Pembangunan perindustrian dan impak terhadap ekonomi lokal di Dumai, Riau, Indonesia.

Pembangunan perindustrian di Indonesia pada era autonomi daerah harus dapat menjawab segala tentangan globalisasi ekonomi dunia dan mampu menjangkakan perkembangan perubahan persekitaran. Makalah ini bertujuan menganalisis impak pembangunan perindustrian terhadap pembangunan ekonomi lokal pada era autonomi daerah Riau, Indonesia. Kajian lapangan dijalankan untuk mendapatkan pendapat pakar dari key informant di Dumai serta Pekan Baru di Riau, Indonesia. Pembangunan perindustrian mempunyai impak positif dan negatif. Pembangunan perindustrian pada era autonomi daerah lebih mementingkan aspek pertumbuhan ekonomi dan pembangunan fizikal manakala kualiti persekitaran tergugat. Justeru, pembangunan perindustrian mesti mengambilkira kepentingan persekitaran untuk kepentingan generasi hadapan. Kemorosotan kualiti persekitaran memberi impak terhadap kemorosotan kualiti hidup penduduk tempatan dan kualiti persekitaran. Oleh hal sedemikian, langkah-langkah perlu dilaksanakan demi memelihara kesejahteraan dan keselamatan generasi masa akan datang

The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Contains fulltext : 177987.pdf (publisher's version ) (Open Access)BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal

Physiological parameters for Prognosis in Abdominal Sepsis (PIPAS) Study: A WSES observational study

Background: Timing and adequacy of peritoneal source control are the most important pillars in the management of patients with acute peritonitis. Therefore, early prognostic evaluation of acute peritonitis is paramount to assess the severity and establish a prompt and appropriate treatment. The objectives of this study were to identify clinical and laboratory predictors for in-hospital mortality in patients with acute peritonitis and to develop a warning score system, based on easily recognizable and assessable variables, globally accepted. Methods: This worldwide multicentre observational study included 153 surgical departments across 56 countries over a 4-month study period between February 1, 2018, and May 31, 2018. Results: A total of 3137 patients were included, with 1815 (57.9%) men and 1322 (42.1%) women, with a median age of 47 years (interquartile range [IQR] 28-66). The overall in-hospital mortality rate was 8.9%, with a median length of stay of 6 days (IQR 4-10). Using multivariable logistic regression, independent variables associated with in-hospital mortality were identified: age &amp;gt; 80 years, malignancy, severe cardiovascular disease, severe chronic kidney disease, respiratory rate ≥ 22 breaths/min, systolic blood pressure &amp;lt; 100 mmHg, AVPU responsiveness scale (voice and unresponsive), blood oxygen saturation level (SpO2) &amp;lt; 90% in air, platelet count &amp;lt; 50,000 cells/mm3, and lactate &amp;gt; 4 mmol/l. These variables were used to create the PIPAS Severity Score, a bedside early warning score for patients with acute peritonitis. The overall mortality was 2.9% for patients who had scores of 0-1, 22.7% for those who had scores of 2-3, 46.8% for those who had scores of 4-5, and 86.7% for those who have scores of 7-8. Conclusions: The simple PIPAS Severity Score can be used on a global level and can help clinicians to identify patients at high risk for treatment failure and mortality. © 2019 The Author(s)