Search

Introduction: Chronic kidney disease (CKD) is a major health problem in Thailand and health behaviors are central to its risk and progression. Because of the shortage of healthcare personnel, village health volunteers (VHVs) have been collaborating in the primary health care system. However, the contribution of VHVs to CKD reduction has not been evaluated yet. This study aimed to evaluate the efficacy of the VHV-integrated model in preventing and slowing down CKD and its risk factors. Methods: The population-based cohort study was conducted in a rural community of Thailand between 2017 and 2019. Baseline clinical and behavioral characteristics including CKD, diabetes, hypertension, and other high-risk factors of the participants were collected. The integrated care model was initiated by the multidisciplinary care team that facilitated, empowered, and trained VHVs targeting risk factors of CKD, health literacy, and health promotion. Then the participants were educated and trained for lifestyle modification and were monitored continuously for 18 months by VHVs. Changes in the CKD risk factors, and kidney functions before and after the application of integrated care model were compared. Results: A total of 831 subjects participated in the study with an average age of 57.5 years, and 69.5% were female. Among them, 222 participants (26.7%) were diagnosed as having CKD, the vast majority (95%) of which were in the early stages (G1-G3 and A1-A2). CKD risk factors such as high salt intake, smoking, alcohol consumption, self-NSAID (non-steroidal anti-inflammatory drugs) use were significantly decreased after application of the care model. Also, hemoglobin A 1c was significantly reduced in diabetic patients, and blood pressure was controlled better than before in the hypertensive patients. Most importantly, a decline of estimated glomerular filtration rate of the CKD group was improved and lower than the non-CKD group. Conclusion: The integrated care model through VHV significantly attenuated the risk factors associated with CKD in the general and high-risk population and effectively slowed down the progression of CKD.

Background: Telepharmacy shows an effective option to provide pharmacy services in several settings. It could improve patients’ outcomes and save costs. However, the impact of a telepharmacy services in low resource settings remains limited. Objectives: This study assessed the feasibility and effect of telepharmacy services on patient-reported clinical and economic outcomes among patients with epilepsy in Thailand. Methods: A prospective descriptive study was conducted at a university hospital. Patients with epilepsy visiting the clinic from February 2021–December 2021 were included. Telepharmacy services were provided by hospital pharmacists through an application platform. Patients met a pharmacist synchronously using a video conference feature embedded in our developed website. Patients were interviewed for improved clinical symptoms, drug-related problems (DRPs), and health and social behaviors. Travel costs, food and accommodation costs and productivity costs due to hospital visits were also evaluated. Results: A total of 80 patients were included. Of those, 39 patients (48.75%) were men, averaging 35.44 ± 15.09 years old. A total of 22 patients (27.50%) reported better clinical symptoms after the telepharmacy service. Sixty-four DRPs (69.56%) were observed, along with 28 health and social behavior problems (30.44%). The most common DRPs were adverse drug reactions (20/64; 69.56%), followed by patients' non-adherence (20/64; 31.25%). Sixty-six problems (68.04%) were corrected during the telepharmacy service. From the patient's perspective, the average direct nonmedical cost per visit was 1257 ± 857 THB/visit. Travel costs were the major cost driver, accounting for 67.7% of the total cost. Cost savings averaged 6511 ± 4996 THB/year or 54.75% of usual care. Conclusion: Telepharmacy services are likely to improve patient outcomes, detect DRPs, and effectively provide cost-savings. However, further studies hosting a larger number of participants are warranted to assess the impacts of telepharmacy services.

Background and aim: Vernonia cinerea (VC) is a herb that can alleviate nicotine addiction, potentially aiding in smoking cessation. Previous studies have examined four-to eight-week treatments using VC, but have found it to be ineffective. This study aimed to evaluate the smoking cessation effects of VC in addicted smokers over a longer treatment duration with pastilles. Experimental procedure: This was a randomized double-blinded controlled trial conducted at a community pharmacy. The inclusion criteria were age between 18 and 60 years, intention to quit smoking, and low to moderate level of nicotine addiction. All eligible participants were stratified according to nicotine addiction level and then randomly assigned either VC treatment or placebo. The VC group received two pastilles three times daily, while the control group received a placebo for 12 weeks. The outcomes were continuous abstinence rate (CAR) and point abstinence rate (PAR) at four and 12 weeks. Results: There were 121 eligible participants; 10 participants were not willing to participate. In total, there were 111 eligible participants, 54 of whom were treated with VC (48.65%) and 57 of whom were given a placebo (51.35%). Baseline characteristics were comparable between the two groups. The VC group had a significantly higher chance of smoking cessation at 2.01 (95% CI of 1.03, 3.92) compared with the placebo group at the end of the study. There were no significant side effects in either group. Conclusion: The VC pastille group had significantly higher CAR than the placebo group at week 12.

Intravenous levetiracetam has been approved for use as an antiepileptic drug, as well as in cases of status epilepticus. There are few reports that detail the clinical data and outcomes associated with this antiepileptic drug, particularly in patients with renal impairment. This was a retrospective analytical study conducted at Khon Kaen University’s Srinagarind Hospital in Thailand. The study period was between January 1, 2010 and December 31, 2014. The inclusion criteria were that patents were over 15 years old, had renal impairment, and had received intravenous levetiracetam treatment. The main clinical outcomes were seizure control and mortality. Clinical outcomes were compared between those with and without status epilepticus. Mortality of patients with status epilepticus were compared in terms of seizure control and order of intravenous levetiracetam treatment. During the study period, there were 247 patients who met the study criteria. The average age of the patients was 58 years with nearly equal sex distribution. Of those, 90 patients (36.4%) had GRFs of less than 15 mL/min/1.73 m2 and 60 patients (24.3%) received intravenous LEVE due to status epilepticus. The seizure control rates in the status epilepticus and non-status epilepticus groups were 36.7% and 88.7%, respectively (P

Background and Objective. Provocative factors are one causative factor of seizure attacks in persons with epilepsy (PWE). There are limited data of prevalence and major provocative factors in Asian populations. Methods. This study was performed at the Epilepsy Clinic, Khon Kaen University Hospital. The patients who aged 15 years or over, who had been treated at least 3 months with at least one antiepileptic drug, and who were followed up for at least one year were included. Data of seizure control and triggers were collected retrospectively from medical records. Data analysis was performed to identify independent provocative factors. Results. A total of 382 PWE met the study criteria. The mean age was 40.4±0.8 years. Approximately 44% of the patients had at least one provocative factor. By multivariate analysis, the independent provocative factors with the first three highest adjusted odds ratios were sleep deprivation (adjusted OR=8.64, 95% CI 3.73–19.99), alcohol consumption (adjusted OR=6.76, 95% CI 1.44–31.78), and feeling stressful (adjusted OR=2.97, 95% CI 1.29–6.86). Conclusion. Almost half of seizure attacks may be caused by provocative factors in Thai PWEs and some factors may be preventable. Avoidance of these factors should be emphasized to epilepsy patients for improving clinical outcomes and quality of life.

Epilepsy is a common public health problem and needs multi-disciplinary treatment. Therapeutic drug monitoring (TDM) is one of step of the multi-disciplinary treatment in epilepsy at Epilepsy clinic, Khon Kaen University (Thailand). The TDM service has been established since 2008. Here, we aimed to study the roles of TDM order and epilepsy control. This is a prospective descriptive study in which data collection was done from January 1 to December 31, 2010, the period when pharmacists took part in assessing the appropriateness in measurement and interpretation of TDM in order to provide suggestions for physicians. The 112 patients under study had an average age of 38.21±15.36 years; 254 samples were collected for therapeutic drug monitoring; phenytoin was submitted mostly for drug monitoring at 46.46%; 44.49% of sub-missions for drug level monitoring were made owing to a suspected sub-therapeutic level. Associations were found between reasons of sending samples for drug level monitoring and the measured drug levels, i.e., 66.67% of drug levels found was so low that they were undetectable in sample for patients’ compliance investigation and 38.94% of the drug levels were found to be sub-therapeutic as for the case where submission of samples was done because of suspected sub-therapeutic level, 40% of the cases were found to be in toxicity range in the cases with suspected over-therapeutic levels and monitoring levels, 58.25% were found to be within the therapeutic range. Pharmacists used the interpreted results in patients’ care by recommending physicians to monitor therapeutic drug closely, to adjust the dosage of drugs, and to recommend checking patients’ compliance in their use of drugs at 56.5, 38.9, and 4.3%, respectively. Physicians’ responses were found to be absolute follow, partial follow and not follow at 77.95, 11.03, and 7.48%, respectively. In conclusion, associations were found between reasons of TDM order and measured drug level. Therapeutic drug monitoring services at the Epilepsy Clinic was useful in supporting clinical information queries. Pharmacists could make use of interpreted drug level information by recommending physicians to monitor drug levels and adjust individual dosage regimen accordingly. It should be noted that physicians accepted pharmacists’ recommendation, denoting multi-disciplinary care team that would lead to greater efficiency.

The objective of this study was to develop, implement, and evaluate a collaborative smoking cessation program (CSCP) involving community pharmacists and village health volunteers (VHVs) in a rural community. Our strategy included establishment, implementation, and reflection. The CSCP was established through group discussions among community pharmacists, VHVs, and a local officer. VHVs identified smokers and provided basic counselling, while community pharmacists provided smokers specific and intensive counselling. We also assessed clinical outcomes, such as peak expiratory flow rate (PEFR), exhaled partial carbon monoxide (PCO), and continuous abstinence rate (CAR). Finally, interviews from the reflection phase were conducted to investigate attitudes towards participating in the CSCP and unsuccessful quitting. CSCP was completed by 101 out of 108 initial participants. All were men, with an average age of 55.2±10.75 years. After six months, the CSCP resulted in a significant decrease in the mean PCO (P=0.010). Moreover, 23 smokers successfully quit smoking, yielding a sixmonth CAR of 22.8% and stated that the CSCP enforced their perseverance. However, 78 volunteers (72.2%) could not quit smoking owing to withdrawal symptoms and influence from their immediate environment. CSCP is a novel smoking cessation model, which should be promoted to enforce smoking cessation in the community. However, significant efforts and coordination of relevant stakeholders are required. [ABSTRACT FROM AUTHOR]