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"Infeksi terkait perawatan rumah sakit, dalam hal ini Infeksi Aliran Darah (IAD), merupakan masalah serius yang masih sering dijumpai. Salah satu strategi efektif untuk mengatasi hal ini adalah praktik cuci tangan sesuai rekomendasi WHO, namun sampai saat ini angka kepatuhan cuci tangan tenaga kesehatan masih saja belum optimal dilakukan karena berbagai faktor. Tujuan: Mengetahui hubungan kepatuhan cuci tangan tenaga kesehatan terhadap angka kejadian IAD di unit neonatal sebelum dan setelah edukasi. Metode: Penelitian potong lintang yang dilakukan di RSUPN Dr. Cipto Mangunkusumo (RSCM) dengan mengumpulkan data secara retrospektif dari Pencegahan dan Pengendalian Infeksi Rumah Sakit (PPIRS), yaitu laporan audit angka kepatuhan cuci tangan dan kejadian IAD di unit neonatal selama periode Januari 2011-September 2014, kemudian dilakukan uji korelasi Spearman. Hasil: Kejadian IAD mencapai rerata 9,4%0, dengan angka kepatuhan cuci tangan tenaga kesehatan mencapai rerata 68%.Kepatuhan cuci tangan tenaga kesehatan tertinggi pada perawat (70%), diikuti oleh dokter (57%), sedangkan terendah adalah petugas kebersihan dan laboratorium (22%).Tidak didapatkan hubungan korelasi secara statistik antara kepatuhan cuci tangan tenaga kesehatan terhadap kejadian IAD di unit neonatal sebelum dan setelah edukasi (p>0.05). Kepatuhan tertinggi diantara 5 kesempatan cuci tangan adalah setelah terkena cairan tubuh (84%), dan kepatuhan terendah pada kesempatan setelah kontak dengan lingkungan (46%).Terdapat perbedaan tingkat kepatuhan cuci tangan pada unit perawatan, dimana level 3 terbukti lebih tinggi (71,5%) daripada level 2 (69,1%). Simpulan: Tidak didapatkan hubungan yang bermakna secara statistik antara kepatuhan cuci tangan petugas kesehatan di unit neonatal terhadap kejadian IAD sebelum dan setelah edukasi. Secara angka absolut didapatkan penurunan IAD pada peningkatan kepatuhan cuci tangan.

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Healthcare-associated infection (HAI)- bloodstream infection (BSI) remains a serious problem that is often encountered. One of the most effective and simple practice strategy recommended by WHO to reduce HAI-BSI rate is hand hygiene in health care. Unfortunately, hand hygiene compliance of medical staff vary considerably among health centers because of multifactorial.

Objective. To analyse the correlation between hand hygiene compliance and bloodstream infection case in neonatal unit RSCM before and after hand hygiene edeucation.

Methods. Cross sectional study design was used. Hand hygiene compliance and bloodstream infection data was collected retrospectively from prevention and control infection hospital database during January 2011-September 2014. Spearman correlation test was performed to assess it.

Results. Bloodstream infection insidens rate is 9,4%0 and average of hand hygiene compliance in neonatal unit is 68%. The highest hand hygiene compliance is nurses (70%), and doctors (57%), the lowest hand hygiene compliance is laboran and cleaning services (20%). Hand hygiene practice in 5 moments was performed most often after body fluid expossure risk (84%) and the lowest is after touching patient surroundings (46%).There is no signifficant stastical correlation between hand hygiene compliance and bloodstream infection case in neonatal unit RSCM (p>0.05). The hand hygiene compliance in 3rd level(71,5%) is higher than 2nd level (69,1%).

Conclusion. There are no signifficant correlation between hand hygiene compliance and bloodstream infection, including before and after the hand hygiene educational programs in neonatal unit. Basically, there is a decline of bloodstream infection rates inthe increasedof hand hygiene compliance."

"The aim of this paper it to review various scale approaches to the blood flow modelling. Blood motion may be described by three types of mathematical models according to the observed scales or resolutions,namely microscopic,mesoscopic and macroscopic descriptions. The above approaches are discussed together with their advantages and disadvantages. Several results of mesoscopic simulations are presented with particular attention paid to mesoscale semi continuum models suitable for real time blood flow visualisation."

"ABSTRACTAcute lower urinary pathway obstruction is accompanied by renal blood flow alteration and vasoconstriction. The vasoconstriction rate (VCR) provides a morphological tool for measuring the degree of vasoconstriction. The present study consisted of two parts: animal experiments and autopsy case examinations. The experimental work focused on the VCR in the renal arterial system of rabbits with complete unilateral ureteral ligation. At 6 hours after unilateral ureteral obstruction (UUO) in the rabbits, the VCR in the renal and arcuate arteries increased above normal, whereas the interlobular artery VCR remained unchanged. The non-obstructed kidney did not show any significant change in VCR. Blood flow measurements were performed after various time intervals: 15 min, 90 min, and 6 hours. The mal blood flow during UUO in the rabbits increased within minutes after ligation, peaking at 15 min and gradually decreased thereafter. At 6 hours after complete ligation of the ureter, the blood flow of the kidney was 64.6% of baseline. The contra lateral kidney blood flow decreased 13.6%. The glomerulli of the rabbits exhibited ischemic changes characterized by separation of the capillary lobules and shrinkage towards the vascular pole, eventually causing a fairly distended Bowman's space. At 6 hours, electron microscopic examinations revealed focal destruction of the intracellular reticulum with electron dense granule deposition in the tubeles. The non-obstructed kidney showed no changes in morphology from among about 2000 autopsy cases accumulated in 1977-1985 at the Department of Pathology, Nihon University School of Medicine, 5 cases were selected on the basis of clinical and pathological scrutinization to assess how renal arterial vasoconstriction might implicate the kidney in the presence of ureter obstruction as a result, it was found that the renal arterial system experienced vasoconstriction during the presence of lower ureteral obstruction, paralleling the procedure of direct stoppage of urinary flow."

"ABSTRAK Latar Belakang: Skor kualitas hidup yang rendah pada pasien hemodialisis (HD) dikatakan berhubungan dengan peningkatan risiko mortalitas. Namun, belum ada penelitian yang melaporkan hubungan langsung antara laju aliran darah (Qb) dan skor kualitas hidup pada pasien HD dua kali seminggu.Tujuan: Mengetahui hubungan antara laju aliran darah (Qb) dengan skor kualitas hidup pada pasien-pasien yang menjalani hemodialisis kronik dua kali seminggu.Metode: Penelitian potong-lintang ini dilakukan di Unit Hemodialisis di Rumah Sakit Cipto Mangunkusumo, Jakarta. Pasien dengan gangguan fungsi luhur, chronic heart failure NYHA (New York Heart Association) kelas III-IV, buta, imobilisasi ketergantungan berat serta menolak ikut penelitian tidak diikutsertakan dalam penelitian. Pasien kemudian dibagi menjadi grup 1 (Qb > 250 ml/menit) dan grup 2 (Qb ≤ 250 ml/menit). Skor kualitas hidup dinilai menggunakan kuesioner KDQOL-SFTM, yang dibagi dalam skor fisik (PCS), mental (MCS) dan masalah terkait penyakit ginjal (KDCS). Hubungan antara Qb dan skor kualitas hidup dianalisis menggunakan metode chi-square serta regresi logistik untuk mendapatkan nilai rasio prevalensi (RP) yang adjusted.Hasil: Sebanyak 132 pasien dimasukkan kedalam analisis penelitian. Nilai Qb digrup 1 memiliki hubungan dengan skor PCS ≥ 44 (RP 1,86; IK 95% 1,15-2,99), serta skor KDCS ≥ 52 (RP 1,41; IK 95% 1,03-1,92). Setelah analisis multivariat, nilai Qb digrup 1 masih berhubungann dengan skor PCS ≥ 44 (RP adjusted 1,87; IK 95% 1,15-2,51) dan skor KDCS ≥ 52 (RP adjusted 1,31; IK 95% 1,004-1,50).Simpulan: Nilai Qb > 250 ml/menit memiliki hubungan yang signifikan dalam kualitas hidup fisik dan masalah terkait penyakit ginjal yang lebih baik pada pasien hemodialisis 2 kali seminggu.

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ABSTRACT

Background. A low quality of life (QoL) score in hemodialysis (HD) patients was related to increased risk of mortality. However, there was no study reported the direct relationship between BFR and QoL in twice-weekly HD patients.

Objectives. To determine the relationship between blood flow rate and quality of life in twice-weekly hemodialysis patients.

Methods. This cross-sectional study was conducted at the Hemodialysis Unit in Cipto Mangunkusumo Hospital, Jakarta. Patients with neurocognitive impairment, chronic heart failure NYHA (New York Heart Association) class III-IV, blindness, immobilization with severe dependence and refused to participate were excluded in the study. Patients were divided into group 1 (BFR > 250 ml/min) dan group 2 (BFR ≤ 250 ml/min). The QoL was assessed using KDQOL-SFTM questionnaire, which was divided in physical (PCS), mental (MCS) and kidney disease-related (KDCS) scores. Relationship between BFR and QoL scores were analyzed using chi-square and logistic regression methods in order to determine adjusted Prevalence Ratio (PR).

Results. A total of 132 patients were included in the analysis. The BFR in group 1 was associated with PCS scores ≥ 44 (PR 1.86; 95% CI 1.15-2.99), as well as KDCS scores ≥ 52 (PR 1.41; 95% CI 1.03-1.92). After multivariate analysis, BFR values ​​of patients in group 1 were still associated with PCS scores ≥ 44 (adjusted PR 1.87; 95% CI 1.15-2.51) and KDCS scores ≥ 52 (adjusted PR 1.31; 95% CI 1.004-1.50).

Conclusion. The BFR values > 250 ml/min had a significant relationship for better physical and kidney disease-related quality of life in twice-weekly HD patients."

"Hemodialisis merupakan tatalaksana renal replacement yang tersering pada pasien gagal ginjal kronik stadium 5, Akses vaskular dan morbiditas sebagai akibat komplikasi akses merupakan penyebab utama perawatan di rumah sakit. Pada tahun 1989 sampai sekarang posisi tip pada pemasangan kateter double lumen masih belum ada keseragaman. Inti dari perbedaan ini adalah kepentingan terhadap keselamatan pasien dan keinginan untuk kinerja kateter yang optimal dalam hal ini untuk akses hemodialisa yang adekuat. Rancangan penelitian adalah sebuah penelitian prospektif potong lintang terhadap pasien gagal ginjal yang menjalani hemodialisa dengan menggunakan CDL tunneling. Penelitian ini merupakan penelitian analitikkorelatif, mencari korelasi antara posisi tip CDL tunneling dengan lancar atau tidak lancarnya selang CDL dan kekuatan tarikan quick blood saat hemodialisa. Hasil yang didapatkan posisi rontgen thorax CAJ lebih memberikan kenyamanan pada pasien dibandingkan dengan posisiSVC. Uji statistic menunjukkan bahwa terdapat hubungan yang signifikan antara Ro Thorax dengan kenyamanan (p<0.05). Posisi tip di SVC memiliki blood flow <300 mL. sedangkan pada pasien dengan posisi tip di CAJ memiliki blood flow >300 mL. Uji statistic menunjukkan hubungan yang tidak signifikan antara ro thorax dengan blood flow (p>0.05).

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Hemodialysis is the most common procedure of renal replacement in patients with stage 5 chronic renal failure, vascular access complications and morbidity as a result of access is a major cause of hospitalization. In 1989 to the present position of the tip of double lumen catheter is still no uniformity. The core of this difference is of interest to patient safety and the desire for optimal performance in terms of catheters for hemodialysis access adequate. The study design was a prospective cross-sectional study of patients with renal failure undergoing hemodialysis using tunneling CDL. This research is a correlative analytic, looking for a correlation between the position of the tunneling tip CDL smoothly or not smooth hose pull quick CDL and force of blood when hemodialysis. The results obtained CAJ thorax X-ray positioning more comfortable for patients compared to the SVC. Statistical test shows that there is a significant relationship between Ro Thorax with comfort (p <0.05). Position tip at SVC have blood flow <300 mL. whereas in patients with tip position in the CAJ have blood flow> 300 mL. Statistical tests showed no significant association between ro thorax with blood flow (p> 0.05).

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"Addresses external biofluiddynamics concerning animal locomotion through surrounding fluid media - and internal biofluiddynamics concerning heat and mass transport by fluid flow systems within an animal."

"Latar Belakang : Hemodialisis merupakan terapi pengganti ginjal yang paling banyak digunakan di dunia. Fistula Arteriovenosa (FAV) merupakan pilihan akses vaskular terbaik bagi penderita Penyakit Ginjal Tahap Akhir (PGTA) yang menjalani hemodialisis. Akan tetapi, kegagalan maturasi FAV masihrelatif tinggi akibat gangguan dari înflow dan/atau outflow. Pengukuran peningkatan Blood Flow Rate (BFR) dan Peak Systolic Velocity (PSV) intraoperasi pada arteri brakialis diharapkan dapat mengidentifikasi masalah inflow sekaligus outflow sebagai penyebab kegagalan maturasi FAV.Tujuan : Mengetahui hubungan peningkatan BFR dan PSV arteri brakialis intraoperasi serta nilai batasannya yang dapat dijadikan prediktor maturasi FAV Brakiosefalika.Subjek dan Metode : PGTA yang menjalani operasi FAV brakiosefalika di lima Rumah Sakit (RSCM, RSUP Fatmawati, RSUD Kab. Tangerang, RS Hermina Depok dan RS Hermina Bekasi) pada periode Juli 2019 – Februari 2022. Desain penelitian kohort retrospektif menggunakan data sekunder dari penelitian sebelumnya Data yang diteliti meliputi: usia, jenis kelamin, tekanan darah, merokok, diabetes melitus, dan hasil pengukuran USG doppler berupa diameter arteri brakialis dan vena sefalika preoperasi serta peningkatan BFR dan PSV arteri brakialis intraoperasi, kemudian data subjek dengan FAV brakiosefalika yang mengalami maturasi dalam 6 minggu sesuai kriteria rule of 6 dari NKF-KDOQI. Selanjutnya dilakukan analisa statistik adanya korelasi peningkatan BFR dan PSV arteri brakialis intraoperasi terhadap maturitas FAV brakiosefalika serta ditetapkannya nilai batasan sebagai prediktor maturasi. dengan memakai uji diagnostik grafik Receiver Operator Curve (ROC). Hasil : Dari total 83 subjek yang memenuhi kriteria inklusi dan eksklusi, terdapat 50 (60,24%) subjek yang mengalami maturasi dalam 6 minggu pascaoperasi. Dengan menggunakan analisis multivariat dengan uji regresi logistik, peningkatan BFR arteri brakialis intraoperasi (p<0,001) merupakan faktor yang paling berhubungan dengan maturasi FAV brakiosefalika setelah 6 minggu pascaoperasi dengan nilai batasan 184,58 ml/menit, sensitivitas 100%, spesifisitas 84,8%, Nilai Duga Positif 90,9%, Nilai Duga Negatif 100%, Akurasi 93,98%Kesimpulan : Peningkatan BFR arteri brakialis intraoperasi dapat dipakai sebagai prediktor maturasi FAV brakiosefalika 6 minggu pascaoperasi

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Background : Hemodialysis is the most widely used renal replacement therapy in the world. Arteriovenous fistula (AVF) is the best vascular access option for patients with End Stage Kidney Disease (ESKD) undergoing hemodialysis. However, the AVF maturation failure rate is still high due to inflow and/or outflow problem. Measurement of intraoperative increase in Blood Flow Rate (BFR) and Peak Systolic Velocity (PSV) in the brachial artery is expected to identify inflow and outflow problems as the cause of AVF maturation failure.

Objective: To determine the relationship between intraoperative increase in BFR and PSV of the brachial artery and the cut off point that can be used as a predictor of Brachiocephalic AVF maturation.

Subjects and Methods : ESKD who underwent AVF brachiocephalic surgery in five hospitals (RSCM, Fatmawati Hospital, Tangerang Hospital, Hermina Hospital Depok and Hermina Hospital Bekasi) in the period July 2019 – February 2022. The retrospective cohort study design used secondary data from the study previously. The data studied included: age, sex, blood pressure, smoking, diabetes mellitus, and the results of Doppler ultrasound measurements of preoperative brachial artery and cephalic vein diameters and an increase in intraoperative BFR and PSV brachial artery, then data on subjects with maturation of brachiocephalic AVF within 6 weeks according to the rule of 6 criteria of the NKF-KDOQI. Furthermore, statistical analysis was carried out on the correlation between increased intraoperative brachial artery BFR and PSV on brachiocephalic FAV maturity and the determination of cut off value as a predictor of maturation using the Receiver Operator Curve (ROC) graphic diagnostic test.

Results: From a total of 83 subjects who met the inclusion and exclusion criteria, there were 50 (60.24%) subjects who matured within 6 weeks postoperatively. Using multivariate analysis with logistic regression, the increase in intraoperative brachial artery BFR (p<0.001) was the most associated factor of brachiocephalic FAV maturation after 6 weeks postoperatively with a cut off value of 184.58 ml/min, sensitivity 100%, specificity 84.8%, Positive Predictive Value 90.9%, Negative Predictive Value 100%, Accuracy 93.98%

Conclusion: Increased intraoperative brachial artery BFR can be used as a predictor of brachiocephalic FAV maturation 6 weeks postoperatively."

"Penyakit ginjal tahap akhir (PGTA) merupakan masalah kesehatan masyarakat yang memerlukan terapi pengganti ginjal (TPG) seperti Hemodialisis. Fistula Arteriovenosa (FAV) merupakan pilihan akses vaskular terbaik bagi penderita yang menjalani hemodialisis. Akan tetapi, kegagalan maturasi FAV relatif tinggi akibat gangguan dari înflow dan/atau outflow. Pengukuran peningkatan Blood Flow Rate (BFR) pada arteri brakialis proksimal anastomosis, distal anastomosis dan vena outflow dapat mengidentifikasi penyebab kegagalan maturasi FAV. Penelitian dilakukan di RSCM, RS Hermina Depok dan RS Hermina Bekasi pada periode Februari 2024 – Mei 2024. Desain penelitian kohort prospektif menggunakan data primer meliputi: usia, jenis kelamin, hipertensi, merokok, diabetes melitus, aterosklerosis, riwayat pemasangan catheter double lumen (CDL) dan hasil pengukuran USG doppler berupa diameter arteri brakialis, vena sefalika dan BFR arteri brakialis preoperasi serta BFR arteri brakialis proksimal anastomosis, distal anastomosis dan vena outflow (OV) segera setelah tindakan AVF, hari ke 7, hari ke 14 sampai minggu ke 6. Dari total 45 subjek yang memenuhi kriteria inklusi dan eksklusi, terdapat 36 subjek yang mengalami maturasi dalam 6 minggu pascaoperasi. Dengan analisis multivariat uji t-tidak berpasangan, didapatkan diameter arteri brakialis dan vena sefalika nilai rerata >2,5 mm serta nilai BFR arteri brakialis preoperasi 66,22 ± 22,60 (p<0,001). Didapatkan batasan nilai persentase peningkatan BFR arteri brakialis proksimal 167,23% pada hari ke-7 yang memprediksi  keberhasilan maturitas FAV brakiosefalika setelah 6 minggu pascaoperasi dengan sensitivitas 58,3%, spesifisitas 87,5%, interval kepercayaan 97,3%. Nilai persentase peningkatan OV diatas 186,92% pada hari ke-7 dan diatas 468,0% pada hari ke-14 dapat memprediksi keberhasilan maturitas FAV pada minggu ke-6 dengan sensitifitas dan spesifisistas sebesar 61,1% dan 100% untuk hari ke-7 dan 80,6% dan 100% untuk hari ke-14. Sebagai kesimpulan Peningkatan persentase BFR arteri brakialis proksimal anastomosis dan vein outflow hari ke-7 pasca tindakan FAV dapat dipakai sebagai prediktor maturitas FAV brakiosefalika.

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End-stage kidney disease (ESKD) is a public health problem that requires kEnd-stage kidney disease (ESKD) is a public health problem that requires Kidney replacement therapy (KRT) such as hemodialysis. Arteriovenosa fistula (AVF) is the best vascular access option for patients undergoing hemodialysis. However, AVF maturation failure is relatively high due to interruption of inflow and/or outflow. Measurement of increased Blood Flow Rate (BFR) in the brachial arteries of the proximal anastomosis, distal anastomosis and venous outflow can identify the cause of AVF maturation failure. The study was conducted at Ciptomangunkusumo Hospital, Hermina Depok Hospital and Hermina Bekasi Hospital in the period February 2024 – May 2024. The design of the prospective cohort study using primary data includes: age, gender, hypertension, smoking, diabetes mellitus, atherosclerosis, a history of installation of a double lumen catheter and doppler ultrasound measurements of the diameter brachial artery, cephalic vein and BFR of the preoperative brachialis artery as well as BFR proximal anastomosis, distal anastomosis and outflow vein immediately after the AVF operation, day 7, day 14 to week 6. A total of 45 subjects met the inclusion and exclusion criteria. Of these, 36 had matured within six weeks of the operation. A multivariate analysis of the non-pairing t-test revealed that a percentage increase of 167.23% in brachial artery BFR on the 7th day can predict the successful maturation of brachiocephalic AVF after 6 weeks of postoperative treatment. This model demonstrated a sensitivity of 58.3% and a specificity of 87.5%, with a confidence interval of 97.3%. The percentage value of OV increase above 186.92% on day 7 and above 468.0% on the 14th day can be used to predict the success of AVF maturity on week 6. This approach has a sensitivity and specificity of 61.1% and 100% for day 7th and 806% and 100% for day 14th. As a conclusion Increased percentage of BFR of proximal brachial artery anastomosis and venous outflow on day 7 after AVF can be used as a predictor of brachiocephalic FAV maturity."

"Latar Belakang: Arteriovenous fistula telah menjadi akses hemodialisis yang direkomendasikan. Namun tidak semua arteriovenous fistula dapat digunakan dengan baik, National kidney disease outcome quality initiative (NKDOQI) telah merekomendasikan pasien pascaoperasi arteriovenous fistula untuk melakukan latihan tangan, saat ini belum adanya evaluasi serta bentuk program latihan ekstremitas atas terhadap pasien gagal ginjal dengan diabetes melitus yang telah menjalani arteriovenous fistula radiochepalica di RSCM. Metode: Penelitian ini adalah penelitian kuasi eksperimental yang membandingkan data yang memiliki karakteristik sama, subjek yang menjalani arteriovenous fistula radiochepalica pada rentang waktu Februari 2020 – Februari 2021 telah diikutsertakan. Hasil: 23 subjek yang menjalani operasi arteriovenous fistula radiochepalica dilakukan pengamatan, program latihan dapat meningkatkan ukuran diameter draining vein secara bermakna dengan nilai p = 0,006 pada minggu keenam setelah operasi. Dan secara bermakna dapat meningkatkan blood flow rate di minggu keenam setelah menjalani operasi arteriovenous fistula sebesar 210% dengan rerata 616,56 ± 88,80 mL/menit dengan p = 0,002. Selanjutnya dapat menurunkan jarak draining vein dengan kulit pada minggu keempat (p = 0,015), namun hasil menjadi tidak bermakna pada minggu keenam setelah operasi.Kesimpulan: Program latihan isotonik, isometrik dan restriksi parsial ekstermitas atas pascaoperasi dapat meningkatan diameter draining vein, mempengaruhi jarak draining vein dengan kulit, dan meningkatan blood flow rate arteriovenous fistula radiochepalica.

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Background: Arteriovenous fistulas have become the recommended access for hemodialysis. However, not all arteriovenous fistulas can be functional. National kidney disease outcome quality initiative (NKDOQI) has recommended hand exercises for patients following arteriovenous fistula surgery. To date, there has been no evaluation and exercise program for the upper extremity in diabetic patients with kidney failure who have undergone radiocephalic arteriovenous fistula surgery in RSCM.

Methods: This study had a quasi-experimental design, comparing the data which had the same characteristics. Subjects who underwent radiocephalic arteriovenous fistula surgery in February 2020 to February 2021 were included.

Results: Twenty-three subjects who underwent radiocephalic arteriovenous fistula surgery were observed. The exercise program could increase the diameter of the draining veins significantly (p = 0.006) in the 6th week following the surgery. There was also a significant increase in the rate of blood flow as much as 210% with an average of 616.56 ± 88.80 mL/minute (p = 0.002), observed in the 6th week after the operation. Subsequently, there was a decrease in the draining vein-to-skin distance in the 4th week (p = 0.015), however the result was not significant in the 6th week following the surgery.

Conclusion: The upper extremity isotonic, isometric, and partial restriction exercise program following the surgery could increase the diameter of the draining veins, affect the draining vein-to-skin distance, and increase the rate of blood flow in the radiocephalic arteriovenous fistula."