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Peran Farmasis Klinis pada Pasien Gagal Ginjal Tahap Akhir dengan Hemodialisis Rahmatullah, Daril; Widyati, Widyati
Indonesian Journal of Clinical Pharmacy Vol 1, No 2 (2012)
Publisher : Indonesian Journal of Clinical Pharmacy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (611.444 KB)

Pasien gagal ginjal tahap akhir dengan hemodialisis merupakan populasi pasien dengan kondisi multipatologis dan multiterapi yang laju morbiditas serta mortalitasnya terus meningkat. Tujuan penelitian ini adalah untuk mengetahui peran farmasis klinis pada manajemen perkembangan penyakit gagal ginjal tahap akhir yang menggunakan terapi hemodialisis di Indonesia. Penelitian ini menggunakan metode kajian sistematis melalui penelusuran database penelitian. Penelitian yang terlibat terdiri atas 2 penelitian dengan metodologi ekperimental dan 8 metodologi deskriptif. Jenis peran farmasis klinis yang dilakukan adalah review catatan terapi (90%), evaluasi terapi (70%) dan implementasi terapi (20%). Penelitian yang ada telah memberikan gambaran mengenai peran farmasis klinis pada populasi pasien gagal ginjal dengan hemodialisis. Gambaran tersebut masih terbatas pada aktivitas pengkajian atau assessment. Hal ini karena penelitian yang berfokus pada peran farmasis klinis secara umum di Indonesia juga terbatas jumlahnya. Hasil penelitian ini menunjukkan bahwa peran farmasis klinis di Indonesia belum dapat dinilai kebermaknaannya.Kata kunci: Hemodialisis, gagal ginjal, farmasis klinisÂ Clinical Pharmacist Roles On End-Stage Renal Disease Patient with HemodialysisAbstractEnd-stage renal disease with hemodialysis are considered as a multipathology and multitherapy patients which has an increase of morbidity and mortality rate. This research aim was to understand the roles of Indonesia clinical pharmacist, regarding to the subject with hemodialysis therapy. This study was a systematic review through research databases. The clinical pharmacist roles or activities ,which have beendone, were medical record review (9/10), therapeutic evaluation (7/10) and therapeutic implementation(2/10). All the studies have viewed clinical pharmacist activities on hemodialysis patient. Nonetheless the activities were only on assessment step which was actually an initial step. Limitation on quantity of this focused study on clinical pharmacist activitis on hemodialysis in Indonesia has been another constraint. The included studies have given an even more partial view due to lack of documentation on how the finding in the included research was beingÂ assessed then followed as pharmacist care plan by the clinical pharmacist. The result of this study showed that clinical pharmacist role in Indonesia has not been yet defined its significance.Key words: Hemodialysis, renal failure, clinical pharmacist

Profil Penggunaan Antibiotik Pascapencanangan Penerapan Program Pengendalian Resistensi Antibiotik di Intensive Care Unit Rumah Sakit TNI-AL dr. Ramelan Surabaya Setiawan, Stefanie; Widyati, Widyati; Harijono, Pandu
Indonesian Journal of Clinical Pharmacy Vol 7, No 1 (2018)
Publisher : Indonesian Journal of Clinical Pharmacy

Program Pengendalian Resistensi Antibiotik (PPRA) merupakan program wajib rumah sakit Indonesia sesuai Permenkes No. 8 tahun 2015. Rumkital dr. Ramelan Surabaya termasuk salah satu rumah sakit yang telah menerapkan PPRA. Tujuan penelitian ini adalah untuk mengetahui deskripsi kuantitatif-kualitatif pemakaian antibiotik, serta luaran klinis dan mikrobiologis yang teramati pascapencanangan penerapan PPRA di ICU Rumkital dr. Ramelan Surabaya. Desain penelitian adalah studi observasi cross-sectional yang dilakukan selama 3 bulan (FebruariâMei 2016) di ICU Rumkital dr. Ramelan. Deskripsi kuantitatif diamati menggunakan Days of Therapy (DOT/100 hari-pasien), deskripsi kualitatif menggunakan alur Gyssens. Pengamatan luaran klinis dilakukan terhadap infeksi nosokomial, mortalitas terkait infeksi, dan lama tinggal di ICU (Length of Stay/LOS). Pengamatan luaran mikrobiologis dilakukan terhadap pola penyebaran bakteri multiresisten. Hasil perhitungan jumlah konsumsi antibiotik didapatkan 151,63 DOT/100 hari-pasien. Penilaian kualitas antibiotik menunjukkan hasil 52,73% terapi tepat; 8,18% tidak tepat; 7,27% tanpa indikasi; 31,82% tidak tercapai kesepakatan antar penilai (Îº=0,59; p<0,05). Infeksi nosokomial terbanyak yaitu Hospital Acquired Pneumonia (HAP)/Ventilator Associated Pneumonia (VAP), mortalitas terkait infeksi 44,68%; dan LOS rata-rata 7,17Â±1,9 hari (p<0,05). Belum ditemukan adanya insiden Methicillin-resistant Staphylococcus aureus (MRSA) ataupun Extended Spectrum Beta-Lactamase (ESBL), namun ditemukan dua kasus Multi Drug Resistant (MDR) Acinetobacter baumannii.Kata kunci: Alur Gyssens, DOT, ICU, PPRA, resistensi antibiotikÂ Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital SurabayaAntibiotic Stewardship Program (ASP) is mandatory to all Indonesian hospitals, in accordance to the 2015 Minister of Health Decree No. 8. Dr. Ramelan Naval Hospital Surabaya is one among the many hospitals in Indonesia that has implemented the ASP. The study objective was to describe quantitative-qualitatively the use of antibiotics, along with clinical and microbiological outcomes observed in an Intensive Care Unit (ICU) after ASP implementation in dr. Ramelan Naval Hospital Surabaya. The design was a 3-month (FebruaryâMay 2016) cross-sectional observational study. Quantitative description was reported using Days of Therapy (DOT)/100 patient-days, the qualitative description was reviewed using Gyssensâ flowchart. Clinical outcomes observed include nosocomial infection, infection-related mortality, and average length of stay (LOS). Microbiological outcome was observed through the occurences of multi-drug resistant organism. The results showed overall antibiotic use was 151.63 DOT/100 patient-days. Quality of antibiotic use were 52.73% definitely appropriate; 8.18% inappropriate regarding dose, intervals, durations, and timing; 7.27% no indication; and no mutual agreement in 31.82% (Îº=0.59; p<0.05). Hospital Acquired Pneumonias (HAPs)/Ventilator Associated Pneumonias (VAPs) were the most observed nosocomial infection, infection-related mortality rate was 44.68%; and average LOS were 7.17Â±1.9 days (p<0.05). No incidents of Methicillin-resistant Staphylococcus aureus (MRSA) or Extended Spectrum Beta-Lactamase (ESBL) have been found, but there were two cases of Multi Drug Resistant (MDR) Acinetobacter baumannii.Keywords: Antibiotic resistance, ASP, DOT, Gyssensâ flowchart, ICU

Laporan Kasus Tentang Aspirin Dosis Rendah Memicu Anemia Aplastik Widyati, Widyati
JFIOnline | Print ISSN 1412-1107 | e-ISSN 2355-696X Vol 7, No 2 (2014)
Publisher : Indonesian Research Gateway

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Aspirin has been reported could trigger aplastic anemia in an elderly patient who used aspirin as antiplatelet therapy for secondary prevention of coronary heart diseases. Assessment methods used are time series data collection followed by causality analysis using Naranjo Scale. The results of analysis reveals a Naranjo scale of 11 which was then interpreted as definite. This report concluded that low-dose aspirin triggered acquired aplastic anemia. The mechanism of the AA presumably through destruction of immunemediated bone marrow or through direct destruction of blood cells. Keywords: Aspirin, antiplatelet, aplastic anemia, Naranjo scale Aspirin dilaporkan telah memicu anemia aplastik (AA) pada seorang pasien manula yang menggunakan aspirin sebagai antiplatelet untuk prevensi sekunder penyakit jantung koroner. Metode asesmen yang digunakan adalah pengumpulan data secara time series dilanjutkan dengan analisis kausalitas menggunakan Skala Naranjo. Hasil telaah kasus menunjukkan skala Naranjo 11 (definite) yang diinterpretasikan bahwa insiden anemia aplastik tersebut pasti dipicu oleh aspirin. Disimpulkan bahwa aspirin dosis rendah memicu anemia aplastik dengan tipe acquired Aplastic Anemia. Mekanisme terjadinya AA tersebut diduga melalui pengrusakan sumsum tulang yang diperantarai immun atau melalui pengrusakan langsung sel-sel darah Kata kunci: Aspirin, antiplatelet, anemia aplastik, skala Naranjo

Laporan Kasus Tentang Aspirin Dosis Rendah Memicu Anemia Aplastik Widyati, Widyati
Jurnal Farmasi Indonesia Vol 7, No 2 (2014)
Publisher : Jurnal Farmasi Indonesia

Aspirin has been reported could trigger aplastic anemia in an elderly patient who used aspirin as antiplatelet therapy for secondary prevention of coronary heart diseases. Assessment methods used are time series dataÂ collection followed by causality analysis using Naranjo Scale. The results ofÂ analysis reveals a Naranjo scale of 11 which was then interpreted as definite.Â This report concluded that low-dose aspirin triggered acquired aplastic anemia. The mechanism of the AA presumably through destruction of immunemediated bone marrow or through direct destruction of blood cells. Keywords: Aspirin, antiplatelet, aplastic anemia, Naranjo scale Â Aspirin dilaporkan telah memicu anemia aplastik (AA) pada seorang pasien manula yang menggunakan aspirin sebagai antiplatelet untuk prevensi sekunder penyakit jantung koroner. Metode asesmen yang digunakan adalah pengumpulan data secara time series dilanjutkan dengan analisis kausalitas menggunakan Skala Naranjo. Hasil telaah kasus menunjukkan skala Naranjo 11 (definite) yang diinterpretasikan bahwa insiden anemia aplastik tersebut pasti dipicu oleh aspirin. Disimpulkan bahwa aspirin dosis rendah memicu anemia aplastik dengan tipe acquired Aplastic Anemia. Mekanisme terjadinya AA tersebut diduga melalui pengrusakan sumsum tulang yang diperantarai immun atau melalui pengrusakan langsung sel-sel darah Kata kunci: Aspirin, antiplatelet, anemia aplastik, skala NaranjoÂ

DEVELOPING SUPPLEMENTARY READING COMPREHENSION MATERIALS FOR AUTOMOTIVE MECHANICAL SKILLS PROGRAM Widyati, Widyati; Regina, Regina; Sutapa, Y. Gatot
Jurnal Pendidikan dan Pembelajaran Khatulistiwa Vol 7, No 12 (2018): Desember 2018
Publisher : Jurnal Pendidikan dan Pembelajaran Khatulistiwa

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Abstract This present study was administered to develop supplementary reading comprehension materials for the tenth grade students of Automotive Mechanical skills Program. The writer applied Research and Development study (R&D). The participants of the research were tenth grade students of Automotive Mechanical Skills Program of SMK Negeri 2 Pontianak in academic year 2015/2016 and also the English teacher who taught the class. The data of the present study were collected by interview, questionnaire, observation table checklist and validation table checklist. This study found that the problem in the existing reading material was irrelevancy of the materials with the program of the students. Furthermore, about 74,1% students stated that they need reading materials related to their program. Therefore reading comprehension materials needed to be developed. From the finding, there were eight requirements needed to be met. They were suited to syllabus, related to the automotive mechanical skills program, containedÂ vocabularies related to program, contained interesting materials, contained enjoyable activities, could be coped by the teacher and students, related to the studentsâ€™ prior knowledge and must be contextual. As the result, the reading materials developed by the writer had met all the requirements. It got positive responses from both the teacher and students.Â Keywords: Developing Material, Reading Comprehension, AutomotiveÂ Â Mechanical Skills Program.

Comparison Among Proton Pump Inhibitor Inducing Pneumonia in Hospital: Narrative Review Sari, Juwita Permata; Nugroho, Agung Endro; Widyati, Widyati
Majalah Farmaseutik Vol 20, No 3 (2024)
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/farmaseutik.v20i3.88612

Critically ill patients requiring intensive care unit (ICU) are highly vulnerable to the emergence of stress-related gastrointestinal bleeding, a condition closely associated with unfavorable clinical outcomes. Despite advancements in preventive measures, antimicrobial therapies, and supportive medical care, ventilator-associated pneumonia (VAP) and hospital-acquired pneumonia (HAP) continue to effect morbidity and mortality rates significantly. Hospital-acquired pneumonia (HAP) is characterized as a form of pneumonia that does not manifest during the period of hospital admission but rather emerges 48 hours or later after the patient has been admitted. In contrast, VAP occurs after 48 hours of having an endotracheal tube in place. Proton pump inhibitors (PPIs) are used prophylactically to manage stress ulcers in critically ill patients. However, recent scholarly literature has drawn attention to a potential link between using acid-suppressing medications and an increased susceptibility to pneumonia. The precise mechanism through which these acid suppressors might elevate the risk of pneumonia remains unclear. The primary objective of this study was to assess the prevalence of pneumonia associated with different types of proton pump inhibitors. We conducted an extensive literature search using keywords such as "(omeprazole or pantoprazole or lansoprazole or esomeprazole or rabeprazole), ICU, Pneumonia" on two prominent electronic databases: Scopus and PubMed. We identified fourteen articles meeting our inclusion criteria, which were categorized into four groups based on the type of proton pump inhibitor: omeprazole, esomeprazole, lansoprazole, and pantoprazole. The results of this narrative review revealed varying risk levels associated with using different proton pump inhibitors for pneumonia. Esomeprazole had the highest risk level, at 48.84%, followed by lansoprazole at 27.85%, omeprazole at 22.5%, and pantoprazole at 19.94%.

THE EFFECT OF FUROSEMIDE IN CRITICALLY ILL ADULT PATIENTS – A NARRATIVE REVIEW Putri, Cyndi Yulanda; Nugroho, Agung Endro; Widyati, Widyati
Majalah Farmaseutik Vol 20, No 3 (2024)
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/farmaseutik.v20i3.88784

Background: Fluid overload is the common condition in the critically ill patients. This associated with the increased fluid intake and inadequate elimination. The management of fluid overload is by fluid removal with diuretic. Furosemide is a loop diuretic that frequently used as the initial therapy. However, the utilization of furosemide in the critically ill reminds a polarizing subject. The purpose of this study is to investigate the impact of furosemide on patients who are critically ill. Methods: The inclusion criteria included randomized controlled trials as well as observational cohort studies. The data sources utilized in this study were PubMed, Science Direct, ProQuest, and Cochrane.Results: We included 13 articles, of which 9 articles about generally critically ill patients with or without acute kidney injury (AKI), 2 articles about heart failure, and 2 articles about post operative. The furosemide was effective in generally critically ill patients with or without AKI, it can decrease the fluid balance, weight change, and improves the urine output. Furosemide had no harmful effect on kidney function. However, patients without oliguria were not recommended to receive high dose of furosemide. Critically ill patients with heart failure who received continuous infusion of furosemide were more susceptible to increased diuresis and greater depression of thoracic fluid content (TFC). Furthermore, it might cause the decrease of renal function. When compared to furosemide, continuous veno-venous hemodiafiltration (CVVHDF) was more successful at removing excess fluid, reducing weight, relieving symptoms, and improving hemodynamic and cardiac performance. In post operative patients, furosemide might cause metabolic alkalosis. Urinary electrolyte excretion rates were promptly altered by the use of low dose furosemide.Conclusion: Based on the patient's clinical data, furosemide use should be taken into consideration. In general, furosemide is effective to improve diuresis. Furosemide in the AKI condition with oliguria has beneficial effect. However, in heart failure condition, furosemide might affect renal function. In post operative, it might cause metabolic alkalosis. Further randomized controlled trial (RCT) is required.

Peran Farmasis Klinis pada Pasien Gagal Ginjal Tahap Akhir dengan Hemodialisis Rahmatullah, Daril; Widyati, Widyati
Indonesian Journal of Clinical Pharmacy Vol 1, No 2 (2012)
Publisher : Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (611.444 KB)

Pasien gagal ginjal tahap akhir dengan hemodialisis merupakan populasi pasien dengan kondisi multipatologis dan multiterapi yang laju morbiditas serta mortalitasnya terus meningkat. Tujuan penelitian ini adalah untuk mengetahui peran farmasis klinis pada manajemen perkembangan penyakit gagal ginjal tahap akhir yang menggunakan terapi hemodialisis di Indonesia. Penelitian ini menggunakan metode kajian sistematis melalui penelusuran database penelitian. Penelitian yang terlibat terdiri atas 2 penelitian dengan metodologi ekperimental dan 8 metodologi deskriptif. Jenis peran farmasis klinis yang dilakukan adalah review catatan terapi (90%), evaluasi terapi (70%) dan implementasi terapi (20%). Penelitian yang ada telah memberikan gambaran mengenai peran farmasis klinis pada populasi pasien gagal ginjal dengan hemodialisis. Gambaran tersebut masih terbatas pada aktivitas pengkajian atau assessment. Hal ini karena penelitian yang berfokus pada peran farmasis klinis secara umum di Indonesia juga terbatas jumlahnya. Hasil penelitian ini menunjukkan bahwa peran farmasis klinis di Indonesia belum dapat dinilai kebermaknaannya.Kata kunci: Hemodialisis, gagal ginjal, farmasis klinis Clinical Pharmacist Roles On End-Stage Renal Disease Patient with HemodialysisAbstractEnd-stage renal disease with hemodialysis are considered as a multipathology and multitherapy patients which has an increase of morbidity and mortality rate. This research aim was to understand the roles of Indonesia clinical pharmacist, regarding to the subject with hemodialysis therapy. This study was a systematic review through research databases. The clinical pharmacist roles or activities ,which have beendone, were medical record review (9/10), therapeutic evaluation (7/10) and therapeutic implementation(2/10). All the studies have viewed clinical pharmacist activities on hemodialysis patient. Nonetheless the activities were only on assessment step which was actually an initial step. Limitation on quantity of this focused study on clinical pharmacist activitis on hemodialysis in Indonesia has been another constraint. The included studies have given an even more partial view due to lack of documentation on how the finding in the included research was being assessed then followed as pharmacist care plan by the clinical pharmacist. The result of this study showed that clinical pharmacist role in Indonesia has not been yet defined its significance.Key words: Hemodialysis, renal failure, clinical pharmacist

The Incidence and Risk Factor Analysis of Drug Induced Liver Injury (Dili) in a Surabaya Hospital Arrang, Sherly Tandi; Widyati, Widyati
Jurnal Farmasi Galenika (Galenika Journal of Pharmacy) (e-Journal) Vol. 4 No. 2 (2018): (October 2018)
Publisher : Universitas Tadulako

The research has been conducted on the incident and analysis of risk factors drug liver injury (DILI) in a Surabaya Hospital. The aim of this study was to determine the incident of DILI, know which drugs cause DILI, and see the association of risk factors to DILI. The research method was descriptive and analytical observational (prospective cohort). Danan-Benichou scale is a tool used to ascertain drugs that cause DILI. Based on data collected for 3 months, the population was 1202 patients. Samples fulfilling the inclusion and exclusion criteria were 310 patients, the risk drug group of DILI were 285 patients (11 DILI, 274 Non-DILI), and the non-risk drug group 25 patients (11 DILI, 14 Non-DILI). The incident of DILI was 3.55%. Drugs that cause DILI are ranitidine (4 cases), omeprazole (1 case), rifampicin (2 cases), meropenem (1 case), ciprofloxacin (1 case), methotrexate (1 case), and dexamethasone (1 case). Characteristic of patients with DILI (11 patients) are average age of 59.27 Â± 15.54 years (23-73 years), belonging to high risk group (54.55%), male gender (81,82%), have moderate comorbid disease (54.55%), and are not comsumsing alcohol (100%). This research use logistic regression analysis through SPSS 17.0 program to see the relation of risk factor to DILI incident. The p results were obtained from sex (0,156), age (0,534), and comorbid isease (0,213)> Î± (0,05) which means gender, age, and comorbid disease do not significantly affect the incident of DILI.

Efektivitas dan Keamanan Furosemid Continuous Infusion Dosis 10 dan 20 mg/jam pada Pasien Penyakit Ginjal Kronik Kondisi Fluid Overload Syndrome disertai Hipoalbumin di RSUD Abdul Wahab Sjahranie Setiadi, Diga Albrian; Widyati, Widyati; Yakti, Kuntjoro
Jurnal Farmasi Sains dan Terapan (Journal of Pharmacy Science and Practice) Vol. 7 No. 1 (2020): Februari
Publisher : Faculty of Pharmacy, Widya Mandala Surabaya Catholic University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33508/jfst.v7i1.2390

Furosemide continuous infusion is the first choice drug in overcoming the condition of Fluid overload syndrome with hypoalbuminemia in patients with Chronic Kidney Disease (CKD). However, in these conditions, the dose of furosemide used by clinicians is between 10 and 20 mg/hour. No studies have compared the effectiveness and safety of different doses of furosemide. This study aimed to evaluate the effectiveness and safety of 10 and 20 mg/hour furosemide given in continuous infusion in CKD patients with fluid overload syndrome with hypoalbuminemia. The method is a Single-blind, Randomized Clinical Trial conducted during the period of February-April 2017 in the inpatient ward of Abdul Wahab Sjahranie Hospital. Data processing was carried out by statistical analysis, Two Independent T-Test parametric test for data that normally distributed and those that did not correlate with each other, whereas for data that not normally distributed and those that did not correlate with each other, non-parametric test Mann Whitney and Wilcoxon were used. Outcomes studies were 24-hour urine volume, shortness of breath, duration of oxygen consumption, Ronchi and safety of therapy seen from drug side effects (hypotension, hyperuricemia, hyperglycemia, hyponatremia, hypokalemia). The results of the study, 34 patients with CKD with fluid overload syndrome with hypoalbuminemia (2.5-3.0 g/dL) were registered. On the effectiveness of therapy, there was no significant difference in 24-hour urine volume (P = 0.324; P> 0.05; 95%; CI=714.6-1017.8 ml group 1; CI=818.0-1113.2 ml group 2), shortness of breath (P = 0.781; P> 0.05; 95 % CI=0.68-1.32 group 1; CI=0.72-1.40 group 2), duration of oxygen use (P = 0.363; P> 0.05; 95% CI=1.34-2.66 day group 1; CI=1.72-3.10 day group 2), Ronk (P = 0.692; P> 0.05 ) and the absence of drug adverse events (P = 1.000; P> 0.05) between the two groups. In conclusion, the dose of 10 and 20 mg/hour furosemide has the same

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