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"Stroke dapat menyebabkan penurunan status fungsional jika pasien tidak menjalani rehabilitasi terutama pada fase sub-akut. Penelitian ini bertujuan mengidentifikasi faktor yang berhubungan dengan penurunan status fungsional pada pasien stroke fase sub-akut. Penelitian kuantitatif ini menggunakan pendekatan cross-sectional. Hasil penelitian menunjukkan bahwa rerata pasien stroke mengalami ketergantungan sedang dalam melakukan aktivitas fungsional. Faktor-faktor yang berhubungan dengan penurunan status fungsional pada pasien stroke fase sub-akut yaitu usia (p=0,042), jenis kelamin (p=0,000), derajat keparahan (p=0,041), lokasi lesi (p=0,000), fatigue (p=0,023), status kognitif (p= 0,023), dan dukungan sosial (p= 0,037). Tipe stroke diketahui tidak berhubungan dengan penurunan status fungsional (p=0,312). Lokasi lesi merupakan faktor yang paling berhubungan dengan penurunan status fungsional (p=0,010). Penelitian ini diharapkan dapat digunakan sebagai dasar pengkajian dalam asuhan keperawatan pasien stroke fase sub-akut dalam rangka mengetahui masalah terkait status fungsional.

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Stroke can cause a decrease in functional status if the patient does not undergo rehabilitation especially in the sub-acute phase. This study aims to identify factors associated with decreased functional status in sub-acute stroke patients. This quantitative research uses a cross-sectional approach. The results of the study show that the average stroke patient has a moderate dependence on performing functional activities. Factors associated with decreased functional status in sub-acute stroke patients were age (p = 0.042), sex (p = 0.000), severity (p = 0.041), location of the lesion (p = 0,000), fatigue ( p = 0.023), cognitive status (p = 0.023), and social support (p = 0.037). Type of stroke was known not to be associated with a decrease in functional status (p = 0.312). The location of the lesion was the factor most associated with a decrease in functional status (p = 0.010). This research is expected to be used as a basis for the assessment of nursing care for sub-acute stroke patients in order to identify problems related to functional status."

"Latar belakang: Beberapa studi telah melaporkan bahwa banyak pasien stroke berat mengalami sepsis selama fase akut, hal ini berpengaruh pada luaran yang buruk. Pada stroke, terjadi pergeseran dari predominasi limfosit Th1 yang memiliki karakter proinflamasi menjadi predominasi limfosit Th2 yang dapat mengaktifasi respon antiinflamasi yang dapat berakibat pada menurunnya respon imun terhadap invasi patogen.Tujuan: Penelitian ini bertujuan menilai apakah rasio netrofil terhdap limfosit (RNTL) dapat memprediksi berkembangnya kejadian sepsis pada pasien stroke akut.Metode: melakukan penilaian pada pasien stroke akut yang dirawat di Unit Perawatan Intensif (UPI) RSUP Fatmawati sejak September 2019 sampai Mei 2020.Hasil: Rata–rata RNTL pada pasien stroke akut selama perawatan di UPI 16,8 ± 12,5. Dilakukan uji Mann–Whitney, didapatkan mean rank dari beberapa parameter RNTL seperti RNTL awal, RNTL hari ke–3 , RNTL tertinggi, dan delta RNTL (dRNTL) pada pasien stroke akut di UPI berkaitan dengan kejadian sepsis. Terdapat perbedaan nilai median pada RNTL hari ke–3, RNTL tertingggi, dan dRNTL pada kelompok stroke yang mengalami sepsis dengan kelompok stroke yang tidak mengalami sepsis.Kesimpulan: RNTL diperkirakan dapat menjadi penanda awal yang potensial terjadinya sepsis pada stroke akut, sehingga dapat menghindari keterlambatan diagnosa dan tatalaksana sepsis pasa pasien stroke sakit kritis.

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BACKGROUND: Several studies have reported that many severe stroke patients developed sepsis during their acute phase, which leads to poor outcomes. In stroke, there is a shift from predominant Th1 lymphocytes, which have proinflammatory characteristics, to predominant Th2 lymphocytes which activate anti-inflammatory responses that induce hyporesponsiveness of the immune system against an invasion of pathogen, known as stroke-induced immunodepression syndrome.

AIM: This study aims to examine whether the neutrophils-to-lymphocytes ratio (NLR) could predict the development of sepsis in acute stroke patients.

METHODS: Patients were admitted to Fatmawati hospital intensive care unit from September 2019 to May 2020.

RESULTS: The mean NLR of acute stroke patients during their stay in ICU was 16.8 ± 12.5. We performed Mann– Whitney test, which revealed that the mean rank of several NLR parameters, such as initial NLR, day-3 NLR, highest NLR, and dNLR in stroke patients at ICU, was associated with the incidence of sepsis. The median difference in day-3 NLR, highest NLR, and dNLR in the stroke group with sepsis differed from those of the non-sepsis group.

CONCLUSION: NLR is assumed to have potential as an early predictor to distinguish septic conditions from non- septic conditions, to prevent delay in establishing diagnosis and management of sepsis, especially in acute, critically- ill stroke patients."

"ABSTRAK Latar Belakang. Pneumonia sering menjadi komplikasi medis yang timbul pada pasien-pasien stroke iskemik akut yang dirawat di rumah sakit, sehingga diperlukan suatu sistem skor yang valid dan mudah diterapkan untuk memprediksi dan menstratifikasi risiko timbulnya pneumonia pada pasien stroke iskemik akut. Tujuan. Menilai performa kalibrasi dan diskriminasi skor A2DS dalam memprediksi insiden pneumonia pada pasien stroke iskemik akut Metode. Penelitian dengan desain kohort retrospektif menggunakan rekam medik pasien stroke iskemik akut di ruang rawat neurologi dan stroke unit gedung A RSCM periode Januari 2014 ndash; Desember 2016 dengan metode total sampling. Usia, ada tidaknya fibrilasi atrium pada EKG, ada tidaknya disfagia, jenis kelamin laki-laki , dan tingkat keparahan stroke dinilai dengan NIHSS , dinilai pada awal perawatan di RSCM. Pasien diikuti hingga 7 hari sejak onset stroke iskemik untuk dilihat outcome-nya pneumonia atau tidak pneumonia . Performa kalibrasi skor A2DS2 dinilai dengan uji Hosmer-Lemeshow dan plot kalibrasi. Performa diskriminasi skor A2DS2 dinilai dengan Area Under The Curve AUC . Hasil. Sebanyak 281 subjek diikutsertakan ke dalam penelitian ini, dengan angka kejadian pneumonia dalam 7 hari sejak onset timbulnya stroke iskemik sebanyak 118 subjek 42 . Hosmer-Lemeshow menunjukkan p = 0,222. Plot kalibrasi menunjukkan koefisien korelasi r=0,982 dengan p = 0,000. AUC sebesar 0,885 IK95 0,845 - 0,924 .ABSTRACT Pneumonia is the leading cause of morbidity and mortality in acute ischemic stroke patients admitted to hospital. Thus required a valid scoring system which is easy to apply, to predict and stratify the risk of pneumonia in patients with acute ischemic stroke. Aim. To assess the performance of calibration and discrimination of A2DS2 score in predicting the incidence of pneumonia in patients with acute ischemic stroke who are hospitalized in Cipto Mangunkusumo National General Hospital. Methods. This was a retrospective cohort study of adult acute ischemic stroke patients who are hospitalized in Cipto Mangunkusumo Hospital. Age, presence or absence of atrial fibrillation, presence or absence of dysphagia, Sex male , and stroke severity rated with NIHSS were obtained at the beginning of admission. The subjects were followed up for up to 7 days after the onset of ischemic stroke to assess the outcome pneumonia or not . Calibration properties of A2DS2 score were assessed by Hosmer Lemeshow test and calibration plot. Discrimination properties of A2DS2 score were assessed by the area under the curve AUC . Results A total of 281 subjects were followed up. The incidence of pneumonia in acute ischemic stroke patients was observed in 118 patients 42 . Hosmer Lemeshow test of A2DS2 score showed p 0,222 and calibration plot showed r 0,982. Discrimination of A2DS2 score was shown by the AUC value of 0,885 95 CI 0,845 0,924 . Conclusion A2DS2 score have a good calibration and discrimination performance in predicting incidence of pneumonia in patients with acute ischemic stroke who are hospitalized in Cipto Mangunkusumo National General Hospital."

"Pendahuluan: Hipertensi dan diabetes adalah faktor risiko termodifikasi dari stroke, yang merupakan penyakit degeneratif penyebab disabilitas. Salah satu disabilitas tersebut adalah kelainan fungsi kognitif, yang dapat diidentifikasi oleh Montreal Cognitive Assessment versi Indonesia. Tujuan: Studi ini bertujuan untuk meneliti ada/tidaknya hubungan antara hipertensi dan diabetes dengan skor MoCA-Ina. Metode: Subjek penelitian yang merupakan pasien Departemen Rehabilitas Medik RSCM. Studi dilaksanakan menggunakan metode observasi cross-sectional. Penilaian skor MoCA-Ina dilakukan oleh petugas kesehatan, sedangkan riwayat hipertensi dan diabetes mellitus diperoleh dari status rekam medik. Hasil: Didapati 28 subjek penelitian. Terdapat perbedaan median nilai MoCA-Ina antara kelompok hipertensi dan tidak 24,5 12-30 vs 20 29-21 p=0,226 , antara kelompok diabetes dan tidak 20,5 17-23 vs 25 12-30 p=0,037 , serta antara kelompok hipertensi disertai diabetes, dibandingkan dengan yang hanya memiliki salah satu atau tidak keduanya 20 17-23 vs 25 12-30 p=0,049 . Kesimpulan: Diabetes memiliki hubungan yang signifikan secara klinis maupun statistik terhadap skor MoCA-Ina, sedangkan hipertensi tidak. Terdapat hubungan yang juga berbeda bermakna antara kelompok pasien hipertensi disertai diabetes, dibandingkan dengan yang hanya memiliki salah satu atau tidak sama sekali.

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Introduction Hypertension and diabetes are modifiable risk factors of stroke, a degenerative disease that cause disabilities. One of the disabilities is cognitive function impairment, which could be identified by using Montreal Cognitive Assessment Indonesia version. Aim This research aims to study whether there is any association between hypertension and diabetes with MoCA Ina score. Method The subjects in the study are patients of Physical Medicine and Rehabilitation Department of RSCM. This study was conducted using observational cross sectional study design. MoCA Ina assessment was done by the health workers, the hypertension and diabetes status information was derived from medical status. Result There was difference in MoCA Ina score median between group with and without hypertension 24,5 12 30 vs 20 19 20 p 0,226 , between group with and without diabetes 20,5 17 23 vs 25 12 30 p 0,037 , and also between groups that have both hypertension and diabetes, compared to the group that only have one or none of them 20 17 23 vs 25 12 30 p 0,049 . Conclusion Diabetes have significant association with MoCA Ina score, both statistically and clinically, while hypertension does not. There was also significant association between group that has both hypertension and diabetes, compared to group that has only one or none of them."

"Latar Belakang: Stroke merupakan penyakit yang memiliki perbedaan karakteristik antara pria dan wanita. Tujuan: Penelitian bertujuan untuk mengetahui hubungan jenis kelamin dengan fungsi kognitif yang dinilai menggunakan uji Montreal Cognitive Assesment versi Indonesia MoCA-Ina pada pasien stroke fase subakut dan kronik di Departemen Rehabilitasi Medik RSCM, dengan melakukan kontrol terhadap variabel perancu berupa tingkat pendidikan dan usia. Metode: Penelitian merupakan studi observasional analitik dengan desain potong lintang. Sampel penelitian sebanyak 34 subjek, diperoleh melalui teknik consecutive sampling. Analisis bivariat uji Mann-Whitney dan uji korelasi Pearson dilakukan untuk melihat hubungan antarvariabel, dan dilanjutkan dengan analisis multivariat regresi linier. Hasil: Berdasarkan uji Mann-Whitney diperoleh nilai p hubungan jenis kelamin dan tingkat pendidikan dengan skor MoCA-Ina sebesar 0,103 dan 0,076. Nilai korelasi hubungan usia dengan skor MoCA-Ina berdasarkan uji korelasi Pearson sebesar r=0,135 p=0,447 . Persamaan regresi skor MoCA-Ina=21,268-3,620 Wanita 3,762 Pendidikan Tinggi R2=8,6 . Perbedaan rerata skor MoCA-Ina antara pria dan wanita setelah dilakukan kontrol variabel tingkat pendidikan adalah sebesar -3,620 IK95 =-8,928-1,058 , namun secara statistik tidak bermakna p=0,125. Diskusi: Tidak ada perbedaan signifikan pada fungsi kognitif yang dinilai menggunakan MoCA-Ina antara pasien stroke sub-akut dan kronik pria dan wanita.

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Background: Stroke is a disease with different characteristics between men and women.

Objective: This study aims to determine the age and level of education adjusted relationship between gender and cognitive function which is assessed by Montreal Cognitive Assessment in sub acute and chronic stroke patients in the Department of Rehabilitation Medicine RSCM.

Methods: This study is an analytic observational study with a cross sectional design. 34 subjects were selected as samples with consecutive sampling method. Mann Whitney test and Pearson's correlation test were used in to determine the bivariate relationships between the variables, proceeded by a multivariate linear regression analysis.

Results: Based on the Mann Whitney test, the p value of the relationship between gender and the level of education and MoCA Ina score were p 0,103 and p 0,076 respectively. Correlation value between age and MoCA Ina score was r 0,135 p 0,447. The regression equation generated was MoCA Ina score 21,268 3,620 Women 3,762 Higher Education R2 8,6. The mean difference of MoCA Ina score between men and women stroke patients after adjusting for age and level of education was 3,620 CI 95 8,928 1,058, but it was statistically insignificant p 0,125.

Discussion: There was no significant difference in the cognitive function which is assessed by MoCA Ina between the male and female sub acute and chronic stroke patients."

"Stroke iskemik pada pasien geriatri meningkatkan risiko malnutrisi yang dipengaruhi olehbeberapa faktor yaitu disfagia, tipe stroke, masalah gastrointestinal, disabilitas fisik,penyakit komorbid dan psikologis. Tujuan utama intervensi nutrisi adalah membantupemulihan fungsi neurokognitif dan mencegah defisit energi dan protein. Pasien padaserial kasus ini adalah pasien geriatri berusia di atas 65 tahun dengan diagnosis strokeiskemik yang dirawat di RSCM pada bulan Agustus-September 2019. Terapi medik gizidiberikan pada keempat pasien sesuai dengan kondisi klinis masing-masing pasienmelalui jalur enteral. Satu pasien dapat makan melalui jalur oral di akhir perawatan.Suplementasi mikronutrien yang diberikan adalah vitamin B6, vitamin B12, vitamin C,asam folat dan seng. Hasil yang didapatkan selama perawatan sebanyak tiga pasienmencapai kebutuhan energi total (KET)dan satu pasien mencapai kebutuhan 83% KET.Asupan protein mencapai target 1,2 g/kg BB atau lebih pada tiga orang pasien.Suplementasi mikronutrien mencapai nilai AKG bagi usia di atas 65 tahun. Mikronutrienbelum mencapai AKG yaitu vitamin E, vitamin D, kalium, magnesium. Nutrien spesifikomega-3 dan kolin yang diperoleh dari asupan makan pada sebagian pasien belummemenuhi AKG. Lama perawatan pasien di rumah sakit 10 hingga 33 hari. Nilai severitasstroke dengan NIHSS dan kapasitas fungsional dengan FIM di akhir perawatanmenunjukkan perbaikan. Keempat pasien pulang ke rumah dengan keadaan klinisperbaikan. Kesimpulan yang didapatkan yaitu terapi medik gizi yang adekuat berperanmemperbaiki derajat keparahan dan kapasitas fungsional pasien geriatri dengan strokeiskemik.

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The geriatric patient with ischemic stroke increased risk of malnutrition, which becausevarious causes including dysphagia, type of stroke, gastrointestinal problems, physicaldisability, comorbid disease and psychological problem. The main purpose of nutritionintervention is to help restore neurocognitive function and prevent energy/protein deficits.Patients in this case series were geriatric patients aged over 65 years with a diagnosis ofischemic stroke who were treated at the Cipto Mangunkusumo General Hospital inAugust-September 2019. Medical nutrition therapy was given to all four patients,according to the clinical condition of each patient through the enteral route. One patientcould eat by oral route at the end of treatment. Patients have given oral micronutrientsupplementation consisting of vitamin B6, Vitamin B12, vitamin C, folic acid and zinc.The results obtained as many as three patients achieved total energy requirements and onepatient reached 83% energy requirements. Protein intake reached the target of 1,2 g/kgbody weight just in three patients. Supplementation micronutrients oral reached RDAvalues for people over 65 years. Micronutrients that have not yet reached the RDA werevitamin E, vitamin D, potassium, magnesium. Omega-3 and choline obtained from foodintake in some patients do not meet the RDA. The length of stay in the hospital was around10-33 days. The value of stroke severity with NIHSS and functional capacity with FIMat the end of treatment showed improvement. All four patients returned home withimprovement. The conclusion obtained is that adequate nutritional medical therapy playsa role in improving the severity and functional capacity of geriatric patients with ischemicstroke."

"Stroke merupakan kondisi hilangnya fungsi otak karena gangguan aliran darah otak terjadi lebih dari 24 jam. Stroke berdampak fisik maupun mental sehingga klien stroke bergantung kepada keluarga serta membutuhkan perawatan dan pemulihan jangka panjang. Tujuan penelitian untuk mengetahui pengaruh program pemberdayaan keluarga terhadap status fungsional klien dan kesiapan keluarga merawat klien stroke. Desain penelitian quasi experiment dengan pendekatan control group pretest posttest design pada 25 responden meliputi 12 orang kelompok kontrol dan 13 orang kelompok intervensi. Hasil penelitian menunjukkan tidak terdapat perbedaan yang bermakna status fungsional klien antara kelompok kontol dan intervensi setelah program pemberdayaan. Namun, terdapat perbedaan yang bermakna kesiapan keluarga merawat klien stroke antara kelompok kontrol dan intervensi (p = 0,004 pada α = 0,05). Oleh karena itu, pemberian program pemberdayaan keluarga direkomendasikan sebagai intervensi keperawatan untuk mempersiapkan keluarga melaksanakan perawatan terutama ketika klien stroke pulang ke rumah.

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Stroke is a condition of brain function loss due to disturbance in cerebral blood flow that occurs more than 24 hours. The difficulties and dysfunction are caused by brain damage entail long-term disorders of physical and mental balance, so that the patients depend on their families. The aim of this study was to assess the impact of the family empowerment program on the functional status of patients after stroke and also family preparedness to taking care the patients at home. The study design was a quasi-experiment design with pretest-posttest control group approach using 25 respondents. Groups were divided into a control group (n=12) and intervention group (n=13).

The results showed that is no significant difference between functional status in both groups after the intervention, but there is a significant difference in family preparedness to taking care for stroke survivors between the control and intervention groups (p = 0.004 at α = 0.05). Based on the results, the provision of family empowerment program as a preparation for discharge planning could be one of the nursing interventions for families to giving a care for stroke survivors at home."

"Penelitian ini bertujuan untuk membuktikan korelasi antara neurotrofin Brain Derived Neurotrophic Factor (BDNF), dan mobilitas fungsional pada pasien stroke iskemik kronik dalam uji Timed Up and Go (TUG). Penelitian ini merupakan observasi potong lintang dengan kelompok observasi (n = 35) dan kontrol sehat (n = 40). Kriteria inklusi stroke adalah subjek stroke iskemik fase kronik (onset di atas 6 bulan), berusia 40-65 tahun dan ambulasi mandiri. Pemeriksaan BDNF dilakukan di laboratorium, sedangkan uji TUG dilakukan secara pemeriksaan fisik. Hasil utama adalah rerata konsentrasi BDNF secara signifikan lebih rendah pada stroke kronik dibandingkan dengan kontrol sehat (21,654,00±4,250,67 pg/ml vs 23,424,37±3,209,96 pg/ml; p=0,048). Median performa TUG secara signifikan lebih lambat pada subjek stroke [11,90(7,79-50,36) detik vs 9,94(7,79-25,34) detik; p<0,001]. Akan tetapi perbedaan antara BDNF dan TUG ini belum berkorelasi secara signifikan. Sebagai pembahasan, terdapat banyak faktor selain mobilitas yang berkorelasi dengan neuroplastisitas. Juga diketahui bahwa mobilitas berperan penting dalam merangsang neuroplastisitas. Masih dibutuhkan penelitian lebih lanjut untuk membuktikan korelasi BDNF dengan mobilitas. Telah dianalisa bahwa uji TUG mungkin terlalu kompleks dalam menilai mobilitas sebagai sebuah parameter tunggal. Sehingga demikian, studi selanjutnya perlu mempertimbangkan penggunaan pemeriksaan yang lebih sederhana seperti kecepatan berjalan.

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This study is aimed to see the correlation between a neurotrophin called Brain Derived Neurotrophic Factor (BDNF), and physical mobility within chronic ischemic stroke through the timed up and go (TUG) test. This cross sectional observation had recruited 35 subjects of observation group and 40 healthy controls. Stroke inclusion criteria were those with chronic ischemic stroke (onset above 6 months), aged 40-65 years old and able to ambulate independently. BDNF was measured in laboratory, while TUG test were done through physical exam. Main study results were mean stroke BDNF concentration significantly lower as compared to healthy controls (21.654,00±4.250,67 pg/ml vs 23.424,37±3.209,96 pg/ml; p=0,048). Similarly, median TUG performance was significantly slower in stroke subjects [11,90(7,79-50,36) s vs 9,94(7,79-25,34) s; p<0,001]. However, these differences in BDNF and TUG had not been significantly correlated. It was then discussed that there are more than mobility that correlates with neuroplasticity, although prior studies mentioned that mobility has the most crucial role in stimulating it. There needs to be further investigation on correlation of BDNF with mobility. It was also thought that TUG itself may be too complex to examine mobility. Therefore future studies may consider the use of a simpler examination such as gait speed."

"ABSTRAKLatar Belakang: masalah yang sering terjadi setelah pembedahan sendi panggul yaitu defisit kekuatan otot, gangguan fisik, dan gangguan kemampuan berjalan kondisi ini dapat mengakibatkan ketidakmampuan pasien dalam menyelesaikan tugas fungsionalnya secara mandiri. Oleh karena itu, diperlukan intervensi yang berkelanjutan untuk dapat mengembalikan status fungsional pasien. Intervensi berupa program activehip exercise dengan melibatkan keluarga dilakukan untuk meningkatkan kemampuan fungsional. Tujuan: mengetahui pengaruh activehip exercise dan keterlibatan keluarga terhadap kemampuan fungsional pasien pasca pembedahan sendi pinggul. Desain penelitian: penelitian kuantitatif dengan menggunakan quasi experiment pre and post test without control group design dengan jumlah sampel 23 pasien pasca pembedahan panggul. Analisis data menggunakan uji Paired t-Test, Independet t-Tes dan Pearson Correlation. Hasil: analisis menunjukkan terdapat pengaruh activehip exercise dan keterlibatan keluarga dilihat dari adanya perbedaan rerata nilai status fungsional sebelum dan sesudah intervensi (p=0,0001). Hasil analisis bivariat menunjukkan adanya hubungan yang signifikan antara usia (0,001) dan nyeri (0,001) terhadap status fungsional. Kesimpulan: adanya pengaruh activehip exercise dengan keterlibatan keluarga terhadap status fungsional pasien paca pembedahan panggul.

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ABSTRACTBackground: Problems that usually happen after hip joint surgery are deficits in muscle strength, physical disorders, and impaired difficulties to walk or impaired mobility. These conditions can causes patient inablity to to fullfill their functional tasks independently. Therefore, a intervention is required to return functional status optimally. This intervention which is Activehip exercise which is modified with the family involvement was conducted to improve functional abilities. Objective: to identifiy the effect of Activehip exercise and family involvement on the functional abilities of patients after hip joint surgery. Design study: Quantitative research using quasi pre and posttest experiments without control group design with 23 patients after hip joint surgery as a sample. Data analysis used Paired t-Test, Independent t-Test and Pearson Correlation. Results: the result showed that there was an effect of Activehip exercise and family involvement as seen from the difference in mean functional status values before and after the intervention (p = 0.0001). The results of the bivariate analysis showed a significant relationship between age (0.001) and pain (0.001) to status functional. Conclusion: There was an effect of Activehip exercise and family involvement on the functional status of hip joint surgery's patients."