It has a CPIRD Medical Education Center which trains doctors for the MOPH-Mahidol CPIRD Program. It is an affiliated teaching hospital of the Faculty of Medicine Siriraj Hospital, Mahidol University.
OBJECTIVE To determine the proportion of palliative care patients completing a living will and to identify factors associated with completion. METHODS This retrospective study analyzed electronic medical records from Maharaj Nakorn Chiang Mai Hospital, a university hospital in Thailand. Patients who had their initial palliative care consultations between November 1, 2021 and April 30, 2022 were included. Descriptive statistics and multivariable logistic regression were used. RESULTS Of the 389 patients in the study, 205 (52.7%) were female, and the median age was 68 (IQR: 59–79). Most had cancer (67.6%) and poor performance status (PPS 10–30: 69.9%). Decision-making capacity was present in 177 patients (45.5%). A living will was introduced to 83 patients (21.3%) and was completed by 26 (6.7%). Higher PPS (70–100) was associated with being introduced to a living will. The most common reason for not introducing patients to a living will was poor patient symptom control. No factors were significantly associated with living will completion among those who were introduced to a living will. CONCLUSIONS Most patients presented to palliative care with advanced disease and poor performance status, limiting opportunities for living will discussions and emphasizing the need for early consultation. Strengthening symptom management may support earlier and more frequent introduction of a living will, potentially improving completion rates.
OBJECTIVES:Global information on the costs of the autism spectrum disorder (ASD) diagnostic process is limited. No previous research has been conducted in Thailand. This study aimed to determine the societal costs of the ASD diagnostic process after the patients visited 7 tertiary hospitals in the Northern, Central, Northeast, and Southern regions of Thailand. METHODS:A total of 155 children diagnosed with ASD were included from January to December 2022. The societal costs consisted of the patient costs, and service provider costs. Government reimbursement and labor costs were also evaluated. The patient perspective costs were calculated from direct nonmedical costs plus nonreimbursable direct medical costs. Direct nonmedical costs were collected by parent questionnaires. Nonreimbursable direct medical costs and the government reimbursement were acquired from each hospital's financial database. Service provider perspective costs were gathered from the Human Resources Unit hospital database. RESULTS:The median of societal, service provider, patient, labor costs, and government reimbursement for the ASD diagnostic process were 3578.6 (2433.7-5412.8), 259.5 (259.5-314.7), 3319.0 (2169.0-5138.1), 559.6 (488.8-795.6), and 200 (0-300) Thai Bahts (THB)/child, respectively. The caregiver productivity loss was the largest proportion among the total patient perspective costs. The median societal costs by region sorted by descending order were Northeast, Central, North, and South, which were 5197.6 (3248.5-6802.3), 3578.6 (2688.8-5412.8), 3028.6 (2286.7-4905.7), and 2198.9 (1686.8-3483.9) THB/child, respectively. CONCLUSION:The societal costs of the ASD diagnostic process were 3578.6 THB/child. The Northeast region demonstrated the highest costs. The caregiver productivity loss was the largest proportion of the total societal costs.
BackgroundParkinson's disease (PD) remains underdiagnosed in Thailand, and its rising prevalence presents a growing challenge for the healthcare system. The previously validated CheckPD digital population screening platform has been implemented nationally in collaboration with the Thai Red Cross Society (TRCS) and the National Health Security Office (NHSO), enabling integration of digital PD risk screening into preventive health frameworks.ObjectiveTo evaluate the early phase of a national rollout of the CheckPD platform, focusing on population reach, adoption, predictive performance, exploratory usability, and implementation factors influencing scalability across diverse real-world settings.MethodsThis RE-AIM-guided implementation study in 10 Thai provinces assessed reach, adoption, completion, system performance and positive predictive value among neurologist-evaluated screen-positive participants. Preliminary usability was assessed in 30 post-screening completers using the SUS and UEQ-S. Supplementary implementation feedback was collected from Village Health Volunteers and public health officers.ResultsBetween January 2024 and October 2025, 13,381 out of 18,520 users completed screening across 10 provinces (completion rate: 72.3%). The mean SUS score was 83, with a 92% first-time task completion rate. Programme reach was achieved through multiple channels, including Village Health Volunteers (6,742 participants), community field campaigns (5,207), facilitated online training initiatives (3,448), and self-initiated app downloads (3,123). When compared with neurologists' diagnoses among 730 screen-positive participants who underwent evaluation, the screening demonstrated a positive predictive value of 81.23% (593/730; 95% CI 78.39%-84.07%). Key facilitators of implementation included TRCS endorsement and network support, community volunteer engagement, and user-centred app design. Exploratory multivariable logistic regression analysis identified educational attainment and geographic context as significant predictors of screening completion, with higher educational attainment and residence outside Bangkok associated with a higher likelihood of completing the screening workflow.ConclusionsThe CheckPD programme demonstrates that national-scale digital screening for neurological disorders is feasible in a low-to-middle-income country when embedded within trusted institutions, supported by community networks, and aligned with data protection standards. Thailand's experience provides an early, promising, and potentially scalable model for implementing population-level improvements in brain health by enabling earlier detection and assessment of individuals at risk, in alignment with the World Health Organization's Brain Health framework.
Background: Anal stenosis is a frequent complication after anorectal reconstruction for anorectal malformation (ARM) or Hirschsprung disease (HD). Conventional rigid dilators are uncomfortable, expensive, and poorly adapted to pediatric anatomy. Natural rubber dilators may offer better conformity and outcomes but have not been evaluated. The aim of the study was to compare the efficacy and safety of ParaSelf, a natural rubber-based anal dilator, with conventional rigid dilators in children after anorectal surgery. Methods: This retrospective cohort study included 98 children with ARMs or HD. Children who used conventional dilators during 2017-2022 served as the preimplementation control cohort, and children who used ParaSelf during 2022-2025 comprised the post-implementation cohort. The primary endpoint was time to achieve the age-specific target anal diameter, analyzed using multivariable Weibull parametric proportional hazards regression. Secondary endpoints included anal stenosis (including surgery-requiring stenosis), pain, caregiver satisfaction, and major postoperative complications. Results: Of 98 patients, 33 (33.7%) received ParaSelf. The ParaSelf group reached the target diameter faster than controls (median 5.6 vs. 9.4 months). Weibull regression showed a nearly 10-fold higher hazard of reaching the target diameter with ParaSelf (hazard ratio (HR) = 9.9; 95% confidence interval (CI), 5.2 to 18.7; P < 0.001). Pain scores during home dilation were lower (median difference = -2.58; 95% CI, -3.40 to -1.76; P < 0.001), and caregiver satisfaction was higher (median difference = 2.00; 95% CI, 1.52 to 2.48; P < 0.001) with ParaSelf versus conventional dilators. No irritation, bleeding, leakage, or surgery-requiring stenosis occurred in the ParaSelf group. Conclusions: ParaSelf was associated with faster dilation, less pain, fewer complications, and higher caregiver satisfaction than conventional dilators and may be a more acceptable alternative for pediatric anorectal reconstruction.
Background:This study aimed to evaluate the effects of systemic treatment on the overall survival (OS) of patients with superior vena cava (SVC) syndrome caused by neoplasms other than lung and haematological cancers. Materials and methods:Patient data were collected retrospectively. Cox proportional hazards regression was used to analyse the associations between variables and time to death. Results:Twenty-four patients were identified. The median follow-up time was 36 months. The median OS of patients receiving upfront systemic treatment and radiotherapy were 252 and 150 days (p = 0.298), and the 1-year OS rates were 20% and 22.7%, respectively. Patients treated with and without steroids had 1-year OS rates of 30.8% and 10.1% and median OS of 154 and 224 days, respectively (p = 0.426). The median OS of patients treated with and without loop diuretics was 114 and 252 days (p = 0.004), and the 1-year OS rates were 0% and 33.6%, respectively. In multivariable analysis, significant independent factors included upfront systemic therapy [hazard ratio (HR) = 0.022; 95% confidence interval (CI): 0.001-0.413], loop diuretics (HR = 12.364; 95% CI: 2.093-73.032), male sex (HR = 9.746; 95% CI: 1.478-64.276), visceral metastases (HR = 96.265; 95% CI: 5.437-1704.39), and previous systemic treatment for nonmetastatic disease (HR = 0.072; 95% CI: 0.005-0.955). Conclusions:In multivariable analysis, systemic treatment was associated with improved survival. However, this finding remains exploratory because of the small sample size and model instability. Loop diuretics were associated with increased mortality, and steroids showed no benefit in improving survival.
