Regional Public Hospital Research Articles

Budgeting for inventory of personal protection equipment in national health insurance patient services during the Covid-19 pandemic at Bahteramas regional public service agency hospital southeast Sulawesi Province, Indonesia

Background: When the first Covid-19 case appeared in China in 2020, it didn't take long for it to spread throughout the world. In Indonesia, the entry of this disease is the most serious threat as a global pandemic with a fairly high morbidity and mortality rate that has a broad impact on life safety and disrupts the national economy. The availability of personal protective equipment in hospitals is an important part of patient care for the National Health Insurance (NHI). Objective: To determine the budget for the supply of personal protective equipment (PPE) for NHI patient services during the Covid-19 pandemic at the Bahteramas Regional Public Service Agency (RPSA) Hospital Southeast Sulawesi Province. Methods: This type of qualitative research with a case study approach. The research was conducted at the Bahteramas RPSA Hospital, Southeast Sulawesi Province, Kendari City. The research informants consisted of 1 regular informant and 3 key informants. The selection of informants is based on the depth of understanding or experience of the informants. Data was collected using observation, document review, and in-depth interviews. Data analysis is done by matrix Content Analysis. Results: The availability of funds for Covid-19 patient services is not yet available, funding sources are obtained from the regional government and the Central Government, but to fulfill the need for PPE in the early days of the Covid-19 pandemic using the Hospital RPSA budget. The budget for purchasing PPE for Covid-19 services has not been planned in advance because the occurrence of the Covid-19 outbreak is an incident that appears spontaneously without being predicted beforehand. Planning for PPE needs based on the needs of each hospital service unit. The preparation of the budget is based on the applicable Standard Operating Procedures. Conclusion: The decision of the Bahteramas RPSA Hospital to use the RPSA Hospital's funds for the procurement of PPE in the early days of the Covid-19 pandemic was the right decision. When viewed from the increasing need for PPE in the early stages of the pandemic and the limitations of previous PPE planning, the RPSA Hospital budget became an option for Bahteramas Hospital as an alternative to procuring PPE prior to government assistance.

Procurement of personal protective equipment in national health insurance patient services during the Covid-19 pandemic at Bahteramas Regional public service agency hospital Southeast Sulawesi Province, Indonesia

Currently, the incidence of morbidity and mortality due to the Covid-19 disease outbreak in Indonesia is still quite high, with the intensity of transmission being very fast in the community. The occurrence of contact between patients and health workers becomes very vulnerable to the emergence of illness and death in health workers. The importance of the use and availability of personal protective equipment (PPE) in hospitals needs to be continuously pursued. The purpose of the study was to determine the supply of personal protective equipment for the service of national health insurance patients during the Covid-19 pandemic at the Bahteramas Regional Public Service Agency (RPSA) Hospital, Southeast Sulawesi Province. This type of qualitative research with a case study approach. The study was conducted at the Bahteramas RPSA Hospital, Southeast Sulawesi Province, Kendari City, with the reason that this hospital is a referral center for Covid-19 patient services. The informants in the study consisted of 3 regular informants and 6 key informants. Data was collected using observation, document review and in-depth interviews. Data analysis is done by matrix Content Analysis. The results of the study show that the procurement of PPE for Hospitals is carried out through E-catalogs and direct procurement. The vacancy of PPE is caused by internal factors where the hospital procurement party minimizes stock procurement as needed with evaluations carried out every month. Evaluation is carried out to determine the availability of sufficient stock until the deadline for the next PPE purchase, but if the stock is insufficient then the purchase of PPE can be made before the stock period is empty. The external factor causing the stock vacancy is caused by the delay in the distribution of PPE. Conclusion: Procurement of supplies for PPE needs for RPSA Hospitals, apart from making their own procurement from the hospital, also borrows and requests assistance from related agencies. The availability of hospital PPE is influenced by internal factors and external factors. Suggestion; The Hospital Logistics Section should always monitor the procurement of PPE to ensure the availability of PPE is still met as needed.

Preeclampsia correlates with maternal and perinatal outcomes in Regional Public Hospital, Madiun, Indonesia

HIGHLIGHTS 1. Preeclampsia, the high blood pressure during pregnancy, and its complications has significant role in maternal outcomes.2. Correlation between preeclampsia and maternal as well as perinatal outcomes was examined.3. Preeclampsia correlated significantly with delivery process, IUGR, LBW, and preterm birth, but not significantly with antepartum and postpartum hemorrhages, eclampsia, HELLP syndrome, maternal and perinatal mortality, as well as with neonatal asphyxia. ABSTRACT Objectives: This research aimed to find correlation between preeclampsia and maternal as well as perinatal outcomes in Regional Public Hospital, Madiun, Indonesia, from 1 January 2017 to 30 September 2020. Materials and Methods: An observational analysis was applied in this study with a cross-sectional design. This study used secondary data from medical records of Regional Public Hospital, Madiun, Indonesia, with retrospective sampling and total sampling methods. Samples were 250 preeclamptic mothers with or without severe symptoms. Results: Of 250 preeclamptic mothers, only 216 samples could participate in this study. Maternal outcomes included spontaneous PV delivery (12.22%), SC (87.78%), antepartum hemorrhage (0.45%), postpartum hemorrhage (6.33%), eclampsia (0.45%), HELLP syndrome (0.90%), and maternal mortality (0.45%), while perinatal outcomes covered IUGR (7.69%), LBW (33.94%), preterm birth (12.67%), perinatal mortality (2.71%), and asphyxia neonatorum (13.12%). Conclusion: There was a significant correlation between preeclampsia with or without severe symptoms and maternal outcomes, which was the delivery process, and perinatal outcomes, which were the IUGR, LBW, and preterm birth. However, there was no significant correlation for antepartum hemorrhage, postpartum hemorrhage, eclampsia, HELLP syndrome, maternal mortality (maternal outcomes), perinatal mortality and neonatal asphyxia (perinatal outcomes).

Implementing midwifery continuity of care models in regional Australia: A constructivist grounded theory study

Problem/backgroundStrong international evidence demonstrates significantly improved outcomes for women and their babies when supported by midwifery continuity of care models. Despite this, widespread implementation has not been achieved, especially in regional settings. AimTo develop a theoretical understanding of the factors that facilitate or inhibit the implementation of midwifery continuity models within regional settings. MethodsA Constructivist Grounded Theory approach was used to collect and analyse data from 34 interviews with regional public hospital key informants. ResultsThree concepts of theory emerged: ‘engaging the gatekeepers’, ‘midwives lacking confidence’ and ‘women rallying together’. The concepts of theory and sub-categories generated a substantive theory: A partnership between midwives and women is required to build confidence and enable the promotion of current evidence; this is essential for engaging key hospital stakeholders to invest in the implementation of midwifery continuity of care models. DiscussionThe findings from this research suggest that midwives and women can significantly influence the implementation of midwifery continuity models within their local maternity services, particularly in regional settings. Midwives’ reluctance to transition is based on a lack of confidence and knowledge of what it is really like to work in midwifery continuity models. Similarly, women require education to increase awareness of continuity of care benefits, and a partnership between women and midwives can be a strong political force to overcome many of the barriers. ConclusionImplementation of midwifery continuity of care needs a coordinated ground up approach in which midwives partner with women and promote widespread dissemination of evidence for this model, directed towards consumers, midwives, and hospital management to increase awareness of the benefits.

Healthcare Supply Chain Reliability: The Case of Medical Air Transport.

The principal task of national healthcare systems is to provide health services that are safe, accessible, high-quality and people-oriented. To ensure the continuity of healthcare, support activities related to patient transfer and logistics are necessary. Effective implementation of transport processes is a factor affecting the possibility of medical intervention, in terms of both planned and life-saving care. The reliability of the healthcare supply chain is a key factor in patient health. In our research, we have used the method of a single case study of a public regional hospital in Poland providing comprehensive medical services. The aim of the research is to identify the factors that affect the reliability of the healthcare supply chain in relation to the interhospital air transport of patients. Our qualitative research using process mapping reveals what factors affect the reliability of interhospital medical air transport. The analysis of 100 interhospital medical air transport cases has allowed us to create a general procedure related to the movement of patients between the facilities of the healthcare system in Poland. Our research shows that the key factor of reliability is the coherent and integrated cooperation of institutions involved in transport processes.

Self-Efficacy and Compliance Fluid Intake Restriction as a Determinant of The Interdialytic Weight Gain (IDWG) Level

Higher interdialytic Weight Gain (IDWG) is commonly experienced by patients with chronic kidney disease (CKD). Increased IDWG can cause various complications that result in risk of death. CKD patients who had undergoing hemodialysis in the Public Regional Hospital of Indramayu would have different weight gain, but it is not known what factors affect the increase in IDWG. The purpose of this study was to determine the factors that were significantly related to the IDWG level in CKD patients in the Public Regional Hospital of Indramayu. This research design is descriptive-analytic. The number of samples was 86 respondents who were selected by consecutive sampling technique. Data collection tools are questionnaires and the data analysis technique is the Pearson chi-square test. From the result from 86 respondents, it is known that 44 (51.2%) respondents experienced an increase in IDWG level at the mild category (<4%). It is known that the factor influencing to level of IDWG are self-efficacy (p-value = 0.000; 95% CI) and fluid intake compliance (p-value = 0.042; 95% CI). Meanwhile, age, sex, education level, family support, and duration of hemodialysis are not influencing the IDWG level (p-value > 0,05; 95% CI). Self-efficacy and fluid intake compliance are the most significant factor on the IDWG level in CKD patients who had hemodialization. Patients with high self-efficacy can reduce the IDWG level accompanied by compliance with fluid restriction. Recommendation for hemodialysis nurses needs to increase the patient’s self-efficacy in limiting fluid so that can be controlled at the IDWG level.

The influence of service flow changes and drug consultation on quality of life of HIV/AIDS-positive patients in Sunan Kalijaga regional public hospital, Demak regency

Human immunodeficiency virus (HIV infection/AIDS) cannot be cured but can be controlled by antiretroviral medicines. Non-compliance with the treatment is influenced by internal and external factors. The internal factors (predisposing factors) include healthcare systems, socioeconomic conditions, and patients. Meanwhile, the external factors (enabling and reinforcing factors) include the condition of the disease and therapy. This study aims to determine the influence of service flow changes and drug consultation on the quality of life of people living with HIV/AIDS in Sunan Kalijaga Regional Public Hospital, Demak Regency. This research employed a quasi-experimental method with one group and a pre-post design. The research subject was HIV/AIDS-positive patients in Sunan Kalijaga Regional Public Hospital, Demak Regency. These subjects had met the inclusion and exclusion research criteria. The data were collected using an in-depth interview, consisting of 14 questions to determine factors in non-compliance with treatment and patients' quality of life. Patient compliance with treatment and quality of life were measured before and after the intervention. The dependent t-test was employed to determine differences in the average score of the compliance and quality of life before and after the treatment. The majority of HIV/AIDS-positive patients in Sunan Kalijaga Regional Public Hospital are in the productive age (49 people or 96.22%), female (33 people or 62.24%), employed in private jobs (16 people or 30.19%), married (34 people or 64.2%), and graduated from primary school (20 people or 37.7%). The majority of the patients have undergone the treatment for > 1 year (32 respondents or 60.4%) and received the drug regimen of ZDV + 3TC + NVP (90.57%). There is no significant difference in the patient compliance with the treatment before and after the intervention with the sig < 0.05. Moreover, the patients have a high quality of life with a compliance value of 80-100% before and after the intervention. The pre-post-interventions have influenced the physical health domain and the social relation domain with the sig < 0.05. The provision of education affects the quality of life on physical health and social relationship factors (sig < 0.005). The implementation of drug consultation could improve the HIV-positive patients' quality of life in physical health and social relationship domains. In contrast, the intervention does not affect the patients' compliance with the therapy.

Evaluation of service quality and complaint handling on outpatient satisfaction at the pharmaceutical installation of mokoyurli buol regional public hospital

Pharmaceutical installations have an important role in improving and providing effective services to achieve patient satisfaction. Patients' complaints occur if they receive a service that does not meet expectations. The hospital management must investigate the causes of patients' complaints. Solving the patients' complaints indicates that the hospital can fulfill their expectations. The purpose of this study is to examine the results of servqual on service quality, customer satisfaction index, and importance-performance analysis on service quality and complaint handling. This research employed a descriptive design with qualitative and quantitative approaches. The study was conducted by distributing questionnaires to 100 outpatients. The respondents' answers were then analyzed using the Cartesian diagram to obtain quadrants A, B, C, and D. Interviews were directly conducted with the complaint management and pharmaceutical installation staff to explore the attributes included in quadrant A (top priority). The patients were selected using the purposive sampling method. Finally, the data were analyzed using the servqual analysis, importance-performance analysis, and customer satisfaction index. The result shows that the service quality dimension has a negative gap value. The reliability dimension has the smallest gap while the responsiveness dimension has the largest gap. The result of the customer satisfaction index shows that outpatient satisfaction with the service quality and complaint handling has a value of 56.53%. Thus, this dimension is categorized as quite satisfying. The result of the importance-performance analysis shows that the dimensions included in quadrant A are the tangible evidence dimension, including poor physical facilities, and the responsiveness dimension, including patients' long waiting time to manage prescriptions and complaint handling.

A comparison study between single aspirin antiplatelet and single clopidogrel antiplatelet on average period of recurrent stroke dr. Sayidiman Magetan

Stroke is a common neurological disease that rapidly develops clinical signs of focal and global neurological deficits, lasts 24 hours or more, and leads to death. The danger that threatens stroke sufferers is recurrent strokes which can be fatal and result in a worse quality of life than the first attack. This condition indicates that the effect of antiplatelet drugs is not strong, or called antiplatelet resistance. Antiplatelet is a blood thinner used by stroke sufferers to prevent blood clots and treat the narrowing blood vessels in the legs, namely in peripheral artery disease. This research aims to compare single aspirin antiplatelet and single clopidogrel antiplatelet on the average period of recurrent stroke. This observational research employed a cross-sectional approach by processing the medical record data of stroke patients from 2018 to 2020 at dr. Sayidiman Magetan Regional Public Hospital. The obtained data were then analyzed and concluded. The results show that the mean duration of recurrent stroke on aspirin antiplatelet use is 357.88. Meanwhile, the mean duration of recurrent stroke in the antiplatelet clopidogrel is 138.59 days. Moreover, there is a significant difference between the use of a single aspirin antiplatelet and single clopidogrel antiplatelet on the duration of recurrent stroke with a p-value of 0.000.

A study of hemodynamic medicine use in intensive cardiac care unit of dr. Soedarso regional public hospital, Pontianak

Hemodynamic medicines are important to recover patients with a critical period in the ICCU. Hemodynamic medicines have a small range of dose so that it has a large effect on the therapy. Therefore, a study on the use of hemodynamic medicines and doses is necessarily conducted. This study aims to investigate the use and doses of hemodynamic medicines administered to patients in the ICCU of dr. Soedarso Hospital Pontianak. This study is observational research with a descriptive cross-sectional design. The research sample was 49 patients who had met the inclusion criteria. The data were analyzed descriptively to describe the frequency and percentage. The results show that a single hemodynamic medicine is administered to 65% of the patients and a combination of hemodynamic medicines is administered to 35% of the patients. The single medicine refers to dobutamine administered to 84.4% of the patients. Meanwhile, the combination of hemodynamic medicines consists of dobutamine and norepinephrine that are administered to 52.9% of the patients. The doses of hemodynamic medicines frequently administered to patients are 3-5 μg/kg/min dobutamine, 3-10 μg/kg/min dopamine, 0.01-2-2 μg/kg/min norepinephrine, and 1 mg/ml epinephrine. This study concludes that dobutamine (inotropic) is the most frequently used single hemodynamic medicine, and norepinephrine (vasopressor) is the most frequently used combined hemodynamic medicine for the ICCU patients at dr. Soedarso Regional Public Hospital, Pontianak.

Kidney cancer with complications in Dr. Soetomo Regional Public Hospital, Surabaya, Indonesia

Kidney cancer is a disease in which kidney cells become malignant and grow uncontrollably, forming a mass or tumor. Before discussing further kidney cancer, it is important to briefly know the kidneys. The kidneys are two bean-shaped organs located in the lower abdomen on the left and right of the spine. The primary function of the kidneys is to excrete and excrete water, salt, and other unnecessary substances and turn them into urine. The urine collects in the renal pelvis (the funnel-shaped part of each kidney), then travels to the ureters (the tube between the kidneys and bladder), and finally to the bladder, where it is stored before urination. Another function of the kidneys is to help control blood pressure by making the renin hormone and forming red blood cells by forming the hormone erythropoietin. In the United States, an estimated 76,080 adults were diagnosed with kidney cancer, and 13,780 of them died from the disease in 2021. Meanwhile, a total of 2,394 new cases of kidney cancer were found in Indonesia with 1,358 total deaths in 2020. More than half of patients with kidney cancer are diagnosed at an advanced stage.

Non-Medical Logistic Management at Syekh Yusuf Hospital of Gowa in 2021

Good logistic management can have a big impact on service quality, therefore, logistic management needs to be monitored to know the weakness and strengths in its operatoonal implementation so that corrective can be taken for the implementation of logistic management which is not optimal. This studi aims to determine the implementation process of Non-Medical logistic management at the Syekh Yusuf Regional Public Hospital Gowa which focuses on the procurement process, storagr process, process of distribution, usage process, maintenance process, and process of deletion. This type of research used qualitative which aims to determine more deeply about the management of non-medical logistic at the Syekh Yusuf Hospital of Gowa. By conducting in-depth interviews and observations to informans.The research result from the procurement process indicators had not been categorized good, even though in essence the procurement of goods had used direct procurement and tender process. The strorage process had been categorized good. The distribution process had not been categorized as good because if the goods suddenly arrived when needed, the user had to wait because of logistic procurement once in a while a year. Then in the process of maintaining the goods has been effective. Management logistic on the elimination process can be categorized as good. Syekh Yusuf Hospital Gowa is expected to I,prove the procurement process at least every 6 month.

Convalescent Plasma Therapy in Severe-Critical COVID-19 Patients at North Kalimantan Regional Public Hospital: Survival Analysis

Background: Convalescent plasma therapy (CPT) is one of the methods used in treatment in COVID-19, but the administration of CPT to COVID-19 patients is still controversial. This study aims to assess the difference in survival between CPT administration in severe-critical COVID-19 patients and standard therapy. Methods: This research was a retrospective cohort observational research. Survival analysis was carried out on the factor and outcome variables by estimating the median survival time and Kaplan-Meier survival curve.

Compliance with The Implementation of Covid-19 Health Protocol Infection Prevention and Control (IPC) Training and Occupational Safety and Health (OSH) as Mediation on Occupational Risks of Health Workers at Tengku Rafi'an Hospital

There are still employees who do not understand Covid-19 prevention and control protocol in hospitals and are not disciplined in carrying out Covid-19 health protocol. IPC training implementation that has not been appropriately structured is considered the cause of some employees being exposed to Covid-19. This study aims to analyze the effect of compliance Covid-19 health protocol implementation and the implementation of Infection Prevention and Control training on the occupational risks of health workers and Occupational Health and Safety standards implementation as intervening variables in the Covid-19 pandemic era at Tengku Rafi'an Regional Public Hospital simultaneously and partially. This research method is causative descriptive research with a quantitative study approach. The sample of this study was 200 health workers who work in hospitals. The data analysis technique used is index analysis using the three-box method and Structural Equation Modeling (SEM) for path analysis. Conclusion of this study showed the implementation of the Covid-19 Health Protocol, IPC Training, and Occupational Safety and Health Standards implementation together significantly affected the Occupational Risks of Health Workers simultaneously and partially at Tengku Rafi'an Regional Public.

Hubungan Kelainan Letak Janin, Preeklampsia dan Ketuban Pecah Dini dengan Sectio Caesaria di RSUD Dr. H. Mohamad Rabain Muara Enim

Caesarean section is a labor process in which the foetus is delivered through a surgical incision in the abdominal wall and uterus with the requirements that the uterus is in the intact condition and the baby’s weight must be more than 500 grams. This study was aimed to find out the correlation between foetus position, preeclampsia and premature rupture of membranes with caesarean section at Dr. H. Mohamad Rabain Regional Public Hospital Muara Enim year 2020. This study applied analytical survey method using cross sectional approach. The population in this study was 555 respondents and the samples who were taken by applying systematic random sampling technique were 84 respondents. The data used in this study were secondary data. These data were then analysed using chi-square statistics. Based on the result of bivariate analysis, it was found out that there was a correlation between foetus position and caesarean section that is 29.8%. Chi-square test result showed ρ value = 0.000. There was also a correlation between preeclampsia and caesarean section that is 14.3%. Chi-square test result showed ρ value = 0.022. There was a correlation between premature rupture of membranes and caesarean section that is 21.4%. Chi-square test result showed ρ value = 0.001. It can be concluded that there was a correlation between foetus position, preeclampsia and premature rupture of membranes with caesarean section at Dr. H. Mohamad Rabain Regional Public Hospital Muara Enim year 2020. It is suggested that the result of this study be able to give general descriptions of factors correlated with caesarean section. In addition, it can also be used as a means to consider so it can decrease the number of caesarean sections.

MANAJEMEN ASUHAN KEBIDANAN ANTENATAL PADA NY "N" DENGAN ABORTUS INKOMPLIT DI RSUD SYEKH YUSUF KAB. GOWA TAHUN 2019

Introduction Incomplete abortion is the loss of some of the product of conceptiononof pregnancy, causing some of the fetal tissues are still deposited in the uterus such as decidua and placenta. During the process, the initial sign isthe bleeding in the basal decidua followed by the occurrence of necrosis in the surrounding tissue. Afterwards, a part if not all of the conception product would be detached. As it is considered to be a foreign object, the uterus would contract to expel it. At week 8 of gestation, all of the products of conception would be excluded because the choreal villi had not deeply penetrated the decidua. At weeks 8-14 of gestation, the choreal villi already deeply entered the decidua. Therefore, at this stage, some of the conception would come out and some would remain which causes the bleeding on the mother. Method This case study investigated the case of incomplete Abortion on Mrs. “N” at Public Regional Hospital of Syekh Yusuf in Gowa Regency. This study was conducted by employing 7- stages midwifery care approach suggested by Helen Varney and SOAP documentation procedure. The results of the case study conducted on Mrs. “N” indicated that the patient got an incomplete abortion case based on an anamnesis and physical examination taken. Mrs. "N", came to the regional hospital of Syekh Yusuf Gowa with the complaint of bleeding from her birth canal. The patient said that she had been bleeding since October 5, 2019 which stopped after wards. On October 30, 2019 at 6:00 a.m., there was blood as a result of her massage a couple of weeks before. The condition of the patients was considered to be weak, composmentis with the blood pressure of 110/70 mmHg. Her uterine fundal height was not palpable, and her ostium uteri externum and internum were closed. Based on the ultrasound examination with her residual tissue impression, uterine anteflexion, and FL (-), the patient was possibly diagnosed to get an incomplete abortion. Therefore, curettage was administered. On the first day after the curette, the patient’s condition improved. There was some bleeding and pain felt from the vagina, particularly from her lower abdomen. However, in general, the curettage was considered to be successful in which no obstacles were found during the implementation of the procedure. Conclusion After conducting an assessment and analysis based on the 7-stages of Varney and SOAP documentation procedure, it was apparent that the diagnosis given to Mrs “N” was the incomplete abortion case. Therefore, curettage was administered to the patient, and it had been succesfully conducted by the health workers in the hospital.

Appropriateness of referrals from primary care for lumbar MRI

BackgroundInternational guidelines do not recommend routine imaging, including magnetic resonance imaging (MRI), and seek to guide clinicians only to refer for imaging based on specific indications. Despite this, several studies show an increase in the use of MRI among patients with low back pain (LBP) and an imbalance between appropriate versus inappropriate use of MRI for LBP. This study aimed to investigate to what extent referrals from general practice for lumbar MRI complied with clinical guideline recommendations in a Danish setting, contributing to the understanding and approaches to lumbar MRI for all clinicians managing LBP in the primary sector.Materials and methodsFrom 2014 to 2018, all referrals for lumbar MRI were included from general practitioners in the Central Denmark Region for diagnostic imaging at a public regional hospital. A modified version of the American College of Radiology Imaging Appropriateness Criteria for LBP was used to classify referrals as appropriate or inappropriate, based on the unstructured text in the GPs’ referrals. Appropriate referrals included fractures, cancer, symptoms persisting for more than 6 weeks of non-surgical treatment, previous surgery, candidate for surgery or suspicion of cauda equina. Inappropriate referrals were sub-classified as lacking information about previous non-surgical treatment and duration.ResultsOf the 3772 retrieved referrals for MRI of the lumbar spine, 55% were selected and a total of 2051 referrals were categorised. Approximately one quarter (24.5%) were categorised as appropriate, and 75.5% were deemed inappropriate. 51% of the inappropriate referrals lacked information about previous non-surgical treatment, and 49% had no information about the duration of non-surgical treatment. Apart from minor yearly fluctuations, there was no change in the distribution of appropriate and inappropriate MRI referrals from 2014 to 2018.ConclusionThe majority of lumbar MRI referrals (75.5%) from general practitioners for lumbar MRI did not fulfil the ACR Imaging Appropriateness Criteria for LBP based on the unstructured text of their referrals. There is a need for referrers to include all guideline-relevant information in referrals for imaging. More research is needed to determine whether this is due to patients not fulfilling guideline recommendations or simply the content of the referrals.

A severe COVID-19 patient with diabetes mellitus getting dexamethasone with depression disorders: a case report

Background: Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The SARS-CoV-2 coronavirus requires host cells to replicate, leading to rapid and uncontrollable viral replication and could end in increased production of pro-inflammatory cytokines. This case study aims to evaluate a severe COVID-19 patient with diabetes mellitus getting dexamethasone with depression disorders.Case Presentation: A-56 years old Javanese female who lives in Sidoarjo was admitted to the emergency room of Dr. Soetomo Public Regional Hospital, Surabaya due to shortness of breath from the patient’s anamnesis. The shortness of breath was getting worse in the last 3 days before being admitted to the hospital. The patient had a fever in the previous 3 days before being admitted to the hospital. She also had a cough with phlegm for 1 week before being admitted to the hospital. The patient’s condition is oxygen saturation at 93% with a simple mask 6-8 lpm (oxygen saturation at 72% in free air. Her medical history revealed that she had suffered from diabetes since approximately 8 years ago and routinely took 5 mg of glibenclamide once a day. She also had high blood pressure from 5 years ago and routinely took 10 mg of amlodipine once a day. Treatment for this patient in severe condition requires comprehensive management such as symptomatic therapy, oxygenation, and adequate nutritional therapy. In addition, the patient received dexamethasone and antidepressant drugs such as fluoxetine 10 mg.Conclusion: The oxygenation therapy, symptomatic, antiviral, supportive, and adequate nutritional treatment can improve the clinical outcome regarding a severe COVID-19 patient with diabetes mellitus getting dexamethasone with depression disorders.

Patient-reported outcomes of a short hospital stay after total knee replacement in a regional public hospital: a prospective cohort treated 2018-2019.

Patient-reported outcomes and satisfaction following short length of stay (LoS) after total knee arthroplasty (TKA) in the Australian regional context remain unexplored. This study reports complications, outcomes and satisfaction of patients discharged from an enhanced recovery protocol (ERP), 6 weeks after TKA in a regional hospital. Prospective recruitment occurred between 2018 and 2019. Demographics, intraoperative data, complications and emergency department (ED) presentations were retrieved from hospital records. Complications were graded for severity using a published scale. Knee range of motion (ROM), timed up-and-go (TUG), 6-min walk test (6MWT) and Oxford Knee Scores (OKS) were assessed preoperatively and 6 weeks postoperatively. Patient satisfaction was assessed via questionnaire at the postoperative follow-up. One hundred patients/117 primary TKAs were prospectively included. Median LoS was 2 days (interquartile range 1-3 days) with 74.4% and 88.4% of patients satisfied with their knee and LoS, at 6 weeks respectively. Twenty-seven patients presented to the ED a total of 37 times with complication severity of Grade III or less, and 10 patients were readmitted. Significant improvements in objective and subjective outcomes were observed, however only change in median OKS exceeded the minimal clinically important difference (MCID) threshold. An enhanced recovery protocol after TKA in a regional hospital can achieve a median LoS of 2 days without compromising patient-reported outcomes and objective functional measures, whilst maintaining a high level of patient satisfaction with both the surgery and LoS. Further work is required to better optimize management of largely low-grade complications in this patient population.

Analysis of Some Factors that Influence Length of Stay of Anemia Patients in Installation of Inpatient Regional Public Hospital Karawang in 2020

Objective: To determine factors related to the length of stay in anemic patients who are being hospitalized at the Karawang Hospital. Methods: This was a cross-sectional study with cohort-retrospective design. This study was analyzed quantitatively. Data for this study was obtained from medical record data. Result: This study showed that most anemic patients were treated with a length of stay of less than 6 days, with an overall average length of stay of 6.31 days. Most of the samples were treated with severe degree of anemia. Hemoglobin value at discharge has an effect on the length of stay, while the other variables have no significant effect statistically. Conclusion: Description of the length of hospitalization in this study was in accordance with the target from the Ministry of Health. This was influenced by the quality control and financing applied, the blood bank facilities that contributed very well, and the transfusion process carried out directly by the nurses. Keywords: Length of stay, Anemia.