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"Pendahuluan: Kateterisasi vena sentral (KVS) adalah sebuah faktor risiko utama untuk terjadinya stenosis vena sentral (SVS). Kontak berulang dari kateter ke dinding pembuluh darah menyebabkan inflamasi, mikrotrombi, hiperplasia intima, fibrosis dan akhirnya stenosis. Artikel ini melaporkan korelasi antara durasi dan frekuensi KVS dengan terjadinya SVS. Metode: Studi kasus kontrol dilakukan di Rumah Sakit CiptoMangunkusumo. Data diambil dari rekam medis tahun 2013 sampai 2015. Hasil: Lima puluh empat dari 717 pasien yang menjalani KVS untuk hemodialisa menderita SVS. 32 pasien dengan SVS menjadi kasus dan 128 tanpa SVS sebagai kontrol. Durasi KVS >6 minggu tidak meningkatkan resiko SVS (p=0,207), rasio odds SVS ditemukan 30 kali pada pasien yang menjalani KVS >2 kali dibandingkan <2 kali (p<0,001). Konklusi: Frekuensi KVS > 2 kali meningkatkan risiko SVS. Durasi >6 minggu tidak meningkatkan risiko SVS.

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Introduction: Central vein catheterization (CVC) is a major risk factor for central vein stenosis (CVS). Repetitive contacts of the CVC to the blood vessel wall results in inflammation, microthrombi, hyperplasia of the intima, fibrosis and thus development of CVS. This article reports the correlation of duration and frequency of CVC in patients with CVS.

Methods: A matched case control study was conducted in CiptoMangunkusumo Hospital. Samples were gathered from the medical record from 2013 to 2015.

Results: Fifty four out of 717 patients underwent CVC for HD had CVS. 32 patients with CVS included in the study with 128 non-CVS patients included as control. Duration of CVC >6 weeks does not increase the risk of CVS (p= 0.207), whilst the odds ratio of CVS on the frequency of CVC >2 times is 30 times compared to those underwent <2 times (p= <0.001).

Conclusion: The frequency of CVC >2 times increased the risk of CVS. Longer duration of CVC for HD did not increase CVS rate."

"Latar belakang. Penggunaan kateter hemodialisis temporer pada kondisi kronik merupakan faktor risiko terjadinya stenosis vena sentral. Penelitian ini bertujuan untuk mengetahui hubungan penggunaan kateter hemodialisis temporer non-cuffed/non-tunneled double lumen catheter jangka panjang serta faktor risiko lainnya yang berperan dalam terjadinya stenosis vena sentral pada populasi pasien hemodialisis di RSUP dr Cipto Mangunkusumo RSCM .Metode. Dilakukan studi deskriptif analitik dengan desain kasus kontrol pada populasi pasien penyakit ginjal kronis stadium 4-5 yang menjalani hemodialisis di RSCM dan terdiagnosis stenosis vena sentral, baik secara klinis maupun radiologis pada periode tahun 2012-2016 yang dilakukan di Divisi Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM mulai bulan Maret 2016 sampai Juli 2016 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik data sekunder dengan mengambil seluruh kasus stenosis vena sentral total sampling dan kontrol dengan perbandingan 1:1 antara kasus dan kontrol. Analisis data berupa analisis univariat, bivariat dan multivariat dan diuji dengan SPSS version 17.0 for Windows. Hasil. Data subjek penelitian yang diperoleh sebanyak 126 subjek 63 kasus dan 63 kontrol . Durasi penggunaan kateter hingga terjadinya stenosis vena sentral rata-rata 469 hari. Stenosis vena sentral paling banyak terjadi pada vena brakiosefalika 36 subjek, 57,14 , vena subklavia 22 subjek, 34,92 dan vena jugularis interna 5 subjek, 7,94 . Dari hasil analisis multivariat, faktor yang berperan dalam terjadinya stenosis vena sentral yaitu penggunaan jenis kateter temporer p = 0,006, OR 5,97, IK 95 1,65 ndash;21,58 , sisi pemasangan kateter di sebelah kiri p = 0,007, OR 10,17, IK 95 2,01 ndash;52,34 dan penggunaan kateter >2 kali p = 0,006, OR 11,15, IK 95 1,65 ndash;51,05 . Simpulan. Penggunaan kateter non-cuffed/non-tunneled terutama pada kondisi kronik >1 minggu yang dipasang pada sisi kiri tubuh dan dengan riwayat >2 kali pemasangan berisiko tinggi menyebabkan terjadinya stenosis vena sentral.Kata kunci: stenosis vena sentral, kateter hemodialisis temporer, akses vaskular

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Background The use of temporary hemodialysis catheters in chronic condition is a risk factor for central venous stenosis. This study aims to determine the relationship of temporary hemodialysis catheter use non cuffed non tunneled double lumen catheter in chronic condition as well as other factors that play a role in the occurrence of central venous stenosis in hemodialysis patient population in Dr. Cipto Mangunkusumo Hospital RSCM .Method This was a descriptive analytic study with case control design conducted in the Division of Vascular and Endovascular Surgery Department of the Faculty of Medicine RSCM from March 2016 to July 2016. The study population was patients with stage 4 5 chronic kidney disease undergoing hemodialysis RSCM and diagnosed with central venous stenosis, both clinically and radiologically in the period of 2012 2016, which meet the inclusion and exclusion criteria. Source data were extracted from medical records secondary data by taking all cases of central venous stenosis total sampling and control with the ratio of 1 1 between cases and controls. Analysis of the data was presented in the form of univariate, bivariate and multivariate analysis and tested with SPSS version 17.0 for Windows.Results The data obtained by the research subjects were 126 subjects 63 cases and 63 controls . The average duration of catheter use until the occurrence of central venous stenosis was 469 days. Central venous stenosis is the most common among brachiocephalic vein 36 subjects, 57.14 , the subclavian vein 22 subjects, 34.92 and the internal jugular vein 5 subjects, 7.94 . From the results of the multivariate analysis, the factors that play a role in the occurrence of central venous stenosis were namely the use of temporary catheters p 0.006, OR 5.97, 95 CI 1.65 to 21.58 , catheter implantation on the left side ipsilateral to fistula p 0.007, OR 10.17, 95 CI 2.01 to 52.34 and the use of catheters 2 times p 0.006, OR 11.15, 95 CI 1.65 to 51.05 .Conclusions The use of non cuffed non tunneled catheters especially in chronic condition 1 week which is implanted on the left side of the body ipsilateral to fistula and with a history of 2 times catheter implantations cause central venous stenosis.Keywords central venous stenosis, temporary hemodialysis catheter"

"Kateter vena sentral (Central Venous Catheter/CVC) digunakan secara luas terhadap pasien dengan kanker, beresiko menyebabkan infeksi primer aliran darah (IPAD) yang berakibat pada meningkatnya morbiditas, lama hari rawat serta biaya operasional dan pengobatan. Penelitian ini menggunakan disain studi potong lintang untuk mengetahui gambaran kejadian IPAD pasien dengan kanker terkait pemasangan CVC (IPAD-CVC) di RS. Kanker “Dharmais” tahun 2011-2012 pada populasi seluruh pasien kanker yang terpasang CVC dan didapatkan 119 sampel yang telah memenuhi kriteria inklusi dan eksklusi. Analisis univariat menunjukkan frekuensi pasien yang mengalami sepsis (18,5%), kolonisasi (47,9%), bakteremia (14,3%) dengan insidens IPAD-CVC (13,3%) banyak terjadi pada pasien dengan jenis keganasan hematologi (78,4%), pada ruang isolasi imunitas menurun (90%). IPAD-CVC banyak dialami oleh pasien kanker dengan rata-rata lama hari rawat > 30 hari dan sebanyak 45,0% disebabkan oleh bakteri gram-negatif. Perilaku asuhan keperawatan pasien dengan kanker termasuk pemasangan CVC, dukungan manejemen dan pengelolaan data surveilens yang lebih baik diperlukan dalam upaya pencegahan dan pengendalian infeksi aliran darah.

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Central venous catheter (CVC) are used extensively in patient with neoplastic disease, and primary bloodstream infection related to CVC (BSI-CVC) increasing morbidity, prolonged hospital stays including operational costs and treatment. Cross-sectional study with all hospitalized patient with an underlying cancer using CVC in periods 2011-2012 to describe primary bloodstream infections related to CVC at “Dharmais” National Cancer Centre year 2011-2012. 119 patients were selected from inclusion and exclusion criteria were eligible for this study. Univariate analysis shows clinical sepsis (18.5%), colonization (47.9%), bacteremia (14.3%) and cumulative incidence of BSI-CVC (13.3%). Most frequent of BSI-CVC are patient with hematology malignancies (78.4%) and higher proportion are patients in the immunocompromised-care (90%) in patients with average of hospital stays are more than 30 days. 45% Gram-negative bacteria’s are responsible to BSI-CVC. Behavior of nursing care against cancer patients with CVC, management support and surveillance data needed to bloodstream infection control and prevention."

"Latar belakang: Pemasangan kateter vena sentral dapat menimbulkan komplikasi serius terutama IAD terkait kateter vena sentral. Pencegahan IAD merupakan tantangan tersendiri, karena diperlukan pengawasan dan evaluasi kepatuhan yang konsisten terhadap bundle IAD. Melalui metode PDSA bundle IAD diharapkan dapat meningkatkan kepatuhan melaksanakan bundle IAD. Tujuan penelitian ini adalah untuk mengetahui efektivitas implementasi metode PDSA bundle IAD dalam menurunkan angka IAD pada anak di RSCMMetode: Desain penelitian ini adalah quasi ekperimental. anak usia 1 bulan sampai dengan 18 tahun yang dilakukan pemasangan kateter vena sentral oleh tim ERIA RSCM pada periode Juni-November 2022. Teknik pengambilan sampel dilakukan dengan cara consecutive sampling.Hasil: Total subjek pada penelitian ini sebanyak 280. Pada pre-test PDSA pemasangan sebanyak 143, gagal pemasangan 2 pasien. Pada post-test PDSA didapatkan 137 subjek. Terdapat penurunan angka IAD sebesar 4,1/1000 hari pemasangan kateter vena sentral dalam 3 bulan penerapan siklus PDSA. Angka IAD pre-test PDSA total rata-rata sebesar 12,7/1000 hari pemasangan dan menurun menjadi rata-rata 8,6/1000 hari pemasangan pada 3 bulan post-test PDSA. Puncak tertinggi angka IAD pre-test PDSA bulan Juli 2022 yaitu 18,9/1000 hari pemasangan, sedangkan angka IAD terendah dicapai pada bulan November 2022 sebesar 3,4/1000 hari pemasangan.Kesimpulan: Angka IAD dapat menurun sebesar 4,1/1000 hari pemasangan kateter vena sentral dalam waktu 3 bulan, dan mencapai target angka IAD yang ditetapkan RSCM yaitu 3,5/1000 hari pemasangan pada bulan November 2023 dengan angka IAD 3,4/1000 hari pemasangan setelah implementasi metode PDSA) Bundle IAD.

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Background: Insertion of a central venous catheter can cause serious complications, especially CLABSI. Prevention CLABSI is very challenging. The PDSA method is expected to increase compliance in implementing the bundle. The purpose of this study was to determine the effectiveness of implementing bundle CLABSI PDSA method in reducing CLABSI rates in children at Cipto Mangunkusumo Hospital

Method: The design of this study is quasi-experiential. Pediatric patient aged 1 month to 18 years old who were installed CVC by the Pediatric Emergency and Intensive Care team in the period between June-November 2022. The sampling technique is carried out by consecutive sampling

Results: Total subjects were 280. PDSA pre-test were 143 installations, while the PDSA post-test had 137 subjects. CLABSI rate decreased 4.1/1000 days of central venous catheter insertion within 3 months after PDSA. Total CLABSI pre-test PDSA rate 12.7/1000 days of insertion and decreased to 8.6/1000 days of insertion after PDSA implementation. The highest peak of CLABSI rate before PDSA in July 2022 was 18.9/1000 days of insertion, the lowest CLABSI rate achieved in November 2022 of 3.4/1000 days of insertion after PDSA implementation.

Conclusion: The CLABSI rate can decrease by 4.1/1000 days of central venous catheter insertion within 3 months, and reach the CLABSI rate target in Cipto Mangunkusumo Hospital, which is 3.5/1000 days of insertion in November 2023 with a CLABSI rate of 3.4/ 1000 days of insertion after the implementation of the Bundle IAD plan-do-study-act (PDSA) method."

"Kelebihan beban cairan pascaresusitasi dihubungkan dengan luaran buruk sehingga diperlukan deresusitasi. Tekanan vena sentral (TVS) rendah penting untuk menjamin aliran balik darah, meningkatkan curah jantung dan memperbaiki perfusi jaringan. Penelitian ini bertujuan menilai efektivitas deresusitasi dengan target TVS 0–4 mmHg pada pasien pascaresusitasi renjatan sepsis di ICU. Penelitian menggunakan desain randomized controlled trial dan dilakukan di RSUPN dr. Cipto Mangunkusumo pada bulan September 2019–Oktober 2020. Subjek berusia 18–60 tahun dengan renjatan sepsis pascaresusitasi. Kriteria eksklusi adalah gangguan jantung primer, gagal jantung kanan, penyakit jantung bawaan, penyakit paru obstruksi menahun berat, efusi pleura berat, batu atau tumor ginjal dan gagal ginjal kronik. Subjek penelitian dibagi menjadi dua kelompok dengan target TVS 0–4 mmHg dan 8–10 mmHg dan dilakukan dideresusitasi. Target TVS dicapai dengan furosemid drip dan loading kristaloid. Parameter luaran adalah perbedaan hasil PVD, stadium AKI, indeks curah jantung, lama penggunaan ventilator, dan lama hari perawatan di ICU. Data dianalisis program SPSS versi 20.0 meliputi analisis deskriptif dan inferensial memakai uji yang sesuai. Dari 44 subjek, 1 subjek dikeluarkan karena menjalani hemodialisis karena gagal ginjal kronik pada kelompok dengan target TVS 8–10 mmHg. Karakteristik dasar pasien berupa stadium AKI, ureum, kreatinin dan nilai TVS inisial berbeda bermakna pada kedua kelompok. Deresusitasi dengan target TVS 0–4 mmHg tidak berbeda bermakna pada nilai PVD, perbaikan AKI, CI, lama penggunaan ventilator, dan perawatan ICU (p>0,05). Tiga subjek meninggal sebelum selesai follow up pada kelompok dengan target TVS 0–4 mmHg dan 6 subjek meninggal sebelum selesai follow up, pada kelompok dengan target TVS 8–10 mmHg. Simpulan: Tidak didapatkan perbedaan efektivitas antara target deresusitasi TVS 0‒4 mmHg dengan target TVS 8‒10 mmHg terhadap nilai PVD sublingual, perubahan stadium AKI KDIGO, indeks curah jantung, lama penggunaan ventilator, lama perawatan ICU

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Post-resuscitation fluid overload is associated with a poor outcome in critically patient and thus requires deresuscitation (aggressive fluid removal). Low central venous pressure (CVP) is important to ensure the venous return, increase cardiac output and improve tissue perfusion. This study aims to assess the effectiveness of deresuscitation with a CVP target of 0–4 mmHg in post-septic shock resuscitation patients in the emergency department and ICU. This study used a randomized controlled trial design at RSUPN Dr. Cipto Mangunkusumo in September 2019–October 2020. The study sample was patients 18–60 years old with septic shock in the post-resuscitation ICU. Exclusion criteria were patients with primary heart failure, right heart failure, congenital heart disease, severe chronic obstructive pulmonary disease, severe pleural effusion, kidney stones or tumors, and chronic renal failure. The study subjects were deresuscited and divided into two CVP target groups (0–4 mmHg and 8–10 mmHg). Furosemide drip and cristaloid were given to reach target of CVP. Outcome parameters were differences in PVD, AKI stage, cardiac index (CI), ventilator duration, and length of stay in ICU. Statistical analysis includes descriptive and inferential analysis testing the appropriate test. Data analysis was performed using the SPSS version 20.0 statistical program. Results: There were 44 subjects, 1 subject were excluded due to hemodialysis in CVP target of 8–10 mmHg. Baseline characteristics have significant difference in ureum, creatinine, AKI stage and initial CVP value between two groups. Deresuscitation with a CVP target of 0–4 mmHg did not have a significant difference in the value of PVD, improvement in AKI, CI, ventilator duration, and length of ICU stay (p > 0.05). Three subjects died before 7 days of follow up in CVP target of 0–4 mmHg and 3 subjects died before 7 days of follow up in CVP target of 8–10 mmHg."

"ABSTRAKAbstrakLatar belakang. Penggunaan kateter hemodialisis temporer pada kondisi kronik merupakan faktor risiko terjadinya stenosis vena sentral. Penelitian ini bertujuan untuk mengetahui hubungan penggunaan kateter hemodialisis temporer non-cuffed/non-tunneled double lumen catheter jangka panjang serta faktor risiko lainnya yang berperan dalam terjadinya stenosis vena sentral pada populasi pasien hemodialisis di RSUP dr Cipto Mangunkusumo RSCM .Metode. Dilakukan studi deskriptif analitik dengan desain kasus kontrol pada populasi pasien penyakit ginjal kronis stadium 4-5 yang menjalani hemodialisis di RSCM dan terdiagnosis stenosis vena sentral, baik secara klinis maupun radiologis pada periode tahun 2012-2016 yang dilakukan di Divisi Vaskular dan Endovaskular Departemen Ilmu Bedah FKUI-RSCM mulai bulan Maret 2016 sampai Juli 2016 yang memenuhi kriteria inklusi dan eksklusi. Sumber data diambil dari rekam medik data sekunder dengan mengambil seluruh kasus stenosis vena sentral total sampling dan kontrol dengan perbandingan 1:1 antara kasus dan kontrol. Analisis data berupa analisis univariat, bivariat dan multivariat dan diuji dengan SPSS version 17.0 for Windows. Hasil. Data subjek penelitian yang diperoleh sebanyak 126 subjek 63 kasus dan 63 kontrol . Durasi penggunaan kateter hingga terjadinya stenosis vena sentral rata-rata 469 hari. Stenosis vena sentral paling banyak terjadi pada vena brakiosefalika 36 subjek, 57,14 , vena subklavia 22 subjek, 34,92 dan vena jugularis interna 5 subjek, 7,94 . Dari hasil analisis multivariat, faktor yang berperan dalam terjadinya stenosis vena sentral yaitu penggunaan jenis kateter temporer p = 0,006, OR 5,97, IK 95 1,65 ndash;21,58 , sisi pemasangan kateter di sebelah kiri p = 0,007, OR 10,17, IK 95 2,01 ndash;52,34 dan penggunaan kateter >2 kali p = 0,006, OR 11,15, IK 95 1,65 ndash;51,05 . Simpulan. Penggunaan kateter non-cuffed/non-tunneled terutama pada kondisi kronik >1 minggu yang dipasang pada sisi kiri tubuh dan dengan riwayat >2 kali pemasangan berisiko tinggi menyebabkan terjadinya stenosis vena sentral.

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ABSTRACTBackground The use of temporary hemodialysis catheters in chronic condition is a risk factor for central venous stenosis. This study aims to determine the relationship of temporary hemodialysis catheter use non cuffed non tunneled double lumen catheter in chronic condition as well as other factors that play a role in the occurrence of central venous stenosis in hemodialysis patient population in Dr. Cipto Mangunkusumo Hospital RSCM .Method This was a descriptive analytic study with case control design conducted in the Division of Vascular and Endovascular Surgery Department of the Faculty of Medicine RSCM from March 2016 to July 2016. The study population was patients with stage 4 5 chronic kidney disease undergoing hemodialysis RSCM and diagnosed with central venous stenosis, both clinically and radiologically in the period of 2012 2016, which meet the inclusion and exclusion criteria. Source data were extracted from medical records secondary data by taking all cases of central venous stenosis total sampling and control with the ratio of 1 1 between cases and controls. Analysis of the data was presented in the form of univariate, bivariate and multivariate analysis and tested with SPSS version 17.0 for Windows.Results The data obtained by the research subjects were 126 subjects 63 cases and 63 controls . The average duration of catheter use until the occurrence of central venous stenosis was 469 days. Central venous stenosis is the most common among brachiocephalic vein 36 subjects, 57.14 , the subclavian vein 22 subjects, 34.92 and the internal jugular vein 5 subjects, 7.94 . From the results of the multivariate analysis, the factors that play a role in the occurrence of central venous stenosis were namely the use of temporary catheters p 0.006, OR 5.97, 95 CI 1.65 to 21.58 , catheter implantation on the left side ipsilateral to fistula p 0.007, OR 10.17, 95 CI 2.01 to 52.34 and the use of catheters 2 times p 0.006, OR 11.15, 95 CI 1.65 to 51.05 .Conclusions The use of non cuffed non tunneled catheters especially in chronic condition 1 week which is implanted on the left side of the body ipsilateral to fistula and with a history of 2 times catheter implantations cause central venous stenosis.Keywords central venous stenosis, temporary hemodialysis catheter, vascular access"

"Since their first application in 1982, Totally Implantable Venous Access Devices (TIVADs) have become increasingly important in the clinical practice, as more intensive chemotherapy and parenteral treatments have come into use. At this time, there is objective evidence that TIVADs are a safe, effective strategy for long-term venous access; they play a significant role throughout the management of the oncology patient, as they are needed in the initial phases for active treatments as well as in the last stages for palliative measures, making possible repeated administration of chemotherapeutic vesicant agents, nutrients, antibiotics, analgesics, and blood products. According to a number of prospective studies, use of TIVADs is associated with a significant complication rate (10% to 25% of all patients). Evidence-based data support that most complications are directly related to inappropriate technique of placement and/or nursing care, sometimes leading to TIVAD loss, significant morbidity, increased duration of hospitalization, and additional medical cost."

"Latar belakang: Insufisiensi vena kronis IVK derajat berat atau C5-C6 membutuhkan penatalaksanaan yang lebih kompleks dan membawa dampak morbiditas yang lebih berat akibat lamanya waktu pengobatan dan angka kekambuhan yang tinggi. Tata laksana definitif IVK C5-C6 telah mengalami pergeseran dari terapi non operatif terapi kompresi dan medikamentosa menjadi terapi operatif dengan teknik non invasif seperti ablasi endovena. Penelitian ini bertujuan untuk melakukan evaluasi terhadap jenis terapi yang diberikan baik terapi definitif maupun terapi perawatan luka dengan keluaran berupa angka rekurensi dan lama rawat.Metode penelitian: Studi potong lintang analitik dilakukan dengan mengambil total sampel 54 pasien IVK C5-C6 yang datang ke RSCM pada periode Januari 2014-Desember 2015. Pasien IVK yang disertai dengan insufisiensi arteri, insufisiensi vena dalam, dan kelainan kulit akibat penyakit kulit primer, keganasan, trauma dieksklusi. Analisis statistik diolah dengan SPSS 21 for windows, untuk menilai keluaran dari terapi definitif berupa angka kekambuhan dan lama rawat.Hasil penelitian: Angka kekambuhan pasien IVK C5-C6 dengan terapi operatif lebih rendah dibandingkan dengan terapi non operatif yakni 7,1 berbanding 30,8 dalam follow up selama 2 tahun dengan nilai p 0,02 dan OR 0,17 95 IK 0,03-0,91. Lama perawatan rerata pasien IVK C5-C6 pada kelompok terapi operatif selama 10,6 hari dan kelompok non operatif selama 14,8 hari.Kesimpulan: Angka kekambuhan pasien IVK C5-C6 yang memperoleh terapi definitif operatif lebih rendah dari yang hanya memperoleh terapi non operatif dalam evaluasi selama 1-2 tahun

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Background: Severe degree C5-C6 of chronic venous insufficiency CVI require complex management and bring severe morbidity due to long duration of treatment and high recurrence rate. This leads to high treatment costs and interfered quality of patients life. Management of CVI C5-C6 in developed countries has changed from non operative therapy to operative therapy with non-invasive technique, i.e. endovascular treatment. In Indonesia CVI patient characteristics differ from developed countries, where the majority of patients come at advanced stage or C5-C6. This study aims to evaluate the management of CVI C5-C6, both definitive therapy and also wound care techniques, to afford an appropriate treatment in accordance with the characteristics of the patients in Indonesia. Method: a cross sectional analytic study carried out by taking the total sample of 54 patients who came with CVI C5-C6 to Cipto Mangunkusumo Hospital in the period of January 2014-December 2015. Those accompanied by arterial insufficiency, deep venous insufficiency, and skin disorders due to primary skin disease, malignancy, trauma were excluded. Statistical analysis is processed with SPSS 21 for windows, to assess the outcome of the definitive therapy in the form of recurrence rates and length of stay. Results: Recurrence rate of CVI C5-C6 patients with operative therapy is lower than non-operative therapy which is 7.1 versus 30,8 in 2-year follow-up with p-value of 0.02 and OR 0.17 95 CI 0, 03-.91. The mean treatment duration CVI C5-C6 patients in the operative therapy group is 10.6 days and non-operative group is 14.8 days Conclusions: recurrence rate of CVI C5-C6 patients who obtain definitive operative therapy was lower than non-operative therapy group in the evaluation for 1-2 years."

"ABSTRAKTelah dilakukan penelitian tentang PENGARUH GERAK BADAN PEMULIHAN (COOL-DOWN) SETELAH MELAKUKRN KERJA FISIK TERHADAP TEKANAN DARAH DAN FREKUENSI DENYUT JANTUNG, pada 30 orang percobaan, 1ak1-iakl umur 20-30 tahun, bukan atlit.Penelitian I dengan gerak badan pemulihan. penelitian II tanpa gerak badan pemulihan. Seminggu setelah penelitian I. Tekanan darah dan frekuensi denyut jantung diperiksa perubahannya dari saat segera sampai dengan 30 menit setelah kerja fisik dihentikan. Terdapa perbedaan tekanan darah sistolik yang sangat bermakna pada 1/2 menit pertama setelah kerja fisik dihentikan. Terdapat perbedaan frekuensi denyut jantung yang bermakna pada menit ke 1/2, 1, 2, dan 3 dan perbedaan yang sangat bermakna pada menit ke 30 setelah kerja fisik dihentikan.Keluhan subjektif berupa pusing dan lemas terdapat pada yang tidak melakukan gerak badan pemulihan (23.33%), yang timbul pada 1/2 menit pertama setelah kerja fisik dihentikan. Pada yang melakukan gerak badan pemulihan tidak terjadi keluhan subjektif."