<b>Background:</b> Employing a knowledge broker (KB) is one way to transform ideas into action, especially in relation to the development of a specialized hospital. This study aimed to explore the concept of knowledge brokering intervention in the development of a specialize hospital in Indonesia.<br /> <b>Methods:</b> A descriptive qualitative method was applied in this study to collect detailed, rich data from a small number of participants. A snowball sampling approach was chosen to recruit 17 participants from various backgrounds who have worked with KB of a specialized hospital. The data analysis was performed using a content analysis method to identify the themes and categories.<br /> <b>Results: </b>Five themes and 14 categories were constructed for developing the knowledge brokering intervention in the development of a specialized hospital in Indonesia. The themes included characteristics of KB, the role of KB, demand brokering, various perceptions of specialized hospitals, and challenges in developing the specialized hospital.<br /> <b>Conclusion:</b> The findings suggest that the framework of the knowledge brokering intervention consisted of individual and interpersonal capabilities. Characteristics of KBs should be introduced that are trained in all development settings to boost the achievement of the goals in the health sector. The researchers suggest that the concept of KB should be considered for realizing national projects, as this will escalate the health development of the country. This study contributes to the identification and connection of indicators on health knowledge brokering in translating science into practice at specialized hospital in Indonesia.
EFFECTIVITY OF DONEPEZIL IN COGNITIVE FUNCTION OFPOSTOPERATIVE INTRACRANIAL TUMOUR PATIENTSABSTRACTIntroduction: There is still a lack of effective therapy in improving cognitive dysfunction in intracranial tumour patients after surgery. Donepezil is an acetylcholinesterase inhibitor that has been a therapy of Alzheimer's disease and has a significant effect on improving cognitive function.Aim: To determine the effectiveness of donepezil on cognitive function in patients with postoperative intracranial tumours.Methods: A clinical, randomized, double-blind study was conducted on postoperative intracranial tumour patients categorized into two groups (donepezil and placebo). The intervention was donepezil 5mg once a day for three months. For assessment of cognitive function, Mini-Mental State Examination (MMSE) and Indonesian Version of Montreal Cognitive Assessment (MoCA-Ina) was checked at weeks 0 (baseline), 4 (end of the first month), 8 (end of the second month), and 12 (end of the third month). Data were analyzed using SPSS 22.Results: Twenty patients, equally distributed in two groups, were included in the study. Compared to baseline, MMSE and MoCA-Ina scores in the donepezil group increased significantly on the second and third month (p<0.001). There was a remarkable difference in cognitive function between two groups on the third month based on MMSE and MoCA-Ina scores (p=0.027 and 0.024, respectively). At post-intervention, orientation and recalldomain in MMSE showed marked improvement, while visuospatial and delayed recall domain experienced as well in MoCA-Ina. There were no significant side effects of donepezil.Discussion: This results can be considered for administration of donepezil in patients with intracranial tumours after surgery with impaired cognitive function.Keywords: Cognitive function, donepezil, intracranial tumour, MMSE, MoCA-Ina, surgeryABSTRAKPendahuluan: Saat ini belum ada terapi yang efektif dalam memperbaiki gangguan fungsi kognitif pada pasien tumor intrakranial pascaoperasi. Donepezil merupakan inhibitor asetilkolinesterase yang telah menjadi terapi dari penyakit Alzheimer dan memiliki efek yang bermakna dalam memperbaiki fungsi kognitif.Tujuan: Mengetahui efektivitas donepezil terhadap fungsi kognitif pasien tumor intrakranial pascaoperasi.Metode: Studi uji klinis, acak, tersamar ganda dilakukan pada pasien tumor intrakranial pascaoperasi dengan gangguan kognitif yang terbagi dalam dua kelompok (donepezil dan plasebo). Intervensi yang dilakukan berupa pemberian donepezil 5mg satu kali sehari selama 3 bulan. Evaluasi fungsi kognitif menggunakan Mini Mental State Examination (MMSE) dan Montreal Cognitive Assessment Versi Indonesia (MoCA-Ina) pada minggu 0 (awal), 4 (akhir bulan ke-1), 8 (akhir bulan ke-2), dan 12 (akhir bulan ke-2). Data dianalisis menggunakan perangkat SPSS 22.Hasil: Sebanyak 20 subjek yang terbagi sama pada dua kelompok diikutsertakan pada penelitian ini. Dibandingkan dengan kondisi awal, nilai MMSE dan MoCA-Ina pada kelompok donepezil meningkat secara signifikan pada bulan ke-2 dan ke-3 (p<0,001). Terdapat perbedaan bermakna fungsi kognitif antara kelompok terapi dengan placebo pada bulan ke-3 berdasarkan nilai MMSE (p=0,027) dan MoCA-Ina (p=0,024). Domain pada MMSE yang mengalami perbaikan bermakna setelah terapi donepezil adalah orientasi dan recall, sedangkan pada MoCA-Ina adalah domain visuospasial dan delayed recall. Tidak didapatkan efek samping donepezil yang bermakna.Diskusi: Hasil penelitian ini dapat menjadi pertimbangan dalam pemberian donepezil pada pasien dengan tumor intrakranial pascaoperasi yang memiliki gangguan fungsi kognitif.Kata kunci: Donepezil, fungsi kognitif, MMSE, MoCA-Ina, operasi, tumor intrakranial
BACKGROUND Cognitive impairment is frequently found in brain tumor patients. More than 90% of patients with brain tumor have at least one cognitive domain disturbance. Decline in cognitive function could happen before due to the tumor or after the treatment because of surgery, radiotherapy or chemotherapy. Until now there is no available standard treatment for patients with cognitive impairment due to brain tumor. Moreover, Donepezil is an acetylcholinesterase inhibitor known to be useful for improving cognitive function in patients with dementia. This clinical study aims to determine the cognitive effects of donepezil therapy in patients with brain tumors following surgery. MATERIAL AND METHODS This is a pilot study with total of 20 adult brain tumor patients were double blinded randomly assigned to receive a single daily dose (5mg for 12 weeks) of donepezil or placebo. The inclusion criteria were patients with primary brain tumor who had undergone surgery with cognitive impairment at the initial evaluation and age range 18 to 65 years old. Patients with previous cognitive problem, other diseases that can cause cognitive decline e.g. stroke and history of taking donepezil, memantine, methylphenidate, ginkgo biloba, and modafinil were excluded. A cognitive test using Mini Mental State Examination (MMSE) and Montreal Cognitive Assessment Indonesia Version (MoCA-INA) assessing memory, attention, language, visuospatial, verbal fluency, and executive functions were administered before random assignment and at 4, 8 and 12 weeks. A cognitive composite score (primary outcome) and individual cognitive domains were evaluated. Furthermore, side effects and adverse events were also recorded. RESULTS Of this mostly middle-age (30–60 years old), female, meningioma as primary brain tumor with frontal and temporal lobe are the most frequent locations. After 12 weeks of treatment, the composite scores did differ significantly between groups (MMSE P=0.027, MoCA-INA P=0.024). Furthermore, the significant differences favouring donepezil were observed for orientation and recall domains using MMSE with p value 0.017 and 0.006 respectively. Visuospatial (P=0.034) and delayed recall domains (P=0.004) were significant through MoCA-INA evaluation. In addition, Mean MMSE score for pre-donepezil administration was 14.60 ± 4.47 and after 3 months was 20.40 ± 4.24 (P=0.000). Mean MoCA-INA score for pre-donepezil administration was 9.30 ± 3.65 and after 3 months was 15.30 ± 4.24 (P=0.000). However, there was no differences in the placebo group (MMSE P= 0.066, MoCA-INA P=0.313). CONCLUSION Three months treatment with donepezil significantly improve the cognitive functions among post-operative brain tumor patients with no reported side effect. Moreover, further research is needed for longer duration of follow-up and possibility of increased doses.
Knowledge brokering is a type of knowledge translation that bridge the researchers and end users. Knowledge brokering assist the interactions between all agents to understand each other’s perspectives and goals to improve health system performance. The failure to deliver how important the research implementation in society may cause significant outcome. A person or organization who perform knowledge brokering is called knowledge broker (KB). Literature review is conducted for the clinical question of how knowledge brokering impact the health sector and the visible challenges. A literature search is performed by systematic search using three major online databases; Cochrane, PubMed, and EBSCO. Hand-searching also yielded one result that fit the objective of this study. The database result search was being screened from the title and abstract which resulted in 14 relevant articles. After reading the full-text articles, four literatures were ruled-in. The study assessed knowledge brokering process using various methods like single framework or model as well as the combination. The challenges include the lack of communication between internal team and end users, leadership skill, engaging end users, knowledge transfer activity, different timeline, and diverse vision. Evaluating and applying knowledge brokering strategies were needed as the practice itself bringing positive outcomes. Knowledge brokering approaches consist of many methods which tailored to the study objective. Challenges that stand out were communication and personal skill, engaging end users, and perspectives difference. The impact of knowledge brokering is challenging to assess. Further studies that evaluate the impacts of knowledge brokering are still needed.
Background: Approximately one-third of stroke survivors experience depression at some point, which is linked to poor functional results and high mortality rate. Social support from family, friends, and the community is an intervening variable in stroke outcomes aside from the rehabilitation treatments that patients receive. This study assessed the importance of social support for stroke patients with depression and its relationship with patient rehabilitation. Methods: This quantitative study used a cross-sectional approach on stroke patients and their families based on data from the Social Security Administrator for Health (BPJS Kesehatan). One hundred and four participants were recruited using purposive sampling by including stroke patients who have used National Health Insurance (JKN) for stroke medications. Results: We found that instrumental, emotional, interactive, and information support contribute to lowering depressive symptoms. Instrumental support in the form of food availability, money, goods, and services had the highest coefficient value for reducing depression. Emotional support in the form of care and compassion had the second highest value in reducing depression. Further, interaction and informational support remain critical components of social support in reducing depression. Conclusion: The support system plays a key role in decreasing the depression level in stroke survivors. The family and neighborhood have a significant impact on accelerating the rehabilitation process of stroke patients by providing support.
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