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"Latar Belakang. Contoh peran merupakan metode pengajaran dan pembelajaran yang efektif untuk pembentukan karakter profesional. Dosen kedokteran dapat berfungsi sebagai contoh peran positif dan negatif, serta sangat penting pada pembelajaran profesionalisme dokter. Penelitian ini bertujuan untuk eksplorasi contoh peran negatif dan positif dosen kedokteran pada pembelajaran profesionalisme. Metode. Penelitian. Penelitian ini menggunakan disain studi kasus kualitatif. Sampel dipilih dengan purposive sampling pada kelompok mahasiswa dan dosen, alumni, serta pengelola program pendidikan. Pengambilan data primer dilakukan melalui diskusi kelompok terarah, wawancara mendalam, dan observasi. Analisis data dilakukan dengan analisis tematik. Hasil. Penelitian. Diskusi kelompok terarah dilakukan empat kali pada mahasiswa akademik dan profesi. Wawancara mendalam dilakukan pada 14 responden dosen, alumni, dan pengelola program pendidikan , dan observasi dilakukan pada empat dosen akademik dan dua dosen profesi. Peran dosen sebagai contoh peran negatif cenderung lebih sering terjadi pada dosen tahap akademik.Pproses belajar dengan melihat contoh sangat dipengaruhi oleh peran dosen, mahasiswa, dan institusi. Contoh peran positif dapat dipelajari melalui proses self-learning dan coaching-scaffloding. Contoh peran negatif dipelajari melalui proses self-learning serta artikulasi. Atribut utama contoh peran negatif pada tahap akademik adalah tidak disiplin, emosional, dan non-akses, sedangkan untuk tahap profesi adalah emosional, non-akses, dan berorientasi pada uang.Kesimpulan. Dosen kedokteran sebagai contoh peran positif dan negatif selalu ditemukan pada pelaksanaan pendidikan kedokteran. Proses pembelajaran melalui contoh positif dan negatif merupakan dua hal yang berbeda, dan dipengaruhi oleh peran dosen refleksi diri, mawas diri, umpan balik , mahasiswa motivasi internal, kemampuan identifikasi atribut, refleksi diri, feedback-seeking behaviour , dan institusi pengembangan kompentensi dosen, regulasi, reward-punishment.

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Background. Role model medical teacher is the most effective teaching learning method in professionals development. At the same time, physician teacher could became positive and negative role model, and have significant meaning in medical professionalism development. The study aim was to explore positive and negative role model medical teacher in teaching learning professionalism.

Methods. This qualitative research, using a case study design, and sample chosen by purposive sampling to medical students, medical teachers, alumnae, and institution. Primary data collected by focus group discussion, in depth interviews, and nonparticipant observation, until data saturation reached. A thematic analysis was conducted to identify the atribute of positive negative role model medical teacher at pre clinic and clinical phase and the learning process beyond.

Results. Four FGDs, fourteen indepth interviews, and six non participant observations done in this research. Negative role model tend to occure in pre clinical phase. The learning outcome of role modelling can be distinguish, depend on the motivation of observer and the articulating step. Positive role model chosen due to admiration and can be taught through exploration self learning and coaching scaffloding. Learning from negative role model influenced by observer motivation and taught through exploration self learning and articulating. The main attribute of negative role model at pre clinical phase were undisciplined, emotional unstable, and non access, meanwhile at clinical phase, the main attribute were emotional unstable, non access, and money oriented.

Conclusion. Negative positive role model exist in medical education. The learning process through positive and negative role models were two different things, influenced by the teacher abilities to self reflection, introspection, and giving feedback students motivation, attribute role model identification skill, self reflection, and feedback seeking behaviour and institutions obligations to develop faculty development, regulation, and reward punishment among academics society."

"Pendahuluan: Derajat supervisi yang tepat tidak hanya mendorong pencapaian kompetensi peserta didik namun juga menjamin pelayanan kesehatan yang aman dan berkualitas. Namun demikian, hingga saat ini masih ditemukan berbagai kendala dalam penerapannya. Penelitian ini bertujuan memperoleh pemahaman mendalam mengenai kebutuhan, kondisi dan tantangan yang dihadapi terkait pentahapan kompetensi dan supervisi dalam pendidikan profesi dokter spesialis, sebagai masukan dalam pengembangan kurikulum. Metode: Penelitian dijalankan menggunakan desain kualitatif dengan pendekatan fenomenologi untuk mempelajari secara mendalam pentahapan kompetensi dan kewenangan sebagai suatu fenomena berdasarkan pengalaman pihak-pihak yang terlibat secara langsung dalam pendidikan profesi dokter spesialis. Peneliti menggunakan metode pengumpulan data berupa wawancara semi-terstruktur dan focus group discussion untuk mendalami pandangan stakeholder, pengelola, pelaksana pendidikan dan peserta didik mengenai konsep kompetensi, kewenangan dan pentahapan, kebutuhan akan pentahapan kompetensi dan kewenangan, faktor-faktor yang mempengaruhi, pola implementasi, masalah dan tantangan yang dihadapi dalam implementasi, serta bentuk implementasi yang diharapkan. Hasil: Telah dilakukan wawancara dan FGD terhadap 26 narasumber, yang mewakili pihak fakultas, pengelola program studi, staf dan peserta didik dari kelompok keilmuan surgikal, medikal dan penunjang. Pandangan mengenai kompetensi erat kaitannya dengan sistem pentahapan, pemberian kewenangan dan supervisi yang dilakukan. Faktor penentu keberhasilan implementasi meliputi perumusan kompetensi dan unit kewenangan yang jelas, dukungan staf, sistem evaluasi yang valid dan terpercaya, serta sudut pandang yang integratif. Sistem asesmen konvensional masih belum memadai sebagai sumber informasi pengambilan keputusan terkait pentahapan dan supervisi. Beban kerja yang tinggi, khususnya administratif, disadari sebagai tantangan terbesar dalam penerapan supervisi yang efektif pada saat ini. Kemandirian disadari sebagai unsur penting dalam pencapaian kompetensi peserta didik, tingkat kemandirian dalam pendidikan perlu disesuaikan dengan regulasi dan sistem pelayanan kesehatan saat ini. Kesimpulan: Sistem supervisi yang lebih baik dibutuhkan untuk menyeimbangkan antara keselamatan pasien dengan kebutuhan pencapaian kompetensi selaras dengan sistem pendidikan di universitas dan regulasi rumah sakit.

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Introduction: Proper supervision not only promotes the competency development of residents but also the delivery of safe medical care. However, challenges have frequently been identified in its implementation. In this study we attempted to explore the needs, patterns and challenges in the implementation of competency leveling, as inputs for future curriculum development. Methods: This is a qualitative study with phenomenological approach to explore in depth the issue of competency levels and supervision as a phenomenon from the perspectives of the parties directly involved in residency training. Through semi-structured interviews and focus group discussions, we explored the view on the concept of competencies, supervision and leveling; the expressed needs regarding supervision and leveling; factors affecting implementation patters; challenges in its implementation; and the ideal form according to the perspectives of the parties involved. Results: Through interview and FGD with 26 respondents representing the faculty, program directors, staffs and residents from surgical, medical and diagnostic disciplines, we identified that the concept of competencies were closely related to how training programs implement their system of leveling and supervision. Success factors included properly defined competencies and units of supervision, support from staff members, availability of valid and reliable system of assessment, and an integrative view of the system. Conventional assessment methods were inadequate in supporting entrustment decision making. Excessive workload, mainly administrative, were identified as the biggest challenge in implementing effective supervision. Independence was identified as an important part in the development of resident's competence, but the most appropriate system which incorporates demands from regulations and existing healthcare system still needs to be developed. Conclusion: Further curriculum development will need to find the best fit between the current university-based course organization and the unique needs of competency based postgraduate medical education with its characteristics as a workplace-based training."

"Latar Belakang : Pembelajaran keterampilan komunikasi pada tahap akademik seringkali tidak diterapkan di tahap klinik. Penelitian ini bertujuan untuk mengeksplorasi proses komunikasi mahasiswa dalam melakukan anamnesis di Program Studi Kedokteran Fakultas Kedokteran dan Kesehatan Universitas Muhammadiyah Jakarta PSKD FKK UMJ secara mendalam. Metode : Penelitian ini menggunakan metode kualitatif dengan pendekatan fenomenologi. Pengumpulan data dengan melakukan pengamatan terhadap mahasiswa yang sedang melakukan anamnesis dengan pasien di klinik penyakit dalam, dan focus group discussion FGD dengan mahasiswa di stase penyakit dalam. Triangulasi data dilakukan dengan melakukan wawancara mendalam dengan staf pengajar di stase penyakit dalam. Pengamatan dilakukan dengan menggunakan The Calgary Cambridge Observation Guide. Hasil FGD dan wawancara dituliskan dalam bentuk transkrip verbatim lalu dilakukan analisis tematik dan koding. Selanjutnya dilakukan reduksi dan penyajian data. Hasil : Hasil penelitian ini menunjukkan bahwa mahasiswa memiliki kekurangan dalam mengumpulkan informasi, membangun struktur anamnesis, membangun hubungan, dan mengakhiri anamnesis, yang dapat disebabkan oleh beberapa faktor yang berhubungan dengan mahasiswa seperti pelatihan keterampilan komunikasi yang meliputi pelatihan pada tahap klinik dan tahap akademik, faktor pesonal, role model, faktor kepercayaan diri, faktor pengetahuan, faktor psikologis, faktor waktu, dan faktor yang berhubungan dengan pasien. Hal ini juga disebabkan karena belum adanya panduan khusus yang digunakan untuk melakukan keterampilan komunikasi. Kesimpulan : Pembelajaran keterampilan komunikasi di PSKD FKK UMJ sudah diberikan sejak awal pendidikan sampai tahap klinik dan terintegrasi dalam keterampilan anamnesis, namun masih banyak mahasiswa kepaniteraan klinik yang tidak melakukan proses komunikasi dengan baik, yang dipengaruhi oleh faktor mahasiswa dan faktor pasien.

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Background: Learning communication skill in undergraduate medical student are not applied into the clinical phase. This study is aimed to explore of clinical clerkship student rsquo s communication process during the medical interview at Faculty of Medicine Muhammadiyah University of Jakarta.

Method: This study used qualitative research methods with phenomenological approach. Data was collected through observation to student clinical clerkship during the medical interview with patient rsquo s polyclinic in internal medicine and focus group discussion with students in internal medicine. Triangulation data through in depth interview with faculty polyclinic in internal medicine. Observation used The Calgary Cambridge Observation Guide. The result of FGD and interview were transcribed verbatim, analysed thematically and coded, to reduce and present the data.

Result: The results obtained in this study indicate that the student has some weakness in gathering information, providing structure, building relationship, and closing the session which can be caused doctor related factors such as communication skill training in academic phase and clinical phase, personality, role model, self confidence, knowladge factors, psychological factors, time factors, and patient related factors. It can also be caused due to the absence of spescific guidelines that are used to perform communication skills.

Conclusion: Communication skill learning in PSKD FKK UMJ were conducted since in undergraduate and clinical phase by integrated in medical interview skills, but students rsquo performance during clerkship showed that their communication skill still need improvement."

"ABSTRAKAmebiasis merupakan penyakit yang umum yang banyak ditemukan di negara berkembang. Namun hanya sedikit yang bermanifestasi klinis menjadi kolitis amuba. Komplikasi yang paling sering dijumpai adalah abses hati amuba. Abses hati selain disebabkan oleh amuba dapat disebabkan oleh bakteri yang dikenal sebagai abses hati piogenik. Untuk dapat menegakkan penyebab abses hati yang disebabkan oleh amuba maka selain anamnesis dan pemeriksaan fisik, dibutuhkan pemeriksaan penunjang seperti pemeriksaan serologi antigen dan antibodi Entamoeba histolytica. Namun pada praktek klinis, jarang sekali pemeriksaan serologi ini dilakukan. Oleh karena itu penelitian ini mencoba untuk melihat profil pasien dengan dugaan abses hati amuba yang sampelnya dikirimkan ke laboratorium parasitologi FKUI untuk pemeriksaan antibodi E. histolytica serta menilai hubungan antara gejala klinis/tanda tersebut dengan hasil serologi. Sampel diambil dari data pasien RSCM yang sampelnya dikirimkan ke laboratorium parasitologi FKUI dengan dugaan abses hati berupa keluhan utama, pemeriksaan fisik dan hasil laboratorium dan hasil serologinya diambil dari hasil pemeriksaan ELISA antibodi Entamoeba histolytica. Hasil penelitian menunjukkan bahwa sebagian besar pasien yang positif serologi antibodi E. histolytica adalah pasien dari kelompok umur 26-45 tahun dan berjenis kelamin laki-laki. Sedangkan manifestasi klinis yang ditemukan pada pasien tersebut dari yang terbanyak adalah hepatomegali, klinis abses hati, nyeri perut, abdominal discomfort, berat badan turun, diare, muntah, efusi pleura dan mual. Yang memiliki hubungan signifikan dengan hasil serologi positif antibodi E. histolytica hanya hepatomegali. Dari data laboratorium ditemukan sebagian besar pasien memiliki hasil laboratorium normal. Namun ada beberapa pasien yang mengalami penurunan hemoglobin dan hematokrit, leukositosis, peningkatan laju endap darah serta peningkatan fungsi hati SGOT dan SGPT.

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ABSTRACTAmebiasis is a common disease that is found in many developing countries. Yet few have clinically manifested as amoebic colitis. The most common complication is an amoebic liver abscess. A liver abscess other than caused by amoeba can be caused by a bacterium known as a pyogenic liver abscess. To be able to determine the cause of liver abscess caused by amoeba, beside anamnesis and physical examination, laboratory examination such as serological antigen and antibody of Entamoeba histolytica is needed. However, in clinical practice, this serology test is hardly performed. Therefore, this study attempted to look at the profile of the patient with suspected liver abscess whose sample was sent to the parasitology laboratory FMUI for E. histolytica antibody examination and assess the association between the clinical signs with serology results. Samples data were taken from Cipto Mangunkusumo hospital patient whose samples were sent to parasitology laboratory FMUI with suspected liver abscess in the form of main complaint, physical examination and laboratory result. Additionally, serology result was taken from antibody of Entamoeba histolytica ELISA examination. The results showed that most of the positive serologically patients of E. histolytica antibodies were patients at the 26 45 age group and from male group. While the clinical manifestations found in these patients subsequently are hepatomegaly, clinical liver abscess, abdominal discomfort, weight loss, diarrhea, vomiting, pleural effusion and nausea. It is only hepatomegaly that has a significant association with serologic positive results for E. histolytica antibodies. From the laboratory data, most patients have normal laboratory results. However, there were some patients who experienced decreased of hemoglobin and hematocrit, leukocytosis, increased blood sedimentation rate and increased liver function of AST and ALT."

"ABSTRAK Latar belakang :Pendidikan dokter spesialis merupakan pendidikan orang dewasa adult learner untuk mencapai kompetensi klinis yang diharapkan Lingkungan pendidikan merupakan salah satu aktor yang perlu dipertimbangkan dalam pengembangan kurikulum dan proses pendidikan Lingkungan pendidikan dapat diartikan sebagai segala sesuatu yang dirasakan oleh peserta didik yang dapat mempengaruhi proses pendidikan. Perlu lingkungan pendidikan yang mendukung untuk meningkatkan kualitas proses pembelajaran peserta didik. Penelitian ini bertujuan mengetahui persepsi peserta didik, pengelola program dan staf pengajar terhadap lingkungan pendidikan pada Program Pendidikan DokterSpesialis PPDS Paru, FKUI. Metode :Jenis penelitian yang digunakan adalah mixed methods dengan setting sequential explanatory design. Tahap pertama dilakukan penelitian kuantitatif dengan menggunakan kuesioner Postgraduate Hospital Educational Enviroment Measure PHEEM yang diisi oleh peserta PPDS Paru pada bulan Maret-Juni 2014.Hasil PHEEM ini dielaborasi lebih lanjut melalui penelitian kualitatif berupa Focus Group Discussion pada peserta PPDS Paru dan wawancara mendalam dengan pengelola program dan staf pengajar di Departemen Pulmonologi dan Kedokteran Respirasi, FKUI.Hasil :Sebanyak 87 89,7 peserta PPDS Paru periode Maret-Juni 2014 telah mengisi kuesioner PHEEM dan didapatkan sebanyak 74,7 peserta menilai lingkungan pendidikan lebih banyak positif dari pada negative dan memerlukan perbaikan 100,85; rentang nilai 81-120 . Peran otonomi dinilai positif oleh 79,3 peserta 36,93; rentang nilai 29-42 , pengajaran dianggap sudah bergerak kearah yang benar oleh 62,1 peserta 36,56; rentang nilai 31-45 dan 70,1 berpendapat bahwa dukungan social lebih banyak pro dari pada kontra 27,36; rentang nilai 23-33 .Pada penelitian kualitatif diperoleh hasil bahwa peran otonomi yang perlu diperbaiki adalah tersedianya panduan pengajaran dan protokol klinis yang informatif, diperlukan perbaikan system supervise dan pemberian umpan balik pada peran pengajaran, dan perbaikan budaya menyalahkan dan meningkatkan peran penasehat akademik dalam bimbingan dan konseling pada dukungan sosial. Kesimpulan :Lingkungan pendidikan pada PPDS Paru dinilai cukup baik dan kondusif. Perbaikan yang diperlukan untuk menjadikan lingkungan pendidikan lebih optimal adalah pembuatan Buku Rancangan Pengajaran yang informatif, optimalisasi logbook sebagai salah satu instrument evaluasi, peningkatan supervise oleh staf pengajar, keterampilan pemberian umpan balik dan peran pembimbing akademik dalam evaluasi peserta PPDS. Kata kunci :Lingkunganpendidikan, PHEEM, Mixed methods

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ABSTRACT

Background Educational environment is one of the most important factor should be considered in curriculum development. Educational environment is the condition that may affect education process in student. Specialty in medicine is adult learning process to gain define clinical competence. Process ofeducationcan be accelerated with proper educational environment. This study aims to Perception of resident, clinical teacher and study program manager to educational environment in Pulmonology dan Respiratory Medicine Residency Program, Faculty of MedicineUniversitasIndonesia. Methods This study using mixed methods with sequential explanatory design.Preliminary of this study is a quantitative study using Postgraduate Hospital Educational Environment Measure PHEEM questionnaire to Pulmonology residentsonMarch until June 2014. The results of the questionnaire will be elaborated with qualitative study based on Focus Group Discussionamong Pulmonology residents and deep interview to the study program manager and clinical teachers at the Department of Pulmonology and Respiratory Medicine FMUI. Result Eighty seven 89,7 pulmonology residents on March until June 2014 had filled in PHEEM questionnaire resulting in mean of perception of the educational environment total PHEEM mostly 74,7 positive and need to be improved score 100,85 81 120 . Positive perception of the autonomy role is 79,3 score 36,93 29 42 , perception that the teaching role performed in the correct way62,1 score 36,56 31 45 and 70,1 of perception stated pro to social support rather than cons score 27,36 22 33 . The qualitative study resulting an autonomy role which is need to be improved availability of teaching guideline and informative clinical protocols. Based on several aspect of teaching role, we need toimproved the supervision system and feedback giving. The blamming culture, supervision and counseling are the factors that need toimproved on social supporting role. ConclusionEducational environment in Pulmonology and Respiratory Medicine Residency Program is positive and condusive. Theimprovement need of the informative ldquo BukuRancanganPengajaran rdquo and optimalizationof logbook as one of the evaluation instrument.Role of staffs in supervising resident skills, feedback and the role of the academic mentor in evaluating residents still need improvement foroptimalization educational environment that may lead to support the adult learning process in students. "

"Pendahuluan: Virtual Peer Learning (VPL) adalah salah satu bentuk pembelajaran kolaboratif yang dilakukan oleh mahasiswa kedokteran secara daring dalam masa pembatasan sosial akibat pandemi COVID-19. Perspektif mahasiswa terkait peer learning (PL) banyak dipelajari namun belum terdapat penelitian komprehensif dan spesifik terkait VPL, terlebih di Indonesia. Penelitian ini bertujuan untuk mengeksplorasi pengalaman VPL dan faktor-faktor yang mempengaruhi pelaksanaan VPL di Indonesia. Metode: Penelitian ini merupakan penelitian kualitatif dengan pendekatan fenomenologi. Responden adalah mahasiswa kedokteran tahap preklinik maupun tahap klinik yang melakukan VPL selama pandemi COVID-19 yang dipilih menggunakan metode maximum variation sampling. Empat Focus Group Discussion dengan mahasiswa kedokteran dari 16 universitas dilakukan secara daring di bulan Mei 2022 untuk mengeksplorasi persepsi mahasiswa terkait pengalaman dan berbagai faktor yang memengaruhi pelaksanaan VPL. Hasil Penelitian: 31 Mahasiswa kedokteran berpartisipasi sebagai responden. Analisis tematik dari data penelitian memunculkan sembilan tema besar. Terdapat satu tema terkait pemanfaatan VPL, tujuh tema mengenai faktor yang memengaruhi pelaksanaan VPL, serta satu tema terkait ekspektasi mahasiswa terhadap VPL pasca pandemi. Mahasiswa mendeskripsikan kegiatan VPL dari sisi tujuan VPL, bentuk VPL, dan pembagian peran dalam VPL. Faktor yang memengaruhi pelaksanaan VPL terdiri dari faktor efektivitas, manfaat, keunggulan serta kekurangan VPL dibandingkan metode belajar lain, pembentukan kelompok, peran fakultas, dan pengaruh teknologi pada VPL. Terkait ekspektasi VPL pasca pandemi, sebagian mahasiswa tetap menggunakan VPL sebagai kegiatan rutin, sebagian sebagai alternatif PL luring, serta sebagian memilih berpindah ke PL luring. Simpulan: Pemanfaatan VPL selama pandemi dipengaruhi oleh persepsi mahasiswa terhadap berbagai faktor. Variasi dalam pengalaman tersebut akan memengaruhi cara mahasiswa menanggapi kesempatan melakukan VPL pasca pandemi. Pelajaran yang didapat dari VPL selama pandemi dapat menjadi dasar untuk perbaikan dan pengembangan bagi fakultas untuk lebih mendukung kegiatan VPL dan berbagai kegiatan belajar daring lainnya.

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Introduction: Virtual

utillized by medical student amidst COVID-19 Pandemic social restriction. Students’ perspectives of peer learning is widely studied yet none comprehensively and specifically studied VPL, moreover in Indonesia. We aims to answer the lack of publication regarding the medical students’ experience of VPL during COVID-19 pandemic and its contributing factors in Indonesia. Method: This is a qualitative study with phenomenological approach. Respondents are clinical and preclinical medical students who experienced VPL during COVID-19 pandemic selected with maximum variation sampling method. Four focus group discussion conducted to medical students from 16 universities in Indonesia on May 2022 to explore the medical students’ perspectives of VPL during COVID-19 pandemic. Result: A total of 31 medical students participated. Nine themes emerged from the thematic analysis, one regarding utilization of VPL, seven themes regarding factors affecting VPL, and one theme about expectations of VPL after pandemics. Students described their utilisation of VPL in three aspects: the purpose, format, and role division among members. Perceived factors affecting VPL are the perception of VPL effectiveness, the benefits of VPL, advantages and disadvantages of VPL compared to other learning methods, group formation, the impact of technology on VPL, and the roles of faculty in VPL. In terms of their expectation on VPL post pandemics student's perceptions can be categorized into three groups, those who will use VPL regularly, those who will use VPL as an alternative, and those who prefer to do only offline PL post pandemic. Conclusion: The utilization of VPL during pandemics is affected by various perceived factors. Differences in these experiences will affect how medical students view VPL post pandemics. Lessons learned from VPL during pandemic can be utilised as the base of improvement for medical faculty to better support VPL and other online learning modalities."

"Latar Belakang: Secara global, jumlah penduduk usia lanjut terus meningkat yang diiringi dengan jumlah pasien usia lanjut yang menjalani pembedahan juga meningkat. Pasien usia lanjut memerlukan perhatian khusus dalam persiapan, saat pembedahan dan pasca pembedahan karena kemunduran sistem fisiologis dan farmakologi sehingga lebih berisiko mengalami komplikasi. Tujuan: Mendapatkan angka mortalitas, model prediksi, serta performa model prediksi pasien usia lanjut yang menjalani pembedahan elektif di RSCM. Metode: Penelitian menggunakan desain kohort retrospektif dengan metode sampling konsekutif. Data sekunder rekam medis pasien usia lanjut yang menjalani pembedahan elektif di RSCM periode Januari 2015-Desember 2017 dianalisis dengan program statistik SPSS Statistics 20.0 untuk analisis univariat, bivariat, multivariat, Receiving Characteristics Operator (ROC), dan analisis bootstrapping pada uji kalibrasi Hosmer-Lemeshow.Hasil: Terdapat 747 subjek penelitian yang dianalisis untuk mendapatkan angka mortalitas dan prediktor yang bermakna untuk disertakan sebagai komponen sistem skor. Sebanyak 108 (14,5%) pasien meninggal pascabedah. Variabel status fungsional, komorbiditas, kadar albumin serum preoperatif, jenis pembedahan, dan status fisik ASA merupakan variabel yang secara statistik independen berhubungan dengan mortalitas. Sistem skor yang dibuat memiliki nilai AUC = 0,900 (KI 95% 0,873-0,927). Kalibrasi sistem skor baik dengan nilai p>0,05. Hasil ini konsisten setelah dilakukan bootstrapping. Kesimpulan : Angka mortalitas pasien geriatri yang menjalani pembedahan elektif adalah 14,5%. Prediktor dan komponen skor prediksi mortalitas pembedahan elektif pada pasien usia lanjut yaitu status fungsional, komorbiditas, kadar albumin serum preoperatif, jenis pembedahan, dan kategori ASA. Model prediksi memiliki kualitas kalibrasi dan diskriminasi yang baik dan kuat.

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Background: Globally, the number of elderly population continues to grow. It is accompanied by the increasing number of older people undergoing surgery. Elderly patients need certain care in preoperative, intraoperative,and postoperative phase since they are more likely to develop postoperative complication due to physiological and pharmacological deterioration. Aim: To get mortality rate, predictive model, and the performance of predictive model in elderly patients undergoing elective surgery in RSCM. Methods: This study is a retrospective cohort study with consecutive sampling method. Secondary data from patients' medical record who underwent elective surgery from January 2015-December 2017 is analysed using SPSS Statistics 20.0 for univariate, bivariate, multivariate, and Receiving Operator Characteristics (ROC) and SPSS Statistics 20.0 for bootstrapping analysis in Hosmer-Lemeshow calibration test.Results: All 747 subjects are analysed to get mortality rate and predictor variables thatare statiscally significant included as scoring system components. A hundred eight patients (14.5%) died within thirty days after surgery. Functional status, comorbidities, preoperative serum albumin level, type of surgery, and ASA physical status are independently associated with mortality. A scoring system composed of above predictors has an AUC value at 0.900 (95% CI 0.873-0.927). This scoring system shows good calibration with p>0,05 and this result is consistent even after bootstrapping analysis.Conclusion: The mortality rate of elderly patients undergoing elective surgery in RSCM is 14.5%. Scoring system for predicting mortality in elderly patients undergoing elective surgery consist of functional status, comorbidities, preoperative serum albuminlevels, type of surgery and ASA physical status. The predictive model shows good calibration and strong discrimination."

"[ABSTRAKLatar Belakang : Atherosklerosis adalah suatu proses penyakit yang difus, dengan adanya satu pembuluh darah yang rusak akan memprediksikan adanya kelainan pada pembuluh darah lain. Ankle Brachial Indeks (ABI) dan Toe Brakhial Indeks (TBI) adalah test non invasif terbukti sensitive dan spesifik untuk mendeteksi beratnya penyakit arteri perifer.Tujuan : Mengetahui hubungan derajat Penyakit Arteri Perifer (PAP) Asimtomatis dengan beratnya Penyakit Jantung Koroner (PJK) stabilMetode : Dilakukan studi potong lintang pada tujuh puluh tiga pasien PJK stabil yang menjalani angiografi koroner. Derajat stenosis arteri coroner dinilai dengan skor Gensini > 40 (berat) dan < 40 (ringan-sedang). PAP dinilai dengan pemeriksaan ABI dan TBI dengan metode Oscillomtreic. Analisis menggunakan uji Spearman correlation test dan uji Pearson correlation test.Hasil : Proporsi PAP asimtomatis pada PJK stabil 47 pasien (64,4%). Nilai median ABI adalah 1,07 (kisaran 0,57-1,27), nilai rerata TBI adalah 0,57 (SB 0,155) dan nilai rerata skor Gensini adalah 46,60 (SB 33,64). Analisis bivariat ABI dengan skor Gensini menunjukkan tidak terdapat korelasi (r=-0,099, p 0,407) dan analis bivariate TBI dengan skor Gensini juga menunjukkan tidak terdapat korelasi (r= -0,153, p= 0,196)Simpulan : ABI dan TBI dengan metode Oscillometric tidak berkorelasi dengan derajat stenosis arteri koroner berdasarkan skor Gensini. ABI dan TBI tidak memiliki kemampuan yang baik untuk membedakan pasien PJK ringan-sedang dan berat berdasarkan skor Gensini.

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ABSTRACTIntroduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.;Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores., Introduction : Atherosclerosis is a diffuse disease process; in which damaged of a blood vessel will predict abnormalities in other blood vessels. Ankle Brachial Index (ABI) and Toe Brachial Index (TBI) are non-invasive tests, which are proved to be sensitive and specific for detecting and assessing the severity of peripheral arterial disease.Objective : This study was aimed to evaluate of correlation between the degree Peripheral Arterial Disease (PAP) asymptomatic with the severity of stable coronary heart disease (CHD)Method : This cross-sectional study was conducted on seventy-three patients with stable CAD undergoing coronary angiography. The severity of coronary artery stenosis was assessed using a GENSINI scoring system, which scores > 40 were considered severe and scores <40 were considered mild to moderate. Peripheral Arterial Disease was assessed by examination of ABI and TBI with oscillomtric method. Spearman correlation and Pearson correlation tests were used to evaluate the correlation between the studied variables.Results : The proportion of asymptomatic CHD in stable PAP was 47 patients (64.4%). The median value of ankle brachial index was 1.07 (range from 0.57 to 1.27), the mean score of Toe Brachial Index (± 0.155) and the mean score of GENSINI was 46.60 (± 33.64). There was no significant correlation between ankle brachial index and Toe Brachial Index with the GENSINI score with p=0.407 (r = -0.099) and p= 0.196 (r = -0.153), respectively. Conclusion : The study revealed that ABI and TBI with oscillometric method were not correlated with the degree of coronary artery stenosis defined by the GENSINI score. ABI and TBI did not have a good potential to distinguish patients with mild-moderate and severe stable CHD based on the GENSINI scores.]"

"ABSTRAKLatar Belakang: Lesi koroner kompleks berkaitan dengan prognosis buruk SKA. Pentingnya revaskularisasi awal untuk mengurangi angka morbiditas dan mortalitas. PLR berkaitan dengan kompleksitas lesi buruk dan diharapkan menjadi acuan dalam identifikasi dini lesi koroner kompleks.Tujuan: Mengetahui akurasi diagnostik dan nilai titik potong PLR sebagai penapis lesi koroner kompleks baik pada kelompok usia ≤45 tahun dan >45 tahun.Metode: Sebuah studi potong lintang secara retrospektif di ICCU RSUPN-CM. Data diambil dari rekam medis pasien SKA dewasa dan menjalani angiografi koroner dari Januari 2012 ? Juli 2015. Akurasi diagnositik dinilai dengan menghitung sensitivitas dan spesifisitas. Nilai titik potong ditentukan menggunakan kurva ROC.Hasil: Proporsi pasien SKA dengan lesi koroner kompleks 47,2%. Nilai titik potong optimal pada pasien usia ≤45 tahun adalah 111,06 dengan sensivitas 91,3% dan spesifisitas 91,9. Pada kelompok usia >45 tahun nilai titik potong optimal pada angka 104,78 dengan nilai sensivitas 91,7% dan spesifisitas 58,6.Simpulan: Nilai titik potong PLR optimal pada kelompok usia ≤45 adalah 111,06 dan kelompok usia >45 tahun adalah 104,78 dengan akurasi diagnositik masing-masing AUC 93,9% (p <0,001) dan AUC 77,3% (p <0,001).

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ABSTRACT

Background: A Complex coronary lesion is related to poor prognosis in ACS patient. The importance of early revascularization is to decrease mortality and complications. Inflammatory marker such as PLR related to complex coronary lesions and expected to be a tool that can assist physicians and cardiologists to stratify patients who have high probability for having a complex coronary lesion.

Aim: Evaluate the diagnostic accuracy of PLR in identifying a complex coronary lesion in ACS patient. The other aim was to identify the proportion of complex coronary lesion and cut-off point of PLR between ≤45 years old group and >45 years old group subjects.

Method: This is a cross sectional retrospectively study in ACS patients hospitalized in ICCU of RSUPN-CM from January 2012 until July 2015. The inclusion are adult ACS patients and who underwent coronary. The diagnostic accuracy was determined by calculating the sensitivity, specificity, PPV, NPV, Positive LR, and Negative LR. The cut-off point was determined using ROC curve.

Results: The proportion of complex coronary lesion was 47,2%. The optimal cut-off point in ≤45 years old group was 111,06 with sensitivity and specificity respectively 91,3% and 91,9%. The optimal cut-off points in >45 years old groups was 104,78 with sensitivity and specificity respectively 91,7% and 58,6%.

Conclusion: The optimal cut-off point of ≤45 years old groups is 111,06 and for >45 years old group is 104,78. The diagnostic accuracy of PLR in ≤45 years old groups was very good (AUC 93,9%, p value <0,001), while in >45 years old group was moderate (AUC 77,3%, p value <0,001)."