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"Latar Belakang: Prevalensi infeksi yang disebabkan oleh multidrugs resistent microorganism (MDRO), terutama bakteri Enterobacteriaceae penghasil enzim extended-spectum beta-lactamase (ESBL) semakin meningkat. Identifikasi yang cepat dan pemberian antibiotik yang tepat, terutama untuk pasien intensive care unit (ICU), dibutuhkan untuk menurunkan lama rawat dan menurunkan angka mortalitas. Duke clinical score merupakan suatu instrumen stratifikasi risiko untuk memprediksi infeksi bakteri Enterobactericeae penghasil ESBL. Duke clinical score pernah diteliti untuk memprediksi infeksi yang didapat dari komunitas, namun belum pernah diteliti untuk pasien ICU.Metode: Penelitian ini merupakan uji diagnostik dengan design kohort prospektif. Subjek penelitian merupakan pasien ICU RSUPN Dr. Cipto Mangunkusumo (RSCM) yang memenuhi kriteria inklusi selama bulan Januari-Maret 2022. Skrining dengan swab rektum untuk melihat adanya infeksi bakteri Enterobacteriaceae penghasil enzim ESBL dilakukan dalam 24 jam pertama perawatan pasien di ICU. Kultur klinis dilakukan sesuai indikasi. Duke clinical score diperiksa pada awal perawatan pasien di ICU. Pasien yang tidak terinfeksi bakteri Enterobacteriaceae penghasil enzim ESBL di awal perawatan di ICU akan diobservasi dan diambil kembali swab rektum pada akhir perawatan di ICU. Penelitian akan menilai sensitivitas, spesifisitas, positive dan negative predictive value (PPV, NPV), area under curve (AUC) receiver operating characteristic (ROC) Duke clinical score.Hasil: Dari 105 pasien yang memenuhi kriteria inklusi, 55% pasien memiliki swab rektum atau kultur klinis yang positif dengan bakteri Enterobacteriaceae penghasil enzim ESBL dalam 24 jam perawatan pertama di ICU sehingga dieksklusi. Total subjek penelitian 47 pasien yang tidak terinfeksi bakteri Enterobacteriaceae penghasil ESBL pada awal perawatan di ICU. Pada nilai cut-off ≥ 8.5, Duke clinical score memiliki sensitivitas 32%, spesifisitas 89%, PPV 67%, NPV 66%. AUC ROC 0.652.Kesimpulan: Duke clinical score tidak valid sebagai prediktor infeksi bakteri Enterobacteriaceae penghasil enzim ESBL pada pasien ICU RSCM.

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Background: The prevalence of infections caused by multidrugs resistant microorganisms, especially extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae, is increasing. Rapid identification and proper administration of antibiotics, especially for intensive care unit (ICU) patients, are needed to reduce length of stay and lower mortality rates. Duke clinical score is a risk stratification instrument for predicting infection caused by ESBL-producing Enterobactericeae. Duke clinical scores have been studied to predict community-acquired infections, but have never been studied for ICU patients.

Methods: This study was a diagnostic test with a prospective cohort design. The subjects were patients of ICU Cipto Mangunkusumo general teaching hospital (RSCM) during January-March 2022 who met the inclusion criterias. Screening with a rectal swab to see the presence of infection with the ESBL-producing Enterobacteriaceae was carried out within the first 24 hours of admission in ICU. Clinical culture was carried out according to indications. Duke clinical score was examined at the beginning of the patient's treatment in the ICU. Patients who were not infected with the ESBL-producing Enterobacteriaceae at the beginning of treatment in the ICU would be observed and rectal swab would be taken at the end of treatment in the ICU. The study would assess the sensitivity, specificity, positive and negative predictive value (PPV, NPV), area under curve (AUC) receiver operating characteristic (ROC) Duke clinical score.

Results: Of the 105 patients who met the inclusion criteria, 55% of them had a positive rectal swab and/or clinical cultures with ESBL-producing Enterobacteriaceae within the first 24 hours of treatment in the ICU. A total of 47 subjects were identified as patients who were not infected with ESBL-producing Enterobacteriaceae at the beginning of treatment in the ICU. At a cut-off value ≥ 8.5, Duke clinical score have sensitivity 32%, specificity of 89%, PPV of 67%, NPV of 66%. AUC ROC 0.652.

Conclusions: Duke clinical score is invalid as a predictor of ESBL-producing Enterobacteriaceae infection in ICU RSCM patients.

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"Pendahuluan: Laporan kasus fatality di beberapa perusahaan minyak dan gas di Indonesia selama Januari-Maret 2019 terjadi 15 kasus mortalitas pekerja diduga akibat kematian jantung mendadak, tanpa adanya kelainan hasil uji treadmill pada pemeriksaan kesehatan berkala terakhir. Salah satu metode penapisan risiko penyakit jantung koroner (PJK) adalah dengan uji treadmill. Duke Treadmill Score (DTS) merupakan metode yang baik untuk stratifikasi risiko dan menilai prognosis pada uji treadmill. Tujuan: Diketahuinya hubungan antara faktor risiko individu dan jenis pekerjaan dengan DTS. Metode: Penelitian cross sectional yang melibatkan 290 responden pekerja dari empat perusahan migas di Indonesia. Pengumpulan data dilakukan dengan wawancara serta perhitungan DTS berdasarkan hasil uji treadmill pekerja yang dilakukan pada September-Desember 2019. Hasil: Didapatkan 66,9% DTS risiko ringan; 33,1% DTS risiko sedang. Variabel yang berhubungan dengan peningkatan risiko DTS adalah usia >40 tahun dengan (ORadj = 2,70; IK 95%: 1,162-6,282), dan merokok (ORadj = 2,78 IK 95% 1,637- 4,726). Kesimpulan: Tidak terdapat hubungan bermakna antara jenis pekerjaan dengan DTS pada pekerja migas di Indonesia. Terdapat hubungan bermakna antara risiko individu merokok dan usia >40 dengan DTS pada pekerja migas di Indonesia.

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Background: Reports of fatality cases in several oil and gas companies in Indonesia, January - March 2019 period occurred 15 mortality cases of workers due to sudden cardiac death, without any abnormal findings of the treadmill test result on last periodic Medical Check-up. One of the screening method for coronary heart disease is the treadmill test. The Duke Treadmill Score (DTS) is the most powerful method for stratifying risk and assessing the prognosis in the treadmill test.

Objective: To find out the association between individual riks factors and types of work with DTS among oil and gas workers in Indonesia.

Methods: A cross-sectional study design involving 290 respondent oil and gas workers from four oil and gas companies in Indonesia. Data collected by interview and calculation of DTS based on worker’s treadmill test conducted in September-December 2019.

Results: DTS among workers found 66,9% had low risk; 33,1% had moderate risk. Variables associated with increased DTS were age >40 (ORadj= 2,70; 95%CI:1,162-6,282) and smoking (ORadj= 2,78; 95%CI:1,67-4,726).

Conclusions: There was no significant association between types of work and DTS among oil and gas workers in Indonesia. There was a significant association between the risk of individual smoking and age>40 with DTS in oil and gas workers in Indonesia."

"Intoleransi aktifitas adalah gejala utama yang terjadi pada pasien gagal jantung dan sangat relevan, karena berhubungan dengan kualitas hidup yang buruk dan peningkatan kematian. Kemungkinan etiologi gangguan status fungsional atau intoleransi latihan pada pasien gagal jantung adalah penurunan respon curah jantung terhadap aktivitas fisik, disfungsi otot rangka, dan abnormalitas kapasitas vasodilatasi perifer. Tujuan penelitian : mengetahui efektifitas duke activity status index (DASI) sebagai instrumen dalam pengkajian secara mandiri terhadap kemampuan fisik pada pasien gagal jantung. Metode : studi literatur dari beberapa database elektronik seperti Science Direct, Sagepub dan Proquest dari tahun 2010-2021. Hasil: didapatkan 60 artikel yang terkait dengan hasil pencarian, kemudian dilakukan analisis baik melalui kriteria inklusi dan ekslusi dan didapatkan 5 artikel yang relevan. Kesimpulan: DASI terdiri dari 12 item kuesioner untuk mengkaji status fungsional fisik secara mandiri dan dapat digunakan untuk menilai keterbatasan fisik pasien yang memiliki rentang skor 0-58,2. Hasil pengukuran DASI dibandingkan dengan treadmil, 6MWT (6 minute walk test), MLHFQ (minnesota living with heart failure questionnaire) dan NT-ProBNP dinyatakan signifikan sehingga instrumen ini dinyatakan valid dan reliabel.

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Activity intolerance is a major symptom that occurs in patients with heart failure and is very relevant, because it's associated with a poor quality of life and increased mortality. Possible etiologies of impaired functional status or exercise intolerance in patients with heart failure are decreased cardiac output response to physical activity, skeletal muscle dysfunction, and abnormal peripheral vasodilating capacity.

The purpose: to determine the effectiveness of the duke activity status index (DASI) as an instrument in independent assessment of physical abilities in heart failure patients.

Methods: literature study from several electronic databases such as Science Direct, Sagepub and Proquest from 2010-2021.

Results: obtained 60 articles related to the search results, then analyzed both through inclusion and exclusion criteria and only 5 relevant articles.

Conclusion: The DASI consists of 12 questionnaire items to assess physical functional status independently and can be used to assess the physical limitations of patients who have a score range of 0-58.2. The results of the DASI measurement were compared with the treadmill, 6MWT (6 minute walk test), MLHFQ (Minnesota living with heart failure questionnaire) and NT-ProBNP were declared significant so that this instrument was declared valid and reliable."