The Effect of PRKAA2 Variation on Type 2 Diabetes Mellitus in the Asian Population: A Systematic Review and Meta-Analysis.

The prevalence of type 2 diabetes mellitus (T2DM) is increasing among Asians. The adenosine monophosphate-activated protein kinase (AMPK) increases T2DM risk through insulin resistance. Glucose levels are related to AMPK subunit α2 encoded by PRKAA2. This systematic review and meta-analysis aimed to analyse the association between PRKAA2 variation and T2DM risk. Publication search related to PRKAA2 and T2DM used PubMed, ProQuest, and ScienceDirect databases. Article selection based on inclusion and exclusion criteria only included Japanese and Chinese populations. This meta-analysis used five genotype models to estimate the effect of PRKAA2 variation and T2DM risk. Additionally, a fixed-effect model was selected to measure the pooled size effect if P > 0.05 or I2 < 50%. Qualitative analysis included four eligible studies, and meta-analysis included only two studies because both showed data concerning rs2746342 variation. Patients with G allele are 1.45 times more likely to have T2DM than patients with T allele (95% confidence interval [CI]: 1.20, 1.76; P: 0.0001). Notably, patients who had GG genotype have 1.96 times higher risk of T2DM compared with those with TT genotype (95% CI: 1.34, 2.87; P: 0.0005), dominant model (odds ratio [OR]: 1.75; 95% CI: 1.32, 2.31; P: 0.001), and recessive model (OR: 1.43; 95% CI: 1.01, 2.01; P: 0.04). PRKAA2 variation, especially in rs2746342, has an association with T2DM risk in the G allele, additive, dominant, and recessive models. G allele might be the most contributable factor in increasing T2DM susceptibility.

Antibiotic Resistomes and Microbiomes in the Surface Water along the Code River in Indonesia Reflect Drainage Basin Anthropogenic Activities.

Water and sanitation are important factors in the emergence of antimicrobial resistance in low- and middle-income countries. Drug residues, metals, and various wastes foster the spread of antibiotic resistance genes (ARGs) with the help of mobile genetic elements (MGEs), and therefore, rivers receiving contaminants and effluents from multiple sources are of special interest. We followed both the microbiome and resistome of the Code River in Indonesia from its pristine origin at the Merapi volcano through rural and then city areas to the coast of the Indian Ocean. We used a SmartChip quantitative PCR with 382 primer pairs for profiling the resistome and MGEs and 16S rRNA gene amplicon sequencing to analyze the bacterial communities. The community structure explained the resistome composition in rural areas, while the city sampling sites had lower bacterial diversity and more ARGs, which correlated with MGEs, suggesting increased mobility potential in response to pressures from human activities. Importantly, the vast majority of ARGs and MGEs were no longer detectable in marine waters at the ocean entrance. Our work provides information on the impact of different influents on river health as well as sheds light on how land use contributes to the river resistome and microbiome.

Cost-Effectiveness Analysis of Two Chemotherapy Regiments FAC vs. Taxane for Operable Breast Cancer Patients in Indonesia.

BACKGROUND: Breast cancer is the deadliest cancer among women worldwide including Indonesia. Both FAC and Taxane-based chemotherapies are often used for patients with early node-positive breast cancer. However, the study regarding the cost-effectiveness of those regiments is still rare. This study aims to analyze the cost-effectiveness of Taxane versus FAC in the Indonesia setting. METHODS: Twenty-four patients with stage I-IIIA breast cancer who had received surgery, FAC or Taxane-based adjuvant chemotherapy, and radiation were included in this study. Health-related quality of life was assessed using INA-BCHRQoL. INA-BCHRQoL was mapped to the EuroQoL 5D (EQ-5D) index calculator to get the utility score. All direct cost was retrieved from electronic medical records and hospital information system. Whereas, a questionnaire was designed to collect information about society cost from patients. ICER was counted to summarize the cost-effectiveness of two chemotherapy regiments (Taxane versus FAC). A sensitivity analysis was done to assess the uncertainty result. RESULTS: The results showed there was no significant difference between the score of quality of life and utility in respondents who received FAC chemotherapy and Taxane-based chemotherapy. However, in terms of cost, Taxane was 6.5 times higher than the FAC group per patient for chemotherapy drugs only. Moreover, the total cost of treatments in Taxane-based chemotherapy was approximately 3.7 times more costly than the counterpart in the FAC arm (p=0.000). Taxane-based chemotherapy dominated with ICER IDR 765.213.092 per QALY gained. Overall, FAC was found more cost-effective compared to the Taxane regiment. CONCLUSION: FAC represents the value of money compared to Taxane-based for breast cancer patients with stage I-IIIA in Indonesia.

Predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus: A prospective study in Indonesia.

BACKGROUND: The objective of this study was to identify the predictors of the conservative management outcomes in patients with lumbar herniated nucleus pulposus (HNP). METHODS: A prospective study was conducted between June 2010 and April 2012 in Banda Aceh, Indonesia. Clinical and baseline neurologic examinations such as passive straight leg raising test (SLRT), cross SLRT, and patellar and Achilles reflexes were assessed prior to the conservative management. The patients were evaluated at 2nd, 4th, 8th, 12th and 24th week following commencement of the conservative management. RESULTS: We recruited and followed 171 HNP patients of which 35.7% of them had good outcome. At univariate analysis, patients with more than 12 months duration of complaint, those with dominant radicular pain, severe pain intensity (visual analogue scale 7-10), positive SLRT, positive cross SLRT, and reduced motor power of knee extensors (muscle strength grade 1-4), were associated with poor outcome. Multivariate analysis suggested that patients with dominant radicular type of pain were likely to had poor outcome compared to those with dominant back pain (odd ratio (OR) 10.57 with 95% confidence interval (CI) 1.15-96.93). Patients with reduced motor power of knee extensors also had a higher chance to have poor outcome compared to those who were normal (OR: 10.57; 95% CI: 1.15-96.93). CONCLUSION: Type of pain and the strength of lower extremities could be able to predict the failure of conservative management in patients with lumbar disc herniation. However, further studies with the bigger sample size are warrant to validate our results.

Quality of Life in Palliative Post-mastectomy Reconstruction: Keystone versus Rotational Flap.

Late stage breast cancer presents with malignant wound causing skin infiltration, pain, bleeding, and malodour, which affect quality of life (QoL). Palliative mastectomy aims to eliminate wound symptoms and requires prolonged wound care to improve QoL. This study aimed to prospectively investigate QoL differences in 2 alternative reconstructive methods: keystone flap and rotational flap. METHODS: Twenty-four late stage breast cancer patients with symptoms of cancer wounds were included in this study. They were divided into 2 groups: keystone flap and rotational flap. Each patient's QoL was evaluated using EORTC QLQ-C30 and QLQ-BR23 before and 3 weeks after surgery. RESULTS: Global health post-surgery was significantly improved compared with pre-surgery in all patients (P < 0.001), across both the keystone (P = 0.018) and rotational groups (P = 0.007). Breast symptoms post-surgery were also improved compared with pre-surgery in all patients (P = 0.035). However, when analyzed per group, breast symptoms were only improved significantly in the keystone group (P = 0.013) but not in the rotational group (P = 0.575). When compared between 2 groups, future perspective post-surgery in the keystone group [100 (0-100)] was better than the rotational group [66.7 (0-100)], (P = 0.020). CONCLUSIONS: Reconstructive surgery after mastectomy improves QoL in late stage breast cancer patients. The keystone flap is superior to the rotational flap in improving global health and breast symptoms.

A systematic review of the keystone design perforator island flap in the reconstruction of trunk defects.

The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.

Overexpression of Programmed Death-Ligand 1 Receptor mRNA as an Independent Negative Prognostic Factor for Triple Negative Breast Cancer.

BACKGROUND: Triple negative breast cancer (TNBC) (represents roughly 25% of all breast cancers in Yogyakarta) still has the worst survival compared to other breast cancer subtypes. Results from recent studies have shown that inhibition of programmed death-ligand 1 receptor (PD-L1) in TNBC patients is associated with better prognosis. Currently, data on PD-L1 expression and its prognostic value in Indonesian TNBC patients are still relatively unknown. This study aimed to investigate the expression of PD-L1 in Indonesian TNBC patients as preliminary proof to support PD-L1 inhibitor as a possible treatment option near in the future. METHODS: We retrospectively included stage I-III TNBC patients diagnosed between 2014 and 2017 in Dr. Sardjito Hospital, Yogyakarta, Indonesia. Clinical variables were collected from medical record. Paraffin blocks of biopsy specimen were retrieved to examine mRNA level of PD-L1. RESULTS: We included 48 subjects with mean age of 51.09 years and mean body mass index (BMI) of 24.58. The 3-year overall survival (OS) was 58.3%. Overexpression of PD-L1 mRNA in TNBC patients is associated with worse prognosis (P < 0.01). There were no statistically significant associations between PD-L1 mRNA expression and any of the clinicopathologic variables examined. CONCLUSIONS: In summary, PD-L1 mRNA overexpression is associated with worse survival in Indonesian TNBC patients, independent of other established risk factors. PD-L1 mRNA is expressed in all of our samples, presenting as a feasible alternative or complementary method in deciding which patient might benefit from receiving PD-L1 inhibitor.

Survey data of multidrug-resistant tuberculosis, Tuberculosis patients characteristics and stress resilience during COVID-19 pandemic in West Sumatera Province, Indonesia.

This set of data presents a survey data describing multidrug-resistant tuberculosis, tuberculosis patients characteristics and stress resilience during COVID-19 pandemic in West Sumatera Province, Indonesia. The data were gathered from multidrug-resistant tuberculosis, tuberculosis patients through a survey distributed by an online questionnaire, assesing patients characteristics (age, sex, level of education, working status, history of close contact to patients with multidrug resistant tuberculosis and tuberculosis, smoking, alcohol consumption, cavitary pulmonary, diabetes mellitus, nutritional status and tuberculosis outside the lung) and stress resilience (3 items), from 15th July until 7th August 2020. The samples were collected 73 multidrug resistant tuberculosis patients and 219 tuberculosis patients in West Sumatera Province, Indonesia who were willing to fill an online questionnaire. SPSS version 23.0 was used to analyzed the data by descriptive and inferential statistics. The data will help to identify mental health problems and potentially as a warning sign that can support for health education interventions among multidrug-resistant tuberculosis and tuberculosis patients during COVID-19 pandemic.

Survey data of COVID-19 awareness, knowledge, preparedness and related behaviors among breast cancer patients in Indonesia.

This dataset presents a survey data describing COVID-19 awareness, knowledge, preparedness and related behaviors among breast cancer patients in Indonesia. The data were collected from breast cancer patients through a survey distributed by an online questionnaire, assesing social-demographic characteristics (6 items), COVID-19 awareness (5 items), knowledge (2 items), preparedness (2 items) and related behaviors (2 items), from 20th June until 14th July 2020. The samples were gathered 500 breast cancer patients in Indonesia who were willing to fill an online questionnaire. SPSS version 23.0 was used to analyzed the data by descriptive and inferential statistics and SmartPLS 3 to created the partial least square path modeling. The data will help in preventing the transmission of COVID-19 among breast cancer patients and can support for health education and promotion interventions.

Association of Overweight and Obesity with Breast Cancer During Premenopausal Period in Asia: A Meta-Analysis.

BACKGROUND: The association of overweight and obesity with breast cancer risk in premenopausal women and in different ethnicities remains in debate, especially among Asian women. The aim of this systematic review and meta-analysis was to determine the association of overweight and obesity with breast cancer during premenopausal period in Asian women. METHODS: We performed a meta-analysis of research articles on the association of overweight and obesity with breast cancer during premenopausal period in Asian women published from January 2000 to July 2018 in article databases of EBSCO, PubMed, and ProQuest. Pooled odds ratios (ORs) were calculated by fixed and random-effect models. Publication bias was visually evaluated using funnel plots, and then statistically assessed using Egger's and Begg's tests. Review Manager 5.3 (RevMan 5.3) and Stata version 14.2 (Stata Corporation) were used to process the data. We reviewed 886 articles. RESULTS: We found 15 studies conducted systematic review continued by meta-analysis of relevant data with 22,362 patients. There was significant association of obesity [OR = 1.36 (95% confidence interval (CI) 1.26-1.47, P < 0.00001)] and overweight [OR = 1.17 (95% CI 1.10-1.25, P < 0.00001)] with breast cancer during premenopausal period in Asian women. In this study, there was no significant publication bias for studies included in overweight and obesity with breast cancer during premenopausal in Asian women. CONCLUSIONS: This study suggested association of overweight and obesity with breast cancer during premenopausal period in Asian women.

Mortality risk of bloodstream infection caused by either Escherichia coli or Klebsiella pneumoniae producing extended-spectrum ß-lactamase: a prospective cohort study.

OBJECTIVE: Several studies reported that infection of extended-spectrum ß lactamase (ESBL)-producing Escherichia coli (E. coli) or Klebsiella pneumoniae (K. pneumoniae) contributed to higher mortality rates but others found it was not associated with mortality. A prospective cohort study which involved 72 patients was conducted to assess the risk of mortality of bloodstream infection due to ESBL-producing K. pneumoniae or E. coli as compared to those infected by either K. pneumoniae or E. coli which not produce ESBL. RESULT: Mortality in the group of patients infected with ESBL-producing bacteria was 30.6%, whereas in another group which was infected with non ESBL-producing bacteria was 22.2% (p = 0.59). Kaplan-Meier's analysis showed that the survival rate during 14-days follow-up among these two group was not significantly different (p = 0.45) with hazard ratio 1.41 (95% CI 0.568-3.51). Stratification analysis found that adult and elderly patients, patients with sign of leukocytosis, and patients treated with carbapenem were modifier effect variables.

Why do nursing students make medication errors? A qualitative study in Indonesia.

OBJECTIVES: This study aimed to explore Indonesian nursing students' perceptions of the types and causes of medication errors in clinical rotations. METHODS: This descriptive qualitative study was conducted with 26 nursing students who had completed their final clinical rotations. Data were collected through four focus group discussions and analysed by Colaizzi's method. RESULTS: Three themes were obtained from the data analysis: important role played by nurses in medication safety, types of medication errors (near misses) committed by nursing students, and the causes of medication errors during clinical rotations. CONCLUSION: Nurses play a vital role in dispensing medication and ensuring patient safety, but near misses are still reported during clinical rotations. Lack of knowledge, skills, proper supervision, and appropriate role models during clinical rotations lead to medication errors by nursing students. Appropriate role models and adequate supervision in the clinical education stage are necessary to ensure the achievement of medication safety competencies.

Family History of Breast Cancer and Breast Cancer Risk between Malays Ethnicity in Malaysia and Indonesia: A Meta-Analysis.

BACKGROUND: Breast cancer is the most common cancer type in women not only in world but also in Malays ethnicity between Malaysia and Indonesia. Breast cancer has varying incidence in every country, but genetic factor by family history influence the incidence of breast cancer. This systematic review and meta-analysis was performed to determine family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia. METHODS: This meta-analysis was conducted on published research articles on family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia published between Jan 1999 and Jul 2018 in the online article databases of PubMed, ProQuest and EBSCO. Pooled odds ratios (OR) were calculated with fixed and random-effect models. Publication bias was visually evaluated by using funnel plots and statistically assessed through Egger's and Begg's tests. Data were processed using Review Manager 5.3 (RevMan 5.3) and Stata version 14.2 (Stata Corporation). RESULTS: We reviewed 1123 articles. There are 10 studies with number of samples 4511 conducted a systematic review and continued with Meta-analysis of relevant data. The results showed significant association between family history of breast cancer with breast cancer risk in Malays ethnicity in Malaysia and Indonesia (OR = 3.34 [95% CI 2.68-4.15, P<0.00001]). There was not significant publication bias for studies included in family history of breast cancer and breast cancer risk in Malays ethnicity in Malaysia and Indonesia. CONCLUSION: This analysis confirmed the association of family history of breast cancer and breast cancer risk between Malays ethnicity in Malaysia and Indonesia.

Association of Dietary Intake Ratio of n-3/n-6 Polyunsaturated Fatty Acids with Breast Cancer Risk in Western and Asian Countries: A Meta-Analysis

Objective: This systematic review and meta-analysis were performed to determine association of dietary intake ratio of n-3/n-6 polyunsaturated fatty acids with breast cancer risk in Western and Asian countries. Methods: The authors conducted a meta-analysis of published research articles on association of dietary intake ratio of n-3/n-6 polyunsaturated fatty acids (PUFAs) with breast cancer risk in Western and Asian countries published between January 2000 and February 2019 in online article databases of PubMed, ProQuest and EBSCO. Pooled risk ratios (RR) were calculated using fixed and random-effect models. Publication bias was visually evaluated by performing funnel plots and statistically assessed by Egger's and Begg's tests. Data were processed by using Stata version 14.2 (Stata Corporation). Results: This study reviewed 913 articles. There were 13 studies included in systematic review continued by meta-analysis of relevant data with total number of samples: 275,264 patients. The results showed dietary intake ratio of n-3/n-6 PUFAs with breast cancer risk in Western and Asian countries (RR = 0.99; 95% CI: 0.92-1.07). Dietary intake ratio of n-3/n-6 PUFAs with breast cancer risk in Western countries reached (RR = 0.98; 95% CI: 0.91-1.06) and there was any significant publication bias for studies included. Dietary intake ratio of n-3/n-6 PUFAs with breast cancer risk in Asian countries reached (RR = 1.18; 95% CI: 0.94-1.47) and there was not any significant publication bias for studies included. Conclusion: This analysis confirmed association of dietary intake ratio of n-3/n-6 PUFAs with breast cancer risk in Western and Asian countries. Higher dietary intake ratio is associated with lower risk of breast cancer in Asian countries rather than Western countries. This study suggests increasing dietary intake ratio n-3/n-6 PUFAs will provide benefit for breast cancer prevention.

Protective Effect of Omega-3 Fatty Acids in Fish Consumption Against Breast Cancer in Asian Patients: A Meta-Analysis

Objective: This systematic review and meta-analysis was performed to determine the protective effect of omega-3 fatty acids in fish consumption against breast cancer in Asian patients. Methods: The authors conducted a meta-analysis of published research articles on protective effect of omega-3 fatty acids in fish consumption against breast cancer in Asian patients published between January 2000 and July 2018 in online database of PubMed, ProQuest and EBSCO. Pooled odds ratios (OR) were calculated by using fixed and random-effect models. Publication bias was visually evaluated by using funnel plots and statistically assessed in Egger's and Begg's tests. Data were processed by Review Manager 5.3 (RevMan 5.3) and Stata version 14.2 (Stata Corporation). Results: This study reviewed 913 articles. There were 11 studies which conducted systematic review then continued by meta-analysis of relevant data with total number of samples were 130,365 patients. The results showed there was protective effect of omega-3 fatty acids in fish consumption against breast cancer in Asian patients (OR = 0.80 [95% CI 0.73-0.87, p <0.00001]). There was not any study with significant publication bias included. Conclusion: This analysis confirmed the protective effect of omega-3 fatty acids in fish consumption against breast cancer in Asian patients.

Development of multi-criteria decision analysis (MCDA) framework for off-patent pharmaceuticals - an application on improving tender decision making in Indonesia.

BACKGROUND: Off-patent pharmaceuticals (OPPs) hold vital importance in meeting public health objectives, especially in developing countries where resources are limited. OPPs are comprised of off-patent originals, branded generics and unbranded generics; nonetheless, these products are not identical and often there are differences in their equivalence, manufacturing quality standards and reliability of supply. This necessitates reconsideration of the lowest price policy objective in pharmaceutical decision making. The aim of this study was to develop a Multi-Criteria Decision Analysis (MCDA) framework through a pilot workshop to inform the national procurement of OPPs in Indonesia. METHODS: An initial list of potentially relevant criteria was identified based on previous work and a literature review. In a 2-day pilot policy workshop, twenty local experts representing different stakeholder groups and decision-making bodies selected the final criteria, approved the scoring function for each criterion, and assigned weights to each criterion. RESULTS: An MCDA framework was proposed for OPP drug decision making in developing countries, which included price and 8 non-price criteria. Based on the pilot policy workshop 6 + 1 criteria were considered relevant for Indonesia: pharmaceutical price (40% weight), manufacturing quality (18.8%), equivalence with the reference product (12.2%), product stability and drug formulation (12.2%), reliability of drug supply (8.4%), real world clinical or economic outcomes, such as adherence or non-drug costs (4.2%) and pharmacovigilance (3.6%). CONCLUSIONS: According to the pilot policy workshop, other criteria apart from price need to be strengthened in the tendering process. The introduction of additional criteria for OPP procurement in an MCDA framework creates incentives for manufacturers to invest into improved manufacturing standards, equivalence proof, product quality, reliability of supply or even additional real-world data collection, which ultimately may result in more health gain for the society.

Diagnostic Accuracy of Different Machine Learning Algorithms for Breast Cancer Risk Calculation: a Meta-Analysis

Objective: The aim of this study was to determine the diagnostic accuracy of different machine learning algorithms for breast cancer risk calculation. Methods: A meta-analysis was conducted of published research articles on diagnostic test accuracy of different machine learning algorithms for breast cancer risk calculation published between January 2000 and May 2018 in the online article databases of PubMed, ProQuest and EBSCO. Paired forest plots were employed for the analysis. Numerical values for sensitivity and specificity were obtained from false negative (FN), false positive (FP), true negative (TN) and true positive (TP) rates, presented alongside graphical representations with boxes marking the values and horizontal lines showing the confidence intervals (CIs). Summary receiver operating characteristic (SROC) curves were applied to assess the performance of diagnostic tests. Data were processed using Review Manager 5.3 (RevMan 5.3). Results: A total of 1,879 articles were reviewed, of which 11 were selected for systematic review and meta-analysis. Fve algorithms for machine learning able to predict breast cancer risk were identified: Super Vector Machine (SVM); Artificial Neural Networks (ANN); Decision Tree (DT); Naive Bayes (NB); and K-Nearest Neighbor (KNN). With the SVM, the Area Under Curve (AUC) from the SROC was > 90%, therefore classified into the excellent category. Conclusion: The meta-analysis confirmed that the SVM algorithm is able to calculate breast cancer risk with better accuracy value than other machine learning algorithms.

Implementation of Medication Safety Practice in Childhood Acute Lymphoblastic Leukemia Treatment

Objective: Medical Safety Practice (MSP) is a safe procedure in medication process. It is important to investigate the use of MSP among childhood cancer patients because pediatric oncology is a high-risk area for potentially harmful adverse events. The purpose of this study is to determine the effects of the implementation of MSP in chemotherapy on the incidence of medication errors in childhood ALL patient at Dr. Sardjito Hospital, including in 1) transcribing, 2) administering, 3) monitoring, 4) the incidence of adverse drugs events. (ADEs). Methods: The study design is a quasi-experimental study with pre- and post-intervention without control. The sample consists of ALL patients who are taken care of at an academic hospital in Indonesia from 2012 to 2013. The sample was consecutively collected during the period of study. The data were collected through medical records, research form, observation, and discussion with the nurse. The intervention given is training and implementation of medical safety practice in chemotherapy. Result: Based on the analysis of the effect of the implementation of MSP (75 and 106 medical records of pre- and post-intervention), it is obtained: 1) the adherence of chemotherapy transcribing post-intervention increases significantly compared to pre-intervention (p<0.05), 2) the adherence of chemotherapy administering increases significantly in almost every aspect (p<0.05), except in preparing drugs by two different health worker, patient's confirmation of ADEs management, and verification of drug's expired date, 3) The adherence of chemotherapy monitoring improved significantly post-intervention (p<0.05), 4) Adverse Drug Events (ADE) decreased significantly post-intervention (p<0.05), from 52.1% to 30.5%. Conclusion: The implementation of MSP decreased the incidence of medication errors in ALL patients at Dr. Sardjito Hospital in ordering, dispensing, transcribing, administering, and monitoring chemotherapy. It also reduced the incidence of ADEs related to chemotherapy. Specific training for nurses are needed in order to improve the knowledge and skills, especially for medication error and skill in patients' care.

The Development of Quality of Life Questionnaire for Indonesian Breast Cancer Patients: INA-BCHRQoL

Introduction: The breast cancer related incidence and mortality rate in Indonesia are included in the top 10 and top 5 highest in the world. A country-specific Health Related Quality of Life measurement tool is required to help clinician observe and improve the management of the disease. Methods: We developed the questionnaire, namely Indonesian Breast Cancer Health Related Quality of Life (INA-BCHRQoL) by incorporating not only the generic variables such as physical, psychological, and social; but also spiritual variable which is suitable for Indonesian population. The questionnaire was validated to the same population using the value of corrected item-total correlation and the value of Cronbach Alpha. Results: Fourty three questions were considerably valid and reliable on evaluating the HRQoL of early state of breast cancer patients in Indonesia as the value of Cronbach Alpha for physical, cognitive, social and spiritual domain were higher than 0.8 and the corrected item-total correlation were also higher than 0.3. Each domain of the questionnaire was not influenced by the treatment options. Twenty four early stage breast cancer (10 FAC based chemotherapy and 14 Taxan based chemotherapy) were enrolled in the main study and the score of HRQOL obtained from INA-BCHRQoL were considerably high. Conclussion: The INA-BCHRQoL questionnaire can be implemented as a valid and reliable tool to assess quality of life in early stage breast cancer patients in Indonesia.

Impact of chemotherapy-induced nausea and vomiting on quality of life in indonesian patients with gynecologic cancer.

BACKGROUND: Quality of life (QoL) has become a major outcome in the treatment of patients with cancer. This study is aimed at examining the impact of chemotherapy-induced nausea and vomiting on QoL of patients with gynecologic cancer in Indonesia. METHODS: Chemotherapy-naive patients with gynecologic cancer, who were treated with cisplatin at a dosage 50 mg/m or higher as monotherapy or as part of combination chemotherapy regimens, were recruited in the Oncology Department, Dr. Sardjito Hospital, Yogyakarta, Indonesia. Quality of life was assessed by using the Indonesian version of the European Organization for Research and Treatment for Cancer of Quality of Life Questionnaire and Short Form-36, administered immediately before and on day 5 after chemotherapy administration. Patients used a daily diary to record nausea and vomiting during 5 days after chemotherapy. RESULTS: Most (74.9%) of the 179 patients experienced delayed emesis during the 5 days after chemotherapy despite prophylactic use of antiemetics. The delayed nausea and emesis caused significant negative impact on patients' QoL. Nausea in the delayed phase caused negative effects on patients' QoL. CONCLUSIONS: Patients reported a negative impact on the QoL of delayed emesis after chemotherapy. Poor prophylaxis of patients' nausea and vomiting after chemotherapy interferes with patients' QoL. Medical and behavioral interventions may help to alleviate the negative consequences of chemotherapeutic treatment in patients with gynecologic cancers treated with suboptimal antiemetics.