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"Latar Belakang : Pemeriksaan DNA virus Human Papilloma HPV telah digunakan secara luas dalam program deteksi kanker serviks.Pemeriksaan HPV dapat dilakukan melalui pengambilan mandiri sehingga dapat meningkatkan angka cakupan deteksi dini kanker serviks. Namun akurasi klinis dari metode pengambilan mandiri terhadap pengambilan oleh dokter belum banyak dipublikasikan diIndonesia.Tujuan : Untuk mengetahui tingkat akurasi hasil pengambilan sampel mandiri untuk pemeriksaan DNA Hybrid Capture HPVrisiko tinggiterhadap pengambilan sampel oleh dokter dalam deteksi dini lesi pra kanker serviks.Metode : Penelitian uji diagnostikpotong lintangini dilakukan di Poliklinik Kolposkopi Obstetri dan Ginekologi RS Ciptomangunkusumo. Perempuan yang datang kepoliklinik dengan rujukan kelainan sitologi dan hasil inspeksi visual asam asetat positif masuk kedalam perlakuan. Subyek diambil secara konsekutif dan mengambil peran serta dengan melakukan pengambilan sampel apusan vagina secara mandiri dan berikutnya dilakukan pengambilan sampel apusan serviks oleh dokter. Pengambilan sampel menggunakan sikat apusan dari Digene, dan dilakukan pemeriksaanDNA HPV risiko tinggi dengan teknik Hybrid Capture dari Qiagen Lab. Hasil pengambilan sampel oleh dokter dijadikan sebagai standar baku. Dari kedua hasil tersebut dilakukan uji diagnostik kappauntuk menilai kesetaraan dari dua metode pengambilan sampel tersebut.Hasil :Didapatkan 70 subyek dengan kelainan sitologi dan IVA positif, satu diantaranya tidak melanjutkan pemeriksaan karena mengeluh nyeri saat memasukkan sikat apusan. Prevalensi HPV risiko tinggi pada populasi sampel ini adalah 44,9 . Dari hasil analisis kedua pemeriksaan didapatkan nilai kappa cukup baik sebesar 0,76 dengan akurasi hasil pengambilan mandiri sebesar 88,41 . Sensitifitas, spesifisitas, nilai duga positif dan nilai duga negatif metode pengambilan mandiri terhadap pengambilan oleh dokter sebesar 80,65 IK95 ; 63,72-90,81 , 94,74 IK95 ; 82,71-98,54 , 92,59 IK95 ; 76,63-97,94 , 85,71 IK95 ; 72,16-93,28 .Kesimpulan :Penelitian ini menunjukkan bahwa metode pengambilan sampel mandiri dan dokter terhadap HPV DNA risiko tinggi memiliki kesetaraan yang cukup baik. Pengambilan sampel mandiri dapat dijadikan sebagai metode alternatif deteksi dini kanker serviks di Indonesia. Kata kunci: Pengambilan sampel mandiri; Pengambilan sampel dokter; Uji HPV DNA

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Background Human Papilloma Virus HPV DNA detection already widely used in cervical cancer screening program. HPV testing can be done on self taken sampling therefore it offers alternative opportunity to increase cervical cancer screening coverage. However clinical accuracy from self taken sampling methods compare to physician taken sampling has not widely published in Indonesia.Objective To determine the accuracy of Hybrid Capture HPV DNA high risk result from self taken sampling methods to physician taken sampling in cervical cancer screening.Methods This cross sectional diagnostic research conducting in O G Colposcopy polyclinic Ciptomangunkusumo Hospital. All women came with cytology abnormality dan positive VIA were enrolled. Subject was consecutively selected and took place in both vaginal self taken sampling and continued with physician taken sampling. Sample retrieval using Digene cytobrush and high risk HPV DNA test using Hybrid capture DNA II from Qiagen Labs. The sample result taken by physician was taken as gold standard. From those two methods were analyzed and compare with kappa diagnostic test to assess the equality of two methods.Result There were 70 subjects with cytology abnormality and positive VIA, one of them can not finished self examination due to feeling pain while inserting cytobrush. HPV prevalence from this sample population was 44.9 . From analysis result between two methods found kappa value was fairly good at 0.76 with self sampling accuracy was 88.41 . Sensitivity, specificity, positive predictive value and negative predictive value self taken sampling methods to physician taken sampling was 80,65 95 CI 63,72 90,81 , 94,74 95 CI 82,71 98,54 , 92,59 95 CI 76,63 97,94 , 85,71 95 CI 72,16 93,28 .Conclusion This study showed that HPV DNA testing self taken sampling and physician taken sampling had a good equality. HPV testing self sampling can be use as an alternative cervical cancer screening program in Indonesia. Keywords self taken sampling, physician taken sampling, HPV DNA test."

"Latar Belakang: MnSOD adalah antioxidant yang paling umum untuk melindungi sel-sel dari stres radical oksidatif Endogenous dan exogenous radical bebas superoksida . Sel punca kanker diketahui untuk bertahan dalam keadaan hipoksia dan kelangsungan hidup sel punca kanker dipengerahi oleh level ekspresi MnSOD. Namun, efek hipoksia terhadap ekspresi gen MnSOD SOD2 masih belum diketahui.Tujuan: Penelitian ini dilakukan untuk menginvestigasi tingkat ekspresi MnSOD dalam berbagai interval waktu hipoksia dalam induksi hipoksia kepada CD24-/44 sel punca kanker payudara. Metode: Sampel kanker payudara diperoleh dalam klinik dan dipisahkan dengan Magnetic cell Sorting MACs . Sampel berikut di induksi hipoksia dalam interval 0 jam, 30 menit, 4 jam, 6 jam dan 24 jam di dalam ruangan hipoksia. Kemudian, mRNA diisolasi dan dipotimasi untuk primer annealing. C t value Cycle threshold diperoleh dari qRT-PCR dan dilakukan kalkulasi untuk mengetahui ekspresi relatif MnSOD terhadap ekspresi gen 18s. Hasil PCR akan dilakukan elektroforesis untuk mengkonfirmasi amplifikasi MnSOD. Hasil: Tingkat ekspresi MnSOD menurun di setiap interval hipoksia. Ekspresi MnSOD diturunkan paling rendah setelah 4 jam setelah diinduksi hipoksia. Kesimpulan: Semua sel punca kanker payudara CD44 /CD24- yang telah diinduksi dalam interval hipoksia yang berbeda-beda telah berdiferensiasi, hasil ditunjukan dengan penurunan dalam ekspresi MnSOD."

"ABSTRAKLatar belakang: Sistektomi radikal dengan ileal conduit yang merupakan tata laksana utama karsinoma buli adalah prosedur pembedahan kompleks yang seringkali membutuhkan rawat inap yang lama dan menyebabkan berbagai komplikasi. Malnutrisi praoperatif merupakan kontributor penting terhadap tingginya morbiditas dan mortalitas pada sistektomi radikal. Dukungan nutrisi perioperatif yang adekuat bertujuan untuk menurunkan stres akibat pembedahan sehingga dapat mencegah komplikasi, menunjang outcome yang baik, dan memperpendek masa rawat inap pascaoperasi.Metode: Laporan serial kasus ini menyajikan empat kasus karsinoma buli, dengandua kasus termasuk kaheksia kanker dan dua kasus termasuk pra-kaheksia. Keempat pasien dilakukan sistektomi radikal dengan ileal conduit dan diberikan dukungan nutrisi perioperatif yang mencakup carbohydrate loading dan nutrisi enteral dini pascaoperasi serta pemberian nutrisi secara bertahap. Dilakukan pemantauan yang meliputi keluhan klinis, pemeriksaan fisik, antropometri, hasil laboratorium, dan analisis asupan.Hasil: Tiga pasien mengalami hiperglikemia yang berlangsung singkat tanpa membutuhkan terapi insulin. Dua pasien mengalami ileus paralitik pascaoperasi, namun dapat teratasi secara konservatif dalam waktu cepat. Dua pasien mencapai 70-80 target kalori dalam 5 hari pascaoperasi, sedangkan pasien yang mengalami ileus paralitik mencapai target kalori 60-70 dalam waktu 9 hari pascaoperasi. Masa rawat inap pascaoperasi bervariasi mulai dari 7 hingga 10 hari.Kesimpulan: Dukungan nutrisi perioperatif pada keempat pasien menunjang dalam mengontrol stres pembedahan yang terlihat dari hiperglikemia yang hanya berlangsung singkat, mencegah komplikasi, serta memperpendek masa rawat inap.

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ABSTRACT

Background Radical cystectomy and ileal conduit, a mainstay treatment of bladder carcinoma, is a complex surgery which not rarely requires a long hospital stay and has many complications. Preoperative malnutrition is on of important contributor to high morbidity and mortality in radical cystectomy. Adequate perioperative nutritional support aims to alleviate surgical stress, thus prevent complications, support good outcome, and shorten length of hospital stay after surgery.

Method This case series presenting 4 cases of bladder carcinoma, consists of 2 cases of cancer cachexia and 2 cases of pre cachexia. All of the patients had undergone radical cystectomy and ileal conduit, and was supported by perioperative nutrition including carbohydrate loading and postoperative early enteral nutrition. The monitoring included clinical complaints, physical examination, anthropometry, laboratory results, and intake analysis.

Result Three patients had hyperglycemia lasted only in short period and no insulin treatment needed. Two patients experienced postoperative paralytic ileus and was resolved only with conservative treatment. Two patients achieved 70 ndash 80 calorie target on 5 days after surgery, while the others who experienced paralytic ileus achieved 60 ndash 70 calorie target in 9 days postoperative. Length of stay in the hospital after surgery was varied between 7 to 10 days.

Conclusion Perioperative nutritional support on the above patients had contribution in controlling surgical stress, seen on the short period hyperglycemia, preventing complications, and shortening the hospital stays."

"ABSTRACTPurposes This study compared the effectiveness of 1 day vs 3 days antibiotic regimen to prevent surgical site infection (SSI) in open liver resection.MethodWe performed a randomized controlled non inferiority trial in 480 patients at 39 hospitals across Japan (registered as UMIN000002852). Patients with hepatocellular carcinoma scheduled to undergo resection were randomly assigned to receive either a 1 day regimen for antimicrobial prophylaxis, or a 3 day regimen. The primary endpoint was the incidence of SSI.ResultsAmong 480 randomized patients, 232 assigned to the 1 day regimen and 235 to the 3 day regimen were included in the full analysis set. Baseline characteristics of the two groups were well balanced. SSI was diagnosed in 22 patients (9,5%) in the 1 day group vs 23 patients (9,8%) in the 3 day group (difference, -0,30; 90% CI -4,80 to 4,19% (95% CI -5,66% to 5,05%); one sided P = 0,001 for non inferiority), meeting the non inferiority hypothesis. In both groups, remote site infection (16 (6,9%) vs 22 (9,4%), P 0,001 for non inferiority) and drain-related infection (5 (2,2%) vs 4 (1,7%), P 0.001 for non inferiority) were comparable.ConclusionTo prevent SSI in liver cancer surgery, a 1 day regimen of flomoxef sodium is recommended for antimicrobial prophylaxis because of confirming the non-inferiority to longer usage."

"The first laparoscopy-assisted gastrectomy for gastric cancer was performed in Japan in 1991. In the ensuing 20 years, at first through a process of trial and error, then through the sharing of master surgeons’ accumulated experience, the procedure has been honed and refined to its current high level. From the beginning, it soon became evident that this much less invasive form of gastrectomy, in comparison with traditional open surgery, led to improved quality of life for postsurgical patients, and use of the procedure spread rapidly among gastric surgeons. Early on, however, there were calls for the establishment of standard techniques and procedures to be followed, with a recognized need to improve the level of safety and the quality of lymph node dissection for local control in cancer treatment. Toward that end, the Laparoscopy-Assisted Gastrectomy Club was formed in 1999. In the following year, because both Japan and Korea experience a high rate of gastric cancer, specialists from those two nations came together to form the Japan–Korea Laparoscopic gastrectomy joint seminar, to facilitate and encourage the exchange of vital information. The result has been to achieve an evolving consensus among specialists in the field of endoscopic surgery in Japan and Korea with expertise that can be shared worldwide. A compilation of the current state-of-the-art is now presented in this volume, with accompanying DVD, which will be of great value to all endoscopic surgeons who perform laparoscopic gastrectomy."

"ABSTRACTPurposeGeriatric surgery poses specific challenges due to patient vulnerability in relation to aging. We analyzed perioperative challenges concerning super-elderly patients with breast cancer.MethodsBetween 2013 and 2018, 908 patients with breast cancer were treated surgically. Of these, two patient groups were compared: Group A (≥ 85 years old, n = 34, 3,7%) and Group B (75-84 years old, n = 136, 15%).ResultsIn Groups A and B, 26,4% and 36,8% of patients lived alone, respectively. Group A patients had higher rates of psychiatric and cardiovascular disease (32,4% and 41,2%) than Group B (8,8% and 16,2%) (p = 0,0009 and p = 0,0031, respectively). There was no marked difference in the type of surgery or length of hospital stay between groups, and most complications involved surgical site disorders. Postoperatively, Group A had a higher rate of delirium (29,4%) than Group B (3,7%) (p < 0,0001). The 30-day postoperative mortality rate was 0, and 76,5% of Group A and 45,6% of Group B patients received no adjuvant therapy (p = 0,0024).ConclusionsAge alone does not constitute a contraindication for appropriate surgery, although there are some challenges necessary to consider for super-elderly patients."

"ABSTRAKNama : Patiyus Agustiansyah/NPM 1506706023Program Studi : Kajian Administrasi Rumah SakitJudul : Analisis dan Implementasi Lean pada Persiapan OperasiKanker Ginekologi di RSUP dr. Mohammad HoesinPalembangIndonesia saat ini memiliki beban kanker ginekologi besar yaitu insidensi,morbiditas dan mortalitasnya. Salah satu penanganan kanker ginekologi adalahpembedahan yang akan membantu kesintasan pasien. Waktu tunggu penjadwalanoperasi kanker ginekologi hendaklah memperhatikan progresifitas kankersehingga waktu tunggu operasinya tidak melebihi 2 minggu. Waktu tungguoperasi menggambarkan mutu pelayanan rumah sakit.Tujuan penelitian ini adalah,untuk menganalisis waktu tunggu penjadwalan operasi kanker ginekologi diRSUP dr. Moehammad Hoesin Palembang dengan menggunakan prinsip Lean.Hasil penelitian menunjukan penegakan diagnosis selama 43.844 menit dan waktutunggu operasi selama 66.700 menit, dengan menerapkan prinsip lean makapenegakan diagnosis 10.328,5 menit dan waktu tunggu operasi 10.325 menit.Kesimpulan penelitian, pada current state terdapat 26 aktifitas; 12 aktifitas VA value added ratio / VAR waktu 0,46 ; VAR jarak 89,6 dan 14 aktifitas NVA waste pasien dan 4 waste aktifitas petugas. Aliran proses yang menghambat bottle neck terdapat di pendaftaran, di poliklinik, di pemeriksaan penunjang dandi bagian praoperatif waktu tunggu paling lama . Future State memiliki 15aktifitas VA VAR waktu 33 ; VAR jarak 95,8 dengan 8 aktifitas NVA waste aktifitas pasien dan 0 waste aktifitas petugas, dengan waktu tunggudiagnosis 10.328,5 menit sedangkan waktu tunggu penjadwalan operasi 10.325menit. Hasil perbandingan current state dengan future state didapatkanpeningkatan aktifitas value added sebanyak 7,7 dengan penurunan waktutunggu 81,3 dan penurunan jarak tempuh 0,42 . Analisis akar masalahpenyebab waktu tunggu lama penjadwalan operasi kanker ginekologi di RSMHdikarenakan kekurangan SDM registrasi, rekam medis, DPJP dan keterbatasaninfrastruktur CT scan, kamar operasi dan instrumen dan kelemahan mengelolaproses penjadwalan operasi tersebut. Saran peneliti adalah peningkatan kinerjadan penambahan SDM, membuat regulasi untuk memprioritaskan pelayananpasien kanker ginekologi, serta integrasi Sistem Informasi Manajemen RumahSakit di setiap unit pelayanan.Kata Kunci : prinsip lean, value added VA , non value added NVA , waste,waktu tunggu penegakan diagnosis, waktu tunggu operasi, kanker ginekologi

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ABSTRACTName Patiyus Agustiansyah NPM 1506706023Program Studi Hospital Administration StudyTitle Lean Analysis and Implementation of Gynecology CancerOperative Scheduling in General Hospital dr. MohammadHoesin RSMH PalembangIndonesia currently has gynecologic cancer burden in the incidence, morbidityand mortality. One of gynecological cancer treatment is surgery which will helpthe survival rate of patients. The waiting time of gynecological cancer surgeryscheduling should bu focused to cancer progression so the waiting time should notexceed 2 weeks. The waiting time operation illustrates the quality of hospitalservices.The purpose of this study was to analyze the waiting time of gynecologiccancer surgery scheduling in RSMH by using the principles of Lean. The resultsshowed that establishing diagnosed need 43,844 minutes and the waiting timeoperation was 66,700 minutes. By applying Lean then the diagnosis establishing10,328.5 minutes, and operations waiting times 10,325 minutes. The studyconclusion showing for 26 activities of current state with 12 VA activities VARtime 0.46 VAR range for 89.6 and 14 NVA activities with 14 patient rsquo swastes activities and 4 employee wastes activities. The process flow whichinhibits bottle neck were lies in the stage of registration, at the outpatient clinic,at the laboratory examination and at the preoperative division the longest waitingtime . The waiting time for diagnosis process were 43.844 minutes, while thewaiting time scheduling of operation process were 66.700 minutes. Future Statehas 15 VA VAR time of 33 VAR range of 95.8 with 8 NVA activities and 8patients waste activity and 0 employee waste activities. The waiting time for adiagnosis process were 10328.5 minutes, while the waiting time for operationscheduling process were 10.325 minutes. The comparison between the currentstate to the future state resulted increasement of the VA activity for 7.7 with areduction in waiting time for 81.3 and mileage decrease of 0.42 . Analysis ofroot problems revealed that the long waiting times for scheduling process ofgynecologic cancer surgery in RSMH were due to lack of human resourcesquantity registration, medical records, doctor in charge and the lack ofinfrastructure CT scan, operating rooms and instruments and managerialweaknesses in managing the process of scheduling the surgery. Researcherssuggest to improve the performance of existing recruitment human resources,make regulations of a priority of gynecologic cancer patients, as well as theintegration of Hospital Management Information System in each unit.Keywords lean principles, values added VA , non value added NVA , waste,value added ratio, waiting time for establishing diagnosis, surgery waiting times,gynecological cancer"

"This book seeks to promote an integrated approach among the various specialists involved in the management of rectal cancer with a view to ensuring that treatment is tailored appropriately to the individual patient. For ease of use, a question and answer format is employed. The focus is on those issues typically confronted during daily clinical practice in relation to risk factors, imaging, surgery, radiotherapy, and chemotherapy. The services of an outstanding panel of authors representative of the major European oncological societies have been acquired in order to formulate the questions and provide the answers. All who need assistance in addressing concerns that arise from the need for multidisciplinary management of rectal cancer will find the book to be an ideal source of helpful information."

"This book aims to give a homogeneous approach to esophageal cancer treatment, based on the author’s lifetime experience in conjunction with exhaustive review of recent literature. In each chapter surgeons and oncologists will find appropriate tools for correct management of the diagnosis and therapy of this difficult disease. The book analyzes all the aspects of staging and treatment, such as modern diagnostic and staging techniques (MRI or PET-CT), endoscopic treatment of early cancer, new minimally invasive and open surgical techniques, and combined treatment. In addition, there are chapters dedicated to the postoperative course of these patients, as well as their quality of life, with indications for the correct follow-up and treatment of relapses."

"Although there has been a slow but steady decrease in incidence, gastric cancer remains the second leading cause of cancer death worldwide. Several aspects of the oncological and surgical management are still controversial and so gastric cancer represents a challenge for the surgeon. This book aims to delineate the state of the art in the surgical and oncological treatment of gastric cancer, describing the new TNM staging system, the extent of visceral resection and lymphadenectomy focusing on the different open and minimally invasive surgical techniques and discussing intraoperative chemohyperthermia and neoadjuvant and adjuvant treatment. Operative endoscopy and endoscopic ultrasonography are also discussed, as these now have an important role in both diagnostic work-up and palliative care of gastric cancer patients. Only a multidisciplinary approach involving the surgeon, gastroenterologist, and oncologist can produce the comprehensive and integrated overview that today constitutes a winning strategy for the optimization of results.What we hope we have achieved is a flexible, up-to-date, exhaustive publication, rich in illustrations and consistent with evidence-based medicine."