Factors associated with consumption of caffeinated-beverage among Siriraj pre-clinical year medical students, A 2-year consecutive survey.

BACKGROUND: Previous studies showed that significant proportion of medical students consumed caffeine to face sleep-deprived daily schedules. OBJECTIVE: To monitor the trend of caffeinated-beverage consumption among Siriraj medical students as well as to study possible factors associated with caffeine dependency. MATERIAL AND METHOD: The questionnaire was distributed to a class of medical students for 2 consecutive years. Statistical analysis was performed for descriptive purpose. RESULTS: 269 (89.7%) and 225 (74.5%) questionnaires were returned in year 1 and year 2, respectively 16.2% refused to take caffeine-beverages totally. 13% of those who consumed caffeinated-beverages developed caffeine dependence. From logistical analysis, positive history of smoking-family member and female sex were the only other two factors associated with caffeine dependency (OR 2.19, 95% CI 1.04-4.61 and 1.76, 95% CI 1.01-3.07, respectively). Other investigated factors included: exercise (p = 0.08); sleep hours (p = 0.24); reading beverage labels (p = 0.87); alcohol consumption (p = 0.59); class performance (p = 0.87); family member coffee-drinking habits (p = 0.66);family member alcohol-drinking habits (p = 0.18); and family income (p = 0.06). CONCLUSION: Caffeinated-beverage consumption was common among Siriraj medical students. No significant change was detected in the pattern of caffeinated-beverage consumption within the study period. Positive history of smoking family members and female sex were found as the only other two factors correlated with caffeine dependency.

The effectiveness of holistic diabetic management between Siriraj Continuity of Care clinic and medical out-patient department.

BACKGROUND: Diabetes mellitus is one of the most common diseases in the Thai population, and it is well known that diabetic complications could be prevented with appropriate management. Despite published guidelines, most Thai patients with diabetes do not achieve treatment goals. Siriraj Continuity of Care clinic (CC clinic) was recently established in order to provide training for medical students and internal medicine residents. It is possible that the training component in the CC clinic may contribute to better overall outcomes in type 2 diabetes mellitus (type 2 DM) patients when compared with usual care at the medical out-patient department (OPD). OBJECTIVE: To compare the effectiveness of diabetic management in type 2 diabetes mellitus patients who attended the CC clinic and the medical OPD. MATERIAL AND METHOD: Retrospective chart review was performed in type 2 diabetes mellitus patients who were treated at either clinic at Siriraj Hospital in 2007-2011. Baseline demographics, treatment strategies and outcomes, and participation in an appropriate health maintenance program were assessed in both groups. RESULTS: Seven hundred and fifty seven medical records were reviewed, including 383 patients in the CC clinic group and 374 in the OPD group. Mean HbA1c was significantly lower in the CC clinic group compared with the OPD group (7.3 +/- 0.9% and 7.8 +/- 1.3%, respectively, < 0.001). The number of patients who achieved goal HbA1c of less than 7% in CC clinic group was 123 (32.1%) compared with 91 (24.3%) in the OPD group (p = 0.039). More patients were screened for diabetic complications in the CC clinic group compared with the OPD group, including screening for diabetic neuropathy (57.4% vs. 2.1%, p < 0.001), diabetic retinopathy (56.7% vs. 36.6%, p < 0.001), and diabetic nephropathy (80.9% vs. 36.9%, p < 0.001). Patients in the CC clinic group had a higher rate of age-appropriate cancer screening than those in the OPD group (54.2% vs. 13.3%, p < 0.001 for breast cancer; 24.0% vs. 0.9%, p < 0.001 for cervical cancer; and 23.0% vs. 7.4%, p < 0.001 for colon cancer). Moreover, significantly more patients in the CC clinic group received recommended immunization (influenza, diphtheria tetanus and pneumococcal vaccine) compared with the control group (p < or = 0.001). CONCLUSION: Diabetic patients treated at the CC clinic had better clinical outcomes and healthcare maintenance compared with those who received usual care at the medical OPD. Continuity of care and integrated training component may have contributed to the improved outcomes.

Prescribing rate of influenza vaccine among internal medicine residents for outpatient continuum care.

BACKGROUND: Annual epidemics of influenza viruses remain a substantial cause of morbidity and mortality worldwide particularly among vulnerable groups. Immunization is another way to reduce the infection and mortality rates, especially in high-risk groups; however the data concerning prescription rates and possible influencing factors on decisions associated with influenza prescription of Thai internal medicine residents were limited OBJECTIVE: Siriraj internal medicine residency training has provided outpatient continuum care practice for all 1st year residents since 2008. A part of the curriculum was to prepare each trainee to be an effective vaccinator. This study aims to examine the competency ofthose residents who had completed the training, particularly about prescribing influenza vaccine. MATERIAL AND METHOD: The authors retrospectively reviewed medical records of the patients that indicated need for influenza vaccine encountered by 2nd and 3rd year residents during June 2011 and May 2012. The 20-item questionnaire was also sent out in order to study possible factors associated on prescribing the vaccine. RESULTS: Three hundred and seventy-three medical records were included and reviewed. The prescription rate of influenza vaccine was 8.0 percent. Comparing vaccine receiving and non-receiving groups, the authors found having respiratory problems (26.7% vs. 4.4%; odds ratio 8.0 [3.0-20.8]; p < 0.001) and being self-paying (16.7% vs. 5.8%; odds ratio 3.2 [1.1-9.3]; p = 0.023) were the only two significant differences. Only 5.7 percent of total residents were an effective vaccinator One hundred and five residents returned the questionnaire. Residents who had further plans for fellowship trainings had reported a higher influenza vaccine prescription rate than those who will be general internists (45.2% vs. 8.1%; adjusted odds ratio 14.04 [1.6-125.8]; p = 0.018). The authors also found that the rate of vaccine recognition, general knowledge of vaccination, and vaccine coverage remained 61.9%, 29.5%, and 21.0% among medicine residents. CONCLUSION: Prescribing rate of influenza vaccine remained low due to multifactor aspects, including doctor capability, attitude, patient recognition as well as reimbursement issues. In order to improve the rate of influenza vaccine prescriptions, a system-designed approach would be needed.

Clinical outcomes of type 2 diabetic patients before and after attending Siriraj Continuity of Care clinic.

BACKGROUND: Many diabetic patients did not receive proper medical care to achieve treatment goals based on clinical practice recommendations. Siriraj Continuity of Care clinic (CC clinic) has been established specifically for medical students and internal medicine residency training purpose since 2006. The training components in the teaching clinic might contribute to overall better outcomes for Type 2 diabetic patients comparing to regular service clinics. OBJECTIVE: To evaluate the efficacy of Siriraj CC clinic curriculum on improving clinical outcomes of diabetic patients. MATERIAL AND METHOD: The authors retrospectively reviewed medical records of type 2 diabetic patients who had been referred from regular service clinics of Siriraj Out-Patient Department (OPD) to CC clinic during 2007 to 2011. Clinical outcomes of these patients were compared: before vs. after entering CC clinic. RESULTS: One hundred and eighty medical records were reviewed. The mean of HbA1c were 7.5 and 7.3 percent before and after entering CC clinic (p = 0.026). Comparing clinical outcomes before vs. after entering CC clinic, we found that the percentage of patients who had optimal BMI and who had achieved LDL goals were 16.3 vs. 21.6 (p = 0.021), and 56.7 vs. 73.1 (p = 0.001), respectively. The proportion of patients who received annual diabetic complication assessments were also higher after entering CC clinic: the percentage of patients who received examinations of the eye, had urine micro albumin checked, had been screened for diabetic foot were increased from 58.3 to 93.3 (p < 0.001), 35.6 to 83.9 (p < 0.001), and 6.7 to 91.1 (p < 0.001), respectively. Moreover there were more patients who received adult health care maintenance program including: cancer screening program (clinical breast examination, mammography, fecal occult blood test and pap smear) and immunization (influenza, diphtheria tetanus and pneumococcal vaccine) (p < 0.001) after entering CC clinic. CONCLUSION: After entering CC clinic, diabetic patients had better clinical outcomes as well as received better screening and health care maintenance program comparing to regular service clinics. The focus training components in this clinic has played a major role on contributing the preferred clinical performance among medical students and internal medicine residents.

Effect of ambulatory medicine tutorial on clinical performance of 5th year medical students.

BACKGROUND AND OBJECTIVE: The present study provided a group learning activity called "Ambulatory Medicine Tutorial-AMT" for 5th year medical students in order to facilitate learning experience at ambulatory setting and to improve medical students' clinical performance. This research aimed specifically to study the effect of AMT. MATERIAL AND METHOD: Two groups of twenty 5th-year medical students were enrolled during their ambulatory medicine blocks. Each medical student was assigned to have 8 ambulatory sessions. AMT was assigned to one group while the other group only used conventional learning activity. At the end of the present study, total internal medicine scores, patient satisfaction surveys, and data on average time spent on each clinical encounter were collected and compared. RESULTS: The AMT group received a higher total internal medicine score as compared to the conventional group (76.2 +/- 3.6 vs. 72.9 +/- 2.8, p = 0.003). The AMT group could reduce average time spent on each clinical encounter within their first-6 ambulatory sessions while the conventional group could acquire the same skill later in their last 2 ambulatory sessions. There was no significant difference found on comparing patient satisfaction scores between the 2 groups. CONCLUSION: AMT helped improving medical students' outcomes as shown from higher total internal medicine score as well as quicker improvement during real-life clinical encounters, AMT could be a good alternative learning activity for medical students at ambulatory setting.

Awareness of and factors influencing willingness to receive a tetanus-diphtheria toxoid booster vaccine among Thai adults.

Adults who complete the diphtheria tetanus pertussis (DTP) vaccine series during childhood should receive a tetanus-diphtheria toxoid (Td) booster vaccine every 10 years. We studied awareness of and willingness to receive the Td booster vaccine as well as factors influencing these attitudes. A total of 1,284 participants were interviewed using a questionnaire at the out-patient department (OPD) of Siriraj Hospital, Bangkok, Thailand from January 31 to February 28, 2011. The sample population included: OPD patients, family members accompanying patients and medical personnel other than doctors. Seven percent of the 961 general participants and 26.3% of the 320 medical personnel who completed the questionnaire were aware of the need to receive the Td booster vaccine. Eighty-six point five percent of participants stated they be willing to receive the vaccine if they were instructed by their doctors. Logistic regression analyses showed the following factors correlated with awareness of the need to receive the vaccine: born after 1978 (aOR = 2.17; 95% CI: 1.59-2.97), higher income (aOR = 1.93; 95% CI: 1.37-2.72), and higher general preventive awareness score (aOR = 1.08; 95% CI: 1.02-1.14). Factors that correlated with willingness to receive the vaccine were: higher education (aOR = 2.17; 95% CI: 1.54-3.05), a higher score on general knowledge of tetanus-diphtheria (aOR = 2.00; 95% CI: 1.15-3.51), a higher general preventive awareness score (aOR = 1.06; 95% CI: 1.007-1.115), and previous experience with the Td booster vaccine (aOR = 2.85; 95% CI: 1.71-4.76), Under-awareness of the adult vaccination program remains a problem in Thailand especially among older generations and low-socioeconomic groups. As passive immunity wanes with time, public health authorities need to take action to educate the general population and health care workers about the importance of the Td booster vaccine.

Appropriate time-interval application of alcohol hand gel on reducing influenza-like illness among preschool children: a randomized, controlled trial.

BACKGROUND: We studied the efficacy of different time-interval applications of alcohol hand gel as a strategy for the prevention of influenza-like illness (ILI) in preschool-age children. METHODS: We performed a classroom-based cluster randomization at a kindergarten school in Bangkok, Thailand. A total of 1437 children were placed into 3 test groups, based on the frequency of alcohol hand gel use for hand hygiene: only before lunch (q lunch), every 120 minutes (q 120), and every 60 minutes (q 60). The primary outcome was a change in the school absenteeism rate caused by ILI. RESULTS: The rates of absenteeism from confirmed ILI (sick days/present days) were 0.026 in the q lunch group, 0.025 in the q 120 group, and 0.017 in the q 60 group. Significant reductions in absenteeism rates were seen when comparing the q 60 group with the q 120 group (rate difference, 0.009; 95% confidence interval [CI], -0.002 to 0.015; P = .008) and comparing the q 60 group with the q lunch group (rate difference, 0.0096; 95% CI, 0.004-0.016; P = .002). No such differences were detected between the q 120 and q lunch groups (rate difference, 0.001; 95% CI, 0.005-0.007; P = .743). CONCLUSIONS: The compulsory hourly use of alcohol gel as classroom hand disinfection could significantly reduce the rate of absenteeism from ILI in preschool-age children.

The effect of a continuity of care clinic curriculum on cardiovascular risk management skills of medical school graduates.

BACKGROUND: The continuity of care clinic (CCC) curriculum has been added to final-year medical students, class of 2008. The goals were to improve cardiovascular risk management skills for medical students and to develop competent doctors to serve the public. OBJECTIVE: To study the effectiveness of the curriculum by directly comparing postgraduate patient care performance between CCC participants (class of 2008) and non-CCC participants (class of 2006 and 2007). MATERIAL AND METHOD: We collected information about both groups of graduates, when they started their doctor careers. With hospitals'permission, medical charts audits were performed and scored with a 12-task checklist of cardiovascular risk management. The scores from both groups were compared with statistical analyses. RESULTS: Among 266 charts from 17 hospitals, there were 123 charts from 38 CCC participants and 143 charts from 52 non-CCC participants. On 9 of 12 tasks of the checklist, proportionately more CCC participants carried out the tasks than non-CCC participants. Statistical significance was shown on 5 tasks. These were ability to properly adjust antihypertensive medication (13.4% more; p = 0.002); requesting for urine protein screening (12.1% more; p = 0.006); recommending life-style modification (24.9% more; p < 0.001); requesting for serum lipid profile (25.5% more; p < 0.001); prescribing aspirin as primary prevention for cardiovascular disease (13.1% more; p = 0.007). There was no statistically significant difference for the other 7 tasks. CONCLUSION: Cardiovascular risk management performance of CCC participants was better than non-CCC participants in the same period after graduations. The curriculum helped improve the cardiovascular risks management skill of postgraduates. In the public interest, this study recommends further implementation of such a program in the future.