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All Journal The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy International Journal of Economics, Commerce, and Management Jurnal Epidemiologi Kesehatan Indonesia
Ilham Ahmadi
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Decision Sciences, Operations Research & Management Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Social Sciences

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The Success Rate of ERCP for Identification and Stenting in Obstructive Jaundice in Cipto Mangunkusumo Hospital October 2004-July 2007 Simon Salim; Daniel Gunawan; Ilham Ahmadi; Marcellus Simadibrata; Achmad Fauzi; Ari Fahrial Syam
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 9, ISSUE 2, August 2008
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/92200845-47

Abstract

Background: Obstructive jaundice can be caused by malignant or benign origin. The treatment for these situations includes drainage by biliary stenting. The aim of this study was to evaluate the success rate of Endoscopic Retrograde Cholangiopancreatography (ERCP) in evaluating malignant obstructive jaundice and the success rate of plastic stent placement. Method: We conducted a retrospective study based on data of ERCP in Cipto Mangunkusumo hospital from October 2004 until July 2007. Results: We evaluated 100 patients who had undergone ERCP examination, 92 (92%) of them had clinical diagnosis of obstructive jaundice (direct bilirubin indirect bilirubin). Those with obstructive jaundice were found to have no malignancy in 47 (51.1%) patients, with malignancy in 28 (30.4%) patients, and 17 (18.5%) of them would have further diagnostic evaluation. We had conducted a descriptive study in 36 patients who had tried to have plastic stent placement. Nineteen (52.8%) patients succeed in plastic stent placement; whereas 17 (47.2%) patients had failed. Further evaluation showed that age and sex did not affect stent successfulness, and malignancy was showed to be a factor for stent failure (malignancy: 16 fail and 6 successes (27.3%) vs. non malignancy: 1 fail and 13 successes (92.85%). Conclusion: Cipto Mangunkusumo hospital has acceptable success rate for diagnostic ERCP in obstructive jaundice patients. However, it is relatively lower than other studies, which might be caused by late referral and different standard instruments that were used. Keywords: obstructive jaundice, malignancy, ERCP, stent placement
Faktor-faktor yang Berhubungan dengan Ketidakpatuhan Minum Antiretroviral pada Orang dengan HIV di Rumah Sakit Umum Daerah Balaraja Kabupaten Tangerang Sari, Dessi Marantika Nilam; Sudaryo, Mondastri Korib; Nada, Qotrun; Ahmadi, Ilham
Jurnal Epidemiologi Kesehatan Indonesia Vol. 7, No. 2
Publisher : UI Scholars Hub

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Kurangnya kepatuhan terhadap pengobatan menjadi faktor risiko munculnya jenis HIV yang resisten terhadap obat, yang dapat ditularkan kepada orang lain. Kepatuhan terhadap pengobatan yang buruk tidak hanya membahayakan kesehatan individu tetapi juga meningkatkan penularan. Penelitian ini bertujuan untuk mengamati faktor-faktor yang berhubungan dengan terjadinya ketidakpatuhan minum obat ARV pada ODHIV yang mendapatkan terapi ARV di Rumah Sakit Umum Daerah Balaraja. Jenis penelitian ini menggunakan penelitian observasional dengan rancangan cross sectional. Penelitian dilakukan di poli HIV Rumah Sakit Umum Daerah Balaraja Kabupaten Tangerang dan waktu penelitian dilakukan pada bulan Juli 2023 menggunakan data sekunder. Populasi penelitian berjumlah 382 ODHIV yang aktif menjalani pengobatan antiretroviral di Rumah Sakit Umum Daerah Balaraja dengan menggunakan teknik random sampling sesuai dengan kriteria inklusi dan ekslusi sehingga sampel penelitian berjumlah 198 ODHIV. Analisis data menggunakan aplikasi STATA. Hasil analisis kai kuadrat secara statistik ada hubungan antara stadium klinis HIV (P-value=0,036), lamanya terapi (P-value=0,020), dan riwayat infeksi oportunistik TB (P-value=0,029) dengan ketidakpatuhan minum obat ARV. Hasil analisis Cox Regression dengan faktor yang secara statistik berhubungan terhadap kepatuhan minum obat antiretroviral pada ODHIV adalah lamanya terapi (P-value=0,045) dengan nilai PR 1,45 dengan 95% CI (1,01-2,08), yang artinya lamanya minum obat ARV >5 tahun memiliki resiko 1,45 kali lebih besar tidak patuhnya minum obat ARV. Faktor lamanya terapi ARV memiliki pengaruh terhadap kepatuhan minum obat antiretroviral (ARV) pada ODHIV di Rumah Sakit Umum Daerah Balaraja.
Applying Lean Hospital Strategies to Minimise Waiting Times in the Internal Medicine Clinic Ilham Ahmadi; Erry Yudhya Mulyani; Anastina Tahjoo
International Journal of Economics, Commerce, and Management Vol. 3 No. 2 (2026): International Journal of Economics, Commerce, and Management
Publisher : Asosiasi Riset Ekonomi dan Akuntansi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.62951/ijecm.v3i2.1213

Abstract

Prolonged outpatient waiting time remains a major challenge in public hospitals and reflects inefficiencies in service process management. Internal medicine clinics are characterised by high service complexity and patient volume, making them particularly vulnerable to process waste that contributes to extended waiting times. Objective: This study aimed to develop an outpatient service flow model based on the Lean Hospital approach to reduce waiting time in the internal medicine clinic of RSUD Balaraja. Methods: A qualitative case study design was employed. Data were collected through direct observation of outpatient service processes, document review, and Focus Group Discussions (FGD) with relevant stakeholders. Process analysis was conducted using Value Stream Mapping (VSM) to identify value-added and non–value-added activities, while Fishbone Diagram analysis was applied to explore the root causes of process inefficiencies. All findings were integrated to develop a future-state outpatient service flow model. Results: The findings indicate that prolonged outpatient waiting time is primarily influenced by inefficient service flow design, repetitive administrative processes, and weak coordination among service units. The proposed service flow model demonstrates a more streamlined, integrated, and patient-centred process, with potential reductions in waiting time through systematic waste elimination and process improvement. Conclusion: The Lean Hospital approach provides an effective framework for developing outpatient service flow models in public hospitals. The proposed model offers a practical basis for improving outpatient service efficiency in complex clinical settings such as internal medicine clinics.
Co-Authors ACHMAD FAUZI Achmad Fauzi Anastina Tahjoo Ari Fahrial Syam Daniel Gunawan Erry Yudhya Mulyani Marcellus Simadibrata Marcellus Simadibrata Nada, Qotrun Sari, Dessi Marantika Nilam Simon Salim Sudaryo, Mondastri Korib