Measurement of ethylene oxide gas and calculation of a safe period for contact at the medical sterilization unit in Siriraj Hospital.

Measurement of Ethylene Oxide Gas and Calculation of a Safe Period for Contact at the Medical Sterilization Unit in Siriraj Hospital The objectives in measuring the ethylene oxide (EtO) level at the Medical Sterilization Unit in Siriraj Hospital by using a simple Piston gas hand pump, are to examine the residual EtO level at the back of the sterilizer after the sterilizer opened (the end of the sterilization process) at different time periods and to calculate a safe period of time to wait before transferring equipment and supplies to the aerator. The EtO levels at 5,10,15 and 20 minutes after the sterilizer opened were1.5,1.2, 0.7 and 0.4 ppm, respectively. By using a semi-logarithm equation to calculate the slope of elimination between 2 points, the expected time for the concentration of EtO level to be equal to or less than 0.5 ppm would be 18.75 minutes for a room volume of 115.83 cubic meters. A concentration of residual EtO level at 0.5 ppm or lower was safe for workers in routine work environments and could be applied by other laboratories.

Amikacin: Area under curve for once daily dose and its correlation with plasma concentration at six hours post infusion.

Aminoglycosides are commonly used for gram-negative septicemia. Formerly, peak and trough plasma levels were the monitoring parameters for conventional dose which was every eight hours. At present the recommended dose is once daily and the recommended monitoring parameters are the area under concentration time curve and the six-hour (range 146-180) for the area under curve and 6.79 milligrams per liter (range 5.6-7.9) for the six-hour plasma concentration post-infusion. The correlation of the area under curve and the six-hour plasma concentration post-infusion was reported in a linear equation with significance.

Risk factors for falls in the Thai elderly in an urban community.

BACKGROUND: Instability or falls in the elderly are a health condition meeting all criteria for prevention i.e. high frequency, evidence of preventability and a high burden of morbidity. The consequences of a fall affect not only the elderly per se such as fractures and various kinds of physical and mental impairment, but also the family and the society as a whole in terms of the financial expenditure involved. The need for a comprehensive study to identify the risk factors for falls among the Thai elderly is, therefore, crucial for further management. OBJECTIVE: To identify the significant risk factors for falls among the Thai elderly for further prevention and management. METHOD: A cross-sectional study in the urban community around Siriraj Hospital, Bangkok. 1,043 community-dwelling people aged > or = 60 years were recruited. A structured questionnaire, including mental test and physical examinations as well as various laboratory tests, were used to identify the risk factors for falls between faller and control groups. RESULTS: The overall prevalence of falls among elderly Thais in an urban area was 19.8 per cent during a period of 6 months. However, the prevalence was 24.1 per cent in women but only 12.1 per cent in men. Older people who were likely to fall also had a lower bone mass which predisposed them to future fractures. The independent risk factors for falls after multiple logistic regression analysis were: female gender, hypertension, deafness, poor memory, poor self-perceived health status, poor performance in the instrumental activities of daily living, kyphoscoliosis, use of spectacles, rapid pulse rate after a 5 minute rest, higher serum transferrin and poor nutrition in terms of low lean body mass and reduced serum albumin level. CONCLUSIONS: Special sense, activity of daily living, nutritional status, kyphoscoliosis, hypertension and cognitive ability were six important factors determining the likelihood of fall among the elderly in an urban area.

An electrocardiographic survey of elderly Thai people in the rural community.

Electrocardiographic findings in the elderly reflect both common cardiac diseases and physiologic ageing change. This cross-sectional population-based study explored the prevalence of various abnormalities in the electrocardiograms of active older people and those who are free from any cardiac pathology and determined their relationship to age and gender in a rural area of Thailand. Nine hundred and sixty three people aged 60 years or more were recruited. The electrocardiographic prevalence of ischemic heart disease, atrial fibrillation, left axis deviation and conduction defect were 5.5 per cent, 2.2 per cent, 2.5 per cent and 3.1 per cent respectively. After excluding diseases potentially affecting the heart, the prevalence of atrial fibrillation, left axis deviation and conduction defect decreased to 1.3 per cent, 2.0 per cent and 2.2 per cent. The prevalence of atrial fibrillation and ischemic heart disease were significantly less (p = 0.015 and 0.003) in the 80+ year old group. Regarding gender difference, only left axis deviation was found significantly more frequently in older men with an odds ratio of 5.23 (95% confidence interval, 1.28-30.29) in those who were free from diseases potentially affecting the heart. IN CONCLUSION: Atrial fibrillation should not be regarded as degenerative change, but the result of cardiac pathology instead. The most common electrocardiographic abnormality in normal older men was left axis deviation and was found consistently more often than in older women. Therefore, it is appropriate to investigate for any reversible causes of atrial fibrillation while it is not so for left axis deviation in older men.

Comparison between real hospitalization benefits and reimbursements from diagnostic related group (DRG) criteria in HIV patients.

There are an increasing number of patients with the HIV virus in Thailand. The opportunistic infections in these patients are tuberculosis, Cryptococcal meningitis and Pneumocystis carinii pneumonia. The hospitalization benefits of admission were critical in the process of assessing of the economy of Thai government's budget. The coverage reimbursements from the government are classified according the criteria of the Diagnostic related group or DRG. An attempt to compare the real benefits to Siriraj Hospital and the government reimbursements for treating HIV-related illness was made and will eventually lead to further eventually adjustable reimbursements.

Strategy to prevent falls in the Thai elderly: a controlled study integrated health research program for the Thai elderly.

Instability or falls are one of the important warning symptoms of underlying serious illness among the elderly, so many studies have concentrated on the risk factors for falls. However, a study involving a strategic method to reduce the incidence of falls is the next step and is the main objective of this study. 1,043 elderly subjects living in the urban area around Siriraj Hospital Medical School, Bangkok, were recruited, 585 of them were allocated to the study group and 458 subjects to the control group. A leaflet containing information on important risk factors of falls within their community was enclosed with a follow-up postcard in the study group only. In addition, this particular group was allowed free access to the geriatric clinic at Siriraj Hospital if there was any health problem. All of them received a postcard asking about any falls which had occurred over the previous 2 months on 6 occasions and a telephone call if the postcards were not returned to the team. The percentage of elderly who kept in contact was 92.5 per cent, 90.6 per cent, 89.3 per cent, 89.2 per cent, 86.2 per cent and 85.45 per cent for the first to final follow-up respectively. After one year of longitudinal study, the overall incidence of falls was 6.6 per cent in the study group and 10.1 per cent in the control group. The incidence of falls began to show a statistically significant difference between the two groups at the fourth and sixth episodes of follow-up (P = 0.002 and 0.004). The Kaplan-Meier survival analysis also revealed a statistically significant difference in the incidence of falls between the two groups (P =0.01). In conclusion, the incidence of falls was significantly reduced in the study group and a repeated campaign to alert the elderly to the risk of falling is a cost-effective way of fall prevention among the healthy elderly in the community.