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All Journal Journal of the Medical Sciences (Berkala Ilmu Kedokteran)
Dian Paramita Wulandari
Department Of Otorhinolaryngology Head And Neck Surgery, Faculty Of Medicine, Public Health And Nursing, Universitas Gadjah Mada / Dr. Sardjito General Hospital Yogyakarta
Immunology & microbiology Neuroscience

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Evaluation of clinical pathway implementation and clinical practice guidelines in the management of deep neck abscess (DNA) at Dr. Sardjito, General Hospital Yogyakarta, Indonesia Dian Paramita Wulandari; Hesti Dyah Palupi; Feri Trihandoko
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 54, No 4 (2022)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005404202206

Abstract

Deep neck abscess (DNA) is an infectious condition categorized as anemergency case with high mortality and morbidity. The incidence decreasesover time due to extensive use of antibiotics, operative intervention, andimproved awareness of dental hygiene. Management of DNA must be carriedout appropriately and efficiently to prevent complications that may occur,such as jugular vein thrombosis, pericarditis, and pneumonia. Patients withDNA are often categorized as high-cost patients, because of the long durationof hospitalization, the need for special examinations, and complicatedmanagement. Clinical practice guidelines (CPG) and clinical pathways (CP)are a standard created for management, quality, and cost control. The studyaimed to evaluate the implementation of the CPG and CP in DNA patients atDr. Sardjito General Hospital, Yogyakarta. The study used medical recordsdata of DNA patients from January 2018 to December 2020 who met theinclusion and exclusion criteria. A total of 55 subjects were obtained, withcompliance to complete CPG filling of 98.3% and CP filling of 96.2%. There was100% completion in CPG filling categorized as good compliance, whilst thenumber of good compliances for CP was 92.7%. In conclusion, the diagnosisand management of DNA patients at Dr. Sardjito General Hospital has goodcompliance with CPG and CP available.
The effect of appropriate antibiotic use on the length of hospital stay in deep neck abscess (DNA) patients Hesti Dyah Palupi; Dian Paramita Wulandari; Feri Trihandoko
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 55, No 1 (2023)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005501202308

Abstract

Deep neck abscess (DNA) is an emergency in the otorhinolaryngology head and neck surgery field due to the formation of abscesses in the potential space between the deep neck fasciae. It is typically caused by the expansion of infection from various sources, including the teeth, mouth, throat, paranasal sinuses, middle ear, and neck. The increase of DNA cases needs for improvement of patient management especially when the patients have comorbidities which lead to an extended length of treatment. The study aimed to evaluate the appropriateness of empirical antibiotics given according to culture results and any comorbid factors that affect the length of hospital stay (LOHS). It was case-control observational study involving 44 cases of DNA patients who treated at Dr. Sardjito General Hospital Yogyakarta in the period of January 2018 to December 2020. The patients were divided into two groups with 22 patients in each group. The first group was the DNA patients with > 7 d LOHS and the second one was those with ≤ 7 d.  No significantly relationship was observed between variables evaluated included the appropriate antibiotic use  (p=0.546). However, dental caries (DC) was significantly related with the LOHS (p=0.015). In conclusion, there is no relationship between the appropriate antibiotic use and the LOHS. However, the DC is risk factor that influence the LOHS in patients with DNA.
The difference in biofilms formations on duration less than 90 d and more than 90 d of tracheotomy cannula usage Pradhana Fajar Wicaksana; Dian Paramita Wulandari; Angga Kusuma; Siswanto Sastrowijoto
Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 55, No 1 (2023)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.19106/JMedSci005501202307

Abstract

Currently, prevention of local and systemic infections caused by implantable devices is increasingly improved. Tracheostomy is a surgical action followed by an implantable device called tracheotomy cannula into a trachea to maintain upper airway patenting. The incidence of biofilm-related complications and infections is associated with the length of duration of the attached tracheostomy. The formation and spread of biofilms from distal cannula increase the infection incidence in stoma, tracheitis, and even peripheral pneumonia. However, until now there has been no consensus on when the tracheostomy replacement supposedly conducted. Some manufacturers recommend that cannula replacement supposedly conducted within 30 d, but the data are not yet in agreement and need further study. This study aimed to determine the difference in biofilms formations in a duration of less than 90 d and more than 90 d of tracheotomy cannula usage. It was a cross-sectional study involving patients who underwent a tracheostomy at the Department of Otorhinolaryngology of Dr. Sardjito General Hospital, Yogyakarta. Fisher exact test was applied to analyze the biofilms formations of the two different duration of tracheostomy cannula usage. A total of 20 patients were involved in this study.  Durations of more than 90 d had more biofilms formations compared to less than 90 d, although it was not significantly different (p>0.05). However, the PR value of 6 indicated that subjects who have attached cannula more than 90 d clinically have 6 times higher risk for developing biofilms formations than those less than 90. In conclusion, there is no significant differences in biofilms formations between the less than 90 d and more than 90 d of tracheostomy cannula usage. However, clinically subjects with longer duration of tracheostomy cannula usage have higher risk for developing biofilms formations.
Co-Authors Angga Kusuma Feri Trihandoko Feri Trihandoko Hesti Dyah Palupi Hesti Dyah Palupi Pradhana Fajar Wicaksana Siswanto Sastrowijoto