Hospital Bandung Research Articles

Optimisation of daylight admission based on modifications of light shelf design parameters

This study was conducted to optimise daylight admission as ambient lighting in an open-plan examination room of a dental hospital in Bandung, Indonesia. Parametric design was conducted for new light shelves, to be placed on the east and west façades of the building. Optimisation was performed using genetic algorithm, taking into account the external and internal widths, external tilt angles, and specularity of the light shelves, for two scenarios: keeping and removing the existing overhangs on both façades. The optimisation objectives were to maximise the spatial daylight autonomy at the perimeter area (sDA300/50%(p)) and minimise the annual sunlight exposure (ASE1000,250) on the occupied floor area of the examination room. Different optimised values were obtained for the east and west façades. In the first scenario, the resulting objective function yields an increase of 4.9% compared to existing condition, whereas the increase is 16.7% in the second scenario. Both metrics in the second scenario have satisfied the criterion.Uncertainty in the first scenario is found smaller than that in the second scenario, due to the removal of overhangs that bring more daylight in the latter.

Cost of Illness Analysis of Insulin and Insulin-Metformin Combination Usage towards Diabetes Mellitus Type 2 Patients at Hospital in Bandung

Diabetes melitus (DM) tipe 2 merupakan suatu penyakit progresif yang berdampak pada biaya yang dikeluarkan pasien selama mengidap penyakit ini. Penelitian ini dilakukan dari bulan Mei hingga Juni di salah satu rumah sakit di Bandung. Penelitian ini bertujuan untuk memperoleh perhitungan biaya kesakitan penggunaan insulin monoterapi dan kombinasi insulin-metformin pada pasien DM tipe 2 dengan menggunakan analisis Cost of Illness ( COI). Penelitian ini menggunakan metode potong lintang dengan pengambilan data secara retrospektif pada objek penelitian pasien rawat jalan dengan lama terapi selama 6 bulan pada tahun 2013. Komponen biaya yang diukur adalah biaya medik langsung (biaya kunjungan ke dokter, biaya obat, biaya komplikasi dan biaya pemeriksaan laboratorium) dan human capital (HC) seperti biaya tidak langsung non-medis (kehilangan pendapatan per hari). Hasil penelitian menunjukkan nilai COI selama 6 bulan terapi dengan insulin dan kombinasi insulin-metformin secara berurutan Rp661.063,59 dan Rp443.165,28. Penelitian ini menunjukkan bahwa penggunaan terapi kombinasi insulin-metformin memiliki biaya kesakitan yang lebih rendah dibandingkan dengan terapi insulin tunggal dan secara statistik (student t-test ) menunjukkan perbedaan yang signifikan p=0,004 (p<0,05). Kata kunci: COI, diabetes melitus tipe 2, insulin, kombinasi insulin-metformin Cost of Illness Analysis of Insulin and Insulin-Metformin Combination Usage towards Diabetes Mellitus Type 2 Patients at Hospital in Bandung Diabetes mellitus (DM) type 2 is a progressive disease that impact on the patients incurred costs during the illness. This study was conducted on May to June at one of hospital in Bandung. This study aimed to obtain cost of illness calculation of insulin monotherapy and insulin-metformin combination in patients with type 2 diabetes using Cost of Illness analysis (COI). This study used cross-sectional method with retrospective data collection on outpatients with 6 months therapy period in 2013. The cost of the measured components are direct medical costs (the cost of doctor visits, medicine costs, costs of complications and the cost of laboratories test) and human capital (HC) such as indirect non-medical costs (lost revenue per day). The results show the value of COI in the six months treatment of insulin and insulin-metformin combination sequentially 661,063.59 IDR and 443,165.28 IDR. This study shows that the use of combination therapy of insulin-metformin has lower cost of illness compared with insulin monotherapy and statistically (student t-test) showed significant differences p=0.004 (p<0.05). Keywords: COI, diabetes mellitus type 2, insulin, insulin-metformin combination

PERSEPSI PASIEN TERHADAP PELAKSANAAN DISCHARGE PLANNING DENGAN POTENSI RAWAT LANJUT DI RUANG DARUSALAM 5 RS AL ISLAM BANDUNG

Discharge planning for hospitalized patient where nurse's role is not limited to only routine actvities, which is re-control information only. Discharge planning is a form of nurse attitude in nursing services. It is often found where discharge planning execution was only given when patient is about to leave the hospital and nurse's role in implementing discharge planning is not optimal. The aim of this study is to find out patients' perception toward discharge planning execution in Room Darusalam 5 Al Islam Bandung Hospital. This study is a descriptive study using consecutive sampling technique. The sample of this study were inpatients in Room Darusalam 5 Al Islam Hospital consist of 50 inpatients, the average of patient going home each day is 2-3 patients. The result of this study shows that patients' perception toward discharge planning execution overall is 54% positive, however, there are still discharge planning execution lacking according to its components which are communication support fulfillment and education info fulfillment which has 58% patients' perception as less positive. Therefore, strategy development in implementing discharge planning is needed.

Hospital-based Surveillance: Accuracy, Adequacy, and Timeliness of Dengue Case Report in Bandung, West Java, Indonesia of 2015.

Context:Dengue fever (DF) altogether with its severe forms, dengue hemorrhagic fever (DHF) and dengue shock syndrome, has become public health concerns. Indonesia belongs to category A of endemicity for DF/DHF. One of the several efforts to control dengue virus infection in Indonesia is a passive surveillance called “Dengue Case Surveillance.” Timeliness report defined as a report sent within 24 h after the clinical diagnosis is needed to have a proper surveillance. The study on the evaluation of dengue case report in terms of accuracy, adequacy, and timeliness in Indonesia is still limited.Aims:The aim of this study was to identify the accuracy, adequacy, and timeliness from the reports of dengue viral infection (DVI) cases admitted from January 1 to December 31, 2015 to 7 major hospitals in Bandung, West Java, Indonesia.Settings and Design:This was a retrospective analysis study.Materials and Methods:To evaluate the accuracy, all medical records of DVI patients were reviewed epidemiologically, clinically, and laboratory using a standardized questionnaire. To evaluate the adequacy, hospital data were compared with reported data in Bandung Municipality Health Authority. To evaluate the timeliness of report, interview to the person in charge for dengue reporting cases in each hospital and in Bandung Municipality Health Authority were performed.Statistical Analysis Used:Univariate analysis was used for statistical analysis.Results:A total of 4096 (72%) of 5712 hospitalized DVI cases lived in Bandung Municipality. The accuracy of the clinical diagnosis was 3397 out of 4096 cases (82.9%). The adequacy of the accurate cases was 1553 out of 3397 cases (45.7%).Conclusions:The timeliness of report was varied, ranging from days to month. The accuracy of dengue cases was good, but the adequacy and timely reporting should be strengthened.

Correlation of Lactate Concentration in Peripheral Plasma and Cerebrospinal Fluid with Glasgow Outcome Scale for Patients with Tuberculous Meningitis Complicated by Acute Hydrocephalus Treated with Fluid Diversions.

Tuberculous meningitis (TBM) is an endemic infectious disease in developing countries, and it can become a serious illness in children. Treatment of TBM is more difficult and prone to failure than treatment of pulmonary tuberculosis. TBM causes hydrocephalus, cerebral edema, increased intracranial pressure, global ischemia, and neurologic deficits, which disturb cellular metabolism and increase lactate levels. A reliable, widely available clinical indicator of TBM severity is needed. Successful treatment of TBM is assessed using the Glasgow Outcome Scale (GOS). This prospective cohort study included 34patients with TBM and acute hydrocephalus who had undergone fluid diversions and were admitted to Dr. Hasan Sadikin Hospital in Bandung from 2014 to 2015. A portable machine for blood glucose measurement was used to measure lactate concentrations. Statistical significance was defined as P ≤ 0.05. Average levels of plasma and cerebrospinal fluid (CSF) lactate were 1.99 ± 0.70 mmol/L and 3.04±1.05mmol/L, respectively. A significantly higher level of lactate was observed in CSF compared with plasma. Preoperative plasma lactate was negatively correlated to GOS (r=-0.539; P= 0.013), and CSF lactate was negatively correlated to GOS (r=-0.412; P= 0.027). Average lactate levels in CSF (central) were higher than plasma (peripheral) levels. GOS scale of patients decreased with increased plasma and CSF lactate levels. Examination of plasma and CSF lactate levels should be included in routine examinations to determine extent of cellular damage and GOS score in patients with TBM and acute hydrocephalus who have undergone fluid diversions.

CORRELATION STUDY OF SERUM CALCIUM LEVELS AND SERUM CARTILAGE OLIGOMERIC MATRIX PROTEIN LEVELS IN RHEUMATOID ARTHRITIS PATIENTS IN BANDUNG, INDONESIA

Objective: This study was designed is to determine the correlation between serum calcium level and serum cartilage oligomeric matrix protein (COMP) level in Indonesian patients with rheumatoid arthritis (RA).Subjects and Methods: The subjects are patients who visit the rheumatology clinic at a government hospital in Bandung, Indonesia. Serum calcium level was determined by a complexometric method, and the serum COMP level was determined by enzyme-linked immunosorbent assay. Statistical analysis was performed with R software.Results: The serum calcium level was 82.24±44.82 mg/mL in RA patients and 99.04±60.56 mg/mL in normal controls. The serum COMP level was 843.80±35.79 ng/ml in RA patients and 830.00±48.92 ng/ml in normal controls.Conclusion: There is no correlation between serum calcium level and serum COMP levels in RA patients (p=0.967 and rho=0.006).

Postlaparoscopic GnRHagonist Therapy does not Improve Spontaneous Conception Rates of Women with Endometriosis

Objective: To investigate the reproductive benefits of combining laparoscopic surgery with GnRH-agonist hormonal therapy in treating women with endometriosis.&#x0D; Methods: This is a non-randomized prospective analytic study of patients with endometriosis conducted in a private hospital in Bandung during the period of January 2014 to December 2015, whom were later followed up after 12-24 months for assessment of post-surgical reproductive performance. A total of 121 patients were enrolled, 60 of which received post-surgical GnRH-agonist hormonal therapy.&#x0D; Results: We discovered that 56 women (46.3%) eventually achieved spontaneous conception after surgery but upon further analysis, it was discovered that GnRH-agonist played no significantly meaningful role in improving the spontaneous pregnancy rates of these patients (OR 1.539; 95% CI 0.750-3.159; p-value 0.239). Furthermore, even though there was a wide range as to when they achieved conception, those untreated with hormonal therapy tended to conceive far more quickly than those who were (5.91 ± 6.28; 8.56 ± 4.24; p-value: 0.011).&#x0D; Conclusion: Post-laparoscopic GnRH-agonist administration to women with endometriosis does not significantly improve their chances of spontaneous conception. In fact, such administration seems to delay it.&#x0D; [Indones J Obstet Gynecol 2017; 5-2: 87-93]&#x0D; Keywords: endometriosis, GnRH-agonist, laparoscopy

The Improvement of Student Competency in a Clinical Study in Indonesia: What Factors Played an Important Role?

Background: The improvement of nursing student competency currently is still being an issue for the majority of nursing education institutions in Indonesia. This is due to partnership with hospitals has not been supported by adequate policies and other factors.Objectives: The purpose of this study was to identify the appropriate model in improving student competency in a clinical study. Design used in this study was observational study with cross-sectional approach.Methods: The research design used cross-sectional approach with involving five hospitals (Fatmawati Jakarta Hospital, Hasan Sadikin Bandung Hospital, Kariadi Semarang Hospital, Sardjito Yogyakarta Hospital, Soetomo Surabaya Hospital) and five universities namely Muhammadiyah Jakarta University, Padjajaran Bandung University, Gadjah Mada Jogjakarta University, Diponegoro Semarang University, Airlangga Surabaya University. Three hundred and eighty-four participants were recruited from these sites. Data were analyzed using multiple logistic regression.Results: The result showed that partnership contributed 3,36 times, the patient variations 2,96 times, job description of clinical educator 2,30 times, a role model 2,28 times, expertise of faculty educator 2,08 times, toward the achievement of student competency in clinical study.Conclusions: It can be concluded that partnership aspect, the patient variation, job description of clinical educator, role model, expertise of faculty educator, and level of education have significant role to improve the achievement of student competency in clinical study. The results of this study can be used by nursing educational institutions, hospitals and government to organize nursing education model that has been present for more optimal achievement of student competencies.

Impact of Reactive Dengue NS1 Antigen with Time for Hospital Admission in Dengue Viral Infection Patient

Dengue is the most rapidly spreading mosquito-borne viral disease worldwide with estimated 30-fold increase in incidence over the last five decades. The recent study had found an increase in the number of admissions of cases of dengue fever with reactive NS1 antigen. The aim of this study was to evaluate the utility of NS1 antigen as a diagnostic marker and to determine whether there is a higher risk of severe dengue infection for patient with positive NS1 antigen. This was a retrospective analysis study conducted in 7 referral Hospitals in Bandung, West Java, Indonesia. The medical records of all the individuals admitted to the Hospital from 1 January to 31 December 2015 were evaluated. We used a questionnaire as a tool for data collection consisted of the epidemiological, clinical manifestation, laboratory results and final diagnosis data that were collected during the period of hospitalizing. In 2015 there were 4.096 cases of dengue viral infection hospitalized. Most of the patients with positive NS1 antigen were admitted at early phase (0-2 days) and regular phase (3-5 days). Platelet count >100.000/mm3 was significantly associated with positive NS1Ag assay, while lower thrombocytopenia (platelet count 3) was significantly associated with positive IgM dengue antibody. Severe cases of dengue viral infection of DHF significantly more often happen on patient with IgM antibody dengue positive (P<0.005). NS1 Ag assay is useful, sensitive and specific for the diagnosis of dengue detection, with good sensitivity and specificity during acute phase when detectable antibodies still negative.

Assessment of Plasma Selenium-Binding Protein-1 Level in Geriatric Population

Geriatric physiologically undergoes aging process that can cause decreasing cell function and increasing risk of degenerative diseases caused by the accumulation of reactive oxygen species (ROS) in the body. Selenium (Se) is an antioxidant, which is needed for maintaining the balance of ROS. The aim of this study was to observe the selenium-binding protein (SELENBP1) level in relation with the geriatric patients charcateristics including sex, age, body mass index (BMI), activity of daily living (ADL), instrumental activity of daily living (IADL), cognitive function, nutrition, depression, and insomnia status. The study used cross-sectional quantitative descriptive study design on 14 geriatric patients in Geriatric Outpatients Clinics, at a hospital in Bandung. The data was obtained by interviewing the patients and then blood samples were taken. The analysis of SELENBP1 was done using ELISA kit. The average level (SD) of SELENBP1 from all of the characteristics group was 2.68 (0.69) ng/ml. The highest SELENBP1 level was identified in female geriatric patients and followed by male and pre-obese groups. The lowest SELENBP1 level was identified in geriatric patients aged 70-79 years. Keywords: elderly, SELENBP1, selenium.

Prevention of Hypothermia of Low Birth Infants Using The Kangaroo Method

Hypothermia is a common problem in neonates and an important contributory factor to neonatal mortality and morbidity. The results of an evaluation involving several health facilities and health personnel showed that thermal control practices were frequently inadequate in the following areas: ensuring a warm environment at the time of delivery, initiation of breastfeeding and contact with mother, bathing, checking the baby's temperature, thermal protection of low birth weight babies, and care during transportation. During kangaroo method (K-M) the infant is in skin to skin contact with the mother. A pilot study conducted on LBW infants discharged from the General Hospital in Bandung, and follow-up for 4 consecutive weeks showed the skin temperature to be well maintained. Weight increase was more stable compared to the control group and there were no re-hospitalization within the observation period. K-M has a simple and natural appeal, cold stress can be avoided; perhaps the most important benefit of K-M is improvement of lactation. In developing countries especially rural areas, temperature regulation and maintenance of lactation using K-M may be lifesaving for very low birth infants.

The Sterility of Reusable Surgical Instruments with Pouches Packaging on One of the Private Hospital in Bandung

Healthcare associated infection is one of the common infection that happens in Indonesia. One form control to prevent healthcare associated infection is the sterilization process of the materials and medical instruments that used for taking care of patients. At the private hospital whereas a place of research, there’s never been done the study of sterility test for reusable instrument with pouches, based on previous studies showed that 8 sets from 40 sets of reusable instrument with linen were not sterile moreover there were positively influence from the amount of time to the sterility of reusable instrument. The purpose of these studies was to determining the relationship between a long storage time and the sterility of reusable instruments with pouches. The method that used in this study was the sterility testing of reusable instrument with pouches which were stored in a central operations room storage with a long storage time of 1 and 2 months. From 30 reusable instruments with pouches which were stored for nine months there were 5 instruments were not sterile. The results of statistic analysis showed that the amount of storage time not significantly associated to the sterility of reusable instrument with pouches in the operating room central storage space.

Acceptability of Anti‑Tuberculosis Compounded Medicines at a Hospital in Bandung

Abstrak Di berbagai rumah sakit di Indonesia, praktik peracikan OAT-KDT untuk anak dalam bentuk sediaan puyer masih dilakukan sampai saat ini. Meskipun memiliki masalah pada stabilitas dan kualitas sediaan, praktik peracikan puyer OAT tetap dilakukan sebagai upaya individualisasi dosis dan memudahkan pemberian obat pada pasien anak, sehingga diharapkan mampu meningkatkan daya terima pasien terhadap OAT. Daya terima pasien terhadap obat memiliki dampak yang signifikan terhadap kepatuhan yang akhirnya memengaruhi keberhasilan terapi. Penelitian ini bertujuan untuk mengetahui daya terima sediaan puyer racikan OAT dan keberhasilannya di salah satu rumah sakit di Bandung dan dilakukan pada bulan Maret hingga November tahun 2015. Desain penelitian adalah potong lintang dan sampel diambil dengan cara accidental sampling . Kriteria inklusi adalah pasien anak usia 0–14 tahun dengan diagnosis tuberkulosis dan menerima sediaan puyer racikan OAT. Data dikumpulkan melalui wawancara terpimpin menggunakan kuesioner tertutup yang tervalidasi dan reliabel mengenai penerimaan pasien ditinjau dari segi kepraktisan, rasa, dan bau obat. Responden adalah orang tua pasien anak sebanyak 50 orang. Hasil penelitian menunjukkan sediaan puyer racikan OAT diterima baik oleh 40,0% pasien, cukup diterima oleh 52,0% pasien, dan kurang diterima oleh 8% pasien. Faktor usia memengaruhi penerimaan pasien terhadap sediaan puyer racikan (r=0.338). Keberhasilan terapi dicapai oleh 94,6% pasien dengan lama pengobatan 6–9 bulan. Penelitian ini menghasilkan kesimpulan bahwa penggunaan sediaan puyer racikan dapat diterima baik oleh pasien dengan tingkat keberhasilan terapi yang tinggi. Sediaan puyer racikan merupakan bentuk sediaan yang disarankan untuk pasien anak karena dapat meningkatkan daya terima pasien anak terhadap OAT-KDT.

COST-EFFECTIVENESS ANALYSIS OF CEFTAZIDIME-LEVOFLOXACIN AND CEFOTAXIME-ERYTHROMYCIN AS EMPIRICAL ANTIBIOTIC COMBINATIONS IN RESPIRATORY INFECTION-INDUCED SEPSIS

Objective:Pharmacoeconomics has become an important consideration in the selection of therapies, including in patients with sepsis caused by respiratory infection. The aim of this study was to determine the most cost-effective antibiotic combination for respiratory infection-induced sepsis at a public hospital in Bandung, Indonesia.Methods:This retrospective observational study was conducted at one ofpublic hospitals in Bandung. Two interventions were analyzed: (I1) ceftazidime-levofloxacin and (I2) cefotaxime-erythromycin; and compared to the major treatment (I0, the use of other antibiotic combinations). Data were collected from the medical records of inpatients with respiratory infection-induced sepsis from 2010 until 2012. Healthcare perspective was applied by considering only direct medical costs, which were calculated from variable (drug, administrative andtreatment cost) and fixed cost (hospitalization).Results:Comparing with I0, net cost per life saved was calculated to be $3,350 (I1)and $1,589 (12). Number of patients survived was considered to be the most significant parameter on affecting the calculation of net cost per life saved.Conclusion:I2 was more cost effective than I1, compared to I0.

A protocol for a cluster-randomized controlled trial of a self-help psycho-education programme to reduce diagnosis delay in women with breast cancer symptoms in Indonesia

BackgroundBreast cancer (BC) is the most frequent cancer occurring in women across the world. Its mortality rate in low-middle income countries (LMICs) is higher than in high-income countries (HICs), and in Indonesia BC is the leading cause of cancer deaths among women. Delay in breast cancer diagnosis negatively impacts cancer prognosis. Only about 30% of patients who come to the hospital to check on their breast abnormalities, continue thorough examination to biopsy to get a diagnosis based on the results of anatomical pathology. Many Indonesian women with breast cancer were already in an advanced stage when starting treatment. Therefore, delay in diagnosis is a serious problem that needs to be addressed. The present study will investigate whether our newly developed self-help psycho-educational programme, “PERANTARA”, for women with breast cancer symptoms is effective to reduce patient diagnosis delay in Indonesia.MethodsA cluster-randomized controlled trial will be conducted in 106 patients in four hospitals in Bandung, West Java, Indonesia. Data will be collected at baseline (pre-assessment), 7 days after the intervention (post-assessment), and at 3 months (follow-up assessments). The primary outcome is delay in diagnosis and treatment. Secondary outcomes are breast cancer knowledge, anxiety and depression, and quality of life. Exploratively, adherence with treatment will be measured too. Data will be analysed by hierarchical linear modelling (HLM) to assess differential change over time.DiscussionIf proven effective, PERANTARA will be evaluated and implemented in a diversity of settings for local cares (such as in POSYANDU, PUSKESMAS) that provide health education/psycho-education for women with breast symptoms.Trial registrationISRCTN12570738. Date: November 19th, 2016.

Economic Evaluation of the Use of Cefotaxime and Ceftazidime in the Treatment of Pneumonia in Pediatric Patients

The prevalence of pneumonia is particularly high among pediatric patients. Appropriate antibiotics selection is required to reduce mortality and morbidity rates associated with these diseases. However, information on cost-effectiveness of empirical antibiotics treatment for pneumonia was limited. This study was aimed to evaluate cost-effectiveness of cefotaxime and ceftazidime for pneumonia in pediatric patients. This study was a retrospective cross sectional study conducted at a hospital in Bandung during January-December 2012. Data were derived from medical records of pediatric pneumonia inpatients during study period. Cost was calculated based on direct medical cost, i.e., inpatient care, medical support, and medicines that were used from admission until hospital discharge. The results showed that there was no statistical difference in the average medical cost of the treatment using cefotaxime (1,197,017 IDR) and ceftazidime (2,245,748 IDR). Incremental cost effectiveness ratio (ICER) showed that cefotaxime is more cost effective than ceftazidime with greater reduction of leukocytes level (576 IDR/mm3 ). The use of cefotaxime is recommended for the treatment of pnuemonia in pediatric patients. Keywords: cost minimization, cost effectiveness, cefotaxime, ceftazidime, pneumonia

Hubungan Kesesuaian Penulisan Resep dengan Formularium Nasional Terhadap Mutu Pelayanan pada Pasien Jaminan Kesehatan Nasional di Rumah Sakit Umum di Bandung

Pharmaceutical service is one of the activities in hospital that support health service quality. One of the factors that can improve quality of pharmaceutical services is prescription services. In the era of National Health Insurance, prescription given to the patients should be based on the National Formulary. If prescriptions did not suit the national formulary, it would influence the services quality on pharmacy unit. The purposes of this study were to determine suitability of prescription outpatients' national health insurance with national formulary and to determine the relationship of the suitability of prescription with a national formulary to service quality in pharmacy unit in one of general hospitals in Bandung. A cross sectional with servqual questionnaire was used to the patients and the 262 prescription samples needed were taken in January 2017. Mann Whitney test is used for bivariate analysis. The result indicated 91.7% prescriptions was suited the national formulary and the rest was not. There was a significant difference between prescription suitability with the national formulary to service quality in pharmacy unit in the hospital with p-value 0.00 (p< 0,05). It can be concluded that higher percentage of prescriptions suitability with the national formulary in hospital related with the better service quality of pharmacy unit.

The Bandung neurosurgery patient outcomes project, Indonesia (Part I): Methods, participant characteristics, and pre-discharge outcomes.

Little is known about neurosurgery patient outcomes in Indonesia. Our study sought to describe patient characteristics, health care pathways, health-related quality of life, and health/rehabilitation care needs of patients admitted to, and discharged from, a major neurosurgery department. Eligible patients were aged ≥18years admitted to the Neurosurgery Department in a regional referral hospital in Bandung, Indonesia. Baseline data was collected on admission. An in-person interview (in the Indonesian language) was held 1 to 2days pre-discharge. Sociodemographic along with clinical characteristics, Glasgow Coma Scale (GCS), and EQ-5D-5L data were collected. A total of 217 patients were admitted, 37 died before discharge, and a pre-discharge interview was undertaken by 178 (82%). Almost half (48%) were admitted because of injury, 38% brain tumour, 10% acute illness, and 4% other conditions. The mean age was 41years. On admission, 63% had a mild Glasgow Coma Scale, 31% moderate, and 3% severe. The average hospital stay was 8days for injury and 24days for illness patients. Prior to discharge, one-third, or less, of the 178 patients interviewed reported "no problems" in the EQ-5D dimensions of mobility (32%), self-care (27%), usual activities (16%), and pain/discomfort (32%), whereas 70% reported "no problems" with anxiety/depression. A large proportion of patients are being discharged with considerable levels of difficulty in four of the five EQ-5D dimensions. This stresses the importance of providing good follow-up and support of patients and their families.

Repair of Cerebrospinal Fluid Leak After Functional Endoscopy Sinus Surgery

Cerebrospinal fluid (CSF) leak is one of Functional Endoscopic Sinus Surgery (FESS)complications. Since 2001, it was reported that there is one case of CSF leak as FESScomplication in ENT-HN Department, Faculty of Medicine, Maranatha Christian University -Immanuel Hospital in Bandung. The purpose of this case report is present clinical findings andmanagement of CSF leak as FESS complication. A-45 year old male with headache as chiefcomplain after undergone FESS five days before. There was a clear rhinorrhea running frompatient’s right nose. In nasoendoscopic examination, it was showed there was a defect in laminacribrosa. The result of paranasal sinus computed tomography scanning showed an air columnin brain ventricular system. The defect in lamina cribrosa was repaired by transnasalendoscopic using materials such as surgicel, cartilages, and fat tissues. The conclusion is weroll out one case about repair of CSF leak as a FESS complication and it was done with a goodresult.Keywords: cerebrospinal fluid leak, functional endoscopic sinus surgery

Study of the Use of Antibiotics with ATC/DDD System and DU 90% in Digestive Surgery in Hospital in Bandung

tidak tepat dapat menimbulkan berbagai masalah, di antaranya pengobatan akan lebih mahal, efek samping lebih toksik, meluasnya resistensi dan timbulnya kejadian superinfeksi yang sulit diobati. Tujuan penelitian ini adalah untuk mengetahui pola penggunaan antibiotik pada pasien bedah digestif di salah satu rumah sakit di Bandung. Data penggunaan antibiotik diperoleh dari Instalasi Rekam Medis pada Juli–Desember 2013. Data diperoleh dengan metode ATC/DDD dan DU 90%. Penelitian ini merupakan penelitian deskriptif dengan studi retrospektif yang diambil dari catatan medik untuk menilai kuantitas dan kualitas penggunaan antibiotik. Sampel diambil dengan cara simple random sampling . Hasil penelitian menunjukkan bahwa dari 208 catatan medik didapatkan total penggunaan antibiotik 17,9 DDD/100 hari rawat dan antibiotik yang masuk dalam DU 90% yaitu seftriakson (8,77 DDD/100 hari rawat), metronidazol (4,61 DDD/100 hari rawat), sefiksim (1,09 DDD/100 hari rawat), sefepim (0,85 DDD/100 hari rawat), siprofloksasin (0,73 DDD/100 hari rawat), dan meropenem (0,42 DDD/100 hari rawat). Hasil penelitian menunjukkan bahwa secara kuantitas penggunaan antibiotik yang paling banyak adalah seftriakson sebesar 8,77 DDD/100 hari rawat dan antibiotik yang masuk dalam segmen 90% yaitu seftriakson, metronidazol, sefiksim, sefepim, siprofloksasin, dan meropenem. Kata kunci: ATC, DDD, kuantitas, studi penggunaan antibiotik Study of the Use of Antibiotics with ATC/DDD System and DU 90% in Digestive Surgery in Hospital in Bandung Abstract Antibiotics are the most widely prescribed medicines in the hospital. Improper use of antibiotics can cause various problems, such as treatment will be more expensive, more toxic side effects, and the emergence of widespread resistance superinfection events that are difficult to treat. The objective of this study was to determine quantity and pattern of antibiotic usage in hospitalized patients at one hospital in Bandung. Sample were taken by simple random sampling method. The quantity of antibiotics usage was assessed by counting the Defined Daily Dose (DDD)/100 patient days and DU 90%. Based on 208 patient medical records, it was found that total antibiotic usage was 17.9 DDD/100 patient days and antibiotics were included in the DU 90% is ceftriaxone (8.77 DDD/100 patient days), metronidazole (4.61 DDD/100 patient days), cefixime (1.09 DDD/100 patient days), cefepime (0.85 DDD/100 patient days), ciprofloxacin (0.73 DDD/100 patient days) and meropenem (0.42 DDD/100 patient days. The results showed that the use of antibiotics in quantity at most is ceftriaxone for 8.77 DDD / 100 days of hospitalization and antibiotics included in segment 90% were ceftriaxone, metronidazole, cefixime, cefepime, ciprofloxacin, and meropenem. Keywords: ATC, DDD, quantity, study of the use of antibiotics