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"ABSTRAKPercutaneous nephrolithotomy (PCNL) sebagai pendekatan untuk perawatan batu ginjal membutuhkan penggunaan fluoroskopi X-ray C-arm. Namun demikian, pemanfaatan X-ray C-arm sesuai standar sulit untuk dicapai di sebagian besar rumah sakit di Indonesia. Akses ginjal dengan panduan Ultrasonografi (USG) dalam tindakan PCNL menawarkan solusi untuk mengurangi paparan radiasi selama prosedur. Penelitian ini bertujuan untuk menggambarkan hasil operasi prosedur PCNL supine dengan panduan USG di Rumah Sakit Adam Malik, Medan. Sebanyak 13 pasien berturut-turut menjalani prosedur supine PCNL dengan panduan USG di Rumah Sakit Adam Malik Medan, Indonesia, dari bulan April hingga Juni 2018. Pasien dengan riwayat operasi batu ginjal terbuka, gangguan fungsi ginjal, dan urosepsis tidak disertakan dalam penelitian. Penelitian prospektif dilakukan dengan mencatat data pasien yang menjalani PCNL, termasuk karakteristik pasien dan batu ginjal, data intraoperatif, dan status batu sisa. Usia rata-rata pasien adalah 46,00 ± 12,92 tahun. Rasio pria-wanita pada pasien adalah 6 : 7. Lebih dari setengah pasien mempunyai batu ginjal kiri (61,54%). Ukuran rata-rata batu adalah 25,71 ± 13,17 mm. Terdapat 11 pasien (84,62%) yang menerima puncture sebanyak satu kali, sementara yang lain menerima 2 kali (1 pasien; 7,69%) dan tiga kali (1 pasien; 7,69%). Rata-rata waktu puncture hingga tindakan nefroskopi adalah 15,64 ± 3,14 menit. Tindakan dilatasi berhasil dilakukan dengan waktu rata-rata 11,46 ± 1,56 menit. Waktu rata-rata nefroskopi adalah 25 menit (18-62 menit), dan total durasi operasi adalah 85,92 ± 33,95 menit. Tingkat keberhasilan tanpa hidronefrosis, hidronefrosis ringan, sedang, dan berat masing-masing adalah 50%, 100%, 100%, dan 50%. Sepuluh pasien bebas batu setelah prosedur (tingkat keberhasilan 76,92%).USG-PCNL memiliki hasil yang memuaskan. Hal ini dapat menjadi pertimbangan bahwa USG-PCNL bisa menjadi alternatif yang baik untuk mengurangi paparan radiasi pada pasien dan ahli urologi.

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ABSTRACTPercutaneous nephrolithotomy (PCNL) as an approach to kidney stone treatment requires a C-arm X-ray fluoroscopy application. Nevertheless, the utilization of standardized C-arm X-ray is complicated to achieve in most of our country hospitals. Ultrasound (US)-guided renal access for PCNL offers the solution for reducing the radiation exposure in the procedure. The present study aims to describe the operation outcomes of US-guided supine PCNL procedure at Adam Malik Hospital, Medan.A total of 13 consecutive patients underwent US-guided supine PCNL procedure at Adam Malik Hospital Medan, Indonesia, from April until June 2018. Patients with a history of open renal stone surgery, impaired renal function, and urosepsis were excluded from the study. We prospectively recorded the data of patients undergoing PCNL, including patient and stone characteristics, intraoperative data, and residual stone status. The mean age of the patients was 46.00 ± 12.92 years. The male-to-female ratio of the patients was 6:7. More than half of the patients had left kidney stone (61.54%). The mean stone size was 25.71 ± 13.17 mm. There were 11 patients (84.62%) who received one-time successful puncture attempt, while the others received 2 (1 patient; 7.69%) and three attempts (1 patient; 7.69%). The mean puncture-to-nephroscope time was 15.64 ± 3.14 minutes. All patients had successful dilation with the mean dilation time was 11.46 ± 1.56 minutes. The median nephroscopy time was 25 (18-62) minutes, and the total operation duration was 85.92 ± 33.95 minutes. The success rates for no hydronephrosis, mild, moderate, and severe hydronephrosis were 50%, 100%, 100%, and 50% respectively. Ten patients were stone-free after the procedure (76.92% success rate). US-PCNL has satisfactory outcomes. It should be considered that US-PCNL could be a good alternative for reducing radiation exposure of the patient and urologist."

"Penelitian ini bertujuan untuk mengetahui faktor-faktor karakteristik individu perawat, pekerjaan dan situasi pekerjaan yang berhubungan dengan mutu asuhan keperawatan di ruang rawat inap RSUP H. Adam Malik Medan. Penelitian ini merupakan desla-iptif analisis yang pengumpulan datanya secara cross sectional. Hipotesis yang dibuktikan dalam penelitian ini adalah adanya hubungan antara karakteristik perawat, pekerjaan dan situasi pekerjaan perawat pelaksana dengan mutu asuhan keperawatan di ruang rawat inap RSUP H. Adam Malik Medan.Sampel penelitian adalah perawat pelaksana yang bekerja di ruang rawat inap RSUP H. Adam Malik Medan, berjumlah 73 orang yang dipilih secara acak. Untuk akurasi data, pengamatan dilakukan sebanyak 3 kali berlangsung selama 3 minggu. Pengumpulan data dilakukan dengan melibatkan mahasiswa Program Studi Ilmu Keperawatan Fakultas Kedokteran Universitas Sumatera Utara sebanyak 12 orang membantu peneliti. Instrumen yang digunakan adalah instrumen pengukuran karakteristik individu (Stoner, 1996) dan isntrumen pengukuran dokumentasi proses keperawatan (Dep.Kes. RI, 1977), Kedua instrumen tersebut disesuaikan dengan kebutuhan penelitian. Hasil uji coba validitas dan reliabilitas instrumen menggunakan alpha cronbach, dengan hasil baik.Hasil penelitian pada analisis univariat menunjukkan bahwa mutu asuhan keperawatan oleh perawat pelaksana di ruang rawat inap RSUP H. Adam Malik Medan berada pada kategori baik( (50,7%). Dan hasil analisis bivariat diketahui bahwa karakteristik perawat secara statistik mempunyai hubungan yang signifikan dengan mutu asuhan keperawatan melalui pendekatan proses keperawatan adalah dimensi pendidikan formal dengan nilai p = 0,011, dimensi ruang perawatan rawat inap dengan nilai p = 0,045. hasil analisis multivariat dengan uji regresi logistik menggunakan metode Backward (CI = 95 %) menunjukkan bahwa dimensi pendidikan formal dengan nilai p = 0,0296 dan dimensi supervisi dengan nilai p = 0,0280 mempunyai hubungan paling signifikan secara statistik dengan mutu asuhan keperawatan.Berdasarkan hasil penelitian ini, maka pihak RSVP K Adam malik Medan khususnya bidang keperawatan perlu memperhatikan job description sesuai dengan kemampuan tenaga keperawatan yang ada, melakukan penilaian dan rekrutmen tenaga keperawatan sesuai kebutuhan, mengembangkan Model Praktik Keperawatan Profesional untuk meningkatkan mutu asuhan keperawatan , melakukan pelatihan berkelanjutan dalam lingkup mutu asuhan keperawatan dan supervisi. Selain itu, untuk penelitian lanjutan agar dilakukan dengan disain eksperimental menggunakan variabel mutu asuhan keperawatan dilakukan dengan Tara observasi langsung.Daftar Pustaka 60 (1981- 2001)

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Analysis of Factors Related to Quality of Nursing Upbringing in the Room of Stay Overnight Treatment of Central Public Hospital H. Adam Malik Medan Year 2001These research is have purpose to know characteristic factors of individual nurse, working and work situation related to quality of nursing upbringing in the room of stay overnight treatment of Central Hospital of H. Adam Malik Medan.These research is constitute the descriptive analysis which is data collecting in the cross sectional. Hypothesis which are proved in these research is the existence of relation between nurse characteristic, working and work situation of performer nurse with quality of nursing upbringing in the room of stay overnight treatment of Central Hospital of K Adam Malik Medan.Sample of research is the performer nurse which are working in the room of stay overnight treatment of central hospital of H. Adam Malik Medan, in a number of 73 persons who are selected in random manner. For data accuracy, the observation is performed in 3 times performed during 3 weeks. Data collecting is performed with involved university student of Program Study of Nursing Knowledge of Medical of North Sumatera University in a number of 12 persons is gave assist to researcher. Instrument which are used is the instrument of measuring of individual characteristic (Stoner, 1996) and instrument of measuring nursing process documentation (Health Departement of Republic of Indonesia, 1977). The result of validity test and reliability instrument is using alpha cronbach, with good result.Result of research in the univariat analysis is shown that quality of nursing upbringing in the room of stay overnight treatment of Central Hospital of H. Adam Malik Medan located in the good category (50,77 %). From the result bivariat analysis is known that characteristic of nurse in statistically is having significant relationship with quality of nursing upbringing through approach of nursing process is the dimension of formal education with value p = 0,011, dimension of room of stay overnight treatment with value p = 0,045. result of multivariate with logistic regression test is using Backward method (CI = 95 %) and dimension of supervision with value p = 0,0296 is having the most significant relationship in statistically with quality of nursing upbringing.Based on these result of research, then party of Central Hospital of H. Adam Malik Medan especially in the field of nursing is need to be considering the job description in accordance with the ability of nursing manpower which have, performing valuation and recruitment of nursing manpower according to the need, developing professional nursing practice model to increase quality of nursing upbringing, performing training in continuous in the scope of quality of nursing upbringing and supervision. Beside that, for the advanced research in order to be made with experimental design using qualitative approach. Therefore is suggested in order that the data collecting method for the variable of nursing upbringing is performed with direct observation manner.Bibliographi 60 (1981-2001)"

"ABSTRAKSistektomi radikal merupakan penanganan standar pada pasien tumor buli yang telah menembus otot, Perdarahan merupakan salah satu morbiditas yang ditemukan pada prosedur ini. Tujuan penelitian ini untuk mengetahui rata-rata jumlah kehilangan darah pada prosedur sistektomi radikal. Merupakan penelitian non-eksperimental retrospektif-deskriptif-analitik yang mengambil data Rekam Medis dari Januari 2012 Desember 2015 di RSUP H. Adam Malik Medan. Berdasarkan variable yang diperiksa terdapat perbedaan signifikan pada jumlah perdarahan berdasarkan diversi urin yang digunakan, yaitu ureterocutaneostomy dan neobladder. Diperlukan persiapan darah sekitar 951,5 ml sebagai standar persiapan operasi di radikal sistektomi di RSUP H. Adam Malik Medan"

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ABSTRACTRadical cystectomy is a standard management for patients with bladder tumor which has penetrated muscles. Bleeding is one of the morbidity associated with the procedure. This study aims to measure mean blood loss during radical cystectomy. This study was a retrospective analytic study, data was collected using medical records from January 2012 to December 2015 At Haji Adam Malik General Hospital Medan. Variables that affected amount of blood loss staging, type of anesthesia used, and urine diversion, there are no significant differences except on amount of blood loss according to urine diversion method used, which were ureterocutaneostomy and neobladder. Blood preparation is needed about 951.5 ml as standard preparation for surgery in radical sistektomi in RSHAM "

"Usia pasien dan lokasi striktur uretra penting untuk menentukan sebagian besar penyebab dari striktur uretra. Striktur uretra paling sering timbul pada pars bulbosa. Kashefi et al. dalam penelitiannya menunjukkan bahwa diperkirakan 3,2 striktur uretra per 1000 pasien rawat inap disebabkan oleh trauma oleh kateter. Pada pasien berusia di atas 45 tahun, TURP dan prostatektomi radikal adalah penyebab paling umum dari striktur/kontraktur uretra. Penelitian ini bertujuan untuk memberikan gambaran pasien striktur uretra di rumah sakit H. Adam Malik Medan serta penanganan yang dilakukan.Penelitian ini adalah penelitian retrospektif, deskriptif mengenai pasien striktur uretra di Medan, Indonesia. Penelitian dilakukan di rumah sakit H. Adam Malik antara bulan Mei dan Juni 2017, Medan dengan mengumpulkan data dari rekam medis. Data yang dikumpulkan meliputi nama, usia, gejala klinis, lokasi striktur, panjang striktur, dan jenis tindakan yang dilakukan. Data dianalisis menggunakan SPSS 20 mengenai rerata usia, lokasi striktur tersering, rerata panjang striktur, dan jenis tindakan yang digunakan untuk menangani panjang striktur tertentu atau lokasi striktur tertentu. Penyebab striktur paling banyak pada penelitian ini adalah trauma sebanyak 35 pasien dari 60 pasien (58,3%). keluhan tidak dapat BAK menjadi mayoritas penyebab mereka datang ke rumah sakit (46,7%), diikuti dengan BAK sulit ataupun tidak lancar (masing-masing 25%), dan hal yang paling jarang dikeluhkan adalah nyeri saat BAK Penelitian ini menyatakan bahwa karakter pasien striktur uretra di Indonesia tidak berbeda jauh dengan penelitian-penelitian yang ada sebelumnya. Penelitian ini juga menunjukkan bahwa urethrotomy(Sachse) lebih banyak digunakan dibandingkan urethroplasty, serupa dengan diluar negeri meskipun urethroplastymemiliki efektifitas yang lebih baik.

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The age of the patient and the location of urethral stricture are important for determining most of the causes of urethral stricture. Urethral stricture most often occurs in bulbous pars. Kashefi et al. in their study showed that an estimated 3.2 urethral strictures per 1000 inpatients were caused by trauma by the catheter. In patients over 45 years, TURP and radical prostatectomy are the most common causes of urethral stricture/contracture. This study aims to provide an overview of urethral stricture patients at H. Adam Malik Hospital in Medan as well as the treatment performed. This study is a retrospective, descriptive study of urethral stricture patients in Medan, Indonesia. The study was conducted at H. Adam Malik Hospital between May and June 2017, Medan by collecting data from medical records. Data collected included name, age, clinical symptoms, stricture location, stricture length, and type of action performed. Data were analyzed using SPSS 20 regarding age averages, location of the most common strictures, mean length of strictures, and types of actions used to deal with certain strictures or locations of certain strictures. The most common causes of stricture in this study were trauma in 35 patients from 60 patients (58.3%). BAK complaints cannot be the majority of the reasons they come to the hospital (46.7%), followed by difficult or non-BAC (25% each), and the most rarely complained of is pain when BAK This study states that the patient's character Urethral stricture in Indonesia is not much different from previous studies. This study also shows that urethrotomy (Sachse) is more widely used than urethroplasty, similar to abroad even though urethroplasty has better effectiveness."

"ABSTRAKPenelitian prospektif ini bertujuan untuk membandingkan keluaran PCNL dengan posisi prone dibandingkan dengan posisi supine. Sebanyak 57 pasien yang menjalani PCNL dari 1 Januari 2017 hingga 31 Desember 2017 diikutkan dalam penelitian. Kriteria inklusi meliputi pasien dengan batu ginjal > 20 mm dari foto KUB (Kidney-Ureter-Bladder) atau abdominal NCCT (Non Contrast Computed Tomography) yang bersedia operasi PCNL. Kriteria ekslusi berupa pasien berusia < 17 tahun, pasien menolak operasi, pasien sudah pernah menjalani PCNL pada sisi yang sama, pasien dengan gangguan pembekuan darah, kehamilan, dan pasien batu ginjal dengan kelainan ginjal kongenital. Dilakukan randomisasi pasien untuk menjalani PCNL dengan posisi prone atau supine. Sebanyak 29 pasien menjalani PCNL posisi prone dan 28 pasien menjalani PCNL posisi supine. Data karakteristik pasien, lokasi pungsi, jumlah pungsi, penggunaan nefrostomi paska PCNL, lama operasi, ada atau tidaknya batu sisa berukuran ≥ 5 mm, komplikasi total, demam paska operasi, terjadinya sepsis, perdarahan yang memerlukan tranfusi, hematom retroperitoneal, efusi pleura, cidera usus, dan selisih hemoglobin sebelum dan setelah operasi dibandingkan antara kedua kelompok. Tidak didapatkan perbedaan yang bermakna pada jumlah, jenis kelamin, usia, BMI, ukuran batu, hidronefrosis, komorbid pasien pada kedua kelompok. PCNL dengan posisi prone memiliki angka bebas batu 82.8% sedangkan pada posisi supine 92.9%. Perbandingan yang bermakna didapatkan pada perbedaan rerata lama operasi dimana lama operasi PCNL dengan posisi prone 150 menit sedangkan untuk posisi supine 130 menit (p=0.003). Tidak didapatkan perbedaan yang signifikan antara keberhasilan pungsi, komplikasi total, demam paska operasi, sepsis, dan perdarahan yang membutuhkan transfusi. Tidak didapatkan pasien yang mengalami efusi pleura, cidera usus, atau kematian dalam penelitian ini. PCNL posisi supine memiliki efektifitas dan keamanan yang sama dengan PCNL dengan posisi prone. Angka bebas batu PCNL posisi supine lebih tinggi dibandingkan PCNL posisi prone. Lama operasi PCNL posisi supine secara signifikan lebih singkat dibandingkan PCNL posisi prone.

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ABSTRACTThis prospective study aimed to compare the outcomes of PCNL between prone and supine position. A total of 57 patients treated with PCNL in the time period of January 1st, 2017 until December 31st, 2017 were included in the study. Inclusion criteria includes patients with kidney stones greater than 20 mm in size measured with KUB, imaging (Kidney-Ureter-Bladder) or abdominal NCCT (Non Contrast Computed Tomography), who were willing to be treated with PCNL. The exclusion criteria were patients younger than 17 years old, patients who refused surgerical procedure, patients with history of PCNL on the same side, patients with bleeding disorders, pregnancy, and kidney stone in patients with congenital kidney disorders. Patients were randomized for prone or supine group of PCNL, in number of 29 and 28 patients respectively. Data on patient characteristics, puncture location, number of puncture, nephrostomy after PCNL, duration of surgery, presence or absence of residual stones measuring ≥ 5 mm in size, total complications, postoperative fever, sepsis, bleeding requiring transfusion, retroperitoneal hematoma, pleural effusion, intestinal injury, and the difference between hemoglobin count before and after surgery were compared between two groups. There were no significant differences observed in terms of number, sex, age, BMI, stone size, hydronephrosis, and comorbidities in patients of both groups. Stone free rate in PCNL with prone position and supine position were 82.8% and 92.9% respectively. Significant differences were observed in mean duration of surgery, with prone position duration time of 150 minutes and supine position duration time of 130 minutes (p = 0.003). There were no significant differences between successful puncture, total complications, postoperative fever, sepsis, and bleeding requiring transfusion. No patients with pleural effusion and intestinal injury were reported, and no death was reported in this study. PCNL with supine position showed similar effectivity and safety with PCNL prone position. Stone free rate was higher in PCNL with supine position and the duration was also significantly shorter in PCNL with supine position than prone position."

"ABSTRAKTerapi Androgen Deprivation Therapy (ADT) adalah salah satu tatalaksana untuk pasien dengan kanker prostat stadium lanjut yang berhubungan dengan adanya perubahan dari komposisi masa tubuh dan mencetuskan adanya resistensi dari insulin perifer. Penelitian ini dilaksanakan di RSUP H. Adam Malik, Medan sejak Juni 2014 hingga Juni 2015. Terapi ADT menyebabkan peningkatan secara signifikan sebelum dan 6 bulan sesudah pemberian kadar gula darah post prandial 121.12 21 mg/mL vs 134.64 33.35 mg/mL, p-value=0.011 dan Glycosylated hemoglobin HbA1C 5 0.5 vs 5.5 0.79 , p-value = 0.000 . Pemberian ADT selama 3 sampai 6 bulan juga secara signifikan meningkatkan kadar Trigliserida TG 104.4 38.67 vs 131.2 32.27 vs 127 33.43, p-value = 0.005 .

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ABSTRACTTherapy ADT is one of the treatments in patients with advanced prostate cancer in which has been linked to the changes in body mass composition and induction of insulin peripheral resistance in many studies. This research was conducted at Dr H. Adam Malik, Medan from June 2014 to June 2015. ADT administration is found to cause a significant elevation of 2 hour postprandial blood glucose 121.12 21 mg mL vs 134.64 33.35 mg mL, p value 0.011 and Glycosylated hemoglobin 5 0.5 vs 5.5 0.79 , p value 0.000 HbA1c after 6 months of therapy. Additionally, ADT administration within 3 and 6 months of duration had also significantly increased triglyceride TG level when compared to before treatment 104.4 38.67 vs 131.2 32.27 vs 127 33.43 respectively, P value 0.005 ."

"Efikasi diri diperlukan bagi pasien DM tipe 2 untuk meningkatkan kemandirian pasien dalam mengelola penyakitnya. Penelitian ini bertujuan mengidentifikasi hubungan antara motivasi dengan efikasi diri pasien DM tipe 2 di RSUP H. Adam Malik, Medan. Desain dalam penelitian ini adalah analitik cross sectional dengan jumlah sampel 110 pasien DM tipe 2. Analisa data menggunakan Chi square, uji t independen dan regresi logistik berganda. Hasil penelitian didapatkan bahwa karakteristik responden tidak ada yang berhubungan dengan efikasi diri kecuali status sosial ekonomi (p value 0.046; α 0.05). Ada hubungan antara dukungan keluarga dengan efikasi diri (p value 0.010, α: 0.05), ada hubungan antara depresi dengan efikasi diri (p value 0.026; α: 0.05) dan motivasi berhubungan dengan efikasi diri (p value 0.031; α: 0.05). Individu yang memiliki motivasi yang baik berpeluang 3.736 kali menunjukkan efikasi diri yang baik dibandingkan dengan individu yang memiliki motivasi kurang baik setelah dikontrol depresi (CI 95% OR: 1.35-10.32). Diharapkan perawat dapat meningkatkan motivasi dan efikasi diri pasien DM tipe 2 dengan memberikan pendidikan kesehatan terstruktur, memfasilitasi pemberian dukungan sosial dan memberian intervensi untuk mencegah munculnya depresi.

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Self-efficacy is required for patient with type 2 diabetes in managing the disease independently. This study aimed to identify the relationship of motivation with selfefficacy in patient with type 2 diabetes in H. Adam Malik Hospital Medan. This study was a cross sectional analytic, recruited 110 respondents. Statistical analysis used for this study was chi-square, independent t-test and multiple logistic regression.

The results showed that the characteristic of respondents were not associated with self-efficacy, except sosioeconomic state (p value 0. 046, α: 0.05). There were relationships between family support and self efficacy (p value 0.010, α: 0.05), depression and self-efficacy (p value 0.026, α: 0.05) and motivation and self-efficacy ( p value 0.031, α: 0.05). People with good motivation had chance 3.736 times more to show a good self-efficacy than people with average motivation as this condition had been controlled by depression (CI 95% OR: 1.35;10.32).

It is recommended that nurses would be able to enhance motivation and selfefficacy of type 2 diabetes patients through developing structrured educational programmes, facilitating the social support and providing intervention to prevent depression symptoms."

"Dalam sebuah organisasi terdapat iklim organisasi yang terbentuk dari persepsi pekerja terhadap kebijakan, dukungan, kejelasan organisasi, penghargaan dan tanggung jawab. Iklim organisasi selanjutnya akan menciptakan iklim kerja yang dapat mempemgaruhi pekerja dalam tiga hal yaitu : motivasi, kinerja dan kepuasan kerja pekerja.Penelitian ini merupakan penelitian dengan disain deskriptif korelasional yang bertujuan untuk menguji hubungan antara iklim kerja dan karakteristik indidividu dengan kinerja perawat pelaksana di ruang rawat map RSUP H. Adam Malik. Penelitian menggunakan total populasi yang telah memenuhi kriteria inklusi, yaitu sebanyak 157 perawat pelaksana yang bertugas di ruang rawat inap RSUP H. Adam Malik. Kuesioner yang berhasil terkumpul sebanyak 141 responden/perawat. Instrumen yang digunakan adalah iklim kerja dan kinerja perawat yang telah dimodifikasi dan disesuaikan dengan kebutuhan penelitian. Uji validitas dan reliabilitas untuk instrumen iklim kerja nilai alpha = 0,8923 dan untuk instrumen kinerja nilai alpha = 0,9505.Hasil penelitian ini menunjukkan ada 3 variabel yang berhubungan dengan kinerja perawat yaitu : kejelasan visi misi dan tujuan pelayanan keperawatan, tanggung jawab perawat dan umur responden di ruang rawat map RSUP H. Adam Malik. Perawat yang mempersepsikan kejelasan visi misi dan tujuan pelayanan keperawatan baik mempunyai kinerja baik 5,8 kali dibanding perawat yang mempersepsikan kejelasan visi misi dan tujuan pelayanan keperawatan kurang. Demikian juga dengan perawat yang mempersepsikan tanggung jawab perawat baik berpeluang mempunyai kinerja baik 3,9 kali dibanding perawat yang mempersepsikan tanggung jawab kurang. Sedangkan perawat yang berumur 35 tahun berpeluang mempunyai kinerja baik 2,6 kali dibanding perawat yang berumur < 35 tahun. Dengan demikian variabel yang paling dominan berhubungan dengan kinerja adalah kejelasan visi misi dan tujuan pelayanan keperawatan ( p value = 0,001; OR = 5,793 ).Peneliti menyimpulkan bahwa perlunya keterlibatan perawat dengan pimpinan rumah sakit dalam menyusun rencana strategi khususnya pelayanan keperawatan yang nantinya akan merumuskan visi misi dan tujuan pelayanan keperawatan terkait yang akan melahirkan kebijakan, peraturan, standar keperawatan. Perlunya kejelasan tanggung jawab yang meliputi uraian tugas, pendelegasian tugas yang sesuai dengan kemampuan perawat, otonomi yang jelas dan adanya kewenangan dalam pengambilan keputusan secara mandiri dalam memberikan asuhan keperawatan. Usia perawat pelaksana yang lebih banyak pada kelompok usia produktif, merupakan potemsi bagi pengembangan dan pemberdayaan SDM keperawatan di RSUP H. Adam Malik.

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Organizational climate is formed from the staff's perception upon policy, support, organization's clarity, reward and responsibility. In turn it will create a working climate influencing the staff within 3 aspects: motivation, performance and job satisfaction.

The research was descriptive was correlation with cross-sectional design that aimed to examine the relationships between work climate and individual characteristics with nursing performance of the nurses working inpatient wards of H. Adam Malik Hospital. The research used total population which has fulfilled inclusion criteria were 157 nurses inpatient wards of H. Adam Malik Hospital. The questioners that have been collected were 141. The instruments applied to this study was modified an instrument. The validity and reliability test of the work climate instrument was a = 0,8923 and the nursing performance was a = 0,9505.

The study found that there were 3 correlated variables which related to nursing performance namely the vision and mission clarity and the nursing service objectives, nurses who perceived good to the vision and mission clarity and nursing service objectives had good performance 5,8 times compared to the nurses who perceived less to the vision and mission clarity and nursing service objectives. The nurses who perceived good nurses responsibility had odds ratio for good performance 3, 9 times compared to nurses who perceived less to the nurses? responsibility. The nurses at age 35 year old who had good performance 2,6 times compared to nurses at age < 35 year old. Therefore the dominant variables that correlated with performance was the vision and mission clarity (p value = 0,001; OR =-5,793).

The results of this study concluded that lead to the policy, rules, and nursing standards. The study also suggested the importance of the clarity of the responsibilities which covered job descriptions, delegations accord to the staff capabilities, the clarity of autonomy and authority in making decisions of nursing care independently. The big number of productive age of nursing staff was considerably potential to the improvement and empowerment to the nursing human resources at H. Adam Malik Hospital."

"Latar belakang: Malnutrisi rumah sakit (MRS) adalah malnutrisi yang terjadi pada pasien yang dirawat inap. Prevalensi MRS berkisar antara 20% sampai 50%. Deteksi dini untuk mengetahui risiko kejadian MRS diperlukan sehingga MRS dapat dicegah dengan pemberian asuhan nutrisi yang tepat pada anak. Hingga saat ini alur asuhan nutrisi dan tindak lanjut hasil skor STRONGkids belum dijalankan di ruang rawat inap anak RSUP HAM. Tujuan: Menilai hubungan hasil skor STRONGkids modifikasi dengan kejadian MRS dan menyusun rancangan alur asuhan nutrisi anak di ruang rawat inap RSUP HAM. Metode: Penelitian kohort prospektif dilakukan pada anak usia 1 bulan - 18 tabun yang dirawat inap?.7 hari di RSVP HAM, pada bulan Mei hingga Agustrus 2017. Dilakukan penilaian skor STRONGkids modifikasi pada setiap pasien yang dirawat dan pengukuran antropometri saat mulai dirawat dan saat pasien dipulangkan, untuk menilai kejadian MRS. Kriteria MRS apabila dijumpai penurunan berat badan ?.2% selama dirawat atau penurunan lingkar lengan atas pada keJompok pasien dirnana berat badan tidak dapat digunakan untuk menilai status nutrisi. HasH: Terdapat 165 subjek dalam penelitian ini yang memenuhi kriteria inklusi. Angka kejadian MRS adalah 40,6%. Kejadian malnutrisi rumah sakit lebih tinggi pada kelompok pasien yang berat badannya tidak dapat dinilai untuk menilai status nutrisi. Hanya 27.6% pasien dengan risiko tinggi yang dikonsulkan rawat bersama Divisi Nutrisi dan Penyakit Metabolik. Terdapat 45.6% pasien dengan risiko sedang dan 55.2% pasien dengan risiko tinggi STRONGkids modifikasi yang mengalami MRS dengan nilai P<0.001. Pasien dengan hasil skor risiko sedang dan tinggi mempunyai risiko 8.6 kali dan 15.8 kali untuk mengalami MRS selama dirawat di rumah sakit. Simpulan: Terdapat hubungan antara hasil skor STRONGkids modifikasi dengan kejadian MRS. Alur asuhan nutrisi perlu dirancang dan dijalankan untuk mencegah MRS

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Background: Hospital malnutrition is malnutrition that occurred during hospitalization. Prevalence of hospital malnutrition is about 20% to 50% around the world. Early detection of hospital malnutrition risk with screening tools with modified STRONGkids is needed to prevent hospital malnutrition with appropriate pediatric nutrition care in hospitalized children. However, pediatric nutrition care and follow -up of modified STRONGkids is not appropriately done in Adam Malik hospital. Objective: To determine the association between modified STRONGkids with incidence of hospital malnutrition among hospitalized children and propose the pediatric nutrition care scheme pathway. Methods: A prospective cohort study was conducted in Adam Malik hospital patient's ward between May to August 2017 on I-month to 18-years-old hospitalized children with length of stay -7 days. Modified STRONGkids were analyzed in 24 hours hospital admission. Anthropometric and nutritional status measurements of all subject were obtained at time of hospital admission and discharge. Weight loss -2% during hospitalization was defined as hospital malnutrition. And among patients, if body weight can not be indicator as nutritional status, decreased of arm circumference was defined as hospital malnutrition in this study Results: Of 165 participants, prevelence of hospital malnutrition was 40.6%, and was higher among subject with cancer/organomegaly/edemalascites/hydrocephalus. Only 27.6% subject with high risk modified STRONGkids was consulted to Pediatric Nutrition and Metabolic division. There was 45.6% subject with moderate risk and 55.2% subject with high risk modified STRONGkids experiencing hospital malnutrition with P"

"Background: Tire methods of ERCP have been used for diagnostic and therapeutic purposes to pass bile fluid and extract stones from the bite duct in patients with obstructive extrahepatic jaundice.

Method: A retrospective study was performed on patients with obstructive extrahepatic jaundice patients who underwent ERCP dttring a two-years time period from January 1999 to December 2000. ERCP was performed with a premedication of I0 mg midazolam, followed by a chollangiography contrast containing 1 mg/dl of Garamicin and 25 mg of Pethidine if sphincterotomy was performed.

Results: From 126 patients with obstructive extrahepatic jaundice treated with ERCR the male to female ratio was 1.86:1. The majority of the (group) of patients were between 51-60 years of age (33.3 % ). The youngest patient (group) was 24 years and the oldest 97 years. The diagnostic study found the following cases: normal 3 cases (28%), bile duct stone 46 cases (43.4%) carcinoma of ampula voter 20 cases (18.9%), CBD tumor 7 crises (6.6%), carcinoma of head of pancreas 2 cases (1.9%), diverticle 4 cases (38%), duodenal tumor I case (0.9%), carcinoma of ampula vater and bite duct stone 1 case (0.9%), SOD 5 cases (4.7%), CBD stricture 1 case (0.9%) and failure I6 cases (15.1%). The patients received the following treatment: sphyncterotomy 36 cases (51 .4%), stent application 11 cases (15.7%), sphincterotomy with stent 18 cases (25.7%) and basket method 5 cases ( 7. 1%)."