Journal of the Medical Association of Thailand = Chotmaihet thangphaet
-
Treatment of acute coronary syndrome requires a reliable measurement of quality for ensuring evidence-based care. Clinical registries have been used to support quality improvement activities in some countries, but there are few data concerning their implementation in developing countries. In 2008, a multidisciplinary Siriraj ST segment elevation myocardial infarction (STEMI) registry team was formed with the intention to improve the process of care. This report summarizes observational data collected within the first year to characterize the clinical profile, management and in-hospital outcomes of STEMI patients at the author's institute. ⋯ Despite a high utilization rate of reperfusion therapy the time to reperfusion therapy exceeds the length of time recommended by current guidelines. The authors' findings provide important data for future benchmarking and represent a significant opportunity for quality improvement in STEMI-related care and outcomes.
-
Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is considered as an effective technique to obtain cytology specimens for definite diagnosis of the patients who were suspected of having pancreatic cancer and unknown intra-abdominal lymphadenopathy. The value of repeated EUS-FNA in these patients who had inconclusive first EUS-FNA cytology is not well established. ⋯ Repeated EUS-FNA for inconclusive initial cytology of patients with suspected pancreatic cancer and unknown intra-abdominal lymphadenopathy provided a very high yield for definite tissue diagnosis and should be recommended.
-
The purpose of the present study was to determine the quality of analgesia of continuous thoracic paravertebral nerve block after thoracic surgery by inserting a catheter under direct vision and assessing complications related to the analgesia technique. ⋯ The use of continuous thoracic paravertebral blockade under direct vision technique offered satisfactory pain control and less complications. It could be considered as an alternative when thoracic epidural block is difficult to access.
-
Delirium, an acute decline in attention and cognition, is found to be a common life-threatening clinical syndrome among hospitalized older patients. However, there has been no study to date regarding prevalence and incidence of delirium in Thai older patients. ⋯ In conclusion, the prevalence of delirium among older patients admitted to general medical wards in the present study were alarmingly high. Meanwhile, the incidence of delirium was comparable to other studies. Obviously, it requires serious attention from physicians, nurses and hospital administrators. These findings may reflect the importance of delirium detection for proper management. To lower morbidity and mortality in older patients, effective preventive strategies of delirium should be implemented promptly during hospital admission.
-
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS TBNA) is performed by using special bronchoscope which has an ultrasound probe at its tip that could demonstrate lymph node outside the airway and allow for real time observation of transbronchial needle aspiration. The sensitivity and specificity of EBUS TBNA are high in many studies. However because of the high expense and special training required, the impact of this method on clinical practice guidelines (CPG) needs to be further evaluated. ⋯ EBUS TBNA has impact on CPG for assessment of mediastinal node in lung cancer and mediastinal lymphadenopathy patients.