Does power distance in healthcare teams linked to patient satisfaction? A multilevel study of interprofessional care teams in a referral hospital in Indonesia.

BACKGROUND: Interprofessional care teams collaborate to provide care to patients in hospitals to ensure their full recovery. To provide quality patient care, healthcare workers must have a comprehensive understanding of each other's roles and collaborate effectively. Good interpersonal skills are also essential for maintaining cooperative and collaborative relationships, listening, and respecting other team member's values and positions. Therefore, this study aimed to investigate the effect of power distance in interprofessional care on patients' satisfaction. METHOD: A quantitative study was conducted in a hospital by using a questionnaire instrument to collect information from patients and members of the interprofessional care team. The respondents included 10 geriatric, 19 palliative, 36 cancer, 8 burn, and 18 medical intermediate care (MIC) teams. Subsequently, a hierarchical regression analysis was conducted to examine whether interprofessional care could significantly predict the relationship between team power distance and patient satisfaction. RESULTS: The measurement of the effect of power distance in interprofessional care among doctors, nurses, pharmacists, and nutritionists on patient satisfaction revealed nonsignificant results. However, the final analysis indicated negative coefficients with regard to power distance for nutritionists (-0.033098), nurses (-0.064912), and pharmacists (-0.006056). These findings indicated that the power distance associated with these professions was linked with decreased patient satisfaction. CONCLUSIONS: The results suggested that power distance within an interprofessional care team can reduce patient satisfaction.

Influence of Personality on Geriatric Rehabilitation Outcomes in Cauda Equina Syndrome Case.

Cauda Equina Syndrome (CES) becomes more common as the population ages, making diagnosis challenging and leading to underdiagnosis and poor management. Person-centered care is crucial for successful rehabilitation outcomes, and patient's personality influences it. Female, 77 years old, diagnosed with CES caused by nucleus pulposus herniation at fourth to fifth lumbar vertebrae, with a complication of pressure injury grade IV due to immobilization. Her family's lack of caregiving skills, poverty, and histrionic personality disorder were her barriers to comply to rehabilitation program. Adding a psychotherapy based on personality on rehabilitation program increased her functional outcome. This case highlight the significance of assessing each patient's personality to optimize outcomes, emphasizing the importance of tailoring rehabilitation programs to individual needs, including psychosocial and environmental factors.

Improving functional outcomes and quality of life in an elderly woman with sarcopenia and spinal Tuberculosis: A case report.

Background: Indonesia is the world's second-largest contributor to TB patients. According to prevalence by age, the elderly have the most diagnosed TB. In Indonesia, TB spondylitis affects approximately 5% of TB cases and is a common cause of non-traumatic spinal cord injury (NTSCI). Spinal cord injury (SCI) is a growing public health concern, particularly among the elderly, as many of its populations have sarcopenia. Due to the complete absence of voluntary muscle contraction, SCI is followed by a rapid loss of skeletal muscle mass. SCI has several physical, psychological, social, and economic consequences. Case presentation: A 68-years-old woman presented with weakness and numbness of all four limbs. She also had sarcopenia, malnutrition, and dependency on activities of daily living (ADL). In addition, the patient was at a risk of SCI complications. Magnetic resonance imaging (MRI) showed destruction of the vertebral bodies at the level of the 5th and 6th cervical area, tuberculous abscesses of the paravertebral and longus colli muscles. The patient underwent debridement and spinal stabilization. However, the patient was at a risk of developing SCI complications. In these patients, the Physical Rehabilitation and Medicine (PRM) strategy focuses on improving medical conditions, including preventing secondary complications, promoting neurological recovery, and optimizing function. Conclusion: This case highlights the importance of PRM intervention in assessing functional disorders in the elderly to improve their quality of life (QOL).

Recommendations for Physical Medicine and Rehabilitation to Impro ve Systemic Lupus Erythematosus Related Sarcopenia: A Literature Review.

BACKGROUND: Systemic lupus erythematosus (SLE) is currently the most prevalent autoimmune disorder worldwide. A previous study reported the frequency of sarcopenia in patients with chronic inflammation and found a higher rate of sarcopenia in patients with SLE than in control. A preview study found that exercises management given to SLE patients can reduce fatigue and increase vitality. OBJECTIVE: The objective of this study is to understand the relationship between sarcopenia and SLE from Physical Medicine and Rehabilitation (PM&R) standpoint and its intervention. METHODS: Using the PubMed computer-aided search engine specific keywords: "sarcopenia" AND "Systemic lupus erythematosus" OR "lupus" OR "SLE" OR "physical medicine and rehabilitation" OR "rehabilitation" OR "physical therapy" OR "exercises" OR "physical activity" OR "training" OR "nutrition" OR "OR "diet." RESULTS: Exercise rehabilitation can increase energy level, cardiovascular fitness, functional status, and physical capabilities of muscle strength and are safe to be performed by patients with SLE. Resistance training has been shown to improve muscle strength and size, increase mitochondrial content, and reduce oxidative stress. Resistance exercise impacts sarcopenia through several mechanisms in the muscular and neuromotor levels. Aerobic exercises are also beneficial for skeletal muscles to increase mitochondrial bioenergy, improve insulin sensitivity, and reduce oxidative stresses. Nutritional interventions such as protein, amino acids, essential fatty acids, and vitamin D produce biological effects that will enhance the physiological adaptation of exercise. CONCLUSION: Intervention for maintaining muscle function in the prevention and management of sarcopenia in SLE and its complications is a combination of resistance training and nutritional intake through adequate protein intake.

The number of risk factors increases the recurrence events in ischemic stroke.

PURPOSE: Stroke is a significant cause of disability worldwide and is considered a disease caused by long-term exposure to lifestyle-related risk factors. These risk factors influence the first event of stroke and recurrent stroke events, which carry more significant risks for more severe disabilities. This study specifically compared the risk factors and neurological outcome of patients with recurrent ischemic stroke to those who had just experienced their first stroke among patients admitted to the Hospital. PATIENTS AND METHODS: We observed and analyzed 300 patients' data who met the inclusion and exclusion criteria. This retrospective observational study was conducted on consecutive acute ischemic stroke patients admitted to the top referral hospital, West Java, Indonesia. The data displayed are epidemiological characteristics, NIHSS score at admission and discharge, and the type and number of risk factors. Data were then analyzed using appropriate statistical tests. RESULTS: Most patients had more than one risk factor with hypertension as the most frequent (268 subjects or 89.3%). In patients who experienced ischemic stroke for the first time, the average National Institutes of Health Stroke Scale (NIHSS) score was lower (6.52 ± 3.55), and the alteration of NIHSS score was higher (1.22 ± 2.26) than those with recurrent stroke (6.96 ± 3.55) for NIHSS score and 1.21 ± 1.73 for alteration of NIHSS score). We processed the data with statistical analysis and showed a positive correlation between age (P < 0.05) and the number of risk factors (P < 0.001) in the recurrent ischemic stroke group. CONCLUSIONS: Age and the number of risk factors correlate with recurrent ischemic strokes.

Healthcare Workers' Point of View on Medical Robotics During COVID-19 Pandemic - A Scoping Review.

COVID-19 affected how healthcare workers interact with patients. Medical technology and robotics are developed in hospital settings to limit human contact. The aim of this review is to elucidate what kind of medical robotics is required for healthcare workers during COVID-19 pandemic. This review was obtained from electronic databases such as Google Scholar, PubMed, EBSCO, and Cochrane reviews were searched for articles using keywords such as "healthcare professional" OR "health worker" AND "COVID-19" AND "robot application" OR "robotics" OR "health technology" AND "needs assessment" OR "expectation" OR "perception" published during 2020 to 2021. Inclusion criteria were full-text articles related to assessment of healthcare workers' need for medical robotics during COVID-19 pandemics. Exclusion criteria included abstracts, duplicate articles, blogs, news articles, promotional brochures, and conference proceedings. A total of 13,692 articles were identified through the search engines (PubMed 179, Cochrane Library 1300, EBSCO 13, Google Scholar 12,200). Five full-text articles fulfilled the inclusion criteria. Determining robotic functions is important to healthcare workers who will be user of such medical technology. This review divided robotic functions into medical, operational, movement, and social functions. Healthcare workers' demands for robotics were also influenced by the types of robots, such as examination robots, robot-based sample test and medicine production, surgery and rehabilitation robots, disinfection and cleaning robots, delivery and logistic robot, telemedicine, and telepresence robots. Medical robotics is required for healthcare workers during the COVID-19 pandemic. The highest demands for medical robotics functions include cardiac measurements and oxygen saturation monitoring (medical functions); examination record delivery, video and image play, and medical information delivery (operational functions); and the ability to recognize and avoid obstacles (movement functions). Disinfection and cleaning robots were the type of robots with the highest demand among healthcare workers.

Role of Pharmacists in the Interprofessional Care Team for Patients with Chronic Diseases.

Chronic diseases are a major health problem and cause of death worldwide. Patients with chronic diseases should be managed by an interprofessional care team consisting of general practitioners, medical specialists, nurses, and pharmacists. However, the roles of pharmacists in this interprofessional care team have not been fully explored. This study, therefore, examined their roles as members of the interprofessional care team in managing patients with chronic diseases. A search in PubMed, Google Scholar, EBSCO, Scopus, and Cochrane Library databases was conducted for research articles that discussed pharmacists, interprofessional healthcare, and chronic diseases. From initial 420 identified articles, a total of 27 articles were included in this study. The interprofessional healthcare team should have a sense of tolerance and belonging among its members, which is reflected in five dimensions: partnership, coordination, cooperation, decision-making, and therapeutic outcomes. The five dimensions are closely related because they support each other in the success of the therapy. The presence of pharmacists in an interprofessional healthcare team has been proven to help facilitate access to primary care and improve patient outcomes. Pharmacists can assist in managing chronic disease conditions by providing drug information to patients and other healthcare providers and by acting as a consultant for treatment-related issues. The pharmacist's role as part of an interprofessional care team reinforces the importance of a collaborative healthcare team in providing clinical services to patients with chronic diseases.

High-intensity interval training can improve hand grip strength, inspiratory muscle, and quality of life in systemic sclerosis subjects.

INTRODUCTION: Systemic sclerosis/scleroderma (SSc) is a chronic autoimmune disease with connective tissue, multi-organ, and multisystem involvement. The disease has three main characteristics, namely vasculopathy, fibrosis, and autoimmunity. The effect of high-intensity interval training (HIIT) in aerobic exercise on other rheumatic diseases has been studied, for example in patients with rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA). The purpose of this work is to investigate the effectiveness of HIIT of aerobics exercise on improving the inspiratory muscle, quality of life and functional ability for systemic sclerosis subjects. MATERIAL AND METHODS: The study was conducted on patients with confirmed systemic sclerosis who met the inclusion criteria. The research was carried out for 12 months in the outpatient clinic and gait laboratory of the Department of Physical Medicine and Rehabilitation. RESULTS: After HIIT in aerobic exercise, we found significant changes in inspiratory muscle (SNIP values 45.67 [30.92] vs. 54.25 [22.71]), handgrip (13.14 [4.42] vs. 15.63 [4.08]), walking speed (184.70 [26.86] vs. 246.6 [12.30]), metabolic equivalent (3.53 [0.30] vs. 4.21 [1.25]) and Scleroderma-Specific Health Assessment Questionnaire Disability Index for all visual analog scale (VAS) domains except Disability Index. Exercise approaches are characterized by repeated cycles of exercise interrupted by rest. For a range of clinical conditions, HIIT in aerobic exercise is known to remedy blood vessel function. CONCLUSIONS: Our results suggest that HIIT in aerobic exercise has improved functional ability, respiratory muscle strength, and quality of life in SSc subjects. Training twice a week in a 12-week HIIT program is considered to be safe for this population. We have to consider internal and external factors that influenced the result. A larger sample and further exploration of the feasibility of combined exercise in SSc patients should be the focus for future research.

The Lymphocyte Depletion in Patients with Acute Ischemic Stroke Associated with Poor Neurologic Outcome.

PURPOSE: Inflammation plays an important role and is involved in all stages of acute ischemic stroke. One of these stages involves the recruitment of leukocytes from the peripheral circulation into the ischemic tissue. Lymphocytes as a subtype of leukocytes are important mediators and can become a predictor of neurological outcome. Several studies have been conducted regarding the correlation between differential lymphocyte counts and acute ischemic stroke. Most of these studies analyzed lymphocyte ratio to other leukocyte subtypes such as neutrophils and monocytes. This study specifically observed the role of lymphocytes as an indicator of the inflammatory response in patients with acute ischemic stroke. This study aimed to observe the correlation among risk factors, infarct location, leukocyte counts, lymphocyte value and neurologic output in acute ischemic stroke patients. PATIENTS AND METHODS: We observed and analyzed 193 patients' data from medical record which met the inclusion and exclusion criteria with a diagnosis of acute ischemic stroke at the Department of Neurology of Dr. Hasan Sadikin General Bandung. Data were then analysed using appropriate statistical tests. RESULTS: Most patients have more than one risk factor with a leukocyte count of less than 10,000 cell/mm3. Infarct was mostly located in subcortical area (basal ganglia), with moderate average NIHSS values at admission and at discharge. The number of lymphocytes decreased in the subject group with more than 10,000 cell/mm3 leukocytes. Subsequently, data were analyzed using Spearman's test and there was a correlation between NIHSS on admission and lymphocyte depletion. CONCLUSION: The lymphocyte depletion in patients with leukocytosis is a predictor of poor NIHSS.

Telemedicine Guidelines in South East Asia-A Scoping Review.

Background: Telemedicine is a useful tool to deliver healthcare to communities in low- to high-income countries, especially in the coronavirus disease 2019 pandemic era. Guidelines on telemedicine would assist healthcare providers in delivering healthcare services based on local circumstances. Objective: To explore and compare guidelines on telehealth and telemedicine in South East Asian countries. Methods: Electronic databases such as Google, PubMed, and Cochrane reviews were searched for articles using keywords such as "telemedicine" OR "telehealth" OR "eHealth" OR "telemedis" AND "guidelines" AND "South East Asia" OR "Malaysia" OR "Singapore" OR "Indonesia" OR "Thailand" OR "Vietnam" published up to 2020. Inclusion criteria were full articles and gray materials (i.e., policy statements, advisories, blueprints, executive summaries, and circulars) related to telemedicine guidelines. No language restrictions were imposed. Only the first 100 Google searches were included for eligibility based on its relevance to telemedicine guidelines. Exclusion criteria were abstracts, duplicate publications, blogs, news articles, promotional brochures, conference proceedings, and telemedicine projects unrelated to telemedicine guidelines. Results: A total of 62,300 articles were identified through the search engines (Google 62,203, PubMed 77, and Cochrane 20) and six articles from additional sources. Sixty-eight full-text articles fulfilled the inclusion criteria, but only 24 articles contained some form of guidelines on telemedicine: Indonesia (nine), Malaysia (seven), Singapore (five), Thailand (two), and Vietnam (one). There were six laws, six advisory guidelines, five policy statements, and two circulars (regulations) issued by either the Ministry of Communication and Multimedia, Ministry of Health, or Medical Councils from the respective countries. Issues addressed were clinical governance (100%); information and communication technology infrastructure (83.3%); privacy, storage, and record-keeping (77.8%, respectively); ethics and legal (77.8%); security and safety (72.2%); definitions and applications of telemedicine (72.2%); confidentiality (66.7%); licensing (66.7%); identification (55.6%); cost of information and communication technology infrastructure (55.6%); reimbursement (16.7%); mobile applications (11.1%); and feedback and choices (5.6%). The Singapore National Telemedicine Guidelines contained the most domains compared with other guidelines from South East Asia. Conclusions: Although there can be no "one-size-fits-all" telemedicine guideline, there should be a comprehensive and universal telemedicine guideline for any country to adapt based on the local context. Details on patient-identification, data ownership, back-up, and disposal; transregional cybersecurity laws and ways to overcome the limitations of telemedicine compared with face-to-face consultations should be outlined clearly to ensure uniformity of telemedicine service and patient safety.

Strengthening rehabilitation services in Indonesia: A brief situation analysis.

People with disability (PWD) in Indonesia are often neglected by society. Improving their life situation towards full participation in society is crucial. As a health strategy, rehabilitation can improve func-tioning, quality of life and participation in society. However, rehabilitation services in Indonesia need improvement. Making a situation analysis of rehabilitation services and their provision in the country is a pre-requisite to taking any action towards improvement. This paper compiles available data related to disability and rehabilitation services in Indonesia, using the Rehabilitation Services Assessment Tool (RSAT) as a framework. Gaps in provision were analysed, resulting in the compilation of a list of generic recommendations to improve rehabilitation services in the country. Indonesia faces many challenges in rehabilitation services, including the health workforce and the provision of services. This situation analysis and list of generic recommendations may be used in further discussions with relevant stakeholders in the country to develop a national strategy to strengthen rehabilitation services.

Toe-out angle changes after total knee arthroplasty in patients with varus knee osteoarthritis.

PURPOSE: Toeing-out is a commonly proposed kinematic variable that has been suggested to reduce external knee adduction moment. Analyses of the toe-out angle after total knee arthroplasty (TKA) are useful for obtaining a proper understanding of the abnormal gait caused by varus knee osteoarthritis (OA), as well as performing rehabilitation after arthroplasty. Changes in the toe-out angle after arthroplasty have not yet been defined or analysed. METHODS: The study population consisted of 32 knees in 32 patients with varus knee OA who underwent TKA. The femorotibial angle was evaluated on standing anteroposterior radiographs before and after arthroplasty. The subjects underwent three-dimensional motion capture analyses to measure gait parameters (walking speed, cadence, stride length, step length, step width and the relative length of the single-limb support (SLS) percentage of one gait cycle) and the maximal hip adduction angle in the stance phase, the trunk lean angle in the coronal plane and the toe-out angle before and 4 weeks after arthroplasty. RESULTS: The femorotibial angle on the side of arthroplasty improved after surgery. Among the measured gait parameters, only the SLS percentage increased significantly. The hip adduction angle and toe-out angle on the side of arthroplasty increased significantly after surgery. CONCLUSIONS: The knee alignment and hip adduction angle in the coronal plane and SLS phase were normalized after arthroplasty. The increase in the toe-out angle after arthroplasty may be attributable to the restoration of a normal knee alignment. These findings contribute to obtaining a proper understanding of the abnormal gait caused by varus knee OA and are useful for orthopaedic surgeons and rehabilitation therapists when treating patients after arthroplasty. LEVEL OF EVIDENCE: Prospective study, Level II.

Acute phase response of selenium status and glutathione peroxidase activity in blood plasma before and after total knee arthroplasty surgery.

Several studies show the consistent results of the decrease in plasma or serum selenium (Se) after surgery, and the change is suggested to be a negative acute phase response of Se to the surgical inflammation. Plasma glutathione peroxidase (GPx), which is included in the acute phase response proteins, is a selenoenzyme. However, previous studies failed to show any changes in GPx activity before and after surgery. In the present study, we investigated the Se- and selenoenzyme responses that accompany the acute inflammatory reactions during and following major surgery. Patients who underwent elective total knee arthroplasty surgery due to knee osteoarthritis at the Department of Orthopaedic Surgery at Gunma University Hospital in Japan were studied. The plasma Se concentration was determined, and the activity of plasma GPx was measured. C-reactive protein (CRP), albumin, blood urea nitrogen (BUN), and white blood cell (WBC) count were also analysed. Increases in the inflammatory biomarkers of CRP and WBC showed inflammatory reactions with the surgery. A significant increase in plasma GPx activity (p < 0.05) and decreases in the plasma Se concentration (p < 0.05) and in serum albumin (p < 0.05) after surgery were observed. Since albumin is a Se-containing protein and represents a negative acute phase protein that provides amino acids for the production of other series of acute phase proteins, the present results suggest that there is a redistribution of plasma Se to GPx that occurs as an acute phase response, and the source of Se for GPx could be, at least partly, from albumin.