Evaluasi Ketepatan Antibiotik pada Pasien Sepsis

The administration of early intravenous antibiotics was one of the fundamental procedures in sepsis. Inappropriate of antibiotics in septic patients has an impact on mortality and prolongs treatment. The purpose of this study was to evaluate the appropriateness of antibiotics therapy in hospitalized sepsis patients in Central Java based on the parameters right indication, right patient, right drug, and the right dose. This study was observational. Data collected retrospectively and analyzed descriptively. Sampling was done by purposive sampling. The inclusion criteria were inpatients diagnosed with sepsis who received antibiotics therapy with complete medical record data. The exclusion criteria were patients who died of sepsis. Antibiotics analyzed using the DIH 25th edition 2016, IONI 2014, Tata Laksana Sepsis Pada Anak IDAI 2016, Neofax 2014, Kepmenkes PNPK Tata Laksana Sepsis 2017, PPK RS, and SHC Antimicrobial Dosing 2017. Based on data from 108 patients who fulfilled the inclusion criteria obtained results right indication 100%, right patient 97.22%, right drug 90.74%, and the right dose 48.15%. The most used antibiotic was a combination of ampicillin and gentamicin (41.67%), while the single antibiotic was ceftriaxone (12.96%).

Diagnostic Overview of COVID-19 Patients with Comorbid Type 2 Diabetes Mellitus at Royal Prima General Hospital Medan in 2020

COVID-19 is a disease caused by infection with a coronavirus known as SARS-CoV-2. COVID-19 patients with diabetes have a poor prognosis and thus have a shorter life expectancy than those without diabetes. This is because COVID-19 causes severe lung dysfunction and inflammation. The purpose of the study is to find out the description of diagnostic of COVID-19 patients with comorbid diabetes mellitus type 2 at Royal Prima general hospital Medan in 2020. The case study design method is descriptive with a retrospective approach, the sample size of 63 patient medical records is taken by purposive sampling, a complete medical record and analyzed with descriptive statistics. Most patients were aged more than 50 years old (66.7%) and female (50.8%). With symptoms of fever (84.1%), cough (87.3%), shortness of breath (87.3%), headache (28.6%), diarrhea (9.5%), nausea (42.9%), abdominal pain (31.7%), loss of smell (20.6%). The longest hospitalization time (11-20 days) (46%). It can be concluded that the most age is > 50 years, the most gender is female and the most clinical symptoms are cough and shortness of breath.

Maxillary Rhinosinusitis Profil In General Hospital Of Haji Surabaya On January-December 2017

Chronic rhinosinusitis in various countries in the world and Indonesia shows an increase from time to time. At General Hospital of Haji Surabaya, the prevalence of chronic rhinosinusitis has increased from 10.13% in 2016 to 10.26% in 2017. Various factors are thought to cause chronic rhinosinusitis. Chronic rhinosinusitis can interfere with the quality of life and lead to serious complications if left untreated. To determine the profile of chronic rhinosinusitis in General Hospital of Haji Surabaya for January-December 2017 Period. Analytic observational with cross-sectional study approach. Used the total sampling method. Based on patients diagnosed with chronic rhinosinusitis with complete medical record data. The sample in this study were 132 patients. Most chronic rhinosinusitis patients were aged 36-45 years as many as 26 patients (19.69%) and the least number of patients was more than 65 years old as many as 6 patients, women (67.40%) and 43 patients in men (32, 60%). Symptoms of nasal congestion in 79 patients (59.84%), cough as many as 25 patients (18.93%), septal deviation as many as 51 patients (38.63%) and at least 4 patients (3.03%) of nasal polyps. Most rhinosinusitis patients in this study were aged 36-45 years, women with symptoms of nasal congestion and septal deviation as the most comorbidities.

Are medical record front page data suitable for risk adjustment in hospital performance measurement? Development and validation of a risk model of in-hospital mortality after acute myocardial infarction

ObjectivesTo develop a model of in-hospital mortality using medical record front page (MRFP) data and assess its validity in case-mix standardisation by comparison with a model developed using the complete medical record data.DesignA nationally representative retrospective study.SettingRepresentative hospitals in China, covering 161 hospitals in modelling cohort and 156 hospitals in validation cohort.ParticipantsRepresentative patients admitted for acute myocardial infarction. 8370 patients in modelling cohort and 9704 patients in validation cohort.Primary outcome measuresIn-hospital mortality, which was defined explicitly as death that occurred during hospitalisation, and the hospital-level risk standardised mortality rate (RSMR).ResultsA total of 14 variables were included in the model predicting in-hospital mortality based on MRFP data, with the area under receiver operating characteristic curve of 0.78 among modelling cohort and 0.79 among validation cohort. The median of absolute difference between the hospital RSMR predicted by hierarchical generalised linear models established based on MRFP data and complete medical record data, which was built as ‘reference model’, was 0.08% (10th and 90th percentiles: −1.8% and 1.6%). In the regression model comparing the RSMR between two models, the slope and intercept of the regression equation is 0.90 and 0.007 in modelling cohort, while 0.85 and 0.010 in validation cohort, which indicated that the evaluation capability from two models were very similar.ConclusionsThe models based on MRFP data showed good discrimination and calibration capability, as well as similar risk prediction effect in comparison with the model based on complete medical record data, which proved that MRFP data could be suitable for risk adjustment in hospital performance measurement.

Relationship of Nurse's Knowledge Concerning Medical Recording With Nursing Care Document Completeness

Background: Completeness of medical records is a medical record that is completely filled out by a doctor within ≤ 24 hours of completion of outpatient services or after an inpatient is decided to go home.Methods: This type of research is descriptive. The data were collected using a questionnaire and direct observation. The data were processed by editing, coding, processing, and cleaning, which were analyzed using computerization.Results: The results showed that less than half (46.7%) of the medical record files were incomplete and 33.3% had low knowledge of nurses.Conclusions: The conclusion in this study was that less than half (46.7%) of nurses did not complete medical record files and it was found that nurses lack of knowledge in filling out nursing care documents completely. It is better if reward should be done for nursing care documents.

TRANSFORAMINAL INTERSOMATIC LUMBAR ARTHRODESIS: COMPARISON BETWEEN AUTOGRAFT AND CAGE IN PEEK

ABSTRACT Objective: To compare the postoperative outcomes of transforaminal intersomatic lumbar arthrodesis with structured iliac bone autograft and PEEK device. Methods: The total of 93 medical records of patients undergoing transforaminal intersomatic fusion between January 2012 and July 2017 with at least 1 year of postoperative follow-up, with complete medical record, containing clinical file and radiological exams, were reviewed. Results: From the medical records evaluated, 48 patients underwent the procedure with structured iliac autograft (group 1) and 45 with PEEK device (group 2). There was an improvement in functional capacity in both groups (p < 0.001), however there was no difference when comparing them (p = 0.591). Conclusion: The postoperative clinical and radiological results of lumbar arthrodesis with TLIF technique, using a structured iliac bone autograft compared to a PEEK device, were similar. Level of Evidence II, Retrospective study.

Ketidaksesuaian Dosis dan Interval Pemberian Antibiotik pada Lansia di Bangsal Penyakit Dalam RSUD dr Moewardi Solo serta Gambaran Timbulnya Efek Samping yang Merugikan

Aging causes a decrease in renal blood flow velocity and clearance values ​​related to renal filtration function. A decrease in kidney filtration function results in a decrease in the ability of drug elimination so that the drug and its metabolites tend to accumulate in the blood. The dose of certain antibiotics must be adjusted to the patient's kidney function. Clinical estimates of kidney filtration function are expressed in terms of creatinine clearance (CrCl). This study aims to determine the percentage of suitability of the dose and interval of antibiotic administration with the CrCl value of elderly patients and to see description of the side effects arising from the administration of antibiotics. This research was observational with data retrospective retrieval of medical records. The subjects of the study were elderly patients who were hospitalized in the ward ward in dr. Moewardi Solo Hospital in the period January - May 2019 , ≥ 60 years aged with a diagnosis of Pneumonia, Urinary Tract Infection (UTI), Cellulitis and sepsis with complete medical record data. The antibiotics evaluated are all antibiotics given to the patient while being treated. The results showed the suitability of the dose and interval of antibiotic administration with the CrCl value of elderly patients hospitalized in the disease ward in RSUD Dr. Moewardi Solo for the period January-May 2019 was 63.35%, the incidence of side effects arising from the administration of antibiotics was nausea and vomiting (10 patients ) and diarrhea (4 patients).

2526. Side Effects of Antiretroviral Therapy in Children with HIV in a Referral Center in Mexico

Background Human Inmunodeficiency Virus infection (HIV) is still a challenge in many parts of the world, mainly in children. In Mexico the infection has been decreasing, however we still have cases, in 2018 we had 40 perinatal new cases reported. The antiretroviral therapy has shown to be effective to control the disease but it is not free of adverse effects, the children with vertical transmission are exposed to many years of the antiretroviral therapy. Methods Retrospective, observational descriptive study at Instituto Nacional de Pediatría during 2004–2019. We included every children under 18 years old who received treatment for HIV and had a complete medical record. Results We found 61 patients under 18 years that fulfill the data for the analysis. 37 (60%) were male, the mean age at diagnosis of HIV infection was 47 months, the antiretroviral therapy that received 57 patients (93.4%) of the study was zidovudine, lamivudine and lopinavir/ritonavir, only 4 received another therapy: 3 of them received abacavir, lamivudine, and lopinavir/ritonavir and the missing one received abacavir, lamivudine and raltegravir. 43% of the children of our study showed adverse effects after the antiretroviral therapy, the mean time of adverse effects presentation was 37 months after the beginning of the treatment. The most common effect was hypertriglyceridemia with 13 cases, in second place we found hypercholesterolemia in 7 cases, and both in 5 cases, other frequent effects were hepatotoxicity in 5 cases, diarrhea in 4 cases, anemia in 3 cases, vomit in 3 cases, abdominal pain and night terrors in 2 cases each one. It was necessary the change of the therapy because of adverse effects in 6 cases (9.8%). Conclusion Antiretroviral therapy is effective although it has many side effects. We observe that adverse effects are frequent, almost the half, in pediatric population, it depends on the antiretroviral selection, for children we had only a few options because of the little doses they need or the inability to swallow tablets. It′s important to monitor and control all the adverse effects because they increase morbidity and mortality, especially dyslipidemia, that has been associated with cardiovascular risk and it was the most common effect found in our study. Disclosures All authors: No reported disclosures.

Perkiraan Kadar Seftazidim dalam Darah pada Pasien Pneumonia dengan Gangguan Fungsi Ginjal

Pneumonia is one of the major causes of mortality due to infection in hospitalized patients. It was frequently found in patients with renal failure. Clinical outcomes of infected patients with renal failure are worse compared to patients without renal failure. The presence of renal impairment affects the pharmacokinetics of the drug. Ceftazidime is one of the most commonly used antibiotics in patients with pneumonia. Approximately, 80-90% of ceftazidime’s total drug fraction is eliminated by kidneys so that the presence of kidney disorders will affect the concentration of ceftazidime in the blood. This study aimed to determine the estimated concentration of ceftazidime in the blood and clinical outcome of pneumonia patients with renal impairment. This study was a retrospective study with descriptive observational design. Data were obtained from patient’s medical record in a hospital in Yogyakarta between January 2013-June 2017 which fulfilled the inclusion criteria, i.e., ≥18 years old patients with complete medical record data, treated in internal medicine ward with diagnosis of pneumonia (HAP/HCAP) who had chronic renal failure, and received ceftazidime for minimum 72 hours or 3 days. The number of research samples were 40 patients. This study showed that 31 patients (77.5%) had achieved estimated ceftazidime concentration in the blood above the minimum inhibitory concentration of 8 μg/ mL. After ceftazidime therapy, 19 patients (47.5%) had improved clinical outcome and 21 patients (52.5%) had not improved clinical outcome.