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"Tujuan : untuk mengetahui kejadian VTE pada pasien Indonesia yang menjalani bedah ortopedi mayor dan tidak menerima tromboprofi laksis.Metode Uji klinik terbuka pada pasien Indonesia yang menjalani bedah ortopedi mayor, dilakukan di 3 senter di Jakarta. Venografi bilateral dilakukan antara 5 dan 8 hari pasca bedah untuk menemukan VTE yang asimptomatik dan memastikan VTE yang simptomatik. Pasien dievaluasi hingga 1 bulan pasca bedah.Hasil Telah diteliti 17 pasien dengan median usia 69 tahun dan 76,5% di antaranya perempuan. Enam belas dari 17 pasien (94,1%) menjalani bedah fraktur panggul. Median waktu antara fraktur dengan tindakan adalah 23 hari (antara 2 sampai 197 hari), median lamanya tindakan bedah 90 menit (antara 60 sampai 255 menit), dan median lamanya imobilisasi 3 hari (antara 1 sampai 44 hari). Tiga belas dari 17 pasien menjalani venografi kontras untuk mendeteksi VTE yang asimtomatik. VTE ditemukan pada 9 dari 13 pasien (69,2%) saat akan keluar dari rumah sakit (RS). VTE yang simtomatik ditemukan pada 3 pasien (23,1%), semuanya dengan tanda-tanda klinis DVT dan tidak seorangpun dengan tanda klinis embolisme paru (PE). Pasien tersebut diobati dengan heparin berat molekul rendah, dilanjutkan dengan antikoagulan oral warfarin. Tidak ada kematian mendadak sampai pasien keluar dari RS. Tidak ada kasus VTE simtomatik baru sejak keluar dari RS sampai 1 bulan kemudian. Tidak ditemukan kematian mendadak, komplikasi pendarahan, ataupun perawatan ulang di RS dalam studi ini.Kesimpulan Insidens VTE asimtomatik sebesar 69,2% dan simtomatik 23,1% setelah bedah ortopedi mayor tanpa tromboprofi laksis. Studi yang lebih besar dibutuhkan untuk memastikan insidens yang benar, dan yang lebih penting, untuk menggunakan tromboprofi laksis pada pasien-pasien ini.

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Aim To estimate the incidence of VTE in Indonesian patients undergoing major orthopedic surgery and not receiving thromboprophylaxis.

Methods This was an open clinical study of consecutive Indonesian patients undergoing major orthopedic surgery, conducted in 3 centers in Jakarta. Bilateral venography was performed between days 5 and 8 after surgery to detect the asymptomatic and to confi rm the symptomatic VTE. These patients were followed up to one month after surgery.

Results A total of 17 eligible patients were studied, which a median age of 69 years and 76.5% were females. Sixteen out of the 17 patients (94.1%) underwent hip fracture surgery (HFS). The median time from injury to surgery was 23 days (range 2 to 197 days), the median duration of surgery was 90 minutes (range 60 to 255 minutes), and the median duration of immobilization was 3 days (range 1 to 44 days). Thirteen out of the 17 patients were willing to undergo contrast venography. A symptomatic VTE was found in 9 patients (69.2%) at hospital discharge. Symptomatic VTE was found in 3 patients (23.1%), all corresponding to clinical signs of DVT and none with clinical sign of PE. These patients were treated initially with a low molecular weight heparin, followed by warfarin. Sudden death did not occur up to hospital discharge. From hospital discharge until 1-month follow-up, there were no additional cases of symptomatic VTE. No sudden death, bleeding complication, nor re-hospitalization was found in the present study.

Conclusion The incidence of asymptomatic (69.2%) and symptomatic (23.1%) VTE after major orthopedic surgery without thromboprophylaxis in Indonesian patients (SMART and AIDA), and still higher than the results of the Western studies. A larger study is required to establish the true incidence, and more importantly, that the use of thromboprophylaxis in these patients is warranted."

"AbstrakVenous thromboembolism (VTE) is a fatal yet potentially preventable complication of surgery. Routine thromboprophylaxis is still unequivocal prescription is problematic due to perception of low VTE incidence among Asian population. This study aims to investigate the incidence of VTE and thromboprophylaxis prescription among patients undergoing major surgery in a Singapore hospital.Methods: This was a cross-sectional study. Data were obtained from medical record of 1,103 patients who had underwent major orthopaedic or abdominal surgery in 2011-2012 at Khoo Teck Puat Hospital, Singapore. Incidence of VTE events either in the same admission or re-admission in less than one month time were noted as study parameters.Results: Incidence of VTE was 2.1% (95% CI: 1.67 - 2.53) of which 1.3% and 0.8% were DVT and PE cases respectively. Age, gender, history of VTE, ischemic heart disease, and mechanical prophylaxis were associated with VTE incidence based on bivariate analysis. The prescription of pharmacological thromboprophylaxis was associated with prior anticoagulant medication, type of surgery, and incidence of new bleeding.Conclusion: Subsequent to major surgeries, VTE is as common in Asian patients as published data in other populations. Pharmacologic thromboprophylaxis should be considered as recommended in non-Asian guidelines."

"Tesis ini membahas analisis dan perancangan Computer Assisted Surgery (CAS) untuk robot ortopedi yang menggunakan metode Rod and Screw Correcive Manipulation (RSCM) dengan tujuan hasil analisis dan perancangan dapat dipergunakan untuk pembuatan prototipe. Penelitian ini dilakukan dengan tahapan: analisis kebutuhan, analisis sistem dan perancangan sistem. Hasil penelitian menerangkan bahwa masukan sistem ini didefinisikan sebagai nilai pengukuran yang dilakukan oleh robot ortopedi, dan keluarannya merupakan tampilan pada layar monitor yang memberikan nilai tekanan, besar sudut koreksi tulang belakang dan amplitudo keadaan syaraf. Proses untuk mendapatkan keluaran dibuat sesederhana mungkin sehingga proses berjalan cepat dan tepat.

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This thesis discusses the analysis and design of Computer Assisted Surgery (CAS) for orthopedic robot using Rod and Screw Corrective Manipulation (RSCM) methods with the purpose, that the analysis and design can be used for prototyping. This research was carried out in phases: requirements analysis, system analysis and system design.

The results explained that the input defined as the value of measurements made by the orthopedic robot, and its output is the display on the monitor which gives the value of pressure, the angle of correction and the amplitude of spinal nerves. The process to get the output was made as simple as possible so the process goes quickly and accurately."

"With the time available to surgeons-in-training ever dwindling, there is great emphasis placed on practical learning tools. Mirroring his earlier book on practical procedures in trauma surgery, Prof Giannoudis has produced a reference in more elective techniques. In most medical schools, most emphasis is placed on orthopaedic trauma surgery, with elective techniques often delayed until much later in a surgeon?s training."

"Identifikasi mengenai pemilihan Cefazolin sebagai antibiotik profilaksis pasien bedah ortopedi yang diterapkan di RSUD Tarakan Jakarta penting dilakukan untuk mengetahui pemberian antibiotik profilaksis yang telah diterapkan merupakan pilihan yang tepat atau terdapat alternatif antibiotik lain yang lebih baik dibandingkan Cefazolin jika dilihat dari tatalaksana umum yang berlaku. Perbandingan antara penerapan yang telah dilakukan RSUD Tarakan Jakarta dengan tatalaksana yang berlaku dilakukan agar apoteker dapat memahami alur pemberian antibiotik profilaksis yang tepat pada pasien bedah ortopedi. Pengamatan dilakukan secara retrospektif pada salah satu pasien di Gedung A lantai 4 unit OK Sentral lalu dilanjutkan saat pasien telah pindah kembali ke ruang rawat inap di Gedung A lantai 1 unit IGD RSUD Tarakan Jakarta. Kajian ini menggunakan data sekunder berupa daftar pemakaian obat pasien. Hasil pengamatan yang diperoleh diketahui bahwa penggunaan antibiotik profilaksis Cefazolin dari hasil observasi tanggal 22 Juni 2022 di unit OK Sentral RSUD Tarakan Jakarta pada pasien Ny. Y dengan diagnosis fraktur femur merupakan pilihan yang tepat. Hal ini dilihat dari perbandingannya dengan tatalaksana yang tercantum dalam ASHP. Selanjutnya, waktu pemberian antibiotik profilaksis Cefazolin 30-60 menit sebelum operasi dan dosis pemberian antibiotik profilaksis Cefazolin sebesar 2 gram pada pasien bedah ortopedi Ny. Y yaitu di RSUD Tarakan Jakarta telah sesuai dan tidak bertentangan dengan tatalaksana ASHP dimana untuk operasi bedah ortopedi diberikan Cefazolin dosis 2-3 gram untuk pasien dewasa dan waktu pemberian <60 menit sebelum operasi.

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Identification regarding the choice of Cefazolin as a prophylactic antibiotic for orthopedic surgery patients applied at the Tarakan Hospital Jakarta, is important to determine whether the prophylactic antibiotic that has been applied is the right choice or there are other antibiotic alternatives that are better than Cefazolin if seen from the general guideline that applied. A comparison between the implementation carried out by the Tarakan District Hospital in Jakarta and the existing guideline was carried out so that apothecary could understand the appropriate way of administering prophylactic antibiotics to orthopedic surgery patients. Observations were carried out retrospectively on one of the patients in Building A, 4th floor, OK Sentral unit, then continued when the patient had moved back to the inpatient room in Building A, 1st floor, ER unit, Tarakan Hospital Jakarta. This study uses secondary data in the form of a list of patient medication use. The results of the observations obtained revealed that the use of the prophylactic antibiotic Cefazolin from the results of observations on June 22 2022 in the Central OK unit of the Tarakan Regional Hospital, Jakarta in the patient Mrs. Y with a diagnosis of femur fracture is the right choice. This can be seen from the comparison with the management listed in ASHP. Furthermore, the time for giving Cefazolin prophylactic antibiotics is 30-60 minutes before surgery and the dose of Cefazolin prophylactic antibiotics is 2 grams for orthopedic surgery patients, Mrs. Y at Tarakan Regional Hospital Jakarta is appropriate and does not conflict with ASHP guidelines where for orthopedic surgery, a dose of 2-3 grams of Cefazolin is given for adult patients and the administration time is <60 minutes before surgery"

"Asuhan keperawatan yang diberikan oleh perawat sangat mempengaruhi kualitas pelayanan kesehatan yang akan diterima oleh pasien. Upaya yang dilakukan untuk meningkatkan kualitas asuhan keperawatan tersebut salah satunya dengan menerapkan peran ners spesialis. Tujuan penulisan Karya Ilmiah Akhir (KIA) ini adalah mampu menampilkan peran ners spesialis sebagai pemberi asuhan keperawatan lanjut, pembaharu dan peneliti. Metodologi dan pendekatan yang digunakan adalah dengan menggunakan studi literature. Karya Ilmiah Akhir berisi tentang : penerapan teori Virginia Henderson pada pasien dengan Neglected Fracture Left Shaft Femur, penerapan Progressive Muscle Relaxation (PMR) sebagai Evidance Based Nursing dan proyek inovasi yaitu Aplikasi Peran Perawat dalam Program Enhanced Recovery Orthopedic Surgery (EROS) pada Pasien Operasi Total Hip Replacement (THR). Hasil : Penerapan teori Virginia Henderson efektif diterapkan pada kasus muskuloskeletal. Intervensi Progressive Muscle Relaxation (PMR) juga efektif dalam menurunkan Anxiety pasien. Kesimpulan : bahwa teori Virginia Henderson dapat digunakan pada pasien dengan Neglected Fracture Left Shaft Femur untuk meningkatkan kemandirian akibat perubahan fisik dan psikologis. Intervensi Progressive Muscle Relaxation (PMR) dapat digunakan sebagai salah satu alternatif intervensi keperawatan mandiri dalam membantu mengurangi Anxiety pasien fraktur ekstremitas yang akan di lakukan tindakan operasi elektif.

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Nursing care provided by nurses greatly influences the quality of health services patients will receive. Efforts are being made to improve the quality of nursing care, either is applying the role of specialist nurses. The purpose of this Final Scientific Writing is able to show the role of specialist ners as nurse care nurse, change agent and researcher Methodology and approach used is by using literature study. The final work contains: the application of Virginia Hendersons theory to patients with Neglected Fracture Left Shaft Femur, and the Application Progressive Muscle Relaxation as Evidance Based Nursing and innovation projects Application of the Role of Nurses in Enhanced Recovery Orthopedic Surgery (EROS) in Patient Surgery Total Hip Replacement (THR). Results: The application of Virginia Hendersons theory was effectively applied to musculoskeletal cases. The intervention of Progressive Muscle Relaxation (PMR) is also effective in reducing patient anxiety. Conclusion: that Virginia Hendersons theory is appropriately used in patients with Neglected Fracture Left Shaft Femur to improve independence due to physical and psychological changes. The intervention of Progressive Muscle Relaxation (PMR) can be used as one of the alternative independent nursing interventions to help reduce Anxiety patients in limb fracture elective surgery."

"Skripsi ini membahas mengenai tanggung jawab hukum dokter dan rumah sakit dalam tindakan emergency orthopaedi. Selain itu juga membahas peranan informed consent dalam tindakan emergency orthopaedi. Penulis mempertajam penelitian ini dengan menganalisis Putusan No.11/PDT.G/2015/PN.KWG dan No.96/PDT.G/2017/PT.BDG. Permasalahan dalam skripsi ini, yaitu bagaimana tanggung jawab dokter dan rumah sakit serta peranan informed consent dalam tindakan emergency orthopaedi. Sri Lestari mengajukan gugatan perbuatanmelawan hukum atas dasar malpraktek sebagaimana yang diatur di dalam Pasal 1365, 1366, dan 1367 KUHPerdata. Dalam skripsi ini, metode penelitian yang digunakan adalah yuridis normatif dengan tipe penelitian, yaitu deskriptif. Untuk dapat dikategorikan perbuatan melawan hukum, maka harus memenuhi unsurunsur sebagaimana yang diatur di dalam Pasal 1365 KUHPerdata. Selain itu, untuk menentukan seorang dokter dan rumah sakit dapat bertanggung jawab dan memberikan ganti rugi, erat hubungannya antara kesalahan dan kerugian yang ditimbulkan. Sehingga dalam kasus ini, dokter dan rumah sakit tidak dapat bertanggung jawab atas kerugian yang diderita oleh Sri Lestari. Dari hasil penelitian ini, disarankan perlu adanya pengawasan dari pihak rumah sakit terhadap segala tindakan medis yang dilakukan oleh tenaga kesehatan untukmenghindari terjadinya kesalahan dalam melakukan penanganan terhadap pasien.This thesis discusses the legal responsibilities of doctors and hospitals in orthopedic emergency actions. It also discusses the role of informed consent in orthopedic emergency action. The author sharpens this research by analyzing Decision No.11/PDT.G/2015/PN.KWG and No.96/PDT.G/2017/PT.BDG. The problem in this thesis, namely how the responsibility of doctors and hospitals and the role of informed consent in orthopedic emergency action. Sri Lestari filed a lawsuit against the law on the basis of malpractice as regulated in Articles 1365, 1366, and 1367 of the Civil Code. In this thesis, the research method used is normative juridical with the type of research, namely descriptive. To be categorized as an unlawful act, it must meet the elements as regulated in Article 1365 of the Civil Code. In addition, to determine that a doctor and hospital can be responsible and provide compensation, there is a close relationship between errors and losses caused. So in this case, doctors and hospitals cannot be held responsible for the losses suffered by Sri Lestari. From the results of this study, it is suggested that there is a need for supervision from the hospital on all medical actions taken by health workers toavoid errors in handling patients."

"Tindakan operasi orthopaedi membutuhkan tarif yang tinggi karena dilakukandengan alat berteknologi tinggi, proses perawatan komplek dan seringkali menggunakanimplan berharga mahal. Terdapat variasi tarif rumah sakit pada operasi orthopaedi yangperlu diidentifikasi penyebabnya. Penelitian bertujuan mengetahui komponen tarif danmenganalisa faktor-faktor yang berhubungan dengan tarif operasi orthopaedi pasien JKNpada prosedur anggota tubuh atas, sendi tungkai bawah dan fusi tulang belakang padalengkungan tulang belakang di RSUP Fatmawati tahun 2017. Desain penelitian adalahcross sectional dengan pendekatan kuantitatif melalui menghitung tagihan danpendekatan kualitatif melalui wawancara mendalam.Hasil penelitian menunjukkangambaran rata-rata tarif prosedur anggota tubuh atas Rp22.264.612 terdiri atas komponenbahan alat 51, jasa rumah sakit 14 dan jasa pelayanan 35, gambaran rata-rata tarifprosedur sendi tungkai bawah Rp61.700.637 yaitu bahan alat 75, jasa rumah sakit 10 dan jasa pelayanan 15, dan gambaran rata-rata tarif prosedur fusi tulang belakangRp79.501.208 yaitu bahan alat 63, jasa rumah sakit 11 dan jasa pelayanan 26 .Faktor penggunaan dan harga implan, tingkat keparahan, lama hari rawat, danpenggunaan ICU mempengaruhi tarif pada tiga prosedur, sedangkan faktor metode costplus pricing dan kelas perawatan tidak mempengaruhi tarif pada tiga prosedur. RSUP Fatmawati telah melakukan upaya untuk mengatasi variasi tarif pada komponen bahanalat, jasa rumah sakit dan jasa pelayanan. Rumah Sakit perlu melakukan perhitungan unitcost berkala, pembuatan unit cost pada tagihan yang belum memiliki unit cost,pemenuhan dan kepatuhan Clinical Pathway dan Panduan Praktik Klinis untuk tindakanoperasi khususnya yang memiliki lama hari rawat dan jumlah terbanyakKata kunci: variasi tarif operasi orthopaedi, prosedur anggota tubuh atas, prosedur senditungkai bawah, prosedur fusi tulang belakang pada lengkungan tulang belakang, implan.

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Orthopedic surgery requires high rates because it is done with high tech tools,complex maintenance process and often use expensive implans. There are variations inhospital rates on orthopedic surgery that need to be identified. The objectives of the studywere to determine the tariff components and to analyze factors related to the operatingtariffs of JKN patients on upper limb procedures, lower limb joints and spinal fusion inthe spinal arch at Fatmawati Hospital 2017. This study is cross sectional study designwith quantitative approach through counting the bill and qualitative approaches throughin depth interviews.The results of this study showed that the average tariff procedure ofthe limbs of Rp22,264,612 consisted of 51 of appliance component, 14 hospitalsservice and 35 service, the average cost of lower limb joint procedure Rp61,700,637, ,hospital services 10 and service 15 , and average picture tariff of spinal fusionprocedure Rp79.501.208 yaitu appliance 63 , hospital services 11 and service 26 .Factors of use and implanation rates, severity, length of stay, and use of ICUs affect tariffson three procedures, while cost plus pricing and treatment class methods do not affecttariffs on three procedures. RSUP Fatmawati has made efforts to overcome the variationof tariff on components of equipment, hospital services and services. Hospital need to calculate unit cost periodically, unit cost creation on bills that do not have unit cost,compliance and compliance Clinical Pathway and Clinical Practice Guidelines forsurgery, especially those with long days of service and the highest numberKey words tariif variations of orthopeadi surgery, upper limb procedures, lower limbjoint procedures, spine fusion procedures in the spinal cord, implans."