Hubungan Rasionalitas Pengobatan dan Self-care dengan Pengendalian Glukosa Darah pada Pasien Rawat Jalan di Rumah Sakit Bina Husada Cibinong

Diabetes melitus (DM) merupakan kelompok penyakit metabolik yang bila tidak terkendali dengan baik dapat menimbulkan komplikasi yang berbahaya. Pengobatan yang rasional pada penderita DM diduga dapat mengendalikan glukosa darah karena pasien menerima obat sesuai dengan kebutuhan klinisnya. Selain pengobatan yang rasional, penderita DM harus mampu melakukan self-care yang merupakan perawatan diri secara mandiri untuk meningkatkan kualitas hidup dan mencegah komplikasi. Penelitian ini bertujuan untuk mengetahui hubungan antara rasionalitas pengobatan dan self-care dengan pengendalian glukosa darah pasien DM tipe II di Poli Rawat Jalan Rumah Sakit (RS) Bina Husada Cibinong. Penelitian ini menggunakan metode deskriptif analitis dengan desain cross sectional. Pengambilan data dilakukan secara retrospektif maupun prospektif terhadap 109 pasien DM tipe 2 selama periode Maret-Mei 2015. Digunakan kuesioner Diabetes Self-Management Questionnaire untuk mengakses self-care. Hasil penelitian menunjukkan data demografi pasien DM tipe 2 adalah 57,80% wanita dan 42,20% pria dengan kisaran usia terbanyak yaitu 46-55 tahun (49,54%). Persentase pengobatan yang rasional cukup tinggi yaitu 61,47%, sedangkan self care pasien sebagian besar (69,72%) berada pada kriteria “baik” dan sisanya (30,28%) pada kriteria “cukup”. Pada uji korelasi Chi-square independen ditemukan tidak adanya hubungan antara rasionalitas pengobatan dan self care dengan pengendalian glukosa darah (p > 0,05). Hal ini menunjukkan kemungkinan adanya faktor lain yang dapat mempengaruhi pengendalian glukosa darah.Diabetes mellitus (DM) is a group of metabolic diseases and if it is not properly controlled can lead to dangerous complications. A rational treatment in patients with suspected diabetes can control blood glucose for patients receiving the drugs in accordance with their clinical needs. In addition to rational treatment, people with diabetes should be able to perform self-care in order to improve quality of life and prevent complications. This study aims to determine the relationship between treatment rationality and self-care with type II DM outpatients at Bina Husada Cibinong Hospital. This research uses descriptive analysis method with cross sectional design. Data were collected retrospectively and prospectively towards 109 type 2 diabetetic patients during period from March to May 2015. Diabetes Self-Management Questionnaire were used to access self-care. The results showed that the demographic data of type 2 diabetic patients was 57.80% women and 42.20% of men, with the highest age range is 46-55 years (49.54%). The percentage of rational treatment is quite high at 61.47%, while the majority of self-care patients were on the criteria of “good”(69.72%) and the rest were on the criteria of “enough” (30.28%). Chi square correlation test showed no relationship between treatment rationality and self care with blood glucose control (p> 0.05). This suggests the possibility of other factors that can affect blood glucose control

Evaluasi Pelayanan Pemantauan Terapi Obat di Rumah Sakit X Tangerang

Therapeutic Drug Monitoring (TDM) is a clinical practice to increase the effectiveness of therapy and minimize the risk of adverse drug reactions (ADR). The purpose of this study is to describe the implementation of TDM, and whether it is in accordance with the Regulation of the Minister of Health of the Republic of Indonesia (Permenkes) Number 72 of 2016 concerning pharmaceutical service standards at hospitals and the evaluation of TDM services conducted by pharmacists on inpatients. This research covers a descriptive study with a collection of retrospective data from TDM documents of inpatients during the period of January–May 2016 at X Hospital, Tangerang. The implementation of TDM by pharmacists based on the standards was 73%. The number of patients who met the inclusion criteria were 50 patients. Based on the diagnosis of the disease, patients with the potential of receiving TDM were patients with hypertension (10 patients; 20%), congestive heart failure (9 patients; 18%), and diabetes mellitus (8 patients; 16%). Whereas patients with both potential drug interaction and prescribed with more than 10 drugs was 29 patients (58%), patients with both potential drug interaction and diagnosed with three types of diseases was 19 patients (38%). The implementation of TDM in accordance with pharmaceutical service standards requires the competence of clinical pharmacist pharmacists with 2 years work experience. Potential drug interactions can be controlled by prioritizing TDM based on the number of drugs, complications of the disease and type of disease.Pemantauan terapi obat (PTO) merupakan suatu kegiatan untuk meningkatkan efektivitas terapi dan meminimalkan risiko Reaksi Obat yang Tidak Dikehendaki (ROTD). Tujuan penelitian ini untuk menggambarkan kesesuaian pelaksanaan PTO dengan Peraturan Menteri Kesehatan Republik Indonesia (Permenkes) Nomor 72 Tahun 2016 tentang Standar Pelayanan Kefarmasian di Rumah Sakit dan mengevaluasi pelaksanaan PTO yang dilakukan apoteker terhadap pasien rawat inap. Penelitian ini merupakan penelitian deskriptif dengan pengambilan data secara retrospektif menggunakan dokumen PTO pasien rawat inap selama periode Januari – Mei 2016 di rumah sakit X Tangerang. Hasil penelitian menunjukkan kesesuaian pelaksanaan PTO oleh apoteker berdasarkan standar adalah 73%. Jumlah pasien yang memenuhi kriteria inklusi sebanyak 50 pasien. Profil potensi pasien yang mendapatkan PTO berdasarkan diagnosis penyakit adalah hipertensi 10 pasien (20%), gagal jantung kongestif 9 pasien (18%) dan diabetes mellitus 8 pasien (16%). Profil potensi terjadinya interaksi obat berdasarkan resep dengan jumlah obat lebih dari sepuluh adalah 29 pasien (58%). Profil potensi terjadinya interaksi obat pada pasien yang terdiagnosis lebih dari tiga macam penyakit adalah 19 pasien (38%). Pelaksanaan PTO sesuai standar pelayanan kefarmasian membutuhkan kompetensi apoteker farmasi klinik dengan pengalaman 2 tahun kerja. Potensi interaksi obat dapat dikontrol dengan melakukan prioritas PTO berdasarkan jumlah obat, komplikasi penyakit dan jenis penyakit

THE ROLE OF PHARMACISTS IN EVALUATING AND INTERVENING THE PATIENTS WITH DIABETIC NEUROPATHY

Diabetic neuropathies is the presence of and/or signs of peripheral nerve dysfunctions in people with diabetes after the exclusion of other causes. The purpose of this study was to estimate the prevalence and risk factors for diabetic peripheral neuropathy, to evaluate the score of neuropathy, and also to determine the effect of pharmacist intervention towards diabetic neuropathy patients at Gatot Soebroto Hospital Jakarta in 2013. Data about socio-demographic characters, age, duration of diabetic, blood glucose, blood pressure, cardiovascular diseases, lifestyle BMI and smoking were collected. Pharmacist intervention was given to increase patient information about diabetic neuropathy and its risks factors. There were 59 respondents involved in this study. It can be found that 15.3% respondents had mild diabetic peripheral neuropathy, 1.7% had moderate diabetic peripheral neuropathy, 1.7% had severe diabetic peripheral neuropathy, and as much as  81,4% respondents had no neuropathy. There was a correlation (but not statistically significant) between diabetic peripheral neuropathy and its' risks factors such as ages, duration of diabetes, sex, cardiovascular disease (hypertension, cardiac disease)and lifestyle(smoking habit and body mass index). Pharmacist intervention showed an increase on the patients knowledge about diabetic neuropathy and also a significant decrease on the patient's blood glucose level (P˂0,05).Keywords : diabetic neuropathy, pharmacist role, prevalence, score, risk factors, blood glucose

Evaluasi Efek Samping OBat Kemoterapi terhadap Quality of Life (QOL) Pasien Kanker Payudara di Rumah Sakit X Jakarta

Breast cancer is the number one cancer type discovered at women in the world. Most causes are genetic factors and hormonal factors. One cancer treatments with chemotherapy. Chemotherapy drugs active in cells dividing and reproducing, but cells normally to be affected by chemotherapy and side effects from chemotherapy drugs affect quality of life. The aim of the study to evaluate side effects of chemotherapy drugs on the quality of life of breast cancer patients. Sampling technique observational prospective breast cancer patients with completed the chemotherapy cycle from September 2017 to April 2018 with descriptive analysis and statistics by looking correlation between drug side effects and Quality of Life (QoL). Results of the study were side effects of fatigue 100%, nausea 67,5%, vomiting 60%, no appetite 63,75%, fever 42,5%, joint pain 43,75%, diarrhea 16,25%, difficulty swallowing 16,25%, allergies 5%, itching 1,25%, mouth sores 3,75%, swollen right hand 1,25%, constipation 3,75%. QoL results are physical 6,2%; psychology 5,3%; social 4,9%; spiritual 6,8%. Results of Sperman test showed no correlation between the side effects of chemotherapy and QoL P> 0,05. This study shows that there is no relationship between the side effects drug chemotherapy and QoL in breast cancer patients.Kanker payudara merupakan jenis kanker nomor satu ditemui pada wanita di dunia. Penyebab terbanyak disebabkan oleh faktor genetik dan faktor hormonal. Salah satu pengobatan kanker dengan  kemoterapi. Obat kemoterapi aktif pada sel yang sedang membelah dan bereproduksi, namun sel yang normal tidak tertutup kemungkinan akan terpengaruh kemoterapi dan muncul efek samping dari obat kemoterapi yang mempengaruhi kualitas hidup. Tujuan penelitian yaitu mengevaluasi efek samping obat kemoterapi terhadap kualitas hidup pasien kanker payudara. Teknik sampling prospektif observasional terhadap pasien kanker payudara yang sudah menyelesaikan siklus kemoterapi periode September 2017 sampai April 2018 dengan analisis deskriptif dan statistik dengan melihat korelasi antara efek samping obat dan Quality of Life (QoL). Hasil penelitian yaitu terdapat efek samping kelelahan (100%), mual (67,5%), muntah (60%), tidak ada nafsu makan (63,75%), demam (42,5%), sakit pada persendian (43,75%), diare (16,25%), sulit menelan (16,25%), alergi (5 %), gatal (1,25%), ada luka dimulut (3,75%), bengkak tangan kanan (1,25%), sembelit (3,75%). Hasil QoL yaitu domain fisik 6,2%; psikologi 5,3%; sosial 4,9%; spiritual 6,8%. Hasil uji sperman menunjukan tidak ada korelasi antara efek samping kemoterapi dan QoL P>0.05. Penelitian ini menunjukkan bahwa tidak ada hubungan antara efek samping obat kemoterapi dan QoL pada pasien kanker payudara

Analysis of Health-related Quality of Life Determinants in Adult Ashmatic Patients in a District Hospital in East Jakarta

Background: Uncontrolled asthma leads to patients' poor outcomes and decreases health-related quality of life/HRQoL. Little research has been done to analyze the determinants of  HRQoL in asthmatics patients. Objective: To determine asthma control and  patients' compliance levels, and evaluate the appropriateness of medicine use and determinants of HRQoL. Methods: During this prospective study, adult asthmatic patients who currently experienced asthma attack were evaluated in asthma clinic of a district hospital in Jakarta and administered study questionnaires. Demographic variables and data related to asthma control, patients' compliance level and the appropriate use of medications were summarized using descriptive statistics. The determinants of HRQoL were determined using bivariate and multivariate regression analysis. All data were analyzed using SPSS version 22.0. Results: There were 11 males and 43 females aged approximately 45 years old. More than 50% of the patients had uncontrolled asthma and low level compliance to their medications. Nearly all medicines used were inappropriate according to National Asthma Treatment Guideline. Bivariate correlation test revealed four factors which significantly determined the total score of HRQoL, namely asthma duration (P=0.033), asthma control level (p=0.007), asthma severity level (p=0.001) and the presence of smoke exposure in neighbourhood (p=0.032). Further, multivariate analysis showed only the presence of smoke exposure  significantly affecting patients' quality of life. Conclusion: This study uncovered the majority of patients had uncontrolled asthma status and low level of compliance to their medications. In addition, this study highlighted the exposure of smoke exposure as the solely determinant of HRQoL amongst  asthmatic patients

Evaluating the Use of Warfarin Using the HAS-BLED Score and INR on Atrial Fibrillation Patients at Harapan Kita National Heart Center

Patients with atrial fibrillation are associated with a 4-5-fold risk of having a stroke. The most effective treatment for atrial fibrillation is to prevent the formation of blood clots by administering anticoagulant drugs. Warfarin is an anticoagulant drug that has a narrow therapeutic index with side effects of the risk of bleeding; hence it needs supervision in its use. In this study, the HAS-BLED score was used to measure major bleeding risk and as a value representing each risk factor for bleeding. The bleeding risk can be prevented by maintaining a warfarin response in the therapeutic range with an INR (International Normalized Ratio) measurement 2-3. This study was an observational study conducted with retrospective data collection through medical records of patients with a primary diagnosis of atrial fibrillation who received oral warfarin anticoagulant therapy at Harapan Kita National Heart Center in the period of January-December 2017. Using a sample of 40 patients who met the inclusion criteria. According to the data, found that atrial fibrillation patients who received oral warfarin therapy 55% were male patients, while 45% were female patients. Patients with atrial fibrillation who got the most oral warfarin therapy were patients who were over 40 years old with 90% of the total sample, with the highest group in patients aged 50-54 years with 22.5%. The HAS-BLED values arranged from 0-9, the percentage of patients who had HAS-BLED values of 0, 1, 2 respectively at 7.5%, 42.5%, 30%. The HAS-BLED score ≥ 3 showed patients classified as at high risk of bleeding by 20%. The most risk factors based on HAS-BLED score from all study samples were 18 patients with abnormal kidney or 45%. The average INR score in patients at high risk of bleeding showed that 37.5% had an average INR score in the target ratio score of INR 2-3

Pengaruh Kitosan Iradiasi dalam Menurunkan Kadar Gula Darah Mencit Jantan Swiss Webster dengan Metode Tes Toleransi Glukosa Oral

 Chitosan is a dietary iber that has been used as an antihyperglycemia agent. Irradiation of chitosan resulted in 1,4-β glycosidic chain termination which shortened the chitosan chains, lower its molecular weight, and minimize steric effects. This is a preliminary experimental study to ind the effective irradiation dose and chitosan type in lowering blood sugar levels. Fifty two mice were used in this research and divided into various treatment groups which included: normal control, negative control, positive control (Acarbose), non-irradiated chitosan and irradiated chitosan. Chitosan solution were given for 15 days and then oral glucose tolerance test were conducted using 1.5 g/kg bw of glucose. Blood sugar levels were monitored at minute 0, 30, 90, 120, and 150; and Area Under the Curves (AUC) were calculated. The results showed that the irradiation of chitosan can lower blood sugar levels greater than the non-irradiated chitosan; and chitosan irradiation of 100 kGy dose I and II can lower blood sugar levels better than irradiated chitosan and positive control. It was concluded that although the 100 kGy irradiated chitosan appears to have greater ability than the positive control group in lowering blood sugar levels. But after LSD test towards the AUC value, it appears that both groups have the same effectivity.Kitosan merupakan dietary iber yang memiliki khasiat sebagai antihiperglikemia. Iradiasi kitosan mengakibatkan pemutusan rantai pada 1,4-β glikosidik sehingga akan memperpendek rantai kitosan, menurunkan bobot molekulnya dan memperkecil efek sterik. Penelitian ini merupakan penelitian pendahuluan yang bersifat eksperimental untuk menemukan dosis iradiasi dan jenis kitosan yang efektif dalam menurunkan kadar gula darah mencit hiperglikemia. Telah digunakan 52 mencit yang dibagi ke dalam beberapa kelompok perlakuan yaitu kelompok kontrol normal, kelompok kontrol negatif, kelompok kontrol positif (Acarbose), kelompok kitosan iradiasi dan kelompok kitosan non iradiasi. Mencit diberi larutan kitosan selama 15 hari. Selanjutnya dilakukan tes TTGO menggunakan glukosa 1,5 g/kg bb. Data kadar gula darah mencit diukur pada menit ke-0, 30, 90, 120 dan 150; begitu pula nilai Area Under Curves (AUC). Hasil penelitian ditemukan bahwa kitosan iradiasi dapat menurunkan kadar gula darah lebih besar dibandingkan dengan kitosan non iradiasi. Kitosan iradiasi 100 kGy dosis I dan dosis II dapat menurunkan kadar gula darah lebih baik daripada kitosan iradiasi lainnya maupun kontrol positifnya. Disimpulkan bahwa walaupun kitosan iradiasi 100 kGy memiliki kemampuan yang lebih besar dibandingkan dengan kelompok kontrol positif dalam menurunkan kadar gula darah, namun setelah diuji BNTnya ternyata kedua kelompok ini memiliki efektivitas yang sama

Evaluasi Hasil Edukasi Farmasis Pada Pasien Diabetes Melitus Tipe 2 Di Rumah Sakit Dr. Sardjito Yogyakarta

Diabetes mellitus (DM) is a metabolic disorder caused by a defect in insulin secretion or insulin action. Number of diabetic patients will increase if strategies are not prepared for preventing and controlling diabetes. This study aimed to evaluate the outcome of pharmacist education on the level of knowledge, level of medication adherence and diet, as well as the A1C value of type 2 diabetic patients in Dr. Sardjito Hospital Yogyakarta. This research was conducted prospectively using Nonrandomized Concurrent Control Trial. The number of subjects recruited were based on a three-months period and subjects were taken by consecutive sampling method. There were two groups: one group received education intervention for 3 months, and the other group as control did not receive education. Data were analyzed descriptively and quantitatively using Independent T and T-Paired test. The results showed that patients in the control group have developed an increase in the level of knowledge and adherence by themself, on the other hand patients in this group showed a decrease in A1C values, but the decrease was not as big as patients in the intervention group. Patient’s adherence to diet did not improve in either control nor intervention group. It can be concluded that education given by pharmacist can increase knowledge and adherence towards medication and decrease the A1C values of DM type-2 patients.Diabetes melitus (DM) merupakan kelainan metabolik akibat defek pada sekresi insulin, aksi insulin, atau keduanya. Jumlah penderita DM akan meningkat apabila tidak disusun strategi pencegahan dan pengontrolan DM secara tepat. Edukasi terbukti penting dalam meningkatkan pengetahuan, kepatuhan, dan kontrol glikemik pada pasien DM. Penelitian ini bertujuan untuk mengevaluasi hasil edukasi farmasis terhadap tingkat pengetahuan, tingkat kepatuhan pengobatan dan diet, serta terhadap nilai A1C pasien DM tipe 2 di RSUP Dr. Sardjito Yogyakarta. Penelitian ini merupakan penelitian eksperimental yang dilakukan menggunakan rancangan Non-randomized Concurrent Control Trial secara prospektif. Banyaknya subyek yang direkrut didasarkan atas waktu yaitu selama tiga bulan dan subyek diambil dengan metode consecutive sampling. Dua kelompok penelitian yaitu kelompok intervensi yang mendapatkan edukasi selama 3 bulan dan kelompok kontrol yang tidak mendapatkan edukasi. Data dianalisis secara deskriptif dan kuantitatif menggunakan uji t independen dan berpasangan. Hasil penelitian menunjukkan bahwa pasien kelompok kontrol dengan sendirinya mengalami kenaikan pada tingkat pengetahuan dan kepatuhan. Selain itu pasien kelompok tersebut juga mengalami penurunan nilai A1C, namun penurunan tersebut tidak sebesar pasien pada kelompok intervensi. Kepatuhan pasien terhadap diet tidak mengalami perbaikan baik pada kelompok kontrol maupun intervensi. Dapat disimpulkan bahwa edukasi farmasis dapat meningkatkan pengetahuan dan kepatuhan pengobatan, serta menurunkan nilai A1C pasien DM tipe 2

Evaluasi Hasil Edukasi Farmasis Pada Pasien Diabetes Melitus Tipe 2 Di Rumah Sakit Dr. Sardjito Yogyakarta

Diabetes melitus (DM) merupakan kelainan metabolik akibat defek pada sekresi insulin, aksi insulin, atau keduanya. Jumlah penderita DM akan meningkat apabila tidak disusun strategi pencegahan dan pengontrolan DM secara tepat. Edukasi terbukti penting dalam meningkatkan pengetahuan, kepatuhan, dan kontrol glikemik pada pasien DM. Penelitian ini bertujuan untuk mengevaluasi hasil edukasi farmasis terhadap tingkat pengetahuan, tingkat kepatuhan pengobatan dan diet, serta terhadap nilai A1C pasien DM tipe 2 di RSUP Dr. Sardjito Yogyakarta. Penelitian ini merupakan penelitian eksperimental yang dilakukan menggunakan rancangan Non-randomized Concurrent Control Trial secara prospektif. Banyaknya subyek yang direkrut didasarkan atas waktu yaitu selama tiga bulan dan subyek diambil dengan metode consecutive sampling. Dua kelompok penelitian yaitu kelompok intervensi yang mendapatkan edukasi selama 3 bulan dan kelompok kontrol yang tidak mendapatkan edukasi. Data dianalisis secara deskriptif dan kuantitatif menggunakan uji t independen dan berpasangan. Hasil penelitian menunjukkan bahwa pasien kelompok kontrol dengan sendirinya mengalami kenaikan pada tingkat pengetahuan dan kepatuhan. Selain itu pasien kelompok tersebut juga mengalami penurunan nilai A1C, namun penurunan tersebut tidak sebesar pasien pada kelompok intervensi. Kepatuhan pasien terhadap diet tidak mengalami perbaikan baik pada kelompok kontrol maupun intervensi. Dapat disimpulkan bahwa edukasi farmasis dapat meningkatkan pengetahuan dan kepatuhan pengobatan, serta menurunkan nilai A1C pasien DM tipe 2

Buku ajar farmakoterapi: gangguan saluran pernapasan

x, 182 hlm. ; ill. ; 24 cm