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"Gangguan otonom pada penyakit Parkinson lebih banyak dialami dan berdampak pada kualitas hidup dan mortalitas pasien dibandingkan gejala motoriknya. Namun, hal tersebut jarang mendapat perhatian klinis dan data mengenai karakteristiknya masih minim di Indonesia. Oleh karena itu, diperlukan penelitian untuk menggambarkan karakteristik gangguan otonom pada pasien penyakit Parkinson serta faktor yang memengaruhinya menggunakan instrumen SCOPA-AUT INA (Scale for Outcome in Parkinson`s Disease - Autonomic bahasa Indonesia) di RSUPN dr. Cipto Mangunkusumo (RSCM). Penelitian ini dilakukan di RSCM pada Mei 2021 hingga September 2022 dengan desain potong lintang dan melibatkan 31 pasien penyakit Parkinson sebagai subjek. Data diambil melalui wawancara menggunakan SCOPA-AUT INA dan melihat rekam medis. Uji statistik yang digunakan adalah uji univariat, chi-square, dan U Mann-Whitney. Ditemukan bahwa 100,0% subjek mengalami gangguan otonom yang terdistribusi dalam domain gastrointestinal (96,8%), urin (93,5%), termoregulasi (67,7%), seksual (51,6%), kardiovaskular (48,4%), dan pupil (12,9%). Ditemukan hubungan bermakna antara faktor usia ≥60 tahun dengan peningkatan gangguan urin, jenis kelamin laki-laki dengan peningkatan gangguan seksual, terapi levodopa dengan peningkatan gangguan gastrointestinal, dan terapi triheksifenidil dengan peningkatan gangguan pupil. Tidak ditemukan hubungan bermakna antara gangguan otonom dengan durasi dan keparahan penyakit Parkinson. Studi ini menyimpulkan bahwa gangguan otonom ditemukan pada seluruh subjek dengan penyakit Parkinson di RSCM dan dipengaruhi oleh faktor demografis dan klinis, khususnya usia, jenis kelamin, dan jenis terapi anti-Parkinson.

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Autonomic dysfunctions in Parkinson’s disease are often undiagnosed or untreated and the current data regarding its profile is still limited in Indonesia despite it being more common and having more impact on their quality of life and mortality rate compared to motor symptoms of Parkinson’s disease. Therefore, research is needed on the profile and affecting factors of autonomic dysfunction in Parkinson’s disease patients using the SCOPA-AUT INA (Scale for Outcome in Parkinson`s Disease - Autonomic – Indonesian version) in RSUPN dr. Cipto Mangunkusumo (RSCM). This cross-sectional study is done in RSCM from May 2021 to September 2022 with 31 Parkinson’s disease patients enrolled as subjects. The results are taken from interviews using the SCOPA-AUT INA questionnaire and from the subjects’ medical records. Univariable, chi-square test, and U Mann-Whitney statistical tests are used in data analysis. This study found that 100,0% of the subjects reported having autonomic dysfunctions categorized into gastrointestinal (96,8%), urinary (93,5%), termoregulatory (67,7%), sexual (51,6%), cardiovascular (48,4%), and pupillomotor (12,9%). There is a statistically significant correlation between subject age of 60 or above and increase in urinary dysfunction, male sex with increase in sexual dysfunction, levodopa therapy with increase in gastrointestinal dysfunction, and trihexyphenidyl therapy with increase in pupillomotor dysfunction. No correlation is found between autonomic dysfunctions and Parkinson’s disease duration or clinical staging. Autonomic dysfunctions are found in all of the Parkinson’s disease patients enrolled as subjects in this study and are affected by demographic and clinical characteristics, especially age, sex, and anti-Parkinson therapy."

"ABSTRAK Latar belakangKematian akibat sepsis dan syok septik pada pasien rawatan Intensive Care Unit (ICU) yaitu 20-30%. Pemberian antibiotik empirik yang tepat merupakan salah satu langkah awal yang sangat penting. Amikasin merupakan salah satu antibiotik terpilih untuk tata laksana sepsis di ICU RSUPN dr. Cipto Mangunkusumo (RSCM). Saat ini belum pernah dilakukan penelitian mengenai ketercapaian kadar terapi amikasin dengan menggunakan dosis standar amikasin pada pasien sepsis dewasa di ICU RSCM, sehingga studi ini menjadi penelitian pertama di Indonesia.Penelitian ini bertujuan untuk mengetahui ketercapaian kadar amikasin optimal pada pasien ICU RSCM.MetodeData dikumpulkan secara potong lintang melalui observasi terhadap hasil pemeriksaan kadar plasma amikasin, pengukuran minimum inhibitory concentration (MIC) dan perhitungan rasio Cmax/MIC pada pasien sepsis di ICU RSCM periode Mei-September tahun 2015.Hasil penelitianProporsi pasien sepsis dengan kadar amikasin optimal ialah sebesar 57% (4/7). Kadar puncak amikasin yang dapat dicapai dengan dosis 1000 mg sekali sehari tanpa menghiraukan berat badan ialah median 86,4 (43,5-238) µg/mL. Pada penelitian ini ditemukan 87% pasien dengan kadar puncak amikasin di atas 64 µg/mL, meskipun amikasin 1000 mg tersebut lebih rendah dari dosis yang dianjurkan untuk sepsis (25 mg/kgBB). Sebagian besar (78,3 %) subyek pada kenyataannya menerima dosis 15-25 mg/kgBB, dengan pemberian 1000 mg amikasin tanpa memperhatikan berat badan. Bakteri yang banyak ditemukan dari hasil kultur pasien sepsis di ICU RSCM, yaitu K. pneumoniae, A. baumanii, P. aeruginosa dan E. coli. Rentang nilai MIC untuk patogen tersebut berturut-turut yaitu 0,75 - >256 µg/mL, 0,75 - >256 µg/mL, 1,5 - >256 µg/mL dan 0,75 - 16) µg/mL. Sebanyak 84% isolat K. pneumoniae masih sensitif terhadap amikasin, diikuti oleh 63% untuk A. baumanii, 47% P. aeruginosa dan 100% untuk E. coli.KesimpulanOptimalitas amikasin terhadap bakteri Gram negatif penyebab sepsis bergantung kadar puncak dan MIC bakteri. Kadar puncak plasma amikasin yang dicapai dengan dosis 1000 mg sekali sehari sangat bervariasi. Pemberian amikasin dengan dosis per kgBB dapat dipertimbangkan. Kepekaan beberapa bakteri Gram negatif terhadap amikasin mulai menurun dengan rentang MIC yang cukup lebar. Pengukuran ketercapaian kadar optimal dalam terapi definitif dapat dilakukan untuk meningkatkan keberhasilan terapi.ABSTRACT BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment.;BackgroundThe mortality caused by sepsis and septic shock in the Intensive Care Unit (ICU) is 20-50%. The important first step to reduce this conditions is to give the right empirical antibiotics. Amikacin is one of the antibiotics of choice for the sepsis and septic shock in ICU of Cipto Mangunkusumo (CM) Hospital. Studies on the amikacin plasma level in adult patients being given amikacin in ICU RSCM has never been done.The objective of this study is to explore the plasma level of amikacin in septic patients in CM Hospital.MethodsThis was a cross sectional study. Data on plasma amikacin level, microbiological culture, measurement of minimum inhibitory concentration (MIC), and amikacin optimal level in septic patients admitted to ICU of RSCM during May-September 2015.ResultsThe proportion of septic patients that achieve amikacin optimal level was 57% (4/7). Peak amikacin level that can be reached with 1 gram per day dose was 86,4 (43,5-238) g/mL. Although amikacin was given less than recommended dose for sepsis (25 mg/body weight), 87% patients was found to have peak amikacin level > 64 µg/mL. Most (78.3%) of the patients received amikacin with dose range 15-25 mg/kgBW, in which patients was given 1000 mg of amikacin regardless of the body weight. The organisms commonly identified from the microbiological culture septic in patients in ICU of RSCM were K. pneumoniae, A. baumanii, P. aeruginosa, and E. coli. The MIC for these pathogen were 0.75 - >256 µg/mL, 0.75 - >256 µg/mL, 1.5 - >256 µg/mL and 0.75 ? 16 µg/mL, respectively. Most (84%) of K. pneumoniae isolates was still sensitive to amikacin, while 63% A. baumanii isolate, 47% of P. aeruginosa, and 100% of E. coli were sensitive to amikacin.ConclusionsAmikacin?s efficacy to eradicate Gram negative microorganism causing sepsis depend on peak level and MIC of the microorganism. By giving 1000 mg dose per day of amikacin, highly variable peak plasma concentration of the drug was observed. Therefore, amikacin dosing based on weight might be useful to reduce the wide variation. In this study, we found that sensitivity of some Gram negative pathogen are decreasing, with wide range of MIC. Evaluation of optimal level for definitive therapy might be useful to reach more successful treatment."

"Studi retrospektif ini bertujuan untuk mengetahui perbandingan respon terapi radiasi antara teknik konvensional 2D dengan pengecilan lapangan radiasi teknik 2D, 3DCRT atau brakiterapi pada pasien kanker nasofaring stadium dini (stadium I – IIa). Dari 20 sampel didapatkan respon komplit pada 17 pasien (85%) dan respon parsial pada 3 pasien (15%) (p=0.219). Efek samping akut yaitu dermatitis radiasi grade 3-4 adalah 5% (p=0.435), mukositis grade 3-4 adalah 15% (p=0.510) dan xerostomia grade 3-4 adalah 0% (p=0.517). Secara statistik tidak didapatkan perbedaan bermakna tetapi secara klinis mempunyai kesan ada kecenderungan bahwa dengan pengecilan lapangan radiasi teknik brakiterapi dan 3DCRT lebih baik dalam hal efek samping akut mukositis dibanding teknik 2D.

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This retrospective study aimed to compare the response of radiation therapy between 2D conventional technique with the booster of 2D, 3DCRT or brachytherapy techniques in patients with early-stage nasopharyngeal cancer (stage I - IIa). From 20 sample, obtained complete response in 17 patients (85%) and partial response in 3 patients (15%) (p = 0.219). Side effects of acute radiation dermatitis grade 3-4 is 5% (p=0.435) , mucositis grade 3-4 is 15% (p=0.510) and xerostomia grade 3-4 is 0% (p=0.517). The result showed no satistically significant but clinically there is a tendency that with the booster of brachytherapy and 3DCRT techniques, are better compared with 2D technique in terms of acute mucositis side effects."

"Spesialis keperawatan medikal bedah(KMB)khususnya neurologi membentuk nersspesialis neurosains yang berperan dalam praktik residensi selama 2 semester di RSUP dr. Cipto Mangunkusumo dan RSP Otak Nasional untuk memberikan asuhan keperawatan lanjutan, melakukan Evidence Based Nursing dan penerapan inovasi. Asuhan keperawatan yang dilakukan pada satu kasus utama ensefalitis autoimundan 30 pasien resume dengan gangguan neurologis menggunakan pendekatan Model adaptasi Sister Callista Roy. Ensefalitis autoimun merupakan salah satu kasus emergensi neurologi yang memerlukan penata laksanaan cepat dan tepat agar gejala sisa yang ditimbulkan menjadi adaptif. Diagnosa keperawatan pada kasus resume yang terbanyak adalah ketidak efektifan perfusi jaringan serebral. Selanjutnya Evidence Based Nursing dilakukan dengan menerapkan sleep hygiene yang menunjukkan adanya peningkatan kualitas tidur yang signifikan pada 5 pasien stroke dengan insomnia(p value 0,00). Kompetensi ners spesialis yang harus dicapai secara berkelompok adalah penerapan inovasi berupa tata laksana perawatan stroke terkini dengan Constraint Induced Movement Therapy (CIAT), Tongue stretching exercises(TSE), Constraint Induced Movement Therapy (CIMT),sit to stand training(STS),mirror therapy(MT)dan sleep hygiene(SH) sebagai aktivitas intervensi terbaru dengan masalah gangguan bicara dan bahasa, kesulitan menelan, gangguan mobilisasi,dan gangguan tidur yang diaplikasikan dapat membantu untuk mencegah terjadinya komplikasi dan membantu proses penyembuhan.

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Surgical medical nursing specialists (KMB) especially neurology,form neuroscience specialists who play a role in the practice of KMB residency for 2 semesters at RSUP dr. Cipto Mangunkusumo and RSP National Brain to provide advanced nursing care, conduct Evidence Based Nursing and apply innovation. Nursing processwas performed in one major case of autoimmune encephalitis and 30 patients resumed with neurological disorders using the Sister Callista Roy model adaptation approach. Autoimmune encephalitis is one of the cases of neurological emergencies that requires prompt and precise management, than complication becomes adaptive. The nursing diagnosis in most resume cases is the ineffectiveness of cerebral tissue perfusion. Furthermore Evidence Based Nursing was carried out by applying sleep hygiene which showed a significant improvement in sleep quality in 5 stroke patients with insomnia (p value 0.00). Special nurses competencies that must be achieved in groups are the application of innovations in the form of the latest stroke care management with Constraint Induced Movement Therapy (CIAT), Tongue stretching exercises (TSE), Constraint Induced Movement Therapy (CIMT), sit to stand training (STS), mirrors therapy (MT)and sleep hygiene(SH) as the newest intervention activities with speech and language problems, difficultyswallowing, impaired mobilization, and insomniacan help to prevent complications and help the healing process."

"Latar BelakangHemodialisa membutuhkan suatu akses vaskuler yang fungsional dan adekuat untuk mendapatkan hasil terbaik, bagi Negara berkembang seperti Indonesia tingginya biaya perawatan dan tenaga ahli masih merupakan hal yang harus ditanggapi serius oleh semua pihak. NKF-KDOQI menetapkan tiga Tujuan utama suatu unit hemodialisa antara lain meningkatkan pemakaian AV Fistula, Mengurangi pemakaian kateter hingga 10% dan Deteksi dini dari disfungsi akses vaskuler. Hingga saat ini belum ada gambaran akses vaskular yang terdapat di unit hemodialisa RSUPN Ciptomangunkusumo sehingga dapat dibandingkan dengan guideline, dan diharapkan mendapat masukan untuk pelayanan terbaik bagi pasien. MetodePenelitian ini berupa deskriptif retrospektif, Populasi penelitian adalah pasien gagal ginjal kronikyang menjalani hemodialisa dengan akses vaskuler fistula AV dan kateter vena sentral di RumahSakit Cipto Mangunkusumo pada bulan Mei – Desember 2012. Data dari rekam medis penderitadiketahui mengenai tanggal hemodialisa pertama kali, tanggal pembuatan akses vaskuler pertamakali, jenis akses vaskuler yang digunakan pertama kali serta konversi yang mengikutinya, sertalokasi akses vaskuler tersebut.HasilDidapatkan 234 data pasien yang aktif menjalani hemodialisa di unit hemodialisa RSUPNCiptomangunkusumno Jakarta dari bulan Mei – juni 2012, terdiri dari 146 laki laki dan 88perempuan , rerata umur 49.04 tahun dengan rentang umur 11 tahun sampai 78 tahun. Diantarapasien tersebut , 122 (52.1%) pasien dengan AV fistula, dan pasien yang membuat AV Fistulasebelum hemodialisa pertama hanya pada 7 pasien (1.2%) 1 pasien menggunakan graft PTFE,dengan lokasi tersering untuk AV Fistula adalah Radiocephalica sebanyak 29.4%, 48 pasienmenggunakan central venous catheter, dimana 28 pasien dengan longterm catheter (12%) dansisanya dengan shortterm catheter (8.5%). Direct Puncture digunakan oleh pasien sebagai carayang dipakai pertama kali melakukan hemodialisa, sebanyak 49.6%. dari keseluruhan pasienyang pernah menjalani pemasangan AV fistula mengalami primary failure sebanyak 10.65%, dansecondary failure sebanyak 7.37%.KesimpulanMasalah pada suatu unit hemodialisa tidaklah sederhana dan untuk mencapai suatu hasil yangterbaik diperlukan kerjasama dari sebuah tim multidisiplin vaskular akses yang terdiri dari ahliginjal hipertensi, ahli bedah vaskular, ahli radiologi, dan perawat dialisa. Dengan seorangkoordinator yang berdedikasi tinggi yang selalu memperbaharui data base pasien dan updateterbaru dari perkembangan akses vaskuler.

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Background

A vascular access that mantained to be functioning and adequate is a must to achieve the best

result in haemodialysis procedure. For a developing country like Indonesia, a high cost and

expertise in vascular access maintenance reluctantly a serious issues. NKF-KDOQI has

established three primary goals for a haemodialysis unit to achieve, to increase the placement of

native fistulas as vascular access at initiation of hemodialysis procedure until 65 %, to discourage

catheter insertion until 10% and early detection of vascular access dysfunction. Recently at Cipto

Mangunkusumo hospital, there are no profile of vascular access in haemodialysis unit to figure

out the condition and compare with guideline.

Method

This is a descriptive retrospective study with a CRF (Chronic Renal Failure) patients that undergo

hemodialysis with natve fistula and catheter as their vascular access in Cipto Mangunkusumo

hospital from May to December 2012. Data collected from medical record included dates when

initiates their hemodialysis procedure, diagnose of CRF, creation of fistula or other vascular

access, and complication that has occurred.

Results

From 234 patients that undergo hemodialysis procedure from May to December 2012, there werre

146 male and 81 female, with median age of 49.04 years old and distance within 11 – 78 years

old. Among these patients 122(52%) with fistula an 1 patient with graft but only 7 patients (1.2%)

that use native fistula to initiate their hemodialysis procedure. The most location for fistula were

on left radiocephalic in 29.4% of patients, 48 patients use catheter for their vascular access that

ionclude 12% long term and 8.5 % long term catheter. There were 49.6% patients with direct

venous puncture to initiate their hemodialysis. From all fistulas that created there were 10.65%

primary failure and 7.37% secondary failure.

Conclusion

Problems in hemodialysis unit is not as simple as that, and to achieve the best result require the

concerted effort of multivariariate vascular access team that consist nephrologist, vascular

surgeon, radiologist, and nurse with a chief coordinator that updating vascular access patients

database and its development"

"ABSTRAKPasien gagal ginjal terminal dengan terapi pengganti ginjal berupa hemodialisis dapat meningkatkan harapan hidupnya, namun kualitas hidup yang rendah pada pasien tersebut masih banyak ditemui. Penelitian ini bertujuan untuk mengetahui faktor – faktor risiko pada kualitas hidup terkait kesehatan pasien hemodialisis di RSUPN Cipto Mangunkusumo tahun 2014. Sebanyak 94 responden yang diteliti menggunakan kuesioner WHOQOL-BREF dan ditemukan sebesar 51,1% responden memiliki kualitas hidup terkait kesehatan yang buruk. Responden dengan kategori usia muda (75,5%), laki-laki (57,4%), berpendidikan tinggi (80,9%), berstatus tidak bekerja (66,0%), berpenghasilan rendah (61,7%), berstatus gizi baik menurut lingkar otot lengan atas (67,0%),memiliki komorbiditas (75,5%), dan dengan tingkat aktivitas fisik rendah (11,7%). Pendidikan memiliki hubungan yang bermakna dengan kualitas hidup terkait kesehatan (p= 0,024, OR=4,324). Pendapatan memiliki hubungan yang bermakna dengan kualitas hidup terkait kesehatan (p= 0,005, OR= 3,972). Ahli gizi dan staff dapat membantu meningkatkan pengetahuan pasien tentang terapi gizi terkait penyakitnya yang disesuaikan dengan pendapatannya, sehingga pasien dapat mempertahankan status gizinya dan meningkatkan kualitas hidupnya.Pasien gagal ginjal terminal dengan terapi pengganti ginjal berupa hemodialisis dapat meningkatkan harapan hidupnya, namun kualitas hidup yang rendah pada pasien tersebut masih banyak ditemui. Penelitian ini bertujuan untuk mengetahui faktor – faktor risiko pada kualitas hidup terkait kesehatan pasien hemodialisis di RSUPN Cipto Mangunkusumo tahun 2014. Sebanyak 94 responden yang diteliti menggunakan kuesioner WHOQOL-BREF dan ditemukan sebesar 51,1% responden memiliki kualitas hidup terkait kesehatan yang buruk. Responden dengan kategori usia muda (75,5%), laki-laki (57,4%), berpendidikan tinggi (80,9%), berstatus tidak bekerja (66,0%), berpenghasilan rendah (61,7%), berstatus gizi baik menurut lingkar otot lengan atas (67,0%),memiliki komorbiditas (75,5%), dan dengan tingkat aktivitas fisik rendah (11,7%). Pendidikan memiliki hubungan yang bermakna dengan kualitas hidup terkait kesehatan (p= 0,024, OR=4,324). Pendapatan memiliki hubungan yang bermakna dengan kualitas hidup terkait kesehatan (p= 0,005, OR= 3,972). Ahli gizi dan staff dapat membantu meningkatkan pengetahuan pasien tentang terapi gizi terkait penyakitnya yang disesuaikan dengan pendapatannya, sehingga pasien dapat mempertahankan status gizinya dan meningkatkan kualitas hidupnya.

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ABSTRACTESRD patient with maintenance hemodialysis therapy can increase its life expectancy, but its quality of life is found relatively low in many patients. This research is objected to know the difference proportion of some factors of health related quality of life (HRQOL)in hemodialysis patients. Among 94 samples of hemodialysis patients at RSUPN Dr. Cipto Mangunkusumo were participated in this crossectional study.Using WHOQOL-BREF questionnaire there wasfound 51,1% respondent havelow HRQOL. Respondent within the young age category is 75,5%, proportion of male respondent is 57,4%,higher education category is80,9%, unemployeed respondent is 66%, low income category is 61,7%, low nutrition status based on mid arm muscle circumference 67,0%, having comorbidity is 75,5%, and low activity level is 11,7%. Education has a significant relation with health related quality of life (p= 0,024, OR=4,324). Income has a significant relation with health related quality of life (p= 0,005, OR= 3,972). Dietitian and staff can help the patients toincrease their knowledge on nutrition therapy that fit with their disease condition and income, so that patients be able to maintain their nutritional status and increase their quality of life. "

"Diabetes merupakan salah satu masalah kesehatan yang terjadi di perkotaan. Tahun 2012 didapatkan data sebesar 80% kematian terjadi akibat diabetes. kondisi ini berhubungan dengan terjadinya komplikasi serius pada pasien diabetes yaitu adanya hipoglikemi, ketoasidosis, gangguan sirkulasi (makrovaskuler dan mikrovaskuler), neuropati. Penelitian sebelumnya menunjukkan bahwa pemberian terapi prilaku aktivitas (senam kaki) dapat mengurangi gangguan sirkulasi pada pasien diabetes.Tujuan penulisan ini adalah untuk melakukan analisis evidence based mengenai terapi prilaku aktivitas (senam kaki) pada pasien diabetes untuk memperbaiki gangguan sirkulasi dan dapat mengurangi komplikasi serius tersebut. Hasilnya pada pasien ini adalah tidak terjadi penurunan dalam nilai ABI (achiles brachial index), dan tidak terjadi penurunan sensasi rasa (panas dan nyeri) pada kaki. Rekomendasi penulisan ini adalah agar perawat melakukan pemantauan terhadap perubahan sensasi dan dapat melakukan pemeriksaan ABI.

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Diabetics is one of the health problems occurs in urban areas. In 2012, Diabetics is 80% cause of deaths in urban area This condition relates to the occurrence of serious complications in patients with diabetes such as hypoglycemia, ketoacidosis, circulatory disorders (macrovascular and microvascular), and neuropathy. Previous research suggests that behavioral therapy activities (gymnastics feet) can reduce circulation disorders in patients diabetes. The purpose of this paper is to analyze evidence based practice on behavioral therapy activities (gymnastics feet) in diabetic patients to improve impaired circulation and reduce the serious complications. The result of this study indicates there is no increasing in the patient's ABI (Achiles brachial index), and no declining in the patient's feet sensation (hot and Pain). It is highly recommend that nurses can perform Achiles brachial Index (ABI) monitoring and feeth sensation monitoring periodically. "

"Insiden disfungsi seksual pada pria diabetes sangat banyak dan sampai saat ini belum pernah dilakukan eksplorasi mendalam tentang pengalaman mereka. Penelitian ini bertujuan memperoleh gambaran pengalaman disfungsi seksual pada klien pria diabetes di RSUPN Dr. Cipto Mangunkusumo Jakarta dengan metode penelitian kualitatif dan pendekatan fenomenologi. Dilakukan wawancara mendalam kepada 7 partisipan. Temuan memberikan informasi rinci tentang pengalaman pria diabetes menghadapi disfungsi seksual dengan 11 tema utama, diantaranya gambaran disfungsi seksual, dampak, respon support sistem dan kebutuhan pelayanan kesehatan.Disimpulkan bahwa disfungsi seksual terjadi < 5 tahun semenjak terdiagnosa diabetes mellitus yang berdampak pada diri; pasangan dan sosial, klien berupaya mencari cara penyelesaian sesuai persepsinya dan mengharapkan dukungan keluarga, tenaga dan pelayanan kesehatan untuk memperbaiki fungsi seksual mereka.

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The incidence of sexual dysfunction on diabetic men clients is prodigious and until now has not been done in-depth exploration of their experiences. The research purpose is to identify the description of sexual dysfunction experiences oin diabetic men at RSUPN Dr. Cipto Mangunkusumo Jakarta, using qualitative research methods and phenomenology approach. In-depth interviews were conducted with 7 participans. The findings provide detailed information on diabetic men sexual dysfunction experiences, 11 themes were derived, including sexual dysfunction experiences overview and it's impact, the responses of support system and health care needs.Concluded that sexual dysfunction was occured < 5 years since diagnosed of diabetes mellitus. It is to be an effect to them self, social and couple relationship. Clients was seeking the problem solving by their perception with all the hope and support from family (couple), health professionals and health services to improve their sexual function."