Journal Title : Jurnal Kesehatan dan Kedokteran (JUKEKE) Initials : JUKEKE Frequency : Februari, Juni, dan Oktober Print ISSN : 2829-0437 Online ISSN : 2829-050X Editor in Chief : Dr. Abdul Muchlis DOI : 10.56127 Publisher : Asosiasi Dosen Muda Indonesia Sponsored : (Kami Memasang Tarif Untuk Iklan Disini Harap Hubungi ADMIN) Jurnal Kesehatan dan Kedokteran (JUKEKE), ISSN: 2829-0437 (cetak), ISSN: 2829-050X (online) adalah jurnal yang ditujukan untuk publikasi artikel ilmiah yang diterbitkan oleh Asosiasi Dosen Muda Indonesia dan di payungi Oleh Yayasan Dosen Muda Indonesia. saat ini sudah terakreditasi SINTA 5 Sampai 2027 sesuai dengan keputusan Direktur Jendral Pendidikan Tinggi, Riset dan Teknologi Nomer 10/C/C3/DT.05.00/2025. Jurnal Ilmiah Kesehatan dan Kedokteran menyajikan hasil penelitian dan tinjauan pustaka sehingga jurnal ini bermanfaat bagi dokter, pengambil kebijakan, tenaga kesehatan, dosen serta mahasiswa yang tertarik dengan publikasi ilmiah terkait Ilmu Kedokteran dan Kesehatan. Jurnal ini diterbitkan 3 (tiga) kali dalam satu tahun yaitu Edisi Februari, Juni, dan Oktober. Indexed by:
The Effect of Ankle Strategy Exercise on Fall Risk Among Older Adults in Gaji Village, Kerek District, Tuban Regency
Older adults experience physiological decline that reduces balance ability and increases the risk of falls. Falls can lead to serious physical injuries, psychological impacts, decreased quality of life, and even mortality. Therefore, effective and applicable interventions are needed to prevent fall risk, especially in community settings. Objective: This study aimed to determine the effect of ankle strategy exercise on fall risk among older adults in Gaji Village, Kerek District, and to evaluate its role as a community-based nursing intervention. Method: This study employed a quantitative pre-experimental design with a one-group pretest–posttest approach. Participants were selected using purposive sampling based on inclusion criteria. Data were collected using the Berg Balance Scale (BBS) before and after the intervention. Data analysis was conducted using appropriate statistical tests to compare fall risk before and after ankle strategy exercise. Findings: The results showed a significant reduction in fall risk after the intervention. Most participants experienced improved balance performance, indicating that ankle strategy exercise effectively enhances postural stability in older adults. Implications: The findings suggest that ankle strategy exercise can be implemented as a simple, cost-effective, and non-pharmacological intervention in community nursing practice to prevent falls among older adults. This intervention is practical and can be easily adopted in community health programs. Originality: This study provides empirical evidence on the effectiveness of ankle strategy exercise in a rural community setting, highlighting its potential as a feasible and targeted balance training method for fall prevention among older adults.
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Tandem Walking Exercise on Muscle Strength in The Elderly in Prunggahan Kulon Village Semanding District, Tuban
The decline in muscle strength among older adults is a major health concern that contributes to reduced mobility, increased risk of falls, and decreased quality of life. This issue becomes more critical as the elderly population continues to grow, particularly in community-based settings where simple and accessible interventions are needed. Objective: This study aimed to analyze the effect of tandem walking exercise on muscle strength in older adults in Prunggahan Kulon Village, Semanding District, Tuban. Methods: This study employed a quantitative pre-experimental design using a one-group pre-test and post-test approach. A total of 63 elderly participants were selected through purposive sampling. Data were collected using the 30-Second Chair Stand Test (30s-CST) to measure lower limb muscle strength before and after the intervention. The data were analyzed using the Wilcoxon Signed Rank Test. Results: The findings showed a significant improvement in muscle strength after the intervention, where most participants shifted from moderate to high muscle strength categories. Statistical analysis indicated a significant difference between pre-test and post-test results (p < 0.05). Implications: Tandem walking exercise can be applied as a simple, low-cost, and effective intervention to improve muscle strength and reduce fall risk among older adults, particularly in community-based settings. Originality: This study provides new evidence on the effectiveness of tandem walking exercise as a specific balance-based intervention focusing on muscle strength as the primary outcome in a village-based elderly population, which remains limited in previous studies.
Relationship Between Waist Circumference and Body Mass Index with HbA1c Levels in Patients with Type 2 Diabetes Mellitus
Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia and complex pathophysiological mechanisms. Obesity, assessed through Body Mass Index (BMI) and waist circumference (WC), is commonly associated with poor glycemic control, yet previous studies have reported inconsistent findings. Objective: This study aimed to analyze the relationship between waist circumference and BMI with HbA1c levels in patients with T2DM at Haji General Hospital Medan. Methods: A quantitative analytical study with a cross-sectional design was conducted involving 48 patients with T2DM who met the inclusion criteria. Anthropometric data, including BMI and WC, were measured directly, while HbA1c values were obtained from medical records. Bivariate analysis was performed using the Spearman correlation test, and multivariate analysis was conducted using ordinal logistic regression. Results: The analysis showed no significant association between waist circumference and HbA1c levels (r = −0.141; p = 0.339) or between BMI and HbA1c levels (r = 0.075; p = 0.611). Multivariate analysis also indicated that BMI and WC simultaneously did not significantly affect HbA1c categories (p > 0.05). Implications: These findings suggest that glycemic control in T2DM patients is influenced by multifactorial mechanisms beyond anthropometric parameters, highlighting the importance of considering behavioral, clinical, and therapeutic factors in diabetes management. Originality: This study provides context-specific evidence by simultaneously evaluating BMI and WC in a clinical outpatient population, contributing to the ongoing debate regarding the relevance of simple anthropometric indicators in predicting glycemic control.
Association Between Stress Levels and Waist Circumference Among Medical and Health Sciences Students at Universitas Muhammadiyah Sumatera Utara
Stress may influence physiological balance through hormonal mechanisms, particularly increased cortisol levels, which are associated with visceral fat accumulation in the abdominal area. Waist circumference is an important anthropometric indicator for assessing central obesity and cardiometabolic risk. Medical students are vulnerable to stress due to high academic demands, which may affect their health status. Objective: This study aimed to determine the association between stress levels and waist circumference among students of the Faculty of Medicine, Universitas Muhammadiyah Sumatera Utara. Methods: This observational analytic study used a cross-sectional design. A total of 89 students from the 2022–2024 cohorts were selected using quota sampling based on the inclusion criteria. Stress levels were measured using the Depression Anxiety Stress Scale-42 (DASS-42), while waist circumference was measured using a flexible measuring tape according to standard anthropometric procedures. Data were analyzed using an exact statistical test with a significance level of 0.05. Findings: The results showed a statistically significant association between stress levels and waist circumference, with a p-value of 0.011. Students with higher stress levels tended to have a greater proportion of central obesity compared to those with normal stress levels. Implication: These findings highlight the importance of stress management and healthy lifestyle promotion in student health programs. Originality: This study provides empirical evidence on the relationship between psychological stress and waist circumference among medical students in the Indonesian university context.
Antipyretic Activity of Spare Leaf Extract (Erythrina subumbrans (Hassk.) Merr.) on Pepton-Induced Male White Rats (Rattus norvegicus)
Fever is a common physiological response of the body to infection, inflammation, or other pathological conditions and is characterized by an increase in body temperature above the normal range. Although antipyretic drugs such as paracetamol are widely used to reduce fever, the exploration of medicinal plants as alternative natural antipyretic agents remains important. Dadap serep leaves (Erythrina subumbrans (Hassk.) Merr.) are known to contain bioactive compounds such as flavonoids, saponins, tannins, alkaloids, and polyphenols, which are potentially associated with antipyretic and anti-inflammatory activity. Objective: This study aimed to evaluate the antipyretic activity of dadap serep leaf extract in peptone-induced male white rats (Rattus norvegicus) and to determine the most effective dose among 100, 200, and 400 mg/kgBW. Methods: This research was a laboratory experimental study using a pre-test and post-test control group design. A total of 30 male white rats were divided into five groups: negative control receiving 1% Na-CMC, positive control receiving paracetamol, and three treatment groups receiving dadap serep leaf extract at doses of 100, 200, and 400 mg/kgBW. Fever was induced by subcutaneous injection of 5% peptone, and rectal body temperature was measured at several observation times after treatment. Data were analyzed using One-Way ANOVA followed by the Tukey HSD post hoc test. Findings: The results showed that dadap serep leaf extract reduced rectal body temperature in peptone-induced rats. The strongest antipyretic effect was observed at a dose of 400 mg/kgBW, indicating that higher extract doses may produce a greater reduction in fever temperature. Implications: These findings indicate that dadap serep leaf extract has potential as a natural antipyretic agent and may support the development of plant-based fever management. The results may also provide a scientific basis for the traditional use of dadap serep leaves in reducing fever. Originality: The originality of this study lies in providing experimental evidence on the dose-dependent antipyretic effect of Erythrina subumbrans leaf extract in a peptone-induced fever model of male white rats.
Intra-Abdominal Tumor in an Undescended Testis with Acute Abdominal Pain and Histopathological Features Suggestive of Alveolar Rhabdomyosarcoma: A Case Report
Intra-abdominal tumors associated with undescended testis are rare and may present with nonspecific symptoms resembling acute abdominal conditions. In adults, untreated undescended testis can delay diagnosis because the affected testis is not located in the scrotum and may only become clinically evident after tumor enlargement or abdominal symptoms. Objective: This case report aims to describe an intra-abdominal tumor in a 27-year-old male with untreated undescended testis who presented with acute right lower abdominal pain and a mass in the right iliac region. Methodology: This study used a descriptive case report design. Data were collected retrospectively from patient history, physical examination, operative findings, macroscopic tissue documentation, and histopathological examination. The data were analyzed using a descriptive-narrative approach supported by relevant literature. Findings: The patient presented with persistent right lower abdominal pain, progressive abdominal mass, weight loss, decreased appetite, and a history of untreated undescended testis since birth. Physical examination revealed an asymmetrical scrotum, absence of the right testis in the scrotum and inguinal canal, and a solid immobile mass in the right iliac region. Orchidectomy was performed, and macroscopic examination showed a grayish-brown mass measuring 11 × 10 × 7 cm. Histopathological examination revealed a malignant lesion suggestive of alveolar rhabdomyosarcoma. Research Implications: This case emphasizes the importance of genital examination in male patients with unexplained acute abdominal pain. Intra-abdominal testicular or paratesticular tumors should be considered when an empty hemiscrotum or cryptorchidism history is present. Originality: This report presents an unusual case of untreated undescended testis associated with an intra-abdominal tumor and histopathological features suggestive of alveolar rhabdomyosarcoma.
Physiotherapy Management in a Post-Caesarean Section Patient with Lower Limb Oedema and Mobility Limitation: A Case Report
The rate of delivery through Sectio Caesarea (SC) continues to increase globally and is often followed by postoperative problems such as incision pain, lower extremity oedema, impaired mobility, and difficulties in early lactation. These conditions may delay postpartum recovery and reduce maternal functional independence. Comprehensive physiotherapy intervention is therefore important to support early recovery after SC. Objective: This case report aimed to describe the outcomes of a comprehensive physiotherapy management program in a post-SC patient with lower extremity oedema and functional mobility limitation. Methodology: This study used a case report design involving a 28-year-old primigravida woman who underwent SC due to post-term pregnancy and cephalopelvic disproportion. Clinical data were collected through physiotherapy assessment, direct observation, and follow-up evaluation during 72 hours of hospitalization. The intervention program was arranged using the FITT principle and included deep breathing exercise, static contraction, ankle pumping exercise, leg elevation, early mobilization, breast massage, and oxytocin massage. Outcomes were evaluated using the Numeric Rating Scale, figure-of-eight method, clinical mobility observation, lactation status, and Barthel Index. Findings: After intervention, movement pain decreased from NRS 6/10 to 1/10, while the Barthel Index improved from 15, indicating total dependence, to 65, indicating moderate dependence. The patient was able to perform transfers and walk 5–10 meters with supervision. Lactation also improved gradually. However, changes in lower extremity oedema were minimal during the observation period. Implication: This case suggests that early and structured physiotherapy management may support pain reduction, mobility improvement, functional independence, and lactation support after SC. Originality: This report provides an integrated description of physiotherapy management for multiple early postpartum problems during short-term inpatient rehabilitation.
Overview of Outpatient JKN Patient Satisfaction with Pharmaceutical Services at the Pharmacy Installation of Rumah Sakit Islam Karawang
Pharmaceutical services are an essential part of hospital healthcare because they are related to medication safety, rational drug use, service efficiency, and patient satisfaction. In the context of the National Health Insurance program (Jaminan Kesehatan Nasional/JKN), outpatient pharmacy services are required to provide accurate, timely, informative, and equitable services. Objective: This study aimed to describe the characteristics of JKN outpatients and their satisfaction level with pharmaceutical services at the Pharmacy Installation of Rumah Sakit Islam Karawang. Methodology: This study used a descriptive quantitative design with a cross-sectional approach. A total of 358 respondents were selected using accidental sampling. Data were collected using a structured questionnaire based on five SERVQUAL dimensions: reliability, responsiveness, assurance, empathy, and tangibles. The data were analyzed descriptively using frequency distributions and satisfaction percentages. Findings: Most respondents were female, aged 36–45 years, employed, and had a senior high school educational background. The overall patient satisfaction score was 78.95%, categorized as satisfied. The highest scores were found in the tangibles dimension at 83.02% and empathy at 82.83%, both categorized as very satisfied. Responsiveness and reliability obtained scores of 77.37% and 76.12%, respectively. The assurance dimension had the lowest score at 74.62%, although it remained in the satisfied category. Implications: The findings indicate that pharmaceutical services for JKN outpatients were generally satisfactory. However, improvements are needed in assurance, particularly medication availability, medication accuracy, prescription suitability, and patient confidence. Originality: This study provides empirical evidence on JKN outpatient satisfaction with pharmaceutical services at Rumah Sakit Islam Karawang and identifies priority dimensions for service quality improvement.
Physiotherapy Management in a Patient with Coronary Artery Disease 3VD Post Coronary Artery Bypass Grafting in ICCU: A Case Study
Post-Coronary Artery Bypass Grafting (CABG) patients are at risk of postoperative complications, including pain, respiratory disorders, decreased thoracic expansion, and functional mobility limitations due to surgical procedures and prolonged bed rest in the Intensive Cardiac Care Unit (ICCU). Therefore, physiotherapy during the acute rehabilitation phase is essential to support recovery and prevent further complications. Objective: This study aims to describe physiotherapy management in a patient with Coronary Artery Disease (CAD) three-vessel disease (3VD) post-CABG in the ICCU and to evaluate changes in pain, shortness of breath, thoracic expansion, and functional mobility after physiotherapy intervention. Method: This study used a case report design involving a 53-year-old male patient with complaints of sternotomy pain, shortness of breath, and postoperative mobility limitations. Data were collected through physiotherapy assessment, including vital signs, Numeric Rating Scale (NRS), Borg Scale, thoracic expansion measurement using a meterline, and functional ability using the ICU Mobility Scale. Data were analyzed descriptively by comparing clinical outcomes before and after three physiotherapy sessions. Findings: The results showed decreased resting pain from 5/10 to 3/10, reduced shortness of breath from 2/10 to 0/10, increased thoracic expansion, and improved functional mobility from score 1 to score 3 based on the ICU Mobility Scale. These findings indicate positive clinical progress during the acute rehabilitation phase. Implication: Early physiotherapy intervention through diaphragmatic breathing exercise, deep breathing exercise, active range of motion exercise, and gradual mobilization may support respiratory function, reduce pain, improve mobility, and assist early recovery in post-CABG patients in the ICCU. Originality/Value: This case report provides specific clinical evidence regarding comprehensive physiotherapy management in a CAD 3VD post-CABG patient during intensive cardiac care, particularly through measurable outcomes in the acute rehabilitation phase.
Adult-Onset Solitary Verrucous Epidermal Nevus Without Blaschkoid Distribution: A Clinicopathological Diagnostic Challenge
Verrucous epidermal nevus (VEN) is a benign keratinocytic hamartoma that usually appears in childhood and follows Blaschko’s lines. Adult-onset solitary VEN without Blaschko line distribution is rare and may clinically mimic other verrucous lesions, including verruca vulgaris, seborrheic keratosis, and verrucous squamous cell carcinoma. Objective: This case report aims to describe an atypical adult-onset solitary VEN without Blaschko line distribution and emphasize the importance of clinicopathological correlation in establishing the diagnosis. Case: A 27-year-old man presented with a progressively enlarging verrucous plaque on the left lateral malleolus for one year. The lesion was hyperkeratotic, well-demarcated, and associated with pruritus. Clinical differential diagnoses included verruca vulgaris, seborrheic keratosis, and verrucous squamous cell carcinoma. Complete surgical excision was performed, followed by histopathological examination. Discussion: Histopathological findings showed hyperkeratosis, papillomatosis, focal hypergranulosis, acanthosis, and basal hyperpigmentation without koilocytosis, horn cysts, cytologic atypia, or invasive growth. These findings confirmed the diagnosis of VEN and excluded infectious and malignant verrucous lesions. Conclusion: Solitary adult-onset VEN without Blaschko line distribution is a rare diagnostic challenge. Histopathological examination is essential for accurate diagnosis, while excisional biopsy may serve both diagnostic and therapeutic purposes in localized lesions.
Analysis of Factors Associated with the Incidence of Hypertension in the Working Area of Wara Utara Community Health Center, Palopo City
Hypertension is a major public health problem because it often occurs without specific symptoms and may lead to severe complications, including stroke, kidney failure, and cardiovascular disease. Dietary behavior and psychological stress are modifiable factors that may contribute to increased blood pressure, particularly in communities served by primary health care facilities. Objective: This study aimed to analyze the association between sodium dietary intake, stress level, and the incidence of hypertension in the working area of the Wara Utara Community Health Center, Palopo City. Methods: This study used a quantitative analytic observational design with a cross-sectional approach. The sample consisted of 97 respondents aged 35–65 years selected using purposive sampling. Data were collected through blood pressure measurement, sodium intake assessment using a Semi-Quantitative Food Frequency Questionnaire, and stress level measurement using the Depression Anxiety Stress Scales questionnaire. Data were analyzed using univariate analysis, Chi-square test, and binary logistic regression. Findings: The results showed that 70 respondents (72.2%) had hypertension, 37 respondents (38.1%) had excessive sodium intake, and 52 respondents (53.6%) experienced stress. Sodium dietary intake was significantly associated with hypertension (p = 0.007), and stress was also significantly associated with hypertension (p < 0.001). Multivariate analysis showed that stress was the most dominant factor associated with hypertension (OR = 6.71; 95% CI: 2.01–22.38; p = 0.005), followed by excessive sodium intake (OR = 5.13; 95% CI: 1.61–16.32; p = 0.020). Implications: These findings imply that hypertension prevention programs at the primary health care level should integrate sodium intake control, healthy dietary education, routine blood pressure monitoring, and stress management. Originality: The originality of this study lies in its simultaneous analysis of dietary and psychosocial factors associated with hypertension in a local primary health care setting, providing contextual evidence for community-based hypertension prevention strategies.
The Effect of Combined Cinnamon and Ginger Decoction on Fasting Blood Glucose Levels among Patients with Diabetes Mellitus in RT 02 RW 04 Kampung Sukamanah, Parung Panjang, Bogor
Diabetes mellitus is a chronic metabolic disease that requires continuous management to prevent complications and improve patients’ quality of life. In community settings, several patients still experience uncontrolled blood glucose levels due to limited awareness, lifestyle factors, and inconsistent treatment adherence. Cinnamon and ginger are herbal ingredients that contain bioactive compounds and are commonly used as complementary approaches to support blood glucose management. Objective: This study aimed to examine the effect of a combination of cinnamon and ginger decoction on reducing fasting blood glucose levels among patients with diabetes mellitus in RT 02 RW 04 Kampung Sukamanah, Parung Panjang, Bogor. Methods: This study used a quantitative quasi-experimental design with a pretest–posttest without control group approach. A total of 18 respondents with diabetes mellitus were selected using purposive sampling based on predetermined inclusion criteria. Fasting blood glucose levels were measured before and after the administration of cinnamon and ginger decoction. Data were analyzed using univariate analysis and a paired sample t-test to determine differences in blood glucose levels before and after the intervention. Findings: The results showed that the mean fasting blood glucose level before the intervention was 373.72 mg/dL, while the mean level after the intervention decreased to 182.89 mg/dL. Statistical analysis showed a significant difference between pre-test and post-test blood glucose levels, with a p-value of 0.001. These findings indicate that the administration of cinnamon and ginger decoction was associated with a reduction in fasting blood glucose levels among the respondents. Implication: The findings suggest that cinnamon and ginger decoction may be considered as an affordable and accessible complementary non-pharmacological approach to support community-based diabetes management. However, this intervention should not replace standard medical treatment. Originality: This study provides empirical evidence on the combined use of cinnamon and ginger decoction in a community-based setting, particularly among patients with diabetes mellitus in RT 02 RW 04 Kampung Sukamanah, Parung Panjang, Bogor.
The Effect of Pandan Leaf Decoction on Reducing Blood Glucose Levels among Patients with Diabetes Mellitus in RT 02 RW 04 Kampung Sukamanah, Parung Panjang, Bogor
Diabetes mellitus is a chronic metabolic disease characterized by elevated blood glucose levels and may lead to serious complications if not properly controlled. The use of accessible herbal-based complementary therapies, such as pandan leaf decoction, has become an alternative approach to support blood glucose management in the community. Objective: This study aimed to determine the effect of pandan leaf decoction on reducing blood glucose levels among patients with diabetes mellitus in RT 02 RW 04 Kampung Sukamanah, Parung Panjang, Bogor. Method: This study employed a quantitative quasi-experimental design using a one-group pretest-posttest approach. A total of 18 respondents were selected through purposive sampling. Data were collected by measuring fasting blood glucose levels before and after the administration of 200 ml pandan leaf decoction once daily for five consecutive days. Data were analyzed using univariate analysis and the paired sample t-test. Findings: The results showed that the mean fasting blood glucose level decreased from 279.61 mg/dL before the intervention to 153.78 mg/dL after the intervention. Statistical analysis revealed a significant difference between pretest and posttest measurements, with a p-value of 0.001, indicating that pandan leaf decoction was associated with a significant reduction in blood glucose levels among patients with diabetes mellitus. Implications: The findings suggest that pandan leaf decoction may be utilized as an affordable and accessible complementary non-pharmacological intervention to support blood glucose control in community-based diabetes management programs. The results may also serve as a reference for nursing practice and public health promotion related to complementary therapies. Originality: The originality of this study lies in providing empirical evidence from a community setting regarding the potential use of pandan leaf decoction as a complementary herbal intervention for reducing blood glucose levels among patients with diabetes mellitus. This study contributes practical knowledge on the utilization of local herbal resources in supporting diabetes management.
Foot Reflexology Massage for Managing Diabetic Peripheral Neuropathy Symptoms in a Patient with Type 2 Diabetes Mellitus
Diabetic Peripheral Neuropathy (DPN) is a common complication of Type 2 Diabetes Mellitus, often causing numbness, tingling, nocturnal cramps, and sleep disturbance. Complementary nursing interventions are needed to support symptom management in primary healthcare settings. Objective: This study aimed to describe the implementation of foot reflexology massage and its potential contribution to reducing peripheral neuropathy symptoms in a patient with Type 2 Diabetes Mellitus. Method: This study used a descriptive case study design with an Evidence-Based Practice Nursing approach. The subject was a 58-year-old female patient with Type 2 Diabetes Mellitus and peripheral neuropathy symptoms. Data were collected through nursing assessment, physical examination, Toronto Clinical Neuropathy Score (TCNS), and Ankle Brachial Index (ABI). Foot reflexology massage was administered three times per week for two weeks, totaling six sessions. Data were analyzed descriptively by comparing pre- and post-intervention findings. Findings: Before the intervention, the patient had moderate neuropathy with a TCNS score of 10, an ABI value of 0.91, cold acral temperature, dry foot skin, and persistent numbness and tingling. After six sessions, the TCNS score decreased to 7, indicating mild neuropathy, while the ABI increased to 0.96. The patient also reported reduced tingling, disappearance of nocturnal cramps, warmer feet, improved skin moisture, and better sleep quality. Implications: Foot reflexology massage may serve as a simple, low-cost, non-invasive complementary nursing intervention for managing DPN symptoms in primary healthcare. Originality/Value: This study provides a clinical description integrating TCNS and ABI assessment within an Evidence-Based Practice Nursing framework.
Artificial Intelligence in the Initial Assessment of Acute Burn Wounds:
Accurate initial assessment of acute burn wounds is essential for determining severity, healing potential, referral needs, and treatment strategy. However, this assessment remains challenging because burn wounds evolve over time and conventional methods often depend on clinician experience or specialized imaging technologies. Artificial intelligence offers a potential approach to improve the objectivity and efficiency of early burn assessment. Objective: This study aims to analyze current applications of artificial intelligence in the initial assessment of acute burn wounds and evaluate its potential, methodological challenges, and clinical implementation. Methodology: This study employed a narrative literature review. Scientific publications were retrieved from PubMed and Google Scholar from database inception to May 2026. Eligible publications included original research articles, systematic and narrative reviews, clinical practice guidelines, and AI reporting guidelines related to AI-assisted burn assessment. The selected literature was synthesized narratively by comparing evidence on burn detection, burn-depth classification, wound segmentation, total body surface area estimation, prediction of surgical requirements, multimodal AI, and methodological quality. Findings: AI has demonstrated promising performance in burn detection, burn-depth classification, wound segmentation, total body surface area estimation, and prediction of surgical requirements. Recent studies have also expanded AI applications toward multimodal assessment by integrating clinical images with physiological and electronic medical record data. Nevertheless, current evidence is constrained by heterogeneous reference standards, retrospective designs, limited external validation, inconsistent image-acquisition protocols, and inadequate representation of diverse skin tones. Implications: AI should be implemented as a clinical decision-support tool that complements, rather than replaces, serial clinical assessment by burn specialists. Originality: This review integrates technical advances in artificial intelligence with clinically relevant considerations, including burn wound progression, image-acquisition timing, treatment status, reference-standard heterogeneity, external validation, skin-tone diversity, and workflow integration.
Input–Process–Output Evaluation of Inpatient Medical Record Management at Beriman Regional General Hospital, Balikpapan
Inpatient medical record management is essential for continuity of care, administrative accountability, claim verification, legal protection, and hospital service quality. However, hospitals still face problems related to incomplete documents, delayed file returns, limited facilities, and the transition from manual to electronic medical record systems. Objective: This study aimed to evaluate inpatient medical record management based on the input, process, and output dimensions at Beriman Regional General Hospital, Balikpapan. Methodology: This study used a descriptive qualitative design. Data were collected through observation, in-depth interviews, and documentation involving five informants from the Medical Record Unit, consisting of the head of the medical record installation, data processing officer, filing officer, coding officer, and registration officer. Data were analyzed using qualitative descriptive analysis through data collection, data reduction, data display, and conclusion drawing. Findings: The results showed that the number of staff was relatively adequate; however, several personnel did not have an educational background in medical records and had not received structured training. The workflow generally followed standard operating procedures, including registration, file distribution, document completion, assembling, completeness analysis, coding, claim verification, and filing. Nevertheless, implementation was constrained by incomplete discharge summaries, blank informed consent forms, missing physician signatures, illegible handwriting, delayed file returns, limited infrastructure, and repeated file movement in the hybrid manual–electronic system. Document access was relatively easy through SIMRS and borrowing logbook procedures, but file completeness and neatness had not been fully achieved. Implication: The findings highlight the need to strengthen staff competence, regular training, infrastructure, SOP compliance, internal audits, and integrated electronic medical record implementation. Originality: This study provides an integrated input–process–output evaluation model for identifying root causes and improvement priorities in inpatient medical record management.
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Single-Cell Immunology and Multi-Omics: Recent Advances and Emerging Applications in Precision Medicine
The rapid advancement of single-cell sequencing technologies has revolutionized immunological research by enabling comprehensive characterization of immune cells at single-cell resolution. Conventional bulk analytical methods often fail to capture cellular heterogeneity, limiting the understanding of immune mechanisms underlying cancer, autoimmune diseases, infectious disorders, and neurodegenerative conditions. The integration of multi-omics technologies offers new opportunities to overcome these limitations and accelerate precision medicine. Objective: This review aims to synthesize recent advances in single-cell immunology and multi-omics, evaluate their applications across major immunological fields, and identify emerging opportunities and challenges for clinical translation. Methodology: This study employed a qualitative narrative literature review using a structured literature search. Scientific publications were retrieved from PubMed, PubMed Central, Google Scholar, and bioRxiv. Eligible studies were selected based on predefined inclusion criteria and analyzed using thematic narrative synthesis to identify technological developments, translational applications, methodological challenges, and future research directions. Findings: The review demonstrates that single-cell RNA sequencing, CITE-seq, spatial transcriptomics, and integrated multi-omics have substantially improved the identification of immune cell heterogeneity, cellular communication, and disease-specific molecular mechanisms. These technologies have advanced immune atlas construction, enhanced understanding of tumor immune microenvironments, improved characterization of autoimmune diseases, and revealed novel neuroimmune interactions. Artificial intelligence and computational biology further strengthen data integration and biological interpretation. Implications: The findings support the application of single-cell multi-omics in biomarker discovery, disease stratification, therapeutic target identification, and personalized treatment strategies while highlighting the need for standardized analytical pipelines and clinical validation. Originality: This review provides an integrated synthesis of technological innovation, computational methodologies, immune atlas research, oncology, autoimmune diseases, and neuroimmunology within a unified precision immunology framework, offering a comprehensive perspective that extends beyond previous technology- or disease-specific reviews.
Relationship Between Service Quality, Service Satisfaction, and Outpatient Loyalty Following Electronic Medical Record Implementation at Dr. R. Soetijono Regional Hospital, Blora
The implementation of Electronic Medical Records (EMR) is expected to improve healthcare service quality and strengthen patient loyalty by enhancing service quality, and service satisfaction. This study aimed to analyze the relationship between service quality, and service satisfaction with outpatient loyalty after EMR implementation at RSUD dr. R. Soetijono Blora. Method: This study employed a quantitative cross-sectional design involving 100 outpatient respondents selected using accidental sampling. Data were collected through validated and reliable questionnaires and analyzed using univariate analysis and the Spearman Rank test with a significance level of 0.05. Findings: The results showed that most respondents perceived service quality (95%), and service satisfaction (76%) as being at a moderate level, while patient loyalty was categorized as high (100%). Statistical analysis indicated that service quality, hospital image, and service satisfaction were not significantly associated with patient loyalty (p>0.05). Implications: These findings suggest that maintaining patient loyalty after EMR implementation requires attention to additional factors beyond service quality, and service satisfaction, providing valuable input for hospital management in evaluating digital health service strategies. Originality: This study offers empirical evidence regarding outpatient loyalty following EMR implementation in a regional public hospital and demonstrates that high patient loyalty may persist despite the absence of significant relationships with the examined service-related factors.
The Influence of Patient Experience on Outpatient Revisit Intention at Hospital X
Patient experience is an important indicator of healthcare quality because it reflects patients’ perceptions of communication, responsiveness, comfort, and overall service delivery during the care process. A positive patient experience may encourage patients to return to the same healthcare facility, making it an essential factor for hospitals seeking to improve patient retention and service quality. Objective: This study aimed to analyze the effect of patient experience on outpatient revisit intention at Hospital X by examining four dimensions: nurse communication, physician communication, service responsiveness, and physical comfort. Methodology: This study used an analytical observational design with a cross-sectional approach. A total of 57 outpatients were selected using accidental sampling. Data were collected using a structured questionnaire and analyzed using Binary Logistic Regression. Findings: The results showed that physician communication received the highest proportion of good ratings (75.4%), followed by nurse communication (63.2%), while service responsiveness and physical comfort were mostly rated as adequate (59.6%). Most respondents (94.7%) expressed an intention to revisit the hospital. Among the four dimensions examined, service responsiveness was the only dimension significantly associated with revisit intention (p = 0.018; Exp(B) = 7.172). Implications: These findings imply that improving service responsiveness, reducing waiting time, and ensuring timely assistance may strengthen outpatient loyalty and encourage repeat visits. Originality: The originality of this study lies in its specific examination of selected patient experience dimensions rather than assessing patient experience as a single general construct, thereby providing more detailed evidence on which service aspect should be prioritized to improve outpatient revisit intention.
Application of the 45° Semi-Fowler Position and Pursed Lip Breathing in STEMI Patients with Ineffective Breathing Pattern
ST-Elevation Myocardial Infarction (STEMI) is a cardiovascular emergency caused by complete occlusion of a coronary artery, which may result in myocardial ischemia, decreased cardiac function, pulmonary congestion, and impaired tissue oxygenation. Respiratory problems such as dyspnea, increased respiratory rate, and ineffective breathing pattern may occur in STEMI patients and require supportive nursing interventions. The combination of the 45° Semi-Fowler position and Pursed Lip Breathing is a simple non-pharmacological intervention that may help improve ventilation and oxygenation. Objective: This study aimed to describe the implementation of the combination of the 45° Semi-Fowler position and Pursed Lip Breathing in improving respiratory status among STEMI patients with ineffective breathing pattern. Methodology: This study used a descriptive nursing case study design involving two STEMI patients treated in the Intensive Cardiac Care Unit. Data were collected through direct observation of respiratory status before and after the intervention. The observed indicators were peripheral oxygen saturation (SpO₂) and respiratory rate. The data were analyzed descriptively by comparing respiratory parameters during the three-day observation period. Findings: The results showed a tendency toward improvement in respiratory status in both patients. Oxygen saturation increased from 96% to 98%, while respiratory rate decreased from 20–24 breaths per minute before the intervention to 16–20 breaths per minute after the intervention. Implications: The findings suggest that the combination of the 45° Semi-Fowler position and Pursed Lip Breathing may be used as a supportive independent nursing intervention to help improve oxygenation and reduce breathing effort in STEMI patients, without replacing standard medical therapy. Originality: This study provides a clinical description of the combined use of body positioning and breathing exercise in STEMI patients with ineffective breathing pattern, an area that remains limited in previous nursing case studies.
Effectiveness of Structured Preconception Nutritional Counseling on Pregnancy Readiness Among Women Planning Pregnancy in Rural North Sumatra, Indonesia
Preconception nutritional readiness is an important component of maternal and neonatal health because women’s nutritional status before pregnancy may influence pregnancy outcomes, fetal growth, and newborn health. However, structured preconception nutritional counseling has not been widely implemented in rural community settings, including among women planning pregnancy in Bangun Rejo Village, North Sumatra, Indonesia. Objective: This study aimed to examine the effectiveness of structured preconception nutritional counseling on pregnancy readiness among women planning pregnancy. Methods: This study used a quantitative approach with a quasi-experimental non-equivalent control group design. A total of 80 women of reproductive age who intended to conceive within one year were selected using purposive sampling and divided into an intervention group and a control group, with 40 respondents in each group. The intervention group received structured preconception nutritional counseling for eight weeks, while the control group received routine health education. Data were collected using a pregnancy readiness questionnaire and analyzed using descriptive statistics, paired sample t-tests, and independent sample t-tests. Results: The results showed that the intervention group experienced a significant increase in pregnancy readiness scores from 61.75 ± 8.42 to 84.20 ± 6.11 after the counseling program (p < 0.001). In contrast, the control group showed only a small and statistically insignificant increase from 62.10 ± 7.95 to 65.45 ± 7.38 (p = 0.091). Improvements were also observed in nutritional knowledge, dietary behavior, and folic acid awareness, with the highest improvement found in folic acid awareness. Implications: These findings imply that structured preconception nutritional counseling can be integrated into community-based maternal and reproductive health services to improve women’s readiness before pregnancy. Originality: The originality of this study lies in its focus on structured nutritional counseling for women actively planning pregnancy in a rural Indonesian setting, providing practical evidence for strengthening preconception care at the community level.
Evidence-Based Midwifery Management of Premature Rupture of Membranes at Term Pregnancy in Primary Care
Premature Rupture of Membranes (PROM) is a common obstetric complication associated with maternal infection, neonatal morbidity, and adverse pregnancy outcomes if not managed promptly. Comprehensive and evidence-based midwifery care is essential to improve maternal and neonatal safety, particularly in primary healthcare settings. Objective: This case report aimed to describe the implementation of evidence-based midwifery management for a woman with term PROM using Helen Varney's Seven-Step Midwifery Management framework. Methods: A descriptive case report design was employed involving a 26-year-old primigravida (G1P0A0) at 39 weeks of gestation who presented with spontaneous rupture of membranes before the onset of regular uterine contractions. Clinical data were collected through patient interviews, physical and obstetric examinations, labor observations, medical records, and neonatal assessments. Data were analyzed descriptively using a narrative approach based on Helen Varney's Seven-Step Midwifery Management and interpreted according to current evidence-based recommendations. Findings: Following confirmation of PROM, continuous maternal and fetal monitoring was performed until spontaneous labor occurred. The patient delivered a healthy female infant vaginally with a birth weight of 3,000 g, body length of 49 cm, and an Apgar score of 9. The placenta was delivered completely, and the mother remained clinically stable despite experiencing a second-degree perineal laceration that was successfully repaired. No immediate maternal or neonatal complications were observed. Implications: The findings demonstrate that systematic assessment, continuous monitoring, and evidence-based midwifery management can support favorable maternal and neonatal outcomes in women with PROM and may strengthen the quality of maternity care in primary healthcare facilities. Originality: This report highlights the practical implementation of Helen Varney's Seven-Step Midwifery Management in a term PROM case within a primary healthcare setting, providing a structured example of evidence-based midwifery practice.
Relationship Between Pregnant Women's Knowledge of Iron (Fe) Tablets and Incidence of Anemia at PMB Shinta, Medan Polonia District, North Sumatera Province
Anemia during pregnancy remains a major public health problem in Indonesia. One of the contributing factors is inadequate maternal knowledge regarding iron (Fe) tablets, which may affect adherence to supplementation and increase the risk of anemia. Objective: This study aimed to analyze the relationship between pregnant women's knowledge of iron (Fe) tablets and the incidence of anemia at PMB Shinta, Medan Polonia District, North Sumatera Province, in 2025. Methods: This quantitative study employed a cross-sectional design. The study involved all 30 pregnant women attending antenatal care at PMB Shinta, selected through total sampling. Data were collected using a structured questionnaire and hemoglobin examination. The data were analyzed using descriptive statistics and the Chi-Square test. Findings: The results showed that 56.7% of respondents had poor knowledge and 60.0% experienced anemia. A significant relationship was found between maternal knowledge and the incidence of anemia, with a p-value of 0.013. Pregnant women with poor knowledge had a 10.5-times higher likelihood of experiencing anemia than those with good knowledge (OR = 10.5; 95% CI: 1.889–58.359). Implications: The findings indicate the need to strengthen health education during antenatal care, particularly regarding the benefits, dosage, timing, and proper consumption of iron tablets. Improved maternal knowledge is expected to support adherence to iron supplementation and reduce the incidence of anemia during pregnancy. Originality: This study provides recent empirical evidence from a primary midwifery practice in Medan Polonia by directly examining the relationship between maternal knowledge of iron tablets and anemia incidence. The findings offer practical value for developing targeted, community-based maternal health education strategies.
Integrating Maternal Health Literacy and the Health Belief Model for Predicting Preeclampsia Screening Adherence
Preeclampsia remains one of the leading causes of maternal morbidity and mortality, highlighting the importance of improving pregnant women's adherence to early screening and timely clinical decision-making. Objective: This study aims to examine the integrated role of Maternal Health Literacy (MHL) and the Health Belief Model (HBM) in predicting preeclampsia screening adherence and mitigating delays in medical decision-making among pregnant women. Methods: A quantitative predictive study with a cross-sectional design was conducted involving 64 pregnant women at the Sarfina Sembiring Primary Clinic selected through purposive sampling. Data were collected using validated questionnaires measuring MHL and HBM constructs and analyzed using multiple logistic regression. Findings: The results showed that both MHL and HBM significantly predicted preeclampsia screening adherence and mitigation of delay in decision-making. HBM was identified as the strongest predictor of screening adherence (OR = 6.52), whereas MHL demonstrated the greatest influence on reducing delays in clinical decision-making (OR = 8.21). These findings indicate that psychological beliefs and cognitive health literacy play complementary roles in improving maternal preventive health behavior. Implications: The findings support the development of integrated maternal health education programs that combine health literacy enhancement with behavior-based interventions, including digital health education and counseling, to strengthen screening adherence and maternal self-efficacy in primary healthcare settings. Originality: This study proposes and empirically validates an integrated predictive framework combining Maternal Health Literacy and the Health Belief Model. Unlike previous studies that examined these constructs separately, this research demonstrates their complementary roles in improving preeclampsia prevention strategies and reducing delays in maternal healthcare decision-making.
The Effect of Conscientiousness on Organizational Citizenship Behavior: The Mediating Role of Digital Self-Efficacy among University Lecturers
Organizational citizenship behavior (OCB) is increasingly important in higher education because lecturers are expected to contribute beyond their formal duties while adapting to digital transformation. This study examines whether digital self-efficacy mediates the effect of conscientiousness on organizational citizenship behavior among university lecturers. Methodology: This study employed a quantitative cross-sectional design involving 112 lecturers in Jakarta selected through convenience sampling. Data were collected using an online questionnaire distributed through Google Forms and analyzed using correlation and path analysis with JASP software. Findings: Conscientiousness positively influenced both digital self-efficacy and organizational citizenship behavior. Digital self-efficacy also positively affected organizational citizenship behavior. However, the indirect effect of conscientiousness on organizational citizenship behavior through digital self-efficacy was weaker than its direct effect. Therefore, digital self-efficacy did not significantly mediate the relationship between conscientiousness and organizational citizenship behavior. Implications: The findings indicate that lecturers’ voluntary contributions are more strongly influenced by stable personality traits, professional responsibility, and commitment to academic roles than by confidence in using digital technology. Higher education institutions should therefore strengthen professional values, collaborative culture, and recognition of lecturers’ extra-role contributions while continuing to support digital competency development. Originality: This study integrates conscientiousness, digital self-efficacy, and organizational citizenship behavior within a single empirical model and demonstrates that digital self-efficacy is not the primary psychological mechanism connecting conscientiousness with OCB among lecturers.