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"What is a professional psychologist to do when a client brings up the concept of sin? To some, sin may seem like a stifling religious relic that has no place in contemporary psychology. But viewing sin from within the Christian faith, and in tandem with the doctrine of grace, can help psychologists understand why sin is such an important concept for many of their Christian clients. Psychologists' misunderstanding of sin and grace may contribute to relatively low rates of referral from Christian leaders to clinical psychologists, and may sometimes hinder therapeutic progress. Two methods of data collection, involving a total of 171 respondents, were used to discern what Christian leaders wish psychologists understood regarding the doctrine of sin. Respondents emphasized the nature and consequences of sin, grace, and the importance of psychologists understanding sin and grace. Implications for professional psychologists are offered."

"Latar Belakang: Skor Global Registry of Acute Coronary Events (GRACE) adalahmodel stratifikasi risiko yang secara luas telah digunakan untuk memprediksi luaranpada pasien infark miokard akut (IMA). Pasca IMA dapat terjadi disfungsi miokardbaik sistolik maupun diastolik. Myocardial Performance Index (MPI) merupakanparameter ekokardiografi yang mampu menggambarkan fungsi sistolik dandiastolik ventrikel kiri secara bersamaan dan merupakan prediktor independenkejadian Major Adverse Cardiovascular Event (MACE) pasca IMA.Tujuan: Mengetahui peranan penambahan MPI ke dalam skor GRACE untukmemprediksi MACE selama lima hari perawatan rumah sakit.Metode: Penelitian kohort prospektif pada 75 pasien IMA di ruang perawatanintensif jantung RSCM antara Juli-November 2020. Dilakukan perhitungan totalskor GRACE saat pasien masuk rumah sakit dan pemeriksaan ekokardiografi untukmendapatkan nilai MPI dilaksanakan dalam 72 jam perawatan rumah sakit.Observasi terhadap kejadian MACE selama 5 hari perawatan rumah sakit dilakukanpada seluruh pasien. Peranan penambahan parameter MPI ke dalam skor GRACEdinilai menggunakan perubahan area under curve (AUC) metode DeLong,likelihood ratio test (LRT) dan continous net reclassification improvement (cNRI).Hasil: Kemampuan prediksi skor GRACE baik (AUC 0,753 IK 95% 0,639-0,868).Penambahan MPI ke dalam skor GRACE secara signifikan meningkatkan performamodel kombinasi (AUC 0,801 IK 95% 0,699-0,902 p=0,354, LRT 4,65 p=0,03 dancNRI 0,515 IK 95% 0,008-1,021 p=0,046).Simpulan: Penambahan MPI ke dalam skor GRACE signifikan meningkatkankemampuan skor kombinasi untuk memprediksi MACE selama lima hari perawatanrumah sakit pada pasien IMA.

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Background: The Global Registry of Acute Coronary Events (GRACE) risk score

is widely recommended for risk assessment in patients with acute myocardial

infarction (AMI). Myocardial infarction induces variable degrees of impairment in

left ventricular (LV) systolic and diastolic function. Myocardial Performance Index

(MPI) is an echocardiography parameter that capable of estimating combined

systolic and diastolic LV performance and can independently predict Major

Adverse Cardiovascular Events (MACE) post AMI.

Objective: To investigate whether MPI has incremental predictive value over the

GRACE risk score in predicting MACE during five days of hospitalization after

AMI.

Methods: A prospective cohort study was conducted in 75 patients presented with

AMI in Intensive Cardiac Care Unit Cipto Mangunkusumo Hospital between July

to November 2020. Total GRACE score was calculated on patient admission and

echocardiography was conducted within 72 hours of hospitalization for

measurement of MPI. All patients were observed for the incidence of MACE during

five days of hospitalization. The incremental predictive value of the GRACE risk

score alone and combined with MPI was assessed by the change in area under

curve (AUC) by DeLong’s method, likelihood ratio test (LRT) and continuous net

reclassification improvement (cNRI).

Results: The GRACE risk score demonstrated good discrimination for MACE

(AUC 0.753 95% CI 0.639-0.868). Adding MPI to the GRACE risk score improved

model performance significantly (AUC 0.801 95% CI 0.699-0.902 p=0.354, LRT

4.65 p=0.03 and cNRI 0.515 95% CI 0.008-1.021 p=0.046).

Conclusions: Adding MPI to the GRACE risk score significantly improves risk

prediction of MACE during five days of hospitalization after AMI."

"Latar Belakang. Penyakit kardiovaskular masih merupakan masalah kesehatan utama global. Banyak penelitian menghubungkan kondisi Penyakit Ginjal Kronik (PGK) pada pasien Sindrom Koroner Akut (SKA) dengan luaran klinis yang lebih buruk. Mengetahui peran faktor-faktor yang mempengaruhi Major Adverse Cardiovascular Event (MACE) pada pasien SKA dengan PGK penting dalam upaya pencegahan luaran yang buruk.Tujuan. Mengetahui hubungan skor Global Registry of Acute Coronary Events (GRACE), skor Gensini, Left Ventricular Hypertrophy (LVH), dan Rasio Netrofil Limfosit (RNL) terhadap kejadian MACE 30 hari pasien SKA yang mengalami PGK non-dialisis.Metode. Desain penelitian kohort retrospektif menggunakan data sekunder dari rekam medis117 pasien SKA yang menjalani PCI di Rumah Sakit Umum Pemerintah Cipto Mangunkusumo sejak Januari 2018 hingga Juni 2018. Pasien dibagi berdasarkan derajat PGK serta dinilai MACE 30 hari. Dilakukan pencatatan data skor GRACE, skor Gensini, LVH, dan RNL. Analisis hubungan faktor-faktor tersebut dilakukan menggunakan uji chi square.Hasil. Dari 117 pasien 62,3% ST Elevation Myocardial Infarction (STEMI), pada akhir perawatan 67,5% pasien termasuk dalam kelompok derajat 1-2 PGK, 17,1% dalam kelompok PGK derajat 3a-3b dan 15,4% dalam kelompok PGK derajat 4-5. MACE terjadi pada 47 (40,2%) pasien dengan 17 (14,5%) mengalami kematian.Terdapat hubungan bermakna antara skor GRACE dengan MACE (54,8% MACE pada skor GRACE tinggi vs 32% MACE padaskor GRACE rendah-sedang ( p = 0,016) (OR : 2,57 IK95% : 1,18-5,59), sedangkan pada skor Gensini,LVH dan RNL walaupun terdapat peningkatan proporsi MACE namun tidak didapatkan hubungan yang signifikan.Kesimpulan. Skor GRACE berhubungan dengan MACE 30 hari pasien SKA dengan PGK non dialisis.

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Background. Cardiovascular disease is still a major global health problem. Many studies have linked Chronic Kidney Disease (CKD) in Acute Coronary Syndrome (ACS) patients with worse clinical outcomes. Knowing the role of factors that influence MACE in ACS with CKD patients is important in preventing poor outcomes.

Objective. To determine the relationship between GRACE scores, Gensini scores, LVH, and NLR to the 30-day MACE incidence in ACS patients with CKD.

Method. This study is a retrospective cohort study using secondary data from the medical records of 117 ACS patients who underwent PCI at the Cipto Mangunkusumo Government General Hospital from January 2018 to June 2018. Patients were divided based on the degree of CKD and assessed for 30-day MACE. Data were recorded on GRACE scores, Gensini

scores, LVH, and RNL. Analysis of the relationship between these factors was carried out using the Chi Square test.

Results. Of the 117 patients 62.3% were STEMI, at the end of hospital treatment 67.5% were in the normal-grade 2 CKD group, 17.1% in the CKD grade 3a-3b group and 15.4% in the CKD grade 4-5 group. MACE occurred in 47 (40.2%) patients with 17 (14.5%) dying. There was a significant relationship between GRACE scores and MACE (54.8% MACE at high GRACE scores vs. 32% MACE at low-moderate GRACE scores (p = 0.016) (OR : 2,57

CI95% : 1,18-5,59)), while the Gensini score, LVH and NLR scores even though there was an increase in the proportion of MACE but no significant relationship was found.

Conclusion. The GRACE score correlates with the 30-day MACE of ACS with non- dialysis

CKD patients.

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