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This study aims to determine the level of patient satisfaction with pharmaceutical services at the Bobotsari Community Health Center. Patient satisfaction is an important indicator that reflects the quality of healthcare services. This research employed a quantitative descriptive method using a SERVQUAL-based questionnaire, consisting of five dimensions: tangible, reliability, responsiveness, assurance, and empathy. A total of 100 outpatient respondents were selected through accidental sampling. Data were analyzed using descriptive statistics to determine satisfaction scores for each dimension. The results showed that the tangible dimension achieved 80.57% and the reliability dimension achieved 82%, both categorized as very satisfied. Meanwhile, responsiveness (79.02%), assurance (79.05%), and empathy (77.95%) were categorized as satisfied. The overall average satisfaction level was 79.72%, indicating that patients were generally satisfied with the pharmaceutical services. However, several aspects such as service speed, communication clarity, and personal attention from staff still require improvement. The findings emphasize the importance of maintaining service quality to achieve better patient experiences and public trust.

Type 2 Diabetes Mellitus is a chronic disease with an increasing prevalence and requires long-term therapy, resulting in a significant economic burden on healthcare systems. This study aimed to analyze the cost-effectiveness of antidiabetic drug use among Type 2 Diabetes Mellitus patients in the inpatient unit of Dr. R. Hardjanto Hospital, Balikpapan. This research employed an observational analytic design with a cross-sectional approach and retrospective data collection from medical records and administrative data for the period January–December 2023. A total of 54 patients who met the inclusion criteria were included as study samples. Therapeutic effectiveness was assessed based on the achievement of random blood glucose levels ≤200 mg/dL, while the analysis focused on direct medical costs. Cost-effectiveness was evaluated using the Average Cost-Effectiveness Ratio (ACER) and Incremental Cost-Effectiveness Ratio (ICER). The results showed that Metformin–Apidra therapy achieved higher clinical effectiveness (92%) with an average cost of IDR 3,636,721 and an ACER value of IDR 39,529. Meanwhile, Glimepiride–Sansulin therapy demonstrated 81% effectiveness with a lower average cost of IDR 2,519,259 and an ACER value of IDR 31,101. The ICER value of IDR 10,158 indicates the additional cost required to achieve a 1% increase in effectiveness. In conclusion, Metformin–Apidra therapy is more clinically effective, whereas Glimepiride–Sansulin therapy is more cost-effective economically.

Combined spinal epidural (CSE) is a regional anesthesia technique that combines the rapid onset of spinal anesthesia with the flexibility and prolonged analgesia of epidural anesthesia, making it a valuable option for major surgery in elderly patients with comorbidities. We report a case of a 76-year-old man with ASA physical status III diagnosed with multiple nephrolithiasis accompanied by bilateral hydronephrosis, who underwent open right nephrolithotomy under CSE anesthesia. The patient had a history of hypertension and mild renal function impairment, placing him at increased perioperative risk. Intraoperatively, hemodynamic parameters remained stable without significant hypotension, vasopressor requirement, or conversion to general anesthesia. Estimated blood loss was approximately 500 mL and was managed with crystalloid replacement without transfusion. Prophylactic antibiotic and adjuvant medications were administered according to surgical standards. Postoperatively, the patient was monitored in the ICU with stable vital signs and adequate pain control achieved through continuous epidural analgesia. This case highlights that CSE can be a safe and effective anesthetic approach for open nephrolithotomy in selected high-risk geriatric patients, providing satisfactory hemodynamic stability and postoperative recovery.

Background: Recurrent Aphthous Stomatitis (RAS) is one of the most frequently encountered oral mucosal conditions. Although RAS has been extensively considered clinically and through research, ulcer occurrence remains unavoidable, and most treatment approaches are primarily symptomatic. Objective: To identify anxiety as a predisposing factor in patients with minor RAS. Case Report: A 24-year-old female patient presented to Soelastri Dental and Oral Hospital with a complaint of an ulcer on the right upper lip. The patient reported pain and a burning sensation for the past four days. The pain worsened when consuming hot food or beverages. The patient had experienced similar episodes previously but had never sought treatment for this condition. Intraoral examination revealed a single shallow ulcer with an oval shape, regular margins, a yellowish-white base surrounded by an erythematous halo, measuring 3 × 2 mm on the right upper lip, and was symptomatic. Case Management: The treatment provided focused primarily on Communication, Information, and Education (CIE). The patient was informed about the predisposing factor experienced, which may contribute to the occurrence of RAS, namely anxiety. The patient also received education regarding maintaining oral hygiene, consuming fruits and vegetables, increasing water intake, eating more regularly, attending a follow-up visit seven days after treatment, and managing anxiety. Conclusion: In this case, RAS management was focused on eliminating predisposing factors, particularly anxiety, which was strongly suspected to be the triggering factor for minor RAS in this patient.

Ovarian cancer patients undergoing chemotherapy often experience stress due to the side effects of therapy and emotional distress. Religiosity provides a source of inner peace and acceptance of the disease, while coping strategies play a role in how patients deal with the stress they experience. Aims: to determine the relationship between religiosity and coping strategies with stress levels among ovarian cancer patients undergoing chemotherapy. Method: The study employed a descriptive correlational design with a cross-sectional approach. The population included all ovarian cancer patients undergoing chemotherapy totaling 47 patients. The sampling technique used was Total Sampling. Bivariate analysis was performed using the Spearman Rank Correlation test. This research was conducted in the Darussalam and Ma’wa Buildings of Sultan Agung Islamic Hospital Semarang. Result: Based on the Spearman Rank Correlation test on religiosity, the value of r = -0.857 with p-value = 0.000 (p < 0,05) was obtained. This shows a very strong and significant relationshsip between religiosity and stress levels in ovarian cancer patients undergoing chemotherapy. Coping strategies obtained a value of r = -0.810 with p-value = 0.000 (p < 0.05), indicating a very strong and significant relationship between coping strategies and stress levels in ovarian cancer patients undergoing chemotherapy. Conclusion: There is a significant relationship between religiosity and coping strategies with stress levels among ovarian cancer patients undergoing chemotherapy.

Job satisfaction is one of the important factors that affect the quality of health services, especially in the context of care provided by nurses in hospitals. High job satisfaction can have a positive impact on motivation, performance, and nurse retention, thereby contributing to improved healthcare service quality. Conversely, low job satisfaction can lead to high turnover rates, which can disrupt service continuity and negatively impact patients. This study aims to analyze the relationship between years of service, employment status, and job satisfaction among nurses at RSUD Malingping 2025. The research method used is a quantitative descriptive research method. The population in this study consists of 83 nurses at RSUD Malingping, with a total sampling method applied to collect data from all 83 nurses. The analysis used the Chi-Square test. The results of the test showed that there is a significant relationship between length of service and job satisfaction among nurses (P = 0.007), as well as a significant relationship between employment status and job satisfaction among nurses (P = 0.000). The conclusion drawn is that there is a relationship between length of service and employment status with job satisfaction among nurses at RSUD Malingping in 2025. Recommendations for the hospital include paying more attention to the job satisfaction of nurses and other staff, so that healthcare services at RSUD Malingping can be more optimal.

Knee osteoarthritis is a degenerative joint disease that commonly affects older adults and causes pain and functional limitations. Age, obesity, a sedentary lifestyle, and comorbidities influence disease severity and response to medical rehabilitation. This study aimed to describe the characteristics of geriatric patients with knee osteoarthritis receiving medical rehabilitation therapy at Ibnu Sina Hospital, Makassar, in 2024. This was a quantitative descriptive study with a cross-sectional design. The results showed that most geriatric patients with knee osteoarthritis undergoing medical rehabilitation at Ibnu Sina Hospital in 2024 were in the 60–70 year age group and were predominantly female. The majority of patients had a body mass index in the overweight to obese category. Most patients had no history of smoking but had one or more comorbidities, particularly hypertension and diabetes mellitus. Medical rehabilitation therapy was generally provided as a combination of several modalities. In conclusion, geriatric patients with knee osteoarthritis receiving medical rehabilitation were predominantly aged 60–70 years, female, overweight or obese, and had comorbidities. These findings highlight the importance of individualized and multidisciplinary rehabilitation approaches based on patient characteristics

Diuretic resistance is a serious complication in heart failure patients associated with increased morbidity and mortality. Tolvaptan, a vasopressin V2 receptor antagonist, offers an alternative therapeutic mechanism through aquaresis. This study aims to evaluate the effectiveness and safety of tolvaptan in heart failure patients with diuretic resistance. A retrospective cohort study was conducted on 58 hospitalized patients with NYHA III-IV heart failure and diuretic resistance (urine output <1000 mL/day despite furosemide use ≥80 mg/day) who received tolvaptan 7.5-15 mg/day for 7 days. Variables measured included weight change, urine output, serum sodium, and kidney function. The results showed a significant increase in daily urine output from 820±230 mL to 2180±520 mL (p<0.001), along with an average weight loss of 3.4±1.1 kg (p<0.001). Hypernatremia (>145 mEq/L) occurred in 8.6% of patients. In conclusion, tolvaptan is effective in improving diuresis and reducing congestion in heart failure patients with diuretic resistance, although the risk of hypernatremia should be monitored.

Background: Ovarian cancer is one of the most lethal cancers affecting women and requires long-term treatment such as chemotherapy. The chemotherapy process often causes various physical and psychological side effects that may reduce patients’ motivation to undergo treatment consistently. Family support plays an essential role in enhancing motivation, treatment adherence, and patients’ readiness to face therapy. Aims: This study aims to determine the influence of family support on the motivation of ovarian cancer patients undergoing chemotherapy. Methods: This research was conducted at the Darussalam and Ma’wa Buildings of RSI Sultan Agung Semarang. The study used a descriptive correlational design with a cross-sectional approach. A total population of 47 ovarian cancer patients undergoing chemotherapy from January to April was obtained. The sampling technique used was Total Sampling. The bivariate analysis was performed using the Spearman Rank Correlation test. Results: The analysis showed that most respondents had low levels of family support (44.7%) and moderate levels of motivation (36.2%). The Spearman test indicated a correlation value of r = 0.678 with a p-value = 0.000 (p < 0.05), indicating a strong and significant relationship between family support and patient motivation in undergoing chemotherapy. Conclusion: There is a significant influence between family support and the motivation of ovarian cancer patients undergoing chemotherapy.

Generalized pustular psoriasis (GPP) is a severe inflammatory form of psoriasis characterized by widespread sterile pustular eruptions. Pro-inflammatory mediators released during chronic inflammation may contribute to comorbidities, including type 2 diabetes mellitus (T2DM). A 65-year-old woman presented with pustular eruptions over almost the entire body for seven days, accompanied by burning sensation and pruritus. Some pustules coalesced forming “lakes of pus,” while others appeared as erythematous plaques with coarse white scales. The patient had a history of T2DM. Based on clinical findings, the patient was diagnosed with GPP. She was hospitalized for seven days and followed up weekly until week 10. Inflammatory mediators such as Th-1, TNF-α, IL-6, IL-7, IL-8, IL-17, and IL-23 in psoriasis may inhibit insulin receptor signaling and glucose uptake, leading to insulin resistance and increased blood glucose levels. The duration of treatment until remission in psoriasis patients with T2DM tends to be longer than in non-diabetic patients. In patients with comorbidities, low-dose methotrexate (5–7.5 mg/week) was administered. The coexistence of GPP and T2DM may lead to more severe exacerbations, prolonged treatment duration, and reduced quality of life, posing challenges in management.

Nosocomial infections, also known as Healthcare-Associated Infections (HAIs), are infections acquired by patients during their stay in healthcare facilities. These infections remain a serious problem because they can increase morbidity and mortality rates, prolong the length of hospital stay, and raise healthcare costs. One classical yet highly relevant approach to preventing nosocomial infections is Florence Nightingale’s Environmental Theory. This theory emphasizes the importance of maintaining a clean environment, adequate ventilation, proper lighting, effective sanitation, and good personal hygiene to support patient recovery and reduce infection risks. Nightingale believed that environmental factors play a crucial role in improving patient health outcomes and preventing disease transmission. In modern nursing practice, the principles of Nightingale’s theory are still widely applied through infection prevention and control programs, environmental cleanliness standards, and patient-centered care. Therefore, understanding and implementing environmental management in healthcare settings remain essential strategies to reduce nosocomial infection rates and improve the overall quality of healthcare services.

Hypertension, a global health issue, is increasingly prevalent and significantly contributes to morbidity and mortality. It often coexists with obesity, a key risk factor for hypertension and vascular complications. The combination of hypertension and obesity leads to metabolic changes, chronic inflammation, and oxidative stress that damage retinal blood vessels, directly affecting visual acuity. This literature review examines the relationship between hypertension, obesity, and visual acuity, analyzing 20 articles published between 2021 and 2025, sourced from PubMed, Google Scholar, and ScienceDirect. The study found a significant association between hypertension and obesity with decreased visual acuity. Obesity not only serves as a comorbidity but also as a mediator, worsening hypertension's effects through mechanisms like insulin resistance and endothelial dysfunction. Longitudinal studies indicate that visual impairment is progressive, while cross-sectional studies highlight its high prevalence in hypertensive obese populations. The review emphasizes the need for routine eye exams, blood pressure control, and weight management as preventive measures. In conclusion, hypertension and obesity together significantly increase the risk of visual impairment, necessitating a multidisciplinary approach to care and promoting preventive strategies to preserve eye health and enhance patients' quality of life.

This study aims to analyze the effects of work motivation and career development on nurses’ performance through job satisfaction among nurses at Pertamina Balikpapan Hospital. Nurses’ performance is a key determinant of service quality and patient safety because nurses interact most intensively with patients and ensure continuity of nursing care. However, prior studies on the relationships among motivation, career development, job satisfaction, and performance have reported mixed findings. Therefore, further examination is needed by incorporating job satisfaction as a mediating variable to explain the mechanism of influence more comprehensively. This research employed an explanatory design with a quantitative approach. Primary data were collected using a Likert-scale questionnaire distributed to 165 permanent nurses selected through purposive sampling from a population of 292 nurses. Data were analyzed using variance-based SEM with SmartPLS 4, including outer model evaluation (convergent and discriminant validity) and construct reliability, as well as inner model assessment through the coefficient of determination, effect size, and hypothesis testing using bootstrapping. The results indicate that work motivation has a positive and significant effect on job satisfaction, and career development also has a positive and significant effect on job satisfaction. Job satisfaction has a positive and significant effect on nurses’ performance. In addition, work motivation and career development have positive and significant direct effects on nurses’ performance. Indirect effect testing confirms that job satisfaction mediates the relationship between work motivation and nurses’ performance and also mediates the relationship between career development and nurses’ performance. These findings emphasize that hospitals should strengthen strategies to enhance motivation and career development in a targeted manner while ensuring key sources of job satisfaction so that nurses’ performance improves sustainably.

The postpartum period is a critical phase with a high risk of complications, particularly perineal wound infection, especially in mothers with premature rupture of membranes (PROM). PROM increases the risk of microbial invasion into the birth canal, making infection prevention essential. Vulva hygiene is a non-pharmacological intervention that can help reduce this risk. This study aimed to evaluate the application of vulva hygiene in reducing the risk of perineal wound infection in postpartum mothers with PROM. This study used a case study design involving four postpartum mothers with PROM treated in the Wijaya Kusuma Ward of RSUD Limpung Batang in 2025. Data were collected through comprehensive nursing assessments, observation of perineal wound conditions, and evaluation of infection risk signs before and after the intervention. The results showed that regular implementation of vulva hygiene led to a reduction in infection risk signs, decreased perineal pain, and improved genital hygiene in all patients. Nursing education and assistance played a crucial role in the success of this intervention. It can be concluded that vulva hygiene is an effective nursing intervention in preventing perineal wound infection in postpartum mothers with PROM.

Stroke is one of the non-communicable diseases that is the leading cause of disability and death in the world. Clinical factors such as hypertension, diabetes mellitus, body mass index (BMI), and unhealthy lifestyle are known to contribute to the incidence of stroke. Oe-Cusse Referral Hospital serves as the main referral center in the treatment of stroke cases, but data on contributing clinical factors and medical treatment and rehabilitation strategies are still limited. This study aims to analyze the clinical factors that contribute to the incidence of stroke and describe medical treatment and rehabilitation strategies in stroke patients at Oe-Cusse Referral Hospital.This study is a quantitative study with a cross-sectional observational design. The research sample amounted to 50 stroke patients who were treated in the January-November 2025 period, selected using purposive sampling techniques. Data were collected through medical records and questionnaires related to medical treatment and rehabilitation. Data analysis was carried out using the SPSS program, including descriptive analysis and logistic regression to see the relationship between clinical factors (hypertension, diabetes mellitus, lifestyle, BMI, and other factors) and stroke incidence. The results of the descriptive analysis showed that the average age of stroke patients was 56.2 ± 9.8 years, with an age range of 39–78 years. The average BMI of the patient was 27.5 ± 3.1 kg/m² which indicates a tendency to be overweight. The average systolic blood pressure of the patient was 150 ± 18 mmHg, indicating the predominance of hypertension in stroke patients. The average length of rehabilitation lasted 6.3 ± 1.8 weeks. Logistic regression analysis showed a significant relationship between clinical factors, especially hypertension, BMI, and diabetes mellitus, and stroke incidence. Clinical factors such as hypertension, high BMI, and diabetes mellitus contribute significantly to the incidence of stroke at Oe-Cusse Referral Hospital.

The use of radiation-based medical equipment such as CT Scan poses potential risks of radiation leakage that may endanger patients, medical personnel, and the surrounding environment if not properly managed. This study aims to analyze radiation safety policies in anticipating radiation leakage in the CT Scan unit of Royal Prima General Hospital Medan, covering policy frameworks, physical protection measures, implementation challenges, and supervision and evaluation systems. This research employed a qualitative approach with a case study design. Data were collected through in-depth interviews, observations, and document reviews related to radiation safety policies. The results indicate that radiation safety policies at Royal Prima General Hospital Medan have referred to BAPETEN regulations and international standards, particularly in the structural protection of the CT Scan room, which has been proven effective in maintaining radiation exposure levels below the permissible limits. However, policy implementation still faces several obstacles, including budget limitations, non-compliance of some medical staff with the use of personal protective equipment, and suboptimal discipline in adhering to standard operating procedures. Supervision and evaluation have been conducted internally by certified Radiation Protection Officers and externally through periodic inspections by BAPETEN, yet further strengthening is required in terms of staff behavior and safety culture. In conclusion, radiation safety policies have been technically effective, but continuous improvement in compliance, supervision, and safety culture among medical personnel is essential to sustainably minimize the risk of radiation leakage.

Prolactinoma is the most common functional pituitary adenoma, particularly in adolescent females, and is typically characterized by amenorrhea and galactorrhea resulting from hyperprolactinemia. However, in certain cases, serum prolactin levels may appear normal due to the hook effect, an immunoassay measurement error caused by extremely high prolactin concentrations that interfere with antigen–antibody complex formation. We report the case of a 17-year-old female presenting with a five-month history of galactorrhea, accompanied by breast pain, headache, and primary amenorrhea. Brain MRI revealed a pituitary mass measuring 1.4 × 0.8 × 0.5 cm, suspicious for prolactinoma, while serum prolactin was within the normal range (17.33 ng/mL). The discrepancy between clinical manifestations, lesion size, and laboratory findings raised suspicion of the hook effect. The patient was treated with dopamine agonists, bromocriptine and cabergoline, and referred for multidisciplinary management involving endocrinology, neurosurgery, and obstetrics–gynecology. Despite the absence of prolactin dilution testing, MRI findings supported the diagnosis of prolactinoma, and the patient demonstrated a favorable clinical response to therapy. This case highlights the importance of recognizing laboratory variability, performing comprehensive hormonal evaluation, and considering prolactin dilution assays when clinical and laboratory findings are discordant, particularly in adolescent patients with suggestive symptoms.

This study aims to assess the quality of patient care at the Emergency Unit of Sentani City Community Health Center, Jayapura Regency, by examining the experiences and perceptions of patients, their families, and healthcare workers regarding the service. The study used a qualitative approach with a descriptive design. Informants were selected using purposive sampling involving ER patients, their families, and healthcare workers involved in the ER service process at Sentani Community Health Center. Data were collected through in-depth interviews, non-participatory observation, and documentation studies. The data obtained were analyzed qualitatively through the stages of data reduction, data presentation, and conclusion drawing. The research analysis refers to seven dimensions of service quality, namely direct evidence (tangibles), reliability, responsiveness, assurance, empathy, service accessibility, and service systems and flows. The results of the study showed that service quality at the Sentani Community Health Center ER was in the fairly good category, especially the dimensions of empathy, reliability, and responsiveness of healthcare workers. Healthcare workers were friendly, responsive, and provided fair services without discriminating against patient backgrounds. However, a number of obstacles are still found that affect the optimization of services, including limited facilities and infrastructure, the number of health workers that is not commensurate with the service load, patient waiting times in certain conditions, the operating hours of the Emergency Room that are not yet 24 hours, and the low understanding of some patients regarding the applicable service system and flow.

Viral hepatitis is a systemic disease that primarily affects the liver and is characterized by a necroinflammatory process that plays a significant role in clinical and laboratory manifestations. Chronic hepatitis is defined as liver inflammation lasting more than six months, with persistent elevations in aminotransferases and characteristic histological features, and carries a risk of progression to cirrhosis and hepatocellular carcinoma. Chronic hepatitis C virus infection occurs due to an ineffective host immune response to the virus, allowing the infection to persist. The innate immune system, particularly type I interferon, plays a key role in the initial defense mechanisms against viral replication. Various antiviral therapies, such as interferon, nucleoside analogs, and nucleotide analogs, are currently available, which have been shown to reduce viral load and inhibit disease progression. Appropriate therapy is expected to prevent long-term complications in patients with chronic hepatitis.

The Outpatient Unit is an important service unit that contributes to the hospital's revenue. However, at Adam Talib Cikunir Hospital, the number of patient visits has not yet reached the target, thus it is necessary to formulate a strategy to enhance competitiveness. This research aims to develop a strategic plan for the Outpatient Unit to improve service quality and increase its contribution to the hospital's revenue. The research uses a qualitative descriptive approach. Analysis is conducted through Internal Factor Evaluation (IFE), External Factor Evaluation (EFE), SWOT analysis, and Quantitative Strategic Planning Matrix (QSPM). The IFE score of 2.44 and the EFE score of 2.41 place RS DAT Cikunir in Quadrant V of the IE Matrix, which means RS DAT Cikunir is in a Hold and Maintain position. The SWOT analysis generates several alternative strategies, and the QSPM prioritizes three strategies: enhancing specialized services (score 5,84), expanding services and digital promotion (score 5,66), and optimizing cooperation with BPJS and private insurance (score 5,38). The research concludes that improving specialized services, expanding services and digital promotions, as well as optimizing cooperation between BPJS and private insurance are the right strategies to enhance service quality, attract more patients, and strengthen the competitiveness of RS Dokter Adam Talib Cikunir amid competition in the healthcare sector.