Cost-Benefit Analysis of Rubella Vaccination Program for Medical Personnels in Srinagarind Hospital

 The main purpose of rubella immunization is the eradication of congenital rubella syndrome.  The majority of medical personnels are female in reproductive age.  Those personnels with negative rubella antibody are at risk of developing rubella infection during pregnancy.  It is not known whether screening for rubella antibody first and vaccinate only those with negative antibody is more cost benefit than routine vaccination without screening. 137 volunteer female medical personnels have had their blood drawn for rubella antibody before vaccination with attenuated live virus strain wistar RA 27/3, human diploid cells.  All direct and indirect costs are calculated in order to analyes the cost-benefit of each program. The results indicated that the prevalence of positive rubella antibody was 67%.  About 17 of the vaccinees, with and without antibody against rubella experienced side-effects, most of them were mild.  From the perspective of hospital administrator, routine rubella vaccination without screening has more cost-benefit than screening before vaccinating only those who are susceptible.

The True Cost of Recycle Syringe Compared with Disposable Syringe at Srinagarind Hospital

 A comparative study of the true cost of recycled syringe and disposable syringe at Srinagarind hospital in 1987.  The labour cost, present value of the capital cost and overhead cost of the central supply service department were taken into account.  The result presented that the usage rates of all recycled syringes were 698, 484 per year.  The total cost of recycled syringe was 566,632 bahts per year whereas that of disposable syringe was 1,808,850 bahts per year.  There are two factors which might change the total cost of the recycled syringe such as the rates of broken-defective syringe and the labour cost.  However the sensitivity analysis shows that the result is not sensitive to change by those factors.  At the present time the use of recycled syringe is more economically than that of disposable syringe.

Diarrhea due to Vibrio cholera 0139 in Srinagarind Hospital

 The recent epidemic of Cholera Strain Vibrio cholera 0139 were occurred in India and Bengal Surveillance for Vibrio cholera 0139 in Srinagarind Hospital has been done from 11th March 1994 to 5th August, 1994.  One hundred and five patients were infected by this organism. There were three outbreaks of Vibrio cholera 0139 in Srinagarind Hospital.  In the first outbreak from 11-13th March 1994 there were 18 cases of infected patients in the second one in 8-13 June 1994 there were 36 cases and the last one was the 28th July to 5th August, 11 cases were found in only one case of breast feeding was the infant reported to be infected with this organism.  Most of the cases occurred in Amphur Muang, Khonkaen, percentage with a ratio of man : woman, 2:1, and average age was 41 years old (4 days-82 years).  The susceptibility of the organism to Tetracycline, Gentamicin, Nalidixic acid, Neomycin, Ampicillin was good, but there was moderate sensitivity to Chloramphenicol, no response to colistin and Cotrimoxazole Many control programs were done in these outbreaks such as hygeine education, surveillance for infection and the personnel who were carriers and cooked food.  The source of organism in Khon Kaen University was detected in rectal swab C/S of 253 personnel but only 7 cases infection were found and 318 specimens of swab C/S of used water food and vegatables were taken, and 4 specimens were positive for this organism. The implementations for controling of this outbreak were the rapidly indentify and treat, mass media for the communication, including, personal hygiene the used of chlorination etc. the case.

Prevalence of Postpartum Low Back Pain : Analysis of the Risk and Protective Factors

\ Objective.\  To eveluate the prevalence, severity and clinical risk associated with postpartum low back pain among otherwise healthy Thai women.\ Methods.\  Two hundred women attentding the well baby clinic at srinagarind Hospital were randomly selected for study to identify postpartum patients with symptomatic low back pain.\  A complete history and physical examination wer performed by an orthopaedic suregeon and a physiatist.\  Data included any history of back pain and a visula analog scale for pain.\ Results.\  At an average of 8.3  6.5 months postpartum, patients with a mean age of 27.1  4.5 years, exhibited a 35.5% [17/200 women] prevalence of symptomatic low back pain.\  Among the symptomatic group, average pain scale was 30.1  26.7 and 90% had required bed rest to achieve relief.\  Analysis disclosed a significantly [P\<0.001] greater parity and higher frequency of prior back pain among the symptomatic group.\  Patient age and family income were not different by group.\  Symptomatic women were significantly [P\<0.001] less likely to have been compliant with the thai traditional postpartum ritual.\ Conclusions.\  The prevalence data from this study are consistent with those of other studies except for the lack of a correlation with socioeconomic status.\  The Thai-traditional postpartum ritual may be protective against postpartum back pain but the factors responsible for that effect remain uncertain.

Methicillin – resistant Staphylococcus aureus (MRSA) Outbreaks in Srinagarind Hospital

 MRSA   surveillance  was  routinely  done  in  Srinagarind  hospital,  a  713  bed  university hospital  since  April  1993.  There were  3  MRSA  outbreaks  during  April  1993  to  March  1994.  The  first  outbreak  occurred  in  Accidental  and  Emergency  ward  during  October  to  November  1993  which  16  cases  were  involved .  All  of  the  patients  were  in  the  service  of  surgery.  The  second  outbreak  occurred  in  surgical  ward.  All  5  cases  were in  plastic  surgery  and burn team.  The  last  outbreak  was  in  the  newborn  unit,  six  infants  were  involved.   The  mortality  rate  of   these  outbreaks  was  six  out  of  27  cases.  After  outbreaks  were  identified,  several  interventions  were  used  to  control  infection,  such  as  patient   isolation,  emphasis  on  hand  washing  gloving , downing,  growing  and  masking,  prospective  surveillance  by  sputum   culture  in  patients  who  were  on  respirator  and  early  discharging  of  MRSA  cases.  We  also  introduced  identified  to  have nasal  colonization  with  MRSA  and  6  cases  were  successfully  treated  with  topical  mupirocin.  All  these  outbreaks   were  under  control  by  these  combined  control  measures. 

Effect of Malunion of the Clavicle on Motion of Ipsilateral Shoulder

Background:  Clavicular fracture is a common fracture of the upper extremity.  Normally, non-operative treatment is recommended, however, the mal position and shortening of this fracture might affect the shoulder functions.  Therefore, many authors recommend operative treatment.Objectives:  To evaluate the satisfaction and range of motion on the ipsilateral shoulder of the patients with malunited fracture of the clavicle who were treated at Srinagarind Hospital.Design:  This was a retrospective study.Setting:  Srinagarind HospitalResults:  There were 30 patients, regarded to the range of motion of the shoulder that had an ipsilateral malunion of clavicle.  There were 23 men and 7 women.  The mean age of the patients was 29.93 year (range 14-56 years).  The mean duration between finished treatment and the last follow up was 41.80 weeks (range 5-108 weeks).  The right clavicle was fractured in 20 patients (66.67%) and the left clavicle was in 10 pateints (33.33%).  The most common site of fractures was the middle third (27 patients, 90%).  The rest was the distal third.  The most common cause of fractures was traffic accident (26 patients, 86.67%).  The figure of eight casts were applied 28 patients (93.33%) and donut splint for the rest 2 patients.  The mean time for immobilization was 4.9 weeks (range 2-12 weeks).  The mean length of clavicle was 16.03 + 1.44 centimeters (range 13.5-18.5 centimeters).  The mean shortening of the malunited clavicle was 0.83 + 0.58 centimeters (range 0-2 centimeters).  Twenty-one patients (70%) had equally range of motion of the shoulder bilaterally, nine patients had a difference from the normal shoulder.  In the latter group, 8/9 patient had good function status only 1 patient had moderate function status.Conculusion:  Regarding the function of shoulder there were 28 patients (93.33%) had good function and the cosmetic results have a median value of 4 (2-5).  Seventy percent of the patients had normal range of motion compared with the normal sides.Key words:  (1) Clavicle (2) Malunion (3) Shoulder (4) Motion

“Sleeve Awl’’ For Femoral Intramedullary Guide Rod Insertion

Background : Making a hole at the piriformis fossa of the femur is one of the important steps in closed intramedullary femoral nailing . This hole is provided for passage of the devices through it. We design a device that is used as a hole making and the sleeve for changing the instruments. This device facikitates and reduces the time for this procedure.Objective : To present the use of a new device for facilitating and reducing the operative time in closed intramedullary femoral nailing procedure.Study design : Experimental studySetting : Orthopedics department, Faculty of Medicine, Khon Kaen UniversityDevice : “Sleeve awl” was innovated from a 14 –mm. diameter Kuntscher nail which was cut at one end and shaping as a bevel. “Sleeve awl” was used instead of the conventional awl in the closed intramedullary femoral nailing procedure. After pointing the bevel of the “Sleeve awl” into the piriformis then it was driven into the medullary canal of the proximal femur. Leaving the  sleeve awl at this position as a channel for passage of the T-hand reamer and reamer guide rod.Result : The closed intramedullary femoral nailing was performed in 20 cases. All of them were divided equally into 2 groups. The conventional awl was used in the first group and the sleeve awl was used in the second group. The first group consisted of 8 men and 2 woman, the means age were 30.2 years (10-73years). The femur was on the left in 3 cases and on the right 7 cases. The second group consisted of 7 men and 3 woman, the means age were 30.5 years (15-52 years). The femur was on the left in 4 cases and on the right 6 cases. The average times from insertion of the awl into the medullary canal of the proximal femur to the insertion of the guide rod in the first group was 7.13 ± 2.22 minutes (5.20 – 13.20 minutes), and in the second group was 2.25 ± 0.58 minutes (1.30-5.00 minutes) (t-test, p = 0.00001) mean difference = 4.76;95% confidence interval = 3.03,6.48Conclusion : The “Sleeve awl” is a useful device for facilitation in closed intramedullary femoral nailing procedure. The use of this device will reduce the time for seeking the hole at the piriformis fossa at each time for changing the instrument through this site as in the conventional method.Key words : awl, fracture of femur

Cutting a Plaster of Paris Cast using Twisted Wire Compared with and Electrical saw a safe, new and cheapness Device

Background : Plaster of Paris is a material, used for immobilization when the patients have fractures or muscle injuries or dislocation of the joints. Cast removal will be done after finished treatment. The common tool for removing the plaster of Paris cast is an electrical saw. However, the noise and dust produced during the process of cutting are undesirable and most of the patients are scared of the noise and the moving saw blade of the electrical saw. Moreover, the electrical saw is an expensive tool. New methods to conserve energy and to reduce pollution in the office are proposed. Objective to evaluate the efficacy of a new device, twisted wire, compared with the electrical saw for removing the plaster of Paris cast.Study design : Non randomized experimental study.Setting : The outpatient clinic number I at Srinagarind hospital.Subjects : Sixty patients with fracture and ligamentous injuries of the extremities were included in this study; fifty-three males and seven females. The mean age was 26 years old (15-43 years). The four groups of fifteen patients each consisted of those with; short arm casts, long arm casts, short leg and PTB casts, and long leg and cylindrical casts.Result : The mean standard deviation of duration for cutting the short arm cast using the electrical saw and twisted wire 10.02  2.15 seconds and 3.00  1.80 seconds respectively (p \<.005). The mean and standard deviation of duration for\  cutting the long arm cast by using the electrical of duration for cutting the long arm cast by using the electrical saw and twisted wire 17.00  4.35 seconds and 6.10  1.38 seconds respectively (p \< .005). The mean standard deviation for cutting the short leg and PTB casts using the electrical saw and the twisted wire were 15.12  2.56 seconds and 5.01  1.65 seconds respectively (p\<.005). The mean and standard deviation for cutting the long leg cast using the electrical saw and twisted wire were 58.23  9.86 seconds and 15.35  2.69 seconds respectively (p\<.05). The mean and standard deviation to the overall satisfaction of the patients with the electrical saw and twisted wire were 52.25  27.15 and 83.75  9.57 respectively (p\<.05).Conclusion : The twisted wire cutting cast is a new and effective for removing a plaster of Paris cast which is easy to produce and use, safe, cheapness, and noiseless.

Intraobserver and Interobserver Reliability of the Measurement of the Coracoclavicular Distance in Acromioclaviclular Dislocation and A new Technique of Measurement

Background : The diagnosis of acromioclavicular (AC) joint injury depends upon primary physical and radiological examinations. Simultaneous views of both AC joints are obtained and measurements compared between injured and uninjured sides. Most commonly, the severity of injury is determined by the relative differences between the widths of the AC joint space, the coracoclavicular (CC) distance, and degree of elevation of the clavicle above the acromion. These parameters are usually used to decide on surgical or conservative treatments. The measurement’s variation can change the treatment options.Objectives : To evaluate the reliability of the current method for measuring the CC distance and introducing the new method of measuring the width of CC distance by using a Mose’s template.Design : Descriptive studySetting : Department of Orthopedic, faculty of medicine, Khon Kaen University.Subjects : The anteroposterior radiograph of both acromioclavicular joints with Zanza technique were used in this study. Twenty radiographs were selected based on the quality of the radiograph. There were 15 male and female patients. The average age of the patients was 25±6 years old (range 20-48). Thirteen patients had right and seven had left AC joint injuries. Two observers were included in this study to evaluate the reliability of the current and new methods.Results : There were thirty-two of 40 pairs (32/40, 80 %, 95% confidence interval 67.61%-92.39%) of measurement by two observers (interobserver reliability) using Mose’s template had the  same results. However, the current technique used by two observers had the same results only three of 40 pairs (3/40, 7.5%,95% confidence interval 7.2%-7.8%) of measurements. The intraobserver reliability, for the Mose’s template of the observer I and II, there were 8 of 10 (8/10, 80%, 95% confidence interval 30%-90%) and 6 of 10 pairs (6/10, 60%, 95% confidence interval 30%-90%) of measurements had the same results respectively. For the current technique, however, there were only two of 10 pairs(2/10,20%,95% confidence interval 0-45%) and one of 10 pairs (1/10, 10%,95% confidence interval 1%-29%) of measurements of the observer I and II had the same results respectively.Conclusion : The Mose template technique is a more reliable method of measurement the CC distance in the AC joint injury.

Palmaris longus \& Plantaris Tendon : Anatomical Variations \& Relationship

Background : Tendon  grafting  is  the  procedure,  which  often  performed  in  the  hand  reconstruction.  There  are  many  tendons  have been  used  in  this  procedure  for  instance  palmaris  longus,  plantaris  and  toe  extensor  tendons.  Unfortunately,  there  are  many  variations  in  the  presence  or  absence  of  these  tendons.  Moreover,  the  length  and  diameter  of  these  tendons  are  also  varied  from  many  reports.  To  determine  the  length  of  the  tendon,  therefore,  the  length  of  its  corresponding  bone  could  be  used.Purpose : To  identify  the  variations  of  presentation  of  palmaris  longus  and  plantaris  tendons  in  the  cadavers,  and  to  determine  the  relationship  between  these  two  tendons  with  the  length  of  ulnar  and  tibial  bones.Materials  and  Methods : Thirty  cadavers  from  the  Department  of  Anatomy  were  dissected.  Palmaris  longus  and  plantaris  tendons  were  identified  and  measured  their  lengths  and  diameters.  The  length  of  ulna  and  tibia  were  also  measured.  The data  were  recorded  and  analyzed  by  using  Microsoft  Excel  version  program.Study  design : descriptive  studySetting :  Department  of  Anatomy,  Faculty  of  Medicine,  KhonKaen  UniversityResults  :  Eighty  percent  of  the  cases  had  palmaris  longus  in  one  side.  Ninety – three  percent  of  the  cases  had  plantaris  tendons  and  6.6 % had  plantaris  tendon   in  only  one  side.  Of  those  cases  with  absent  palmaris  longus  tendon,  the  plantaris  tendon  stills  present.  The  mean  lengths  of  palmaris  longus  were  14.59+ 2.08 cm. and 14.24 + 2.53 cm. on  the  left  and  right  sides  respectively.  The  mean  lengths  of  plantaris  tendon  were  33.46 +  3.09 and 31.41 +  3.01 on  the  left  and  right  sides  respectively.  There  was  only  one  case  in whom  the  plantaris  tendon  width  was  smaller  than  2  nn.. There  was  no  correlation  between  the  lengths  of  the  tendons  and  the  corresponding  bones.Conclusions :  The  palmaris  longus  tendons  seem to  be  more  absent  than  the  plantaris  tendon.  The  length  of  the  ulna  could  not  be  del\termined  the  length  of  the  palmaris  longus  tendon  and also  the  length  of  the  tibia  could  not  be  determined  the  length  of  the  plantaris  tendons.

Suprascapular Nerve Entrapment Syndrome : A Literature Review and Case Report in Srinagarind Hospital

Background :  The suprascauplar nerve entrapment syndr9ome is not a common disease in Srinagarind hospital. The patient with the synptom of the shoulder pain should be re-evaluated if the clinical mainfestation was not responded to the previous treatment because the clinical sign such as the atrophy of the muscle will be present later.  Therefore, the thorughness  of the physical examination is the essential clue for the diagnosis of this condition.Objective : To review the literature and remind the clinican who had the patient with shoulder pain to carefully evaluate the patient especially the patient who had proviously failed the medical treatment. Design : Case report and a literature review.Setting : Srinagarind hospital.Conclusions : The patient had the symptom of the right shoulder pain which was not responded to the medial treatment, physiotherapy and the acupuncture treatment.  He came to out clinic and we found that he had the syndr9ome of the right suprascapular nerve entrapment.  We carried out the operation and found the lipoma compressed the nerve at eht spinoglenoid notch which was one of the common path9ologies.  After the mass removal, his symptoms had been gradually improved and he gained a good recovery.  He can return to the heavy duty within six months after surgery.  We would like to emphasize that the careful examinations of the patient with the should pain is the most important way to diagnose the diseases around the shoulder.

Differentiating between Septic arthritis and Primary Psoas abscesses: The clinical diagnosis .

Background: A child who has an acutely irritable hip can pose a diagnostic challenge. The purposes of this study were to determine the diagnostic value of presenting variables for differentiating between septic arthritis and primary psoas abscesses in children who present with hip pain.Purpose: This study was to determine the diagnostic value of the clinical presentations in children for differentiating between septic arthritis of the hip joint and psoas abscess.\ Methods:\  The cases of children evaluated for an acutely irritable hip at a university hospital between 1984 and 2001 were reviewed retrospectively.\  Diagnoses of septic arthritis of the hip joint and psoas abscess were defined by the presence of pus in the hip joint or in the psoas muscles, results of cultures of the joint fluid, blood and pus, and the clinical course.\  The clinical presentations were used to differentiate between septic arthritis and psoas abscesses;\  univariate and multiple logistic regression analyses were used to assess their statistical significance.Study design: Case-control studySetting: Department of Orthopedics, Faculty of Medicine, Khon Kaen UniversityResults:\  Thirty-seven patients, 13 girls and 24 boys, had septic arthritis of the hip joint and ten, 4 girls and 6 boys, had a psoas abscess. The mean age of the septic hip and psoas abscess groups were 9.7 3.6 years (range, 4 to14 years) and 8.34.2 years (range, 5 months to 14 years) respectively. The left hip joint was affected in 21 cases, the left psoas muscle in 7.\  Staphylococcus aureus was the causative pathogen in 25 cases of the septic hip group and 6 of the psoas abscess group. Most of the psoas abscess group (90 percent, 9/10 cases) presented with a lower abdominal mass whereas none were found in the septic hip group (p\<. 001). All of patients in the psoas abscess group experienced abdominal pain, while none in the septic hip group did (p\<. 001). None of the patients in the septic hip group was able to walk but all of the psoas abscess group was able to do so (p\<. 001). All cases in both groups presented with fever and hip flexion contracture except one in the septic hip group. Results of other laboratory investigations were similar for both groups, except that ultrasound of abdomen revealed abscesses inside affected psoas muscles.\  The mean duration of symptoms was 9.5  8.8 days and 31.635.2 days in the septic hip and psoas abscess groups, respectively (p\<. 001). The multiple logistic regression indicated that lower abdominal mass and pain, and ability to bear weight were significant variables only in the psoas abscess group.Conclusions:\  Pyogenic psoas abscess is the most likely diagnosis in children who present with fever, hip pain and flexion contracture of the hip joint, but can bear weight, and have clinical findings that include lower abdominal masses and pain.

Incidence of Positive Culture form Catheter Tip after Endotracheal Tube Suctioning Uning Disposable VS. Sterilized Reusable Gloves

Background : The Center for Disease Control Infection of Sringarind Hospital recommended using sterile reusable gloves during tracheal suction to reduce the incidence of infection; however, this method is expensive and requires several steps to make the gloves reusable.Objective : To assess the incidence of positive culture from a catheter tip after endotracheal tube suctioning using disposable gloves (aseptic by not touching the end 6 inches of the catheter tip) vs.  sterile reusable gloves.Study design : Prospective, randomized, double-blind, controlled trial.Method : We included 1}502 patients undergoing general anesthesia with an endotracheal tube.  The patients wetre computer-randomized to two groups : Group 1 was the control performed with sterile gloves; whereas Group 2 was performed with disposable gloves and an aseptic technique.  Tracheal suctioning was performed before extubation.  The catheter tip was removed (using an aseptic technique) and sent for culturing.Results : There was a significantly (P

The Study of Prevalence of Staphylococcus aureus Contamination in Health Personal’s Mobile Phone at Srinagarind Hospital

Background: Health personnel always carry and use mobile phone for communication; therefore, mobile phone may be the source and cause of Staphylococcus aureus contamination and endemic in the hospital.Objective: To study the prevalence of S. aureus contamination on the mobile phone of health personnel in Srinagarind hospital.Materials and Methods: Health personnel will be randomized by simple method; the outer surfaces of the mobile phone will be swabbed and cultured using Transferred Mannitol salt agar. Study design: Descriptive Study.Site of the study: Srinagarind Hospital.Population and sample: Two hundred twenty mobile phones of health personnel.Results: Sixty four of 220 samples (34.5%) of mobile phones were contaminated, thirty two samples (14.5%) were found to be S. aureus and 32 samples (14.5%) were not S. aureus. Methicillin sensitive Staphylococcus aureus (MSSA) was found in seven sample (3.2%), however, there was no Methicillin resistant Staphylococcus aureus (MRSA) found in this study. Eighty five (43.2%) personnel always clean their mobile phones using clean wet cloth or alcohol to wipe out their mobile phones. The risk of mobile phone contamination was 1.5 times higher in the no-cleaning mobile phone than the cleaning one. Conclusion: There was 14.5% prevalence of S. aureus contamination on the health personnel’s mobile phone at Srinagarind hospital. To clean and wipe out the mobile phone will reduce the chance of this contamination. Keywords: Staphylococcus aureus, mobile phones, health personnel, contamination, mehticilin resistant / sensitive