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Analysis of the Diffrence of Completeness of Reporting and Documentation of Laboratory Critical Values Pre and Post-Intervention in Bona Ward Dr. Soetomo Hospital Surabaya Zubir Zubir; Hartono Kahar; M. Robiul Fuadi; Elly Sulistyani; Tito Yustiawan
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 26, No 1 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v26i1.1342

Abstract

Completeness of laboratory critical values reporting and documentation in medical records is important for patient safety, hospital accreditation, and legality. Preliminary study in Dr. Soetomo Hospital’s ward showed the laboratory critical value report and documentation was 0% complete, 4% incomplete, and 96% undocumented. This was a quasi experimental study with one group pretest and posttest design. Technical guidance of laboratory critical values reporting and documentation in medical records and supervision were given to 26 doctors. The results evaluated were doctor knowledge and attitude towards critical value reporting, completeness of documentation in medical records, and turn around time (TAT). Reporting critical values samples number was 72 before and after the intervention. The critical values samples taken by purposive sampling. The data was analyzed using Mann-Whitney test. There were significant differences in the level of knowledge, doctor’s attitudes, and completeness of critical values documentation before and after the intervention. Doctors with good knowledge increased from 3.85% to 92.31%. The attitude to complete critical values documentation improved from 0% to 76%. Completeness of critical values documentation in medical records improved from 100% undocumented to 19.44% undocumented, 11.11% incomplete, and 69.45% complete. There were no significant differences of TAT before and after the intervention, all of TAT were less than 30 minutes and meeting the TAT category. The intervention succeeded in increasing doctor knowledge, attitude, and completeness of the laboratory critical values reporting and documentation in the patient's medical record. Keywords: Laboratory critical value, medical record, turn around time.
KEUNTUNGAN DAN KERUGIAN PENJAMINAN MUTU BERDASARKAN UJI MEMASTIKAN KECERMATAN (POCT) Hartono Kahar
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 13, No 1 (2006)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v13i1.898

Abstract

Laboratory examination especially for critical care such as emergency care, intensive care has been developed near the site of patientcare which is referred to point-of-care testing (POCT). As to the definition of POCT, there are many synonyms such as ancillary testing,satellite testing, and bedside testing, near patient testing, home testing, self-management, patient self-management, remote testing andphysician’s office laboratories. Based on evidence-based POCT, the National Academy of Clinical Biochemistry (NACB) has recommendedsome POCT such as coagulation tests, transcutan bilirubin testing, marker for acute coronary syndromes, diabetes mellitus, drugsand ethanol, Infectious disease testing, occult blood test, pH testing, renal function test, intraoperative PTH, renal function test andreproduction test. Some researchers conclude that performing POCT for critical care is efficient, while others found it not efficient,therefore, careful assessment of the advantages and disadvantages is important when implementing POCT. Nurses are the personnelin the acute care unit who often perform POCT; however they desire that laboratory personnel take the responsibility, therefore it isimportant to discuss which personnel are appropriate to conduct quality control of POCT.
TEG's Utility to Detect Hypercoagulability in Adult Patients at Post-Cardiac Surgery Using Cardiopulmonary Bypass in ICU Hildegardis Dyna Dumilah; Hartono Kahar; Arifoel Hajat; Philia Setiawan; Heroe Soebroto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 27, No 1 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i1.1615

Abstract

The use of Cardiopulmonary Bypass (CPB) in adult patients of cardiac surgery disrupts the coagulation system. The mostcommon complication of the coagulation system is bleeding; however, that does not rule out the possibility of a dangeroushypercoagulation condition. A quick and precise coagulation test can provide clues for clinicians to predict futurehemostatic disorders or determine interventional therapy. aPTT and PT are standard laboratory tests, which are limited todetect a deficiency of coagulation factors. Thromboelastography (TEG) test (R time, K time, α angle, MA, and LY30) providesan overview of the entire coagulation and fibrinolysis process with faster results. A 2.7 mL citrate blood sample was takenand tested in a TEG®5000 device, then centrifuged. The plasma was then tested for aPTT and PT using the Sysmex CS-2100idevice. Bleeding volume was measured from chest drain 1-2 hours in the ICU after chest closure in the operating room.Bleeding criteria were as follows: > 1.5 mL/kg/hour for 6 hours consecutively in 24 hours or > 100 mL/hour. The resultsshowed 30 patients with no clinically significant bleeding. A significant correlation was found between PT and bleedingvolume at IV hour (p=0.008, r= 0.472). There was no correlation between aPTT and TEG (R time, K time, α angle, MA, andLY30) with the bleeding volume at I, II, III, and IV hours. There was a hypercoagulation indication of the TEG test of 56.7%,which showed clinical importance for the patient. PT can be used to analyze changes in bleeding volume at IV hour and TEGis more superior to detect hypercoagulability of adult patients after cardiac surgery with CPB.
Comparison of K2 and K3 EDTA Anticoagulant on Complete Blood Count and Erythrocyte Sedimentation Rate Harida Zahraini; Yulia Nadar Indrasari; Hartono Kahar
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 28, No 1 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i1.1735

Abstract

The use of anticoagulants is one of the important pre-analytic factors in hematological tests. Both dipotassium (K2) andtripotassium (K3) Ethylene Diamine Tetraacetic Acid (EDTA) are widely used anticoagulants. International CouncilStandardization of Hematology (ICSH) and several researchers recommend the use of K2 EDTA due to its less hyperosmolareffect on blood cells compared to K3 EDTA. This study aimed to compare the results of Complete Blood Count (CBC) andErythrocyte Sedimentation Rate (ESR) using anticoagulant K2 EDTA and K3 EDTA. This study was an analytic observationalstudy with a cross-sectional design conducted from April to December 2018. The subject of the study were 103 healthyadults selected by consecutive sampling. Blood samples were collected in both anticoagulant tubes with a volume of 3 mLeach. Samples were tested twice, in the first 0 hours and the next 6 hours using Sysmex XN 1000 and Alifax Roller 20 LC.Kolmogorov-Smirnov test, paired T-test and Wilcoxon rank test were used for statistical analysis. The agreement testbetween both anticoagulants was carried out using the Bland Altman plot for parameters with a significant difference. Therewas a significant difference between both anticoagulants for the parameters of hemoglobin, hematocrit MCV, MCHC, RDW,PDW, MPV, PLC-R, and erythrocyte sedimentation rate in both the first and second tests. The agreement test using the BlandAltman plot showed that the difference in these parameters was within the Limit of Agreement (LOA) range of 95%. Thisstudy showed that there were differences in some parameters of complete blood count and erythrocyte sedimentation ratebetween the two anticoagulants (K2 K3 EDTA), but these differences were within the LOA range.
Cut-Off Value of Procalcitonin in Sepsis and Septic Shock patients at Dr. Soetomo Hospital Shinta Lungit Ambaringrum; Yetti Hernaningsih; Edward Kusuma; Hartono Kahar
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 28, No 2 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i2.1827

Abstract

Sepsis is a state of life-threatening organ dysfunction caused by dysregulation of the body's response to infection. Organ dysfunction is marked by an increase in SOFA score ≥ 2 or qSOFA score ≥ 2. Septic shock is a subset of sepsis with fairly severe circulatory disorders that can significantly increase mortality. Although the current gold standard diagnosis method for sepsis is bacterial culture, some researchers believe PCT can help identify sepsis severity because bacterial culture requires a relatively long time. This study aims to determine the cut-off point of procalcitonin in patients with sepsis and septic shock. The data taken were secondary data from the medical records of sepsis and septic shock patients in Dr. Soetomo General Hospital from 2017 to 2019. Determination of cut-off PCT for sepsis and septic shock using Receiver Operating Characteristic (ROC) analysis curve. Most sepsis patients were young (18 - 65 years) (69%) (p = 0.331) and male (60%) (p = 0.156). The majority of the clinical sepsis patients have focal infections of the respiratory system (55.17%). Patients with respiratory tract infections who develop sepsis have an OR of 6.182, which means it is six times more likely to develop septic shock. There was a significant difference between septic and non-septic PCT levels (p = 0.000), and there was a positive correlation between PCT and sepsis. The cut-off of procalcitonin in sepsis was 0.6 ng/mL, and the cut-off of procalcitonin in septic shock was 10 ng/mL.
Effect of ethanol extract of Hedyotis corymbosa (L.) Lamk against parasitemia and hepatomegaly in Plasmodium berghei ANKA-infected mice Jelita Aprisano Putri; Nabilla Feirizky Chairunnisa; Heny Arwati; Hartono Kahar
Qanun Medika - Jurnal Kedokteran FK UMSurabaya Vol 7 No 1 (2023): Qanun Medika Vol 07 No 01 January 2023
Publisher : Universitas Muhammadiyah Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30651/jqm.v7i1.15903

Abstract

Malaria is a parasitic infectious disease that remains one of the focuses of world health problems. The ethanol extract of Hedyotis corymbosa has biochemical compounds potentially become a new antimalarial drug. This study aimed to analyze the effect of this extract on parasitemia and hepatomegaly in mice infected with Plasmodium berghei ANKA. Twentyfive BALB/c mice were infected with P. berghei ANKA and grouped into 5 groups. Group 1-3 were treated with 250 mg/Kg BW (HC250), 300 mg/Kg BW (HC300), and 350 mg/Kg BW (HC350) of ethanol extract of H. corymbosa (EEHC), respectively. Group 4 was a positive control (POS) which was given dihydroartemisisnin-piperaquin (DHP) and Group 5 was a negative control (NEG) which was only given CMC Na 1%. Treatments were given orally once a day for four consecutive days. Parasitemia was observed daily on Giemsa-stained tail blood smear. On day 5 the mice were sacrificed, blood were collected by cardiac punctured, the livers were removed and the length, width, and weight were measured. There was no significant difference on parasitemia between Group 1, 2, 3 and NEG. However, the highest inhibition of parasite s growth was found in Group 3 (61.4%. Observation on hepatomegaly, showed that a significant difference on the length of the liver was found between Group 3 and NEG.
Analysis of the Diffrence of Completeness of Reporting and Documentation of Laboratory Critical Values Pre and Post-Intervention in Bona Ward Dr. Soetomo Hospital Surabaya Zubir Zubir; Hartono Kahar; M. Robiul Fuadi; Elly Sulistyani; Tito Yustiawan
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 26 No. 1 (2019)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v26i1.1342

Abstract

Completeness of laboratory critical values reporting and documentation in medical records is important for patient safety, hospital accreditation, and legality. Preliminary study in Dr. Soetomo Hospital's ward showed the laboratory critical value report and documentation was 0% complete, 4% incomplete, and 96% undocumented. This was a quasi experimental study with one group pretest and posttest design. Technical guidance of laboratory critical values reporting and documentation in medical records and supervision were given to 26 doctors. The results evaluated were doctor knowledge and attitude towards critical value reporting, completeness of documentation in medical records, and turn around time (TAT). Reporting critical values samples number was 72 before and after the intervention. The critical values samples taken by purposive sampling. The data was analyzed using Mann-Whitney test. There were significant differences in the level of knowledge, doctor's attitudes, and completeness of critical values documentation before and after the intervention. Doctors with good knowledge increased from 3.85% to 92.31%. The attitude to complete critical values documentation improved from 0% to 76%. Completeness of critical values documentation in medical records improved from 100% undocumented to 19.44% undocumented, 11.11% incomplete, and 69.45% complete. There were no significant differences of TAT before and after the intervention, all of TAT were less than 30 minutes and meeting the TAT category. The intervention succeeded in increasing doctor knowledge, attitude, and completeness of the laboratory critical values reporting and documentation in the patient's medical record. Keywords: Laboratory critical value, medical record, turn around time.
TEG's Utility to Detect Hypercoagulability in Adult Patients at Post-Cardiac Surgery Using Cardiopulmonary Bypass in ICU Hildegardis Dyna Dumilah; Hartono Kahar; Arifoel Hajat; Philia Setiawan; Heroe Soebroto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 1 (2020)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i1.1615

Abstract

The use of Cardiopulmonary Bypass (CPB) in adult patients of cardiac surgery disrupts the coagulation system. The most common complication of the coagulation system is bleeding; however, that does not rule out the possibility of a dangerous hypercoagulation condition. A quick and precise coagulation test can provide clues for clinicians to predict future hemostatic disorders or determine interventional therapy. aPTT and PT are standard laboratory tests, which are limited to detect a deficiency of coagulation factors. Thromboelastography (TEG) test (R time, K time, α angle, MA, and LY30) provides an overview of the entire coagulation and fibrinolysis process with faster results. A 2.7 mL citrate blood sample was taken and tested in a TEG®5000 device, then centrifuged. The plasma was then tested for aPTT and PT using the Sysmex CS-2100i device. Bleeding volume was measured from chest drain 1-2 hours in the ICU after chest closure in the operating room. Bleeding criteria were as follows: > 1.5 mL/kg/hour for 6 hours consecutively in 24 hours or > 100 mL/hour. The results showed 30 patients with no clinically significant bleeding. A significant correlation was found between PT and bleeding volume at IV hour (p=0.008, r= 0.472). There was no correlation between aPTT and TEG (R time, K time, α angle, MA, and LY30) with the bleeding volume at I, II, III, and IV hours. There was a hypercoagulation indication of the TEG test of 56.7%, which showed clinical importance for the patient. PT can be used to analyze changes in bleeding volume at IV hour and TEG is more superior to detect hypercoagulability of adult patients after cardiac surgery with CPB.  
Comparison of K2 and K3 EDTA Anticoagulant on Complete Blood Count and Erythrocyte Sedimentation Rate Harida Zahraini; Yulia Nadar Indrasari; Hartono Kahar
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 28 No. 1 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i1.1735

Abstract

The use of anticoagulants is one of the important pre-analytic factors in hematological tests. Both dipotassium (K2) andtripotassium (K3) Ethylene Diamine Tetraacetic Acid (EDTA) are widely used anticoagulants. International CouncilStandardization of Hematology (ICSH) and several researchers recommend the use of K2 EDTA due to its less hyperosmolareffect on blood cells compared to K3 EDTA. This study aimed to compare the results of Complete Blood Count (CBC) andErythrocyte Sedimentation Rate (ESR) using anticoagulant K2 EDTA and K3 EDTA. This study was an analytic observationalstudy with a cross-sectional design conducted from April to December 2018. The subject of the study were 103 healthyadults selected by consecutive sampling. Blood samples were collected in both anticoagulant tubes with a volume of 3 mLeach. Samples were tested twice, in the first 0 hours and the next 6 hours using Sysmex XN 1000 and Alifax Roller 20 LC.Kolmogorov-Smirnov test, paired T-test and Wilcoxon rank test were used for statistical analysis. The agreement testbetween both anticoagulants was carried out using the Bland Altman plot for parameters with a significant difference. Therewas a significant difference between both anticoagulants for the parameters of hemoglobin, hematocrit MCV, MCHC, RDW,PDW, MPV, PLC-R, and erythrocyte sedimentation rate in both the first and second tests. The agreement test using the BlandAltman plot showed that the difference in these parameters was within the Limit of Agreement (LOA) range of 95%. Thisstudy showed that there were differences in some parameters of complete blood count and erythrocyte sedimentation ratebetween the two anticoagulants (K2 K3 EDTA), but these differences were within the LOA range.
Cut-Off Value of Procalcitonin in Sepsis and Septic Shock patients at Dr. Soetomo Hospital Shinta Lungit Ambaringrum; Yetti Hernaningsih; Edward Kusuma; Hartono Kahar
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 28 No. 2 (2022)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v28i2.1827

Abstract

Sepsis is a state of life-threatening organ dysfunction caused by dysregulation of the body's response to infection. Organ dysfunction is marked by an increase in SOFA score ≥ 2 or qSOFA score ≥ 2. Septic shock is a subset of sepsis with fairly severe circulatory disorders that can significantly increase mortality. Although the current gold standard diagnosis method for sepsis is bacterial culture, some researchers believe PCT can help identify sepsis severity because bacterial culture requires a relatively long time. This study aims to determine the cut-off point of procalcitonin in patients with sepsis and septic shock. The data taken were secondary data from the medical records of sepsis and septic shock patients in Dr. Soetomo General Hospital from 2017 to 2019. Determination of cut-off PCT for sepsis and septic shock using Receiver Operating Characteristic (ROC) analysis curve. Most sepsis patients were young (18 - 65 years) (69%) (p = 0.331) and male (60%) (p = 0.156). The majority of the clinical sepsis patients have focal infections of the respiratory system (55.17%). Patients with respiratory tract infections who develop sepsis have an OR of 6.182, which means it is six times more likely to develop septic shock. There was a significant difference between septic and non-septic PCT levels (p = 0.000), and there was a positive correlation between PCT and sepsis. The cut-off of procalcitonin in sepsis was 0.6 ng/mL, and the cut-off of procalcitonin in septic shock was 10 ng/mL.