) is the fourth most common cancer in Thailand. Colonoscopy under sedation is the standard procedure for CRC screening and diagnosis. However, it carries a risk of anesthetic complications. This study aimed to determine the prevalence of anesthetic complications and the associated factors of patients who undergoing the one-day colonoscopy.

Methods: A retrospective descriptive study was conducted by reviewing medical records of 178 patients aged 50–70 years who underwent one-day colonoscopy at Kranuan Crown Prince Hospital from April to July 2024. Prevalence of anesthetic complications and associated factors were analyzed with statistical significance level at p < 0.05.

Results: The majority of patients were female (58.4%) with age range between 59.37 ± 5.21 years. Most patients were classified as ASA class II (53.4%). Fentanyl combined with propofol was the most commonly used as sedation regimen (92.7%). The overall complication rate was 11.23%; anesthetic complications occurred in 10.67% of patients, comprising bradycardia (9.55%) and hypotension (1.12%) and procedure-related complication (colonic perforation) occurred in 0.56%. No respiratory complications were observed. The type of procedure was the only factor significantly associated with complications. The patients who received colonoscopy with polypectomy had a higher complication rate than the patients who undergone diagnostic colonoscopy only. Other factors including age, sex, BMI, comorbidities, ASA Physical status, and sedation drug type and dose were not significantly associated with complications.

Conclusions: One-day colonoscopy under sedation demonstrated a high safety profile. All complications were minor and simply managed by anesthetic unit. The type of endoscopic procedure (colonoscopy with polypectomy) was the only factor associated with anesthetic complications. These findings provide valuable data for developing surveillance protocols and improving patient care quality in CRC screening programs.

Effectiveness of Intraoperative 0.25% Povidone-iodine Irrigation during Cataract Surgery for Prevention of Postoperative Endophthalmitis

2026-04-29T16:02:57+07:00

Background and objective: Cataract is a major cause of treatable blindness, while postoperative endophthalmitis, although rare, is a severe complication. The objective of this study was to evaluated the safety and clinical outcomes of intraoperative 0.25% povidone-iodine irrigation during cataract surgery for prevention of postoperative endophthalmitis.

Methods: A retrospective review of medical records was conducted in patients who underwent cataract surgery between January 1, 2021, and March 30, 2025, with intraoperative irrigation using 0.25% povidone-iodine solution. Data were analyzed using descriptive statistics.

Results: A total of 838 patients were included with mean age 66.9 ± 9.6 years, most were female (56.9%). The majority underwent phacoemulsification with intraocular lens implantation (97.6%). On postoperative day 1, anterior chamber inflammation graded 1+, 2+ and 3+ were observed in 28.6%, 60.0% and 11.4%, respectively, decreasing to trace in 99.5% within 7 days. The mean time to absence of inflammation was 32.9 ± 6.9 days. No postoperative endophthalmitis was detected during mean follow-up of 9.9 ± 6.0 months. Postoperative visual acuity of 6/12 or better was achieved in 77% of patients after 6 months of surgery.

Conclusions: The intraoperative use of 0.25% povidone-iodine solution during cataract surgery demonstrated a favorable safety profile and acceptable clinical outcomes, with no cases of postoperative endophthalmitis observed during the follow-up period. However, as this study did not include a comparison group, it could not determine whether the preventive effect against postoperative endophthalmitis differed from that of no prophylactic use or other preventive approaches.

Outcomes of Transcatheter Atrial Septal Defect Closure in Adult: A Retrospective Study at Queen Sirikit Heart Center of the Northeast, Khon Kaen University

2026-03-11T14:11:23+07:00

Background and objectives: Transcatheter device closure is currently the first-line treatment for secundum atrial septal defect (ASD). After transesophageal echocardiography (TEE) confirms suitable anatomy for device closure, normally patients are often scheduled for transcatheter treatment because of shorter recovery time, reduced length of hospital stays, and fewer complications compared with surgery. This study aimed to evaluate the outcomes of transcatheter closure of secundum ASD in adults at Queen Sirikit Heart Center, Khon Kaen University.

Methods: This retrospective descriptive study included adult patients aged over 18 years with secundum ASD treated at Queen Sirikit Heart Center, between April 1, 2018, and March 31, 2024. TEE was performed to assess defect size and surrounding rims. Patients with anatomy suitable for device closure underwent transcatheter ASD closure. The primary outcome was procedural success rate, and the secondary outcome was the incidence of complications.

Results: A total of 132 patients were included, with a mean age of 50.9 ± 15.5 years; 105 patients were female (79.5%). The most common presenting symptom was dyspnea. The mean ASD size measured by TEE was 2.12 ± 0.59 cm. Mild pulmonary hypertension was observed, with a mean pulmonary artery pressure of 30 mmHg. Successful transcatheter closure was achieved in 130 patients (98%). The mean length of hospital stay was 2 days. No major complications were observed. Minor complications included arrhythmia in 10 patients (7.7%) and mild residual shunt in 7 patients (5.4%) after device closure.

Conclusion: Transcatheter device closure for secundum atrial septal defect is a safe and effective treatment in adult patients. This study suggested detailed anatomical assessment using transesophageal echocardiography is essential for optimal outcomes. Our findings also show that the procedure offers short recovery time, minimal invasiveness, short hospital stay, and a low complication rate. Minor complications included arrhythmia and mild residual shunt.

Efficacy and Safety of Two Doses of Local Anesthetic for Transesophageal Echocardiography Preparation in Cardiovascular Patients: A Single-Center Randomized Controlled Trial at Queen Sirikit Heart Center, Khon Kaen University.

2026-03-25T08:18:34+07:00

Background and objective: Transesophageal echocardiography (TEE) is used to evaluate cardiovascular patients. Before the procedure, patients are prepared by administering local anesthetic drug to the oral cavity and pharynx. This study aimed to compare the effects of two doses of local anesthetic in order to evaluate efficacy, safety, and drug-related side effects.

Methods: This study was a randomized controlled trial that divided patients undergoing TEE into two groups. One was the intervention group, which received a lower dose local lidocaine, and the other was the control group. The study was conducted from 16 June 2024 to 30 April 2025. The primary outcomes was the success rate of TEE insertion, and secondary outcomes were complications during TEE insertion and side effects of lidocaine.

Results: 70 patients were enrolled, the intervention group of 36 and control group of 34. The mean age of patients in the intervention group and control group were 51.1 ± 16.2 yrs and 53.7 ± 12.0 yrs, respectively. Most patients had Modified Mallampati class I or II airway. Total lidocaine dose was 85.0 ± 7.4 mg in the intervention group and 201.2 ± 4.1 mg in the control group, although 10% lidocaine spray was more frequently required in the intervention group (p = 0.007). TEE insertion was successful in both groups. There were no complications during TEE insertion, however side effects of lidocaine were more commonly found in the control group such as bitter taste and perioral paresthesia (p < 0.001).

Conclusions: An intervention group, which used lower dose of local lidocaine, was effective for preparation before TEE, with comparable efficacy to the control group. TEE insertion was successful, with no complications and no drug-related side effects observed.

Incidence and Impact of Drug-related Problems on Asthma Control, and Effectiveness of a Pharmacist-led Education Program in Pediatric Asthma

2026-03-10T09:58:01+07:00

Background and objectives: Asthma is the most common chronic disease in children, with a prevalence of 13% in Thailand. Drug-related problems (DRPs), including poor medication compliance and incorrect inhaler technique, are major contributors to uncontrolled asthma. This study aimed to determine the incidence and types of DRPs, to evaluate the association between DRPs and asthma control, and to assess the effectiveness of a pharmacist-led education program on asthma control at Srinagarind Hospital, Khon Kaen University.

Methods: This was a retrospective observational study utilizing electronic medical records of pediatric patients with asthma aged less than 18 years attending the Pediatric Respiratory Clinic between January 1, 2023 and December 31, 2024. The outcomes of interest included: (1) the incidence and types of DRPs, encompassing poor medication compliance and incorrect inhaler technique; (2) the association between DRPs and asthma control; and (3) the rate of asthma control following a pharmacist-led education program. Asthma control was assessed according to the Global Initiative for Asthma (GINA) 2024 criteria at the subsequent clinic visit. Data were analyzed using the Chi-square test and Fisher’s exact test to compare DRP incidence and asthma control rates, and multiple logistic regression to identify independent factors associated with uncontrolled asthma.

Results: A total of 303 patients were enrolled, of whom 58.4% were male, with a mean age of 8.0 ± 3.5 years. DRPs were identified in 45.9% of patients. Poor medication compliance was independently associated with uncontrolled asthma (adjusted OR 2.04, 95% CI 1.09–3.80, p = 0.020). Following the pharmacist-led education program, 69.8% of patients with DRPs achieved asthma control (p = 0.003). The highest asthma control rate was observed in the 0–4 year age group (81.3%, p = 0.001), followed by the 6–12 year age group (76.9%, p = 0.008), whereas the adolescent group aged 12–18 years demonstrated the lowest control rate (45.8%, p = 0.200).

Conclusions: DRPs were highly prevalent among pediatric asthma patients, particularly poor medication compliance, which was independently and significantly associated with uncontrolled asthma. The pharmacist-led education program demonstrated favorable effectiveness in young children and school-aged children; however, targeted strategies for adolescents were still needed. These findings supported the integration of clinical pharmacist roles and systematic DRP screening into routine asthma care.

The Influence of Nursing Leadership Components on Nurses’ Performance: A Systematic Review

2026-03-13T10:26:20+07:00

Background and objectives: Nursing leadership is a critical factor that affects nurses’ work performance and the quality of nursing care in healthcare systems. This study aimed to synthesize nursing leadership components that influence nurses’ performance through a systematic literature review.

Methods: A systematic literature review was conducted following PRISMA 2020 guidelines. Six electronic databases (CINAHL, Cochrane, EMBASE, HealthSTAR, Medline, and PsychINFO) were searched for articles published since 2000 to the persent. Articles were selected based on relevance to nursing leadership and nurses’ performance. Quality assessment was performed using Cummings and Estabrooks’ tool. Data were analyzed using content analysis.

Results: From 2,847 articles identified, 12 met the quality criteria. Five main components of nursing leadership affecting nurses’ performance were identified: (1) Professional autonomy, (2) Work relationships, (3) Access to resources, (4) Nurse characteristics, and (5) Leadership behaviors. These components showed positive relationships with nurses’ motivation and performance effectiveness.

Conclusions: Nursing leadership influences nurses’ performance through five main components. Nurse managers should develop leadership skills that promote autonomy, build positive relationships, allocate resources appropriately, and demonstrate supportive leadership behaviors

Outcomes of Arteriovenous Fistula Creation for Hemodialysis in End-Stage Renal Disease Patients: A Case Study at Kalasin Hospital

2026-04-08T13:00:45+07:00

Background and objectives: Although arteriovenous fistula (AVF) creation is the stand method for vascular access in patients with end-stage renal disease (ESRD), evidence regarding outcomes and complications in provincial hotpital settings is still limited. This study aimed to evaluate AVF outcomes including primary/secondary patency rates, thrombosis, infection, stenosis requiring intervention, and CVC usage among ESRD patients at Kalasin Hospital.

Methods: This was a retrospective descriptive study using medical records of 156 ESRD patients who underwent AVF creation between October 2023 and September 2025.

Results: Mean age 58.4 ± 12.3 years; 54.5% male; diabetes 62.8%; hypertension 74.4%; radiocephalic AVF 58.3%. Maturation rate was 78.2%. Primary patency rates at 6 months, 1 year, and 2 years were 82.1%, 68.6%, and 54.3%; secondary patency rates were 91.7%, 83.3%, and 72.4%. Thrombosis 16.7%, infection 2.6%, significant stenosis 21.8%, CVC required 37.2%. Independent predictors of primary failure: female sex (OR = 2.14, 95%CI: 1.12-4.09, p = 0.021), diabetes (OR = 1.87, 95%CI: 1.03-3.40, p = 0.041), wrist AVF (OR = 2.43, 95%CI: 1.29-4.59, p = 0.006).

Conclusion: AVF outcomes at Kalasin Hospital were within acceptable international standards, with areas for improvement in reducing primary failure among female and diabetic patients through optimal surgical site selection.

Development of an Integrated Innovative Management Model for Enhancing Screening and Culturally Tailored Health Literacy among Liver Fluke and Cholangiocarcinoma High-risk Groups

2026-04-02T14:00:26+07:00

Background and objectives: Cholangiocarcinoma (CCA) remains a critical emerging public health challenge, with Thailand reporting the highest problem globally. This study aimed to investigate existing problems and needs, develop and implement an integrated management model, and evaluate its effectiveness in enhancing screening efficiency and culturally tailored health literacy.

Methods: This study employed a research and development (R&D) design, conducted in four phases. In Phase 1, the sample consisted of 500 at-risk individuals aged 15 years and older. Phase 2 involved 12 administrators and relevant stakeholders, along with 9 experts who validated the proposed model. Phase 3 included 120 research participants and 12,697 at-risk individuals aged 15 and above who underwent screening. Finally, Phase 4 involved 9 experts for the final quality evaluation of the model. Data were collected using questionnaires, focus group interview guides, performance records, and standardized assessment forms. Data analysis was performed using descriptive statistics, content analysis Z-test and, Wilcoxon signed rank test. Statistical significance was set at a 95% confidence interval (p < .05).

Results: The study results are as follows: 1) Situational Analysis: Findings revealed a critical disconnect between state policies and the sociocultural realities of local communities, where the traditional consumption of raw fish persists. Additional barrier included delayed access to screening systems, a lack of effective inter-agency coordination, and the failure of conventional health communication strategies to trigger authentic, subconscious behavioral shifts. 2) Integrated Innovative Management Model: The developed model comprises four primary strategic activities: (1) Analysis of localized behaviors and cultural values; (2) Implementation of a screening management system spearheaded by Village Health Volunteers (VHVs); (3) Targeted behavioral modification interventions; and (4) Utilization of information technology for individualized health monitoring and follow-up. 3) Effectiveness of the Screening and Referral System: The screening identified suspected Cholangiocarcinoma (CCA) cases at a rate of 0.90%. Following the intervention, the target group exhibited significantly higher median scores in health literacy, awareness, and health-related behaviors compared to the pre-intervention period, with a moderate effect size, and 4) Lessons Learned and Model Validation: The synthesis of the model’s implementation underscored its core principles, primary objectives, operational processes, evaluation frameworks, and critical success factors for scalability. The finalized model was rigorously validated, demonstrating a high level of overall appropriateness and accuracy (μ= 4.49, σ = 0.25).

Conclusion: The developed integrated health innovation significantly improved screening participation and health literacy among high-risk groups. Relevant authorities should consider scaling this model to other endemic areas.

Pre-employment Health Examinations: Evidence and Implications for Practice in Thailand

2026-03-30T07:58:57+07:00

Background and objective: Pre-employment health examinations are widely used, however, their effectiveness in preventing adverse occupational health outcomes remains in question. Therefore, this study aimed to examine the evidence on the effectiveness of pre-employment and pre-placement assessments and to consider their implications for practice, with particular reference to Thailand.

Methods: This study is a narrative review synthesizing evidence from studies identified through database searches (PubMed and Scopus), focusing on effectiveness, predictive value, and implications of pre-employment and pre-placement assessments.

Results: Overall, current evidence is insufficient to support a routine pre-employment examination in reducing occupational injury, illness, or sickness absence. Some evidence suggests that assessments focused on specific job risks may be more appropriate.

Conclusions: A targeted, risk-based approach is more appropriate than routine screening. In Thailand, a gap exists between policy and practice. Further research is required to support evidence-based occupational health policies.

Role of Tarlatamab in Extensive Stage Small Cell Lung Cancer

2026-02-21T17:07:19+07:00

Lung cancer is one of the most common cancers and remains the leading cause of cancer-related deaths worldwide. Currently, novel therapeutic approach including bispecific T-cell engager (BITE) therapies, have been developed to improve overall survival outcome. Tarlatamab was approved by United States Food and Drug Administration (USFDA) in 2024 for the treatment of patients with extensive-stage small cell lung cancer (ES-SCLC) who are refractory to treatment or have experienced relapse or recurrence after an initial response. The clinical study of tarlatamab demonstrated a median progression-free survival (mPFS) of 4.9 months and a median overall survival (mOS) of 6 months. Thus, tarlatamab might be considered a potential treatment option for patients with relapse or refractory ES-SCLC who have limited therapeutic alternatives.