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Adolescents face significant barriers in accessing reproductive health services due to fears of privacy breaches and social stigma. In primary healthcare facilities, healthcare professionals are often trapped in a dilemma between the obligation to maintain medical confidentiality based on professional ethics and national regulatory demands requiring parental involvement for underage patients. This study aims to analyze the practice of protecting adolescent patient data privacy at Mardi Saras Primary Clinic and identify the gap between practical implementation and the norms of medical ethics and applicable legal regulations. This study employs a socio-legal research method with a qualitative approach. Data were collected through in-depth interviews with doctors and nurses, observation of service procedures, and study of the clinic's Standard Operating Procedures. The results indicate that although Mardi Saras Primary Clinic has implemented basic confidentiality protocols such as closed consultation rooms, there are substantial weaknesses in informed consent management, which still heavily relies on parental presence for all adolescent cases. This practice is driven by healthcare professionals' fear of legal risks, thereby ignoring the principle of developing autonomy in adolescents. These findings indicate a disparity between rigid administrative compliance and the spirit of protecting adolescent health rights within national regulations. The implication of this study underscores the urgency of developing specific SOPs that are sensitive to adolescent rights, as well as the need for continuous training for healthcare professionals regarding the legal and ethical boundaries of maintaining confidentiality for underage patients without compromising legal safety aspects.

In the planning of removable partial dentures (RPD), design is a crucial factor that must be tailored to each patient’s clinical condition, while one of the main challenges in RPD design is anatomical variation in the oral cavity such as torus palatinus, which may affect retention, stability, and patient comfort. This report aims to discuss the design considerations of acrylic resin RPD in patients with torus palatinus, particularly in determining optimal design modifications. A 42-year-old female patient presented with complaints of difficulty chewing due to the loss of several teeth in both the maxilla and mandible. Intraoral examination revealed missing teeth 15, 11, and 25, with healthy mucosal and periodontal conditions, and a nodular torus palatinus measuring approximately 2.5 × 2 cm was identified along the midline of the palate. RPD design planning in this case requires an individualized approach, particularly in the selection of the major connector and base adaptation to avoid pressure on the torus area, and design modifications were implemented to improve load distribution and patient comfort. The use of a U-shaped major connector with relief over the torus area effectively avoids direct contact, thereby enhancing comfort, preventing mucosal irritation, and supporting masticatory function.

Rheumatoid arthritis (RA) is a daily disease seen in rheumatology clinics. It predominantly involves the appendicular skeleton. The axial skeleton is mostly spared except for the cervical spine where instability can occur and can be carefully assessed with cervical spine radiographs in flexion and extension. Radiographs may show erosion at the C1-C2 level with destruction of the transverse ligament that can result in atlantoaxial subluxation. Diagnosis is based on clinical, laboratory, and radiographic findings. Conventional radiography has been the mainstay for diagnosis of joint damage and subsequent follow-up. Radiography can provide only indirect information on synovial inflammation, however, and the technique is insensitive to early bone damage. Hand radiographs are frequently ordered as the first imaging modality in the assessment of patients presenting with peripheral arthritis. They can provide invaluable information about the bones, joints, mineralization, soft tissues and the distribution of abnormalities. Given the wide spectrum of rheumatic diseases, it might be challenging to make the diagnosis solely based on the clinical findings and imaging plays an important role in narrowing the differential diagnosis. Having the knowledge of the common radiographic manifestations of inflammatory arthritis is of paramount importance for clinicians and radiologists to diagnose the underlying disease in early stages of disease in order to start treatment. The purpose of the article is to review the key radiographic findings of common rheumatic diseases in the hands.

Typhoid fever during pregnancy can lead to complications such as uteroplacental infection, miscarriage, and vertical transmission, which causes neonatal typhoid. Typhoid fever is found worldwide and is highly prevalent in developing countries, particularly in tropical regions. It is estimated that there are 11–21 million cases per year and approximately 128,000–161,000 deaths per year; the majority of cases occur in Southeast Asia, South Asia, and Sub-Saharan Africa. Salmonella typhi is a gram-negative bacterium capable of intracellular survival. Symptoms in typhoid patients vary among different groups. While pregnant women with typhoid are more likely to exhibit coughing, non-pregnant patients more frequently report nausea/vomiting compared to pregnant patients. The effects of typhoid fever on pregnancy result from prolonged high fever and poor general health, which can lead to miscarriage, preterm labor, and intrauterine fetal death, especially if the infection occurs during the first or second trimester. Morbidity and mortality rates may be higher in pregnant women. Pregnancy itself does not affect the course of the disease. Prevention of typhoid fever involves adopting a clean and healthy lifestyle, as well as receiving the typhoid vaccine. Two effective vaccines are available for typhoid fever. The live-attenuated oral vaccine (Ty21a) requires four doses, administered 48 hours apart, without concurrent use of antibiotics or antimicrobial medications. Due to reduced gastrointestinal motility in early pregnancy and frequent nausea and vomiting associated with symptomatic gastroesophageal reflux requiring acid-reducing therapy, we do not recommend the Ty21a oral vaccine for pregnant patients.

Antimicrobial resistance is a persistent threat to hospital care, particularly when empirical therapy relies on broad-spectrum antibiotics without continuous evaluation of local use and susceptibility patterns. This literature review aimed to synthesize evidence from four Indonesian hospital-based studies regarding antibiotic utilization, rationality assessment, and bacterial resistance profiles. A structured narrative review was conducted using four selected articles provided by the author. Data were extracted for study design, setting, population, antibiotic evaluation method, dominant antibiotic classes, rationality indicators, resistance profile, and stewardship implications. The four studies were descriptive and hospital-based, using retrospective records, concurrent observation, ATC/DDD with DU 90%, qualitative rationality criteria, and antibiogram data. The synthesis showed a consistent concentration of antibiotic use in broad-spectrum groups, especially third-generation cephalosporins, penicillins, quinolones, and macrolides. In a Bandung public hospital, total antibiotic consumption reached 95,719.01 DDD, with penicillins, cephalosporins, quinolones, macrolides, and sulfonamides included in the DU 90% segment. In intensive care, ceftriaxone was the most frequently used antibiotic and most rationality indicators were appropriate, although clinically significant drug interactions were still identified. In pediatric acute respiratory infection inpatients, cefotaxime and ceftriaxone dominated empirical therapy. Resistance mapping in Denpasar highlighted relevant Gram-positive and Gram-negative pathogens and recommended antibiotics according to susceptibility levels. Overall, the reviewed evidence supports an integrated antimicrobial stewardship model combining ATC/DDD-DU 90% surveillance, qualitative rationality evaluation, antibiogram-based empirical guidance, and periodic feedback to prescribers.

Hydrocephalus is defined as active distension of the brain’s ventricular system, resulting from inadequate flow of cerebrospinal fluid from its site of production to its site of absorption into the systemic circulation. Hydrocephalus can affect anyone at any age; pediatric hydrocephalus affects 1 in 1,000 live births and is the most common cause of brain surgery in young patients. Hydrocephalus is a pathological condition characterized by abnormal accumulation of cerebrospinal fluid (CSF) due to increased production, impaired flow, or reduced absorption. Ventricular enlargement occurs in response to increased CSF volume and can lead to structural damage to the brain parenchyma. This condition can be congenital or acquired. One key point in prenatal diagnosis is the differentiation between fetal hydrocephalus and non-hypertensive ventriculomegaly. The former qualifies for intrauterine treatment with good outcomes. However, the latter can result in either favorable or catastrophic outcomes due to a damaging etiology, as seen in viral infections such as Zika virus. For an accurate diagnosis, fetal MRI is performed to detect brain anomalies, in addition to fetal ultrasound (to detect common complications), karyotype testing, and TORCH testing (toxoplasma, rubella, cytomegalovirus, herpes simplex). Obstetric management of fetal hydrocephalus depends on the gestational age at diagnosis and the presence of other anomalies. Treatment options include termination of pregnancy before the fetus is viable, placement of a ventriculoamniotic shunt, cephalocentesis before delivery, and/or cesarean section.

Introduction: Ramadan fasting is a religious practice observed by Muslims by abstaining from food and drink from dawn until sunset. These changes may increase the need for oral and dental healthcare. However, some Muslims still perceive that undergoing dental treatment while fasting may invalidate the fast, leading many patients to delay or avoid dental visits during Ramadan. Objective: This study aims to review and analyse various scientific literature regarding the safety and permissibility of dental procedures for patients who are observing fasting during Ramadan. Methods: This study used a narrative review method by searching scientific articles through PubMed, ScienceDirect, and Google Scholar databases using keywords relevant to the research topic. Articles were selected based on predetermined inclusion and exclusion criteria. Results: The review findings indicate that most dental procedures, such as local anaesthesia administration, scaling, restorative treatment, and tooth extraction, generally do not invalidate fasting as long as no material or fluid is intentionally swallowed. The use of suction devices, isolation of the treatment area, and proper scheduling of dental procedures are important factors in minimizing the risk of swallowing fluids during treatment. Conclusion: Most dental procedures can be safely performed on fasting patients while still considering both medical aspects and Islamic principles. Patient education regarding the safety of dental procedures during fasting should be improved to prevent delays in treatment and complications in oral health.

 Background: Perineal pain due to episiotomy is a common complaint experienced by postpartum mothers and can affect patient comfort, mobility, and recovery. Nonpharmacological pain management is needed to help reduce discomfort with minimal risk of side effects. Objective: This study aimed to determine the effectiveness of applying cold compresses using ice packs in reducing perineal pain intensity in postpartum mothers with episiotomy. Methods: The study used a descriptive case study design in three vaginal postpartum patients with episiotomy who were treated in the postpartum ward. The intervention involved applying cold compresses using ice packs to the perineal area for 10–15 minutes, as per nursing procedures. Pain was measured using the Numeric Rating Scale (NRS) before and after the intervention. Findings: The results showed a decrease in pain intensity in all patients after the application of cold compresses. Patient P1 experienced a decrease in pain score from 5 to 4, patient P2 from 6 to 5, and patient P3 from 5 to 4, with an average decrease of 1 point. Implications: Cold compresses using ice packs have the potential to be an effective non-pharmacological nursing intervention to help reduce perineal pain and improve the comfort of postpartum mothers with episiotomies during the care period.

Nurse workload is the total number or volume of tasks that must be completed by nurses during their professional practice in hospitals, including both physical and mental responsibilities in providing nursing care to patients. Meanwhile, nurse burnout is a condition of emotional and mental fatigue experienced by nurses due to prolonged work pressure and the high intensity of emotional demands in the hospital environment. However, workload problems are still commonly found in hospitals, with one of the main contributing factors being work stress caused by excessive job demands and continuous pressure during work activities. The population in this study were outpatient, inpatient and emergency nurses at Ibnu Sina Islamic Hospital, Bukittinggi in 2025 This study used a quantitative method with a cross-sectional approach, analyzing the relationship between one variable and another. This study had 130 samples consisting of outpatient nurses, inpatient nurses, and emergency room nurses. Sampling was carried out using a total sampling technique. The results of this study indicate a significant relationship between workload and burnout at a significance level of 0.00 (≤ 0.05). There is a significant relationship between workload and nurse fatigue at Ibnu Sina Islamic Hospital Bukittinggi in 2025.

Allergic rhinitis (AR) is an inflammatory process of the nasal mucosa initiated by a hypersensitivity reaction and caused by exposure to allergens mediated by immunoglobulin E (IgE), with several characteristic symptoms including: nasal congestion, a runny nose or watery nasal discharge (rhinorrhea), nasal itching, sneezing, and  postnasal drip (PND). According to the World Health Organization’s Allergic Rhinitis and its Impact on Asthma (WHO-ARIA) guidelines, based on the duration of symptoms, allergic rhinitis is classified into two categories: intermittent allergic rhinitis (symptoms lasting less than 4 days per week or for less than 4 weeks) and persistent allergic rhinitis (symptoms lasting more than 4 days per week and for more than 4 weeks). The prevalence of allergic rhinitis based on a doctor’s diagnosis is approximately 15%; however, it is estimated to reach 30% when considering patients with nasal symptoms. Appropriate management of allergic rhinitis, in addition to alleviating symptoms, is also expected to improve the quality of life of patients whose lives have been disrupted by the condition, as the higher the severity and frequency of allergic rhinitis symptoms, the greater the impact on reduced quality of life.

Hyperemesis gravidarum is excessive nausea and vomiting in pregnant women to the point of interfering with daily activities. Hyperemesis gravidarum affects the mother's physiological condition. Continuous nausea and vomiting can cause carbohydrate and fat reserves to be used up for hormonal needs, resulting in activity intolerance, and imperfect fat oxidation, resulting in ketosis. This case study aims to explain Nursing Care for Patient Mrs. B with Hyperemesis Gravidarum Case in Providing Ginger Water Decoction to Reduce Nausea and Vomiting in Pregnant Women in Arafah Room 3 RSUDZA Banda Aceh. This design is a case study with a nursing process approach, the results of the case study found three nursing diagnoses, namely nausea related to pregnancy, the risk of nutritional deficits related to psychological factors (reluctance to eat) and anxiety related to lack of exposure to information. The nursing actions given are providing non-pharmacological therapy: ginger decoction, encouraging patients to eat little but often and providing information about physiological symptoms in pregnant women in the first trimester, including nausea and vomiting. The results of the evaluation after 5 visits for the nursing diagnosis of Nausea related to pregnancy were obtained at the fifth visit. The subjective data evaluation of the client said that nausea was still felt occasionally, the client said that vomiting was no longer present, the client said that appetite had started to improve

Hospitals play a strategic role in improving public health through professional, safe, and high-quality healthcare services. In modern healthcare organizations, service quality is not only determined by medical facilities and technology but also by the quality of human resources, particularly healthcare workers who directly interact with patients. This study aims to analyze the influence of authentic leadership on healthcare workers’ performance and hospital service quality. The study employed a quantitative explanatory research design involving 120 healthcare workers in a hospital setting. Data were collected using questionnaires and analyzed through multiple linear regression analysis. The findings demonstrate that authentic leadership has a positive and significant effect on healthcare workers’ performance, with a regression coefficient value of 0.648 and a significance level of 0.000. Furthermore, authentic leadership indirectly influences hospital service quality through healthcare workers’ performance, with an indirect effect value of 0.521. These findings indicate that leaders who demonstrate honesty, transparency, integrity, and interpersonal support are able to create a healthy work environment that enhances healthcare workers’ motivation, responsibility, and professionalism. Consequently, improved employee performance contributes to better hospital service quality, particularly in responsiveness, empathy, and communication with patients. This study highlights that authentic leadership is an effective leadership approach for strengthening healthcare human resources and improving hospital service quality in contemporary healthcare organizations.

Therapeutic adherence is a fundamental cornerstone in managing Type 2 Diabetes Mellitus (DM) to maintain stable blood glucose levels and prevent chronic complications. Family support serves as a significant external determinant influencing the development of long-term patient adherence behaviors. This quantitative study, utilizing a correlational analytic design with a cross-sectional approach, aimed to analyze the relationship between family support and therapeutic adherence levels among Type 2 DM patients at Royal Prima Hospital, Jambi City. Through total sampling, 92 respondents were enrolled as the study sample. Data were collected via questionnaires and analyzed using the Chi-Square test. Univariate analysis revealed that the majority of respondents received moderate family support (46.7%) and demonstrated adherent behavior (62.0%). Bivariate analysis yielded a Pearson Chi-Square value of 17.186 with a p-value of 0,000 (α < 0,05), leading to the rejection of H0 and the acceptance of Ha. In conclusion, there is a statistically significant relationship between family support and therapeutic adherence levels among Type 2 DM patients at Royal Prima Hospital, Jambi City, indicating that more optimal family support is directly proportional to increased therapeutic adherence.

Background: Acute respiratory infection (ARI) remains a major public health concern, particularly in primary care settings. Lifestyle factors such as dietary patterns and physical activity are increasingly recognized as potential contributors to respiratory health. Objective: This study aimed to examine the association between dietary patterns, physical activity, and ARI among primary care patients in East Halmahera, Indonesia. Methods: A cross-sectional study was conducted at a primary health care facility in East Halmahera, Indonesia, from January to February 2026, involving 106 respondents selected using a total sampling technique. Data were collected using structured questionnaires and medical records. Variables included sociodemographic characteristics, dietary patterns, physical activity, and ARI status. Data were analyzed using descriptive statistics and Chi-square tests with a significance level of p < 0.05. Results: The prevalence of ARI among respondents was 77.4%. Bivariate analysis showed that dietary patterns (p = 0.006) and physical activity (p = 0.015) were significantly associated with ARI. In contrast, age, gender, marital status, education level, employment status, smoking, and alcohol consumption were not significantly associated with ARI (p > 0.05). Conclusion: Dietary patterns and physical activity were significantly associated with ARI among primary care patients in East Halmahera. These findings highlight the importance of lifestyle-related factors in addressing respiratory infections at the primary care level.  

Dengue Hemorrhagic Fever (DHF) remains a major public health problem in Indonesia, particularly in densely populated areas. Control efforts require accurate data and spatial analysis to understand disease distribution patterns. Geographic Information System (GIS) is an effective tool for visualizing case distribution and supporting surveillance and planning of control programs at the primary healthcare level. This study aims to describe the spatial distribution of Dengue cases based on medical record data and produce a geographic distribution map to support Dengue control efforts at the Puskesmas level. This study used a quantitative descriptive design with secondary data from medical records at Karangsari Health Center. The sample consisted of 255 DHF patients in 2025, selected using a total sampling technique. Data were processed through editing, geocoding patient addresses, and spatial analysis using QGIS software.The results showed 255 Dengue  cases in 2025 with fluctuating monthly trends, peaking in April and lowest in December. Case distribution was uneven and tended to cluster. High-risk areas accounted for 15.7%–21.2%, moderate-risk areas 9.8%–15.7%, and low-risk areas 7.1%–9.8%. Megu Cilik Village had the highest proportion of cases, while other villages were categorized as moderate and low risk. This pattern indicates that Dengue incidence is influenced by environmental conditions, vector density, host factors, rainfall, and Aedes aegypti presence. GIS provides clearer spatial visualization, helping identify high-risk areas and supporting targeted public health interventions.

Chronic kidney disease is a progressive disease requiring long-term hemodialysis therapy that may cause physical, psychological, social, and spiritual problems. Patients undergoing hemodialysis often experience spiritual distress due to changes in health conditions and dependence on therapy. This study aimed to determine the relationship between the duration of hemodialysis and the level of spiritual distress in chronic kidney disease patients at the Hemodialysis Unit of Baiturrahim Hospital Jambi. This study used a quantitative design with a cross sectional approach. The sample consisted of 57 respondents selected using a purposive sampling technique. The research instrument used a spiritual distress questionnaire that had been tested for validity and reliability with a Cronbach’s Alpha value of 0.955. Data were analyzed using the Chi-Square test with a significance level of 0.05. The results showed that most respondents underwent hemodialysis for ≥12 months, totaling 39 respondents (68.4%), and the majority experienced moderate spiritual distress, totaling 20 respondents (35.1%). Statistical analysis showed a p-value of 0.030 (p<0.05), indicating a significant relationship between the duration of hemodialysis and the level of spiritual distress in chronic kidney disease patients. The longer patients undergo hemodialysis, the lighter the spiritual distress tends to be because patients gradually adapt to their disease condition and therapy.

Schizophrenia is a severe mental disorder often accompanied by auditory hallucinations and has a significant impact on patients’ psychosocial functioning. This condition can reduce medication adherence, thereby increasing the risk of relapse. In this context, the role of caregivers is crucial in supporting treatment success. This study aims to describe psychiatric nursing care for patients with auditory hallucinations in improving medication adherence through caregiver involvement. The method used is a case study with a nursing process approach, including assessment, nursing diagnosis, planning, implementation, and evaluation. Interventions focus on hallucination management, psychoeducation, and caregiver involvement in care. The results show an increase in patients’ and families’ knowledge regarding the illness and its treatment, improved medication adherence, and enhanced patient ability to control responses to auditory hallucinations. Caregiver involvement has been shown to assist in supervision and providing support to patients. Therefore, comprehensive psychiatric nursing care through hallucination management, psychoeducation, and caregiver involvement is effective in improving medication adherence and controlling symptoms in patients with auditory hallucinations.

According to the WHO and the Ministry of Health, hypertension is defined as blood pressure ≥ 140/90 mmHg, consistent with the ESC/ESH guidelines. Hypertension is one of the leading causes of premature death worldwide. Symptoms experienced by patients with hypertension include headaches, sweating, palpitations, snoring, daytime sleepiness, muscle weakness, cramps, and cardiac arrhythmia. Clinical manifestations of hypertensive urgency include elevated blood pressure, severe headache, anxiety, and shortness of breath. Mrs. M, a 68-year-old woman, came to the Samudera Community Health Center complaining of a headache that had worsened approximately 3 days ago. The headache is felt at the back of the head, feeling heavy, and sometimes radiates throughout the entire head. The patient also describes the headache as throbbing. The headache was exacerbated when the patient could not sleep, consumed salty foods, and did not take her medication regularly.  The headache subsides slightly when the patient takes medication and sleeps with their head elevated.  The patient reported that the symptoms were also accompanied by nausea, dizziness, palpitations, and an inability to sleep at night. The patient has been diagnosed with hypertension for approximately 5 years. On physical examination, the patient’s blood pressure was 190/100 mmHg. The patient was advised to adopt a healthy diet by reducing salt intake. The patient was also prescribed the following medications: Captopril 25 mg twice daily, Amlodipine 5 mg once daily, Paracetamol 500 mg three times daily, and Domperidone 10 mg twice daily, to be taken as needed.

The ICU is one of the largest clinical cost centers in hospitals due to its high demand for human resources, medical equipment, and operational costs. This situation emphasizes that intensive care unit efficiency is a multidimensional issue that cannot be assessed solely from a single aspect. This study aims to analyze the efficiency of the intensive care unit at Ciremai Hospital, Cirebon City, using the Data Envelopment Analysis (DEA) model to determine resource optimization. Analytical quantitative study with a cross-sectional design. The population in this study consisted of personnel in the ICU of Ciremai Hospital from 2023 to 2025, with total sampling applied. The input variables included the number of physicians, nurses, beds, monitors, and ventilators, while the output variables consisted of BOR, LOS, and recovered patients. The ICU input variables remained stable during the study period, while output variables fluctuated with a declining trend in BOR and LOS. The results of the Data Envelopment Analysis (DEA) indicated that all study periods achieved an efficiency score of 1.00 (efficient), with a slack value of 0.00 across all input variables.

Critically ill patients are individuals with unstable health conditions who require close monitoring of hemodynamic parameters. The high mortality rate among critically ill patients treated in intensive care units reaches 36.5% of 33,148 patients. Hemodynamic instability in critically ill patients can be influenced by underlying diseases, medical interventions, as well as physical and psychological stress responses during treatment. Therefore, in addition to pharmacological therapy, non-pharmacological interventions such as Asmaul Husna dhikr therapy are needed, as they can provide a relaxation effect and help stabilize hemodynamic parameters in critically ill patients. To determine the outcomes of the implementation of Asmaul Husna dhikr therapy. This study used a descriptive case study method involving two critically ill patients with unstable non-invasive hemodynamic parameters. Changes in non-invasive hemodynamic parameters were observed in both respondents after the implementation of Asmaul Husna dhikr therapy. In respondent 1, the hemodynamic status was initially categorized as increased and became stable after the intervention. Similarly, in respondent 2, the hemodynamic status changed from increased before the intervention to stable after the intervention. The implementation of Asmaul Husna dhikr therapy can be used as a complementary therapy to help stabilize hemodynamic parameters in critically ill patients.