Ensuring equity in medical specialist distribution is essential for achieving universal health coverage (UHC). This study explored the changes in the availability and distribution of medical specialists in Thailand from 2015 to 2024 and assessed the equity impacts on workforce.

A retrospective longitudinal analysis of national administrative workforce data.

Public and private hospitals across Thailand, covering 1471 facilities in 77 provinces.

The primary outcomes were specialist-to-population ratios and geographical equity measured using the Gini coefficient (G), where values closer to 0 indicate greater equity. Explanatory variables included specialty type, geographical region and the timing of major workforce policies, including mandatory service and specialty-specific legislative interventions.

Between 2015 and 2024, the GPs and specialists in Thailand expanded significantly, with improvements in both density and distribution. The Gini coefficient for GPs showed the largest equity improvement (G=0.42 in 2015 and G=0.22 in 2024), reflecting the impact of mandatory service programme and rural recruitment programmes. Among specialists, emergency and family medicine have shown rapid growth and significant reductions in distribution inequity, reflecting the success of legislative policies. Sustainability of workforce policies was challenged by the ‘leaking stock’ phenomenon due to attraction of career opportunities and economic drives.

Workforce targeted interventions have led to improvements in the availability and equitable distribution of GPs and medical specialists over the past decade. Further policy, such as retention incentives and assisted technology, is needed to achieve equitable distribution across all specialties, particularly in low-density fields. Thailand’s experience offers the lessons for other low- and middle-income countries as the evidence-based and equity-focused workforce policies for UHC advancement.

Total alloplastic replacement of the temporomandibular joint (TMJ) is a viable treatment option for severe TMJ disorders (TMDs) unresponsive to conservative approaches, as well as for reconstruction of congenital or acquired TMJ defects. However, clinical data on indications, outcomes, complications and long-term effects remain limited, and no global registry currently exists. This study aims to address this gap by establishing an international registry to collect data from patients undergoing total alloplastic TMJ replacement systematically. The registry will document clinical indications and disease progression, explore relationships between treatments, outcomes and quality of life, identify predictors of favourable outcomes and inform future research.

This international, prospective, multicentre, observational registry will enrol approximately 200 patients with TMD requiring total alloplastic TMJ replacement, with follow-up lasting up to 5 years postoperatively. The data collected will include underlying disease, treatment details, functional outcomes, patient-reported outcomes and procedure-related adverse events. The registry will also monitor patients who decline surgery and record their reasons. All treatments will adhere to the standard of care at each participating centre.

Ethics approval was obtained from the responsible ethics committee (EC) at each participating site prior to TMJ surgery. All patients will be enrolled following an informed consent process approved by the relevant EC. Study results will be disseminated through peer-reviewed publications.

Approving ECs include: Krishnadevaraya College of Dental Sciences and Hospital EC, KCDS/Ethical Comm/54/2022–23; Ethikkommission Nordwest- und Zentralschweiz, 2019–02387; University of Belgrade School of Dental Medicine EC, 36/19; National Videnskabsetisk Komité, 2401881; University of KwaZulu-Natal Biomedical Research EC, BREC/00001592/2020; Etikprövningsmyndigheten, 2019–04477; Ethikkommission Medizinische Hochschule Hannover, 8660_BO_K_2019; Ethik-Kommission an der Medizinischen Fakultät der Universität Leipzig, 080/21-lk; Comité de Ética de la Investigación con Medicamentos Hospital Universitario 12 de Octubre, 19/392; Landesärztekammer Rheinland-Pfalz EC, 2025–18012-andere Forschung/nachberatend; Local Ethical Committee at National Medical and Surgical Centre named after NI Pirogoov, LEC meeting 5; Ethikkommission bei der LMU München, 19–589; Komisja Bioetyczna przy Warmiłsko-Mazurskiej Izbie Lekarskiej w Olsztynie, 12/2021; De Medisch Ethische Toetsings Commissie Erasmus MC, MEC-2019–0696 and Comissão Nacional de Ética em Pesquisa, 3.825.711.

NCT03991728.

To evaluate the effectiveness of short-duration self-learning (SSL) and mastery learning (ML) strategies on the acquisition and 6-month retention of cardiopulmonary resuscitation (CPR) skills and basic life support (BLS) knowledge among hospital administrative staff in Thailand.

Comparative assessment of two CPR training strategies.

Tertiary-level academic institution in Thailand.

A total of 163 hospital administrative staff aged ≥18 years without prior BLS certification were enrolled and randomly allocated to either the SSL group (n=82) or the ML group (n=81). Participants with previous CPR certification, medical limitations preventing chest compressions or those unwilling to attend the 6-month retention test were excluded. 71 participants in each group completed the 6-month follow-up.

All participants viewed an 8 min self-directed instructional video on BLS and subsequently performed CPR practice using real-time feedback manikins. The SSL group practised independently for up to five 1 min sessions, while the ML group practised until achieving a predefined mastery threshold (QCPR (Quality Cardiopulmonary Resuscitation) score >90%).

The primary outcome was CPR skill retention at 6 months, measured by QCPR overall performance score. Secondary outcomes included observational BLS performance (scene safety, responsiveness, emergency activation, breathing assessment and correct hand placement), knowledge retention scores and the number of attempts required to achieve mastery in the ML group.

Both SSL and ML groups demonstrated significant improvement in CPR performance and BLS knowledge immediately after training (p

Both SSL and ML effectively enhanced CPR performance and knowledge retention among non-medical hospital staff. SSL offers a practical, resource-efficient and scalable approach for CPR training in large-scale community or institutional settings. Future studies should investigate the cost-effectiveness and optimal refresher frequency for sustaining CPR competency.

TCTR20210521003.

To analyse the impact of selected neonatal care interventions on regional care capacity.

Design

Discrete event simulation modelling based on clinical data.

Neonatal care in the southwest of the Netherlands, consisting of one tertiary-level neonatal intensive care unit (NICU), four hospitals with high-care neonatal (HCN) wards and six with medium-care neonatal (MCN) wards.

44 461 neonates admitted to at least one hospital within the specified region or admitted outside of the region but with a residential address inside the region between 2016 and 2021.

The impact of three interventions was simulated: (1) home-based phototherapy for hyperbilirubinaemia, (2) oral antibiotic switch for culture-negative early onset infection and (3) changing tertiary-level NICU admission guidelines.

Regional neonatal capacity defined as: (1) occupancy per ward level, (2) required operational beds per ward level to provide care to all inside region patients at maximum 85% occupancy, (3) proportion rejected, defined as outside region transfers due to no capacity to provide local care and (4) the weekly rejections in relation to occupancy to provide a combined analysis.

In the current situation, with many operational beds closed due to nurse shortages, occupancy was extremely high at the NICU and HCNs (respectively 91.7% (95% CI 91.4 to 92.0) and 98.1% (95% CI 98.0 to 98.2)). The number of required beds exceeded available beds, resulting in >20% rejections for both NICU and HCN patients. Although the three interventions individually demonstrated effect on capacity, clinical impact was marginal. In combination, NICU occupancy was reduced below the 85% government recommendation at the cost of an increased burden for HCNs, highlighting the need for redistribution to MCNs.

Our model confirmed the severity of current neonatal capacity strain and demonstrated the potential impact of three interventions on regional capacity. The model showed to be a low-cost and easy-to-use method for regional capacity impact assessment and could provide the basis for making informed decisions for other interventions and future scenarios, supporting data-driven neonatal capacity planning and policy development.

We evaluated the performance of risk models that incorporate ambulatory ECG data and clinical information for prediction of healthcare expenditures related to heart failure (HF) and stroke events in treated and untreated patients.

A retrospective cohort study of Medicare patients who underwent Zio XT ambulatory monitoring in the USA was conducted between 2014 and 2020.

14-day ambulatory ECG data and claims data were evaluated in the study sample which included 89 923 patients in the HF hospitalisation group, 75 870 in the new-onset HF group and 90 159 in the stroke hospitalisation group. Predictive models for new-onset HF, HF hospitalisation and stroke hospitalisation were generated using LASSO Cox regression with ambulatory ECG variables and components of the CHA₂DS₂-VASc. For each outcome, we scored patients using standardised linear predictors from three composite risk models, and we evaluated the association between risk score and total Medicare cost.

The following hazard ratios per one SD increase in the new risk score were observed for the model that included all CHA₂DS₂-VASc components and ECG variables: HF hospitalisation in treated 2.94, 95% CI 2.75 to 3.15; new-onset HF in treated 1.84, 95% CI 1.75 to 1.93; HF hospitalisation in untreated 3.51, 95% CI 3.23 to 3.82; and new-onset HF in untreated 1.92, 95% CI 1.85 to 2.00. Risk scores generated by the model were also predictive of Medicare cost in both treated and untreated patients, with patients in the high-risk category for all outcomes having the greatest Medicare costs during 1 year of follow-up.

Integrating arrhythmia data from ambulatory ECG monitoring into clinical risk models allows for better prediction of healthcare utilisation and cost in both treated and untreated patients at high risk for HF and stroke events.

Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide, and detecting CAD in stable chest pain patients is challenging but crucial for early intervention. Strain and strain rate (S/SR) imaging offers a non-invasive method to assess myocardial function and detect coronary stenosis before symptoms occur. In this study, we aimed to demonstrate how effectively and accurately resting strain echocardiography can diagnose CAD.

We conducted a prospective diagnostic accuracy study of patients with chest pain who were referred for CT coronary angiography (CCTA).

Single-centre study conducted in the University Hospital of North Norway in Tromsø, Norway between 2016 and 2021.

A total of 510 patients with chest pain were included in the present study.

Echocardiography examination with S/SR imaging was performed.

Echocardiography findings were compared with CCTA and coronary angiography findings. A novel scoring model incorporating S/SR parameters was developed to assess diagnostic accuracy.

In this study, we showed that receiver operating characteristic curve analysis of early diastolic strain rate (SRe), systolic strain rate (SRs) and peak longitudinal strain (PLS) has high sensitivity and specificity with area under the curve (AUC) scores: SRe, 0.91; PLS, 0.81; SRs, 0.71 in identifying patients undergoing coronary artery bypass graft (CABG). However, these parameters showed lower sensitivity and specificity with AUC scores: SRe, 0.580; SRs, 0.539; PLS, 0.552 in detecting patients undergoing percutaneous coronary intervention (PCI).

Our study emphasises the potential of S/SR imaging in detecting CAD, particularly in high-risk CABG patients. However, its diagnostic utility in PCI patients is limited. Our study highlights the need for comprehensive approaches in coronary disease prediction.

There remains little consensus or guidelines for the clinical management of traumatic orbital fractures (OFx). The OFx Registry aims to increase real-world clinical evidence for the treatment of OFx via prospective, multicentre, international data collection. The primary objectives of this observational cohort study are (1) to document current treatment practices for and (2) to assess the outcomes of surgical and non-surgical treatment of orbital floor and/or medial wall fractures.

Approximately 300 adult patients presenting with a displaced OFx in the orbital floor and/or medial wall will be enrolled prospectively over a recruitment period of ~36 months. All eligible patients treated either surgically or non-surgically as per routine standard of care will have follow-up assessments at 6 weeks, 3 months and 6 months post-treatment. Demographic data, injury details, treatment details and outcome measures will be documented in a cloud-based database. Outcome measures include clinical outcomes (eg, diplopia, extraocular motility, and condition of the eyelid, globe and soft tissues), radiological outcomes from collected images, patient-reported outcomes (eg, Diplopia Questionnaire and the newly developed AO Craniomaxillofacial (CMF) Injury Symptom Battery) and complications. A statistical analysis plan will be prepared before final analysis summarising the descriptive statistics to be used for data assessment. Appropriate research questions and statistical tests may be applied additionally, depending on the availability and quality of data collected.

Ethics approval was obtained before patients were enrolled at each participating site. Patient enrolment followed an informed consent process approved by the responsible ethics committee. Peer-reviewed publications are planned to disseminate the study results.

NCT03887988.

Evaluating skin reactions is crucial in topical product development. Turmeric/epigallocatechin-3-gallate (EGCG) emulgel demonstrates therapeutic potential for cutaneous diseases, warranting further investigation in human studies. The Human Repeat Insult Patch Test (HRIPT) of skin irritation and sensitisation potential caused by the turmeric/EGCG emulgel is designed to evaluate the safety of the investigational product in healthy volunteers prior to conducting the efficacy study in patients with dermatological diseases.

60 healthy Thai volunteers will be enrolled in this single-centre, double-blind HRIPT pilot clinical trial to evaluate skin irritation and sensitisation potential caused by turmeric/EGCG emulgel. Primary endpoints include the number and proportion of participants exhibiting skin irritation and sensitisation, while secondary endpoints focus on the frequency and severity of adverse events. The study will comprise a screening period, a 3-week induction phase, a 2-week rest phase and a 1-week challenge phase. Fully occlusive adhesive patches containing study products will be applied to participants’ backs 10 times. Skin irritation will be assessed using the Draize dermal irritation scoring system, and skin sensitisation will be evaluated using the International Contact Dermatitis Research Group scoring system.

The Research Ethics Committee of the Faculty of Medicine, Chiang Mai University, approved this study protocol and related documents on 6 March 2025 (Ref. No. 108/2025).

TCTR20250317007.