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"ABSTRAK Off-label merupakan istilah penggunaan obat yang diresepkan di luarinformasi yang tertera pada izin edar. Penggunaan obat off-label memiliki risikotinggi terkait dengan aktivitasnya pada kelompok pasien tertentu, salah satunyayaitu pasien hamil. Penelitian ini bertujuan untuk mengevaluasi pola penggunaanobat off-label pada pasien hamil di Instalasi Rawat Inap dan Gawat DaruratKebidanan-Kandungan RSUP Fatmawati periode Maret 2015. Penelitian inimenggunakan desain studi cross-sectional dengan pengambilan data melaluiresep, rekam medis, serta kardeks. Sampel penelitian adalah data pasien hamilyang menerima obat pada bulan Maret 2015. Evaluasi dilakukan terhadap 670terapi obat dari 196 pasien yang sebagian besar berusia 20-35 tahun dengan usiakehamilan trimester ketiga dengan diagnosis persalinan kurang bulan. Terdapatsebanyak 8 obat off-label yang meliputi 5 obat off-label (62,50%) dengan 145terapi off-label di Instalasi Rawat Inap dan 3 obat off-label (37,50%) dengan 37terapi off-label di Instalasi Gawat Darurat Kebidanan-Kandungan. Penggunaanobat off-label dalam terapinya di kedua instalasi dengan kategori off-label indikasisebanyak 58,65%, kategori obat off-label kontraindikasi sebanyak 27%, dankategori obat off-label dosis sebanyak 14,35%. Berdasarkan hasil dapat diketahuibahwa penggunaan obat off-label tertinggi terdapat di Instalasi Rawat Inap dengangolongan obat sistem kardiovaskuler.

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ABSTRACT Off-label is a term used in drug which is prescribed outside the officialinformation of the marketing authorization. Off-label use of drug has a high riskto certain group of patient regarding to its activity, especially pregnant patient.This study aimed to evaluate the pattern of off-label use in pregnant patients in theInpatient Unit and Obstetric-Gynecology Emergency Unit Fatmawati HospitalMarch 2015. Cross-sectional study design was used for the research and the datawas collected from prescriptions, medical records, as well as index card. Theresearch sample were the data of pregnant patients who received drug on March2015. Evaluation was conducted to 670 drugs therapy of 196 patients aged 20-35years old with third trimester of pregnancy and preterm labour diagnosed mostly.There were 8 off-label drugs use including 5 (62,50%) drugs and 145 medicationswere off-label in the Inpatient Unit also 3 (37,50%) drugs and 37 medicationswere off-label in the Obstetrics-Gynecology Emergency Unit. The medicationswith the off-label indication category were 58.65%, off-label contraindicationcategory were 27%, and off-label dose category were 14,35%. Based on theresults, it can be concluded that the highest use of off-label drug was at InpatientUnit with the drug classification of cardiovascular system class."

"ABSTRAKPemerintah melalui Departemen Kesehatan telah memberikan secara gratis hematinik yang mengandung 200 gram fero sulfat dan 0.25 gram asam folat sejak tahun 1970, namun prevalensi anemia pada pasien hamil di Puskesmas Kecamatan Matraman masih 30% pada tahun 2014. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang dapat memengaruhi efektivitas dari hematinik yang dikonsumsi oleh pasien hamil di Puskesmas Kecamatan Matraman periode Maret-Mei 2015. Metode penelitian menggunakan rancangan studi cross-sectional dengan teknik pengambilan data purposive sampling. Data diperoleh dari hasil pemeriksaan kadar hemoglobin pasien dan hasil wawancara pasien dengan menggunakan kuesioner yang telah diuji validitas dan reliabilitasnya. Responden adalah pasien hamil yang mengonsumsi hematinik dari pemerintah dan telah melakukan pemeriksaan kadar hemoglobin minimal 2 kali. Jumlah sampel yang masuk kriteria inklusi pada penelitian sebanyak 85 pasien. Berdasarkan hasil penelitian, terdapat hubungan bermakna antara pengaruh kebiasaan konsumsi teh dengan kadar hemoglobin pasien (p=0,000) dan pengaruh keteraturan konsumsi hematinik dengan kadar hemoglobin pasien (p=0,004). Namun tidak ada hubungan yang bermakna antara pengaruh pola makan dengan kadar hemoglobin pasien (p=0,105) dan pengaruh cara mengonsumsi hematinik dengan kadar hemoglobin pasien (p=0,684). Penelitian ini menunjukkan bahwa faktor-faktor yang memengaruhi efektivitas penggunaan hematinik adalah kebiasaan konsumsi teh dan keteraturan konsumsi hematinik.

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ABSTRACT

The government through Health Department has been giving hematinic that contains 200 gr of ferro sulfas and 0.25 gr of folic acid to pregnant patient since 1970, but anaemia prevalence in pregnant patient at Matraman primary health care still 30%. This research aimed to analyze factors that were influencing hematinic effectiveness that has been used by pregnant patient at Matraman primary health care in the period of March-May 2015. The method used for this research was cross-sectional study with purposive sampling technique. Data was obtained from the result of laboratory test for haemoglobin level and interview using valid and reliable questionnaire. Respondents of this research were pregnant patient who used hematinics that were given from government and their haemoglobin level had been measured at least twice during their pregnancy. Total respondent who met the inclusion criteria were 85 patients. Based on the result, there were significant association between tea consumption habits and haemoglobin level (p=0.000) and also significant association between patient compliance on hematinic consumption and haemoglobin level (p=0.004). But there were no significant association between dietary habit and haemoglobin level (p=0,105) and between how to consume hematinic and haemoglobin level (p=0,684). This study showed factors influencing hematinic effectiveness were tea consumption habits and patient compliance on hematinic consumption."

"Ketidaknyamanan fisik yang dirasakan selama kehamilan yang dapat menyebabkan berbagai dampak, salah satunya adalah dapat memperburuk kualitas tidur serta menimbulkan kecemasan pada ibu hamil. Oleh karena itu, penelitian ini memiliki tujuan untuk mengetahui hubungan antara ketidaknyamanan fisik selama kehamilan dengan kualitas tidur serta tingkat kecemasan pada ibu hamil trimester III di DKI Jakarta. Penelitian ini merupakan penelitian kuantitatif cross sectional dengan metode consecutive sampling untuk mengumpulkan total 115 sampel. Kuesioner yang digunakan dalam penelitian ini terdiri dari karakteristik pasien atau data demografi, kuesioner Maternal Physical Discomfort Scale (MPDS), Sleep Quality Index (PSQI), dan Pregnancy Related Anxiety Questionnaire (PRAQ). Mayoritas responden mengalami ketidaknyamanan fisik sedang (53,9%), kualitas tidur yang buruk (55,7%), serta tingkat kecemasan ringan (51,3%). Berdasarkan hasil uji korelasi spearman, didapatkan bahwa terdapat hubungan yang signifikan antara ketidaknyamanan fisik selama kehamilan dengan kualitas tidur (p value = 0,004) dan tingkat kecemasan (p value = 0,00). Hasil penelitian ini dapat digunakan sebagai acuan untuk mengembangkan asuhan keperawatan maupun program kesehatan pada ibu hamil terutama yang sudah memasuki trimester III yang berkaitan dengan ketidaknyamanan fisik, kualitas tidur, serta kecemasan selama kehamilan.

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The physical discomfort felt during pregnancy can cause various impacts, one of which is that it can worsen sleep quality and cause anxiety in pregnant women. Therefore, this study aims to determine the relationship between physical discomfort during pregnancy and sleep quality and anxiety levels in third trimester pregnant women in DKI Jakarta. This research is a quantitative cross-sectional study with consecutive sampling method to collect a total of 115 samples. The questionnaire used in this study consisted of patient characteristics or demographic data, the Maternal Physical Discomfort Scale (MPDS) questionnaire, the Sleep Quality Index (PSQI), and the Pregnancy Related Anxiety Questionnaire (PRAQ). The majority of respondents experienced moderate physical discomfort (53.9%), poor sleep quality (55.7%), and mild anxiety (51.3%). Based on the results of the Spearman correlation test, it was found that there was a significant relationship between physical discomfort during pregnancy and sleep quality (p value = 0.004) and anxiety levels (p value = 0.00). The results of this study can be used as a reference for developing nursing care and health programs for pregnant women, especially those who have entered the third trimester related to physical discomfort, sleep quality, and anxiety during pregnancy."

"[Obat Off-label merupakan obat yang diresepkan tidak sesuai dengan ketentuan izin edar termasuk indikasi, dosis, kontraindikasi, usia, dan rute pemberian. Penelitian ini dilakukan untuk mengevaluasi pola penggunaan obat off-label untuk pasien usia 0 sampai 2 tahun di Instalasi Rawat Jalan Rumah Sakit Umum Pusat Fatmawati periode Maret 2015. Penelitian ini menggunakan design studi cross-sectional dan data diambil dari resep dan rekam medis periode Maret 2015 dengan teknik total sampling. Sampel penelitian adalah data pasien usia 0 sampai 2 tahun yang menerima obat pada periode Maret 2015. Evaluasi dilakukan terhadap 156 terapi obat dari 25 jenis obat yang digunakan pada 64 pasien dari 113 pasien dengan pasien usia kurang dari 1 bulan (5%) dan pasien usia >1 bulan sampai 2 tahun (95%) terdiri atas laki-laki atau perempuan sebesar 50% serta diagnosis terbanyak adalah epilepsy (36%). Terdapat 8 jenis obat dengan 55 terapi obat. Proporsi kategori off-label dosis sebanyak 20 terapi obat (36%) dengan penggunaan tertinggi adalah sefiksim (50%) dan off-label usia sebanyak 35 terapi obat (64%) dengan penggunaan tertinggi adalah asam valproat (80%). Berdasarkan hasil penelitian, penggunaan obat off-label lebih tinggi pada pasien 1 bulan-2 tahun dan golongan obat yang paling banyak digunakan adalah obat golongan saluran pernapasan sebanyak 5 jenis obat (63%).;Off-label drug is a prescribed drug that unsuitable with official drug information, and patient age, drug indications, dosage, and route of administration that are not appropriate. This study aimed to evaluate of off-label drugs use in under 2-year-old patients in Fatmawati General Hospital on March 2015. Sample data was data of under recieving drug therapy on march 2015. Cross-sectional was used and data were collected by total sampling from prescriptions and medical records. Sample are data 2-year-old patients that recieve drug on March 2015. Sample were 156 drug therapy of 25 item drugs that were used in 64 patients from 113 patients that consist of patient under 1 month (5%) and after 1 month until 2 years (95%) with boys as big as girls (50%) and the highest diagnostic was epilepsy (36%).There were 8 items drugs with 55 off-label drug therapy that consist of 20 (36%) off-label doses with sefiksim was the highest used and 35 (64%) off-label age with valproic acid was the highest used. Based on the results, off-label drug use was higher (63%) in babies and respiratory system drug class was the most frequently used drug in those patients which is 5 item drugs that used., Off-label drug is a prescribed drug that unsuitable with official drug information, and patient age, drug indications, dosage, and route of administration that are not appropriate. This study aimed to evaluate of off-label drugs use in under 2-year-old patients in Fatmawati General Hospital on March 2015. Sample data was data of under recieving drug therapy on march 2015. Cross-sectional was used and data were collected by total sampling from prescriptions and medical records. Sample are data 2-year-old patients that recieve drug on March 2015. Sample were 156 drug therapy of 25 item drugs that were used in 64 patients from 113 patients that consist of patient under 1 month (5%) and after 1 month until 2 years (95%) with boys as big as girls (50%) and the highest diagnostic was epilepsy (36%).There were 8 items drugs with 55 off-label drug therapy that consist of 20 (36%) off-label doses with sefiksim was the highest used and 35 (64%) off-label age with valproic acid was the highest used. Based on the results, off-label drug use was higher (63%) in babies and respiratory system drug class was the most frequently used drug in those patients which is 5 item drugs that used.]"

"Acute Kidney Injury (AKI) merupakan komplikasi serius yang umum terjadi pada pasien rawat inap. Berdasarkan penelitian tahun 2005, terjadi peningkatan insiden dan keparahan AKI hingga 50% akibat penggunaan obat selama rawat inap. Salah satu tugas apoteker di RS adalah melakukan pemantauan terapi obat, terdapat beberapa obat di RSUI yang dinilai mampu menginduksi terjadinya AKI. Oleh karena itu, dilakukan pembuatan daftar obat yang dapat menginduksi terjadinya AKI serta studi kasus terjadinya AKI pada pasien rawat inap akibat penggunaan obat di RSUI pada bulan Maret 2023. Daftar obat penginduksi AKI dibuat berdasarkan studi literatur dari pustaka tahun 2005 – 2023 kemudian obat dikategorikan berdasarkan kelas terapi obat. Sedangkan, studi kasus dilaksanakan secara retrospektif menggunakan data sekunder pasien rawat inap RSUI pada bulan Maret 2023 yaitu rekam medis salah satu pasien yang memenuhi kriteria inklusi dan eksklusi. Terdapat 26 obat yang mampu menginduksi AKI di RSUI. Berdasarkan studi kasus, terapi ramipril diduga mampu meningkatkan risiko terjadinya AKI pada salah satu pasien RSUI yang dinilai berdasarkan peningkatan nilai serum kreatinin dan penurunan nilai GFR. Ramipril diduga menjadi penyebab peningkatan risiko terjadinya AKI berdasarkan angka prevalensinya sebesar 28%, adanya riwayat perbaikan fungsi ginjal saat penghentian obat, serta fungsi ginjal yang kembali memburuk ketika terapi ramipril kembali dilanjutkan. Penilaian kondisi pasien menggunakan instrumen naranjo dibutuhkan untuk mengonfirmasi insiden terjadinya AKI akibat ramipril.

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Acute Kidney Injury (AKI) was a serious complication that commonly occurs in inpatients. Based on a study in 2005, there was an increase in the incidence and severity of AKI up to 50% due to drug induce during hospitalization. One of the responsibilities of the pharmacist in the hospital was to perform drug therapy monitor and several drugs in RSUI were considered likely to induce AKI. Therefore, a list of drugs induced AKI was created, and a case study of drug-induced AKI in hospitalized patients at RSUI in March 2023 was performed. The list of drugs induced AKI was made based on a literature study from 2005 – 2023, then the drugs were categorized based on the drug therapy class. Meanwhile, the case study was carried out retrospectively using secondary data from hospitalized patients at RSUI in March 2023, which was the medical records from one of the patients who met the inclusion and exclusion criteria. There are 26 drugs-induced AKI in RSUI. Based on the case study, ramipril therapy was thought to be likely to increase the risk of developing AKI in one of the RSUI patients as assessed by the increase of creatinine serum and the decrease GFR values. Ramipril is thought to be the cause of the increased risk of AKI based on its prevalence rate which was 28%, history of improvement in kidney function when stopping the drug, and worsened kidney function when ramipril therapy is resumed. Assessment of the patient's condition using the Naranjo instrument is needed to confirm the incidence of AKI due to ramipril."

"Kusta merupakan penyakit yang menyerang sel saraf tepi dan organ tubuh dalam jangka panjang sehingga mengakibatkan sebagian anggota tubuh penderita tidak dapat berfungsi dengan normal. Kusta disebabkan oleh bakteri Mycobacterium leprae. Saat ini Indonesia masih menghadapi berbagai tantangan dalam pencegahan dan pengendalian penyakit kusta. Menurut data WHO tahun 2020, Indonesia masih menjadi negara dengan kasus baru Kusta nomor 3 terbesar di dunia dengan jumlah berkisar 8% dari kasus dunia. RSUP Fatmawati merupakan salah satu rumah sakit yang melayani pengobatan untuk penyakit kusta. Penelitian ini bertujuan untuk mengidentifikasi penggunaan obat kusta dan sekaligus mengetahui jumlah pasien yang melakukan pengobatan selama periode Mei – Agustus 2023. Pengambilan data dilakukan dengan melihat arsip data resep fisik dan nantinya data akan dikelompokkan berdasarkan jenis kelamin, usia dan terapi yang digunakan serta lama pengobatannya. Terdapat 84 pasien yang mengidap kusta pada periode Mei – Agustus 2023 yang terdiri dari 26 wanita dan 58 pria dalam rentang usia anak anak hingga lansia. Jenis obat yang digunakan juga beragam dari jenis MB (multibasiller) sampai PB (pausibasiller).

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Leprosy is a disease that affects the peripheral nerves and internal organs in the long term, resulting in some of the patient's body parts being unable to function normally. Leprosy is caused by the bacterium Mycobacterium leprae. Currently, Indonesia still faces various challenges in the prevention and control of leprosy. According to WHO data in 2020, Indonesia remains the third largest country in terms of new leprosy cases globally, comprising approximately 8% of worldwide cases. RSUP Fatmawati is one of the hospitals that provides treatment for leprosy. This study aims to identify the usage of leprosy drugs and simultaneously determine the number of patients undergoing treatment during the period from May to August 2023. Data collection was conducted by examining physical prescription records, which will later be categorized by gender, age, type of therapy used, and duration of treatment. There were 84 leprosy patients during the period from May to August 2023, consisting of 26 women and 58 men spanning from children to the elderly. The types of drugs used varied from multibacillary (MB) to paucibacillary (PB)."

"Latar Belakang. Mortalitas KAD sebagai komplikasi akut DM di negara berkembang seperti Indonesia masih tinggi. Karena itu, diperlukan model prediksi untuk menapis pasien-pasien KAD yang memiliki risiko mortalitas tinggi. Tujuan. Mendapatkan model prediksi mortalitas 72 jam pasien KAD di IGD RSUPN Cipto Mangunkusumo. Metode. Penelitian dengan desain kohort retrospektif menggunakan rekam medik pasien KAD di IGD RSUPN Cipto Mangunkusumo periode Januari 2011 - Juni 2017 dengan metode sampling konsekutif. Hubungan mortalitas 72 jam dengan prediktor yaitu, usia, tingkat kesadaran, jenis DM, riwayat KAD, jumlah komorbid dan parameter laboratorium kadar bikarbonat, kalium, anion gap, ?-hidroksibutirat, laktat dan fungsi ginjal akan dinilai dan dilanjutkan dengan pembuatan model prediksi. Seluruh analisis dilakukan menggunakan program SPSS Statistics 20.0. Hasil. Sebanyak 86 subjek 28,57 dari 301 subjek yang dianalisis meninggal dalam waktu 72 jam. Prediktor yang berhubungan bermakna dengan mortalitas pada analisis multivariat p 4 mmol/L HR 5,585; IK 95 2,966 - 10,519 . Keempat prediktor dilanjutkan ke dalam sistem skor dan didapatkan model prediksi mortalitas 72 jam pasien KAD RSCM yang memiliki performa baik dengan probabilitas mortalitas sebesar 15,41 untuk skor 0 - 2, 78,01 untuk total skor 3 - 4 dan 98,22 untuk total skor 5 - 6. Simpulan. Mortalitas 72 jam pasien KAD di RSUPN Cipto Mangunkusumo adalah 28,57 . Model prediksi mortalitas memiliki performa yang baik dan terdiri dari komorbid, riwayat KAD, tingkat kesadaran, dan kadar laktat.Kata Kunci. Model Prediksi, Mortalitas, Ketoasidosis Diabetikum.

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Mortality rate of DKA as acute complication of DM in Indonesia is still high. Therefore, a mortality prediction model is needed to screen high risk mortality DKA patients.

Aim. To identify prediction model of 72 hours mortality in diabetic ketoacidosis patients at emergency unit Cipto Mangunkusumo General Hospital.

Methods. This was a retrospective cohort study with consecutive sampling method. Subjects were adult DKA patients in emergency unit Cipto Mangunkusumo General Hospital from January 2011 to June 2017. Data were obtained from medical records. Association of predictors age, type of DM, history of DKA, comorbidities, level of consciousness, bicarbonate, potassium, anion gap, lactate, hydroxybutirate and renal function and 72 hours mortality was analyzed and submitted to prediction model. All analysis was done using SPSS Statistics 20.0.

Results. A total of 86 subjects out of 301 subjects did not survive in 72 hours since hospital admission. Comorbidities HR 2,407 95 IC 1,181 - 4.907 , level of consciousness HR 10,345 95 IC 4,860 - 22,019 , history of DKA HR 2,126 95 IC 1,308 - 3,457 and lactate level HR 5,585 95 IC 2,966 - 10,519 were significant predictors and submitted to scoring system. A prediction model was derived with a good performance. Subjects with 0 - 2 points were at 15,41 risk of mortality, 3 - 4 points were 78,01 and 5 - 6 points were 98,22 risk of mortality.

Conclusion. Seventy two hours mortality rate in Cipto Mangunkusumo General Hospital was 28,57. The mortality prediction model had a good performance, consisted of comorbidities, history of DKA, level of consciousness dan lactate level."

"ABSTRAKReaksi obat tidak dikehendaki (ROTD) adalah salah satu masalah kesehatan di masyarakat yang terjadi terutama pada populasi anak.  ROTD pada anak dapat memiliki efek yang relatif lebih parah bila dibandingkan dengan orang dewasa. Penggunaan obat off-label merupakan faktor risiko terjadinya ROTD pada anak. Penelitian tentang penggunaan obat off-label sudah dilakukan di beberapa tempat di Indonesia tetapi sebagian besar hanya sebatas persentase penggunaan obat off-label tetapi tidak diketahui lebih lanjut tentang pengaruhnya terhadap munculnya ROTD. Tujuan dari penelitian ini adalah mengevaluasi penggunaan obat off-label dan on-label sebagai faktor risiko terjadinya reaksi obat tidak dikehendaki pada pasien pediatri di ruang rawat Rumah Sakit Umum Pusat Fatmawati.  Penelitian ini merupakan penelitian studi kohor yang membandingkan reaksi obat tidak dikehendaki antara peresepan secara ­on-label  dan off-label selama masa rawat pasien. Studi ini meneliti 130 pasien dengan jumlah penggunaan obat sebanyak 549 obat selama 4 bulan masa penelitian. Sebanyak 141 obat digunakan secara off-label dan 408 obat digunakan secara on-label. Pemberian obat off-label memiliki risiko untuk terjadinya ROTD 5,787 (Relative Risk=5,787; 95% Confidence Interval 1,072- 31,256) atau 5 kali lebih besar dibandingkan dengan pemberian obat on label. Peneitian ini mengindikasikan bahwa pemberian obat off-label merupakan faktor risiko terjadinya reaksi obat tidak dikehendaki. Variabel perancu yang berhubungan bermakna dengan kejadian ROTD adalah variabel umur (p< 0,05).

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ABSTRACT

Adverse drug reaction (ADR) is  one of the health problems in the community that occurs mainly in the pediatric population. ADR in children can have a relatively more severe effect compared to adults. The use of off-label drugs is a risk factor for ADR in children. Research on off-label drug use has been carried out in several places in Indonesia, but most are only limited to the percentage of off-label drug use, but it is not known more about its effect on the emergence of ROTD. The purpose of this study was to evaluate the use of off-label and on-label drugs as risk factors for adverse drug reactions in pediatric patients in the ward room at the RSUP Fatmawati. This study is a cohort study that compares adverse drug reactions between on-label and off-label prescriptions during the patient's care period. The study examined 130 patients with a total drug use of 549 during the 4 months of the study, 141 drugs are used off-label and 408 drugs are used on-label. Patients who received an off-label drug has a risk for ADR 5,787 (Relative Risk = 5,787; 95% Confidence Interval 1,072-31,256) or 5 times higher than patients who received the drug on label. This research indicates that giving off-label drugs is a risk factor for adverse drug reactions. Confounding variables that are significantly related to the incidence of ADR are age variables (p <0.05).

 

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"Pandemi COVID-19 merupakan tantangan besar yang dihadapi dunia saat ini. Puncak pandemi yang terjadi di Indonesia menjadi tantangan baru dalam tatalaksana pasien COVID-19 di Instalasi Gawat Darurat (IGD) dengan segala keterbatasannya. Modifikasi dilakukan sebagai upaya stabilisasi pasien dengan memperhatikan prinsip penangan oksigenasi pasien COVID-19, yaitu dengan strategi eskalasi dan memaksimalkan penggunaan terapi oksigen non invasif. Studi kasus ini menggambarkan upaya stabilisasi pasien, perempuan berusia 55 tahvun dengan Probable COVID-19 derajat berat yang datang ke IGD dengan saturasi 53% menggunakan simple mask. Berdasarkan hasil pemeriksaan, masalah keperawatan yang diangkat adalah gangguan pertukaran gas. Intervensi keperawatan yang diberikan adalah pemberian terapi oksigen dan pengaturan posisi. Modifikasi dilakukan dengan memberikan terapi oksigen Non-Rebreathing Mask (NRM) dan nasal kanul disertai dengan proning position secara bersamaan. Setelah dilakukan terapi tersebut didapatkan status oksigenasi pasien lebih baik dibandingkan sebelum mendapatkan terapi.

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The COVID-19 pandemic is a major chalenge facing the world today. The peak of pandemic that occurred in Indonesia was a new chalenge in the management of COVID- 19 patients in emergency unit with al its limitations. The modification was carried out as an effort to stabilize the patient by paying attention to the oxygenation principes of COVID-19 patients, namely by escalation strategies and maximizing the use of non- invasive oxygen therapy. This case study describes an effort to stabilize the patient, a 55- year-old female with severe COVID-19 who came to the ED with a saturation of 53% using a simple mask. Based on the examination result, the nursing problem which raised was gas exchange disorders. The intervention which given was providing oxygen therapy and positioning. Modifications were carried out by giving Non-Rebreathing Mask (NRM) and nasal cannula accompanied by a proning position simultaneously. After the therapy, the patient's oxygenation status was better than before receiving the therapy."

"Patient satisfaction was one thing that was very important in reviewing the quality of health services, including health center. Measuring patient satisfaction can be used to evaluate the quality of health services. In this study the dimensions related to health service user satisfaction, were in terms of reliability, assurance, tangible, emphaty and responsiveness. The purpose of this research was to know the level in district of outpatient services and inpatient care at district health center Sidoarjo."