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INFLUENCE OF SERVICE QUALITY, BRAND IMAGE, AND COMMUNICATION ON PATIENT SATISFACTION AND LOYALTY OF UROLOGY PATIENT AT SILOAM HOSPITAL MANADO IN 2023 Toreh, Christof; Wuisan, Dewi Sri Surya
JMBI UNSRAT (Jurnal Ilmiah Manajemen Bisnis dan Inovasi Universitas Sam Ratulangi). Vol 11 No 1 (2024): JMBI UNSRAT Volume 11 Nomor 1
Publisher : FEB Universitas Sam Ratulangi Manado

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35794/jmbi.v11i1.53784

Abstract. Indonesia's entry into the free-market competition has led to a surge in the number of hospitals, resulting in intensified competition with increasingly selective consumers, higher expectations, and lower loyalty. According to the 2022 report from Siloam Hospital Manado, there has been a decline in urology patient visits, and no research has been conducted on patient satisfaction levels regarding service quality, brand image, communication, and their impact on urology patient loyalty. This situation raises concerns about a potential decline in patient visits, which is crucial during this period to enhance the hospital's marketing function for achieving patient satisfaction and loyalty. To analyze the influence of service quality, brand image, and communication on patient satisfaction and their subsequent impact on patient loyalty. This study employs a descriptive-analytic design with a quantitative approach, utilizing purposive sampling with a sample size of 161. Data is collected through questionnaires, and the analysis is conducted using Structural Equation Modeling-Partial Least Squares (SEM-PLS). Abstrak. Masuknya Indonesia ke dalam persaingan pasar bebas telah menyebabkan lonjakan jumlah rumah sakit, sehingga persaingan menjadi semakin ketat dengan konsumen yang semakin selektif, ekspektasi yang lebih tinggi, dan loyalitas yang lebih rendah. Berdasarkan laporan RS Siloam Manado tahun 2022, terjadi penurunan kunjungan pasien urologi, dan belum dilakukan penelitian mengenai tingkat kepuasan pasien mengenai kualitas pelayanan, brand image, komunikasi, dan dampaknya terhadap loyalitas pasien urologi. Situasi ini menimbulkan kekhawatiran akan potensi penurunan kunjungan pasien, yang sangat penting pada periode ini untuk meningkatkan fungsi pemasaran rumah sakit guna mencapai kepuasan dan loyalitas pasien. Untuk menganalisis pengaruh kualitas layanan, citra merek, dan komunikasi terhadap kepuasan pasien dan dampak selanjutnya terhadap loyalitas pasien. Penelitian ini menggunakan desain deskriptif-analitik dengan pendekatan kuantitatif, menggunakan purposive sampling dengan jumlah sampel 161. Data dikumpulkan melalui kuesioner, dan analisis dilakukan menggunakan Structural Equation Modeling-Partial Least Squares (SEM-PLS).

Relation of Pre-operative Ureteral Catheter Use and Complications of Intraoperative Ureteral and Bladder Trauma in Gynecologic Oncology Patients Undergoing Major Surgical Procedures Sinurat, Bintang; Toreh, Christof; Astram, Ari; Arianto, Eko; Langi, Fima
Medical Scope Journal Vol. 7 No. 1 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i1.56265

Iatrogenic injury to the urinary tract is a potential complication of all surgical procedures performed in or retroperitoneum and pelvis. Gynecological surgery in particular has a risk of urinary tract injury due to the close anatomy of the urinary tract and the reproductive system in women. This study aimed to evaluate the relation between pre-operative ureteral catheter use and complications of intraoperative ureteral and bladder trauma in gynaecologic oncology patients undergoing major surgical procedures. This study used cohort data of patients undergoing major surgical procedures at Prof. Dr. R. D. Kandou Hospital, Manado, recorded in medical records from January 1, 2023 to June 30, 2023. The bivariate test showed that patients who received pre-operative ureteral catheter insertion had fewer urological trauma events (4.5%) compared to patients who did not get pre-operative ureteral catheter (95.5%). The relations between pre-operative ureteral catheters and the incidence of urological trauma was found to be statistically significant with a p-value of 0.019 and the history of chemotherapy had a p-value of 0.036, meanwhile the relations with other variables showed p-values of >0.05. Therefore, the use of pre-operative catheters could not significantly eliminate the occurrence of ureteral trauma because many of the confounding factors were accompanied by several other conditions that were also studied in the multivariate analysis. In conclusion, there is no association between the use of pre-operative ureteral catheters and complications of intraoperative ureteral trauma in gynecologic oncology patients undergoing major surgical procedures. Future studies using samples from more sources are expected to assess the relation between pre-operative ureteral catheter use and the incidence of urological trauma more accurately, and to assess the ease of use of pre-operative ureteral catheter. Keywords: ureteral catheter; ureteral trauma; gynaecologic oncology patients

Comparison of Scoring Systems in Predicting Stone-Free Rate in Flourless Retrograde Intrarenal Surgery Arianto, Eko; Astram, Ari; Toreh, Christof; Wihono, Frendy; Krishna, Mahesa
Medical Scope Journal Vol. 7 No. 1 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i1.57388

Abstract: Thus far, there is no standardised method for predicting outcomes from fluoro-less retrograde intrarenal surgery (RIRS) procedure. This study aimed to compare scoring systems in predicting stone-free rate (SFR) in RIRS patients This was an observational and analytical study with a retrospective cohort design. Samples were obtained from medical records of Dr. J. H. Awaloei Hospital from March 2022 to October 2023. This study only analyzed three scoring systems: Guy's Stone Score (GSS), Resorlu-Unsal Stone Score (RUSS), and Seoul National University Renal Stone Complexity Score (S-ReSC). The results obtained 219 patients with an average age of 55 years, GSS grade I in 108 patients, and grade II in 50 patients. Related to RUSS score, 43 patients got a score of 1, 108 got a score of 2, and 60 got a score of 60. Meanwhile, S-ReSC score was at a high level with a percentage of 65.3%, 20.4% at the medium level, and 14.4% at the low level. Moreover, GSS sensitivity 76%, specificity 75%, PPV 93.2%, NPV 41.1%, AUC 75%; RUSS score sensitivity 75.4%, specificity 62.2%, PPV 90%, NPV 36.2%, AUC 70%; S-ReSC score sensitivity 71%, specificity 77.5%, PPV 93.4%, NPV 37.3%, AUC 72%. In conclusion, Guy's Stone Score, Resorlu-Unsal Stone Score, and Seoul National University Renal Stone Complexity Score have similar abilities in predicting stone-free rate. Further research is needed with a larger sample size or population to confirm the findings of this study. Keywords: nephrolithiasis; stone-free rate; scoring system; retrograde intrarenal surgery

First Endoscopic-Guided Percutaneous Nephrolithotomy (ePSL) with Prone Split-Leg Position in Manado Phoebus, Andrien; Astram, Ari; Toreh, Christof; Arianto, Eko; Wihono, Frendy
e-CliniC Vol. 13 No. 1 (2025): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v13i1.59320

Abstract: Literature has not yet defined the best position for percutaneous nephrolithotomy (PCNL) based on the complexity of the stone burden. This case of left-sided complex kidney stones underwent endoscopic-guided PCNL in an PSL (prone split-leg position). A 61-year-old woman with a chief complaint of right pelvic pain. Standard prone PCNL was planned for this patient, however, due to so much debris in the pelviocalyceal system during URS evaluation and ureter catheter insertion, we decided to puncture with ultrasound guidance rather than fluoroscopy. Intraoperatively there was residual superior calyx stone that was beyond the reach of nephroscope. We decided not to do a double puncture because of poor vision due to the floating debris. In the second procedure, the ePSL method was utilized. A C-arm and nephroscope examination revealed no active bleeding, no infundibulum laceration, and no remaining stones. The primary goals of this method were to remove stones from the urinary tract throughout the entire tract using a one-step, one-access procedure that made the most of the full range of endourologic equipment. There were a number of reasons why the prone split-leg position was chosen, including operator preference, familiarity with the position, and the inability to make a direct puncture in the upper pole. The main drawback was that patient would not be able to see how well and safely this method worked over time. In conclusion, complex kidney stones can be treated with ePSL performed in the prone split-leg position, which is a safe procedure with a low risk of complications. Keywords: percutaneous nephrolithotomy; prone split-leg position; complex kidney stones

Long-Term Follow-up after Kidney Trauma at Prof. Dr. R. D. Kandou General Hospital Manado Arianto, Eko; Panelewen, Bryan P.; Astram, Ari; Toreh, Christof; Wihono, Frendy
e-CliniC Vol. 13 No. 2 (2025): e-CliniC
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/ecl.v13i2.59605

Abstract: Renal trauma, caused by blunt or penetrating injuries, is associated with severe complications such as hypertension, chronic kidney disease (CKD), and pyelonephritis, especially in high-grade renal trauma. The study aimed to evaluate the complications and management of renal trauma patients at Prof. Dr. R. D. Kandou Hospital Manado from January 2022 to October 2024. This was an observational study with a cross-sectional design involving 17 patients that met the inclusion criteria. Data included types of trauma, severity level, management approaches, and post-trauma complications. Trauma severity was classified using the American Association for Surgery of Trauma (AAST) grading system. The results showed that 58.8% of patients had penetrating trauma, while 41.2% experienced blunt trauma. The highest percentages were found in grade II severity (29.4%). Operative management was the most common approach (58.8%). Post-trauma complications included CKD (70.5%), hypertension (29.4%), and pyelonephritis (29.4%). In conclusion, renal trauma, whether blunt or penetrating, often leads to significant complications such as CKD and hypertension. Proper long-term management and monitoring of kidney function and blood pressure are crucial to minimize the complications. This study highlights the need for early and effective intervention in high-grade renal trauma cases. Keywords: renal trauma; hypertension; acute kidney injury (AKI); chronic kidney disease (CKD); post-trauma complications

Validation of Guy’s Stone Score, RUSS, S-RESC SCORE, and S.T.O.N.E Score for Predicting Stone Free Rate in Percutaneous Nephrolithotomy in a Residency Teaching Hospital Panelewen, Bryan P.; Arianto, Eko; Astram, Ari; Toreh, Christof; Wihono, Frendy
Medical Scope Journal Vol. 7 No. 2 (2025): Medical Scope Journal
Publisher : Universitas Sam Ratulangi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35790/msj.v7i2.61296

Abstract: Kidney stones represent a significant health burden globally, with a high risk of recurrence. Percutaneous nephrolithotomy (PCNL) is the primary treatment option for kidney stones larger than 20 mm, offering superior outcomes compared to open surgery. Several scoring systems, including Guy’s Stone Score (GSS), S.T.O.N.E. Nephrolithometry Score, Resorlu Unsal Stone Score (RUSS), and Seoul Renal Stone Complexity (S-ReSC), have been developed to predict the Stone-Free Rate (SFR) following PCNL. However, the comparative effectiveness of these scoring systems remains unclear. This study aimed to evaluate and compare the predictive accuracy of GSS, S.T.O.N.E., RUSS, and S-ReSC scoring systems in determining SFR after PCNL. This was an analytical and retrospective study. Data were collected from 60 patients with kidney stones treated at Prof. Dr. R. D. Kandou Hospital Manado from January to December 2023. Patients underwent PCNL, and preoperative non-contrast CT scans and postoperative plain abdominal X-rays were used for evaluation. Statistical analyses included univariate, bivariate, and multivariate tests, as well as ROC curve analysis. The results showed that all four scoring systems were statistically significant in predicting SFR (p<0.005). The RUSS score demonstrated the highest predictive value, with an odds ratio 20 times higher than without scoring. The ROC analysis showed AUC values of 0.792 for GSS, 0.913 for RUSS, 0.694 for S-ReSC, and 0.945 for S.T.O.N.E. These findings highlight significant relationships between stone complexity scores and SFR, emphasizing their utility in surgical planning. In conclusion, each scoring system has significant predictive value for SFR following PCNL. Among them, RUSS showed the highest reliability, followed by S.T.O.N.E. and GSS. Despite differences in focus, all scores contribute to treatment planning and patient management. Further research is needed to optimize these tools and integrate them with advanced imaging and minimally invasive techniques for personalized patient care. Keywords: percutaneous nephrolithotomy; kidney stones; Stone-Free Rate; Guy’s Stone Score; S.T.O.N.E Nephrolithometry Score; Resorlu Unsal Stone Score; Seoul Renal Stone Complexity

Mitroanoff Appendicovesicostomy Procedure On Bladder Neck Stenosis: A Case Report Arianto, Eko; Hardianti Kusanto, Putri; Astram, Ari; Toreh, Christof; Wihono, Frendy; R. Torry, Stivano
International Journal of Health and Pharmaceutical (IJHP) Vol. 5 No. 2 (2025): May 2025 ( Indonesia - Iraq - Malaysia)
Publisher : CV. Inara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51601/ijhp.v5i2.411

The Mitrofanoff Appendicovesicostomy (MAC) procedure is a significant surgical intervention for patients with bladder neck stenosis, particularly in cases of severe urological dysfunction. This case report presents a 34-year-old female with a history of urinary incontinence and vesicovaginal fistula (VVF) following a cesarean section. The patient underwent the MAC procedure to address her bladder neck stenosis and restore urinary continence. Preoperative assessments, surgical techniques, and postoperative outcomes are discussed, highlighting the effectiveness of the MAC procedure in providing a new pathway for urine flow and improving the patient's quality of life. This report emphasizes the importance of a multidisciplinary approach in managing urinary incontinence, considering both physical and psychological factors. It also underscores the need for timely diagnosis and tailored surgical interventions to enhance patient outcomes. Future research should focus on identifying risk factors and developing personalized treatment strategies to mitigate urinary incontinence and related complications in postpartum patients. By integrating clinical evidence and holistic care, healthcare providers can better navigate the complexities of urinary incontinence and improve the quality of life for affected individuals.

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