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Analisis Implementasi Clinical Pathway Terhadap Length Of Stay (Los) Dan Biaya Perawatan Pasien Anak Dengan Demam Berdarah Dengue (Dbd) Di Rsi Nu Demak, Akhmad Safi’I, Muhammad Zulfikar Asumta, Abdul Aziz

Jurnal Ekonomi Kesehatan Indonesia

Clinical pathway (CP) is a quality and cost control instrument in hospitals designed to ensure service standardization, efficiency of Length of Stay (LOS), and control of healthcare costs. Dengue Haemorrhagic Fever (DHF) in children is an infectious disease that often requires hospitalization, with considerable variation in LOS and treatment costs. This study aimed to assess the effectiveness of CP implementation on LOS and cost of care among pediatric DHF patients at Rumah Sakit Islam Nahdlatul Ulama (RSI NU) Demak. This research applied a quantitative approach using a retrospective descriptive-analytic design. Data were obtained from medical records of 34 pediatric DHF …

Analisis Pending Claim Pasien Rawat Inap Di Rumah Sakit Dharma Kerti Tabanan, Gusti Ayu Putu Putri Maha Dewi, Made Karma Maha Wirajaya, Putu Ayu Laksmini, Putu Ika Farmani

Jurnal Ekonomi Kesehatan Indonesia

In the BPJS health claim submission process, not all documents submitted by the hospital can be accepted immediately. Claims are declared ineligible or pending if the submitted files are incomplete or do not meet BPJS Kesehatan requirements. At Dharma Kerti Hospital, Tabanan, from August to October 2024, 16.7% or 130 of 779 inpatient claim files were recorded as pending. This study aims to analyze the factors that influence pending claims for inpatients in the period November 2024 to January 2025 by reviewing coding, medical, and administrative aspects. The study used a mixed methods approach, namely quantitative analysis of the claim …

Determinan Kepuasan Peserta Jkn Terhadap Sistem Rujukan Berjenjang Di Provinsi Bali, Made Karma Maha Wirajaya, I Ketut Tunas, Putu Ika Farmani, Putu Ayu Laksmini

Jurnal Ekonomi Kesehatan Indonesia

The Indonesian government, through the National Health Insurance (JKN) Program, is committed to achieving Universal Health Coverage (UHC) by ensuring equitable, high-quality, and sustainable healthcare services. One key element in JKN implementation is a tiered referral system designed to improve the effectiveness and efficiency of healthcare services. However, in practice, the tiered referral system still faces various obstacles that may reduce the level of satisfaction of JKN participants with health services. This study aims to examine factors related to JKN participant satisfaction with the implementation of a tiered referral system in Bali Province. This study used an analytical cross-sectional design …

Analisis Biaya Perawatan Ulkus Diabetes Dan Implementasi Clinical Pathway Serta Cost Recovery Rate Di Rumah Sakit Xyz, Jawa Tengah, Nur Alaydrus, Chriswardani Suryawati, Puji Harto

Jurnal Ekonomi Kesehatan Indonesia

The INA-CBGs payment system in the National Health Insurance (JKN) program requires hospitals to improve cost efficiency through quality and cost containment. This study aims to analyze the implementation of the Clinical Pathway (CP) for diabetic ulcers, calculate the unit cost of care, and evaluate the Cost Recovery Rate (CRR) at XYZ Hospital, Central Java, using the Activity-Based Costing (ABC) method. A descriptive quantitative study with a cross-sectional design was conducted on all inpatients with a single diagnosis of diabetic ulcer without comorbidities from October to December 2024. Data were collected through activity-based CP observation, medical record review, and hospital …

Analisis Biaya Standar Pelayanan Minimal (Spm) Kesehatan Menggunakan Aplikasi Siscobikes Di Tingkat Kabupaten/Kota Di Indonesia, Purwa K. Sucahya, Resi Natalia Turnip, Lemi Kurniawan, Bondan Wicaksono Adhi, Iwan Supriyadi, Ni’Matun Nurlaela

Jurnal Ekonomi Kesehatan Indonesia

This research investigates the capacity of the Siscobikes (Health Costing System) application to forecast the financial requirements for the execution of Minimum Service Standards (SPM) within Indonesia’s health sector at the district and city levels.. The study utilized cross-sectional data from 166 districts/cities to ascertain the projected health financing requirements and juxtaposed these estimates with the actual budgetary allocations. The results show that each district/city requires approximately IDR 16 billion annually for SPM. Districts require around IDR 17 billion annually, while cities require approximately IDR 13 billion. Substantial regional disparities are observed: Eastern Indonesia has the highest per capita needs …

Factors Influencing Maritime Boundary Delimitation: Particular Reference To The Case Of The Sultanate Of Oman, Abdullah Elhabeeb A. Almahjoub

Sultan Qaboos University Legal Studies Journal

This research aims to clarify the maritime zones of coastal states subject to boundary delimitation under the 1982 United Nations Convention on the Law of the Sea and the extent to which this delimitation is influenced by several factors, most notably geographical, economic, political, and security considerations. These factors typically form the core of negotiations between adjacent or opposite coastal states regarding the delimitation of their maritime boundaries. This research focuses on the practical application of these factors by examining them and applying them to several cases in international practice, particularly the Omani case, to demonstrate their impact on maritime …

Crises In The Nigerian Defence Sector In The Post-Civil War Period, Hussaini Jibrin

Zamani: A Journal of African Historical Studies

History has it that post-war period in any country in the world appeared to be with many challenges of re-planning the defence system. It involves the reconstruction of pre-war institutions that are destroyed during the war for onward growth and development. Contrary to this tradition, this article explores that, in 1970 while Nigerians were celebrating about the end of the Nigerian civil war, fresh crises emerged in the country’s defence sector. Thus, General Yakubu Gowon’s government redirected its focus on addressing the crises. The crises are numerous, however, this article dwells on four only. These are demobilization exercise in the …

Labour Migrancy And Ethnic Stereotypes: Experiences From Mufindi Tea Plantation, Ca. 1920s To 2000s, Hezron R. Kangalawe

Zamani: A Journal of African Historical Studies

While tea plantations brought good fortunes to some parts of Southern Highlands in Tanzania such as Mufindi and Rungwe during the British mandate, its production sites became centres of ethnic contestations in relation to work discipline. The colonial and post-colonial enterprises labelled some ethnic groups as “reliable labourers” and others “unreliable”. This article, uses the tea plantations in Mufindi district, Iringa, to debate the labour question and ethnic identity in tea plantations between 1920s and 2000s. It argues that tea plantations were practical point of colonial stereotyping whose architects were anthropologists. Interviews in Mufindi tea plantations and factories, archival and …

Collaboration In The Spread Of Missionary Christianity In Africa: The Case Of The Apostolic Church Of Nigeria, Caleb Abiodun Adeleye, Oluwasegun Peter Aluko

Zamani: A Journal of African Historical Studies

This article explores the significance of collaboration in the spread of missionary Christianity in Africa through a historical study of The Apostolic Church of Nigeria (TACN). It examines how the partnership between British missionaries and Nigerian leaders produced a hybrid mission model that combined Western ecclesiastical structure with African spirituality. Drawing on historical records, church documents, and existing scholarship, the article adopts a narrative–analytical method to trace how figures such as Pastors George Perfect, Idris J Vaughan and DO Odubanjo negotiated issues of theology, finance and cultural identity. The study finds that collaboration initially fostered institutional growth and doctrinal development …

Hubungan Kadar Malondialdehida (Mda) Serum Dan Fraksi Ejeksi Ventrikel Kiri Pada Pasien Hemodialisis Reguler, Teguh Setiadi Amir, Taufik Indrajaya, Zulkhair Ali

Jurnal Penyakit Dalam Indonesia

Introduction. Malondialdehyde (MDA) is a marker of oxidative stress that is elevated in chronic kidney disease (CKD) patients undergoing regular hemodialysis. Oxidative stress can affect cardiac function especially left ventricular function. This study aimed to evaluate the relationship between serum MDA levels with left ventricular function in regular hemodialysis patients at Dr. Mohammad Hoesin Genaral Hospital, Palembang.

Methods. This study was an analytic observational study with a cross-sectional design conducted on regular hemodialysis patients in the Hemodialysis Installation of Dr. Mohammad Hoesin Genaral Hospital, Palembang. The MDA levels were examined from the serum of post-hemodialysis patients using ELISA …

Takikardia Ventrikel Berulang Pasca Coronary Artery Bypass Grafting (Cabg): Laporan Kasus Berbasis Bukti, Ika Prasetya Wijaya, Simon Salim, Audina Dhiya Nabila

Jurnal Penyakit Dalam Indonesia

Coronary artery bypass grafting (CABG) remains the treatment of choice for patients with complex multivessel coronary artery disease but carries a risk of serious perioperative complications, including ventricular arrhythmias such as ventricular tachycardia (VT). Although VT following CABG is rare, it is potentially life-threatening and often results from multiple interrelated factors. This report presents a case of recurrent ventricular tachycardia after CABG and to highlight the underlying mechanisms, risk factors, and evidence-based management strategies aimed at preventing adverse outcomes.We report a 54-year-old woman with diabetes, hypertension, prior myocardial infarction, and severe left ventricular dysfunction who underwent urgent CABG for three-vessel …

Variabel Dan Model Prediktor Perdarahan Varises Esofagus Berulang Pada Pasien Sirosis Hati Di Rsupn Dr. Cipto Mangunkusumo, Ifani Media Sari, Juferdy Kurniawan, Kemal Fariz Kalista, Aulia Rizka, Eka Ginanjar, Sally Aman Nasution, Leonard Nainggolan Md. Internal Medicine, Tropic-Infection Spesialist, Sukamto Koesnoe

Jurnal Penyakit Dalam Indonesia

Introduction. Liver cirrhosis is a chronic condition associated with severe complications, including esophageal variceal bleeding, which carries high morbidity and mortality rates. Approximately 60% of patients with cirrhosis experience recurrent bleeding within one year, with a mortality rate of 20–60% within six weeks after the initial bleeding episode. Therefore, identifying predictors of recurrent bleeding is essential for improving preventive strategies. This study aimed to identify predictors of recurrent esophageal variceal bleeding in patients with liver cirrhosis and to develop a predictive model.

Methods. This retrospective study included 220 patients with liver cirrhosis and a history of esophageal variceal …

Kontinuitas Terapi Lupus: Kesenjangan Antara Evidence-Based Medicine Dan Real-World Practice, Abirianty P. Araminta

Jurnal Penyakit Dalam Indonesia

No abstract provided.

Hubungan Penggantian Imunosupresan Tidak Terencana Dengan Aktivitas Penyakit Lupus Eritematosus Sistemik: Studi Kohort Retrospektif Di Rsupn Dr. Cipto Mangunkusumo, Jakarta, Rosvitha Amanda, Sukamto Koesnoe, Alvina Widhani, Ikhwan Rinaldi, Adityo Susilo, Juferdy Kurniawan, Rudi Putranto, Birry Karim

Jurnal Penyakit Dalam Indonesia

Introduction. Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease with diverse clinical manifestations. Treatment stabilization is crucial for optimal disease control, but the consistency of immunosuppressive therapy may be affected by non-ideal conditions, including drug unavailability or adverse effects. This study aimed to assess the association between unplanned immunosuppressant switching and increased disease activity in SLE patients.

Methods. A retrospective cohort study of SLE patients meeting the inclusion criteria, whose disease activity was evaluated using the MEX-SLEDAI score during immunosuppressant substitution. Participants were grouped into an exposed group undergoing unplanned immunosuppressant switching due to drug unavailability …

Efektivitas Penambahan Suplementasi Vitamin C Terhadap Penurunan Malondialdehid Dan Perbaikan Derajat Aktivitas Penyakit Lupus Eritematosus Sistemik: Uji Klinis Acak Tersamar Ganda, Yuniza Yuniza, Nova Kurniati, Theodorus Theodorus, Eddy M. Salim, Kristian S. Hartanto

Jurnal Penyakit Dalam Indonesia

Introduction. Vitamin C is an antioxidant that exerts its effects at multiple cellular levels. However, evidence regarding its effects in systemic lupus erythematosus (SLE) remain inconclusive. This study aimed to evaluate the potential of vitamin as an adjunctive antioxidant therapy in patients with SLE by assessing its effects on serum malondialdehyde (MDA) levels and disease activity using the Mexical Systemic Lupus Erythematosus Disease Activity Index (MEX-SLEDAI) score.

Methods. This pilot double-blind, randomized controlled trial was conducted at Dr. Mohammad Hoesin General Hospital, Palembang. Participants were patients with mild-to-moderate SLE diagnosed according to the 2019 European Alliance of Association …

Profil Biomarker Apolipoprotein B Dan Lipid Terhadap Skor Syntax Pada Pasien Sindrom Koroner Kronik, Muhammad Novran Chalik, Erwin Sukandi, Taufik Indrajaya, Ferry Usnizar, Syamsu Indra, Imran Saleh, Rukiah Chodilawati, Irfannuddin Irfannuddin

Jurnal Penyakit Dalam Indonesia

Introduction. Apolipoproteins are structural components of plasma lipoproteins that are involved in lipoprotein metabolism and lipid transport, reflecting the number of circulating atherogenic particles. The degree of coronary artery stenosis can be assessed by calculating the Synergy between PCI with TAXUS/paclitaxel-eluting stent and Cardiac Surgery (SYNTAX) score, which is an angiographic scoring system used to evaluate the complexity of coronary artery lesions. This study aimed to investigate the profile of apolipoprotein B and lipids, as well as their correlation with the SYNTAX score in patients with chronic coronary syndrome.

Methods. An observational analytic study with a cross-sectional design …

Gagal Jantung Kanan Pada Hipertiroid Tidak Terkontrol: Laporan Kasus, Kevin Lazuardy, Leonard Nainggolan, Nadim Marchian Tedyanto

Jurnal Penyakit Dalam Indonesia

Right heart failure is a clinical syndrome that is influenced by various factors. The incidence of heart failure reaches 5/1,000 population, while the prevalence of heart failure reaches 1-2% of the adult population. Management of the main etiology of heart failure is the main therapy. In some cases, hyperthyroidism is an indirect cause of heart failure, especially in right heart failure. Hyperthyroidism can cause reversible pulmonary hypertension which causes right heart failure, although the underlying mechanism is uncertain at the moment. This study reports a 46-year-old woman who was diagnosed with right heart failure and also had hyperthyroidism. In this …

Miopati Atrium, Fibrilasi Atrium, Dan Stroke: Mengungkap Hubungan Tersembunyi, Muhammad Yamin, Mohamad Syahrir Azizi, Anneira Amanda Putri

Jurnal Penyakit Dalam Indonesia

Atrial fibrillation (AF) is the most common arrhythmia and has been long recognized as a cause for atrial thrombus formation leading to cardioembolic stroke. However, recent studies reveal that the relationship between atrial fibrillation and stroke is an association rather than a temporal relationship. Left atrial thrombus formation is associated with vascular risk factor, atrial remodeling, and thrombogenesis. Various atrial electrical and structural markers of atrial myopathy have been linked to ischaemic stroke, even in the absence of AF. In addition to the CHA2DS2-VASc score as a consideration for anticoagulant administration, accurate atrial myopathy markers are needed to allow early …

Compound Role Of Using Advanced Materials And Design Procedures On Improving The Performance Of Baghdad Buildings Facades, Abeer Qasim Jbur

Al-Esraa University College Journal for Engineering Sciences

The research idea addresses improving the thermal performance of buildings in Baghdad by selecting and employing facade materials to reduce heat gain and energy consumption associated with cooling in a hot-dry climate. The study discusses the pivotal role of facade materials in interacting with solar radiation, heat transfer, and inward thermal transmittance, as well as their capacity to store and release heat in ways that maintain thermal comfort within architectural spaces and reduce reliance on mechanical cooling systems. A range of traditional materials such as stone, earth, and concrete is presented alongside modern materials like high-performance glass and thermal storage …

Real-Time Adaptive Control Of Machining Parameters In Cnc Milling Using An Ensemble Digital Twin And In-Process Vibration Monitoring For Enhanced Surface Integrity, Ali Qasim Abdulwahid

Al-Esraa University College Journal for Engineering Sciences

Achieving consistent surface integrity in CNC milling under varying materials and degraded tool conditions remains a critical challenge because fixed cutting parameters often induce regenerative chatter, accelerate tool wear, and cause surface and subsurface damage. This paper presents an integrated solution that combines an Ensemble Digital Twin (EDT), real-time in-process vibration monitoring, and a hybrid adaptive controller to maintain high surface quality while preserving productivity. The EDT fuses a physics-based milling dynamics model with a recurrent LSTM surrogate through a context-aware meta-learner that weights model outputs by process state (e.g., tool wear, engagement). A compact real-time monitoring pipeline computes a …

Effect Of Nano-Additives On Fracture Toughness Of Engineering Materials: An Experimental Study, Humam Ahmed Awad

Al-Esraa University College Journal for Engineering Sciences

Structural integrity and service life of engineering components is based on fracture resistance. The paper presents an experimental study on the nano-additive that can be added to the locally-produced Iraqi engineering materials in order to enhance their fracture toughness. The research was inspired by the increasing demand in high-performance materials in the main sectors of the country such as infrastructure and energy besides the need to improve the properties of local resources. The tested material systems were two Portland cement composites and epoxy-based polymers. Nano-silica (n-SiO₂ nano-alumina (n-Al₂O₃) and multi-walled carbon nanotubes (MWCNTs) were added …

An Intelligent System For Managing High-Priority Vehicle Routing In Smart Cities Using Artificial Intelligence And Spatial Data Analytics, Bahjat Abdulelah Madhloom

Al-Esraa University College Journal for Engineering Sciences

In developing metropolises, there is a risk to public safety in addition to the usual traffic jams. Traffic delays can have life-altering effects every second that fire trucks and ambulances are delayed. Large cities like Baghdad, which suffer from haphazard road sealing and incompetent traffic management, are especially affected, creating daily emergency crisis problems. We create a new intelligent routing system for these top priority vehicles in order to solve this life-or-death problem. Our method uses a trained model with real-time spatial information instead of outdated static maps. A Long Short-Term Memory (LSTM) neural network at its core constantly forecasts …

Evaluation Of Il-17/Il-23 Axis In Iraqi Patients With Essential Hypertension, Fatima Jalal Ayez, Manal Mohammed Kadhim

Al-Qadisiyah Medical Journal

Background: Essential hypertension is a multifactorial disorder and a major global public health concern. Emerging evidence suggests that chronic low-grade inflammation plays a key role in its pathogenesis. The interleukin-17/interleukin-23 (IL-17/IL-23) axis has been identified as a critical inflammatory pathway linking immune activation to vascular dysfunction and elevated blood pressure. Aim of study: Evaluate the IL-17/IL-23 axis including the levels of IL-17A and IL-23 in patients with essential hypertension and to investigate their potential role as inflammatory biomarkers. Patients, Materials and Methods: A case-control study was conducted in Al-Diwaniyah Governorate, Iraq, from October 2025 to February 2026. The study …

Mobile Money And Economic Wellbeing In Sub-Saharan Africa: Evidence From The 2021 Global Findex Survey, Emanuel Sulle Joseph, Martin Chegere, Kenneth Mdadila

Tanzanian Economic Review

Mobile money has expanded rapidly across Sub-Saharan Africa, accompanied by increasing mobile phone ownership and a growing number of registered users. Despite this, there is a concern about its effects on well-being. It has been argued that mobile money favoured those who were already financially included and financially stable. Therefore, the study used the Global Findex 2021 database, with a sample of 22686 respondents, to analyse the effects of mobile money on well-being and disaggregated the results by sex and location. The study employed binary probit regression and the results indicated that mobile phone ownership is not significantly associated with …

Multidimensional Screening For Quality With An Application To Health Insurance, Hector Chade, Victoria Marone, Amanda Starc, Jeroen Swinkels

Cowles Foundation Discussion Papers

We analyze a multidimensional screening model in which a principal offers a menu of quality-price pairs to a consumer with multiple dimensions of private information and a quasilinear utility function. We derive necessary conditions for optimality, and use them to provide insight into optimal exclusion, positive trade, and screening. We then recast the problem in terms of incremental quality levels and prices, the so-called demand-profile approach (DPA). Under DPA, the problem decouples across increments and can be solved one at a time. We provide novel conditions under which DPA recovers the solution to the full problem exactly or approximately, and …

Discourse Representation Of Self And Other In The 2020 Trump-Biden Presidential Debates, Victor Babajide Ogunleye, Adesina B. Sunday

Journal of English and Applied Linguistics

Presidential aspirants in the United States engage in debates during campaigns as a medium of enlightening the electorate. Existing studies on the American presidential debates have largely focused on politeness, rhetoric, syntax, and gender, with little attention to the strategies employed to construct the self and opponent(s). Therefore, this research investigates the discourse representation in the presidential debates between Trump and Biden using van Dijk’s socio-cognitive model of critical discourse analysis. Ten excerpts were purposively selected for their relevance in illustrating representation strategies. The analysis revealed positive self-representation and negative other-representation. Positive self-representation featured the self as competent, honest, altruistic, …

Arrhythmia Burden And Clinical Responses Under Continuous Monitoring In Heart Failure: Observations From The Alleviate-Hf Trial., Rami Kahwash, Javed Butler, Muhammad Shahzeb Khan, David Zhang, Jonathan Dukes, Madhu Reddy, Rachel M Kaplan, Anish Amin, Rahul Kanwar, Shantanu Sarkar, Verla Laager, Jennifer Wehking, Brian Van Dorn, Bart Gerritse, Nirav Patel, Aimee Laechelt, Michael R Zile, Alleviate-Hf Investigators

OhioHealth Research Institute Articles

BACKGROUND: Arrhythmia burden in ambulatory patients with symptomatic heart failure (HF) without cardiac implantable electronic devices (CIEDs) is not well defined, and it remains uncertain whether device-guided remote congestion management modifies arrhythmia occurrence.

OBJECTIVES: The goal was to assess whether arrhythmia burden differed between randomized congestion-management strategies and characterize the occurrences and associations of insertable cardiac monitor (ICM)-detected arrhythmias with therapeutic actions and clinical events.

METHODS: In ALLEVIATE-HF, patients with NYHA functional class II-III HF with any ejection fraction (EF) and a recent HF event, without prior CIEDs, underwent ICM implantation and were randomized to ICM-guided, physician-directed, nurse-facilitated congestion management …

Exploring The Role Of Circulating Mir-21 As A Potential Biomarker For Celiac Disease In Pediatric Patients, Shaymaa M. Jabbar, Manal M. Khadhim

Al-Qadisiyah Medical Journal

Background: This training explored the possibility of circulating miR-21 as a biomarker for celiac illness (CD) in pediatric patients. The demographic and clinical characteristics were compared between groups. A case-control design was employed with 45 pediatric CD patients and 45 healthy controls. Aim: The present training stayed directed to exploring the expression of circulating miRNAs in those sick with celiac disease—three miRNAs—miR-21-3p. Methods: Blood samples were collected from participants, and RNA was isolated. miR-21 expression was quantified using STEM-LOOP RT-qPCR. Demographic data (age, gender, residence) and clinical features (family history, disease duration, symptoms) were collected. Serological tests for CD diagnosis …

Interaction Between Tnf Inhibitors And Serum Il21levels With Susceptibility To Rheumatoid Arthritis, Maryam Yaseen Shaker, Orass Madhi Shaheed

Al-Qadisiyah Medical Journal

Background: Objectives: To estimate the significance of the central role of the immunological marker IL-21 level and know the interaction between TNF inhibitors and IL-21 with susceptibility to rheumatoid arthritis (RA) sickness. Material and Methods: Serum testers were obtained from three distinct categories: the initial group consisted of those sick and diagnosed with RA who were undergoing treatment with TNF inhibitors, the second group included individuals who were recently diagnosed with RA, and the third group comprised healthy volunteers. The serum from this sample was utilized for quantifying the levels of IL-21 using the ELISA technique. Result: The level of …

Building An Inclusive Workforce: Closing Equity Gaps In Community Colleges And Vocational Schools With Elliott’S Embodied Inclusion 360 Framework Plain Language Summary, Niki Elliott Ph.D.

Inclusion in Postsecondary Education

This paper explains why community colleges and vocational schools need to do more to support students who are neurodiverse (such as students with ADHD, autism, dyslexia, or mental health conditions), especially students of color and men of color. Community colleges and vocational schools serve millions of students and are often the main path to good-paying jobs in the skilled trades. However, many students who enroll, especially students with disabilities and students of color, do not complete their programs. The article argues that schools must move beyond basic disability accommodations and instead redesign how they teach, support, and structure learning environments.