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All Journal Proceedings of the International Conference on Applied Science and Health Indonesian Journal of Health Development eJournal Kedokteran Indonesia The Indonesian Journal of Gastroenterology, Hepatology and Digestive Endoscopy Jurnal Penyakit Dalam Indonesia Jurnal ARSI : Administrasi Rumah Sakit Indonesia
Eka Ginanjar
Divisi Kardiologi Departemen Ilmu Penyakit Dalam FKUI/RSCM, Unit Pelayanan Jantung Terpadu RSCM
Biochemistry, Genetics & Molecular Biology Decision Sciences, Operations Research & Management Education Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences

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THE IMPLEMENTATION OF CODE STEMI PROGRAM TO AFFECT THE QUALITY OF HEALTHCARE IN ST-ELEVATION MYOCARDIAL INFARCTION (STEMI) PATIENTS: A SYSTEMATIC LITERATURE REVIEW Ginanjar, Eka; Sjaaf, Amal C
Proceedings of the International Conference on Applied Science and Health No 4 (2019)
Publisher : Yayasan Aliansi Cendekiawan Indonesia Thailand (Indonesian Scholars' Alliance)

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Abstract

Backgrounds: The Clinical importance of coronary artery disease manifests as Acute Coronary Syndrome with the highest mortality is known as ST-Elevation Myocardial Infarction (STEMI). Delay in STEMI management not only affect mortality and complications, but also healthcare quality. The CODE STEMI program was developed to shorten the time and reduce delay in treatments for STEMI patients. This study aims to review the effect of CODE STEMI program implementation on clinical outcome and healthcare quality in STEMI patients. Methods: This study was a systematic review of literature that used meta-analysis (PRISMA) protocol. Data obtained from Electronic databases Google Scholar, PubMed, and MEDLINE that published over several years and we began on May 2019. Assessment of healthcare quality was based on Donabedian theory that consists of 7 main components, efficacy, effectiveness, efficiency, optimality, acceptability, legitimacy and equity. Analysis between studies was reported as descriptive narration. Results: The search found 15 studies, of which 4 studies as the final results that are suitable for this literature review through the keyword findings CODE STEMI, STEMI, and quality of healthcare. Studies in several countries over the globe reported a decrease of door-to-balloon/ diagnosis-to-wire time. Some studies reported reduced mortality, complications, and cost after implementation of CODE STEMI program, while others only found insignificant trends. Conclusions: Implementation of CODE STEMI protocol made a better Quality of Healthcare. However, it needs further study to review and evaluate the effect of CODE STEMI implementation, especially on the quality of healthcare in STEMI patients.
PENGARUH CODE STEMI TERHADAP STRATEGI PEMASARAN RSUPN DR CIPTO MANGUNKUSUMO Eka Ginanjar; Amal Sjaaf; Wahyu Sulistyadi
Indonesian Journal of Health Development Vol 2 No 1 (2020): IJHD
Publisher : Fakultas Ilmu kesehatan UPN Veteran Jakarta

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52021/ijhd.v2i1.28

Abstract

Dewasa ini, persaingan bisnis industri jasa rumah sakit semakin ketat. Akibatnya, rumah sakit dituntut untuk memiliki inovasi dan strategi untuk menarik pasien. Salah satu hal yang diperlukan untuk menarik minat pasien adalah strategi pemasaran rumah sakit. Penelitian ini bertujuan untuk mengetahui pengaruh pelaksanaan program CODE STEMI terhadap unsur-unsur strategi pemasaran rumah sakit RSUPN Dr. Cipto Mangunkusumo. Penelitian ini menggunakan metode kuantitatif dengan penelusuran rekam medik dan dokumen administrasi, serta metode kualitatif dengan observasi dan wawancara mendalam. Hasil penelitian menunjukan penurunan mortalitas, MACE, door to balloon time, total biaya, dan lama rawat setelah diterapkannya program CODE STEMI. Hasil-hasil tersebut berdampak baik pada bauran pemasaran produk, harga, distribusi, manusia, proses, dan sarana fisik. Pasien merasa puas dengan pelayanan yang diberikan, dan jumlah pasien STEMI pun meningkat sejak diterapkannya program CODE STEMI tersebut. Berdasarkan hasil tersebut, ditarik kesimpulan bahwa program CODE STEMI berdampak positif terhadap strategi pemasaran RSUPN Dr. Cipto Mangunkusumo. Disaranakan untuk mengadakan kegiatan promosi untuk memperkenalkan program CODE STEMI ini ke masyarakat luas.
Diagnosis and Management of Blastocystis Hominis Infection in Patient with HIV-AIDS Eka Ginanjar; Agnes Kurniawan; Teguh Hardjono; Ari Fahrial Syam; Ceva Wicaksono Pitoyo
The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy VOLUME 8 ISSUE 2 August 2007
Publisher : The Indonesian Society for Digestive Endoscopy

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24871/82200757-62

Abstract

The incidence of AIDS/HIV infection has been increasing worldwide. Patients with AIDS/HIV infection is at high risk to get opportunistic infection which is often become life-threatening. Common infections associated with AIDS/HIV are tuberculosis (TB) infection and viral hepatitis. Commensal organism found in human body is actually not pathogenic. Blastocystis hominis is generally considered as commensal organism of intestinal tract and might cause opportunistic infection in patients with AIDS. We reported a case of young male patient with AIDS/HIV infection and evidence of opportunistic infection of Blastocystis hominis found in ascitic fluid along with concomitant lung TB and viral hepatitis. Patient was well-responded to treatment of B. Hominis. Keywords: AIDS/HIV infection, opportunistic infection, Blastocystis hominis
In-Hospital Major Adverse Cardiac Events Factor Predictors on ST-Elevation Myocardial Infarction after Primary Percutaneous Coronary Intervention at dr. Cipto Mangunkusumo General Hospital Sally Aman Nasution; Hendra Perkasa; Eka Ginanjar; Ikhwan Rinaldi
eJournal Kedokteran Indonesia Vol. 10 No. 2 - Agustus 2022
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.23886/ejki.10.193.107-13

Abstract

Major Adverse Cardiac Events (MACE) are the main causes to increase mortality in ST-Elevation Myocardial Infarction (STEMI) patients who undergo Primary Percutaneous Coronary Intervention (PPCI). In-hospital MACE inducing factor predictors identification is expected to enhance STEMI patients’ care and outcome. This study aims to identify in-hospital MACE factor predictors in STEMI patients with PPCI treatment at RSCM. Retrospective cohort study by tracing medical records on patients with PPCI treatment at RSCM from January 2015 - March 2020. The chi-squared bivariate analysis concluded between predictor factors; age, smoking, hypertension, diabetic Mellitus, chronic kidney disease, time-to-treatment, Killip class, left ventricle ejection fraction (LVEF) and LDL cholesterol level. Logistic regression is used in multivariate and prediction model analysis on variables with p<0,25 in bivariate analysis. This study involves 291 patient subjects. The occurrence of MACE is 43.3% on patients age > 60 years (29,6%), smoking (61,2%), hypertension (50,9%), diabetes mellitus (36,1%), chronic kidney disease (6,2%), Killip class II-IV (32,2%), LVEF > 50% (57%) dan cholesterol LDL level > 100 mg/dl (79,4%). Median time-to-treatment is 528 (379-730) minutes. Age, Killip class, and LVEF influences in-hospital MACE during PPCI with OR (95% CI) consecutively are 2,15 (1,22-3,79), 4,34 (2,49-7,56) and 2,88 (1,72-4,82). MACE prediction model in this study produces area under curve (AUC) 0,729 (95% CI 0,67-0,78). In-hospital MACE on STEMI patients after PPCI occurrence is 43.3%, influenced by age, Killip class, and LVEF. Keywords: major adverse cardiac events, primary percutaneous coronary intervention, myocardial infarction.   Faktor Prediktor Major Adverse Cardiac Events Selama Perawatan pada Pasien ST-Elevasi Miokard Infark yang Menjalani Intervensi Koroner Perkutan Primer di RSUPN dr. Cipto Mangunkusumo Abstrak Major Adverse Cardiac Events (MACE) merupakan penyebab utama meningkatnya mortalitas pada pasien STElevasi Miokard Infark (STEMI) yang menjalani intervensi koroner perkutan primer (IKPP). Identifikasi faktor prediktor yang mempengaruhi terjadinya MACE selama perawatan diharapkan dapat meningkatkan perawatan dan luaran klinis dari pasien STEMI. Penelitian ini bertujuan untuk mengetahui faktor prediktor MACE selama perawatan pada pasien STEMI yang dilakukan IKPP di RSCM. Studi kohort retrospektif dengan menelusuri rekam medis pasien yang menjalani IKPP di RSCM periode Januari 2015-Maret 2020. Dilakukan analisa bivariat antara faktor prediktor usia, status merokok, hipertensi, diabetes mellitus, penyakit ginjal kronik, time-to-treatment, kelas killip, fraksi ejeksi ventrikel kiri (FEVK) dan kadar kolesterol LDL dengan kejadian MACE selama perawatan pada pasien STEMI yang menjalani IKPP, menggunakan metode Chi-square. Analisa multivariat dan analisa model prediksi dilakukan dengan metode regresi logistik terhadap variabel dengan nilai p= <0,25 pada analisa bivariat.Didapatkan subyek sebanyak 291 pasien untuk diteliti. Major Adverse Cardiac Events selama perawatan didapatkan sebesar 43,3% dengan usia >60 tahun (29,6%), status merokok (61,2%), hipertensi (50,9%), diabetes mellitus (36.1%), penyakit ginjal kronik (6,2%), kelas Killip II-IV (32,2%), FEVK > 50% (57%) dan kadar kolesterol LDL > 100 mg/dl (79,4%). Median timeto-treatment didapatkan sebesar 528 (379-730) menit. Usia, kelas killip dan FEVK mempengaruhi kejadian MACE selama perawatan dengan OR (IK 95%) masing-masing 2,15 (1,22-3,79), 4,34 (2,49-7,56) dan 2,88 (1,72-4,82). Model prediksi MACE selama perawatan pada pasien STEMI yang menjalani IKPP memiliki nilai area under curve (AUC) 0,729 (IK 95% 0,67-0,78). Major Adverse Cardiac Events (MACE) selama perawatan Kata kunci: major adverse cardiac events, intervensi koroner perkutan primer, infark miokard.
The Impact of “CODE STEMI” Program Implementation on Door to Balloon Time and Major Adverse Cardiac Events of Patients with ST Elevation Myocardial Infarction Funay, Prijander L B; Wijaya, Ika Prasetya; Ginanjar, Eka; Shatri, Hamzah
Jurnal Penyakit Dalam Indonesia Vol. 7, No. 4
Publisher : UI Scholars Hub

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Abstract

Introduction. Delay in the management of ST Elevation Myocardial Infarction (STEMI) patients is a cause of high mortality and the incidence of major adverse cardiac events (MACE). Efforts that can be made in health facilities with primary percutaneous coronary intervention (PCI) capability are achieving timely reperfusion of STEMI patients. Various strategies were carried out to achieve timely reperfusion including implementation the CODE STEMI program. This study aimed to determine the effect of the implementation of the CODE STEMI program on Door to Balloon Time (D2BT) and MACE of STEMI patients undergoing primary PCI. Methods. This was a retrospective cohort study conducted among STEMI patients undergoing primary PCI before the application of the CODE STEMI program (2015-2016) and after the application of the CODE STEMI program (2017-2018). Data were obtained from patients’ medical record. Analysis was performed quantitatively by Mann Whitney test for D2BT and chi square for MACE. Results. There were 111 patients in the non-CODE STEMI group and 144 patients in the CODE STEMI group. D2BT decreased significantly 110 minutes from 275 (99-2356) minutes in the non-CODE STEMI group to 165 (67-1165) minutes in the CODE STEMI group (p < 0.001). Analysis in both group (CODE STEMI vs. non-CODE STEMI) showed as follows: MACE events (48.4% vs 51.6%; p = 0.120), heart failure (46.6% vs 42%; p = 0.288), cardiogenic shock (27% vs 19.4%; p = 0.152), arrhythmia (12.6% vs 6.2%; p = 0.079), stroke (4.5% vs 5.6%; p = 0.705), and mortality rate (7.2% vs 3.5%; p = 0.179) which were similar between the two groups. The incidence of reinfarction (4.5% vs 0.7%; p = 0.047) and repeated PCI (2.7% vs 0.0%; p = 0.047) were significantly reduced in the CODE STEMI group. Conclusions. The CODE STEMI program reduces D2BT. The CODE STEMI program did not reduce the overall MACE incidence but reduced the incidence of reinfarction and repeated PCI of STEMI patients undergoing primary PCI
Relationship between Symptoms of Depression and Anxiety with Major Adverse Cardiac Event in 7 days in Patients with Acute Coronary Syndrome in Cipto Mangunkusumo Hospital Sari, Diah Pravita; Mudjaddid, E; Ginanjar, Eka; Muhadi, Muhadi
Jurnal Penyakit Dalam Indonesia Vol. 5, No. 4
Publisher : UI Scholars Hub

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Abstract

Introduction. One of the causes of death in acute coronary syndrome is the occurrence of complication known as major adverse cardiac events (MACE). There are several predictors of the occurance of MACE in patients with ACS, including depression and anxiety. Thi study aimed to determine the association between depression and anxiety with major adverse cardiac events within 7 days in patients with acute coronary syndrome. Methods. Study with prospective cohort design to examine the association between depression and anxiety with MACE within 7 days of ACS patients, using HADS questionnaires on ACS patients undergoing treatment at ICCU, Hospitalization RSCM in January - May 2018. Bivariate analysis was performed to calculate the risk ratio (RR) of MACE occurrence within 7 days in the depression and anxiety group using SPSS. Results. Obtained number of subjects who meet the inclusion criteria of 114 people. Depression was obtained in 7% of subjects, Anxiety was obtained in 28,95% of subjects, and MACE was obtained in 9.6% of subjects. In the Depression group, MACE 7 days occurred in 12.5% of subjects. In the Anxiety group, MACE 7 days occurred in 21,2% of subjects. In bivariate analysis, Anxiety increased the risk of MACE within 7 days in patients with ACS, with relative risk (RR) of 4,2 (IK 1,34 – 13,70). Conclusions. Anxiety in patients with ACS is an independent predictor of MACE within 7 days and increases the risk of a 7 day MACE. There was no correlation between depression and MACE within 7 days in patients with ACS.
Fungsi Ginjal dan Kematian Akibat Sindrom Koroner Akut Ginanjar, Eka
Jurnal Penyakit Dalam Indonesia Vol. 3, No. 4
Publisher : UI Scholars Hub

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Abstract

Penyakit kardiovaskuler merupakan salah satu penyebab kematian utama di dunia. World Health Organization (WHO) melaporkan 17,5 juta orang meninggal akibat penyakit kardiovaskuler pada tahun 2012, atau diperkirakan 3 dari 10 kematian terjadi akibat penyakit jantung.
Perbedaan Serotonin Plasma dan Kortisol Saliva terhadap Gejala Depresi pada Pasien Pasca Sindrom Koroner Akut Firmansyah, Irman; Shatri, Hamzah; Putranto, Rudi; Ardani, Yanuar; Ginanjar, Eka; koesnoe, sukamto; Rizka, Aulia; Isbagio, Harry; Yunir, Em
Jurnal Penyakit Dalam Indonesia Vol. 10, No. 3
Publisher : UI Scholars Hub

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Abstract

Introduction. Psychological disorders are closely associated with hormonal factors, including cortisol and serotonin. In patients with acute coronary syndrome (ACS), autonomic dysfunction and dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis can occur, leading to an increase in cortisol levels that may worsen the prognosis of ACS patients. Therefore, it is important to understand the hormonal impact, namely cortisol and serotonin levels, on depressive symptoms, which will be examined in this study. Methods. This was a cross-sectional study to determine the impact of cortisol and serotonin in the incidence of depression in post-treatment ACS patients at the ICCU RSUPN dr. Cipto Mangunkusumo, Jakarta. Data collection from patients meeting the inclusion criteria was carried out 10-14 days post-treatment through interviews, HADS questionnaire completion, physical examinations, and laboratory tests. The Mann-Whitney test was used to examine the differences between serotonin and salivary cortisol levels in patients with and without depression. Results. Among the 73 ACS patients included in this study, the average age was 57.53 (9.97) years, with 68.5% was male. Posttreatment depression was observed in 15.1% of subjects. The median serotonin levels were lower in patients with depression [175 (147 – 227.64) ng/mL vs. 189.31 (152.87-235.44) ng/mL], while cortisol levels were higher in patients with depression [3.09 (1.46-6.26) ng/mL vs. 2.15 (0.92-3.91) ng/mL]. However, the statistical analysis showed no significant differences between plasma serotonin and depression (p=0.482) or saliva cortisol and depression (p=0.275). Conclusions. There were no significant differences in cortisol and serotonin levels concerning depressive symptoms among post-acute coronary syndrome patients. Nevertheless, this study holds clinical importance due to the observed lower plasma serotonin levels and higher saliva cortisol levels in ACS patients with depression.
Pengaruh Pelaksanaan CODE STEMI Terhadap Strategi Pemasaran RSUPN Dr Cipto Mangunkusumo Ginanjar, Eka; Sjaaf, Amal Chalik; Sulistiadi, Wahyu
Jurnal ARSI : Administrasi Rumah Sakit Indonesia
Publisher : UI Scholars Hub

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Abstract

Nowadays, the competition in the hospital industry business is getting tougher. For this reason, hospitals are required to have innovations and strategies to attract patients. One of the necessary things to encourage patients to come to the hospital is a good hospital marketing strategy. This research aims to identify the impact of CODE STEMI program on the marketing strategy of the Cipto Mangunkusumo National General Hospital. This research uses quantitative methods by tracking medical records and administrative documents, as well as qualitative methods by observation and in-depth interviews. The results showed a decrease in mortality, MACE, door to balloon time, total cost, and length of stay after the implementation of the CODE STEMI program. These results have a good impact on the product marketing mix, such as price, distribution, people, processes, and physical facilities. Patients are satisfied with the services provided, and the number of STEMI patients coming to the hospital has increased since the implementation of the CODE STEMI program. Based on these results, it was concluded that the CODE STEMI program had a positive impact on the marketing strategy of RSUPN Dr. Cipto Mangunkusumo. Nowadays, the competition in the hospital industry business is getting tougher. For this reason, hospitals are required to have innovations and strategies to attract patients. One of the necessary things to encourage patients to come to the hospital is a good hospital marketing strategy. This research aims to identify the impact of CODE STEMI program on the marketing strategy of the Cipto Mangunkusumo National General Hospital. This research uses quantitative methods by tracking medical records and administrative documents, as well as qualitative methods by observation and in-depth interviews. The results showed a decrease in mortality, MACE, door to balloon time, total cost, and length of stay after the implementation of the CODE STEMI program. These results have a good impact on the product marketing mix, such as price, distribution, people, processes, and physical facilities. Patients are satisfied with the services provided, and the number of STEMI patients coming to the hospital has increased since the implementation of the CODE STEMI program. Based on these results, it was concluded that the CODE STEMI program had a positive impact on the marketing strategy of RSUPN Dr. Cipto Mangunkusumo.
Korelasi Stenosis Penyakit Arteri Perifer di Bawah Lutut dengan Kecepatan Hantar Saraf pada Penyandang Neuropati Perifer Diabetes Melitus Tipe 2 Antono, Akbarbudhi; Antono, Dono; Karim, Birry; Hakim, Manfaluthy; Harimurti, Kuntjoro; Sulistianingsih, Dyah Purnamasari; Ginanjar, Eka; Nelwan, Erni Juwita; Nugroho, Pringgodigdo
Jurnal Penyakit Dalam Indonesia
Publisher : UI Scholars Hub

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Introduction. One consequence of DM is the emergence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy is a complication of diabetes that presents signs and symptoms of motor and sensory disturbances, while PAD is an atherosclerosis condition that gradually develops in the arterial vessels. This study aimed to determine correlation of arterial obstruction assessed using arteriography and the nerve impairment assessed using nerve conduction velocity (NCV) in DM patients with PAD and DPN. Methods. This is a cross-sectional study that takes secondary data from previous research conducted from July 2018 to June 2021 in Cipto Mangunkusumo hospital. Subjects were people with DM type 2 who had NPD and PAP who met the inclusion criteria and did not meet the exclusion criteria. Subjects underwent an arteriography examination to assess the stenosis in the peroneal artery, anterior tibial artery, and posterior tibial artery. Subjects also underwent nerve conduction velocity (NCV) examinations in the peroneal N. communis, N. peroneal superficialis, N. tibialis, and N. suralis. The correlation between the two variables was then tested using the Spearman correlation test. Results. The peroneal artery stenosis had a moderate negative correlation (r = - 0.420) with the sensory NCV of the superficial peroneal nerve which was statistically significant (p = 0.023). Meanwhile, the correlation of stenosis and NCV disorders in the peroneal nerve with the common peroneal nerve, anterior tibial nerve with tibialis nerve and posterior tibial nerve with sural nerve was not statistically significant. This can be explained by the possibility of collaterals appearing in people with PAD, the structure of vasculature on the nerves, and the small number of samples. Conclusions. There is a moderate negative correlation between the stenosis of the peroneal nerve and the sensory NCV of the peroneal superficialis. However, insignificant results were found in the correlation between peroneal artery with common peroneal nerve, anterior tibialis artery with tibial nerve, and posterior tibial artery with sural nerve.
Co-Authors Agnes Kurniawan Amal C Sjaaf Amal Sjaaf Antono, Akbarbudhi Aprildah Nur Sapardin Ardani, Yanuar Ari Fahrial Syam Aulia Rizka, Aulia Birry Karim Ceva W. Pitoyo Diah Pravita Sari Dono Antono E Mudjaddid E Mudjaddid, E E. Mudjaddid A. Siswanto Deddy N.W.Achadiono Hamzah Shatri Em Yunir, Em Erni Juwita Nelwan, Erni Juwita Funay, Prijander L B Hakim, Manfaluthy Harry Isbagio Hendra Perkasa Heppi Kartika Rahmawati Ika Prasetya Wijaya Ikhwan Rinaldi Irman Firmansyah Kuntjoro Harimurti Muhadi Muhadi Muhadi Muhadi, Muhadi Prijander Lombardia Funay Pringgodigdo Nugroho, Pringgodigdo Ratna Agtasari Rudi Putranto Sally Aman Nasution Sari, Diah Pravita Setyawan, Wawan Simon Salim Sjaaf, Amal C Sjaaf, Amal Chalik Sukamto Koesnoe Sulistianingsih, Dyah Purnamasari Teguh Hardjono Vika Wahyudi Anggiri Wahyu Sulistiadi Wahyu Sulistyadi Wahyu Sulistyadi Yulianto Yulianto Yusuf Subekti