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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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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
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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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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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Article ; Online: Polypharmacy in Older Adults Undergoing Major Surgery

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

Frontiers in Medicine, Vol

Prevalence, Association With Postoperative Cognitive Dysfunction and Potential Associated Anesthetic Agents

2022 Volume 9

Abstract: BackgroundPolypharmacy, 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	BackgroundPolypharmacy, 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.MethodsThis 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.ResultsA 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; p = 0.08). Benzodiazepine, desflurane, or isoflurane administration during surgery were all significantly associated with POCD in univariate analysis. Multivariate analysis revealed intraoperative benzodiazepine (adjusted OR [aOR]: 2.24, 95% CI: 1.10–4.68; p = 0.026) and isoflurane (aOR: 2.80, 95% CI: 1.35–5.81; p = 0.006) as two independent variables associated with the development of POCD. Desflurane was found to be a protective factor for POCD with a crude OR of ...
Keywords	prevalence ; polypharmacy ; postoperative cognitive dysfunction ; older adult patients ; elective major surgery ; Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Model for enhancing the research conducted by the university medical staff

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

Heliyon, Vol 9, Iss 2, Pp e13208- (2023)

Participatory action research

2023

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.
Keywords	Business model canvas (BMC) ; Business model innovation (BMI) ; Participatory action research (PAR) ; Theory of planned behavior (TPB) ; Science (General) ; Q1-390 ; Social sciences (General) ; H1-99
Subject code	650
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Severity of frailty using modified Thai frailty index, social factors, and prediction of mortality among community-dwelling older adults in a middle-income country

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

Frontiers in Medicine, Vol

2022 Volume 9

Abstract: BackgroundFrailty has been increasingly recognized as a public health problem for aging populations with significant social impact, particularly in low- and middle-income countries. We aimed to develop a modified version of the Thai Frailty Index (TFI) ... ...

Abstract	BackgroundFrailty has been increasingly recognized as a public health problem for aging populations with significant social impact, particularly in low- and middle-income countries. We aimed to develop a modified version of the Thai Frailty Index (TFI) and explore the association between different frailty statuses, socioeconomic factors, and mortality in community-dwelling older people from a middle-income country.MethodsThe data from participants aged ≥60 years in the Fourth Thai National Health Examination Survey were used to construct the 30-item TFI. Cutoff points were created based on stratum-specific likelihood ratio. TFI ≤ 0.10 was categorized as fit, 0.10–0.25 as pre-frail, 0.25–0.45 as mildly frail, and >0.45 as severely frail. The association of frailty status with mortality was examined using Cox proportional hazard models.FindingsAmong 8,195 older adults with a mean age of 69.2 years, 1,284 died during the 7-year follow-up. The prevalence of frailty was 16.6%. The adjusted hazard ratio (aHR) for mortality in pre-frail was 1.76 (95% CI = 1.50–2.07), mildly frail 2.79 (95% CI = 2.33–3.35), and severely frail 6.34 (95% CI = 4.60–8.73). Having a caretaker in the same household alleviated mortality risk for severely frail participants with an aHR of 2.93 (95% CI = 1.92–4.46) compared with an aHR of 6.89 (95% CI = 3.87–12.26) among those living without a caretaker.InterpretationThe severity of frailty classified by the modified TFI can predict long-term mortality risk for community-dwelling older adults. Identification of severely frail older people to provide appropriate care might alleviate mortality risk. Our findings can inform policymakers to appropriately allocate services in a resource-limited setting.
Keywords	frailty ; older ; mortality risk ; Thailand ; caretaker ; Medicine (General) ; R5-920
Subject code	310
Language	English
Publishing date	2022-12-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Detection of Postoperative Cognitive Dysfunction by Telemedicine Among Octogenarian Patients Who Underwent Minor Elective Surgery; Prospective Cohort Study

Hathaichanok Suesat / Varalak Srinonprasert / Panita Limpawattana / Salinee Nakyos / Jiraporn Poontananggul / Chalita Jiraphorncharas / Wiraphon Manatarinat / Thanachai Noomprom / Arunotai Siriussawakul

Siriraj Medical Journal, Vol 74, Iss 2, Pp 126-

2022 Volume 133

Abstract: Objective: Postoperative cognitive dysfunction (POCD) is associated with permanent disability, increased mortality, and diminished quality of life. The incidence of acute POCD among geriatric patients who have undergone minor surgery is uncertain because ...

Abstract	Objective: Postoperative cognitive dysfunction (POCD) is associated with permanent disability, increased mortality, and diminished quality of life. The incidence of acute POCD among geriatric patients who have undergone minor surgery is uncertain because they are typically discharged before acute POCD is detected. Owing to the efficient postoperative care that can be provided, telemedicine is an attractive tool to investigate POCD. The primary objective of our research was to explore the incidence of acute POCD, while its secondary objective was to describe the consequences of POCD on functional recovery and quality of life. Materials and Methods: This prospective cohort study enrolled patients aged ≥ 80 years and scheduled for minor elective surgery. During pre-anesthetic visits, we installed a telecommunications program on the patients’ smartphones. Assessments of cognitive and other functions were performed preoperatively and 1 week postoperatively via telemedicine. Results: Forty octogenarian patients undergoing minor surgery were included in the final analysis. The acute-POCD incidence was 10% (95% CI 4.79-18.39). Recall memory was the main cognitive domain impaired after the procedures. Nevertheless, there were no significant differences in the functional recovery and quality of life of the POCD and non-POCD patients. Conclusion: The acute-POCD patients demonstrated minor symptoms that were unrelated to delayed postoperative functional recovery or decreased quality of life.
Keywords	anesthesia ; geriatrics ; postoperative cognitive dysfunction ; rudas-thai ; telemedicine ; Medicine (General) ; R5-920
Subject code	616 ; 610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Mahidol University
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Incidence of Adverse Perioperative Airway Complications in Obese Non-Pregnant and Pregnant Patients Undergoing General Anesthesia

Sumon Mantaga / Chayanan Thanakiattiwibun / Arunotai Siriussawakul / Natwara Asanathong / Natticha Jiamjira-anon / Jatuporn Eiamcharoenwit (Thonsontia) / Nonthida Rojanapithayakorn

Siriraj Medical Journal, Vol 74, Iss 3, Pp 178-

2022 Volume 184

Abstract: Objective: Airway complications in obese patients are a major concern during surgical operation. This study aimed to determine the incidence of airway- and respiratory-related anesthetic complications for obese (including maternal) patients undergoing ... ...

Abstract	Objective: Airway complications in obese patients are a major concern during surgical operation. This study aimed to determine the incidence of airway- and respiratory-related anesthetic complications for obese (including maternal) patients undergoing general anesthesia. Materials and Methods: This multicenter, retrospective, observational study evaluated obese female patients (BMI≥ 30 kg/m2), both non-pregnant and pregnant, undergoing general anesthesia in 5 hospitals across Thailand during May 2013 - August 2016. The primary observation was anesthesia-related airway complications (difficult and failed intubations, aspiration, desaturation, and airway injuries) detected during anesthesia. An analysis was performed to compare the incidents of the adverse events and to determine the risk factors for airway-related adverse events in both groups. Results: There were 1,347 obese patients enrolled (777 non-pregnant and 570 pregnant). The overall incidence of airway and respiratory complications was observed in 129 patients (9.6%), with a higher rate in pregnant patients (12.5% vs. 7.5%; p<0.05). The most common complications were desaturation (5.6%) followed by airway injuries (3.6%) and difficult intubation (1.5%). The factors significantly associated with adverse airway-related events were obesity class II (OR=1.63 [1.05–2.54]), obesity class III (OR=2.25 [1.19–4.25]), pregnancy (OR=1.73 [1.18–2.54]), Mallampati classifications III–IV (OR=1.69 [1.16–2.48]), and neck circumference <43 cm (OR=3.33 [1.02-10.81]), p<0.05). Conclusion: The incidence of the anesthesia-related airway and respiratory complications was 9.6%, with a higher rate in pregnant patients. The most common adverse airway event was desaturation. However, the frequency of serious airway events was low.
Keywords	airway ; obesity ; perioperative ; complication ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2022-03-01T00:00:00Z
Publisher	Mahidol University
Document type	Article ; Online
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Article ; Online: Incidence of Oral Injury and Risk Factors Associated with Oral Injury in Psychiatric Patients Undergoing Electroconvulsive Therapy in Siriraj Hospital

Anchala Jirakulsawat / Arunotai Siriussawakul / Namtip Triyasunant / Aungsumat Wangdee / Yutika Jiraroch / Matinee Chiripu

Siriraj Medical Journal, Vol 64, Iss

2020 Volume 5

Abstract: Objective: Oral injury during Electroconvulsive therapy (ECT) has been mitigated by modified ECT and the use of mouth protection. However, the number of reports of oral structure injuries remains high. The objectives of our study were to find out the ... ...

Abstract	Objective: Oral injury during Electroconvulsive therapy (ECT) has been mitigated by modified ECT and the use of mouth protection. However, the number of reports of oral structure injuries remains high. The objectives of our study were to find out the incidence and possible risk factors of oral injury in patients undergone ECT. Methods: Fifty one psychiatric patients undergoing ECT over a one-year period were reviewed. Patientsâ€™ demographics, pos- sible risk factors of oral injury, drugs used to anesthetize patients and the locations of oral structure injury were collected. The primary outcome was the incidence of oral injury, and the secondary outcome was factors affecting oral injury in modified ECT. Results: ECT was performed 217 times among the 51 patients. There were 24 males and 27 females aged 44 Â± 15 years old. Psychiatric problems were schizophrenia (80.4%), mood disorder (13.7%), depression (3.9%) and others (2%). Incidence of oral injury was 10.1% (22/217). Injury characteristics were abrasion at lips and mucosa (72.8%), bleeding at the gum (22.7%) and tooth avulsion (4.5%). Patients who received of a lower dose of succinycholine (0.9 versus 1 mg/kg) were more likely to have oral injury (p=0.009). Conclusion: The incidence of oral injury in ECT was 10.1%. Abrasion at the lips and mucosa was common. A multidis- ciplinary approach, adjustment of the anesthetic drugs dosage and the use of delicate mouth protections might decrease the incidence of oral injury.
Keywords	Modified electroconvulsive therapy ; oral injury ; thiopental ; succinylcholine ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2020-07-01T00:00:00Z
Publisher	Mahidol University
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