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"Latar Belakang: Identifikasi risiko mortalitas pascabedah diketahui hanya pada 66 pembedahan dan 34 sisanya tidak teridentifikasi. Modalitas P-POSSUM dianggap lebih superior dibandingkan dengan modalitas ASA dalam memprediksi morbiditas dan mortalitas karena memperhitungkan beban pembedahan.Metode: Uji kesahihan ini dilakukan di RSUPN dr. Cipto Mangunkusumo. Dilakukan penelusuran data fisiologis dan operatif dari enam puluh delapan pasien bedah risiko tinggi elektif kemudian dilakukan perhitungan prediksi risiko dengan koefisien perhitungan skor P-POSSUM dalam situs internet http://www.riskprediction.org.uk dan dibandingkan dengan luaran mortalitas aktual. Kesahihan dinilai dengan penilaian kemampuan kalibrasi dan diskriminasi. Dilakukan analisis untuk mengetahui hubungan parameter-parameter P-POSSUM dengan mortalitas. Hipotesis penelitian ini adalah P-POSSUM sahih dalam memprediksi mortalitas 30 hari pasien bedah risiko tinggi dengan kemampuan prediksi lebih dari 80 .Hasil: Kemampuan diskriminasi didapatkan dengan menghitung luas AUC yaitu sebesar 89.2 IK 95 0,756 ndash;1,000; p=0,000 . Kemampuan kalibrasi dinilai baik dari analisis Hosmer-Lemeshow p=0,23 . Pada analisis bivariat hanya hemoglobin p=0,003 , tekanan darah sistolik p=0,031 dan leukosit p=0,007 yang berhubungan dengan mortalitas. Pada analisis regresi logistik didapatkan hanya tekanan darah sistolik p=0,043 dan leukosit p=0,010 yang berhubungan dengan mortalitas.Simpulan: P-POSSUM sahih dalam memprediksi mortalitas 30 hari pasien bedah risiko tinggi dengan kemampuan prediksi lebih dari 80 . Berdasarkan analisis bivariat didapatkan hemoglobin, tekanan darah sistolik dan leukosit yang berhubungan dengan mortalitas. Setelah analisis regresi logistik didapatkan hanya tekanan darah sistolik dan leukosit yang berhubungan dengan mortalitas. Kata Kunci: kesahihan, P-POSSUM, mortalitas, risiko tinggi

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BACKGROUND Postsurgery mortality risk identified only in 66 surgery and 34 remain unknown. P POSSUM considered more superior than ASA stratification in predicting morbidity and mortality since it calculates surgical risk.METHODS This research was performed in RSUPN dr. Cipto Mangunkusumo. Physiological and surgical parameter of sixty eight high risk patients were taken from medical record and then risk prediction was calculated by calculation coefficient of P POSSUM scoring from http www.riskprediction.org.uk. The comparison between predicted and actual mortality was performed. Validation is assessed by calibration and discrimination ability. The researchers also analyzed the correlation between P POSSUM parameters and mortality. We hypothesized that P POSSUM valid in predicting 30 days mortality high risk surgical patients with predicting ability more than 80.RESULTS Pada analisis regresi logistik didapatkan hanya tekanan darah sistolik p 0,043 dan leukosit p 0,010 yang berhubungan dengan mortalitas. Discrimination ability was assessed by calculating AUC area which is 89.2 CI 95 0,756 ndash 1,000 p 0,000 . Calibration ability is good based on Hosmer Lemeshow analysis p 0,23 . From bivariat analysis only hemoglobin p 0,003 , sistolic blood pressure p 0,031 and leukocyte p 0,007 have relationship with mortality. From multivariate logistic regression anylisis only sistolic blood pressure p 0,043 and leukocyte p 0,010 have relationship with mortality.CONCLUSION P POSSUM is valid in predicting 30 days mortality high risk surgical patients with predicting ability more than 80 . From bivariat analysis only hemoglobin, sistolic blood pressure and leukocyte have relationship with mortality. From multivariate logistic regression anylisis only sistolic blood pressure and leukocyte have relationship with mortality. Keywords validation, P POSSUM, mortality, high risk "

"ABSTRAKLatar belakang: Stratifikasi risiko terhadap pembedahan sangat membantu dalam pengambilan keputusan klinis perioperatif, edukasi, evaluasi, dan audit klinis. Kraniotomi pada tumor otak sebagai tindakan pembedahan berisiko tinggi belum memiliki stratifikasi risiko yang akurat di RSUPNCM karena masih menggunakan ASA yang bersifat subjektif dan kurang informatif. P-POSSUM terbukti tepat dalam prediksi mortalitas pascabedah kraniotomi di India dan Inggris, namun belum diketahui ketepatannya di Indonesia, khususnya di RSUPNCM. Tujuan: Penelitian ini bertujuan untuk mengetahui ketepatan P-POSSUM dalam prediksi mortalitas pascabedah kraniotomi pada tumor otak di RSUPNCM. Metode: Disain penelitian adalah deskriptif analitik retrospektif terhadap seluruh pasien dewasa dengan tumor otak yang menjalani kraniotomi di RSUPNCM selama periode Januari 2015 - Desember 2016. Hasil: Sebanyak 196 subjek dilibatkan dalam analisis risiko mortalitas. Didapatkan rasio O:E 1,68 secara keseluruhan dengan rasio O:E 1,91 pada jangkauan risiko 0-5 dan 1,69 pada jangkauan risiko 11-20 . Hasil uji Hosmer-Lemeshow menunjukkan perbedaan yang signifikan antara angka mortalitas prediksi dan aktual p=0,006 . Simpulan: P-POSSUM tidak tepat dalam prediksi mortalitas pascabedah kraniotomi di RSUPNCM. Diperlukan kajian dan penyesuaian lebih lanjut sebelum P-POSSUM dapat digunakan pada populasi bedah saraf di RSUPNCM.

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ABSTRACTBackground Risk stratification in surgery helps in perioperative clinical decision making, education, evaluation, and clinical audit. Craniotomy on brain tumor as a high risk surgery does not have an accurate risk stratification in RSUPNCM because they still use ASA, which is subjective and not informative. P POSSUM had been proven to be accurate in predicting postoperative mortality after craniotomy in India and England, but it has not been studied in Indonesia, especially in RSUPNCM. Aim This study was done to gain knowledge about the accuracy of P POSSUM for predicting mortality after craniotomy in brain tumor in RSUPNCM. Methods This was a retrospective descriptive analytic study on adults with brain tumor scheduled to have elective craniotomy in RSUPNCM between January 2015 ndash December 2016. Result 196 subjects were analyzed in this study. Overall O E ratio was 1.68 with O E ratio of 1.91 in the risk range of 0 5 and 1.69 in the risk range of 11 20 . Hosmer Lemeshow test showed significant difference between predicted and actual mortality rate p 0.006 . Conclusion P POSSUM was not accurate for predicting mortality after craniotomy in RSUPNCM. Further studies and adjustments are needed before P POSSUM can be used in neurosurgery population in RSUPNCM."

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Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) merupakan sistem skoring yang memprediksi morbiditas dan mortalitas berdasarkan 12 parameter fisiologis dan 6 parameter pembedahan. American Society of Anesthesiologist’s Physical Status (ASA-PS), yang terdiri dari 6 tingkatan, adalah skoring prediksi risiko pembedahan yang pertama kali dikembangkan dan paling sering digunakan saat ini. Penelitian ini bertujuan untuk menilai apakah kemampuan prediksi in-hospital mortality skoring P-POSSUM lebih baik dibanding skoring ASA-PS. Penelitian kohort retrospektif di RSCM selama bulan Mei-Juli 2018. Sebanyak 230 rekam medis diambil sesuai pasien yang menjalani laparotomi emergensi pada periode 1 Januari 2016-31 Desember 2017. Penilaian status ASA dicatat sesuai rekam medis dan dilakukan penilaian P-POSSUM. Analisis data dilakukan dengan komparatif Area Under the Curve (AUC), Hosmer Lemeshow goodness of fit dan multivariat regresi logistik. Angka in-hospital mortality pasien pascalaparotomi emergensi periode Januari 2016-Desember 2017 adalah sebesar 21,3%. Nilai kalibrasi ASA-PS lebih baik dibanding dengan P-POSSUM (p 0,072 vs 0,043). Nilai diskriminasi P-POSSUM lebih baik dibanding dengan ASA-PS (AUC 87,9% vs 76,2%). Komponen P-POSSUM yang paling berhubungan dengan in-hospital mortality adalah usia, riwayat gangguan napas, GCS, hemoglobin, natrium, kontaminasi intraperitoneal dan EKG. Skor P-POSSUM lebih baik dibanding ASA-PS dalam memprediksi in-hospital mortality pasien pascalaparotomi emergensi.

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Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM) is a scoring system which predicts morbidity and mortality based on 12 physiologic and 6 operative parameters. American Society of Anesthesiologist’s Physical Status (ASA-PS), consists of 6 categories, is the first scoring system predicting risk preoperatively and mostly use to this date. Our goals are to evaluate and compare the ability of these two scores in predicting mortality. This is a retrospective cohort taken place in RSCM within May to July 2018. There was 230 medical records taken as samples based on patient who underwent emergency laparotomy within period 1 January 2016 to 31 December 2017. ASA physical status was recorded and P-POSSUM score was assessed. Data were analyzed to compare Area Under the Curve (AUC), Hosmer Lemeshow goodness of fit and multivariate of logistic regression. In-hospital mortality of patient undergoing emergency laparotomy within period January 2016 to December 2017 is 21.3%.  Calibration performance of ASA-PS is better than P-POSSUM (p 0,072 vs 0,043). Discrimination performance of P-POSSUM is better than ASA-PS (AUC 87,9% vs 76,2%). Parameters of P-POSSUM, which most related with in-hospital mortality, are age, respiratory disorder, GCS, hemoglobin, sodium, intraperitoneal contamination and ECG. P-POSSUM is better than ASA-PS in predicting in-hospital mortality of patient undergoing emergency laparotomy.

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"Latar Belakang: Secara global diperkirakan terdapat 313 juta pembedahan yang dilakukan, dengan angka kematian 30 hari pascaoperasi mencapai 4.2 juta jiwa. Penilaian kondisi pasien preoperatif diperlukan untuk memprediksi morbiditas danmortalitas pasien pascabedah, maka modalitas yang digunakan dalam menilai risiko pembedahan sebaiknya memiliki akurasi dan objektivitas yang baik. Salah satu modalitas yang rutin digunakan di RSUPN Cipto Mangunkusumo (RSUPNCM) adalah skor ASA-PS. Namun skor ini sudah banyak ditinggalkan oleh negara maju dan beralih pada skor P-POSSUM yang dinilai lebih objektif, dan akurat. Studi ini menguji kesahihan skor P-POSSUM dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ICU, yang mencerminkan keparahan morbiditaspascabedah. Tujuan: Studi ini menguji kemampuan kalibrasi dan diskriminasi skor P-POSSUM dalam memprediksi lama perawatan di ICU, dan menganalisis hubungan antar variabel skor P-POSSUM dengan lama perawatan di ICU pada pasien pasabedah digestif mayor. Metode: Studi ini merupakan studi kohort retrospektif di RSUPNCM selama Januari 2017 hingga Desember 2018. Sebanyak 289 subjek yang sesuai kriteria inklusi dianalisis dari data rekam medis. Lama perawatan pascabedah di ICU dan skor P-POSSUM subjek dicatat sesuai dengan data rekam medis. Variabel PPOSSUM yang berpengaruh terhadap lama perawatan subjek dianalisis dengan analisis bivariat dan regresi logistik multivariat. Kesahihan skor dinilai menggunakan uji kalibrasi Hosmer-Lemeshow dan uji diskriminasi dengan melihatnilai Area Under Curve. Hasil: Hasil analisis statistik menghasilkan bahwa skor P-POSSUM memiliki kemampuan kalibrasi yang baik (uji Hosmer-Lemeshow p=0.815) dan kemampuandiskriminasi yang cukup baik (AUC 77.8%, IK 95% 0.717-0.827). Variabel PPOSSUM yang secara statistik berpengaruh signifikan (p<0.05) terhadap lama perawatan di ICU adalah kadar natrium, jumlah perdarahan, laju jantung, dan EKG.Kesimpulan: Skor P-POSSUM sahih dalam memprediksi lama perawatan pasien pascabedah digestif mayor di ruang intensif (ICU).

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Background: It was estimated that there was 313 million surgery underwent worldwide, with the 30-days postoperative mortality rate reaching 4.2 million cases. The evaluation of preoperative patients’ conditions is encouraged to predict

postoperative morbidity and mortality, thus the modality used to assess surgery risk should be accurate and objective. RSUPN Cipto Mangunkusumo (RSUPNCM) routinely uses ASA-PS score to assess patients’ condition. Nonetheless, ASA-PS has

been regarded as subjective. Developed countries has started to replace this score with P-POSSUM score which was considered to be more accurate and objective. This study finds out the validity of P-POSSUM Score in predicting the length of

hospital stay in the ICU in patients who underwent digestive surgery, which reflects the severity of postoperative morbidity. Goals: This study investigated the calibration and discrimination ability of PPOSSUM score in predicting the length of stay in the ICU, and also explored the relationship between variables in P-POSSUM score and the length of stay in the ICU in patients who underwent digestive surgery.

Methods: This retrospective cohort study was conducted in RSUPNCM in January 2017 to December 2018 on 289 subjects who met the inclusion criteria. P-POSSUM score and the length of stay in the ICU unit were recorded, the data was taken from

medical record. Bivariate and multivariate logistic regression was used to investigate the relationship between P-POSSUM variables and the length of stay. The validity of P-POSSUM score was assessed by Hosmer-Lemeshow calibration

test and the measurement of the Area Under Curve (AUC).

Results: Statistical analysis showed that P-POSSUM had a good calibration ability (p=0.815 for Hosmer-Lemeshow test) and moderate discrimination ability (AUC 77.8%, CI 95% 0.717-0.827). Four P-POSSUM variables were found to be significantly associated with length of stay in the ICU (p<0.05), namely natrium level, total blood loss, heart rate and ECG. Conclusion: P-POSSUM score is valid in predicting the length of stay in the ICU in patients who underwent digestive surgery."

"Kesadahan pada air merupakan air dengan kandungan ion Ca2+ dan CO3 2- tinggi. Kesadahan menyebabkan pendepositan kerak dan meningkatnya penggunaan deterjen. Sehingga diperlukan cara untuk mengurangi kesadahan air. Beberapa penelitian telah membuktikan adanya beberapa proses yang dapat mengurangi kesadahan air. Penelitian yang kini dilakukan adalah penurunan kesadahan air dengan proses pengadukan dan magnetisasi. Penelitian dilakukan dengan membuat model air sadah, dan diberi perlakuan khusus untuk mendapat hasil berupa ppm CaCO3. Untuk analisa jumlah endapan, dilakukan titrasi EDTA dengan menghitung jumlah ion Ca2+ yang belum terpresipitasi. Dari penelitian akan didapatkan peningkatan presipitasi CaCO3 seiring peningkatan konsentrasi larutan, jumlah magnet, kecepatan dan waktu pengadukan.

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Hardness in the water with a water content of high Ca2+ and CO3 2-. It cause the deposit of crust hardness and increasing use of detergents. So needed a way to reduce water hardness. Several studies have proven the existence of several processes that can reduce water hardness. Research is currently doing is lowering the water hardness with stirring and the magnetization process. The study was conducted by making models of hard water, and given special treatment to get results in the form of ppm CaCO3. To analyze the amount of sediment, EDTA titration performed by counting the number of Ca2+ ions are not precipitated. Of the study will be obtained CaCO3 precipitation increase with increases in the concentration of the solution, the number of magnets, stirring speed and time."

"Introduction: This study aims to know the performance of the Vascular – Physiological and Operative Severity Score for Enumeration of Mortality and Morbidity (V-POSSUM) score as a predictor of 30-day mortality after the Endovascular Aortic Aneurysm Repair (EVAR) – Thoracic Endovascular Aortic Repair (TEVAR) procedure in Abdominal Aortic Aneurysms (AAA) and Thoracic Aortic Aneurysms (TAA) patients in Cipto Mangunkusumo Hospital. Method: This was a retrospective cohort study using data from medical records. Data were taken according to the variables contained in the V-POSSUM scoring system in the patient who undergone EVAR – TEVAR procedure, on the period of 2013 to July 2018. Results: The study involved 85 patients who met the study requirements. It was known that physiological scores, morbidity risk, and mortality risk could be used as a model to predict mortality outcomes because they had good accuracy and discrimination performance, while the severity of the operation score cannot. The result of the goodness of fit model’s physiological score, morbidity risk, and mortality risk was significant (p <0.001), while the severity score of the operation was 0.18 (p >0.05). The Area Under the Curve (AUC) was 94%, 93%, 93%, with the cut points at 31, 68.8, and 10.6 for the physiological score, morbidity risk, and mortality risk, respectively. Conclusion: The V-POSSUM score had good accuracy and discrimination for the physiological score, morbidity risk, and mortality risk."