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Cytokines and Vitamin K in crohn’s disease patients have been evaluated to discover the conceivable via biomarkers of diagnosed patients compared to control. Sera samples of Eighty patients and control of both genders. forty patients diagnosed crohn’s which the span of age between (20-36) years and 40 healthy volunteers as a control with span age (18-39) years. The patient were guests to Marjan hospital in Babylon city during the period (1/July/2025 to 1/September/2025). The current results showed a significant difference in statistic marks at (P<0.05). Vitamin K in patients below control. There is significance different between values of patients and controls in Magnesium, Calcium, Vitamin K, InterL10 and Toll-like receptor 4. According to word axel, there is magnitude significant relationship among cytokine InterL10 and Toll-like receptor 4, Magnesium, Calcium, & Vitamin K. The cytokines both InterL10 and Toll-like receptor 4 patients’ levels larger than control levels. Calcium and Magnesium which there is significance variance between both patients and Control

Background: Chronic Obstructive Pulmonary Disease (COPD) is defined as a non-communicable disease related to the respiratory system, where airway spasm occurs which is interpreted through shortness of breath, decreased oxygen saturation, and increased sputum production. This sputum production is caused by exposure to harmful substances that can inhibit mucociliary clearance, goblet cell proliferation occurs which causes hyperplasia and hypertrophy resulting in the growth and enlargement of mucous glands which results in increased sputum production and causes ineffective airway clearance nursing problems. The purpose of this study was to describe nursing care for ineffective airway clearance (COPD) with effective cough training at RSUD dr. R. Soedarsono. Methods: This research used a case study design. The research participants were COPD patients with ineffective airway clearance nursing problems who were given interventions in the form of effective cough training in Interna Room 2 at RSUD dr. R. Soedarsono. Data collection was done through interviews, observation, physical examination, and documentation. Results: Ineffective airway clearance is resolved as shown by the patient saying the cough has decreased and is not tight, able to remove phlegm, additional breath sounds decrease, sputum production decreases and breathing frequency is 20x/minute.  Conclusion: Effective cough training is proven to be effective in improving airway clearance in COPD patients, so it can be one of the non-pharmacological interventions to overcome this problem.

Introduction: Experiential marketing has become a growing trend in promotional activities by emphasizing personalization and active customer involvement. Preliminary observations indicate a decline in outpatient visits among patients with general insurance and non-JKN coverage in 2023, which may be influenced by a decrease in their intention to use outpatient services. This condition highlights the need for hospitals to implement experiential marketing strategies to enhance patient interest and experience. Objective: This study aims to empirically examine the influence of patient experience and service perception on the intention to use outpatient services, with Strategic Experiential Modules (SEMs) as an intervening variable. Methods: This quantitative research employs a causal design involving outpatient service users as the population. A non-probability sampling technique was used, yielding 249 respondents. Data were collected using a questionnaire and analyzed using Structural Equation Modeling (SEM) with AMOS software. Results: The findings reveal that patient experience and service perception simultaneously have a significant positive influence on the intention to use outpatient services through SEMs. Service perception directly shows a significant positive effect on both SEMs and intention to use outpatient services, while SEMs also significantly enhance usage intention. Service perception emerges as the dominant variable in increasing SEMs and usage intention, whereas patient experience has the weakest effect. Conclusion: Patient experience and service perception collectively influence the intention to use outpatient services with SEMs as an intervening variable. Strengthening Customer Relationship Management is essential by improving human resources and optimizing service asset.

Anxiety disorders are common mental health problems in society, often unrecognized by the sufferer. Identifying the type of anxiety disorder and its influencing factors is crucial for proper treatment. This research aims to apply the K-Nearest Neighbor (K-NN) method in identifying types of anxiety disorders based on influencing factors, focusing on patient data from Sylvani Hospital, Binjai. The K-NN method was chosen because of its ability to classify based on data proximity. This study used medical record data of patients with anxiety disorders, which were processed using MATLAB and Microsoft Excel software. The results show that the K-NN method is effective in identifying types of anxiety disorders, with a high level of accuracy, especially in the identification of Panic Disorder (K05) and Social Anxiety Disorder (K03). The use of MATLAB simplified the identification process by automating results, while data processing in Excel improved classification accuracy. This study concludes that the K-NN method can be an effective alternative in identifying anxiety disorder types based on the factors that influence them. It is recommended for future research to involve more variables and mental health experts for a more comprehensive validation of the results.

Syndrome is a serious problem in children's health because it has a major impact on growth and development, especially in terms of intelligence and daily activities. Down Syndrome, as one of the most well-known chromosomal disorders, is often the main cause of intellectual developmental disorders, hypotonia, facial dysmorphism, early onset of Alzheimer's disease, and various behavioral disorders. Diagnosing syndrome diseases in children is often difficult due to complex and varied symptoms, requiring lengthy, costly, and time-consuming medical evaluations. This study aims to design a Case-Based Reasoning (CBR)-based expert system for diagnosing syndromes in children, which is expected to help accelerate the disease identification process and provide more effective and efficient solutions. The method used is the development of an expert system with a CBR approach, in which the system performs calculations and matching based on the symptoms selected by the user against the available case base. The results of the study show that from symptom inputs such as wide hands with short fingers, short stature, small head, stunted growth, small lower jaw, abnormal body appearance, and weak joints, the system was able to diagnose Klinefelter syndrome with a percentage of 43.58%. This system can be an alternative for patients or families who have limited time and funds to obtain medical consultations, so that diagnosis and follow-up can be carried out more quickly and efficiently.

Hirschsprung’s disease is a congenital disorder caused by abnormal nerve cell development in the large intestine, leading to chronic intestinal obstruction in infants. This condition often manifests through symptoms such as constipation, abdominal distension, vomiting, and failure to thrive. The weak immune system of infants makes them highly susceptible to bacterial infections and further complications. At Bidadari General Hospital, there were 110 patients suspected of having Hirschsprung’s disease. One of the major challenges in managing these cases is the limited number of medical specialists, particularly pediatricians and pediatric surgeons, resulting in long waiting times for accurate diagnosis, especially during peak service hours. To address this issue, this study applies the Dempster-Shafer method in an expert system to assist in diagnosing Hirschsprung’s disease based on clinical symptoms. The method effectively handles uncertainty and combines multiple pieces of medical evidence to produce more accurate diagnostic probabilities. The analysis results show that from the selected symptoms, the highest diagnosis probability corresponds to short-segment Hirschsprung’s disease with a confidence level of 71.54%. These findings suggest that the Dempster-Shafer method can serve as an effective alternative tool to support early and accurate diagnosis of Hirschsprung’s disease in infants.

Modern healthcare services are undergoing transformation toward a more humanistic and patient-centered approach, emphasizing hospitality based services in hospitals. However, many healthcare institutions, particularly in outpatient settings, have not fully adopted this concept. Patients often experience psychological distress, and when coupled with an unsupportive physical environment, their comfort and overall experience may be diminished. These conditions can negatively affect perceptions of service quality, patient satisfaction, and loyalty toward hospital services. This study aimed to analyze the influence of patients’ psychological conditions and the physical environment on hospitality-based services, with patient experience as an intervening variable, at the internal medicine outpatient clinic of BM Hospital. A quantitative research design using a cross-sectional approach was employed. The study involved 200 respondents selected through purposive sampling. Data were collected using structured questionnaires with Likert-scale items and analyzed with Structural Equation Modeling Partial Least Squares (SEM-PLS). The results showed that patients’ psychological conditions, the physical environment, and patient experience simultaneously and significantly influenced hospitality-based services. Hypothesis testing confirmed that both psychological conditions and the physical environment had a direct and significant impact on hospitality-based services. Furthermore, patient experience played a mediating role, strengthening the relationship between these factors and perceived service quality. The findings highlight the need for hospitals to integrate psychological support and a conducive physical environment into outpatient care delivery. Enhancing these dimensions can improve patient experience, foster greater satisfaction and comfort, and build stronger loyalty toward hospital services

Hypertension is a major factor contributing to high mortality rates and is often identified as the silent killer. Various non-pharmacological interventions have been developed to help lower blood pressure, such as the use of acupressure, herbal remedies, relaxation breathing exercises, meditation, aromatherapy, and reflexology on the soles of the feet. The focus of this study is to examine the effects of reflexology on the soles of the feet on blood pressure dynamics in individuals with hypertension in Gue Gajah Village, Darul Imarah District. The methodology applied was quantitative research with a quasi-experimental design, and the data collection pattern was a single group with pre- and post-treatment measurements (one group pretest-posttest). From a total of 328 hypertensive patients in the area, 15 research participants were purposively selected as samples. The study process took place from May 2 to 28, 2025. The results of the analysis using a paired t-test showed a significant change in blood pressure between before and after the foot reflexology treatment, both in systolic pressure (p-value = 0.000; p < 0.05) and diastolic pressure (p-value = 0.000; p < 0.05). Based on these findings, it can be stated that foot reflexology massage therapy has an effect on lowering blood pressure in hypertensive patients. These findings are expected to serve as a reference for health workers to expand the use of non-pharmacological interventions in the management of hypertension and open opportunities for further research with larger sample sizes and designs.

Background: Sectio caesarea is performed to ensure the safety of the mother and baby. Before the operation, health workers, especially nurses, need to provide education to the mother about informed consent and the operation procedure to reduce the mother's anxiety and concerns about the safety of her baby. Objective: To determine the effect of providing informed consent education on surgical preparation with anxiety levels in patients with Pre-Operational Caesarean Section. Method: This study is an analytical survey study using the cross-sectional method. The study was conducted at RSIA Murni Teguh Rosiva Medan. The population was 30 people and all of them were used as samples, sampling was done using purposive sampling. The analysis was performed univariately in the frequency distribution table and bivariately using the Kendall's tau-b test. Results: This study showed that the majority of pre-operative caesarean section patients stated that the provision of informed consent education in preparation for surgery was in the good category (60.0%). The majority of pre-operative caesarean section patients felt mild anxiety (50.0%). The provision of informed consent education in preparation for surgery had a significant effect on the level of anxiety of pre-operative caesarean section patients at RSIA Murni Teguh Rosiva Medan, p-value = 0.005 <0.05. Conclusion: The anxiety of pre-operative caesarean section patients was influenced by the provision of informed consent education in preparation for surgery by nurses. Suggestion: It is recommended that nurses provide informed consent education regarding preparation for caesarean section surgery to improve the knowledge and readiness of mothers to overcome anxiety that can affect caesarean section procedures.

Background: Indonesia, as an agrarian country, has a large workforce engaged in physically demanding activities that increase the risk of myofascial pain. The prevalence of myofascial pain syndrome (MPS) in the upper trapezius muscle in Indonesia reaches 40% annually, with a higher rate in women. This condition often causes complaints in the neck, shoulders, and lower back, leading to a decline in quality of life. Various management strategies exist, but many are less effective in the long term and carry potential side effects. Lidocaine, as a local anesthetic, offers an alternative therapy due to its simple procedure, affordable cost, rapid effect, and good safety profile; therefore, its effectiveness in managing myofascial pain needs to be evaluated. Methods: This study was an observational research with a prospective cohort design conducted at PKU Muhammadiyah Gamping Hospital. Patients with myofascial pain who received lidocaine injections were followed for 4 weeks, and pain intensity was measured using the Numeric Rating Scale (NRS) to assess the relationship between lidocaine administration and pain reduction. Results: The study showed that lidocaine injection was effective in significantly reducing myofascial pain. The Wilcoxon Signed Rank Test produced negative Z values with p = 0.000 (<0.05) for all comparisons from pretest to the fourth week. The Friedman test also indicated significant differences between weeks (χ² = 9.731; p = 0.021), with optimal pain reduction observed in the second week. Although lidocaine provided significant analgesic effects, its effectiveness tended to decrease in subsequent weeks, indicating a short-term effect that should be combined with other interventions for sustained outcomes. Conclusion: Lidocaine injection proved effective in reducing pain among patients with myofascial pain syndrome, with the most optimal reduction occurring in the second week after therapy. The dominant factors influencing the outcomes were the relatively short duration of lidocaine’s action and individual variability in response. This implies that lidocaine can be used as an effective initial therapy, but should be combined with other interventions such as physiotherapy or activity modification to achieve more stable and sustainable pain management.

Patients with chronic kidney disease (CKD) often experience shortness of breath, fatigue, and a decline in quality of life due to fluid imbalance, anemia, and reduced lung capacity. These conditions highlight the need for simple, safe, and effective non-pharmacological interventions. This community service program, titled “Napas Lega Bersama” (“Breathing Relief Together”), aimed to improve the knowledge and skills of CKD patients in applying pursed-lip breathing (PLB) techniques as a strategy to enhance breathing patterns and overall well-being. The activity was conducted at a partner hospital’s hemodialysis unit through educational sessions, live demonstrations, and guided PLB practice over a two-week period. Pre- and post-program assessments were performed using standardized questionnaires to measure participants’ knowledge and perceived quality of life. The results showed an 85% increase in participants’ understanding of PLB and a 70% improvement in perceived comfort and daily activity performance after the intervention. Participants also reported reduced shortness of breath and greater relaxation during dialysis sessions. This program demonstrates that pursed-lip breathing can serve as a simple and effective complementary therapy to improve the quality of life of CKD patients. It is recommended that this initiative be continued through routine mentoring and interdisciplinary collaboration to promote therapeutic breathing exercises across healthcare settings.

The World Health Organization (WHO) reported in 2019 that 40 million people worldwide require palliative care, including those with cardiovascular disease (38%), cancer (34%), chronic lung disease (10.3%), AIDS (5.7%), and diabetes (4.6%). Palliative care aims to improve the quality of life of patients and families facing life-threatening illnesses by managing pain and physical, psychological, social, and spiritual problems. The main goal of this care is to reduce suffering and help patients cope with the limitations imposed by illness. The principles are to respect life, consider death a normal process, neither hasten nor delay death, and provide support until the end of life. This study aims to determine whether knowledge can influence the level of self-efficacy of nursing students at Awal Bros University. Using a correlational quantitative method, data were collected through the Palliative Care Quiz for Nursing and Self-efficacy Palliative Care Scale questionnaires. The results of the study show a significant relationship between knowledge and self-efficacy among students with p<0.005. These findings can be used as a basis for learning to improve the understanding of nursing students, especially in the context of palliative care, which is important for the quality of health services in the future.

The admission of patients to the Intensive Care Unit (ICU) or Intensive Cardiology Care Unit (ICCU) often occurs suddenly and under critical conditions, causing family members to experience psychological pressure such as anxiety, stress, and fear of losing their loved ones. This study aims to analyze the relationship between family knowledge and the level of anxiety among family members of patients treated in the ICU at Meuraxa General Hospital, Banda Aceh. The research employed a quantitative method with a descriptive correlational design and a cross-sectional approach. The population consisted of 114 patient families, with 35 respondents selected through purposive sampling. The instrument used was the Hamilton Anxiety Rating Scale (HARS), which demonstrated high reliability (α = 0.897). Data were collected from June 18 to July 5, 2025, and analyzed using univariate and bivariate methods with the chi-square test. The results showed that 19 respondents (54.3%) experienced moderate anxiety, while 14 respondents (40%) had low knowledge regarding ICU/ICCU care. Statistical analysis revealed a p-value of 0.005, indicating a significant relationship between family knowledge and anxiety levels. These findings highlight the importance of healthcare professionals in providing education to family members to improve understanding and help reduce anxiety during the patient’s treatment period in the ICU or ICCU.

Labor is a complex interaction between psychological and physiological drives in women. (90%) delivery is accompanied by pain. In the active phase there is an increase in the intensity and frequency of contractions, so that the peak pain response is in this phase. Pain and soreness during labor are basically caused by strong contractions during labor. Breathing relaxation techniques can control pain by minimizing sympathetic activity in the autonomic nervous system. This study aims to determine the effect of deep breathing relaxation techniques on reducing labor pain in the first active phase. The type of design in this study is pre-experimental with The number of samples was taken according to the Accidental Sampling technique, samples were taken when patients went to the Andra Agustiana PMB Clinic with a minimum of 30 respondents. The data collection technique used a questionnaire sheet and a Numeric Rating Scale (NRS) pain scale. Data analysis used the Wilcoxon test. The results showed that before being given the breathing relaxation technique, most respondents experienced severe pain or pain levels on a scale of 7-10, namely 25 respondents (71.4%) and after being given deep breathing relaxation technique treatment, most respondents experienced moderate pain (scale 4-6) as many as 28 respondents (80%). The results of data analysis obtained the Asymp.significancy value = 0.000 (ρ<0.05). The conclusion is that there is an effect of providing deep breathing relaxation techniques on reducing labor pain in the first active phase. It is hoped that deep breathing relaxation techniques can be applied in the management of labor care as an alternative to reduce labor pain for mothers giving birth in the first active phase

Burns are one of the global health problems that still cause high morbidity and mortality rates, especially in countries with limited resources. Burn management is currently undergoing rapid development through a multidisciplinary approach that includes early resuscitation, local wound care, infection control, pain management, nutritional support, and long-term rehabilitation. This study uses the literature review method by examining articles from international databases for the period 2020–2025 to obtain the latest information on burn management updates. The results of the analysis showed that innovative therapies such as the use of stem cells, biomaterials (e.g. fish skin graft), as well as nanomedicine technology with silver nanoparticles have been proven to accelerate tissue healing and reduce complications. In addition, classic approaches such as early debridement, modern dressing selection, and enteral nutrition remain the primary basis in clinical treatment. Psychosocial and physical rehabilitation aspects are also increasingly considered because they have a significant effect on the quality of life of patients. Although various therapeutic innovations have shown promising results, translation to clinical practice still faces barriers in the form of cost, regulation, and limited facilities. Therefore, updates on burn management are needed to ensure more effective, efficient, and equitable management in modern medical practice.

Community Health Centers (Puskesmas) serve as the frontline for basic healthcare services for the community. However, the services at Waimangura Community Health Center are not yet fully optimal due to several obstacles, particularly in patient data recording, which is essential for registering every individual who visits for health check-ups, registration, and medical record management. Therefore, an information technology-based system is needed to enhance the effectiveness and efficiency of services. This research aims to implement a healthcare service system at Waimangura Community Health Center using the CodeIgniter 3 framework by applying the MVC (Model, View, Controller) method. The MVC method was chosen because it can separate application logic, display, and data management, making the system more structured, easier to develop, and maintaining consistency. The research stages include needs analysis, system design, implementation, and testing. The implementation results show that the built system is capable of assisting officers in patient registration, medical record data management, and information services. Patients also benefit from more transparent and efficient services. Based on the trial results, the system operates according to user needs and can improve the quality of healthcare services at the Waimangura Community Health Center. Thus, the implementation of CodeIgniter 3 with the MVC method has proven effective in building a structured, easily maintainable healthcare service system that can be further developed to support digital-based healthcare services.

Cancer is a disease caused by the abnormal growth of body tissue cells. Breast cancer is one of the leading causes of death for women worldwide. The 5-year survival rate approaches 97% when tumor cells are confined to breast tissue and drops dramatically to 23% when tumor cells have metastasized to other organs at the time of diagnosis. Myelosuppression is a side effect of chemotherapy in cancer patients. Myelosuppression is a decrease in the number of hemoglobin, platelets, neutrophils, and leukocytes below normal, leading to anemia, thrombocytopenia, neutropenia, and leukocytopenia. This study aims to determine the effect of chemotherapy on leukocyte and platelet counts in breast cancer patients. This study is a qualitative descriptive study that describes the research topic data using a similar approach to the topic of the literature review. The results of this study indicate that most breast cancer patients undergoing chemotherapy experience a decrease in platelet and leukocyte counts

Tuberculosis (TB) is an infectious disease that remains a global and national health problem, with Indonesia among the top three countries with the highest TB burden in the world. Long TB treatment often impacts the physical, social, emotional, functional, and spiritual aspects of patients, so measuring the quality of health is important in assessing the success of therapy comprehensively. This study aims to determine the description of the quality of health of Tuberculosis patients at Wava Husada Hospital Malang using the Functional Assessment of Chronic Illness Therapy Tuberculosis (FACIT-TB) instrument. This study is a descriptive study with a cross-sectional approach conducted on outpatient TB patients at Wava Husada Hospital Malang during June–August 2025. A total of 113 respondents who met the inclusion criteria were included. Data were obtained through the FACIT-TB questionnaire, which comprises five main variables: Physical Well-Being, Social/Family Well-Being, Emotional Well-Being, Functional Well-Being, and Spiritual Well-Being. The results showed that the majority of patients (53.1%) experienced moderate physical impairment, 73.5% had good social engagement, and 70.8% were emotionally stable. Fifty-four percent of respondents still had moderate functional impairment, while 45.1% were in the moderate spiritual impairment category. These findings indicate that although most patients demonstrated good emotional and social adaptation, physical, functional, and spiritual challenges remain that require further attention in healthcare. In conclusion, the overall quality of health of TB patients at Wava Husada Hospital in Malang is in the moderate category. These results underscore the importance of a multidimensional approach to TB patient management, emphasizing not only medical aspects but also psychosocial and spiritual support to improve therapy success and patient quality of life.

Osteoarthritis of the knee is a degenerative condition of the knee joint characterized by the thinning of cartilage, leading to friction between the femur and tibia. This condition results in pain, limited joint mobility, and reduced strength of the quadriceps and hamstring muscles. Physiotherapy plays a crucial role in reducing these symptoms through modality-based approaches and structured exercise therapy. This study is a case study involving a single patient with right knee osteoarthritis. Data were collected through direct observation and evaluation of therapeutic outcomes. Interventions were conducted over four sessions using Transcutaneous Electrical Nerve Stimulation (TENS) to reduce pain, Ultrasound to enhance blood circulation and reduce inflammation, and exercise therapy focusing on improving muscle strength and joint range of motion. After four therapy sessions, there was a reduction in pain intensity, improved strength of the quadriceps and hamstrings, and increased joint range of motion. These results demonstrate that the combination of TENS, ultrasound, and exercise therapy is effective in improving function and quality of life for patients with right knee osteoarthritis. This study emphasizes the importance of a multimodal physiotherapy approach in managing chronic musculoskeletal disorders.

Patient satisfaction is a feeling that arises from the performance of health services that have been obtained after the patient compares it with what was expected. Rather than the reality that occurs there are still complaints about outpatient registration services based on electronic medical records, Frequent obstacles are if the network is disrupted, then access to the EMR can be hampered or cannot be accessed at all and the limited capacity of the waiting room is also an obstacle, especially with the large number of patients during peak hours so that many patients wait outside the waiting room. This study aims to determine the level of patient satisfaction in outpatient registration based on EMR. This study uses a quantitative method with a population of 13,750 and a sample of 99 outpatients. Based on the results of the study in 2025, it can be concluded that patient satisfaction with RME-based outpatient registration in the aspect of tangibles can be categorized as "Less Satisfied" especially regarding facilities such as AC/Television, from the aspect of reliability it can be categorized as "Satisfied" even though there are a few respondents who answered "Less Satisfied", from the aspect of responsiveness it can be categorized as "Satisfied" even though there are some patients who feel "Less Satisfied", from the aspect of assurance in RME-based outpatient registration it can be categorized as "Satisfied" but there are a small number of patients who answered "Less Satisfied" and from the aspect of empathy it can be categorized as "Satisfied" even though there are some patients who answered "Less Satisfied". So the researcher's suggestion is that the Hospital improves the quality of the waiting room, especially AC, television, increases the number of chairs and provides adequate seating for all patients, so that patients are more comfortable and avoid overcrowding