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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.

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 Emergency Room (ER) is a hospital service unit that plays a strategic role in treating patients with critical and emergency conditions. The high number of patient visits and limited resources require an effective triage system to ensure quality of service and patient safety. The Emergency Severity Index (ESI) is a five-level triage system that classifies patients based on the level of severity and resource requirements. This study aims to analyze the relationship between the implementation of triage based on the Emergency Severity Index and the improvement of EAD service quality at Sari Asih Cipondoh Hospital. This study used a quantitative design with a cross-sectional approach. The study sample consisted of EAD patients who met the inclusion criteria. Data were collected through observation of triage implementation and patient satisfaction questionnaires, then analyzed using univariate and bivariate analysis. The results showed that the proper implementation of ESI triage was significantly associated with improved quality of ED services, particularly in terms of speed of service and patient satisfaction. The conclusion of this study confirms that the implementation of ESI triage is an important factor in efforts to improve the quality of ED services.

Non-hemorrhagic stroke occurs due to blockage of blood flow to the brain by a thrombus or embolus. The blockage results in focal neurological disorders that affect the musculoskeletal system, namely weakness in the extremities, which gives rise to nursing problems of impaired physical mobility. To overcome the problem of impaired physical mobility, rubber ball grip exercises (ball squeezing) are given. These exercises have been shown to increase muscle strength, prevent joint stiffness, and improve blood circulation. This scientific paper was conducted to determine the description of nursing care for non-hemorrhagic stroke patients with nursing problems of impaired physical mobility. During the meeting, the nurse provided rubber ball grip exercises (ball squeezing) for 10-15 minutes for 3 times in 24 hours. Evaluation of these actions showed that the patient who initially experienced weakness in the upper extremities with muscle strength 2-3 and after being given rubber ball grip exercises (ball squeezing), the problem of impaired physical mobility was resolved, as evidenced by the patient being able to perform therapy, the extremities feeling slightly lighter, and muscle strength 4. Therefore, it is recommended that non-hemorrhagic stroke patients be given rubber ball grip exercises (ball squeezing) to overcome impaired physical mobility.

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.  

Gastritis is a common gastrointestinal disorder that is influenced by both behavioral and psychological factors, including dietary patterns and stress. This study aimed to examine the association between dietary patterns and stress levels among patients with gastritis at a primary healthcare center in West Halmahera Regency. A quantitative analytical study with a cross-sectional design was conducted in November 2025. A total of 60 gastritis patients were recruited using a total sampling technique. Data were collected using structured questionnaires to assess dietary patterns and stress levels. Statistical analysis was performed using SPSS version 26. Descriptive analysis was used to summarize respondents’ characteristics, while the Chi-square test or Fisher’s exact test was applied to analyze the association between variables. The results showed that most respondents had unhealthy dietary patterns and experienced high stress levels. Dietary pattern was significantly associated with stress level (p = 0.038), whereas demographic characteristics were not significantly related to stress level. Patients with unhealthy dietary patterns were more likely to experience high stress. In conclusion, dietary pattern is significantly associated with stress levels among gastritis patients. These findings highlight the importance of promoting healthy eating behaviors as part of stress management strategies in primary health care settings.

Compliance with taking medication is very important for pulmonary tuberculosis patients because it can ensure that the tuberculosis infection is controlled and does not spread to other people. Motivational interviewing counseling can help tuberculosis patients increase medication adherence with an empathetic and supportive approach to providing information. Through this technique, counselors can foster the patient's internal motivation to overcome obstacles that arise related to taking medication regularly. This research has gone through an ethical process with No. 000.9/002/KEPKRSUDBTG/1/2025. This type of research is quantitative, a quasi-experimental method with a one group pretest-posttest without control design. The sampling technique in this research used purposive sampling of 30 respondents. Data analysis used univariate and bivariate analysis with the Wilcoxon rank test. The research results show: The patient's level of compliance with taking TB medication before Motivational Interviewing counseling is in the medium category and the low category. The level of patient compliance in taking TB medication after Motivational Interviewing counseling has increased, namely the high category and the medium category. There is an influence of motivational interviewing counseling on medication adherence in pulmonary tuberculosis patients at Batang Regional Hospital. There is a significant difference between the results of compliance with taking TB medication before and after counseling motivational interviewing at Batang Regional Hospital.

Stroke is a major cause of long-term disability and frequently results in balance impairment that limits functional mobility and increases the risk of falls. Impaired trunk control and postural instability are common consequences of stroke, highlighting the need for effective rehabilitation strategies. This study aimed to analyze the effect of Core Stability Exercise on balance improvement in stroke patients undergoing rehabilitation at the Medical Rehabilitation Polyclinic of RS Adhyaksa Jakarta. A case study design with a pretest–posttest approach was applied to three patients with ischemic stroke who presented with balance disorders. The intervention consisted of Core Stability Exercise, including bridging, bird-dog exercise, and seated balance exercise, conducted three times per week for eight sessions. Balance performance was measured using the Berg Balance Scale before and after the intervention. The findings demonstrated a consistent increase in Berg Balance Scale scores in all patients, indicating improvements in static and dynamic balance as well as a reduction in fall risk. Patients with better initial motor control showed faster and greater improvement, although positive changes were also observed in patients with more severe impairments. These results suggest that Core Stability Exercise contributes to enhanced trunk stability, postural control, and functional balance in stroke patients. The study implies that integrating Core Stability Exercise into routine physiotherapy programs may support more comprehensive and individualized stroke rehabilitation, particularly in addressing balance-related functional limitations.

The high cost of colloid fluids and the large number of patients are concerns in determining which treatment standard should be chosen from several treatment alternative, where the total cost for 43 cases with a combination of crystalloid colloid fluids is IDR 209.370.993 while the total cost for 45 cases of crystalloid fluids is only UDR 146.492.268 which causes hospital losses. This study aims to determine the difference in the cost-effectiveness between crystalloid fluids and crystalloid-colloid combinations in hospitalized dengue fever patients without shock at Tangerang City Hospital. The research design used was cross-sectional with a comparative quantitative analysis method, where cost effectiveness was analyzed using the Average Cost Effectiveness Ratios (ACER) method. There were two groups of study samples: the first group, 25 patients who received crystalloid fluids, and the second group, 23 patients who received crystalloid-colloid combination fluids. This study showed a difference in the average hospitalization costs for dengue patients between crystalloid fluid therapy and crystalloid-colloid combination therapy. Hospitalization costs for dengue patients were lower in the crystalloid fluid group, with a significant difference (p=0.000). It was also found that crystalloid fluids were more cost-effective than the crystalloid-colloid combination. The implications of the study results consist of theoretical implications and practical implications. Based on the results of the analysis carried out, the crystalloid solutions are more cost-effective than crystalloid-colloid combinations. This finding can be used as a consideration in making decisions and policies that are in accordance with quality control and cost control for patients covered by the National Health Insurance (BPJS Health insurance).

Tambak Mother and Child Hospital experienced a 15% decline in patient visits in 2024, involving both new and returning patients. This decline highlights the importance of patient loyalty, as loyal patients are more likely to continue using hospital services and recommend the hospital to others. This study aims to examine the effects of social media marketing and patient experience on patient loyalty, with patient engagement as a mediating variable.This study employed a quantitative causal research design. Data were collected from 190 patients using purposive sampling. Partial Least Squares–Structural Equation Modeling (PLS-SEM) was used to analyze the relationships among variables.The results indicate that social media marketing, patient experience, and patient engagement simultaneously have a significant effect on patient loyalty. Individually, social media marketing, patient experience, and patient engagement each show a positive and significant influence on patient loyalty. In addition, social media marketing and patient experience positively affect patient engagement. The findings further confirm that patient engagement mediates the relationships between social media marketing and patient loyalty, as well as between patient experience and patient loyalty.These findings suggest that hospital management should strengthen interactive communication through social media platforms, particularly Instagram, improve service efficiency by increasing staffing levels, and enhance service quality through friendly staff behavior and faster service processes. Future research is recommended to include broader samples across Mother and Child Hospitals and incorporate additional variables such as patient satisfaction, service quality, and trust.

Expressive feelings therapy is a form of mental health nursing modality therapy that aims to help individuals express their thoughts and emotions openly without violating the rights of others. This study aims to explore the effectiveness of cognitive therapy focused on “expressing feelings” in improving emotional expression abilities among female patients in the recovery phase at the Anggrek Ward of the Aceh Government Mental Hospital. This descriptive qualitative study was conducted through group therapy activities with structured stages, using media such as emotion expression picture cards and a spin-the-bottle game as interaction stimuli. The population consisted of 18 patient in the Anggrek ward, with a sample of 12 patients who were cooperative, psychologically stable, able to communicate bidirectionally, and willing to participate in group therapy. The results showed that participants experienced an improvement in their ability to express emotions such as happiness, sadness, anger, and anxiety more openly, accompanied by increased social interaction and reduced emotional tension. The therapy also encouraged greater self-confidence and a sense of emotional relief. These findings support that expressive feelings therapy can be incorporated as part of routine nursing interventions for patients who experience difficulties in emotional regulation. It is recommended that further research be conducted over a longer duration and with a broader scope to strengthen the validity of the findings.

Malpractice in dental health services has become a complex legal issue as public awareness of service quality and patient rights continues to increase. The enactment of Law Number 17 of 2023 on Health introduces important changes in regulating the legal accountability of medical personnel, including dentists, particularly in relation to criminal liability for malpractice. This study analyzes the forms of dental malpractice and the criminal responsibility of dentists under the new Health Law. The research uses an empirical legal method with sociological and statutory approaches. Data were obtained through interviews and a review of relevant legislation, legal doctrines, and court decisions. The results show that dental malpractice can arise from negligence, failure to comply with professional standards, violations of standard operating procedures, and the absence or disregard of informed consent. Law Number 17 of 2023 stipulates that criminal liability for dentists can only be applied after a recommendation from the Professional Discipline Board, ensuring a clear distinction between inherent medical risks and professional misconduct. This framework is designed to provide balanced legal protection for both patients and dentists while strengthening legal certainty in malpractice case resolution. Consequently, dentists must understand professional standards and criminal liability mechanisms to practice responsibly and professionally.

Arrhythmias are generally classified into two groups: disorders of impulse formation and disorders of impulse conduction. Cardiac arrhythmias can also be categorized into three main types: supraventricular arrhythmias, ventricular arrhythmias, and bradyarrhythmias. One of the most commonly encountered arrhythmias in clinical practice is Atrial fibrillation. This study employed a case study method using a nursing process approach. The subjects consisted of two patients: Mrs. S, a 74-year-old female, and Mr. R, a 44-year-old male. The nursing intervention administered was antiarrhythmic therapy using intravenous digoxin. Evaluation was conducted by monitoring the patients’ heart rate and cardiac rhythm using an electrocardiogram (ECG) monitor. The results of the case studies in both patients showed that digoxin therapy produced a positive therapeutic response, as evidenced by a gradual reduction in heart rate. However, ECG monitoring revealed no significant changes in cardiac rhythm. These findings suggest that digoxin is effective for rate control, although it does not restore sinus rhythm.

The growing number of alleged medical malpractice cases in Indonesia, particularly physicians’ misdiagnosis resulting in patient death, underscores the need for stronger legal certainty and accountability in healthcare services. Physicians are professionally obligated to conduct diagnosis and medical treatment in accordance with professional standards, service standards, and standard operating procedures; however, negligence may occur and lead to severe harm. This study aims to analyze the legal provisions governing physicians’ liability for misdiagnosis causing patient death and to examine the forms of legal responsibility that may be imposed. The research applies a normative juridical method using a case approach and literature review, relying on primary legal materials such as the Indonesian Civil Code, the Criminal Code, the Medical Practice Law, the Hospital Law, and Law Number 17 of 2023 on Health, supported by secondary and tertiary sources. The findings indicate that physicians may be held liable under civil, criminal, and administrative law if the essential elements of medical negligence are proven, namely duty of care, breach of duty, harm (including death), and a causal relationship between the misdiagnosis and the fatal outcome. Moreover, liability may extend to hospitals under the doctrines of vicarious liability, hospital liability, and strict liability. This study implies the importance of strengthening professional competence, reinforcing disciplinary mechanisms, and ensuring balanced legal protection for both patients and healthcare professionals within Indonesia’s health law framework.

The prevalence of diabetic ulcers in Indonesia reaches 12-15% of all sufferers. This condition has an impact on the patient's psychological condition in the form of anxiety due to wounds that are difficult to heal, changes in body image, and concerns about the possibility of amputation. One of the nonpharmacological interventions that can help overcome anxiety is the slow deep breathing technique. The purpose of writing this scientific paper is to carry out Nursing Care for Mrs. M with Diagnosis of Diabetic Ulcers using the application of slow deep breathing intervention in reducing anxiety at Az-Zahra Hospital. The writing method is a nursing care process that includes the stages of study, nursing diagnosis, planning, implementation, and evaluation. The subject of care was Mrs. M, a patient with diabetic ulcers in the inpatient room of Az-Zahra Hospital. Data collection was carried out through interviews, observations, documentation studies, and physical examinations, and using a medical-surgical nursing care assessment format. The ethical principles applied use the principles of Nursing Ethics. The results of nursing care showed that after three days of slow deep breathing intervention, patients reported feeling calmer, sleeping better, and anxiety levels decreased from moderate to mild based on observation results and anxiety scales used. This suggests that slow deep breathing interventions are effective in helping to reduce anxiety in patients with diabetic ulcers. It is hoped that patients and families can continue these breathing exercises independently as part of stress management efforts and quality of life improvement.  

RS at Kemayoran continues to experience low conversion of antenatal care (ANC) patients to delivery services, with a conversion rate of 6.9% in 2024. The maternity ward Bed Occupancy Rate (BOR) also remains below national standards. Preliminary assessments indicate dissatisfaction with the hospital’s healthscape, low mimetic desire reflected in limited recommendations, and suboptimal perceived value. This study examines the effects of healthscape and mimetic desire on childbirth location decisions, with perceived value tested as a mediating variable.Methods: A quantitative cross-sectional study was conducted using Structural Equation Modeling (SEM). Data were collected from 210 ANC patients at RSUD Kemayoran through structured questionnaires. Variables included healthscape, mimetic desire, perceived value, and delivery location decision. All instruments met validity and reliability criteria.Results: Healthscape and mimetic desire significantly influenced the decision to choose RSUD Kemayoran for childbirth. Healthscape did not significantly affect perceived value, whereas mimetic desire showed a significant effect. Perceived value had a significant direct effect on delivery decisions but did not mediate the relationships between healthscape or mimetic desire and delivery choice. Healthscape emerged as the most influential determinant.Conclusion: Physical healthcare environments play a critical role in childbirth location decisions. Improving healthscape quality and strengthening professional and social recommendations may enhance ANC-to-delivery conversion rates in public hospitals.

This study examines the binding force of the WHO Patient Safety Rights Charter (2024) as a soft law instrument within the Indonesian legal system and evaluates the potential application of its principles in the formulation of national health policies. The research employs a normative juridical method with descriptive, analytical, and comparative approaches toward international norms, including the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Global Patient Safety Action Plan (2021–2030), as well as relevant national regulations. The findings indicate that although the WHO Charter is not legally binding, it possesses substantial normative and moral authority derived from the ethical legitimacy of the World Health Organization and its alignment with the principles of the right to health. In Indonesia, several principles of the Charter have been partially reflected in Law No. 17 of 2023 on Health; however, normative gaps remain, particularly regarding patients’ participatory rights and medical justice. Soft law acquires its normative strength through moral legitimacy, broad acceptance, and integration into domestic policy frameworks. The study concludes that strengthening legal protection for patient safety in Indonesia requires the explicit incorporation of the WHO Charter’s principles into implementing regulations, thereby fostering a health law system that is equitable, accountable, and grounded in human rights.

According to Al-Ghazali, Islamic education is education that strives to form a perfect human being, both in this world and in the hereafter. According to Al Ghazali, humans can achieve perfection if they are willing to strive to seek knowledge and then practice fadhilah through the knowledge they have learned. According to Al Ghazali, the main goal of Islamic education is to obey Allah the Creator, and the most perfect human being in his view is a human being who always draws closer to Allah. This goal seems to have religious and moral nuances, without ignoring worldly problems. The method used to classify al-Ghazali into two parts: First, the special method of Religious education, this special method of religious education has an orientation towards knowledge of faith because religious education in reality is more difficult than other education, because religious education involves intuitive problems and focuses more on the formation of students' personalities. Second, the special method of moral education, Al-Ghazali said: "Just as a doctor, if he gives his patients only one kind of medicine, will surely kill most of the sick people, so too a teacher, if he shows his students the way with only one kind of practice, will surely destroy their hearts.

Type 2 diabetes is a persistent medical condition with an increasing incidence that requires long-term treatment. One of the decisive factors in blood glucose control Patient self-awareness is a key variable examined in this study. The research was conducted to assess the relationship between self-awareness and blood glucose levels among individuals with type 2 diabetes in the Tuban Community Health Center area. A correlational analytic study with a cross-sectional design was utilized. The study involved a population of 135 patients, with a sample of 101 respondents selected using simple random sampling.Research data collection was conducted using a self-awareness questionnaire and a blood glucose observation sheet. Data analysis was performed using a chi-square test with a significance level of 0.05. The results of the analysis showed a p-value of 0.002 (p < 0.05), indicating a significant association between self-awareness and blood glucose levels. Based on these results, the study findings generally indicate that greater self-awareness typically allows for more optimal control of blood glucose levels.  

Covid-19 referral hospitals were studied and it was found that their operational costs had increased. However, their income had actually decreased. This was because there were not many general patients. In addition, asset utilisation was also hampered by the Covid-19 pandemic, which affected the economy. This study sought to find out whether there had been an increase or decrease due to Covid-19. The study used a quantitative method, namely calculating the effectiveness and efficiency ratios. This study uses a descriptive method. The results will be explained in detail. This study compares the conditions before and during Covid-19. The results show that effectiveness in 2019 was 114%. Then, in 2023, it rose to 128%, or an increase of 14%. Meanwhile, efficiency in 2019 was 88%. In 2023, it was 107%. This means there was a decrease of 19%. In conclusion, the budget was well prepared and very effective in 2019 and 2023. However, the use of operational costs during Covid-19 was less efficient. From being quite efficient in 2019, it became inefficient in 2023.