PKM Pendampingan Penyusunan Kurikulum Sekolah Ramah Anak pada Taman Kanak Kanak (TK) Az-Zainiyah II Paiton Probolinggo

Konsep Sekolah Ramah Anak yang diterapkan di Taman Kanak-Kanak Az Zainiyah II Desa Karanganyar Kecamatan Paiton Kabupaten Probolinggomerupakan program untuk mewujudkan  kondisi aman, bersih, sehat, peduli, dan berbudaya lingkungan hidup, yang mampu menjamin pemenuhan hak dan perlindungan anak dari kekerasan, diskriminasi, dan perlakuan salah lainnya, selama anak berada di satuan pendidikan, serta mendukung partisipasi anak terutama dalam perencanaan, kebijakan, pembelajaran dan pengawasan. PKM ini bertujuan untuk memberikan pendampingan kurikulum sekolah ramah anak pada TK Az-Zainiyah II Paiton Probolinggo. Sekolah Ramah Anak bukanlah membangun sekolah baru, namun mengkondisikan sebuah sekolah menjadi nyaman bagi anak, serta memastikan sekolah memenuhi hak anak dan melindunginya, karena sekolah menjadi rumah kedua bagi anak, setelah rumahnya sendiri. Pendampingan ini dilakukan untuk melaksanakan kurikulum ramah anak di TK Az Zainiyah Karanganyar agar mamapu menerjemahkan keinginan pemerintah dalam melaksanakan sekolah yang aman, bersih, sehat dan berdampak pada bukan hanya warga sekolah tetapi pada lingkungan sekolah yang peduli terhadap anak

Cost-utility of revisions for cervical deformity correction warrants minimization of reoperations.

Background: Cervical deformity (CD) surgery has become increasingly more common and complex, which has also led to reoperations for complications such as distal junctional kyphosis (DJK). Cost-utility analysis has yet to be used to analyze CD revision surgery in relation to the cost-utility of primary CD surgeries. The aim of this study was to determine the cost-utility of revision surgery for CD correction. Methods: Retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: C2-C7 Cobb \u3e10°, cervical lordosis (CL) \u3e10°, cervical sagittal vertical axis (cSVA) \u3e4 cm, chin-brow vertical angle (CBVA) \u3e25°. Quality-adjusted life year (QALY) were calculated by EuroQol Five-Dimensions questionnaire (EQ-5D) and Neck Disability Index (NDI) mapped to SF-6D index and utilized a 3% discount rate to account for residual decline to life expectancy (men: 76.9 years, women: 81.6 years). Medicare reimbursement at 30 days assigned costs for index procedures (9+ level posterior fusion, 4-8 level posterior fusion with anterior fusion, 2-3 level posterior fusion with anterior fusion, 4-8 level anterior fusion) and revision fusions (2-3 level, 4-8 level, or 9+ level posterior refusion). Cost per QALY gained was calculated. Results: Eighty-nine CD patients were included (61.6 years, 65.2% female). CD correction for these patients involved a mean 7.7±3.7 levels fused, with 34% combined approach surgeries, 49% posterior-only and 17% anterior-only, 19.1% three-column osteotomy. Costs for index surgeries ranged from $20,001-55,205, with the average cost for this cohort of$44,318 and cost per QALY of $27,267. Eleven revision surgeries (mean levels fused 10.3) occurred up to 1-year, with an average cost of$41,510. Indications for revisions were DJK (5/11), neurologic impairment [4], infection [1], prominent/painful instrumentation [1]. Average QALYs gained was 1.62 per revision patient. Cost was $28,138 per QALY for reoperations. Conclusions: CD revisions had a cost of$28,138 per QALY, in addition to the $27,267 per QALY for primary CD surgeries. For primary CD patients, CD surgery has the potential to be cost effective, with the caveats that a patient livelihood extends long enough to have the benefits and durability of the surgery is maintained. Efforts in research and surgical technique development should emphasize minimization of reoperation causes just as DJK that significantly affect cost utility of these surgeries to bring cost-utility to an acceptable range

Extension of previous fusions to the Sacro-Pelvis vs. Primary spino-pelvic fusions in the setting of adult deformity: A Comparison of health related quality of life measures and complications [abstract]

Comparative Medicine - OneHealth and Comparative Medicine Poster SessionSummary: Clinical and radiographic evaluation of revision extension of previous long thoracolumbar fusion to the sacro-pelvis compared to primary lumbosacral fusion indicates that although the two patient populations are heterogeneous, clinical outcomes and complication rates of salvage procedures where a prior spinal fusion procedure is extended to the sacropelvis compare favorably to primary sacro-pelvic fusion for adult spinal deformity. Introduction: Patients previously treated with thoracolumbar fusion for spinal deformity may develop degenerative changes below the fusion requiring revision fusion to the sacro-pelvis. Little data exists on the characteristics of patients treated with revision extension to sacro-pelvis compared to primary lumbosacral fusion. We evaluated the differences between patients undergoing revision extension of fusion vs. primary fusion to the sacro-pelvis, minimum 2-year follow-up. Methods: The revision group (REVISION) included multicenter retrospective evaluation of 44 of 54 consecutive patients (1995-2006) that had a previous long fusion ending from L3-5, revised by extension fusion to the sacro-pelvis for symptomatic degeneration. The primary group (PRIMARY) included 20 of 20 consecutive patients prospectively enrolled (2000-2006) at a single center database that received primary long arthrodesis to the sacro-pelvis for adult deformity. Clinical and radiographic evaluation included demographics, coronal and sagittal measures, postoperative SRS-22 scores, and perioperative complications. Results: Mean patient age was 52 years (range 21-81 years). Mean follow up was 43 months (range 23-135 months). PRIMARY had greater median age (59 vs. 49 years; p<0.01) and longer follow up (44 vs. 31 months, p<0.05) than REVISION. PRIMARY had larger preoperative thoracolumbar curve (median TL; 48° vs. 36°; p<0.01) and less sagittal imbalance (median SVA; 0.0. vs. 5.0 cm; p<0.05) than REVISION. Postoperative SVA was similar for PRIMARY and REVISION (median 0.9 vs. 2.6 cm, respectively; p=0.25). REVISION had better postoperative SRS-22 scores (median 3.80 vs. 3.12, p<0.01) and fewer patients with minimum one complication [11 (25%) vs. 11 (55%), p<0.05] than PRIMARY (Table 1) Conclusion: Significant differences were demonstrated between patients undergoing primary vs. revision extension to the sacro-pelvis. PRIMARY were older, and had larger TL curves, whereas REVISION had greater sagittal imbalance. While PRIMARY had more complications, multiple factors could account for this other than surgery type, including differences in age or number of levels fused. The retrospective nature of the study may have also underrepresented minor complications. Although the groups were heterogeneous, radiographic, SRS-22 and complications analysis indicate clinical outcomes of salvage procedures where a prior spinal fusion procedure is extended to the sacropelvis compare favorably to primary sacro-pelvic fusion for adult spinal deformity

PKM Pendampingan Penyusunan Kurikulum Sekolah Ramah Anak pada Taman Kanak Kanak (TK) Az-Zainiyah II Paiton Probolinggo

Konsep Sekolah Ramah Anak yang diterapkan di Taman Kanak-Kanak Az Zainiyah II Desa Karanganyar Kecamatan Paiton Kabupaten Probolinggomerupakan program untuk mewujudkan  kondisi aman, bersih, sehat, peduli, dan berbudaya lingkungan hidup, yang mampu menjamin pemenuhan hak dan perlindungan anak dari kekerasan, diskriminasi, dan perlakuan salah lainnya, selama anak berada di satuan pendidikan, serta mendukung partisipasi anak terutama dalam perencanaan, kebijakan, pembelajaran dan pengawasan. PKM ini bertujuan untuk memberikan pendampingan kurikulum sekolah ramah anak pada TK Az-Zainiyah II Paiton Probolinggo. Sekolah Ramah Anak bukanlah membangun sekolah baru, namun mengkondisikan sebuah sekolah menjadi nyaman bagi anak, serta memastikan sekolah memenuhi hak anak dan melindunginya, karena sekolah menjadi rumah kedua bagi anak, setelah rumahnya sendiri. Pendampingan ini dilakukan untuk melaksanakan kurikulum ramah anak di TK Az Zainiyah Karanganyar agar mamapu menerjemahkan keinginan pemerintah dalam melaksanakan sekolah yang aman, bersih, sehat dan berdampak pada bukan hanya warga sekolah tetapi pada lingkungan sekolah yang peduli terhadap anak.</jats:p

Comparison of Best versus Worst Clinical Outcomes for Adult Spinal Deformity Surgery: A Prospective, Multicenter Assessment with Minimum 2-Year Follow-Up

Introduction Adults with spinal deformity typically present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for ASD based on a prospective, multicenter patient population. Patients and Methods This is a multicenter, prospective analysis of consecutive patients with ASD electing for op or non-op care at enrollment. Inclusion criteria are age 0.001) and had worse deformity based on pelvic tilt, PI–LL, and C7SVA (p > 0.002). Before reaching minimum 2-year follow-up, 38 non-op patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up, all HRQL measures assessed significantly improved for op patients (p > 0.001), but none of these measures improved significantly for non-op patients (p 0.001), but the 97 matched non-op patients lacked significant improvement in any of the HRQL measures (p 0.001), except SF36 MCS (p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, non-op treatment appears to at best maintain presenting levels of pain and disability

Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multicenter Matched and Unmatched Cohort Assessment with Minimum 2-Year Follow-Up

Introduction Adults with spinal deformity typically present with pain and disability. Aim Our objective was to compare outcomes for operative (op) and nonoperative (nonop) treatment for ASD based on a prospective, multicenter patient population. Material and Methods This is a multicenter, prospective analysis of consecutive ASD patients electing for op or nonop care at enrollment. Inclusion criteria: age > 18 year and ASD. Propensity scores were used to match op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI-LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met with the criteria, including 286 op and 403 nonop, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS (p < 0.001) and had worse deformity based on pelvic tilt, PI-LL, and C7SVA (p ≤ 0.002). Before reaching minimum 2-year follow-up 38 nonop patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up all HRQL measures assessed significantly improved for op patients (p < 0.001), but none of these measures improved significantly for nonop patients (p ≥ 0.11). Total 97 matched op–nonop pairs were identified based on propensity scores. At last follow-up the 97 matched op patients had significant improvement in all HRQL measures assessed (p < 0.001), but the 97 matched nonop patients lacked significant improvement in any of the HRQL measures (p ≥ 0.20). Paired op–nonop analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed (p < 0.001), except SF36 MCS (p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, nonop treatment appears to at best maintain presenting levels of pain and disability