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Objectives: Fatigue is a frequent and burdensome symptom in patients with advanced disease in palliative care. However, it is under-assessed and undertreated in clinical practice, even though many treatment options have been identified in systematic reviews. Care pathways with defined and standardised steps have been recommended for effective management in the clinical setting. This paper describes a care pathway for managing fatigue in palliative care patients. This study aims to develop a care pathway with detailed guidance for screening, assessment, diagnosis, and treatment of fatigue in palliative care patients. Material and methods: A collaborative effort of multidisciplinary clinicians participated in constructing the care pathway. The care pathway was developed using the following steps: (a) Developing an intervention; (b) piloting and feasibility; (c) evaluating the intervention; (d) reporting; and (e) implementation. This paper covers the first step, which includes the evidence base identification, theory identification/development, and process/outcomes modeling. A literature search was conducted to understand the extent of the fatigue problem in the palliative care setting and identify existing guidelines and strategies for managing fatigue. Consistent recommendations emanating from the included papers were then contributed to a care pathway. Patient representatives and palliative care professionals provided feedback on the draft. Results: The care pathway address the following care processes: (1) Screening for the presence of fatigue; (2) assessment to evaluate the severity of fatigue; (3) diagnostic procedure, including history, physical examination, and laboratory finding; (4) therapeutic management pathway for clinical decision-making; and (5) valuation of treatment effect, using questionnaires, diaries and physical activity monitoring with body-worn sensors. Conclusion: The development of a care pathway will help to implement regular and structured assessment, diagnosis, and treatment of fatigue for healthcare professionals treating palliative care patients. Reviewing the pathway with a multidisciplinary expert group and field testing the pathway will be the next steps toward implementation.

The current cross-sectional study aimed to examine the relationship between social support, fear, and psychological distress among frontline nurses during the coronavirus disease 2019 (COVID-19) pandemic. Participants from 20 wards for adult patients from public and private hospitals in Indonesia were recruited. The Fear of COVID-19 Scale, Job Stress Scale, and Perceived Social Support Questionnaire were used to measure outcomes of interest. Questionnaires were completed by a total of 211 nurses. High risk working unit, higher fear score, younger age, less working experience, and less social support were significant influences on nurses' psychological distress. Social support as a modifiable factor is a potential target for intervention strategies to manage psychological issues among nurses. Findings can help policymakers and managers better understand how to support frontline nurses' psychological health and maintain well-engaged nursing staff. [ Journal of Psychosocial Nursing and Mental Health Services, 61 (5), 53–58.]

Background: Surgery and anesthesia are associated with increased patient anxiety. Perioperative anxiety is a common problem in regional anesthesia procedures and has an extensive impact. Immersive virtual reality (IVR) is a potential non-pharmacological distraction method to reduce anxiety. Immersive virtual reality creates a virtual environment that allows patients to interact and immerse in the virtual world, reducing patient anxiety. Objectives: This study aimed to examine the effect of IVR on the anxiety of patients undergoing regional anesthetic surgery. Methods: A total of 30 participants referred to Dr. Kariadi General Hospital (Indonesia) from October 2021 to December 2021 were enrolled in this randomized, single-blind clinical trial. The patients were divided into virtual reality (VR) and control groups (n = 15 in each group). The control group received midazolam (0.02 mg/kg) as premedication. The VR group received an IVR intervention without premedication. The data of anxiety scores were assessed using the Spielberger State-Trait Anxiety Inventory 6 (STAI-6). This study also collected vital signs, side effects, and patient and surgeon satisfaction level data. Results: The average anxiety level during surgery in the operating room decreased in both groups (P < 0.05); the VR group had a lower score (P = 0.04). A significant reduction in perioperative anxiety levels was observed in the VR group compared to the control group. The patient satisfaction level was also significantly higher in the VR group than in the control group (P = 0.024). Both groups had no significant difference in monitored vital signs, side effects, and surgeon satisfaction. Conclusions: The IVR intervention could reduce anxiety in patients undergoing surgery under regional anesthesia and improve patient satisfaction.

Background: Breakthrough pain (BTP) is a transient increase in pain that occurs on a background of stable pain. It contributes substantially to the suffering experienced by most cancer patients. The pharmacologic options for management of BTP have been expanded considerably in the past decade. Opioids remain the most effective pharmaceuticals used for the BTP case. In this systematic review we attempted to provide the currently available clinical data about pharmacological treatment for breakthrough cancer pain.Objective: To evaluate the efficacy of pharmacological treatments for Breakthrough painMethods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) and PubMed for the last ten years (from September 2010 to September 2020. Further potentially relevant studies were identified from reference lists of studies marked for inclusion and relevant reviews. Two review authors independently assessed trial quality and extracted data. We screened the search results and included studies if they met the selection criteria.Result: We screened 205 publications of which 14 met the inclusion criteria. In total, we analysed data from 2129 participants. Overall, participant with BTP were treated with short acting opioid. Literature searching did not find any published evidence of non opioid drug to treat the BTP. Most adverse effects of the investigated drugs seemed to be moderate.Conclusion: The findings of this review suggest that rapid onset opioids play significant role for BTP. Future studies may be conducted to explore the efficacy and safety profiles each regimen for patients with certain categories of cancer.

Piutang timbul ketika perusahaan menjual barang atau jasa secara kredit. Dalam situasi ini, semakin banyak piutang, semakin banyak uang yang dibutuhkan untuk berinvestasi dalam piutang tersebut. PT Indorama Synthetics adalah perusahaan yang bergerak dalam bidang textile. PT Indorama Synthetics dalam melakukan kegiatan operasionalnya selalu berusaha untuk meningkatkan penjualan. Salah satu cara yang digunakan untuk meningkatkan penjualan adalah dengan menggunakan sistem penjualan kredit. Data Penjualan Kredit dan Piutang Usaha pada PT. Indorama Synthetics Tahun 2017 s/d 2021 digunakan untuk analisis pada penelitian ini. Tahun 2021 menunjukkan rasio perputaran piutang mengalami kenaikan sebesar 1,54% yaitu berputar sebesar 9,24 kali dengan membutuhkan waktu pengumpulan piutang selama 39,52 hari. berdasarkan perhitungan selama tahun 2017 s/d 2021, maka tahun 2021 menunjukkan tingkat perputaran piutang tertinggi dibandingkan dengan 4 tahun sebelumnya

Cucumber is an annual plant whose life is creeping or climbing on twisted or spiral handles with a fairly high nutritional content, namely 0.65% protein, 0.1% fat and carbohydrates, 2.2%, calcium, iron, magnesium, phosphorus, vitamin A. , B1, B2 and C. To meet the needs of cucumbers, it can be started by providing quality seeds by optimizing cucumber seed production activities through the application of Gandasil D leaf fertilizer as well as shoot pruning treatment. The purpose of this study was to determine the effect of interaction between gandasil D leaf fertilizer and shoot pruning on the production and quality of cucumber seeds. The research was conducted for 3 months at PT. Wira Agro Nusantara Sejahtera Kediri with a factorial randomized block design (RBD). The first factor is the concentration of gandasil D leaf fertilizer (K) with 3 levels, namely Concentration of 0 grams/liter (K0), Concentration of 2 grams/liter (K1), and Concentration of 4 grams/liter (K2). While the second factor was shoot pruning (P) with 3 levels, without pruning (P0), trimming shoots on the 10th segment (P1), and trimming the shoots on the 20th segment (P2). Data were analyzed by ANOVA followed by Duncan's Multiple Range Test further test at 95% significance level. The results showed that the concentration treatment of Gandasil D leaf fertilizer had a very significant effect on fruit weight, but had no significant effect on other parameters. The shoot pruning treatment had a very significant effect on fruit weight, fruit diameter, seed weight per plant, seed weight per hectare, and weight of 100 grains. Cucumber plants that were trimmed at the 20th segment (K2) showed the highest values, namely 5.29 cm for fruit diameter, 12.66 grams for seed weight per plant, 334,83 kgs for seed production per hectart, and 2.23 grams for weight of 100 grains. The interaction of the two treatments only affected fruit weight, where cucumber plants fertilized with Gandasil leaves with a concentration of 4 grams/l (K2) and trimmed shoots on the 20th segment (P2) had the highest fruit weight, which was 278.40 grams.

This paper aims to analyze how the government's level of satisfaction has so far been and how the inevitability of prospective leaders who will compete in the 2024 election celebrations for newcomers. The methodology used in this study uses a library research approach, starting with a search for articles using the keywords of government policies in the fields of economics, law, social and democratic and political dynamics ahead of the 2024 elections in the Scopus and Google Scholar the 2015-2022 period and then reviewedbased on four stages, including: 1) Search for articles, 2) Mapping discussion topics, 3). Topic analysis, and 4). Further analysis with the support of credible data that has been published by credible survey institutions. The results of the study and analysis concluded that the hope of bringing in future leaders still reaps pessimism, this happens because in public reading of their satisfaction with the government's performance, in this case the Jokowi-Ma'ruf cabinet, which is already in its third year, is currently considered to have failed to control the government. policy on a number of aspects, especially regarding the fulfillment of public needs, and economic investment, then another challenge is political and democratic disruption, the existence of a presidential threshold will have an impact on the leadership relay which has an oligarchic background and network similar to the political strategy played by elites and political parties. so far. S

Background Aging is an irreversible, progressive and cumulative process that involves biological, anatomical, physiological, and functional changes that occur over a period of time. Emergency surgery in geriatrics is challenging due to the limited time for surgery planning. Charlson Age Comorbidity Index (CACI) can be used as a predictor of mortality in geriatric patients undergoing surgery. The study’s aim is to determine the association between CACI and mortality in geriatric patients undergoing emergency surgery. Methods This study was a prospective analytic observational multicenter study. This study was conducted from February 2021 to April 2021. This study used the whole sampling method and was followed up 30 days after surgery. The data were analyzed using regression and the ROC Curve test with a confidence interval of 95%. Results We obtained 116 geriatric patients undergoing emergency surgery with a 30-day mortality rate of 11.2%. CACI significantly correlated with 30 day-mortality in geriatric underwent emergency surgery (p = 0.000) with B = 4.831. The AUC of the CACI score was 0.966, with a cut-off value of 5.5. For geriatric patients with CACI scores > 5.5, the risk of mortality within 30 days of treatment is 125.33 times greater (95% CI: 14.58–1077.67) than for patients with CACI scores

Background: The COVID-19 pandemic continues to have an impact on geriatric patients worldwide since geriatrics itself is an age group with a high risk due to declined physiological function and many comorbidities, especially for those who undergo surgery. In this study, we determine the association between perioperative factors with 30-day mortality and a survival rate of geriatric patients undergoing surgery during COVID-19 pandemic. Methods: A prospective cohort study was conducted at 14 central hospitals in Indonesia. The recorded variables were perioperative factors, 30-day mortality, and survival rate. Analyses of associations between variables and 30-day mortality were performed using univariate/multivariable logistic regression, and survival rates were determined with Kaplan–Meier survival analysis. Results: We analyzed 1621 elderly patients. The total number of patients who survived within 30 days of observation was 4.3%. Several perioperative factors were associated with 30-day mortality (p < 0.05) is COVID-19 (OR, 4.34; 95% CI, 1.04–18.07; p = 0.04), CCI > 3 ( odds ratio [OR], 2.33; 95% confidence interval [CI], 1.03–5.26; p = 0.04), emergency surgery (OR, 3.70; 95% CI, 1.96–7.00; p ≤ 0.01), postoperative ICU care (OR, 2.70; 95% CI, 1.32–5.53; p = 0.01), and adverse events (AEs) in the ICU (OR, 3.43; 95% CI, 1.32–8.96; p = 0.01). Aligned with these findings, COVID-19, CCI > 3, and comorbidities have a log-rank p < 0.05. The six comorbidities that have log-rank p < 0.05 are moderate-to-severe renal disease (log-rank p ≤ 0.01), cerebrovascular disease (log-rank p ≤ 0.01), diabetes with chronic complications (log-rank p = 0.03), metastatic solid tumor (log-rank p = 0.02), dementia (log-rank p ≤ 0.01), and rheumatology disease (log-rank p = 0.03). Conclusions: Having at least one of these conditions, such as COVID-19, comorbidities, emergency surgery, postoperative ICU care, or an AE in the ICU were associated with increased mortality in geriatric patients undergoing surgery during the COVID-19 pandemic.

Penyakit COVID-19 merupakan salah satu pandemik terbesar saat ini dan cepat sekali penyebarannya. Salah satu akibat yang dirasakan adalah timbulnya kecemasan pada tenaga medis terutama karena ketersediaan0alat pelindung diri (APD) untuk petugas kesehatan masih kurang/tidak sesuai standar. Studi ini bertujuan untuk mengetahui hubungan kekurangan APD terhadap tingkat kecemasan tenaga kesehatan dalam memberikan pelayanan kepada0pasien COVID-19. Studi ini dilakukan secara analitik dengan menggunakan metode potong lintang. Subyek studi adalah 32 tenaga kesehatan di RSUD Mukomuko yang secara langsung memberikan pelayanan kepada pasien COVID-19. Subyek studi diambil secara purposive sampling. Tingkat kecemasan diukur menggunakan kuesioner Zung Self rating anxiety scale dan dikategorikan sesuai skor. Dari 23 (71,9%) subyek yang mengatakan terbatasnya ketersediaan APD, 17 orang (73,9%) mengalami kecemasan tingkat sedang-berat dan 6 orang mengalami kecemasan tingkat ringan. Semua subyek yang mengatakan ketersediaan APD cukup tergolong dalam kecemasan tigkat ringan. Hasil uji Fisher Exact didapatkan adanya hubungan yang0bermakna antara ketersediaan APD dan kecemasan pada tenaga kesehatan (p=0,001) dan tenaga kesehatan yang bekerja dalam keterbatasan APD memiliki risiko sebesar 14,6 kali lipat untuk mengalami kecemasan dibandingkan tenaga kesehatan yang bekerja dengan APD yang mencukupi (PR=14,6). Kekurangan APD dapat berisiko meningkatkan rasa cemas pada petugas kesehatan yang nantinya dapat berpengaruh pada pelayanan kesehatan.

Background With the more advanced science in the field of medicine and disease management, the population of geriatric intensive care patients is increasing. The COVID-19 pandemic has impacted healthcare management around the globe, especially on critically-ill elderly patients. We aim to analyse the relationship between underlying illnesses, including COVID-19, and the survival rate of elderly patients who are treated in the intensive care setting. Methods We conducted a prospective cohort study at 14 teaching hospitals for Anaesthesiology and Intensive Therapy Education in Indonesia. We selected all subjects with 60 years of age or older in the period between February to May 2021. Variables recorded included subject characteristics, comorbidities, and COVID-19 status. Subjects were followed for 30-day mortality as an outcome. We analysed the data using Kaplan-Meier survival analysis. Results We recruited 982 elderly patients, and 728 subjects were in the final analysis (60.7% male; 68.0 ± 6.6 years old). The 30-day mortality was 38.6%. The top five comorbidities are hypertension (21.1%), diabetes (16.2%), moderate or severe renal disease (10.6%), congestive heart failure (9.2%), and cerebrovascular disease (9.1%). Subjects with Charlson’s Comorbidity Index Score > 5 experienced 66% death. Subjects with COVID-19 who died were 57.4%. Subjects with comorbidities and COVID-19 had lower survival time than subjects without those conditions (p p < 0.005, R coefficient 0.22). Conclusion Approximately one in four elderly intensive care patients die, and the number is increasing with comorbidities and COVID-19 status.

Physical condition is needed to improve physical ability to perform certain tasks, without fatigue. The purpose of this study was to analyze the anthropometry and physical condition of floorball athletes in the city of Surabaya. This study uses a quantitative descriptive approach. The sample in this study were 20 males floorball athletes in the city of Surabaya. The variables analyzed in this study are anthropometry and physical conditions which include agility, speed, endurance and power. The results showed that the average weight of the athletes was 59.35 ± 12.04 kg. The average height of the athletes was 1.69 ± 0.06 m, the average BMI of the athletes was 20.74 ± 3.99. The results of physical condition analysis showed that majority of athletes had agility and speed in the less category, which were 65% and 55% respectively. In term of endurance and power, it was found that 55% of endurance and power level of floorball athletes fell into sufficient category. Thus, the results of the research on floorball athletes in the city of Surabaya should be of special concern to coaches to improve the physical condition of athletes by providing structured and appropriate training programs in order to obtain better results.

BACKGROUND: Pandemics can increase disease spread, as well as unpredictable and highly in patient demand, which can have a negative impact on hospital capacity and the overall functioning of the health-care system. The preparedness and capacity of intensive care services to respond to COVID-19 in Indonesia are remain unknown. AIM: This study aimed to investigate the preparedness and capacity of intensive care services in Indonesia to respond to the initial stage of the COVID-19 pandemic. METHODS: A mixed-method research design was used in this study using in-depth interviews and an online survey. An in-depth interview was conducted with the medical team (intensive care consultant and an anesthesiologist) who is actively involved in the provision of COVID-19 services in 15 national referral hospitals. The online survey was conducted to all medical teams that provide direct care to the COVID-19 patients. A total of 459 (response rate was 95.2%) agreed to join the survey. The content analysis technique was used to analyze qualitative data and a descriptive analysis was used to describe issues encountered in providing health services to COVID-19 patients. RESULTS: The analysis preparedness and capacity of intensive care service in Indonesia to respond to the initial stage of the COVID-19 pandemic resulting in 4 themes with 12 sub-themes. The four themes were limited quality and quantity of standardized intensive care unit (ICU) isolation room (inadequate zoning systems, adequacy of the standardized ICU isolation room, the readiness of the hospital infrastructure, and telemedicine facilities are not yet widely used, including in the COVID-19 isolation room), limited medical service support (lack of personal protective equipment (personal protective equipment [PPE], re-used PPE, lack of availability of medical devices), limitations in the medical team’s quality and quantity management (lack of number and distribution of expert doctors and medical team screening for ICU), and command systems (task shifting, effective communication, and leadership). CONCLUSION: Medical team encounters several difficulties, particularly related to the quality of facilities, staff preparedness, and systems for the provision of services to COVID-19 patients with critical conditions. There is a critical need for well-defined pathways, legal protection, and occupational health for medical teams providing services in the aftermath of a pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID)-19 pandemic is a challenge for the intensive care unit (ICU) medical team. It requires management of space, stuff (medical equipment including drugs), staff, and system readiness (4S) to deal with the surge in the number of patients. AIM: This survey aims to describe the current readiness efforts among ICU medical team at the COVID-19 referral hospitals in Indonesia; space, stuff readiness, staff, and systems readiness. METHODS: We conducted a cross-sectional national web-based survey of ICUs across referral hospitals during pandemic COVID-19 in Indonesia from June to October 2020. The medical teams survey included 53 questions in multiple parts addressing five dimensions. A linear regression model was applied to determine the factors related with readiness. RESULTS: A total of 459 participants (83.6%) agreed to join in this study. The participants’ average age was 40.43 years (SD = 5.78). About 62.53% were male, 51.20% had bachelor degree, and 55.77% lived outside of Java Island. The mean of total score of medical team readiness was 2.76 (SD = 0.320) and the highest (maximum score) mean score of medical team readiness domain was stuff (2.81, SD = 7.72). Education, working experience, training, perception of risk of contracting COVID-19, and residence had a substantial effect on the readiness, with R2 values of 0.378, p < 0.05. CONCLUSIONS: This study provides an initial view of current preparedness efforts among a group of ICUs in Indonesia’s leading hospital during the first wave of pandemic. Interventions must be developed and implemented quickly to increase the medical team’s readiness to care for a future pandemic.

This study aimed to explore the perspectives of care and protection of healthcare workers during the pandemic COVID-19 using a descriptive qualitative study in Indonesia. This study used a qualitative descriptive approach in COVID-19 National Referral Hospitals. Purposive sampling was used to collect the sample. There were 45 respondents, with 22 men and 23 women taking part in this study. The qualitative data were analyzed using the content analysis. Three themes that emerge from the data analysis: health protection, legal protection, and incentive schemes. Health protection including calculation of the medical team's workload and lack of a systematic procedure for medical team quarantine. There was a lack of legal basis for medical practice in long-term disaster services. Dimension of incentive scheme, including incentives shift from rewards to demands, changes in incentive regulations, and discrepancy in incentive calculation. By stressing protection and rewards for each level of the medical profession, it is hoped to boost motivation in actively participating and supporting the service of COVID-19 patients in critical conditions across Indonesia.

Latar Belakang : Corona Virus Disease 2019 (COVID-19), pertama kali dilaporkan pada bulan Desember 2019 di Cina, merupakan penyakit yang disebabkan oleh virus SARS-CoV-2 yang menyebar lebih cepat pada populasi manusia dan dalam waktu singkat berkembang menjadi pandemi di seluruh dunia. Sebagian besar kasus yang berujung pada kematian dilaporkan terkomplikasi dengan koagulopati dan disseminated intravascular cogulation (DIC). Kasus : Seorang laki-laki terkonfirmasi positif COVID-19 berusia 50 tahun dengan sesak, batuk dan demam dan komorbiditas hipertensi dirujuk ke intensive care unit (ICU), selama di ICU pasien mendapat terapi heparin dengan dosis terapi dengan melihat kadar aPTT. Setelah perawatan intensif selama 14 hari, pasien mengalami perbaikan yang signifikan. Pembahasan : Pasien dengan infeksi COVID-19 yang progresif dan parah dengan acute respiratory distress syndrome (ARDS) seringkali ditemukan dengan kadar D-dimer dan fibrinogen yang sangat tinggi, yang berujung pada keadaan hiperkoagulasi. Penggunaan antikoagulan untuk pasien dengan COVID-19 yang parah telah. Banyak institusi telah menerapkan penggunaan antikoagulan dosis penuh secara empiris berdasarkan risiko venous thrombo embolism (VTE) dan insiden rendah perdarahan (3-5%). Kesimpulan: Penggunaan antikoagulan, khususnya unfractionated heparin (UFH) dengan dosis lebih tinggi, direkomendasikan untuk pasien dengan COVID-19 yang parah, meskipun belum ada panduan yang mutlak.