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"ABSTRACTAcute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly and diabetics. Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality. Herein we report a case of 46 years old male presenting with a sudden onset of severe acute upper back pain 6 hours prior to hospital admission. Diagnosis of AMI was delayed until 12 hours later after typical ischemic chest pain manifested and ECG reading showed evolution of ST Elevation Myocardial Infarction (STEMI). Due to the atypical clinical presentation, diagnosis of AMI in this patient was delayed. Vigilant observation and low threshold for acute coronary syndrome (AC5) work up are obligatory to prevent delayed diagnosis and management."

"ABSTRAKAcute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly, diabetics, and patients with prior stroke or heart failure.1 Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality.2 Abstract : Acute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly and diabetics. Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality. Herein we report a case of 46 yearsold male presenting with a sudden onset of severe acute upper back pain 6 hours prior to hospital admission. Diagnosis of AMI was delayed until 12 hours later after typical ischemic chest pain manifested and ECG reading showed evolution of ST-Elevation Myocardial In- farction (STEMI). Due to the atypical clinical presentation, diagnosis of AMI in this patient was delayed. Vigilant observation and low threshold for acute coronary syndrome (ACS) work-up are obligatory to prevent delayed diagnosis and management. "

"Nyeri punggung atas adalah salah satu gejala atipikal dari infark miokard akut (IMA) yang lebih sering ditemukan pada perempuan, lanjut usia dan penderita diabetes. Kegagalan untuk mengenali presentasi atipik dari IMA menyebabkan telatnya diagnosis yang dihubungkan dengan meningkatnya mortalitas dan morbiditas. Dalam kasus ini kami melaporkan seorang laki-laki berusia 46 tahun datang dengan keluhan nyeri punggung atas yang berat dan mendadak sejak 6 jam sebelum masuk rumah sakit. Diagnosis IMA tertunda hingga 12 jam kemudian ketika nyeri dada tipikal dirasakan dan EKG menunjukan evolusi dari STEMI. Karena presentasi klinis yang atipikal, diagnosis IMA pada pasien ini tertunda. Pemantauan yang jeli dan pemeriksaan lanjutan untuk sindrom koroner akut (SKA) wajib dilaksanakan untuk mencegah tertundanya diagnosis dan tata laksana yang sesuai."

"ABSTRACTBackground: Pericardial effusion is a common condition in clinical practice. Manifestation of effusion depends on its causes and the underlying diseases as well as influenced by patients characteristics and geographical location. This study was conducted to determine the characteristic of pericardial effusion patient based on age, gender, cytological and clinical diagnosis. Method: The study was conducted using descriptive retrospective method. The data collected was medical record of pericardial effusion patients for 5 years from 1St January 2009 to 31 December 2013. This study was conducted in SMF Pathology Anatomy Dr. Hasan Sadikin General Hospital Bandung. Fifty four cases were collected as samples through total sampling technique. The variables were age, gender, cytological diagnosis and clinical diagnosis. Results: Pericardial effusion mostly occurred in 21 to 30 years old. Pericardial effusion is more common in man than woman. Based on the type of cytology, the most common pericardial effusion was non specific inflammation. The most common clinical features of patients is tuberculous infection. Conclusions: Pericardial effusion frequently occurred in 21 to 30 years old. Based on gender, pericardial effusion is not significantly distributed between male and female. Based on cytological diagnosis, pericardial effusion is mostly diagnosed as non spesific inflammation type. The manjority of clinical feature of pericardial effusion is tuberculosis infection."

"ABSTRAKPenulisan ini bertujuan untuk memahami bagaimana sebuah kualitas interior menghadirkan attention-diversion yang mampu memberikan kontrol terhadap pengalaman pasien sehingga dapat mengalihkan perhatian dan memunculkan perasaan positif saat menunggu. Proses pemahaman ini ditelusuri melalui studi mengenai pengalaman menunggu dan proses pembentukan kualitas interior untuk menghadirkan attention-diversion melalui pengalaman mengindra. Untuk mengetahui bagaimana cara menghadirkan attention diversion akan dilakukan penelusuran dengan membandingkan kualitas interior pada dua ruang tunggu kesehatan di Memorial Sloan Kettering Cancer Centre. Melalui analisis ini dapat dipahami bahwa konfigurasi dan elemen ruang mampu menghasilkan kualitas interior yang dibutuhkan untuk menghadirkan attention diversion. Keberagaman dari elemen ruang diversity of element dan konfigurasi ruang yang beragam menghadirkan kualitas keberagaman layout diversity of layout . Kedua kualitas interior tersebut kemudian mampu memberikan kesempatan pasien untuk memilih dan mengontrol lingkungannya ketika menunggu. opportunity of controlling

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ABSTRACTThis undergraduate thesis aims to understand how an interior quality can presents attention diversion that gives a sense of control to the patient 39 s waiting experience, so it can gives positive distraction and create positive feelings. The understanding process involves study on waiting experiences and the process of interior quality formation to present attention diversion through sensory experience. To find out how to present attention diversion,it will be done by comparing the quality of the interior in two waiting rooms at the Memorial Sloan Kettering Cancer Center. Through this analysis it can be understood that the configuration and spatial elements are capable of producing the interior quality required to present attention diversion.The diversity of spatial elements and diverse spatial configurations create a diversity of layout quality. Both of these interior qualities are able to provide the opportunity for patient to choose and control their environment while waiting."

"ABSTRAKInfeksi saluran pernafasan akut (ISPA) merupakan penyakit menular melaluiudara yang menyerang saluran nafas atas hingga saluran nafas bawah. ISPA padabalita terutama pneumonia merupakan penyebab kematian kedua di Indonesia.Penelitian ini bertujuan untuk mengetahui pemanfaatan fasilitas kesehatan olehbalita penderita ISPA di Indonesia berdasarkan Riskesdas 2013. Sampel padapenelitian cross sectional ini adalah balita penderita ISPA dan menjadi sampelRiskesdas 2013, berjumlah 23.310 orang. Hasil penelitian, 36% balita penderitaISPA memanfaatkan fasilitas kesehatan. Terdapat hubungan antara umur, waktutempuh, dan alat transportasi ke fasilitas kesehatan dengan pemanfaatan fasilitaskesehatan. Akses yang dianalisis yaitu waktu tempuh dan alat transportasi yangdigunakan terbukti berhubungan dengan pemanfaatan fasilitas pelayanankesehatan balita dengan ISPA. Faktor yang berhubungan dengan pemanfaatanfasilitas kesehatan adalah umur, waktu tempuh dan alat transportasi ke fasilitaskesehatan. Masih ada kendala akses dalam pemanfaatan fasilitas kesehatanterutama di pedesaan dan luar Pulau Jawa. Pemerintah perlu memperhatikanpeningkatan akses ke fasilitas kesehatan di pedesaan dan luar Pulau Jawa sertameningkatkan program pencegahan.

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ABSTRACTAcute respiratory infections (ARI) was airborne communicable diseases, attacksupper respiratory to lower respiratory track. ARI in children under 5 years,especially pneumonia was second leading cause of death in Indonesia. Theobjective of this study was to know the healthcare facilities utilization among thechildren under five with ARI in Indonesia. Samples were the children under fivewith ARI in Riskesdas 2013, amounted to 23,310. The study found that only 36%children under five with ARI utilized healthcare facilities. Factors related to theutilization were age, time, and transportation to healthcare facilities withhealthcare facilities utilization. Factors associated with utilization were age,times and transportation to healthcare facilities. It was suggested to solve barrierto access healthcare facilities in rural and outside Java island, as well ascontinuing preventive programs"

"Indeks Pembangunan Kesehatan Masyarakat tahun 2013 menempatkanKabupaten Cianjur terendah di Jawa Barat, dan Kota Sukabumi terjadi penurunanpaling signifikan di Provinsi Jawa Barat. Tujuan studi ini untuk menjelaskanimplementasi kebijakan urusan kesehatan di Kabupaten Cianjur dan KotaSukabumi serta mengetahui faktor-faktor yang mempengaruhinya. Penelitiandengan pendekatan postpositivisme menggunakan metode kualitatif. Hasilpenelitian implementasi kebijakan urusan kesehatan di Kabupaten Cianjurmenunjukkan belum validnya data masyarakat miskin untuk program pembiayaankesehatan, adanya hutang Pemerintah Daerah ke fasilitas kesehatan, anggarankesehatan belum 10 , akses masyarakat ke fasilitas kesehatan masih sulit,rujukan puskesmas ke rumah sakit masih tinggi, kurangnya jumlah sumber dayamanusia kesehatan dan kualitas kompetensinya yang rendah, serta belum adaperencanaan dan program pengembangan sumber daya manusia kesehatan.Sementara Kota Sukabumi implementasi kebijakan urusan kesehatan yangmeliputi pembiayaan kesehatan, fasilitas kesehatan, dan sumber daya manusiakesehatan sudah berjalan dengan baik, namun yang masih harus diperhatikanadalah program pengembangan sumber daya manusia kesehatan yang belumberjalan. Faktor kepemimpinan, komunikasi, dan sosio cultural menjadi faktordominan yang mempengaruhi implementasi kebijakan desentralisasi urusankesehatan berdasarkan konsep factors affecting implementation ofdecentralization policies yang dikemukan oleh Cheema dan Rondinelli.Kata Kunci : Kesehatan, Desentralisasi, Implementasi Kebijakan, PembiayaanKesehatan, Fasilitas Kesehatan, Sumber Daya Manusia Kesehatan, KabupatenCianjur, Kota Sukabumi

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West Java is one of the provincial area in Indonesia which consist of 25 districtsand cities. Based on 2013 Indonesian Public Health Development Index IPHDI ,there were two areas in West Java with major public health developmentconcerns. District of Cianjur has the lowest IPHDI rank in 2013, while City ofSukabumi experienced a significant decrease in IPDHI rank from 2007 to 2013.This study aimed to analyze implementation of health affair policy and to identifyfactors that affecting it in Cianjur and Sukabumi by using post positivismapproach and qualitative method. The results of the implementation of healthaffairs policy in Cianjur showed that the accurate data on poor society for healthfinancing program was not established, the presence of local government debt tohealth facilities, health budget has not covered 10 of the total budget, difficultiesin accessing health facilities, the number of referral from Puskesmas to hospitalwas high, the number and quality of competence in health human resources waslow, and human health resources development plan and program were notavailable. On the other hand, even though Sukabumi had significant decrease inIPDHI rank, this research found out that Sukabumi has established a wellperformedimplementation of health affairs policy which consist of healthfinancing programs, health facilities and health human resources. However,Sukabumi had to consider to implement the human health resource programswhich were not yet started. Overall, the findings from Cianjur and Sukabumishowed that leadership, communication and sociocultural are the dominant factorswhich influence the implementation of health affairs policy decentralization basedon factors affecting implementation of decentralization policies conceptbyCheema dan Rondinelli.Key words Healthy, Desentralization, Policy Implementation, Health Financing,Health Facility, Human Health Resources, Cianjur, Sukabumi"

"Radiation recall is an acute inflammatory reaction that can be triggered when systemic agents are administered long time after radiotherapy. Because radiotherapy is now indicated for many types of cancer, care should be taken regarding possible toxic events relating to radiotherapy in combination with radio-sensitizing agents. Gemcitabine, one such anti-cancer agent, is widely used, especially for urologic cancers. We report an intriguing case of possible radiation recall in the rectum caused by gemcitabine administration 37 years after radiation therapy. From a review of the literature, it appears that there have been no reported cases of radiation recall in the rectum with such a long interval be- tween radiation therapy and chemotherapy. Here, we describe the case and provide a literature review."

"This timely book is a road map for defining the care of acute heart failure patients in the short stay or observation unit setting. Produced in collaboration with the Society of Chest Pain Centers, this book provides an understanding of the diverse medical needs and solutions, administrative processes, and regulatory issues necessary for successful management. In an environment of increasing financial consciousness, medical practice is changing drastically. Short stay care is premier among the new specialties that cater to the complex balance of optimizing patient outcomes while minimizing fiscal burdens. The observation unit has proven to be an excellent arena for the care of acute heart failure, replete with opportunities to improve both medical management and quality metrics. Unique to the field, Short stay management of acute heart failure, providing the medical, regulatory, and economic tools necessary to create and implement successful short stay management protocols and units for the care of the heart failure patient. It is an essential guide for health care professionals and for hospitals and institutions wishing to be recognized as quality heart failure centers as accredited by the Society of Chest Pain Centers."

"Kerugian ekonomi akibat adanya gangguan kesehatan yaog dialami seseorang berdampak terhadap pembiayaan kesehatan pemerintah dao pengeluaran rumah tangga. Dalam periode tahun 2005-2006, jumlah kasus penyakit infeksi akut lain saluran pernafasao atas menempati posisi teratas dalam proporsi sepuluh penyakit terbesar di kota Jambi. Tahun 2005 sebaoyak 108.292 kasus (34,51 %) dao pada tahun 2006 sebaoyak 99.332 (32,75%). Untuk mencapai kesembuhan, seseorang yaog menderita sakit memerlukan tindakan pengobatan. Layaoao pengobatan yang dilakukan terhadap pasien, akao menimbulkao biaya pada provider selaku penyedia jasa layanan dan juga pada pasien yaog memanfaatkan jasa layanan. Biaya yang timbul pada sisi provider maupun pasien masing-masing diklasifikasikan sebagai biaya laogsung (drect cost) dan biaya tak langsung (indirect cost). Secara umum, penelitian ini bertujuan untuk memperoleh gambaran tentang besarao biaya yaog ditimbulkan akibat sakit (cost of illness) untuk rawat jalao ISPA. Tujuao khusus penelitian ini adalah untuk memperoleh gambaran tentang : karakteristik responden dan pasien rawat jalao ISPA, besaran biaya langsung (direct cost) dan biaya tak langsung (indirect cost) pada sisi provider dan pasien yang melakukao kunjungan berobat untuk mencapai kesembuhan dalam satu periode sakit. Penelitian ini menggunakao desain studi analisis biaya, yaog dilaksanakao di wilayah kerja Puskesmas Simpaog rv Sipin pada bulao Jaouari s/d. Maret 2007, dengao jumlah sampel penelitiao 96 responden. Data yaog digunakao dalam penelitiao ini adalah data sekunder yaog diperoleh dari lokasi penelitiao serta data primer yaog diperoleh dari basil interview kepada responden. Hasil penelitian menunjukkao bahwa jumlah responden terbaoyak berusia kuraog dari atau sama dengao 31 tahun. Sebagiao besar responden berjenis kelamin perempuao dao berstatus sebagai ibu rumah tangga yaog tidak memiliki penghasilao. Berdasarkao jenis kelarnin, pasien terbaoyak adalah laki-laki. Jumlah pasien terbanyak pada kelompok umur 13 - 36 bulao.Untuk mencapai kesembuhan dalam satu periode sakit, 80,21 % dari seluruh pasien masing-masing melakukan 1 kali kunjungan berobat, sisanya 19,79 % masing-masing melakukan 2 kali kunjlUlgan berobat. Jumlah klUljlUlgan berobat dalam satu periode sakit yang dilakukan oleh setiap pasien lUltuk mencapai kesembuhan, sangat berpengaruh terhadap besaran biaya yang menjadi tangglUlgan provider mauplUl biaya yang harus dikeluarkan oleh pasien. Semakin banyak jumlah klUljlUlgan berobat yang di1akukan oleh pasien maka akan semakin besar biaya yang timbul pada sisi provider mauplUl pada sisi pasien. Opportunity cost tetap ada pada biaya yang dikeluarkan oleh repondenlpasien dalam memanfaatkan layanan rawat jalan ISPA.Untuk kese1uruhan pasien, total biaya pada provider lebih besar dari total biaya pada pasien. Cost of illness pasien rawat jalan ISPA adalah Rp 2.316.259,45 dengan rata-rata Rp 24.127,70. Untuk pasien yang melakukan 1 kali kunjungan berobat, total biaya pada provider lebih besar dari total biaya pada pasien. Cost of illness pasien rawat jalan ISPA adalah Rp 1.597.144,85 dengan rata-rata Rp 20.742,14. Untuk pasien yang melakukan 2 kali kunjlUlgan berobat, total biaya pada provider lebih besar dari total biaya pada pasien. Cost of illness pasien rawat jalan ISPA adalah Rp 719.114,60 dengan rata-rata Rp 37.848,14.Saran yang dapat disampaikan adalah : Dinas Kesehatan Kota/Kabupaten serta sarana kesehatan pemerintah yang memberikan layanan pengobatanl perawatan perlu melakukan perhitlUlgan dan analisis biaya secara menyeluruh berdasarkan kegiatan dalam memberikan pelayanan. Puskesmas seyogyanya mempertahankan dan meningkatkan penerapan pola pelayanan pengobatan sesuai standar. Perlu dilakukan pengembangan model perhitlUlgan biaya ini ke dalam bentuk perangkat lunak komputer. Kepada peneliti lain diharapkan dapat melakukan penelitian serupa terhadap jenis penyakit lainnya.

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Economic loss due to health disorder experienced by patient have an impact to governmenthealth financing and household health expenditure. From 2005 to 2006 period, acute respiratory infection disease was in first place of top ten diseases in Jambi City. In 2005 there were 108.292 cases (34,51%) and in 2006 were 99.332 cases (32,75%). The patient needs medical care to recover from the illness. Medical service for patient will incur the cost upon the provider who provides the service and the patient who uses the service. The cost incurred upon both the provider and the patients are classified into direct cost and indirect cost.

The aim of this study was to describe the amount of the cost of illness for acute respiratory infection disease outpatient. The particular objectives were to describe characteristics of the participant and patient of acute respiratory infection disease outpatient, the amount of direct cost and indirect cost upon provider and the patient who performed medical visit to get recovery from the illness period.

This study used cost analysis design, carried out in Simpang IV Sipin Public Health Centre from January to March2007, with 96 participants. Datawere secondary data collected from study area and primary data obtained from interviewed participants.

The findings demonstrated that most patients were less or equal to 31 years old. Majority of them female and housewives. Base on gender the most patients were male. The most patients were in 13 -36 months age group.

To get recovery in one illness period, 80,21% of total patients performed once medical visit, the remaining patients did twice medical visit. The medical visit patient performs in one illness period to get recovery from the illness highly influence the amount of cost upon provider and the patient. The more visits patient has, the higher the cost required upon provider and the patient. Opportunity cost I remains upon the patients expenditures in using acute respiratory infection outpatient services.

For all patients, the total costs upon provider were higher than the total costs uponpatient. Cost of illness for acute respiratory infection out patient was. Rp 2.316.259,45 with Rp 24.127,70 on average. For the patients who did once medical visit, the total costs upon provider were higher than total costs upon patients. Cost of illness foracute respiratory infection out patient were Rp1.597.144,85withRp. 20.742,14 on average. For the patients who did twice medical visit, the total costs upon provider were higher than total costs upon patients. Cost of illness for acute respiratory infection outpatient were Rp 719.114,60 with Rp. 37.848,14 on average.

It is suggested that District Health and government health facilities that provide medical/nursing care are required to calculate and conduct cost analysis as a whole based on activities in providing services. Public Health Centre must maintain and improve medical service pattern application by standard. It is need to develop this cost calculation model into computer software. Further researchers are needed to do the similar study for other diseases."