Journal of Health Sciences Sukhothai hospital

The effects of a massage program combined with warm moist compresses on breast milk flow within 24 hours after a cesarean section

Pornnatee Thongpir — 2026-08-27

Background: Cesarean delivery may delay breastfeeding initiation and the onset of lactogenesis. Pain, fatigue, stress, and delayed breastfeeding stimulation can contribute to delayed milk flow. Breast massage combined with warm moist compresses may promote local circulation, relaxation, and milk flow.

Objective: To compare the proportion of post-cesarean mothers achieving level 2 breast milk flow within 24 hours between the experimental group and the control group.

Methods: This quasi-experimental study was conducted among post-cesarean mothers admitted to the Obstetrics and Gynecology ward at Sukhothai Hospital between February and April 2024. A total of 88 participants were recruited, with 44 assigned to each of the experimental and control groups. The research instruments consisted of a breast massage program combined with warm moist compresses, a general information recording form, and a breast milk flow level monitoring form. The content validity index (CVI) of the instruments was 0.90, and the reliability coefficient was 0.80. Data were analyzed using descriptive statistics and the chi-square test, with the significance level set at 0.05.

Results: The proportion of post-cesarean mothers with level 2 breast milk flow within 24 hours was significantly different between the experimental group, which received the intervention program, and the control group, which received routine nursing care (p < .05) . In the experimental group, 72.7% of mothers achieved level 2 breast milk flow within 24 hours, compared to only 4.5% in the control group.

Conclusion: Breast massage combined with warm moist compresses promoted level 2 breast milk flow within 24 hours among post-cesarean mothers. The program may be considered as an adjunct to routine nursing care for post-cesarean mothers with delayed milk flow.

Effects of a Health Behavior Change Care Model on Self-Management Behavior and Clinical Outcomes in Stage 2–3a CKD Patients at NCD Clinic in Ban Khlong Khu Sub-district Health Promoting Hospital, Phichit Province.

Nipa Purksawan — 2026-08-28

Background: Chronic kidney disease (CKD) is an important public health problem, particularly among patients with diabetes mellitus and hypertension. At Ban Khlong Khu Sub-district Health Promoting Hospital, Phichit Province, most CKD patients were found to be in stages 2–3a, which represent a critical period for delaying kidney function decline. However, routine care still has limitations in behavioral assessment and continuous follow-up.

Objective: To evaluate the effects of a health behavior change care model on self-management behaviors and clinical outcomes among patients with stage 2–3a chronic kidney disease.

Methods: This study employed a two-group pretest–posttest quasi-experimental design. The sample consisted of 60 participants selected by purposive sampling and divided into an experimental group and a control group, with 30 participants in each group. The experimental group received the 12-week care model, while the control group received usual care. Data were analyzed using descriptive statistics, paired t-test, and independent t-test.

Results: After the intervention, the experimental group had a significant increase in knowledge scores regarding CKD and delaying kidney function decline, from 8.63 ± 1.72 to 12.87 ± 1.26. Self-management behavior scores for delaying kidney function decline also increased from 51.87 ± 7.94 to 72.43 ± 8.15. These improvements were statistically significant (p < .001) and significantly higher than those of the control group (p < .001). Regarding clinical outcomes, the experimental group showed a significant increase in eGFR and significant reductions in serum creatinine, systolic blood pressure, and body mass index (p < .05). Satisfaction with the care model was at the highest level (Mean = 4.54, SD = 0.38).

Conclusion: The health behavior change care model effectively improved knowledge regarding CKD and delaying kidney function decline, self-management behaviors for delaying kidney function decline, and clinical outcomes related to slowing CKD progression. The model is appropriate for application in primary care NCD clinics.

Effectiveness of Developing a Prehospital Emergency Medical Service Delivery Model in Phichit Municipality on Response Time, Fiscal Year 2026

woraluk Boonnuwong — 2026-08-31

Background: Prehospital Emergency Medical Services (EMS) play a vital role in providing timely access to emergency care, particularly for time-sensitive conditions. However, the EMS system of Phichit Municipality had a response time exceeding the national benchmark of 8 minutes, indicating the need to develop a service model tailored to the local context.

Objectives: To (1) investigate the current situation and factors associated with EMS response time; (2) develop a prehospital EMS service model for Phichit Municipality; and (3) evaluate the effectiveness of the developed model in reducing response time and increasing the proportion of patients reached within 8 minutes.

Methods: This research and development (R&D) study was conducted between 2025 and 2026 in three phases: (1) situation analysis using EMS operational data and interviews with 15 purposively selected stakeholders; (2) development of the EMS service model through participatory workshops; and (3) evaluation of the model using a quasi-experimental before-and-after design, comparing 348 EMS missions before and 348 missions after implementation. Research instruments were validated by three experts (IOC = 0.67–1.00). Data were analyzed using descriptive statistics, Spearman's rank correlation, Kruskal–Wallis test, independent t-test, and chi-square test.

Results: Before implementation, the mean response time was 9.0 ± 3.3 minutes, and 41.4% of patients were reached within 8 minutes. Response time was significantly associated with travel distance, operational period, and service zone (p < .05). The developed EMS service model comprised standardized dispatch protocols, strategic deployment of EMS units, vehicle and equipment readiness checks, standardized time recording, and performance monitoring. Following implementation, the mean response time significantly decreased to 7.6 ± 2.8 minutes, while the proportion of patients reached within 8 minutes increased to 67.0% (p < .001).

Conclusions: The developed prehospital EMS service model effectively reduced response time and improved timely access to emergency care. The model may be adapted for use in settings with similar characteristics, with appropriate modifications to suit local resources and service contexts.

Treatment Outcomes of Trabeculectomy with Mitomycin C for Glaucoma at Sukhothai Hospital

Nithiracht Saenpen — 2026-08-31

Background: Glaucoma is a leading cause of permanent blindness. Trabeculectomy with Mitomycin C (MMC) is a standard surgical procedure for lowering intraocular pressure (IOP). Because surgical outcomes under routine care at Sukhothai Hospital have not been formally evaluated and may differ according to the local case mix and available resources, this study was undertaken.

Objective: This study aimed to evaluate IOP reduction, medication reduction, surgical success rates, and complications of trabeculectomy with MMC in patients with glaucoma at Sukhothai Hospital.

Methods: A retrospective descriptive study of glaucoma patients who underwent trabeculectomy with MMC (0.2 mg/ml for 2 minutes) at Sukhothai Hospital from 2020–2024. After excluding re-trabeculectomy and lost-to-follow-up cases, 167 eyes were analyzed. IOP, number of medications, and complications were recorded preoperatively and at 1 and 6 months postoperatively, Data were summarized using mean (SD) and frequency (percentage), as appropriate.

Results: Mean age was 60.9 ± 10.9 years; 50.3% were male. POAG was the most common diagnosis (47.9%). Mean IOP decreased from 27.3 ± 12.2 to 15.5 ± 8.2 mmHg at 1 month and 14.3 ± 8.2 mmHg at 6 months (p < .001). Complete success rate was 61.1% and overall success was 86.8% at 6 months. The median number of medications decreased from 4 (IQR 1–4) preoperatively to 0 (IQR 0–1) at 6 months postoperatively. Complications occurred in 42.5%, mostly flat or shallow bleb.

Conclusion: Trabeculectomy with MMC yielded a complete success rate of 61.1%, effectively lowering intraocular pressure and reducing the reliance on anti-glaucoma medications. This procedure is suitable for glaucoma patients inadequately controlled on medical treatment.

Obstetric and Neonatal Outcomes in Pregnant Women with Methamphetamine Use Delivering at Nakhon Thai Crown Prince Hospital

Chariwan Vanitchayakosol — 2026-08-31

Background: Methamphetamine use during pregnancy adversely affects both mothers and infants; however, data in the context of community hospitals remain limited.

Objective: To compare obstetric and neonatal outcomes between pregnant women who used and did not use methamphetamine at Somdet Phra Yupparat Nakhon Thai Hospital.

Methods: A retrospective comparative study was conducted using medical records from October 1, 2017, to September 30, 2025. A total of 207 pregnant women were included, comprising 48 women with methamphetamine detected in urine and 159 women without methamphetamine detected in urine. Data were analyzed using descriptive statistics, Chi-square test, Fisher’s exact test, independent samples t-test, Mann-Whitney U test, and multiple logistic regression.

Results: The proportion of inadequate antenatal care was higher among women with methamphetamine detected in urine than among those without methamphetamine detected in urine (66.7% vs. 25.1%; p < .001). The rates of preterm birth (31.3% vs. 10.0%; p = .001), preeclampsia (12.5% vs. 3.1%; p = .021), and low birth weight (33.3% vs. 9.4%; p < .001) were also higher. In addition, fetal death was found only among women with methamphetamine detected in urine (6.3% vs. 0.0%; p = .012). Infants in the methamphetamine-detected group had lower mean body length and mean body temperature at birth, a higher proportion of Apgar scores <7 at 5 minutes, and longer hospital stays. Multiple logistic regression analysis showed that methamphetamine detected in urine was independently associated with low birth weight (aOR = 3.35; 95% CI: 1.67–6.72) and preterm birth (aOR = 3.12; 95% CI: 1.55–6.27).

Conclusion: Methamphetamine detected during pregnancy was associated with adverse maternal and neonatal outcomes. These findings support the importance of proactive screening, continuous antenatal care, and multidisciplinary care to reduce complications.

Prevalence and Clinical Characteristic of Chloroquine and Hydroxychloroquine Maculopathy in Patients at Sukhothai Hospital

Saralai Yoosamran — 2026-08-31

Background: Chloroquine and Hydroxychloroquine can cause maculopathy that can lead to incurable and irreversible visual impairment in patients who received these drugs for a long time. Regular screening for Chloroquine- and Hydroxychloroquine-induced maculopathy in patients receiving these drugs is important to reduce the risk of permanent vision loss.

Objective: To evaluate prevalence and clinical characteristics of Hydroxychloroquine (HCQ) and Chloroquine (CQ) maculopathy in patients at Sukhothai hospital.

Methods: A Retrospective descriptive study of 222 patients who received either Chloroquine (CQ) or Hydroxychloroquine (HCQ) from 1^st January 2019 – 31^st December 2020 at Sukhothai hospital. Medical records were reviewed to collect details regarding age, body weight, daily doses of CQ or HCQ, duration of treatment and eye examination records consisting of VA, Ishihara test, time domain optical coherence tomography (TD-OCT), computed tomography visual fields (CTVF), and fundus photography.

Results: 180 patients who received CQ or HCQ and were screened for maculopathy were included. Mean age was 60.19 years (SD 11.87). Diagnoses were Lupus 18.75% and Rheumatoid arthritis 81.25%. From 180 patients, maculopathy was found in 8.89% (Chloroquine 17.02%, Hydroxychloroquine 0.6%). 56.25% received CQ or HCQ for 5-10 years, 43.75% for 1-5 years. No maculopathy was found in patients who received the drug less than 1 year. 62.50% received daily dose in high risk range. Most patients were moderate visual impairment 43.75%, no visual impairment 31.25%, and blindness 6.25%. All patients had color defect. CTVF and TD-OCT showed Perifoveal pattern 43.75%, Parafoveal pattern 31.25%, and Mixed pattern 25%. Only 2 of 16 showed Bull's eye pattern on fundus photography.

Conclusion: The prevalence of Chloroquine (CQ) and Hydroxychloroquine (HCQ) induced maculopathy in patients at Sukhothai hospital is 8.89% (prevalence of CQ maculopathy 17.02%, HCQ maculopathy 0.6%). Most patients received CQ or HCQ for more than 5 years and the shortest duration that caused maculopathy was 1 year 6 months. Almost all cases received high-risk doses for toxicity. Visual acuity was mostly moderate visual impairment and all patients had a color defect. CTVF and TD-OCT showed Perifoveal pattern of maculopathy predominating over Parafoveal pattern.