General Hospital Malang Research Articles

The Relationship between Accessibility of Telemedicine Services and Decisions on Use: A Cross-Sectional Study at X General Hospital Malang

As many as 65% of patients interviewed about telemedicine at Outpatient Hospital X in Malang Regency admitted that they were only aware of telemedicine services like Halodoc, Alodokter, Klikdokter, and the hospital's telemedicine applications, but had never directly used them. The patient acknowledges that the application menu service on several telemedicine platforms is overly complicated and challenging to navigate, particularly for patients over the age of 45. The aim of this study was to determine the relationship between the accessibility of telemedicine service applications and the decision to use them. In January 2023, we conducted this research at the outpatient facility of one of the hospitals in Malang Regency. This study had a total sample size of 67 patients. Researchers gathered the data through a questionnaire utilising a Likert scale, concentrating on the accessibility of telemedicine and the choices made concerning it. Researchers conducted statistical analyses using Pearson correlation. The findings revealed a significant correlation between telemedicine service accessibility and utilisation, with a significance level of 0.000, thereby validating the hypothesis. The decision to employ the telemedicine application for outpatient care is made. The hospital in Malang Regency is influenced by factors such as the ease of communication with health care providers, the clarity of their voices, the provision of diagnoses based on the patient's condition, the patient's ability to clearly see the health care provider or health worker, and the ease of using the telemedicine application itself.

Correlation between Risk Stratification of Complications and Types of Antihyperglycemia Drugs with Incidence of Acute Diabetic Complications in Patients with Diabetes Mellitus during Ramadan Fasting

Ramadan fasting for Diabetes Mellitus (DM) patients can lead to acute complications such as hypoglycemia, hyperglycemia, diabetic ketoacidosis (DKA) and thrombosis. Risk stratification predicts fasting safety of DM patients. Dose and timing of antihyperglycemia drugs adjusted during Ramadan fasting. Aim: To know the correlation between the risk stratification of Ramadan fasting and type of antihyperglycemia drugs with the incidence of acute complications in DM patients undergoing Ramadan fasting. Methods: DM patients in Endocrinology Clinic, dr. Saiful Anwar, General Hospital Malang who intend to fast during Ramadan classified in IDF-DAR risk stratification, conduct blood glucose monitoring and filled out a daily logbook during fasting. Results: Thirty-seven subjects were included in the study, only 1 patient with type-1 DM. Average fasting time is 18 days. Acute complications found higher in very high-risk group (5/6) compared to mild/moderate (2/13) and high-risk group (7/18) (p=0.009). Acute complications found higher in group with OAD and insulin combination regiment (2/4) compared to OAD (9/24) or insulin group (3/9) (p= 0. 731). One subject in very high-risk group suffered from acute coronary syndrome. Relationship between risk stratification and the incidence of hypoglycemia (p=0.040) and hyperglycemia (p=0.031) was significant. Relative risk in the very high-risk group was 2.538 compared to mild/moderate risk RR (95% CI)= 0.77 (0.62-0.96). Conclusions: There is a correlations between risk stratification and acute complications in DM patients undergoing Ramadan fasting. No relationship between type of antihyperglycemia drugs with acute complications of Ramadan fasting.

IPP AS PREDICTIVE FACTOR FOR ACUTE URINARY RETENTION IN BPH PATIENTS

Objective: To demonstrate usefulness of Intra Prostatic Protrusion (IPP) as Predictive Factor for Acute Urinary Retention (AUR) in Benign Prostate Hyperplasia (BPH) Patients. Material & methods: Cross sectional retrospective study of case records from January to July 2012 of BPH patients at Saiful Anwar General Hospital (SAGH) Malang was carried out. The data were collected from the Medical Record Division in SAGH Malang. We noted age, prostate volume, IPP, IPSS and urinary retention status. The patients were classified by IPP degree < 5 mm (group A), 5-10 mm (group B), 10 -15mm (group C), > 15mm (group D) and we compared all parameters that we noticed. Results: Eighty patients, mean age was 66.32 years were enrolled. Transabdominal ultrasound determined the mean IPP was 13.5 mm, and prostatic volume 95 cc. IPP values were distributed as follows: group A 10 (12.5%), group B 25 (31.25%), group C 24 (30%), group D 21 (26.25%), with AUR incidence in group A 20%, group B 36%, group C 79%, and group D 81%. The IPP showed a significant correlation with urinary retention (r = 0.8, p < 0.05, OR = 15) and IPSS (r = 0.6, p < 0.05). Conclusion: IPP can be used as predictive factor for the incidence of acute urinary retention in BPH Patients.Keywords: Intra Prostatic Protrusion, Acute Urinary Retention, Benign Prostate Hyperplasia.

THE USE FGSI AS PREDICTIVE OF UROLOGICAL SIRS PATIENTS

Objective: To demonstrate the usefulness of Fournier’s Gangrene Severity Index (FGSI) score for differentiating the outcome between Systemic Inflammatory Response Syndrome (SIRS) patients with upper and lower urological abnormalities. Material & Method:A retrospective study of case records from year 2009-2012 of SIRS patients with urological abnormalities at Saiful Anwar General Hospital (SAGH) Malang was carried out. The data were collected from the Medical Record Division in SAGH Malang. SIRS was clinicaly diagnosed based on medical history, physical examination and laboratory findings. SIRS without urological abnormalities were excluded from the analysis. The FGSI, which was developed to assign a numerical score that describes the severity of disease, was used in our study. This index presents patients vital signs (temperature, heart and respiratory rates) and metabolic parameters (sodium, potassium, creatinine, and bicarbonate levels, hematocrit, and white blood cell count). Patients with SIRS and urological abnormalities were divided according to upper tract and lower tract urological abnormalities. Total FGSI score was classified as mild (0-8), moderate (9-17), severe (> 17). The data were assessed according to whether the patient survived or died.Results:75 of the 203 evaluated patients died. From those 75 patients, 67% were male and 33% were female, 75% with upper urological abnormalities and 25% with lower abnormalities (p < 0,05). From those 203 patients; the results were analyzed with binary logistical regression and Spearman correlation analysis using SPSS 15 softwarewith 95% confidence interval (CI). There is significant relationship between FGSI and outcome of the patient with upper urological abnormalities and lower urological abnormalities, with correlation coefficient more high in relationship between FGSI and outcome of the patient with upper urological abnormalities (0,4 vs 0,1). Conclusion: FGSI is simple and objective outcome predictor to differentiate survival between SIRS patients with upper urological abnormalities and lower urological abnormalities. There is a significant difference in outcome between SIRS patient with upper urological abnormalities and lower urological abnormalities even with same level of FGSI score.Keywords: Fournier’s gangrene severity index, systemic inflammatory response syndrome, upper urological abnormalities, lower urological abnormalities, outcome predictor.