HUBUNGAN KEPATUHAN PENGGUNAAN OBAT DENGAN REHOSPITALISASI PASIEN CONGESTIVE HEART FAILURE (CHF) DI ICCU RSUD TIDAR KOTA MAGELANG: The Relationship Between Compliance Use of Drugs and Readmission Case on Congestive Heart Failure (CHF) Patients at ICCU Tidar Magelang Hospital

Pendahuluan: Congestive Heart Failure (CHF) adalah kondisi abnormalitas dari fungsi dan struktur jantung. Abnormalitas ini menimbulkan sindom klinis pada pasien CHF. Penyakit ini mempunyai angka mortalitas dengan jumlah 20-50% pertahun. CHF juga merupakan penyakit dengan frekuensi rehospitalisasi sebesar 45% pertahun. Kepatuhan penggunaan obat sangat berpengaruh pada kondisi pasien CHF. Ketidakpatuhan dalam penggunaan obat mapu meningkatkan angka mortalitas, morbiditas, dan rehospitalisasi pasien CHF di rumah sakit. Metode: Penelitian ini dimulai pada tanggal 31 Januari - 3 Maret 2018 di ICCU RSUD Tidar Kota Magelang dengan 27 responden. Sumber data pada penelitian ini berasal dari data primer dan sekunder. Data primer menggunakan pertanyaan-pertanyaan yang ada di kuesioner dengan cara melakukan wawancara terhadap pasien, sedangkan data sekunder menggunakan rekam medis rumah sakit. Penelitian ini menggunakan lembar kuesioner yang terdiri dari: kuesioner data demografi, kuesioner kepatuhan penggunaan obat, dan lembar observasi. Lembar observasi berisi rawat inap ulang (rehospitalisasi) pada pasien CHF. Analisis data pada penelitian ini menggunakan Chi Square. Hasil: Hasil uji statistik memperlihatkan responden yang tidak patuh penggunaan obat sejumlah 17 orang (94,4%) dengan frekuensi rehospitalisasi > 1 kali, sementara yang patuh terhadap penggunaan obat terdapat 2 orang (22,2%) dengan frekuensi rehospitalisasi > 1 kali. Responden yang tidak patuh terhadap penggunaan obat sejumlah 1 orang (5,6%) dengan frekuensi rehospitalisasi 1 kali, sementara yang patuh terhadap penggunaan obat terdapat 7 orang (77,8%) dengan frekuensi rehospitalisasi 1 kali. Hasil uji statistik (Chi Square) menunjukkan bahwa 1 cell (25,0%) dengan nilai expected < 5 artinya cells (kotak) yang nilai expectednya di bawah 5 sebanyak 25,0%. Nilai minimum expectednya 2,67 artinya tidak ada nilai expected yang < 1. Continuity Correction dengan nilai p = 0,001. Nilai p Fisher’s Exact Test = 0,000. Hasil tabel Symetric Measure (uji korelasi) diperoleh nilai Contingency Coefficient (r) = 0,598 dengan nilai p = 0,000. Kesimpulan: Kesimpulan dari uji statistik ini adalah terdapat hubungan antara kepatuhan penggunaan obat dengan rehospitalisasi pasien CHF. Kata Kunci: Kepatuhan Penggunaan Obat, Rehospitalisasi, Congestive Heart Failure (CHF

CONGESTIVE HEART FAILURE SELF‐MANAGEMENT EDUCATION AND READMISSION AFTER HOSPITALIZATION

Background: Congestive Heart Failure (CHF) is a condition where the heart can no longer pump blood to the body tissues either to the entire body (systemic circulation) or to the lungs (pulmonary circulation). CHF is a clinical syndrome in patients with structural abnormalities and heart function. Heart function impairment may be a systolic or diastolic function disorder, heart rhythm disturbance, or preload and after load mismatch. This condition can cause death to the patient. Deaths from CHF range from 20-50% per year, in addition CHF is a disease that requires readmission . Frequency of CHF patient readmission  by 45% per year.Purpose: This study aims to analyze the relationship of congestive heart failure self‐management education and readmission after hospitalizationMethods: The study was conducted at ICCU Tidar Magelang hospital with 27 CHF patients who had readmission. The sampling technique was done by consecutive sampling technique. Data analysis in this study using Chi square. The result of statistical test (Chi Square) shows that 2 cells (50%) with expected value <5 means the cells (boxes) whose expected value is below 5 by 50%. The minimum expected value of 2.07 means no expected value <1. Continuity Correction with p = 0,000. Fisher's Exact Test p value = 0,000.Resuts: The results of Symmetric Measure table (correlation test) obtained by the value of Contingency Coefficient (r) = 0.674 with p = 0,000.Conclusion: The conclusion of this statistical test is that there is a correlation between Experience of Self-Management Education (SME)  and readmission  of CHF patients

Persepsi dan Harapan Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis dengan Disfungsi Ereksi terhadap Asuhan Keperawatan Pemenuhan Kebutuhan Seksual di RS TK II.04.05.01 Dr. Soedjono Magelang

Latar belakang. Penyakit Ginjal Kronik merupakan gangguan fungsi ginjal yang bersifat progresif dan irreversible. Pasien laki-laki Penyakit Ginjal Kronik yang menjalani hemodialisis dapat mengalami masalah gangguan seksual disfungsi ereksi. Persepsi dan harapan pasien penyakit ginjal kronik yang menjalani hemodialisis dengan disfungsi ereksi terhadap asuhan keperawatan pemenuhan kebutuhan seksual perlu diketahui dan belum banyak diteliti hingga saat ini. Tujuan. mengeksplorasi persepsi dan harapan pasien penyakit ginjal kronik yang menjalani hemodialisis dengan disfungsi ereksi. Metode. Penelitian observasional menggunakan rancangan penelitian kualitatif dengan pendekatan fenomenologi. Subjek penelitian adalah pasien penyakit ginjal kronik yang menjalani hemodialisis dengan disfungsi ereksi di Unit Hemodialisa RS Dr.Soedjono Magelang sebanyak 7 orang. Pengumpulan data dengan cara indepth interview dilakukan bulan Februari–April 2016. Hasil. Penelitian didapatkan tujuh tema yaitu persepsi asal mula terjadinya penyakit ginjal kronik dan disfungsi ereksi, faktor penyebab terjadinya disfungsi ereksi, sikap dan perasaan terkait kondisi disfungsi ereksi, upaya memenuhi kebutuhan seksual, adaptasi / mekanisme koping, respon / gambaran perasaan pasangan, dampak hubungan dengan pasangan, dan harapan terhadap perawat terkait kondisi disfungsi ereksi. Kesimpulan. Asuhan keperawatan pemenuhan kebutuhan seksual yang komprehensif dapat diterapkan sehingga mencegah terjadinya permasalahan psikososial seperti depresi, yang berefek pada tingkat kesembuhan dan dapat berperan terhadap upaya kesembuhan pasien laki-laki dengan penyakit ginjal kronik yang menjalani hemodialisis dengan permasalahan disfungsi ereksi. Kata Kunci : Disfungsi Ereksi, Hemodialisis, Penyakit Ginjal Kroni

Wound healing activity of aloe vera extract spray on acute wound in male balb/c mice

Acute wounds are tissue injuries that are at risk of infection so they require good treatment and care. Aloe vera (Aloe vera L) contains glukomanan compound that are thought to be beneficial in the wound healing process. Spray preparations in the treatment of wounds can provide concentrared content, dry quickly, and easy to use. The purpose of this study was to examine the spray activity of Aloe extract as an acute wound healer in male balb/c mice. This research method is experimental research. The steps that have been carried out include maceration extraction from Aloe vera simplicia powder with 70% ethanol which is then thick extracted in freeze drying to powder extract. Aloe vera spray preparations are made with concentrations of 1%, 3% and 5%. Balb / C mice that had made full thickness acute wounds were divided into 5 treatment groups namely positive control (PC), negative control (NC), F1, F2, and F3. Mice were treated for 14 days then the wound ratio was calculated and analyzed with one way anova test followed by post hoc tukey cramer test. The results showed that the higher of the percentage of Aloe vera extract is the higher of the wound healing activity.

Hasil cek similarity"Efektivitas Kombinasi Plasma Jet Non -Thermal Dan Spray Aloe vera (L). Burm. f . Pada Penyembuhan Luka Diabetes"

Plasma jet non thermal has benefit in wound healing, but less control can to accumulation of reactive oxygen species. This study aims to determine the effectiveness of the combination of plasma jet and A. vera spray 1% for wound healing in diabetic wounds mice model with parameters of malondialdehyde levels, the skin wound ratio, and blood profile. This study used male Balb/C were induced by a streptozotocin (STZ) and divided into 4 groups, namely groups of untreated diabetic mice wounds (N), groups of diabetic mice wound with A. vera spray 1% (Av), groups of diabetic mice wound with plasma jet non thermal at distance of 20 mm for 3 minutes (P), and groups of diabetic mice wound with plasma jet non thermal at distance of 20 mm for 3 minutes and A. vera spray 1% (PAv). The solution of A. vera spray 1% preparation consists of A. vera, DMSO, and aquabidest extracts. The wounds of all groups treated for 14 days then the malondialdehyde, skin wound ratio and blood profile were calculated by SPSS Statistic. The results of blood glucose before treatment were 241.74 dL ± 51.99. The combination of plasma jet and A. vera spray 1% groups were significant (p 0.05), and not effect on blood profile data (p> 0.05). In conclusion, A. vera spray 1% can reduce the side effects of plasma jet in diabetic wounds by reducing malondialdehyde levels

Hasil cek similarity" Efektivitas Perlakuan Kombinatif Plasma Medis dan Ekstrak Daun Sirih untuk Mempercepat Penyembuhan Luka Fase Proliferasi pada Model Mencit Diabetik"

The continued increase in the number of people with Diabetes Mellitus (DM) in Indonesia is a serious problem. One of the big problems for people with Diabetes Mellitus (DM) is the emergence of complications of diabetic wounds. To date the strategy for treatment of diabetic wounds has been limited to the use of wound dressing, cell therapy and oxygen therapy. The problem is that the strategy is not fully successful. Thus, it is very important to look for new strategies to improve the quality of diabetic wound healing, such as by applying a combination of plasma medicine and local natural product, like the extraction of Daun sirih (Piper betle) leaves. Plasma medicine is a relatively new and multidisciplinary study involving plasma science, biomedical, pharmaceutical and other health sciences aimed at applying plasma to therapeutic health. Plasma is the fourth phase of matter, after the solid, liquid and gas phase. The medical aspects of plasma are related to the ability of plasma to produce biological molecules Reactive Oxygen and Nitrogen Species (RONS). If RONS is controlled in the right dosage it can be efficacious for health therapy. This study intends to examine the effects of combinative treatment of plasma medicine and Piper betel leaf extract for proliferation phase of wound healing in diabetic small animal model. This study used male Balb c mice with acute wounds which were divided into 5 groups, namely groups of untreated normal mice (ND-TP), groups of untreated diabetic mice (D-TP), groups of diabetic mice wounds with Piper betel leaf extract (DS ), the wound group of diabetic mice with plasma medicine (DP) and the wound group of diabetic mice with plasma medicine and Piper betel leaf (DPS). The plasma medicine was treated on wound with condition non-contact style (the plasma jet did not touch the wound) with a distance of plasma jet reactor nozzle to the surface of wound about 20 mm, for 2 minutes, every day. Macroscopic observation of wounds is carried out every day from day 0 to 7. On day 7 it was seen that the size of the wound area for D-P-S was smaller than the other groups. The results of this study indicated that Piper betel leaf extract can potentially be used to optimize the performance of plasma medicine in accelerating diabetic wound healing during the proliferation phase. Further investigation, however, is important to be conducted to study the effect for all phases of wound healing and its mechanism histo-pathologically

Hasil cek similarity" Ethanolic extract of the natural product of Daun sirih (Piper betle) leaves may impede the effectiveness of the plasma jet contact style for acute wounds"

Purpose: An investigation was carried out to determine the effect of an ethanolic extract of the natural product of Daun sirih or Piper betle leaves on the effectiveness of plasma jet treatment for cutaneous acute wound healing in a small animal model mimicking a clinical setting. Method: An atmospheric plasma jet using medical grade argon gas as a carrier gas was developed. The ethanolic extract of Piper betle leaf (EPB) was formulated. Optical emission spectroscopy and chemical methods were applied to evaluate the presence of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in the gas phase and in aqueous and ethanolic media. Small animals were classified into 5 groups, namely, Control (C), Plasma jet (P), Ethanolic extract of Piper betle leaf (EPB), Plasma jet followed by EPB (P-EPB) and EPB followed by plasma jet (EPB-P). The contact and meander styles of plasma jet treatment for wounds were applied daily on acute wounds for 1 min, either alone or before or after EPB treatments. Visual evaluation of wounds was conducted for 14 days. Microscopic evaluation was conducted on days 7, 11 and 14. General staining, namely, haematoxylin-eosin and Azan staining, was conducted to evaluate neoepithelialisation and new collagen formation. Results: This research showed that wound healing in the P group was faster than that in the other groups, while that in groups containing EPB was the same as that in C. In the P group, the number of days to reach peak inflammation was the fewest. On day 7, neoepithelialisation and new collagen formation in P were significantly higher than those in other groups. Conclusion: Plasma jet treatment alone is able to promote inflammation, neoepithelialisation and new collagen formation to accelerate acute wound healing; however, its admixture with EPB may impede such effectiveness. Based on the characterization of the ROS and RNS results, the ethanol solvent may play a primary role in impeding its effectivenes

Hasil Cek Similarity" When plasma jet is effective for chronic wound bacteria inactivation, is it also effective for wound healing?"

Purpose: This investigation aimed to compare the effectiveness of two styles of plasma jet treatment (i.e., contact and non-contact styles) for two biological materials, namely, wound related bacteria and acute wounds. Method: An atmospheric plasma jet operated at a frequency of 18.32 kHz and high AC voltage with a peak-topeak voltage of 9.58 kV and a current of 55.2 mA was applied. Argon gas was used as the carries gas of plasma jet generation and was fixed at a flow rate of 1 standard liters per minute (slm).Two biological materials (i.e., wound related bacteria and acute wound) were applied as experimental objects. The sample groups were based on the two styles of plasma jet treatment: contact and non-contact styles. Microbial inhibition zone calculation and macroscopic and histological observations were also performed. Results: This investigation emphasized that the contact and non-contact styles of plasma jet treatment had significantly different effects for wounds and wound-related chronic bacteria. On the one hand, the contact style was visually attractive and more effective for inactivate bacteria. On the other hand, it caused negative effects, such as damaging normal tissue, significantly impeding wound healing and impeding the growing of new epithelial tissue. The non-contact style, however, was less effective at inactivating bacteria; however, it could accelerate wound healing. Conclusion: In the context of wound healing, the non-contact style of plasma jet treatment may be better than the contact style of plasma jet treatment

Ethanolic extract of the natural product of Daun sirih (Piper betle) leaves may impede the effectiveness of the plasma jet contact style for acute wounds

Purpose: An investigation was carried out to determine the effect of an ethanolic extract of the natural product of Daun sirih or Piper betle leaves on the effectiveness of plasma jet treatment for cutaneous acute wound healing in a small animal model mimicking a clinical setting. Method: An atmospheric plasma jet using medical grade argon gas as a carrier gas was developed. The ethanolic extract of Piper betle leaf (EPB) was formulated. Optical emission spectroscopy and chemical methods were applied to evaluate the presence of reactive oxygen species (ROS) and reactive nitrogen species (RNS) in the gas phase and in aqueous and ethanolic media. Small animals were classified into 5 groups, namely, Control (C), Plasma jet (P), Ethanolic extract of Piper betle leaf (EPB), Plasma jet followed by EPB (P-EPB) and EPB followed by plasma jet (EPB-P). The contact and meander styles of plasma jet treatment for wounds were applied daily on acute wounds for 1 min, either alone or before or after EPB treatments. Visual evaluation of wounds was conducted for 14 days. Microscopic evaluation was conducted on days 7, 11 and 14. General staining, namely, haematoxylin-eosin and Azan staining, was conducted to evaluate neoepithelialisation and new collagen formation. Results: This research showed that wound healing in the P group was faster than that in the other groups, while that in groups containing EPB was the same as that in C. In the P group, the number of days to reach peak inflammation was the fewest. On day 7, neoepithelialisation and new collagen formation in P were significantly higher than those in other groups. Conclusion: Plasma jet treatment alone is able to promote inflammation, neoepithelialisation and new collagen formation to accelerate acute wound healing; however, its admixture with EPB may impede such effectiveness. Based on the characterization of the ROS and RNS results, the ethanol solvent may play a primary role in impeding its effectiveness

When plasma jet is effective for chronic wound bacteria inactivation, is it also effective for wound healing?

Purpose: This investigation aimed to compare the effectiveness of two styles of plasma jet treatment (i.e., contact and non-contact styles) for two biological materials, namely, wound related bacteria and acute wounds. Method: An atmospheric plasma jet operated at a frequency of 18.32 kHz and high AC voltage with a peak-topeak voltage of 9.58 kV and a current of 55.2 mA was applied. Argon gas was used as the carries gas of plasma jet generation and was fixed at a flow rate of 1 standard liters per minute (slm).Two biological materials (i.e., wound related bacteria and acute wound) were applied as experimental objects. The sample groups were based on the two styles of plasma jet treatment: contact and non-contact styles. Microbial inhibition zone calculation and macroscopic and histological observations were also performed. Results: This investigation emphasized that the contact and non-contact styles of plasma jet treatment had significantly different effects for wounds and wound-related chronic bacteria. On the one hand, the contact style was visually attractive and more effective for inactivate bacteria. On the other hand, it caused negative effects, such as damaging normal tissue, significantly impeding wound healing and impeding the growing of new epithelial tissue. The non-contact style, however, was less effective at inactivating bacteria; however, it could accelerate wound healing. Conclusion: In the context of wound healing, the non-contact style of plasma jet treatment may be better than the contact style of plasma jet treatment