Analisis biaya terapi diabetes mellitus di Rumah Sakit Dr. Sardjito Yogyakarta

Abstrak Diabetes mellitus merupakan penyakit kronis yang diakui pemerintah Indonesia sebagai masalah kesehatan masyarakat, dengan konsekuensi tidak hanya pada efek yang tidak dikehendaki, tetapi juga menjadi beban ekonomi pada sistem pelayanan kesehatan. Tujuan dari penelitian ini adalah untuk mendapatkan gambaran biaya terapi pada pasien diabetes mellitus tipe 2 termasuk biaya untuk mengatasi komplikasi. Penelitian ini dilakukan dengan rancangan deskriptif pada pasien yang berkunjung ke Bagian EndokrinologiRS Dr. Sardjito Yogyakarta antara bulan Juli sampai Agustus 2005. Kriteria inklusi adalah pasien yang berkunjung pada saat penelitian ini dilakukan. Kriteria eksklusi meliputi pasien diabetes melitus dengan penyakit penyerta lain. Biaya yang dihitung adalah biaya medik langsung (sudut pandang rumah sakit), yaitu biaya obat, biaya kunjungan dokter, pemeriksaan laboratorium, biaya untuk mengatasi komplikasi, dan biaya penyakit penyerta. Dari 100 pasien yang dianalisis, 44% adalah wanita dan 56% laki-laki. Rata-rata umur pasien 60,75 tahun dengan rentang antara 41 sampai 85 tahun. Biaya terapi total setiap pasien adalah Rp 208.500 per bulan, nilai terbesar adalah Rp 754.500. Biaya tertinggi adalah biaya obat (59,5%), diikuti biaya untuk mengatasi komplikasi (31%). Kontrol gula darah dengan menggunakan terapi kombinasi, terbesar adalah dengan sulfonilurea dan biguanid (44,62%). Kombinasi biguanid, a-glukosidase inhibitor, dan insulin menunjukkanbiaya obat terbesar, yaitu Rp571.000. Hipertensi,neuropathy, dan hiperlipidemia adalah komplikasi yang sering terjadi. Biaya untuk mengatasi komplikasi terbesar adalah pasien dengan komplikasi hipertensi dan retinopathy,yaitu sebesar Rp 754.500. Kata kunci : identifikasiblaya, diabetes mellitus, Rumah Saklt Dr. Sardjlt

IMPLEMENTASI PROGRAM BANTUAN OPERASIONAL MANAJEMEN MUTU (BOMM) (Suatu Studi Dakriptif tentang Implementasi Program Bantuan Operasional Manajemen Mutu (BOMM) di SMU Negeri 6 Surabaya dan SMU Negeri 19 5urabaya)

ABSTRAKSI Otonomi pendidikan telah dilalcsanakan di negara kita telah menimbulkan suatu pendekatan baru dalam upaya peningkatan mutu pendidikan atau yang dikenal dengan Manajemen Peningkatan Mutu Berbasis Sekolah (MPMBS). Hal tersebut telah mendorong Direktorat Pendidikan Menengah Umum Departemen Pendidikan Nasional untuk mengalokasikan sejumlah anggaran untuk mendukung upaya peningkatan mutu penyelenggaraan pendidikan, seperti diadakannya program peningkatan mutu dan relevansi pendidikan menengah umum, yang diarahkan untuk meningkatkan mutu keluaran SMU, yang salah satunya diberikan dalam bentuk bantuan operasional majemen mutu (BOMM). Sebagai salah satu program pendidikan yang tergolong baru, program BOMM sangat menarik untuk diteliti mengingat selama ini program yang djjalankan selama ini banyak berupa program yang bersifat sentra/istik tanpa memberikan kesempatan kepada sekolah, sebagai salah satu institusi pelalcsana pendidikan, untuk menjalankan kegiatan sekolahnya dengan mandiri, yang kegiatankegiatannya telah disesuaikan dengan kondisi riil sekolah. Untuk itu, penelitian ini dilakukan untuk melihat bagaimana implementasi program bantuan operasional manajemen mutu (BOMM) khususnya di Kota Surabaya. Penelitian ini dilakukan dengan menggunakan metode pene/itian kua/itatif dengan tipe pene/itian deskriptif, dimana penelitian dimalcsudkan untuk memberikan gambaran mengenai fenomena sosial tertentu secara cermat dan terperinci sehingga dapat diperoleh suatu pemahaman yang lebih jelas mengenai fenomena tersebut. Adapun lokasi penelitian yang dipilih oleh peneliti adalah di SMU Negeri 6 Surabaya dan SMU Negeri 19 Surabaya. Teknik pengarnbilan sampel pada penelitian ini adalah teknik pengambilan sampe/ purposif, dimana data yang diperoleh berasal dari orang-orang yang ahli dan terkait dengan permasalahan penelitian. Agar suatu hasil penelitian dapat dipertanggungjawabkan baik secara praktis maupun ilmiah, maka diperlukan teknik pemerilcsaan keabsahan data-dalam penelitian ini temik yang digunakan adalah teknik triangu/asi sumber. Berdasarkan hasil penelitian yang telah dilakukan, dapat disimpulkan bahwa implementasi program BOMM -yang mengambillokasi penelitian di SMU Negeri 6 Surabaya dan SMU Negeri 19 Surabaya-telah be~alan dengan baik. Akan tetapi tidak jarang juga ditemui kendala-kendala yang bersifat teknis seperti kurangnya komunikasi serta keterbatasan aparat pelalcsana dalam menjalankan kegiatan program BOMM. Dengan digunakannya kajian ilmu Administrasi Negara sebagai dasar analisis hasil dari penelitian ini, maka penulis berharap agar hasil penelitian dapat digunakan untuk memperkaya kajian ilmu Administrasi Negara, khususnya kajian ilmu Studi Implementasi

Cement stabilisation of crude-oil-contaminated soil

© 2016, Thomas Telford Services Ltd. All rights reserved. Crude-oil-contaminated soils are usually considered unsuitable construction materials for earthworks. This paper presents an experimental investigation of the effects of applying Portland cement on the plasticity, strength and permeability of a crude-oil-contaminated soil in order to ascertain its suitability for use as an earthworks construction material. Series of specific gravity, Atterberg limits, compaction, strength and permeability characteristics were determined for a natural soil, the soil after being artificially contaminated with crude oil and the contaminated soil with varying proportions of added cement. It was found that the geotechnical properties of the soil became less desirable after contamination with crude oil, but the application of cement to the contaminated soil improved its properties by way of cation exchange, agglomeration and cementation. Cement stabilisation of crude-oil-contaminated soil provides a stable supporting structure, as well as a capping layer, that prevents the crude oil from interacting with the construction materials above. Thus, instead of disposing of contaminated soils, creating unnecessary waste and incurring costs, stabilisation with cement – which is practically feasible to undertake on site – makes such soils useful for supporting structural foundations or road pavement structures

The Journey Experience of Visually Impaired People on Public Transport in London

The use of public transport is critical for Visually Impaired People (VIP) to be independent and have access to out-of-home activities. Despite government policies promoting accessible transport for everyone, the needs of VIP are not well addressed, and journeys can be very difficult to negotiate. Journey requirements can often differ from those of other categories of people on the disability spectrum. Therefore, the aim of this research is to evaluate the journey experience of VIP using public transport. Semi-structured interviews conducted in London are used. The results show that limited access to information, inconsistencies in infrastructure and poor availability of staff assistance are the major concerns. Concessionary travel, on the other hand, encourages VIP to make more trips and hence has a positive effect on well-being. The findings suggest that more specific policies should be introduced to cater to the special needs of particular disabilities rather than generalising the types of aids available. It is also concluded that the journey experience of VIP is closely related to an individual’s independence and hence inclusion in society

TOWERS, URNS AND CASTLETS. HISTORICAL EVIDENCE OF ANCIENT SYSTEMS OF WATER SUPPLY AND CONVEYANCE IN PALERMO

Le vestigia del sistema distributivo idrico in uso a Palermo fino agli inizi del ventesimo secolo, sono ancora oggi visibili in alcune vie cittadine. Sono i castella dividicula, ovvero bacini di raccolta e distribuzione idrica. I castella dividicula comprendevano un sistema di urne, torri e castelletti posti ad un livello piezometrico equivalente alla quota della sorgente, sfruttando il principio dei vasi comunicanti. Il perpetuarsi del disuso e l\u2019intensificarsi dell\u2019attivit\ue0 edificatoria ha fatto si che molti di questi manufatti scomparissero inglobati all\u2019interno di fabbricati, cortili, pozzi luce, o abbandonati come ruderi all\u2019angolo di una piazza o lungo una via. Considerate per secoli costruzioni secondarie o minori, soprattutto quelle architettonicamente pi\uf9 povere, di alcune ne rimane solo la traccia, di altri il ricordo. Altre mantengono ancora intatta la struttura ed il paramento murario. Molte risultano modificate rispetto al loro visus originario per l\u2019usura del tempo e per le metamorfosi strutturali, compiute nel corso degli anni. Altre ancora pur avendo perso la loro funzione originaria, si configurano come elementi architettonici strutturanti gli spazi urbani, divenendo elementi caratterizzanti una piazza o un cortile. Da queste considerazioni nasce lo studio, condotto presso il Dipartimento di Architettura della Scuola Politecnica dell\u2019Universit\ue0 di Palermo. E\u2019 un viaggio attraverso il tempo che ci ha accompagnato alla riscoperta di una parte della nostra storia, del nostro passato, di un sistema antico e ormai dimenticato ma che si inserisce a pieno titolo nel tessuto urbano della citt\ue0. Degli elementi ancora oggi presenti sul territorio palermitano, 101 sono quelli attualmente censiti. L\u2019analisi condotta, supportata da rilievi fotografici e architettonici e da notizie apprese in archivi, biblioteche e talvolta dagli abitanti delle zone urbane visitate, ha permesso anche di studiare l\u2019evoluzione tecnologica legata a tali strutture, sia nell\u2019uso dei materiali, sia nelle tecniche costruttive e nell\u2019espressione formale. L\u2019opera di censimento si \ue8 concretizzata, tra l\u2019altro, in una schedatura con lo scopo di fornire dati sulla localizzazione, i caratteri, la tipologia, l\u2019analisi strutturale, lo stato di conservazione dei manufatti censiti e sensibilizzare l\u2019attenzione delle pubbliche amministrazioni su questi beni isolati che possono essere definiti monumenti in quanto documenti della storia e della cultura di un Paese e di una civilt\ue0.The remains of the water distribution system in use in Palermo until the early 20th century, are still visible in some streets. The castella dividicula that is a system of catchment and distribution basins. The castella dividicula included a system of urns, towers and castlets places to a piezometric level equal to the dimension of the source, exploiting the principle of connecting vases. The perpetuation of disuse and the intensification of construction activity has meant that many of these artifacts disappear, incorporated within buildings, courtyards, light wells or abandoned as ruins at the corner of a square or along a street. In the centuries they were considered secondary or minor constructions, especially the architecturally poorest, some just left architectural tracing, other memories only. Others still maintain intact the structure and the masonry. Many are modified from their original visus owing to the time wear and the structural metamorphosis, accomplished over the years. Still others despite having lost the original purpose, constitute structuring urban spaces architectural elements, becoming connotative elements for a square or a courtyard. From these considerations comes the study, conducted at the Department of architecture of the Polytechnic School of the University of Palermo. It is a journey through the time that drove us to rediscover a part of our history, of our past, of an ancient system and now forgotten but that fits fully into the urban fabric of the city. About the elements still present in the territory of Palermo, 101 are currently registered. The analysis conducted, supported by photographic and architectural reliefs and by information obtained in archives, libraries and sometimes by the inhabitants of urban areas visited, also allowed to study the technological evolution linked to these structures, both in the use of materials, both in construction techniques and formal expression. The work of census has resulted, inter alia, in a filing with the purpose of providing information about localization, fonts, type, structural analysis, the state of conservation of listed artifact and raise attention of public administrations on these isolated artifacts that can be defined monuments as documents of the history and culture of a country and of a civilization