Sapporo Medical Journal

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,

Abstract : .Background : Bone Mineral Density (BMD), which uses a specialized scan to measure the density of minerals present in bones, can be measured using Body Mass Index (BMI), which is a good indicator. The aim of this study to predict the BMD based on body parameters such as BMI , height and age . Method and Results a retrospective study were conducted at King Abdullah Bin Abdul-Aziz hospital university between May 2022 and August 2022. Seventy patients were selected based on the selection criteria. DEXA scan done for hip joints and lumber spine .The data was coded and analyzed using SPSS version 26 , DEXA results are obtained in T & Z score , the study found 70 patients comprised 82.9% (n=58) female and 17.1% (n=12) male .The descriptive statistical evaluation results showed that the mean age of the patients was 61.31(±12.30) years and observed mean BMI was 29.98 (±6.92) kg/m2 ,this study found that had linear regression relation between T and Z score of hip joints and spine and patients BMI ( P < 0.0001) also showed that had linear relation between Z & T of spine score and patients height and age respectively. Conclusion This study concluded that can predict the Z & T score of hip joints and spine from patient’s body parameters such as BMI ,age and height

Abstract : Invasive candidiasis is the most commonly encountered fungal disease in intensive care units. Year after year, the mortality rate rises for a variety of reasons. Fungus colonization has drawn attention and been acknowledged as a separate risk factor for the emergence of invasive candidiasis. This has been demonstrated in numerous investigations using Candida colonization as a grading system and a tool for predicting the emergence of invasive candidiasis. This study is a prospective observational cohort study to examine the relationship between risk factors and Candida morphology change and colonization increase in axilla and rectal swabs in critically ill patient while considering time exposure of each factor. Inclusion criteria were ICU patients aged 18-70 years old who were predicted to stay more than two days, sequential organ failure assessment (SOFA) scores more than two. Parenteral nutrition, leukocyte day 1, old age and female have a hazard ratio more than one, which it means all risk was associated with Candida morphology change and colonization increase in axilla and rectal swabs. Further research is needed to determine the likelihood Candida morphology change and colonization increase in axilla and rectal swabs, such as system scoring. It will help clinician to know how to start antifungal administration.

Abstract : Retinopathy of prematurity (ROP) is a fibrovascular retinal disease that affects the development of premature infants’ retinal vessels. Early retinal screening may play an important role to abolish visual loss among premature neonates. The current study was designated to report the local pediatricians’ and neonatologists’ perception of ROP screening protocols as well as its treatment. An anonymous self-administrated questioner was electronically distributed among pediatricians on a national scale. One hundred ten responded to the questionnaire. Nearly 87% worked in hospitals where ROP screening protocols existed. While the remaining had no screening protocol available in their facilities. Majority of study participants (91%) stated good information about ROP, however, less than 50% of them correctly reported sufficient information about ROP risk factors. Nevertheless, the majority agreed that screening programs are mandatory to be adopted within neonatal intensive care unit (NICU). They agreed that Laser photocoagulation therapy must be considered as the Soule treatment of choice. As Laser is superior to other modalities such as injectable anti-vascular endothelial growth factors and cryotherapy This concluded that most of national pediatricians do have sufficient information in regard of ROP that although junior residents still need to be weaponed with a comprehensive information about the disease.