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"Latar BelakangCOVID-19 adalah sebuah infeksi virus yang memiliki angka mortalitas yang sangat tinggi dalam periode waktu yang sangat sempit. Infeksi COVID-19 akan menyebabkan inflamasi di jaringan paru tubuh yang dapat diukur dengan serum D-dimer. Keparahan gejala dari infeksi COVID-19 dapat dilihat dalam gejala klinis dan keterlibatan segmen paru pada gambaran CT-Scan. Penelitian ini bertujuan untuk mengetahui hubungan antara level D-dimer dengan keparahan klinis pasien COVID-19 serta dengan keterlibatan lobus paru pada gambaran CT-Scan pasien COVID-19MetodePenelitian ini menggunakan metode potong lintang retrospektif dengan uji korelasi gamma untuk melihat hubungan antara level d-dimer dengan keparahan klinis dan keparahan gambaran CT-Scan pada pasien COVID-19. Penelitian ini menggunakan data sekunder dari penelitian “Implementasi Pencitraan Diagnostik Foto Toraks dan CT- Scan Toraks Coronavirus Disease 2019 (COVID-19) Menggunakan Artificial Intelligence” oleh Kamelia T, dkk. di tiga rumah sakit (Rumah Sakit Bunda Menteng, Rumah Sakit Bunda Depok, dan Rumah Sakit dr. Cipto Mangunkusumo) dalam periode 2020-2024, dimana terdapat 50 subjek yang melakukan pemeriksaan laboratorium (D- dimer) dan pemeriksaan CT-Scan.HasilDidapatkan 50 subjek dimana terdapat 25 (50%) subjek yang mengalami peningkatan level D-dimer dan 25 (50%) subjek dengan level D-dimer normal. Uji korelasi antara level D-dimer dengan keparahan klinis memiliki nilai P <0,001 dengan koefiesien korelasi sebesar 0,806. Uji korelasi antara level D-dimer dengan keparahan CT-Scan memiliki nilai P 0,012 dengan koefisien korelasi sebesar 0,528. Koefisien korelasi yang dianggap bermakna pada penelitian ini adalah 0,4.KesimpulanLevel D-dimer memiliki korelasi sangat kuat dengan keparahan klinis serta korelasi sedang dengan keparahan CT-Scan, sehingga dapat menjadi biomarker potensial untuk menentukan tingkat keparahan gejala klinis pasien dan keparahan gambaran CT-Scan thoraks pasien COVID-19.

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Introduction

COVID-19 is a viral infection associated with a high mortality rate within a relatively short period. The infection triggers inflammation in lung tissues, which can be measured using serum D-dimer levels. The severity of COVID-19 symptoms can be assessed through clinical manifestations and the extent of pulmonary segment involvement observed on CT-Scan imaging. This study aims to determine the correlation between D- dimer levels and the clinical severity of COVID-19, as well as the involvement of pulmonary lobes on CT-Scan images of COVID-19 patients.

Method

This study employed a retrospective cross-sectional method with a gamma correlation test to examine the relationship between D-dimer levels, clinical severity, and CT-Scan severity in COVID-19 patients. This study utilized secondary data from the research “Implementation of Diagnostic Imaging of Chest X-rays and CT-Scans for Coronavirus Disease 2019 (COVID-19) Using Artificial Intelligence” by Kamelia T, et al., conducted at three hospitals (Bunda Menteng Hospital, Bunda Depok Hospital, and Dr. Cipto Mangunkusumo Hospital) from 2020 to 2024, involving 50 subjects who underwent laboratory (D-dimer) and CT-Scan examinations.

Results

A total of 50 subjects were included, with 25 (50%) showing elevated D-dimer levels and 25 (50%) with normal D-dimer levels. The correlation test between D-dimer levels and clinical severity showed a p-value <0.001 with a correlation coefficient of 0.806. The correlation test between D-dimer levels and CT-Scan severity yielded a p-value of 0.012 with a correlation coefficient of 0.528. A correlation coefficient of 0.4 or higher was considered significant in this study.

Conclusion

D-dimer levels can serve as a potential biomarker for determining the severity of clinical symptoms and the severity of thoracic CT-Scan findings in COVID-19 patients."

"Latar BelakangN-asetilsistein (NAC) merupakan kandidat potensial untuk strategi drug repurposing dalam menangani pandemi COVID-19, terutama untuk menurunkan progresi COVID-19 derajat berat yang dapat diprediksi oleh rasio neutrofil-limfosit (RNL). Namun, belum banyak studi yang meneliti hubungan NAC dengan RNL. Oleh karena itu, penelitian ini bertujuan untuk menilai hubungan pemberian NAC dengan RNL pasien COVID-19 derajat berat di RSUP Persahabatan.MetodePenelitian potong lintang dilakukan melalui rekam medis 60 pasien COVID-19 derajat berat di RSUP Persahabatan (mendapat NAC: 30; tidak mendapat NAC: 30). Studi ini meninjau karakteristik subjek penelitian berdasarkan usia, jenis kelamin, komorbiditas, dan riwayat pengobatan lain. Fokus penelitian ini adalah parameter RNL sebelum dan setelah perawatan. Analisis dilanjutkan dengan menilai hubungan pemberian NAC terhadap RNL.HasilSecara keseluruhan, terdapat 60 subjek yang mayoritas terdiri atas laki-laki (53,3%) dengan median usia 54 (23 – 69). Tidak ada perbedaan sebaran jenis kelamin, usia, komorbiditas, dan riwayat pengobatan lain antara kedua kelompok yang bermakna secara statistika. RNL kelompok yang mendapat NAC lebih rendah daripada kelompok yang tidak mendapat, baik sebelum perawatan (6,21 [2,21 – 33,32] vs 6,92 [2,25 – 36,15]) maupun setelah perawatan (5,14 [0,99 – 17,16] vs 5,74 [1,88 – 21,95]), tetapi perbedaan tersebut tidak signifikan secara statistika (p = 0,941; p = 0,451, masing-masing). Pemberian NAC tidak mempengaruhi penurunan RNL secara bermakna (p = 0,060). Adapun perbedaan median perubahan RNL antara dua kelompok tidak ditemukan bermakna (p = 0,460).KesimpulanNAC tidak signifikan secara statistik dalam menurunkan RNL pasien COVID-19 derajat berat.

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Introduction

N-acetylcysteine (NAC) is a potential candidate for drug repurposing strategies in dealing with the COVID-19 pandemic, especially in reducing the development of severe COVID- 19 which can be predicted by the neutrophil-lymphocyte ratio (NLR). However, due to limited research of NAC’s effect on NLR, this study aims to assess their relationship in severe COVID-19 patients at Persahabatan Central General Hospital.

Method

A cross-sectional study from medical records of 60 severe COVID-19 patients at Persahabatan Central General Hospital (received NAC: 30; not received NAC: 30) reviewed the characteristics of the subjects based on age, gender, comorbidities, and other treatment history. This study focused on NLR before and after treatment, assessing the relationship between NAC administration and NLR.

Results

Most of the overall subjects were male (53.3%) with a median age of 54 (23–69). There was no statistically significant difference in the distribution of gender, age, comorbidities, and other treatment history between two groups. Group that received NAC had lower NLR than group that didn’t, both before treatment (6.21 [2.21–33.32] vs 6.92 [2.25– 36.15]) and after treatment (5.14 [0.99–17.16] vs 5.74 [1.88–21.95]), but the difference was not statistically significant (p = 0.941; p = 0.451, respectively). NAC administration did not significantly decrease NLR (p = 0.600). The difference in median changes in NLR between two groups was also not found to be significant (p = 0.460).

Conclusion

NAC did not statistically significant in reducing NLR in severe COVID-19 patients."

"Latar Belakang: Pandemi COVID-19 telah menjadi tantangan besar bagi dunia kesehatan. Tenaga kesehatan merupakan populasi yang sangat rentan tertular dikarenakan tingginya intensitas dan frekuensi pajanan SARS-CoV-2. Risiko penularan meningkat apabila tenaga medis melakukan tindakan yang memicu aerosilisasi, salah satunya adalah intubasi endotrakeal karena tingginya viral load pada saluran napas. Sebanyak 3,2% pasien COVID-19 memerlukan tindakan intubasi endotrakeal dan ventilasi mekanis. Intubasi endotrakeal yang efektif pada pasien COVID-19 penting dilakukan untuk menurunkan mortalitas dan risiko penularan. Penelitian ini bertujuan intuk mengetahui faktor-faktor yang memengaruhi efektivitas intubasi endotrakeal pada pasien terkonfirmasi COVID- 19 di RSUP Persahabatan.Metode: Penelitian ini merupakan penelitian observasional yang menggunakan desain potong lintang yang dilakukan di IGD, ICU Rasmin Rasjid dan ICU PINERE RSUP Persahabatan pada bulan Juni 2021 – Juni 2022. Subjek peneltian ini adalah pasien terkonfirmasi COVID-19 yang dilakukan tindakan intubasi endotrakeal yang memenuhi kriteria inklusi dan eksklusi. Tindakan intubasi endotrakeal dinilai dari observasi rekaman CCTV. Selanjutnya karakteristik subjek, karakteristik intubasi endotrakeal dan faktor-faktor yang memengaruhi intubasi endotrakeal dievaluasi.Hasil: Pada penelitian ini didapatkan 59 subjek penelitian. Proporsi intubasi endotrakeal efektif pada pasien COVID-19 sebesar 20,34%. Median lama waktu tindakan intubasi endotrakeal adalah 38 (19-189) detik. Sebanyak 32 (54,24%) tindakan intubasi endotrakeal dilakukan oleh spesialis anestesi dan 27 (45,76%) oleh PPDS Pulmonologi dan Kedokteran Respirasi. Hasil analisis bivariat didapatkan hasil bermakna secara statistik pada variabel penyakit kardiovaskular+DM (OR 0,24 (IK 95% 0,06-0,91), p=0,028) dan variabel operator (OR 0,07 (IK 95% 0,01-0,62), p=0,004). Hasil analisis multivariat menunjukkan hasil bermakna secara statistik hanya pada variabel operator (adjusted OR 0,06 (IK 95% 0,01-0,60), p=0,016).Kesimpulan: Terdapat hubungan penyakit kardiovaskular+DM dan operator terhadap intubasi endotrakeal efektif pada pasien COVID-19 di RSUP Persahabatan.

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Background: The COVID-19 pandemic has become a major challenge for the healthcare system. Healthcare workers are vulnerable population of COVID-19 transmission due to high intensity and frequency of exposure to SARS-CoV-2. The risk of transmission increases in aerosolization procedure such as endotracheal intubation because of the high viral load in the airways. Approximately 3.2% of COVID-19 patients require endotracheal intubation and mechanical ventilation. Effective endotracheal intubation in COVID-19 patients is important parameter to reduce mortality and the risk of transmission to healthcare workers. This study aims to determine the factors that influence the effectiveness of endotracheal intubation in patients with COVID-19 in National Respiratory Center, Persahabatan Hospital.

Methods: This study is an observational study using a cross-sectional design which was carried out in the emergency department, ICU Rasmin Rasjid and ICU PINERE of National Respiratory Center, Persahabatan Hospital in June 2021 – June 2022. The subjects of this study were COVID-19 patients who underwent endotracheal intubation who met the criteria inclusion and exclusion. The endotracheal intubation procedure was assessed from the observation of CCTV recordings. The characteristics of the subject, the characteristics of endotracheal intubation and the factors that influence endotracheal intubation were evaluated.

Results: In this study, there were 59 subjects. The proportion of effective endotracheal intubation in COVID-19 patients was 20.34%. The median length of time for endotracheal intubation was 38 (19-189) seconds. Among the subjects, 32 (54.24%) endotracheal intubation were performed by anesthesiologists and 27 (45.76%) were performed by Pulmonology and Respiratory Medicine residents. The results of the bivariate analysis showed statistically significant results on the cardiovascular disease + DM comorbid (OR 0.24 (95% CI 0.06-0.91), p=0.028) and operator (OR 0.07 (95% CI 0.01-0.62), p=0.04). The results of the multivariate analysis showed statistically significant results only for operator (adjusted OR 0.06 (95% CI 0.01-0.60), p=0.016).

Conclusion: There is relationship of cardiovascular disease + DM comorbid and operator with effective endotracheal intubation in COVID-19 patients at National Respiratory Center, Persahabatan Hospital."

"COVID-19 atau coronavirus disease 2019 adalah penyakit menular yang memengaruhi sistem organ, terutama sistem pernapasan dan disebabkan oleh virus SARS-CoV-2. Individu yang terinfeksi COVID-19 memiliki tingkat keparahan yang berbeda. Salah satu faktor yang berasosiasi terhadap tingkat keparahan pasien COVID-19 adalah usia. Tingkat keparahan yang tinggi pada kondisi seseorang cenderung mempengaruhi banyaknya treatment yang dibutuhkan, hingga akhirnya juga mempengaruhi waktu yang dibutuhkan seseorang tersebut untuk sembuh. Penelitian ini berfokus pada faktor usia, dimana faktor tersebut diduga menyebabkan perbedaan karakteristik tertentu dari pasien dan durasi rawat yang dibutuhkan oleh pasien COVID-19. Tujuan dari penelitian ini adalah untuk menganalisis perbandingan karakteristik pasien COVID-19 berdasarkan kelompok usia, dan mengidentifikasi bagaimana kaitan usia terhadap durasi rawat pasien COVID-19 hingga mengalami kematian, perbaikan kondisi COVID, dan rawat jalan. Analisis perbandingan karakteristik pasien COVID-19 berdasarkan kelompok usia dilakukan dengan menerapkan metode exploratory data analysis (EDA). Selanjutnya metode EDA dan regression tree diterapkan untuk mengetahui bagaimana kaitan usia terhadap durasi rawat pasien COVID-19 hingga mengalami kematian, perbaikan kondisi, dan rawat jalan. Hasil yang diperoleh pada penelitian ini adalah terdapat kecenderungan perbedaan pada pasien COVID-19 berdasarkan kelompok usia jika dilihat berdasarkan faktor jenis kelamin, durasi rawat, status akhir, gejala, komorbid, komplikasi, dan pengukuran laboratorium darah. Selain itu, usia merupakan pertimbangan utama dalam memperkirakan durasi rawat pasien COVID-19 dengan faktor lainnya adalah hipertensi, klorida, HPR, PWR, MLR dan gejala demam.

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COVID-19 or coronavirus disease 2019 is an infectious disease that affects the organ systems, especially the respiratory system and is caused by the SARS-CoV-2 virus. Individuals infected with COVID-19 have different levels of severity. One of the factors associated with the severity of COVID-19 patients is age. The severity level of a person tends to affect the number of treatments needed, and therefore will affect the time it takes for the person to recover. This study focuses on age, where this factor is suspected to cause differences in certain characteristics of COVID-19 patients and length of hospital stay required by COVID-19 patients. The purpose of this study is to analyse the characteristics comparison of COVID-19 patients by age group, and to identify on how age affects the length of hospital stay for COVID-19 patients to death, improved conditions, or outpatient care. Comparative analysis of the characteristics of COVID-19 patients by age group is done using exploratory data analysis (EDA). Furthermore, EDA and regression tree are used to find out how age is related to the length of hospital stay for COVID-19 patients to death, improved COVID conditions, or outpatient care. The results show that there was tendency of differences in gender, length of hospital stay, clinical outcome, symptoms, comorbidities, complications, and blood laboratory measurements in COVID-19 patients based on age group. In addition, age is a major consideration in estimating the length of hospital stay for COVID-19 patients with other factors such as hypertension, chloride, HPR, PWR, MLR and fever."

"Latar belakang: Coronavirus Disease 2019 (COVID-19) adalah penyakit baru. Infeksi saluran napas akibat virus yang disertai infeksi bakteri akan meningkatkan derajat keparahan dan angka mortalitas. Insidens ventilator associated pneumonia (VAP) pada kelompok COVID-19 yaitu 21-64%. Kasus VAP dapat menjadi penyebab tingginya mortalitas pada pasien COVID-19 terintubasi.Metode penelitian : Penelitian ini adalah penelitian retrospektif di RS Persahabatan. Seluruh sampel yang digunakan adalah kelompok pasien COVID- 19 terintubasi >48 jam dalam periode tahun 2020-2022 yang memenuhi kriteria inklusi dan eksklusi.Hasil penelitian : Penelitian ini meliputi 196 data penelitian yang memenuhi kriteria inklusi. Proporsi laki-laki lebih banyak dibandingkan perempuan dan hanya 29% adalah populasi usia lanjut. Proporsi VAP pada COVID-19 terintubasi pada tahun 2020-2022 mencapai 60% dengan VAP rates 92,56. Terdapat dua faktor bermakna terhadap VAP pada pasien COVID-19 terintubasi yaitu penggunaan azitromisin (OR 2,92; IK95% 1,29-6,65; nilai-p 0,01) dan komorbid penyakit jantung. (OR 0.38; IK95% 0,17-0,87; nilai-p 0,023). Proporsi terbesar biakan mikroorganisme aspirat endotrakeal adalah Acinetobacter baumannii (44%), Klebsiella pneumoniae (23%), Escherichia coli (9%).Kesimpulan : Proporsi VAP pada COVID-19 terintubasi adalah 60%. Terdapat hubungan bermakna pada penggunaan azitromisin dan komorbid penyakit jantung sedangkan usia lanjut dan penggunaan steroid tidak memiliki hubungan bermakna terhadap VAP pada pasien COVID-19 terintubasi.

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Background : Coronavirus Disease 2019 (COVID-19) is a novel disease. Viral respiratory infection following bacterial infection could increase the severity and mortality of the disease. The incidence of Ventilator (VAP) in COVID-19 group is 21-64%. VAP might be the leading cause of high mortality in intubated COVID-19 patient.

Methods : This research is a retrospective study at Persahabatan hospital. The collected samples is a group of COVID-19 patient intubated for >48 hours in the period of 2020 to 2022 that meet the inclusion and exclusion criteria.

Results : This study consist of 196 data fulfilling the inclusion criteria. Male proportion much greater than female and only 29% is an elderly population. The proportion of VAP in the period of 2020-2022 is 60% with the VAP rates 92,56. There are two factors significantly affected VAP in intubated COVID-19 patient which are the usage of azitromisin (OR 2,92; CI95% 1,29-6,65; p-value 0,01) and cardiovascular disease comorbidity(OR 0.38; CI95% 0,17-0,87; p-value 0,023). The most abundance proportion of endotracheal aspirate microorganism culture are Acinetobacter baumannii (44%), Klebsiella pneumoniae (23%), and Eschrichia coli (9%).

Conclusion : The proportion of VAP in intubated COVID-19 is 60%. There are significant association of azitromicin usage and cardiovascular comorbidity while elderly and the usage of steroid are not significantly associated to VAP in intubated COVID-19 patient."

"Latar belakang. Coronavirus disease-2019 (COVID-19) memiliki spektrum penyakit yang sangat luas dari gejala ringan sampai berat, hingga kematian. Reaksi inflamasi berat akibat dari COVID-19 ini menimbulkan gangguan hemostasis yang disebut dengan COVID-19 associated coagulopathy. Penelitian ini bertujuan untuk menilai profil koagulasi pada pasien dalam pemantauan (PDP) ataupun terkonfirmasi COVID-19 serta hubungannya terhadap mortalitas 30-hari pasien. Metode. Studi ini merupakan studi kohort retrospektif di RS Cipto Mangunkusumo (RSCM) selama Maret 2020 hingga Juni 2020. Sebanyak 106 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Dilakukan pengambilan data berupa data demografik, klinis atau hemodinamik pasien, profil koagulasi saat subjek ditentukan sebagai PDP atau terkonfirmasi COVID-19, pemberian terapi tromboprofilaksis heparin, dan status mortalitas 30 hari setelah admisi. Perhitungan statistik dilakukan dengan menggunakan Statistical Package of Social Science (SPSS) versi 24.0. Profil koagulasi subjek penyintas 30 hari dibandingkan dengan subjek yang mengalami mortalitas. Variabel profil koagulasi yang bermakna kemudian dianalisis dengan analisis bivariat dan regresi logistik multivariat. Hasil. Pada kelompok yang mengalami mortalitas 30-hari ditemukan adanya peningkatan jumlah leukosit (p: 0,022), penurunan kadar trombosit (p: 0,016), dan waktu protrombin (PT) dan waktu activated partial thromboplastin time (APTT) yang lebih panjang (p: 0,002 dan p: 0,018) dibandingkan pada kelompok penyintas 30-hari. Tidak ditemukan perbedaan fibrinogen dan d-Dimer yang bermakna secara statistik. PT merupakan suatu profil koagulasi tunggal yang dapat digunakan sebagai prediktor mortalitas 30-hari dengan odds ratio (95% CI) sebesar 1,407 (1,072 – 1,846), nilai p: 0,014.Simpulan. Terdapat hubungan antara faktor koagulasi pasien COVID-19 dengan mortalitas 30 hari di RSCM, khususnya PT yang dapat digunakan sebagai prediktor mortalitas 30-hari.

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Background. Coronavirus disease-2019 (COVID-19) has a very broad spectrum of disease from mild to severe symptoms, to death. The severe inflammatory reaction as a result of COVID-19 infection causes a hemostasis disorder called COVID-19 associated coagulopathy. This study aims to assess the coagulation profile of patients under monitoring (PDP) or confirmed COVID-19 and its relationship with 30-day mortality.

Method. This retrospective cohort study was conducted at RS Cipto Mangunkusumo (RSCM) from March 2020 to June 2020. A total of 106 subjects who met the inclusion criteria were analyzed from medical record data. Data were collected in the form of patient demographic, clinical or hemodynamic data, coagulation profile when the subject was determined as PDP or confirmed as COVID-19, administration of heparin thromboprophylaxis therapy, and mortality status 30 days after admission. Statistical calculations were performed using the Statistical Package of Social Science (SPSS) version 24.0. We compared the coagulation profiles of the survivor group in contrast to the non-survivor group. Significant coagulation profile variables were analyzed using bivariate analysis and multivariate logistic regression.

Results. There was elevated number of leukocytes (p: 0.022), reduced platelet levels (p: 0.016), and longer prothrombin time (PT) as well as activated partial thromboplastin time (APTT) (p: 0.002 and p: 0.018, consecutively) in non-survivor group. There were no statistical differences in fibrinogen and d-Dimer levels in both groups. Additionally, PT is a single coagulation profile which predicted 30- day mortality with an odds ratio (95% CI) of 1.407 (1.072 - 1.846), and p value: 0.014.

Conclusion. This present study shows abnormal coagulation results are associated with 30-day mortality in COVID-19 patients at RSCM. Prolonged PT was an independent predictor for 30-day mortality in COVID-19 patients."

"Pandemi Covid-19 menjadi tantangan bagi RS UI dalam mengedepankan pelayanan kepada pasien yang bersifat holistik, demi kepentingan dan keselamatan pasien. Case manager merupakan jabatan baru di RS UI, sehingga dianggap masih memiliki banyak celah dalam penerapannya. Peran case manager dirasakan belum optimal di lapangan, terutama oleh klinisi dan manajemen. Tujuan penelitian adalah untuk merumuskan tugas pokok fungsi case manager dalam pelayanan pasien Covid-19, dan mengidentifikasi peran yang telah dilaksanakan oleh case manager. Penelitian ini merupakan penelitian non eksperimental kualitatif, menggunakan pendekatan fenomenologi dengan desain potong lintang. Peneliti menemukan bahwa case manager RS UI belum menjalankan peran sesuai rumusan tugas pokok fungsi case manager yang ada dalam standar akreditasi RS; rumusan tugas pokok fungsi case manager belum sesuai dengan kebutuhan pelayanan pasien Covid-19 di RS UI, sehingga case manager RS UI belum menjalankan peran sesuai rumusan tugas pokok fungsi case manager untuk kebutuhan pelayanan pasien Covid-19 di RS UI. Secara garis besar, terdapat tiga hambatan peran case manager, yaitu hambatan pengorganisasian, hambatan aktivitas, dan hambatan evaluasi. Peneliti merekomendasikan agar tupoksi case manager tetap memenuhi standar akreditasi, dan disesuaikan dengan karakteristik RS. Selain itu, perlu dilakukan penguatan case manager secara kualitas dan kuantitas, agar dapat berperan lebih optimal.

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The Covid-19 pandemic is a challenge for UI Hospital in prioritizing its services to patients that are holistic in nature, for the benefit and safety of patients. Case manager is a new position at UI Hospital, so it is considered that there are still many gaps in its implementation. The role of the case manager is felt to be not optimal in the field, especially by clinicians and management. The purpose of the study was to formulate the main duties and functions of the case manager in the service of Covid-19 patients, as well as to identify the roles that have been carried out by the case manager. This research was a non-experimental qualitative using a phenomenological approach with a cross-sectional design. The researcher found that the case manager of the UI Hospital had not carried out the role according to the formulation of the main duties and functions of the case manager in the hospital accreditation standard; The formulation of the main duties and functions of the case manager was not in accordance with the service needs of Covid-19 patients at the UI Hospital. Therefore, the case manager was considered not to have carried out the roles accordingly for the service needs of Covid-19 patients at the UI Hospital. Thus, in general terms, there are three barriers to the role of the case manager, namely organizational barriers, activity barriers, and evaluation barriers. The researcher recommends that the main duties of the case manager still meet accreditation standards, and are adjusted to the characteristics of the hospital. In addition, it is necessary to strengthen case managers in terms of quality and quantity, so that they can play a more optimal role."

"Latar Belakang. Pandemi COVID-19 yang terjadi sejak akhir tahun 2019 telah menginfeksi puluhan juta orang di di dunia, termasuk di Indonesia. Tes pemeriksaan PCR sebagai tes standar untuk diagnosis merupakan salah satu upaya pencegahan sekunder penting untuk mencegah penyebaran penyakit, mengetahui besar masalah dan pengambilan keputusan segera untuk upaya pencegahan selanjutnya. Adanya jeda waku yang panjang untuk menunda pemeriksaan diagnosis PCR ini berpotensi menimbulkan penyebaran virus yang lebih luas dan kemungkinan kesalahan diagnosis. Tujuan. Mengetahui gambaran jeda waktu diagnosis pasien COVID-19 dan faktor-faktor pasien yang berpengaruh. Metode Penelitian. Penelitian dilakukan dengan Sumber data Rekam Medis pasien rawat inap COVID-19 tahun 2020 di Rumah Sakit Universitas Indonesia dengan pendekatan cross sectional. Total sampling dilakukan dengan menerapkan kriteria inklusi dan eksklusi. Hasil. Dari 254 subjek penelitian, laki-laki lebih banyak (55.1%). Panjang jeda waktu diagnosis di luar fasilitas pelayanan kesehatan median 6 hari, di fasilitas pelayanan kesehatan 1 hari, dan total 7 hari. Jumlah pasien terlambat di luar fasilitas pelayanan ksesehatan lebih banyak dibandingn dengan terlambat di dalam fasilitas pelayanan kesehatan (80.7% vs. 5.7%). Dari uji chi-square, faktor yang berhubungan dengan keterlambatan diagnosis yaitu jenis kelamin (p=0.013), umur (p=<0.01), status perkawinan (p=0.021), pendidikan (p=0.024), riwayat kontak (p=0.031), dan gejala (p=0.003). Kesimpulan. Ada hubungan antara keterlambatan diagnosis COVID-19 dengan beberapa faktor demografi dan faktor penyakit pasien.

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Background. The COVID-19 pandemic that has occurred since the end of 2019 has infected tens of millions of people worldwide, including in Indonesia. PCR test as a standard test for diagnosis is one of the important secondary prevention efforts to prevent the spread of the disease, find out the magnitude of the problem and make immediate decisions for further prevention. This long delay in delaying PCR diagnosis may represent a wider spread of the virus and a possible misdiagnosis. Objective. To find out the description of the time lag in the diagnosis of COVID-19 patients and the factors that influence it Research methods. The study was conducted using Medical Record data sources for COVID-19 inpatients in 2020 at the Universitas Indonesia Hospital with a cross sectional approach. Total sampling was done by applying inclusion and exclusion criteria. Results. Of the 254 research subjects, more men (55.1%). The length of time delay for diagnosis outside health care facilities is a median of 6 days, at a health service facility 1 day, and a total of 7 days. The number of late patients outside health care facilities was higher than those late in health care facilities (80.7% vs. 5.7%). From the chi-square test, factors associated with late diagnosis were gender (p=0.013), age (p=<0.01), marital status (p=0.021), education (p=0.024), contact history (p=0.031), and symptoms (p=0.003). Conclusion. There is a relationship between the delay in the diagnosis of COVID-19 with several demographic factors and patient disease factors."

"Peningkatan angka kasus COVID-19 yang tidak terkendali mengakibatkan fasilitas kesehatan di Indonesia kurang mampu untuk menampung seluruh pasien yang terinfeksi COVID-19. Sementara itu, pasien COVID-19 harus mendapatkan pengobatan dan perawatan. Salah satu upaya untuk yang dilakukan adalah isolasi mandiri bagi pasien tanpa gejala dan bergejala ringan. Penelitian ini dilakukan dengan tujuan mengeksplorasi akses pasien COVID-19 untuk memperoleh obat saat isolasi mandiri di rumah serta kendala yang dialami saat isolasi. Instrumen penelitian menggunakan kuesioner yang dikembangkan oleh peneliti berdasarkan studi literatur dan telah divalidasi dua tahap. Kuesioner disebarkan secara online dan mendapatkan 115 responden sebagai subjek penelitian. Butir pertanyaan kuesioner memuat tentang data sosiodemografi, gambaran keadaan subjek saat melakukan isolasi mandiri, dan aspek – aspek akses obat (aksesibilitas, ketersediaan, keterjangkauan). Sebagian besar responden melakukan isolasi mandiri pada periode Januari – Maret (53,2%). Persebaran responden paling banyak melakukan isolasi mandiri di Jakarta (45,22%). Ditinjau dari persentase tertinggi setiap aspek, 71,3% mengatakan sangat mudah dalam aspek aksesibilitas, 48,7% mengatakan ketersediaan obat cukup baik, dan 41,7% mengatakan harga obat cukup terjangkau. Adapun kendala yang terjadi selama isolasi mandiri, seperti kemacetan lalu lintas sehingga membutuhkan waktu lebih untuk ke fasilitas kesehatan, informasi obat tidak valid, serta harga antivirus mahal dengan ketersediaan yang minim. Uji komparatif dilakukan untuk mengetahui faktor yang mempengaruhi akses obat dan terdapat perbedaan bermakna pada variabel periode COVID-19 (p=0,003). Dari hasil analisis skor akses obat, disimpulkan bahwa akses obat saat isolasi mandiri mudah (89,6%) bagi pasien COVID-19 di Jabodetabek.

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The number of COVID-19 cases that increased uncontrollably cause the health facilities in Indonesia being unable to accommodate all patients infected with COVID-19. Meanwhile, patients must receive treatment and care. One of the efforts to do is self- isolation for asymptomatic patients and mild symptoms. This study was conducted with the aim of exploring the accessibility of COVID-19 patients to obtain medication during self-isolation at home and the obstacles experienced during isolation. The research instrument used a questionnaire developed by the researcher based on a literature study and was validated in two stages. The questionnaire was distributed online and got 115 respondents as research subjects. Questionnaire items contain sociodemographic data, a description of the subject's condition when doing self-isolation, and aspects of drug access (accessibility, availability, affordability). Most of the respondents self-isolated in the January – March period (53.2%). The distribution of respondents who mostly self- isolated in Jakarta (45.22%). Judging from the highest percentage of each aspect, 71.3% said it was very easy in terms of accessibility, 48.7% said the drug availability was quite good, and 41.7% said the price of the medicine was quite affordable. The Obstacles that occur during self-isolation, such as traffic jams that require more time to go to health facilities, invalid drug information, and expensive antivirus prices with minimal availability. A comparative test was conducted to determine the factors that influence drug access and there was a significant difference in the COVID-19 period variable (p=0.003). From the results of the analysis of drug access scores, it was concluded that access to drugs during self-isolation is easy (89.6%) for COVID-19 patients in Jabodetabek."

"Latar Belakang: Penggunaan heparin inhalasi pada beberapa penelitian COVID-19memberikan hasil dalam perbaikan klinis pasien, baik dalam menurunkan lama rawat,perbaikan oksigenasi paru, dan mortalitas. Dosis harian total heparin inhalasi yangbervariasi terutama bila diberikan bersamaan dengan antikoagulan sistemik, memilikiresiko komplikasi perdarahan yang memerlukan kajian terhadap keefektifan dankeamanannya.Tujuan: Meneliti keefektifan dan keamanan inhalasi heparin dosis 150,000 IU/haridengan dosis 100.000 IU/hari dinilai dari AaDO2, aPTT dan d-Dimer dalam 7 haripengamatan pada pasien ICU COVID-19.Metode: Penelitian ini merupakan penelitian observasional dengan studi kohortretrospektif menggunakan data sekunder rekam medis pasien ICU COVID-19 bulanSeptember 2020 – September 2021. Terdapat 300 sampel menggunakan consecutivesampling. Pasien dikelompokkan menjadi kelompok heparin dosis 150.000 IU/hari dan100.000 IU/hari. Pencatatan dilakukan dalam 7 hari pengamatan. Uji Statistikmenggunakan uji Mann Whitney untuk menilai tingkat keparahan, Uji Wilcoxon rank testuntuk melihat perbedaan variabel dependen hari pertama dengan hari ketujuh padamasing-masing dosis.Hasil: Heparin inhalasi baik dosis 150.000 IU/hari dan 100.000 IU /hari bermaknamenurunkan AaDO2 pada 7 hari pengamatan (p 0.001). Nilai aPTT tidak memanjangpada kedua kelompok, dan kedua dosis heparin sama- sama menurunkan nilai d-Dimerpada 7 hari pengamatan (p 0.001).Simpulan: Heparin Inhalasi dosis 150.000 IU/hari sama efektif dinilai dari AaDO2, dansama amannya terhadap aPTT dan d-Dimer dibandingkan heparin inhalasi dosis 100.000IU/hari.

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Rationale: The use of inhaled heparin in several COVID-19 studies has resulted in

clinical improvements in patients, both in reducing length of treatment, improving

pulmonary oxygenation, and reducing mortality. The varying total daily dose of inhaled

heparin, especially when given together with systemic anticoagulants, poses a risk of

bleeding complications that require review of its effectiveness and safety.

Objective: To analyze effectiveness and safety of heparin inhalation dosage 150,000

IU/day compare to 100,000 IU/day assessed from AaDO2, aPTT and d-Dimer from 7

days observation in ICU COVID-19 patients with invasive and non-invasive ventilator

patterns.

Methods: An observational cohort retrospective study used secondary data from medical

records ICU COVID-19 patients with invasive and noninvasive ventilator patterns from

September 2020 – September 2021. There were 300 samples using consecutive sampling.

Patients divided into 2 groups, one received dosage 150,000 IU / day heparin inhalation,

the other received heparin inhalation dosage 100,000 IU / day. Recording of the research

from medical records is carried out at 7 days of ICU treatment. Statistical tests were

carried out using Mann Whitney to assess severity, Wilcoxon rank test to see the

difference in dependent variables day 1 and day 7 to dose.

Measurements and Main Results: Heparin inhalation at dose of 150,000 IU/day and

100,000 IU/day both significantly decreased AaDO2 at 7 days of observation (p 0.001).

The aPTT on both groups at 7 days of observation are within normal limits. Both doses

of heparin inhalation decreased d-dimer at 7 days of observation (p 0.001).

Conclusion: Inhaled heparin doses of 150,000 IU/day as effective and as safe as inhaled

heparin doses of 100,000 IU/day."