Factors Affecting Surgical Waiting Time in Cancer Patients at Referral Hospitals of West Java Province

A challenge for hospitals in facing the high number of patient visits is to provide quality services. One of the vital services in dealing with patients, especially those who will have cancer surgery considering the high rate of mortality cancer, is an improvement in waiting time (WT). Waiting time for elective surgery is one indicator of service quality with a standard of ≤2 days. This research aimed to determine the average WT for surgery, influencing factors, and optimal queuing models. The method used was quantitative and qualitative methods applied to 207 samples with consecutive sampling at West Java Provincial Al-Ihsan Regional General Hospital Bandung from October to December 2016. The analysis used partial least squares (PLS). The results of the study showed that the average WT for surgery was 32 days. Factors that influence WT were inpatient rooms, number of medical personnel, condition of patients, and health insurance. The optimal queue model to reduce surgical waiting time are adding inpatient beds, oncologist doctor, and creating an online system for registration and confirmation of inpatient rooms and operating.   FAKTOR YANG MEMENGARUHI WAKTU TUNGGU OPERASI PASIEN KANKER DI RUMAH SAKIT RUJUKAN JAWA BARAT Tantangan bagi rumah sakit dalam menghadapi jumlah kunjungan pasien yang tinggi adalah mampu memberikan pelayanan berkualitas. Salah satu pelayanan signifikan bagi pasien kanker yang akan menjalani operasi adalah perbaikan waktu tunggu karena mortalitas pasien kanker yang tinggi. Waktu tunggu operasi elektif merupakan salah satu indikator mutu pelayanan dengan standar ≤2 hari. Penelitian bertujuan mengetahui waktu tunggu operasi rerata, faktor yang memengaruhi, dan model antrean yang optimal. Metode yang digunakan adalah kuantitatif dan kualitatif yang diterapkan pada 207 sampel secara consecutive sampling di RSUD Al-Ihsan Provinsi Jawa Barat Bandung dari Oktober hingga Desember 2016. Analisis menggunakan partial least squares (PLS). Hasil penelitian menunjukkan bahwa waktu tunggu operasi rerata adalah 32 hari. Faktor yang berpengaruh terhadap waktu tunggu operasi adalah ruang rawat inap, jumlah tenaga medis, kondisi pasien, dan jaminan kesehatan. Model antrean yang optimal untuk menurunkan waktu tunggu operasi adalah penambahan tempat tidur rawat inap, penambahan dokter spesialis bedah onkologi, serta pembuatan sistem daring untuk pendaftaran dan konfirmasi kesiapan ruang rawat inap dan ruang operasi

Pro-inflammatory cytokine (IL-6) and total count lymphocyte profiles in COVID-19 patients with different severity levels

COVID-19 is caused by the SARS-CoV-2 infection that attacked the human respiratory system. In severe conditions, it causes pneumonia, kidney failure, acute respiratory distress syndrome (ARDS), and even death. The SARS-CoV-2 infection triggers the immune cells to secrete an excess of pro-inflammatory cytokines lead to cytokine storm. It is believed to become one of the mechanisms that cause the ARDS condition. The level of pro-inflammatory cytokines will differ with each case severity. This study aimed to evaluate the profile of pro-inflammatory cytokines in COVID-19 patients with different severity. Therefore, it could be used as therapeutic approach for cytokine storm conditions. It was a cross sectional study using plasma samples of COVID-19 patients from Jakarta Islamic Hospital, Pondok Kopi and Dr. M. Goenawan Partowidigdo Hospital, Cisarua, Indonesia. The COVID-19 patients with severe (n=20) and mild to moderate (n=25) severity were involved in this study. As negative control plasma sample from healthy subjects (n=13) was used. Plasma IL-6 levels were measured using the ELISA technique and plasma lymphocyte levels were measured using a hematology analyzer. The results showed that no significant difference between severity and gender was observed (p=0.256). Meanwhile, there is a significant difference in IL-6 level between negative control, mild-moderate, and severe categories (p=0.015). The average IL-6 level in severe categories was higher than mild-moderate and negative control categories, with values 105.375, 59.75, and 64.577 pg/mL, respectively. This result becomes supporting evidence that there is a cytokine storm condition in severe COVID-19 patients. Furthermore, the lymphocyte level in the severe group is significantly lower than the mild to moderate group. This result may indicate lymphocytopenia in the severe group

Impact on Medical Education and the Medical Student’s Attitude, Practice, Mental Health, After One Year of the Covid-19 Pandemic in Indonesia

Introduction: The COVID-19 pandemic has caused disruptions in educational institutions across the country, prompting medical schools to adopt online learning systems. This study aims to determine impact on medical education and the medical student’s attitude, practice, mental health after 1 year of the Covid-19 pandemic in Indonesia. Methods: This study utilized a cross-sectional design. An online questionnaire was distributed digitally to 49 medical schools in Indonesia from February–May 2021. A total of 7,949 medical students participated in this study. Sampling was carried out based on a purposive technique whose inclusion criteria were active college students. This research used questionnaires distributed in online version among 49 medical faculties that belong to The Association of Indonesian Private Medical Faculty. Instruments included demographic database, medical education status, experience with medical tele-education, ownership types of electronic devices, availability of technologies, programs of education methods, career plans, attitudes toward pandemic, and the mental health of respondents. Univariate and bivariate statistical analysis was conducted to determine the association of variables. All statistical analyses using (IBM) SPSS version 22.0. Results: Most of the respondents were female (69.4%), the mean age was 20.9 � 2.1 years. More than half of the respondents (58.7%) reported that they have adequate skills in using digital devices. Most of them (74%) agreed that e-learning can be implemented in Indonesia. The infrastructure aspects that require attention are Internet access and the type of supporting devices. The pandemic also has an impact on the sustainability of the education program. It was found that 28.1% were experiencing financial problems, 2.1% postponed their education due to this problems. The delay of the education process was 32.6% and 47.5% delays in the clinical education phase. Around 4% student being sick, self-isolation and taking care sick family. the pandemic was found to affect students’ interests and future career plans (34%). The majority of students (52.2%) are concerned that the pandemic will limit their opportunities to become specialists. Nearly 40% of respondents expressed anxiety symptoms about a variety of issues for several days. About a third of respondents feel sad, depressed, and hopeless for a few days. Results: Most of the respondents were female (69.4%), the mean age was 20.9 � 2.1 years. More than half of the respondents (58.7%) reported that they have adequate skills in using digital devices. Most of them (74%) agreed that e-learning can be implemented in Indonesia. The infrastructure aspects that require attention are Internet access and the type of supporting devices. The pandemic also has an impact on the sustainability of the education program. It was found that 28.1% were experiencing financial problems, 2.1% postponed their education due to this problems. The delay of the education process was 32.6% and 47.5% delays in the clinical education phase. Around 4% student being sick, self-isolation and taking care sick family. the pandemic was found to affect students’ interests and future career plans (34%). The majority of students (52.2%) are concerned that the pandemic will limit their opportunities to become specialists. Nearly 40% of respondents expressed anxiety symptoms about a variety of issues for several days. About a third of respondents feel sad, depressed, and hopeless for a few days. Conclusion: The infrastructure and competency of its users are required for E-learning to be successful. The majority of medical students believe that e-learning can be adopted in Indonesia and that their capacity to use electronic devices is good. However, access to the internet remains a problem. On the other side, the pandemic has disrupted the education process and mental health, with fears of being infected with SARSCoV- 2, the loss of opportunities to apply for specialty training, and the potential for increased financial difficulties among medical students. Our findings can be used to assess the current educational process in medical schools and maximize e-learning as an alternative means of preparing doctors for the future. Keywords: COVID-19, e-learning, Indonesia, medical education, student