scholarly journals Analisis pelaksanaan clinical pathway di RSUP Prof. Dr. R. D. Kandou Manado

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Cicilia Paat ◽  
Erwin Kristanto ◽  
Flora P. Kalalo
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
General Hospital ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
Dengue Shock Syndrome ◽  
Benign Prostatic Hypertrophy ◽  
Standard Of Care ◽  
Clinical Governance ◽  
Administrative Policy

Abstract: Clinical pathway is a significant administration document to achieve the good clinical governance in the hospital. In Indonesia, this document is one of the very critical requirements that should be provided by the hospital to fulfil the KARS 2012 policy. As the center of referral teaching hospital of East Indonesia, Professor Dr. R. D. Kandou General Hospital has committed to fulfil the international standard of care, inter alia implementation of the clinical pathways based on the main cause of death, high risk, and high cost. There are several obstacles concerning this implementation, such as the irresponsibility of the doctors due to overloaded work, lack of concentration in filling the formation of clinical pathway, and uncertainity in the usage of clinical pathway. This study was aimed to evaluate the implementation of the clinical pathway and its limitation in the hospital above. The results showed that the administrative policy of the clinical pathway had been provided by the top management leader with the specialization in dengue shock syndrome (DSS), chronic kidney disease (CKD), eclampsia, benign prostatic hypertrophy (BPH), and myocardial infarction (MCI) without complication. Conclusion: Clinical pathway was implemented at Prof. Dr. R. D. Kandou General Hospital according to the Minister Health Regulation No. 012 Year 2012 about Standard Accreditation for Hospital.Keywords: clinical pathway, hospitalAbstrak: Clinical pathway merupakan bagian penting dari dokumen dan alat dalam mewujudkan good clinical governance di rumah sakit. Di Indonesia, dokumen ini juga menjadi salah satu syarat yang harus dipenuhi dalam Standar Akreditasi Rumah Sakit versi KARS 2012. Rumah Sakit Prof. Dr. R. D. Kandou merupakan rumah sakit pendidikan dan pusat rujukan untuk wilayah Indonesia Timur, berkomitmen untuk meningkatkan pelayanan berstandar internasional; salah satu upayanya dengan mengimplementasikan clinical pathway. Pemilihan clinical pathway ditujukan pada penyakit-penyakit yang merupakan penyebab utama kematian, berisiko tinggi, dan biaya tinggi. Kendala penggunaan clinical pathway antara lain kurangnya kepatuhan dokter penanggung jawab pasien terhadap clinical pathway, kurangnya konsentrasi dalam pengisian pembentukan clinical pathway, serta kesulitan kepastian penggunaan clinical pathway. Penelitian ini bertujuan untuk mengetahui pelaksanaan clinical pathway dan analisis terhadap kendala-kendalanya di RSUP Prof. Dr. R. D. Kandou Manado. Hasil studi menunjukkan bahwa pada tingkat manajerial telah tersedia kebijakan clinical pathway dan spesialisasinya yaitu dengue shock syndrome (DSS), penyakit ginjal kronik (PGK), preeklamsia berat, benign prostat hypertrophy (BPH), dan miokard cardiac infark (MCI) tanpa komplikasi. Simpulan: Clinical pathway telah diterapkan di RSUP Prof. Dr. R. D. Kandou berdasarkan Permenkes Nomor 012 tahun 2012 tentang Standar Akreditasi Rumah Sakit.Kata kunci: clinical pathway, rumah sakit

scholarly journals Online clinical pathway for chronic kidney disease management in primary care: a retrospective cohort study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Maoliosa Donald ◽  
Michelle D. Smekal ◽  
Meghan J. Elliott ◽  
Kerry McBrien ◽  
Robert G. Weaver ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
Angiotensin Receptor Blockers ◽  
Improve Patient Care ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Rate Of Change ◽  
Converting Enzyme Inhibitors

Abstract Background Clinical pathways aim to improve patient care. We sought to determine whether an online chronic kidney disease (CKD) clinical pathway was associated with improvements in CKD management. Methods We conducted a retrospective pre/post population-based cohort study using linked health data from Alberta, Canada. We included adults 18 years or older with mean estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. The primary outcome was measurement of an outpatient urine albumin creatinine ratio (ACR) in a 28-day period, among people without a test in the prior year. Secondary outcomes included use of guideline-recommended drug therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins). Results The study period spanned October 2010 to March 2017. There were 84 independent 28-day periods (53 pre, 31 post pathway implementation) including 345,058 adults. The population was predominantly female (56%) with median age 77 years; most had category 3A CKD (67%) and hypertension (82%). In adjusted segmented regression models, the increase in the rate of change of ACR testing was greatest in Calgary zone (adjusted OR 1.19 per year, 95% CI 1.16–1.21), where dissemination of the pathway was strongest; this increase was more pronounced in those without diabetes (adjusted OR 1.25 per year, 95% CI 1.21–1.29). Small improvements in guideline-concordant medication use were also observed. Conclusions Following implementation of an online CKD clinical pathway, improvements in ACR testing were evident in regions where the pathway was most actively used, particularly among individuals without diabetes.

scholarly journals RESOURCES REQUIRED IN CLINICAL PATHWAY FOR TYPHOID FEVER TREATMENT AT KALIWATES GENERAL HOSPITAL IN 2017

2019 ◽  
Vol 7 (2) ◽  
pp. 155
Author(s):  
Pratiti Swesti Komala Dewi ◽  
Christyana Sandra ◽  
Eri Witcahyo
Keyword(s):  
Typhoid Fever ◽  
Performance Appraisal ◽  
General Hospital ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
Healthcare Services ◽  
Job Description ◽  
Fever Treatment ◽  
Method Factors ◽  
Service Standards

Background: A clinical pathway is a concept of an integrated service which describes the stages of healthcare services from the admission until the return of  patients based on the medical service standards and evidence-based nursing care with measurable results. Kaliwates General Hospital is an accredited hospital with a clinical pathway. Typhoid case was the highest disease in 2017 at Kaliwates General Hospital.Aims: This study aims to describe the resources at Kaliwates General Hospital in the implementation of clinical pathways, especially typhoid fever treatment.Method: This study was a descriptive and qualitative study. Nine respondents were selected using purposive sampling, including one internist and the quality team at Kaliwates General Hospital. The variables studied include human resource factors, budget factors, method factors, and time factors.Results: The results suggested that the human resources at Kaliwates General Hospital had high commitment, motivation, and moderate knowledge in the implementation of clinical pathways. All equipment and documents were considered adequate. The communication among the implementers was good, but compliance and training for staffs were considered less prominent. The task division of each staff was fairly distributed even though the pharmacy unit perceived that the division was quite unfair.Conclusion: The implementation of the clinical pathway for typhoid fever treatment at Kaliwates General Hospital runs quite well. The hospital must identify and plan staff training regularly, prepare the job description appropriately, and perform performance appraisal based on the job description that has been developed.Keywords: clinical pathway, typhoid fever, resource.

scholarly journals Comorbidities in patients with gout in rheumatology clinic Dr. Hasan Sadikin general hospital in 2012 - 2013

2018 ◽  
Vol 8 (1) ◽  
Author(s):  
W R Limanjaya ◽  
Rachmat Gunadi Wachjudi ◽  
H Tansah
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Blood Glucose ◽  
Kidney Disease ◽  
General Hospital ◽  
Myocardial Infarct ◽  
Fasting Blood Glucose ◽  
Developed Countries ◽  
Rheumatology Clinic

Background: Gout is a metabolic disease manifested mainly as an intense monoarticular inflammatory reaction which is strongly associated with hyperuricemia. Latest evidence showed that uric acid exerted effects on the development of other diseases. Many studies in developed countries had estimated the frequency of comorbidities associated with gout suchas hypertension, obesity, diabetes mellitus, Chronic Kidney Disease (CKD), and Myocardial Infarct (MCI). However, no data regarding these frequencies have been found in Indonesia up to now to the best of the author’s knowledge. This study aimed to establish thefrequency of these comorbidities in patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.Methods: All medical records of patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital from January 2012 to December 2013 were collected. The data on blood pressure; Body Mass Index (BMI); random blood glucose, fasting blood glucose or 2 hourspost prandial blood glucose; history of myocardial infarction; and creatinine were taken and analyzed to determine the presence of comorbidities Results: Among all patients with gout in Rheumatology Clinic Dr. Hasan Sadikin General Hospital, 53.08% had chronic kidney disease, 42.73 % had hypertension, 25.39% had diabetes mellitus, 15.70% had myocardial infarction and 12.22% had obesity.Conclusions: Comorbidities commonly found in patients with gout in order of frequency were chronic kidney disease, hypertension, diabetes mellitus, myocardial infarct, and obesity.Keywords: gout, comorbidities, frequency.

scholarly journals Online Clinical Pathway for Chronic Kidney Disease Management in Primary Care: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Maoliosa Donald ◽  
Michelle D. Smekal ◽  
Meghan J Elliot ◽  
Kerry McBrien ◽  
Robert Weaver ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Clinical Pathway ◽  
Clinical Pathways ◽  
Angiotensin Receptor Blockers ◽  
Improve Patient Care ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Rate Of Change ◽  
Converting Enzyme Inhibitors

Abstract BackgroundClinical pathways aim to improve patient care. We sought to determine whether an online chronic kidney disease (CKD) clinical pathway was associated with improvements in CKD management. MethodsWe conducted a retrospective pre/post population-based cohort study using linked health data from Alberta, Canada. We included adults 18 years or older with mean estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. The primary outcome was measurement of an outpatient urine albumin creatinine ratio (ACR) in a 28-day period, among people without a test in the prior year. Secondary outcomes included use of guideline-recommended drug therapies (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and statins). Results The study period spanned October 2010 to March 2017. There were 84 independent 28-day periods (53 pre, 31 post pathway implementation) including 345,058 adults. The population was predominantly female (56%) with median age 77 years; most had category 3A CKD (67%) and hypertension (82%). In adjusted segmented regression models, the increase in the rate of change of ACR testing was greatest in Calgary zone (adjusted OR 1.19 per year, 95% CI 1.16-1.21), where dissemination of the pathway was strongest; this increase was more pronounced in those without diabetes (adjusted OR 1.25 per year, 95% CI 1.21–1.29). Small improvements in guideline-concordant medication use were also observed. Conclusions: Following implementation of an online CKD clinical pathway, improvements in ACR testing were evident in regions where the pathway was most actively used, particularly among individuals without diabetes.

Myocardial Infarction with and without ST-segment Elevation: a Contemporary Reappraisal of Similarities and Differences

2020 ◽  
Vol 16 ◽  
Author(s):  
Andreas Mitsis ◽  
Felice Gragnano
Keyword(s):  
Myocardial Infarction ◽  
Clinical Presentation ◽  
Standard Of Care ◽  
Epidemiologic Studies ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
P2y12 Inhibitors ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Similarities And Differences

Abstract:: Understanding the similarities and differences between myocardial infarction with or without ST-segment elevation is an essential step for a proper patients’ management in current practice. Both syndromes are caused by a critical stenosis or a total occlusion of coronary arteries (mostly due to thrombosis on atherosclerotic plaque), and manifest with a similar clinical presentation. Recent epidemiologic studies show that the relative incidence of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) moves in an opposite fashion (decreasing and increasing respectively), with a prognosis that is worse at short-term follow-up for STEMI but comparable at long-term. Current management differs, as for STEMIs an immediate reperfusion is recommended, while for NSTEMIs risk stratification is mandatory in order to stratify patients’ risk, and then decide the timing for coronary angiography. Periprocedural and technical aspects of the interventional management as well antithrombotic medications are for the most similarly implemented in the two types of MI, with routine radial access, DES implant, and novel P2Y12 inhibitors representing the standard of care in both cases. The following review article aims to compare the two types of MI, with and without persistent ST-segment elevation. The main purpose is to explore their similarities and differences and address areas of uncertainty with regards to clinical presentation, therapeutic management, and prognosis. The identification of high-risk NSTEMI patients is important as they may require an individualised approach that can substantially overlap with current STEMI recommendations and their mortality remains high if their management is delayed.

scholarly journals High-sensitive cardiac troponin for the diagnosis of acute myocardial infarction in different chronic kidney disease stages

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Daijin Ren ◽  
Tianlun Huang ◽  
Xin Liu ◽  
Gaosi Xu
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Cardiac Troponin ◽  
Optimal Cutoff ◽  
Cutoff Values ◽  
Optimal Value ◽  
Disease Stages

Abstract Background Chronic kidney disease (CKD) are associated with acute myocardial infarction (AMI). High-sensitive cardiac troponin (hs-cTn) has been evidenced to enhance the early diagnostic accuracy of AMI, but hs-cTn levels are often chronically elevated in CKD patients, which reduces their diagnostic utility. The aim of this study was to derive optimal cutoff-values of hs-cTn levels in patients with CKD and suspected AMI. Methods In this retrospective paper, a total of 3295 patients with chest pain (2758 in AMI group and 537 in Non-AMI group) were recruited, of whom 23.1% were had an estimated glomerular filtration rate (eGFR) of < 60 mL min−1 (1.73 m2)−1. Hs-cTnI values were measured at presentation. Results AMI was diagnosed in 83.7% of all patients. The optimal value of hs-TnI in diagnosing AMI was 1.15 ng mL−1, which were higher in males than females comparing different cutoff-values of subgroups divided by age, gender and renal function, and which increased monotonically with decreasing of eGFR because in patients with CKD without AMI, the correlation between hs-cTnI and renal function is low but significant (r2 = 0.067, P < 0.001). Conclusions Different optimal cutoff-values of hs-cTnI in the diagnosis of AMI in patients with CKD were helpful to the clinical diagnosis of AMI in various populations and were higher in males than females, but which was needed to be validated by multicenter randomized controlled clinical studies in the future.

scholarly journals Risk for recurrent cardiovascular disease events among patients with diabetes and chronic kidney disease

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Demetria Hubbard ◽  
Lisandro D. Colantonio ◽  
Robert S. Rosenson ◽  
Todd M. Brown ◽  
Elizabeth A. Jackson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Health Insurance ◽  
High Risk ◽  
Kidney Disease ◽  
Peripheral Artery ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Very High

Abstract Background Adults who have experienced multiple cardiovascular disease (CVD) events have a very high risk for additional events. Diabetes and chronic kidney disease (CKD) are each associated with an increased risk for recurrent CVD events following a myocardial infarction (MI). Methods We compared the risk for recurrent CVD events among US adults with health insurance who were hospitalized for an MI between 2014 and 2017 and had (1) CVD prior to their MI but were free from diabetes or CKD (prior CVD), and those without CVD prior to their MI who had (2) diabetes only, (3) CKD only and (4) both diabetes and CKD. We followed patients from hospital discharge through December 31, 2018 for recurrent CVD events including coronary, stroke, and peripheral artery events. Results Among 162,730 patients, 55.2% had prior CVD, and 28.3%, 8.3%, and 8.2% had diabetes only, CKD only, and both diabetes and CKD, respectively. The rate for recurrent CVD events per 1000 person-years was 135 among patients with prior CVD and 110, 124 and 171 among those with diabetes only, CKD only and both diabetes and CKD, respectively. Compared to patients with prior CVD, the multivariable-adjusted hazard ratio for recurrent CVD events was 0.92 (95%CI 0.90–0.95), 0.89 (95%CI: 0.85–0.93), and 1.18 (95%CI: 1.14–1.22) among those with diabetes only, CKD only, and both diabetes and CKD, respectively. Conclusion Following MI, adults with both diabetes and CKD had a higher risk for recurrent CVD events compared to those with prior CVD without diabetes or CKD.

scholarly journals PCV80 Characterization of the Clinical Pathway and Treatment Patterns for Post-Myocardial Infarction Patients: A Physician Survey

2020 ◽  
Vol 23 ◽  
pp. S501
Author(s):  
N. Qureshi ◽  
S. Antoniou ◽  
J.H. Cornel ◽  
F. Schiele ◽  
P. Perrone-Filardi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Pathway ◽  
Treatment Patterns ◽  
Post Myocardial Infarction ◽  
Physician Survey

Coronary Care in a General Hospital

1971 ◽  
Vol 16 (3) ◽  
pp. 173-182 ◽  
Author(s):  
Gavin Shaw ◽  
Bernard Groden ◽  
Evelyn Hastings
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
First Year ◽  
Duration Of Stay ◽  
Before And After ◽  
The Mean ◽  
Coronary Care ◽  
Made In

The establishment, staffing and structure and observations made in the first year of the existence of coronary care in an intensive care unit in a general hospital are recorded. Two hundred and twenty eight patients were admitted during the year in whom the diagnosis of myocardial infarction was confirmed. There were 29 deaths in the unit and 14 deaths occurred in the wards of the hospital after discharge from the unit. 49.1 per cent of the patients were admitted within 4 hours of the onset of symptoms and the mean duration of stay in the unit was 86.5 hours. The type of arrhythmia detected in the unit, and the treatment given to the patients both before and after admission to the intensive care unit are described.

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