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Fakultas Kedokteran Universitas Brawijaya Gedung Graha Medika Lt. 1, Ruang 104
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INDONESIA
Jurnal Kedokteran Brawijaya
Published by Universitas Brawijaya
ISSN : 02169347     EISSN : 23380772     DOI : http://dx.doi.org/10.21776/ub.jkb
Core Subject : Health,
JKB contains articles from research that focus on basic medicine, clinical medicine, epidemiology, and preventive medicine (social medicine).
Articles 822 Documents
Factors Causing Stock-Outs and Drug Stagnation at Pharmacy Installation of Puri Bunda Mother and Child Hospital Malang Tri Utami, Ni Nyoman Ayu; Ratri, Devita Rahmani; Nuthea, Merry
Jurnal Kedokteran Brawijaya Vol. 31 Supplement 2 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.02.14s

Abstract

Hospital pharmacy service is a supporting service as well as a revenue center in a hospital. More than 90% of hospital services utilize pharmaceutical supplies, and 50% of hospital revenues originate from pharmaceutical supply management. In the Covid-19 pandemic situation, the pharmacy installation must calculate the logistics management of the medicine correctly. However, based on stocktaking in May-July at Puri Bunda Mother and Child Hospital, there were stock-outs (4.06%) and drug stagnation (2.44%) due to poor drug procurement, causing declining drug sales. This study analyzed the factors causing stock-outs and drug stagnation in the Pharmacy Installation of Puri Bunda Mother and Child Hospital. This study uses a descriptive approach with data collection methods using observations, Focus Group Discussion (FGD), and Likert-scale questionnaires to find the roots of the problems. The data were analyzed using the Fishbone Diagram and Pareto Diagram. The research subjects based on total sampling were all 12 staff of the Pharmacy Installation. The results obtained through the Fishbone Diagram were 13 root causes covering the aspects of Man, Money, Method, Machine, Material, and Environment. The priority of the root cause of stock-outs and drug stagnation in the Pharmacy Installation of Puri Bunda Mother and Child Hospital Malang is the suboptimal use of the Hospital Management Information System (HMIS). The possible solutions are conducting intensive training for Pharmacy Installation staff in using HMIS, developing HMIS related to drug procurement, as well as repairing warehouse and pharmacy installation facilities and infrastructure.
Why the Emergency Department Visit Decreased during the Covid-19 Pandemic? Case Study in Hospital, Malang Regency Kusumawati, Anita Mardiana; Widyaningrum, Kurnia
Jurnal Kedokteran Brawijaya Vol. 31 Supplement 2 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.02.5s

Abstract

During the 2020 Covid-19 pandemic, emergency department experienced a drastic decreasing visit that could disrupt hospital financing. This study was conducted to identify the root cause of the declining ED visit. The study was conducted descriptively from FGD involving eight selected respondents, surveys on 83 patients regarding service perceptions and satisfaction, as well as secondary data on visits and requests of discharge against medical advice. The results showed that the decreasing visit was due to the patient's refusal on treatment in the isolation room, the staff's skills to provide communication and education, and the potential of cooperation termination from partners. Those refusals were due to the patient's perception of hospital services and the differences in patient needs on health protocols resulted from the lack of individual and organizational communication. Hospitals need to build staff's skills in communication and education as well as intensive communication strategies with partners to communicate policies and service system changes so that trust and a positive image are built.
Laboratory Service Process Checklist: Preventive Measures to Increase Blood Glucose Test Accuracy Setyawan, Yudi; Wardhani, Viera
Jurnal Kedokteran Brawijaya Vol. 31 Supplement 2 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.02.15s

Abstract

The accuracy of the blood glucose test results is an essential measurement for hospital quality since it affects the plan, decision, and outcome of the treatment. This study aimed to develop a checklists model to improve the laboratory results accuracy. The checklist development is based on the laboratory services processes covering pre-analytic, analytic, and post-analytic stages, which are implemented in all blood glucose test requests during the study period (65 examinations), the first week of October 2020. The implementation resulted in no incidence of test inaccuracy when conformed with patient clinical information. The staff expressed that completing the checklist is quick and easy to complete (3-5 minutes) and beneficial. The problem occurs when staff works alone, causing delays in completing the checklist. Therefore, regular monitoring and evaluation are suggested to ensure compliance and divide the checklist into two stages. The pre-analytic stage is first carried out for all patients, followed by the analytical and post-analytic stages because the last two activities were located on different floors. In short, checklists are effective as preventive measures to increase the conformity of laboratory examination results with patient clinical information.
Seven Rights of Medication Administration: Nurses' Knowledge, Attitude, and Compliance Puspitasari, Shinta Dwi; Dewanto, Aryo; Holipah, Holipah; Muliawan, Arrasyid Indra
Jurnal Kedokteran Brawijaya Vol. 31 Supplement 2 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.02.9s

Abstract

Medication error becomes one of the main concerns in ensuring patient safety. In 2020, X Hospital reported medication error incidents. Although categorized near miss, the incidents should have been prevented. One of the methods to prevent medication errors is by applying the seven rights of medication administration. This study aimed to identify the inhibiting factors in the implementation of the seven rights of medication administration in X Hospital and obtain alternative solutions to those obstacles. This study used an analytic observational design with a cross-sectional design. Data were collected from observations and a survey. Observations and a survey through questionnaires to 20 nurses at X Hospital were made to see the implementation of the procedure. At the end of the data collection, interviews were conducted to find out the obstacles in the inpatient installation in applying the seven rights of medication administration. The results show that the main root causes of medication administration errors were the standard operating procedure (SOP) that has not been standardized and nurses' non-compliance behavior on the seven rights procedure. To resolve medication administration errors, the hospital manager should revise the SOP, conduct internal workshops, and perform scheduled supervision to the nurses.
How Do Hospital Staff Cope with Covid-19 at Work? A Phenomenological Study Febrianto, Wahyu; Indriani, Wiwin; Dewanto, Aryo; Holipah, Holipah
Jurnal Kedokteran Brawijaya Vol. 31 Supplement 2 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.02.6s

Abstract

The Covid-19 pandemic has brought negative consequences on hospital finances, the mental health of health care workers (HCWs), and even resulted in the deaths of several health workers at Hasta Brata Hospital (HBH). This study aimed to explore the experiences of HBH's staff in dealing with the pandemic in the hospital. This research is qualitative research with a phenomenological approach. Data were collected using in-depth interviews with two of HBH's staff and then followed by the theme analysis. Hospital staff experienced job demands including emotional and physical stress at work, fear of infection, repeated conflicts with patient visitors, different mindsets among staff, increased workload, and feelings of frustration towards people who do not comply with prevention protocols. Fortunately, they had adequate job resources, ranging from the provision of personal protective equipment, nutrition improvement, and regular Covid-19 screening; update knowledge and methods of handling Covid-19; to motivational and spiritual support from HBH leaders. The staff also had strong personal resources so that they could cope with stressful work situations, feel optimistic that they could win against Covid-19, and hoped that the pandemic would end. Spiritual support embodies tawakal, an Islamic concept that gives complete surrender to God after employing maximum effort. The presence of strong job and personal resources has moderated job demands and resulted in work engagement. Tawakal is an added value for personal resources staff who finally realize that Covid-19 cannot be avoided and must be fought before surrendering entirely to God.
Development of Caesarean Section Clinical Pathway: A Lesson Learned Sastrawan, I Gede; Wardhani, Viera
Jurnal Kedokteran Brawijaya Vol. 31 Supplement 2 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.02.7s

Abstract

Although clinical pathway (CP) is aimed to ensure quality and cost, the development of CP at hospitals is primarily for administrative purposes as it is required by accreditation standards, thus causing high variations in its implementation. This study aimed to develop a clinical pathway for caesarean section and explore the problem during development and implementation test. The selection of caesarean section was based on high volume, risk, and cost. Using participatory action research, the researcher started the program by performing an implementation evaluation, literature review, and regulatory development. The evaluation identified implementation discrepancies and prolonged length of stay. Based on the evaluation and literature review results, the Professional Care Provider (PCP) in the hospital conducted discussions and made suggestions by considering available resources, current practices, and behavior. The main differences of the new clinical pathway are: 1) it is developed based on literature and current practice, and 2) it should be added with notification, explanation, inclusion and exclusion criteria, and references. Before the implementation test, the hospital provide resources, develops a standard operational procedure followed by monitoring and evaluation. Differences in the type of medication and documentation method were found, which then further discussed with all involved PCP to define the agreed solutions. Professional engagement and openness culture that embraces along the process are the main key lesson learned in addition to the understanding that CP development and implementation is a continuous learning process.
Covid-19 Countermeasure Policy in the Province of Jakarta Capital City Yunita, Irma; Achadi, Anhari; Saputra, Maman; Kusumo, Rangga; Hasani, Nurul; Rusdi, Farhannuddin
Jurnal Kedokteran Brawijaya Vol. 32 Supplement 1 (2022)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2022.032.01.12s

Abstract

Jakarta is the highest province of positive Covid-19 cases nationally and the epicenter region in Indonesia. This study aims to analyze the development of the number of cases and Covid-19 countermeasure policy in the Province of Jakarta Capital City. This study uses a qualitative method with in-depth interviews and document review. Primary data was collected from selected informants, namely the Head of Jakarta Health Office and Assistant to the Provincial Secretary for Governmental. Secondary data is taken from legal and policy documents, reports, websites, and press releases. The fluctuation of Covid-19 cases in Jakarta depends on the capacity of the examining laboratory and the capacity of contact tracing. Until April 30, 2020, The Provincial Government of Jakarta Capital City has made 74 policies. They made Covid-19 as a serious policy agenda and collaborates with the whole of government, privates, professional/community/ religious organizations, and society. Situational factors are the most influential factors in the policymaking process. The Provincial Government of Jakarta Capital City concerns early since the Wuhan Pneumonia case with the epidemiological surveillance system of the Health Office, which has been running regularly monitoring infectious diseases from the community health center level. Policy formulation is based on research and scientific studies. Monitoring and evaluation are carried out both formatively and summatively to address problems and obstacles in policy implementation. The Provincial Government of Jakarta Capital City took the early response to collaborates with the whole of government, privates, and society in policymaking and implementation.
Effectiveness of Motivational Interviewing on Self-Management of Type 2 Diabetes Mellitus Patients: A Systematic Review Siska Puji Lestari; Titin Andri Wihastuti; Dina Dewi Sartika Lestari Ismail
Jurnal Kedokteran Brawijaya Vol. 31 No. 4 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.04.11

Abstract

Diabetes mellitus is a health problem that will affect the health status of patients. Motivational interviewing a counseling technique focusing on clients and it is designed for helping individuals explore and accomplish ambivalence in behavior. This systematic review aimed at describing effectiveness motivationaI interviewing on self-management of diabetes mellitus type 2 patients. There are 1359 articles of 526 ScienceDirect articles, 422 ProQuest, 290 PubMed, and 121 Ebsco articles. The systematic review method began by identifying 20 articles from four electronic databases for previous studies that were published during 2011-2021. The results of the systematic review obtained that motivational interviewing can provide improved self-management and control blood glucose DM type 2 patients. The conclusion motivational interviewing can affect the patient's self-management especially on blood glucose profile, dietary compliance, quality of life, self-efficacy, HbA1c levels of DM type 2 patients.
Cardiovascular Outcomes in High-Risk Patients Undergoing OPCAB Surgery Compared to Traditional CABG Widya Trianita Suwatri; Dudy Arman Hanafy; Sugisman Sugisman
Jurnal Kedokteran Brawijaya Vol. 31 No. 4 (2021)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2021.031.04.9

Abstract

The benefit of coronary artery bypass graft (CABG) for coronary artery disease (CAD) with Ejection Fraction (EF) 30% and ischemic burden (IB) 10% is still debatable. The objective of this study is to analyze mortality and morbidity in patients with EF 30% and ischemic burden 10% undergoing OPCAB compared to traditional CABG (TCABG).  The retrospective analytic cohort study was performed using data from January 2015–November 2018 at National Cardiovascular Center Harapan Kita Jakarta, Indonesia. 109 patients were included. 35 patients undergoing OPCAB and 74 patients undergoing TCABG. The primary outcomes were mortality rate, morbidity rate, and length of stay. Arrhythmia is statistically lower in OPCAB compared to TCABG (8.6% vs 39.2%; p=0.001). Kidney injury is statistically lower in OPCAB (8.6% vs 27.0 %; p=0.027). Stroke is statistically lower in OPCAB (1.0 % vs 17.6%; p=0,032). There is no significant difference between OPCAB and TCABG in mortality, 5.7% vs 16.2%, (RR=3.20; CI 95%=0.67–15.12; p= 0.126). There was a statistically significant difference in the occurrence of postoperative morbidity in CAD patients with EF <30% and IB<10% who underwent OPCAB surgery compared with patients who underwent TCABG. Mortality that occurred after OPCAB procedure was lower in CAD patients with EF < 30% and IB<10% compared to TCABG although the statistical difference was not significant. Therefore, patients with this condition are more advisable to undergo OPCAB.
Combination of Vitamin C and E Improves Spermatogenesis of White Male Rat Model of Paradoxical Sleep Deprivation Stress Fitranto Arjadi; Mustofa Mustofa; Yudhi Wibowo; Nur Signa Aini Gumilas; Dzicky Rifqi Fuadi
Jurnal Kedokteran Brawijaya Vol. 32 No. 1 (2022)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2022.032.01.2

Abstract

Paradoxical Sleep Deprivation (PSD) elevates glucocorticoid and Reactive Oxygen Species (ROS) levels that cause oxidative stress, trigger spermatogenic cells damage, and reduce the number of sertoli cells. Vitamin C and E are antioxidants that could prevent spermatogenesis damage by preventing free radical formation. The study aimed to determine the effect of single and combined doses of vitamin C and E in improving spermatogenesis of white male rats (Rattus norvegicus) model of PSD. This is experimental research with post-test only and control group design on 28 white male rats distributed into four groups, i.e. group I (control, PSD), group II (PSD+vitamin C), group III (PSD+vitamin E), and group IV (PSD+a combination of vitamin C and E). Testicular preparations were stained using Hematoxylin-Eosin staining, quantitative scores of spermatogenic cells were measured using the Johnsen method, and the number of sertoli cells was counted in 10 seminiferous tubules in each of the three testicular sections. Group I has the lowest mean of Johnsen score (5.27±0.28), and group IV has the highest mean score (8.95±0.62), while the Mann-Whitney test showed a significant difference (p<0.05) between group II, III and IV compared to group I (control group). Mean sertoli cells number of group I is the lowest (10.66±1.04), and group IV has the highest sertoli cells number. The post-hoc LSD test showed a significant difference (p<0.05) between group IV and the other groups. Thus, the combination of vitamins C and E improves Johnsen score and sertoli cells number of male rats (Rattus norvegicus) experiencing PSD.