Objective: Fast-track hip fracture surgery is urgent. Time-limited preoperative optimization increase the risk of perioperative cardiovascular issues, affecting postoperative outcomes. This study aimed to identify risk factors for intraoperative hypotension in elderly patients undergoing fast-track hip fracture surgery with spinal anesthesia. Materials and Methods: This retrospective observational analysis was conducted at a university-based hospital. Medical records from 2018 to 2022 were examined to compare variables associated with intraoperative hypotension. Multivariate logistic regression analysis was used to determine the risk variables for intraoperative hypotension. Results: The incidence of intraoperative hypotension was 50.1%. Significant factors associated with intraoperative hypotension included a history of previous stroke (adjusted odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.38–4.21, P = 0.002), a preoperative baseline SBP below 100 mmHg (adjusted OR: 2.34; 95% CI: 1.34–4.08, P = 0.003), a preoperative urine output less than 0.5 ml/kg/h (adjusted OR: 2.74; 95% CI: 1.07–6.96, P = 0.034), undergoing an intramedullary nail procedure (adjusted OR: 2.64; 95% CI: 1.85–3.77, P < 0.001). Conversely, protective factors included receiving preoperative blood transfusions (adjusted OR: 0.43; 95% CI: 0.24–0.77, P = 0.004) and receiving a spinal bupivacaine dose of 7.5 mg or above (adjusted OR: 0.59; 95% CI: 0.36–0.95, P = 0.033). Conclusion: Modifiable factors include ensuring adequate preoperative intravascular volume to optimize urine output and blood pressure, and correcting anemia. Prioritizing these measures for at-risk patients can help prevent complicated hospital stays.
{"title":"Risk Factors for Intraoperative Hypotension in Elderly Patients Undergoing Fast Track Hip Fracture Surgery under Spinal Anesthesia: A Retrospective Observational Study","authors":"Samita Pirotesak, Waroonwan Neti, Phuengjai Weerapong, Bharadee Teeravidja, Pawinee Pangthipampai, Busara Sirivanasandha","doi":"10.33192/smj.v76i7.269205","DOIUrl":"https://doi.org/10.33192/smj.v76i7.269205","url":null,"abstract":"Objective: Fast-track hip fracture surgery is urgent. Time-limited preoperative optimization increase the risk of perioperative cardiovascular issues, affecting postoperative outcomes. This study aimed to identify risk factors for intraoperative hypotension in elderly patients undergoing fast-track hip fracture surgery with spinal anesthesia.\u0000Materials and Methods: This retrospective observational analysis was conducted at a university-based hospital. Medical records from 2018 to 2022 were examined to compare variables associated with intraoperative hypotension. Multivariate logistic regression analysis was used to determine the risk variables for intraoperative hypotension.\u0000Results: The incidence of intraoperative hypotension was 50.1%. Significant factors associated with intraoperative hypotension included a history of previous stroke (adjusted odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.38–4.21, P = 0.002), a preoperative baseline SBP below 100 mmHg (adjusted OR: 2.34; 95% CI: 1.34–4.08, P = 0.003), a preoperative urine output less than 0.5 ml/kg/h (adjusted OR: 2.74; 95% CI: 1.07–6.96, P = 0.034), undergoing an intramedullary nail procedure (adjusted OR: 2.64; 95% CI: 1.85–3.77, P < 0.001). Conversely, protective factors included receiving preoperative blood transfusions (adjusted OR: 0.43; 95% CI: 0.24–0.77, P = 0.004) and receiving a spinal bupivacaine dose of 7.5 mg or above (adjusted OR: 0.59; 95% CI: 0.36–0.95, P = 0.033).\u0000Conclusion: Modifiable factors include ensuring adequate preoperative intravascular volume to optimize urine output and blood pressure, and correcting anemia. Prioritizing these measures for at-risk patients can help prevent complicated hospital stays.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"35 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711335","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.33192/smj.v76i7.268122
Wanchai Wongkornrat, A. Siriussawakul, P. Suraarunsumrit, Tasapol Charoenrat, Tipchutha Satidwongpibool
Objective: Warfarin is extensively used as an oral anticoagulant; however, its clinical application is complicated by a narrow therapeutic index. This investigation evaluated the efficacy of a drug reminder application versus traditional care in facilitating patients’ maintenance of the therapeutic range, as well as in stabilizing the time in the therapeutic range (TTR). Material and Methods: A single-blind randomized controlled trial recruited 40 warfarin users (≥3 months) with stable INR for 6 months. The intervention group received a smartphone app reminder. All INR values were collected for 6 months. Primary outcomes were TTR, INR, TTR during drug-drug interactions, and warfarin complications. Results: Forty patients were recruited between January 2021 and August 2023. The mean TTR was 66.11%±9.8% for the intervention group and 67.31%±18.08% for the control group. With analysis of covariance, the results were slightly better in the intervention group, but the differences were not statistically significant (95%CI = -5.67 – 1.92, P-value = 0.323). For the 6-month INR monitoring, 6 out of 8 patients who could maintain the therapeutic INR range were in the intervention group. There were no statistically significant differences in warfarin-related complications between the two groups (20% vs 15%, RR 1.333, 95%CI = 0.3413 – 5.2086, P-value = 0.6790). Conclusion: The drug reminder application likely improved the TTR, although without statistical significance. Further studies are needed to identify technology assistance in improving treatment outcomes.
{"title":"Effectiveness of Smartphone Applications vs Conventional Care in Warfarin Therapy: A Randomized Controlled Trial on the Time in the Therapeutic Range","authors":"Wanchai Wongkornrat, A. Siriussawakul, P. Suraarunsumrit, Tasapol Charoenrat, Tipchutha Satidwongpibool","doi":"10.33192/smj.v76i7.268122","DOIUrl":"https://doi.org/10.33192/smj.v76i7.268122","url":null,"abstract":"Objective: Warfarin is extensively used as an oral anticoagulant; however, its clinical application is complicated by a narrow therapeutic index. This investigation evaluated the efficacy of a drug reminder application versus traditional care in facilitating patients’ maintenance of the therapeutic range, as well as in stabilizing the time in the therapeutic range (TTR).\u0000Material and Methods: A single-blind randomized controlled trial recruited 40 warfarin users (≥3 months) with stable INR for 6 months. The intervention group received a smartphone app reminder. All INR values were collected for 6 months. Primary outcomes were TTR, INR, TTR during drug-drug interactions, and warfarin complications.\u0000Results: Forty patients were recruited between January 2021 and August 2023. The mean TTR was 66.11%±9.8% for the intervention group and 67.31%±18.08% for the control group. With analysis of covariance, the results were slightly better in the intervention group, but the differences were not statistically significant (95%CI = -5.67 – 1.92, P-value = 0.323). For the 6-month INR monitoring, 6 out of 8 patients who could maintain the therapeutic INR range were in the intervention group. There were no statistically significant differences in warfarin-related complications between the two groups (20% vs 15%, RR 1.333, 95%CI = 0.3413 – 5.2086, P-value = 0.6790).\u0000Conclusion: The drug reminder application likely improved the TTR, although without statistical significance. Further studies are needed to identify technology assistance in improving treatment outcomes.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"26 60","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: The aim of this study was to evaluate the knowledge level and patient satisfaction after receiving multimedia education on delirium developed by the Siriraj Integrated Perioperative Geriatric Excellent Research Center (SiPG), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand in geriatric patients undergoing elective noncardiac surgery. Materials and Methods: This randomized controlled study included geriatric patients scheduled for elective noncardiac surgery. The patients were randomized and categorized into an intervention group or a control group. The intervention group received multimedia education on delirium developed by SiPG, comprising a video. After watching the video clip, the patients took an examination for acute delirium, and were also asked to complete a satisfaction survey questionnaire. The control group took only the delirium examination. The average scores between the two group were compared by using independent t-tests. Results: Fifty-four geriatric patients were included in the study (27 patients per group). The average score of the examination in the intervention group (6.56±1.58 out of 8) was significantly higher than the control group (4.96±1.65). In the satisfaction survey, all the patients stated they were “highly satisfied” with the multimedia video clip. Conclusion: The multimedia video clip on delirium developed by SiPG has a potential to serve as an effective tool for promoting preoperative education in geriatric patients. Our study demonstrated its ability to improve patient knowledge and increase patient satisfaction.
{"title":"Assessment on Knowledge and Satisfaction Level of Delirium Video for Education in Geriatric Patients Undergoing Elective Noncardiac Surgery","authors":"Anchala Jirakulsawat, Nisa Noocharoen, Bussaba Srinimit, Suthawan Anakmeteeprugsa","doi":"10.33192/smj.v76i7.267359","DOIUrl":"https://doi.org/10.33192/smj.v76i7.267359","url":null,"abstract":"Objective: The aim of this study was to evaluate the knowledge level and patient satisfaction after receiving multimedia education on delirium developed by the Siriraj Integrated Perioperative Geriatric Excellent Research Center (SiPG), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand in geriatric patients undergoing elective noncardiac surgery.\u0000Materials and Methods: This randomized controlled study included geriatric patients scheduled for elective noncardiac surgery. The patients were randomized and categorized into an intervention group or a control group. The intervention group received multimedia education on delirium developed by SiPG, comprising a video. After watching the video clip, the patients took an examination for acute delirium, and were also asked to complete a satisfaction survey questionnaire. The control group took only the delirium examination. The average scores between the two group were compared by using independent t-tests.\u0000Results: Fifty-four geriatric patients were included in the study (27 patients per group). The average score of the examination in the intervention group (6.56±1.58 out of 8) was significantly higher than the control group (4.96±1.65). In the satisfaction survey, all the patients stated they were “highly satisfied” with the multimedia video clip.\u0000Conclusion: The multimedia video clip on delirium developed by SiPG has a potential to serve as an effective tool for promoting preoperative education in geriatric patients. Our study demonstrated its ability to improve patient knowledge and increase patient satisfaction.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"2 s1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141703315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.33192/smj.v76i7.267376
Chutima Leewatchararoongjaroen, S. Tangwiwat, Piyawadee Rungmongkolsab, Pawadee Sutthaso
Objective: This study aimed to evaluate the analgesic efficacy of preoperative fascia iliaca compartment block (FICB) in terms of preoperative pain score reduction in geriatric hip fracture patients. Secondary objectives were to compare opioid consumption, procedure-related complications, and patient outcomes. Materials and Methods: This single-center retrospective study included patients aged 65 or older with hip fractures who experienced moderate to severe pain in a tertiary care university hospital from January 2019 to July 2021. The variables collected for analysis were patient baseline characteristics and the pain score at rest, including during movement from the beginning of service and subsequently each morning after admission until the day of surgery. Results: A total of 439 patients were included in this study, 109 patients (24.8%) receiving preoperative FICB (FICB group). When comparing the FICB and non-FICB groups, a significant reduction in pain scores was observed on postadmission day 1, both at rest (0 [IQR=0-4] vs. 0 [IQR=0-2], p<0.001) and during movement (0 [IQR=0-4] vs. 0 [IQR=0-2], p=0.018). This difference in pain reduction persisted on day 2 during movement (3 [IQR=0-5.75] VS 0 [IQR=0-3], p=0.001). No significant differences in preoperative opioid consumption or postoperative morbidities were observed between these two groups, and no complications related to the procedure were observed. Conclusion: For patients experiencing moderate to severe preoperative pain at the beginning of treatment, preoperative FICB can reduce pain scores for up to 2 days.
{"title":"Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Compartment Block (FICB) and Outcomes in Preoperative Fast-track Geriatric Patients with Hip Fracture: A Single-center Retrospective Study","authors":"Chutima Leewatchararoongjaroen, S. Tangwiwat, Piyawadee Rungmongkolsab, Pawadee Sutthaso","doi":"10.33192/smj.v76i7.267376","DOIUrl":"https://doi.org/10.33192/smj.v76i7.267376","url":null,"abstract":"Objective: This study aimed to evaluate the analgesic efficacy of preoperative fascia iliaca compartment block (FICB) in terms of preoperative pain score reduction in geriatric hip fracture patients. Secondary objectives were to compare opioid consumption, procedure-related complications, and patient outcomes.\u0000Materials and Methods: This single-center retrospective study included patients aged 65 or older with hip fractures who experienced moderate to severe pain in a tertiary care university hospital from January 2019 to July 2021. The variables collected for analysis were patient baseline characteristics and the pain score at rest, including during movement from the beginning of service and subsequently each morning after admission until the day of surgery.\u0000Results: A total of 439 patients were included in this study, 109 patients (24.8%) receiving preoperative FICB (FICB group). When comparing the FICB and non-FICB groups, a significant reduction in pain scores was observed on postadmission day 1, both at rest (0 [IQR=0-4] vs. 0 [IQR=0-2], p<0.001) and during movement (0 [IQR=0-4] vs. 0 [IQR=0-2], p=0.018). This difference in pain reduction persisted on day 2 during movement (3 [IQR=0-5.75] VS 0 [IQR=0-3], p=0.001). No significant differences in preoperative opioid consumption or postoperative morbidities were observed between these two groups, and no complications related to the procedure were observed.\u0000Conclusion: For patients experiencing moderate to severe preoperative pain at the beginning of treatment, preoperative FICB can reduce pain scores for up to 2 days.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"25 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141699630","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.33192/smj.v76i7.268063
Pawit Somnuke, O. Pongraweewan, A. Siriussawakul
Thailand has transitioned into an aging society characterized by a notable demographic shift toward senior citizens. This demographic trend underscores the imperative of addressing age-related challenges. The aging process accounts for the progressive deterioration of physical and cognitive functions, often necessitating medical interventions such as medications or surgical procedures. As the elderly population continues to grow, prioritizing strategies to enhance quality of life and mitigate the onset of physical and cognitive impairments becomes increasingly crucial. Prudent patient care is paramount due to the heightened vulnerability of elderly patients and the elevated risk of adverse health outcomes. This review aimed to examine perioperative evaluation and optimization strategies tailored specifically for elderly individuals scheduled for surgery. Special emphasis was placed on preserving postoperative functional capacity and cognitive acuity among this group of patients.
{"title":"Optimizing Perioperative Care for Elderly Surgical Patients: A Review of Strategies and Evidence-Based Practices","authors":"Pawit Somnuke, O. Pongraweewan, A. Siriussawakul","doi":"10.33192/smj.v76i7.268063","DOIUrl":"https://doi.org/10.33192/smj.v76i7.268063","url":null,"abstract":"Thailand has transitioned into an aging society characterized by a notable demographic shift toward senior citizens. This demographic trend underscores the imperative of addressing age-related challenges. The aging process accounts for the progressive deterioration of physical and cognitive functions, often necessitating medical interventions such as medications or surgical procedures. As the elderly population continues to grow, prioritizing strategies to enhance quality of life and mitigate the onset of physical and cognitive impairments becomes increasingly crucial. Prudent patient care is paramount due to the heightened vulnerability of elderly patients and the elevated risk of adverse health outcomes. This review aimed to examine perioperative evaluation and optimization strategies tailored specifically for elderly individuals scheduled for surgery. Special emphasis was placed on preserving postoperative functional capacity and cognitive acuity among this group of patients.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"235 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.33192/smj.v76i7.267837
Thanawut Jitsinthunun, Pawika Supannanont, M. Raksakietisak
Objective: Hip fractures are a major health problem in older individuals. Surgical repair is the recommended treatment. Intraoperative hypotension (IOH) due to spinal anesthesia is common and may be associated with unfavorable outcomes. This study aimed to identify the incidence, risk factors, and outcomes of IOH in patients with hip fracture under spinal anesthesia. Materials and Methods: Retrospective data from a Thai hospital (January 2018-December 2020) were reviewed. Patients over 50 who underwent hip surgery were included, excluding those receiving general anesthesia, with high-energy/pathological fractures, or multiple traumas. Patients were categorized into no-IOH and IOH groups, with outcome measures compared. Results: In total, 264 patients were included for analysis. The mean age was 80.9 ± 8.3 years, with 77.3% females. The incidence of IOH was 37.9% [95% CI: 30.8%, 46.1%] and an independent risk factor was age > 65 years (OR [95% CI]: 6.23 [1.13, 34.47]. The two protective factors for IOH were higher preoperative mean arterial pressure (OR [95% CI]: 0.96 [0.93, 0.99]) and time from fracture to surgery > 24 hours (OR [95% CI]: 0.43 [0.21, 0.89]). Postoperative blood transfusions were administered more frequently (53.7%) in the IOH group than in the no-IOH group (37.9%, p = 0.014). Conclusion: The incidence of intraoperative hypotension in hip fracture surgery was 38%. Aging is the only identified risk factor. IOH was related to a higher frequency of blood transfusion, but no other postoperative complications or mortality rates.
{"title":"Incidence, Risk-factors, and Outcomes of Intraoperative Hypotension Following Spinal Anesthesia in Hip Fracture Surgery: A Retrospective Study from Thailand","authors":"Thanawut Jitsinthunun, Pawika Supannanont, M. Raksakietisak","doi":"10.33192/smj.v76i7.267837","DOIUrl":"https://doi.org/10.33192/smj.v76i7.267837","url":null,"abstract":"Objective: Hip fractures are a major health problem in older individuals. Surgical repair is the recommended treatment. Intraoperative hypotension (IOH) due to spinal anesthesia is common and may be associated with unfavorable outcomes. This study aimed to identify the incidence, risk factors, and outcomes of IOH in patients with hip fracture under spinal anesthesia.\u0000Materials and Methods: Retrospective data from a Thai hospital (January 2018-December 2020) were reviewed. Patients over 50 who underwent hip surgery were included, excluding those receiving general anesthesia, with high-energy/pathological fractures, or multiple traumas. Patients were categorized into no-IOH and IOH groups, with outcome measures compared.\u0000Results: In total, 264 patients were included for analysis. The mean age was 80.9 ± 8.3 years, with 77.3% females. The incidence of IOH was 37.9% [95% CI: 30.8%, 46.1%] and an independent risk factor was age > 65 years (OR [95% CI]: 6.23 [1.13, 34.47]. The two protective factors for IOH were higher preoperative mean arterial pressure (OR [95% CI]: 0.96 [0.93, 0.99]) and time from fracture to surgery > 24 hours (OR [95% CI]: 0.43 [0.21, 0.89]). Postoperative blood transfusions were administered more frequently (53.7%) in the IOH group than in the no-IOH group (37.9%, p = 0.014).\u0000Conclusion: The incidence of intraoperative hypotension in hip fracture surgery was 38%. Aging is the only identified risk factor. IOH was related to a higher frequency of blood transfusion, but no other postoperative complications or mortality rates.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"280 2‐3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141708185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.33192/smj.v76i7.268007
Surapa Tornsatitkul, P. Suraarunsumrit, Laddawan Jensarikit, A. Siriussawakul, S. Niyomnaitham
Objective: Postoperative Cognitive Dysfunction (POCD) is a complication that arises in the elderly. Because of the limited knowledge of POCD, researchers must handle a substantial amount of data to ensure the comprehensive collection of all relevant factors. To deal with this data, a validation study is a valuable method that aids in qualifying the data. Materials and Methods: A validation exercise was performed for 40% of the data in the Siriraj POCD database (n=250) in 2020-2023. The validation covered 30 items, including demographic data, surgical and anesthetic factors. The validation study had two components: internal validation, which aimed to assess the completeness, uniformity, plausibility, and accuracy of the data in the database, and external validation, where the results were compared to external literature to confirm their correspondence. Results: The completeness was 99.2% for creatinine and 94.0% for hemoglobin, while others showed 100% completeness. The accuracy ranged from 73.6% to 99.6%, with a median of 97.4%. Most errors found were related to “body weight”, followed by “hemoglobin levels” and “Propofol targeted controlled infusion”, with accuracy rates of 73.6%, 84.0%, and 85.2%, respectively. In the external validation, the POCD incidence at 1 week from surgery in the literature review ranged from 8.9%–46.1% compared to 26.0% in our study. Conclusion: The Siriraj POCD cohort study database was found to be reasonably valid. Therefore, this data can support high-quality research. Our recommendations for developing a good database include implementing a dedicated plan, employing trained staff, and using reliable data sources.
{"title":"Validation Study of the Postoperative Cognitive Dysfunction Database in Siriraj Hospital, Thailand","authors":"Surapa Tornsatitkul, P. Suraarunsumrit, Laddawan Jensarikit, A. Siriussawakul, S. Niyomnaitham","doi":"10.33192/smj.v76i7.268007","DOIUrl":"https://doi.org/10.33192/smj.v76i7.268007","url":null,"abstract":"Objective: Postoperative Cognitive Dysfunction (POCD) is a complication that arises in the elderly. Because of the limited knowledge of POCD, researchers must handle a substantial amount of data to ensure the comprehensive collection of all relevant factors. To deal with this data, a validation study is a valuable method that aids in qualifying the data.\u0000Materials and Methods: A validation exercise was performed for 40% of the data in the Siriraj POCD database (n=250) in 2020-2023. The validation covered 30 items, including demographic data, surgical and anesthetic factors. The validation study had two components: internal validation, which aimed to assess the completeness, uniformity, plausibility, and accuracy of the data in the database, and external validation, where the results were compared to external literature to confirm their correspondence.\u0000Results: The completeness was 99.2% for creatinine and 94.0% for hemoglobin, while others showed 100% completeness. The accuracy ranged from 73.6% to 99.6%, with a median of 97.4%. Most errors found were related to “body weight”, followed by “hemoglobin levels” and “Propofol targeted controlled infusion”, with accuracy rates of 73.6%, 84.0%, and 85.2%, respectively. In the external validation, the POCD incidence at 1 week from surgery in the literature review ranged from 8.9%–46.1% compared to 26.0% in our study.\u0000Conclusion: The Siriraj POCD cohort study database was found to be reasonably valid. Therefore, this data can support high-quality research. Our recommendations for developing a good database include implementing a dedicated plan, employing trained staff, and using reliable data sources.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"18 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.33192/smj.v76i7.267386
Sawita Kanavitoon, S. Chumpathong, A. Chutipongtanate, Jutarat Tanasansuttiporn, S. Rattana-arpa
Objective: Effective clinical training is essential for healthcare personnel with clinical skill requirements. This studyaimed to identify an effective learning medium for anesthesia residents by comparing text-based and video-based online training. Materials and Methods: This online, randomized, multicenter study was conducted between October 2020 and March 2021. Three Thai institutions were involved: the Faculty of Medicine Siriraj Hospital, Mahidol University; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University; and the Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University. In all, 126 anesthesia residents were randomized into a “text group” and a “video group.” Four residents were excluded due to contamination of their learning material. The 122 eligible students undertook 3 knowledge and skill assessments (“Pretest,” “24-hour posttest,” and “3-month posttest”). The primary outcome was the gain score after training. This was measured in 2 ways: the difference between the 24-hourposttest and Pretest scores and the difference between the 3-month posttest and Pretest scores. Results: The mean gain scores for Pretest and 24-hour posttest were higher in the text group with no significant difference (P = 0.347). The mean differences between the 3-month posttest and Pretest scores were higher in the text group without a significant difference (P = 0.488). The mean satisfaction score was higher in the video group. Conclusion: Video-based e-learning training provided better satisfaction without significantly improving gain scores compared to text-based e-learning training. Online video-based was beneficial over text-based for ease of understanding in clinical learning points.
{"title":"Comparing Effectiveness of Online Text-based and Video-based Material in Anesthesia with Jet Ventilation and Microlaryngeal Surgery: A Multicenter Randomized Trial","authors":"Sawita Kanavitoon, S. Chumpathong, A. Chutipongtanate, Jutarat Tanasansuttiporn, S. Rattana-arpa","doi":"10.33192/smj.v76i7.267386","DOIUrl":"https://doi.org/10.33192/smj.v76i7.267386","url":null,"abstract":"Objective: Effective clinical training is essential for healthcare personnel with clinical skill requirements. This studyaimed to identify an effective learning medium for anesthesia residents by comparing text-based and video-based online training.\u0000Materials and Methods: This online, randomized, multicenter study was conducted between October 2020 and March 2021. Three Thai institutions were involved: the Faculty of Medicine Siriraj Hospital, Mahidol University; the Faculty of Medicine, Ramathibodi Hospital, Mahidol University; and the Faculty of Medicine, Songklanagarind Hospital, Prince of Songkla University. In all, 126 anesthesia residents were randomized into a “text group” and a “video group.” Four residents were excluded due to contamination of their learning material. The 122 eligible students undertook 3 knowledge and skill assessments (“Pretest,” “24-hour posttest,” and “3-month posttest”). The primary outcome was the gain score after training. This was measured in 2 ways: the difference between the 24-hourposttest and Pretest scores and the difference between the 3-month posttest and Pretest scores.\u0000Results: The mean gain scores for Pretest and 24-hour posttest were higher in the text group with no significant difference (P = 0.347). The mean differences between the 3-month posttest and Pretest scores were higher in the text group without a significant difference (P = 0.488). The mean satisfaction score was higher in the video group.\u0000Conclusion: Video-based e-learning training provided better satisfaction without significantly improving gain scores compared to text-based e-learning training. Online video-based was beneficial over text-based for ease of understanding in clinical learning points.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"16 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.33192/smj.v76i7.266174
Chatchaya Thalerngnawachart, John Marc O'Donnell, Usapan Surabenjawong
Objective: To compare the basic airway management skill score of Thai medical students who learned airway management utilizing blended peer-to-peer teaching with those who learned by the standard face-to-face approach. The learners’ pre- and post-learning confidence, satisfaction with the learning, and stress levels were evaluated. Materials and Methods: A randomized crossover study was conducted with third-year medical students in Thailand. Basic airway management was taught, including oropharyngeal and nasopharyngeal airway insertion, and bag-mask ventilation skills. After the learning, two blinded and independent experts rated the learners on performing the procedures. Results: In total, 32 participants took part in the study. The blended group had significantly lower skill scores for oropharyngeal airway (8.69 ±1.078 and 9.69 ± 0.479, p-value 0.004) and nasopharyngeal airway (7.87 ± 1.408 and 9.38 ± 0.500, p-value 0.001) management, respectively. The bag-mask ventilation skills scores were also lower in the blended group. The confidence level was increased in both groups. Learning with the face-to-face method was found to be slightly less stressful. Overall, the majority of the students preferred learning by the standard method. Conclusion: Unlike Western students, Thai learners can learn basic airway management skills more effectively with the face-to-face instructor-led method than with the peer-oriented blended method.
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Objective: Postoperative delirium (POD) has three subtypes: hyperactive, hypoactive, and mixed, with each having distinct features and implications. This study aimed to determine the incidence, management, and clinical outcomes of each POD subtype in elderly patients admitted to the surgical intensive care unit (SICU) after surgery. Materials and Methods: This was a secondary analysis of a prospective cohort study of POD in the SICU. Patients aged ≥65 years admitted to the SICU and expected to stay in the SICU for >24 h were recruited. POD was screened using the Confusion Assessment Method for the ICU (CAM-ICU). Patients with positive CAM-ICU were defined as having POD and included in the analysis. The POD subtypes were categorized, pharmacological and nonpharmacological treatments were identified, and clinical outcomes were reported. Results: Of the 300 included patients, 117 developed POD, with 20 (17.1%) having hypoactive, 45 (38.5%) hyperactive, and 52 (44.4%) mixed. Medications were prescribed in 1 (5.0%), 34 (75.6%), and 35 (67.3 %) in patients with hypoactive, hyperactive, and mixed POD, respectively (P <0.001). Patients with hypoactive POD had the longest duration of delirium, longest length of stay in both the SICU and hospital, and highest hospital mortality. Multivariate regression analysis revealed that hypoactive POD was significantly associated with increased hospital mortality (odds ratio, 3.88; 95% confidence interval, 1.15–13.11). Conclusion: Different POD subtypes resulted in different outcomes. Although hypoactive POD had the lowest incidence, it carried the highest mortality risk.
目的：术后谵妄（POD）有三种亚型：过度活跃型、低活跃型和混合型，每种亚型都有不同的特征和影响。本研究旨在确定手术后入住外科重症监护室（SICU）的老年患者中每种 POD 亚型的发生率、管理和临床结果：这是一项关于 SICU 中 POD 的前瞻性队列研究的二次分析。研究招募了年龄≥65 岁、入住 SICU 且预计在 SICU 停留时间超过 24 小时的患者。使用重症监护室意识障碍评估方法（CAM-ICU）筛查 POD。CAM-ICU 阳性的患者被定义为 POD 患者并纳入分析。对 POD 亚型进行了分类，确定了药物和非药物治疗方法，并报告了临床结果：在纳入的 300 名患者中，117 人出现了 POD，其中 20 人（17.1%）为低活泼型，45 人（38.5%）为高活泼型，52 人（44.4%）为混合型。低能、多能和混合型 POD 患者中分别有 1 人（5.0%）、34 人（75.6%）和 35 人（67.3%）接受了药物治疗（P <0.001）。POD亢进患者的谵妄持续时间最长，在重症监护室和医院的住院时间最长，住院死亡率最高。多变量回归分析表明，低反应性 POD 与住院死亡率增加显著相关（几率比为 3.88；95% 置信区间为 1.15-13.11）：结论：不同的POD亚型会导致不同的结果。结论：不同的 POD 亚型会导致不同的结果，虽然低活性 POD 的发病率最低，但其死亡风险最高。
{"title":"Incidences, Characteristics, Management and Outcomes of Different Subtypes of Postoperative Delirium in Elderly Patients Admitted to the Surgical Intensive Care Unit: A Secondary Analysis of a Prospective Cohort Study","authors":"Thirada Srinil, Suchanun Lao-amornphunkul, Akarawat Narksut, Napat Thikom, Cholticha Pansangar, Chayanan Thanakiattiwibun, Thassayu Yuyen, Onuma Chaiwat, Annop Piriyapatsom","doi":"10.33192/smj.v76i7.267145","DOIUrl":"https://doi.org/10.33192/smj.v76i7.267145","url":null,"abstract":"Objective: Postoperative delirium (POD) has three subtypes: hyperactive, hypoactive, and mixed, with each having distinct features and implications. This study aimed to determine the incidence, management, and clinical outcomes of each POD subtype in elderly patients admitted to the surgical intensive care unit (SICU) after surgery.\u0000Materials and Methods: This was a secondary analysis of a prospective cohort study of POD in the SICU. Patients aged ≥65 years admitted to the SICU and expected to stay in the SICU for >24 h were recruited. POD was screened using the Confusion Assessment Method for the ICU (CAM-ICU). Patients with positive CAM-ICU were defined as having POD and included in the analysis. The POD subtypes were categorized, pharmacological and nonpharmacological treatments were identified, and clinical outcomes were reported.\u0000Results: Of the 300 included patients, 117 developed POD, with 20 (17.1%) having hypoactive, 45 (38.5%) hyperactive, and 52 (44.4%) mixed. Medications were prescribed in 1 (5.0%), 34 (75.6%), and 35 (67.3 %) in patients with hypoactive, hyperactive, and mixed POD, respectively (P <0.001). Patients with hypoactive POD had the longest duration of delirium, longest length of stay in both the SICU and hospital, and highest hospital mortality. Multivariate regression analysis revealed that hypoactive POD was significantly associated with increased hospital mortality (odds ratio, 3.88; 95% confidence interval, 1.15–13.11).\u0000Conclusion: Different POD subtypes resulted in different outcomes. Although hypoactive POD had the lowest incidence, it carried the highest mortality risk.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"53 50","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141689752","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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