The Difference in Length of Stay, Quality of Life, and Cost Effectiveness of Care for Geriatric Patients in Acute Care for Elderly Dr. Cipto Mangunkusumo National Hospital Before and After National Health Insurance Program Implementation

Geriatric population with special characteristics tend to have longer average length of stay. The aim of the study is to evaluate the implementation of NHIP (national health insurance program) system according to length of stay, quality adjusted life days (QALD) and cost effectiveness of care in Cipto Mangunkusumo National Hospital (CMNH). This is a retrospective cohort study with historical control. The subjects were geriatric patients with geriatrics giants on July to December 2013 (non NHIP) and January to June 2014 (NHIP). We used independent t-test to compare two means of length of stay and QALD. The characteristics were similar between 100 subjects in non NHIP group and 125 subjects in NHIP group. The median of age was 70 (60-86) dan 68 (60-85) years old respectively. There was no significant difference between length of stay in non NHIP, median 12(2-76) days and NHIP group, median 12(2-59) days, p= 0.974. As for QALD, there was also no significant difference between non NHIP, median 0.812 (-3.1–24.37) and NHIP group, median 0.000 (-7.37–22.43), p= 0.256. The median cost spent was Rp 19.961.000 (Rp2.57–Rp100 millions) in non NHIP and Rp 20.832.000 (Rp3.067-Rp100 millions) in NHIP group. Incremental cost effectiveness ratio (ICER) scheme showed NHIP is more expensive Rp1.500.000 to have 0.91 shorter days than non NHIP system. For QALD, the cost was cheaper Rp3.484.887 to have 0,25 QALD lower than non NHIP. There was no significant difference in length of stay and quality of life of patients who admitted in CMNH with CGA approach before and after NHIP implementation

High Glucose, But Not Testosterone, Increases Platelet Aggregation Mediated by Endothelial Cells

Endothelial cells inhibit platelet aggregation by releasing thromboregulators, such as prostacyclin and nitric oxide. Male subject is a traditional risk factor for cardiovascular diseases. Platelet hyperreactivity has been frequently found in patient with diabetes mellitus. To examine whether testosterone and high glucose modify platelet aggregation through endothelial cells, we did an in vitro study using endothelial cells culture from human umbilical vein (HUVEC). Treatments were performed in HUVEC sub culture as either normoglucose (5.6 mM) or high glucose (22.4 mM) medium, with or without testosterone (0, 1, 10, 100 nM), for 24 hours. HUVEC were trypsinized, resuspended, and then incubated with platelet rich plasma from healthy male donors with ratio 1:104 for 3 minutes. Platelet aggregation measured by turbidimetry methode. This study showed that testosterone did not significantly influence platelet aggregation through endothelial cells in normoglucose (p = 0.144) or high glucose (p = 0.916) medium. There was no main effect of testosterone (p = 0.73) as well as no interaction between testosterone and glucose (p = 0.69), but there was a main effect of glucose (p = 0.004), to platelet aggregation through endothelial cells. In conclusion, high glucose, but not testosterone, inhibits platelet aggregation mediated by endothelial cells

Literasi Keuangan, Sikap Keuangan dan Perilaku Keuangan dan Kinerja UMKM

This study aims to examine the effect of financial literacy variables, financial attitudes, and financial behavior on the performance of Micro, Small, and Medium Enterprises (MSMEs) in Palembang city. The respondents who were involved were 115 MSMEs. The data were collected using an online questionnaire, namely google form. This research uses the validity test to test the research instrument, the reliability of the research questionnaire, and test the classical assumptions to fulfill the research regression model which is the Best Linear Unbiased Estimator. They were analyzed using Multiple regression models and research hypothesis testing was also done. The Financial literacy of MSMEs owner is moderate, while their financial attitudes and behavior are relatively good. The findings show that financial attitudes have a positive effect on the performance of MSMEs. Another finding shows that financial literacy and financial behavior have no effect on the performance of MSMEs. MSMEs owners need to develop good financial attitudes in managing their businesses so that the achievement of business performance is more optimal