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HUBUNGAN PENINGKATAN KADAR CREACTIVE PROTEIN DENGAN PENURUNAN FUNGSI KOGNITIF PASIEN GERIATRI RAWAT JALAN Stefanus Erdana Putra,* Muhammad Hafizhan,** Raden Ajeng Hanindia Riani Prabaningtyas*
NEURONA Vol. 37 No. 1 Desember 2019
Publisher : Neurona Majalah Kedokteran Neuro Sains

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

INTRODUCTION GERIATRIC PATIENTS HAVE DIFFERENT CHARACTERISTICS COMPARED TO OTHER PATIENTS IN GENERAL IN WHICH THEY POTENTIALLY EXPERIENCING COGNITIVE IMPAIRMENT DECREASING OF PHYSIOLOGICAL AND FUNCTIONAL STATUS ALSO THE IMMUNOLOGICAL SYSTEM THIS SITUATION CAUSES VARIOUS INFLAMMATORY REACTIONS THAT PLAY A ROLE IN THE DEVELOPMENT OF NEURODEGENERATIVE DISEASES INCLUDING THE INCREASE PRODUCTION OF ACUTE PHASE PROTEIN CALLED CREACTIVE PROTEIN CRP
THE RELATIONSHIP BETWEEN WORKING PERIOD OF BATIK CRAFTSMEN AND INCIDENT OF CARPAL TUNNEL SYNDROME Subandi, Subandi; Mirawati, Diah Kurnia; Putra, Stefanus Erdana; Hafizhan, Muhammad; Susilo, Wahyu Agung; Danuaji, Rivan
Malang Neurology Journal Vol 6, No 2 (2020): July
Publisher : Malang Neurology Journal

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2020.006.02.5

Abstract

Background: Carpal Tunnel Syndrome (CTS) is the most common mono-neuropathy caused by median nerve entrapment on the wrist. Major risk factor of the CTS is repetitive use of the hand, whether from occupational activities or hobbies. One of the most frequent occupation affected with CTS is the batik craftsmen.Objective: To investigate the relationship between working period of batik craftsmen with the incident of CTS at Kampung Batik Tulis Laweyan.Methods: Participants of this cross-sectional study were 30 batik craftsmen from Kampung Batik Tulis Laweyan who met the inclusion and exclusion criteria. They were classified into two groups based on working period (less or more than five years), clinically examined, and underwent the Nerve Conduction Velocity studies. Bland's classification was administered for grouping the nerve injury. Spearman correlation test was performed to investigate the correlation between working period and incident of CTS.Results: There was a significant medium positive correlation between working period and nerve injury based on Bland’s classification (r=0.559; p=0.013). While the chief complaints were also correlated with the working period, the association was not statistically significant (p=0.355).Conclusion: This research suggests an association between the incident of CTS and longer working period in batik craftsmen.
Relationship between APO-A, APO-B, and C-reactive Protein with Depression in Epileptic Patients Mirawati, Diah Kurnia; Widhianingsih, Nella Lusti; Rakhma, Titian; Subandi, Subandi; Danuaji, Rivan; Budianto, Pepi; Prabaningtyas, Hanindya Riani; Putra, Stefanus Erdana
Indonesian Journal of Medicine Vol 5, No 4 (2020)
Publisher : Masters Program in Public Health, Universitas Sebelas Maret, Indonesia

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Abstract

Background: Epilepsy is one of the oldest neurological disease requiring long-term treat­ment. Long-term use of certain anti-epileptic drugs (AED) will strongly induce cytochrome-P450 (CYP) enzyme resulting increase of homo­cysteine associated with risk of cerebrovascular disease and depression. The purpose of this study was to determine relationship between serum level of ApoA, ApoB, and C-Reactive Protein (CRP) with depression in epileptic patients receiving AED therapy.Subjects and Method: Respondents of this cross-sectional study were epileptic outpatients in neurology clinic Dr. Moewardi Hospital, Surakarta receiving AED therapy and met inclusion and exclusion criteria. Depression condition was evaluated by Hamilton Depress­ion Rating Scale (HDRS). Serum level of ApoA, ApoB, and CRP of each respondent were mea­sured from vein blood. Data were analyzed by a multiple linear regression.Results: There were 51 epileptic patients with proportional ratio between men and women (1.2:1) with age range from 18 to 59 years old. The average length of AED 92.67 months (Mean= 92.67; SD= 91.58). Average of HDRS score was 8.49. Meanwhile, average of ApoA level was 86.14 mg/dL, average of ApoB level was 47.57 mg/dL, and average of CRP level was 0.18 mg/dL. Serum level of ApoA, ApoB, and CRP increased depression (HDRS score) in epileptic patients.Conclusion: There was a statistically signi­fi­cant relationship between serum level of ApoA, ApoB, and CRP with depressive condi­tion of epileptic patients receiving long-term AED treatment.Keywords: ApoA, ApoB, C-Reactive Protein, depression, epilepsyCorrespondence: Diah Kurnia Mirawati. Neurology Department of Dr. Moewardi Regional General Hospital/ Medical Faculty of Universitas Sebelas Maret, Indonesia. Email: diahkm@staff.uns.ac.id.Indonesian Journal of Medicine (2020), 05(04): 282-290https://doi.org/10.26911/theijmed.2020.05.04.03. 
The impact of gadget use for medical education during covid-19 pandemic on neck pain, neck disability, and sleep quality among medical students in Indonesia Pepi Budianto; Dewi Hayu Kirana; Muhammad Hafizhan; Stefanus Erdana Putra; Diah Kurnia Mirawati; Hanindia Riani Prabaningtyas
International Journal of Public Health Science (IJPHS) Vol 11, No 2: June 2022
Publisher : Intelektual Pustaka Media Utama

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11591/ijphs.v11i2.21203

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During the COVID-19 pandemic, nation-wide social restriction policy is implemented to prevent virus spread. Medical students are relying on gadget and internet-based services for online learning. Prolonged use of gadget is related to various medical condition. This study aims to determine correlation between duration of gadget use and their relationship to neck pain, neck disability, and sleep quality among medical student. This was a cross-sectional study conducted using Numeric Pain Rating Scale (NRS), Oswestry Disability Index (ODI), and Pittsburgh Sleep Quality Index (PSQI) in online form. Sample was selected with simple random sampling from the population of medical student of Universitas Sebelas Maret, entrance year of 2017-2020. Results: A total of 271 students were included in this study. Statistically significant correlation between duration of gadget uses and neck pain (p=0,014); neck disability (0.471,p=0.042); and sleep quality (0.571,p=0.023). Duration of gadget use increased the incidence of neck pain by 3.028 times (95% CI 2.272-4.327,p=0.037); incidence of neck disability by 2.144 times (95% CI 1.174-3.461,p=0.015); and decreased sleep quality by 2.384 times (95% CI 1.107-3.661,p=0.007). Duration of gadget use increased the incidence of neck pain, neck disability, and decreased sleep quality of medical student. Awareness of the importance of proper ergonomics while using gadget for medical education during COVID-19 pandemic should be raised among students, lecturers, and healthcare professional.
Pelatihan PELATIHAN PEMBELAJARAN KLINIK TERINTEGRASI DENGAN MENGGUNAKAN MODUL YANG BERBASIS PENDEKATAN SYMPTOM PADA PRECEPTOR DI PUSKESMAS Siti Munawaroh; Veronika Ika Budiastuti; Eti Poncorini Pamungkasari; Atik Maftuhah; Dian Nugroho; Maria Sekar Cahyaningrum; Stefanus Erdana Putra; Muhammad Hafidzan
Abdimas Universal Vol. 3 No. 2 (2021): Oktober
Publisher : Lembaga Penelitian dan Pengabdian kepada Masyarakat Universitas Balikpapan (LPPM UNIBA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36277/abdimasuniversal.v3i2.137

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Primary healthcare is one of the vehicles in learning for students of the medical profession. The preceptor clinic in primary healthcare is expected to guide and direct students studying there so that it can be effective. Integrated learning in all fields of medical science that is applied is expected to prepare medical graduates who are ready to enter the community. The symptom and sign approach is considered one of the effective methods in learning primary healthcare. Therefore, we intend to provide integrated clinical learning training using a module based on the symptom approach at primary healthcare. This community service involves ten primary healthcare located in the Boyolali and Klaten areas. The activity begins with exploring the problems that exist when guiding students of the medical profession who study primary healthcare. Then proceed with introducing guidance methods using clinical learning guides with a sign and symptom approach and ends with training evaluations. The participants of this activity received this training and provided some input regarding the existing modules. Suggestions from the primary healthcare preceptors were used as input to improve the modules that had been prepared.
Relationship between Tension-Type Headache and Quality of Sleep, Excessive Daytime Sleepiness, and Fatigue Syndrome among Healthcare Workers during COVID-19 Pepi Budianto; Stefanus Erdana Putra; Muhammad Hafizhan; Fauzi Novia Isnaening Tyas; Astrida Fesky Febrianty; Hanindia Riani Prabaningtyas; Diah Kurnia Mirawati; Rivan Danuaji; Subandi Subandi
Global Medical & Health Communication (GMHC) Vol 9, No 3 (2021)
Publisher : Universitas Islam Bandung

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (124.598 KB) | DOI: 10.29313/gmhc.v9i3.8530

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Coronavirus disease 2019 (COVID-19) is an infectious disease that was later declared a pandemic. During a pandemic, excessive workloads cause an increase in physical symptoms, such as tension-type headaches, in medical personnel. Tension-type headache (TTH) is associated with decreased sleep quality which will lead to excessive daytime sleepiness (EDS) and fatigue syndrome. This study aims to determine the relationship between TTH and sleep quality, EDS, and fatigue syndrome in medical personnel during the pandemic. This study is a cross-sectional study conducted on health workers at Sebelas Maret University Hospital, Surakarta, Indonesia in March–August 2020. The relationship between TTH and three other variables was analyzed using the Spearman correlation test. Multiple logistic regression analysis was used to calculate the odds ratio (OR) of headache associated with the covariate. The Kruskal-Wallis test was used to compare sleep quality, EDS, and fatigue syndrome in the TTH, non-TTH headache, and control groups. There were 120 respondents (mean age 30.93±12.48) in this study. The Spearman correlation test found a weak positive correlation between TTH and the three dependent variables. OR sleep quality, EDS, and fatigue syndrome with the incidence of TTH respectively 2.33 (95% CI=1.18–5.11, p<0.001); 2.52 (CI 95%=1.17–4.79, p=0.001), and 4.46 (95% CI=2.71–7.69, p<0.001). The Kruskal-Wallis test showed that the TTH group had poorer sleep quality and more frequent EDS and fatigue syndrome. There is a significant relationship between TTH and sleep quality, EDS, and fatigue syndrome in medical personnel during the pandemic. HUBUNGAN NYERI KEPALA TIPE TEGANG DENGAN KUALITAS TIDUR, RASA KANTUK BERLEBIHAN DI SIANG HARI, DAN SINDROM KELELAHAN PADA TENAGA MEDIS SELAMA COVID-19Coronavirus disease 2019 (COVID-19) merupakan penyakit menular yang kemudian dinyatakan sebagai pandemi. Selama pandemi, beban kerja yang berlebihan menyebabkan peningkatan gejala fisik, seperti nyeri kepala tipe tegang (tension-type headache) pada tenaga medis. Tension-type headache (TTH) dikaitkan dengan penurunan kualitas tidur yang akan menyebabkan rasa kantuk berlebihan di siang hari (excessive daytime sleepiness, EDS) dan sindrom kelelahan. Penelitian ini bertujuan mengetahui hubungan TTH dengan kualitas tidur, EDS, dan sindrom kelelahan pada tenaga medis selama pandemi. Penelitian ini merupakan studi potong lintang yang dilakukan pada petugas kesehatan di RS Universitas Sebelas Maret, Surakarta, Indonesia pada Maret–Agustus 2020. Hubungan antara TTH dan tiga variabel lainnya dianalisis menggunakan uji korelasi Spearman. Analisis regresi logistik ganda digunakan untuk menghitung odds ratio (OR) nyeri kepala yang terkait dengan kovariat. Uji Kruskal-Wallis digunakan untuk membandingkan kualitas tidur, EDS, dan sindrom kelelahan pada kelompok TTH, nyeri kepala non-TTH, dan kontrol. Terdapat 120 responden (rerata usia 30,93±12,48). Uji korelasi Spearman menemukan korelasi positif lemah antara TTH dan tiga variabel terikat. OR kualitas tidur, EDS, dan sindrom kelelahan dengan kejadian TTH secara berurutan 2,33 (IK 95%=1,18–5,11; p<0,001); 2,52 (IK95 %=1,17–4,79; p=0,001); dan 4,46 (IK 95%=2,71–7,69; p<0,001). Uji Kruskal-Wallis menunjukkan bahwa kelompok TTH memiliki kualitas tidur yang lebih buruk dan lebih sering mengalami EDS, serta sindrom kelelahan. Terdapat hubungan yang signifikan TTH dengan kualitas tidur, EDS, dan sindrom kelelahan pada tenaga medis selama pandemi.
Hubungan Profil Lipid dan Kadar High-Sensitivity C-Reactive Protein dengan Outcome Pasien Stroke Iskemik Akut Stefanus Erdana Putra; Fauzi Novia Isnaening Tyas; Muhammad Hafizhan; Raden Ajeng Hanindia Riani Prabaningtyas; Diah Kurnia Mirawati
Smart Medical Journal Vol 3, No 2 (2020): Smart Medical Journal
Publisher : Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13057/smj.v3i2.43779

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Pendahuluan: Stroke adalah penyebab utama kecacatan jangka panjang dengan dampak klinis dan sosial ekonomi yang signifikan di seluruh dunia. Hiperlipidemia dan inflamasi memainkan peranan penting dalam patofisiologi stroke iskemik. Meskipun high-sensitivity C-Reactive Protein (hs-CRP) dan kadar lipid merupakan penentu risiko penyakit pembuluh darah, kekuatan penggunaan biomarker ini dalam penentuan prognosis stroke iskemik belum dapat dipastikan. Penelitian ini bertujuan untuk mengetahui hubungan kadar hs-CRP dan profil lipid pada pasien stroke iskemik akut di Rumah Sakit Universitas Sebelas Maret dan memahami hubungan antara biomarker tersebut dengan outcome jangka pendek.Metode penelitian: Penelitian cross-sectional dilakukan pada 34 pasien dengan serangan stroke iskemik pertama kali. Profil lipid dan hs-CRP diukur pada hari pertama masuk rumah sakit. Defisit neurologis diukur menggunakan National Institutes of Health Stroke Scale (NIHSS) dan outcome diukur menggunakan Barthel Index pada hari ke-7 perawatan di unit stroke. Selanjutnya, kadar serum hs-CRP dan profil lipid dianalisis korelasinya dengan defisit neurologis dan outcome jangka pendek.Hasil penelitian: Pasien stroke iskemik memiliki kadar hs-CRP, kolesterol total (TC), trigliserida (TG), low-density lipoprotein (LDL) yang lebih tinggi; serta kadar high-density lipoprotein (HDL) yang lebih rendah dari kriteria normal. Berdasarkan uji korelasi Pearson, LDL memiliki korelasi signifikan dengan NIHSS (r = 0,447; p = 0,008) sedangkan hs-CRP memiliki korelasi signifikan yang lebih kuat dengan Barthel Index daripada NIHSS (r = -0,412; p = 0,015). TC dan HDL juga memiliki korelasi signifikan dengan NIHSS.Kesimpulan: Penelitian ini menunjukkan bahwa profil lipid dan hs-CRP dapat digunakan sebagai prediktor prognosis outcome stroke iskemik akut. Introduction: Stroke is the leading cause of long-term disability with significant clinical and socioeconomic impact worldwide. Hyperlipidemia and inflammation play major roles in ischemic stroke. While high-sensitivity C-Reactive Protein (hs-CRP) and lipid levels are established risk determinants for vascular disease, the relative strength of these biomarkers for ischemic stroke is uncertain. The purpose of this study is to investigate the association of hs-CRP levels and lipid profile in acute ischemic stroke patients and understand correlation between those markers and short-term outcome.Methods: This was a cross-sectional study of 34 first-timer ischemic stroke patients. Lipid profiles and hs-CRP were measured on admission day. The neurological deficit was quantified using National Institutes of Health Stroke Scale (NIHSS) and outcome was quantified using Barthel Index at the 7th day in stroke unit. Serum level of hs-CRP and lipid profile were estimated and correlated with neurological deficit and short-term outcome.Results: Ischemic stroke patients had higher levels of hs-CRP, total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL); and lower level of high-density lipoprotein (HDL) than normal criteria. Based on Pearson correlation test, LDL had significant correlation with NIHSS (r=0.447; p=0.008) while hs-CRP had stronger significant correlation with Barthel Index than NIHSS (r=-0.412; p=0.015). TC and HDL also had significant correlation with NIHSS.Conclusions: This research suggests that lipid profile and hs-CRP can be used as predictors of prognosis for acute ischemic stroke outcome. Keywords: Barthel index, C-reactive protein, National Institutes of Health Stroke Scale, lipid profile, ischemic stroke.
Komplikasi Neurologis dan Non-Neurologis Prosedur Digital Subtraction Angiography Serebral di RSUD Dr. Moewardi Periode Juni 2013-Mei 2018 Subandi Subandi; Pepi Budianto; Stefanus Erdana Putra; Wahyu Gusti Randa
Smart Medical Journal Vol 3, No 1 (2020): Smart Medical Journal
Publisher : Faculty of Medicine Universitas Sebelas Maret

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13057/smj.v3i1.38356

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Pendahuluan: Digital subtraction angiography (DSA) serebral menjadi gold standard untuk memeriksa penderita dengan gangguan serebrovaskular. Banyak kemajuan yang telah diperoleh untuk meningkatkan keamanan penggunaan DSA serebral, seperti kontras yang lebih aman, kateter yang lebih kecil, kawat (hydrophilic guides), dan sistem pengamatan digital yang semakin baik. Hingga saat ini, belum ada penelitian terkait komplikasi neurologis maupun non-neurologis dari prosedur DSA yang dilakukan di Indonesia. Tujuan penelitian ini adalah mengetahui berbagai komplikasi prosedur DSA, sehingga operator dapat meminimalisasi timbulnya komplikasi tersebut saat prosedur DSA dilakukan di kemudian hari.Metode penelitian: Penelitian deskriptif dilakukan di RSUD Dr. Moewardi terhadap 486 pasien yang menjalani prosedur DSA. Data yang dikumpulkan meliputi umur, jenis kelamin, komplikasi, serta temuan angiografi. Komplikasi neurologis dan non neurologis dikelompokkan menjadi: early, yang akan menghilang kurang dari 7 hari dan late, bila komplikasi terjadi lebih dari 7 hari. Kriteria inklusi pada penelitian ini adalah semua pasien yang menjalani prosedur DSA di RSUD. Dr. Moewardi periode Juni 2013 hingga Mei 2018 dan pasien yang mengalami komplikasi neurologis dan non-neurologis.Hasil penelitian: Terdapat 15 (3%) dari 486 pasien yang menjalani prosedur DSA serebral mengalami komplikasi. Komplikasi neurologis early terjadi pada 10 kasus (2%), dan tidak didapatkan komplikasi pada tipe late, sedangkan komplikasi non-neurologis early terjadi pada 2 kasus (0.4%), dan late pada 3 kasus (0.6%). Kejadian ini sebanding dengan penelitian yang dilakukan oleh studi internasional lainnya.Kesimpulan: Prosedur DSA serebral relatif aman, baik dalam hal komplikasi neurologis, komplikasi non-neurologis maupun terjadinya kematian. Komplikasi neurologis yang terjadi masih dalam batas yang direkomendasikan sesuai dengan petunjuk keamanan untuk melakukan DSA serebral.Kata kunci: Angiografi serebral; keamanan; komplikasi
ASSOCIATION OF LIPID PROFILES AND COGNITIVE FUNCTION DETERIORATION OF GERIATRIC OUTPATIENTS AT NEUROLOGY CLINIC GUNUNGSITOLI REGIONAL GENERAL HOSPITAL Stefanus Erdana Putra; Berkat Hia; Muhammad Hafizhan; Astrida Fesky Febrianty; Fauzi Novia Isnaening Tyas
Callosum Neurology Vol 4 No 1 (2021): Callosum Neurology Journal
Publisher : The Indonesia Neurological Association Branch of Denpasar

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.29342/cnj.v4i1.135

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Background: The increase of life expectancy in Indonesia causes increasing numbers of dementia, mostly caused by Alzheimer's disease (AD). High serum cholesterol level has been suggested as a risk factor for AD. The strongest evidence linking lipid profile with AD provided by previous experimental studies where adding or reducing cholesterol altered amyloid precursor protein (APP) and amyloid ?-protein (A?) levels is the basic of this research. Objective: To determine whether lipid profile is associated with cognitive function deterioration of geriatric outpatients at Neurology Clinic Gunungsitoli Regional General Hospital. Methods: Participants of this cross-sectional study were outpatient geriatric patients at Neurology Clinic Gunungsitoli Regional General Hospital (n=85; mean age, 62.46±5.49 years old). The cognitive state was evaluated using Montreal Cognitive Assessment Indonesian Version (MoCA-INA) and those with MoCA-INA score <24 were considered cognitively declined. Concentrations of serum lipid profile were measured and correlated with cognitive state using Pearson’s correlation. Multiple logistic regression analysis was used to calculate odds ratios (ORs) for cognitive decline. Results: Based on Pearson’s correlation test, high-density lipoprotein (HDL) level had significant strong positive correlation with MoCA-INA score (r=0.876;p=0.000) and triglyceride level had significant strong negative correlation with MoCA-INA score (r=-0.726;p=0.000). Relatively to cognitive decline, ORs for decreased HDL level was 3.19 (95%CI 2.02-4.36) and increased triglyceride level was 2.59 (95%CI 1.29-3.91). Conclusion: There was a significant relationship between decreased HDL-cholesterol level and increased triglyceride level with cognitive decline in geriatric outpatients.
Efektivitas Pelatihan Manajemen Disfagia terhadap Pengetahuan Tenaga Kesehatan RSUD Dr. Moewardi Ira Ristinawati; Raden Andi Ario Tedjo; Diah Kurnia Mirawati; Subandi Subandi; Rivan Danuaji; Pepi Budianto; Hanindia Riani Prabaningtyas; Muhammad Hafizhan; Stefanus Erdana Putra
Smart Society Empowerment Journal Vol 2, No 3 (2022): Smart Society Empowerment Journal
Publisher : Fakultas Kedokteran UNS

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (409.782 KB) | DOI: 10.20961/ssej.v2i3.67279

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Pendahuluan: Disfagia atau kondisi kesulitan menelan makanan dari rongga mulut ke lambung merupakan salah satu komplikasi dari stroke. Disfagia merupakan komplikasi yang sangat mempengaruhi luaran klinis pasien stroke. Adanya kesulitan menelan akan memperumit kondisi neurologis pasien stroke. Manajemen disfagia merupakan hal yang sangat penting untuk dipahami oleh tenaga kesehatan sehingga dapat meningkatkan kualitas hidup pasien.Metode: Pelatihan manajemen disfagia dilakukan dengan metode presentasi yang dilanjutkan dengan sesi diskusi bersama pemateri. Untuk menilai pengetahuan peserta mengenai manajemen disfagia, peserta menjalani pretest dan posttest. Hasil pretest dan posttest kemudian dibandingkan dengan uji T-berpasangan untuk mengetahui efektivitas pelatihan terhadap pengetahuan tenaga kesehatan mengenai manajemen disfagia pasca strokeHasil dan pembahasan: Pelatihan ini diikuti oleh 72 orang tenaga kesehatan di RSUD Dr Moewardi yang terdiri dari 27 (37.5%) orang perawat, 22 (30.5%) orang dietisien, dan 23 (32.0%) orang fisioterapis. Hasil uji korelasi menunjukkan perbedaan yang signifikan antara nilai pretest dan posttest perawat (r=0.812, p=0.021), nutrisionis (r=0.792, p=0.038), dan fisioterapis (r=0.649, p=0.002)Kesimpulan: Terdapat peningkatan pengetahuan tentang manajemen disfagia pada tenaga kesehatan di RSUD Dr. Moewardi.Kata Kunci: disfagia, stroke, tenaga kesehatan, pelatihan