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Irwin Tedja

Peran skor malnutrition screening tool untuk memprediksi mortalitas pasien tuberkulosis paru selama perawatan inap = Role of malnutrition screening tool for predicting in hospital mortality in pulmonary tuberculosis patients

"Pasien tuberkulosis paru yang dirawat inap memiliki kondisi nutrisi yang bervariasi. Sebuah metode skrining nutrisi yang sederhana dibutuhkan untuk memprediksi prognosis buruk, terutama mortalitas. Malnutrition Screening Tool (MST) merupakan sebuah metode skrining nutrisi yang sederhana, cepat dan valid untuk mengidentifikasi pasien dengan risiko malnutrisi. Penelitian ini dimaksudkan untuk mengetahui peran skor MST untuk memprediksi mortalitas pasien tuberkulosis paru selama perawatan inap.

Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien tuberkulosis paru yang dirawat inap di RSCM dalam kurun waktu Januari 2011 sampai dengan September 2013. Skor MST didapatkan dari rekam medis saat masuk rawat inap, dilakukan pengamatan sampai selesai rawat inap, kemudian dikelompokkan menjadi: hidup atau meninggal. Data penyerta yang dikumpulkan adalah data demografis, status BTA, gambaran radiologis toraks, status HIV, skor Charlson Comorbidity Index, dan kondisi sepsis.

Hasil: Sebanyak 345 subjek diikutsertakan pada penelitian ini. Didapatkan angka mortalitas selama perawatan inap sebesar 25,8%. Median skor MST pasien tuberkulosis paru yang dirawat inap di RSCM adalah 3 (rentang 0 sampai 5). Hasil analisis ROC mendapatkan skor MST > 3 sebagai titik potong skor MST yang terbaik untuk mendeterminasi mortalitas pasien tuberkulosis paru selama perawatan inap dengan AUC 0,644 (IK 95% 0,581-0,707). Skor MST > 3 meningkatkan risiko kematian pasien tuberkulosis paru selama perawatan inap (RR 2,288; IK 95% 1,507-3,474; p < 0,001). Hasil analisis multivariat, dengan menyertakan variabel perancu, mendapatkan bahwa skor MST > 3 meningkatkan risiko kematian pasien tuberkulosis paru selama perawatan di rumah sakit, namun tidak bermakna secara statistik (fully adjusted OR 2,227; IK 95% 0,994-4,988; p = 0,052).

Simpulan: Skor MST > 3 berhubungan dengan mortalitas pasien tuberkulosis paru yang lebih tinggi selama perawatan inap.

Pulmonary tuberculosis patients who are hospitalized have varying nutritional conditions. A simple nutrition screening method is needed to predict a poor prognosis, especially mortality. Malnutrition Screening Tool (MST) is a simple, rapid and valid nutrition screening method for identifying patients at risk of malnutrition. This study was aimed to know the role of MST for predicting in-hospital mortality in pulmonary tuberculosis patients.
Methods: This study was a retrospective cohort study among pulmonary tuberculosis patients who were hospitalized in Cipto Mangunkusumo Hospital between January 2011 and September 2013. MST scores were obtained from medical records at admission, subjects were observed to evaluate their in-hospital mortality. The other collected data are demographic data, sputum smear status, pulmonary radiological lesion, HIV status, Charlson Comorbidity Index, and condition of sepsis.
Results: As many 345 subjects met the inclusion criteria. The in-hospital mortality rate was 25.8%. Median MST score of hospitalized pulmonary tuberculosis patients was 3 (range 0-5). ROC analysis got MST score > 3 as the best cut-off for determination in-hospital mortality in pulmonary tuberculosis patients (AUC 0.644; 95% CI 0.581-0.707). MST score > 3 increased the risk of in-hospital mortality in pulmonary tuberculosis patients (RR 2.288; 95 % CI 1.507-3.474, p < 0.001). Multivariate analysis found that the MST score > 3 increased the risk of in-hospital mortality in pulmonary tuberculosis patients, but was not statistically significant (fully adjusted OR 2.227; 95 % CI 0.994-4.988, p = 0.052).
Conclusion: MST score > 3 increased the risk of in-hospital mortality in pulmonary tuberculosis patients."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

SP-Pdf

UI - Tugas Akhir Universitas Indonesia Library

Christofan Lantu

Proporsi tuberkulosis paru pada pasien penyakit paru obstruktif kronik di Rumah Sakit Umum Pusat Persahabatan Jakarta = Proportion of pulmonary tuberculosis in chronic obstructive pulmonary disease patients at Persahabatan Hospital

"[ABSTRAK

Penyakit paru obstruktif kronik (PPOK) merupakan penyebab utama morbiditas dan mortalitas di dunia.Beberapa faktor risiko PPOK juga merupakan faktor risiko terjadinya tuberkulosis (TB).Beberapa penelitian di luar ditemukan prevalens TB paru pada pasien PPOK sekitar 2,6% - 10%.Indonesia khususnya di RSUP Persahabatan belum ada data proporsi TB paru pada pasien PPOK.Objektif: tujuan penelitian ini adalah mendapatkan angka proporsi TB paru pada pasien PPOK di RSUP Persahabatan Jakarta.Metode: desain penelitian ini adalah potong lintang. Pasien PPOK (belum diobati dengan obat anti tuberkulosis) yang berkunjung di poliklinik Asma/PPOK RSUP Persahabatan yang memenuhi kriteria inklusi dan eksklusi.Subjek diperiksa dahak BTA dan pemeriksaan Xpert MTB/RIF. Saat pasien berkunjung, dilakukan anamnesis gejala, eksaserbasi, riwayat merokok, penggunaan kortikosteroid (oral atau inhalasi), komorbid, skor CAT, penilaian status gizi, spirometri dan foto toraks. Semua data dilakukan analisis dengan uji chisquare.Hasil: subjek terbanyak adalah laki-laki (97,3%) dengan kelompok usia 60-79 tahun (74,3%), dengan komorbid terbanyak penyakit jantung (41,9%), gejala klinis terbanyak batuk berdahak (81,1%). Berdasarkan derajat PPOK terbanyak adalah GOLD 3 (44,6%) dan frekuensi eksaserbasi tersering 0-1 (78,4%) dengan menggunakan steroid sebanyak 59,5%. Pada penelitian ini didapatkan pemeriksaan dahak BTA positif 1,4% dan Xpert MTB/RIF positif 2,7%, artinya pemeriksaan Xpert MTB/RIF mempunyai angka kepositifan lebih tinggi dibanding dahak BTA. Dalam penelitian ini didapatkan proporsi TB paru pada pasien PPOK sebanyak 2,7%.Dalam Penelitian ini tidak terdapat hubungan bermakna secara statistik antara derajat PPOK, status gizi, penggunaan kortikosteroid, status merokok dengan prevalens TB paru pada pasien PPOK (p > 0,05).Pada penelitian ini didapatkan hubungan bermakna pada frekuensi eksaserbasi PPOK, hasil pemeriksaan dahak BTA dan hasil pemeriksaan Xpert MTB/RIF dengan proporsi TB paru (p < 0,05).Kesimpulan: proporsi TB pada pasien PPOK di RSUP Persahabatan Jakarta adalah 2,7%. Terdapat hubungan yang bermakna secara statistik antara frekuensi eksaserbasi PPOK dengan proporsi TB paru pada pasien PPOK (p = 0,0006). Terdapat hubungan yang bermakna secara statistik antara hasil pemeriksaan dahak BTA dan hasil pemeriksaan Xpert MTB/RIF dengan proporsi TB paru pada pasien PPOK dengan nilai p < 0,05 (p = 0,000).

ABSTRACT

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world. Some of the risk factors for COPD are also risk factors for tuberculosis (TB). Some studies abroad have found the prevalence of pulmonary tuberculosis in COPD patients were 2.6 - 10%. There are no data on the prevalence of pulmonary tuberculosis patients with COPD in Indonesia, particularly in The Department of Pulmonology PersahabatanHospital, Jakarta. Objective: the purpose of this study is to obtain proportion of pulmonary TB in COPD patients in The Department of Pulmonology Persahabatan Hospital, Jakarta. Methods: this is a cross-sectional study. COPD patients (anti-tuberculosis drugs naive) who visit the Asthma/COPD clinic PersahabatanHospital which meet the inclusion and exclusion criteria. Subjects went through acid-fast bacilli sputum smear and Xpert MTB/RIF examination. On patients visit, symptoms, exacerbations history, history of smoking, use of corticosteroids (oral or inhaled), comorbidities, CAT scores, assessment of nutritional status, spirometry and chest X-ray data had been obtained. All data were analyzed with chi-square test. Results: most subjects were male (97.3%) in the age group 60-79 years (74.3%), with mostly found comorbid was heart disease (41.9%), and mostly found clinical symptoms was productive cough (81.1%). Based on classification of COPD is GOLD 3 (44.6%) and the most exacerbation frequency was 0-1 (78.4%) with 59.5% history of steroid usage. In this study, examination of AFB sputum smear positive 1.4% and the Xpert MTB/RIF positive 2.7%, It shows Xpert MTB/RIF examination has a higher positivity rate than AFB sputum smear. The proportion of pulmonary tuberculosis in patients with COPD was 2.7%. We also found no statistically significant relationship between classification of COPD, nutritional status, use of corticosteroids, smoking status with the proportion of pulmonary tuberculosis in COPD patients (p> 0.05) but we found a significant difference in the exacerbations frequency of COPD, the results of sputum smear examination and the results of Xpert MTB/RIF with proportion of pulmonary TB (p <0.05).Conclusion: the proportion of tuberculosis in patients with COPD in The Department of PulmonologyPersahabatan Hospital Jakarta is 2.7%. There is astatistically significant difference between the frequency of exacerbations of COPD with proportion of pulmonary TB in patients with COPD (p = 0.0006). An association is statistically significant different between the results of sputum smear examination and the results of Xpert MTB/RIF with the proportion of pulmonary tuberculosis in patients with COPD with a value of p <0.05 (p = 0.000)., Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and

mortality in the world. Some of the risk factors for COPD are also risk factors for

tuberculosis (TB). Some studies abroad have found the prevalence of pulmonary

tuberculosis in COPD patients were 2.6 - 10%. There are no data on the prevalence of

pulmonary tuberculosis patients with COPD in Indonesia, particularly in The Department

of Pulmonology Persahabatan Hospital, Jakarta. Objective: the purpose of this study is to

obtain proportion of pulmonary TB in COPD patients in The Department of Pulmonology

Persahabatan Hospital, Jakarta. Methods: this is a cross-sectional study. COPD patients

(anti-tuberculosis drugs naive) who visit the Asthma/COPD clinic Persahabatan Hospital

which meet the inclusion and exclusion criteria. Subjects went through acid-fast bacilli

sputum smear and Xpert MTB/RIF examination. On patients visit, symptoms,

exacerbations history, history of smoking, use of corticosteroids (oral or inhaled),

comorbidities, CAT scores, assessment of nutritional status, spirometry and chest X-ray

data had been obtained. All data were analyzed with chi-square test. Results: most

subjects were male (97.3%) in the age group 60-79 years (74.3%), with mostly found

comorbid was heart disease (41.9%), and mostly found clinical symptoms was productive

cough (81.1%). Based on classification of COPD is GOLD 3 (44.6%) and the most

exacerbation frequency was 0-1 (78.4%) with 59.5% history of steroid usage. In this

study, examination of AFB sputum smear positive 1.4% and the Xpert MTB/RIF positive

2.7%, It shows Xpert MTB/RIF examination has a higher positivity rate than AFB

sputum smear. The proportion of pulmonary tuberculosis in patients with COPD was

2.7%. We also found no statistically significant relationship between classification of

COPD, nutritional status, use of corticosteroids, smoking status with the proportion of

pulmonary tuberculosis in COPD patients (p> 0.05) but we found a significant difference

in the exacerbations frequency of COPD, the results of sputum smear examination and

the results of Xpert MTB/RIF with proportion of pulmonary TB (p <0.05). Conclusion:

the proportion of tuberculosis in patients with COPD in The Department of Pulmonology

Persahabatan Hospital Jakarta is 2.7%. There is a statistically significant difference

between the frequency of exacerbations of COPD with proportion of pulmonary TB in

patients with COPD (p = 0.0006). An association is statistically significant different

between the results of sputum smear examination and the results of Xpert MTB/RIF with the proportion of pulmonary tuberculosis in patients with COPD with a value of p <0.05 (p = 0.000).]"

Fakultas Kedokteran Universitas Indonesia, 2015

SP-PDF

UI - Tugas Akhir Universitas Indonesia Library

Leny Wulandari

Peran Pengetahuan terhadap Perilaku Pencarian Pengobatan Penderita Suspek TB Paru di Indonesia (Analisis Data Survei Pengetahuan, Sikap dan Perilaku Tuberkulosis, 2010) = The Role of Knowledge on Treatment Seeking Behavior of Patients Suspected of Pulmonary Tuberculosis in Indonesia (Data analysis of Knowledge Attitude and Behavior Survey of Tuberculosis in 2010)

"Penelitian ini bertujuan untuk mengukur peran pengetahuan terhadap perilaku pencarian pengobatan penderita suspek TB Paru setelah dikontrol oleh umur, jenis kelamin, status perkawinan, status pekerjaan, tingkat pendidikan, jarak dan waktu tempuh ke Puskesmas dan RS. Penelitian ini adalah penelitian kuantitatif dengan desain cross sectional yang menggunakan data sekunder hasil survei Pengetahuan Sikap Perilaku (PSP-TB) 2010. Sampel penelitian adalah anggota keluarga yang berumur ≥ 15 tahun yang mengalami gejala TB Paru sebanyak 443 responden. Hasil penelitian menemukan bahwa ada hubungan antara peran pengetahuan penderita suspek TB Paru dengan Perilaku Pencarian Pengobatan TB Paru di Indonesia setelah dikontrol pekerjaan (OR=2,3, CI=1,349-3,952). Serta adanya interaksi antara pengetahuan dan pekerjaan.

This study aims to quantify the role of knowledge on treatment seeking behavior of patients with suspected pulmonary TB after controlled by age, gender, marital status, employment status, education level, distance and travel time to health center and hospital. The study was a quantitative study with cross sectional design using secondary data of Knowledge Attitudes Behaviour (PSP-TB) Survey 2010. Research sample is a sample of respondents aged ≥ 15 years with symptoms of pulmonary TB as many as 443 respondents. Based on the results of the study found there is a relationship between the role of knowledge of patients with suspected pulmonary TB with treatment seeking Behavior of Pulmonary TB in Indonesia after controlled by variable of employment status (OR = 2.3, CI = 1.349 to 3.952), and there is interaction between knowledge and employment status."

Depok: Fakultas Kesehatan Masyarakat Universitas Indonesia, 2012

T31727

UI - Tesis Open Universitas Indonesia Library

Tintin Sukartini

Pengembangan model peningkatan kepatuhan berbasis teori sistem interaksi king dan pengaruhnya terhadap kepatuhan pasien tuberkulosis paru = The influence of adherence improvement model based on king interaction system theory toward pulmonary tuberculosis patients

"Faktor utama penyebab kegagalan pengobatan TB paru adalah ketidakpatuhan pasien. Perawat berperan penting dalam meningkatkan kepatuhan pasien melalui proses interaksi. Berdasarkan hal ini maka perlu dikembangkan model intervensi berbasis sistem interakasi untuk meningkatkan kepatuhan. Tujuan penelitian yaitu menghasilkan model yang dapat meningkatkan kepatuhan pasien TB paru berbasis teori sistem interaksi King.

Penelitian melalui dua tahap penelitian yaitu, tahap I: Penelitian kualitatif dan pengembangan model peningkatan kepatuhan berbasis teori sistem interaksi King yang dihasilkan melalui penelitian kualitatif, studi literatur dan konsultasi pakar; Tahap II: Validasi model dengan desain quasy eksperimen dengan kelompok kontrol. Metode sampling yang digunakan adalah consecutive sampling dengan sample sebanyak 50 pasien. Uji statistik menggunakan uji chi square, independent t-test, Mancova dan GLM-RM.

Hasil didapatkan 1) Tahap I: diperoleh 12 tema kepatuhan dan model peningkatan kepatuhan berbasis teori sistem interaksi dengan 1 modul untuk pasien; 2) Tahap II: terdapat perbedaan bermakna dalam pengetahuan, self efficacy, motivasi, pencegahan penularan, kepatuhan nutrisi dan kepatuhan pengobatan.

Kesimpulan, model peningkatan kepatuhan berbasis teori sistem interaksi King terbukti efektif meningkatkan kepatuhan pasien TB paru. Rekomendasi: Model peningkatan kepatuhan berbasis teori sistem interaksi King dapat diintegrasikan dalam clinical pathway pada pasien TB paru di poli paru. Penelitian lebih lanjut mengenai pengembangan model kepatuhan pada pasien TB paru yang memiliki keterbatasan sistem interpersonal dengan keluarga yaitu pada pasien yang tidak memiliki keluarga atau tinggal terpisah jauh dari keluarga.

The main factor cause the failure of Tuberculosis (TB) treatment was the patient's non-adherence. Nurses play an important role in improving patient's adherence through interaction nurse-patient. It is necessary to develop interaction model based on interaction system theory to improve patient's adherence. The purpose of the study was to develop adherence improvement model based on King's inetraction system theory.
This study was divided into 2 phase, Phase 1: qualitative study and development adherence improvement model based on King's interaction system theory resulted from qualitative study, literature review and expert consultation. Phase II: validation of the model by quasy experiment design with control group. Sampling used in the study was consecutive sampling to select 50 patients. Data were analyzed using chi square, independent t-test, Mancova and GLM-RM.
Result shows: Phase I: There were found 12 themes and adherence improvement model based on King's interaction system. Phase II: There were significant different on knowledge, self efficacy, motivation, prevention transmission, nutrition adherence and treatment adherence.
Conclusion, Adherence improvement model based on King's interaction system theory is effective on improving TB patient's adherence. Development adherence improvement model based on King's interaction system theory can be integrated into clinical pathway in TB patients. Further study on adherence improvement model with limited interpersonal system, namely patient without family and separated."

Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2015

D2049

UI - Disertasi Membership Universitas Indonesia Library

Titi Sekarindah

Pengaruh pemberian Vitamin A terhadap profil imun pasien Tuberkulosis Paru dengan terapi obat anti Tuberkulosis = The effect of vitamin A supplementation on the immune profile of pulmonary Tb patient during oral anti tuberculosis treatment

"ABSTRAK

Ruang Lingkup dan Cara Penelitian : Penyakit tuberkulosis paru masih merupakan masalah di negara berkembang termasuk Indonesia. Tuberkulosis menduduki urutan ke 2 sebagai penyebab kematian menurut hasil survey nasional 1992. Dari kepustakaan diketahui bahwa pada penderita tuberkulosis didapati kelainan imunitas seluler, sehingga untuk penyembuhan penyakit tuberkulosis diperlukan pengaktifan sistem imun testa imunitas seluler. Vitamin A sudah lama dikenal sebagai imunomodulator. Dari penelitian terdahulu pemberian retinoid dapat meningkatkan respon imun seluler antara lain kenaikan sel T penolong dan T penolong/supresor. Pada penelitian ini diharapkan pemberian vitamin A sejumlah 2x 200000IU pada penderita TB paru dengan OAT dapat meningkatkan imunitas seluler. Tujuan penelitian ini adalah menilai pengaruh pemberian vitamin A pada penderita tuberkulosis paru yang sedang mendapat OAT terhadap jumlah limfosit total, limfosit T total, sub populasi limfosit T, kadar retinol plasma, dan keadaan klink penderita. Vitamin A 200.000 IU diberikan pada awal penelitian dan setelah 4 minggu. Penelitan dilakukan secara uji klinik tersamar ganda pada 40 penderita TB paru. Penderita dibagi dalam 2 kelompok masing-masing 20 orang yang diberi vitamin A dan placebo. Pada akhir penelitian yaitu setelah 8 minggu, ada 5 orang drop out.

Hasil dan kesimpulan : Dari 40 orang peserta penelitian 10% kadar retinol plasma rendah (<20pg/dl), 30%normal, rendah(20-30pg/d.l), 60% normal. Pada pemeriksaan imunitas seluler 53,85% ada gangguan dan 46,15% normal. Nilai rata rata hitung (X) retinal plasma kelompok placebo dan perlakuan sebelum pemberian vit. .A/placebo berturut-turut adalah 30,24 ± 7,51 µg/dl dan 30,82 ±7,31 µg/dl. Setelah pemberian adalah 36,85 ± 9,74 µg/dl dan 38,02 ± 8,29 µg/dl. Pada uji t berpasangan dari kelompok perbkkan kenaikannya bermakna (p

ABSTRACT
Scope and Method of Study : Pulmonary tuberculosis is still a major health problem in the developing countries including Indonesia. Tuberculosis is number 2 as cause of death (National Survey's data, 1992). According to literature study tuberculosis patients are suffering from an immune defect. To recover from the disease the immune response especially the cellular immune response needs to be activated, because mycobacterium TB are living intracellular. Vitamin A is known as an immunomodulator. From earlier research it is known that retinoid could enhance cellular immune response, ie. increasing T helper cells and the ratio Thelperffsupresor. The hypothesis is that supplementation of vitamin A 2x2000001U to pulmonary TB patients could increase the cellular immunity. The aim of this study was to asses the vitamin A supplementation on the immune?s profile of pulmonary TB patient who are on oral anti tuberculosis treatment. Plasma retinot, nutrients intake, BMI, clinical findings were examined. Vitamin A 200.000M was given twice, in the beginning of the study and after 4 weeks. The design of the study was a randomized double blind clinical trial. Forty patients were selected and divided into 2 groups, a placebo and treatment (vitamin A) group. At the end of the study (after the 8th week), 5 patients dropped out.
Findings and Conclusions : Among 40 patients 10% showed plasma ret noK20 p g/dl), 30% normal low (20-30pgldl) and 60% normal. (03011g041). The cellular immunity was 53,85% abnormal and 46,15% normal The means (X) of plasma retinol of the placebo and study group before supplementation were 30.24 ± 7,51 µg/dl and 30.82 ± 7.31µg/dl respectively; after supplementation 36.85±9.74µg/dl and 38.02 ± 8.29µgldl respectively. Statistical analysis using paired t test showed that the study group was increasing s' 0,05), however there was no Significant difference between the 2 groups. The mean (X) of total lymphocyte before supplementation of the placebo and study group were 22.61 ± 6.51% and 22.63 ± 8,62%; after supplementation 38.09 ± 19.91% and 35.20 + 10.71%. Both were increasing significant; however there was no significant difference between the 2 groups. The T lymphocyte, T helper and ratio Thelper CT supresor were decreasing. T helper more in the placebo group 5.75% 2.29% but there was no significant difference. This study concluded that although vitamin A supplementation 2 X 200.000 IU could increase the plasma retinol but could not yet improve the immune response and clinical status significantly."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 1996

T-Pdf

UI - Tesis Membership Universitas Indonesia Library

Susilowati

Gambaran faktor-faktor yang mempengaruhi putus obat anti tuberkulosis pada pasien tuberkulosis paru dewasa = Description of factors that influence the default of tuberculosis in adult patients with tuberculosis

"Tuberkulosis merupakan penyakit menular yang menjadi masalah kesehatan global saat ini. Penelitian ini meneliti pasien tuberkulosis yang mengalami riwayat putus obat anti tuberkulosis atau default. Dampak yang ditimbulkan dari putus obat ini akan meningkatkan resiko terjadinya Multi drug resistance tuberculosis (MDR-TB), yang berakibat pengobatan lebih lama, lebih mahal dan lebih banyak menularkan ke orang lain. Tujuan dari penelitian ini untuk mengetahui faktorfaktor yang menyebabkan pasien tuberkulosis berhenti minum obat anti tuberkulosis sebelum waktunya di suatu rumah sakit di Jakarta. Desain penelitian yang digunakan adalah deskriptif kwantitatif dengan pendekatan cross sectional, menggunakan total sampling sebanyak 31 pasien putus obat anti tuberkulosis. Hasil dari analisa univariat didapatkan faktor tertinggi yang mempengaruhi putus obat anti tuberkulosis adalah kurang mengerti informasi. Implikasi keperawatan di penelitian ini adalah perawat perlu meningkatkan perannya sebagai edukator, konselor, dan motivator serta mereview kembali pendekatan edukasi yang selama ini diberikan pada pasien tuberkulosis dengan pengobatan obat anti tuberkulosis.

Tuberculosis is an infectious disease that becomes a global health problem today. This study examines patients who had a history of default tuberculosis. Where the impact of default tuberculosis will increase the risk of multiple drug resistance tuberculosis, which resulted in longer treatment, more expensive and more infect other people. The purpose of this study was to determine the factors that cause tuberculosis patient stopped taking anti-tuberculosis medication prematurely in the pulmonary clinic of a hospital in Jakarta, Indonesia. The design study is a descriptive quantitative with cross-sectional approach, using total sampling as many as 31 samples patients of default tuberculosis. Results showed that the highest factor affecting default of anti tuberculosis drug is a lack of understanding about information given. This study suggests that nurse have to improve their educating, coseling, motivating and reviewing the education approach that have been provided to tuberculosis patient with anti-tuberculosis medication treatment."

Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2014

S56415

UI - Skripsi Membership Universitas Indonesia Library

Agus Jati Sunggoro

Faktor-faktor prediktor mortalitas pasien tuberkulosis saat rawat inap = Predictors of mortality among hospitalized tuberculosis patients

"Latar Belakang: Indonesia merupakan negara peringkat keempat penyumbang kasus TB terbanyak di dunia. TB adalah penyebab kematian kedua terbanyak di Indonesia. Pasien TB mempunyai tingkat kematian yang lebih tinggi saat dirawat dibandingkan pasien non-TB. Pengetahuan tentang prediktor mortalitas dapat membantu pengambilan keputusan klinis untuk tatalaksana pasien dan mengetahui prognosis pasien. Studi-studi tentang faktor prediktor mortalitas pasien tuberkulosis saat rawat inap menunjukkan hasil yang berbeda-beda dan tidak ada penelitian yang komprehensif di Indonesia.

Tujuan: Mengetahui faktor-faktor prediktor mortalitas pasien tuberkulosis saat rawat inap di RSCM.

Metode: Penelitian ini merupakan studi kohort retrospektif pada pasien rawat inap di RSCM selama kurun waktu 1 Januari 2008 sampai dengan 31 September 2013. Data klinis dan laboratorium beserta status luaran (hidup atau meninggal) selama perawatan diperoleh dari rekam medis. Analisis bivariat menggunakan tes Chisquare dilakukan pada 13 variabel prognostik, yaitu kelompok usia, jenis kelamin, riwayat pengobatan TB sebelumnya, tingkat keparahan TB, status BTA, hipoalbuminemia, IMT, status HIV, adanya konkomitan pneumonia, sepsis, gagal napas, gambaran radiologis toraks, komorbiditas (skor Charlson Comorbidity Index). Adanya data yang tidak lengkap dilakukan imputasi mengunakan teknik multiple imputation. Variabel yang memenuhi syarat disertakan pada analisis multivariat dengan regresi logistik.

Hasil: Subjek penelitian terdiri atas 470 pasien. Angka mortalitas selama perawatan sebesar 25,1%. Sebanyak 339 (72,1%) pasien adalah laki-laki dan 131 (27,9%) pasien adalah perempuan. Median usia pasien 34 (rentang 18 sampai 86) tahun dan median lama perawatan adalah 10 (rentang 1 sampai 97) hari. Faktor prediktor independen mortalitas yang bermakna pada analisis multivariat adalah kadar albumin < 3 g/dL (OR 5,12; IK 95% 1,80 sampai 14,57), gambaran radiologis toraks lesi kavitas (3,91; 1,53 sampai 9,97) adanya sepsis (23,31; 8,95 sampai 60,68), adanya gagal napas (177,39; 27,09 sampai 1161,55).

Kesimpulan: Adanya gagal napas, adanya sepsis, hipoalbuminemia (kadar albumin < 3 g/dL), serta gambaran radiologis toraks lesi kavitas merupakan faktor prediktor independen mortalitas pasien tuberkulosis saat rawat inap.

Background: Indonesia is the world’s fourth highest tuberculosis burden in the world. Tuberculosis is the second leading cause of death for all age in the country, according to the Health Ministry. Mortality remains high among tuberculosis hospitalized patients compare to the non-TB patients. The prediction of patients outcome is important in decision-making process and in the effort reducing mortality rate. Studies exploring predictors of mortality in patients with pulmonary tuberculosis produced conflicting results and there are no comprehensive reports in Indonesia.
Objective: To determine predictors of mortality among hospitalized tuberculosis patients in Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
Methods: We performed a retrospective cohort study among hospitalized tuberculosis patients in Cipto Mangunkusumo Hospital between January 2008 - September 2013. Data were collected at initiation of inpatients period and the main outcome was all-cause mortality during hospitalization. We analyzed age, sex, history of previous anti-tuberculosis treatment, tuberculosis severity, sputum smear positivity, hypoalbuminemia, BMI, HIV status, concomitant pneumonia, sepsis, respiratory failure, pulmonary radiographic lesion, comorbidity (CCI score) in bivariate analysis using Chi-square test. Missing data were handled using multiple imputation methods. Multivariate logistic regression analysis was performed to identify independent predictors of mortality.
Results: A total of 470 patients were evaluated in this study. In-hospital mortality rate was 25.1%. There were 339 (72.1%) male and 131 (27.9%) female patients. Median age of the population was 34 (range 18 to 86) years old and median length of stay was 10 (range 1 to 97) days. The independent predictors of mortality in multivariate analysis were hypoalbuminemia (OR 5,12; 95% CI 1,80 - 14,57), cavitary lesion (3,91; 1,53-9,97), sepsis (23,31; 8,95-60,68), and respiratory failure (177,39 ; 27,09-1161,55).
Conclusion: Respiratory failure, sepsis, hypoalbuminemia, and cavitary lesion were independent predictors of in-hospital mortality among hospitalized tuberculosis patients."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2014

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Girsang, Yastriana Liku

Gambaran harga diri pada pasien Tuberkulosis di Poliklinik Paru RS Persahabatan = Descriptive of self esteem in clinic Pulmonary TB patient in Persahabatan Hospital

"Tingkat kejadian TB Paru di Indonesia masuk dalam kelompok urutan ketiga setelah India dan China berdasarkan laporan WHO tahun 2009 (Riskesdas, 2010). Di Indonesia TB Paru merupakan pembunuh nomor satu diantara penyakit menular dan merupakan penyebab kematian nomor tiga setelah jantung dan penyakit pernapasan akut pada seluruh kalangan usia (Soedarsono, 2006). TB Paru merupakan penyakit menular yang menyebar melalui batuk dan dahak. Penyakit TB ini dipengaruhi oleh faktor usia, pekerjaan, status pernikahan dan riwayat penyakit.

Desain yang digunakan pada penelitian ini adalah deskriptif, sampel yang digunakan yaitu pasien TB di poliklinik paru RS Persahabatan sejumlah 99 responden. Pengambilan sampel menggunakan simple non random sampling dengan teknik accidental sampling.

Hasil penelitian dianalisis menggunakan analisis univariat ditemukan 89,1% responden memiliki harga diri tinggi (normal). Pada penelitian ini berarti tidak adanya gangguan pada harga diri pasien TB di poliklinik paru RS Persahabatan. Rekomendasi untuk pihak RS Persahabatan untuk memberikan pendidikan kesehatan kepada pasien TB tentang pengobatan teratur sehingga tidak terjadi kasus TB berulang.

Pulmonary TB incidence rate in Indonesia in the group third after India and China by 2009 WHO report (Riskesdas, 2010). In Indonesian Tuberculosis is the number one killer among infectious diseases and is the third cause of death after heart disease and acute respiratory in all the ages (Sudarsono, 2006). Tuberculosis is an infectious disease that spreads through coughing and phlegm. TB disease is influenced by age, occupation, marital status and history of disease.
Design used in this study is descriptive, ie the sample used in the clinic of pulmonary TB patients Friendship Hospital a number of 99 respondents. Sampling using non simple random sampling with accidental sampling technique.
The results were analyzed using univariate analysis found 89.1% of respondents have a high selfesteem (normal). In this study means no compromise on dignity pulmonary TB patients in the clinic Persahabatan Hospital. Recommendations for the Persahabatan Hospital to provide health education to patients on TB treatment so it does not happen regularly recurrent TB cases."

Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2013

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Krisna

Pengaruh pendapatan pasien tuberkulosis terhadap konversi tuberkulosis di rumah sakit persahabatan = income as a contributing factor towards tuberculosis conversion of patients in persahabatan hospital

"Tuberkulosis masih menjadi masalah kesehatan masyarakat yang utama di seluruh dunia terlepas dari kemajuan ilmiah utama dalam diagnosis dan manajemen Dalam Laporan WHO 2012 Global Tuberculosis Pengendalian mengungkapkan diperkirakan 9 3 juta kasus insiden TB pada tahun 2011 secara global dengan Asia memimpin di bagian atas 59 Beberapa studi di masa lalu telah mengungkapkan hubungan antara kekayaan dan kondisi hidup dengan konversi TB dan mengurangi kejadian TB

Sasaran dari penelitian ini adalah untuk mengetahui dan menganalisis berbagai tingkat ekonomi di masyarakat selama masa pengobatan sebagai faktor yang berkontribusi terhadap konversi TB Penelitian ini menggunakan desain cross sectional dengan mewawancarai pasien TB yang diberi obat kategori pertama selama minimal 2 bulan n 106

Hasil penelitian menunjukkan bahwa pasien pada kelompok pendapatan yang lebih tinggi memiliki persentase kesembuhan lebih besar 77 dari 57 pasien dibandingkan dengan kelompok berpenghasilan rendah 49 dari 49 pasien Hasil tambahan yang diperoleh adalah beberapa pasien masih menggunakan uang mereka sendiri untuk konsultasi dan obat obatan yang seharusnya ditanggung oleh pemerintah

Penelitian ini menegaskan hipotesis bahwa pendapatan memang terkait dengan konversi TB pada 2 bulan di RS Persahabatan selama pengobatan lini pertama obat Beberapa faktor yang berkorelasi dengan pendapatan yang lebih tinggi termasuk pendidikan transportasi dan makanan sehat berkontribusi terhadap konversi

Penelitian ini menyarankan bahwa pemerintah harus membayar lebih banyak perhatian terhadap konversi dan pengobatan TB sebagai studi ini menemukan bahwa tingkat tertentu pendapatan minimum perlu dipenuhi untuk mendapatkan konversi pada 2 bulan Kata kunci Tuberkulosis Program pengobatan Tuberkulosis Kategori satu obat Tuberkulosis Tingkat Penghasilan.

Tuberculosis remains a major public health problem worldwide in spite of major scientific advancements in its diagnosis and management In WHO Report 2012 ndash Global Tuberculosis Control reveals an estimated 9 3 million incident cases of TB in 2011 globally with Asia leading at the top 59 Several studies in the past have revealed the relationship between wealth and living condition with TB conversion and reducing TB incidence
The Aim of this study was to determine and analyze variety of economic level in society during the treatment period as a contributing factor towards TB conversion This study used cross sectional design by interviewing patients with TB who are given first category drugs for at least 2 months n 106
Results showed that patient in the higher income group had greater cure percentage 77 from 57 patients compared to the low income group 49 from 49 patients Additional result gained was some of the patient still use their own money for consultation and drugs which should have been covered by the government
This study confirmed the hypotheses that income indeed associated with TB conversion at 2 months in Persahabatan Hospital during first line drug treatment Some factors that correlate with higher income including education transportation and healthy foods contribute to the conversion
This study suggested that government should pay more attention towards TB conversion and treatment as the study found that certain level of minimum income needed to be fulfill in order to get the conversion at 2 months Keywords TB TB treatment programs TB drugs first category Income."

Jakarta: Fakultas Kedokteran Universitas Indonesia, 2013

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Tiara Saraswati

Tatalaksana nutrisi pada tuberkulosis paru dengan komplikasi = Medical nutrition therapy in pulmonary tuberculosis with complications

"[ABSTRAK

Serial kasus ini bertujuan untuk mempelajari dan menerapkan terapi nutrisi sebagai bagian dari terapi tuberkulosis (TB) paru. Komplikasi yang menyertai TB paru dapat meningkatkan morbiditas dan mortalitas. Seluruh pasien serial kasus ini dalam kondisi malnutrisi dan terdapat komplikasi yang menyertai masingmasing kasus berupa drug-induced hepatotoxicity, peritonitis TB, diabetes melitus tipe 2, dan pneumotoraks dengan dispepsia. Pemberian nutrisi disesuaikan dengan kondisi, penyakit penyerta, dan kebutuhan yang bersifat individual. Kebutuhan energi basal dihitung dengan persamaan Harris-Benedict dengan kebutuhan energi total setara dengan 35?40 kkal/kg BB. Makronutrien diberikan dalam komposisi seimbang dengan protein 15?20% kebutuhan energi (1,2?1,5 g/kg BB). Saran pemberian mikronutrien minimal mencapai angka kecukupan gizi. Pasien yang mendapat obat antituberkulosis berupa isoniazid disarankan mendapat suplementasi vitamin B6 dengan dosis tertentu untuk mencegah neuritis perifer. Outcome yang dinilai meliputi kondisi klinis, asupan, dan toleransi asupan. Pemberian terapi nutrisi sebagian besar pasien dimulai dari kebutuhan energi basal yang pada akhir masa perawatan dapat mencapai target kebutuhan energi total. Pemantauan jangka panjang pasca rawat inap, disarankan tidak hanya menilai outcome berdasarkan perubahan berat badan, namun dilakukan penilaian komposisi tubuh, terutama massa lemak, karena pada kasus TB terjadi abnormalitas metabolisme yang disebut anabolic block.

ABSTRACT

The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary tuberculosis (TB) therapy. Pulmonary TB with complications was associated with increased of morbidity and mortality. Malnutrition was coexisted with several complications such as drug-induced hepatotoxicity, peritoneal TB, type 2 diabetes mellitus, and pneumothorax with dyspepsia. HarrisBenedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35?40 kcal/body weight. Balanced macronutrient composition was given with protein 15?20% energy requirement (1,2?1,5 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Patients with isoniazid therapy needed to get pyridoxine supplementation to prevent peripheral neuritis. Outcome measurements included clinical condition, amount of intake, and intake tolerance. Most patients were given initial nutrition therapy from basal energy requirement and has shown increment. At the end of hospitalization, all of patients could achieve total energy requirement. Due to abnormality of metabolism, usually termed as anabolic block, it was recommended not only to measure body weight as primary outcome, but also body composition., The aim of this case series was to study and apply nutrition therapy as integral part of pulmonary tuberculosis (TB) therapy. Pulmonary TB with complications was associated with increased of morbidity and mortality. Malnutrition was coexisted with several complications such as drug-induced hepatotoxicity, peritoneal TB, type 2 diabetes mellitus, and pneumothorax with dyspepsia. HarrisBenedict equation was used to calculate basal energy requirement with total energy requirement equivalent to 35–40 kcal/body weight. Balanced macronutrient composition was given with protein 15–20% energy requirement (1,2–1,5 g/body weight). Micronutrient recommendation was given to fulfill one fold recommended daily allowance. Patients with isoniazid therapy needed to get pyridoxine supplementation to prevent peripheral neuritis. Outcome measurements included clinical condition, amount of intake, and intake tolerance. Most patients were given initial nutrition therapy from basal energy requirement and has shown increment. At the end of hospitalization, all of patients could achieve total energy requirement. Due to abnormality of metabolism, usually termed as anabolic block, it was recommended not only to measure body weight as primary outcome, but also body composition.]"

Fakultas Kedokteran Universitas Indonesia, 2015

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