AV fistula allows external vascular access for hemodialysis patients. Because hemodialysis patients experience puncture wounds and stabbing pain approximately 300 times a year, development of methods to decrease pain intensity are of great importance. Some techniques, such as the Valsalva maneuver, are known to reduce pain. This study aims to assess the effect of the Valsalva maneuver on decreasing the intensity of AV fistula pain in patients receiving hemodialysis. The quasi-experimental research of pre and post without control applying consecutive sampling to get as many as 63 respondents. Pain intensity was measured by using the Numerical Pain Rating Scale (NPRS). The Valsalva maneuver was performed during insertion of the AV fistula needle for 16-20 seconds. The results showed significant differences in pain intensity between before and after the intervention with the difference in mean that is 1.35 (SD= 0.54), t= 19.70, p= 0.001. The Valsalva maneuver is effective in reducing the pain of AV fistula insertion because it stimulates the vagus nerve to induce an antinociceptive effect. Nurses are highly recommended to teach the Valsalva maneuver to patients undergoing routine hemodialysis.

Coronary heart disease (CHD) is a chronic inability of heart to draw an adequate blood on myocardium due to specific problem in coronary artery. When the artery that supplies myocardium is interrupted, thus the heart is unable pumping the blood effectively to fill up an adequate blood perfusion to vital organs and other peripheral tissues. If the perfusion is impaired in time of oxygenation, the patient will threatened by a sudden death. This is a quantitative, analytical and observational research with a design of case study control, in which the subject is CHD patients and the control is non-CHD patients. The research populations were 2318 outpatients with CHD who visited Heart Polyclinic at Zainoel Abidin Hospital Banda Aceh. The sample studied were 92 patients with CHD and 92 patients with non-CHD (control). We used primary and secondary data that processed through editing, coding, entry, cleaning and tabulating. The data was analyzed using univariate, bivariate and multivariate analysis. The results showed that the CHD occurrences are significantly influenced by eating behavior (p = 0,000), smoking habit (p = 0,000) and sporting habit (p = 0,000). Therefore, health workers are expected to increase health promotion in order to improve the quality of life of people, especially in elderly people, by adopting a healthy lifestyle and avoiding CHD risk factors. Moreover, people are also suggested to take regular lipid profile check up and keep off smoking habit in order to do early prevention of CHD.

AbstrakMenurut data Riskesdas (2013) sebanyak 40 persen orang meninggal karena serangan jantung tidak mengetahui kalau dirinya mengidap penyakit jantung koroner. Bila ditinjau dari gaya hidup masyarakat Aceh ada beberapa faktor risiko meningkatkan kejadian PJK terutama bila dilakukan secara berlebihan, antara lain merokok, minum kopi, makan makanan berlemak dan kurangnya aktifitas fisik serta tidak mampu mengendalikan stress. Faktor-faktor tersebut sebagai gaya hidup sangat berpotensi meningkatkan risiko PJK yang dibuktikan dari beberapa laporan statistik menunjukkan PJK di Aceh tertinggi. Tujuan penelitian untuk menganalisis determinan gaya hidup penderita penyakit jantung koroner di Rumah Sakit Zainoel Abidin. Penelitian kuantitatif dengan desain case control pada Bulan April 2017 di RSUD Zainoel Abidin menganalisis 206 kasus PJK dan 206 non PJK berdasarkan dokumen rekam medik dan menggunakan kuesioner tentang gaya hidup yang telah diuji validitas dan reliabilitas. Hasil penelitian menunjukkan determinan gaya hidup yang berhubungan bermakna adalah pola pengendalian stress, gaya hidup dan minum kopi dengan PJK (p<0,05), sedangkan pola makan tidak menunjukkan hubungan bermakna dengan PJK (p>0,05). Determinan gaya hidup yang paling dominan sebagai faktor risiko PJK adalah pengendalian stress dan kebiasaan minum kopi, yaitu pasien dengan riwayat pengendalian stress yang kurang efektif dan kebiasaan minum kopi lebih berisiko 4 kali dibandingkan pasien dengan pola pengendaian stress yang efektif dan tidak memiki kebiasaan minum kopi. Pengaruh gaya hidup terhadap PJK turut dipengaruhi oleh faktor pendapatan. Implikasi penelitian menawarkan kebijakan keterlibatan aktif berbagai pihak untuk melakukan upaya-upaya promotif dan preventif dengan melibatkan masyarakat dengan mengembangkan berbagai inovasi. Kata Kunci: Determinan, gaya hidup, penyakit jantung koroner, RS Zainoel Abidin AbstrackAccording to Riskesdas data (2013) as many as 40 percent of people die due to no heart attack know that he has coronary heart disease. When viewed from the lifestyle of the people of Aceh there are several risk factors for increasing the incidence of CHD, especially if done excessively, including smoking, drinking coffee, eating fatty foods and lack of physical activity and unable to control stress. These factors as lifestyle have the potential to increase the risk of CHD as evidenced by several statistical reports showing the highest CHD in Aceh. The purpose of this study was to analyze the lifestyle determinants of patients with coronary heart disease at Zainoel Abidin Hospital. Quantitative research with case control design in April 2017 at Zainoel Abidin Regional Hospital analyzed 206 cases of CHD and 206 non-CHDs based on medical record documents and used a questionnaire about lifestyle that had been tested for validity and reliability. The results showed that lifestyle determinants that were significantly related were stress control patterns, lifestyle and drinking coffee with CHD (p <0.05), while diet did not show a significant r...

AV fistula allows external vascular access for hemodialysis patients. Because hemodialysis patients experience puncture wounds and stabbing pain approximately 300 times a year, development of methods to decrease pain intensity are of great importance. Some techniques, such as the Valsalva maneuver, are known to reduce pain. This study aims to assess the effect of the Valsalva maneuver on decreasing the intensity of AV fistula pain in patients receiving hemodialysis. The quasi-experimental research of pre and post without control applying consecutive sampling to get as many as 63 respondents. Pain intensity was measured by using the Numerical Pain Rating Scale (NPRS). The Valsalva maneuver was performed during insertion of the AV fistula needle for 16-20 seconds. The results showed significant differences in pain intensity between before and after the intervention with the difference in mean that is 1.35 (SD= 0.54), t= 19.70, p= 0.001. The Valsalva maneuver is effective in reducing the pain of AV fistula insertion because it stimulates the vagus nerve to induce an antinociceptive effect. Nurses are highly recommended to teach the Valsalva maneuver to patients undergoing routine hemodialysis.

BACKGROUND: Many studies have reported that diabetes mellitus correlates with vascular calcification event that increases progressively in uncontrolled diabetes. Osteoprotegerin (OPG) is known to act as a promoter in vascular calcification, contrary to Matrix Gla Protein (MGP), which is an inhibitor in vascular calcification. The aim of this study was to observe the progress of vascular calcification in uncontrolled diabetes patients by assessing biochemical markers OPG as promoter and MGP as inhibitor in vascular calcification.METHODS: This was an observational study with cross sectional design on adult male patients with type 2 diabetes mellitus, defined by DM Consensus Criteria Indonesia, 2006.RESULTS: The results of this study showed that there was a positive significant correlation between OPG and HbA1c (r=0.261, p=0.030), in contrast with MGP that showed no significant correlation with HbA1c. OPG also correlated significantly with Fasting Plasma Glucose (r=0.261, p=0.014). In uncontrolled diabetes group there was positive significant correlation between OPG and HbA1c (r=0.397, p=0.014). There was no significant difference found in the levels of OPG in controlled and uncontrolled diabetes groups (p=0.567), but OPG/MGP index showed higher difference (p=0.259). The OPG/MGP index also had positive significant correlation with HbA1c (r=0.285, p=0.018) and Fasting Plasma Glucose (r=0.313, p=0.009).CONCLUSIONS: This study suggested progress to vascular calcification in uncontrolled type 2 diabetes mellitus. The use of vascular calcification biomarkers are recommended to predict/detect vascular calcification event in type 2 diabetes mellitus patients.KEYWORDS: type 2 diabetes mellitus, vascular calcification, OPG, MGP, HbA1c

γ-GT in Predicting Coronary (eart Disease Arifin M, et al.) )ndones Biomed J. ; : -DO): . /inabj.v i .

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Background: Acute Coronary Syndrome (ACS) is one of the main problems in the field of cardiovascular diseases because of high hospitalization rate, high mortality and high medical cost. Rapid and accurate risk stratification is needed to calculate the risk of complication and right now exist two most used score which is GRACE and TIMI. Heart score has 5 simple variables that can be calculated easily and this score considered to have better predictive ability compared to other score. The aim of this study is to examine HEART score as a predictor for in hospital Major Cardiovascular Event (MACE) in patient diagnosed as Non ST Segment Elevation Acute Coronary Syndrome (NSTEACS) that hospitalized at Haji Adam Malik (HAM) General Hospital Medan. Methods: This is a prospective cohort study that includes 52 NSTEACS patient that hospitalized at HAM General Hospital since November 2018 until January 2019. Patient that diagnosed as NSTEACS were calculated for GRACE, TIMI, and HEART score then observed during hospitalization. Outcome of this study is MACE during hospitalization. Statistical analysis was performed to test HEART score as MACE predictor and then comparison was done with GRACE and TIMI Results: By using ROC curve analysis, the cut-off value of HEART score was 5 (AUC 0.947, 95% CI 0.883-0.997, p<0.01). Study subject that experienced MACE with HEART score ≥5 was 21 patients (87.5%) compared to 2 patients (7.1%). HEART score ≥5 can predict MACE with sensitivity 87.5%, specificity 92.9%, negative predictive value (NPV) 89.7% and positive predictive value (PPV) 91.3%. ROC curve comparison was done between HEART with GRACE and TIMI then it was found that HEART score has better predictive ability compared to TIMI and GRACE (AUC 0.947 vs 0.829 vs 0.807, p < 0.01). Conclusion: HEART score can be used as MACE predictor which is relatively simpler but have better predictive ability compared to GRACE and TIMI.