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"Latar belakang: Modified Blalock-Taussig shunt (MBTS) merupakan prosedur bedah jantung sederhana namun memiliki angka mortalitas cukup tinggi. Karakteristik terutama usia pasien yang menjalani prosedur MBTS di Indonesia berbeda dengan negara lain.Tujuan: Membandingkan angka mortalitas operatif MBTS berdasarkan kriteria usia dan  mengidentifikasi faktor prediktor mortalitas operatif dan morbiditas pascaoperasi MBTS.Metode: Penelitian ini merupakan studi kohort retrospektif mortalitas pada 400 pasien yang menjalani operasi MBTS di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita.Hasil: Mortalitas berdasarkan kriteria usia yaitu 32,1% pada usia ≤ 28 hari, 19,9% pada usia 29-365 hari, 3,6% pada usia 366-1825 hari dan 8% pada usia > 1825 hari. Berat badan kurang dari 3 kg, kadar hematokrit lebih dari 45% sebelum operasi dan kadar activated partial thromboplastine time (aPTT) < 60 detik sebagai prediktor mortalitas. Transfusi packed red cell  (PRC) > 6 ml/kg, penggunaan ventilasi mekanik dan penggunaan prostaglandin preoperasi dan kadar aPTT < 60 detik 4 jam pasca operasi terbukti sebagai prediktor morbiditas.Kesimpulan: Terdapat perbedaan bermakna angka mortalitas pascaoperasi berdasarkan usia. Kriteria usia tidak terbukti sebagai prediktor mortalitas. Berat badan < 3 kg meningkatkan mortalitas. Prediktor morbiditas pascaoperasi adalah transfusi PRC > 6ml/kg, penggunaan ventilator, penggunaan prostaglandin dan kadar aPTT < 60 detik.

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Background: Modified Blalock-Taussig shunt (MBTS) is a simple procedure but has a considerable operative mortality rate. Patient’s characteristics who underwent MBTS in Indonesia is different than other country. There was no predictor of operative mortality has been identified in Indonesian.

Objectives: To compare mortality rate based on age criteria and to identify mortality and morbidity predictors after MBTS procedure.

Methods: A retrospectively cohort study was conducted on 400 patients who underwent MBTS at National cardiovascular center Harapan Kita (NCCHK).

Results: There were 32,1% death at age ≤ 28 days, 19,9% at age 29-365 days, 3,6% at age 366-1825 days and 8% at age > 1825 days. Body weight < 3 kg, haematocrite level > 45% before procedure and activated partial thromboplastine time level (aPTT) < 60 seconds were operative mortality  predictors. Packed red cell  transfusion (PRC) > 6 ml/kg, mechanical ventilator and prostaglandin E1 use before procedure, aPTT level < 60 seconds after procedure were identified as postoperative morbidity predictors.

Conclusion: age was not proven as an operative mortality predictors. Body weight < 3 kg increase mortality rate. Postoperative morbidity predictors were PRC transfusion > 6ml/kg, aPTT level < 60 seconds, mechanical ventilator and prostaglandine E1 use."

"PendahuluanKeputusan untuk melakukan ligasi Patent Ductus Arteriosus pada saat operasi modifikasi pintas Blalock Taussig pada pasien neonatus dengan duct dependent masih diperdebatkan. Tujuan penelitian ini adalah mencari hubungan antara melakukan ligasi patent ductus arteriosus durante operasi modifikasi pintas Blalock Taussig dengan luaran klinis pada pasien neonatus dengan duct dependent.MetodePenelitian retrospektif ini mencakup neonatus dengan duct dependent yang menjalani operasi modifikasi pintas Blalock Taussig di Pusat Jantung Nasional Harapan Kita antara Januari 2009 sampai Desember 2014. Lama rawat, lama penggunaan ventilator, skor inotropik, kejadian low cardiac output syndrome, kejadian resusitasi, reintervensi dan mortalitas pasca operasi menjadi luaran klinis yang diteliti.HasilTujuh puluh enam neonatus (usia rata rata 11 ± 5,5 hari) menjalani operasi modifikasi pintas Blalock Taussig. Tindakan ligasi patent ductus arteriosus dilakukan pada 31 pasien. Pada kelompok pasien yang dilakukan ligasi patent ductus arteriosus ditemukan angka kejadian low cardiac output syndrome lebih tinggi (32,2 % versus 13,3%, p = 0,047) dan skor inotropik yang lebih tinggi (median 10,1 versus 7,9; p = 0,049). Tidak ada perbedaan yang signifikan antara lama rawat, lama penggunaan ventilator, kejadian resusitasi, kejadian reintervensi dan mortalitas antara kedua kelompok.KesimpulanPada neonatus dengan duct dependent, ligasi PDA durante operasi modifikasi pintas Blalock Taussig berkaitan dengan peningkatan angka kejadian low cardiac output syndrome dan skor inotropik pada periode pasca operasi.

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ObjectiveThe question of whether to ligate the patent ductus arteriosus when performing modified Blalock-Taussig shunt surgery in neonates is still a controversy. The aim of this report was to compare the results of ligate versus non ligate of the patent ductus arteriosus during modified Blalock Taussig shunt surgery in neonates with duct dependent.Patient and methodsThis retrospective study included neonates with duct dependent diagnosis who underwent modified Blalock Taussig shunt surgery at Harapan Kita National Cardiovascular Center from January 2009 to December 2014. Hospital stay, intubation time, inotropic score, low cardiac output syndrome event, resuscitation event, reintervention event, and mortality postoperative were studied as clinical outcomes.ResultsSeventy-six neonates (mean age 11 ± 5.5 days) underwent a modified Blalock Taussig procedure. The arterial duct was ligated in 31 patients. Compared with patients in whom the patent ductus arteriosus was left open, patients with a surgically closed arterial duct had a higher incidence of low cardiac output syndrome (32.2 % versus 13.3%, p = 0,047) and higher inotropic score (median 10.1 versus 7.9; p = 0.049). There were no significant difference between length of hospital stay, time to extubation, resuscitation event, reintervention event and mortality between the two groups.ConclusionsIn newborns with duct dependent, ductal ligation during Modified Blalock Taussig shunt procedure is associated with increased incidence of low cardiac output syndrome events and higher inotropic score during the postoperative period."

"Latar belakang: Modified Blalock-Taussig Shunt (MBTS) merupakan terapi paliatif untuk pasien dengan penyakit jantung bawaan (PJB) sianotik, namun memerlukan tatalaksana antikoagulan pascaoperasi agresif untuk mencegah komplikasi oklusi shunt dan perdarahan yang berujung pada kematian. Penelitian ini menilai efektivitas pemeriksaan koagulasi alternatif yaitu Activated Clotting Time (ACT) yang lebih mudah dan cepat dihasilkan dibandingkan dengan Activated Partial Thromboplastin Time (APTT) untuk regulasi antikoagulan yang lebih agresif untuk mencegah komplikasi pascaoperasi MBTS.Metode: Desain penelitian adalah retrospektif longitudinal. Semua pasien yang menjalani MBTS di periode Januari 2017 hingga Mei 2018 dibagi menjadi dua kelompok, yang menggunakan ACT setiap jam dan kelompok APTT yang diperiksa setiap empat jam. Kedua kelompok dievaluasi selama perawatan pascaoperasi adanya kejadian oklusi shunt, perdarahan, operasi ulangan, dan kematianHasil: Total subjek adalah 174 pasien yang menjalani MBTS, sebanyak 59 pasien dilakukan regulasi heparin pascaoperasi dengan ACT dan 115 pasien dilakukan pemeriksaan APTT. Angka kejadian operasi ulangan lebih rendah signifikasn pada kelompok ACT dibandingkan APTT sebesar 6,77% (p= 0,023).Tidak terdapat perbedaan bermakna antara kedua kelompok pada kejadian oklusi (p=0,341; OR 0,571 IK95% 0,178-1,834), perdarahan pascaoperasi (p= 0,547; OR 0,563 IK95% 0,149-2,128), dan kematian (p=0,953; OR 0,975 IK95% 0,369-2,554). Kelompok ACT menunjukkan kecenderungan protektif terhadap kejadian-kejadian morbiditas pascaoperasi MBTS.Simpulan: Regulasi dosis heparin menggunakan pemeriksaan ACT nenurunkan kejadian operasi ulangan dan menunjukkan hasil protektif terhadap morbiditas pascaoperasi MBTS lainnya sehingga dapat dipertimbangkan penggunaannya.

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Background: Modified Blalock-Taussig Shunt (MBTS) is a palliative treatment for cyanotic congenital heart disease (CHD) which needs postoperative anticoagulant treatment to prevent shunt occlusion and postoperative bleeding. This study was to find out the effectivity of alternative coagulation test of Activated Clotting time (ACT) which is faster and easier to produce compared to Activated Partial Thromboplastin Time (APTT) for a more aggressive anticoagulant regulation to prevent postoperative complcations.

Methods: The study design is retrospective longitudinal study. All patients that underwent MBTS from January 2017 to Mei 2018 is deviden into 2 groups, first using ACT to regulate heparin and the second group using APTT. Both groups are studied for the incidence of shunt occlusion, bleeding, redo operation, and death.

Results: Total subjects who underwent MBTS were 174 patients. Postoperative heparin is regulated using ACT in 59 patients and APTT in 115 patients. There are less shunt occlusion in ACT group (6,78%) compared to APTT (11,03%) but statistically insignificant (p = 0,341). Bleeding is less in ACT group (5,08%) compared to APTT (8,69%) but statistically insignificant (p= 0,547). Mortality is lower in ACT group (11,86%) compared to APTT (12,17%) but statistically insignificant (p = 0,953). Redo operation is significantly lower in ACT group (6,77%) compared to APTT (20%) with p = 0,023. Although statistically insignificant, ACT group showed clinically significant lower shunt occlusion, bleeding, and mortality.

Conclusion: No significant difference between ACT and APTT in shunt occlusion, bleeding, and mortality, but redo operation is significantly lower in ACT group. ACT might be considered as alternative test for easier and faster method to regulate postoperative MBTS heparin dose."

"Latar Belakang : Terdapat dua modalitas terapi paliatif pada populasi pasien penyakit jantung bawaan biru pulmonary duct dependent yaitu intervensi kateterisasi dengan PDA stent dan pembedahan dengan mBTT shunt. Sampai saat ini belum ada penelitian yang membandingkan luaran kedua tindakan paliatif ini pada usia yang lebih tua.Tujuan: Mengetahui luaran tindakan PDA stent dibandingkan dengan mBTT shunt sebagai terapi paliatif pada pasien penyakit jantung bawaan sianotik dengan pulmonary duct dependent.Metode : Dilakukan studi kohort retrospektif menggunakan data sekunder terhadap 143 pasien yang menjalani terapi paliatif PDA stent dan mBTT shunt pada periode Agustus 2016 sampai Agustus 2022 di RS Pusat Jantung Harapan Kita. Dilakukan pemantauan selama perawatan hingga 30 hari pasca tindakan. Hasil: Total 143 pasien yang dimasukkan ke dalam analisis luaran primer dan sekunder; 43 pasien menjalani PDA stent dan 100 pasien menjalani mBTT shunt dengan median usia kelompok PDA stent 110 (31-1498) hari dan kelompok mBTTshunt 174.5 (30-1651) hari. Komposit luaran primer tidak bermakna pada kedua kelompok meliputi mortalitas 30 hari (6(14%) vs 14 (14%), p=1,000), reintervensi (1(2,3%) vs 7 (7%),p = 0,436) , dan rehospitalisasi 30 hari (0(0%) vs 2(2%),p=0,319). Analisis luaran sekunder didapatkan angka lama rawat inap ICU lebih pendek pada kelompok PDA stent(2 (0-16) hari vs 4 (1-63) hari, p =0,002).Kesimpulan: PDA stent memiliki luaran yang tidak berbeda dengan tindakan mBTT shunt pada komposit luaran meliputi mortalitas 30 hari, reintervensi, dan rehospitalisasi 30 hari namun berbeda bermakna pada lama rawat ICU.

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Background: There are two modalities of palliative therapy in the population of patient with pulmonary duct dependent which is catheterization intervention with PDA stent and surgery with BTT shunt. To date, there have been no studies that have compared the outcomes of these two palliative strategy in older age.

Objectives: To determine the outcome of PDA stent compared to mBTT shunt as palliative therapy in patients with pulmonary duct dependent congenital heart disease.

Methods: A retrospective cohort study was conducted using secondary data on 143 patients undergoing palliative therapy for PDA stents and mBTT shunts from August 2016 to August 2022 at National Cardiovascular Center Harapan Kita. Monitoring was carried out during treatment up to 30 days after the procedure.

Results : A total of 143 patients were included in the primary and secondary outcome analysis; 43 patients underwent PDA stent and 100 patients underwent mBTT shunt with median age of PDA stent group 110 (31-1498) days and mBTT shunt group 174.5 (30-1651) days. Primary outcome composite was not significant in both groups including 30 days mortality (6(14%) vs 14(14%), p=1.000), reintervention (1(2.3%) vs 7(7%),p=0.436) , and 30 days rehospitalization (0(0%) vs 2(2%),p=0.319). Secondary outcome analysis showed shorter ICU length of stay in the PDA stent group (2 (0-16) days vs 4 (1-63) days, p = 0.002).

Conclusion: PDA stent has an outcome that is not different from the mBTT shunt procedure in the composite outcome including 30 days mortality, reintervention, and 30 days rehospitalization but significantly different in ICU length of stay."

"ABSTRAKAmeloblastoma merupakan aspek penting dalam patologi mulut dan maksilofasial.Frekuensi dan distribusi ameloblastoma bervariasi di setiap negara, namun masihsangat sedikit penelitian mengenai hal ini yang dilakukan di Indonesia. Penelitian inibertujuan mengetahui frekuensi dan distribusiameloblastoma di RSUPN Dr. CiptoMangunkusumo periode Januari 2008-September 2014. Analisis dilakukan pada 98kasus ameloblastoma. Frekuensi dan distribusi dilihat berdasarkan usia, jeniskelamin, dan tipe histopatologis. Mayoritas pasien berusia 30-39 tahun (33.67%) danberjenis kelamin laki-laki (59.18%) dengan perbandingan 1.45:1 terhadapperempuan. Tipe histopatologis yang paling banyak ditemukan adalah tipe campuranpleksiform dan folikuler (18.37%).

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ABSTRACTAmeloblastoma constitutes an important aspect of oral and maxillofacial pathology.Frequency and distribution of ameloblastoma varies in different countries, howeververy few studies have been done in Indonesia. This study aims to evaluate thefrequency and distribution of ameloblastoma cases in Dr. Cipto MangunkusumoGeneral Hospital from January 2008-September 2014. 98 ameloblastoma cases wereanalyzed. Frequency and distribution was analyzed based on age, gender, andhisopathologic type. Most of the patients were 30-39 years old in age (33.67%) andmen were more involved than women (59.18%) with ratio 1.45:1. The most frequenthistopathologic type that was found is plexiform and follicular mixed type (18.37%)."

"Organisasi yang menghasilkan suatu produk seperti jasa, memerlukan suatu evaluasi berupa penilaian mandiri (self assessment) yang dapat meningkatkan kualitas pelayanan secara terus-menerus (continous improvement) sehingga didapatkan kualitas pelayanan yang tinggi dan sesuai dengan tuntutan zaman. Salah satu penilaian keberhasilan suatu organisasi adalah hasil kinerja yang optimal yang diukur berdasarkan target-target yang ditentukan organisasi itu sendiri. Peneliti menggunakan 7 (tujuh) kriteria yang terdapat dalam Malcolm Baldrige Health Care Criteria for Performance Excelence untuk mengetahui mutu organisasi Direktorat Bina Upaya Kesehatan Rujukan tahun 2014. Metode penelitian adalah mix methode dengan sequential eksplanatory design. Hasil analisis bivariat menunjukkan hubungan yang kuat dan berpola positif antara hasil kinerja organisasi dengan enam kriteria Malcolm Baldrige. Sedangkan hasil analisis multivariat menunjukkan empat kriteria yang positif dan satu kriteria negatif yang dapat menjelaskan hasil kinerja organisasi sebesar 65,7% sementara satu kriteria tidak masuk dalam pemodelan. Hasil kinerja Direktorat Bina Upaya Kesehatan Rujukan termasuk dalam range sangat rendah. 3 permasalahan yang masih yang menonjol antara lain organisasi belum menetapkan sasaran, tujuan dan ukuran kinerja (key perfomance indicator) dalam perencanaan organisasi; belum menetapkan visi, misi dan nilai-nilai organisasi serta perencanaan belum disusun berdasarkan periode jangka panjang dan jangka pendek. Permasalahan tersebut dapat diselesaikan jika direktur dan pimpinan organisasi segera menetapkan visi, misi dan nilai-nilai organisasi, menyusun perencanaan strategis sesuai dengan tugas dan fungsi organisasi serta berdasarkan periode jangka panjang dan jangka pendek.

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Organizations that produce a product such as services, requires an evaluation of a self-assessment to improve service quality continuously to obtain a high quality of service and in accordance with the demands of the times. One of the assessment of an organization's success is the result of optimal performance as measured by the target-the specified target organization itself. Researchers are using seven (7) criteria contained in the Malcolm Baldrige Health Care Criteria for Performance Excelence to determine the quality of the organization of the Refferal Health Directorate Building Effort, 2014. Research method is the sequential explanatory mixed method design.

The results of the bivariate analysis showed a strong association between positive and patterned organizational performance results with the six criteria of the Malcolm Baldrige. While the results of the multivariate analysis showed four positive criteria and negative criteria that one can explain the results of the organization's performance by 65.7%, while the criteria are not included in the modeling.

The results of the performance of the Refferal Health Directorate Building Effort references included in the very low range. 3 problems that still stand out among other organizations have not set goals, objectives and performance measures (key perfomance indicators) in the planning of the organization; has not set a vision, mission and values of organization and planning has not been prepared based on a period of long-term and short-term. These problems can be solved if the director and the head of the organization immediately set the vision, mission and values of the organization, strategic planning in accordance with the duties and functions of the organization as well as by long-term period and the short-term."

"Tesis ini membahas tentang analisa mutu pelayanan unit hemodialisa ditinjau dari Kriteria Baldrige di Rumah Sakit Anna Medika Bekasi Tahun 2015. Hal ini didasari karena saat ini unit hemodialisa menjadi rumah sakit dengan tindakan hemodialisa terbesar ke dua di Jawa Barat, sehingga perlu diketahui kekuatan dan kelemahan dalam pelayanan unit hemodialisa. Hal lain karena belum dilakukan kajian terhadap mutu pelayanan, maka dilakukan analisa dengan menggunakan kriteria Baldrige. Kriteria Baldrige digunakan karena fleksibel, tidak mengukur satu aspek saja, namun terhadap faktor organisasi, operasional dan hasil pelayanan. Jenis penelitian ini adalah penelitian kualitatif dengan pendekatan deskriptif. Pengumpulan data dengan wawancara mendalam, observasi dan telaah dokumen. Pengolahan dan analisa data menggunakan petunjuk/panduan penilaian kriteria Baldrige. Hasil penelitian menemukan bahwa mutu pelayanan unit hemodialisa telah mencapai poin 527,75 dari total skor dalam kriteria Baldrige yakni 1000 poin. Dalam penilaian ini, unit hemodialisa menuju tahap pengembangan dan perbaikan. Aspek yang terkuat dalam pelayanan unit hemodialisa terletak pada kepuasan pelanggan (pasien), operasional dan berorientasi terhadap pelayanan, namun terdapat aspek yang perlu perbaikan yakni dalam hal strategi, monitoring dan evaluasi serta kepemimpinan. Saran penelitian ini agar unit memperhatikan, membuat program kerja, pedoman pelayanan/standar operasional prosedur, sistem keamanan dan keselamatan pasien dan karyawan guna mencapai pelayanan yang bermutu tinggi.

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This thesis discusses the analysis of service quality hemodialysis unit in terms of the Baldrige Criteria Anna Medika Hospital in Bekasi year since 2015. This is based on current hemodialysis unit into a hospital with action hemodialysis second largest in West Java, so keep in mind the strengths and weaknesses in service hemodialysis unit. The other thing because it has not done a study of quality of service, then the analysis using the Baldrige criteria. Baldrige criteria is used because it is flexible, does not measure one aspect only, but to factor organizational, operational and service delivery.

The research is a qualitative study with a descriptive approach. Collecting data with in-depth interviews, observation and document analysis. Data processing and analysis using manual / guide assessment Baldrige criteria.

The study found that service quality hemodialysis unit has reached a total score of 527.75 points in the Baldrige criteria for 1000 points. In this assessment, hemodialysis unit towards the stages of development and improvement. Aspects of the strongest in the service of hemodialysis unit located on customer satisfaction (patient), operational and oriented towards services, but there are aspects that need improvement in terms of strategy, monitoring and evaluation, and leadership.

This research suggestion that the unit pay attention, make the program work, ministry guidelines / standard operating procedures, systems security and safety of patients and employees in order to achieve high quality services."

"Hospitalisasi merupakan suatu kondisi seseorang karena sakit dan masuk rumah sakit. Tujuan penelitian mengetahuipengaruh metode bimbingan imajinasi rekaman audio terhadap stres hospitalisasi pada anak usia sekolah di RumahSakit di Kota Palu. Desain penelitian quasi eksperimental dengan pre and post test design with control group. Sampelyaitu anak usia 7–12 tahun sebanyak 26 responden kelompok intervensi dan 26 responden kelompok kontrol. Intervensiyaitu metode bimbingan imajinasi rekaman audio, diberikan 3 kali selama 2 hari (6 sesi @ 15 menit)). Hasil penelitianmenunjukkan ada perbedaan yang signifikan rerata skor stres hospitalisasi setelah intervensi (pv = 0,004). Tidak adakontribusi variabel confounding. Berdasarkan hasil penelitian ini, bimbingan imajinasi rekaman audio dapat diterapkanpada asuhan keperawatan anak sakit di rumah sakit.Audio Recorded Guided Imagery Method to Reduce Stress Hospitalisazation in School Age Children in PaluHospital. Hospitalization is a condition of a person because of illness and hospital admission. Research objectivesdetermine the influence of audio recorded guided imagery method to stress of hospitalization in school-age children inhospital in Palu. Quasi-experimental research design with pre and post test design with control group. The sample ofchildren aged 7-12 years were 26 respondents intervention group and 26 control group respondents. Intervention is themethod of audio recorded guided imagery, three times a day for two days (one session equal to15 minutes). The resultsshowed the significant difference mean stress score of hospitalization after the intervention (Pv = 0.004). Nocontribution of confounding variables. Based on these results, audio recorded guided imagery intervention can beapplied to care the sick pediatric in hospital."

"Penelitian ini bertujuan untuk mengetahui hubungan usia gestasi dengan tumbuh kembang anak usia 1 tahun yang lahir prematur. Penelitian kuantitatif yang menggunakan desain cross sectional dengan metode wawancara dan pemeriksaan tumbuh kembang (z-score dan Denver II). Subyek penelitian adalah anak yang dilahirkan prematur (usia gestasi < 37 minggu) yang berusia 1 tahun pada tahun 2013 dengan jumlah responden sebanyak 44. Hasilnya tidak ada perbedaan proporsi kejadian gangguan pertumbuhan pada perbedaan usia gestasi (p value = > 0,05) dan terdapat perbedaan proporsi kejadian suspek keterlambatan perkembangan pada perbedaan usia gestasi (p value = 0,002, OR 1,7). Semakin muda usia gestasi akan berisiko mengalami suspek keterlambatan perkembangan sebesar 1,7 kali lebih tinggi dibandingkan dengan usia gestasi yang lebih tua.

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This study aimed to know the correlation of gestational age with the growth of children development in 1 year old who were born prematurely. The study used quantitative cross-sectional design with interviews and examination of growth (z-score and the Denver II). The subjects of this research were children who were born prematurely (gestational age <37 weeks) 1 year old in 2013 with a number of respondents were 44 patients. The results is there was no differences of impaired growth in the proportion of gestational age (p value> 0.05) and there were differences in the proportion of events with suspected developmental delays in gestational age difference (p value = 0.002, OR 1.7). The younger of gestational age would be at risk of developmental delay at 1.7 times higher than the older gestational age."