ผลการศึกษาวิจัย(Summary of Successful research series )

การศึกษาวิจัยภายในประเทศเพื่อค้นหาคำตอบสำหรับการพัฒนาคุณภาพการรักษาโรคที่ดีเยี่ยมด้านศัลยกรรมประสาทและพัฒนาคุณภาพแพทยศาสตร์ศึกษา โดยทำการศึกษาวิจัยต่อเนื่องเป็นชุดเพื่อหาวิธีแก้ปัญหาที่เกิดขึ้นจริงสร้างองค์ความรู้ภายในประเทศ : รวบรวมและรายงานผลสำเร็จของการรักษาโรค,การเรียนผ่านสื่ออิเลกโทรนิกส์,การฝึกผ่าตัดโดยใช้หุ่นจำลองเพื่อลดข้อผิดพลาดจากการผ่าตัดทัดเทียมอารยประเทศ

Succesful research series project for excellence surgery
Target :The best surgical treatment outcome

   1.)Clinical Research
        1.The successful development of neurosurgical research series  
        2. Successful decompressive craniectomy for TBI
        3. Successful of neurosurgical operation for  ICH                                           
        4. Successful AVM resection before definite investigation    

5.Successful rupture cerebral aneurysm treatment                            
        6. Successful  decompressive craniectomy in cerebral infarction in the young
        7. Successful surgical operation for Compressive myelopathy
        8. Successful treatment of refractory intracranial hypertension with Thiopental    .                                            
        9. Successful treatment of ophtalmoplegia from brainstem infarction
       10. Successful simple surgery(Single burrhole irrigation) for chronic subdural hematoma
       11.Successful botulinum toxin(Botox)injection for abnormal movement
       12. Traumatic Brain Injury Prognosis Model
       13. The outcome of TBI treatment in PMK hospital Powerpoint presentation
        14. ICH in thai military
        15. Prognotic factor of supratentorial hemorrhage
        16. Efficacy of the EVD for IVH
        17. Risk factor of CSF shunt infection 
        18. How to prevent CSF shunt infection Powerpoint presentation
        19.Mesenchymal chondrosarcoma of the orbit(First case &report in Thailand)

   2.) Medical education research
        20.The neurosurgical E-learning Powerpoint presentation
        21.The development of Ethical e learning project                                               
        22.Ethic & Behavioral change                                                                             
  3.) Innovation research
        23.The outcome of neurosurgical training Model  Powerpoint presentation                                              
        24-37.The series of skill training model
                     24.Ventriculostomy
                     25. Neuroanatomy quiz
                     26. Scalp flap&Skull planing
                     27. Exploratory burr hole ,Craniectomy
                     28. Small craniectomy remove ICH
                     29. Brain tumor resection
                     30. Temporal bone drilling
                     31. Release of peripheral nerve entrapment
                     32. Skull retractiom
                     33. Acupuncture
                     34. pulse detection
                     35. Brain abscess resection
                     36.Fetal surgery: Hysterotomy&Closure of Myelomeningocoel
                     37.Fetal surgery: Ventriculoamniotic shunt insertion by Fetoscope(Wireless fetoscope)
        38.The Simple Virtual reality neuronavigator
        39.The virtual simulation of neurological operations : pilot study brain abscess resection
        40.The fetal surgey : myelomenigocoel repair
        41.The fetal surgery: ventriculo-amniotic shunt insertion for hydrocephalus
        42.The fetoscope :Wireless neuroendoscope(Fetoscope)
        43.The simple neurosurgical instrument(low cost : high effective):Guide wire for Ventriculoperitoneum shunt insertion
 4.) Military research
        44.Empowering ethic in military medical center (Ethic e-learning, Ethic&behavioral change,Transparency organization) 

 

 

สรุปผลชุดงานวิจัยต่อเนื่อง:Summary of research series

Stroke summary

1.)ICH in military population 2000
       Descriptive study:In military most common cause of ICH is  hypertension not different from other population .conservative treatment:operative treatment 6:4 military population n=71cases 5years record

2.)The factor that influnce outcome of cerebral aneurym treatment 2000

Descriptive retrospective study :Cerebral aneurysm should be operated by craniotomy clipping of aneurysm as early as possible to prevent reruptured.Factor that influence the outcome of Cerebral aneurysm treatment are age (<60year favorable outcome),level of consciousness(Glassgow coma score) (GCS 14-15 survival rate 100%,GCS<8 surviaval rate 50%) Hunt&Hess grading(Grade 1 good outcome90% no MR.,Gr.2 good outcome 70%,Gr.3 good outcome 50%,Gr.4 good outcome 20% ,Gr.5 MR. 100%),Fisher grade,Medical complication Most common cause of death is infection (Pneumonia,UTI,CNS infection)

n=30 cases 4 years record

3.)Risk factor for poor outcome of moderated size supratentorial hemorrhage 2001
      Descriptive study:surgery for moderate size ICH was success 75% ,poor out come 25% Factor that related to poor outcome of treatment supratentorial hemorrhage are previous cva,systolic blood pressure at 2 day post operative >200 mmHg(poor control HT.),alcoholic consumption(liver disease),irregular shape of hematoma on CTscan moderate size ICH
n=248 from total 412 case 4year record

4.)The efficacy of  external ventricular drainage for moderate size ICH with IVH 2000
      Case control study:mortality rate from small to moderate size ICH with IVH =80% are higher than ICH alone (previous report)mortality rate  ICH alone=25% most common cause of death from infection (most common : pneumonia43%),other commom complication:UTI 30%,Ventriculitis 10%. The treatment outcome conservative treatment is not significant different from surgical EVD   but in EVD group some patient survive
n=51 ,4years record

5.)The successful surgical resection of AVM before definite investigation 2009
         Case series:The ICH from AVM can be safetyresected in the same operation with bloodclot evacuation.No mortality the result is good All patient 7 AVM patients age range from2years-35years present with intracerebral hematoma in the coma state (GCS 4-8) ,that required emergency operation .The AVM were diagnosed by age incidence and history &physical examination  that rule out other possible cause.The CT Scan reveal  moderate to large size intracerebral  hematoma (Vol. 40-100cc.) The AVM resection was performed with blood clot evacuation in the same operation before cerebral angiography . The diagnosis was confirmed by pathological report.No patient die(Mortality rate 0%).Most of patient have good outcome 70%: GOS5(Normal) :4,GOS 4(Minimal disability):1,GOS 3(Severe deficit):2 at 1year follow up  total resection 6/7(85%) Only 1case have a second operation for total resection  The outcome were very good that no mortality and not increase major morbidity.Even the  comatose patient s who have decerebrate posture can improve to walk, run and have a normally activity of daily living.The major morbidity : Hemiparesis,Monoparesis in 2 cases because of Large AVM in eloquent area.

n=7,10 years record

6.)The successful treatment of CVA 2009
       Case series,Operative technic :The outcome are excellent ,no surgical mortality even in large size ICH  and morbidity,medical mortality in large ICH =20%, meticulous non invasive technic small size craniectomy, less cortical damage for blood clot evacuation with vigerous good intra and post operative blood pressure control (mean BP = 150/90mmHg.) excellent outcome :good recovery in 1 month postoperation  in moderate to large size some patient improve from hemiparesis motor power grade 1 to near normal grade 4-5 normal gait, independent ADL,language disorder from global aphasia to normal language 
n=30 cases, 2years record

From research study of stroke the target point is to improve quality of treatment ,decreased mortality  from ICH alone 25%,ICH with IVH 80%  to 0% in moderated size ICH,no surgical morbidity,excellent outcome  improve neurological deficit from disable to independent normal ADL in short time(Recovery in 1 month) such as global aphasia improve to normal speech ,hemiplegia improve to independent ambulate& near normal gait.

This is to demonstrate the value of previous research for continuous development of clinical use.The true value of reseach series is for excellent surgical outcome.When we known ourself. what is the problem (incidence in thai military population, risk factor of poor outcome , mortality rate,treatment modality conservative and surgical operation.)
We can solve the problem and prevent risk factor of poor outcome and success in surgical operation.Not by instrument or technology  but by acknowledgement about disease (CVA), which case should have benefit from surgical operation and good surgical technic . The significant factor to improve quality is to known how to correct all risk factor that yield poor outcome(learn from the fault). The all unexpected medical complication should be awared and prevented with appropriated treatment.
                         So  it is clear that the surgical treatment for CVA is effective in the appropriated selected case.
  (Excellence outcome=no mortality,no morbidity, good recovery from severe(coma) to normal(good conscious) or less neurological deficit)

Traumatic brain injury summary
     
     1.The outcome of TBI treatrment in PMK hospital 2008
    Descriptive study:The outcome of TBI treatrment overall mortality rate 1.7% ,  severe TBI 11% ,mild head injury 0.05%(talk and deteriorate) most of TBI is mild head injury (2/3),Surgery in moderate to severe head injury 37%(540/1450)  soldier 60% non soldier 40%most common cause from motor vehicle accident ,Penetrating head injury 5%(72 cases). In moderate to severe head injury that admitted to hospital : Diffuse Axonal Injury (DAI) 16 %,EDH 20 %,SDH 50%Cerebral contusion 10%,Depressed skull fracture  10% ,surgical operation:Decompressive craniectomy 70%(378cases),Craniotomy30%(162cases) The waiting time between admitted to hospital  to surgery was 35min-15 hours, no significant definite time for  good outcome(Golden period)( because of other different factor such as severity,type,age,plasticity of brain,unexpected complication)but in the cases waiting time longer  than 6 hours have probability of poor outcome.The prognostic factor  were depend on clinical aspect:age,severity,post resuscitation GCS,refractory increased ICP,CT Brain: Cerebral swelling more than intracranial hematoma                    
n=3450 cases 5year record
 
       2.Decompressive craniectomy in TBI  2007
          Case series:The outcome of decompressive craniectomy for severe TBI that have refractory increased ICP were good(GOS 4,5) 45%,severe disability(GOS 2,3) 45%,Mortality 10%
n=9cases 1 year record

Even severe traumatic brain injury is the leading caused of death ,The appropriated treatment can change the result from death to survived ,decreased mortality &motbidity .

The CNS infection series

1.Risk factor of CNS shunt infection 2001

Descriptive study: The significant risk factor of CNS shunt infection in PMK hospital were age<6 months,immunocompromised host,skin condition,length of operation,experience of neurosurgeon. The incidence for CNS shunt infection was 9.1%

n=150 cases,4 years record

2. How to reduce CNS shunt infection in PMK hospital 2006

Historical comparative study: The incidence of shunt infection in pramongkutkloa army hospital  was simply decreased from 9.1% to 2.5% by   1) select the appropriated patient for shunt implantation, 2) prevent shunt devices,surgical instruments from contamination with skin and operating room environment,3)the use of prophylaxis antibiotic,4)The shunt implantation should be performed by the experienced neurosurgeon.

n= 198 cases,4years record  

The CNS shunt infection can be prevented with simple appropriatede protocol for CNS shunt insertion

The medical education & surgical innovation research series
 
1.The neurosurgical E-learning pilot study project 2008
Descriptive Pilot study : pilot study the use of neurosurgical E-learning via internet and intranet by 30 rehabilation student,30 medical student  ,evaluate learning result:all student can pass the examinatioin ,attitude: most of the student appreciate and like to learn with e learning(mean numeric rating scale=4),quality of media is good. So that E-learning is the effective alternate pattern of learning which increase quality of learning

n=60,1 year record

2.The development of ethical E-learning project 2009
Experimental randomized case control study: to compare the effective learning of e-learning (Active Self direct learninig)with traditional learning(Passive lecture learning) study in 80 medical students,20 surgical residents total 100 pops.randomized selected in 2 group e learning group and traditional group .evaluate learning result:e-learning group have better score than traditional group,no performance problem,Attitude: most student satisfied with e-learning, This is to confirm the effective active self direct learning via intranet&internet. And the first time in Thailand,PMKcollege to create ethical elearning and experimental research study result. To improve quality of  ethic
and surgical educationand  to create the good (both moral &professional quality)doctor.

n=100,1 year record

3.The brain training center :learning center&religious on the internet 2010
Experimental study :The true ,freedom of learnining  :to use technology for wisdom creation and make the best thing in the internet for widespread of the good soul,spiritual throughout the world ,the method of brain and mind improvement  how to be genius,make the better world the wisdom world or the fourth wave to change  the world.

unlimit population,unlimit time evaluation time interval 5 years

New concept of learning(freedom E-learning) have been proved the better result from traditional learning .Continue development should be performed for the future.

4.The intracranial moldable model for neurosurgical skill training :ventriculostomy 2006

Historical comparative study :The iatrogenic complication from ventricular puncture was reduced from 5% to 0% after the use of intracranial moldable model for neurosurgical operative skill training,This is the first time in thailand and our Pramongkutkloa hospital to create neurosurgical model to improve skill training quality and to correct iatrogenic complication.The neurosurgical residents were satisfied to used the model instead of cadaver and animal

n=7cases 1year record

5.The model for neurosurgical operative skill training 2009

Inovative study : Continue development of neurosurgical operative skill training model in thailand is perfoming.The series of models for operative skill training were designed and constructed for Exploratory burr hole,Craniectomy remove blood clot,surgery for intracerebral hematoma remove,Brain tumor resection,Temporal bone drilling ,surgery for Carpal tunnel syndrome,Guyon canal sydrome.With the new concept of self direct learning by short course self study and skill training to improve quality of surgical training and to prevent iatrogenic complication.

n=11cases 2 years record

6.The development of neurosurgical practice model for skill training project 2010

Innovative experimental study:To construct the surgical model for skill training course and evaluate the result of training project .The result of short course self direct skill learning by use operative model is good include acknowledge,attitude and performance

n=30 Cases 1 year record

The innovation : Neurosurgical operative skill training model are useful to improve quality of surgical training and quality of surgical treatment and can be used instead of cadaver and animal. The effective of model are simple,cheap,easy,ready to use,real operative skill practive,creative innovation (not copy),correct the iatrogenic complication for surgical patient safety.

งานวิจัยต่างประเทศไม่อาจนำมาใช้ได้ทั้งหมด ควรทำงานวิจัยในประเทศที่ก่อให้เกิดความรู้ที่เป็นประโยชน์และใช้งานได้จริง ปัจจุบันงานวิจัยส่วนใหญ่ลอกเลียนงานวิจัยต่างประเทศซึ่งไม่ก่อให้เกิดประโยชน์ต่อการสร้างองค์ความรู้ใหม่ ควรริเริ่มสร้างงานวิจัยที่ไม่ลอกเลียนแบบใครและแก้ปัญหาที่ต่างประเทศทำไม่สำเร็จให้สำเร็จ จากการศึกษาวิจัยนำไปสู่การสร้างโครงการต่างๆที่เป็นประโยชน์
วัตถุประสงค์

  1. เพื่อพัฒนางานวิจัยด้านประสาทศัลยศาสตร์และสร้างองค์ความรู้ภายในประเทศ เพื่อใช้อ้างอิงในการใช้งานทางคลินิก,การสร้างตำราและการพัฒนางานวิจัยให้เกิดประโยชน์นำไปใช้ได้จริงอย่างต่อเนื่อง
  2. ติดตามและแก้ไขปัญหาที่เกิดขึ้นโดยการค้นหาคำตอบและวิธีการทางวิทยาศาสตร์จากงานวิจัย
  3. เพื่อเพิ่มการศึกษาวิจัยในทหารและด้านเวชจริยศาสตร์
  4. พัฒนาคุณภาพและคุณธรรม
  5. เผยแพร่ความรู้ที่มีประโยชน์

The evolution of Successful clinical research& Medical Education& innovation:e-learning by Year plan  

    2549-2550
 PMK:Succesful treatment of refractory intracranial hypertension with Thiopental in pmk
Intranet online learning ( MOODLE) The Intranet handbook  of neurological surgery
Online learning  การรักษาบาดเจ็บที่ศีรษะ
                           ประสาทศัลยศาสตร์สำหรับบุคลากรทางการแพทย์
                          โรคติดเชื้อในระบบประสาท
                           การรักษาบาดเจ็บที่เส้นประสาท
Moldable intracranial model for neurosurgical practice ;ventriculostomy                                                                                                                                                                                                  
model for neurosurgical practice  trauma
Shunt insertion set
                                                                                       
    2551                                                                                                                                                                                                               
ผลการรักษาบาดเจ็บที่ศีรษะในรพ.พระมงกุฎเกล้า
PMK:The development of Neurosurgical e-learning
The Internet Handbook of Neurological Surgery
Model for neurosurgical practice stroke ,PNL

   2552
RCST: The model for neurosurgical operative skill training
PMK:Successful neurosurgical operation for CVA
The Internet Handbook of Surgical Ethic                                                                  
model for neurosurgical practice  tumor
Online learning congenital,ethic

  2553  Award                     
RCST:Ethical e-learning Project (Class  1)
Brain training&E learning website construction             
Neurosurgical operation E-learning                                                                             
Model for skull traction
Model for acupuncture   

2554 Succesful target approach:ASEAN
ASEAN congress of Neurological surgery :
       The successful  development of Neurosurgical research series project
       The development of the Ethic E-learning project
       The series of models for neurosurgical operative skill training
PMK:
      The Successful of Botulinum toxin injection for the treatment of Abnormal movement
      Ethic & Behavioral change
      Successful decompressive craniectomy for cerebral infarction in the young
      The Simple neuronavigator
      The Neurosurgical operation simulator & neuronavigator
      The development of  neurosurgical procedure CAI & Simulator
The Internet Handbook of neurosurgical operative technic
The Internet Handbook of Acupuncture for neurological diseases
The Cyber wisdom world: Brain training&E-learning project :
                     Excellence strategies
                     Special warfare conquerer strategies
                     Genius formation
                     Logo &meaning
                     Night tale นิทานช่วยชาติ
Simulation artificial brain for surgical operative training
Skull base surgery
Neurosurgical procedure CAI
Model for neurosurgical practice  abscess resection
simple virtual reality Neuronavigator

2555 
PMK: TBI Prognostic model, Succesful simple surgery(Single burrhole irrigation) for chronic subdural hematoma,Succesful treatment of ophtalmoplegia from brainstem infarction,Succesful surgical operation for Compressive myelopathy
          
          The fetal surgery, Wireless endoscope

2558 Article future innovation & Brain-Computer interface(BCI,BMI,Mind control,telepathy) objective of website construction E-brain Evolution