eJournal Kedokteran Indonesia
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Validitas Isi Alat Ukur Burnout Staf Pengajar Fakultas Kedokteran di Indonesia
No full textStaf pengajar kedokteran memiliki tugas dalam pendidikan, penelitian, dan pengabdian kepada masyarakat atau pelayanan kesehatan yang dapat memberikan risiko burnout. Burnout dapat dinilai menggunakan alat ukur seperti Maslach Burnout Inventory Educator Survey (MBI-ES). Penelitian ini bertujuan untuk menilai kesesuaian konten alat ukur MBI-ES untuk mengetahui burnout staf pengajar kedokteran di Indonesia. Penelitian dilaksanakan di Fakultas Kedokteran Universitas Indonesia pada bulan Februari – Mei 2018. Metode potong lintang dengan pendekatan kualitatif dilakukan melalui 2 tahap, yaitu tahap focus group discussion (FGD) terhadap 17 staf pengajar kedokteran dan tahap kajian dari 24 panel ahli. Analisis tematik data transkripsi verbatim FGD menghasilkan 3 tema utama: tugas dan tanggung jawab staf pengajar, pemahaman burnout, dan MBI-ES modifikasi. Tahap telaah oleh panel ahli menganalisis butir pernyataan MBI-ES modifikasi berdasarkan kesepakatan ≥ 80% panel ahli. Kesepakatan meliputi 3 kategori penilaian. Kategori I adalah butir pernyataan MBI-ES modifikasi yang diterima, kategori II butir yang memerlukan perbaikan bahasa dan redaksional, dan kategori III adalah butir yang dieksklusi karena tidak memiliki konteks burnout yang relevan dengan staf pengajar kedokteran. Disimpulkan bahwa MBI-ES belum dapat menggambarkan burnout yang terjadi pada staf pengajar kedokteran di Indonesia. Penelitian selanjutnya perlu difokuskan pada evaluasi validasi konstruk, proses respons, dan validasi konkuren. Content Validity of Burnout Measurement of Medical Teacher in Indonesia Medical teachers have important tasks in teaching, research, and community services/patient care which can be very demanding and might risk them from experiencing burnout. Burnout can be assessed using tools such as Maslach Burnout Inventory Educator Survey (MBI-ES). This study aimed to assess content validity of MBI-ES with the context of burnout in medical education. The study was conducted in Faculty of Medicine Universitas Indonesia in February-May 2018. The cross-sectional design using qualitative approach was carried out through two stages. First, Focus Group Discussion (FGD) with 17 medical teaching staff, and second, expert panel review with 24 experts. Thematic analysis of the verbatim transcription of the FGD resulted in 3 main themes: duties and responsibilities of teaching staff, understanding of burnout, and modified MBI-ES. Analysis of the modified MBI-ES items during expert panel stage was carried out based on an agreement of ≥80% of expert panels. The agreement covers 3 categories: category I is MBI-ES accepted items, category II is accepted items with required language improvement, and category III is excluded items due to irrelevance with burnout among medical teachers. In conclusion, MBI-ES is not yet able to represent burnout in medical teaching staff in Indonesia. Future research will focus on evaluating construct validity, response processes, and concurrent validity if neede
Hallux Valgus as an Occupational Disease among Indonesian Female Workers:A Study Using Seven Steps of Occupational Diagnosis Approach
No full textShoes are a necessity for female workers. Not only they are used as footwear, they also play role in workers’ appearance. Company policies sometimes require female workers to use high heels, which could consequently lead to frequent foot problems such as hallux valgus (HV). This cross-sectional study was conducted to determine the prevalence of HV as an occupational disease among female workers at M department store, in Bekasi City West Java on May to June 2018, using a seven steps of occupational diagnosis approach. Female workers with HV were included as study subjects and were given questionnaires. Data was analyzed using the seven steps of occupational diagnosis method to establish the diagnosis of HV as an occupational disease or work-related disease or non-occupational disease. A total of 35 subjects were diagnosed with HV by the orthopedic specialist, 19 subjects of whom had an occupational disease and 8 subjects of work-related HV and 8 subjects of non-occupational HV. The majority of HV cases among the female workers at the department store was an occupational disease. Keywords: occupational disease, seven steps of occupational diagnosis, female workers, hallux valgus. Hallux Valgus Akibat Kerja di Pekerja Perempuan Indonesia: Suatu Studi Menggunakan 7 Langkah Diagnosis Okupasi Abstrak Sepatu sangat penting untuk pekerja perempuan, selain sebagai alas kaki, sepatu juga menambah penampilan. Kebijakan perusahaan kadang menghendaki pekerja perempuan menggunakan sepatu berhak tinggi sehingga menimbulkan masalah kaki antara lain hallux valgus (HV). Studi potong lintang ini bertujuan mengetahui prevalensi HV akibat kerja di M departemen store, di Kota Bekasi Jawa Barat pada bulan Mei sampai Juni 2018, menggunakan tujuh langkah diagnosis okupasi. Pekerja perempuan dengan HV dikumpulkan sebagai subjek, diberikan kuesioner dan dikaji dengan metode tujuh langkah diagnosis okupasi untuk menentukan HV akibat kerja atau HV berhubungan dengan pekerjaan atau HV bukan akibat kerja. Terdapat 35 subjek didiagnosis HV oleh spesialis ortopedi; 19 subjek termasuk HV akibat kerja dan 8 subjek masing-masing untuk HV berhubungan dengan pekerjaan dan HV bukan akibat kerja. Sebagian besar HV yang timbul di pekerja perempuan yang bekerja di department store adalah HV akibat kerja. Kata kunci: penyakit akibat kerja, tujuh langkah diagnosis okupasi, pekerja perempuan, hallux valgus
Next-Generation Sequencing pada Kanker Paru
No full textKanker merupakan penyakit genetik, oleh sebab itu, tata laksana kanker didasarkan pada kelainan atau mutasi genetik yang terjadi pada masing-masing pasien kanker. Next-generation sequencing (NGS) adalah teknologi sekuensing gen dengan sensitivitas dan spesifisitas tinggi, yang dikembangkan untuk mendeteksi lebih dari satu kelainan genetik secara bersamaan dalam sekali pemeriksaan. Teknologi NGS tidak memerlukan banyak materi genetik untuk menghasilkan data besar. Diagnosis kanker paru ditegakkan berdasarkan temuan histolopatologi pada sediaan biopsi yang umumnya diperoleh melalui prosedur bronkoskopi. Sediaan biopsi dari bronkoskopi relatif sedikit sehingga pemeriksaan mutasi genetik yang dapat dilakukan hanya terbatas pada mutasi yang sering (hotspot). Oleh sebab itu, teknologi NGS dapat menjadi metode yang lebih sesuai untuk mengetahui profil mutasi pasien agar tata laksana kanker paru dengan prinsip precision medicine dapat diterapkan. Next-Generation Sequencing in Lung Cancer Cancer is a genetic disease, hence, it is understandable that cancer management should be based on genetic alterations of each cancer patients. Next-generation sequencing is a high-sensitivity and specificity technology developed to detect multiple gene alterations in a single test that requires only a little amount of genetic materials and yet may generate big data. Lung cancer diagnosis is still based on histopathological findings on a limited biopsy specimen obtained during bronchoscopy. Consequently, genetic detection in lung cancer is often limited to hotspot mutations. Therefore, NGS can be a suitable method for genetic mutation profiling in order to apply precision medicine principle in lung cancer management.  
Indonesian Urologists’ Current Practice on Nocturnal Enuresis
No full textNocturnal enuresis (NE) is a symptom and a condition of intermittent incontinence which takes place during periods of sleep. Being the most common form of incontinence in children, the prevalence of NE in Indonesia is 2.3%. The objective of the study was to review Indonesian urologists' current practice on NE. This was a descriptive cross-sectional study using a self-constructed questionnaire which was distributed during several urological scientific meetings from August 2017 until August 2018. Indonesian urologists were asked to fill out these questionnaires which contained characteristics of the respondents and NE patients they had seen in their practices, diagnostic modalities and treatment options for NE. 133 out of 400 urologists participated. Most urologists had to deal with 1-5 cases NE per month. It was most commonly seen in 5-10 age group and affecting more girls than boys (45.9% vs 27.8% respectively). Approximately only half of Indonesian urologists utilized bladder diary for NE cases. Almost 90% urologist educated and proposed lifestyle intervention to manage NE. Alarm therapy and desmopressin was chosen by 51.1% and 21.8% of urologists respectively as treatment. Desmopressin was still less commonly prescribed compared to antimuscarinic and beta 3 agonist. To conclude, diagnostic strategies for NE are mostly in accordance with available guidelines although bladder diary was only opted by approximately half of urologists. Regarding treatment, education, lifestyle intervention and alarm therapy were the most form of treatment utilized for this condition.Praktik Terkini Spesialis Urologi Indonesia dalam Menangani Enuresis Nokturnal Enuresis nokturnal adalah bentuk inkontinensia urine intermiten yang terjadi saat tidur yang merupakan inkontinensia urine tersering pada anak dengan prevalensi di Indonesia 2,3%. Tujuan penelitian ini adalah mengetahui praktik terkini dokter spesialis urologi dalam menangani enuresis nokturnal. Studi deskriptif potong lintang ini menggunakan kuesioner yang dibagikan pada dokter spesialis urologi pada bulan Agustus 2017–Agustus 2018. Sebanyak 133 dari 400 spesialis urologi berpartisipasi dalam studi ini. Mayoritas spesialis urologi mendapat 1-5 kasus enuresis nokturnal per bulan. Usia pasien tersering adalah 5-10 tahun dan lebih banyak anak perempuan dibandingkan anak laki-laki (45,9% vs 27,8%). Setengah spesialis urologi menggunakan catatan harian berkemih untuk diagnosis enuresis nokturnal. Hampir 90% responden memilih edukasi dan intervensi gaya hidup sebagai tata laksana. Terapi alarm dan desmopressin digunakan oleh 51,1% dan 21,8% responden untuk terapi. Anti-muskarinik dan beta-3-agonis lebih sering diberikan dibandingkan desmopressin. Disimpulkan strategi diagnostik untuk enuresis nokturnal telah sesuai dengan panduan tata laksana kecuali untuk catatan harian berkemih. Terapi yang paling banyak dipilih adalah edukasi, intervensi gaya hidup, dan terapi alarm. 
Burnout Syndrome among General Practitioners in A Tertiary Referral Center
No full textMany demanding jobs, such as medical professionals are the targets of burnout syndrome. Although burnout syndrome was frequently reported in many studies abroad, Indonesia lacks the relevant data specifically burnout syndrome in the hospital staff. This study aimed to determine burnout syndrome in a tertiary referral center and its associated factors. This was a cross-sectional study involving general practitioners who worked in a tertiary referral hospital. The questionnaire used the Maslach Burnout Inventory (MBI). This study was performed in a tertiary referral hospital in Jakarta, from March to April 2019. The data were analyzed using univariate and bivariate analysis and compared with the chi-square test or Fisher test. Results: The total participants were 31 doctors; 25 of them were female, while half of them worked in the hospital at under 30 years (n=16). Most of them were married (n=20) and had a shift in the clinical unit (n=23). The majority of them worked longer than others (n=24) and earned a lower level of monthly salary (n=19). As many as 12 physicians in this institution were detected to be burnout. Medical doctors who suffered from burnout are marked with female (n=10), young age (n=10), marriage (n=9), longer working hours (n=11), low salary (n=7), and less working experience (n=6). Bivariate analysis showed age significantly associate with burnout syndrome (P-value=0.010). Burnout syndrome was found among medical doctors in a tertiary referral center with age as the only significant associating factor. Kejadian Burnout Syndrome pada Dokter Umum di Sebuah Rumah Sakit Rujukan Tertier Sindrom Burnout banyak ditemukan pada profesi tertentu seperti dokter. Meskipun demikian, data mengenai angka kejadian Sindrom Burnout belum banyak dilaporkan di Indonesia, khususnya pada profesi dokter umum yang bertugas di rumah sakit rujukan tersier. Penelitian ini dilakukan untuk menentukan angka kejadian dan faktor yang berpengaruh terhadap Sindrom Burnout pada dokter umum rumah sakit rujukan tersier. Studi potong lintang ini melibatkan 31 dokter umum sebagai responden penelitian. Studi ini dilakukan di sebuah rumah sakit rujukan tersier di Jakarta, pada bulan Maret-April 2019. Pengambilan data primer menggunakan kuesioner Maslach Burnout Inventory (MBI) untuk menentukan kejadian Sindrom Burnout. Data dianalisa dengan analisa univariat (data sosiodemografi) dan bivariat. Analisa bivariat dilakukan untuk melihat hubungan antara variabel karakteristik sosiodemografi terhadap kejadian Sindrom Burnout dengan menggunakan chi-square test atau fisher test. Hasil : Responden sebagian besar merupakan wanita (n=25), yang telah menikah (n=20), bekerja di unit pelayanan (n=23), bekerja lebih dari 60 jam (n=24), dan berpenghasilan di bawah 10 juta (n=19). Sebanyak 12 dokter umum mengalami Sindrom Burnout. Sindrom Burnout pada dokter umum ditandai dengan perempuan (n=10), usia yang lebih muda (n=10), telah menikah (n=9), jam kerja yang lebih lama (n=11), penghasilan yang lebih rendah (n=7), dan pengalaman kerja yang lebih sedikit (n=6). Analisis bivariat menunjukkan usia berhubungan secara signifikan terhadap kejadian Sindrom Burnout (P-value= 0,010). Sindrom burnout dialami oleh dokter umum yang bekerja di rumah sakit rujukan tersier. Usia merupakan satu-satunya faktor yang berhubungan dengan sindrom burnout.  
Demand Readiness Level: Upaya Menembus Batas Inovasi Bidang Kesehatan di Era "New Normal"
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Correlation of Body Mass Index and Bioelectrical Impedance Analysis of Total Body Fat with Serum Lipid Profile
No full textSince dyslipidemia is a known primary factor that can cause cardiovascular disease, it is important to evaluate the parameters of serum lipid profile. Determination of body mass index (BMI) and total body fat using the impedance method can be applied as an indirect strategy to predict body fat. Both these methods are easy to perform and can be used by the community. The aim of this study was to determine the relationship of BMI and total body fat measured using the impedance method with serum lipid profile. Using a cross-sectional study design, 128 subjects were recruited in this investigation and their lipid profiles were evaluated at the Clinical Pathology Laboratory, Cipto Mangunkusumo National Hospital, Jakarta. Body weight, height, and total body fat using the impedance method were measured. Lipid profile data, i.e., the levels of triglycerides, total cholesterol, HDL cholesterol, and LDL cholesterol, were obtained from the Clinical Pathology Laboratory information system in April–Juni 2016. Data were analyzed by the Pearson test to determine the relationship of BMI and total body fat measured using the impedance method with serum lipid profile. The results showed no significant correlation between BMI and serum lipid profile (P > 0.5), no significant correlation was found between total body fat and serum lipid profile (P > 0.5) and no correlation was found in each group of subjects with normal and high total body fat. In conclusion there is no association of BMI and total body fat with the lipid profile parameters, including the levels of triglycerides, total cholesterol, HDL cholesterol, and LDL cholesterol (p>0.05). Keywords: body mass index, impedance method, serum lipid profile, total body fat. Hubungan Indeks Massa Tubuh dan Lemak Total Menggunakan Metode Bioelectric Impedansi dengan Profile Lipid Serum Abstrak Dislipidemia merupakan faktor primer yang dapat menyebabkan penyakit kardiovaskular, sehingga evaluasi parameter profil lipid serum perlu dilakukan. Indeks massa tubuh (IMT) dan total lemak tubuh metode impedansi merupakan cara untuk memprediksi lemak tubuh secara tidak langsung. Kedua cara ini merupakan metode yang mudah dan dapat digunakan masyarakat. Penelitian bertujuan mencari hubungan IMT dan total lemak tubuh metode impedansi dengan profil lipid serum. Penelitian menggunakan desain penelitian potong lintang pada 128 subyek yang memeriksakan profil lipidnya ke Laboratorium Patologi Klinik, RSUPN dr. Cipto Mangunkusumo (RSUPNCM). Subyek diukur berat badan, tinggi badan, total lemak tubuh dengan metode impedansi. Data profil lipid, yaitu trigliserida, kolesterol total, kolesterol-HDL, dan kolesterol- LDL, diperoleh dari sistem informasi Laboratorium Patologi Klinik RSUPNCM pada bulan April– Juni 2016. Data diolah dengan uji Pearson untuk mengetahui hubungan IMT dan total lemak tubuh metode impedansi dengan profil lipid serum. Hasil tidak terdapat hubungan yang bermakna antara IMT dan profil lipid serum (P > 0,5), tidak ditemukan adanya hubungan yang bermakna antara total lemak tubuh dengan profil lipid serum (P > 0,5) dan tidak didapatkan juga hubungan pada setiap kelompok subyek dengan total lemak tubuh normal dan tinggi. Disimpulkan tidak terdapat hubungan IMT dan total lemak tubuh metode impedansi dengan parameter profil lipid, meliputi trigliserida, kolesterol total, kolesterol-HDL, dan kolesterol-LDL (p>0,05). Kata Kunci: Indeks massa tubuh, metode impedansi, profil lipid serum, total lemak tubuh
Kolaborasi dalam Pengelolaan Tiroid di Indonesia: Fokus pada Pencegahan Oftalmopati pada Penyakit Grave
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The Effect of Near-work Activity Time to The Incidence of Myopia in Children
No full textMyopia has been a global problem leading to visual impairment and blinding complications with associated factors including time spent outdoor and near-work activity time. Excessive near-work activities are inevitable in children nowadays. However, the association between near-work activity time and myopia are still inconsistent between studies. The aim of this study is to review whether excessive near-work activities is associated with myopia incidence. A literature search on six different database (Pubmed, Cochrane Library, Scopus, Clinical Key, Google Scholar, and EBSCOhost). Articles matched with inclusion criteria were appraised using Therapeutic Study Critical Appraisal Tool by CEEBM, University of Oxford. Three cohort trials were obtained from the literature search. Incidence of myopia and the hazard ratio (HR) in Ku et al, Tsai et al, and You et al are 27.7%, HR 1.31 (95% CI 1.03-1.68) for ≥2 hours/day cram school attendance; 25.2% HR 1.12 (95%CI 1.02-1.22) for ≥5 hours/week after-school program; 16% HR 1.05 (0.96-1.16) for ≥2.95 ± 1.72 hours/day near work time, respectively. The protective factor pointed out by the studies was outdoor time. Tsai et al showed HR 0.90 (95%CI 0.82-0.99, p<0.001) for ≥30 minute time spent on outdoor activities after school on weekdays; and Ku et al showed a protective dose-response relationship (p<0.001) between increased outdoor activity time and myopia. Near-work activity is a strong risk factor candidate for myopia incidence, while outdoor activity is a strong protective candidate. Hubungan Aktivitas Jarak Dekat terhadap Insidens Miopia pada Anak Miopia merupakan penyakit mata terbanyak yang dapat mengakibatkan kebutaan. Faktor yang berpengaruh antara lain aktivitas luar ruangan dan aktivitas jarak dekat. Pada era milenial olahraga luar ruangan jarang dilakukan dan aktivitas jarak dekat sangat melekat dengan kehidupan sehari-hari. Studi ini bertujuan untuk meninjau hubungan aktivitas jarak dekat dengan insidens miopia. Pencarian melalui enam basis data ilmiah (Pubmed, Cochrane Library, Scopus, Clinical Key, Google Scholar, and EBSCOhost) menghasilkan tiga studi kohort yang selanjutnya ditelaah menggunakan Therapeutic Study Critical Appraisal Tool by CEEBM, University of Oxford. Insidens miopia dan hazard ratio (HR) aktivitas jarak dekat pada Ku et al, Tsai et al, dan You et al adalah 27,7%, HR 1,31 (95% CI 1,03-1,68) untuk ≥2 jam/hari les akademik; 25,2% HR 1,12 (95% CI 1,02-1,22) untuk ≥5 jam/minggu program akademik; 16% HR 1,05 (0,96-1,16) untuk ≥2,95 ± 1,72 jam/hari aktivitas jarak dekat. Aktivitas luar ruangan merupakan faktor protektif terhadap insidens miopia dengan HR 0,90 (95% CI 0,82-0,99, p<0,001) untuk ≥30 menit kegiatan luar ruangan pada hari kerja. Terdapat hubungan dosis-respons protektif (p<0,001) antara aktivitas luar ruangan dan miopia. Aktivitas jarak dekat merupakan faktor risiko kuat untuk miopia sedangkan aktivitas luar ruangan merupakan faktor protektif.  
The Quality of Life of Leprosy Patients in Dermatovenereology Polyclinic of Dr. Cipto Mangunkusumo Hospital Jakarta: Study on Social Stigma
No full text Leprosy is a skin disease that has physical and psychosocial effects. Until now there are still many new cases of leprosy in Indonesia. Various causative factors include late diagnosis, patient not complaining about the illness, or similarities with other skin disorders. Eradication of leprosy is difficult especially due to the stigma of leprosy, both self and social, which can cause a decrease in quality of life. This study uses a mixed research design, quantitatively by filling in the Indonesian language DLQI questionnaire, followed by qualitative research through in-depth interviews with four subjects. Of the 40 subjects, the highest DLQI score range was between 11-20, which means that leprosy has a major influence on the subject’s life. Based on statistical tests, there was no significant association between DLQI scores and gender, age group, leprosy type, or occupation. The level of education has a statistically significant association with the DLQI score (p = 0.031). Based on in-depth interviews, leprosy was found to have an impact on subject’s education and work activities, as well as psychological effects due to the stigma caused. The use of instruments such as DLQI can quantitatively measure the quality of life of leprosy patients. In-depth interviews were conducted to assess psychological aspects that cannot be measured by using questionnaires. The data obtained can be used as a basis in giving counseling to leprosy patient