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Objectives: In 2021, Thailand experienced its fourth and fifth waves of COVID-19, overwhelming the nation's public health system. The significant gap between health resources and the demand for services from patients was one of the primary challenges in responding to the catastrophic COVID-19 pandemic. Hospitals were inundated with a surge in new patients, leading to a growing backlog of individuals suffering delayed care or even rejection from the healthcare system. To tackle this issue, strategies such as "outpatient self-isolation" (SI), "home-based isolation" (HI), and "community-based isolation" (CI) were implemented to stabilize COVID-19 cases with mild to moderate symptoms. This review aimed to explore the experiences in the management of COVID-19 care in patients with mild to moderate symptoms and identify challenges after the initial response of the Thailand health system to the pandemic. Methods: This study was conducted during the Delta pandemic (June–November 2021) and the Omicron pandemic (December 2021–15 March 2022). We present the lessons learned from the management of the HI system based on experiences gained at a university hospital, which provided remote professional-to-patient support during the pandemic. The study involved retrospective data from electronic medical records and qualitative analysis of responses provided during the pandemic using the HI system. Results: Data from a total of 2704 and 1912 participants were included in the analysis. The vast majority of patients were assigned to HI immediately after being diagnosed with COVID-19. This system facilitated remote consultations, provision of necessary medications, and delivery of survival kits to patients' homes. Qualitative reviews indicated several key factors that could contribute to successful COVID-19 management under the HI system: (1) effective management and vaccine status, (2) establishment of home isolation using the find-test-trace-isolate-support system, and (3) adherence to home isolation guidelines and system support. Challenges included the digitalization of tools for securing isolation, team preparedness and adequate support system during HI, as well as hospital policies for psychological support for healthcare workers and measures to alleviate their workload. Conclusions: Our investigation suggests that the HI teleconsultation system was an effective approach to managing COVID-19. It allowed for a prompt response to patients' needs and provided timely access to medical support, particularly for individuals with mild to moderate symptoms. [ABSTRACT FROM AUTHOR]

Background: In December 2021, Omicron replaced Delta as the dominant coronavirus disease 2019 (COVID-19) variant in Thailand. Both variants embody diverse epidemiological trends and immunogenicity. We investigated whether Delta and Omicron patients' biological and clinical characteristics and immunogenicity differed post-COVID-19 infection. Methods: This retrospective cohort study investigated the clinical outcomes and laboratory data of 5181 patients with mild-to-moderate COVID-19 (Delta, 2704; Omicron, 2477) under home isolation. We evaluated anti-receptor-binding domain immunoglobulin G (anti-RBD IgG) and surrogate viral neutralizing (sVNT) activity in 495 individuals post-COVID-19 infection during the Delta pandemic. Results: Approximately 84% of all patients received favipiravir. The median cycle threshold (Ct) values were lower for Omicron patients than Delta patients (19 vs. 21; p < 0.001), regardless of vaccination status. Upper respiratory tract symptoms were more frequent with Omicron patients than Delta patients. There were no significant associations between Ct and Omicron symptoms (95% confidence interval 0.98–1.02). A two-dose vaccine regimen reduced hospital readmission by 10% to 30% and death by under 1%. Anti-RBD IgG and sVNT against Delta were higher among older individuals post-COVID-19 infection. Older individuals expressed anti-RBD IgG and sVNT for a more extended period after two-dose vaccination than other age groups. Conclusions: After a full vaccination course, breakthrough mild-to-moderate Delta and Omicron infections have limited immunogenicity. Prior infections exert reduced protection against later reinfection or infection from novel variants. However, this protection may be sufficient to prevent hospitalization and death, particularly in countries where vaccine supplies are limited. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Relationships between cardiometabolic risk and glycemia have rarely been studied in people under clinical evaluation and treatment for cardiometabolic risk and with prediabetes. We investigated relationships between glycemia and cardiometabolic risk factors in clinic participants with prediabetes. Materials and Methods: This was a cross‐sectional analysis of data collected at a center in Thailand. Clinic attendees were at high risk of diabetes or cardiovascular disease, with hemoglobin A1c (HbA1c) 39–<48 mmol/mol or fasting plasma glucose (FPG) 5.6–<7.0 mmol/L. The relationships between glycemia and cardiometabolic risk factors were explored. Results: Of 357 participants, two or more insulin resistance‐related metabolic disturbances were present in 84%; 61% took a statin and 75% an antihypertensive agent. Independently of age, sex, adiposity, medication use, possible non‐alcoholic fatty liver disease and sex–glycemia interaction, neither FPG nor HbA1c were associated with variation in any other cardiometabolic risk factors. High‐density lipoprotein cholesterol decreased with HbA1c in women (female–HbA1c interaction, P = 0.03) but, unexpectedly, increased with FPG in men (male–FPG interaction, P = 0.02). Conclusions: Overall, in Thai people treated for high cardiometabolic risk and with prediabetes defined by FPG and/or HbA1c, neither FPG nor HbA1c were associated with other cardiometabolic risk factors. However, according to sex, high‐density lipoprotein cholesterol showed the expected relationship with glycemia in women, but the reverse in men. [ABSTRACT FROM AUTHOR]

Aims: Variation in cardiometabolic risk in prediabetes and any impacts of ethnicity on such variation have been little studied. In an ethnically diverse dataset, selected according to a high-risk HbA1c-based definition of prediabetes, we have investigated relationships between glycaemia and cardiometabolic risk factors and the influence of ethnicity on these relationships.Methods: We undertook a cross-sectional analysis of baseline data from a diabetes prevention study in the UK and a chronic care clinic in Thailand, selected for people without diabetes (fasting plasma glucose <7.0 mmol/l) with HbA1c 6.0-6.4% (42-47 mmol/mol). Thai (n=158) and UK White (n=600), South Asian (n=112), Black (n=70) and other/mixed (n=103) groups were distinguished and measurements included fasting plasma glucose (FPG), blood pressure (BP), lipids and insulin resistance-related risk factors (IRFs).Results: Independently of individual characteristics including ethnicity, only systolic BP was weakly associated with FPG (beta coefficient 1.76 (95%CI 0.10-3.42), p 0.03) and only LDL-c with IFG (FPG 5.6 to <7) (adjusted -0.14 (-0.27, -0.003) p 0.04). There were no significant independent associations with cardiometabolic risk factors when categories of impaired fasting glucose (FPG ≥ 6.1 to <7.0 mmol/L) were considered. Relative to White, South Asian ethnicity was independently associated with lower systolic and diastolic BP, Black with lower triglycerides, cholesterol/HDL-c ratio and having 2 or more IRFs, and Thai with lower cholesterol/HDL-c ratio and all three non-white ethnicities with lower total and LDL cholesterol.Conclusion: In high-risk HbA1c-defined prediabetes additional measurement of FPG will add little to evaluation of cardiometabolic risk. Additionally, UK Whites tend to have the most adverse cardiometabolic profile of any ethnic group. [ABSTRACT FROM AUTHOR]

Background: Direct observation and supervision (DOS) is the teaching method where a mentor provides direct observation during patient encounter and provides feedback to the learner in real-time manner Previous studies showed that DOS improves patient care and trainees' clinical skill but is difficult to implement., Objective: To evaluate students' performance and attitude after implementing DOS to the 5th year medical students., Material and Method: DOS was introduced for the whole class of the 5th year medical students throughout the year at out-patient setting department of Medicine, Siriraj Hospital in 2012. DOS sessions were provided during the first few patients 'encounters. Students 'performances at out-patients clinics were ratedfor other 8 subsequence sessions. The average score were compared to the 5th year medical students in 2011 (Conventional technique, CT)., Results: Two hundred andforty six students were supervised in DOS group. The mean score ofstudents who received DOS was significantly higher than CT group with the score of 8.2 compared to 7.9, respectively (p < 0.001). With respect to students'satisfaction, 75% of students rated DOS as a learning method with high to very high benefit., Conclusion: DOS method is feasible to implement and could improve student's performance with good satisfaction from medical students.

Background: Annual epidemics of influenza viruses remain a substantial cause of morbidity and mortality worldwide particularly among vulnerable groups. Immunization is another way to reduce the infection and mortality rates, especially in high-risk groups; however the data concerning prescription rates and possible influencing factors on decisions associated with influenza prescription of Thai internal medicine residents were limited, Objective: Siriraj internal medicine residency training has provided outpatient continuum care practice for all 1st year residents since 2008. A part of the curriculum was to prepare each trainee to be an effective vaccinator. This study aims to examine the competency ofthose residents who had completed the training, particularly about prescribing influenza vaccine., Material and Method: The authors retrospectively reviewed medical records of the patients that indicated need for influenza vaccine encountered by 2nd and 3rd year residents during June 2011 and May 2012. The 20-item questionnaire was also sent out in order to study possible factors associated on prescribing the vaccine., Results: Three hundred and seventy-three medical records were included and reviewed. The prescription rate of influenza vaccine was 8.0 percent. Comparing vaccine receiving and non-receiving groups, the authors found having respiratory problems (26.7% vs. 4.4%; odds ratio 8.0 [3.0-20.8]; p < 0.001) and being self-paying (16.7% vs. 5.8%; odds ratio 3.2 [1.1-9.3]; p = 0.023) were the only two significant differences. Only 5.7 percent of total residents were an effective vaccinator One hundred and five residents returned the questionnaire. Residents who had further plans for fellowship trainings had reported a higher influenza vaccine prescription rate than those who will be general internists (45.2% vs. 8.1%; adjusted odds ratio 14.04 [1.6-125.8]; p = 0.018). The authors also found that the rate of vaccine recognition, general knowledge of vaccination, and vaccine coverage remained 61.9%, 29.5%, and 21.0% among medicine residents., Conclusion: Prescribing rate of influenza vaccine remained low due to multifactor aspects, including doctor capability, attitude, patient recognition as well as reimbursement issues. In order to improve the rate of influenza vaccine prescriptions, a system-designed approach would be needed.

Background: Diabetes mellitus is one of the most common diseases in the Thai population, and it is well known that diabetic complications could be prevented with appropriate management. Despite published guidelines, most Thai patients with diabetes do not achieve treatment goals. Siriraj Continuity of Care clinic (CC clinic) was recently established in order to provide training for medical students and internal medicine residents. It is possible that the training component in the CC clinic may contribute to better overall outcomes in type 2 diabetes mellitus (type 2 DM) patients when compared with usual care at the medical out-patient department (OPD)., Objective: To compare the effectiveness of diabetic management in type 2 diabetes mellitus patients who attended the CC clinic and the medical OPD., Material and Method: Retrospective chart review was performed in type 2 diabetes mellitus patients who were treated at either clinic at Siriraj Hospital in 2007-2011. Baseline demographics, treatment strategies and outcomes, and participation in an appropriate health maintenance program were assessed in both groups., Results: Seven hundred and fifty seven medical records were reviewed, including 383 patients in the CC clinic group and 374 in the OPD group. Mean HbA1c was significantly lower in the CC clinic group compared with the OPD group (7.3 +/- 0.9% and 7.8 +/- 1.3%, respectively, < 0.001). The number of patients who achieved goal HbA1c of less than 7% in CC clinic group was 123 (32.1%) compared with 91 (24.3%) in the OPD group (p = 0.039). More patients were screened for diabetic complications in the CC clinic group compared with the OPD group, including screening for diabetic neuropathy (57.4% vs. 2.1%, p < 0.001), diabetic retinopathy (56.7% vs. 36.6%, p < 0.001), and diabetic nephropathy (80.9% vs. 36.9%, p < 0.001). Patients in the CC clinic group had a higher rate of age-appropriate cancer screening than those in the OPD group (54.2% vs. 13.3%, p < 0.001 for breast cancer; 24.0% vs. 0.9%, p < 0.001 for cervical cancer; and 23.0% vs. 7.4%, p < 0.001 for colon cancer). Moreover, significantly more patients in the CC clinic group received recommended immunization (influenza, diphtheria tetanus and pneumococcal vaccine) compared with the control group (p < or = 0.001)., Conclusion: Diabetic patients treated at the CC clinic had better clinical outcomes and healthcare maintenance compared with those who received usual care at the medical OPD. Continuity of care and integrated training component may have contributed to the improved outcomes.

Background: Many diabetic patients did not receive proper medical care to achieve treatment goals based on clinical practice recommendations. Siriraj Continuity of Care clinic (CC clinic) has been established specifically for medical students and internal medicine residency training purpose since 2006. The training components in the teaching clinic might contribute to overall better outcomes for Type 2 diabetic patients comparing to regular service clinics., Objective: To evaluate the efficacy of Siriraj CC clinic curriculum on improving clinical outcomes of diabetic patients., Material and Method: The authors retrospectively reviewed medical records of type 2 diabetic patients who had been referred from regular service clinics of Siriraj Out-Patient Department (OPD) to CC clinic during 2007 to 2011. Clinical outcomes of these patients were compared: before vs. after entering CC clinic., Results: One hundred and eighty medical records were reviewed. The mean of HbA1c were 7.5 and 7.3 percent before and after entering CC clinic (p = 0.026). Comparing clinical outcomes before vs. after entering CC clinic, we found that the percentage of patients who had optimal BMI and who had achieved LDL goals were 16.3 vs. 21.6 (p = 0.021), and 56.7 vs. 73.1 (p = 0.001), respectively. The proportion of patients who received annual diabetic complication assessments were also higher after entering CC clinic: the percentage of patients who received examinations of the eye, had urine micro albumin checked, had been screened for diabetic foot were increased from 58.3 to 93.3 (p < 0.001), 35.6 to 83.9 (p < 0.001), and 6.7 to 91.1 (p < 0.001), respectively. Moreover there were more patients who received adult health care maintenance program including: cancer screening program (clinical breast examination, mammography, fecal occult blood test and pap smear) and immunization (influenza, diphtheria tetanus and pneumococcal vaccine) (p < 0.001) after entering CC clinic., Conclusion: After entering CC clinic, diabetic patients had better clinical outcomes as well as received better screening and health care maintenance program comparing to regular service clinics. The focus training components in this clinic has played a major role on contributing the preferred clinical performance among medical students and internal medicine residents.