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  1. Article ; Online: The Intention to Use Telemedicine by Surgical Patients in Response to COVID-19

    Arunotai Siriussawakul / Thanawan Phongsatha

    Siriraj Medical Journal, Vol 74, Iss

    2022  Volume 11

    Abstract: Objective: This study explored patients’ intention to use telemedicine instead of traveling to a hospital during the current global COVID-19 crisis. The framework focused on the relationships between variables derived from the technology acceptance model ...

    Abstract Objective: This study explored patients’ intention to use telemedicine instead of traveling to a hospital during the current global COVID-19 crisis. The framework focused on the relationships between variables derived from the technology acceptance model and the extended unified theory of acceptance and use of technology model. Materials and Methods: Multistage sampling procedures were applied to recruit samples using nonprobability sampling methods. Adult patients who had undergone surgery at a university hospital participated; all were experienced in using online meeting applications and online payment services in their daily lives. Consent forms and online questionnaires were distributed via a Google Forms link. Results: Between October and December 2021, 502 patients undergoing procedures participated in the study. Five variables—social influence, trust, price, perceived usefulness, and perceived ease of use—significantly impacted intention to use. Perceived ease of use significantly impacted perceived usefulness, with a value of 0.679***. In addition, perceived ease of use indirectly influenced intention to use (impact value, 0.103***). Performance expectancy did not significantly impact intention to use, with an impact value of -0.012. Conclusion: The contributions of this study will enable developers, medical professionals, and marketers to improve telemedicine services to better satisfy patients undergoing surgery and increase their intention to use telemedicine. However, the performance expectancy aspect may not warrant patients’ intention. Additionally, the research is recommended on other potential variables influencing telemedicine utilization, such as psychological expectations, performance expectations, and technical conditions.
    Keywords Telemedicine ; Covid 19 ; surgery ; intention to use ; Medicine (General) ; R5-920
    Language English
    Publishing date 2022-11-01T00:00:00Z
    Publisher Mahidol University
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Ward Characteristics Related to Quality and Pitfalls of Basic Life Support in Cardiopulmonary Resuscitation Simulated Survey

    Arunotai Siriussawakul

    Siriraj Medical Journal, Vol 65, Iss

    2016  Volume 2

    Abstract: Objective: To assess the quality of nurses’ basic life support (BLS) and to determine pitfalls in BLS in relation to ward characteristics. Setting: A 2,400-bed university hospital in Thailand. Methods: A 1-year retrospective simulated audit for 2009 to ... ...

    Abstract Objective: To assess the quality of nurses’ basic life support (BLS) and to determine pitfalls in BLS in relation to ward characteristics. Setting: A 2,400-bed university hospital in Thailand. Methods: A 1-year retrospective simulated audit for 2009 to assess nurses’ BLS performance at each step. Each observer assessed the subjects’ performance by using a scoring sheet and noting the objective manikin data related to chest compression. Results: A total of 57 wards from intensive care units, critical wards, procedural units, general wards or outpatient units were audited. Only 24 out of 57 (42.1%) did airway maneuvers correctly, while only 2 out of 57 (3.5%) could rescue breathing with chest movement. For the circulation maneuvers, carotid pulse check, hand position, the depth and the rate of cardiac compression were mostly performed incorrectly. Exactly 14.0% of subjects did not palpate the carotid pulse, and 52.6% palpated it incorrectly. Thirty-three nurses (57.9%) located and placed their hands on the wrong position. Forty-one nurses (71.9%) did not achieve the requisite chest compression depth, while thirty-one nurses (54.4%) did not achieve the target chest compression rate. The overall BLS performance of nurses in the High Risk Zone was better than that of nurses in the Low Risk Zone, except in the case of the airway sector. Conclusion: The CPR audit evaluated the resuscitation performance during simulated cardiac arrest in the service setting, and compared wards nurses in 2 categories related to the risk of cardiac arrest. Improvement in the organisation of training and the systematic approach to CPR should be adopted.
    Keywords Medicine (General) ; R5-920
    Language English
    Publishing date 2016-08-01T00:00:00Z
    Publisher Mahidol University
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: The Role of Ultrasonography in Confirming Position of Endotracheal Tube when Interpreted by Emergency Medicine Residents

    Arunotai Siriussawakul

    Siriraj Medical Journal, Vol 67, Iss

    2015  Volume 5

    Abstract: Background: Delays in the detection of endotracheal tube (ETT) misplacement increase morbidity and mortality. Although numerous methods have been suggested to verify ETT position, each method has its limitations in terms of its reliability and ... ...

    Abstract Background: Delays in the detection of endotracheal tube (ETT) misplacement increase morbidity and mortality. Although numerous methods have been suggested to verify ETT position, each method has its limitations in terms of its reliability and applicability. Recently, ultrasonography (US) has emerged to assess the ETT position. Objectives: This observation study was designed to assess the role of using ultrasonography for examining the ETT position among intubated patients who were admitted to the emergency department (ED). Methods: The study was conducted in patients at the ED of a university-based hospital from September 2010 to November 2010. The ultrasound was performed after confirmation by a clinical assessment and a portable chest radiograph (CXR)conducted by a second- or third-year,emergency-medicine resident on-call at ED. Results: Eighty patients were enrolled. The average time of US usage (time from turning the US machine on to finishing the confirmation of the ETT position and depth) was 149.9+91.7 seconds. The average time of CXR evaluation, which was the gold standard, was 30± 10 minutes. Improper position of ETT was detected by CXR in 11 cases and by US in one case. Conclusion: Ultrasonography could be used as the first line non-invasive ETT position instead of using CXR in ED. Keywords: Ultrasound, airway, confirmation, emergency
    Keywords Medicine (General) ; R5-920
    Language English
    Publishing date 2015-10-01T00:00:00Z
    Publisher Mahidol University
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Early postoperative neurocognitive complications in elderly patients: comparing those with and without preexisting mild cognitive impairment- a prospective study.

    Somnuke, Pawit / Srishewachart, Pensiri / Jiraphorncharas, Chalita / Khempetch, Asamaporn / Weeranithan, Jirapa / Suraarunsumrit, Patumporn / Srinonprasert, Varalak / Siriussawakul, Arunotai

    BMC geriatrics

    2024  Volume 24, Issue 1, Page(s) 84

    Abstract: Background: As societies age, increasing numbers of older adults undergo surgeries with anesthesia. Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) frequently occur in older surgical patients. Most of these patients already ... ...

    Abstract Background: As societies age, increasing numbers of older adults undergo surgeries with anesthesia. Postoperative delirium (POD) and postoperative cognitive dysfunction (POCD) frequently occur in older surgical patients. Most of these patients already have preoperative mild cognitive impairment (MCI). However, the correlation between MCI and POD remains unclear. This study aimed to determine the incidence of POD in elderly patients with and without preexisting MCI.
    Methods: A prospective study enrolled patients aged 60 years and above scheduled for major surgeries between December 2017 and April 2022. Preoperative MCI was determined by a Montreal Cognitive Assessment (MoCA) score between 18 and 24. POD was diagnosed using criteria from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). POCD was characterized by a MoCA score reduction of 2 or more points from the preoperative score. The primary outcome was the incidence of POD within the first 72 h postoperatively. Secondary outcomes encompassed other postoperative complications, including POCD.
    Results: The study comprised 223 elderly patients with MCI and 56 without MCI. The incidence of POD was 16.6% in the MCI group and 14.3% in the non-MCI group (P = 0.839). POCD occurred in 24.3% of MCI patients and 50% of non-MCI patients (P = 0.001). There were no significant differences in other postoperative complications between the groups. Postoperatively, the MCI group notably declined in visuospatial, attention, and orientation domains, while the non-MCI group declined in all domains except delayed recall.
    Conclusions: The incidence of POD was similar in the MCI and non-MCI groups. However, the non-MCI group demonstrated a higher incidence of POCD than the MCI group. This was identified by a reduction in postoperative MoCA scores for the visuospatial, naming, attention, language, abstraction, and orientation domains. These findings underscore the importance of postoperative cognitive assessments for both elderly patients with preexisting MCI and those with previously intact cognitive functions.
    Trial registration: This trial was retrospectively registered in the Thai Clinical Trials Registry on 15/01/2019 (registration number: TCTR20190115001).
    MeSH term(s) Aged ; Humans ; Prospective Studies ; Postoperative Complications/diagnosis ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Cognitive Dysfunction/diagnosis ; Cognitive Dysfunction/epidemiology ; Emergence Delirium ; Postoperative Cognitive Complications/diagnosis ; Postoperative Cognitive Complications/epidemiology ; Postoperative Cognitive Complications/etiology
    Language English
    Publishing date 2024-01-22
    Publishing country England
    Document type Journal Article
    ZDB-ID 2059865-8
    ISSN 1471-2318 ; 1471-2318
    ISSN (online) 1471-2318
    ISSN 1471-2318
    DOI 10.1186/s12877-024-04663-5
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Corrigendum: Severity of frailty using modified Thai Frailty Index, social factors, and prediction of mortality among community-dwelling older adults in a middle-income country.

    Morkphrom, Ekkaphop / Srinonprasert, Varalak / Sura-Amonrattana, Unchana / Siriussawakul, Arunotai / Sainimnuan, Supawadee / Preedachitkun, Rinrada / Aekplakorn, Wichai

    Frontiers in medicine

    2023  Volume 10, Page(s) 1272092

    Abstract: This corrects the article DOI: 10.3389/fmed.2022.1060990.]. ...

    Abstract [This corrects the article DOI: 10.3389/fmed.2022.1060990.].
    Language English
    Publishing date 2023-08-31
    Publishing country Switzerland
    Document type Published Erratum
    ZDB-ID 2775999-4
    ISSN 2296-858X
    ISSN 2296-858X
    DOI 10.3389/fmed.2023.1272092
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Modified Mallampati Test, Neck Circumference and Short Inter-Incisor Gap Are Risk Factors for Troublesome Intubation in Thai Obese Patients

    Arunotai Siriussawakul

    Siriraj Medical Journal, Vol 66, Iss

    2014  Volume 6

    Abstract: Background: Several alternative airway tools have now become primary devices for endotracheal intubation in obese patients. Since there were no guidelines to suggest which patient characteristics may be best suited for alternative techniques, we ... ...

    Abstract Background: Several alternative airway tools have now become primary devices for endotracheal intubation in obese patients. Since there were no guidelines to suggest which patient characteristics may be best suited for alternative techniques, we conducted this study to identify which airway bedside tests could predict the occurrence of troublesome intubation while performing conventional endotracheal intubation in obese Thai patients. Methods: This cohort study was conducted in 200 obese patients who were expected to not use alternative tools for first-line management in a tertiary care university hospital. Troublesome intubation was defined using an intubation difficulty scale (IDS) score > 0. An IDS value of 0 means ideal intubation, i.e., one performed without effort, on the first attempt, practiced by one operator, using one technique, with no impediment of the tube passage. Eleven types of preoperative airway assessment – including malformation of central teeth in the upper jaw, a modified Mallampati test, an upper-lip bite test, the range of motion of the neck (flexion and extension), the inter-incisor gap, the hyomental distance, the thyromental distance, the sternomental distance, the neck circumference, and the length of the neck – were examined in all patients. Results: The inter-observer reliability of raters was > 0.7 before initiation of the study. Overall, 52.5% of patients experienced troublesome intubation during conventional endotracheal intubation. According to a multivariate analysis, the independent risk factors were a modified Mallampati test, the neck circumference, and the inter-incisor gap. Conclusion: Based on our findings, alternative airway tools should be the first line of airway management in the case of patients with a high modified Mallampati test, a large neck circumference, and a short inter-incisor gap. Keywords: Difficult intubation, prediction, airway assessment, obesity
    Keywords Medicine (General) ; R5-920
    Subject code 610
    Language English
    Publishing date 2014-11-01T00:00:00Z
    Publisher Mahidol University
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article: Polypharmacy in Older Adults Undergoing Major Surgery: Prevalence, Association With Postoperative Cognitive Dysfunction and Potential Associated Anesthetic Agents.

    Lertkovit, Saranya / Siriussawakul, Arunotai / Suraarunsumrit, Patumporn / Lertpipopmetha, Wanicha / Manomaiwong, Natapong / Wivatdechakul, Wittachi / Srinonprasert, Varalak

    Frontiers in medicine

    2022  Volume 9, Page(s) 811954

    Abstract: Background: Polypharmacy, which is defined as the use of 5 or more medications, can exert significant adverse impact on older adult patients. The objective of this study was to determine the prevalence of polypharmacy, and to investigate its association ...

    Abstract Background: Polypharmacy, which is defined as the use of 5 or more medications, can exert significant adverse impact on older adult patients. The objective of this study was to determine the prevalence of polypharmacy, and to investigate its association with postoperative cognitive dysfunction (POCD) in older adult patients who underwent elective major surgery at Siriraj Hospital-Thailand's largest national tertiary referral center.
    Methods: This prospective study included older adult patients aged ≥65 years who were scheduled for elective major surgery during December, 2017 to December, 2019 study period. Patient demographic, sociodemographic, anthropometric, clinical, comorbidity, anesthetic, surgical, and medication data were collected and compared between the polypharmacy and non-polypharmacy groups. Postoperative cognitive dysfunction (POCD) was diagnosed in patients with at least a 2-point decrease in their Montreal Cognitive Assessment score after surgery. Multivariate logistic regression analysis was used to identify independent predictors of POCD.
    Results: A total of 250 patients (141 males, 109 females) with an average age of 72.88 ± 6.93 years were included. The prevalence of polypharmacy was 74%. Preoperative data showed the polypharmacy group to be more likely to be receiving potentially inappropriate medications, to be scheduled for cardiovascular thoracic surgery, and to have more comorbidities. There was a non-significant trend in the association of polypharmacy and POCD (crude odds ratio (OR): 2.11, 95% confidence interval [CI]: 0.90-4.94;
    Conclusion: There was a high prevalence of polypharmacy in this study; however, although close (
    Language English
    Publishing date 2022-02-15
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2775999-4
    ISSN 2296-858X
    ISSN 2296-858X
    DOI 10.3389/fmed.2022.811954
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article: Model for enhancing the research conducted by the university medical staff: Participatory action research.

    Somnuke, Pawit / Punpocha, Pornpunsa / Punikhom, Ploythai / Panitrat, Rungnapa / Nivatpumin, Patchareya / Thanakiattiwibun, Chayanan / Ramlee, Rachaneekorn / Thongkaew, Nichapat / Siriussawakul, Arunotai

    Heliyon

    2023  Volume 9, Issue 2, Page(s) e13208

    Abstract: This study employed mixed methods with a participatory action research approach to explore factors currently undermining the conduction of research and to develop strategies to boost research productivity. A questionnaire was distributed to 64 staff ... ...

    Abstract This study employed mixed methods with a participatory action research approach to explore factors currently undermining the conduction of research and to develop strategies to boost research productivity. A questionnaire was distributed to 64 staff members of the Department of Anesthesiology at a university-based hospital. Thirty-nine staff members (60.9%) gave informed consent and responses. Staff views were also collected through focus group discussions. The staff reported that limited research methodology skills, time management, and complex managerial processes were the limitations. Age, attitudes, and performance expectancy were significantly correlated with research productivity. A regression analysis demonstrated that age and performance expectancy significantly influenced research productivity. A Business Model Canvas (BMC) was implemented to gain insight into the goal of enhancing the conduct of research. Business Model Innovation (BMI) established a strategy to improve research productivity. The concept, comprising personal reinforcement (P), aiding systems (A), and a lifting-up of the value of research (L), the PAL concept, was considered key to enhancing the conduct of research, with the BMC providing details and integrating with the BMI. To upgrade the research performance, the involvement of management is imperative, and future action will involve the implementation of a BMI model to increase research productivity.
    Language English
    Publishing date 2023-01-24
    Publishing country England
    Document type Journal Article
    ZDB-ID 2835763-2
    ISSN 2405-8440
    ISSN 2405-8440
    DOI 10.1016/j.heliyon.2023.e13208
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Incidence, Outcomes, and Risk Factors of Intraoperative Cardiac Arrest During Orthotopic Liver Transplantation.

    Tovikkai, Parichat / Suphathamwit, Aphichat / Raksakietisak, Manee / Tovikkai, Chutwichai / Siriussawakul, Arunotai / Sujirattanawimol, Kittiphong / Piriyapatsom, Annop / Pongraweewan, Orawan / Tankul, Rattanaporn / Hemtanon, Nattachai / Boonyakarn, Sutatta / Noinonthong, Chularat / Rattanaruangrit, Chumsab / Soontarinka, Suvit

    Transplantation proceedings

    2024  

    Abstract: Background: Intraoperative cardiac arrest (ICA) during liver transplantation (LT) is a rare surgical complication that results in devastating outcomes. Moreover, previous worldwide studies have found inconsistencies in the risk factors associated with ... ...

    Abstract Background: Intraoperative cardiac arrest (ICA) during liver transplantation (LT) is a rare surgical complication that results in devastating outcomes. Moreover, previous worldwide studies have found inconsistencies in the risk factors associated with ICA in LT.
    Methods: This was a retrospective cohort study of adult patients who underwent LT between January and October 2021 at Siriraj Hospital, a tertiary care hospital. The incidence of ICA and outcomes of patients who experienced ICA were examined. Risk factors associated with ICA were investigated as a secondary objective.
    Results: Among 342 patients, the incidence of ICA was 3.5% (95% CI 1.8%-6.1%). Of these, 33.3% died intraoperatively. Among patients with ICA, 41.7% died within 30 days, compared with only 7.6% in those without ICA (P = .002). Moreover, the in-hospital mortality rate of those with ICA was 58.3%, which was significantly higher than that of those without ICA (9.7%, P < .001). However, 41.7% of patients with ICA were discharged alive with long-term survival. Because ICA is a rare event, we found only 2 independent factors significantly associated with ICA. These factors include intraoperative temperature below 35°C, with an odds ratio (OR) of 6.07 (95% CI:1.32-27.88, P = .02) and elevated intraoperative serum potassium, with an OR of 4.57 (95% CI:2.15-9.67, P < .001).
    Conclusions: ICA is associated with high perioperative and in-hospital mortality. However, our findings suggest that with effective management of ICA, more than 40% of these patients could be discharged with excellent long-term outcomes. Hypothermia and hyperkalemia were independent risk factors significantly associated with ICA.
    Language English
    Publishing date 2024-02-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 82046-5
    ISSN 1873-2623 ; 0041-1345
    ISSN (online) 1873-2623
    ISSN 0041-1345
    DOI 10.1016/j.transproceed.2024.01.029
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article ; Online: Validation of a delirium predictive model in patients admitted to surgical intensive care units: a multicentre prospective observational cohort study.

    Chaiwat, Onuma / Chittawatanarat, Kaweesak / Mueankwan, Sirirat / Morakul, Sunthiti / Dilokpattanamongkol, Pitchaya / Thanakiattiwibun, Chayanan / Siriussawakul, Arunotai

    BMJ open

    2022  Volume 12, Issue 6, Page(s) e057890

    Abstract: Objective: To internally and externally validate a delirium predictive model for adult patients admitted to intensive care units (ICUs) following surgery.: Design: A prospective, observational, multicentre study.: Setting: Three university- ... ...

    Abstract Objective: To internally and externally validate a delirium predictive model for adult patients admitted to intensive care units (ICUs) following surgery.
    Design: A prospective, observational, multicentre study.
    Setting: Three university-affiliated teaching hospitals in Thailand.
    Participants: Adults aged over 18 years were enrolled if they were admitted to a surgical ICU (SICU) and had the surgery within 7 days before SICU admission.
    Main outcome measures: Postoperative delirium was assessed using the Thai version of the Confusion Assessment Method for the ICU. The assessments commenced on the first day after the patient's operation and continued for 7 days, or until either discharge from the ICU or the death of the patient. Validation was performed of the previously developed delirium predictive model: age+(5×SOFA)+(15×benzodiazepine use)+(20×DM)+(20×mechanical ventilation)+(20×modified IQCODE>3.42).
    Results: In all, 380 SICU patients were recruited. Internal validation on 150 patients with the mean age of 75±7.5 years resulted in an area under a receiver operating characteristic curve (AUROC) of 0.76 (0.683 to 0.837). External validation on 230 patients with the mean age of 57±17.3 years resulted in an AUROC of 0.85 (0.789 to 0.906). The AUROC of all validation cohorts was 0.83 (0.785 to 0.872). The optimum cut-off value to discriminate between a high and low probability of postoperative delirium in SICU patients was 115. This cut-off offered the highest value for Youden's index (0.50), the best AUROC, and the optimum values for sensitivity (78.9%) and specificity (70.9%).
    Conclusions: The model developed by the previous study was able to predict the occurrence of postoperative delirium in critically ill surgical patients admitted to SICUs.
    Trial registration number: Thai Clinical Trail Registry (TCTR20180105001).
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Critical Care ; Critical Illness ; Delirium/diagnosis ; Delirium/epidemiology ; Delirium/etiology ; Humans ; Intensive Care Units ; Middle Aged ; Prospective Studies
    Language English
    Publishing date 2022-06-21
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2599832-8
    ISSN 2044-6055 ; 2044-6055
    ISSN (online) 2044-6055
    ISSN 2044-6055
    DOI 10.1136/bmjopen-2021-057890
    Database MEDical Literature Analysis and Retrieval System OnLINE

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