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"Latar Belakang: Respons patologis kanker payudara terhadap terapi neoadjuvan masih relatif rendah, khususnya di RSCM. Intensitas sTIL dan ekspresi PD-L1 telah diteliti sebagai prediktor respons terapi neoadjuvan. Penelitian ini menilai peran intensitas sTIL dan ekspresi PD-L1 terhadap repons terapi neoadjuvan kanker payudara. Data tersebut dapat dimanfaatkan sebagai data awal di Indonesia, untuk perencanaan terapi pasien kanker payudara yang lebih baik, terlebih dengan sudah tersedianya imunoterapi anti-PD-1/PD-L1.Tujuan: Mengetahui intensitas sTIL dan ekspresi PD-L1 sebagai prediktor respons patologis kanker payudara terhadap terapi neoadjuvan di RSCM.Metode: Penelitian berdesain kohort retrospektif, analitik observasional, pada kasus kanker payudara yang mendapatkan terapi neoadjuvan dan mastektomi di RSCM periode Januari 2014-Desember 2021. Dilakukan total sampling sebanyak 60 kasus. Ekspresi PD-L1 (imunohistokimia, klon 22C3) dan intensitas sTIL (histopatologi) diperiksa pada spesimen biopsi. Dilakukan analisis multivariat regresi linear untuk mendapatkan prediktor independen respons terapi neoadjuvan.Hasil: Didapatkan 60 pasien perempuan, median usia 46 tahun, 91,7% karsinoma invasif no special type. Median intensitas sTIL 10% (1%-70%). Intensitas sTIL rendah (≤10%) pada 58,3% sampel. Ekspresi PD-L1 positif (CPS ≥1) pada 28,3% sampel. Hanya 8,3% sampel mencapai pCR, 90% tergolong RCB kelas II-III. Didapatkan prediktor independen skor RCB: Setiap peningkatan 1% intensitas sTIL, tidak adanya invasi limfovaskular, dan pemberian kemoterapi berbasis taksan diprediksi menurunkan skor RCB sebanyak 0,058 (0,039-0,078), 0,781 (0,241-1,321), dan 0,594 (0,037-1,152). Ekspresi PD-L1 yang positif berhubungan dengan tercapainya pCR-RCB kelas I (p=0,048), tetapi skor CPS bukan merupakan prediktor skor RCB pada analisis multivariat regresi linear.Kesimpulan: Intensitas sTIL merupakan prediktor respons patologis kanker payudara terhadap terapi neoadjuvan di RSCM. Ekspresi PD-L1 berhubungan dengan tercapainya pCR-RCB kelas I, tetapi skor CPS bukan prediktor skor RCB.Kata kunci: PD-L1, programmed-death ligand 1, sTIL, stromal tumour infiltrating lymphocyte, kanker payudara, kemoterapi neoadjuvan, respons patologis

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Background: Pathological responses to neoadjuvant therapy were still relatively poor, especially in RSCM. Studies had been done to search for predictors of response such as sTIL intensity and PD-L1 expression, which is known to block sTIL action in killing cancer cells. This research assessed sTIL intensity and PD-L1 expression as predictors of response to neoadjuvant therapy in breast cancer. The preliminary data might be used to better tailored breast cancer patient therapy, considering the availability of anti-PD-1/PD-L1 immunotherapy nowadays.

Objective: To assess TIL intensity, PD-L1 expressions, and their roles as pathological predictors of breast cancer reponse to neoadjuvant therapy in RSCM.

Method: This was an observational analytic retrospective cohort study on breast cancer patients receiving neoadjuvant therapy and mastectomy in RSCM from January 2014 to December 2021. Total sampling was done. PD-L1 expression (immunohistochemistry, clone 22C3) and sTIL intensity (histopathology) was examined in the biopsy specimen. Linear regression analysis was done to determine the independent predictors of neoadjuvant therapy response (evaluated in the mastectomy specimen with residual cancer burden/RCB score).

Results: There were 60 female patients, median age 46 years old. 91,7% had invasive carcinoma of no special type. Median sTIL intensity was 10% (1%-70%). 58,3% patients had low sTIL intensity (≤10%). 28,3% patients had positive PD-L1 expression (CPS ≥1). Only 8,3% patients had pCR, while 90% patients had RCB class II-III. Every 1% increase in sTIL intensity, no lymphovascular invasion, and taxane chemotherapy were predicted to lower RCB score by 0,058, 0,781, dan 0,594, respectively. PD-L1 expression associated with pCR-RCB class I (p=0,048), but CPS score was not a predictor of RCB score in linear regression analysis.

Conslusion: sTIL intensity was an independent predictor of breast cancer response to neoadjuvant therapy in RSCM. PD-L1 expression associated with pCR-RCB class I, but CPS score was not a predictor of RCB score.

Keywords: PD-L1, programmed death ligand 1, sTIL, stromal tumour infltrating lymphocyte, breast cancer, neoadjuvant therapy, pathological response"

"Latar belakang: Osteosarkoma adalah tumor tulang ganas yang paling banyak terjadi pada anak dan remaja. Kemoterapi neoadjuvan dapat meningkatkan kesintasan 5 tahun hingga 60 – 80% pada pasien osteosarkoma. Baku emas evaluasi respon kemoterapi neoadjuvan adalah histological mapping untuk menilai persentase nekrosis tumor. Volumetri-Magnetic Resonance Imaging (MRI) menggunakan 3D Slicer dapat menilai nekrosis tumor, tumor viabel, dan volume tumor total secara kuantitatif. Tujuan: Menganalisa korelasi volume dan persentase tumor viabel berdasarkan volumetri-MRI dengan nilai persentase tumor viabel berdasarkan pemeriksaan histopatologi pada pasien osteosarkoma pasca kemoterapi neoadjuvan. Metode: Melakukan volumetri tumor pada MRI pasca kemoterapi neoadjuvan dengan menggunakan teknik segmentasi manual dan semiotomatis pada 3D Slicer untuk mendapatkan volume total tumor, area nekrosis, serta tumor viabel. Hasil pengukuran volumetri tumor viabel dan persentase tumor viabel pasca kemoterapi dikorelasikan dengan persentase tumor viabel berdasarkan histopatologi. Analisis dilakukan dengan uji Spearman. Hasil: Pada 31 subyek penelitian, nilai median persentase tumor viabel berdasarkan volumetri-MRI yaitu 65,9% (range 19,7 – 99,5%), sedangkan berdasarkan pemeriksaan histopatologi didapatkan nilai median 53% (range 8 – 100%). Persentase tumor viabel berdasarkan volumetri-MRI tidak berkorelasi signifikan (p>0,05) dengan persentase tumor viabel berdasarkan histopatologi dengan nilai R: 0,333. Kesimpulan: Terdapat kecenderungan berbanding lurus antara persentase tumor viabel berdasarkan volumetri-MRI dan pemeriksaan histopatologi, walaupun tidak terdapat korelasi yang signifikan.

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Background: Osteosarcoma is the most common malignant bone tumor in children and adolescents. Neoadjuvant chemotherapy can improve 5-year survival up to 60 - 80% in osteosarcoma patients. The gold standard of neoadjuvant chemotherapy response evaluation is histological mapping to determine the percentage value of tumor necrosis. 3D Slicer volumetry based on Magnetic Resonance Imaging (MRI) can quantitatively assess tumor necrosis, viable tumor, and total tumor volume. Objective: Analyze the correlation between volume and percentage of viable tumors based on MRI-volumetry and histopathological in osteosarcoma patients post neoadjuvant-chemotherapy. Methods: Perform tumor volumetry on MRI post neoadjuvant-chemotherapy using manual and semiautomatic segmentation techniques on 3D Slicer to obtain total tumor volume, necrosis area, and viable tumor. The results of volumetric measurement of viable tumor and the percentage of viable tumor post chemotherapy were correlated with the percentage of viable tumor from histopathological examination. Analysis was performed with Spearman's test. Results: Based on 31 study subjects, the median percentage of viable tumors based on MRI-volumetry was 65.9% (range: 19.7 - 99.5%), while based on histopathology, the median value was 53% (range: 8 - 100%). The percentage of viable tumors based on MRI-volumetry was not significantly correlated (p>0.05) with the percentage of viable tumors based on histopathology with an R value: 0.333. Conclusion: There is a directly proportional trend between the percentage of viable tumors based on MRI-volumetry and histopathological examination, although there was no significant correlation."

"Pendahuluan: Efikasi neoadjuvan kemoembolisasi transarterial (N-TACE) pada karsinoma hepatoseluler (KSH) yang dapat direseksi masih diperdebatkan. Meskipun N-TACE dapat mengurangi ukuran tumor, dampaknya terhadap luaran jangka panjang masih belum dapat disimpulkan.Metode: Meta-analisis ini meninjau studi terkait N-TACE vs. Reseksi Hati (RH) pada karsinoma sel hati soliter besar (KSHSB) hingga Maret 2023 dari empat database online.Hasil: 5 penelitian dengan total sampel 1556 pasien (N-TACE = 474; LR = 1082) dilakukan analisis. Dari hasil analisis, tidak ada perbedaan signifikan antara kelompok N-TACE dan RH yang diamati pada KS dan KBT 1, 3, atau 5 tahun. Odds Ratio yang didapatkan adalah 0,91 (95% CI 0,54 – 1,54), 0,80 (95% CI 0,56 – 1,15), dan 0,88 (95%CI 0,47 – 1,65) untuk KS 1, 3, dan 5 tahun dan 0,66 ( 95% CI 0,32 – 1,34), 0,70 (95% CI 0,37 – 1,33), dan 0,75 (95% CI 0,28 – 1,98) masing- masing untuk KBT 1, 3, dan 5 tahun. Tidak ada perbedaan signifikan yang diamati pada kehilangan darah intraoperatif antar kelompok. Analisis subgroup menunjukkan KS 1, 3, dan 5 tahun yang mengarah ke N-TACE pada kombinasi kemoterapi dan KS 1 tahun yang lebih baik pada kelompok RH di kemoterapi agen tunggal. Selain itu, KBT 5 tahun lebih mengarah pada RH di kelompok agen kemoterapi tunggal (OR 2,82 95% CI 1,18 – 6,72) dan N-TACE pada kelompok kombinasi (OR 0,75 95%CI 0,28 – 1,98).Kesimpulan: Pengelolaan KSHSB memerlukan pertimbangan yang rumit dan diperlukan peningkatan strategi pengobatan untuk subkelompok HCC yang ini. Pengaruh N-TACE terhadap kelangsungan hidup jangka panjang dan kehilangan darah intraoperatif pada KSHSB memiliki hasil tidak signifikan. Namun, kombinasi kemoterapi pada N-TACE memberikan hasil yang lebih baik terhadap kesintasan pasien KSHSB.

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Introduction: The efficacy of neoadjuvant transarterial chemoembolization (N- TACE) in resectable hepatocellular carcinoma (HCC) remains debated. While N- TACE may reduce tumor size, its impact on long-term outcomes is inconclusive. Methods: This meta-analysis reviewed studies on N-TACE before surgical resection vs. LR SLHCC up to March 2023 from four online databases.

Results: 5 studies with 1556 patients (N-TACE = 474; LR = 1082) were analyzed. No significant differences between N-TACE and LR groups were observed in 1-, 3-, or 5-year OS and DFS. The pooled HRs were 0.91 (95% CI 0.54 – 1.54), 0.80 (95% CI 0.56 – 1.15), and 0.88 (95%CI 0.47 – 1.65) for the 1-, 3-, and 5-year OS and 0.66 (95% CI 0.32 – 1.34), 0.70 (95% CI 0.37 – 1.33), and 0.75 (95% CI 0.28 – 1.98) for 1-, 3-, and 5-year DFS respectively. No significant differences were observed in intraoperative blood loss between groups as well. Subgroup analysis showed favorable 1-, 3-, and 5-year OS with combination chemotherapy N-TACE (combination group) and better 1-year OS in the LR group with single-agent chemotherapy N-TACE (single-agent group). In addition, 5-year DFS favored LR in the single-agent group (OR 2.82 95% CI 1.18 – 6.72) and N-TACE in the combination group (OR 0.75 95%CI 0.28 – 1.98).

Conclusion: Managing SLHCC requires intricate considerations and enhancement of treatment strategies for this challenging subgroup of HCC is needed. The influence of N-TACE on long-term survival and intraoperative blood loss in SLHCC appears limited. However, combination chemotherapy in N-TACE results in better outcomes."

"Introduction : crafts in perspective -- The case for crafts and creative media: justification for use in occupational therapy -- Analyzing and grading crafts and creative media -- Documenting the use of crafts and creative media -- Using crafts and creative media in practice -- Mosaic and glass crafts -- Woodworking -- Metal crafts -- Ceramics -- Leatherwork -- Needlework -- Gardening and nature crafts -- Cooking as a craft -- Crafts from found and recycled materials -- Paper crafts -- Bead and wire work -- Miscellaneous crafts -- Electronic media -- Expressive media."

"Penelitian ini bertujuan untuk mengetahui efektivitas cognitive behavioral play therapy dalam mengatasi selective mutism pada anak usia sekolah. Penelitian ini mengunakan desain single-subject. Subyek penelitian ini berjenis kelamin perempuan, berusia 10 tahun dan duduk di kelas lima Sekolah Dasar. Efektivitas program diukur dengan mengunakan pendekatan kualitatif dan kuantitatif dengan data yang diperoleh melalui metode observasi. Sebagai intervensi, peneliti menggunakan cognitive behavioral play therapy. Hasil Penelitian menunjukkan program cognitive behavioral play therapy efektif dalam membangun pikiran alternatif yang adaptif, membentuk coping perilaku berupa deep breath dan meningkatkan frekuensi bicara pada L. Sebagai hasil tambahan program ini juga mempengaruhi motivasi subyek untuk mau bermain dengan teman-teman.

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Cognitive behavioral play therapy are aplied to reduce selective mutism on middle childhood children. This research is single subject design with 10 years old little girl as subject. In qualitative and quantitative approch, this research use observational method. For cognitive and behavior change, researcher use cognitive behavior technic such as psychoeducation, cognitive change strategies (identifying and challenging maladaptive thought), positive self-statement, problem solving, bibliotherapy, modeling, role play, relaxation, exposure, and positive reinforcement. As the result, cognitive behavioral play therapy are effective to develop subject‟s alternative adaptive thought and adaptive behavior coping, and increase talk behavior frequencies."

"ABSTRAKPasung merupakan suatu tindakan memasang sebuah balok kayu pada tangan dan/atau kakiseseorang, diikat atau dirantai, diasingkan pada suatu tempat tersendiri di dalam rumahataupun di hutan. Bireuen menempati urutan pertama untuk kasus pasung terbanyak diAceh. Keluarga dengan klien gangguan jiwa yang dipasung seringkali merasakan bebanyang berkaitan dengan perawatan klien. Alasan keluarga melakukan pemasungan adalahmencegah prilaku kekerasan, mencegah risiko bunuh diri, mencegah klien meninggalkanrumah dan ketidakmampuan keluarga merawat klien gangguan jiwa. Tujuan penelitian iniuntuk mengetahui pengaruh FPE terhadap beban dan kemampuan keluarga dalam merawatklien pasung dan mengetahui tingkat kemandirian klien pasung dalam perawatan dirisetelah mendapatkan asuhan keperawatan defisit perawatan diri. Desain penelitian quasieksperiment dengan pendekatan pre post test without control group. Penelitian dilakukandi 8 Puskesmas di Kabupaten Bireuen menggunakan total sampling yaitu 20 keluarga yangterdiri dari 11 keluarga dengan klien pasung dan 9 keluarga dengan klien lepas pasung.Family Psychoeducation (FPE) merupakan sebuah metode terapi keluarga yangdikembangkan oleh NAMI (National Alliance for Mentally Ill) untuk memberikandukungan kepada keluarga. FPE dilakukan melalui 5 sesi dan asuhan keperawatan defisitperawatan diri sebanyak 4 sesi. Hasil uji statistik dependen t-Test menunjukkan penurunanbeban keluarga dan peningkatan kemampuan keluarga secara bermakna setelah mendapatFPE. Aspek kemandirian klien (aktivitas harian, aktivitas sosial, cara mengatasi masalahdan pengobatan) dalam perawatan diri meningkat secara bermakna setelah mendapatintervensi defisit perawatan diri. Diharapkan penerapan FPE pada keluarga dengan pasungdapat dilakukan di pelayanan kesehatan jiwa Puskesmas sehingga pada akhirnya dapattercapai ‘Aceh Bebas Pasung’.

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ABSTRACTPasung represent an action which installing a log wood at hand or feet, bound or enchainedis then detached at one particular separate place within doors and or in the forest. Bireuenhas the most pasung cases number in Aceh. Usually a lot of problems, subjective orobjective burden related to client treatment got by family. The reasons given for pasungwere often multiple, including violence, concern about the person wandering off or runningaway and coming to harm, concern about possibility of suicide, and the unavailability of acaregiver. Family Psychoeducation is a therapy method developed by NAMI (NationalAlliance for Mentally Ill) to give fully support to the family. The aim of this research is tofind out the FPE influence towards burden and family ability in taking care of pasungclient. Also expand the research about client independence after getting deficit self caretreatment. This quasi experiment did with pre post test without control group. The sampleswas taken to 20 families (11 families of client pasung and 9 families of ex client pasung)spread in 8 Puskesmas of Bireuen District with total sampling method. FPE conduct in 5sesion and 4 sesion for deficit self care treatment. The statistic result of dependent t-Testshowed that there was a significant effect in decreasing the family burden and increasingthe family ability. The aspect of client independence (daily activity, social activity, solvedthe problems and medication) in self care also increased significantly after gettingintervention of self care deficit. After all the research result, it’s strongly recommendedespecially for Puskesmas should be a facilitating unit in implementing FamilyPsychoeducation to families which has pasung client to achieve better life “ Free AcehFrom Pasung”."

"Hipertensi merupakan golongan penyakit tidak menular yang masih menjadi masalah kesehatan masyarakat secara luas khususnya pada beberapa negara berkembang dengan ekonomi menengah kebawah termasuk Indonesia. Dampak psikologis hipertensi yaitu stres, ansietas dan kemarahan, perasaan kurang bertenaga. Beberapa penelitian menunjukan bahwa Cognitive Behaviour Therapy (CBT) efektif untuk klien hipertensi dalam mengontrol tekanan darah sistolik dan diastolik, menurunkan gejala cemas dan depresi, serta meningkatkan kualitas tidur. Hasil dari studi -studi menuliskan pelaksanaan CBT dari segi waktu dan jumlah pertemuan masih beragam Tujuan : penelitian ini bertujuan untuk mengekplorasi kebutuhan terapi psikososial : CBT untuk klien hipertensi. Metode: penelitian ini menggunakan metode kualitatif deskriptif. Data dikumpulkan dengan wawancara mendalam, partisipan dalam penelitian ini didapatkan 20 orang. Penelitian ini menggunakan teknik thematic analysis dengan 6 langkah yaitu Familiarising, Genarating Codes, Searching For Themes, Reviewing Themes , Defining and Naming Theme dan Producing The Report. Hasil: Hasil wawancara dan catatan lapangan dari partisipan mengidentifikasi 4 tema yaitu respons emosi terhadap penyakit, respons kognitif dan perilaku terhadap penyakit, strategi teknis CBT dan harapan dan manfaat CBT. Kebutuhan terapi psikososial : CBT untuk pasien Hipertensi lebih tergambar dari tema ketiga yaitu kebutuhan pada startegi teknis CBT. Kebutuhan strategi dan teknis CBT berbeda antara pasien di Puskesmas Semplak dan di Rumah Sakit Marzoeki Mahdi , seperti tempat pertemuan, dan teknis tugas tambahan. Kesimpulan: Kebutuhan klien Hipertensi terhadap startegi teknis pelaksanaan CBT di Puksesmas adalah kunjungan rumah dengan sebulan sekali, kemudian Rumah Sakit Jiwa Marzoeki Mahdi waktu sebulan sekali tetap di Rumah sakit.

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Hypertension is a group of non-communicable diseases that are still a public health problem, especially in several developing countries with lower-middle economies, including Indonesia. The psychological impact of hypertension is stress, anxiety and anger, feeling less energetic. Several studies have shown that Cognitive Behavior Therapy (CBT) is effective for hypertensive clients in controlling systolic and diastolic blood pressure, reducing symptoms of anxiety and depression, and improving sleep quality. The results of studies that describe the implementation of CBT in terms of time and number of meetings are still varied. Objectives: This study aims to explore the need for psychosocial therapy: CBT for hypertensive clients. Methods: this research uses descriptive qualitative method. Data collected by in-depth interviews, participants in this study obtained 20 people. This study uses a thematic analysis technique with 6 steps, namely Familiarising, Generating Codes, Searching For Themes, Reviewing Themes, Defining and Naming Themes and Producing The Report. Results: The results of interviews and field notes from participants identified 4 themes, namely emotional responses to illness, cognitive and behavioral responses to illness, CBT technical strategies and expectations and benefits of CBT. The need for psychosocial therapy: CBT for hypertension patients is illustrated by the third theme, namely the need for CBT technical strategies. The need for CBT strategies and techniques differed between patients at the Semplak Health Center and Marzoeki Mandi Hospital, such as meeting places, and additional technical tasks. Conclusion: Hypertension clients' needs for technical strategies for implementing CBT at Community Health Centers are home visits once a month, then Marzoeki Mahdi Mental Hospital once a month stays in the hospital."

"Activity Analysis, Creativity, and Playfulness in Pediatric Occupational Therapy: Making Play Just Right applies foundational occupational therapy tools for the pediatric population including activity analysis, therapeutic use of self, clinical reasoning, and the selection and adaptation of meaningful therapeutic activities. Theory, evidence, and the process of doing occupational therapy are interwoven, emphasizing their interrelated value for students and occupational therapists new to pediatrics. Play occupations and playful approaches to daily activities are highlighted as the foundation for providing client-centered, occupation-based intervention in pediatrics."