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All Journal JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit) Cermin Dunia Kedokteran
Romaniyanto, Romaniyanto
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Economics, Econometrics & Finance Health Professions Medicine & Pharmacology Nursing Public Health

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Transforming Orthopedic Services at a National Referral Hospital: Expertise, Technology, and Policy Sumarwoto, Tito; Sari, Ayi Wagiati; Rizai, Ahmad; Pamela, Dina Sintia; Idulhaq, Mujaddid; Romaniyanto, Romaniyanto
JMMR (Jurnal Medicoeticolegal dan Manajemen Rumah Sakit) Vol. 15 No. 2 (2026): August 2026
Publisher : Universitas Muhammadiyah Yogyakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.18196/jmmr.v15i2.702

Abstract

This study describes the strategic transformation of Prof. Dr. R. Soeharso Orthopedic Hospital, Indonesia’s national orthopedic referral center, using a five‑pillar framework: subspecialty development, advanced technologies, infrastructure and rehabilitation, alignment with national health priorities, and structured monitoring. A mixed-methods case study design was employed, integrating qualitative thematic analysis of institutional and policy documents with longitudinal quantitative analysis of performance data spanning 2019–2025. Institutional documents and national policy sources were analyzed thematically and benchmarked against leading international orthopedic hospitals. Service indicators showed substantial growth after the COVID‑19 downturn: total outpatients increased by 54.5% (89,705 to 138,604), surgical procedures by 157.9% (4,661 to 12,024), and hospitalizations by 106.7% (5,014 to 10,365). Bed occupancy recovered to 68.0%, while average length of stay declined from 4.81 to 3.74 days, indicating improved efficiency. Subspecialty outpatient volume rose 358%, with spine and adult reconstruction services showing the fastest growth. Transformation milestones included 100% EMR implementation across 24 clinical units, six dedicated subspecialty operating theatres, SNARS accreditation, and formal designation as a Main Provider Teaching Hospital in 2024. The framework offers a context‑specific, replicable model for orthopedic service transformation in low‑ and middle‑income countries.
Effects of Hypoxic Adipose-Derived Mesenchymal Stem Cells and Their Secretome on Type II Collagen Expression in a Rabbit Model of Disc Degeneration: Research Dzikri, Dykall Naf'an; Romaniyanto, Romaniyanto; Dzikri, Dykall; Sadewa, Daffa; Fachreza, Muhammad Setya
Cermin Dunia Kedokteran Vol 53 No 10 (2026): Oktober 2026 - CDK 357
Publisher : PT Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55175/cdk.v53i10.2354

Abstract

Introduction: Intervertebral disc (IVD) degeneration is a major cause of low back pain, and is characterized by the loss of extracellular matrix, particularly type II collagen. Regenerative therapies using mesenchymal stem cells (MSCs) and their secretome have shown promise, but their comparative effects on type II collagen expression require further investigation. This study aimed to evaluate and compare the effects of allogeneic hypoxic adipose-derived mesenchymal stem cells (Ad-MSCs) and their secretome on type II collagen expression in a rabbit model of IVD degeneration. Methods: A true experimental study was conducted on 18 New Zealand White rabbits. Degeneration was induced by needle puncture. Subjects were divided into three groups: control (fibrin glue), P1 (hypoxic Ad-MSC), and P2 (secretome). After 8 weeks, type II collagen expression was analyzed using immunohistochemistry. Results: Both P1 and P2 showed significantly higher type II collagen expression than the control (p = 0.001 and p < 0.001, respectively). The secretome group (P2) showed significantly higher expression than the Ad-MSC group (P1) (p = 0.039). These findings suggest that the secretome may provide a greater stimulatory effect on type II collagen expression than direct cell administration. Conclusion: The hypoxic Ad-MSC-derived secretome resulted in higher type II collagen expression than hypoxic Ad-MSCs administration in this rabbit model.
Co-Authors Dzikri, Dykall Dzikri, Dykall Naf'an Fachreza, Muhammad Setya Idulhaq, Mujaddid Pamela, Dina Sintia Rizai, Ahmad Sadewa, Daffa Sari, Ayi Wagiati Sumarwoto, Tito