Hospital Bandung Research Articles

064. Overview of Bacterial Patterns and Antibiotic Resistance on Cholangitis Patients at Hasan Sadikin General Hospital from January to December 2023

Background: Cholangitis is a serious infection of the bile ducts that requires prompt treatment, often with antibiotic therapy. Although antibiotic use, especially ceftriaxone and metronidazole, is vital in treatment, antibiotic resistance remains a significant challenge. Unfortunately, data on bacterial resistance patterns in cholangitis patients treated at Doctor Hasan Sadikin Hospital in Bandung is still limited. This study aims to describe the bacterial patterns and antibiotic resistance in cholangitis patients at Doctor Hasan Sadikin General Hospital. Another objective is to assess the effectiveness of ceftriaxone and metronidazole therapy in patients with moderate to severe cholangitis. Methods: This research employed a retrospective descriptive design by collecting data from the medical records of acute cholangitis patients treated at Doctor Hasan Sadikin General Hospital from January to December 2023. A total of 126 patient samples meeting the inclusion criteria were analyzed through blood cultures, and sensitivity tests were conducted against various antibiotics. Data were analyzed using SPSS software. Results: The results showed that Escherichia coli (26.3%) was the most commonly found bacterium, followed by Staphylococcus haemolyticus and Klebsiella pneumoniae (each at 13.2%). The highest resistance was observed against ampicillin (78.9%), while the most effective antibiotic was tigecycline (92.1% sensitivity). Conclusion: In conclusion, ceftriaxone and metronidazole as empiric therapy remains effective for most cholangitis patients, although resistance to certain antibiotics like ampicillin warrants attention. This study highlights the importance of regular monitoring of antibiotic resistance patterns to ensure proper treatment and reduce morbidity and mortality rates among cholangitis patients.

Association between tumour-infiltrating lymphocyte-T CD8+ and programmed death-ligand 1 protein with the occurrence of metastasis in colorectal cancer patients: An observational study

Background: Tumour-infiltrating lymphocytes CD8+ (TILs CD8+) as an anticancer immune response and Programmed Death-Ligand 1 (PD-L1) as an immune checkpoint molecule expression are important in colorectal cancer (CRC) as their expression correlates with the immune status and the progression of cancer. The primary objective of this study is to examine the relationship between TILs CD8+ and PD-L1 expression levels and CRC metastasis to provide insights into the immune microenvironment’s role in CRC progression and metastasis, potentially improving patient outcomes and treatment response. Methods: This study was an observational study involving colorectal cancer patients who were treated at a tertiary hospital in Bandung, West Java, Indonesia. There were 40 patients included in the study. Tumour tissue samples were collected from patients, and immunohistochemical staining was performed to evaluate TILs CD8+ infiltration and PD-L1 expression levels. Clinical data, including metastasis occurrences, were collected from the cancer registry. Results: Analysis of TILs CD8+ and PD-L1 expression levels in CRC patients revealed significant findings regarding metastasis occurrence and cancer staging. There was a notable positive correlation between PD-L1 expression and TILs-CD8+ infiltration in the presence of distant metastasis and advanced cancer stage (p < 0.05). However, no significant association was observed between TILs CD8 and PD-L1 expression levels and lymphatic metastasis. Conclusion: This study highlights the potential prognostic value of TILs CD8+ and PD-L1 expression levels in predicting CRC progression and metastasis. However, the lack of a significant correlation with lymphatic metastasis suggests the need for further investigation into the underlying mechanisms. Understanding the roles of PD-L1 and TILs-CD8+ expression in CRC metastasis may facilitate the development of targeted therapeutic strategies to improve patient outcomes.

Tacrolimus Therapy Among Steroid-Resistant Nephrotic Syndrome Children: A Preliminary Study in West Java, Indonesia

Objective: To explore the outcomes of Tac therapy for Steroid-Resistant Nephrotic Syndrome (SRNS) and its implication in reducing the number of CKD events.Methods: An open, prospective, cohort study was conducted at a tertiary hospital in Bandung, West Java, Indonesia. Children (age 1–18 years old) with steroid and cyclophosphamide resistant nephrotic syndrome were enrolled in this study. Blood pressure, urinary protein, serum ureum, and creatinine levels were measured every month, Tac and soluble urokinase plasminogen activator receptor (supaR) levels were assessed at the 0, third, and sixth months.Results: Ten of fifteen subjects enrolled in this study got better within 3–6 months with a trend of decreasing suPAR level and proteinuria, as well as stable blood pressure and serum creatinine and ureum level. During treatment, no side effects of the subjects were found with the Tac level maintain safely.Conclusion: Tac is an effective and safe agent in treating SRNS, especially for those do not respond well to an alkylating agent.

Clinical Features, Adverse Events and Treatment Outcomes of Multidrug/Rifampicin-resistant Tuberculosis in Children and Adolescents: An Eight-year Retrospective Cohort Study in Bandung, Indonesia.

Data on childhood and adolescent multidrug/rifampicin-resistant tuberculosis (MDR/RR-TB) in Indonesia are lacking. We aimed to assess clinical features, adverse events (AEs) and treatment outcomes of childhood and adolescent MDR/RR-TB. A retrospective cohort study was performed in children and adolescents aged <18 years treated for MDR/RR-TB at Hasan Sadikin General Hospital in Bandung, Indonesia, between June 2016 and March 2024. Multivariable logistic regression analyses were used to calculate adjusted odds ratios (aOR) for predictors of all-cause mortality. Among 84 included patients, 69 (82%) were adolescents aged 10-17 years, 54 (64%) were female, 54 (64%) were malnourished and 55 (65%) had culture-confirmed disease. Among 69 (82%) patients with known outcomes, 48 (70%) were successfully treated, 14 (20%) died (including 5 pretreatment deaths) and 7 (10%) were lost to follow-up (LTFU) (including 5 pretreatment LTFU). Predictors of all-cause mortality included shortness of breath on admission [aOR: 6.4, 95% confidence interval (CI): 1.3-49.1], high bacillary burden on Xpert MTB/RIF assay (aOR: 17.0, 95% CI: 1.6-260.5) and the presence of lung cavities on chest radiograph (aOR: 4.8, 95% CI: 1.1-23.3). Among 74 patients who initiated treatment, 39 (53%) had at least one grade 1-2 AE, and 4 (5%) had one grade 3-4 AE each, including hepatotoxicity, QT prolongation, hearing loss and rash/hyperpigmentation. Younger children were underrepresented among those treated for MDR/RR-TB, indicating reduced access to care. Severe AEs were uncommon during MDR/RR-TB treatment. Baseline indicators of extensive disease were associated with all-cause mortality. The high proportion of pre-treatment mortality and LTFU may reflect complex patient pathways limiting access to care.

Analysis of The Level of Patient Satisfaction with Pharmaceutical Services In Xyz Regional Hospital Bandung Indonesia

Abstract Hospitals are health facilities that provide various services, one of which is pharmaceutical services. Pharmaceutical services are an activity organized to maintain and improve the health of patients. Patient satisfaction is an important indicator in achieving conformity with expectations in health services in hospitals. The level of patient satisfaction can be seen from good service. The purpose of this study is to determine and evaluate the level of patient satisfaction with pharmaceutical services at the XYZ regional hospital in Bandung, West Java. In this study, the application used in SPSS to process data with the methods used, namely the Importance Performance Analysis (IPA) method and the Customer Satisfaction Index (CSI). This method is used to identify the level of importance of each service attribute and the priority of improvements that must be made by a hospital to determine the level of patient satisfaction. IPA analysis shows that the point included in quadrant I (high importance and low satisfaction) is R6, namely complete available drugs but in reality, the drugs are not available so this statement is considered important by patients because it has facts that are not yet appropriate and need to further improve their performance so that the service is more satisfying. Meanwhile, based on the results of the CSI analysis, it is known that the overall value of the respondent's satisfaction level for all attributes is 83.9%. So based on the satisfaction index patients are satisfied with pharmaceutical services at the XYZ Bandung Regional Hospital. Keyword: Patient Satisfaction, IPA, CSI, Hospital

Pengaruh Pemberian Informasi tentang Asuhan Perkembangan pada BBLR terhadap Tingkat Pengetahuan dan Sikap Perawat di Rumah Sakit Al Islam Bandung

Development care is an effort to modify the environment and respond to changes in the behavior of newborns, especially in infants Low Birth Weight, The purpose of this study was to determine the effect of training on developmental care on nurses' ability to care for babies with low birth weight. The design of this study used "quasi experiment pre and post test control", which involved 19 nurses in the perinatology room of Al Islam Bandung Hospital. The results showed a significant increase in the mean score of nurses' knowledge, attitudes and actions after the intervention (p value = 0,000, α = 0.05). This training is effective in increasing nurses' knowledge and attitudes. The recommendation of this study is the need for socialization to all health workers supported by the hospital policy to implement development care and evaluate the implementation of development care in LBW care.

Implementation of Digital Signatures in the Integrated Patient Progress Notes System at XYZ Hospital Bandung

This study aims to implement a digital signature system for filling out Integrated Patient Progress Notes (CPPT) using QR-Code technology. The research method employed is the waterfall development model. The stages of the study include requirements analysis, data collection from various sources, system design, implementation according to the design, testing, and reporting. The study was conducted at XYZ Hospital in Bandung, where it was found that the CPPT signing process is still manually done using a pen, which is considered inefficient as it takes a long time for authorization and is prone to manipulation, thereby reducing the document's validity. The implementation of a digital signature aims to simplify the document signing process quickly without the need for printing, sending, or waiting for physical documents, allowing it to be done digitally and automatically, thereby increasing speed and efficiency. This system also provides authentication assurance by the rightful owner, ensures document security, reduces the risk of damage or loss, and minimizes the possibility of manipulation, thus providing convenience for staff and doctors in terms of time and data accuracy.

Profiles of diphtheria cases in children in Hasan Sadikin Hospital, West Java

Background Diphtheria cases continue to be reported in Indonesia, which has long been one of the countries with the highest number of diphtheria cases worldwide. One of Indonesia's province with the highest annual diphtheria cases is West Java. Dr. Hasan Sadikin General Hospital (RSHS) is one of the tertiary referral hospitals in Bandung, West Java, that treats several diphtheria cases annually. No study focused on the clinical characteristics of diphtheria cases in children admitted to RSHS between 2017 and 2021 yet. Therefore, this study sought to analyze that. Objective To find out the profiles of children &lt; 18-year-old with diphtheria admitted in RSHS between 2017-2021. Methods This descriptive, cross-sectional study reviewed the medical records of diphtheria patients 0 to 18-year-old who were admitted to RSHS between year 2017 and 2021. Results Out of 45 subjects, 76% were males. The median of age was eight years old, ranging from 2 to 17 years. Most patients lived in urban areas and had normal anthropometry status, although some showed abnormal findings. The data showed that 44% had more than 3 days of onset until admission to the hospital, and the median length of stay was 9 days. The clinical characteristics showed that 91% of patients had pseudomembrane, also present with cough, common cold, hoarseness, stridor, and bull’s neck. As many as 44% of patients did not have complete basic immunization status. Complications found were airway obstructions, myocarditis, and sepsis, and 2 deaths were reported. Conclusion Pseudomembrane was found in the majority of patients. Most patients were over five years of age, and almost half number of the patients did not have complete basic immunization status, indicating the need for improved immunization and booster coverage.

The Correlation Between Smoking Habits and Stroke Severity Among Patient with Stroke at General Public Hospital in Bandung, Indonesia

The Correlation Between Smoking Habits and Stroke Severity Among Patient with Stroke at General Public Hospital in Bandung, Indonesia

Analysis of Marketing Strategies For Health Services in The National Health Insurance Era in Hospital Muhammadiyah Bandung

The National Health Insurance (JKN) has brought significant changes to the healthcare industry. The programme provides financial protection to Indonesians to meet their basic health needs. In the JKN era, hospitals are also faced with challenges and intense competition, so they need to improve service quality and implement effective marketing strategies. The purpose of this study is to analyse the application of the marketing mix in the marketing strategy implementation process as well as the selected marketing strategy in the JKN era at Muhammadiyah Bandung Hospital. This study used a descriptive research method with a qualitative approach, which involved interviews with the head of the marketing unit and the hospital's marketing executive staff. The results showed that well-targeted marketing strategies can strengthen the hospital's image, increase visibility and public awareness of the hospital's healthcare offerings, thus helping to reach more potential patients, and improve patient satisfaction. The implications of this study emphasise the important role of effective marketing strategies in improving healthcare services at Rumah Sakit Muhammadiyah Bandung in the era of the National Health Insurance (JKN).

Ergonomics Risk Control on Occupational Safety of Service Personnel in Muhamammadiyah Bandung

The importance of implementing ergonomics in a hospital environment to improve the occupational safety and health of service workers. Service workers at Rumah Sakit Muhammadiyah Bandung work in an environment that is not ergonomic, they are more vulnerable to health problems such as fatigue, muscle and joint injuries, and even the risk of accidents. The purpose of this study was to determine ergonomic risk control on occupational safety of service personnel at the Muhammadiyah Bandung Hospital. The research method used is a qualitative method with a phenomenological approach. The research techniques were interviews and observations to service officers of the information unit, outpatient registration, and logistics. The results showed that service officers at the Muhammadiyah Bandung Hospital experienced complaints at work due to facilities that were not ergonomic, such as chairs, tables, narrow rooms, and leaking roofs. To reduce the risk of work accidents, hospital management checks the facilities in each room unit every 3 (three) months and conducts training on ergonomic risk control so that officers are more aware and understand the importance of ergonomics to health.

Characteristics of COVID-19 comorbidities and severity profiles among pregnant women from a single-center cross-sectional study.

The study aimed to determine the characteristics of comorbidities, association between comorbidities and coronavirus disease 2019 (COVID-19), as well as characteristics of COVID-19 severity among pregnant women at a tertiary hospital in Bandung. We conducted a cross-sectional study by taking secondary data between January 2020 and December 2021 involving 278 pregnant women aged 16 to 45 years that confirmedly diagnosed with COVID-19 via RT-PCR. We collected information from the medical record on severity and comorbidities. The admission C-reactive protein (CRP) profiles were compared between the severe and nonsevere COVID-19 patients. This study employed bivariate analysis, t test, and multivariate analysis with logistic regression models. Of the 278 data included in this study, 120 cases had comorbidities. Most patients were asymptomatic (82%). Obesity was the most common comorbid proportion. Only hypertension as comorbid showed a significant association with symptomatic or asymptomatic COVID-19 (<0.05). Pregnant women with hypertension were 6 times more likely to show symptoms than those without hypertension (OR = 6.092; 95% CI 3.103-11.962). Pregnant women with comorbidities were at higher risk of cesarean sections and stillbirth. The CRP levels which were found to have statistically significant association with COVID-19 severity (<0.05). The domination of asymptomatic COVID-19 in pregnant women was found in this study. Hypertension comorbid has a significant association with COVID-19 symptoms. Maternal and neonatal outcomes appear to be influenced by maternal comorbidities. Moreover, the CRP levels were found to be significant risk factors for COVID-19 severity in pregnant women that might have association with comorbidities.

Umbilical Venous Catheter Position Evaluation in Hasan Sadikin General Hospital : Overview of the Time Required

Background: An umbilical venous catheter (UVC) is one of the most frequently used access in neonates. In developed countries, bedside ultrasonography (USG) is used in assessing the position of the UVC catheter’s tip. However, this is difficult to be implemented in developing countries. In Indonesia, which categorized as a middle- income developing country, the evaluation of UVC mainly used chest radiographs. However, this procedure would take time. The delay in ascertaining UVC positioning through chest radiography among neonatologists in Indonesia remains unstudied, despite its potential on the clinical efficacy. Therefore, this study aimed to determine the time required for the installation of the UVC and the interval from the completion of UVC insertion until the release of the chest radiography result. Method: In this prospective observational cohort study, neonates requiring UVC access were examined in Dr. Hasan Sadikin Hospital in Bandung, West Java. Patients underwent anthropometric measurements and UVC installation. Duration required for UVC installation and the interval between the completion of UVC insertion and the release of the chest radiography result were documented. Descriptive data were shown in percentage, mean and standard deviation. Result: 127 neonates were studied. The average time taken for UVC insertion was 31 minutes and the average time taken from the completion of UVC insertion until the release of chest radiography results was 6 hours. Conclusion: The long wait for chest radiography results significantly delayed the administration of fluids, medications, and parenteral nutrition in this study. Therefore, we need alternative tools to evaluate the UVC location that can be used bedside right after the installation.

Analysis of Readiness to Switch Manual Medical Records to Electronic Medical Records to Support the Effectiveness of Outpatient Registration at Muhammadiyah Hospital

The transition from manual to electronic medical records (EMR) is becoming a global trend in healthcare, driven by the Indonesian Ministry of Health's policy to improve service quality and efficiency in patient data management. This study aims to assess the readiness of Muhammadiyah Bandung Hospital to transition from paper-based medical records to EMR in outpatient registration. This descriptive qualitative study involved 5 informants, with data collected through interviews and direct observations. The results indicate that Muhammadiyah Bandung Hospital is ready to transition from paper-based to EMR in outpatient registration, although further engagement with key personnel in the polyclinic (PPA) and improvements in other factors such as infrastructure and staff training are needed. In conclusion, while the hospital shows good readiness, comprehensive strategies are required to ensure a smooth and effective transition.

Effect of Brand Image and Relationship Quality on Patient Satisfaction

This study aims to determine and analyze the effect of brand image and relationship quality on the satisfaction of outpatients of Hermina Pasteur Bandung Hospital. The results of this study are expected to be input for Hermina Pasteur Hospital in organizing health services, especially in increasing satisfaction. The research method used is descriptive and verification analysis. Data collection used is an interview using a questionnaire accompanied by observation techniques and literature, sampling using consecutive sampling. Data collection in the field was carried out in 2023. Data analysis techniques using Path Analysis. The results showed that in general, brand image, relationship quality, and patient satisfaction tend to be quite good. There is an influence of brand image and relationship quality on patient satisfaction both simultaneously and partially at Hermina Pasteur Hospital. Hermina Pasteur Hospital must carry out service recovery for patient complaints or complaints quickly, so as not to cause dissatisfaction from patients, to handle patient complaints quickly the hospital can form a customer care program

Value of Platelet to Lymphocyte Ratio in Nasopharyngeal Carcinoma Various Stages.

Nasopharyngeal Carcinoma (NPC) is among the most common head and neck cancer, significantly affecting the growth of human tumors. Therefore, this study aimed to investigate platelet-to-lymphocyte ratio (PLR) as a measure of inflammation in patients with various stages of NPC. This retrospective case-control study was conducted on patients diagnosed with NPC between 2016 and 2020 in Dr. Hasan Sadikin Bandung Hospital, Indonesia. Based on NPC classification criteria, patients were classified into early and advanced groups. Subsequently, the PLR ratio was calculated as the number of platelet divided by the absolute number of lymphocytes in the two groups, and the results were statistically analyzed using Unpaired T-test, Pearson, and Chi-square test. A total of 102 patients with an age range of 40 to 49 years were included in this study. A slight correlation of 0.272 (P<0.001) was observed between PLR and clinical stage, while NPC patients with PLR value > 188 had a 2.7 times higher risk of advanced stage (RR=2.702). The PLR was significantly related to the clinical stage of NPC cancer.

Does Innovative Work Behavior Matter for Performance? Green Talent Management and Green Servant Leadership in the Healthcare Industry

This study aims to analyze the influence of green talent management and green servant leadership on employee performance while also considering the mediating role of innovative work behavior and the moderating role of green servant leadership in the relationship between green talent management and innovative work behavior. It was carried out in the context of employees in the health industry in Bandung. This study utilized a quantitative approach with a causal explanation to test the hypotheses. The respondents were employees who worked in private hospitals in Bandung, with 190 sample sizes selected using purposive sampling. The data were collected and processed using structural equation modeling with the help of Smart PLS software. The results revealed that green talent management and green servant leadership influenced employees’ innovative work behavior, leading to job performance. Moreover, green servant leadership could also strengthen the influence of green talent management on innovative work behavior. This study contributes to the understanding of the concept of environmentally-friendly business through innovative work behavior so it can improve work performance by adopting green practices, thereby reducing the damage caused by the organization. Furthermore, organizations must also consider that environmentally-friendly business practices are a concern and that a strong sensitivity must be instilled.

Cognitive Disorders in Post-Stroke Patients

Blood circulation disorders in post-stroke patients can cause cognitive disorders. Cognitive disorders in post-stroke patients can include memory impairment, difficulty speaking, difficulty understanding things, difficulty communicating, and mood disorders. The presence of cognitive disorders in stroke patients can worsen the patient's post-stroke condition, requiring longer treatment time. This study aimed to identify the level of cognitive disorders in post-stroke patients. This research is a descriptive study to identify dementia in post-stroke patients. The sampling technique was accidental sampling for two weeks at the Neurology Polytechnic and Stroke Clinic at one of the hospitals in Bandung, totaling 83 people. The questionnaire used in this research was the Mini-Mental State Examination (MMSE). The collected data is analyzed and presented using frequency and percentage distributions. The results of this study showed that the majority of post-stroke patients (72.3%) did not experience dementia or did not experience cognitive impairment, 15.66% experienced mild cognitive impairment, and 12.04% experienced severe cognitive impairment. From the results of this study, it can be concluded that some post-stroke patients do not experience cognitive impairment, but some post-stroke patients experience severe cognitive impairment. Cognitive impairment in stroke patients can worsen the patient's condition and increase the length of treatment time. Based on the results of this research, health workers especially nurses, are expected to be able to carry out early assessments and provide particular interventions for post-stroke patients aimed at preventing the worsening of dementia and improving the patient's cognitive abilities. The intervention can be in the form of education, psychological support, and social support in the form of counseling during rehabilitation.

Clinical Presentation and 6-Month Outcomes of Patients with Peripartum Cardiomyopathy in Indonesia.

Due to the rarity of peripartum cardiomyopathy (PPCM) globally, baseline characteristic data for PPCM patients are still scarce. Therefore, this study aims to determine the baseline characteristics and 6-month outcomes of PPCM patients in Indonesia. From January 2014 to December 2021, all PPCM patients aged ≥18 years who were admitted to Dr. Hasan Sadikin General Hospital in Bandung, Indonesia, participated in this single-center, prospective cohort study. All patients were re-evaluated within 6 months of PPCM diagnosis. A total of 138 patients with PPCM were admitted to Dr. Hasan Sadikin General Hospital in Bandung. The mean age of all patients was 30.4 ± 6.4 years old. Approximately 60% patients were multipara and had preeclampsia. All guideline-directed medical therapy for heart failure was received by most patients, excluding mineralocorticoid receptor antagonists (25.2%) and bromocriptine (14.1%). The neonatal mortality rate was 5.1%. Among those who survived, 61.2% had normal weight, 31.8% had low birth weight, and 7% had very low birth weight. At the 6-month follow-up, 6.7% of the patients died, 63.3% recovered, and 1.9% were rehospitalized. The present study found a high incidence of PPCM in Indonesia. Our patients frequently had preeclampsia, which contributed to the higher rate of miscarriage and low birth weight. Our liberal use of beta-blockers and ACEi/ARB may have contributed to the higher 6-month recovery rate than that in other countries.

Immunogenicity, Safety, and Efficacy of Influenza Vaccine in T2DM and T2DM with Chronic Kidney Disease.

Patients with Type 2 diabetes mellitus (T2DM) and Chronic Kidney Disease (CKD) face an increased risk of morbidity and mortality after influenza infection. Several studies have shown that the influenza vaccine effectively prevents morbidity and mortality in T2DM patients. However, there has been limited research aimed at assessing the effectiveness of the trivalent influenza vaccine in T2DM-CKD patients. This study aimed to identify Geometric Mean Titers (GMTs), seroprotection, seroconversion, safety, and efficacy. This open-label clinical trial was conducted at AMC Hospital in Bandung, West Java, Indonesia between June 2021 and July 2022. The study subjects consisted of 41 T2DM and 26 T2DM-CKD patients who were administered the trivalent influenza vaccine. There was a significant difference in the average age, with the T2DM-CKD patients being older. Median titers post-vaccination for the B/Washington virus were higher in the T2DM patients compared to the T2DM-CKD patients, and this difference was statistically significant. A majority, comprising 75.6% of the T2DM and 80.8% of the T2DM-CKD patients monitored post-influenza-vaccination, did not experience any adverse reactions. The most common reaction was the sensation of fever, with incidence rates of 12.2% in the T2DM patients and 15.4% in the T2DM-CKD patients. Furthermore, we observed that the incidence of Influenza-like Illness was highest at 7.3% in the T2DM patients and 7.7% in the T2DM-CKD patients. The trivalent influenza vaccine demonstrated equivalent safety and effectiveness in both groups.