bluuebunny/crossref_metadata_2025 huggingface dataset:
Analisis Minimisasi Biaya Amlodipin Generik dan Bermerk pada Pengobatan Hipertensi di RS X Pekanbaru Tahun 2015
Authors: Merliana Hanny
Published: March 2018

Abstrak Hipertensi merupakan tantangan besar di Indonesia, berdasarkan data Riskesdas 2013 prevalensi kejadian sebesar 25% ser­ta kondisi yang sering ditemukan pada pelayanan kesehatan primer. Disamping itu, pengontrolan hipertensi belum adekuat meskipun obat-obatan yang efektif banyak tersedia. Amlodipine adalah salah satu obat hipertensi yang paling sering direse­pkan di RS X Pekanbaru. Untuk itu,dipandang perlumelakukan analisis minimisasi biaya dari pengggunaan amlodipine generik dan bermerek sebagai bentuk kendali mutu dan kendali biaya.Penelitian ini merupakan studi retrospektif yangmenggunakan data pasien hipertensi ringan sampai sedang dan periode pengobatan selama 1 bulan dari bulan Januari sampai Desember ta­hun 2015. Analisa CMA berdasarkan perspektif provider (rumah sakit sebagai pemberi pelayanan).Hasil analisis data ditemu­kan bahwa penggunaan amlodipin generik lebih banyak dibandingkan penggunaan obat bermerk di Poli Jantung dan Penyakit Dalam RS. X.Rerata biaya pengobatan dengan amlodipin generik Rp 68.660,- per bulan sedangkan dengan amlodipin ber­merk sebesar Rp. 374.844.- atau sekitar 5,4 kali lebih tinggi dari amlodipin generik. Penggunaan amlodipin generik maupun bermerk menurukan tekanan darah secara bermakna, namun tidak terdapat perbedaan bermakna antas penurunan tekanan darah yang dicapai dengan pemberian amlodipin generik maupun amlodipin bermerk. Disimpulkan bahwa amlodipin generik merupakan pilihan yang efisien dalam menurunkan tekanan darah dan memiliki biaya yang lebih efisien dibandingkan dengan amlodipin bermerk.Abstract Hypertension in a big challenge in Indonesia, proven by its prevalence that reached 25% in 2013 and conditions that mostly found in primary health care. In addition, hypertension management is considered to be suboptimal despite the availability of effective drugs. Amlodipine is one of anti-hypertensive that is commonly prescribed by X Hospital, Pekan Baru. Therefore, it is important to do cost minimization analysis to compare both generic and branded Amlodipine as an implementation of cost and quality control. This ret­rospective study involved early and medium stage of hypertensive patients that have at least a month period of treatment from Jan­uary to December 2015 using provider’s perspectives of CMA (Cost Minimization Analysis). The result showed that generic form of Amlodipine is the most common anti-hypertensive drugs prescribed in Cardiology and Internal Medicine Clinic, X Hospital. It was suggested that average cost of generic form of Amlodipine was IDR 68.660 while branded one was IDR 374.844 or approximately 5.4 times higher. Both generic and branded Amlodipine significantly reduced blood pressure, but there was not any distinguish effect between them. It was concluded that generic form of Amlodipine was a less expensive and efficient choice in reducing blood pressure.
Biaya Satuan dan Pemulihan Biaya (Cost Recovery Rate) Layanan Pasien Acute Coronary Syndrome dengan Rawat Inap di Rumah Sakit X Tahun 2015
Authors: Aurelia Anna , Pujiyanti Eka
Published: March 2018

Abstrak Rumah Sakit X merupakan salah satu rumah sakit kelas C di Jakarta Selatan yang mengalami lonjakan pasien sejak diber­lakukannya rujukan berjenjang oleh BPJS. Pasien Acute Coronary Syndrome (ACS) merupakan pasien dengan kegawatdaru­ratan medis yang membutuhkan penanganan intensif di ICU. Tujuan penelitian ini adalah menganalisis biaya pelayanan pasien ACS dengan rawat inap di RS X pada tahun 2015 menggunakan metode Activity Based Costing. Hasil penelitian menyatakan bahwa biaya satuan untuk menyelenggarakan pelayanan pasien ACS dengan rawat inap di RS X pada tahun 2015 adalah Rp 6.083.444,-. Diperoleh hasil analisis Cost Recovery Rate untuk pasien umum adalah 227.98 % dan pasien BPJS adalah 71.38 %. Disarankan agar Rumah Sakit X mengembangkan clinical pathway untuk penyakit ACS sebagai panduan tindakan dan hari rawat pasien, dan merekrut dokter tetap untuk pengendalian biaya operasional.Abstract X Hospital is a Class C Hospital in South Jakarta, which experiencing a substantial increased number of patients since the BPJS has implemented the referral system. Acute Coronary Syndrome (ACS) patient is a patient with a medical emergency require intensive treatment in the ICU. The purpose of this study was to analyze the cost for hospitalized ACS patients at X Hospital in 2015 using activity based costing. The study revealed that the unit cost of hospitalized ACS patients at X Hospital in 2015 was Rp 6.083.444,-. The Cost Recovery Rate for patients with fee-for-service was 227.98% and for BPJS patient was 71.38%. This study suggested the hospital to develop clinical pathway for ACS guidance, as well as recruiting full time doctors.
Analisis Penerapan Cost Containment pada Kasus Sectio Caesarea dengan Jaminan BPJS di RS Pemerintah XY di Kota Bogor Tahun 2016
Authors: Istianisa Nazirah , Oktamianti Puput
Published: March 2018

AbstrakSistem pembayaran prospektif dengan paket tarif INA-CBG’s untuk kasus dengan jaminan BPJS menuntut rumah sakit agar dapat melakukan kendali biaya. Penelitian ini bertujuan untuk menilai upaya Cost Containment RS XY melalui penerapan Clinical Pathway, formularium, dan struktur insentif. Studi dilakukan pada kasus Sectio Caesarea periode Januari-Maret 2016 secara kuantitatif dengan membandingkan selisih klaim BPJS dan tagihan RS serta menilai penerapan Clinical Pathway dan secara kualitatif dengan wawancara mendalam. Total Selisih yang didapat sebesar Rp.1.014.125.684,00 dengan rata-rata selisih sebesar Rp.4.899.157,89 per kasus. Didapatkan 84% kasus memiliki length of stay sesuai Clinical Pathway (CP). Dari kasus tersebut, 96% visitasi dokter sesuai, 21% penggunaan obat dan BHP sesuaidengan, 48% pemeriksaan laboratorium sesuai dengan yang ditentukan dalam CP. Formularium yang digunakan sesuai dengan formularium nasional. RS XY belum memiliki sistem evaluasi untuk menilai penerapan clinical pathway dan penggunaan obat. Struktur insentif yang digunakan adalah sistem fee-for-service pada staf medik yang tidak sesuai dengan metode pembayaran jasa medis yang prospektif. AbstractProspective payment system with INA-CBG’s fare for cases using BPJS Insurance demands hospital to control their cost. This study aims to see the cost containment in XY Hospital through the implementation of clinical pathway, drug formulary, and incentive structure. The study looked into Sectio Caesarea cases from January to March 2016, using quantitative method, comparing BPJS claim with hospital billing and assesst the implementation of clinical pathwayusing qualitative method through in depth interview. Result shows there is deficit amount of Rp.1.014.125.684,00 and the average of deficit per case is Rp.4.899.157,89. Eighty four percent of cases have length of stay in accordance with clinical pathway. From those cases, 96% has concordant doctors visit, 21% has concordant drug usage, and 48% has concordant laboratory diagnostic test. The hospital formulary uses the national formulary. It is found that XY Hospital does not have an evaluation system for clinical pathway implementation and drug usage. The incentive structure that is used is fee-for-service system which is not suitable for prospective payment method.
Proporsi dan Faktor-Faktor yang Berhubungan dengan Kejadian Hipotensi Postprandial pada Usia Lanjut
Authors: Hamonangan Rachmat , Alwi Idrus , Wahyudi Edy Rizal , Setiati Siti
Published: March 2018

Pendahuluan. Hipotensi postprandial sebenarnya sering terjadi dan saat ini dikenal sebagai masalah klinis yang penting.Studi-studi yang ada menunjukkan bahwa prevalensi hipotensi postprandial pada usia lanjut cukup tinggi. Hipotensi postprandial merupakan prediktor mortalitas pada orang usia lanjut dan menyebabkan banyak sekuele yang signifikan pada subyek yang terkena. Hingga saat ini, penelitian-penelitian yang berkaitan dengan hipotensi postprandial lebih banyak dilakukan pada kelompok usia lanjut di negara-negara maju yang definisi usia lanjut, proporsi penyakit, proporsi obat-obatan yang digunakan serta proporsi asupan yang berbeda dengan kelompok usia lanjut di negara berkembang khususnya Indonesia. Tujuan. Mengetahui proporsi dan faktor-faktor yang berhubungan dengan kejadian hipotensi postprandial pada kelompok usia lanjut.Metode. Penelitian studi potong-lintang dilakukan pada subjek usia lanjut di RSCM. Dilakukan pengisian kuesioner dan pengukuran tekanan darah sebelum makan dan setiap 15 menit sampai 2 jam setelah makan. Makanan yang dimakan dicatat untuk dianalisis.Hasil. Selama periode Januari – Maret 2010 terkumpul 119 subjek usia lanjut dengan rerata umur 67,50 ± 5,92 tahun. Sebanyak 53,8% memiliki hipertensi dan menggunakan obat anti hipertensi, 36.1% memiliki riwayat diabetes mellitus dan menggunakan obat pengontrol gula darah, 9,2% pernah mengalami stroke, 7.6% menggunakan terapi digoksin, 29.4% menggunakan terapi nitrat dan 3.4% menjalani hemodialisis rutin. Hipotensi postprandial didapatkan pada 55% subjek. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Selain itu diketahui pula bahwa penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat.Simpulan. Penelitian ini menyimpulkan bahwa proporsi hipotensi postprandial pada subjek usia lanjut adalah 55%. Penggunaan obat diuretik loop dan insulin berhubungan dengan kejadian hipotensi postprandial. Penurunan tekanan darah postprandial lebih besar pada subjek dengan hipertensi, menggunakan obat ACE inhibitor, menggunakan obat diuretik loop/furosemid, menggunakan diuretik HCT, menggunakan insulin dan menggunakan obat nitrat.
Peran Tindakan Revaskularisasi terhadap Kesintasan Pasien Non ST Elevation Myocardial Infarction (NSTEMI)
Authors: Amarendra Gerie , Makmun Lukman H , Antono Dono , Dewiasty Esthika
Published: March 2018

Pendahuluan. Pengaruh revaskularisasi terhadap kesintasan pasien non ST elevation myocardial infarction (NSTEMI) masih belum jelas. Waktu revaskularisasi yang optimal pada pasien NSTEMI belum ditemukan. Penelitian ini bertujuan mengetahui pengaruh revaskularisasi terhadap kesintasan pasien NSTEMI, juga mengetahui pengaruh waktu revaskularisasi terhadap kesintasan pasien NSTEMI.Metode. Penelitian dengan disain kohort retrospektif dilakukan terhadap 300 pasien non ST elevation myocardial infarction yang dirawat di RSUPNCM pada kurun waktu Desember 2006-Maret 2011. Data klinis, laboratorium, elektrokardiografi (EKG), ekokardiografi, dan angiografi koroner dikumpulkan. Pasien yang telah terhitung enam bulan setelah onset kemudian dihubungi melalui telepon untuk melihat status mortalitasnya. Perbedaan kesintasan revaskularisasi ditampilkan dalam kurva Kaplan Meier dan perbedaan kesintasan diantara dua kelompok diuji dengan Log-rank test dengan batas kemaknaan <0,05, serta analisis multivariat dengan Cox proportional hazard regression untuk menghitung adjusted hazard ratio (dan interval kepercayaan 95%) antara pasien NSTEMI yang menjalani terapi medikamentosa dan revaskularisasi terhadap kelompok medikamentosa dengan memasukkan variabel perancu.Hasil. Terdapat perbedaan kesintasan yang bermakna pada uji log rank (p<0,001) antara pasien NSTEMI yang menjalani revaskularisasi dan terapi medikamentosa saja dengan crude HR 0,19 (IK95% 0,11-0,34) dan fully adjusted HR 0,33 (IK95% 0,17-0,64). Faktor perancu yang bermakna adalah penurunan fungsi ginjal dan syok kardiogenik. Pada analisis kesintasan berdasarkan waktu revaskularisasi tidak didapatkan perbedaan kesintasan antara pasien yang menjalani revaskularisasi < 1 minggu, 1-2 minggu, 2-3 minggu, 3-4 minggu, 4-5 minggu dengan p=0,853.Simpulan. Kesintasan enam bulan pasien NSTEMI yang menjalani terapi medikamentosa dan revaskularisasi lebih baik dibandingkan dengan terapi medikamentosa saja. Tidak terdapat perbedaan kesintasan enam bulan pasien NSTEMI berdasarkan waktu revaskularisasi.
Perubahan Kadar Fibrinogen Plasma dan Korelasinya dengan Perubahan Kadar hs- CRP dan Aktivitas Fibrinolisis pada Sindroma Koroner Akut
Authors: Sudrajat Dedy G , Atmakusuma Djumhana , Alwi Idrus , Harimurti Kuntjoro
Published: March 2018

Pendahuluan. Peningkatan kadar fibrinogen yang menetap merupakan faktor risiko yang kuat untuk kejadian penyakit jantung koroner (PJK).  Di sisi lain peningkatan fibrinogen plasma dapat merupakan respon fase akut. Pada kondisi ini peningkatan fibrinogen plasma bukan merupakan faktor risiko PJK. Penelitian ini bertujuan untuk mengetahui apakah kadar fibrinogen plasma meningkat pada fase akut dan tetap tinggi pada fase pasca akut dan mengetahui korelasi antara perubahan kadar fibrinogen plasma dengan perubahan aktivitas inflamasi dan fibrinolisis.Metode. Desain penelitian adalah studi prospektif dengan metode pengambilan sampel secara konsekutif. Pengambilan sampel fase akut untuk hs-CRP, aktivitas fibrinolisis, dan fibrinogen masing-masing diambil pada hari ke-2, 5, dan 6 pasca awitan sedangkan fase pasca akut diambil pada hari ke-13 pasca awitan. Fibrinogen diperiksa dengan metode Clauss, hs-CRP dengan metode ELISA, dan aktivitas fibrinolisis dengan metode ECLT manual. Analisis beda rerata dilakukan dengan uji t-berpasangan dengan alternatif uji wilcoxon. Analisis korelasi dengan uji Spearman.Hasil. Sampai akhir penelitian didapatkan 38 subyek sesuai kriteria inklusi dan eksklusi. Terdapat penurunan median kadar fibrinogen plasma pada fase pasca akut dibandingkan fase akut (415,5vs380,5mg/dL;p<0,001). Terdapat penurunan median kadar hs-CRP fase pasca akut bila dibandingkan fase akut (22,62vs13,61mg/L;p<0,001). Terdapat penurunan rata-rata ECLT pada fase pasca akut bila dibandingkan fase akut (351,18vs189,61 menit; p<0,001). Subyek dengan hiperfibrinogenemia yang menetap pada fase pasca akut adalah sebesar 52,6%. Pada kelompok ini aktivitas inflamasi 65% subyek pada fase pasca akut masih tinggi meski terdapat penurunan bermakna dibanding fase akut, sedangkan aktivitas fibrinolisis fase pasca akut pada kelompok ini menunjukkan penurunan bermakna 65% telah pada kisaran normal. Hasil uji korelasi didapatkan hasil bahwa perubahan kadar fibrinogen plasma dan perubahan kadar hs-CRP didapatkan korelasi positif yang lemah (r=0,31; p=0,049), dan antara perubahan kadar fibrinogen plasma dan ECLT merupakan korelasi positif yang lemah (r=0,359; p=0,027).Simpulan. Pada sindroma koroner akut, perubahan aktivitas fibrinolisis dan inflamasi memiliki korelasi positif lemah terhadap perubahan kadar fibrinogen. Pada kelompok dengan hiperfibrinogenemia yang menetap kadar fibrinogen pasca akut masih dominan dipengaruhi aktivitas inflamasi yang masih cukup aktif.
Perubahan Kendali Glikemik dan Plasminogen Activator Inhibitor-1 (PAI-1) pada Penyandang Diabetes Melitus Tipe-2 yang Berpuasa Ramadhan di RSUPN Cipto Mangunkusumo
Authors: Khomimah Khomimah , Waspadji Sarwono , Yunir Em , Abdullah Murdani
Published: March 2018

Pendahuluan. Penyandang diabetes melitus (DM) mempunyai risiko tinggi mengalami penyakit kardiovaskular (PKV), yang progresivitasnya dipercepat oleh penurunan kapasitas fibrinolisis. Penyandang DM yang berpuasa Ramadhan mengalami berbagai perubahan yang dapat memengaruhi kendali glikemik dan status fibrinolisisnya. Penelitian ini bertujuan mengetahui penurunan fruktosamin dan plasminogen activator inhibitor-1 (PAI-1).Metode. Penelitian dikerjakan dengan metode kuasi eksperimental one group design self control study pada penyandang DM tipe-2 yang berpuasa Ramadhan dan berusia 40-60 tahun. Hasil. Penelitian ini menunjukkan sebagian besar subjek memiliki 3 faktor risiko PKV dan dengan kendali glikemik yang jelek sebelum puasa Ramadhan. Terdapat penurunan yang bermakna pada glukosa puasa plasma, tetapi tidak bermakna pada glukosa darah 2 jam setelah makan. Tidak terdapat perbedaan asupan kalori pada 18 subjek yang dianalisis. Tidak didapatkan penurunan yang bermakna pada fruktosamin serum maupun PAI-1 plasma. Kendali glikemik yang dicapai sebelum dan asupan kalori selama berpuasa Ramadhan kemungkinan merupakan faktor yang memengaruhi penurunan fruktosamin. Selain glukosa darah, faktor yang memengaruhi kadar PAI-1 plasma di antaranya adalah insulin plasma, angiotensin II, faktor pertumbuhan dan inflamasi, yang tidak diukur dalam penelitian ini.Simpulan. Tidak terdapat penurunan kadar fruktosamin serum sesudah berpuasa Ramadhan lebih dari sama dengan 21 hari pada penyandang DM tipe-2. Tidak terdapat penurunan kadar plasminogen activator inhibitor-1 (PAI-1) plasma sesudah berpuasa Ramadhan lebih dari sama dengan 21 hari pada penyandang DM tipe-2.
Parameter Akhir Resusitasi Makrosirkulasi dan Mikrosirkulasi pada Sepsis Berat dan Renjatan Septik
Authors: Sinto Robert , Suwarto Suhendro
Published: March 2018

Sepsis berat dan renjatan septik telah menjadi masalah kesehatan yang utama di seluruh dunia. Untuk menekan angkamortalitas dini, upaya resusitasi yang dilakukan pada keadaan sepsis berat dan renjatan septik harus ditujukan padapencapaian target parameter makrosirkulasi maupun mikrosirkulasi, khususnya yang telah terbukti berhubungan denganmortalitas dini. Parameter tersebut meliputi tekanan vena sentral, rerata tekanan arteri, produksi urin, saturasi oksigen venasentral, hematokrit, laktat, bersihan laktat, dan ekses basa standar. Kelebihan dan keterbatasan tiap parameter harusdipahami dengan baik dalam upaya interpretasi yang tepat terhadap hasil pemeriksaan parameter tersebut.
Peran Procalcitonin sebagai Penanda Inflamasi Sistemik pada Sepsis
Authors: Dharaniyadewi Dana , Chen Lie Khie , Suwarto Suhendro
Published: March 2018

Terapi antibiotika awal dan tepat merupakan faktor yang penting untuk kesintasan pasien sehingga diperlukan pemeriksaan yang cepat dan akurat untuk deteksi adanya bakteri di sirkulasi. PCT merupakan biomarker yang paling sering dipelajari dan rutin digunakan dalam praktik klinik dan rekomendasi saat ini di beberapa negara. Kadar PCT serum meningkat pada sepsis. Kadar PCT normal di bawah 0,5 ng/mL dan kadar PCT > 2 ng/mL memiliki risiko tinggi untuk sepsis. PCT lebih unggul daripada CRP untuk diagnosis dan prognosis sepsis pada pasien kritis tetapi penggunaannya harus tetap diiringi dengan penilaian secara klinis. Hal ini terutama penting pada awal infeksi atau pasien dengan infeksi fokal dan pasien pembedahan. PCT mungkin lebih baik untuk menyingkirkan diagnosis sepsis daripada untuk diagnosis sepsis itu sendiri pada pasien kritis terutama jika dilakukan pemeriksaan PCT serial. Pemeriksaan PCT juga dapat digunakan untuk membantu dalam penggunaan antibiotika. Pemeriksaan PCT dapat digunakan untuk menghindari penggunaan antibiotika yang tidak diperlukan pada pasien kritis dengan gejala SIRS tanpa infeksi; walaupun demikian, emeriksaan PCT tetap harus diinterpretasikan sesuai dengan temuan klinis dan parameter laboratoris lainnya.
Faktor - Faktor yang Berhubungan dengan Kejadian Hepatitis C pada Pasangan Seksual Pasien Koinfeksi Human Immunodeficiency Virus dan Virus Hepatitis C
Authors: Kurniawati Sri Agustini , Karjadi Teguh H , Gani Rino A
Published: March 2018

Pendahuluan. Pencegahan transmisi hepatitis C pada pasangan seksual pasien koinfeksi HIV/HCV merupakan upaya penatalaksanaan hepatitis C. Namun demikian, belum ada data prevalensi hepatitis C dan faktor yang berhubungan dengan transmisi hepatitis C pada pasangan seksual pasien koinfeksi HIV/HCV di Indonesia, sehingga perlu dilakukan penelitian untuk memperoleh data tersebut. Penelitian ini bertujuan untuk mengetahui prevalensi hepatitis C dan faktor-faktor yang berhubungan dengan kejadian hepatitis C pada pasangan seksual pasien koinfeksi HIV/HCV.Metode. Studi potong lintang pada pasangan heteroseksual pasien koinfeksi HIV/HCV yang berobat di Pokdisus RSCM. Faktor yang diteliti meliputi penggunaan narkotika suntik, transfusi darah, status HIV, penggunaan kondom, jumlah hubungan seksual, jumlah pasangan seksual, tipe hubungan seksual dan hitung CD4+ pasien koinfeksi HIV/HCV. Pengambilan data dilakukan dengan wawancara secara terpisah dan pemeriksaan darah antiHCV total dan antiHIV. Analisis statistik dilakukan dengan uji chi-square dan Fisher dan regresi logistik menggunakan program SPSS.Hasil. Selama periode Mei-Agustus 2008, diperoleh 119 subyek penelitian pada rentang usia 19-39 tahun (median 26 tahun) dan 95,8% diantaranya berjenis kelamin perempuan. Didapatkan prevalensi hepatitis C sebesar 10,1%. Hasil analisis bivariat kelompok subyek nonpengguna narkotika suntik didapatkan status HIV reaktif dan hubungan seksual nonvaginal berhubungan dengan kejadian hepatitis C. Pada hasil analisis multivariat didapatkan hanya tipe hubungan nonvaginal yang berhubungan dengan kejadian hepatitis C (adjusted RP 8,051; IK95% 1,215-53,353).Simpulan. Prevalensi hepatitis C pada pasangan seksual pasien koinfeksi HIV/HCV sebesar 10,1%. Tipe hubungan nonvaginal dan status antiHIV positif dapat meningkatkan risiko terjadinya kejadian hepatitis C sebesar 8 kali. Dibutuhkan studi lanjutan dengan sampel yang lebih besar dan desain yang lebih baik untuk menentukan transmisi seksual hepatitis C.
Apakah Hemodialisis Tiga Kali Seminggu Lebih Baik?
Authors: Nugroho Pringgoidgdo
Published: March 2018

Hemodialisis merupakan salah satu modalitas terapi pengganti ginjal yang paling banyak digunakandi Indonesia. Seperti terapi pengganti ginjal yang lain, saat ini hemodialisis (HD) tidak hanya bertujuan untuk memperpanjang harapan hidup namun juga untuk mencapai kualitas hidup pasien yang baik. Kualitas hidup pasien HD merupakan penilaian status kesehatan pasien berdasarkan persepsi pasien dalam menjalani kehidupan dengan HD kronik dengan kehidupan yang bermakna bagi pasien.
Analisis Faktor-Faktor yang Berhubungan dengan Tingginya Rujukan Kasus Non Spesialistik Pasien Jaminan Kesehatan Nasional pada Puskesmas di Kabupaten Sukabumi Tahun 2015
Authors: Alawi Masykur , Junadi Purnawan , Latifah Siti Nur
Published: March 2018

AbstrakPuskesmas sebagai garda terdepan dalam pelayanan kesehatan dasar diharuskan menuntaskan kasus-kasus non spesialistik. Namun, data laporan BPJS Kesehatan pada tahun 2015 menunjukkaan adanya 11.487 rujukan kasus non spesialistik dari 58 Puskesmas di Kabupaten Sukabumi. Tujuan penelitian ini adalah mengetahui faktor-faktor yang berhubungan dengan tingginya rujukan kasus non spesialistik pasien JKN pada puskesmas di Kabupaten Sukabumi tahun 2015. Penelitian menggunakan desain cross sectional, pada sampel 58 Puskesmas dengan satu orang dokter dari setiap Puskesmas dengan menggunakan whole sampling. Hasil analisis data didapatkan ada hubungan antara wilayah (nilai p=0,000); kecukupan obat (nilai p=0,040);kecukupan alat kesehatan (nilai p=0,024) dan jarak puskesmas (nilai p=0,003) dengan rujukan kasus non spesialistik. Perlu adanya pemenuhan obat-obatan, alat kesehatan sesuai standar Puskesmas dan monitoring dan evaluasi rujukan kasus non spesialistik dari Puskesmas dan BPJS Kesehatan. AbstractPublic Health Center is the frontline in the basic health services that include non-specialist cases to be solved in this primary health care level. However, a report from BPJS Kesehatan in 2015 showed that there were 11.487 referral of non-specialist cases in Primary Health Cares (PHCs) in Sukabumi. This study was to determine factors associated with high referral rate of National Health Insurance’s members with non-specialist cases by PHCs in Sukabumi in 2015. The study employed cross-sectional design in 58 PHCs along with a general practitioner in each centers using a whole sampling. The result showed that there were correlation between characteristics of the region (P=0,000); adequacy of drug (P=0,040); adequacy of medical devices (P=0,024); and distance from the PHCs to the referral health care facilities (P=0,003) with non-specialist cases referral rate. It is recommended for the PHCs to meet the needs of drugs, medical devices according to the standard, monitor and evaluate the non-specialist referral cases, both from health centers and the Social Security Agency for Health of Sukabumi.
Synapse maintenance and restoration in the retina by NGL2
Authors: Soto Florentina , Zhao Lei , Kerschensteiner Daniel
Published: March 2018

Synaptic cell adhesion molecules (CAMs) promote synapse formation in the developing nervous system. To what extent they maintain and can restore connections in the mature nervous system is unknown. Furthermore, how synaptic CAMs affect the growth of synapse-bearing neurites is unclear. Here, we use adeno-associated viruses (AAVs) to delete, re-, and overexpress the synaptic CAM NGL2 in individual retinal horizontal cells. When we removed NGL2 from horizontal cells, their axons overgrew and formed fewer synapses, irrespective of whether Ngl2 was deleted during development or in mature circuits. When we re-expressed NGL2 in knockout mice, horizontal cell axon territories and synapse numbers were restored, even if AAVs were injected after phenotypes had developed. Finally, overexpression of NGL2 in wild-type horizontal cells elevated synapse numbers above normal levels. Thus, NGL2 promotes the formation, maintenance, and restoration of synapses in the developing and mature retina, and restricts axon growth throughout life.
A transcription factor collective defines the HSN serotonergic neuron regulatory landscape
Authors: Lloret-Fernández Carla , Maicas Miren , Mora-Martínez Carlos , Artacho Alejandro , Jimeno-Martín Ángela , Chirivella Laura , Weinberg Peter , Flames Nuria
Published: March 2018

Cell differentiation is controlled by individual transcription factors (TFs) that together activate a selection of enhancers in specific cell types. How these combinations of TFs identify and activate their target sequences remains poorly understood. Here, we identify the cis-regulatory transcriptional code that controls the differentiation of serotonergic HSN neurons in Caenorhabditis elegans. Activation of the HSN transcriptome is directly orchestrated by a collective of six TFs. Binding site clusters for this TF collective form a regulatory signature that is sufficient for de novo identification of HSN neuron functional enhancers. Among C. elegans neurons, the HSN transcriptome most closely resembles that of mouse serotonergic neurons. Mouse orthologs of the HSN TF collective also regulate serotonergic differentiation and can functionally substitute for their worm counterparts which suggests deep homology. Our results identify rules governing the regulatory landscape of a critically important neuronal type in two species separated by over 700 million years.
Biosynthesis of silver nanoparticles using Caesalpinia ferrea (Tul.) Martius extract: physicochemical characterization, antifungal activity and cytotoxicity
Authors: Soares Mônica R. P. S. , Corrêa Rafael O. , Stroppa Pedro Henrique F. , Marques Flávia C. , Andrade Gustavo F. S. , Corrêa Charlane C. , Brandão Marcos Antônio F. , Raposo Nádia R. B.
Published: March 2018

Background

Green synthesis is an ecological technique for the production of well characterized metallic nanoparticles using plants. This study investigated the synthesis of silver nanoparticles (AgNPs) using a Caesalpinia ferrea seed extract as a reducing agent.

Methods

The formation of AgNPs was identified by instrumental analysis, including ultraviolet–visible (UV–Vis) spectroscopy, scanning electron microscopy (SEM), X-ray diffraction (XRD) of the AgNPs, and surface-enhanced Raman scattering (SERS) spectra of rhodamine-6G (R6G). We studied the physicochemical characterization of AgNPs, evaluated them as an antifungal agent against Candida albicans, Candida kruzei, Candida glabrata and Candida guilliermondii, and estimated their minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) values. Lastly, this study evaluated the cytotoxicity of the AgNPs in murine L929 fibroblasts cells using an MTT assay.

Results

The UV–Vis spectroscopy, SERS, SEM and XRD results confirmed the rapid formation of spheroidal 30–50 nm AgNPs. The MIC and MFC values indicated the antifungal potential of AgNPs against most of the fungi studied and high cell viability in murine L929 fibroblasts. In addition, this study demonstrated that C. ferrea seed extracts may be used for the green synthesis of AgNPs at room temperature for the treatment of candidiasis.
Half-lives of PAHs and temporal microbiota changes in commonly used urban landscaping materials
Authors: Roslund Marja I. , Grönroos Mira , Rantalainen Anna-Lea , Jumpponen Ari , Romantschuk Martin , Parajuli Anirudra , Hyöty Heikki , Laitinen Olli , Sinkkonen Aki
Published: March 2018

Background

Polycyclic aromatic hydrocarbons (PAHs) accumulate in urban soils, and PAH contamination can change soil microbial community composition. Environmental microbiota is associated with human commensal microbiota, immune system and health. Therefore, studies investigating the degradation of PAHs, and the consequences of soil pollution on microbial communities in urban landscaping materials, are crucial.

Methods

Four landscaping materials (organic matter 1, 2, 13 and 56%) were contaminated with PAHs commonly found at urban sites (phenanthrene, fluoranthene, pyrene, chrysene and benzo(b)fluoranthene) in PAH concentrations that reflect urban soils in Finland (2.4 µg g -1 soil dry weight). PAHs were analyzed initially and after 2, 4, 8 and 12 weeks by gas chromatography-mass spectrometry. Half-lives of PAHs were determined based on 12-weeks degradation. Bacterial communities were analyzed at 1 and 12 weeks after contamination using Illumina MiSeq 16S rRNA gene metabarcoding.

Results

Half-lives ranged from 1.5 to 4.4 weeks for PAHs with relatively low molecular weights (phenanthrene, fluoranthene and pyrene) in landscaping materials containing 1–2% organic matter. In contrast, in materials containing 13% and 56% organic matter, the half-lives ranged from 2.5 to 52 weeks. Shorter half-lives of phenanthrene and fluoranthene were thus associated with low organic matter content. The half-life of pyrene was inversely related to the relative abundance of Beta-, Delta- and Gammaproteobacteria, and diversity of Bacteroidetes and Betaprotebacteria. Compounds with higher molecular weights followed compound-specific patterns. Benzo(b)fluoranthene was resistant to degradation and half-life of chrysene was shorter when the relative abundance of Betaproteobacteria was high. Temporal microbiota changes involved increase in the relative abundance of Deltaproteobacteria and decrease in genera Flavobacterium and Rhodanobacter. Exposure to PAHs seems to adjust microbial community composition, particularly within class Beta- and Deltaproteobacteria.

Conclusions

In this study, PAH degradation depended on the organic matter content and bacterial community composition of landscaping materials. Contamination seems to alter bacterial community composition in landscaping materials depending on material type. This alteration includes changes in bacterial phyla associated with human health and immune system. This may open new possibilities for managing urban environments by careful selection of landscaping materials, to benefit health and wellbeing.
Rational Design and Synthesis of Low-Temperature Fuel Cell Electrocatalysts
Authors: Tian Na , Lu Bang-An , Yang Xiao-Dong , Huang Rui , Jiang Yan-Xia , Zhou Zhi-You , Sun Shi-Gang
Published: March 2018

Recent progresses in proton exchange membrane fuel cell electrocatalysts are reviewed in this article in terms of cathodic and anodic reactions with a focus on rational design. These designs are based around gaining active sites using model surface studies and include high-index faceted Pt and Pt-alloy nanocrystals for anodic electrooxidation reactions as well as Pt-based alloy/core–shell structures and carbon-based non-precious metal catalysts for cathodic oxygen reduction reactions (ORR). High-index nanocrystals, alloy nanoparticles, and support effects are highlighted for anodic catalysts, and current developments in ORR electrocatalysts with novel structures and different compositions are emphasized for cathodic catalysts. Active site structures, catalytic performances, and stability in fuel cells are also reviewed for carbon-based non-precious metal catalysts. In addition, further developmental perspectives and the current status of advanced fuel cell electrocatalysts are provided.

Graphical Abstract
Time to Detection in Culture Supports Prediction of Low Transmissibility of Tuberculosis and Discontinuation of Isolation for Low-Risk Patients With A Single AFB-Negative and NAAT-Negative Respiratory Specimen
Authors: Khan Saahir , Nakasone Audrey , Ghajar Minoo , Zhowandai Mariam , Prabhu Sunita , Alexander Rick , Low Julie , Peterson Ellena , Thrupp Lauri
Published: March 2018

For 94 patients with culture-positive pulmonary tuberculosis, time-to-detection (TTD), acid-fast bacilli (AFB) smear, and nucleic acid amplification test (NAAT) results were reviewed. All 12 patients whose first specimen was negative by AFB smear and NAAT had prolonged TTD, indicating low transmissibility and supporting discontinuing isolation for low-risk patients.

Infect Control Hosp Epidemiol 2018;39:619–621
The Impact ofClostridium difficileInfection on Future Outcomes of Solid Organ Transplant Recipients
Authors: Luo Ruihong , Weinberg Janice M. , Barlam Tamar F.
Published: March 2018

OBJECTIVE

Clostridium difficileinfection (CDI) is common in solid organ transplant (SOT) recipients, but few studies have examined long-term outcomes. We studied the impact of CDI after SOT on mortality and transplant organ complication-related hospitalizations (TOH).

METHODS

SOT recipients ≥18 years of age with at least 1 year of posttransplant data were analyzed using the MarketScan database for 2007–2014. Patients who died within one year of transplant were followed until death. Patients were grouped as early CDI (ie, first occurrence ≤90 days posttransplant), late CDI (ie, first occurrence >90 days posttransplant) and controls (ie, no CDI occurrence during follow-up). The risk of mortality or TOH after CDI was evaluated using Cox and logistic regressions, respectively.

RESULTS

Overall, 96 patients had early CDI, 97 patients had late CDI, and 5,913 patients were used as controls. The risk for death was significantly higher in the early CDI group than the control group (hazard ratio [HR],1.92; 95% confidence interval [CI], 1.12–3.29;P=.018); there was no significant difference between the late CDI group and the control group (HR, 0.86; 95% CI, 0.38–1.94;P=.717). Both the early CDI group (odds ratio [OR], 2.19; 95% CI, 1.45–3.31;P<.001) and the late CDI group (OR, 4.36; 95% CI, 2.84–6.71;P<.001) had higher risk for TOH than the control group. For those patients who survived >90 days posttransplant, both the early CDI group (n=89) and the late CDI group (n=97) had increased risk for death or TOH during follow-up than the control group (n=5,734).

CONCLUSION

Though our study could not prove causality, both early and late CDI occurrence in SOT recipients were associated with worse future outcomes than for SOT recipients without CDI.

Infect Control Hosp Epidemiol2018;39:563–570
Continent-wide estimates of Antarctic strain rates from Landsat 8-derived velocity grids
Authors: ALLEY KAREN E. , SCAMBOS TED A. , ANDERSON ROBERT S. , RAJARAM HARIHAR , POPE ALLEN , HARAN TERRY M.
Published: March 2018

Strain rates are fundamental measures of ice flow and are used in a wide variety of glaciological applications including investigations of bed properties, calculations of basal mass balance on ice shelves, and constraints on ice rheological models. However, despite their extensive application, strain rates are calculated using a variety of methods and length scales and the details are often not specified. In this study, we compare the results of nominal and logarithmic strain-rate calculations based on a satellite-derived velocity field of the Antarctic ice sheet generated from Landsat 8 satellite data. Our comparison highlights the differences between the two common approaches in the glaciological literature. We evaluate the errors introduced by each approach and their impacts on the results. We also demonstrate the importance of choosing and specifying a length scale over which strain-rate calculations are made, which can strongly influence other derived quantities such as basal mass balance on ice shelves. Finally, we present strain-rate data products calculated using an approximate viscous length-scale with satellite observations of ice velocity for the Antarctic continent.
‘Cleanse or Die’: British Naval Hygiene in the Age of Steam, 1840–1900
Authors: Smith Elise Juzda
Published: March 2018

This article focuses on the consolidation of naval hygiene practices during the Victorian era, a period of profound medical change that coincided with the fleet’s transition from sail to steam. The ironclads of the mid- to late- nineteenth century offered ample opportunities to improve preventive medicine at sea, and surgeons capitalised on new steam technologies to provide cleaner, dryer, and airier surroundings below decks. Such efforts reflected the sanitarian idealism of naval medicine in this period, inherited from the eighteenth-century pioneers of the discipline. Yet, despite the scientific thrust of Victorian naval medicine, with its emphasis on collecting measurements and collating statistics, consensus about the causes of disease eluded practitioners. It proved almost impossible to eradicate sickness at sea, and the enclosed nature of naval vessels showed the limitations – rather than the promise – of attempting to enforce absolute environmental controls. Nonetheless, sanitarian ideology prevailed throughout the steam age, and the hygienic reforms enacted throughout the fleet showed some of the same successes that attended the public health movement on land. It was thus despite shifting ideas about disease and new methods of investigation that naval medicine remained wedded to its sanitarian roots until the close of the nineteenth century.
Adherence to the Mediterranean diet and risk of lung cancer in the Netherlands Cohort Study
Authors: Schulpen Maya , van den Brandt Piet A.
Published: March 2018

The evidence on a cancer-protective effect of the Mediterranean diet (MD) is still limited. Therefore, we investigated the association between MD adherence and lung cancer risk. Data were used from 120 852 participants of the Netherlands Cohort Study (NLCS), aged 55–69 years. Dietary habits were assessed at baseline (1986) using a validated FFQ and alternate and modified Mediterranean diet scores (aMED and mMED, respectively), including and excluding alcohol, were calculated. After 20·3 years of follow-up, 2861 lung cancer cases and 3720 subcohort members (case-cohort design) could be included in multivariable Cox regression analyses. High (6–8) v. low (0–3) aMED excluding alcohol was associated with non-significantly reduced lung cancer risks in men and women with hazard ratios of 0·91 (95 % CI 0·72, 1·15) and 0·73 (95 % CI 0·49, 1·09), respectively. aMED-containing models generally fitted better than mMED-containing models. In never smokers, a borderline significant decreasing trend in lung cancer risk was observed with increasing aMED excluding alcohol. Analyses stratified by the histological lung cancer subtypes did not identify subtypes with a particularly strong inverse relation with MD adherence. Generally, the performance of aMED and World Cancer Research Fund/American Institute for Cancer Research dietary score variants without alcohol was comparable. In conclusion, MD adherence was non-significantly inversely associated with lung cancer risk in the NLCS. Future studies should focus on differences in associations across the sexes and histological subtypes. Furthermore, exclusion of alcohol from MD scores should be investigated more extensively, primarily with respect to a potential role of the MD in cancer prevention.
CHEATING AND DISHONESTY
Authors: Virgo Graham
Published: March 2018

THE key issue for determination by the Supreme Court in Ivey v Genting Casinos (UK) Ltd. [2017] UKSC 67, [2017] 3 W.L.R. 1212 was whether the crime of cheating at gambling, contrary to s. 42 of the Gambling Act 2005, requires proof of dishonesty. Even though the Court unanimously held that it did not, the Court went on to consider the appropriate test of dishonesty in both criminal and civil law and, in doing so, adopted a unified test which is essentially objective.
CONTRACT FORMATION AND IMPLIED TERMS
Authors: Davies Paul S.
Published: March 2018

WELLS was struggling to sell some flats. He mentioned this to a neighbour, who put Wells in touch with Devani. Wells and Devani spoke over the telephone. The trial judge found that Devani told Wells that he was an estate agent, and his usual commission was 2% + VAT. Wells agreed to this, but the parties did not expressly agree upon what was to trigger the commission. Devani subsequently introduced a purchaser to Wells who bought the flats. Was there a binding contract between Wells and Devani? Lewison and McCombe L.JJ. answered “No” (Wells v Devani [2016] EWCA Civ 1106, [2017] Q.B. 959). The trial judge and Arden L.J., dissenting in the Court of Appeal, answered “Yes”. The Supreme Court has granted permission to appeal. It is to be hoped that the Justices will clarify the important issues of contract law raised by these simple facts and allow the appeal.
General
Authors: Petrovic Andrej
Published: March 2018

‘The truth is out there’: the tagline of The X-Files, the iconic spooks'n'aliens TV show from the nineties, is twice borrowed by Jan Kwapisz in his Introduction to Fragments, Holes and Wholes: Reconstructing the Ancient World in Theory and Practice, an edited volume resulting from a conference organized at the University of Warsaw in 2014. The epilogue of this volume consists of a re-enactment, and a record, of discussion exchanges between Han Baltussen and S. Douglas Olson, entitled ‘A Conversation on Fragments’, which indeed is partly a conversation on what constitutes a fragment, but also a conversation on issues of the truth – S. Douglas Olson's pointed claim, printed on the last page of the epilogue states that ‘Greek poetic texts…do not matter much.… There may be no truth, but there is methodology’ (406). Well then, if these two statements are anything to go by, there must have been some lively debates taking place in Warsaw in 2014.
Divine goodness and the efficacy of petitionary prayer
Authors: REIBSAMEN JONATHAN
Published: March 2018

Is divine goodness incompatible with efficacious petitionary prayer? Scott Davison has recently argued that prayer cannot make a difference in what God would do since a good God must always do what is best. I examine Davison's presentation of the divine goodness problem for petitionary prayer, and argue that the argument fails. I go on to argue that, since there are certain relational benefits uniquely made available through responding to petitionary prayer, divine goodness leads us to expect that God would at least sometimes respond to petitionary prayer – even prayers for third parties.
The Copernican principle, intelligent extraterrestrials, and arguments from evil
Authors: RUHMKORFF SAMUEL
Published: March 2018

The physicist Richard Gott defends the Copernican principle, which claims that when we have no information about our position along a given dimension among a group of observers, we should consider ourselves to be randomly located among those observers in respect to that dimension. First, I apply Copernican reasoning to the distribution of evil in the universe. I then contend that evidence for intelligent extraterrestrial life strengthens four important versions of the argument from evil. I remain neutral regarding whether this result is a reductio of these arguments from evil or the statement of a genuine evidential relationship.
Can fictionalists have faith? It all depends
Authors: HOWARD-SNYDER DANIEL
Published: March 2018

Can fictionalists have faith? It all depends on how we disambiguate ‘fictionalists’ and on what faith is. I consider the matter in light of my own theory. After clarifying its central terms, I distinguish two fictionalists – atheistic and agnostic – and I argue that, even though no atheistic fictionalist can have faith on my theory, agnostic fictionalists arguably can. After rejecting Finlay Malcolm's reasons for thinking this is a problem, I use his paradigmatic agnostic fictionalist as a foil to explore a variety of ways in which to describe agnostic fictionalists, none of whom pose a problem for my theory.
‘It makes your life worthwhile. It gives you a purpose in living’: mobility experiences among active older adults with low income
Authors: FRANKE THEA , SIMS-GOULD JOANIE , CHAUDHURY HABIB , WINTERS MEGHAN , MCKAY HEATHER
Published: March 2018

The World Health Organization claims that mobility is vital to healthy ageing and is the best guarantee of older adults being able to cope and remain in their homes and communities. Mobility enables older adults to maintain their physical health, independence and participation in society. In general, mobility is examined objectively, from a quantitative perspective where mobility is measured as physical movement (e.g.physical activity) and/or travel behaviour (e.g.trips, modes and distances). The predominant focus on the functional aspects of mobility tends to overlook the subjective (e.g.perceptions, attitudes and motivations) and temporal dimensions of older adults’ mobility experiences. Using a constructivist grounded theory methodology, we conducted 24 in-depth interviews with six highly active community-dwelling older adults with low income, aged 65 or over, over a period of four years. Our analysis identified the following themes: maintaining a sense of self, being resourceful, openness to engagement, engaging in superficial contact, experiencing social capital, accessing transportation, leaving the immediate neighbourhood and facing affordability. Findings illustrate that intrapersonal factors, in addition to environmental (built, social and cultural) and temporal-level factors, play a crucial role in mobility. In the future, this gained knowledge can be incorporated into approaches to study the multiple interrelated factors and their interrelations that influence older adults’ mobility.
Resiliency dynamics of norm clusters: Norm contestation and international cooperation
Authors: Lantis Jeffrey S. , Wunderlich Carmen
Published: March 2018

This study examines the effects of contestation on individual norms that are embedded in larger norm clusters. We define norm clusters as collections of aligned, but distinct norms or principles at the center of a regime. Norm clusters include multiple norms that can be insulated from contestatory challenges by degrees of cohesion, institutionalisation, and legalisation. While some constructivists argue that the most important dynamic to study is ‘robustness’ of individual norms, we contend that ‘resiliency’ of norm clusters offers a richer assessment of prospects for international cooperation and long-term impact on state behaviours. Thus, this study distinguishes conceptually between different structural layers that can generate various effects in conjunction with norm contestation. We add a third, or intervening layer of explanation with norm clusters, between the intersection of norms (lowest layer) and normative structures (broadest layer). To explore this argument, comparative case studies examine the resiliency of two prohibitionary norms – the nuclear disarmament norm within the non-proliferation regime and the norm banning assassination of foreign adversaries, which is not embedded in a regime structure. While the robustness of individual norms may be challenged, our results suggest a role for resilient structures in promoting overall longevity of norm clusters.