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"Latar Belakang: Stadium saat terdiagnosis merupakan faktor prognostik terpenting yang menentukan kesintasan pasien kanker kolorektal (KKR). Sebagian besar pasien terdiagnosis pada stadium lanjut dan dilaporkan mengalami keterlambatan diagnosis dan terapi. Penelitian ini bertujuan untuk mengetahui peran case manager dalam efisiensi waktu tunggu diagnosis dan terapi serta melihat faktor-faktor yang memengaruhi keterlambatan diagnosis dan terapi tersebut.Metode: Studi analisis deksriptif dengan desain potong lintang untuk mengetahui hubungan antara faktor-faktor yang memengaruhi keterlambatan diagnosis dan terapi pada pasien KKR yang dengan case manager dan tanpa case manager yang dirujuk ke Departemen Radioterapi Rumah Sakit Cipto Mangunkusumo periode Juli 2018 sampai Maret 2019.Hasil: Sebanyak 20 pasien yang memenuhi kriteria inklusi, enam pasien didampingi oleh case manager dan 14 pasien tidak. Total enam pasien (100%) yang dengan case manager tidak ada yang mengalami keterlambatan diagnosis dan terapi, sedangkan pada kelompok yang tanpa case manager didapatkan keterlambatan diagnosis pada tiga pasien (21,4%), keterlambatan terapi pada empat pasien (28,6%) dan keterlambatan sistem pada lima pasien (35,7%), meskipun hal ini tidak bermakna secara statistik (p > 0,05). Didapatkan waktu tunggu diagnosis yang lebih singkat pada kelompok case manager versus tanpa case manager [14 hari (SB 13) versus 18,5 hari (SB 13); p 0,496]. Hasil serupa juga terlihat pada waktu tunggu terapi [17,5 hari (SB 6,7) versus 21,5 hari (9-189 hari); p 0,076]. Tidak didapatkan hubungan yang bermakna secara statistik antara usia, tingkat pendidikan, domisili, dan stadium saat terdiagnosis dengan keterlambatan diagnosis dan terapi.

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Background: The stage of a colorectal cancer (CRC) at the time of treatment is the most important prognostic factor influencing survival. Majority of CRC patients are diagnosed at an advanced stage and eventually experiencing delay in diagnosis and therapy. The aim of this study was to investigate the effectiveness of case manager oncology in shortening the waiting time for diagnosis and therapy and analyse factors influencing the delay.

Method: A descriptive cross-sectional study was conducted to determine the relationship between factors influencing the delay in diagnosis and therapy in CRC patients with or without accompaniment of case manager who were referred to Radiotherapy Department of Cipto Mangunkusumo Hospital during period July 2018 to March 2019.

Result: There were 20 eligible patients enrolled in this study, 6 patients were assisted by case manager and 14 patients were not. None patients (100%) having delay of diagnosis and therapy in case manager group while in non-case manager group there were 3 patients (21.4%) having delay in diagnosis, 4 patients (28.7%) having delay in therapy, and 5 patients (35.7%) delay in system, although no statistically significant differences were found. The waiting time for diagnosis was shorter in case manager group versus non-case manager group [14 days (SD 13) versus 18,5 days (SD 13); p 0,496] and similar result were also seen in waiting time for therapy [17,5 days (SD 6,7) versus 21,5 days (9-189 days); p 0,076]. There were no significant association between age, level of education, place of residence, and stage at diagnosis with delay in diagnosis and therapy."

"ABSTRAKLatar Belakang : Di Indonesia, Kanker Nasofaring (KNF) merupakan insiden terbanyak ke lima yang mencapai 5.2% dari seluruh kasus kanker, dan merupakan kanker terbanyak ke tiga pada laki-laki serta penyebab kematian ke tujuh akibat kanker. Tatalaksana kanker menjadi semakin kompleks sehingga meningkatkan risiko terjadinya keterlambatan pada penanganan kanker, dan kanker nasofaring (KNF) adalah salah satu diantaranya. Penelitian ini dilakukan untuk mengidentifikasi faktor-faktor keterlambatan penatalaksanaan kanker dan mengetahui peran dan hubungan case manager terhadap keterlambatan diagnosis dan terapi pada pasien KNF. Metode : Penelitian potong lintang retrospektif terhadap 110 pasien kanker nasofaring yang dirujuk ke RSCM periode Juli 2018-Maret 2019, dilihat karakteristik pasien, peran case manager terhadap faktor keterlambatan diagnosis dan terapi yang didapat. Analisis univariat, bivariate, chi square, kolmogorov smirnov dan kaplan Meier dilakukan pada pasien yang memenuhi kriteria inklusi. Hasil : Didapatkan 64,6% pasien adalah laki-laki, rerata usia 44 (12-66) tahun, rujukan internal RSCM 83,3% dengan perujuk 90% dari Departemen THT-KL. Sebagian besar pasien datang dengan stadium IV A (64,6%) dengan domisili terbanyak dari luar DKI Jakarta (81,3%). Secara umum didapatkan perbedaan yang signifikan pada kelompok tanpa pendampingan case manager lebih banyak mengalami keterlambatan diagnosis dibandingkan pada kelompok yang dengan pendampingan case manager (73,3% versus 24,2%; P = 0,001). Demikian pula pada keterlambatan tindakan pengobatan atau terapi (86,7% versus 54,5%; P = 0,031), namun tidak berbeda signifikan pada waktu tunggu keseluruhan pelayanan pasien, walaupun secara proporsi tetap lebih tinggi waktu tunggu pelayanan pasien pada yang tanpa pendampingan case manager (60% versus 54,5%; P = 0,724). Untuk faktor yang mempengaruhi keterlambatan tatalaksana kanker lainnya didapatkan tidak ada hubungan yang bermakna antara usia, tingkat pendidikan dan tempat tinggal terhadap keterlambatan waktu diagnosis ataupun terapi. Kesimpulan : Case manager terbukti dapat mengoptimalkan pelayanan kesehatan sehingga dapat memperbaiki waktu tatalaksana pada pasien kanker Nasofaring di RSCM.

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Background: In Indonesia, Nasopharyngeal Cancer (NPC) is the fifth highest incidence which reaches 5.2% of all cancer cases, and is the third most cancer in men after lung cancer and liver cancer and the seventh cause of cancer death. The management of cancer became more complex which increasing the risk of delays in cancer treatment, and nasopharyngeal cancer (NPC) is one of them. This study was conducted to identified the delay factors in cancer management and to determine the role and relation of case manager on factors from diagnosis delay and treatment delay for NPC patients. Methods: A retrospective cross sectional study of 110 nasopharyngeal cancer patients reffered to Cipto Mangunkusumo General Hospital (RSCM) for the period of July 2018-March 2019, analyzed the characteristics of patients and the role of case managers on the factors of diagnosis and treatment delay obtained. Bivariate, univariate, chi square, kolmogorov smirnov and kaplan Meier analyzes were performed on patients who met the inclusion criteria. Results: Obtained 67.1% of patients were men, mean age of patients 44 (12-66) years old, RSCM internal majority of patients came with stage IV A (64.6%) and staying mostly outside from DKI Jakarta area (81.3%). In general, there were significant differences in the group without case manager had a higher delay in diagnosis than in the group with the case manager (73.3% versus 24.2%; P = 0.001). Same as in treatment delay (86.7% versus 54.5%; P = 0.031), but not significantly different in awaiting time overall patient care, however in a proportion, the waiting time for patient care was higher in group without case manager (60% versus 54.5%; P = 0.724). For the other factors that influence the delay treatment of cancers showed, there is no relations which related to age, education level and place of residence to delay the time of diagnosis or treatment. Conclusion: Case manager are proven to optimize health services that can improve management time and decrease treatment delay in Nasopharyngeal cancer patients at RSCM.

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"[Tujuan: Untuk mengetahui profil pasien kanker rektum di Departemen Radioterapi RSCM. Metode: Dilakukan penelitian restrospektif deskriptif analitik terhadap 144 pasien kankerrektum yang menjalani radiasi di Departemen Radioterapi RSCM periode Januari 2009Januari2014, dilihat karakteristik pasien dan tumor. Respons radiasi dinilai menggunakanmetode RECIST 1.1. Hubungan antara OTT dan DTT dengan respons radiasi dinilai dengankorelasi Spearman dan analisis kesintasan dihitung dengan kurva Kaplan Meier. Hasil: Pasien laki-laki sebesar 65.9%, median usia 53 (23-81) tahun dengan mayoritas beradapada kelompok usia 50-59 tahun. Tipe histopatologi terbanyak adalah adenokarsinoma(88.8%) dan pasien paling banyak datang dengan stadium IIIB (25.0%). Kemoradiasidilakukan pada 29.8% pasien, dengan toksisitas radiasi akut terbanyak adalah pada kulit(derajat I) sebesar 20.1%. Respons radiasi yang dinilai dengan metode RECIST 1.1menunjukkan respons terbanyak adalah stabil (71.4%). Tidak ditemukan korelasi antara OTTdan DTT dengan respons radiasi. Dari 118 pasien, didapatkan analisis kesintasan keseluruhan3 dan 5 tahun masing-masing adalah 65% dan 45% dengan median survival 59 bulan. Padakelompok pasien yang menjalani radiasi panjang, analisis kesintasan keseluruhan 3 dan 5tahun masing-masing adalah masing-masing 91% dan 78%. Kesimpulan: Karakteristik pasien rektum di Departemen Radioterapi RSCM yang berbedadengan berbagai studi sebelumnya hanya usia. Respons radiasi yang paling banyak dijumpai adalah stabil. Tidak ditemukan korelasi antara OTT dan DTT dengan respons radiasi.;Purpose: To obtain the profile of rectal cancer patients in Department of Radiotherapy, National General Hospital of Cipto Mangunkusumo.Method: A restrospective study was conducted over 144 rectal cancer patients undergone radiation therapy in Department of Radiotherapy, National General Hospital of CiptoMangunkusumo during period of January 2009 to January 2014. The characteristics ofpatients and tumour were assessed. The radiation response was evaluated with the RECIST1.1 method. The correlation between OTT and DTT with radiation response was analyzedwith Spearman?s correlation and the survival analysis was determined using Kaplan-Meiercurve. Result: The majority of patients were male (65.9%), with median age of 53 (23-81) years oldwhere most patients belonged to age group of 50-59 years old. The most frequenthistopathologic type found was adenocarcinoma (88.8%) with most patients were in stageIIIB (25.0%). Chemoradiation was performed in 29.8% of patients, and grade I skin toxicitywas the most frequent acute side effect of radiation found (20.1%). Radiation responseassessed with the RECIST 1.1 method showed stable disease as the mostly seen response(71.4%). There was no correlation found between OTT and DTT with radiation response.Overall survival from 118 patients for 3 and 5 years were 65% and 45%, respectively, withmedian survival of 59 months. In the group of patients underwent long-course radiotherapy,the overall survival for 3 and 5 years were 91% and 78%, respectively. Conclusion: The sole characteristic of rectal cancer patients in Department of Radiotherapy atCipto Mangunkusumo Hospital that is different from previous studies is the age group wheremost patients were in. Stable disease is the most frequent radiation response. There was no correlation found between OTT and DTT with radiation response., Purpose: To obtain the profile of rectal cancer patients in Department of Radiotherapy, National General Hospital of Cipto Mangunkusumo.Method: A restrospective study was conducted over 144 rectal cancer patients undergone radiation therapy in Department of Radiotherapy, National General Hospital of CiptoMangunkusumo during period of January 2009 to January 2014. The characteristics ofpatients and tumour were assessed. The radiation response was evaluated with the RECIST1.1 method. The correlation between OTT and DTT with radiation response was analyzedwith Spearman’s correlation and the survival analysis was determined using Kaplan-Meiercurve. Result: The majority of patients were male (65.9%), with median age of 53 (23-81) years oldwhere most patients belonged to age group of 50-59 years old. The most frequenthistopathologic type found was adenocarcinoma (88.8%) with most patients were in stageIIIB (25.0%). Chemoradiation was performed in 29.8% of patients, and grade I skin toxicitywas the most frequent acute side effect of radiation found (20.1%). Radiation responseassessed with the RECIST 1.1 method showed stable disease as the mostly seen response(71.4%). There was no correlation found between OTT and DTT with radiation response.Overall survival from 118 patients for 3 and 5 years were 65% and 45%, respectively, withmedian survival of 59 months. In the group of patients underwent long-course radiotherapy,the overall survival for 3 and 5 years were 91% and 78%, respectively. Conclusion: The sole characteristic of rectal cancer patients in Department of Radiotherapy atCipto Mangunkusumo Hospital that is different from previous studies is the age group wheremost patients were in. Stable disease is the most frequent radiation response. There was no correlation found between OTT and DTT with radiation response.]"

"ABSTRAKLatar Belakang: Insiden kanker serviks di RSCM masih tinggi, sebagian besar datang pada stadium lanjut, dan angka harapan hidup yang masih rendah. Jika respon radiasi komplit dan eradikasi tumor lokoregional dapat tercapai pada pasien kanker serviks, diperkirakan dapat meningkatkan kesintasan. Oleh karena itu, kami bermaksud mengadakan penelitian terhadap respon terapi radiasi dan karakteristik klinis serta patologi yang berhubungan pada pasien kanker serviks di RSCM.Metode: Penelitian kohort ini dilakukan dengan menggunakan data sekunder terhadap 123 pasien kanker serviks stadium IIA-IIIB yang menjalani radiasi kuratif definitif sesuai protokol standard bulan Januari 2014-Des 2015 di RSUPN CiptoMangunkusumo. Dilakukan pencatatan karakteristik klinis dan patologis sebelum radiasi, Dicatat juga efek samping akut gastrointestinal, traktus genitourinaria, dan hematologis selama menjalani protokol radiasi sampai 3 bulan pasca radiasi. Data respon tiga bulan pasca radiasi lengkap berdasarkan klinis dan pemeriksaan ultrasonografi transrektal/transvaginal dicatat dan diklasifikasikan sesuai Response Evaluation Criteria in Solid Tumors RECIST .Hasil: Dari 123 kasus, 84 kasus 68,29 diperoleh respon komplit, 30 kasus 24,39 respon parsial, 6 kasus 4,88 respon stabil, dan 3 kasus 2,44 respon progresif. Berdasarkan efek samping akut gastrointestinal, tidak didapatkan efek samping derajat 0 pada 99 kasus 80,49 , derajat 1 pada 20 kasus 16,26 , derajat 2 pada 4 kasus 3,25 , derajat 3 pada 0 kasus 0 . Berdasarkan efek samping akut genitourinaria, tidak didapatkan efek samping derajat 0 pada 105 kasus 85,37 , derajat 1 pada 17 kasus 13,82 , derajat 2 pada 1 kasus 0,81 , dan derajat 3 pada 0 kasus 0 . Berdasarkan efek samping akut hematologis, tidak didapatkan efek samping derajat 0 pada 108 kasus 87,80 , derajat 1 pada 15 kasus 12,20 , derajat 2 pada 0 kasus 0 , dan derajat 3 pada 0 kasus 0 . Dengan membandingkan kelompok respon komplit dan tidak respon parsial, stabil, progresif didapatkan faktor usia dengan p=0,266 RR 0,87;IK95 0,67-1,12 , klasifikasi tekanan darah dengan p=0,882 RR 0,98; IK95 0,76-1,27 , Indeks Masa Tubuh dengan p= 0,397 RR 1,06;IK95 0,83-1,34 , kadar hemoglobin dengan p= 0,193 RR 0,71;IK95 0,40-1,27 , jumlah leukosit darah dengan p=0,969 RR=1,00; IK95 0,78-1,29 , kadar albumin darah dengan p= 0,198 RR 0,73;IK95 0,44-1,20 , stadium FIGO dengan p=0,526 RR 1,08; IK95 0,85-1,38 , diameter tumor terbesar dengan p=0,034 RR 1,30; IK95 1,03-1,63 , jenis histopatologis dengan p=0,159 RR 1,18;IK95 0,90-1,55 , dan derajat diferensiasi dengan p=0,469. Pada analisa multivariat, didapatkan hubungan bermakna antara diameter tumor p=0,036;RR 2,64; IK95 1,07-6,56 dengan respon radiasi komplit.Kesimpulan: Gambaran respon radiasi kuratif definitif pada kanker serviks stadium IIA-IIIB di RSCM adalah 68,29 respon komplit, 24,39 respon parsial, 4,88 respon stabil, dan 2,44 progresif. Efek samping akut gastrointestinal, genitourinaria, dan hematologis pada umumnya tidak terjadi selama dan sampai 3 bulan pasca radiasi, yaitu 80,49 tidak mengalami efek samping akut gastrointestinal, 85,37 tidak mengalami efek samping akut genitourinaria, dan 87,80 tidak terjadi efek samping akut hematologi. Sebagian besar efek samping akut yang terjadi berderajat rendah yaitu grade 1 dan 2 traktus gastrointestinal, masing-masing 16,26 dan 3,25 , grade 1 dan 2 traktus genitourinaria, yaitu masing-masing 13,82 dan 0,81 , dan grade 1 hematologi, yaitu 12,20 . Terdapat hubungan bermakna antara diameter tumor terbesar dengan respon komplit radiasi. Tidak terdapat hubungan bermakna antara usia, Indeks Masa Tubuh, kadar hemoglobin, jumlah leukosit darah, kadar albumin serum, stadium FIGO, jenis histopatologis, dan derajat diferensiasi dengan respon terapi radiasi."hr>""b>ABSTRACT"Background The incidence of cervical cancer was still high in RSCM, whom most of them was found in advanced stage. The issue that still become a problem related to radiotherapy on those patients was non satisfying local tumor control, which range 20 50 . If we can reach complete response and eradication of locoregional tumor on cervical cancer patients, it is estimated that the survival rate will increase. Therefore, we conducted a research to find out response of radiotherapy and related clinic pathologic characterictics on cervical cancer patients in our hospital.Methods This cohort study used secondary data on 123 patients of cervical cancer stage IIA IIIB who had undergone radiation therapy based on standard protocol in our hospital, during Januari 2014 to Dec 2015. The clinical factors of those patients, such as age, Body Mass Index, blood pressure, hemoglobin level, blood leucocyte count, serum albumin, largest tumor diameter FIGO staging and pathologic characteristic, i.e histopathology and grading were recorded. During radiation protocol until 3 months post radiation, we also noted any side effects of gastrointestinal tract, genitourinary tract, and hematologic. Evaluation of radiotherapy response was based on Response Evaluation Criteria in Solid Tumors RECIST .Results Among 123 cases, 84 cases or 68.29 was complete response, 30 cases or 24.39 was partial response, 6 cases or 4.88 was stabile response, and 3 cases or 2.44 was progressive. Based on gastrointestinal side effect, there was no side effect or grade 0 on 99 cases 80.49 , grade 1 on 20 cases 16.26 , grade 2 on 4 cases 3.25 , grade 3 on 0 case 0 . Based on side effect of genitourinary, there was no side effect or grade 0 on 105 cases 85,37 , grade 1 on 17 cases 13.82 , grade 2 on 1 case 0.81 , grade 3 on 0 case 0 . Based on hematologic side effects, there was no side effect on 108 cases 87.80 , grade 1 on 15 cases 12.20 , grade 2 on 0 case 0 , grade 3 on 0 case 0 . On bivariate analysis, p of each factors were age p 0.266 RR 0.87 0.67 1.12 , Body Mass Index p 0.397 , blood pressure classification p 0.658 RR 0.98 0.76 1.27 , largest tumor diameter p 0.034 RR 1.30 1.03 1.63 , haemoglobin level p 0.193 RR 0.98 0.76 1.27 , blood leucocyte count p 0.969 RR 1.00 0.78 1.29 , FIGO staging II vs III p 0.526 RR 1.08 0.85 1.38 , histopathology result squamous cell carcinoma vs nonsquamous cell carcinoma p 0.159 RR 1.18 0.90 1.55 , and grading p 0.469 . on multivariate analysis, tumor diameter was statistically significant, with p 0.036 RR 2.64 1.07 6.56 .Conclusion Most of definitive curative radiotherapy response on cervical cancer stage IIA IIIB was complete 68.29 . Partial response was 24.49 , stable response was 4.88 , and progressive was 2.44 . The Acute side effect of gastrointestinal tract, genitourinary tract, and hematologic were commonly can be tolerable during and 3 months post radiation therapy. Clinico pathologic characteristic that significantly related to complete response of radiotherapy were largest tumor diameter."

"Kanker Nasofaring KNF merupakan salah satu kasus keganasan paling sering di Indonesia dengan karakteristik yang unik secara epidemiologi, patologi dan klinis. Faktor prognosis KNF telah menjadi fokus penelitian yang cukup penting dalam sejumlah studi yang telah dilakukan. Penelitian ini bertujuan mengetahui karakteristik pasien KNF yang terdiagnosis di Poli THT RSCM serta angka kesintasan dengan melakukan analisis terhadap faktor yang berperan terhadap prognosis. Penelitian ini merupakan suatu penelitian kohort retrospektif dengan subjek penelitian bersifat total sampling pasien KNF yang terdiagnosis di Poli THT. Sebanyak 561 subjek penelitian ini, pria memiliki prevalensi sebanyak 2.8 kali daripada wanita. WHO tipe 3 dan WF tipe A menjadi jenis histopatologi paling dominan. Stadium IV A didapatkan pada 30.1 subjek dan 18.9 subjek sudah berada dalam kondisi metastasis jauh. Nilai tengah untuk waktu tunggu radiasi adalah 91 12-344 hari dengan durasi radiasi 53 39-95 hari. Stadium IVC, p= 0,000 , N3 p= 0,018 , metastasis jauh p= 0,000 , dan drop out atau tidak mendapat terapi p= 0,000 menjadi faktor yang memberikan kesintasan lebih buruk pada penelitian ini.

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Nasopharyngeal Cancer NPC is one of the most frequent cancer in Indonesia which has a unique characteristic in epidemiology, pathology and clinical features. Prognostic factors are recently became the most important research foci, and a large number of investigation in this area have been performed. The objective of this study is to know the characteristics of NPC patients that have been diagnosed in ENT Department of RSCM and analyzed some factors that might have role in overall survival. This is the retrospective cohort study with total sampling subject. From 561 subjects, Male has 2.8 higher prevalence than female. WHO type 3 92,3 and WF type A 97,1 are the majority hisopathological result. Stage IV A is found in 30,1 subjects and 18,9 subjects were already in metastatic state. The median value of radiation waiting time was 91 12 344 days, duration time of radiation was 53 39 95 days. Stage IVC p 0,000 , N3 p 0,018 , distant metastatic p 0,000 , and drop out or no treatment p 0,000 are found to be the factors that give a negative impact in overall survival."

"Studi retrospektif ini bertujuan untuk mengetahui perbandingan respon terapi radiasi antara teknik konvensional 2D dengan pengecilan lapangan radiasi teknik 2D, 3DCRT atau brakiterapi pada pasien kanker nasofaring stadium dini (stadium I – IIa). Dari 20 sampel didapatkan respon komplit pada 17 pasien (85%) dan respon parsial pada 3 pasien (15%) (p=0.219). Efek samping akut yaitu dermatitis radiasi grade 3-4 adalah 5% (p=0.435), mukositis grade 3-4 adalah 15% (p=0.510) dan xerostomia grade 3-4 adalah 0% (p=0.517). Secara statistik tidak didapatkan perbedaan bermakna tetapi secara klinis mempunyai kesan ada kecenderungan bahwa dengan pengecilan lapangan radiasi teknik brakiterapi dan 3DCRT lebih baik dalam hal efek samping akut mukositis dibanding teknik 2D.

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This retrospective study aimed to compare the response of radiation therapy between 2D conventional technique with the booster of 2D, 3DCRT or brachytherapy techniques in patients with early-stage nasopharyngeal cancer (stage I - IIa). From 20 sample, obtained complete response in 17 patients (85%) and partial response in 3 patients (15%) (p = 0.219). Side effects of acute radiation dermatitis grade 3-4 is 5% (p=0.435) , mucositis grade 3-4 is 15% (p=0.510) and xerostomia grade 3-4 is 0% (p=0.517). The result showed no satistically significant but clinically there is a tendency that with the booster of brachytherapy and 3DCRT techniques, are better compared with 2D technique in terms of acute mucositis side effects."

"ABSTRAKStroke iskemik berdampak negatif berupa cacat tetap. Cacat ini dapat dihindari dengan trombolisis cepat dengan aktivator plasminogen tipe rekombinan (rtPA). Pasien yang datang dengan onset > 6 jam dinyatakan mengalami pre-hospital delay. Keluarga sebagai orang terdekat dengan pasien berperan penting dalam membantu pengambilan keputusan. Penelitian ini bertujuan untuk mengetahui hubungan antara pengetahuan keluarga dengan keterlambatan pra-rumah sakit pada pasien stroke iskemik. Penelitian dengan desain cross sectional ini melibatkan 154 keluarga pasien stroke iskemik yang diperoleh melalui teknik purposive sampling. Hasil penelitian ini menemukan bahwa ada hubungan yang signifikan antara pengetahuan keluarga dengan keterlambatan pra-rumah sakit pada pasien stroke iskemik (p = 0,000; <0,05). Analisis lebih lanjut menunjukkan bahwa keluarga pasien yang memiliki tingkat pengetahuan baik memiliki peluang 14,6 kali untuk tidak mengalami keterlambatan pra-rumah sakit dibandingkan dengan keluarga yang memiliki pengetahuan kurang baik. Penelitian ini membuktikan bahwa pengetahuan keluarga merupakan faktor penting dalam membantu pengambilan keputusan pasien stroke iskemik untuk dibawa ke IGD.ABSTRACTIschemic stroke has a negative impact in the form of permanent disability. This defect can be avoided by rapid thrombolysis with recombinant type plasminogen activator (rtPA). Patients who came with onset > 6 hours were stated to have pre-hospital delay. The family as the closest person to the patient plays an important role in helping decision making. This study aims to determine the relationship between family knowledge and prehospital delay in ischemic stroke patients. This study with a cross sectional design involved 154 families of ischemic stroke patients obtained through purposive sampling technique. The results of this study found that there was a significant relationship between family knowledge and prehospital delay in ischemic stroke patients (p = 0.000; <0.05). Further analysis showed that the patient's family who had a good level of knowledge had a 14.6 times chance of not experiencing pre-hospital delays compared to families who had poor knowledge. This study proves that family knowledge is an important factor in helping ischemic stroke patients make decisions to be brought to the ER."

"Di Indonesia kebanyakan pasien kanker serviks datang pada stadium lanjut (62%) yang merupakan 66% dari penyebab kematian ginekologik. Pemeriksaan Pap Smear merupakan salah satu cara untuk mendeteksi secara dini kanker serviks sehingga penanganan kanker serviks dapat dilakukan sebelum menyebar ke luar rahim.Tujuan penelitian ini adalah untuk mengetahui peranan faktor-faktor yang menyebabkan mereka terlambat memeriksakan diri di RSUPN Dr. Cipto Mangunkusumo Jakarta. Penelitian ini memadukan metoda kuantitatif dan kualitatif. Data primer diambil dengan menggunakan kuesioner, wawancara mendalam dan membaca catatan dokumen.Hasil penelitian menunjukkan bahwa variabel-variabel yang berhubungan seeara statistik dengan keterlambatan pasien kanker serviks memeriksakan diri adalah pengetahuan, sikap, ketersediaan pelayanan Pap Smear dan dorongan suami. Biaya dan dorongan petugas kesehatan tidak berhubungan secara statistik tetapi penting khususnya penghasilan untuk membayar biaya pemeriksaan. Ketersediaan pelayanan Pap smear merupakan variabel yang dominan mempengaruhi variabel dependen.Berdasarkan wawancara mendalam dapat disimpulkan bahwa memang tidak tersedianya pelayanan Pap Smear disamping kurangnya pengetahuan yang menjadi penyebab informan terlambat memeriksakan diri dengan alasan tidak ada satupun petugas kesehatan atau orang lain yang menyampaikan informasi mengenai Pap Smear dan kanker serviks.Mempertimbangkan hasil penelitian maka disarankan kepada semua pihak yang terkait untuk meningkatkan upaya penanganan kanker serviks melalui KIE secara terkoordinir lintas sektoral kepada masyarakat umumnya, terutama kepada wanita masa reproduksi dan lansia agar memperhatikan pelayanan deteksi dini (Pap Smear).

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An Analysis on the Delay of Cervix Cancer Patient in Examining Their selves in The National Hospital of Dr. Cipto Mangunkusumo, JakartaIn Indonesia most of the cervix cancer patients come to see doctors after advanced stadium (62 %) which 66 % ended with gynecological death. The smear test is a method to detect the cervix cancer earlier before spreading outside the uterus.

The purpose of this research is to identify factors related to the delay of the health examination in The National Hospital of Dr. Cipto Mangunkusumo, Jakarta. This research combines quantitative and qualitative methods by using questionnaire, in-depth interview and examine medical records to supplement the primary data.

The research result indicates variables related statistically with the cancer patient delay are; knowledge, attitudes, the availability of the Pap smears service, and the husband's support. Financial problem and encouragement from the health providers are not related statistically but it is important especially the income. The availability of Pap smear service plays as a dominant variable in affecting the dependent variable.

Based on depth interview it is concluded that the unavailability of Pap smear services despite the lack of knowledge has caused the informant did not use the early detection service (Pap smear) with reason there was no health provider or other people gave information about the Pap smear and cervix cancer.

Considering the research result, it is suggested that all related parties improve the handling of the cervix cancer through Communication, Information and Education (KIE), which is coordinated through cross sector way to the public, especially KIE should be focused on women during their reproductive term and the elder women so that they will pay more attention to early detection service (Pap smear)."

"Latar belakan: Kanker serviks merupakan kanker terbanyak kedua dan tingkat kematian terbesar ketiga di Indonesia. Sebagian besar pasien datang dengan stadium lanjut (IIB-IIIB), sehingga terapi pilihan untuk pasien adalah radioterapi atau kemoradiasi. Penelitian sebelumnya membuktikan bahwa terdapat perbedaan respon tumor antara pasien yang dilakukan radiasi di pagi hari dibandingkan sore hari. Terlepas dari hal tersebut, kualitas dan kuantitas tidur dihubungkan dengan peningkatan faktor karsinogenik yang dapat menyebabkan imunosupresi. Penelitian juga menunjukkan bahwa gangguan tidur merupakan faktor prognostik independen dalam memengaruhi overall survival pasien kanker kolorektal. Penelitian ini bertujuan untuk mengetahui hubungan antara kualitas dan kuantitas tidur terhadap respon klinis pada pasien kanker serviks stadium lokal lanjut yang menjalani radioterapi.Metode: Penelitian ini menggunakan desain studi cross-sectional pada pasien kanker serviks stadium IIB – IIIB yang telah menjalani radioterapi di IPTOR RSCM. Data pola dan kebiasaan tidur didapatkan dari wawancara yang telah dilakukan kepada pasien kanker serviks dari penelitian terdahulu oleh Ramli dkk., berupa durasi, kualitas, dan jam mulai tidur malam, serta frekuensi, durasi, kualitas, dan jam mulai tidur siang. Data hasil terapi didapatkan dari pencatatan hasil pemeriksaan fisik di rekam medik.

Hasil : Rerata usia dari 43 sampel adalah 50 tahun dengan jenis karsinoma sel skuamosa tidak berkeratin diferensiasi sedang. Pada analisis regresi logistik univariat, didapatkan adanya hubungan antara jam mulai tidur malam dengan respon klinis (p=0.032), dengan pengaruh yang cukup kuat (OR: 3,13, 95%CI; 1,10-8,88). Pada analisis multivariat, variabel jam mulai tidur malam masih memberikan signifikansi 0,032, dengan pengaruh terhadap respon yang cukup kuat (OR: 3,14,95%CI; 1,10-8,94), dimana jam mulai tidur yang lebih malam akan meningkatkan kemungkinan terjadinya respon tidakkomplit pada pasien.

Kesimpulan: Tidak terdapat hubungan antara kualitas tidur dan respon klinis pada pasien kanker serviks stadium lokal lanjut yang menjalani radioterapi. Terdapat hubungan antara jam mulai tidur dan respon klinis pada pasien kanker serviks stadium lokal lanjut yang menjalani radioterapi. Semakin telat pasien tidur akan meningkatkan kemungkinan respon klinis yang lebih buruk. Setelah disesuaikan dengan faktor-faktor lain, dapat diketahui bahwa jam mulai tidur pasien mempengaruhi secara independen terhadap respon klinis pada pasien kanker serviks stadium lokal lanjut yang menjalani radioterapi

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Background: Cervical cancer is the second most common cancer and the third largest cause of mortality due to cancer in Indonesia. Definitive chemoradiotherapy is the main modality in treating locally advanced cervical cancer patient. Previous studies have shown that there is a difference in tumour response between patients who received radiation in the morning compared to the afternoon. It is known that the quality and quantity of sleep is associated with an increase in carcinogenic factors, and may cause immunosuppression. Research also shows that sleep disturbance is an independent prognostic factor in influencing overall survival. The aim of this study is to determine the relationship between sleep quality and quantity on clinical response in locally advanced cervical cancer patients undergoing radiotherapy.

Methods: This is a cross-sectional study in cervical cancer patients treated with definitive chemoradiotherapy in Radiotherapy Department, Ciptomangunkusumo Hospital. Quality and quantity of sleep data was extracted from previous interview done with study subjects by Ramli et al, which include the duration, quality, and night bedtime schedule, and also the frequency, duration, quality, and nap time. Clinical response was assessed by physical examination by the end of radiotherapy treatment.

Results: Mean age of 43 patients were 50 years with non-keratinizing, moderate differentiation squamous cell carcinoma. From univariate logistic regression, there was an association between bedtime schedule and clinical response (p=0.032) with a good strength (OR: 3.13; 95% CI: 1.1-8.88). Multivariate analysis also showed that with a late bedtime schedule, there was a higher chance of incomplete clinical response in patients (p=0.035, OR: 3.14; 95% CI: 1.1-8.94)

Conclusion: There was no relationship between quality of sleep and clinical response for locally advanced cervical cancer who underwent radiotherapy. Meanwhile, bedtime yield a significant association with cervical cancer clinical response. After further adjustment with other factors, bedtime was an independent factor for locally advanced cervical cancer clinical response. "

"Latar Belakang: Disfagia adalah gangguan fungsi menelan yang disebabkan oleh gangguan neurologik, non-neurologik, ataupun campuran. Disfagia dapat menyebabkan berbagai komplikasi yang membahayakan kehidupan jika tidak ditangani dengan baik. Profil pasien disfagia baik di Indonesia maupun di negeri lain tidak terdata dengan baik sehingga diperlukan lebih banyak penelitian dalam hal ini guna meningkatkan kualitas dan efisiensi rehabilitasi disfagia di masa yang mendatang. Metode: Penelitian deskriptif retrospektif ini dilakukan di RSCM dengan mendata profil 52 pasien disfagia yang datang ke poli rehabilitasi medik RSCM dari Januari sampai dengan Juni 2023 yang terpilih menggunakan teknik consecutive sampling. Usia, jenis kelamin, fase disfagia, etiologi disfagia, dan derajat disfagia dari subjek terpilih dikumpulkan melalui akses rekam medis masing-masing pasien. Hasil: Subjek berumur 58–67 tahun paling prevalen dengan perbandingan keseluruhan jenis kelamin subjek laki-laki terhadap perempuan sebesar 1.08:1. Seluruh subjek didiagnosis dysphagia orofaringeal dan 84,6% kasus disebabkan oleh etiologi neurologik. Derajat disfagia beragam di antara subjek dengan skor penetration-aspiration scale (PAS) 8 paling prevalen (32,7%). Kesimpulan: Penelitian ini telah mendata profil usia, jenis kelamin, fase disfagia, etiologi disfagia, dan derajat disfagia dari 52 pasien disfagia yang terpilih. Data yang telah terkumpul dan disajikan direkomendasikan untuk dipakai dan dianalisis lebih lanjut oleh penelitian lain di masa mendatang.

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Background: Dysphagia is defined as the dysfunction in swallowing which is caused by neurologic, non-neurologic, and other mixed etiologies. Dysphagia can lead to multiple life-threatening complications if proper intervention isn’t given. Profiles of patients with dysphagia aren’t well documented in Indonesia nor in other countries. This calls for more researches to study this topic to increase the quality and efficiency of dysphagia rehabilitation in the future. Methods: A retrospective descriptive study was done at RSCM by collecting the data of 52 patients with dysphagia that visited RSCM’s medical rehabilitation ward from January to June of 2023 chosen with the consecutive sampling technique. Age, gender, dysphagia phase, dysphagia etiology, and dysphagia degree of selected subjects was collected by accessing the their medical records. Results: Subjects aged 58–67 years old were the most prevalent with an overall comparable man to woman ratio of 1.08:1. All subjects were diagnosed with oropharyngeal dysphagia mostly caused by neurologic etiologies (84,6%). Dysphagia degree amongst subjects showed a considerable variety with a penetration-aspiration scale (PAS) score of 8 being the most prevalent (32.7%). Conclusion: This research has documented the age, gender, dysphagia phase, dysphagia etiology, and dysphagia degree profiles of 52 selected dysphagic patients. The data presented is recommended to be used and analysed further in future studies."