Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Multicenter Study Clinical Trial
Ondansetron: prevention of nausea & vomiting in cisplatin based chemotherapy.
Ondansetron in the prophylaxis of Cisplatin-induced emesis and nausea. The 5-HT3 antagonist ondansetron clearly offers a new approach to the control of Cisplatin-induced emesis and has been evaluated in Thailand. To evaluate anti-emetic efficacy of ondansetron in the prevention of nausea and vomiting induced by Cisplatin containing cancer chemotherapy regimen, we carried out an open multicentre study from January 1991 to December 1992. ⋯ Complete response (complete control of emesis) was achieved in 60 per cent; major response (1-2 emetic episodes) was 13 per cent; minor response (3-5 emetic episodes) was 13 per cent; and failure (5+ emetic episodes) was 10 per cent. Side effects were very mild and not significant. We conclude that ondansetron is efficacious in protecting patients from Cisplatin induced emesis and nausea.
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During the period when the hospital ran out of cobra antivenom, 4 patients bitten by cobra with neuromuscular symptoms and respiratory depression were treated with artificial respiration. Complete recovery was noted within 36 to 72 hours. The data are interpreted to indicate the reversible binding of the venom to receptors. Artificial ventilation appears to be another alternative to specific antivenom treatment and may be used when the antivenom is not available or if there is antivenom hypersensitivity.
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Randomized Controlled Trial Clinical Trial
Laboratory investigation utilization in pediatric out-patient department Ramathibodi Hospital.
Laboratory investigations are inappropriately utilized in the Pediatric OPD of Ramathibodi Hospital and this is due to lack of knowledge and unawareness of the cost of tests. ⋯ 1. The utilization pattern was not correlated to the level of seniority of the physicians. 2. There was inappropriate laboratory utilization in this group of residents: overutilization defined as should not be ordered (26.9%), and underutilization defined as should have been ordered (17.7%). Most of the inappropriateness occurred in the ordering of microbiology (50%) and special blood chemistry (40%). 3. Only the number of tests per patient ordered by the R2I group was significantly lower than that of the R2C group in the late post-intervention period. The cost of tests per patient ordered by the R2C group was significantly increased as compared to their baseline. This suggested that the combination of education, chart audit and active feedback strategies was more effective than each strategy alone. 4. The appropriateness of the test ordering behavior of the resident intervention groups improved during the post-intervention period, although the change was not statistically significant. The control groups' behavior was statistically worse. This suggested that the strategy prevented the inappropriateness of test ordering behavior. 5. With the intervention, the overutilization significantly decreased while the underutilization increased. The underutilization might be a consequence of cost containment on laboratory utilization. 6. The cost of unnecessary tests accounted for 17.6 per cent of the total cost of tests ordered by the residents.
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A case of severe puffer fish poisoning was reported. After ingestion of puffer fish, symptoms develop rapidly with paralysis of the whole body, respiratory distress and nonreactive dilated pupils. After ventilatory support, the patient gradually recovered to normal activity within 48 hrs.