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"Latar Belakang: Nyeri masih menjadi penyebab utama kegagalan prosedur office hysteroscopy. Obat anti inflamasi nonsteroid (OAINS), salah satunya ketoprofen masih digunakan secara rutin untuk mengatasi nyeri selama prosedur office hysteroscopy. Namun penggunaan ketoprofen menimbulkan beberapa efek samping, paling sering pada saluran pencernaan dengan gejala dan tanda seperti mual, muntah, dispepsia, diare, dan ulkus peptikum. Dalam pedoman RCOG (Royal College of Obstetricians and Gynaecologists), parasetamol juga dapat digunakan dalam manajemen nyeri untuk office hysteroscopy. Namun, belum ada bukti klinis yang menunjukkan efikasi parasetamol untuk manajemen nyeri pada office hysteroscopy.Tujuan: Untuk mengetahui efikasi pemberian parasetamol tablet 1000 mg per oral dibandingkan dengan ketoprofen tablet 100 mg per oral dalam manajemen nyeri saat prosedur office hysteroscopy dan cramping 30 menit setelah prosedur office hysteroscopy serta efek samping, refleks vagal, dan tingkat kenyamanan pada pasien selama prosedur.Metode: Penelitian ini merupakan uji klinis acak tersamar ganda untuk menilai intensitas nyeri selama prosedur office hysteroscopy dan cramping dalam 30 menit setelah prosedur office hysteroscopy pada kelompok parasetamol 1000 mg per oral dibandingkan dengan kelompok ketoprofen 100 mg per oral. Kedua kelompok masing-masing terdiri dari 30 subjek. Alokasi subjek dilakukan dengan randomisasi blok. Penilaian intensitas nyeri selama prosedur (saat alat hysteroscope masuk ke dalam ostium uteri externum) dan cramping dalam 30 menit setelah prosedur office hysteroscopy dilakukan dengan menggunakan Visual Analogue Scale (VAS) dalam kuesioner.Hasil: Karakteristik subjek penelitian mempunyai usia rata-rata 48,3 tahun dengan durasi prosedur rata-rata 26 menit. Sebagian besar subjek adalah multipara (55%), belum menopause (53,3%), tidak ada dismenore (80%), tidak ada nyeri panggul kronik (90%), dan tidak pernah sectio caesaria (75%). Baik pada kelompok parasetamol maupun kelompok ketoprofen tidak bermakna secara statistik terhadap nyeri selama prosedur (nilai p = 0,266), dan cramping setelah 30 menit prosedur (nilai p = 0,499). Sebagian besar subjek merasakan nyeri dengan median 2 (0 – 8), cramping 30 menit setelah tindakan dengan median 0 (0 – 5), dan tingkat kenyamanan dengan median 9 (7 – 10). Selain itu, sebagian besar subjek tidak merasakan efek samping apapun (95%) dan seluruhnya tidak mengalami refleks vagal (100%).Kesimpulan: Tidak ada perbedaan bermakna nilai VAS pada pemberian parasetamol 1000 mg tablet per oral dibandingkan dengan ketoprofen 100 mg tablet per oral untuk manajemen nyeri selama prosedur dan cramping 30 menit pasca prosedur office hysteroscopy.

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Introduction: Pain is still the main cause of failure of office hysteroscopy procedures. Non- steroidal anti-inflammatory drugs (NSAIDs), one of which is ketoprofen, are still used routinely to treat pain during office hysteroscopy procedures. However, the use of ketoprofen causes several side effects, most often in the digestive tract with symptoms and signs such as nausea, vomiting, dyspepsia, diarrhea and peptic ulcers. In the RCOG (Royal College of Obstetricians and Gynecologists) guidelines, paracetamol can also be used in pain management for office hysteroscopy. However, there is no clinical evidence showing the efficacy of paracetamol for pain management during office hysteroscopy.

Objective: To determine the efficacy of administering paracetamol tablets 1000 mg orally compared with ketoprofen tablets 100 mg orally in managing pain during office hysteroscopy procedures and cramping 30 minutes after office hysteroscopy procedures as well as side effects, vagal reflexes, and the level of comfort in patients during the procedure.

Methods: This study was a double-blind, randomized clinical trial to assess the intensity of pain

during the office hysteroscopy procedure and cramping within 30 minutes after the office hysteroscopy procedure in the paracetamol 1000 mg orally group compared with the ketoprofen 100 mg orally group. Both groups each consisted of 30 subjects. Subject allocation was carried out by block randomization. Assessment of pain intensity during the procedure (when the hysteroscope instrument enters the external uterine ostium) and cramping within 30 minutes after the office hysteroscopy procedure was carried out using the Visual Analogue Scale (VAS) in the questionnaire.

Results: The characteristics of the research subjects were an average age of 48.3 years with an average procedure duration of 26 minutes. Most of the subjects were multiparous (55%), had not had menopause (53.3%), had no dysmenorrhea (80%), had no chronic pelvic pain (90%), and had never had a caesarean section (75%). Neither the paracetamol group nor the ketoprofen group had statistical significance regarding pain during the procedure (p value = 0.266), and cramping after 30 minutes of the procedure (p value = 0.499). Most subjects felt pain with a median of 2 (0 – 8), cramping 30 minutes after the procedure with a median of 0 (0 – 5), and a comfort level with a median of 9 (7 – 10). In addition, the majority of subjects did not feel any side effects (95%) and all did not experience vagal reflexes (100%).

Conclusion: There was no significant difference in VAS scores when administering paracetamol 1000 mg tablets orally compared with ketoprofen 100 mg tablets orally for pain management during the procedure and cramping 30 minutes after the office hysteroscopy procedure."

"ABSTRAKLatar belakang: Intoleransi minum merupakan masalah yang sering dihadapi bayi kurang bulan. Eritromisin merupakan salah satu prokinetik yang sering digunakan, namun pemberiannya masih merupakan kontroversi.Tujuan: Mengetahui efikasi eritromisin oral dalam meningkatkan toleransi minum pada bayi kurang bulan.Metode: Penelitian ini merupakan penelitian uji klinis acak tersamar yang dilakukan pada bayi kurang bulan di RSUP. Sanglah Denpasar dari bulan Juni 2015 hingga Januari 2016. Sampel dilakukan randomisasi menjadi dua kelompok, kelompok perlakuan mendapatkan eritromisin 12,5 mg/kg setiap 8 jam sedangkan kelompok kontrol mendapat plasebo. Luaran primer yang dicari adalah waktu untuk mencapai nutrisi enteral penuh. Luaran sekunder adalah berat badan saat mencapai nutrisi enteral penuh dan lama rawat rumah sakit.Hasil: Selama penelitian didapat 62 sampel, dimana 3 sampel di drop-out. Tiga puluh sampel didapat pada kelompok eritromisin dan 29 sampel pada kelompok kontrol. Tidak ada perbedaan data dasar pada kedua kelompok. Rerata usia gestasi adalah 31,4+1,7 minggu pada kelompok perlakuan dan 32,4+2,2 minggu pada kelompok kontrol. Tidak terdapat perbedaan yang bermakna dalam mencapai nutrisi enteral penuh yakni 10+5,3 hari pada kelompok eritromisin dibandingkan 8+6,5 hari pada kelompok kontrol (p=0,345). Tidak ada perbedaan yang bermakna dalam berat badan saat mencapai nutrisi enteral penuh dan lama perawatan di rumah sakit.Simpulan: Eritromisin dosis oral 12,5 mg/kgBB setiap 8 jam secara rutin tidak mempercepat waktu nutrisi enteral penuh pada bayi kurang bulan. Tidak ada perbedaan berat badan saat mencapai nutrisi enteral penuh dan lama perawatan pada kedua kelompok.

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ABSTRACTBackgrounds: Feeding intolerance is a common condition that affects premature infants. Erythromycin is one of the prokinetic agents to treat feeding intolerance, but the use of this agent is still controversy.Objectives: To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in premature infants.Design: This study is a prospective randomized controlled trial on premature infants in Sanglah Hospital from June 2015 until January 2016. Eligible infants were randomized to receive 12.5 mg/kgBW/dose 8 hourly oral erythromycin or plasebo. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were weight at full enteral feeding and duration of hospital stay.Results: There were 62 samples during the study, 3 infants were dropped out. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline of the two groups was similar, mean of gestational age was 31.4+1.7 weeks in erythromycin group and 32.4+2.2 weeks in placebo group. The time to reach full enteral feeding did not differ statistically between the 2 groups, 10+5.3 days in erythromycin group vs 8+6.5 days (p=0,345) in placebo group. There were no significant differences between the two groups regarding the body weight at full enteral feeding and duration of hospital stay.Conclusion: Erythromycin 12.5 mg/kgBW/dose every 8 hours as prophylactic treatment does not enhance feeding tolerance in premature infants. There were no significant differences between the two groups regarding body weight at full enteral feeding and duration of hospital stay."

"Pembedahan mayor abdomen yang berhubungan dengan kanker Cholangiocarcinoma (CCA) seringkali dikaitkan dengan kejadian perawatan ICU pasca pembedahan dan mengakibatkan intensitas nyeri yang tinggi pasca operasi. Penatalaksanaan nyeri yang tidak optimal dapat berkontribusi pada komplikasi dan memiliki efek buruk pada kesembuhan pasien. Oleh karena itu, diperlukan terapi komplementer yang berfokus pada kenyamanan dan preferensi pasien sebagai bentuk optimalisasi penatalaksanaan nyeri pasien CCA pasca pembedahan abdomen di ICU. Karya Ilmiah Akhir ini bertujuan untuk memaparkan hasil praktik berupa asuhan keperawatan medikal bedah pada pasien tumor distal Common Bile Duct (CBD) post laparatomy double bypass dengan penerapan manajemen nyeri menggunakan aromaterapi lavender di ICU Rumah Sakit. Intervensi ini dilakukan pada pasien usia 25 tahun dengan ikterik obstruktif et causa tumor distal Common Bile Duct (CBD) suspek ganas kesan unresectable. Setelah dilakukan intervensi selama tiga hari, didapatkan kesimpulan bahwa aromaterapi lavender dapat digunakan sebagai intervensi manajemen nyeri non-farmakologi yang menyempurnakan terapi farmakologi dalam menurunkan nyeri pada pasien sadar pasca operasi laparatomy double bypass di ICU.

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Major abdominal surgery related to Cholangiocarcinoma (CCA) cancer is often associated with post-surgical ICU admission and results in high pain intensity post-surgery. Suboptimal pain management can contribute to complications and have an adverse effect on patient recovery. Therefore, complementary therapy is needed that focuses on patient comfort and preferences as a form of optimizing pain management for CCA patients after abdominal surgery in the ICU. This Final Scientific Work aims to present practical results in the form of medical surgical nursing care for patients with distal Common Bile Duct (CBD) tumors post double bypass laparotomy with the application of pain management using lavender aromatherapy in the ICU Hospital. This intervention was carried out on a 25-year-old patient with obstructive jaundice caused by a distal Common Bile Duct (CBD) tumor, which was suspected to be malignant and unresectable. After three days of intervention, it was concluded that lavender aromatherapy could be used as a non-pharmacological pain management intervention that complements pharmacological therapy in reducing pain in conscious patients after double bypass laparotomy surgery in the ICU."

"Hospitalisasi dengan berbagai ketidaknyamanan bagi anak akan berdampak bagi tumbuh kembang berikutnya. Kolcaba dengan teori kenyamanan yang holistik dan bersifat individual bertujuan untuk mengatasi ketidaknyamanan anak. Hal ini sesuai dengan filosofi keperawatan anak yaitu atraumatic care. Salah satu bentuk ketidaknyamanan yang dialami anak adalah nyeri. Pelaksanaan asuhan tanpa trauma dalam mengatasi nyeri pada anak melalui pendekatan teori kenyamanan Kolcaba yaitu melalui penerapan EBNP menggunakan Buzzy Pain Relief. Hasil pemberian asuhan keperawatan menggunakan model teori kenyamanan Kolcaba ini dapat diaplikasikan pada anak dengan masalah nyeri.

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Hospitalization with various discomforts for children for example needle insertion procedure impacts the growth and development. Kolcaba with holistic and individual comfort theory is expected to overcome the discomfort of the child. This is according to pediatric nursing philosophy of atraumatic care. One of the discomforts that children experience is pain. Implementation of atraumatic care to reduce discomfort like pain through the approach theory of comfort Kolcaba is to use Buzzy Pain Relief. The results of nursing care using this model Kolcaba comfort theory can be applied to children with pain problems. "

"ABSTRAKLatar Belakang: Di Indonesia diperkirakan ada 100 pasien kanker baru per 100.000 penduduk setiap tahun dan nyeri menjadi salah satu masalah utama yang dihadapi pasien dengan kanker. Paint Management Index (PMI) adalah suatu instrumen untuk menilai tingkat kesesuaian terapi nyeri kanker yang dibuat berdasarkan panduan terapi nyeri kanker WHO dan Agency for Health Care Policy and Research (AHCPR). Kesesuaian terapi nyeri dinyatakan baik bila pemberian obat analgesik sesuai dengan kualitas nyeri yang dikeluhkan pasien.Tujuan: Mengetahui hubungan antara tingkat pendidikan dan latar belakang dokter PPDS dengan tingkat kesesuaian terapi nyeri pada pasien kanker berdasarkan PMI.Metode: Penelitian ini menggunakan desain potong lintang. Populasi penelitian adalah pasien kanker yang berobat rawat jalan maupun rawat inap di RSCM. Sampel diambil dengan metode consecutive. Data penelitian didapatkan melalui wawancara Subjek penelitian. Data dianalisis menggunakan uji chi-square dan nilai p yang dianggap bermakna apabila kurang dari 0,05.Hasil: Sampel sebanyak 98 pasien kanker dengan rerata usia 47,2 ± 13,4 tahun dan jenis kelamin terbanyak adalah perempuan (52%). Lokasi kanker tertinggi pada daerah genital (23,5%) dengan stadium kanker terbanyak pada stadium 3 (38,7%). Median intensitas nyeri sebelum dan sesudah terapi ada pada skala nyeri 4 (1-9) dan 1 (0-6). Latar belakang pendidikan dokter berasal dari 5 departemen dengan tahun pendidikan terbanyak pada tahun ketiga (54,1%). Proporsi kesesuaian terapi Antinyeri (Skor PMI ≥ 0) sebesar 54,1%. Hubungan antara kesesuaian terapi nyeri dengan latar belakang pendidikan dokter PPDS (p<0,001) dan tahun pendidikan (p=0,022).Simpulan: Proporsi kesesuaian terapi nyeri pada pasien kanker di RSCM sebesar 54,1% dan terdapat hubungan antara tingkat pendidikan dan latar belakang pendidikan dokter PPDS dalam kesesuaian terapi nyeri kanker.

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ABSTRACT

Background: In Indonesia, there are an estimated 100 new cancer patients per 100.000 populations every year and pain becomes one of the major problems faced by patients with cancer. Paint Management Index (PMI) is an instrument to assess the suitability of cancer pain therapy which is based on the WHO cancer pain treatment guidelines and Agency for Health Care Policy and Research (AHCPR). Suitability of pain therapy is considered good when giving analgesics according to the pain quality which complained by the patient.

Aim: To know the relationship between level of education and background of doctors who participate in specialist medical education program with the suitability of pain therapy in cancer patients based on PMI.

Method: This study used a cross-sectional design. The study population was outpatients or inpatients with cancer at the RSCM. Samples were taken with consecutive sampling. Data were obtained through interview with the subjects. Data were analyzed using chisquare test and p values were considered significant if lower than 0.05.

Result: There were 98 cancer patients with a mean age of 47.2 ± 13.4 years and most were female (52%). Highest location of cancers was in the genital area (23.5%) and cancer stage mostly in stage 3 (38.7%). Median of pain intensity before and after the therapy were 4 (1-9) and 1 (0-6) respectively. Doctors? educational background came from 5 different departments with the highest level of education was in the third year (54.1%). Suitability of anti-pain therapy (PMI Score ≥ 0) was 54.1%. The relationship between the suitability of pain therapy by doctors who participate in specialist medical education program (p <0.001) and level of education (p = 0.022).

Conclusion: Suitability of anti-pain therapy in cancer patients in RSCM was 54,1% and there was association between the suitability of pain therapy by doctors who participate in specialist medical education program and level of education."

"ABSTRACT Kanker merupakan penyebab kematian kedua tertinggi di Indonesia. Kanker payudara menempati urutan pertama sebagai penyebab kematian kanker pada perempuan. Penderita kanker payudara membutuhkan efikasi diri yang tinggi agar patuh dalam menjalani kemoterapi oral. Pada 45 responden di RS Kanker Dharmais, Jakarta didapatkan hasil bahwa efikasi diri pasien kanker payudara yang tinggi tidak memiliki hubungan dengan kepatuhan pasien dalam menjalani kemoterapi oral dengan nilai p value > 0,05 p value = 1,000. Hasil analisis juga menunjukkan bahwa karakteristik stadium kanker memiliki hubungan yang signifikan terhadap tingkat efikasi diri p=0,001 . Sedangkan riwayat pernah menjalani kemoterapi IV memiliki hubungan yang signifikan terhadap kepatuhan p=0,002.

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ABSTRACTCancer is the second leading cause of death in Indonesia. Breast cancer has first as a cause of cancer death in women. Breast cancer patients need high self efficacy to adhere to oral chemotherapy. In 45 respondents at Dharmais Cancer Hospital, Jakarta, it was found out that self efficacy of high on breast cancer patients, but did not have relationship with patient adherence in oral chemotherapy with p value 0,05 p value 1,000. The results of the analysis also showed that the characteristics of the stage of cancer have a significant relationship to the level of self efficacy p 0.001 . While the history of undergoing intravenous chemotherapy has a significant relationship to adherence p 0.002. "

"Oral lichen planus (OLP) is a rather common oral disease, mainly affecting adults, occurring more often in women than in men. The etiopathogenesis is still unclear. The diagnosis may be cumbersome, even in the presence of a biopsy. In addition, there are several lesions that may resemble lichen planus (lichenoid lesions) both clinicallyand histopathologically. Treatment of OLP can only be symptomatic and usually consists of topical application of corticosteroids. The disease is characterized by remissions and exacerbations and may persist in some patients lifelong. There is an ongoing debate in the literature as whether OLP is a potentially malignant disease. Because of this uncertainty, annual follow-up is advised."

"Penanganan masalah nyeri secara non-farmakologi dengan terapi musik belum digunakan secara optimal di Indonesia. Tujuan penelitian ini yaitu untuk menganalisis dari berbagai sumber literatur mengenai manfaat terapi musik dan untuk membuat rekomendasi penelitian terkait standar operasional prosedur terapi musik terhadap penurunan nyeri setelah tindakan pembedahan. Metode yang digunakan adalah studi literatur dengan mengumpulkan artikel penelitian eksperimental terkait terapi musik pada anak usia 0-18 tahun. Desain penelitian ini yaitu dengan melakukan pencarian artikel menggunakan database ProQuest, Scopus, ScienceDirect, dan Sage Journal. Pada penelitian ini didapatkan 2917 artikel penelitian dengan kata kunci children, music therapy, pain, pediatric, post operative, dan post surgery. Dalam penelitian ini didapatkan 8 artikel yang dianalisis sesuai dengan kriteria inklusi yaitu 1) artikel jurnal dengan penelitian eksperimental terkait terapi musik untuk penanganan nyeri setelah pembedahan pada anak, 2) literatur berbahasa Inggris, dan 3) literatur yang dipublikasikan dalam periode 10 tahun terakhir. Kriteria eksklusi yaitu jika literatur yang diterbitkan dalam database tidak lengkap hanya berupa abstrak. Berdasarkan penelitian yang dilakukan, didapatkan bahwa terapi musik efektif sebagai penatalaksanaan nyeri setelah tindakan pembedahan serta telah dibuat rekomendasi standar operasional prosedur terkait terapi musik pada anak. Hasil penelitian ini diharapkan dapat bermanfaat untuk perawat dalam penanganan nyeri secara non-farmakologi pada anak setelah pembedahan dengan penerapan terapi musik.

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Non-pharmacological therapy for pain with music has not been used optimally in Indonesia. The aim of this study was to analyze from various sources of literature on the benefits of music therapy and to make research recommendations related to the operational standard of music therapy procedures for pain after surgery. The method used in this study was literature review by collected experimental research related to music therapy in children aged 0-18 years. The design of this study was to collect article using the ProQuest, Scopus, ScienceDirect, and Sage Journal databases. In this study, 2917 research articles were obtained with the keywords children, music therapy, pain, pediatrics, post-surgery, post-surgery. Then 8 articles were analyzed with inclusion criteria 1) articles with experimental research related to music therapy for reduce pain after surgery in children, 2) English-language literature, and 3) literature that can be used in the last 10 years. The exclusion criteria in this study is that if the literature published in the database is incomplete it only contains abstracts. Based on studies conducted, that music therapy is effective as pain management after surgery and standard operating procedure recommendation has been made for children in this study. The results is expected to be useful for nurses to application of music therapy for pain management after surgery."

""Some patients present with a primary complaint of pain while others complain of pain secondary to a more generalized disease process or procedure. As a healthcare professional, you are trained to diagnose the pathology and then treat it. A patient presents with pneumonia, your work-up supports the diagnosis; you treat it, then the patient gets better. However, another layer of patient care needs more focus in the medical community. If the patient with pneumonia complains of intercostal pain secondary to a violent cough, we have the ability to manage the symptoms of pain effectively, and should not hesitate to do so promptly. Our actions to alleviate pain will not hinder our ability to treat the underlying disease. Yet modern medicine often considers these goals mutually exclusive, with pain management a distance second. As medical professionals, when we have an incomplete understanding of how to treat a condition, we under treat it, erring on the side of do no harm. This book will give you the confidence to confront your patient's discomfort and succeed in conquering the pain"--Provided by publisher."