Thira Woratanarat

Meta-analysis of pinning in supracondylar fracture of the humerus in children.

Objectives: The purpose of this study was to compare the outcomes of lateral pinning versus cross pinning in pediatric supracondylar humerus fractures. Data Sources: The Cochrane library, MEDLINE, CINAHL, specific orthopaedic journals, abstracts/papers from conferences and meetings, and reference lists of articles were searched from inception to September 2007. Study Selection: All randomized controlled trials and cohort studies comparing outcomes (ie, loss of fixation, iatrogenic ulnar nerve injury, and Flynn criteria) between crossed and lateral pinning were identified. Data Extraction: Two authors independently assessed methodological quality and extracted data by using a standardized data extraction form. Data Synthesis: Heterogeneity among studies was assessed using the Q test. Pooled relative risk was estimated using the Mantel-Haenszel method. Eighteen of 1829 studies were included with 1615 supracondylar fractures (837 and 778 children with cross and lateral pinning, respectively). The average age was 6.1 ± 0.9 years. The risk of iatrogenic ulnar nerve injury was 4.3 (95% confidence interval, 2.1–9.1) times higher in cross pinning compared with lateral pinning. There was no significant difference for loss of fixation, late deformity, or Flynn criteria between the two types of pinning. Conclusions: Lateral pinning is preferable to cross pinning for fixation of pediatric supracondylar humerus fractures as a result of decreased risk of ulnar nerve injury.

Meta-analysis of hypercoagulability genetic polymorphisms in Perthes disease.

Perthes disease is an osteonecrosis of the femoral epiphysis with unclear etiology. This study aimed to systematically review the association between genetic determinants of hypercoagulability (Factor V Leiden, prothrombin II, and methylenetetrahydrofolate reductase; MTHFR) and Perthes disease. PubMed and Scopus searched from inception to January 2012, data extraction and quality assessment were performed. The odds ratio (OR) for the allele effect was pooled, and heterogeneity and publication bias were assessed. Twelve case–control studies met inclusion criteria and had sufficient data for extraction. There were 824 cases and 2,033 controls with a mean age range of 6.1–14.7 years. The prevalence of the minor allele in controls was 0.015 (95% confidence interval (CI): 0.008, 0.023), 0.012 (95% CI: 0.008, 0.017), and 0.105 (95% CI: 0.044, 0.167) for factor V Leiden, prothrombin II, and MTHFR, respectively. The factor V Leiden allele increased the risk of Perthes with a pooled OR of 3.10 (95% CI: 1.68, 5.72), while prothrombin II and MTHFR had non‐significantly pooled OR 1.48 (95% CI: 0.71, 3.08), and 0.97 (95% CI: 0.72, 1.30), respectively. The factor V Leiden mutation is significantly related to Perthes disease, and its screening in at‐risk children might be useful in the future.

The evaluation of short fusion in idiopathic scoliosis.

Background: Selective thoracic fusion in type II curve has been recommended by King et al. since 1983. They suggested that care must be taken to use the vertebra that is neutral and stable so that the lower level of fusion is centered over the sacrum. Since then there has been the trend to do shorter and selective fusion of the major curve. This study was conducted to find out whether short posterior pedicle instrumentation alone could provide efficient correction and maintain trunk balance comparing to the anterior instrumentation. Materials and Methods: A prospective study was conducted during 2005-2007 on 39 consecutive cases with idiopathic scoliosis cases King 2 and 3 (Lenke 1A, 1B), 5C and miscellaneous. Only the major curve was instrumented unless both curves were equally rigid and of the same magnitude. The level of fusion was planned as the end vertebra (EVB) to EVB fusion, although minor adjustment was modified by the surgeons intraoperatively. The most common fusion levels in major thoracic curves were T6–T12, whereas the most common fusion levels in the thoraco-lumbar curves were T10–L3. Fusion was performed from the posterior only approach and the implants utilized were uniformly plate and pedicle screw system. All the patients were followed at least 2 years till skeletal maturity. The correction of the curve were assessed according to type of curve (lenke IA, IB and 5), severity of curve (less than 450, 450-890 and more than 900), age at surgery (14 or less and 15 or more) and number of the segment involved in instrumentation (fusion level less than curve, fusion level as of the curve and fusion more than the curve) Results: The average long-term curve correction for the thoracic was 40.4% in Lenke 1A, 52.2% in Lenke 1B and 56.3% in Lenke 5. The factors associated with poorer outcome were younger age at surgery (<11 years or Risser 0), fusion at wrong levels (shorter than the measured end vertebra) and rigid curve identified by bending study. However, all patients had significant improved trunk balance and coronal hump at the final assessment at maturity. Two patients underwent late extension fusion because of junctional scoliosis. Conclusions: With modern instrumentations, the EVB of the major curve can be used at the end of the instrumentation in most cases of idiopathic scoliosis. In those cases with either severe trunk shift, younger than 11 years old, or extreme rigid curve, an extension of one or more levels might be safer. In particular situations, the concept of centering the lowest vertebra over the sacrum should be adopted.

Ethnographic Edutainment for Transformative Medical Education: Thailand

Transformative learning is a most important issue in medical education. Ethnographic edutainment is a concept that consists of reward, competition, and motivation strategies, which are more effective in engaging with learners. First-year medical students (N = 321) were included in this study during the Doctor and Society course at Chulalongkorn University in 2011. Four preset learning objectives were set and participants assigned a term group project with clouding technologies. The deliverables and the attitude toward this method were evaluated. Nineteen of 20 (95%) groups achieved all objectives. Females rated higher scores for this activity than males (P < 0.001). Statistically significant differences were found between lecture-based sessions and field visit sessions as well as ethnographic edutainment activity sessions and other types (P < 0.01). The results were consistent in both male and female groups. Ethnographic edutainment can be well-accepted with higher satisfaction than some other types of teaching.

Promoting healthy foods in healthcare system in Thailand

Abstract Background: Inadequate access to healthy foods is among the most important factors contributing to obesity and chronic illnesses due to over-crowdedness of junk foods and bakery shops. Objective: To address an innovative operational model to mitigate the healthy foods inequity in Thailand. Methods: In 2013, the network of health/allied-health professionals from Chulalongkorn University, domestic sciences experts, food professionals and chronic diseases patients from King Chulalongkorn Memorial Hospital (KCMH) were formed. Healthy foods availability, channel of accessibility and consumer behavior were three main strategies deployed. Ready-to-eat healthy foods (RTEHF) were created to match with simple criteria considering calories per portion, fiber, sugar, fat and salt in accordance with recommended daily intake. Four-squared meter area at outpatient building of the KCMH was provided for operation. The kiosk operated in the morning from Mondays to Fridays during September 2014–May 2015. Consumer survey was done to assess satisfaction and adoption. Results: Sixty-two RTEHF menus were created and >50,000 portions were delivered. Monthly surveys were done with high satisfaction rate. Disease-specific healthy menu book was published and disseminated to the public with >10,000 copies downloaded since December 2016. Large public hospitals expressed their interest to adopt this model. Small/medium foods enterprises voluntarily co-created more healthy foods menus to scale up to all public hospitals. Mass media regarded this as a new way for hospital social responsibility. The KCMH administrators offered permanent healthy-foods-area to serve more patients with integrated on-site health education in 2017. Conclusion: Healthy eating in health care system can be successfully achieved by multi-disciplinary and inter-professional collaboration.

Higher satisfaction with ethnographic edutainment using YouTube among medical students in Thailand

Purpose: At present, transformative learning is one of the most important issues in medical education, since a conventional learning environment is prone to failure due to changing patterns among students. Ethnographic edutainment is a concept that consists of reward, competition, and motivation strategies that be used to effectively engage with learners. Methods: A total 321 first-year medical students took part in ethnographic edutainment sessions in 2011. We defined four preset learning objectives and assigned a term group project using clouding technologies. Participatory evaluation was conducted to assess the delivery of and attitudes towards this method. Results: Career lifestyles in the general population and expected real-life utilization of the final product were used as motivating factors, with competition and rewards provided through a short film contest. Nineteen out of twenty groups (95%) achieved all learning objectives. Females were more satisfied with this activity than males (P<0.001). We found statistically significant differences between lecture-based sessions and field visit sessions, as well as ethnographic edutainment activity sessions and other instructional approaches (P<0.01). The results were consistent in male and female groups. Conclusion: Ethnographic edutainment is well accepted, with higher satisfaction rates than other types of teaching. The concepts of health promotion and the social determinants of health can be learned through ethnographic edutainment activities, which might help train more humanized health professionals.