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"ABSTRACTBackground: chronic and terminal diseases require holistic therapy that covers the biopsychosocial aspect, and it can be found in palliative therapy. Patients who receive palliative therapy exhibit very diverse profiles. As such, researchers are keen to study the general characteristics of palliative patients. In addition, researchers will also assess the patients and their familys insight that influences the success of the therapy and the impact of estimated survival time in making treatment decisions. Methods: this research used cross-sectional descriptive analytic study and secondary data of 300 palliative patients who consult to Psychosomatic Palliative Team at Dr. Cipto Mangunkusumo Hospital. The data were processed using SPSS version 25. The data processed included: sociodemographic characteristics, length of stay, incidence of death in hospital, DNR cases, the patients and their familys insight, and the impact of estimated survival time on treatment decisions. Results: most palliative patients were women (52.0%) aged 51 - 60 years (27.0%), unemployed (29.0%), and suffered from cancer (55.3%). In addition, the patients were generally treated for less than 1 month (83.6%), died in the hospital (37.3%), and consented to DNR orders (36.7%). These DNR cases are highly correlated to the familys understanding regarding the prognosis of the patients condition (p = 0.022). The familys understanding of the diagnosis, prognosis, and treatment goals (92.3%, 81.3%, and 87.7%) was better than the patients (79.0%, 64.0%, and 69.7%). Furthermore, no link was found between the therapy choice (optimal, withholding, and withdrawing therapies) with the patients estimated survival time (p = 0.174). Conclusion: female, elderly, and cancer patients most often get palliative therapy. The consent for DNR orders to palliative patient is notably frequent. Currently, the familys insight is much better than the patients, which means that health care providers need to improve patient education and information. In addition, patients and families generally still opt for optimal therapy despite low estimated survival time."

"Latar Belakang. Striktur bilier ditemukan pada 70-90% kasus keganasan pankreatobilier dan menimbulkan morbiditas dan mortalitas yang tinggi terutama pada stadium lanjut yang unresectable. Pada stadium tersebut, tata laksana paliatif bertujuan untuk meningkatkan kualitas hidup pasien dan memperbaiki kesintasan. Tata laksana paliaitf yang dapat dilakukan adalah dengan pemasangan sten bilier perendoskopik dan operasi pintas saluran bilier. Sehingga, perlu diketahui perbedaan kesintasan satu tahun pasien dengan striktur bilier maligna yang mendapatkan terapi paliatif dengan prosedur biliodigestive double bypass dan pemasangan sten bilier perendoskopik di RSCM. Tujuan. Mengetahui perbedaankesintasan antara pasien striktur bilier distal maligna yang menjalani prosedur double bypass dan prosedur pemasangan sten bilier per endoskopik.Metode. Penelitian dilakukan dengan metode kohort retrospektif dengan subyek penelitian pasien striktur bilier maligna distal yang menjalani prosedur pemasangan sten perendoskopik atau prosedur double bypass di RSCM pada periode 1 Januari 2015 – 31 Desember 2019 dan dilakukan pengamatan selama 1 tahun sejak pasien menjalani prosedur tersebut. Kesintasan dinilai dengan metode Kaplan-Meier dan dilanjutkan dengan analisis multivariat terhadap faktor-faktor yang dinilai dapat menjadi faktor perancu.Hasil. Penelitian ini berhasil mengumpulkan 119 subjek pada kelompok sten endoskopik dan 39 subjek pada kelompok double bypass. Pada pengamatan kesintasan satu tahun, didapatkan median kesintasan 93 hari pada kelompok sten endoskopik dan 140 hari pada kelompok double bypass [HR 0,871 (IK95% 0,551-1,377; p = 0,551)]. Tidak ditemukan perbedaan kurva kesintasan pada kedua kelompok. Pada analisis multivariat, didapatkan Charlson Comorbidity Index, usia, dan bilirubin adalah variabel perancu.Kesimpulan. Tidak terdapat perbedaan kesintasan antara pasien striktur bilier distal maligna yang menjalani prosedur double bypass dan prosedur pemasangan sten bilier perendoskopik. Usia, CCI 34, dan kadar bilirubin merupakan faktor perancu terhadap kesintasan kesintasan antara pasien striktur bilier distal maligna yang menjalani prosedur double bypass dan prosedur pemasangan sten bilier per endoskopik.

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Background. Biliary strictures are observed in 70-90% of cases of pancreatic malignancy and cause high morbidity and mortality, especially in advanced, unresectable stage. At this stage, palliative management aims to improve the patient's quality of life and survival. Palliative management can be done is by placing an endoscopic biliary stent and biliary tract bypass surgery. Thus, it is necessary to know the one-year survival of patients with malignant biliary stricture who received palliative therapy with billio-digestive double bypass procedures and perendoscopic biliary stent placement in RSCM. Objective. To determine the survival between patients with distal malignant biliary stricture who underwent a double bypass procedure and an endoscopic biliary stent placement procedure.

Methods. This is a restrospective cohort study with the subjects being patients with distal malignant biliary strictures who underwent endoscopic stenting procedures or double bypass procedures at RSCM in the period 1 January 2015 – 31 December 2019 and was observed for one year since the patient underwent the procedure. Survival was done using the Kaplan-Meier method and followed by multivariate analysis using the cox regression test.

Result. We collected 119 subjects in the endoscopic stent group and 39 subjects in the double bypass group. After one year, median survival was 93 days in the endoscopic stent group and 140 days in the double bypass group [HR 0,871 (95%CI 0,551-1,377; p = 0,551)]. In multivariate analysis, it was found that Charlson Comorbidity Index, age, and bilirubin were confounding variables.

Conclusion. There was no difference in survival between patients with malignant distal biliary stricture who underwent a double bypass procedure and an endoscopic biliary stent procedure. Age, CCI 4, and bilirubin levels were confounding factors for survival among patients with malignant distal biliary stricture who underwent a double bypass procedure and an endoscopic biliary stent placement procedure."

"PurposePancreatic ductal adenocarcinoma (PDAC) is a lethal disease; however, the frequency of recurrence can be reduced if curative surgery following adjuvant chemotherapy is applied. At present, adjuvant chemotherapy is uniformly performed in all patients, as it is unclear which tumor types are controlled best or worst. We investigated patients with recurrence to establish the optimum treatment strategy.MethodsOf 138 patients who underwent curative surgery for PDAC, 85 developed recurrence. Comprehensive clinicopathological factors were investigated for their association with the survival time after recurrence (SAR).ResultsThe median SAR was 12.6 months. Treatments for recurrence included best supportive care, GEM-based therapy and S-1. The performance status [hazard ratio (HR) 0.12, P < 0.001], histological invasion of lymph vessels (HR 0.27, P < 0.001), kind of treatment for recurrence (HR 5.0, P < 0.001) and initial recurrence site (HR 2.9, P < 0.001) were independent significant risk factors for the SAR. The initial recurrence sites were the liver (n = 21, median SAR 8.8 months), lung (n = 10, 14.9 months), peritoneum (n = 6, 1.7 months), lymph nodes (n = 6, 14.7 months), local site (n = 17, 13.9 months) and multiple sites (n = 25, 10.1 months). A shorter recurrence-free survival (< 1 year) and higher postoperative CA19-9 level were significantly associated with critical recurrence (peritoneal/liver).ConclusionsSeveral risk factors for SAR were detected in this study. Further investigations are needed to individualize the adjuvant chemotherapy for each patient with PDAC."

"pain is one of the most often symptoms experienced by patients with advanced or chronic diseases which can cause a decrease in the quality of life of palliative patients. Pain in palliative patients has not yet received enough attention, especially factors associated with pain and its management. This study aimed to determine the factors associated with pain in palliative patients and also assess whether there is a two-way relationship between psychological factors and pain. In addition, we will also see whether spiritual services play a role in relieving pain. Methods: cross-sectional study were used and secondary data were obtained from medical records of 285 palliative patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data were processed to determine the psycho-socio-demographic characteristics, the reciprocal relationships of psychological and pain aspects, and the relationship of pharmacological therapy (opioids), non-pharmacological therapy (spiritual services), and combination of both therapies in pain management. Results: of the 285 palliative patients, 60.3% had pain, which was found more in cancer patients (74.4% vs 25.6%). Pain was found more in patients aged 41-60 years (51.1%), women (51.2%), and unemployed (30.2%). The severity of the pain was found to be significant in patients with depressive symptoms (p=0.045), while patients with anxiety symptoms (p=0.155) and sleep disorders (p=0.619) had no significant relationship. Pain experienced by palliative patients was not statistically significant in causing depression (p=0.058), anxiety (p=0.107), and sleep disorder (p=0.639). Moreover, pain management with opioids, spiritual services, or combination of them turned out to have significant results (p=0.022). Conclusion: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly.

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atar belakang: nyeri merupakan gejala yang paling sering dialami oleh pasien paliatif yang dapat menyebabkan penurunan kualitas hidup pasien. Nyeri pada pasien paliatif belum mendapatkan perhatian yang cukup, terutama faktor-faktor yang berkaitan dengan nyeri dan penatalaksanaannya. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan nyeri pada pasien paliatif dan juga menilai apakah terdapat hubungan timbal balik antara faktor psikologis dengan nyeri. Selain itu, akan dinilai pula apakah layanan spiritual berperan dalam mengurangi rasa nyeri.

Metode: penelitian ini menggunakan studi potong lintang dengan data sekunder melalui rekam medis 285 pasien paliatif di RSUPN Cipto Mangunkusumo, jakarta, Indonesia. Data diolah untuk menentukan karakteristik psiko-sosio-demografik, hubungan timbal balik aspek psikologis dan nyeri, serta hubungan terapi faramakologis (opioid), terapi non-farmakologis (layanan spiritual), dan kombinasi kedua terapi dalam pengelolaan nyeri pada pasien paliatif.

Hasil: dari 285 pasien paliatif, 59.9% pasien merasakan nyeri, yang terutama ditemukan pada pasien kanker (74.4% vs 25.6%). Nyeri lebih banyak ditemukan pada pasien berusia 41 – 60 tahun (51.1%), wanita (51.2%), dan pengangguran (30.2%). Derajat nyeri memiliki signifikansi pada pasien dengan gejala depresi (p=0.045), sedangkan pada pasien dengan gejala ansietas (p=0.155) dan gangguan tidur (p=0.619) tidak memiliki hubungan yang signifikan. Nyeri yang dialami oleh pasien paliatif juga tidak signifikan secara statistik dalam menyebabkan depresi (p=0.058), ansietas (p=0.107), dan gangguan tidur (p=0.639). Selain itu, tatalaksana nyeri dengan opioid, layanan spiritual, atau kombinasi keduanya ternyata memiliki hasil yang berbeda secara signifikan (p=0.022). Kesimpulan: nyeri pada pasien paliatif terutama dialami oleh pasien kanker dan lansia. Faktor psikologis mempengaruhi kondisi nyeri, sehingga penatalaksanaan nyeri dengan memperhatikan aspek biopsikososial akan mampu mengurangi rasa nyeri secara signifikan."

"pain is one of the most often symptoms experienced by patients with advanced or chronic diseases which can cause a decrease in the quality of life of palliative patients. Pain in palliative patients has not yet received enough attention, especially factors associated with pain and its management. This study aimed to determine the factors associated with pain in palliative patients and also assess whether there is a two-way relationship between psychological factors and pain. In addition, we will also see whether spiritual services play a role in relieving pain. Methods: cross-sectional study were used and secondary data were obtained from medical records of 285 palliative patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data were processed to determine the psycho-socio-demographic characteristics, the reciprocal relationships of psychological and pain aspects, and the relationship of pharmacological therapy (opioids), non-pharmacological therapy (spiritual services), and combination of both therapies in pain management. Results: of the 285 palliative patients, 60.3% had pain, which was found more in cancer patients (74.4% vs 25.6%). Pain was found more in patients aged 41-60 years (51.1%), women (51.2%), and unemployed (30.2%). The severity of the pain was found to be significant in patients with depressive symptoms (p=0.045), while patients with anxiety symptoms (p=0.155) and sleep disorders (p=0.619) had no significant relationship. Pain experienced by palliative patients was not statistically significant in causing depression (p=0.058), anxiety (p=0.107), and sleep disorder (p=0.639). Moreover, pain management with opioids, spiritual services, or combination of them turned out to have significant results (p=0.022). Conclusion: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly.

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atar belakang: nyeri merupakan gejala yang paling sering dialami oleh pasien paliatif yang dapat menyebabkan penurunan kualitas hidup pasien. Nyeri pada pasien paliatif belum mendapatkan perhatian yang cukup, terutama faktor-faktor yang berkaitan dengan nyeri dan penatalaksanaannya. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan nyeri pada pasien paliatif dan juga menilai apakah terdapat hubungan timbal balik antara faktor psikologis dengan nyeri. Selain itu, akan dinilai pula apakah layanan spiritual berperan dalam mengurangi rasa nyeri.

Metode: penelitian ini menggunakan studi potong lintang dengan data sekunder melalui rekam medis 285 pasien paliatif di RSUPN Cipto Mangunkusumo, jakarta, Indonesia. Data diolah untuk menentukan karakteristik psiko-sosio-demografik, hubungan timbal balik aspek psikologis dan nyeri, serta hubungan terapi faramakologis (opioid), terapi non-farmakologis (layanan spiritual), dan kombinasi kedua terapi dalam pengelolaan nyeri pada pasien paliatif.

Hasil: dari 285 pasien paliatif, 59.9% pasien merasakan nyeri, yang terutama ditemukan pada pasien kanker (74.4% vs 25.6%). Nyeri lebih banyak ditemukan pada pasien berusia 41 – 60 tahun (51.1%), wanita (51.2%), dan pengangguran (30.2%). Derajat nyeri memiliki signifikansi pada pasien dengan gejala depresi (p=0.045), sedangkan pada pasien dengan gejala ansietas (p=0.155) dan gangguan tidur (p=0.619) tidak memiliki hubungan yang signifikan. Nyeri yang dialami oleh pasien paliatif juga tidak signifikan secara statistik dalam menyebabkan depresi (p=0.058), ansietas (p=0.107), dan gangguan tidur (p=0.639). Selain itu, tatalaksana nyeri dengan opioid, layanan spiritual, atau kombinasi keduanya ternyata memiliki hasil yang berbeda secara signifikan (p=0.022). Kesimpulan: nyeri pada pasien paliatif terutama dialami oleh pasien kanker dan lansia. Faktor psikologis mempengaruhi kondisi nyeri, sehingga penatalaksanaan nyeri dengan memperhatikan aspek biopsikososial akan mampu mengurangi rasa nyeri secara signifikan."

"pain is one of the most often symptoms experienced by patients with advanced or chronic diseases which can cause a decrease in the quality of life of palliative patients. Pain in palliative patients has not yet received enough attention, especially factors associated with pain and its management. This study aimed to determine the factors associated with pain in palliative patients and also assess whether there is a two-way relationship between psychological factors and pain. In addition, we will also see whether spiritual services play a role in relieving pain. Methods: cross-sectional study were used and secondary data were obtained from medical records of 285 palliative patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data were processed to determine the psycho-socio-demographic characteristics, the reciprocal relationships of psychological and pain aspects, and the relationship of pharmacological therapy (opioids), non-pharmacological therapy (spiritual services), and combination of both therapies in pain management. Results: of the 285 palliative patients, 60.3% had pain, which was found more in cancer patients (74.4% vs 25.6%). Pain was found more in patients aged 41-60 years (51.1%), women (51.2%), and unemployed (30.2%). The severity of the pain was found to be significant in patients with depressive symptoms (p=0.045), while patients with anxiety symptoms (p=0.155) and sleep disorders (p=0.619) had no significant relationship. Pain experienced by palliative patients was not statistically significant in causing depression (p=0.058), anxiety (p=0.107), and sleep disorder (p=0.639). Moreover, pain management with opioids, spiritual services, or combination of them turned out to have significant results (p=0.022). Conclusion: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly.

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atar belakang: nyeri merupakan gejala yang paling sering dialami oleh pasien paliatif yang dapat menyebabkan penurunan kualitas hidup pasien. Nyeri pada pasien paliatif belum mendapatkan perhatian yang cukup, terutama faktor-faktor yang berkaitan dengan nyeri dan penatalaksanaannya. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan nyeri pada pasien paliatif dan juga menilai apakah terdapat hubungan timbal balik antara faktor psikologis dengan nyeri. Selain itu, akan dinilai pula apakah layanan spiritual berperan dalam mengurangi rasa nyeri.

Metode: penelitian ini menggunakan studi potong lintang dengan data sekunder melalui rekam medis 285 pasien paliatif di RSUPN Cipto Mangunkusumo, jakarta, Indonesia. Data diolah untuk menentukan karakteristik psiko-sosio-demografik, hubungan timbal balik aspek psikologis dan nyeri, serta hubungan terapi faramakologis (opioid), terapi non-farmakologis (layanan spiritual), dan kombinasi kedua terapi dalam pengelolaan nyeri pada pasien paliatif.

Hasil: dari 285 pasien paliatif, 59.9% pasien merasakan nyeri, yang terutama ditemukan pada pasien kanker (74.4% vs 25.6%). Nyeri lebih banyak ditemukan pada pasien berusia 41 – 60 tahun (51.1%), wanita (51.2%), dan pengangguran (30.2%). Derajat nyeri memiliki signifikansi pada pasien dengan gejala depresi (p=0.045), sedangkan pada pasien dengan gejala ansietas (p=0.155) dan gangguan tidur (p=0.619) tidak memiliki hubungan yang signifikan. Nyeri yang dialami oleh pasien paliatif juga tidak signifikan secara statistik dalam menyebabkan depresi (p=0.058), ansietas (p=0.107), dan gangguan tidur (p=0.639). Selain itu, tatalaksana nyeri dengan opioid, layanan spiritual, atau kombinasi keduanya ternyata memiliki hasil yang berbeda secara signifikan (p=0.022). Kesimpulan: nyeri pada pasien paliatif terutama dialami oleh pasien kanker dan lansia. Faktor psikologis mempengaruhi kondisi nyeri, sehingga penatalaksanaan nyeri dengan memperhatikan aspek biopsikososial akan mampu mengurangi rasa nyeri secara signifikan."

"pain is one of the most often symptoms experienced by patients with advanced or chronic diseases which can cause a decrease in the quality of life of palliative patients. Pain in palliative patients has not yet received enough attention, especially factors associated with pain and its management. This study aimed to determine the factors associated with pain in palliative patients and also assess whether there is a two-way relationship between psychological factors and pain. In addition, we will also see whether spiritual services play a role in relieving pain. Methods: cross-sectional study were used and secondary data were obtained from medical records of 285 palliative patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data were processed to determine the psycho-socio-demographic characteristics, the reciprocal relationships of psychological and pain aspects, and the relationship of pharmacological therapy (opioids), non-pharmacological therapy (spiritual services), and combination of both therapies in pain management. Results: of the 285 palliative patients, 60.3% had pain, which was found more in cancer patients (74.4% vs 25.6%). Pain was found more in patients aged 41-60 years (51.1%), women (51.2%), and unemployed (30.2%). The severity of the pain was found to be significant in patients with depressive symptoms (p=0.045), while patients with anxiety symptoms (p=0.155) and sleep disorders (p=0.619) had no significant relationship. Pain experienced by palliative patients was not statistically significant in causing depression (p=0.058), anxiety (p=0.107), and sleep disorder (p=0.639). Moreover, pain management with opioids, spiritual services, or combination of them turned out to have significant results (p=0.022). Conclusion: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly.

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atar belakang: nyeri merupakan gejala yang paling sering dialami oleh pasien paliatif yang dapat menyebabkan penurunan kualitas hidup pasien. Nyeri pada pasien paliatif belum mendapatkan perhatian yang cukup, terutama faktor-faktor yang berkaitan dengan nyeri dan penatalaksanaannya. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan nyeri pada pasien paliatif dan juga menilai apakah terdapat hubungan timbal balik antara faktor psikologis dengan nyeri. Selain itu, akan dinilai pula apakah layanan spiritual berperan dalam mengurangi rasa nyeri.

Metode: penelitian ini menggunakan studi potong lintang dengan data sekunder melalui rekam medis 285 pasien paliatif di RSUPN Cipto Mangunkusumo, jakarta, Indonesia. Data diolah untuk menentukan karakteristik psiko-sosio-demografik, hubungan timbal balik aspek psikologis dan nyeri, serta hubungan terapi faramakologis (opioid), terapi non-farmakologis (layanan spiritual), dan kombinasi kedua terapi dalam pengelolaan nyeri pada pasien paliatif.

Hasil: dari 285 pasien paliatif, 59.9% pasien merasakan nyeri, yang terutama ditemukan pada pasien kanker (74.4% vs 25.6%). Nyeri lebih banyak ditemukan pada pasien berusia 41 – 60 tahun (51.1%), wanita (51.2%), dan pengangguran (30.2%). Derajat nyeri memiliki signifikansi pada pasien dengan gejala depresi (p=0.045), sedangkan pada pasien dengan gejala ansietas (p=0.155) dan gangguan tidur (p=0.619) tidak memiliki hubungan yang signifikan. Nyeri yang dialami oleh pasien paliatif juga tidak signifikan secara statistik dalam menyebabkan depresi (p=0.058), ansietas (p=0.107), dan gangguan tidur (p=0.639). Selain itu, tatalaksana nyeri dengan opioid, layanan spiritual, atau kombinasi keduanya ternyata memiliki hasil yang berbeda secara signifikan (p=0.022). Kesimpulan: nyeri pada pasien paliatif terutama dialami oleh pasien kanker dan lansia. Faktor psikologis mempengaruhi kondisi nyeri, sehingga penatalaksanaan nyeri dengan memperhatikan aspek biopsikososial akan mampu mengurangi rasa nyeri secara signifikan."

"pain is one of the most often symptoms experienced by patients with advanced or chronic diseases which can cause a decrease in the quality of life of palliative patients. Pain in palliative patients has not yet received enough attention, especially factors associated with pain and its management. This study aimed to determine the factors associated with pain in palliative patients and also assess whether there is a two-way relationship between psychological factors and pain. In addition, we will also see whether spiritual services play a role in relieving pain. Methods: cross-sectional study were used and secondary data were obtained from medical records of 285 palliative patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data were processed to determine the psycho-socio-demographic characteristics, the reciprocal relationships of psychological and pain aspects, and the relationship of pharmacological therapy (opioids), non-pharmacological therapy (spiritual services), and combination of both therapies in pain management. Results: of the 285 palliative patients, 60.3% had pain, which was found more in cancer patients (74.4% vs 25.6%). Pain was found more in patients aged 41-60 years (51.1%), women (51.2%), and unemployed (30.2%). The severity of the pain was found to be significant in patients with depressive symptoms (p=0.045), while patients with anxiety symptoms (p=0.155) and sleep disorders (p=0.619) had no significant relationship. Pain experienced by palliative patients was not statistically significant in causing depression (p=0.058), anxiety (p=0.107), and sleep disorder (p=0.639). Moreover, pain management with opioids, spiritual services, or combination of them turned out to have significant results (p=0.022). Conclusion: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly.

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atar belakang: nyeri merupakan gejala yang paling sering dialami oleh pasien paliatif yang dapat menyebabkan penurunan kualitas hidup pasien. Nyeri pada pasien paliatif belum mendapatkan perhatian yang cukup, terutama faktor-faktor yang berkaitan dengan nyeri dan penatalaksanaannya. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang berhubungan dengan nyeri pada pasien paliatif dan juga menilai apakah terdapat hubungan timbal balik antara faktor psikologis dengan nyeri. Selain itu, akan dinilai pula apakah layanan spiritual berperan dalam mengurangi rasa nyeri.

Metode: penelitian ini menggunakan studi potong lintang dengan data sekunder melalui rekam medis 285 pasien paliatif di RSUPN Cipto Mangunkusumo, jakarta, Indonesia. Data diolah untuk menentukan karakteristik psiko-sosio-demografik, hubungan timbal balik aspek psikologis dan nyeri, serta hubungan terapi faramakologis (opioid), terapi non-farmakologis (layanan spiritual), dan kombinasi kedua terapi dalam pengelolaan nyeri pada pasien paliatif.

Hasil: dari 285 pasien paliatif, 59.9% pasien merasakan nyeri, yang terutama ditemukan pada pasien kanker (74.4% vs 25.6%). Nyeri lebih banyak ditemukan pada pasien berusia 41 – 60 tahun (51.1%), wanita (51.2%), dan pengangguran (30.2%). Derajat nyeri memiliki signifikansi pada pasien dengan gejala depresi (p=0.045), sedangkan pada pasien dengan gejala ansietas (p=0.155) dan gangguan tidur (p=0.619) tidak memiliki hubungan yang signifikan. Nyeri yang dialami oleh pasien paliatif juga tidak signifikan secara statistik dalam menyebabkan depresi (p=0.058), ansietas (p=0.107), dan gangguan tidur (p=0.639). Selain itu, tatalaksana nyeri dengan opioid, layanan spiritual, atau kombinasi keduanya ternyata memiliki hasil yang berbeda secara signifikan (p=0.022). Kesimpulan: nyeri pada pasien paliatif terutama dialami oleh pasien kanker dan lansia. Faktor psikologis mempengaruhi kondisi nyeri, sehingga penatalaksanaan nyeri dengan memperhatikan aspek biopsikososial akan mampu mengurangi rasa nyeri secara signifikan."

"Latar Belakang: Penelitian pengaruh terapi reperfusi terhadap kesintasan satu tahun pasien STEMI usia lanjut sudah diteliti di negara lain sebelumnya, namun penelitian tersebut di Indonesia belum pernah dilakukan. Karena adanya perbedaan karakteristik, demografi dan budaya serta adanya kontroversi pemilihan terapi sehingga penelitian ini dilakukan. Penelitian-penelitian terdahulu belum banyak yang menggunakan analisis kesintasan, sehingga data survival pasien STEMI usia lanjut yang dilakukan terapi reperfusi sulit didapatkan.Tujuan: Mengetahui pengaruh terapi reperfusi terhadap kesintasan satu tahun pada pasien STEMI usia lanjut.Metode: Penelitian menggunakan metode kohort retrospektif dengan analisis kesintasan. Sampel dikumpulkan dari pasien STEMI usia lebih dari atau samadengan 60 tahun yang dirawat di ICCU RSCM januari 2007- mei 2013, yang kemudian dibagi menjadi dua kelompok yaitu pasien yang mendapat terapi reperfusi dan tidak reperfusi. Kurva Kaplan-Meier digunakan untuk mengetahui kesintasan masing-masing kelompok. Analisis bivariat mengunakan uji log-rank, analisis multivariat menggunakan cox proportional hazard regression. Besarnya hubungan variabel terapi reperfusi dengan kesintasan dinyatakan dengan crude HR dan IK 95% serta adjusted HR dan IK 95% setelah dimasukkan variabel perancu.Hasil: Terdapat 185 pasien STEMI usia lanjut yang dibagi menjadi dua kelompok yaitu 86 pasien kelompok terapi reperfusi dan 99 pasien kelompok tidak reperfusi. Hasil penelitian ini kelompok terapi reperfusi menurunkan mortalitas pada STEMI usia lanjut dengan crude HR 0,16 (0,07-0,33), p value <0,001, dengan kesintasan kumulatif satu tahun pasien STEMI usia lanjut yang dilakukan terapi reperfusi yaitu 91% (SE 3,1%), sedangkan kelompok tidak reperfusi 54% (SE % 5,0%). Rerata kesintasan pada kelompok terapi reperfusi 339,38 hari, dan kelompok tidak reperfusi 216,71 hari. Analisis multivariat menunjukkan terapi reperfusi merupakan prediktor independen terjadinya kesintasan satu tahun (Adjusted HR 0,17; IK95% 0,08-0,37).Simpulan: Terapi reperfusi memperbaiki kesintasan satu tahun pada pasien STEMI usia lanjut.

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Background: This study was done because of the effect of reperfusion therapy on one year survival in elderly STEMI patients has not been studied in Indonesia. There are differences in characteristic, demographic and culture of elderly patients that had been studied in other countries and there are still controversies of therapy modality in elderly STEMI patients. Most of previous studies do not use survival analysis, hence, survival data of elderly STEMI patients is still limited.

Aim: To know about the effect of reperfusion therapy on one year survival in elderly STEMI patients.

Methods: Retrospective study was done with survival analysis approach. Sample was collected from STEMI patients aged > 60 years old that admitted to hospital in golden period (less than twelve hours) who was hospitalized in ICCU RSCM from january 2007 to may 2013, divided to reperfusion therapy and not reperfusion therapy group. Kaplan Meier curve was used to know survival in each group. Bivariate analysis was done by log rank test and multivariate analysis was done by cox proportional hazard regression test. The relation between reperfusion therapy variables with one year survival denoted as crude HR and 95%CI then as adjusted HR and 95%CI after confounding factors were calculated.

Results: There are 185 STEMI elderly patients that divided into two groups : 86 patients in reperfusion therapy group and 99 patients in not reperfusion therapy group. The result is reperfusion therapy reduces mortality in elderly STEMI patient with crude HR 0,16 (0,07-0,33), p value <0,001, One year survival cumulative in reperfusion therapy group is 91% ( SE 3,1%) and 54% ( SE 5,0%) in not reperfusion therapy group. Mean survival of reperfusion therapy group is 339,38 days, and the not reperfusion therapy group is 216,71 days. Multivariate analysis shows that reperfusion therapy is an independent predictor in one year survival of elderly STEMI patients (Adjusted HR 0,17 ; 95%CI 0,08-0,37).

Conclusion: Reperfusion therapy improves one year survival in elderly STEMI patients."