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"Clinical Pathway (CP) merupakan perangkat alat multidisiplin ilmu yang digunakan untuk perawatan kesehatan berbasis bukti (evidence based). CP memiliki fungsi menyeragamkan terapi sehingga mampu meminimalkan komplikasi dan kesalahan pengobatan. Rumah Sakit Pusat Otak Nasional (RS PON) merupakan rumah sakit rujukan otak dan persarafan nasional. Stroke perdarahan menjadi penyakit kedua tertinggi di RS.PON. Keberagaman keputusan dilakukannya operasi atau tidak, meskipun sudah masuk indikasi, menjadi poin penting untuk menganalisis implementasi pelaksanaan Clinical Pathway ini.Tujuan penelitian: menilai implementasi CP stroke perdarahan yang telah dijalankan sehingga diharapkan mampu menjadi dasar penentu kebijakan rumah sakit jejaring maupun rumah sakit seluruh Indonesia. Menilai hubungan antara variabel-variabel dalam clinical pathway terhadap Length of Stay (LOS), morbiditas dan mortalitasMetode: ​​Penelitian ini menggunakan metode mixed method, dengan pendekatan retrospektif. Dalam penelitian kuantitatif dilakukan analisis univariat dan multivariat, dimana menggunakan data sekunder dari rekam medis pasien stroke perdarahan yang dirawat di RS PON pada januari 2020 - Desember 2021. Dari total populasi 1254 pasien setelah dilakukan kriteria inklusi dan inklusi didapatkan 1001 pasien. Penelitian kuantitatif, dilakukan dengan menganalisis pengaruh implementasi CP terhadap lama hari rawat, morbiditas (nilai NIHSS) dan mortalitas. Faktor risiko dan efek atau penyakit yang terjadi di masa lampau diukur melalui catatan historis. Sementara pengumpulan data secara kualitatif menggunakan kuisioner dan wawancara secara mendalam kepada Kepala Bidang Pelayanan Medis, Kepala Komite Medis, Kepala Komite Keperawatan, Kepala Divisi Vaskular, Dokter Spesialis Neurologi, Dokter Spesialis Bedah Saraf, Dokter IGD, Perawat, Fisioterapi, Terapi wicara, Gizi dan Farmasi untuk mengetahui tahapan proses Clinical Pathway di RS PON. Total responden 129 orang. Penelitian kualitatif menilai pengetahuan tenaga medis dan paramedis terkait CP, implementasi, supervisi, monitoring dan evaluasi.Hasil: penelitian kuantitatif menemukan adanya hubungan antara beberapa variabel yang berada dalam CP, seperti pemeriksaan penunjang, terapi sesuai indikasi dan penyakit komorbid terhadap LOS, morbiditas dan mortalitas. Sementara pada penelitian kualitatif menilai implementasi CP di RS PON memerlukan perbaikan dari segi sosialisasi, implementasi, monitoring dan evaluasi.

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Clinical Pathway is a multidisciplinary toolkit used for evidence-based health care. The Clinical Pathway has the function to unify the therapy so as to minimize complications and medication errors. The National Brain Center Hospital (PON Hospital) is a national brain and nervous referral hospital. Hemorrhagic stroke is the second-highest disease in PON Hospital. The diversity of decisions to have surgery or not, even though it is indicated, is an important point to analyze the implementation of this Clinical Pathway.

Objective: to evaluate the implementation of CP bleeding stroke that has been carried out so that it is expected to be the basis for determining policy for network hospitals and hospitals throughout Indonesia. Assessing the relationship between variables in clinical pathways on Length of Stay (LOS), morbidity, and mortality

Methods: This study uses a mixed-method, with a retrospective approach. In this quantitative study, univariate and multivariate analyzes were carried out, which used secondary data from the medical records of hemorrhagic stroke patients treated at the PON Hospital in 2020-2021. From the total population of 1254 patients, after the inclusion and inclusion criteria were carried out, there were 1001 patients. Quantitative research was conducted by analyzing the effect of Clinical Pathway implementation on length of stay, morbidity (NIHSS value), and mortality. `Risk factors and effects or diseases that occurred in the past are measured through historical records. Meanwhile, qualitative data collection used in-depth interviews with the Head of Medical Services, Head of the Medical Committee, Head of Nursing, Head of the Vascular Division, Neurology Specialist, Neurosurgeon Specialist, Emergency Room Doctor, Nurse, Farmation, physiotherapist, speech therapist, nutritionist to find out the stages of the Clinical Pathway process at the PON Hospital. The total number of respondents are 129 people. Qualitative research assesses the knowledge of medical and paramedical personnel related to CP, implementation, supervision, monitoring, and evaluation.

Result: Quantitative research found a relationship between several variables in CP, such as investigations, therapy, and comorbid with LOS, morbidity, and mortality. Meanwhile, qualitative research showed that the implementation of CP in the PON Hospital was still unsatisfactory in terms of socialization, implementation, monitoring and evaluation.

Conclusion: Implementation of CP is associated with clinical outcomes of hemorrhagic stroke patients."

"Demam Berdarah Dengue (DBD) adalah penyakit tular vektor oleh virus dengue dengan vektor Aedes sp. Cempaka Putih Barat tergolong salah satu kelurahan dengan jumlah kasus DBD yang tinggi, sehingga perlu dilakukan pengendalian vektor dengan memberantas tempat berkembangbiak nyamuk Aedes sp., yaitu container luar rumah. Penelitian ini dilakukan dengan tujuan mengetahui sebaran container luar rumah dan keberadaan larva Aedes sp di RW 03 dan RW 07 Kelurahan Cempaka Putih Barat. RW tersebut dipilih karena homogenitas karakteristik pemukiman, dimana RW 03 dihuni oleh rumah besar dengan jarak rumah yang lebar dan RW 07 dihuni oleh rumah kecil, padat dengan jarak rumah yang sempit. Penelitian menggunakan desain cross sectional dan survei larva menggunakan single larva method. Di RW 03 ditemukan enam puluh container luar rumah dengan empat belas jenis container dan terbanyak ember. Larva paling banyak ditemukan di tong. Di RW 07 ditemukan 31 container luar rumah dengan sepuluh jenis container dan terbanyak kolam/akuarium. Larva paling banyak ditemukan di drum dan kaleng bekas. Dengan demikian container luar rumah lebih banyak ditemukan di RW 03 tetapi berdasarkan uji statistik didapatkan container luar rumah positif larva lebih banyak di RW 07 (25,8%) daripada di RW 03 (8,3%) dengan (p=0,024), dapat disimpulkan terdapat perbedaan bermakna keberadaan larva Aedes sp. pada container luar rumah di RW 03 dan RW 07 Kelurahan Cempaka Putih Barat.

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Dengue Hemorrhagic Fever (DHF) is a vector-borne disease by dengue virus and Aedes sp. as vector. West Cempaka Putih as one of district that the number of dengue cases are high. Therefore it is necessary to control the vector by eradicating potential breeding ground for Aedes sp. mosquitoes, container outside the house.The aim of study to identify the distribution of outdoor container and the presence of Aedes sp. larvae in RW 03 and RW 07 Cempaka Putih Barat. These was chose because homogenity of settlement characteristic that RW 03 is populated by people with big house and distance between houses are far. RW 07 is populated by people with small house and distance between houses are quite close. This study used cross sectional design and survey of larvae used single larvae method. In RW 03 was found sixty outdoor containers, fourteen types of container with most frequent container is bucket and larvae most commonly found in cans. In RW 07 was found thirty one outdoor containers, ten types of container with most frequent container is pond/aquarium and larvae most commonly found in the drums and tin cans. Thus the outdoor container is more commonly found in RW 03, but based on statistic test found that the number of containers with larvae in RW 07 (25,8%) is higher than in RW 03 (8.3%) with (p = 0.024). It can be concluded that there are significant differences in the existence of Aedes sp. larvae in the outdoor container between RW 03 and RW 07 West Cempaka Putih."

"Kegiatan pencatatan dan pelaporan saat pelaksanaan Posbindu PTM Puskesmas Banjarejo Kota Madiun berulang (double report) yaitu ditulis manual kemudian merekap data dalam bentuk file excel offline untuk dikirim ke Dinas Kesehatan Kota Madiun, hal ini tidak efektif karena tidak jarang data peserta Posbindu PTM dan hasil pemeriksaan pada formulir excel offline tersebut kosong atau tidak lengkap, penumpukan saat menginput data dari kertas hasil pemeriksaan ke file excel offline oleh petugas pencatatan dan pelaporan diakhir kegiatan Posbindu PTM sehingga tidak selesai saat itu juga. Sekitar 82,35% surveilans Posbindu PTM dilakukan secara offline sehingga tidak lengkap dan tidak tepat waktu (Renyaan EY, dkk., 2018). Penelitian ini bertujuan untuk mengembangkan sistem informasi pendukung pencatatan dan pelaporan kegiatan Posbindu PTM di Puskesmas Banjarejo Kota Madiun. Penelitian ini merupakan penelitian kualitatif dengan pendekatan studi kasus menggunakan tahapan perancangan System Development Life Cycle (SDLC) dengan model pendekatan prototype. Hasil penelitian ini berupa perancangan sistem informasi pendukung pencatatan dan pelaporan kegiatan Posbindu PTM Puskesmas Banjarejo Kota Madiun. Tim Posbindu PTM Puskesmas Banjarejo sebagai user merasa puas, mudah dalam menggunakan rancangan sistem informasi, dan merasa lebih efektif serta efisien menggunakan sistem informasi yang dirancang. Pengembangan sistem informasi pendukung pencatatan dan pelaporan kegiatan Posbindu PTM Puskesmas Banjarejo dapat meringankan beban kerja petugas, mempercepat dan mempermudah kegiatan pencatatan dan pelaporan Posbindu PTM, dapat menampilkan kembali data dari pelaksanaan Posbindu PTM yang dibutuhkan puskesmas, dan menghasilkan laporan kegiatan Posbindu PTM yang lengkap dan berkualitas. Sebaiknya pengembangan sistem informasi pendukung pencatatan dan pelaporan kegiatan Posbindu PTM Puskesmas Banjarejo berlanjut hingga sistem informasi dapat diimplementasikan dalam kegiatan Posbindu PTM, dilakukan proses uji coba yang mendalam kepada user mengenai dampak terhadap kemudahan dan kepuasan dari kinerja sistem informasi dalam kegiatan Posbindu PTM Puskesmas Banjarejo.

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Recording and reporting activities during the implementation of Posbindu PTM Banjarejo Health Center in Madiun City repeatedly (double report) that is written manual then they fill the data in the form of offline excel files to be sent to the Madiun City Health Office, this is not effective because it is not uncommon for posbindu PTM participants data and the results of checks on offline excel forms are blank or incomplete,  buildup when inputting data from the examination paper to offline excel files by the recording and reporting officer at the end of Posbindu PTM activities so that it is not completed at that time. About 82.35% of Posbindu PTM surveillance is conducted offline so it is incomplete and not on time (Renyaan EY, et al., 2018). This research aims to develop an information system supporting the recording and reporting of Posbindu PTM activities in Banjarejo Health Center in Madiun City. This research is qualitative research with a case study approach using the design stages of the System Development Life Cycle (SDLC) with a prototype approach model. The results of this study are in the form of the design of information systems supporting the recording and reporting of Posbindu PTM Banjarejo Health Center in Madiun City activities. Posbindu PTM Banjarejo Health Center team as users feel satisfied, easy to use the design of information systems, and feel more effective and efficient using the information system designed. The development of information systems supporting the recording and reporting of Posbindu PTM Banjarejo Health Center activities can ease the workload of officers, accelerate and facilitate the recording and reporting activities of Posbindu PTM, can display data from the implementation of Posbindu PTM needed by the health center, and produce a complete and quality Posbindu PTM activity report. We recommend that the development of information systems supporting the recording and reporting of Posbindu PTM Banjarejo Health Center activities continues until the information system can be implemented in Posbindu PTM activities, an in-depth trial process to users regarding the impact on the ease and satisfaction of information system performance in Posbindu PTM Banjarejo Health Center activities."

"Sepsis merupakan suatu penyakit sistemik yang dapat disebabkan oleh translokasi bakteri. B. animalis subsp. lactis merupakan salah satu bakteri yang berpotensi dalam mencegah translokasi bakteri. Gen grpE merupakan salah satu target spesifik dalam mendeteksi B. animalis subsp. lactis. Penelitian bertujuan untuk mengoptimasi primer dengan target gen grpE untuk kurva standar, mengetahui hubungan konsentrasi primer terhadap nilai Ct, serta mengetahui sensitivitas dan spesifisitas primer. Isolat diisolasi dari sampel feses bayi menggunakan metode fenol-kloroform. Pasangan Primer dirancang berdasarkan sekuens gen grpE B. animalis subsp. lactis (NZ_ABOT01000010.1) menggunakan program Primer3. Optimasi primer dilakukan menggunakan lima konsentrasi berbeda,yaitu 50/50 nM, 100/100 nM, 300/300 nM, 500/500 nM, dan 1.000/1.000 nM.Hasil penelitian menunjukkan bahwa pasangan primer F_HNO19_grpE dan R_HNO19_grpE dengan konsentrasi 1.000/1.000 nM menghasilkan kurva standar yang optimal dengan efisiensi dan koefisien korelasi (R2) masing-masing sebesar 99,095% dan 0,971. Berdasarkan uji sensitivitas dan spesifistas, pasangan primer F_HNO19_grpE dan R_HNO19_grpE konsentrasi 1.000/1.000 nM dapat mengamplifikasi DNA target sampai dilusi 10-5 , tetapi spesifisitasnya hanya sampai dilusi 10-2. Konsentrasi primer tidak berkorelasi terhadap nilai Ct. Pasangan primer F_HNO19_grpE dan R_HNO19_grpE dapat digunakan untuk kuantifikasi B. animalis subsp. lactis dengan kisaran nilai Ct sebesar 15,74--33,89.

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Sepsis is a systemic disease that can be caused by bacterial translocation. B. animalis subsp. lactis is one of the bacteria that has the potential to prevent the bacterial translocation. grpE gene is a specific target in the detection of B.animalis subsp. lactis. The research aims to optimize primer pair with target gene grpE for generating standard curve, to know the correlation between primer concentration and Ct value, and to know the primer sensitivity and specificity. Isolates were isolated from infant stool samples using phenol-chloroform method. Primer pair is designed based on B. animalis subsp. lactis grpE gene sequence (NZ_ABOT01000010.1) using the Primer3 program. The primer optimization is done using five different concentrations, which are 50/50 nM, 100/100 nM,300/300 nM, 500/500 nM, and 1.000/1.000 nM. The results showed that the primer pair F_HNO19_grpE and R_HNO19_grpE with 1.000/1.000 nM concentration can be used to generate an optimal standard curve with efficiency and correlation coefficient (R2) each by 99.095% and 0.971. Based on sensitivity and specificity test, primer pair F_HNO19_grpE and R_HNO19_grpE with 1.000/1.000 nM concentration can amplify DNA targets up to 10-5 dilution, but its specificity is only up to 10-2 dilution. Primer concentration and DNA samples with different concentrations were not correlated to the Ct value. F_HNO19_grpE and R_HNO19_grpE primer pair can be used for quantification of B. animalis subsp. lactis with a range of Ct values of 15.74 to 33, 89."

"ABSTRAKAnalisis Sistem merupakan penguraian operasional suatu sistem yang meliputiupaya pengidentifikasian tujuan, kegiatan, pelaksanaan kegiatan, situasi yangdihadapi serta informasi yang dibutuhkan sistem disetiap tahap pelaksanaannya.Penelitian ini menggunakan pendekatan perpaduan Teori Sistem Donabedian-Azwar, dengan pokok tahapan Struktur/Input-Proses-Output/Outcome untukmelihat sistem pelayanan penyakit jantung di RSUD Dr.Kanujoso DjatiwibowoBalikpapan Tahun 2014. Penelitian dilakukan pada bulan April hingga Nopember2015, menggunakan rancangan kualitatif dengan metode deskriptif analitik.Analisis dilakukan dengan data bersumber dari telaah dokumen medik pasienpenyakit jantung di RSUD Dr Kanujoso Djatiwibowo Balikpapan tahun 2014,observasi dan wawancara mendalam terhadap informan terpilih. Hasil penelitianmenunjukan faktor dari Struktur/Input yang berpengaruh terhadap mortalitadalam sistem pelayanan penyakit jantung di RSUD Dr Kanujoso DjatiwibowoBalikpapan adalah faktor Pasien, SDM, Fasilitas, dan Metode. Faktor Prosesberupa proses pemberian pelayanan, koordinasi dokter-perawat dan keterpaduanlayanan. Disarankan agar pihak RSUD Dr Kanujosos Djatiwibowo Balikpapanmelakukan penambahan tenaga dokter Spesialis Jantung, membuat pelayanan satuatap pasien penyakit jantung/Cardiac Center dan meningkatkankerjasama/koordinasi yang baik antara pihak RSUD Dr Kanujosos Djatiwibowodengan Faskes Pelayanan Primer, Dinas Kesehatan Kota Balikpapan dan pihakrumah sakit lainnya yang ada di Kota Balikpapan.

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ABSTRACTDecomposition Analysis System is operating a system that includes identificationefforts objectives, activities, implementation of activities, the situation faced andinformation needed at each stage of system implementation. This study uses ablend of Systems Theory approach Donabedian-Azwar, the principal stages ofStructural / Input-Process-Output / Outcome to look at heart disease care systemin hospitals Dr.Kanujoso Djatiwibowo Balikpapan 2014. The study wasconducted from April to November 2015, using a design qualitative descriptiveanalytic method. Analysis was performed with the data derived from the study ofmedical documents cardiac patients in hospitals Dr Kanujoso DjatiwibowoBalikpapan in 2014, observation and depth interview with selected informants.The results showed a factor of structure / Inputs that influence mortality incardiovascular disease care system in the Hospital Dr Kanujoso DjatiwibowoBalikpapan is Patient factors, human resources, facilities, and methods. Factorssuch as the process of service delivery, the doctor-nurse coordination andintegration of services. It is recommended that the hospitals Dr KanujososDjatiwibowo Balikpapan perform additional doctors Heart Specialist, create onestopservice for cardiovascular disease / Cardiac Center and increase cooperation /coordination between the hospitals Dr Kanujosos Djatiwibowo with PrimaryHealth Care Facility, City Health Department Balikpapan and house parties otherhospitals in the city of Balikpapan."

"Ners Spesialis peminatan kardiovaskular didapatkan setelah melalui program praktik residensi keperawatan. Praktek residensi keperawatan terdiri dari 2 program yaitu praktek residen umum dan praktek residensi peminatan yaitu kardiovaskular. Kegiatan praktek residensi peminatan termasuk peran perawat sebagai pemberi asuhan keperawatan, peneliti, dan inovator. Peran pemberi asuhan keperawatan yaitu melakukan asuhan keperawatan pada 1 kasus utama dan 30 kasus resume pasien gangguan sistem kardiovaskular menggunakan model konservasi Levine. Peran peneliti adalah melakukan penerapan EBN yaitu akupresur terhadap kecemasan pasien preoperasi jantung. Hasil penerapan EBN; akupresur sebagai intervensi nonfarmakologi, nonivasif, mudah, sederhana dan aman dapat menurunkan kecemasan preoperasi jantung. Terakhir, peran inovator yaitu penggunaan skala Munro untuk mencegah kejadian perioperative related pressure injury pada pasien bedah jantung. Instrumen skala Munro sebagai pengkajian risiko pressure injury spesifik pada perioperatif, dilakukan 3 tahapan (preoperatif, intraoperatif, dan postoperatif), valid dan reliabel. Instrumen dapat digunakan sebagai bagian dari satuan intervensi pencegahan perioperative related pressure injury bersama dengan pengkajian kulit.

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Nurse Specialist in cardiovascular is obtained after going through a nursing residency practice program. Nursing residensy practice consists of 2 programs, namely general residency practice and specialization residency practice, namely cardiovascular. Specialization residency practice activities include the roel of nurses as nursing care providers, researchers and innovators. The role of nursing care provder is to manage nursing care in 1 main case and 30 resume cases of pastients with cardiovascular system disorders using Levine conservation model. The role of researcher is to implement EBN, namely acupressure on the anxiety of preoperative cardiac patients.

Results of the EBN application; acupressure as a non-pharmacological intervention, non-invasive, simple, easy and safe can reduce anxiety of preoperative cardiac. Finally, the rola of an innovator is the use of Munro scale to prevent perioperative related pressure injury in cardiac surgery patients. Instrument of Munro scale as an assessment of the risk of specific in perioperative pressure injury, carried out 3 stages (preoperative, intraoperative, dan postoperative), valid and reliable. Instrument can be used as bundle of an intervention for the prevention of perioperative related pressure injury along with skin assessment."

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Praktik spesialis keperawatan merupakan sebuah proses penting dari pendidikan profesi dalam mengaplikasikan peran perawat spesialis dalam peningkatan kualitas layanan keperawatan. Praktik residensi keperawatan dilakukan di RSUPN Dr. Cipto Mangunkusumo. Kegiatan residensi terdiri dari pemberian asuhan keperawatan pada pasien kanker dengan pendekatan teori Peaceful End Of Life. Asuhan keperawatan telah diberikan pada pasien dengan kanker nasofaring. Penerapan Evidence Based Nursing (EBN) diberikan melalui intervensi mendengarkan terapi musik untuk mengurangi kecemasan dan meningkatkan rasa nyaman pasien kanker payudara yang menjalani radioterapi. Proyek inovasi melalui latihan Progressive Muscle Relaxation (PMR) untuk mengurangi mual muntah akibat kemoterapi pada pasien kanker.   Dalam praktik residensi ini menunjukkan bahwa teori Peaceful End of Life tepat diberikan pada pasien kanker nasofaring dengan end of life care. Intervensi mendengarkan musik dapat menurunkan tingkat kecemasan dan meningkatkan kenyamanan pasien kanker. Latihan Progressive Muscle Relaxation (PMR) mampu mengurangi mual muntah akibat kemoterapi khususnya pada fase lambat.

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Nursing specialist practice is an important process of professional education in applying the role of specialist nurses in improving the quality of nursing services. Nursing residency practices are carried out at the Dr. Cipto Mangunkusumo. Residency activity consists of giving nursing care to cancer patients with the Peaceful End Of Life theory approach, especially in nasopharyngeal cancer. Evidence Based Nursing (EBN) is given through listening to music therapy to reduce anxiety of breast cancer patients undergoing radiotherapy. Nursing innovation project through Progressive Muscle Relaxation (PMR) exercises to reduce chemotherapy induced nausea and vomiting.This residency practice shows that the Peaceful End of Life theory is precisely given to nasopharyngeal cancer patients with end of life care. Music listening interventions can reduce anxiety levels in breast cancer patients. Progressive Muscle Relaxation (PMR) exercises can reduce chemotherapy induced nausea and vomiting especially in the delayed phase.

 

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