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Abstrak: Latar belakang: Upaya mengenal nyeri sentral pada pasien pascastroke dapat dilakukan dengan menyediakan alat bantu diagnosis. Penelitian ini bertujuan untuk mengembangkan sistem skoring diagnostik nyeri sentral pascastroke (NSPS) di rumah sakit, dan menganalisis akurasi dan reliabilitas penggunaan sistem skoring tersebut di puskesmas. Metode: Penelitian ini merupakan penelitian dengan rancangan potong-lintang dan merupakan studi diagnostik pada 166 pasien di rumah sakit dan 303 pasien di puskesmas se-wilayah Kota Manado dan sekitarnya. Hasil: Terdapat tiga variabel utama yang dominan sebagai determinan NSPS berdasarkan uji regresi cox yakni keparahan stroke, defisit nyeri tajam dan defisit raba halus. Prevalensi NPSP di rumah sakit berdasarkan baku emas didapatkan sebesar 30,1%. Dengan titik potong skor ≥2 maka didapatkan nilai sensitifitas 82,0% dan sensitifitas 78,45%. Berdasarkan perhitungan menurut teorema Bayes maka didapatkan probabilitas NSPS di RS dengan skor ≥2 sebesar 62,12%, dan <2 sebesar 8,98%. Berdasarkan hasil pemeriksaan spesialis neurologik di puskesmas maka didapatkan prevalensi NSPS di puskesmas berdasarkan skor Sasmita adalah sebesar 40,9%. Hasil uji akurasi menunjukkan sensitivitas skor Sasmita oleh spesialis neurologi dan dokter umum di puskesmas adalah 71,61% dan sensitivitas 76,35%. Perhitungan dengan teorema Bayes didapatkan probabilitas NSPS di puskesmas dengan skor skor ≥2 sebesar 67,69%, dan <2 sebesar 20,42%. Uji reliabilitas antar dokter umum di puskesmas adalah sebesar 0,576. Kesimpulan: Terdapat tiga variabel utama yang dominan sebagai determinan NSPS yakni keparahan stroke, defisit nyeri tajam dan defisit raba halus. Secara deskriptif didapatkan bahwa kualitas hidup pasien stroke dengan NSPS adalah lebih rendah dibandingkan tanpa NSPS. Pada keseluruhan pasien dengan NSPS, domain yang paling sering mengalami gangguan adalah energi. Saran: Skor Sasmita dapat digunakan sebagai dalam penelitan selanjutnya terkait epidemiologi klinik nyeri pascastroke.

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Introduction: The identification of central poststroke pain (CPSP) can be facilitated by the provision of diagnostic tools. This study aimed to develop a diagnostic scoring system for CPSP in hospital settings and to analyze the accuracy and reliability of its use in Puskesmas. Method: This cross-sectional diagnostic study was conducted on 166 hospital and 303 stroke survivors from Puskesmas in Manado City and its outskirts area. Result: Based on cox regression, three key variables were identified as dominant determinants of CPSP: stroke severity, pin-prick deficit, and light-touch deficit. The prevalence of CPSP in hospitals, determined using the gold standard, was 30.1%. With a cut-off score of ≥2, the sensitivity and specificity were 82.0% and 78.45%, respectively. Using Bayes' theorem, the probability of CPSP in hospitals with a score ≥2 was 62.12%, and <2 was 8.98%.  At the primary health centers, neurological specialist examinations revealed a CPSP prevalence of 40.9% based on the Sasmita scoring system. The accuracy test showed that the sensitivity of the Sasmita score assessed by neurologists and general practitioners was 71.61% and 76.35%, respectively. Bayes' theorem calculations indicated a CPSP probability at the Puskesmas of 67.69% with a score ≥2 and 20.42% with a score <2. Inter-rater reliability testing among general practitioners yielded a value of 0.576. Descriptively, stroke patients with CPSP had lower quality of life compared to those without CPSP, with the most commonly affected domain being energy. Conclusion: Three key variables were identified as dominant determinants of CPSP: stroke severity, pin-prick deficit, and light-touch deficit. The prevalence of CPSP in this study is relatively high both at hospital and Puskesmas settting. Sasmita score has good accuracy and moderately reliable in detecting CPSP at primary and tertiary care level. Suggestion: The Sasmita scoring system can be utilized in future studies related to the clinical epidemiology of poststroke pain. Serial assessment is encouraged to be conducted for high risk poststroke patients.

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Heart failure is a clinical syndrome that occurs when the heart fails to meet the body’s demand for oxygen and nutrients. The prevalence and mortality rate of heart failure in Indonesia are relatively high compared to other Southeast Asian countries. The occurrence of heart failure in young adults increases the risk of premature death, recurrent rehospitalization, reduced quality of life, and a greater burden on the healthcare system. Several factors such as obesity, type 2 diabetes mellitus (T2DM), hypertension, smoking, dyslipidemia, family history of premature coronary artery disease (PCAD), and sex have been identified as being associated with heart failure. Developing a predictive model to identify the most influential risk factors for heart failure in young adults is crucial for preventive strategies and early interventions. This study employed a fixed retrospective cohort design involving patients aged 18–54 years who visited the cardiology outpatient clinic or were hospitalized at four tertiary hospitals in Indonesia (National Cardiovascular Center Harapan Kita, Jakarta; Hasan Sadikin Hospital, Bandung; Sebelas Maret University Hospital, Solo; and Adam Malik Hospital, Medan) in 2021. Patients without an initial diagnosis of heart failure were included, and their risk factors were recorded according to the study variables. The patients were followed monthly from 2021 until the end of observation in 2024 to determine whether they developed heart failure. Descriptive, bivariate, and multivariable analyses were conducted using the Poisson Generalized Linear Model (GLM) to estimate coefficients, incidence rate ratios (IRR) with 95% confidence intervals, and to construct the most accurate predictive model. Based on the model, a scoring system and probability value for the occurrence of heart failure were developed. A total of 321 participants met the inclusion and exclusion criteria, with a median age of 51 years (P25–P75: 46–52 years). After four years of observation, the cumulative probability of developing heart failure was 0.713 (95% CI: 0.661–0.760). The analysis identified three significant predictors for heart failure in young adults: obesity (IRR 1.87; 95% CI 1.31–2.68), dyslipidemia (IRR 2.58; 95% CI 1.87–3.56), and T2DM (IRR 2.79; 95% CI 2.01–3.87). The IDD Score (Body Mass Index–Dyslipidemia–Diabetes) was developed as a predictive scoring system for heart failure in young adults, with a total score of 13 corresponding to a 76.8% probability. Obesity, dyslipidemia, and T2DM were found to be significant risk factors for heart failure in young adults. The proposed IDD Score demonstrated good sensitivity and specificity in predicting the occurrence of heart failure within this population.

Abstrak: Pengaruh pelaksanaan clinical pathway terhadap proses pelayanan dan lama hari rawat pasien stroke iskemik di tiga rumah sakit Indonesia Pengaruh pelaksanaan clinical pathway terhadap proses pelayanan dan lama hari rawat pasien stroke iskemik di tiga rumah sakit Indonesia

Abstrak: COVID-19 menjadi pandemi di seluruh dunia sejak Maret 2020. Hipertensi merupakan penyakit penyerta yang banyak diderita oleh pasien COVID-19. Banyaknya kasus COVID-19 membuat daya tampung fasilitas kesehatan hampir tidak mencukupi untuk memberikan pelayanan medis rawat inap yang memadai pada pasien COVID-19.Perpanjangan lama rawat inap pasien COVID-19 berefek terhadap besaran biaya yang ditanggung pemerintah atau pasien sendiri. Penentuan prioritas pasien rawat inap menjadi penting untuk rekomendasi panduan pelayanan pasien COVID-19. Saat ini penelitian tentang hubungan hipertensi dengan durasi lama rawat inap pasien COVID-19 di Indonesia masih belum ada. Penelitian bertujuan mengetahui hubungan antara hipertensi dengan lama rawat inap pasien terkonfirmasi COVID-19 di Rumah Sakit Universitas Indonesia (RSUI). Desain studi kohort retrospectif dilakukan pada 369 pasien terkonfirmasi COVID-19 yang dirawat inap di RSUI selama Maret sampai dengan Oktober 2020, menilai hubungan hipertensi dengan lama rawat inap pasien terkonfirmasi COVID-19 setelah di kontrol usia, jenis kelamin, komorbid, tingkat keparahan, status PCR saat pulang dan status pasien pada akhir rawat

Abstrak: Limfedema merupakan komplikasi kronis yang umumnya terjadi setelah diseksi kelenjar getah bening (KGB) aksila pada pasien kanker payudara. Penelitian ini bertujuan untuk mengetahui angka kejadian, faktor risiko, dan model prediksi limfedema pasca diseksi KGB aksila pada pasien kanker payudara stadium lanjut. Penelitian ini merupakan desain kohort retrospektif pada 174 pasien di Rumah Sakit Kanker Dharmais. Regresi Cox digunakan untuk mengidentifikasi faktor risiko signifikan terhadap limfedema. Keakuratan model prediksi dinilai dengan menghitung area under the receiver operating characteristic curve (AUROC). Hasil penelitian menunjukkan limfedema teridentifikasi pada 88/174 (50,6%) pasien dan sebagian besar mengalami limfedema pada 12 hingga 36 bulan pertama setelah diseksi KGB aksila. Faktor risiko yang terkait dengan limfedema di antaranya adalah usia, obesitas, diabetes, kemoterapi neoadjuvan, dan kemoterapi adjuvan. Model prediksi menunjukkan sensitivitas yang baik (80,2%) pada populasi penelitian dengan nilai AUC 0,706 (95% CI 0,629-0,783; p-value < 0,05). Dapat disimpulkan bahwa model prediksi yang dikembangkan dalam penelitian ini cukup baik untuk diterapkan oleh para klinisi dalam mengestimasikan risiko limfedema, khususnya untuk pasien kanker payudara dengan stadium lanjut.

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Lymphedema is a chronic complication that commonly occurs after axillary lymph node dissection (ALND) in breast cancer patients. This study aimed to determine the incidence, risk factors, and prediction model for lymphedema after ALND in advanced-stage breast cancer patients. This was a retrospective cohort design on 174 patients at Dharmais Cancer Hospital. Cox regression was used to identify significant risk factors for lymphedema. The prediction accuracy of the model was assessed by calculating the area under the receiver operating characteristic curve (AUROC). The results showed that lymphedema was identified in 88/174 (50.6%) patients and most of them experienced lymphedema in the first 12 to 36 months after ALND. Risk factors associated with lymphedema include age, obesity, diabetes, neoadjuvant chemotherapy, and adjuvant chemotherapy. The prediction model showed good sensitivity (80.2%) in the study population with an AUC value of 0.706 (95% CI 0.629-0.783; p-value < 0.05). It can be concluded that the prediction model developed in this study is good enough to be implemented by clinicians in estimating the risk of lymphedema, especially for advanced-stage breast cancer patients in our hospital.

Abstrak: Hasil. Median kesintasan lama rawat intensif 43 jam. Nilai skor EuroSCORE tidak memenuhi asumsi hazard proporsional. Model baru telah dibuat dari 7 variabel EuroSCORE yang secara substansi berhubungan dengan lama rawat intensif (AUC 0,67). Kesimpulan. Model baru dari tujuh faktor EuroSCORE cukup dapat memprediksi lama rawat intensif 48 jam. Kata Kunci: Model prediksi, lama rawat intensif, bedah jantung, regresi Cox