disagreement from the medical team while communicating with unsatisfied clients, which would lead to misunderstanding and make things worse. 3.4 Reconstructing According to Jarvis, 18 I need to renew my awareness and communicate actively. Firstly, I am required to develop clinical skills and knowledge over a professional lifetime. Secondly, developing attitudes and attributes allows me to care for and communicate with patients in a sensitive way. Learning communication skills and specific knowledge makes me develop a positive change with reference to my clients and
Elyda Akhya Afida Misrohmasari, Hestieyonini Hadnyanawati, Kiswaluyo, Berlian Prihartiningrum and Dina Eka Putri
. 5 The differences in the prevalence of toothache demonstrated in this study with some previous researches may be attributed to numerous factors. Variation of the questions concerning dental pain could have contributed to these differences. Some studies asked for the toothache experience in life. Bastos et al. 9 requested information on lifetime prevalence of toothache, whereas in the current study this information was collected for the last 4 weeks. Whether this question type overestimated or underestimated the prevalence of toothache, it is difficult to
Nattawut Sastravaha, Yutthana Khanasuk and Worasun Taweewuthisub
motorcycle accident Open injury from work Initial treatment Direct repair of radial collateral ligament and K-wire fixation Repair of radial collateral ligament, central slip and K-wire fixation Started time of using the frame 3 weeks after injury 2 weeks after injury Overall time of using the frame 4 weeks 4 weeks Useful life (days) 1 st frame 8 9 2 nd frame 7 7 3 rd frame 8 8 4 th frame (end of treatment) 5 4 Average lifetime 7.6 8 (1 st -3 rd frame
Adawan Permpanich, Vithaya Kulsomboon and Kamol Udol
trials and the local registry database. The model was run until the patients were 100 years old or died. Figure 1 Structure of the Markov model The main assumptions made in this model were as follows; 1) patients in the acute health state (MI, stroke, HF) would not move to other acute health state; 2) the effectiveness of n-3 PUFAs would be maintained over life-time horizon; 3) the duration in each cycle was 1 year. The discount rate of 3% was applied for both costs and outcomes. The time horizon of the model and the effects in life expectancy
Phanthipha Wongwai, Pritaporn Kingkaew, Somkiat Asawaphureekorn and Tharatip Kolatat
and offer treatment accordingly. A lifetime time horizon was used to estimate the long-term costs and outcomes of infants becoming blind. All future costs and outcomes were discounted at a rate of 3% per annum. For intercountry comparisons, costs were converted into international dollars ($IS) using the purchase power parity exchange rate of $IS1 = 17.659 THB (Thai baht) [ 9 ]. All costs were adjusted to 2013 values using the general consumer price index [ 10 ]. A probabilistic sensitivity analysis was conducted using a second-order Monte Carlo simulation with 1
, peripheral arterial disease, aortic disease, such as aortic aneurysm. Specific preventive measures can be used to modify many risk factors for cardiovascular disease. These measures include lifestyle changes (smoking cessation, a healthy diet, regular exercise, moderate alcohol consumption), clinical interventions, such as statins, aspirin, antihypertensives, control of dyslipidemia and control of diabetes. Modifiable factors account for most of the population-attributable risk [ 4 ]. Therefore, once the 10-year and lifetime risk estimates are conducted, it is important
Pongphaya Choosakulchart, Tanattha Kittisopee, Suchet Takdhada, Yoel Lubell and Janet Robinson
Background: Influenza can exacerbate chronic coronary heart diseases (CHD) and health policy recommends influenza vaccination in this population group. However, cost effectiveness of influenza vaccination in protecting CHD population has not been, to our knowledge, well studied before especially in CHD patients with different disease severities.
Objectives: To assess life-time cost utility of influenza vaccination in CHD patients either with angina and/or cardiac arrest/myocardial infarction (CA/MI) and to identify the most cost-effective influenza vaccination strategies.
Method: The Markov model of CHD progression concurrent with the influenza infection was developed to quantify life-time costs and health effects of the three influenza vaccination strategies compared with no influenza vaccination (base case): (1) influenza vaccination in all CHD patients, (2) influenza vaccination in CA/MI patients-only, and (3) influenza vaccination in angina patients-only. The cost-effectiveness analysis (CEA) was based on the societal perspective. Deterministic and probabilistic sensitivity analyses were performed to identify variables that influence the sensitivity of the results and examine the effects of model parameters uncertainty, respectively.
Results: For the base case, the expected value (EV) results of no influenza vaccination, influenza vaccination in all CHD groups, influenza vaccination in angina patients, and influenza vaccination in CA/MI are 346,437 Thai baht (THB) yielded 18.26 Quality adjusted life year (QALYs), 454,664 THB yielded 21.46 QALYs, 360,786 THB yielded 19.96 QALYs, and 437,901 THB yielded 19.72 QALYs; respectively. CEA graph comparing all influenza vaccination strategies shows that vaccination in all CHD patients groups and angina patients are in the costeffectiveness frontier, but not influenza vaccination in CA/MI patients. The cost-effectiveness rankings report shows that the willingness-to-pay (WTP) threshold (100,000 THB) is greater than the incremental cost effectiveness ratio (ICER) of vaccination in all CHD groups (ICER = 33,813 THB per QALY gained) and angina group (8,420 THB per QALY gained) and therefore the vaccination in all CHD groups, which is more expensive, but more effective would be recommended. The deterministic sensitivity analysis shows the most influential parameters driving the cost-effectiveness of vaccination strategies are the effect of influenza vaccination on CHD both for acute myocardial infarction and cardiovascular death, respectively. The probabilistic sensitivity analysis shows the same influenza strategy recommendation (vaccination in all CHD groups) as the base case analysis.
Conclusion: From a societal perspective, influenza vaccination in all CHD groups is recommended. The information from economic modeling should be confirmed by primary economic research.
Attasit Srisubat, Jiruth Sriratanaban, Sureerat Ngamkiatphaisan and Kriang Tungsanga
Background: Diabetes is a leading cause of end stage renal disease (ESRD), which impacts on treatment costs and patients’ quality of life. Microalbuminuria screening in patients with diabetes as an early intervention is beneficial in slowing the progression of diabetic nephropathy.
Objectives: We aimed to assess the cost-effectiveness of annual microalbuminuria screening in type 2 diabetic patients.
Methods: We compared screening by urine dipsticks with a “do nothing” scenario. To replicate the natural history of diabetic nephropathy, a Markov model based on a simulated cohort of 10,000 45-year-old normotensive diabetic patients was utilized. We calculated the cost and quality of life gathered from a cross-sectional survey. The costs of dialysis were derived from The National Health Security Office (NHSO). We also calculated the incremental cost-effectiveness ratio (ICER) for lifetime with a future discount rate of 3%.
Results: The ICER was 3,035 THB per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses showed that all ICERs were less than the Thai Gross Domestic Product (GDP) per capita (150,000 THB in 2011) based on World Health Organization’s suggested criteria.
Conclusions: Annual microalbuminuria screening using urine dipsticks in type 2 diabetic patients is very costeffective in Thailand based on World Health Organization’s recommendations. This finding has corroborated the benefit of this screening in the public health benefit package.
Panruethai Trinavarat, Supika Kritsaneepaiboon, Chantima Rongviriyapanich, Pannee Visrutaratna and Jiraporn Srinakarin
CT has been used to save many patients’ lives and the demand for CT is still increasing. At the same time, there has been increasing concern of the probability of cancer induction by CT radiation. It is necessary for everyone involved in CT scanning, particularly physicians who have to communicate with patients when planning a CT scan, to have a basic knowledge of the CT radiation dose and its potential adverse effects. We have undertaken a systematic review of the literatures to document the radiation dose from CT, the lifetime cancer risk from CT exposure, CT dose parameters, the internationnal CT diagnostic reference levels, and the use and limitation of the CT effective dose. In addition, we conducted a brief survey of the use of CT scan in some university hospitals in Thailand and estimated current CT doses at these hospitals. Our review and survey suggests that CT scanning provides a great benefit in medicine but it also becomes the major source of X-ray exposure. Radiation doses from a CT scan are much higher than most conventional radiographic procedures. This raises concerns about the carcinogenic potentials. We encourage every CT unit to adhere to the International Guidelines of CT dose parameter references. Our preliminary survey from some university hospitals in Thailand revealed that CT radiation doses are within acceptable standard ranges. However, the justification for utilization of CT scans should also be required and monitored. The importance of adequate communication between attending physician and consulting radiologist is stressed.
Wichaporn Intharachuti, Rungnapa Ittiwut, Jenifer Listman, Viroj Verachai, Apiwat Mutirangura, Robert T. Malison and Rasmon Kalayasiri
Background: Inhalants are abused by adolescents worldwide, but genetic markers of inhalant use or dependence are poorly understood.
Objective: We assessed the frequency and association of a functional polymorphism in the gene encoding catechol-O-methyltransferase (COMT Val158Met) in inhalant-dependent (ID) subjects and inhalant users (IU).
Methods: Demographic and diagnostic data were collected by interviewing 456 Thai-speaking methamphetamine (MA) users by using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). COMT Val158Met (rs4680) genotyping was acquired by restriction fragment length polymorphism. Individuals with ID or IU were compared with non-ID or non-IU by using a χ2 test. After that, factors associated with ID or IU were analyzed by logistic regression. Blood samples from 217 healthy blood donors were used as controls for ID and IU in the allele frequency comparison. Deviation from Hardy-Weinberg Equilibrium Expectations (HWEE) was also tested.
Results: Out of 456 MA users, deviation from HWEE was observed in IU but not in ID, non-ID or from the total sample. The “Met” allele was significantly associated with ID (p = 0.02) and IU (p = 0.002) among MA users, but not in allele frequency comparisons when compared to the healthy control group (p > 0.1). With respect to logistic regression analysis, homo or heterozygosity for the “Met” allele, male sex, younger age, lower level of education, a major depressive episode (MDE), and alcohol dependence were associated with ID. Analyses of IU vs. non-IU yielded the same results except for age and MDE. In addition, individuals with MA-induced paranoia (MIP) were more likely to have used inhalants at least once in their lifetime compared to those without.
Conclusion: COMT 158Met, male sex, younger age, lower level of education, MDE, MIP, and alcohol dependence increased risk for inhalant use and/or dependence.