ABSTRACT
Background: Hospital incidence reporting system has limitation on sensitivity and underreport in detecting the adverse events thus under report them. Trigger tool may provide a more simplified review process for detecting adverse events in a developing country setting. Objectives: To evaluate the effectiveness of the trigger tool on identifying adverse events in Thai hospitalized patients, and to classify the events by the patient safety goals. Materials and methods: A cross-sectional medical record review was conducted to identify adverse events in hospitalized patients at King Chulalongkorn Memorial Hospital during January 2 2008, using the Global Trigger Tool (GTT) by Institute for Healthcare Improvement. Adverse events, severity rating, and preventability were determined by reviewer teams. Types of adverse events were described according to the Patient Safety Goals of Thailand. Results: Five hundred seventy six medical records were reviewed. The total patient-days were 4,460 days. Two hundred thirty six adverse events were detected with a mean rate of 41.0 events per 100 patients or 50.4 events per 1,000 patient-days. One hundred twenty five events (53%) were temporary harm, while 122 (51.7%) were preventable. Regarding the category of adverse event, 75 (31.8%) were related to patient care process, 48 (20.3%) were in safe surgery and 42 (17.8%) were in medication and blood safety. Conclusion: Adverse events using the GTT detected more events than previous reports. Most events had low severity and were preventable. Most events were related to prevention of complications, safe surgery, and medication safety. Assessment of validity is needed before using GTT in medical service.
ABSTRACT
Background: Highly active antiretroviral therapy (HAART) reduces the morbidity and mortality in HIV-infected patients by enhancing the immunologic response and viral load suppression. Non-adherence to HAART leads to development of resistance mutation resulting in treatment failure. Depression is a common psychological problem among HIV-infected patients. However, the association between depression and adherence to HAART has not been studied in Thailand.Objectives: To estimate the prevalence of non-adherence to HAART and to determine the association of depression and related factors with adherence to HAART in Thai adult HIV-infected patients.Material and method: A cross-sectional study was conducted at King Chulalongkorn Memorial Hospital, Thailand between October 2007 and January 2008. Three hundred seventy nine participants were recruited from the immunology and sexual transmitted disease clinics. Participants completed seven questionnaires regarding socio-demographic characteristics and medication information, adherence to HAART, depression, cognitive function, alcohol use, HIV social support, and physical symptoms.Results: The prevalence of non-adherence to HAART was 34.6% and the prevalence of depression among adult HIV-infected patients was 32.2%. The statistically significant risk-factors associated with non-adherence were depression (adjusted OR=4.68; 95%CI=2.77-7.88), no past history of opportunistic infection (OR=2.13; 95%CI=1.26-3.63), using herbal medications (OR=2.44; 95%CI=1.07-5.55), and never getting a reminder of adherence to HAART (OR=2.78; 95%CI=1.29-5.98).Conclusion: Depression was a strong predictor for non-adherence to HAART among Thai HIV-infected patients. Health care providers should screen for depression among HIV-infected patients before starting HAART and motivate those with depression on adherence to HAART.
ABSTRACT
Background and objective: Extended-spectrum β-lactamase (ESBL)-producing organisms have been reported among nosocomial pathogens. The objective of this study is to determine the risk factors for nosocomial infections in adults caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E-coli) or Klebsiella pneumoniae (K. pneumoniae) in regional and provincial government hospitals in Thailand.Methods: A nested case-control study was conducted, and the patients were enrolled between July 1 and December 31, 2007. We compared 288 patients with nosocomial infections caused by ESBL-producing E. coli or K. pneumoniae to 288 hospital-matched controls with nosocomial infections caused by non ESBL-producing E. coli or K. pneumoniae.Results: The independent risk factors associated with nosocomial infections caused by ESBL producing strains included Charlson comorbidity index (Odds ratio=1.18, 95% confidence interval (CI) =1.06-1.31, p-value=0.001) and previous third generation cephalosporin use (OR=4.82, 95% CI=3.23-7.21, p-value \< 0.001).Conclusion: This is the first nested case-control study regarding the risk factors of nosocomial infections caused by ESBL-producing organisms. The Charlson comorbidity index and previous third-generation cephalosporin use were the contributing factors of nosocomial infections caused by these organisms. An emphasis on appropriate use of the third-generation cephalosporins as well as effective infection control measures in patients with high comorbidity index are needed to reduce the incidence of nosocomial infections caused by these organisms.
ABSTRACT
Background: Currently, “multiple risk factor reduction program” for coronary heart disease (CHD) risk is proposed in Thailand, but there is little information about its effectiveness for Thai hypertensive patients. Objectives: To investigate the effectiveness of the CHD risk program among hypertensive patients in Thai community hospitals. Material and methods: Seven hundred eighty one hypertensive patients (aged 35-64 years) were selected from four hospitals in Sisaket, Thailand between Sept 2007 and Aug 2008. The intervention program included: a) provide training about the overview of CHD and global risk assessment, and b) patient training about risk factor modification skill. The control subjects received health education and usual care. The program effectiveness was evaluated using changes in the RAMA-EGAT heart score and risk factors, such high density lipoprotein cholesterol or serum total cholesterol, one year after the program implementation. Data analysis was conducted using “t”-test for the pre-post difference between the intervention and control groups. Results: The changes in the RAMA-EGAT heart score were -0.03 vs +0.09 for the intervention and control groups, respectively. Changes in high density lipoprotein cholesterol, waist circumference, systolic, diastolic, and serum total cholesterol were statistically significant between for the both groups. The CHD knowledge was improved significantly between the both groups, but the smoking quit-rate was not significantly different. There was a significant association of intervention with the improvement in knowledge score, HDL-C, and waist circumference, but blood pressure and serum total cholesterol levels in the control were reduced greater than those in the intervention groups. Conclusion: This program did not sufficiently reduce the change global risk score, but some risk factors were improved significantly. The global risk assessment should be integrated with behavior counseling and treatment activity for hypertensive patients.