Sapporo Medical Journal

Abstract : Background - Stroke is a disease with the highest mortality rate and high treatment billing disease in Indonesia. The prevalence of ischemic stroke (IS) is the greatest among all types of stroke where the incidence is 85% of the total stroke [9]. In general, the purpose of this study was to understand the variation in billing in ischemic stroke inpatient services based on the determinant factors that influence it. Methods - The study design was a Non-Experimental Research Design with retrospective data from October to December 2019 and the unit of analysis was ischemic stroke patients who were treated at the National Brain Center Hospital (RS PON) Prof. Dr. dr. Mahar Mardjono Jakarta. Analysis is used to see the determinant factors that influence the variation in billing strokes. Results - The results of the study are expected to get an overview of billing variations influenced by the determinant factors observed, namely age, length of treatment (days), NIHSS score, comorbid (hypertension, tryglicerid and LDL), give positive contribution. While gender, speed of getting treatment after attack (hours), comorbid (diabetes, total cholesterol, HDL) are giving negative contribution. Conclusion - After descriptive analysis shows that hypertension, fasting glucose, LDL, length of stay and NIHSS score have an influence on total billing. However, after regression analysis showed that length of stay and NIHSS score were the variables that most influenced the variation in total ischemic

Abstract : Background and aim: The inability of a man to make his clinically fertile woman partner pregnant is known as male infertility. Several published studies have demonstrated that men who are infertile have a greater risk of chromosomal abnormalities than those who are fertile. Male infertility has been linked to various variables, including genetic and environmental factors. This study aimed to examine the hormonal changes and establish the incidence and kind of chromosomal alterations in infertile men with azoospermia and oligozoospermia. Materials and Methods: The traditional study of GTG-banded metaphases from cultured lymphocytes was conducted on 120 individuals with primary infertility. The retrieved data included medical history, family history, sperm analysis, and hormone profiles. The polymerase chain reaction was used to detect Yq11 microdeletions in all men with oligospermia/azoospermia with normal karyotypes. Results: The incidence rate of chromosomal abnormalities was 5.8%. A total of 65.8% of the men exhibited azoospermia, with 6.3% having chromosomal abnormalities. Oligozoospermia affected 33.3% of men, with 2.5% having chromosomal abnormalities. In 5.8% of cases (07/120), chromosomal abnormalities were detected. Two of the seven men had the karyotype of Klinefelter's syndrome, which is the most frequent numerical sex chromosomal abnormality. One patient had mosaic chromosomal aberration 46,XY (88%)/45,X (12%), and another had 46,XX (SRYpositive) chromosomal makeup

Abstract : Phlebitis is one of the common complications after peripheral intravenous (PIVC) cannulation, especially in admitted patients. Objective: This study aimed to determine the incidence of phlebitis after povidone-iodine (PVP-I) versus alcohol isopropyl scrubbings as antiseptics in PIVC in patients admitted to the intensive care unit (ICU). A randomized prospective study was conducted in Shar Teaching Hospital, Sulaimaniyah, Iraq, on 201 patients admitted to the ICU from January 2022 to September 2022. Patients were allotted into two groups. Group I (n=99) used povidone-iodine-10% scrub, and group II (n=102) used alcohol isopropyl-70% scrub for sterilizing the skin before PIVC. The study variables included age, gender, site of insertion, place of insertion, cannula size, past medical history, and reason for admission. Phlebitis stages were estimated using a visual infusion phlebitis score (VIPS). The phlebitis incidence in studied patients was 90.5% (87.9% in group I and 93.1% in group II). Most phlebitis cases were developed in patients aged >65 years that had hypertension and were associated with non-significant sex distribution, small catheter size (20 gauge), and insertion on a dorsal metacarpal vein on the right site after 72 hours of IV drug/fluid administration. There was no significant association (P>0.05) between the study groups' variables and their phlebitis stages concerning using different antiseptics. The phlebitis rate was much higher than the global standard rate,

Abstract : Quality and cost control policies for the National Health Insurance (JKN) program are currently developed in various measurement indicators. The development of service quality while still paying attention to aspects of hospital efficiency also continues to get wider space. In addition, for Social Insurance Administration Organization (BPJS) or the is very important for the use of Big Data in the development of the JKN Evidence Based Policy program. The aim of this study is determine the structural model of the quality of BPJS advanced referral health facilities based on the Malcolm Baldrige criteria. A cross sectional study using secondary data from BPJS Health Facilities Quality Index 2017 which specifically measures based on Malcolm Baldrige's criteria. Model development was analyzed using the SmartPLS application to produce a quality model design for advanced referral health facilities (FKRTL). The results of the analysis showed that the Service Quality model based on Malcolm Baldrige's criteria describes the entire dependent variable as a good model with an R2 value of 0.782. From the results of the analysis it was also found that the dependent variable which had a large influence was the measurement analysis and knowledge management variable and Process variable.

Abstract : Microvascular free tissue transfer has gained popularity throughout the years. Many plastic surgery centers perform such challenging surgery on patients requiring extensive defect closure, including our center in the last five years. We will review our previous cases in order to achieve and assess our learning curve in a developing country. In this case series study, we looked at all patients who had a microvascular free tissue transfer conducted by a single operator (PA) in one institution between 2014 and 2018. Multivariate analysis was conducted to find out factors involved in free flap failure, which were age, gender, BMI, an indication of surgery, location of the defect, type of flap, number of veins anastomosed, vein graft usage, length of hospital stay, length of intensive care unit stay, and perioperative complications. Then, 203 microvascular tissue transfers were performed to reconstruct and close defects of various anatomic locations by a single operator. The patients' age ranged from 5.5 to 79 years. Most defects were due to tumor ablation, besides trauma and congenital deformity. The microvascular free flap reconstruction of various kinds of indications all over the body showed a viable flap rate of 90.6%. We concluded that to achieve a consistent high success rate, the parameters impacting the flap's viability must be evaluated regularly. This study found that the flap's viability can be affected by the number of veins anastomosed, BMI, length of hospital stay,