The effectiveness of community-based interprofessional education for undergraduate medical and health promotion students.

BACKGROUND: Community-based interprofessional education (CBIPE) has been proven effective in enhancing the interprofessional competencies of medical and health professional students. However, there is a lack of evaluation on the impact of experiential CBIPE among undergraduate medical and health promotion students in Thailand. Therefore, the objective of this study is to assess the influence of CBIPE learning on the collaborative competencies of these students. METHODS: A one-group pre-posttest design in 193 (152 medical students and 41 health promotion) students were involved in the CBIPE program, later divided into 12 groups. Data was collected by direct observations of mentors using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS). The Wilcoxon matched-pairs signed-rank test was conducted to evaluate the effectiveness of the CBIPE program. RESULTS: A total of 175 (90.67%) completed ICCAS and satisfaction questions before and after the CBIPE program. The mean age of respondents was 20.29 ± 1.63 years; 60.57% were women and 39.43% were men. The results showed a significant increase in collaborative competencies before and after the 2-week course. Gender-stratified analysis showed an improvement after CBIPE training for all subscales in women, while the communication, collaboration, conflict management, and functioning team skills segment score was significantly higher in the post-assessment among men. CONCLUSION: The implementation of CBIPE learning was successful in enhancing collaborative competencies among both medical and health promotion students. These findings will provide valuable insights for the design and improvement of CBIPE learning programs in other universities.

The Influence of the Partner's Involvement in Antenatal Genetic Group Counseling on Pregnant individuals' Scores on Tests of Vital Knowledge Relating to Pregnancy.

OBJECTIVE: Physicians and other medical providers counsel patients to provide them with most important information and available medical service options. How to provide the most effective antenatal counseling is an important focus among experts. Our study focuses on the influence of the partner's involvement during antenatal genetic group counseling (AGGC). This study aimed to compare the ratio of pregnant individuals who have knowledge score improvement after AGGC, with a focus on pregnant individuals who attend counseling with/without their partner and to identify other possible factors that could influence the knowledge improvement. STUDY DESIGN: A prospective cohort study was conducted. Pregnant individuals were assessed for their knowledge by using a self-questionnaire prior to and immediately after AGGC. RESULTS: A total of 553 pregnant women were enrolled; 310 and 243 participants attended the AGGC without and with their partner, respectively. The ratio of the participants who increased their overall knowledge score was significantly higher after the AGGC for those who were with partner compared with those without. The medians (Q1-Q3) of the overall knowledge scores before and after the AGGC were 32 (29-36) and 36 (31-39) in the AGGC with their partner, respectively, and 33 (30-36) and 35 (32-39) in the AGGC without their partner, respectively. Knowledge of trisomy-21 screening of all participants got the lowest score and less improvement when compared with other topics. CONCLUSION: Partner's involvement in the AGGC was associated with a higher ratio of the participants who increased their overall knowledge score when comparing the scores prior to and immediately after the AGGC.

Efficacy of a 28-compartment pillbox for improving iron supplement compliance in healthy pregnant women: a randomised controlled trial.

A randomised controlled trial was conducted. The primary objective was to evaluate the efficacy of a pillbox for increasing iron supplement compliance by comparing the proportion of pregnant women who had no remaining iron tablets between pregnant women attending ANC who were given a pillbox to use and women with no pillbox in four-week period between ANC visits. The secondary objective was to evaluate the reasons for poor compliance and possible factors associated with the non-compliance. One hundred and ninety pregnant women were enrolled, 95 participants were randomised into each of the groups. The proportion of pregnant women who had no remaining iron tablets at the end was statistically significantly lower in the pillbox group than in the control group [53.3% and 23.1%, respectively, p < .001, RR2.308 (95% CI 1.515 - 3.517)]. The most common reason given for having of iron tablets remaining was forgetfulness. The visual analog scale (VAS) scores indicated that patient's responsibility feeling, duration of sleep each day and presence of a handicapped or small child in care significantly influenced the proportion of pregnant women who had remaining iron tablets at the end in both groups. We concluded that a pillbox was found to be an effective tool for improving pregnant women's compliance with taking their iron supplements.IMPACT STATEMENTWhat is already known about this subject? Antenatal care (ANC) influences maternal and neonatal outcomes. The incidence of anaemia in pregnant women is reported to be around 42% and approximately 50% result from iron deficiency. Maternal anaemia increases the risk of foetal low birth weight, preterm birth, perinatal mortality, stillbirth and maternal mortality.What do the results of this study add? The 28-compartment pillbox is effective for improving iron supplement compliance in healthy pregnant women. Forgetfulness is the most common reason given for having remaining iron tablets. The lower score on the visual analog scale of patient's feeling of responsibility, long duration of sleep a day and the presence of a handicapped or small child in their care were significantly associated with having remaining iron tablets.What are the implications are of these finding for clinical practice and/or further research? The 28-compartment pillbox can be implied to routine antenatal care for improving iron supplement compliance in healthy pregnant women. Health care providers should be reminded to encourage compliance with iron supplement prescription in pregnant women who are at risk of poor compliance as indicated by low VAS of the patient's feeling of responsibility, long duration of sleep in a day and pregnant women who have responsibility to take care of handicapped or small children.

Accuracy and factors influencing Leopold's manoeuvres in determining vertex presentation during late third trimester of pregnancy.

This prospective descriptive study was conducted for examine the accuracy of Leopold's manoeuvres in determining vertex presentation and to identify factors which may influence the accuracy. Pregnant women gestational age more than 34 weeks were examined using Leopold's manoeuvre for foetal presentation, and findings confirmed on subsequent ultrasonographic (US) examinations. Our study found Leopold's manoeuvre for foetal presentation determination during the late third trimester of pregnancy has high sensitivity but low specificity. Accuracy of performance of Leopold's manoeuvre for foetal presentation and lie were 89 and 96%, respectively. The sensitivity, specificity and PPV for vertex presentation diagnosis were 93.2, 30 and 94.9%, respectively. A larger foetal abdominal circumference decreased the accuracy of performance of Leopold's manoeuvre (Adjusted OR 0.821, 95% CI 0.703-0.959, p = .013). Using an AC cut-off value of ≥33.01 cm, the sensitivity, specificity, PPV and NPV for accurate vertex presentation diagnosis were 54.3, 57.6, 91 and 13%, respectively.IMPACT STATEMENTWhat is already known about this subject? Leopold's manoeuvre is a method for assessing fetal presentation. Previous studies have found the overall accuracy of Leopold's manoeuvre to be 63-88%.What the results of this study add? Leopold's manoeuvre has high sensitivity but low specificity. Increased fetal AC influences the accuracy of Leopold's manoeuvre.What the implications are of these finding for clinical practice and/or further research? Fetal non-vertex presentation and fetal AC ≥33.01 cm measured by ultrasonographic examination during late third-trimester pregnancy should be followed for determine the fetal presentation by ultrasonographic examination, patient' counselling and planning the route of delivery for non-vertex presentation in case of emergency. Further investigations about the cost effectiveness of universal ultrasonographic examination for fetal presentation determination in late third-trimester pregnancy are needed.

Infant growth rates predict childhood obesity in Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Thailand.

BACKGROUND: Obesity is increasingly becoming a problem among the Thai people; infant growth rates have been shown to be linked to childhood obesity. OBJECTIVE: The aim of the present study was to determine the period of infant growth and to identify a cut-off point, in order to be able to predict overweight and obesity in children age 3-4 years at the Well Baby Clinic, Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center (HRH MSMC). MATERIAL AND METHOD: The design was retrospective cohort. All subjects born on 2005 at HRH MSMC, in Nakhon Nayok. The author used means of weight and length at 1-6 months, 7-12 months, 13-18 months, 19-24 months and 37-48 months and then constructed a weight-for-length Z score using the LMS method. The difference in Z score between each age group was compared, to predict overweight and obesity at 37-48 months of age. A defined cut-off point, with a receiver operating characteristic (ROC) curve, p-value < 0.05 was regarded as significant. RESULTS: The 227 from newborns were included in the present study. The prevalence of overweight and obesity at 3-4 years of age was 14%. The cut-off point for accelerated growth was > or = 0.62SD or > or = 23.2 percentiles (Z score changes from 7-12 months to 13-18 months), with a positive predictive value of 40%. CONCLUSION: The accelerated change of weight-for-length at 7-12 to 13-18 months of age can be used to predict overweight and obesity at 3-4 years of age at HRH MSMC.

Cost evaluation of corneal ulcer treatment.

BACKGROUND: Corneal ulcer is a common disease. To find the costs of corneal ulcer treatment would help plan the treatment strategy. OBJECTIVE: To evaluate the cost of treatment for corneal ulcers. MATERIAL AND METHOD: Age, gender type of payment, causative organism, hospitalization days, and cost of treatment of hospitalized patients with clinically diagnosed corneal ulcer presenting between January 2011 andApril 2012 was collected RESULTS: Fifty-three patients were analyzed The median cost (interquartile range) was 20,699.0 (11,379.0-56,981.0) Thai Baht. The median cost (interquartile range) for the fungal group, bacterial group, and unknown organisms was 70,040.0 (34,697.0-112,118), 17,881.5 (10,555.3-31,100.8), and 15,015.3 (9,542.3-46,866.6) Thai Baht respectively. Costoftreatment for fungal group was statistically significantly higher than for the unknown organisms and bacterial groups (p< O. 05). CONCLUSION: The expense of corneal ulcer treatment is high and fungal infection treatment tends to be the most expensive.

An optimal cut-off point of serum C-reactive protein in prediction of neonatal sepsis.

OBJECTIVE: To determine an optimal cut-off point of serum C-reactive protein (CRP) levels for prediction of neonatal sepsis. MATERIAL AND METHOD: A prospective cohort study of neonates aged from birth to 30 days old presenting with signs and symptoms of neonatal sepsis in neonatal intensive care unit (NICU) from January 2010 through December 2011 was performed. Neonates were assigned to either sepsis or normal group depending on blood culture status. Serial CRP (12-24 hours apart) and complete blood count were then analyzed using independent t-test, Wilcoxon rank-sum test and Receiver operating characteristic (ROC) curves. RESULTS: Of 53 neonates recruited into the present study, 26 (49%) were assigned to sepsis group and the remaining 27 (51%) were assigned to normal group. Baseline characteristics for the two groups were similar except for the higher amount of male participants in sepsis group (p-value 0.006). Most patients in sepsis group (7/26) demonstrated coagulase-negative staphylococci (CoNS) sepsis. The values of 1st CRP and 2nd CRP were significantly higher in sepsis group compared to normal group (p-value < 0.001 and 0.003). From ROC curves, at the cut-off points of 1st CRP > or = 1.90 mg/L and 2nd CRP > or = 1.25 mg/L, the sensitivity were as high as 92.6% and 96.3%, respectively, and the specificity were both at 100%. CONCLUSION: Serial CRP is safe as diagnostic tool to consider antimicrobial treatment in neonatal sepsis with sensitivity of 92.6% and 96.3% for the first CRP cut-off point > or = 1.90 mg/L and the second CRP > or = 1.25 mg/L with 100% positive predictive value. Moreover, these safety profiles might help in reducing overuse of antibiotics with negative predictive value 96.3%.

Evaluation of ocular biometry in primary angle-closure disease with two swept source optical coherence tomography devices.

PURPOSE: To investigate agreement between 2 swept source OCT biometers, IOL Master700 and Anterion, in various ocular biometry and intraocular lens (IOL) calculations of primary angle-closure disease (PACD). SETTING: Rajavithi Hospital, Bangkok, Thailand. DESIGN: Prospective comparative study. METHODS: This study conducted in a tertiary eye care center involving biometric measurements obtained with 2 devices in phakic eye with diagnosis of PACD. Mean difference and intraclass correlation coefficient (ICC) with confidence limits were assessed, and calculations of estimated residual refraction of the IOL were analysed using Barrett's formula. RESULTS: Sixty-nine eyes from 45 PACD patients were enrolled for the study. Excellent agreement of various parameters was revealed, with ICC (confidence limits) of K1 = 0.953 (0.861-0.979), K2 = 0.950 (0.778-0.98), ACD = 0.932 (0.529-0.978), WTW = 0.775 (0.477-0.888), and LT = 0.947 (0.905-0.97). Mean difference of axial length (AL) was -0.01 ± 0.02 mm with ICC of 1.000. IOL calculation was assessed with Barrett's formula, and Bland-Altman plot showed excellent agreement in the results of the 2 devices for the IOL power and estimated post-operative residual refraction (EPR). CONCLUSIONS: Mean differences of biometric parameters, obtained with IOL Master700 and Anterion, were small, and ICC showed excellent concordance. No clinical relevance in calculation of IOL power was found, and the two devices appeared to be comparably effective in clinical practice.

Clinical evaluation of ocular biometry of dual Scheimpflug analyzer, GALILEI G6 and swept source optical coherence tomography, ANTERION.

To evaluate the performance of a new swept source optical coherence tomography optical biometer, ANTERION, in ocular biometry and intraocular lens (IOL) calculation compared with the reference standard of Dual Scheimpflug Analyzer (GALILEI, G6). A prospective comparative study was conducted in a tertiary eye center. Cataract patients were scanned with both devices in a random fashion, and parameters from the devices were analyzed in terms of mean difference and intraclass correlation coefficient (ICC). Bland-Altman plots were performed to compare agreement between the devices. Ninety-six eyes from 96 patients were enrolled for evaluation. With the exception of ACD, all parameters were significantly different, but excellent agreement was revealed for all of them. The mean difference in axial length was 0.03 mm, and ICC was 0.999. Calculated IOL power with Barrett formula revealed that 93.75% were within 1 diopter and the prediction error was 0.03 diopter. Biometry of the devices were arithmetically different. However, the mean difference of the key factors in IOL calculation were small and appeared to be negligible for the purposes of clinical application. The performance of ANTERION was comparable to that of G6 in biometric measurement and IOL calculation; however, the devices cannot be used interchangeably.

Diagnostic performance of anterior segment optical coherence tomography in detecting plateau iris.

Objective: To evaluate the diagnostic performance of manual grading of anterior segment optical coherence tomography (AS-OCT) in detection of plateau iris configuration (PIC) based on the presence of standardised ultrasound biomicroscopy (UBM) criteria in at least two quadrants; namely, clinical diagnosis of PIC (DxPIC). Methods and analysis: In this cross-sectional study, paired AS-OCT and UBM images were evaluated by three glaucoma specialists. AS-OCT was classified into two mechanisms, PIC versus non-PIC, of primary angle closure disease (PACD) and AS-OCT-PIC diagnostic performance was tested with DxPIC. Results: One hundred and seventy-nine eyes of 142 patients were enrolled for analysis, and DxPIC was found in 85 eyes (47.49%). Intraobserver agreement rates of AS-OCT classification by the graders were 0.77, 0.701 and 0.742 (all p<0.001), and interobserver agreement rates, between a senior glaucoma specialist and the other two glaucoma specialists, were 0.68 and 0.702 (all p<0.001). Plateau iris was classified in AS-OCT images by the three graders, rated 32.96%-39.1% and 24.58%-34.08% in the horizontal and vertical axes, respectively. Diagnostic performance was analysed, yielding sensitivity ranging from 56.47% to 77.78%, and specificity of 48.94% to 64.29%. We applied disease prevalence of 30%, revealing positive predictive values varying from 32.16% to 44.44%, and negative predictive values of 72.4% to 85.71%. Accuracy ranged from 51.2% to 65%. Agreement between the two devices was fair, kappa range 0.31-0.351. Conclusion: Performance of manual grading of AS-OCT in detection of DxPIC was relatively poor; therefore, unadjusted AS-OCT does not appear to be good for manual PIC screening in PACD patients and cannot serve as a substitute for UBM in PIC detection.

Real-world Surgical Outcomes of Primary Angle-closure Glaucoma.

PURPOSE: To evaluate surgical outcomes of the four common procedures utilized for primary angle-closure glaucoma (PACG). METHODS: A retrospective study of survival rate in surgical management of PACG was conducted in a referral eye center. One hundred and ninety-nine eyes from 173 PACG patients were collected for chart review. The procedures used were phacoemulsification (PE), combined PE with goniosynechialysis (PE-GSL), combined PE with trabeculectomy (PE-Trab), and trabeculectomy alone. Failure was defined as postoperative IOP >21 mmHg in patients who needed second surgical intervention or those who had IOP <5 mmHg with loss of light perception. Cumulative survival rates, risk of surgical failure, and complications were analyzed. RESULTS: PE, PE-GSL, PE-Trab, and trabeculectomy were performed in 84 eyes (42.2%), 76 eyes (38.2%), 21 eyes (10.6%), and 18 eyes (9%), respectively. Cumulative survival rates at 60 months were 13%, 55%, 42% and 43%, respectively. Cox regression analysis indicated that each mmHg IOP increased, the risk of surgical failure decreased by 13% (adjusted hazard ratio (HR) 0.87; 95%CI: 0.84-0.93, p<0.001). CONCLUSION: Real-world surgical outcomes of PACG showed that PE alone had a low survival rate of 13% in 60-month follow-up whereas PE-GSL achieved the highest rate of 55%. PE-GSL should be initially considered for management of PACG, since it can restore and sustain the physiologic aqueous pathway and preserve the conjunctiva for future filtering surgery if needed.

Psychological problems and overweight in medical students compared to students from Faculty of Humanities, Srinakharinwirot University, Thailand.

BACKGROUND: Medical students have a high prevalence of stress, depression, daytime sleepiness, sleep deprivation and overweight. The students from the social sciences such as Faculty of Humanities, may have different problems. The aim of this study was to compare the epidemiology of stress, depression, daytime sleepiness, sleep deprivation and overweight of medical students with students from Faculty of Humanities, Srinakharinwirot University. MATERIAL AND METHOD: Total of 646 students from Faculty of Medicine and 103 students from Division of Children's Literature, Faculty of Humanity from Srinakharinwirot University were selected; the response rate was 75% and 83.5%, respectively. The design was cross-sectional study. Each participant was evaluated by Health-Related Self-Reported (HRSR) Scale from Psychological Department, Ministry of Public Health, Suanprung stress test from Suanprung Hospital, Thailand, and Epworth sleepiness scale during February, 11th 2008 to March, 4th 2008. Categorical variables were analyzed using the Chi-square test or Fisher exact test and p-value less than 0.05 was considered significant. RESULTS: The prevalence of depression in medical students was 11.5% and the prevalence of depression in students from Faculty of Humanities was 12.2%. Medical students in clinical class had high to severe stress more than medical students in pre-clinical class and had the most sleep deprivation on class 6. Male medical students had sleep deprivation and overweight more than female. Medical students with underlying diseases had high to severe stress, but students from Faculty of Humanities had depression. Medical students had odds ratio of stress and sleep deprivation 0.61 and 0.39, respectively compared to the students from Faculty of Humanities. CONCLUSION: The students from Faculty of Humanities had high to severe stress and sleep deprivation more than medical students but they were the same as depression, excessive daytime sleepiness and overweight. The administrators of each faculty should adjust the curriculum and train the advisors to support their students.

Correlation of ultrasound estimated placental volume and umbilical cord blood volume in term pregnancy.

OBJECTIVE: To investigate the correlation between ultrasound measured placental volume and collected umbilical cord blood (UCB) volume in term pregnancy. MATERIAL AND METHODS: An observational cross-sectional study of term singleton pregnant women in the labor ward at Maha Chakri Sirindhorn Medical Center was conducted. Placental thickness, height, and width were measured using two-dimensional (2D) ultrasound and calculated for placental volume using the volumetric mathematic model. After the delivery of the baby, UCB was collected and measured for its volume immediately. Then, birth weight, placental weight, and the actual placental volume were analyzed. The Pearson's correlation was used to determine the correlation between each two variables. RESULTS: A total of 35 pregnant women were eligible for the study. The mean and standard deviation of estimated placental volume and actual placental volume were 534±180 mL and 575±118 mL, respectively. The median UCB volume was 140 mL (range 98-220 mL). The UCB volume did not have a statistically significant correlation with the estimated placental volume (correlation coefficient 0.15; p=0.37). However, the UCB volume was significantly correlated with the actual placental volume (correlation coefficient 0.62; p<0.001) and birth weight (correlation coefficient 0.38; p=0.02). CONCLUSION: The estimated placental volume by 2D ultrasound was not significantly correlated with the UCB volume. Further studies to establish the correlation between the UCB volume and the estimated placental volume using other types of placental imaging may be needed.

See-and-treat approach to cervical intraepithelial lesions in HRH Princess Maha Chakri Sirindhorn Medical Center.

BACKGROUND: To evaluate the overtreatment rate with the see and treat approach in the management of women with abnormal cervical cytology. MATERIALS AND METHODS: A retrospective review of patients with abnormal cervical cytology who underwent S and T at MSMC between January 2008 and December 2012 was conducted. Loop electrosurgical excision procedure (LEEP), histological results, cytology and colposcopic impression were analyzed to evaluate overtreatment rate, cyto-histologic correlation and related factors. RESULTS: Average age of S and T cases was 42 years. Ninety seven percents were referred from affiliated health care providers. The study revealed 83.2% patients had HSIL or higher from cervical cytology. Correlation between HSIL and final histology was relatively low at 75% compared to other studies. Overtreatment rate was 28%. CONCLUSIONS: S and T was done in 197 patients in a tertiary care health facility with patient satisfaction. Overtreatment occurred, but the rate can be reduced with appropriate recommendations. HSIL Pap smears should be reexamined before S and T while low grade and lesser colposcopic impression groups should obtain conventional colposcopic approach for patient future reproductive benefit.