Hasil Pencarian  ::  Simpan CSV :: Kembali

"Penelitian ini bertujuan untuk mengetahui implementasi dan pengembangan clinical pathway pneumonia ringan. Jenis penelitian yang digunakan adalah kuantitatif dan kualitatif dengan metode telaah data, telaah dokumen dan wawancara mendalam. Analisis data kuantitatif menggunakan Tools Pengembangan Pra Clinical Pathway dan Evaluasi Clinical Pathway versi beta 2.3. Hasil penelitian menunjukkan bahwa pada variabel input tidak memiliki kendala, staf sudah siap untuk melakukan implementasi clinical pathway. Tim pengembangan clinical pathway masih terbatas pada satu golongan tenaga medis saja. Masih terdapatnya variasi yang tinggi pada pemakaian obat-obatan. Rata-rata lama hari rawat sudah sesuai yaitu 4,19 hari dengan pasien terbanyak pulang pada hari rawat keempat. Sebanyak 14 pasien dari total 67 pasien dirujuk ke Rumah Sakit lain pada hari rawat pertama. Beberapa hal yang dapat Rumah Sakit lakukan yaitu libatkan lebih banyak staf dari berbagai disiplin ilmu dalam proses pengembangan clinical pathway, lakukan berbagai cara untuk sosialisasi clinical pathway, lakukan evaluasi rutin terkait kepatuhan terhadap clinical pathway dan evaluasi formulir clinical pathway berdasarkan dengan variasi pada penelitian ini.

---

This study aims to determine the implementation and development of clinical pathway of simple pneumonia. The type of research used quantitative and qualitative study withdata analysis, document review and in depth interviews methods. Quantitative data analysis using Pre Clinical Pathway Development Tools and Clinical Pathway Evaluation beta 2.3. The results showed that in the input variables have no constraints, the staff is ready to implement the clinical pathway. Clinical pathway development team is still limited to one class of medical personnel only. There is still a high variation in the use of drugs. The average length of stay was 4,19 days with most patients discharge from the hospital on the fourth day of treatment, 14 patients from 67 patients were referred to another hospital on the first day of treatment. Some things the Hospital can do include involving more staff from various disciplines in the clinical pathway development process, doing various ways to socialize clinical pathways, conducting routine evaluations about clinical pathway compliance and clinical pathway form evaluation based on variations in this study."

"Pendahuluan. Skor CURB-65 merupakan suatu sistem skor untuk menilai derajat penyakit pneumonia, namun beberapa penelitian menilai performanya kurang baik, sehingga diperlukan faktor prognostik lain sebagai penambah variabel. C-Reactive Protein dinilai mempunyai peran sebagai faktor independen dalam memprediksi mortalitas pasien pneumonia. Penelitian ini dilakukan untuk menilai peran C-Reactive Protein pada skor CURB-65 dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas rawat inap. Metode. Penelitian ini merupakan studi prospektif berbasis riset prognostik dengan subjek penelitian yaitu pasien pneumonia komunitas yang dirawat di IGD dan gedung A Rumah Sakit dr. Cipto Mangunkusumo RSCM, Jakarta bulan Oktober-November 2017. Keluaran yang dinilai pada penelitian ini yaitu mortalitas pasien dalam 30 hari. Pada subjek dilakukan penilaian performa skor CURB-65 sebelum dan setelah ditambah dengan nilai C-Reactive Protein. Performa diskriminasi dinilai dengan area under the curve AUC. Hasil. Sebanyak 200 pasien ikut serta dalam penelitian ini dengan angka mortalitas 37. Performa diskriminasi skor CURB-65 menunjukkan nilai AUC 70,1 IK 95 0,62-0,77. Setelah ditambahkan dengan nilai C-Reactive Protein berdasarkan cut off ge;48,5 mg/L, didapatkan peningkatan nilai AUC skor CURB-65 menjadi 88,0 IK 95 0,83-0,92. Simpulan. C-Reactive Protein memiliki peran pada skor CURB 65 sebagai prediktor mortalitas 30 hari pasien pneumonia komunitas rawat inap.

---

Introduction. CURB 65 is a scoring system to evaluate the degree of pneumonia, but some research identified that its performance to predict mortality was below expectations. Therefore, we need other prognostic factor as an added value. C Reactive Protein has a role as an independent factor to predict mortality in community acquired pneumonia. This study aims to evaluate role of C Reactive Protein in CURB 65 score to predict 30 days mortality in hospitalized community acquired pneumonia patient.

Method. A prospective cohort study was conducted to hospitalized community acquired pneumonia patients in Cipto Mangunkusumo Hospital, Jakarta from October to November 2017. Outcome of the study was mortality in 30 days. Performance of CURB 65 score was evaluated before and after addition of C Reactive Protein. Discrimination was evaluated with area under curved AUC.

Results. Total of 200 patients were included in this study with number of mortality was 37. Performance discrimination CURB 65 score was shown by ROC curve, the AUC is 70,1 CI 95 0,62 ndash 0,77. After addition of C Reactive Protein based of cut off ge 48,5 mg L, the AUC score improved to 88,0 CI 95 0,83 ndash 0,92.

Conclusion. C Reactive Protein has a role to CURB 65 score to predict 30 days mortality in hospitalized community acquired pneumonia patient."

"Latar Belakang. Pneumonia berat masih menjadi masalah kesehatan utama di Indonesia dan dunia. Sistem imun diketahui memiliki peranan penting dalam patogenesis pneumonia, namun tidak banyak studi yang menilai hubungan antara kadar CD4 dan CD8 darah dengan mortalitas akibat pneumonia berat pada pasien dengan status HIV negatif.Tujuan. Mengetahui data hubungan dan nilai potong kadar CD4 dan CD8 darah dengan angka mortalitas 30 hari pada pasien pneumonia berat di RSCM. Metode. Penelitian berdesain kohort prospektif yang dilakukan di ruang rawat intensif RSCM periode Juni-Agustus 2020. Keluaran berupa kesintasan 30 hari, nilai titik potong optimal kadar CD4 dan CD8 darah untuk memprediksi mortalitas 30 hari dan risiko kematian. Analisis data menggunakan analisis kesintasan Kaplan-Meier, kurva ROC dan multivariat regresi Cox. Hasil. Dari 126 subjek, terdapat 1 subjek yang loss to follow up. Mortalitas 30 hari didapatkan 26,4%. Nilai titik potong optimal kadar CD4 darah 406 sel/μL (AUC 0,651, p=0,01, sensitivitas 64%, spesifisitas 61%) dan kadar CD8 darah 263 sel/μL (AUC 0,639, p=0,018, sensitivitas 62%, spesifisitas 58%). Kadar CD4 darah < 406 sel/μL memiliki crude HR 2,696 (IK 95% 1,298-5,603) dan kadar CD8 darah < 263 sel/μL memiliki crude HR 2,133 (IK 95% 1,035-4,392) dengan adjusted HR 2,721 (IK 95% 1,343-5,512). Bila sepsis dan tuberkulosis paru ditambahkan dengan kadar CD4 darah dan CD8 darah, didapatkan nilai AUC 0,752 (p=0,000). Kesimpulan. Kadar CD4 dan CD8 darah memiliki akurasi yang lemah dalam memprediksi mortalitas 30 hari pasien pneumonia berat. Kadar CD4 darah < 406 sel/μL dan kadar CD8 darah < 263 sel/μL memiliki risiko mortalitas 30 hari yang lebih tinggi.

---

Background. Severe pneumonia is a major health problem in Indonesia and the world. The immune system is known to play an important role in the pathogenesis of pneumonia, but few studies have assessed the relationship between blood CD4 and CD8 count and mortality from severe pneumonia in patients with negative HIV status.

Objectives. Knowing the correlation data and the cut-off value of blood CD4 and CD8 count with a 30-days mortality rate in severe pneumonia patients at RSCM.

Methods. This study is a prospective cohort study conducted at RSCM intensive care rooms from June to August 2020. The outputs were 30-days survival rate, optimal cut-off value for blood CD4 and CD8 count to predict 30-days mortality and mortality risk. Data analysis used Kaplan-Meier survival, ROC curves and multivariate Cox regression analysis.

Results. Of the 126 subjects, there was 1 subject who lost to follow up. The 30-days mortality rate was 26.4%. The optimal cut-off value for blood CD4 count was 406 cells/μL (AUC 0.651, p=0.01, sensitivity 64%, specificity 61%), blood CD8 count was 263 cells/μL (AUC 0.639, p=0.018, sensitivity 62%, specificity 58%). CD4 blood count < 406 cells/μL had a crude HR of 2.696 (95% CI 1.298-5.603) and blood CD8 count < 263 cells/μL had a crude HR of 2.133 (95% CI 1.035-4.392) with an adjusted HR of 2.721 (CI 95% 1,343-5,512). If sepsis and pulmonary tuberculosis were added to the blood CD4 and CD8 count, the AUC value was 0.752 (p=0.000).

Conclusion. Blood CD4 and CD8 count had poor accuracy in predicting 30-days mortality in patients with severe pneumonia. The group with blood CD4 count < 406 cells/μL and blood CD8 count < 263 cells/μL had a higher risk of 30-days mortality."