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"Background: chronic and terminal diseases require holistic therapy that covers the biopsychosocial aspect, and it can be found in palliative therapy. Patients who receive palliative therapy exhibit very diverse profiles. As such, researchers are keen to study the general characteristics of palliative patients. In addition, researchers will also assess the patients and their familys insight that influences the success of the therapy and the impact of estimated survival time in making treatment decisions. Methods: this research used cross-sectional descriptive analytic study and secondary data of 300 palliative patients who consult to Psychosomatic Palliative Team at Dr. Cipto Mangunkusumo Hospital. The data were processed using SPSS version 25. The data processed included: sociodemographic characteristics, length of stay, incidence of death in hospital, DNR cases, the patients and their familys insight, and the impact of estimated survival time on treatment decisions. Results: most palliative patients were women (52.0%) aged 51 - 60 years (27.0%), unemployed (29.0%), and suffered from cancer (55.3%). In addition, the patients were generally treated for less than 1 month (83.6%), died in the hospital (37.3%), and consented to DNR orders (36.7%). These DNR cases are highly correlated to the familys understanding regarding the prognosis of the patients condition (p = 0.022). The familys understanding of the diagnosis, prognosis, and treatment goals (92.3%, 81.3%, and 87.7%) was better than the patients (79.0%, 64.0%, and 69.7%). Furthermore, no link was found between the therapy choice (optimal, withholding, and withdrawing therapies) with the patients estimated survival time (p = 0.174). Conclusion: female, elderly, and cancer patiens most often get palliative therapy. The consent for DNR orders to palliative patient is notably frequent. Currently, the familys insight is much better than the patients, which means that health care providers need to improve patient education and information. In addition, patients and families generally still opt for optimal therapy despite low estimated survival time.

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Latar belakang: penyakit kronis dan terminal membutuhkan terapi holistik yang mencakup aspek biopsikososial, dan dapat ditemukan dalam terapi paliatif. Pasien yang menerima terapi paliatif menunjukkan profil yang sangat beragam. Oleh karena itu, peneliti ingin melihat karakteristik umum pasien paliatif. Selain itu, peneliti juga akan menilai tilikan pasien dan keluarga yang mempengaruhi keberhasilan terapi dan pengaruh perkiraan waktu bertahan hidup dalam membuat keputusan pengobatan. Metode: penelitian ini menggunakan studi analitik deskriptif potong lintang dan data sekunder dari 300 pasien paliatif yang berkonsultasi dengan Tim Paliatif Psikosomatik di Rumah Sakit Dr. Cipto Mangunkusumo. Data diproses menggunakan SPSS versi 25. Data yang diproses termasuk karakteristik sosiodemografi, lama tinggal, kejadian kematian di rumah sakit, kasus DNR, tilikan pasien dan keluarga, dan pengaruh perkiraan waktu bertahan hidup terhadap jenis pengobatan yang dipilih.

Hasil: sebagian besar pasien paliatif adalah wanita (52,0%) berusia 51 - 60 tahun (27,0%), tidak bekerja (29,0%), dan menderita kanker (55,3%). Selain itu, pasien umumnya dirawat kurang dari 1 bulan (83,6%), meninggal di rumah sakit (37,3%), dan menyetujui DNR (36,7%). Kasus-kasus DNR ini sangat berkorelasi dengan pemahaman keluarga mengenai prognosis kondisi pasien (p = 0,022). Pemahaman keluarga tentang diagnosis, prognosis, dan tujuan pengobatan (92,3%, 81,3%, dan 87,7%) lebih baik daripada pasien (79,0%, 64,0%, dan 69,7%). Lebih lanjut, tidak ada hubungan yang ditemukan antara pilihan terapi (optimal, pembatasan, dan pengurangan terapi) dengan perkiraan waktu kelangsungan hidup pasien (p=0,174).

Kesimpulan: pasien wanita, lansia, dan kanker paling sering mendapatkan terapi paliatif. Persetujuan untuk DNR pada pasien paliatif sangat sering. Saat ini, tilikan keluarga jauh lebih baik daripada pasien, yang berarti bahwa penyedia layanan kesehatan perlu meningkatkan pendidikan dan informasi ke pasien. Selain itu, pasien dan keluarga umumnya masih memilih terapi yang optimal meskipun waktu perkiraan bertahan hidup yang rendah"

"Latar Belakang. Pendekatan holistik di bidang Psikosomatik menekankan faktor spiritualitas dan dukungan pada sisi spiritualitas dapat meningkatkan pelayanan serta memperbaiki kondisi psikologis pada pasien. Selama prosedur hemodialisis respon inflamasi akan meningkat dibuktikan dengan peningkatan konsentrasi interleukin-6 (IL- 6). Aspek spiritual yang dapat menurunkan respon inflamasi masih perlu diteliti. Tujuan. Untuk mengetahui gambaran aspek spiritual pasien yang menjalani hemodialisis kronik dan untuk mengetahui korelasi aspek spiritual dengan kadar IL-6 serum pada pasien yang menjalani hemodialisis kronik. Metode. Penelitian ini merupakan studi cross sectional dilakukan pada 51 pasien hemodialisis kronik di unit Hemodialisis RSUP. H. Adam Malik dan RSU. Dr. Pirngadi Medan mulai bulan Juli-Agustus 2014. Pemeriksaan kadar IL-6 serum diukur dengan metode quantitative enzyme-linked immunosorbent assay (ELISA) dilakukan pengambilan sampel darah dan pengukuran spiritual dilakukan dengan pengisian kuesioner FACIT Sp-12 pada pagi hari 30 menit sebelum hemodialisis berlangsung. Hasil. Skor subskala meaning (makna) 10.67 (SB 2.66), peace (damai) 9.63 (SB 2.19) dan faith (iman) 11.47 (SB 2.91). Nilai median kadar IL-6 serum pada penelitian ini adalah adalah 5,63 (1,48-28,88) pg/mL. Nilai median FACIT Sp-12 adalah 30,00 (18-48). Hasil uji korelasi antara tingkat spiritual dengan kadar IL-6 serum menunjukkan koefisien korelasi -0,330 dengan nilai p = 0,018 yang secara statistik menunjukkan korelasi negatif yang lemah. Simpulan. Spiritual pada pasien hemodialisis kronik tinggi. Terdapat korelasi negatif yang lemah antara aspek spiritual dengan kadar IL-6 pada pasien hemodialisis kronik.

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Background: Holistic approach in psychosomatic focus on spirituality factor and spiritual support is expected to improve services and psychological condition of the patients. Inflammatory response during haemodialysis procedure hence increased with the evidence of increasing level of serum interleukin-6 (IL-6). Further research is still needed to see the spiritual factors that can decrease the inflammatory factors.

Objective: To assess spiritual aspect of chronic haemodialysis patients and to assess correlation between serum IL-6 level and spiritual aspect in chronic haemodialysis patients.

Methods: Cross sectional study on 51 chronic haemodialysis patients at RSUP. H. Adam Malik and RSU dr. Pirngadi Medan between July-August 2014. Serum IL-6 was measured using quantitative enzyme-linked immunosorbent assay (ELISA) methods. Blood samples and spiritual aspect assessment by handing out FACIT. Sp-12 questionnaire to patients were taken in the morning, 30 minutes before haemodialysis.

Results: Subscale meaning 10.67 (SB 2.66), peace 9.63 (SB 2.19) and faith 11.47 (SB 2.91). Median serum IL-6 level is 5,63 ( 1,48-28,88 ) pg/mL. Median FACIT Sp-12 is 30,00 (18-48). Correlation test between serum IL-6 level and spiritual aspect have shown statistically weak negative correlation (correlation coefficient -0,330, p = 0.018).

Conclusion: spirituality level in chronic hemodialysis patients are higher. Weak negative correlation between serum IL-6 level and spiritual level on chronic haemodialysis patients was found in this study."

"ABSTRAKDokter di Pusat Kesehatan Masyarakat (Puskesmas) kadang tidak mengenali adanya depresi pada seseorang. Pemberian pelatihan psikiatri untuk dokter di Puskesmas diperkirakan dapat meningkatkan pengetahuan dan keterampilan diagnosis terhadap masalah psikiatri. Divisi Psikiatri Komunitas Departemen Psikiatri Fakultas Kedokteran Universitas Indonesia telah menyusun suatu modul pelatihan yaitu ADAPT (Advance in Depression and Psychosomatic Treatment). Modul bertujuan untuk meningkatkan keterampilan dokter di Puskesmas dalam melakukan deteksi kasus gangguan jiwa yang sering di masyarakat. Modul merujuk pada PPDGJ III.Tujuan: Mengetahui efektivitas pemberian pelatihan modul ADAPT dalam meningkatkan pengetahuan dan keterampilan mendiagnosis gangguan depresi pada dokter di Puskesmas.Metode: Desain penelitian yang digunakan adalah one group pre dan post test. Subjek penelitian adalah lima belas dokter umum yang bertugas di Puskesmas Wilayah Kecamatan Tebet Jakarta Selatan. Penelitian dilakukan dalam kurun waktu Juli 2012 ? Oktober 2012. Sampel diambil secara convenient. Seluruh subjek penelitian mengikuti pelatihan modul ADAPT selama satu hari. Pengetahuan dinilai sebelum pelatihan, segera, satu bulan dan tiga bulan setelah pelatihan dengan kuesioner pengetahuan yang diisi sendiri oleh subjek. Keterampilan diagnosis dinilai sebelum pelatihan, satu hari, satu bulan dan tiga bulan setelah pelatihan dengan cara peneliti dan subjek memeriksa pasien yang sama di ruang yang berbeda. Data diolah secara deskriptif.Hasil: Segera setelah pelatihan, 100% subjek mengalami peningkatan pengetahuan. Penilaian satu dan tiga bulan setelah pelatihan hanya 66,7% subjek yang tetap mengalami peningkatan pengetahuan. Satu hari setelah pelatihan sebanyak 93,3% subjek mengalami peningkatan keterampilan diagnosis. Satu bulan setelah pelatihan 73,3% subjek mengalami peningkatan keterampilan diagnosis. Tiga bulan setelah pelatihan hanya 60% subjek yang tetap mengalami peningkatan keterampilan diagnosis.Kesimpulan: Pemberian pelatihan modul ADAPT efektif dalam meningkatkan pengetahuan dokter Puskesmas mengenai gangguan depresi segera setelah pelatihan. Satu bulan dan tiga bulan setelah pelatihan <70% subjek yang masih mengalami peningkatan pengetahuan. Pemberian pelatihan modul ADAPT efektif dalam meningkatkan keterampilan dokter Puskesmas dalam mendiagnosis gangguan depresi satu hari dan satu bulan setelah pelatihan. Tiga bulan setelah pelatihan <70% subjek yang masih mampu mendiagnosis gangguan depresi.

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ABSTRACTIntroduction: Physicians in Public Health Center (PHC) sometime do not recognize the existence of depression in a person. Provision of psychiatric training for physicians in PHC is expected to enhance the knowledge and skills of physicians to the problem of psychiatric diagnosis.. Division of Community Psychiatry Departement of Psychiatry School of Medicine University of Indonesia has developed a training module that is ADAPT (Advance in Depression and Psychosomatic Treatment). This module aims to enhance the skills of doctors in the health center in case of detection of mental disorders in the community frequently. The module refers to PPDGJ-III.Objective: To assess the effectiveness of training module ADAPT toward physicians to enhance their knowledge and skills to diagnose depressive disorders.Methods: The study design used was one group pre and post test. Subjects were fifteen general practitioner who served in Tebet Sub Regional Health Center in South Jakarta. The study was conducted in the period July 2012 - October 2012. Samples were taken at convenient. All recipients ADAPT training modules for one day. Knowledge assessed before training, immediately, one month and three months after training with the knowledge questionnaires filled by the subject. Skills diagnosis assessed before training, one day, one month and three months after the training of researchers and subjects by examining the same patient in a different room. Data processed descriptively.Results: Immediately after training, 100% of subjects experienced an increase in knowledge. But one and three months after training only 66.7% of the subjects continued to experience an increase in knowledge. One day after training, 93.3% of subjects experienced an increase in diagnosis skills. One month after training 73.3% of subjects experienced an increase in diagnosis skills. But three months after training only 60% of subjects were still at increased diagnosis skills.Conclusion: Providing ADAPT training modules effective to improve knowledge of physician about depressive disorders immediately after training. However, one month and three months after training <70% of subjects were still experiencing an increase in knowledge. Providing ADAPT training modules effective in improving the ability physician skills clinic to diagnose depressive disorder one day and one month after the training. But three months after the training <70% of subjects who are capable of diagnosing depressive disorders."

"Latar belakang : Pandemi COVID-19 mempengaruhi kesehatan fisik dan mental. Pasien LES juga rentan mengalami gangguan psikosomatik yang dapat menurunkan kualitas hidup pasien LES. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan gangguan psikosomatik pada pasien LES pada masa pandemi COVID-19. Metode : Penelitian ini merupakan studi potong lintang pada pasien LES wanita dewasa di poliklinik Alergi Imunologi dan poliklinik Reumatologi RS Cipto Mangunkusumo pada bulan September hingga Oktober 2021. Data mengenai gangguan psikosomatik menggunakan kuesioner SCL-90, kemudian dilanjutkan pengumpulan data mengenai faktor demografis (usia, tingkat pendidikan, persepsi kondisi COVID-19, persepsi stres dengan PSS, dan stresor psikososial dengan skor Holmes dan Rahe) serta faktor klinis (derajat aktivitas penyakit dengan MEX-SLEDAI, terapi kortikosteroid, dan riwayat terinfeksi COVID-19 pada pasien dan keluarga). Analisis bivariat menggunakan uji Chi-square. Variabel dengan nilai p < 0,25 dianalisis lebih lanjut dengan regresi logistik, dengan nilai p < 0,05 dianggap signifikan. Hasil : 200 pasien wanita dewasa dengan SLE direkrut dalam penelitian. Lebih dari separuh subjek penelitian (54%) mengalami gangguan psikosomatik. Dari analisis multivariat diperoleh tingkat pendidikan tinggi, stresor psikososial risiko sedang-tinggi, serta derajat aktivitas penyakit sedang-sangat berat berhubungan secara signifikan dengan gangguan psikosomatik pada pasien LES di masa pandemi COVID-19 Kesimpulan : Tingkat pendidikan, stresor psikososial, dan derajat aktivitas penyakit berhubungan secara signifikan dengan terjadinya gangguan psikosomatik pada pasien LES di masa pandemi COVID-19.

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Background : The COVID-19 pandemic affects physical and mental health. SLE patients are also prone to psychosomatic disorders which could decrease quality of life. This study aimed to find out the factors that were associated with psychosomatic disorders among SLE patients during the COVID-19 pandemic. Method : This was a cross sectional study of adult female SLE patients from outpatient clinic of Cipto Mangunkusumo Hospital, Jakarta, from September to October 2021. Data regarding psychosomatic disorders using SCL-90 questionnaires, then demographic factors (age, education level, perception of COVID-19 conditions, perception of stress using PSS, psychosocial stressors using Holmes and Rahe scores) and clinical factors (disease activity using MEX-SLEDAI, corticosteroid, and history of being infected with COVID-19 in patients or their family) were collected. Bivariate analysis was conducted with Chi-square test. Variables with a p-value <0.25 were further analyzed with logistic regression, a p-value <0.05 was considered significant. Results : There were 200 female SLE patients recruited. More than half of the subjects (54%) experienced psychosomatic disorders. From multivariate analysis, high education level, moderate to high psychosocial stressors, and moderate to very severe disease activity level were significantly associated with the occurrence of psychosomatic disorders in SLE patients during the COVID-19 pandemic. Conclusion : Education level, psychosocial stressors, and disease activity level were significantly associated with the occurrence of psychosomatic disorders in SLE patients during the COVID-19 pandemic."

"In the past 10 years, recent development of targeted therapy in metastatic renal cell carcinoma (mRCC) has provided a new hope and significantly enhanced the prognosis of the disease. Three class of targeted therapy were developed, including multi-targeted tyrosine kinase inhibitors (TKI), the mammalian target of rapamycin (mTOR) complex-1 kinase inhibitors, and the humanized antivascular endothelial growth factor (VEGF) monoclonal antibody. Hence, the objective of this article was to critically examine the current evidence of targeted therapy treatment for patients with mRCC. In the majority of trials evaluating targeted therapy, patients were stratified according to Memorial Sloan Kattering Cancer Center (MSKCC) risk model and the recommendation of targeted treatment based on risk features. In first-line setting (no previous treatment), sunitinib, pazopanib, or bevacizumab plus IFN-α were recommended as treatment options for patient with favorable- or intermediate- risk features and clear cell histology. Patients who progressed after previous cytokine therapy would have sorafenib or axitinib as treatment options. Clear-cell mRCC with favorable- or intermediate- risk features and failure with first-line TKI therapy might be treated with sorafenib, everolimus, temsirolimus or axitinib. However, the current evidence did not show the best treatment sequencing after first-line TKI failure. In patients with poor-risk clear-cell and non-clear cell mRCC, temsirolimus was the treatment option supported by phase III clinical trial. In addition, several new drugs, nowadays, are still being investigated and waiting for the result of phase II or III clinical trial, and this might change the standard therapy for mRCC in the future.

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ada sepuluh tahun terakhir, perkembangan terapi target pada karsinoma sel renal bermetastasis menjadi harapan baru dan mampu meningkatkan prognosis penyakit tersebut. Terdapat tiga terapi target yang telah dikembangkan termasuk multi-targeted tyrosine kinase inhibitors (TKI), penghambat mammalian target of rapamycin (mTOR) complex-1 kinase, dan antibodi monoklonal humanized antivascular endothelial growth factor (VEGF). Tujuan artikel ini secara kritis menelaah studi terkini terapi target untuk tatalaksana pasien tersebut. Pada sebagian besar uji klinis yang mengevaluasi terapi target, pasien distratifikasi berdasakan model yang dikembangkan oleh Memorial Sloan Kattering Cancer Center (MSKCC) dan rekomendasi terapi berdasarkan tingkat resiko pasien. Terapi target lini pertama (belum pernah mendapatkan terapi sistemik sebelumnya), sunitinib, pazopanib, atau bevacizumab ditambah IFN-α merupakan pilihan terapi dengan tingkat resiko menguntugkan dan sedang serta gambaran histologi sel jernih. Pasien yang mengalami progresifitas pasca terapi sitokin, sorafenib atau axitinib adalah pilihan yang direkomendasikan. Karsinoma sel ginjal bermetastasis tipe sel jernih dengan tingkat resiko menguntungkan dan sedang yang gagal pada terapi target lini pertama dapat ditatalaksana dengan sorafenib, everolimus, temsirolimus atau axitinib. Akan tetapi, studi saat ini menunjukkan tidak ada pilihan terapi sekuensial terbaik pasca kegagalan terapi lini pertama. Pasien dengan tingkat risiko buruk dan gambaran histologi bukan sel jernih, temsirolimus merupakan terapi target yang didukung oleh uji klinis fase III. Saat ini, beberapa obat baru masih dalam tahap uji klinis fase II dan III dan hasil uji klinis tersebut mungkin dapat mengubah terapi standar pasien karsinoma sel ginjal bermetastasis di masa yang akan datang."