Operational Research for STD Service: Improvement of Treatment and Care at Siriraj Hospital.

Objective: Operational research for sexually transmitted disease (STD) service was conducted to: 1) create the potential for systematic care: to assess and monitor for HIV and STI; 2) create the linkage among OB-GYN, Medicine and Pediatric Departments of Siriraj Hospital; 3) cervical cancer screening in HIV-infected females by Pap smear once a year; 4) create a system file for collection of STI data of the unit; 5) promote HIV counseling, disclosure and keep records; 6) promote condom usage and reduce risk behaviors of HIV-infected females continuously. Methods: HIV positive females attending STD Clinic, Department of Obstetrics & Gynecology, Siriraj Hospital were enrolled in to the study during March 1, 2005 to September 1, 2006. The procedures include: 1) provide STI testing/treatment, risk-reduction and HIV disclosure counseling, provision of free condoms, and cervical cancer screening at least once a year; 2) develop standardized procedures and data collection tools and strengthen data management; 3) refer women from different departments to the STI clinic for screening; 4) provide training in risk reduction counseling and HIV disclosure counseling. Results: Most of the primary visits were check-up. Chlamydial infection was 2.1% (year 2005). GC infection was 0.5% (year 2005). Abnormal Pap was significantly related to low CD4 count. L-SIL = 9.3%; H-SIL = 26.8%. Among the participants, 10.4% had CD4 count <200. Conclusion: Early detection and treatment of STI is 30%. Early detection of cervical cancer and treatment were increased. Access to ARV for HIV-1 PMTCT was also increased. Cross sectional analysis will show more realistic data since the follow up visit may be a group who came to receive condoms which could be missed as high condom use rate. KPI of success in good clinical tracer include increased condom use and CD4 count, decrease STI, opportunistic infection, and viral load.

One-year assessment of women receiving sub-dermal contraceptive implant at Siriraj Family Planning Clinic.

BACKGROUND: The single-rod Implantable contraceptive method, called 'Implanon', has been introduced for use in Thailand since the 1990s. The outstanding attribute was that it requires only a few minutes for insertion and removal as it has only one capsule. The single-rod implant was used in women at Siriraj Hospital in 2006. The present study looked at characteristics of women, complications of insertion and removal, menstrual events that occurred to women during one year of use and reason for removal of the method. MATERIAL AND METHOD: This was a retrospective clinic based study. All women's record files were examined at Siriraj Hospital's Family Planning Clinic. There were 166 women enrolled to undergo this method, and only 89 women (54.6%) came back for the one-year follow-up visit. Women's accounts on irregularity of menses, complaints during method used and reason for discontinuation, pregnancy and body weight change were assessed. RESULTS: Most women (68%) using the implant contraceptive method were 29 years of age with 74% of vocational or lower education. Their BMI was 22.66 +/- 4.06 Insertion time was about 1 minute with no difficulty or complication. Of those women, 40.4% of them considered having regular menstrual cycle and 30.3% had regular menstrual flow for a few months alternately with no menses for a few months. Prolonged menstrual bleeding was the most complaint in this group of women. Amenorrhoea was also reported. Vertigo had occurred to some women without reported medication. One woman asked for the removal of the method due to pain at the implanted site after 8 months of use. Removal time was around 2-3 minutes. There was no pregnancy that occurred in the course of one year of use. CONCLUSION: Of 89 women using the implant contraceptive method, menstrual irregularity was the important issue that women complained about. However, the removal of the method in one woman was due to the pain at the implanted site. There was no difficulty or complications in insertion or removal of the implant. Close counseling about side effects of the method is emphasized during use to maintain long-term use or until completion of the duration of the device.

Preliminary report on characteristics of women participating in the meeting of the Oral Contraceptive Pill Members Club at Siriraj Hospital.

BACKGROUND: Oral Contraceptive (OC) services are not frequented a lot in Siriraj Hospital. Therefore, the OC services initiated the Siriraj OC Members Club to increase the number of OC users, develop a 'one-stop-service' clinic and a 'help line' to assist women cope with the side effects during OC use, and provide proper information. MATERIAL AND METHOD: Hospital personnel who worked at Sirriaj Hospital were informed about the program of the Siriraj OC Members Club by posters, leaflets, hospital website, and word of mouth. Those who registered as members participated in the half-day meeting of the program. Questionnaire assessment was distributed to all members who attended the meeting. RESULTS: The average age ofparticipants was 31.4 years. The lowest education level was secondary school and the highest was doctorate. Most married members have used at least one kind of contraceptive method OC's and condoms were the most common contraceptive method used in the past. Their source for obtaining OC was drug stores. In general, most women had had irritability and depression. Almost all women expected to have more information about advantages and disadvantages of OC use to cope with fear and side effects of OC use. CONCLUSION: Women who attended the meeting still need accurate and full information about the OC's. This program proposed to provide them with up-to-date and correct information about the OC. Furthermore, the one-stop-service will save their time and the help-line will assist them to cope with the side effects of OC use.

The comparative study of different contraceptive methods between copper T 380A and norplant 6, Siriraj experience.

Objective: To evaluate and study the demographic and clinical profile among the users of these 2 different contraceptive methods, to assess the continuation rates of these 2 methods as well as the frequency of Pap smear screening plus the resultsof Pap smears in each contraceptive method. Methods: This was a case note-based study in which the data were transferred to a standardized pre-tested proforma. Results: During 1 January - 31 December 2001 There were 162 Copper T 380 A users and 307 Norplant 6 users. The age group of IUD users were found higher than Norplant-6 users with a statistical difference. The continuation rates after 5 years were 39.5% for copper T 380 A and 11.4% for Norplant users. The frequency of Pap smear screening as well as the follow up rate was found much higher in copper T 380 A. The results of Pap smear of these two groups using long-acting contraception were statistically different : IUD users had a higher infection rate but Norplant users had higher abnormal cells. After treatment all users return to normal Pap smear. Conclusion: This contraceptive study was conducted in 2001. The continuation rate for copper T 380 A was significantly higher than Norplant 6 and encouraged the participants to have Pap smear screening as well as keeping the appointment for follow up. The report of Pap smear screening was found abnormally higher in the Norplant users. Actinomyces infection was commonly found with copper T 380 A.

Ethics and the comprehensive application of epistemology in medical practice.

Our simple definition of ethics is good thought, speak and action. Epistemology means the hypothesis of facts about thought, speech and action. Medical practice is all means of medicine. Medicine classifies people into normal and abnormal. The abnormal are the sick. They loose some organs or those normal looking organs are dysfunctional. They are social problems, some can be treated, and some do not get the appropriate care. The problems of society of normal people are overeating and obesity, abortion, drug abuse, promiscuity, torture, terrorism, disobeying rules and order, corruption, brain-washing and unethical advertisements, etc. On the other hand, the social problems of the abnormal are down, deafness, blindness, dumb, hypertension, hypercholesterolemia, diabetes mellitus and cancer, etc. An example of the social-doctor problem is the mal distribution of doctors in rural areas. It was reported by the ministry of public health that the ratio of doctor to population to be 1:800 in Bangkok and 1:5, 700 in some rural areas in the north eastern part of Thailand. The doctors, themselves, are at a high grade of worker and intelligent quotient. They know all the problem and, at the same time, create problems, both, faster than the general population can do. It affects good and bad in the society. In the past, present and the foreseeable future the medical students get their studies in the western style. Their medical schools are situated in big cities. These schools are old and famous. They learn their medical procedure in a big hospital of more than 400 beds in the inpatient department wards. Their instructors and professors are highly qualified, are middle class people and well accepted in the society. Their families are lovely and warm. Their children study in the first class schools in town. The medical students feel very happy and appreciate seeing their professors in television routinely at prime time. In conclusion, their professors are an example of role model for them to follow. Everyone looks for security in her/his profession. Facts need no proof and reference. People with justice in mind should believe and understand the above mentioned. This leads to the problem of mal distribution of doctors in rural areas, why do doctors live in big cities or wish to be in the private sector? In fact, not many a number of doctors serve in the rural area. About 4-5 of them, their name will be announced yearly as the best rural doctor award. After the big ceremony, lasted not longer than a month, it is hard to remember their name. They are proud to be praised, it pushes them into stress intentionally with all the best of their intelligence and the total of their body strength to work harder in rural. Unfortunately their earning, the security of their profession, the increased chance of being sued, to get caught in the medical litigation, the expenses of their family social status and the study of their children cannot be compared to of those doctors in big city and/or in the private sector. Mal distribution of doctors in remote rural areas has been a persisting unresolved problem in many parts of the world, why not apply the principles of ethics and epistemology? They have been left, untouched forever.

Medical ethics for senior medical doctors (episode I).

A good leader will never ever forget themselves, or abuse the power or authority, and also not trust only the inner circle voice, nevertheless they have to listen and consider the voice of disagreement from others. Otherwise, they will transform themselves to be a "dictator" unconsciously which is very dangerous and harmful to the democratic ruling system as well as themselves and their family members, as you can see from the past history of foreign countries and even Thailand itself. Thai culture is surrounded and consistes of kindness, mercy and good wishes to each other. The patient is so grateful and appreciates the value of the medical doctor for saving their life. Even although the Western culture is penetrating globally as a business-oriented culture in which medico-legal cases such as patient's rights, the value of the patient's benefit protection and certainly it requires the legal act to get involved eventually. The compromised culture which has been embedded in Thai society for a prolonged period can be changed firmly and gradually because of the usual and regular condition and definitely the good and valued medical doctors is still around. The opportunity of medical doctors to act as a pioneer of the trend and conflicted societies, is responsible to them and it's a great opportunity for Thai medical doctors to reach out to these goals and excellence. The above statements can be found in various media. Is it true that the medical doctors will absolutely be hundred percent good guys and have good luck from time to time? But for sure, even our medical colleagues are very much dedicated and concentrated in their job, as the family members of our medical profession, they have been left out, they have no time to share with or even be responsible to them. Many of our friends in the same profession might feel so sorry or appreciate the term "short-belt situation" or "unexpected" event which might attack us from the society violently and unmercifully.

Searching for medical ethics in Dharma conversation.

Our medical ethics team has a great opportunity to consider the terminology of"Moral Rights", "Good guys", "Understanding the real world" and the issues about "live salvation". What has been mentioned about these terms in Buddhism? In Buddhism, it has been cited that moral duty is the cause that leads to the moral rights as result. When we act the right as well as decent things, we are entitled to get the fair deals in return. We used to forget to consider that, isn't our moral duty or not?, to just either pay respect to the other people's rights or simply protect the other people's rights. Regarding to the Buddhism religion, there are a certain criteria to be "Good guys" i.e. firstly, not to make any sin at all such as not to exploit the others physically, verbally and mentally. Secondly, to make merits, such as helping out; showing the mercy and kindness to the underprivileged; donating money, land and properties, or even sharing the justified idea is also included. We also forgot to ask about tempting the others with a certain of hindrance i.e. assets, land and properties. Have you already made the sin with these temptations or dominating the idea of people? How the people will understand the fine line between the sin and meritorious deed? Buddhism kindly advises us to understand and consider the real world in two steps as well as in parallel way. Looking around us as surrounding of illusion. These illusion or fantasies will not be sustainable, only temporarily indeed. For example, human being has to go through aging process, illness and eventually death. What we need to consider in parallel is the matter about "Within us". What is the secret issue about "Within us"? Brain, spirit, heart or extremities, wherever we point at, will be just only human biological tissues or various elements. Last, but not least, practicing salvation when you still alive is perplexing. Live salvation is already existed within us, nowadays. No need to wait for the next life. Salvation can exist when we still alive. Salvation is to purify our spirit which require proper training to keep it clean in sustainable way.