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Abstrak :
Stres sebagai salah satu faktor risiko PJK belum mendapat perhatian sebagaimana faktor risiko PJK lain. Stres dapat mencetuskan sindrom koroner akut seperti Infark Mioakard Akut (IMA) dan mempengaruhi terjadinya komplikasi lebih lanjut selama perawatan, namun masih kurang menjadikan perhatian. Tujuan penelitian untuk mengetahui pengaruh stres terhadap terjadinya komplikasi IMA selama perawatan. Bahan dan Cara : penderita yang dirawat di ICCU RSUPNCM 1990-1997 dengan kohort historiakal. Hasil : Stres merupakan prediktor yang independen terhadap terjadinya komplikasi pada penderita IMA selama perawatan intensif. (RR 2,17, p 0,02 ,CI 1,33 - 3,53). Komplikasi aritmia merupakan komplikasi yang terbanyak pada IMA dengan pajanan stres dan berbeda bermakna secara statistik. (p 0,03 ). Komplikasi lain seperti prolong chest pain, pericarditis (sindrom Dressler), gagal jantung, syok kardiogenik sampai dengan kematian juga lebih tinggi pada penderita IMA, dengan stres selama perawatan intensif. Kesimpulan stres sebagai prediktor independen terhadap terjadinya komplikasi IMA selama perawatan intensif perlu mendapat perhatian sebagai mana faktor klinis lain seperti hipertensi dan diabetes melitus, sehingga morbiditas dan mortalias IMA dapat lebih diturunkan.

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The Influence of Stress on Acute Myocardial Infarction during Intensive CareIt has been known that stress is one of many risk factors for coronary heart disease. Stress may also become a trigger factor to acute coronary syndrome such as event of Acute Myocardial Infarction (AMI) and further complications during intensive care. However most clinicians have still less concern to stress in the relation to these cardiac events. The objective of this study is to determine the influence of stress on acute myocardial infarction during intensive care. The study was perform in January, 1998-December 1998 using historical cohort design. Populations of the study consist of patients hospitalized in Intensive Coronary Care Unit (ICCU), Ciptomangunkusumo Hospital, Jakarta, Indonesia. We observed 160 cases of AMI exposed to stress and of 160 cases of AMI unexposed to stress. Totally 320 cases of AMI hospitalized in ICCU were included the study. The result of this study indicated that the complications of AMI exposed to stress about 2 times higher compared to AMI which were unexposed to stress during intensive care, (p 0.002; CI 1.33 -3.53 ). The proportion of arrhythmia on AMI with stress 32 (20 %) was higher than AMI without stress 18 (11 %) and statistically significant, (p <0,005 ). Other complications on AMI with stress such as heart failure, Dressler syndrome and mortality were also higher compared to AMI without stress. The conclusion of this study suggested that stress is one of independent predictor to AMI complications during intensive care. Stress needs more attentions to reduce morbidity and mortality during intensive care of AMI.

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ABSTRACT
Background: chronic and terminal diseases require holistic therapy that covers the biopsychosocial aspect, and it can be found in palliative therapy. Patients who receive palliative therapy exhibit very diverse profiles. As such, researchers are keen to study the general characteristics of palliative patients. In addition, researchers will also assess the patients and their familys insight that influences the success of the therapy and the impact of estimated survival time in making treatment decisions. Methods: this research used cross-sectional descriptive analytic study and secondary data of 300 palliative patients who consult to Psychosomatic Palliative Team at Dr. Cipto Mangunkusumo Hospital. The data were processed using SPSS version 25. The data processed included: sociodemographic characteristics, length of stay, incidence of death in hospital, DNR cases, the patients and their familys insight, and the impact of estimated survival time on treatment decisions. Results: most palliative patients were women (52.0%) aged 51 - 60 years (27.0%), unemployed (29.0%), and suffered from cancer (55.3%). In addition, the patients were generally treated for less than 1 month (83.6%), died in the hospital (37.3%), and consented to DNR orders (36.7%). These DNR cases are highly correlated to the familys understanding regarding the prognosis of the patients condition (p = 0.022). The familys understanding of the diagnosis, prognosis, and treatment goals (92.3%, 81.3%, and 87.7%) was better than the patients (79.0%, 64.0%, and 69.7%). Furthermore, no link was found between the therapy choice (optimal, withholding, and withdrawing therapies) with the patients estimated survival time (p = 0.174). Conclusion: female, elderly, and cancer patients most often get palliative therapy. The consent for DNR orders to palliative patient is notably frequent. Currently, the familys insight is much better than the patients, which means that health care providers need to improve patient education and information. In addition, patients and families generally still opt for optimal therapy despite low estimated survival time.

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ABSTRACT
pain is one of the most often symptoms experienced by patients with advanced or chronic diseases which can cause a decrease in the quality of life of palliative patients. Pain in palliative patients has not yet received enough attention, especially factors associated with pain and its management. This study aimed to determine the factors associated with pain in palliative patients and also assess whether there is a two-way relationship between psychological factors and pain. In addition, we will also see whether spiritual services play a role in relieving pain. Methods: cross-sectional study were used and secondary data were obtained from medical records of 285 palliative patients at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. The data were processed to determine the psycho-socio-demographic characteristics, the reciprocal relationships of psychological and pain aspects, and the relationship of pharmacological therapy (opioids), non-pharmacological therapy (spiritual services), and combination of both therapies in pain management. Results: of the 285 palliative patients, 60.3% had pain, which was found more in cancer patients (74.4% vs 25.6%). Pain was found more in patients aged 41-60 years (51.1%), women (51.2%), and unemployed (30.2%). The severity of the pain was found to be significant in patients with depressive symptoms (p=0.045), while patients with anxiety symptoms (p=0.155) and sleep disorders (p=0.619) had no significant relationship. Pain experienced by palliative patients was not statistically significant in causing depression (p=0.058), anxiety (p=0.107), and sleep disorder (p=0.639). Moreover, pain management with opioids, spiritual services, or combination of them turned out to have significant results (p=0.022). Conclusion: pain in palliative patients is mainly experienced by cancer patients and the elderly. Psychological factors affect the condition of pain, so the management that includes biopsychosocial aspect will be able to reduce pain significantly.

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Background: health workers are one of the groups affected physically as well as psychologically from the pandemic. Recent studies showed many of the health workers reported experiencing anxiety, depression, and insomnia. This study aims to identify psychotherapy as a psychological health intervention, for healthcare workers during the COVID-19 pandemic. Methods: an evidence based clinical review of psychotherapy as a psychological health intervention, reported in the literature, which is developed for healthcare workers during the COVID-19 pandemic. The review was conducted following set out for Evidence-based clinical review by searching the following digital libraries: PubMed, ProQuest, Cochrane, and Google Scholar. Results: six publications were selected. The identified psychotherapy used as a mental or psychological intervention for healthcare workers during COVID-19 consists of supportive psychotherapy, psychoeducation, social support, and music therapy. Overall, it shows that psychotherapy, especially supportive psychotherapy, can reduce anxiety, depression, and insomnia. Conclusion: the physiological condition of health workers needs to get attention during the COVID-19 pandemic. Although there is no standard of therapy yet, psychotherapy could be an option as it is proven to be able to reduce anxiety, depression, and insomnia.