Rantai Pasok Pemasaran Produk Kelompok Tani di Era Pandemic Covid-19

The people of each region always have different characteristics and uniqueness of each, especially between rural communities which tend to be homogeneous and have strong elements of customs compared to urban communities which tend to be heterogeneous and begin to reduce the elements of their customs. Building rural communities through empowerment is the main key to mobilizing the potential of the Indonesian agricultural sector. Surya Tani farmer group is a farmer group located in Mekaragung village, Cigundi village. The farmer group was founded on the initiative of Mr. Deddy, who was diligent as a farmer in the broad and narrow sense. From the results of surveys and interviews with members of the Surya Tani farmer group, the researchers wanted to know how to apply supply chains and market expansion to the marketing of products or crops at the Surya Tani farmer group in Cibadak, Lebak – Banten. Methods of collecting data were observations, interviews and questionnaires to the chairman and members of the Surya Tani farmer group. The data analysis technique was carried out with a descriptive qualitative approach. From the results of the study, it was found that the Surya Tani farmer group had not implemented a supply chain but the Surya Tani farmer group was able to expand the market to market their agricultural products out of the Lebak-Banten area market to the DKI Jakarta main market. However, it is different in the distribution process, which is experiencing delays in delivery due to the implementation of PSBB in the era of the covid-19 pandemic

The surgical margin status after breast-conserving surgery: discussion of an open issue

Hypothesis: The best therapeutic approach to the involved or proximal surgical margins has not been defined yet; surgical margins status can influence the local relapse of disease in breast carcinoma, but the impact on overall survival has not been clearly demonstrated. Purpose of this work is to find in the available literature further evidence to guide the therapeutic behaviour in patients with close margins by invasive carcinoma. Design: Review of the currently available literature on the evaluation of surgical margins in breast conserving surgery; influence of margin involvement by invasive component or intraductal component. Patients or other participants: Literature research by PubMed on the topics of breast carcinoma, conservative surgery and margin definition and status; therapeutic approach to involved margins. Main outcome measure: We reviewed the available literature focusing our attention to the definition of clear surgical margins and to the value of the close proximity of margins in relation to the local control of disease and the best therapeutic management of different situations. Results: Further evidence is needed on large numbers of patients to understand how to evaluate surgical margins in invasive breast carcinoma. Conclusions: There is no consensus on the definition of "clear surgical margins", and the ideal approach to the close proximity of margins has not been defined. It is not sure whether a new surgical procedure is really needed in every case of close proximity of tumor cells to the margins. Radiation therapy could be a good option in the management of these cases, but further evidence is needed to establish the real impact of clear surgical margins on local control of disease and, furthermore, on survival

Paget's disease of the breast : the experience of the European institute of oncology and review of the literature

Background: Paget's disease of the breast is an uncommon presentation of breast malignancy, accounting for 1-3% of all the breast tumors and presents in different histopathologic patterns: in association with an underlying invasive or non invasive carcinoma, or without any underlying neoplasia. In the literature, different methods are used for the treatment. Mastectomy with or without axillary dissection has been considered as the standard treatment procedure for many years. Several studies have already shown that breast conservation with radiation therapy is an oncologically safe option. Regarding the axillary approach, several studies have documented the presence of positive sentinel lymph node even in Paget's disease alone. The objective of this study was to retrospectively analyze outcome of patients affected by Paget's breast disease and to define our institutional experience. Patients and methods: Between May 1996 and February 2003, 114 patients with confirmed Paget's disease of the breast were retrieved and underwent surgery at the European Institute of Oncology of Milan, Italy. The median age of the patients was 54 years at the time of the diagnosis. In our study, the histopathological examination of the operated specimen revealed one hundred seven patients with Paget's disease associated with an underlying invasive or non invasive carcinoma, and seven patients without underlying carcinoma. Patients underwent either conservative breast surgery or mastectomy, with or without sentinel lymph node biopsy and/or axillary surgery. Each patient was evaluated after surgery at a multidisciplinary meeting to selecting systemic therapy. Results: Seven patients had "pure" Paget's disease of the breast and one hundred seven had the disease associated with an underlying carcinoma. As surgical techniques 71 mastectomies and 43 breast conserving surgeries have been performed. Complete axillary dissection was done in patients with clinically positive lymph node and/or sentinel lymph node biopsy positive. Sentinel lymph node biopsy was performed in nineteen patients with invasive component and five were positive and underwent axillary dissection. Eleven sentinel lymph node biopsies were done in patients with non invasive component and none of them was positive. Adjuvant systemic therapies were based on the final tumor, node and metastasis stage: thirty patients received adjuvant chemotherapy alone, fourteen received endocrine treatment alone, twenty-six patients were evaluated to receive both chemo and endocrine therapy. The median duration of follow up was 73 months and was updated in the last 6 months. Five patients developed local recurrence, one had regional recurrence, another two had loco-regional recurrences and fourteen had distant metastasis as a first event. Malignancy-related deaths were censored in the statistical analyses cancer for and due to another tumor in eleven patients. Additionally, deaths were not related to malignancy totally in thirteen patients. Conclusions: Screening examination and imaging techniques are fundamental. Breast conserving surgery combined with breast irradiation for patients with invasive and non invasive breast carcinoma has become the treatment of first choice. All surgical conservative approaches should include the complete nipple-areolar complex and margins of resected specimen free of tumor. Thanks to the evolution of the conservative approach, good cosmetic result can be obtained. To be informed about the axillary lymph node status and to avoid the patient to have a second surgical approach, sentinel lymph node biopsy should be performed

Intraoperative radiotherapy during breast conserving surgery in patients previously treated with radiotherapy for Hodgkin’s disease

Aims and background: Women who have received radiotherapy for Hodgkin's disease have an increased risk of developing breast cancer. Breast-conserving surgery followed by breast irradiation is generally considered to be contraindicated in such patients owing to the high cumulative radiation dose to the breast. Mastectomy is therefore recommended as the preferred treatment option in these women. Methods: We report 3 patients affected by breast cancer who had previously been treated with mantle radiation for Hodgkin's disease and on whom breast-conserving surgery and full-dose intraoperative radiotherapy with electrons (ELIOT) were performed. Results: A total dose of 17 Gy (prescribed at 100% isodose) in one case and 21 Gy (at the 90% isodose) in two cases was delivered directly to the mammary gland without acute complications and with good cosmetic results. Conclusions: In women previously irradiated for Hodgkin's disease, ELIOT could avoid repeat irradiation of the whole breast, thereby permitting conservative surgical treatment

MANAJEMEN PROYEK (TINJAUAN TEORI DAN PRAKTIS)

Dalam menyelesaikan sebuah proyek, hal utama yang perlu diperhatikan adalah manajemen waktu dan sumber daya yang dibutuhkan. Sehingga, setiap kebutuhan dapat terencana dengan baik dan terstruktur. Salah satu cara untuk dapat menyelesaikan masalah tersebut adalah dengan menerapkan strategi manajemen proyek yang optimal. Secara umum, pengertian manajemen proyek adalah suatu metode atau sistem pengelolaan maupun pengorganisasian berbagai aktivitas dari sebuah bisnis selama jangka waktu tertentu. Di mana, untuk mencapai tujuan tersebut banyak parameter yang harus dikerjakan mulai dari manajemen anggaran, resources, tim proyek, hingga operasional kerja. Salah satu ciri utama dari sebuah proyek adalah sifatnya yang repetitif. Aktivitas yang sesuai untuk menerapkan manajemen proyek adalah yang menghasilkan produk atau jasa dalam jangka waktu tertentu. Dalam mengelola project management yang baik, tentu ada beberapa hal yang perlu dioptimalkan dan memerlukan strategi efektif. Dalam pelaksanaannya, manajemen proyek akan melalui sejumlah tahapan, seperti initiation, planning, execution, sampai closure. Proses tersebut pada dasarnya hanya dilakukan ketika suatu perusahaan atau bisnis ingin melaksanakan sebuah proyek atau kegiatan