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"Penyebab, gejal klinis, diagnosis banding, diagnosis, laboratis, terapi"

"The paradigm of Evidence Based Medicine (EBM) is new in the world of medicine and is used in practice praxis and medical research through a systematic observation, standardized, and objective. The article brings to light whether EBM and the supportive apparatus are able to defend the theory of decision-making concept of Pellegrino and Thomasma and how it affects the attitude of the practitioners in making a well-thought decision to administer a rational, objective, and effective treatment for the patients."

"Pengembangan humanisme sebagai inti profesionalisme diperlukan karena dokter profesional masa kini dituntut melakukan pelayanan berpusat pada pasien dan mengesampingkan kepentingan pribadi. Pengembangan humanisme dipengaruhi persepsi mahasiswa terhadap lingkungan pembelajaran terutama di klinik. Meskipun demikian, belum ada instrumen untuk menilai hal tersebut. Tujuan penelitian ini adalah menyusun instrumen penilaian iklim humanis lingkungan pembelajaran klinis.Penelitian ini menggunakan desain sequential exploratory mixed method dan dilakukan di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) pada bulan Januari – Desember 2019. Penelitian dilakukan dalam empat tahap yaitu penyusunan instrumen, uji coba, penyusunan model iklim humanis lingkungan pembelajaran klinis dan implementasi. Tahapan penyusunan instrumen dimulai dengan sintesis konsep iklim humanis lingkungan pembelajaran klinis melalui telaah pustaka, focus group discussion dan wawancara mendalam. Dari penyusunan tersebut diperoleh konsep yang dijadikan rujukan draf instrumen Humanistic Climate Measure (H-CliM) yang terdiri atas 89 butir pertanyaan; 7 domain. Tahap kedua, dilakukan uji coba H-CliM bersama instrumen untuk menilai kompetensi humanisme Integrity Compassion Altruism Respect Empathy (ICARE). Kedua instrumen terbukti valid (r > 0,3) dan reliabel (α-cronbach > 0,7). Dilakukan analisis faktor untuk memvalidasi konstruk dan menghasilkan instrumen H-CliM final (46 butir pertanyaan; 4 domain) serta ICARE final (15 butir pertanyaan; 2 domain). Analisis receiver operating characteristic (ROC) menghasilkan titik potong ≥ 184,5 artinya, skor H-CliM ≥ 184,5 tergolong humanis. Analisis regresi logistik menghasilkan model iklim humanis yang 62% dapat menjelaskan variasi iklim humanis (R2 = 0,62). Model tersebut adalah:Logit P (iklim humanis) = 0,782 (rotasi klinis non-bedah) + 0,048 (kurikulum formal dan informal terkait humanisme) – 0,213 (hidden curriculum) + 0,036 (relasi dan fasilitas yang mendukung humanisme) + 0,044 (pengembangan kepribadian dan profesionalisme) + 0,409 (perempuan) + e.Penelitian ini berhasil mengembangkan instrumen penilaian iklim humanis yang valid dan reliabel yaitu instrumen H-CliM (α-Cronbach = 0,86). Lingkungan pembelajaran non-bedah 2 kali lebih humanis dibanding bedah (p = 0,0001). Persepsi terhadap iklim humanis lingkungan pembelajaran klinis berkorelasi lemah dengan capaian kompetensi humanisme.

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The development of humanism as the core of professionalism is crucial, seeing that professional doctors today are expected to carry through patient-centered services and put aside their personal interests. In clinical setting, cultivating humanism is highly influenced by students 'perceptions on clinical learning climate, therefore, it is necessary to assess that perception. However, to date there is no instrument to assess clinical learning climate. The purpose of this study is to develop an instrument to assess humanistic learning climate.

This study utilizes a sequential exploratory mixed method design and is conducted at the Cipto Mangunkusumo hospital (RSCM) in January - December 2019. The research was conducted in four stages, which are the preparation of instruments, trials, development of humanistic climate models of clinical learning environments and implementation of the instrument. The stages of instrument preparation begin with the synthesis of concept of the humanistic clinical learning climate through literature review, focus group discussions and in-depth interviews. Afterward, the concept that was obtained utilized as a reference for drafting instrument of Humanistic Climate Measure (H-CliM) consisting of 89 questions; 7 domains. The second stage, an H-CliM trial was carried out along with instruments to assess the competence of the Integrity Compassion Altruism Respect Empathy (ICARE).

Both instruments proved to be valid (r > 0.3) and reliable (α-Cronbach > 0.7). Factor analysis was carried out to validate the construct and produce the final H-CliM instrument (46 questions; 4 domains) and the final ICARE (15 questions; 2 domains). Receiver operating characteristic (ROC) analysis resulted in cut-off point of 184.5, which means that the H-CliM score ≥ 184.5 was classified as humanistic climate. Humanistic climate models obtained from the logistic regression analysis could explain 62% of variation of humanistic climate (R2= 0,62). The model is:

Logit P (humanistic climate) = 0.782 (non-surgical clinical rotation) + 0.048 (formal and informal curriculum related to humanism) - 0.213 (hidden curriculum) + 0.036 (relationship and facilities that support humanism) + 0.044 (personality development and professionalism) + 0,409 (female) + e.

This research succeeded in developing a valid and reliable humanistic climate assessment instrument, the H-CliM instrument (α-Cronbach = 0,86). Compare with surgical rotation, the non-surgical learning environment is twice more humanistic (p = 0.0001). Perceptions of the humanistic climate of the clinical learning environment are weakly correlated with the achievement of humanism competencies."

"Meningkatnya kasus COVID-19 di Indonesia mengakibatkan kebutuhan akan perawatan di rumah sakit bagi pasien COVID-19 juga meningkat. Oleh karena itu, perlu diketahui laju perbaikan kondisi klinis pasien COVID-19 serta faktor-faktor yang memengaruhinya agar pasien COVID-19 dapat diberikan perawatan yang tepat sehingga pasien dapat lebih cepat mengalami perbaikan. Tujuan penelitian ini adalah untuk mengetahui laju perbaikan kondisi klinis dari pasien COVID-19, sekaligus melihat karakteristik pasien yang berasosiasi dengan laju perbaikan kondisi klinis tersebut. Faktor-faktor yang digunakan dalam penelitian ini antara lain usia, jenis kelamin, jenis-jenis gejala, jenis-jenis komorbid, pengukuran darah perifer lengkap (DPL) dan hitung jenis leukosit, procalcitonin, C-Reactive Protein, urea, dan kreatinin. Metode yang digunakan berupa survival tree dan regresi Cox proportional hazard dalam menganalisis laju perbaikan kondisi klinis pasien COVID-19 berdasarkan beberapa faktor. Algoritma survival tree yang digunakan dalam penelitian ini adalah relative risk tree. Data yang digunakan merupakan data pasien COVID-19 salah satu rumah sakit di Jakarta yang berjumlah 286 observasi. Data diambil pada periode Maret 2020 hingga Maret 2021. Berdasarkan hasil analisis, terbentuk empat kelompok kelajuan perbaikan kondisi klinis yang berbeda berdasarkan masing-masing faktor yang berasosiasi. Faktor-faktor yang diketahui berasosiasi terhadap laju perbaikan klinis pasien COVID-19 berdasarkan hasil pembentukan survival tree antara lain usia, procalcitonin, trombosit, Platelete-to-Lymphocyte Ratio (PLR), leukosit dan jumlah komorbid. Pasien dengan karakteristik laju perbaikan kondisi klinis yang relatif lebih cepat memiliki risiko lebih besar untuk keluar dari ruang perawatan COVID, sedangkan pasien dengan karakteristik laju perbaikan kondisi klinis yang relatif lambat memiliki risiko lebih rendah untuk keluar dari ruang perawatan COVID.

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The increased number of COVID-19 cases in Indonesia has resulted in a large increase in COVID-19 patient hospitalizations. As a result, it is necessary to understand the rate of clinical improvement in COVID-19 patients, as well as the factors that influence it, so that the patients can be given the right treatment in order for them to improve their conditions faster. The aim of this study was to determine the rate of clinical improvement in COVID-19 patients, as well as the patient characteristics that were associated to that rate. Age, gender, types of symptoms, types of comorbidities, complete blood count (CBC), white blood count (WBC), procalcitonin, C-Reactive Protein, urea, and creatinine were used in this study. The survival tree and Cox proportional hazard regression methods were applied in this study to analyze the rate of clinical improvement of COVID-19 patients based on several factors. Survival tree algorithm that used in this study is relative risk tree. Data used in this study was COVID-19 patients data from a hospital in Jakarta with 286 observations. Data was taken from March 2020 to March 2021. Based on the results of analysis, there are four different groups of rates of clinical improvement COVID-19 patients based on each covariate. Age, measurement of procalcitonin, platelets, Platelet-to-Lymphocyte Ratio (PLR), leukocytes, and the number of comorbidities are known to be associated with the rate of clinical improvement of COVID-19 patients based on survival tree results. Patients with a relatively faster rate of clinical improvement have a greater risk of leaving from COVID treatment room, whereas patients with a relatively slow rate of clinical improvement have a lower risk of leaving the COVID treatment room."

"Recognized as the definitive book in laboratory medicine since 1908, Henry's Clinical Diagnosis and Management by Laboratory Methods, edited by Richard A. McPherson, MD and Matthew R. Pincus, MD, PhD, is a comprehensive, multidisciplinary pathology reference that gives you state-of-the-art guidance on lab test selection and interpretation of results. Revisions throughout keep you current on the latest topics in the field, such as biochemical markers of bone metabolism, clinical enzymology, pharmacogenomics, and more!"--Provided by publisher"

"Lumbar canal stenosis merupakan penyebab utama disabilitas pasien. Selective Nerve Root Block (SNRB) pada area lumbar adalah salah satu metode terapi untuk mengatasi nyeri akibat radikulopati lumbar yang bertujuan mengurangi kebutuhan operasi. Ultrasonografi (USG) muncul sebagai alternatif dengan kelebihan seperti tanpa radiasi, mobilitas tinggi, kemampuan pencitraan jaringan lunak, dan penetrasi jarum real-time jika dibandinagkan menggunakan Floroskopi. Penelitian ini merupakan studi uji klinis acak non-inferiority tersamar tunggal yang dilakukan di 2 Rumah Sakit. 52 subjek penelitian yang terdiri dari 26 subjek yang dilakukan tindakan SNRB dengan panduan fluoroskopi dan 26 subjek yang dilakukan tindakan SNRB dengan panduan USG. Tidak ada perbedaan karakteristik dasar antara kedua kelompok berdasarkan usia, jenis kelamin, IMT, durasi gejala. level lumbar VAS, maupun ODI pre operasi (p > 0,05). Penelitian ini menunjukkan penurunan signifikan pada nilai VAS di kelompok floroskopi dan USG pada 30 menit, 2 minggu, dan 12 minggu setelah tindakan dibandingkan dengan baseline (p < 0,01). Kendati demikian, tidak ada perbedaan VAS dan ODI yang signifikan antara kedua metode panduan pada setiap titik waktu (p > 0,05). Tidak terdapat perbedaan dalam pengurangan nyeri radikular lumbal, skor ODI, dan kejadian komplikasi antara tindakan SNRB dengan panduan fluoroskopi maupun USG. Penggunaan panduan USG pada SNRB terbukti lebih efisien dengan durasi yang lebih singkat dan sama efektifnya dengan fluoroskopi.

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Lumbar canal stenosis is a leading cause of patient disability. Selective Nerve Root Block (SNRB) in the lumbar area is a therapeutic method aimed at alleviating pain from lumbar radiculopathy to reduce disability and surgical needs. SNRB typically employs fluoroscopy but has drawbacks such as radiation exposure. Ultrasonography (USG) has emerged as an alternative offering benefits. This was a randomized single-blind non-inferiority clinical trial conducted at 2 Hospitals. There were 52 subjects, with 26 undergoing SNRB with fluoroscopy guidance and 26 with USG guidance. No baseline characteristic differences were found between the groups in terms of age, gender, BMI, symptom duration, preoperative lumbar level VAS, or ODI (p > 0.05). The study demonstrated significant reductions in VAS scores in both fluoroscopy and USG groups at 30 minutes, 2 weeks, and 12 weeks post-procedure compared to baseline (p < 0.01). However, no significant differences in VAS and ODI were observed between the two guidance methods at any time point (p > 0.05). There was no difference in the reduction of lumbar radicular pain, ODI scores, and complication rates between SNRB procedures guided by fluoroscopy and USG. USG guidance in SNRB proves to be more efficient with shorter duration and equally effective as fluoroscopy."

"Dalam menghadapi persaingan yang semakin ketat di era globalisasi, sebagai revenue centre yang menyumbang sekitar 46,52% dari semua penerimaan operasional RSMG maka manajemen Apotik IFRSMG yang tepat menjadi sangat penting. Dari data yang ada terlihat bahwa kinerja Apotik IFRSMG menunjukkan kecenderungan yang semakin menurun setiap tahun terutama untuk pasien rawat jalan di mana persentase obat yang tidak terlayani mencapai 63,37% pada tahun 2001 Hal ini membawa kerugian finansial yang sangat besar dan mengancam kelangsungan hidup RSMG.Untuk meningkatkan volume penjualan resep di Apotik IFRSMG, maka dilakukan penelitian cross sectional pada bulan Juni 2004 dengan metode kuantitatif dan kualitatif. Data dianalisa secara univariat dan bivariat dengan analisa uji statistik chi square dengan menggunakan program statistik SPSS versi 11.0. Tujuan penelitian ini adalah mendapatkan hubungan antara bauran pemasaran dengan konsep 7P ( produk, harga, lokasi, promosi, petugas, bukti fisik dan proses pembelian ) dengan keputusan pembelian obat oleh pasien rawat jalan RSMG.Penelitian ini menggunakan data primer berupa kuesioner yang ditanyakan langsung kepada responden di 8 poli rawat jalan serta data sekunder dari survei pesaing dan pencatatan harian di Apotik IFRSMG.Dari hasil penelitian didapatkan jumlah resep yang dilayani dari poli rawat jalan sebanyak 45% (meningkat dibanding tahun 2003) dengan 92,9% sudah >2 kali membeli obat. Sampel pada penelitian ini terdiri dari 60,5% yang tidak membeli/sebagian dan 39,5% yang membeli penuh. Alasan utama tidak membeli adalah: mahal (43,3%) dan lama (22,38%). Strategi harga yang digunakan adalah mark up sebanyak 21% dari harga beli dan untuk obat bebas 12-20%. Harga obat secara umum jauh lebih mahal dibanding harga pesaing. Persediaan obat sudah cukup baik di mana rata-rata 2,11 resep yang ditolak setiap hari akibat tidak tersedia di apotik. Lokasi apotik dikeluhkan sulit terlihat oleh 81% responden. Sumber informasi masih sangat kurang terbukti dari 71% yang tidak pernah mendengar tentang apotik ini. Promosi oleh dokter hanya 7,6%. Mutu petugas secara umum termasuk sedang dengan nilai 3,26. Kecepatan petugas masih termasuk buruk dengan nilai 2,49. Ruang tunggu apotik juga termasuk sedang dengan nilai 3,15. Kerapian dan kenyamanan masih termasuk kategori buruk. Proses pembelian sudah termasuk baik.Dari uji bivariat diketahui bahwa dari 15 variabel yang dinilai ternyata ada 12 variabel yang bermakna dengan nilai p-0,000 yaitu ketersediaan obat, lokasi, kecepatan petugas, keramahan petugas, keterangan petugas, kesopanan petugas, kemampuan petugas, cara komunikasi petugas, kerapian petugas, kerapian dan kenyamanan ruang tunggu serta proses pembelian. Sedangkan 3 variabel yang tidak bermakna yaitu: sumber informasi, kebersihan petugas dan kebersihan ruang tunggu.Sebagai saran untuk perbaikan, maka diusulkan beberapa strategi pemasaran yang perlu dilakukan oleh manajemen yaitu: pengembangan target konsumen, penentuan posisi apotik sebagai apotik yang unggul dan lengkap dengan harga yang kompetitif, ketersediaan obat dengan analisa ABC Index Kritis, strategi harga yang berorientasi pasar (bukan lagi strategi mark up), promosi dari dalam oleh tenaga medis ditingkatkan, penggunaan sistem komputer yang terintegrasi antara apotik dan tiap poli rawat jalan, pelayanan yang baik dan cepat serta berorientasi pada pelanggan, discount yang menarik, pemindahan lokasi apotik, peningkatan mutu petugas, peningkatan kemampuan komunikasi petugas, penataan interior dan display yang lebih baik, kenyamanan ruang tunggu ditingkatkan, riset dan audit pemasaran berkala, proses pembelian dipermudah, melakukan riset operasional mengenai sistem antrian resep dan penelitian lanjutan dengan masyarakat sekitar.Akhirnya strategi yang dibuat harus bisa beradaptasi dengan perubahan kesempatan dan tantangan global.Daftar Bacaan: 40 ( 1984 - 2004 )

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Analysis the Relationship Between Marketing Mix and Purchasing Decision of Medicine by the Out-patient at Pharmacy Installation Dispensary of Medika Gria Hospital 2004In facing the tight competition of the globalization era, as the greatest revenue centre that contribute about 46,52% of the overall operational income of Medika Gria Hospital in 2003, the proper management of the Pharmacy Installation Dispensary of Medika Gria Hospital therefore become the highlight point. From the data we can see that the performance of the pharmacy show a declining tendency every year especially for the out-patient where the percentage of the un-served prescriptions were reaching 63,37% of the overall prescriptions made by outpatient doctor by the year 2003. This is a big threat and causing the big losing and therefore create a financial problem that influence the survival of Medika Gria Hospital.

In order to increase the volume of sales at the pharmacy, a cross sectional research was done in June 2004 with quantitative and qualitative method. Data analysis used are univariate and bivariate with Chi-square test using statistic program analysis with SPSS for Windows version 11.0. The purpose of this research is to find out the relationship between the Seven Ps of marketing mix ( product, place, price, promotion, people, physical evidence and processes ) and the purchasing decision of the out-patient of Medika Gria Hospital.

In this research the primary data are obtained by using questionnaire which were directly asked to 210 respondents (patient or family) from 8 out-patient clinic_ While secondary data are obtained by doing survey of one competitor and the daily observation at the pharmacy.

The research has shown that 45% of all the prescriptions of out-patient clinic is served at the pharmacy ( better than the year 2003) whereas 92,9% has ever purchased more than 2 times at the pharmacy. The sample of this research are divided into 2 categories i.e: 60,5% refuse 1 incomplete to purchase and 39,5% agree to purchase. The main reason to refuse is: expensive (43,3%) and long waiting hours (22,38%). Pricing strategy used is cost-based with 21% mark up for out-patient and 12-20% for OTC. In general the price is still far more expensive compare with competitor. The availability of medicine is quite good where only 2, 11 prescriptions daily are rejected due to out of stock. The location of the pharmacy is hard to find according by 81% of respondents.

Source of information is still bad that 71% of the respondents answer that they never heard about the pharmacy. Internal promotion by medical doctor is only 7,6%. The quality of all the dispensary staff is moderate with the score 3,26. The speed of the staff is still bad with the score 2,49. The waiting room is classified moderate with the score 3,15. The tidiness and comfort are still bad. The purchasing process is consider good

Using bivariate analysis we could see that 12 of the 15 variables that are observed has shown significant statistical relationship with p value :1000 i.e: availability of medicine, location; prompt service, friendliness, quality of information, courtesy, capabilitiy, the way to communicate and neatness of the staff; tidy and comfortable waiting room as well as the whole process of purchasing. Meanwhile there are 3 variables tnat have no significant statistical relationship i.e: source of information, cleanliness of dispensary staff and waiting room.

To increase the performance, some suggestion regarding marketing strategy should be consider by the management i.e: increase target market, positioning the pharmaceutical as one of the best pharmaceutical with complete medicine and competitive price, improve the availability of medicine by ABC critical index analysis, market-oriented pricing strategy instead of mark-up strategy, increase internal promotion by medical staff, integrated computerized system between pharmaceutical and outpatient clinic, an excellent and prompt service, customer-oriented service, an interesting discount, changing the location of the pharmacy, increase the quality of staff, improve communication skill of all staff, a good interior and display setting, improve the comfort of waiting room, a routine marketing research and audit, improve the purchasing process, operational research on prescriptions queuing system and further research with outer community.

Finally, strategy will have to take into account changing global opportunities and challenges.

Bibliography : 40 ( 1984 - 2004 )"