The Health Service Model for Promoting Good Death in Critically Ill End-of-Life Patients in the Emergency Department: A Qualitative Study

Good death is one of the important outcomes of end-of-life care service delivery. The initial management of critically ill patients in the Emergency Department (ED) for promoting good death often challenging since it requires a focus on human dignity and equity at the end of life. A qualitative approach was used included eight bereaved family members who loss of their loved one in the ED and 25 emergency staff, including 11 emergency physicians and 14 emergency nurses of a super tertiary hospital in Thailand. Semi-structured, face-to-face interviews were conducted from February to August 2021. All the interviews were transcribed verbatim for content analysis. The result identified four distinct scenarios and seven core themes of end-of-life patient characteristics in the ED. To promote a good death in the ED, health care provider should consider the unique service deliver for each critically end-of-life patients and their family members.

A Nationwide Survey and System Analysis of Emergency Triage System in Lao People's Democratic Republic

Objective: To assess the present status of the emergency department (ED) triage system in 162 hospitals across the Lao People's Democratic Republic (Lao PDR). Materials and Methods: The Lao PDR nationwide survey participants recruited ED administrators. The EDs were randomly recruited. The standard questionnaire package was used for data collection including patients’ demographics and triage systemic factors. Descriptive analysis was applied to analysis the outcome of interest. Results: A majority of triage officers were emergency room nurses (58.6%), general physicians (20.4%), or both (11.1%). Most hospitals (89.5%) used informal triage scales such as clinical experiences or colors to prioritize ED patients. Only 17 hospitals (10.5%) had a formal triage scale in their ED care systems and used it in their practice. Conclusion: These findings provide knowledge of the ED triage system in the Lao PDR. The results indicate that the Lao PDR lacks a formal ED triage scale but uses a variety of informal scales. Thus, it is necessary to set up a standard triage system at all hospitals to standardize ED healthcare across the country.

Factors Influencing Pre-Cardiopulmonary Arrest Signs among Post-General Surgery Patients in Critical Care Service System

Health service system factors can lead to pre-cardiopulmonary arrest signs (pre-CA), which refer to a critical condition in the body leading to a circulatory and respiratory system disruption. The purpose of this study was to assess the incidence rate of an event leading to pre-cardiopulmonary arrest signs within the first 24 h, and also to analyze the factors influencing the health service system in critical post-general surgery patients in the intensive care unit. These results of the study found the incidence rate of pre-CA was 49.05 per 1000 person-hours, especially 1 h after admission to the ICU. Hemodynamic instability, respiratory instability, and neurological alteration were the most common pre-CA symptoms. The patient factors associated with high pre-CA arrest sign scores were the age from 18-40 years, with an operation status as emergency surgery, elective surgery compared with urgent surgery, and the interaction of operation status and age in critical post-general surgery patients. The organization factors found advanced hospital level and nurse allocation were associated with pre-CA. To improve quality of care for critical post-general surgery patients, critical care service delivery should be delegated to nurses with nurse allocation and critical care nursing training. Guidelines must be established for critically ill post-general surgery patient care.

Factors Associated with 24-Hour Clinical Outcome of Emergency Patients; a Cohort Study

Introduction

Pre-hospital and in-hospital emergency management play an important role in quality of care for emergency patients. This prospective cohort study aimed to determine factors associated with the 24-hour clinical outcome of emergency patients.

Methods

The sample included 1,630 patients, randomly selected through multi-stage stratified sampling from 13 hospitals in 13 provinces of Thailand. Data were collected during January-November 2018. Clinical outcome was determined using pre-arrest sign score. Data were analyzed via ordinal multivariate regression analysis.

Results

Factors influencing 24-hour clinical outcome of emergency patients were age (OR: 0.965; 95% CI: 0.96-0.97), having coronary vascular disease (CAD) (OR: 1.41; 95% CI: 1.05-1.88), and severity of illness based on Rapid Emergency Medical Score (REMS) (OR:1.09; 95% CI: 1.05-1.15). Self-transportation and being transported by emergency medical service ambulance with non-advanced life support (EMS-Non-ALS) did not influence clinical outcome when compared to EMS-ALS transport. Being transported from a community hospital increased pre-arrest sign score 1.78 times when compared to EMS-ALS (OR: 1.78; 95% CI: 1.17-2.72). Increased transportation distance increased the risk of poor clinical outcome (OR: 1.01; 95% CI: 1.002-1.011). Length of stay in emergency department (ED-LOS) more than 4 hours (OR: 0.21; 95% CI: 0.15-0.29) and between 2-4 hours (OR: 0.60; 95% CI: 0.47-0.75) decreased the risk of poor clinical outcome when compared to ED-LOS less than 2 hours.

Conclusion

Having CAD, severity of illness, increased transport distance, and ED-LOS less than 2 hours were found to negatively influence 24-hour clinical outcome of emergency patients.

Quality of Life in Postoperative Colorectal Cancer Survivors: A Structural Equation Model

Objective: The present study has been aimed at constructing a causal model to determine factors affecting healthrelatedquality of life (HRQoL) in postoperative patients with colorectal cancer (CRC) following discharge.Materials and Methods: A cross-sectional study was conducted with 396 postoperative CRC cancer patients fromten tertiary hospitals representing each of the four Regions of Thailand. Data was collected through a standardquestionnaire. Structure equation modeling (SEM) was applied to analyze data.Results: The findings revealed that the majority of patients with CRC surgery had a moderate HRQoL. One hundredand twenty-three patients (31.1%) had complications. SEM showed a good fit with ƛ2=40.347, df=28, p=0.062,GFI=0.980, CFI=0.959 and RMSEA=0.033. The final model showed that age, stage of cancer and healthcare servicebeing received following CRC surgery had direct effects on HRQoL. Nutritional status and follow-up outpatientclinic had indirect effects on HRQoL during postoperative complications. Moreover, social support and primaryfamily caregiver support had indirect effects on HRQoL through self-management capacity.Conclusion: The findings of this study emphasized the importance of implementing effective strategies to improvequality of life among postoperative patients with CRC after discharge and indicated these strategies should focuson quality of healthcare service following CRC surgery, self-management capacity and prevention of postoperativecomplications. Postoperative complications can be reduced by providing effective follow-up in outpatient clinicsand nutritional status management, consequently improving quality of life among this population.

Effects of Four Noble Truths Practice on Hypertension Control

Objective: To examine the effects of Four Noble Truths practice in controlling blood pressure with three-group comparison, involving a Mobile Web group, Guidebook group and usual care group in patients with stage 1 hypertension.Methods: This randomized controlled trial was conducted in one university hospital setting.  145 participants were recruited into the study by randomized selection and were randomly assigning to the three groups. Of these, 45 participated as Mobile Web users, 50 as Guidebook users and 50 in the control group. The Mobile Web and Guidebook were developed using the guidance of the Four Noble Truths and received a phone call every two weeks for three times while control received a usual care. Then, the outcomes were measured including blood pressure and satisfaction at two-month after recruitment. The average blood pressure and satisfaction were compared by comparative descriptive statistic. Finally, analysis of covariance (ANCOVA) was used to analyze the covariate that may influence the outcomes with the post hoc analysis by Bonferroni. Results: Participants who received Mobile Web and Guidebook had reduced their blood pressure more than those receiving usual care, with statistical significance (P < 0.05). It was found that blood pressures could be lowered to a maximum level of 5.09 ± 9.62mmHg within 8 weeks of treatment. Altogether, both groups were satisfied with healthcare services more than those receiving usual care, with statistical significance (P < 0.05).Conclusion: The program could be applied to control high blood pressure in patients with stage 1 hypertension. The outstanding of this program could support overall difference in healthcare of each patient with fast efficacy.

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand

Background

Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand.

Methods

A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH.

Results

The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95,50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6–10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively.

Conclusions

This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.

Factors associated with access to health services and quality of life in knee osteoarthritis patients: a multilevel cross-sectional study

BACKGROUND

The main purpose of health service systems is to improve patients' quality of life (QoL) and to ensure equitable access to health services. However, in reality, nearly half of knee osteoarthritis (OA) patients present to the health system do not have access to health services, and their QoL remains poor. These circumstances raise important questions about what (if any) factors can improve health care accessibility and QoL for knee OA patients.

METHODS

A multicenter, cross-sectional survey was performed with 618 knee OA patients who received care at 16 hospitals in Thailand. Structural equation modeling (SEM) was conducted to investigate the association of health service factors and patient factors with access to health services and QoL.

RESULTS

The QoL of knee OA patients was very poor (mean score = 33.8). Only 2.1% of the knee OA patients found it easy to obtain medical care when needed. Approximately 39.4% of them were able to access appropriate interventions before being referred for knee replacement. More than 85% of orthopedic health services had implemented chronic disease management (CDM) policy into practice. However, the implementation was basic, with an average score of 5.9. SEM showed that QoL was determined by both health system factors (β = .10, p = .01) and patient factors (β = .29, p = .00 for self-management and β = -.49, p = .00 for disease factors). Access to health services was determined by self-management (β = .10, p = .01), but it was not significantly associated with QoL (β = .00, p = 1.0).

CONCLUSIONS

This study provides compelling information about self-management, access to health services and QoL from the individual and health service system perspectives. Furthermore, it identifies a need to develop health services that are better attuned to the patient's background, such as socioeconomic status, disease severity, and self-management skills.

Recovery Symptoms and Mood States in Thai CABG patients

Recovery symptoms and related mood states during early recovery after coronary artery bypass graft surgery (CABG) have never been assessed in Thailand. This cross-sectional descriptive correlational study was to identify the relationships between frequency of recovery symptoms and mood states of a convenience sample of 91 Thai CABG patients during 2 weeks after discharge. Standardized tools/procedures were used to measure the variables of interest. The most common recovery symptoms were chest and leg incision pain, having trouble sleeping, and neck and shoulder or back discomfort. The most common mood states were confusion, anxiety, and anger, respectively. In addition, Thai CABG patients who had more frequent recovery symptoms also had greater negative mood disturbance. These findings provide a beginning explanation about the phenomena of recovery symptoms and mood states in a specific culture, Thai CABG patients.

Coping and Health Problems of Caregivers of Survivors with Traumatic Brain Injury

Objetivos: Evaluar el afrontamiento y los problemas de salud de los cuidadores en el momento en que el sobreviviente fue dado de alta y un mes después de que el sobreviviente fue dado de alta y determinar las correlaciones entre los datos de carácter personal, afrontamiento y los problemas de salud de los cuidadores y la incapacidad de los sobrevivientes. Método: Ochenta y cinco díadas de supervivientes con lesiones cerebrales traumáticas y sus cuidadores fueron incluidos en la investigación. Los instrumentos utilizados para la recolección de datos fueron la versión tailandesa de la Escala de Medición del Proceso de Afrontamiento y Adaptación – Formato Corto, con 27 ítems, el Cuestionario de Problemas de Salud para los cuidadores y la Clasificación de Escala de Discapacidad para los sobrevivientes. El Modelo de Adaptación de Roy se utilizó como marco conceptual para este estudio. La correlación producto-momento de Pearson se utilizó para el análisis. Resultados: No se encontraron diferencias estadísticas entre los problemas de afrontamiento y de salud en los cuidadores. Los problemas de salud reportados más frecuentemente por los cuidadores fueron dolor de cabeza en el día de alta y ningún problema de salud después de un mes de participación en el cuidado del sobreviviente. El nivel de la discapacidad de los sobrevivientes y el estado civil de los cuidadores se correlacionaron negativamente con el afrontamiento (r = - 0,245 , p = 0,024 , r = - 0,220 , p = 0,043 , respectivamente). Conclusiones: Los resultados demuestran que los cuidadores permanecieron capaces de manejar las dificultades que implica el cuidado de los sobrevivientes en casa con menos problemas de salud. Los cuidadores casados eran propensos a manejar esta carga mejor que otros cuidadores.