REKONSTRUKSI PEMAKNAAN TINDAK TERMINASI KEHAMILAN OLEH DOKTER BERBASIS KEADILAN

Studi ini dilatarbelakangi oleh realitas empirik kasus-kasus terminasi kehamilan yang terjadi di Indonesia. Fakta menunjukkan bahwa tindak terminasi kehamilan merupakan salah satu penyebab kematian ibu. Hal mana Angka Kematian Ibu di Indonesia adalah masih termasuk tinggi di ASEAN. Dokter memiliki keengganan untuk melakukan tindak terminasi kehamilan karena ketakutan akan adanya sanksi hukum dan keterikatannya dengan Kode Etika kedokteran juga sumpah dokter. Permasalahan penelitian adalah: (i). Bagaimanakah pemaknaan terminasi kehamilan oleh dokter dan pasien? (ii). Mengapa pemaknaan terminasi kehamilan dokter belum mewujudkan akuntabilitas dokter yang berkeadilan substansial? (iii). Bagaimana merekonstruksi pemaknaan terminasi kehamilan dari dokter untuk konsep perlindungan hak perempuan pada tindak terminasi kehamilan guna mewujudkan akuntabilitas dokter menuju keadilan substansial dalam melakukan tindak terminasi kehamilan? Studi ini tergolong dalam tradisi penelitian hukum non-doktrinal dengan pendekatan sosio-legal. Latar belakang sosial studi adalah pelayanan kesehatan tindak terminasi kehamilan dengan subjek penelitian dokter yang didukung sebagaimana informan dan nara sumber. Data dihimpun dengan metode wawancara, observasi dan studi dokumen. Data dianalisis mengikuti model interaktif dari Mattew B. Miles dan A. Michael Haberman. Validasi data dilakukan dengan triangulasi sumber dan metode. Hasil penelitian: 1) Menunjukkan bahwa terdapat perbedaan pemaknaan atas tindak terminasi kehamilan antara dokter dengan pasien. Ada dua karakteristik pemaknaan dokter tentang terminasi kehamilan yaitu pemaknaan sempit dan luas. 2) Dokter mengambil pemaknaan sempit yang belum memberikan konsep makna yang berkeadilan substansial pada perempuan hamil yang memerlukan tindakan terminasi kehamilan, sedangkan pemaknaan luas mengacu pada penafsiran kontekstual yaitu penafsiran yang di samping mendasarkan pada teks juga memperhatikan konteks situasi yang melengkapi peristiwa tersebut sebagaimana yang diatur dalam UU Kesehatan Pasal 75 dan 76. 3). Rekonstruksi pemaknaan diarahkan bagi dokter untuk dapat mengambil pemaknaan luas. Penelitian ini merekomendasikan pentingnya kehadiran hukum progresif dan paradigma etikolegal sebagai dasar rekonstruksi pemaknaan tindak terminasi kehamilan oleh dokter, yang meliputi: rekomendasi untuk sosialisasi peraturan perundang-undangan tindakan terminasi: meningkatkan kewaspadaan dokter dan polisi untuk kasus tindak terminasi kehamilan, karena kasus terminasi kehamilan terjadi karena adanya dorongan dari perempuan yang tidak sehat secara holistik. Kata-kata kunci: rekonstruksi pemaknaan, terminasi kehamilan, hukum progresif, hermeneutika hukum, hukum kedokteran, dokter

Relationships between Age, Sex, Laboratory Parameter, and Length of Stay in Patients with Dengue Hemorrhagic Fever

Background: Dengue Hemorrhagic Fever (DHF) is an infectious disease caused by dengue virus. Until now, Dengue virus infection remains a health problem in Indonesia. The things which cause problems in DHF case are high mortality rates, diseases spread which are easily spread, especially affect children. Handling of DHF patients needs long of a length of stay which has large costs.Subjects and Method: This was an analytic observational study with a cross-sectional design. This study was conducted at Dr. Moewardi Hospital, Surakarta, based on medical records. 32 samples were selected using purposive sampling. The independent variables were age, sex, platelet count, hematocrit value, and a number of leukocytes. The dependent variable was the length of stay. The data were obtained from medical records using a Chi-square test. Bivariate analysis was used to determine the factors which affected DHF on length of stay using Chi-square, Kolmogorov Smirnov, continuing with multiple linear regression analysis.Results: The age of DHF patients was from 1 year of age to 53 years of age with an average age of 20.07 +13.45 years. The number of female patients was 15 patients. Platelets level (x 1,000) was 25 for minimum and 308 for maximum. Mean ± SD platelet was 94.86 + 67.97. Hematocrit level was 28 for minimum and 54 for maximum. Mean ± SD hematocrit was 40.69 + 6.59. Leukocytes level (x 1,000) was 1.6 for minimum and 10.8 for maximum. Mean ± SD leukocytes was 5.50 + 2.95. The shortest length of stay was 3 days and the longest was 11 days. Mean ± SD length of stay was 5.21 ± 1.90 days. The result of multiple linear regression analysis showed a statistically non-significant relationship (p> 0.05) between age, sex, platelets, hematocrit, leukocytes, and length of stay.Conclusion: There is a non-significant relationship between age, sex, platelet count, hematocrit value, leukocyte count, and length of stay.Keywords: DHF, length of stay, platelet count, hematocrit value, leukocyte countCorrespondence: Maria Devi Arianti. Masters Program in Family Medicine, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: ariantidevi­[email protected] Mobile: 08124612699Journal of Epidemiology and Public Health (2019), 4(4): 307-313https://doi.org/10.26911/jepublichealth.2019.04.04.0

The Relationship of Radiological Value and Functional Scale of Lower Motion Devices in Patients with Bone Defects Given Synthetic Bone Graft and BMP2

Background: Broken bones in a severe lower motion device, especially those associated with a bone defect, often fail or are slow to fuse. The possibility of non-union in patients triggering clinicians to use bone-grafting as part of a procedure aims at achieving the union. The Gold Standard is to use autogenous bone graft, but it actually has some disadvantages. To overcome this, there are alternative measures of bone grafting. Hydroxyapatite is known to be synthetic bonegraft which has good osteoconductive properties. For hydroxyapatite, it has been widely used and easily available. Bone morphogenetic proteins (BMPs) are the family of osteo-inductive proteins in the bone matrix. This study aims to evaluate the effectiveness of synthetic bone graft and BMP-2 as a bonegraft in the process of bone healing with "bone defect" in long bones by evaluating the process of radiological closure of defects and clinical bone healing process.Subjects and Method: This was a cross sectional study. A sample of 20 patients with bone defect in the tibia and femur was selected for this study. An evaluation of radiological defect closure was evaluated using a calculation system using the FDA-determined radiological evaluation method and a periodic lower function of the LEFS (Lower Extremity Functional Scale) every 2 months up to the 6th month. The statistical tests were performed using linear regression.Results: There is a negative relationship between the radiological value and the functional scale of the lower motion device (b = -1.26; p = 0.001). There is an improvement in bone defect closure and clinical functional improvement in patients who performed a synthetic bonegraft closure action added by BMP-2 as well. The evaluation is carried out through radiological calculations that show a periodically reduced size of the defect which affects the increase in the value of the functional scale of the lower motion device.Conclusions: There is a negative relationship between radiological values and functional scale of lower motion devices in patients with bone defect in the tibia bone or femur given synthetic bone graft and Bmp2.Keywords: bone defects, synthetic bone grafts and BMP-2, LEFSCorrespondence:Farid Ibrahim. Masters Program in Family Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java.Indonesian Journal of Medicine (2018), 3(2): 77-83https://doi.org/10.26911/theijmed.2018.03.02.0

The Result of Functional Mobility Scale (FMS) on Cerebral Palsy Spastic Diplegic That Treated by SEMLS (Single Event Multi Level Surgey) Method in Orthopaedic Hospital Prof. Dr. R. Soeharso, Surakarta

Background: Cerebral Palsy is a permanent non-progressive brain disorders that occur in early childhood where abnormalities in the brain due to damage on immature brain can cause movement disorders and postural dysfunctionNowadays, the treatment of choice for CP Spastic diplegic is using SEMLS (Single Event Multi Level Surgery). There was many scoring to evaluate outcome of SEMLS, but only a few scoring system that can evaluate changing after SEMLS. Functional Mobility Scale (FMS) is an outcome measure designed to evaluate mobility of children with cerebral palsy (CP). FMS has been shown to detect both improvement and deterioration in mobility status during the rehabilitation period following multilevel orthopaedic surgery in children with spastic diplegicSubjects and Method:This was a cross sectional observasional study. The sample are obtained by sensus from January 1st 2014 untill March 1st 2015. The patient's characteristic that we include in this study are gender, age when the patient had a surgery, and where the contracture are involved. We evaluate the outcome using FMS before operation, 3 month, 6 month, 9 month, and 12 month after operation on three different distance (5, 50, 500 meter) that represent home, school, and community. After that we analyze the result using regression logistic model to better understands about changes and time of changes on patient after SEMLS procedure. We also analyze the corelation between age, sex, and location of contracture with the outcome after SEMLS procedureResult : 51 patients were reviewed and identified, there were 31 males (61%) and 20 females (39%), mean age when the patient was operated was 8.07 years old, with the most common cases are CP Spastic Diplegic with hip, knee, ankle contracture bilateral about 41 patient (80.3%), knee ankle bilateral about 7 patient (13.2%), and hip ankle bilateral about 3 patient (5.88%). From evaluation of FMS scoring, we found most patient had an improvement on their mobility after SEMLS procedure (OR > 1), with the time changes for 5 and 50 meters distance is at six months (OR : 1.52) and (OR= 1.47), and 500 meters is at 12 months (OR= 3.45). We also found no significant relationships (p value > 0.05) between age (p value= 0.632), sex (p value= 0.576) and location of contracture (p value= 0.222) with the outcome of the FMS after SEMLSConclusion: We found that SEMLS gives a good result to increased mobility of patient with CP Spastic Diplegic. FMS Score were able to asses the outcome of SEMLS procedure, and also responsive to change that occur after SEMLS. Age, sex, and contracture's location were not significantly influence the FMS outcome after SEMLSKeywords: CP Spastic Diplegic, SEMLS (Single Event Muti Level Surgery), FMS (Functional Mobility Scale).Correspondence: Seti Aji Hadinoto. Masters Program of Family Medicine, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java.Indonesian Journal of Medicine (2017), 2(2): 100-106https://doi.org/10.26911/theijmed.2017.02.02.0

PERBEDAAN PENGARUH ANTARA KRISTALOID DAN KOLOID TERHADAP PERUBAHAN ELEKTROLIT (Na, K, Cl)

Cairan tubuh manusia sekitar 60% dari berat badan (BB) tubuh yang terdiri dari elektrolit dan non elektrolit. Resusitasi cairan pada pasien operasi harus dimonitoring dengan baik untuk menghindari terjadinya gangguan keseimbangan asam basa tubuh. Pemberian cairan pada pasien yang akan operasi, khususnya section caesaria (SC). Monitoring elektrolit pasien yang menjalani operasi penting dilakukan. Penulis tertarik untuk melakukan penelitian mengenai pengaruh pemberian cairan kristaloid dan koloid sebagai cairan pengganti pasien yang menjalani operasi. Tujuan penelitian ini adalah menganalisis perbedaan pengaruh antara kristaloid dan koloid terhadap perubahan elektrolit (Na, K, Cl) pasca operasi sectio caesaria. Penelitian dilakukan di Instalasi Bedah Pusat RSUD Dr. Moewardi Surakarta, dimulai pada bulan Juni sampai September 2015. Jenis penelitian eksperimental berupa uji klinik dengan desain single blind pre and post test accidental control trial pada pasien yang menjalani operasi sectio caesaria elektif dan emergensi sebagai subyek penelitian. Kelompok penelitian dibagi menjadi dua yaitu kelompok Kristaloid (K1), dan Koloid (K2). Terdapat perbedaan yang signifikan kadar elektrolit (Na, K, dan Cl) sebelum dan sesudah perlakuan pada kelompok yang diberi cairan ringerfundin dimana terjadi penurunan kadar Na = 2,0% , K = 12,1% , dan Cl = 3,2%. Ringerfundin dan tetraspan sama-sama dapat mencegah turunnya elektrolit pada pasien operasi (p>0,05). Pada kelompok ringerfundin terjadi penurunan/perubahan kadar elektrolit yang signifikan (p<0,05), sedangkan pada kelompok tetraspan kadar elektrolit tidak terjadi penurunan/perubahan signifikan (p>0,05) sehingga dapat diketahui bahwa terdapat perbedaan pengaruh pemberian ringerfundin dan tetraspan terhadap perubahan kadar elektrolit.Kesimpulan pada penelitian ini adalah terdapat perbedaan pengaruh pemberian ringerfundin dan tetraspan terhadap perubahan kadar elektrolit dimana pemberian tetraspan sebagai  airan perioperatif dapat mempertahankan keseimbangan kadar elektrolit tubuh lebih baik daripada cairan ringerfundin

The Result of Functional Mobility Scale (FMS) on Cerebral Palsy Spastic Diplegic that treated by SEMLS (Single Event Multi Level Surgey) method in Orthopaedic Hospital Prof. Dr. R. Soeharso, Surakarta

Background: Cerebral Palsy is a permanent non-progressive brain disorders that occur in early childhood where abnormalities in the brain due to damage on immature brain can cause movement disorders and postural dysfunctionNowadays, the treatment of choice for CP Spastic diplegic is using SEMLS (Single Event Multi Level Surgery). There was many scoring to evaluate outcome of SEMLS, but only a few scoring system that can evaluate changing after SEMLS. Functional Mobility Scale (FMS) is an outcome measure designed to evaluate mobility of children with cerebral palsy (CP). FMS has been shown to detect both improvement and deterioration in mobility status during the rehabilitation period following multilevel orthopaedic surgery in children with spastic diplegicSubjects and Method:This was a cross sectional observasional study. The sample are obtained by sensus from January 1st 2014 untill March 1st 2015. The patient’s characteristic that we include in this study are gender, age when the patient had a surgery, and where the contracture are involved. We evaluate the outcome using FMS before operation, 3 month, 6 month, 9 month, and 12 month after operation on three different distance (5, 50, 500 meter) that represent home, school, and community. After that we analyze the result using regression logistic model to better understands about changes and time of changes on patient after SEMLS procedure. We also analyze the corelation between age, sex, and location of contracture with the outcome after SEMLS procedureResult : 51 patients were reviewed and identified, there were 31 males (61%) and 20 females (39%), mean age when the patient was operated was 8.07 years old, with the most common cases are CP Spastic Diplegic with hip, knee, ankle contracture bilateral about 41 patient (80.3%), knee ankle bilateral about 7 patient (13.2%), and hip ankle bilateral about 3 patient (5.88%). From evaluation of FMS scoring, we found most patient had an improvement on their mobility after SEMLS procedure (OR > 1), with the time changes for 5 and 50 meters distance is at six months (OR : 1.52) and (OR= 1.47), and 500 meters is at 12 months (OR= 3.45). We also found no significant relationships (p value > 0.05) between age (p value= 0.632), sex (p value= 0.576) and location of contracture (p value= 0.222) with the outcome of the FMS after SEMLSConclusion: We found that SEMLS gives a good result to increased mobility of patient with CP Spastic Diplegic. FMS Score were able to  asses the outcome of SEMLS procedure, and also responsive to change that occur after SEMLS. Age, sex, and  contracture’s location were not significantly influence the FMS outcome after SEMLSKeywords: CP Spastic Diplegic, SEMLS (Single Event Muti Level Surgery), FMS (Functional Mobility Scale).Correspondence: Seti Aji Hadinoto. Masters Program of Family Medicine, Sebelas Maret University, Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java.Indonesian Journal of Medicine (2017), 2(2): 100-106https://doi.org/10.26911/theijmed.2017.02.02.04

Pengaruh Karakteristik Individu, Kualitas Pelayanan, Kepuasan Terhadap Loyalitas Pasien Di Rs. Indriati Solo Baru

This study aims to analyze the Effect of Individual Characteristics, Service Quality, Satisfaction on Patient Loyalty at Rs. Indriati Solo Baru. The sample in this study amounted to 102 consumers at Rs. Indriati Solo Baru using a questionnaire for data collection. The sampling technique using probability convenience sampling method. The data analysis technique uses path analisis. The results of this study indicate that: 1) The Effect of Service Quality on patient satisfaction. 2) The Effect of Service Quality on Patient Loyalty. 3) The Effect of Patient Satisfaction on Patient Loyalty. 4) Satisfaction can mediate between service quality and patient loyalty. 5) There is a Relationship between the Quality of Health Service Quality and Patient Loyalty

Pengaruh Kualitas Pelayanan, Usia, Tingkat Pendidikan, Jenis Kelamin, Dan Status Perkawinan Terhadap Kepuasan Dan Kepercayaan Pasienrawat Inap Di Rumah Sakit Parudr. Ario Wirawan Salatiga

The aim of this research is to determine the effect of service quality, age, gender, and marital status on satisfaction and trust of inpatients at the Lung Hospital, dr. ArioWirawanSalatiga. The instrument used in this study was a questionnaire, while the analysis technique used in this study was the Path Analysis. The direct effect test was carried out by using the t test, while the indirect effect was tested by using the sobel test. The results of this study indicate that empirically service quality, age, education level, and marital status have a significant positive effect on patient satisfaction, while gender is not proven to have an effect on patient satisfaction.The results also showed that patient satisfaction had a significant effect on patient trust. In addition, it was also explained that patient satisfaction did not interfere with the effect of service quality, age, gender, and marital status on patient trust

pengaruh kualitas pelayanan terhadap kepuasan pasien rawat inap di Rumah Sakit PKU Muhammadiyah Karanganyar

This study aims to analyze the effect of service quality on patient satisfaction inpatient at RS PKU Muhammadiyah Karanganyar. The sample in this study amounted to 120 consumers at RS PKU Muhammadiyah Karanganyar using a questionnaire for data collection. The sampling technique using nonprobability sampling insidental method. The data analysis technique uses multiple linear regression analysis. The results of this study indicate that: 1) The Effect of Tangibles on patient satisfaction inpatient. 2) The Effect of Assurance on patient satisfaction inpatient. 3) The Effect of Responsiveness on patient satisfaction inpatient. 4) The Effect of Reliability on patient satisfaction inpatient. 5) The Effect of Empathy on patient satisfaction inpatient