How to engage patients in achieving patient safety: A qualitative study from healthcare professionals' perspective.

All parties involved in health care, including patients and their families/caregivers play a significant role to achieve patient safety. Furthermore, patient engagement (PE) has not been adequately implemented to achieve safe healthcare in Indonesia, despite the introduction of the patient-centered care paradigm. This study aims to explore healthcare professionals' (HCPs) perspectives on PE and its application technique. A qualitative study was conducted in the chronic wards of a faith-based private hospital in Yogyakarta Province, Indonesia. Four focus group discussions among 46 HCPs, followed by 16 in-depth interviews, were carried out. Furthermore, the verbatim transcripts were subjected to thematic analysis. The result showed four main themes, including PE as a strategy for achieving safe healthcare, factors affecting its implementation, the need for comprehensive strategies to engage the patients, and their roles in safety efforts. Furthermore, the implementation of PE can be enhanced by encouraging healthcare professionals (HCPs) to play proactive roles in empowering recipients. To achieve PE, "partnership culture" and the removal of potential barriers as well as determining factors, must be established. This requires a high-level commitment, organizational support with a top-down approach, and integration into healthcare systems. In conclusion, PE is essential for patient safety and can be enhanced by strengthening organization support, integrating into the healthcare system, improving HCPs' roles, and empowering patients and caregivers to overcome potential barriers.

Mobile application development for improving medication safety in tuberculosis patients: A quasi-experimental study protocol.

The COVID-19 pandemic, the growth of smartphones, and the internet have driven the use of technology for monitoring TB patients. Innovation in management of TB patients is needed to improve treatment outcomes. The study was conducted to obtain a predictive model of medication safety and solution model for at-risk patients, and to improve medication safety through mobile applications. The research was conducted in 4 stages, namely qualitative, quantitative (cross-sectional), qualitative, and quantitative (quasi-experimental, post-test group control design). Data were taken at the Public Health Center in Jakarta, Indonesia. Samples were taken by cluster random sampling. For quantitative research, 2nd phase (n = 114) and 4th phase (n = 96) were analyzed using logistic regression. This study analyzed predictors of medication safety to assist in monitoring patients undergoing treatment. At-risk patients were educated using an algorithm programmed in the application.

A self-assessment model for hospital safety culture maturity.

BACKGROUND: Studies on safety culture maturity in health care is very rare, and the existing ones only focus on patients and the use of Manchester Patients Safety Framework (MaPSaF) instrument. The objective of this study is to develop a comprehensive instrument for measuring safety culture maturity in hospitals. DESIGN AND METHODS: This study used a cross-sectional design with three stages. First, we used secondary data analysis from the Hospital Accreditation Commission. Second, evaluation of primary data obtained from safety climate questionnaire. Third, we did focus group discussions, and in-depth interviews for validation of secondary data and development of DUTA-RS website. We analyzed using Structural Equation Modeling (SEM) test. RESULTS: DUTA-RS instrument contains 1,118 elements based on the first edition of the Indonesian Hospital Accreditation National Standard. Its safety culture maturity is at the proactive level (58.0%), with the highest accreditation levels of proactive (50.8%) and generative (48.7%). The variables affecting the safety culture maturity are situational and safety behavior variables, with leadership, risk management, and safety compliance as the strongest indicators. The weakest indicators of climate are organizational learning and communication. The mean value of climate for primary and secondary data is in the good category and showed in proactive level. CONCLUSIONS: The DUTA-RS as a website to measure the safety culture maturity in accredited hospitals by taking the advantage of the existing information technology of hospital accreditation committee as the benchmark enables improvement of SCML in hospitals. Further studies are required for the development of DUTA-RS website.

Factors Affecting Delayed Presentation and Diagnosis of Breast Cancer in Asian Developing Countries Women: A Systematic Review.

BACKGROUND: Advance in screening strategies and management had steadily decreased the mortality rates of breast cancer. In developing countries, conducting screening and early diagnosis of breast cancers may face several problems. This systematic review aims to determine factors affecting the delayed diagnosis of breast cancer in developing countries in Asia. METHODS: Literature research was conducted through Pubmed, ScienceDirect, Scopus, EbscoHost, Cochrane Library, and Google Scholar. The main keywords were "breast cancer", "delayed diagnosis" and "developing countries". Both quantitative and qualitative studies were included. RESULTS: A total of 26 studies were included. The definition of delayed presentation or diagnosis varied from 1 month to 6 months. Among all the factors from patients and providers, breast symptoms and examinations consistently showed a significant contribution in reducing delayed diagnosis. Strengthened by qualitative studies, patients' knowledge and perception also had a major role in delayed diagnosis. CONCLUSION: Among Asian developing countries, breast symptoms and examination, as well as individual knowledge and perception, are the main factors related to delayed diagnosis of breast cancer.

Tuberculosis control within Indonesia's hospital accreditation.

BACKGROUND: Tuberculosis (TB) is an infectious disease that is a major problem in Indonesia, placing Indonesia among the three major countries with the highest TB cases in the world. In addition, reporting of TB data from health service facilities, especially hospitals, is still weak. Since the implementation of Directly Observed Treatment Shortcourse (DOTS) in hospitals in 1995, the number of new TB case reports from hospitals is still low. In order to increase hospital participation in TB control, the government has made a breakthrough strategy, which is the integration of the DOTS strategy in hospital accreditation. DESIGN AND METHODS: This study conducted a literature review and document analysis related TB control standards in hospital accreditation and the implication for the involvement of hospitals in national TB program. This study analyzed regulations, policies, and procedures, including hospital accreditation instruments and annual reports of TB. RESULTS: Accreditation standards related to TB control include: i) Hospital must implement a tuberculosis control program in the hospital, including monitoring and evaluation through activities such as health promotion, tuberculosis surveillance, controlling risk factors, detection and treatment of tuberculosis cases, providing immunity and preventive drugs; ii) Hospital prepares resources for service delivery and tuberculosis control; iii) hospital provides facilities and infrastructures for tuberculosis services in accordance with regulations; and iv) hospital conducts tuberculosis services and efforts to control tuberculosis risk factors in accordance with regulations. CONCLUSIONS: Standards and elements of the assessment of TB control components in accreditation are adjusted to the national TB control guidelines.

The fight against stigma: Multilevel stigma interventions in schizophrenia patients.

Background: Stigma is one of the main factors causing pasung (physical restraint or confinement in Indonesian terms) in schizophrenia patients. It is the main obstacle to reducing the number of pasung throughout the world. Thus, there is a need for appropriate interventions to reduce stigma in schizophrenia patients who go through pasung. This study aims to identify multilevel stigma interventions in people with schizophrenia who go through pasung (physical restraint and confinement). It can be applied and adapted to various cultural contexts. Design and Methods: Quasi-experimental research with pretest and post-test analysis consists of 82 people with schizophrenia who go through pasung. Respondents were divided into the intervention group and the control group. A multilevel stigma intervention was given to the intervention group for three months. Results: There was a significant difference in the average stigma score in the control group (moderate category stigma) and the intervention group (mild category stigma) after multilevel stigma intervention (p-value = 0.04). The average stigma score of schizophrenia patients in the intervention group decreased by 8.2%, while the average stigma score in the control group increase of 20.4%. Conclusions: Multilevel stigma interventions are effective in reducing stigma in people with schizophrenia who go through pasung. We underline that multilevel stigma interventions through collaboration from various parties can provide great opportunities in stigma reduction programs in people with schizophrenia who go through pasung.

Modulation of Interleukin-8 Production by Vitamin D Supplementation in Indonesian Patients with Diabetic Polyneuropathy: A Randomized Clinical Trial.

OBJECTIVES: We sought to assess the modulation of interleukin-8 (IL-8) production by vitamin D supplementation in Indonesian patients with diabetic polyneuropathy (DPN). METHODS: We conducted a cohort prospective, randomized, placebo-controlled, double-blind trial. This study was approved by the Local Ethical Committee and conducted from July 2018 to February 2019. We recruited 50 subjects with type 2 diabetes mellitus attending Haji Adam Malik General Hospital Medan, and divided them into two groups. The groups were treated for 10 weeks, either with placebo or vitamin D (D3) supplementation of 50 000 IU/week. They were evaluated by routine nerve conduction study (NCS) in the upper and lower limbs, and their serum vitamin 25-hydroxyvitamin D (25(OH)D) and IL-8 levels before and 10 weeks after placebo or vitamin D supplementation were measured. The role of IL-8 and vitamin D supplementation on the NCS was analyzed using linear regression. RESULTS: There was a significant difference between the mean vitamin 25(OH)D (p = 0.001) and IL-8 levels (p = 0.002) before and after vitamin D supplementation. There was no significant correlation between changes in vitamin 25(OH)D and IL-8 levels (p = 0.743). There was significant role of IL-8 on amplitude of the sensory sural nerve (p = 0.047; B = -0.009) and the nerve conduction velocity (NCV) of the motor tibial nerve (p = 0.007; B = -0.027). There was a significant role of vitamin D supplementation on NCSs. CONCLUSIONS: Higher IL-8 levels were correlated with poorer amplitude of the sensory sural nerve and the NCV of motor tibial nerves. Lower vitamin 25(OH)D levels were correlated with poorer distal latencies, amplitudes, and NCVs. There was no significant correlation between vitamin 25(OH)D and IL-8 levels. Thus, no sufficient evidence that vitamin D supplementation modulates IL-8 in Indonesian patients with DPN. Vitamin D3 improved NCSs in diabetic patients.

Predictive Model of Diabetic Polyneuropathy Severity Based on Vitamin D Level.

BACKGROUND: Type 2 Diabetes Mellitus is one of the most common metabolic diseases worldwide. The most common complication of DM is diabetic neuropathy (DN), especially diabetic polyneuropathy (DPN). Vitamin D plays an important role in the pathogenesis of DN, thus affecting its severity which can be assessed using nerve conduction study (NCS). AIM: This study aimed to develop a predictive model of DPN severity based on vitamin D level. METHODS: This was a prospective cohort study involving 50 subjects with DM which was conducted in Haji Adam Malik General Hospital Medan. All subjects were fulfilling inclusion criteria underwent laboratory examination to determine HbA1c and 25 (OH) D levels. Predictive variables were sex, age, duration of DM, smoking status, type and number of anti-diabetic drugs, the presence of metabolic syndrome, HbA1c and vitamin D levels. A scoring system was developed to determine a predictive model. The DPN severity was assessed using NCS and was re-evaluated after 3 months. RESULTS: Most of the subjects were female (60%), belonged to ≥ 50 years old age-group (88%), with DM duration < 5 years (56%), were non-smoker (90%), we're using one anti-diabetic drug (60%), were using insulin (50%), had metabolic syndrome (68%), had HbA1c level > 6.5% (94%), and had vitamin D level < 20 ng/ml (56%). A score of > 4 on this predictive model of DPN severity had a relative risk (RR) of 2.70. The predictive model had a sensitivity of 82.8% and specificity of 61.9%. CONCLUSION: A score of higher than 4 on this predictive model showed a 2.7 times higher risk of severe DPN. A predictive model of DPN severity based on vitamin D level had high sensitivity and specificity.

The Vascular Endothelium in Patients with Dengue Haemorrhagic Fever.

BACKGROUND: Dengue fever is the most serious consequence of mosquito-borne infection worldwide. The pathophysiology of DHF in human is complex, which involve endothelial cell activation and impaired endothelial barrier leading to plasma leakage triggering the activation of the haemostatic system. The increased vascular permeability may lead to hypovolemia, hypotension and shock, which is life-threatening. AIM: The objective of the study was to determine the effects of dengue haemorrhagic fever on the vascular endothelium. METHODS: Fifty patients (males 34, females 16), were recruited, Grade 1 (n = 41), Grade 2 (n = 6), Grade 3 (n = 2) and Grade 4 (n = 1) DHF. Blood sampling was performed at the febrile, defervescence and convalescent phases for the determination of haemoglobin, haematocrit, platelets, prothrombin fragment F1 + 2, Von Willebrand Factor (VWF), vascular endothelial growth factor (VEGF) and D-dimer levels. Fifteen normal subjects were recruited to serve as normal controls. RESULTS: The patients aged between 4 and 54 years old. Grades 1 & 2 DHF showed no significant differences in the parameters studied. However, thrombocytopenia, elevated F1 + 2, VWF, VEGF and D-dimer levels were evident in febrile, defervescence and convalescent phases suggesting endothelial activation and plasma leakage. Pleural effusion was observed only in severe DHF. The three patients with Grades 3 and 4 DHF had similar study results. No mortality was recorded in the study. CONCLUSION: In dengue haemorrhagic fever, the vascular endothelium is activated, causing plasma leakage triggering the activation of the haemostatic system creating a hypercoagulable and enhanced fibrinolytic state evident by marked fibrinolysis.

The Relationship between Concordance Behaviour with Treatment Compliance and Quality Of Life of Patients with Pulmonary Tuberculosis in Medan.

BACKGROUND: Indonesia is the country with the second highest number of tuberculosis in the world. Patient compliance with tuberculosis treatment is still very low. Thus the success rate of treatment is also unsatisfactory. Concordance behaviour is a model of the doctor-patient relationship that combines aspects of the partnership, sharing decision making and trust. It is considered better than adherence to improve compliance and quality of life in patients with pulmonary tuberculosis. AIM: This study aims to assess the relationship between concordance and the level of adherence to pulmonary tuberculosis treatment along with the quality of life in Medan. METHODS: A cross-sectional study was conducted on 259 tuberculosis patients from several clinics and hospitals in Medan from 2015 to 2017, by asking patients to fill out questionnaires that had been tested for validity and reliability first. The concordance behaviour questionnaire contains 56 questions covering aspects of knowledge, partnership, sharing decision making, trust, and support. While compliance was measured by 14 questions covering attitude and behaviour. Statistical analysis was performed by Chi-Square test in SPSS v20. RESULTS: This study shows that most TB patients (75.7%) have a good concordance, in which the aspect of knowledge, partnership, sharing and support were all good. However, the component of trust in the most patient (75.7%) was still low. Based on the level of compliance, 84.2% of patients had good compliance. However, the level of behaviour in 55.2% of patients was still low. Statistical analysis showed that there was a significant relationship between concordance and compliance (p = 0.009), in which patient with good concordance had 2.6 higher probability for good compliance. However, there was no significant association between concordance and quality of life (p = 0.63). CONCLUSION: Concordance behaviour is a good concept to be applied to improve treatment compliance of pulmonary TB patients.

The Role of Placental Growth Factor, Soluble Endoglin, and Uterine Artery Diastolic Notch to Predict the Early Onset of Preeclampsia.

BACKGROUND: Reducing maternal mortality is one of the targets in the Millennium Development Goals (MDGs). In a systematic review, 4.6 per cent (95% CI 2.7-8.2) of pregnancies were complicated by preeclampsia worldwide. Preeclampsia occurs in around 10% of pregnancies in the world whereas developing countries contribute more than developed countries. In developing countries, there are 13 cases of preeclampsia in every 1,000 births, whereas in developed countries only 2-3 cases of preeclampsia are found in every 10,000 deliveries. Variations in prevalence among countries reflect, at least in part, differences in the distribution of maternal age and the proportion of nulliparous pregnant women in the population. AIM: We aimed to investigate the role of placental growth factor, soluble endoglin, and uterine artery diastolic notch to predict the early onset of preeclampsia. METHODS: This study used an analytical study with a nested case-control design. The study was conducted at Bunda Thamrin Hospital, Tanjung Mulia Mitra Medika Hospital, Sundari Hospital and a private clinic, from March to November 2018 with a total sample of 70 research subjects. RESULTS: Uterine artery diastolic notch was not found in 50% of subjects. A total of 27 subjects (38.6%) had a unilateral diastolic notch, and 8 subjects (11.4%) had a bilateral diastolic notch. Cut-off point PIGF levels was 441 pg/ml, and Area Under Curve (AUC) 82.5% (95% CI 61.5%-100%), with sensitivity 80% and specificity 87.7%. The levels sEng in this study could not predict the incidence of early-onset preeclampsia (p = 0.113). Combined PlGF and pulsatile index of uterine arteries may predict early onset preeclampsia with sensitivity 40% and specificity 90.77%. From these results, pregnant women o 22-24 weeks of pregnancy, the levels of PlGF and the uterine artery pulsatility index can be a predictor of early-onset preeclampsia. Examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia. CONCLUSION: From these results, it can be concluded that in pregnant women of 22-24 weeks, the diastolic notches in uterine arteries cannot predict the incidence of early-onset preeclampsia. PlGF levels and pulsatile index of uterine arteries can be used as predictors of early-onset preeclampsia although examination of PlGF levels alone is sufficient as a predictor of early-onset preeclampsia.

Dimensional Analysis of CD44High CD24Low and Ki67 in Triple Negative Breast Cancer.

AIM: To study the dimensional analysis CD44high CD24low and Ki67 in triple negative breast cancer (TNBC). METHODS: This cross-sectional study was performed on patients with breast cancer in Haji Adam Malik Hospital Medan from 2013 to 2016 to determine the frequency and pathologic features of TNBC by immunohistochemistry stained. RESULTS: By using immunohistochemistry staining panel of CD44, CD24, Twist, Claudin 7, CK5, CK8/18, EMA, E-Cadherin, Ki-67, a total 67 breast tumour samples with TNBC were classified as 9 stem-cells like 1 basal, 22 baso-luminal, and 23 luminal subtypes. CONCLUSION: By using immunohistochemical staining panel, TNBC can be differentiated into stem cells like basal, baso-luminal and luminal subtypes. Didifferentiation and EMT can produce heterogeneity in TNBC subtypes and this will affect in handling TNBC. Stemness in stem cells- like subtypes are resistant to therapy. Therefore, TNBC needs special attention in order to assist in more optimal handling.

Risk Factors of Dental Caries: Consumption of Sugary Snacks Among Indonesian Adolescents

Objective: To determine the risk factors of caries among adolescents in Padang City, by assessing the frequency of sugary snack consumption. Material and Methods: A cross-sectional study was conducted on 150 randomly selected junior high school students using a selfadministered questionnaire along with oral examinations. The questionnaire consisted of questions on socio-demographic characteristics, oral health behavior, and frequency of consumption of sugary foods. Data were analyzed using the Chi-square tests and multivariate analysis. Results: Dental caries was found in 61% of the total students and was more prevalent in males when compared with females. The mean DMFT score was 1.3±1.4. Sugary snack consumption, attitude, and protective factors were significantly related to the occurrence of caries (p<0.001). The risk of dental caries in subjects with high amounts of sugary snack consumption was 5.67 times higher (OR=5.7; CI: 2.7-11.9) than those with low consumption. Subjects with low protective factors, high consumption of sugary foods and drinks, and bad attitude presented with a caries prevalence of 94%. Conclusion: The consumption of sugary foods was found to play an important role in the development of caries in the current study.

The Correlation between Adherence and Asthma Patients Quality of Life in Medan, Indonesia.

BACKGROUND: Asthma is a chronic airway disease that is based on an inflammatory process and a serious health problem around the world. Asthma is often associated with treatment management factor. Adherence is the patient's compliance towards their doctor's advice, which is accompanied by their understanding and follows the doctors' advice consistently. AIM: This study aimed to get a valid and reliable adherence measure in asthma patients especially in Medan. METHODS: This research used the method of quantitative done by the cross-sectional approach. The sample (200 adult asthma patients) used standard asthma medication, stable asthma patients and did not suffer from severe asthma or other accompanying diseases. Data were analysed using univariate, bivariate and multivariate analysis, which is SEM (Structural Equation Modeling) analysis. RESULTS: The best dimension of medication adherence was the dimension of beliefs in medication 64%. The highest education adherence is at college education level which is 67.6%. Employment status with highest adherence value is medication on civil servant/military/police with the value of 67.7. CONCLUSIONS: There is a correlation between adherence and asthma patient's quality of life in Medan.

Development and validation of prediabetes risk score for predicting prediabetes among Indonesian adults in primary care: Cross-sectional diagnostic study.

OBJECTIVE: To develop and validate a risk score model for recognizing prediabetes among Indonesian adults in primary care. METHODS: This was a cross-sectional diagnostic study. After excluding subjects with diabetes from Indonesian National Basic Health Survey (INBHS) data set, 21,720 subjects who have completed fasting plasma glucose test and aged >18 years were selected for development stage. About 6,933 subjects were selected randomly from INBHS for validation stage in different diagnostic criteria of prediabetes-based random plasma glucose. Logistic regression was used to determine significant diagnostic variable and the receiver operating characteristic analysis was used to calculate area under the curve (AUC), cutoff point, sensitivity, specificity, and predictive values. RESULTS: Age, sex, education level, family history of diabetes, smoking habit, physical activity, body mass index, and hypertension were significant variables for Indonesian Prediabetes Risk Score (INA-PRISC). The scoring range from 0 to 24, the AUC was 0.623 (95% CI 0.616-0.631) and cutoff point of 12 yielded sensitivity/specificity (50.03%/67.19%, respectively). The validation study showed the AUC was 0.646 (95% CI 0.623-0.669) and cutoff point of 12 yielded sensitivity/specificity (55.11%/65.81%, respectively). CONCLUSION: INA-PRISC, which consists of eight demographical and clinical variables, is a valid and a simple prediabetes risk score in primary care.

Transplantation of mesenchymal stem cells, recombinant human BMP-2,and their combination in accelerating the union after osteotomy and increasing, the mechanical strength of extracorporeally irradiated femoral autograft in rat models.

BACKGROUND: Delayed union, nonunion, and mechanical failure is still problems encountered in limb salvage surgery (LSS) using extracorporeal irradiation (ECI). This study aimed to determine whether bone marrow mesenchymal stem cells (MSC) and recombinant human bone morphogenetic protein-2 (rhBMP-2) improve hostgraft union after osteotomy and also increase its mechanical strength. METHODS: Thirty Sprague Dawley rats were randomly divided into five groups. Group I (control) underwent LSS using ECI method with 150 Gy single doses. Similar procedures were applied to other groups. Group II received hydroxyapatite (HA) scaffold. Group III received HA scaffold and MSC. Group IV received HA scaffold and rhBMP-2. Group V received HA scaffolds, MSC, and rhBMP-2. Radiograph were taken at week-2, 4, 6, and 8; serum alkaline phosphatase and osteocalcin were measured at week-2 and 4. Histopathological evaluation and biomechanical study was done at week-8. RESULTS: The highest radiological score was found in group IV and V Similar result was obtained in histological score and ultimate bending force. These results were found to be statistically significant. There was no significant difference among groups in serum alkaline phosphatase and osteocalcin level. CONCLUSION: Combination of MSC and rhBMP-2 was proven to accelerate union and improve mechanical strength of ECI autograft.

Iron deposit state and risk factors for anemia in the elderly.

AIM: To determine the type of anemia, iron deposit and risk factors for anemia in the elderly. METHODS: A cross-sectional study was conducted among 84 patients admitted to the geriatric inpatient ward of dr. Cipto Mangunkusumo Hospital. The patients underwent anamnesis, administration of a dietary questionnaire which included SQFF and food recording, physical examination, laboratory investigations (blood, urine and benzidine test), chest x-ray, ECG and spirometry. Anemic elderly patients also underwent iron store measurements, including serum iron (SI), total iron binding capacity (TIBC) and serum ferritin (SF). RESULTS: The proportion of anemia was 54.76%. Increased anemia was inversely correlated with increased body mass index (OR 0.870; 95% CI 0.762-0.994), serum albumin (OR 0.285; 95% CI 0.090-0.907) and calorie intake (OR 0.998; 95% CI 0.996-0.999), and positively correlated with renal impairment (OR 2.647; 95% CI 1.084-6.467). Anemia due to chronic disease (ACD) accounted for 21 subjects, 5 subjects with iron deficiency coexisting with ACD, 1 subject with megaloblastic anemia, and the cause of anemia in 19 patients could not be identified due to diagnostic procedural limitation. Most of the anemic elderly subjects had normal iron deposits. As many as 42.1% of the men and 44.4% of the women had elevated iron deposits. The level of hemoglobin, SI, TIBC in ACD patients were lower than in non-ACD patients (Hb 10.4 vs 10.8 g/dl, SI 58.71 vs. 92.38 ug/dl, TIBC 283.11 vs. 288.95 microg/dl). In contrast, serum ferritin levels in ACD patients were higher than in non-ACD (178.26 vs. 111.35 ng/ml). CONCLUSION: Body mass index, serum albumin, calorie intake and renal impairment are risk factors for anemia in the elderly. Normal iron deposits accounted for 57.9% and 55.6% of anemic elderly men and women with elevated iron deposits.