ERMIN DUNIA KEDOKTERAN __....-u

(ERMIN
r--~'-_o-,---
DUNIA KEDOKTERAN
ISSN: 0125-913 X 1171/ vol. 36 no. 5/ Agustus 2009
A:""'_~""~-"
__
""~"'-
__
':'" .~
.• "'~~~
....-u_
__
__~ __
http.//www.kalbe.co.id/cdk
~,"'-'4-
,_. __
•
i
•
HASIL PENELITIAN
Efektivitas Larutan Antiseptik
Klorheksidin Glukonat 0,5%
yang Tergenanguntuk
Cuci Tangan"
TIN.!AUAN PUSTAKA
Toxic Shock Syndrome
Prospect of Nucleic-Acid Based Immune
System - RNAi as Potent
Antiviral Agerits
PROFIL
Prof. Dr. Djoko Widodo,
DTM&H, SpPD-KPTI
Pasien adalah Sumber IImu
yang Tidak Terbatas
1
.
~~;,.<:--
. f'~:.:;
;l, >.C~A: .
~
_
INFORMATIKA
KEDOKTERAN
'.
:ir
,
(
Sistem Informasi Kesehatan
dari tv'1asake Masa
Johan Harlan
Pus at Studi informatika
Universitas Gunadarma
Kedoktcran
Jakarta. Indonesia
Sistem Informasi dan Teknologi
Informasi
Sistem informasi adalah suatu tatar.an
informasi (data), proses, manusia, dan
teknologi informasi yang saling berinteraksi untuk mengurnpulkan, mengolah,
menyimpan, dan menyediakan keluaran
informasi yang dibutuhkan untuk menunjang organisasi. Teknulogi informasi adalah kombinasi antara teknologi komputer
(perangkat keras dan lunak) dengan data
dan teknologi telekomunikasi (jejaring
data, citra, dan suara). Teknologi informasi
merupakan salah satu komponen sistem
informasi, walaupun di masa kini istilah
sistem informasi seringkali dianggap sarna
dengan teknologi informasi (Wager et al,
2005).
kecil daripada komputer mainframe, namun berkemampuar. lebih tinggi. Perkernbangan teknologi informasi sejak 1980-an
mentransformasikan
proses komputasi
yang sebelumnya semata-rnata bersifat otomatisasi ini menjadi sistem penunjang bagi
dokter, perawat, serta pemasok layanan
kesehatan lainnya. Ketersediaan akses terhadap Internet dan jejaring komputasi di
masa kini dan akan datang diharapkan
akan dapat memperluas ranah sistem informasi kesehatan dalam komunitas dengan fokus untuk memberdayakan pasien
(Gambar 1; de Velde & Degoulet, 2003).
Kompleksitas
Perkembangan Sistem Informasi
Kesehatan
Fenggunaan komputer dalam bidang
layanan kesehatan bermula sejak awal
1960-an, dalam bentuk sistem informasi
rumah sakit (Hospital Information System;
HIS), yang mencakup fungsi administratif
maupun medis. Sistem ini terutama diranc~ng atas dasar orientasi keuangan untuk
memfasilitasi manajemen penagihan biaya
serta keluar-masuknya dan perjanjian bagi
pasien dengan menggunakan perangkat
teknologi informasi yang tersedia pada
waktu itu yaitu komputer mainframe. Dalam perkembangan selanjutnya, tersedia
pula layanan tambahan secara departemental (yang berdiri sendiri-sendiri) untuk laboratorium, apotek, dan radiologi.
Pada saat itu telah tersedia komputer
berskaia-menengah yang berukuran lebih
1960
r
1980
1990
2000
2010
Gambar 1. Arah perubahan teknologi informasi dalam sektor kesehatan
(de Velde & Degoulet, 2003)
",CDK
386
1970
I AGUSTUS
2009
2020
-~;~.~"~
7
...
Ii
I!J
~
..
INFORMATIKA
KEDOKTERAN
001 '.
\
Gambar 2. Evolusi sistem
informasi rumah sakit (de Velde &
Degoulet, 2003)
HIS : Hospital Information System
CHIN: Community Health Information Network
Proses otomatisasi medis yang bersifat departemental (berdiri sendiri-sendiri)
mernbentuk sistem departemental
tututup. Sistem ini relatif tidak efisien derigan
seringnya terjadi pengulangan pengumpulan data yang sarna untuk gudang penyimpanan data yang berbeda (redundant
storag~). Untuk meng ••fisienkan pernanfaatan data, dikembangkan sistem informasi
rumah sakit tersentralisasi (HIS tersentralisasi) dengan satu basis-data tunggal
untuk menyimpan seluruh data rumah
sakit, narnun perluasan dan penarnbahan
berbagai fasilitas dalarn suatu rumah sakit
menyebabkan
basis-data tunggal menjadi sangat besar dan kompleks. Basis-data
tunggal yang sangat besar dan kompleks
akan memperlambat proses komputasi, selain iru tiap pernbaharuan yang relatifkecil
akan mernbutuhkan restrukturisasi besarbesaran pada basis-data.
Alternatif yang iebih menguntungkan
ialah dengan mengembangkan sistem departemental
federasi sebagai perbaikan
terhadap sistem departemental
tertutup.
Dalam sistem departemental federasi, data
tetap tersebar di sejumlah basis-data yang
berorientasi ranah masing-masing seperti
laboratorium, apotek, radiologi, dan sebagainya, tetapi saling terinterkoneksi secara
logik (relational databases) dan aksesibel
secara kcmbinasi untuk prose~ komputasi
dan berbagai aplikasi pada satu komputer
sentral.
Dalam tahap lebih lanjut, ketersediaan
workstation multimedia te1ah me mungkinkan dikembangkannya
sistem informasi I umah sakit terdistribusi (HIS terdistribusi). Dalain sistem informasi rumah
sakit terdistribusi, basis-data tetap tersebar
di berbagai bagian rumah sakit dan saling terinterkoneksi
dalam suatu jejaring
area-lokal (local area-network; LAN). Di
masing-masing
bagian rumah sakit ini
tersedia komputer lckal (workstation) yang
dapat melakukan proses komputasi dengan
mengakses basis-datanya sendiri maupun
basis-data bagian lain yat1.gierinterkoneksi
dalarn jejaring (Ccltri, 2006).
Perkembangan terbaru yang lebih menekankan pada pernberdayaan pasien dalam ranah komunitas telah menghasilkan
pengembangan aplikasi sistem informasi
rumah sakit terdistribusi dalam jejaring informasi kesehatan komunitas (Community
Health Information Networks; CHIN). Di
sini keseluruhan sistem informasi rumah
sakit rnaupun sistern informasi berbagai
sentra layanan kesehatan lainnya saling
terinterkoneksi dalam satu jejaring informasi kesehatan komunitas.
Jejaring dan Komunikasi Data
Kesehatan
Komunikasi data adalah transmisi data
elektronik di dalam ataupun antar kornputer dan devais (d~"ice; peralatan) lain
yang berkaitan. Untuk melakukan kornunikasi antar dua program atau dua devais
yang berbeda harus dibangun suatu antariCDK
muka (interface). Dalarn suatu jejaring
komputer (computer network) seperti jejaring area-Iokal diperlukan adanya protokol,
yaitu seperangkat aturan dan sinyal yang
digunakan oleh komputer dalarn jejaring
untuk saling berkomunikasi. Keberadaan
protokol akan membatasi dan mengurangi, walaupun tidak dapat menghapuskan
penggunaan antar-rnuka. Contoh protokol
antara lain yaitu Transmission Control
Protocol/Internet Protocol (TCP/IP) yang
digunakan pada trasmisi data dari server
pengunduh
dalarn jejaring Internet ke
komputer pengguna.
Untuk mengembangkan
JeJarmg informasi kesehatan komunitas, harus diupayakan pencapaian interoperabilitas antar
komputer diberbagai institusi layanan kesehatan, yaitu kemampuan untuk melayani
pertukaran data antar sistem informasi institusi. Pencapaian interoperabilitas dalarn
kornunikasi dan transmisi data elektronik
pada layanan kesehatan ini hanya dimungkinkan dengan adanya standar, yaitu protokol yang dapat diterima dan digunakan
oleh sekurung-kurangnya
sebagian besar
dari institusi layanan kesehatan sedunia.
Tiga standar pertukaran data yang terpenting yang ada pad a saat ini untuk transmisi data layanan kesehatan ialah HL7,
DICOM, dan MIB. HL7 (Health Level 7)
adalah standar untuk transmisi data teks,
DICOM (Digital Imaging and Communications in Medicine) adalah standar untuk
transmisi data citra (image), sedangkan
I AGUSTUS 2009
387
r
~- ~4;;.Ji--
A·r4~-.c:
./~~
:!l~
~lw.
INFORMATIKA
KEDOKTERAN
.,
MIB (Medical Information Bus) adalah
standar untuk transmisi data dari devais
sisi-ranjang (bedside devices) yang umumnya berupa grafik (Gambar 3). Ketiga standar ini dikembangkan dengan maksud untuk penggunaan global sedunia, sedangkan
untuk implernentasinya masih dibutuhkan
pengcmbangan versi lokal di masing-masing negara yang berminat.
-
.
Komunikasi klinik dan administratif
Komunikasi devais sisi-ranjang
Pengambangan dan Aplikasi
Sistem Inforrr.asi Kesehatan di
Masa Depan
Pembahasan mengenai standar di atas
hanya merupakan sebagian di antara sejumlah besar permasalahan
yang harus
diatasi dalam pengembangan Sistem Informasi Kesehatan. Kemajuan teknologi tidak
dapat langsung diterapkan, dibutuhkan
waktu beberapa tahun sebelum pemikiran
manusia dapat melihat manfaatnya dan
bersedia untuk menerirnanya.
Beberapa tahun berikutnya dibutuhkan
untuk
mengimplementasHcannya
dalam suatu
sistem informasi, dan setelah irnplementasinya ternyata menimbulkan permasalahan lain, baru biasanya akan ada upaya
untuk menyusun regulasi administratifnya
(Gambar 4).
Komunikasi Citra
Gambar 3. Standar pertukaran data pada sistem informasi rumah sakit
(de Velde & Degculet, 2003)
T;mnutakhirkan,
teradaptasi
Regulasi
Administratif
1
i
3
5
4
6
8
9
10
11
12
13
14
15
Kerangka Waktu (Tahun)
Kadaluwarsa,
tak teradaptasi
Gambar 4. Dampak perubahan teknologi terhadap pemikiran manusia,
organisasi, dan regulasi administratif (de Velde & Degoulet, 2003)
Kepustakaan
18
1.
Coltri A, 2006, Databases in Health Care, dalam Aspects of Electronic Health Record Systems, 2nd edn, eds Lehmann HP et ai, Springer, New York, pp 225-25l.
2.
de Velde RV, Degoulet P,2003, Clinical Information
3.
Wa'ger KA, Lee FW, Glaser JP,2005, Managing
System: A Component·Based
Health Care Information
$CDK
Approach, Springer, New York.
Systems: A Practical Approach for Health Care Executives,Jossey·Bass, San Francisco.
I AGUSTUS
2009
(ERMIN
DUNIA KEDOKTERAN
http.//www.kalbe.co.id/cdk
ISSN: 0125-913 X I 181 / vol. 37 no. 8 / November - Desember 2010
HASIL PENELITIAN
TINJAUAN
MMPI-2 Score among Indonesian
High School Graduates Detected
as Substance User
PUSTAKA
Aripiprazol sebagai Terapi Tambahan
pada Gangguan Depresi Mayor
---
-- .. --~-----
..-
----~ ._
PROFIL
Dr. Tun Kurniasih Rastaman, Sp.KJ
"Semua Dokter (hendaknya) Ingat
Sumpah Hipocrates"
.... - .-. --~-.-
..- ....-....
_.
_._ .. _
...
-.- ...-.... _ ..-
t.~
- (!J"'~';(!J
1!J~""ff~ HASIL PENELITIAN'...---~:-==-----
_
MMPI-2 Score among Indonesian
High School Graduates Detected
as Substance User
Johan Harlan
Informatics Study Center, Gunadarma University Jakarta, I
INTRODUCTION
MMPI serves as the most widely used personality inventory,
i.e. to generate descriptions of and inferences about respondents based on their test results.' Substance users are presumed to exhibit distinct personality aspects.s-' that could be
detected by MMPI test.
This study is intended to obtain personality aspects of substance users based on their MMPI test results, and to compare them with personality aspects of non-users.
MATERIAL AND METHODS
The tern, 'substance users' in this study includes narcotic users (morphine and its derivatives) as well as psychotropic and
other illicit substance users (benzodiazepines and its derivatives; marijuana; amphetamine and its derivatives; and methamphetamine and its derivatives).
The detection of users were based on urine test results, supported by questionnaire on history of narcotics and other illicit
substance use, and psycho!ogical interviews. Based on urine
test (table 1), the users are classified as THe users (marijuana;
tetrahydrocannabinol), BZO users (benzodiazepines or its derivatives), AMP users (amphetamine or its derivatives). MET
users (methamphetamine or its derivatives). and MOP users
(morphine or its derivatives).
574
~ CDK
I
NOVEMBER·
Urine tests were performed on all candidates enrolled in
Gunadarma University in 2006 as part of screening tests
for new students. The screening tests were conducted in
several sites in Jakarta and West Java, Indonesia. All candidates who were detected as users were included in the
study sample. For each user, a non-user candidate of similar gender was selected as control. The control subject was
the one with nearest registration number with his / her substance user counterpart.
After obtaining informed consent from each respondents,
they vsete asked to complete questionnaires on demographic data and history of narcotics and other illicit substance use, and underwent MMPI-2 tests The main scales
of interest in this study are validity scales, clinical scales,
and content scales (table 2).
Sample size calculation was not done, as the study is exploratory in design; and the overall users to be detected
are estimated to be small in number, hence all of them
should be recruited as study sample.
Data processing and statistical analyses were done with
STATA 8. Mean differences of various MMPI scale scores
between user and non-user groups were analyzed with
Mann-Whitney test, as the sample size was presumed to be
DESEMBER
2010
~~
HASIL PENELITIAN
small in number.
Table 1. Types of urine tests in substance
~~
user study, '2006
RESULTS
A total of 5560 candidates (3582 males and 1978 females)
were examined during enrollment process; 21 (18 males and
3 females) were detected as substance users. Eighteen male
candidates were detected as THe users and 3 females were
detected as BZO users; 2 male- and 1 female users withdrew
early in the enrollment process, leaving 16 male- and 2 female users in the study. No other type of illicit substance user
was detected among the examinees. As control, 18 non-user candidates (16 males and 2 females) were recruited. Total
sample size was 36. After obtaining detailed explanation on
the study objectives, all 18 users and 18 non-users gave their
informed consent and agreed to join the study.
Table 2. The main scales of interest in substance
user study, 2006
Basic characteristics of study population are shown in table
3. The two groups are fairly comparable. The sole obvious
different characteristic is first-child position - 66.7% among
users vs 38.9% among non-users. Average number of siblings is 3.17 in user's family vs 3.50 in non-user's family.
Assessment of L, F, and K validity scale scores shows that
all test results are invariably valid. Although maximum
true-scores for the L, F, and K scales are 79, 82, and 78
consecutively," not a single invalid profile is found. The
mean raw-scores of validity scales for the user and non-user
groups are shown in table 4.
Table 3. Basiccharacteristics of respondents in Indonesian substance user study, 2(X)6
The mean raw scores of clinical scales fer user and nonuser groups are showed in table 5. Statisticaiiy significant
difference was detected for Scale 0 (Social Introversion) (p
= 0.035), but the result of this exploratory study can not be
generalized as that obtained from a confirmatory one. In
Scale 2 (Depression) and Scale 3 (Hysteria), the p values are
0.099 and 0.090 consecutively, which might be statistically
significant should the sample size is greater.
The mean raw-scores of content scales are shown in table
6. The only content scale that is statistically significantly different between groups was Scale FRS (Fears). ( p= 0.005).
DISCUSSION
Substance users prevalence (positive urine test-result
prevalence) of 2.07%, 3.31%, 2.00%, and 0.49% had been
detected during the Gunadarrna University enrollment processes in 1994, 1997, 2000, and 2003 consecutive I!" but
these results cannot be compared, as the types of urine
tests are net similar. The urine tests in 1994 was only for
THe and MOp, while in 2003 and 2006 the tests were for
THe, BZO, AMp, MET. and MOp'6
Positive urine test-result prevalence decreased since 2001.
In 2001, 2002, and 2004 the detected user prevalence were
0.94%, 0.75%, and 0.42% consecutively'", The decreased
prevalence may be just the consequence of decreased
4CDK
Table 4. MMPI-2 validity scale scores in Indonesian substance user study, 2006
*) Mann-Whitney test
I NOVEMBER· OESEMBER 201 0
575
!!I"1~
.~
HASIL PENELITIAN
Table 5. MMPI-2 clinical scale scores in Indonesian substance user study, 2006
versity (28.6% if the average number of child in the family is
3.50). and the proportion of respondents who are the first
child is obviously higher in the user group.
Statistical analyses showed that THC and BZO users are
more socially introverted than control group (table 5).
They might also tend to be more depressed and hysterical (table 5). Assessment of the FRS scale scores indicates
*) Mann-Whituey
greater likelihood for substance users to report multiple
specific fears or phobias.' compared with non-user group.
Substance users in this study do not include severe dependence (perhaps also moderate dependence).
test
Table 6. MMPI-2 content scale scores in Indonesian substance user study, 2006
Drug Dependence Hospital, Jakarta data showed that
more than one third of its drug-dependent patients (47.8%
in 2002) were senior high school graduates.4
As this study is still exploratory, we hope to test the hypotheses generated in this study in a specially designed
confirmatory study with greater sample size.
Acknowledgements.The author is particularly indebted
to Drs. Zainuddin SK, MPsi and Prof. Dr. Suprapti S. Markam
(clinical psychologists). for their kind review of the manu- .
script.
REFERENCES
*) Mann-Whitney
test
Graham JR. MMPI-2: Assessing personality
and psychopathology.
Npw
York: Oxford University Press; 1990.
number of substance users who enroll the university. In DrugDependence Hospital, Jakarta, Indonesia, the reported
number of narcotic patients increased four-fold during the
period of 2000-2004.7
2.
Anthony Jc. Epidemiology
of drug dependence.
In' Galanter M, Kleber
HD, .editors. Textbook of Substance Abuse Treatment. 2nd ed. Washington, DC: American Psychiatric Press, Inc; 1999. p. 47-58.
3.
Cloninger CR. Genetics of Substance Abuse. In: Galanter M, Kleber HD,
editors. Textbook of Substance Abuse Treatment. 2nd ed. Washington,
In our annual screening test for new students, the pattern
of results remain the same, mostly consist of THC users'", It
should be noted that most narcotic prisoners initially consumed marijuana before turning to other illicitsubstances,"
DC: American Psychiatric Press, Inc; 1999. p. 59-66.
4.
Information
scriptions
and Data Center, Health Ministry, Republic of Indonesia. Deof narcotics and substance abusers in treatment
institutions
for narcotics and substance abusers, 2001-2003 [in Indonesian]. Jakarta:
Health Ministry, Republic of Indonesia; 2004.
Miv1PI-A (adolescent) is recommended for 17 years old respondents': but the respondents were already graduated
from high-school and had social relations with older school
mates. Hence, they were not considered suitable to undergo
MM~I-A test which contains adolescence-specific items in the
areas of identity formation, school and teachers, etc.t lt should
also be noted that some formal institutions nowadays also use
MMPI-2 test for 17 year-old respondents.'? We also need one
sole standard test for the all respondents in our study.
5.
Indonesian]. Jurnailimiah
6.
576
$COK
scales for In-
Penelitian Psikologi. 2005 Jun;l(10):1-10.
Harlan J. Execution report of medical examination
and narcotics / illicit
substance using screening test for new students, Gunadarma
University,
1994-2006 [in Indonesian).
University;
Final report. Jakarta: Gunadarma
2006. Sponsored by Gunadarma Health Foundation.
7.
Padmo L. Community-based
prevention of substance abusing [in Indone-
sian; cited 2006 Oct 1). Available from: http://www.bnn.go.id.
8.
Another interesting fact is greater proportion of 'first child in
the family'among users (66.7%) compared with in non-user
group (38.9%). This may indicates greater likelihood for the
first child in the family to become substance user among
sample subjects. Based on the average number of children
in the non-user families, a slight and non-significant increase
in probability was noted for the first child to enroll at the uni-
Harlan J. Standard values of MMPI-2 validity and content
donesian hospital employees and senior high school graduates, 2003 [in
Martin. Executive summary of "Narcotics
prisoner
problem
research in
Indonesian jails, 2003" [in Indonesian; cited 2006 Oct 1). Available from:
http://www.bnn.go.id.
9.
Lanyon RI, Goodstein
LD. Personality Assessment. 3rd ed. New York: John
Wiley & Sons, Inc; 1997.
10. Benet WE. Psychological assessment: testing and practice resources [updated 2007 October 2; cited 2007 November
www.nlm.nih.gov/bsd/uniform_requirements.html.
I NOVEMBER· DESEMBER 2010
10). Available from: http://