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""Some patients present with a primary complaint of pain while others complain of pain secondary to a more generalized disease process or procedure. As a healthcare professional, you are trained to diagnose the pathology and then treat it. A patient presents with pneumonia, your work-up supports the diagnosis; you treat it, then the patient gets better. However, another layer of patient care needs more focus in the medical community. If the patient with pneumonia complains of intercostal pain secondary to a violent cough, we have the ability to manage the symptoms of pain effectively, and should not hesitate to do so promptly. Our actions to alleviate pain will not hinder our ability to treat the underlying disease. Yet modern medicine often considers these goals mutually exclusive, with pain management a distance second. As medical professionals, when we have an incomplete understanding of how to treat a condition, we under treat it, erring on the side of do no harm. This book will give you the confidence to confront your patient's discomfort and succeed in conquering the pain"--Provided by publisher."

"Latar Belakang: Osteosarkoma merupakan keganasan tulang primer dengan beragamsubtipe dan memerlukan pendekatan multidisiplin dalam diagnosis dan tatalaksananya.Hingga saat ini belum ada alat diagnostik yang terbukti dapat mendekaticlinicopathological conference (CPC) sebagai standar baku emas. Keterbatasan fasilitas,biaya, dan antrian pemeriksaan yang panjang sering kali menunda diagnosisosteosarkoma. Penelitian ini bertujuan untuk membuat model sistem skoring berdasarkantemuan klinis, laboratorium, radiografi konvensional, dan histopatologis untukmendiagnosis osteosarkoma secara cepat dan tepat.Metode: Penelitian ini dilakukan dalam dua tahap. Tahap pertama bertujuan untukmemformulasikan sistem skoring untuk mendiagnosis osteosarkoma menggunakan datasekunder secara retrospektif di RS. Dr. Cipto Mangunkusumo tahun 2016 hingga 2020.Studi ini melibatkan semua pasien dengan suspek keganasan tulang primer dandidiagnosis akhir berdasarkan CPC. Uji analisis dilakukan secara univariat, bivariat, danmultivariat menggunakan regresi logistik backward stepwise dilanjutkan dengan ujikalibrasi dan diskriminasi menggunakan uji Hosmer-Lemeshow dan kurva receivingoperator characteristic (ROC), serta menentukan titik potong pada model. Tahap keduaditujukan untuk mengevaluasi model sistem skoring yang diformulasi pada tahap pertamasecara prospektif menggunakan data primer sejak September 2022 hingga Desember2022 di poliklinik Orthopaedi dan Traumatologi RS. Dr. Cipto Mangunkusumo.Hasil: Penelitian tahap pertama melibatkan 120 subjek dan menghasilkan dua modelsistem skoring, yaitu dengan mempertimbangkan riwayat pijat (model 1) dan tanpamempertimbangkan riwayat pijat (model 2). Dari hasil analisis multivariat, didapatkansembilan variabel yang dimasukan dalam model sistem skoring yaitu usia, indeks massatubuh (IMT), onset, riwayat pijat, lokasi tumor, kadar alkaline phosphatase (ALP), laktatdehidrogenase (LDH), letak lesi berdasarkan radiografi konvensional, serta gambaranhistopatologis berdasarkan fine needle aspiration biopsy (FNAB). Uji kalibrasi model 1dan 2 menunjukan kalibrasi yang baik (p=0,498 dan p=0,917). Uji diskriminasi padamodel sistem skoring menunjukan nilai area under the curve (AUC) 0,818 dengan nilaip<0,001 pada model 1 dan 2. Titik potong pada model 1 dan 2 berturut-turut adalah 19dan 11 poin. Penelitian tahap kedua melibatkan 34 subjek dan menunjukan sensitivitas,spesifisitas, dan akurasi model 1 dan 2 berturut turut sebesar 81,25% dan 87,5%, 100%dan 100%, dan 91,1% dan 94,1%.Kesimpulan: Didapatkan dua model sistem skoring yang mampu mendiagnosisosteosarkoma dengan cepat dan tepat dibandingkan dengan CPC. Lokasi tumor di lututdan gambaran sel pleiomorfik dengan atau tanpa matriks osteoid ganas merupakan faktoryang paling berpengaruh terhadap diagnosis osteosarkoma.

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Introduction : Osteosarcoma, being one of the most prevalent among the primary bone

malignancies, consists of multiple subtypes and requires a multidisciplinary approach for

proper diagnosis and treatment. Lately, there have not been a diagnostic tool that is able

to rival the accuracy of clinicopathological conference (CPC) as a gold standard in

determining the diagnosis and treatment of osteosarcoma. Limitations in budgeting, as

well as the time taken for each patient to undergo supporting examinations often leads to

a delayed diagnosis. This research aims to create a scoring system that is based on clinical

symptoms, laboratory results, conventional radiology, as well as histopathological results

to establish a quick and accurate diagnosis for osteosarcoma.

Method: This research was conducted in two stages; the first stage aims to formulate the

scoring system for diagnosing osteosarcoma by using a retrospective, secondary data

obtained from Dr. Cipto Mangunkusumo Hospital from 2016 up to 2020. This study

involved all patients with suspected bone malignancies that was eventually diagnosed

with osteosarcoma by means of CPC. The analysis was done with univariate, bivariate,

and multivariate analysis using backward stepwise logistic regression method followed

by calibration and discrimination test using Hosmer-Lemeshow test and receiving

operator characteristic (ROC) curve analysis, and determined the cut-off point in the

scoring system model. The second stage was aimed to prospectively evaluate the

previously formulated scoring system model in the first stage using primary data from

September 2022 to December 2022 at Orthopaedic and Traumatology outpatient clinic

Dr. Cipto Mangunkusumo Hospital.

Result: The first stage of the study involved 120 subjects and resulted two models of

scoring system, namely by considering massage history (model 1) and without

considering massage history (model 2). From multivariate analysis, nine variables were

included in the scoring system model, including age, body mass index (BMI), onset,

massage history, tumor location, alkaline phosphatase (ALP) levels, lactate

dehydrogenase (LDH), location of the lesion based on conventional radiography, and

histopathological finding based on fine needle aspiration biopsy (FNAB). Calibration

tests for models 1 and 2 showed good calibration (p=0.498 and p=0.917). The

discrimination test on the scoring system model showed an area under the curve (AUC)

value of 0.818 with a p-value <0.001 in both models 1 and 2. The cut-off points in model

1 and 2 were 19 and 11, respectively. The second stage of the study involved 34 subjects

with the sensitivity, specificity, and accuracy of models 1 and 2 showing 81.25% and

87.5%, 100% and 100%, and 91.1% and 94.1%, respectively.

Conclusion: This study has proposed two models of scoring systems that can be used

for a more rapid and accurate diagnosis of osteosarcoma when compared to CPC; the

location of the tumor mass in the knee joint and the appearance of pleomorphic cells, with

or without the appearance of malignant osteoids, both being significant factors in

diagnosing osteosarcoma"

"Tujuan Mendapatkan metode diagnostik kanker paru dengan cara tidak invasif dengan HRCT sistem skoring yang setara dengan pemeriksaa Patologi Anatomik. Metode Penelitian dilakukan dari Desember 2006 sampai dengan Maret 2008. Sebanyak 55 pasien, 40 laki-laki dan 15 perempuan yang diduga kanker paru diperiksa dengan CT-scan toraks teknik HRCT tanpa dan dengan kontras, dilanjutkan TTB dengan tuntunan CT untuk mendapatkan bahan sitologi. Hasil Pemeriksaan PA didapatkan 43 pasien (78%) kanker paru dan 12 pasien (22%) tidak terbukti ganas/jinak. Berdasarkan kecocokan gambaran HRCT dan PA dibuat skor untuk umur > 49 tahun, volume tumor lebih dari 68 cm3, HU lebih dari 21, spikula positif , dan angiogram + serta KGB + , dengan nilai masing?masing 20, 19, 10, 24, 18, dan 17 skor total 108. Kesimpulan Tehnik baru dalam mendiagnosis kanker paru dengan HRCT sistem skoring setara dengan pemeriksaan patologi anatomik dengan sensitivitas 97,7% dan spesifisitas 83,3% dengan nilai batas skor 35. Bila skor < 35 berarti lesi jinak dan bila skor >35 berarti ganas

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AbstractAim To find a non-invasive diagnostic method for lung cancer with results almost as accurate as histopathological examinations with HRCT scoring system. Method This study was conducted from December 2006 until March 2008. A total number of 55 persons, comprised of 40 male and 15 female patients suspected of having lung cancer, underwent high resolution computed tomography with and without contrast as well as CT-guided transthoracic needle aspiration to obtain cytology specimens.. Results Histopathological examinations revealed the existence of lung cancer in 43 patients (78%) and benign lesions in 12 patients (22%). A scoring system was then made based on the similarities of findings from CT and findings from pathological examinations, where the age group of 49 years and above, tumor volume of more than 68 cm3, HU of more than 21, spicula positive, angiogram positive and lymph node positive had a value of respectively 20, 19, 10, 24, 18, and 17 (total score 108). Conclusion This new method to diagnose lung cancer using high resolution computed tomography converted into a scoring system is constantly as accurate as histological findings with a sensitivity of 97.7% and a specificity of 83,3% and a cut-off score of 35. According to this system, a score of less than 35 indicates that the lesions were benign while a score higher than 35 was considered an indication that the lesions were malignant."

"Dalam penelitian Computer Aided Diagnose (CAD) Radiografi Paru pasien dewasa dengan metode Fuzzy C Means (FCM), telah dilakukan dalam keadaan tahap awal. Penelitian ini bertujuan untuk mengetahui apakah metode clustering FCM dapat digunakan untuk membuat perangkat penolong untuk melihat abnormalitas pada paru-paru dari 200 data citra Radiografi sinar-X. Pembuatan perangkat dilakukan dengan menggunakan GUI pada Matlab. Perancangan di bagi menjadi dua metode menggunakan metode FCM otomatis dan manual kemudian untuk mengetahui perbedaan nilai piksel digunakan metode ambang rata-rata. Kedua metode ini berdasarkan intensitas derajat keabuan 0-256. Metode FCM digunakan untuk melihat visualisasi abnormalitas secara cepat dan mengetahui garis besar posisi yang abnormal. Kemudian diteruskan dengan segmen kotak dari metode ambang rata-rata untuk mengetahui perbedaan nilai pixel citra abnormalitas dan yang normal. Hasil penelitian nenujukkan bahwa, Kinerja Metode FCM Akurasi 57,7%, sensitifitas 50,0%, spesifikasi 89,5% , Overal Error 42,3% dan Presisi 95,1%. Sedangkan metode Segmen per kotak Akurasi 56,7%, sensitifitas 51,7%, spesifikasi 88,5% , Overal Error 43,3% dan Presisi 96,7%. berdasarkan penelitian dapat disimpulkan bahwa Metode FCM dalam paru hanya bisa menunjukkan visual secara cepat dan garis besar namun tidak memberikan akurasi yang cukup memuaskan, hal ini di karenakan data input yang random tidak dapat dijadikan patokan untuk ukuran keberhasilan.

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In the study Computer Aided Diagnose (CAD) Lung Radiography adult patients with Fuzzy C Means (FCM), has been carried out in a state of infancy. This study aims to determine whether the FCM clustering method can be used to make the device helper to see abnormalities in the lungs of 200 image data of X-ray radiography. Making the device is done by using the GUI in Matlab.

The design is divided into two methods using automated and manual methods FCM then to determine differences in pixel value threshold method is used on average. Both methods are based on the intensity of gray 0-256 degrees. FCM method is used for visualizing abnormalities quickly see and know the outline of an abnormal position. Then forwarded to the segment boxes of the average threshold method to determine differences in pixel values abnormalities and normal image.

That research results, performance FCM method Accuracy 57.7%, 50.0% sensitivity, 89.5% specification, Overal Error 42.3% and 95.1% precision. While the method of segment per box Accuracy 56.7%, 51.7% sensitivity, 88.5% specification, Overal Error 43.3% and 96.7% precision. based study concluded that the method of FCM in the lungs can only show rapid visual and outline but does not give a satisfactory accuracy, it is in because random input data can not be used as a benchmark to measure success."

"Latar belakang. Penegakan diagnosis demam tifoid masih sulit dilakukan jika hanya menggunakan gejala klinis. Dibutuhkan skor klinis untuk dapat menegakkan diagnosis di awal dengan tepat. Variabel pada skor Nelwan merupakan data yang dapat diperoleh melalui anamnesis dan pemeriksaan fisik sehingga dapat membantu penegakan diagnosis secara dini. Penelitian nilai dignostik skor Nelwan untuk mendiagnosis demam tifoid belum pernah dilakukan sebelumnyaTujuan. Mendapatkan nilai titik potong dan nilai diagnostik skor Nelwan dalam penegakkan diagnosis demam tifoid dewasaMetode. Penelitian ini menggunakan desain potong lintang dengan pendekatan uji diagnosis. Penelitian dilakukan dengan cara mengumpulkan data primer dari pasien poliklinik, IGD, dan rawat inap RSUP Persahabatan, RSUD Budhi Asih, RSUD Tanggerang Selatan, RS Hermina Ciputat, RS Metropolitan Medical Center dan Puskesmas di daerah Jakarta. Kriteria inklusi adalah pasien dengan keluhan demam selama 3-14 hari, mempunyai keluhan saluran cerna, dan bersedia mengikuti penelitian. Diagnosis demam tifoid didapatkan melalui kultur darah, kultur swab rektal dan PCR. Nilai titik potong skor Nelwan ditentukan berdasarkan kurva Receiver Operating Characteristic ROC . Titik potong tersebut kemudian dianalisis dan didapatkan sensitivitas, spesifisitas, nilai duga positif NDP , nilai duga negatif NDN , rasio kemungkinan positif RKP dan rasio kemungkinan negatif RKN .Hasil. Selama penelitian didapatkan 233 sampel dengan proporsi demam tifoid 4,72 . Titik potong skor Nelwan yang optimal adalah 10 dengan AUC 71,3 95 IK 65,9 - 88,7 . Skor Nelwan dengan nilai cut off 10 memiliki sensitivitas 81,8 , spesifisitas 60,8 , nilai duga positif 9,3 , nilai duga negatif 98,5 , rasio kemungkinan positif 2,086, rasio kemungkinan negatif 0,299.Kesimpulan. Skor Nelwan dengan titik potong 10 dapat digunakan sebagai screening pasien dengan klinis demam tifoid.Kata kunci : skor Nelwan, demam tifoid.

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Background. Typhoid fever can be complicated to diagnose if only clinical signs and symptoms are used. By using clinical scores, we can provide an early diagnosis precisel. Variables in Nelwan Scores are derived from history taking and physical examination. Evaluation of diagnostic value of Nelwan score has never been done before.Objectives. To get the cut off point and the diagnostic value of Nelwan score in diagnosing typhoid fever in adult patients.Methods. This study is a diagnostic test with a cross sectional method, involving subjects with fever 3-14 days and gastrointestinal complaints from policlinic, emergency department and hospital ward in Persahabatan Hospital, Budhhi Asih Hospital, South Tanggerang Hospital, HerminaCiputat Hospital, MMC Hospital, Jatinegara and Gambir Primary Health Centre. Diagnosis are confirmed by blood culture, rectal swab culture, and PCR. Cut off analysis was performed using Receiver Operating Characteristic ROC curve and diagnostic value was then analyzed to generate sensitivity, specificity, predictive value and a likelihood ratio.Result. This study involving 233 subjects with a proportion of typhoid fever is 4,72 . The optimal cut off point of Nelwan score is 10 with AUC 71,3 95 IK 65,9 - 88,7 . This cut off point has sensitivity 81,8 , specificity 60,8 , PPV 9,3 , NPV 98,5 , LR 2,086, and LR - 0,299.Conclusion. Nelwan score with cut off point 10 has a good diagnostic value as a screening tool for patients with typhoid fever clinical presentationKeywords :Nelwan score, typhoid fever "

"Malaria harus dideteksi melalui pemeriksaan sampel darah perifer. Implementasi kebijakan pemerintah untuk malaria adalah penegakan diagnosa malaria. Tujuan. Mengevaluasi implementasi serta mengetahui faktor penghambat kebijakan penegakan diagnosa malaria di Provinsi NTB tahun 2011. Permasalahan implementasi kebijakan penegakan diagnose malaria di Provinsi NTB adalah belum disusunnya Peraturan daerah Provinsi NTB sebagai tindaklanjut Kepmenkes RI Nomor 293 Tahun 2009. Faktor penghambat implementasi kebijakan penegakan diagnosa malaria yaitu sumberdaya; karakteristik agen pelaksana; disposisi; komunikasi antar organisasi; lingkungan. Sehingga perlunya peningkatan komunikasi antar Kemenkes dan Pemerintah daerah Provinsi NTB serta komitmen pelaksana dan pemangku kebijakan untuk implementasi kebijakan penegakan diagnosa malaria.

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Malaria, health problem must detects by examination of peripheral blood samples, by implementing policy of establishing malaria diagnose. Aims. Evaluating policy implementation and exploring resistors of establishing malaria diagnose in NTB Province. Problem of policy implementation for establishing malaria diagnose in NTB Province is lack of regulator as determinant of Kepmenkes Nomor 293 Year 2009. Resistors are resources; characteristics; disposition; communication among organizations; environment. It needs communication and commitment among Ministry of Health and NTB government to improve implementation policy of establishing malaria diagnose."

"ABSTRAKLatar belakang. Cedera inhalasi dapat terjadi saluran napas atas hingga bawah. Sebagai prediktor diagnosis cedera inhalasi di instalasi gawat darurat IGD masih terbatas pada temuan klinis adanya edema laring pada saluran napas atas. Bronkoskopi sebagai baku emas diagnostik cedera inhalasi belum dapat dilakukan di IGD. Penelitian ini dilakukan untuk mencari hubungan antara temuan klinis edema laring dengan temuan bronkoskopi pada pasien luka bakar dengan cedera inhalasi.Metode. Studi potong lintang retrospektif pada 18 subjek. Di IGD dilakukan laringoskopi untuk menilai adanya edema laring. Hanya subjek yang dilakukan pemasangan selang endotrakeal dan dilakukan bronkoskopi dimasukkan sebagai kriteria inklusi, sedangkan derajat cedera inhalasi dibagi menurut kriteria Chou yang diamati melalui bronkoskopi.Hasil. Subjek terbanyak pria yaitu 16 subjek. Usia berkisar antara 19-56 tahun. Luas luka bakar berkisar antara 5-95 . Dari 14 subjek didapatkan adanya edema laring. Dari 14 subjek yang didapatkan edema laring, 13 subjek terdapat cedera inhalasi. Hubungan antara temuan klinis edema laring dengan adanya cedera inhalasi yang diamati melalui bronkoskopi memiliki nilai sensitivitas 76,4 , spesifitas 0 .Kesimpulan. Adanya edema laring berhubungan dengan cedera inhalasi pada saluran napas bawah meski secara statistik belum signifikan serta belum mampu menunjukkan akurasi derajat cedera inhalasi.

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ABSTRACTBackground. Inhalation injury may occur from the upper until the lower respiratory tract. In the ER, diagnose of inhalation injury only suspected from the presence of laryngeal edema based on laryngoscopy. Bronchoscopy as a gold standard diagnostic of inhalation injury could not been done in the ER. This study was conducted to determine the association between clinical findings of laryngeal edema and bronchoscopic findings in burns which is suspected inhalation injury.Objectives. This study was conducted to determine the association between clinical findings of laryngeal edema and bronchoscopic findings in burns which is suspected inhalation injury.Materials and Methods. A retrospective cross sectional study was conducted in 18 subjects. In the ER laryngoscopy was performed to assess the presence of laryngeal edema. Only subjects which is intubated and bronchoscopy were included as inclusion. The degree of inhalation injury was divided according to the Chou criteria which is observed through bronchoscopy.Results. Subjects most are men 16 subjects. Age ranges from 19 56 years. Burns range between 5 95 . 14 subjects presences larygeal edema. Of the 14 subjects who had laryngeal edema, 13 subjects had inhalation injury. The association between laryngeal edema in the presence of inhaled injury observed through bronchoscopy has a sensitivity value of 76.4 , a specificity of 0 .Conclusions. In this study The presence of laryngeal edema associated with inhalation injury in the lower airway although not statistically significant and has not been able to show the accuracy of the degree of inhalation injury. "

"Pendahuluan : Pemeriksaan high resolution computer tomography (HRCT) menjadi pilihan metode pemeriksaan penunjang untuk penegakan diagnosis hipersensitif pneumonitis. Dengan belum adanya pemeriksaan baku emas penegakan diagnosis maka perlu ditelaah mengenai keakuratan penggunaan metode penunjang penegakan diagnosis tersebut.Metode : metode pencarian artikel menggunakan pubmed dan scopus serta melakukan skrining artikel berdasarkan kriteria inklusi dan eksklusi yang telah ditentukan sebelumnya. Hasil pencarian artikel tersebut kemudian dilakukan telaah dengan menggunakan kriteria penilaian validitas, tingkat pentingnya hasil yang didapat pada penelitian tersebut, dan kemampu-terapan.Hasil : Hasil pencarian didapatkan sebanyak 415 artikel dari Pubmed dan 343 artikel dari Scopus. Ditemukan hanya 2 (dua) artikel uji diagnosis yang memenuhi kriteria inklusi, eksklusi dan metode PICO yang ditetapkan sebelumnya. Artikel pertama oleh Lynch dkk (1992) ditemukan sensitivitas 45 %, spesifisitas 90 % dan akurasi diagnosis sebesar 74 %. Artikel kedua oleh Rival G (2016) dkk menemukan nilai sensitivitas 66 %, spesifisitas 96 % dan akurasi diagnostik sebesar 86 %. Sehingga terbukti bahwa pemeriksaan high resolution computer tomography (HRCT) sebagai metode / alat penegakan diagnosis hipersensitif pneumonitis memiliki tingkat akurasi yang baik namun tidak cukup akurat sebagai alat skrining diagnosis hipersensitif pneumonitis.

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Introduction : High resolution computer tomography (HRCT) examination becomes the preferred method of investigation for the diagnosis of hypersensitivity pneumonitis. In the absence of a gold standard of diagnosis, it is important to examine the sensitivity and specificity of this method.

Method : The articles searching methods by using Pubmed and Scopus and screening the articles with inclution and exclution criteria which were predetermined, articles were than performed using the assesment criteria of validity, importance, and ability applied.

Result : The results were 415 articles from Pubmed and 343 articles from Scopus. 2 (two) articles diagnostic test were found in accordance with the inclution, exclution criteria and PICO methods which were predetermined. These articles were than performed a systematic review of articles and the result was valid. The first Article by Lynch et all (1992) found 45 % sensitivity, 90 % specificity and the accuration of diagnose was 74 % and the second article by Rival G et all (2016) found 66 % sensitivity, 96 % specificity and the accuration of diagnose was 86 %. There were found an evidence about using the accuration of high resolution computer tomography (HRCT) as a tool for diagnosis hypersensitivity pneumonitis was good. But the accuracy was not accurate enough as a screening tool for hypersensitivity pneumonitis.

Conclusion : using high resolution computer tomography (HRCT) is more acurate as a diagnostic examination than a screening method."