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"Obat berpotensi tidak tepat (potentially inappropriate medications / PIMs) umumnya terjadi pada usia lanjut dengan multi morbiditas dan polifarmasi. PIMs menjadi salah faktor penyebab kejadian tidak diinginkan (KTD). Penelitian ini mengembangkan instrumen identifikator PIMs versi Bahasa Indonesia melalui adaptasi dari kriteria STOPP version 2, mengidentifikasi PIMs menggunakan instrumen STOPP versi Bahasa Indonesia, dan menilai hubungan PIMs dengan KTD. Adaptasi instrumen meliputi terjemahan kedepan, terjemahan balik, tinjauan pemegang otoritas, tinjauan tim ahli, dan pra uji. Tahap ini melibatkan penerjemah, pemegang otoritasi STOPP version 2, tim ahli, dan 34 apoteker rumah sakit umum (RSU). Tahap validasi diikuti 230 apoteker RSU di Indonesia dengan desain survei melalui post sampling. Tahap identifikasi PIMs dan menilai hubungan dengan KTD, melibatkan 63 pasien usia ≥ 60 tahun, multi morbiditas, dan menjalani hospitalisasi di RSUPN Cipto Mangunkusumo. Data kategorikal dan dikotom dalam dalam jumlah (%), diskrit dalam mean ± SD. Analisis menggunakan Content validity ratio (CVR), content validity index (CVI), Pearson correlation, explanatory factor analysis (EFA) dan Cronbach alpha untuk validitas dan reliabilitas. Mann Whitney U Test untuk menilai perbedaan rata-rata (means) antara kelompok pasien dengan obat teridentifikasi PIMs dan tanpa PIMs. Analisis chi-square dan Kappa untuk menilai hubungan antara PIMs dengan KTD, pada α = 0,05. Hasil penelitian menunjukkan adaptasi instrumen STOPP version 2 ke Bahasa Indonesia dapat diterima. Setiap kriteria memberikan CVR > 0,75, r Pearson > 0,45 (p < 0,001), dan faktor loading > 0,4. Reliabilitas instrumen sebesar 0,978. Subyek penelitian pada tahap identifikasi PIMs melibatkan pasien usia 70 ± 7,7 tahun, komorbiditas 6,6 ± 2 CCI, terapi obat 9,9 ± 3,1 obat, dan lama hari rawat 16,3 ± 10,3 hari. Ada perbedaan rata-rata bermakna untuk variabel polifarmasi dan lama rawat antara dua kelompok subyek (p <0,001). Hubungan antara PIMs dengan KTD menunjukkan nilai kemaknaan, p < 0,001 dan nilai Kappa sebesar 0,72 (p < 0,001). Obat yang teridentifikasi PIMs dan menyebabkan KTD adalah golongan antihipertensi, obat dengan efek kolinergik, antikoagulan, dan OAINS. Mayoritas KTD yang diderita pasien, seperti hipotensi orthostatik (sesuai kriteria K3), hiponatremi (sesuai krietria A3 dan D4), perdarahan (sesuai kriteria C3 dan C5), dan penurunan LFG (sesuai kriteria E4). Penelitian menghasilkan instrumen STOPP versi Bahasa Indonesia yang valid dan reliabel dan hasil identifikasi PIMs memberikan pengukuran kesepakatan yang baik.

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Potentially inappropriate medications (PIMs) commonly occur in the elderly with multiple morbidity and polypharmacy. PIMs are one of the factors causing adverse events (AEs). This study developed an Indonesian version of the PIMs identifier instrument through adaptation of the STOPP version 2 criteria, identifying PIMs using the Indonesian version of the STOPP instrument, and assessing the relationship between PIMs and AEs. Adaptations of the instrument include forward translation, reverse translation, authority review, expert team review, and pre-test. This stage involved the translator, the holder of STOPP version 2 authorization, a team of experts, and 34 general hospitals (GH) pharmacists. The validation phase was followed by 230 pharmacists at the RSU in Indonesia with a survey design through post sampling. The identification phase of PIMs and assessing the relationship with AEs involved 63 patients aged ≥ 60 years, multimorbidity, and underwent hospitalization at Cipto Mangunkusumo National Hospital. Data were categorical and dichotomous in numbers (%), discrete in mean ± SD. Data were analyzed with content validity ratio (CVR), content validity index (CVI), Pearson correlation, explanatory factor analysis (EFA) and Cronbach alpha for validity and reliability. Mann Whitney U test to assess the mean difference (means) between groups of patients with PIMs and without PIMs. Chi-square and Kappa analysis to assess the association between PIMs and AEs, at α = 0.05. The results showed that the adaptation of the STOPP version 2 instrument to Indonesian was acceptable. Each criterion gives a CVR> 0.75, Pearson's r> 0.45 (p <0.001), and a loading factor> 0.4. The reliability of the instrument was 0.978. Research subjects at the PIMs identification stage involved patients aged 70 ± 7.7 years, comorbidity 6.6 ± 2 CCI points, drug therapy 9.9 ± 3.1 drugs, and length of stay 16.3 ± 10.3 days. There was a significant mean difference for polypharmacy variables and length of stay between the two groups of subjects (p <0.001). The correlation between PIMs and AEs showed a chi-square value of p <0.001 and a Kappa value of 0.72 (p <0.001). Drugs identified as PIMs and causing AEs are antihypertensive, drugs with cholinergic effects, anticoagulants, and NSAIDs. The majority of adverse events suffered by patients, such as orthostatic hypotension (according to K3 criteria), hyponatremia (according to A3 and D4 criteria), bleeding (according to criteria C3 and C5), and decreased eGFR (according to criteria E4). The study produced a valid and reliable Indonesian version of the STOPP instrument and the results of the identification of PIMs provided a good measure of agreement to AEs."

"ABSTRAKGangguan kognitif ringan merupakan gejala awal dari perkembangan penyakit demensia yang dapat dicegah dan diperbaiki. Deteksi MCI menggunakan bantuan informan memiliki kelebihan dibandingkan pemeriksaan langsung ke lansia. Salah satu pemeriksaan berdasarkan informan adalah IQCODE-S. Tujuan dari penelitian ini untuk melakukan adaptasi lintas budaya, uji validitas dan reliabilitas IQCODE-S Bahasa Indonesia.Metode Penelitian. Penelitian dibagi menjadi 2 tahap. Tahap pertama meliputi adaptasi lintas budaya berdasarkan ketentuan World Health Organization WHO , dilanjutkan uji validitas interna, reliabilitas interna dan reliabilitas test-retest pada 30 pasien epilepsi yang memenuhi kriteria inklusi. Tahap kedua adalah uji diagnostik. Hasil IQCODE-S dengan titik potong ge;3,19 dibandingkan dengan pemeriksaan neuropsikologi sebagai baku emas.Hasil. Kuesioner IQCODE-S versi bahasa Indonesia didapatkan melalui proses adaptasi lintas budaya menurut WHO. Hasil uji validitas interna dengan korelasi Spearman didapatkan koefisien korelasi 0,382 hingga 0,778. Uji reliabilitas konsistensi interna dengan Cronbach rsquo;s Alpha 0,854. Perbedaan nilai koefisien korelasi dan Cronbach rsquo;s Alpha antara pemeriksaan pertama dan retest menunjukkan reliabilitas test-retest yang baik. Dari 63 subyek uji diagnostik, proporsi MCI hasil pemeriksaan neuropsikologi sebanyak 87,3 . Dengan titik potong ge;3,19, IQCODE-S memiliki sensitivitas 76,4 dan spesifisitas 87,5 . Kesimpulan. Kuesioner IQCODE-S versi Indonesia terbukti valid dan reliabel sehingga dapat digunakan untuk menapis MCI. Dengan titik potong ge;3,19, IQCODE-S memiliki nilai akurasi yang tinggi tapi belum dapat menjadi alat skrining MCI di komunitas.Kata Kunci. MCI, IQCODE-S versi Indonesia, uji validitas dan reliabilitas, uji diagnostik.

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ABSTRACTMild cognitive impairment MCI is the most early clinical symptom from the progression stage of dementia which this stage can be prevented or fixed. Detection of MCI by using informant based report has many advantages compared with objective screening test. One of informant based tools is Informant Questionnaire on Cognitive Decline in the Elderly short version IQCODE S . The aim of this study is to develop transcultural adaptation, validity and reliability test and diagnostic test with neuropsychological test of the IQCODE S.Method. The study was conducted in two phases. The first phase included transcultural adaptation based on World Health Organization WHO standards, followed by internal validity test, internal reliability test and test retest in 30 elderly patients within their informants who fulfill the inclusion criteria. The second phase was diagnostic test, in which, IQCODE S, with cut off point ge 3,19,will be compared with Neuropsychological test as the gold standard examination for diagnosing MCI.Results. The Indonesian version of IQCODE S was obtained by transcultural adaptation based on WHO standards. Internal validity test with Spearman correlation obtained the correlation coefficient 0.38 to 0.778 Internal consistency reliability test with Cronbach rsquo s Alpha was 0.854. The difference of correlation coefficient and Cronbach rsquo s Alpha between the first and the retest showed good test retest reliability. Out of 63 of subjects of diagnostic test, the proportion of MCI using neuropsychological test was 87.3 . With cut off point 3,19, IQCODE S had sensitivity rate of 76,4 and specificity 87,5 .Conclusion. The Indonesian version of the the IQCODE S was proven to be valid and reliable, also was found to be accurate but there should be cut off point determination as screening test so sensitivity could be higher than specificity. Keywords. MCI, IQCODE S Indonesian version, validity and reliability test, diagnostic test. "

"Di Indonesia, kegiatan telefarmasi atau pelayanan kefarmasian jarak jauh telah berkembang luas dan banyak digunakan masyarakat, termasuk pada pembelian obat dengan resep. Banyak keuntungan yang dapat diperoleh dari pelayanan ini, namun terdapat hambatan dan tantangan karena keterbatasan pengalaman, pengetahuan, dan studi yang serupa, termasuk pada penjaminan mutu. Penelitian ini bertujuan untuk mengeksplorasi bagaimana kegiatan telefarmasi dalam pelayanan resep dilakukan dan mengevaluasi mutu pelayanan berdasarkan kepuasan pasien. Pengembangan kuesioner sebagai instrumen dilakukan berdasarkan dimensi mutu pelayanan kesehatan menurut WHO dan divalidasi dua tahap. Survei online yang dilakukan menghasilkan 106 responden sebagai subjek penelitian. Informasi sosiodemografi, implementasi, dan kepuasan responden terhadap kegiatan telefarmasi diperoleh dari jawaban kuesioner. Kuesioner memenuhi uji validitas dan reliabilitas dengan nilai r masing-masing item pertanyaan kuesioner bervariasi dari 0,378 – 0,857 (r tabel=0,361) dan rentang nilai cronbach’s alpha 0,805 – 0,900 pada setiap bagian kuesioner. Sebagian besar responden (35%) melakukan kegiatan telefarmasi di Jakarta dan komunikasi dengan apoteker/petugas farmasi dilakukan secara tulisan (46,23%) dan lisan (20,76%). Persentase pasien puas pada setiap dimensi dari yang tertinggi hingga terendah berturut-turut adalah aman (96,2%); adil (90,6%); aksesibilitas (80,2%); efektif (76,4%); efisien (71,7%), dan berpusat pada pasien (61,3%). Uji beda rerata untuk melihat faktor yang dapat mempengaruhi kepuasan pasien menunjukkan terdapat perbedaan bermakna pada rata-rata skor kepuasan pasien kelompok jenis kelamin (p=0,017). Dari hasil analisis skor kepuasan, dapat disimpulkan bahwa sebagian besar pasien (83%) puas terhadap kegiatan telefarmasi yang dilakukan dimana dimensi pelayanan yang berpusat pada pasien memiliki persentase pasien puas yang paling rendah sehingga perlu dilakukan peningkatan mutu pelayanan.

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In Indonesia, telepharmacy or remote pharmaceutical care have developed and are widely used by citizen, including prescriptions drug transaction. Many benefits can be obtained from this service, but there are obstacles and challenges due to limited experience, knowledge, and similar studies, including quality assurance. This study aims to explore how telepharmacy activities in prescribing services works and evaluate service quality based on patient's satisfaction. The development of questionnaire as research instrument carried out based on WHO quality of care dimensions and was validated for two stages. The online survey conducted and resulted 106 respondents as research subjects. Respondents' sociodemographic information, implementation, and satisfaction score on telepharmacy were obtained. The questionnaire fulfills validity and reliability test with r value for each question varying from 0.378-0.857 (r table=0.361) and Cronbach's alpha values range at 0.805-0.900 in each part of the questionnaire. Most respondents (35%) using telepharmacy services in Jakarta and the communication with pharmacist have carried out by text (46.23%) and verbal (20.76%). The number of satisfied patients for each dimension from the most satisfied, respectively was safe (96.2%); equitable (90.6%); accessible (80.2%); effective (76.4%); efficient (71.7%), and patient-centered (61.3%). Mean difference test to assess factors affecting patient satisfaction showed that there was a significant difference in average of patient satisfaction scores for gender group (p = 0.017). Based on analysis results, we can conclude that most patient (83%) are satisfied with telepharmacy activities and patient-centered dimension has the lowest satisfied patients, so it necessary to improve services quality."

"PendahuluanUntuk menentukan apakah diperlukan fusi tulang belakang disamping dekompresi untuk kasus stenosis spinal lumbar (SSL) akan bergantung kepada stabilitas segmen tulang belakang yang terkena. Stabilitas tulang belakang didefinisikan sebagai kemampuan tulang belakang untuk mempertahankan kemampuan geraknya dengan serta mencegah terjadinya nyeri, defisit neurologis, dan angulasi yang tidak normal. Namun, sampai saat ini, belum ada konsensus yang jelas tentang definisi ketidakstabilan untuk menentukan apakah diperlukan fusi pada kasus SSL. Dalam penelitian ini, kami mengembangkan sistem penilaian baru, yang disebut dengan Indonesia Score of Spinal Instability (ISSI), untuk membantu menentukan adanya ketidakstabilan pada tulang belakang dan mengevaluasi kebutuhan fusi pada LSS.Metodologi Penelitian ini terdiri dari tiga tahap, tahap pertama adalah tinjauan sistematis untuk menemukan prediktor ketidakstabilan tulang belakang pada SSL, tahap kedua adalah pengembangan sistem penilaian untuk ketidakstabilan tulang belakang - Indonesia Score of Spinal Instability (ISSI) melalui pendapat ahli dan teknik Delphi yang dimodifikasi, dan tahap ketiga adalah studi validitas dan reliabilitas sistem penilaian yang baru dikembangkan. Tinjauan sistematis dilakukan dengan menggunakan pedoman dari Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Pendapat ahli dan teknik Delphi yang dimodifikasi dilakukan oleh ahli bedah tulang belakang berpengalaman di Indonesia yang telah terpilih, tahap ini dilakukan dua kali untuk menilai apakah ada perbedaan antara putaran pertama dan kedua. Tahap kedua akan menghasilkan ISSI yang baru. Pengujian validitas dan reliabilitas dilakukan di rumah sakit institusional kami, yang melibatkan ahli bedah Ortopedi dan Ahli Radiologi yang bersertifikasi dan dibandingkan dengan penilaian radiologis dari White & Panjabi.HasilSebanyak 54 studi dimasukkan dalam tinjauan sistematis, dan prediktor ketidakstabilan pada stenosis tulang belakang dibagi menjadi klinis (adanya nyeri punggung sebagai gejala primer atau sekunder), radiografi polos statis (adanya vacuum phenomenon, kolaps diskus intervertebralis, sklerosis subkondral, dan traction spur), radiografi polos dinamik (translasi dan angulasi dinamik), dan temuan pencitraan resonansi magnetik/ (magnetic resonance imaging, MRI) yang terdiri dari efusi sendi faset, degenerasi otot multifidus, degenerasi endplate, dan degenerasi diskus. Melalui pendapat para ahli dan teknik Delphi yang dimodifikasi, penilaian ISSI dikembangkan dan terdiri dari komponen klinis (nyeri punggung), komponen radiografi dinamik (translasi horizontal dan angulasi), dan komponen MRI (efusi sendi faset), masing- masing komponen tersebut akan diberi nilai, dan total nilai adalah 0 hingga 14. Penilaian akhir akan mengklasifikasikan pasien ke dalam tiga kelompok: kelompok stabil (nilai 0 hingga 4) di mana fusi tidak diperlukan, kelompok berpotensi tidak stabil (nilai 5 hingga 8) di mana keputusan fusi didasarkan pada penilaian klinis dokter bedah, dan kelompok tidak stabil (nilai 9 hingga 14) di mana fusi diperlukan. Tahap akhir penelitian menyimpulkan bahwa ISSI ini memiliki validitas dan reliabilitas yang baik.Diskusi dan KesimpulanISSI yang baru dikembangkan adalah sistem penilaian ketidakstabilan tulang belakang pada kasus SLL degeneratif yang sahih (valid) dan dapat diandalkan (reliabel), yang dapat membantu mengidentifikasi adanya ketidakstabilan pada SSL degenratif. ISSI diharapkan dapat digunakan sebagai pedoman untuk memutuskan apakah fusi tulang belakang diperlukan.

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Introduction

Whether spinal fusion is performed in addition to a decompression for lumbar spinal stenosis (LSS) depends on the stability of the involved spinal segments. Spinal stability is defined as the ability of the spine to maintain its degree of motion while simultaneously preventing pain, neurologic deficits, and abnormal angulation. However, until currently, there is no clear consensus regarding the definition of instability to perform fusion in the cases of LSS. We developed a new scoring system, the Indonesia Score of Spinal Instability (ISSI), to identify spinal instability and to evaluate the need of spinal fusion in LSS.

Materials and Methods

This study consisted of three stages, the first stage was the systematic review to find predictors of spinal instability in LSS, the second stage was the development of scoring system for spinal instability – the Indonesia Score of Spinal Instability (ISSI) through expert opinion and modified Delphi technique, and the third stage was validity and reliability studies of the new developed scoring system. The systematic review was performed through Preferred Reporting Items for Systematic Reviews and Meta- Analyses (PRISMA) guideline. Expert opinion and modified Delphi technique were performed by experience spine surgeons in Indonesia who had been elected, this stage was performed twice to assess whether there was difference between first and second rounds. The second stage would yield the new developing ISSI. Validity and reliability testing were performed in our institutional hospitals, which included the board-certified Orthopaedic surgeon and Radiologist and was compared with the radiological checklist from White & Panjabi.

Results

A total of 54 studies were included in the systematic reviews, and the predictors of instability in spinal stenosis were divided into clinical (presence of back pain as primary or secondary symptoms), static plain radiograph (presence of vacuum phenomenon, intervertebral disk collapse, subchondral sclerosis, and traction spurs), dynamic plain radiograph (horizontal translation and angulation), and magnetic resonance imaging/ MRI findings (facet joint effusion, fatty degeneration of multifidus, endplate degeneration, and disk degeneration). Through expert opinion and modified Delphi technique, ISSI score was developed and consisted of the clinical component (back pain), dynamic radiograph component (horizontal translation and angulation), and MRI component (facet joint effusion), each of the component would be scored, and the total scoring would be from 0 to 14. The final scoring would classify patients into three groups: stable group (score of 0 to 4) in which the fusion is not needed, potentially unstable group (score of 5 to 8) in which the decision of fusion is based on surgeon’s clinical judgment, and unstable group (score of 9 to 14) in which the fusion is needed. Final stage of study concluded that this ISSI had good reliability and validity

Discussion and Conclusion

The new developed ISSI was a valid and reliable scoring system that could help to identify the presence of instability in LSS and the need of fusion. This ISSI can be used as a guideline to decide whether spinal fusion would be needed."

"Peningkatan angka kasus COVID-19 yang tidak terkendali mengakibatkan fasilitas kesehatan di Indonesia kurang mampu untuk menampung seluruh pasien yang terinfeksi COVID-19. Sementara itu, pasien COVID-19 harus mendapatkan pengobatan dan perawatan. Salah satu upaya untuk yang dilakukan adalah isolasi mandiri bagi pasien tanpa gejala dan bergejala ringan. Penelitian ini dilakukan dengan tujuan mengeksplorasi akses pasien COVID-19 untuk memperoleh obat saat isolasi mandiri di rumah serta kendala yang dialami saat isolasi. Instrumen penelitian menggunakan kuesioner yang dikembangkan oleh peneliti berdasarkan studi literatur dan telah divalidasi dua tahap. Kuesioner disebarkan secara online dan mendapatkan 115 responden sebagai subjek penelitian. Butir pertanyaan kuesioner memuat tentang data sosiodemografi, gambaran keadaan subjek saat melakukan isolasi mandiri, dan aspek – aspek akses obat (aksesibilitas, ketersediaan, keterjangkauan). Sebagian besar responden melakukan isolasi mandiri pada periode Januari – Maret (53,2%). Persebaran responden paling banyak melakukan isolasi mandiri di Jakarta (45,22%). Ditinjau dari persentase tertinggi setiap aspek, 71,3% mengatakan sangat mudah dalam aspek aksesibilitas, 48,7% mengatakan ketersediaan obat cukup baik, dan 41,7% mengatakan harga obat cukup terjangkau. Adapun kendala yang terjadi selama isolasi mandiri, seperti kemacetan lalu lintas sehingga membutuhkan waktu lebih untuk ke fasilitas kesehatan, informasi obat tidak valid, serta harga antivirus mahal dengan ketersediaan yang minim. Uji komparatif dilakukan untuk mengetahui faktor yang mempengaruhi akses obat dan terdapat perbedaan bermakna pada variabel periode COVID-19 (p=0,003). Dari hasil analisis skor akses obat, disimpulkan bahwa akses obat saat isolasi mandiri mudah (89,6%) bagi pasien COVID-19 di Jabodetabek.

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The number of COVID-19 cases that increased uncontrollably cause the health facilities in Indonesia being unable to accommodate all patients infected with COVID-19. Meanwhile, patients must receive treatment and care. One of the efforts to do is self- isolation for asymptomatic patients and mild symptoms. This study was conducted with the aim of exploring the accessibility of COVID-19 patients to obtain medication during self-isolation at home and the obstacles experienced during isolation. The research instrument used a questionnaire developed by the researcher based on a literature study and was validated in two stages. The questionnaire was distributed online and got 115 respondents as research subjects. Questionnaire items contain sociodemographic data, a description of the subject's condition when doing self-isolation, and aspects of drug access (accessibility, availability, affordability). Most of the respondents self-isolated in the January – March period (53.2%). The distribution of respondents who mostly self- isolated in Jakarta (45.22%). Judging from the highest percentage of each aspect, 71.3% said it was very easy in terms of accessibility, 48.7% said the drug availability was quite good, and 41.7% said the price of the medicine was quite affordable. The Obstacles that occur during self-isolation, such as traffic jams that require more time to go to health facilities, invalid drug information, and expensive antivirus prices with minimal availability. A comparative test was conducted to determine the factors that influence drug access and there was a significant difference in the COVID-19 period variable (p=0.003). From the results of the analysis of drug access scores, it was concluded that access to drugs during self-isolation is easy (89.6%) for COVID-19 patients in Jabodetabek."