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"Peningkatan arus globalisasi diantaranya berimplikasi pada perubahan penyakit infeksi ke penyakit degeneratif, dimana selain penyakit koroner dan hipertensi, ternyata diabetes militus (DM) merupakan penyakit degeneratif yang saat ini semakin bertaimbah jumlahnya. Artinya hal tersebut harus segera diantisipasi dengan pelayanan paripurna dan profesional sehingga penderita tidak hanyut ke dalam komplikasi fatal.Pada penelitian kali ini disusun pengembangan studi kelayakan klinik diabetik RSPP dengan mempertimbangkan faktor eksternal dan internal. Penyusunan kelayakan pengembangan dilakukan dengan menggunakan analisis trend atau kecenderungan jumlah permintaan (kunjungan), dimana dari analisis tingkat kebutuhan klinik diabetik untuk jumlah pasien diasumsikan meningkat sebesar 0.45% untuk tahun pertama dan 9% untuk tahun ke-II sampai dengan tahun ke-X. Asumi didasarkan pada tingkat inflasi dan suku bunga SBI serta kondisi ekonomi yang relatif stabil.Perhitungan dilakukan dengan pendekatan sistem input, proses dan output. Inputnya adalah kebijakan pemerintah dan sumber dana, prosesnya yakni kebutuhan pelayanan kesehatan, permintaan dan tingkat pendapatan masyarakat Jakarta Selatan dan Outputnya adalah menghitung kelayakan investasi dengan NPV, IRR dan PbP.Dari hasil perhitungan analisis kelayayakan investasi diperoleh nilai NPV sebesar 1.259.746.218, IR.R sebesar 53.90%, dan PayBack Period 2,5. Nilai NPV yang lebih besar dari 0 dan IRR yang lebih besar dari suku bunga SBI (15.49%) menunjukkan bahwa pengembangan klinik dabetik dapat diterima atau dilanjutkan; sedangkan nilai PbP sebesar 2.5 menunjukkan bahwa modal dapat dikembalikan dalam jangka waktu dua tahun 5 bulan.Karena pengembangan klinik Diabetik dinyatakan layak, maka saran yang perlu dipertimbangkan antara lain: (1) perbaikan pada sistem informasi Keuangan dan Rekam Medis, (2) membuat rencana induk (Master Plan) dan rencana bisnis (Business Plan), (3) memperhatikan pengertian layak dari aspek social dalam rangka meningkatkan kesejahteraan masyarakat, dan (4) Perlunya diperhatikan aspek design fisik, yaitu dengan merubah design lokasi SIDL sebelumnya yang disesuaikan dengan rencana jangka panjang.

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The stream of globalization impacts to transform the diseases from infection disease to degenerative ones. Beside coroner and hypertension disease, diabetic mellitus (DM) is one of degenerative diseases, which seems to be more prevalent. It show that such case immediately should be anticipated by professional and complete service to avoid the patient leading to fatal complication.

The feasibility study for diabetic clinic at RSPP was conducted with regard to the external and internal factors. This study used trend analysis of demand frequency (patient visit) with assumption that the increase of number of patient in the -diabetic clinic was 0.45% in the first year and 9% in the second year up to the tenth year. That assumption was based on a stable inflation and interest rate as well as economy condition.

The analysis was done using system approach (input, process, and output). The input included government policy and fund resource, while the process included the need and demand of health care, and level of community income in South Jakarta area. The output was done by calculating the feasibility of investment such as NPV, IRR and PbP.

The study resulted that the feasibility of investment values as follows: NPV=Rp 1,259,746,218; IRR=53.9%; Payback Period-2.5. NPV showed higher than 0 and IRR vas higher than Indonesian interest rate (15A9%) meant that diabetic clinic development could be accepted or followed up. As PbP was 2.5, it showed that the capital could be paid back in the term of 2 years and 5 months.

Due to the diabetic clinic development was stated feasible, it is recommended to improve the accounting information system and medical records, to build master plan and business plan, and to understand the meaning of feasible in social aspect in order to increase community prosperous, and also to notice the physical design by changing SIDL location that appropriates with long term planning."

"Smoking is known as a variable that can be changed through a specific intervention activity. Recently in Indonesia, research related to chronic complication among elderly with type 2 Diabetes Mellitus (DM) was not available. This research has objective in exploring the risk of smoking towards chronic complication among elderly with type 2 DM. This research was using Riset Kesehatan Dasar (Riskesdas) in 2007. Riskesdas is a representative Indonesia Health Survey. 1,565 elderly (aged 60++ years) with type 2 DM have selected by random. 70-80% of the elderly have Chronic Complications and 32.11% of the sample is smokers. The elderly who smoke more than 24 cigarettes per day have risk 2.5 (95% CI, 1.54-3.97), smoker 1-12 cigarettes per day, and smoker 13-24 cigarettes per day have risk 1.3 and 1.6 respectively to get chronic complication compared with those who do not smoke, controlled by age, obesity, and physical activity. The proportion of smokers among elderly with type 2 DM is high, most of them are low education, low socioeconomic status, lack of access to the health services, low of physical activity, and low consume vegetables and fruit. Smoking increases the risk of chronic complication of type 2 DM.

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Hubungan antara Merokok sebagai Faktor Risiko yang dapat Dimodifikasi dari berbagai Komplikasi Kronis pada Lansia dengan Diabetes Mellitus Tipe 2. Merokok dikenal sebagai variabel yang dapat diubah melalui aktifitas intervensi yang spesifik. Saat ini di Indonesia belum terdapat penelitian mengenai komplikasi kronis di antara para lansia penderita Diabetes Mellitus (DM) tipe 2. Penelitian ini bertujuan untuk mempelajari risiko dari aktifitas merokok terhadap komplikasi kronis di antara para lansia penderita DM tipe 2. Penelitian ini menggunakan Riset Kesehatan Dasar (Riskedas) 2007. Sebanyak 1.565 lansia (usia 60++ tahun) penderita DM tipe 2 dipilih secara acak. Sebanyak 70-80% dari para lansia tersebut memiliki komplikasi kronis, dan 32,11% sampel penelitian adalah perokok. Para lansia yang merokok lebih dari 24 batang per hari memiliki risiko 2,5 (95% CI, 1,54-3,97), sementara itu lansia yang merokok 1-12 batang per hari, dan yang merokok 13-24 batang per hari memiliki risiko masing-masing setinggi 1,3 dan 1,6 untuk terserang komplikasi kronis dibandingkan mereka tidak merokok, terkontrol secara usia, tingkat obesitas, dan aktifitas fisik. Persentase perokok di antara para lansia penderita DM tipe 2 cukup tinggi. Sebagian besar dari mereka memiliki tingkat pendidikan, tingkat status sosioekonomi, aktifitas fisik, serta tingkat konsumsi buah dan sayur yang rendah. Mereka pun kurang memiliki akses terhadap layanan kesehatan. Merokok meningkatkan risiko komplikasi kronis DM tipe 2."

"Latar belakang: Penelitian ini bertujuan menilai peran berbagai adiponektin dan indeks leptin bebas terhadap dislipidemia aterogenik pada pria obesitas sentral non diabetes.Metode: Desain penelitian ini adalah potong lintang pada 120 pria obesitas sentral non-diabetes yang dilakukan di Jakarta. Parameter yang diukur adalah adiponektin total, adiponektin berat molekul tinggi, adiponektin berat molekul sedang, adiponektin berat molekul rendah, leptin, soluble leptin receptor, trigliserida, kolesterol HDL, kolesterol LDL dan apolipoprotein B (Apo B). Kriteria dislipidemia aterogenik adalah rendahnya kadar kolesterol HDL, disertai trigliserida dan small dense LDL (sdLDL) yang tinggi. Kadar sdLDL didapat dari rasio kolesterol LDL / Apo B. Indeks leptin bebas adalah rasio leptin dengan soluble leptin receptor dengan menggunakan median sebagai titik dikotomi. Dilakukan krostabulasi untuk data kategorial. Hubungan antara adiponektin multimerik, indeks leptin bebas dengan lipid aterogenik dianalisis dengan uji Spearman, selanjutnya hasil interaksi keseluruhan parameter terhadap dislipidemia aterogenik dianalisis dengan regresi logistik ganda.Hasil: Adiponektin berat molekul tinggi berkorelasi negatif secara bermakna dengan dislipidemia aterogenik (p< 0,05), sedangkan adiponektin berat molekul sedang dan adiponektin berat molekul rendah tidak berkorelasi (p> 0,05) dengan dislipidemia aterogenik. Indeks leptin bebas berkorelasi positif secara bermakna dengan dislipidemia aterogenik (p< 0,05). Odds Rasio (OR) adiponektin berat molekul tinggi terhadap kejadian dislipidemia aterogenik adalah 3,62 (p< 0,05), sedangkan risiko dislipidemia aterogenik pada subyek dengan indeks leptin bebas rendah adalah 4,57 (p< 0,05).Kesimpulan: Adiponektin berat molekul tinggi dan indeks leptin bebas berperan dalam meningkatkan risiko dislipidemia aterogenik. (Med J Indones 2011; 20:119-24).

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AbstractBackground: To analyze the role of various adiponectin and free leptin index on the occurrence of atherogenic dislipidemia in non-diabetic central obese menMethods: This is a cross-sectional study on 120 non-diabetic central obese men that was done in Jakarta. The measured indicators were total adiponectin, high molecular weight adiponectin (HMW adiponectin), medium molecular weight adiponectin (MMW adiponectin), low molecular weight adiponectin (LMW adiponectin), leptin, soluble leptin receptor, triglycerides, high-density lipoprotein cholesterol (HDL cholesterol), low density lipoprotein cholesterol (LDL cholesterol) and apolipoprotein B (Apo B). Atherogenic dyslipidemia was characterized by reduced level of HDL cholesterol, and high levels of triglyceride and small dense LDL (sdLDL). Ratio of LDL cholesterol and Apo B were calculated to get sdLDL. Free Leptin Index (FLI) was the ratio between total leptin and soluble leptin receptor (sOB-R), and median values were used as cut off to defi ne high and low values of each parameter. Cross tabulation were done on categorical data. Relationships between multimeric adiponectin and free leptin index with atherogenic lipids were analyzed by using Spearman analysis. Further, the interaction of all indicators with the occurence of atherogenic dyslipidemia was analyzed using binary logistic regression.Results: A negative correlation of HMW adiponectin with atherogenic dyslipidemia (p< 0.05), whereas there were no correlation between MMW adiponectin and LMW adiponectin with atherogenic dyslipidemia (p> 0.05). Free Leptin Index was associated positively with atherogenic dyslipidemia (p< 0.05). Odds Ratio (OR) of HMW adiponectin for the occurrence of atherogenic dyslipidemia was 3.62 (p< 0.05), where as OR of FLI with atherogenic dyslipidemia was 4.57 (p< 0.05).Conclusion: HMW Adiponectin and FLI might contribute to atherogenic dyslipidemia in central obese non-diabetic males. (Med J Indones 2011; 20:119-24)."

"[ABSTRAKKerentanan lansia terhadap masalah kesehatan seperti diabetes mellitus meningkat seiring dengan bertambahnya usia. Karya Ilmiah Akhir ini mengintegrasikan teori manajemen pelayanan keperawatan dan tiga model keperawatan yaitu Community as Partner, Family Centred Nursing dan Functional Consequencies. Asuhan keperawatan diberikan pada 32 lansia diabetisi di kelurahan Sukamaju Baru selama 9 bulan. Intervensi inovasi yang dikembangkan adalah booklet DM yang didasari pada program CERDIIK Kemenkes RI, Diabetes Self Management Education (DMSE) dan empat pilar penatalaksanaan DM. Hasil intervensi yang dilakukan menunjukkan adanya perubahan perilaku lansia diabetisi, kelompok pendukung dan sebaya dalam melakukan penatalaksanaan DM. Penurunan rata-rata kadar gula darah lansia kelompok sebaya sebesar 101,5 poin. Penggunaan booklet DM efektif dalam mengontrol kadar gula darah lansia diabetisi dengan wadah kelompok sebaya dan dukungan kader kelompok pendukung. program ini diharapkan dapat diteruskan dengan peningkatan keterlibatan keluarga, kader dan tenaga kesehatan.

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ABSTRACTThe vulnerability of the elderly to health problems such as diabetes mellitus increases with age. This final internship report integrated nursing service management theory with three nursing models, which are Community as Partner, Family Centred Nursing dan Functional Consequencies. A nursing care was provided to 32 elderly with diabetic at district Sukamaju Baru for 9 months. An innovative intervention was developed that was DM booklet based on CERDIIK program from Ministry of Health Indonesia, Diabetes Self Management Education (DMSE) and the four pillars of DM management of care. Result of intervention showed changes of healthy behavior from elderly with DM, support group dan peer group in providing DM care management. There was a reduce of elderly blood glucose level in average about 101,5 poin. The DM booklet usage was effective in controlling blood glucose level of elderly with DM who actively involved in peer group and support group of community workers. This program was expected to be sustained and get more family involvement, as well as involvement from community workers and health workers. , The vulnerability of the elderly to health problems such as diabetes mellitus increases with age. This final internship report integrated nursing service management theory with three nursing models, which are Community as Partner, Family Centred Nursing dan Functional Consequencies. A nursing care was provided to 32 elderly with diabetic at district Sukamaju Baru for 9 months. An innovative intervention was developed that was DM booklet based on CERDIIK program from Ministry of Health Indonesia, Diabetes Self Management Education (DMSE) and the four pillars of DM management of care. Result of intervention showed changes of healthy behavior from elderly with DM, support group dan peer group in providing DM care management. There was a reduce of elderly blood glucose level in average about 101,5 poin. The DM booklet usage was effective in controlling blood glucose level of elderly with DM who actively involved in peer group and support group of community workers. This program was expected to be sustained and get more family involvement, as well as involvement from community workers and health workers. ]"

"ABSTRAKKompleksitas penanganan diabetes terlihat dari interaksi faktor yang bekerjaberlawanan. Pasien menjadi bingung dan merasa kesulitan untuk mencapaipenanganan yang optimal. Fokus penelitian ini terletak pada pasien dari kelompoksosek rendah yang mengalami stres terkait diabetes. Penerapan teknik pemecahanmasalah dapat memberikan kemampuan mengendalikan diabetes pada pasiendengan cara mengurangi stres. Teknik yang digunakan adalah relaksasi,identifikasi pikiran negatif (ABC), dan pengelolaan emosi (SSTA). Penelitian inidilakukan terhadap 3 pasien menggunakan desain kuasi-eksperimental. Ketigapartisipan mengalami penurunan stres dilihat dari berkurangnya skor DiabetesDistress Scale-17. Perubahan skor Problem Solving Test menandakan bahwapartisipan telah memahami pentingnya menerapkan problem solving untukmengurangi stres.

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ABSTRACTThe complexity of diabetes management can be seen in the interaction of severalfactors that work in opposite direction. Patients may become confused and find itdifficult to achieve optimal outcomes. This study focuses on those of lowersocioeconomic status who experience diabetes-related distress. Application ofproblem solving techniques works to provide a sense of control over diabetes byreducing stress. Various techniques used in this study are relaxation, negativethoughts identification (ABC), and negative emotion regulation (SSTA). Thisstudy was conducted using quasi-experimental design. All three participantsexperienced less stress as shown by lower average scores of Diabetes DistressScale-17. Changes in Problem Solving Test score indicates that participants haveunderstood about the importance of using problem solving techniques for dealingwith diabetes-related distress."

"ABSTRAKLatar belakang: Vitamin D dianggap berperan dalam patogenesis diabetes melitus tipe 1 (DMT1), memperbaiki kontrol metabolik dan menurunkan risiko terjadinya komplikasi mikrovaskuler.Tujuan: Mengetahui profil kadar vitamin D remaja DMT1 dan hubungan kadar vitamin D dengan retinopati dan nefropati diabetik.Metode: Penelitian potong lintang pada remaja DMT1 usia 11-21 tahun dengan lama sakit minimal satu tahun. Semua subjek dilakukan wawancara menggunakan kuesioner, pemeriksaan fisis lengkap, kadar 25(OH)D, HbA1c, rasio albumin/kreatinin urin, dan fotografi fundus.Hasil: Terdapat 49 subjek, 34 (69,4%) perempuan dan 15 (30,6%) lelaki dengan median lama sakit lima tahun (1-16 tahun). Sebanyak 96% subjek menggunakan insulin basal bolus. Median HbA1c adalah 9,5% (6,3% - 18%). Tidak ada subjek dengan kadar 25(OH)D ≥ 30 ng/mL, 6 subjek (12,2%) dengan kadar 25(OH)D 21-19 ng/mL dan 87,8% memiliki kadar 25(OH)D ≤ 20 ng/mL. Rerata kadar 25(OH)D adalah 12,6 ng/mL (SD ±5,4 ng/mL). Faktor yang berhubungan dengan kadar vitamin D adalah lama pajanan matahari (RP 13,3; 95%IK = 1,8-96, p= 0,019). Jenis pakaian, penggunaan sunblock, IMT, lama sakit, konsumsi susu tidak berhubungan dengan kadar vitamin D. Prevalens retinopati pada penelitian ini adalah 8,2%, mikroalbuminuria 28,5%, dan nefropati 16,3%. Tidak terdapat hubungan bermakna antara kadar vitamin D dengan retinopati, mikroalbuminuria, dan nefropati diabetik.Kesimpulan: Tidak ada remaja DMT1 dengan kadar vitamin D yang cukup dan tidak ada hubungan antara kadar vitamin D dengan retinopati, mikroalbuminuria, dan nefropati diabetik.;Background: Many studies showed that vitamin D involved in the pathogenesis of type 1 diabetes mellitus (T1DM), metabolic control and decreased the risk of microvascular complication.

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ABSTRACT

Objective: To find out the vitamin D profile in adolescence with T1DM and its association with retinopathy and nephropathy diabetic.

Methods: This was a cross sectional study performed during April to May 2015 involving T1DM adolescence aged 11-21 years old with duration of illness ≥ 1 year. We used questionnaire to know factors associated with vitamin D level. We performed physical examinations, tests for level of 25(OH)D serum, HbA1c, urine albumin/creatinine ratio and fundal photographic.

Results: There were 49 subjects, 34 female (69.4%) and 15 male (30.6%) with median duration of illness was five years (1-16 years). Most of the subjects (96%) were on basal bolus regimen. Median of HbA1c level was 9.5% (range 6.3%-18%). None of the subject had 25(OH)D level ≥ 30 ng/mL, 12.2% with 25(OH)D level of 21-19 ng/mL and 87,8% was ≤ 20 ng/mL. Mean of 25(OH)D level was 12.6 ng/mL (SD ±5.4 ng/mL). Duration of sun exposure was associated with 25(OH)D level (prevalent ratio of 13.3; 95%CI = 1.8-96, p= 0.019); While type of clothing, sunblock, body mass index, milk and juice intake were not associated with 25(OH)D level. Diabetic retinopathy was found in 4 subjects (8.2%), microalbuminuria in 14 subjects (28.5%), and nephropathy in 8 subjects (16.3%). All the subjects who suffered from microvascular complication had 25(OH)D level ≤ 20 ng/mL. None of the subjects with 25 (OH)D > 20 ng/mL suffered had microvascular complication. There was no significant association between vitamin D level with diabetic retinopathy, microalbuminuria, or diabetic nephropathy.

Conclusion: None of the adolescent with type 1 DM had sufficient vitamin D level, and 87.8% had vitamin D deficiency. There was no association between vitamin D level with diabetic retinopathy, microalbuminuria, or diabetic nephropathy."

"Piper cf. fragile, Benth dan Centella asiatica, (L.) Urb telah diketahui berpotensi menyembuhkan luka. Tujuan dari penelitian ini adalah untuk mengetahui efek penyembuhan luka diabetes dari kombinasi infusa daun Piper cf. fragile, Benth dan herba Centella asiatica, (L.) Urb pada luka tikus yang diabetes. Hewan uji dibagi menjadi 7 kelompok dan dilukai menggunakan metode Morton. Semua kelompok diinduksi aloksan secara intraperitoneal dengan dosis 32 mg/200 g BB tikus kecuali kelompok 1. Kelompok I sebagai kontrol normal menerima akuades dan kelompok II sebagai kontrol induksi. Kelompok III diberi glibenklamid dengan dosis 0,9 mg/200 g BB tikus, kelompok IV diberi infusa dosis tunggal daun Piper cf. fragile, Benth dan kelompok V, VI dan VII diberi kombinasi infusa daun Piper cf. fragile, Benth dan herba Centella asiatica, (L.) Urb. Persentase penyembuhan luka dianalisis secara statistik dengan uji ANAVA satu arah. Hasilnya menunjukkan tidak ada perbedaan bermakna antar kelompok perlakuan selama 8 hari perlakuan.

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Piper cf.fragile, Benth. and Centella asiatica, (L.) Urb were evaluated for their wound healing potential. The aim of this study was to assess the wound healing effect of a combination of Piper cf. fragile leaves and Centella asiatica, (L.) Urb herbs infusions on diabetic male rats. Rats divided into 7 groups and experimentally wounded by Morton methode. All groups received intraperitoneally 32 mg/ 200 g bw of alloxan except group I. Group I was normal control received aquadest and group II was induced control. Group III received 0.9 mg/200 bw of glibenclamide, group IV had been treat with a single dose of Piper cf.fragile, Benth leaves infusions and group V, VI and VII had been given a combination of Piper cf. fragile leaves and Centella asiatica, (L.) Urb herbs infusions. The percentage of wound healing analized statistically by one way ANOVA. The result showed no significant different between groups for 8 days treatment."

"ABSTRAK Latar Belakang : Pasien diabetes melitus tipe 2 dengan penyakit arteri perifer (terutama critical limb ischemia) memiliki tingkat amputasi yang masih tinggi. Perkembangan teknik endovaskular memungkinkan tindakan revaskularisasi dengan tingkat keberhasilan yang tinggi dan komplikasi yang rendah dibandingkan operasi bypass.Tujuan : Penelitian ini bertujuan mengetahui tingkat keberhasilan klinis 1 tahun setelah tindakan Percutaneus Transluminal Angioplasty dan distribusi faktor-faktor yang mempengaruhi keberhasilan klinis.Metode : Penelitian ini merupakan studi kohort retrospektif pada pasien diabetes melitus tipe 2 dengan penyakit arteri perifer yang menjalani tindakan PTA pada tahun 2008-2012 di Pelayanan Jantung Terpadu Rumah Sakit Cipto Mangunkusumo Jakarta. Pasien diikuti selama 1 tahun setelah tindakan PTA. Luaran yang dinilai pada penelitian ini adalah keberhasilan klinis dan limb salvage. Definisi keberhasilan klinis adalah tidak mengalami amputasi mayor, tidak terjadi restenosis, dan tidak mengalami nyeri berulang. Sedangkan tingkat limb salvage adalah proporsi pasien dengan plantar stand yang utuh setelah tindakan PTA.Hasil : Tindakan PTA dilakukan pada 43 pasien dengan diabetes tipe 2. Manifestasi paling sering adalah gangren (30.2%) dan luka iskemik (30.2%). Sedangkan 8(18.2%) pasien datang dengan nyeri pada istirahat dan 9(20.2%) pasien datang dengan klaudikasio. Selama 1 tahun, 3 pasien mengalami amputasi mayor, 3 pasien mengalami restenosis, dan 4 pasien mengalami nyeri berulang. Keberhasilan klinis untuk 1 tahun adalah 75% dan tingkat limb salvage selama 1 tahun adalah 90%. Pasien dengan diabetes terkendali dan CTO memiliki proporsi keberhasilan klinis yang lebih tinggi.Simpulan : Tindakan PTA pada pasien diabetes melitus tipe 2 dengan PAD memiliki keberhasilan klinis dan tingkat limb salvage yang cukup baik.Kata Kunci : Angioplasti; diabetes; critical limb ischemia; penyakit arteri perifer; PTA; limb Salvage

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ABSTRACT Background : Diabetic patient with PAD (especially critical limb ischemia) still have a high rate of limb amputation. The development in endovascular technique allows revascularization with high level of success and low complication compare to surgical (bypass).Objectives :The aim of this study is to evaluate the clinical outcome 1 year after PTA in type 2 diabetic patient with PAD.Methods : This was a retrospective cohort study, with 1 year follow up, to evaluate the clinical outcome of diabetic patients with PAD that has undergone PTA procedure in 2008-2012 in Cipto Mangunkusumo Hospital. The main outcome measured were clinical success and limb salvage rate. Clinical success defined as no major amputation, no restenosis, and no reccurence pain after PTA. Limb salvage rate defined as proportion of patient with intact plantar stand after PTA.Results : PTA was performed in 43 patient with diabetes. In this study most frequent manifestation were gangren (30.2%) and ischemic wounds (30.2%), while 8 patients (18.2%) came with resting pain, and 9 patients (20.2%) have claudication. During one year follow up 3 patients (6.9%) had major amputation, 3 patients (6.9%) had restenosis, and 4 patients had resting pain reccurence. The clinical succes rate for one year is 75%, with limb salvage rate for 1 year is 90%. Patients with controlled diabetes and chronic total occlusion had a higher proportion of clinical success.Conclusion : PTA procedure for diabetic patient with PAD has good clinical outcome with high level of limb salvage rate.Keyword : Angioplasty; critical limb ischemia; diabetes; peripheral arterial disease; PTA; limb salvage"

"ABSTRAKDiabetes melitus merupakan sekelompok gangguan metabolisme tubuh, ditandai dengan hiperglikemik kronis yang dapat mengakibatkan komplikasi akut dan kronis. Salah satu peran perawat sebagai pemberi asuhan adalah memberikan asuhan keperawatan yang berkualitas melalui pendekatan Teori Self Care Orem. Penggunaan pendekatan teori ini diharapkan dapat membantu perawat dalam menanggulangi keterbatasan yang dimiliki pasien dan melibatkan pasien secara aktif dalam proses perawatannya melalui peilaku perawatan mandiri. Tujuan penulisan karya ilmiah akhir ini adalah menganalisis hasil proses belajar residensi keperawatan medikal bedah melalui penerapan asuhan keperawatan, penerapan evidence based nursing practice, dan inovasi keperawatan. Data yang diperoleh selama praktik klinik menunjukkan sebagian besar pasien diabetes melitus mengalami komplikasi ulkus kaki diabetik yang disebabkan oleh perilaku perawatan kaki mandiri belum optimal. Hasil penerapan evidence based nursing practice berupa kegiatan edukasi perawatan kaki mandiri dapat meningkatkan pengetahuan dan membentuk perilaku perawatan kaki sebagai tindakan pencegahan dini. Hasil kegiatan inovasi keperawatan melalui pengkajian kesehatan mandiri adalah pasien dapat melakukan pengkajian mandiri terhadap kebutuhan edukasi dan mendapatkan edukasi sesuai kebutuhan mereka. Kesimpulan dari karya ilmiah akhir ini adalah perlunya peningkatan kualitas asuhan keperawatan pada pasien diabetes melitus melalui pendekatan teori keperawatan untuk meningkatkan kemandirian pasien dalam pengelolaan penyakitnya.

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ABSTRACTDiabetes mellitus is a metabolic disorder that characterized by chronic hyperglycemia which could lead to acute and chronic complications. One of nurse roles in managing diabetes mellitus is deliver nursing care using Orem's Theory of Self Care as guide of nursing practice. With this theoretical approach, nursing is expected to be able to overcome the limitations and inability of the patients and actively involve patients in the treatment process through self-care behaviors. The aims of this paper is to analyze the implementation of nursing care, application of evidence based nursing practice, and innovation program which integrated to clinical practice. Based on patient collective data, that was found that the majority of diabetes mellitus patients had been hospitalized with diabetic foot ulcers complications that caused by non-optimal foot self-care behavior. The results of evidence based nursing practice showed that the diabetic foot care education program can improve the knowledge and build the foot self-care behavior as early prevention action. The results of innovation program through self-health assessment program are patients could assess their needs of educations and get health education according to assessment results. In conclusion, it's needed to improve the quality in caring for diabetes mellitus patients through application of nursing theory to increase the self-care behaviors in management of disease."

"Klinik gigi DN merupakan salah satu klinik gigi yang saat ini masih menggunakan sistempengoperasian secara offline, banyak penggunaan kertas dalam pencatatan, appointmentdilakukan secara manual, dan data yang tidak terintegrasi. Hal ini dapat menyebabkanterhambatnya pelayanan pasien sehingga timbulnya persepsi buruk dari pasien akanpelayanan yang dilakukan klinik gigi DN. Berdasarkan masalah tersebut, timpengembang mengembangkan sebuah sistem informasi yang dapat menjadi solusi daripermasalahan tersebut. Pada pengembangan, dikembangkan dua sistem terpisah (internalweb apps dan aplikasi PWA [Progressive Web Apps]) yang saling terintegrasi satu samalain. Internal web apps akan digunakan oleh pihak internal klinik gigi DN dalammenjalankan proses bisnisnya, sementara aplikasi PWA (Progressive Web Apps)digunakan oleh pasien klinik gigi DN. Sistem ini dikembangkan menggunakan salah satumetode pengembangan perangkat lunak agile, yaitu Scrum. Kerangka kerja Scrum yangdigunakan terdiri dari tiga fase, yaitu pre-game, game (development), dan post-game.Pada fase pre-game, dilakukan requirement gathering, perencanaan, danarchitecture/high level design. Pada fase game, dijalankannya sprint untuk pengerjaanproyek. Pada fase post-game dilakukannya testing terhadap sistem yang telahdikembangkan. Pada pengembangan sistem di klinik gigi DN ini, dihasilkan dua sistem(Internal web apps untuk internal klinik dan aplikasi PWA [Progressive Web Apps] bagipengguna eksternal klinik) yang dibangun dengan framework Spring Boot dan React JS.Dengan dikembangkan sistem informasi dan aplikasi tersebut, diharapkan pihak klinikgigi DN dapat lebih efektif dan efisien dalam melayani pasien.

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DN dental clinic that currently uses an offline operating procedure, uses a lot of paper in

recording, appointments are done manually, and the data is not integrated. This can cause

delays in serving patients so that there is a bad perception from patients about the services

provided by the DN dental clinic. Based on these problems, the development team

developed an information system that could be a solution to these problems. During the

development, two separate system (internal web apps and PWA [Progressive Web Apps]

application) were developed which were integrated with each other. The internal web

apps will be used by DN dental clinic internal parties in carrying out their business

processes, while the PWA (Progressive Web Apps) application is used by DN dental

clinic patients. The system is developed using one of the agile software development

methods, namely Scrum. The Scrum framework used consists of three phases, namely,

pre-game, game (development), and post-game. In the pre-game phase, requirements

gathering, planning, and architecture/high level design are carried out. In the game phase,

sprints are executed. In the post-game phase, testing of the system that has been developed

is carried out. In the development of the DN dental clinic information system, two system

(internal web apps for internal clinic and PWA [Progressive Web Apps] application

deliver to patient) were produced which were built with Spring Boot and React JS

frameworks. By developing the system information and applications, it is oped that the

DN dental clinic can be more effective and efficient in serving patients."