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"ABSTRAKNyeri pasca bedah abdomen adalah gabungan dari beberapa pengalaman sensori, emosional, dan mental yang tidak menyenangkan akibat trauma bedah. Walaupun nyeri telah dikelola dengan baik, kira-kira 86% pasien mengalami nyeri sedang ke hebat pasca bedah meskipun analgesik ditingkatkan. Penelitian ini bertujuan mendeskripsikan karakteristik responden (exploratory study) dan selanjutnya menjelaskan faktor-faktor yang mempengaruhi intensitas nyeri pasca bedah abdomen (explanatory study). Desain penelitian ini adalah deskriptif analitik dengan pendekatan cross sectional pada 67 orang responden pasca bedah abdomen. Pada penelitian ini digunakan instrumen State Anxiety Inventory (S-AI) Form Y untuk menilai keadaan cemas pasien pasca bedah abdomen, sikap dan keyakinan terhadap nyeri, dan skala nyeri untuk menilai intensitas nyeri pasca bedah menggunakan kombinasi Visual Analog Scale (VAS) dan Numeric Rating Scale (NRS). Hasil penelitian ini menunjukan bahwa faktor-faktor yang mempengaruhi secara signifikan terhadap intensitas nyeri pasca bedah abdomen adalah jenis kelamin (p value = 0,005), letak insisi (p value = 0,0005), dan tingkat kecemasan (p value = 0,0005). Faktor yang paling mempengaruhi intensitas nyeri pasca bedah abdomen adalah tingkat kecemasan (standardized coefficient β 0,501). Hasil penelitian ini bermanfaat bagi praktisi keperawatan sebagai acuan asuhan keperawatan dalam melakukan pengelolaan nyeri pasca bedah abdomen untuk mempertimbangkan faktor tingkat kecemasan, jenis kelamin, dan letak insisi. Rekomendasi hasil penelitian ini perlu adanya penelitian lebih lanjut dengan jumlah sampel yang lebih besar dan faktor-faktor lain yang dapat mempengaruhi nyeri.

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ABSTRACT

Abdominal postoperative pain is a combined of several unpleasant sensory, emotional, and mental experience precipitated by the surgical trauma. Pain experience are influenced by many factors and it is difficult to understand and about 86% of patients experience moderate to severe pain following surgery in the hospital. The purpose of this study was to identify the characteristic of respondent (exploratory study) and to explain influencing factors of abdominal postoperative pain intensity (explanatory study). The design was an analytic description using a cross sectional for 67 respondents abdominal postoperative. In the study using State Anxiety Inventory (S-AI) Form Y instrument was used to measure the abdominal postoperative state anxiety, attitudes and beliefs about pain, and pain scale using a combined Visual Analog Scale (VAS) and Numeric Rating Scale (NRS) was used to measure postoperative pain intensity. The finding showed that gender (p value = 0,005), incision site (p value = 0,0005), and anxiety levels (p value = 0,0005) were significantly influencing factors of abdominal postoperative pain intensity. The most influencing factor of abdominal postoperative pain intensity was anxiety levels (standardized coefficient β 0,501). This study information for nursing practitioner as reference in nursing care planning should be considered anxiety levels, gender, and incision site to management of patients with postoperative pain relief. It is recommended to conduct further research using more samples and other factors that also may alter pain reaction."

"Tesis ini membahas mengenai performa skor V-POSSUM sebagai prediktor mortalitas 30 hari pasca tindakan EVAR TEVAR pada pasien AAA dan TAA di RSUPN Cipto Mangunkusumo.Penelitian ini merupakan studi kohort retrospektif menggunakan data dari rekam medis. Data yang diambil sesuai variabel yang terdapat dalam sistem skoring dalam bentuk kategorik lalu diolah secara statistik untuk menguji validitas skor V-POSSUM. Hasil penelitian melibatkan 85 pasien yang memenuhi syarat penerimaan penelitian. Dari pengolahan data statistik diketahui bahwa skor fisiologis, risiko morbiditas, dan risiko mortalitas dapat digunakan sebagai model untuk memprediksi luaran kematian karena memiliki performa akurasi dan diskriminasi yang baik, sedangkan skor kepelikan operasi tidak dapat digunakan karena secara statistik tidak menunjukkan hal yang sama. Nilai P hasil perhitungan 'Goodnes of Fit Model' skor fisiologis, risiko morbiditas, risiko mortalitas masing-masing adalah 0.00, sedangkan skor kepelikan operasi 0.18 (>0.05). 'Area Under the Curve' (AUC) masing-masing adalah 94%, 93%, 93%, dengan titik potong masing-masing berada di angka 31, 68.8, dan 10.6. Sebagai kesimpulan adalah bahwa skor V-POSSUM memiliki akurasi dan diskriminasi yang baik bukan hanya pada skor risiko mortalitasnya saja, namun pada skor fisiologis dan skor risiko morbiditasnya.

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This thesis discusses the performance of V-POSSUM score as a predictor of 30 days mortality after EVAR TEVAR in AAA and TAA patients at Cipto Mangunkusumo Hospital. This study is a retrospective cohort method using data from medical records. Data taken according to the variables contained in the scoring system in categorical form then processed statistically to test the validity of the V-POSSUM score. The results of the study involved 85 patients who met the research acceptance requirements. From the processing of statistical data it is known that physiological scores, morbidity risk, and mortality risk can be used as a model to predict the outcome of death because it has good performance in accuracy and discrimination, while the severity score of surgery cannot be used because it does not show the same result statistically. The P value calculated by the Goodnes of Fit Model physiological score, the morbidity risk, the mortality risk of each was 0.00, while the severity score of the operation was 0.18 (> 0.05). Area Under the Curve (AUC) are 94%, 93%, 93%, respectively, with points 31, 68.8 and 10.6. The conclusion is that the V-POSSUM score has good accuracy and discrimination not only on the mortality risk score, but also on the physiological score and the morbidity risk score."

"Although there has been a slow but steady decrease in incidence, gastric cancer remains the second leading cause of cancer death worldwide. Several aspects of the oncological and surgical management are still controversial and so gastric cancer represents a challenge for the surgeon. This book aims to delineate the state of the art in the surgical and oncological treatment of gastric cancer, describing the new TNM staging system, the extent of visceral resection and lymphadenectomy focusing on the different open and minimally invasive surgical techniques and discussing intraoperative chemohyperthermia and neoadjuvant and adjuvant treatment. Operative endoscopy and endoscopic ultrasonography are also discussed, as these now have an important role in both diagnostic work-up and palliative care of gastric cancer patients. Only a multidisciplinary approach involving the surgeon, gastroenterologist, and oncologist can produce the comprehensive and integrated overview that today constitutes a winning strategy for the optimization of results.What we hope we have achieved is a flexible, up-to-date, exhaustive publication, rich in illustrations and consistent with evidence-based medicine."

"Pendahuluan, Obesitas merupakan masalah epidemic global diseluruh dunia. dan memperlihatkan kecendrungan yang meningkat secara tajam. Prevalensi nasional obesitas di Indonesia sebesar 19,1% dan 18,8% diantaranya adalah obesitas sentral. Obesitas sentral memiliki dampak yang lebih buruk terhadap penyakit degenartif dan kematian. Obesitas sentral dipengaruhi oleh berbagai faktor. Faktor risiko tersebut dapat berkembang sesuai dengan karakteristik masyarakat dan kondisi ekonomi setempat. Sampai saat ini, penelitian mengenai faktor risiko yang berpengaruh di kota maupun kabupaten masih tergolong langka. Metode penelitian, Disain studi yang digunakan dalam penelitian ini adalah cross sectional. Data penelitian adalah data sekunder Riset Kesehatan Dasar tahun 2007 yang diambil dari 440 kabupaten/kota seluruh Indonesia. Unit analisa yang digunakan adalah penduduk usia dewasa dengan rentang umur 20 sampai 64 tahun sebanyak 448.352 individu. Analisa data yang digunakan adalah analisa Regresi Logistik Ganda untuk mendapatkan model prediksi dan nilai OR dilanjutkan dengan uji interaksi multivariat terhadap variabel status kota berdasarkan pertimbangan logika substantif. Hasil penelitian, Prevalensi nasional obesitas sentral populasi dewasa sebesar 23,9%. Dengan prevalensi kota 29,5% dan kabupaten 20,5%. Faktor risiko yang berpengaruh terhadap obesitas sentral dalam model prediksi akhir adalah status kota (OR 1,519) umur (OR 3,314), jenis kelamin (4,480), pendidikan (OR 0,870), aktifitas fisik (OR 1,181), energy total (OR 1,960), Konsumsi karbohidrat (OR 0.860), konsumsi lemak (0,976), perokok (OR 0,616), mantan perokok (0,976) dan alcohol (OR 1,674). Setelah dilakukan uji interaksi terhadap status kota ditemukan bahwa lima variable memiliki interaksi yang bermakna yaitu umur, pendidikan, perokok, karbohidrat dan lemak terhadap status kota. Hal ini mengindikasikan bahwa adanya pengaruh yang berbeda dari kelima variable tersebut di kota dan kabupaten. Sehingga dapat disimpulkan factor risiko obesitas sentral dikota adalah umur diatas 40 tahun (OR 2,309), pendidikan tinggi (OR 1,107) dan karbohidrat berlebih (OR 1,29), sedangkan di kabupaten factor risiko obesitas sentral adalah umur diatas 40 tahun (OR 3,409).

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Introduction, the global epidemic of obesity is a problem worldwide. and showed a tendency to increase significantly. National prevalence of obesity in Indonesia amounted to 19.1% and 18.8% of which were abdominal obesity. Abdominal obesity has a worse impact on degenartif disease and death. Abdominal obesity is influenced by various factors. These risk factors can be developed in accordance with the characteristics of the community and local economic conditions. Until recently, research on risk factors that affect the Urban and district is still relatively rare. Research methods, study design used in this study is cross sectional. The research data is secondary data Health Research Association in 2007 which was taken from the 440 districts throughout Indonesia. Unit of analysis used was the adult population with a lifespan of 20 to 64 years were 448 352 individuals. Analysis of the data used is multiple logistic regression analysis to obtain the model prediction and the value of OR followed by a multivariant interaction test variable logic status of the Urban based on substantive considerations.

Results of research, the national prevalence of abdominal obesity 23.9% of the adult population. With a prevalence of 29.5% and 20.5% district. Factors influencing the risk of abdominal obesity in the final prediction model is the status of the Urban (OR 1.519), age (OR 3.314), gender (4.480), education (OR 0.870), physical activity (OR 1.181), total energy (OR 1.960), Consumption of carbohydrates (OR 0860), consumption of fat (0.976), smoking (OR 0.616), exsmokers (0.976) and alcohol (OR 1.674). After interaction test of the status of the Urban found that five variables had a significant interaction such as age, education, smoking, carbohydrate and fat on the status of the city. This indicates that the influence of five variables that are different from those in the cities and counties. It can be concluded in the city's abdominal obesity risk factors are age above 40 years (OR 2.309), higher education (OR 1.107) and an excess of carbohydrates (OR 1.29), while in districts of abdominal obesity risk factors are age above 40 years (OR 3.409)."

"Latar belakang :Tesis ini membahas tentang analisis kasus kematian pada pasien Aneurisma aorta abdominal di RSUP Fatmawwati yang menjalani operasi elektif. Sampel dan Metode : Data pasien diambil periode 2013 sampai April 2018. Semua pasien yang meninggal dari operasi elektif aneurisma aorta abdominal akan di data. Penelitian ini ditampilkan dalam bentuk deskriptif, dengan data kualitatif dan kuantitatif. Data kualitatif didapatkan dengan melakukan wawancara dengan tim operasi, operator, tim anestesi dan paramedis instrumen. Data kuantitatif didapatkan dengan telusur rekam medis. Hasil : Terdapat 27 kasus, selama periode 2013 sampai April 2018. Hanya 15 kasus yang rekam medis lengkap, 5 kasus hidup, 2 kasus meninggal pada operasi emergency dan 8 kasu meninggal pada operasi elektif. Dari 8 kasus ini, 5 kasus disertai anemia dan trombositopenia yang menetap sampai pada tahap postoperasi, 2 kasus dengan gangguan ginjal dan 1 kasus dengan penyebab yang belum jelas. Pada 8 kasus kematian, lama operasi berkisar dari 4 jam 20 menit sampai 8 jam 10 menit. Jumlah perdarahan berkisar dari 750 cc sampai 7.000 cc. Kadar creatinin preoperasi, berkisar dari 1,0 sampai 4,3 mg/dL. Kadar creatinin postoperasi berubah dari 1,0 sampai 4,5 mg/dL. Kadar hemoglobin postoperasi berkisar 5,9 sampai 9,4 g/dL. Kadar trombosit, berkisar 45.000 sampai 108.000/uL. Rata rata jumlah perdarahan adalah 3.156 cc. Kesimpulan : Penelitian ini menyimpulkan bahwa kasus dengan hasil akhir kematian, sebagian besar disertai oleh jumlah perdarahan yang masif. Perbaikan yang dilakukan untuk resusitasi komponen darah tidak mencapai hasil yang optimal.

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Background : The aim of this study is to confirm the factors that affect the mortality following open elective abdominal aortic aneurysm repair. Subject and Methode : This study was a retrospective study. Qualitative and quantitave data were collected from interviewing the team in charge and from the hospital database medical record. The data were collected for five years, from 2013 until April 2018. Data will be displayed in descriptive. Result : Twentyseven cases were hospitalized during the periode of 2016 until April 2018. Ten cases were not availlable to analyze, medical record were missing. Out of two case from these fivteen cases, was an emergency case. Five cases were alive when they discharge from the hospital. The other eight were elective cases and were able to analyze. Five cases, out of this eight, were accompanied by anemia and thrombositopenia, which last until they all move from the surgery room to the ICU. Two cases with renal disfunction, and one case with unclear cause of death. Duration of surgery in all this elective cases, ranged from 4 hours 20 minutes until 8 hours 10 minutes. Bood loss during surgery, estimated from 750 cc to 7.000 cc. Preoperative creatinin level, ranged from 1,0 to 4,3 mg/dL. Postoperative cretainin level, ranged from 1,0 to 4,5 mg/dL. Postoperative hemoglobin level, ranged from 5,9 to 9,4 g/dL. Postoperative platelet count , ranged from 45.000 to 108.000/uL. Mean blood loss during surgery was 3.156 cc. Conclusion : This study concluded that most of the death case was accompanied by massive bleeding. And all those attempt to improve by blood rescusitation, was not promptly worked."

"Recurrent abdominal pain is one of the most common symptoms found in children. Description of abdominal pain is important in determining the etiologic cause. Organic pain must be ruled out first before suspecting psychogenic cause of pain. However; Children and infant are likely having difficulties in describing abdominal pain. Referred pain may lead to misdiagnosis. Alarm symptoms of abdominal pain are important indices and must be recognized. Careful and complete anamnesis and physical examination play critical role in management approach of recurrent abdominal pain in children and determine whether medical therapy only or combination with surgical intervention is considered necessary."

"Aneurisma aorta abdominal merupakan kasus yang relatif sering dijumpai, namun hingga saat ini belum ada analisis karakteristik serta evaluasi klinik yang memadai. Dilakukan penelitian dengan desain retrospektif analitik untuk mendapatkan karakteristik serta evaluasi klinik melalui data rekam medis. Dilakukan analisis pada faktor risiko pasien untuk melihat hubungan dengan tipe aneurisma, letak aneurisma, serta komplikasi pasca bedah. Selama Januari 2009 - Desember 2012 terdapat 32 pasien aneurisma aorta abdominal. didapatkan beberapa faktor risiko pasien 15 orang dengan diabetes, 22 orang dengan hipertensi, 24 orang dengan perokok serta 11 orang dengan riwayat aneurisma dalam keluarga. Didapatkan perbedaan signifikan pada kategori usia dengan tipe aneurisma (p=0,012). Demikian dengan jenis kelamin dengan tipe aneurisma (p=0,012). Pada uji statistik juga didapatkan kemaknaan fraksi ejeksi jantung (p=0,047) dan ukuran aneurisma (p= 0,009) terhadap tipe aneurisma. Juga terdapat kemaknaan faktor sistolik preoperatif terhadap komplikasi pasca bedah (p=0,025).

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Abdominal aortic aneurysm (AAA) is relatively common in Indonesia, however until the present, there is no sufficient data on the characteristics and clinical evaluation of AAA. This study utilized an analytic retrospective design to obtain data on the characteristics and clinical evaluation of AAA. Analysis was done to evaluate the association between risk faktors and the type of aneurysm, location of the aneurysm, and postoperative complications.Between January 2009 and December 2012, 32 patients with abdominal aortic aneurysm treated in RS Dr. Cipto Mangunkusumo. Risk faktors were identified, 15 patients had diabetes, 22 patients had hypertension, 24 patients were smokers, and 11 patients had a family history. Significant association was found between age category (above and below 45 years) and the type of aneurysm (p=0,012). Significant association was also found between gender and the type of aneurysm (p=0,012). It also was done to evaluate the association between cardiac ejection fraction (p=0,047) and the aneurysm diameter (p= 0,009) as risk faktors for the type of aneurysm. Significant association was also found between postoperative complications and preoperatif systolic blood pressure (p=0,025)."