Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones.

BACKGROUND: Nephrolithiasis is a common urological disease worldwide. Extracorporeal shock wave lithotripsy (ESWL) has been used for the treatment of renal stones since the 1980s, while retrograde intrarenal surgery (RIRS) and percutaneous nephrolithotomy (PCNL) are newer, more invasive treatment modalities that may have higher stone-free rates. The complications of RIRS and PCNL have decreased owing to improvement in surgical techniques and instruments. We re-evaluated the best evidence on this topic in an update of a Cochrane Review first published in 2014. OBJECTIVES: To assess the effects of extracorporeal shock wave lithotripsy compared with percutaneous nephrolithotomy or retrograde intrarenal surgery for treating kidney stones. SEARCH METHODS: We performed a comprehensive search in CENTRAL, MEDLINE, Embase, and ClinicalTrials.gov with no restrictions on language or publication status. The latest search date was 6 December 2022. SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs that compared ESWL with PCNL or RIRS for kidney stone treatment. DATA COLLECTION AND ANALYSIS: Two review authors independently classified studies, extracted data, and assessed risk of bias. Our primary outcomes were treatment success rate at three months (defined as residual fragments smaller than 4 mm, or as defined by the study authors), quality of life (QoL), and complications. Our secondary outcomes were retreatment rate, auxiliary procedures rate, and duration of hospital stay. We performed statistical analyses using a random-effects model and independently rated the certainty of evidence using the GRADE approach. MAIN RESULTS: We included 31 trials involving 3361 participants (3060 participants completed follow-up). Four trials were only available as an abstract. Overall mean age was 46.6 years and overall mean stone size was 13.4 mm. Most participants (93.8%) had kidney stones measuring 20 mm or less, and 68.9% had lower pole stones. ESWL versus PCNL ESWL may have a lower three-month treatment success rate than PCNL (risk ratio [RR] 0.67, 95% confidence interval [CI] 0.57 to 0.79; I2 = 87%; 12 studies, 1303 participants; low-certainty evidence). This corresponds to 304 fewer participants per 1000 (397 fewer to 194 fewer) reporting treatment success with ESWL. ESWL may have little or no effect on QoL after treatment compared with PCNL (1 study, 78 participants; low-certainty evidence). ESWL probably leads to fewer complications than PCNL (RR 0.62, 95% CI 0.47 to 0.82; I2 = 18%; 13 studies, 1385 participants; moderate-certainty evidence). This corresponds to 82 fewer participants per 1000 (115 fewer to 39 fewer) having complications after ESWL. ESWL versus RIRS ESWL may have a lower three-month treatment success rate than RIRS (RR 0.85, 95% CI 0.78 to 0.93; I2 = 63%; 13 studies, 1349 participants; low-certainty evidence). This corresponds to 127 fewer participants per 1000 (186 fewer to 59 fewer) reporting treatment success with ESWL. We are very uncertain about QoL after treatment; the evidence is based on three studies (214 participants) that we were unable to pool. We are very uncertain about the difference in complication rates between ESWL and RIRS (RR 0.93, 95% CI 0.63 to 1.36; I2 = 32%; 13 studies, 1305 participants; very low-certainty evidence). This corresponds to nine fewer participants per 1000 (49 fewer to 48 more) having complications after ESWL. AUTHORS' CONCLUSIONS: ESWL compared with PCNL may have lower three-month success rates, may have a similar effect on QoL, and probably leads to fewer complications. ESWL compared with RIRS may have lower three-month success rates, but the evidence on QoL outcomes and complication rates is very uncertain. These findings should provide valuable information to aid shared decision-making between clinicians and people with kidney stones who are undecided about these three options.

Young-onset diabetes patients in Thailand: Data from Thai Type 1 Diabetes and Diabetes diagnosed Age before 30 years Registry, Care and Network (T1DDAR CN).

AIMS/INTRODUCTION: There is a lack of current information regarding young-onset diabetes in Thailand. Thus, the objectives of this study were to describe the types of diabetes, the clinical characteristics, the treatment regimens and achievement of glycemic control in Thai patients with young-onset diabetes. MATERIALS AND METHODS: Data of 2,844 patients with diabetes onset before 30 years-of-age were retrospectively reviewed from a diabetes registry comprising 31 hospitals in Thailand. Gestational diabetes was excluded. RESULTS: Based on clinical criteria, type 1 diabetes was identified in 62.6% of patients, type 2 diabetes in 30.7%, neonatal diabetes in 0.8%, other monogenic diabetes in 1.7%, secondary diabetes in 3.0%, genetic syndromes associated with diabetes in 0.9% and other types of diabetes in 0.4%. Type 1 diabetes accounted for 72.3% of patients with age of onset <20 years. The proportion of type 2 diabetes was 61.0% of patients with age of onset from 20 to <30 years. Intensive insulin treatment was prescribed to 55.2% of type 1 diabetes patients. Oral antidiabetic agent alone was used in 50.8% of type 2 diabetes patients, whereas 44.1% received insulin treatment. Most monogenic diabetes, secondary diabetes and genetic syndromes associated with diabetes required insulin treatment. Achievement of glycemic control was identified in 12.4% of type 1 diabetes patients, 30% of type 2 diabetes patients, 36.4% of neonatal diabetes patients, 28.3% of other monogenic diabetes patients, 45.6% of secondary diabetes patients and 28% of genetic syndromes associated with diabetes patients. CONCLUSION: In this registry, type 1 diabetes remains the most common type and the prevalence of type 2 diabetes increases with age. The majority of patients did not achieve the glycemic target, especially type 1 diabetes patients.

Type 1 diabetes management and outcomes: A multicenter study in Thailand.

AIMS/INTRODUCTION: The Thai Type 1 Diabetes and Diabetes Diagnosed Before Age 30 Years Registry, Care and Network was established in 2014 and involved 31 hospitals. The objective of the registry was to evaluate glycemic control and complications of patients with type 1 diabetes. MATERIALS AND METHODS: Patients' demographics, clinical data, frequencies of daily self-monitoring of blood glucose (SMBG), glycemic control and complications were collected. RESULTS: Among the 1,907 type 1 diabetes patients, the mean age was 21.2 ± 11.3 years. The mean glycated hemoglobin level was 9.35 ± 2.41%, with significant variations among age groups (P < 0.001). Conventional insulin treatment and intensive insulin treatment were used in 43 and 57% of patients, respectively. Mean glycated hemoglobin levels were significantly higher in patients treated with conventional insulin treatment compared to those treated with intensive insulin treatment (9.63 ± 2.34 vs 9.17 ± 2.46%, P = 0.002). Compared to the conventional insulin treatment group, significantly more patients in the intensive insulin treatment group achieved good glycemic control (P < 0.001), and fewer had diabetic retinopathy (P = 0.031). The prevalence of microvascular complications increased significantly with age (P < 0.001). Multivariate analysis showed good glycemic control to be associated with age 25 to <45 years, intensive insulin treatment with SMBG three or more times daily and diabetes duration of 1 to <5 years. CONCLUSIONS: Most Thai type 1 diabetes patients were not meeting the recommended glycemic target. As a result of this study, the national program to improve the quality of diabetes treatment and education has been implemented, and the results are ongoing.

Survival Rates and Mortality Risk Factors of Thai Patients with Type 2 Diabetes Mellitus.

Background: Type 2 diabetes mellitus (T2DM) is a common public health problem due to both its micro- and macro-vascular chronic complications. Data on survival rates and mortality risk factors of T2DM in Thailand need to be investigated and updated. Objective: To assess the survival rate and mortality risk factors in T2DM patients. Material and Method: This study is a part of the Thai DMS Diabetes Complications project which is a prospective observational 4-year study of Thai T2DM patients. All patients were recruited from out-patient departments of seven public hospitals and received standard treatment from their doctors. Their clinical and laboratory status were evaluated annually over 4 years, with particular emphasis on diabetic nephropathy, retinopathy and neuropathy. Outcomes at the end of the four-year study were expressed as survival or death, and causes of mortality were identified. Results: 1,097 from 1,120 stable T2DM patients were enrolled. After 4 years of follow-up, 80 patients (7.3%) had died. Causes of death were: cardiovascular disease (20 cases, 25.0%); infection (20 cases, 25.0%); malignancy (10 cases, 12.5%); end-stage renal disease (4 cases, 5.0%); and other causes (26 cases, 32.5%). Survival rates at 1, 2, 3, and 4 years were 98.9, 97.5, 96.2 and 92.7% respectively. Hazard ratios (95% CI) of all-cause mortality were being over 60 years old 1.84 (1.15-2.94) and having diabetic nephropathy 1.75 (1.12-2.75). Survival rates from cardiovascular mortality at 1, 2, 3, and 4 years were 99.2, 98.4, 97.4 and 94.5% respectively. Hazard ratios (95% CI) of cardiovascular mortality were: female gender 1.75 (1.05-2.94); diabetic nephropathy 1.72 (1.03-2.88); and diabetic retinopathy 1.74 (1.02-2.94). Conclusion: The survival rate of Thai patients with T2DM over the 4 years was 92.7%. Being over 60 years old and having diabetic nephropathy were associated with all-cause mortality. Female gender, diabetic nephropathy and diabetic retinopathy were associated with cardiovascular mortality.

Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones.

BACKGROUND: Stones in the urinary tract are a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are also widely applied. This is an update of a review first published in 2009. OBJECTIVES: This review aimed to assess the effectiveness and complications of ESWL for kidney stones compared with PCNL or RIRS. SEARCH METHODS: We searched the Cochrane Renal Group's Specialised Register to 3 March 2014 through contact with the Trials' Search Co-ordinator using search terms relevant to this review. SELECTION CRITERIA: Randomised controlled trials (RCTs) assessing the use of ESWL compared to PCNL or RIRS for kidney stone management. DATA COLLECTION AND ANALYSIS: Two authors independently assessed all the studies for inclusion. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). MAIN RESULTS: Five studies (338 patients) were included, four studies compared ESWL to PCNL and one compared ESWL with RIRS. Random sequence generation was reported in three studies and unclear in two. Allocation concealment was not reported in any of the included studies. Blinding of participants and investigators could not be undertaken due to the nature of the interventions; blinding of outcome assessors was not reported. Reporting bias was judged to be low risk in all studies. One study was funded by industry and in one study the number of participants in each group was unbalanced.The success of treatment at three months was significantly greater in the PCNL compared to the ESWL group (3 studies, 201 participants: RR 0.46, 95% CI 0.35 to 0.62). Re-treatment (1 study, 122 participants: RR 1.81, 95% CI 0.66 to 4.99) and using auxiliary procedures (2 studies, 184 participants: RR 9.06, 95% CI 1.20 to 68.64) was significantly increased with ESWL group compared to PCNL. The efficiency quotient (EQ; used to assess the effectiveness of procedures) higher for PCNL than ESWL; however EQ decreased when stone size increased. Duration of treatment (MD -36.00 min, 95% CI -54.10 to -17.90) and hospital stay (1 study, 49 participants: MD -3.30 days, 95% CI -5.45 to -1.15) were significantly shorter in the ESWL group. Overall more complications were reported with PCNL, however we were unable to meta-analyse the included studies due to the differing outcomes reported and the timing of the outcome measurements.One study compared ESWL versus RIRS for lower pole kidney stones. The success of treatment was not significantly different at the end of the third month (58 participants: RR 0.91, 95% CI 0.64 to 1.30). Mean procedural time and mean hospital stay was reported to be longer in the RIRS group. AUTHORS' CONCLUSIONS: Results from five small studies, with low methodological quality, indicated ESWL is less effective for kidney stones than PCNL but not significantly different from RIRS. Hospital stay and duration of treatment was less with ESWL. Larger RCTs with high methodological quality are required to investigate the effectiveness and complications of ESWL for kidney stones compared to PCNL if there is any technological progress in the non-invasive elimination of the residual fragments. Moreover, further research is required for the outcomes of ESWL and RIRS in lower and non-lower pole studies including PCNL versus RIRS.

A 4-year prospective study on long-term complications of type 2 diabetic patients: the Thai DMS diabetes complications (DD.Comp.) project.

OBJECTIVE: To assess the clinical course of long-term diabetic complications; diabetic retinopathy, nephropathy, and foot problems in Thai patients with type 2 diabetes. MATERIAL AND METHOD: Patients with type 2 diabetes were followed for four years between March 2006 and September 2010. Seven hospitals in all levels of care under the Ministry of Public Health Thailand were included in the present study. A physical examination and a diabetic complications assessment were performed each year during the study period, by physician specialists in the related areas. RESULTS: Among 1,120 patients who participated in the present study, 705 (62.95%) patients completed the 4-year follow-up time. There were 88 (7.86%) patients reported deaths during the present study period. The mean age was 59.14 +/- 10.12 years. The average duration of diabetes was 7.30 +/- 6.14 years. Approximately 57.32% of patients had a family history of diabetes. The average plasma glucose level and HbA1C were 153 to 160 mg/dl and 8.25 to 8.75%. Moreover less than one-fourth of patients had HbA1C below 7%. The prevalence for diabetic retinopathy and nephropathy were approximately 23.7% and 38.3%. In addition, more than 15% of patients had diabetic foot problems, loss of protective sensation and pedal pulse deficit. Finally, the incidence rates were 80.1 per 1,000 person-years (95% CI 69.7, 91.8) for diabetic retinopathy, and 91.1 per 1,000 person-years (95% CI 78.8, 105.1) for diabetic nephropathy CONCLUSION: Problems regarding poor diabetes control exist in Thai diabetes patients. It results in high prevalence and incidence of diabetic complications. As such, it is crucial to establish the country's diabetes management plan as well as evaluate the long-term complications in diabetic patients annually, in order for patients to receive the benefits of early treatment and prevent further complications.

The Thai DMS Diabetes Complications (DD.Comp.) project: prevalence and risk factors of diabetic retinopathy in Thai patients with type 2 diabetes mellitus.

OBJECTIVE: To determine the prevalence of diabetic retinopathy (DR) among patients with type 2 diabetes mellitus (T2DM) in Thailand and their associated risk factors. MATERIAL AND METHOD: A cross-sectional, multi-sites, hospital-based study was carried out between June and December 2006. Diabetic patients from the outpatient department of seven public hospitals (3 tertiary, 2 secondary and 2 community hospital) in Thailand were performed by retinal specialist. RESULTS: One thousand seven of 1,120 diabetic patients received retinal examination using indirect ophthalmoscope. Patients were divided into two groups (absent and present DR). Most patients in both groups were female (72.7 and 68.0%). The prevalence of DR was 24.0% (n = 242), mild NPDR 9.4% (n = 95), moderate NPDR 10.5% (n = 106), severe NPDR 1.3% (n = 13), and proliferative (PDR) 2.8% (n = 28). Age at onset, duration of DM, systolic blood pressure, body mass index (BMI), fasting plasma glucose (FPG), HbA1c, Triglyceride (TG), alcohol consumption, foot ulcer, and proteinuria were recorded. Metformin and insulin taking were statistically, significantly different among these groups. There is more prevalent NPDR and PDR in insulin-taking than non-insulin-taking groups. The grading of diabetic retinopathy is associated with the duration of diabetes. In multivariate regression analysis, associated risk factors of DR patients were the duration of DM, HbA1c levels, and proteinuria. CONCLUSION: Diabetic retinopathy was present in about one fourth of type 2 diabetic patients in this study. Associated risk factors of DR were the duration of DM, HbA1c levels, and proteinuria. Regular screening for DR especially in T2DM with associated risk factor should be done for early treatment.

Prevalence of factors predisposing to foot complication and their relation to other risks.

BACKGROUND: Diabetic neuropathy and peripheral vascular disease (PVD) have been identified as major risk factors for diabetic foot ulceration and amputation in patients with type 2 diabetes mellitus (T2DM) but in Thailand have been a few of prospective studied about the prevalence and risk factors of diabetic neuropathy and PVD. OBJECTIVE: To evaluate the prevalence of diabetic neuropathy and PVD in Thai patients with T2DM and to determine other factors that related with them. MATERIAL AND METHOD: A cross-sectional study of 899 Thai T2DM patients from the out-patient department of seven public hospitals in Thailand between January 2007 and September 2008 was performed. Histories of these patients, complete physical examinations, feet examination, and blood with urine chemistry were obtained. RESULTS: Most of the patients were females with the average age of 59.64 years, the average of body mass index (BMI) was 27.32 kg/m2, the average duration of diabetes was 8.12 years and 85.17% of patients were HbA1C > or = 7%. Diabetic patients with PVD group compared with no PVD group, there were statistically significant differences for duration of having diabetes (OR 1.08; 95% CI [1.01-1.16]; p-value 0.047), creatinine level (OR 1.62; 95% CI [1.12-2.33]; p-value 0.01), present diabetic neuropathy (OR, 7.37; 95% CI [2.52-21.59]; p-value < 0.001). Patients with diabetic neuropathy group compared with no diabetic neuropathy group, there were statistically significant differences of age (OR, 1.04; 95% CI [1.01-1.06]; p-value 0.003), duration of having diabetes (OR, 1.04; 95% CI [1.01-1.07]; p-value 0.008), on ACEI or ARB drug (OR, 1.77; 95% CI [1.24-2.55]; p-value 0.002), HbA1C (OR, 1.14; 95% CI [1.03-1.27]; p-value 0.012), creatinine level (OR, 1.38; 95% CI [1.04-1.79]; p-value 0.014), present diabetic retinopathy (OR, 1.96; 95% CI [1.22-3.13]; p-value 0.005), present PVD (OR, 7.37; 95% CI [2.52-21.59]; p-value < 0.001), present diabetic nephropathy with microalbuminuria (OR, 1.74; 95% CI [1.12-2.69]; p-value 0.013). CONCLUSION: Two percent of T2DM patients had PVD that associated with duration of diabetes, creatinine level, and diabetic neuropathy and 15% of T2DM patients had diabetic neuropathy that depended on age, duration of having diabetes, on ACEI or ARB drug, creatinine level, HbA1C, diabetic retinopathy, diabetic nephropathy, and PVD.

Prevalence and risk factors of diabetic nephropathy among Thai patients with type 2 diabetes mellitus.

BACKGROUND: Diabetic nephropathy (DN) is the leading cause of end stage renal disease. Clinically, DN is classified into 3 stages: microalbuminuria (MA), macroalbuminuria and ESRD. The prevalence and risk factors of DN among patients with type 2 diabetes mellitus (T2DM) in Thailand have not been well studied. OBJECTIVE: To assess the prevalence of DN in patients with T2DM and to determine their associated risk factors. MATERIAL AND METHOD: A cross-sectional study evaluating 877 T2DM patients from the out-patient department of seven public hospitals in Thailand was performed. Three random spot urine samples from all patients were collected during 3 consecutive months. Normoalbuminuria, MA and macroalbuminuria were defined as the presence of at least two out of three spot urine tests for urine albumin/creatinine ratio showing less than 30, 30-300 and more than 300 mg/gm respectively. RESULTS: Most patients were female, 60 years of age or older, with BMI above 25 kg/m2, a family history of DM, uncontrolled blood pressure, HbA1c above 7.0% and LDL above 100 mg/dl. The prevalence of normoalbuminuria, MA and macroalbuminuria was 62.8, 26.0 and 11.2% respectively. The prevalence of diabetic retinopathy in T2DM with normoalbuminuria, MA and microalbuminuria was 18.5, 35.5 and 48.0% respectively. Associated risk factors of DN were the duration of DM, HbA1c levels and uncontrolled hypertension. CONCLUSION: The prevalence of all DN was 37.2%. Associated risk factors of DN were the duration of DM, HbA1c levels and uncontrolled hypertension.

Accuracy of urine dipstick test for microalbuminuria in type 2 diabetes mellitus patients.

BACKGROUND: Testing for microalbuminuria (MA) is an important tool for detection of the earliest clinical manifestation of diabetic nephropathy Dipstick test for MA is commonly used for screening MA but this dipstick test has not been validated in Thai patients with DM. OBJECTIVE: To evaluate the diagnostic accuracy of the dipstick test for MA in random spot urine samples of type 2 diabetic mellitus patients, using urinary albumin to creatinine ratio (UACR) as the reference standard method. MATERIAL AND METHOD: Type 2 diabetic mellitus patients from the out-patient department of seven public hospitals were recruited. Random spot urine samples from all patients were screened for microalbuminuria by Combi-Screen dipstick test and UACR. RESULTS: A total of 6,223 urine samples from 899 diabetic patients were screened for MA. From UACR criteria, these urine samples were classified as normoalbuminuria (4,016 samples, 64.5%), MA (1,795 samples, 28.8%) and macroalbuminuria (412 samples, 6.6%). The dipstick test for MA had an overall sensitivity of 83.7%, specificity of 92.6% with a positive predictive value of 83.4% and a negative predictive value of 92.7%. The area under the receiver operating characteristics curve of the dipstick test for MA is 0.9427. CONCLUSION: The dipstick test for MA may be a useful method to initially screen for MA in Thai patients with type 2 DM.

Extracorporeal shock wave lithotripsy (ESWL) versus percutaneous nephrolithotomy (PCNL) or retrograde intrarenal surgery (RIRS) for kidney stones.

BACKGROUND: Stones in the urinary tract are a common medical problem in the general population. At present, the great expansion in minimally invasive techniques has led to the decrease in open surgery. Extracorporeal shock wave lithotripsy (ESWL) has been introduced as an alternative approach which disintegrates stones in the kidney and upper urinary tract through the use of shock waves. Nevertheless, as there are limitations with the success rate in ESWL, other minimally invasive modalities for kidney stones such as percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) are also widely applied. OBJECTIVES: To evaluate the effectiveness and complications of ESWL compared with PCNL or RIRS for managing kidney stones. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE, EMBASE and reference lists of articles without language restriction. SELECTION CRITERIA: Randomised controlled trials (RCTs) assessing the use of ESWL compared to PCNL or RIRS for kidney stone management. DATA COLLECTION AND ANALYSIS: Two authors independently assessed all the studies for inclusion. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI). MAIN RESULTS: Three studies (214 patients) were included, however results could not be pooled. Two RCTs compared ESWL to PCNL. The success rate at three months for lower pole kidney stones was statistically higher for PCNL (RR 0.39, 95% CI 0.27 to 0.56). Re-treatment (RR 1.81, 95% CI 0.66 to 4.99) and using auxiliary procedures (RR 9.06, 95% CI 1.20 to 68.64) after PCNL were less compared to ESWL. The efficiency quotient (EQ) in PCNL was higher than ESWL. Hospital stay (MD -3.30 days, 95% CI -5.45 to -1.15), duration of treatment (MD -36.00 minutes, 95% CI -54.10 to -17.90) and complications were less for ESWL. One RCT compared ESWL versus RIRS for lower pole kidney stones. The success rate was not significantly different at the end of the third month (RR 0.91, 95% CI 0.64 to 1.30). AUTHORS' CONCLUSIONS: Results from three small studies, with low methodological quality, indicated ESWL is less effective for lower pole kidney stones than PCNL but not significantly different from RIRS. Hospital stay and duration of treatment was less with ESWL. More RCTs are required to investigate the effectiveness and complications of ESWL for kidney stones compared to PCNL or RIRS.

Information use behavior of clinicians in evidence-based medicine process in Thailand.

OBJECTIVE: To investigate the information-use behavior of Thai clinicians in the evidence-based medicine (EBM) process. MATERIAL AND METHOD: Based on the survey research, 198 questionnaires were sent to EBM clinicians working in public hospitals in Thailand. The data were analyzed by mean, percentage, and factor analysis. RESULTS: One hundred and fifty-seven questionnaires (79.3%) were returned. The results revealed that 52.9% of the clinicians used EBM process in clinical practice at a high level and 41.4% at a moderate level. Most respondents (91.7%) used information for supporting their teaching and learning process as well as for professional self-development. About two-third used information for supporting their clinical decision. The types of information that the clinicians used in high percentage were research articles from medical journals (89.7%), systematic reviews (83.4%), textbooks, and reference books in the medical field (80.8%). The information resources that were often used including Internet resources (84.1%), hospital or medical school libraries (73.7%), expert consultation (59.8%), and the medical record unit (41.9%). Most of the respondents (89.7%) used PubMed, search engine (85.6%) and Cochrane Library (56.4%) as the tools for accessing information. Most respondents frequently had accessed to information 2-3 days a week and 93.7% of them preferred to access information resources via the Internet by themselves at their office or home. For searching strategies, most clinicians used key words (95%). In the present study, 20 variables were designed to test the factors correlated with the clinicians' information use. The results showed that the six variables (information use, EBM use, experience, organization, competency, and educational background) were significantly correlated with information used by clinicians in EBM process. CONCLUSION: Most Thai clinicians in the present study used EBM process. They regularly searched information by themselves with simple strategy. The results of the present study could be used for planning to improve the quality of clinicians in EBM practice. Since information use is important in using EBM, all hospitals should have adequate facilities to provide medical information for clinical practice. Relevant data from the present study may be useful for planning the use of EBM process and to further researches.

The relationship between microalbuminuria by using urine dipsticks and diabetic retinopathy in type 2 diabetes.

OBJECTIVE: Study the association between microalbuminuria and diabetic retinopathy in type 2 diabetic patients. MATERIAL AND METHOD: A cross-sectional analytic study of 1,111 cases with type 2 diabetic patients recruited from seven public hospitals, between June and December 2006 was performed RESULT: Two hundred eighty six subjects (79 males and 207 females) with urine dipsticks for microalbuminuria detection tested positive at least 2 of the 3 morning urine samples within 6 months. They were divided into 2 equal groups, micro- and normoalbuminuria based on quantity of albumin. Indirect ophthalmologic examination of all subjects' eyes for diabetic retinopathy was performed by ophthalmologists (retinal specialists). The present study showed that the proportion of diabetic retinopathy was 19.6% (28/143) and 12.6% (18/ 143) in micro- and normoalbuminuric groups, respectively. The difference of proportion between the groups was 7% but was statistically not significant (p = 0.108). CONCLUSION: Microalbuminuria detected using urine dipstick was not cross-sectionaly associated with diabetic retinopathy in type 2 diabetic patients.