Trauma is one of the major causes of deaths worldwide. The referral time of trauma patients to the trauma center is a vital determinant of traumatic injury patients’ survival. Ambulance delays and crashes are the major causes of delay of patient transportation to the hospital. This review was conducted to find the main factors that cause ambulance crashes and ambulance delays; and discuss the correlation of both factors. Hence, the authors might suggest an appropriate solution to minimize ambulance delay and crash incidents. This integrative literature review applied the PRISMA-P protocol to ensure a robust literature search. A total of nine databases and publishers (i.e., PubMed, Scopus, ScienceDirect, ASCE Library, Clinical Key, EBSCO, Cambridge, Taylor & Francis, and ProQuest) were searched using relevant keywords to obtain studies on ambulance delays and ambulance crashes. The literature search retrieved 620 studies to be screened based on the exclusion-inclusion criteria which finally resulted in the 12 studies included in the review. The researchers conducted a risk of bias assessment using Joanna Briggs Institute's critical appraisal tools. Data from the included studies were then extracted and analyzed using descriptive statistics to identify the factors affecting ambulance delays and crashes. After conducting an integrative literature review, the main factor that causes ambulance delays is traffic congestion. Meanwhile, the main factor causing ambulance crashes is intersection. Traffic congestion often occurs especially at intersections. The authors concluded that, intersections have a significant effect on ambulance delays and also ambulance crashes. To overcome this problem, the authors suggest to make an additional ambulance caution signal lamp on all congested intersections.

The burden of musculoskeletal disease has increased significantly to become the second leading cause of YLD (years of life with disability). Osteoarthritis (OA) therapy that is often given is ibuprofen (NSAID) often give side effects. Therefore, it is necessary to conduct a literature review to explore evidence of how much potential these materials have for treating OA. The literature review was conducted on four databases, e.g., Pubmed, Scopus, Science direct, Clinical Key. We used several keywords to find each topic of discussion. Topic 1, benefits of glucosamine chondroitine; topic 2, benefits of chitosan; topic 3, benefits of phytoestrogens. Data from included studies were then extracted. Obtained data were analyzed using descriptive statistical methods. Glucosamine-chondroitin had a significant effect in reducing pain, reducing inflammation, reducing the rate of joint space narrowing and helping to improve joint function in OA patients with long-term use. Furthermore, the potential of chitosan can help bone remodeling, reduce pain, and inflammation. Besides, phytoestrogens also have the potential to increase bone mineral density, reducing the rate of bone turnover and reduce the occurrence of obesity through its anti-cholesterol effects. The complexity of the mechanism of action given, ranging from preventing the biggest risk factor, namely obesity; treating the main causes such as inflammation and cartilage damage; and also to treating the symptoms such as joint pain and stiffness. In the future, it is necessary to conduct clinical trials study using the ingredients glucosamine, chondroitin, chitosan and phytoestrogens to treat patients with OA.

Ciplukan (Physalis angulata Linn.) has been used by the community as an anti-diabetic drug. The antidiabetic effect is due to ingredients such as unsaturated fatty acids, alkaloids, flavonoids, saponins, polyphenols, steroids, triterpenoids, monoterpenoids, and sesquiterpenoids. Part of the fruit of P. angulata contains many active substances of flavonoids with the proportion of fruit extract 300 μg/ml is 84%. Therefore the exploration for compounds responsible for antidiabetic activity in P. angulata needs to be done to ensure empirical evidence. The purpose of this study was to find the active fraction of P. angulata L. which has anti-hyperglycemic properties. This study used Myoblast cells as subjects and the Bioassay Guided Fractionation method for separating compound groups through three stages of the extraction, partitioning, and fractionation processes which were monitored using TLC and the Glucose Consumption Assay test. The results showed that the chloroform extract (CHCl3) was more active in lowering glucose levels compared to the methanol extract (MeOH) (4.86% vs -8.74%). MeOH insoluble extract was more active than MeOH soluble extract (5.14% vs -8.52). The fractionation results showed that Fraction I was the most active in lowering glucose levels compared to FII, III, and IV (26.47%; 13.18%; 0.15%; 13.76%). Therefore Fraction 1 which contains a class of flavonoid compounds is a potential candidate to be developed as an antidiabetic agent.