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ObjectiveClinical management is hypothesized to be critical for hospital management and hospital performance. The aims of this study were to develop and validate professional involvement scales for measuring the level of clinical management by physicians and nurses in European hospitals.DesignTesting of validity and reliability of scales derived from a questionnaire of 21 items was developed on the basis of a previous study and expert opinion and administered in a cross-sectional seven-country research project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE).Setting and participantsA sample of 3386 leading physicians and nurses working in 188 hospitals located in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey.Main outcome measuresValidity and reliability of professional involvement scales and subscales.ResultsPsychometric analysis yielded four subscales for leading physicians: (i) Administration and budgeting, (ii) Managing medical practice, (iii) Strategic management and (iv) Managing nursing practice. Only the first three factors applied well to the nurses. Cronbach's alpha for internal consistency ranged from 0.74 to 0.86 for the physicians, and from 0.61 to 0.81 for the nurses. Except for the 0.74 correlation between 'Administration and budgeting' and 'Managing medical practice' among physicians, all inter-scale correlations were

ObjectiveTo explore how European hospitals have implemented patient safety strategies (PSS) and evidence-based organization of care pathway (EBOP) recommendations and examine the extent to which implementation varies between countries and hospitals.DesignMixed-method multilevel cross-sectional design in seven countries as part of the European Union-funded project 'Deepening our Understanding of Quality improvement in Europe' (DUQuE).Setting and participantsSeventy-four acute care hospitals with 292 departments managing acute myocardial infarction (AMI), hip fracture, stroke, and obstetric deliveries. Main outcome measure Five multi-item composite measures-one generic measure for PSS and four pathway-specific measures for EBOP.ResultsPotassium chloride had only been removed from general medication stocks in 9.4-30.5% of different pathways wards and patients were adequately identified with wristband in 43.0-59.7%. Although 86.3% of areas treating AMI patients had immediate access to a specialist physician, only 56.0% had arrangements for patients to receive thrombolysis within 30 min of arrival at the hospital. A substantial amount of the total variance observed was due to between-hospital differences in the same country for PSS (65.9%). In EBOP, between-country differences play also an important role (10.1% in AMI to 57.1% in hip fracture).ConclusionsThere were substantial gaps between evidence and practice of PSS and EBOP in a sample of European hospitals and variations due to country differences are more important in EBOP than in PSS, but less important than within-country variations. Agencies supporting the implementation of PSS and EBOP should closely re-examine the effectiveness of their current strategies.

ObjectiveTo assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals.DesignA quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits.ParticipantsOne hundred and fifty-five CEOs and 155 quality managers.SettingOne hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s) Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda.ResultsDiscussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships.ConclusionsHaving quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters.

ObjectiveTo describe hospitals' organizational arrangements relevant to the abstraction of administrative data, to report on the completeness of administrative data collected and to assess associations between organizational arrangements and completeness of data submission.DesignA cross-sectionalStudy designutilizing administrative data.Setting and participantsRandomly selected hospitals from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain, and Turkey).Main outcome measuresCompleteness of data submission for four quality indicators: mortality after acute myocardial infarction, stroke and hip fractures and complications after normal delivery.ResultsIn general, hospitals were able to produce data on the four indicators required for this research study. A substantial proportion had missing data on one or more data items. The proportion of hospitals that was able to produce more detailed indicators of relevance for quality monitoring and improvement was low and ranged from 40.1% for thrombolysis performed on patients with acute ischemic stroke to 63.8% for hip-fracture operations performed within 48 h after admission for patients aged 65 or older. National factors were strong predictors of data completeness on the studied indicators.ConclusionsAt present, hospital administrative databases do not seem to be an appropriate source of information for comparison of hospital performance across the countries of the EU. However, given that this is a dynamic field, changes to administrative databases may make this possible in the near future. Such changes could be accelerated by an in-depth comparative analysis of the issues of using administrative data for comparisons of hospital performances in EU countries.

ObjectiveTo define a checklist that can be used to assess the performance of a department and evaluate the implementation of quality management (QM) activities across departments or pathways in acute care hospitals.DesignWe developed and tested a checklist for the assessment of QM activities at department level in a cross-sectional study using on-site visits by trained external auditors.Setting and participantsA sample of 292 hospital departments of 74 acute care hospitals across seven European countries. In every hospital, four departments for the conditions: acute myocardial infarction (AMI), stroke, hip fracture and deliveries participated.Main outcome measuresFour measures of QM activities were evaluated at care pathway level focusing on specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies and clinical review (CR).ResultsParticipating departments attained mean values on the various scales between 1.2 and 3.7. The theoretical range was 0-4. Three of the four QM measures are identical for the four conditions, whereas one scale (EBOP) has condition-specific items. Correlations showed that every factor was related, but also distinct, and added to the overall picture of QM at pathway level.ConclusionThe newly developed checklist can be used across various types of departments and pathways in acute care hospitals like AMI, deliveries, stroke and hip fracture. The anticipated users of the checklist are internal (e.g. peers within the hospital and hospital executive board) and external auditors (e.g. healthcare inspectorate, professional or patient organizations).

ObjectiveThe aim of this study was to develop and validate an index to assess the implementation of quality management systems (QMSs) in European countries.DesignQuestionnaire development was facilitated through expert opinion, literature review and earlier empirical research. A cross-sectional online survey utilizing the questionnaire was undertaken between May 2011 and February 2012. We used psychometric methods to explore the factor structure, reliability and validity of the instrument.Setting and participantsAs part of the Deepening our Understanding of Quality improvement in Europe (DUQuE) project, we invited a random sample of 188 hospitals in 7 countries. The quality managers of these hospitals were the main respondents.Main outcome measureThe extent of implementation of QMSs.ResultsFactor analysis yielded nine scales, which were combined to build the Quality Management Systems Index. Cronbach's reliability coefficients were satisfactory (ranging from 0.72 to 0.82) for eight scales and low for one scale (0.48). Corrected item-total correlations provided adequate evidence of factor homogeneity. Inter-scale correlations showed that every factor was related, but also distinct, and added to the index. Construct validity testing showed that the index was related to recent measures of quality. Participating hospitals attained a mean value of 19.7 (standard deviation of 4.7) on the index that theoretically ranged from 0 to 27.ConclusionAssessing QMSs across Europe has the potential to help policy-makers and other stakeholders to compare hospitals and focus on the most important areas for improvement.

ObjectiveTo investigate the relationship between ISO 9001 certification, healthcare accreditation and quality management in European hospitals.DesignA mixed method multi-level cross-sectional design in seven countries. External teams assessed clinical services on the use of quality management systems, illustrated by four clinical pathways.Setting and participantsSeventy-three acute care hospitals with a total of 291 services managing acute myocardial infarction (AMI), hip fracture, stroke and obstetric deliveries, in Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey.Main outcome measureFour composite measures of quality and safety [specialized expertise and responsibility (SER), evidence-based organization of pathways (EBOP), patient safety strategies (PSS) and clinical review (CR)] applied to four pathways.ResultsAccreditation in isolation showed benefits in AMI and stroke more than in deliveries and hip fracture; the greatest significant association was with CR in stroke. Certification in isolation showed little benefit in AMI but had more positive association with the other conditions; greatest significant association was in PSS with stroke. The combination of accreditation and certification showed least benefit in EBOP, but significant benefits in SER (AMI), in PSS (AMI, hip fracture and stroke) and in CR (AMI and stroke).ConclusionsAccreditation and certification are positively associated with clinical leadership, systems for patient safety and clinical review, but not with clinical practice. Both systems promote structures and processes, which support patient safety and clinical organization but have limited effect on the delivery of evidence-based patient care. Further analysis of DUQuE data will explore the association of certification and accreditation with clinical outcomes.

ObjectiveThe objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies.DesignA cross-sectional, multilevelStudy designthat surveyed quality managers and department heads and data from an organizational audit.SettingRandomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey).ParticipantsHospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012.Main outcome measuresFour items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level.ResultsCurrent levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies.ConclusionsThere is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect.

ObjectiveThe assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships between the various quality measures.DesignIt is a multi-level, cross-sectional, mixed-method study.Setting and participantsAs part of the DUQuE project, we invited a random sample of 74 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Furthermore, data of site visits of external surveyors assessing the participating hospitals were used.Main outcome measuresThree measures of QM at hospitals level focusing on integral systems (QMSI), compliance with the Plan-Do-Study-Act quality improvement cycle (QMCI) and implementation of clinical quality (CQII). Four measures of QM activities at care pathway level focusing on Specialized expertise and responsibility (SER), Evidence-based organization of pathways (EBOP), Patient safety strategies (PSS) and Clinical review (CR).ResultsPositive significant associations were found between the three hospitals level QM measures. Results of the relationships between levels were mixed and showed most associations between QMCI and department-level QM measures for all four types of departments. QMSI was associated with PSS in all types of departments.ConclusionBy using the seven measures of QM, it is possible to get a more comprehensive picture of the maturity of QM in hospitals, with regard to the different levels and across various types of hospital departments.

This research was conducted on nodular cast iron FCD 500 and white cast iron Ni-Hard1 in the manufacturing of grinding rolls. These rolls were joined together using the furnace brazing method, with CuZn 35 filler metal placed between the two parent metals. The pressure applied in this experiment was 26,000 N using a pressure aid. The assembled parts of the grinding rolls were heated in a muffle furnace with temperature variations of 900, 950, and 1000 °C, with a holding time of 120 minutes. The results of the furnace brazing process revealed that the grinding roll sample achieved the highest shear strength at a temperature of 900 °C, with a shear strength of 6.52 MPa. The observed low shear strength is due to the penetration bonding between the metals. This was confirmed by the line analysis test, which indicated no diffusion process occurring between the metals. As the holding temperature of the brazing furnace increased, the shear strength decreased, primarily due to the melting of the CuZn 35 metal at temperatures above 900 °C, resulting in micro porosity. During the furnace brazing process, changes were observed in the microstructure of the FCD 500 parent metal. There was an increase in the amount of pearlite fraction, which in turn increased the hardness value. Additionally, the microstructure of Ni-Hard1 changed from austenite to martensite, leading to an increase in the hardness value.

This systematic literature review aims to analyze the psychosocial and psychosexual interventions for addressing sexual health problems among men in urban areas of Indonesia, with a focus on indigenous practices such as Mak Erot. The review follows the PRISMA guidelines, involving a comprehensive search of multiple databases, selection of relevant studies, data extraction, and synthesis. List the databases and other sources searched: PubMed, Scopus, Google Scholar, and Indonesian local journals, grey literature, and reference lists of selected articles. Search term strategies with the combination used include; Psychosocial interventions", Psychosexual problems", "Male sexual health", "Indigenous treatments", "Mak Erot", and "Urban areas in Indonesia". Based on data analysis the findings highlight the significance of culturally sensitive interventions in improving sexual and mental health outcomes for men in urban Indonesian contexts.

Penyakit antraknosa merupakan penyakit penting pada buah pepaya yang disebabkan oleh Colletotrichum gloeosporioides. Pengendalian penyakit tanaman mengunakan fungisida nabati berasal dari bahan-bahan alami, seperti daun mangga, daun pepaya, daun mengkudu, dan rimpang lengkuas dapat menghambat C. gloeosporioides. Penelitian ini bertujuan untuk mengetahui keefektifan ekstrak daun mangga, daun pepaya, daun mengkudu, daun sirih, dan rimpang lengkuas berdasarkan nilai AUDPC dalam mengendalikan penyakit antraknosa C. gloeosporioides. Percobaan dilakukan dalam dua tahap yaitu uji in vitro dan uji in vivo. Rancangan percobaan yang digunakan uji in vitro disusun dalam Racangan Acak Lengkap dengan 6 perlakuan 5 ulangan. dan uji in vivo disusun dalam Racangan Acak Kelompok dengan 6 perlakuan 5 kelompok. Data yang diperoleh diuji lanjut mengunakan uji BNT pada taraf 5%. Konsentrasi yang digunakan masing masing ekstrak yaitu 60%. Hasil penelitian menunjukkan bahwa ekstrak daun sirih memiliki pengaruh yang paling efektif dalam menghambat pertumbuhan C. gloeosporioides dibandingkan dengan perlakuan ekstrak daun mangga, daun mengkudu, daun pepaya, dan rimpang lengkuas

Humans strive to create a prosperous life, both physical, social and psychological conditions, so that the quality of life improves, including honorary teachers. Psychological well-being has a relationship with the behavior of gratitude and patience. The research aims to determine the correlation of gratitude and patience with subjective well-being in honorary teachers. This research uses quantitative with explanatory correlational type. Subjects were taken using purposive sampling. Respondents in this study were 155 people. Data collection used 3 instruments; gratitude scale, patience scale, and subjective well-being scale. Data analysis used multiple linear regression with the help of SPSS. The results of this research show that there is a significant correlation between gratitude and patience on subjective well-being in honorary teachers. The higher the level of gratitude and patience, the higher the subjective well-being experienced by honorary teachers.

Information technology is developing rapidly, especially for smartphone users. Smartphones have become a communication and information tool in everyday life. The activity of using smartphones with excessive intensity can cause various impacts on users, such as nomophobia. Someone who is unable to exercise self-control in using a smartphone or has low self-control will be susceptible to addiction. The research aims to determine the effectiveness of group counseling on self-management techniques to reduce nomophobia by increasing self-control. This research uses a pretest and posttest design. The subjects of this research were 10 people. The sampling used was purposive sampling. Data was collected using self-control and nomophobia questionnaires. Data analysis used mediation analysis with a bootstrap bias-corrected method with a confidential interval of 95% assisted by micro-process software (N=5000). The research results show that there is an effect of group counseling on effective self-management techniques in reducing nomophobia by increasing self-control.

Cabai keriting (Capsicum annum L.) merupakan komoditas hortikultura yang memiliki nilai ekonomi. Kebutuhan cabai yang terus meningkat menyebabkan perlunya pasokan cabai yang mencukupi. Alternatif untuk mengatasi kondisi tersebut adalah budidaya perkotaan pemanfaatan pekarangan. Budidaya perkotaan dapat dilakukan dengan penggunaan wadah polybag. Media tanam perlu mengandung unsur hara yang mencukupi bagi tanaman dan memiliki sifat fisik yang baik. Penelitian ini bertujuan untuk mengetahui pengaruh media tanam tanah, serbuk kayu, arang sekam, dan serbuk sabut kelapa atau kombinasinya dan media tanam yang terbaik di antara tanah, serbuk kayu, arang sekam, dan serbuk sabut kelapa atau kombinasinya untuk pertumbuhan dan produksi cabai dalam polybag. Penelitian ini menggunakan Rancangan Acak Kelompok (RAK) dengan faktor tunggal 3 ulangan dan 7 perlakuan yaitu A0 (Tanah/Kontrol), A1 (Tanah + Serbuk Kayu), A2 (Tanah + Arang Sekam), A3 (Tanah +Serbuk Sabut Kelapa), A4 (Tanah +Serbuk Kayu +Arang Sekam), A5 (Tanah +Serbuk Kayu +Serbuk Sabut Kelapa), dan A6 (Tanah +Arang Sekam +Serbuk Sabut Kelapa). Data yang diperoleh diuji keaditifan dengan uji Tukey, homogenitas ragamnya dengan uji Barlett dan perbedaan nilai tengah diuji dengan menggunakan Uji BNJ pada taraf 5%. Produksi tanaman terbaik hingga 18 MST terdapat pada jenis media tanam tanah +arang sekam +serbuk sabut kelapa dengan jumlah buah layak konsumsi per tanaman terbanyak yaitu 132,33 buah dan bobot buah per tanaman yaitu 393,67 g. Pada penelitian lanjutan 27 MST bahan media yang menggunakan serbuk kayu mulai terdekomposisi dengan hasil jumlah buah total per tanaman paling banyak pada perlakuan tanah +serbuk kayu +serbuk sabut kelapa yaitu 13 buah dan bobot buah total per tanaman paling banyak yaitu 52,26 g.

In this study, bronze-based brake linings containing 0-8 wt% glass powder were manufactured by a hot pressing process and tribological properties of produced samples were investigated using a Chase-type friction tester. The hardness and density of the samples were also determined. The microstructures and friction surfaces of the samples were examined using scanning electron microscopy (SEM). As a result, it was dermined that the sample that was reinforced with 8 wt% glass powder has exhibited the best wear behavior. Furthermore, a reduction in the friction coefficient of all the samples with increasing friction surface temperature was observed. The results have showed that friction coefficient stability of the brake lining samples could be improved with the increasing content of glass powder.

Penelitian ini bertujuan untuk mengetahui pengaruh jenis dan konsentrasi POC serta mengatahui pengaruh jenis POC terhadap pertumbuhan dan produksi tomat rampai bergantung pada penambahan konsentrasi POC. Penelitian ini menggunakan rancangan acak kelompok (RAK) faktorial (2 x 4) dengan tiga ulangan sebagai kelompok. Faktor pertama yaitu jenis POC dan faktor kedua yaitu konsentrasi POC. Penelitian ini diuji dengan uji Bartlett (homogenitas) dan uji Tukey (additivitas) yang kemudian dilakukan analisis ragam (uji F), dilanjutkan pemisahan nilai tengah menggunakan BNT dengan taraf nyata 5%. Hasil penelitian menunjukkan jenis POC kulit pisang lebih baik daripada POC kotoran kambing pada variabel pengamatan jumlah, diameter buah, dan berat kering brangkasan. Semakin tinggi konsentrasi POC hingga 120 ml/l air akan meningkatkan pertumbuhan dan produksi tomat rampai pada variabel pengamatan tinggi tanaman, jumlah daun, cabang produktif, berat buah, jumlah buah, diameter buah, berat basah brangkasan, dan berat kering brangkasan. Pengaruh jenis POC bergantung terhadap pemberian konsentrasi POC terjadi pada variabel pengamatan tinggi tanaman.

Penelitian ini bertujuan untuk mengetahui pengaruh aplikasi pupuk hayati dan pupuk pelengkap alkalis serta interkasi antara kedua faktor perlakuan terhadap pertumbuhan dan produksi tanaman semangka (Citrullus vulgaris Schard). Penelitian ini dilaksanakan di Desa Sukabanjar, Kabupaten Pesawaran pada Oktober 2019 – Januari 2020. Penelitian ini menggunakan Rancangan Acak Kelompok (RAK) yang disusun secara faktorial (3x3) dengan tiga ulangan sebagai kelompok dan terdapat 9 kombinasi perlakuan. Hasil penelitian menunjukkan bahwa aplikasi pupuk hayati dan pupuk pelengkap alkalis serta interaksinya berpengaruh nyata hampir pada semua variabel pengamatan, namun tidak terjadi interaksi pada variabel panjang buah. Aplikasi pupuk hayati 30 ml/l yang disertai aplikasi pupuk alkalis 2 g/l menghasilkan bobot buah tertinggi yaitu 5,81 kg/tanaman dan lebih tinggi dibanding tanpa perlakuan yang hanya menghasilkan 2,7 kg/tanaman. Aplikasi pupuk hayati konsentrasi 30 ml/l mampu meningkatkan produksi buah semangka per tanaman sebesar 92,59% dari 2,70 kg/tanaman menjadi 5,20 kg/tanaman, sementara aplikasi pupuk pelengkap alkalis konsentrasi 2 g/l mampu meningkatkan produksi buah semangka per tanaman sebesar 46,6% dari 2,70 kg/tanaman menjadi 3,96 kg/tanaman. Peningkatan tersebut disertai dengan meningkatnya panjang tanaman, jumlah bunga betina, jumlah buah/tanaman, bobot per buah, diameter buah dan panjang buah.

This research aimed to determine the effect of biofertilizer application and alkali supplement fertilizer on the growth and yield of chili (Capsicum annuum L.) This research is arranged in a randomized block design (RBD) consisting of two factors and three replications. The first factor is biofertilizer with three levels, i.e., H0=without biofertilizer; H1= dose of 4 ml/plant; H2= dose of 8 ml/plant. The second factor is alkali supplement fertilizer with three levels, i.e., P0=without alkali supplement fertilizers; P1= dose of 0,05 gr/plant; P2= dose of 0,1 gr/plant. The results showed that the growth variable did not have a significant interaction effect between biofertilizer and alkali supplement fertilizer. Meanwhile, in production variables, there are interaction effects between the application of biofertilizers and alkali supplement fertilizer in variables of number of flowers, number of fruit consumption, and fruit weight per plant. The biofertilizer application with a dose of 8 ml/plant accompanied by alkali supplement fertilizers dose of 0,1 gr/plant resulted in the highest fruit weight, 436.70 grams/plant. The biofertilizer application of 8 ml/plant produced 402.12 grams/plant3, while the application of alkali supplement fertilizer with a dose of 0,1 gr/plant produces chili production of 400.51 grams/plant.

Peningkatan produksi bawang merah banyak menghadapi kendala salah satunya yaitu serangan hama dan patogen. Penyakit yang sering dijumpai pada budidaya bawang merah yaitu moleryang disebabkan oleh Fusarium oxysporum f. sp. cepae. Penyakit moler dapat menimbulkan kerusakan danmenurunkan hasil umbi hingga 50%. Penggunaan pupuk kandang sapi, arang sekam dan pestisida teki diharapkan dapat menekan intensitas penyakit moler pada tanaman bawang merah. Penelitian ini bertujuan untuk mengetahui pengaruh kombinasi pupuk kandang sapi, arang sekam dan pestisida teki terhadap intensitas penyakit moler pada tanaman bawang merah dan mengetahui pengaruh kombinasi pupuk kandang sapi, arang sekam dan pestisida teki terhadap pertumbuhan dan produksi tanaman bawang merah. Penelitian dilakukan di Laboratorium Penyakit Tanaman dan Laboratorium Lapang Terpadu, Fakultas Pertanian, Universitas Lampung, pada September hingga Desember 2019. Perlakuan dalam penelitian ini disusun dalam Rancangan Acak Kelompok (RAK) yang terdiri dari 8 perlakuan. Perlakuan diulang sebanyak 3 kali sehingga total unit percobaan yang digunakan sebanyak 24. Perlakuan terdiri dari kombinasi taraf dosis pupuk kandang sapi 5, 10 dan 15 ton/ha dengan arang sekam 5, 10 dan 15 ton/ha kemudian ditambahkan pestisida teki dengan dosis 5%. Hasil percobaan dari kombinasi pupuk kandang sapi dan arang sekam pada berbagai taraf dosis tidak menunjukkan pengaruh terhadap pertumbuhan bawang merah tetapi memberikan pengaruh nyata terhadap produksi bawang merah. Pestisida teki dengan konsentrasi 5% tidak memberikan pengaruh nyata terhadap pertumbuhan dan produksi bawang merah tetapi pestisida teki dengan konsentrasi 5% memberikan pengaruh nyata terhadap penurunan intensitas penyakit pada bawang merah. Kombinasi dosis pupuk kandang sapi 15 ton/ha, arang sekam 15 ton/ha dan pestisida teki 5% menunjukkan intensitas terserang penyakit paling rendah.

Fruit quality is an important aspect that requires attention and more study when it comes to commercializing tropical fruits, including guava ‘Kristal’. This study aimed to evaluate the effect of bagging treatment and altitude of growing orchard on fruit quality of guava (Psidium guajava var. ‘Kristal’). This study was conducted at two local orchards managed by small-scale farmers, at Gunung Batu (1000 meters above sea level, m asl) and Brajaselebah (25 m asl), Lampung Province, Indonesia. A nested design was applied to test 5 types of bagging treatments and 2 levels of land altitude. Fruit quality was assessed by measuring both physical and chemical characteristics. Fruit size indicated by fruit weight and diameter was significantly larger in lowland compared to highland. The total soluble solids (TSS) were significantly higher in the lowland compared to the highland, while titratable acid (TA) showed an opposite result. Vitamin C of the fruits varied from140 to 146 mg per 100 g. Different types of fruit bagging and land altitudes did not affect the physical and chemical characteristics of “Kristal” guava fruits. Fruit scar intensity was higher in lowland, especially in fruit without bagging. Fruit bagging is highly recommended for farmers due to the success of this treatment to reduce fruit scar intensity, thus resulting in good fruit quality, irrespective of the growing locations.

Shallot is one of important horticultural crops in Indonesia; shallot consumption per capita is estimated to be 4.6 kg per year. The objective of this study was to evaluate the effect of combining biofertilizer and organic fertilizer on the production of shallot in Sukabanjar village, Pesawaran, Lampung, Indonesia. The study was set up using a randomized completely block design with two factors, biofertilizers and various organic fertilizers, i.e. cow manure, chicken manure, rice straw compost, oyster mushroom baglog. Our study demonstrated that combining biofertilizer and organic fertilizer significantly increased the number, diameter, and fresh and dry weight of tubers of “Bima Brebes” shallot. Shallots treated with biofertilizer combined with oyster mushroom baglog produced the highest tuber yield of 1788 g compared to 282 g in the control.

Pendahuluan: Mucous Membrane Pemphigoid (MMP) adalah suatu kelainan autoimun yang jarang terjadi. Gambaran lesinya sangat bervariasi (dengan didahului lesi berbentuk blisters) biasanya melibatkan mukosa oral dan mukosa mata. Kelainan ini sering menyerang penderita usia diatas 50 tahun. Berdasarkan gambaran klinis diagnosis penyakit ini sulit dibedakan dengan penyakit autoimun lain yang melibatkan mukosa, dan sering dipicu oleh penggunaan obat-obatan. Tujuan: Melaporkan tata laksana kasus pada penderita MMP usia 60 tahun suku Jawa Kasus: Pasien wanita, usia 60 tahun sejak 3 bulan yang lalu terdapat ulser disertai erosi di seluruh mukosa rongga mulut dan ada sedikit perdarahan, tanpa fase sembuh, terasa sakit. Ulser muncul tanpa didahului gejala prodromal. Pada bibir bawah ditemukan adanya krusta, warna coklat kehitaman, sakit dan tidak ditemukan adanya lesi di kulit dan mata. Pasien mengaku sering mengkonsumsi obat-obatan herbal. Tata Laksana: Pasien diresepkan obat kumur antiinflamasi dan antiseptik. Dan kemudian dilakukan beberapa tes penunjang. Hasil tes menunjukkan terdapat kenaikan Laju Endap Darah, pemeriksaan mikologi menunjukkan adanya yeast, fungsi hati, ginjal, dan kadar gula darah normal. Pasien dirawat dengan kortikosteroid per oral, antifungi topikal, immunomodulator, dan obat kumur antiseptik. Perawatan dilakukan selama 1 bulan. Kesimpulan: Diagnosis Mucous Membrane Pemphigoid (MMP) ditegakkan berdasarkan anamnesis, gambaran klinis, pemeriksaan ektra oral dan intra oral. Perawatan Mucous Membrane Pemphigoid (MMP) memerlukan pemberian kortikosteroid jangka panjang, oleh karena itu dibutuhkan kerjasama yang baik antara operator dan pasien, ketaatan pasien dalam minum obat serta kontrol teratur.

Background: Herpes labialis is a form of secondary or recurrence of primary herpes simplex infection. Herpes simplex virus is latent. It can reactivate due to reactivation of the virus induced by emotional stress, high fever, ultraviolet exposed, oral mucosal or nerve tissue trauma, immunosuppression condition, and hormonal disorders. Purpose: The study aimed to report the management of patients with herpes labialis on the lower lip triggered by emotional stress. Case: A 58 year-old woman complained of pain in her lower lip. The patient had suffered from the pain since one month ago. The patient had been treated with a lip ointment, triamcinolone acetonid 0.1% (Kenalog®), for 2 weeks, but became thick, dry, and worse. She said that she got many calamities related to her family, leading to the increased busyness and psychologically distressed conditions. Extra oral examination of the lower lip showed erythematous erosion sized 4x4 mm, yellowish red crusting sized 3x4 mm, and translucent multiple vesicles sized 1x1 mm with well circumscribed as well as irregular edges. On palpation submandibular lymph nodes, dextra and sinistra were palpable, rubbery, mobile and painless. Based on intra-oral examination, however, there were no abnormalities. Case management: The diagnosis was determined based on anamnesis, clinical examinations, and supporting examination of Ig M and anti HSV-1 Ig G. The patient then was prescribed systemic and topical Acyclovir. Conclusion: Some laboratory tests are necessary to confirm the diagnosis and determine the accurate therapy of herpes labialis in addition to the history and clinical features.

Allergic contact cheilitis is a common cause inflammation of the outer lip or vermillion margin. It is due to a type IV hypersensitivity reaction following contact with an allergen. Allergic contact cheilitis is more common in women than men. Lip cosmetics are the most common allergen source in women, while toothpastes allergy occur mostly in men. Purpose: To report the management of allergic contact cheilitis due to lip cosmetics. Case : A 22-years old woman complaint was dryness of the lips, cracking and peel off after using lip cosmetics since one week ago. Patient used new lips-cosmetics two weeks ago. No history to atopic allergy and no medication. Intra oral examination was normal. Management : patient was advised to avoid wearing lip-cosmetics. To relieve symptoms were given topical anti-inflammation non steroids, multivitamin and maintain to oral hygiene. Patient revered to patch testing. Patient had strongly positive result to the tested lip cosmetics. Patient were given topical anti inflammation steroids and from dermatology department were given antihistamine tablets. Conclusion : Patch testing is the key to this diagnosis and for determining of contact allergen.

Background: Therapy for chronic ulcer in diabetic patient is by modifying local inflammation response using drugs that acts as immunomodulator, neuromodulator and growth factors stimulator. Topical zinc is one of drug that can modifiy local inflammation response, immunostimulation or immunosuppresion. Purpose: This study was to prove about the number of macrophage in oral ulcer between normal and diabetes microscopically and the difference if treated by 1% ZnSO4 gel topically. Method: Ulcer in lower labial mucosa was made in normal and diabetic Wistar rats (induced by STZ), then applied 1% ZnSO4 gel and CMC-Na gel as control. They were decapitated in third and fifth day and specimen was made by processing lower labial mucosa Result: Microscopically, the result showed the number of macrophages in oral ulcer in diabetic condition was significantly higher than normal and the application of 1% ZnSO4 increased the number of macrophages in fifth day. Conclusion: The number of macrophages was higher in diabetic than normal condition, and was proven that topical application of 1% ZnSO4 increased the number macrophages of oral ulcer diabetic and normal condition.

Background: Oral candidosis is an infection caused by mainly Candida albicans. Candida species are common normal flora in the oral cavity and have been reported to be present in 40% to 60% of the population. Candida is predominantly an opportunistic infectious agent. Infection frequency has increased because of the presence of both local and systemic risk factors. The elderly age and diabetes mellitus may decrease the amount of saliva (xerostomia) and potentially increase the risk of colonization and secondary infection by Candida. Herpes Zoster (HZ) is a manifestation of the reactivation of latent varicella zoster virus. It is characterized by unilateral, painful, vesicular rash with a dermatomal distribution. The clinical manifestations of this disease can erupt to the skin and mucous membrane. If maxillary nerve is involved, the lesion can appear on unilateral facial skin and oral mucous membrane. Purpose: The purpose of this paper is to report and discuss the difficulties in managing the oral candidosis in elderly patient (57 year old male) who suffered from maxillary Herpes Zoster and diabetes mellitus. Case management: At first, the patient was treated with 2% chlorhexidine gluconate and mycostatin oral suspension as topical antimycotic and reffered to dermathology clinic for viral infection treatment, however the oral candidosis did not improved. Subsequently, ketokonazole tablet was given three times daily for three weeks and regulated blood glucose level. In systemic antifungi (ketokonazole) treatment the oral candidosis disappeared. Conclusion: In this case, it is conclude that the management of oral candidosis are adequate, antiviral, blood glucose level regulating and systemic antifungal therapy.

Diabetes Mellitus (DM) is a chronic disorder of carbohydrate, fat and protein metabolism. A defective or deficient of the insulin secretory, which is translated into impaired carbohydrate (glucose) use, is characteristic feature of DM, as the resultant is hyperglycemia. There is variability among patients, however, morphologic changes are likely found in arteries (atherosclerosis), basement membrane of the blood vessel wall tissues (micro angiopathy), kidneys (diabetic nephropathy), retina (retinopathy), nerves (neuropathy) and other tissues. If it involves salivary glands, the clinical sign is xerostomia. The type 2 of DM is caused by a combination of peripheral resistance to insulin action and an inadequate secretory response of the pancreatic b-cell. Approximately 80% to 90% of patients have type 2 diabetes. The purpose of this study was to determine the prevalence of xerostomia and its relation with level of blood glucose in type 2 DM. The data was taken using cross sectional method on the diabetic patients of Internal Medicine clinic, Hajj Hospital Surabaya from February to March 2006. The result that showed among 50 samples of the type 2 DM, the prevalence of xerostomia were 38 patients (76%). Most of the patients (32 patients = 84%) on bad regulation of DM with level of fasting glucose ≥ 126 mg/dl and level of post prandial glucose ≥ 180 mg/dl. The study showed that bad regulation of type 2 DM could develop complication on salivary glands, with xerostomia as the clinical sign.

Oral lichen planus (OLP) is a chronic inflammatory disease of the oral mucous membrane which is characterized by unpredictable exacerbation and remission. The pathognomonic of oral features of OLP are hyperkeratotic striation surrounded white patches of mucosal erythema are called Wickham’s Striae. Chronic inflammation or epithelial damage of the mucous membrane often followed by candidosis as secondary infection. Candida species are commensal microorganism, its population in oral cavity reach 70% of the oral microorganism. It is harmless, but it could become opportunistic pathogen when the condition of oral environment support, i.e. decrease of oral immune response or the oral microorganism ecosystem change. This purpose of the paper was to report the case of a female patient (49 years old) who came to the clinic of Oral Medicine Faculty of Dentistry Airlangga University Surabaya with clinical and mycological evidence of thrush (Oral acute pseudomembrane candidosis). The patient not only suffered thrush, but also chronic cervicitis vaginalis. So the patient also consumed the antibiotic which was given by gynecologist. The used of the antibiotic for chronic servicitis vaginalis was the contrary treatment of oral thrush, after treated with nystatin oral suspention, clinical examination showed clearly hyperkeratotic lesion (Wickham’s striae), and hystopathological test result showed that it was OLP. The chronic oral inflammation and epithelial damage (OLP) or antibiotic consumption could inhibited the candidosis treatment. The case report suggested that the first treatment should be given antimicotic if the mycological test of candidosis showed positive result.