How the Type of Surgery and Adherence to the Clinical Pathway Correlate with Quality Control and Cost Control in Endometriosis Surgery: Bagaimana Jenis Pembedahan dan Kepatuhan pada Clinical Pathway Berhubungan dengan Kontrol Kualitas dan Kontrol Biaya pada Operasi Endometriosis

Objective: This study examined the correlation of the type of surgery and adherence to the clinical pathway corresponding to the national guidelines in terms of quality and cost control. Methods : Quantitative economic evaluation was conducted to assess the type of surgery and adherence to clinical pathways in terms of quality and cost control. The data were analyzed using the chi-square or Mann–Whitney test. Results : Of the sample of 82 patients who had undergone laparoscopy or laparotomy, 54.9% had a laparoscopic procedure, while 45.1% had undergone laparotomy ; only 25.6% of the case procedures adhered to the clinical pathway. In general, it can be interpreted that, in a laparoscopy procedure, the potential risk that a mismatch will occur in quality control is up to 32 times that of a laparotomy procedure. Moreover, good adherence to the clinical pathway does not correlate with good cost control. Overall, of the 82 cases, only three (3.7%) showed a good fit for both quality control and cost control. Conclusions : The type of surgery correlates with quality and cost control, whereas adherence to the clinical pathway does not correlate with either quality or cost control. Keywords: Laparotomy, Laparoscopy, surgery, endometriosis, national health insurance Abstrak Tujuan: Studi ini menguji korelasi jenis operasi dan kepatuhan terhadap jalur klinis yang sesuai dengan pedoman nasional dalam hal kontrol kualitas dan biaya. Metode: Evaluasi ekonomi kuantitatif dilakukan untuk menilai jenis operasi dan kepatuhan terhadap jalur klinis dalam hal kualitas dan pengendalian biaya. Data dianalisis menggunakan uji chi-square atau Mann-Whitney. Hasil: Dari sampel 82 pasien yang pernah menjalani laparoskopi atau laparotomi, 54,9% menjalani prosedur laparoskopi, sedangkan 45,1% pernah menjalani laparotomi ; hanya 25,6% dari prosedur kasus yang mengikuti jalur klinis. Secara umum dapat diartikan bahwa, dalam prosedur laparoskopi, potensi risiko terjadinya ketidaksesuaian dalam kontrol kualitas adalah hingga 32 kali lipat dari prosedur laparotomi. Selain itu, kepatuhan yang baik terhadap jalur klinis tidak berkorelasi dengan pengendalian biaya yang baik. Secara keseluruhan, dari 82 kasus, hanya tiga (3,7%) yang menunjukkan kesesuaian yang baik untuk pengendalian kualitas dan pengendalian biaya. Kesimpulan: Jenis pembedahan berkorelasi dengan kualitas dan pengendalian biaya, sedangkan kepatuhan terhadap jalur klinis tidak berkorelasi dengan kualitas atau pengendalian biaya. Kata kunci: Laparotomi, Laparoskopi, pembedahan, endometriosis, jaminan kesehatan nasiona

Role of Platelet-Rich Plasma Application on Mesh-Tissue Integration: Peran Aplikasi Platelet-Rich Plasma pada Integrasi Mesh dengan Jaringan

AbstractObjective: To review the advantage of PRP use on mesh-augmented surgery.Methods: Literature review of PRP application of mesh.Results: The application of PRP on mesh shows potential promising outcome.Conclusion: PRP may improve the mesh-tissue integration.Keywords: mesh-augmented surgery, pelvic organ prolapse, platelet-rich plasma, wound healing.AbstrakTujuan: Untuk menganalisa keuntungan penggunaan PRP pada pembedahan rekonstruktif dengan mesh.Metode: Kajian pustaka dari penggunaan PRP pada pembedahan rekonstruktif dengan mesh.Hasil: Aplikasi PRP pada mesh menunjukkan hasil yang positif.Kesimpulan: Aplikasi PRP dapat meningkatkan integrasi mesh dengan jaringanKata kunci: pembedahan rekonstruksi dengan mesh, penyembuhan luka, platelet-rich plasma, prolaps organ panggul

The Use of Vaginal Pessary for Pelvic Organ Prolapse’s Treatment

Pelvic organ prolapse (POP) is the descent of the anterior and/or posterior vaginal wall or vagina apex (uterus or vaginal apex after a hysterectomy) and has negative effects on woman’s daily activities and reduces her quality of life. One of the treatments of POP is pessary that has limited evidence but still commonly used for treatment of genital prolapse and considered as the first line treatment by the American Urogynecologic Society (AUGS). This evidence-based case report (EBCR) is made to critically analyze from the current studies whether the use of pessary improves the symptoms of pelvic organ prolapse or not. A search of literature was performed in two databases, MEDLINE and Cochrane. Eligible articles were observational studies, clinical trials, systematic reviews, or meta-analyses that published within the last 5 years. All studies showed symptoms improvement with four studies using Pelvic Organ Prolapse Distress Inventory (POPDI) score and one study using International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS). Keywords: pelvic organ prolapse, pessary, treatment. Penggunaan Pesarium Vagina untuk Penatalaksanaan Prolaps Organ Pelvik Abstrak Prolaps organ pelvik (POP) adalah penurunan dinding anterior dan atau posterior vagina atau apeks vagina (uterus atau apeks vagina setelah histerektomi) yang memiliki dampak negatif terhadap aktivitas sehari-hari dan menurunkan kualitas hidup. Salah satu tata laksana POP adalah pesarium yang memiliki bukti ilmiah terbatas tetapi masih digunakan untuk tata laksana prolaps genitalia dan dipertimbangkan sebagai terapi utama menurut American Urogynecologic Society (AUGS). Evidence-based case report (EBCR) dibuat untuk menganalisis secara kritis dari studi yang sudah ada apakah penggunaan pesarium dapat memperbaiki gejala dari prolaps organ pelvik atau tidak. EBCR ini dilakukan dalam dua databases, MEDLINE dan Cochrane. Artikel yang memenuhi syarat merupakan studi observasional, percobaan klinis, ulasan sistematis, atau meta-analisis yang telah dipublikasi pada 5 tahun terakhir. Semua studi menunjukan bahwa terdapat perbaikan dari gejala (POP) dengan empat studi menggunakan pelvic organ prolapse distress inventory (POPDI) score dan satu studi lainnya menggunakan International Consultation on Incontinence Questionnaire – Vaginal Symptoms (ICIQ-VS). Kata kunci: prolapse organ pelvik, pesarium, penatalaksanaan

Use of 2D and multislice transperineal ultrasonography to describe the degree of perineal laceration following vaginal delivery

Background: Perineal tear is the most common complication after vaginal delivery. Pill-rolling test is a widely used clinical evaluation method to determine the degree of perineal tear. However, the evaluation results of anal sphincter complex (ASC) differ between clinical examination and 2D/multislice transperineal ultrasonography (TPUS). This study aims to describe measurement variation between these modalities. Methods: This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from November 2015 to May 2016. Subjects were primiparous women after vaginal delivery. Clinical examination using pill-rolling test was performed to determine the degree of perineal laceration. Suture was conducted accordingly. The subjects were subjected to 2D/multislice TPUS 72 hours after delivery to evaluate the integrity of internal and external anal sphincters. Data were collected and analyzed to determine compatibility between these examinations. Results: Among 70 prospective primiparous women, five were excluded due to unavailability to undergo 2D/multislice TPUS 72 hours after delivery. The mean duration to perform 2D/multislice TPUS was 4.5 minutes, and pain was tolerable during the examination. The compatibility values of clinical examination with 2D and multislice TPUS were 0.98 and 0.93, respectively, with Cohen’s kappa of 0.92 (95% CI 0.81–1.00) and 0.79 (95% CI 0.58–0.99), respectively. Conclusion: Clinical examination is compatible with 2D/multislice TPUS for determining the degree of perineal tear after vaginal delivery

Knowledge, Attitudes, and Behaviors of Practitioners Supporting Cancer Patients in Fertility Preservation in DKI Jakarta: A Crosssectional Study

Background: More than 135,000 people aged under 45 yr are diagnosed with cancer annually in Indonesia. Good detection and management of cancer increase the quality of life. Objective: To determine the knowledge, attitudes, and behaviors of practitioners supporting cancer patients in fertility preservation. Materials and Methods: This cross-sectional study was conducted in 18 type D government hospitals and Dr. Cipto Mangunkusumo Hospital, in Jakarta, Indonesia, between January 2018 and August 2019. This study involved practitioners providing care to cancer patients. Data were described descriptively. Results: Most of the general practitioners, specialists, and subspecialists who participated in this study were aged 26-30 yr (65.4%), 31-35 yr (70.4%), and 31-40 yr (53.0%), respectively. The fertility treatment most known by general practitioners was in vitro fertilization with embryo cryopreservation (12.1%); for specialists it was sperm cryopreservation (24.5%). Meanwhile, subspecialists knew most about in vitro fertilization with embryo cryopreservation and sperm cryopreservation using a GnRH agonist (such as leuprolide injection) pre-cancer treatment (13%). A positive attitude towards fertility preservation as an important priority for cancer patients was shown in 72.0% of general practitioners, 73.3% of specialists, and 100% of subspecialists. General practitioners mostly referred patients to fertility specialists (44.4%). Many specialists (54.9%) and subspecialists (67%) discussed the possible impact of the patient's condition and / or treatment on fertility. Conclusion: The knowledge of and practices related to fertility preservation differed among general practitioners, specialists, and subspecialists. However, positive attitudes among them were similar. Key words: Knowledge, Attitude, Practice, Doctor, Fertility preservation