Search

Abstract Background Older cancer patients are vulnerable to poorer health outcomes during cancer treatment. Although the Thai elderly had their own preferences towards future medical care and advance care planning (ACP) could help cancer patients make informed decisions, Thai physicians report a low ACP engagement rate. Thus, this study aimed to explore the perceptions of older cancer patients and their families towards ACP engagement. Method We used a qualitative approach to explore the perceptions of non-haematological cancer patients aged ≥ 60 years old and their primary caregivers. The study was conducted at the Oncology Radiotherapy Referral Center, Songklagarind Hospital in Southern Thailand. Semi-structured in-depth interviews were conducted with the patients and their caregivers. Thematic analysis was used to identify and analyze recurring patterns and themes of perceptions regarding ACP engagement within the interview transcripts. Results Among the 138 families approached, 32 interviews were conducted. Three themes were found: (1) Advantageous opportunity: the patients believed ACP would help them realize their life values, and ensure that their preference would be respected; (2) contemplation and barriers to ACP: ACP is unfamiliar and unnecessary, might have low utility, worry patients and family members, take away optimism, would not be a proper activity for the patient at the current health situation; and (3) Cues for ACP initiation: perceived conformity with one’s religion, awareness of the current cancer state, having multiple comorbidity or experience suffering related with medical care, wishing not to burden family, having close family members, and trust in physicians. Conclusion ACP engagement could be hindered or promoted by perceptions of older patients and/ or their family members, as well as the communication skills of the care providers. Care professionals who aim to initiate ACP should minimize the potential barriers, make the ACP benefits salient, and watch for cues indicating a propitious time to start the ACP conversation.

Abstract Background The integration of Health System Science (HSS) in medical education emphasizes mastery of competencies beyond mere knowledge acquisition. With the shift to online platforms during the COVID-19 pandemic, there is an increased emphasis on Technology Enhanced Assessment (TEA) methods, such as video assessments, to evaluate these competencies. This study investigates the efficacy of online video assessments in evaluating medical students’ competency in HSS. Methods A comprehensive assessment was conducted on first-year medical students (n = 10) enrolled in a newly developed curriculum integrating Health System Science (HSS) into the Bachelor of Medicine program in 2021. Students undertook three exams focusing on HSS competency. Their video responses were evaluated by a panel of seven expert assessors using a detailed rubric. Spearman rank correlation and the Interclass Correlation Coefficient (ICC) were utilized to determine correlations and reliability among assessor scores, while a mixed-effects model was employed to assess the relationship between foundational HSS competencies (C) and presentation skills (P). Results Positive correlations were observed in inter-rater reliability, with ICC values suggesting a range of reliability from poor to moderate. A positive correlation between C and P scores was identified in the mixed-effects model. The study also highlighted variations in reliability and correlation, which might be attributed to differences in content, grading criteria, and the nature of individual exams. Conclusion Our findings indicate that effective presentation enhances the perceived competency of medical students, emphasizing the need for standardized assessment criteria and consistent assessor training in online environments. This study highlights the critical roles of comprehensive competency assessments and refined presentation skills in online medical education, ensuring accurate and reliable evaluations.

Abstract Background Due to limited numbers of palliative care specialists and/or resources, accessing palliative care remains limited in many low and middle-income countries. Data science methods, such as rule-based algorithms and text mining, have potential to improve palliative care by facilitating analysis of electronic healthcare records. This study aimed to develop and evaluate a rule-based algorithm for identifying cancer patients who may benefit from palliative care based on the Thai version of the Supportive and Palliative Care Indicators for a Low-Income Setting (SPICT-LIS) criteria. Methods The medical records of 14,363 cancer patients aged 18 years and older, diagnosed between 2016 and 2020 at Songklanagarind Hospital, were analyzed. Two rule-based algorithms, strict and relaxed, were designed to identify key SPICT-LIS indicators in the electronic medical records using tokenization and sentiment analysis. The inter-rater reliability between these two algorithms and palliative care physicians was assessed using percentage agreement and Cohen’s kappa coefficient. Additionally, factors associated with patients might be given palliative care as they will benefit from it were examined. Results The strict rule-based algorithm demonstrated a high degree of accuracy, with 95% agreement and Cohen’s kappa coefficient of 0.83. In contrast, the relaxed rule-based algorithm demonstrated a lower agreement (71% agreement and Cohen’s kappa of 0.16). Advanced-stage cancer with symptoms such as pain, dyspnea, edema, delirium, xerostomia, and anorexia were identified as significant predictors of potentially benefiting from palliative care. Conclusion The integration of rule-based algorithms with electronic medical records offers a promising method for enhancing the timely and accurate identification of patients with cancer might benefit from palliative care.

IntroductionPain is a major symptom in cancer patients. World Health Organization recommends opioids as the main analgesic agent. Few studies have examined the amount of opioid uses in cancer patients in Southeast Asia, however, none of them have examined the factors associated with the amount of opioid uses which were lower than required.ObjectivesTo assess the trends and factors associated with opioid prescriptions for cancer patients in Songklanagarind Hospital, the largest referral center in Southern Thailand.DesignMulti-method quantitative study.MethodsWe reviewed the electronic medical records of 20,192, outpatients aged ≥18 years diagnosed with cancer between 2016 and 2020 who received opiod prescriptions. Oral morphine equivalents (OME) were calculated using the standard conversion factors and the OME trend during the study period was assessed by a generalized additive model. Factors affecting the morphine equivalent daily dose (MEDD) were assessed using multiple linear regression with a generalized estimating equation.ResultsThe mean overall MEDD for all study patients was 27.8 ± 21.9 mg per day per patient. The bone and articular cartilage cancer patients had the highest MEDD. For every 5-year increase in the duration of cancer, the MEDD increased by 0.02 (95% confidence interval [CI]: 0.01 - 0.04). Patients with stage 4 cancer received a higher average MEDD of 4.04 (95% CI: 0.30-7.62) as compared to those with stage 1 cancer. Patients with bone metastasis received a average higher MEDD of 4.03 (95% CI: 0.82-7.19) compared to those without. Age was inversely associated with the MEDD. Patients aged 42-58, 59-75 and >76years old received MEDDs of 4.73 (95% CI: 2.31-7.15), 6.12 (95% CI: 3.66-8.59) and 8.59 (95% CI: 6.09-11.09) compared with those aged 18-42 years old. Brain metastasis was inversely associated with MEDD of 4.49 (95% CI: 0.61-8.37) compared to those without.ConclusionOpioid use in cancer patients in this study is lower than the average global usage. Promoting opioid prescriptions for pain management through medical education can help doctors overcome opiophobia.

Objective: To determine the prevalence of and to assess factors associated with diabetic foot in type 2 diabetes mellitus (DM) patients in the primary care unit (PCU) of Songklanagarind Hospital. Materials and Methods: The present study was a cross-sectional study that collected the data of 160 type 2 DM patients attending the PCU of Songklanagarind Hospital between March and July 2020 using a questionnaire and face-to-face interviews. The classification of diabetic foot severity was based on foot examination using the 2017 Guideline of the Diabetes Association of Thailand. Results: There were 160 participants in the present study, 44.4% were male and 55.6% were female. There were 58.1% aged less than 60 years and 41.9% aged more than or equal to 60 years. The diabetic patients who had foot ulcer were not found in the present study. There were 31.2%, 63.1%, and 5.6% of the patients had low, medium, and high risk of diabetic foot, respectively. In multivariate analysis, the adjusted odds ratios (ORs) with 95% confidence intervals (CI) found the factors associated with positively increased diabetic foot risk were some occupations including self-employed 5.19 (1.53 to 18.91) and agriculturist 4.82 (1.38 to 18.44), chronic kidney disease (CKD) 18.17 (2.46 to 131.32), longer duration of DM 3.14 (1.40 to 7.40), diabetic retinopathy (DR) 11.90 (3.44 to 50.00). Some factors negatively increased the risk were low-density lipoprotein (LDL) less than 100 mh/dL 0.37 (0.16 to 0.81), self-care behavior including asking others to check blind areas of the foot 0.21 (0.07 to 0.63), and foot exercise 0.29 (0.12 to 0.68) (p<0.05). Conclusion: Diabetic foot in type 2 DM patients at the PCU of Songklanagarind Hospital was not found. However, it is important to establish PCU to identify feet at risk included occupations, CKD, longer duration of DM, LDL more than 100 mh/dL, DR, and lack of self-care practices for primary and secondary prevention in DM patients. [ABSTRACT FROM AUTHOR]