Nanan Sekarwana
Departemen Ilmu Kesehatan Anak Fakultas Kedokteran Universitas Padjadjaran/Rumah Sakit Dr. Hasan Sadikin Bandung

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Comparison of Estimated Glomerular Filtration Rate Mean Value of HARUS 15-30-60, HADI, and ASIAN Fomula Accuracy in Diabetes Mellitus Type 2 Rachmayati, Sylvia; Parwati, Ida; Martakusumah, Abdul Hadi; Soelaeman, Rachmat; Sekarwana, Nanan
International Journal of Integrated Health Sciences Vol 3, No 1 (2015)
Publisher : International Journal of Integrated Health Sciences

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Objective: To compare the accuracy of HARUS 15-30-60, HADI, and Asian Formulas (Chinese-equation (Ch-E), Japanese-equation (Jp-E), and Thai- equation (Th-E)) for estimated glomerular filtration rate (eGFR).Methods: The Kidney Dialysis Outcome Quality Initiative (KDOQI) has published a guideline to measure renal function, which is based on glomerular filtration rate (GFR). This procedure is complicated and expensive, therefore an estimated GFR (eGFR) has been proposed. The modification of diet in renal disease (MDRD) study prediction equation is the most frequently eGFR used. This method still have a weakness in accuracy, so the chronic kidney disease epidemiology collaboration (CKD-EPI) formula is developed. Since CKD-EPI is not practical for daily use, the MDRD is published for Asian population that includes Ch-E, Jp-E, and Th-E. In Indonesia, the MDRD formula has not been validated using any gold standard, therefore 2 new formulas have been developed, i.e. HARUS 15-30-60 and HADI formulas. In this study, we analyzed 102 medical records of Diabetes Mellitus Type 2 (DMT2) patients who visited Dr. Hasan Sadikin General Hospital, Bandung during the period of 2012 to 2013. We analyzed the data using HARUS 15-30-60, HADI, Asian formulas, and then compared them to CKD-EPI to see the accuracy. Statistical analysis used was paired t-test in SPSS-17 program.Results: The accuracy of the different formulas are as follows: HADI (p=0.173), HARUS 15-30-60 (p=0.060), Ch-E (p=0.001), Th-E (p=0.000), and Jp-E (p=0.000).Conclusions: HADI is the most accurate formula, followed by HARUS Formula, Ch-E, and Th-E and Jp-E, respectively.Keywords: Chinese-equation, HADI and HARUS 15-30-60 formulas, Japanese-equation, and Thai-equation DOI: 10.15850/ijihs.v3n1.403
Korelasi Kadar Albumin Serum dengan Persentase Edema pada Anak Penderita Sindrom Nefrotik dalam Serangan Novina, -; Gurnida, Dida Akhmad; Sekarwana, Nanan
Majalah Kedokteran Bandung Vol 47, No 1 (2015)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Sindrom nefrotik (SN) merupakan kelainan glomerulus yang ditandai proteinuria masif, hipoalbuminemia, edema, dan hiperlipidemia. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar albumin serum dan persentase edema pada anak penderita SN dalam serangan. Suatu uji analitik korelasional rancangan cross-sectional dilakukan selama bulan Agustus 2009 sampai Januari 2010. Subjek penelitian adalah anak penderita SN dalam serangan, usia 1–14 tahun, berobat ke poliklinik atau dirawat di Rumah Sakit Dr. Hasan Sadikin dan RS Jejaring (RSU Cibabat dan RSU Ujung Berung). Persentase edema dihitung dengan mengurangi total body water (TBW) anak saat sakit dengan TBW ideal, kemudian hasilnya dipersentasekan dengan TBW ideal. Analisis statistik menggunakan Uji korelasi Spearman. Pada penelitian ini didapatkan 29 subjek terdiri atas 26 laki-laki dan 3 perempuan. Kadar albumin serum rata-rata 1,45 g/dL dan persentase edema 21,6%. Hasil Uji korelasi Spearman menunjukkan hubungan yang sangat bermakna (p=0,006) antara kadar albumin serum dan persentase edema (r=-0,501). Simpulan, terdapat hubungan negatif antara kadar albumin serum dan persentase edema pada anak penderita SN dalam serangan. [MKB. 2015;47(1):55–9]Kata kunci: Kadar albumin serum, persentase edema, sindrom nefrotik dalam seranganCorrelation Between Serum Albumin Levels and Percentage of Edema during Nephrotic Stage in Children with Nephrotic Syndrome Nephrotic syndrome (NS) is a glomerular disorder characterized by massive proteinuria, hypoalbuminemia, edema, and hyperlipidemia. The aim of this study was to evaluate the correlation between serum albumin levels and percentage of edema during nephrotic stage in children with NS. Cross-sectional design with correlational analytic was used in this study. The subjects of this study were outpatients and inpatients with NS during nephrotic stage, aged between 1 and 14 years old, admitted to Dr. Hasan Sadikin General Hospital Bandung, Cibabat Hospital, and Ujung Berung Hospital from August 2009 to January 2010. Percentage of edema was calculated by substracting total body water (TBW) during illness to ideal TBW, then divided the result by ideal TBW. Subjects were 29 children, consisted of 26 boys and 3 girls. Mean serum albumin levels was 1.45 g/dL and percentage of edema was 21.6%. Analysis using Spearman correlation test showed a highly significant correlation (p=0.006) between serum albumin levels and percentage of edema in children with NS during nephrotic stage (r=-0.501). In conclusion, there is a negative correlation between serum albumin levels and percentage of edema during nephrotic stage in children with NS. [MKB. 2015;47(1):55–9]Key words: Nephrotic syndrome, nephrotic stage, percentage of edema serum albumin levels    DOI: 10.15395/mkb.v47n1.408
ANALISIS TINGKAT KEPUASAN MASYARAKAT TERHADAP DIMENSI KUALITAS PELAYANAN TENAGA PELAKSANA ELIMINASI MENGGUNAKAN PEMODELAN RASCH sari, dini riyantini; Sekarwana, Nanan; Hinduan, Zahrotur Rusyda; Sumintono, Bambang
Jurnal Sistem Kesehatan Vol 2, No 1 (2016): Volume 2 Nomor 1 September 2016
Publisher : Universitas Padjadjaran

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Jenis penyakit filariasis limfatik telah lama menjadi masalah kesehatan khususnya daerah endemis filariasis di Indonesia. Tahun 2014 angka mikrofilaria rate (Mf rate) di Kelurahan Nibung Putih sebesar 2,08%. Tingginya prevalensi penyakit filariasis limfatik berhubungan dengan kualitas pelayanan Tenaga Pelaksana Eliminasi (TPE). Penelitian ini bertujuan menganalisis tingkat kepuasan masyarakat terhadap dimensi kualitas pelayanan TPE di Kelurahan Nibung Putih Kabupaten Tanjung Jabung Timur Provinsi Jambi. Instrumen yang digunakan adalah kuesioner berupa formulir pengumpulan data hasil modifikasi dari penelitian yang dilakukan oleh Valarei dan Nasution D.C. Pemodelan Rasch digunakan untuk analisis data kuesioner, desain penelitian ini adalah observasional analitik kuantitatif dengan metode survei, pendekatan waktu cross sectional studies pada bulan April 2016 dengan subjek warga Kelurahan Nibung Putih yang berjumlah 103 orang. Item pada masing-masing konstruk didapati mempunyai daya diskriminasi yang beragam, yang menunjukkan instrumen mempunyai kemampuan mengukur. Hasil analisis keseluruhan responden bahwa sebanyak 103 berada di atas rata-rata logit item (+0,00 logit) yang menunjukkan persetujuan responden pada kualitas pelayanan. Hasil analisis univariat berdasarkan karakteristik responden dapat disimpulkan bahwa umur masa remaja akhir (42,9%), jenis kelamin laki-laki (55,2%), pendidikan tidak tamat SD (66,7%), pekerjaan buruh dan karyawan swasta (100%), memberikan penilaian sangat puas terhadap dimensi kualitas pelayanan TPE di Kelurahan Nibung Putih.Kata Kunci: Kualitas Pelayanan, Pemodelan Rasch, Tenaga Pelaksana Eliminasi
Hubungan Kadar Albumin Serum dengan Neutrophil Gelatinase-Associated Lipocalin Urine pada Penderita Sindrom Nefrotik Anak Nurisya, Deasy; Nataprawira, Heda Melinda; Sekarwana, Nanan
Majalah Kedokteran Bandung Vol 46, No 3 (2014)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Neutrophil gelatinase-associated lipocalin  (NGAL)  merupakan  penanda biologis  kerusakan ginjal yang kadarnya meningkat sejalan dengan terjadinya kerusakan pada tubulus proksimal. Tujuan  penelitian untuk  menganalisis hubungan  kadar albumin serum dengan NGAL urine pada penderita SN anak dalam serangan.  Subjek adalah  penderita SN dalam serangan berusia 1−14 tahun. Penelitian observasional analitik dengan metode potong lintang dilaksanakan  di Departemen Ilmu Kesehatan Anak Rumah  Sakit Dr. Hasan Sadikin Bandung dan Rumah Sakit Umum Daerah Kota Bandung dari September 2011 sampai Maret 2012. Pemeriksaan kadar albumin serum  dilakukan dengan metode bromcresol green dan  NGAL urine dengan metode enzyme-linked immunosorbent assay (ELISA). Uji statistik dengan Korelasi  Pearson  untuk data dengan distribusi normal.  Subjek terdiri atas 14 laki-laki dan 10 perempuan. Kadar albumin serum rerata dan  NGAL urine rerata  adalah 1,37 (SB 0,33) g/dL dan  2.719,37 (SB 3.781,82) ng/mL.  Hasil analisis menunjukkan hubungan bermakna antara penurunan kadar albumin serum dan  peningkatan kadar NGAL urine (r=-0,519; p=0,009).  Simpulan, semakin rendah kadar albumin serum maka semakin tinggi kadar  NGAL urine. Pada penderita SN anak dengan hipoalbuminemia perlu diwaspadai penurunan fungsi ginjal.    Kata kunci: Albumin, anak,  NGAL urine, sindrom nefrotikCorrelation between Serum Albumin and Urine Neutrophil Gelatinase Associated Lipocalin Levels in Children with Nephrotic SyndromeNeutrophil gelatinase-associated lipocalin (NGAL) is a biological marker found in kidney damage that increases in proximal tubular  damage. The purpose of this study was to analyze the correlation between serum albumin and  urine NGAL (uNGAL) levels in children with NS at initial presentation or relapse. Subjects in this study were 1−14 year-old children with NS. An observational analytical study with cross sectional design was conducted in the Pediatric Department of Dr. Hasan Sadikin General Hospital Bandung and Bandung City Public Hospital from September 2011 to March 2012. The serum albumin level and uNGAL level were measured using bromcresol green method and enzyme-linked immunosorbent assay (ELISA), respectively. Data were analyzed using Pearson correlation test on normal distribution data. Subjects consisted of 14 boys  and 10 girls. Mean serum albumin  and  uNGAL levels were 1.37 (SD 0.33) g/dL  and  2,719.37 (SD 3,781.82) ng/mL, respectively. There was a significant correlation between decreased albumin level and elevated uNGAL level (r=−0.519, p=0.009). In conclusion, the lower the albumin level, the higher the uNGAL level. An awareness should be developed towards the possibility that hypoalbuminemia in children with NS might decrease renal function. Key words:  Albumin, children, nephrotic syndrome, uNGAL DOI: 10.15395/mkb.v46n3.319
Deteksi Dini Pengalaman Kekerasan Pada Anak Di Tingkat Keluarga Di Kecamatan Jatinangor Dewi, Nurusofa Surti; Arisanti, Nita; Rusmil, Viramitha Kusnandi; Sekarwana, Nanan; Dhamayanti, Meita
Jurnal Sistem Kesehatan Vol 2, No 3 (2017): Volume 2 Nomor 3 Maret 2017
Publisher : Universitas Padjadjaran

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Undang-Undang Republik Indonesia No. 35 Tahun 2014, menyatakan setiap anak memiliki hak untuk mendapatkan perlindungan dari kekerasan dan diskriminasi. Kejadian  terbanyak  kekerasan  pada  anak  terjadi  di  tingkat  keluarga.  Penelitian dilakukan untuk mengetahui gambaran dan karakteristik kekerasan pada anak di tingkat keluarga di Kecamatan Jatinangor sebagai deteksi dini terhadap kekerasan. Penelitian ini dilakukan menggunakan studi desain deskriptif kuantitatif dengan rentang waktu pengambilan data September sampai November 2016 secara satu kali potong lintang pada siswa/i Sekolah Menengah Pertama (SMP) aktif berusia 13-15 tahun di Kecamatan Jatinangor, Kab. Sumedang dengan sampel valid diambil sebanyak 98 orang. Ditinjau dengan kejadian terbanyak berdasarkan pengalaman kekerasan di rumah dan lingkungan yaitu pernah melihat orang dewasa di rumah meneriaki dan berteriak yang membuat takut (37.8%), serta berdasarkan jenis pengalaman disiplin dan mendapatkan tindak kekerasan   yaitu   memberi   sesuatu   istimewa   atau   uang   (90.82%).   Berdasarkan pengalaman  pola  asuh  yaitu  terluka/jatuh  karena  tidak  ada  orang  dewasa  yang mengawasi (27.6%), berdasarkan pengalaman kejadian menakutkan yaitu seseorang masuk ke rumah untuk mencuri sesuatu (16.34%), dan berdasarkan pengalaman kekerasan  seksual  yaitu  menyuruh  melihat  organ  vital/pribadinya  atau  sebaliknya (8.2%). Sebagian besar anak pernah mengalami kekerasan di rumah dan sekitarnya.Kata Kunci: kekerasan pada anak, keluarga, pengalaman
Characteristics of Hypertension in Children at Dr. Hasan Sadikin General Hospital Bandung in January to December 2014 Meilani, Meilani; Sekarwana, Nanan; Pratiwi, Yuni Susanti
Althea Medical Journal Vol 4, No 3 (2017)
Publisher : Althea Medical Journal

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Background: Hypertension is often found in children. It could cause serious complications and added risk of hypertension in adulthood. Hypertension in children is likely secondary type and some of them might be severe. The aim of this study was to determine the demographic and clinical characteristics of hypertension in children admitted to Dr. Hasan Sadikin General Hospital Bandung in January to December 2014.Methods: The study design used was a quantitative, descriptive cross-sectional study. Data were obtained from medical records retrospectively of inpatient children from the period January to December 2014. Data were collected from the period  September to November 2015 based on age and gender as a demographic characteristics and stage of hypertension, etiology of hypertension, and emerge of hypertensioncomplication as a clinical characteristics.Results: Ninety(1.9%)children with hypertension were found from 4,681 of total inpatient children consisting of 58 males and 32 females with median of age 8 (0−13) years old.The main stage of hypertension was hypertension stage 2 with 55 cases and nephrotic syndrome as the most common causes with 43 cases. The complications were present in hypertension stage 2 with 3 cases and hypertensive crisis with 2 cases.Conclusions: Children with hypertension are most commonly males and median of age was 8 years old. Hypertension is characterized by hypertension stage 2 and nephrotic syndrome as the most common etiology. Complications of hypertension appear in severe hypertension.
Perubahan Kompensasi Berdasarkan Peraturan Menteri Kesehatan Nomor 28 Tahun 2014 Pada Pegawai Puskesmas Kota Cimahi Intania, Sekky; Sekarwana, Nanan; Wiwaha, Guswan
Jurnal Sistem Kesehatan Vol 3, No 1 (2017): Volume 3 Nomor 1 September 2017
Publisher : Universitas Padjadjaran

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Perubahan kompensasi pelayanan kesehatan Puskesmas berdasarkan Permenkes 28/2014 menimbulkan persepsi negatif berupa ketidakpuasan kerja di kalangan pegawai. Dugaan ketidakpuasan kerja ditunjukkan dengan adanya turnover kepala puskesmas sebanyak 38,46% di Kota Cimahi pada tahun 2014-2015. Penelitian dilakukan untuk menganalisis perbedaan kompensasi finansial sebelum dan sesudah penerapan Permenkes 28/2014 pada Pegawai Puskesmas di Kota Cimahi. Pada penelitian ini digunakan metode observasional dengan rancangan cross sectional. Telah dipilih 150 pegawai sebagai sampel secara stratified random sampling. Data kompensasi finansial sebelum dan sesudah penerapan Permenkes 28/2014 merupakan data sekunder dari Dinas Kesehatan. Kedua data dianalisis dengan uji komparatif rata-rata dua sampel berkorelasi Wilcoxon. Penelitian ini dilaksanakan pada bulan Agustus – November 2016 diseluruh puskesmas di Kota Cimahi. Hasil penelitian menunjukkan terdapat perbedaan yang siginfikan antara kompensasi finansial sebelum dan sesudah penerapan Permenkes 28/2014 pada Pegawai Puskemas. Adanya variabel daerah pada Peraturan Menteri Kesehatan Nomor 28 Tahun 2014 dinilai baik.Kata kunci: Permenkes 28/2014, perubahan kompensasi, puskesmas
Hubungan Kadar Seng Plasma dengan Derajat Penyakit Pneumonia Winarni, Paramita Diah; Rachmadi, Dedi; Sekarwana, Nanan
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Pneumonia merupakan masalah kesehatan utama anak di dunia dan sebagai penyebab terbanyak morbiditas dan mortalitas anak di negara berkembang. Anak dengan defisiensi mikronutrien termasuk seng berisiko tinggi terjadi pneumonia, karena gangguan sistem imun. Penelitian ini bertujuan mengetahui hubungan kadar seng plasma dengan pneumonia, pneumonia berat, dan sangat berat pada anak usia 2–59 bulan. Penelitian observasi analitik dengan rancangan potong lintang dilakukan bulan Agustus sampai November 2009 di Departemen Ilmu Kesehatan Anak RS Dr. Hasan Sadikin Bandung, RS Ujung Berung, dan RS Cibabat. Subjek harus memenuhi kriteria diagnosis klinis pneumonia menurut World Health Organization (WHO) Indonesia dan berusia 2–59 bulan. Pengambilan sampel darah untuk pemeriksaan kadar seng plasma dilakukan saat penderita datang. Analisis data menggunakan uji eksak Fisher dan untuk melihat hubungan kadar seng plasma dengan derajat pneumonia menggunakan uji Mann-Whitney. Dari total 42 subjek yang memenuhi kriteria inklusi, didapatkan 1 (2%) anak pneumonia, 32 (76%) pneumonia berat, dan 9 (22%) pneumonia sangat berat. Terdapat perbedaan bermakna (p=0,032) kadar seng plasma antara kelompok pneumonia berat dan sangat berat dengan median 96,685 μg/dL (57,32–195,66 μg/dL) untuk penumoia berat dan 80,240 μg/dL (63,01–111,84 μg/dL) untuk pneumonia sangat berat. Penelitian ini menunjukkan bahwa bahwa kadar seng plasma memiliki hubungan dengan pneumonia berat dan sangat berat pada anak usia 2–59 bulan. [MKB. 2012;44(4):213–17].Kata kunci: Pneumonia, seng plasma, sistem imun Association Plasma Zinc Level with Severity of PneumoniaPneumonia is a major health problem affecting children all over the world and remains a major cause of childhood morbidity and mortality in developing countries. Children with micronutrients deficiency including zinc, which might cause immune system disorder, have higher risk to have pneumonia. The aim of this study was to investigate the association between plasma zinc level and pneumonia, severe, and very severe pneumonia in children aged 2–59 months. This observational analytic with cross-sectional study was performed at the Pediatric Department of Dr. Hasan Sadikin General Hospital, Ujung Berung Hospital and Cibabat Hospital, in August to November 2009. Subjects of this study were 2–59-month-old children who meet the WHO Indonesian classification for pneumonia. Blood samples for plasma zinc examination were collected on admission. Data were analysed using exact Fisherand Mann-Whitney test for the association between plasma zinc level and severity of pneumonia. A total of 42 subjects were enrolled, 1 (2%) child were classified as having pneumonia, 32 (76%) children with severe, and 9 (22%) with very severe pneumonia. There were significant differences (p=0.032) in plasma zinc levels between severe and very severe pneumonia with a median of 96.685 μg/dL (57.32–195.66 μg/dL) for severe pneumonia and 80.240 μg/dL (63.0–111.84 μg/dL) for very severe pneumonia. This study shows an association between plasma zinc levels and severe and very severe pneumonia in children aged 2–59 months. [MKB. 2012;44(4):213–17].Key words: Pneumonia, plasma zinc, immune system DOI: http://dx.doi.org/10.15395/mkb.v44n4.177
KONSEP KUALITAS PELAYANAN KESEHATAN BERDASAR ATAS EKSPEKTASI PESERTA JAMINAN KESEHATAN NASIONAL Hadiyati, Ida; Sekarwana, Nanan; Sunjaya, Deni Kurniadi; Setiawati, Elsa Pudji
Majalah Kedokteran Bandung Vol 49, No 2 (2017)
Publisher : Faculty of Medicine, Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (19.202 KB) | DOI: 10.15395/mkb.v49n2.1054

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Masyarakat memiliki hak untuk mendapatkan pelayanan kesehatan yang bermutu dan terjangkau. Sejak awal tahun 2014, pemerintah berupaya meningkatkan akses pelayanan kesehatan melalui program Jaminan Kesehatan Nasional. Pelayanan kesehatan tersebut tentunya harus tetap berkualitas. Peneliti bertujuan merumuskan konsep kualitas pelayanan kesehatan berdasar atas ekspektasi pasien. Desain penelitian ini adalah kualitatif dengan paradigma konstruktivisme. Partisipan terdiri atas 17 pasien rawat jalan peserta Jaminan Kesehatan Nasional dan 7 petugas kesehatan Rumah Sakit Umum Daerah Al-Ihsan dan Soreang Kabupaten Bandung, Pengumpulan data dilakukan dengan cara wawancara mendalam selama bulan Agustus?November 2016. Pelayanan kesehatan yang berkualitas terdiri atas 11 dimensi. Dimensi sarana prasarana mengutamakan kecukupan kapasitas fasilitas. Dimensi karyawan mengutamakan kesesuaian jumlah kapasitas tenaga kerja. Dimensi pelayanan medis mengutamakan komunikasi. Dimensi pelayanan administrasi mengutamakan sistem antrian yang tertib. Dimensi keamanan pelayanan mengutamakan minimalisasi risiko bahaya. Dimensi kepercayaan menunjukkan loyalitas. Dimensi akses mengutamakan kemudahan menjangkau rumah sakit. Dimensi kesetaraan merupakan perlakuan yang sama antara pasien peserta JKN dan non-JKN. Dimensi transparansi informasi merupakan penyajian informasi yang jelas. Dimensi iur biaya mengungkapkan tidak ada penambahan biaya dalam tindakan medis maupun pengobatan. Dimensi kualitas antar bagian merupakan pelayanan yang sama di setiap titik bagian pelayanan. Pelayanan kesehatan yang berkualitas berdasar atas harapan pasien meliputi dimensi sarana prasarana, karyawan, pelayanan medis, pelayanan administrasi, keamanan pelayanan, kepercayaan terhadap rumah sakit, akses, kesetaraan, transparansi informasi, iur bayar, dan kualitas antarbagian. [MKB. 2017;49(2):102?9] Kata kunci: Ekspektasi pasien, Jaminan Kesehatan Nasional, kualitas pelayanan kesehatan  Health Service Quality Concept based on Expectation of the National Health Insurance Participants Community has the right to receive affordable and qualified health care. Since the early 2014, the government has attempted to increase health care access through the implementation of the National Health Insurance (Jaminan Kesehatan Nasional, JKN) scheme that still requires quality health care. The aim of this study was to formulate the concept of health care quality based on patients? expection. This was a qualitative study using constructivism paradigm on 17 JKN-member outpatients and 7 health care workers of Al-Ihsan General Public Hospital and Soreang Public District Hospital, Bandung District. Data were collected through in-depth interviews during the period of August?November 2016. Quality health care consists of 11 dimensions: facility and infrastructure dimension that prioritizes on adequacy of facility capacity; employee dimension that prioritizes on the number and capacity of human resource; medical service dimension that prioritizes on communication; administrative service dimension that prioritizes on orderly queuing system; service safety dimension that prioritizes on minimizing hazard risk; trust dimension that shows loyalty; access dimension that prioritizes on easy access to hospital; equality dimension that emphasizes same treatment for JKN and non-JKN patients; information transparency that prioritizes on clear information provision; cost sharing dimension that underlines no additioanl fee for medical actions and treatments; and inter-department quality dimension that includes same services in each service point. It is revealed that quality health care based on patients? expectation includes facility and infrastrucutre, employee, medical service, administrative service, service security, trust towards hospital, access, equality, information transparency, cost-sharing, and inter-department quality. [MKB. 2017;49(2):102?9] Key words: Health Service Quality, National Health Insurance, Patient Expectation 
Diet-Induced Changes in Serum Ganglioside Spectrum Patterns in 6-Month-Old Infants Gurnida, Dida A.; Idjradinata, Ponpon; Muchtadi, Deddy; Sekarwana, Nanan; Fong, Bertram; McJarrow, Paul; Rowan, Angela; Norris, Carmen
Majalah Kedokteran Bandung Vol 44, No 4 (2012)
Publisher : Faculty of Medicine, Universitas Padjadjaran

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Abstract

Human milk contains higher levels of gangliosides when compared to infant formula. Gangliosides play a role in neuronal growth, migration, maturation, sinaptogenesis, and myelination. Seven of the identified gangliosides (GM1, GM2, GM3, GD3, GD1a, GD1b, and GT1b) are dominant gangliosides with different specific functions. Thus, the aim of the study was to understand the effects of ganglioside-enhanced diet and to compare the spectrum patterns of those seven classes of serum gangliosides in infants consuming standard infant formula (IF group), ganglioside-fortified infant formula (GA group) and exclusive breastfeeding (BF group). This study used liquid chromatography–mass spectrometry (LC-MS) method. This was a prospective study involving 30 infants in IF group, 29 in GA group and 32 in BF group. Subject recruitment was performed using consecutive admission  approach from March 2008 to February 2009 in Bandung. Statistical analyses using Wilcoxon test showed that there was a significant change in the spectrum patterns of GD3, GM1, GM2 and GT1b in IF group; of GD1a, GM1 and GM2 in GA group and of GD1a, GD1b, GM1 and GM3 in BF group. It is concluded that ganglioside-enriched diet extends spectrum patterns of gangliosides especially in seven of them, i.e. GM1, GM2, GM3, GD3, GD1a, GD1b, and GT1b, in 6-month old infants. [MKB. 2012;44(4):240–44]..Key words: Gangliosides, human milk, infants, infant formula, LC-MSPerubahan Pola Spektrum Gangliosida Serum yang Diinduksi Makanan pada Bayi Usia 6 BulanAir susu ibu (ASI) mengandung gangliosida yang kadarnya lebih tinggi dibandingkan dengan susu formula. Gangliosida berperan dalam pertumbuhan, migrasi, maturasi saraf, sinaptogenesis, dan mielinisasi. Tidak kurang dari 100 tipe gangliosida telah ditemukan, tujuh di antaranya (GM1, GM2, GM3, GD3, GD1a, GD1b, dan GT1b) merupakan kelas utama dengan fungsi yang berbeda. Penelitian ini bertujuan untuk mengetahui efek penambahan diet gangliosida serta membandingkan pola spektrum tujuh kelas gangliosida serum tersebut pada bayi yang mengonsumsi susu formula standar (kelompok infant formula/IF), susu formula difortifikasi gangliosida (kelompok GA), dan ASI eksklusif (kelompok breastfeeding/BF). Penelitian ini menggunakan metode liquid chromatography-mass spectrometry (LC-MS) untuk menghitung kadar ketujuh kelas gangliosida tersebut. Penelitian ini adalah penelitian prospektif yang melibatkan 30 bayi kelompok IF, 29 bayi kelompok GA, dan 32 bayi kelompok BF. Perekrutan subjek penelitian dilakukan dengan cara consecutive admission dari bulan Maret 2008 sampai bulan Februari 2009 di Bandung. Analisis statistik tes Wilcoxon menunjukkan perubahan bermakna pada pola spektrum GD3, GM1, GM2 dan GT1b pada kelompok IF; GD1a, GM1, dan GM2 pada kelompok GA; GD1a, GD1b, GM1, dan GM3 pada kelompok BF. Kesimpulan, penambahan diet gangliosida akan meningkatkan 7 spektrum gangliosida yaitu GM1, GM2, GM3, GD3, GD1a, GD1b, dan GT1b pada anak usia 6 bulan. [MKB.2012;44(4):240–44].Kata kunci: ASI, bayi, gangliosida, LC-MS, susu formula DOI: http://dx.doi.org/10.15395/mkb.v44n4.217