Factors Affecting Commitment Midwives Implementation in 7T Minimum Care Standards Antenatal Care in Konawe District

Coverage of K1 and K4 services in District of Konawe in 2012 was still low, namely 60.2% and54.2% respectively. A preliminary study revealed that commitment of village midwives inimplementing 7T minimum care standards in Antenatal Care (ANC) services was still low. Thisresearch aimed to identify factors influencing the commitment of village midwives in implementingthe 7T minimum care standards in ANC services in District of Konawe. This was observational analytic research with cross-sectional approach. Independent variablesconsisted of work condition, expectation, availability of jobs, compensation, personal value, andmoral obligation. On the other hand, commitment of village midwives was as a dependent variable.Data collection used a questionnaire. Number of samples were 80 village midwives selected usinga purposive sampling technique from 12 selected health centers in District of Konawe. Furthermore,data were analyzed using methods of bivariate (Chi Square test) and multivariate analyses (LogisticRegression test).The result of this research showed that most respondents had good commitment (51.2%), goodwork condition (62.5%), lack of expectation (52.5%), good availability of jobs (52.5%), goodcompensation (67.5%), good personal value (53.8%), and good moral obligation (61.5%). Theresult of bivariate analysis revealed that variables of expectation (p=0.045), availability of jobs(p=0.003), compensation (p=0.000), personal value (p=0.002), and moral obligation (p=0.005)had significant association with the commitment of village midwives. In contrast, the factor ofwork condition was not significant. Furthermore, variables of compensation (p=0.000; OR=7.9)and expectation (p=0.037; OR=2.9) jointly influenced the commitment of village midwives.As suggestions, there needs support and facilities of ANC services such as providing simplelaboratory equipment, providing compensation based on the standard, and increasing expectationof midwives to improve the their commitments in implementing 7T minimum care standards

Cost of Treatment Tonsilektomi Di Instalasi Bedah Sentral RSUD Kajen Kabupaten Pekalongan Tahun 2015

Tarif pelayanan RSUD Kajen yang dibebankan pada pasien umum saat ini dibuat berdasarkan perhitungan biaya operasional yang terjadi, seperti biaya jasa medis, bahan habis pakai, obat – obatan, kelas perawatan, dan sewa kamar operasi, tetapi belum menghitung seluruh komponen biaya yang terlibat untuk tindakan tonsilektomi. Pembuatan tarif belum memperhitungkan biaya – biaya yang tidak langsung. Perda Nomor 1 Tahun 2012, untuk tindakan tonsilektomi RSUD Kajen berdasarkan telusur di rawat inap biaya penanganan tonsilektomi adalah Rp 3.275.100,00 untuk kelas 3, sedangkan untuk klaim BPJS tindakan tonsilektomi kelas 3 di RS Regional 1 tipe C Rp 1.767.900,00;dalam hal ini masih ada selisih biaya antara besaran biaya yang seharusnya dikeluarkan untuk penanganan tonsilektomi dengan besarnya klaim dari BPJS. Seharusnya setiap pembiayaan perlu dihitung dengan baik sesuai dengan clinical pathway agar dapat ditetapkan unit costnya sehingga dapat menjadi efektif dan efisien agar tercipta pelayanan kesehatan yang bermutu. Tujuan penelitian ini adalah mengetahui besaran unit cost berbasis clinical pathway pada diagnosis tonsilektomi di RSUD Kajen. Jenis penelitian ini adalah penelitian observasional analitik dengan melakukan studi kasus di RSUD Kajen. Perumusan clinical pathway dilakukan melalui rapat tim penyusun. Perhitungan unit cost dilakukan dengan metode Activity Based Costing (ABC), penetapan biaya lebih. Hasil Perumusan clinical pathway menunjukkan bahwa tahapan pathway diagnosis tonsilektomi adalah admision (pendaftaran), diagnostic (pemeriksaan), therapy(pengobatan) & follow up (tindak lanjut). Dari perhitungan dengan metode ABC diperoleh unit cost diagnosis tonsilektomi sebesar Rp. 2.717.662,00. Hasil perhitungan analisis pemulihan biaya (cost recovery rate) diketahui bahwa CRR pada pasien umum sebesar 121% sedangkan pasien BPJS sebesar 65% hal ini menunjukkan bahwa untuk setiap pasien umum RSUD Kajen mendapatkan surplus sebesar 21% sedangkan untuk pasien BPJS RSUD Kajen mendapatkan minus sebesar 35%. Rekomendasi manajerial yang dapat diberikan adalah: penyusunan clinical pathway kemudian implementasi konsep final clinical pathway tersebut sebagai quality control RUSD Kajen. Disarankan agar RSUD Kajen melakukan penelusuran biaya dan monitoring serta evaluasi kepatuhan clinical pathway. Tariff of services at Kajen Public Hospital charged on general patients was calculated based on operational costs like cost of medical services, consumables, medicines, treatment class, and rental cost of surgery room. Unfortunately, all components of costs for tonsillectomy treatment had not been included. Determination of the tariff had not calculated indirectly costs. Tariff of tonsillectomy treatment at the Kajen Public Hospital at inpatient room based on a local regulation Number 1 year 2012 was Rp 3,275,000 for class 3 whereas tariff for claim of BPJS at the same class at a regional hospital type C was Rp 1,767,900. In this case, there was any difference between costs that had to be spent for tonsillectomy treatment and claim from BPJS. Each cost must be calculated in accordance with clinical pathway to determine unit cost in order to provide high-quality of services. The aim of this study was to figure out amount of unit cost based on clinical pathway on tonsillectomy diagnosis at the Kajen Public Hospital. This was an observational analytic study by conducting a case study at the Kajen Public Hospital. Clinical pathway was arranged through meeting of a drafting team. A calculation of unit cost was performed using a method of Activity Based Costing (ABC), determination of exceeding cost. The results of clinical pathway arrangement showed that steps of tonsillectomy diagnosis pathway were as follows: admission, diagnostic, therapy, and follow up. Unit cost of tonsillectomy diagnosis based on the ABC calculation was Rp 2,717,662. The results of cost recovery rate calculation demonstrated that CRR among general patients was 121% whereas among BPJS patients was 65%. It means that each general patient of the Kajen Public Hospital obtained surplus as many as 21% otherwise each BPJS patient obtained minus as many as 35%. Arrangement of clinical pathway and implementation of final clinical pathway could be used as quality control of the Kajen Public Hospital. The hospital management needs to trace costs, to monitor, and to evaluate the obedience of clinical pathway

Analisis Kesiapan Peran Tim Safeguarding Jkn Dinas Kesehatan Kota Semarang dalam Memfasilitasi Pelaksanaan Koordinasi Badan Penyelenggara Jaminan Sosial Kesehatan

Implementation persistence of JKN program can be supported by goverment role (provine and Regency/City) which has made Safeguarding team in JKN program implementation. Safeguarding team consist 9 people and in their implementaion has no mission, vission, task and function. The aim in in this research is to analyze readiness of safeguarding team JKN Health Departement Semarang City in facilitating the coordination implementation BPJS Kesehatan. The method in this research is qualitative method with descriptive by using indepth interview. The subject in this research point to Dinas Kesehatan Semarang City Instantition in helping and participate in hold BPJS Kesehatan who are 9 people Safeguarding team and 4 people as triangulation (1 from hospital, 2 from public health center and 1 from BPJS Kesehatan). Anlyze data used are collective data, reduction data, display data, conclusion and verfication. Based on this research it can be concluded that Safeguarding team Dinas Kesehatan are not ready in facilitating implementation coordination because there are not enough human resources for Safeguarding team and multitasking role so the work does not optimum and uneffective, SK that legalized by Head of Health Office 441.91/050 not also with more specific job description but by duty that act by Safeguarding Team JKN guidance to SK Ministry of Health Number 332/Ministry of Health/SK/V2006, not yet accomplished a few fullfilment resources to healthy facilitation for fullfilment quality during service, fixed schedule in supporting helath facilitation and monitoring that has not yet done by JKN Safeguarding team or Dinas Kesehatan team during BPJS Kesehatan so can delayed team work in the future

High Temperature Oxidation Behavior of Fe-Cr Steel in Air at 1000-1200 K

The high temperature oxidation behavior of Fe-Cr steel was studied in air at elevated temperatures of 1000, 1100 and 1200 K for up to 72 ks. The mass change of all samples was recorded in order to evaluate their oxidation kinetic. The structure of oxide scales was investigated by mean of X-ray diffraction and SEM-EDX. According to oxidation kinetic curve, the mass gain of oxidized sample increases with increasing oxidation time and temperature. At 1000 and 1100 K, the Fe-Cr steel exhibits an excellent oxidation resistance. As oxidation temperature increase to 1200 K, however, the accelerated oxidation occurred. This is considered due to breakaway oxidation. The Fe-Cr steel forms a duplex oxide layer consisting of Fe-rich oxides in the outer layer and Fe-Cr oxides in the inner layer. The obtained results suggest that the oxidation temperature strongly affects the oxidation resistance of Fe-Cr steel and the structure of formed oxide layer on the steel surface. The influence of oxidation temperature on the oxidation resistance and scale structure is discussed in this paper

High Temperature Oxidation Behavior of Fe-Cr Steel in Air at 1000-1200 K

The high temperature oxidation behavior of Fe-Cr steel was studied in air at elevated temperatures of 1000, 1100 and 1200 K for up to 72 ks. The mass change of all samples was recorded in order to evaluate their oxidation kinetic. The structure of oxide scales was investigated by mean of X-ray diffraction and SEM-EDX. According to oxidation kinetic curve, the mass gain of oxidized sample increases with increasing oxidation time and temperature. At 1000 and 1100 K, the Fe-Cr steel exhibits an excellent oxidation resistance. As oxidation temperature increase to 1200 K, however, the accelerated oxidation occurred. This is considered due to breakaway oxidation. The Fe-Cr steel forms a duplex oxide layer consisting of Fe-rich oxides in the outer layer and Fe-Cr oxides in the inner layer. The obtained results suggest that the oxidation temperature strongly affects the oxidation resistance of Fe-Cr steel and the structure of formed oxide layer on the steel surface. The influence of oxidation temperature on the oxidation resistance and scale structure is discussed in this paper

Agronomical valorization of eluates from the industrial production of microorganisms: Chemical, microbiological, and ecotoxicological assessment of a novel putative biostimulant

Plant Biostimulants (BSs) are a valid supplement to be considered for the integration of conventional fertilization practices. Research in the BS field keeps providing alternative products of various origin, which can be employed in organic and conventional agriculture. In this study, we investigated the biostimulant activity of the eluate obtained as a by-product from the industrial production of lactic acid bacteria on bare agricultural soil. Eluates utilization is in line with the circular economy principle, creating economical value for an industrial waste product. The research focused on the study of physical, chemical, biochemical, and microbiological changes occurring in agricultural soil treated with the biowaste eluate, applied at three different dosages. The final aim was to demonstrate if, and to what extent, the application of the eluate improved soil quality parameters and enhanced the presence of beneficial soil-borne microbial communities. Results indicate that a single application at the two lower dosages does not have a pronounced effect on the soil chemical parameters tested, and neither on the biochemical proprieties. Only the higher dosage applied reported an improvement in the enzymatic activities of β-glucosidase and urease and in the chemical composition, showing a higher content of total, nitric and ammonia N, total K, and higher humification rate. On the other hand, microbial communities were strongly influenced at all dosages, showing a decrease in the bacterial biodiversity and an increase in the fungal biodiversity. Bioinformatic analysis revealed that some Operative Taxonomic Units (OTUs) promoted by the eluate application, belong to known plant growth promoting microbes. Some other OTUs, negatively influenced were attributed to known plant pathogens, mainly Fusarium spp. Finally, the ecotoxicological parameters were also determined and allowed to establish that no toxic effect occurred upon eluate applications onto soil

LABs Fermentation Side-Product Positively Influences Rhizosphere and Plant Growth in Greenhouse Lettuce and Tomatoes

New agronomical policies aim to achieve greener agricultural systems, sustainable fertilizers and fungicides, a reduction in Greenhouse gases (GHG), and an increase in circular economic models. In this context, new solutions are needed for the market, but it is necessary to carefully assess both their efficacy and their ecological impact. Previously, we reported the biostimulatory activity on soil microbiome for a side-product from Lactic Acid Bacteria (LABs) fermentation: a concentrated post-centrifugation eluate. In the present study, we investigated whether this solution could partially substitute mineral N (N70% + N30% from eluate) in a fertigation (N100% vs. N70%) regime for tomato and lettuce under greenhouse conditions. The impact of the application was investigated through plant physiological parameters (number and weight of ripened fruits, shoots, and roots biomass) and biodiversity of the rhizosphere microbial composition of bacteria and fungi (High-Throughput Sequencing-HTS). The eluate (i) enhanced the plant canopy in lettuce; (ii) increased the shoot/root biomass ratio in both tomato and lettuce; and (iii) increased the harvest and delayed fruit ripening in tomato. Moreover, we found a strong correlation between the eluate and the enrichment for OTUs of plant-growth-promoting microbes (PGPMs) such as Sphingomonas sediminicola, Knoellia subterranean, and Funneliformis mosseae. These findings suggest that integrating the eluate was beneficial for the plant growth, performance, and yield in both tomato and lettuce, and additionally, it enriched specialized functional microbial communities in the rhizosphere. Further studies will investigate the underlying mechanisms regulating the selective activity of the eluate toward PGPMs and its biostimulatory activity towards target crops

Management Analysis of Infection Prevention: Nurses' Compliance in Implementing Hand Hygiene in the Inventories of Rantauprapat Hospital

Purpose: This study aims to analyze infection control prevention management on nurses' compliance in implementing hand hygiene in the in-patient rooms of Rantauprapat Hospital. Methods: An analytical survey was employed with a cross-sectional design. The population included the nurses who served in the in-patient rooms of Regional General Hospital (RSUD) Rantauprapat with a sample of 64 participants. The data was collected using purposive sampling. For data analysis, univariate, bivariate analysis with chi square and multivariate logistic regression tests were used. Results:The results showed that there is a relationship between infection control prevention management and nurses' compliance in implementing hand hygiene in the in-patient rooms of Rantauprapat Hospital in 2020 with the results of the chi-squares-p = 0.0001 test. In addition, there is a relationship between infection control prevention management based on policy / SPO on nurses' compliance in implementing hand hygiene in the in-patient rooms of Rantauprapat Hospital in 2020 with the results of the chi-square sig-p = 0.001. The most dominant variable that affects nurses' compliance in implementing hand hygiene is supervision because it has the greatest regression coefficient (B), which is 2.444 with an Exp (B). Conclusion: Based on the results of the study, it is concluded that regular supervision and training serve as the most effective option in infection control prevention management. Moreover, nurses' compliance with the implementation of hand hygiene in the in-patient rooms of Rantauprapat Hospital has a direct relationship with good infection control prevention management