Hasil Pencarian  ::  Simpan CSV :: Kembali

"[Latar Belakang : Kejadian Penyakit Paru Obstruktif Kronis (PPOK) Eksaserbasi akut pada jemaah haji meningkat selama menjalankan aktivitas haji. oleh karena itu, diagnosis dan stratifikasi PPOK sebelum haji perlu dilakukan untuk memulai tatalaksana PPOK sejak dini dan menurunkan risiko eksaserbasi akut. Indeks BODE (Body mass, Obstruction, Dyspnoe, Exercise) merupakan salah satu sistim stratifikasi multidimensional yang dapat dipakai untuk menentukan risiko eksaserbasi. Penelitian ini dibuat untuk mengetahui hubungan antara Indeks BODE dengan kejadian PPOK eksaserbasi akut pada jemaah haji.Metode : Studi kohort retrospektif pada jemaah haji PPOK asal Daerah Khusus Ibukota (DKI) Jakarta tahun 2012. Indeks BODE ditentukan dari rekam medis. Rekam medis berasal dari skrining PPOK pada jemaah haji yang dilaksanakan 24 jam sebelum keberangkatan, dan eksaserbasi ditentukan segera setelah jemaah pulang haji melalui proses anamnesis subjek penelitian, laporan dokter kloter, dan melihat catatan di buku kesehatan haji. Hubungan antara dua variabel dan risiko relatif ditentukan dengan uji Chi-Square.Hasil : Terdapat 60 orang subjek penelitian PPOK yang diambil secara konsekutif dari data sekunder. Ada 35 (58.3%) subjek penelitian yang mengalami PPOK eksaserbasi akut, dan dari keseluruhan eksaserbasi akut ada 5 orang (14.2%) yang rawat inap. Rentang indeks BODE dari 0-6. Subjek penelitian dengan indeks BODE 0-2 berjumlah 48 orang (80%), indeks BODE 3-4 ada 6 orang (10%) dan indeks BODE 5-6 ada 6 orang (10%). Uji Chi Square dengan Fisher Exact Test antara kelompok risiko rendah (indeks BODE 0-3) dengan risiko tinggi (indeks BODE >3) didapatkan p =0.009, RR 1.9 (IK 1.4-2.5)Simpulan : Rentang Indeks BODE pada jemaah haji PPOK adalah 0-6 dimana Jemaah haji PPOK dengan indeks BODE >3 memiliki risiko eksaserbasi akut 1.9 kali lebih tinggi dibandingkan dengan jemaah haji PPOK dengan indeks BODE 0-3., Background: Incident of acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) increase in pilgrims during hajj period. Early diagnosis and grading of COPD before hajj is important to start treatment and reduce risk of acute exacerbation. BODE Index (Body mass, Obstruction, Dyspnoe, Exercise) is one of multidimensional grading system to predict risk of acute exacerbation COPD. This research was intend to find association between BODE Index and incident of acute exacerbation COPD in hajj pilgrimsMethods: This is a retrospective cohort study among COPD hajj pilgrims year 2012 from Jakarta. BODE index was calculated from medical record. Medical record was obtained by screening process of COPD among hajj pilgrims 24 hours before flight. Exacerbation was determined immediately after arrival through history taking and examination of subject, interview of the physician in charge of the flight group (kloter), and analyzed record from personal hajj book. Association between two variables and the relative risk were calculated by Chi-Square test or Fisher Exact test.Results: Sixty COPD subjects with complete BODE index data were identified and subsequently recruited. Thirty five subjects (58.3%) suffered from acute exacerbation of COPD. Of all exacerbation, there were 5 subjects (14.2%) who were hospitalized. BODE index range from 0-6, 48 subjects (80%) had BODE index 0-2, 6 subjects (10%) had BODE index 3-4, and 6 subjects (10%) had BODE index 5-6. Fisher Exact Test result between low risk group (BODE index 0-3) and high risk (BODE index >3) is p = 0.009, relative risk 1.9 (CI 1.4-2.5)Conclusion: The range of BODE index among COPD hajj pilgrims is 0-6; COPD hajj pilgrims with BODE index > 3 have significant higher risk of acute exacerbation of COPD 1.9 times compared with BODE index 0-3.]"

"Mortalitas pasien pneumonia di rumah sakit meningkat pada saat pandemi COVID-19. Perlu diidentifikasi faktor-faktor risikonya dari determinan biologi, gaya hidup, lingkungan dan pelayanan kesehatan. Penelitian ini menggunakan disain campuran studi kuantitatif kohort retrospektif dan studi kualitatif sequential explanatory. Sampling studi kuantitatif diambil secara acak sederhana dari rekam medis Mei 2020-Desember 2021 di RS dr. Cipto Mangunkusumo, Jakarta. Studi kualitatif berupa wawancara mendalam bersama enam orang informan. Terdapat 1945 subjek pneumonia dengan insiden kematian 34,1%. Determinan yang berhubungan dengan peningkatan risiko kematian adalah pneumonia berat (HR 1,8;IK95% 1,38-2,43), skor CCI ≥2 (HR 1,5;IK95% 1,16-2,08). komplikasi ≥2 (HR 5,9; 95%IK 2,9-11,9), intubasi (HR 1,6;IK95% 1,27-2,05) dan lama tunggu di IGD ≥8 jam (HR1,4;IK95% 1,12-1,63), tren kematian rawat inap meningkat seiring dengan bertambahnya usia. Risiko kematian lebih rendah pada subjek dengan infeksi utama selain paru (HR 0,4;IK95% 0,35-0,51), subjek yang mendapat perawatan intensif (HR 0,3;IK95% 0,25-0,41), terapi antikoagulan (HR 0,3;IK95% 0,27-0,44) dan terapi steroid pada pneumonia non-COVID-19 kondisi berat (0,7;IK95% 0,5-0,9). Ketangguhan rumah sakit terjaga dengan adanya kebijakan zonasi, penerapan prinsip mitigasi risiko, dan modulasi layanan. Beban finansial berkurang melalui donasi atau hibah. Kerentanan rumah sakit antara lain kerapuhan infrastruktur, kecepatan kembali ke layanan reguler lebih lambat, rasa takut tenaga kesehatan, dan triase pra-rumah sakit belum berjalan.Determinan biologi, lingkungan dan pelayanan kesehatan berhubungan dengan sintas rawat inap pasien pneumonia pada masa pandemi COVID-19. Ketahanan rumah sakit perlu dinilai dengan melihat dampak pandemi terhadap kematian pneumonia COVID-19 maupun pneumonia non-COVID-19.

---

In-hospital mortality of pneumonia increased during the COVID-19 pandemic. It is necessary to identify risk factors from biological determinants, lifestyle, environment and health services. This research uses a mixed design of a retrospective cohort quantitative study and a sequential explanatory qualitative study. Quantitative subjects were selected using simple random sampling based on medical records May 2020-December 2021 at Dr. Cipto Mangunkusumo Hospital, Jakarta. In-depth interviews with six informants were performed. There were 1945 pneumonia subjects with a mortality incidence of 34,1%. Determinants associated with an increased mortality risk were severe pneumonia (HR 1,8; 95% CI 1,38-2,43), CCI score ≥2 (HR 1,5; 95% CI 1,16-2,08). complications ≥2 (HR 5,9; 95% CI 2,9-11,9), intubation (HR 1,6; 95% CI 1,27-2,05) and waiting time in the ER ≥8 hours (HR1,4 ;95% CI 1,12-1,63), the trend of inpatient mortality increases with increasing age. The risk of death was lower in subjects with primary infections other than lung (HR 0,4; 95% CI 0,35-0,51), subjects receiving intensive care (HR 0,3; 95% CI 0,25-0,41), anticoagulant therapy (HR 0,3; 95% CI 0,27-0,44) and steroid therapy in severe non-COVID-19 pneumonia (0,7; 95% CI 0,5-0,9). Hospital resilience is maintained by having zoning policies, implementing risk mitigation principles, and modulating services. Financial burden is reduced through donations or grants. Hospital vulnerabilities include infrastructure fragility, slower return to regular services, fear of health workers, and pre-hospital triage not yet in place. Biological, environmental and health service determinants are related to the survival rate of pneumonia patients during the COVID-19 pandemic. Hospital resilience needs to be assessed by looking at the impact of the pandemic on mortality from COVID-19 pneumonia and non-COVID-19 pneumonia."