Srinagarind Medical Journal <p>Frequency : in every&nbsp;two months; on February, April, June, August, October&nbsp;and December. Policy is to encourage distribution of scientific information in medical and health sciences. It publishes seven types of article; medical innovation, original article, case report, review article, conference, symposium and letter to editor.</p> Faculty of Medical, Khon Kaen University en-US Srinagarind Medical Journal 0857-3123 Quality of Life and Utility in Cardiac Surgical Patients at Queen Sirikit Heart Center of the Northeast <p><strong>Background and Objectives:</strong> Open-heart surgery impacts both patient’s physical and mental health. Nowadays, there are a lot of studies about quality of life in post-cardiac surgery patients. There is still a lack of research about the utility. This study aimed to study the quality of life and compare pre- and post-cardiac surgery utility.</p> <p><strong>Methods</strong><strong>: </strong>This study was observational analytic in open-heart surgery patients. The Thai EQ 5D 5L questionnaire was used to measure the quality of life in pre-operation and 12 weeks post-operation.</p> <p><strong>Results</strong><strong>: </strong>From 126 participants, 54.76 % were male. The mean age was 56.51 years. Quality of life in pre-operative patients showed slight pain and discomfort, but the quality of life after surgery improved in all dimensions. The three-month post-operative utilities from&nbsp; EQ-5D-5L and EQ-VAS were 0.98 ± 0.03 and 97.58 ± 5.09, respectively. The post-operative utilities were statistically significantly increased from pre-operation.</p> <p><strong>Conclusion</strong><strong>:</strong> Post-operative patients had a statistically significant better quality of life in all dimensions and higher utility.</p> Panadda Yasud Pajeemas Kittipanya-ngam Copyright (c) 2021-06-18 2021-06-18 36 3 253 259 Respiratory Muscle Strength and Anterior Scalene Muscle Activity in Women with Chronic Neck Pain <p><strong><u>Background and objectives:</u></strong> Chronic neck pain affects the musculoskeletal system in the neck, and fatigue of the muscles around the shoulder and thoracic wall. This study aimed to compare respiratory muscle strength, and anterior scalene (AS) muscle activity in participants with chronic neck pain and participants without neck pain.</p> <p><strong><u>Method:</u></strong> Ten participants with chronic neck pain over six months and ten participants without neck pain performed respiratory muscle strength tests and measured AS muscle activity while performing the respiratory muscle strength test.</p> <p><strong><u>Results:</u></strong> Participants with neck pain found that respiratory muscles strength inhalation and exhalation were lower than participants without neck pain (51.1 ± 5.5 and 72.5 ± 4.9 cmH<sub>2</sub>O, p &lt;0.001) and (59.1 ± 3.3 and 80.0 ± 3.4 cmH<sub>2</sub>O, p &lt;. 0.001). During the inhalation muscle strength test, AS muscle activity of right and left site in participants with neck pain were higher than subjects without neck pain (58.7 ± 11.8 and 46.1 ± 6.7, p &lt;0.05) and (62.9 ± 14.2 and 47.6 ± 3.8, p &lt;0.05) respectively.</p> <p><strong><u>Conclusion:</u></strong> Participants with chronic neck pain for more than 6 months had lower respiratory muscle strength than participants without neck pain and increases AS muscle activity while performing the inhaled muscle strength test compare with participants without neck pain.</p> Sudarat Borisut Jirawat wattanapanyawech Copyright (c) 2021-06-18 2021-06-18 36 3 260 266 Long-Term Follow-up 5 years Prognostic Value of Estimating Functional Capacity and Return to work in Work force age Patients of Post CABG or Valvular Surgery <p><strong><u>Background and Objectives</u></strong><strong>: </strong>Improving functional activity and could return to work &nbsp;in labor age is the long term goal of post cardiac surgery rehabilitation.Long term follow up was discreted,therefore mail tracking is another option for 1) Comparison of Metabolic Equivalent (METs) from a 12-activity questionnaire (DASI) among patients of five years after CABG or valve surgery with pre-surgery 2) compared METs of the returning and no returned groups and 3) METs study was in return to work group.</p> <p><strong><u>Methods</u></strong>: Retrospective study in patients after CABG or valve surgery for 5 years. The samples were &nbsp;selected from QSHC medical record from 2012-2013, who were 15-60 years old &nbsp;that&nbsp; completed pre surgery DASI questionnaire. DASI and level of work questionnaire were sent by mail. The received METs was analyzed with SPSS program.</p> <p><strong><u>Results</u></strong><u>: </u>1) METs after 5 years of surgery were higher than before surgery (p = 0.000) 2) METs in the group that returned to work was higher than the no returned to work group (p = 0.024) 3) METs in the DASI questionnaire was higher than the METs in level of work questionnaire (p = 0.00). Returned to work 's METs from level of work questionnaire was moderate to heavy level (5.55 ± 1.72 METs).</p> <p><strong><u>Conclusions:</u></strong> Functional activity of CABG and valvular surgery patients increased from 5 years post surgery. The returned to work group was higher functional activity than those of the no returned group.The returning group had a moderate to heavy intensity level.</p> Montana Donsom Copyright (c) 2021-06-18 2021-06-18 36 3 267 272 Prevalence and Factors Associated with Metabolic Syndrome at Health Promoting Hospital, Khon Kaen <p><strong><u>Objective:</u></strong> Metabolic syndrome is one of the most important causes of cardiovascular and cerebrovascular diseases. Nowadays, the global prevalence of metabolic syndrome has been increased. The authors aimed to study the prevalence and the associated factors of metabolic syndrome in Health Promoting hospital, Regional health promotion center 7, Khonkaen.</p> <p><strong><u>Method:</u></strong> This was an analytical cross-sectional study, A convenience sample composed of 302 persons who came for check up at health promotion clinic, in health promoting hospital, Regional health promotion center 7, during 15 January - 15 March 2021. Metabolic syndrome was diagnosed by using modified NCEP ATP III 2005 criteria. The prevalence of metabolic syndrome was calculated. The significant health factors related to metabolic syndrome were analyzed, using 2-sided Chi-square and logistic regression analysis.</p> <p><strong><u>Results:</u></strong> The overall prevalence of metabolic syndrome was 32.78 % (23.71% in men, 25.66 % in women who age&lt; 60 years and 52.94% in men, 50% in women who age <u>&gt;</u>60 years). Factors that were significantly related to metabolic syndrome were age, body mass index, smoking, physical activity, and familial history of dyslipidemia.</p> <p><strong><u>Conclusion:</u></strong> Nearly one-third of the population in our study had metabolic syndrome. It is important to find the related factors that should be mainly focused to modify and prevent the metabolic syndrome.</p> Paiboon Chattakul Copyright (c) 2021-06-18 2021-06-18 36 3 273 280 The Result of Continuous Antibiotics Injection in Out Patient, Sawanpracharak Hospital <p><strong><u>Background and Objective</u></strong>: Increasing the use of outpatient intravenous antibiotic therapy and Outpatient &nbsp;parenteral antimicrobial therapy (OPAT) program have been developed standardization in many country. Objective of this research is to assess the effects of continuous antibiotic injection in the treatment of infectious diseases in outpatients who receiving medicine at Sawanpracharak Hospital</p> <p><strong><u>Methods</u></strong>: The descriptive study was performed in 529 outpatients receiving antibiotic injection between 1 October 2019 to 30 September 2020.</p> <p><strong><u>Results</u></strong>: According to the study, 616 episodes&nbsp; OPAT for 529 patients were prescribed. The department which was the highest amount of prescribing was internal medicine (289 episodes, 46.90 %). The most commonly prescribed drug was ceftriaxone 426 episodes (67.73%). The most infectious disease was urinary tract infections 228 episodes (37.01%). There were 318 patients ( 51.62%) using an outpatient injection service at Sawanpracharak Hospital. The most drug related problem prescription error was that the type of solution and the dose rate of administration was not specified 98.92%. Treatment outcomes were clinical improvement by 90.90% and 4.06% of patients had to admit in hospital for treatment &nbsp;infection. There were adverse drug event 3 cases and none-compliance 18 cases.</p> <p><strong><u>Conclusion</u></strong>: Outcomes&nbsp; of The continuous antibiotic injection in outpatients. there was clinical improvement 90.90 % can reduce length of stay and also reduce the cost of hospital stay by more than 2.5 million bahts per year. Orientation for referring to patients by pharmacists. There were adverse drug event 3 cases and none-compliance 2.92%.</p> Aunchalee Aungsathammarat Budsaya Dejpun Copyright (c) 2021-06-18 2021-06-18 36 3 281 286 Depression in the First to Third Year Medical Students of College of Medicine and Pubic Health, Ubonratchatani University <p><strong><u>Background and Objective</u></strong><strong>:</strong> Depression plays an important role in mental disorders. This study aimed to &nbsp;investigate the prevalence and associated factors of depression in the first to third year medical students of College of Medicine and Pubic Health, Ubonratchatani University.</p> <p><strong><u>Methods</u></strong><strong>:</strong> A cross-sectional descriptive study was performed on pre-clinical year medical students who registered in 2019. The participants completed a general information, the Thai-version of Patient Health Questionnaire (PHQ-9), and the questionnaire about factors that involved in depression &nbsp;Descriptive statistics were analyzed with general information. To determine the relationship between the factors and depression using univariate logistic regression and multivariate logistic regression were used and presented in a crude odds ratio, adjusted odds ratio, and 95%confidence interval.</p> <p><strong><u>Results</u></strong><strong>:</strong> Of the 143 first to third year medical students that participated in the study, 53 were male and 90 were female. The prevalence of depression was found to be 32.87 %; 27.97 % had mild depression, 4.20 % had moderate depression and 0.70 % had severe depression. Depression related with many factors in this study including student examination, parents’ decisions of study in medicine, disinterest in studies and un-readiness to learn.</p> <p><strong><u>Conclusions and Discussions</u></strong><strong>:</strong> Pre-clinic medical students had a high rate of depression at 32.9% and related with student examination, parents’ decisions of study in medicine, disinterest in studies and un-readiness to learn, respectively. The results from this study confirmed previous study results and might be one of basic information for further supports medical student who has depression.</p> Patcharee Phanpanich Mereerat Manwong Praewwarin Vongsuphakphan Latiporn Udomsuk Copyright (c) 2021-06-18 2021-06-18 36 3 287 294 Effect of Chrysin on Methotrexate Chemotherapy Induced Reductions of Memory and Hippocampal Neurogenesis in Adult Rats <p><strong><u>Background and objective:</u></strong> Methotrexate (MTX)is a chemotherapy drug that is the most widely used to protect against many malignancies. Several reports have shown that MTX can induce cognitive impairment<strong>. </strong>Chrysin is a natural flavonoid that is found in natural products. Previous studies have found that chrysin has neuroprotective and cognitive improving properties. Therefore, this study was designed to determine the protective effect of chrysin against MTX-induced memory impairments.</p> <p><strong><u>Methods:</u></strong> Seventy-two male Sprague Dawley rats were divided into 6 groups; control, MTX, chrysin 10, chrysin 30, chrysin 10+MTX and chrysin 30+MTX groups. The control group received saline and propylene glycol. Chrysin (10 and 30 mg/kg) was administered by oral gavage for 15 days. A single dose of MTX (75 mg/kg) was administered by intravenous injection on days 8 and 15. Three days after the end of drug administration, the body weight and locomotor activity were determined. The memories were evaluated using novel object location (NOL) and novel object recognition (NOR) tests.</p> <p><strong><u>Results:</u></strong> The data of all groups showed no significant differences in term of total exploration times. In both the NOL and NOR tests, the control, chrysin 10, chrysin 30, chrysin 10+MTX and chrysin 30+MTX groups could significantly discriminate between the familiar and novel location or object except the MTX group.</p> <p><strong><u>Conclusion:</u></strong> This study demonstrates that MTX induces memory impairment. In contrast, chrysin could improve memory impairment in rats received MTX.</p> Tanaporn Anosri Soraya Kaewngam Nataya Sritawan Ram Prajit Kornrawee Suwannakot Apiwat Sirichoat Anusara Aranarochana Wanassanan Pannangrong Jariya Umka Welbat Copyright (c) 2021-06-18 2021-06-18 36 3 295 300 Factors Associated with Using Online Social Media among Patients with Breast Cancer Receiving Chemotherapy <p><strong><u>Background and Objectives:</u></strong> Breast cancer is the fifth most common cause of death from cancer among women around the world. Breast cancer treatments may have many side effects in patients, such as hair loss, mouth sore, nausea, diarrhea and loss of appetite. The patients used online social media for searching the health information concerning their treatment. This study aimed to investigate the factors associated with online social media (OSM) used in breast-cancer patients (BP) receiving chemotherapy.</p> <p><strong><u>Methods:</u></strong> A cross-sectional study was conducted among breast-cancer patients receiving chemotherapy at Ubon Ratchathani Cancer Hospital, Ubon Ratchathani province during the period April to December 2019. Data were collected by questionnaires comprising socio-demographic characteristics, online social media usage behavior and an instrument to measure health-related quality of life. The obtained data were analyzed using descriptive and analytic statistics with a computerized statistical package.</p> <p><strong><u>Result:</u></strong> A total of 204 BP participated in the study; 43.63% had ever used online social media. The factors which were significantly related to OSM among BP included: patients over 60&nbsp;years of age, secondary education level and occupation (p&lt;0.05).</p> <p><strong><u>Conclusion: </u></strong>&nbsp;Age, education level and occupation represent relate to online social media for breast-cancer patients. Therefore, health services authority should be taken the factors of age, education, and occupation to consider in providing information about breast cancer through the OSM, which are popular among breast-cancer patients, easy-to-understand information to meet the needs of patients.</p> Sairung Prakobchit Wiyada Wannasen Sopit Tubtimhin Sopittra Somharnwong Rungsinoppadol Thotong Copyright (c) 2021-06-18 2021-06-18 36 3 301 309 The Effects of Nine-Square Exercise On Balance in the Elderly with Falls Risk <p><strong><u>Background and objective:</u></strong> Presently, “nine-square exercise” is popular among community-dwellers in Thailand. However, evidences in the benefits of nine-square exercise on balance in older persons remained unclear. This study aimed to evaluate the effects of nine-square exercise on balance in the elderly with falls risk.</p> <p><strong><u>Methods:</u></strong> Thirty-four older persons (mean age 63.8±2.0 years) were divided into experimental and control groups (17 of each). The experimental group was assigned to practice nine-square exercise for 3 days/week, 30 minutes/day for a total of 5 weeks, while the control group attended health education classes at weeks 2 and 4 of the study. At pre- and post-study, all participants were evaluated for dynamic and static balance by using the Timed Up and Go Test (TUGT) and the One Leg Stance Test (OLST), respectively. Data were analyzed by using the T-tests.</p> <p><strong><u>Results:</u></strong> At the end of the study, the experimental group significantly improved their balance (<em>p</em>&lt;0.05). When compared between groups, the experimental group showed significantly less time taken to complete the TUGT than did the control group (<em>p</em>&lt;0.001). No statistically significant difference between groups was found in the OLST (<em>p</em>&gt;0.10).</p> <p><strong><u>Conclusions:</u></strong> Nine-square exercise could improve dynamic balance in the elderly with falls risk. Therefore, this exercise is possibly an alternative exercise regimen for improving balance in community-dwelling older persons.</p> Sasiwimon Wannapong Saowanee Nakmareong Surussawadi Bennett Nomjit Nualnetr Copyright (c) 2021-06-18 2021-06-18 36 3 310 316 Incident and Associated factors of Dyslipidemia in Personnel of Faculty of Medicine, Khon Kaen University <p><u>Background and Objectives</u>: Dyslipidemia is an important risk factor for coronary artery disease and stroke. Our aims were to determine incidence and investigated the relationship between the various factors and Dyslipidemia among personnel of Faculty of Medicine, Khon Kaen University.</p> <p><u>Method</u>: These data collected from personnel of Faculty of Medicine data base between 2017 and 2018, of 753 patients and follow up until Dyslipidemia occurred. We estimated incidence and investigated the relationship between various factors and dyslipidemia by using Generalized Linear Models (GLM), presenting Adjusted RR ​​and theirs <em>95</em><em>%</em> <em>confidence interval</em><em>.</em></p> <p><u>Results</u>: Incidence rate was 68.1 person-year (95% CI: 64.7 - 71.4). After adjusting all variables in the model, personnel who drinking alcohol at risk of developing dyslipidemia was 1.23 times when compared to who did not. (Adjusted RR = 1.23, 95% CI: 1.05 - 1.38, p=0.007)</p> <p><u>Conclusion</u>: Drinking alcohol is at risk of developing dyslipidemia. Therefore, there should be a set up for personnel who are risk group to referral for treatment and to raise awareness.</p> Sophida Suwannabupha Supot Kamsa-ard Copyright (c) 2021-06-18 2021-06-18 36 3 317 327 Dysphagia Knowledge of Stroke Patients with Dysphagia <p><strong><u>Background and objective:</u></strong> Dysphagia is a common condition in stroke patients which may result in complications such as aspiration pneumonia and malnutrition.&nbsp; Such complications can lead to prolonged hospitalization or death. Proper management of dysphagia by the medical personnel, including the knowledge and understanding about dysphagia of the patient and caregivers, can play an important role in complication prevention. Therefore, the researchers aimed to study the level of dysphagia knowledge among stroke patients with dysphagia.</p> <p><strong><u>Methods:</u></strong>&nbsp;A cross-sectional study was conducted among 95 dysphagia stroke patients who were admitted to the rehabilitation clinic, Srinagarind hospital. Demographic data were retrieved from all participants.&nbsp; Dysphagia knowledge was assessed by using questionnaires, which consisted of the following questions: 1) general knowledge 7 items, 2) complications prevention 8 items, and 3) rehabilitation 5 items. Then, dysphagia knowledge was categorized into 3 levels based on the total scores of each participant (full 20 points); low (1-7 points), moderate (8-14 points) and high (15-20 points). The data were analyzed using descriptive statistics.</p> <p><strong><u>Result</u></strong>s: Of 95 participants, 26%, 56% and 18% of dysphagia patient had low, moderate and high level of dysphagia knowledge, respectively. The average score of general knowledge, complication prevention and rehabilitation were 4.32 ± 2.73, 3.64 ± 2.86 and 1.52 ± 0.42, respectively</p> <p><strong><u>Conclusions</u></strong>:&nbsp;Most stroke patients with dysphagia had dysphagia knowledge at a moderate level. Whereas the score in prevention and rehabilitation domain were low.</p> Chompilai Nuntharuksa Pajeemas Kittipanya-ngam Pattra Wattanapan Copyright (c) 2021-06-18 2021-06-18 36 3 328 332 Needs and Need Responses of the Family Members of Patients Treated in the Intensive Care Unit <p><strong><u>Background and objective</u></strong>: Having a family member getting sick in a crisis could stress and worry in other family members. If the patients&nbsp; receive a proper care, it will help them coping with the illness of the patients. This study aimed to assess needs and need responses of the family members of patients treated in the intensive care unit.&nbsp;</p> <p><strong><u>Materials and m</u></strong><strong><u>ethod</u></strong><strong><u>s</u></strong>: This descriptive research was based on the family members’ need concept of Gaglione. The participants were 132 family members of the patients who were treated in the intensive care unit of Udonthani hospital using purposive sampling. The research instrument were needs and need-responses questionnaire. The data were analyzed by descriptive statistics and Pearson's correlation coefficient statistics.</p> <p><strong><u>Results</u></strong><u>:</u> 1. The overall need score of family members of the patients treated in the intensive care unit was at the highest level. &nbsp;2. The overall need-response score of family members was at the high level. &nbsp;3. The Correlation coefficient of family members’ needs and need responses was significantly low. (r = 0.219, p ≤ 0.05)</p> <p><strong><u>Conclusion:</u></strong> The findings can be used to improve quality of care for family members of critically ill patients treated in the intensive care unit.</p> Siriorn Khoyun Watjana Sukonthawat Benjawan Kitkhuandee Pasinee Thoin Copyright (c) 2021-06-18 2021-06-18 36 3 333 339 Treatment Outcomes of Quality of life and Nasolabial Appearance in Patients with Cleft Lip and Palate of 10-Year-Old Group <p><strong><u>Background and Objectives</u></strong><strong>: </strong>Cleft lip and palate (CLP) requires a long term management from an interdisciplinary team since it affects the quality of life (QoL) and nasolabial appearance in patients during puberty.</p> <p><strong><u>Methodology</u></strong><strong>: </strong>The descriptive studies in 10–year-old group of patients with CLP who received treatment care from Tawanchai Center, Srinagarind Hospital, during the Year 2017-19, a total of 30 cases. The tool was a five-aspect QoL questionnaire with39 items with a reliability of 0.94, photos of patients face in frontal and lateral sides to assess nasolabial appearance in 4 dimensions. The score of aesthetics rating scale of 5 levels from 5 raters was gathered. The data were analyzed by using percentage statistics, mean and standard deviation.</p> <p><strong><u>Results</u></strong><strong>:</strong> It was found that 53.3% of the patients were male, 63.3 percent of the total UCLP. Most of the parents were primary caregivers and73.3 percent of the parents completed primary school. The family income per month was in the range of 5,001-10,000 baht (30percent). While the QoL in 5 aspects showed the satisfaction level as follows; the service was at the highest level (4.30 ± 0.98), medical treatment and expenses was at a high level (3.72 ± 1.15), (3.70 ± 1.14), the parents in the psychosocial dimension, and the impact on the family was moderate (3.33 ± 1.08), (2.81 ± 1.46). As for the nasolabial appearance most of them had a good average score 53.3 percent.&nbsp;</p> <p><strong><u>Conclusion</u></strong><strong>: </strong>Most of the patients were male and had UCLP. Parents had 3 aspects of good to very good QoL and 2 moderate levels. Most of them had a good to average nasal appearance.</p> Palakorn Surakunprapha Suteera Pradubwong Yupin Paggasang Kamonwan Jenwitheesuk Poonsak Pisek Bowornsilp Chowchuen Copyright (c) 2021-06-18 2021-06-18 36 3 340 346 Stress of Anesthesia Personnel at Srinagarind Hospital during Covid-19 Pandemic <p><strong><u>Background and Objective</u></strong>: The outbreak of Covid-19&nbsp;has caused stress to medical personnel who dealed with the patients. The objective of this study was to evaluate the level of stress and related factors in anesthesiologists and nurse anesthetists.&nbsp;</p> <p><strong><u>Methods</u></strong>: This was a&nbsp;prospective descriptive study in anesthesiologists and nurse anesthetists working at Srinagarind Hospital,&nbsp;Khon Kaen University&nbsp;between August and September 2020 with purposive sampling using a questionnaire consisted of Suanprung Stress Test-20 (SPST-20) with&nbsp; related factors.</p> <p><strong><u>Results</u></strong>: A total of 72 samples were recruited. The overall stress level was moderate with mean SPST-20 score of 2.56 ± 1.34. The main related factors were: complicated working protocol; expertise requirement; people contact; definite criteria for job promotion; and inadequate rest area.</p> <p><strong><u>Conclusions</u></strong>: Under the Covid-19 pandemic, the stress level of anesthetic personnel at Srinagarind Hospital was moderate. The related factors in 5 categories were identified for developing interventions to reduce stress in the next pandemic.</p> Charinee Aimnang Sirirat Tribuddharat Thepakorn Sathitkarnmanee Lamyai Sabangban Copyright (c) 2021-06-18 2021-06-18 36 3 347 352 A Protocol for Morphine Subcutaneous Administration at Home in dying patient <p><strong><u>Background and Objectives: </u></strong>Palliative care in Thailand is still in an early integration into the national health care system. Morphine availability is an essential component in quality palliative care.</p> <p>The objective of this study is to develop a strict protocol for using morphine injection via syringe driver in dying patients at their home.</p> <p><u>&nbsp;</u><strong><u>Methods:</u></strong> This protocol was developed after joint meetings with hospital pharmacists. Palliative care doctors are the only doctors to prescribe morphine injections to be used at home. Patients who require morphine injections at home will be visited by Karunruk Palliative Care Center (KPC) team or by the community nurses near their home. The amount of morphine injection allowed per prescription is 3-7 days dosage. The community nurses will prepare the medication in a syringe according to the order from KPC, and the family will connect it via a syringe driver. The community nurses who prepare the medication record the exact amount of morphine injection used and sign daily in the booklet provided by KPC. When the patient dies, the family will return the syringe driver and the unused morphine injections to KPC. The palliative care nurse will validate and record the number of used and unused morphine ampules and return them to the hospital pharmacists. This protocol was introduced to all the hospitals in Health Service Area 7.&nbsp;</p> <p><strong><u>Results:</u></strong> The results of the study revealed as following:Have obtained syringe drivers to be used at home and percentage of morphine injections to be used in the patients’ home are 30.52, 34.85, 42.49 and 11.19&nbsp; (sort by 2015-2018). After 3 years of protocol implementation coupled with intensive health professional education by KPC, now 76.1% of the hospitals in Health Service Area 7 have obtained syringe drivers to be used at home and 98.5% of these hospitals have changed their policies to allow morphine injections to be used in the patients’ home.</p> <p><strong><u>Conclusion:</u></strong> This&nbsp; protocol created confidence for the health care providers and enables morphine injection to be used at home in dying patients. The number of palliative care patients of&nbsp; Karunrak Center reduces morphine injections at home because the network has adopted this protocol more.</p> Rattanaporn Siriket Srivieng Pairojkul Parichart Piasupun Saipin Saidum Copyright (c) 2021-06-18 2021-06-18 36 3 353 357 Real Time Tele-Monitoring and On-Line Medical Direction for Inter-Facility Transfer in The Critically Ill Patients <p><strong><u>Background and Objectives:</u></strong> The Tele-Monitoring system has been implemented in all public health hospitals in Khon Kaen Province since 2014. In 5 years later, On-line medical direction program has been initiated to provide real-time consultation for the healthcare personnel during transferring patients. The purposes of the system are to increase the confidence of providers and to enhance the safety management during inter-facility transfer. This study aimed to analyze the association between Tele-Monitoring system used and mortality in first 24 hours.&nbsp;&nbsp;&nbsp;&nbsp;</p> <p><strong><u>Methods:</u></strong> It was a retrospective cohort study. The critically ill transferred patients from the rural hospitals to Khon Kaen hospital from October 2018 to September 2019 were enrolled. Descriptive Statistics were used for descriptive data. The association between Tele-Monitoring used and mortality within the first 24 hours was analyzed by Chi-square.&nbsp; P-value &lt;0.05 was set for statistical significance.</p> <p><strong><u>Results:</u></strong> There were 3,750 patients enrolled, 2,867 (75.5%) used the Tele-Monitoring system during inter-facility transfer. The mean age was 61.80±16.58 years, male sex was 63.7% and 11.1 % were trauma patients. The most common indication for the Tele-Monitoring used was ESI level 1. The mortality within first 24 hours was not different between Tele-Monitoring used and in non Tele-Monitoring used groups (p=0.978).</p> <p><strong><u>Conclusion:</u></strong> The Tele-Monitoring system is a high investment and maintenance of inter-facility. However, the Tele-Monitoring and On-line medical directions will help patients to receive treatment promptly along transferring with reducing death or disability.</p> Seathapong Thanoorat Thanyaras Piyawatchwela Copyright (c) 2021-06-18 2021-06-18 36 3 358 365 Emergency Room – Resuscitative Endovascular Balloon Occlusion of the Aorta (ER-REBOA) in Trauma Patient <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Non-compressible torso hemorrhage such as thorax, abdomen or pelvis is the leading cause of death in trauma patients. Previously, resuscitative thoracotomy provided 8.5% of survival rate which is not satisfactory and recommended in only cardiac arrested patient. It is the origin of the new life-saving procedure called “Resuscitative endovascular balloon occlusion of the Aorta – REBOA”. The procedure is to insert the balloon into the aorta via common femoral artery then inflate the balloon to occlusion of the aorta. The result is to slow down the hemorrhage in abdomen or pelvis and increase blood flow to heart and the organs above the occlusion level. Then move the patient to surgery for stop bleeding in abdomen or pelvis. Thus, this procedure will increase survival rate in trauma patients.</p> Panu Teeratakulpisarn Copyright (c) 2021-06-18 2021-06-18 36 3 366 374