Journal of Chiang Rai Provincial Health Office

การพัฒนาเทคนิคในการถ่ายภาพเอกซเรย์ช่องท้องระบบดิจิทัลเพื่อลดปริมาณรังสีที่ผิวผู้ป่วยได้รับ

Somsak Sanit — 2025-08-30

Abstract

This experimental research aimed to develop digital abdominal radiography techniques that could reduce radiation dose while maintaining adequate diagnostic image quality. Data were collected from 82 patients during January to March 2025, including gender, age, weight, height, examination thickness, kV, mAs, and DI values. These data were used to calculate patient radiation doses and analyze them to establish new techniques for abdominal X-ray radiation dosage.

The results showed that after technique development, the patient radiation dose significantly decreased from 1.43 mGy to 1.31 mGy, representing an 8.39% reduction (p = 0.024), which was lower than Thailand's 2023 diagnostic radiation reference levels. Regarding image quality, after technique development, all images fell within the appropriate Deviation Index range (-3 < DI < 3), showing a 39.02% improvement from the original. Correlation analysis revealed that tube current-time product (mAs) had a high positive correlation with entrance surface dose (r = 0.825, p < 0.001), abdominal thickness showed a moderate positive correlation (r = 0.432, p < 0.001), and tube voltage (kVp) demonstrated a low positive correlation (r = 0.160, p = 0.005). No factors were found to correlate with the Deviation Index.

This study benefits both patients and physicians by reducing patients' radiation risks while improving image quality for diagnosis. The findings can be further applied to develop radiographic techniques for other body parts.

*Department of Radiology, Chiangsaen Hospital

E-mail address : somsak_krap@hotmail.com

Keywords: Abdominal radiography, Entrance Surface Air Kerma, Deviation Index

การพัฒนานวัตกรรมแผ่นกระดานรองหลังสำหรับผู้ป่วยเด็กที่ได้รับบาดเจ็บทางศีรษะ และกระดูกสันหลังรุ่นที่ 2 โรงพยาบาลเทิง จังหวัดเชียงราย

Nittaya Prappai — 2025-08-30

This R2R research aimed to develop and evaluate an innovative for pediatric patients with head and spinal injuries Gen 2, addressing the need for appropriate immobilization devices designed for children's anatomical requirements.

This study employed Watson's Caring Theory and the ADDIE Model development process, this study involved 80 pediatric patients aged 1-8 years with head and spinal injuries. Research instruments included the innovative backboard, patient recording forms, and satisfaction questionnaires. Content validity (CVI = 0.6-1.00) and reliability (0.93) were established. Data analysis used descriptive and inferential statistics (t-test).

The Pediatric long spinal board for traumatic brain and spinal cord injury Gen 2 features single-piece PVC canvas construction with foam padding, providing durability, water resistance, and enhanced comfort. Key advantages include optimal pediatric sizing, radiolucency, easy cleaning, reusability, and cost-effectiveness (2,500 baht/unit). Implementation in 80 pediatric patients showed statistically significant improvements (p < .05) in heart rate, respiratory rate, and pain levels at 15, 30, 45, and 60-minute intervals compared to baseline measurements. The innovative backboard Version 2 effectively addresses clinical requirements for pediatric spinal immobilization, demonstrating measurable improvements in patient comfort and physiological parameters while ensuring safety during mobilization and transport. Expansion to community health promotion hospitals and emergency medical services units is recommended to enhance pediatric trauma care accessibility.

Keywords: Pediatric long spinal board, pediatric head and spinal injuries, Thoeng Hospital, Watson's Caring Theory, ADDIE Model

Development of clinical ethical behaviors of professional nurses

Kankanok Kittiteeranurak — 2025-08-30

This action research aimed to Study the problems concerning the clinical ethical behavior of professional nurses. Develop a model for enhancing the clinical ethical behavior of professional nurses. Examine the outcomes of the model for developing the clinical ethical behavior of professional nurses.

The sample group consisted of professional nurses working in the inpatient department at Mae Chan Hospital and new patients admitted to Mae Chan Hospital, who were purposively selected based on specific criteria. Data were gathered using questionnaires on perceived and actual ethical behavior, in-depth interviews, and the developed model. Analysis involved content analysis descriptive statistics and paired samples t-tests to compare before-and-after the development.

The research findings revealed that obstacles to ethical development included: an unsupportive organizational climate for ethical practice, excessive nursing workload, lack of knowledge and skills in professional ethics, lack of awareness regarding ethical risks, and insufficient clinical ethical courage. These findings led to the development of a Clinical Ethical Behavior Development Model for Professional Nurses (Maechan Moral Model: 3M), comprising four key approaches: 1) creating a supportive organizational climate and managing nursing workload; 2) strengthening knowledge and skills in professional ethics; 3) enhancing awareness of clinical ethical risks; and 4) cultivating clinical ethical courage.

The outcomes of the developed model for enhancing professional nurses' clinical ethical behavior showed that: Patients' perceptions of nurses' ethical behavior (t=5.008, p=0.000) and nurses' self-reported ethical behavior (t=4.054, p=0.000) were both significantly higher after the intervention (p < 0.05) Recommendations: The developed model (Maechan Moral Model: 3M) be refined into a professional ethics program and adopted by nursing organizations to drive the ethical mechanisms.

Outcomes of telepharmacy on asthma control In Chiang Saen Hospital

Phanida Chomborisut — 2025-08-30

Abstract

This study aimed to evaluate the outcomes of pharmaceutical care using telepharmacy services in patients with asthma. A pre-experimental one-group pretest-posttest design was conducted without a control group. Twenty-six asthma patients were followed and counseled via the Line Official Account application for eight weeks. Outcomes were assessed in three domains: clinical, humanistic, and economic.

Results showed a statistically significant improvement in asthma control, increasing from 50% to 84.62% (p < 0.05). Emergency inhalation visits decreased from 0.85 to 0.35 times/person, and hospitalization rate declined from 0.31 to 0.02 times/person. Drug-related problems dropped from 18 to 1 case (94.44% reduction). The proportion of patients correctly using inhalers rose from 26.92% to 100% (p < 0.05). Knowledge scores improved from 5.19 ± 0.71 to 7.81 ± 0.02 (p < 0.05), and satisfaction with the service was rated “very satisfied” (4.78 ± 0.35). Economically, patients saved an average of 473.69 ± 396.49 THB, equivalent to 46.51% ± 26.73 in cost reduction.

In conclusion, telepharmacy-based pharmaceutical care in asthma patients enhances disease control, promotes correct medication use, reduces drug-related problems, increases patient knowledge and satisfaction, and lowers healthcare expenses. It is, therefore, a suitable and sustainable model for long-term patient care.

Development of oral health care system for homebound and bedridden elderly in Chiang rai province

Rujira Saendee — 2025-08-30

This action research aimed to develop an oral health care system for home-bound and bedridden older adults in Chiang Rai Province, Thailand.

The study was conducted from July 2024 to June 2025 and involved 334 participants, including 234 family caregivers and 100 health care providers. The service providers comprised village health volunteers, multidisciplinary health personnel, and members of the committee responsible for developing the province's oral health care system.

The research was carried out in four phases: planning, action, observation, and reflection. Data were collected through questionnaires, interviews, and participatory workshops, and were analyzed using descriptive statistics.

The study resulted in the development of a community-based oral health care system that emphasized continuous, home-based care, supported by regular follow-ups and consultations from local health services. Key components of the system included structured referral pathways, caregiver training, and the integration of oral health into the broader health care system, grounded in holistic care principles. The initiative fostered collaboration among stakeholders and was recognized as a priority within provincial health policy. However, its long-term success will require sustained policy commitment and financial support to address challenges in implementation.