YASOTHON MEDICAL JOURNAL

A Comparative Study of Hemorrhoid Surgery Vessel-Sealing Devices Hemorrhoidectomy with Traditional Surgery (Conventional Ferguson Hemorrhoidectomy) in Amnat Charoen Hospital Amnat Charoen Province

2024-10-21T11:07:28+07:00

Background: Hemorrhoids are a common disease in medical practice and hemorrhoid surgery is often performed by surgeons in grade 3 and 4 hemorrhoids from the past until the present. In the past, conventional hemorrhoidectomy (Milligan-Morgan or Ferguson) was used. Current use of tools; the trend of electrothermal bipolar vessel sealing systems (Ligasure TM) in assisting surgery is increasing. Many studies have reported that it is a reliable and safe tool. Many studies have shown the use of surgical tools developed as Vessel-Sealing Devices Hemorrhoidectomy which gives better results in many ways.

Objective: To study and compare pain after hemorrhoid surgery. Clinical results (Surgery time Length of hospital stay including patient satisfaction and complications associated with conventional surgery. Conventional Ferguson hemorrhoidectomy with surgery using Vessel-Sealing Devices in Amnat Charoen Hospital.

Study style: Experimental study.

Methods: Retrospective data were collected from the medical records of patients diagnosed with grade 3 and 4 hemorrhoids from 1 October 2021 to 30 September 2022. The total number of patients was 95, divided into 2 groups. Namely, the group that received Conventional Ferguson hemorrhoidectomy, 50 cases, the group that received surgery Vessel-Sealing Devices hemorrhoidectomy 45 cases. They were analyzed and compared with the time required for surgery. Amount of bleeding during surgery postoperative pain score length of hospital stay, amount of NSAIDs given after surgery wound healing time cost of hospital stay, and postoperative complications. The results obtained from both groups will be compared with statistics. Chi-square test and Fisher'sexact test, which analyzed inferential statistics at the statistical significance level p-value < 0.05.

Results: It was found that the duration of surgery amount of bleeding during surgery postoperative pain score length of hospital stay Amount of NSAIDs given after surgery, and wound healing time in patients who have undergone surgery Vessel-Sealing Devices hemorrhoidectomy were less than those who received Conventional Ferguson hemorrhoidectomy. Statistically significant; by surgery time (8.01 ± 4.82 minutes and 20.82 ± 12.51 minutes; p < 0.001), intraoperative bleeding volume (2.81 ± 1.32 ml and 15.71 ± 14.05 ml; p < 0.001), postoperative pain scores on the first day (3.82 ± 1.22 and 7.31 ± 1.31; p < 0.001) and the second day (2.08 ± 1.10 and 4.15 ± 1.11; p < 0.001), length of hospital stay (1.82 ± 0.71 days 2.51 ± 2.21; p< 0.001), amount of NSAIDs received postoperatively (3.03 ± 0.81 times and 5.44 ± 2.22 times; p < 0.001), and wound healing rate (3.51 ± 0.74 weeks and 5.84 ± 1.23 weeks 0; p < 0.001). Therefore, the use of Vessel-Sealing Devices hemorrhoidectomy is used to operate on level 3 and 4 hemorrhoids, so it has such benefits and when considering the cost and condition complications were found to be not significantly different between the two methods.

Conclusion: Surgery time amount of bleeding during surgery postoperative pain scores on the first and second-day length of hospital stay amount of NSAIDs given after surgery wound healing time in patients who have undergone Vessel-Sealing Devices hemorrhoidectomy less than those who received Conventional Ferguson hemorrhoidectomy. Statistically significant.

Incidence of Cardiovascular Disease in Diabetic Patients in Yasothon Hospital

2024-10-21T11:31:54+07:00

Background: The increasing prevalence of cardiovascular and cerebrovascular diseases is significantly attributed to diabetes mellitus. Complications from diabetes exacerbate public health challenges, necessitating effective screening and prevention strategies to mitigate cardiovascular and cerebrovascular complications in diabetic patients.

Objective: To investigate the incidence of cardiovascular and cerebrovascular events in type 2 diabetes patients receiving pioglitazone and to identify associated risk factors and side effects.

Methods: This retrospective cohort study analyzed inpatient medical records from Yasothon Hospital's Department of Internal Medicine, covering the period from October 1, 2022 to September 30, 2023. The study included 401 type 2 diabetes patients diagnosed based on the International Classification of Diseases (ICD-10) coding system. Data collected encompassed general demographics, health factors, metabolic abnormalities, behavioral risks, and medication usage. Descriptive statistics, including frequency distribution, percentages, means, and standard deviations, were utilized. Chi-square tests, correlation coefficients, and logistic regression were applied to identify predictive factors.

Results: The study population consisted predominantly of females (83.54%) with a mean age of 60.21 years (range 28-93 years). Among the patients, 171 (42.64%) were identified as high risk for cardiovascular disease. Most patients (87.53%) were covered under the universal health coverage scheme. Multivariate logistic regression analysis revealed that atrial fibrillation (AF) (OR=0.268), LDL levels (OR=3.654), waist circumference (OR=2.149), and simvastatin use (OR=11.018) were significant predictors of cardiovascular disease in type 2 diabetes patients.

Conclusion: The findings indicate a significant prevalence of cardiovascular risk among type 2 diabetes patients receiving pioglitazone, with key predictors including AF, elevated LDL levels, increased waist circumference, and simvastatin use. These results underscore the importance of comprehensive risk assessment and targeted interventions in managing cardiovascular complications in diabetic patients.

Nursing Care for ABO-Incompatible Kidney Transplantation

2024-10-21T13:09:12+07:00

Chronic kidney disease (CKD) is a global public health problem, including Thailand. End-stage renal disease (ESRD) is the last stage of chronic kidney disease and remains a significant source of reduced quality of life and premature mortality. The treatments of ERSD were supportive care, hemodialysis, peritoneal dialysis, and kidney transplantation. Kidney transplantation is considered the best therapy for patients with end-stage renal disease. However, the shortage of organ donations poses a substantial obstacle, leading to prolonged waiting times for transplant candidates. Consequently, an increasing number of individuals require kidney transplantation each year. Therefore, ABO-Incompatible kidney transplantation is an alternative treatment.

Nurses can play an integral role in preoperative and postoperative care until the patients are discharged home. This article reviewed the knowledge about ABO-incompatible kidney transplantation, nursing care for preoperative, and postoperative care, complications, and case studies. To provide nursing guidelines for ABO-incompatible kidney transplantation for patients' safety and better quality of life.

Develop a Nursing Model for Pediatric Thalassemia Patients Yasothon Hospital

2024-10-21T13:35:05+07:00

This research is a research and development with the objective of developing a nursing model for thalassemia children at Yasothon Hospital. The study was conducted from January 2022 to October 2022. There were 4 phases; Phase 1: Study the situation; Phase 2: Develop a nursing model; Phase 3: Trial and Phase 4: Evaluation. The sample groups were purposively selected as follows: 1) Service recipients: 60 caregivers of thalassemia children and thalassemia children; 2) Service providers: 10 professional nurses. The research instruments were: 1) The new manual for nursing standards for thalassemia children; 2) the instruments used for data collection were: (1) a recording form for nursing indicators before, during and after blood transfusion. (2) Personnel satisfaction questionnaire (3) Knowledge measurement form for caregivers of thalassemia children (4) Patient satisfaction questionnaire. Data were analyzed using descriptive statistics and inferential statistics to compare the difference in mean scores before and after providing knowledge using paired t-test statistics.

The results of the study found that 1) Nursing care model for pediatric thalassemia patients consists of nursing standards for children with thalassemia and health education videos for thalassemia 2) The effectiveness of the system consists of service provider results, including overall personnel satisfaction at a very high level ( = 4.97, S.D. = 0.37) and compliance with nursing standards It was in the range of 88.7-100 percent. Results for service users included complications from blood transfusions. The knowledge of caregivers after development was significantly higher than before development ( before = 8.52, after = 14.67) significantly at the .01 (p-value= .000), and patient satisfaction. The overall level is at a very high level ( = 4.98, S.D. = 0.04)

Nursing Care of Patients Stroke in the Young: 2 Comparative Case Studies

2024-10-21T13:51:06+07:00

Stroke in young adults is a neurological disease caused by abnormalities in cerebral blood vessels. It can result from cerebral artery stenosis, embolism from other sources such as the heart, or cerebral hemorrhage leading to blood accumulation. These events cause brain tissue compression, edema, and damage, impairing function. If brain tissue suffers severe damage, patients may experience permanent disability or death. Therefore, accurate patient assessment, prompt nursing care, close symptom monitoring, and preventing complications from the initial admission phase through the continuous care phase and discharge phase are crucial to ensure patient safety and reduce disease severity.

Objective: To study and compare nursing care for stroke patients in two young adults.

Methodology: Two case studies were purposively selected from young adult stroke patients admitted to the Special Medical Ward at Yasothon Hospital between February 23, 2024, and May 31, 2024.

Results: The study found that 1) both cases received antiplatelet medication and treatment for their underlying conditions. There were 9 similar nursing diagnoses and 2 different ones between the cases. 2) Nursing interventions addressed patient-specific problems, including monitoring for increased intracranial pressure, complications from antiplatelet medication, muscle tension pain, phlebitis, anxiety, insomnia, hyperglycemia, and prevention of complications such as falls, aspiration, pressure ulcers, joint stiffness, and shoulder dislocation. Patients and relatives also received education on post-discharge care. Both patients were treated according to their needs and problems until their conditions improved. They were discharged after 10 days with a follow-up appointment scheduled for one month later.

Conclusion: Stroke in young adults is a critical condition that threatens the patient's life. Assessment of symptom changes, monitoring for complications, and problem-solving from the initial admission, continuation, and discharge phases ensure patient safety, including rehabilitation and comprehensive discharge planning, so that patients and their families are ready to return to a near-normal life and can prevent recurrence.

Nursing Care of Patients with Lumbar Fractures and Spinal Cord Injuries Who Have Undergone Surgery: Case Study Compare 2 Case

2024-10-21T14:24:23+07:00

Lumbar spinal injuries and spinal cord injuries are acute conditions that are serious injuries and are major health problems resulting in the body’s movement. Perception of sensations is impaired. It is the result of the spinal nerve being damaged. This will cause pain to radiate along the compressed nerve. There is weakness in the legs which has an impact on health, causing loss of lift, disability, long treatment periods, and patient discomfort from pain or death from complications of the disease. The goal of treatment in the first phase of this group of patients is to reduce the death rate and reduce additional injuries of the spinal cord together with prevention of complications and continuous care with the ultimate goal of keeping patients safe. Physically, mentally, emotionally, socially, and without any disability. So that patients can return to society as quickly as possible and have a good quality of life.

Objective: This is a comparative study of two case studies of the nursing care of patients with lumbar spinal fractures and spinal cord injuries who had undergone surgery.

Methods: Two purposive care studies were selected from patients with lumbar spinal fractures and spinal cord injuries. Surgery was admitted to Yasothon Hospital between March 2024 and June 2024. Data were collected from medical records and statistics of Yasothon Hospital. Case studies were analyzed using Gordon's health perception model and patient care using nursing processes and Orem's nursing theory.

Results: In both case studies, it was found that 1) patients with lumbar spinal fractures and spinal cord injuries who received surgery 2 cases had the same 7 diagnoses and 1 different diagnosis. 2) Received nursing care was consistent with the problems, including, Neurogenic Bowel, Neurogenic Bladder, pain management, patient and relative anxiety, risk of complications in each system, care and prevention of pressure sores, and discharge planning. Received care according to the problems and needs of each patient until symptoms improved, discharged, and scheduled a follow-up appointment in 1 month.

Conclusion: Patients with lumbar spinal fractures and spinal cord injuries who received surgery have various life-threatening critical conditions. Monitoring and solving problems at every stage of care will keep patients safe. Nurses therefore play an important role in assessing and monitoring changes in symptoms, preventing complications, and planning nursing care that covers physical, mental, emotional, social, and family aspects, as well as continuous care when patients return to society.

Effects of the Oral Health Care Practice Guidelines in the VAP Bundle to Prevention of Ventilator Associated Pneumonia in Medical Intensive Care Unit, Yasothon Hospital

2024-10-21T14:30:55+07:00

This quasi-experimental research aimed to study the effects of using the VAP Bundle oral health care guidelines to prevent ventilator-associated pneumonia in the Medical ICU, Yasothon Hospital, from March 15 to July 1, 2023. The population was two groups: (1) Patients on mechanical ventilation admitted to the medical intensive care unit 2, randomly assigned to either a control group (before guideline implementation) or an intervention group (after guideline implementation); (2) 17 professional nurses working in the medical intensive care unit 2. Research tools included oral health care guidelines within the VAP Bundle and data collection instruments such as oral health assessment using the modified Beck Oral Assessment Scale (BOAS), VAP diagnosis reports, nurse questionnaires, knowledge tests, guideline feasibility assessments, satisfaction surveys, and nurse practice observation forms. Data were analyzed using frequency, percentage, mean, standard deviation, T-test, Chi-square, and Fisher's Exact Test.

Results: The group using the VAP Bundle oral health care guidelines to prevent ventilator-associated pneumonia in the medical intensive care unit had a VAP incidence rate of 3.86 per 1,000 ventilator days, which was lower than the group not using the guidelines and could reduce the VAP incidence rate by 1.92 per 1,000 intubation days. The intervention group had significantly lower BOAS scores than the control group. Nurses' knowledge increased significantly after guideline implementation (p < .001), and satisfaction levels were very high.

Discussion and Recommendations: Continuous implementation and adherence to the guidelines are recommended, along with increased awareness and regular supervision to ensure sustainable practice. Future research should examine the effectiveness of these tools in larger sample sizes

Nursing Care for Ischemic Stroke Patients during the Rehabilitation Period: 2 Comparative Cases

2024-10-21T14:41:43+07:00

Ischemic stroke is a severe neurological disease often found in the elderly. Nowadays, it is found in increasing numbers of adults of working age. Each year, approximately 15 million people worldwide suffer a stroke. On average every 6 seconds, at least 1 person dies from a stroke. It is the second leading cause of death in the world.

Objectives: The studies and compare nursing care for ischemic stroke patients during the rehabilitation period. Two comparison cases.

Method: The analysis of the situation of Ischemic stroke patients in the rehabilitation period. Select 2 specific case studies, treatment beds in the Stroke Unit and special medicine ward, Yasothon Hospital from 1 March 2024 to 30 June 2024.

Results: The study found that 1) Case Study 1: A 76-year-old Thai woman comes to the hospital with weakness in her left limb, slurred speech, and a distorted face. The 7 hours before coming to the hospital, she received antiplatelet medication. A progressive stroke was found 30 minutes later, she had more weakness in the left limb. Watch out for high intracranial pressure and pneumonia from aspiration. Antibiotics were given and fed through a tube. She can’t walk and has motor power in her left upper 1/lower grade 2, right grade 5 all, Refer back to the community hospital for intermediate care, the number of bed days was 14 days, and the follow-up appointment was 1 month. 2) Case Study 2: A 49-year-old Thai man came with weakness in his left arm, slurred speech, and crooked mouth. 5 hours before coming to the hospital, he received antiplatelet medication. Diabetic diagnosed and high blood fat feeding through a tube for the first 3 days, eating by mouth. Can walk using crutches, motor power left upper 1/lower grade 3, right grade 5 all, sold for relief, number of bed days were 19 days, follow-up appointment 2 wks. 3) Two case studies total 12 nursing diagnoses, 9 of which were the same, and 3 were different. They received care from the initial admission period, continuation period, and discharge period. There is rehabilitation comprehensive distribution planning until being able to control and prevent various complications.

Conclusion: Both case studies had ischemic stroke and provided care from the first period of admission, continuing phase, discharge phase, monitoring, and prevention of various complications. There is a systematic process for rehabilitating patients. Comprehensive distribution planning As a result, the patient's condition gradually improved, and discharged, go back and live with family.