Royal Thai Airforce Medical Gazette

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2 wounds VS 4 wounds laparosopic cholecystectomy
(Royal Thai Airforce Medical Gazette, 2010-03-14) Thiti Sawaengtham
Background: Laparoscopic cholecystectomy is now standard treatment of gallstone disease. For now 3 or 4 wounds techniques are usually used. Many of the studies reported using of 2 wounds techniques but most of them required special instruments. This study is to compare the 2 wounds and 4 wounds technique by using standard instruments. Methods: From 2003 to 2005, 40 patients undergoing elective laparoscopic cholecystectomy for gallstone disease by one surgeon were divided into two groups to received the 2 wounds or 4 wounds technique. Analgesia requirements, length of operation and postoperative stay were measured. Results: Demographic data were comparable for both groups. There was no difference between two groups in length of operation, postoperative stay and success rate. The 2 wounds group required fewer analgesic injections (81±36.55 vs 123±42.31, p=0.01). Conclusions: The 2 wounds laparoscopic cholecystectomy resulted in less surgical scars, good cosmetic and less pain. The 2 wounds laparoscopic cholecystectomy can be used as standard procedure by only using of standard instruments.
The accuracy of transcutaneous bilirubin (TcB) compare to ranserumbilirubin (TsB)
(Royal Thai Airforce Medical Gazette, 2010-03-14) Phipaporn Khongcharoensombat
Objective: 1. To evaluate the accuracy of transcutaneous bilirubin (TcB) measured by JM 103 from both sites (Head, sternum), when compare to transerumbilirubin (TsB). 2. To develop cut off point of TcB levels which indicate the need for serum bilirubin assessment in the hospital setting. Statistics: Prospective descriptive study. Methods: Total 215 pairs of TcBH-TsB; and 215 pairs of TcBS-TsB were evaluated from term and near term infants between Aug 2005 and Nov 2005. Using Minolta air shield JM 103 for transcutaneous bilirubin and Bilirubin Tester for evaluating the transerumbilirubin (TsB). The correlation of TcB from both sites and TsB was analysed by using simple linear regression. The accuracy of TcB from both sites compared to TsB by using pretest probability and post-test probability. ROC was generated to develop cut off point of TcB level for serum bilirubin assessment in the hospital setting. Results: 215 paired TsB-TcBH, 215 paired TsB-TcBS. Average birth weight was 3,072 g (SD=428). Average TsB was 10.12 mg/dl (SD=2.5). The correlation coefficient between TsB-TcBH, TsB-TcBS were significant (r=815 and r=0.866, p \< 0.001 respectively). The mean difference of TsB-TcBH were 0.36 mg/dl (95 % CI 0.19 to 0.52). The mean difference of TsB-TcBS were 0.06 mg/dl (95 % CI -0.26 to 0.14). The accuracy of TcB measured from both sites compares to TsB were nearly similar. The r of TcBH was higher than TcBS. TcBH values of 7.5, 8.5, 10, 13 mg/dl (corresponded to ages after birth 25-36 hr, 37-48 hr, 49-72 hr, \>72 hr respectively) can be used as a screeing test before draw blood for TsB, which TcBH values were under TsB values estimated 2 mg/dl at each ages after birth. Conclusion: TcB demonstrated high accuracy compared to TsB in both skin sites. It can be used as a screening test before blood sample was drawn to identify significant jaundice.
Acupuncture
(Royal Thai Airforce Medical Gazette, 2010-03-14) . .
Abstract not available
Anatomical variation of Lateral femoral circumflex artery in Thai people
(Royal Thai Airforce Medical Gazette, 2010-03-14) Pradab Pradabsuk
Objective: To investigate anatomical pattern of leteral femoral circumflex artery (LFCA) in Thai people. To find percentage of variation in location, size and length in each pattern. To identify the difference between genders (male \& female) and between 2 sides (left \& right). To suggest precautions for artery surgery in the patient diagnosed as having variation of LFCA. Study design: Descriptive study. Subjective: 15 formalin embalmed cadavers (30 sides) from department of anatomy, faculty of dentistry, Chulalongkorn University. Data collection: Structure and location of LFCA anatomy were investigated from cadavers. Localized anatomy for comparison includes distance from anterior superior iliac spine, length of artery (millimeter), diameter of artery measured by microscope Olympus model CHS (Lamp 6 V, 20 w) x 10 (mm). Statistical comparisons were conducted by using the compare means and pair T- test. Result: From 9 cases in male (60%), 6 cases in female (40%), at average 75 year-old (51-92), there were 5 patterns of LFCA including: Type A Type B Type C Type D Type E 20% (6/30) 40% (12/30) 26.6% (8/30) 6.6% (2/30) 6.6% (2/30) Lateral femoral circumflex artery ended with two terminal branches – the ascending and descending branch. Transverse branch only as the largest branch of the ascending branch. There was one case absent transverse branch. From the whole study cases, there was 20% LFCA originated from femoral artery while 80% originated from deep femoral artery. Length: measurement -Ascending Rt 62.0 (45.0-80.0) mm/ Lt 61.8 (40.0-78.0) mm. Transverse Rt 52.4 (45.0-80.0) mm /Lt 52.0 (46.0-75.0) mm. Descending Rt 130.0 (80.0-120.0) mm/Lt 132.0 (84.0-132.0) mm. Diameter: -Ascending Rt 1.38 (1.10-1.80) mm/Lt 1.43 (1.10-1.90) mm. Transverse Rt 1.30 (1.20-1.80) mm/Lt 1.26 (1.10-1.70) mm. Distance: from ASIS to ascending branch was 81.2 mm, from ASIS to transverse branch was 103.0 mm. There was no significant difference in type, length and diameter between male and female and no significant difference in length and diameter between right and left (95% CI). Results from the study can be used for assessment and localization of the LFCA for free vascularized fibular bone graft (FVFBG) surgery. One dissection that the transverse branch of LFCA was absent suggested an awareness of these variations, which could help avoiding unexpected injuries.
Ascorbic acid
(Royal Thai Airforce Medical Gazette, 2010-03-15) ฉัตรชัย ไตรทอง
Abstract not available
Causes of Visual Loss of Patient of Wanornnivas Hospital
(Royal Thai Airforce Medical Gazette, 2010-03-14) Nuttakant Saelee
Background and Rationale: Patient with visual loss of Wanornnivas Hospital will not be diagnosis and delay treatment until symptomatic late complication were detected. Objective: Causes of visual loss of patient of Wanornnivas Hospital. Patient and methods: Patient of Wanornnivas Hospital between 2 December 2006 to 2 September 2007 were screened, interviewed, diagnosed, treated by ophthalmologist. Preliminary result: 687 patient with visual loss were cataract 360 (52.4%), pterygium 55 (8%), AMD 12 (1.74%), others (myopia, glaucoma) 260 (37.84%). Almost patient have sunlight exposure, smooking history. None has genetic problem. Conclusion: Early prevention is important to treatment. Modify lifestyle; no smoking, avoid sunlight exposure, diet vegetable can prevent causes of visual loss.
Cognitive Improved Following Sensory Stimulation Program in Severe TBI Patients
(Royal Thai Airforce Medical Gazette, 2010-03-14) Tanate Chanduykit; Sasitorn Sirikul
Traumatic Brain Injury (TBI) is a major health problem. Although emergency care, diagnostic technology, medical intervention, and nursing care have resulted in increased survival following TBI, However those persons who sustain a TBI experience long-term functional impairments, including physical, cognitive behavioral and emotional changes. TBI effects individuals’ cognitive function including loss of memory, awareness, and attention. Cognitive is the basic of learning. The purpose of this study was to describe cognitive function following sensory stimulation program. In this prospective the effects of a Sensory Stimulation Program (SSP) were examined in 7 severe TBI patients. Recovery was measured by the Glasgow Coma Scale, the Rancho Los Amigo Scale (RLAS) the Sensory Modality Assessment and Rehabilitation Technique, length of coma. Results of this study that 4 patients improved cognitive functions, 2 patients no change of cognitive functions, 1 patient dead from Complication. Conclusion: The sensory stimulation program enhances plasticity and lead to reorganization of structure of the brain that support cognitive function in longterm.
Competency of HR developers in Royal Thai Air Force
(Royal Thai Airforce Medical Gazette, 2010-03-15) Khanuengnich Anuroj
The purposes of this research are; (1) to study factors covering personal status, organizational climate, self directed learning readiness, and to study competencies of the HR developers in the Royal Thai Air Force (RTAF), (2) to examine the relations between each foresaid factor to the competencies of HR developers in the RTAF, and (3) to explore both direct and indirect influences of the personal factors, organizational climate factors and the factors of self directed learning readiness on competencies of HR developers in RTAF. The 311 officers from 22 RTAF corps whose responsibilities including personnel management, planning and HR development were selected by stratified random sampling technique. The instrument used in this research was a set of questionnaires with 5 levels of rating scale. The questionnaires passed the validity test by \>.50 of congruence indicator and also passed the reliability test by Cronbach’s alpha coefficiency range between 0.79 and 0.96. The data was statistically analyzed by SPSS for Window and AMOS programs. The SPSS for Window was used to determine the mean, standard deviation and correlation. The AMOS program was done for confirmatory factor analysis (CFA) and to synthesize a structural equation model according to the CFA. The regression from hypothesized part diagram was also analyzed by the AMOS program as to modified model of influenced factors of competencies of Human Resource developers in RTAF.The research result revealed that: (1) RTAF climate, self directed learning readiness and Human Resource competencies in RTAF were rated averaging at high level. (2) The coefficient of correlation points of the foresaid factors to competencies of Human Resource developers in RTAF indicated that the personal factors did not correlate with the HR competencies at .05 leveled statistical significance. It was found that the RTAF Climate factors, consisted clarity, flexibility, team commitment, responsibility, standards, learning supports and reward, had correlation with HR competencies at .05 statistical significance level. The self directed learning readiness factors correlated with HR competencies at .05 statistical significance level. (3) The causal correlation between the factors of RTAF climate and of self directed learning readiness with competencies of HR developers in RTAF were at .05 statistical significance level which had direct effects from self directed learning readiness factors and from the RTAF climate covering flexibility and learning supports, and also had indirect effects from the RTAF climate covering flexibility, responsibility and learning supports. The overall factors, as stated above, could forecast competencies of HR developers in RTAF with accuracy of 77%. The variables influencing competencies of HR developers in RTAF, which did not reach statistical significance level at .05, were age, work duration, duration on HR development positions, team commitment, standard, and rewards. The dissertation consequence clarified that hypothesized model was consistent with modified model at the best criteria level, with values of chi-square=77.61, P-value=.14, df=65, RMSEA=.03, GFI=.97 and AGFI=.94.
The Correlation Between Timing of Endoscopy and The Outcome of Upper Gastrointestinal Bleeding (UGIB) in Emergency Room Bhumibol Adulyadej Hospital
(Royal Thai Airforce Medical Gazette, 2011-01-25) Thitima Charanyananda; Chalermporn Boonsiri; Chinnavat Sutthivana
Abstract not available
The Development of an Inventory Management System for The Royal Thai Air Force Medical Depot
(Royal Thai Airforce Medical Gazette, 2010-03-14) Chaiyong Suksrisomboon
The purpose of this study to apply the basic principle of EOQ (Economic Order Quantity) and Reorder Point to improve drug inventory management of Institute of Aviation Medicine, Directorate of Medical Services, Royal Thai Air Force, through the use of a model based on a computer program, Microsoft Excel. From the research findings, the application of such principle can lead to better control drug inventory and to determine more appropriate reorder points. It also reduces the operation costs. The current situation on drug inventory administration was analyzed and it was found that there was a large stock of medicine on hand, resulting in extremely high overhead and inventory costs. At the same time, certain types of medicine were absent and so the Institute could not meet the needs of the clients. This was due to the lack of efficiency in the existing approach and management of drug inventory. The findings showed that with the model developed to increase efficiency in drug inventory management of Institute of Aviation Medicine, Directorate of Medical Services, Royal Thai Air Force, it was possible to reduce overall expenses by 137,865 Baht, approximately 25.97% of the total. Furthermore, it was able to reduce the average inventory cost by 17,628,312 Baht, or 34.65%.
Development of Self-Care Agency Model in Diabetics Patients of Primary Care Unit at Bhumibol Adulyadej Hospital
(Royal Thai Airforce Medical Gazette, 2010-02-02) Khanuengnich Anuroj
The objectives of this study are as follows: (1) to develop the self-care agency Model in Diabetics Patients of Primary Care Unit (PCU) at Bhumibol Adulyadej Hospital, (2) to study the effectiveness of the self-care agency Model in Diabetics Patients of PCU at Bhumibol Adulyadej Hospital. Selected the volunteer 54 Diabetics Patients of PCU at Bhumibol Adulyadej Hospital with include criteria, Fasting Blood Sugar (FBS) \> 150 mg/del and HbA1C \> 7, as the samples.The instruments of research were (1) Education self-care manual for diabetics patients (2) Diabetics patients’ portfolio for recorded habit and blood test for FBS, Hb A1C (3) Self-care evaluation questionnaires with 3-level scales. In testing for validity, it was found that the questionnaires and self-care manual satisfied validity criteria by referring to the Index of Consistency (IOC) at a congruence indicator level greater than 0.50.The samples will be tested for FBS, Hb A1C and will undergo a diabetes-related general knowledge pre-test. Then, the samples will be grouped in fives to carry on the self care intervention—a set of activities focused on peer-to-peer knowledge sharing—for 3 hours, 5 times in afternoon Wednesdays. The activities include the following 5 topics: Knowledge in diabetes, Medication, Nutrition, Exercising and Foot-caring. The activities are carried out by a team of nurses, nutritionists, physical therapists and pharmacists. After intervention the samples will be tested for FBS, Hb A1C and will undergo the same diabetes-related general knowledge quiz again for post-test.The data obtained from the set of questionnaires was statistically analyzed by Statistical Product and Service Solutions (SPSS) for Windows. The software involved in determining the means, standard deviations and paired-simple t-test.Research findings are as follows: (1) Self-care average after participating in the intervention is better than before, at the .01 level of statistical significance. (2) Blood tests for FBS and Hb A1C Aafter participating in the intervention are better than before, at the .01 level of statistical significance.
Drug Resistant Mycobacterium Tuberculosis in New Cases in Maharat Nakhon Ratchasima Hospital in 2007
(Royal Thai Airforce Medical Gazette, 2010-03-14) Tawatchai Wiwatworapan
BACKGROUND: Standard anti-tuberculosis regimen is usually effective in drug sensitive cases of tuberculosis. On contrary, it may possible fail in cases of drug resistance (MDR-TB). In 1998, 2002, MDR-TB is rarely found, routine culture and sensitivity test are not recommended. OBJECTIVE: To verify the incidence of drug resistance in new cases of pulmonary tuberculosis and study the risk factors. METHOD: All smear positive pulmonary tuberculosis patients in 2007 were recruited. History taking and sputum culture with sensitivity test were performed. Anti-HIV test was recommended in all cases. RESULT: Sputum culture for M.tuberculosis were performed in 161 patients who had positive AFB in sputum. 132 were newly treated while 29 were previously treated. For new cases the culture were yielded in 86 cases, 7 case were INH single drug resistant, whereas one of them was HIV positive, and 7 cases were MDR-TB and only 1 case was HIV positive. For previously treated cases culture were yielded in 22 cases, 6 were MDR-TB, 2 of them were HIV positive. MDR-TB in previously treated were higher than newly treated cases (OR=4.23, 95% CI=1.25-14.27) and did not related to HIV infection. CONCLUSION: We founded 8.1% INH single drug resistance in new cases and did not related to HIV infection. MDR-TB was founded 8.1% in new cases did not related to HIV infection too. In previously treated cases we founded MDR-TB 27.3% which is more than newly treated cases.
Editor Note
(Royal Thai Airforce Medical Gazette, 2010-05-27) Kriengsak Anuroj
Not Available
The effect of a project of mentor as a counselor on a stress and satisfaction of the Royal Thai Air Force nursing student in Clinical Practice in Maternal-Newborn Nursing and Midwifery 2 course
(Royal Thai Airforce Medical Gazette, 2010-03-14) Jeangkum Kungvon; Chalida Chamchareon; Chanita Amornratanathada; Aurathai Mingmith; Nittaya Suksean
Objectives: 1. To identify stress level of RTAF nursing student in MNM2. 2. To compare scores of stress between control and experiment group of the RTAF nursing student in MNM2. 3. To define scores of satisfaction between control and experiment group of the RTAF nursing student in MNM2. Methodology: Quasi-experiment was used. Samples were fifty-eight of third year nursing students. Samples were divided into two groups of control and experiment equally. Research instrument were stress assessment form and questionnaires of satisfaction of the nursing student. Data were analyzed by t-test. The research findings: 1. Stress levels of the RTAF nursing student after 6 weeks in experiment group were 3.70 whereas control group were 21.42. 2. The scores of stress in experiment group were lower than control group at level of .05 significantly. 3. The scores of satisfaction in term of mentor roles as a counselor in experiment group were higher than control group at a level of .05 significantly.Suggestions: 1. For teaching curriculum: All of nursing practice subjects should have a mentor as a counselor. 2. For teaching management: Should emphasize theory and practice to provide more benefits for the nursing student along with the nursing mentor. This process will develop the instruction process and improve attitude. It is necessary for a student to grow and develop in order to be a good nurse. 3. For research: Research should help the students and their colleagues as a group to develop and increase their potential as students and nurses.
The Effect of Intravenously Dexamethasone in Alleviating Post-tonsillectomy Pain
(Royal Thai Airforce Medical Gazette, 2010-09-10) Jampole, P. B.sc (Pharm.) * Jampole, P. MD. **
non
Effectiveness of the Prostate Specific Antigen (PSA) For the Semen Detection in Vaginal Specimens of Raped Women
(Royal Thai Airforce Medical Gazette, 2010-09-10) AVM.Vicharn Peonim; MD.Forensic Unit
Abstract not available
The Evaluation of the Bachelor of Nursing Science Program (revised curriculum 2003) Royal Thai Air Force Nursing College
(Royal Thai Airforce Medical Gazette, 2010-03-14) Sripaiboon Sirimungkhala; Supit Prasopsil; Donleudee Rojviriya; Watcharaporn Paorohit; Bang–on Ritudom; Sukon Maenaidtip
Objectives of the study: to evaluate the Bachelor of Nursing Science Program (revised curriculum 2003) using the CIPP Model where C stands for context, I stands for input, P stands for process and P stands for product. Context included the evaluation of the curriculum objectives, structure and content of the curriculum. Input involved the evaluation of the readiness of the nursing student, infra-structure, audio-visual aids, and the role of the nurse instructors. Process included teaching learning process, measurement and evaluation. Product involved the characteristics of the graduated nurse. Research methodology: This study was a descriptive study. Questionnaires were used to collect data. The samples of the study were 25 nurse instructors and fourth year nursing students, academic year 2006. Data were analyzed by using frequency, arithmetic mean and standard deviation. Research findings: 1. The nursing instructor’s opinions towards the characteristics of the curriculum objectives were vivid, responses to social problem solving were practical, and emphasized personal characteristics were at a high level. 2. The opinions of the fourth year nursing students towards the structure of the first year course were at a high level. 3. The opinions of the fourth year nursing students towards the structure of the second year course were appropriate at a high level. 4. The opinions of the fourth year nursing students towards the structure of the third year course were appropriate at a high level. 5. The opinions of the fourth year nursing students towards the structure of the fourth year course were appropriate at a high level. 6. The opinions of the fourth year nursing students towards the nursing profession were appropriate in terms of pride to be a nurse, helping family and others, being disciplined and dedicated to others. 7. The opinions of the fourth year nursing students towards the supporting factors in teaching and learning process were found that with audiovisual aids, videos and slides were not up to date and insufficient and the equipment in learning resource center and science laboratory room were not up to date. 8. The opinions of the fourth year nursing students towards the characteristics of the graduate were found that the mean scores of the directing and cooperation competency were lowest. The mean scores of honesty were highest.
Excessive daytime sleepiness in obstructive sleep apnea In Bhumibol Adulyadej Hospital
(Royal Thai Airforce Medical Gazette, 2010-03-14) Jarinratn Sirirattanapan; Artima Boonwan; Jungrak Phromchairak
Background: Excessive daytime sleepiness is a serious effect on obstructive sleep apnea leading to health problems, altered quantity and quality of work in daytime, especially risk of industrial and automobile accident. Material and Method: Cross-sectional Descriptive study. To collected demographic data of the patients such as Age, Sex, Body mass index (BMI). All of the patients underwent of Polysomnography (PSG) and Epworth Sleepiness Scale questionnaire (ESS).Results: There were patients who underwent Polysomnography have inclusion in this study 160 patients Range of age 26-80 year, Male 77.5%, Female 22.5%, Mean age 49.1±11.4, Lowest BMI 16.6 Highest BMI 45.7 Mean BMI 27.6±4.2, Mean lowest oxygen saturated 78.4%±12.1. Lowest Apnea hypopnea index (AHI) 5.4 Highest 93.6 Mean AHI 33.0 ±25.1, OSA classify in mild (AHI \> 5-15) 27.4%, moderate (AHI 16-30) 24.0%, severe (AHI \> 30) 48.6%. Excessive daytime sleepiness (EDS) was demonstrated in Epworth sleepiness Scale (ESS) Mean 11.8±5.0, EDS classify in mild degree (ESS \>10-15) 36.2%, severe (\>15) 20.0%. EDS in male and female Mean ESS 15.74±4.01 and 13.88±2.35. The prevalence of EDS in OSA 52.5% to classified in mild degree 33.1% and severe 19.4%. The prevalence of EDS classify in male 41.2%, female 15%. The prevalence of EDS classify in BMI \> 25 and BMI \> 30 found 44.3% and 15%, when classify in each age groups 20-40, 41-55, \> 55 years the prevalence are 10%, 30.6% and 15.6%. Significant differences EDS between male and female at p \< 0.05. EDS in each age group 20-40, 41-55, \> 55 years Mean ESS 14.56±3.20, 15.29±3.89 and 15.60±3.77. No significant differences among age groups p \< 0.05. For study correlations between obstructive sleep apnea and excessive daytime sleepiness found that weak relations between AHI and ESS p=0.003 (Pearson Correlation = 0.218).Conclusion: The excessive daytime sleepiness in obstructive sleep apnea patients found the prevalence of EDS in OSA 52.5% classify in mild 33.1% severe 19.4%. This study found more than 50% of patients have excessive daytime sleepiness. If no other management in these patients these problems are accumulate and severe resulting in health problem leading to poor quality of life, lack of work efficiency, increased risk for accidents and turn to chronic illness diseases.
The Expectation and Perception of Anesthetic Service Quality of Orthopedic Patient, Police General Hospital
(Royal Thai Airforce Medical Gazette, 2010-09-10) Police Colonel Nachada Nernsawai *
non
Factors affecting alcohol consumption behavior : case study of the air technical students
(Royal Thai Airforce Medical Gazette, 2010-03-15) ปุณณภา สุวรรณโชติ
Objective: To evaluate the perception of harmfulness of alcohol beverages and study factors affecting alcohol consumption behavior of the air technical students.Methods: Survey descriptive study. The total of 926 air technical students were target population and specify selected by Yamane’s formula to be 280 person, using SPSS program, t-test, One-Way ANOVA, and analyze of Pearson Product Moment Correlation. Results : The different age group of 15-16 years old, 17-18 years old and 19 years old up, the difference of corps, income, visiting place on holidays, history of substance usage, alcohol consumption behavior of the family and also the difference of peers association with alcohol consumption, these all made different alcohol consumption behavior at 0.05 level of statistical significance. The difference of grade point average, frequency of other drugs usage, knowledge of alcohol beverages, perception of taking risk and impact of alcohol, family relation, the influence of media and attention to alcohol beverages advertisement those all did not effect alcohol consumption behavior at 0.05 level of significance. Conclusion: Factors related to alcohol consumption behavior, the personal background which related to alcohol consumption behavior were age, corps, income, visiting place on holidays, history of substance usage. The alcohol consumption behavior of family and peers association with alcohol consumption. The difference of those all induced different alcohol consumption behavior.

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