Buddhasothorn Hospital Journal

Home Ward Care Outcomes and Determinants in Poorly Controlled Type 2 Diabetes Patients from Primary Care Cluster Buddhasothorn Hospital

2026-05-27T22:07:20+07:00

Background: Currently, Buddhasothorn Hospital implemented the Home Ward model for patients with hyperglycemia to reduce hospital overcrowding and improve the quality of life for both patients and caregivers. However, evidence regarding the outcomes of this service remains limited. Therefore, this study aimed to investigate the outcomes of the Home Ward service among patients with uncontrolled diabetes at primary care units.

Objective: To evaluate the outcomes of the Home Ward service on glycemic levels and to identify factors associated with glycemic control among patients with uncontrolled type 2 diabetes at the primary care units of Buddhasothorn Hospital.

Methods: This retrospective descriptive-analytic study evaluated 73 patients with type 2 diabetes. Data were retrieved from the A-MED and HosXP systems between October 1, 2024, and September 30, 2025. Data analysis was performed using descriptive statistics, paired t-test, and logistic regression.

Results: Following the intervention, patients demonstrated reductions in both hemoglobin A1c (HbA1c) and fasting blood sugar (FBS) levels at 3 and 6 months. The reduction in HbA1c was statistically significant (p < 0.001). Multiple logistic regression analysis revealed that factors significantly associated with uncontrolled blood glucose levels included obesity with a BMI ≥ 25 kg/m² (aOR = 3.14, 95% CI: 1.29 - 7.62, p = 0.011), a baseline HbA1c >12 (aOR = 2.68, 95% CI: 1.19 - 6.01, p = 0.017), and a duration of care under the Home Ward program of less than 7 days (aOR = 2.68, 95% CI: 1.19 - 6.01, p = 0.017)

Conclusion: The Home Ward care model was significantly associated with a reduction in glycemic levels. Furthermore, a body mass index BMI ≥ 25 kg/m², a baseline HbA1c >12, and a duration of admission less than 7 days were key factors significantly associated with glycemic control in this patient population.

Predictors of Mortality in Patients Presenting with ST-segment Elevation Myocardial Infarction at Nan Hospital

2026-04-21T23:24:03+07:00

Background: ST-segment elevation myocardial infarction (STEMI) remains a major cause of mortality, particularly in rural and resource-limited settings. This study aimed to identify predictors of in-hospital mortality among patients with STEMI admitted to Nan Hospital.

Methods: A retrospective cohort study was conducted among 312 consecutive STEMI patients admitted between October 1, 2020 and September 30, 2023. Baseline characteristics, clinical presentation, and treatment strategies were collected. Independent predictors of in-hospital mortality were identified using multivariable logistic regression analysis.

Results: The in-hospital mortality rate was 20.8%. Multivariable analysis demonstrated that increasing age (adjusted OR 1.04, 95% CI 1.00–1.07; p=0.031), delayed presentation to the emergency department >6 hours after symptom onset (adjusted OR 2.78, 95% CI 1.29–5.97; p=0.009), and cardiogenic shock (adjusted OR 4.28, 95% CI 1.05–17.49; p=0.043) were independent predictors of in-hospital mortality. Serum creatinine, systolic blood pressure, cardiac arrest at presentation, Killip class III–IV, and primary percutaneous coronary intervention were not independently associated with mortality after adjustment.

Conclusions: Older age, delayed hospital presentation, and cardiogenic shock independently predicted in-hospital mortality among STEMI patients. Strategies aimed at reducing pre-hospital delay and improving the early recognition and management of cardiogenic shock may improve clinical outcomes.

Incidence of Grade 4 Neutropenia During the Nadir Period After the First Cycle of Doxorubicin and Cyclophosphamide Chemotherapy in Patients with Breast Cancer

2026-08-19T15:48:23+07:00

BACKGROUND: Grade 4 neutropenia is a common hematologic toxicity associated with doxorubicin and cyclophosphamide (AC) chemotherapy. However, the incidence of Grade 4 neutropenia during the nadir period after the first cycle of AC chemotherapy in routine clinical practice in Thailand remains unclear.

OBJECTIVES: This study aimed to determine the incidence of Grade 4 neutropenia during the nadir period after the first cycle of AC chemotherapy and to identify factors associated with Grade 4 neutropenia. Secondary objectives were to describe other hematologic toxicities and subsequent chemotherapy management following the first cycle.

METHODS: This retrospective observational study included patients with breast cancer who received doxorubicin (60 mg/m²) and cyclophosphamide (600 mg/m²) chemotherapy at Pattaya Bhattamakun Hospital between May 2023 and May 2026. Complete blood counts obtained approximately 14 days after the first chemotherapy cycle were reviewed to assess hematologic toxicity during the expected nadir period. No patients received primary prophylactic granulocyte colony-stimulating factor (G-CSF) before the first cycle. Factors associated with Grade 4 neutropenia were evaluated using univariable and multivariable logistic regression analyses.

RESULTS: A total of 138 patients were included. Grade 4 neutropenia occurred in 68 patients, corresponding to an incidence of 49.3% (95% CI, 40.7–57.9%). Overall, neutropenia of any grade occurred in 128 patients (92.8%; 95% CI, 87.1–96.5%). Anemia of any grade occurred in 23 patients (16.7%), and thrombocytopenia occurred in 1 patient (0.7%). No documented febrile neutropenia or neutropenia-related hospitalization was observed. Subsequent chemotherapy dose reduction was required in 13 patients (9.4%), and and G-CSF was administered after chemotherapy in 3 patients (2.2%). In the multivariable analysis, baseline ANC was significantly associated with Grade 4 neutropenia. For every 1,000 cells/µL increase in baseline ANC, the odds of developing Grade 4 neutropenia decreased by 24% (adjusted OR, 0.760; 95% CI, 0.601–0.962; p = 0.022).

CONCLUSIONS: Grade 4 neutropenia occurred in approximately half of patients during the nadir period after the first cycle of AC chemotherapy. Baseline ANC was significantly associated with Grade 4 neutropenia; However, its ability to predict clinically consequential outcomes or guide prophylactic G-CSF use could not be established in this study. Further prospective studies are warranted to validate this association and determine its clinical utility.

Nursing Care for Patient with Septic Shock : Case Study

2026-07-08T10:08:24+07:00

Background and significance
Septic shock is a critical and life-threatening condition resulting from bloodstream infection. When pathogens invade the body, they release toxins that trigger a systemic inflammatory response, leading to organ dysfunction and potentially progressing to multiple organ failure. Delayed diagnosis and treatment may result in circulatory collapse, septic shock, and increased mortality. Early recognition of sepsis and prompt implementation of Early Goal-Directed Therapy (EGDT) within the first six hours have been shown to reduce mortality, length of hospital stay, and healthcare costs.
Objectives

To study the pathophysiology, clinical manifestations, and treatment approaches of patients with septic shock.
To identify nursing problems and care needs of patients with septic shock.
To develop and implement a holistic nursing care plan based on the nursing process.
To evaluate nursing outcomes and strategies for preventing complications.

Study methods

A case study was conducted involving a patient diagnosed with septic shock with complete clinical data available. Data were collected from medical records, including demographic information, medical history, presenting symptoms, diagnostic investigations, treatment plans, and nursing care documentation. Relevant literature regarding septic shock, treatment guidelines, and evidence-based nursing practices was reviewed. Data were analyzed using the nursing process framework to provide comprehensive and holistic care. The findings were summarized, discussed, and used to formulate recommendations for improving nursing care quality.

Results of the study

The patient presented with septic shock and had underlying diseases including diabetes mellitus, hypertension, and pulmonary embolism requiring long-term anticoagulant therapy.The patient received nursing care according to professional standards and was promptly diagnosed and treated following the Early Goal-Directed Therapy (EGDT) protocol within the first six hours of admission. Comprehensive nursing interventions and close monitoring contributed to successful management of the patient's condition, prevention of complications, and stabilization of clinical status. The total duration of care was 15 days.

Summary
Septic shock is a medical emergency associated with high morbidity and mortality. Delayed diagnosis and treatment can lead to progressive organ dysfunction, multiple organ failure, and death. Effective nursing care, including early recognition of warning signs, timely intervention, and continuous monitoring, plays a crucial role in improving patient outcomes and preventing complications. Nurses are essential members of the multidisciplinary team, particularly in hemodynamic monitoring and ongoing assessment of clinical changes. Continuous professional development in sepsis and septic shock management, including knowledge enhancement, clinical assessment skills, and adherence to evidence-based practice guidelines, is recommended to improve the quality and safety of care for critically ill patients.