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"ABSTRAK Latar Belakang : Angka kejadian reseksi anastomosis pada kasus intususepsi masih sangat tinggi. Hal ini dikarenakan masih seringnya pasien datang terlambatsetelah 72 jam, kurangnya SDM untuk melakukan reduksi non operatif, dankurangnya penunjang seperti USG untuk menegakkan diagnosa. Penting untukmemperhatikan presisi, tehnik dan mempertimbangkan usus yang tersisa dalammelakukan reseksi anastomosis. Hingga saat ini belum ada standar operasi khususyang dapat menjadi panduan bagi para dokter bedah dalam melakukan reseksiakibat intususepsi. Karena itu, peneliti tertarik untuk mencari batas reseksi yangdiperlukan untuk menghasilkan suatu anastomosis end-to-end yang optimal danrendah tingkat kebocorannya. Penelitian akan dilakukan kepada tikus sebagai pilotstudy sebelum dilakukan penelitian lebih lanjut. Tujuan : Mengetahui batas reseksi usus yang optimal dinilai dari kebocorananastomosis berdasarkan grading kolagen pada batas reseksi tersebut. Metode : Penelitian ini merupakan penelitian eksperimental dengan hewan cobatikus putih Sprague Dawley. Tikus putih dilakukan intususepsi denganmenggunakan stylet, dari proksimal ke distal. Setelah 45 menit, intususepsi direduksi.Tikus putih dikelompokkan dalam tiga kelompok sesuai batas reseksianastomosis, yang kemudian batas reseksi ini dilakukan pemeriksaan gradingkolagen. Setelah 5 hari, dilakukan laparotomi untuk menilai kebocorananastomosis. Hasil : Pada perbandingan grading kolagen dengan reseksi usus didapatkangrading terbanyak pada batas 1 adalah grading 2 (57,1 %), pada batas 2 grading 2(71,4 %) ,batas 3 grading 3 (71,4%).Perforasi terbanyak ditemukan pada grading 2 sebanyak 5 sampel. Pada perbandingan batas reseksi dengan perforasi didapatkan perforasi terbanyak pada batas 1 (85,7 %)Simpulan : Terdapat perbedaaan grading kolagen pada batas reseksi usus dimana batas kelompok batas 3 memiliki grading kolagen yang lebih baik ( grade 3 dan 4)sehingga kelompok batas 3 lebih direkomendasikan secara histopatologis.Grading kolagen dapat dinilai untuk melihat kemungkinan perforasi hasilanastomosis. Terdapat faktor-faktor lain yang dapat mempengaruhi kejadian perforasi selain grading kolagen. ;Background ABSTRACT There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. ;Background : There is still high presentation of intussuseption cases with resection andanastomose, caused of multi factors as : patient delay more than 72 hours, less onprofesional expert to do non operative reduction and less of examination such as ultrasound to make a diagnose. That is important to take attention with pretition, tehniquesand less of intestine when do the resection. There is still no operative standard about theboundary of resection cause of intussuseption, thats why the author want to do theexperimental to find the optimal part of resection with minimal leakage. The experimental will do on rat as a pilot study. Aim : How to get the optimal part of resection compared with anastomotic leakege basedon collagen grading. Method : The experimental test using a Sprague Dawley rat. We make a intussuseptionon gut rat using a styleth from proximal to distal. The release do after 45 minutes. Therats then separated into three boundaries group, and did resection-anastomose with eachgut from groups were performed a histopatologic test to count collagen grading. Leakageof anastomose were examinated after 5 days Result : In comparison between collagen grading and the extent of resectionobtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5sample).in comparison the extent of resection and leakage,the highest is group 1(85,7%). Summary : There are differences about collagen gradingin the extent of bowelresection which is the third group of resection has higher collagen grading (3 and4 ) and then more recommended as histopatologic exam. Collagen grading couldbe marked to see possibilities of anastomotic leakage. There is some factors thataffect a leakage besides collagen grading. "

"Latar Belakang: Kebocoran anastomosis adalah komplikasi yang dapat terjadi pasca dilakukannya reduksi manual, reseksi dan anastomosis end-to-end pada kasus intususepsi. Faktor-faktor yang mempengaruhi kebocoran anastomosis antara lain teknik operator, kondisi lokal usus, kondisi umum pasien dan grading kolagen yang terbentuk pada proses penyembuhan luka. Tujuan: Mengetahui pengaruh perubahan grading kolagen usus pasca reseksi anastomosis terhadap kebocoran pada kasus intususepsi. Metode: Dua puluh satu tikus Sprague-dawley dilakukan laparatomi untuk dibuat model intususepsi (IN). Setelah 45 menit dilakukan destrangulasi selama 10 menit, dinilai adanya nekrosis dan dilanjutkan reseksi anastomosis. Tikus dibagi menjadi 3 kelompok, kelompok A : reseksi anastomosis pada batas usus yang nekrosis, kelompok B : reseksi anastomosis pada batas usus yang mengalami trombosis pembuluh darah mesenteriumnya, dan kelompok C : reseksi anastomosis pada batas usus yang sehat. Sampel usus yang direseksi diperiksa secara Histopatologi untuk menilai grading kolagen. Setelah 5 hari dilakukan laparatomi ulang, dinilai secara subjektif ada tidaknya kebocoran anastomosis, lalu diambil sampel segmen anastomosis usus untuk dinilai kembali grading kolagennya. Diharapkan jika terjadi kenaikan grading kolagen, anastomosis akan paten, sebaliknya jika terjadi penurunan akan terjadi perforasi. Hasil: Kelompok A: grading kolagen menurun dengan perforasi 6 (85,7%), grading kolagen tetap tanpa perforasi 1 (14,2%). Kelompok B: grading kolagen menurun dengan perforasi 2 (28,6%), tetap dengan perforasi 1 (14,3%), meningkat tanpa perforasi 4 (42,9%). Kelompok C: grading kolagen meningkat tanpa perforasi 5 (71,4%), menetap tanpa perforasi 2 (28,6%). Kesimpulan: Terdapat perubahan grading kolagen pasca reseksi anastomosis usus yang mempengaruhi tingkat kebocoran anastomosis pada kasus intususepsi.

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Background: Anastomosis leakage is a common complication following manual reduction, resection and end-to-end anastomosis in treating intussusceptions. Factors influencing the anastomosis leakage such as surgeon?s technique, local bowel condition, systemic condition of patients and the concentration of collagen in the bowel tissue during the anastomosis healing.

Aim: To study the effect of collagen concentration changes after resection and anastomosis procedure, in relation to the anastomosis leakages in intussusceptions case.

Methods: 21 Sprague-dawley rats were performed laparotomy to create the intussusception model (IN). The IN models were applied for 45 minute, after the bowel considered necrotic, destrangulation were performed for 10 minutes continued with resection and anastomosis on 3 group of resection margin: A on necrotic margin of bowel, B: on the thrombotic mesenterium vessel margin, C: on normal bowel margin. Resected bowels were sent for histopathology examination of collagen concentrations. After 5 days, another laparotomy was performed and the anastomosis leakages were subjectively assessed. The anastomosed segments were sampled for collagen concentration and grade.

Results: In study group A the collagen grading were found to be decreased with 6 leakages occurred (85.7%) and 1 subject (14.2%) with stable collagen grading and no leakages. From group B, subjects with decreased collagen and leakages were 2 (28.6%), and 1 subjects (14.3%) were stable in grading with leakages, and 4 subjects (42.9%) with increased collagen without leakages. In Group C, 5 rats (71.4%) had increased collagens without leakages, and 2 rats were at stable collagen grade without leakages.

Conclusion: There were collagen grade changes in bowel anastomosis that affect the extent of leakages in intussusceptions case."

"Latar Belakang : Angka kejadian reseksi anastomosis pada kasus intususepsimasih sangat tinggi. Hal ini dikarenakan masih seringnya pasien datang terlambatsetelah 72 jam, kurangnya SDM untuk melakukan reduksi non operatif, dankurangnya penunjang seperti USG untuk menegakkan diagnosa. Penting untukmemperhatikan presisi, tehnik dan mempertimbangkan usus yang tersisa dalammelakukan reseksi anastomosis. Hingga saat ini belum ada standar operasi khususyang dapat menjadi panduan bagi para dokter bedah dalam melakukan reseksiakibat intususepsi. Karena itu, peneliti tertarik untuk mencari batas reseksi yangdiperlukan untuk menghasilkan suatu anastomosis end-to-end yang optimal danrendah tingkat kebocorannya. Penelitian akan dilakukan kepada tikus sebagai pilotstudy sebelum dilakukan penelitian lebih lanjut.Tujuan : Mengetahui batas reseksi usus yang optimal dinilai dari kebocorananastomosis berdasarkan grading kolagen pada batas reseksi tersebut.Metode : Penelitian ini merupakan penelitian eksperimental dengan hewan cobatikus putih Sprague Dawley. Tikus putih dilakukan intususepsi denganmenggunakan stylet, dari proksimal ke distal. Setelah 45 menit, intususepsi direduksi.Tikus putih dikelompokkan dalam tiga kelompok sesuai batas reseksianastomosis, yang kemudian batas reseksi ini dilakukan pemeriksaan gradingkolagen. Setelah 5 hari, dilakukan laparotomi untuk menilai kebocorananastomosis.Hasil : Pada perbandingan grading kolagen dengan reseksi usus didapatkangrading terbanyak pada batas 1 adalah grading 2 (57,1 %), pada batas 2 grading 2(71,4 %) ,batas 3 grading 3 (71,4%).Perforasi terbanyak ditemukan pada grading2 sebanyak 5 sampel. Pada perbandingan batas reseksi dengan perforasididapatkan perforasi terbanyak pada batas 1 (85,7 %)Simpulan : Terdapat perbedaaan grading kolagen pada batas reseksi usus dimanabatas kelompok batas 3 memiliki grading kolagen yang lebih baik ( grade 3 dan 4)sehingga kelompok batas 3 lebih direkomendasikan secara histopatologis.Grading kolagen dapat dinilai untuk melihat kemungkinan perforasi hasilanastomosis. Terdapat faktor-faktor lain yang dapat mempengaruhi kejadianperforasi selain grading kolagen.

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Background : There is still high presentation of intussuseption cases with resection and

anastomose, caused of multi factors as : patient delay more than 72 hours, less on

profesional expert to do non operative reduction and less of examination such as ultra

sound to make a diagnose. That is important to take attention with pretition, tehniques

and less of intestine when do the resection. There is still no operative standard about the

boundary of resection cause of intussuseption, thats why the author want to do the

experimental to find the optimal part of resection with minimal leakage. The experimental

will do on rat as a pilot study.

Aim : How to get the optimal part of resection compared with anastomotic leakege based

on collagen grading.

Method : The experimental test using a Sprague Dawley rat. We make a intussuseption

on gut rat using a styleth from proximal to distal. The release do after 45 minutes. The

rats then separated into three boundaries group, and did resection-anastomose with each

gut from groups were performed a histopatologic test to count collagen grading. Leakage

of anastomose were examinated after 5 days

Result : In comparison between collagen grading and the extent of resection

obtained the highest grading in group 1 is grade 2 (57,1%), group 2 is grade 2

(71,4%), group 3 (71,4%). The highest Leakage can be found on grade 2 (5

sample).in comparison the extent of resection and leakage,the highest is group 1

(85,7%).

Summary : There are differences about collagen gradingin the extent of bowel

resection which is the third group of resection has higher collagen grading (3 and

4 ) and then more recommended as histopatologic exam. Collagen grading could

be marked to see possibilities of anastomotic leakage. There is some factors that

affect a leakage besides collagen grading."

"Pendahuluan. Kebocoran anastomosis merupakan komplikasi yang berat berhubungan dengan peningkatan morbiditas, dan mempengaruhi lama rawat di rumah sakit. Banyak peneliti yang telah meneliti faktor resiko terjadinya kebocoran usus, diantaranya sepsis, malnutrisi, ketegangan garis anastomosis, gangguan perfusi jaringan, obstruksi distal, dll. Usus adalah organ yang rentan terhadap cedera, cedera pada usus dapat menyebabkan edema, ileus, dan kegagalan mekanisme pertahanan usus. Kondisi ini dapat ditemukan pada gastroshizis, invaginasi, strangulasi, penyakit radang usus dan sirosis. Pemberian cairan berlebih dapat menyebabkan edema, peningkatan tekanan intra abdomen, menurunkan aliran darah mesenterik, berpengaruh terhadap penyembuhan dan meningkatkan kebocoran anastomosis. Studi ini bertujuan untuk mengetahui pengaruh edema terhadap anastomosis usus. Metode. Studi eksperimental pada tikus Sprague–Dawley untuk mengetahui pengaruh edema dan pemberian cairan yang berlebihan terhadap anastomosis usus. Hasil. Tidak terdapat perbedaan antara edema usus dan pemberian cairan berlebihan dengan peningkatan kebocoran anastomosis (p=0,178)  Kesimpulan. Edema usus tidak ada hubungan dengan kebocoran anastomosis.

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Introduction. Anastomotic leak is a severe complication associated with increased morbidity, and affects hospital stay. Many researchers have examined risk factors for intestinal leakage, including sepsis, malnutrition, anastomotic line tension, impaired tissue perfusion, distal obstruction, etc. The intestine is an organ that is prone to injury, injury to the intestine can cause edema, ileus, and failure of the intestinal defense mechanism. This condition can be found in gastroshizis, invagination, strangulation, inflammatory bowel disease and cirrhosis. Excessive fluid can cause edema, increase intra-abdominal pressure, decrease mesenteric blood flow, affect healing and increase anastomotic leakage. This study is to investigate intestinal edema on anastomosis. Method. This is an experimental study using Sprague-Dawley to determine the effect of edema and excessive fluid administration on intestinal anastomosis Results. There was no difference between intestinal edema and excessive fluid administration with increased anastomotic leak (p = 0.178). Conclusion. Intestinal edema is not associated with anastomotic leakage."

"ABSTRAK Pendahuluan Intussusepsi merupakan kegawatdaruratan yang sering terjadi pada anak di bawah dua tahun dengan salah satu plihan tata laksananya adalah operasi Dalam terapi operatif dapat dilakukan dengan dua jenis operasi yaitu reseksi anastomosis langsung atau pembuatan stoma sementara Studi ini dilakukan untuk mengevaluasi keluaran kedua jenis operasi tersebut berupa lama rawat masa awal asupan oral infeksi daerah operasi dan re operasi Metode Studi retrospektif dengan desain potong lintang berdasarkan kelompok jenis operasi reseksi anastomosis langsung atau pembuatan stoma sementara dilakukan di RSCM melalui penelusuran rekam medis Pengambilan sampel secara consecutive sampling dengan kriteria inklusi usia 0 18 th menjalani operasi reseksi anastomosis langsung ditunda di RSCM sedangkan kriteria ekslusi adalah data tidak lengkap atau tidak dilakukan reseksi Data diolah secara statistik dengan analisis komparatif numerik dengan uji Chi square atau uji T tidak berpasangan bila sebaran data normal bila tidak normal dengan uji Mann Whitney Hasil Terdapat 106 subjek dilakukan operasi dengan 40 subjek menjalani operasi reseksi anastomosis langsung dan 46 subjek dengan pembuatan stoma sementara serta 20 subjek dieklusi karena tidak dilakukan reseksi Lama rawat inap dengan median 11 hari 4 36 hari dengan masa awal asupan oral dengan median tiga hari 1 7 hari durasi gejala dengan median tiga hari ABSTRACT Introduction Intussusception is an emergency that found mostly under two years old which one of the therapy is operative management There are two kinds of operation mostly done which are resection anastomosis and temporary stoma followed by stoma closure This study aims to explain outcome of each techniques operation including length of stay duration to start oral intake surgical site infection and re operation Methods Retrospective study using cross sectional design grouping as resection anastomosis group and temporary stoma group was done at RSCM by reviewing patients rsquo medical records Sample achieved by methods of consecutive sampling with inclusion criterias are ages 0 18 years old underwent surgical resection and anastomosis delayed anastomosis at RSCM hospital while the exclusion criterias are incomplete data or not have surgical resection The data were processed statistically Chi square test or unpaired T test used to analyze comparative numerical variables if data distribution is normal While it rsquo s not normal Mann Whitney test was used Results There were 106 subjects consisted of 40 patients belonged to resection anastomosis group and 46 subjects were temporary stoma group while 20 subjects were exluded Median of overall length of stay was 11 days 4 36 days the median of duration to the first oral intake was 3 days 1 7 days and median of clinical onset was three days"

"Latar belakang : Tindakan diversi fekal sclama kurun waktu tertentu dapat menyebabkan hilangnya kekuatan dan kontraktilitas otot polos usus scrta atrofi villi mukosa usus segmen distal, yang secara makroskopis tampak scbagai perbedaan diameterantara puntung proksimal dengan puntung distal. Akhirnya, stoma tidak dapat dianastomosis langsung namun memerlukan prosedur Santulli terlebih dahulu, kemudianpenutupan stoma. Untuk mencegah morbiditas ini, anastomosis stoma harus sudah dilakukan sebelum puntung distal mengecil.Tujuan : Untuk mengetahui rentang waktu rata-rata antara diversi fekal dan anastomosis secara langsung, antara diversi fekal dan prosedur Santulli, scrta antara prosedur Santulli dan penutupan Santulli.Subyek & Cara Kerja : Subyek dari studi Kohort retrospektif ini adalah scmua pasien atresia ani dengan data rekam medis yang lengkap, yang telah dilakukan diversi fekal pada usia < 13 tahun dan sudah menjalani operasi PSARP, yang dirawat untuk dilakukanoperasi penutupan stoma di RSUPN-CM, antara bulan Juni 2006 dan bulan Pebruari 2010.Hasil : Didapatkan 50 pasien, terdiri dari 25 laki-laki (8 anastomosis langsung; 17Santulli) dan 25 perempuan (21 anastomosis langsung, 4 Santulli). Jenis atresia anidengan : fistel rektovestibuler (36%); fistel rektouretra (24%); tanpa fistel (18%); fistelrektoperineal (10%); fistel rektovesika dan anus anterior (masing-masing 4%); scrta fistelrektovagina dan kloaka (masing-masing 2%). Rentang waktu antara diversi fekal -anastomosis langsung : rata-rata 427 (SD 213) hari, median 358 hari; antara diversi fekal- prosedur Santulli: median 1267 (minimum 335, maksimum 6848) hari. Hasil ujistatistik non parametrik '2-independent samples' dengan Mann Whitney nilai p < 0.05.Rentang waktu antara prosedur Santulli - penutupan Santulli: rata-rata 245 (SD 112)hari.Kesimpulan : Rentang waktu rata-rata antara diversi fekal - anastomosis langsungdengan diversi fekal - proscdur Santulli berbeda Sebaiknya operasi penutupan stoma telah dilakukan sebelum waktu minimum perbedaan diameter puntung terjadi"

"Penyakit ginjal tahap akhir (PGTA) merupakan masalah kesehatan masyarakat yang memerlukan terapi pengganti ginjal (TPG) seperti Hemodialisis. Fistula Arteriovenosa (FAV) merupakan pilihan akses vaskular terbaik bagi penderita yang menjalani hemodialisis. Akan tetapi, kegagalan maturasi FAV relatif tinggi akibat gangguan dari înflow dan/atau outflow. Pengukuran peningkatan Blood Flow Rate (BFR) pada arteri brakialis proksimal anastomosis, distal anastomosis dan vena outflow dapat mengidentifikasi penyebab kegagalan maturasi FAV. Penelitian dilakukan di RSCM, RS Hermina Depok dan RS Hermina Bekasi pada periode Februari 2024 – Mei 2024. Desain penelitian kohort prospektif menggunakan data primer meliputi: usia, jenis kelamin, hipertensi, merokok, diabetes melitus, aterosklerosis, riwayat pemasangan catheter double lumen (CDL) dan hasil pengukuran USG doppler berupa diameter arteri brakialis, vena sefalika dan BFR arteri brakialis preoperasi serta BFR arteri brakialis proksimal anastomosis, distal anastomosis dan vena outflow (OV) segera setelah tindakan AVF, hari ke 7, hari ke 14 sampai minggu ke 6. Dari total 45 subjek yang memenuhi kriteria inklusi dan eksklusi, terdapat 36 subjek yang mengalami maturasi dalam 6 minggu pascaoperasi. Dengan analisis multivariat uji t-tidak berpasangan, didapatkan diameter arteri brakialis dan vena sefalika nilai rerata >2,5 mm serta nilai BFR arteri brakialis preoperasi 66,22 ± 22,60 (p<0,001). Didapatkan batasan nilai persentase peningkatan BFR arteri brakialis proksimal 167,23% pada hari ke-7 yang memprediksi  keberhasilan maturitas FAV brakiosefalika setelah 6 minggu pascaoperasi dengan sensitivitas 58,3%, spesifisitas 87,5%, interval kepercayaan 97,3%. Nilai persentase peningkatan OV diatas 186,92% pada hari ke-7 dan diatas 468,0% pada hari ke-14 dapat memprediksi keberhasilan maturitas FAV pada minggu ke-6 dengan sensitifitas dan spesifisistas sebesar 61,1% dan 100% untuk hari ke-7 dan 80,6% dan 100% untuk hari ke-14. Sebagai kesimpulan Peningkatan persentase BFR arteri brakialis proksimal anastomosis dan vein outflow hari ke-7 pasca tindakan FAV dapat dipakai sebagai prediktor maturitas FAV brakiosefalika.

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End-stage kidney disease (ESKD) is a public health problem that requires kEnd-stage kidney disease (ESKD) is a public health problem that requires Kidney replacement therapy (KRT) such as hemodialysis. Arteriovenosa fistula (AVF) is the best vascular access option for patients undergoing hemodialysis. However, AVF maturation failure is relatively high due to interruption of inflow and/or outflow. Measurement of increased Blood Flow Rate (BFR) in the brachial arteries of the proximal anastomosis, distal anastomosis and venous outflow can identify the cause of AVF maturation failure. The study was conducted at Ciptomangunkusumo Hospital, Hermina Depok Hospital and Hermina Bekasi Hospital in the period February 2024 – May 2024. The design of the prospective cohort study using primary data includes: age, gender, hypertension, smoking, diabetes mellitus, atherosclerosis, a history of installation of a double lumen catheter and doppler ultrasound measurements of the diameter brachial artery, cephalic vein and BFR of the preoperative brachialis artery as well as BFR proximal anastomosis, distal anastomosis and outflow vein immediately after the AVF operation, day 7, day 14 to week 6. A total of 45 subjects met the inclusion and exclusion criteria. Of these, 36 had matured within six weeks of the operation. A multivariate analysis of the non-pairing t-test revealed that a percentage increase of 167.23% in brachial artery BFR on the 7th day can predict the successful maturation of brachiocephalic AVF after 6 weeks of postoperative treatment. This model demonstrated a sensitivity of 58.3% and a specificity of 87.5%, with a confidence interval of 97.3%. The percentage value of OV increase above 186.92% on day 7 and above 468.0% on the 14th day can be used to predict the success of AVF maturity on week 6. This approach has a sensitivity and specificity of 61.1% and 100% for day 7th and 806% and 100% for day 14th. As a conclusion Increased percentage of BFR of proximal brachial artery anastomosis and venous outflow on day 7 after AVF can be used as a predictor of brachiocephalic FAV maturity."

"Kondisi kritis pasien mengacu pada kondisi yang memerlukan perawatan intensif khusus yang tidak jarang memerlukan alat bantu napas baik berupa dukungan oksigenasi maupun peralatan yang lebih advance lainnya seperti ventilator mekanik. Posisi tirah baring merupakan posisi yang kerap kali dialami oleh pasien kritis yang dirawat di unit perawatan intensif. Minimnya pergerakan dan status nutrisi yang buruk dapat menimbulkan masalah lain yaitu luka tekan. Tujuan dari penulisan ini adalah untuk mengetahui tingkat efektivitas madu manuka sebagai balutan madu pada perawatan luka tekan yang dialami oleh pasien kritis tirah baring lama. Evaluasi perkembangan luka dipantau setiap hari melalui pergantian balutan luka untuk diamati ukuran, kedalaman, eksudat, pus, biofilm, perdarahan aktif dan slough. Hasilnya, terdapat perbaikan luka ditandai dengan berkurangnya panjang, lebar dan kedalaman luka, terhentinya perdarahan aktif dan tidak ada lagi eksudat baik pus, biofilm maupun slough.

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The critical condition of the patient refers to conditions that require special intensive care which often require breathing apparatus in the form of oxygenation support or other more advanced equipment such as mechanical ventilators. The bed rest position is a position that is often experienced by critically ill patients who are treated in the intensive care unit. Lack of movement and poor nutritional status can cause another problem, namely pressure sores. The purpose of this paper is to determine the level of effectiveness of manuka honey as a honey dressing in the treatment of pressure sores experienced by critically ill patients on prolonged bed rest. Evaluation of wound development was monitored every day by changing wound dressings to observe size, depth, exudate, pus, biofilm, active bleeding and slough. As a result, there was improvement in the wound characterized by reduced length, width and depth of the wound, cessation of active bleeding and no more exudate either pus, biofilm, or slough."

"Residensi keperawatan medikal bedah dilaksanakan selama mengikuti program spesialis keperawatan medikal bedah dengan menerapkan asuhan keperawatan pada pasien dengan gangguan sistem perkemihan. Teori keperawatan yang digunakan adalah teori self care Orem yang merupakan suatu pendekatan dinamis dimana perawat bertugas mengembangkan kemampuan pasien dan keluarga untuk memenuhi kebutuhan self care pasien. Masalah keperawatan utama pada pasien dengan gangguan sistem perkemihan adalah kelebihan volume cairan, ketidakseimbangan nutrisi: kurang dari kebutuhan tubuh, ketidakpatuhan, kelemahan dan cemas. Perencanaan diberikan berdasarkan tingkat ketergantungan pasien meliputi: bantuan seluruhnya, bantuan sebagian dan support edukasi. Evaluasi keperawatan berfokus pada kemampuan pasien untuk mempertahankan kebutuhan self care, kemampuan untuk mengatasi deficit self care dan sampai sejauhmana perkembangan kemandirian pasien, serta kemampuan keluarga dalam memberikan bantuan self care jika pasien tidak mampu. Pelaksanaan evidence based nursing practice berupa penerapan intervensi edukasi dalam merencanakan inisiasi dialisis pada pasien penyakit ginjal kronik. Dari 11 pasien yang diberikan edukasi terdapat 7 pasien (63,6%) menerima yang terdiri dari 5 pasien menjalankan inisasi dialisis karena sudah ada indikasi untuk inisiasi dialisis, dan 2 pasien akan mengikuti pengobatan secara teratur dan menjalankan perilaku hidup sehat. Sedangkan 4 pasien (36,4%) menolak walaupun sudah ada indikasi untuk inisiasi dialisis. Kegiatan inovasi adalah mengembangkan media edukasi berupa leaflet, booklet dan video untuk merencanakan inisiasi dialisis pada pasien penyakit ginjal kronik.

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Medical surgical nursing residency program implemented during specialist medical surgical nursing care focuses on patient with urinary system disorders. Nursing theory using self care Orem theory which is a dynamic approach in which the nurse on duty to develop the ability of the patient and the family to meet the needs of the patient's self care.

Major nursing problems in patients with the urinary system disorders are excess fluid volume, imbalance nutrition: less than body requirements, non compliance, weakness and anxiety. Planning is given based on the patient is level of dependence include the wholly compensatory nursing system, partially compensatory nursing system and support educative compensatory.

Evaluation of nursing focuses on the patient's ability to over come self care deficit and the extent to which development of patient autonomy and the ability to overcome self care deficit and the ability of families to provide assistance in self care if the patient is incapacitated. Implementation of evidence based nursing practice is the application of education on chronic kidney disease patient's plans to initiate dialysis.

The results obtained from 11 patients who were given education, there were 7 patients (63,6%) received consisting of 5 patient's plans to initiate dialysis because already an indication for initiate dialysis and 2 patients will follow the treatment regularly and implement healthy behavior. Whereas 4 patients (36,4%) refused although there has been an indication for initiate dialysis. Innovation activities was to develop educational media such as leaflets, booklets and videos on chronic kidney disease patient's plans to initiate dialysis."

"Kejadian jatuh merupakan penyebab paling sering klien dewasa masuk ke rumah sakit dan mengalami trauma brain injury atau cedera kepala. Cedera kepala merupakan salah satu masalah kesehatan yang dapat mengancam jiwa. Dampak yang dirasakan dari cedera kepala juga beresiko tinggi untuk mengalami peningkatan tekanan intrakranial .Klien dengan cedera kepala beresiko mengalami peningkatan tekanan intrakranial karena akibat dari adanya massa dari edema maupun hematoma. Elevasi kepala 30° diketahui dapat membantu mengurangi dan mencegah terjadinya peningkatan tekanan intrakranial. Karya ilmiah ini bertujuan untuk menganalisis asuhan keperawatan pada pasien dengan cedera kepala sedang dalam perawatan di ruang rawat. Elevasi kepala 30° dilakukan dengan pemberian intervensi asuhan keperawatan lainnya selama tiga hari kepada pasien. Hasil menunjukan terdapat penurunan tanda dan gejala adanya peningkatan tekanan intrakranial.

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Falls are the most frequent cause of adult clients entering the hospital and experiencing brain injury or head injury. Head injury is one of the health problems that can be life-threatening. The perceived impact of a head injury is also a high risk for increased intracranial pressure. The risk of experiencing increased intracranial pressure due to the presence of a mass from edema or hematoma. Head elevation of 30° is known to help reduce and prevent an increase in intracranial pressure. This scientific work aims to analyze nursing care in patients with head injuries who are being treated in the ward. Head elevation of 30° is done by providing other nursing care interventions for three days to the patient. The results showed a decrease in signs and symptoms of increased intracranial pressure."