A cost-effectiveness analysis of using umbilical cord blood pH for the diagnosis and management of neonatal asphyxia in term high-risk pregnancy.

OBJECTIVE: The objective was to evaluate the cost-effectiveness of using umbilical cord blood pH (UC-pH) in combination with APGAR score for neonatal asphyxia, in terms of high-risk pregnancies, compared to using the APGAR score only. Neonatal outcomes and the proportions of patients admitted to the neonatal intensive care unit (NICU) were evaluated. METHODS: A cost-effectiveness ambispective analysis study was carried out, comparing (i) UC-pH combined with APGAR score and (ii) APGAR score only in 399 term pregnancies with a high risk for neonatal asphyxia. Costs included implementation, medical, and admission costs. Incremental cost-effectiveness ratios (ICER) were calculated. The proportions of patients admitted to the NICU were evaluated. RESULTS: UC-pH combined with APGAR score demonstrated a cost-effective outcome (3990.64 USD vs 5545.11 USD) and an ICER shown as saving 103.66 USD compared to the APGAR score alone. The need for NICU admission was less in the umbilical cord blood collection group (18 vs 33 cases). CONCLUSION: A combination of UC-pH with APGAR score assessment for neonatal asphyxia in a high-risk term pregnancy can effectively reduce costs and requirement for NICU admission.

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.

Determinants and prevalence of relapse among patients with substance use disorder in a rural population: A retrospective observational study.

INTRODUCTION: Substance use relapse after successful detoxication and rehabilitation is one of the most important aspects of addiction worldwide. This study aims to examine the current prevalence of relapse and to determine the factors associated with relapse among patients with substance use disorder (SUD) in a rural population. METHODS: This single-centered retrospective observational study enrolled a total of 915 patients with SUD who visited Banna hospital, Nakhon Nayok province, Thailand, from January 1, 2019, to December 31, 2021. Multiple logistic regression models determined the factors associated with relapse among the patients with SUD. RESULTS: The substance use relapse rate in this rural Thai population was 24 % (95%CI 21.16-26.70). Multivariate analysis revealed that being over 40 years of age, single, and unemployed, and having no legal history were associated with relapse among the patients with SUD. Furthermore, family disputes, addicted friends, and addicted close relatives resulted in a major significant increase in the risk of substance use relapse. CONCLUSIONS: The current study confirmed that family disputes, addicted friends, and addicted close relatives were the main associations with addiction relapse. Therefore, addiction rehabilitation programs based on the findings of the current study may reduce and contribute to preventing the risk of substance use relapse.

Barbed pharyngoplasty for obstructive sleep apnea: A meta-analysis.

PURPOSE: The purpose of this study was to perform a meta-analysis of barbed pharyngoplasty (BP) in the treatment of obstructive sleep apnea (OSA). METHODS: Databases included PubMed, Ovid MEDLINE, Cochrane Library, Web of Science and Scopus, and reference lists. Relevant articles were searched through August 2021, following the PRISMA guidelines. RESULTS: Twenty articles with 762 participants were included. The mean success in BP as a single-level surgery was 85.2% (MD, 95% CI 77.6%, 92.7%). There was a significant reduction of oxygen desaturation index (ODI) of -11.7 (MD 95% CI -16, -7.4). The lowest oxygen saturation (LSAT) improved 8.9% (MD, 95% CI 1.3%, 16.7%). Epworth Sleepiness Scale (ESS) and snoring score significantly decreased -6.8 (MD 95% CI -8.3, -5.2) and -5.3 (MD 95% -7.9, -2.7), respectively. The apnea-hypopnea index (AHI) significantly decreased -23.9 events/h (MD, 95% CI -25.5, -22.9) with a 69% reduction. The mean surgical time was 23 min. A significant improvement of AHI, ODI, ESS, and LSAT was also revealed in BP as a multilevel surgery. Complications included suture extrusion (18%), dysphagia (20%), velopharyngeal insufficiency (15%), and dysgeusia (3%) without serious consequences. The median follow-up period was 6 months, ranged 1 to 26 months. CONCLUSION: Barbed pharyngoplasty as a single-level or multilevel surgery is a safe and effective procedure with significant objective and subjective outcomes for OSA patients with palatal obstruction. However, randomized clinical controlled trials with multicenter cooperation and long-term study are necessary.

Upper airway stimulation vs other upper airway surgical procedures for OSA: a meta-analysis.

PURPOSE: The aim was to compare the outcomes of upper airway stimulation (Stim) and other upper airway surgical procedures (Surg) in the treatment of obstructive sleep apnea (OSA). METHODS: Data sources included PubMed, Ovid MEDLINE, Cochrane Library, Web of Science, Scopus, and reference lists. Relevant articles were identified from various databases according to the PRISMA guidelines. RESULTS: Five articles with a total of 990 patients were included. The mean cure rates in the Stim group and the Surg group was 63% and 22%, and the mean success rates was 86% and 51% which were higher in the Stim group (p < 0.001). The apnea-hypopnea index reduction was -23.9 events/ hour (MD, 95% CI -25.53, -22.29) in the Stim group and -15.5 events/hour (MD, 95% CI -17.50, -13.45) in the Surg group which was greater in the Stim group (P < 0.001). Epworth Sleepiness Scale decreased -4.9 (MD, 95% CI -5.45, -4.32) in the Stim group and -5.1 (MD 95% CI -5.88, -4.37) in the Surg group without significant difference between the groups (P = 0.62). Oxygen saturation nadir improvement was 8.5% (MD 95% CI 7.05%, 9.92%) in the Stim group and 2.2% (MD 95% CI-0.22%, 4.58%) in the Surg group which was higher in the Stim group (P < 0.001). Hospital stay and readmission rate were lower in the Stim group. The timing of follow-up ranged from 2 to 13 months. CONCLUSION: Upper airway stimulation provides improved objective and similar subjective outcomes compared to other upper airway surgical procedures for selected patients with moderate to severe OSA with difficulty adhering to CPAP treatment. However, further studies are essential to confirm outcomes in the long term.

Barbed Reposition Pharyngoplasty versus Expansion Sphincter Pharyngoplasty: A Meta-Analysis.

OBJECTIVE: This study was to compare barbed reposition pharyngoplasty (BRP) and expansion sphincter pharyngoplasty (ESP) in the treatment of obstructive sleep apnea (OSA). METHODS: Relevant 907 articles were searched from various databases until August 2020, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science and Scopus, and reference lists. RESULTS: Four studies with a total of 208 participants were included. The mean reduction of apnea-hypopnea index (AHI) in the BRP group was 74.03% and the mean reduction of AHI in the ESP group was 60.17%. The mean success rate in the BRP group and the ESP group was 84.96% and 79.87%, respectively. The mean difference (MD) of the change in AHI between groups was not significantly different (MD = -1.24 event/hr, 95% CI [-11.86, 9.36], P = .82). There was no significant difference in postoperative AHI, postoperative Epworth Sleepiness Scale, pain, hospital stay, time to oral diet, and the change in oxygen desaturation index in both groups whereas the analgesic requirement was lower in the BRP group. Operative time was lower in the BRP group (MD = 21.72 minutes, 95% CI [18.85, 24.60], P < .0001). CONCLUSION: The outcomes in both procedures are comparable in the improvement of OSA with palatal collapse. BRP is superior to ESP in term of surgical time. However, randomized clinical controlled trials with multicenter cooperation and long-term follow-up are essential to further demonstrate the efficacy of these procedures. Laryngoscope, 131:1420-1428, 2021.

Er:YAG laser for snoring: a systemic review and meta-analysis.

A new outpatient non-surgical method using Er:YAG laser for snoring has been demonstrated. The aim of this systematic review and meta-analysis was to investigate the effects of this treatment on snoring. Relevant 1548 articles were searched from various databases from 1 January 2000 to September 2018 including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus and reference lists. Meta-analysis was performed with RevMan software. Cochran's Q and I2 statistics were used to assess heterogeneity. The overall effect was evaluated using z-tests. Seven studies and two hundred forty-seven participants treated with two to three sessions of Er:YAG 2940 nm laser (long pulse mode, 10 Hz, fluence 1.6 J/cm2) were included. There was a statistically significant reduction of pooled snoring VAS (mean difference (MD) (95% CI), - 6.89 (- 7.62, - 6.15)). Patient satisfaction rate after laser treatment was 80% (95% CI, 70.69, 89.05) of cases. A widening of the upper airway dimension was revealed; however, changes in apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) were not significantly different. Mean follow-up period was 3 to 36 months. Patients tolerated the procedure well without anesthesia. There were minimal side effects without serious adverse effects. Er:YAG laser is shown to be effective in a way to reduce snoring without significant AHI or RDI changes. However, randomized controlled trials, objective data, multicenter cooperation, and long-term outcomes are needed to confirm the benefits of this laser for snoring.

Measures of Comparative Behavior in Hearing Loss Patients with Cochlear Implant: Caretaker Assessment.

The aim of this study was to assess comparative behavior domain in patients with cochlear implants, using caretaker assessment. A prospective cross-sectional study was conducted. Of 106 patients with hearing loss and receiving cochlear implants were included along with their caretakers. The caretaker' perspective questionnaire-22 was implemented covering emotions, education, and social relationships domain. A repeated measure ANOVA was used to statistical analysis. The implantation elicited a slight reduction in emotions scores domain as well as slight increase in social relationships scores from pre-cochlear implants to 12 months in all aged (6-10 years: - 10.7, 95%CI - 8.4 to 12.9; 4.2, 95%CI 3.0-5.5, 11-20 years: - 8.6, 95%CI - 6.7 to 10.5; 2.5, 95%CI 1.6-3.3, 21-59 years: - 6.8, 95%CI - 4.9 to 8.6; 2.0, 95%CI 1.3-2.7, and older 60 years: - 12.1, 95%CI - 9.5 to 14.6; 3.6, 95%CI 2.7-4.5, respectively). However, the education scores domain has slight increase only in aged 21-59 years group (1.8, 95%CI 0.7-2.8). A long-term after cochlear implants (12 months), but not after only 6 months elicits a statistically significant increase the social relationships scores and the reduction in negative emotions scores in all aged at implantation. However, the education scores have slight increase only in aged 21-59.