Evaluasi Program Penanggulangan Kejadian Luar Biasa Infeksi Daerah Operasi Pasca SC di Departemen Obsgin RSCM

ABSTRACTBackground: Surgical Site Infection (SSI) is one of the complication of surgery that disturbing, both in the patient nor the doctor and the hospital as a health care provider. There is an increased incidence of SSI post-Cesarian Section in the Department of Obstetric and Gynecology in August 2014 ie from the range of 0.16% - 0.33% to 2.32%, whereas RSCM standard should not be more than 2%. The hospital has made several efforts in the prevention program of outbreak SSI post-Cesarian Section by some parties concerned, namely the Committee on Hospital Infection Prevention (PPIRS) by IPCN (Infection Prevention Control Nurse).Method: This study uses a realist evaluation with context, mechanism, and outcome. The data is collected by interviews and focus group discussions with related parties as well as conducting a document review and observations. The results of the study were analyzed using content analysis.Result. Using the hypothesis of C-M-O, that the context is correct, however IPCN and infrastructure in operating rooms also provide a big influence in overcoming the problem of IDO, to decrease the incidence of SSI and increased compliance. Conclusion. The program succeeded in reducing the incidence of SSI with an improved C-M-O. Keywords: Surgical Site Infection (SSI), context, mechanism, outcome, realist evaluation ABSTRAKLatar belakang: Infeksi Daerah Operasi (IDO) merupakan salah satu komplikasi tindakan operasi yang sangat mengganggu, baik dari sisi pasien maupun dokter dan rumah sakit sebagai penyedia layanan kesehatan. Terjadi peningkatan insiden IDO pasca-SC di Departemen Obstetri dan Ginekologi pada bulan September 2014 yaitu dari kisaran 0,16% - 0,33% menjadi 2,32%, sedangkan ambang di RSCM tidak boleh lebih dari 2%. Rumah sakit telah melakukan beberapa upaya dalam program penanggulangan KLB IDO pasca-SC oleh beberapa pihak yang terkait, yaitu Panitia Penanggulangan Infeksi di Rumah Sakit (PPIRS) oleh IPCN (Infection Prevention Control Nurse).Metode: Penelitian ini menggunakan metode realist evaluation dengan pola context, mechanism, dan outcome. Pengumpulan data dilakukan dengan wawancara dan FGD kepada pihak terkait serta melakukan telaah dokumen dan observasi. Hasil penelitian dianalisis menggunakan analisis isi.Hasil: Dengan menggunakan hipotesis C-M-O, bahwa context sudah tepat, mechanism selain peran IPCN, sarana dan prasarana di ruang-ruang operasi juga memberikan andil yang cukup besar dalam penanggulangan masalah IDO, danoutcome terjadi penurunan angka kejadian IDO dan peningkatan kepatuhan.Kesimpulan: Program berhasil menurunkan kejadian IDO dengan C-M-O yang sudah disempurnakan. Kata Kunci: IDO, context, mechanism, outcome, realist evaluatio

A Japan compact bus terminal; Review on Hakata bus terminal, Fukuoka

A mass transportation system has a main role in every development process of countries in the modern world. In Japan, transportation infrastructure such as train stations or bus terminals plays as an important node that determines the development of functions and other community activities in the surrounding area. Based on the compact city development concept, various types of transport infrastructure were constructed in the integrated area of city nodes and mixed with a various public and commercial functions and supported with a well-structured management of transportation systems. With the condition of limited land in the city nodes, transport infrastructure has to be built as a compact building. This paper reviews design and system of Bus Terminal in Japan from the architectural perspective with the issue of a compact building. As a study case, Hakata Bus terminal is one of Japanese bus terminal built with a slim building and vertically extended level without bus parking area. The platform was divided into three different floor levels with total ten building stories filled by various public and commercial functions. Time schedule, information system, people and vehicle circulation, and the other aspect become the main support to create a compact bus terminal. However, the commercial function is more prominent than the overall function of the building, thus making Hakata bus terminal does not show the typology terminal design in general. Overall, the terminal provides community services without ignoring the main function as a mass transportation system in a compact bus terminal

Indonesian primary care physician perception towards contraception usage: a review

Background: Indonesian Health Profile (IHF) showed that Indonesian population reached 255.46 million people in 2015. A way to control population growth is through family planning (FP). This study aims to evaluate knowledge, attitude, and practice (KAP) of general practitioner in Indonesia regarding to contraception and postpartum contraception.Methods: A cross sectional descriptive study to all internship doctors in Indonesia was held between July and August 2016. There were 8, 10, 9, 6 questions focusing on characteristics demographic, knowledge, attitude, and practice towards contraception including postpartum contraception, respectively. The inclusion criteria were all general practitioners who were doing the internship in Indonesia during this study. The exclusion criteria were general practitioners who postponed the internship due to any reasons. Descriptive statistics were used for data analysis using SPSS 23.0 for Windows.Results: Most of them (56.4%) had good knowledge, 97.4% respondents pointed out positive attitude, and 72.3% of them showed positive practice towards contraception. Meanwhile, the experience of inserting IUD, implant, and performing contraceptive injection was only 58.5%, 43.6%, and 79.0%; contributively.Conclusions: Supervision training starting from contraceptive counselling to procedure of insertion on long acting and permanent methods (LAPM) should be conducted to allow quality contraceptive service in Indonesia

Urinary Incontinence in Women Living in Nursing Homes: Prevalence and Risk Factors

Objective: To identify the prevalence of urinary incontinence, the distribution of the type of urinary incontinence and related risk factors in women older than 50 years. Method: This is a descriptive study with cross sectional design. Two hundred and seventy eight women older than 50 years old living in nursing home were interviewed using the Questionnaire for Urinary Incontinence Diagnosis (QUID) that has been translated and validated. The prevalence will be presented in the form of percentage; while the relationship between risk factors and the incidence or urinary incontinence will be analyzed using Chi square test or Fisher’s exact test, as appropriate, and multivariate analysis. Result: Of 278 research subjects, we obtained 95 subjects (34.2%) suffering from urinary incontinence. Moreover, the distribution of the type is 67 subjects (70.5%) with mixed urinary incontinence, 17 (17.9%) with stress incontinence and 11 subjects (11.6%) with urge incontinence. Body mass index (BMI) showing overweight and obesity are not related with the prevalence of urinary incontinence (p>0.05), which may be caused by the low number of subjects with overweight and obesity. Meanwhile, factors related to urinary incontinence are age older than 60 years (OR=7.79, p=0.021), menopause 10 years (OR=5.08, p=0.004) and multiparity (OR=1.82, p=0.019). Based on multivariate analysis, the risk factor of age older than 60 years is no longer related to urinary incontinence (p>0.05). Thus it can be inferred that age older than 60 years is not a singular factor causing urinary incontinence but rather a part of a multifactorial model. Conclusion: This study shows that the prevalence of urinary incontinence in women living in nursing home is 34.2%; while the distribution of the urinary incontinence is 67 subjects (70.5%) with mixed urinary incontinence, 17 subjects with stress incontinence (17.9%) and 11 subjects (11.6%) with urge incontinence. Risk factors for urinary incontinence are menopause 10 years and multiparity.  Keywords: mixed urinary incontinence, menopause, multiparity, prevalence, stress incontinence, urge incontinence, urinary incontinence, Questionnaire for Urinary Incontinence Diagnosis (QUID

The Impacts of Pelvic Floor Dysfunction Counseling to Knowledge Level and Attitude of Pregnant Women with Gestational Age above Thirty Six Weeks in the Selection of Delivery Method

Objective: To determine the level of knowledge about pelvic floor dysfunction before and after counseling in term pregnant women and knowing whether a difference a change of attitude in the selection method of delivery before and after counseling. Methods: This study design using pre - post test. At the beginning of our study provide some sort of written test to determine the initial knowledge of participants prior to the extension and the selection of the desired method of delivery. Having obtained the results of the test, followed by education about pelvic floor dysfunction. Then do the post-test to determine the level of knowledge of the subject and mode of delivery that would be pursued. The study took place between February and May 2016 in 5 Public Health Center (PHC) in Jakarta that PHC Warakas (North Jakarta), PHC Tanah Abang (Central Jakarta), PHC Cengkareng (West Jakarta), PHC Jatinegara (East Jakarta) and PHC Jagakarsa (South Jakarta). Results: A total of 102 study subjects who began the study gave the results of the pretest mean 71 10.49 (p<0.0001) and post test results of 80.725 7.7 (p<0.0001). Of the 102 subjects who began the study, there were two people who had previously chose method of delivery by caesarean section turned into vaginal. Conclusion: There is a change scores better in knowledge about pelvic floor dysfunction after counseling. There was no significant difference between selecting the desired method of delivery before the after counseling. [Indones J Obstet Gynecol 2017; 5-2: 99-104] Keywords: fecal incontinence, pelvic floor dysfunction, sexual dysfunction, stress urinary incontinence, uterine prolaps

Changes in Quality of Life Score of Patients with Pelvic Organ Prolapse after Vaginal Surgery Measured by Pelvic Floor Distress Inventory (PFDI20) and Pelvic Floor Impact Questionnaire (PFIQ7) Questionnaires

Objective: To determine changes in the quality of life in patients with pelvic organ prolapse who had undergone vaginal surgery. Methods: Prospective cohort study, carried out in Dr. Cipto Mangunkusumo and Fatmawati during the period of July 2015 to October 2016. The quality of life of the subjects was followed up three months after undergoing vaginal surgery. We used the Indonesian version of Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). Results: In this study, 25 subjects were involved. The results showed significant score reduction in the quality of life in patients treated with vaginal surgery with p < 0.05 in almost all scales except CRAIQ-7. Conclusion: There is a reduction in quality of life scores in patients treated with vaginal surgery at all scales except CRAIQ-7 with a value of p <0.05. [Indones J Obstet Gynecol 2017; 5-3: 164-167] Keywords: PFDI-20, PFIQ-7, POP, vaginal surger

A Japan Compact Bus Terminal; Review on Hakata Bus Terminal, Fukuoka

A mass transportation system has a main role in every development process of countries in the modern world. In Japan, transportation infrastructure such as train stations or bus terminals plays as an important node that determines the development of functions and other community activities in the surrounding area. Based on the compact city development concept, various types of transport infrastructure were constructed in the integrated area of city nodes and mixed with a various public and commercial functions and supported with a well-structured management of transportation systems. With the condition of limited land in the city nodes, transport infrastructure has to be built as a compact building. This paper reviews design and system of Bus Terminal in Japan from the architectural perspective with the issue of a compact building. As a study case, Hakata Bus terminal is one of Japanese bus terminal built with a slim building and vertically extended level without bus parking area. The platform was divided into three different floor levels with total ten building stories filled by various public and commercial functions. Time schedule, information system, people and vehicle circulation, and the other aspect become the main support to create a compact bus terminal. However, the commercial function is more prominent than the overall function of the building, thus making Hakata bus terminal does not show the typology terminal design in general. Overall, the terminal provides community services without ignoring the main function as a mass transportation system in a compact bus terminal

The Outcome of Percutaneous Mitral Balloon Commissurotomy (PMBC) in Pregnant Women with Mitral Stenosis: An Evidence Based Study: Luaran Komisurotomi Balon Mitral Perkutan pada Perempuan Hamil

Abstract Objective: To review the outcome of percutaneous mitral balloon commissurotomy (PMBC) both to maternal and neonatal. Methods: The search was conducted on Pubmed®, Cochrane Library®, and Ovid® using MeSH. Critical appraisal determining the validity, importance, and applicability (VIA) was conducted by two independent authors. Results: Several studies showed that performing the PMBC had good outcome for pregnant women functional class based on NYHA. Most of them decreased from NYHA III/IV to I/II. For delivery outcome, all studies concluded that more than 80% pregnant women with mitral stenosis undergoing PMBC delivered at term, and no congenital anomalies found. Conclusion: Percutaneous mitral balloon commissurotomy for pregnant women with severe MS is safe during pregnancy. Keywords: mitral stenosis, outcome, percutaneous mitral balloon commissurotomy, &nbsp;pregnancy, &nbsp; Abstrak Tujuan: Mengulas luaran komisurotomi balon mitral perkutan (KBMP) baik pada maternal maupun neonatus. Metode: Pencarian dilakukan melalui Pubmed®, Cochrane Library®, dan Ovid® menggunakan MeSH. Telaah kristis dilakukan oleh 2 penulis independen berdasarkan validitas, kepentingan, dan aplikabilitas. Hasil: Beberapa studi memperlihatkan KBMP memiliki luaran yang baik di kalangan perempuan hamil berdasarkan kelas fungsional NYHA. Kebanyakan mereka mengalami penurunan NYHA dari III/IV menjadi I/II. Untuk&nbsp; luaran persalinan, seluruh studi menyimpulkan lebih dari 80% perempuan dengan mitral stenosis yang menjalani pembedahan KBMP melahirkan pada usia term dan tidak ditemukan kelainan. Kesimpulan: KBMP aman dilakukan pada perempuan hamil dengan mitral stenosis berat. Kata kunci: kehamilan, komisurotomibalon mitral perkutan, luaran, stenosis mitra

Pelvic Floor Muscle Strength Stress Urinary Incontinence: Kekuatan Otot Dasar Panggul dan Stres Inkontinensia Urin

&nbsp; Objective: To examine the relationship between muscle strength and muscle thickness of levator ani with stress urinary incontinence (SUI) in women.Methods: This study uses a comparative cross-sectional study design. We collected 82 women who visiting the Obstetrics and Gynecology clinic of RSUPN Dr. Cipto Mangunkusumo with the study group were subjects with positive cough tests while the control group were subjects with negative cough tests. The data obtained in the form of history taking, Questionnaire for Urinary Incontinence Diagnosis (QUID), physical examination (POPQ), cough test. perineometer, and ultrasound.Results: We found no significant difference between the levator ani muscle thickness to the incidence of SUI with the median levator ani muscle thickness 0.63 cm (range 0.31-1.02 and p = 0.897). While levator ani muscle strength against SUI has a median of 19.5 (range 4.6-88.6 and p = 0.001). In multivariate analysis it was found that purely SUI, prolapse and age had no significant effect on the strength of levator ani muscles with a p-value of 0.243; 0.844; 0.903.Conclusions: There is no significant difference in levator ani muscle thickness between women who experience SUI compared to those who do not. Women with SUI have weaker levator ani muscle strength than those who do not experience but are not statistically significant. And there is no correlation between muscle strength and levator ani muscle thickness in women with SUI.Keywords: muscle strength, muscle thickness, perineometer, stress urinary incontinence, ultrasound. &nbsp; Abstrak Tujuan : Untuk mengkaji hubungan antara kekuatan otot dan ketebalan otot levator ani dengan keluhan IU-T pada perempuan.Metode : Penelitian ini menggunakan desain perbandingan potong lintang dengan melibatkan 82 wanita yang berkunjung di poliklinik Obstetri dan Ginekologi RSUPN Dr. Cipto Mangunkusumo dengan kelompok studi adalah subyek dengan tes batuk positif sedangkan kelompok kontrol adalah subyek dengan tes batuk negative. Data yang diperoleh berupa hasil anamnesis, Questionnaire for Urinary Incontinence Diagnosis (QUID), pemeriksaan fisik (POPQ), tes batuk. perineometer , dan USG.Hasil: Hasil penelitian ini didapatkan tidak ada perbedaan bermakna antara ketebalan otot levator ani terhadap kejadian IUT dengan median ketebalan otot levator ani 0,63 cm (jarak 0,31-1,02 dan p=0,897). Sedangkan kekuatan otot levator ani terhadap IUT memiliki median 19,5 (jarak 4,6-88,6 dan p=0,001). Pada analisis multivariat didapatkan bukti bahwa secara murni IUT, prolap dan usia tidak mempunyai pengaruh bermakna terhadap kekuatan otot levator ani dengan nilai p masing-masing 0,243; 0,844; 0,903.Kesimpulan : Tidak terdapat perbedaan yang bermakna pada ketebalan otot levator ani antara perempuan yang mengalami IU-T dibanding yang tidak mengalami. Perempuan IU-T mempunyai kekuatan otot levator ani yang lebih lemah dibanding yang tidak mengalami, namun tidak bermakna secara statistik. Tidak terdapat hubungan korelasi antara kekuatan otot dan ketebalan otot levator ani pada perempuan yang mengalami IU-T. Kata kunci : inkontinensia urin jenis tekanan, ketebalan otot, kekuatan otot, perineometer, US

Is Zuspan Regimen Adequate for Preventing Eclampsia?: A Case Report

Magnesium sulphate (MgSO4) is believed to treat preeclampsia and eclampsia for more than a century with a total dose of MgSO4 varying from 2 to 5g per 24 hours. Zuspan and Pritchard are two internationally recommended regimens that are accepted as the standard regimen. In this case report, we presented a 41 year old woman with puerperal preeclampsia prescribed with a complete Zuspan regimen. She had eclamptic seizure after completing Zuspan regimen with Mg SO4 level of 4.3 mg/dL. In this case, the possibility of eclamptic seizures might be due to a lack of MgSO4 dose. The administration of MgSO4 for preeclampsia with severe features and prophylactic of eclampsia should be adjusted