(PMJCS) Phrae Medical Journal and Clinical Sciences

The Incidence and Associated Factors of Metformin-associated lactic acidosis ( MALA ) in patients with type 2 Diabetes Mellitus

2025-08-18T09:20:31+07:00

Background: Metformin is the first-line treatment for type 2 diabetes. Although generally safe, it carries a risk of metformin-associated lactic acidosis (MALA), a rare but serious condition. Understanding the incidence and risk factors of MALA in patients using Metformin are vital to establish appropriate medication guidelines and to prevent MALA

Objective: To examine the incidence and factors associated with MALA in patients with type 2 diabetes

Study design: A retrospective case-control study on patients with type 2 diabetes receiving Metformin and diagnosed with lactic acidosis at Phrae Hospital from January 1, 2020, to June 30, 2023

Results: The incidence of MALA from Metformin use was 0.35 (350 per 100,000 cases). Patients with underlying diseases had a higher risk of MALA, including liver disease (AOR=4.53;95%CI=1.81-11.81), chronic heart failure (AOR=5.26;95%CI=3.24-8.55), and chronic obstructive pulmonary disease (AOR=5.06;95%CI=1.53-16.67). eGFR < 60 ml/min/1.73m² increased the risk by 4.08 times, while eGFR < 45 ml/min/1.73m² raised it by 8.60 times. MALA patients with pneumonia had a 3.33 times higher risk of death, and lactate levels ≥10 mmol/L increased the mortality risk by 3.06 times

Conclusion: The incidence of MALA in Phrae hospital is 350 cases per 100,000 population. Regular monitoring of diabetic patients taking metformin with underlying diseases or impaired kidney function have a higher risk of MALA. Lactate levels and eGFR, along with appropriate dosage adjustments, can help reduce the risk of MALA-related mortality

Keywords: Metformin, Metformin-associated lactic acidosis (MALA), Type 2 diabetes, Incidence, Risk facter

Effects of cold compress application to the uterus in combination with standard postpartum care on blood loss in normal parturients

2025-10-31T12:12:22+07:00

Background: According to the maternal mortality report, early postpartum hemorrhage is the leading cause of maternal death.

Objective: To compare the amount of blood loss after the placenta delivery in the first 2 hours between the experimental and control groups.

Study design: A quasi-experimental research with a two-group post-test design. The samples were randomly assigned to the experimental group, which were women who received uterine massage immediately after the placenta delivery and then applied cold compresses to the uterus for 5 minutes until 2 hours after delivery, and the control group, which were women who received standard care, with 17 patients per group. Data were collected using a maternal blood loss record form after delivery. General data were analyzed using descriptive statistics and the mean blood loss was compared using the independent t-test.

Results: The experimental and control groups did not differ in general data and delivery-related information. The experimental group had significantly lower mean blood loss in the first 2 hours after the placenta delivery than the control group (p<.001).

Conclusion: In normal delivery, after the first 2 hours after the placenta delivery, uterine massage after the placenta delivery combined with applying cold compresses to the uterus reduced the amount of blood loss in the mother after delivery.

Keywords: Cold compress, Uterine massage, Postpartum hemorrhage

Effect of Pharmaceutical Care in Outpatient Patients Receiving Warfarin, Pasang Hospital, Lamphun Province

2025-08-20T11:00:35+07:00

Background: Warfarin is a high alert drug. Its use must be done with caution and with monitoring of treatment efficacy and safety.

Objective: To compare international normalized ratio (INR), adverse drug reaction of warfarin, knowledge about warfarin and behavior of patients taking warfarin.

Study design: This is a quasi-experimental research. The sample group is 87 patients who received warfarin at the warfarin clinic, Pa Sang Hospital, Lamphun Province, between February 1, 2025 and April 30, 2025. The research instrument was a pharmaceutical care program for outpatients receiving warfarin. Data collection tools included a patient personal and health record form, a knowledge assessment form, and a behavior assessment form for patients taking warfarin. Data analysis used descriptive statistics, including frequency, percentage, mean, standard deviation, and inferential statistics, including: McNemar test and Paired samples t-test.

Results: The study results found that after receiving pharmaceutical care, patients receiving warfarin had a statistically significant increase in INR values within the treatment target range, from 40.2 percent to 82.8 percent. (p<0.001). The incidence of adverse drug reaction from warfarin was significantly reduced from 16.1% to 4.6% (p<0.05). The patients' knowledge score increased from 7.93±3.78 to 12.23±2.64 (total score 15) and their average behavior increased from 2.30±0.35 to 2.94±0.21 (total score 3) with statistical significance (p<0.05).

Conclusions: Pharmaceutical care in outpatients receiving warfarin helps patients control INR, reduce adverse drug reaction, and improve patient knowledge and behavior.

Keywords: Pharmaceutical care, Outpatient Patients, Warfarin

Factors associated with Major errors in Death certification practice at Phrae hospital

2025-09-01T09:08:35+07:00

Background: Mortality statistics derived from death certificates are a crucial indicator used as basic data for planning public health policies. However, the quality of death certificates in most countries remains poor. There are serious errors that affect the reliability of mortality statistics, and studies on factors associated with errors are limited

Objective: To evaluate errors in death certificates and the factors associated with major errors.

Study design: Data from 1,396 death certificates recorded by doctors at Phrae hospital between January 1, 2023 and December 31, 2023 were retrospectively evaluated for major and minor errors. Then, all death certificates were divided into a major error group (ME) and a non-major error group (Non-ME) base on the World Health Organization (WHO) standards, and analyzed using multivariable risk ratio regression to identify factor associated with major error.

Result: The study found 88.3% errors in all death certificates, which is a major error (ME) of 32.2%. The Most common major error is misdiagnosis of the underlying cause of death (22.1%). The Most common minor is no time of event (77.8%). Factors associated with ME are department, age and the experience of the physician. The Medicine department, interns and 41-50 year-old physicians increased the risk for ME.

Conclusion: The quality of death certification in Thailand is still poor, with a high rate of errors identified. Further training programs for young physicians are needed. Additionally, the implementation of audit and autopsy system is recommended to improve the quality of death certification in Thailand.

Keywords: Death certification, Major errors, Mortality statistics, Associated factor

Prevalence and Associated Factors of the Cervical Ossification of the Posterior Longitudinal Ligament in Patient with Cervical Spine Problem, Phrae Province, Thailand

2026-01-06T09:23:27+07:00

Background: Ossification of the Posterior Longitudinal Ligament (OPLL) in the cervical spine is a condition that may lead to spinal cord compression and neurological dysfunction. Despite its clinical significance, epidemiological data on OPLL in Thailand, particularly in rural areas like Phrae Province, remain limited.

Objective: To investigate the prevalence and associated factors of the cervical ossification of the posterior longitudinal ligament in patient with cervical spine problem in Phrae Province, Thailand.

Study design: This descriptive cross-sectional study reviewed medical records of 219 patients who attended the orthopedic clinic at Phrae Hospital between 2020 and 2024. Patients were selected using systematic sampling. Descriptive statistics, chi-square tests, and logistic regression analysis were employed.

Results: Study results: The prevalence of cervical OPLL was found to be 34.7%, with the Segmental type being the most common. Predictive factors for cervical OPLL included numbness of the upper extremities, which increased the risk by 27.79 times (95% CI=[4.27–180.93], p=0.001); motor weakness of the shoulder, which increased the risk by 16.93 times (95% CI=[1.63–176.09], p=0.018); and cervical canal stenosis, which increased the risk by 123 times (95% CI=[10.52–1437.76], p<0.000). These three predictive factors could explain 78.3% of the likelihood of developing cervical spine OPLL.

Conclusion: The prevalence of cervical OPLL is at a level that warrants attention, particularly among individuals with upper extremity numbness, shoulder muscle weakness, and cervical canal stenosis. Timely diagnosis and treatment upon the onset of symptoms are therefore crucial.

Keywords: Cervical OPLL, Prevalence, Associated Factors

Factors Affecting Motivation of Support Staff in Phrae Hospital

2026-01-21T15:19:45+07:00

Background: Support staff at Phrae Hospital play a crucial role in driving the organization forward. However, there is a lack of studies regarding the factors influencing their work motivation, which is essential for developing specific and effective administrative policies.

Objective: To study the level of motivation and the factors affecting the performance of support staff in Phrae Hospital.

Study design: This study was cross-sectional analytical research conducted among 121 support staff members. The research instrument was a questionnaire covering personal information, motivator factors, and hygiene factors. Data were analyzed using descriptive statistics and multivariable logistic regression analysis.

Result: The majority of the sample were female (58.68%). Overall work motivation was found to be at a high level. Multivariable analysis revealed that education level was a significant supporting factor; individuals with an education higher than a bachelor's degree were 4.32 times more likely to have high work motivation compared to those with lower education (AOR=4.32, 95% CI: 1.12–16.65, p=0.034). In contrast, duration of work was identified as a preventive factor; for every additional year of service, the likelihood of maintaining high work motivation decreased to 0.91 times, or a 9% reduction per year (AOR=0.91, 95% CI: 0.85–0.98, p=0.012).

Conclusion: Management should prioritize supporting continuous education and implementing job rotation to reduce routine boredom and burnout among long-tenured staff, thereby sustaining organizational motivation and efficiency.

Keywords: Work motivation, Motivator factors, Hygiene factors, Support personnel, Phrae Hospital

Effects of a Self-Management Program on Health Behaviors of Patients with Uncontrolled Hypertension at Ban-Thi Hospital

2025-10-31T10:09:32+07:00

Background: Promoting self-management in hypertensive patients will help them take care of themselves and control their blood pressure.

Objective: To compare health behaviors and blood pressure levels before and after receiving the self-management promotion program for patients with uncontrolled hypertension between the experimental group and the control group.

Study design: It is a quasi-experimental research. The sample consisted of hypertensive patients who received treatment at the hypertension clinic at Ban-Thi Hospital between between February 5, 2025 and April 30, 2025. They were divided into two groups: an experimental group of 30 people and a control group of 30 people. The research instrument used was a self-management promotion program for hypertensive patients. Data collection tools included a general information questionnaire and a health behavior questionnaire for hypertensive patients. Data analysis used descriptive statistics including frequency, percentage, mean, and standard deviation. And inferential statistics include: Independent t-test.

Results: The study results found that after receiving the program, the experimental group had significantly better behaviors in terms of taking medication, eating, exercising, stress relief, avoiding risk factors, and attending check-ups than the control group (p<0.05). And the experimental group was able to control blood pressure levels to be within the normal range significantly better than the control group (p<0.05).

Conclusions: This self-management program for patients with uncontrolled hypertension promotes healthy behaviors and helps patients effectively control their blood pressure levels.

Keywords: Self-Management, Health Behaviors, Hypertension

The Effects of Applying the Emergency Severity Index (ESI) Triage Guideline in the Emergency Department, Phrae Hospital

2025-10-28T16:08:23+07:00

Background: Triage based on the severity of emergency cases in the Emergency department is a crucial aspect of providing fast, accurate, and safe healthcare

Objective: To study the effects of using the Emergency Severity Index (ESI) for patient triage and to evaluate the satisfaction of professional nurses with the new guideline in the emergency department of Phrae Hospital.

Study design: This was a quasi-experimental research study. The sample group consisted of: 1) 906 patients who visited the emergency department at Phrae Hospital between June 2025 and August 2025. They were divided into a control group (using the original triage method) of 453 people and an experimental group (using the new guideline) of 453 people. 2) 19 professional nurses working in the emergency department at Phrae Hospital. The tools used in the experiment were the Emergency Severity Index (ESI) triage guideline for Phrae Hospital's emergency department, a patient triage record form at the triage point, and a professional nurse satisfaction evaluation form. Data were analyzed using descriptive statistics (frequency, percentage, mean, standard deviation) and inferential statistics (Chi-Square test and t-test) with a statistical significance level set at 0.05.

Results: The study found that the accuracy of patient triage increased with statistical significance. Both under triage and over triage decreased. The waiting time for patients in Category 1 (Resuscitation) and Category 2 (Emergency) was reduced with statistical significance (p<0.05). The rate of patient deterioration decreased from 0.88% to 0.22% after using the new guideline, although this was not statistically significant. Professional nurses reported a high level of satisfaction with the guideline in all aspects.

Conclusions: The implementation of the Emergency Severity Index (ESI) for patient triage helps to increase triage accuracy, reduce waiting times, and decrease the risk of patient deterioration. It also enhances the efficiency of medical resource management.

Keywords: Patient triage, Emergency Severity Index, Emergency department

Prevalence of Eosinophilic Asthma and Its Association with Severe Asthma Exacerbations in Children Admitted to the Pediatric Ward of Phrae Hospital

2025-12-22T08:22:46+07:00

Background: Asthma is a chronic inflammatory disease of the airways involves multiple inflammatory cells. Asthma patients are also more sensitive to various stimuli than those without asthma, leading to bronchospasm and difficulty breathing. Symptoms can range from mild to life-threatening. While asthma is not curable, it can be effectively controlled. However, studies on pediatric eosinophilic asthma in Thailand remain limited.

Objective: To study the prevalence of asthma based on eosinophil levels in children aged 1-15 years admitted to the pediatric ward at Phrae Hospital and to examine the relationship between eosinophils and severe asthma exacerbations in this population.

Study design: This retrospective cohort study. Collected data from medical records and electronic medical record of pediatric patients aged 1–15 years who were diagnosed with asthma and admitted at Phrae Hospital between January 2020 and December 2024, Descriptive statistics were used to describe general characteristics among participants using frequency statistics, percentages, means, and standard deviations, and analyzing the relationship between eosinophilic asthma and severe asthma exacerbations were analyzed using Pearson's correlation coefficient and Chi-Square test.

Result: From a total of 97 participants, the study found that there were 68% of all participants who had eosinophilic asthma. The group with Eosinophil counts >300 cells/µL was the most common. Analysis show that the relationship between eosinophilic asthma and severe exacerbations within the past 12 months, peripheral oxygen saturation (SpO₂,%), treatment location, oxygen administration, and medications used to control asthma were not significantly associated with eosinophilic asthma in children (p>0.05). However, the relationship between the duration of hospital stay and respiratory rate showed a moderate positive correlation (r=0.439, p<0.001)

Conclusion: This study found a high prevalence (68%) of eosinophilic asthma among children in Phrae Province. Although no statistically associations were observed. Patients with high eosinophil levels tended to have higher risk of hypoxia and ICU admission. Therefore, close monitoring and development of management guidelines for this patient group should be recommended.

Keyword: Eosinophilic Asthma, Severe Asthma Exacerbations

Effective of Coaching on Self-Care of Caregiver of Neonatal Jaundice upon Discharge at the Pediatrics Department, Lamphun Hospital, Lamphun Province

2025-12-08T10:07:53+07:00

Background: Neonatal jaundice is a major health problem that affects newborn development.

Objective: To compare the average knowledge scores, Ability score in caring for newborns with neonatal jaundice before and after coaching and follow up on the results of coaching caregivers of newborns with neonatal jaundice on the rate of Readmit for neonatal jaundice upon discharge from Lamphun Hospital.

Study design: This is a quasi-experimental research. The sample consisted of 30 mothers of newborns diagnosed by doctors with neonatal jaundice who received phototherapy treatment in the Pediatrics Department of Lamphun Hospital between December 1, 2024, and April 30, 2025. The research tools used include coaching activities for caring for newborns with neonatal jaundice. Data collection tools included maternal and newborn data forms, knowledge assessment forms, competency assessment forms, and records of bilirubin levels and Readmit for neonatal jaundice. Data analysis used descriptive statistics including frequency, percentage, mean, standard deviation and inferential statistics including: Paired samples t-test.

Reults: After coaching the mothers caring for newborns, their knowledge and ability to care for newborns with neonatal jaundice significantly increased (p<0.05). The bilirubin levels of newborns with jaundice improved significantly (p<0.05). And found a rate of Readmit with neonatal jaundice 3.3%.

Conclusions: Coaching improves knowledge and skills in caring for newborns with neonatal jaundice, leading to better health outcomes for newborns and reduced Readmit.

Keywords: Coaching, Neonatal Jaundice, Caregiver