(ERMIN DUNIA KEDOKTERAN

ISSN: 0125-913 X 1171/ vol. 36 no. 5/ Agustus 2009 http.//www.kalbe.co.id/cdkr--~'-_o-,--- A:""'_~""~-" __ ""~"'- __ ':'" .~ .• "'~~~ __....-u_ __~ __ ~,"'-'4- ,_. __ • 1i•

HASIL PENELITIANEfektivitas Larutan AntiseptikKlorheksidin Glukonat 0,5%

yang TergenanguntukCuci Tangan"

TIN.!AUAN PUSTAKAToxic Shock Syndrome

Prospect of Nucleic-Acid Based ImmuneSystem - RNAi as Potent

Antiviral Agerits

PROFILProf. Dr. Djoko Widodo,

DTM&H, SpPD-KPTIPasien adalah Sumber IImu

yang Tidak Terbatas

~_ INFORMATIKA KEDOKTERAN

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Sistem Informasi Kesehatandari tv'1asake Masa

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Pusat Studi informatika KedoktcranUniversitas Gunadarma Jakarta. Indonesia

kecil daripada komputer mainframe, na-mun berkemampuar. lebih tinggi. Perkern-bangan teknologi informasi sejak 1980-anmentransformasikan proses komputasiyang sebelumnya semata-rnata bersifat oto-matisasi ini menjadi sistem penunjang bagidokter, perawat, serta pemasok layanan

kesehatan lainnya. Ketersediaan akses ter-hadap Internet dan jejaring komputasi dimasa kini dan akan datang diharapkanakan dapat memperluas ranah sistem in-formasi kesehatan dalam komunitas den-gan fokus untuk memberdayakan pasien(Gambar 1; de Velde & Degoulet, 2003).

Johan Harlan

Sistem Informasi dan TeknologiInformasi

Sistem informasi adalah suatu tatar.aninformasi (data), proses, manusia, danteknologi informasi yang saling berinter-aksi untuk mengurnpulkan, mengolah,menyimpan, dan menyediakan keluaraninformasi yang dibutuhkan untuk menun-jang organisasi. Teknulogi informasi ada-lah kombinasi antara teknologi komputer(perangkat keras dan lunak) dengan datadan teknologi telekomunikasi (jejaringdata, citra, dan suara). Teknologi informasimerupakan salah satu komponen sisteminformasi, walaupun di masa kini istilahsistem informasi seringkali dianggap sarnadengan teknologi informasi (Wager et al,2005).

Kompleksitas

Perkembangan Sistem InformasiKesehatan

Fenggunaan komputer dalam bidanglayanan kesehatan bermula sejak awal1960-an, dalam bentuk sistem informasirumah sakit (Hospital Information System;HIS), yang mencakup fungsi administratifmaupun medis. Sistem ini terutama diran-c~ng atas dasar orientasi keuangan untukmemfasilitasi manajemen penagihan biayaserta keluar-masuknya dan perjanjian bagipasien dengan menggunakan perangkatteknologi informasi yang tersedia padawaktu itu yaitu komputer mainframe. Da-lam perkembangan selanjutnya, tersediapula layanan tambahan secara departe-mental (yang berdiri sendiri-sendiri) un-tuk laboratorium, apotek, dan radiologi.Pada saat itu telah tersedia komputerberskaia-menengah yang berukuran lebih

1960 1970 19901980 2000 2010 2020

Gambar 1. Arah perubahan teknologi informasi dalam sektor kesehatan(de Velde & Degoulet, 2003)

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Proses otomatisasi medis yang bersi-fat departemental (berdiri sendiri-sendiri)mernbentuk sistem departemental tutu-tup. Sistem ini relatif tidak efisien deriganseringnya terjadi pengulangan pengum-pulan data yang sarna untuk gudang pe-nyimpanan data yang berbeda (redundantstorag~). Untuk meng ••fisienkan pernanfaa-tan data, dikembangkan sistem informasirumah sakit tersentralisasi (HIS tersen-tralisasi) dengan satu basis-data tunggaluntuk menyimpan seluruh data rumahsakit, narnun perluasan dan penarnbahanberbagai fasilitas dalarn suatu rumah sakitmenyebabkan basis-data tunggal men-jadi sangat besar dan kompleks. Basis-datatunggal yang sangat besar dan kompleksakan memperlambat proses komputasi, se-lain iru tiap pernbaharuan yang relatifkecilakan mernbutuhkan restrukturisasi besar-besaran pada basis-data.

Alternatif yang iebih menguntungkanialah dengan mengembangkan sistem de-partemental federasi sebagai perbaikanterhadap sistem departemental tertutup.Dalam sistem departemental federasi, datatetap tersebar di sejumlah basis-data yangberorientasi ranah masing-masing sepertilaboratorium, apotek, radiologi, dan seba-gainya, tetapi saling terinterkoneksi secaralogik (relational databases) dan aksesibelsecara kcmbinasi untuk prose~ komputasidan berbagai aplikasi pada satu komputersentral.

Dalam tahap lebih lanjut, ketersediaan

Gambar 2. Evolusi sisteminformasi rumah sakit (de Velde &Degoulet, 2003)

HIS : Hospital Information SystemCHIN: Community Health Information Network

workstation multimedia te1ah me mung-kinkan dikembangkannya sistem infor-masi Iumah sakit terdistribusi (HIS terd-istribusi). Dalain sistem informasi rumahsakit terdistribusi, basis-data tetap tersebardi berbagai bagian rumah sakit dan sal-ing terinterkoneksi dalam suatu jejaringarea-lokal (local area-network; LAN). Dimasing-masing bagian rumah sakit initersedia komputer lckal (workstation) yangdapat melakukan proses komputasi denganmengakses basis-datanya sendiri maupunbasis-data bagian lain yat1.gierinterkoneksidalarn jejaring (Ccltri, 2006).

Perkembangan terbaru yang lebih me-nekankan pada pernberdayaan pasien da-lam ranah komunitas telah menghasilkanpengembangan aplikasi sistem informasirumah sakit terdistribusi dalam jejaring in-formasi kesehatan komunitas (CommunityHealth Information Networks; CHIN). Disini keseluruhan sistem informasi rumahsakit rnaupun sistern informasi berbagaisentra layanan kesehatan lainnya salingterinterkoneksi dalam satu jejaring infor-masi kesehatan komunitas.

Jejaring dan Komunikasi DataKesehatan

Komunikasi data adalah transmisi dataelektronik di dalam ataupun antar korn-puter dan devais (d~"ice; peralatan) lainyang berkaitan. Untuk melakukan kornu-nikasi antar dua program atau dua devaisyang berbeda harus dibangun suatu antar-

muka (interface). Dalarn suatu jejaringkomputer (computer network) seperti jejar-ing area-Iokal diperlukan adanya protokol,yaitu seperangkat aturan dan sinyal yangdigunakan oleh komputer dalarn jejaringuntuk saling berkomunikasi. Keberadaanprotokol akan membatasi dan menguran-gi, walaupun tidak dapat menghapuskanpenggunaan antar-rnuka. Contoh protokolantara lain yaitu Transmission ControlProtocol/Internet Protocol (TCP/IP) yangdigunakan pada trasmisi data dari serverpengunduh dalarn jejaring Internet kekomputer pengguna.

Untuk mengembangkan JeJarmg in-formasi kesehatan komunitas, harus diu-payakan pencapaian interoperabilitas antarkomputer diberbagai institusi layanan kes-ehatan, yaitu kemampuan untuk melayanipertukaran data antar sistem informasi in-stitusi. Pencapaian interoperabilitas dalarnkornunikasi dan transmisi data elektronikpada layanan kesehatan ini hanya dimung-kinkan dengan adanya standar, yaitu pro-tokol yang dapat diterima dan digunakanoleh sekurung-kurangnya sebagian besardari institusi layanan kesehatan sedunia.

Tiga standar pertukaran data yang ter-penting yang ada pad a saat ini untuk trans-misi data layanan kesehatan ialah HL7,DICOM, dan MIB. HL7 (Health Level 7)adalah standar untuk transmisi data teks,DICOM (Digital Imaging and Communi-cations in Medicine) adalah standar untuktransmisi data citra (image), sedangkan

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MIB (Medical Information Bus) adalahstandar untuk transmisi data dari devaissisi-ranjang (bedside devices) yang umum-nya berupa grafik (Gambar 3). Ketiga stan-dar ini dikembangkan dengan maksud un-tuk penggunaan global sedunia, sedangkanuntuk implernentasinya masih dibutuhkanpengcmbangan versi lokal di masing-mas-ing negara yang berminat.

Pengambangan dan AplikasiSistem Inforrr.asi Kesehatan diMasa Depan

Pembahasan mengenai standar di atashanya merupakan sebagian di antara se-jumlah besar permasalahan yang harusdiatasi dalam pengembangan Sistem Infor-masi Kesehatan. Kemajuan teknologi tidakdapat langsung diterapkan, dibutuhkanwaktu beberapa tahun sebelum pemikiranmanusia dapat melihat manfaatnya danbersedia untuk menerirnanya. Bebera-pa tahun berikutnya dibutuhkan untukmengimplementasHcannya dalam suatusistem informasi, dan setelah irnplemen-tasinya ternyata menimbulkan permasala-han lain, baru biasanya akan ada upayauntuk menyusun regulasi administratifnya(Gambar 4).

T;mnutakhirkan,teradaptasi

1Kadaluwarsa,tak teradaptasi

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Komunikasi devais sisi-ranjang Komunikasi klinik dan administratif

Komunikasi Citra

Gambar 3. Standar pertukaran data pada sistem informasi rumah sakit(de Velde & Degculet, 2003)

RegulasiAdministratif

4 5 6 8 9 10 11 12 13 14 15Kerangka Waktu (Tahun)

Gambar 4. Dampak perubahan teknologi terhadap pemikiran manusia,organisasi, dan regulasi administratif (de Velde & Degoulet, 2003)

Kepustakaan1.2.3.

Coltri A, 2006, Databases in Health Care, dalam Aspects of Electronic Health Record Systems, 2nd edn, eds Lehmann HP et ai, Springer, New York, pp 225-25l.

de Velde RV, Degoulet P,2003, Clinical Information System: A Component·Based Approach, Springer, New York.Wa'ger KA, Lee FW, Glaser JP,2005, Managing Health Care Information Systems: A Practical Approach for Health Care Executives,Jossey·Bass, San Francisco.

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ISSN: 0125-913 X I 181 / vol. 37 no. 8 / November - Desember 2010 http.//www.kalbe.co.id/cdk

HASIL PENELITIANMMPI-2 Score among IndonesianHigh School Graduates Detected

as Substance User

TINJAUAN PUSTAKAAripiprazol sebagai Terapi Tambahan

pada Gangguan Depresi Mayor

PROFILDr.Tun Kurniasih Rastaman, Sp.KJ"Semua Dokter (hendaknya) Ingat

Sumpah Hipocrates"

--- -- .. --~----- ..-----~ ._ .... - .-. --~-.- ..-....-.... _. _._ .. _ ... -.- ...-.... _ ..-

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MMPI-2 Score among IndonesianHigh School Graduates Detected

as Substance UserJohan Harlan

Informatics Study Center, Gunadarma University Jakarta, I

INTRODUCTIONMMPI serves as the most widely used personality inventory,i.e. to generate descriptions of and inferences about respon-dents based on their test results.' Substance users are pre-sumed to exhibit distinct personality aspects.s-' that could bedetected by MMPI test.

This study is intended to obtain personality aspects of sub-stance users based on their MMPI test results, and to com-pare them with personality aspects of non-users.

MATERIAL AND METHODSThe tern, 'substance users' in this study includes narcotic us-ers (morphine and its derivatives) as well as psychotropic andother illicit substance users (benzodiazepines and its deriva-tives; marijuana; amphetamine and its derivatives; and meth-amphetamine and its derivatives).

The detection of users were based on urine test results, sup-ported by questionnaire on history of narcotics and other illicitsubstance use, and psycho!ogical interviews. Based on urinetest (table 1), the users are classified as THe users (marijuana;tetrahydrocannabinol), BZO users (benzodiazepines or its de-rivatives), AMP users (amphetamine or its derivatives). METusers (methamphetamine or its derivatives). and MOP users(morphine or its derivatives).

Urine tests were performed on all candidates enrolled inGunadarma University in 2006 as part of screening testsfor new students. The screening tests were conducted inseveral sites in Jakarta and West Java, Indonesia. All can-didates who were detected as users were included in thestudy sample. For each user, a non-user candidate of simi-lar gender was selected as control. The control subject wasthe one with nearest registration number with his / her sub-stance user counterpart.

After obtaining informed consent from each respondents,they vsete asked to complete questionnaires on demo-graphic data and history of narcotics and other illicit sub-stance use, and underwent MMPI-2 tests The main scalesof interest in this study are validity scales, clinical scales,and content scales (table 2).

Sample size calculation was not done, as the study is ex-ploratory in design; and the overall users to be detectedare estimated to be small in number, hence all of themshould be recruited as study sample.

Data processing and statistical analyses were done withSTATA 8. Mean differences of various MMPI scale scoresbetween user and non-user groups were analyzed withMann-Whitney test, as the sample size was presumed to be

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small in number.

RESULTSA total of 5560 candidates (3582 males and 1978 females)were examined during enrollment process; 21 (18 males and3 females) were detected as substance users. Eighteen malecandidates were detected as THe users and 3 females weredetected as BZO users; 2 male- and 1 female users withdrewearly in the enrollment process, leaving 16 male- and 2 fe-male users in the study. No other type of illicit substance userwas detected among the examinees. As control, 18 non-us-er candidates (16 males and 2 females) were recruited. Totalsample size was 36. After obtaining detailed explanation onthe study objectives, all 18 users and 18 non-users gave theirinformed consent and agreed to join the study.

Basic characteristics of study population are shown in table3. The two groups are fairly comparable. The sole obviousdifferent characteristic is first-child position - 66.7% amongusers vs 38.9% among non-users. Average number of sib-lings is 3.17 in user's family vs 3.50 in non-user's family.

Assessment of L, F, and K validity scale scores shows thatall test results are invariably valid. Although maximumtrue-scores for the L, F, and K scales are 79, 82, and 78consecutively," not a single invalid profile is found. Themean raw-scores of validity scales for the user and non-usergroups are shown in table 4.

The mean raw scores of clinical scales fer user and non-user groups are showed in table 5. Statisticaiiy significantdifference was detected for Scale 0 (Social Introversion) (p= 0.035), but the result of this exploratory study can not begeneralized as that obtained from a confirmatory one. InScale 2 (Depression) and Scale 3 (Hysteria), the p values are0.099 and 0.090 consecutively, which might be statisticallysignificant should the sample size is greater.

The mean raw-scores of content scales are shown in table6. The only content scale that is statistically significantly dif-ferent between groups was Scale FRS(Fears). ( p= 0.005).

DISCUSSIONSubstance users prevalence (positive urine test-resultprevalence) of 2.07%, 3.31%, 2.00%, and 0.49% had beendetected during the Gunadarrna University enrollment pro-cesses in 1994, 1997, 2000, and 2003 consecutive I!" butthese results cannot be compared, as the types of urinetests are net similar. The urine tests in 1994 was only forTHe and MOp, while in 2003 and 2006 the tests were forTHe, BZO, AMp, MET. and MOp'6

Positive urine test-result prevalence decreased since 2001.In 2001, 2002, and 2004 the detected user prevalence were0.94%, 0.75%, and 0.42% consecutively'", The decreasedprevalence may be just the consequence of decreased

Table 1. Types of urine tests in substance user study, '2006

Table 2. The main scales of interest in substance user study, 2006

Table 3. Basiccharacteristics of respondents in Indonesian substance user study, 2(X)6

Table 4. MMPI-2 validity scale scores in Indonesian substance user study, 2006

*) Mann-Whitney test

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Table 5. MMPI-2 clinical scale scores in Indonesian substance user study, 2006

*) Mann-Whituey test

versity (28.6% if the average number of child in the family is3.50). and the proportion of respondents who are the firstchild is obviously higher in the user group.

Statistical analyses showed that THC and BZO users aremore socially introverted than control group (table 5).They might also tend to be more depressed and hysteri-cal (table 5). Assessment of the FRSscale scores indicatesgreater likelihood for substance users to report multiplespecific fears or phobias.' compared with non-user group.Substance users in this study do not include severe depen-dence (perhaps also moderate dependence).

Drug Dependence Hospital, Jakarta data showed thatmore than one third of its drug-dependent patients (47.8%in 2002) were senior high school graduates.4

As this study is still exploratory, we hope to test the hy-potheses generated in this study in a specially designedconfirmatory study with greater sample size.

Acknowledgements.- The author is particularly indebtedto Drs. Zainuddin SK, MPsi and Prof. Dr. Suprapti S. Markam(clinical psychologists). for their kind review of the manu- .script.

REFERENCES

Graham JR. MMPI-2: Assessing personality and psychopathology. Npw

York: Oxford University Press; 1990.

2. Anthony Jc. Epidemiology of drug dependence. In' Galanter M, Kleber

HD, .editors. Textbook of Substance Abuse Treatment. 2nd ed. Washing-

ton, DC: American Psychiatric Press, Inc; 1999. p. 47-58.

3. Cloninger CR. Genetics of Substance Abuse. In: Galanter M, Kleber HD,

editors. Textbook of Substance Abuse Treatment. 2nd ed. Washington,

DC: American Psychiatric Press, Inc; 1999. p. 59-66.

4. Information and Data Center, Health Ministry, Republic of Indonesia. De-

scriptions of narcotics and substance abusers in treatment institutions

for narcotics and substance abusers, 2001-2003 [in Indonesian]. Jakarta:

Health Ministry, Republic of Indonesia; 2004.

5. Harlan J. Standard values of MMPI-2 validity and content scales for In-

donesian hospital employees and senior high school graduates, 2003 [in

Indonesian]. Jurnailimiah Penelitian Psikologi. 2005 Jun;l(10):1-10.

6. Harlan J. Execution report of medical examination and narcotics / illicit

substance using screening test for new students, Gunadarma University,

1994-2006 [in Indonesian). Final report. Jakarta: Gunadarma University;

2006. Sponsored by Gunadarma Health Foundation.

7. Padmo L. Community-based prevention of substance abusing [in Indone-

sian; cited 2006 Oct 1). Available from: http://www.bnn.go.id.

8. Martin. Executive summary of "Narcotics prisoner problem research in

Indonesian jails, 2003" [in Indonesian; cited 2006 Oct 1). Available from:

http://www.bnn.go.id.

9. Lanyon RI, Goodstein LD. Personality Assessment. 3rd ed. New York: John

Wiley & Sons, Inc; 1997.

10. Benet WE. Psychological assessment: testing and practice resources [up-

dated 2007 October 2; cited 2007 November 10). Available from: http://

www.nlm.nih.gov/bsd/uniform_requirements.html.

Table 6. MMPI-2 content scale scores in Indonesian substance user study, 2006

*) Mann-Whitney test

number of substance users who enroll the university. In Drug-Dependence Hospital, Jakarta, Indonesia, the reportednumber of narcotic patients increased four-fold during theperiod of 2000-2004.7

In our annual screening test for new students, the patternof results remain the same, mostly consist of THC users'", Itshould be noted that most narcotic prisoners initially con-sumed marijuana before turning to other illicitsubstances,"

Miv1PI-A (adolescent) is recommended for 17 years old re-spondents': but the respondents were already graduatedfrom high-school and had social relations with older schoolmates. Hence, they were not considered suitable to undergoMM~I-A test which contains adolescence-specific items in theareasof identity formation, school and teachers, etc.t lt shouldalso be noted that some formal institutions nowadays also useMMPI-2 test for 17 year-old respondents.'? We also need onesole standard test for the all respondents in our study.

Another interesting fact is greater proportion of 'first child inthe family'among users (66.7%) compared with in non-usergroup (38.9%). This may indicates greater likelihood for thefirst child in the family to become substance user amongsample subjects. Based on the average number of childrenin the non-user families, a slight and non-significant increasein probability was noted for the first child to enroll at the uni-

576 $COK I NOVEMBER· DESEMBER 2010