THE EMPOWERMENT OF BAN DONG COMMUNITY NETWORK

FOR THE SURVEILLANCE OF EMERGENCY

CARDIOVASCULAR DISEASE

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Title : The Empowerment of Ban Dong Community Network for the Surveillance

of Emergency Cardiovascular Disease

Names : Chanatipf Siripakkulwat, Chayanit Bhuddee, Nuthwasa Rungjang

Advisors : Dr. Vitaya Chadbunchachai, Director of WHO Collaborating Center for

Injury Prevention and safety Promotion Khon kaen Hospital,

Dr. Apisit Thamrongwaranggoon, Ubolrattana Hospital Director,

Dr. Nipaporn Lakornwong, Yasothon Hospital

Lt. Col. Dr. Tanongson Tienthavorn, Phramongkutklao College of

Medicine,

Assoc. Prof. Dr. Jaruayporn Srisasalux, Health System Research Institute

ABSTRACT

The aim of this study is for learning the technique of emergency caring method

to cardiovascular system patients with the participation of the community by qualitative research

studies. An Area of study is Ban Dong sub-district administration organization, Ubonrat district,

Khon Kaen province. Contributors and Participantsin the study consists of four major

organizations in the community; 1) 3 Representatives from local governments, 2) 15

Representatives from local organizations, 3) 27 Representatives of public organizations, 4) 5

Representatives from public and private organizations. Collecting data by observation, intensive

interviews and group discussion, hold from December 2015 to July 2016. The data were analyzed

by percentage statistics and content analysis.

The result of study is procedure to beware for cardiovascular system with the

participation of the community by follow; 1) formed to educate people about the cardiovascular

disease 2) multimedia that using to suggest the lack of knowledge people 3) establishment of

emergency volunteer group to shift for beware cardiovascular system patients 4) plan to establish

rescuer fund in community for supporting service of emergency cardiovascular system patients.

A workshop for educate people with process to beware for cardiovascular system with

the participation of the community, allow people to have knowledge, exchange their mutual

experience learning and found new innovative respirator during resuscitation. Ban Dong citizens

accept as true that procedure be able to support people requirement in Ban Dong community to

classify patient efficiency, reduce complications and decreasing death condition of wrong

treatment or late transport. Furthermore, it make a community to get unity and proud with

themselves that can help their neighbors in community.

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2) Non ST- segment elevation myocardial

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non ST elevation MI (NSTEMI, or Non Q wave MI)

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(PQRST)] 1) PQ= pain quality

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MB (Specificity) Cardiac troponins

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basic laboratory tests X-ray

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3.2) Cardiovascular system

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(D-N) 1 3

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(primary PCI)

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< 90 , 75 Onset > 3

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2) non ST-elevation

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2.1) Invasive strategy

24-48

Conservative strategy

2.2) Conservative strategy

NSTEMI UA

TIMI Risk score Anman et al. 7 > 65 ,

50, 3 ,

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TIMI risk score

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fibrin specific agents

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prehospital GUSTO trial

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22

strokes 3 1000 Reteplase Alteplase

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(door to needle time) 30

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mg 75 75 mg 75

Hemorrhagic

stroke

0.9%- 1%

(cerebrovascular disease)

major non-cerebral bleeding 4-13%

(procedure related bleeding)

failed thrombolysis

(rescue PCI) persistent ST elevation

ST segment lead 50%

60-90

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recurrent ischemia

rescue PCI

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mg.%

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CTA

digital subtraction angiography(DSA)

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CTA (static images) DSA

flow rate ( , 2557)

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2.1) Blood Test: FBS, CBC, Lipid profile (Total cholesterol,

Triglyceride. HDL, LDL) : BUN, Creatinine, Electrolyte, Liver function test, PT, PTT, VDRL

urine exam Base line Condition

26

2.2) Cardiac work up: CXR, EKG

Electrocardiogram

2.3) 45

Atherosclerosis

ESR ANA profile, Coagulogram, Protein C, Protein S, Antithrombin III,

Anticardiolipin, Homocysteine, facter VII leden, Prothrombin gene, Vascular work up Anti HIV

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, 2550)

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92%)

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- (congestive heart failure)

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- hypertensive encephalopathy)

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20 2

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4-6

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( 10-15%) 2.5 mg/hr

5 15 mg/hr

27

* Nifedipine

1.3 DBP > 140 mmHg 2 5

- Nitroprusside 0.5 mg/kg/min

( 10-15%) 1-5

- Nitroglycerine 5 mg 1-4 mg/hr

- 1.2

-blocker

1-4

SBP/DBP < 100/70 mmHg

3)

Isotonic solution 0.9 %

NaCl Free water

4) Massive

infarction

5) 140/80 mmHg (< 7.78-10

mmol/litre)

6)

7)

8)

2.3.7 (Acute treatment) 48

1) (Antiplatelets) aspirin 160-325

48 (Appendix 7) - aspirin

- Non lacunar infarcteith midline shift

28

2) (Anticogulants)

acute stroke extracranial carotid

vertebral dissection cerebral venous thrombosis

3) Neuroprotective agents

4) immunosuppressive vasculitis

5) stroke unit

2.3.8 (Antiplatelet)

1)

aspirin 60-325 (class 1, level of evidence A)

aspirin aspirin

aspirin ()

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CBC 3 ) (class IIa, lecel of evidence A)

Clopidogrel 75 (class IIa, level of evidence A) aspirin 25

Dipyridamole extended release 200 (class IIa, level of evidence A) 2

Cilostazol 200 (class IIa, level of evidence B)

2)

1

(Anticoagulant)

Warfrin

International normalized ratio (INR) = 2.0-3.0

- Persistent or paroxysmal AF (class I, level of evidence A)

- Acute MI and LV thrombus (class IIa, level of evidence B)

- Cardiomyopathy (class IIb, level of evidence C)

- Rheumatic mitral valve disease (class IIa, level of evidence C)

- Bioprosthetic heart valve (class IIb, level of evidence C)

Intenational normalized ratio (INR) 2.5 3.5

mechanical prosthetic heart valves (classI, level of evidence B)

29

3) (Carotid endarterectomy)

70-99%

(carotid endarterectomy)

4) (Carotid angioplasty)

(carotid angioplasty)

2.3.9

1) Deteration of acute stroke

1.1) Systemic cause Dehydration Hypotension Extreme

degree of hypertension Hypoxia Infection (Pneumonia, Urinary tract infection, Sepsis) MyOcardial

ischemia and Electrolyte Imbalance eg. Hyponatremia

1.2) Neurological Cause Recurrent Stroke Progressive

of Thrombosis Hemorrhagic transformation Cerebral edema Hydrocephalus and Seizure

3.

3.1

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3.4 ( , ...)

(Participation Research)

(Action Research) (Quantitative Research)

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35

3.4.1

1)

2)

3)

4)

5)

3.4.2

1)

1.1)

1.2)

2)

36

3)

4)

5)

6)

What Where When Why Who How

7)

8)

3.4.3

1) (Observation)

1.1) (Setting)

1.2) (Act)

1.3) (Activity)

1.4) (Relationship)

37

1.5) (Participation)

1.6) (Meaning)

2) (Interview)

3) (Focus Group)

6-12 4-5

2

4)

38

5)

4. (Knowledge Management and Health literacy

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4.2

2 (Explicit Knowledge)

(Tacit Knowledge)

2

Tacit Explicit Explicit

Tacit

2 1.Tuna Model

2.Xerox Model 1 Model

I-cando Model

4.2.1 .

1 3

1) () KV (Knowledge Vision)

(Knowledge Identification)

() KS (Knowledge Sharing)

2)

(Knowledge Sharing)

40

()

3)

(Knowledge Access)

4.2.2

7 6

4.2.3

(Competency) 3

(Knowledge) (Knowledge

assessment) (Attitude) (Attitude

assessment) (Skill)

(Performance assessment)

4.3 (Health literacy) ( , 2554)

(Rootman,

2002) (Nutbeam D., 2000)

(outcomes)

(health education) (communication activities)

(intervention)

41

1) (illiteracy populations)

2) (low-literacy populations)

3) (general populations)

4) (health provider groups)

The Canadian Education Research Information System: CERIS(1999)

6 (1) quantitative (2)

42

scientificliteracy (3)

technologicalliteracy (4) cultural literacy (5)

medialiteracy(6) computer

literacy

(The National HealthEducation Standards: NHES)

8

(1)

(2)

(3)

(4)

(5) (6)

(7)

(8)

6 (1)

(access) (2) (cognitive) (3)

(communication skill) (4) (decisionskill) (5) (medialiteracy)

(6) (self-management)

functional healthliteracy

communicative/ interactive health literacy

critical health literacy

3

43

The Canadian Education Research Information System: CERIS (1999)

5. (, ...)

5.1

(Risk Behavior)

(Proactive Health Education)

(Intervention)

(Health Behavior Development Process)

(Individual) (Family) (Community) (Society)

(Systematics)

(Ongoing) (Pattern)

(Awareness)

5.2

Health Behavior

Situation Awareness

44

5.3

1) Passive surveillance

- hospital-based

- routine report

2) Active surveillance

- searching for data

- expensive resources

3) Sentinel surveillance

- report of selected health event by selected area passive and active

4) Surveillance base on secondary data analysis

5) Special surveillance surveys and investigations

5.4

1) Actions = Comprehensive Chronic Disease Prevention in Thailand

2) Chronic Disease ( )

- Ischemic Heart Disease - Stroke - Hypertension - Diabetes - Cancer - Injury

3) Surveillance information system = Major supporting system for comprehensive

Chronic Disease Prevention Policies in Thailand

6.

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7.2.2

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7.2.4

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