Ditemukan 11 dokumen yang sesuai dengan query :: Simpan CSV
Sekplin Sekeon; Promotor: Asri C. Adisasmita; Kopromotor: Mondastri Korib Sudaryo, Aida C. Tantri; Penguji: Dessy R. Emril, Soewarta Kosen, Syahrizal Syarif, Tiara Aninditha
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.
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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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.
D-549
Depok : FKM UI, 2025
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Johanes Edy Siswanto; Promotor: Sudarto Ronoatmodjo; Ko Promotor: Soemantri, Rita S. Sitorus; Penguji: Sudijanto Kamso, Ratna Djuwita, Asri C. Adisasmita, Iswari Setianingsih, Ratna Sitompul
Abstrak:
Latar Belakang: Retinopati Prematuritas atau ROP merupakan gangguan vaskular retina bayi prematur yang dapat menyebabkan pelepasan retina dan terjadinya kebutaan. Variasi gen Norrie disease Pseudoglioma (NDP) serta paparan oksigen diduga terlibat dengan kejadian dan perkembangan ROP. Tujuan: Mengetahui peran variasi NDP serta faktor layanan neonatal khususnya paparan oksigen dalam memprediksi kejadian ROP pada bayi prematur Indonesia. Metodologi: Studi dilaksanakan tahun 2009-2014 di beberapa pusat pelayanan perinatologi dan mata sekitar Jakarta. Sebanyak 6 situs mutasi pada ekson 3 dideteksi yaitu C597A, L108P, R121W, A105T, Val60Glu, dan C110G. Perubahan susunan basa gen NDP dianalisis dengan mengampilifikasi gen NDP bagian ekson 3 menggunakan metode Polymerase Chain Reaction (PCR-RFLP dan PCR-SSP). Hasil diverifikasi dengan sekuensing DNA. Model multivariat hasil analisis regresi logistik dan regresi Cox digunakan sebagai model skoring untuk memprediksi kejadian dan keparahan ROP. Hasil: Tidak ditemukan polimorfisme dan mutasi pada situs NDP exon 3. Hasil analisis multivariat didapatkan BBL, PJT(NCB-KMK), transfusi tukar, lama suplementasi O2, SpO2 terendah, dan sosial ekonomi sebagai variabel yang berhubungan dengan kejadian ROP. Sedangkan dalam hubungannya dengan keparahan ROP, didapatkan usia gestasi, lama suplementasi O2 > 7 hari, SpO2 terendah, rujukan RS, dan sosial ekonomi. Kesimpulan: Tidak didapatkan polimorfisme dan mutasi gen NDP exon 3 pada kasus ROP bayi prematur Indonesia. Lama suplementasi O2 dan nilai SpO2 terendah mempunyai peran dalam meningkatkan risiko kejadian dan berkembangnya ROP menjadi lebih berat.
Background: Retinopathy Prematurity or ROP is retinal vascularization disorder on premature infants that causing retina detachment and eventually blindness. NDP gene mutation and oxygen exposure might have role in incidence of ROP. Objective: This study was conducted to determine the role of NDP gene polymorphism and mutation, and oxygen exposure for predicting the incidence of ROP in Indonesia. Methodology: Data were collected from few Perinatology and Opthalmology centres around Jakarta during 2009-2014. DNA samples isolated from blood and buccal cell. This study tried to detect 6 mutations site on exon 3 of NDP gen which are C597A, L108P, R121W, A105T, Val60Glu, and C110G. Alterations of NDP gene were analized with amplification of NDP gene in exon 3 region using Polymerase Chain Reaction (PCR-RFLP dan PCR-SSP) methods. The result verified with DNA sequencing. Scoring model were made by using logistic regression to predict the incidence and development of ROP.
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Result: No NDP gene polymorphism and mutations at exon 3 region was detected. The result have been analized with PCR-RFLP and verified with DNA sequencing. Multivariate analysis using logistic regression for incidence of ROP retain birth weight, IUGR, gender, respiratory distress, exchange transfussion, length of O2 supplementation, SpO2 minimum, and socioeconomic variables. As for ROP severity, multivariate analysis retain gestational age, gender, access to hospital (inborn/outborn), apnea, length of O2 supplementation, SpO2 minimum, and socioeconomic variables.
Conclusion: The relationship between polymorphisms and mutations of NDP gene and ROP cases that happened in Indonesian premature infants population did not showed in this study. Length of O2 supplementation and minimum value of SpO2 85 - 90% significantly increase the risk for ROP incidence and development of severe ROP.
D-319
Depok : FKM-UI, 2015
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Muhammad Rizky Ardiansyah; Pembimbing: Nasrin Kodim; Penguji: Kusharisupeni, Rinni Yudhi Pratiwi
S-6563
Depok : FKM-UI, 2011
S1 - Skripsi Pusat Informasi Kesehatan Masyarakat
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Wahyuningsih Djaali; Promotor: Asri C. Adisasmita; Kopromotor: Helda, Hasan Mihardja; Penguji: Ella Nurlaella Hadi, Ratna Djuwita, Aida Rosita Tantri, Rudy Hidayat, Gea Pandhita
D-575
Depok : FKM-UI, 2025
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Shafira Rahmania; Pembimbing: Helda; Penguji: Ratna Djuwita, Tri Wisesa Soetisna, Rudyanto Sedono
Abstrak:
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Penyakit kardiovaskular, khususnya penyakit arteri koroner (Coronary Artery Disease/CAD), merupakan salah satu penyebab utama kematian global. Bedah pintas arteri koroner (Coronary Artery Bypass Graft/CABG) merupakan salah satu intervensi utama untuk CAD yang bertujuan mengurangi morbiditas dan meningkatkan kualitas hidup pasien. Namun, perawatan intensif yang berkepanjangan pasca CABG dapat berdampak negatif terhadap luaran kondisi pasien dan beban sumber daya kesehatan. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang memengaruhi kesintasan pasien pasca bedah pintas arteri koroner (CABG) untuk keluar dari ICU dalam waktu ≤48 jam dan mengembangkan model skoring prediksi lama rawat intensif. Studi menggunakan desain kohort retrospektif dengan data sekunder dari registri bedah jantung dewasa di RS Jantung dan Pembuluh Darah Harapan Kita periode Januari 2019 – Agustus 2024. Analisis mencakup univariat, bivariat (log-rank dan uji Cox proportional hazard), serta multivariat untuk memperoleh model prediksi terbaik. Hasil menunjukkan bahwa faktor faktor usia (adjHR 1.22; 95% CI 1.12-1.32), stroke (adjHR 1.29), gangguan fungsi ginjal berat (adjHR 1.51); gangguan fungsi ginjal sedang (adjHR 1.89), fungsi jantung normal (adjHR 1.80), kondisi kritis pre-operasi (adjHR 3.37), disfungsi jantung sedang (adjHR 1.85), disfungsi jantung ringan (adjHR 2.51), fungsi jantung normal (adjHR 3.03); mengalami infark miokard >21 hari pre-operasi (adjHR 1.35); tidak pernah mengalami infark miokard (adjHR 1.36); dan status prosedur elektif (adjHR 1.36) sebagai prediktor signifikan perawatan ICU ≤48 jam. Model skoring yang dikembangkan memiliki nilai AUC 68,87%, dengan titik potong skor ≥14 menunjukkan prediksi keberhasilan pasien menyelesaikan perawatan ICU dalam waktu ≤48 jam pasca operasi CABG.
Cardiovascular diseases, particularly coronary artery disease (CAD), are among the leading causes of global mortality. Coronary Artery Bypass Graft (CABG) surgery is one of the primary interventions for CAD, aimed at reducing morbidity and improving patients' quality of life. However, prolonged intensive care post-CABG can negatively impact patient outcomes and place a burden on healthcare resources. This study aims to analyze factors influencing the survival of post-CABG patients to leave the ICU within ≤48 hours and to develop a scoring model for predicting intensive care length of stay. The study employed a retrospective cohort design using secondary data from the adult cardiac surgery registry at RS Jantung dan Pembuluh Darah Harapan Kita from January 2019 to August 2024. The analysis included univariate, bivariate (log-rank and Cox proportional hazards tests), and multivariate approaches to obtain the best predictive model. Results identified are age (adjHR 1.22; 95% CI 1.12–1.32), stroke (adjHR 1.29), severe renal dysfunction (adjHR 1.51), moderate renal dysfunction (adjHR 1.89), normal cardiac function (adjHR 1.80), critical preoperative condition (adjHR 3.37), moderate cardiac dysfunction (adjHR 1.85), mild cardiac dysfunction (adjHR 2.51), normal cardiac function (adjHR 3.03), myocardial infarction >21 days preoperatively (adjHR 1.35), no history of myocardial infarction (adjHR 1.36), and elective procedure status (adjHR 1.36) as significant predictors for ICU stays ≤48 hours. The developed scoring model achieved an AUC of 68.87%, with a cutoff score of ≥14 indicating successful prediction of ICU discharge within ≤48 hours post-CABG surgery
T-7179
Depok : FKM UI, 2025
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Fadhila Nafilah Azzahra; Pembimbing: Nurhayati Adnan; Penguji: Putri Bungsu, Bambang Widyantoro, Prima Almazini
Abstrak:
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Infark Miokard Akut (IMA) menjadi penyebab kematian tertinggi di Indonesia. Studi tahun 2022 mendapatkan mortality rate pasien IMA di Indonesia mencapai 8,9%. Penelitian ini bertujuan untuk mengetahui hubungan antara faktor demografi, faktor risiko, komorbiditas, parameter klinis, parameter laboratorium, pemberian terapi inisial, dan pemberian tindakan revaskularisasi dengan kejadian kematian intrahospital pada pasien IMA di RS Jantung dan Pembuluh Darah Harapan Kita Jakarta Tahun 2019 – 2023. Desain studi cross sectional dengan populasi penelitian pasien IMA yang tercatat dalam registri Sindroma Koroner Akut (SKA) di RSJPDHK pada Januari 2019 – Agustus 2023. Analisis multivariat dengan menggunakan regresi logistik berganda untuk menemukan prediktor kematian, dan analisis skoring dilakukan dengan menggunakan ROC Curve untuk mengetahui kualitas diskriminasi skor. Sampel penelitian berjumlah 3593 pasien IMA dengan kejadian kematian intrahospital sebesar 9,6%.Variabel yang dapat dijadikan prediktor kejadian kematian intrahospital pada pasien IMA adalah Usia ≥65 tahun (AOR 1,64; 95% CI=1,24 – 2,18; p=0.001), kejadian gagal ginjal akut (AOR 1,80; 95% CI=1,32 – 2,44; p<0.001), gagal jantung akut (AOR 2,76; 95% CI=1,95 – 3,92; p<0.001), syok kardiogenik (AOR 24,45; 95% CI=16,85 – 35,47; p<0.001), FEVKi ≤ 40% (AOR 1,54; 95% CI=1,14 – 2,08; p=0.005), Hs Troponin ≥ 9 ng/dL (AOR 2,01; 95% CI=1,19 – 3,40; p=0.009), kreatinin > 2 mg/dL (AOR 1,83; 95% CI=1,26 – 2,65; p=0.001), GDS ≥ 200 mg/dL (AOR 1,71; 95% CI=1,30 – 2,25; p<0,001), riwayat dislipidemia (AOR 0,57; 95% CI=0,40 – 0,81; p=0,002), ticagrelor (AOR 0,63; 95% CI=0,41 – 0,99; p=0,043), statin (AOR 0,38; 95% CI=0,25 – 0,57; p<0,001), dan tindakan revaskularisasi (AOR 0,71; 95% CI=0,52 – 0,98; p=0,035). Hasil penilaian skoring menunjukkan nilai diskriminasi yang baik (AUC 0,886).
Acute myocardial infarction (AMI) is the leading cause of death in Indonesia. A study in 2022 found that the mortality rate of AMI patients in Indonesia reached 8.9%. This study aimed to know the relationship between demographic factors, risk factors, comorbidities, clinical parameters, laboratory parameters, administration of initial therapy, and provision of revascularization procedures with the incidence of in-hospital mortality in AMI patients at National Cardiovascular Center Harapan Kita from 2019 to 2023. The study design was cross-sectional with a population of AMI patients who were recorded in the Acute Coronary Syndrome (ACS) registry at RSJPDHK from January 2019 to August 2023. Multivariate analysis used multiple logistic regression to find predictors of in hospital mortality, and scoring analysis was carried out using the ROC Curve to determine the quality of score discrimination. Sample of this study consisted of 3593 AMI patients with an in-hospital mortality rate of 9.6%.Variables that can be used as predictors of inhospital mortality in AMI patients are age ≥65 years (AOR 1.64; 95% CI=1.24 – 2.18; p=0.001), acute kidney injury (AOR 1.80; 95% CI=1.32 – 2.44; p<0.001), acute heart failure (AOR 2.76; 95% CI=1.95 – 3.92; p<0.001), cardiogenic shock (AOR 24.45; 95% CI=16.85 – 35.47; p<0.001), left ventricular ejection fraction (LVEF) ≤ 40% (AOR 1.54; 95% CI=1.14 – 2.08; p=0.005), Hs Troponin ≥ 9 ng/dL (AOR 2.01; 95% CI=1.19 – 3.40; p=0.009), creatinine > 2 mg/dL (AOR 1.83; 95% CI=1.26 – 2.65; p=0.001), blood glucose (BG) ≥ 200 mg/dL (AOR 1.71; 95% CI=1.30 – 2.25; p<0.001), history of dyslipidemia (AOR 0.57; 95% CI=0.40 – 0.81; p=0.002), ticagrelor (AOR 0.63; 95% CI=0.41 – 0.99; p=0.043), statin (AOR 0.38; 95% CI=0.25 – 0.57; p<0.001), and revascularization (AOR 0.71; 95% CI=0.52 – 0.98; p=0.035).The results of the scoring assessment showed good discrimination values (AUC 0.886).
T-6883
Depok : FKM-UI, 2024
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
☉
Beny Rilianto; Pembimbing: Helda; Penguji: Asri C. Adisasmita, Gea Pandhita S
Abstrak:
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Latar Belakang: Perdarahan intrakranial simtomatik merupakan salah satu komplikasi yang fatal pada pasien stroke iskemik akut yang mendapat terapi trombolisis. Penelitian ini bertujuan untuk membuat sistem skoring prediksi perdarahan intrakranial pasca trombolisis. Metode: Penelitian ini dilakukan dengan desain cohort retrospective dari registri stroke trombolisis di Rumah Sakt Pusat Otak Nasional periode Januari 2018 hingga Desember 2022. Variabel luaran adalah perdarahan intrakranial simtomatik berdasarkan kriteria European Cooperative Acute Stroke Study III (ECASS III). Analisis regresi Cox dengan constant time dilakukan untuk mendapatkan risiko relatif (RR) pada determinan terpilih dan dilakukan konversi dari koefesien beta menjadi sistem poin. Hasil : Dari 655 pasien, terdapat 26 (3,97%) mengalami perdarahan intrakranial simtomatik. Model skoring dibuat berdasarkan rentang skor 0-4. Prediktor pada perdarahan intrakranial simtomatik adalah: Glucose >200 mg/dL (11 poin), Early infarct sign (10 poin), NIHSS>10 (12 poin), atrium fibrilasi (13 poin) menunjukkan nilai diskriminasi AUC ROC 0,745 (95%CI 0,656-0,841) dengan nilai p Hosmer–Lemeshow (HL) sebesar 0,6483. Kesimpulan : Model skoring baru memberikan nilai prediksi dalam meningkatkan diagnostik risiko perdarahan intrakranial simtomatik pasca trombolisis intravena.
Background: Symptomatic intracranial hemorrhage is a fatal complication in acute ischemic stroke patients receiving thrombolysis therapy. This study aims to create a risk scoring system for post-thrombolysis intracranial hemorraghe. Methods: This study was conducted with a retrospective cohort design from the thrombolysis stroke registry at the National Brain Center Hospital for the period January 2018 to December 2022. The outcome variable was symptomatic intracranial hemorrhage based on the European Cooperative Acute Stroke Study III (ECASS III) criteria. Cox regression analysis with constant time was performed to obtain the relative risk (RR) of the selected determinants and the beta coefficient was converted to a point system. Results: Of the 655 patients, 26 (3.97%) had symptomatic intracranial hemorrhage. The scoring model is made based on the score range 0-4. Predictors of symptomatic intracranial hemorrhage were: Glucose >200 mg/dL (11 point), Early infarct sign (10 point), NIHSS>10 (12 point), atrium fibrilasi (13 point) score showed an AUC ROC discrimination value of 0,751 (95%CI 0,656-0,841) with a Hosmer–Lemeshow (HL) p value of 0,6483. Conclusion: The new scoring model provides a predictive value for the risk of symptomatic intracranial hemorrgahe after intravenous thrombolysis.
T-6655
Depok : FKM-UI, 2023
S2 - Tesis Pusat Informasi Kesehatan Masyarakat
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Suprohaita; Promotor: Asri C. Adisasmita; Kopromotor: Mulyadi M. Djer, Johanes Edy Siswanto; Penguji: Sudarto Ronoatmodjo, Sukman T. Putra, Yudithya Purwosunu, Didi Danukusumo, Eva Suarthana, Syahrizal Syarif
Abstrak:
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Latar Belakang : Angka Kematian Bayi (AKB) dan Angka Kematian Neonatal (AKN) di Indonesia mengalami kecenderungan penurunan dan melandai. Salah satu kontributor tingginya AKB dan AKN adalah defek kongenital pada bayi baru lahir. Laporan WHO yang menyebutkan 7% penyebab AKB adalah defek kongenital. PJB merupakan 25% dari defek kongenital penyebab AKB khususnya PJB kritis yang memiliki risiko kematian di awal-awal kehidupan bayi. Angka ini menjadi dasar untuk mengevaluasi adanya PJB pada bayi yang dilahirkan hidup dan meninggal pada awal kehidupan bayi. Data mengenai kesintasan bayi dengan PJB dan faktor-faktor determinan yang mempengaruhi kematian sangat dibutuhkan untuk memprediksi risiko kematian bayi dengan PJB. Berbagai penelitian telah dilakukan untuk melihat kelangsungan hidup bayi dengan PJB, namun belum dilakukan metode sistem skoring yang mempermudah prediksi risiko kematian bayi dengan PJB. Method : Penelitian ini menggunakan studi observasional kohort retrospektif untuk mengevaluasi luaran/outcome kesintasan atau kelangsungan hidup (survival rate) bayi dengan PJB lahir hidup di RSAB Harapan Kita dalam pengamatan 1 tahun dan membuat model sistem skoring untuk memprediksi risiko kematian bayi dengan PJB yang lahir hidup. Analisis statistik dilakukan dengan menggunakan Stata versi 17. Hasil : Faktor determinan utama yang mempengaruhi kematian bayi dengan PJB yang lahir hidup di RSAB Harapan Kita dalam pengamatan 1 tahun, yaitu klasifikasi kritis dengan HR 2,486 (95%CI 1,480-4,174), berat lahir < 2500 gram dengan HR 1,500 (95%CI 0,947 – 2,377), status sindrom dengan HR 3,080 (95%CI 1,849 – 5,131), saturasi oksigen dengan HR 1,382 (95%CI 0,819 – 2,332), lama rawat NICU dengan HR 1,352 (95%CI 0,773 – 2,366), paritas > 2 dengan HR 1,356 (95%CI 0,827 – 2,224) dan riwayat abortus dengan HR 1,528 (95%CI 0,890 – 2,624). Model sistem skoring dapat digunakan untuk memprediksi risiko kematian bayi dengan PJB dengan akurasi prognostik yang baik berdasarkan kurva ROC sistem skoring yang mendapatkan nilai AUC 0,745 (95%CI 0,668-0,812) dengan nilai p < 0,001. Pada penelitian ini didapatkan uji sensitivitas dan spesifisitas sistem skoring dan angka skoring > 67 dengan sensitivitas 72,15% dan spesifisitas 63,01%.
Background: Infant Mortality Rate (IMR) and Neonatal Mortality Rate (NMR) in Indonesia experience a downward and sloping trend. One of the contributors to the high IMR and NMR is congenital defects in newborns. The WHO report states that 7% of the causes of IMR are congenital defect. CHD is 25% of congenital defect especially critical CHD, which has a risk of death in the early days of a infant's life. This figure is the basis for evaluating the presence of CHD in infants who are born alive and die early life. Data regarding the survival of infants with CHD and the determinant factors that influence it is needed to predict mortality risk. Various studies have been conducted to evaluate the survival of infants with CHD, but a scoring system model has not been carried out that makes it easier to predict mortality risk of infants with CHD. Methods: This study used a retrospective cohort observational study to evaluate the survival rate of infants with CHD who born alive at Harapan Kita National Women and Children Centre in observing 3 months and creating a scoring system model to predict mortality risk of infants with CHD. Statistical analysis was performed using Stata version 17. Results: The main determinant factors affecting the survival of infants with CHD born alive at RSAB Harapan Kita in the 0-3 month survival observation were critical classification with HR 2,486 (95%CI 1,480-4,174), birth weight < 2500 grams with HR 1,500 (95%CI 0,947 – 2,377), syndrome status with HR 3,080 (95%CI 1,849 – 5,131), oxygen saturation with HR 1,382 (95%CI 0,819 – 2,332), length stay of NICU with HR 1,352 (95%CI 0,773 – 2,366), and parity > 2 with HR 1,356 (95%CI 0,827 – 2,224), abortive history with HR 1,528 (95%CI 0,890 – 2,624). The scoring system model can be used to predict mortality risk in infants with CHD with good prognostic accuracy based on the ROC curve of the scoring system which AUC value of 0.745 (95%CI 0.668-0.812) with a p value < 0.001. In this study, the sensitivity and specificity test of the scoring system was obtained and the scoring number > 67 with a sensitivity of 72,15% and specificity of 63,01%.
D-542
Depok : FKM UI, 2024
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
☉
Rudyanto Sedono; Promotor: Asri C. Adisasmita; Kopromotor: Ratna Djuwita, Made Wiryana; Penguji: Amal Chalik Sjaaf, Mardiati Nadjib, Syahrizal, Retno Wahyuningsih; Bachti Alisjahbana; Anis Karuniawati
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Latar Belakang: Mayoritas kandidiasis invasif pada pasien sakit kritis berkembang setelah masuk ke unit perawatan intensif. Penyebab paling umum dari penyakit jamur invasif adalah Candida yang merupakan organisme komensal dalam tubuh manusia tetapi dapat berubah menjadi patogen. Infeksi kandida diawali dengan peningkatan kolonisasi, perubahan bentuk dan produksi enzim yang merusak mukosa inang sehingga kandida dapat masuk ke jaringan tubuh atau pembuluh darah. Metode: Penelitian ini adalah studi observasional prospektif pasien sakit kritis yang dirawat di ruang intensif. Pengambilan sampel berupa darah, swab ketiak dan swab dubur diambil pada hari pertama, kelima, dan kesembilan. Data rekam medis dan biaya medis langsung dikumpulkan dari hari pertama penelitian hingga akhir penelitian. Analisis data menggunakan STATA. Hasil: Sebanyak 142 subjek direkrut dan 115 subjek dianalisis dalam penelitian ini. Analisis multivariat mengidentifikasi usia > 60 tahun, nutrisi parenteral >= 7 hari, CVC >= 10 hari, kortikosteroid, PCT hari ke-5, perubahan morfologi axilla dan swab rektal, dan perubahan morfologi dan peningkatan koloni Candida swab rektal hari ke-9 sebagai faktor risiko independen kandidiasis invasif. Faktor risiko ini dapat digunakan sebagai variabel sistem skoring berdasarkan RS tipe A dengan atau tanpa pemeriksaan mikologi dan RS tipe C. Pemberian obat antijamur lebih cost effective dibandingkan dengan tidak diberikan obat antijamur. Kesimpulan: Faktor risiko dapat digunakan untuk mencegah terjadinya kandidiasis invasif, serta penggunaan sistem skoring dapat membantu dalam skrining diagnosis dan pemberian obat antijamur lebih cost effective.
Background: The majority of invasive candidiasis in critically ill patients develops after admission to the intensive care unit. The most common cause of invasive fungal disease is Candida which is a commensal organism in the human body but can transform into a pathogen. Candida infection begins with increased colonization, changes in shape and production of enzymes that damage mucosa then candida can enter body tissues or blood vessels. Methods: This study is a prospective observational study of critically ill patients who admitted to the intensive care unit. Blood samples, armpit swabs and rectal swabs were taken on the first, fifth and ninth days. Medical record data and direct medical costs were collected from the first day of the study to the end of the study. Data analysis using STATA. Results: A total of 142 subjects were recruited and 115 subjects were analyzed in this study. Multivariate analysis identified age > 60 years, parenteral nutrition >= 7 days, CVC >= 10 days, corticosteroids, PCT day 5, changes in axillary and rectal swab morphology, and morphological changes and increased Candida colonies on day 9 rectal swabs as risk factors independent of invasive candidiasis. This risk factor can be used as a scoring system variable based on type A hospital with or without mycological examination and type C hospital. Giving antifungal drugs is more cost effective than not giving antifungal drugs. Conclusion: Risk factors can be used to prevent invasive candidiasis from occurring, and the use of a scoring system can assist in screening diagnoses and administering more cost-effective antifungal drugs.
D-494
Depok : FKM-UI, 2023
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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Utami Purbasari; Promotor: Nurhayati Adnan Prihartono; Kopromotor: Helda, Budhi Antariksa; Penguji: Ratna Djuwita, Sudarto Ronoatmodjo, Yohanes WH George, Rahmad Mulyadi, Rusli Muljadi
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Acute Respiratory Distress Syndrome (ARDS) meningkatkan kebutuhan perawatan intensif pada pasien COVID-19. Diperlukan upaya deteksi cepat untuk memilah prioritas pasien COVID-19 yang berisiko ARDS. Penelitian bertujuan memprediksi derajat ARDS menggunakan kuantifikasi luas opasitas/konsolidasi foto dan mengidentifikasi faktor prediktor ARDS. Metode: Desain studi crossectional dilakukan di Rumah Sakit Umum Pusat Fatmawati Jakarta pada Juni-Desember 2022. Uji diagnostik terhadap hasil skoring foto toraks dengan komparasi 3 metode yaitu Brixia, Reeves dan modifikasi skoring foto dengan metode skoring Universal Thorax ARDS Measurement Index (UTAMI) dibandingkan dengan diagnosis ARDS menggunakan kriteria Berlin sebagai gold standard. Hasil: Sebanyak 318 pasien rawat inap COVID-19 dengan pneumonia dianalisis. Faktor laboratorium seperti kadar neutrofil, CRP, D-dimer, saturasi dan respiratory rate merupakan faktor prediktor ARDS dengan metode Berlin. Pada metode skoring UTAMI, diketahui komorbid CAD, CRP dan saturasi oksigen dapat memprediksi kejadian ARDS. CRP merupakan faktor prediktor terhadap ARDS pada kedua metode Berlin (PR 1,28; 95% CI 0,97 -1,70) dan UTAMI (PR 1,71; 95% CI 1,19– 2,46). Pada uji AUROC diketahui bahwa nilai PaO2/FiO2 dengan metode berlin bisa memisahkan pasien ARDS ICU dan non-ARDS ICU dengan akurasi 81,2% sedang Metode skoring UTAMI sebesar 79,8 %. sehingga sensitifitas dan spesifisitas pada metode skoring UTAMI terhitung kategori baik. Kesimpulan: Metode UTAMI dapat digunakan untuk memprediksi level ARDS pasien yang membutuhkan ICU . Saran: Klinisi dapat mengaplikasikan model prediktif ARDS ini untuk meningkatkan pelayanan ICU di rumahsakit
Background: Acute Respiratory Distress Syndrome (ARDS) has an impact to increase the need for intensive care among COVID-19 patients. Early detection is needed to prioritize COVID-19 patients at risk of ARDS. The research aims to predict the level of ARDS using quantification of the extent of photo opacity/consolidation and identifying factors of ARDS. Method: A cross-sectional study design was carried out at the Fatmawati Central General Hospital, Jakarta in June-December 2022. Diagnostic tests on the results of thorax x-ray scoring using a comparison of 3 methods, consist of Brixia, Reeves and modified photo scoring using the UTAMI method were compared with ARDS diagnosis using the Berlin criteria as gold standards. Results: A total of 318 hospitalized COVID-19 patients with pneumonia were analyzed. Laboratory factors such as neutrophil levels, CRP, D-dimer, saturation and respiratory rate are predictor factors for ARDS using the Berlin method. Meanwhile, using UTAMI scoring, it is known that comorbid CAD, CRP and Oxygen Saturation are predictor the incidence of ARDS. CRP was a predictor factor for ARDS in both the Berlin (PR 1.28; 95% CI 0.97 –1.70) and UTAMI (PR 1.71; 95% CI 1.19–2.46) methods. In the AUROC test, it was found that the PaO2/FiO2 using the Berlin method could separate ARDS ICU patients from non-ARDS ICU patients with an accuracy of 81.2%. Meanwhile, the UTAMI scoring method was 79.8%. so that the sensitivity and specificity of the UTAMI scoring method are in fair discrimination. Conclusion: The UTAMI method can be used to predict a patient's ARDS level. Recommendation: Clinicians could use UTAMI method as predictive model score to estimate the need of Intensive Care Unit in ARDS.
D-505
Depok : FKM-UI, 2024
S3 - Disertasi Pusat Informasi Kesehatan Masyarakat
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