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"Penelitian ini bertujuan mengidentifikasi efektifitas pengkajian metode NIHSS dan ESS dalam membuat diagnosa keperawatan aktual pada pasien stroke berat fase akut di RSUP X Jakarta. Penelitian ini menggunakan desain pra-eksperimen post-test only design (the one shot case study) dengan purposive sampling melibatkan 18 responden. Hasil menunjukkan hubungan sangat kuat berpola positif (r= 0,904) pada nilai NIHSS dan berpola negatif (r= -0,912) pada nilai ESS (p= 1,000; α= 0,05). Tidak ada perbedaan efektifitas penggunaan metode NIHSS dan ESS terhadap pembuatan diagnosa keperawatan yang aktual pada pasien stroke berat fase akut. Sebagai seorang perawat di ruang unit stroke sangatlah penting untuk menguasai pengkajian metode ini dalam rangka meningkatkan mutu asuhan keperawatan sehingga mempercepat proses penyembuhan pasien."

"Unit Stroke (US) telah terbukti sangat baik dalam peawatan pasien stroke.Penelitian US pada tahitn 1990 menunjukkan hasil dengan peningkatan rata-rata kehidupan dan perbaikan status fungsionai pendetita dun menurunkan hari perawatan pasien, Di Indonesia US masih bum sehingga penelitian tentang tatalaksana perawatan dl US sangat diperlukan.Penelitian ini dilakukan untuk evaluasi manfaat US sebagai perawatan pasien stroke khususnya perbaikan status fungsional pasien dibandingkan perawatan pasien di Sudut Stroke Bangsal Umum Neurologi. Hasil penelitian menunjukan perbaikan status fungsionai stroke (Skor NIHSS) baik di US maupiin di Sudut Stroke Bangsal Neurologi Umum.Data memperlihatkan penumnan nilai NIHSS yaitu 17,35 tnenjadi 5,31 sedangkan di Sudut stroke 13,83 menjadi 8,87. Dengan menggunakan Independent t-test,penurunan NIHSS di US signifikan dibandingkan sudut stroke di bangsal neurologi umum. (MedJ Indones 2006; 15:30-3).

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Stroke unit has been believed us the best institutional care for stroke patients. Recent researches in 1990s indicated thai stroke units can produce increasing survival rate and improving the functional state of the patients which can reduce the need for institutional care after stroke. In Indonesia, stroke unit is still new. Because stroke unit has educational role beside its clinical importance, the research about stroke unit especially in its value in managing stroke patients in Indonesia is needed.

This study was evaluated the effectiveness of stroke unit care in managing stroke patients especially in improving the functional state of the patients in compared with conventional care of stroke corner in general neurology ward. This study indicated that both stroke unit (SU) and stroke corner in general neurology ward (SC) shows reduction in NIHSS score. In Stoke Unit, the reduction of NIHSS was 17.35 to 5.31 while in Neurology ward from 13.83 to 8.87. Using independent t-test, the reduction of NIHSS in stroke unit is more significance compared with stroke corner in general neurology ward (p=0,000). (Med J Indones 2006; 15:30-3)."

"Recently, lactate has been recognized as energy resources for neuron metabolism. According to ANLS hypothesis, glucose being particularly uptaken by astrocyte is eventually metabolized via glycolisis. Lactate produced in astrocyte is then released into extracelluler matrix and uptaken by neuron then converted into pyruvate that used in oxydative metabolism. That proccess is resulted more ATP than that of conventional theory. A few in vitro studies has demonstrated that there is an increased of ATP in neuron at hypoxic condition, agreed with ANLS hypothesis.This study was aimed to learn the correlation between plasma lactate level and functional scale in acute thrombotic stroke patients. Forty patients with acute thrombotic stroke were admitted to neurology ward, dr. Soetomo General Hospital Surabaya in May until July 2013. Those patients had been examined for plasma lactate level using lactate-oxydase colorimetric method and functional scale by NIHSS (National Institute of Health Stroke Scale). The results showed that mean of age was 58,98 ± 11,91 years old, plasma lactate level was 1,51 ± 0,47 mmol/L, and mean of NIHSS was 6,83 ± 2,978. There was negative correlation between plasma lactate level and functional scale measured by NIHSS in acute thrombotic stroke patients, which was statistically significant (r = - 0,366 and p = 0,020)."

"ABSTRAKSitikolin adalah neuroprotektor yang paling banyak digunakan untuk memperbaiki kerusakan neurologis pada penderita stroke iskemik, namun efektivitas sitikolin masih diperdebatkan berdasarkan penelitian ilmiah karena memberikan hasil yang heterogen. Penelitian bertujuan untuk mengetahui pengaruh terapi sitikolin terhadap fungsi neurologis yang dinilai dengan The National Institute of Health Stroke Scale (NIHSS) dan kemampuan fungsional yang dinilai dengan Barthel Index. Penelitian pada pasien stroke iskemik berdasarkan terapi sitikolin yang dilakukan di 18 rumah sakit di Indonesia yang berkontribusi dalam registri penyakit stroke. Desain studi penelitian ini adalah kohort retrospektif menggunakan data registri stroke Indonesia. Penilaian perbaikan fungsi neurologis berdasarkan perubahan nilai NIHSS sebesar > 2 poin dan penilaian kemampuan fungsional berdasarkan perubahan nilai Barthel Index sebesar > 20 poin yang diukur pada saat masuk dan keluar rumah sakit. Pasien stroke iskemik yang mendapat terapi sitikolin memiliki peluang perbaikan fungsi neurologis sebesar 1,34 kali (CI 95% 1,058-1,658) dibanding pasien yang tidak mendapat terapi sitikolin setelah dikontrol variabel neurorestorasi. Peluang perbaikan kemampuan fungsional pasien stroke iskemik yang mendapat terapi sitikolin sama dengan pasien yang tidak mendapat sitikolin setelah dikontrol dengan neurorestorasi dengan relative risk 1,07 (CI95% 0,879-1,293; p=0,53).

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ABSTRACTCiticoline is the most widely used neuroprotective to repair neurological deficit in ischemic stroke patients, however the effectiveness of citicoline is still controversial and raise arguments against scientific research because it provided heterogeneous results.The objectives of the study are to identify citicoline effect on neurological function improvement using The National Institute of Health Stroke Scale (NIHSS) and functional ability improvement using Barthel Index (BI) in the treatment of ischemic stroke patients at 18 hospitals involved in Indonesia stroke registry. The design of this study is retrospective cohort study using stroke registry data. Improvement of neurological function assessed by changes of NIHSS score >2 and improvement of functional ability assesed by changes of Barthel Index score > 20 as measured at the time of admission and discharge of the hospital.The result shows that the probability of functional neurological improvement on citicoline treatment group is higher than no citicoline treatment group with adjusted RR by neurorestoration is 1,34 (95% CI 1.058 to 1.658, p=0,0014). There is no difference of functional ability improvement between citicoline and no citicoline treatment group, with adjusted RR by neurorestoration is 1.07 (CI95% 0.879 to 1.293; p=0,53)."

"Tujuan PenelitianUntuk mendapatkan data perubahan kadar vitamin C plasma dan faktor-faktor yang berhubungan pasien stroke iskemikTempat PenelitianRuang rawat inap B Rumah Sakit Umum Pusat Nasional Dr. Cipto MangunkusumoDesain PenelitianPenelitian dengan desain cross sectional dilakukan pada 29 pasien stroke iskemik dengan onset kurang dari 48 jam. Pengambilan subyek penelitian dengan Cara consecutive sampling. Pemeriksaan vitamin C dengan metode spektrofotometri. Data yang dikumpulkan meliputi: karakteristik demografi, faktor risiko, pola makan, asupan nutrisi berdasarkan recall I x24 jam, food frequency amount (FFA) dan food record, pemeriksaan antropometri (BB, TB), pemeriksaan klinis dengan National Institutes of Health Stroke Scale (NIHSS)Subyek PenelitianJumlah subyek penelitian 29 orang (22 laki-laki dan 7 perempuan). Rerata usia 60 ± 10,1 tahun. Sebanyak 56,7% mempunyai pola makan kurang. Asupan vitamin C selama observasi di bawah angka yang dianjurkan (55,8 ± 15,4 mg/dL ; 54,2 ± 14,2 mg/dL ; 56,1 ± 15,6 mg/dL ; 53,8 ± 16,7 mgldL) Berdasarkan FFA dan recall terdapat korelasi positif bermakna antara kadar vitamin C plasma dengan asupan vitamin C (r:1,42 - 0,43, p<0,05). Berdasarkan food record terdapat korelasi positif cukup antara kadar vitamin C plasma dengan asupan energi (r--0,33 - 0,35 p>0,05 ), dan asupan protein (r3,32 - 0,35, p>0,05)_ Korelasi positif bermakna antara kadar vitamin C plasma dengan asupan vitamin C (r- 0,39 - 0,43, p<0,05). Kadar vitamin C plasma perokok lebih rendah dibandingkan non perokok. Perubahan kadar "vitamin C plasma tidak berbeda menurut jenis kelamin (p-0,05). Demikian pula kadar kadar vitamin C plasma menurut usia (p > 0,05). Tidak terdapat perubahan bermakna nilai NIHSS ( 9,8 ± 6,9 ; 9,8 ± 7,1 ; 9,5 ± 7,1 ; 9,3 ± 7,6 ). Antara kadar vitamin C plasma dengan nilai NIHSS terdapat korelasi negatif (r 0,28 - -0,34, p>0,05).Hasil PenelitianPenelitian ini menunjukkan terdapat perubahan kadar vitamin C plasma pasien stroke iskemik. Penurunan bermakna kadar vitamin C plasma Mari ke 3 dan 5 terhadap kadar vitamin C plasma hari pertama. Persentase asupan energi, protein, serat dan vitamin C masih di bawah kebutuhan. Terdapat korelasi negatif antara kadar vitamin C plasma dengan nilai NIHSS.

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Objective

To investigate the changes of vitamin C plasma level and associated factors in stroke ischemic paitents.

Place IRNA B, Cipto Mangunkusumo General Hospital, Jakarta

Methods

A cross sectional study was carried out among 29 patient with ischemic stroke of recent onset (< 48 hours). Consecutive sampling method was used to obtain the subject. Plasma vitamin C level was measured using spectrofotometry. Data collected were demographic characteristics include, risk factors, pattern food, nutrition intake using 24 hours recall, FFA and food record food, antropometri assessment, neurology examination using NIHSS.

Result

The subject consist of 29 patients (20 males and 6 females) with mean of age was 60 ± 10,1 years. There were 56,7% have less dietary profile. Vitamin C intake during observation was under recommendation (55,8 ± 15,4 mg/di. ; 54,2 + 14,2 mg/dL ; 56,1 ± 15,6 mg/dL ; 53,8 f 16,7 mg/dL). Based on FFA and recall, there was significant positive correlation between vitamin C plasma level with intake of vitamin C (r = 0,42 - 0,43 p<0,05). Based on record, there was positive correlation between the level of vitamin C plasma level with energy intake (r = 0,33 - 0,35 p50,05 ), and protein intake (r=0,32 - 0,35 p>0,05). There was significant correlation between level of vitamin C plasma with vitamin C intake (r=0,39 - 0,43, p<0,05) The plasma vitamin C Ievel of smoker lower than non smoker patients. There was no relationship between vitamin C plasma level and sex (p>0,05), age (p>0,05). During the observation there were no significant difference in score of NIHSS (9,8 ± 6,9 ; 9,8 ± 7,1 ; 9,5 ± 7,1 ; 9,3 ± 7,6 ). There was negative correlation between the level of vitamin C plasma and NIHSS score, as follows (r = -0,28 - -0,34, p>0,05).

Conclusion

This study showed that there were changes in the level of the vitamin C plasma of ischemic stroke patient. There was significant decrease in plasma vitamin C level between the third and fourth days and at admission The percentage of energy, protein, fiber and vitamin C intake under the recommendation. There was negative correlation between NIHSS and vitamin C plasma level."

"LATAR EELAKANGKejadian stroke menimbulkan kerusakan sel otak. Berbagai faktor risiko telah dikenal meliputi faktor risiko mayor dan minor. Kadar magnesium endogen sebagai salah satu faktor risiko kerusakan set otak masih belum banyak dianalisa dengan berbagai hasil penelitian yang masih kontroversial.METODEPenelitian ini merupakan penelitian prospektif longitudinal (retreated measurement design) dengan data printer diperoleh dari penderita stroke iskemik yang berobat ke RSCM yang memenuhi kriteria inklusi dan eksklusi. Diagnosis stroke iskemik dilakukan melalui pemeriksaan klinis dan CT Scan atau MRI kepala. Dilakukan pemeriksaan laboratorium darah, analisa urin, EKG, dan foto thoraks pada saat masuk. Dilakukan pemeriksaan magnesium serum, plasma, eritrosit pada hari ke-2, ke-4 dan ke-7 dan skor NIHSS pada hari dan saat yang sama.HASILJumlah objek penelitian 53 orang. Sebagian besar rerata magnesium serum dan plasma dalam batas normal (1,4-2,0 mmEq/l) pada tiap hari pengambilan (Mg serum 67,9% - 90,6%, Mg plasma 75-5% - 88,7%) sedangkan ditemukan hipoMg eritrosit pada hari ke-4 dan ke-7 onset stroke (81,1 % dan 73,6%). Ditemukan hubungan sangat bermakna antara Mg serum dengan Mg plasma pada tiap hari pengambilan (p=0,000) dan hubungan bermakna antara Mg serum dengan Mg eritrosit (p=0,02) dan Mg plasma dan Mg eritrosit (p=0,033) pada hari ke-4. Ditemukan hubungan bermakna independen antara Mg plasma hari ke-4 dengan NIHSS hari ke-4 (p=0,005) di samping faktor risiko riwayat stroke /TIA, aritmia jantung dan hiperkoleslerolemia dengan NIHSS.KESIMPULANPenderita iskemik serebral menunjukkan perubahan kadar Mg serum, plasma, eritrosit yang dipengaruhi berbagai faktor risiko lain dan hubungan bermakna antara kadar Mg plasma dan skor NIHSS hari ke-4.KATA KUNCI: Stroke iskemik, hipertensi, magnesium serum, plasma, eritrosit, NIHSS.

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PREFACE

Stroke causes damage to brain cells. Many risk factors of stroke are known like mayor and minor risk factors. Endogen magnesium level as one of risk factor of brain cell damage is analyzed rarely with the controversially results of its studies.

METHOD

The design of this study was repeated measurement with its primary data were collected from ischemic stroke patients in Cipto Mangunkusumo hospital who fulfilled inclusion and exclusion criteria. Diagnosis of stroke was made by physical exam, CT scan or head MRI and completed by blood and urine analysis, echocardiography and chest photo. Serum, plasma and erythrocyte Mg were collected on the 2nd, 4th, aid 7th days after onset and compared with NIHSS scores at the same times.

RESULT

There are 53 persons of subjects studied. Almost all means of the serum Mg and plasma Mg were in normal limits (1,4-2,0 mEq/l) on every days of data collection (serum Mg : 67,6%-90,6%, plasma Mg : 75,5%-88,7%), but there were erythrocyte hipoMg on the 4th and 7th days of stroke onset (81,1% and 73,6%). There were very significant relationship between serum Mg with plasma Mg (p=0,000) on every days of data collection and significant relationship between serum Mg with erythrocyte Mg (p=0,02) and plasma Mg with erythrocyte Mg (p 1,033) on the 4th day onset. There were significant independent relationship between plasma Mg on the 4th day onset with NIHSS in the same day (p=0,005), besides between the history of stroke/TIA, aritmia and hypercholesterolemia with NIHSS.

CONCLUSION

Cerebral ischemic patients showed changes of serum, plasma and erythrocyte Mg levels which were influenced by other risk factors and there was significant relationship between plasma Mg and NIHSS score in the 4th day."

"Faktor yang sangat penting pada tahap awal perawatan pada pasien stroke berat fase akut adalah mengetahui kondisi pasien sedini mungkin untuk mencegah komplikasi yang lebih parah dan kematian, oleh sebab itu diperlukan suatu metode pengkajian fokus sistem syaraf yang lengkap dan akurat seperti metode NIHSS dan ESS. Hasil penelitian terdahulu menunjukkan keakuratan kedua metode ini hampir sama untuk melihat kondisi pasien stroke fase akut.Penelitian ini bertujuan mengidentifikasi efektifitas pengkajian metode NIHSS dan ESS dalam membuat diagnosa keperawatan aktual pada pasien stroke berat fase akut di RSUP Fatmawati Jakarta. Penelitian ini menggunakan desain pra-eksperimen "Postest only design" sering juga disebut "The one shot case study". Besarnya sampel menggunakan teknik "Non Random jenis Purposive Sampling" sehingga didapat 18 responden yang merupakan total sampel yaitu pasien yang dipilih sesuai kriteria inklusi. Kemudian dilakukan analisis dengan α = 0,05 menunjukkan hubungan sangat kuat (r = 0,904 ) berpola positif pada nilai NIHSS dan berpola negatif ( r = -0,912 ) dan p value =1.000.Penelitian ini menyimpulkan tidak ada perbedaan efektifitas penggunaan metode NIHSS dan ESS terhadap pembuatan diagnosa keperawatan yang aktual pada pasien stroke berat fase akut. Hal ini terjadi karena komponen pemeriksaan pada NIHSS juga terdapat pada ESS. Oleh sebab itu sebagai seorang perawat di ruang unit stroke sangatlah penting untuk menguasai pengkajian metode ini dalam rangka meningkatkan mutu asuhan keperawatan sehingga mempercepat proses penyembuhan pasien.

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The most important factor on early stage of caring patient with severe stroke is identifying patient condition as early as possible to prevent serious complication and death. Therefore, it is important to have assessment method that is focused on neurology system, comprehensive and accurate like NIHSS and ESS assessment method. The previous study shows that both NIHSS and ESS methods are effective to distinguish acute phase severe stroke`s patient.The goal of this study is to identify the effect of NIHSS and ESS assessment method on the developing actual nursing diagnosis on the acute phase severe stroke`s patient in Fatmawati Hospital Jakarta. This study uses experiment with post-test only design which is commonly called as the one shot case study. Non-random purposive sampling is the sampling method that is used in this study. Based on the inclusive criteria eighteen respondents were identified as samples in this study. The data analysis using α = 0,05 shows the strong positive relationship (r = 0,904) for NIHSS assessment value and negative pattern (r = -0,912) for ESS assessment value with the p value = 1.000.There is no significant different the effect of using NIHSS and ESS methods on developing actual nursing diagnosis on the acute phse severe stroke`s patient. This possibly happens since some of assessment components of NIHSS are the same with ESS assessment method. Therefore, it is important for the nurses to be able to use both assessment methods in order to improve the quality of nursing care and shorten the recovery process of the patient."