Penyakit Paru Obstruktif Kronik (PPOK) adalah penyakit kronis saluran napas yang ditandai dengan hambatan aliran udara dan bersifat progresif lambat yang semakin lama semakin memburuk. Bronkodilator dan kortikosteroid merupakan obat pilihan pertama yang digunakan pada pasien PPOK. Pemberian terapi yang tepat diharapkan dapat menurunkan angka morbiditas maupun mortalitas pada pasien PPOK. Salah satu hal yang menjadi penyebab tingginya angka kematian akibat PPOK adalah hasil terapi yang tidak efektif. Terapi obat yang tidak efektif dapat menurunkan outcome klinis dan meningkatkan biaya yang dikeluarkan pasien. Tujuan dari penelitian ini adalah unutk membandingkan efektivitas-biaya antara kelompok pasien PPOK yang mendapatkan terapi bronkodilator dibandingkan dengan kelmpok pasien yang mendapatkan terapi kombinasi bronkodilator-kortikosteroid. Penelitian ini merupakan penelitian observasional dengan desain studi cohort. Pengambilan data dilakukan di RSUP Fatmawati pada bulan Mei-Agustus 2019. Hasil penelitian menunjukkan bahwa rata-rata biaya pengobatan pasien yang hanya memperoleh bronkodilator saja lebih murah dibandingkan dengan kombinasi bronkodilator dan kortikosteroid (Rp 342.384,- vs Rp 615.201,-). Namun efektivitas diantara kedua kelompok pasien sama (16,67%). Nilai ACER (Average Cost Effective Ratio) bronkodilator adalah Rp 20.538,- sedangkan ACER untuk kombinasi bronkodilator-kortikosteroid sebesar Rp 36.904,-. Berdasarkan hasil penelitian dapat disimpulkan bahwa penggunaan bronkodilator lebih cost-effective dibandingkan dengan kombinasi bronkodilator-kortikosteroid pada passien PPOK. Kata Kunci: Analisis Efektivitas-Biaya, Bronkodilator, Bronkodilator-Kortikosteroid, PPOK
Background: Chronic Obstructive Pulmonary Disease (COPD) is a chronic airway disease which is characterized by progressive airway obstruction. Bronchodilators and corticosteroids are the first choices of therapy in COPD patients. The goal therapy of COPD patients is to prevent respiratory failure, which can impact on death. But nowadays, the mortality rate due to COPD continues to increase. WHO predicts mortality from COPD in the year 2030 will be ranked third in the world. This high mortality can be caused by the ineffectiveness of therapy given. Objective: The aim of this study is to find out the effectiveness of bronchodilator and corticosteroid treatments in COPD patients. Methods: An observational study conducted retrospectively in the 2018 period at Fatmawati Central General Hospital. The effectiveness of therapy was assessed from the patient's clinical condition, blood gas values (PaO2 & PaCO2) and the average length of stay (AvLOS). Results: COPD was mostly suffered by males (83,33%), and the highest age for COPD was in the range of 45 years and above (90%). Bronchodilator that commonly prescribed were albuterol (30.08%), ipratropium bromide (12.2%), fenoterol hydrobromide (10.57%), terbutaline sulfate (8.13%), theophylline (1.63%) and aminophylline (5.69%), while the corticosteroids were budesonide (17.07%), methylprednisolone (9.76%) and dexamethasone (4.88%). Bronchodilator and corticosteroid had improved patient's clinical condition (96.67% patients) and also improved PaO2 & PaCO2 values patients. There was a significant improvement in PaO2 and PaCO2 value in COPD patients (p <0.05). Conclusion: Bronchodilator and corticosteroid in COPD patients had improved patient's clinical condition and PaO2 & PaCO2 values, but the average length of stay exceeds the standard (6-9 days). Keywords: Bronchodilator, Corticosteroid, COPD, Blood Gas Analysis, Average Length of Stay
Hipertensi atau tekanan darah tinggi adalah peningkatan tekanan darah sistolik lebih dari 140 mmHg dan tekanan darah diastolik lebih dari 90 mmHg pada dua kali pengukuran dengan selang waktu lima menit dalam keadaan cukup istirahat/tenang. Hipertensi masih menjadi salah satu penyakit yang prevalensinya mengalami peningkatan. Tujuan dari penelitian ini adalah untuk mengetahui profil pengobatan dan kesesuaian pemberian obat antihipertensi pada pasien lansia di Puskesmas Sukarami Palembang tahun 2020. Penelitian ini merupakan penelitian non eksperimental dengan metode deskriptif dan pengambilan data secara retrospektif. Data diambil dari rekam medis pasien di Puskesmas Sukarami Palembang tahun 2020. Hasil penelitian menggunakan 72 sampel, didapatkan hasil bahwa kebanyakan pasien dalam penelitian ini, berjenis kelamin laki-laki (54,17%), usia kisaran 60-74 tahun (91,67%), dengan terbanyak hipertensi stage II (65,28%) serta penyakit penyerta terbanyak yaitu diabetes mellitus (15,28%). Golongan obat antihipertensi terbanyak yaitu CCB dengan obat terbanyak amlodipin (94,44%). Pola terapi paling banyak yaitu monoterapi golongan CCB amlodipin (94,44%), penggunaan politerapi dua obat dengan kombinasi terbanyak yaitu golongan CCB dan ACEI (4,17%). Kesesuaian pemilihan obat antihipertensi seluruh pasien dikatakan sesuai dengan JNC 8 (100%) dan kesesuaian pemilihan dosis obat antihipertensi dengan JNC 8 sebanyak 69 pasien (95,83%) dan dosis terlalu tinggi sebanyak 3 pasien (4,17%).
Blood pressure is the pressure of the blood pumped by the heart against the walls of the arteries and is divided into systolic and diastolic. Blood pressure decreases 10% in the evening at normal circadian rhythms and rises again in the morning. Insomnia is one of the factors that can affect blood pressure. This study aims to look at differences in morning and evening blood pressure at the age of 45–65 years. The research method uses observational analytic with a cross sectional approach. Collecting samples using consecutive non-probability sampling. Subjects aged 45–65 were 301 people. Blood pressure was measured in the morning and evening. Insomnia data obtained based on a questionnaire. The statistical test used paired t test with a significance of p <0.05. The results showed a significant difference between morning and evening systolic blood pressure (P = 0,023), but there was no difference between morning and evening diastolic blood pressure (P = 0,224). There is a relationship between insomnia and morning blood pressure (p=0,001). The conclusion from the research results is that systolic blood pressure in the afternoon is higher than in the morning. Morning blood pressure is associated with difficulty sleeping at night.
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