Introduction. Toxic Epidermal Necrolysis (TEN) is a acute and severe reactions of skin and mucosa that can lead to serious clinical outcomes and morbidity. TEN is considered to be rare in children and usually has a fatal outcome due to sepsis.Case. 9-year old girl, went to Universitas Gadjah Mada (UGM) Hospital with complaint of erythematous, purpuric rash, blister starting from the neck and also involving the inside of the mouth, lips and eyes, and spreading over the entire body. Three weeks before hospital admission, she received combination of drugs valproate sodium, clonazepam, phenobarbital and piracetam. Two week after, she developed skin rash and progress to develop TEN. Sodium valproate and clonazepam were discontinued, and intravenous methylprednisolone, prophylactic systemic antibiotics, intravenous immunoglobulin (IVIG), intravenous fluid supplement, antipyretic, special wound care at semi sterile room, and supportive medical care fro TEN were administered. She was discharged from hospital in a stable, good condition.Discussion. This case suggests that sodium valproate contributed to the development of TEN. Appropriate case management will give excellent result, and reduce long-term complications.

Background: E-learning as a learning method with a flexible and interactive pedagogical approach has a positive impact on the value of self-confidence of nursing students. School of Nursing, Faculty of Medicine Public Health and Nursing Universitas Gadjah Mada (FMPHN UGM) develop e-learning for nursing students in clinical practice learning which requires an evaluation to e-learning implementation by describing the self-confidence of the nursing student after use e-learning. The purpose of this study was to describe self-confidence (SC) of the clinical nursing students based on 3 selfconfidence’s components that consist of cognitive, affective, and psychomotor.Methods: A Descriptive study with a cross-sectional design toward 95 clinical nursing students in the stage of nursing management and basic nursing practice in September 2018 period at the School of Nursing FMPHN UGM. Data analysis used the univariate analysis with descriptive statistic test to describe respondent characteristic and variable. Student Satisfaction and Self-Confidence in Learning Instrument by National League for Nursing (NLN) in 2005 was used in this study. The instrument was through cultural adaptation and modification first.Results: The self-confidence of nursing students as e-learning evaluation found that the majority of respondents (90,5%) had high levels of self-confidence. Components of self confidence, consist of cognitive, affective and psychomotor also showed that the majority of respondents were in the high category (84,2%; 88,4%; 66,3%).Conclusion: Clinical nursing students have high self-confidence after going through e-learning.

Background: Health services provided by hospitals can be used as capital to improve the image of services and compete with other hospitals in order to be the patients’ preferred choice in solving their health problems. Patients have different perceptions of medical services provided which can be used for describing the quality of hospital services.Methods: This research was a descriptive analytic study with a cross-sectional design, where data retrieval used a questionnaire which measures the patients’ expectations and perceptions of services from the Outpatient, Inpatient and Emergency Departments with 5 dimensions of quality: tangibles, responsiveness, empathy, reliability and assurance. The study population was patients who visited the outpatient, inpatient and emergency departments totaling 5000 samples as calculated by the Slovin formula, with a sample set of 120 respondents selected by random sampling. Data were analyzed using independent sample t tests to determine differences in patients’ expectations and perceptions of services obtained at the time of visit. ANOVA tests were used to analyze data about differences in patients’ expectations and perceptions of the outpatient, inpatient and ER departments. For the descriptive study, the data were analyzed by finding the average of the patients’ responses. Results: Patient expectations of service quality was an important quality dimension which reached an average value of 93.97. The perception of the quality of services reached a value of 84.12. Statistically, there was no difference between the quality of the outpatient, emergency and inpatient departments with p=0.4 (>0.05). There was a statistically significant difference in patient expectations and perceptions of service quality delivered both with p=0.000 (<0.05). Conclusions: According to the perceptions of patients, quality of service at the Universitas Gadjah Mada Hospital is excellent. There was no difference between the quality of service in the outpatient, emergency and inpatient units. There were statistically significant differences between patient expectations and perceptions of service quality.