Evaluasi Dampak Penerapan Automated Dispensing Machine terhadap Dispensing Error di Farmasi Rawat Jalan Instalasi Farmasi Rumah Sakit Bethesda Yogykarta

Dispensing error is not uncommon in the medication proccess. Otomatisation of outpatient pharmacy services decrease the incidence of dispensing error, as well as improving the efficiency of picking, packing and labeling process. Since August 2014 an automated dispensing machine was installed in outpatient pharmascy Bethesda Hospital Yogyakarta, integrated with electronic prescribing and hospital information system. The objective of the study was to evaluate the impact of automated dispensing machine on the dispensing error at outpatient pharmacy Services using before and after study method. The procentage of drugs deliver by automated dispensing machine at the third and sixth month of implementation was 46% and 59%. Failure mode and effeect analysis of dispensing process done before the implementation, and the integration with electronic prescription and hospital information system, as well as the development of smart pack is the key of successed. The average of medications picked after the implementation of automated dispensing machine was (37,915.33 ± 3,160.12), higher than before implementation (36,812.67 ± 2,890.81), but not significant. The average of dispensing error after implementation (15,67 ± 6,28) was reduced significantly (p<0,05) than before (50.33 ± 34.47). The most frequent type of dispensing error were wrong quantity dispensed, wrong drug dispensed and wrong strength dispensed. The implementation of automated dispensing machine significantly reduce the incidence of dispensing error. Further investigaation needed to know the incidence of dispesning error cause by the machine and manual and factors that influenced

Pemberian Kombinasi Vitamin B1, B6 dan B12 sebagai Faktor Determinan Penurunan Nilai Total Gejala pada Pasien Neuropati Perifer Diabetik

Diabetic neuropathy is defined as symptoms of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes. According to the earlier studies symptoms of neuropathy such as pain, burning, paresthesia/tingling and numbness can be reduced with neurotropic supplementation. The aim of the research is to determine vitamin B1, ­B6 and B12 as a determinant factor in the reduce total symptom score in patient with diabetic peripheral neuropathy. This research used case series studies and choose 43 sample with consecutive sampling method. We observed symptoms of diabetic peripheral neuropathy (pain, burning, tingling and numbness) measured as total symptoms score, among the patients treated with vitamin B1 (100mg), ­B6 (100mg) and B12 (5000mcg) for a month. Measurement of total symptoms score performed at first meeting, the second week later (day-14) and the fourth week later (day-30). The data were analyzed using univariate and bivariate statistics. The patients (n=43) consisted of 20 male (46.5 %) and 23 female (53.5 %). The symptoms of diabetic peripheral neuropathy (pain, burning, tingling and numbness) that measured by total symptoms score compared with first visit (4.70 ± 1.83), second visit (2.99 ± 1.61) and third (2:37 ± 1.62). Bivariate analysis, showed a correlation between a reduction in total symptoms score after giving therapy of vitamin B1 (100mg), ­B6 (100mg) and B12 (5000mcg) with p = 0.00. Vitamin B1, ­B6 and B12 proved to be a determinant factor to reduce total symptoms score (pain, burning, tingling, and numbness) in patients with diabetic peripheral neuropathy

Dampak Pemberian Vitamin B1, B6, B12 Parenteral terhadap Proporsi Hiperhomosisteinemia pada Pasien Hemodialisis

Banyak pasien gagal ginjal kronis menderita hiperhomosisteinemia yang dapat meningkatkan risiko terjadinya penyakit vaskuler. Dari penelitian sebelumnya ditemukan bahwa pemberian vitamin B dapat mengurangi hiperhomosisteinemia pada pasien yang menjalani hemodialisis. Penelitian ini dilakukan untuk mengukur dampak pemberian vitamin B1, B6, B12 parenteral terhadap proporsi hiperhomosisteinemia pasien gagal ginjal kronik yang menjalani hemodialisis. Penelitian dilakukan dengan desain one group pretest-posttest menggunakan data sekunder rekam medis hasil laboratorium. Data didapatkan dari 117 pasien dengan metode consecutive sampling dan analisis data dilakukan menggunakan SPSS berlisensi dengan uji McNemar. Hasilnya terdapat penurunan proporsi hiperhomosisteinemia yang bermakna setelah pemberian vitamin B selama 2 minggu (70,94%; p=0,000) dan 4 minggu (66,38%; p=0,000), sehingga kesimpulannya, pemberian vitamin B1, B6, dan B12 dalam jangka waktu 2 minggu maupun 4 minggu dapat menurunkan proporsi hiperhomosisteinemia secara bermakna pada pasien gagal ginjal kronis yang menjalani hemodialisis

Perbandingan Tingkat Pencapaian Target Tekanan Darah oleh Lisinopril dan Valsartan pada Pasien Stroke Iskemik dengan Faktor Risiko Hipertensi

Hipertensi merupakan salah satu faktor risiko terpenting pada stroke iskemik. Terapi antihipertensi bertujuan mencegah kekambuhan stroke. Tujuan penelitian ini adalah untuk membandingkan tingkat pencapaian tekanan darah antara lisinopril dan valsartan pada pasien stroke iskemik dengan faktor risiko hipertensi di instalasi rawat jalan Rumah Sakit Bethesda Yogyakarta. Jenis penelitian adalah penelitian observasional analitik kohort retrospektif. Data dianalisis univariat dan bivariat dengan uji Chi-square atau uji Fisher. Data 108 pasien hipertensi pasca-stroke iskemik terdiri dari kelompok yang diberi valsartan 81 pasien dan lisinopril 27 pasien. Target tekanan darah yang tercapai pada kelompok valsartan adalah 40 orang (49,4%) dan lisinopril 15 orang (50,9%), tidak berbeda bermakna (p value >0,05). Hasil penelitian menunjukkan tidak terdapat perbedaan dalam mencapai target tekanan darah antara lisinopril dan valsartan pada pasien stroke iskemik dengan faktor risiko hipertensi di instalasi rawat jalan Rumah Sakit Bethesda Yogyakarta

Celecoxib sebagai Terapi Add-on pada Depresi

Latar Belakang: Depresi merupakan gangguan suasana perasaan yang sering ditemukan. Banyak pasien depresi tidak memberikan respon baik terhadap terapi anti-depresan standar. Celecoxib, obat golongan penghambat COX 2, dapat digunakan sebagai terapi add-on. Tujuan: Mengetahui manfaat celecoxib sebagai terapi add on pada depresi. Pembahasan: Depresi memiliki kaitan erat dengan proses inflamasi, yang ditunjukkan dengan peningkatan kadar CRP dan sitokin pro-inflamasi, khususnya IL-6, IL-1, serta TNF-. Celecoxib bekerja menghambat sintesis PG, sehingga tidak terbentuk metabolit aktif PG yaitu PGE2 yang berperan dalam patofisiologi depresi. Celecoxib juga dapat meningkatkan neurotransmitter serotonin dan noradrenalin di SSP dan menekan aktivitas berlebih aksis HPA. Celecoxib sebagai terapi add on mengurangi skor HDRS, menurunkan kadar IL-6 serum, menunjukkan tingkat respon dan remisi lebih baik daripada anti-depresan tunggal atau plasebo. Dosis celecoxib yang paling sering digunakan untuk efek anti-depresan adalah 400 mg/hari selama 6 minggu. Celecoxib dapat ditoleransi dengan baik pada mayoritas pasien. Simpulan: Celecoxib efektif menurunkan gejala depresi, menurunkan konsentrasi sitokin pro-inflamasi dalam darah, menurunkan skor HDRS, dan dapat ditoleransi dengan baik.Background: Depression is the most frequent mood disorder. Many depression patients are not responsive to standard anti-depressant. Celecoxib, a COX-2 inhibitor, can be used as add-on therapy. Objective : To learn the benefits of celecoxib as add-on therapy for depression. Discussion : Depression is related to inflammatory processes, indicated by the elevated level of CRP and pro-inflammatory cytokines, such as IL-6, IL-1, and TNF-α. Celecoxib works by inhibiting the synthesis of PG, so no active metabolite PGE2 which has an important role in depression pathophysiology, is produced. Celecoxib also increases the production of serotonin and noradrenalin in the CNS and suppress the hyperactivity of HPA axis. Previous studies proved celecoxib as an add-on therapy reduced HDRS score, lowered the level of IL-6, increased the response and remission rate, better than placebo or a single anti-depressant. The most frequent dosage was 400mg/day for 6 weeks. Celecoxib is proved to be well tolerated in the majority of patients. Conclusion : Celecoxib is effective in reducing depression symptoms, blood pro-inflammatory cytokines concentration, HDRS score, and well tolerated