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"ABSTRACTPurposesLaparoscopic gastrectomy using ultrasonic devices occasionally causes postoperative pancreatic fistula. Robotic gastrectomy using monopolar scissors may reduce intraoperative injury to the pancreas. We evaluated the safety and feasibility of robotic gastrectomy.MethodsA multicenter prospective study was conducted to evaluate the surgical outcomes of robotic gastrectomy. The primary endpoints were the incidence of intraoperative and postoperative complications and operative mortality.ResultsA total of 115 patients were enrolled. The clinical T stages were T1 in 68 patients and T2 or higher in 47 patients. The types of surgery included distal gastrectomy (n = 72), total gastrectomy (n = 39), and proximal gastrectomy (n = 4). Two patients developed intraoperative complications (1,7%), but no cases required conversion to open surgery. The amylase concentration in drainage fluid was higher in cases with pancreatic compression, especially in those with compression for longer than 20 min. Postoperative complications of Clavien-Dindo grade ≥ II occurred in 11 patients (9,6%). There was no mortality. A multivariate analysis indicated that a high body mass index and pancreatic compression by an assistant for longer than 20 min were independent risk factors for postoperative complications (P = 0,029 and P = 0,010). Conclusions Robotic gastrectomy using monopolar scissors is safe and feasible. Robotic dissection without compression of the pancreas may reduce postoperative complications."

"Latar Belakang : Tebal ramus mandibula merupakan salah satu faktor penting yang harus diperhatikan saat melakukan Bilateral Sagittal Split Osteotomy BSSO . Fraktur unvaforable atau bad split dapat terjadi saat melakukan BSSO apabila ramus mandibula tipis. Data antropometri tentang tebal ramus mandibula masih belum banyak diteliti. Data antropometri tentang tebal ramus mandibula bisa dipakai sebagai acuan jika akan melakukan BSSO. Tujuan : untuk mengetahui tebal ramus mandibula berdasarkan CBCT Scan sebagai acuan tindakan BSSO. Metode : Subjek penelitian ini terdiri dari 61 sampel data DICOM CBCT Scan yang kemudian dilakukan reorientasi dalam 3 bidang dan dilakukan pengukuran pada tebal ramus mandibula menggunakan software Osirix LXIV. Hasil : Didapatkan rata-rata tebal ramus mandibula pada laki-laki 8.049 1.205 mm dan pada perempuan 8.463 1.358 mm. Pada kelompok usia 18-30 tahun didapatkan rata-rata tebal ramus mandibula 8.087 1.29 mm, kelompok usia 31-40 tahun 8.176 1.49 mm, kelompok usia 41-50 tahun 8.742 1.04 mm. Kesimpulan : Berdasarkan CBCT Scan, secara statistik tidak terdapat perbedaan yang bermakna tebal ramus mandibula pada jenis kelamin laki-laki dan perempuan maupun pada kelompok usia.

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Backgorund: Ramus mandibular thickness is one of the most important factor that has to be concerned when performing Bilateral Sagittal Split Osteotomy BSSO . Unfavorable fracture or bad split could happen when performing BSSO if the ramus mandible thickness is thin. There only a few regarding antropometric data about thickness of mandibular ramus.

Objective: To measure thickness of mandibular ramus based on CBCT Scan as a reference when performing BSSO.

Methods: Subject of this research consist of 61 data sample DICOM CBCT Scan which reoriented in three planes and measuring thickness of the ramus mandible using Osirix LXIV.

Result: Mean thickness of the ramus mandible for male is 8.049 1.205 mm and female 8.463 1.358 mm. In group age of 18 30 mean thickness of the ramus mandible is 8.087 1.29 mm, group age 31 40 is 8.176 1.49 mm, group age 41 50 is 8.742 1.04 mm.

Conclusion: Based on CBCT Scan there are no difference statistically between thickness of ramus mandible in male and female, and group of age."

"Keperawatan adalah sebuah seni dan ilmu pengetahuan yang merupakan gabungan dari ilmu fisik, manusia, sosial dengan kompetensi klinis dan kualitas yang berpusat pada pasien. Adanya peningkatan teknologi dan promosi kesehatan, maka perawat diharapkan memberikan pelayanan yang lebih berkualitas. Tujuan dari praktik residensi untuk memperoleh gambaran analisis pelaksanaan dan pengalaman praktik residensi keperawatan medikal bedah peminatan onkologi dalam menjalankan peran professional selama praktik residensi di RSUPN dr. Cipto Mangunkusumo. Residensi dilaksanakan selama 2 semester baik di ruang rawat inap, rawat jalan dan IGD dengan memberikan asuhan keperawatan, penerapan EBN yoga untuk mengurangi fatigue dan Proyek inovasi Edukasi Penanganan Mual Muntah berbasis Video untuk meningkatkan pengetahuan  pada pasien yang menjalani  kemoterapi. Pemberian asuhan keperawatan dilakukan pada pasien 1 kasus kelolaan dengan Adenocarsinoma Recti Sigmoid dan 30 kasus keganasan lainnya dengan menggunakan pendekatan Teori Model Adaptasi Roy, yoga terbukti efektif dalam menurunkan fatigue dan edukasi Penanganan Mual Muntah berbasis Video terbukti dapat meningkatkan pengetahuan pasien. Praktek residen bermanfaat dan dapat meningkatkan pengetahuan, keterampilan dan kompetensi dalam menjalankan peran perawat professional.

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Nursing is an art and a science, which combination of knowledge from the physical sciences, humanities, and social sciences along with clinical competencies and quality patient centered care.The improvement of technology and health promotion, nurses are expected to provide better quality services. The aims of the residency practice is to obtain an analysis of the implementation and practical experience of residency oncology specialization medical nursing residency in carrying out professional roles during residency practice at RSUPN Dr. Cipto Mangunkusumo. Residency was held for 2 semesters both in the inpatient, outpatient and emergency room by providing nursing care, implementing EBN yoga to reduce fatigue and the Innovation Project Video-based Vomiting Nausea Education Education to increase knowledge in patients undergoing chemotherapy. The provision of nursing care was carried out on patients with 1 case of management with Adenocarsinoma Recti Sigmoid and 30 other cases of malignancy using Roys Adaptation Model Theory approach, yoga effective in reducing fatigue and Video-based Vomiting Handling education effective to increase patient knowledge. Resident practices are useful and can increase knowledge, skills and competencies in carrying out the role of professional nurses."

"Praktik residensi keperawatan medikal bedah adalah bagian dari pendidikan profesi yang mempunyai tujuan untuk menghasilkan perawat spesialis. Perawat spesialis diharapkan dapat melaksanakan perannya dalam memberikan pelayanan keperawatan pada kasus dengan gangguan sistem pernapasan. Peran tersebut sejalan dengan kompetensi yang harus dicapai selama praktik residensi berupa pemberian asuhan keperawatan, penerapan praktik keperawatan berbasis bukti dan proyek inovasi. Pemberian asuhan keperawatan diterapkan kepada satu pasien kelolaan utama dengan kasus PPOK dan 30 kasus resume menggunakan pendekatan model adaptasi Roy. Penerapan tindakan keperawatan berbasis bukti ilmiah yang dilakukan yaitu pemberian posisi condong kedepan dan Latihan nafas pursed lips breathing pada pasien dyspnea dengan penyakit paru. Proyek inovasi yang diterapkan yaitu Pengembangan Self Manajemen Dengan Video Latihan Breathing Exercise : ACBT Dalam Meningkatkan Airway Clearance Pada Pasien Dengan Penyakit Paru Obstruksi Kronis (PPOK). Hasil analisis praktik menunjukkan bahwa model adaptasi Roy dapat digunakan sebagai pendekatan dalam asuhan keperawatan pasien dengan gangguan sistem pernapasan untuk mengembangkan mekanisme adaptif pasien. Pemberian posisi condong kedepan dan Latihan nafas pursed lips breathing dapat menurunkan sesak napas pada pasien dengan penyakit paru. Selain itu, Latihan Breathing Exercise : ACBT Dalam Meningkatkan Airway Clearance Pada Pasien mendapat evaluasi yang positif dan dapat diterapkan di tatanan klinis sebagai inovasi pengkajian dan manajemen keperawatan mandiri pada pasien PPOK selama di rumah.

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Medical surgical nursing residency practice is part of professional education that aims to produce specialist nurses. Specialist nurses are expected to carry out their role in providing nursing services in cases with respiratory system disorders. The role is in line with the competencies to be achieved during residency practice in the form of providing nursing care, implementing evidence-based nursing practice and innovation projects. Nursing care was applied to one primarily managed patient with a case of COPD and 30 resume cases using Roy's adaptation model approach. The application of scientific evidence-based nursing actions carried out is the provision of a forward leaning position and pursed lips breathing exercises in dyspnea patients with lung disease. The innovation project applied is the Development of Self Management with Video Breathing Exercise: ACBT in Increasing Airway Clearance in Patients with Chronic Obstructive Pulmonary Disease (COPD). The results of the practice analysis show that Roy's adaptation model can be used as an approach in nursing care of patients with respiratory system disorders to develop patient adaptive mechanisms. Forward leaning and pursed lips breathing exercises can reduce shortness of breath in patients with lung disease. In addition, Breathing Exercise: ACBT in Increasing Airway Clearance in Patients received a positive evaluation and can be applied in clinical settings as an innovation in self-assessment and nursing management in COPD patients while at home."

"Professionalime ilmu keperawatan adalah bagian disiplin ilmu keperawatan sampai dengan keperawatan sub spesialisasi dimana perawat spesialis sebagai seorang perawat yang dipersiapkan melampaui level seorang perawat generalis yang berwenang untuk praktek sebagai spesialis dengan keahlian dalam cabang bidang keperawatan. Ners spesialis keperawatan medikal bedah dengan peminatan muskuloskletal berperan dalam perawatan kekhususan masalah dan kasus kelolaan yang berkaitan dengan orthopedi atau muskuloskletal. Tujuan utama memberikan asuhan keperawatan secara komprehensif pada pasien kasus Spinal Cord Injury dengan trauma melalui pendekatan keperawatan model teori self-care Orem. Asuhan berupa pengelolaan 1 kasus kelolaan uatam dan 30 resume yang terdiri 3 bagian kasus besar yaitu kasus Spine, ekstremitas atas, dan ekstremitas atas dengan menggunakan teori model keperawatan Self-Care Orem yang menekankan tentang kebutuhan perawatan diri. Pencegahan terjadinya luka tekan dengan pemberian Aloe vera gel sebagai bagian dari tindakan mandiri keperawatan berdasarkan bukti penelitian ilmiah. Proyek inovasi berupa pengkajian resiko DVT dengan menggunakan Autar Scale adalah bentuk pengembangan dari intervensi keperawatan untuk pencegahan resiko terjadinya DVT pada pasien dengan kasus muskuloskletal. Tujuan seluruh kegiatan yang dilakukan selama kegiatan residensi adalah mewujudkan asuhan keperawatan yang komprehensif berdasarkan bukti ilmiah terkini.

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Professional expertise is part of the discipline of expertise up to sub-specialization where specialist nurses as nurses who are prepared go beyond the level of a generalist nurse who is classified to practice as a specialist with expertise in their field of expertise. Medical surgeon specialist nurses with specialization in musculoskeletal play a role in treating specific problems and managing cases related to orthopedics or musculoskeletal issues. The main goal is to provide comprehensive care assistance to patients with spinal cord injury cases with trauma through the Orem self-care model of therapy. The care is in the form of managing 1 main case and 30 resumes consisting of 3 major case sections namely the Spine, upper extremity and upper extremity cases using a theoretical model including Orem's Self Care who is depressed about the need for self-care. Prevention of pressure sores by administering Aloe Vera Gel as part of an independent act of kindness based on scientific research evidence. The innovation project in the form of DVT risk assessment using the Autar Scale is a form of developing interventions to prevent the risk of DVT in patients with musculoskeletal cases. The aim of all activities carried out during the residency activities is to realize comprehensive group care based on the latest scientific evidence."

"Analisis praktik residensi keperawatan medikal bedah ini merupakan karya ilmiah akhir Pendidikan Ners Spesialis yang bertujuan memberikan gambaran proses praktik residensi melalui pengelolaan kasus utama, kasus resume, penerapan evidence based nursing (EBN) dan proyek inovasi. Kasus utama yang dilaporkan adalah asuhan keperawatan pasien dengan tumor spinal menggunakan Model Adaptasi Roy (MAR) dengan diagnosis utama pada pre-operatif adalah nyeri kronik berhubungan dengan kompresi dan sensitisasi persepsi nyeri dan masalah keperawatan utama post-operasi adalah nyeri, gangguan mobilisasi fisik dan inkontinensia urine refleks. Sebanyak 30 kasus resume didapatkan rerata usia pasien adalah 52,40 (SD 14.51), mayoritas perempuan (53,3%), dan terbanyak dengan pendidikan menengah (56,7%). Masalah keperawatan terbanyak pada kasus resume adalah risiko perfusi serebral tidak efektif, gangguan mobilitas fisik, dan nyeri akut. Penerapan EBN yang dipilih adalah Implementasi Reduksi Mechanical Bowel Preparation pada Pasien yang Menjalani Pembedahan Elektif Tulang Belakang dan terbukti bahwa tidak memberikan dampak penurunan luaran klinis pasien sehingga dapat dilanjutkan untuk diterapkan. Proyek inovasi yang diimplementasikan secara berkelompok oleh mahasiswa residen adalah Penerapan Nurse-Led Early Mobilization pada Pasien Pasca Pembedahan elektif Tulang Belakang yang berdasarkan analisis situasi dapat dikembangkan dan diterapkan sebagai intervensi mandiri perawat.

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This analysis of medical surgical nursing residency practice is the final scientific paper of specialist nurse education program which aims to provide an overview of the residency practice process through management of main cases, case resumes, implementation of evidence based nursing (EBN) and innovation projects. The main case reported was nursing care of patients with spinal tumors using the Roy Adaptation Model (MAR) with the main pre-operative diagnosis is chronic pain associated with compression and sensitization of pain perception and the main post-operative nursing problems are pain, impaired physical mobilization and incontinence reflex urine. In a total of 30 cases of resumes, the average age of the patients was 52.40 (SD 14.51), the majority were women (53.3%), and most of them had secondary education (56.7%). The most common nursing problems in cases of resumes are the risk of ineffective cerebral perfusion, impaired physical mobility, and acute pain. The chosen application of EBN is the Implementation of Mechanical Bowel Preparation Reduction in Patients Undergoing Elective Spine Surgery and it is proven that it has no benefit for the patient's clinical outcome so that it can be continued to be implemented. An innovation project implemented in groups by resident students is the Application of Nurse-Led Early Mobilization in Post-Elective Spine Surgery Patients which based on situational analysis can be developed and implemented as an independent nurse intervention."

"Karya Ilmiah Akhir ini merupakan laporan seluruh kegiatan praktik klinik residensi Ners Spesialis Keperawatan Medikal Bedah kekhususan kardiovaskular. Kegiatan praktik klinik meliputi pelaksanaan asuhan keperawatan pada pasien dengan masalah sistem kardiovaskular melalui pendekatan Comfort Theory Kolcaba, pelaksanaan praktik keperawatan berbasis bukti dan melakukan inovasi keperawatan. Asuhan keperawatan menggunakan Comfort Theory Kolcaba melihat pada status yang dialami oleh pasien terhadap comfort measures untuk memenuhi kebutuhan segera yang dikelompokkan dalam 3 jenis comfort, yaitu relief, ease, transcendence dan dalam 4 konteks pengalaman yaitu fisik, psikospiritual, sosial, dan lingkungan. Sehingga pemberian pelayanan keperawatan berdasarkan Comfort Theory Kolcaba lebih berfokus pada proses mengkaji kebutuhan kenyamanan klien, mengembangkan dan menerapkan intervensi keperawatan yang sesuai, dan mengevaluasi kenyamanan klien dan intervensi keperawatan yang telah diberikan. Praktik keperawatan berbasis bukti yang dilakukan adalah Spiritual Emotional Freedom Technique (SEFT) untuk menurunkan intensitas nyeri pasien pasca bedah jantung. Pelaksanaan inovasi keperawatan berupa penyusunan formulir pengkajian khusus mulut dan intervensi oral higiene pada pasien yang terpasang ETT dan ventilator di ICVCU Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita Jakarta.

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The final scientific paper is reporting of all activities of nurses specialist residency clinical practice Medical Surgical Nursing cardiovascular specificity. The Activities include implementation of clinical practice nursing care to patients with the cardiovascular system problems using Kolcaba’s Comfort Theory approach, the implementation of evidence-based nursing practice and innovation on nursing. Kolcaba’s Comfort Theory look at the status experienced by patients on comfort measures to meet the immediate needs are grouped the 3 types of comfort, which is a relief, ease, and transcendence in the context of the experience that is 4 physical, psikospiritual, social, and environmental. So the provision of nursing services by Comfort Theory Kolcaba more focused on the process of assessing the needs of the clients comfort, develop and implement appropriate nursing interventions, and evaluating the client's comfort and nursing interventions that have been given. Evidence-based nursing practice is carried Spiritual Emotional Freedom Technique (SEFT) to reduce post-cardiac surgery pain intensity. Implementation of nursing innovations in the form of the preparation of the mouth and form a special assessment of oral hygiene interventions in patients with ETT and ventilator installed in ICVCU of National Cardiovascular Center Harapan Kita Jakarta."

"Keperawatan medikal bedah merupakan area praktik keperawatan pada orang dewasa yang mengalami perubahan fisiologis atau mempunyai resiko terjadi perubahan fisiologis, trauma atau kecacatan Tujuan dari penulisan Karya Ilmiah ini adalah menjabarkan analisis kegiatan praktik residensi keperawatan medikal bedah peminatan onkologi di Rumah Sakit Umum Pusat Nasional Cipto Mangunkusumo dengan penerapan Model Keperawatan Adaptasi Roy dalam pemberian asuhan keperawatan pada kasus keganasan, melakukan aplikasi evidence based nursing (EBN), dan melaksanakan proyek inovasi. Praktik residensi dilaksanakan selama 2 semester dengan mengelola 30 kasus resume dengan berbagai jenis kasus keganasan dan 1 kasus utama (osteosarkoma). Penerapan evidence based nursing tentang auricular acupressure efektif untuk mengurangi konstipasi pada pasien kemoterapi dan pelaksanaan inovasi video edukasi meningkatkan pengetahuan pasien untuk manajemen mual muntah efek samping kemoterapi. Praktik residensi sangat bermanfaat untuk meningkatkan pengetahuan dan keterampilan klinik pada mahasiswa ners spesialis.

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Medical surgical nursing is an area of nursing practice in adults who have physiological changes or risk of physiological changes, trauma or disability. The aim of this writing is to describe the analysis of residency practice in medical surgical nursing especially oncology at Cipto Mangunkusumo National Center General Hospital with the application of Roys Adaptation Nursing Model in the provision of nursing care in malignancy cases, conduct evidence based nursing (EBN) applications, and implement innovation project. The residency practice is held for 2 semesters by managing 30 cases of resumes with various types of malignancy cases and 1 main case (osteosarcoma). The application of evidence based nursing auricular acupressure is effective for reducing constipation in chemotherapy patients and the implementation of innovative educational video projects increases the knowledge of patients to manage chemotherapy-induced nausea and vomiting. The residency practice is very useful for increasing clinical knowledge and skills of nursing specialist students"

"Praktik residensi keperawatan medikal bedah adalah rangkaian program pendidikanmagister keperawatan yang dilaksanakan dalam tatanan pelayanan keperawatan.Keperawatan medikal bdah berfokus pada konsep dan prinsip dasar medikal dan bedahdalam penerapan ilmu dan teknologi keperawatan untuk memenuhi kebutuhan pasiendewasa yang mengalami perubahan fisik dengan atau tanpa gangguan struktural. Praktikresidensi ini dilaksanakan di Rumah Sakit Umum Pusat Fatmawati. Kegiatan praktikresidensi ini terdiri dari pemberi asuhan keperawatan (care giver) dengan gangguanmuskuloskeletal menggunakan pendekatan teori adaptasi Roy. Asuhan keperawatan telahdiberikan pada pasien fraktur, MBD, SCI, Spondilitis TB, Skoliosis dan kasus lainnya.Penerapan evidencebased nursing (EBN) melalui intervensi penerapan pada BriefMassage pada pasien post operasi THR dan TKR yang membantu dalam menurunkannyeri, kecemasan dan meningkatkan kepuasan terhadap manajemen nyeri. Proyek inovasiyang diterapkan adalah peran perawat sebagai pioneer dalam pengembangan penerapanERAS (Enhanced Recovery After Surgery) pada pasien operasi hip. Diharapkan denganpengembangan program ini mengurangi lama hari rawat (LOS), mengurangi komplikasiyang terjadi, mengurangi angka morbiditas.The practice of medical surgical nursing residency is a series of nursing master educationprograms carried out in the nursing service order. Medical nursing has focused on theconcepts and basic medical and surgical principles in applying nursing science andtechnology to meet the needs of adult patients who experience physical changes with orwithout structural disorders. This residency practice was carried out at Fatmawati CentralGeneral Hospital. This residency practice activity consists of care giver providers withmusculoskeletal disorders using Roy's adaptation theory approach. Nursing care has beengiven to patients with fractures, MBD, SCI, Spondylitis TB, Scoliosis and other cases.Application of evidence-based nursing (EBN) through application intervention in theBrief Massage in patients with postoperative THR and TKR that help reduce pain,anxiety and increase satisfaction with pain management. The innovation project applied isthe role of nurses as a pioneer in the development of the application of ERAS (EnhancedRecovery After Surgery) in patients with hip surgery. It is expected that the development ofthis program will reduce the length of day of care (LOS), reduce the complications thatoccur, reduce morbidity rates."

"Praktek klinik residensi keperawatan medikal bedah kekhususan ginjal urologi memberikan bekal kemampuan pemberi asuhan keperawatan secara langsung, clinical case manager, penerapan evidence-based nursing, dan penerapan inovasi. Asuhan keperawatan diberikan dengan pendekatan Teori 14 kebutuhan dasar Virginia Henderson pada kasus utama Unilateral non-functioning kidney dan 30 kasus resume. Pengelolaan nyeri akut dan manajemen kesehatan ginjal menjadi fokus pada kasus utama. Peran sebagai clinical case manager tampak pada pengelolaan kasus resume. Masalah kelebihan cairan menjadi masalah keperawatan yang paling banyak diangkat pada kasus resume. Intervensi yang diberikan berfokus pada manajemen cairan dan pemberian konseling untuk pembatasan cairan dan konsumsi garam. Peran sebagai peneliti tampak dalam literature review evidence-based nursing. Hasil literature review menunjukkan bahwa passive leg raising bermakna (p<0,05). Peran sebagai inovator dan kepemimpinan tampak pada pelaksanaan proyek inovasi. Proyek inovasi berupa buku harian HD meningkatkan proporsi Interdialytic weight gain baik (<2,5 kg) sebesar 14,8% di akhir penerapan inovasi.

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Clinical practice phase of medical surgical nursing specialist in nephrology gives basic skill in delivering nursing care, clinical case manager, implementing evidence-based nursing, and innovation project. We used 14 basic needs Virginia Henderson theory towards one main case-study and thirty resume case. In the main case-study, the focus is managing acute pain post-operatively and preserve the remain kidney. The role as clinical case manager was gained from managing 30 resume cases. Excess fluid volume is the most prevalent problem across resume cases. The intervention then focused on fluid management and counselling about fluid and sodium intake. The role as researcher was gained from evidence-based nursing project. The literature review showed that passive leg raising could increase blood pressure among intradialytic hypotension case. Passive leg raising showed significant results (p<0,05). The innovation project gave experience as innovator and leadership. The implementation of HD diary book showed improvement of the proportion of good Interdialytic weight gain (<2.5 kg) 14.8% at the end of observation."