Hasil Pencarian  ::  Simpan CSV :: Kembali

"Latar belakang: Stenosis mitral (SM) merupakan peyempitan dari orifisium katup mitral, dimana SM berat didefinisikan sebagai area katup mitral (AKM) <1 cm² dan biasanya berhubungan dengan gradien transmitral >10 mmHg. Pada praktik klinis, ketidaksesuaian antara hasil pengukuran AKM dan gradien transmitral sering ditemukan. Pasien SM berat dengan gradien transmitral rendah (≤10 mmHg) memiliki kecenderungan menetapnya gejala klinis paska tindakan pembedahan katup mitral dan kurangnya perbaikan klinis paska tindakan komisurotomi mitral transkateter perkutan (KMTP). Namun hingga saat ini, belum banyak studi mengenai faktor yang berhubungan dengan gradien transmitral rendah pada SM berat. Tujuan:Penelitian ini bertujuan untuk mengetahui faktor yang berhubungan dengan gradien transmitral rendah pada SM berat. Metode: Studi potong lintang pada 322 pasien SM berat. Dilakukan evaluasi catatan rekam medik dan hasil pemeriksaan ekokardiografi transtorakal. SM berat didefinisikan sebagai SM dengan AKM <1 cm² yang diukur secara planimetri dan gradien transmitral rendah didefinisikan sebagai gradien transmitral ≤10 mmHg. Hasil: Dari 322 subjek penelitian, sebanyak 36% memiliki gradien transmitral ≤10 mmHg, 68,9% perempuan dan 72% memiliki irama fibrilasi atrium (FA). Berdasarkan analisis multivariat, didapatkan faktor independen gradien transmitral rendah pada SM berat adalah net atrioventricular compliance (IK 95% 3,57–11,02, OR 6,27), maximal tricuspid regurgitation velocity (IK 95% 0,14–0,45, OR 0,26), irama fibrilasi atrium (IK 95% 1,20–4,91, OR 2,43) dan jenis kelamin perempuan (IK 95% 1,07–3,69, OR 1,99). Kesimpulan: Net atrioventricular compliance, maximal tricuspid regurgitation velocity, irama fibrilasi atrium dan jenis kelamin perempuan berhubungan dengan gradien transmitral rendah pada stenosis katup mitral berat.

---

Background: Mitral stenosis (MS) is the narrowing of mitral valve orifice, in which severe MS is defined as planimetered mitral valve area (MVA) <1 cm² with transmitral gradient >10 mmHg. However, discrepancy between planimetered MVA and transmitral gradient is not uncommon in patients with severe MS, suggesting the presence of low gradient (LG) severe MS. Patients in this group display less benefit from valvuloplasty and a greater risk for persistent symptoms after mitral valve replacement (MVR). Yet, factors associated with LG severe MS has not been studied extensively. Objective: Aim of this study is to determine factors associated with LG severe MS. Methods: This is a cross-sectional study in 322 patients with severe MS. Medical records and transthoracic echocardiography examination results were evaluated. Severe MS was defined as planimetered MVA <1 cm² and LG was defined as transmitral gradient ≤10 mmHg. Results: Of 322 subjects, 36% had transmitral gradient ≤10 mmHg, 68,9% were women, and 72% had atrial fibrillation. According to multivariate analysis, several independent factors to LG severe MS were net atrioventricular compliance (95% CI 3,57–11,02, OR 6,27), maximal tricuspid regurgitation velocity (95% CI 0,14–0,45, OR 0,26), atrial fibrillation (95% CI 1,20–4,91, OR 2,43) and women (95% CI 1,07–3,69, OR 1,99). Conclusion: Net atrioventricular compliance, maximal tricuspid regurgitation velocity, AF and women were associated with LG severe MS."

"ABSTRAK Penatalaksanaan Fistel Enterokutan masih sangat beragam dan sulit dengan tingkat kekambuhan dan kematian pasca pembedahan yang masih tinggi. Tujuan dari penatalaksanaan pasien dengan fistel enterokutan adalah koreksi defisit metabolik dan nutrisi, penutupan fistel dan mengembalikan kesinambungan saluran cerna. Tujuan dari penelitian ini adalah untuk melakukan evaluasi penatalaksanaan bedah pada fistel enterokutan yang dirawat di RSUPN Cipto Mangunkusumo selama tahun 2014-2015. Penelitian ini dirancang secara retrospektif analitik dengan mengambil data rekam medik penderita di RSUPN Cipto Mangunkusumo pada periode 2014-2015. Ditemukan 27 kasus fistel enterokutan, dimana 21 kasus yang di evaluasi, rentang umur 27-65 tahun, terbanyak pada kelompok 40-60 tahun (52,38%), letak fistel terbanyak di ileum (57,14%), high output (71,43%), gizi buruk (52,38%), dilakukan tindakan operatif (85,71%), lama rawat <20 hari (66,67%), rekurensi fistel (19,05%) dan angka kematian (14,29%).ABSTRACT Management of enterocutaneous fistula still varies and frustrating with high recurrence and mortality rate. The goal of management for patient with enterocutaneous fistula are correct metabolic and nutritional deficits, close the fistula and reestablish continuity of the gastrointestinal tract. The purpose of this study was to evaluate the surgical management of the enterocutaneous fistula treated at Cipto Mangunkusumo Hospital during 2014-2015. This study designed analytic retrospectively by taking the patient medical record data at Cipto Mangunkusumo Hospital ini the period 2014-2015. Found 27 cases of enterocutaneous fistula which 21 cases were evaluated, age range 40-60 years (52,38%), the location of the fistula largest in the ileum (57,14%), high output (71,43%), malnutrition (52,38%), operative management (85,71%), length of stay in hospital <20 days (66,67%), fistula recurrence (19,05%) and mortality rate (14,29%).;Management of enterocutaneous fistula still varies and frustrating with high recurrence and mortality rate. The goal of management for patient with enterocutaneous fistula are correct metabolic and nutritional deficits, close the fistula and reestablish continuity of the gastrointestinal tract. The purpose of this study was to evaluate the surgical management of the enterocutaneous fistula treated at Cipto Mangunkusumo Hospital during 2014-2015. This study designed analytic retrospectively by taking the patient medical record data at Cipto Mangunkusumo Hospital ini the period 2014-2015. Found 27 cases of enterocutaneous fistula which 21 cases were evaluated, age range 40-60 years (52,38%), the location of the fistula largest in the ileum (57,14%), high output (71,43%), malnutrition (52,38%), operative management (85,71%), length of stay in hospital <20 days (66,67%), fistula recurrence (19,05%) and mortality rate (14,29%).;Management of enterocutaneous fistula still varies and frustrating with high recurrence and mortality rate. The goal of management for patient with enterocutaneous fistula are correct metabolic and nutritional deficits, close the fistula and reestablish continuity of the gastrointestinal tract. The purpose of this study was to evaluate the surgical management of the enterocutaneous fistula treated at Cipto Mangunkusumo Hospital during 2014-2015. This study designed analytic retrospectively by taking the patient medical record data at Cipto Mangunkusumo Hospital ini the period 2014-2015. Found 27 cases of enterocutaneous fistula which 21 cases were evaluated, age range 40-60 years (52,38%), the location of the fistula largest in the ileum (57,14%), high output (71,43%), malnutrition (52,38%), operative management (85,71%), length of stay in hospital <20 days (66,67%), fistula recurrence (19,05%) and mortality rate (14,29%)."

"ABSTRACT

The Factors Which Related with the Operation Delay in Central Surgery Installation at Dr.Cipto Mangunkusumo General HospitalIn accordance with scientific and technology development, surgery procedures are becoming a specialist and expensive health services.

There is a trend to minimize the cost of hospital services by establishing centralized of the high cost units such as operation rooms.

Dr. Cipto Mangunkusumo general hospital is the type A and National top referral hospital which has full array of experts/specialists physician while the tariff of the services is relatively lower than the surrounding private hospitals. The consequence of this condition, bring this hospital has to serve patients beyond its capacity which in turn overburdened the services. This condition is also affected at the central operation room, i.e. Central Surgery Installation.

In performing elective surgery procedures, the patients should wait for operation schedule. The preliminary observation showed that there were many delayed and canceled of the scheduled surgery, so that affected the hospital management and hospital performance.

The aim of this study is to know the percentage of delayed operations and affecting factors. This is a cross sectional study using observation and interviews. The sample is all of the surgery procedures during 6 working days at 12 operation rooms, in June 1996. The data was collected as primary data by filling the form and questionnaires.

The results:

1. Delayed surgery level is 90.9 %.

The delayed percentage of the arrival of consultant surgeon who needed for teaching the resident is 80.8 %, with average time of delay is 40 minutes. Then the delayed percentage of the arrival of anesthesiology resident is 60.6 % with the average time of delay is 36.6 seconds and the delayed percentage of arrival of patients is 62.1 % with the average time of delay is 4.2 minutes.

There is statistically significant correlation between the operation delay and the arrival delay of paramedic, anesthesiology resident, surgeon assistant, surgeon, surgeon consultant, the patients and the duration of operation. But there is no statistically significant correlation between the operation delay and the kind of surgery. This study is also revealed the percentage of operation cancel lance by 12.4 % with the common cause is patient subjectivity (28.6 %).

2. There are many operations which its duration are not appropriate with allocated time.

3. Lack of appropriate and adequate amount of linen, both for patients and provider, i.e. surgery linen such as jas pack, lap pack.

Suggestions :

1. Good communication between provider inside and outside of Central Surgery Installation.

2. It is necessary to make the evaluation about the report of tasks and responsibility of Central Surgery Installation and the procedure of surgery especially about the arrival of the provider.

3. It is necessary to make good cooperation with the medical committee of the hospital to take an appropriate action in case of any mistakes.

4. It is necessary to give special attention from the hospital administrator according to linen budgeting in the Central Surgery Installation.

5. It is necessary to make the longitudinal study about surgery duration according to the kind of surgery, to increase the optimal utilization of the operation room.

Bibliography : 24 ( 1969 - 1995 )

xi + 124 pages + 36 tables + 2 figures + 5 annexes;Sejalan dengan perkembangan IPTEK maka kebutuhan pelayanan kesehatan melalui tindakan bedah menjadi bentuk pelayanan kesehatan yang spesialistik, mahal.

---

ABSTRAK

Terdapatnya kecenderungan penghematan biaya pada pelayanan Rumah Sakit dengan melakukan sentralisasi unit-unit yang memerlukan biaya tinggi atau unit sebagai cost center diantaranya adalah kamar operasi.

Rumah Sakit Dr. Cipto Mangunkusumo sebagai rumah sakit tipe A dan rujukan tingkat nasional mempunyai tenaga ahli yang lengkap dan tarif yang relatif murah menyebabkan pasien yang datang melebihi kapasitas dan perlu mengalami antrian yang panjang. Hal ini dapat terjadi di kamar operasi yang dikenal dengan nama Instalasi Bedah Pusat. Dalam melaksanakan tindakan operasi efektif pasien harus menunggu antrian jadwal operasi, sedangkan dari pengamatan awal didapatkan masih adanya keterlambatan atau pembatalan operasi sehingga pasien harus menunggu jadwal antrian berikutnya. Tentunya hal ini selain mempunyai dampak kepada pasien juga terhadap manajemen rumah sakit serta penampilan kerja rumah sakit.

Penelitian ini bertujuan untuk mengetahui persentase keterlambatan/pernbatalan operasi dan faktor-faktor yang mempengaruhinya. Penelitian ini merupakan studi cross sectional dengan cara pengamatan kegiatan operasi dan wawancara. Adapun sampel pada penelitian ini adalah seluruh operasi pada 12 kamar operasi selama 6 hari kerja pada bulan Juni 1996 di Instalasi Bedah Pusat RSCM. Pengumpulan data dilakukan dengan menggunakan data primer berupa formulir pengisian dan kuesioner. Analisa statistik yang dilakukan adalah analisis univariat dan bivariat.

Hasil penelitian yang didapat :

1. Tingkat keterlambatan operasi 90,9%.

Diantara anggota provider, kedatangan konsulen operator yang dibutuhkan untuk bimbingan/ujian pada 26 operasi mempunyai persentase keterlambatan sebesar 80,8% dengan rata-rata waktu keterlambatan yaitu 40 menit, diikuti keterlambatan PPDS Anestesi 60,6% dengan rata-rata waktu keterlambatan 37,6 menit. Sedangkan pasien mempunyai persentase keterlambatan 62,1% dengan rata-rata waktu keterlambatan 4,2 menit. Adanya hubungan bermakna secara statistik antara keterlambatan operasi dengan keterlambatan kedatangan paramedik, PPDS anestesi, asisten operator, operator, konsulen operator, pasien, lama operasi. Sedangkan tidak ada hubungan bermakna secara statistik antara keterlambatan operasi dengan jenis operasi. Pada penelitian ini juga terdapat pembatalan operasi sebesar 12,4%. Dimana alasan terbanyak disebabkan faktor subyektivitas pasien (28,6%).

2. Adanya lama operasi yang belum sesuai dengan alokasi waktu (rencana) yang di tentukan.

3. Kurang tersedianya linen khususnya linen pasien, linen operasional (Jas pack, Lap pack) didalam kegiatan operasi.

Saran-saran yang diusulkan antara lain :

1. Adanya hubungan komunikasi (HAM) yang baik antara anggota provider baik yang berada di bawah atau yang tidak berada di bawah Instalasi Bedah Pusat, begitu pula dengan ruang rawat yang terkait.

2. Perlunya evaluasi terhadap laporan tertulis tentang tugas/tanggung jawab IBP dan tata tertib laksana tindakan bedah khususnya mengenai kedatangan provider yang telah disetujui oleh semua pihak yang terkait.

3. Perlunya bekerja sama dengan Direktur RSCM (komite medik) untuk mengambil langkah-langkah yang dianggap perlu apabila peraturan tertulis tersebut tidak dipatuhi.

4. Perlunya perhatian administrator Rumah Sakit terhadap anggaran pengadaan linen di Instalasi Bedah Pusat.

5. Perlu diadakan suatu survai lama operasi (alokasi waktu) berdasarkan jenis operasi untuk memudahkan dalam pembuatan waktu rencana operasi, sehingga dapat meningkatkan utilisasi kamar operasi.

Daftar Pustaka : 24 (1969-1995)

xi + 124 halaman + 36 tabel + 2 gambar + 5 lampiran"