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-429 T/C and -374 T/A Polymorphisms in Receptor Advanced Glycation Endproducts (RAGE) gene in Type 2 Diabetic Patients with Diabetic Retinopathy at the Dr. Sardjito General Hospital Yogyakarta Djuma, Agustina Welhelmina; ., Sunarti; Hastuti, Pramudji
Indonesian Journal of Biotechnology Vol 17, No 1 (2012)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (212.796 KB)

Receptor of advanced glycation endproduct (RAGE) plays an important role in the pathogenesis of diabetic vascular complications, such as diabetic retinopathy. The interaction between the RAGE and advanced glycation end product (AGE) leads to oxidative stress and could result in cellular activation and infl ammation. The production of AGE occurs normally during aging but it increases in hyperglycemia condition. The objective of this research was to investigate the association between -429 T/C and -374 T/A polymorphisms in RAGE gene with the risk of diabetic retinopathy (DR) of type 2 diabetic patients in Javanese population. This was a case control study which consisted of 40 type 2 diabetic patients with DR as case subjects and 40 type 2 diabetic patients without DR (NDR) as control subjects. Genotyping of polymorphism was performed by PCR-RFLP. Chi-square test and odds ratio models were used to evaluate the association of both polymorphisms and DR risk and to examine 2-SNP haplotype of -429 T/C and -374 T/A polymorphisms in RAGE gene on DR. The genotype frequencies of -429 T/C polymorphism in RAGE gene in DR subjects were TT = 72.5% and TC/CC = 27.5%; while in NDR subjects were TT = 80% and TC/ CC = 20%, with p = 0.431. The allele frequencies of -429 T/C polymorphism in DR subjects were T = 83.7% and C= 16.3%, while in NDR subjects were T = 87.5% and C = 12.5%, with p = 0.499. The genotype frequencies of -374T/A polymorphism in RAGE gene in DR subjects were TT = 67.5%, TA = 32.5% while in NDR subjects were TT =82.5%, TA = 17.5%, with p = 0.121. In DR subjects, the frequencies of T and A were 83.7% and16.3%, while in NDR subjects the frequencies of T and A were 91.2 % and 8.8%, with p = 0.151. Odds ratios of -429 T/C polymorphism were 1.52 (95% CI = 0.54 – 4.29) for TC/CC genotype and 1.358 (95% CI = 0.56 – 3.31) for C allele. Odds ratios of -374 T/A polymorphism were 2.27 (95% CI = 0.79 – 6.49) for TA genotype and 2.02 (95% CI = 0.76 – 5.37) for A allele. χ2-value for 2-SNP haplotype was p = 0.127. The -374 T/A polymorphism in RAGE gene was a stronger risk factor of DR than -429 T/C polymorphism in RAGE gene. There were not signifi cantly different of frequencies of genotypes, allele, and two-SNP haplotype of -429 T/C and -374 T/A polymorphisms in RAGE gene between DR subjects and NDR subjects.

PEMERIKSAAN KOLESTEROL DAN GULA DARAH PADA MASYARAKAT DI LASIANA KUPANG NUSA TENGGARA TIMUR Djuma, Agustina W.; Octrisdey, Karol; Bia, Mikhael B.; Tangkelangi, Marni; Wuan, Adrianus Ola; Nurdin, Kuntum Ekawati; Novicadlitha, Yoan; Susilawati, Ni Made
JURNAL PENGEMBANGAN KOMUNITAS Vol 2 No 2 (2018): December
Publisher : JURNAL PENGEMBANGAN KOMUNITAS

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Pengabdian masyarakat institusi dosen dan mahasiswa politeknik kesehatan kementrian kesehatan kupang dilakukan pada 28 Oktober 2018. Kegiatan pengabdian masyarakat ini diselenggarakan secara bersama-sama jurusan keperawatan, kebidanan, keperawatan gigi, gizi, farmasi, kesehatan lingkungan dan analis kesehatan. Program studi analisis kesehatan memfokuskan pada beberapa pemeriksaan kesehatan salah satunya adalah pemeriksaan kadar kolesterol total dan glukosa darah menggunakan point of care testing (POCT) autocheck. Kegiatan pengabdian masyarakat ini bertujuan melakukan screening terhadap kadar kolesterol dan gula darah masyarakat sekaligus memberikan pemahaman tentang bahaya kadar kolesterol dan gula darah yang tinggi pada kesehatan. Masyarakat yang hadir dalam kegiatan pengabdian masyarakat ini adalah semua warga yang ada pada wilayah kelurahan lasiana kupang. Berdasarkan hasil pemeriksaan kadar kolesterol total dan gula darah masyarakat lasiana menunjukan rata-rata penduduk memiliki kadar kolesterol total dan gula darah yang normal namun yang menarik bahwa untuk kadar dengan risiko tertinggi pada jenis kelamin perempuan yaitu 19 %. Sedangkan kelompok laki-laki banyak yang memiliki nilai kolesterol yang relatif normal. Hal yang sama juga pada kadar glukosa darah sewaktu dimana masyarakat yang gula darah sewaktunya normal (106 -144 mg/dL) sebanyak 11 orang, kadar glukosa darah sewaktu rendah (106 mg/dL) terdapat pada 28 orang dan tinggi sebanyak 5 orang.   Kata Kunci : Kolesterol, Gula Darah, Lasiana

Karakteristik Pasien HIV/AIDS Yang Sedang Menjalankan Terapi Obat Antiretroviral DI RSUD Mgr. Gabriel Manek, SVD Atambua Norma Kambuno; Maria Herlinda Mali; Agustina Wilhelmina Djuma
JURNAL KESEHATAN PRIMER Vol 5 No 2 (2020): JKP (Jurnal Kesehatan Primer)
Publisher : Poltekkes Kemenkes Kupang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31965/jkp.v5i2.439

Background: HIV or Human Immunodeficiency Virus is a type of virus that attacks or infects white blood cells which causes a decrease in human immunity. AIDS or Acquired Immuno Deficiency Syndrome is a set of symptoms that arise due to decreased immunity caused by HIV. Objective: This study aims to find out the characteriction of HIV / AIDS patients who are currently undergoing antiretroviral drug therapy at RSUD Mgr. Gabriel Manek, SVD Atambua from 2017 to 2019. Methods: This research is a descriptive study. The place of research was conducted at RSUD Mgr. Gabriel Manek, SVD Atambua. The variable used in this study is a single variable which includes a description of the number of HIV / AIDS patients currently undergoing antiretroviral drug therapy at Mgr Gabriel Manek, SVD Atambua Hospital. The data are presented in tabular table in the form of frequency distribution, number of patients, age, marital status and employment. Results: The results showed that the number of HIV / AIDS sufferers at RSUD Mgr. Gabriel Manek, SVD Atambua from 2017-2019 were 448 patients, there were 306 patients treated with antiretroviral therapy, and 142 people were not. Conclusion: The number of HIV / AIDS sufferers undergoing antiretroviral therapy based on the age category 25-49 years old were 238 patients, there were 164 patients in women category, 250 patients were married people and in employment status there were 143 housewives. Latar Belakang: HIV atau Human Immunodeficiency Virus adalah virus yang menyerang atau menginfeksi sel darah putih yang menyebabkan turunnya kekebalan tubuh manusia. AIDS atau Acquired Immuno Deficiency Syndrome adalah sekumpulan gejala penyakit yang timbul karena turunnya kekebalan yang disebabkan oleh HIV. Tujuan: Penelitian ini bertujuan untuk mengetahui karakteristik pasien HIV/AIDS yang sedang menjalankan terapi obat antiretroviral di RSUD Mgr. Gabriel Manek, SVD Atambua tahun 2017 sampai 2019. Metode: Penelitian ini merupakan penelitian deskriptif. Tempat penelitian dilakukan di RSUD Mgr. Gabriel Manek, SVD Atambua. Variabel yang digunakan dalam penelitian ini adalah variabel tunggal yang meliputi gambaran jumlah pasien HIV/AIDS yang sedang menjalankan terapi obat antiretroviral di RSUD Mgr. Gabriel Manek, SVD Atambua. Data – data disajikan dalam bentuk tabel berupa distribusi frekuensi, jumlah penderita, umur, status perkawinan dan pekerjaan. Hasil: Jumlah penderita HIV/AIDS di RSUD Mgr. Gabriel Manek, SVD Atambua dari tahun 2017-2019 berjumlah 448 orang, yang menjalankan terapi antiretroviral sebanyak 306 orang dan tidak menjalankan terapi antiretroviral sebanyak 142 orang. Kesimpulan: Jumlah penderita HIV/AIDS yang menjalankan terapi antiretroviral berdasarkan karakteristik umur terbesar pada kalangan dewasa jenjang umur 25-49 tahun sebanyak 238 orang, karakteristik jenis kelamin tertingi pada perempuan sebanyak 164 orang, status perkawinan tertinggi yang telah menikah sebanyak 250 orang dan status pekerjaan tertinggi pada Ibu Rumah Tangga sebanyak 143 orang.

ANALISIS FAKTOR PENULARAN VIRUS HEPATITIS B KONTAK SERUMAH DI DI DESA BONE KABUPATEN KUPANG Agustina Welhelmina Djuma; Diana Ayu Eiga Julianty; Wilhelmus Olin; Agustina Setia
Klinikal Sains : Jurnal Analis Kesehatan Vol 11 No 2 (2023): Desember
Publisher : LPPM Universitas Abdurrab

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36341/klinikal_sains.v11i2.3818

Virus Hepatitis B (VHB) dari famili Hepadnaviridae merupakan penyebab terjadinya penyakit Hepatitis B. Pajanan VHB menyebabkan keluaran klinis yaitu hepatitis akut dan Hepatitis kronik. Hepatitis akut akan sembuh dan membentuk kekebalan terhadap penyakit ini, sedangkan hepatitis yang berkembang menjadi kronik akan berakibat pada peradangan hati akut atau menahun. Pada beberapa kasus perkembangan peradangan hati akut ataupun menahun dapat menjadi sirosis hati. Virus Hepatitis B dtransmisikan secara vertikal dan horizontal. Penularan dari ibu kepada janinya melalui plasenta pada masa perinatal merupakan penularan vertikal, sedangkan penularan melalui cairan tubuh penderita Hepatitis B antara lain air liur, darah, atau cairan tubuh dan kontak seksual merupakan jenis penularan secara horizontal. Penelitian ini bertujuan menganalisis karakteristik, perilaku berisiko dan tingkat pengetahuan dari anggota keluarga yang kontak serumah dengan penderita Hepatitis B di Desa Bone. Jenis penelitian ini observasional analitik menggunakan rancangan cross sectional. Perilaku berisiko dan tingkat pengetahuan diukur menggunakan kuisioner. Analisis Chi-Square untuk mengkaji faktor yang berhubungan dengan penularan Hepatitis B. Responden pada penelitian ini berjumlah 40 orang. Hasil penelitian menunjukkan 37,5% responden dengan HBsAg positif terdapat pada laki-laki 20% dan 17,5% pada perempuan. Responden dengan HBsAg positif terbanyak pada kelompok usia 26-45 tahun sebesar 27,5%. Usia merupakan faktor yang berhubungan dengan Hepatitis B (p<0,05). Tidak ditemukan adanya hubungan antara beberapa kebiasaan yang dapat berisiko menularkan VHB, yaitu penggunaan alat pribadi bersama (p>0,05) dengan kejadian Hepatitis B. Meskipun tingkat pengetahuan masyarakat tentang Hepatitis B tergolong rendah (69,4%), namun tingkat pengetahuan responden di Desa Bone tidak merupakan faktor yang ada hubungannya dengan kejadian Hepatitis B.

Analisis darah (hemoglobin, hematokrit, dan trombosit) pada pasien anak demam berdarah dengue Agni Yudhaswara, Novian; Djuma, Agustina Wilhelmina; Nurdin, Tri Wulandari
JURNAL KESEHATAN PRIMER Vol 8 No 1 (2023): JKP (Jurnal Kesehatan Primer)
Publisher : Poltekkes Kemenkes Kupang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31965/jkp.v8i1.947

Introduction: Dengue Hemorrhagic Fever (DHF) is an infection caused by the Dengue virus which is transmitted through the bites of Aedes aegypti and Aedes albopictus mosquitoes. Based on laboratory criteria, low platelet count (thrombocytopenia) and plasma leakage are important indicators for DHF. The purpose of this study was to analyze Hb levels, Ht levels, and platelet counts and their relationship in DHF patients so that when these values are at the threshold, health workers can anticipate and provide ideal care. Methods: This article is a descriptive retrospective study by taking secondary data at RSUD S.K. Lerik City of Kupang in 2020 with a total sample population of 135 DHF pediatric patients (0-11 years). Results: The results of this study, Hb values were below normal at 10.8 ± 1.4 g/dL in 52 (39%) patients, Ht values were above normal at 42.5 ± 2.3% in 81 (60%) patients, and platelet values were not normal or low 110,000 ± 12,500 per microliter of blood in 130 (97%). Researchers also wanted to show the relationship between Hb, Ht, and Platelets in the analysis with the Pearson Correlation Test (α = 0.05). Conclusion: The conclusion of this article is that there is no correlation between Hb and Ht and platelets, while Ht and platelets have a significantly low correlation (r=-0.32), which means that there is a relationship between high hematocrit and low platelet values in pediatric DHF patients so that patients DHF in children needs to be examined both.

Crystal sediment profile in the urine of public transportation drivers on route 2 in Kupang city Ledoh, Yaksem Yohanis; Djuma, Agustina Welhelmina; Kapitan, Lely Adel Violin
Journal of Indonesian Medical Laboratory and Science Vol 5 No 1: April 2024
Publisher : Asosiasi Institusi Pendidikan Tinggi Teknologi Laboratorium Medik Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.53699/joimedlabs.v5i1.121

Background: Drivers have a profession that requires prolonged sitting, leading to the release of bone calcium into the bloodstream, which can trigger the formation of urinary stones or nephrolithiasis. Urinary stone (nephrolithiasis) is a condition where stones form in the urinary tract. Objectives: The aim of this study was to describe the crystal sediment profile in the urine of public transportation drivers on Route 2 in Kupang City. Materials and Methods: This descriptive study involved 16 public transportation drivers on Route 2 in Kupang City as research subjects. Data were collected through interviews. Results: The results showed the presence of various crystals in the urine sediment, including Calcium Oxalate crystals (25%), Calcium Carbonate crystals (18.75%), Uric Acid crystals (12.5%), and Amorphous crystals (6.25%). Conclusions: Based on the characteristics and habits of the respondents, it was found that frequent urinary retention, drinking less than 1 liter of water per day, and consuming supplemented or carbonated drinks were the three main factors affecting urine sedimentation in public transportation drivers on Route 2 in Kupang City.

HBsAg Status, Molecular Detection and Therapy Evaluation of Hepatitis B Patient Djuma, Agustina W.; Dewu, Sherly; Banunu, Ayorince Herlinalt Gloria; Kambuno, Norma T.; Astuti, Aldiana
JURNAL INFO KESEHATAN Vol 21 No 4 (2023): JURNAL INFO KESEHATAN
Publisher : Research and Community Service Unit, Poltekkes Kemenkes Kupang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31965/infokes.Vol21.Iss4.1110

The management of chronic hepatitis B involves various therapeutic approaches, including nucleotide analogs (NUCs) and pegylated-interferon alpha (peg-IFN), either in isolation or in combination. Reverse transcriptase enzyme is competitively inhibited by NUCs, which effectively suppresses HBV replication and lowers viral load. Concerning their cost-effectiveness, high response rates, low side effects, and oral administration, NUCs are recommended. Prolonged use, particularly of NUCs with a low genetic barrier or as monotherapy, can, however, lead to resistance, long-term safety issues, and the need for ongoing treatment. Physicians and other healthcare professionals are extremely concerned about the emergence of resistance and possible safety concerns related to the long-term use of NUCs. Moreover, the requirement for continuous therapy presents notable obstacles concerning patient adherence, distribution of healthcare resources, and overall economic viability. To clarify these problems and direct the creation of more potent and long-lasting treatment plans for chronic hepatitis B, urgent research is required. Hepatitis B surface antigen (HBsAg) detection is frequently accomplished via the use of the Chemiluminescent Microparticle Immunoassay (CMIA), which is a crucial early serologic marker for screening and diagnosis. Polymerase chain reaction (PCR) molecular testing is employed to confirm the presence of HBsAg. Polymerase Chain Reaction (PCR) was the technique we utilized to verify the outcomes. Twenty-eight of the HBsAg-positive patients at W.Z. Johannes Kupang Hospital had positive PCR results, highlighting the significance of molecular confirmation. The results of this study emphasize the value of precise HBsAg testing and the supplementary function of molecular confirmation in the treatment of patients with chronic hepatitis B. Furthermore, it clarifies the current therapeutic approaches applied to this patient population, highlighting the necessity of customized therapeutic approaches based on each patient's unique profile and potential complications.

Karakteristik Pasien HIV/AIDS Yang Sedang Menjalankan Terapi Obat Antiretroviral DI RSUD Mgr. Gabriel Manek, SVD Atambua Kambuno, Norma; Mali, Maria Herlinda; Djuma, Agustina Wilhelmina
JURNAL KESEHATAN PRIMER Vol 5 No 2 (2020): JKP (Jurnal Kesehatan Primer)
Publisher : Poltekkes Kemenkes Kupang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31965/jkp.v5i2.439

Background: HIV or Human Immunodeficiency Virus is a type of virus that attacks or infects white blood cells which causes a decrease in human immunity. AIDS or Acquired Immuno Deficiency Syndrome is a set of symptoms that arise due to decreased immunity caused by HIV. Objective: This study aims to find out the characteriction of HIV / AIDS patients who are currently undergoing antiretroviral drug therapy at RSUD Mgr. Gabriel Manek, SVD Atambua from 2017 to 2019. Methods: This research is a descriptive study. The place of research was conducted at RSUD Mgr. Gabriel Manek, SVD Atambua. The variable used in this study is a single variable which includes a description of the number of HIV / AIDS patients currently undergoing antiretroviral drug therapy at Mgr Gabriel Manek, SVD Atambua Hospital. The data are presented in tabular table in the form of frequency distribution, number of patients, age, marital status and employment. Results: The results showed that the number of HIV / AIDS sufferers at RSUD Mgr. Gabriel Manek, SVD Atambua from 2017-2019 were 448 patients, there were 306 patients treated with antiretroviral therapy, and 142 people were not. Conclusion: The number of HIV / AIDS sufferers undergoing antiretroviral therapy based on the age category 25-49 years old were 238 patients, there were 164 patients in women category, 250 patients were married people and in employment status there were 143 housewives. Latar Belakang: HIV atau Human Immunodeficiency Virus adalah virus yang menyerang atau menginfeksi sel darah putih yang menyebabkan turunnya kekebalan tubuh manusia. AIDS atau Acquired Immuno Deficiency Syndrome adalah sekumpulan gejala penyakit yang timbul karena turunnya kekebalan yang disebabkan oleh HIV. Tujuan: Penelitian ini bertujuan untuk mengetahui karakteristik pasien HIV/AIDS yang sedang menjalankan terapi obat antiretroviral di RSUD Mgr. Gabriel Manek, SVD Atambua tahun 2017 sampai 2019. Metode: Penelitian ini merupakan penelitian deskriptif. Tempat penelitian dilakukan di RSUD Mgr. Gabriel Manek, SVD Atambua. Variabel yang digunakan dalam penelitian ini adalah variabel tunggal yang meliputi gambaran jumlah pasien HIV/AIDS yang sedang menjalankan terapi obat antiretroviral di RSUD Mgr. Gabriel Manek, SVD Atambua. Data – data disajikan dalam bentuk tabel berupa distribusi frekuensi, jumlah penderita, umur, status perkawinan dan pekerjaan. Hasil: Jumlah penderita HIV/AIDS di RSUD Mgr. Gabriel Manek, SVD Atambua dari tahun 2017-2019 berjumlah 448 orang, yang menjalankan terapi antiretroviral sebanyak 306 orang dan tidak menjalankan terapi antiretroviral sebanyak 142 orang. Kesimpulan: Jumlah penderita HIV/AIDS yang menjalankan terapi antiretroviral berdasarkan karakteristik umur terbesar pada kalangan dewasa jenjang umur 25-49 tahun sebanyak 238 orang, karakteristik jenis kelamin tertingi pada perempuan sebanyak 164 orang, status perkawinan tertinggi yang telah menikah sebanyak 250 orang dan status pekerjaan tertinggi pada Ibu Rumah Tangga sebanyak 143 orang.

Analisis darah (hemoglobin, hematokrit, dan trombosit) pada pasien anak demam berdarah dengue Agni Yudhaswara, Novian; Djuma, Agustina Wilhelmina; Nurdin, Tri Wulandari
JURNAL KESEHATAN PRIMER Vol 8 No 1 (2023): JKP (Jurnal Kesehatan Primer)
Publisher : Poltekkes Kemenkes Kupang

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31965/jkp.v8i1.947

Introduction: Dengue Hemorrhagic Fever (DHF) is an infection caused by the Dengue virus which is transmitted through the bites of Aedes aegypti and Aedes albopictus mosquitoes. Based on laboratory criteria, low platelet count (thrombocytopenia) and plasma leakage are important indicators for DHF. The purpose of this study was to analyze Hb levels, Ht levels, and platelet counts and their relationship in DHF patients so that when these values are at the threshold, health workers can anticipate and provide ideal care. Methods: This article is a descriptive retrospective study by taking secondary data at RSUD S.K. Lerik City of Kupang in 2020 with a total sample population of 135 DHF pediatric patients (0-11 years). Results: The results of this study, Hb values were below normal at 10.8 ± 1.4 g/dL in 52 (39%) patients, Ht values were above normal at 42.5 ± 2.3% in 81 (60%) patients, and platelet values were not normal or low 110,000 ± 12,500 per microliter of blood in 130 (97%). Researchers also wanted to show the relationship between Hb, Ht, and Platelets in the analysis with the Pearson Correlation Test (α = 0.05). Conclusion: The conclusion of this article is that there is no correlation between Hb and Ht and platelets, while Ht and platelets have a significantly low correlation (r=-0.32), which means that there is a relationship between high hematocrit and low platelet values in pediatric DHF patients so that patients DHF in children needs to be examined both.

Integrated Intervention for Stunting and Tuberculosis Screening in Mothers and Children: A Case Study at Kapan Health Center, East Nusa Tenggara Kambuno, Norma Tiku; Kleden, Simon S; Seran, Agustina A; Nur, Astuti; Peni, Jane A; Mirong, Ignasensia Dua; Nubatonis, Melkisedek O; Baunsele, Novianti P; Bia, Michael B.; Djuma, Agustina W; Valensia, Yualeny
Buletin Penelitian Kesehatan Vol. 53 No. 2 (2025)
Publisher : Poltekkes Kemenkes Palu

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33860/bpk.v53i2.4172

Background: The procedure for storing medical record documents (MRDs) involves sorting the records by their medical record numbers before returning them to the medical records department and placing them in storage. This process facilitates the retrieval of required records and streamlines storage operations, thereby preventing misfiling when the documents are needed for patient care. Delays in locating MRDs on the filing racks can result from storage or placement errors, commonly referred to as misfiling. Efficient storage of medical record documents (MRDs) requires proper sorting by medical record numbers before returning them to the filing system. This process ensures quick retrieval and minimizes errors. However, delays in locating MRDs often occur due to misfiling—typically caused by improper storage or placement. This study aims to identify factors contributing to misfiling, focusing on the storage system, alignment, numbering, and human resources. Methods: This study is quantitative research with a descriptive design. The analysis used is univariant analysis. The population comprises inpatient medical records returned from the care units after patient discharge during the period of January to December 2023. The sampling method employed is non-probability sampling, specifically using accidental sampling. Results: Among 50 inpatient MRDs stored in the filing room at Makassar City Regional General Hospital, 15 (30%) were misfiled Conclusion: The factors contributing to the misfiling of medical record documents in the filing room include incompetent medical record personnel, misalignment in the filing system, the absence of tracers, and the lack of an expedition logbook. Misfiling was associated with several factors, including untrained personnel, inconsistencies in the filing alignment, absence of tracers, and the lack of a delivery logbook (previously referred to as an “expedition logbook”) used to track the movement of documents. Addressing these issues may improve filing accuracy and support patient care efficiency.

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