Development and evaluation of a virtual reality basic life support for undergraduate students in Thailand: a project by Mae Fah Luang University (MFU BLiS VR).

BACKGROUND: In traditional basic life support training for university students or the public, trainees practice simulations only once or twice during the course, potentially limiting their competence. In contrast, virtual reality allows trainees to independently study and practice as often as needed, enhancing their skills. This research and development project aimed to develop and evaluate a novel learning device, virtual reality basic life support for undergraduate students of Mae Fah Luang University (MFU BLiS VR). METHODS: This study employed a two-group, pre- and post-test design, involving seventy students (n = 35 in each group) from Mae Fah Luang University, Thailand. Data were collected from March 2022 to January 2023. The experimental group received the MFU BLiS VR, in addition to traditional teaching, while the control group received only traditional teaching. Data analysis employed descriptive statistics, Chi-square, Mann-Whitney U test, and Wilcoxon signed ranks test. RESULTS: "MFU BLiS VR" provided a learning experience in out-of-hospital basic life support for adult patients in four scenarios: (1) a person who was not breathing but had a pulse; (2) a person who was not breathing, had no pulse, and required defibrillation; (3) a person who was not breathing, had no pulse, and did not require defibrillation; and (4) a person with normal breathing and pulse but was unconscious. Each scenario was presented sequentially from scenario one to scenario four. The scenarios encompassed common and complex situations requiring prompt and effective bystander responses to save lives. The results revealed that the experimental group had a significantly shorter no-flow time compared to the control group (Z = -5.02, p < .001) and achieved significantly higher knowledge scores than the control group (Z = -3.39, p < .01) as well as superior practical skills (Z = -7.26, p < .001). Both groups reported the highest satisfaction levels in all aspects, with no significant differences. CONCLUSION: MFU BLiS VR is an effective training approach for teaching and learning basic life support and the use of an automated electronic defibrillator. It captures students' attention and enhances their understanding of these essential life support skills, which are crucial for everyone.

The Care-Integrated Concentration Meditation Program for Patients With Weaning Difficulty: A Pilot Study.

Because of the multifaceted process of weaning patients with prolonged mechanical ventilation, enhancing weaning success remains a challenge. The Care-Integrated Concentration Meditation Program was developed on the basis of Buddhist philosophy and implemented to determine its procedural feasibility. A qualitative case study with 3 participants was conducted, and the process and initial outcomes were evaluated.

Cerebral venous thrombosis: comparing characteristics of infective and non-infective aetiologies: a 12-year retrospective study.

BACKGROUND: Most cases of cerebral venous thrombosis (CVT) have non-infective causes. Infective CVT, though less common, often results in a catastrophic outcome. The distinctive clinical characteristics of infection-associated CVT (IACVT) and non-infection-associated CVT (NIACVT) would facilitate early detection and proper management. OBJECTIVE: To compare the characteristics of IACVT and NIACVT. METHODS: All patients with CVT admitted to Songklanagarind Hospital between January 2002 and December 2013 with the ICD10 codes I636, I676, O225 and G08 were identified and recruited. We compared the clinical presentations, neuroimaging results and hospital outcomes for patients with IACVT and those with NIACVT. We analysed the differences using descriptive statistics. Additionally, for patients with IACVT, we described the primary sites of infection, associated CVT, host immune status and microbiological results. RESULTS: Twenty of the 83 patients with CVT (24.1%) had IACVT. Male gender (70.0% vs 34.9%) and pre-existing diabetes mellitus (35.0% vs 4.8%) were significantly more prevalent in the IACVT than the NIACVT group. Additionally, cavernous sinus thrombosis predominated in IACVT (80.0% vs 11.1%), whereas focal neurological syndrome was more common among patients with NIACVT (50.8% vs 15.0%). Paracranial infections, mostly sinusitis and orbital cellulitis, were common primary infections (80.0%) among patients with IACVT. Lastly, fungus was a devastating causative pathogen in IACVT-five of six patients with fungal infection had intracranial complications. CONCLUSIONS: Cavernous sinus thrombosis is a distinctive clinical presentation of IACVT, whereas focal neurological syndrome is a hallmark feature of NIACVT. Paracranial fungal infections are highly virulent and frequently associated with intracranial complications.

Predictors of hospital outcome in patients with cerebral venous thrombosis.

BACKGROUND: The studies regarding clinical presentations, risk factors, and outcomes of cerebral venous thrombosis (CVT) in Thai people are scarce. This study aims to identify predictors of hospital outcomes among the Thai patients with CVT. METHODS: Patients diagnosed with CVT in Songklanagarind Hospital from January 2002 to December 2013 were identified from computerized medical record system. Demographic data, clinical presentations, associated factors, method of neuroimaging studies and results, treatment, and hospital outcomes were presented by descriptive statistics. Predictors of hospital outcomes were analyzed by both univariate and multivariate logistic regression analysis. RESULTS: There were 90 patients with a diagnosis of CVT. The mean age (± standard deviation) was 41.22 (± 17.13) years (range, 15-80). The common clinical presentations were focal neurologic deficits (36.7%), seizure (33.3%), and cavernous sinus syndrome (32.2%). The common associated conditions were intracranial or paracranial infections (30.0%) and cancer (11.1%). Intracranial hemorrhage was found in 33 patients (36.7%). Forty-seven patients (52.2%) were dependent or death (Modified Rankin Scale [mRS], 3-6) on hospital discharge. Eleven patients (12.2%) were dead, of which 7 cases (7.78%) were CVT-related deaths. The independent predictors of dependency or death (mRS, 3-6) identified by multivariate logistic regression analysis were focal neurologic (odds ratio [OR], 14.26; 95% confidence interval [CI], 2.28-89.04; P = .001), mRS score of 3-5 on admission (OR, 35.26; 95% CI, 7.30-170.42; P = .000), and seizure (OR, .19; 95% CI, .03-1.02; P = .037). CONCLUSIONS: Focal neurologic deficit and severely disabled patients (mRS, 3-5) on admission were independent predictors of dependency or death in CVT patients. However, seizure predicted the lower incidence of dependency or death. The characteristic findings of CVT among Thai patients were the higher incidence of cavernous sinus syndrome and rhinosinal or intracranial infection.

Using nursing practice guidelines for the prevention of multidrug-resistant tuberculosis among hospitalized adult patients in Bangladesh.

Multidrug-resistant tuberculosis (MDR-TB) is one of the major public health concerns worldwide particularly in developing countries, including Bangladesh. Thus far, there are no well-validated clinical guidelines for the prevention of MDR-TB. This study aims to evaluate the improvement in nurses' practice using the newly developed Nursing Practice Guidelines for the Prevention of MDR-TB (NPG: MDR-TB) among hospitalized adult patients in Bangladesh. The guidelines were developed, disseminated and evaluated among 64 nurses by assessing nursing practice for the prevention of MDR-TB during pre- and postimplementation of the guidelines. Significant differences between pretest and post-test mean scores of nursing practice for the prevention of MDR-TB in case finding and case holding were found in three levels of wards, including Level 0 (non-TB), Level 1 (TB) and Level 2 (MDR-TB) (P < 0.001). This indicated that the guidelines might be applicable to reduce the development of MDR-TB in hospitals. However, this was a preliminary study with a limited time frame. Further evaluation is, therefore, needed.

A model predicting health status of patients with heart failure.

OBJECTIVE: To test the causal relationships among the components of sociodemographic (age, gender, education, and income), illness characteristics (duration of illness, severity of illness, and comorbid diseases), and self-management ability, and health status in the model of health status of patients with heart failure (HSHF). DESIGN: : Descriptive cross-sectional study. MATERIALS AND METHODS: Participants were 400 heart failure patients hospitalized or attending an out patient clinic at six hospitals in southern Thailand. A survey-interview method was used for data collection. Questionnaires were related to study factors including sociodemographics, duration of illness, the New York Heart Association Functional Classification (NYHA-FC), the Charlson Comorbidity Index, the Self-Care of Heart Failure Index (SCHFI), the Short Form-36 Health Survey (SF-36). The relationship of the study variables was tested and modified under the structural equation modeling (SEM) technique by using LISREL. RESULTS: The initial hypothesized model did not fit the data. The modified model adequately fit the data and accounted for 64% of the variance in health status. Age had a direct negative effect on health status (beta = -0.20, P < 0.01) and had an indirect negative effect on health status through self-management ability, severity of illness and comorbid disease (beta = -0.13, P < 0.01). Education had a direct positive effect on health status (beta = 0.12, P < 0.01). Gender and income had indirect negative effects on health status through severity of illness (beta = -0.05; -0.05, P < 0.05). Duration of illness had an indirect positive effect on health status through self-management ability (beta = 0.09, P < 0.05). Severity of illness and comorbid disease had a direct negative effect on health status (beta = -0.31; -0.16, P < 0.01, respectively) and indirect negative effect on health status through self-management ability (beta = -0.06; -0.05, P < 0.05, respectively). Self-management ability had a direct positive effect on health status (beta = 0.38, P < 0.01). CONCLUSIONS: This model provides a guideline for explaining and predicting health status of patients with heart failure. Continuity care programs promoting self-management ability should be developed and implemented both in hospital-based and home-based settings in order to improve health status.

Yoga during pregnancy: effects on maternal comfort, labor pain and birth outcomes.

This study examined the effects of a yoga program during pregnancy, on maternal comfort, labor pain, and birth outcomes. A randomized trial was conducted using 74-primigravid Thai women who were equally divided into two groups (experimental and control). The yoga program involved six, 1-h sessions at prescribed weeks of gestation. A variety of instruments were used to assess maternal comfort, labor pain and birth outcomes. The experimental group was found to have higher levels of maternal comfort during labor and 2h post-labor, and experienced less subject evaluated labor pain than the control group. In each group, pain increased and maternal comfort decreased as labor progressed. No differences were found, between the groups, regarding pethidine usage, labor augmentation or newborn Apgar scores at 1 and 5 min. The experimental group was found to have a shorter duration of the first stage of labor, as well as the total time of labor.

Comparison of the efficacy of fixed-dose enoxaparin and adjusted-dose unfractionated heparin in patients with cerebral venous thrombosis.

OBJECTIVE: Anticoagulants are the standard treatment for cerebral venous thrombosis (CVT). Although low-molecular-weight heparin (LMWH) is recommended in CVT, the specific type and dosage regimen of LMWH have never been specifically suggested. This study compared the clinical outcomes and adverse events in patients who received adjusted-dose unfractionated heparin (AD-UFH) versus fixed-dose enoxaparin (FD-E). METHODS: A retrospective cohort study was conducted at a university hospital in Thailand. Patients included in the study were those treated for CVT initially with either AD-UFH or FD-E followed by oral warfarin for 1year between January 2002 and December 2015. Electronic medical records were reviewed by the investigators. The baseline clinical characteristics, anticoagulant regimens, complications and outcomes at hospital discharge and 1-year follow-up were analyzed. Clinical outcomes (independency defined by modified Rankin score (mRS) 0-2 at hospital discharge and 1-year follow-up) and adverse events (gastrointestinal bleeding and intracranial hemorrhage) were compared between patients who received AD-UFH or FD-E. RESULTS: Seventy-five patients met the inclusion criteria. Thirty-nine patients received AD-UFH and 36 patients received FD-E. The baseline demographic and clinical characteristics between the two groups were comparable. Independency at hospital discharge accounted for 51.28% in the AD-UFH group and 61.11% in the FD-E group (p=0.392). There were no significant differences in the incidence of expansion of preexisting intracerebral hematoma (14.29% vs 18.18%; p=0.773) or new symptomatic intracranial hemorrhage (7.69% vs 8.33%; p=0.855). Independency at 1-year follow-up was also comparable between the two groups (71.78% vs 77.78%; p=0.552). CONCLUSION: This current study suggested a comparable efficacy and safety of FD-E and AD-UFH in patients with CVT.

A chart audit of postoperative pain assessment and documentation: the first step to implement pain assessment as the fifth vital sign in a University Hospital in Thailand.

PURPOSE: To describe the documentation of pain assessment and management in the first 72 hrs postoperatively. DESIGNS: Retrospective descriptive study MATERIAL AND METHOD: Four hundred and twenty five hospital charts in December 2002 were audited to reveal the quality of postoperative pain assessment and documentation. Scores above 21 from the possible maximum of 28 (75%) were accepted for the review. RESULTS: Nurses documented pain assessment more often than doctors (98.8% vs 29.4%). An assessment of pain intensity using a numerical rating scale (0 to 10) was found in 192 (45.2%) charts, and using a pain descriptor scale in 408 (96%) charts. The documentation of pain both before and after giving analgesics was scarce during the first 3 days postoperatively. Apart from charts that used a patient-controlled analgesia (PCA) technique which had a specific record form, regular pain assessment every 2 to 4 hrs during the first 24 hrs was found in only 2 (0.5%) charts. Pain assessment items which were documented inconsistently and below accepted standards were pain assessment after administration of analgesics, pain assessment every 2 hours in the first 24 hours (day 1), and pain assessment thereafter every 4 hours in the first 24-72 hours (days 2 and 3). The other 4 of 7 audit pain items were documented in higher scores: initial patients' pain intensity and sedation assessment, pain treatment, continuity of pain assessment and pain assessor s name scores. Nevertheless, because of the low total audit score [mean+/-SD = 10.7+/-3 out of 28], it was considered that none of the reviewed charts reflected good quality pain assessment and documentation. CONCLUSION: The present study revealed that the existing practices of pain assessment and documentation were poor. The need for development of regular pain assessment as if pain is the fifth vital sign should be widely emphasized as a part of quality assurance.

Psychometric properties of pain intensity scales comparing among postoperative adult patients, elderly patients without and with mild cognitive impairment in China.

BACKGROUND: Western studies have shown that patients with mild or moderate cognitive impairment (CI) can use pain intensity scales to report pain reliably and validly, however, the qualities of pain intensity scales use in various age groups including elderly with CI are varied. In China, there is a lack of studies. OBJECTIVE: To compare psychometric properties of five evidence-supported pain intensity scales including the Verbal Descriptor Scale (VDS), the Numeric Rating Scale (NRS), the Faces Pain Scale (FPS), the Numeric Box-21 Scale (BS-21), and the Colored Analogue Scale (CAS) in postoperative adults varying in ages including elderly with mild CI. DESIGN: Descriptive comparative study. SETTING: A university-affiliated hospital in China. PARTICIPANTS: Two hundred surgical patients were recruited purposively with 50 for each group: young adults, middle-aged adults, elderly without CI, and elderly with mild CI. METHODS: Participants rated the vividly remembered, current, worst, least, and average pain, and indicated scale preference and simplicity. Scale face validity, concurrent validity, convergent validity, and test-retest reliability were assessed. Fisher's exact tests were used to investigate whether face validity was related to different age groups and levels of CI. One-way ANOVA and Kruskal-Wallis test were used to test the differences of concurrent validity, convergent validity, and test-retest reliability coefficients of each pain scale among the four groups. RESULTS: Regarding face validity, the FPS was ranked best as nearly half of the patients selected it as both the most preferred and simplest scale and it had low errors; the VDS and the NRS were ranked following the FPS; however, the BS-21 and the CAS were ranked last. The concurrent validity, convergent validity, and test-retest reliability of all five pain scales were supported in use with the four groups. The differences in psychometric properties among the four groups were only found in face validity and test-retest reliability. CONCLUSION: The findings support the psychometric properties of all five pain scales for pain assessment in Chinese adults including elderly with mild CI. However, the FPS appears to be the best, followed by the VDS and the NRS.