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"Latar belakang: Trakeostomi adalah tindakan membuka leher anterior pada trakea untuk memintas saluran napas atas. Jumlah prosedur trakeostomi anak semakin meningkat setiap tahunnya dan prosedur trakeostomi pada anak dapat mengakibatkan komplikasi intraoperatif, dini  pascaoperatif, dan lanjut pascaoperatif. Tujuan: Mengetahui karakteristik trakeostomi anak, proporsi kejadian komplikasi, sebaran komplikasi dan faktor yang berpengaruh dan hubungannya dengan dua komplikasi yang tersering, sehingga dapat menurunkan angka kejadian komplikasi trakeostomi pada anak. Metode: Penelitian ini merupakan studi potong lintang dari 97 subjek, data yang diambil berupa data sekunder rekam medik manual dan elektronik. Hasil: Karakteristik subjek trakeostomi yang paling sering adalah pada kelompok usia 28 hari-< 12 bulan (42,3%), jenis kelamin laki-laki (56,7%), status gizi baik (64,3%), dengan penyakit dasar masalah jalan napas (29,9%), dua komorbid (26,8%). Penyakit dasar tersering pada indikasi prolong intubasi adalah penyakit paru (n=26), pada indikasi sumbatan jalan napas adalah stenosis subglotis (n=13), dan pada indikasi proteksi jalan napas inadekuat adalah defisit neurologis (n=7). Indikasi trakeostomi terbanyak adalah prolong intubasi (57,7%), sebagian besar subjek dilakukan trakeostomi terintubasi (86,6%). Rata-rata intubasi terlama adalah  lebih dari 7 hari (57,7%), dengan rata-rata 20,1 hari (1─99 hari). Teknik insisi trakea tersering adalah vertical (81,4%), Sebagian besar subjek dilakukan stay suture (66%), dan hanya Sebagian kecil subjek yang dilakukan safety suture (3,1%). Ukuran kanul yang tersering digunakan adalah nomor ≤ 4 (46,4%), dengan jenis kanul terbanyak adalah tanpa balon (74,2%). Waktu penggantian kanul terbanyak adalah dalam jangka waktu lebih dari 3 bulan (27,8%), namun terdapat subjek yang tidak sempat dilakukan penggantian karena meninggal atau sudah dapat dilakukan dekanulasi (31,9%). Tindakan trakeostomi tersering dilakukan di ruang rawat intensif (60,8%). Dekanulasi dilakukan pada 12,4% subjek, dengan rata-rata waktu dekanulasi 212,67 hari. Proporsi komplikasi yang terjadi adalah 41%. Jenis komplikasi yang terbanyak adalah komplikasi lanjut pascaoperatif (25,8%), yaitu oklusi kanul (12,4%), dan dekanulasi spontan (9,3%). Dua komplikasi tersering adalah oklusi kanul (n=14), dan dekanulasi spontan (n=13). Jenis kelamin bermakna secara statistik (p=0,007)  terhadap terjadinya komplikasi trakeostomi anak pada penelitian ini dengan proporsi laki-laki 50% dan perempuan 23,8%. Kelompok umur bermakna secara statistik (p=0,036) terhadap terjadinya komplikasi dekanulasi spontan dengan proporsi 0-12 bulan sebesar 28,57%, 1-< 5 tahun sebesar 14,28%, dan 5-<18 tahun sebesar 0%. Kesimpulan: Proporsi komplikasi trakeostomi pada anak adalah 41%, dengan komplikasi tersering adalah oklusi kanul dan dekanulasi spontan. Kelompok umur bermakna secara statistik terhadap terjadinya dekanulasi spontan, dengan proporsi 0-12 bulan sebesar 28,57%. Perawatan pasca operasi harus dilakukan dengan teliti terutama pada kelompok usia 0-12 bulan

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Background: Tracheostomy is the act of opening the anterior neck of the trachea to bypass the upper airway. The number of pediatric tracheostomy procedures is increasing every year and tracheostomy procedures in children can result in intraoperative, early postoperative, and late postoperative complications. Objective: To determine the characteristics of pediatric tracheostomy subjects, the proportion of complications, the distribution of complications and relevant factors and their association with the two most common complications, so as to reduce the incidence of pediatric tracheostomy complications. Methods: This study was a cross-sectional study of 97 subjects, the data taken were secondary data from manual and electronic medical records. Results: The most frequent characteristics of tracheostomy subjects were in the age group of 28 days-< 12 months (42.3%), male gender (56.7%), good nutritional status (64.3%), with underlying disease airway problems (29.9%), two comorbidities (26.8%). The most common underlying disease in the indication of prolonged intubation was pulmonary disease (n=26), in the indication of airway obstruction was subglottic stenosis (n=13), and in the indication of inadequate airway protection was neurological deficit (n=7). The most common indication for tracheostomy was prolonged intubation (57.7%), and most subjects underwent intubated tracheostomy (86.6%). The longest average intubation was more than 7 days (57.7%), with a mean of 20.1 days (1─99 days). The most common tracheal incision technique was vertical (81.4%), most subjects had a stay suture (66%), and only a small number of subjects had a safety suture (3.1%). The most commonly used cannula size was number ≤ 4 (46.4%), with the most common cannula type being uncuffed(74.2%). The most common time of cannula replacement was within a period of more than 3 months (27.8%), but there were subjects who did not have time for replacement because of death or could be decanulated (31.9%). Tracheostomy was most commonly performed in the intensive care unit (60.8%). Decanulation was performed in 12.4% of subjects, with an average decanulation time of 212.67 days. The proportion of complications that occurred was 41%. The most common types of complications were late postoperative complications (25.8%), such as cannula occlusion (12.4%), and spontaneous decanulation (9.3%). The two most common complications were cannula occlusion (n=14), and spontaneous decanulation (n=13). Gender was statistically significant (p=0.007) for the occurrence of pediatric tracheostomy complications in this study with a proportion of 50% males and 23.8% females. Age group was statistically significant (p=0.036) to the occurrence of spontaneous decanulation complications with the proportion of 0-12 months by 28.57%, 1-< 5 years by 14.28%, and 5-< 18 years by 0%. Conclusion: The proportion of tracheostomy complications in children was 41%, with the most common complications being cannula occlusion and spontaneous decanulation. Age group was statistically significant for spontaneous decanulation, with the proportion of 0-12 months at 28.57%. Postoperative care should be done carefully especially in the age group of 0-12 months."

"ABSTRAK Latar Belakang: Abses leher dalam adalah keadaan infeksi yang dapat menyebabkan komplikasi serius sehingga angka morbiditas dan mortalitasnya cukup tinggi. Anatomi kompleks leher dan lokasi ruang yang dalam membuat diagnosis dan penatalaksanaan menjadi sulit. Pemeriksaan laboratorium, Computed Tomography (CT) scan dan kultur kuman berperan penting dalam diagnosis maupun tatalaksana abses leher dalam, sehingga penyakit penyerta dan komplikasi dapat terdeteksi secara dini. Tujuan: Mengetahui metode penegakan diagnosis abses leher dalam, gambaran penyakit penyerta dan komplikasi. Metode: Desain penelitian ini adalah studi potong lintang bersifat deskriptif analitik secara retrospektif pada 85 percontoh. Hasil: Laki-laki lebih banyak menderita abses leher dalam (72,9%), faktor etiologi terbanyak adalah odontogenik (60%), ruang peritonsil paling banyak terlibat (42,4%). Penyakit penyerta terbanyak adalah hipertensi dan diabetes melitus, komplikasi yang terbanyak menyebabkan kematian adalah sepsis. Diabetes melitus meningkatkan risiko kematian (p=0,041). Sefalosporin dan metronidazol masih disarankan sebagai antibiotik empiris. Kesimpulan: Tatalaksana abses leher dalam khususnya penderita yang menjalani rawat inap tidak optimal karena pemeriksaan kultur dan CT scan leher belum dilakukan secara rutin. Metode diagnostik terbaik dan tatalaksana komprehensif yang mengikutsertakan departemen terkait lainnya harus selalu dilakukan pada penderita abses leher dalam dengan penyakit penyerta

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ABSTRAK Background: Deep neck abscess is an infection causing serious complications resulting in high morbidity and mortality. The complex deep neck anatomy makes diagnosis and treatment difficult. Laboratory examination, Computed Tomography (CT) scan and bacterial culture play important roles in the diagnosis and treatment of deep neck abscess, so that comorbidities and complications can be detected in early stage. Purpose: To understand the best diagnostic methods, comorbidities and complications. Methods: The study design was cross-sectional study, retrospective analytic descriptive in 85 samples. Results: Men are more likely to suffer from deep neck abscess (72,9%), odontogenic is the most common etiologic factor (60%), the most involved space is peritonsillar space (42,4%). Hypertension and diabetes mellitus are the most common comorbid diseases, sepsis is a dominant complication leading to death. Diabetes mellitus increases the risk of death (p=0,041). Cephalosporin and metronidazol are still recommended as empiric antibiotics. Conclusion: The treatment of deep neck abscess particularly hospitalized patients is not optimum because bacterial culture and CT scan examination are not performed regularly. The best diagnostic methods and comprehensive management involving other relevant departments should always be performed in patients with deep neck abscess with comorbidities"

"Kanker Nasofaring KNF merupakan salah satu kasus keganasan paling sering di Indonesia dengan karakteristik yang unik secara epidemiologi, patologi dan klinis. Faktor prognosis KNF telah menjadi fokus penelitian yang cukup penting dalam sejumlah studi yang telah dilakukan. Penelitian ini bertujuan mengetahui karakteristik pasien KNF yang terdiagnosis di Poli THT RSCM serta angka kesintasan dengan melakukan analisis terhadap faktor yang berperan terhadap prognosis. Penelitian ini merupakan suatu penelitian kohort retrospektif dengan subjek penelitian bersifat total sampling pasien KNF yang terdiagnosis di Poli THT. Sebanyak 561 subjek penelitian ini, pria memiliki prevalensi sebanyak 2.8 kali daripada wanita. WHO tipe 3 dan WF tipe A menjadi jenis histopatologi paling dominan. Stadium IV A didapatkan pada 30.1 subjek dan 18.9 subjek sudah berada dalam kondisi metastasis jauh. Nilai tengah untuk waktu tunggu radiasi adalah 91 12-344 hari dengan durasi radiasi 53 39-95 hari. Stadium IVC, p= 0,000 , N3 p= 0,018 , metastasis jauh p= 0,000 , dan drop out atau tidak mendapat terapi p= 0,000 menjadi faktor yang memberikan kesintasan lebih buruk pada penelitian ini.

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Nasopharyngeal Cancer NPC is one of the most frequent cancer in Indonesia which has a unique characteristic in epidemiology, pathology and clinical features. Prognostic factors are recently became the most important research foci, and a large number of investigation in this area have been performed. The objective of this study is to know the characteristics of NPC patients that have been diagnosed in ENT Department of RSCM and analyzed some factors that might have role in overall survival. This is the retrospective cohort study with total sampling subject. From 561 subjects, Male has 2.8 higher prevalence than female. WHO type 3 92,3 and WF type A 97,1 are the majority hisopathological result. Stage IV A is found in 30,1 subjects and 18,9 subjects were already in metastatic state. The median value of radiation waiting time was 91 12 344 days, duration time of radiation was 53 39 95 days. Stage IVC p 0,000 , N3 p 0,018 , distant metastatic p 0,000 , and drop out or no treatment p 0,000 are found to be the factors that give a negative impact in overall survival."

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Latar Belakang

Brain Arteriovenous Malformation (BAVM) merupakan salah satu anomali vaskular pada otak yang dapat menyebabkan berbagai komplikasi. Baku emas untuk mendeteksi BAVM adalah dengan digital subtraction angiography (DSA), namun modalitas ini tidak tersedia secara luas di Indonesia. Penelitian ini disusun untuk memberikan gambaran profil karakteristik klinis dan temuan dari DSA, CT-Angiography (CTA), dan MR-Angiography (MRA) dalam sesuai penilaian Grade Spezler-Martin.

Metode

Data rekam medis dan hasil pencitraan kasus BAVM dengan DSA disertai atau tidak pemeriksaan MRA atau CTA didapat dari Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo (RSCM) pada periode 2018-2022. Kasus yang memenuhi kriteria inklusi dan eksklusi disertakan penelitian deskriptif obserasional ini.

Hasil

Terdapat total 37 subjek pada penelitian ini. Kasus BAVM didominasi oleh laki-laki (62,2%) dan lebih banyak pada pasien dewasa berusia >18 tahun (75,7%). Hampir seluruh pasien menggunakan jaminan kesehatan BPJS (94,6%) dan asal rujukan terbanyak adalah dari Jabodetabek (54,1%). Gejala terbanyak pada pasien adalah nyeri kepala 59,4%), diikuti dengan kesadaran terganggu (37,8%) dan kejang (35,1%). Temuan DSA tidak berbeda jauh dengan temuan MRA dan CTA. Hampir seluruh pasien memiliki feeding artery [DSA (97,3%); CTA dan MRA (100%)], mayoritas terdapat lokasi eloquent [DSA (67,6%); MRA (71,4%); CTA (80%)], berukuran sedang (3-6 cm) [DSA (59,5%); MRA (71,4%); CTA (40%)], dan memiliki drainase vena superficial [DSA (59,5%); MRA (71,4%); CTA (40%)]. Presentase grade SM terbanyak adalah grade III (31,6%), diikuti oleh grade IV (28,9%) dan grade II (21,1%).

Kesimpulan

Pengetahuan akan profil karakteristik klinis dan profil temuan pencitraan dapat memberikan pengetahuan lebih untuk membantu dokter menunjang diagnosis BAVM.

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Background

Brain Arteriovenous Malformation (BAVM) is a vascular anomaly in the brain that can cause various complications. The gold standard for detecting BAVM is digital subtraction angiography (DSA), but this modality is not widely available in Indonesia. This study was designed to provide an overview of the profile of clinical characteristics and findings from DSA, CT-Angiography (CTA), and MR-Angiography (MRA) in accordance with the Spezler-Martin Grade assessment.

Method

Medical record data and imaging results of BAVM cases with DSA accompanied/not by MRA or CTA examination were obtained from the Department of Neurosurgery, RSUPN Dr. Cipto Mangunkusumo (RSCM) in the 2018-2022 period. Cases that met the inclusion and exclusion criteria were included in this observational descriptive study.

Results

There was a total of 37 subjects in this study. BAVM cases are dominated by men (62.2%) and are more common in adult patients aged >18 years (75.7%). Almost all patients use BPJS health insurance (94.6%) and the highest number of referrals is from Jabodetabek (54.1%). The most common symptom in patients was headache, 59.4%), followed by impaired consciousness (37.8%) and seizures (35.1%). DSA findings do not differ much from MRA and CTA findings. Almost all patients had a feeding artery [DSA (97.3%); CTA and MRA (100%)], the majority had eloquent locations [DSA (67.6%); MRA (71.4%); CTA (80%)], medium-sized (3-6 cm) [DSA (59.5%); MRA (71.4%); CTA  (40%)], and had superficial venous drainage [DSA (59.5%); MRA (71.4%); CTAs (40%)].  The highest percentage of SM grade was grade III (31.6%), followed by grade IV (28.9%) and grade II (21.1%).

Conclusion

Knowledge of the profile of clinical characteristics and profile of imaging findings can  provide more knowledge to help doctors support the diagnosis of BAVM.

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"[LATAR BELAKANGPenyebab terbanyak Penyakit Arteri Perifer (PAP) pada usia diatas 40 tahun adalah aterosklerosis. Prevalensi penyakit aterosklerosis perifer meningkat pada kasus dengan diabetes melitus, dislipidemia, hipertensi dan perokok. Critical Limb Ischemia (CLI) merupakan manifestasi dari PAP berat, CLI dikaitkan dengan risiko kehilangan tungkai yang sangat tinggi. Pada pasien CLI tanpa adanya revaskularisasi, pasien biasanya akan dilakukan amputasi dalam hitungan minggu atau bulan. Revaskularisasi secara terbuka memiliki morbiditas yang cukup banyak. Seiring kemajuan teknologi, revaskularisasi secara terbuka perlahan-lahan digantikan dengan adanya intervensi endovaskuler dalam dua dekade terakhir. Revaskularisasi endovaskuler di Departemen Ilmu Bedah RSCM baru mulai dilakukan pada tahun 2012 dan di Indonesia saat ini belum ada studi yang menilai hasil dari tindakan revaskularisasi.METODEMetode yang diambil adalah analitik komparatif berpasangan dengan disain penelitian longitudinal pre-post study. Selama Agustus 2013 hingga Agustus 2014 didapatkan 16 pasien yang masuk kriteria inklusi. Dilakukan pengambilan data nilai ABI sebelum dan sesudah revaskularisasi endovaskuler. ABI digunakan sebagai penilaian efektivitas revaskularisasi.HASILHasil didapatkan nilai mean ABI sebelum tindakan 0,7±0,118 dan nilai mean ABI sesudah tindakan 0,844±0,127. Didapatkan peningkatan nilai ABI sesudah tindakan 0,14. Dari hasil uji T berpasangan didapatkan nilai p=0,001. Secara statististik didapatkan peningkatan yang signifikan antara nilai ABI sebelum tindakan dan sesudah tindakan.KESIMPULANDapat ditarik kesimpulan tindakan revaskularisasi endovaskuler terhadap pasien PAP efektif berdasarkan nilai ABI;BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI, BACKGROUNDPeripheral Arterial Disease (PAD) above 40 years old mostly cause by atherosclerotic. Peripheral Atherosclerotic prevalence increase with DM, dyslipidemia, hypertension and smoking. CLI had higher amputation risk. Without revascularization CLI patients will do amputation within week or month. Surgical revascularizaton had many morbidity, endovascular revascularization established within 2 decade. Endovascular revascularization in RSCM surgery department established at 2012 and in Indonesia no research to evaluate revascularization effectiveness.METHODSResearch method is dependent category comparative analytic with longitudinal pre-post study. Within August 2013 to August 2014, we collect 16 patients that rolled on inclusion criteria. We collect ABI results before endovascular revascularization and ABI results after endovascular revascularization. ABI were used to evaluated revascularization effectiveness.RESULTSResults are ABI mean before endovascular revascularization 0,7±0,118 and ABI mean after endovascular revascularization 0,844±0,127. There were ABI increased after endovascular revascularization mean 0.14. Statistic analysis with pairing T-test result p=0.001. Based on statistic analysis there were significant increase between ABI before endovascular revascularization and ABI after endovascular revascularization.CONCLUSIONEndovascular revascularization in PAD patients effective base on ABI]"

"Latar Belakang Kelainan bawaan bertanggung jawab atas 11,3% kematian bayi di dunia. Di negara-negara berpenghasilan rendah dan menengah, neural tube defect merupakan jenis kelainan bawaan yang berperan penting dalam kecacatan dan kematian neonatus, yaitu sekitar 17% hingga 70% dari seluruh kematian akibat kelainan bawaan. Penelitian ini bertujuan untuk mengetahui profil karakteristik klinis dan tata laksana anak dengan neural tube defect di Departemen Bedah Saraf FKUI-RSCM pada tahun 2018–2022. Metode Desain penelitian ini adalah deskriptif observasional dengan metode penelitian potong lintang. Hasil Jenis kelamin yang paling banyak ditemukan adalah perempuan (51,7%). Jaminan kesehatan yang paling banyak digunakan adalah BPJS (94,8%) dengan rujukan paling banyak berasal dari fasilitas kesehatan di wilayah Jabodetabek (65,5%). Jenis NTD yang paling banyak ditemukan adalah myelomeningocele (25,9%), lipomyelomeningocele (24,1%), dan encephalocele occipital (20,7%). Faktor risiko maternal yang teridentifikasi adalah usia maternal > 35 tahun (12,1%). Proporsi ibu yang rutin mengonsumsi vitamin hamil sejak prekonsepsi sangat rendah (1,7%). Riwayat infeksi saat hamil ditemukan pada sebagian kecil kasus (3,4%) sedangkan riwayat kontak ibu dengan unggas atau hewan peliharaan cukup banyak ditemukan (22,4%). Waktu tahu hamil paling banyak saat usia kehamilan < 5 minggu (55,2%). Riwayat keluarga dengan NTD, riwayat diabetes pregestasional, dan riwayat konsumsi obat antiepilepsi maternal tidak ditemukan. Jenis operasi yang paling banyak dilakukan adalah rekonstruksi tutup defek. Sebagian besar operasi untuk NTD bersifat elektif (89,7%). Kesimpulan Jenis NTD yang paling banyak ditemukan adalah myelomeningocele, lipomyelomeningocele, dan encephalocele occipital dengan jenis operasi tersering berupa rekonstruksi tutup defek.

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Introduction Birth defects are responsible for 11.3% of infant deaths worldwide. In low- and middle-income countries, neural tube defect are a type of birth defect that plays an important role in neonatal disability and death, accounting for around 17% to 70% of all deaths due to birth defect. This study aims to determine the clinical and therapeutic profile of children with neural tube defects in the Department of Neurosurgery at Cipto Mangunkusumo Hospital, Indonesia, period 2018–2022. Method The design used in this research is descriptive observational with cross-sectional research method. Results The most common gender found was female (51.7%). The most widely used health insurance was BPJS (94.8%) with most referrals coming from health facilities in the Jabodetabek area (65.5%). The most common types of NTD were myelomeningocele (25.9%), lipomyelomeningocele (24.1%), and occipital encephalocele (20.7%). The maternal risk factor identified was maternal age > 35 years (12.1%). The proportion of mothers who regularly take pregnancy vitamins since preconception was very low (1.7%). A history of infection during pregnancy was found in a small number of cases (3.4%) while a history of maternal contact with poultry or pets was quite common (22.4%). The most common time the mothers knew that they’re pregnant was when the gestational age was < 5 weeks (55.2%). Family history of NTDs, history of pregestational diabetes, and history of maternal antiepileptic drug consumption were not found. The most common type of surgery performed was repair of the defect. Most operations for NTDs were elective (89.7%). Conclusion The most common types of NTD found were myelomeningocele, lipomyelomeningocele, and occipital encephalocele while the type of surgery most frequently performed was repair of the defect."

"Bedah ambulatori merupakan prosedur bedah yang memiliki banyak keuntungan bagi pasien, seperti mencegah infeksi nosokomial, lebih time-effective, dan cost-effective. Penelitian ini bertujuan untuk melihat insidensi pasien rawat inap yang memenuhi kriteria bedah ambulatori dan karakteristik yang berhubungan. Penelitian ini merupakan penelitian deskriptif yang dilakukan di Departemen Bedah RSCM pada tahun 2022. Peneliti menggunakan metode total sampling untuk menghitung insidensi pasien rawat inap yang memenuhi kriteria bedah ambulatori berdasarkan durasi operasi dan jenis operasi, usia, BMI, dan skor ASA melalui rekam medis pasien di Departemen Bedah RSCM pada tahun 2022 yang diambil dari laporan tahunan Instalasi Pelayanan Bedah Terpadu (IPBT) 2022 dan rekam medis RSCM. Pasien Departemen Bedah menyumbang angka paling besar yaitu sebanyak 2117 (31,19%). Insidensi pasien operasi rawat inap yang memenuhi kriteria bedah ambulatori di Departemen Bedah pada tahun 2022 adalah 91 (4,30%) dengan proporsi terbesar yaitu berusia 0-19 tahun (47,25%), BMI normoweight (27,47%), mean durasi operasi 105,5 menit, dan skor ASA II (90,1%). Insidensi pasien yang memenuhi kriteria bedah ambulatori di Departemen Bedah RSCM pada tahun 2022 sangat rendah. Oleh karena itu, diperlukan evaluasi terhadap praktik bedah ambulatori yang dilakukan di RSCM untuk meningkatkan jumlah pasien yang dapat menjalani prosedur bedah ambulatori.

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Ambulatory surgery procedure has many advantages, such as preventing nosocomial infections, time-effective, and cost-effective. Therefore, this study aims to look at the incidence of inpatients who meet the criteria for ambulatory surgery and related characteristics.The research is a descriptive study conducted with a total sampling method to calculate the incidence of surgery inpatients who met the criteria based on duration and type of surgery, age, BMI, and ASA score for surgery at the RSCM Surgery Department in 2022, taken from the 2022 Instalasi Pelayanan Bedah Terpadu (IPBT) annual report and RSCM medical records. Surgery Department patients contributed the largest number, namely 2117 (31.19%). The incidence of inpatients who meet the criteria for ambulatory surgery in the Surgery Departemen in 2022 is 91 (4.30%) with characteristics such as age ≤ 19 years (47.25%), BMI normoweight (27.47%), mean duration of operation 105,5 minutes, and ASA score II (90.1%). The incidence of patients who meet the criteria for ambulatory surgery at the RSCM Surgery Department in 2022 is very low. Therefore, it is necessary to evaluate the ambulatory surgical practices carried out at RSCM to increase the number of patients who can undergo ambulatory surgical procedures. "

"Latar belakang: Resistensi antibiotik merupakan ancaman kesehatan global. Tingginya tingkat reproduksi mikroorganisme dan kemampuan tekanan selektif yang kuat dari mikroorganisme menghadapi antibiotik pilihan merupakan permasalahan penggunaan antibiotik saat ini. Salah satu cara agar dapat menguatkan pemahaman dan ketaatan staf medis adalah melalui edukasi. Pemanfaatan teknologi seperti e-learning merupakan salah satu cara untuk meningkatkan tingkat pengetahuan dan ketepatan penggunaan antibiotik.Metode: Penelitian intervensi ini melibatkan seluruh DPJP dan PPDS Sp1 Ilmu Kesehatan Anak yang berstatus aktif di FKUI RSCM. Intervensi e-learning dilakukan terhadap DPJP dan PPDS dengan topik Antimicrobial Stewardship (AMS) via website EMAS UI kemudian dinilai tingkat pengetahuan pra- dan pasca-intervensi. Penggunaan antibiotik satu bulan pra- dan pasca-intervensi dinilai dengan alur Gyssens untuk menilai ketepatan penggunaan antibiotik.Hasil: Total penggunaan antibiotik pra- dan pasca-intervensi berturut-turut adalah 248 dan 229 antibiotik. Sebanyak 135 (54,4%) penggunaan antibiotik pra-intervensi dan 170 (72,24%) penggunaan antibiotik pasca-intervensi dinilai tepat. Analisis bivariat terhadap ketepatan penggunaan antibiotik menunjukkan terdapat hubungan bermakna pra- dan pasca-intervensi (OR= 0,537, IK 95% 0,363-0,795; p< 0,002). Sebanyak 42 dari total 56 DPJP anak dan 119 dari total 123 PPDS Sp1 Ilmu Kesehatan Anak mengikuti intervensi e-learning. Analisis bivariat menunjukan terdapat hubungan bermakna terhadap tingkat pengetahuan DPJP pra- dan pasca-intervensi (1 vs 32; p<0,001) dan PPDS pra- dan pasca-intervensi (10 vs 66; p<0,001).Kesimpulan: Terdapat peningkatan signifikan tingkat ketepatan penggunaan antibiotik pada pasien anak di ruang perawatan RSCM dan tingkat pengetahuan ketepatan pemberian antibiotik pada DPJP dan PPDS setelah dilakukan intervensi edukasi melalui metode e-learning.

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Backgorund: Antibiotic resistance is a global health threat. The high rate of reproduction of microorganisms and the strong selective pressure ability of microorganisms against antibiotics are the problems of the current use of antibiotics. Education is a way to strengthen the understanding and obedience of medical staff. Utilization of technology such as e-learning can be used to increase the level of knowledge and the effectiveness of using antibiotics.

Method: This intervention study involved all active pediatric staff and pediatric residents from the Department of Child Health in FMUI-CMH. Staff and residents underwent intervention through e-learning on the topic of Antimicrobial Stewardship (AMS) via the EMAS UI website, and then the level of their pre- and post-intervention knowledge was assessed. The use of antibiotics one month pre- and post-intervention was assessed by Gyssen's flowchart to assess the appropriateness of the antibiotics usage.

Result: A total of 135 (54.4%) uses of pre-intervention antibiotics and 170 (72.24%) uses of post-intervention antibiotics were considered appropriate. Bivariate analysis of the appropriate use of antibiotics showed that there was a significant relationship pre- and post-intervention (135 vs. 170, 95% CI 0.363-0.795; p 0.002). Forty two out of 56 staff and 119 out of 123 residents participate in e-learning. Bivariate analysis showed that there was a significant relationship between the level of knowledge of pre- and post-intervention in pediatric staff (1 vs. 32; p 0.001) and pre- and post-intervention pediatric residents (10 vs. 66; p 0.001).

Conclusion: There was a significant increase in the appropriateness level of using antibiotics in pediatric patients at CMH and the level of knowledge about the appropriateness of giving antibiotics to staff and residents after educational interventions were carried out through the e-learning."

"Resistensi antibiotik merupakan ancaman kesehatan global. Tingginya tingkat reproduksi mikroorganisme dan kemampuan tekanan selektif yang kuat dari mikroorganisme menghadapi antibiotik pilihan merupakan permasalahan penggunaan antibiotik saat ini. Salah satu cara menguatkan pemahaman dan ketaatan staf medis adalah melalui edukasi. E-learning merupakan salah satu cara untuk meningkatkan tingkat pengetahuan dan ketepatan penggunaan antibiotik. Penelitian intervensi ini melibatkan seluruh DPJP dan PPDS Sp1 Ilmu Kesehatan Anak yang berstatus aktif di FKUI RSCM. Intervensi e-learning dilakukan terhadap DPJP dan PPDS dengan topik Antimicrobial Stewardship (AMS) melalui website EMAS UI kemudian dinilai tingkat pengetahuan pra- dan pasca-intervensi. Penggunaan antibiotik satu bulan pra- dan pasca-intervensi dinilai dengan alur Gyssens untuk menilai ketepatan penggunaan antibiotik. Sebanyak 135 (54,4%) penggunaan antibiotik pra-intervensi dan 170 (72,24%) penggunaan antibiotik pasca-intervensi dinilai tepat. Analisis bivariat terhadap ketepatan penggunaan antibiotik menunjukkan terdapat hubungan bermakna pra- dan pasca-intervensi (OR= 0,537, IK 95% 0,363-0,795; p< 0,002). Sebanyak 42 dari total 56 DPJP anak dan 119 dari total 123 PPDS Sp1 Ilmu Kesehatan Anak mengikuti intervensi e-learning. Analisis bivariat menunjukan terdapat hubungan bermakna terhadap tingkat pengetahuan DPJP pra- dan pasca-intervensi (1 vs 32; p<0,001) dan PPDS pra- dan pasca-intervensi (10 vs 66; p<0,001). Terdapat peningkatan signifikan tingkat ketepatan penggunaan antibiotik pada pasien anak di ruang perawatan RSCM setelah dilakukan intervensi edukasi melalui metode e-learning.

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Antibiotic resistance is a global health threat. The high rate of reproduction of microorganisms and the strong selective pressure ability of microorganisms against antibiotics are the problems of the current use of antibiotics. Education is a way to strengthen the understanding and obedience of medical staff. E-learning can be used to increase the level of knowledge and the effectiveness of using antibiotics. This intervention study involved all active pediatric staff and pediatric residents from the Department of Child Health in FMUI-CMH. Staff and residents underwent intervention through e-learning on the topic of Antimicrobial Stewardship (AMS) via the EMAS UI website, and then the level of their pre- and post-intervention knowledge was assessed. The use of antibiotics one month pre- and post-intervention was assessed by Gyssen's flowchart to assess the appropriateness of the antibiotics usage. A total of 135 (54.4%) uses of pre-intervention antibiotics and 170 (72.24%) uses of post-intervention antibiotics were considered appropriate. Bivariate analysis of the appropriate use of antibiotics showed that there was a significant relationship pre- and post-intervention (135 vs. 170, 95% CI 0.363-0.795; p 0.002). Forty two out of 56 staff and 119 out of 123 residents participate in e-learning. Bivariate analysis showed that there was a significant relationship between the level of knowledge of pre- and post-intervention in pediatric staff (1 vs. 32; p 0.001) and pre- and post-intervention pediatric residents (10 vs. 66; p 0.001). The total use of pre- and post-intervention antibiotics being, respectively, 248 and 229 antibiotics. There was a significant increase in the appropriateness level of using antibiotics in pediatric patients at CMH after educational interventions were carried out through the e-learning."

"Latar belakang: Hemofilia merupakan gangguan perdarahan yang bersifat herediter yang disebabkan oleh kekurangan faktor VIII. Pada kadar faktor koagulasi yang sama dapat menunjukkan karakteristik klinis yang berbeda. Tujuan: Mengidentifikasi karakteristik klinis, penggunaan faktor VIII, dan komplikasi pada anak hemofilia A. Metode: Penelitian kohort retrospektif pada anak le;18 tahun. Data diambil dari rekam medis Januari 2014 ndash; Juni 2016 meliputi data usia awitan perdarahan sendi, usia saat didiagnosis, kekerapan perdarahan, lokasi perdarahan, penggunaan faktor VIII, dan komplikasi yang dialami. Hasil: Terdapat 109 subjek anak lelaki terdiri dari 2,8 subjek hemofilia A ringan, 27,5 hemofilia A sedang, dan 69,7 hemofilia A berat. Perdarahan paling sering ditemukan pada sendi 60,6 terutama pada lutut 37,2 . Anak hemofilia A berat menunjukkan usia awitan perdarahan sendi yang lebih dini median 12,5 4 - 120 bulan , kekerapan perdarahan sendi yang lebih sering median 8 1-44 kali/tahun , menggunakan konsentrat faktor VIII yang lebih banyak median 712 131 - 1913 IU/kg/tahun . Komplikasi yang ditemukan adalah hemofilik artropati dan sinovitis 46,8 , terbentuknya inhibitor faktor VIII 7,3 , anemia akibat perdarahan 2,6 , pseudotumor 0,9 , dan fraktur 0,9 . Terdapat 15,5 subjek hemofilia A berat yang menunjukkan karakteristik klinis yang lebih ringan. Simpulan: Usia awitan perdarahan sendi berhubungan dengan kekerapan perdarahan sendi, kebutuhan faktor VIII, dan artropati. Artropati dan sinovitis merupakan komplikasi yang paling banyak ditemukan.

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Background: Hemophilia A is a congenital bleeding disorder caused by deficiency of factor VIII. Phenotypic differences between patients with hemophilia is well known from clinical practice.

Aim: To identify clinical characteristics, factor VIII usage for on demand therapy, and complications of children with hemophilia A.

Method: A retrospective cohort study on children aged le 18 years. Data was obtained from medical record January 2014 ndash June 2016 including age of diagnosis, age of first joint bleed, number of bleeding, site of bleeding, treatment requirement, and complications.

Result: We found a total of 109 boys with hemophilia A consisted of 2.8 mild, 27.5 moderate, and 69.7 severe hemophilia. The most common bleeding was hemarthrosis 60.6 of the knee 37.2 . Severe hemophilia children showed earlier age of first joint bleed median 12,5 4 to 120 months , higher number of joint bleeds median 8 1 44 times year , and higher consumptions of clotting factor median 712 131 to 1913 IU kg year compared to mild and moderate hemophilia. Complications commonly found in severe hemophilia were haemophilic arthropathy and sinovitis 46.8 , followed by factor VIII inhibitors 7.3 , anaemia due to bleeding 2.6 , pseudotumour 0.9 , and fracture 0.9 . This study showed that 15.5 of patients with severe hemophilia A have mild clinical characteristics.

Conclusion: The onset of joint bleeding is related with number of joint bleeds, treatment requirement, and arthropathy and may serve as an indicator of clinical phenotype."