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"Latar belakang. Kombinasi spray lidokain dan anestetika intravena saat ini merupakan pilihan utama pada prosedur endoskopi saluran cerna, namun spray lidokain mempunyai kekurangan berupa iritasi lokal, mual, muntah dan rasa pahit. Gel lidokain merupakan alternatif pilihan anestetik lokal. Gel lidokain memiliki keuntungan karena dapat mengurangi gesekan mukosa dengan endoskop saat insersi serta memungkinkan pemberian lidokain yang tebal dan lengket sehingga menghasilkan anestesia lokal yang lebih baik pada rongga mulut dan orofaring dibandingkan spray lidokain. Pada penelitian ini kami ingin mengetahui perbandingan keefektifan gel lidokain dengan spray lidokain dalam mengurangi jumlah penggunaan propofol. Metode. Penelitian ini merupakan uji klinis acak tersamar ganda terhadap pasien endoskopi saluran cerna atas dengan sedasi di Rumah Sakit Cipto Mangunkusumo pada bulan Juli-September 2015. Sebanyak 52 subyek diambil dengan metode consecutive sampling dan dibagi ke dalam 2 kelompok (kelompok gel lidokain 2% dan spray lidokain 10%). Pasien secara acak diberikan gel lidokain 2% atau spray lidokain 10% sebagai anestetik lokal. Total dosis propofol, angka kejadian gag refleks, hipotensi, bradikardia, dan desaturasi dicatat pada masing-masing kelompok. Analisis data dilakukan dengan uji t-test tidak berpasangan. Hasil. Rerata dosis propofol berbeda bermakna diantara 2 kelompok, dimana rerata dosis propofol pada grup gel lidokain 2% adalah 186,92±43,52 mg, sedangkan rerata dosis propofol pada grup spray lidokain 10% adalah 218,85±61,01 mg (p=0.035, IK 95%=31,92). Simpulan. Gel lidokain 2% lebih efektif dibandingkan spray lidokain 10% dalam mengurangi dosis propofol pada pasien endoskopi saluran cerna atas.

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Background. A combination of lidocaine spray and intravenous anesthetics is currently the common choice in gastrointestinal endoscopy procedures, but lidocaine spray has some side efects like local irritation, nausea, vomiting and bitter taste. Lidocaine jelly is an alternative choice of local anesthetic. Lidocain jelly reduce friction of endoscope and enables to apply thick and sticky lidocaine resulting in better local anesthesia in the oral cavity and oropharynx compared to lidocaine spray. In this study, we want to compare the effectiveness between lidocaine jelly and lidocaine spray to reduce the propofol dose.

Methods. This study was a randomized double-blind control trial on upper gastrointestinal endoscopy patiens with sedation in Cipto Mangunkusumo Hospital in July to September 2015. A total of 52 subjects were taken with consecutive sampling method and divided into 2 groups (2 % lidocaine jelly group and 10% lidocaine spray group). Patients were randomly given 2% lidocaine jelly or 10% lidocaine spray as a local anesthetic. Total propofol dose, the incidence of gag reflex, hypotension, bradycardia and desaturation recorded in each group. Data analysis was performed by unpaired t-test.

Results. Mean propofol dose significantly different between 2 groups. The Mean propofol dose 2% lidocaine jelly was 186.92 ±43.52 mg, while the mean propofol dose in10% lidocaine spray group was 218.85 ± 61.01 mg (p = 0.035, CI 95% = 31.92).

Conclusion. 2% Lidocaine gel was more effective than 10% lidocaine spray in reducing the propofol dose in patients with upper gastrointestinal endoscopy."

"Latar belakang dan tujuan: Penyakit refluks gastroesofagus (PRGE) merupakan salah satu penyebab terbanyak batuk kronik dan menjadi faktor risiko terjadinya eksaserbasi pada penyakit paru obstruktif kronik (PPOK), menurunkan kualitas hidup dan memperparah gejala respirasi dan pencernaan. Total 40 pasien diikutkan pada penelitian ini. Pasien diambil secara konsekutif dari poliklinik asma PPOK di RSUP Persahabatan dimulai dari bulan Mei 2017. Diagnosis PPOK berdasarkan GOLD 2017 yaitu nilai spirometri VEP₁/KVP pasca bronkodilator < 0.7. Diagnosis PRGE menggunakan endoskopi saluran cerna bagian atas apabila ditemukan kerusakan mukosa esofagus. Kriteria eksklusi yaitu eksaserbasi dan kelainan esofagus yang sudah diderita sebelumnya.Metode: Penelitian ini adalah potong lintang pada pasien PPOK stabil yang berkunjung ke poli asma-PPOK di RSUP Persahabatan mulai bulan Juli sampai Nopember 2017. Sebanyak 40 pasien dipilih secara konsekutif sejak bulan Mei 2017. Pemeriksaan berupa wawancara, spirometri dan endoskopi dilakukan pada semua subjek yang memenuhi kriteria inklusi.Hasil: Subjek yang mengikuti penelitian sebanyak 40. Prevalens PRGE pada PPOK adalah 40% (16/40). Tidak ada perbedaan bermakna diantara kedua grup berdasarkan usia, jenis kelamin, Indeks Brinkman (IB) dan Indeks Massa Tubuh (IMT). Keterbatasan aliran udara yang lebih berat dan nilai spirometri pascabronkodilator yang lebih rendah memiliki kecenderungan terjadinya PRGE lebih besar walaupun secara statistik tidak bermakna. Rerata pasien berusia lanjut dan mempunyai riwayat merokok. Eksaserbasi dan skor CAT berhubungan secara bermakna (p < 0.05) dengan kejadian PRGE. Penggunaan obat-obatan PPOK seperti LABA, LAMA dan SABA tidak berubungan bermakna dengan PRGE. Gejala dada terbakar (heartburn) bermakna secara statistik (p < 0.05) sebagai tanda PRGE.Kesimpulan: Prevalens PRGE cukup tinggi pada pasien PPOK dan bahkan lebih tinggi dibandingkan pasien bukan PPOK dengan gejala dispepsia di Jakarta. Dokter harus mempertimbangkan kemungkinan PRGE sebagai salah satu komorbid yang penting pada PPOK. Penelitian kohort dan strategi pencegahan disarankan untuk dilakukan selanjutnya.

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Background/Aim: Gastroesophageal reflux disease (GERD) is one of the most common causes of chronic cough and is a potential risk factor for exacerbation of chronic obstructive pulmonary disease (COPD), decreasing quality of life in COPD patients, aggravating symptoms both respiratory and gastro-intestinal. Total 40 patients were recruited consecutively from the outpatient of Asthma and COPD clinic at Persahabatan hospital Jakarta started from May 2017. The diagnosis of gastroesophageal reflux disease (GERD) was based on the mucosal break on the esophageal lining through endoscopic examination. Exclusion criteria were COPD exacerbation and known esophageal disease.

Methods: This is a cross sectional study among stable COPD patients who visited asthma-COPD clinics at Persahabatan Hospital from July to November 2017. 40 patients were recruited consecutively started from May 2017. Interview, spirometry and endoscopy performed to all subjects who meet the inclusion criteria.

Results: A total 40 subjects were enrolled in our study. Prevalence of GERD in COPD was 40%. There was no significant difference between the two groups regarding age, sex, Index Brinkman (IB) and Body Mass Index (BMI), although in the RE group has a slightly higher BMI. More severe airflow obstruction tends to increase in GERD group although no significant statistical difference Most patients were elderly and smoker/ex. Exacerbation and CAT score were significantly associated with GERD (p<0.05). Post BD spirometry showed greater airway and severe COPD tends to also had GERD similar to results of other studies. Respiratory medication such as ICS + LABA, LAMA and SABA statistically insignificant with GERD. Heartburn as a symptom showed statistically significant to predict GERD (p < 0.05).

Conclusion: Prevalence of GERD was high in COPD patient and even higher than previously reported in general patient with dyspepsia syndrome in Jakarta. Physician should consider GERD as one of the most important comorbidities in COPD. Cohort study and preventive strategy are warranted in the future."

"Latar Belakang : Penggunaan spray lidokain dengan obat anestetik intravena merupakan pilihan untuk sedasi pada endoskopi saluran cerna atas. Tetapi terdapat ketidaknyamanan dari pasien mengenai penggunaan spray lidokain. Inhalasi lidokain merupakan pilihan alternatif anestetik lokal. Penelitian ini bertujuan untuk membandingkan keefektifan dari spray lidokain dan inhalasi lidokain pada endoskopi saluran cerna atas. Metoda : 150 pasien yang menjalani endoskopi saluran cera atas dengan sedasi di RSUPN Cipto Mangunkusumo sejak November 2017 hingga April 2018, dengan kesan ASA I-II, BMI 18,5-29,9, dan setuju untuk mengikuti penelitian, dilakukan randomisasi dan dibagi menjadi 2 grup yang akan mendapatkan 1,5 mg/kgbb spray lidokain atau 1,5 mg.kgbb inhalasi lidokain. Untuk sedasi akan diberikan fentanyl 1 mcg.kgbb dan propofol 1,5 mg/kgbb bolus pada kedua grup . Tiap kejadian gag reflex dan penambahan dosis propofol akan dicatat. Hasil : Gag reflex terjadi sebanyak 1,3 % total pasien di grup inhalasi lidokain dan 30,7% pada grup spray lidokain (P<0,001). Rerata rescue dose propofol yang didapatkan pada grup inhalasi lidokain (0,67 ± 5,77 mg/kg) dan (11 ± 17,9 mg/kg) pada grup spray lidokain. Parameter lain seperti usia, jenis kelamin, kategori ASA, BMI didapatkan tidak signifikan. Simpulan : Inhalasi lidokain lebih efektif sebagai anestetik lokal dibandingkan spray lidokain sebagai adjuvan pada endoskopi saluran cerna atas.

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Background : Combination of spray lidocaine and intravenous anesthetic was the choice for upper gastrointestinal endoscopy (UGE). However, spraying lidocaine was found uncomfortable to the patient. Nebulized lidocaine was the alternative for local anesthetic. This study aimed to compare the effectiveness of spraying and nebulized lidocaine for patients undergoing UGE.

Methods : 150 patients undergoing UGE under sedation at Cipto Mangunkusumo National Hospital from November 2017 until April 2018, with physical status ASA I-II, BMI 18,5-29,9, and agree to join the experiment, were randomized to receive either 1,5 mg/kg of spray lidocaine or 1,5 mg/kg of nebulized lidocaine. Combined sedation was achieved using fentanyl 1 mcg/kg and Propofol 1,5 mg/kg IV boluses. Every gag reflex occurred and rescue dose of propofol administered were recorded.

Result : Gag reflex occurred 1,3% in nebulized lidocaine group and 30,7% occurred in spray lidocaine (P < 0,001). Mean rescue dose of propofol in nebulized lidocaine group (0,67 ± 5,77 mg/kg) and (11 ± 17,9 mg/kg) in spray group. Outcomes parameters including sex, age, ASA category, BMI were statistically unsignificant.

Discussion : We think inability of spray lidocaine to resist gag reflex is because the process of spraying should be equal from each side of vocal cord, pharynx and larynx. Nebulization could split the lidocaine into small particle, so the spread of the lidocaine will be spread evenly.

Conclusion : Nebulized lidocaine is more effective as local anesthetic than spray lidocaine for adjuvant in UGE."

"Latar belakang: Sleep disordered breathing (SDB) merupakan satu spektrum kelainan abnormalitas pola pernapasan pada saat tidur. Diperlukan visualisasi untuk menilai kedinamisan saluran napas atas untuk menentukan lokasi, konfigurasi dan derajat sumbatan saluran napas atas saat terjaga dan saat tidur secara spesifik pada setiap subjek berdasarkan hasil inklusi dari kuisioner STOP BANG dikarenakan karakteristik dan faktor risiko yang berbeda-beda pada setiap individu. Tujuan penelitian: Mengetahui perbedaan lokasi, konfigurasi dan derajat sumbatan jalan napas atas yang terjadi antara pemeriksaan (Perasat Muller) PM saat terjaga dan pemeriksaan Drug Induced Sleep Endoscopy (DISE) saat tidur serta dengan menggunakan pemeriksaan polisomnografi (PSG) untuk menentukan derajat gangguan tidur. Untuk mengetahui hasil pemeriksaan perbedaan saturasi oksigen terendah antara pemeriksaan PSG dan DISE saat tidur, dengan tujuan untuk mendapatkan cara diagnosis yang dapat memberikan nilai tambah pada pasien SDB. Metode: Penelitian ini merupakan penelitian studi potong lintang (cross sectional) dengan data sekunder yang bersifat retrospektif; 1) Deskriptif analitik, dan 2) Membandingkan gambaran lokasi, derajat dan konfigurasi sumbatan jalan napas dengan pemeriksaan PM, DISE dan PSG pada kasus SDB di RSUPN Dr. Cipto Mangunkusumo dengan 46 subjek yang diambil dari data Januari 2017 hingga April 2019. Hasil: Karakteristik kelompok pasien SDB pada penelitian ini mempunyai rentang usia antara 18-73 tahun dengan laki-laki dan perempuan mempunyai proporsi yang sama besar. Pada anamnesis didapatkan STOP BANG risiko tinggi sebesar 58,7%, Epworth Sleepiness Scale (ESS) risiko gangguan tidur 93,5%, skor Nasal Obstruction Score Evalutaion (NOSE) dengan risiko hidung tersumbat 97,8%, subjek obesitas 56,5%, subjek dengan Refluks laringofaring (RLF) 67,4%, hipertensi 28,3%, kelainan jantung 30,4%. Terdapat 13 subjek (28,2%) SDB non OSA, 18 subjek (39,13%) OSA ringan, 10 subjek (21,73%) OSA sedang, dan 5 subjek (10,86%) OSA berat. Terdapat perbedaan bermakna pada lokasi dan konfigurasi sumbatan jalan napas atas antara PM dan DISE pada area velum, orofaring dan epiglotis dengan nilai p berturut-turut p = 0,036; p<0,001 dan p = 0,036. Terdapat perbedaan bermakna pada lokasi dan derajat sumbatan jalan napas atas antara PM dan DISE pada area velum, orofaring, dasar lidah dan epiglotis dengan nilai p berturut-turut p = 0,002; p<0,001; p<0,001 dan p<0,001. Subjek dengan SDB non OSA dan OSA ringan dapat juga menunjukkan sumbatan multilevel dengan konfigurasi yang berbeda-beda. Derajat RDI tidak selalu berhubungan dengan konfigurasi sumbatan jalan napas atas. Tidak terdapat perbedaan bermakna antara kadar saturasi oksigen terendah saat tidur pada saat DISE dan PSG dengan nilai p = 0,055. Pada penelitian ditemukan sumbatan jalan napas atas pada fase tidur REM dan NREM diihat berdasarkan derajat RDI pada PSG, terlihat kecenderungan adanya RDI REM dengan nilai yang lebih tinggi dibandingkan RDI NREM pada subjek dengan OSA ringan dan OSA sedang. Pada SDB non OSA dan OSA berat nilai RDI NREM sama dengan RDI REM.

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Background: Sleep disordered breathing (SDB) is a spectrum of breathing abnormality during sleep. Direct visualization needed to evaluate the level, configuration and degree of upper airway obstruction during sleep in each patient due to the difference in characteristic and risk factor of SDB based on STOP BANG questionnaire. Purpose: Evaluate the differences of location, configuration, and degree of upper airway obstruction between Muller Maneuver (MM) during awake and Drug Induced Sleep Endoscopy (DISE) during sleep using polysomnography (PSG) to determine the degree severity of sleep disorder. To evaluate the lowest oxygen saturation between PSG and DISE during sleep thus acquired a better diagnostic value for SDB patient. Methods: Analitical decriptive of cross sectional study with retrospective secondary data evaluate the difference of location, configuration and degree of upper airway obstruction in SDB subject using Mueller Maneuver (MM) and DISE in ENT-HNS Cipto Mangunkusumo Hospital from January 2017 until April 2019 with 46 subjects. Result: The age range of subjects between 18-73 years old, both each male and female are 26 subjects, using anamnesis and questionnaire STOP Bang with high risk 58,7%, ESS high risk of SDB 93,4%, NOSE score with nasal congestion 97,8%, obesity 56,5%, Laryngopharungeal Reflux 67,4%, hypertension 39%, heart disease 30,4%. Based on polysomnography data there were 28,2% subjects with SDB non OSA (Obstructive Sleep Apnea), 39,1% subjects mild OSA, 21,7% subjects moderate OSA, 10,7% subjects severe OSA. Statistically difference in configuration of upper airway obstruction between MM and DISE in level velum (p = 0,036), oropharynx (p<0,001), epiglotits (p = 0,036), also statistically different in location and degree of upper airway obstruction between MM and DISE in velum, oropharynx, tongues base and epiglottis with p = 0,002; p<0,001; p<0,001 dan p<0,001. No statisticaly difference on lowest oxygen saturation during polysomnography and DISE (p = 0,055). Subjects with SDB non OSA and mild OSA alos shown multilevel obstruction with different airwal collaps configuration. RDI degree didnt always correlate with upper airway obstruction configuration. RDI NREM was higher in subject with mild OSA and moderate OSA, in SDB non OSA and severe OSA RDI REM as same as RDI NREM."

"Latar Belakang: Akalasia adalah gangguan motilitas esofagus yang jarang terjadi dan memengaruhi jutaan orang di seluruh dunia. Peroral Endoscopic Myotomy (POEM) adalah pengobatan baru untuk akalasia dengan tingkat efektivitas dan kepuasan pasien yang tinggi. Indonesia adalah negara Asia Tenggara pertama yang menampilkan POEM pada tahun 2015. Penelitian ini bertujuan untuk menyelidiki hasil POEM untuk akalasia dan faktor-faktor yang mempengaruhinya di Indonesia.Metode: Sebuah studi observasional dengan desain kohort retrospektif dilakukan untuk menentukan hasil pasca operasi POEM pada pasien akalasia di Indonesia dan faktor-faktor yang mempengaruhinya. Hasil yang buruk didefinisikan sebagai memiliki skor Eckardt lebih dari 3 selama periode tindak lanjut. Faktor yang dianalisis dalam penelitian ini adalah usia, indeks massa tubuh, jenis akalasia, lama penyakit, pengobatan sebelumnya, penyakit penyerta, riwayat merokok, dan riwayat konsumsi alkohol. Analisis dilakukan dengan menggunakan grafik Kaplan Meier dan analisis regresi cox.Hasil: Sebanyak 108 subjek dilibatkan dalam penelitian ini dengan masa tindak lanjut 26,1 + 16,9 bulan. Kesuksesan klinis diperoleh pada 99 (91,7%) subjek. Kelangsungan hidup bebas penyakit kumulatif di antara subyek adalah 98,1%, 97,3%, 95,2%, 96,6% dan 90% masing-masing selama 5 tahun pertama. Faktor-faktor yang mempengaruhi hasil POEM yang lebih buruk pada pasien akalasia adalah usia yang lebih tua (RR 6,099, p <0,05), riwayat penyakit sebelumnya (RR 6,004, p <0,05), dan akalasia tipe III (RR 14,4, p <0,05).Kesimpulan: Luaran baik didapatkan oleh 91,7% pasien akalasia yang menjalani POEM di Indonesia. Faktor-faktor yang mempengaruhi hasil POEM yang lebih buruk di antara pasien akalasia adalah usia yang lebih tua, riwayat penyakit sebelumnya, dan akalasia tipe III.

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Background: Achalasia is a rare esophageal motility disorder affecting millions worldwide. Peroral Endoscopic Myotomy (POEM) is a novel treatment for achalasia with a high level of effectiveness and patients’ satisfaction. Indonesia is the first South East Asian country to perform POEM in 2015. This study aims to investigate the outcome of POEM for achalasia and its affecting factors in Indonesia.

Methods: An observational study using retrospective cohort design was performed to determine the postoperative outcome of POEM among achalasia patients in Indonesia and its affecting factors. Poor outcome was defined as having Eckardt score of more than 3 during the follow-up period. The factors analyzed in this study was age, body mass index, achalasia type, disease duration, prior treatment, comorbidities, smoking history, and alcohol consumption history. Analysis was done using Kaplan Meier graph and cox regression analysis.

Results: A total of 108 subjects were included in this study with follow up period of 26,1 + 16.9 months. Clinical success (absence of poor outcome) was obtained by 99 (91.7%) subjects during the follow-up duration. The cumulative disease-free survival among subjects was 98.1%, 97.3%, 95.2%, 96.6%, and 90% for the first 5 year, respectively. Factors affecting the worse outcome of POEM among achalasia patients was older age (RR 6,099, p <0,05), prior history (RR 6,004, p <0,05), and type III (RR 14,4, p <0,05).

Conclusion: Five-year good outcome was obtained by 91.7% of achalasia patients undergoing POEM in Indonesia. Factors affecting worse outcome of POEM among achalasia patients was older age, prior history, and type III achalasia."

"Latar Belakang: Berdasarkan alat yang digunakan, pendekatan operasi kraniofaringioma terbagi menjadi endoskopik dan mikroskopik. Masing-masing pendekatan memiliki kelebihan dan kekurangan masing-masing sehingga akan memberikan luaran klinis, resektabilitas dan efektifitas pembiayan yang berbeda-beda. Belum diketahui luaran pasca operasi baik pendekatan mikroskopik maupun endoskopik di RSUPN dr. Cipto Mangunkusumo.Tujuan: Mengetahui luaran operasi pasien kraniofaringioma di RSUPN dr. Cipto Mangunkusumo..Metode: Kohort retroprospektif pasien kraniofaringioma yang menjalani pembedahan sejak tahun 2012 hingga tahun 2021 di RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia. Pasien dengan masalah ekstrakranial, pasien endoskopi dengan kraniotomi luas dikeluarkan dari penelitian. Dilakukan pengambilan data demografis, luaran klinis dan resektabilitas tumor dan efektifitas pembiayaan. Data dikelompokkan menjadi variabel kategorik dan numerik. Analisa variabel kategorik dan kategorik diolah menggunakan uji Chi-square. Sedangkan variabel kategorik dan numerik diolah menggunakan T-Test. Pengolahan data menggunakan SPSS 25.0. Hasil: Pada 30 subjek penelitian, 22 subjek (73%) menjalani tindakan operasi mikroskopik dan 8 subjek (27%) menjalani tindakan operasi endoskopik. Perdarahan intraoperasi rata-rata pendekatan mikroskopik 445ml (50-1600), sedangkan endoskopik 57ml (20-200). Secara signifikan perdarahan intraoperasi pendekatan endoskopik lebih rendah dibandingkan pendekatan mikroskopik, p < 0,01. Durasi operasi rata-rata pendekatan mikroskopik 3 jam (2-4jam), sedangkan endoskopik 6,6jam (2,5-14jam). Secara signifikan waktu operasi pendekatan endoskopik lebih singkat dibandingkan mikroskopik, p=0,001. Kesimpulan: Pendekatan endoskopik memiliki potensi yang baik untuk dikembangkan sebagai pilihan tatalaksana bedah pasien kraniofaringioma.

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Based on the equipment used, the surgical approach to craniopharyngioma is divided into endoscopic and microscopic. Each approach has its own advantages and disadvantages so that it will provide different clinical outcomes, resectability, and cost effectiveness. The postoperative outcome for both microscopic and endoscopic approaches in RSUPN dr. Cipto Mangunkusumo is unknown.

Objective: Knowing the operative approach outcome of craniopharyngioma patients at RSUPN dr. Cipto Mangunkusumo.

Methods: A retrospective cohort of craniopharyngioma patients undergoing surgery from 2012 to 2021 at RSUPN dr. Cipto Mangunkusumo, Jakarta, Indonesia. Patients with extracranial problems, assisted endoscopic approach were excluded from the study. Demographic data, clinical outcome, and tumor resectability and cost effectiveness were collected. The data are grouped into categorical and numeric variables. The analysis of categorical and categorical variables was processed using the Chi-square test. Meanwhile, categorical and numerical data were processed using T-Test. Data processing using SPSS 25.0.

Results: In 30 study subjects, 22 subjects (73%) underwent microscopic surgery and 8 subjects (27%) underwent endoscopic surgery. Intraoperative bleeding using microscopic approach average 445ml (50-1600), while endoscopic 55ml (20-200). Intraoperative bleeding was significantly lower in the endoscopic approach than the microscopic approach, p<0.01. The average duration of surgery for the microscopic approach is 3 hours (2-4 hours), while the endoscopic approach is 6.6 hours (2.5-14 hours). The operating time for the endoscopic approach was significantly shorter than the microscopic one, p=0.001.

Conclusion: The endoscopic approach has good potential to be developed as a surgical treatment option for craniopharyngioma patients."

"Persaingan di industri kesehatan, pertumbuhan pelayanan Endoskopi dan rendahnya tarif BPJS dibandingkan dengan tarif rumah sakit, mendorong Rumah Sakit XYZ untuk mengevaluasi perhitungan biaya pelayanannya secara lebihmendalam. Manajemen kendali mutu dan kendali biaya merupakan kunci sukses dalam menerapkan strategi pelayanan kesehatan berbasis nilai (Value-based healthcare). Time-Driven Activity Based Costing (TDABC) adalah metodeakuntansi biaya yang memberikan perkiraan biaya secara lebih akurat dibandingkan dengan metode biaya tradisional. TDABC menunjukkan kapasitas tidak terpakai (unused capacity) dari sumber daya yang dimiliki sehingga membantu pengelolaan sumber daya agar lebih efisien dan efektif. Tujuan penelitian ini adalah untuk menunjukkan bagaimana penerapan metode TDABC di unit Endoskopi Rumah Sakit XYZ melalui pemahaman tentang berbagai kelompok sumber daya (resource group) yang digunakan dalam proses pelayanan dan bagaimana melakukan alokasi biaya tidak langsung (indirect cost) dengan menggunakan waktu sebagai pemicu biaya utama (cost driver) sehingga dapat diketahui unused capacity dan disusun capacity-based income statement. Jenis penelitian ini adalah studi kasus deskriptif dengan pendekatan kualitatif dan kuantitatif melalui analisa biaya dan profitabilitas di unit Endoskopi. Pengumpulan data berdasarkan data Rumah Sakit XYZ periode Januari-Desember 2017 serta hasil wawancara dan observasi langsung yangdilakukan pada Oktober dan November 2018. Hasil studi kasus ini menyimpulkan bahwa dengan metode TDABC, biaya dan profitabilitas setiap jenis tindakan Endoskopi dianalisa secara lebih rinci dan akurat dimana indirect cost dialokasikan sesuai dengan sumber daya aktual yang digunakan sehingga dapat diketahui unused capacity dari setiap resource group. Melalui capacity-based income statement yang disusun, tingkat efisiensi menjadi lebih jelas dan terukur. Peninjauan kembali secara periodik terkait manajemen biaya dan tarif rumah sakit perlu dilakukan agar tetap selaras dengan perubahan lingkungan bisnis Rumah Sakit XYZ.

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Competition in the healthcare industry, the growth of endoscopy procedures and the low rate of BPJS for endoscopy compared with the regular tariff, prompted XYZ

Hospital to evaluate the cost of its services. Management of quality and cost control are key to success in applying Value-based healthcare strategy. Time-Driven Activity Based Costing (TDABC) is a cost accounting method that can provide more accurate cost estimation than traditional costing method. TDABC can reveal the unused capacity of its resources that help hospital resource management runs

efficiently and effectively. The purpose of this case study is to demonstrate how TDABC method is applied in Endoscopy unit of XYZ Hospital by understanding the various resource groups used in the service processes and the indirect cost allocation using time as the main cost driver so that unused capacity can be identified, and capacity-based income statement can be prepared. This is a

descriptive case study with qualitative and quantitative approaches through cost and profitability analysis in the Endoscopy unit. Data collection based on XYZ Hospital database from January to December 2017 and the results of interviews and a direct observation conducted in October and November 2018. The result of this case study concludes that through TDABC, the cost and the profitability of

endoscopy procedures can be analyzed in more detail and accurate where indirect costs are allocated according to the actual usage of resources, therefore the unused capacity can be identified for each resource group. Through the capacity-based income statement, the efficiency level can be clearly defined and more measurable. Periodically, a review of the company's cost management and tariff is needed in order to stay in line with the company's business and environments.

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"Recurrent abdominal pain (RAP) is a very common presenting complaint in pediatric population. There is still a debate regarding the role of Helicobacter pylori (H. pylori) infection as an etiology of RAR Typically the inflammatory process in the gastric mucosa of infected individuals is chronic gastritis. Serologic and histologic examination are widely used for the diagnosis. This study was aimed to determine the role of H.pylori infection in Indonesian children with RAR The presence of serum IgG antibody to H. pylori and upper gastrointestinal endoscopy were performed on the 101 children with RAR Mztcosal biopsies were obtained for histologic analysis. The prevalence of H. pylori infection indicated by serology was 32.7% and by histology was 27. 7%. Histologic evidence of gastritis was present in 94.1 % children and 45% of them had chronic atrophic and active gastritis. Seventy percent children with H. pylori positive were found abnormal through endoscopy and all of the infected children were revealed abnormal through histological examination. Forty eight percent of seropositive children were found H. pylori positive and 80% of seronegatives children were found to be H pylori negative through histologic examination. Conclusion: H. pylori infection can be a cause of RAP in children. Work up for H. pylori infection should be performed when symptoms are suggestive of organic disease. Larger prospective studies are needed to be perforated for a longer time of period to clarify this issue."

"This third edition text provides a completely revised and updated new version of this unique, modern, practical text that covers the strategic evaluation, specific approaches, and detailed management techniques utilized by expert colorectal surgeons caring for patients with complex problems–whether they result from underlying colorectal disease or from complications arising from previous surgical therapy. The format follows that of both a “how to” manual as well as an algorithm-based guide to allow the reader to understand the thought process behind the proposed treatment strategy. By making use of evidence-based recommendations, each chapter includes not only background information and diagnostic/therapeutic guidelines, but also provides a narrative by the author on his/her operative technical details and perioperative “tips and tricks” that they utilize in the management of these complex surgical challenges. Distinctive to this book, is the reliance on experts in the field including past presidents of the ASCRS, as well as multiple other national and internationally recognized surgeons, to lend their personal insight into situations where data may be more sparse, but individual and collective experience is paramount to making sound decisions and thereby optimizing patient outcomes. The text includes chapters on the assessment of risk and methods utilized to minimize perioperative complications. In addition, it incorporates sections covering the medical and surgical therapies for abdominal, pelvic and anorectal disease. Moreover, the technical challenges of managing complications resulting from the original or subsequent operations is addressed. The underlying focus throughout the text is on providing pragmatic and understandable solutions that can be readily implemented by surgeons of varying experience to successfully treat complex colorectal problems. However, it also goes beyond the technical aspects of colorectal surgery and includes special sections highlighting the essence of a surgeon; covering aspects involving the medical-legal, ethical, and economic challenges confronting surgeons. Throughout the text, each author provides an ongoing narrative of his/her individual surgical techniques along with illustrations and diagrams to “personally” take the reader through the crucial steps of the procedure, and key points of patient care inherent to that topic. Additionally, where appropriate, links to online videos give the reader an up-front look into technical aspects of colorectal surgery."

"Latar belakang: Pada penelitian terdahulu disebutkan bahwa pembedahan hidung dapat memperbaiki keluhan subjektif dan meningkatkan kualitas hidup pada pasien sleep disordered breathing (SDB), namun secara objektif yang dinilai dengan polisomnografi masih terdapat kontroversi. Diperlukan suatu evaluasi lain yaitu dengan drug induced sleep endoscopy (DISE) yang dapat menilai sesuai patofisologi utama SDB yaitu adanya kolaps jalan napas pada saat tidur. Tujuan penelitian: untuk mengetahui efektivitas pembedahan hidung endoskopik pada pasien SDB yang disertai sumbatan hidung secara subjektif dengan menilai perbedaan skor Nasal Obstruction Symptom Evaluation (NOSE) dan Epworth Sleepiness Scale (ESS), secara objektif menilai perbedaan parameter polisomnografi (PSG) dan Drug Induce Sleep Endoscopy (DISE) dengan melihat perbedaan lokasi, konfigurasi dan derajat sumbatan jalan napas atas sebelum dan sesudah pembedahan hidung endoskopik. Metode: Penelitian ini menggunakan desain pre-eksperimental jenis pre-post intervention pada subjek SDB dengan sumbatan hidung yang di dapat dengan total population sampling. Pengumpulan data sebelum pembedahan diperoleh secara sekunder (nilai kuesioner, PSG, video DISE) dan data evaluasi sesudah pembedahan diperoleh secara primer selama rentang waktu Agustus 2019 hingga Desember 2019. Hasil: Terdapat perbedaan bermakna pada parameter subjektif menggunakan skor NOSE (p=0,005) dan ESS (p=0,003) dan objektif pada parameter PSG untuk sleep architechture yaitu REM sleep (p=0,020). Belum terdapat kemaknaan secara statistik untuk parameter respiratory disturbance index (RDI), respiratory effort related arousal (RERA),deep sleep, light sleep. Perbedaan secara statistik untuk parameter DISE belum dapat dibuktikan namun terdapat perbaikan secara klinis pada lokasi derajat dan konfigurasi kolaps pada beberapa subjek setelah pembedahan terutama pada level velum dan orofaring. Diperlukan penelitian lanjutan untuk parameter-parameter tersebut dengan jumlah sampel sesuai hasil akhir hitung ulang jumlah sampel pada penelitian ini.

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Background : Previous studies mentioned that nasal surgery can improve subjective complaints and improve quality of life in patients with sleep disordered breathing (SDB), but objectively assessed by polysomnography there is still controversy. Another evaluation is needed, drug induced sleep endoscopy (DISE) is a tool that can evaluate according to the primary pathophysology of SDB, the presence of airway collapse during sleep. Objective : to find out the success rate of endoscopic nasal surgery in SDB patients with nasal obstruction by subjectively assessing differences in scores of Nasal Obstruction Symptom Evaluation (NOSE) and Epworth Sleepiness Scale (ESS), objectively assessing differences in polysomnographic parameters (PSG) and Drug Induce Sleep Endoscopy (DISE) by looking at differences in location, configuration and degree of upper airway obstruction before and after endoscopic nasal surgery. Method: This is pre-experimental study design type of pre-post intervention on SDB subjects with nasal obstructions obtained with total population sampling. Data collection before surgery was obtained secondary (questionnaire values, PSG, DISE video) and evaluation data after surgery were obtained primarily during the period of August 2019 to December 2019. Result : There were significant differences in subjective parameters using NOSE scores (p = 0.005) and ESS (p = 0.003) and objective in PSG parameters for sleep architechture, namely REM sleep (p = 0.020). There is no statistical significance for the respiratory disturbance index (RDI) parameters, respiratory related related arousal (RERA) parameters, deep sleep, light sleep. The statistical difference for DISE parameters has not been proven yet but there is a clinical improvement in the degree location and collapse configuration in some subjects after surgery, especially at the velum and oropharyngeal level. Further research is needed for these parameters with the number of samples in accordance with the final results recalculate the number of samples in this study."