Integrated Care Model by the Village Health Volunteers to Prevent and Slow down Progression of Chronic Kidney Disease in a Rural Community, Thailand.

INTRODUCTION: Chronic kidney disease (CKD) is a major health problem in Thailand and health behaviors are central to its risk and progression. Because of the shortage of healthcare personnel, village health volunteers (VHVs) have been collaborating in the primary health care system. However, the contribution of VHVs to CKD reduction has not been evaluated yet. This study aimed to evaluate the efficacy of the VHV-integrated model in preventing and slowing down CKD and its risk factors. METHODS: The population-based cohort study was conducted in a rural community of Thailand between 2017 and 2019. Baseline clinical and behavioral characteristics including CKD, diabetes, hypertension, and other high-risk factors of the participants were collected. The integrated care model was initiated by the multidisciplinary care team that facilitated, empowered, and trained VHVs targeting risk factors of CKD, health literacy, and health promotion. Then the participants were educated and trained for lifestyle modification and were monitored continuously for 18 months by VHVs. Changes in the CKD risk factors, and kidney functions before and after the application of integrated care model were compared. RESULTS: A total of 831 subjects participated in the study with an average age of 57.5 years, and 69.5% were female. Among them, 222 participants (26.7%) were diagnosed as having CKD, the vast majority (95%) of which were in the early stages (G1-G3 and A1-A2). CKD risk factors such as high salt intake, smoking, alcohol consumption, self-NSAID (non-steroidal anti-inflammatory drugs) use were significantly decreased after application of the care model. Also, hemoglobin A1c was significantly reduced in diabetic patients, and blood pressure was controlled better than before in the hypertensive patients. Most importantly, a decline of estimated glomerular filtration rate of the CKD group was improved and lower than the non-CKD group. CONCLUSION: The integrated care model through VHV significantly attenuated the risk factors associated with CKD in the general and high-risk population and effectively slowed down the progression of CKD.

Can a multidisciplinary approach slow renal progression in CKD patients?

Background: Several randomized controlled trials have examined the benefits of multidisciplinary CKD care on estimated glomerular filtration rate (eGFR). But, the results are inconclusive. Purpose: This study aimed to evaluate whether or not multidisciplinary CKD care was beneficial in terms of CKD progression. Methods: This is a randomized controlled trial and conducted at community hospital, Thailand. The inclusion criteria were patients with age of 18 years or older and diagnosed with up to stage 3b CKD based on the KDIGO guidelines. Eligible patients divided into two groups: intervention and control group. The intervention group received a type of multidisciplinary treatment, while patients in the control group received the standard treatment administered at the outpatient clinic. The primary outcome was eGFR outcomes at three months after enrollment. Results: During the study period, there were 334 patients who met the study criteria. Eligible patients were divided into two groups: intervention (166 patients; 49.70%) and control (168 patients; 50.30%). There were three outcomes that differed significantly between the two groups at 3 months: mean difference of eGFR from baseline, proportion of patients with eGFR decline greater than 4 mL/min/1.73 m2, and difference in CKD stage from baseline. A significantly higher percentage of patients in the intervention group experienced CKD improvement by one stage (24.10% vs 5.95%), and a significantly lower percentage experienced decline by one stage (8.43% vs 35.12%) than in the control group. Conclusion: Slower renal progression in patients with up to stage 3b CKD was shown in patients who were treated by a multidisciplinary approach.

Evidence-Triggers for Care of Patients with Cleft Lip and Palate in Srinagarind Hospital: The Tawanchai Center and Out-Patients Surgical Room.

Background: Cleft lip and palate (CLP) is a congenital anomaly of the lip and palate that is caused by several factors. It was found in approximately one per 500 to 550 live births depending on nationality and socioeconomic status. The Tawanchai Center and out-patients surgical room of Srinagarind Hospital are responsible for providing care to patients with CLP (starting from birth to adolescent) and their caregivers. From the observations and interviews with nurses working in these units, they reported that both patients and their caregivers confronted many problems which affected their physical and mental health. Based on the Soukup's model (2000), the researchers used evidence triggers from clinical practice (practice triggers) and related literature (knowledge triggers) to investigate the problems. Objective: The purpose of this study was to investigate the problems of care for patients with CLP in the Tawanchai Center and out-patient surgical room of Srinagarind Hospital. Material and Method: The descriptive method was used in this study. For practice triggers, the researchers obtained the data from medical records of ten patients with CLP and from interviewing two patients with CLP, eight caregivers, two nurses, and two assistant workers. Instruments for the interview consisted of a demographic data form and a semi-structured questionnaire. For knowledge triggers, the researchers used a literature search. The data from both practice and knowledge triggers were collected between February and May 2016. The quantitative data were analyzed through frequency and percentage distributions and the qualitative data were analyzed through a content analysis. Results: The problems of care gained from practice and knowledge triggers were consistent and were identified as holistic issues, including 1) insufficient feeding, 2) risks of respiratory tract infections and physical disorders, 3) psychological problems, such as anxiety, stress, and distress, 4) socioeconomic problems, such as stigmatization, isolation, and loss of income, 5)spiritual problems, such as low self-esteem and low quality of life, 6) school absence and learning limitation, 7) lack of knowledge about CLP and its treatments, 8) misunderstanding towards roles among the multidisciplinary team, 9) no available services, and 10) shortage of healthcare professionals, especially speech language pathologists (SLPs). Conclusion: From evidence-triggers, the problems of care affect the patients and their caregivers holistically. Integrated long-term care by the multidisciplinary team is needed for children with CLP starting from birth to adolescent. Nurses should provide effective care to these patients and their caregivers by using a holistic approach and working collaboratively with other healthcare providers in the multidisciplinary team.

Evidence-Triggered for Care of Patients with Cleft Lip and Palate in Srinagarind Hospital: Operating Room.

Background: The operating room Srinagarind hospital handles most cases that require surgical repair including cleft lip and palate patients. The average number of patients undergone surgical correction has risen to 216 in 2016 from 150 in 2014. Patients who underwent surgery, particularly infants had to be separated from family, stay in restricted place, abstaining from food and water, these create stress, fear, anxiety and pain to the child and may have affected to the outcomes of the treatment. For parents and families will also are anxious, and fears about the disease and treatment, losing children, disabled children after the surgery. In addition, their concerns with complications of surgery and chance of recovery. Therefore, there is a need to examine the clinical problems of patients who undergo surgery for cleft lip and palate in order to provide comprehensive care. Objective: To identify problems in regards to care for patients with cleft lip and palate, in the operating room, Srinagarind Hospital. Material and Method: The descriptive study was conducted involving nine departments of nursing services, Srinagarind Hospital. After the consideration of human ethic, both quantitative and qualitative data were collected based on The Center for Advance Nursing Practice Model through the following four stimulators: 1) reviewed 30 patients medical records; 2) reviewed four related literatures; 3) surveyed nurses opinion towards health condition's and the effects of the 10 families with cleft lip and palate; and 4) interviewed ten mothers and families towards the health of cleft lip and palate children. The interviews obtained 15-20 minutes per case with a total of eight months of collecting data (June 2015 - January 2016). The quantitative data were analyzed using percentage and content analyses were used with qualitative data. Results: There were four cases underwent operation for cleft lip and palate (40%) four cases underwent age 3-6 months and 10-18 month four cases underwent age 3-6 months and 10-18 month(40%) which included six male (60%) and ten female caregivers (100%), four of which aged older than 50 years (40%), three cases were each a farmer and housekeeper. For nurses, the majority aged between 40-44 years, nine of which had bachelor degree (90%). The results from nurses' survey found that the caregiver concerned about patients' hunger, and surgical complications such as hypothermia, pressure ulcers from operation, postural, bleeding after operation which need additional operation, something stuck in operating wound, and infected wound. The interviewing with the caregiver and mother towards patient health conditions found that the caregivers concerned about anesthetic procedure, wound separation and infection, and the operating cost. Most patients felt fear of fainting and thirsty since food and water discontinuation. Based on the literature review, the problems included the caregivers' concerns about surgical complications which these were similar to those results from the nurses' survey. Conclusion: Problems for care of patients with cleft lip and palate in the operating room in Srinagarind Hospital were: 1) concerns about the operation and cost of treatment, 2) surgical complication both immediate and long-term complications, 3) concerns about pain and wound infection. Such evidence would be used in the development plan towards nursing system for cleft lip and palate patients in the operating room.

Strengthening the self-care of women working in the informal sector: local fabric weaving in Khon Kaen, Thailand (Phase I).

The first phase of this study was undertaken using Participatory Action Research (PAR) to identify the factual situations of fabric-weaving women working in the informal sector in Thailand. The aims were to enhance the mutual understanding of the women and researchers concerning the problems faced by these women and to establish an action plan to address these problems. The participant group consisted of 107 women working in the informal sector from three local villages who voluntarily took part in the study. Data were collected using quantitative and qualitative methods through structured questionnaires, focus groups, in-depth interviews, participant observations, and field notes. The results of the study revealed that the women learned their health problems were related to work and their labor potentially placed them at a risk for illness. When the women realized the gravity of their situation, they attained a sense of empowerment and took the initiative in establishing action plans to address their problems.