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"Latar Belakang: Meskipun kontroversial, hospital readmission (HR) dapat mencerminkan keadaan pasien saat dipulangkan dan sebagai indikator untuk mengevaluasi mutu perawatan rumah sakit (RS). Penelitian ini bertujuan untuk mengetahui insidensi dan faktor risiko HR pada pasien infeksi intrakranial.Metode Penelitian: Studi kohort retrospektif pasien infeksi intrakranial periode April 2019-November 2021, menggunakan data Indonesian Brain Infection Study dan telusur rekam medis. Analisis bivariat menggunakan uji Chi Square dan Mann Whitney, dilanjutkan dengan analisis multivariat regresi logistik.Hasil: Insidensi HR pasien infeksi intrakranial sebesar 28,45%. Mayoritas subjek mengalami HR sebelum 30 hari (64,7%). Penyebab HR terbanyak adalah penyakit lain yang berbeda dengan diagnosis awal (55,9%). Komorbid penyakit ginjal meningkatkan risiko HR (aOR=7,2, IK 95%=2,2-23,8,p=0,000). Gejala klinis saat perawatan awal berupa kelemahan motorik dan kejang juga meningkatkan risiko HR (aOR=2,27,IK 95%=1,28-4,01, p=0,001) dan (aOR=1,93,IK 95%=1,02-3,62, p=0,037). Sedangkan ketersediaan pelaku rawat dapat menurunkan risiko HR (aOR=0,07,IK 95%=0,03-0,45, p=0,002).Kesimpulan: Insidensi HR pada pasien infeksi intrakranial dalam waktu 6 bulan sebesar 28,45%. Penyakit ginjal, gejala klinis kelemahan motorik dan kejang pada perawatan awal merupakan faktor yang dapat meningkatkan risiko HR, sedangkan ketersediaan pelaku rawat merupakan faktor yang dapat menurunkan risiko HR. 

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Background: Although controversial, hospital readmission (HR) can reflect the patient's condition at discharge and as an indicator to evaluate the quality of hospital care. This study aims to determine the incidence and risk factors for HR in intracranial infections.

Method: A retrospective cohort study of intracranial infection patients, in period April 2019-November 2021, using secondary data from the Indonesian Brain Infection Study and tracing medical records. Bivariate analysis using Chi Square and Mann Whitney test, followed by multivariate logistic regression analysis.

Results: The incidence of HR in patients with intracranial infections was 28.45%. The majority of subjects experienced HR before 30 days (64.7%). The most common cause of HR was other diseases that were different from the initial diagnosis (55.9%). Kidney disease comorbidity increased HR risk (aOR=7.2;95%CI=2.2-23.8;p=0.000). Clinical symptoms during initial treatment such as motor weakness and seizures also increased the risk of HR (aOR=2.27;95%CI=1.28-4.01;p=0.001) and (aOR=1.93;95%CI=1.02-3.62;p=0.037). Meanwhile, the availability of caregivers can reduce HR risk (aOR=0.07;CI 95=0.03-0.45;p=0.002).  

Conclusion: The incidence of HR in patients with intracranial infection within 6 months was 28.45%. Kidney disease, motor weakness and seizures are factors that can increase the risk of HR, while the availability of caregivers is a factor that can reduce the risk of HR."

"Latar belakang: Infeksi intrakranial merupakan masalah yang menjadi tantangan berat bagi setiap dokter yang merawat. Tingkat kematian saat rawat inap pasien infeksi intrakranial sangat tinggi. Walaupun pasien infeksi intrakranial dapat keluar dari rumah sakit dalam keadaan hidup, namun berbagai komplikasi dan masalah paska rawat inap yang kompleks dapat menyebabkan kematian pasien saat rawat jalan. Metode penelitian: Penelitian ini merupakan penelitian kohort retrospektif untuk mengetahui kesintasan 180 hari pada pasien infeksi otak yang dirawat di RS Cipto Mangunkusumo. Populasi penelitian ini adalah subjek dari penelitian Optimization of Diagnosis and Treatment of Tuberculous Meningitis ODT-TBM selama periode Januari-Desember 2015. Keluaran 180 hari subjek diketahui dengan penelusuran data kunjungan rawat jalan melalui rekam medis, telepon, pesan singkat atau kunjungan rumah. Analisis kesintasan Total survival rate dilakukan dengan menggunakan analisis cox regression baik univariat maupun multivariat. Penyajian data kesintasan dilakukan dengan menggunakan kurva kaplan meier. Hasil: Didapatkan 218 pasien dengan diagnosis akhir infeksi intrakranial. Berdasarkan status HIV, didapatkan 47,7 subjek HIV positif dan 52,3 HIV negatif. Tingkat kesintasan 180 hari pasien infeksi intrakranial di RSCM secara umum adalah 43,5. Kesintasan pada kelompok HIV positif 32,7 secara bermakna p 0,005; Rasio Hazard 1,695 1,177-2,442 lebih buruk daripada HIV negatif 53,5. Faktor lain yang mempengaruhi kesintasan adalah usia, papiledema, suhu aksila awal, SKG awal, anemia, hiponatremia, gambaran herniasi serebri pada pencitraan otak, rasio glukosa CSS/serum, dan kadar protein CSS. Kesimpulan : Tingkat kesintasan 180 hari pasien infeksi intrakranial pada penelitian ini rendah. Infeksi HIV secara bermakna mempengaruhi kesintasan pasien infeksi intrakranial.

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Background: Managing brain infection patients is a challenge for every physician. Beside a very high in hospital mortality, many complexes problems and complications can cause patient die after discharge.

Methods: This is a retrospective cohort research to find 180 days outcomes of brain infection patients that admitted in Cipto Mangunkusumo Hospital. The study population is Optimization of Diagnosis and Treatment of Tuberculous Meningitis ODT TBM research subject that admitted in 2015. Health records, phone calls, short message or home visit is done to find patient rsquo s outcome. Total survival rate analysis is done with univariate and multivariate cox regression analysis. The comparison of survival rates between 2 groups is presented by Kaplan Meier curve.

Results: A total of 218 subjects were included in this study. There were 47,7 subjects with HIV positive and 52,3 HIV negative. Overall 180 days survival rates is 43,5. HIV status is strongly influenced the survival rate of brain infection patients in this study p value 0,005 Hazard Ratio 1,695 1,177 2,442. The survival rate of HIV negative subjects was 53,5 that significantly higher than HIV positive subjects 32,7. Other factors that influenced the survival rate in this research are age, papil edema, early axial temperature, Glasgow coma scale, anemia, hyponatremia, imaging of brain herniation, blood CSF glucose ratio and CSF protein.

Conclusion: The survival rate of brain infection patients in this research is low. HIV infection significantly influenced patients rsquo survival rates."

"Salah satu indikator untuk menunjukkan mutu pelayanan kesehatan di rumah sakit adalah data atau informasi dari rekam medis yang baik dan lengkap. Rekam medis yang lengkap dapat memberikan gambaran secara keseluruhan tentang pasien yang akan digunakan untuk berobat kembali. Rekam medis adalah bukti otentik jika terjadi tuntuntan di pengadilan. Penelitian ini bertujuan untuk memperoleh gambaran mengenai karakteristik dokter dalam kelengkapan pengisian rekam medis dan faktor-faktor ekstrinsik yang mempengaruhinya. Jenis penelitian ini adalah metode observasional. Data diambil secara potong lintang sebanyak 50 rekam medis selama bulan September-November 2011 yang diisi oleh 10 dokter spesialis, serta dilakukan wawancara langsung dengan menggunakan kuesioner. Hasil analisis menunjukkan variabel beban kerja (Pvalue=0,001), prosedur kerja (Pvalue 0,001), dan supervisi teknis (Pvalue=0,036) mempengaruhi langsung kelengkapan pengisian rekam medis. Variabel yang paling dominan mempengaruhi kelengkapan rekam medis adalah variable dengan nilai coeff. B paling besar yaitu status prosedur kerja dengan coeff B=13,7. Saran yang diberikan kepada RS. Hermina Depok ialah melakukan sosialisasi dan pelatihan pengisian rekam medis secara rutin. Selainitu, melakukan pemeriksaan dan pengawasan dalam hal pengisian rekam medis secara tepat dan sesuai dengan periode yang ditetapkan.

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One of the indicators of the health service quality in the hospital is the comprehensive information from patients? medical records. A comprehensive medical record could display the whole patient?s condition which can be used for their next treatment. A medical record, in addition, is also important legal evidence used in the court, provided there is any lawsuit.

This research is carried out to illustrate the link between Doctors individual characteristics with the completion of patients? medical records together with other external related factors.

Observational study is the method used in the research, with cross sectional data from 50 patients? medical records in September-November 2011, filled out by 10 specialist doctors; as well as data collection from interview with the use of questionnaires.

The Results indicate: workload variable (Pvalue=0,001), work procedures (Pvalue 0.001), and supervisory techniques (Pvalue=0,036) affecting the completion of the medical records directly. The most dominant variable affecting the completion of health records is the one with the highest Coeff B value work procedures with Coeff B value=13.7.

Suggestion given to RS HerminaDepok is to perform regular training and socialization, as well as to carry out checks and supervision in regard to the correct completion of patients? medical records based on the indicated period."

"This article about accountability of hospitals for medical malpractice in relation whit the medical service is a sociologist research about the legal principle, norm and various legal definition concerning contractual law, tort and judicial decision related to accountability by the hospital for medical malpractice. The result of research at Dr. Sardjito Hospital and a public hospital in the Sleman subdistrict of Yogyakarta shows that relation between hospital and doctor in the medical service execution is legal relationship based in giving medical service. In the execution of the medical services by doctor in the hospital, the doctor bears full responsibility for the rights and duties. The complete freedom in exercising his rights and responsibilities of the doctor determined by the type of medical service which has to be giving to the patient."

"ABSTRAK Lesi fokal otak merupakan komplikasi neurologi pada pasien HIV yang ditandai oleh lesi desak ruang (Space Occupying Lesion) yang membutuhkan penanganan cepat dan tepat. Di beberapa negara, lesi ini dapat disebabkan oleh toksoplasma ensefalitis dan limfoma otak primer. Lesi yang disebabkan oleh toksoplasmosis dan limfoma otak primer yang disebabkan oleh Epstein Barr virus sulit untuk dibedakan menggunakan CT scan ataupun MRI. Pemeriksaan gold standar untuk membedakan keduanya yaitu dengan biopsi otak, namun hal ini merupakan tindakan invasif dan dapat menimbulkan komplikasi. Penelitian ini bertujuan untuk memperoleh uji deteksi untuk diagnosis cepat infeksi Toxoplasma gondii dan Epstein Barr virus. Desain yang dipakai pada penelitian adalah studi eksperimental laboratorium. Uji deteksi yang dikembangkan adalah dupleks real-time PCR yang dapat mendeteksi T.gondii dan EBV atau kombinasi keduanya dalam satu reaksi pada sampel pasien HIV dengan gejala klinis tersangka infeksi otak. Tahap pertama dilakukan optimasi dupleks real-time PCR meliputi suhu annealing, konsentrasi primer dan probe, uji volume elusi dan volume cetakan. Penentuan ambang batas deteksi dilakukan untuk mengukur minimal T.gondii dan EBV yang dapat dideteksi. Reaksi silang untuk mengetahui spesifisitas teknik dilakukan menggunakan bakteri dan virus sebagai berikut Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Mycobacterium tuberculosis H37Rv, Candida spp, Cytomegalo virus, Herpes zoster virus, dan Varicella zoster virus. Dupleks real-time PCR yang telah optimal diaplikasi pada sampel pasien. Sampel yang digunakan adalah darah dan cairan serebrospinal dari pasien HIV dengan gejala klinis infeksi otak yang dirawat di bagian neurologi RSCM. Hasil optimasi dupleks real-time PCR diperoleh suhu annealing untuk T.gondii dan EBV 58°C, konsentrasi primer forward dan reverse untuk T.gondii dan EBV adalah 0,2 µM, konsentrasi probe T.gondii 0,4µM, konsentrasi probe EBV 0,2 µM. Deteksi ambang batas minimal DNA untuk T.gondii 5,68 copy /ml, sedangkan EBV 1,31 copy/ml. Uji yang dikembangkan pada penelitian ini termasuk uji yang sensitif dibandingkan hasil penelitian lain. Uji reaksi silang primer dan probe dupleks real-time PCR terhadap beberapa bakteri dan virus lain, menunjukkan tidak bereaksi silang dengan primer dan probe yang digunakan untuk mendeteksi T.gondii dan EBV. Hasil pemeriksaan dupleks real-time PCR pada sampel darah diperoleh 16% positif T.gondii, 40% positif Epstein Barr virus, sebanyak 16% positif Epstein Barr virus dan T.gondii dan pada sampel cairan serebrospinal diperoleh hasil 20% positif T.gondii, sebanyak 28% positif Epstein Barr virus dan 4% positif terhadap Epstein Barr Virus dan T.gondii. ABSTRACT Focal brain lesion is neurology complication in HIV that marked with Space Occupying Lesion (SOL), that need rapid and effective handling. In most country, this lesion could be cause by encephalitis toxoplasma and Primary Central Nervous System Lymphoma that related to Epstein Barr virus infection that was difficult to distinguished using CT scan or MRI. Gold standard to distinguished was brain biopsy, but this examination was invasive procedure that cause complication. Therefore, we need a reliable and rapid examination to distinguished it. This study aimed to get detection for rapid diagnosis of T.gondii and EBV infection. This study was an experimental laboratory. First step was optimation of dupleks real-time PCR include annealing temperature, primer andprobe consentration, elution volume and template volume. Minimal detection of DNA to measured minimal T.gondii and EBV that could be detected. Cross reaction to know technique spesivisity using bacterial and virus Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Mycobacterium tuberculosis H37Rv, Candida spp, Cytomegalo virus, Herpes zoster virus, and Varicella zoster virus. Dupleks real-time PCR has been optimally applied to patient. The sample from blood and cerebrospinal fluid of HIV patients who admitted in the neurology department of RSCM then examined to duplex real-time PCR to detect T.gondii and EBV. The optimation of duplex real-time PCR, the annealing temperature for T.gondii and EBV were 58°C, consentration of primer forward and reverse for T.gondii and EBV were 0,2 µM, consentration of probe for T.gondii was 0,4µM and EBV was 0,2µM.. Minimal DNA detection for T.gondii was 5,68 copy/ml and EBV was 1,31 copy /ml. This study was sensitive like the others. Spesivisity technique of real-time PCR, there was not cross reaction between another bacteria and virus that used as primer and probe for T.gondii and EBV. From the results of the duplex real-time PCR on blood samples, 16 % was positive T.gondii, 40% Epstein Barr virus, and 16% were positive Epstein Barr virus and T.gondii and from cerebrospinal fluid samples 20% was positive T.gondii, 28% was positive Epstein Barr virus and 4% were positive for Epstein Barr Virus and T.gondii.;Focal brain lesion is neurology complication in HIV that marked with Space Occupying Lesion (SOL), that need rapid and effective handling. In most country, this lesion could be cause by encephalitis toxoplasma and Primary Central Nervous System Lymphoma that related to Epstein Barr virus infection that was difficult to distinguished using CT scan or MRI. Gold standard to distinguished was brain biopsy, but this examination was invasive procedure that cause complication. Therefore, we need a reliable and rapid examination to distinguished it. This study aimed to get detection for rapid diagnosis of T.gondii and EBV infection. This study was an experimental laboratory. First step was optimation of dupleks real-time PCR include annealing temperature, primer andprobe consentration, elution volume and template volume. Minimal detection of DNA to measured minimal T.gondii and EBV that could be detected. Cross reaction to know technique spesivisity using bacterial and virus Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Mycobacterium tuberculosis H37Rv, Candida spp, Cytomegalo virus, Herpes zoster virus, and Varicella zoster virus. Dupleks real-time PCR has been optimally applied to patient. The sample from blood and cerebrospinal fluid of HIV patients who admitted in the neurology department of RSCM then examined to duplex real-time PCR to detect T.gondii and EBV. The optimation of duplex real-time PCR, the annealing temperature for T.gondii and EBV were 58°C, consentration of primer forward and reverse for T.gondii and EBV were 0,2 µM, consentration of probe for T.gondii was 0,4µM and EBV was 0,2µM.. Minimal DNA detection for T.gondii was 5,68 copy/ml and EBV was 1,31 copy /ml. This study was sensitive like the others. Spesivisity technique of real-time PCR, there was not cross reaction between another bacteria and virus that used as primer and probe for T.gondii and EBV. From the results of the duplex real-time PCR on blood samples, 16 % was positive T.gondii, 40% Epstein Barr virus, and 16% were positive Epstein Barr virus and T.gondii and from cerebrospinal fluid samples 20% was positive T.gondii, 28% was positive Epstein Barr virus and 4% were positive for Epstein Barr Virus and T.gondii.;Focal brain lesion is neurology complication in HIV that marked with Space Occupying Lesion (SOL), that need rapid and effective handling. In most country, this lesion could be cause by encephalitis toxoplasma and Primary Central Nervous System Lymphoma that related to Epstein Barr virus infection that was difficult to distinguished using CT scan or MRI. Gold standard to distinguished was brain biopsy, but this examination was invasive procedure that cause complication. Therefore, we need a reliable and rapid examination to distinguished it. This study aimed to get detection for rapid diagnosis of T.gondii and EBV infection. This study was an experimental laboratory. First step was optimation of dupleks real-time PCR include annealing temperature, primer andprobe consentration, elution volume and template volume. Minimal detection of DNA to measured minimal T.gondii and EBV that could be detected. Cross reaction to know technique spesivisity using bacterial and virus Staphylococcus aureus, Klebsiella pneumonia, Pseudomonas aeruginosa, Mycobacterium tuberculosis H37Rv, Candida spp, Cytomegalo virus, Herpes zoster virus, and Varicella zoster virus. Dupleks real-time PCR has been optimally applied to patient. The sample from blood and cerebrospinal fluid of HIV patients who admitted in the neurology department of RSCM then examined to duplex real-time PCR to detect T.gondii and EBV. The optimation of duplex real-time PCR, the annealing temperature for T.gondii and EBV were 58°C, consentration of primer forward and reverse for T.gondii and EBV were 0,2 µM, consentration of probe for T.gondii was 0,4µM and EBV was 0,2µM.. Minimal DNA detection for T.gondii was 5,68 copy/ml and EBV was 1,31 copy /ml. This study was sensitive like the others. Spesivisity technique of real-time PCR, there was not cross reaction between another bacteria and virus that used as primer and probe for T.gondii and EBV. From the results of the duplex real-time PCR on blood samples, 16 % was positive T.gondii, 40% Epstein Barr virus, and 16% were positive Epstein Barr virus and T.gondii and from cerebrospinal fluid samples 20% was positive T.gondii, 28% was positive Epstein Barr virus and 4% were positive for Epstein Barr Virus and T.gondii."

"Sumberdaya manusia dalam organisasi rumah sakit adalah penentu pemberian pelayanan kesehatan yang bermutu. Manajemen kinerja yang efektif adalah alat untuk mengevaluasi dan meningkatkan kinerja individu dalam rangka mencapai tujuan organisasi. Bagian terpenting dari manajemen kinerja di rumah sakit adalah penilaian kinerja Dokter. Pelaksanaan penilaian kinerja individu Dokter merupakan bagian tersulit dari pekerjaan manajer rumah sakit di Indonesia. Penelitian ini bertujuan untuk mengembangkan model Instrumen Penilaian Kinerja Dokter Spesialis Obsgyn melalui Analisis Kinerja yang sesuai untuk RSIA Budi Kemuliaan. Penelitian ini bersifat deskriptif dengan metode dan analisis kualitatif. Penelitian ini melibatkan Dokter Spesialis Obsgyn dan stakeholder yang terlibat dalam manajemen kinerja Dokter Spesialis Obsgyn di RSIA Budi Kemuliaan. Penelitian ini berhasil mengembangkan metode penyusunan instrumen penilaian kinerja yang valid yaitu dengan menggunakan Metode Nominal Group Technique. Sehingga didapatkan Form Penilaian Kinerja Dokter Spesialis Obsgyn, yang berisi 8 indikator kinerja kunci individu berbasis kompetensi dan diklasifikasikan sesuai dengan kerangka kerja kompetensi dari JCAHO, lengkap dengan standar, bobot, kriteria penilaian dan skoring untuk setiap indikator tersebut, yang sesuai untuk RSIA Budi Kemuliaan.

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The human resources in healthcare is determinant to high quality of health care services. Effective performance management is a tool for evaluating and improving individual performance to achieve organization?s goals. The most important activity of performance management is how to measure Medical Doctors performance. Appraising individuals Medical Doctors is the most difficult aspects of a manager?s hospitals job in Indonesia.

The purpose of this studyis to develop an instrument that appropriate to measured Obstetrician and Gynecologist performance in Budi Kemuliaan Hospital through Performance Analysis. Descriptive study with qualitative method aims to constructed a Performance Appraisal?s Instrument. A convenience Informan of Obstetrician and Gynecologists and stakeholders in Budi Kemuliaan Hospital participated in this study.

This study successfully developed a valid method to constructed a Performance Appraisal?s Instrument in Budi Kemuliaan Hospital by using Nominal Group Technique Method. A performance appraisal?s instrument contains 8 (eight) specific measurable criteria for Obstetrician and Gynecologists using the JCAHO's six competencies to evaluated Medical Doctors performance that suitable for Budi Kemuliaan Hospital, with standards each specific measurable criteria and scoring categories."

"ABSTRAKLatar belakang: Perawatan-kembali 30 hari merupakan salah satu parameter penting yang berhubungan dengan biaya kesehatan tinggi dan outcome yang buruk, namun hal ini berpotensi dicegah. Usia lanjut merupakan kelompok yang rentan mengalami perawatan dengan karakteristik khusus yang dapat dinilai dengan pengkajian paripurna pasien geriatri (P3G). Beberapa penelitian menunjukkan komponen P3G merupakan faktor prognostik perawatan-kembali pada pasien usia lanjut sehingga dapat digunakan sebagai model prediksi perawatan-kembali 30 hari pada populasi ini. Belum ada penelitian prospektif yang khusus menilai komponen P3G sebagai model prediksi perawatan-kembali 30 hari. Tujuan: Mengembangkan model prediksi perawatan-kembali 30 hari pada pasien usia lanjut yang dirawat di bangsal medik RS Cipto Mangunkusumo. Metode: Penelitian adalah studi kohort prospektif pada 263 subjek usia >60 tahun yang diikuti hingga 30 hari pasca rawat. Data demografis dan komponen P3G dikumpulkan melalui wawancara dan rekam medik saat perawatan. Analisis kesintasan secara bivariat dan multivariat berjenjang dilakukan untuk mendapatkan hazard ratio. Dikembangkan suatu model prediksi dan persamaan fungsi hazard untuk memprediksi risiko perawatan-kembali 30 hari pasca rawat. Komponen P3G yang diukur adalah skor FRAIL (fatigue, resistance, ambulance, illness, loss of weight), Geriatric Depression Scale-15 (GDS-15), Mini nutrition Assessment short form (MNA-SF), Activity Daily Living (ADL)-Barthelindex, Cumulative illness rating scale-geriatric (CIRS-G), Zarits-4 item screening test, uji Mini Cog, dan polifarmasi. Hasil: Status nutrisi dan status depresi berhubungan secara signifikan dengan perawatan-kembali 30 hari dengan HR 2,368 (IK95%: 1,412-3,972, p=0,001) dan HR 1,627 (IK95%: 1,080-2,450, p=0,02), berurutan. Model prediksi menggunakan dua komponen tersebut memiliki AUC 0,663, Hosmer Lemeshow Goodness-of fit test 0,48, p<0,005. Probabilitas perawatan kembali 30 hari pada subjek dengan gangguan nutrisi dan depresi menggunakan persamaan fungsi Hazard adalah 79%. Simpulan: Status nutrisi dan status depresi memiliki hubungan signifikan dengan perawatan-kembali 30 hari. Model prediksi perawatan-kembali 30 hari yang menggunakan komponen ini memiliki tingkat diskriminasi tidak terlalu baik dengan performa yang baik, namun dapat dihitung menggunakan suatu persamaan cox proportional Hazard.

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ABSTRACTassociated with high costs and poor outcomes for hospitalized elderly patients. This population are vulnerable for hospital admission due to aging-related characteristics which can be assessed by comprehensive geriatrics assessment (CGA). Several studies have shown that CGA components were related to 30-day readmissions in elderly patients, on the contrary, only few studies consider these components as predictive score. Objective: To develop a prediction model for 30 days unplanned readmission in elderly patients who are treated in medical ward of Cipto Mangunkusumo Hospital. Methods: A prospective observational study followed 312 subjects aged >60 years old from admission to 30 days after discharge. Demographic data and CGA components were compeleted through interviews and medical records. Bivariate followed by stepwise multivariate survival analysis was used. Then, a prediction score and a hazard functional equation were developed to predict the risk of 30 days unplanned readmission. The CGA components measured were FRAIL score (fatigue, resistance, ambulance, illness, loss of weight), Geriatric Depression Scale-15 (GDS-15), Mini nutrition Assessment short form (MNA-SF), Activity Daily Living (ADL)-Barthel index, Cumulative illness rating scale-geriatric (CIRS-G), Zarits-4 item screening test, Mini Cog test, and polypharmacy. Results: Nutritional and depression status were significantly related to 30-day unplanned readmission with HR 2,368 (CI95%: 1,412-3,972, p=0,001) and HR 1,627 (CI95%: 1,080-2,450, p=0,02), respectively. Prediction model using these two components had AUC 0,663, Hosmer Lemeshow Goodness-of-fit test 0,48, p<0.005. Probability for readmission in a patient with nutritional and depression problem on the 30th days after discharge using functional hazard equation was 79%.Conclusion: Nutritional and depression status have significant relationship with 30-day unplanned readmision. The prediction model had moderate level of discrimination but good calibration. Also, a cox proportional hazard equation can be calculated as an alternative. "

"Penelitian ini bertujuan untuk mengetahui faktor- faktor yang berhubungan dengan kinerja dokter di poliklinik rawat jalan Rumah Sakit Angkatan Laut Dr. Mintohardjo, yang dilakukan terhadap seluruh dokter sebagai responden, menggunakan kuesioner penelitian dengan analisa univariat dan bivariat dengan disain cross sectional. Penilaian kinerja dokter dilakukan oleh pasien yang meliputi perilaku, kehadiran dan komunikasi. Hasil penelitian menunjukkan bahwa faktor - faktor yang mempengaruhi kinerja dokter di poliklinik rawat jalan Rumkital Dr. Mintohardjo Jakarta adalah faktor psikologis (kepuasan kerja), faktor organisasi (kepemimpinan) dan faktor organisasi (budaya organisasi).

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The research aims to find out the factors that relate to the performance of doctors in outpatient polyclinics Naval Hospital Dr. Mintohardjo, with the respondents of all doctors, using the questionnaire, analysis of univariate and bivariate by cross sectional design. Performance appraisal of doctor was performed by patients, which covers the behavior, presence and communication.

The result showed that factors that influence the performance of doctors in outpatient polyclinic Naval Hospital Dr. Mintohardjo Jakarta are psychological factor (satisfaction work), the organization factor (leadership) and the organization factor (organization culture)."

"Skripsi ini membahas usulan perbaikan unit kerja laundry, unit ini merupakan unit. pendukung layanan RSCM, perbaikan proses bisnis dilakukan guna meningkatkan kinerja unit setelah terjadi pemindahan pengelolaan dari pihak luar (outsourcing) ke pihak RSCM pada bulan Nopember 2005. Perbaikan proses bisnis bertujuan untuk mendukung misi organisasi, meningkatkan efektifitas dan efisiensi.Untuk alasan tersebut, perbaikan berfokus pada mendesain ulang proses secara keseluruhan guna mendapatkan keuntungan bagi organisasi dan konsumen laundry serta menjaga agar optimasi sub-sub proses melakukan kinerja yang optimal. Hasil perbandingan antara proses sekarang dengan proses usulan menunjukan bahwa proses usulan mampu memperbaiki proses sekarang, Ini dapat dilihat dari penurunan jumlah aktivitas dan waktu yang dibutuhkan untuk menyelesaikan satu sirklus proses. Peningkatkan efisiensi waktu minimum penyelesaian proses pencucian infeksius sekitar 11,13%, pencucian non infeksius sekitar 8,98%.

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The skripsi is studying improvement at unit laundry. This unit is the part one of is support unit RSCM medical service. Improve ment of process business is doing to 'increase performance work this unit after contract with outsourcing company has been end in November 2005. The aims of improvement are to get better support the organizations mission, increase eifectiveness and efficiency.

For that reason, improvement focuses on redesigning the core process as a whole in order to achieve the greatest possible benefits to organization, their laundry customers and maintains optimizing sub processes performance. The comparison between the current process according to the number decreased of activity and the length of time needed for completing one cycle of process. The improvement on the minimum washing infection process time efficiency about 11.13% and non infection about 8.98 %."

"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 rekurensi yang tinggi. Hal ini menyebabkan biaya pengobatan yang tinggi dan menurunkan kualitas hidup penderita. 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. Namun karakteristik pasien IVK di Indonesia berbeda dengan di negara maju, dimana sebagian besar pasien datang pada stadium lanjut atau C5-C6. Penelitian ini bertujuan untuk melakukan evaluasi terhadap jenis terapi yang diberikan baik terapi definitif maupun terapi perawatan luka, sehingga didapatkan penanganan IVK C5-C6 yang sesuai dengan karakteristik pasien di Indonesia. 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 rekurensi 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."