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"ABSTRACTSurgical skill training using cadavers is important for surgeons to gain an understanding of anatomical approaches. However, the laws and guidelines stipulating surgical technique training using corpses differ in each country. We discuss the new guidelines and the current situation in Japan in comparison with that in Western Europe and the United States."

"This is designed to give a concise account of both basic immunology and its clinical impact on different areas of modern surgical practice - organ transplantation, trauma, infection, cancer, and others"

"Medical-surgical nursing: an integrated approach 3-Eis a comprehensive, reader friendly resource for the practical/vocational nursing student. The 3rd Edition has been completely reinvisioned and thoroughly updated in all aspects of its coverage, with chapters now broken out into smaller, more manageable portions. In addition to rich coverage of all body systems with anatomy & physiology, data collection, disease information, and a strong focus on the nursing process, exciting new chapters on family processes and issues, psychobiological issues, bioterrorism and more have been added. Engaging features including case studies, critical thinking exercises, evidence-based practice boxes, informatics boxes, memory tricks, and more support student learning and retention throughout the text. NCLEX style questions and Theory to Practice activities provide opportunities to test understanding and apply concepts. This is the ideal choice for instructors looking for depth of coverage and student-focused features."

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Latar Belakang :  Carpal Tunnel Syndrome (CTS) merupakan kelainan neuropati perifer terbanyak pada ekstremitas atas akibat terjebaknya atau terjepitnya saraf medianus pada terowongan karpal. Pada pekerja seringkali diakibatkan oleh gerakan repetitif dengan fleksi dan ekstensi pada daerah pergelangan tangan, gerakan menggenggam erat, getaran. Kasus CTS merupakan gangguan muskuloskeletal pada ekstremitas atas yang mengakibatkan pembiayaan kesehatan yang besar, kurangnya produktivitas, hilangnya hari kerja hingga terjadinya disabilitas.

Tujuan : menilai efektivitas terapi nonoperatif bila dibandingkan dengan terapi operatif pada pasien dengan CTS.

Metode : Penelusuran artikel dengan menggunakan Pubmed dan Google Scholar dan menggunakan kriteria inklusi dan eksklusi yang telah ditentukan sebelumnya. Hasil pencarian artikel tersebut kemudian dilakukan telaah dengan menggunakan kriteria penilaian validitas, tingkat pentingnya hasil yang didapat pada penelitian tersebut, dan kemamputerapan.

Hasil : Studi dalam systematic review ini masih mencakup studi yang sedikit dan sangat heterogen dengan outcomes yang bervariasi sehingga secara clinical efficacy belum dapat diyakini bahwa salah satu intervensi lebih baik yang lainnya pada tatalaksana CTS. Hasil gabungan dari analisis subgrup berupa peningkatan fungsi, peningkatan gejala, peningkatan parameter neurofisiologis, dan biaya perawatan pada waktu tindak lanjut yang berbeda menunjukkan bahwa perbedaan tidak signifikan secara statistik antara kedua intervensi. Perbedaan komplikasi dan efek samping secara statistik signifikan dan pengobatan non operatif mencapai hasil yang lebih baik daripada operatif (OR= 2,03, 95% CI= 1,28-3,22, p= 0,003).

Kesimpulan : Tatalaksana pada pasien Carpal Tunnel Syndrome baik dengan intervensi operatif maupun non operatif memiliki keuntungan masing- masing. Hasil intervensi dari segi peningkatan fungsi, perbaikan gejala dan parameter neurofisiologi serta pembiayaan tidak ada ada perbedaan yang signifikan antara keduanya. Intervensi operatif dapat dilakukan apabila perawatan non operatif gagal.

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Background : Carpal Tunnel Syndrome (CTS) is the most common peripheral neuropathy in the upper extremities due to trapping or pinching of the median nerve in the carpal tunnel. In workers it is often caused by repetitive movements with flexion and extension on the wrist area, tight grasping movements, vibration. CTS cases are musculoskeletal disorders of the upper extremities with the most expensive health financing in the United States. In addition, it also causes loss of work days that exceed other occupational diseases other than fractures. CTS also results in large compensation expenditures, lack of productivity to disability.

Objective: to assess the effectiveness of nonoperative therapy when compared with operative therapy in patients with CTS.

Methods: Searching the articles by using Pubmed and Google Scholar as well as inclution and exclution criteria predetermined, articles were than performed using the assesment criteria of validity, importance, and ability applied

Results: The studies in this systematic review still include few and very heterogeneous studies with varying outcomes so that clinical efficacy cannot yet be believed that one of the other interventions is better in the management of CTS. The combined results from the subgroup analysis of improved function, improved symptoms, increased neurophysiological parameters, and treatment costs at different follow up times showed that the difference was not statistically significant between the 2 interventions. The difference in complications and side effects was statistically significant and nonoperative treatment achieved better results than operative (OR= 2.03, 95% CI= 1.28-3.22, p= 0.003).

Conclusion: The management of Carpal Tunnel Syndrome patients with both operative and non-operative interventions has their respective advantages. The results of the intervention in terms of improved function, improvement of symptoms and neurophysiological parameters and financing there is no significant difference between the two. Operative intervention can be done if non-operative care fails.

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"ABSTRACTPurpose To evaluate the status of surgical training in Japan through a national level needs assessment. Methods A survey was sent to all 909 graduating residents (GRs) and their 611 program directors (PDs) for the year 2016. A working group of surgical educators from around the country was formed under the education committee of the Japan Surgical Society. The survey items were developed by consensus of this working group. The survey investigated the knowledge and problems of the current curriculum, and the status of the current residency training.ResultsThe response rates were 56,3% of the GRs and 76,8% of the PDs. Among the participants, 47,6% of the GRs and 29,4% of the PDs believed that the residency curriculum did not match the clinical experience. Over 80% of the GRs and PDs agreed on the importance of training outside of the OR, whereas only 13% of the GRs had received such training regularly. Trainees also reported a lower satisfaction rate about the opportunity to train outside of the OR.ConclusionThis national level needs assessment of surgical training in Japan identified several gaps in the curriculum. These results provide valuable data to assist the ongoing efforts for surgical residency curriculum improvement."

"Seksio Sesaria merupakan prosedur rutin yang sering dilakukan di bidang obstetri. Tingginya angka seksio sesaria di RSAU dr. Esnawan Antariksa (80%) dibandingkan dengan tandar WHO (15%), dapat berdampak terhadap luaran pasien, khususnya meningkatkan peluang terjadinya infeksi dan lama rawat. Tujuan penelitian ini adalah mencari hubungan kelengkapan pengisian Surical Safety Checklist (SSC) pada seksio sesaria terhadap Infeksi Luka Operasi (ILO) pasca seksio sesaria. Karakterisik demografis dan klinik diperoleh dari rekam medis. Pasien yang dilakukan seksio sesaria diikuti sampai 30 hari dan ditelusuri terjadinya ILO. Desain penelitian ini berupa kuantitatif kohort retrospektif, hubungan dianalisis dengan regresi logistik. Ditemukan bahwa kejadian ILO pasca SC sebesar 3,2% (31 pasien). Kelengkapan pengisian SSC mayoritas sudah lengkap (n=978). Kelengkapan pengisian SSC fase sign in, time out dan sign out yaitu 92,1%, 82,2% dan 92,4%. Tidak terdapat hubungan antara kelengkapan pengisian SSC fase sign in dan time out dengan ILO pasca seksio sesaria serta terdapat hubungan berlawanan arah yang signifikan secara statistik antara kelengkapan SSC fase sign out, dengan ILO (P=0,026). Kesimpulannya mayoritas kelengkapan pengisian SSC di RSAU dr. Esnawan Antariksa sudah lengkap, ada hubungan berlawanan arah antara kelengkapan pengisian SSC fase sign out pada seksio sesaria dengan ILO di RSAU dr. Esnawan Antariksa.

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Caesarean section is an routine obstetrics procedure. Number of cesarean sections at RSAU dr. Esnawan Antariksa (80%) was higher than WHO standard (15%).That phenomena impact to patient outcomes, particularly increasing the probability of infection and length of stay. The purpose of This study purposes to find correlation between the completeness of the Surical Safety Checklist (SSC) and surgical site infection (SSI) after cesarean section. Patients who underwent cesarean section were followed up for 30 days and traced SSI. This was retrospective quantitative cohort study. We found SSI prevalence was 3.2% (31 patients). The majority of SSC completion were complete (n=978). The completeness of filling in SSC phases of sign in, time out and sign out are 92.1%, 82.2% and 92.4%. There was no association between the completeness of the SSC filling in the sign-in and time-out phases with SSI following cesarean section and there was a statistically significant opposite correlation between the completeness of the SSC in the sign-out phase and SSI (P=0.026). In conclusion, although the majority of the completeness of SSC filling in RSAU dr. Esnawan Antariksa was complete, and there was opposite association between the completeness of filling out the SSC in the sign out phase, SSC recommended used as maintenance patient safety quality standar."

"Salah satu indikator dari mutu pelayanan bagian bedah adalah lama hari rawat pasien bedah tertentu.Dari hasil pengamatan sebelumnya diketahui, bahwa lama hari rawat untuk pasien bedah Appendicitis di Rumah Sakit Islam Jakarta tahun 1993 cukup tinggi,yaitu 6.6 hari dengan SD 3.4.Penelitian ini bertujuan untuk mendapatkan informasi yang memberikan gambaran mengenai faktor-faktor yang berhubungan dengan lama hari rawat pasien bedah Appendicitis di Rumah Sakit Islam Jakarta.Metode penelitian adalah cross sectional dengan memakai data sekunder,yang diambil dari sampel dengan No kode ICD 540.9 (Appendicitis Acut) dan No kode 542 ( Appendicitis Kronis ) yang dirawat di kelas I,II dan III, selama Th 1993.Analisa statistik menggunakan bantuan komputer dengan memakai program Epi Info 5.01 B yang di disain oleh WHO dan C D C (center for disease control).Dari hasil penelitian ditarik kesimpulan bahwa ada 4 faktor yang berasal dari faktor input (jenis penyakit dan diagnosa dasar ),faktor proses (dokter operator) dan faktor lingkungan (kelas perawatan pasien) yang berhubungan dengan lama hari rawat.Sedangkan 4 faktor lainnya yaitu faktor umur, jenis kelamin, penjamin biaya rawat dan sifat operasi tidak dapat di buktikan berhubungan.Jenis penyakit Appendicitis Kronis, yang mendapat tindak bedah, lama hari rawatnya lebih panjang dibandingkan dengan jenis penyakit Appendicitis Acut.Pasien dengan diagnose dasarnya lebih dari satu, pada tindak bedah Appendik, lama hari rawatnya lebih panjang daripada pasien dengan diagnose dasarnya tunggal hanya Appendicitis saja.Dokter operator tamu, merawat pasien lebih lama daripada dokter operator tetap (Fulltimer) Rumah Sakit.Sedangkan lama hari rawat pasien bedah Appendik di ruang perawatan kelas III, lebih panjang dibandingkan dengan pasien yang di rawat di ruang perawatan kelas I dan II.Diharapkan dari hasil penelitian dan saran saran yang disampaikan, dapat membantu peningkatan kualitas pelayanan pasien rawat inap pada umumnya dan pasien bedah khususnya di Rumah Sakit Islam Jakarta

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One of the indicators that show the quality of cares in surgery division is the patient's post surgical length of stay in the hospital.

Previous observations showed that the length of stay of appendectomy cases at Rumah Sakit Islam Jakarta in 1993, averaging 6.6 days, with standard deviation 3.4 days, was relatively high.

This study aims at finding out information providing some ideas on the factors related to the length of stay of appendectomy patients at Rumah Sakit Islam Jakarta.

The study employs cross sectional method using secondary data from samples code numbered ICD 540.9 (Acute appendicitis) and ICD 542 (Chronic appendicitis) who were hospitalized in the first, second and third classes during 1993 period.

The statistical analysis uses Epi Info 5.01 B computer program designed by WHO as well as CDC (Centre for disease control).

The study shows that there are four factors influencing the length of stay of appendectomy patients at Rumah Sakit Islam Jakarta:

a. The input factor

1. Type of disease

2. Basic diagnoses

b. The process factor

3.The surgeons

c. The environment factor:

4. Class of hospitalize

The other four factors, age, sex, cost of care guarantor and type of operation are not proven to have significant correlation.

The length of stay of chronic appendicitis is longer than that of acute appendicitis.

Appendectomy patient originally diagnosed as having complication will have a longer stay at the hospital than a patient diagnosed with appendectomy only.

The part timer or visiting surgeons tend to keep their patients longer at the hospital, than the fulltime doctors.

The length of the hospital stay for patients in lower classroom (third class) is longer than that in the higher class, the first and second classes.

It is expected that the study results and suggestions provided, will be able to improve the quality of service of surgical patients at Rumah Sakit Islam Jakarta."

"A patient undergoing surgery faces great physiologic and psycologic stress, so nutritional demands are greatly increased during this period and deficiencies can easily develop. If this deficiencies are allowed to develop and are not met in screening, serious malnutrition and clinical problem can occur. Therefore careful attention must be given to a patient's nutritional status in preparation of surgery, as well as to the individual nutritional needs. If these needs are met complications are less likely developing. Nutritional resources provide for rapid recovery. Proper nutrition can speed healing in surgical patients with major trauma, severe malnutrition, burns and other severe illnesses. New techniques for tube feeding, intravenous nutrition for patients with serious weight loss due to gastrointestinal disorders and use of supplements can hasten wound healing and shorten recovery times. "

"Dengan semakin majunya ilmu dan teknologi di dunia di segala aspek kehidupan turut memberikan konsekuensi semakin majunya ilmu kedokteran yang ada di dunia. limu Kedokteran Forensik adalah salah satu dari ilmu kedokteran tersebut. Adapun Ilmu Kedokteran Forensik terdefinisikan sebagai salah satu cabang spesialistik dari ilmu kedokteran yang memanfaatkan ilmu kedokteran dan bermanfaat untuk membantu penegakkan hukum dan masalah-masalah hukum. Pada mulanya ilmu kedokteran forensik hanya diperuntukkan bagi kepentingan peradilan, namun perkembangan jaman mengakibatkan pemanfaatannya juga di bidang-bidang yang bukan peradilan.Pada masyarakat kita, pemanfaatan ilmu kedokteran forensik Iebih banyak dikenal dalam pelayanan pembuatan visum et repertum yakni melalui pemeriksaan mayat atau bedah mayat. Meskipun sebenarnya masih banyak pelayanan yang bisa diberikan dari ilmu kedokteran forensik, seperti pemeriksaan korban perkosaan, pencabulan, paternitas dan lain sebagainya, namun sepertinya hal tersebut masih belum "familiar" atau karena memang belum dikenal. Jika boleh dikatakan saat ini masyarakat Iebih cenderung memberikan istilah dari ilmu kedokteran forensik adalah lama halnya dengan "ilmu bedah mayat" dan dokter forensik adalah "dokter mayat" atau "dokter bedah mayat", atau istilah-istilah semakna lainnya.Di Indonesia, sejak abad 19 pemanfaatan kedokteran forensik sudah dilakukan oleh dokter Belanda untuk kepentingan peradilan dan Iebih banyak dikenal berkaitan dengan bedah mayat atau pelayanan otopsinya saja. Sedangkan pemanfaatan pembuatan visum untuk orang hidup nampaknya belum lama dikenal oleh masyarakat atau konsumen pemintanya (penyidik).Dengan semakin majunya negara, akan menimbulkan konsekuensi meningkatnya kompleksitas pada setiap bidang kehidupan. Di negara berkembang kompleksitas ini mengakibatkan persaingan yang masingmasing berusaha untuk dapat mempertahankan kehidupannya, sehingga akhirnya mengakibatkan meningkatnya angka kriminaiitas. Sebagai gambaran maka jumlah kasus kejahatan di Indonesia terhadap tubuh dan jiwa manusia berfluktuasi sekitar 10.000 per tahunnya."