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Pungjitprapai A.,Charoenkrung Pracharak Hospital | Tantawichien T.,Chulalongkorn University
Southeast Asian Journal of Tropical Medicine and Public Health | Year: 2011

The purpose of this study was to evaluate the appropriate of restricted antibiotics at a tertiary care hospital in Bangkok, Thailand. Data from patient charts during September-November, 2009 were obtained regarding appropriate use of antibiotics following hospital antibiotic guidelines. Of 307 prescriptions reviewed, the prevalence of appropriate antibiotic use was 74.6% (229/307). Most patients were male (185/307) with a mean age of 64.2±18.0 years. There was a significant association between appropriate antibiotic use and patients having underlying disease, a previous history of recent antibiotic use, a recent hospitalization, admission to a medical unit and having a recent health-care institution acquired infection (p<0.001). The diagnosis of pneumonia was associated with proper use of antibiotics compared with other diagnoses (OR 1.8). Admission to a medical ward was more likely to be associated with correct antibiotic use than having surgery (OR 7.8 and 0.07). Having a health-care institution acquired infection more likely to be associated with appropriate antibiotic use than having a community acquired infection (OR 5.5 and 0.13). Meropenem was more likely to be used appropriately than cefoperazone/sulbactam (OR 1.9 and 0.2). After multivariate analysis, controlling confounding factors, admission to a medical unit and having a health-care institution acquired infection were factors associated with proper use of restricted antibiotics (adjusted OR 9.0 and 7.1; 95% CI 2.27-35.73 and 2.38-20.95; p=0.002 and p<0.001, respectively). The prevalence of appropriate use of restricted antibiotics was high; physicians followed local hospital antibiotic guidelines. Future studies of compliance with hospital antibiotic guidelines and its impact on bacterial resistance and infection related mortality should be carried out to determine if appropriate antimicrobial use leads to improve outcomes. Source


Dhippayom T.,Naresuan University | Chaiyakunapruk N.,Naresuan University | Chaiyakunapruk N.,University of Queensland | Chaiyakunapruk N.,University of Wisconsin - Madison | Jongchansittho T.,Charoenkrung Pracharak Hospital
Drug Safety | Year: 2011

Background: The limited use of nortriptyline for smoking cessation is likely due to concerns about its serious adverse effects. Objective: To examine the safety of nortriptyline at doses equivalent to those used in aiding smoking cessation. Data Sources: A systematic search of relevant articles inMEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, CINAHL, PsychINFO,WHO publications and the Clinical Trials database (through November 2008). Study Selection: All studies of nortriptyline at doses between 75 and 100mg in any indication were reviewed. Data Extraction: The quality of included studies was assessed based on the Jadad score. Data were extracted using a data extraction form. Data Synthesis: From 442 potentially relevant articles identified, 17 studies met our selection criteria and were included for data analysis. Indications for nortriptyline in these studies were smoking cessation (eight studies), depression (five studies), neuropathic pain (three studies) and schizophrenia (one study). 2885 individuals participated in these studies, with exposure time ranging between 4 and 12 weeks. The major comparator used in these trials was placebo. Overall, no life-threatening events occurred in these studies. Orthostatic hypotension was significantly higher in nortriptyline users than in comparator groups (relative risk 2.8; 95% CI 1.4, 5.3). Other adverse events significantly associated with nortriptyline were anticholinergic-related effects including drowsiness, dizziness, gastrointestinal disturbance and dysgeusia. Conclusions: Current evidence suggests that nortriptyline, at doses between 75 and 100 mg, is not significantly associated with serious adverse events when administered in patients without underlying cardiovascular disease. © 2011 Adis Data Information BV. All rights reserved. Source


Cheerranichanunth P.,Charoenkrung Pracharak Hospital | Poolnoi P.,Charoenkrung Pracharak Hospital
Journal of the Medical Association of Thailand | Year: 2012

Objective: To determine whether using pictogram can improve visual estimation of blood loss in a mock cesarean setting and whether profession and clinical experience influence the accuracy of blood loss estimation. Material and Method: Photographs of measured blood volume absorbed in different percentage of surface area of common surgical materials were taken and arranged in the table of pictogram. Pictures of seven cesarean scenarios were set with known blood volumes (20, 35, 60, 100, 350, 400, and 1200 ml) in different surgical materials. Forty-nine participants from four professions had to view all seven pictures and quantitatively estimate blood volume pre-post using the pictogram. Percent error of estimated blood loss was analyzed. Results: Before using the pictogram, tendency of underestimation, overestimation and accurate assessment in lower and higher blood loss volumes were 43.4%, 25.7%, and 30.9% respectively. There was a trend in overestimating blood loss at the lower volumes and underestimating or accurate estimating blood loss at higher volumes. Profession affected the accuracy in estimation of some small blood loss volumes but clinical experience had no influence. After using the pictogram, accurate estimation increased significantly from 30.9% to 61.8%. No difference in ability to determine blood loss in all professions and clinical experience. Conclusion: Estimated blood loss pictogram is a simple tool, easy to use for initial evaluation of blood loss in cesareans and can improve the accuracy of visual blood loss assessment significantly. Source


Sripahol P.,Charoenkrung Pracharak Hospital | Niyomnaitham S.,Mahidol University | Huang K.-G.,Chang Gung University
Journal of Gynecologic Surgery | Year: 2015

Background: Abnormal findings of intra-abdominal organs can be examined during a laparoscopic surgery. Studies show that 4.7% of patients who underwent laparoscopic surgery for benign gynecologic conditions had liver abnormalities, such as perihepatic adhesion (Fitz-Hugh-Curtis syndrome), adenoma, hemangioma, and hepatic cirrhosis. Case: A 44-year-old woman, para3, presented with abnormal Pap smears and classified as cervical intraepithelial neoplasia (CIN) III. She was scheduled for laparoscopic-assisted vaginal hysterectomy. Her preoperative laboratory tests were within normal limit except for the reactive result of HBsAg. Intraoperative findings revealed a normal-sized liver with a nodular surface (Fig. 1a). Liver cirrhosis was suspected and subsequently diagnosed by the gastroenterologist. Conclusion: Abnormality of intra-abdominal organs can be detected during a laparoscopic surgery for a gynecologic condition, especially in the upper abdomen. © Copyright 2015, Mary Ann Liebert, Inc. 2015. Source


Ratchaworapong K.,Charoenkrung Pracharak Hospital | Thanawut S.,Charoenkrung Pracharak Hospital | Yodavudh S.,Charoenkrung Pracharak Hospital | Chottanapund S.,Bamrasnaradura Infectious Diseases Institute
Asian Biomedicine | Year: 2014

Background: The sentinel lymph node (SLN) is the first lymph node to receive lymphatic drainage from a primary breast tumor. If the SLN contains no metastatic tumor, then it is unlikely other lymph nodes will contain breast cancer metastasis. When the SLN does contains metastasis, an axillary lymph node dissection (ALND) is recommended to further stage the axilla and to maintain locoregional control. SLNs can be identified by using a dye, radioisotope, or combined techniques. Asian BiomedicineObjective: To determine the rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital, Thailand, and factors that affect it.Methods: This prospective study of 106 consecutive cases breast cancer enrolled 105 women (1 bilateral breast cancer case) between October 2011 and October 2013 at Charoenkrung Pracharak Hospital. Clinical and pathological features were analyzed for the effectiveness of SLN identification using isosulfan blue dye.Results: The rate of SLN identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital was 92%. The method was safe and well tolerated in early-stage breast cancer patients.Conclusion: The effectiveness of sentinel node identification using isosulfan blue dye in breast cancer patients at Charoenkrung Pracharak Hospital is consistent with that shown in studies from other countries. © 2013 is published by the Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Source

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