The Comparative studies of Treatment Outcomes of Diabetes Thai patients in HRH Princess Mahachakri Sirindhorn Medical Center Using The ADA 2008 guideline.

The study aims to compare treatment outcomes and complication surveillance among diabetes mellitus type II patients in the service area of HRH Princess Mahachakri Srindhon Medical Center (MSMC) with the American Diabetes Associate guideline 2008 (ADA 2008) and comparing the difference in treatment outcomes between the primary care unit (PCU) and the tertiary care unit (TCU). Data were collected by questionnaires from all type 2 diabetes patients and their medical records during 2009 – 2010 in a cross-sectional study. There were 274 type 2 diabetes patients in this study, 131 cases in PCU and 143 cases in TCU. Glycemic controls in these patients were monitored by using HbA1c at 72.5% and 74.1% in PCU and TCU, respectively. Microalbuminuria was screened in all of patients when comparing treatment service between PCU and TCU, the patients in PCU were less accomplished and less monitored than TCU patients; however, the differences were not statistically significant according to the ADA 2008 except in eye and foot examinations. In conclusion, the majority of type II diabetes patients were monitored according to the ADA 2008. The patients in TCU successfully achieved glycemic and metabolic control better than the patients in PCU without statistical significance. In consequence, physicians should be concerned about complications among type II DM patients according to the  standard guidelines, especially, in PCU. Nevertheless, physicians also should be concerned about the quality of care index using the holistic approach

Lifestyle modification and drug administration among Thai Muslim patients with diabetes mellitus type 2 during Ramadan (การปรับเปลี่ยนพฤติกรรมและการใช้ยาในช่วงเดือนถือศีลอดของผู้ป่วยมุสลิมที่เป็นโรคเบาหวานชนิดที่ 2)

Understand the lifestyle modification and the drug administration among Thai Muslim patients with diabetes mellitus type 2 during Ramadan. The in-depth semi-structured interview was conducted during September – November 2007. Content analysis was performed by 2 researchers independently before making the conclusion together. Total of 20 Muslim patients age between 39-77 years in Nakhon Nayok province were interviewed. It was found that most patients didn’t prepare before fasting in Ramadan month. All intended to fast every years but only one could fast strictly throughout the whole holy month each year. The patients assessed their own health while fasting by consideration of acute illness rather than their underlying DM. They didn’t think that DM had significant impact on their fasting. Moreover, they thought that fasting in Ramadan helped them control their blood sugar. There were only several pantients who thought that multiple DM drugs, especially insulin would have an effect on their fasting. Physician was the important factor which impacted on their fasting. However, none of patients had suggestion from their physicians for using drugs and adjusting lifestyle modification during Ramadan. Moreover, some were inhibited to fast or to take ritual fruit for this time. Patients adjusted drugs and dose by themselves. Many had hypoglycemic-like symptoms but not severe. In addition, all Thai Muslim patients with DM type II adjusted their lifestyles and intake of drugs by themselves during Ramadan without physician’s suggestion, which led to mild hypoglycemic-like symptoms in most patients. Therefore, we recommended that physicians working in Muslim community should be cultural-sensitive to ask and give them an advice on how to modify medical intervention which proper to Muslim life during Ramadan month

Situational Analysis of Palliative Care Education in Thai Medical Schools

Objective The Thai Medical School Palliative Care Network conducted this study to establish the current state of palliative care education in Thai medical schools. Methods A questionnaire survey was given to 2 groups that included final year medical students and instructors in 16 Thai medical schools. The questionnaire covered 4 areas related to palliative care education. Results An insufficient proportion of students (defined as fewer than 60%) learned nonpain symptoms control (50.0%), goal setting and care planning (39.0%), teamwork (38.7%), and pain management (32.7%). Both medical students and instructors reflected that palliative care education was important as it helps to improve quality of care and professional competence. The percentage of students confident to provide palliative care services under supervision of their senior, those able to provide services on their own, and those not confident to provide palliative care services were 57.3%, 33.3%, and 9.4%, respectively. Conclusions The lack of knowledge in palliative care in students may lower their level of confidence to practice palliative care. In order to prepare students to achieve a basic level of competency in palliative care, each medical school has to carefully put palliative care content into the undergraduate curriculum