Hasil Pencarian  ::  Simpan CSV :: Kembali

"ABSTRAKKarsinoma sel basal (KSB) merupakan salah satu tipe kanker kulit yang memiliki prevalensi yang tinggi di berbagai belahan dunia. Adapun disregulasi jalur sonic hedgehog agaknya memiliki peran krusial dalam patogenesis KSB, baik pada KSB herediter maupun sporadik. Meskipun sejauh ini banyak kasus KSB dapat ditangani melalui pendekatan terapi bedah maupun radioterapi, beberapa kasus agaknya bersifat resisten dengan pendekatan-pendekatan di atas. Berdasarkan investigasi kami sebelunya, ditemukan bahwa sebagian kasus, terutama subtipe yang tergolong agresif, memiki kecenderungan terjadinya kasus rekurensi yang lebih tinggi. Sesuai dengan panduan NCCN bagi KSB, kasus-kasus yang demikian agaknya memerlukan pendekatan lainnya; di sinilah peran dari preparat inhibitor jalur sonic hedgehog menjadi bermakna. Untuk menyelidiki lebih lanjut sejauh mana peran jalur sonic hedgehog dalam perkembangan kasus KSB di Indonesia, serta perannya dalam perkembangan pola pertumbuhan agresif yang ditemukan pada beberapa subtipe KSB, kami mengobservasi ekspresi faktor transkripsi GLI1 ? yang berperan sebagai marker dari jalur ini - pada sejumlah subtipe histologi KSB.Metode penelitian menggunakan blok parafin sebagai sampel, yang diperoleh dari arsip Instalasi Patologi Anatomi Rumah Sakit Kanker Dharmais (RSKD), Indonesia, yang berasal dari jaringan KSB pasien yang berobat di RSKD sepanjang periode 2006-2010. Ekspresi GLI1 dievaluasi melalui teknik imunohistokimia. Dari hasil yang diperoleh, tidak diteukan korelasi yang kuat dan bermakna antara ekspresi GLI1 dengan agresifitas pola pertumbuhan subtipe histologi KSB.

---

ABSTRACT

Basal cell carcinoma (BCC) is one form of skin cancer that has high prevalence worldwide. It seems that the aberration of sonic hedgehog pathway plays pivotal roles in its pathogenesis, whether hereditary or sporadically. Though many cases of BCC can be treated by surgical procedures or radiotherapy, some cases seem to be resistant with the aforesaid approaches. In our previous investigation, we found that several cases, especially subtypes with aggressive growth pattern, have high tendency of recurrence. In accordance with NCCN Guidelines for BCC, such cases may need another approach; hence the use of the inhibitor of sonic hedgehog pathway (such as SMO-inhibitor), may be crucial. In order to further investigate the role of sonic hedgehog signaling pathway in the development of BCC cases in Indonesia, as well as its role in aggressive growth pattern of some BCC subtypes, we observe the expression of GLI1 transcription factor ? as the marker of the pathway ? in various histological subtypes of BCCs.

The method used paraffin blocks, as samples, collected from the archives of Department of Anatomical Pathology, Dharmais Cancer Hospital, Indonesia, which were originated from BCC patients of the hospital from the period of 2006 up to 2010. The expression of GLI1 was investigated by immunohistochemical technique. According to the result, there is no significant correlation between the expressions of GLI1 and the aggressiveness of the growth pattern of BCCs histological subtypes."

"Kanker serviks menduduki peringkat kedua sebagai kanker yang paling mematikan pada wanita di seluruh dunia dan menjadi kanker yang paling mematikan pada wanita di negara berkembang. Namun saat ini masih belum terdapat metode pengobatan yang efektif untuk kanker serviks. Oleh karena itu penting dilakukan pencarian obat yang lebih baik dalam mengobati kanker serviks.Kanker serviks disebabkan oleh infeksi human papillomavirus (HPV). Virus ini memiliki kemampuan untuk mengaktivasi jalur pensinyalan Hedgehog (Hh). Jalur ini berperan penting dalam mengatur proliferasi, ketahanan dan migrasi sel kanker serviks. Dalam penelitian ini, senyawa terbarukan dari turunan asam herbarat akan dirancang sebagai kandidat inhibitor untuk protein Sonic Hedgehog (Shh). Seluruh inhibitor yang berpotensial akan dianalisa dan dibandingkan dengan inhibitorinhibitor yang telah ada, seperti robotnikinin, melalui pendekatan penambatan dan dinamika molekul. Analisis QSAR (Quantitative structure-activity relationship) dan farmakologikal, analisis kemudahan sintesis dan sifat-sifat ADMET nya.Penambatan molekul dari 6310 ligan dilakukan dengan menggunakan metode LibDock pada software Accelrys Discovery Studio 2.5, dan tahap produksi 5 ns simulasi dinamika molekul dilakukan dengan menggunakan forcefield GROMOS96 43a1 pada software GROMACS 4.6.5. Setelah dilakukan analisis interaksi kompleks dan simulasi dinamika molekul, diketahui bahwa ligan Sd32 merupakan ligan terbaik untuk menginhibisi protein Sonic Hedgehog.

---

Cervical cancer ranks second as the most common deadly cancer in women worldwide and ranks first in developing countries. However there is no effective treatment yet for this disease. Therefore it is necessary to find a better drug for the cervical cancer treatment.

Cervical cancer caused by human papillomavirus (HPV) infection. This virus has an ability to activate the Hedgehog (Hh) signaling pathway and regulate cervical cancer cells proliferation, survival and migration. In this study, a novel series of herbaric acid derivates were designed as the potential inhibitor candidates of the sonic hedgehog (Shh) signaling pathway. All of the potential inhibitors are going to be analyzed and compared with Shh available inhibitors, such as robotnikinin, through molecular docking and dynamics. QSAR (quantitative structure-activity relationship) and pharmacological analysis, synthetic accessibility analysis, and ADMET properties were also analyzed.

Molecular docking of these 6310 ligands was done through Accelrys Discovery Studio (DS) software by using LibDock method, and 5 ns production molecular dynamics simulation was completed with GROMOS96 43a1 forcefield using GROMACS 4.6.5 software. After the analysis of complex interaction and molecular dynamics simulation, it turns out that Sd32 ligand was the best ligand for inhibits sonic hedgehog protein."

"Biaya pengobatan semakin meningkat akibat inflasi dan teknologi yang semakin maju, maka clinical pathway adalah alat yang tepat sebagai kendali mutu dan biaya. Adanya clinical pathway seksio sesarea di RS Awal Bros Tangerang tetap menimbulkan variasi terapi yang berakibat pada variasi tagihan, oleh karena itu clinical pathway yang ada perlu direvisi.Tesis ini membahas faktor - faktor yang mempengaruhi variasi tagihan seksio sesarea selama bulan Desember 2013 - Februari 2014 di Rumah Sakit Awal Bros Tangerang yang hasilnya digunakan untuk merevisi isi clinical pathway seksio sesarea yang sudah ada. Desain yang digunakan dalam penelitian ini adalah observasional dengan pengambilan data secara crosseksional dengan metode kuantitatif dilanjutkan kualitatif. Hasil penelitian mendapatkan clinical pathway baru yang sesuai dengan bukti praktek klinis terbaik dengan biaya paling efisien. Diperlukan dukungan semua pihak terutama dokter spesialis untuk mematuhi clinical pathway yang baru . Variasi tagihan seksio sesarea dipengaruhi jenis pembiayaan, kelas perawatan, tindakan tambahan selain seksio sesarea.

---

Increased cost of treatment due to inflation and increasingly advanced technology, the clinical pathways is an appropriate tool as a quality control and cost. The presence of clinical pathways Caesarean section in Awal Bros Hospital Tangerang still cause variations in treatment that result in variations in the bill, therefore existing clinical pathways need ti revised.Tesis discusses factors that affect variation in cesarean bill during December 2013-February 2014 in Awal Bros Hospital Tangerang the results are used to revise the content of clinical pathways existing Caesarean section. The design used in this study is observational data retrieval crossectional the continued qualitative quantitative methods. The results of the study to get a new clinical pathways according to the best evidence of clinical practice with the most efficient cost. Required the support of all multidisiciplin team, especially the obstetrician to comply with the new clinical pathway. Variation bill Caesarean section affected by types of patient financing, class of treatment, additional action other than section sesarea."

"Kesehatan adalah hak fundamental setiap warga sehingga negara bertanggung jawab untuk mengaturnya. Pemerintah dengan program Jamkesmas menjamin pembiayaan masyarakat miskin dengan perhitungan biaya berdasar sistem pembiayaan INA-CBG. Kraniotomi termasuk 3 terbanyak tindakan medik operatif pasien Jamkesmas tahun 2011 di RSUP dr. Kariadi. Terdapat perbedaan pengelompokan dan perbedaan biaya kraniotomi berdasar INA - CBG dan RSUP Dr. Kariadi Semarang. Clinical pathway kraniotomi belum ada di RSUP Dr. Kariadi Semarang. Tujuan penelitian ini adalah menyusun clinical pathway dan menganalisa biaya kraniotomi berdasar tarif paket INA CBG di RSUP Dr. Kariadi Semarang tahun 2012. Data primer yang didapatkan meliputi : jumlah dan identitas pasien Jamkesmas yang menjalani tindakan kraniotomi pada tahun 2012, hasil wawancara dan wawancara mendalam, hasil wawancara dalam fokus grup diskusi, hasil pengamatan langsung pada saat kraniotomi dilakukan. Data sekunder didapatkan dari dokumen rekam medis pasien Jamkesmas yang menjalani tindakan kraniotom pada tahun 2012. Instrumen yang digunakan pada penelitian ini yaitu formulir penelitian, pedoman wawancara, data biling tagihan keuangan pasien Jamkesmas yang menjalani kraniotomi, dan pedoman diskusi grup. Berdasar diagnosis utama, diagnosis penyerta dan penyulit, tingkat kesadaran, lokasi dan besar neplasma / perdarahan, tersusun 6 clinical pathway kraniotomi yaitu : kranitomi ringan trauma, kraniotomi ringan non trauma, kraniotomi sedang trauma, kraniotomi sedang non trauma, kraniotomi berat trauma, dan kraniotomi berat non trauma. Cost of treatment tindakan kraniotomi di RSUP Dr. Kariadi untuk kelompok kraniotomi ringan Rp. 22.627.449,00, kraniotomi sedang Rp. 27.589.090,00, dan kraniotomi berat Rp. 46.372.634,00. Terdapat selisih antara cost of treatment tindakan kraniotomi berdasar tarip INA CBG dan RSUP DR. Kariadi Semarang. Selisih biaya untuk kraniotomi ringan Rp. 18.715.922,80, kraniotomi sedang Rp. 22.066.987,50, dan untuk kraniotomi berat Rp. 39.827.762,99.

---

Right to health is a one of basic human rights, and it’s an obligation for the government that every citizens have it equally.The Indonesian government with its social program guarantee the cost of health expenditure for the poor named INA CBG payment scheme. One of the top 3 most performed medical surgery with the Jamkesmas social insurance payment at Kariadi hospital in 2011 was craniotomi. There’s differences in grouping and cost in craniotomi procedure if we compare between INA CBG medical expenditure plan with Kariadi hospital. Kariadi hospital don’t have clinical pathway on craniotomi.

The goal of this research is to make a clinical pathway on craniotomi and to analyze the craniotomi expenditure plan based on INA CBG for Kariadi hospital in 2012. The primary data will be patients with Jamkesmas social insurance that had craniiotomi procdure in 2012, deep and structured interviewed on focus group discussion, direct observation when craniotomi’s were performed. Secondary data was medical records on patients with jamkesmas social insurance that had craniotomi in 2012. The research instruments are research form, deep and structured interview guidance and discussion group protocol.

Based on primary diagnosis, complimentary diagnosis, the difficulty level, the degree of conciuosness, location and the degree of bleeding/ the size of the neoplasma, we managed to make 6 clinical pathway on craniotomi procedures which are mild trauma craniotomi, mild non trauma craniotomi, intermediate trauma craniotomi, intermediate non trauma craniotomi, severe trauma craniotomy, and severe non trauma craniotomy. The cost of treatment of mild craniotomi in Kariadi hospital was Rp. 22.627.449,00, intermediate craniotomi was Rp. 27.589.090,00, while severe craniotomy was Rp. 46.372.634,00. There were differences cost of treatments on craniotomy procedure between INA CBG and Kariadi hospital which were : for mild craniotomy Rp. 18.715.922,80, intermediate craniotomy Rp. 22.066.987,50, and severe craniotomi Rp. 39.827.762,99."

"It is common for us today to associate the practice of science primarily with the act of seeing—with staring at computer screens, analyzing graphs, and presenting images. We may notice that physicians use stethoscopes to listen for disease, that biologists tune into sound recordings to understand birds, or that engineers have created Geiger tellers warning us for radiation through sound. But in the sciences overall, we think, seeing is believing. This open access book explains why, indeed, listening for knowledge plays an ambiguous, if fascinating, role in the sciences. For what purposes have scientists, engineers and physicians listened to the objects of their interest? How did they listen exactly? And why has listening often been contested as a legitimate form of access to scientific knowledge? This concise monograph combines historical and ethnographic evidence about the practices of listening on shop floors, in laboratories, field stations, hospitals, and conference halls, between the 1920s and today. It shows how scientists have used sonic skills—skills required for making, recording, storing, retrieving, and listening to sound—in ensembles: sets of instruments and techniques for particular situations of knowledge making. Yet rather than pleading for the emancipation of hearing at the expense of seeing, this essay investigates when, how, and under which conditions the ear has contributed to science dynamics, either in tandem with or without the eye."

"Tujuan Pemeriksaan: Membuktikan bahwa KSB tipe agresif menunjukkan ekspresi Ki-67 lebih tinggi dibandingkan dengan yang non-agresifi. Material dan Metode: Pada penelitian ini didapatkan sampel sebanyak 46 blok parafin jaringan KSB tipe agresif dan non-agresif di Insta1asi Patologi Anatomi RS Kanker ?Dharmais? yang memenuhi kritcria inklusi mulai tahun 1995 - 2008 serta dapat dilacak rekam mcdiknya untuk dapat diperiksakan ekspresi Ki-67 secara imunohistokimiau Analisa data karakteristik pasien dari sampel tersebut dilakukan secara bivariat berdasarkan kelompok umur, jenis kelamin, jenis histopatologi. Hasil: Rerata umur 61.30 i 11,97 tahun dengan median 61.50 tahun, pasien termuda berumur 24 tahun dan tertua 84 tahun. Berdasarkan kelompok umur didapatkan hasil sebanyak 16 pasien ( 34,8%) berumur kurang dari 60 tahun dan 30 pasien ( 65,2%) bcmmur lebih atau sama dengan 60 tahun. Pembagian berdasarkan jenis kelamin dari 46 pasiqn, laki-laki berjumlah 14 (30,4%) dan perempuan 32 (69,6%)Ekspresi Ki-67 positif pada KSB sebanyak 29 (63%) dari 46 pasien dan ekspresi negatif 17 (37%) dari 46 pasien, dengan pcmbagian pada tipe agresif terdapat 23 (50%) dari 46 pasien dan tipe non agresif 12 (26%) dari 46. Ekspresi Ki-67 negatif pada tipe agresif scbanyak 6 (13%) dari 46 pasien dan 5 (11%) dari 46 pasien tipe non-agresif. KSB tipe agresif menunjukkan ekspresi Ki-67 Iebih tinggi 79,31% dibandingkan dengan KSB tipe non agresif 70,59%. Kesimpulan: KSB tipe agresif menunjukkan ekspresi Ki-67 lebih tinggi 79,31% dibandingkan dengan KSB tipe non agresif 70,59%. Hasil uji statistik diperoleh p value 0.097. Ada perbedaan proporsi kejadian KSB antara yang negatif dengan posititf Dari hasil analisis diperoleh OR l.597, artinya KSB agrcsif mempunyai peluang 1.597 kali dibanding dengan KSB non agresif.

---

Purposed: To prove that aggressive type basal cel carcinoma shows Ki-67 expression higher than non aggressive type.

Method: In this study obtained samples of 46 paraffin blocks of Dharmais Cancer Center that the criteria of inclusion from the year 1995-2008 to be assessed Ki-67 expression in histochemistry. Patient characteristics of the data analysis was performed by bivariate sample based on age groups, types of sex, type of histopathology.

Result: Rcrata age ot`61 .30 += 11.97 years with a median of 61.50 years, Patient 24 years old the youngest and the oldest 84 years. Based on the results obtained ages of 16 Patient (34.8%) aged less than 60 years and 30 Patient (65.2%) aged more than or equal to 60 years. Distribution based on the type of sex from 46 Patient, 14 men (30.4%) and 32 women (69.6%). The results of expression of Ki-67 negative on aggressive type of 6 (13%) of 46 patients and 5 (11%) of 46 patients with non-aggressive type. Aggressive type of BCC, Ki-67 expression is higher by 79.31% compared to non-aggressive type of BCC 70.59%.

Conclusion: Aggressive type of BCC, Ki-67 expression is higher by 79.31% compared to non-aggressive type of BCC 70.59%. Results obtained by statistical test p value of 0097. There is a difference between the proportion of negative events with BCC positive. The results of analysis OR 1597, that means aggressive BCC has chance BCC 1.597 times compared with non-aggressive."

"Clinical Pathway di rumah sakit merupakan pedoman yang mencakup semua aktivitas dari pasien masuk hingga keluar rumah sakit. Tesis ini membahas mengenai pengaruh clinical pathway terhadap lama hari rawat dan biaya resep pasien di RS IMC. Penelitian ini adalah kualitatif dan kuantitatif dengan desain studi kasus analisis deskriptif. Hasil penelitian menggambarkan tahapan proses implementasi clinical pathway di RS IMC dimulai dengan perencanaan, pembentukan tim, penyusunan draft formulir clinical pathway, sosialisasi, uji coba hingga implementasi; serta terjadi penurunan lama hari rawat dan biaya resep pasien hernia inguinalis akibat pengaruh implementasi clinical pathway di RS IMC Bintaro.

---

Clinical Pathway in the hospital is a guideline which includes all activities from admission until hospital discharge. This thesis discusses the effect of clinical pathways towards length of stay and cost of prescription patient in IMC hospital. This study is a qualitative and quantitative, analysis of a descriptive case study design. Results of the study illustrate the stages of the process of implementing clinical pathways in IMC Hospital that begins with planning, team building, clinical pathways form drafting, dissemination, trial and implementation; as well as a decline in length of stay and cost of prescription inguinal hernia patients due to the effect of the implementation of clinical pathways in IMC Hospital."

"Sebagai salah satu rumah sakit swasta di Jakarta, Appendisitis akut merupakan kasus bedah terbesar ke-3 di RS "X". Pada tahun 2012, CP merupakan salah satu persyaratan yang harus dipenuhi dalam standar akreditasi rumah sakit. Berdasarkan hasil wawancara singkat dengan Komite Medik 2017 , telah dilakukan evaluasi implementasi CP Apendistis akut dari sisi kendali mutu. Sedangkan sebagai kendali biaya, belum pernah dilakukan. Penelitian ini menggunakan metode Mix Methods. Sampel kuantitatif adalah rekam medis Appendisitis akut secara total sampling Juli 2016 ndash; Juni 2017, n=35. Sampel kualitatif adalah orang-orang yang terlibat implementasi CP Appendisitis akut dengan teknik purposive sampling.Dalam penelitian ini terdapat perbedaan antara tagihan pasien yang sesuai CP dan tidak sesuai CP, selisih antara tagihan total sesuai clinical pathway dan rata-rata tagihan total pasien paling besar ditemukan pada pasien kelas II sebesar 176 , sedangkan pada kelas III sebesar 65 dan kelas I sebesar 83. Besarnya selisih pada variabel outcome disebabkan oleh kepatuhan clinical pathway Variabel Output sebesar: 37 pasien untuk lama hari rawat, 94 pasien untuk tatalaksana medis, 29 pasien untuk medikasi dan pemeriksaan penunjang, 36 untuk konsultasi anastesi. Kepatuhan clinical pathway 100 hanya pada pemantauan medis dan nutrisi.

---

Acute Appendicitis is the 3rd largest surgical case in RS X. In 2012, Clinical Pathway is one of the requirements that must be met in the hospital 39 s accreditation standards. An evaluation of the implementation of Acute Appendicitis pathway has been conducted in terms of quality control. As for cost control, it has never been done.This research use Mix Methods. The quantitative sample is the medical record of Acute Appendicitis in total sampling July 2016 June 2017, n 35. In depth interviews to staffs who involved in the implementation of clinical pathway of acute appendicitis by purposive sampling technique.There is difference of patients bill between comply with and not comply with the clinical pathway. The difference between total bill according to the clinical pathway and the average total patient billing rate in class II patients was 176 , while in class III was 65 and class I was 83. The magnitude of the outcome variables was attributed to clinical pathway compliance 37 of patients for length of stay, 94 of patients for medical management, 29 for medication and investigation, 36 for anesthesia consultation. 100 clinical pathway compliance was found in medical monitoring and nutrition."

"

Analisis Pemanfaatan Clinical Pathway Sectio Caesaria Di Rumah Sakit Dalam Program Jaminan Kesehatan Nasional Penelitian ini bertujuan menganalisis hubungan antara faktor sosial ekonomi dan klinis ibu melahirkan Sectio Caesaria (SC) di Rumah Sakit (RS) dengan pemanfaatan Clinical Pathway (CP), outcome klinis serta pembayaran klaim. Studi desain Cross Sectional pada unit analisis 1155 data rekam medis ibu melahirkan SC periode 1 Januar-31 Desember 2018 di 3 RS. Hasil penelitian menunjukan pemanfaatan CP peserta Jaminan Kesehatan Nasional (JKN) yaitu sebanyak 939 Ibu melahirkan SC proporsinya sebesar 43.1% masih menunjukkan pemanfaatan yang kurang baik. Pemanfaatan CP terkait penyimpanan dokumen Clinical Pathway ibu melahirkan SC peserta JKN sebanyak 71.8% tidak tersimpan di Rekam Medis, 72.6% tidak lengkap pengisiannya dan 64.6% kondisi klinis Ibu melahirkan SC tidak sesuai dengan PPK RS. RS Pemda memiliki Proporsi tertinggi skor pemanfaatan CP yang kurang baik sebesar 76.8%, kemudian diikuti RSP (36.8%). RSNP menunjukkan proporsi skor pemanfaatan CP baik. Jenis RS (p=0.000), Kelas rawat (p=0.014) dan Rujukan (p=0.008), jenis SC (p=0.005), Usia Ibu (p=0.053), Paritas (p=0.016), Riwayat ANC (p=0.000), Kondisi Panggul p=0.000), kondisi plasenta (p=0.001), penyakit penyerta (p=0.000) dan riwayat SC (p=0.000) menunjukkan berhubungan secara signifikan dengan pemanfaatan CP (p<0.05). Pemanfaatan CP ibu melahirkan SC peserta JKN menunjukan adanya hubungan yang signifikan dengan Outcome klinis (p=0.002). Outcome Klinis ibu melahirkan SC menunjukkan sebesar 67.5% bermasalah antara lain terkait LOS yang tidak sesuai Panduan Praktek Klinis (PPK) RS, Ibu memiliki komplikasi klinis paska SC atau kondisi bayi saat dilahirkan tidak normal. Pemanfaatan CP berhubungan secara signifikan dengan pembayaran klaim (p=0.000). Pembayaran klaim ibu melahirkan SC peserta JKN bermasalah sebesar 39.3% terkait jangka waktu pembayaran klaim dari BPJSK ke pihak RS. Pembayaran klaim yang tidak bermasalah pada pemanfaatan CP yang kurang baik lebih banyak. Monitoring dan evaluasi yang komprehensif pada pemanfaatan CP, outcome klinis dan proses pembayaran klaim sebagai kendali mutu pelayanan ibu melahirkan SC dalam JKN oleh RS, Organisasi Profesi dan Pemerintah. Pemerintah harus membuat payung hukum yang bersifat operasional pada pemanfaatan CP Ibu melahirkan SC di RS dalam program JKN, sehingga kendali mutu dan kendali biaya pelayanan ibu melahirkan SC menjadi efektif dan efisien. Pedoman Nasional Pelayanan Kedokteran perlu segera diterbitkan dan disosialisikan ke Rumah Sakit. Kata kunci: SC, Sosial-ekonomi dan Klinis, Pemanfaatan Clinical Pathway, Outcome Klinis, Klaim Pembayaran

---

Analysis of Sectio Caesarea Clinical Pathway Utilization in Hospital Under National Health Insurance This study aims to analyze the relationship between socioeconomic and clinical factors of women giving birth to Sectio Caesaria (SC) in Hospitals (RS) with the utilization of Clinical Pathway (CP), clinical outcomes and claim payment. Cross Sectional design study in the 1155 unit of analysis of medical records of women giving birth to SC for the period January 1 to December 31, 2018 in 3 hospitals. The results showed that the utilization of CP for mothers giving birth to SC (939) participants of the National Health Insurance (JKN) from the 3 research study hospitals, the proportion of 43.1%, still showed poor utilization. Utilization of CP related to document keeping of mother who gave birth SC to JKN participants as much as 71.8% were not kept in the Medical Record, 72.6% were incomplete filling and 64.6% of clinical conditions of mother who gave birth to SC were not in accordance with PPK RS. Regional Government Hospital has the highest proportion of poor CP utilization scores of 76.8%, followed by RSP (36.8%). RSNP shows the proportion of good CP utilization scores. Type of hospital (p = 0.000), nursing class (p = 0.014) and type of referral (p = 0.008), type of SC (p = 0.005), maternal age (p = 0.053), parity (p = 0.016), ANC history (p = 0.000), Pelvic Conditions (p = 0.000), placental conditions (p = 0.001), comorbidities (p = 0,000) and history of SC (p = 0,000) showed significant correlation with CP utilization (p <0.05). Utilization of CP for mothers giving birth to SC JKN participants showed a significant relationship with clinical outcome (p = 0.002). Clinical Outcomes of mothers giving birth to SC showed that 67.5% had problems, among others related to LOS that was not in accordance with the Clinical Practice Guidelines (PPK) of the Hospital. CP utilization was significantly related to claim payment (p = 0,000). Claim Payment of mothers with SC under JKN participants was 39.3% related to the period of payment of claims from BPJSK to the hospital. The utilization of CP which were under score mean seems not having administration problem and paid by JKN earlier and without any problem. Comprehensive monitoring and evaluation of the utilization of CP , clinical outcomes and the process of claim as a quality control service for SC mothers in JKN by hospitals, professional organizations and the government. The government must make an operational legal policy on the utilization of CP for women giving birth to SC in hospitals under the JKN program, so that quality control and cost control of maternal care services for SC become effective and efficient. National Guidelines for Medical Services need to be immediately published and disseminated to hospitals. Keywords: SC, Socio-economic and Clinical, Clinical Pathway Utilization, Clinical Outcome, Payment Claims

"

"ABSTRAKTujuan: Menilai ekspresi protein Epidermal Growth Factor Receptor (EGFR) pada Karsinoma Sel Ginjal (KSG) serta kaitannya dengan faktor-faktor prediktor prognosis yang dinilai secara histopatologik (subtipe, staging histopatologik, derajat anaplasia inti Fuhrman)Metode: Studi potong lintang terhadap jaringan yang difiksasi formalin dan diletakkan di dalam parafin dari pasien-pasien dengan KSG, yang diwarnai menggunakan metode imunohistokimia terhadap protein EGFR. Hasil: Ekspresi EGFR pada membran ditemukan pada 46% dari keseluruhan kasus (N=41) dan ekspresi EGFR di sitoplasma ditemukan pada 49% dari keseluruhan kasus (N=41). Terdapat hubungan antara subtipe histopatologik dan derajat anaplasia inti Fuhrman dengan ekspresi EGFR di sitoplasma (nilai p 0,017 dan 0,014 dengan uji Fisher’s exact). Tidak ditemukan asosiasi antara staging histopatologik dengan ekspresi EGFR.Diskusi: Perlu dibuat penelitian lanjutan dengan membandingkan ekspresi EGFR terhadap angka kesintasan pasien serta dibandingkan dengan faktor prediktor prognosis yang lain. Kemaknaan lokasi ekspresi EGFR di sitoplasma juga memerlukan perhatian khusus dan pembuktian secara ilmiah.

---

ABSTRACTObjective: To study the expression of Epidermal Growth Factor Receptor protein in Renal Cell Carcinoma (RCC) and its relationship with prognostic predictor factors evaluated histopathologically (subtype, histopathological staging, Fuhrman nuclear grading). Methods: This was a cross-sectional study on 41 formalin-fixated paraffin-embedded tissue of patients with RCC, stained using immunohistochemical method against EGFR protein. Result: Membranous EGFR expression was found in 46% of cases (N=41), while cytoplasmic EGFR expression was found in 49% of cases. There was a significant association between histopathological subtype or Fuhrman nuclear anaplasia grading and cytoplasmic expression of EGFR (p value 0,017 and 0,014, respectively, using Fisher’s exact test). No significant association was found between histopathological staging and EGFR expressionDiscussion: A further study on the association EGFR expression and survival, and its comparison to other prognostic factors is necessary. The significance of EGFR expresion in the cytoplasm requires special attention and further scientific evidence."