Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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To determine functional outcome after decompressive laminectomy and instrumented arthrodesis in patients with degenerative lumbar spinal stenosis and identify predictors of failed clinical outcome in these patients. ⋯ Decompression and instrumented arthrodesis in degenerative lumbar spinal stenosis gained satisfactory functional outcome. Older age, prolonged onset and long level of instrumentation were the factors of failed clinical outcome change.
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Randomized Controlled Trial
Effect of intramuscular diclofenac after explore laparotomy for gynecologic surgery: a randomized double-blinded placebo controlled trial.
Several adjuvant analgesic agents proposed to treat the postoperative pain while reducing the doses of opioid and its derivatives. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used in several operative procedures. The present study aimed to demonstrate the morphine-sparing effects of single-dose intramuscular diclofenac sodium in explore laparotomy gynecologic surgery. ⋯ The present study demonstrated that single dose of diclofenac sodium has morphine-sparing effects and can be safely used in explore laparotomy gynecologic surgery without significant adverse effects.
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Randomized Controlled Trial
Effect of polyethylene bag to prevent heat loss in preterm infants at birth: a randomized controlled trial.
Hypothermia at birth has been associated with increased morbidity and mortality in preterm infants. ⋯ Polyethylene bag prevents heat loss at delivery in preterm infant less than 32 weeks gestation. Incidence of hypothermia was significantly reduced by use of polyethylene bag, a simple and inexpensive intervention.
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Case Reports
Pierre Robin sequence: challenges in the evaluation, management and the role of early distraction osteogenesis.
The challenges for the management of Pierre Robin Sequence (PRS) are the evaluation and management of airway and feeding difficulty from glossoptosis and associated cleft palate. ⋯ Primary management of airway insufficiency in patients with PRS can be managed in a prone position with or without nasopharyngeal airway, prolonged intubation, tongue-lip adhesion, mandibular distraction osteogenesis and tracheostomy. The present study confirmed that proper conservative management can be used to manage most of the patients with PRS. However, early mandibular distraction should be considered when (a) indicated in patients with respiratory insufficiency to avoid tracheostomies or (b) successfully decannulating tracheostomies. Interdisciplinary team management is needed to ensure proper evaluation, improve care and optimum outcome.
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Auditing the return visit charts of patients who returned within 48 hours is a very important method of quality assurance. Several factors can be possible causes of unscheduled emergency return visits. Therefore, identifying these factors is critical to decreasing the number of unnecessary visits in this group. ⋯ Unscheduled ED return visit patients represent high risk patients. Patients in this group are associated with various factors. The present study indicates that the most common factor behind return visits were illness-related. Illness-related and patient-related factors were significantly associated with discharged patient. Observational units could reduce unnecessary return visit in this group. Doctor-related and healthcare-related factors were significantly associated with admitted return visit patients. Emergency physician training system and guideline implementation for doctors could reduce unexpected early discharge in this group.