Implementasi Program Pencegahan dan Pengendalian Infeksi di RS Umum Royal Prima Tahun 2018

Implementasi  program  pencegahan  dan  pengendalian  infeksi  di  RSU Royal Prima sudah berjalan baik. Dukungan manajemen terhadap program pencegahan dan pengendalian infeksi di RSU Royal Prima juga sudah cukup maksimal. Direktur RSU Royal Prima sudah memahami dan melaksanakan  kegiatan manajerial PPI  yaitu  perencanaan,  pengawasan, pembinaan, monitoring dan evaluasi pelaksanaan program dengan baik. Standar Pelayanan Medik (SPM) bahwa tim PPI yang terlatih dilihat sudah sesuai dengan yang ditetapkan sebanyak 75% tim PPI   sudah mengikuti pendidikan dan pelatihan baik dari luar rumah sakit (PERSI dan HIPPI) ataupun dari dalam rumah sakit (In House Training). Struktur  organisasi  komite  PPIRS  Royal  Prima  sudah  sesuai  dengan susunan  yang  di  tetapkan  Depkes  RI,  2008.  Direktur  sebagai  posisi tertinggi dalam struktur organisasi serta sudah ada susunan komite dan tim PPIRS.     Posisi    komite    PPIRS    juga    sudah    melibatkan    seluruh unit/komite/departemen terkait di rumah sakit. Uraian tugas komite dan tim PPI sudah sesuai antara penentu kebijakan dan pelaksana kebijakan. Terbukti dengan terlaksananya tugas komite PPI dan tim PPI dalam melaksanakan evaluasi berkala pada kebijakan dan pelaksanaan kebijakan PPI. Uraian tugas pengawasan oleh IPCN sudah berjalan baik sedangakan tugas pengawasan oleh IPCLN belum optimal akibat banyaknya tugas dan tanggungjawab yang harus dilaksanakan serta tidak adanya insentif atau tunjangan secara khusus yang diberikan kepada IPCLN. Fasilitas yang disediakan di rumah sakit sudah cukup memadai. Informan menyatakan bahwa penyediaan fasilitas bahan dan peralatan sebagai pelaksanaan program PPI di RSU Royal Prima selalu terpenuhi. Laporan kepada direktur untuk menyediakan barang yang dibutuhkan selalu dipenuhi dan disetujui sehingga gudang penyediaan barang akan menyediakan barang yang dibutuhkan. Penyediaan fasilitas penunjang untuk kerja komite dan tim PPI sudah baik dikarenakan terdapatnya ruangan  khusus komite   PPIRS Royal  Prima.  Manajemen  rumah  sakit telah memberikan perhatian terhadap kelengkapan penyediaan fasilitas sebagai upaya pencegahan dan pengendalian infeksi rumah sakitKomitmen individu sudah tampak dari adanya keinginan dan keperdulian seluruh informan untuk terlibat dan peduli dalam implementasi PPI di rumah  sakit  dengan  adanya  arahan  dari  direktur  rumah  sakit

Information gaps for patients requiring craniotomy for benign brain lesion: a qualitative study

Doctor–patient communication in the setting of a life-threatening illness poses considerable challenges. This study aimed to determine the information needs of a subset of neurosurgical patients. Qualitative case study methodology was used. Twenty-five semi-structured interviews were conducted with ambulatory adult patients who had undergone surgery for a benign brain tumor, arteriovenous malformation, or unruptured aneurysm. Interviews were digitally audio recorded and transcribed, and the data subjected to thematic analysis. Six overarching themes emerged from the data: (1) the amount of information patients want varies; (2) the type of information needed is not limited to information about treatment options and risks; (3) patients engage in independent information seeking for a variety of reasons; (4) patients consider compassion from their surgeon as important; (5) direct communication with the surgeon post-operatively is very important; and (6) patients’ information needs are greatest post-operatively. Many patients felt that the amount and quality of information they received was not sufficient, particularly regarding post-operative recovery and long-term life issues, leading many to do their own research. The findings from this study emphasize the need for improved communication with patients so they can participate meaningfully in choices about their treatment, give a truly informed consent, and effectively participate in their own recovery

Population structure and linkage disequilibrium unravelled in tetraploid potato

Association mapping is considered to be an important alternative strategy for the identification of quantitative trait loci (QTL) as compared to traditional QTL mapping. A necessary prerequisite for association analysis to succeed is detailed information regarding hidden population structure and the extent of linkage disequilibrium. A collection of 430 tetraploid potato cultivars, comprising two association panels, has been analysed with 41 AFLP® and 53 SSR primer combinations yielding 3364 AFLP fragments and 653 microsatellite alleles, respectively. Polymorphism information content values and detected number of alleles for the SSRs studied illustrate that commercial potato germplasm seems to be equally diverse as Latin American landrace material. Genome-wide linkage disequilibrium (LD)—reported for the first time for tetraploid potato—was observed up to approximately 5 cM using r2 higher than 0.1 as a criterion for significant LD. Within-group LD, however, stretched on average twice as far when compared to overall LD. A Bayesian approach, a distance-based hierarchical clustering approach as well as principal coordinate analysis were adopted to enquire into population structure. Groups differing in year of market release and market segment (starch, processing industry and fresh consumption) were repeatedly detected. The observation of LD up to 5 cM is promising because the required marker density is not likely to disable the possibilities for association mapping research in tetraploid potato. Population structure appeared to be weak, but strong enough to demand careful modelling of genetic relationships in subsequent marker-trait association analyses. There seems to be a good chance that linkage-based marker-trait associations can be identified at moderate marker densities

The validation of the Hungarian version of the ID-migraine questionnaire

Despite its high prevalence, migraine remains underdiagnosed and undertreated. ID-Migraine is a short, self-administrated questionnaire, originally developed in English by Lipton et al. and later validated in several languages. Our goal was to validate the Hungarian version of the ID-Migraine Questionnaire.Patients visiting two headache specialty services were enrolled. Diagnoses were made by headache specialists according to the ICHD-3beta diagnostic criteria. There were 309 clinically diagnosed migraineurs among the 380 patients. Among the 309 migraineurs, 190 patients had only migraine, and 119 patients had other headache beside migraine, namely: 111 patients had tension type headache, 3 patients had cluster headache, 4 patients had medication overuse headache and one patient had headache associated with sexual activity also. Among the 380 patients, 257 had only a single type headache whereas 123 patients had multiple types of headache. Test-retest reliability of the ID-Migraine Questionnaire was studied in 40 patients.The validity features of the Hungarian version of the ID-Migraine questionnaire were the following: sensitivity 0.95 (95% CI, 0.92-0.97), specificity 0.42 (95% CI, 0.31-0.55), positive predictive value 0.88 (95% CI, 0.84-0.91), negative predictive value 0.65 (95% CI, 0.5-0.78), missclassification error 0.15 (95% CI, 0.12-0.19). The kappa coefficient of the questionnaire was 0.77.The Hungarian version of the ID-Migraine Questionnaire had adequate sensitivity, positive predictive value and misclassification error, but a low specificity and somewhat low negative predictive value

Single low-dose primaquine for blocking transmission of Plasmodium falciparum malaria - a proposed model-derived age-based regimen for sub-Saharan Africa.

BACKGROUND: In 2012, the World Health Organization recommended blocking the transmission of Plasmodium falciparum with single low-dose primaquine (SLDPQ, target dose 0.25 mg base/kg body weight), without testing for glucose-6-phosphate dehydrogenase deficiency (G6PDd), when treating patients with uncomplicated falciparum malaria. We sought to develop an age-based SLDPQ regimen that would be suitable for sub-Saharan Africa. METHODS: Using data on the anti-infectivity efficacy and tolerability of primaquine (PQ), the epidemiology of anaemia, and the risks of PQ-induced acute haemolytic anaemia (AHA) and clinically significant anaemia (CSA), we prospectively defined therapeutic-dose ranges of 0.15-0.4 mg PQ base/kg for children aged 1-5 years and 0.15-0.5 mg PQ base/kg for individuals aged ≥6 years (therapeutic indices 2.7 and 3.3, respectively). We chose 1.25 mg PQ base for infants aged 6-11 months because they have the highest rate of baseline anaemia and the highest risks of AHA and CSA. We modelled an anthropometric database of 661,979 African individuals aged ≥6 months (549,127 healthy individuals, 28,466 malaria patients and 84,386 individuals with other infections/illnesses) by the Box-Cox transformation power exponential and tested PQ doses of 1-15 mg base, selecting dosing groups based on calculated mg/kg PQ doses. RESULTS: From the Box-Cox transformation power exponential model, five age categories were selected: (i) 6-11 months (n = 39,886, 6.03%), (ii) 1-5 years (n = 261,036, 45.46%), (iii) 6-9 years (n = 20,770, 3.14%), (iv) 10-14 years (n = 12,155, 1.84%) and (v) ≥15 years (n = 328,132, 49.57%) to receive 1.25, 2.5, 5, 7.5 and 15 mg PQ base for corresponding median (1st and 99th centiles) mg/kg PQ base of: (i) 0.16 (0.12-0.25), (ii) 0.21 (0.13-0.37), (iii) 0.25 (0.16-0.38), (iv) 0.26 (0.15-0.38) and (v) 0.27 (0.17-0.40). The proportions of individuals predicted to receive optimal therapeutic PQ doses were: 73.2 (29,180/39,886), 93.7 (244,537/261,036), 99.6 (20,690/20,770), 99.4 (12,086/12,155) and 99.8% (327,620/328,132), respectively. CONCLUSIONS: We plan to test the safety of this age-based dosing regimen in a large randomised placebo-controlled trial (ISRCTN11594437) of uncomplicated falciparum malaria in G6PDd African children aged 0.5 - 11 years. If the regimen is safe and demonstrates adequate pharmacokinetics, it should be used to support malaria elimination

Provider and lay perspectives on intra-uterine contraception: a global review

BACKGROUND: Intra-uterine contraception (IUC) involves the use of an intra-uterine device (IUD), a highly effective, long-acting, reversible contraceptive method. Historically, the popularity of IUC has waxed and waned across different world regions, due to policy choices and shifts in public opinion. However, despite its advantages and cost-effectiveness for programmes, IUC's contribution to contraceptive prevalence is currently negligible in many countries. This paper presents the results of a systematic review of the global literature on provider and lay perspectives on IUC. It aims to shed light on the reasons for low use of IUC and reflect on potential opportunities for the method's promotion. METHODS: A systematic search of the literature was conducted in four peer-reviewed journals and four electronic databases (MEDLINE, EMBASE, POPLINE, and Global Health). Screening resulted in the inclusion of 68 relevant publications. RESULTS: Most included studies were conducted in areas where IUD use is moderate or low. Findings are similar across these areas. Many providers have low or uneven levels of knowledge on IUC and limited training. Many wrongly believe that IUC entails serious side effects such as pelvic inflammatory disease (PID), and are reluctant to provide it to entire eligible categories, such as HIV-positive women. There is particular resistance to providing IUC to teenagers and nulliparae. Provider opinions may be more favourable towards the hormonal IUD. Some health-care providers choose IUC for themselves. Many members of the public have low knowledge and unfounded misconceptions about IUC, such as the fear of infertility. Some are concerned about the insertion and removal processes, and about its effect on menses. However, users of IUC are generally satisfied and report a number of benefits. Peers and providers exert a strong influence on women's attitudes. CONCLUSION: Both providers and lay people have inaccurate knowledge and misconceptions about IUC, which contribute to explaining its low use. However, many reported concerns and fears could be alleviated through correct information. Concerted efforts to train providers, combined with demand creation initiatives, could therefore boost the method's popularity. Further research is needed on provider and lay perspectives on IUDs in low- and middle-income countries

Genetic programming and its application in real-time runoff forecasting

Genetic programming (GP), a relatively new evolutionary technique, is demonstrated in this study to evolve codes for the solution of problems. First, a simple example in the area of symbolic regression is considered. GP is then applied to real-time runoff forecasting for the Orgeval catchment in France. In this study, GP functions as an error updating scheme to complement a rainfall-runoff model, MIKE11/NAM. Hourly runoff forecasts of different updating intervals are performed for forecast horizons of up to nine hours. The results show that the proposed updating scheme is able to predict the runoff quite accurately for all updating intervals considered and particularly for updating intervals not exceeding the time of concentration of the catchment. The results are also compared with those of an earlier study, by the World Meteorological Organization, in which autoregression and Kalman filter were used as the updating methods. Comparisons show that GP is a better updating tool for real-time flow forecasting. Another important finding from this study is that nondimensionalizing the variables enhances the symbolic regression process significantly