Papers by Yuwares Sittichanbuncha
The Southeast Asian Journal of Tropical Medicine and Public Health, Sep 1, 2014
Courses of post-exposure rabies vaccination in clinical practice are often not administered compl... more Courses of post-exposure rabies vaccination in clinical practice are often not administered completely. If suspected animals are still alive after 10 days of observation, full post-exposure vaccination will usually be withheld from bite victims. In this study, we compared the cost differences between complete and incomplete courses of post-exposure rabies vaccination. The cost calculations were based on the principle that all patients will have at least one more animal bite in the future. Costs were compared between patients who received post-exposure rabies vaccination and if they completed or did not complete the vaccine regimen. In this study, 46.7% of 372 patients completed the full course of five doses of the rabies vaccine. Based on the study rationale, complete vaccination would save nation budget 224,700 Baht for WHO wound category 2, 801,474 Baht for WHO wound category 3 with equine rabies immunoglobulin treatment, and 2,618,916 Baht for WHO wound category 3 with human rabies immunoglobulin treatment. Physicians should encourage complete courses of post-exposure rabies vaccination to save further costs from animal bites in the future.
Thammasat Medical Journal, 2013
Therapeutics and Clinical Risk Management, 2015
High-sensitivity troponin T (HS Trop T) plays an important role as a diagnostic marker for acute ... more High-sensitivity troponin T (HS Trop T) plays an important role as a diagnostic marker for acute coronary syndrome. It is also related to cardiovascular outcomes. HS Trop T levels may be varied in individuals with renal dysfunction. This study aimed to find the appropriate HS Trop T cutoff points in chronic kidney disease (CKD) patients who had coronary artery occlusion. The study was conducted at the Emergency Department, Ramathibodi Hospital, Mahidol University, Thailand. CKD patients stage 3-5 who had HS Trop T levels after 2 hours of chest pain and had coronary angiographic results were enrolled. Patients were divided into two groups: those who had significant occlusion of more than 70% of a coronary artery as the coronary artery disease (CAD) group and the non-CAD group. In total, 210 patients met the study criteria. There were 132 patients (62.86%) who had significant stenosis of coronary arteries by coronary angiograms. The average age (standard deviation) of all patients was 71.02 (9.49) years. HS Trop T levels were significantly higher in all CKD patients with CAD than the non-CAD group (0.4973 versus 0.0384 ng/mL). Sex and HS Trop T levels were significantly associated with CAD by multivariate logistic regression analysis. The HS Trop T level of 0.041 ng/mL gave sensitivity and specificity of 65.91% and 75.65%, respectively, for CAD. The HS Trop T level of 0.041 ng/mL provided diagnostic properties for established coronary artery occlusion in CKD patients.
Turkish Journal of Emergency Medicine, 2015
Emergency Medicine International, 2015
Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenti... more Background. To differentiate acute coronary syndrome (ACS) from other causes in patients presenting with chest pain at the emergency department (ED) is crucial and can be performed by the nurse triage. We evaluated the effectiveness of the ED nurse triage for ACS of the tertiary care hospital. Methods. We retrospectively enrolled consecutive patients who were identified as ACS at risk patients by the ED nurse triage. Patients were categorized as ACS and non-ACS group by the final diagnosis. Multivariate logistic analysis was used to predict factors associated with ACS. An online model predictive of ACS for the ED nurse triage was constructed. Results. There were 175 patients who met the study criteria. Of those, 28 patients (16.0%) were diagnosed with ACS. Patients with diabetes, patients with previous history of CAD, and those who had at least one character of ACS chest pain were independently associated with having ACS by multivariate logistic regression. The adjusted odds ratios (95% confidence interval) were 4.
Asian Pacific journal of allergy and immunology / launched by the Allergy and Immunology Society of Thailand, 2015
Anaphylaxis is an emergency condition and may be fatal. Approximately 20% of patients with anaphy... more Anaphylaxis is an emergency condition and may be fatal. Approximately 20% of patients with anaphylaxis may develop recurrent episodes of anaphylaxis within 72 hours or biphasic anaphylaxis. The severity of biphasic anaphylaxis can be either more or less severe than the first episode. Knowledge of factors associated with biphasic anaphylaxis in particular in Asian populations is still limited. To study predictors for biphasic anaphylaxis in Thai patients at the Emergency Department (ED). All consecutive patients diagnosed as anaphylaxis at the ED, Ramathibodi Hospital, Mahidol University, Bangkok were enrolled. The study was prospectively conducted from January to December 2011. Patients were divided into two groups; uniphasic and biphasic anaphylaxis. Multivariate logistic regression was used to identify factors associated with biphasic anaphylaxis. During the study period, there were 63 patients diagnosed with anaphylaxis at the ED. Of those, 16 patients were excluded due to or tre...
Journal of the Medical Association of Thailand = Chotmaihet thangphaet, 2014
Emergency medical services (EMS) in Thailand have been established for more than 20 years. Howeve... more Emergency medical services (EMS) in Thailand have been established for more than 20 years. However evaluation of EMS is limited The present study aimed to determine providers 'perspectives on EMS in Thailand The present study was conducted at the tenth Academic Annual Meeting of Emergency Medicine between February 9 and 13, 2009 at Rajavithi Hospital, Bangkok. All participants at the meeting were eligible and randomly selected for the survey Subjects were physicians, nurses, or paramedics who worked in Emergency Department/Room at hospitals in Thailand. The survey was performed by self-rated questionnaire. Four hundred fifty questionnaires were distributed and 425 were returned completed (94.4%). Of those, 365 subjects (85.9%) were female, 359 (84.5%) were nurses, 103 (24.5%) worked at the ER for more than 10 years, and 284 (67.6%) worked at the community hospitals. The most three common issues of EMS system were insufficient medical personnel, insufficient medical devices, and ...
The Southeast Asian journal of tropical medicine and public health, 2014
Courses of post-exposure rabies vaccination in clinical practice are often not administered compl... more Courses of post-exposure rabies vaccination in clinical practice are often not administered completely. If suspected animals are still alive after 10 days of observation, full post-exposure vaccination will usually be withheld from bite victims. In this study, we compared the cost differences between complete and incomplete courses of post-exposure rabies vaccination. The cost calculations were based on the principle that all patients will have at least one more animal bite in the future. Costs were compared between patients who received post-exposure rabies vaccination and if they completed or did not complete the vaccine regimen. In this study, 46.7% of 372 patients completed the full course of five doses of the rabies vaccine. Based on the study rationale, complete vaccination would save nation budget 224,700 Baht for WHO wound category 2, 801,474 Baht for WHO wound category 3 with equine rabies immunoglobulin treatment, and 2,618,916 Baht for WHO wound category 3 with human rabi...
Gastroenterology Research and Practice, 2013
Hematochezia is one of common gastrointestinal complaint at the Emergency Department (ED). Causes... more Hematochezia is one of common gastrointestinal complaint at the Emergency Department (ED). Causes may be due to upper (UGIB) or lower (LGIB) gastrointestinal tract bleeding. Here, clinical factors were studied to differentiate sites of bleeding in patients with hematochezia. All patients with an age of more than 18 years who were diagnosed with GIB at the ED, Ramathibodi Hospital, Thailand were enrolled. Patients who presented with hematochezia and received complete workups to identify causes of bleeding were studied and categorized as being in the UGIB or LGIB groups. There were 1,854 patients who presented with GIB at the ED. Of those, 76 patients presented with hematochezia; 30 patients were in the UGIB group, while 43 patients were in the LGIB group. Clinical variables between both groups were mostly comparable. Three clinical factors were significantly associated with UGIB causes in patients with hematochezia including systolic blood pressure, hematocrit level, and BUN/Cr ratio. The adjusted odds ratios for all three factors were 0.725 (per 5 mmHg increase), 0.751 (per 3% increase), and 1.11 (per unit increase). Physicians at the ED could use these clinical factors as a guide for further investigation in patients who presented with hematochezia.
Advances in Medical Education and Practice, 2015
There are different teaching methods; such as traditional lectures, bedside teaching, and worksho... more There are different teaching methods; such as traditional lectures, bedside teaching, and workshops for clinical medical clerkships. Each method has advantages and disadvantages in different situations. Emergency Medicine (EM) focuses on emergency medical conditions and deals with several emergency procedures. This study aimed to compare traditional teaching methods with teaching methods involving workshops in the EM setting for medical students. Fifth year medical students (academic year of 2010) at Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand participated in the study. Half of students received traditional teaching, including lectures and bedside teaching, while the other half received traditional teaching plus three workshops, namely, airway workshop, trauma workshop, and emergency medical services workshop. Student evaluations at the end of the clerkship were recorded. The evaluation form included overall satisfaction, satisfaction in overall teaching methods, and satisfaction in each teaching method. During the academic year 2010, there were 189 students who attended the EM rotation. Of those, 77 students (40.74%) were in the traditional EM curriculum, while 112 students were in the new EM curriculum. The average satisfaction score in teaching method of the new EM curriculum group was higher than the traditional EM curriculum group (4.54 versus 4.07, P-value <0.001). The top three highest average satisfaction scores in the new EM curriculum group were trauma workshop, bedside teaching, and emergency medical services workshop. The mean (standard deviation) satisfaction scores of those three teaching methods were 4.70 (0.50), 4.63 (0.58), and 4.60 (0.55), respectively. Teaching EM with workshops improved student satisfaction in EM education for medical students.
Critical Care, 2014
The aim of this study was to conduct a systematic review and meta-analysis for determining the ef... more The aim of this study was to conduct a systematic review and meta-analysis for determining the effects of prehospital adrenaline administration on return of spontaneous circulation, hospital admission, survival to discharge and discharge with cerebral performance category 1 or 2 in out-of-hospital cardiac arrest patients. MEDLINE and Scopus databases were searched to identify studies reported to March 2014. Study selection and data extraction were independently completed by two reviewers (PA and SR). The baseline characteristics of each study and number of events were extracted. Risk ratios (RR) and 95% confidence interval (CI) were estimated. Heterogeneity and publication bias were also explored. In total 15 studies were eligible and included in the study. Of 13 adult observational studies, four to eight studies were pooled for each outcome. These yielded a total sample size that ranged from 2,381 to 421,459. A random effects model suggested that patients receiving prehospital adrenaline were 2.89 times (95% CI: 2.36, 3.54) more likely to achieve prehospital return of spontaneous circulation than those not administered adrenaline. However, there were no significant effects on overall return of spontaneous circulation (RR = 0.93, 95% CI: 0.5, 1.74), admission (RR = 1.05, 95% CI: 0.80, 1.38) and survival to discharge (RR = 0.69, 95% CI: 0.48, 1.00). Prehospital adrenaline administration may increase prehospital return of spontaneous circulation, but it does not improve overall rates of return of spontaneous circulation, hospital admission and survival to discharge.
Journal of Neuroimaging, 2012
Delays between hospital arrival and neuroimaging prevented patients from receiving thrombolysis. ... more Delays between hospital arrival and neuroimaging prevented patients from receiving thrombolysis. We report impact of Stroke Fast Track (SFT) on time to imaging, and rates of recombinant tissue plasminogen activator (rt-PA) in eligible patients. Characteristics, time intervals, and rates of rt-PA were evaluated in 464 patients with suspected acute stroke within 7 days (2005-2006). Complete time intervals were available on 380. Median times between emergency room arrival, brain computerized tomography (CT), and CT results were 25 and 45 minutes, respectively, for patients arriving <3 hours from onset, 40, and 65 minutes for those arriving >3 hours, and 35 and 60 minutes for all patients, which is significantly shorter than 2.5 hours to CT in 2004, prior to SFT (P < .0001). Although not different in time to first physician, patients arriving >3 hours had longer times to CT and CT results (P < .001). Overall, 5.5% of ischemic stroke patients received intravenous rt-PA, including 27.1% of those arriving within 3 hours, which represented 100% of all eligible patients, compared with 0% in 2004. SFT reduced time delay in neuroimaging and increased use of rt-PA in Thailand. Continuous quality improvement is needed to achieve best results in each setting, and to insure optimal care for acute stroke patients.
Sudden cardiac arrest is a common emergency condition found in the emergency department of the ho... more Sudden cardiac arrest is a common emergency condition found in the emergency department of the hospital. The survival rate of out-of-hospital cardiac arrest patients is 2.0%-10.0% and 7.4%-27.0% percent for in-hospital cardiac arrest patients. The factors for survival outcome are divided into three main groups: patient characteristics, pre-hospital factors, and resuscitated information. The objective of this study was to evaluate the related factors, outcome, and survival rate in patients with cardiac arrest who received cardiopulmonary resuscitation (CPR) at Ramathibodi Emergency Medicine Department. There are limited data for this issue in Thailand and other Asian countries. This retrospective study included all patients who were older than 15 years with sudden cardiac arrest and who were resuscitated in the emergency room between January 2005 and December 2010. Descriptive analytic statistics and logistic regressions were used to analyze factors that related to the sustained return of spontaneous circulation (ROSC) and survival at discharge. There were 181 patients enrolled. The overall sustained ROSC rate was 34.8% and the survival rate at discharge was 11.1%. There were 145 out-of-hospital cardiac arrest patients, in whom the survival rate was 52.4% and the survival to discharge rate was 7.6%. For inhospital cardiac arrest, there were 36 patients with a survival rate of 86.1% and the survival to discharge rate was 25.0%. Statistically significant factors related to sustained ROSC were good and moderate cerebral performance, in-hospital cardiac arrest, beginning of CPR in less than 30 minutes, and cardiopulmonary cause of arrest. The factors influencing survival to discharge were cardiopulmonary causes of cardiac arrest. Factors associated with sustained ROSC were functional status before cardiac arrest, location of cardiac arrest, duration of CPR, and cause of cardiac arrest. Survival rate was related to the cause of cardiac arrest.
Emergency Medicine International, 2014
Background. Overcrowding in the emergency department (ED) is a significant public health problem ... more Background. Overcrowding in the emergency department (ED) is a significant public health problem in the US, Europe, and Asia. Factors associated with prolonged length of stay in Thailand are still limited. Methods. This study was conducted at the ED, Ramathibodi Hospital, Mahidol University, Thailand, during July 2011. We selected 300 patients (5.77%) from a total of 5,202 who visited the ED during the study period by simple random sampling. Charts were retrospectively reviewed baseline characteristics, clinical factors, and duration of ED stay. Multivariate logistic regression analyses were performed to identify independent factors for an ED stay more than or equal to 8 hours. Results. We excluded 33 patients (11%) due to incomplete data or stroke fast track enrollment. In total, 267 patients were in the analysis and 53 patients (19.85%) had an ED visit time more than or equal to 8 hours. The number of rounds of blood testing and the type of insurance were associated with prolonged ED stay of more than or equal to 8 hours. Conclusion. ED physicians may need to consider appropriate investigations to shorten the length of stay in the ED.
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Papers by Yuwares Sittichanbuncha