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Abstrak :
Latar belakang: Beberapa studi telah melaporkan bahwa banyak pasien stroke berat mengalami sepsis selama fase akut, hal ini berpengaruh pada luaran yang buruk. Pada stroke, terjadi pergeseran dari predominasi limfosit Th1 yang memiliki karakter proinflamasi menjadi predominasi limfosit Th2 yang dapat mengaktifasi respon antiinflamasi yang dapat berakibat pada menurunnya respon imun terhadap invasi patogen. Tujuan: Penelitian ini bertujuan menilai apakah rasio netrofil terhdap limfosit (RNTL) dapat memprediksi berkembangnya kejadian sepsis pada pasien stroke akut. Metode: melakukan penilaian pada pasien stroke akut yang dirawat di Unit Perawatan Intensif (UPI) RSUP Fatmawati sejak September 2019 sampai Mei 2020. Hasil: Rata–rata RNTL pada pasien stroke akut selama perawatan di UPI 16,8 ± 12,5. Dilakukan uji Mann–Whitney, didapatkan mean rank dari beberapa parameter RNTL seperti RNTL awal, RNTL hari ke–3 , RNTL tertinggi, dan delta RNTL (dRNTL) pada pasien stroke akut di UPI berkaitan dengan kejadian sepsis. Terdapat perbedaan nilai median pada RNTL hari ke–3, RNTL tertingggi, dan dRNTL pada kelompok stroke yang mengalami sepsis dengan kelompok stroke yang tidak mengalami sepsis. Kesimpulan: RNTL diperkirakan dapat menjadi penanda awal yang potensial terjadinya sepsis pada stroke akut, sehingga dapat menghindari keterlambatan diagnosa dan tatalaksana sepsis pasa pasien stroke sakit kritis. ......BACKGROUND: Several studies have reported that many severe stroke patients developed sepsis during their acute phase, which leads to poor outcomes. In stroke, there is a shift from predominant Th1 lymphocytes, which have proinflammatory characteristics, to predominant Th2 lymphocytes which activate anti-inflammatory responses that induce hyporesponsiveness of the immune system against an invasion of pathogen, known as stroke-induced immunodepression syndrome. AIM: This study aims to examine whether the neutrophils-to-lymphocytes ratio (NLR) could predict the development of sepsis in acute stroke patients. METHODS: Patients were admitted to Fatmawati hospital intensive care unit from September 2019 to May 2020. RESULTS: The mean NLR of acute stroke patients during their stay in ICU was 16.8 ± 12.5. We performed Mann– Whitney test, which revealed that the mean rank of several NLR parameters, such as initial NLR, day-3 NLR, highest NLR, and dNLR in stroke patients at ICU, was associated with the incidence of sepsis. The median difference in day-3 NLR, highest NLR, and dNLR in the stroke group with sepsis differed from those of the non-sepsis group. CONCLUSION: NLR is assumed to have potential as an early predictor to distinguish septic conditions from non- septic conditions, to prevent delay in establishing diagnosis and management of sepsis, especially in acute, critically- ill stroke patients.

Abstrak :
Pengembangan humanisme sebagai inti profesionalisme diperlukan karena dokter profesional masa kini dituntut melakukan pelayanan berpusat pada pasien dan mengesampingkan kepentingan pribadi. Pengembangan humanisme dipengaruhi persepsi mahasiswa terhadap lingkungan pembelajaran terutama di klinik. Meskipun demikian, belum ada instrumen untuk menilai hal tersebut. Tujuan penelitian ini adalah menyusun instrumen penilaian iklim humanis lingkungan pembelajaran klinis. Penelitian ini menggunakan desain sequential exploratory mixed method dan dilakukan di Rumah Sakit dr. Cipto Mangunkusumo (RSCM) pada bulan Januari – Desember 2019. Penelitian dilakukan dalam empat tahap yaitu penyusunan instrumen, uji coba, penyusunan model iklim humanis lingkungan pembelajaran klinis dan implementasi. Tahapan penyusunan instrumen dimulai dengan sintesis konsep iklim humanis lingkungan pembelajaran klinis melalui telaah pustaka, focus group discussion dan wawancara mendalam. Dari penyusunan tersebut diperoleh konsep yang dijadikan rujukan draf instrumen Humanistic Climate Measure (H-CliM) yang terdiri atas 89 butir pertanyaan; 7 domain. Tahap kedua, dilakukan uji coba H-CliM bersama instrumen untuk menilai kompetensi humanisme Integrity Compassion Altruism Respect Empathy (ICARE). Kedua instrumen terbukti valid (r > 0,3) dan reliabel (α-cronbach > 0,7). Dilakukan analisis faktor untuk memvalidasi konstruk dan menghasilkan instrumen H-CliM final (46 butir pertanyaan; 4 domain) serta ICARE final (15 butir pertanyaan; 2 domain). Analisis receiver operating characteristic (ROC) menghasilkan titik potong ≥ 184,5 artinya, skor H-CliM ≥ 184,5 tergolong humanis. Analisis regresi logistik menghasilkan model iklim humanis yang 62% dapat menjelaskan variasi iklim humanis (R2 = 0,62). Model tersebut adalah: Logit P (iklim humanis) = 0,782 (rotasi klinis non-bedah) + 0,048 (kurikulum formal dan informal terkait humanisme) – 0,213 (hidden curriculum) + 0,036 (relasi dan fasilitas yang mendukung humanisme) + 0,044 (pengembangan kepribadian dan profesionalisme) + 0,409 (perempuan) + e. Penelitian ini berhasil mengembangkan instrumen penilaian iklim humanis yang valid dan reliabel yaitu instrumen H-CliM (α-Cronbach = 0,86). Lingkungan pembelajaran non-bedah 2 kali lebih humanis dibanding bedah (p = 0,0001). Persepsi terhadap iklim humanis lingkungan pembelajaran klinis berkorelasi lemah dengan capaian kompetensi humanisme. ......The development of humanism as the core of professionalism is crucial, seeing that professional doctors today are expected to carry through patient-centered services and put aside their personal interests. In clinical setting, cultivating humanism is highly influenced by students 'perceptions on clinical learning climate, therefore, it is necessary to assess that perception. However, to date there is no instrument to assess clinical learning climate. The purpose of this study is to develop an instrument to assess humanistic learning climate. This study utilizes a sequential exploratory mixed method design and is conducted at the Cipto Mangunkusumo hospital (RSCM) in January - December 2019. The research was conducted in four stages, which are the preparation of instruments, trials, development of humanistic climate models of clinical learning environments and implementation of the instrument. The stages of instrument preparation begin with the synthesis of concept of the humanistic clinical learning climate through literature review, focus group discussions and in-depth interviews. Afterward, the concept that was obtained utilized as a reference for drafting instrument of Humanistic Climate Measure (H-CliM) consisting of 89 questions; 7 domains. The second stage, an H-CliM trial was carried out along with instruments to assess the competence of the Integrity Compassion Altruism Respect Empathy (ICARE). Both instruments proved to be valid (r > 0.3) and reliable (α-Cronbach > 0.7). Factor analysis was carried out to validate the construct and produce the final H-CliM instrument (46 questions; 4 domains) and the final ICARE (15 questions; 2 domains). Receiver operating characteristic (ROC) analysis resulted in cut-off point of 184.5, which means that the H-CliM score ≥ 184.5 was classified as humanistic climate. Humanistic climate models obtained from the logistic regression analysis could explain 62% of variation of humanistic climate (R2= 0,62). The model is: Logit P (humanistic climate) = 0.782 (non-surgical clinical rotation) + 0.048 (formal and informal curriculum related to humanism) - 0.213 (hidden curriculum) + 0.036 (relationship and facilities that support humanism) + 0.044 (personality development and professionalism) + 0,409 (female) + e. This research succeeded in developing a valid and reliable humanistic climate assessment instrument, the H-CliM instrument (α-Cronbach = 0,86). Compare with surgical rotation, the non-surgical learning environment is twice more humanistic (p = 0.0001). Perceptions of the humanistic climate of the clinical learning environment are weakly correlated with the achievement of humanism competencies.