FOUR Score sebagai Alternatif dalam Menilai Derajat Keparahan dan Memprediksi Mortalitas pada Pasien Cedera Otak Traumatik yang Diintubasi

Skala yang mengukur koma yang ideal seharusnya bersifat linear, reliabel, valid, dan mudah digunakan. Berbagai macam skala telah dikembangkan dan divalidasi untuk mengevaluasi tingkat kesadaran secara cepat, derajat penyakit, dan prognosis terhadap morbiditas maupun mortalitas. Glasgow Coma Scale (GCS) merupakan alat pemeriksaan tingkat kesadaran yang paling sering digunakan dan dijadikan gold standard, namun GCS mempunyai keterbatasan karena pasien yang diintubasi tidak dapat dinilai komponen verbal. Full Outline of UnResponsiveness (FOUR) score dikembangkan untuk mengatasi berbagai keterbatasan GCS. Pemeriksaan FOUR score adalah skala penilaian klinis dalam penilaian pasien dengan gangguan tingkat kesadaran. FOUR score lebih sederhana dan memberikan informasi yang lebih baik, terutama pada pasien cedera otak traumatik yang diintubasi. Hasil penelitian menunjukkan bahwa GCS dan FOUR score memiliki nilai prediksi yang tinggi tidak hanya kematian pada pasien trauma tetapi juga luaran pada pasien yang dipulangkan. Studi multicentre menunjukkan FOUR score dan GCS tidak berbeda dalam memprediksi kematian di rumah sakit. Studi tersebut menyarankan bahwa FOUR score dapat menjadi alat diagnostik yang lebih baik untuk menilai refleks batang otak dan pola pernapasan. Namun penelitian lain didapatkan juga hasil yang bertentangan antara GCS dan FOUR score dalam prediksi luaran pasien. Adanya kontradiksi tersebut menunjukkan perlunya dilakukan lebih banyak studi. Oleh karena itu, telaah literatur ini dilakukan dengan tujuan untuk membandingkan skor GCS dan FOUR dalam memprediksi mortalitas pasien trauma.   FOUR Score as an Alternative in Assessing the Degree of Severity and Predicting Mortality in Intubated Traumatic Brain Injury Patients Abstract The ideal consciousness scoring scale must be linear, reliable, valid, and user-friendly. There is a need to develop and validate a scale to quickly evaluate the level of consciousness, the severity of the disease, and the prognosis of morbidity and mortality. Glasgow Coma Scale (GCS) is the most commonly used tool to assess the level of consciousness and is considered the gold standard. However, GCS has several limitations, such as inability to evaluate verbal components in intubated patients. To overcome these challenges, researchers developed the Full Outline of UnResponsiveness (FOUR) score. FOUR scores is a clinical grading scale to assess the altered state of consciousness. FOUR scores is simpler and able to provide better information, especially in intubated-traumatic brain injury (TBI) patients. Some studies showed that GCS and FOUR scores have the high predictive value in predicting not only the mortality of trauma patients but also the outcome of discharged patients. A multicentre study showed that FOUR scores and GCS do not differ in predicting inpatient mortality. This study suggested that the FOUR scores could be a better diagnostic tool for assessing brainstem reflexes and breathing patterns. Unfortunately, some studies have found conflicting results between GCS and FOUR scores in predicting patient outcomes. These contradictions suggest the need to conduct more studies. Therefore, this literature review will compare GCS and FOUR scores in predicting mortality of TBI patients

Pengelolaan Kadar Gula Darah Perioperatif pada Pasien Diabetes Mellitus dengan Tumor Cerebellopontine Angle

Prevalence of patients with diabetes mellitus (DM) increases rapidly in the 21st century, mainly due to obesity, aging and lack of physical activity. International Diabetes Federation (IDF) predicted that by the year of 2025, 380 million people will suffer from DM. Diabetic patients undergoing surgery might have other diseases caused by DM. Episodes of hypoglycemia, hyperglycemia and high perioperative glucose level put the patients into higher perioperative risks. Anesthesiologists play a key role in perioperative management in these patients, moreover in neurosurgery pastients, as brain is very glucose-dependent. A 46 year old diabetic woman with cerebellopontine angle (CPA) tumor underwent elective surgery of tumor removal. Surgery was done under general endotracheal anesthesia and lasted for nine hours. Challenges during perioperative period are to maintain glucose level within target range to minimize secondary injury to the brain which may influence cognitive outcome and other possible perioperative complications. Patient was taken care at the ICU post operatively with ventilator. Patient was weaned and extubated three hours later with stable glucose control and no sequelae

Pengelolaan Anestesi untuk Eksisi Tumor Intradura Intramedula (IDIM) Setinggi Vertebra Cervical 5-6 dengan Panduan Intraoperative Neurophysiological Monitoring

Excision of intradural intramedullary (IDIM) tumor using intraoperative neurophysiological monitoring (IOM) is one surgical technique aiming to excise tumor as maximum as possible, with minimum neurological deficit. In anesthesia management for IDIM tumor excision under IOM guidance, an anesthesiologist is required to master neuroanesthesia knowledge and skill, especially for spine surgery. Moreover, understanding the art of anesthesia technique, drug and dose supporting surgery with IOM. A male patient, 52 years old, with IDIM tumor at the level of cervical 5-6th underwent surgery for tumor excision using IOM. Surgery was done under general anesthesia, started with intravenous induction, and intubation was done using video laryngoscope. Surgery was done under IOM guidance, total intravenous anesthesia was implemented and no additional muscle relaxant was given after intubation. Surgery lasted for six hours and tumor was resected completely. Challenges during perioperative period are meticulous preoperative assessment and preparation, patient positioning and appropriate anesthesia technique

Patient Acceptability of Symptom Screening and Patient Education Using a Chatbot for Autoimmune Inflammatory Diseases: Survey Study

BackgroundChatbots have the potential to enhance health care interaction, satisfaction, and service delivery. However, data regarding their acceptance across diverse patient populations are limited. In-depth studies on the reception of chatbots by patients with chronic autoimmune inflammatory diseases are lacking, although such studies are vital for facilitating the effective integration of chatbots in rheumatology care. ObjectiveWe aim to assess patient perceptions and acceptance of a chatbot designed for autoimmune inflammatory rheumatic diseases (AIIRDs). MethodsWe administered a comprehensive survey in an outpatient setting at a top-tier rheumatology referral center. The target cohort included patients who interacted with a chatbot explicitly tailored to facilitate diagnosis and obtain information on AIIRDs. Following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the survey was designed to gauge the effectiveness, user acceptability, and implementation of the chatbot. ResultsBetween June and October 2022, we received survey responses from 200 patients, with an equal number of 100 initial consultations and 100 follow-up (FU) visits. The mean scores on a 5-point acceptability scale ranged from 4.01 (SD 0.63) to 4.41 (SD 0.54), indicating consistently high ratings across the different aspects of chatbot performance. Multivariate regression analysis indicated that having a FU visit was significantly associated with a greater willingness to reuse the chatbot for symptom determination (P=.01). Further, patients’ comfort with chatbot diagnosis increased significantly after meeting physicians (P<.001). We observed no significant differences in chatbot acceptance according to sex, education level, or diagnosis category. ConclusionsThis study underscores that chatbots tailored to AIIRDs have a favorable reception. The inclination of FU patients to engage with the chatbot signifies the possible influence of past clinical encounters and physician affirmation on its use. Although further exploration is required to refine their integration, the prevalent positive perceptions suggest that chatbots have the potential to strengthen the bridge between patients and health care providers, thus enhancing the delivery of rheumatology care to various cohorts

Implementation of an ecohealth approach for better management of leptospirosis in Kulon Progo District, Yogyakarta Special Province, Indonesia

Outbreaks of leptospirosis in Yogyakarta Special Province, Indonesia cause serious problems in humans and animals. With case fatality rates for the Kulon Progo District, Yogyakarta Special Province of 5.8% for 2011, 7.1% for 2012 and 33.3% for 2013 the PH importance has been clearly demonstrated. High mortalities in human due to renal failure can be observed whereas in animals a loss of production (i.e. due to abortions) is most prominent. The observed re-emergence of leptospirosis seems to be caused by multifactor components, and highly linked to environmental factors. However, observed cases of leptospirosis and related health impacts need to be better understood. Classical sector specific approaches have failed to be effective. Thus a more successful control and prevention requires alternative concepts such as EcoHealth to ensure transdisciplinary and participatory approaches across sectoral barriers. The objective of this study is to explore potential risk factors for leptospirosis in human and animals by using qualitative and quantitative tools for data collection. In-depth interviews (IDI) targeted on knowledge of zoonotic diseases particularly leptospirosis and behavior of people. Focus group discussions (FGD) were performed and included farmers, village officials, and stakeholders from Municipal Health Services and Livestock Services. The survey was carried out in between April to May 2013 in selected communities (N=9) of Kulon Progo with high (N=3), medium (N=3) and low cases (N=3) of human leptospirosis based on a recent serological survey. It is anticipated that the results from the FGD and IDI will provide additional information to the first phase of the project (Oct 2011 – May 2012) which focused on quantitative data collection such as prevalence surveys for leptospirosis in animals, questionnaires and spatial analysis using GIS including veterinarians, physicians, ecologists, demographist, social sciences, others stakeholders (government and public sector). Key results from both phases will be presented and synthesized. The synthesis from the qualitative and quantitative surveys will contribute to a better integrated understanding of disease emergence and the basis for a more effective addressing of public health policy concerns in order to better management the disease

Fast Track Algorithm: How To Differentiate A “Scleroderma Pattern” From A “Non-Scleroderma Pattern”

Objectives: This study was designed to propose a simple “Fast Track algorithm” for capillaroscopists of any level of experience to differentiate “scleroderma patterns” from “non-scleroderma patterns” on capillaroscopy and to assess its inter-rater reliability. Methods: Based on existing definitions to categorise capillaroscopic images as “scleroderma patterns” and taking into account the real life variability of capillaroscopic images described standardly according to the European League Against Rheumatism (EULAR) Study Group on Microcirculation in Rheumatic Diseases, a fast track decision tree, the “Fast Track algorithm” was created by the principal expert (VS) to facilitate swift categorisation of an image as “non-scleroderma pattern (category 1)” or “scleroderma pattern (category 2)”. Mean inter-rater reliability between all raters (experts/attendees) of the 8th EULAR course on capillaroscopy in Rheumatic Diseases (Genoa, 2018) and, as external validation, of the 8th European Scleroderma Trials and Research group (EUSTAR) course on systemic sclerosis (SSc) (Nijmegen, 2019) versus the principal expert, as well as reliability between the rater pairs themselves was assessed by mean Cohen's and Light's kappa coefficients. Results: Mean Cohen's kappa was 1/0.96 (95% CI 0.95-0.98) for the 6 experts/135 attendees of the 8th EULAR capillaroscopy course and 1/0.94 (95% CI 0.92-0.96) for the 3 experts/85 attendees of the 8th EUSTAR SSc course. Light's kappa was 1/0.92 at the 8th EULAR capillaroscopy course, and 1/0.87 at the 8th EUSTAR SSc course. C Conclusion: For the first time, a clinical expert based fast track decision algorithm has been developed to differentiate a “non-scleroderma” from a “scleroderma pattern” on capillaroscopic images, demonstrating excellent reliability when applied by capillaroscopists with varying levels of expertise versus the principal expert and corroborated with external validation.Wo

Listening to patients, for the patients: The COVAD Study-Vision, organizational structure, and challenges

Background: The pandemic presented unique challenges for individuals with autoimmune and rheumatic diseases (AIRDs) due to their underlying condition, the effects of immunosuppressive treatments, and increased vaccine hesitancy. Objectives: The COVID-19 vaccination in autoimmune diseases (COVAD) study, a series of ongoing, patient self-reported surveys were conceived with the vision of being a unique tool to gather patient perspectives on AIRDs. It involved a multinational, multicenter collaborative effort amidst a global lockdown. Methods: Leveraging social media as a research tool, COVAD collected data using validated patient-reported outcomes (PROs). The study, comprising a core team, steering committee, and global collaborators, facilitated data collection and analysis. A pilot-tested, validated survey, featuring questions regarding COVID-19 infection, vaccination and outcomes, patient demographics, and PROs was circulated to patients with AIRDs and healthy controls (HCs). Discussion: We present the challenges encountered during this international collaborative project, including coordination, data management, funding constraints, language barriers, and authorship concerns, while highlighting the measures taken to address them. Conclusion: Collaborative virtual models offer a dynamic new frontier in medical research and are vital to studying rare diseases. The COVAD study demonstrates the potential of online platforms for conducting large-scale, patient-focused research and underscores the importance of integrating patient perspective into clinical care. Care of patients is our central motivation, and it is essential to recognize their voices as equal stakeholders and valued partners in the study of the conditions that affect them