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Abstrak :
ABSTRAK
Latar Belakang. Gangguan otonom merupakan gejala yang cukup sering dialami oleh pasien Parkinson. Gangguan ini sudah dapat ditemukan sejak awal stadium penyakit. Gangguan otonom meliputi gangguan gastrointestinal, urologi, kardiovaskular, seksual dan termoregulasi. Untuk mendeteksi gangguan otonom dapat digunakan kuesioner SCOPA-AUT (Scale for Outcomes in Parkinson’s Disease for Autonomic Symptoms). Tujuan dari penelitian ini adalah untuk mengetahui gambaran gangguan otonom pada pasien Parkinson di Poliklinik Saraf RSUPN Cipto Mangunkusumo dan RSUPN Fatmawati. Metode. Penelitian dilakukan dengan menggunakan desain potong lintang. Pengumpulan data dilakukan pada bulan April hingga Juni 2012. Hasil. Sebanyak 54 subyek penelitian yang terdiri dari 33 (61,1%) pria dan 21 (38,9 %) wanita diikutsertakan dalam penelitian ini. Pasien Parkinson pada penelitian ini berusia antara 45-79 tahun. Sebagian besar pasien memiliki durasi sakit kurang dari 5 tahun (63%), stadium Hoehn & Yahr 1-2 (63%) dan memakai terapi kombinasi levodopa dengan agonis dopamin (79,6%). Gangguan otonom didapatkan pada seluruh subyek penelitian. Gangguan otonom yang paling sering dialami pasien Parkinson adalah masalah urologi berupa nokturia (79,6%) dan urinary frequency (57,3%), serta masalah gastrointestinal yaitu sialorea (51,9%) dan mengejan kuat saat buang air besar (50%) Tidak ada pasien yang mengalami inkontinensia feses atau jatuh pingsan. Kesimpulan. Seluruh pasien Parkinson pada penelitian ini mengalami gangguan otonom. Telah diketahui proporsi gangguan otonom pada pasien Parkinson di Poliklinik Saraf RSUPN Cipto Mangunkusumo dan RSUPN Fatmawati.

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ABSTRACT
Background. Autonomic symptoms are quite often reported by Parkinson’s disease patients. These symptomps are found already in early stage of disease. Autonomic symptomps comprise gastrointestinal, urinary, cardiovascular, sexual and thermoregulation symptomps. SCOPA-AUT (Scale for Outcomes in Parkinson’s Disease for Autonomic Symptoms) questionnaire can detect autonomic dysfunctions. The purpose of this study is to obtain profile of autonomic symptomps in Parkinson’s disease patients in neurology clinic in RSUPN Cipto Mangunkusumo and RSUPN Fatmawati. Methods: a cross sectional study was conducted between April and June 2012 Results: A total of 54 patients, i.e. 33 (61,1%) man and 21 (38,9 %) woman, were recruited in this study. The age of patients was between 45 and 79 years. Most patients have illness duration less than 5 years (63%), Hoehn & Yahr stage 1-2 (63%) and use combination therapy (levodopa with dopamine agonist) (79,6%). Autonomic symptoms are complained by all patients. Most frequent autonomic symptomps reported by Parkinson’s disease patients are nocturia (79,6%), urinary frequency (57,3%), sialorea (51,9%) and strain hard when pass stools (50%). There are no patients who complained involuntary loss of stools or fainted. Conclusion. All Parkinson’s disease patients in this study reported autonomic symtomps. Autonomic symptomps profile has been known in Parkinson’s disease patients in neurology clinic in RSUPN Cipto Mangunkusumo and RSUPN Fatmawati

Abstrak :
Rumah Sakit Pusat Otak Nasional (RSPON) merupakan RS Pusat Rujukan Nasional yang menangani kasus otak dan persarafan, salah satunya yaitu penanganan pasien Stroke Iskemik Hiperakut dengan terapi trombolisis. Tatalaksana SIHT khususnya dilakukan di Instalasi Gawat Darurat (IGD), dengan mengutamakan pemberian terapi pada golden period, dengan harapan terapi tersebut akan menurunkan skor NIHSS dan mencegah proses kecacatan yang lebih berat. Desain penelitian yang digunakan adalah operational research secara retrospektif, dengan metode kuantitatif dan kualitatif. Data kuantitatif didapatkan dari telaah dokumen rekam medis dengan jumlah sampel 102 rekam medis, sedangkan data kualitatif didapatkan dengan FGD dan wawancara mendalam. Hasil penelitian menunjukan bahwa terapi trombolisis berhasil menurunkan skor NIHSS pasien sebanyak 74,5%. Pada analisis time matriks tatalaksana SIHT, menunjukan bahwa dari data normal (n=84), komponen Door to Ct Scan and Lab initiation, Door to Ct Scan and Lab expertise, serta Door to needle mengalami perlambatan waktu dari target. Keseluruhan variabel independen yang mempengaruhi perubahan skor NIHSS adalah skor NIHSS awal yang merupakan salah satu kriteria inklusi pemberian trombolisis, sedangkan variabel yang secara bermakna bersama-sama mempengaruhi perubahan skor NIHSS yaitu onset time, skor NIHSS awal, door to CT Scan initiation, dan door to CT Scan interpretation. Onset time memiliki pengaruh paling bermakna terhadap perubahan skor NIHSS, hal ini dihubungkan dengan pentingnya edukasi prehospital kepada masyarakat untuk mengenal gejala stroke secara dini. Rekomendasi perbaikan dimulai dari divisi Neurovaskular untuk membuat revisi panduan dan SPO serta Clinical Pathway Trombolisis sesuai Guideline terbaru, sosialisasi dan simulasi algoritma SIHT secara komprehensif melibatkan seluruh unsur, monitoring dan evaluasi berkala tatalaksana SIHT melalui diskusi ilmiah. ......RS Pusat Otak Nasional (RSPON) is national's referral hospital which handles health cases regarding brain and nervous system, one of which is the management of Hyperacute Ischemic Stroke patients using thrombolysis therapy. Hyperacute Ischemic Stroke Thrombolysis (HIST) management at the Emergency Room, focused on patients who arrived during the golden period, in hope that the therapy would be able to decrease the NIHSS score and to prevent more severe impairment to the patients. This research used retrospective operational research design, and qualitative and quantitative methods simultaneously. Quantitative data was gotten from medical records with total 102 medical records used, while the qualitative data was gotten from FGD and in depth interviews. This research found that thrombolysis therapy succeeded in decreasing NIHSS score in 74,5% of patients. HIST time matrix analysis from the normal data (n=84),it's shown that Door to Ct Scan and Lab initiation, Door to Ct Scan and Lab expertise, and Door to needle components were slower than target. The independent variable that effected NIHSS score as dependent variable was pre-therapy NIHSS, while the variables that effected the dependent variable simultaneously were onset time, pre-therapy NIHSS score, door to CT Scan initiation, and door to CT Scan interpretation. Onset time was the most significant factor to NIHSS' score change, this is mostly related to the importance of pre-hospital education for people to make them know the early symptoms of stroke. Recommendation offered is started from Neurovascular division to update thrombolysis' regulation, SOP, and Clinical Pathway according to the newest guideline, to disseminate and simulate the HIST algorithm comprehensively and to monitor and evaluate HIST management through discussion.

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Clinical Pathway (CP) merupakan perangkat alat multidisiplin ilmu yang digunakan untuk perawatan kesehatan berbasis bukti (evidence based). CP memiliki fungsi menyeragamkan terapi sehingga mampu meminimalkan komplikasi dan kesalahan pengobatan. Rumah Sakit Pusat Otak Nasional (RS PON) merupakan rumah sakit rujukan otak dan persarafan nasional. Stroke perdarahan menjadi penyakit kedua tertinggi di RS.PON. Keberagaman keputusan dilakukannya operasi atau tidak, meskipun sudah masuk indikasi, menjadi poin penting untuk menganalisis implementasi pelaksanaan Clinical Pathway ini. Tujuan penelitian: menilai implementasi CP stroke perdarahan yang telah dijalankan sehingga diharapkan mampu menjadi dasar penentu kebijakan rumah sakit jejaring maupun rumah sakit seluruh Indonesia. Menilai hubungan antara variabel-variabel dalam clinical pathway terhadap Length of Stay (LOS), morbiditas dan mortalitas Metode: ​​Penelitian ini menggunakan metode mixed method, dengan pendekatan retrospektif. Dalam penelitian kuantitatif dilakukan analisis univariat dan multivariat, dimana menggunakan data sekunder dari rekam medis pasien stroke perdarahan yang dirawat di RS PON pada januari 2020 - Desember 2021. Dari total populasi 1254 pasien setelah dilakukan kriteria inklusi dan inklusi didapatkan 1001 pasien. Penelitian kuantitatif, dilakukan dengan menganalisis pengaruh implementasi CP terhadap lama hari rawat, morbiditas (nilai NIHSS) dan mortalitas. Faktor risiko dan efek atau penyakit yang terjadi di masa lampau diukur melalui catatan historis. Sementara pengumpulan data secara kualitatif menggunakan kuisioner dan wawancara secara mendalam kepada Kepala Bidang Pelayanan Medis, Kepala Komite Medis, Kepala Komite Keperawatan, Kepala Divisi Vaskular, Dokter Spesialis Neurologi, Dokter Spesialis Bedah Saraf, Dokter IGD, Perawat, Fisioterapi, Terapi wicara, Gizi dan Farmasi untuk mengetahui tahapan proses Clinical Pathway di RS PON. Total responden 129 orang. Penelitian kualitatif menilai pengetahuan tenaga medis dan paramedis terkait CP, implementasi, supervisi, monitoring dan evaluasi. Hasil: penelitian kuantitatif menemukan adanya hubungan antara beberapa variabel yang berada dalam CP, seperti pemeriksaan penunjang, terapi sesuai indikasi dan penyakit komorbid terhadap LOS, morbiditas dan mortalitas. Sementara pada penelitian kualitatif menilai implementasi CP di RS PON memerlukan perbaikan dari segi sosialisasi, implementasi, monitoring dan evaluasi. ......Clinical Pathway is a multidisciplinary toolkit used for evidence-based health care. The Clinical Pathway has the function to unify the therapy so as to minimize complications and medication errors. The National Brain Center Hospital (PON Hospital) is a national brain and nervous referral hospital. Hemorrhagic stroke is the second-highest disease in PON Hospital. The diversity of decisions to have surgery or not, even though it is indicated, is an important point to analyze the implementation of this Clinical Pathway. Objective: to evaluate the implementation of CP bleeding stroke that has been carried out so that it is expected to be the basis for determining policy for network hospitals and hospitals throughout Indonesia. Assessing the relationship between variables in clinical pathways on Length of Stay (LOS), morbidity, and mortality Methods: This study uses a mixed-method, with a retrospective approach. In this quantitative study, univariate and multivariate analyzes were carried out, which used secondary data from the medical records of hemorrhagic stroke patients treated at the PON Hospital in 2020-2021. From the total population of 1254 patients, after the inclusion and inclusion criteria were carried out, there were 1001 patients. Quantitative research was conducted by analyzing the effect of Clinical Pathway implementation on length of stay, morbidity (NIHSS value), and mortality. `Risk factors and effects or diseases that occurred in the past are measured through historical records. Meanwhile, qualitative data collection used in-depth interviews with the Head of Medical Services, Head of the Medical Committee, Head of Nursing, Head of the Vascular Division, Neurology Specialist, Neurosurgeon Specialist, Emergency Room Doctor, Nurse, Farmation, physiotherapist, speech therapist, nutritionist to find out the stages of the Clinical Pathway process at the PON Hospital. The total number of respondents are 129 people. Qualitative research assesses the knowledge of medical and paramedical personnel related to CP, implementation, supervision, monitoring, and evaluation. Result: Quantitative research found a relationship between several variables in CP, such as investigations, therapy, and comorbid with LOS, morbidity, and mortality. Meanwhile, qualitative research showed that the implementation of CP in the PON Hospital was still unsatisfactory in terms of socialization, implementation, monitoring and evaluation. Conclusion: Implementation of CP is associated with clinical outcomes of hemorrhagic stroke patients.

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ABSTRAK
Latar Belakang. Sekitar 75% perawat di rumah sakit menjalani kerja gilir. Salah satu dampak negatif akibat kerja gilir jangka panjang adalah gangguan fungsi kognitif. Mekanisme yang menjelaskan gangguan fungsi kognitif adalah gangguan tidur kronik, desinkronisasi irama sirkadian dan stress kerja. Pengetahuan mengenai fungsi kognitif pada perawat gilir merupakan hal yang penting karena akan mempengaruhi produktivitas kerja perawat.

Metode. Desain penelitian berupa studi potong lintang. Subyek penelitian adalah perawat gilir di IGD, ICU dan bangsal gedung A RSCM yang memenuhi kriteria inklusi dan eksklusi. Subyek diperoleh secara konsekutif proporsional. Pada subyek dilakukan wawancara, pengisian kuesioner, pemeriksaan fisik dan fungsi kognitif. Pemeriksaan fungsi kognitif dilakukan minimal dua malam setelah gilir malam terakhir. Dilakukan analisis data menggunakan perangkat SPSS 17.0.

Hasil. Diperoleh 36 subyek perawat gilir di masing – masing unit kerja. Prevalensi gangguan kognitif pada perawat gilir berdasarkan MoCA-Ina adalah 14,8%. Proporsi gangguan fungsi kognitif terbanyak terdapat pada perawat IGD (50,0%) diikuti oleh bangsal gedung A (31,2%) dan ICU (18,8%). Pada domain fungsi kognitif rerata tertinggi terdapat pada perawat ICU, kecuali pada domain visuospasial terdapat pada perawat bangsal, sedangkan pada domain orientasi sama pada semua unit.

Kesimpulan. Sebagian perawat gilir mengalami gangguan fungsi kognitif. Tidak terdapat perbedaan bermakna rerata skor MoCA-Ina maupun proporsi gangguan fungsi kognitif antar unit kerja. Pada domain MoCA-Ina perbedaan rerata yang bermakna hanya terdapat pada domain atensi-konsentrasi-working memory.

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ABSTRACT
Background. About 75% hospital nurses work in shift. One of negative effects due to long term shift work is cognitive function impairment. Mechanisms explaining the cognitive function impairment are chronic sleep disorder, circadian rhythm desynchronisation, and work stress. Knowledge of cognitive function in shift nurses is important because affects nurse work productivity.

Method. This is a cross sectional study. The subjects of this study were shift nurses working at Emergency Ward, Intensive Care Unit, and Inpatient Ward of RSCM who are eligible based on inclusion and exclusion criteria. This study used proportional concecutive sampling, where all subjects were interviewed, filled questionnaires, and underwent physical and cognitive examination. The cognitive examination were done at least two nights after last night shift. Data was analyzed by using SPSS 17.0.

Result. There were 36 shift nurses in each work unit. Prevalence of cognitive impairment in shift nurses based on MoCA-Ina battery was 14.8%, which the most prevalence was found at Emergency Ward (50.0%), followed by Inpatient Ward (32.1%) and Intensive Care Unit (18.8%). The highest score of all cognitive domains was found at Intensive Care Unit, except in visuospatial which was found at Inpatient Ward, meanwhile every unit had similar mean score in orientation.

Conclusion. A few shift nurses had cognitive impairment. There was no significant difference in both MoCA-Ina mean score and proportion of cognitive impairment among work units. There was significant difference in mean score of attention-concentration-working memory.