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"Latar belakang: Tujuan penelitian ini adalah untuk membandingkan hasil pengobatan antara penggunaan pengobatan konservasi payudara (breast conserving therapy, BCT) dan mastektomi pada pasien kanker payudara T1-2N0.Metode: Penelitian retrospektif ini dilakukan pada pasien kanker payudara T1-2N0 yang menerima pengobatan antara Januari 2001 dan Desember 2010 di Departemen Radioterapi Rumah Sakit Cipto Mangunkusumo dan Jakarta Breast Center. Hasil akhir penelitian ini adalah kesintasan (OS), kekambuhan lokal (LR), kanker payudara kontra lateral (CBC), metastasis jauh (DM), dan disease free survival (DFS).Hasil: Diantara 262 pasien yang memenuhi kriteria, 200 (76,3%) pasien menjalani BCT sedangkan 62 (23,7%) pasien menjalani mastektomi. Tidak ada perbedaan antara kelompok BCT dan mastektomi dalam hal kesintasan 5 tahun (5-year-overall-survival) 5-Y OS (88,2% vs 86,7%, p = 0,743), LR (7,4% vs 2,7%, p = 0,85), CBC (3,4% vs 5,3%, p = 0,906 ), DM (17,7% vs 37,7%, p = 0,212), dan DFS (78,5% vs 60,7%, p = 0,163). Dalam analisis multivariat, grade 3 dikaitkan dengan OS lebih buruk (HR 2,79, 95% CI 1,08-7,21, p = 0,03) dan DFS (HR 2,32, 95% CI 1,06-5,06). Wanita premenopause dikaitkan dengan risiko penurunan DM (HR 0,37, 95% CI 0,17-0,80) dan DFS (HR 0,38, 95% CI 0,19-0,78).Kesimpulan: BCT dan mastektomi menunjukkan hasil yang sama dalam hal OS, LR, CBC, DM, dan DFS.

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Background: This study aimed to compare the treatment outcomes between the use of breast-conserving treatment (BCT) and mastectomy for T1-2N0 breast cancer patients.

Methods: This study retrospectively reviewed T1-2N0 breast cancer patients who received treatment between January 2001 and December 2010 at Department of Radiotherapy Cipto Mangunkusumo Hospital and Jakarta Breast Center. The endpoints of this study were overall survival (OS), local recurrence (LR), contra-lateral breast cancer (CBC), distant metastasis (DM), and disease-free survival (DFS).

Results: Among the 262 eligible patients, 200 (76.3%) patients underwent BCT while 62 (23.7%) patients underwent mastectomy. There were no differences between BCT and mastectomy groups in 5-Y OS (88.2% vs 86.7%, p = 0,743), LR (7.4% vs 2.7%, p = 0.85), CBC (3.4% vs 5.3%, p = 0.906), DM (17.7% vs 37.7%, p = 0.212), and DFS (78.5% vs 60.7%, p = 0.163). In multivariate analysis, grade 3 was associated with worse OS (HR 2.79; 95% CI 1.08 ? 7.21, p = 0.03) and DFS (HR 2.32; 95% CI 1.06 ? 5.06). Premenopausal women were associated with decreased risk of DM (HR 0.37; 95% CI 0.17 ? 0.80) and DFS (HR 0.38; 95% CI 0.19 ? 0.78).

Conclusion: BCT and mastectomy showed similar outcome in terms of OS, LR, CBC, DM, and DFS."

"Background a meta-analysis of randomized control trials (RCTs) on category I pulmonary tuberculosis (PTB) treatments showed that either part-daily (2RHZE/4R3H3) or daily dose (2RHZE/4RH) had the same failure and recurrence rates. However, the World Health Organization (WHO) concluded that the part-daily dose had higher failure and recurrence rates. Therefore, this study was conducted to compare the treatment outcomes between both regimens, whether daily dose regimen has a better treatment outcome than part-daily dose regimen, and the adverse effects between both regimens. Methods this was an analytic cross-sectional study of patients at the Persahabatan General Hospital, over the period of January 2015-June 2018. Data were taken from medical records and supported by telephone interviews, each regimen group had 175 patients.Results there were no significant differences for success rates (p=0.470), lost to follow up rates (p=0.659), failure rates (p=1.000), death rates (p=1.000), and adverse effects in the continuation phase (p=0.324) between the groups. There were, however, significant differences in cure rates (p < 0.001) and complete treatment rates (p<0.001) between the groups. Conclusion the cure rate and complete treatment rate were found to be better for the part-daily than the daily doses. The success rate of both regimens were the same as Indonesia's target (90%). In the continuation phase, there were no significant difference of adverse effects between both regimens."

"Mutu pelayanan Rumah Sakit di Indonesia sangat bervariasi. Keadaan ini mendorong Pemerintah melalui Depkes Rl untuk menetapkan standar baku tarif dan mutu Rumah Sakit yang berlaku secara nasional melalui suatu sistem Case mix dengan nama INA DRG Depkes. Namun dalam kenyataan penempan tarif INA DRG Depkes menimbulkan polemik bagi pihak Rumah Sakit. Tujuan penelitian ini adalah untuk mengetahui penetapan cost of treatment berbasis clinical pathway kasus kanker payudara dengan tindakan bedah masektomi radikal modifikasi dan kemoterapi FAC dengan tarif INA DRG Depkes di Rumah Sakit Kanker Dharmais tahun 2008. Hasil penelilian menunjukkan adanya perbedaan pengelompokan kanker payudara menurut AR DRG versi 5.2 dimana ditemukan penyakit penyerta DM, asma, hipertensi, dan penyakit penyulil anemia. Lama hari rawat tidak berbede di setiap diagnosa. Perbedean hanya terletak pada jenis obat yang diberikan yang disesuaikan dengan penyakit yang menyertai. Pada tarif INA DRG Depkes penempan tarif melalui rata-rata data yang dikirimkan oleh 15 Rumah Sakit tanpa adanya clinical pathway dan cost of treatment. Tindakan bedah MRM payudara dan cost of treatment FAC berada lebih tinggi daripada tarifiNA DRG Depkes. Penelitian ini belum menggambarkan seluroh penatalaksanaan pada kanker payudara, sehingga disarankan untuk d.ilakukan penelitian Jebih lanjut khususnya untuk penetapan COT radiotherapi yang mengikuti tindekan bedah MRM dan kemoterapi. Kami sarankan kepada Depkes Rl untuk melengkapi tarif INA DRG Depkes agar dapat membuat clinical pathway sebsgai standar utilisasi pelayanan kesebatan dan selalu melakukan revisi daftar tarif INA DRG Depkes setiap tahun agar dapat mempertahankan mutu pelayanan Rumah Sakit.

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The Quality service of Hospital in Indonesia is highly varied. This situation make the Government through Depkes RI to specify the standard of the Hospital quality and tariff applied nationally through a Case mix system by the name of INA DRG DEPKES. But in reality of applying of tariff INA DRG DEPKES generate polemic for Hospital.

This research purpose is to know the cost of treatment based on clinical pathway breast cancer case with Modified Radical MMastectomy nd F AC Chemotherapy with INA DRG Depkes tariff at Dharmais Cancer Hospital year of2008.

Research result show the difference of breast cancer grouping according to AR DRG version of5.2 where found DM disease, asthma, hypertension, and anaemia. Every diagnosis have the same length of stay. Difference only in the given drug type based on disease accompanied. INA DRG Depkes tariff based on data delivered by 15 Hospital without existence of clinical pathway and cost of treatment. Surgery on MRM breast cancer and cost of treatment FAC higher than INA DRG Depkes tariff. This research not yet show the entire breast cancer surgery, we suggest to do a further research spceially on Cost of Treatment radiotherapy following the action operate on MRM and chemotherapy.

We suggest to Depkes RI to complete the INA DRG Dcpkes tariff so that they can make clinical pathway as standard service utility of health and always revise the INA DRG Depkes tariff list every year so that they can maintain the quality service of Hospital."

"Generally we do not know about the presence of the barrier that cause the children, students, or patients to have dyslexia, i.c. difficulties in learning abilities on writing, spelling, speaking and counting. Physicians and dentists also face some difficulties in treating them, and sufferers are often improperly treated. At home they may be treated as if they had a physical defect, and in the school as if they were dull-witted students. Dyslexia has the characteristic of continually adhering to the patient until adult and then old age. There is no prevention for this condition, but the patient can be helped by excavating their existing potential. However, for this purpose it is necessary that the parentsm educators, physicians, dentists, helpers, and people in general are aware about dyslexia."

"Intensive one-session treatment of specific phobias not only provides a summary of the evidence base, it also serves as a practical reference and training guide. This concise volume examines the phenomenology, epidemiology, and etiology of phobias, laying the groundwork for subsequent discussion of assessment strategies, empirically sound one-session treatment methods, and special topics. In addition, expert contributors address challenges common to exposure therapy, offer age-appropriate guidelines for treating young clients, and describe innovative computer-assisted techniques."

"ABSTRAKKanker payudara adalah kanker pada jaringan payudara. Kanker ini merupakan kankeryang paling umum diderita wanita. Pengalaman dan pengobatan kanker tersebutmempunyai pengaruh yang besar dalam kualitas hidup pasien, seperti kelemahan,nausea dan nyeri. Efek samping atau keluhan dari kanker dan pengobatannya cenderungmeningkat selama perawatan dan dapat menetap selama berbulan-bulan atau bertahuntahun.Untuk mencapai proses penyembuhan dan pemulihan yang baik pada pasienkanker payudara pasca mastektomi perlu adanya manajemen nyeri yang tepat. Penelitianini bertujuan mengidentifikasi pengaruh latihan fisik terhadap nyeri pada pasien kankerpayudara pasca mastektomi di RSUD Dr. Achmad Mochtar Bukittinggi. Desainpenelitian ini adalah quasi eksperiment, khususnya non-equivalent control group denganpre dan post test. Sampel berjumlah 30 orang (15 orang kelompok intervensi yangdiberikan 7 hari latihan fisik ditambah analgesik dan 15 orang kelompok kontrol yangdiberikan terapi standar analgesik), yang diambil dengan metode non probabilitysampling jenis consecutive sampling. Evaluasi tingkat nyeri dilakukan setiap hari baikpada kelompok intervensi maupun kelompok kontrol. Hasil penelitian diperoleh adanyapenurunan tingkat nyeri setiap harinya, baik pada kelompok intervensi maupun kelompokkontrol. Penurunan yang lebih besar terjadi pada kelompok intervensi (p=0,000), artinyalatihan fisik pada pasien kanker payudara pasca mastektomi dapat berpengaruh terhadappenurunan tingkat nyeri. Rekomendasi hasil penelitian ini perlu adanya penelitian lanjutdengan jumlah sampel yang lebih besar dan dilanjutkan dengan perawatan di rumah sertadapat di jadikan salah satu intervensi keperawatan dalam menangani manajemen nyeripasca mastektomi.

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ABSTRACTBreast cancer is one of the common types of cancer among women. The trajectory of theexperience for having the disease and its trestment are believed to produce a big effect onthe quality of life of the patients. The experiences such as weaknesses, nauseated, andpain have to be through by the patients on the daily bases. This side effects andcomplaints created form the cancer and its therapy tend to increase during hospitalizationand can be pertinent for months or ever years. Therefore, to achieve a better healing andrecovery processes for the breast cancer patients especially post mastectomy requires theright pain management.The purpose of this study is to identify the effect of physical exercise on pain perceivedby the breast cancer patient after mastectomy at Dr Achmad Mochtar General Hospital,Bukittinggi. The design was a quasi experimental using a non-equivalent control groupwith pre and post test approach. There was 30 subjects participated in the study dividedtwo groups (the intervention group was provided with analgesic and seven days physicalexercise; and, the control group was provided with analgesic only); 15 subjects for eachgrup. A non probability sampling method-consecutive type was utilized to gather thesubjects. The pain was evaluated each day to both groups.The findings of the study demonstrated that there is a daily pain reduction between bothgroups. Further, the comparison of the pain reduction between these two group leads tothe bigger pain reduction in the intervention group compared to the control group(p=0.000). This finding showed that the physical exercise provided to the postmastectomy-breast cancer patients has a significant effect to reduce the pain level. Thiswith home care; also this finding can be used as a foundation to involve physicalexercise as on of the nursing intervention in managing post mastectomy pain commonlyexperienced by breast cancer patients."

"Pendahuluan: Kanker payudara lokal lanjut merupakan skenario klinis yang amat sering dijumpai di negara berkembang, dimana rekurensi masih menjadi permasalahan. Mastektomi merupakan salah satu terapi utama. Usia, stadium klinis, keterlibatan kelenjar getah bening, tipe histopatologis, grade histopatologis, subtipe tumor merupakan faktor-faktor klinikohistopatologis yang mempengaruhi rekurensi. Tujuan penelitian ini adalah untuk mengetahui pengaruh faktor-faktor tersebut terhadap rekurensi kanker payudara lokal lanjut pasca mastektomi. Metode: Desain penelitian bersifat analitik potong lintang. Pengumpulan data dilakukan pada semua pasien kanker payudara lokal lanjut yang telah dilakukan mastektomi serta terapi definitif sesuai stadium tumor dan terdapat disease free interval serta dapat diikuti minimal 24 bulan pada periode Januari 2011 - Desember 2012 di RS Dr.Cipto Mangunkusumo. Hasil: Didapatkan 39 pasien dengan kanker payudara lokal lanjut yang telah dilakukan mastektomi serta terapi definitif dan terdapat disease free interval dengan median follow up 30 bulan. Jumlah rekurensi adalah 7,6%. Pada analisis bivariat ditemukan hubungan bermakna antara jenis histopatologi (p 0,008) dan keterlibatan kelenjar getah bening (p 0,026) dengan rekurensi. Pada analisis multivariat didapati faktor yang paling berpengaruh terhadap rekurensi adalah keterlibatan kelenjar getah bening (p 0,002). Konklusi: Faktor yang paling berpengaruh terhadap terjadinya rekurensi kanker payudara lokal lanjut pasca mastektomi adalah kelenjar getah bening positif tumor dengan jumlah lebih dari tiga.

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Introduction: Locally advanced breast cancer is clinical scenario that is very common in developing countries where recurrence is still a problem. Mastectomy is one of the primary teraphy. Age, clinical stage, lymph nodes involvement, histopathlogic type, histopatologic grades, tumor subtypes are clinicohystopatoligic factors affecting recurrence. The purpose of this study was to determine the influence of these factors on the recurrence of locally advanced breast cancer after mastectomy.

Methodology: The study design was analytical cross-sectional. Data collection was performed in all patients with locally advanced breast cancer who had performed mastectomy and appropriate definitive therapy according to tumor stage, had disease free interval and can be followed at least 24 month in the period January 2011 - December 2012 at the Hospital Dr. Cipto Mangunkusumo.

Result: There were 39 patient with locally advanced breast cancer patient who had performed mastectomy as well as definitive therapy, had disease free interval with a median follow-up interval of 30 months. The number of recurrences was 7,6%. In the bivariate analysis found a significant relationship between the hystopathology type (p 0,008), lymph node involvement (p 0,026) with recurrence. In multivariate analysis found that the most influential factor to reccurrence was lymph node involvement (p 0,002).

Conclusion: The most influential factor on the occurrence of locally advanced breast cancer recurrence after mastectomy is tumor positive lymph nodes in an amount greater than three."