ASUHAN KEBIDANAN PADA PRIMIPARA INTRAPARTAL KALA I DENGAN PERPANJANGAN FASE AKTIF DI RUANG BERSALIN RSUD PROF. DR. W. Z. JOHANNES KUPANG TANGGAL 01 - 13 FEBRUARI 2016.

Latar Belakang: Kematian pada ibu disebabkan oleh komplikasi obstetrik yang sering tidak dapat diramalkan pada saat kehamilan maupun persalinan dan kebanyakan komplikasi ini terjadi pada saat atau sekitar persalinan, salah satunya yaitu persalinan lama. Persalinan lama merupakan satu keadaan yang perlu diwaspadai dan perlu penanganan serta observasi yang ketat. Pada persalinan primipara persalinan lama berlangsung lebih dari 12jam, dan multipara lebih dari 6 jam. Penanganan dan observasi yang tidak sesuai dapat menngkatkan angka kematian ibu bersalin dengan penyebab kala I lama. Tujuan:Melaksanakan asuhan kebidanan pada primipara intrapartal dengan perpanjangan fase aktif dengan menggunakan pendekatan manajemen kebidanan. Pembahasan:Berdasarkan asuhan yang dilakukan yang dimulai dengan pengumpulan data yaitu data subyektif dan obyektif, menginterpretasikan data, menentukan masalah potensial yang terjadi, menentukan tindakan segera yang dilakukan untuk mencegah terjadinya masalah potensial, membuat perencanaan berdasarkan kebutuhan yaitu ibu inpartu dengan perpanjangan fase aktif,perencanaan meliputi pemberian induksi oksitosin, tindakan asuhan sayang ibu, mengajarkan ibu teknik relaksasi, melakukan pertolongan persalinan, mengevaluasi dan mengikuti perkembangan ibu selama pemberian asuhan. Berdasarkan teori yang dijelaskan dalam tinjauan teori dan asuhan yang dilaksanakan dalam tinjauan kasus tidak terdapat kesenjangan. Simpulan:Pada tanggal 08 Februari 2016 dilakukan asuhan kebidanan pada ibu G1P0A0AH0, inpartu kala I dengan perpanjangan fase aktif di Ruang Bersalin RSUD Prof. Dr. W.Z.Johannes Kupang. Tindakan yang dilakukan ialah pemberian cairan RL 500 ml dan drip oksitosin 5 IU dimulai dengan 8 tetes/menit dan diobservasi setiap 15 menit sampai pembukaan lengkap

Sarcoidosis presenting as granulomatous myositis in a 16-year-old adolescent

BACKGROUND: Sarcoidosis is a multi-system disease characterized by the presence of non-caseating epithelioid granulomas in affected tissues, including skeletal muscle. These organized collections of immune cells have important pathophysiologic action including cytokine production leading to inflammation as well as enzymatic conversion of cholecalciferol to calcitriol via 1-α hydroxylase. There are limited reports of isolated granulomatous myositis causing hypercalcemia in pediatric patients. Our patient uniquely presented with symptoms from hypercalcemia and renal insufficiency caused by an overwhelming burden of granulomatous myositis in her lower extremities, but was otherwise asymptomatic. CASE PRESENTATION: A 16 year old Caucasian female presented with protracted symptoms of fatigue, nausea and prominent weight loss with laboratory evidence of hypercalcemia and renal insufficiency. She lacked clinical and physical findings of arthritis, weakness, rash, uveitis, fever, lymphadenopathy or respiratory symptoms. After extensive negative investigations, re-examination yielded subtle soft tissue changes in her lower extremities, with striking MRI findings of extensive myositis without correlative weakness or serum enzyme elevation. Biopsy showed the presence of non-caseating epithelioid granulomas and calcium oxalate crystals. The patient responded well to prednisone and methotrexate but relapsed with weaning of steroids. She reachieved remission with addition of adalimumab. CONCLUSIONS: Sarcoidosis should be considered in patients presenting with symptomatic hypercalcemia with no apparent causes and negative routine workup. The absences of decreased muscle strength or elevated muscle enzymes do not preclude the diagnosis of granulomatous myositis

Clinical phenotypes and biologic treatment use in juvenile dermatomyositis-associated calcinosis

Abstract Background Few risk factors have been identified for the development of calcinosis among patients with Juvenile Dermatomyositis, and currently no clinical phenotype has been associated with its development. We analyzed a large database of patients to further elucidate any relationships among patients with and without calcinosis. Method The CARRA legacy registry recruited pediatric rheumatology patients from 55 centers across North America from 2010 through 2014, including over 650 subjects with Juvenile Dermatomyositis. We compared the demographic characteristics, clinical disease features and treatment histories of those with and without calcinosis using univariate and multivariate logistic regression. Results Of the 631 patients included in the analysis, 84 (13%) had a current or prior history of calcinosis. These patients were statistically more likely to have longer durations of disease prior to diagnosis and treatment, have lipodystrophy and joint contractures, and to have received intravenous immune globulin or rituximab as treatments. Conclusions Calcinosis is found more often in patients with prolonged active disease, severe disease, and certain clinical features such as lipodystrophy and joint contractures. When these factors are combined with other known associations and predictors, groups of at-risk patients can be more effectively identified, treated and studied to improve overall outcomes

Corporate Strategic Management: A Proposal for the Use of Sustainability Performance Indicators

A sustentação do tema é uma das principais organizações, uma vez que a saúde é sustentável e alinhada com os indicadores sociais e ambientais para melhorar a imagem corporativa e a melhor vantagem competitiva. Por meio de componentes de Planejamento Estratégico de Negócios, contamos com as ferramentas de gerenciamento do Balanced Scorecard, é possível realizar as práticas do ambiente de produção com a implementação de metas e objetivos estratégicos, porém essa integração ainda não é traduzida como real meio ambiente e contraído pela atividade central da empresa dentro da perspectiva da sustentabilidade.Portanto, este estudo é baseado em uma estratégia de gestão baseada no Balanced Scorecard, que também considera os indicadores de desempenho de sustentabilidade, dentro da economia, dimensões sociais e ambientais, a fim de permitir que os gestores se desenvolvam e sigam a organização Planejamento Estratégico de Negócios e Gestão estática está funcionando no nível operacional de sustentabilidade desejável. Como metodologia, o estudo baseou-se em uma pesquisa qualitativa-quantitativa, exploratória e prescritiva. Como este é o seu método de estudo, as estatísticas e critérios hídricos, sob parâmetros qualitativos e quantitativos, são suas estratégias e metas em direção às operações para um desempenho de sustentabilidade satisfatório.o estudo baseou-se em pesquisa qualitativa-quantitativa, exploratória e prescritiva. Como este é o seu método de estudo, as estatísticas e critérios hídricos, sob parâmetros qualitativos e quantitativos, são suas estratégias e metas em direção às operações para um desempenho de sustentabilidade satisfatório. o estudo baseou-se em pesquisa qualitativa-quantitativa, exploratória e prescritiva. Como este é o seu método de estudo, as estatísticas e critérios hídricos, sob parâmetros qualitativos e quantitativos, são suas estratégias e metas em direção às operações para um desempenho de sustentabilidade satisfatório

Favorable outcomes with reduced steroid use in juvenile dermatomyositis

BACKGROUND: High-intensity glucocorticoid regimens are commonly used to induce and maintain remission in Juvenile Dermatomyositis but are associated with several adverse side-effects. Evidence-based treatment guidelines from North American and European pediatric rheumatology research societies both advocate induction with intravenous pulse steroids followed by high dose oral steroids (2 mg/kg/day), which are then tapered. This study reports the time to disease control with reduced glucocorticoid dosing. METHODS: We retrospectively reviewed the records at a single tertiary-care children\u27s hospital of patients diagnosed with Juvenile Dermatomyositis between 2000 and 2014 who had a minimum of 2 years of follow-up. The primary outcome measure was time to control of muscle and skin disease. Additional outcome measures included glucocorticoid dosing, effect of treatment on height, frequency of calcinosis, and complications from treatment. RESULTS: Of the 69 patients followed during the study period, 31 fulfilled inclusion criteria. Median length of follow-up was 4.58 years, (IQR 3-7.5). Myositis control was achieved in a median of 7.1 months (IQR 0.9-63.4). Cutaneous disease control was achieved in a median of 16.7 months (IQR 4.3-89.5). The median starting dose of glucocorticoids was 0.85 mg/kg/day, (IQR 0.5-1.74). The median duration of steroid treatment was 9.1 months, (IQR 4.7-17.4), while the median duration of any pharmacotherapy was 29.2 months (IQR 10.4 to 121.3). Sustained disease control off medications was achieved in 21/31 (68%) patients by the end of review. Persistent calcinosis was identified in only one patient (3%). CONCLUSION: Current accepted treatment paradigms for Juvenile Dermatomyositis include oral glucocorticoids beginning at 2 mg/kg/day and reduced over a prolonged time period. However, our results suggest that treatment using reduced doses and duration with early use of steroid-sparing agents is comparably effective in achieving favorable outcomes in Juvenile Dermatomyositis

Knowledge management: a model study and its relationship with innovation in organizations

This study aims to analyze models of knowledge management, searching from its framework to characterize the context of its application in business and its relationship to the process of innovation. In the development of this paper, innovation and its basis in information and knowledge are discussed, outlining the building blocks of information and its convergence to the generation of knowledge. From a literature review on models of knowledge management, this study performs an analytical reading of its framework based on information and knowledge, identifying their characteristics to the effective realization of management. Finally, some considerations are made about the knowledge management models and its support for innovation.O presente estudo tem por objetivo analisar modelos de gestão do conhecimento, procurando, a partir de sua estrutura, caracterizar o contexto de sua aplicação nas empresas e sua relação com o processo de inovação. No desenvolvimento do trabalho, discorre-se sobre a inovação e seu embasamento na informação e no conhecimento, delineando os elementos construtivos da informação e sua convergência para a geração do conhecimento. A partir de um levantamento bibliográfico sobre modelos de gestão do conhecimento, realiza-se uma leitura analítica de sua estrutura com base na informação e no conhecimento, identificando suas características para a realização efetiva da gestão. Ao final, faz-se considerações a respeito dos modelos de gestão do conhecimento e seu suporte para a inovação.2119711

Time‐Trends in Publication Productivity of Young Transplant Surgeons in the United States

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90090/1/j.1600-6143.2011.03878.x.pd

Knowledge Management: A Model Study And Its Relationship With Innovation In Organizations

O presente estudo tem por objetivo analisar modelos de gestão do conhecimento, procurando, a partir de sua estrutura, caracterizar o contexto de sua aplicação nas empresas e sua relação com o processo de inovação. No desenvolvimento do trabalho, discorre-se sobre a inovação e seu embasamento na informação e no conhecimento, delineando os elementos construtivos da informação e sua convergência para a geração do conhecimento. A partir de um levantamento bibliográfico sobre modelos de gestão do conhecimento, realiza-se uma leitura analítica de sua estrutura com base na informação e no conhecimento, identificando suas características para a realização efetiva da gestão. Ao final, faz-se considerações a respeito dos modelos de gestão do conhecimento e seu suporte para a inovação.2019711