Bangkok Hospital

The digital transformation of health systems is crucial for enhancing healthcare delivery, particularly in border areas like Nong Khai province, Thailand, situated along the Mekong River. This strategic region faces unique challenges in cross-border disease surveillance and health data interoperability between Thailand and the Lao People’s Democratic Republic (Lao PDR). Consequently, healthcare personnel in this area require robust eHealth competencies to manage these complexities effectively. This study aimed to identify the determinants associated with the need for eHealth competency development among healthcare personnel working in the primary care network of a border province along the Mekong River. A cross-sectional analytical study was conducted among 460 healthcare personnel in Nong Khai province. Data were collected using a structured questionnaire assessing socio-economic status , social support, organizational innovation management , and digital intelligence (DQ). Generalized Linear Mixed Models (GLMM) were employed to analyze the factors associated with high needs for eHealth competency development, accounting for the clustering effects of professional differences within the health service network. The study found that 53.26

Digital health has become a critical driver of health system strengthening and universal health coverage. In Thailand, national digital health strategies emphasize workforce readiness as a key mechanism for effective implementation, particularly within primary healthcare systems. Kalasin Province, located along the R9 East–West Economic Corridor (EWEC), represents a strategically important context characterized by increasing population mobility, economic activity, and complex public health demands. Despite ongoing investments in digital health infrastructure, disparities in workforce readiness and digital competency development remain evident across primary healthcare settings. Therefore, this study assessed the perceived need for digital health competency development as the primary outcome. This construct captures healthcare personnel’s awareness of competency gaps rather than objectively measured competency levels. This study aimed to examine factors associated with the perceived need for digital health competency development in driving digital health strategies among public health personnel working within primary healthcare service networks in Kalasin Province, Thailand. A cross-sectional analytical study was conducted among 430 public health personnel using a structured questionnaire. Data were collected on socioeconomic characteristics, change management, digital intelligence, and social support from supervisors and colleagues. Generalized Linear Mixed Models (GLMMs) with a logistic link function were applied to identify factors associated with a high level of self-reported perceived need for digital health strategy competency development, accounting for clustering by professional position as a random effect. Overall, 70.7

Prostate-specific membrane antigen (PSMA)-targeted radionuclide therapy has become an established treatment option for metastatic castration-resistant prostate cancer. Although lutetium-177 (177Lu) PSMA therapy has shown promising clinical benefits, terbium-161 (161Tb) PSMA is an emerging theranostic agent offering potential advantages due to its combination of beta and Auger electron emissions. This work presents the first documented case in Thailand and Southeast Asia of a patient treated at Ramathibodi Hospital with 161Tb-PSMA following progression on 177Lu-PSMA therapy. This report describes the clinical application of this novel radiopharmaceutical, the implementation of quantitative imaging protocols, single photon emission computed tomography/computed tomography calibration processes, and absorbed dose estimations from voxel-based dosimetry that contributed to individualised treatment planning.

Background. To evaluate the diagnostic accuracy of plain radiography in detecting bony Bankart lesions compared to computed tomography (CT) and to identify clinical factors that delineate the necessity for CT investigation using machine learning-powered analysis. Material and methods. A retrospective analysis of 69 cases of traumatic anterior glenohumeral dislocation was performed. Two blinded observers evaluated plain radiographs for bony Bankart lesions. Inter-observer reliability was assessed using Cohen’s kappa (κ). Diagnostic metrics (sensitivity, specificity, PPV, NPV) were calculated using CT as the gold standard. Multivariate logistic regression and machine learning (decision tree) models were utilized to identify predictors for ‘hidden’ lesions (X-ray negative, CT positive). Results. Inter-observer agreement for X-ray was fair (κ = 0.272). Observer 1 demonstrated 100% specificity but low sensitivity (27.27%). Multivariate analysis identified ‘Time from first dislocation’ as a significant predictor for CT-detected lesions (p = 0.019). ROC and machine learning models identified a critical cut-off of 36–42 weeks; patients presenting within this window had a 55.6-70% probability of a hidden lesion, compared to 16.7% for chronic cases. Conclusions. 1. Conventional radiographs demonstrated high specificity but limited sensitivity and only fair in­terobserver reliability for detecting bony Bankart lesions compared with CT. 2. A negative radiographic result does not reliably exclude a bony Bankart lesion in patients with traumatic anterior shoulder instability. 3. CT examination should be performed in patients presenting within 42 weeks after their first anterior shoulder dislocation, particularly when radiographs are negative but clinical suspicion persists. 4. CT should also be strongly considered in patients with recurrent instability, especially those with ≥3 dislocation episodes, to facilitate early identification of occult osseous pathology and guide appropriate surgical planning.

PURPOSE:To evaluate the safety and immunogenicity of intramuscularly delivered personalized neoantigen synthetic long peptide (SLP) vaccines in patients with advanced solid tumors. PATIENTS AND METHODS:In this phase I trial, 12 patients with advanced melanoma (n = 9) or renal cell carcinoma (n = 3) who lacked access to further reimbursed standard therapies at enrollment received intramuscular neoantigen SLP vaccines with Polyinosinic-Polycytidylic acid stabilized with polylysine and carboxymethylcellulose (poly-ICLC). Each vaccine contained about 20 predicted neoantigen peptides. Adverse events were monitored throughout vaccination and follow-up. Immune profiling was performed at baseline and predefined postvaccination time points. RESULTS:Intramuscular neoantigen vaccination was well tolerated, with only grade 1 to 2 local pain or fever and no immune-mediated toxicities. All participants developed de novo T-cell responses, which were detectable as early as 1 week after vaccination in most patients. On average, 53% of peptides per patient were immunogenic, inducing both CD8+ and CD4+ neoantigen-specific responses. Patients previously treated with immune checkpoint inhibitors (ICI) had higher baseline immunity but achieved comparable postvaccination responses to ICI-naïve patients. IFNγ-dominant CD8+ and TNFα-dominant CD4+ responses were observed, along with increased effector memory differentiation. Two patients with higher CD8+ terminal effector memory RA (TEMRA) proportions were the longest survivors. Tumor biopsies revealed enhanced CD8+ infiltration, and epitope spreading occurred in two evaluable cases. An analysis of 239 peptides showed greater immunogenicity for dual MHC I/II-binding, cysteine-containing, in-frame insertions or deletions-derived or low variant allele frequency-derived mutations, whereas proline substitutions reduced responses. CONCLUSIONS:Intramuscular neoantigen SLP vaccination with poly-ICLC is safe and induces rapid, mutation-specific T-cell immunity with robust CD8+ effector responses. These findings support intramuscular administration as a promising strategy for peptide-based cancer vaccines.