DESAIN DIDAKTIS KONSEP USAHA BERDASARKAN HAMBATAN BELAJAR PADA SISWA SMA KELAS X

Pada kegiatan pembelajaran fisika sering ditemui berbagai hambatan belajar yang dialami oleh siswa. Jika dilihat dari komponen yang membentuknya, hambatan belajar dapat dikategorikan menjadi tiga bagian yaitu hambatan ontogenik, hambatan didaktis dan hambatan epistemologis. Salah satu upaya untuk mengatasi berbagai hambatan belajar yang dialami siswa adalah perlu adanya penyusunan rancangan pembelajaran oleh guru dengan mempertimbangkan hambatan belajar siswa sebagai prediksi respon yang kemungkinan muncul dari siswa selama ataupun setelah proses pembelajaran berlangsung. Upaya tersebut dikenal dengan Penelitian Desain Didaktis atau Didactical Design Research (DDR). Tujuan dari penelitian ini adalah menganalisis hambatan epistemologis berdasarkan hasil Tes Kemampuan Responden (TKR) dan hambatan ontogenik berdasarkan hasil Angket Kesiapan Belajar Siswa pada konsep usahaserta menyusun sebuah desain didaktis yang dapat mengantisipasi hambatan-hambatan belajar tersebut. Penelitian ini menggunakan metode kualitatif deskriptif dan desain yang digunakan adalah Didactical Design Research dengan tiga tahapan analisis, yakni analisis situasi didaktis, analisis metapedadidaktis dan analisis retrospektif. Hasil dari penelitian ini adalah diperolehnya jenis hambatan epistemologis dan profil hambatan ontogenik siswa pada konsep usaha serta dihasilkan suatu desain didaktis pembelajaran konsep usaha yang telah diimplementasikan pada tiga kelas dengan kemampuan siswa yang relatif sama. Dalam penyusunannya, desain didaktis mengalami dua kali revisi. Implementasi desain didaktis revisi keduadengan urutan materi ajar; 1) definisi konsep usaha, 2) usaha pada benda di bidang datar, 3) usaha pada benda bidang miring, dan 4) usaha melalui grafik F-s,secara umum mampu mengantisipasi hambatan-hambatan belajar yang dialami siswa pada konsep usaha.;--In physics learning activities often encountered various learning obstacles that experienced by students.If viewed from the components that make it up, learning obstacles can be categorized into three parts, namely ontogenic obstacles, didactical obstacles and epistemological obstacles.One effort to overcome the various learning obstacles experienced by students is the need for the preparation of the learning design by teachers by considering student learning obstacles as predictions of responses that may arise from students during or after the learning process takes place.This effort is known as Didactical Design Research (DDR). The purpose of this study is to analyze the epistemologicalobstacles based on the Respondent Ability Test results and ontogenic obstacles based on Questionnaireof Student Learning Readiness resultsin work concepts and to create a didactical design that can anticipate these learning obstacles.This research used descriptive qualitative method and design used Didactical Design Research with three stages of analysis that is didactical situation analysis, metapedadidactic analysis and retrospective analysis.The result of this research is obtained the type of epistemological obstacles and the ontogenic obstacles profile of the students on the work concepts as well as the result of didactic design of work concepts learning that has been implemented in threeclasses in with relatively equal student abilities. In the process, didactical design has two revisions. The implementation of the second revised didactical design with the order of teaching material 1) the definition of work concept, 2) work on an object in flat sruface, 3) work on an object in inclined plane and 4) work from F-s graph is generally able to anticipate the learning obstacles that students experience on the work concepts

Comparison between critical-care pain observation tool and physiologic indicators for pain assessment in the critically ill, mechanically ventilated adult patients

Background and Objectives: Pain assessment of nonverbal, critically ill patients continues to present a challenge in Intensive Care Unit (ICU). The Critical-Care Pain Observation Tool (CPOT) rates critically ill patients' pain based on clinical observation. In the present study, the accuracy of CPOT was compared with physiological indicators of pain in mechanically ventilated, critically ill patients. Methods: This quantitative prospective observational study was conducted to assess pain in the critically ill, mechanically ventilated patients in comparison to physiologic indicators such as blood pressure and heart rate. A repeated measures design was chosen, and a sample size of 180 was taken from 60 patients with sepsis, acute exacerbations of chronic obstructive pulmonary disease, community-acquired pneumonia, and postsurgical patients in the ICU. The two painful procedures chosen were tracheal suction and patient positioning. The data were collected at rest, at tracheal suctioning, 20 min later at positioning of the patient, and final reading 20 min later. Three testing periods, each including 4 assessments for a total of 12 pain assessments with sixty patients, were completed during each patient's ICU course. A total of six assessments were done with the patient at rest and three each with pain stimulus of tracheal suctioning and patient positioning. Results: There was a significant increase in both hemodynamic variables (systolic blood pressure and diastolic blood pressure) during painful procedures except for the heart rate during positioning. The correlation between the CPOT and Ramsay scale was negative and significant. Conclusions: The present study provides evidence that the CPOT has good psychometric properties. It might prove useful for pain assessment in uncommunicative critically ill patients

Coagulopathies in cyanotic cardiac patients: An analysis with three point - of - care testing devices (Thromboelastography, rotational thromboelastometry, and sonoclot analyzer)

Introduction: In the last few years, viscoelastic point-of-care (POC) coagulation devices such as thromboelastography (TEG), rotational thromboelastometry (ROTEM), and Sonoclot (SON) analyzer have been increasingly used in major surgeries for timely assessment and management of coagulopathies. The aim of the present study was to evaluate coagulation profile of cyanotic cardiac patients with TEG, ROTEM, and SON analyzer. In addition, we assessed the correlation of standard laboratory coagulation tests and postoperative chest drain output (CDO) with the parameters of POC testing devices. Materials and Methods: Thirty-five patients of either gender, belonging to the American Society of Anesthesiologists Grade I–III, and undergoing elective cardiac surgery on cardiopulmonary bypass for cyanotic congenital heart disease were included in this study. To identify possible coagulation abnormalities, blood samples for TEG, ROTEM, SON, and standard laboratory coagulation were collected after induction of anesthesia. The correlations between variables were assessed using Pearson's correlation coefficient. P < 0.05 was considered statistically significant. Results and Discussion: EXTEM clot time (CT) and clot formation time (CFT) were prolonged in 87% and 45% patients whereas INTEM CT and CFT were prolonged in 36% and 73% patients, respectively. FIBTEM maximum clot firmness (MCF) was decreased in 30% patients. We observed significant correlation between fibrinogen concentration and ROTEM FIBTEM MCF (r = 0.94, P < 0.001). The SON platelet function (SON PF) showed good correlation with platelet count (r = 0.85, P < 0.001). We also found significant correlation between preoperative FIBTEM MCF and CDO in first 4 postoperative hours (r = 0.49, P = 0.004) and 24 postoperative hours (r = 0.52, P = 0.005). Receiver operating characteristic analysis demonstrated that SON PF and TEG maximum amplitude are highly predictive of thrombocytopenia below 100 × 109/L (area under the curve [AUC] - 0.97 and 0.92, respectively), while FIBTEM-MCF is highly predictive of hypofibrinogenemia (fibrinogen <150 mg/dL (AUC, 0.99). Conclusion: Cyanotic cardiac patients have preoperative coagulation abnormalities in ROTEM, TEG, and SON parameters. ROTEM FIBTEM is highly predictive of hypofibrinogenemia while SON PF is highly predictive of thrombocytopenia. ROTEM FIBTEM can be studied as a marker of increased postoperative CDO

Comparative evaluation of Truview evo2 and Macintosh laryngoscope for ease of orotracheal intubation in children – A prospective randomized controlled trial

Background and Aims: Truview evo2 has been found to improve the glottic view when compared with the Miller blade in pediatric population. However, there is limited literature comparing it with Macintosh laryngoscope in children. We thus aimed to assess and compare Truview evo2 with the Macintosh laryngoscope for orotracheal intubation in children with regards to time to intubate, laryngoscopic view, ease of intubation, and associated hemodynamic changes. Material and Methods: Fifty ASA I-II children aged 2–8 years for elective surgery requiring general anesthesia with orotracheal intubation participated in this prospective randomized-controlled study. They were randomly allocated to two groups. In group-M (N = 25), laryngoscopy and intubation were performed using Macintosh laryngoscope, and in group-T (N = 25), Truview evo2 laryngoscope was used. Modified Cormack–Lehane grade, time to intubation, intubation difficulty score (IDS), and hemodynamic changes were compared between the groups. Data were analyzed using SPSS statistical software version 17 and P value <0.05 was considered statistically significant. Results: CL grade 1 was found in a larger number of patients of group-T (P = 0.003) and CL grades2a and 2b were found in a larger number of patients of group-M (P = 0.023 and P = 0.037, respectively). The mean time to intubation was significantly longer in group-T (19.0 ± 3.4 seconds) than in group-M (13.1 ± 2.1 seconds), P = 0.00. The over all IDS was lower in group-T than group M [i.e. median (IQR): 0 (0-0) vs 1 (0-2), respectively]. Heart rate, systolic and diastolic blood pressure, and oxygen saturation were comparable between the groups at all times. Conclusion: Truview evo2 provides better laryngeal view and has a lesser IDS, but takes longer for intubation, when compared to the Macintosh laryngoscope in children