Journal Of The Indonesian Medical Association

Bullying in Cardiology: How to Act as an Ethical Cardiologist

Sidhi Laksono — 2024-11-06

The foundation of decision-making in the health care system is patient care and results. For patient care delivery to be successful overall, staff members must be courteous, cooperative, and respectful of one another. The delivery of healthcare is positively impacted by cohesive health care teams and efficient communication. However, encounters in the health care industry are not always courteous. Among 5,931 cardiologists (77% male; 23% female), 44% reported a hostile work culture, and 79% of those who worked in a hostile work environment reported negative impacts on professional activities with coworkers and patients. These findings are supported by the Global Prevalence and Impact of Hostility, Discrimination, and Harassment in the Cardiology Workplace survey.

Relationship Between SpO2/FiO2 Ratio and PaO2/FiO2 Ratio In Patients with Acute Respiratory Distress Syndrome (ARDS) in the ICU at H. Adam Malik Hospital

Agus Pramono — 2024-11-06

Introduction: The PaO2/FiO2 (P/F) ratio is the main choice for invasively assessing ARDS. The SpO2/FiO2 (S/F) ratio can be used as a noninvasive oxygenation parameter in ARDS patients. This study was conducted to determine the relationship between the SpO2/FiO2 ratio and the PaO2/FiO2 ratio.

Methods: This study was observational with a cross-sectional research method to see the relationship between the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in ARDS patients. The total sample was 29 intubated ICU patients diagnosed with ARDS. This study excluded patients with congestive heart disease, anemia, and systolic blood pressure less than 90 mmHg.

Result: A linear regression analysis was obtained between the PaO2/FiO2 and the SpO2/FiO2 ratio with a relationship coefficient of 0,955 and p-value of 0,001. A relationship was found between the S/F ratio and the P/F ratio in assessing the severity of ARDS (p-value less than 0.05).

Conclusion: Assessment analysis of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio has a relationship so that it can be used as a predictor of ARDS.

User Acceptance and Usability for Early Detection of Hearing Loss Using The LittlEars Application: A Validity Study

Amien Suharti — 2024-11-06

Introduction: This study aims to evaluate the acceptance among Posyandu cadres of the Littlears application, which is designed to identify hearing impairments in children early on.

Method: The LittlEars Questionnaire, designed to identify hearing impairment in children, has evolved into the LittlEars application with the objective of early detection of hearing loss. The evaluation of system usability within the framework of the USE Questionnaire involves four key elements: usability, user-friendliness, learnability, and user satisfaction, and is assessed through 35 specific questions.

Result: The usability assessment of the LittlEars application through the USE questionnaire revealed that its usefulness stands at 95.4%, its ease of use at 93.5%, its ease of learning at 92.8%, and satisfaction levels at 94.6%. The average for all dimensions combined is 9.07%.

Conclusion: The LittlEars application can be accepted by users, especially Posyandu cadres, and is an application that is easy to use in detecting hearing loss in children.

The Association of Diaphragm Wall Thickness and Weaning Success in Critical Patients in the ICU of Haji Adam Malik Hospital Medan

Muhamad Soleh — 2024-11-06

Introduction: Critically ill patients are at risk of developing persistent organ dysfunction that can deteriorate the patient's clinical outcome. This leads to patients in life-threatening conditions that require intensive care. Patients in the Intensive Care Unit (ICU) mostly require mechanical ventilation. Prolonged mechanical ventilation can cause a decrease in the contractile ability of the diaphragm along with diaphragmatic muscle atrophy. This is known as Ventilator Induced Diaphragm Dysfunction (VIDD). Diaphragm dysfunction remained a major cause of weaning difficulty or failure. Ultrasonography measurement of diaphragm function can be used to predict the outcome of weaning from mechanical ventilation.

Methods: This study used a prospective observational study with a cross-sectional method. The total sample consisted of 36 critical patients on mechanical ventilators in the ICU who were planned for weaning. Patients were measured for diaphragm wall thickness fraction using ultrasonography.

Result: In the diaphragm thickness fraction less than 30%, the successful weaning group was 3 people (8.3%), and failed weaning as many as seven people (27.8%); in the diaphragm thickness fraction greater than 30%, the successful weaning group was 24 people (66.7%) and failed weaning as many as two people (5.6%). The mean diaphragm thickness fraction in the successful weaning group was 40.77 ± 10.12, while in the weaning failure group, it was 24.50 ± 6.89. There is a relationship between diaphragm wall thickness as a predictor of successful weaning in critical patients in the ICU with a p-value = 0.001.

Conclusion: Measurement of diaphragm wall thickness using ultrasonography can be used to predict weaning success in critically ill patients on ventilators in the ICU.

The Correlation between Pain and Delirium in Patients Intubated in the ICU of Haji Adam Malik General Hospital Medan

Nurchotijah Nurchotijah — 2024-11-06

Introduction: Pain can sometimes trigger a stress response and stimulate adrenergic-sympathetic activity. Delirium, a serious disruption of consciousness, is characterized by fluctuating perceptions, confused thinking, and varying levels of attention. Undiagnosed pain and delirium can lead to increased infection rates, prolonged mechanical ventilation, hemodynamic instability, and delirium. This study utilizes the Critical-Care Pain Observation Tool (CPOT) to measure pain and the Confusion Assessment Method (CAM) ICU to evaluate delirium in intubated patients in the ICU of RSUP HAM to explore the connection between pain and delirium.

Method: The research employed a quantitative, cross-sectional observational analytical method. It investigated the association between pain and delirium in patients who were intubated at H. Adam Malik General Hospital Medan between January and February 2023, using the CPOT and CAM ICU scales. The chi-square test was used to analyze the relationship between pain and delirium, as well as the relationship between confounding factors and both pain and delirium.

Results: The association between pain and delirium had a P-value of 0.001. The association between fentanyl dosage and pain in intubated patients also had a P-value of 0.001. Confounding factors included the length of stay with pain (P-value less than 0.001) and delirium with age (P-value = 0.026), gender (P-value = 0.013), and length of stay (P-value = 0.001). However, the doses of fentanyl and midazolam showed no significant association between patients with and without delirium (P-value = 0.5).

Conclusion: There is a significant associations between pain and delirium.

Analysis Xpert® -Carba-R on Carbapenem Resistant Enterobacterales Screening in Intensive Care Unit in National Referral Hospital in Jakarta

Yulia Rosa Saharman — 2024-11-06

Introduction: Carbapenem-resistant Enterobacterales (CRE) represent a significant global health problem due to their high resistance to antibiotics. Traditional methods for identifying resistance genes, such as Real-Time PCR (RT-PCR), are accurate but time-consuming and involve complex techniques. This study aimed to compare the Cepheid Xpert^® Carba-R test with RT-PCR, used as the gold standard, to determine its effectiveness in rapidly identifying carbapenem resistance genes in CRE.

Method: The study was performed from January to June 2022, involving patients admitted to the Intensive Care Unit (ICU) at Dr. Cipto Mangunkusumo National Hospital. Rectal or perirectal swabs were collected upon ICU admission. If patients tested negative for CRE upon admission, repeat swabs were taken at discharge or death, with a maximum length of stay (LOS) of 14 days in the ICU. Genotypic identification of carbapenem resistance genes, including KPC, NDM, OXA-48, VIM, and IMP, was performed using the Cepheid Xpert^® Carba-R and compared to RT-PCR. Additionally, phenotypic identification through bacterial culture was performed using the Vitek method.

Result: Out of 102 ICU patients, 10.23% (22/215 isolates) were found to be positive for CRE, with the most common bacterial isolates being Escherichia coli (148/215, 68.83%) and Klebsiella pneumoniae (53/215, 24.65%). CRE was found in 1 of 148 E. coli isolates (0.67%) and in 21 of 53 K. pneumoniae isolates (39.62%). The most frequently detected carbapenem resistance gene was OXA-48 (16/22, 72.73%), followed by NDM (6/22, 27.27%). The Xpert^® Carba-R test demonstrated a sensitivity and specificity of 100%, with positive predictive value (PPV) and negative predictive value (NPV) both equal to 1. A discrepancy was observed between the phenotypic and genotypic identification, with 27 phenotypically identified CRE isolates compared to 22 genotypically confirmed ones.

Conclusion: The Cepheid Xpert^® Carba-R test provides a reliable, rapid alternative for identifying carbapenem resistance genes in CRE, demonstrating perfect sensitivity and specificity in this study. This study indicates that Xpert^® Carba-R can be an alternative in the rapid identification of CRE resistance genes.

Screening for Premature Infants in the Neonatal Care Unit

Putri Maharani Tristanita Marsubrin — 2024-11-06

Premature infants have a higher risk of mortality and morbidity compared to full-term infants. Therefore, screening in the neonatal unit is necessary to detect these conditions, allowing for timely intervention to be implemented. This article discusses various screening procedures for premature infants, such as head ultrasounds for intraventricular hemorrhage, eye exams for retinopathy of prematurity, hearing tests, heart evaluations, and others. Early identification can reduce morbidity and improve long-term outcomes for premature infants.