Life after stroke: an ethnomethodological study of emotion work among adult stroke survivors and their carers in rural areas of Nakhon Sawan Province, Thailand

This thesis aims to explore the nature of emotion work within the context of care occurring in adult stroke survivors (18-59) and their carers situated at home in Nakhon Sawan Province, Thailand. It also investigates how their roles were constructed after the stroke event. An ethnomethodological approach facilitated the understanding of the sense-making processes in daily routines. Data collection was comprised of semi-structured interviews and observations which were gathered from a sample of twelve pairs of stroke survivors and carers, 24 participants in all, over a period of three months. Data were analysed by a thematic analysis approach. Stroke survivors’ belief about the cause of stroke and its effects on their attitude towards themselves and carers, and carers’ accounting for their care of stroke survivors emerged as two overarching themes derived from the interview data. The first theme illustrates that stroke survivors described difficult experiences during the first six months post stroke as the turning point of their lives. They searched their life experiences to create their current status within society. A self-evaluation of their health created a positive or negative attitude towards themselves, which affected their emotions in everyday living. In all cases the stroke survivors’ appreciation of carers’ help was significant. For carers, family relationships and expectations influenced their sense of responsibility and expectations. The feeling of gratitude, the morality of Buddhist values and a sense of duty were their underlying reasons for taking the caring role. Carers’ expectations of stroke survivors’ ability to perform routine activities were influential in managing their own feelings and actions in everyday life. The influence of neighbours reinforced carers’ ideas of moral standards of caring for stroke survivors. Emotion management is the third theme. Emotion work is involved in stroke survivors’ and carers’ everyday affairs which helped to keep their current life situations in balance and assist them in continuing to live as normal. Their life experiences and specific feeling rules (the feeling of gratitude and the sense of responsibility) govern the achievement of their emotion work. A differentiation between male and female roles also influenced their emotion work. Stroke survivors and carers presented how emotion work served to maintain their interpersonal relationship and to minimise difficult conditions in ordinary living. A conceptual framework of the process of emotion work is presented to facilitate understanding of how they engage in and accomplish emotion work during caring interactions. Emotion work emerges as a means to show their gratitude to each other and represents one of several ways to fulfil their Buddhist beliefs in the law of karma. They exchange emotion work for the values of caring and gratitude. These findings will be beneficial to stroke survivors and carers for dealing effectively with emotional problems in day-to-day life. Community nurses and other health professionals will gain a deeper knowledge of emotion work in order to assist them in providing holistic care for stroke survivors and carers. The findings will also be of interest to health policy makers to enable them to organise information and home-healthcare activities in future stroke care and health promotion strategies in rural communities in Thailand and elsewhere

Correlation Between CT Findings of Invasive Pulmonary Aspergillosis and Severity of Neutropenia

Objective: The purpose of this study was to investigate the association between CT findings of invasive pulmonary aspergillosis and neutrophils level. Methods: This retrospective study included the patients diagnosed with invasive pulmonary aspergillosis by computed tomography (CT) at Siriraj Hospital (Bangkok, Thailand) during May 2006 to May 2010. The patients were classified into two groups: group I = neutrophils <500 cells/mm3, and group II = neutrophils ≥500 cells/mm3. Patient demographic and clinical data were collected. CT findings were compared between groups, including consolidation, pulmonary nodule, pulmonary mass, centrilobular nodule, CT halo sign, CT hypodense, air crescent, central cavity, lymphadenopathy, and pleural effusion. Results: Of the 43 patients that were included, 14 patients were assigned to group I, and 29 patients were allocated to group II. The mean age of patients was 40.2 years, and 48.8% were male. The most common CT finding of invasive pulmonary aspergillosis was pulmonary nodules (83.7%), followed by CT halo sign (76.7%) and consolidation (69.7%). The CT finding that showed significantly more commonly in patients in group I and group II was consolidation (p=0.02) and central cavity (p=0.03), respectively. Conclusion: Consolidation was the CT finding significantly most commonly observed in invasive pulmonary aspergillosis with neutrophils <500 cell/mm3, and central cavity was the finding significantly most commonly found in patients with neutrophils ≥500 cell/mm3 with non-specific distribution. 

Does Acute Kidney Injury Condition Affect Revised BAUX Score in Predicting Mortality in Major Burn Patients?

Objective: This study aimed to assess the accuracy of the revised BAUX score for predicting mortality among the major burn patients with acute kidney injury (AKI) compared with non-AKI group. The epidemiologic information and risk factors of AKI in major burn patients were also the point of interest. Methods: This study was a retrospective cohort study. The medical records of 144 major burn patients admitted at the burns unit of Siriraj Hospital from 2010-2016 were reviewed and important data were retrieved. Results: Age, hypertension, diabetes mellitus, severity of the burn injuries, and inhalation injuries were the factors related to AKI in major burn patients. The mortality rate due to AKI in burn patients was high (44.4%). The accuracy of the revised BAUX score in predicting the mortality among the major burn patients from our series was only fair (66.7%). Conclusion: AKI affected on mortality of the major burn patients. Until the better predictor comes up, the revised BAUX score should be considered as a predictor of mortality in these patients

Meta-analysis and systematic review of skin graft donor-site dressings with future guidelines.

Background: Many types of split-thickness skin graft (STSG) donor-site dressings are available with little consensus from the literature on the optimal dressing type. The purpose of this systematic review was to analyze the most recent outcomes regarding moist and nonmoist dressings for STSG donor sites. Methods: A comprehensive systematic review was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library databases to search for comparative studies evaluating different STSG donor-site dressings in adult subjects published between 2008 and 2017. The quality of randomized controlled trials was assessed using the Jadad scale. Data were collected on donor-site pain, rate of epithelialization, infection rate, cosmetic appearance, and cost. Meta-analysis was performed for reported pain scores. Results: A total of 41 articles were included comparing 44 dressings. Selected studies included analysis of donor-site pain (36 of 41 articles), rate of epithelialization (38 of 41), infection rate (25 of 41), cosmetic appearance (20 of 41), and cost (10 of 41). Meta-analysis revealed moist dressings result in lower pain (pooled effect size = 1.44). A majority of articles (73%) reported better reepithelialization rates with moist dressings. Conclusion: The literature on STSG donor-site dressings has not yet identified an ideal dressing. Although moist dressings provide superior outcomes with regard to pain control and wound healing, there continues to be a lack of standardization. The increasing commercial availability and marketing of novel dressings necessitates the development of standardized research protocols to design better comparison studies and assess true efficacy.R01 EB021308 - NIBIB NIH HHSPublished versio

Comparative Clinical Study of Bactigras and Telfa AMD for Skin Graft Donor-Site Dressing

The Bactigras® paraffin tulle coated with chlorhexidine is normally used for the treatment of donor-site wounds in burn patients who received split-thickness skin grafts in several centers. It has some disadvantages, such as adhesion to wound surfaces and pain from the irritation caused by this dressing. The Telfa AMD®, a non-adherent wound dressing which consists of absorbent cotton fibers impregnated with polyhexamethylene biguanide enclosed in a sleeve of thermoplastic polymers, is a new option for donor-site wound care which causes less adherence to the wound. The purpose of this study was to compare clinical efficacy of these two dressings for the management of donor-site wounds. Thirty-two patients who received split-thickness skin grafts by donor site harvesting from the thigh were enrolled in this study and randomized into two groups receiving either the Bactigras® or the Telfa AMD® wound treatment. Re-epithelialization, pain, infection and cost-effectiveness analyses were compared between both groups. The results showed that there was no significant difference in age, area of donor sites or length of hospital stays between the groups (p > 0.05). However, the day of re-epithelialization (≥90%) was significantly shorter in patients treated with the Telfa AMD® compared to the Bactigras® group (14.00 ± 3.05 vs. 9.25 ± 1.88 days for Bactigras® and Telfa AMD® groups, respectively, p < 0.001). The average pain score was also significantly lower in the Telfa AMD® group (1.57 ± 0.55 vs. 4.70 ± 1.16, p < 0.001). There was no difference in the cost of treatment between the groups (4.64 ± 1.97 vs. 5.72 ± 2.54 USD, p = 0.19). This study indicated that the Telfa AMD® was an effective dressing for the treatment of donor-site wounds

Comparison of Economic Evaluation Methods Across Low-income, Middle-income and High-income Countries: What are the Differences and Why?

There are marked differences in methods used for undertaking economic evaluations across low-income, middle-income, and high-income countries. We outline the most apparent dissimilarities and reflect on their underlying reasons. We randomly sampled 50 studies from each of three country income groups from a comprehensive database of 2844 economic evaluations published between January 2012 and May 2014. Data were extracted on ten methodological areas: (i) availability of guidelines; (ii) research questions; (iii) perspective; (iv) cost data collection methods; (v) cost data analysis; (vi) outcome measures; (vii) modelling techniques; (viii) cost-effectiveness thresholds; (ix) uncertainty analysis; and (x) applicability. Comparisons were made across income groups and odds ratios calculated. Contextual heterogeneity rightly drives some of the differences identified. Other differences appear less warranted and may be attributed to variation in government health sector capacity, in health economics research capacity and in expectations of funders, journals and peer reviewers. By highlighting these differences, we seek to start a debate about the underlying reasons why they have occurred and to what extent the differences are conducive for methodological advancements. We suggest a number of specific areas in which researchers working in countries of differing environments could learn from one another

Coital Experience Among Adolescents in Three Social-Educational Groups in Urban Chiang Mai, Thailand

This article compares coital experience of Chiang Mai 17–20-year-olds who were: (1) out-of-school; (2) studying at vocational schools; and (3) studying at general schools or university. Four-fifths, two-thirds and one-third, respectively, of males in these groups had had intercourse, compared to 53, 62 and 15 per cent of females. The gender difference for general school/university students, but not vocational school students, probably reflects HIV/AIDS refocusing male sexual initiation away from commercial sex workers. Vocational school females may have been disproportionately affected. Loss of virginity was associated, for both sexes, with social-educational background and lifestyle, and was less likely in certain minority ethnic groups. Among males, it was also associated with age and parental marital dissolution, and among females, with independent living and parental disharmony. Within social-educational groups, lifestyle variables dominated, but among general school/university students, parental marital dissolution (for males) and disharmony (for females) were also important, and Chinese ethnicity deterred male sexual experimentation