Public Hospital Center Research Articles

Correlation between Beck Depression Inventory and World Health Organization Quality of Life-BREF Scores in Stage III of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Patients at Central Public Hospital of Pusyansus RSUP Haji Adam Malik Medan

Background: Depression is the psychiatric complication that mostly associated with HIV disease. For people in HIV positive infection stage, unstable and declining physical conditions followed by the appearance of physical symptoms and intense social pressure from the environment can be a source of stress that results in depression. After entering the stage of AIDS, depression is more susceptible to experience because of worsening health conditions. Furthermore, patients also often feel that their life will be not long so that everything that happen in his or her life will be in vain which will have an impact on their quality of life.
 Objective: To determine the correlation between Beck Depression Inventory (BDI) II and World Health Organization Quality of Life (WHOQOL-BREF) scores in stage III of HIV / AIDS patients at Pusyansus RSUP Haji Adam Malik Medan.
 Methods:This study is a cross-sectional study using a correlative analytic design, which was conducted at the Pusyansus Haji Adam Malik Hospital Medan, North Sumatra from May 2019 to November 2019. The research subjects were 65 people diagnosed with HIV / AIDS stage III. The degree of depression was measured based on the Beck Depression Inventory (BDI) II and the quality of life was measured based on the World Health Organization Quality of Life (WHOQOL-BREF).
 Conclusion: There is a significant correlation between Beck Depression Inventory (BDI) II score and World Health Organization Quality of Life (WHOQOL-BREF) score in HIV / AIDS patients stage III at the RSUP Haji Adam Malik Medan Hospital.

Modification of Calgary Cambridge for Indonesian medical students: Communication guidelines

Effective communication skill applied by doctors in the doctor-patient consultation process becomes one of important factors that can improve the consultation outcomes such as patient satisfaction, adherence to treatment and recovery process. However, effective doctor-patient communication is rarely applied in practice. Limited consultation time, patient overload, doctor burnout, and poor communication skills are among the factors that cause ineffective doctor-patient communication process. This study aimed to develop a new effective communication guideline for doctor-patient communication in Indonesia by modifying the Calgary Cambridge medical interview guide. This study uses qualitative approach within four stages: expert panel, student panel and focus group discussion, expert review, and trials. Informants were chosen purposively. Three points of high category, 24 points of middle category and 44 points of low category are resulted from expert panel stage which consists of specialist representatives from 12 clinical divisions in Dr. Moehammad Hoesin central public hospital (RSMH), Palembang, South Sumatera, Indonesia. The high and middle category were discussed by two groups of internships doctors in RSMH in student panel and focus group discussion (FGD) session. The results were validated by a doctor-patient communication expert (expert reviewer) and then tested by the internship doctors through role play at the trial stage. The final result yields eight main points and eleven effective tips of the Calgary Cambridge Guide checklist modification with five to six minutes effective consultation time. This modified guideline is appropriately applicable for doctor-patient communication in daily consultation in Indonesian practical, social and cultural context.

Factors Affecting Survival Outcome After Percutaneous Nephrostomy as Palliative Urinary Diversion in Obstructive Uropathy due to Advance Cervical Cancer Patients

Introduction:Cervical cancer is the 3rd most common cancer in women. In late stages, obstructive uropathy due to mass infiltration is common and the mainstay of treatment for this condition is palliative urinary diversion through percutaneous nephrostomy. Nevertheless, complications due to nephrostomy may have adverse effects on some patients. Further study is necessary to determine whether nephrostomy is suitable for all cervical cancer patients with obstructive uropathy. This study aims to identify the determinants of survival rate of cervical cancer patients undergoing nephrostomy for obstructive uropathy and determine the group of cervical cancer patients that would benefit the most from nephrostomy. Methods:Data were obtained from medical records of cervical cancer patients in Hasan Sadikin Central Public Hospital from January 2018 to December 2019. Log-rank analysis was performed to assess the survival rate of patients based on clinical conditions (age, metastasis, and ECOG performance status) and initial laboratory results (hemoglobin, leukocyte, thrombocyte and blood acidity).Results:A total of 163 cases were identified from the medical records, with a median survival of 5(1-17) months. The results of the analysis showed that the survival rates of cervical cancer patients undergoing nephrostomy were significantly affected by age (p = 0.0001), metastasis (p = 0.0001), and ECOG performance status (p = 0.0001), while laboratory findings were not significant factors affecting survival (pHb=0.501; pLeu=0.634; pTr=0.077; pBGA=0.687). Conclusion:The survival after nephrostomy in advanced cervical cancer patients is largely affected by age, metastasis, and performance status. The choices of doing nephrostomy in those patients should be considering those factors to maximize the benefit over the risk of complications.

Difference in Profiles of Oxidative Stress Marker (MDA) in STEMI and NSTEMI

ABSTRACT Introduction: Acute Myocardial Infarction (AMI) results in necrosis of the myocardium due to blockage in the coronary artery. AMI is classified into two categories, STEMI and NSTEMI. AMI is a multifactorial condition closely related to the increase in production of reactive oxygen species (ROS). As the end product of lipid peroxidase, Malondialdehyde (MDA) is often used as a biomarker for oxidative stress. Purpose: To prove the difference between profiles of oxidative stress marker (MDA) in STEMI and NSTEMI. Methods: An observational analytic study with a cross-sectional study approach done in Dr. Kariadi Central Public Hospital and Diponegoro National Hospital, Semarang, Central Java, between April and September 2020. Subjects were diagnosed by the presence of chest pains and an increase in CKMB and troponin levels. The study was conducted on 47 subjects consisting of 20 STEMI samples and 27 NSTEMI samples. Serum MDA was examined using the TBARS method. Data were analyzed by a computer program. Results: Mean serum MDA in STEMI and NSTEMI was 0,22 ± 0,12 μmol/L and 0,82 ± 0,92 μmol/L respectively. From the statistical analysis, results showed that the difference in serum MDA concentrations between STEMI and NSTEMI were significant (p = 0,007). Conclusion: Malondialdehyde concentration in NSTEMI was significantly higher than in STEMI. It is suggested that further research be done to know which type of MDA is more accurate, to understand the effect of lipid profile towards STEMI and NSTEMI, and to put patient’s medical history into consideration. Key Words: Acute Myocardial Infarction, Reactive Oxygen Species, Oxidative Stress, Malondialdehyde

Pituitary Macroadenoma Manifesting As Acromegaly: A Case Report

Background: Acromegaly is an uncommon clinical disorder driven by high serum levels of growth hormone (GH) and insulin-like growth factor 1 (IGF-1). Over 99% of patients with acromegaly harbor a GH emitting pituitary adenoma. Pituitary tumors represent about 15% of essential intracranial neoplasms. Case presentation: A 38 years old woman, was referred to the H. Adam Malik central public hospital on December 15th, 2020, with chief complaints of enlarged fingers and toes. The patient complained that the patient's fingers and toes were getting bigger in the past 2 years. The brain MRI was performed showed intrasella spherical intensity lesions measuring ± 2.3x1.5x2 cm with the impression of macroadenoma. The patient later diagnosed with acromegaly due to pituitary macroadenoma. Therefore the patient was treated with administration of sandostatin injection, novorapid 6-6-6 IU SC, then 0-0-12 IU SC, 3x1 salt capsules. The patient is also consulted to the neurosurgery department for surgical management plans and a consulted to the Ophthalmology Department. Conclusion: We report an instance of acromegaly suspected because of pituitary macroadenoma in a patient with unmistakable clinical highlights, with comprehensive management.

Relationship of Lipid Profile with Wagner Severity Level in Diabetic Feet at General Hospital Dr. M. Djamil Padang

A B S T R A C TIntroduction Diabetic foot is an erosion or injury to the epidermis or the distal soleof the foot and the base of the foot in people with diabetes mellitus (DM). Diabeticfoot is a major cause of limb amputation in non-traumatic cases. Per year, as manyas 2-3% of people with diabetes experience complications of diabetic foot. Theprevalence of DM sufferers with diabetic foot is 20-40% in developing countries. InIndonesia, the prevalence of DM sufferers with diabetic foot is around 15% with 32%mortality rate. One factor plays an important role in predisposing the occurrence ofdiabetic foot is the lipid profile. The aim of this study was to determine the correlationbetween lipid profile and Wagner Severity Level on diabetic foot patients at Dr. M.Djamil Central Public Hospital, Padang in the period of July 2020 to December 2020.Method: This research is an observational analytic study with cross sectionalanalytic design. The research sample of 47 cases was taken by non-probabilitysampling with the consecutive sampling method. This research is an observationalanalytic study with cross sectional analytic design. The research sample of 47 caseswas taken by non-probability sampling with the consecutive sampling method.Result: There were 47 cases that met the inclusion criteria where the 51-60 yearsage group (55.3%) was the largest group in cases of diabetic foot. Of these groups, itwas dominated by female patients, namely 31 patients (66.0%). Meanwhile, the BodyMass Index (BMI) was dominated by the group with BMI <25 kg/m2 with a total of26 patients (55.3%). Diabetic foot patient at Dr. M Djamil Central Public HospitalPadang who underwent amputation was 25 patients (53.2%) where most of them,namely 40 patients (85.1%) had suffered from Diabetes Mellitus for> 5-10 years. Thefindings obtained based on the Wagner Severity Level were that the Wagner grade 3-5 (heavy) group consisted of 24 people (51.1%) and Wagner 1-2 (mild) as many as 23people (48.9%). The results of the bivariate test between lipid profile levels withWagner Severity Level in diabetic foot patients showed a significant correlation asindicated by a p value <0.05. Conclusion: Wagner Severity Level which is gettinghigher in diabetic foot patients shows low HDL levels, high LDL levels and high levelsof triglycerides in blood plasma.

Change management in the implementation of electronic health records (EHR) systems at Inkosi Albert Luthuli Central Hospital, South Africa

For decades, public hospitals have relied on managing records manually using different formats of classification. However, driven by an eHealth strategy, hospitals in South Africa are now changing to electronic health records (EHR) systems for their day-to-day functioning. Earlier studies conducted on health records management in the South African provinces of KwaZulu-Natal (KZN), Limpopo, Eastern Cape, Gauteng and Western Cape, all point to minimal evidence of change management in EHR system implementation in public hospitals. This paper presents empirical results of an investigation into the management of change in the implementation of an EHR system at the Inkosi Albert Luthuli Central Public Hospital in the eThekwini area of KZN. The findings show that an ill-defined change management approach in the EHR system implementation hinders the progress of the implementation and thus the improvement of health service delivery. The study recommends that the implementation of a robust and functional EHR system be accompanied equally by a viable, parallel and executable change management blueprint.

A retrospective review of speech-language therapy services provided to adult inpatients at a central-level hospital in Gauteng, South Africa.

BackgroundThe quadruple burden of disease (BoD) and multimorbidity reflected in South Africa’s public health sector challenges speech-language therapists (SLTs) to optimise patient management in this context. For planning and delivery of appropriate services, it is important to understand the profile of speech-language therapy (SLT) patients and the public healthcare services provided by SLTs.ObjectivesThis study aimed to describe the prevalence of inpatient adult speech, language and swallowing disorders associated with various medical conditions and South Africa’s BoD, in addition to the target areas and duration of SLT interventions provided at a central public hospital.MethodA retrospective review was conducted on records of 2549 adult inpatients who received SLT services between January 2014 and December 2015 at Chris Hani Baragwanath Academic Hospital. Data, including demographics, medical and SLT diagnoses, and treatment recommendations, were analysed using descriptive and inferential statistics.ResultsNon-communicable diseases (NCDs) were most prevalent (77.48%), with multimorbidity of BoD categories in 29.27% of patients. Cerebrovascular disease (CeVD) comprised 52.45% patients, with CeVD, traumatic brain injury, other neurological conditions, cancer and burns comprising 88.74% patients. More than a third of the patients with CeVD were < 56 years (n = 486; 36.35%). Dysphagia (48.96%), aphasia (30.95%) and dysarthria (23.62%) were the most common, with 44.68% of patients having multiple SLT diagnoses. The number of SLT sessions significantly correlated with SLT comorbidity (rs = 0.4200; p = 0.0000), but not BoD comorbidity (rs = 0.0049; p = 0.8058).ConclusionSpeech-language therapy patients reflected a heavy NCD burden and multimorbidity. Provision of SLT services should take into consideration a profile of increased complexity of medical conditions and SLT diagnoses.

Analysis of Compliance with the Implementation of Medicines Standards by Pharmaceutical Staff at the Dr. Tadjuddin Chalid Central Public Hospital Makassar

Medication errors are incidents that are detrimental to patients due to handling by health workers (human error) which is preventable. This study aims to analyze the application of drug administration standards by the pharmacy staff at Dr. Tadjuddin Chalid Makassar. This type of research is a combination research method (Mixed Methods) using the Sequential Explanatory model. The informants of this research were the pharmacy staff of the Central General Hospital (RSUP) dr. Tadjuddin Chalid Makassar. The results showed that the pharmacist's lack of accuracy was like a misreading of the doctor's writing. It is recommended that the hospital management conduct special training on the implementation of good drug administration standards and according to the SOP for drug administration, involving all health workers (doctors, nurses, pharmacists). Then conduct socialization of standard drug delivery SOPs and conduct regular evaluations (once a month) by including all officers related to drug administration.

Impact of the COVID-19 lockdown on the epidemiology of maxillofacial trauma activity: a French multicentre comparative study

The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P=0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.

Understanding the large heterogeneity in hospital readmissions and mortality for acute myocardial infarction

This study aims to investigate the variation in two acute myocardial infarction (AMI) outcomes across public hospitals in Portugal. In-hospital mortality and 30-day unplanned readmissions were studied using two distinct AMI cohorts of adults discharged from all acute care public hospital centers in Portugal from 2012−2015. Hierarchical generalized linear models were used to assess the association between patient and hospital characteristics and hospital variability in the two outcomes.Our findings indicate that hospitals are not performing homogeneously—the risk of adverse events tends to be consistently larger in some hospitals and consistently lower in other hospitals. While patient characteristics accounted for a larger share of the explained between-hospital variance, hospital characteristics explain an additional 8% and 10% of hospital heterogeneity in the mortality and the readmission cohorts respectively. Admissions to hospitals with low AMI caseloads or located in Alentejo/Algarve and Lisbon had a higher risk of mortality. Discharges from larger-sized hospitals were associated with increased risk of readmissions. Future health policies should incorporate these findings in order to incentivize more consistent health care outcomes across hospitals. Further investigation addressing geographical disparities, hospital caseload and practices is needed to direct actions of improvement to specific hospitals.

Rate of uncontrolled blood pressure and its associated factors in patients with predialysis chronic kidney disease in Bali, Indonesia

PurposeHypertension is a key determinant for the development and progression of chronic kidney disease (CKD). The purpose of this study is to assess the rate of uncontrolled blood pressure (BP) and identify its associated factors in patients with predialysis CKD in Bali, Indonesia.Design/methodology/approachA cross-sectional study was conducted among 165 patients who attended the nephrology clinic in a central public hospital in Bali. Data were obtained by measuring BP at threshold 130/80 mmHg, as well as collected through standardized questionnaires. Univariate analysis was done using Chi-square test, and multivariate analyses were carried out using multiple logistic regression.FindingsA total of 165 patients (111 males and 54 females) with predialysis CKD participated in this study. About 64% of the participants had uncontrolled BP. In multiple logistic regression, all selected variables significantly explained 63.2% of the variance in uncontrolled BP. However, low physical activity (odds ratio [OR] = 24.287, 95% confidence interval [CI]: 3.114–189.445), unhealthy dietary pattern (OR = 10.153, 95% CI: 2.770–37.210), as well as perceived moderate stress (OR = 4.365, 95% CI: 1.024-18.609) and high stress (OR = 10.978, 95% CI: 2.602–46.312) were significantly associated with uncontrolled BP.Research limitations/implicationsThe study findings provide evidence for health care providers to improve BP control among patients with predialysis CKD.Originality/valueControlling BP among patients with predialysis CKD was poor. Lifestyle modification and stress management are keys to improving BP control.

Patients’ perceptions of family engagement in health information practices: influences on the self-management of asthma

ABSTRACT Background Involving patients and family members in care is a growing area of research and practice as more family members express the desire to participate as constituents of the patient care team. In this study, we aim to understand patients’ perceptions of family participation in asthma self-management, particularly concerning health information seeking behavior. Methods Semistructured interviews with 35 patients with asthma were conducted at the Immunoallergology wards of both a central public hospital and a private hospital in Porto, Portugal. Data were collected through the McGill Illness Narrative Interview. Interviews were thematically analyzed as case-based and process tracing-oriented. Results Asthma in the family history appeared to be a major determinant of two profiles of patients with asthma: Group 1 (n = 23/35) patients with asthma who are ‘nonseekers’ of health information and for whom asthma ispart of their family histories and who easily adapt to illness in their daily lives, although they had difficulties controlling their asthma, given the disease severity; and Group 2 (n =12/35) patients with asthma who are ‘seekers’ and do not have family histories of asthma and whose experiences of illness brought limitations to their daily lives, raising questions of bafflement (Why me?) and control (What can be done?). Conclusions Asthma patients with family histories tend to be more accepting of their diagnosis but require basic information for daily management. Asthma patients without family histories tend to deny the condition and require more emotional support to cope with it. The family should be considered as integral to the processes of knowledge-sharing and decision-making, and how families experience the disease should be taken into account by health professionals when offering a treatment plan.

Continuity of care for TB patients at a South African hospital: A qualitative participatory study of the experiences of hospital staff.

BackgroundEnsuring effective clinical management and continuity of TB care across hospital and primary health-care services remains challenging in South Africa. The high burden of TB, coupled with numerous health system problems, influence the TB care delivered by hospital staff.ObjectiveTo understand factors from the perspectives of hospital staff that influence the clinical management and discharge of TB patients, and to elicit recommendations to improve continuity of care for TB patients.DesignParticipatory action research was used to engage hospital staff working with TB patients admitted to a central public hospital in the Western Cape province, South Africa. Data were collected through eight focus group discussions with nurses, junior doctors and ward administrators. Data analysis was done using Miles and Huberman’s framework to identify emerging patterns and to develop categories with themes and sub-themes. The participants influenced all phases of the research process to inform better practices in TB clinical management and discharge planning at the hospital.ResultsThe emerging themes and sub-themes were categorized into two overall sections: The clinical care management process and the discharge and referral process. Nurses expressed a fear of exposure to TB and MDR-TB due to challenges in clinical and infection-prevention control. Clinical hierarchies, poor interdisciplinary teamwork, limited task shifting and poor communication interfered with effective clinical and discharge processes. A high workload, staff shortages and inadequate skills resulted in insufficient information and health education for TB patients and their caregivers. Despite awareness of the patients’ socio-economic challenges, some aspects of care were not patient-centered, and caregivers were not included in discharge planning. Communication between the hospital and referral points was inefficient and poorly supported by information systems. Hospital staff recommended improved infection prevention and control practices and interdisciplinary teamwork in the hospital, that TB education for patients be integrated with hospital staff functions, with more patient-centered discharge planning, and improved communication across hospitals and primary health care levels.ConclusionsInterdisciplinary teamwork, more patient-centered care, and better communication within the hospital and with primary health-care services are needed for improved continuity of care for TB patients. Further studies on factors contributing to, and interventions to improve, continuity of TB care in similar hospital settings are needed.

Hubungan komunikasi efektif dokter-pasien terhadap tingkat kepuasan pasien dalam pelayanan medik

Introduction: Indonesia is the biggest contributor of medical tourists to Malaysia and Singapore in recent years, mostly from Medan. Literature reviews and experts opinion of community medicine revealed that poor doctors’ communication skills in Indonesia lead to decreased patients satisfaction and lead to the number of patients seeking treatment abroad.Aim: This study aimed to analyze the relationship between physician-patient communication on the level of patient satisfaction in Central Public Hospital Haji Adam Malik, Medan.Method: This research uses a combination of descriptive-analytic study with cross sectional design. Statistical analysis was performed by chi-square test. The sample selection of research done by consecutive sampling. Measurement doctor-patient communication and patient satisfaction rate is determined by using modified CAT (Communication Assessment Tool) questionnaire.Result: Ten outpatient clinics of Central Public Hospital Haji Adam Malik (10 patients per outpatient clinic) participated in the field test. The average mean score was 4.086 across all modified CAT items (SD = 0.609, range 2.23-5.00). The average proportion of satisfaction rate was 81.7% (S.D. = 12.19, range 44.62-100%). There was a significant relationship between physician-patient communication with patient satisfaction (p &lt;0.05).Conclusion: Assessment doctor-patient communication in Outpatient Clinics of Central Public Hospital Haji Adam Malik categorized as good. Patient satisfaction rate in Outpatient Clinics of Central Public Hospital Haji Adam Malik categorized as satisfied. Effective physician-patient communication associated with patient satisfaction with the physician.

The relationship between family acceptance and quality of life and self esteem of PLWH MSM in Medan, North Sumatera, Indonesia

To identify the correlation between family acceptance and quality of life and self-esteem of People Living with HIV Men Who Have Sex With Men (PLWH MSM) in Medan. This cross-sectional study applied a purposive sampling technique and involved 175 PLWH MSM from H. Adam Malik Public Central Hospital, Medan Pringadi Hospital, Padang Bulan, and Teladan Public Health Centers. The research instruments used are the Perceived Acceptance Scale (PAS), WHOQOL-BREF, and the Rosenberg Self-Esteem Scale. This research has passed the ethical test of the Faculty of Nursing Universitas Indonesia with number 157/UN2/F12.D/HKP.02.04/2018. Bivariate analysis found that family acceptance was related to quality of life and self-esteem (p=0.006, α=0.05; p<0.001, α=0.05). Family acceptance has a positive relation with QOL and self-esteem. These results show that high family acceptance is associated with good QOL and high self-esteem. Family acceptance is correlated with quality of life and self-esteem. If family acceptance is promoted by especially nursing, quality of life and self-esteem can play an optimum role in decreasing risky sexual behaviors.

Prevalence of obesity and prediabetes in above 40 years age group based on glycated hemoglobin levels among health care professional in Patna, India

Background: This study aimed to assess the prevalence of prediabetes using glycated hemoglobin (HbA1c) in above 40 years age group health care professional in Patna.Methods: This was a cross sectional study carried out amongst 315 employees of the Independent Public Central Hospital in Patna. The selection of healthcare professionals for the study was random. The largest study subgroup (63.4%) were nurses, followed by word attender (13.5%), other administrative employee (10.3%), and orderlies (6.6%). All subjects underwent glycated hemoglobin level measurement at hospital laboratory. Data were analysed using descriptive statistics, chi-square and binary logistic regression tests at value of p &lt;0.05.Results: The study group was evaluated for prediabetes (expressed in the form of HbA1c levels) with an American Diabetes Association-approved classification. The results indicated that a vast majority of the evaluated healthcare personnel (383 people; 82.4%) had normal glycated hemoglobin levels. The remainder of the study group showed carbohydrate metabolism disturbances. The range of glycated hemoglobin levels (5.7-6.4%) found in 73 people (15.7%) suggested an increased risk for diabetes. As a result of the study, as few, or as many, as 9 people (1.9%) were diagnosed with diabetes (initial diagnosis).Conclusions: These results emphasize the need to develop an urgent public program to improve the detection, prevention, and treatment of diabetes. Most of the evaluated healthcare professionals (79.36%) showed no evidence of being at risk for type 2 diabetes mellitus. Only 17.6% of respondents were unaware of their metabolic disturbances. The study demonstrated a positive correlation between body mass index values and glycated hemoglobin levels in the evaluated group of healthcare professionals (R=0.3), which was similar to that found in the general population.

Determinant Factors: Work Productivity of Nurse Practicioner in RSUP Dr. M. Djamil Padang Indonesia in 2018

Improving work productivity program of nurses in inpatient ward of Central Public Hospital (RSUP) Dr. M. Djamil Padang has shown good results. This condition is happened due to several factors that lead positive impact on the productivity of nurses working in the inpatient ward of RSUP Dr. M. Djamil Padang. This study aims to analyze the factors associated with work productivity of nurses in the dr. M. Djamil Padang in 2018. This study uses descriptive analytical research design with cross sectional study approach. It takes 168 nurses as sample with proportional random sampling. The result of this study is good worker nurse productivity 71%, good organizational characteristic is 81%, good work characteristic is 73% and good organization environment is 71%. In detail, there is a relationship of organizational characteristics, job characteristics and organizational environment with work productivity of nurses in dr. M. Djamil Padang. The writer's suggestion for service institutions is to maintain and improve a conducive working environment by maintaining or improving the hospital's managerial system by conducting managerial or leadership training activities.

Measurements of Entrance Skin Dose in Egyptian Pediatric During Diagnostic X-Rays using Thermo Luminescence Dosimeter (TLD -100)

Radiation protection in pediatric radiology deserves special attention where children are more sensitive to radiation than adults This study is concerned with the measurements of pediatric entrance surface dose (ESD) using thermo luminance dosimeter (TLD, LIF100) for patients ranging from age intervals: 0.1 -5 years, 5-10 years and 10-16 years . A central public pediatric hospital and 120 Egyptian patients were included in this investigation . By careful selection of patients three types of simple radiography were select ;(50chest,35abdomen and 35 skull). Pediatric chest examinations are the most frequent radiological examinations comparisons were made between these doses and diagnostic reference levels (DRLs). The results showed that mean patient skin doses measured with TLD for age ranged from 10-16 years old were 0.20 mGy 14%, 1.10 mGy 23% and 1.00 mGy 40% for chest, abdomen and skull examination respectively. The mean ESD values are found to be within the range ESD reference values except for chest examination.

Detection of meca gene from methicillin resistant staphylococcus aureus isolates of north sumatera

Methicillin Resistant Staphylococcus aureus (MRSA) is a major pathogen associated with hospital-acquired infections (nosocomial infections). MRSA is a type of S. aureus resistant to the sub-group of beta-lactam antibiotics such as penicillin, cephalosporin, monobactam, and carbapenem. MRSA is resistant because of genetic changes caused by exposure to irrational antibiotic therapy. This study aimed to detect mecA gene in North Sumatra isolates of MRSA and to determine the pattern of antibiotic resistance in S.aureus isolates classified as MRSA by Vitek 2 Compact in the Central Public Hospital Haji Adam Malik, Medan. Samples were 40 isolates of S. aureus classified as MRSA obtained from clinical microbiology specimens. DNA isolation of the isolates was conducted by a method of freeze-thaw cycling. Amplification of mecA gene was done by PCR technique using specific primer for the gene. PCR products were visualized using mini-gel electrophoresis. The results showed that all MRSA isolates showed to have 533 bp band of mecA. Antibiotics test of Vitek 2 Compact showed that despite all isolates were resistant to beta-lactam antibiotics groups; the isolates showed multidrug resistant to other common antibiotics, such as aminoglycosides, macrolides, and fluoroquinolones. However, they were still sensitive to vancomycin (82.5% isolates), linezolid (97.5% isolates), and tigecycline (100% isolates).