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Abstrak :
Delirium (acute confusional state) merupakan kondisi krisis yang sering ditemui dan berpotensi menimbulkan morbiditas dan mortalitas. Para lanjutusia sangat rentan terhadap delirium. Diagnosis delirium seringkali sulit ditegakkan sehingga banyak kasus delirium menjadi terabaikan. Algoritma Confusion Assessment Method adalah salah satu instrumen yang dapat digunakan untuk meningkatkan identifikasi dan pengenalan delirium pada lanjut usia. Penelitian ini bertujuan untuk meneliti kesahihan dan keadalan instrumen Algoritma Confusion Assessment Method versi Bahasa Indonesia pada pasien usia lanjut yang datang ke IGD. Hasil Penelitian ini menunjukkan bahwa instrumen Algoritma Confusion Assessment Method versi bahasa Indonesia adalah instrumen yang sahih dan andal untuk digunakan sebagai alat penapisan delirium lanjut usia.

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Delirium (acute confusional state) is a state of emergency which is often found and potentially causing morbidity and mortality. Elderly people are especially prone to delirium. Diagnosis of delirium is often difficult to establish, so there are a lot of delirium cases become neglected. The Confusion Assessment Method Algorithms is an instrument that can be used to increase the identification and recognition of delirium for elderly people. This study aims to examine the validity and reliability of the Confusion Assessment Method Algorithms to elderly people at Emergency Unit in the Indonesian version. The results of this study indicate that the Indonesian version of the Confusion Assessment Method algorithms is a valid and reliable instrument, using as a screening tool for delirium in elderly people at Emergency Unit.

Abstrak :
Latar Belakang: Beberapa penelitian telah menunjukkan tingginya angka morbiditas dan mortalitas yang diakibatkan oleh kongesti paru pada pasien hemodialisis. Pemeriksaan yang dilakukan selama ini untuk menentukan pasien telah bebas kongesti paru atau dianggap mencapai berat badan kering adalah dengan menggunakan pemeriksaan fisik. Penilaian kemampuan pemeriksaan fisik untuk deteksi kongesti paru belum jelas. Tujuan: Untuk membandingkan kemampuan pemeriksaan fisik dengan ultrasonografi paru dalam menilai kongesti paru pada pasien hemodialisis. Metode: Penelitian potong lintang terhadap data primer pasien hemodialisis yang menjalani dialisis kronik di RSCM antara Juni sampai Juli 2015. Analisis dilakukan untuk mendapatkan proporsi, sensitifitas, spesifisitas, nilai duga positif, nilai duga negatif disertai dengan rasio kemungkinan positif. Hasil: Jumlah sampel yang diteliti adalah 60 pasien. Pada pemeriksaan interobserver di 20 pasien didapatkan angka korelasi interobserver kappa 0,828. Pada pemeriksaan keseluruhan 63 pasien didapatkan kongesti paru pada 36 pasien (57,1 %), yaitu kategori ringan 24 (38,1 %) dan sedang 12 (19 %). Pada pemeriksaan DVJ dibandingkan dengan USG paru didapatkan angka Sensitivitas = 0,47 (IK95% 0,31-0,63), spesifisitas = 0,73 (IK95% 0,54-0,86), Nilai Duga Positif = 0,51 (IK95% 0,36-0,67), Nilai Duga Negatif = 0,70 (IK95% 0,49 - 0,84), Rasio Kemungkinan Positif = 1,75 (IK95% 0,88 - 3,47), Rasio Kemungkinan Negatif = 0,72 (IK95% 0,47 - 1,12). Sedangkan untuk pemeriksaan auskultasi paru didapatkan sensistivitas = 0,56 (IK95% 0,39 - 0,71), spesifisitas = 0,54 (IK95% 0,35 - 0,71), NDP = 0,61 (IK95% 0,44 - 0,76), NDN = 0,48(IK95% 0,31 - 0,66), RKP = 1,21 (IK95% 0,73 - 2,0) dan RKN = 0,82 (IK95% 0,49 - 1,38). Simpulan: Akurasi pemeriksaan DVJ dan auskultasi paru fisik tidak baik dalam mendiagnosis kongesti paru. Proporsi kongesti paru pada pasien-pasien hemodialisis kronik yang telah mencapai berat badan kering di RSUPN CM adalah 57,1%. ......Background: A few research has shown hemodialysis patient with lung congestion had a high morbidity and mortality. Patient was assumed to be lung congestion free if they had reached their dialysis dry weight. To achieve this usually physical examination were used. The accuracy of physical examination in detecting lung congestion has not been established yet. Objective: To compare the capability of physical examination in compare with lung ultrasound in detection of lung congestion. Methods: A cross sectional data collection was done in hemodialysis patients in RSUPN CM between June to July 2015. Analysis was done to obtain proportion,sensitivity, specificity, positive predictive value, negative predictive value and positive likelihood ration. Results: Sixty patients were obtained as sample. From the inter observer of 20 patients we found the kappa was 0,828. From th all 60 patients, we found 36 patients (57,1 %) had lung congestion. Mild lung congestion were found in 24 (38,1 %) and 12 (19 %) had moderate degree. In the analysis comparing jugular venous pressure to lung ultrasound we found sensitivity = 0,47 (CI95% 0,31 - 0,63), specificity = 0,73(CI95% 0,54 - 0,86), Positive Predictive Value (PPV) = 0,51 (CI95% 0,36 - 0,67), Negative Predictive Value (NPV) = 0,70 (CI95% 0,49 - 0,84), Positive Likelihood Ratio (PLR) = 1,75 (CI95% 0,88 - 3,47), Negative Likelihood Ratio (NLR) = 0,72 (CI95% 0,47 - 1,12). For lung auscultation we found sensitivity = 0,56 (CI95% 0,39 - 0,71), specificity = 0,54 (CI95% 0,35 - 0,71), PPV = 0,61 (CI95% 0,44 - 0,76), NPV = 0,48 (CI95% 0,31 - 0,66), PLR = 1,21 (CI95% 0,73 - 2,0) and NLR = 0,82 (CI95% 0,49- 1,38). Conclusions: Jugular venous distention and lung auscultation examination is not good in detection of lung congestion. The proportion of lung congestion in hemodialysis patients in RSUPN CM is 57,1%.

Abstrak :
Review : Mosby's Guide to Physical Examination is a comprehensive textbook of physical examination, history-taking, and health assessment with a unique emphasis on differential diagnosis and variations across the lifespan. The book conveys a uniquely compassionate, patient-centered approach to physical examination with a strong evidence-based foundation." "This book has Clinical Pearls boxes which give brief clinical insights with expert tips on techniques, findings, and patient teaching; Mnemonic boxes deliver engaging auditory, visual, and other memory cues to help you remember series of assessment or exam steps; Physical Variations boxes detail multicultural considerations for assessing patients from diverse ethnic and cultural groups; Staying Well boxes describe holistic approaches to health promotion and patient teaching; Risk Factors boxes highlight modifiable and nonmodifiable risk factors for a variety of conditions; Differential Diagnosis boxes give comparisons of expected findings for similar conditions and explain how disease presentations vary; Physical Examination boxes provide current data on the most effective techniques for delivering quality patient care; Functional Assessment boxes focus on the patient?s functional abilities and present a holistic approach to patient care; Downloadable text and PDA summaries allow for quick review of the key steps in each system exam; Dynamic learning exercises on the companion website test your knowledge and provide instant feedback on your progress; Updates throughout reflect the latest research findings and evidence-based practice for techniques, normal and abnormal findings, genetics, and assessment; 60 video clips demonstrate exam techniques for each system and are downloadable for use on Video iPod devices; 25 new anatomy and physiology animations provide narrated explanations of processes beneath the skin; New audio chapter summaries, downloadable for use on MP3 players, offer a convenient way to review key content on the go; New 3-column tables featuring Pathophysiology, Subjective Data, and Objective Data provide an illustrated reference that allows for quick and accurate comparisons; and 75 new illustrations and dozens of new photos of normal and abnormal findings help to clarify anatomic concepts and exam techniques