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HUBUNGAN FAKTOR KOMORBIDITAS, INTENSIFIKASI TERAPI, DAN PENGENDALIAN TEKANAN DARAH Rita Suhadi; Jarir Atthobari; Bambang Irawan; Iwan Dwiprahasto
Jurnal Farmasi Sains dan Komunitas (Journal of Pharmaceutical Sciences and Community) Vol 10, No 1 (2013)
Publisher : Sanata Dharma University

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (543.778 KB) | DOI: 10.24071/jpsc.0082

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Abstract: Background: Therapy intensification (TI) is the most important factor in bloodpressure control among the adherent patients. The TI is the physician prescription behavior toadd the item(s) and/or the dosage of hypertensive medicine when the patients' BP was ?10mmHgabove the target. Comorbid patients have 10mmHg lower BP target. Aims: to evaluate the effectof comorbidity on TI score and blood pressure control; and to correlate the variables of TI and BPcontrol. Method: retrospective cohort study done in 4 hospitals in Yogyakarta for 5 months. Thesubjects of age 18 years, hypertensive out-patient covered with Askes insurance, and ?1 visitwith uncontrolled BP were included. Hemodialysis subjects were excluded. Subjects weregrouped into with/without comorbid. The BP profile was analyzed with T-test, repeatedmeasurement Anova, and odds ratio. Results: subjects consisted of without (WO) (n=268) vs.with comorbid (W) (n=401) patients. Comorbid subjects had older age, more male proportionand more visits (p0.05). The profiles of final SBP/DBP in WO vs. W subjects were as follow:148.9/89.1 (WO) vs. 143.8/86.1mmHg (W) (p0.05); TI score (-) 0.360.26 (WO) vs. (-)0.380.24 (W) (p0.05); the final SBP: worse BP control 20.9 (WO) vs.16.2% (W), notcontrolled in all visits 38.1 vs. 45.9%, improved 17.5 vs. 23.9%, and good controlled in all visit23.5 vs.13.2%; proportion of subjects reached BP target 40.7% (WO) vs. 37.4% (W) (p0.05);the different of final minus target SBP: (-)9.018.5 vs. (-)13.917.4mmHg (p0.05); correlationbetween TI and variables of SBP (p0.05) with the coefficient (r) at 0.4-0.6 (medium).Conclusion: comorbidity had no effect on TI score; but subjects with comorbid had worse BPcontrol (p0.05); TI score correlated in medium level with SBP.Keywords: Comorbidity Factor, Therapy Intensification, Blood Pressure Control
EVALUASI PENGGUNAAN ANTIBIOTIKA PROFILAKSIS DARI ASPEK KETEPATAN JENIS, WAKTU DAN DURASI PEMBERIAN PADA PASIEN INSTALASI BEDAH SENTRAL SEBUAH RUMAH SAKIT SWASTA DI YOGYAKARTA Dimas Adhi Pradana; Iwan Dwiprahasto; Satibi Satibi
Jurnal Ilmiah Farmasi Vol. 6 No. 1 (2009)
Publisher : Universitas Islam Indonesia

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Abstract

ABSTRACTSurgical site infection is one of surgical infection that frequently happened in hospital sothat the use of antibiotic prophylaxis must be safe. The research was conducted to know incidenceof adverse event at usage of antibiotic prophylaxis in surgery installation. We use concordancesheet of antibiotic prophylaxis either from accuracy aspect of the drug type, administration time,duration of usage. Result analysis in the form of calculation relative risk of usage of antibioticdissected pre prophylaxis to risk the happening of surgical site infections cases. Result thisresearch show that relative risk value of usage of antibiotic to case of infection of operation hurtevaluated from inaccurate of type antibiotic 1,12 ( CI 95 %: 0,138-9,1), inaccurate aspect of gift time5,8 ( CI 95 % : 1,024 - 32,86) and from inaccurate aspect of duration of gift 3,21 ( CI 95 % : 1,043 -9,9).Keywords: antibiotic prophylaxis, surgical site infections, relatives risk
Compliance Pengguna Antihipertensi di RSUP DR. SARDJITO Yogyakarta (Periode Juli 2006- Juni 2009) Dimas Pramita Nugraha; Iwan Dwiprahasto; Jarir At Thobari
Jurnal Ilmu Kedokteran Vol 8, No 2 (2014): Jurnal Ilmu Kedokteran
Publisher : Fakultas Kedokteran Universitas Riau

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (45.112 KB) | DOI: 10.26891/JIK.v8i2.2014.70-75

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Hypertension is the second largest of the 10 diseases on an outpatient at a hospital in Indonesia. The poor complianceto therapy of hypertension is a major cause of uncontrolled blood pressure. The aim of this study is to determinecompliance antihypertension on patient at DR. Sardjito hospital Yogyakarta. This study was designed with aretrospective cohort study design using a database of participants claimed prescribing health insurance (ASKES) inthe DR. Sardjito hospital using antihypertensive drugs. Compliance measured with medication possession ratio (MPR).Data was analysed by chi- square and logistic regression statistic. From 8.011 patients, compliance of antihypertensivedrugs during the first year is 7,6%. Analysis for compliance showed that the type of antihypertensive diuretics aremore compliance compare with angiotensin II receptor blockers, ACE inhibitors, calcium channel blockers and betablockers. Combination therapy (20,7%) is more compliance than monotherapy ( 4,1%), as well as drugs administration1 time a day (8,2%) is more compliance than drug administration 2 times (2,5%) and 3 times a day (3%). Theproportion of compliance in antihypertensive users at DR. Sardjito hospital classified as less good. Compliancepattern indicates that therapy is not continuous, the longer the use of antihypertensive therapy, the higher thediscontinuous therapy.
The effect of chronic usage of Renin-Angiotensin-Aldosterone System Blocking Agents on Incidence of Contrast-Induced Nephropathy in patients with Diabetes Mellitus and Renal Insufficiency. A Restropesctive Cohort Study astika widy utomo; dwi aris agung nugrahaningsih; iwan dwiprahasto
Jurnal Kardiologi Indonesia Vol 40 No 1 (2019): Indonesian Journal of Cardiology: January-March 2019
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v40i1.920

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Background: This study was to investigate the effect of long term use of Renin-Angiotensin-Aldosterone System(RAAS) blocking agents on the incidence of Contrast-Induced Nephropathy(CIN) on patients with Diabetes Mellitus(DM) and renal insufficiency underwent Percutaneous Coronary Intervention (PCI). Methods:A total 281 of subjects were included in this study and divided into two groups based on prior use of RAAS blocking agents (RAAS +, n = 146; RAAS -, n = 135). CIN was defined as an increase of ≥25% in creatinin over baseline value 48-72 hours after PCI. Result: Total incidence of CIN was 14,95%. There was no difference in the incidence of CIN between 2 study groups (p = 0,952) and relatif risk for CIN was 1,02. Left Ventricular ejection Fraction (LVEF) ≤ 40 % (OR 2,300; 95% CI 1,028 – 5,143; p = 0,043), anemia (OR 2,628; 95% CI 1,274 – 5,422; p = 0,009) and Glomerular Filtration rate (GFR) pre PCI ≤ 60 mL/menit (OR 2,782; 95% CI 1,293 – 5,987; p = 0,009) were important predictors of CIN. Conclusion: Long term use of RAAS blocking agents do not increase the incidence of CIN on patients with DM and renal insufficiency underwent PCI.
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS COLONIZATION AND SCREENING METHOD EFFECTIVENESS FOR PATIENTS ADMITTED TO THE INTENSIVE CARE Andaru Dahesihdewi; Budi Mulyono; Iwan Dwiprahasto; Supra Wimbarti
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 24, No 1 (2017)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v24i1.1149

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Methicillin-resistant S.aureus (MRSA) menyebabkan banyak infeksi nosokomial (inos) dan penyebarannya menunjukkan mutu cleancare. Kejadian inos MRSA meningkatkan angka kesakitan, kematian, lama rawat inap, kebutuhan antibiotika dan meluasnya resistensi,readmisi serta biaya kesehatan. Penapisan kolonisasi MRSA di pasien yang akan dirawat intensif diperlukan untuk mencegah penyebarandan mengendalikan peresepan antibiotika. Pemeriksaannya diharapkan tepat guna untuk mendukung Sistem Jaminan KesehatanNasional. Penelitian dilaksanakan di Ruang Rawat Intensif RSUP Dr Sardjito Yogyakarta di seluruh pasien pada tahun 2015 saat masuksesuai patokan kesertaan dan non-kesertaan. Spesimen dari nares anterior dan kulit (aksila-inguinal), diambil dalam 1x24 jam, dinilaikepositifan MRSA menggunakan beberapa media identifikasi di Instalasi Laboratorium Klinik. Perbandingan analitik dan praktikabilitasmetode identifikasi dianalisis efektivitasnya. Kejadian kolonisasi S.aureus dan MRSA di pasien saat masuk perawatan Ruang Intensif23,4% dan 9,7%. Faktor kebahayaan dominan kolonisasi MRSA adalah riwayat perawatan RS. Nares anterior dominan sebagai tempatkolonisasi S.aureus (74,2%) dan MRSA (33,7%). Terdapat 7,7% kolonisasi lolos deteksi bila sampling hanya dilakukan di nares.Kesepakatan hasil pemeriksaan antar metode baik (indeks Kappa >0,8) dengan metode yang disarankan adalah penggunaan mediaselektif MRSA langsung atau urutan metode deteksi menggunakan Blood Agar, pengecatan Gram, uji aglutinasi, media khromogenikselektif MRSA. Metode penapisan dengan tingkat deteksi dan praktikabilitas yang baik bermanfaat mendukung pengendalian infeksidi ruang berkebahayaan tinggi.
KESAHIHAN DIAGNOSTIK HEMOGLOBIN RETIKULOSIT UNTUK DETEKSI DEFISIENSI ZAT BESI DI KEHAMILAN (Diagnostic Validity of Reticulocyte Hemoglobin for Iron Deficiency Detection in Pregnancy) Tri Ratnaningsih; Budi Mulyono; Sutaryo Sutaryo; Iwan Dwiprahasto
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 21, No 3 (2015)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v21i3.1282

Abstract

Entering the second trimester of pregnancy, more iron is required due to the increase in erythrocyte mass, plasma volume andthe development of fetus as well as chorion. Iron is needed the most in the third trimester. The existing hematological iron stageparameters can only detect iron deficiency in the latest stage. The aim of this study was to know the assessment validity of Ret-Heexamination as a new parameter to diagnose iron deficiency in pregnant women with anemia, as well as a screening tool for those interm pregnancy without anemia. The research design was cross sectional. The subjects were women in term pregnancy, gathered fromPKU Muhammadiyah Hospital, Bantul Yogyakarta from May to November 2013. A seven (7) mL blood sample was taken from thecubital vein of the subjects. Two mL of the sample was tested for routine hematological examination using an EDTA tube, while theRet-He was assessed using an automatic hematological instrument Sysmex XT-2000-i (Symex Corporation, Kobe, Japan). The serumof the remaining five (5) mL was used to check the serum iron and TIBC to obtain the saturation value (Tsat) using Cobas analyzerC501 (Roche Diagnostics, Germany), while the serum ferritin (SF) was examined using Minividas. The subjects were classified into two(2) groups based on the Hb levels, namely: anemia (Hb<11 g/dL) and those who did not (Hb≥11 g/dL). Furthermore, they were alsoclassified into two (2) groups based on transferrin saturation values: iron deficient (Tsat <9%) and normal (Tsat ≥9%). From 291subjects, 59 (20.3%) were found to have anemia and 232 (79.7%) did not. The cut off value of Ret-He to diagnose iron deficiency inpregnant women with anemia was 29.8 pg (82% sensitivity and 72% specificity). Meanwhile, the cut-off value of Ret-He for irondeficiency screening in pregnant women without anemia was 29.8 pg, with a sensitivity and specificity of 92% and 87% respectively.The Ret-He holds a good diagnostic validity to detect iron deficiency in pregnancy, with or without anemia.
PHYLOGENETIC PROFILE OF ESCHERICHIA COLI CAUSING BLOODSTREAM INFECTION AND ITS CLINICAL ASPECT Osman Sianipar; Widya Asmara; Iwan Dwiprahasto; Budi Mulyono
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 24, No 1 (2017)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v24i1.1152

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Escherchia coli merupakan satu dari bakteri yang paling sering ditemukan dalam infeksi aliran darah. Tujuan penelitian ini adalahuntuk mengeksplorasi profil filogenetik E. coli yang menyebabkan infeksi aliran darah dan aspek klinisnya. Ini merupakan penelitianobservasional yang melibatkan 12 subjek yang menderita infeksi aliran darah yang disebabkan oleh E.coli. Isolat klinis E.coli serta hasiluji kepekaan antimikroba diperoleh dari metode kaldu microdilution otomatis. Data klinis diperoleh dari rekam medis dan analisisfilogenetik yang dilakukan dengan polymerase chain reaction menggunakan gena chuA dan YjaA. Data dianalisis dengan menggunakanstatistik deskriptif. Sumber infeksi ini berasal dari saluran kemih, paru-paru, saluran pencernaan dan kulit yang ditemukan dalam 7kasus. Namun, sumber infeksi tidak diketahui dalam 5 kasus. Sebagian besar subjek adalah pria dewasa dengan keganasan sebagaipenyakit yang mendasarinya. Escherichia coli sebagai etiologi infeksi aliran darah sebagian besar (75%) menghasilkan enzim ESBL danresistensinya terhadap antimikroba seperti ampicilin, ampicilin/sulbactam, ceftazidime, ceftriaxon, cefepime, aztreonam, ciprofloxacindan trimetropim-sulfamethoxazol yang cukup tinggi. Kelompok filogenetik dari isolat klinis ini sebagian besar (75%) adalah grup B2dan grup D yang dikenal sebagai strain virulen ekstraintestinal. Isolat klinis yang tersisa (25%) dapat digolongkan sebagai kelompokfilogenetik A atau B1 dimana kelompok A dikenal sebagai strain komensal.
KEPATUHAN PENGGUNAAN ANTIHIPERTENSI SEBAGAI PREDIKTOR LAJU KEJADIAN DAN BIAYA RAWAT INAP Nurmainah Nurmainah; Achmad Fudholi; Iwan Dwiprahasto
JURNAL MANAJEMEN DAN PELAYANAN FARMASI (Journal of Management and Pharmacy Practice) Vol 4, No 4
Publisher : Faculty of Pharmacy, Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jmpf.288

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Persistensi penggunaan antihipertensi pada pasien hipertensi sangat diperlukan. Mengingat luaran utama dari terapi hipertensi adalah menurunkan atau mencegah terjadinya kejadian penyakit kardiovaskular seperti infark miokard, stroke yang berujung pada risiko kematian. Penelitian ini bertujuan untuk mengevaluasi dampak klinis berupa laju kejadian dan biaya rawat inap pada kelompok pasien hipertensi yang persisten dan tidak persisten menggunakan obat antihipertensi berdasarkan klaim resep pengobatan PT Askes (Persero). Rancangan penelitian yang digunakan adalah studi kohort retrospektif dengan menggunakan basis data pasien hipertensi rawat jalan peserta asuransi kesehatan PT Askes (Persero) di RSUD Panembahan Senopati Bantul. Jumlah subjek yang ikut dalam penelitian ini sebanyak 304 pasien hipertensi yang menggunakan obat antihipertensi pertama kali (tanggal indeks pengobatan 1 Juli 2007 – 31 Desember 2008). Analisis data yang digunakan pada penelitian ini, antara lain uji khi kuadrat, analisis kesintasan Kaplan-Meier, dan cox proportion hazard test. Setelah dilakukan pengamatan berkisar 3 sampai 4,5 tahun bahwa laju kejadian rawat inap pada pasien yang persisten menggunakan antihipertensi lebih lambat dan bermakna secara statistik daripada pasien hipertensi yang tidak persisten menggunakan antihipertensi (HR= 0,12; IK 95%= 0,006-0,23). Rata-rata biaya untuk mengatasi luaran klinis berupa rawat inap pada kelompok pasien yang persisten menggunakan antihipertensi (Rp. 2.758.109,28) lebih rendah daripada kelompok pasien hipertensi yang tidak persisten menggunakan antihipertensi dan dirawat inap (Rp. 4.125.412,00). Kesimpulan dari penelitian ini adalah peningkatan persistensi penggunaan antihipertensi pada pasien hipertensi dapat menekan laju kejadian dan biaya rawat inap. Kata kunci: persistensi, hipertensi, kejadian rawat inap, biaya