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"Latar belakang: Separasi sternum atau dehisensi adalah komplikasi sternotomi mediana yang jarang terjadi tetapi memiliki angka morbiditas dan mortalitas yang tinggi. Ketidakstabilan sternum merupakan salah satu faktor timbulnya dehisensi dan teknik aproksimasi sternum adalah komponen penting dalam pencegahannya. Penelitian ini membandingkan dua teknik aproksimasi sternum menggunakan kawat baja tahan karat antara teknik trans-sternal figure-of-eight dan simple interrupted.Metode: Penelitian eksperimental secara in vivo pada 24 sternum kambing. Setelah sternotomi, 12 sternum di aproksimasi menggunakan kawat baja tahan karat dengan teknik trans-sternal figure-of-eight dan 12 sternum yang lain dengan teknik simple interrupted. Uji biomekanik yang terdiri dari regangan transversal, longitudinal dan tarikan lateral dilakukan dengan pembebanan 100- 400 N pada setiap kelompok 4 sternum . Separasi sternum diukur pada setiap pembebanan. Analisis dilakukan dengan uji T-test independent.Hasil: Pada uji biomekanik regangan transversal dan longitudinal, aproksimasi sternum menggunakan kawat baja tahan karat dengan teknik trans-sternal figure-of-eight memiliki perbedaan bermakna secara statistic dibandingkan teknik simple interrupted p 0,05.Kesimpulan: Aproksimasi sternum menggunakan kawat baja tahan karat dengan teknik trans-sternal figure-of-eight lebih stabil dibandingkan simple interrupted secara biomekanik. Kestabilan ini diharapkan dapat memberikan penyembuhan yang lebih baik pada sternum.

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Backgrounds Sternal separation or dehiscence is a rare complication of median sternotomy with high morbidity and mortality. Instability after sternotomy is one factor for the development of the dehiscence and sternal approximation technique is a key component in prevention of that. This study compares two sternal approximation technique using stainless steel between trans sternal figure of eight and simple interrupted.Methods Experimental in vivo studies using 24 goat rsquo s sternum. Sternotomy is performed. 12 sternum fixed with trans sternal figure of eight sutures using a stainless steel wire and 12 others fixed with trans sternal simple interrupted sutures. Biomechanical test consists of testing of transverse shear, longitudinal shear, and lateral distraction performed on each group 4 sternum each type of the test with a load ranging from 100 Newtons to 400 Newtons. Sternal separation was measured for each level of loading. Independent T test was performed to analize the data.Results Biomechanical test of transverse and longitudinal shear, sternal approximation using trans sternal figure of eight technique is better than simple interrupted and the difference was statistically significant p 0.05.Conclusions Sternal approximation using stainless steel wire, trans sternal figure of eight technique provides better stability rather than simple interrupted based on biomechanical analysis. This stability is expected to affect the rate of healing of the sternum better. "

"ABSTRAKLatar belakang: Beberapa komplikasi sulit yang timbul setelah tindakan sternotomi mediana yang menjadi penyebab utama mortalitas dan morbiditas pasien. Hal ini dapat dicegah dengan aproksimasi sternum yang stabil, Berbagai macam teknik jahitan fiksasi untuk aproksimasi sternum menggunakan wire. Peneliitian ini membandingkan biomekanik teknik jahitan figure of eight trans-sternal dan peristernal. Metode: Penelitian eksperimental pada sternum kambing sebanyak 36 sampel, dilakukan sternotomi mediana, kemudian dilakukan fiksasi sternum menggunakan wire, 18 sampel dilakukan fiksasi jahitan figure of eight peristernal dan 18 sampel trans-sternal. Dinilai dengan uji komparasi tiga dimensi: lateral distraction, transversal shear dan longitudianal shear dengan beban 125N, 150N, 200N, 250N, 300N, 400N. pergeseran diukur dalam mm setiap tingkat pembebanan. Dilakukan analisis statistik dengan uji independent sample t-test. Hasil: Pada uji lateral distraction dan longitudinal shear didapatkan perbedaan bermakna pada pemberian beban ringan 125N, 150N dan 200N, pada beban 300N dan 400N tidak ada perbedaan bermakna. Uji transversal shear tidak ada perbedaan bermakna pada kedua teknik jahitan. Pada hasil uji tarik kedua teknik jahitan mengalami pergeseran lebih dari 2mm pada pembebanan 250 N. Kesimpulan: Stabilitas sternum pada teknik jahitan figure of eight peristernal sama dibanding jahitan figure of eight trans-sternal.

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ABSTRACTBackgrounds There are troublesome complications following median sternotomy which are lead to major causes of morbidity and mortality of patients. This can be prevented by stable sternal approximation, Various suturing fixation method for sternal approximation using wire. To compare the biomechanics of the figure of eight trans sternal and the peristernal suturing method. Methods Experimental study on goat sternum 36 samples, performed sternotomi mediana, then performed sternum fixation using wire, 18 samples performed suturing fixation of figure of eight peristernal and 18 sample trans sternal. Assessed by a three dimensional comparative test lateral distraction, transversal shear and longitanium shear with loads of 125N, 150N, 200N, 250N, 300N, 400N. Shifts are measured in mm at each loading level. Statistical analysis was performed using independent sample t test. Results In lateral distraction and longitudinal shear tests, there were significant differences in the loading of light loads of 125N, 150N and 200N. The transverse shear test no significant difference in the two suturing techniques, In the bending test results both suturing method experience a shift of more than 2mm at 250 N loading. No other significant differrences in clinical outcomes. Conclusions The sternal stability of the peristernal figure of eight method is the same as that of the trans sternal figure of eight."

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Latar Belakang : Terdapat perdebatan jangka panjang di antara dokter bedah plastik mengenai bahan benang yang ideal untuk penjahitan luka. Banyak dokter bedah berpendapat bahwa material monofilamen lebih baik dibandingkan dengan monofilamen karena lebih mudah dalam melakukan simpul, tidak mudah terbuka, dan menimbulkan reaksi radang yang minimal. Pendapat lain tidak keberatan dengan benang multifilamen dan menganggap hasil yang diberikan tidak lebih buruk dibandingkan dengan monofilamen Pasien dan Metode : Defek sekunder donor tandur kulit full-thickness di area inferior abdomen dijahit menggunakan Vicryl 4.0 untuk lapisan dalam, dan pada lapisan luar dibagi menjadi grup Vicryl 4.0 dan grup Nylon 4.0. Seluruh pasien dilakukan follow-up hingga enam bulan setelah tindakan operasi dan diukur nilai VAS masing-masing pasien terhadap bekas luka jahitan. Hasil : Terdapat total 20 pasien disertakan dalam penelitian ini. Setelah 6 bulan pasca operasi, skor VAS pada grup pasien multifilamen memiliki nilai rerata 6.8, sedangkan pada grup monofilamen nilai rerata 7. Komplikasi berupa infeksi, dehisens, dan peradangan ditemukan pada satu pasien dari setiap grup. Kesimpulan : Tidak didapatkan perbedaan signifikan antara bekas luka yang dihasilkan dan komplikasi yang terjadi pada luka yang dijahit menggunakan benang multifilamen dengan monofilamen.

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Background : There is long-standing disagreement among plastic surgeons as to the ideal suture material for closing skin wounds. Many surgeons believe hat monofilament suture material is preferable, as it is easier to tie, is unlikely to break prematurely, and elicits a minimal inflammatory response. Others feel that these issues are of minor importance and prefer absorbable multifilament sutures because they do not have to be removed, thus saving the surgeon time and decreasing patient anxiety and discomfort. Patients and Methods: Full thickness skin graft were taken from inferior abdominal. All deep tissues were closed with 4.0 Vicryl, while on the subcuticular level one group was sutured using 4.0 Vicryl and the other with 4.0 Nylon. All patients were followed for up to 6 months after surgery and VAS score of the scar were recorded from each patient. Result : Twenty patients were included in this study and divided into two groups. After 6 months evaluation, the mean VAS score for the aesthetic perception of the scar from the multifilament suture group was 6.8 and from the monofilament group was 7. Infection, dehiscence, and inflammation were found on one patient from the multifilament group and hypertrophic scar on one patient from each group. Conclusion : There are no significant difference on scar formation and complication between FTSG donor defects that were sutured using multifilament and monofilament suture.

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"SBRT adalah salah satu metode dalam radioterapi dengan menggunakan fraksi yang sedikit namun memiliki efek samping berpotensi menghasilkan wilayah hostpsot. Diusulkan volume target baru, yaitu Definie Target Volume (DTV). DTV memiliki probabilitas tinggi dimana jaringan target berada. DTV ditentukan melalui probabilitas okupansi dan kontraksi margin. DTV akan menjadi target prioritas dan PTV-crop diberlakukan seperti PTV pada perencanaan klinis. Optimisasi DTV dilakukan dengan eksplorasi dosis secara maksimum namun dengan membatasi dosis ke bagian OAR. Berdasarkan perencanaan, pada volume DTV kasus HCC, peningkatan 𝐷𝑚𝑎𝑥 tertinggi mencapai 187,3% dengan rata-ratanya 124,98% ± 29,02%. Untuk volume PTV-crop, rata-rata peningkatan 𝐷𝑚𝑒𝑎𝑛 adalah 103,84% ± 4,69%. Peningkatan 𝐷𝑚𝑎𝑥-DTV kasus serviks mencapai 138,49% dan rata-ratanya 116,80% ± 13,19%. Pada PTV-crop, rata-rata peningkatan 𝐷𝑚𝑒𝑎𝑛 serviks 101,89% ± 5,58%. Pemberian dosis yang besar pada target DTV akan berkaitan dengan peningkatan pada OAR. Peningkatan dosis OAR-HCC sebesar 106,93% ± 5,57% dan OAR-serviks sebesar 101,18% ± 1,87%. Hasil penelitian ini didapatkan dosis pada target DTV mengalami peningkatan yang cukup tinggi namun target PTV-crop mempunyai peningkatan dosis yang masih sesuai dalam standar untuk klinis. Selain itu OAR sekitar target meskipun dosis rata-ratanya meningkat, namun tidak terlalu signifikan dan masih dibawah konstrain.

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SBRT is a method in radiotherapy using a small fraction but has side effects that have the potential to produce a host site. A new target volume is proposed, namely the Define Target Volume (DTV). DTV has a high probability of where the target network is. DTV is determined through the probability of occupancy and the contraction margin. DTV will be a priority target and PTV-crop is treated like PTV in clinical planning. Optimization of DTV is carried out by exploring the maximum dose but by limiting the dose to the OAR. Based on the plan, on the DTV volume of HCC cases, the highest 𝐷𝑚𝑎𝑥 reached 187.3% with an average of 124.98% ± 29.02%. For PTV-crop volume, the average 𝐷𝑚𝑒𝑎𝑛 increase to 103.84% ± 4.69%. The dose escalation in 𝐷𝑚𝑎𝑥-DTV for cervical cases reached 138.49% and the average was 116.80% ± 13.19%. In the PTV-crop, the average escalation in cervical 𝐷𝑚𝑒𝑎𝑛 was 101.89% ± 5.58%. Prescription of large doses to target DTV will be associated with an increase in OAR. The increase in the dose of OAR-HCC was 106.93% ± 5.57% and OAR-cervix was 101.18% ± 1.87%. The results of this study obtained that the dose on the DTV target had increased quite high, but the PTV-crop target had an increased dose that was still according to clinical standards. In addition, the OAR is around the target, although the average dose has increased, it is not very significant and is still under constraints."

"ABSTRAK Penelitian ini bertujuan untuk menguji signifikansi antara teknik manajemen danpraktik akuntansi manajemen dalam meningkatkan kinerja perusahaan dengan tigastrategi yang berbeda, yaitu differentiation, low cost, dan combination. Teknikmanajemen mencakup improving existing processes, quality systems,manufacturing systems innovation, integrating systems, team-based structures,dan human resource management policies. Sedangkan, praktik akuntansimencakup traditional techniques, activity-based techniques, balance performanemeasures, employee-based measures, benchmarking, dan strategic planning.Penelitian menggunakan sampel orang yang memiliki pengalaman kerja diperusahaan manufaktur dan menggunakan model persamaan struktural. Hasilnyaterdapat perbedaan kombinasi dari komponen teknik manajemen dan praktikakuntansi manajemen dari ketiga strategi yang berpengaruh terhadap kinerja.

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ABSTRACT This research aims to test whether significance of management techniques andmanagement accounting practices can improve the performance of the company inthree different strategies, which are differentiation, low cost, and combination.Management techniques include improving existing processes, quality systems,manufacturing systems by innovation, integrating systems, team-based structures,and human resource management policies. While, management accountingpractices include traditional techniques, activity-based techniques, balancesperformane measures, employee-based measures, benchmarking, and strategicplanning. Samples are people who have working experience in manufacturingcompanies, and use structural equation modelling. Results concluded that thereare differences combination of management techniques and managementaccounting practices components for the strategies which have an effect on to theperformance."

"ABSTRAKIbu pasca bedah sesar dapat mengalami postpartum blues karena tidak mampu mengontrol terhadap perubahan fisik maupun psikologis selama masa nifas. Penelitian ini bertujuan untuk mengetahui efektifitas paket pendidikan kesehatan dan teknik relaksasi terhadap kejadian postpartum blues pada ibu pasca bedah sesar. Penelitian ini menggunakan desain quasi eksperimen. Teknik pengambilan sampel menggunakan konsekutif pada 60 responden yang terbagi dalam kelompok kontrol dan intervensi. Instrumen yang digunakan berupa kuesioner postpartum blues.Hasil penelitian menunjukkan ada perbedaan yang signifikan kejadian postpartum blues sebelum dan setelah intervensi pada kelompok intervensi p 0 000 paket efektif 16 kali menurunkan kejadian postpartum blues setelah dikontrol oleh faktor pendidikan OR 16 2 CI 95 3 212 81 698. Paket pendidikan kesehatan dan teknik relaksasi efektif menurunkan kejadian postpartum blues dan direkomendasikan di pelayanan kesehatan untuk meningkatkan kesehatan ibu pasca bedah sesar.

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ABSTRACT

Post caesarean mothers may experience postpartum blues because they are unable to control their physical and psychological changes during postpartum period. This study aimed to measure the effectiveness of the health education package and the relaxation techniques against the incidence of postpartum blues in post caesarean mothers. This study applied a quasi experimental design. The samples were 60 respondents divided into a control and an intervention groups selected by consecutive sampling. The instrument was the postpartum blues questionnaire.

The results showed that there was a significant difference between the incidence of postpartum blues before and after the intervention in the intervention group p 0 000. The intervention package was 16 times more effective to decrease the incidence of postpartum blues after being controlled by the education factor OR 16 2 95 CI 3 212 81 698. The health education package and the relaxation techniques were effectively reduced the incidence of postpartum blues and recommended in health care to improve the health of post caesarean mothers."