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"ABSTRAK Latar Belakang: Malnutrisi berdampak besar pada pasien kanker sehingga harusdievaluasi dengan Patient-Generated Subjective Global Assessment (PG-SGA),namun memakan waktu dan membutuhkan tenaga kesehatan terlatih. Pengukurankekuatan genggam tangan (KGT) memiliki keuntungan lebih singkat dan mudahdibandingkan PG-SGA, tetapi belum ada data titik potong dan akurasi diagnostikKGT pada pasien kanker di Indonesia. Tujuan: Mendapatkan titik potong dan akurasi diagnostik KGT sebagai penapismalnutrisi pasien kanker rawat jalan di RSCM.Metode: Penelitian potong lintang ini dilakukan pada pasien 18-59 tahun dipoliklinik onkologi RSCM selama 4 Mei-1 Oktober 2015. Titik potong KGTdianalisis menggunakan kurva ROC. Akurasi diagnostik KGT dinilai denganmenghitung sensitivitas, spesifisitas, NDP, NDN, RKP, dan RKN.Hasil: Proporsi pasien dengan status nutrisi baik, malnutrisi sedang, danmalnutrisi berat adalah17,4%, 64,2%, dan 18,4%. Titik potong optimal KGT pasien kanker lelaki dan perempuan berturut-turut adalah ≤ 36,5 dan ≤ 21,5 kgfdengan sensitivitas 92,2% dan 73,9%, spesifisitas 54,6% dan 60,9%, NDP 92,2% dan 88,3%, NDN 54,6% dan 36,8%, RKP 2 dan 1,9, serta RKN 0,1 dan 0,4. Simpulan: Titik potong optimal KGT pasien kanker lelaki dan perempuanberturut-turut adalah ≤ 36,5 dan ≤ 21,5 kgf. Akurasi diagnostik KGT pasienkanker lelaki dan perempuan sebagai penapis malnutrisi berturut-turut dinilai baik dan sedang.ABSTRACT Background: Malnutrition has a huge impact on cancer patients and therefore ithas to be evaluated using PG-SGA, but there are limitations such as the timeconsumingnature and the need of trained health personnels. Measurement ofHGS is faster and easier, but there is no sufficient information regarding its cutoffpointand diagnosticaccuracyfor cancerpatientsin Indonesia.Aim:defining cut-off point and diagnostic accuracy of HGS as a malnutritionscreening modality for outpatient cancer population at RSCM.Method: A cross-sectional study was conducted at RSCM oncology outpatientclinic from May 4th-October 1st, 2015. Subjects were 18-59 years old. Cut-offpoint and diagnostic accuracy of HGS were analyzed to generate sensitivity,specificity, PPV, NPV, LR+, and LR- .Result: The proportion of well nourished, moderately malnourished, and severelymalnourished subjects were 17.4%, 64.2%, and 18.4%, respectively. The optimalHGS cut-off point in male and female cancer patients were ≤ 36.5 and ≤ 21.5 kgfrespectively with sensitivity 92.2% and 73.9%, specificity 54.6% and 60.9%,, PPV92.2% and 88.3%, NPV 54.6% and 36.8%, LR+ 2 and 1.9, and LR- 0.1 and 0.4. Conclusion: The optimal HGS cut-off point in male and female cancer patientswere ≤ 36.5 and ≤ 21.5 kgf, respectively. Diagnostic accuracy of HGS as amalnutrition screening modality in male and female cancer patients were good and moderately good.;Background: Malnutrition has a huge impact on cancer patients and therefore ithas to be evaluated using PG-SGA, but there are limitations such as the timeconsumingnature and the need of trained health personnels. Measurement ofHGS is faster and easier, but there is no sufficient information regarding its cutoffpointand diagnosticaccuracyfor cancerpatientsin Indonesia.Aim:defining cut-off point and diagnostic accuracy of HGS as a malnutritionscreening modality for outpatient cancer population at RSCM.Method: A cross-sectional study was conducted at RSCM oncology outpatientclinic from May 4th-October 1st, 2015. Subjects were 18-59 years old. Cut-offpoint and diagnostic accuracy of HGS were analyzed to generate sensitivity,specificity, PPV, NPV, LR+, and LR- .Result: The proportion of well nourished, moderately malnourished, and severelymalnourished subjects were 17.4%, 64.2%, and 18.4%, respectively. The optimalHGS cut-off point in male and female cancer patients were ≤ 36.5 and ≤ 21.5 kgfrespectively with sensitivity 92.2% and 73.9%, specificity 54.6% and 60.9%,, PPV92.2% and 88.3%, NPV 54.6% and 36.8%, LR+ 2 and 1.9, and LR- 0.1 and 0.4. Conclusion: The optimal HGS cut-off point in male and female cancer patientswere ≤ 36.5 and ≤ 21.5 kgf, respectively. Diagnostic accuracy of HGS as amalnutrition screening modality in male and female cancer patients were good and moderately good."

"Pasien rawat inap di rumah sakit dengan keganasan sering terjadi malnutrisi. Deteksi dini malnutrisi mempercepat terapi awal nutrisi sehingga mengurangi morbiditas dan mortalitas. Penelitian ini merupakan studi uji diagnostik membandingkan MST dan PG-SGA dengan SGA pada pasien kanker ginekologik rawat inap di RSUPN Cipto Mangunkusumo sebanyak 66 orang pada bulan April 2015. Pengumpulan data menggunakan formulir skrining, pemeriksaan fisik, dan pengukuran antropometri. MST memiliki sensitivitas 70%, spesifisitas 88%, PPV 90%, NPV 65%, AUC 0,79. PG-SGA mempunyai sensitivitas 100%, spesifisitas 92%, PPV 95%, NPV 100%, AUC 0,96. Terdapat perbedaan signifikan lama waktu pengerjaan di antara ketiganya, dengan waktu tercepat dimiliki oleh MST. Prevalensi malnutrisi berdasarkan SGA sebesar 60,6%. PG-SGA merupakan alat skrining yang sesuai dalam mendeteksi malnutrisi pasien kanker ginekologik rawat inap.

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Malnutrition is a common problem in hospitalized patients with malignancies. Early recognition of malnutrition leads to appropriate nutritional care plans and reduces rate of both morbidity and mortality. This diagnostic test study which comparing between MST and PG-SGA against SGA, was conducted on 66 hospitalized gynecologic cancer patients in April 2015. Data collection was obtained using screening tool forms, physical examination, and anthropometric measurement. According to SGA, 60.6% of patients were malnourished. MST had a sensitivity of 70% and a specificity of 88%. The PPV of MST was 90%, NPV 65%, and AUC value was 0.79. PG-SGA had a sensitivity of 100% and a specificity of 92%. The PPV of PG-SGA was 95%, NPV 100%, and AUC value was 0.96. There were a significant difference in time spent applying questionnaires between these screening tools, and MST had the quickest among three. PG-SGA is suitable screening tool for detecting risk of malnutrition in hospitalized patients with gynecologic cancer."

"Malnutrisi sering dialami oleh pasien kanker dan dapat menyebabkan penurunan kualitas hidup. Oleh karena itu, identifikasi awal pasien yang berisiko malnutrisi harus dilakukan pada semua pasien kanker, namun hingga saat ini, belum ada baku emas alat skrining yang digunakan di bagian rawat jalan radioterapi. Penelitian ini merupakan studi potong lintang yang dilakukan untuk membandingkan skrining malnutrisi Malnutrition Screening Tool (MST) dan Abridged Patient-Generated Subjective Global Assessment (abPG-SGA) pada 144 pasien kanker yang akan menjalankan radioterapi di RSUPNCM, dengan Patient- Generated Subjective Global Assessment (PG-SGA) sebagai baku emas. Didapati sebanyak 41% pasien berisiko malnutrisi (PG-SGA). Skrining MST dinilai mudah dan cepat dengan rerata waktu pengerjaan 21 detik, dan memiliki nilai sensitivitas 84,75%, spesifisitas 77,65%, nilai prediksi positif (NPP) 0,73, nilai prediksi negatif (NPN) 0,88, dan nilai area under the ROC curve (AUC) 0,812. Skrining abPG-SGA memiliki sensitivitas 98,31%, spesifisitas 92,94%, NPP 0,91, NPN 0,99, AUC 0,956, dan rerata waktu pengerjaan 2 menit 24 detik. Kesimpulan yang dapat diambil adalah abPG-SGA merupakan alat skrining yang lebih baik dan akurat untuk digunakan di bagian rawat jalan radioterapi.

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Malnutrition is common among cancer patients and can lead to decreased quality of life. Therefore, early identification of patients at risk of malnutrition should be performed in all cancer patients, but until now, there is no gold standard of nutrition screening tool that should be used in outpatient radiotherapy setting. This study was a cross-sectional study conducted to compare Malnutrition Screening Tool (MST) and Abridged Patient-Generated Subjective Global Assessment (abPG-SGA) as nutrition screening tools in 144 radiotherapy outpatients against Patient-Generated Subjective Global Assessment (PG-SGA) as the gold standard. Forty-one percent of patients were at risk of malnutrition (PG- SGA). The MST was a simple and quick tool with an average of 21 seconds. It had 84.75% sensitivity, 77.65% specificity, positive predictive value (PPV)=0.73, negative predictive value (NPV)=0.88, and area under the ROC curve (AUC)=0.812. The abPG-SGA yielded 98.31% sensitivity, 92.94% specificity, PPV=0.91, NPV=0.99, AUC=0.956, and it took an average of 2 minutes 24 seconds. In conclusion, the abPG-SGA is a better and more accurate screening tool in outpatient radiotherapy setting."

"Tujuan penelitian ini adalah untuk mengetahui korelasi antara penilaian risiko malnutrisi menggunakan skor PG-SGA dengan kadar CRP serum sehingga dapat digunakan untuk memprediksi tingkat inflamasi pada pasien kanker kepala dan leher stadium I_IV guna mencegah terjadinya kaheksia. Malnutrisi hingga kaheksia pada kanker terjadi karena interaksi faktor tumor, faktor pejamu dan faktor-faktor lainnya. Faktor tumor berupa sitokin pro-inflamasi akan memicu respons pejamu untuk memproduksi protein fase akut seperti CRP. Protein fase akut memerlukan sejumlah substrat yaitu asam amino yang berasal dari otot rangka. Otot rangka akan mengalami degradasi sehingga menyebabkan wasting otot rangka. Oleh karena itu, CRP selain dapat digunakan sebagai marker inflamasi sistemik juga dapat digunakan sebagai salah satu indikator faktor risiko yang berperan dalam terjadinya malnutrisi dan kaheksia. Efek wasting otot rangka yang ditimbulkan secara tidak langsung oleh CRP dapat dinilai dengan terdapatnya penurunan BB maupun berkurangnya massa otot yang juga merupakan komponen dalam penilaian PG-SGA. Penelitian ini merupakan studi potong lintang dengan menggunakan consecutive sampling yang melibatkan 51 subjek kanker kepala dan leher stadium I_IV yang belum mendapatkan terapi. Hasil penelitian didapatkan rerata usia 46,6 13,9 tahun, sebanyak 76,5 berjenis kelamin laki-laki. Kanker nasofaring merupakan kanker terbanyak 80,4 , dan stadium terbanyak yaitu stadium IVA. Rerata indeks massa tubuh IMT yaitu 20,6 4,0 kg/m2, dan sebanyak 37,3 subjek berada pada IMT normal. Berdasarkan skor PG-SGA sebanyak 64,7 subjek berisiko tinggi malnutrisi dengan rerata skor PG-SGA 11,7 6,2. Nilai median CRP yaitu 6,4 0,4_170,4 . Penelitian ini memperoleh korelasi positif yang signifikan antara skor PG-SGA dengan kadar CRP serum dengan kekuatan korelasi lemah r = 0,372; p = 0,007.

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The purpose of this study was to determine the correlation between the malnutrition risk assessment using PG SGA score with serum CRP levels so that it can be used to predict the levels of inflammation in head and neck cancer patients stage I IV to prevent cachexia. Malnutrition and cancer cachexia occurs due to the interaction of tumor factors, host factors and other factors. Tumor factors such as pro inflammatory cytokines will trigger a response of the host to produce acute phase proteins such as CRP. Acute phase protein which require a number of amino acids derived from skeletal muscle. Skeletal muscles will be degraded, causing skeletal muscle wasting. Therefore, CRP can be used as a marker of systemic inflammation and can be used as one indicator of the risk factors also that contribute to malnutrition and cachexia. Effect of skeletal muscle wasting which caused indirectly by the CRP can be assessed by the weight loss and reduced muscle mass which is a component in the assessment of PG SGA also. This study is a cross sectional study using consecutive sampling, 51 subjects head and neck cancer stage I IV who had not received treatment participated in this study. Data showed the mean age of subjects was 46.6 13,9 years, and 76 were male. Most cancer sites were as nasopharyngeal 80,4, and mostly in stage IVA. The mean body mass index BMI is 20,6 40 kg m2, with most of the BMI is normal 37,3. Based on PG SGA score 64,7 of the subjects at high risk of malnutrition, and the PG SGA mean score is 11,7 6,2. The median value of CRP is 6,4 0,4 170,4. The result of this study showed a significant positive correlation between PG SGA score with serum CRP levels with the strength of correlation is weak r 0,372 p 0,007. "

"Penelitian ini bertujuan untuk mengetahui alat skrining malnutrisi yang sesuai untuk pasien kanker dewasa rawat inap pra bedah sehingga malnutrisi cepat dikenali dan dapat diberikan dukungan nutrisi secara dini. Penelitian ini merupakan uji diagnostik alat skrining Malnutrition Screening Tool (MST) dan Royal Marsden Nutrition Screening Tool (RMNST) dengan Subjective Global Assessment (SGA) sebagai pembanding terhadap 58 pasien kanker rawat inap pra bedah yang masuk rumah sakit kurang dari 24 jam. Sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), dan area under the curve (AUC) dihitung untuk mengetahui metode yang paling baik diantara dua alat skrining dibanding standar baku. Hasil penelitian didapatkan prevalensi malnutrisi berdasarkan SGA sebesar 34,6%. Sensitivitas, spesifisitas, NDP, NDN, dan AUC MST berturut-turut adalah 88.9%, 97%, 94,12%, 94,28%, dan 93% sedangkan sensitivitas, spesifisitas, NDP, NDN, dan AUC RMNST masing-masing adalah 94.4%, 82.35%, 73,9%, 96,55%, and 88%. Hal ini menunjukkan bahwa RMNST lebih baik dibanding MST dalam menapis malnutrisi pada pasien kanker rawat inap pra bedah.

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This study aimed to determine malnutrition screening tool which appropriate for adult hospitalized pre-surgical cancer patients, therefore, malnutrition could be recognized quickly and nutritional intervention could be provided at an early stage. This study was a diagnostic test of Malnutrition Screening Tool (MST) and the Royal Marsden Nutrition Screening Tool (RMNST) compared to Subjective Global Assessment (SGA) on 58 cancer pre-surgical inpatients who were admitted to the hospital less than 24 hours. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the curve (AUC) were calculated to evaluate the perfomance of tools compared the standard. The result showed that the prevalence of malnutrition by SGA was 34.6%, the sensitivity, specificity, PPV, NPV, and AUC of MST were 88.9%, 97%, 94,12%, 94,28%, and 93% respectively while the sensitivity, specificity, PPV, NPPV, and AUC of RMNST were 94.4%, 82.35%, 73,9%, 96,55%, and 88% respectively. This indicated that RMNST better than MST in screening malnutrition in the cancer pre-surgical inpatients."

"Pasien kanker serviks berisiko tinggi mengalami malnutrisi. Asupan makanan yang tidak adekuat, peningkatan kebutuhan, penurunan aktivitas fisik dan hiperkatabolisme, mendorong terjadinya malnutrisi. Kondisi ini dapat terjadi selama sakit maupun pada saat pengobatan, yang dapat memengaruhi status gizi pasien. Prevalensi malnutrisi pada pasien kanker serviks sebesar 48−66% dan meningkat hingga 82% setelah mendapat terapi. Pasien kanker serviks, 25% mengalami cachexia dan 33−69% mengalami sarkopenia. Penurunan massa otot yang merupakan penyusun utama massa bebas lemak (MBL), secara negatif memengaruhi efektivitas terapi dan kelangsungan hidup pasien. Bioelectrical impedance analysis (BIA) adalah alat tervalidasi untuk mengukur MBL sebagai bagian dari diagnosis malnutrisi, namun tidak selalu tersedia di fasilitas kesehatan. Penelitian menunjukkan bahwa kekuatan genggam tangan (KGT) dapat dijadikan sebagai prediktor MBL. Pengukuran KGT dengan handheld dynamometers (HHD) yang relatif murah, valid, dan andal, masih jarang digunakan. Penelitian ini bertujuan untuk melihat hubungan antara KGT dan MBL pada pasien kanker serviks yang menjalani radioterapi di Poliklinik Radioterapi RSCM. Penelitian menggunakan desain potong lintang pada subjek usia 18−60 tahun. KGT dinilai menggunakan Jamar digital HHD. MBL dinilai menggunakan BIA single frequency Omron® HBF−375. Terdapat 54 subjek dengan median usia 49 tahun, mayoritas stadium III, tidak terdapat metastasis dan komorbid, dan mendapat radioterapi saja. Mayoritas subjek tergolong BB lebih, dengan rerata asupan energi 20,79 ± 6,70 kkal/kgBB/hari, median asupan protein 0,68 (0,05−1,87) g/kgBB/hari, dan rerata asupan lemak 31,22 ± 8,81% dari energi total. Mayoritas asupan energi, protein dan lemak tergolong kurang dibandingkan dengan rekomendasi ESPEN. Rerata KGT 23,54 ± 5,16 kg dan rerata MBL 36,40 ± 6,03 kg. Dilakukan uji korelasi antara KGT dan MBL. Terdapat korelasi positif yang cukup antara KGT dan MBL pada pasien kanker serviks yang menjalani radioterapi (r = 0,346, p = 0,010). KGT berkorelasi positif kuat dengan MBL (r = 0,601, p = 0,001) pada pasien kanker serviks yang hanya menjalani radioterapi (n=28). Pemeriksaan KGT kemungkinan dapat memprediksi MBL, sehingga dapat membantu diagnosis malnutrisi lebih dini dan mencegah luaran buruk pada pasien kanker serviks yang menjalani radioterapi, terutama di fasilitas kesehatan yang tidak tersedia BIA. Penelitian lebih lanjut diperlukan untuk mendapatkan formulasi dalam memprediksi MBL dari KGT.

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Cervical cancer patients are at high risk for malnutrition. Inadequate food intake, increased energy and protein requirements, decreased physical activity and hypercatabolism in cancer patients lead to malnutrition. This condition can occur during illness or during treatment, which can affect the nutritional status of the patient. The prevalence of malnutrition in cervical cancer patients was 48−66% and increased to 82% in patients receiving therapy. Patients with cervical cancer, 25% were cachectic and 33%–69% were sarcopenic. Loss of muscle mass, which are the main constituents of fat free mass (FFM), negatively impact therapeutic efficacy and survival in cervical cancer patients. Bioelectrical impedance analysis (BIA) is a validated tool for measuring FFM, as part of malnutrition, but it is not always available in health facilities. Research shows that hand grip strength (HGS) can be used as a predictor of FFM. HGS measurement with handheld dynamometers (HHD) which is relatively cheap, valid, and reliable, is still rarely used. This study aims to examine the relationship between HGS and FFM in cervical cancer patients undergoing radiotherapy at the Radiotherapy Outpatients Clinic of Dr. Cipto Mangunkusumo Hospital. The study used a cross-sectional design on subjects aged 18−60 years. HGS was assessed using a Jamar digital hand dynamometer. FFM was assessed using the BIA single frequency Omron® HBF−375. A total of 54 study subjects with a median age of 49 years, the majority were in stage III, had no metastases, received radiation therapy only, and had no comorbidities. Most of the subjects were classified as overweight and obes, with a mean of energy intake 20.79 ± 6.70 kcal/kgBW/day, a median of protein intake 0.68 (0.05−1.87) g/kgBW/day, and an average of fat intake 31.22 ± 8.81% of the total energy. The majority of the energy, protein and fat intakes were less than the ESPEN recommendations. The mean HGS in the subjects was 23.54 ± 5.16 kg and the mean FFM was 36.40 ± 6.03 kg. Correlation test was conducted between HGS and FFM. There was a moderately positive correlation between HGS and KGT in cervical cancer patients undergoing radiotherapy (r = 0.346, p = 0.010). HGS was strongly positive correlation with FFM (r = 0.601, p = 0.001) in cervical cancer patients undergoing radiotherapy only (n=28). HGS maybe able to predict FFM for early diagnose of malnutrition and prevent poor outcomes in cervical cancer patients undergoing radiotherapy, especially in health facilities where BIA isn’t available. Further research is needed to get a formulation in predicting FFM from HGS."

"Subjective Global Assessment (SGA) dan Nutritional Risk Screening (NRS) 2002 merupakan alat skrining malnutrisi yang bertujuan untuk mendeteksi passien yang mengalami malnutrisi maupun berisiko malnutrisi. Dampak malnutrisi terhadap pasien dan rumah sakit, antara lain memperpanjang lama perawatan, meningkatkan morbiditas dan mortalitas pasien, serta bertambahnya biaya pengobatan rumah sakit. Dalam penelitian ini dilakukan pengujian terhadap alat skrining tersebut pada pasien bedah rawat inap di Ruang Rawat Bedah Gedung A RSUP Nasional Dr. Cipto Mangunkusumo (RSUPNCM ) dan membandingkan kedua hasilnya. Penelitian ini bertujuan untuk mengetahui prevalensi malnutrisi pasien bedah dewasa rawat inap dan mengetahui metode skrining yang tepat dan praktis untuk mendeteksi pasien berisiko malnutrisi. Secara khusus, penelitian ini bertujuan mengetahui spesifisitas dan sensitivitas metode skrining NRS-2002, serta waktu pelaksanaan skrinng tersebut. Penelitian ini merupakan studi potong lintang pada pasien bedah dewasa rawat inap di RSUPNCM yang memenuhi kriteria penelitian dengan jumlah sampel 75 orang. Seluruh instrumen penelitian divalidasi sebelum pengambilan data. Pengumpulan data meliputi wawancara menggunakan kuesioner dan formulir metode skrining malnutrisi, pengukuran berat badan dan tinggi badan estimasi serta penilaian indeks masa tubuh. Didapatkan prevalensi malnutrisi sebesar 40% pada pasien bedah dewasa rawat inap di RSUPNCM dengan sensitivitas NRS 83,3% dan spesifisitas 100%. Jumlah penderita malnutrisi yang tertinggi berada pada kelompok umur >60 tahun ( p = 0,04) dengan kasus bedah gastrointestinal yang malnutrisi lebih banyak signifikan (p = 0,008) dibandingkan dengan kasus bedah non gastrointestinal serta waktu pelaksanaan berbeda signifikan antara SGA dan NRS 2002 (p = 0,00).

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The Subjective Global Assessment (SGA) and Nutritional Risk Screening (NRS) 2002 are screening tools aimed at detecting malnourished individuals and those at risk for malnutrition. The consequences of malnutrition for both patient and hospital include prolonged hospital length of stay, increased morbidity and mortality rate, and high hospital expenses.

In this study we examined the applicability of those screening tools in surgery hospitalized patients at Gedung A RSUP Nasional Dr. Cipto Mangunkusumo (RSUPNCM ) and compared the result.

The aim of this study is to investigate the prevalence of malnutrition in Dr. Cipto Mangunkusumo general hospital and to determine which screening tools is more appropriate and practical for identifying the risk of malnutrition. Particularly, this study is to determine specificity, sensitivity and time consuming of the NRS 2002. The study is a cross-sectional study at surgery hospitalized patient in RSUPNCM and icluded 75 patients. All of the instruments will be validated prior to data collection, which includes interview using questionnaire and malnutrition tools form, weight and height estimated measurements and the assessment of body mass index.

The prevalence of malnutrition at surgery hospitalized patient in RSUPNCM was 40% with the sensitivity and the specificity of the NRS 2002 were 83,3% and 100% consecutively. The malnourished patients were significantly higher in the age group >60 years old (p= 0,04) with cases of gastrointestinal surgery more significant (p=0,08) compared with the case of non-gastrointestinal surgery as well as the time consuming significantly different between SGA and NRS 2002 (p=0,00)."

"Malnutrisi sering pada karsinoma hepatoselular (KHS), diakibatkan oleh anoreksia, penurunan asupan serta keadaan katabolik. Serial kasus bertujuan memberikan terapi gizi guna proses penyembuhan dan memperbaiki kualitas hidup. Empat orang pasien berusia 42–67 tahun, dengan KHS, penurunan berat badan 14,3–29,6% selama dua bulan hingga satu tahun. Tiga orang pro reseksi dan satu orang mendapat terapi paliatif dengan kanker kaheksia. Pemberian nutrisi disesuaikan keadaan klinis. Kebutuhan kalori berdasarkan Harris-Benedict. Sebelum pembedahan kebutuhan kalori total tercapai Setelah pembedahan, toleransi asupan baik, nutrisi ditingkatkan bertahap. Saat pulang keadaan umum stabil, kapasitas fungsional membaik, luka operasi baik.

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Malnutrition is common in hepatocellular carcinoma (HCC), caused by anorexia, decreased intake and catabolic state. The aim of this case series provide nutrition therapy to support the healing process and to improve quality of life. Patients were four people, age between 42–67 years, with HCC, weight loss 14,3–29,6 % for two months to one year. Three people with pro resection and one person had palliative therapy and cachexia cancer. Nutrition was given according to clinical state. Calorie requirement was based on Harris-Benedict. Total calorie needs was achieved prior to surgery, and good tolerance intake after surgery, nutrition enhanced gradually. Patients discharge from hospital with stable general condition, improved functional capacity, and good surgical wound healing."

"Peran seorang apoteker di rumah sakit salah satunya yaitu pemantauan terapi obat pasien. Pemantauan terapi obat dilakukan untuk menganalisa masalah terkait obat atau Drug Related Problem (DRP) yang terjadi pada pasien selama masa perawatan di rumah sakit. Dalam hal ini dilakukan pemantauan terapi obat pada salah satu pasien di RSUP Persahabatan dengan diagnosis Kanker Nasofaring T4N3M0 dengan Malnutrisi High Risk Refeeding Syndrome dan Penurunan Kesadaran Akibat Suspek Metastasis Intrakranial. Pasien kanker nasofaring (KNF) sering mengalami malnutrisi dengan prevalensi 35% dan sekitar 6,7% mengalami malnutrisi berat. Kejadian malnutrisi pada pasien KNF dipengaruhi oleh efek kemoradiasi terutama komplikasi oral berupa disfagia dan xerostomia. Maka dari itu, pasien yang mengalami malnutrisi membutuhkan asupan nutrisi yang cukup. Namun, pemberian nutrisi pada pasien malnutrisi dapat berisiko terjadinya Refeeding Syndrome (RFS). Refeeding Syndrome terjadi ketika pemberian nutrisi yang berlebih pada pasien malnutrisi kronik dalam waktu yang terlalu cepat atau singkat. Malnutrisi juga dapat ditandai dengan rendahnya kadar elektrolit dalam tubuh seperti hiponatremia, hipokalemia, hipomagnesia, hipofosfatemia, dan hipokalsemia. Oleh karena itu, pasien malnutrisi perlu dilakukan pemantauan kadar elektrolit dan asupan nutrisinya agar tetap seimbang serta pemantauan terapi pengobatan lainnya yang diterima pasien. Masalah terkait obat (MTO) yang ditemukan dalam proses pengobatan pasien meliputi ada indikasi tanpa obat, pemilihan obat kurang tepat, dan dosis terlalu tinggi. Peneliti memberikan rekomendasi terapi pada setiap MTO yang ditemukan selama masa perawatan pasien serta melakukan pemantauan terapi hingga obat dikonsumsi oleh pasien.

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One of the roles of a pharmacist in a hospital is monitoring patient drug therapy. Monitoring drug therapy is carried out to analyze drug-related problems or Drug Related Problems (DRP) that occur in patients during the hospital treatment period. In this case, drug therapy monitoring was carried out on one of the patients at Friendship Hospital with a diagnosis of Nasopharyngeal Cancer T4N3M0 with Malnutrition High Risk Refeeding Syndrome and Decreased Consciousness Due to Intracranial Metastatic Suspects. Nasopharyngeal cancer (KNF) patients often experience malnutrition with a prevalence of 35% and about 6.7% experience severe malnutrition. The incidence of malnutrition in KNF patients is influenced by the effects of chemoradiation, especially oral complications in the form of dysphagia and xerostomia. Therefore, patients who experience malnutrition need adequate nutritional intake. However, providing nutrition to malnourished patients can be at risk of Refeeding Syndrome (RFS). Refeeding Syndrome occurs when overnutrition in chronically malnutrition patients is too fast or short. Malnutrition can also be characterized by low levels of electrolytes in the body such as hyponatremia, hypokalemia, hypomagnesemia, hypophosphatemia, and hypocalcemia. Therefore, malnutrition patients need to monitor electrolyte levels and nutritional intake to remain balanced and monitor other treatment therapies received by patients. Drug-related problems (MTO) found in the patient's treatment process include no drug indications, improper drug selection, and too high doses. Researchers provide therapy recommendations on each MTO found during the patient's treatment period and monitor therapy until the drug is consumed by the patient."

"Keakuratan dari skrining risiko malnutrisi merupakan hal yang penting untuk memberikan dukungan gizi yang optimal yang sesuai bagi kondisi pasien sebagai salah satu upaya untuk mencegah kejadian malnutrisi di rumah sakit dan mempercepat proses penyembuhan. Berdasarkan hal tersebut, menjadi suatu hal yang penting untuk mengetahui validitas alat skrining risiko malnutrisi yang digunakan. Penelitian ini bertujuan untuk mengetahui validitas dan reliabilitas MST pada pasien rawat inap dewasa di RSCM, Jakarta. Penelitian ini merupakan penelitian obervasional dengan desain studi cross sectional. Sampel dalam penelitian ini berjumlah 105 pasien rawat inap dewasa di RSCM. Semua pasien dilakukan skrining menggunakan MST dan SGA oleh observer dan tenaga kesehatan lain. Validitas MST ditentukan dengan mengetahui nilai sensitivitas dan spesifisitas yang dibandingkan dengan SGA. Inter-rater reliability ditentukan dengan nilai kappa ? untuk mengetaui tingkat kesepakatan antar obsever. Prevalensi malnutrisi berdasarkan MST adalah 46,47 untuk malnutrisi ringan, 40 untuk malnutrisi sedang, dan 13,33 untuk malnutrisi berat. Prevalensi malnutrisi berdasarkan SGA adalah 47,62 untuk malnutrisi ringan, 37,15 untuk malnutrisi sedang, dan 15,23 untuk malnutrisi berat. Kemudian apabila dibandingkan dengan SGA, MST memiliki sensitivitas dan spesifisitas masing-masing 96 dan 98,2 untuk malnutrisi ringan, 94,9 dan 92,4 untuk malnutrisi sedang, serta 81,3 dan 98,9 untuk malnutrisi berat. Reliabilitas antar observer MST adalah 0,492 untuk malnutrisi ringan, 0,315 untuk malnutrisi sedang, dan 0,437 untuk malnutrisi berat. Berdasarkan hasil penelitian ini, MST direkomendasikan untuk mengidentifikasi risiko malnutrisi pada pasien dewasa. Namun diperlukan evaluasi dan pelatihan yang berkelanjutan terhadap tenaga kesehatan yang menggunakan alat skrining ini.

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The accuracy of nutritional screening are necessary to ensure the provision of optimal nutrition support for the patient to prevent hospital malnutrition and speed up the healing process. Thus, it is necessary to validate the nutrition screening tool used. The present study determined validities and reliabilities of MST among adult patients at risk of malnutrition at RSCM, Jakarta.

This is an observational study with cross sectional design. The subjects were 105 adult patients admitted to RSCM. All patients were screened using the MST and SGA by the observer and other health care workers. The validity of the MST will be tested by measuring the sensitivity and specificity of MST were conducted against the SGA. Inter rater reliability was evaluated using kappa value to determine the level of agreement between raters. A total of 105 adult patients participated in this study. Prevalence of malnutrition according to MST was 46,47 for mild malnutrition, 40 for moderate malnutrition, and 13,33 for severe malnutrition.

Prevalence of malnutrition according to SGA was 47,62 for mild malnutrition, 37,15 for moderate malnutrition, and 15,23 for severe malnutrition. As compared to SGA, MST had a sensitivity and specificity 96 and 98,2 for mild malnutrition, 94,9 and 92,4 for moderate malnutrition, and 81,3 and 98,9 for severe malnutrition, respectively. The inter rater reliability of MST was 0,492 for mild malnutrition, 0,315 for moderate malnutrition, and 0,437 for severe malnutrition. MST is a simple, quick and valid tool which can be used to identify patients at risk of malnutrition. Based on our result, MST is recommended for use in identifying adult patients. It can be used as a malnutrition screening tool but there is a need to evaluate and train the health care workers who use this tools."