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CLINICAL-IMMUNOLOGICAL ASSESSMENT FAILURE ON INITIAL COMBINATION USE OF ZIDOVUDINE-LAMIVUDINENEVIRAPINE IN CHILDREN WITH HIV/AIDS AT SANGLAH HOSPITAL BALI R., Niruri; Maharani, A. A. S.; Kumara, K. D.; Rahajeng, I. M.
BALI MEDICAL JOURNAL Vol 3 No 2 (2014)
Publisher : BALI MEDICAL JOURNAL

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (297.354 KB)

Background: Assessing clinical progression and CD4+ level were important in determining the efficacy of antiretroviral (ARV) and switching to other regimens, especially when viral-load data were not available. This research aims to assess combination of zidovudine-lamivudine-nevirapine (Co-ZLN) failure using WHO 2010 criteria on clinical failure (CF) and immunological failure (IF), single or together, to determine correlation between CF and IF; and to evaluate two failure categories (CF alone and combination of CF-IF) in making decision to switch to second-line of ARV. Methods: Children at Sanglah General Hospital, who gain initial treatment of Co-ZLN in period of March 2006–March 2013 were selected. Cross sectional study was applied. The ARV response was assessed twice. First period (P1) and second period (P2) of evaluation were conducted after patients received the Co-ZLN at least 6 and 12 months. Results: Forty five patients were included in this study. After at least 6 and 12 months of therapy, more patients showed IF (10 and 9 children in P1 and P2) than those in CF (4 and 2 patients in P1 and P2). Only one child met to CF-IF category in P2. The low clinical condition (HIV stage 4) did not always associate with deteriorating immunologic marker in the treatment-failure (TF). The patients who fit on CF and CF-IF based decision to switch regimen criteria were different. In resource-limited hospital, CF-IF based decision could give a better picture of patients’ condition and be used as an indicator to assess TF compared to single CF criteria.

Diabetes Melitus Tergantung Insulin dengan Ketoasidosis pada Anak Usia 12 Tahun Ida Bagus Eka Utama; Mei Dwi Rahajeng; Leopold Simanjuntak
Majalah Kedokteran UKI Vol. 26 No. 1 (2008): JANUARI-MARET
Publisher : Fakultas Kedokteran Universitas Kristen Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33541/mkvol34iss2pp60

Abstrak Prevalensi diabetes tergantung insulin (Insulin dependent diabetes mellitus-IDDMM) tertinggi di Eropa bagian utara yaitu Negara Skandinavia. Di Finland insiden tersebut sekitar 1-2 dari 100.000/ tahun. Di Indonesia, prevalensi IDDM secara pasti belum diketahui. IDDM dengan Ketoasidosis merupakan kondisi kadar gula darah yang tinggi dan kadar insulin yang rendah atau tidak ada. Tubuh mulai menggunakan lemak sebagai sumber energy yang akan menghasilkan keton dan berakibat asidosis. Seorang pasien anak perempuan, umur 12 tahun, berat badan 33 kg datang ke RSU FK UKI dengan keluhan utama sesak nafas dan keluhan tambahan sakit perut, mual, dan muntah. Pasien pernah mengalami keluhan seperti ini sekitar dua tahun yang lalu dengan diagnosis diabetes ketoasidosis. Pada pemeriksaan fisik didapatkan keadaan umum tampak sakit berat, kesadaran somnolen, frekuensi pernafasan 54x/menit, terdapat retraksi suprasternal, interkosta, dan epigastrium. Hasil pemeriksaan laboratorium ; kadar gula darah sewaktu 363 mgdl, urin lengkap didapatkan protein (+)2, reduksi (+)2, aseton (+3), analisis gas darah Ph 6,847, pCO2 5,2mmHg, base excess -29,4 mmol/L dan buffer base 18,5mmol/L. Pada pasien ini dilakukan koreksi terhadap cairan elektrolit, status asam basa dan pemberian insulin. Setelah perawatan selama ± 14 hari keadaan pasien membaik. Pasien kemudian dirujuk ke RSCM sub bagian endokrinologi untuk mendapatkan terapi insulin lebih lanjut. Dengan diagnosis yang cepat dan tepat, serta penanganan yang tepat dapat mengurangi resiko edema serebri bahkan kematian. Kata Kunci : IDDM dengan ketoasidosis, insulin, tatalaksana Abstract The highest IDDM incidence is in Scandinavia, North Europe. In Indonesia, the IDDM incidence has not been investigated yet. However, it is omit that the prevalence is very rare. Ketoacidosis is a probem due to the low insulin concentration which cause high blood glucose level. The body start use lipid as the energy source which could produce keton that might cause acidosis. A 12 years old girl was admitted to FK UKI Hospital with diabetic ketoacidosis. She has the same problem two years ago, diagnosed as diabetic ketoacidosis patient. She looks weak, dyspneic, with suprasternal, intercostals and epigastrium retraction. The Laboratory results are blood glucose 363 mg/dL, urine analysis shown protein (+)2, reduction (+)2, aseton (+)2, and the blood gas analysis shown pH 6, pCO2 5,2mmHg, base excess -29,4 mmol/L and buffer base 18,5 mmol/L. Rehydration and electrolyte correction had been applied, Furthermore, insulin also had been given to her. After 14 days of treatment, an improvement shown, Then she was forwarded to the sub division of endocrinology of the RSCM hospital for further treatment. With early diagnosis and accuracy in treatment, an edema cerebi and a death risk could be decreased in a patient with diabetes ketoacidosis. Key words : IDDM, ketoacidosis, insulin, therapy

THE APPLICATION OF CLINICAL JUDGMENT AND DECISION MAKING OF CRITICAL CARE NURSES IN INTENSIVE CARE UNITS (ICUs): DOI: https://doi.org/10.35654/ijnhs.v2i1.20 Indah Mei Rahajeng; Faridatul Muslimah
International Journal of Nursing and Health Services (IJNHS) Vol. 2 No. 1 (2019): International Journal of Nursing and Health Services (IJHNS)
Publisher : Alta Dharma Publisher

Background Intensive Care Unit (ICU) is the hospital setting in which applied specific application of clinical decision making and judgement. The critical patient conditions in ICU may drive nurses to make decision and clinical judgement in short period of time. The approach of clinical decision making which appropriate to be applied in the critical circumstances is important to be identified, thus it could become a guidance for novice and expert critical nurses. Aim The aim of this study was to explain how clinical decision making is applied in Intensive Care Unit (ICU) Method A systematic review of 22 articles was carried out, articles were retrieved from CINAHL, MEDLINE, PUBMED and DISCOVERED databases. The articles were critically reviewed and analized to answer this study’s aim. Result The critically review of the articles were categorized in themes: 1) application of Tanner’s clinical judgment model in ICU, 2) Types of decisions in ICU, 3) Theoretical approach: implementation of decision-making in ICU, 4) Case illustration of decision-making scheme in ICU, 5) Influencing factors of decision-making in ICU, 6) Supporting tools for clinical decision-making in ICU, 7) Understanding of attributes and concepts may enhance the quality of the clinical decision-making process in ICU, 8) Implications for nursing education and practice of understanding clinical decision making in ICU. Conclusions Critical care nurses usually combine different techniques in making decisions; analytical methods including the hypothetic-deductive method, pattern recognition, intuition, narrative thinking, and decision analysis theory are potentially applied. Clinical decision activities in ICU appear in many clinical situations, such as intervention decisions, communication decisions, and evaluation decisions. There are several factors influencing clinical decision-making in intensive care units, including nurses’ experience, the patient’s situation, the layout of the ICU, shift work, inter-professional collaboration practice, physical and personnel resources. The application of clinical decision making could be supported by systematic tools, and the nurses’ knowledge about the concepts and attributes used in ICUs affect their clinical decision-making abilities. Keywords: clicinal decision making, critical care nurse, ICU

Empowering the PKK Cadres as a Waste Bank Agent in Waste Management Efforts to Keep Environmental Health Ni Putu Emy Darma Yanti; Kadek Cahya Utami; Indah Mei Rahajeng; Gusti Ayu Ary Antari
Jurnal Peduli Masyarakat Vol 2 No 3 (2020): Jurnal Peduli Masyarakat, September 2020
Publisher : Global Health Science Group

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/jpm.v2i3.213

Waste management that needs to be carried out comprehensively and integratedly from the downstream flow in order to provide economic benefits, be healthy for the community, safe for the environment and can change people's behavior. Tista Village already has a Garbage Bank which is headquartered at the Village Office, but it has not been utilized properly by the community. The purpose of this community service activity is knowledge and attitudes regarding PKK waste management as a waste bank agent and the implementation of the Waste Bank program in Tista Village. The community service activity carried out was to provide training on the implementation of the waste bank with the method of lectures, discussions, demonstration, and focus group discussions attended by 35 PKK cadres. Methods of using data using a questionnaire given before and after training. Data analysis used the Wilcoxon test with a confidence level of 95%. The results of the community service activities received an increase in the knowledge and attitude of PKK cadres as Garbage Bank agents about proper waste management after being given training.

Nurses’ Perceptions About Conflict Management Strategy of Head Nurse Rai Rosita Candra Dewi; Ni Putu Emy Darma Yanti; Indah Mei Rahajeng; Komang Menik Sri Krisnawati
Nursing and Health Sciences Journal (NHSJ) Vol. 2 No. 3 (2022): September 2022
Publisher : KHD-Production

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53713/nhs.v2i3.133

Conflict is one of the factors that affect the performance of nurses. Nurse’s conflict management is closely related to the role of leaders in creating a conducive and productive work environment. The purpose of this study was to describe the perception of implementing nurses on the management of ward head conflict in a hospital in Bali. This research is a quantitative descriptive study with a cross sectional approach. The respondents involved were 71 nurses using purposive sampling technique. Collecting data using a questionnaire about conflict management that has been valid and reliable. The results of the research on the perception of implementing nurse on the conflict management of head nurse from dominating strategy were the “Not Good” category (56.95%), the collaboration strategy was “Good” (85.75%), the avoidance strategy was “Not Good” (44%), the accommodate “Good” (82%), and the compromise strategy “Good” (87%). The majority of implementing nurses perceive that the head nurse uses a compromise strategy in managing conflict in their work area, and the least perceived is that the leader uses a conflict avoidance management strategy. The head nurse is expected to be able to use appropriate conflict management strategies to resolve conflicts in his scope of work, because in general all strategies have their respective advantages and disadvantages to overcome a problem.

Empowering the PKK Cadres as a Waste Bank Agent in Waste Management Efforts to Keep Environmental Health Ni Putu Emy Darma Yanti; Kadek Cahya Utami; Indah Mei Rahajeng; Gusti Ayu Ary Antari
Jurnal Peduli Masyarakat Vol 2 No 3 (2020): Jurnal Peduli Masyarakat, September 2020
Publisher : Global Health Science Group

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/jpm.v2i3.213

Waste management that needs to be carried out comprehensively and integratedly from the downstream flow in order to provide economic benefits, be healthy for the community, safe for the environment and can change people's behavior. Tista Village already has a Garbage Bank which is headquartered at the Village Office, but it has not been utilized properly by the community. The purpose of this community service activity is knowledge and attitudes regarding PKK waste management as a waste bank agent and the implementation of the Waste Bank program in Tista Village. The community service activity carried out was to provide training on the implementation of the waste bank with the method of lectures, discussions, demonstration, and focus group discussions attended by 35 PKK cadres. Methods of using data using a questionnaire given before and after training. Data analysis used the Wilcoxon test with a confidence level of 95%. The results of the community service activities received an increase in the knowledge and attitude of PKK cadres as Garbage Bank agents about proper waste management after being given training.

Kajian Sistematik: Efek Gen Multi Drug Resistance-1 pada Farmakokinetik Klopidogrel Niruri, Rasmaya; Noviyani, Rini; Rahajeng, indah Mei
Jurnal Kefarmasian Indonesia VOLUME 9, NOMOR 1, FEBRUARI 2019
Publisher : Pusat Penelitian dan Pengembangan Biomedis dan Teknologi Dasar Kesehatan

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22435/jki.v9i1.584

Multi Drug Resistance-1 (MDR-1) gene polymorphisms encoding for P-glycoprotein can affect clopidogrel intestinal absorption. This systematic review aim to identify the impact of MDR-1 gene 3435 variants on clopidogrel pharmacokinetics. Literature review were retrieved from MEDLINE, Science Direct, Scopus, Clinical Key, ProQuest and Google Scholar databases. The articles are critically reviewed and analyzed to answer this systematic review’s aim. The result showed that, in patients with cardiovascular disease, the peak plasma concentration (Cmax) and the total area under the plasma concentration–time curve (AUC) of clopidogrel and its active metabolites were lower in 3435TT compared to 3435CC. Nevertheless, the variants of MDR-1 gene were not significantly correlated to the plasma concentration in healthy subjects. Clopidogrel pharmacokinetic profile varied widely between MDR-1 3435 variants and subjects.

DINAMIKA PERAWATAN PASIEN DENGAN PENYAKIT JANTUNG KORONER: STUDI KUALITATIF Sawitri, Ni Komang Ari; Rahajeng, Indah Mei; Prapti, Ni Ketut Guru; Sulistiowati, Ni Made Dian; I Gusti Agung Kumala Dewi
Majalah Kesehatan Vol. 12 No. 3 (2025): Majalah Kesehatan
Publisher : Faculty of Medicine Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/majalahkesehatan.2025.012.03.7

Pasien dengan penyakit jantung dan pembuluh darah memerlukan perawatan diri yang adekuat dalam kehidupan sehari-hari. Aktifitas perawatan diri dalam penyakit kronis secara keseluruhan dilakukan oleh individu dan keluarga. Penelitian ini akan mengesplorasi informasi dari pasien, keluarga dan tenaga kesehatan dalam penatalaksanaan penyakit jantung dan pembuluh darah. Tujuan penelitian ini untuk mengetahui kebutuhan dari pasien, keluarga dan tenaga kesehatan dalam memberikan dukungan yang adekuat untuk penatalaksanaan penyakit. Penelitian ini adalah penelitian kualitatif dengan menggunakan metode wawancara untuk pengambilan datanya. Wawancara mendalam kepada pasien dengan penyakit jantung dan pembuluh darah, keluarga pasien, tenaga kesehatan yang bertanggung jawab terhadap penyakit jantung dan pembuluh darah baik di Puskesmas maupun poliklinik jantung di rumah sakit rujukan BPJS di Kota Denpasar. Didapatkan satu tema besar dan 3 subtema dalam penelitian ini. Tema besarnya adalah “keberlangsungan perawatan” dan subtemanya adalah “rujukan, “kerjasama” dan “dinamika dukungan”. Perawatan bagi pasien PJK mengalami dinamika yang berkaitan dengan mekanisme rujukan, kerjasama pasien-keluarga-tenaga kesehatan, serta dukungan yang bersifat positif dan negatif dari keluarga terhadap pasien penyakit jantung koroner (PJK).

The Effect of Puzzle as Health Education Media on Knowledge and Attitude of DHF Prevention Among Trash Warrior Community Aris Mudariani; Ni Komang Ari Sawitri; Indah Mei Rahajeng; Putu Ayu Sani Utami
Caring: Indonesian Journal of Nursing Science Vol. 5 No. 1 (2023): Caring: Indonesian Journal of Nursing Science
Publisher : Talenta Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/ijns.v5i1.12447

Dengue Haemorrhagic Fever (DHF) is a significant public health threat that can be controlled by engaging all community groups in preventive measures. Interventions targeting early age are pivotal in improving knowledge and attitudes toward DHF prevention. This study proposes a health promotion strategy using a Puzzle as an educational media targeting the Trash Warrior Community members aged 9-12 years to enhance knowledge and attitudes towards DHF prevention. This was a pre-experimental study with a one-group pretest-posttest conducted from February to March 2023. All Trash Warrior Community members aged 9 â€“ 12 (n=20) were included as respondents. They were given a questionnaire consisting of 13 questions of knowledge and ten statements of attitudes towards DHF prevention before and after the health education. The intervention in this study was health education using puzzles in 5 small groups, each consisting of 4 children. Each group was given 30 minutes to arrange the puzzle. This study shows an improvement of mean value on knowledge for 2.1 points and attitude for 0,75 points. Based on the result of bivariate analysis using the Wilcoxon test, it was found that there was a significant effect of education using puzzle media on knowledge (p=0.000, p<0.05) and attitudes (p=0.045, p<0.05) in preventing DHF among Trash Warrior Community members aged 9-12 years. Health education using puzzles effectively increases childrenâ€™s knowledge and attitude toward DHF prevention.

HUBUNGAN DIGITAL HEALTH LITERACY PERAWAT DENGAN PENERAPAN DOKUMENTASI METODE ELECTRONIC MEDICAL RECORD (EMR) DI RUANG RAWAT INAP RSUP PROF. DR. I.G.N.G. NGOERAH Serena Kartikasari; Indah Mei Rahajeng; Ni Putu Emy Darma Yanti; Komang Menik Sri Krisnawati
Community of Publishing in Nursing Vol. 12 No. 6 (2024): Desember 2024
Publisher : Udayana University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/coping.2024.v12.i06.p04

Literasi Kesehatan Digital (DHL) mengacu pada kemampuan seseorang untuk mencari, menilai, dan menggunakan informasi kesehatan bersama dengan menggunakan teknologi digital. DHL bagi perawat sangat penting dalam penerapan EMR. Tujuan dari penelitian ini adalah untuk mengetahui hubungan antara DHL perawat dengan penerapan dokumentasi metode EMR di ruang rawat inap RSUP Prof. Dr. I.G.N.G. Ngoerah. Metode penelitian analitik korelasional diterapkan. Pada bulan Mei 2023, penelitian ini dilakukan pada perawat ruang rawat inap. Kuesioner penilaian mandiri skala kompetensi informatika keperawatan (SANICS) dan kuesioner literasi e-kesehatan Cina (C-eHLS) digunakan untuk DHL. Kuesioner evaluasi rekam medis elektronik digunakan dalam kuesioner EMR dari sudut pandang pengguna. Temuan penelitian menunjukkan adanya hubungan yang signifikan antara DHL berdasarkan SANICS dan implementasi dokumentasi metode EMR dengan nilai p-value<0,001 dan hubungan yang digambarkan sebagai kuat (R = 0,622), serta hubungan yang signifikan antara DHL berdasarkan C-eHLS dan implementasi dokumentasi metode EMR dengan nilai p-value<0,001 dan hubungan yang digambarkan sebagai moderat (R = 0,407). Temuan penelitian ini menunjukkan adanya hubungan yang baik antara Digital Health Literacy perawat dengan penggunaan dokumentasi metode EMR di ruang rawat inap. Rumah sakit diharapkan dapat membuat Kebijakan Kesehatan Digital untuk membantu pengembangan literasi kesehatan digital perawat dan pengembangan sistem EMR.

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