e-CliniC

Effect of Preoperative Embolization on the Intraoperative Bleeding during Posterior Stabilization in Thoracolumbal Fracture Cases at Prof. Dr. R. D Kandou Hospital Manado

2022-12-27T21:11:12+08:00

Abstract: Embolization is a technique to stop or prevent bleeding by inserting an object, such as an air-filled membrane (balloon), or an embolic material such as foam into a blood vessel to block the blood flow. This study aimed to prove that preoperative embolization might affect and reduce the amount of intraoperative bleeding during the posterior stabilization procedure for thoracolumbal vertebrae fracture. A quasi-experimental method was chosen for this study, and samples were not taken at random. Samples were patients with thoracolumbal vertebrae fracture who underwent the posterior stabilization procedure. Samples were divided into two groups, treated with and without preoperative embolization groups. The treatment was given 24-48 hours before posterior stabilization procedure. The intraoperative bleeding was measured in milliliters. The resulys showed that the average intraoperative blood loss was 283.3 mL, meanwhile of the untreated group was 583.3 mL. The one-way t-test resulted in a p-value of 0.004 at 5% of significance. In conclusion, preoperative embolization could reduce the amount of blood loss during intra-operative posterior stabilization in patients with thoracolumbar vertebral fractures. Further research on preoperative embolization in patient who will undergo posterior stabilization surgery of the thoracolumbal region due to fracture, either mechanically or generatively, is needed.

Keywords: preoperative embolization; intraoperative blood loss

Luaran Terapi Balloon Eustachian Tuboplasty pada Disfungsi Tuba Eustachius

2022-12-14T14:52:14+08:00

Abstract: Eustachian tube dysfunction (ETD) is a common condition complained by patients and most of them are still managed today by medical therapy. Newer management techniques such as Balloon Eustachian Tuboplasty (BET) has been introduced. This study aimed to evaluate the available studies regarding the indications, safety, and efficacy of BET in reducing the symptoms of patients with ETD. This was a systematic review study. A comprehensive literature search was carried out according to PRISMA guidelines, and seven articles were obtained. The follow-up results showed a significant improvement in the ETDQ-7 score and the results of middle ear assessments. Progress observed over 1-12 months confirmed the efficacy and demonstrated the durability of the BET procedure, without complications that occurred during follow-up. In conclusion, based on the literature review the procedure BET was found to be safe and efficient in the short and long terms up to five years post operatively in patient with chronic ETD.

Keywords: Balloon Eustachian Tuboplasty; Eustachian tube dysfunction

Abstrak: Disfungsi tuba Eustachius (ETD) merupakan kondisi yang umum dikeluhkan oleh pasien dan sebagian besar masih dikelola saat ini dengan terapi medis. Dewasa ini teknik manajemen yang lebih baru seperti Balloon Eustachian Tuboplasty (BET) telah diperkenalkan. Penelitian ini bertujuan untuk mengevaluasi studi-studi yang tersedia mengenai indikasi, keamanan, keberhasilan BET dalam mengurangi gejala pasien ETD. Jenis penelitian ialah suatu systematic review. Pencarian literatur dilakukan secara komprehensif sesuai dengan pedoman PRISMA. Hasil penelitian mendapatkan tujuh artikel untuk dilakukan tinjauan sistematis. Hasil follow-up dari semua peserta yang menjalani BET menunjukkan peningkatan bermakna berdasar-kan skor ETDQ-7 dan hasil penilaian telinga tengah. Perkembangan selama 1-12 bulan menunjuk-kan kemanjuran dan daya tahan prosedur BET tanpa disertai komplikasi berat yang muncul selama masa follow-up. Simpulan penelitian ini ialah prosedur BET dilaporkan aman dan efektif dalam jangka pendek dan jangka panjang hingga mencapai lima tahun pasca operasi pada pasien dengan ETD kronis.

Kata kunci: Balloon Eustachian Tuboplasty; disfungsi tuba Eustachius

Faktor-faktor yang Berhubungan dalam Pendokumentasian Asuhan Keperawatan di Ruang Rawat Inap Rumah Sakit Umum Pusat Ratatotok Buyat

2023-01-02T20:30:45+08:00

Abstract: Documentation of patient nursing records is important as evidence of accountability for nursing actions provided in the service. This study aimed to analyze the relationship between leadership, rewards, and attitudes of nurses in documenting nursing care at the inpatient ward of Ratatotok Buyat General Hospital. This was an analytical and observational study with a cross-sectional design. Sampls were all nurses, totaling 77 people. Data were analyzed with univariate and bivariate analysis of chi-square test. The results showed that documentation of good nursing care was 80.5% and poor nursing care was 19.5%; good leadership was 87% and poor leadership was 13%; rewards experienced by health workers were 67.5% and poor rewards were 32.5%; good attitude was 70.1% and poor attitude was 29.9%. The chi square test obtained a p-value of 0.000 as a whole from each variable. In conclusion, there is a relationship between leadership, rewards, and attitudes with the documentation of nursing care at the inpatient ward of Ratatotok Buyat General Hospital.

Keywords: documentation of nursing care; leadership; rewards; attitudes; nurses

Abstrak: Pendokumentasian catatan keperawatan pasien merupakan hal penting sebagai bukti pertanggungjawaban terhadap tindakan keperawatan dalam pelayanan. Penelitian ini bertujuan untuk menganalisis hubungan antara kepemimpinan, imbalan, dan sikap perawat dalam mendokumentasikan asuhan keperawatan di ruang rawat inap Rumah Sakit Umum Pusat Ratatotok Buyat. Jenis penelitian yaitu observasional analitik dengan studi potong lintang. Sampel ialah seluruh perawat yang berjumlah 77 orang. Analisis data penelitian secara univariat dan bivariat dengan uji chi-square. Hasil penelitian mendapatkan variabel pendokumentasian asuhan keperawatan yang baik sebesar 80,5% dan yang kurang baik 19,5%; kepemimpinan yang baik sebesar 87% dan yang kurang baik 13%; imbalan yang dialami oleh petugas kesehatan sebesar 67,5% dan yang merasa imbalan kurang baik sebesar 32,5%; sikap petugas kesehatan yang baik sebesar 70,1% dan yang kurang baik sebesar 29,9%. Hasil uji chi square mendapatkan nilai p=0,000 secara keseluruhan dari setiap variabel yang diteliti. Simpulan penelitian ini ialah terdapat hubungan kepemimpinan, imbalan dan sikap dengan pendokumentasian asuhan keperawatan di ruang rawat inap Rumah Sakit Umum Pusat Ratatotok Buyat.

Kata kunci: pendokumentasian asuhan keperawatan; kepemimpinan; imbalan; sikap; perawat

Hubungan Perilaku Aktivitas Fisik dan Penggunaan Screen Time dengan Status Gizi pada Pemuda GMIM Kawangkoan

2023-01-02T20:47:30+08:00

Abstract: Today the world faces a double burden that includes undernourishment and overweight, especially in low and middle-income countries. The high intensity of screen time will cause changes in nutritional status from being fat to obesity, due to the lack of body movement in daily activities. This study aimed to evaluate whether there was a relationship between physical activity behavior and screen time with nutritional status among GMIM Kawangkoan youths. This was a quantitative study. Samples were a total population of 60 respondents. Data were analyzed univariately and bivariately with the chi square test. The results showed that the majority of respondents had poor screen time (52.6%) and poor nutritional status (56.4%). The chi square test showed significant relationships between physical activity behavior and nutritional status (p=0.006), and between screen time and nutritional status (p=0.000). In conclusion, there are significant relationships between physical activity behavior and screen time with nutritional status among youths GMIM Kawangkoan.

Keywords: nutritional status; physical activity behavior; screen time

Abstrak: Saat ini dunia menghadapi beban ganda yang mencakup kekurangan gizi dan kelebihan berat badan, terutama di negara-negara berpenghasilan rendah dan menengah. Tingginya intensitas screen time yang dilakukan akan menyebabkan perubahan status gizi menjadi gemuk hingga obesitas oleh karena kurangnya gerakan tubuh dalam aktivitias sehari-hari. Penelitian ini bertujuan untuk mengetahui adanya hubungan antara perilaku aktivitas fisik dan screen time dengan status gizi pada pemuda GMIM Kawangkoan. Jenis penelitian ialah kuantitatif. Sampel ialah total populasi berjumlah 60 responden. Analisis yang digunakan univariat dan bivariat uji chi square. Hasil penelitian mendapatkan bahwa mayoritas responden memiliki kategori screen time kurang baik (52,6%) dan status gizi kurang baik (56,4%), sedangkan responden dengan kategori aktivitas fisik baik dan kurang baik sama banyak. Hasil uji chi square tabulasi silang antara perilaku aktivitas fisik dengan status gizi mendapatkan nilai p=0,006 dan antara penggunaan screen time dengan status gizi mendapatkan nilai p=0,006 yang berarti terdapat hubungan yang bermakna antara kedua variabel tersebut. Simpulan penelitian ini ialah terdapat hubungan antara perilaku aktivitas fisik dan penggunaan screen time dengan status gizi pada pemuda GMIM Kawangkoan.

Kata kunci: status gizi; perilaku aktivitas fisik; screen time

Gambaran Pola dan Derajat Luka pada Kasus Kekerasan dengan Permintaan Visum et Repertum di RSUP Prof. Dr. R. D. Kandou Tahun 2020-2021

2022-12-27T21:04:18+08:00

Abstract: Visum et Repertum is a written statement from a doctor at the official request of an authorized law enforcement officer with the aim of conducting a forensic medical examination to determine the cause and severity of wound. This study aimed to obtain the profile of pattern and severity of wounds in cases of violence with VeR request at Prof. Dr. R. D. Kandou Manado in 2020-2021. This was a descriptive and retrospective study using medical record data. The results found 70 cases of violence with VeR request in 2020-2021. The year 2020 showed the highest number of cases of violence with visum et repertum, namely 43 VeRs (61.8%) while in 2021 there was 27 VeRs (38.6%). The majority of cases were dominated by males with 64 cases (91.4%) versus 6 (8.6%) cases in females. Age group was dominated by teenagers of 12-16 years old and early adults of 17-25 years old. The pattern of wounds was mostly sharp force injury in 43 cases followed by blunt force injury in 17 cases. The severity of wounds was dominated by moderate category as many as 51 cases stated at the VeRs. In conclusion, the description of the pattern and severity of wounds in cases of violence with request for VeR at Prof Dr. R. D. Kandou Hospital in 2020-2021 revealed that most victims were male with sharp force injury of moderate severity.

Keywords: Visum et Repertum; pattern of wound; severity of wound

Abstrak: Visum et Repertum (VeR) adalah keterangan tertulis dari seorang dokter atas permintaan resmi dari penegak hukum dengan tujuan untuk mencari penyebab dan derajat keparahan luka. Penelitian ini bertujuan untuk mengetahui gambaran pola dan derajat luka pada kasus kekerasan dengan permintaan VeR di RSUP Prof. Dr. R. D. Kandou Manado tahun 2020-2021. Jenis penelitian ialah deskriptif retrospektif dengan menggunakan data rekam medis. Hasil penelitian mendapatkan 70 VeR selama 2020-2021. Pada tahun 2020 didapatkan jumlah kasus kekerasan dengan pembuatan VeR terbanyak yaitu sebanyak 43 VeR (61,8%) sedangkan pada tahun 2021 sebanyak 27 VeR (38,6%). Jenis kelamin terbanyak ditemukan ialah laki-laki dengan jumlah 64 (91,4%) kasus. Usia didominasi oleh usia remaja 12-16 tahun dan dewasa muda 17-25 tahun. Pola luka terbanyak pada kasus kekerasan tajam yaitu 43 kasus dan kekerasan tumpul sebanyak 17 kasus yang didominasi dengan derajat perlukaan sedang sebanyak 51 kasus dalam keterangan VeR. Simpulan penelitian ini ialah gambaran pola dan derajat luka pada kasus kekerasan dengan permintaan Visum et Repertum di RSUP Prof. Dr. R. D. Kandou tahun 2020-2021 mengungkapkan korban terbanyak dialami oleh laki-laki dengan jenis luka kekerasan tajam dan derajat keparahan luka derajat sedang.

Kata kunci: Visum et Repertum; pola luka; derajat luka

Tindakan Trabekulektomi pada Pasien dengan Glaukoma Sudut Tertutup Primer Unilateral – Laporan Kasus

2022-12-27T21:14:31+08:00

Abstract: Primary angle closure glaucoma (PACG) is the leading cause of blindness in Asia. In PACG, degenerative changes in the trabecular meshwork resulting from iridiotrabecular contact (ITC) cause high intraocular pressure resulting in glaucomatous optic atrophy. We reported a 58-year-old woman came with the chief complaint of pain in the right eye for three months, accompanied by red and watery eye, and glare when exposed to light. Patient also complained of headaches and sometimes nausea. There was a history of hypertension since one year ago, but not taking any drugs. In ophthalmological examination of the right eye, visual acuity was 6/20, intraocular pressure 39 mm Hg, conjunctival injection, corneal edema, Van Herick 1 shallow anterior chamber, iris atrophy, round shaped and centrally located pupil with a diameter of 5 mm and a NO3NC3 lens. In the posterior segment of the right eye, non-uniform fundal reflexes were found, papillae were round, vital, well-defined with a cup and disc ratio of 0.7-0.8. The patient was diagnosed with primary angle-closure glaucoma in the right eye and a trabeculectomy was performed on the right eye. After trabeculectomy, the intraocular pressure of the right eye was 17.7 mm Hg. In conclusion, trabeculectomy has a high success rate in terms of controlling intraocular pressure in primary angle closure glaucoma.

Keywords: glaucoma; primary angle closure; tabeculectomy

Abstrak: Glaukoma penutupan sudut primer (PACG) merupakan penyebab utama kebutaan di Asia. Pada PACG, perubahan degeneratif dalam trabecular meshwork yang dihasilkan dari kontak iridiotrabecular (ITC) menyebabkan tekanan intraokular tinggi yang menghasilkan glaucomatous optic atrophy. Kami melaporkan kasus eorang perempuan berusia 58 tahun datang dengan keluhan nyeri mata kanan sejak tiga bulan yang lalu, disertai dengan mata merah, berair dan silau saat terkena cahaya. Pasien juga mengeluh adanya nyeri kepala dan kadang disertai mual. Riwayat hipertensi sejak satu tahun sebelumnya, tidak mengonsumsi obat-obatan. Pada pemeriksaan oftalmologi mata kanan didapatkan visus 6/20, tekanan intraokuler 39 mmHg, konjungtiva injeksi, kornea edema, bilik mata depan dangkal Van Herick 1, iris atrofi, pupil berbentuk bulat letak sentral dengan diameter 5 mm serta lensa NO3NC3. Pada segmen posterior mata kanan ditemukan refleks fundus non uniform, papil bulat, vital, berbatas tegas dengan cup and disc ratio 0,7-0,8. Pasien didiagnosis dengan glaukoma sudut tertutup primer mata kanan dan dilakukan tindakan trabekulektomi pada mata kanan. Setelah tindakan trabekulektomi, tekanan intraokuler mata kanan menjadi 17,7 mmHg. Simpulan kasus ini ialah trabekulektomi terbukti memiliki tingkat keberhasilan yang tinggi dalam hal mengontrol tekanan intraokuler pada glaukoma penutupan sudut primer.

Kata kunci: glaukoma; sudut tertutup primer; trabekulektomi

Hubungan Stres Kerja, Hubungan Interpersonal dan Tugas Tambahan dengan Beban Kerja Perawat di Ruangan Palma RSUP Prof. Dr. R. D. Kandou, Manado

2023-01-02T20:55:10+08:00

Abstract: Covid-19 pandemic has had an impact on all aspects, especially on health care workers resulting in an increase in the physical workload of nurses. This study aimed to determine the relationship between work stress, interpersonal relationships, and additional tasks with the workload of nurses in Palma room of Prof. Dr. R. D. Kandou Hospital. This was a quantitative study. Samples were the total population of 48 nurses. Data were analyzed using the chi-square and the logistic regression tests. The results obtained sufficient and high workload (39.6% and 60.4%); sufficient and high work stress (31.3% and 68.8%); good and poor interpersonal relationship (47.9% and 52.1%); sufficient and high additional tasks (60.4% and 39.9%). The chi-square test showed the p-values, as follows: 0.001 for the relationship between work stress and workload; 0.000 for the relationship between interpersonal relationships and workload; and 0.034 for the relationship between additional tasks and workload. The logistic regression test found that the interpersonal relationship variable had the strongest relationship with workload compared to the other variables (Exp (B) interpersonal relationships, namely 11.441). In conclusion, there are relationships between work stress, interpersonal relationships, and additional tasks with the workload of nurses in Palma Room, Prof. Dr. R. D. Kandou Hospital, Manado. The most related variable with workload is interpersonal relationships.

Keywords: workload; work stress; interpersonal relations; additional tasks

Abstrak: Pandemi Covid-19 membawa dampak pada semua aspek, terutama pada tenaga kesehatan perawat yang mengakibatkan meningkatnya beban kerja fisik perawat. Penelitian ini bertujuan untuk mengetahui hubungan antara stres kerja, hubungan interpersonal, dan tugas tambahan dengan beban kerja perawat di ruangan Palma RSUP Prof. Dr. R. D. Kandou. Jenis penelitian kuantitatif. Sampel ialah total populasi sebanyak 48 perawat. Analisis statistik menggunakan uji chi-square, dan regresi logistik. Hasil penelitian mendapatkan variabel beban kerja cukup dan tinggi (39,6% dan 60,4%); stres kerja cukup dan tinggi (31,3% dan 68,8%); hubungan interpersonal baik dan kurang baik (47,9% dan 52,1%); serta tugas tambahan cukup dan tinggi (60,4% dan 39,9%). Hasil uji chi square mendapatkan nilai p=0,001 untuk hubungan stres kerja dengan beban kerja; p=0,000 untuk hubungan interpersonal dengan beban kerja; p=0,034 untuk hubungan tugas tambahan dengan beban kerja. Hasil uji regresi logistik menunjukkan hubungan interpersonal memiliki hubungan paling kuat dengan beban kerja (Exp (B) hubungan interpersonal yaitu 11,441). Simpulan penelitian ini terdapat hubungan antara stres kerja, hubungan interpersonal, dan tugas tambahan dengan beban kerja perawat di Ruangan Palma RSUP Prof. Dr. R. D Kandou Manado dan variabel yang paling berhubungan dengan beban kerja ialah hubungan interpersonal.

Kata kunci: beban kerja; stres kerja; hubungan interpersonal; tugas tambahan

First Experience of Patent Ductus Arteriosus Stenting in Neonate with Pulmonary Atresia and Intact Ventricular Septum in North Sulawesi, Indonesia

2023-03-07T15:15:51+08:00

Abstract: Stenting of patent ductus arteriosus (PDA) is a minimally invasive catheter-based temporary palliative procedure, and it serves as an alternative to surgical shunt in neonates with duct dependent pulmonary perfusion, such as pulmonary atresia. This presentation aimed to report the first experience of PDA stenting in a neonate with pulmonary atresia in North Sulawesi, Indonesia. We reported a female neonate patient, weighing 3775 grams, referred from primary hospital with suspect congenital heart disease. The patient was born at 40 weeks of gestational age by caesarean section delivery from a primigravid mother aged 23 years with inertia uteri and strangulation of nuchal cord. At birth, she cried immediately and her APGAR score was 6-7. On her first day of life, she looked cyanotic, therefore she was referred to Prof. Dr. R. D. Kandou Hospital. Physical examination showed that she had perioral cyanotic and peripheral cyanotic with SpO2 58%. Chest X-ray showed cardiomegaly. Echocardiography revealed pulmonary atresia with PDA with intact ventricular septum. PDA stenting was done on her second day of admission. After the procedure, she was clinically stable with SpO2 80%, and was treated with intravenous antibiotic, and intravenous heparin and aspirin enterally. On the third day post procedure, she was discharged and no complication was found. PDA stenting in patient with duct-dependent pulmonary circulation appeared to be an alternative to surgery. It provided bridging palliation until the time of definitive surgery. The effectiveness of the procedure was highlighted by the fact that all the patients showed significant improvement in arterial saturation and pulmonary vascular marking. In conclusion, PDA stenting is considered feasible, safe and associated with lower mortality rates and shorter hospital length of stay than systemic-pulmonary surgical shunt procedure. Early detection and timely management are imperative to save the life.

Keywords: patent ductus arteriosus stenting; pulmonary atresia

Evaluasi Klinik Autorefraktor NIDEK TONOREF III Dibandingkan dengan Refraksi Subjektif pada Populasi Miopia Muda

2023-02-25T10:05:36+08:00

Abstract: Incidence of myopia has continued to increase in the last few decades and is expected to increase continually from time to time. Early detection of myopia is expected to prevent the occurrence of amblyopia, strabismus or other eye disorders. Autorefractor is a medical device that can be used before refraction examination in order to increase the efficiency in measurement of refractive disorders. However, the autorefractor used needs to be tested first to ensure the reliability of the tool in supporting clinical examinations. This study aimed to evaluate the reliability of the NIDEK TONOREF III autorefractor in daily clinical practice in young myopia population. The results obtained 42 subjects with myopic refractive error aged 20-41 years. The majority were females and had mild myopia. The statistical analysis showed no significant difference in the calculation of pupillary distance (p=0.581) and the correction results (p=0.842) between autorefractor and subjective refraction. In conclusion, the NIDEK Tonoref III autorefractor exhibits a high degree of reliability in evaluating glasses prescription and pupillary distance for cases of myopia.

Keywords: autorefractor; myopia; NIDEK TONOREF III; objective refraction; subjective refraction

Abstrak: Angka kejadian miopia terus mengalami peningkatan dalam beberapa dekade terakhir dan diperkirakan akan terus bertambah. Deteksi dini miopia diharapkan dapat mencegah terjadinya ambliopia, strabismus ataupun kelainan mata lainnya. Autorefraktor merupakan alat pemeriksaan yang dapat digunakan mendahului pemeriksaan refraksi untuk meningkatkan efisiensi pemeriksaan kelainan refraksi. Namun, autorefraktor yang digunakan perlu diuji terlebih dahulu sehingga menjamin keterandalan alat dalam menunjang pemeriksaan klinis. Penelitian ini bertujuan untuk menguji keterandalan autorefraktor NIDEK TONOREF III dalam praktik klinis sehari-hari pada populasi miopia muda. Hasil penelitian mendapatkan 42 subjek penelitian dengan kelainan refraksi miopia pada rentang usia 20-41 tahun. Subjek terbanyak berada pada kategori miopia ringan dan berjenis kelamin perempuan. Hasil uji t-independen menunjukkan tidak terdapat perbedaan bermakna pada perhitungan jarak antar pupil (p=0,581) serta hasil koreksi (p=0,842) antara autorefraktor dan refraksi subjektif. Simpulan penelitian ini ialah autorefraktor NIDEK Tonoref III memiliki keterandalan yang baik dalam menilai koreksi kacamata dan jarak antar pupil untuk kasus miopia.

Kata kunci: autorefraktor; miopia; NIDEK TONOREF III; refraksi objektif; refraksi subjektif