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"Penyakit Paru Obstruktif Kronis (PPOK) adalah suatu kondisi yang irreversible dimana terjadi penyempitan saluran udara, peningkatan obstruksi aliran udara dan hilangnya rekoil elastis paru. Efikasi diri yang rendah pada pasien PPOK menyebabkan penurunan kualitas hidup. Penelitian ini bertujuan untuk mengetahui hubungan efikasi diri dengan kualitas hidup pasien PPOK di RS Paru Batu dan RSU Dr. Saiful Anwar Malang Jawa Timur. Penelitian ini menggunakan desain analitik korelasi dengan pendekatan cross-sectional. Jumlah sampel 84 responden dipilih dengan menggunakan teknik consecutive sampling. Hasil analisis menggunakan korelasi Uji Chi Square menunjukkan ada hubungan efikasi diri dengan kualitas hidup (P Value: 0,022, α: 0,10). Variabel confounding terhadap hubungan efikasi diri dengan kualitas hidup adalah dukungan keluarga, pekerjaan, status merokok, lama menderita PPOK dan umur. Berdasarkan hal tersebut, perawat perlu melakukan pengkajian, perencanaan dan intervensi efikasi diri dalam meningkatkan kualitas hidup dalam memberikan asuhan keperawatan pada pengelolaan pasien PPOK.

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Chronic Obstructive pulmonary Disease (COPD) is an irreversible condition of airway alteration resulted from narrowing of airways, increasing airflow obstruction and loss of lung elastic recoil. Low of self efficacy in patients with COPD causes a decrease in their quality of life. This research aimed to determine the correlation between self efficacy and quality of life among COPD at Paru Batu Hospital and Saiful Anwar Malang General Hospital East Java. The research used the analytic design of correlation with crosssectional methode. The research recruited 84 respondents by consecutive technique sampling.

The results showed that there was correlation between self efficacy and quality of life (P value: 0.022, α:0.10). The confounding variables of the correlation between self efficacy and quality of life were the family support, employment, smoking status, COPD periode and age. Nurses need to conduct assessment, intervention and implementation of self efficacy integrated in nursing care of COPD patients in order to improve quality of life based."

"ABSTRAKAdanya pengaruh pada pergerakan target akibat dari proses pernapasan maupun parameter pitch dan faktor modulasi pada pesawat tomoterapi, maka penelitian ini dilakukan untuk menginvestigasi pengaruh dari manajemen pergerakan menggunakan citra yang didapatkan dari hasil fusi antara metode pemindaian statik dan dinamik pada fantom CIRS Thoraks. Teknik pemindaian dilakukan dengan menggunakan dua teknik yakni aksial dan helikal. Variasi amplitudo yaitu 10 mm, 15 mm, dan 20 mm. Selanjutnya dilakukan planning menggunakan TPS TomoPlan dengan variasi pitch 0.25-0.5 dan MF 2 dan 3 . Evaluasi planning menggunakan parameter dosis pada target dan OAR, HI, serta nilai mean LOT. Perubahan volume organ target untuk amplitudo 10 mm, 15 mm, dan 20 mm sebesar 10.9 cc, 10.3 cc, 16.1 cc untuk teknik aksial dan 6.6 cc, 8.5 cc, 14.9 cc untuk teknik helikal dari volume target statik sebesar 3.53 cc. Didapatkan perubahan volume yang lebih besar untuk teknik pemindaian aksial dibandingkan dengan helikal. Hasil parameter optimum yang didapatkan pada planning yaitu dengan nilai pitch 0.5 dan MF 3 berdasarkan evaluasi mean LOT dan HI. Oleh karena itu perlu adanya manajemen pergerakan untuk organ target yang bergerak selama penyinaran dengan pertimbangan pada penambahan volume target akibat adanya pergerakan pernapasan agar target menerima dosis preskripsi yang cukup.

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ABSTRACT

The influence on target motion resulted from the respiratory process, the pitch and modulation factor presented in Tomotherapy. This study was aimed to investigate the effect of motion management using CT images obtained from the fusion process between static and dynamic scanning mode on the CIRS Thorax Phantom. The images were scanned using axial and helical modes. The amplitude were varied from 10 mm, 15 mm, and 20 mm. Then, the organ structures were planned using TomoPlan TPS with variation of pitch ranging from 0.25 to 0.5, and the MF in the range 2 to 3. Furthermore, evaluation of radiotherapy planning was performed using dose parameters on target and OAR, HI, and mean LOT. Target volume for static mode was 3.53 cc, where target volume has changed to 10.9 cc, 10.3 cc, 16.1 cc for axial and 6.6 cc, 8.5 cc, 14.9 cc for helical scanning. The optimum parameters were pitch 0.5 and MF 3 based on evaluation of mean LOT and HI. Therefore, motion management was needed during irradiation for the moving target organs with consideration of the target volume increment due to the movement of the respiratory system so the target volume would precisely accept the prescription dose."

"Pergerakan respirasi saat treatment radioterapi tumor dalam toraks seperti pada kasus Non-small Cell Lung Cancer (NSCLC) merupakan salah satu hal yang perlu dipertimbangkan dalam keakurasian dosis. Pergerakan tersebut menghasilkan ketidakpastian posisi target pada saat treatment radiasi yang dapat mengakibatkan adanya kekurangan dosis akibat adanya dose blurring dan interplay effect. Penelitian terdahulu membuktikan bahwa penambahan margin internal pada PTV dapat mengurangi perbedaan dosis perencanaan dengan dosis terukur. Penelitian ini bertujuan untuk mempelajari pengaruh metode optimasi robust yang memperhitungkan ketidakpastian posisi relatif terhadap volume target dalam perencanaan radioterapi dan perbandingannya dengan metode konvensional yang dilakukan pada fantom toraks dinamik in-house. Penggunaan metode ini meningkatkan nilai konformitas dosis pada teknik IMRT dan VMAT, meningkatkan uniformitas dosis pada teknik VMAT, namun mengurangi kecuraman dosis fall-off perencanaan. Metode ini meningkatkan nilai dosis target pada perencanaan IMRT konvensional dari rerata 199,63 cGy menjadi 200,43; 206,26; dan 204,20 cGy untuk ketidakpastian 5 mm, 10 mm, dan 15 mm, tetapi menurunkan dosis target pada perencanaan VMAT konvensional dari rerata 201,59 cGy menjadi 198,84; 199,05; dan 199,06 cGy untuk ketidakpastian 5 mm, 10 mm, dan 15 mm. Metode ini juga meningkatkan dosis OAR di area terdekat target dan menurunkan dosis di area lainnya pada teknik IMRT, namun hampir seluruh area OAR mendapatkan peningkatan dosis pada teknik VMAT.

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Respiration movement, when treating radiotherapy to the tumor in the thorax, such in the case of NSCLC, is one of the challenges of dose accuracy. The target movement during radiation treatment causes dose blurring and interplay effects. A previous study proved that internal margins on PTV reduce the differences between plan and measured doses. This study aims to observe the effect of robust optimization, which provide uncertainty of target volume position on photon planning. We compared the robust with a conventional method on the in-house thorax dynamic phantom. This method enhanced the dose conformity index in the IMRT and VMAT techniques and the dose uniformity in the VMAT technique. However, robust planning reduces the steepness of the dose in both IMRT and VMAT. The average target dose of IMRT technique was increased from 199.63 cGy in conventional planning to 200.43; 206.26; and 204.20 cGy for planning with an uncertainty of 5 mm, 10 mm and 15 mm. On the other hand, the average target dose was reduced from 201.59 cGy in conventional planning to 198.84; 199.05; and 199.06 cGy with an uncertainty of 5 mm, 10 mm and 15 mm for VMAT techniques, respectively. We found that the robust plan delivered a higher dose at OAR near the target than the conventional plan, but the dose is lower in the other areas on the IMRT technique. For VMAT, most of the OAR achieved a higher dose on a robust photon plan."

"Deteksi DNA adduct dapat dijadikan sebagai pendekatan untuk mendeteksi dini risiko kanker. Salah satu produk kerusakan oksidatif DNA adalah 8-hidroksi-2’-deoksiguanosin (8-OHdG). Penelitian ini dilakukan untuk mendeteksi 8-OHdG secara in vitro dan in vivo. Studi in vitro dilakukan dengan inkubasi 2’-deoksiguanosin dengan H2O2 dan akrilamida pada variasi pH 7,4 dan 8,4 selama 24 jam dalam suhu 37 oC. Kemudian hasil inkubasi dianalisis menggunakan HPLC. Sedangkan secara in vivo dilakukan deteksi 8-OHdG dalam urin pasien kanker paru stadium III-IV, urin perokok, dan urin non perokok dengan menggunakan LCMS/MS. Pada validasi instrumen HPLC diperoleh nilai regresi linier 0,9985, nilai LOD dan LOQ sebesar 6,108 ppb dan 20,361 ppb. Sedangkan untuk LCMS/MS diperoleh nilai regresi linier sebesar 1, nilai LOD dan LOQ sebesar 1,819 ppb and 6,066 ppb. Hasil penelitian menunjukkan bahwa paparan H2O2 dan akrilamida dapat membentuk 8-OHdG. Konsentrasi 8-OHdG yang terbentuk dari inkubasi 2-deoksiguanosin dan H2O2 serta 2-deoksiguanosin, H2O2, dan akrilamida maksimum pada pH 8,4 yakni sebesar 2,151 ppm dan 2,617 ppm. 8-Hidroksi-2’-Deoksiguanosin terdeteksi dalam urin pasien kanker paru, perokok, dan non perokok masing-masing sebesar 4,668 – 19,919 ppb, 6,873 – 12,111 ppb, -0,502 – 6,578 ppb. Nilai rata-rata konsentrasi 8-OHdG dalam sampel urin pasien kanker paru, perokok dan non perokok masing-masing sebesar 9,710 ppb, 10,226 ppb, dan 3,080 ppb.

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DNA adduct detection could be an approach to early detection of risk cancer. One of oxidative DNA damage products is 8-hydroxy-2’-deoxyguanosine (8-OHdG). This study was conducted to detect DNA adduct 8-OHdG in vitro and in vivo. In vitro study was started to incubate 2’-deoxyguanosine added by H2O2 and acrylamide in various pH for 24 hours at 37 oC. Then the result was analyzed with HPLC. In vivo study was conducted detection 8-OHdG in urine of lung cancer patients with stage III-IV disease, smokers and non smokers using LCMS/MS. Instrument validation (HPLC) was yielded linear regression value 0,9985, LOD and LOQ as much as 6,108 ppb and 20,361 ppb as well as validation instrument of LCMS/MS was yielded linier regression value 1, LOD and LOQ as much as 1,819 ppb and 6,066 ppb.The results of study found exposure of H2O2 to 2-deoxyguanosine induced 8-OHdG formation and the addition of acrylamide increased 8-OHdG formation. The highest 8-OHdG level obtained by incubation of 2’-deoxyguanosine and H2O2 then 2’deoxyguanosine, H2O2 and acrylamide at pH 8,4 as much as 2,151 ppm and 2,617 ppm. 8-Hydroxy-2’-Deoxyguanosine was detected in urine of lung cancer patients, smokers and non smokers respectively 4,668 – 19,919 ppb, 6,873 – 12,111 ppb, -0,502 – 6,578 ppb. The mean value of 8-hydroxy-2’-deoxyguanosine in urine of lung cancer patients, smokers and non smokers as much as 9,710 ppb, 10,226 ppb, and 3,080 ppb."

"Homeostasis protein berperan penting dalam memperlambat proses malnutrisi dan dalam mempertahankan massa bebas lemak pasien kanker. Kehilangan signifikan massa bebas lemak terutama massa otot skelet akan mengurangi mobilitas fisik, kapasitas fungsional, dan skor kualitas hidup pasien kanker. Penelitian ini merupakan studi potong lintang yang bertujuan untuk mengetahui korelasi antara asupan protein dengan massa bebas lemak dan kapasitas fungsional pada pasien kanker paru di poli onkologi RS Persahabatan Jakarta. Didapatkan 52 subjek laki-laki dengan rerata usia 55,63 6,77 tahun. Jenis dan stadium kanker yang terbanyak ditemukan adalah adenokarsinoma 63,5, stadium IV 65,4. Status nutrisi kurang berdasarkan IMT ditemui pada 21,2 subjek, dan berdasarkan kadar albumin serum didapatkan 30,8 subjek dengan hipoalbuminemia. Lebih dari 50 subjek dengan asupan energi dan protein dibawah rekomendasi asupan untuk pasien kanker. Pada pemeriksaan komposisi tubuh didapatkan rerata massa bebas lemak 47,20 6,28 kg, dengan 48,1 indeks massa bebas lemak rendah, massa otot rerata 44,74 5,98 kg dengan 40,4 massa otot tergolong kurang. Nilai kapasitas fungsional skala Karnofsky.

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The homeostasis of protein plays an important role in decreasing the process of malnutrition and in maintaining fat free mass in cancer patients. The significant loss of fat free mass, especially skeletal muscle mass could decrease physical activity, functional capacity, and quality of life of cancer patients. This was a cross sectional study aimed to investigate the correlation of protein intake, fat free mass and functional capacity in lung cancer patients in the Oncology Unit of Persahabatan Hospital Jakarta. Obtained 52 male subjects with a mean age of 55,63 6,77 years old. The most cancers type were adenocarcinoma 63,5 and most of subjects were at stage IV 65,4 . Nutritional status of the subjects 21,2 were in undernutrition based on body mass index parameter, and 30,8 of the subjects were in hypoalbuminemia. More than 50 of the subjects had low energy and protein intake. The mean of fat free mass was at 47,20 6,28 kg, that 48,1 of fat free mass index were in low categorized, and 40,4 of muscle mass were also in small categorized, that the mean was at 44,74 5,98 kg. Functional capacity Karnofsky scale of the subjects 26,9 showed less than 70. The data showed that the subjects had nutrition problems. This study showed positive and significant correlations between protein intake with fat free mass index r 0,379, p "

"Summary: When Breath Becomes Air What makes life worth living in the face of death? What do you do when the future, no longer a ladder toward your goals in life, flattens out into a perpetual present? What does it mean to have a child, to nurture a new life as another fades away? These are some of the questions Kalanithi wrestles with in this profoundly moving, exquisitely observed memoir. Paul Kalanithi died in March 2015, while working on this book, yet his words live on as a guide and a gift to us all. "I began to realize that coming face to face with my own mortality, in a sense, had changed nothing and everything, "he wrote. "Seven words from Samuel Beckett began to repeat in my head: I can't go on. I'll go on.' -- "--Janet Maslin, --USA Today "It's (Kalanithi's) unsentimental approach that makes When Breath Becomes Air ("When Breath Becomes Air From the Hardcover edition"

"ABSTRAKKeluhan utama yang sering ditemukan pada pasien kanker paru adalah dyspnea. Salah satu terapi non farmakologi yang dapat digunakan untuk mengurangi dyspnea adalah menggunakan External Nasal Dilator Strips. Penelitian ini bertujuan mengetahui pengaruh pengunaan External Nasal Dilator Strip terhadap Dyspnea pasien kanker paru. Desain Penelitian adalah Quasy Experiment dengan rancangan pre and post test nonequivalent control group. Penelitian ini melibatkan 34 responden dengan menggunakan Non Probability Sampling jenis Consecutive Sampling yang dibagi menjadi 17 responden kelompok intervensi dan 17 responden kelompok kontrol. Hasil analisis statistik didapatkan bahwa terdapat perbedaan yang bermakna selisih skor dyspnea antara responden pada kelompok intervensi dan kontrol setelah intervensidengan nilai p = 0,031. External Nasal Dilator Strips dapat dijadikan salah satualternatif intervensi keperawatan manajemen jalan napas pada pasien kanker paru.

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ABSTRACTThe main complaint is often found in lung cancer patients is dyspnea. One of the nonpharmacological therapies that can be used to reduce dyspnea is to use External Nasal Dilator Strips. This study aims to determine the effect of the use of External Nasal Dilator Strip against Dyspnea lung cancer patients. Research Design is Quasy Experiment with pre and post test nonequivalent control group design. This study involved 34 respondents using Non Probability Sampling type Consecutive Sampling divided into 17 respondents intervention group and 17 respondents control group. The result of statistic analysis showed that there was a significant difference of dyspnea score between respondents in intervention group and control after intervention withp= 0,031. External Nasal Dilator Strips can be used as an alternative to nursing airway management interventions in lung cancer patients."

"Latar belakang: Kanker paru yang bermetastasis dapat meningkatkan risiko penurunan kualitas hidup. Masalah yang timbul pada pasien kanker paru yang bermetastasis mengakibatkan peningkatan kecemasan pada keluarga. Tujuan: Mendapatkan gambaran pengelolaan pasien kanker paru yang bermetastasis dengan mengaplikasikan teori Peaceful End Of Life Ruland Dan Moore dengan pendekatan intervensi berbasis Evidence Based Practice Nursing Psikoedukasi pada keluarga untuk mengurangi kecemasan keluarga. Metode: Studi kasus ini melibatkan lima pasien kanker paru yang dirawat di ruang rawat inap Rumah Sakit Kanker Dharmais yang diberikan asuhan keperawatan dengan pendekatan teori peacefull end of life Rulland dan Moore dan intervensi psikoedukasi pada keluarga. intervensi psikoedukasi pada keluarga diberikan sebanyak lima sesi, masing-masing sesi tiga puluh menit Hasil: Pendekatan proses keperawatan mulai dari pengkajian sampai evaluasi diterapkan pada lima pasien kanker paru yang bermetastasis. Pendekatan teori peacefull end of life meliputi bebas nyeri, kenyamanan, perasaan damai, kedekatan orang yang bermakna Beberapa masalah kesehatan yang muncul adalah ansietas, harga diri rendah, fatigue dan nyeri. Melalui intervensi psikoedukasi pada keluarga kelima pasien kanker paru yang bermetastasis mengalami peningkatan kualitas hidup Kesimpulan: Pendekatan teori peacefull end of life dapat diberikan pada pasien kanker paru yang bermetastasis. Intervensi keperawatan psikoedukasi efektif untuk mengurangi kecemasan keluarga.

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Background: Metastatic lung cancer can increase the risk of decreasing quality of life. Problems that arise in metastatic lung cancer patients result in increased anxiety in the family. Objective: Obtain an overview of the management of metastatic lung cancer patients by applying Ruland Dan Moore's Peaceful End Of Life theory with an intervention approach based on Evidence Based Practice Nursing Psychoeducation in families to reduce family anxiety. Methods: This case study involved five lung cancer patients who were treated in the inpatient room of the Dharmais Cancer Hospital who were given nursing care using Rulland and Moore's peacefull end of life theory approach and psychoeducational interventions in the family, five session, and thirty minute. Results: The nursing process approach from assessment to evaluation was applied in five metastatic lung cancer patients. The peacefull end of life theory approach includes pain-free, comfort, feeling of peace, closeness of meaningful people. Some of the health problems that arise are anxiety, low self-esteem, fatigue and pain. Through psychoeducational interventions in the fifth family of metastatic lung cancer patients, the quality of life is improved. Conclusion: A peaceful end of life theoretical approach can be given to metastatic lung cancer patients. Psychoeducational nursing interventions are effective for reducing family anxiety."