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Abstrak :
Indonesia telah mengadopsi tingkat panduan dosis yang direkomendasikan oleh IAEA BSS 115 untuk beberapa jenis pemeriksaan sejak 2003. Pengukuran dosis masuk permukaan (entrance surface dose /ESD) untuk kepala dan cervical spine dengan menggunakan TLD dilakukan atas 4 pesawat sinar-X pada 3 rumah sakit di Jakarta yang diberi kode 1D, 1F, 1H dan 3H dengan reseptor sistem Kodak CR (computed radiography). Pengukuran ESD juga dilakukan berdasarkan parameter eksposinya menggunakan metode kalkulasi. Juga dilakukan pengukuran ESD pada fantom kepala ANSI dengan tujuan untuk mendapatkan faktor konversi fantom-pasien yang akan berguna dalam pengumpulan data ESD tanpa pasien. Pelaksanaan penelitian dimulai dari penentuan ukuran standar orang dewasa Indonesia, uji fungsi pesawat sinar-X, preparasi TLD, pengambilan data ESD pasien dan diakhiri dengan pembuatan dan verifikasi fantom kepala ANSI. Sebanyak 20 orang pasien dewasa menjalani pemeriksaan kepala dengan 2 atau 3 proyeksi (AP/PA, lateral dan waters), dan 17 pasien dewasa menjalani pemeriksaan cervical spine dengan 2 proyeksi (AP dan lateral). Pengukuran ESD dengan TLD dengan cara menempatkan TLD pada kulit pasien pada pusat lapangan radiasi. Dari pengukuran ESD menggunakan TLD pada pasien didapatkan nilai ESD pada kuartil ke-3 sebesar 1.4 mGy mGy, 1.4 mGy, dan 2.1 mGy untuk pemeriksaan kepala AP/PA, lateral, dan waters, serta 1.3 mGy dan 1.4 mGy untuk pemeriksaan cervical spine AP dan lateral. Sedangkan dari metode kalkulasi didapatkan nilai yang lebih tinggi, yaitu 2.7 mGy, 1.8 mGy dan 5.2 mGy untuk pemeriksaan kepala AP/PA, lateral, dan waters, serta 1.5 mGy for AP and 2.3 mGy untuk pemeriksaan cervical spine AP dan lateral. Rasio antara ESD pasien dengan fantom yang disebut faktor konversi fantom didapatkan sebesar 0.64 dan 0.77 untuk skull AP/PA dan lateral. Dalam penelitian ini, nilai ESD lebih dipengaruhi oleh kebiasaan radiografer dalam penentuan faktor eksposi yang akan digunakan. Meski demikian, nilai ESD yang didapatkan cenderung lebih kecil daripada nilai referensi yang ada. Selain itu penggunaan fantom kepala ANSI akan sangat bermanfaat dalam pengumpulan data ESD mengingat jumlah pemeriksaan kepala cukup jarang. ......Indonesia has adopted radiation dose guidance levels recommended by IAEA BSS 115 for several diagnostic examinations since 2003. Measurements of entrance surface dose (ESD) for head and cervical spine using TLD (thermo luminescence dosimeter) were carried out with 4 X-ray machines at 3 hospitals in Jakarta which were coded by 1D, 1F, 1H and 3H with Kodak CR (computed radiography) receptor system. Based on exposure, ESD for these examinations were also determined. ESD measurements were also conducted on ANSI skull phantom aiming to get conversion factors of phantom to patient that will be useful in collecting ESD data without patients. This study began with determining Indonesian adult standard size, following by X-ray machine performance test, TLDs preparation, patient ESD measurement and ended with making ANSI skull phantom and ESD verification. There 20 adult patients for head examination with 2 or 3 radiography projections (AP/PA, lateral and waters), and 17 adult patients for cervical examination. The ESD was measured by TLD (thermo lunminiscence dosimeter), placed on the patient's skin, at the center of radiation field. From the patient's ESD measurement using TLDs, the 3rd quartile ESD values were 1.4 mGy mGy, 1.4 mGy, and 2.1 mGy for head examination of AP/PA, lateral, and waters, while for AP and lateral cervical spine were 1.3 mGy and 1.4 mGy. Whereas ESD values from the calculation method based on exposure were higher, i.e. AP/PA, lateral and waters head examinations were 2.7 mGy, 1.8 mGy, and 5.2 mGy respectively, and for AP and lateral cervical spine examination were 1.5 mGy for AP and 2.3 mGy. The ratio between patient ESD and phantom ESD, namely conversion factors, were 0.641 and 0.765 for AP/PA and lateral skull examination. In this study, ESD values found were more affected by technical habit of the radiographer in setting the exposure condition. In spite of that fact, it was found that these ESD values were still lower than references. Besides that, the usage of inhouse ANSI skull phantom will be beneficial for collecting ESD data considering the low frequency of head examinations.

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ABSTRAK
Latar BelakangNyeri merupakan penanda penyakit degenerasi tulang belakang, dan menjadi pendorong utama pasien untuk mencari pengobatan.1,2 Kualitas nyeri akan berpengaruh pada aktivitas sehari-hari penderita, tingkat aktivitas pasien yang terkait nyeri ini tergambar pada ODI.3,4 Oleh karena itu ODI digunakan sebagai salah satu indikator keberhasilan operasi.4 Penelitian ini bertujuan menilai hubungan antara derajat nyeri sebelum operasi dengan perubahan skor ODI.MetodePenelitian retrospektif dilakukan terhadap pasien DSD yang telah menjalani operasi di Departemen Bedah Saraf Rumah Sakit Cipto Mangunkusumo tahun 2014-2016. Data demografi, VAS pre operasi, dan ODI 3 bulan pasca operasi dicatat berdasarkan data yang diperoleh dari rekam medik pasien RSCM dan data registrasi pasien di divisi spine departemen bedah saraf. VAS dikelompokan menjadi le; 4 dan >4, sedangkan ODI 3 bulan dinilai peningkatan atau penurunan skor.Perubahan ODI dianggap bermakna bila perubahannya lebih dari 10 4.HasilJumlah kasus 50 pasien; rerata umur 52,8 SD tahun; jumlah lelaki dan perempuan sama; Segmen cervikal 19 , torakal 4 , lumbar 58 , VAS pre operasi le; 4 44 , VAS pre operasi > 4 56 , LOS < 8 78 , LOS ge; 8 22 , pekerjaan: non load bearing 80 dan load bearing 20 . Rerata skor ODI pra-operasi adalah 51 , sedangkan rata-rata ODI skor 3 bulan pasca operasi adalah 27 . Pasien VAS pra operasi le; 4 yang mengalami penurunan skor ODI setelah 3 bulan adalah 100 ; VAS pre operasi > 4 yang mengalami penurunan skor ODI setelah 3 bulan adalah 82 dan yang mengalami peningkatan 18 ; dengan rata-rata LOS adalah 7,04 hari.KesimpulanKualitas nyeri pra operasi tidak berhubungan dengan hasil operasi yang diukur dengan ODI.

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ABSTRACT
Background Pain is one of signs for degenerative spinal disease and became a main reason for patients looking for treatment.1,2 Quality of pain will affect daily activities as reflected in ODI functional score.3,4 Therefore ODI used as one of indicator for outcome patient after surgery.4 This study aims to assess the relationship between the degree of pain before surgery with changes the ODI score. MethodsThis study is a retrospective study of DSD patients who underwent surgery in Department of Neurosurgery Hospital Cipto Mangunkusumo in 2014 2016. The demographic data, preoperative VAS and ODI 3 months postoperatively were determined based on data obtained from patient medical records and registration data in spine division department of neurosurgery. VAS was grouped into le 4 and 4, while the 3 month ODI was rated increase and decrease. ODI score changes are defined to be significant if there were changes more than 10 percents4.ResultThe number of cases are 50 patients mean age of 52.8 years old the number of men and women are equal Segment cervical 19 , thoracic 4 , lumbar 58 , VAS preoperative le 4 44 , VAS preoperative 4 56 , LOS 4 ODI changes was 82 decreased and 18 was increased with an average LOS was 7.04 days.ConclusionQuality of pain pre operatively have no corelation with surgical outcome as reflected by ODI.

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Latar Belakang. Nyeri punggung bawah ( NPB ) merupakan keluhan yang sering dijumpai pada pekerja dan dapat mengurangi produktivitas pekerja. Sektor Usaha Mikro, Kecil dan Menengah ( UMKM ) merupakan sektor yang menyerap banyak tenaga kerja namun perhatian pemerintah pada kesehatan pekerja pada sektor ini dirasakan masih kurang. Salah satu faktor yang mempengaruhi kejadian nyeri punggung bawah adalah posisi duduk pada stasiun kerja selama bekerja. Tujuan. Selain untuk mengetahui perbedaan proporsi nyeri punggung bawah antara pekerja yang duduk di bangku dengan yang di lantai, penelitian ini juga mengidentifikasi hubungan posisi punggung , masa kerja dan faktor- faktor lain dengan kejadian nyeri punggung bawah. Metode. Penelitian ini menggunakan desain potong lintang. Pengumpulan data meliputi wawancara, kuesioner, pemeriksaan fisik umum dan spesifik serta pengamatan posisi kerja. Hasil. Secara keseluruhan dari 40 responden didapatkan proporsi nyeri punggung bawah 67,5%. Proporsi nyeri punggung bawah pada responden yang duduk di bangku sebesar 55% sedangkan yang duduk di lantai 80% namun tidak didapatkan perbedaan bermakna di antara kedua kelompok tersebut. Posisi duduk dan faktor risiko lainnya seperti umur, jenis kelamin, status perkawinan, tingkat pendidikan, masa kerja, stasiun kerja dan Indeks Massa Tubuh tidak mempuyai hubungan bermakna dengan kejadian nyeri punggung bawah. Pada analisis multivariat posisi punggung fleksi > 20º memiliki hubungan bermakna dengan kejadian nyeri punggung bawah ( ORadj 19,05 ). Tidak terdapat perbedaan bermakna antara nilai Visual Analog Scale ( VAS ) pagi, siang dan sore pada pekerja yang duduk di bangku dan di lantai, namun ada perbedaan bermakna antara nilai VAS pagi, siang dan sore tiap kelompok. Kesimpulan. Tidak terdapat perbedaan bermakna proporsi nyeri punggung bawah antara pekerja yang duduk di bangku dan di lantai. Posisi punggung fleksi > 20º memiliki hubungan bermakna dengan nyeri punggung bawah.

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Background. Low Back Pain ( LBP ) is a common complaint in workers and can reduce worker productivity. The Small and Medium Scale Enterprise is a sector that employ many workers but the government's attention to the health of worker in this sector is still low. One of the factors that influence the occurance of low back pain is sitting position in work station during work. Purpose. In addition to know the differences in the proportion of low back pain among workers who sit on the bench with on the floor, the study also identified the relationship of the back position, length of employment and other factors with the occurance of low back pain. Methods. The study used a cross sectional design. Data collection includes interviews, questionnaires, general and specific physical measurement and observation of the job positions. Result. Overall from 40 respondents, the proportion of low back pain was 67,5%. Proportion of low back pain among respondents who sat on the bench was 55% while sitting on the floor was 80% but there was no significant difference between them. Sitting position and other risk factors such as age, sex, marital status, level of education, length of work, work station and body mass index had no significant association with the occurance of low back pain. In multivariate analysis, spine flexion > 20º had a significant association with the occurance of low back pain ( ORadj 19,05 ). There was no significant difference between the value of morning, noon and afternoon Visual Analog Scale ( VAS ) on worker who sat on the bench and on the floor but significant difference among morning, noon and afternoon VAS value in each group were found. Conclusion. There was no significant difference in proportion of low back pain among respondents sat on the bench and on the floor. Spine flexion > 20º had a significant association with low back pain.

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Latar belakang dan tujuan: Spondilitis mencakup 2 ndash;7 dari seluruh kasus infeksi musculoskeletal, biasanya merupakan proses sekunder dari fokus infeksi primer. Infeksi diskus intervertebralis dan perluasannya paling baik dievaluasi menggunakan modalitas MRI vertebra. Penggunaan Gd-DTPA berguna untuk menilai sejauh mana perluasan massa jaringan lunak, pemeriksaan ini memiliki nilai sensitivitas, spesifisitas, serta akurasi yang tinggi dalam menegakan diagnosis spondilitis. Namun saat ini ketersediaan kontras di beberapa daerah di Indonesia masih belum merata, dan harganya yang cukup mahal juga menjadi kendala. Penelitian ini bertujuan membandingkan kesesuaian diagnosis spondilitis pada MRI vertebra tanpa kontras dengan MRI dengan kontras. Metode: Uji kesesuaian menggunakan desain potong lintang dengan data sekunder untuk mengetahui kesesuaian diagnostik MRI vertebra tanpa kontras dan MRI dengan kontras dalam mendiagnosis spondilitis. Pemeriksaan dilakukan berdasarkan data pemeriksaan MRI vertebra dengan suspek spondilitis dalam kurun waktu Agustus 2012 sampai September 2016. Hasil: Hasil uji McNemar didapatkan hasil p = 0,368, kappa R = 0,88 p

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ABSTRACT
Background and objective Spondylitis accounts for 2 7 of all cases in musculoskeletal infections, usually as a secondary process originated from primary infection. Intervertebral disc infection and its extent best evaluated using spine MRI. The use of Gd DTPA contrast is useful for assessing the extent of soft tissue mass expansion, this examination has high sensitivity, specificity, and accuracy in diagnosing spondylitis. However, the availability of contrast in some areas in Indonesia is still uneven, the expensive price is also another obstacle. This study aims to compare the suitability of diagnosis of spondylitis in spine MRI without contrast and MRI with contrast. Methods Cross sectional study with secondary data to determine compatibility of spine MRI without contrast and MRI with contrast in diagnosing spondylitis. The examination was performed based on spine MRI examination data in suspected spondylitis patients in the period between August 2012 to September 2016. Result McNemar test results in p 0,368, kappa R 0,88 p

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This unique, findings-oriented guide to computed tomography is organized to reflect the way radiologists really work: progressing from general impressions to definitive diagnoses. In nearly 1000 high-quality scabs, the radiologist will find CT findings depicting frequently encountered congenital and acquired diseases and disorders. Included in the wide-ranging survey of CT findings are traumatic injuries; congenital anomalies; and infectious, inflammatory, neoplastic, and degenerative disease processes. For convenience, these are grouped anatomically by brain, head and neck, spine, musculoskeletal system, chest, abdomen, and pelvis. In addition, the book's extensive index systematically cross-references diseases and CT findings, providing even greater accessibility to key information"--Provided by publisher.

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Karya Ilmiah ini merupakan hasil analisis pengalaman praktik residensi spesialis keperawatan medikal bedah kekhususan peminatan neurologi. Laporan ini bertujuan untuk memberikan gambaran pengalaman praktik residensi spesialis keperawatan medikal bedah dalam mengolola berbagai kasus dengan gangguan neurologis. Karya ilmiah ini terdiri asuhan keperawatan pada kasus kelolaan utama pada klien dengan tuberculosis of spine dengan menggunakan pendekatan model adaptasi Roy, penerapan Evidence Based Nursing (EBN) dengan intervensi mengunyah permen karet untuk pemulihan gastrointestinal pasca operasi tulang belakang, proyek inovasi nurse-led early mobilization, dan analisis pada 30 kasus resume pada klien dengan gangguan neurologis. Hasil analisis diagnosa pada 30 kasus resume ditemukam tiga diagnose keperawatan yang paling sering pada klien dengan gangguan neurologis yaitu penurunan kapasitas adaptif intrakranial, hambatan mobilitas fisik dan nyeri. Intervensi keperawatan yang paling sering dilakukan dalam menjalankan asuhan keperawatan diantaranya promosi perfusi serebral, pemantauan tekanan intrakranial, dan terapi fisik: kontrol otot. ......This scientific work is the result of an analysis of the practical experience of a medical surgical nursing specialist residency with a specialization in neurology. This report aims to provide an overview of medical surgical nursing specialist residency experience in managing various cases with neurological disorders. This scientific work consists of nursing care in primary managed cases for clients with tuberculosis of the spine using the Roy Adaptation Model approach, application of Evidence Based Nursing (EBN) with chewing gum interventions for gastrointestinal recovery post operative spine surgery, nurse-led early mobilization innovation projects, and analysis on 30 case resumes on clients with neurological disorders. The results of the analysis of diagnoses in 30 resume cases found the three most common nursing diagnoses in clients with neurological disorders, namely decreased intracranial adaptive capacity, impaired physical mobility, and pain. The most frequently performed nursing interventions in carrying out nursing care include promoting cerebral perfusion, monitoring intracranial pressure, and physical therapy: muscle control.

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Analisis praktik residensi keperawatan medikal bedah ini merupakan karya ilmiah akhir Pendidikan Ners Spesialis yang bertujuan memberikan gambaran proses praktik residensi melalui pengelolaan kasus utama, kasus resume, penerapan evidence based nursing (EBN) dan proyek inovasi. Kasus utama yang dilaporkan adalah asuhan keperawatan pasien dengan tumor spinal menggunakan Model Adaptasi Roy (MAR) dengan diagnosis utama pada pre-operatif adalah nyeri kronik berhubungan dengan kompresi dan sensitisasi persepsi nyeri dan masalah keperawatan utama post-operasi adalah nyeri, gangguan mobilisasi fisik dan inkontinensia urine refleks. Sebanyak 30 kasus resume didapatkan rerata usia pasien adalah 52,40 (SD 14.51), mayoritas perempuan (53,3%), dan terbanyak dengan pendidikan menengah (56,7%). Masalah keperawatan terbanyak pada kasus resume adalah risiko perfusi serebral tidak efektif, gangguan mobilitas fisik, dan nyeri akut. Penerapan EBN yang dipilih adalah Implementasi Reduksi Mechanical Bowel Preparation pada Pasien yang Menjalani Pembedahan Elektif Tulang Belakang dan terbukti bahwa tidak memberikan dampak penurunan luaran klinis pasien sehingga dapat dilanjutkan untuk diterapkan. Proyek inovasi yang diimplementasikan secara berkelompok oleh mahasiswa residen adalah Penerapan Nurse-Led Early Mobilization pada Pasien Pasca Pembedahan elektif Tulang Belakang yang berdasarkan analisis situasi dapat dikembangkan dan diterapkan sebagai intervensi mandiri perawat. ......This analysis of medical surgical nursing residency practice is the final scientific paper of specialist nurse education program which aims to provide an overview of the residency practice process through management of main cases, case resumes, implementation of evidence based nursing (EBN) and innovation projects. The main case reported was nursing care of patients with spinal tumors using the Roy Adaptation Model (MAR) with the main pre-operative diagnosis is chronic pain associated with compression and sensitization of pain perception and the main post-operative nursing problems are pain, impaired physical mobilization and incontinence reflex urine. In a total of 30 cases of resumes, the average age of the patients was 52.40 (SD 14.51), the majority were women (53.3%), and most of them had secondary education (56.7%). The most common nursing problems in cases of resumes are the risk of ineffective cerebral perfusion, impaired physical mobility, and acute pain. The chosen application of EBN is the Implementation of Mechanical Bowel Preparation Reduction in Patients Undergoing Elective Spine Surgery and it is proven that it has no benefit for the patient's clinical outcome so that it can be continued to be implemented. An innovation project implemented in groups by resident students is the Application of Nurse-Led Early Mobilization in Post-Elective Spine Surgery Patients which based on situational analysis can be developed and implemented as an independent nurse intervention.

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Dendrites are complex neuronal structures that receive and integrate synaptic input from other nerve cells. They therefore play a critical role in brain function. Although dendrites were discovered over a century ago, due to the development of powerful new techniques there has been a dramatic resurgence of interest in the properties and function of these beautiful structures. This is the first book to be devoted exclusively to dendrites. It contains a comprehensive survey of the current state of dendritic research across a wide range of topics, from dendritic morphology, evolution, development, and plasticity through to the electrical, biochemical, and computational properties of dendrites, and finally to the key role of dendrites in brain disease. The third edition has been thoroughly revised, with each chapter updated or completely rewritten by leading experts, plus the addition of a number of new chapters. Dendrites should be of interest to researchers and students in neuroscience and related fields, as well as to anyone interested in how the brain works.