Kajian Hukum Peran “Apoteker” dalam Saintifikasi Jamu

Background: The Regulation of Minister of Health, Permenkes 003/MENKES/PER/2010 on scientification of herbal medicine also elucidate to regulation on human resources and recording, yet the regulation has not analyzed roles of pharmacists. The study aimed to determine roles of pharmacists associated with the legislation on scientification of herbal medicine. Methods: tt was conducted in 3 (three) municipality of Surabaya, Yogyakarta and Denpasar, with respondents among pharmacists especial/y whom practice in community pharmacy Data were col/ected by discussion to have conclusions on argumentation of law then fol/owed by round table discussion with experts in law, professional organization of pharmacist (Ikatan Apoteker lndonesia) and The National Commisions of scientification herbal medicine. Results: Results showed that the roles and responsibilities of pharmacists in scientification of herbal medicine compose of process on formulating/supplying simplicia and storage, prescription services including screening prescriptions, medication preparation, compounding, label/ing, packaging of drugs, drug delivery, and drug information, counseling, monitoring drug use, promotion and education, home care as well as recording and reporting. The analysis concluded that it needs special regulation pharmacist roles on scientification of herbal medicine complementary to Permenkes No. 03/2010 to elucidate more detaiIs the roles of pharmacists to the preparation of service-based research in health care facilities (c1inics herbal medicine) and scientification of herbal medicine, the synergy to conventional treatment and enhance use of nature medicines as traditional health care. The addition Permenkes needs to include Record Pharmaceutical Formulations (Pharmaceutical Record) conducted by a pharmacist on scientification of herbal medicine. Recommendation: tt is recommended that in addition to Permenkes 003/MENKES/PER/2010 it requires complementary Permenkes to regulate pharmacists on scientification of herbal medicine that differs from pharmacists in general, as consist of curriculum related to scientification of herbal medicine in Pharmacy group and stressing the col/aboration between physicians and pharmacists for program activity on scientification of herbal medicine in accordance to the Republic of lndonesia affairs

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Virtual Reality Berbasis Cognitive Behavior Therapy untuk Menurunkan Kecemasan Berbicara di Depan Umum

Most students carry out formal communication such as presenting assignments or expressing opinions in formal forums and there is anxiety about public speaking in their implementation. Virtual reality based on cognitive behavior therapy (VR-CBT) is one of the psychological interventions that can be applied in this study with the aim of reducing the level of anxiety in public speaking. The public speaking anxiety scale, TMAS, and psychological tests were used as measures to determine the subject's anxiety level. Collecting data using observation and interviews with subjects and related parties. This research design uses descriptive qualitative with a case study approach (case study). This study consisted of one subject who was a 20 year old sixth semester student. The VR CBT consisted of 10 sessions (+60 minutes / session). The data analysis technique used qualitative data analysis. The results showed that the subject's public speaking anxiety level decreased. That is, VR CBT is effective in reducing the level of public speaking anxiety

T cell responses to highly active antiretroviral therapy defined by chemokine receptors expression, cytokine production, T cell receptor repertoire and anti-HIV T-lymphocyte activity

The immunological correlates of highly active antiretroviral therapy (HAART)-induced suppression of human immunodeficiency virus type 1 (HIV-1) replication have been investigated. 20 HIV-1-infected patients with mean CD4(+) T cell count of 298/mul, plasma viral load of 4.7 log(10) copies/ml and naive for protease inhibitors (PI) were studied during 12 months of HAART. An increased number of both CD4(+) and CD8(+) naive T cells and a normalization of the frequency of CCR5- and CXCR4-expressing CD4(+) T cells were readily observed after starting therapy. Single cell analysis of cytokine production after 12 months of HAART showed an increased number of interleukin (IL)-2-, but not IIL-4- and (IFN)-gamma-, producing T cells and a decreased percentage of CD8+ TFN-gamma + cells. A correlation between the frequency of IFN-gamma-producing T cells and that of memory, CCR5(+) and CD95(+) T cells was demonstrated in both CD4(+) and CD8(+) subsets. The diversity of T cell receptor (TCR) variable beta (BV) chain repertoire significantly increased after 12 months of HAART within the CD4(+) but not the CD8(+) T cell subset. However, the level of perturbation of the third complementarity-determining region (CDR3), was not significantly modified by effective therapy. The number of anti-HIV Gag and Pol cytotoxic T lymphocytes precursors (CTLp) decreased during HAART and highly correlated with the CD8 IFN-gamma response. Ameliorated clinical conditions were observed in all patients in absence of any opportunistic infections during all the study period. These observations indicate that a better restoration of immunity may be obtained in patients starting HAART at less advanced stages of the disease