Obstetric Referral System during COVID-19 Pandemic : Tertiary Referral Hospital Perspective: istem Rujukan Obstetri dalam Masa Pandemi COVID-19 : Perspektif Rumah Sakit Rujukan Tersier

Abstract Objective : To evaluate the effectiveness of obstetric referrals to the dr. Cipto Mangunkusumo National Central General Hospital (RSCM), a tertiary hospital in Indonesian referral system, during the COVID-19 pandemic. Methods : A cross-sectional descriptive-analytic study that compared the effectiveness of referrals before (July-December 2019) and during the COVID-19 pandemic (March-August 2020) at the National Central General Hospital dr. Cipto Mangunkusumo (RSCM). Referral effectiveness is assessed based on two criteria, namely the suitability of the diagnosis and procedural compliance which includes communication through the integrated emergency response system (SPGDT), delivery by ambulance, and attachment of a referral letter. Results: The study found 198 referral cases from 464 obstetric cases (42.67%) before the pandemic and 231 referral cases from 486 obstetric cases (47.53%) during the pandemic. The diagnostic concordance increased from 57.58% before the pandemic to 71.00% during the pandemic (p = 0.004). Referral procedural compliance increased from 28.28% before the pandemic to 45.45% during the pandemic (p < 0.001). Based on these criteria, the effectiveness of referrals at the RSCM during the COVID-19 pandemic era was found to be significantly higher, namely before the pandemic by 21.72% and during the pandemic by 40.26% (p < 0.001). Conclusion : The effectiveness of referral to the RSCM based on the suitability of the diagnosis and the accuracy of the procedure during the COVID-19 pandemic was found to be better than before the pandemic. Keywords: COVID-19, obstetric referral system, pandemic.   Abstrak Tujuan : Untuk menilai efektivitas rujukan obstetri ke Rumah Sakit Pusat Nasional dr. Cipto Mangunkusumo, rumah sakit tersier dalam sistem rujukan Indonesia, selama pandemi COVID-19 Metode: Penelitian deskriptif-analitik berdesain potong lintang yang membandingkan efektivitas rujukan sebelum (Juli-Desember 2019) dan saat pandemi COVID-19 (Maret-Agustus 2020) di Rumah Sakit Umum Pusat Nasional dr. Cipto Mangunkusumo (RSCM). Efektivitas rujukan dinilai berdasarkan dua kriteria, yakni kesesuaian diagnosis dan kepatuhan prosedur yang meliputi komunikasi melalui sistem penanggulangan gawat darurat terpadu (SPGDT), pengantaran dengan ambulans, dan pelampiran surat rujukan. Hasil: Penelitian menemukan 198 kasus rujukan dari 464 kasus obstetri (42,67%) sebelum pandemi dan 231 kasus rujukan dari 486 kasus obstetri (47,53%) saat pandemi. Kesesuaian diagnosis meningkat dari 57,58% sebelum pandemi menjadi 71,00% saat pandemi (p = 0,004). Kepatuhan prosedur rujukan meningkat dari 28,28% sebelum pandemi menjadi 45,45% saat pandemi (p < 0,001). Berdasarkan kriteria tersebut, efektivitas rujukan di RSCM pada era pandemi COVID-19 ditemukan lebih tinggi secara signifikan, yakni sebelum pandemi sebesar 21,72% dan saat pandemi sebesar 40,26% (p < 0,001). Kesimpulan: Efektivitas rujukan ke RSCM berdasarkan kesesuaian diagnosis dan kepatuhan prosedur saat pandemi COVID-19 ditemukan lebih baik. Kata kunci: COVID-19, pandemi, sistem rujukan obstetri &nbsp

Development and initial validation of the bronchiectasis exacerbation and symptom tool (BEST)

BACKGROUND: Recurrent bronchiectasis exacerbations are related to deterioration of lung function, progression of the disease, impairment of quality of life, and to an increased mortality. Improved detection of exacerbations has been accomplished in chronic obstructive pulmonary disease through the use of patient completed diaries. These tools may enhance exacerbation reporting and identification. The aim of this study was to develop a novel symptom diary for bronchiectasis symptom burden and detection of exacerbations, named the BEST diary. METHODS: Prospective observational study of patients with bronchiectasis conducted at Ninewells Hospital, Dundee. We included patients with confirmed bronchiectasis by computed tomography, who were symptomatic and had at least 1 documented exacerbation of bronchiectasis in the previous 12\u2009months to participate. Symptoms were recorded daily in a diary incorporating cough, sputum volume, sputum colour, dyspnoea, fatigue and systemic disturbance scored from 0 to 26. RESULTS: Twenty-one patients were included in the study. We identified 29 reported (treated exacerbations) and 23 unreported (untreated) exacerbations over 6-month follow-up. The BEST diary score showed a good correlation with the established and validated questionnaires and measures of health status (COPD Assessment Test, r =\u20090.61, p =\u20090.0037, Leicester Cough Questionnaire, r =\u2009-\u20090.52,p =\u20090.0015, St Georges Respiratory Questionnaire, r =\u20090.61,p <\u20090.0001 and 6\u2009min walk test, r =\u2009-\u20090.46,p =\u20090.037). The mean BEST score at baseline was 7.1 points (SD 2.2). The peak symptom score during exacerbation was a mean of 16.4 (3.1), and the change from baseline to exacerbation was a mean of 9.1 points (SD 2.5). Mean duration of exacerbations based on time for a return to baseline symptoms was 15.3\u2009days (SD 5.7). A minimum clinically important difference of 4 points is proposed. CONCLUSIONS: The BEST symptom diary has shown concurrent validity with current health questionnaires and is responsive at onset and recovery from exacerbation. The BEST diary may be useful to detect and characterise exacerbations in bronchiectasis clinical trials

Pflege und Wohnungslosigkeit

Hintergrund: Wohnungslose Menschen sind aufgrund ihrer gesundheitsbelastenden Lebensbedingungen meist beträchtlich vorgealtert und haben einen großen Bedarf an medizinischer und pflegerischer Versorgung. Die Integration dieses Personenkreises in die klassische Altenpflege ist hinsichtlich der Lebensgeschichte, die zumeist geprägt ist durch soziale Schwierigkeiten, der Voralterung sowie psychiatrischer Störungen kaum möglich. Statistiken zeigen, dass ein Bedarf an Unterbringung für ältere Wohnungslose besteht. Die Wiener Wohnungslosenhilfe hat dies erkannt und „Sozial betreute Wohnhäuser“ errichtet, in denen Wohnungslosen ein Wohnraum sowie professionelle medizinische, pflegerische und soziale Betreuung angeboten wird. Die Begleitung und Versorgung wird von Diplomierten Gesundheits- und Krankenpflegepersonen als auch von anderen Berufsgruppen, wie z.B. Ärzten und Sozialarbeitern vor Ort, gewährleistet. Eine Literaturrecherche in Hinblick auf ältere wohnungslose Menschen und deren pflegerische Versorgung hat ergeben, dass das subjektive Erleben der Pflegepersonen in der Arbeit mit älteren Wohnungslosen bisher kaum näher erforscht wurde. Forschungsfragen: „Wie beschreiben Diplomierte Gesundheits- und Krankenpflegepersonen in sozial betreuten Wohnhäusern für ältere ehemals wohnungslose Menschen ihr Arbeitsfeld?“ und „Wie erleben Diplomierte Gesundheits- und Krankenpflegepersonen die Arbeit mit älteren ehemals wohnungslosen Menschen in sozial betreuten Wohnhäusern?“ Methode: Zur Bearbeitung der Forschungsfragen wurde ein qualitativer Forschungsansatz gewählt. Die Datenerhebung erfolgte mittels halbstandardisierter Interviews mit acht Pflegepersonen aus sozial betreuten Wohnhäusern. Zur Auswertung der Daten wurde ein interpretativ-reduktives Verfahren herangezogen. Ergebnisse: Beziehungsaufbau und Kommunikation mit älteren ehemals Wohnungslosen können als wesentliche Aspekte des pflegerischen Handelns definiert werden. Die Pflegepersonen übernehmen eine beratende Rolle und sind Ansprechpartner für gesundheitliche Fragen. Sie sind dafür verantwortlich, ein Gesundheitsbewusstsein bei älteren ehemals Wohnungslosen zu schaffen. Dieser Aufgabenbereich wird von den Befragten als herausfordernd erlebt. Des Weiteren sind sie „Vermittler“ zwischen dem Wohnungslosen und dem gesundheitlichen Versorgungssystem. Belastungen der Pflegepersonen resultieren aus dem Verhalten der Bewohner sowie aus deren körperlich-seelischen Zustand. Ablehnung von Seiten der älteren ehemals Wohnungslosen gegenüber Hilfeangeboten zu akzeptieren, den körperlichen Verfall sowie das Sterben der Bewohner mitzuerleben, wird von den Befragten als belastend wahrgenommen. Als Entlastungsstrategien wenden die Pflegepersonen zum Beispiel das Gespräch mit Kollegen an. Soziale Kompetenzen, wie Offenheit und Wertfreiheit gegenüber der Lebensgeschichte und dem Verhalten der Bewohner, werden als wesentliche Voraussetzung angesehen, um in diesem Feld tätig sein zu können. Positive Rückmeldungen von den Bewohnern, die Sinnhaftigkeit des eigenen Handelns zu sehen sowie vielfältige Möglichkeiten und Herausforderungen tragen unter anderem dazu bei, dass alle Befragten ihre Arbeit als positiv erleben.Background: Due to health-straining living conditions homeless people age very often prematurely and need extensive medical and nursing care. The integration of this group of people into the classic elderly care is hardly possible considering the biographies characterised by social problems, pre-mature aging and psychiatric disorders. Statistics reveal a demand for the accommodation of the elderly homeless. The „Wiener Wohnungslosenhilfe“ (Viennese Homeless Assistance) has identified this demand and established „Sozial betreute Wohnhäuser“ (residence houses with social assistance) providing housing space for the homeless as well as professional medical, nursing and social care. The clients are supported and treated by nurses in cooperation with other professional groups, such as doctors and social workers. Literature research concerning nursing care for elderly homeless people shows that the personal experience of nurses working with elderly homeless persons has hardly been investigated. Leading questions: „How do nurses describe their field of work in socially assisted housing institutions for elderly formerly homeless persons?“ and „How do nurses experience their work with elderly formerly homeless persons in socially assisted housing institutions?“ Research method: Dealing with the leading questions a qualitative research approach was applied. Data were gathered by using partly-standardised interviews with eight nurses from socially assisted housing institutions. For data analysis an interpretive-reductive technique was used. Results: The major aspects of their nursing activities can be summarised in establishing relationships and communicating with their clients. Nurses in this field of work become counseling partners for their clients. They are contact persons concerning health matters. In this position they are responsible to establish health awareness in elderly formerly homeless persons and encourage them to benefit from medical and nursing care. This responsibility is experienced as a challenge. Furthermore they are an intermediary between the homeless and the health care system. The behaviour, the physical and mental conditions of the residents are the two components that imply stress for nurses. To accept the refusal of assistance by an elderly formerly homeless and to experience the physical deterioration and death of a client are other stress factors mentioned. A strategy of relief for nurses is to communicate and discuss the problem with co-workers. Essential requirements identified to be working in this field are social skills, such as open-mindedness and unbiasedness to the biographies and behaviour of the residents. All interviewees experience high job-satisfaction which can be ascribed to the following reasons: to get positive feedback by the clients, to recognise the meaningfulness of this work, to have a variety of possibilities and challenges

On the road without a map: why we need an “ethic of road ecology”

Over the past two decades, our knowledge of the ecological impacts of roads has increased rapidly. It is now clear that the environmental effects of transportation infrastructure are inextricable from transportation benefits to economic, social, and cultural values. Despite the necessity of optimizing these multiple values, road planners, scientists, and practitioners have no established methodology or pluralistic approach to address growing ethical complexities. We articulate five ethical issues that could be addressed by developing an ethic of road ecology in order to facilitate the identification, reasoning, and harmonization of ethical dimensions of road planning and development. This inquiry into road ecology can draw lessons from existing applied ethics, such as in ecological restoration and urban planning, to build a narrative that is informed by both science and ethics. We illustrate five ethical issues presented through case studies that elaborate on the motivations, responsibilities, and duties that should be considered in ethically and scientifically complicated road building decisions. To address these issues, we encourage the development of a code of ethics, dedicated intellectual forums, and practical guidance to assist road planners, and more broadly transportation practitioners, to resolve complex ethical quandaries systematically. We hope this perspective encourages conversation for a holistic yet pragmatic approach to this applied ethics problem, while also assisting responsible parties as they navigate difficult moral terrain

Global urban environmental change drives adaptation in white clover.

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Global urban environmental change drives adaptation in white clover

Urbanization transforms environments in ways that alter biological evolution. We examined whether urban environmental change drives parallel evolution by sampling 110,019 white clover plants from 6169 populations in 160 cities globally. Plants were assayed for a Mendelian antiherbivore defense that also affects tolerance to abiotic stressors. Urban-rural gradients were associated with the evolution of clines in defense in 47% of cities throughout the world. Variation in the strength of clines was explained by environmental changes in drought stress and vegetation cover that varied among cities. Sequencing 2074 genomes from 26 cities revealed that the evolution of urban-rural clines was best explained by adaptive evolution, but the degree of parallel adaptation varied among cities. Our results demonstrate that urbanization leads to adaptation at a global scale

Evaluation of the Accuracy of Implementation of Obstetric Referral Cases to the Emergency in the JKN Era: Evaluasi Ketepatan Pelaksanaan Rujukan Kasus Gawat Darurat Obstetri ke Instalasi Gawat Darurat dalam Era Jaminan Kesehatan Nasional

Abstract Objective: To investigate the circumstances of the obstetric referral case at the emergency department of the Dr.Cipto Mangunkusumo Hospital as well as the accuracy of the referral implementation. Method: We used cross-sectional study. Medical records of obstetric patients at Emergency department in RSCM in January 2013-July 2014 were obtained, then information about patients and their characteristic were collected. The accuracy of referral cases is based on emergency obstetric criteria by BPJS rules. Results: Primary Health Care became the leading referrer. Inappropriate diagnostic referral cases amounted to 21.2%when JKN first began to be implemented in 2014. Cases with improper diagnoses were more referred when JKN was implemented which amounted to 16.8% and non-emergency referral cases of 6.9% in 2014. Conclusion: Referral implementation has not been efficient and effective, the number of obstetric referral cases to emergency department of RSCM that can actually be handled in the secondary advanced health services after the application of JKN is still high. Monitoring and evaluation is needed by the Local Health Office to improve the quality of the referral system that applied in the newly JKN era.   Keywords:accuracy of referrals,BPJS, JKN, obstetric emergencies, referral system.   Abstrak Tujuan: Mengetahui gambaran kasus rujukan obstetri di IGD RSCM dan ketepatan pelaksanaan rujukan.  Metode: Deskriptif desain studi potong lintang. Data diambil dari rekam medis pasien obstetri di IGD RSCMpada bulan Januari 2013 hingga Desember 2014, kemudian informasi mengenai data dan karakteristik pasien dikumpulkan. Ketepatan pelaksanaan rujukan kasus gaat daraurat obstetri berdasarkan Krietria gawatdarurat bagian kebidanan menurut ketentuan BPJS Kesehatan. Hasil: Perujuk terbanyak adalah Puskesmas (FKTP). Kasus rujukan dengan ketidaksesuaian diagnosa lebih banyakjumlahnya pada saat JKN mulai diterapkan pada tahun 2014 sebesar 21.2%. Kasus dengan diagnosa yang tidak tepat rujuk lebih banyak pada saat JKN di laksanakan yaitu sebesar 16.8% dan kasus rujukan yang bukan gawatdarurat sebesar 6.9% pada tahun 2014. Kesimpulan: Pelaksanaan rujukan belum efisien dan efektif, jumlah rujukan obstetri ke IGD RSCM yangsebenarnya dapat ditangani di fasilitas kesehatan tingkat lanjutan sekunder setelah penerapan JKN masih tinggi. Dibutuhkan monitoring dan evaluasi oleh Dinas Kesehatan setempat untuk meningkatkan kualitas sistem rujukan yang berlaku di era JKN yang baru diterapkan. Kata kunci :  BPJS, gawat darurat obstetri, JKN, ketepatan rujukan, sistem rujukan

Spatio-Temporal Keyword Queries in Social Networks

none5Due to the large amount of social network data produced at an ever growing speed and their complex nature, recent works have addressed the prob- lem of efficiently querying such data according to social, temporal or spatial di- mensions. In this work we propose a data model that keeps into account all these dimensions and we compare different approaches for efficient query execution on a large real dataset using standard relational technologies.noneV. Cozza;A. Messina;D. Montesi;L. Arietta;M. MagnaniV. Cozza;A. Messina;D. Montesi;L. Arietta;M. Magnan