Download Royal Thai Air Force Medical Gazette 25 Vol. 61 No. 1 January

Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 25
26 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
สาส์นเจ้ากรมแพทย์ทหารอากาศ
ในการเป็ นประธานพิธีเปิ ดการประชุมวิชาการทางการแพทย์
ประจําปี
ครังที
ในวันพุธที - วันพฤหัสบดีที มีนาคม
ณ ห้องประชุม พลอากาศเอกประพันธ์ ธูปะเตมีย ์ ชัน อาคาร “คุม้ เกล้าฯ”
ผมมีความยินดีเป็ นอย่างยิง ทีได้มาเป็ นประธานเปิ ดการประชุมวิชาการทางการแพทย์ ประจําปี
ครังที ของ
โรงพยาบาลภูมพิ ลอดุลยเดช กรมแพทย์ทหารอากาศ ในวันนี
ปี
นับเป็ นปี ทสํี าคัญยิงของภูมภิ าคเอเชียตะวันออกเฉียงใต้ เพราะเรากําลังจะก้าวเข้าสู่การเป็ นประชาคมอาเซียน
(ASEAN Community) โดยในช่วง - ปี มานี รัฐบาลได้เร่งประชาสัมพันธ์และให้ความรูแ้ ก่ประชาชนอย่างต่อเนือง ก่อให้เกิด
การตืนตัวในทุกภาคส่วนเพือเตรียมพร้อมรับมือกับความเปลียนแปลงทีจะเกิดขึน แม้กระทังกรมแพทย์ทหารอากาศก็ตอ้ งมีการ
เตรียมการเพือรับมือกับการเกิดขึนของอาชีพเสรีในอาเซียน โดยเฉพาะอาชีพทางด้านสาธารณสุข ได้แก่ แพทย์ ทันตแพทย์
และพยาบาล ซึงจะก่อให้เกิดการเคลือนย้ายแรงงานอย่างเสรีขนึ อาจส่งผลให้ประเทศไทยเกิดภาวะวิกฤตขาดแคลนบุคลากร
เหล่านีได้ ประกอบกับปัจจุบนั เทคโนโลยีต่าง ๆ เจริญรุดหน้าไปอย่างรวดเร็ว โดยเฉพาะเทคโนโลยีทางด้านการแพทย์ จึงจําเป็ น
อย่างยิงทีเราจะต้องก้าวตามไปให้ทนั เพือทีจะสามารถแข่งขันกับนานาประเทศได้
กรมแพทย์ทหารอากาศ ในฐานะทีเป็ นตัวแทนทางด้านสาธารณสุขของกองทัพอากาศ ได้เล็งเห็นถึงความสําคัญ
ของสถานการณ์ดงั กล่าว จึงได้กาํ หนดจัดประชุมวิชาการทางการแพทย์ขึน เพือให้ขา้ ราชการภายในกองทัพอากาศและผู ท้ มีี
ความสนใจ ได้รบั ทราบทิศทางและวิสยั ทัศน์ของกองทัพอากาศทางด้านสาธารณสุขภายใต้การเกิดขึนของประชาคมอาเซียน
และการเปลียนแปลงอย่างรวดเร็วของเทคโนโลยี ตลอดจนเป็ นการส่งเสริมและพัฒนาความรู ใ้ ห้แก่บุคลากรเพือให้ส ามารถ
นํามาใช้ในการปฏิบตั ิงานและให้บริการได้อย่างมีประสิทธิภาพมากทีสุด
ผมขอขอบคุณคณะกรรมการ เจ้าหน้าทีผู ด้ าํ เนิ นการจัดประชุมวิชาการ ผู น้ าํ เสนอผลงานทางวิชาการ ตลอดจน
ผู ม้ ี อุปการะคุ ณที สนับสนุ นการประชุมวิชาการในครังนี ทีได้ร่ วมแรงร่ วมใจดํา เนิ นกิ จกรรมอันเป็ นประโยชน์ นี ขึน และ
ขออํานาจสิงศักดิสิทธิทังหลาย อันเป็ นทีเคารพเลือมใสของทุกท่าน ตลอดจนพระบารมีแห่งองค์พระบาทสมเด็จพระเจ้าอยู ่หวั
และสมเด็จพระนางเจ้าฯ พระบรมราชินีนาถ ได้โปรดดลบันดาลพระราชทานพรให้ทุกท่านทีเข้าร่วมประชุมวิชาการในครังนี
จงประสบแต่ความสุข ความเจริญ ถึงพร้อมด้วยจตุรพิธพรชัย สัมฤทธิผลในสิงอันพึงปรารถนาทุกประการ และขออวยพร
ให้การประชุมวิชาการครังนี ประสบความสําเร็จบรรลุวตั ถุประสงค์ตามทีมุ่งหมายไว้ทุกประการ
พลอากาศโท
(สุรศักดิ โปร่งจันทึก)
เจ้ากรมแพทย์ทหารอากาศ
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 27
สาส์นผูอ้ ํานวยการ โรงพยาบาลภูมิพลอดุลยเดช กรมแพทย์ทหารอากาศ
ในการเป็ นประธานพิธีปิดการประชุมวิชาการทางการแพทย์
ประจําปี
ครังที
ในวันพฤหัสบดีที มีนาคม
ณ ห้องประชุม พลอากาศเอกประพันธ์ ธูปะเตมีย ์ ชัน อาคาร “คุม้ เกล้าฯ”
โรงพยาบาลภูมิพลอดุลยเดช กรมแพทย์ทหารอากาศ ได้ตระหนักถึงความสําคัญของประชาคมอาเซียนทีกําลัง
จะเกิดขึนในปลายปี
นี เพราะจะส่ งผลกระทบต่ อการขาดแคลนบุคลากรทางด้านสาธารณสุ ขอย่างหลีกเลียงไม่ ไ ด้
ประกอบกับเดินทางอย่างเสรีระหว่างกัน ก็ยอ่ มจะทําให้ประเทศไทยมีชาวต่างชาติเดินทางเข้า-ออก เพิมมากขึน ปัญหาหนึงทีจะ
เกิดขึน คือ ปัญหาทางด้านสุขภาพอนามัย ซึงเป็ นปัญหาทีสถานพยาบาลหลาย ๆ แห่งจะต้องเตรียมการรับมืออย่างแน่นอน
ทังการกลับมาแพร่ระบาดของโรคทีเคยหมดไปจากเมืองไทยแล ้ว และการเกิดโรคอุบตั ใิ หม่ทไม่
ี เคยพบมาก่อน ซึงจะต้องมีการ
จัดการอย่างมีประสิทธิภาพเพือแก้ไขปัญหาเหล่านีให้ได้ จึงมีความจําเป็ นทีโรงพยาบาลภูมพิ ลอดุลยเดช กรมแพทย์ทหารอากาศ
จะต้องมีการเตรียมความพร้อมเพือรับมือกับสถานการณ์ต่าง ๆ ทีอาจจะเกิดขึน เพือให้ข้าราชการกองทัพอากาศและประชาชน
เกิดความเชือมันและไว้วางใจในการมาใช้บริการ
ดังนัน โรงพยาบาลภูมพิ ลอดุลยเดช กรมแพทย์ทหารอากาศ จึงได้จดั การประชุมวิชาการขึนเป็ นประจําปี อย่างต่อเนือง
สําหรับปี
นับเป็ นการประชุมวิชาการครังที โดยมีวตั ถุประสงค์เพือให้ความรู แ้ ละความเข้าใจเกียวกับทิศทางของ
กองทัพอากาศต่อการแพทย์ในยุคดิจิตอลและประชาคมอาเซียน รวมทังการปรับตัวของแพทย์เมือเข้าสู่การรวมตัวอย่างเป็ น
ทางการ ตลอดจนการนําเสนอผลงานวิจยั ทางการแพทย์ใหม่ ๆ เพือเป็ นการพัฒนาศักยภาพของบุคลากร อันจะนําไปสู่การ
พัฒนาโรงพยาบาลภูมพิ ลอดุลยเดช กรมแพทย์ทหารอากาศ ให้มีความเจริญก้าวหน้าต่อไป
ในนามของโรงพยาบาลภู มิพลอดุ ลยเดช ผมขอขอบคุณวิทยากร ผู ท้ รงคุ ณวุฒิ และผู น้ าํ เสนอผลงานทีได้กรุณา
สละเวลาอันมีค่ ามาให้ความรู ้ ข้อคิ ดเห็นและประสบการณ์ ทีเป็ นประโยชน์อย่างยิงต่ อผู เ้ ข้าร่วมประชุม คณะกรรมการจัด
ประชุมวิชาการและฝึ กอบรม เจ้าหน้าทีผู เ้ กียวข้อง และผู ใ้ ห้การสนับสนุ นทุกท่าน ผมหวังเป็ นอย่างยิงว่าการจัดงานประชุม
วิชาการในปี นี จะประสบความสําเร็จตามวัถตุประสงค์และเป็ นประโยชน์ต่อผู เ้ ข้าร่วมงาน อีกทังจะเป็ นประโยชน์ในการนําไป
พัฒนาโรงพยาบาลต่อไป
พลอากาศตรี
(ธเนศร์ศกั ดิ วุฒาพิทกั ษ์)
ผูอ้ าํ นวยการ โรงพยาบาลภูมพิ ลอดุลยเดช กรมแพทย์ทหารอากาศ
28 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
กําหนดการ
ประชุมวิชาการทางการแพทย์ประจํ าปี
รพ.ภูมิพลอดุลยเดช พอ.
ครังที
วันพุธที มี.ค.
ห้องประชุม ชัน อาคาร “คุม้ เกล้าฯ”
0745-0815
0815-0830
0830-0930
0930-1000
1000-1030
1030-1200
1200-1300
1300-1600
ลงทะเบียน
พิธีเปิ ดการประชุมวิชาการทางการแพทย์ประจําปี
ครังที
ปาฐกถาพิเศษ พล.อ.ท.น้อย ปาณิกบุตร
เรือง “วิสยั ทัศน์ของกองทัพอากาศต่อการแพทย์ทหาร ในยุค Digital Airforce”
และ “Asean Community”
องค์ปาฐก พล.อ.อ.จอม รุ่งสว่าง ณ ห้องประชุม พล.อ.อ.ประพันธ์ ธู ปะเตมีย ์
เรือง “มารูจ้ กั ศูนย์ปฏิบตั กิ ารแพทย์ทหารอากาศ พอ.”
โดย พล.อ.ต.กลศร ภัคโชตานนท์
ณ ห้องประชุม พล.อ.อ.ประพันธ์ ธู ปะเตมีย ์
พักรับประทานเครืองดืมและอาหารว่ าง
Panel Discussion เรือง “การปรับตัวของการแพทย์ไทยเพือเข้าสู่ Asean Community”
โดย พล.อ.ต.อนุ ตตร จิตตินนั ทน์, พล.อ.ต อิทธิพร คณะเจริญ และ น.ท.ดุลย์ ดํารงศักดิ
ณ ห้องประชุม พล.อ.อ.ประพันธ์ ธู ปะเตมีย ์
Lunch Symposium เรือง “Hypertension and Diabetes : The Consensus Approach”
โดย น.อ.วรงค์ ลาภานันท์ และ น.อ.หญิง อุษณีย ์ สุนนั ท์
Modulator โดย พล.อ.ต.อนุ ตตร จิตตินนั ทน์
ณ ห้องประชุม บุรพรัตน์
Resident Presentation
ณ ห้องประชุม พล.อ.อ.ประพันธ์ ธู ปะเตมีย ์
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 29
วันพฤหัสบดีที มี.ค.
ห้องประชุม ชัน อาคาร “คุม้ เกล้าฯ”
0800-1000
1030-1100
1100-1200
1200-1300
1300-1500
1500-1530
Free paper ณ ห้องประชุมบุรพรัตน์ (ห้อง )
Free paper ณ ห้องประชุมเย็นสุดใจ (ห้อง )
พักรับประทานเครืองดืมและอาหารว่ าง
Emerging & Reemerging Infectious Disease
โดย น.อ.ธนาสนธิ ธรรมกุล และ น.อ.หญิง จุฑารัตน์ เมฆมัลลิกา
ณ ห้องประชุม พล.อ.อ.ประพันธ์ ธู ปะเตมีย ์
Lunch Symposium เรือง “Benefit Along Cardiovascular Continuum with
New Combination in Thailand
โดย พล.อ.ต.อนุ ตตร จิตตินนั ทน์ และ น.อ.ธนวิตต สกุลแสงประภา
ณ ห้องประชุมบุรพรัตน์
Panel Discussion เรือง ยังเจ๋ง ยังแจ๋ว
โดย น.อ.วรงค์ ลาภานันท์, น.ต.พาคินทร์ วาทิน, น.ต.ธนัตถ์ วัลลีนุกูล, ร.อ.เดชาพล บูรณพิทกั ษ์สนั ติ
และ ร.อ.หญิง ปวีณา ผาลิวงษ์
ณ ห้องประชุม พล.อ.อ.ประพันธ์ ธู ปะเตมีย ์
พิธีปิดการประชุมวิชาการทางการแพทย์ประจําปี
ครังที
และมอบของรางวัลประกวดผลงานวิจยั แพทย์ประจําบ้าน
โดย ผอ.รพ.ภูมพิ ลอดุลยเดช พอ.
30 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
การนําเสนอผลงานวิจัยทางการแพทย์ (ประกวด)
วันพุธที มี.ค. (
)
ห้องประชุม พล.อ.อ.ประพันธ์ ธู ปะเตมีย ์ ชัน อาคารคุม้ เกล้าฯ
ประธาน น.อ.สินาท พรหมมาศ
ประธานร่วม น.อ.หญิง ปั ญจฉัตร รัตนมงคล
1300-1315
1315-1325
แนะนําประธาน, ประธานร่ วม และ กรรมการตัดสิน
Effectiveness of combined nebulized epinephrine with dexamethasone in acute
bronchiolitis in Children : A Randomized controlled trial
Siriket Amhirun MD., กกม.
1327-1337
Factors effect on the result of free vascularized fibular grafting for the treatment of
osteonecrosis of the femoral head in Bhumibol Adulyadej Hospital
Pataporn Prachapinyo MD., กอป.
1339-1349
Emergency department, Bhumibol Adulyadej Hospital, Bangkok, Thailand Prevalence
and factor related to seizure from tramadol misuse at emergency room, Bhumibol Adulyadej
Hospital, Royal Thai Air Force
Hatairat Chantarapromkul MD., กตน.
1351-1401
Curcumin in Reduction Size of Myoma Uteri
Akarapon Sukonthanonta MD. กสก.
1403-1413
Outcomes of neonates born to mothers with hyperthyroidism in Bhumibol Adulyadej
Hospital
Sumana Karom MD., กกม.
1415-1425
Risk Factors for Fetal Macrosomia at Bhumibol Adulyadej Hospital
Songsit Chuenthammakarn MD., กสก.
1437-1447
พัก
Rate and Clinical characteristics of intravenous immunoglobulin resistance Kawasaki
disease
Rattawanlop Somanandana MD., กกม.
1447-1457
Evaluation the effectiveness of a brief intervention with the alcoholic injured patients in
the accident and Emergency Room of Bhumibol Adulyadej Hospital
Duangruethai Pakdeevanissukho MD., กตน.
Vol. 61 No. 1 January - April 2015
1459-1509
Royal Thai Air Force Medical Gazette 31
Effect of Amphetamine and Other Addict Drugs Which Used in Pregnancy of Newborn
Pornpitchaya Lekhavat MD., กกม.
1511-1521
Emergency Department, Bhumibol Adulyadej Hospital, Bangkok, Thailand
Sivanath Peeracheir MD., กสก.
1523-1533
Association of Fetal Growth Rate in First Trimester and Being Large or Small for
Gestational Age
Warangkana Wongmongkol MD., กสก.
1535-1545
Assessing materal knowledge of newborn card : Improving the quality of maternal
education at Bhumibol Adulyadej Hospital
Patrada Thanee MD., กกม.
32 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
การนําเสนอผลงานวิจัยทางการแพทย์ (Free Paper)
วันพฤหัสบดีที มี.ค. (
)
ห้องประชุม บุรพรัตน์ (ห้อง ) ชัน อาคารคุม้ เกล้าฯ
ประธาน น.อ.หญิง รุ่งทิพย์ เมธะสิริ
ประธานร่วม น.อ.หญิง ศศวรรณ ชินรัตนพิสิทธิ
0830-0840
The Study of Screening Efficacy of The Hospital Staff at The Outpatient Clinic for
Military Personnel at Bhumibol Adulyadej Hospital in 2014 Before and After Attend
Knowledge Management Program of Emergency Severity Index
Krittaya Loichuen MD., กตน.
0840-0850
Descriptive Study Knee Arthroscopic Surgery in Bhumibol Adulyadej Hospital
Pawin Rattanasumrit MD., กอป.
0850-0900
Timing of Hospital Stay Before Surgery in Fracture Around The Hip Related Incident of
Post Operative Deep Vein Thrombosis
Atikom Wongsrisant MD., กอป.
0900-0910
Care of Central Venous Catheter : Where are We ?
AVM Vibul Trakulhoon MD., กศก.
0910-0920
Comparison Respiratory Distress Syndrome (RDS) Rate in Late Pre-term Infants
Between Gestational Age 34 Weeks and 35-36 Weeks
Rarin Imkesorn MD., กสก.
0920-0930
Flat foot in Armed Forces Academies Preparatory Pre Cadet : Prevalence and its Effect
on Physical Fitness
Tomorn Tarnpichprasert MD., กอป.
0930-0940
Efficacy of Skin Traction to Control Pain for Hip Fracture
Pokrat Ugsornwong MD., กอป.
0940-0950
A Comparison of Kinyoun Staining and Fluorescent Microscopy for Diagnosis of
Tuberculosis
Thidarat Saewong MD., กพก.
0950-1000
Prevalence of Rotational Malalignment of Femur Following Intramedullary Nailing
Attanakan Kawpradist MD., กอป.
1000-1010
Laparoscopic Choledochoduodenostomy with Small Silicone Stent Placement for Patent
Choledochoduodenostomy end-to-side Anastomosis in Patients with Difficult CBD Stones
Phrompirun Wattanawiggid MD., กศก.
Vol. 61 No. 1 January - April 2015
1010-1020
Royal Thai Air Force Medical Gazette 33
Polyethylene Glycol 4,000 Without Electrolytes Versus Milk of Magnesia for The
Treatment of Functional Constipation in Infants and Young Children: A Randomized
Controlled Trial
“A Thai Research of Pediatric Constipation to Cochrane Review and International
Guideline”
Panjachat Ratanamongkok MD., กกม.
1020-1030
The Perception and The Expectation in Second Year of Air Force Student Nurses to
Clinical Teaching Behaviors of Pediatric Nurse Instructiors in Pediatric Nursing Practicum1
Wg.Cdr. Nattaya Pungswang, วพอ.
34 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
การนําเสนอผลงานวิจัยทางการแพทย์ (Free Paper)
วันพฤหัสบดีที มี.ค. (
)
ห้องประชุม เย็นสุดใจ (ห้อง ) ชัน อาคารคุม้ เกล้าฯ
ประธาน น.อ.หญิง อิศรญา สุขเจริญ
ประธานร่วม น.ท.หญิง บุษกร อินทรวิชยั
0830-0840
0840-0850
A Study of Anxiety, Readiness, achievement motivation of Air Force Student Nurses in
Professional Nurse Licensure Examination
Wg.Cdr. Bang-orn Ritudom, วพอ.
A Comparative Study of Perceived Stress, Adaptation, Self-esteem and Resilience of The
Armed Forces Nursing Academy Cadets, Republic of Korea and The Royal Thai Air
Force Nursing College, Student Nurses, Thailand
Gp.Capt. Watcharaporn Paorohit, วพอ.
0850-0900
Lesson Learned : Asia Pacific Military Nursing Exchangte 8th, Republic of Korea 2014
Sqn.Ldr. Papasorn Suriyo, วพอ.
0900-0910
Learning Experiences : Exchange Program of RTAFNC and KAFNA 2014
Wg.Cdr. Chanita Amornratanathada, วพอ.
0910-0920
Compare Effectiveness of Vaseline and Zinc Paste on Healing Time of Diapers Rash in
Diarrhea Children
Wg.Cdr. Sommai Tratong, กกม.
0920-0930
0930-0940
The Effectiveness of The Clinical Practice Guidelines for The Prevention of Pressure
Ulcers. In Patients Who have been Weighted Pull Through the Skin
Sqn.Ldr. Waraporn Tumtong, กอป.
Causes of Surgical Delay in Patients with Hip Fracture in Bhumibol Adulyadej Hospital
Pichai Lertwattanaseri MD., กอป.
0940-0950
0950-1000
The Survey Study of Self-harm Patients Arrived at The Accident and Emergency Room,
Bhumibol Adulyadej Hospital, RTAF
Phasut Nganwai MD., กตน.
Treatment Outcome of Childhood Acute Lymphoblastic Leukemia
Sutatip Watthanaphanalai MD., กกม.
1010-1020
1020-1030
Placental Weight for Gestational Age and Adverse Neonatal Outcome at Bhumibol
Adulyadej Hospital
Kesinee Lonimitdee MD., กสก.
Effectiveness of The Development in Tranformation Model Using Focus Charting in
Surgical Intensive Care Unit of Bhumibol Adulyadej Hospital Directorate of Medical
Services Royal Thai Air Force
Sqn.Ldr. Arpadorn Boonto MD., กศก.
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 35
Effectiveness of Combined Nebulized Epinephrine with Dexamethasone in Acute
Bronchiolitis in Children : A Randomized controlled Trial
Siriket Amhirun MD.
Department of Pediatrics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : Although acute bronchiolitis is the most common lower respiratory infection of infancy, the
optimal treatmentis still controversial. The aim of this study is to compare the early and late effects of
nebulized epinephrine in 3% NaCl and a single dose intravenous dexamethasone combination therapy
with nebulized salbutamol and placebo in patients with acute bronchiolitis.
Methods : Children with bronchiolitis, double-blind, placebo-controlled trial in which children (6 weeks to
36 months of age) with bronchiolitis who admit in Bhumibol Adulyadej Hospital are randomly assigned
to one of two study groups. One group received two treatments of nebulized epinephrine (2.5 ml of
epinephrine (1:1000) in 3 % NaCl) and a single intravenous injection of 0.6 mg/kg dexamethasone
(the epinephrine in 3 % NaCl–dexamethasone group), the second group received nebulized NSS and placebo
(the placebo group). The primary outcome is the resolution of respiratory distress, determined by a clinical
score (derived from the respiratory rate, occurrence of wheezing, chest retraction, and oxygen saturation.)
at 1, 4, 12, 24, 48 hr and the secondary outcome is length of stay after treatment between two groups.
Results : The improvement in clinical severity scores not significantly at 1, 4, 12, 24, 48 hr after treatment
between the two groups (p= 0.137). Also, length of stay not significantly between the two groups.
(p= 0.326).
Conclusions : We conclude that in non-asthmatic, non-severely children with acute bronchiolitis in
hospitalized aerosolized. Among infants with bronchiolitis treated by nebulized epinephrine (2.5 ml of
epinephrine (1:1000) in 3 % NaCl) and a single intravenous injection of 0.6 mg/kg dexamethasone not
decreases symptoms and length of stay as compared to the second group received nebulized NSS and
placebo.
Keywords : Dexamethasone;Epinephrine; Hypertonic saline solution; Respiratory syncytial virus; Viral
bronchiolitis
36 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Factors effect on the result of free vascularized fibular grafting for the
treatment of osteonecrosis of the femoral head in Bhumibol Adulyadej Hospital
Pataporn Prachapinyo MD., Gp.Capt. Apikit Srisermphoak MD.
Department of Orthopedics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objectives : To study about factors that effect on the result of free vascularized fibular grafting for the
treatment of osteonecrosis of the femoral head in Bhumibol Adulyadej Hospital such as stage of the disease,
etiology of the osteonecrosis, age and gender of the patient and Harris hip score before surgery.
Study design : Case-control study.
Setting : Department of Orthopedic, Bhumibol Adulyadej Hospital.
Subjects : Patient who had undergone free vascularized fibular grafting for the treatment of osteonecrosis
of the femoral head in Bhumibol Adulyadej Hospital since 2008-2012.
Methods : We collected the data from medical record of patient who had undergone free vascularized fibular
grafting for the treatment of osteonecrosis of the femoral head in Bhumibol Adulyadej Hospital, since 20082012 and evaluated the Harris Hip Score post operatively at 2 years follow up. We defined conversion to
total hip arthroplasty as the failure end point and divided the outcomes in two groups ; Poor result and
Good result. The data was studied in statistical analysis by Binary logistic regression about factors that
effect on the results.
Results : There are 16 patients were recruited in this study whom are 12 males and 4 females. Baseline age
of patients were 25-45 years old (36.87+6.77 years old). There are 24 hips underwent to surgery which
divided in good result group 17 hips (70.8 %) and poor result group 7 hips (29.2 %). There are 2 in 7 hips of
poor result group (28.57 %) which conversion to total hip arthroplasty in 2 years follow up. We compared the
factors of age and gender of patients in two groups that were no different in results. The most stage of
disease in the good result group was Ficat and Arlet classification Stage 2A (58.82 %) and there are not
Stage 3 in this group, opposited to the poor result group, the most stage of disease was Stage 2B (57.14 %).
Then we evaluated the etiology of the osteonecrosis that in the good result group were alcohol abuse
(38.89%), systemic steroid use (33.33 %) and idiopathic (27.78 %) respectively. The most etiology of the
osteonecrosis in the poor result group were alcohol abuse (62.5 %) and systemic steroid use (37.5 %). Harris
Hip Score post operative at 2 years follow up in good result group 63-91 (mean 68.58) was higher than poor
result group 49-65 (mean 57.57). We analyzed the data by Binary logistic regression about factors that effect
on the result, however, there was no statistically significant effects.
Conclusion : The result of this study showed no statistically significant effects about factors such as stage
of the disease, etiology of the osteonecrosis, age and gender of the patient and Harris hip score before
surgery on the result of surgery due to the amount of study population is less than calculated sample size.
Further research trials evaluating of these effects are needed.
Keywords : Osteonecrosis of the femoral head, Free vascularized fibular grafting
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 37
Prevalence and Factor Related to Seizure from Tramadol Misuse
at Emergency Room, Bhumibol Adulyadej Hospital, Royal Thai Air Force
Hatairat Chantarapromkul, MD
Emergency Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : There is an increasing tendency in seizure from tramadol misuse in Thailand. It causes
patients to be taken to emergency room for medical treatments. These days information of prevalence and
factors related to seizure in tramadol misuse is restricted.
Objective : To study the prevalence and the factors related to seizure from tramadol misuse at emergency
room, Bhumibol Adulyadej Hospital, Royal Thai Air Force.
Research method : By cross section analysis, collecting the information from the patients with seizure
caused by the use of tramadol (case group) and pairing them with those who have not been treated with
tramadol (control group). This study was conducted with the patients taken to the emergency room,Bhumibol
Adulyadej Hospital, Royal Thai Air Force, for medical treatment during January 1, 2012 – September 30,
2014 in the ratio 1:1, collecting population data, information of the use of tramadol and the seizure,
prevalence analysis information and factors related by multivariable logistic regression statistic.
Results : Prevalenceof 141 patients with tramadol misuse is divided by year accordingly, in 2014 - 66
patients (46.8 %), in 2013 – 54 patients (38.3 %), in 2012 – 21 patients (14.9 %). Most patients with seizure
from tramadol misuse are male. The average age is 17+2.02 years. They are in high school years, living with
parents. The average seizure time is 3.43+1.51 minutes and the seizure begins after taking the tramadol,
the average hour after the last tramadol taken is 4 hours. The tramadol dose from 100 mg causes the
seizure in patients. The mean of dose causing the seizure is 500+250 mg. The main cause of tramadol
misuse is peer pressure. The factors related to seizure from tramadol misuse are age which is 12-15 years
and 16-20 years (Adjusted OR 149.22, 95 % CI 15.6-874.8 p-value = 0.001, and 55.48, 95 % CI 6.3-354.3
p-value <0.001, accordingly), BMI below 18 kg/m 2 (Adjusted OR 7.31, 95 % CI 1.14-22.89 p-value
= 0.033), patients with previous underlying disease (Adjusted OR 0.52, 95 % CI 0.02-0.20 p-value <0.001)
and patients with drug abuse history (Adjusted OR 2.3, 95 % CI 1.2-4.7 p-value = 0.015). For the condition
of the patients with seizure from tramadol misuse, it has been founded in the patients who have heart rates
more than 100 times/minute. (Adjusted OR 149.94, 95 % CI 31.95-567.57 p-value <0.001) Glasgow coma
score is between 13-15 (Adjusted OR 14.51, 95 % CI 1.03-68.24 p-value = 0.046)
Conclusion : There is an increasing tendency in prevalence of the patients with seizure. The factor related
to seizure is the misuse of tramadol. For the age under 20 years, BMI is below 18 kg/m2 with the seizure
history. Heart rates more than 100 times/minute and Glasgow coma score is not intense.
Keywords : seizure, tramadol, characteristic, factor related seizure
38 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Curcumin in Reduction Size of Myoma Uteri
Akarapon Sukonthanonta MD.
Department of Obstetrics and Gynecology, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objective : The objectives of the study were to determine effects of curcumin in decreasing size of
leiomyoma and to determine adverse effects of curcumin.
Materials and Methods : The study was a prospective study conducted in reproductive women with
leiomyoma in Bhumibol Adulyadej Hospital. 35 women with 81 leiomyoma lumps were recruited to
participate by convenience sampling. Ultrasound measurement size of leiomyoma was done before
treatment with curcumin. Patients were taken curcumin 1,200 milligrams orally per day for 6 months.
Ultrasound measurement size of leiomyoma was repeated at 3 and 6 months after curcumin was started.
Main outcomes measure was size of leiomyoma. Size of leiomyoma were compared between before and
after taken curcumin for 6 months.
Results : The mean diameter of leiomyoma was statistically different at before and after 3 (4.74 + 2.78
centimeters VS 4.64 + 2.75 centimeters) and 6 months (4.74 + 2.78 centimeters VS 4.46 + 2.61 centimeters)
curcumin intake. And both mean volume of leiomyoma was statistically different at before and after 3 and
6 months curcumin intake. Adverse effect of curcumin was not found.
Conclusions : Curcumin decreased size of myoma uteri after taken 6 months with statistically significant.
Keywords : Curcumin, Leiomyoma, Reduction size
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 39
Outcomes of Neonates Born to Mothers with Hyperthyroidism in
Bhumibol Adulyadej Hospital
Sumana Karom MD.
Department of Pediatrics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : Thyroid hormone is essential tometabolic process of the body, physical growth and brain
development, especially in newborn period. Hyperthyroidism in pregnant womenmay cause complications
such as preterm labour, stillbirth, intrauterine growth retardation, low birth weightand abnormal of thyroid
hormone level after birth. In addition, thyroid drug treatment during pregnancy also affect the fetus as well.
Objective : To study outcomes of neonates born to mothers with hyperthyroidism in term of birth weight,
gestational ageand thyroid hormone levels.
Material and methods : Medical records ofdescriptive study of mothers with hyperthyroidism and their
neonates at Bhumibol Adulayadej Hospital between April 1, 2009 to April 30, 2014 were reviewd.
Result : Fourty two mothers with hyperthyroidism and 43 newborns (1 pair of twin) were enrolled. The
most common etiology of maternal hyperthyroidism in this study is Graves’ disease (54.8 %). Thyroid
function during pregnancy is euthyroid (66.7 %) and hyperthyroidism (33.33 %). Outcome of neonate, there
were preterm labor 18.6 %, low birth weight (25.28 %). Euthyroid was found 79.07 %. Eight babies had
transient congenital hypothyroidism (18.60 %) and 1 baby had hyperthyroidism (2.33 %). Thyroid hormone
are statistically significant positive correlation (P=0.003) between Free T4 of the mother during the 3rd
trimester of pregnancy with the Free T4 of the newborn, as estimated at the age of 48-72 hours. In addition,
the treatment of PTU in the 3rd trimester of pregnancy that affects to neonatal total T4 and Free T4 which
measured at age 48-72 hours statistically significant at P 0.00 and 0.001 sequence. And the treatment of
PTU in the 3rd trimester of pregnancy was found to affect the levels of total T3 and T4 which measured at age
7-14 statistically significant at P 0.042 and 0.023, respectively.
Conclusion : Maternal hyperthyroidism, may result in low birth weight, premature labor and abnormal
thyroid function in babies. Especially mothers who received higher dose may result in congenital
hypothyroidism in infant.
Keywords : Outcomes of neonates, mothers with Hyperthyroidism
40 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Risk Factors for Fetal Macrosomia at Bhumibol Adulyadej Hospital
Songsit Chuenthammakarn MD.
Obstetrics and Gynecology Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : Macrosomia, defined as a birthweight at least 4,000 g., is one of the major health problem that
affects both maternal and neonatal morbidity and mortality. Many studies have carried out on risk factors
that have been associated with fetal macrosomia.
Objective : To evaluate the risk factors for fetal macrosomia in Bhumibol Adulyadej Hospital.
Material and Methods : Medical records between 1st January 2011 and 30th April 2014 were reviewed.
The data of age, parity, height, prepregnancy weight, weight at delivery, fetal birth weight and medical
complication during pregnancy were collected. The data was then analysed using SPSS version 20.
Results : A total of 340 patients were recruited, 170 cases of macrosomia and 170 cases of control.
The risk factors for fetal macrosomia were The prepregnancy BMI > 23 kg/m2 (OR 40.85 , p < 0.05), BMI at
delivery > 30 kg/m2 (OR 53.94 , p < 0.05), weight gain > 15 kg. (OR 20.02 , p < 0.05), gestational age at
delivery > 40 weeks (OR 11.11, p < 0.05), gestational diabetes type 2 (OR 13.60, P<0.05 )
Conclusion : In this study risk factors for delivery of a newborn with macrosomia were found to related
with prepregnancy BMI > 23 kg/m2, BMI at delivery > 30 kg/m2, weight gain > 15 kg., gestational age at
delivery > 40 weeks and gestational diabetes type 2 significantly.
Keyword : fetal macrosomia, BMI, weightgain, GDM, pregnancy
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 41
Rate and Clinical Characteristics of Intravenous Immunoglobulin
Resistance Kawasaki Disease
Rattawanlop Somanandana MD.
Department of Pediatrics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : Approximately 10 % to 20 % of Kawasaki Disease patients will have unresponsiveness to
initial intravenous immunoglobulin treatment. IVIG resistance is a major risk factor for development of
coronary artery abnormality in Kawasaki Disease. The early identification of patients at risk for resistance
would allow for the timely administration of additional therapies.
Objective : To evaluate rate and risk factors associated unresponsiveness to intravenous immunoglobulin
in Kawasaki disease among patient admitted at Bhumibol Adulyadej Hospital.
Material and method : This is cross-sectional descriptive study. We reviewed the medical records of
Kawasaki Disease patients who admitted at Bhumibol Adulyadej Hospital between 31 December 2003 and
31 December 2014. Data collected included patient characteristics, clinical manifestations, laboratory findings, outcome and complication of Kawasaki disease.
Results : Kawasaki disease was diagnosed in 48 patients, 26 patients were boys (54.2 %), 22 patients were
girls (45.8 %). The average age was 34.6 months old. All received high dose IVIG for treatment of Kawasaki
disease 6 of 48 patients (12.5 %) were IVIG resistant Kawasaki disease. We found that the clinical
manifestation were not statistic significant to predict unresponsiveness Kawasaki disease. Patients who
had laboratory findings ; Serum sodium < 133 mmol/l (P=0.001), Band form of neutrophil > 20 %
(P=0.010), Albumin < 3 g/dl (P=0.013), CRP > 100 mg/dl (P=0.029) and Neutrophil > 80 % (P=0.038)
were statistic significant to predict IVIG unresponsiveness Kawasaki disease. On multiple logistics
regression model identified serum sodium < 133 mmol/l (P=0.005) as the independent predictor of IVIG
unresponsiveness Kawasaki disease.
Conclusion : Approximately 12.5 % of Kawasaki Disease patients at Bhumibol Adulyadej Hospital will
have unresponsiveness to initial intravenous immunoglobulin treatment. The factor significantly related to
predict unresponsiveness to intravenous immunoglobulin in Kawasaki disease was serum sodium < 133
mmol/l.
Keywords : Kawasaki disease, Rate of resistance Kawasaki disease, IVIG resistance Kawasaki disease,
Predict resistance Kawasaki disease, Risk factors of resistance Kawasaki disease
42 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Evaluation the Effectiveness of a Brief Intervention with the Alcoholic Injured
Patients in the Accident and Emergency Room of Bhumibol Adulyadej Hospital
Duangruethai Pakdeevanissukho MD.
Emergency Medicine Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objectives : To research the difference of the Alcohol Use Disorder Identification Test (AUDIT) score
between group of the patients, before and after intervention and group of the patients without the brief
intervention.
Background : Excessive alcohol consumption is a main factor that causes substantial risk and harm to the
person injuries. Thus, there are a number of patients have to be treated in the accident and emergency
room. Nowadays, the results of the brief intervention have proved that the brief intervention has been able
to reduce the amount of alcohol consumption, especially in the patients who have complicated life styles.
As the general said “We have to strike while the iron is hot” that bring the advantage of treatment
decisively and quickly as soon as the brief intervention.
Materials and Methods : This case study is the experiment of the injured patients from the excessive
alcohol consumption in the Accident and Emergency Room, Bhumibol Adulyadej Hospital. Between 1st of
June to 30th of November 2014. 104 patients have been devided equally into 2 groups of a control group and
an experimental group. Both groups have received in the interview on the first day of the accident for
analysis the AUDIT score. The control group has not received the brief intervention but the experimental
group has received the brief intervention. Then, the AUDIT score of the both group have been
analysed again a month after the first day of the accident.
Results : The patients who have received the brief intervention early by doctor, the AUDIT score has been
decreased 3.194 but in the patient without the brief intervention, it has been decreased only 2.912.
The Statistic value of this case study have shown as P=0.004 (P<0.05) Furthermore, most of the AUDIT
values have been decreased in the area of the amount and the frequency of the alcohol consumption.
Conclusion : From this case study, the AUDIT score have been decreased in both groups of the patients
with and without the brief intervention but the patients with the brief intervention’s AUDIT score have
decreased more. However, this decreasing score may cause of the beginning of the accident so the patients
have been in pain and not be able to consume the alcohol as usual. Therefore, AUDIT score need to
analyzed in some periods of time after the accident to evaluate the accurate long term values.
Keywords : Alcohol Use Disorder Identification Test ; Brief Intervention
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 43
Effect of Amphetamine And Other Addict Drugs
Which Used In Pregnancy on Newborn
Pornpitchaya Lekhavat MD.
Department of Pediatrics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : Amphetamine abuse is widespread problem in Thai community. Effect of amphetamine abuse
in pregnant women should be emphasized, since it may cause deformities in neonates. Moreover, other
types of substance abuse used in combination with amphetamine may aggravate the effect.
Objectives : To find out relationship between amphetamine exposure in pregnancy and birth outcomes.
Materials and methods : A Cross-sectional descriptive study was performed at Bhumibol Adulyadej Hospital between 1st June 2009 and 30th May 2014. Electronic databases of Bhumibol Adulyadej Hospital were
searched by ICD 10 to identify newborn who were history of maternal amphetamine used. Descriptive
statistics were used to analyze the data.
Results : The total number of the sample group was 59 people. Most of the group were around 20 to 35 years
old (72.9 %), and approximately 45.8 % of the group had the highest education level as compulsory. The
main occupation of the group was housewife (55.9 %). The group had inadequate income as their whole
family income was nearly only 11,925+9555.6 baht per month. The main proportion of the group had records
of using Amphetamine with other addictive substances (61 %) while 39 % used only Amphetamine.
The addictive substance that was used with Amphetamine the most was cigarette (75 %). Moreover, the
study showed that 71.2 % of the group had inadequate prenatal care which led to negative effects on their
babies. For instance, their new born babies had less weight than the 10th percentile (SGA) of newborn
babies as high as 28.8 %. The head circumference were less than the 10th percentile (55.9 %). The most
common abnormal states after birth was hypoglycemia (11.9 %).
Conclusion : There was high possibility that mothers using Amphetamine and other addictive substances
while in pregnant had age around 20-35. Also, they had the highest education level as compulsory and
worked as housewife with low level of incomes. The babies born by this group of mother tended to have
SGA, have less than the 10th percentile (55.9), and had hypoglycemia.
Keywords : Amphetamine and Other Addict Drugs, Pregnancy, Newborn
44 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
The Comparison of Infection Rate between Sterile Gloves and Clean Gloves
Used for Repair Uncomplicated Lacerations in the Emergency Department,
Bhumibol Adulyadej Hospital, Royal Thai Air force
Sivanath Peeracheir MD.
Emergency Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background of the study : Uncomplicated lacerations are wounds normally found in the Emergency
Department although sterile technique for laceration management continues to be recommended, studies
supporting this practice are lacking. Using clean non-sterile gloves rather than individually packaged
sterile gloves for uncomplicated wound repair in the Emergency Department may result in cost and time
savings and sometimes assistance is required.
Study Objective : This study was aimed to compare the infection rate between sterile gloves and clean
gloves for the repair of uncomplicated lacerations in the Emergency Department, Bhumibol Adulyadej
Hospital, Royal Thai Air-force.
Research procedure : This pilot study was an experimental research conducted with the patients who had
their wounds repaired in the hospital. The data were collected by Residencies of the Emergency Medicines
who described the details of the study to the patients before joining the project. The patients were asked
to sign their names in the consent documents. They were then, asked to complete the questionnaires for
their demographic information including wound repair methods.
Results : The patients joining the study were divided into 2 groups, i.e. the sterile gloves group and the
clean gloves group. Three days follow-up was obtained 136 patients, 68 patients for sterile gloves group
and 68 patients for clean gloves group. The infection rate in the sterile glove group was 10.3 % and was
23.6 % in the clean gloves group but there was no statistically significant difference in the incidents of
infection between the two groups at 0.05 level (p<0.05).
Conclusion : This study demonstrated that there was no difference in infection rate between using sterile
and clean gloves for the repair of uncomplicated lacerations in the Emergency Department, Bhumibol
Adulyadej Hospital, Royal Thai Air-force. This can be explained that the patients with uncomplicated
lacerations were carefully treated by the residences with systematic wound repair process or due to other
factors.
Keywords : infection rate between sterile and clean gloves, uncomplicated lacerations
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 45
Association of Fetal Growth Rate in First Trimester and Being Large
or Small for Gestational Age
Warangkana Wongmongkol MD.
Obstetrics and Gynecology Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objective : To evaluate the association of fetal growth rate in first trimester and fetal birth weight.
Materials and Methods : The prospective cohort study was performed at the department of Obstetrics and
Gynecology, Bhumibol Adulyadej Hospital, Bangkok, Thailand. Fetal growth rate was measured by
ultrasound twice in first trimester. First Crown Rump Length (CRL) ultrasound was measured at first
antenatal care (ANC) and second CRL ultrasound was at four weeks later. Delta CRLs was calculated and
divided into 3 groups : larger than expected, smaller than expected and equal as expected. Patients were
followed until delivery. Fetal birth weights were stratified and labeled as large for gestational age (LGA),
small for gestational age (SGA) and appropriate for gestational age (AGA) by birth weight percentile at
gestational age at delivery. Fetal growth rate in first trimester and fetal birth weight were analyzed.
Result : 114 pregnant women were recruited. 59 fetuses were equal as expected (51 %), 43 fetuses were
smaller than expected (38 %) and 12 fetuses were larger than expected (11 %). The delta CRLs were
significantly associate to fetal birth weights (P = 0.000). Diabetic mellitus and hypertension were not
significantly associated to fetal birth weights.
Conclusion : Fetal growth rate in first trimester was significantly associated to fetal birth weight.
Keywords : Delta Crown Rump Length (delta CRLs), large for gestational age (LGA), small for gestational
age (SGA), crown-rump length (CRL), ultrasound scans, birth weight
46 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Assessing Materal Knowledge of Newborn Card: Improving the Quality of
Maternal Education at Bhumibol Adulyadej Hospital
Patrada Thanee MD.
Department of Pediatrics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Wellness and free from any complication is important in neonatal health. The factor which take
influence the most is the mothers who should have knowledges and awareness about taking care of the
newborns. Because of the early detection of newborn sickness can decrease the number of newborn
morbidity and mortality. Maternal education programs about newborn cares are important and also necessary for the neonatal healths.
Objective : Improving the quality of maternal education at Bhumibol Adulyadej Hospital.
Methods : The study was quasi study, involve 318 mothers per group who were included by the inclusion
criteria - delivered the children and followed up at the well-baby clinic at the Bhumibol Adulyadej Hospital.
First group, studied from 1 January – 30 June 2013, received the traditional maternal education program and
evaluated by questionares and examination. Second group, studied from 1 September – 31 December 2013,
received the new maternal education program and evaluate by the same examination.
Results : Mothers who received the new maternal education program had mean of total scores (14.86 scores)
with significant different from mothers who recieved the traditional maternal education program (14.28).
(p = .002)
Conclusion : The new maternal education program has more effectiveness than the traditional program
concerning maternal knowledge in newborn cares.
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 47
The Study of Screening Efficacy of the Hospital Staff at the Outpatient Clinic
for Military Personnel at Bhumibol Adulyadej Hospital in 2014 : Before and
After Attend Knowledge Management Program of Emergency Severity Index
Krittaya Loichuen MD.
Outpatient Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objective : To compare the agreement on emergency severity index (ESI) among triage nurse and
professional physicians between the time before and after the nurse getting knowledge management
program of ESI.
Research Methodology : Observational analytic study. The population of the study was the agreements on
emergency severity index (ESI) among triage nurse and professional physicians. We used the professional
physicians as a gold standard. The 200 patients were selected from the Outpatient clinic for Military
Personnel at Bhumibol hospital during 22 September 2014 to 30 November 2014. The knowledge
management program was set in 6 November 2014. The patient were divided into two groups, 100 patients
each. The first group was the patient coming to clinic before 6 November 2014 and the second group was
the patient coming after 6 November 2014. All were ranked the severity by the nurse and professional
physicians. Kappa coefficient was used to determine the consistent. The accuracy, over-triage and
under-triage were analysed.
Results : Before getting into knowledge management program, the agreement on emergency
severity index (ESI) among triage nurse and professional physicians was kappa coefficient = 0.28 and
P-value < 0.001. The accuracy was 83 %. The over-triage and the under-triage were 17 % and 0 %
respectively. After the program, the agreement on emergency severity index (ESI) among triage nurse and
professional physicians was kappa coefficient = 0.60 and P-value < 0.001. The accuracy was 91 %.
The over-triage and the under-triage were 6 % and 3 % respectively.
Conclusion : In this study, the kappa coefficient showed that the agreement on ESI among the assessors
before the program was in low level whereas the agreement on ESI after the program was in moderate
level. This imply that the knowledge management program should be benefit to triage staff at the
Outpatient clinic for Military Personnel at Bhumibol Adulyadej Hospital.
Keywords : ESI, triage, Out patient clinic
48 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Descriptive Study Knee Arthroscopic Surgery in Bhumibol Adulyadej Hospital
Pawin Rattanasumrit MD.
Orthopedic Surgery Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Nowaday, knee arthroscopic surgery is the standard for treatment in knee pathology. this study
is a descriptive study to report the statistic and information about arthroscopic knee surgery in orthopedics
department ,Bhumibol adulyadej hospital from 2552 to october 2557. Total number of patients is 314
patients. Male 83.7 % Female 16.3 % the most common surgery is about cruciated reconstruction
surgery (60.5 %). Mean total expense 38,955 per case.
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 49
Timing of Hospital Stay Before Surgery in Fracture Around the Hip Related
Incident of Post Operative Deep Vein Thrombosis
Atikom Wongsrisant MD.
Orthopedic Surgery Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : As in the background knowledge, incidence of deep vein thrombosis in patient fracture
around the hip is about 23 percent .Early surgical management in the group of patient can reduce post
operative morbidity and mortality rate. This research study in the time to surgery related rate of post
operative deep vein thrombosis and may affect post operative recovery, rehabilitation, ambulation, pain
and time of hospital stay.
Methodology : We collect data of patient fracture around the hip along the inclusion criteria and general
data as age, gender, diagnosis, timing to surgery, type to surgery and time of post operative hospital stay.
We investigate for deep vein thrombosis by Doppler ultrasound this research was Descriptive prospective
cohort study.
Rsult : Over all 68 patients with fracture around the hip, finding 10 cases of deep vein thrombosis (about
14.7 %). The patients with normal droppler ultrasound had less average time to surgery than deep vein
thrombosis cases.
Conclusion : In patients with fracture around the hip. Timing of hospital stay before surgery affect incident
of post operative deep vein thrombosis.
50 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Care of Central Venous Catheter : Where are We ?
AVM Vibul Trakulhoon MD.
Surgery Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
The VAD (vascular access devices) placement and post procedure care carry risks of
complications which simply divided into infectious and non infectious aspect. According to Safdar N, et al.
(Ann Intern Med 2005), the mortality of catheter related blood stream infection (CR-BSI) was 12-25 %.
CDC guidelines had proposed the Central Line Bundle of practice to reduce the associated CVC infection.
The bundle contains 5 components : hand hygiene; maximal barrier precaution; chlorhexidine gluconate
(2 % CHG with 70 % isopropyl alcohol; skin antisepsis; optimal catheter site selection; daily assessment of
line need. Non infectious complications related to VAD are catheter occlusion, migration, dislodgement,
thrombosis, breakage and other mechanical complication. A retrospective study by Brown JR, et al (J Am
Coll Surg 2009.) of 205 patients with elective subclavian vein Port placement found 2.4 % of catheter
malposition and 2 % pneumothorax (negative by the post-procedure CXR but became positive by a repeat
CXR on symptomatic patient).
Device stabilization The VAD should be placed stabilizely by sutures or steristrips to prevent
the movement of catheter tip against the blood vessel wall. The tip can irritate and induce thrombus
formation. Recent Infusion Nursing Standard of Practice (2011) recommend to use the manufactured
securement devices for stabilization of the catheter.
Catheter Patency and Occlusion Routine anticoagulant solution flush is controversial. However,
most practices recommend a regular interval flush with heparin solution. A study by Jonker MA
et al. (JPEN 2010) compared a routine heparin flush (10 units/cc.) versus saline decrease thrombotic
occlusion. The flush volume is generally twice the volume of the catheter. (for non tunneled and tunneled
cuff CVC are 1-2 cc. and 1-3 cc. respectively; 2-3 cc. for PICC daily, and 3 cc. at least for Port every
4 weeks.
Intraluminal occlusion can develop by drug-heparin interaction, or parenteral nutrition with
inappropriate Ca/PO4 ratios, and also lipid residue. These occurrence can be prevented by using 0.9 %
saline flush between each intravenous medications.
The placement of VADs are frequently performed in Bhumibol Adulyadej Hospital. Is it better to
have a protocol or any guidelines to utilize the VADs safely and effectively ?
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 51
Comparison Respiratory Distress Syndrome (RDS) Rate in Late Pre-term
Infants Between Gestational Age 34 Weeks and 35-36 Weeks
Rarin Imkesorn MD.
Obstetrics and Gynecology Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objective : The main objective of this study is to compare the occurring rates of respiratory distress
syndrome (RDS) in late preterm infants at gestational age of 34 weeks and 35-36 weeks. The second
objective is compare the rates of short term neonatal complications among infants at gestational age of 34,
35-36 weeks and term (37-40 weeks).
Materials and Methods : This is a retrospective cohort design. 200 late preterm (99 cases for GA 34 weeks
and 101 cases for GA of 35-36 weeks) and 100 normal term neonates were recruited. RDS rate and
short-term complications in neonates who were born at the Bhumibol Adulyadej Hospital from January 2011
to June 2014 were compared. The data were analyzed with Chi-square test, Student’s t-test and analysis of
variance where appropriate.
Result : RDS rate was found higher in the late preterm group with GA 34-346/7 weeks than in the group
with GA 35-366/7 weeks (15 % and 4.0 % respectively with p=0.015). The RDS rate of normal term (GA 3740 weeks) was zero. The short-term complications: oxygen requirement, hyperbilirubinemia, hypoglycemia,
hypothermia, NICU admission and hospital stay were also higher in 34-346/7 week gestation group.
Conclusion : The rate of RDS is significantly higher in late preterm with GA 34-346/7 weeks than others
group.
Keywords : Respiratory distress syndrome, Respiratory complication
52 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Flat foot in Armed Forces Academies Preparatory Pre Cadet:
Prevalence and its effect on physical fitness
Tomorn Tarnpichprasert MD.
Orthopedic Surgery Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : In Thailand, The Royal Thai Armed Forces and police enrollment policy were still debating
to use flatfoot for exclusion criteria. However, during period of military training at Armed Forces
Academies Preparatory School, Pre-cadets who have flatfoot suffering from longitudinal plantar arch pain
and intolerated to complete training. There has been limited knowledge about complication of flatfoot in
physical training and prevalence of flatfoot. The objective of this study is to investigate the prevalence of
flatfoot and the relationship between flatfoot and physical fitness in Armed Forces Academies Preparatory
Pre Cadet.
Methodology : 1,608 Pre-cadets were recruited to participate in this study. Questionnaire and physical
fitness testing data (50 meter splint, distance run 1 km, standing long jump, shuttle run) were collected.
Both sides of footprints were performed with Harris’s mat. Chippaux-Smirak index (CSI) were calculated
from the footprints and diagnosed to be flatfoot in case of CSI > 0.45. Jack’s toe rising test and ankle
dorsiflexion were used to classify the flexibility of flatfoot and tightness of Achilles tendon.
Results: The prevalence of flatfoot was 35.3 % (flexible flatfoot 29.9 % and rigid flatfoot 5.3 %). 2.7% was
flexible flatfoot with short TA and 2.8 % was rigid flatfoot with short TA. Flatfoot increased pain during
training comparing with normal feet significantly (odds ratio 2.09, P < 0.05). The odds ratio of rigid flatfoot,
flexible flatfoot with short TA, rigid flatfoot with short TA comparing with normal feet were 4.58, 5.5, and
8.45, respectively. However, in this study shows the relation between standing long jump and flatfoot that
Pre-cadets who had flexible flatfoot without short TA could jump further than normal feet, flexible flatfoot
with short TA and rigid flatfoot without short TA significantly.
Conclusions : The prevalence of flatfoot in Armed Forces Academies Preparatory Pre Cadet was 35.3 %.
Flatfoot were associated to pain during training. The relationship between flatfoot and physical fitness,
however needs further investigation.
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 53
Efficacy of Skin Traction to Control Pain for Hip Fracture
Pokrat Ugsornwong MD.
Department of Orthopedics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objective : To compare the analgesic benefit of preoperative skin traction in patients with hip fracture.
Material and Method : Patients with hip fracture from the Bhumiphol Hospital were enrolled and assessed
for initial pain score. Patients were randomly divided into two equal groups. The first group received skin
traction and the second group was treated with bed rest only. Both groups were assessed the pain score by
use a visual analogue scale at 12, 24, 36, 48 hour after admission and the times of receiving the morphine
injection. The pain score and times of receiving the morphine were compared by using independent t-test.
Results : A total of 47 patients were recruited. Twenty-four patients were randomized to be treated with
skin traction and the other were treated with bed rest. No significant differences were found in the
demographic data between two groups. The pain scores of the patient who were treated with skin traction
was 7.62+1.84, 6.62+1.18, 5.50+1.31, 4.75+1.04 and the pain scores in bed rest group were 6.87+2.47,
5.87+2.29, 5.75+2.29, 4.25+1.28 at 12, 24, 36, 48 hour respectively.The times of receiving the morphine
injection were 2.25+1.58 in skin traction group and 2.00+2.13 in bed rest group. No significant differences
were found in the pain score and the times of receiving the morphine injection between two groups.
Conclusion : The preoperative skin traction in patients with hip fractures does not provide significant pain
relief as compared with bed rest only.
54 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
A Comparison of Kinyoun Staining and Fluorescent Microscopy for
Diagnosis of Tuberculosis
Thidarat Saewong
Microbiology Division, Department of Pathology, Bhumibol Adulydej Hospital, RTAF, Bangkok, Thailand
Background : According to WHO one third of the world population have tuberculosis. Sputum smear
microscopy is fast and inexpensive technique for early detection of tuberculosis (TB) in high incidence
areas. The Ziehl–Neelsen and Kinyoun staining methods have low sensitivity. WHO have recommended
the new sensitivity method, fluorescence staining was instead. This study showed the comparison
between fluorescence stain and conventional Kinyoun stain in their efficacy for tuberculosis diagnosis.
Methods : By active screening 411 specimens were identified from Bhumibol Adulyadej Hospital.
All specimens were screen for Acid Fast Bacilli (AFB) by Kinyoun and Fluorescence staining methods.
Both smears were then air dried, heat fixed, and stained by the Kinyoun and Fluorescence staining
technique. The stained slides were graded following International Union Against Tuberculosis and Lung
Diseases guidelines. 43 specimens were cultured for TB by Liquid method, results were considered as gold
standard to calculate sensitivity.
Results : Of 411 specimens of suspected tuberculosis were included in the study. 49 positive specimens
showed that, only 21 (42.9 %) specimens were positive fluorescence staining methods and 28 (57.1 %)
specimens were positive both on direct methods. In addition, the result of 43 positive TB culture showed
that, 16 (37.2 %) specimens were positive on both method and only 9 (20.9 %) specimens were positive
fluorescence staining method. The sensitivity of Kinyoun and Fluorescence staining methods was different
when using positive culture as the gold standard (37.2 % vs. 58.1 %).
Conclusions : The results showed that fluorescence staining methods has a high sensitivity more than
Kinyoun stain by 20.9 %. Therefore, the national programs in high TB burden countries may consider
incorporating the technique into their guidelines at least in the district and higher level laboratories to
improve case finding strategy.
Keywords : Kinyoun staining, fluorescent microscopy, diagnosis of tuberculosis
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 55
Prevalence of Rotational Mal-alignment of Femur Following Intramedullary Nailing
Attanakan Kawpradist MD.
Orthopedics Surgery, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : Intramedullary (IM) nailing has become the preferred method of treatment for fractures of the
femur in adults. It requires a small incision and minimum dissection, gives excellent healing of the fracture
and rapid recovery. The semi-closed approach makes IM nailing a technically demanding procedure.
It is impossible to secure an anatomical reduction under direct vision, resulting in less rotational control
in comparison to the classical method of fixation by a plate. However, initial biomechanical studies
suggest that it causes a substantial change in load bearing in the affected extremity. CT is useful in the
identification of the degree of mal-rotation and in surgical planning.
Objective : This study was designed to evaluate the prevalence of rotationalmalalignment of femur
following intramedullary nailing.
Materials and methods : All closed unilateral femoral shaft fractures in patients aged 18 or over treated
between March 2009 and December 2013 were included in the current study. All patients received
a postoperative CT-scan to estimate femoral antetorsion. All fractures were treated with intramedullary
nailing on a radiolucent table. Retrospectively, all patients were analyzed according to the following
parameters: (1) femoral antetorsion of both limbs and antetorsion difference in degrees, (2) incidence of
femoral malrotation.
Results : Eight patients (17 %) patients in 45 patients were included in this study, 100 % male, average age
24.5 years (range 17–34 years). Clinically relevant malrotation (greater than 150) was found in 4 cases (50 %).
Conclusion : CT is useful identification clinically relevant degree of mal-rotation and in surgical planning.
Keyword : computer tomography, Intramedullary Nailing
56 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Laparoscopic Choledochoduodenostomy with Small Silicone Stent Placement
for Patent Choledochoduodenostomy End-to-side Anastomosis in Patients
with Difficult CBD Stones
Phrompirun Wattanawiggid MD.
Surgery Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Management of difficult common bile duct stones in the era of laparoscopy is controversy.
Although endoscopic retrograde cholangiopancreatography (ERCP) is widely used procedure for remove
common bile duct stones but occasionally biliary bypass procedure is required. In the case of impacted
stone of distal part of common bile duct (CBD), benign biliary stricture or failure of endoscopic stone
removal, laparoscopic choledochoduodenostomy (CDD) may be an option for treatment in these conditions.
This surgical procedure has been scared about its complications, but in our experience this procedure
offered best outcome especially in elderly patient who cannot tolerate major operation.
In our series, ten laparoscopic CDD was performed under two surgeons between 2013 and 2015.
Average age of patient was 74 years (55-95), 80 % has comorbid diseases. Indication for bilioenteric bypass
is impacted CBD stone, multiple CBD stones with benign stricture and failure of endoscopic stones
removal. We had the recent patient in our series, 95 year-old female, she had multiple (>3) large (3 cm) CBD
stones which can removed and underwent laparoscopic CDD uneventfully.
The laparoscopic port was placed by 4-5 ports. One cm diameter end-to-side CDS anastomosis
was performed with interrupted sutures over small silicone stent. The operative time was 178+20 (136-205)
min. There was no conversion. The hospital stay was 6.7 days. There was no mortality. Two weeks follow
up of patients showed normal liver function test and good short term results.
In conclusion, the laparoscopic CDD gives good short-term outcomes and feasible in our
experience and could be considered as an alternative to treatment patients with indication; impacted CBD
stone, multiple CBD stones and CBD stone which cannot be remove by ERCP. The utilization of small
silicone stent is anastomosis patency in couple weeks and suturing technique.
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 57
Polyethylene Glycol 4,000 without Electrolytes Versus Milk of Magnesia
for the Treatment of Functional Constipation in Infants and Young Children:
A Randomized Controlled Trial
Gp.Capt. Panjachat Ratanamongkol MD.
Pediatric Department, Bhumibol Adulydej Hospital, RTAF, Bangkok, Thailand
“A Thai Research of Pediatric Constipation to Cochrane Review and International Guideline”
Background : Functional constipation is a common pediatric problem. Polyethylene glycol and milk of
magnesia are osmotic agents used to treat constipation. There were few studies comparing the two
laxatives for the treatment of functional constipation in infants and young children.
Objective : To compare two laxatives, polyethylene glycol 4,000 without electrolytes (PEG) and milk of
magnesia (MOM), by evaluating the effectiveness, adverse effects and patient compliance.
Materials and methods : A randomized controlled trial was performed for 94 patients aged one-four years
who attended at the pediatric outpatient clinic of Bhumibol Adulyadej Hospital and met the Rome III
criteria for functional constipation receiving either PEG or MOM for four weeks. The primary outcome
evaluation was the improvement rate. The secondary outcomes included the improvement of stool frequency, adverse effects and compliance rate.
Results : Eighty-nine patients completed the study, including 46 in the PEG group and 43 in the MOM
group. Baseline characteristics of age, body weight, sex, initial stool frequency and duration of constipation
were similar between groups. At the four week follow-up visit, 91 % of PEG-treated patients and 65 % of the
MOM-treated patients exhibited improvement (p=0.003). Patients in the PEG group had greater increase
of stool frequency after treatment than patients in the MOM group. Overall adverse effects were mild,
transient and not different among groups, but there was more diarrhoea in MOM treated patients. No
serious adverse effects were observed. Compliance rates were 89 % for PEG and 72 % for MOM (p=0.041).
Conclusion : PEG was more effective and had greater patient compliance than MOM for the management
of functional constipation in infants and children aged one-four years.
Keywords : Functional constipation, milk of magnesia, polyethylene glycol
58 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
The Perception and the Expectation in Second Year of Air Force Student
Nurses to Clinical Teaching Behaviors of Pediatric Nurse Instructors in
Pediatric Nursing Practicum1
Wg.Cdr. Nattaya Pungswang RN; MSN., Wg.Cdr. Tossaporn Promwa RN; MSN.
Royal Thai Air Force Nursing College, RTAF, Bangkok, Thailand
Objective : 1, to study perception of Air Force Student Nurses to Clinical Teaching Behaviors of Pediatric
nurse Instructors. 2, to study expectation of Air Force Student Nurses to Clinical teaching behaviors of
Pediatric nurse Instructors. 3, to compare perception and expectation of Air Force student Nurses to
clinical Teaching Behaviors of pediatric nurse instructors.
Descriptive research : The sample were 49 Second Year of Air Force Student Nurses.
Method : data were collected using questionnaires of perception and expectation with 5 rating scales.
Content validity was done by three experts. Reliability was 0.92.
Results :
1, the clinical teaching behaviors of pediatric nurse instructors were perceived by Air Force
Student Nurses were found at high levels, x = 4.83.
2, the clinical teaching behaviors of pediatric nurse instructors were expected by Air Force
Student Nurses were found at high levels, x = 4.70 .
3, the comparison of the perception and expectation of Air Force Student Nurses were significant
different at 0.00.
Conclusion : The study provided the benefit for the nurse instructors to improve teaching and learning
method in clinic. The study defined high standard of teaching of the nurse instructors thus, nurse
instructors should remain their abilities in clinical teaching and develop method of teaching continuously.
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 59
A Study of Anxiety, Readiness, Achievement Motivation of Air Force Student
Nurses in Professional Nurse Licensure Examination
Wg.Cdr. Bang-orn Ritudom
Royal Thai Air Force Nursing College, RTAF, Bangkok, Thailand
Objective : 1, to examine the level of anxiety. 2, to study the readiness. 3, to investigate the achievement
motivation and 4, satisfaction of the preparedness of professional nurse licensure examination program.
Research : This study is a descriptive research.
Samples : 49 Senior Air Force student nurses were selected in this study.
Method : Research instrument were questionnaires with five rating scales of the anxiety, readiness,
achievement motivation and satisfaction of the preparedness program. Reliability of the research
instrument was 0.95. Data were analyzed by arithmetic mean and t-test.
Research results :
1, the anxiety of Senior Air Force student nurses toward licensure examination one month were
at high levels.
2, the readiness of Senior Air Force student nurses for licensure examination were at high levels.
3, the achievement motivation of Senior Air Force student nurses before licensure took place
were found at a high level.
4, the satisfaction toward professional nurse licensure examination program of Senior Air Force
student nurses were at a high level.
Conclusion : the study revealed high level of anxiety which could cause physical illness. Thus during the
period of preparedness, nurse instructor should support their mental health and promote their physical
strength. The high level of readiness, high achievement motivation for licensure examination could bring
them a chance to pass the licensure examination. Thus, nurse instructor should enhance their readiness
and achievement motivation in order to increase the successful of licensure examination. The professional
nurse licensure examination program was very significant. Since, this program could assist senior Air
Force Student nurse decreased anxiety and built their confidences to deal with the licensure examination.
60 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
A Comparative Study of Perceived Stress, Adaptation, Self- esteem, and
Resilience of the Armed Forces Nursing Academy Cadets, Republic of Korea
and the Royal Thai Air Force Nursing College, Student Nurses, Thailand
Gp.Capt. Watcharaporn Paorohit. RN; PhD.
Royal Thai Air Force Nursing College, RTAF, Bangkok, Thailand
Objectives : 1, To compare perceived stress, adaptation, self esteem, and resilience of AFNA Cadets, and
RTAFNC student nurses. 2, To investigate the differences of perceived stress, adaptation, self esteem, and
resilience of AFNA Cadets, and RTAFNC, student nurses classified by general characteristic of grade,
boyfriend, mentor and health problems.
Materials and Method : Descriptive study was carried out. Samples composed of 264 A.F.N.A. cadets, and
196 RTAFNC. Student nurses. Research instrument composed of 4 sets of questionnaires of stress, adaption,
self-esteem and resilience. Data were gathered at A.F.N.A and RTAFNC after receiving permission to
collect data. 264 AFNA Cadets and 196 RTAFNC student nurses who agreed to participate in the study
were asked to fill out the questionnaires after receiving permission by informed consent from. The comparisons of mean scores were computed by t-test and ANOVA.
Research Results : The Comparison of A.F.N.A cadets, and RTAFNC SN perceived stress, adaptation,
self esteem and resilience were found all variables were significantly different, perceived stress (t= 18.05
p < .001), adaptation (t= 92.88, p< .001), self esteem (t= 14.01,p<.001), resilience (t= 555.07, p< .001).
The comparisons mean scores of RTAFNC student nurses perceived stress were not significant different
when classified by grade, boyfriend, mentor and health problem. Comparison mean scores of adaptation
were significant different when classified by health problem (t=4.52, p<.05). Comparison mean scores of self
esteem when classified by grade revealed grade 1, 3, 4 differed from grade 4 Besides, the differences mean
score of self- esteem classified by having boyfriend and no having boyfriend determined the differences of
the two groups. Having mentored and no mentor had shown no significant different between of perceived
stress, adaptation, self esteem, and resilience. Health problem and no health problem indicated no
significant different mean scores of adaptation.
Conclusion : The mentors play a vital role in the increment of adaptation, self esteem and resilience. As a
consequence, mentor system should be strengthened in the military nursing academy. Besides, health
status takes effect on adaptation, thus the student nurses who had health problems should be promote
healthy status.
Keywords : Stress, Adaptation, Self- esteem, and Resilience
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 61
Lesson Learned : Asia Pacific Military Nursing Exchange 8th, Republic of Korea. 2014
Sqn.Ldr. Papasorn Suriyo RN.
Royal Thai Air Force Nursing College, RTAF, Bangkok, Thailand
Background : Thai military nurses play a vital in peace and war. The main mission of Thai military nurses
is to save lives and assist the armed forces personnel and the people. Every year USAPAC and one of the
Asian nations are the co-host to arrange the conference which is called Asia Pacific Military Nursing
Exchange (APMNE). The conference provided a great benefit to the delegate from many Asian nations.
Being the co-host of the conference would take turn to all members around Pacific regions. Last year
(2014), USAPAC and Republic of Korea decided to be the co-host of APMNE 8th which was held in
Daejeon.
Objectives : 1, to describe how to prepare before the conference. 2, to explain experiences gained by the
conference. 3, to depict how to deal with disaster and emergency situation.
Materials and Method : Descriptive study was done. Five Air Force Nurses istructors were purposively
selected in this study. Research instrument were self report and journal writing. Content analysis was
used to discover critical issue.
Results : 1. Self preparedness of English language was very important to communicate among delegates.
Understanding the cultural different of Asian nations was needed before the conference. Rank, medal,
insignia of each the military nurses in Asian nations should be studied prior to the conference. Academic
article, abstract should be written and submitted at least 2 months before the conference was held.
2. Experiences gained were how to deal with crisis situation in the battle field such as triage and transport
the patient from the battle field to the staging unit. Besides, health promotion researches for all level of
the armed forces personnel in ASEAN nations were presented which provide benefit information that can
apply to Thai military context. 3. When disaster and emergency situation occurred, military nurses were
ready to respond to those crisis situation. Many nations keep training every 6 months to deal with disaster
and emergency situation. Medical supply and medical equipment were manage by military nurses. Many
nursing therapeutic were shared and discussed in the conferences such as acupuncture and acupressure
which took effect on pain relieve and decrease blood pressure.
Conclusion : APMNE 8th provided a great benefit for Thai military nurses. Thus, Thai Air Force nurses
should prepare themselves particularly in English language and military nursing skill of disaster and
emergency nursing in order to share experiences among participants.
62 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Learning Experiences: Exchange Program of RTAFNC and KAFNA. 2014
Wg.Cdr. Chanita Amornrattanathada
Royal Thai Air Force Nursing College, RTAF, Bangkok, Thailand
Background : Exchange Program of Royal Thai Air Force Nursing College (RTAFNC) and Korea Armed
Forces Nursing Academy (KAFNA) began in 2012. The program launches continuously every year.
The main purpose of the program is to exchange learning experiences of how to train to be a good military
nurse in insurgent and calamity circumstance. The program was 5 days training which focused on disaster
and emergency nursing and cultural tour. In 2014, the exchange program emphasized on simulation of
natural disaster and in the battle field which could be applied to the RTAFNC context both in theory and
practice.
Objectives : 1, to explain how to train the cadets when encounter disaster and emergency nursing. 2, to
describe cultural differences of the Thai Air Force student nurses and KAFNA cadets. 3, to identify
training material for skill development.
Materials and Method : Descriptive study was done. Air Force Student Nurses were purposively selected.
Research instrument were interview and journal writing. Content analysis was used to discover significant
issue.
Result : 1. The strategy of training was defined as “we trained as we flight”. Theories of disaster and
emergency nursing were taught by expert professors. Table exercise was done to develop triage
competency. Simulation of earth quake was used to train disaster nursing and simulation of wartime was
used to train for emergency nursing. 2. Cultural differences of the cadets and AFNS were command and
control system. Senior Cadets (class 4) did physical exercises harder than junior cadets where as senior
AFSNs did physical exercises less than junior AFSNs. The sense of pride and discipline of cadets and
AFSN were found the same. Cadets had stronger military training program than AFSN. 3. Training
materials for skill development of KAFNA were complicated and modernized whereas RTAFNC had less
training materials. Training material of KAFNA could illustrate human body and internal organs naturally.
Conclusion : Exchange Program of RTAFNC and KAFNA was a unique program. Cadets and AFSN were
satisfied with the program because they gained precious experiences of military training and cultural
differences. This program should be continued and supported by the leaders of the two institutions.
Keywords : Learning experiences, Exchange Program of RTAFNC and KAFNA
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 63
Compare Effectiveness of Vaseline and Zinc Paste on Healing Time of
Diapers Rash in Diarrhea Children
Wg.Cdr. Sommai Tratong RN.
Pediatric Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Introduction : Diapers rash is one common rash in diarrhea children. Cause of diapers rash is skin wetness,
elevated pH fecal enzymes, and microbial agent. It is patient children discomfort and pain at buttock and
risk of infection because they often have prevention skin. Important care was used skin barrier products for
early healing times of diapers rash.
Objective : This research was aimed to compare efficiency of Vaseline and Zinc paste on healing time of
diapers rash in diarrhea children.
Materials and methods : This research was double blind control study design. The sample was 32 children
patients with diapers rash from diarrhea who admitted at Pediatric Department Bhumibol Adulyadej
Hospital RTAF from April to September 2010. Assessing severity of diapers rash was applied from Jordan
and et.al. 1986. The products both Vaseline and zinc paste were randomized to left buttock and right
buttock. The particular area of all samples were covered by pampers. There were 3 steps in this study to
evaluate the healing time of diapers rash. The first, all samples were talked a photography of diapers rash
to determine severity of diapers rash, then recorded time of diarrheas and the last, monitored healing time
of diapers rash respectively.
Results : The subjects were 32 children patients enrolled in the study, 14 (43.75 %) were males and 18
(56.25 %) were females, age were ranged between 1 to 24 months. Chi-square test was used to compare the
severities of diapers rash between using Vaseline and zinc paste. It was found that the severity of diapers
rash in both two group were not significantly different. (P> .05) Comparing efficiency of Vaseline and zinc
paste on healing time of diapers rash in diarrhea children by pair t-test were not significantly different.
(p> .05). However, maternal satisfactions preferred to Vaseline because it was very easy to clean.
Conclusion : On the basis of this study finding, the effectiveness of Vaseline and zinc paste on healing time
of diapers rash were not significantly different.
Keyword : Vaseline, Zinc Paste, healing time, diapers rash
64 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
The Effectiveness of the Clinical Practice Guidelines for the Prevention of
Pressure Ulcers. In Patients who have been Weighted Pull through the Skin
Waraporn Tumtong
Orthopaedic Team, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
This research project to develop a routine. Aims to reduce the incidence of pressure ulcers in
patients with weighted pull through the skin. The sample consisted of patients who had been diagnosed
as Fx Around Hip and treated with a draw weight through the skin at the orthopedic ward in Bhumibol
Adulyadej Hospital. In the 6-month period between November 2556 - April 2557 total 35 case in the
Methodology Storage Case control is used to collect data. In patients with hip fractures in patients Admit
Orthopaedic in Bhumibol Adulyadej Hospital By using the best practices developed in the care of patients
who have been pulled through the skin, which is weighted by a review of materials research. Reviews of
specialist orthopedic and nurses with experience in caring for patients with orthopedic. The instrument
used in this study consisted Set Skin Traction, Transperant Film, Webril and Elastic Bandage data analysis
using statistical analysis by computer by SPSS is general descriptive statistics, including the number,
percentage and compared. The relationship of the variables tested using Chi - square test.
Results were as follows :
1. The incidence of pressure ulcers as a hamstring pull weight. 0 percent
2. The number of days in hospital an average decrease of 2.2 days.
3. The cost of medical treatment, a reduction of 10,340 baht per person.
4. The patient satisfaction rate of increase in healthcare. Equal to 7.5 percent
5. The clinical practice guidelines for the prevention of pressure ulcers in patients who have been
weighted pull through the skin.
Keywords : prevention of pressure ulcers, clinical practice guidelines
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 65
Causes of Surgical Delay in Patients with Hip Fracture in
Bhumibol Adulayadej Hospital
Pichai Lertwattanaseri MD., Sqn.Ldr. Rahut Jarayapun MD.
Department of Orthopedics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Introduction : Delayed time to surgery is associated with an increase in medical complications and delayed
rehabilitation for hip-fracture patients. The aim of this study was to evaluate whether an improved fast
tracking system for hip-fracture patients can reduce waiting time to surgery.
Design : Prospective cohort study.
Measurements : Time to surgery, reasons for surgical delay.
Results : Median time to surgery was more than 72 hours. Lack of operating room availability (60.7 %) and
medical problems (33.1 %) were the main reasons for delays longer than 48 hours.
Conclusion : The reported association between late surgery and higher morbidity and mortality in patients
with hip fracture is mostly explained by medical reasons for surgical delay, although some association
between very delayed surgery and worse outcomes persists. By fast-tracking hip-fracture patients straight
to the orthopaedic ward, our clinic was able to decrease the mean time from arrival to start of surgery and
the majority of these patients underwent surgery within 48 h. We believe that this fast-track system could
be used in our and other hospitals.
66 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
The Survey Study of Self – Harm Patients Arrived at the Accident and
Emergency Room, Bhumibol Adulyadej Hospital
Phasut Nganwai MD., Panida Yongskulrote MD.
Emergency Medicine Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objective : To study of self-harm patient’s level of SAD person score and to study characteristics and
associated factors of suicidal behavior in self-harm patients arrived at the Accident and Emergency Room,
Bhumibol Adulyadej Hospital.
Material and Method : This was a survey study to study characteristic of self – harm patients arrived at the
Accident and Emergency Room, Bhumibol Adulyadej Hospital. Collect data between 1 January 2013 and
31 December 2013. The study sample was included 153 patients. Associations between factors and
self-harm were analyzed by the following statistical evaluation method : chi – square test , Fisher’s exact
test, Stepwise Logistics Regression Analysis, Odd ratio, 95 % confident interval.
Results : of the 153 self – harm patients studied, most were female (62.25 %), age between 16 – 45 years
(62 %), Thai Nationality (97.38 %), Buddhism (99.3 %), couple (80.67 %), diploma (54.61 %). The two most
common occupations were laborers (64.24 %) and student (31.12 %), Stay with my family (48.68 %), 3.3 % of
the sample had psychiatric problems, 9.86 % of the sample had depressive disorders. The most common
motivating events were described as, “Love affair problems” (67.3 %). The most common methods of
committing self – harm were described as, “ingesting overdosed drugs” (37.3 %). Most (93.5 %) self – harm
impulsively with no pre-mediated plan. Regarding Intent 67.11 %, factors that were found to be associated
with intentions to die were gender, educational level, occupation and psychiatric disorders. Notable factor
rations included: female to male (0.84:1); occupation laborers to student (0.441:1); and underlying
psychiatric disorders to no psychiatric disorders (0.834:1)
Conclusion : factor that were found to be associated with intentions to die include: female gender,
educational level above High School, occupation laborers and psychiatric disorders.
Keywords : self – harm, suicidal behavior
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 67
Treatment Outcome of Childhood Acute Lymphoblastic Leukemia
Sutatip Watthanaphanalai MD.
Department of Pediatrics, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Background : Acute lymphoblastic leukemia (ALL) is the most common pediatric malignancy. Survival
rate and outcome after treatment vary among institutes and depend on protocol of treatment. In 2006,
Thai Pediatric Oncology Group (Thai POG) developed the national guidelines for the treatment of
childhood leukemia.
Objective : To assess the outcomes of treatment Thai POG protocol for ALL and to evaluate the factors
influencing relapse among childhood ALL treated under Thai POG protocol at Bhumibol Adulyadej
Hospital between 1 January 2006 and 30 June 2014.
Materials and methods : This study design was retrospective cohort study.
Results : Fourteen cases of childhood Acute Lymphoblastic Leukemia (0-15 years of age), male/female
ratio1.7:1. The first there common clinical presentating were anemia, hepatomegaly and fever. All of the
patients had complete remission after induction of remission. The survival rate at 3 years survival was 94.7
(95 % CI: 78.75-110.67).
Conclusion : The survival rate at 3 years and 5 years were 94.7 and 78.8 (95 % CI: 78.75-110.67).
The comparisons of clinical characteristics, laboratory tests, febrile neutropenia between the remission
group and the relapsed or died group were not statistically significant difference.
Keywards : Acute lymphoblastic leukemia, Childhood, Outcome, ThaiPOG protocol, Survival rate
68 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Incidence and wound complications of patients bitten
by green pit vipers who had normal initial venous clotting time(VCT)
or 20 minute whole blood clotting test(20WBCT)
at the Emergency Department in Bhumibol Adulyadej Hospital, RTAF
Chonlatid Prapan MD.
Emergency Medicine Department, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Objective : The study had two objectives which were incidence of patients bitten by green
pit vipers and their wound complications.
Materials and Method : This was a descriptive study to look back in time to study events
that have already occurred.Collected data of patients bitten by snakes between January
1,2009 to December 31,2013.The sample population is 320 patients.The data was analyzed
by SPSS version 17 presenting in numbers percentage mean standard deviation and
95 % Confidence Interval.
Results : 32o patients were studied by.There are 182 males (56 %) and138 females (43.1 %).
141 patients were bitten by green pit viper (44.06 %). 179 patients were bitten by other
snakes (55.94 %). The ration of female to male was1 : 1.32. Mean age was 40.3. The incidence
of green pit viper bite was 141. The 95 % confidence interval is 33 to 55, Which had lower
limit of 106 and upper limit of 176. There were wound complications among patients bitten
by green pit viper and other snakes. Which had statistical significant in wound infections.
There were 10 patients bitten by green pit viper (7.1 %) and 5 patients bitten by other
snakes (2.8 %). It was statistical significant at P< 0.00001
Conclusion : The incidence of green pit viper bite is 141,which 95 % CI 33-55.
Keywords : Incidence, green pit viper, complications
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 69
Placental Weight for Gestational Age and
Adverse Neonatal Outcome at Bhumibol Adulyadej Hospital
Kesinee Lonimitdee, MD., Sinart Prommas, MD.
Obstetrics and Gynecology Department, Bhumibol Adulyadej Hospital, Bangkok, Thailand
Objectives : To exam association between placental weight and perinatal outcome.
Materials and Methods : The retrospective cohort study was performed. Data recorded from birth records
were reviewed. Placental weight was divided in to three groups, abnormal and normal weight (high and
low, normal) according to placenta weight percentile at 10 and 90 percentile respectively. The association
to birth weight was analyzed.
Results : The abnormal placental weight group was associated with increased Apgar score at 1 and 5
minute less than 7 (RR 4.0, 95 % CI=1.79-8.91 and RR 4.22, 95 % CI=1.31-13.55), NICU admission rates
(RR 4.29, 95 % CI=2.42-7.59), and respiratory complication (RR 3.0, 95 % CI=1.34-6.04) when compared with
the normal placental weight group.
Conclusions : Abnormal placental weight was significantly associated with adverse pregnancy outcomes
such as Apgar score at 1 and 5 minute less than 7, NICU admission rates and respiratory complication.
Keywords : Placental Weight for Gestational Age, Adverse Neonatal Outcome
70 Royal Thai Air Force Medical Gazette
Vol. 61 No. 1 January - April 2015
Effectiveness of The Development in Tranformation Model Using Focus
Charting in Surgical Intensive Care Unit of Bhumibol Adulyadej Hospital
Directorate of Medical Services Royal Thai Air Force
Sqn.Ldr. Thitima Khanngoen MD., Flt.Lt. Wiparat Suwanmas MD.
Department of Surgery, Bhumibol Adulyadej Hospital, RTAF, Bangkok, Thailand
Surgical Intensive Care Unit of Bhumipol Adulyadej Hospital Directorate of Medical Service Royal
Thai Air Force where is perform in patient care who has critical condition and get into trouble health way
and the conspiracy heals that absorb to overlap. They must have check heal with a tool and all Technology
for help survive there is doing something through 24 hour and the symptoms of the patient have the
change stay all the time that must modify the conspiracy heals to follow the symptoms of the patient.
The symptoms and the preservation of each patient lay to have the absorb overlap and modify to quickly
and might enhance violence level menaces can arrive at the life. These data is the necessities
and important in something Medical report and subsequent lying submit data for. Patient care has
continuously and effective is born the advantage build. The researches this time is the research and
develop to have the objective for (1) increase efficiency the communication in patient care (2) decrease the
period of time in transformation (3) development in transformation system in Surgical Intensive Care Unit.
A tool that use in the research for example (1) transformation report format with FOCUS MODEL
(2) the document collecting data compose a problem of the patient that must follow up (3) contentment
questionnaire of vocation nurse analyze the data by frequency distribution percentage average, the part
deviates the standard and the statistics tests is paired t-test. The research result can summarize as follows
(1) transformation report format with FOCUS MODEL provided the guideline and cover the problem of
patiens. (2) Decrease the period of taking time for transformation (3) The perception of professional nurses
in transformation model after the development higher than prior the development (p< 0.001).
Vol. 61 No. 1 January - April 2015
Royal Thai Air Force Medical Gazette 71
คณะกรรมการจัดประชุมวิชาการและฝึ กอบรม รพ.ภูมิพลอดุลยเดช พอ.
น.อ.สันติ
น.อ.ธนาสนธิ
น.อ.ธํารงค์ประวัติ
น.อ.สินาท
น.อ.หญิง นันทนา
น.อ.หญิง วิไลลักษณ์
น.อ.หญิง ม.ล.อภิรดี
น.อ.หญิง พิมพา
น.อ.หญิง ศศวรรณ
น.ท.หญิง สัญสนีย ์
น.ท.หญิง มณฑกาญจน์
น.ท.หญิง พัชรี
น.ต.พาคินทร์
ร.อ.หญิง ปาริชาติ
ร.ท.หญิง อาจารี
ร.ท.อรรถสิทธิ
ศรีเสริมโภค
ธรรมกุล
เชิดเกียรติกลุ
พรหมมาศ
กวียานันท์
ปาลกะวงศ์ ณ อยุธยา
กฤดากร
รุ่งนพคุณ
ชินรัตนพิสทิ ธิ
พงษ์ภกั ดี
ระหงษ์
สิงห์เจริญ
วาทิน
เทียบรัตน์
กันภัย
ดุลอํานวย
ทีปรึกษา
ประธานกรรมการ
รองประธานกรรมการ
กรรมการ
กรรมการ
กรรมการ
กรรมการและเหรัญญิก
กรรมการและเลขานุ การ
กรรมการ
กรรมการ
กรรมการ
กรรมการ
กรรมการ
กรรมการ
กรรมการ
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