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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.

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.

Typhoid fever is a febrile illness that commonly occurs in urban areas with poor sanitation. It is usually caused by the consumption of untreated water and contaminated food. Because the S. typhi bacterium can survive in water for days, contamination of surface water—such as wastewater, freshwater, and groundwater—serves as the primary cause of typhoid fever. The patient presented to the Emergency Department of Cut Meutia General Hospital with complaints of high fever for approximately 4 days prior to admission, which had worsened over the past 2 days. The fever fluctuated and was accompanied by chills. It worsened at night and was not influenced by weather or temperature. These symptoms were accompanied by vomiting every time the patient tried to eat, nausea, abdominal pain, headache, and weakness. The patient reported vomiting the contents of their meal every time they ate, leading to a loss of appetite. These symptoms began when the patient first developed a fever. The patient also experienced abdominal pain. Spontaneous bleeding was denied. On physical examination, the patient appeared weak but was alert and oriented. On neck examination, palpable enlargement of the thyroid glands was found on the right and left sides of the neck, measuring 2x2 cm, mobile, and soft. On abdominal examination, increased bowel sounds were noted. Vital signs were normal except for the patient’s febrile temperature. Laboratory tests revealed a Tubex blood test result of scale 4 and a positive dengue IgG serology result.

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.

Hypertension is one of the most common chronic diseases encountered in primary healthcare and may lead to serious complications if left uncontrolled. This case report aims to describe the management of a 48-year-old female patient with grade II hypertension through a family medicine approach at Nisam Primary Health Center, North Aceh Regency. The patient presented with intermittent headaches for one week, which worsened after physical activity and were accompanied by numbness in both legs. She had a five-year history of hypertension with poor adherence to antihypertensive medication. Physical examination revealed a blood pressure of 165/70 mmHg, leading to a diagnosis of grade II hypertension. Comprehensive management was conducted using patient-centered and family-centered approaches, including education regarding hypertension, lifestyle modification, DASH diet implementation, physical activity, medication adherence, and family support through home visits and family folders. The interventions were expected to improve blood pressure control, prevent complications, and enhance the patient’s quality of life. A family medicine approach plays an important role in comprehensive hypertension management at the primary healthcare level.

 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.

The completeness of nursing care documentation serves as a primary indicator of hospital service quality and remains a critical component of patient safety, clinical communication, and legal accountability. Despite its importance, empirical evidence from various healthcare facilities indicates that nursing records are frequently suboptimal, incomplete, or inconsistent. This study aims to analyze the complex interrelationships between burnout and coaching on the completeness of nursing care documentation, specifically examining the role of nursing competence as a mediating (intervening) variable at the Dr. Chasbullah Abdulmadjid General Hospital in Bekasi City. Utilizing a quantitative research framework with a cross-sectional design, this study sampled practicing nurses stationed across inpatient and intensive care units. Primary data were gathered through a validated, structured questionnaire designed to measure psychological burnout, the frequency of clinical coaching, perceived professional competence, and the objective completeness of documentation. The data were subjected to rigorous analysis using Structural Equation Modeling–Partial Least Squares (SEM-PLS) to test the hypothesized pathways within the conceptual model. The results demonstrated that burnout exerts a significant negative influence on both nursing competence and the quality of documentation, suggesting that emotional exhaustion hinders professional performance. Conversely, systematic coaching was found to have a significant positive impact, directly improving both competence levels and documentation adherence. Critically, the analysis confirmed that nursing competence acts as a vital intervening variable; it effectively mediates and strengthens the influence of both burnout reduction and coaching interventions on the overall completeness of nursing care records. This study concludes that proactive burnout management and the institutionalization of structured coaching programs are essential strategic priorities. By addressing these factors, hospital management can enhance individual nurse competence, thereby ensuring high-quality, comprehensive nursing documentation that supports patient safety and institutional integrity.

Effective communication is essential for teamwork effectiveness in healthcare, particularly in inpatient units where patient care requires coordination among multiple professionals. Internal data from Hospital X showed that more than 50% of medical incidents in the last two years were related to miscommunication among healthcare workers. In addition, the 2024 employee satisfaction survey reported that workplace communication satisfaction was only 62%, below the hospital target of 75%. This study aimed to examine the influence of effective communication on teamwork effectiveness with interprofessional collaboration as an intervening variable at Hospital X.This study used a quantitative cross-sectional design involving 226 healthcare workers, including doctors, nurses, and medical support staff. Data were analyzed using the Three-Box Method and PLS-SEM. The findings revealed that effective communication significantly influenced teamwork effectiveness both directly and indirectly through interprofessional collaboration. Interprofessional collaboration also acted as a significant mediating variable between communication and teamwork effectiveness. These results indicate that communication is a key foundation for strengthening collaboration and improving teamwork in hospitals. Therefore, hospitals should enhance communication training and interprofessional collaboration programs to improve healthcare quality and patient safety

The optimal therapeutic impact of local vaginal drug delivery systems is strongly influenced by the physical characteristics balance of Solid Vaginal Suppositories. A comprehensive review regarding the comparison of mechanical profiles, specifically melting time and crushing strength parameters, from various base classifications constitutes the primary objective of this literature research. The implementation of a Literature Review study design was executed through the extraction of empirical data from twelve experimental journals published within the last ten years. Excessively rapid phase transformation characteristics at physiological basal temperatures and low compression resistance were consistently demonstrated by lipophilic bases such as Oleum Cacao. The risk of structural deformation during the distribution process is highly susceptible to unmodified lipid preparations. High surface elasticity accompanied by a delay in molecular hydration duration reaching 120 minutes was recorded in the utilization of Glycerinated Gelatin Base. Structural rigidity exceeding 4 kgF and disintegration time efficiency under 60 minutes were optimally demonstrated by Polyethylene Glycol (PEG) Base. An enhancement in mechanical resistance against external shocks during the storage period is offered by the thorough modification of the synthetic polymer ratios. Therefore, the determination of the PEG base as the most optimal material is recommended to maintain the quality stability of pharmaceutical products. Compendial regulation standards regarding the physical strength testing of pharmaceutical preparations must be obeyed by every institution to ensure long-term treatment effectiveness. Thus, the alignment between active substance release duration and physical preparation endurance can be realized for absolute patient comfort.

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.

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.

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.

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.

Pressure ulcers are a common complication in patients with impaired consciousness due to prolonged immobilization. This condition can increase morbidity and prolong the length of stay, thus requiring effective preventive interventions such as progressive mobilization. To determine the outcomes of implementing progressive mobilization on the incidence of pressure ulcers in patients with impaired consciousness at the Anggrek 2 High Care Unit (HCU) of Dr. Moewardi General Hospital. This study employed a case study design involving two participants with impaired consciousness. The intervention, consisting of progressive mobilization, was conducted over 3 days with monitoring of skin condition and pressure ulcer risk. Findings: Following the implementation of progressive mobilization, both participants showed improvement in skin condition and a reduction in the risk of pressure ulcers, as evidenced by the absence of progression to more severe wounds and an increase in skin integrity. The application of progressive mobilization is effective in preventing and reducing the risk of pressure ulcers in patients with impaired consciousness. This intervention can serve as a safe and planned nursing intervention in the intensive care unit.

This article examines Romans 14:7-9 as a foundational biblical text for the concept of life ownership in New Testament ethics. Using a historical-exegetical and theological-systematic approach, it demonstrates that the passage clearly declares that neither life nor death belongs to the individual believer. Both are to be lived and died “to the Lord,” affirming that Christians are ultimately the possession of Christ as Kyrios. This theocentric view directly challenges the modern secular principle of radical patient autonomy that underpins euthanasia and physician-assisted suicide. The study provides a detailed exegesis of Romans 14:7-9 in its literary and historical context, explores parallel New Testament texts on life ownership, and discusses its ethical implications for contemporary medical practice. It argues that Romans 14:7-9 offers strong biblical grounds for rejecting active euthanasia while supporting compassionate palliative care that honors human dignity until natural death. In the Indonesian context, where euthanasia is legally prohibited, this perspective provides a robust theological foundation for Christian bioethics and public policy. A truly good death, according to the New Testament, is one that occurs in submission to the sovereignty of the risen Lord.

Laparotomy is a major surgical procedure associated with a high risk of acute postoperative pain. According to Gan (2017), if pain is not properly managed, it can progress to chronic pain. (Toro et al., 2018) reported that severe pain on the first postoperative day is still commonly found in laparotomy patients, while (Small & Laycock, 2020) indicated that moderate to severe pain within the first 24 hours following major surgery remains a significant clinical issue. This study aims to evaluate the effectiveness of pharmacological pain management following laparotomy under general anesthesia, specifically to identify the types of opioid analgesics used, analyze their effectiveness in reducing pain intensity, identify side effects, and examine administration techniques and routes. This study employed a Systematic Literature Review (SLR) method following the PRISMA guidelines. Literature searches were conducted in the PubMed, ScienceDirect, and SpringerLink databases covering the years 2015–2026. The included studies comprised randomized controlled trials (RCTs), cohort studies, and retrospective studies addressing opioid pharmacological pain management in adult patients following laparotomy under general anesthesia. Study quality assessment was performed using the Joanna Briggs Institute (JBI) instrument. A total of 11 studies met the inclusion criteria. The results of the systematic literature review indicate that opioids are effective in reducing postoperative pain following laparotomy under general anesthesia. The most commonly used opioids are morphine, fentanyl, and oxycodone. Of all the opioids reviewed, oxycodone provided the best pain control, while intrathecal morphine was most effective in reducing the need for supplemental opioids during the early postoperative period. Other opioids, such as extended-release dinalbuphine sebacate and tegileridine, are also effective, but the number of studies is still limited. The most common side effects are nausea, vomiting, pruritus, sedation, and dizziness. Pharmacological pain management using opioids is effective in reducing the intensity of postoperative pain following laparotomy under general anesthesia. Morphine, fentanyl, and oxycodone are the most commonly used opioids. Oxycodone and intrathecal morphine have shown good results in improving pain control and reducing the need for supplemental opioids. The selection of opioid type, dosage, and administration technique must be tailored to the patient’s clinical condition to achieve optimal analgesia with minimal side effects.

Mindfulness intervention therapy is a psychotherapy that can be used to reduce depressive symptoms. This study aims to determine whether mindfulness therapy contributes to reducing the level of depression in patients cancer at the Cipto Mangunkusumo Hospital, Jakarta. The research design used was the experimental design of the one group pretest-posttest design. The total number of samples used for the population was 30 people who met the criteria for depression. Relevant data was collecterd through clinical interviews, observations and psychological test. The Beck Depression Inventory II (BD-II) questionnaire was used to collect data for this study. According to the Wilcoxon analysis, the results were statistically significant p = 0.000, indicating a large effect size in reducing depressive symptoms with mindfulness therapy. These results are supported by improved patients understanding of depression and mindfulness concepts, as well as enhanced abilities in adapting emotional coping strategies. The results of qualitative analysis showed that subjek felt more happy, be positive, not hopeless, effective communication skills and be able to resolve their problems. This research can make a significant contribution to efforts to prevent and treat depression in cancer patients, improving their quality of life through increasing mindfulness.

Malpractice in the health professions is one of the issues that can cause harm to patients, health professionals, and healthcare institutions. A lack of understanding among students as prospective health professionals regarding ethical aspects, legal principles, professional standards, and proper service procedures may increase the risk of malpractice. This Community Service activity aims to provide students of STIKES Pasapua Ambon with an understanding of the concept of malpractice, the factors causing malpractice, and preventive efforts through the implementation of professional ethics, compliance with standard operating procedures, effective communication, and the improvement of professional competence. The activity was carried out through counseling, educational sessions, interactive discussions, and guidance on health law for participants. The results of the activity indicate an increase in students’ knowledge and awareness of the importance of understanding the limits of professional authority, legal responsibility, and preventive measures to avoid malpractice in healthcare practice. This activity is expected to help develop future health professionals who are professional, ethical, and responsible in providing safe and high-quality healthcare services.