Quality of life and hemoglobin levels of hemodialysis patient at Siriraj Hospital.

Objective: To evaluate the relationship of the quality of life (QOL), and hemoglobin (Hb) level of hemodialysis (HD) patients. Methods: This study was a cross-sectional study. Face-to-face interviews using a Kidney Disease Quality of Life - Short Form (KDQOL-SF™1.3) questionnaire (which consisted of SF-36 and kidney disease questionnaires) were conducted during November-December 2009 with 152 patients receiving hemodialysis at Siriraj hospital, Bangkok, Thailand. QOL measures were compared in stepwise Hb levels of 9, >9 to 10, >10 to 11, >11 to 12, and >12 g/dl. Scores of QOL and Hb level were examined for the relationship and statistical significance using ANOVA. Results: The increasing Hb levels are statistically significant increases in kidney disease domain scores on the kidney disease component of the questionnaire (p=0.042). About the SF36 component, the difference between 5 groups of Hb levels were significant in the general health (p=0.023), role emotion (p=0.015), social functioning (p=0.008), and mental component summary scores (p=0.039). Conclusion: The difference of the Hb levels were statistically significant differences in the effects of kidney disease, general health, role emotion, and social function scores, and mental component summary scores of the KDQOL-SF questionnaire. However, a long-term assessment should be considered. These findings have implications for the care of hemodialysis patients in terms of the initiation of the Hb target of erythropoietin (EPO) therapy.

The effect of a life style modification campaign for Bangkok provincial electricity officers.

Background: Office workers with sedentary life styles might be at risk to become obese and later develop cardiovascular risk factors. A life style modification campaign (LSMC) had been introduced to 4,300 provincial electricity officers (PEO) during July 2007-June 2008. The campaign was designed with the aim to encourage behavioral change within a large organization. Objective: To evaluate the effectiveness of the LSMC on improving health status among PEOs who attended the program regularly, occasionally, and rarely. Methods: A quasi experimental study was performed to compare pre- and post- health status records (HSR) including: body mass index (BMI), systolic blood pressure (SBP), waist-hip circumference ratio (WHC), skin fold measurement (SFM), hand grip strength (HG), body flexibility (BF) and cardio-respiratory fitness (CRF) of the PEOs who attended the LSMC. Results: After 1 year of LSMC, there were 173 PEOs who completed the program. Within the regularly attending group, we found statistically significant improvement in BMI, SBP, WHC, SFM, and CRF with p-values of 0.02, 0.03, <0.001, <0.001 and 0.048 respectively. Meanwhile the group that occasionally and rarely attended the program did not do as well. Conclusion: The LSMP has demonstrated its effectiveness in reducing modifiable risk factors within the well compliant group. The benefit toward work performance or the cost effectiveness of the campaign was not included in this study.

Primary percutaneous coronary intervention in acute myocardial infarction at Siriraj Hospital: the improvement over time.

OBJECTIVE: To evaluate the efficacy of the acute ST segment elevation treatment guidelines in reducing the door-to-balloon time at Siriraj Hospital. MATERIAL AND METHOD: Retrospective analysis of the data and records obtained from one hundred and twenty eight patients who underwent primary percutaneous intervention for acute ST segment elevation myocardial infarction at Siriraj Hospital between June 2002 and February 2006. Control chart analysis was applied to evaluate the efficacy of the guidelines. RESULTS: The mean door-to-balloon time was consistently reduced from 243.23 minutes before to 137.13 minutes after the guidelines implementation. Control chart analysis showed that this reduction in door-to-balloon time reached statistical significance. CONCLUSION: The guidelines developed by a multidisciplinary approach could effectively reduce the door-to-balloon time.

Comparison of the efficacy between lidocaine spray plus lidocaine jelly lubrication and lidocaine jelly lubrication alone prior to nasogastric intubation: a prospective double-blind randomized controlled study.

OBJECTIVE: Although a common procedure, nasogastric (NG) intubation is also painful and unsatisfactory. Previous studies showed the benefits of local anesthesia in various forms over lubricant jelly alone, but they are rarely used due to their inconvenience and unavailability. The authors conducted a double-blind randomized controlled study to compare a commercial-available 10% lidocaine spray plus 2% lidocaine jelly lubrication and 2% lidocaine jelly lubrication alone prior to NG intubation. MATERIAL AND METHOD: Patients who fulfilled the indications for NG intubation were randomized to receive either 10% lidocaine spray or placebo (normal saline) spray to the nostril and throat prior to NG intubation. NG tubes lubricated with 2% lidocaine jelly were then inserted by experienced physicians. Physician, who sprayed, inserted the NG tubes and collected the patient's data, did not know the content of the spray, while patients were also blinded against the information of the spray. RESULTS: Sixty patients were included in the present study. Thirty one randomly received lidocaine spray and 29 received placebo spray. There were more female patients in the lidocaine group (65% vs. 28%, p=0.04), but ages, indications for NG intubation, size of NG tube, and physicians' experience in the procedure were similar in both groups. Patients' discomfort after being sprayed was also similar in both groups. However during the NG intubation, the patients in the lidocaine group experienced less pain as measured by visual analog scale (23.6 +/- 16.6 vs. 43.1 +/- 31.4 mm, p=0.005) and less discomfort (30.0 +/- 24.4 vs. 51.4 +/- 30.0 mm, p=0.004) than the placebo group. Ninety-three percent of the patients in the lidocaine group favored the same spray for their next intubations, while 65% of the placebo group did (p = 0.009). In addition, there was more physicians' satisfaction in the lidocaine group as measured by 5-point Likert scale (p=0.041). Likewise, 61% of the physicians favored lidocaine spray compared to 34.5% of the placebo spray (p=0.038). Degree of difficulty, duration of intubation, number of attempts and success rates of NG intubations were as well similar in both groups. No complications were found in the present study. CONCLUSION: 10% lidocaine spray plus 2% lidocaine jelly lubrication was more effective in relieving patients' pain, discomfort, and resulted in higher physicians' satisfaction. There were also no additional side effects as compared to 2% lidocaine jelly lubrication alone. Therefore, it should be recommended for routine application.