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All Journal Jurnal Farmasi Klinik Indonesia Indonesian Journal of Biotechnology Indonesian Journal of Cancer INDONESIAN JOURNAL OF PHARMACY Gadjah Mada Journal of Psychology
Iwan Dwiprahasto
Staf Pengajar Bagian Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Gadjah Mada/ RSUP Dr. Sardjito Yogyakarta
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Materials Science & Nanotechnology Medicine & Pharmacology

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CYP3A4*1G gene Polymorphism on Javanese People Sutrisna, Em; Dwiprahasto, Iwan; Astuti, Indwiani; Kristin, Erna
Indonesian Journal of Biotechnology Vol 16, No 2 (2011)
Publisher : Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (43.035 KB)

Abstract

AbtractMost of drugs are metabolized by cytochrome P 450 (CYP) enzyme. Cytochrome P450 3A4 is the cytochrome that is involved in metabolizing more than 60% of all medicine used in human. The variation of this CYP3A4 gene will affect the catalytic activity of this enzyme. Recently, CYP3A4*1G in intron 10 was found in Chinese and Japanese population. There is a substitution of G to A at position 82266 in intron 10. The purpose of this research was to investigate the frequency of allele and genotype CYP3A4*1G. Samples were taken from bloods of the subjects of the research. The examination of CYP3A4*1G was conducted by RTLP-PCR method.As the results of this research, the frequency of CYP3A4*1G in Javanese people is CYP3A4*1/*1 0.25, CYP3A4*1/*1G 0.55 and CYP3A4*1G/*1G 0.20. Frequency of allele G: 0.53, allele A: 0.47. The Fisher’s exact- test shows that the allele and genotype frequencyis p. 1.000. The allele and genotype frequency of Javanese people isstill in Hardy-Weinberg equilibrium.Keywords : CYP3A4*1G gene, polymorphism, Javanese people
Pemahaman Perawat Mengenai Medication Errors di Bangsal Perawatan Kanker Anak RSUP Dr. Sardjito MULATSIH, SRI; DWIPRAHASTO, IWAN; -, SOETARYO
Indonesian Journal of Cancer Vol 9, No 3 (2015): Jul - Sept 2015
Publisher : "Dharmais" Cancer Center Hospital

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Abstract

Advances in medical therapy including prosecuting perpetrators paramedics to carry out a good treatment standards because the risk of medication errors events are higher. The purpose of this study was to determine the level of understanding about ME paramedics in the department of child cancer ward Dr. Sardjito.Do pre- and post- design with a quasi-experimental methods. The sample was nurses who serve childhood cancer patients. Intervention in the form of socialization policies, handbooks and training ME. Evaluation of outcomes given the level of understanding of nurses using a questionnaire before and after intervention.Of the officers a number of 24 pre and 23 post-intervention found no difference statistically significant on all respondents between before and after the intervention in terms of gender, the last education, type of work, whether there is a work permit, work sites and the average period work. There is an increase in the number of nurses who received the intervention of 11 (46%) to 21 (91%). An understanding of ME increased significantly (P <0.05) after receivingintervention, however, the respondents still do not fully understand the source of ME. Understanding the paramedics about ME is quite good, especially after training and familiarization guidebook, unlessthe source ME needed more specific training methods to improve the understanding of ME. Kemajuan terapi menuntut para pelaku kesehatan, termasuk paramedis, untuk melaksanakan standar pengobatan yang baik karena risiko kejadian Medication Errors (ME) yang semakin tinggi. Tujuan penelitian ini untuk mengetahui tingkat pemahaman paramedis mengenai ME di bangsal perawatan kanker anak RSUP Dr. Sardjito. Dilakukan pre- dan post- design dengan metoda kuasi ekperimental. Sebagai sampel adalah perawat yang melakukan pelayanan pasien kanker anak. Intervensi yang dilakukan berupa sosialisasi kebijakan, buku panduan, serta pelatihan Medication Errors (ME). Evaluasi luaran dengan melihat tingkat pemahaman perawat menggunakan kuesioner sebelum dan setelah intervensi.Dari petugas 24 pre- dan 23 post-intervensi, tidak ditemukan perbedaan bermakna secara statistik pada seluruh responden antara sebelum dan sesudah intervensi dalam hal jenis kelamin, pendidikan terakhir, jenis pekerjaan, ada tidaknya surat ijin bekerja, lokasi kerja, serta rata-rata masa kerja. Terdapat peningkatan jumlah perawat yang mendapatkan intervensi dari 11 (46%) menjadi 21 (91%). Pemahaman tentang ME meningkat secara bermakna (P < 0,05) setelah mendapatkan intervensi. Namun demikian, responden masih belum sepenuhnya memahami mengenai sumber ME. Pemahaman paramedis mengenai ME cukup baik, terutama setelah dilakukan pelatihan dan sosialisasi buku pedoman, kecuali mengenai sumber ME. Diperlukan metoda pelatihan yang lebih spesifik untuk meningkatkan pemahaman ME, khususnya paramedis.
Pengaruh Pemberian Umpan Balik Tekanan Darah kepada Dokter terhadap Perubahan Biaya Terapi Pasien Hipertensi Suhadi, Rita; Thobari, Jarir At; Irawan, Bambang; Dwiprahasto, Iwan
Indonesian Journal of Clinical Pharmacy Vol 4, No 3 (2015)
Publisher : Indonesian Journal of Clinical Pharmacy

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (414.518 KB) | DOI: 10.15416/ijcp.2015.4.3.186

Abstract

Suatu penelitian intervensi analitik telah dilakukan dengan tujuan untuk mengevaluasi cost-effectiveness terapi pasien rawat jalan hipertensi di empat rumah sakit (RS) di Kota Yogyakarta. Penelitian dilakukan dengan metode grafik scatter-plot; aksis-X dan aksis-Y menunjukkan selisih tekanan darah (TD) dan biaya antar kelompok. Pemberian umpan balik TD diberikan kepada dokter spesialis perlakuan sebanyak empat kali setelah informed consent, sementara dokter kontrol menjalani terapi secara alamiah. Pasien dari dokter subjek >18tahun, menerima antihipertensi, Askes *, ≥4 kali kunjungan, dan ≥1 kali TD sistolik (TDS) ≥140mmHg diikutkan penelitian. Data terapi, TD, dan biaya terapi pasien dikumpulkan selama 8 bulan secara prospektif sejak intervensi pertama dari catatan medik pasien dan klaim pembayaran RS kepada Askes. Seluruh biaya terkait hipertensi dan kardiovaskular dengan perspektif RS diikutkan analisis. Data diperoleh dari rekam medik dan klaim biaya terapi oleh RS kepada PT. Askes. Hipotesis: proporsi pasien di kuadran kanan grafik mencapai ≥90%. Kuadran kanan menunjukkan TDS perlakuan lebih baik. Hasil penelitian menunjukkan pasien perlakuan (n=379) dan kontrol (n=266) tidak berbeda bermakna untuk umur, jender, TD, dan jumlah antihipertensi. Pasien perlakuan memiliki TD diastolik lebih baik, biaya antihipertensi per kunjungan lebih tinggi (p<0,05) tetapi sama untuk obat kardiovaskular serta biaya total (p>0,05). Proporsi pasien kuadran kanan sebesar 56,2%. Analisis subgrup pada perempuan, tanpa umur 80–90tahun, TDS final≤160mmHg, rerata TDS ≤150mmHg, dan antihipertensi 1–3 item diperoleh proporsi kuadran kanan 66,9% tetapi belum mencapai 90%. Pemberian umpan balik TD kepada dokter meningkatkan proporsi pasien di kuadran kanan meskipun belum mencapai proporsi yang diharapkan.*Askes pada saat sekarang ini sudah berubah menjadi Jaminan Kesehatan Nasional oleh BPJSKata kunci: Biaya terapi, cost-effectiveness, hipertensi, umpan balik tekanan darah kepadadokterThe Effect of Blood Pressure Feedback Intervention to Doctors on the Change of the Hypertensive Patient Therapy CostAn analytical intervention study has been done with the aim to evaluate the therapy cost-effectiveness among the hypertensive ambulatory patients at four hospitals in Yogyakarta city. The study was done with the scatter-plot method; x-axis and y-axis were for the difference of blood pressure and therapy cost between groups respectively. Blood pressure feedback intervention was delivered monthly for four times to the specialists in the intervention group since the informed-consent approval. The control specialists preceded the natural practice. The included patients were the specialist’s subjects with the following criteria: >18 years, “Askes” -insured, ≥4 visits, and ≥1 visit with systolic blood pressure (SBP) ≥140mmHg. The medication profile, BP level, and therapy cost profile were collected prospectively for eight months since the first intervention from medical record and the hospital claim to Askes. All hypertensive and cardiovascular therapy cost with the hospital perspective were included in the analysis. Hypothesis: the patient proportion in the right quadrants of the graph reached ≥90%. The right quadrantsof graph indicated lower mean SBP of intervention group. The result showed that the intervention (n=379) and control (n=266) groups were similar for age, gender, BP, and items of antihypertensive medicine. The intervention group had only improved diastolic BP and higher antihypertensive medicine cost (p<0.05), but similar for cardiovascular medicine and the total therapy cost (p>0.05). Patients in the right quadrant were 56.2%. Sub-group analysis for female only, without 80–90 years, final SBP ≤160mmHg, and mean ≤150mmHg, and 1–3 antihypertensive items resulted 66.9% of right-quadrant patients but it was lower than 90%. Feedback intervention improved the proportion of patients in the right-quadrants of the graph though it was lower than the expected proportion.Keywords: Blood pressure feedback to physicians, cost effectiveness analysis, cost of therapy, hypertension
Cost Effectiveness Analysis of Rivaroxaban Compared to Warfarin and Aspirin for Stroke Prevention Atrial Fibrillation (SPAF) in the Indonesian healthcare setting Dwiprahasto, Iwan; Kristin, Erna; Endarti, Dwi; Pinzon, Rizaldy Taslim; Yasmina, Alfi; Thobari, Jarir At; Pratiwi, Woro Rukmi; Kartika, Yolanda Dyah; Trijayanti, Christiana
Indonesian Journal of Pharmacy Vol 30 No 1, 2019
Publisher : Faculty of Pharmacy Universitas Gadjah Mada, Yogyakarta, Skip Utara, 55281, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (1127.563 KB) | DOI: 10.14499/indonesianjpharm30iss1pp74

Abstract

Main drugs used in the prevention of stroke among atrial fibrillation (AF) patients are antiplatelets (aspirin) and oral anticoagulants (OAC). OAC therapy can be difficult to administer due to drug and food interactions, adds the burden of required blood monitoring, narrow therapeutic window, and requirements for dose titration. Rivaroxaban is a single-dose oral anticoagulant which does not require blood monitoring, dose titration or has dietary interactions. Phase III clinical data from the ROCKET trial have recently been reported the non-inferiority of rivaroxaban over warfarin for the prevention of strokes in AF patients. To develop an economic model evaluating the clinical and cost-effectiveness of rivaroxaban for the prevention of stroke in non-valvular AF patients in the Indonesian health care settings. We conducted cost effectiveness analysis from the perspective of payer (national health insurance). Effectiveness data used the international data from previous RCT and network metaanalysis studies. Costs data used local data of Indonesia from national health insurance’s reimbursement tariffs. Markov model was used, comprised of health and treatment states describing the management and consequences of AF. The main analysis was based on data from the phase III trials. Three months was used as cycle length. The time horizon was set at patients’ lifetime (20 years). Costs and outcomes were discounted at a 3% annual rate. Subgroup analysis and extensive sensitivity analysis was conducted. Willingness to pay (WTP) threshold in Indonesia was set as 3 times GDP of Indonesia in 2015, equal about IDR 133,375,000 per quality-adjusted life year (QALY). Base case rivaroxaban vs warfarin has ICER of IDR 141,835,063per QALY at the current cost of rivaroxaban IDR 23,500 and ICER of 130,214,687 per QALY at the proposed cost of rivaroxaban IDR 22,000. One-way sensitivity analysis showed that the key drivers of cost-effectiveness were the utility decrement applied to stable warfarin patients, discontinuation/subsequent discontinuation rates for rivaroxaban, and discontinuation/subsequent discontinuation rates for warfarin. The probabilistic sensitivity analysis suggested that rivaroxaban was cost-effective compared to warfarin in about 45% of cases at the WTP per QALY. Rivaroxaban with the proposed price of IDR 22,000 was considered to be more cost-effective when compared to warfarin.
Kinerja Akseleran dalam Rotasi Klinik: suatu Kajian terhadap Pencapaian Kompetensi Klinik Mahasiswa Kedokteran Wardhani, Sri Linuwih Susetyo; Kekalih, Aria; Dwiprahasto, Iwan; Emilia, Ova; Prabandari, Yayi Suryo; Kumara, Amitya
Jurnal Psikologi Vol 41, No 1 (2014)
Publisher : Faculty of Psychology, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (452.903 KB) | DOI: 10.22146/jpsi.6956

Abstract

Sebagian kecil mahasiswa fakultas kedokteran adalah mahasiswa dengan riwayat pernah mengikuti program akselerasi ditingkat pendidikan dasar dan menengah, dan kelompok ini disebut sebagai akseleran. Akseleran merupakan siswa berbakat dan memiliki inteligensi serta kemampuan akademik yang tinggi, namun, akseleran umumnya imatur baik sosial, emosional maupun fisik. Dengan demikian dapat diprediksi akan mengalami penurunan kompetensi ketika berada pada tahap rotasi klinik. Tujuan penelitian ini adalah untuk melakukan evaluasi kinerja akseleran dalam pencapaian kompetensi di rotasi klinik. Penelitian ini menggunakan rancangan penelitian campuran, dengan pendekatan kualitatif lebih dominan. Responden penelitian ialah mahasiswa fakultas kedokteran di semester tujuh dan delapan dengan riwayat pernah mengikuti program akselerasi. Hasil penelitian ini mendapatkan bahwa kemampuan dasar akseleran berada pada skala baik dan baik sekali; sikap kerja cukup hingga baik, sedangkan kepribadian pada komponen stabilitas emosi serta daya tahan stres berada pada skala kurang hingga cukup. Nilai median kompetensi klinik akseleran sedikit lebih tinggi dibandingkan non-akseleran, tetapi secara satistik perbedaannya tidak bermakna. Kesimpulan penelitian adalah, kinerja akseleran dalam rotasi klinik cukup baik, namun akseleran menghadapi masalah non-akademik terutama aspek kepribadian yang dapat memengaruhi nilai akademik. Perlu pertimbangan seleksi calon mahasiswa kedokteran terhadap akseleran dengan menggunakan pemeriksaan psikologik untuk menilai kematangan kepribadian. Kata kunci: akseleran, kompetensi klinik, seleksi calon mahasiswa
Co-Authors A.A. Ketut Agung Cahyawan W Achmad Fudholi Alfi Yasmina Amitya Kumara Aria Kekalih Budiarti, Endang Budiarti, L Endang Dewi Dewi Em Sutrisna Erna Kristin fitri pratiwi, fitri Indwiani Astuti Jarir At Thobari Nurmainah Nurmainah Oktaviani, Devi Ova Emilia Pratiwi, Woro Rukmi Rita Suhadi Rizaldy Pinzon SOETARYO -, SOETARYO Sri Linuwih Susetyo Wardhani, Sri Linuwih Susetyo Sri Mulatsih Tri Murti Andayani Trijayanti, Christiana Yayi Suryo Prabandari Yolanda Dyah Kartika