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"Latar Belakang. Postoperative nausea and vomiting (PONV) atau mual dan muntah pascaoperasi adalah komplikasi yang paling sering terjadi setelah tindakan operasi dengan anestesi pada 24 jam pertama pascaoperasi. Tatalaksana PONV di RSCM masih berdasarkan kebijakan terkait dengan cost effective menggunakan kombinasi deksametason dan metoklopramid pada seluruh pasien tanpa melihat faktor risiko. Tujuan penelitian ini untuk mengetahui keefektifan tatalaksana PONV berdasarkan stratifikasi risiko PONV dan tatalaksana yang terdapat di RSCM. Metode Penelitian ini merupakan uji klinik acak tidak tersamar dengan 354 pasien yang menjalani operasi elektif dengan anestesi umum. Subjek dibagi menjadi dua kelompok: 193 pasien menerima tatalaksana standar (kombinasi deksametason 4 mg dan metoklopramid 10 mg), sedangkan 161 pasien lainnya mendapatkan intervensi berdasarkan stratifikasi risiko menggunakan kombinasi deksametason dan ondansetron untuk risiko sedang serta penambahan haloperidol untuk risiko tinggi. Hasil: Persentase kejadian PONV di RSCM berdasarkan penelitian adalah sebesar 14,6% pada seluruh sampel, dengan 52 pasien dari total 354 mengalami PONV. Kejadian PONV pada pasien risiko tinggi dengan anestesi umum berdasarkan stratifikasi risiko PONV lebih rendah secara bermakna dibandingkan pada pasien dengan tatalaksana kombinasi deksametason dan metoklopramid yang terdapat di RSCM (p < 0,001; OR 0,08; 95% CI: 0,01–0,28). Kesimpulan. Pencegahan PONV dengan Stratifikasi Risiko lebih efektif dibandingkan Tatalaksana Kombinasi Deksametason dan Metoklopramid pada Pasien Risiko Tinggi PONV.

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Background. Postoperative nausea and vomiting (PONV) are the most common complications occurring within the first 24 hours following surgery under anesthesia. PONV management at RSCM is currently guided by cost-effectiveness policies, using a combination of dexamethasone and metoclopramide for all patients without considering risk factors. This study aims to evaluate the effectiveness of PONV management based on PONV risk stratification compared to the standard management used at RSCM. Methods. This study is a randomized, open-label clinical trial involving 354 patients undergoing elective surgery with general anesthesia. Subjects were divided into two groups: 193 patients received standard management (a combination of dexamethasone 4 mg and metoclopramide 10 mg), while the other 161 patients received intervention based on risk stratification using, namely, a combination of dexamethasone and ondansetron for moderate risk and the addition of haloperidol for high risk. Results. The overall incidence of PONV among all samples was 14,6%, with 52 out of 354 patients experiencing PONV. Among high-risk patients undergoing general anesthesia, the incidence of PONV was significantly lower with risk stratification-based management compared to standard treatment using a combination of dexamethasone and metoclopramide (p < 0.001; OR 0.08). Conclusion. PONV prevention based on risk stratification is more effective than standard management using a combination of dexamethasone and metoclopramide in high-risk PONV patients."

"Post Operastive Nausea and Vomiting (PONV) adalah akibat yang sering terjadi pada pasien yang dilakukan tindakan operasi. Skor risiko untuk memprediksi kejadian PONV digunakan sebagai cara untuk mengklasifikasikan pasien sesuai dengan prediksi risiko. Penelitian ini dilakukan untuk melihat keakuratan antara skor Apfel dan skor Koivuranta dalam memprediksi PONV. Mual dan muntah post operasi dikaji dengan menggunakan Rhodes Index Vomiting, Nausea and Retching (RINVR). Desain penelitian yang digunakan adalah metode deskriptif, rancangan studi cross sectional analitik. Berdasarkan perhitungan rumus tunggal untuk estimasi proporsi sampel yang digunakan berjumlah 80 pasien yang akan menjalani tindakan operasi. Hasil penelitian skor Apfel memiliki sensitivitas (0,92) dan spesifitas (0,92) lebih tinggi dibandingkan dengan skor koivuranta, skor Apfel memiliki akurasi 0,9. Skor apfel adalah skor prediksi PONV yang sederhana dengan sensitivitas tinggi sangat cocok digunakan di tatanan klinik untuk menskrining mual dan muntah pada pasien post operasi. Setelah diketahui skor prediksi dapat ditentukan penanganan yang tepat mencegah PONV.

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Post Operastive Nausea and Vomiting (PONV) is a common consequence in patients who underwent surgery. Risk score to predict the incidence of PONV is used as a way to classify patients according to risk prediction. This study was performed to see the accuracy of the Apfel scores and Koivuranta scores in predicting PONV. Postoperative nausea and vomiting was assessed using the Rhodes Index Nausea Vomiting, and Retching (RINVR). The design of study used is descriptive, crosssectional analytical study design. Based on the calculation of a single formula to estimate the proportion of samples used were 80 patients undergoing surgery.

The results of the study Apfel score had a sensitivity (0.92) and specificity (0.92) is higher than the Koivuranta score, Apfel has an accuracy score of 0.9. Score prediction score PONV apfel is simple with high sensitivity is very suitable to be used in order clinics to screen nausea and vomiting in postoperative patients. Once known prediction score can be determined proper treatment to prevent PONV."

"Stroke merupakan penyebab kedua kematian dan penyebab ketiga kecacatan di seluruh dunia. Pendekatan terbaik yang dapat dilakukan untuk mencegah terjadinya stroke adalah dengan memberikan edukasi pada pasien yang berisiko tinggi stroke. Penelitian ini bertujuan untuk mengembangkan model edukasi pencegahan stroke untuk menurunkan faktor risiko stroke serta meningkat kemampuan merawat diri pasien yang berisiko tinggi stroke. Penelitian ini menggunakan metode Action Research yang terdiri dari dua tahapan, tahap satu adalah identifikasi masalah sampai pengembangan model yang didasari dengan penelitian kualitatif tentang persepsi pasien dalam kepercayaan kesehatan yang dimilikinya dalam rangka menurunkan faktor risiko stroke. Selanjutnya dikembangkan Model Edukasi Pencegahan Stroke dengan mengintegrasikan tema hasil penelitian kualitatif, studi literatur dan konsultasi pakar. Penelitian tahap dua adalah melakukan uji coba Model Edukasi Pencegahan Stroke untuk menentukan pengaruh model dalam menurunkan faktor risiko stroke dan meningkatkan kemampuan merawat diri pasien berisiko tinggi stroke. Penelitian tahap dua adalah penelitian kuasi eksperimen menggunakan desain post test control group, dengan jumlah sampel sebanyak 140 orang yang terdiri dari 70 orang kelompok intervensi dan 7 orang kelompok kontrol. Hasil penelitian tahap satu didapatkan 4 tema dari hasil deep interview dengan partisipan sehingga dihasilkan Model Edukasi Pencegahan Stroke beserta buku panduan intervensi model, modul untuk perawat serta booklet untuk pasien dan keluarga. Hasil penelitian tahap dua membuktikan adanya perbedaan faktor risiko, self efficacy dan kemampuan merawat diri (self care) yang bermakna pada awal penilaian sampai penilaian bulan ke tiga antara kelompok intervensi dengan kelompok kontrol. Kesimpulan hasil penelitian yaitu Model Edukasi Pencegahan Stroke efektif menurunkan faktor risiko stroke, meningkatkan self efficacy dan meningkatkan kemampuan merawat diri (self care).

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Stroke is the second leading cause of death and the third leading cause of disability worldwide. The best approaches that can be taken to prevent stroke is to provide education for patients at high risk of stroke. The purpose of this research was to develop a stroke prevention education model in reducing stroke risk factors and improving self care for patients at high risk of stroke. This study uses an action research method which consist of two stages, the first stage is the identification of the problem to the development of a model based on a qualitative research about the patient’s perceptions of their health beliefs to reduce risk factors for stroke. Furthermore, the Stroke Prevention Education Model was developed by integrating the results, literature review and expert review. The second stage was examination the Stroke Prevention Education Model to identified its effect of the model in reducing stroke risk factors and improving self care for patients at high risk of stroke. This study was a quasi-experimental research using a post test control group design, with a total sample of 140 participants (70 samples in intervention groups and 70 samples in control groups). The qualitative study identified 4 themes from deep interviews with participants, this themes leads to the development of a Stroke Prevention Education Model and its devices include intervention manual, modules for nurses, booklet for patients and their families. The second stage of research proves the significant difference in risk factors, self efficacy and self care between the first measurement to the third measurement after intervention groups. We conclude that Stroke Prevention Education Model effectively reduce stroke risk factors, improve self efficacy and improve self care."

"Stroke merupakan salah satu penyebab utama kematian. Stroke memiliki berbagai faktor risiko mayor yang dapat diubah (modifiable risk factor) antara lain hipertensi, diabetes melitus, atrial fibrilasi, dan hiperkolesterol. Pengetahuan mengenai tanda dan gejala stroke, faktor risiko, dan perilaku pencegahan faktor risiko stroke dapat dikembangkan menjadi sikap waspada yang menjadi dasar dalam mengambil tindakan yang sesuai apabila terjadi serangan stroke sehingga menurunkan kejadian morbiditas dan mortalitas. Tujuan dari penelitian ini adalah untuk melihat hubungan kewaspadaan pada pasien risiko tinggi stroke dengan penanganan prehospital stroke. Kewaspadaan pada pasien risiko tinggi stroke diukur menggunakan kuesioner Knowledge, Attitude, and Practice (KAP) of Stroke. Sedangkan, penanganan prehospital stroke menggunakan kuesioner The Stroke Action Test (STAT). Penelitian ini menggunakan desain cross-sectional dan teknik purposive sampling yang melibatkan 144 responden. Hasil penelitian ini menunjukkan bahwa usia terbanyak responden berada pada rentang 36-40 tahun, sebanyak 56,3% berjenis kelamin perempuan, 53,5% memiliki jenjang pendidikan perguruan tinggi, 42,4% adalah suku jawa, 43,8% memiliki penghasilan perbulan �Rp3.300.000, sebanyak 45,8% mengenal seseorang yang mengalami stroke, 87,5% bukan perokok dan 38,2% adalah pasien hipertensi. 47,9% responden memiliki kewaspadaan tinggi, 52,1% responden memiliki kewaspadaan yang rendah, sebanyak 49,3% memiliki penanganan prehospital yang sesuai dan 50.7% responden memiliki sikap penanganan prehospital yang tidak sesuai.  Terdapat hubungan bermakna antara kewaspadaan pada pasien risiko tinggi stroke dengan penanganan prehospital stroke (p=0,000; �±=0,05). Edukasi mengenai tanda gejala dan faktor risiko stroke penting dilakukan untuk meningkatkan kemampuan penanganan prehospital stroke apabila terjadi serangan stroke.

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Stroke is one of the major cause of death. Stroke has a variety of major risk factors that can be changed (modifiable risk factors), including hypertension, diabetes mellitus, atrial fibrillation, and hypercholesterolemia. Knowledge about the signs and symptoms of stroke, risk factors, and prevention behaviour of stroke risk factors can be developed into awareness that is the basis for taking appropriate action in the event of a stroke to reduce the incidence of morbidity and mortality. This study aims to identify the relationship between awareness among patients at high risk for stroke and prehospital stroke action. Stroke awareness was measured by the Knowledge, Attitude, and Practice (KAP) of Stroke instrument. Meanwhile, prehospital stroke action was measured by the Stroke Action Test (STAT) instrument. This study used a cross-sectional design and purposive sampling technique involving 144 respondents. The result shows that most respondents were in the range of 36-40 years, 56.3% were female, 53.5% had tertiary education, 42.4% were Javanese, 43.8% had a monthly income of � IDR 300,000, 45.8% knew someone who had stroke, 87.5% were non-smokers, and 38.2% were hypertensive patients. 47,9% of respondents had high awareness, 52,1% of respondents had low awareness, 49,3% respondent had corresponding prehospital stroke action, and 50,7% of respondents had noncorresponding prehospital stroke action. There was a significant relationship between awareness among patients at high risk for stroke and prehospital stroke action (p-value = 0,000; �± = 0.05). The higher awareness stroke, the better management of prehospital. Based on these findings, Education and information are needed among patients at high risk for stroke to increase stroke awareness and develop their ability of prehospital stroke action."

"ABSTRAKLATAR BELAKANG: Hipoperfusi perioperatif yang diawali oleh hipoperfusi splanknik meningkatkan morbiditas dan mortalitas pada pasien pascaoperasi risiko tinggi. Parameter kadar laktat, P(cv-a)CO2 dan konsentrasi ScvO2 darah dapat digunakan untuk menilai hipoperfusi global. Peningkatan volume residu lambung dihubungkan dengan terjadinya hipoperfusi regional saluran cerna. Penelitian ini bertujuan mengetahui korelasi parameter hipoperfusi global (laktat, P(cv-a)CO2, ScvO2) dengan volume residu lambung pada pasien pascaoperasi risiko tinggi yang dirawat di ICU RSCM. METODE: Sebanyak 48 subyek penelitian yang dianalisis didapatkan dengan metode consecutive sampling. Subyek penelitian yaitu pasien usia ≥18 tahun yang memenuhi kriteria pascaoperasi risiko tinggi, dapat dipasang pipa oro/nasogastrik, pasien tidak menolak diikutsertakan dalam penelitian, bukan pascaoperasi gastrektomi, tidak ada hematemesis, pasien tidak dengan gastrostomi, tidak diberikan opioid pascabedah, serta dilakukan pemasangan kateter vena sentral pada v. cava superior. Pasien akan dikeluarkan dari penelitian apabila pasien meninggal dan dilakukan resusitasi jantung paru sebelum 24 jam pascaoperasi, diberikan opioid. Pasien dirawat di ICU pascaoperasi dan dicatat volume residu lambung, kadar laktat, P(cv-a)CO2, konsentrasi ScvO2 pada jam ke-0, ke-8 dan 24. HASIL: Terdapat korelasi lemah antara kadar laktat dengan volume residu lambung pada jam ke-0 (r=0,301 p<0,05), jam ke-8 (r=0,374 p<0,01) dan jam ke-24 (r=0,314 p<0,05). Tidak terdapat korelasi antara kadar P(cv-a)CO2 dan ScvO2 dengan volume residu lambung pada jam ke-0,8 dan 24. KESIMPULAN: Tidak terdapat korelasi antara parameter hipoperfusi global (laktat, P(cv-a)CO2, ScvO2) dengan volume residu lambung.

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ABSTRACTPerioperative hypoperfusion preceded by splanchnic hypoperfusion increased morbidity and mortality in high risk surgical patients. Parameter levels of blood lactate, P(cv-a)CO2 and concentration ScvO2 can be used to assess global hypoperfusion. Increased gastric residual volume associated with the occurrence of gastrointestinal regional hypoperfusion. This study aims to determine the correlation parameter global hypoperfusion (lactate, P(cv-a)CO2, ScvO2) with gastric residual volume in high risk surgical patients admitted to the ICU RSCM. METHODS: A total of 48 subjects analyzed were obtained by consecutive sampling method. The subjects are patients aged ≥ 18 years who meet the criteria of high risk surgical patients, can be mounted oro/ nasogastric tube, patients did not refuse to be included in this study, not postoperative gastrectomy, no hematemesis, without gastrostomy, not given opioid postoperatively, do the insersion of central venous catheter in v. cava superior. Patient will be excluded from the study if the patient died and performed CPR before 24 hours, administered opioid. Patients admitted to the ICU postoperatively and recorded gastric residual volume, levels of lactate, P(cv-a)CO2 , ScvO2 concentration at 0, 8th and 24th hour. RESULTS: There is a weak correlation between lactate level with gastric residual volume at 0 hour(r=0.301, p<0.05), 8th hour(r=0.374, p<0.01) and 24th hour (r=0.314, p<0.05). There is no correlation between P(cv-a)CO2 level and ScvO2 concentration with gastric residual volume at 0, 8th and 24th hour. CONCLUSION: There was no correlation between the parameters of global hypoperfusion (lactate, P(cv-a)CO2, ScvO2) with gastric residual volume."

"[ABSTRAKIbu hamil risiko tinggi rentan mengalami kecemasan dan depresi yang berdampak pada kelekatannya dengan janin. Penelitian ini bertujuan untuk mengidentifikasi hubungan antara dukungan sosial dengan kelekatan ibu dan janin pada ibu hamil risiko tinggi. Penelitian cross sectional ini melibatkan 108 ibu hamil risiko tinggi yang dipilih menggunakan consecutive sampling. Hasil penelitian menunjukkan bahwa terdapat hubungan antara dukungan sosial dengan kelekatan ibu dan janin pada ibu hamil risiko tinggi (p=0.003). Ibu dengan dukungan sosial tinggi berpeluang 3,9 kali mempunyai kelekatan tinggi dengan janinnya dibandingkan ibu yang dukungan sosialnya rendah setelah dikontrol depresi (OR=3.9; 95% CI=1.66-8.99). Hasil penelitian ini menegaskan bahwa aspek psikososial perlu lebih diperhatikan dalam perawatan ibu hamil sehingga status sejahtera bagi ibu dan bayi dapat dicapai.

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ABSTRACTHigh risk pregnant women tend to experience anxiety and depression that occur prenatal attachment dismissed. This study aimed to identify the relationship between social support and prenatal attachment among high risk pregnant women. This cross sectional study involved 108 high risk pregnant women which selected by consecutive sampling. The result showed that there is relationship between social support and prenatal attachment among high risk pregnant women (p= 0,003). Pregnant women with high social support had prenatal attachment 3,9 times higher than women with low social support after controlled by depression (OR= 3,9; 95% CI=1.66-8.99). This finding confirms that the psychosocial aspects need to be considered in the antenatal care in order to achieve the wellness status for both mother and the baby.;High risk pregnant women tend to experience anxiety and depression that occur prenatal attachment dismissed. This study aimed to identify the relationship between social support and prenatal attachment among high risk pregnant women. This cross sectional study involved 108 high risk pregnant women which selected by consecutive sampling. The result showed that there is relationship between social support and prenatal attachment among high risk pregnant women (p= 0,003). Pregnant women with high social support had prenatal attachment 3,9 times higher than women with low social support after controlled by depression (OR= 3,9; 95% CI=1.66-8.99). This finding confirms that the psychosocial aspects need to be considered in the antenatal care in order to achieve the wellness status for both mother and the baby.;High risk pregnant women tend to experience anxiety and depression that occur prenatal attachment dismissed. This study aimed to identify the relationship between social support and prenatal attachment among high risk pregnant women. This cross sectional study involved 108 high risk pregnant women which selected by consecutive sampling. The result showed that there is relationship between social support and prenatal attachment among high risk pregnant women (p= 0,003). Pregnant women with high social support had prenatal attachment 3,9 times higher than women with low social support after controlled by depression (OR= 3,9; 95% CI=1.66-8.99). This finding confirms that the psychosocial aspects need to be considered in the antenatal care in order to achieve the wellness status for both mother and the baby., High risk pregnant women tend to experience anxiety and depression that occur prenatal attachment dismissed. This study aimed to identify the relationship between social support and prenatal attachment among high risk pregnant women. This cross sectional study involved 108 high risk pregnant women which selected by consecutive sampling. The result showed that there is relationship between social support and prenatal attachment among high risk pregnant women (p= 0,003). Pregnant women with high social support had prenatal attachment 3,9 times higher than women with low social support after controlled by depression (OR= 3,9; 95% CI=1.66-8.99). This finding confirms that the psychosocial aspects need to be considered in the antenatal care in order to achieve the wellness status for both mother and the baby.]"

"Latar belakang: Prevalensi karies pada anak (ECC) cukup tinggi. Karies gigi merupakan penyakit kronis akibat infeksi bakteri yang salah satunya disebabkan Veillonella spp. yang terdapat di saliva, lidah, dan mukosa bukal. Veillonella spp. ditemukan pada anak yang mengalami karies dini.Tujuan: Mengetahui korelasi antara kuantitas Veillonella spp. di plak lidah dan saliva anak usia 3-5 tahun dengan kategori risiko karies tinggi.Metode: Kuantifikasi menggunakan qPCR.Hasil: Terdapat korelasi yang tidak bermakna antara kuantitas Veillonella spp. plak lidah dan saliva dengan risiko karies tinggi.Kesimpulan: Tidak terdapat korelasi antara kuantitas Veillonella spp. di plak lidah dan saliva dengan risiko karies tinggi.

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Background: The prevalence of caries in children (ECC) is quite high. Dental caries is a chronic disease caused by bacterial infection, which is caused by Veillonella spp. in saliva, tongue, and buccal mucosa. Veillonella spp. found in children with severe early childhood caries.

Aim: To know the correlation between the quantity of Veillonella spp. on tongue plaque and saliva of children aged 3-5 years with high risk caries.

Methods: Quantification using qPCR.

Results: There?s no significant correlation between the quantity of Veillonella spp. on tongue plaque and saliva with high risk caries.

Conclusion: The quantity of Veillonella spp. in tongue plaque and saliva has no correlated with high risk caries."

"Pendahuluan: Transpor neonatus dari unit neonatologi ke kamar operasi dan sebaliknya memiliki risiko terjadinya KTD (Kejadian tidak diharapkan) yang tinggi. Akan tetapi, belum ada studi terperinci yang mempelajari tentang hal tersebut. Studi ini ditujukan untuk mengetahui faktor-faktor risiko yang berperan dalam terjadinya KTD pada transfer perioperatif neonatus. Metode: Kami melakukan studi kohort retrospektif di RSUPN dr. Cipto Mangunkusumo. Neonatus yang memenuhi kriteria inklusi dan melalui kriteria eksklusi dilibatkan dalam penelitian ini. Faktor-faktor risiko serta profil KTD dihimpun dari neonatus yang terlibat. Analisis dilakukan secara komparatif univariat, bivariat, dan multivariat. Studi ini memiliki izin etik dari RSUPN dr. Cipto Mangunkusumo. Hasil: Tercatat sebanyak 87 KTD pada 56 neonatus yang menjadi subjek di dalam penelitian ini. Diketahui bahwa 51,79% subjek adalah perempuan, dengan 48,21% prematur, 58,93% berat badan lahir rendah, dengan rata-rata berat badan lahir 2.138 gram. Gambaran KTD terbanyak adalah desaturasi, mencakup 71,43%. Terdapat hubungan antara respiratory support invasif dengan hipotermia (OR = 0,052; IK 95% = 0,005 – 0,506). Terdapat hubungan antara respiratory support invasif dengan medical device adverse event (OR = 0,175; IK 95% = 0,043 – 0,707). Respiratory support invasif merupakan faktor yang paling berperan dalam medical device adverse event berdasarkan analisis multivariat (aOR = 0,023; IK 95% = 0,054–0,995). Angka kejadian KTD paling banyak pada kelompok satu kali transfer (64,29%), yaitu sebanyak 36 kasus dengan 13 (23,21%) di antaranya mengalami desaturasi. Terdapat hubungan antara frekuensi transfer pasien operasi unit neonatologi dan desaturasi (p-value = 0,047; Crude OR : 5,727 dan 95% CI : 1,148 - 28,573). Kesimpulan: Prematuritas, BBLR, dan kelainan kongenital tidak berhubungan dengan KTD. Sedangkan, penggunaan respiratory support invasif berhubungan dengan hipotermia dan medical device adverse event pada pasien transfer operasi unit neonatologi. Terdapat hubungan antara frekuensi transfer pasien dan KTD desaturasipada proses transfer neonates.

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Introduction: Transport of neonates from the neonatology unit to the operating room and vice versa carries a high risk of adverse events (KTD). However, there have been no detailed studies studying this. This study aims to determine the risk factors that play a role in the occurrence of adverse events during perioperative transfer of neonates. Methods: We conducted a retrospective cohort study at RSUPN dr. Cipto Mangunkusumo. Neonates who met the inclusion criteria and the exclusion criteria were included in this study. Risk factors and adverse event profiles were collected from the study subjects. Analysis was carried out using univariate, bivariate and multivariate analyses. This study was approved by RSUPN dr. Cipto Mangunkusumo. Results: A total of 87 adverse events were recorded in the 56 neonates who were subjects in this study. Fifty one point seventy nine percent of the subjects were female, 48.21% of the subjects were premature, 58.93% had low birth weight, with an average birth weight of 2,138 grams. The most common adverse event features were desaturation, covering 71.43% of the study subjects. There is a significant association between invasive respiratory support and hypothermia (OR = 0.052; 95% CI = 0.005 – 0.506). There is a significant association between invasive respiratory support and medical device adverse events (OR = 0.175; 95% CI = 0.043 – 0.707). Invasive respiratory support is the factor that plays the most role in medical device adverse events based on multivariate analysis (aOR = 0.023; 95% CI = 0.054–0.995). The highest incidence of adverse events (AEs) occurred in the single-transfer group (64.29%), with 36 cases, 13 (23.21%) of which experienced desaturation. There is a relationship between the frequency of patient transfers in the neonatal surgery unit and desaturation (p-value = 0.047; Crude OR: 5.727 and 95% CI: 1.148 - 28.573). Conclusion: Prematurity, LBW, and congenital abnormalities were not associated with adverse events. Meanwhile, the use of invasive respiratory support is associated with hypothermia and medical device adverse events in neonatology unit surgery transfer patients. There is a significant association between the frequency of patient transfers and desaturation adverse events during the transfer process of neonates. "

"ABSTRAKLatar Belakang: Hipertensi dan diabetes melitus merupakan faktor risiko penyakit stroke yang paling dominan. Tujuan: Penelitian bertujuan untuk mengetahui hubungan faktor risiko stroke, hipertensi dan diabetes melitus, dengan ketergantungan pasien stroke fase kronis di Departemen Rehabilitasi Medik RSCM. Metode: Penelitian dilakukan dengan metode observasional analitik menggunakan studi potong lintang. Penelitian ini menggunakan sampel sebanyak 44 yang dipilih berdasarkan sistem quota sampling. Hubungan antar variabel dianalisis menggunakan uji bivariat Chi Square dan analisis multivariat uji Regresi Logistik. Hasil: Dari hasil uji Chi Square didapatkan faktor risiko hipertensi dan diabetes melitus terhadap nilai MSBI, bernilai p=0,122 dan p=0,002. Dari uji Regresi Logistik didapatkan faktor risiko hipertensi p=0,076 OR 4,076; IK95 0,861-19,297 dan faktor risiko diabetes melitus p=0,007 OR 22,690; IK95 2,332-220,722 terhadap nilai MSBI. Diskusi: Diabetes melitus merupakan faktor risiko utama yang menyebabkan ketergantungan berat pasien stroke fase kronis.

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ABSTRACTBackground Hypertension and diabetes melitus are the most common risk factors of stroke. Objective The study aimed to determine the relationship between stroke risk factors, hypertension and diabetes melitus, with dependency of chronic stroke patients in Department of Medical Rehabilitation RSCM. Methods The study is conducted by using the analytical observational cross sectional study. The samples used in this study were 44 respondents selected by quota sampling method. The relationship between variabels was analyzed by bivariate test Chi Square and multivariate analysis Logistic Regretion. Results . Based on Chi Square test, relationship between MSBI scoring with hypertension and diabetes melitus as stroke risk factors, sequentiallly p 0,122 and p 0,002. Furthermore, Logistic Regression test suggested that hypertension and diabetes melitus as stroke risk factors related to MSBI scoring, respectively hypertension p 0,076 OR 4,076 IK95 0,861 19,297 and diabetes melitus p 0,007 OR 22,690 IK95 2,332 220,722 . Discussion Diabetes melitus is the most prominent risk factor in severe dependecy of chronic stroke patients."

"Latar belakang: Demam neutropenia dan komplikasinya adalah salah satu penyebab utama tingginya morbiditas dan mortalitas pasien anak dengan kanker, termasuk di RSCM. Selain antibiotik empiris, tata laksana lain seperti stratifikasi risiko, eskalasi dan modifikasi antibiotik, inisiasi antijamur dan penggunaan GCSF belum disusun menjadi suatu algoritme khusus sehingga praktiknya masih bervariasi. Salah satu antibiotik empiris yang banyak direkomendasikan adalah piperasilin tazobaktam. Tata laksana yang seragam direkomendasikan untuk menjaga kualitas layanan dan memperbaiki luaran.Tujuan: Mengetahui efektivitas algoritme Kiara dibandingkan tanpa algoritme dalam tata laksana demam neutropenia risiko tinggi pada anak dengan luaran bebas demam, kenaikan absolute neutrophil count (ANC) >500/µL dalam 7 hari, dan pertumbuhan mikroorganisme serta resistensi antibiotik.Metode: Uji klinis terbuka, terandomisasi dengan kontrol pada anak 0-18 tahun dengan demam neutropenia risiko tinggi, sejak Januari-Mei 2024. Kelompok uji mendapat antibiotik empiris piperasilin-tazobaktam. Eskalasi, modifikasi antibiotik, antijamur, dan G-CSF diberikan sesuai algoritme. Kelompok kontrol mendapat seftazidim serta tata laksana tanpa menggunakan algoritme. Pasien dipantau selama 7 hari.Hasil: Terkumpul 58 subjek, terbanyak adalah pasien tumor padat dengan gejala infeksi saluran pencernaan. Komplikasi dialami oleh 8 subjek, setengahnya merupakan kasus pneumonia, dengan 75% merupakan pasien malnutrisi, 37,5% menggunakan akses sentral dan 87,5% memiliki hasil kultur yang positif. Hasil kultur positif terbanyak adalah pada urin (14,5%), feses (10,2%), dan darah (6%). Kuman gram negatif terbanyak adalah Klebsiella pneumoniae (37%), Acinetobacter sp (20%), dan Escherichia coli (14,2%), sedangkan kuman gram positif terbanyak adalah Staphylococcus aureus (40%), Enterococcus faecalis (30%), dan Staphylococcus epidermidis (20%). Resistensi seftazidim didapatkan lebih tinggi (50% vs 31,1%) dan eskalasi-modifikasi antibiotik lebih banyak di kelompok kontrol.Simpulan: Algoritme Kiara tidak lebih baik dalam hal lama demam dan capaian kondisi bebas demam dalam 7 hari pemantauan. Pemberian GCSF di kelompok uji yang lebih selektif terbukti dapat meningkatkan kadar ANC >500/µL, sama baik dengan kelompok kontrol yang menggunakan GCSF dua kali lebih banyak.

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Background: Neutropenic fever and its complications are one of the main causes of high morbidity and mortality in pediatric cancer patients, including in Cipto Mangunkusumo Hospital. Apart from empiric antibiotics, other management such as risk stratification, antibiotic escalation and modification, antifungal initiation, and use of GCSF have not been compiled into a specific algorithm so practice still varies. Piperacillin-tazobactam is one of treatment choice in children with neutropenic fever. Local guidelines are recommended to maintain quality of care and improve outcomes.

Objective: To determine the effectiveness of the Kiara algorithm versus without algorithm in the management of high-risk febrile neutropenia in children with outcomes of fever-free, increase in absolute neutrophil count (ANC) >500/µL in 7 days, as well as the growth of bacteria and antibiotic resistance.

Methods: Open, randomized clinical trial with controls in children aged 0-18 years with high-risk febrile neutropenia, from January-May 2024. Experimental groups received piperacillin-tazobactam empirically. Escalation and modification of antibiotics, antifungals, and G-CSF were administered according to the algorithm. The control group received ceftazidime and treatment without an algorithm. Patients were followed up to 7 days of monitoring.

Results: A total of 58 subjects were included, most of whom were solid tumor patients with symptoms of digestive tract infections. Complications were experienced by 8 subjects, half of them were pneumonia and 75% were malnourished, 37,5% with central venous catheter and 87,5% had positive culture. Highest bacteria growth is in urine (14,5%), feces (10,2%), and blood (6%). The majority of gram-negative bacteria are Klebsiella pneumoniae (37%), Acinetobacter sp (20%), and Escherichia coli (14,2%) while the gram-positive bacteria are Staphylococcus aureus (40%), Enterococcus faecalis (30%), and Staphylococcus epidermidis (20%). Antibiotic resistance was higher in the control group (50% vs 31,1%) as well as the antibiotic escalation and modification rate.

Conclusion: The Kiara algorithm was not proven to be better in achieving fever-free conditions within 7 days of monitoring. The more selective administration of GCSF in the algorithm was proven to increase ANC levels to >500/µL, comparable to the control group with twice GCSF use."