Pathogenesis of Leptospirosis-Associated Acute Kidney Injury

Leptospirosis is a disease caused by Leptospira, a genus from spirochaetes bacteria. It is transmitted to human through direct contact with contaminated water or soil by vector's urine. About 10% cases can develop to severe forms including acute respiratory distress syndrome, pulmonary edema, hepatic failure, and acute kidney injury (AKI). The pathogenesis of leptospirosis-associated AKI including, direct effect of Leptospira, tubular alterations, prerenal AKI, hyperbilirubinemia, and rhabdomyolysis. Clinical manifestations in AKI of leptospirosis are characterized by the absence of oliguria and normal or reduced potassium serum

IMPACTS OF BINDER AND DISINTEGRANT ON DETAM II SOYBEAN (GLYCINE MAX (L.) MERR) TABLET MADE BY DRY GRANULATION

Keywords: Detam II black soybean (Glycine max (L.) Merr), Tablet, Binder, Disintegrant, Disintegration time Black soybean (Glycine max L. Merr) Detam II Variety has a scavenging activity and total phenolic compound higher than yellow soybean. As a natural compound, the flow properties of black soybean (Glycine max (L.) Merr) Detam II powder is poor due to its high content of moisture, so it must be made by dry granulation method. Dry binder and disintegrant have opposite functions on tablets formula where one serves to increase consolidation between particles while other accelerate the disintegration time as the rate limiting step of dissolution. The effects of disintegrant and dry binder variation on the physical characteristics of black soybean tablets have been observed. The variations of polyvinylpyrrolidone (PVP)-K30 combined with Plasdone S-630 were used as binders, while sodium starch glycolate (SSG) was used as a disintegrant. Approximately 4% of PVP-K30 as a single binder in the formula component provides better hardness and friability value of tablets, but the disintegration time was longer than other formulas. The amount of SSG used was increased to 4 and 8%, respectively in the formula component. 4% was the ideal amount of SSG as a disintegrant to get the best physical tablet characteristics and also disintegration time, about 4.45 minutes. Increasing the amount of SSG has no significant effect on the disintegration time even tends to slow down

Persepsi Tenaga Kesehatan terhadap Praktik Kolaborasi Interprofesional dalam Terapi Antibiotik pada Bedah Ortopedi

Kolaborasi interprofesional (Interprofessional Collaborative/IPC) menjadi strategi untuk menjawab kebutuhan akan pelayanan kesehatan yang terpadu. Dalam terapi antibiotik, praktik IPC yang efektif dapat meningkatkan ketepatan peresepan dan penggunaan antibiotik yang berdampak pada penurunan kejadian resistensi antibiotik. Agar tercipta praktik IPC yang efektif, perlu dilakukan identifikasi permasalahan yang ada dari persepsi tenaga kesehatan yang terlibat dalam IPC. Penelitian ini bertujuan menilai persepsi tenaga kesehatan terhadap praktik IPC dalam terapi antibiotik di unit bedah ortopedi. Penelitian ini merupakan penelitian observasional dengan pendekatan cross-sectional. Persepsi tenaga kesehatan dinilai menggunakan kuesioner Collaborative Practice Assessment Tool (CPAT) yang terdiri dari 8 domain dengan total 53 item pernyataan. Penelitian melibatkan 47 responden tenaga kesehatan di unit bedah ortopedi. Hasil penelitian menunjukkan terdapat perbedaan persepsi yang signifikan antara perawat dan tenaga kefarmasian terhadap domain hambatan tim dalam kolaborasi. Pada domain kepemimpinan terdapat perbedaan yang siginifikan antara tenaga kefarmasian dan dokter. Penelitian ini menyimpulkan secara umum, tenaga kesehatan menilai praktik IPC sudah berjalan dengan baik  (76,47% dari skor maksimum CPAT).Perawat menilai otonomi mereka dalam IPC masih terbatas ( 52% dari skor maksimum domain hambatan tim dalam kolaborasi), serta tenaga kefarmasian menilai masih adanya dominasi tenaga kesehatan lain dalam praktik IPC  (72% dari skor maksimum domain kepemimpinan

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia

Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria

Effective Clinical Pathway Improves Interprofessional Collaboration and Reduces Antibiotics Prophylaxis Use in Orthopedic Surgery in Hospitals in Indonesia

Clinical pathways can improve the quality of health services. The effectiveness and impact of implementing clinical pathways are controversial. The preparation of clinical pathways not only enacts therapeutic guidelines but requires mutual agreement in accordance with the roles, duties, and contributions of each profession in the team. This study aimed to investigate the perception of interprofessional collaboration practices and the impact of clinical pathway implementation on collaborative and Defined Daily Dose (DDD) prophylactic antibiotics per 100 bed-days in orthopedic surgery. The Collaborative Practice Assessment Tool (CPAT) questionnaire was used as a tool to measure healthcare’ perceptions of collaborative practice. The clinical pathway (CP) in this study was adapted from existing CPs published by the Indonesian Orthopaedic Association (Perhimpunan Dokter Spesialis Orthopaedi dan Traumatologi Indonesia, PABOI) and was commended by local domestic surgeons and orthopedic bodies. We then compared post-implementation results with pre-implementation clinical pathway data using ANCOVA to explore our categorical data and its influence towards CPAT response. ANOVA was then employed for aggregated DDD per 100 bed-days to compare pre and post intervention. The results showed that the relationships among members were associated with the working length. Six to ten years of working had a significantly better relationship among members than those who have worked one to five years. Interestingly, pharmacists’ leadership score was significantly lower than other professions. The clinical pathway implementation reduced barriers in team collaboration, improved team coordination and organization, and reduced third-generation cephalosporin use for prophylaxis in surgery (pre: 59 DDD per 100 bed-days; post: 28 DDD per 100 bed-days). This shows that the clinical pathway could benefit antibiotic stewardship in improving antibiotic prescription, therefore reducing the incidence of resistant bacteria