Abstrak: Tesis ini membahas tentang penetapan posisi dan penentuan strategi Badan Rumah Sakit Umum Tabanan dalam pengembangan poliklinik sore. Penelitian ini merupakan penelitian operasional dengan analisis data kualitatif dan data kuantitatif. Dengan menggunakan analisis situasi menganalisis peluang-ancaman, kekuatan-kelemahan dan penetapan posisi BRSU Tabanan menggunakan matriks TOWS dan matriks IE. Kesimpulan pada penelitian menetapkan posisi BRSU Tabanan pada Future Quadrant pada matrik TOWS dan pada sel II pada matriks IE. Dengan menggunakan QSPM, poliklinik penyakit dalam sebagai prioritas poliklinik sore yang akan dikembangkan.

Abstrak: Iodine supplementation during pregnancy is a common practice in developed countries. However, scant evidence is available regarding the safety and effectiveness of maternal iodine supplementation with regard to child neuropsychological development. We previously reported an inverse association between iodine supplementation and the psychomotor development of infants in a birth cohort from Valencia, Spain. In the present study, we assessed this association in a wider sample of mother and child pairs from 3 other regions in Spain. Neuropsychological development was assessed using the Bayley Scales of Infant Development in 1,519 infants (median age, 16 months) between 2006 and 2009. In multivariate analyses, maternal consumption of 150 μg/day or more of iodine from supplements was related to a 1.5-fold increase in the odds of a psychomotor score less than 85 (95% confidence interval: 0.8, 2.9) and to a 1.7-fold increase in the odds of a mental score less than 85 (95% confidence interval: 0.9, 3.0). Findings previously reported in the Valencia cohort were only partially verified. The results of the present study suggest that, at least in these regions, iodine supplementation does not improve infant neuropsychological development at 1 year of age. Further research is needed on the risks and benefits of supplementary iodine for both maternal thyroid function and child neurodevelopment.

Abstrak: In utero tobacco exposure has been associated with fetal growth restriction, but uncertainty remains about critical windows of exposure and specific effects on body segments. In the present study, we aimed to examine the association of maternal smoking with fetal biometry in different stages of pregnancy. The study population comprised 2,478 fetuses from a Spanish birth cohort study that was established between 2003 and 2008. Biparietal diameter, femur length, abdominal circumference, and estimated fetal weight were evaluated at 12, 20, and 34 weeks of gestation. Fetal size and growth were assessed by standard deviation scores adjusted by maternal and fetal characteristics. Maternal smoking was assessed using questionnaire and a sample of urinary cotinine at week 32 of gestation. Associations were estimated using multiple regression analysis. Smokers at week 12 of gestation showed decreased fetal growth as reflected by all growth parameters at 20–34 weeks, leading to a reduced fetal size at week 34. The reduction was greatest in femur length, at -9.4% (95% confidence interval -13.4, -5.4) and least in abdominal circumference, at -4.4% (95% CI: -8.7, -0.1). Fetuses of smokers who quit smoking before week 12 showed reduced growth only in femur length (-5.5; 95% CI: -10.1, -0.9). Dose–response curves for smoking versus fetal growth parameters (abscissa: log2 cotinine) were linear for biparietal diameter and femur length.

Abstrak: Rumah sakit dalam memberikan pelayanan kesehatan masyarakat harus dapat menjaga mutu dan kualitas. Salah satu upaya pemerintah untuk meningkatkan mutu pelayanan rumah melalui akreditasi. Akreditasi wajib dilakukan dan merupakan syarat ijin operasional sesuai aturan pemerintah. Rumah Sakit Prima Medika melakukan persiapan akreditasi KARS 2012 yang terdiri dari 4 sasaran pokok, namun penelitian ini pada dua sasaran yaitu sasaran keselamatan pasien dan Milenium Development Goals. Tujuan penelitian ini untuk mengetahui tahapan, masalah dan monitoring dalam proses persiapan akreditasi. Penelitian ini menggunakan metode kualitatif melibatkan partisipan sebanyak 7 orang yang terlibat dalam kelompok kerja akreditasi. Pengumpulan data dengan teknik wawancara mendalam dan penelusuran dokumen, dianalisis menggunakan content analysis. Hasil wawancara persiapan akreditasi dimulai komitmen dari seluruh jajaran rumah sakit, kelompok kerja akreditasi ditetapkan direktur, penyusunan dokumen sesuai elemen penilaian akreditasi, sosialisasi pada staf medis maupun non medis, implementasi sangat penting karena penilaian lebih terfokus pada pelaksanaan dilapangan, monitoring dan evaluasi dengan laporan monev, indikator mutu dan turun langsung ke lapangan. Kesimpulan tahapan persiapan yang penting adalah komitmen seluruh jajaran rumah sakit, melakukan pendekatan kepada dokter spesialis secara formal maupun informal, menambah pelatihan internal. Kata Kunci: persiapan akreditasi, sasaran keselamatan pasien,

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Goals Hospitals in providing public health services should be able to maintain quality of services. One of the government's efforts to improve the quality of home services through accreditation, which is compulsory and required by government regulation. This study focus on two goals of Prima Medika Hospital in preparation of KARS 2012 accreditation: International Patient Safety Goals and Millennium Development Goals. The purpose of this study is to determine the stages, problems and monitoring in the preparation process of accreditation on the patient's safety goals and the Millennium Development Goals. This research uses qualitative method by involving 7 participants working group of accreditation. Data collected by in-depth interview technique and document tracing, then analyzed using content analysis. The results of the interviews show that the preparation phase begins with the commitment of all hospitals, the accreditation working group established by the director, the compilation of documents of the assessment elements according to the accreditation standards, program dissemination to medical and non-medical staff, then the implementation. The next stage are monitoring and evaluation, through monev report, quality indicator and field inspection. In conclusions, the very important stages in preparation process are: commitment from all level of hospital, approaches to the specialist doctors formally or informally, more internal training. Keywords: preparation, accreditation, international patient safety, Millennium Development Goals