eJournal Kedokteran Indonesia

Effective Learning Strategies in The Emergency Department for Medical Students

Imamul Aziz Albar — 2023-12-29

Clinical learning in the emergency department is one of the rotations carried out by medical students in the medical education program. Learning in the emergency department can help students fulfill their competence in emergency clinical skill, such as basic life support, management of acutely ill patients and some other competencies. However, the emergency department has some limitations, such as the variety of professionals and students serving the patients, various diseases with varying levels of severity, as well as the unpredictable condition and number of patients. Those reasons make it difficult for students to study and practice emergency medicine well. Therefore, clinical educators’ awareness of the conditions in the emergency department and the application of appropriate learning models will enable students to get the best learning experience in the emergency department.

Inkontinensia Urin pada Perempuan

Suskhan Djusad — 2023-12-29

Inkontinensia Urin (IU) merupakan kondisi pasien yang tidak dapat menahan keluarnya urin atau keluarnya urin secara involunter. Faktor risiko IU adalah usia, status hormonal dan menopause, obesitas, diabetes melitus tipe 2, PPOK, merokok, persalinan per vaginam, ras, serta riwayat keluarga/genetik. Jenis IU dapat dibedakan menjadi transien dan murni; IU murni dibagi menjadi tipe tekanan, desakan, overflow, dan kontinu. Diagnosis IU ditegakkan berdasarkan anamnesis, pemeriksaan fisik umum dan khusus, voiding diary, dan pemeriksaan penunjang. Tata laksana meliputi terapi konservatif dengan latihan Kegel dan pemasangan pesarium serta pembedahan antara lain dengan prosedur kolporafi anterior atau sling pubovaginal. Program intervensi harus menargetkan pasien dan suaminya agar menyesuaikan diri dengan kondisi sehingga dapatmeningkatkan kualitas hidup secara efektif.

Online Nutritional Education Using Wordwall Game to Improve Knowledge Among Overweight and Obese Children in Palembang

Tri Novi Kurniati Akhiryani — 2023-12-29

The increasing prevalence of overweight and obesity in school children can be prevented by providing nutrition education to improve their nutrition knowledge. PowerPoint media and online games have improved learning outcomes and increased interest and motivation during online education. This study aimed to analyze the effect of online nutritional education using PowerPoint media, with and without Wordwall Game, on nutritional knowledge among overweight and obese elementary school-aged children in Palembang, from March 6^thto 15^th, 2023. It followed a quasi-experimental design, using a nonequivalent control group model, and measured pre and post-intervention data. The study utilized a purposive sampling technique, resulting in a total of 108 overweight and obese students aged 10-12, with 54 subjects in each group. Nutritional knowledge data were obtained through structured questionnaires previously tested for validity and reliability. The results of the independent t-test showed a significant difference in the mean scores of nutrition knowledge, with better results observed in the experimental group (p= ≤0.001). This indicates that providing online nutrition education through Wordwall Games and PowerPoint media is more effective in improving six aspects of nutritional knowledge in elementary school children than those who only use PowerPoint slides.

Persepsi Pembelajaran Daring Mahasiswa Kedokteran

Mona Marlina — 2023-12-29

Proses belajar mengajar di Fakultas Kedokteran Universitas Pelita Harapan (FKUPH) berubah signifikan pada awal tahun 2020 akibat pandemi COVID-19. Program S1 Kedokteran, murni dilakukan melalui pembelajaran daring. Setelah satu semester menyelesaikan pembelajaran daring, FKUPH melakukan evaluasi secara kualitatif menggunakan Focus Group Discussion (FGD) pada Agustus 2020 sebagai bagian dari evaluasi pembelajaran. Total responden yang mengikuti FGD 21 mahasiswa dengan status aktif; 7 laki-laki dan 14 perempuan dari angkatan 2017, 2018 dan 2019. Pemilihan angkatan responden berdasarkan pengalaman belajar daring dan luring. FGD menghasilkan 4 tema yang terdiri atas pemahaman pembelajaran daring, keuntungan, kerugian pembelajaran daring, dan perasaan mahasiswa. Responden mampu beradaptasi terhadap perubahan dengan sangat baik. Fleksibilitas pembelajaran dan efisiensi waktu, memiliki lebih banyak waktu berkualitas bersama keluarga, terpenuhinya kebutuhan sehari-hari oleh keluarga, berkurangnya jenis pengeluaran selama kuliah, dan bahan pelajaran yang dapat diulang merupakan suatu keuntungan. Kerugiannya adalah masalah listrik dan internet, konsentrasi belajar menurun dan mudah teralihkan, suasana belajar tidak terasa, motivasi menurun, kesulitan menyediakan alat praktik klinik, miskomunikasi dalam tugas, godaan menyontek saat ujian, merindukan sosialisasi di kampus dan kehilangan kelompok belajar. Kekhawatiran tidak kompeten, kurang siap, dan perasaan terisolasi merupakan kerugian yang dirasakan responden. Respons cepat dari fakultas untuk mengantisipasi dan mengakomodasi keperluan mahasiswa merupakan dukungan yang berarti dan mampu meningkatkan rasa percaya diri mahasiswa selama menempuh pembelajaran jarak jauh.

Strengthening Competence of Hospital Data Management to Control The Quality Of Cesarean Section Rate in Banten Province, Indonesia

Omo Abdul Madjid — 2023-12-29

Cesarean delivery dramatically increased worldwide, including in Indonesia, especially after the implementation of National Health Insurance, with a steady increase of 2-3% every year. This study aims to evaluate the effect of guidance in implementing the Robson Classification in cesarean section quality control in hospitals. Three hospitals in Banten were enrolled in this study: one public hospital and two private hospitals. Each hospital’s staff were given online and offline training on quality control of cesarean section, managing cesarean section data, data entry, data analysis and presentation using Robson Classification. Participant’s knowledge and attitude were collected before and after intervention using a standardized questionnaire. The results showed that the intervention improved many aspects of the workflow and knowledge of the hospital staff regarding cesarean section. There was an increase of up to 77.7% in digital data management, a 23.6% increase in routine meeting activities, and a 29.5% increase in cesarean quality control. The Robson classification system was implemented successfully, increasing the staff's ability to identify the groups needing cesarean sections more effectively. Guidance on data management for cesarean section increases the ability of the three hospitals in Banten to control cesarean section using Robson's Classification. Guidance methods can be used to assist other hospitals in controlling cesarean section.

Incidence of Anxiety and Depression and Its Related Factors in Family Caregivers of Cancer Patients

Ana Yuliani — 2023-12-29

Cancer patients’ family caregivers are critical in supporting and caring, particularly in developing countries with limited resources. However, little is known about the incidence of anxiety and depression among cancer patients’ caregivers in Indonesia. This study aimed to identify the incidence of anxiety and depression and explore the related factors among cancer patients' family caregivers at Soehadi Prijonegoro Public Hospital Indonesia. A cross-sectional study was conducted from November 2022 to January 2023, involving 85 caregivers. The Hamilton Anxiety and Depression Rating Scale were used to assess anxiety and depression levels, respectively. The study revealed high anxiety (3.5%) and mild to moderate anxiety levels (89.4%) among family caregivers. Additionally, approximately half of the caregivers (45.9%) experienced depression, with mild depression being the most common (35.3%). Significant correlations were found between anxiety and age (p=0.007), length of patient's sick time (p=0.010), and family care time (p=0.009). Age was negatively correlated with anxiety and depression. Moreover, the caregiver who lived with the patient correlated with anxiety (p=0.005) and depression (p=0.016). This study highlights the significant burden of anxiety and depression among cancer patient caregivers. Healthcare professionals should consider the identified factors when developing tailored interventions.

Kadar 25-hydroxyvitamin D Pre-operatif pada Lansia dengan Fraktur Tulang Panjang

Abror Irsan — 2023-12-29

Vitamin D merupakan komponen penting pada tubuh. Kadar vitamin D yang cukup dapat terlihat pada densitas mineral tulang, kejadian fraktur, dan fungsi neuromuskular. Pada lansia, vitamin D berpengaruh terhadap fungsi otot rangka yaitu mengurangi resiko jatuh dan patah tulang. Penelitian mengenai kadar vitamin D preoperatif pada lansia dilakukan secara deskriptif - cross sectional dengan total 35 pasien di Rumah Sakit Anton Soedjarwo, Pontianak pada periode Juli 2022 hingga Desember 2022. Pengukuran konsentrasi serum 25-hydroxyvitamin D dilakukan dengan metode Chemiluminescent Microparticle Immunoassay (CMIA). Pada 35 pasien lansia dengan fraktur tulang panjang didapatkan 23 pasien perempuan dan 12 laki-laki. Kadar 25-hydroxyvitamin D didapatkan kategori defisiensi 23 pasien, insuffisiensi 6 pasien, dan suffisiensi 6 pasien. Kondisi defisiensi kadar vitamin D paling banyak ditemukan pada kejadian fraktur femur, yaitu 12 pasien. Hasil penelitian menunjukkan mayoritas pasien lansia yang mengalami fraktur tulang panjang mengalami defisiensi vitamin D.

Coronavirus Disease 2019 Associated Liver Injury and Disease Severity: A Cross-Sectional Study

Leonard Nainggolan — 2023-12-29

Recent data on the coronavirus disease 2019 (Covid-19) outbreak has begun to shine light on the impact of the disease on the liver. However, data regarding Covid-19-associated liver injury remains limited. We analyzed whether there was a significant difference in liver injury in patients with different disease severity. A cross-sectional study was conducted for confirmed Covid-19 cases in dr. Cipto Mangunkusumo National Hospital from April 2020 until March 2021. Patients were divided based on disease severity: mild-to-moderate and severe Covid-19. Patients with existing chronic hepatitis, liver cirrhosis, fatty liver, or liver malignancies were excluded. Data on liver transaminase, prothrombin time, albumin, and bilirubin levels upon admission were analyzed for both groups. A total of 100 patients were included, consisting of 50 patients with mild-to-moderate cases and 50 patients with severe cases. Both alanine and aspartate aminotransferase levels elevation were predominantly found in the severe group (p<0.001 and p=0.002, respectively). We also found lower albumin levels in the severe group (p<0.001), but no significant difference in bilirubin level (p=0.568) and prothrombin time (p=0.253) was noted among the two groups. Liver injury is more common in severe than mild-to-moderate Covid-19 cases. This should be a consideration by physicians to handle the patients comprehensively.

Characteristics of Charity Cleft Patients in Haulussy General Hospital 2017-2019

Jilvientasia Godive Lilihata — 2023-12-29

Cleft lip and palate is a common congenital disorder with an incidence of 1 per 300 live births of Asian descent. There is a lack of cleft epidemiological data due to the absence of plastic surgeons, patients were referred to other provinces or enlisted to charity programs. This paper aims to evaluate the characteristics of our cleft patients at Haulussy General Hospital, Ambon, Maluku from 2017 – 2019. This is a retrospective study of 69 patients treated at Haulussy General Hospital, Ambon, Maluku, charity program from 2017 – 2019. Age, gender, diagnosis, procedure, and nutritional status were collected. 52% of patients are male with a median age of 4 years (range: 3 months – 34 years). The most common diagnosis was complete cleft palate (n=19), and the rarest was microform cleft lip (n=1). Complete cleft lip is more common in males, while isolated cleft palate is more common in females. The median age for primary lip repair, lip revision, and primary palate repair/revision was 1 year, 4.5 years, and 8 years, consecutively. Among 32 patients assessed for nutritional status, 22% were malnourished (19% were underweight, and 3% were severely underweight). Lip repair was done in 28 patients, palate repair in 36 patients, and lip or palate revision in 16 patients. The main techniques used were Lazy S and von Langenbeck.This retrospective study at Haulussy General Hospital from 2017 to 2019 highlights predominant cleft cases and malnutrition among patients. The findings emphasize the importance of tailored interventions and comprehensive care for individuals with cleft lip and/or palate.

Hubungan Terapi Anti-Koagulan dan Status Gizi pada Pasien COVID-19 Derajat Sedang-Berat dengan Mortalitas di Rumah Sakit Sumber Waras, 2021

Roy Akur Pandapotan — 2023-12-29

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) adalah patogen dengan target utama sistem pernapasan dan berhubungan dengan gangguan hiperkoagulasi. Pencegahan insidens trombosis pada pasien COVID-19 dengan obesitas menjadi masalah yang berkaitan dengan efektivitas dan variasi dosis antikoagulan. Tujuan penelitian ini adalah mengetahui hubungan jenis terapi antikoagulan pada pasien COVID-19 derajat sedang-berat yang mengalami status gizi normal dan obesitas dengan mortalitas. Penelitian menggunakan desain retrospektif cross-sectional di Rumah Sakit Sumber Waras, Jakarta Barat pada bulan Januari sampai Juni 2021 pada pasien COVID-19 gejala sedang-berat yang diberikan antikoagulan (unfractioned heparin atau fondaparinux/UFH). Data dianalisis dengan uji chi-square. Jumlah subjek yang dianalisis 152 pasien dengan status gizi terbanyak adalah obesitas 1 (38,82%). Rerata D-dimer subjek obesitas lebih tinggi dari kelompok status gizi normal (2040,61 vs 1955,79 mg/dL). Jumlah subjek yang mendapat heparin dan meninggal adalah 27,3% pada kelompok gizi normal dan 11,1% pada kelompok obesitas. Pada subjek yang mendapat fondaparinuks dan meninggal adalah 31,3% pada kelompok gizi normal dan 15,7% pada kelompok obesitas Tidak terdapat hubungan antara tingkat mortalitas dengan status gizi pada subjek yang mendapat heparin (p=0,08, OR=0,33) maupun fondaparinuks (p=0,17; OR=0,41). Tidak terdapat hubungan antara tingkat mortalitas dengan kondisi obesitas yang mendapat heparin maupun fondaparinuks. Antikoagulan menjadi salah satu manajemen penting untuk penderita COVID-19 dengan obesitas.

Predicting Urinary Incontinence among Postpartum Women

Surahman Hakim — 2023-12-29

Urinary incontinence (UI) is common during a pregnancy-puerperium period, with a prevalence of 18.6-75% during pregnancy and 6-31% during postpartum. This study aims to review several published studies on which risk factors impact the incidence of UI.The search was conducted on Pubmed®, Cochrane Library®, and Ovid®, resulted in 57, 30, and 11 studies, respectively. We included cross-sectional, cohort, or case-control studies related to this aim. The risk of bias within the study was assessed using the Cochrane and Forrest plot was analysed using Review Manager 5.3. On maternal characteristics, age less than 35 years (OR 0.49; 95% CI 0.35-0.67), primiparity (OR 0.29; 95% CI 0.22-0.38), and BMI <25 kg/m2 (OR 0.67; 95% CI 0.55-0.83) were considered as protective factors. A low level of education (OR 2.16; 95% CI 1.69-2.77) increased the risk of UI, Meanwhile, they showed heterogeneity among studies (I²>50%). On delivery methods, the most prone to UI was emergency caesarean section followed by instrumental vaginal deliveries, spontaneous vaginal deliveries, and caesarean section. Episiotomy, epidural analgesia, and obstetric anal sphincter injury (OASIS) were not associated with UI (p>0.05). On neonatal parameters, head circumference <35 cm has a protective effect on UI (OR 0.82; 95% CI 0.73-0.93; I²=0%). Methods of delivery and head circumference will affect postpartum UI according to p-value (p<0.05) and homogeneity among studies (I²<50%).

In Silico Analysis of Single Nucleotide Polymorphisms Related to Susceptibility and Severity in COVID-19 Patients

Yulia Ariani — 2023-12-29

Coronavirus disease 2019 (COVID-19) is a respiratory tract symptoms caused by the infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which exhibits a wide range of symptoms, from mild to severe. Genetic factors play a significant role in determining severity of the symptoms. Specifically, certain variants within genes can predispose individuals to experience severe COVID-19 symptoms. Therefore, this study aims to analyze these variants, also known as single nucleotide polymorphisms (SNP) within the ABO, TMPRSS2, ACE2, PAI-1, and IFNAR2 genes. The in silico method was used based on internet sites and software to identify the level of SNP pathogenicity, stability, visualization of 3-dimensional protein structures, and figures of amino acid changes as well as to analyze the pathomechanism of variants that lead to susceptibility or severe symptoms of COVID-19 patients. The results showed that the presence of SNP influences changes in the structure or stability of proteins, and the 3-dimensional structure of all proteins affected by SNP was successfully visualized. Based on pathomechanism analysis and amino acid structure of F216I and P74S protein ABO residues, V160M protein TMPRSS2, I468V, and K26R protein ACE2 are associated with susceptibility of the patient to SARS-CoV-2 infection. In addition, the results of the in silico analysis showed that A15T residues of PAI-1 protein, F10V, and F8S IFNAR2 protein were included with pathomechanisms leading to severe symptoms of COVID-19.

Perbandingan Hemodialisis dan Continuous Ambulatory Peritoneal Dialysis terhadap Kualitas Hidup

Ryan Andika — 2023-12-29

Insiden penyakit ginjal kronik terus bertambah setiap tahunnya. Pada pasien penyakit ginjal kronik tahap akhir atau end stage renal disease (ESRD) dibutuhkan renal replacement therapy. Kualitas hidup pada pasien yang menjalani renal replacement therapy adalah faktor penting yang perlu dipertimbangkan
dalam memberikan terapi pada pasien ESRD. Laporan kasus berbasis bukti ini bertujuan membandingkan kualitas hidup pasien ESRD yang mendapat terapi continuous ambulatory peritoneal dialysis (CAPD) dengan hemodialisis berdasarkan short form 36 (SF-36). Penelusuran literatur dilakukan pada tanggal 23
Februari 2023 menggunakan database PubMed, Science Direct, dan Scopus. Berdasarkan kriteria inklusi dan eksklusi, didapatkan 1 artikel randomized controlled trial (RCT) dan 1 artikel tinjauan sistematis ditelaah kritis. Studi RCT yang diinklusi menunjukkan kualitas hidup lebih baik pada kelompok CAPD dibandingkan
hemodialisis. Pemilahan studi dalam systematic review berdasarkan penggunaan SF-36 didapatkan kualitas hidup kelompok CAPD lebih baik dalam 2 artikel dan kelompok hemodialisis lebih baik dalam 1 artikel. Pasien ESRD yang menjalani CAPD memiliki kualitas hidup lebih baik dibandingkan kelompok hemodialisis.

Peran Perawatan Paliatif Anak pada End-of-Life

Murti Andriastuti — 2023-12-29

Menurut World Health Organization, perawatan paliatif didefinisikan sebagai pencegahan, dan tata laksana untuk mengatasi penderitaan pasien dan keluarganya dalam menghadapi penyakit yang mengancam jiwa. Pada tahun 2011 65,5% negara tidak memiliki perawatan paliatif untuk anak. Sajian kasus berbasis bukti ini bertujuan untuk membandingkan efektivitas, dan manfaat dari intervensi perawatan paliatif serta tanpa perawatan paliatif di masa akhir kehidupan pada anak dengan penyakit berat. Pencarian literatur secara online menggunakan database Pubmed, EBSCO, dan Cochrane melalui metode PICO. Seluruh artikel diseleksi terlebih dahulu sesuai kriteria eligibilitas. Satu artikel menunjukkan permintaan pasien untuk tidak dilakukan resusitasi/DNR saat terjadi perburukan 8 kali lebih besar dengan pendampingan paliatif (rasio odd disesuaikan 7,92; 95% CI 2,02-31,12). Artikel lain didapatkan bahwa pasien dengan perawatan paliatif pada kondisi menjelang kematian cenderung dalam status DNR (rasio odd 7,71; P<0,001). Intervensi tim paliatif pada pasien di akhir kehidupan memfasilitasi pengambilan keputusan besar untuk tidak dilakukannya resusitasi dibandingkan pada pasien tanpa perawatan paliatif.

Adenoma Pleomorfik di Tonsil: Kasus Langka

Olivia Claudia Pelealu — 2023-12-29

Adenoma pleomorfik adalah gambaran tumor jinak secara histopatologis yang dapat ditemukan di kelenjar liur, kelenjar parotis, kelenjar submandibular, kelenjar palatina minor dan kelenjar bukal minor. Pada makalah ini dilaporkan kasus adenoma pleomorfik di tonsil pada perempuan berusia 38 tahun dengan keluhan rasa tersumbat di tenggorok sejak 1 tahun lalu. Pasien sulit menelan tanpa disertai rasa nyeri saat menelan. Demam, batuk, flu, keluar darah dari telinga, hidung, mulut dan gangguan pendengaran disangkal. Pada pemeriksaan orofaring didapatkan T4/T3, hingga menutupi uvula. Pada pemeriksaan leher, tidak tampak pembesaran dan pada saat palpasi leher tidak teraba pembesaran kelenjar getah bening. Dilakukan biopsi jaringan di tonsil dengan hasil adenoma pleomorfik dan tidak ada keganasan sehingga dilakukan tonsilektomi pada kedua tonsil. Pengangkatan kedua tonsil diharapkan dapat mencegah rekurensi dan diferensiasi ke arah keganasan. Dengan laporan kasus ini diharapkan kewaspadaan dokter pada pembesaran tonsil.

Urgensi Pemanfaatan Metode Seleksi Atribut Non-Kognitif Dalam Sistem Seleksi Calon Mahasiswa Kedokteran Tahap Undergraduate

Diantha Soemantri — 2023-12-29