pusat infokes dr iwan – Page 2 – Iwansuwandy's Blog

Iwansuwandy's Blog Driwancybemuseum's blog

pusat infokes dr iwan

Modul Pelatihan Praktisi Rekam Medis Unit 2 : “Patient Identification,Registration Index & The Master Patient Index” October 26, 2010October 26, 2010

iwansuwandy

18 Comments

Education Module for Health Record Practice UNIT 2 – PATIENT IDENTIFICATION, REGISTRATION AND THE MASTER PATIENT INDEX This unit is designed to enable the participant to discuss methods of patient identification and registration and identify processes required to develop, use and maintain an effective patient identification system in a hospital, clinic or primary health care centre. OBJECTIVES: At the conclusion of this unit the participant should be able to: 1. Discuss the importance of complete and accurate patient identification 2. State the purpose of a master patient index (MPI) 3. List the items, which should be included in a master patient index 4. Develop and implement a master patient index (MPI) 5. Trace the flow of a patient’s index card from admission to discharge 6. Use alphabetical or phonetic filing rules to correctly file cards in a manual master patient index 7. Discuss the need for crossreferencing names in a master patient index 8. State the types of supplies and equipment commonly used for maintenance of a manual master patient index (MPI). A. PATIENT IDENTIFICATION The identifying information is an important part of a patient’s health record. It should include enough information to uniquely identify an individual patient. Most facilities will ask to view and/or copy the patient’s driver’s license or identification card in order to verify this data. The patient identification data that is collected during the patient registration process is used to populate the Master Patient Index (MPI), which will be discussed later in this unit. The patient identification data may be entered into a computerized database, or manually typed onto a registration form. This section of the medical record should contain at least the following information: 1. The full legal name of the patient, including the surname (or family name), first name, middle name or initial, suffixes (e.g., Jr.) and prefixes (e.g., Doctor). It is also important to collect the patient’s alias, previous name, or maiden name, as the patient may have been seen at the facility under another name. 2. Internal identification number or hospital registration number. This is the number used to identify and file a health record, also called the patient’s health record number. (This number is may be assigned at the patient’s first inpatient admission or outpatient encounter at this facility, or a new number is also assigned for each subsequent visit.) 3. Place and date of birth (MM/DD/YYYY or DD/MM/YYYY), gender, race, ethnicity, marital status, address, phone numbers, and any unique identifying number, such as a national identification number or social security number. 4. Name, address and telephone number of nearest relative (next of kin) or friend. 5. Name and address of attending doctor, and name and address of referring doctor, if applicable. 6. Occupation, name and address of patient’s employer. 7. Date and time of admission or encounter, and name of unit or clinic. 8. Details of health insurance and medicolegal information if appropriate. The above information should be obtained from the patient, if possible, or otherwise from the person accompanying the patient to the hospital or clinic. Care must be taken to ensure the correct spelling of names and that all names are recorded accurately and in full. Patients should be asked how they spell their names (both surname and given names) as names that sound alike may be spelled quite differently. Names should be recorded in the manner used for all official documents of the state or country. B. PATIENT REGISTRATION The complete and accurate collection of patient identification information is an important part of the patient registration process. For statistical purposes, a method for counting all outpatient encounters and hospital admissions each day is essential. There are a variety of methods in use, which are separate from the allocation of new health record numbers and will be discussed in Unit 7. Important aspects of patient registration are: 1. When a patient presents at a hospital or clinic for the first time, they should be registered as a new patient. However, to make sure that the patient is, in fact, a new patient they should be asked if they have been to the hospital or clinic previously. Even if they say no, the admission or clinic staff should still check in the facility’s computerized patient database, the manual master patient index or with the health record department, depending upon the level of computerization at the facility. This step is necessary to make sure that the patient does not already have a health record number at that hospital or clinic; and to ensure that duplicate records are not created. 2. If the patient does not have an entry in the MPI or a health record number, the identifying information is collected and either entered into the computerized database, or recorded on the front sheet of a new record. The patient is registered and a patient identification number is assigned. In most hospitals and health care centres, this registration number is used as the patient’s health record number. In a manual system, an Admission, or Patient Register is maintained at the point where the number is issued, and should contain the following information: Health Record Patient’s Name Date of Issue Doctor/ Number Clinic 10 26 42 John Doe 01/01/2004 Dr. Lee This register is maintained as a control to avoid duplication of numbers and the issuing of the same number to two people. 3. If the patient has an existing file in the MPI and a health record number, the current identifying information should be checked with previous data and changes noted. C. MASTER PATIENT INDEX (MPI) Indexes are a must for any hospital, health clinic, or primary health care facility. They serve as a guide to the location of an item. An index can be a table, file, or catalogue, listing an item and furnishing information for easy access to that item. The Master Patient Index (MPI) is a permanent listing, containing the names of all patients who have ever been admitted to or treated in a hospital or clinic (also called Patients’ Index, Master Person Index, Patient’s Master Index, or Master File). Because the Master Patient Index is the key to locating a patient’s health record, it is considered to be one of the most important tools maintained in the health record department, clinic or primary health care centre. Since health records are filed numerically in most healthcare facilities, the MPI is used to identify a patient’s health record number and locate the record. Typically, a manual MPI is maintained using individual index cards for each patient that are filed alphabetically. In a manual MPI, each patient who is registered in the facility has an index card in the MPI that is maintained in the health record department. However, an increasing number of health facilities are maintaining computerized Master Patient Indexes and this is described in more detail in Unit 6, Hospital Medical Record Computer Applications. A computerized MPI is maintained using specialized database software. Reference to the computerized MPI will be made in this Unit, when applicable. The basic principles are the same, whether the data collection is done manually or by computer. 1. Content of the master patient index The information contained in this index varies with the needs of the hospital or clinic. Whether the MPI is computerized or manual will determine the amount of data that will be maintained, based on space limitations. In a manual system, only information of an identifying nature necessary for prompt location of a particular health record should be recorded on the patient’s MPI card. A computerized MPI will allow the facility to maintain additional information. Typically, the MPI contains two basic types of data: demographic level and visit level. The privacy necessary for maintaining confidential information should be considered when thinking of recording diagnoses and procedures on a MPI card, and should be avoided. The information recorded should include: Demographic Level Internal identification number – number assigned at the time of hospital registration, also called the health record number. It is the number used to file the health records. Patient’s full name – family name, given name, middle name or initial, and pertinent suffixes and prefixes Date of birth (MM/DD/YYYY or DD/MM/YYYY) – in cases where patients have the same name, the age and date of birth provides additional information for identifying and obtaining the correct health record Complete address – street, city, state, zip code/post code, country Gender Race/Ethnicity Other unique identifying information, which will assist the identification of the patient, such as the mother’s maiden name, national identification number or social security number. (This information is limited by the amount of space available, i.e., computerized database or index card.) Visit Level The following additional information may also be listed on the patient’s master index card if there is a need and adequate storage available: Account number – the billing number used to identify admission or encounter charges Admission and discharge dates – for inpatient hospitalizations Type of service – inpatient, emergency, outpatient surgery, etc. Encounter date or date of service – for outpatient visits Disposition – discharged, transferred, or died Admitting and/or attending physician’s name The following is an illustration of a MPI card used in a manual master patient index. The information at the top is collected at the time of the first encounter of the patient with the hospital or clinic. If the entries on the card must be handwritten, a pre-printed card will help ensure that the required data elements are recorded and made in a uniform place on the card. Master Patient Index Card _______________________________________________________ | DOE, John William MR# 172842 | | | | 17 Western Avenue DOB 02/17/1949 | | Anytown, Indiana 46321 Sex: M | | 219-555-3083 | | | | Adm Date Dis Date Service Physician Account # | | | | 02/14/2004 02/17/2004 IP Smith 04-3332112 | | 05/16/2004 OPS Jones 04-3332866 | | | | | | | | | |_______________________________________________________| 2. Manual Master Patient Index a. For inpatients, the procedure for a manual master patient index could be as follows: 1) Each day the admission registration staff notifies the health record department of all patients registered in the facility. This may be done by sending copies of the admission slips for all patients admitted to hospital, which are usually the carbon copies or computer printouts of the registration forms or face sheets. 2) The MPI is checked to see if any of the patients whose names appear on the admission slips have been previously admitted and if they have an index card. If yes, these cards are pulled out and the current admission information is recorded. The demographic information on the index card must also be checked for any changes in name, address, etc. 3) If the patient has had no previous admission, and therefore no card in the MPI, a new index card is prepared. 4) In some hospitals the completed cards of inpatients are filed in a separate file, called the “inhospital” or “in-house” file, and remain there until the patient is discharged. 5) At discharge, the MPI card is removed from the “inhospital box” and the discharge date is recorded. If a death occurred the date may be recorded in red. The patients’ index cards are then filed into the MPI. Given the importance of the integrity and accuracy of this index, many hospitals have a second person check the filed card for accuracy. b. Organization of the MPI In the absence of a computerized MPI, special index cards or books or may be used for the listing of patients’ names, with index cards being the most preferred. The most popular and efficient method of maintaining the MPI is on index cards arranged alphabetically in a vertical file with a separate card for each patient. Using this method a single index card can be located readily in one search. If using a book, it is divided into alphabetical sections. Names are listed under the first letter of the surname in chronological order by date of admission. This method is only feasible for a small facility, but retrieval becomes cumbersome and increasingly difficult for large hospitals, or where the volume of patient admissions or encounters is great, because a strict alphabetical order is maintained. This method is NOT generally recommended for a MPI. It is not recommended to maintain the master patient index by year of admission or encounter. This is not a good method as patients often forget the date of their last visit, or if they were ever admitted to a particular hospital at all. Much time is lost searching through several sections of the index for the appropriate index card. Nor is it recommended to separate the MPI by sex, that is, to file the cards of male patients in one file and the cards of female patients in another. c. Methods used for filing 1) Alphabetical The MPI cards are arranged in the file like the words in a dictionary, following letter by letter of the family name first, then by the given name, and last by the middle name or initial. If there are two or more patients with the same family name, cards should be filed alphabetically by the given name. If given names are the same, the middle name or initial should be used to arrange the cards. If the entire name is identical the cards are filed by date of birth, filing the earliest birth date first (the card of the patient who was born first is filed first). If an initial is given for a patient’s first or middle name, the rule is to “file nothing before something” (Huffman, 1994). Thus, SMITH, P. would come before SMITH, PETER. Last names beginning with a prefix or containing an apostrophe are filed in strict alphabetical order, ignoring any spaces or apostrophes. For example, the name O’Leary would be filed as Oleary, and the name Mac Dougal would be filed as Macdougal. Compound or hyphenated names are filed letter by letter, as one word; thus AiMin would be filed AIMIN. 2) Phonetic in phonetic filing systems the patients’ master index cards are arranged in the file by the first letter of the surname, and then according to sound rather than spelling. Thus all surnames that sound alike, but are spelled differently, are filed together. For example: SMITH P. LEA S. GREENE, JAMES EDGAR SMYTH P. LEE S. GREEN, JAMES EDWARD SMYTHE P. LEIGH S. GREENE, JAMES EDWIN While an alphabetical filing system uses 26 letters the “Soundex” system uses only six code numbers. Names, which sound alike, but are spelled differently are grouped together in a phonetic patient index, rather than filed letter by letter as in an alphabetical patient index. Grouping similar sounding names together lessens the chance of lost index cards due to misspellings and index cards having misspelled names can be more easily located. d. General filing rules for a Master Patient Index 1) Rules for filing MPI cards must be very detailed. It is not easy to locate medical records if you cannot locate the correct MPI card. Filing rules should be posted near the patients’ master index for easy reference. 2) Use of the MPI and filing of the cards should be by authorized personnel only. Careful orientation of new employees to the proper filing procedures is necessary, as is periodic followup on the accuracy of these procedures. 3) The MPI should be a continuous file, that is, not divided into years. 4) A MPI card should be removed from the file only for updating or placing in the in-hospital box. 5) Occasional auditing of the MPI is recommended to monitor filing accuracy. This can be done by having the file clerk place a slightly higher card of a different colour behind each individual card at the time it is filed. A second person, known as the auditor or checker, removes the audit card after checking that each card has been correctly filed. It is useful to audit the filing done by new personnel to ensure that they are applying the rules correctly. 6) A patient whose name has changed since a previous admission will need a new index card. The new index card should be crossreferenced to the original index card. All information recorded on the original card should be entered on the new card. The original card should be crossreferenced to the new card. 3. Supplies and equipment for a manual Master Patient Index Index cards, index guides and filing equipment are needed for maintaining a manual MPI. a) Index cards 3 x 5 inch cards (7.5 x 12.5 cms) are generally used, but the size may vary depending on the amount of information to be recorded. Since the MPI is a permanent file, the card must be durable to withstand much handling. Remember, however, that the heavier the card, the more space required in the file. b) Index guides Index guides for an alphabetical or phonetic MPI file facilitate the location of an individual patient’s card. Being slightly larger than the patient’s card, the top of the guide with an initial letter of a common surname is extended above the other cards, thus serving as a guide. Phonetic index guides will require, in addition to guides with initial letters or surnames, subguides indicating basic code numbers. The size and activity of the index will determine the number of guides needed. Sturdy construction of guides is also essential. c) Filing equipment Patients’ index cards may be filed in cabinets suitable to the card’s size. If 3 x 5 inch (7.5 x 12.5 cms) cards are used, they are usually filed in vertical, eightdrawer, triple compartment file cabinets. A power file is considered feasible when the MPI has more than 500,000 actively used cards. At the touch of a button, a power file delivers the required section of the index to the front of the file for easy access. 4. Computerized Master Patient Index As mentioned earlier, It is also possible to maintain the MPI in a computer. At the time of admission to a facility, the registration staff searches the computer database for a particular patient. If the patient has been in hospital or attended a clinic previously, the patient’s information is displayed on the computer screen. The registrar then updates any demographic information that has changed since the previous admission or visit. If the patient has not been to the hospital previously, the registrar collects the patient demographic information and the system automatically assigns a new registration, or medical record number, and stores this information in its memory. At the time of the patient’s discharge, the date of discharge is entered into the system, thereby completing the current MPI entry. A computerized MPI is discussed in more detail in Unit 6. SUMMARY The master patient index (MPI) is a permanent listing of all patients who have ever been admitted to, or treated by, the clinic, doctor or hospital. MPI cards should be prepared as soon as possible following the registration of a new patient and not later than 24 hours after the patient’s presentation to the clinic or admission office. As the MPI is the key to finding a patient’s health record, in a manual system they must be filed promptly in alphabetical or phonetic order. The type of equipment required will depend upon the type and size of the cards used. The size generally used is a 3 x 5 inch card (7.5 x 12.5 cms). Regardless of the size of the card, however, only basic identification information needed to promptly locate a medical record should be recorded. MPI cards must be filed promptly and removed only for updating information. To help find a card guides should be used at regular intervals. If computerization of hospital information is considered, the registration process and the MPI should be computerized first, if computer storage is available. The patient demographic and visit information contained on the cards can be stored in a computer database, and at the time of a patient’s admission to, or outpatient encounter at a hospital, the staff can check the name and file number via a computer terminal in the office. REVIEW QUESTIONS: 1. What is the purpose of a Master Patient Index? 2. What are the contents of a Master Patient Index? 3. How is a master patient index card prepared? How are data collected? 4. What equipment would be needed for a Master Patient Index? 5. How does the “Soundex” phonetic system work? When would it be most useful? 6. Why is the Master Patient Index important? 7. How long should a Master Patient Index be kept? REFERENCES: 1. American Health Information Management Association. Practice Brief, “Master Patient (Person) Index (MPI)—Recommended Core Data Elements, “ Journal of the American Health Information Management Association (July 1997). 2. Davis, Nadinia, LaCour, Melissa. Introduction to Health Information Technology. Philadelphia, PA: W.B. Saunders, 2002. 3. Huffman, Edna K. Health Information Management. 10th ed. Berwyn, IL: Physicians Record Company, 1994. 4. Johns, Merida, ed. Health Information Management Technology: An Applied Approach. Chicago: AHIMA, 2002. 5. Skurka, Margaret. Health Information Management: Principles and Organization for Health Information Services. San Francisco, CA: Jossey- Bass, 2003 selesai@hak (mailto:selesai@hak) cipta dr Iwan Suwandy 2010

Report this ad Report this ad pusat infokes dr iwan

Modul Pelatihan praktisi Rekam Medis Unit I.”Health Record” October 26, 2010October 26, 2010

iwansuwandy

Leave a comment

INTERNATIONAL FEDERATION OF

Education Module for Health Record Practice Based on IFHRO Modul.

UNIT 1 THE HEALTH RECORD In this first Unit participants are introduced to the health record, the forms within the record; documentation and content of a good health record, as well as the uses of and responsibility for a patient’s health record. Participants are reminded of the importance of health records in patient care and are encouraged to develop an acute awareness of all the essential requirements of an accurate, complete health record.

OBJECTIVES: At the conclusion of this unit the participant should be able to: 1. define what is meant by a “health record” 2. explain in detail the reasons for developing and keeping health records 3. state five general principles of good forms design 4. list and describe the four component parts of a problem oriented health record 5. describe the benefits of a structured health record 6. state the value and uses of the health record together with the requirements for a good health record 7. state the purposes of a health record 8. describe the development of a health record from admission to the discharge of a patient in a hospital 9. design health record forms for use in a hospital or primary health care center 10. identify the purpose of health record forms and describe what information should be included on each form 11. identify who is responsible for the health records in hospitals or health centers and explain this responsibility 12. describe the activities of a Health Record Committee and state who should be included on such a committee 13. develop a policy for the release of information from a health record 14. design a form to be used for recording information to be released from a health record 15. analyse privacy and confidentiality issues relating to health care in a hospital or clinic. A. THE HEALTH RECORD A health record is a written collection of information about a patient. It is derived from the patient’s first encounter or treatment at a hospital, clinic or other primary health care centre. The health record is thus a record of all the procedures carried out on that patient, whilst he is in hospital or under treatment at a clinic or centre. It should contain the past medical history of the patient, including opinions, investigations and other details relevant to the health of the patient. As a document it may appear in many shapes and sizes with varied information related to the care of the patient recorded by many persons in many ways. In physical appearance, it consists of a number of sheets of paper or cards and may be placed in a cover or envelope. In more advanced systems, the information may be recorded digitally in a computer; the sheets of paper scanned onto optical media or the actual sheets may be microfilmed. Huffman (1994) defines a health record as “a compilation of pertinent facts of a patient’s life and health history, including past and present illness(es) and treatment(s), written by the health professionals contributing to that patient’s care. The health record must be compiled in a timely manner and contain sufficient data to identify the patient, support the diagnosis, justify the treatment, and accurately document the results.” The actual physical record should be of an acceptable size and standardised on suitable forms, as far as possible to enable interchange of information, from hospital to hospital, hospital to health centre, hospital to general practitioner or other primary health worker. The record must contain sufficient forms to cover the needs of the ‘centre’, without unnecessary and useless forms, which add bulk. The forms should be of a standard size within each record system. B. PURPOSE OF THE HEALTH RECORD As indicated above a good complete health record should encompass all information about a patient’s health, ill health and treatment over a period of time and be readily accessible. Health records are kept for: 1. communication purposes 2. continuity of patient care 3. evaluation of patient care 4. medicolegal purposes 5. statistical purposes 6. research and education. 7. historical purposes 1. Communication purposes

Health records are kept initially for communication between persons responsible for the care of the patient for present and future needs. Many health professionals often see a patient. In a hospital the registration staff collects identification information and finds out the patient’s financial status. While under care, others who may be involved in looking after a patient and who contribute to the health record include: all medical staff including consultants, physicians, surgeons, obstetricians, etc nurses physical therapists occupational therapists medical social workers laboratory technicians dieticians medical students radiologists, etc. All the data collected about a patient must be recorded and coordinated. The findings of each professional must be available for others to perform their function intelligently, especially the doctor responsible for the patient who must make the final diagnosis and order treatment on the basis of all the documented findings. This first use of the record is a personal one and is in the interest of the patient for both present and future care. 2. Continuity of patient care The patient may be readmitted to the same or another hospital or visit a clinic where all his past medical history should be available for assessment in the light of current symptoms. Communications on the basis of the health record is essential between hospitals, clinics and primary health workers in contact with the patient. It is vital that the primary health worker, who is responsible for the patient as a whole, should receive information about a patient’s hospitalisation as soon as possible after the patient is discharged from hospital.

The main function of the health record department in a hospital or clinic, in this context, is as a service area, that is, medical records should be produced for patient care at all times and as quickly as possible. Also, discharge summaries and letters must be processed so that people outside the hospital may be informed of the patient’s progress and their continued management after discharge. 3. Evaluation of patient care In any setting in which an individual puts the responsibility for their health and wellbeing into the hands of others, there should be some mechanism that enables evaluation of the standard of care being given. In some countries, hospital medicine is evaluated by an ‘accreditation’ system. Surveys of each hospital are made and hospitals given ‘accreditation’ by a Board for a limited number of years, depending on the standard which they reach. Also, in some countries, the health record services of a hospital must meet predetermined standards. Accreditation by this Board leads to increased status and is necessary for acceptance of postgraduate trainees in many areas. Other methods of evaluation of patient care in hospitals include: a) Patient care committee meets regularly and may review samples of records and evaluate the standard of care recorded. b) Peer review Doctors of a service may evaluate the work of each other and the unit through the records. c) Hospital administrative committee may evaluate the standard of care in a particular ward or by a particular physician or surgeon. d) Statistics derived from records may also be used in assessment of standards. This may be within the hospital, for example, evaluating the infection rate in a particular ward or for a particular operation or between clinics, hospitals, states or countries, in which case the statistics are used by Government Departments such as the Department of Public Health, Bureaus of Census and Statistics or nongovernment organizations such as the World Health Organization. In most countries the Department of Public Health also requires notification of communicable diseases, such as tuberculosis, cholera, hepatitis, etc. 4. Medicallegal Here, the main use of the record is as evidence of unbiased opinion of a patient’s condition, history and prognosis, all assessed at a time when there was no thought of court action, and therefore extremely valuable. It is used both in and outside the court for settlement of such disputes as: assessing extent of injury in accident cases establishing negligence or otherwise of the health professional or hospital in the treatment of a patient. This assists in protecting the legal interests of the patient, hospital, and health professional. 5. Statistical purposes Statistics are collected in hospitals, clinics and in primary health care centres. They may be used to tabulate numbers of diseases, surgical procedures and incidence of recovery after certain treatments; to assess areas which the hospital or clinic serves by collecting demographic details; or for public health or epidemiology. They are also used in planning for future development. 6. Research and education In the past, health records have been mainly used in medical research, but demographic and epidemiological information contained in the record is more often used today for administrative and other public health research. Analyses of the types of people, together with studies of the types of diagnosed illnesses within the hospital, a particular ward or clinic, are essential for planning future services and equipment. The turnover rate of patients is an indication of the numbers of staff required in all departments. The workflow of the hospital or clinic can be analysed once it is recorded in the medical record as it is added to by different health professionals involved in the patient’s care. All this information shows the efficiency or otherwise of health planning and communication systems. 7. Historical purposes The record acts as a sample of the type of patient care and method of treatment used at a particular point in time. C. USES OF THE HEALTH RECORD The uses of the health record can be divided into personal and impersonal use depending on whether the user of the record is viewing the patient as a ‘person’ or as a ‘case’. For example, the statistical, research and historical uses are usually impersonal, the name of the patient is not important. In other cases the use is patientoriented. When a record is to be used in a “PERSONAL” way; AN AUTHORIZATION FOR RELEASE OF INFORMATION MUST BE OBTAINED FROM THE PATIENT, unless there is a legal obligation to provide information. The information compiled in the record is private and privileged and given to the health professional in complete confidence. This trusting relationship between health professionals and the patient must not be broken by revealing the contents of the health record to unauthorized persons. In IMPERSONAL uses, however, WHERE THE NAME OF THE PATIENT IS NOT REVEALED, authorization is not usually necessary. It is usual to obtain the consent of the health professional in charge of the patient before allowing a record to be used for research. But remember that consideration must always be given to the patient’s rights in any release of information. D. DEVELOPMENT OF THE HEALTH RECORD a) The health record usually begins at the registration counter of the clinic or the admission office of the hospital, or the emergency room office the first time a patient presents or is brought in for care/treatment or is seen for the first time. b) The collection of essential and accurate identification information is the first step in the development of the medical record and will be discussed in full in the next Unit. The essential identification data includes the patient’s: full name (family name, given, and middle name or initial) health record or hospital file number date of birth address gender. c) If the patient is being admitted to hospital, the provisional or admitting diagnosis must also be included at this time, that is, the reason the patient is being admitted for care/treatment should be recorded on the front sheet of the health record. The patient is then sent, with the health record, to the clinic, emergency room or unit, whichever is applicable. In the clinic the nurses and doctors record the information collected at this time onto the forms provided, remembering to write the name and hospital file number on the top of every new form used. The person who provides the service should sign each entry. In the emergency room the same procedure as for clinic. In the unit the nurse adds data relating to nursing care plan and doctors record their notes on a patient’s: past medical history family medical history history of present illness physical examination plan for treatment and requests for laboratory/Xray tests. The doctor continues to record, on a daily basis, writing notes on the patient’s progress, medical findings, treatment (including prescriptions for medication), test results, and the general condition of the patient. Nurses record all observations, medications administered, treatment and other services rendered by them to the patient. Other health professionals record their findings and treatment as required during the patient’s hospitalization. At discharge when the patient is discharged, the doctor records, at the end of the progress notes, the condition of the patient at discharge, the prognosis, treatment and whether the patient has to return for follow up. In addition, the doctor should also write a discharge summary, and write, on the front sheet of the record, the principal diagnosis, other diagnoses and operative procedures performed, and sign the front sheet to indicate responsibility for the information recorded under his signature. E. VALUE OF THE HEALTH RECORD An accurate and complete health record is of value: 1. to the patient 2. to the hospital, clinic, or other health facility 1. to the doctor and other health professionals 2. for research, statistics and teaching 5. for patient billing. 1. The patient As the health record contains a complete report of a patient’s illness and results of treatment, it is of great value to the patient for a) future care for the same or other illnesses b) informing them (by giving access) of their care and treatment, and c) as a legal document to support claims for injury, or malpractice. 2. The hospital, clinic or other health facility The health record may be used by the health facility to evaluate the standard of care rendered by staff and the end results of treatment. If adequate records are not kept, the facility cannot justify the results of treatment. The health record is also of value to the facility for medicolegal purposes. 3. The doctor and other health professionals The health record is of value to all health professionals caring for a patient. The patient may have been treated by them previously or by other health professionals. The health record enables pertinent clinical, social or other relevant information to be readily available for continuing patient care. In addition the health record is of value for review of certain diseases, treatment and response to treatment. 4. For medical research, statistics and teaching In scientific research the health record is a major tool. The information within a health record supplies a practical and reliable source of material for the advancement of medical science. This information is also valuable in the collection of statistics on health care and the incidence of diseases, and for teaching future health professionals. 5. For patient billing Without the information within a health record, payment for services could not be justified. Often the health insurance agencies require supporting evidence for claims this evidence is found in the health record. F. CONTENT OF THE HEALTH RECORD As mentioned previously, a written health record should be maintained on every patient attending a hospital or clinic, or seen in a primary health care setting. The patient may be an inpatient, an outpatient, an emergency patient, or domiciliary patient. The health record stores the information concerning a patient and the care given by health professionals associated with the hospital or clinic. To be complete and of use for future patient care, medicolegal purposes, research and teaching, the health record must contain sufficient information to: IDENTIFY the patient, SUPPORT the diagnosis, JUSTIFY the treatment, and DOCUMENT the results facts accurately. (Huffman 1994) For better patient care, only one health record should be kept for each patient. Good medical care generally means a good health record is developed and maintained on each patient. An inadequate health record, that is, one that does not contain ‘sufficient information to identify the patient, support the diagnosis and justify the treatment given (Huffman, 1994), may reflect a poor standard of care given by the doctors, nurses or other health professionals within the clinic or hospital. The actual forms and their content make up a health record. The organization of data on each form, however, is determined by the needs of each individual health facility. Listed below are forms that are found in a health record. 1. Administrative Forms a. The admission or identification form, which should always be kept at the front of each admission or at the beginning of the outpatient or primary care record. This form contains space for identification and sociological data to positively identify a patient. The type of data recorded here is discussed in Unit 2. b. Consent forms are extremely important and should be part of every health record. The back of the admission form is generally used for consent and authorisation for treatment data. The form usually carries a statement indicating that the patient agrees to basic treatment. Separate sections of the forms relate to the consent for release of information. When signed by the patient the health facility can release information from the medical record to health insurance, workers, compensation agencies and private insurers. The patient in the admission or reception office of the facility signs both these authorizations. The purpose of the forms, however, should be clearly explained to the patient by the staff collecting the identification and sociological data. In the hospital situation, special consent forms are required for any nonroutine diagnostic or therapeutic procedures performed on the patient. These forms provide written evidence that the patient understands the nature of the procedure, including any risks involved and likely outcomes, and consents to the specified procedure. The patient is asked to sign the form after having all details clearly explained to him/her by the attending doctor. That is, the patient gives informed consent. 2. Clinical Forms Clinical forms for inpatients constitute the bulk of a patient’s health record, and include the following: a. Medical/general history or data base This is usually divided into a number of sections and includes space for data relating to: presenting signs and symptoms previous illnesses and operations family history occupation and social data current drug therapy and treatment. b. Physical examination, which is used for the collection of baseline data about a patient presenting for care. The content of this form usually includes: general survey and state of health of patient system review all systems checked vital signs, such as pulse, respiration, blood pressure, temperature provisional diagnosis. c. Doctors orders or plan for care Once the data base has been established the doctor records his/her findings and writes a course of action outlining the planned care and treatment for the patient. These orders should be dated and signed as should all entries in a health record.

d. Progress notes These notes indicate the condition of the patient and his/her response to treatment on a continuing basis throughout the admission. All health professionals should document the care they provide and the patient’s response to treatment. Some hospitals use special forms for each specialty, which is not really necessary; as an integrated progress note is more effective. Progress notes should be recorded at least once a day and more often in cases of acutely ill and critically injured patients. e. Pathology, radiology and other special investigations Appropriate forms should be used to record special investigation such as pathology, chemistry, radiography. These forms are often mounted on a backing sheet or in hospitals with a computerized system cumulative reports are generated on a daily basis. Whatever the method it is important to make sure important findings are readily available in the record. f. Nurses notes and graphic charts Appropriate forms should be used for all nursing care including bedside notes, temperature, pulse and respiration charts, blood pressure charts, medication and treatment charts. Most of these forms are designed in flow chart sequence. g. Operative and anesthetic and recovery forms These forms are important for surgical patients and should contain consent for surgery, preanesthesia and postanesthesia reports, the operation report, and other relevant data required. h. Discharge summary All health records should have a final summary of the patient’s hospitalization, which is usually referred to as the discharge summary. It should contain a concise summary of the patient’s course of treatment and significant findings with treatment on discharge and followup arrangements. i. Other forms for special services such as obstetrics, newborn and paediatrics, neurological, physiotherapy, occupational therapy, speech therapy, dental therapy, and short stay admissions, should be available if required. However, the use of the form must be determined before introducing it to an already bulky record. 3. Outpatient and ambulatory care forms: a. Patient history and general findings similar to the inpatient form usually completed at first attendance. b. Clinical observations and progress notes. c. Pathology, radiology and other test reports as for inpatients. d. Special forms for individual specialties caring for ambulatory patients. These would include special diabetic forms, growth charts, home care plan for treatment, etc. These are only a few of the forms used in health care facilities. Their production should be based on their need and the needs of the health professional caring for the patients. This need will vary from large metropolitan hospitals to isolated primary health care units. Both are important and simple forms should be available for use to meet the needs of the situation. G. DOCUMENTATION AND RECORD STRUCTURE 1. The documentation of care given to patients during their stay in the hospital is an essential part of the provision of that care. The tool used for this documentation is the patient’s medical record. As previously mentioned, it is the WHO, WHAT, WHY, WHERE and HOW of patient care, and to be complete, the medical record must contain: a. sufficient information to clearly identify an individual patient b. a comprehensive medical history, including: chief complaint history of present illness family medical history physical examination c. detailed progress notes showing the course of the patient’s illness, treatment and end results of that treatment d. a discharge summary displaying comprehensive data to justify the treatment, support the diagnosis and record the end results (Huffman, 1994). 2. The content of a health record is developed as a result of the interaction of the members of the health care team who use it as a communication tool. Documentation may be organized according to the source of the data or by patient problems. 3. There are two basic formats that a paper-based health record may take: a. Source Oriented Medical Record In a source oriented medical record, the information about a patient’s care and illness(es) is organized according to the “source” of the information within the record, that is, if it is recorded by the physician, the nurse, or data collected from an xray or laboratory test, usually in chronological order. How effective is an average health record as a communication tool? Information goes in, but is it easily and readily retrievable? In many cases it is not, because the documentation is often unstructured and scattered in admission notes, medical histories, progress notes, nurses’ notes, or in Xray and laboratory reports, often without reference to the condition or problem to which it refers. The health record often becomes bulky and disorganized, making the retrieval of vital information both difficult and frustrating, and communication within the health care team is hampered. Many experts consider that the answer to this problem is to develop a health record that is STRUCTURED, and facilitates easy access to information relating to care given to a patient during hospitalization. Structure refers to a form, which has been planned so that the language and layout are uniform. That is, all persons using the form follow the same format and yet the structure of the record is adaptable to all situations. An example of a structured form appears in Appendix 2. Structured records are more easily automated and with the present increase in the use of computers in health care, a change from a manual to an automated record system would be easier if a structured record format was already in use. A disadvantage of a fully structured health record, however, is that there is less room for individual description and health workers find it too restricting. b. Problem Oriented Medical Record (POMR) One form of structured health record developed to meet these criteria is the problem oriented medical record or the “POMR.” First designed by Dr. Lawrence Weed in the late 1950s, this concept requires the doctor to approach all the problems of a patient, treating each problem individually, in its proper context within the total number of problems and the interrelationship of the problems (Weed, 1969). The decision pathway used by the doctor in defining and handling each problem is clear and can be evaluated on the bases of all the facts available. The problem oriented medical record has four parts: ü DATABASE Collection of data ü PROBLEM LIST Formulation of problems ü INITIAL PLAN Development of a care plan ü PROGRESS NOTES Numbered and titled progress notes 1) Data Base The first step in the establishment of a problem oriented health record is a comprehensive database. As with the traditional source oriented health record, the data base should include the chief complaint as expressed by the patient; a patient profile including history of the present illness, past medical history, family medical history, a systems review and results of a physical examination. 2) Problem List Once the database has been collected, an assessment of the information is made and a problem list is developed. The PROBLEM LIST is kept in the front of the record and can be likened to a table of contents in a book. That is, the problem number and name are equivalent to the chapter number and title. The most conceptual difference between a source oriented and problem oriented health record is this PROBLEM LIST. Another conceptual characteristic of the POMR is problems are expressed at the level of the writer’s understanding and do not include diagnostic impressions which are considered as part of the treatment plan. Before progressing further we should clarify the term “Problem.” A problem is anything requiring management or diagnostic workup, that is, a problem is anything that interferes with the health, well being and quality of life of an individual, and may be medical, surgical, obstetric, social or psychiatric. When constructing a problem list, each problem should be dated, numbered and titled with problem status clearly defined as active, inactive or resolved. The function of a problem list is to: register all problems maintain efficiency, thoroughness, and reliability in treating the ‘whole’ patient communicate with peers, patients, other health professionals and with oneself indicate the status of problems, whether active, inactive or resolved serve as a guide for patient care. 3) Initial Plan The development of the initial plan for the management of a patient’s problems, as defined in the problem list, is the third step in planning patient care using a problem oriented health record. The initial plan should be considered in 3 parts: Diagnostic (Dx) that is plans for collecting more information Therapeutic (Rx) plans for treatment and, Patient Education plans for informing the patient as to what is to be done. 4) Progress Notes The fourth step in the formation of a POMR is the problem oriented PROGRESS NOTES. These should indicate: what has happened to the patient what is planned for the patient, and how the patient is responding to therapy. Progress notes should contain four component parts: ü Subjective part written in the patient’s own words ü Objective part the doctors observation and test results ü Assessment of progress and ü Plan for continued treatment. The progress note must be problem oriented. That is, since each problem must be dealt with individually, each must clearly denote the problem by number and name and be divided into the four components or SOAP parts. This structured type of progress note increases the doctor’s ability to deal with each problem clearly and to show the logic of his thought process and decision pathways. If correctly written, both the current level of understanding of each problem and the management of each problem will be clear to everyone involved with the care of the patient, and in evaluating the quality of that care. Some additional items may supplement the progress notes: a) Flow Sheet When dealing with multiple, fastmoving problems, the doctor may want to supplement the progress notes with the use of a flow sheet. Flow sheets provide the most appropriate method of monitoring a patient’s progress, and are also used with source oriented health records. Steps to be taken when designing a flow sheet include: ü define the clinical setting within which the flow sheet will be used ü define the clinical status of the patient to be monitored ü define the monitoring frequency of data collection required to give maximum care. This is usually specified across the top of the page. The clinical situation in which the flow sheet will be used will usually dictate the monitoring frequency. Flow sheets are a special form of progress note and may be added to the record if warranted, but do not necessarily need to be put into every problem oriented or source oriented medical record. b) Discharge Summary The final step in completing any medical record is the preparation of a discharge summary. In the problem oriented medical record this task is made a lot easier. When dictating a problem oriented discharge summary, the doctor can briefly summarise the therapeutic outcomes, which resulted in the resolution of a patient’s specific problems. They can emphasise the problems NOT resolved at discharge and outline a diagnostic, therapeutic and educational plan for future care. The logical display system used in the structured problem oriented health record starts with the database to collect information, followed by a problem list, which helps the doctor decide what is wrong with the patient. This information is placed at the front of the record so everyone caring for the patient is aware of all problems. From the database and problem list, the initial plan for treatment and diagnostic work-up is developed. That is, the doctor caring for the patient decides what to do. The next step is to follow through on the decision by recording problem oriented progress notes using the SOAP method for each individual problem. Progress notes may be narrative or in the form of a flow sheet. The problem oriented health record is a useful communication tool because it encourages a clear display of medical data and communication between doctors and other health professionals. Appendix 3 illustrates samples of a POMR. As mentioned previously, a structured health record enhances the application of computers in health record systems, clinical research and teaching. It also improves information retrieval for patient care evaluation and helps elevate the quality of patient care by treating the ‘WHOLE’ patient and not just isolated incidents or episodes. The use of a structured POMR, however, is not widespread, particularly in large busy hospitals. It is more widely used in small hospitals, clinics and primary health care centres. No matter whether a record is source oriented or problem oriented the health information manager should assist medical staff and other health professionals by preparing wellstructured forms to enhance data collection and easy access to information relating to patient care at all levels. H. RESPONSIBILITY FOR HEALTH RECORDS 1. Medical and other health professional staff The primary function of a hospital, clinic, or other health care facility is to provide high quality patient care to all patients, whether inpatients, emergencies or outpatients. The governing body of the facility, through the administrator, is legally and morally responsible for the quality of care rendered to patients. This responsibility is in turn delegated to medical, nursing and other health professional staff. As the information within a health record reflects the care given to patients, it is important that the health information management/health record professional understands the responsibilities within the clinic or hospital in order to assist the doctor and other professionals to maintain a complete, accurate and available health record. Poorly documented clinical information is of little use to a patient during his treatment, for his future care or for evaluation of the care rendered by doctors, nurses and other health professionals. Alternatively, a complete well-written health record provides a clear picture of the patient’s illness and course of treatment. All health professionals, including doctors and nurses, can exercise their responsibility to ensure good quality health records through the Health Record Committee. 2. Medical Record Committee Doctors, nurses and other health professionals are responsible for the documentation of medical/health information that meets the required standards for accuracy, completeness and clinical pertinence. The Health Record Committee is responsible for the following: Review of health records for timely completion, clinical pertinence, accuracy and adequacy of patient care, teaching, evaluation, research, and medicolegal issues. Determination of the format of the complete health record, the forms used and any problems relating to storage and retrieval. a. Membership of the committee should include: the hospital administrator representatives from medical and surgical service a representative from the nursing service representatives from Xray, Pathology, and the health information management/health record professional. b. Activities of the committee may include the following: The committee should meet at least once every three months and more frequently if required. The committee should establish/recommend policies regarding health record documentation. Members should study random samples of health records to monitor the quality of recording. Members are able to study the trend of clinical work in the hospital using statistics compiled by staff of the health record department. Members of the health record committee may wish to conduct retrospective studies or set up some prospective research. The health record committee should review all medical record forms, thus eliminating unnecessary duplication of information and attain uniformity of content, appearance, and size. 3. Health Information Management/Health Record Professional The health record is the property of the hospital or clinic and serves as a medicolegal document for the benefit of the patient, the doctor, and the hospital or clinic. The health record should contain sufficient information to enable another doctor to take over the care of the patient if required, and for a consultant to give a satisfactory opinion when requested. The responsibility for the accuracy and completeness of a health record rests with the attending doctor. The health information management/health record professional is responsible to the hospital administrator for providing the necessary services to the medical staff to assist with the development and maintenance of a complete and accurate health record. I. HEALTH RECORD FORMS Let us now look at the design of the forms contained in the record. Good forms design is essential in any office to assist in the efficient gathering of data and dissemination of information. Not only can it reduce the cost and time taken in processing forms, but it can also lessen the possibility of error or misunderstanding by staff or the public. Workers in the health information management/health record field should be aware of the variety of record forms, duplication, and lack of uniformity to be found in many hospitals, clinics and primary health service settings. It stands out quite markedly that there is a strong need for forms control, which, quite clearly, is a very large task. Whether one works at the administrative or technical level, one should be aware of the essential and recurrent task of correct forms design so that, as far as possible, they can ensure that all forms are neat, simple in appearance, easy to understand, write up and interpret. 1. Definition of a form A form could be defined, as a piece of paper or card on which there is a formal arrangement of date, usually with spaces for the entry of additional data. Or, it could be defined as a prescribed written means of shaping information for communication. Forms are used to collect, record, transmit, store and retrieve data. That is, they request action, record the outcome of the action, instruct and assist with the evaluation of data. When being designed, the needs of all health professionals involved with patient care must be taken into consideration, as well as the needs of health authorities requiring information about the incidence of disease, outcome of care, as well as demographic and epidemiological data. Forms may also be designed to accompany legislation. Filling in a form is invariably the first step in data collection. The design of forms, their physical layout, the determination of the data to be requested, and the way, in which it is collected, has an impact the quality and quantity of data collected and subsequent information produced. 2. Forms design a. When preparing to design a form one must consider the: ü need for the form, ü purpose of the form, and then design the form within the constraints that apply, such as the budget, type of paper available, abilities of the printer, and the abilities of the users. Standards must be established so that consistency is maintained. There should be fixed responsibility for forms design, so that individuals and departments cannot start their own forms in isolation. There must be positive control, especially from the point of view of cost. b. The term forms layout refers to a number of issues and can be summarized as follows: how the information is displayed on the form how material is presented, provided it is consistent with efficiency and economy, attractive presentation is an important secondary purpose the order in which data will be requested, must also be considered along with the logical connections between data requested, the space between entries, whether columns, boxes, or highlighting will be used, the size and type of print, and the need to allow adequate space for entries. A well-designed form is appropriate to the work in which it is used, permits ease of entry, conveys information or instructions clearly, and is efficient to use. A form should be set out in an orderly way of thinking, for example, bracket all the information of the same sort in one area as a wellstructured form points your thoughts in the direction of the information required. Some forms summarize particular events or record data compiled from other forms, for example, a summary fluid balance form. c. Questions to ask before designing a new form include: ü What is the general purpose of the form? ü Is the form really necessary? ü What benefits will be derived from the introduction of a new form? ü What information is to be provided and what is its general purpose and need? ü What are the operations, through which the form will pass, for example, entry of data, sorting of data? ü How is it (the form) going to be filed? Where will it be attached side or top? ü Who will the users be? When is the form to be used? ü Where will the form be used and what will the associated working conditions be? ü Are there any other special features, which need to be considered? ü If a signature is required, is it also necessary to ask for the name to be printed? ü Does the form state what to do with it when it has been filled in? d. To summarize, the general principles to be considered when designing a form include: 1) All health record forms used in the clinic or hospital should be of STANDARD SIZE. They should also be readable, useful and allow for the standardisation of information. The kind and size of typeface, margins, ink, and paper colour and weight, should be standard within a hospital, clinic or primary health centre. 2) All forms should have a STANDARD FORMAT at the top to include the name of the patient, hospital number, ward, and name of attending doctor. This information should appear in the same place on ALL forms. 3) The correct paper for the task of each form should be chosen with the aim for paper and printing economy. 4) The persons who will be required to use the form should understand the language used on the form. 5) Each form should have a descriptive TITLE, e.g. nurse’s bedside notes, laboratory reports. 6) All forms should have simply printed INSTRUCTIONS for use to ensure uniformity in the collection of information. If these instructions are detailed they could be printed on the reverse side or in a separate instruction sheet. 7) Captions should clearly indicate the data to be entered, for example, just name is not sufficient, usually one wants “full name of patient, family name last“. The use of boxes is also very good and saves time, for example, male and female categories may be set up in a boxed arrangement as follows: M ¨ F ¨ and the clerk then just has to add an “X” or a check mark. 8) Forms should be FUNCTIONAL and spacing should allow sufficient room to record the data being requested. If data are to be filled in with the use of a typewriter, this should be taken into consideration when planning the form. 9) If one piece of data depends on another, put the dependent data after the other in the order to be filled in, for example, date of birth age; previous admission date. That is, group items into order of action and be logically consistent with related forms so that data are easily used after entry on the form. 10) If an automated or other type of embossed imprinting plate addressograph system is to be used, spacing on the form should be provided for the imprinting of patient identification. 11) The use of color is effective, but remember that different colored paper and ink will affect photocopying, microfilming and scanning in different ways. Color strips along the outside edge are most effective and help with identification of the form, but may be expensive. 12) For forms management, each form should have a reference or form number for identification and ordering purposes, and carry a notation as to date designed or date printed and name of printer. 13) For filing requirements clinical forms should be prepunched for inclusion in the health record, and adequate space (margin) should be planned to allow for binding at top or side. 14) Instructions in conjunction with explicit headings must be carefully prepared so that the person filling in the form knows in advance what is required. General instructions may be required for the completion of certain forms, for example, patient identification forms. 15) If the form is to be put in an envelope, make sure it is the right size or that it will fit when folded. Suggest arrows on the form as to where to fold. 16) If photocopying, the quality of the copy will decrease each time it is copied. Best to keep the original and copy that each time. 17) A ‘Forms Committee’ should be set up (a subcommittee of the health record committee) to assume responsibility for forms design and production. The health information management/health record professional should be a member of the Forms Committee and strict control maintained over the production of health record forms. Criteria should be established to analyse the need, purpose, use and arrangement of each form. e. Specific technicalities 1) Spacing Printers allow 1/4² (5 mm) before they start printing, so leave 1/4² (5 mm) for the printer and design the form within that limit. Allow a 7/8² (20 mm) margin if holes are to be punched or the form is to be bound. Recommended margins: At top 3/8² or 8 mm Other sides 1/4² or 5 mm Except filing margin 7/8² or 20mm Spacing for handwriting in general, 8 handwritten characters to the 1 ² or 2.5 cms. However, it is important to remember that too much space seems to encourage bad handwriting. 2) Line spacing Relate the form to the characteristics of any machine used to fill in the form so that the design is suitable to handwriting and machine entries, especially if it will be typewritten: for handwriting use 6 mm or 7 mm line spacing for typewriting it will depend on the size of typeface and line spacing should conform to the THROW of the typewriter (i.e. the distance covered by a turn of the roller). The form should also be designed to allow for the use of typewriter TABS. Also, determine the PITCH or FONT SIZE (or width of each character) of the typewriter or golf balls used, usually 10 or 12 pitch preferred. Allow 1 space on each side of a vertical line, i.e. leave 1 space between entries and the vertical line. Extra space may be required to allow for typing near the very top or bottom, for example, a disease index card with tear off strip. 3) Ballot box style for use with computerized data entry. Be consistent with either left or right boxes on the form. Provide clear instructions if it should be checked off or crossed off. The format should make it very clear which box belongs to which question. 4) Identification Remember, all forms should carry: an identifying title an identifying number of the form the name of institution the date of the last design review, particularly for forms used in data collections, which may change some data items each year. may include the date of last print run, to facilitate storage and assist with ordering and identification. Identifying type should be punchy, explicit, tactful, boldly printed, with identifying numbers placed in a relatively inconspicuous part of the form. 5) Ink Traditionally, almost all forms are printed in black, however, use of some coloured inks help to distinguish forms but often photocopy poorly. A strong colour contrast stands out. Consider the cost, but colour can be used effectively to group similar forms – for example anaesthetic, operation and consent forms with the same colour but different patterned borders. 6) Ruling Thin lines are best used for column or caption break-ups and very thin lines for writing guides. When designing new forms or reviewing existing forms remember to consult: those responsible for the form and its content those who will be entering data on the form those who do not enter data but who refer to it to gain information from the data. Another important point to keep in mind is that successful implementation of a new or revised form is just as important as the analysis and design of the form. Often a form, which is badly implemented and introduced to the users, is worse than keeping an old form. Therefore, evaluation and testing is an important part of forms design. You may ask the question “How can forms be tested?” To start with they should be tested in a realistic environment and secondly the end users should test them. J. MEDICOLEGAL ASPECTS Health records should be kept for the benefit of the patient, the doctor, and other health professionals, the hospital or clinic for patient care, medical-legal purposes, research, statistics, and teaching. As a legal document, the record should have sufficient information to: identify the patient, support the diagnosis, justify the treatment, and accurately document the results As discussed previously, the health record is the property of the hospital or clinic as the information it contains is an integral part of a person’s life and may not be used without the patient’s written consent. Patient consent is not always necessary, however, when the record is being used for statistics, research, or teaching, when the patient’s identity is not known or sought. Remember, the health record is a confidential document and the patient’s right to privacy must be considered at all times. The information contained within the health record is a confidential communication between the doctor or other health professional and the patient. The patient should have access to the information which should be explained to him, if necessary, by the doctor or health professional responsible for his/her care. If a request is made for the release of information, the authorization should contain the following: 1. 2. 3. 4. 5. 6.

full name of patient, address and date of birth name of person/persons or institution to receive information purpose or need for information extent or nature of information to be released, including treatment dates signature of patient or authorised representative date of patient’s or authorised representative’s signature.

A letter from the patient which can be verified, directing the hospital to release certain information to a specified person or institution (eg. health insurance) is often accepted as proper authorisation as long as it is, or can be, verified. In general, it is best to have written policies relating to the release of information and ensure that all staff are familiar with these policies. SUMMARY In this unit we have looked at the medical record, the forms within the record, content of the forms, uses and value of the medical record, medicolegal requirements, and responsibilities, and the need to have a wellstructured, orderly, available medical record, regardless of whether in a hospital, clinic, community health centre, or other primary health care situation. REVIEW QUESTIONS 1. In your own words, explain the uses, purposes and value of a health record. 2. List and describe the four component parts of a problem oriented health record. 3. What is meant by a “structured” health record? 4. Describe the development of an inpatient’s health record from admission to discharge. 5. Who is responsible for the documentation, completeness and accuracy of a health record? 6. Who should be on a Health Record Committee? What activities would a Health Record Committee undertake? 7. Outline five general principles of good forms design. 8. Why is confidentiality and privacy an important issue in health record administration? REFERENCES: 1. Davis, Nadinia, and LaCour, Melissa. Introduction to Health Information Technology. Philadelphia, PA: W.B. Saunders, 2002. 2. Huffman, Edna K. Health Information Management. 10th ed. Berwyn, IL: Physicians Record Company, 1994. 3. Johns, Merida, ed. Health Information Management Technology: An Applied Approach. Chicago: AHIMA, 2002. 4. LaTour, Kathleen M., and Eichenwald, Shirley. Health Information Management: Concepts, Principles and Practice. Chicago: AHIMA, 2002. SELESAI @HAKCIPTA Dr Iwan Suwandy,MHA 5. Skurka, Margaret. Health Information Management: Principles and Organization for Health Information Services. San Francisco, CA: Jossey- Bass, 2003. pusat infokes dr iwan

Ilmu Racun”Toksikologi”Perlu Dipelajari Agar Anda Dapat Terhindar Dari Keracunan Makanan Dan Polusi Udara. October 12, 2010October 12, 2010 iwansuwandy Leave a comment Ilmu Racun”Toksikologi” Perlu Dipelajari Agar Anda dapat terhindar Dari Keracunan makanan Dan Polusi Udara. Santernya berita ditariknya Mie Instant Oleh pihak Luar Negeri dan maraknya tulisan tentang hal tersebut tanpa penjelasan secara ilmiah ilmu” toksikologi” atau ilmu racun sehingga banyak pembaca jadi bingung dan emosi.

(https://iwansuwandy.files.wordpress.com/2010/10/mie-instant.jpg) Sebenarnya masalah keracunan sudah menjadi permasalah sejak dahulu kala, terutama dilingkungan kerajaan dalam rangka pembuhunan secar halus lawan politik dalam perebutan kekuasaan. Kaisar Tiongkok memiliki upaya untuk mendetiksi racun yang mengandung zat kimia asam atau basa keras dengan sumpit logam perak yang bila ditaruh dalam minuman atau makanan pasti akan mengalami perubahan warnaya akibat reaksi kedua senyawa kimia tersebut. Sebelum itu dalam upaya mencegah keracunan Kaisar Tiongkok atau Romawi sebelum minum atau makan sesuatu meminta budaknya atau dayangnya untuk mencicipi makanan tersebut terlebih dahulu sebagai upaya test. Banyaknya kasus keracunan di Indonesia baik karena sengaja yang termasuk pembunuhan seperti kasus pemimpin Kontras yang meninggal saat naik pesawat ke negeri Belanda,diperkirakan oleh karena zat arsen.maupun keteledoran seperti kasus mie instan dan biskuit beracun. Banyak buku detektif yang dikarang tentang hal ini,salah satu yang terkenal adalah pembunuhan oleh seorang dokter setelah menikah dengan beberapa janda kaya untuk memperoleh kekayaan dnegan menyuntikan obat diabetes insulin sehingga korban mengalami penurunan gula darah atau dengan menyuntikan arsen dosis rendah sehingga hati korban mengalami kerusakan hati dan meninggal seperti mengalami suatu penyakit. Di Jepang pernah timbul keributan karena banyak kematian akibat keracunan logam berat,seperti “Hg”air raksa akibat makan ikan yang tercemar polusi dari limbah buangan pabrik ,sama seperti yang diributkan dalam kasus tambang Mas Newmont di Gorontalo sehingga mengimbas kepada makanan laut dipantai utra jakarta yang juga banyak pabrik disana.

(https://iwansuwandy.files.wordpress.com/2010/10/polusi-pabrik.jpg)*polusi pabrik Akhir -akhir ini juga diributkan dengan upaya pemerintah mengurangi polusi udara dari gas buangan kendaraan bermotor karena partikel gas buangan dapat menimbulkan keruskan pada selsel paru-paru, hal sama juga dari gas buangan pabrik terumatama asben,sebab asbes atau nama penyakitnya asbestosis dapt menimbulkan kanker hati, karena seluruh zat-zat kimia yang masuk tubuh dinetralsir di Hati,tetapi bila lama-lama dosis tinggi hati akan mengalami keruskan,sel-selnya mati berubah jadi lemak (timbul penyakit Fatty Liver) atau jari serabut (nama penyakitnya Cirrhosis Hepatis),akibatnya timbul kematian dengan kegalan fungsi Hati ,zat kimia sisa bahan makanan tak dapat diproses, timbul peningkatan zat kimia organik Amonia dalam darah yang dibawa aliran darah sehingga merusak Pusat Pernafasan di Batang otak berakibat fatal. Kasus yang pernah menimbulkan keributan tahun 1990 ,roti dan biskuit beracun akibat kesalahan mengambil bahan zat kimia untuk membuat roti yang tertukar dengan pupuk kimia,sehingga banyak perusahaan roti dan biskuit jadi pailit. Pabrik Biskuit Kong Guan sangat mengalami banyak tekanan saat itu ,tetapi mereka tetap survive.Kemudian anda pasti sudah dengan kasus mie dan susu beracun karena diberikan zat pengawet unsur formalin dlam dosis yang tidak dapt ditoleransi oleh tubuh manusia,dan kasus saat ini dengan mie instant merupakan hal yang hampir sama dengan kasus saat ini. Untuk memahami ilmu Racun, pembaca harus mempelajari unsur kimia terlebih dahulu,secara umum unsur kimia dibagi dalam dua golongan besar kimia organik dan anorganik, penulis jadi ingat saat mengajar di SMA dulunya.Selanjutmnya ilmu Racun atau Sehubunggan dengan hal tersebut diatas , penulis berbagi pengetahuan yang sudah dipelajari saat menempuh pendidikan dan pendalaman serta pengalaman saat bertugas di Lembaga DOKPOL MABES POLRI. sebagai berikut,mohon maaf ini buka mengurui tertapi berbagi info,pasti ada yang lebih berkompeten dari penulis, bagi yang sudah mengetahui harap dijadikan nostalgia. Informasi toksikologi singkat sebagai berikut Zat-zat kimia terdapat dialam bebas dan kemudian mencemari minuman dan makanan sehingga untuk menghindari pencemarana unsur kimia yang beracun atau disebut Toksik, pemerintah telah membuat suatu Badan yang disebut POM (Pengawasan Obat Dan Makanan), karena keracuna tidak saja liwat makanan, tetapi juga liwat obat ,serta liwat partikel udara yang disebut polusi.Penulis yakin hampir seluruh masyarakat sudah maklum tentang ini, hanya bagaimana proses racun merusak tubuh mungkin belum banyak yang tahu kecuali sarjana bidang kesehatan seab mereka diberikan kuliah tentang Patologi, penulis pernah selama lima tahun mengajar matapelajari ini di FKM( fakultas Kesehatan masyarakat) Secara sederhana dapat dijelaskan bahwa setiap unsur kimia apabila masuk kedalam sistem organ tubuh yang terdiri dari berbagai sistem seperti sistem pencernaan makanan , sistem pernafasan , dan liwat sistem pembuluh darah bila dengan suntikan. Setiap unsur kimia dapat menjadi racun apabila unsur tersebut adalah suatu benda yang sifatnya “asing” alias tidak sesuai dengan keseimbangan zat kimia didalam jaringan maupun dalam cairan tubuh (darah dan limfe) , akibatnya timbul gangguan keseimbangan cairan tubuh , selain itu juga akan merusak sel-sel tubuh, bentuknya bermacam-macam, proses perubahan itu dipelajari dalam cabang ilmu Penyakit ,Patogenesis suatu ilmu mempelajari bagaimana proses timbulnya kelainan penyakit didalam tubuh dan Morfologi Patologi suatu ilmu mempelajari kerusakan sel-sel tubuh dan Patofisiologi mempelajari dampak gangguan fungsi sitemik Organ tubuh akibat aksi dari luar maupun dalam tubuh tersebut. Pada saat memberikan kuliah mata pelajaran ini, para mahasiswa FKM dan APIKES(akademi perekam kesehatan atau rekam medis) umumnya mengatakan ilmu ini adalah ilmu yang paling sulit pernah dipelajari. Sebenarnya mereka kurang mendalami ilmu dasar tentang anatomi, faal, dan kimia tubuh manusia dalam keadaan normal, sehingga membedakan dengan keadaan dalam sakit.Saya yakin pembaca juga mengalami hal yang sama, untuk itu penulis menghimbua pihak Departemen Kesehatan lewat badan POM lebih banyak mengadakan penyuluhan tenag ilmu ini agar masyarakat lebih memahami proses pencegahan keracunan makanan ,dan polusi udara. Terakhir perlu diingat jangan minum obat seenaknya, karena obat itu adalah racun yang dikendalikan, jika dosisnya tak tepat dan tak sesuai denagn keadaan tubuh anda, maka anda akan mengalami ketagihan ( drug abuse ),dan akhirnya juga keracunan dengan berbagai dampak mulai dari yang ringan sampai fatal,istilah kalangan kesehatan disebut “game’alias tamat riwayatnya atau sederhana disebut “Tit”.Demikianlah info singkat bagi teman-teman,khusus para penulis agar memahami apa yang ditulis oleh mereka.Bila ada yang kurang benar mohon dimaafkan karena tidak ada manusia yang sempurna. Selesesai@hakcipta (mailto:Selesesai@hakcipta) Dr iwan suwandy 2010 pusat infokes dr iwan

Pusinfokes KESharini “DIVISI KESkini” September 27, 2010October 17, 2010 iwansuwandy Leave a comment SELAMAT DATANG DI PUSAT INFORMASI KESEHATAN DUNIA MAYA Dr IWAN S. ‘KESharini. (KESEHATAN HARI INI)’ DIVISI INFO KINI (KESkini) A.INFOKES NASIONAL 1.Selasa 18 Oktpber 2010

Mempersiapkan Keturunan Sehat Sebelum Menikah Merry Wahyuningsih – detikHealth

(Foto: thinkstock) Jakarta, Saat mempersiapkan pernikahan, sebaiknya jangan lewatkan tes kesehatan pra nikah. Selain memperdalam keyakinan Anda terhadap pasangan, tes kesehatan pra nikah juga memungkinkan Anda mendapatkan keturunan yang sehat. Pemeriksaan pra nikah merupakan salah satu tahap dalam persiapan yang tidak boleh dilewati. Banyak konflik dalam pernikahan yang mungkin berujung pada perceraian diakibatkan oleh masalah kesehatan, kesuburan dan keturunan. Tapi dengan saling mengenal kondisi kesehatan Anda dan pasangan, masalah itu telah Anda antisipasi dan cegah sejak awal. “Setiap pasangan yang akan menikah butuh keterbukaan tentang kesehatan,” jelas dr Frizar Irmansyah, SpOG, dokter spesialis ginekologi dari RS Pusat Pertamina, dalam acara Seminar Kesehatan 100% Siap Nikah di Prodia Tower, Jakarta, Sabtu (16/10/2010). Tes kesehatan sebelum pernikahan bisa mendeteksi kemungkinan berbagai penyakit (http://www.detikhealth.com/index.php? fa=parserads.search&idkanal=755&keyword=Mw==&width=280&height=125) menular, menahun, genetik yang diturunkan seperti: 1. 2. 3. 4. 5. 6. 7.

Diabetes Mellitus Kelainan jantung bawaan Hipertensi Hepatitis B HIV/AIDS TORCH (Toksoplasma, Rubella, Cytomegalovirus, dan Herpes simplex virus tipe 2). Penyakit (http://www.detikhealth.com/index.php?fa=parserads.search&idkanal=755&keyword=Mw==&width=280&height=125) menular seksual (PMS) seperti sifilis, herpes, gonorrhea (kencing nanah). 8. Ketidakcocokkan golongan darah ABO dan rhesus “Penyakit-penyakit tersebut tentunya sangat mempengaruhi kesehatan pasangan dan keturunannya kelak. Jadi pemeriksaan pra nikah ini penting untuk bisa mendapatkan keturunan yang sehat,” jelas dr Frizar lebih lanjut. Berikut akibat-akibat penyakit yang bisa menurun: 1. Penyakit seperti diabetes melitus, kelainan jantung dan hipertensi, kelainan darah cenderung diturunkan. Calon ibu yang mempunyai kadar gula tinggi, bila tidak dikontrol dapat berisiko cacat pada janinnya atau mengalami komplikasi kehamilan seperti janin besar, gangguan pertumbuhan pada janin, proses kelahiran yang sulit atau janin meninggal di dalam kandungan. Tapi bila kondisi ini diketahui sejak awal, dapat dilakukan perubahan gaya hidup dan bila perlu dilakukan pengobatan agar kadar gula darah terkendali dan komplikasi dapat dicegah atau dihindari. 2. Penyakit infeksi seperti hepatitis B juga bisa ditularkan ibu kepada janinnya atau dari sang suami kepada istrinya. Sebagian besar PMS termasuk sifilis, herpes, gonorrhea juga bisa mengakibatkan terjadinya kecacatan pada janin. 3. Ketidakcocokkan rhesus juga sangat mempengaruhi janin, seperti janin mengalami anemia, jaundice (kuning) dan komplikasi lainnya. Ketidakcocokkan rhesus ini sering terjadi pada pasangan berbeda ras. “Dengan tes kesehatan, pasangan bisa mengetahui penyakit-penyakit tersebut lebih awal, sehingga nantinya bisaa dilakukan usaha pengobatan untuk menghindari hal-hal yang tidak diinginkan,” jelas dr Frizar. Kapan melakukan tes kesehatan pra nikah? 6 bulan sebelum pernikahan dilangsungkan adalah waktu ideal untuk melakukan pemeriksaan, dengan pertimbangan masih cukup waktu untuk menangani masalah kesehatan yang mungkin ditemukan. Namun, jika tidak memungkinkan, kapan pun sebelum pernikahan dilangsungkan, Anda bila melakukan pemeriksaan pra nikah. 2..senin 11 Oktober 2010 Senin, 11/10/2010 16:02 WIB

7 Tanda-tanda Bayi Sakit Vera Farah Bararah – detikHealth

(Foto: thinkstock) Jakarta, Orangtua yang baru punya anak terkadang masih belum memahami kondisi seperti apa yang menunjukkan si kecil sakit. Untuk itu ketahui 7 tanda bahwa bayi sakit. Saat bayi masih berusia di bawah usia 6 bulan, maka tubuhnya rentan terkena berbagai penyakit (http://www.detikhealth.com/index.php? fa=parserads.search&idkanal=755&keyword=Mw==&width=280&height=125). Seperti dikutip dari Sheknows, Senin (11/10/2010) ada 7 tanda-tanda bahwa bayi sedang sakit, yaitu: Demam Bayi dikatakan demam jika suhunya lebih dari 38 derajat celsius. Jika demam diikuti dengan ruam, sulit bernapas, leher kaku, muntah atau diare, maka segera hubungi dokter. Demam sendiri bukanah suatu penyakit, melainkan respons bayi terhadap suatu penyakit terutama akibat infeksi. Dehidrasi Dehidrasi bisa terjadi jika bayi memiliki nafsu makan yang buruk, demam, lingkungan yang terlalu hangat atau muntah dan diare terus menerus. Kondisi ini bisa dikenali dengan cara mulut dan gusi kering, popok yang jarang basah serta tidak ada air mata ketika menangis. Diare Orangtua perlu menghubungi dokter jika terdapat darah di dalam tinja atau tinja berwarna hitam, lebih dari enam kali buang air besar dan berair serta susah untuk minum. Muntah Bayi mungkin sering mengalami gumoh setelah menyusui, jika hanya terjadi satu atau dua kali saja kemungkinan hal tersebut bukanlah kondisi serius. Tapi jika kondisi tersebut terjadi dalam frekuensi yang sering maka harus menjadi perhatian. Sulit bernapas Bayi yang memiliki kesulitan bernapas ditandai dengan gejala napas yang lebih cepat dari biasanya, bayi mendengus saat menghembuskan napas, kepala bayi terayun-ayun dan bibir bayi atau kulitnya terlihat kebiruan. Kondisi ini sebaiknya mendapatkan perhatian serius dan segera hubungi dokter. Ruam Jika ruam mencakup area yang luas, terutama jika terjadi di wajah, disertai demam, perdarahan atau bengkak, maka ada kemungkinan ruam disebabkan oleh infeksi. Pilek Infeksi saluran pernapasa atas disebabkan oleh virus dan sangat umum terjadi pada bayi, biasanya bisa berlangsung selama satu atau dua minggu. Jika disertai dengan demam dan nafsu makan yang buruk selama beberapa hari, maka penyembuhannya bisa lebih lama dan membutuhkan bantuan dokter. 1a jumaat 8 oktober 2010 Jumat, 08/10/2010 16:00 WIB

Payudara Sensitif dengan Polusi Kendaraan Merry Wahyuningsih – detikHealth

(Foto: thinkstock) Kanada, Perempuan yang tinggal di kota besar harus makin rajin mengecek payudaranya. Bukan apa-apa selain asap rokok yang bisa memicu kanker payudara (http://us.health.detik.com/read/2010/10/05/101706/1455775/763/wanita-rentan-kanker-payudara-jika-sering-kena-asap-rokok?l991101755), organ seksi perempuan ini juga sensitif terhadap polusi kendaraan. Studi yang dilakukan peneliti dari McGill University dan University of Montreal menemukan kasus kanker payudara akan semakin meningkat di daerah tinggi polusi karena udaranya mengandung banyak gas nitrogen dioksida (NO2). Hal inilah yang membuat wanita dua kali lebih rentan kena kanker payudara. “Kami menemukan hubungan antara kanker payudara pasca menopause dan paparan nitrogen dioksida, yang merupakan penanda untuk polusi yang terkait kanker payudara,” jelas Dr Mark Goldberg dari Research Institute of the McGill University Health Centre di Kanada, seperti dilansir dari Dailymail, Jumat (8/10/2010). Menurut Goldberg, risiko kanker payudara akan meningkat sekitar 25 persen dengan setiap kenaikan lima bagian NO2 per miliar. “Dengan kata lain wanita yang tinggal di daerah tinggi polusi tinggi hampir dua kali lebih mungkin mengembangkan kanker payudara daripada daerah dengan tingkat polusi rendah,” jelas Goldberg lebih lanjut. Goldberg menjelaskan, gas NO2 bukan hanya polusi yang dihasilkan oleh gas buangan dari mobil atau truk, tetapi juga ada gas-gas lain, serta partikel dan senyawa yang kaitkan dengan lalu lintas. Beberapa dari senyawa ini bisa bersifat karsinogen. “NO2 hanya penanda, bukan agen karsonogenik yang sebenarnya,” tungkas Goldberg. Hasil studi Goldberg ini telah diterbitkan dalam jurnal Environmental Health Perspectives. Meningkatkan daya tahan tubuh adalah faktor utama yang bisa menangkalnya. Membiasakan makan sehat, tidur teratur dan olahraga bisa membuat daya tahan tubuh terjaga. (mer/ir) 2.Kemis 7 Oktober 2010 Kamis, 07/10/2010 15:35 WIB

Menangani Penyakit yang Tak Bisa Disembuhkan Vera Farah Bararah – detikHealth

(Foto: thinkstock) Jakarta, Orang-orang yang mengalami cobaan penyakit (http://www.detikhealth.com/index.php?fa=parserads.search&idkanal=755&keyword=Mw==&width=280&height=125) (http://www.detikhealth.com/index.php?fa=parserads.search&idkanal=755&keyword=Mw==&width=280&height=125) yang tidak bisa disembuhkan sungguh berat menjalani hidupnya. Tapi dengan pengobatan paliatif, pasien akan tetap memiliki kualitas hidup yang baik meski penyakitnya tak bisa disembuhkan. (http://www.detikhealth.com/index.php?fa=parserads.search&idkanal=755&keyword=Mw==&width=280&height=125) Perawatan paliatif artinya meringankan penderitaan si pasien yang sudah sakit parah dan tidak dapat disembuhkan seperti misalnya kanker, pasien (http://www.detikhealth.com/index.php? fa=parserads.search&idkanal=755&keyword=Mw==&width=280&height=125)penyakit (http://www.detikhealth.com/index.php? fa=parserads.search&idkanal=755&keyword=Mw==&width=280&height=125) motor neuron, penyakit degeneratif saraf dan pasien HIV/AIDS. Tujuannya agar penderita dapat menjalani hari-hari sakitnya dengan tidak putus asa. “Pasien dengan penyakit yang tidak bisa disembuhkan kebanyakan berpikir sudah tidak ada lagi yang bisa dilakukan. Untuk itulah perawatan paliatif dibutuhkan,” ujar Prof Dr dr Akmal Taher, SpU(K) dalam acara seminar dan konferensi press Memperingati Hari Hospis dan Perawatan Paliatif Sedunia di Gedung A RSCM, Jakarta, Kamis (7/10/2010). Perawatan paliatif merupakan metode yang ampuh dalam membantu pasien lepas dari penderitaannya, baik nyeri berkepanjangan ataupun keluhan lain. Kondisi ini akan membantu meningkatkan kualitas hidup pasien dan juga keluarganya. Pada awalnya perawatan paliatif ini hanya ditujukan untuk pasien kanker (http://www.detikhealth.com/read/2010/04/13/163053/1337537/763/pasien-kanker-parah-perlu-perawatanpaliatif-biar-senang) (kecuali di Afrika Selatan awalnya untuk pasien HIV/AIDS). Tapi kini perawatan paliatif juga bisa digunakan untuk penyakit lain seperti paru obstruktif kronis (COPD), stroke, parkinson, gagal jantung, gagal ginjal, penyakit genetika dan juga infeksi seperti HIV/AIDS. Seperti apa perawatan paliatif itu? Intinya perawatan ini lebih berupa dukungan dan motivasi ke pasien. Kemudian setiap keluhan yang timbul ditangani dengan pemberian obat untuk mengurangi rasa sakit. Perawatan paliatif ini bisa mengeksplorasi individu pasien dan keluarganya bagaimana memberikan perhatian khusus terhadap penderita, penanggulangannya serta kesiapan untuk menghadapi kematian. Perawatan paliatif dititikberatkan pada pengendalian gejala dan keluhan, serta bukan terhadap penyakit utamanya karena penyakit utamanya tidak dapat disembuhkan. Dengan begitu pasien terbebas dari penderitaan akibat keluhan dan bisa menjalani akhir hidupnya dengan nyaman. “Perawatan paliatif dilakukan dengan kerja sama antara dokter, perawat, terapis, sosial-media, psikolog, rohaniawan, relawan dan profesi lain yang diperlukan. Hal ini bertujuan untuk agar pasien bebas dari penderitaan, sehingga kehidupannya tetap berkualitas dan berakhir dengan tenang,” ujar Prof dr R Sunaryadi Tejawinata, SpTHT(K), FAAO, PGD, PAllMed. Lebih lanjut Prof Sunaryadi menuturkan dari tahun 1992-2010 pelayanan perawatan paliatif baru ada di 6 ibukota besar yaitu DKI Jakarta, Jawa Barat, DI Yogyakarta, Jawa Timur, Bali dan Sulawesi Selatan. Perawatan paliatif kebanyakan terdapat di rumah sakit pemerintah seperti RS Hasan Sadikin Bandung, RSCM, RSK Dharmais, RSU Dr Soetomo Surabaya, RS Sanglah Bali, RS Dr Wahidin Sudirohusodo Makasar dan RSUP Dr Sardjito Yogyakarta. Sementara Prof Dr I W Suardana, SpTHT(K) menuturkan berbagai keluhan biasanya dirasakan oleh pasien perawatan paliatif ini. Keluhan yang muncul seperti nyeri, gangguan saluran cerna (mual, muntah, diare, konstipasi), gangguan kulit (gatal, kering atau akibat berbaring terlalu lama), kelemahan umum, gangguan respirasi, kelemahan anggota gerak, gangguan saluran kemih dan juga merasa bingung. Nah, dengan perawatan paliatif pasien diajak untuk lebih bisa menerima keadaannya sehingga masih bisa menjalani hidupnya meskipun umurnya tak lama lagi. Karena kebanyakan kualitas hidup pasien dengan penyakit tak bisa disembuhkan akan terus memburuk atau menurun jika harapan pasien tidak sesuai dengan kenyataan yang ada. “Jadi tugas dari tim paliatif adalah memodifikasi ekspektasi dari pasien, sehingga jarak antara harapan dan kenyataannya menjadi lebih dekat. Bisa dengan cara membangkitkan spirit untuk hidup, orientasi masa depan, keimanan bahkan tentang seksualitasnya,” ungkap Dr Siti Annisa Nuhonni, SpKFR(K). Dr Nuhonni menuturkan harapan selalu ada, tapi sebaiknya tidak memberikan harapan yang palsu karena harapan juga harus disesuaikan dengan hasil pemeriksaan. Untuk itu keluarga merupakan kunci makna hidup dalam perawatan paliatif. Tempat untuk melakukan perawatan paliatif beragam, seperti: 1. Rumah sakit, untuk pasien yang harus mendapatkan perawatan dengan pengawasan ketat, tindakan khusus atau meemrlukan peralatan khusus. 2. Puskesmas, untuk pasien yang melakukan rawat jalan. 3. Rumah singgah atau panti (hospis), untuk pasien yang tidak memerlukan pengawasan ketat, tindakan atau peralatan khusus, tetapi belum dapat dirawat di rumah karena masih memerlukan pengawasan tenaga kesehatan. 4. Rumah pasien (http://www.detikhealth.com/read/2010/09/14/140009/1440289/763/masa-masa-kritis-penderita-kanker-sebaiknya-dilalui-di-rumah), untuk pasien yang tidak memerlukan pengawasan ketat, tindakan atau peralatan khusus, serta keterampilan perawatan bisa dilakukan oleh anggota keluarga. Selain mengurangi gejala-gejala yang muncul, perawatan paliatif juga memberikan dukungan dalam hal spiritual dan psikososial. Perawatan ini bisa dimulai saat diagnosis diumumkan sampai akhir hayat dari si pasien. “Meski pasien telah meninggal dunia, perawatan paliatif tidak berhenti sampai di situ. Karena relawan paliatif juga akan memberikan dukungan moral kepada keluarga yang berduka,” ujar Prof Sunaryadi. (http://openx.detik.com/delivery/ck.php?n=a9f2d374&cb=INSERT_RANDOM_NUMBER_HERE) 2..Juma’at 1 Oktober 2010

EDITOR’S CHOICE

“Salon Kaki” Manjakan Pengidap Diabetes (http://health.kompas.com/read/2010/10/01/08503136/.quot.Salon.Kaki.quot..Manjakan.Pengidap.Diabetes)

Bagi para penderita diabetes, luka…

Minum Pil KB Pun Ada Aturannya (http://health.kompas.com/read/2010/09/30/1628416/Minum.Pil.KB.Pun.Ada.Aturannya)

Agar efektif mencegah kehamilan, pil…

Bumi Makin Panas, Nyamuk Jadi Ganas (http://health.kompas.com/read/2010/09/29/13520890/Bumi.Makin.Panas..Nyamuk.Jadi.Ganas)

Meningkatnya suhu dan kelembaban akan

LATEST

Jumat, 1 Oktober 2010 | 14:34 WIB

Tiga Cara Kuatkan Tulang (http://health.kompas.com/read/2010/10/01/14345430/Tiga.Cara.Kuatkan.Tulang) Puncak massa tulang dicapai ketika seseorang berusia 30 tahun. Setelah itu massa tulang akan menurun (http://health.kompas.com/read/2010/10/01/14345430/Tiga.Cara.Kuatkan.Tulang)

Jumat, 1 Oktober 2010 | 13:57 WIB

Meja Makan Jauhkan Remaja dari Narkoba (http://health.kompas.com/read/2010/10/01/13572140/Meja.Makan.Jauhkan.Remaja.dari.Narkoba) Berawal dari meja makan, akan terbentuk keluarga yang berkualitas. (http://health.kompas.com/read/2010/10/01/13572140/Meja.Makan.Jauhkan.Remaja.dari.Narkoba)

Jumat, 1 Oktober 2010 | 11:38 WIB

Alat Makan Penunjang Diet (http://health.kompas.com/read/2010/10/01/1138318/Alat.Makan.Penunjang.Diet) Menjaga pola makan dengan asupan sehat dan rendah lemak barulah separuh dari perjuangan melawan kegemukan. (http://health.kompas.com/read/2010/10/01/1138318/Alat.Makan.Penunjang.Diet) : “kesehatan” ditemukan dalam 20350 dokumen

Wakil Menperin Kaget Ada Sepeda Seharga City Car (http://www.detikfinance.com/read/2010/10/01/151018/1453177/68/wakil-menperin-kaget-ada-sepeda-sehargacity-car) Alex berharap masyarakat Indonesia bisa menggunakan sepeda sebagai alat kesehatan atau back to basic. Terlebih saat ini isu polusi udara semakin mencuat di seluruh dunia. “Kita bicara green economy, tujuannya Jumat, 01/10/2010 15:10 WIB – www.detikfinance.com (http://www.detikfinance.com)

7 Benda Sehari-hari yang Bisa Menjadi Pemicu Kanker (http://www.detikhealth.com/read/2010/10/01/150102/1453169/766/7-benda-sehari-hari-yang-bisa-menjadipemicu-kanker) Selain bisa memicu kanker, BPA juga sering dikaitkan dengan berbagai gangguan kesehatan yang lain. Diantaranya serangan jantung, kerusakan saraf, diabetes impotenisi hingga kematian. Dalam pembuatan plastik polimer Jumat, 01/10/2010 15:01 WIB – www.detikhealth.com (http://www.detikhealth.com)

Dubes AS: Presiden Obama Kecewa 2 Kali Batal ke Indonesia (http://www.detiknews.com/read/2010/10/01/140429/1453080/10/dubes-as-presiden-obama-kecewa-2-kali-batalke-indonesia) Pada bulan Maret, Obama tak jadi ke Indonesia karena di AS tengah heboh dengan ratifikasi UU Kesehatan. Sedangkan pada bulan Juni lalu, Obama terpaksa kembali membatalkan kunjungannya karena adanya tragedi tumpahan Jumat, 01/10/2010 14:04 WIB – www.detiknews.com (http://www.detiknews.com)

Luka di Leher, Ahmad Belum Bisa Dimintai Keterangan (http://www.detiknews.com/read/2010/10/01/121655/1452972/10/luka-di-leher-ahmad-belum-bisa-dimintaiketerangan) Karena itu kini polisi berkonsentrasi terhadap kondisi kesehatan Ahmad. Jika keadaan Ahmad sudah memungkinkan, maka polisi bisa leluasa mengorek keterangan dari pria bertubuh gempal tersebut, terkait apakah ada orang (http://foto.detik.com/readfoto/2010/09/30/125758/1452148/157/1/bom-rakitan-meledak-di-kalimalang) Jumat, 01/10/2010 12:16 WIB – www.detiknews.com (http://www.detiknews.com)

Bos Warna Warni Masih Terbaring di RS Bhayangkara (http://surabaya.detik.com/read/2010/10/01/120739/1452968/466/bos-warna-warni-masih-terbaring-di-rsbhayangkara) Bos PT Warna Warni, Soekotjo Gunawan, masih terbaring di Rumah Sakit Bhayangkara tk IV Muhammad Dahlan. Kondisi kesehatan pemilik biro reklame di Surabaya ini masih belum stabil. “Saya belum mendapat laporan pagi ini. Jumat, 01/10/2010 12:07 WIB – surabaya.detik.com (http://surabaya.detik.com)

Pascaoperasi, Kondisi Kembar Siam Lamongan Membaik (http://surabaya.detik.com/read/2010/10/01/113455/1452928/466/pascaoperasi-kondisi-kembar-siam-lamonganmembaik) Setelah menjalani operasi pemisahan, kondisi kesehatan bayi kembar siam asal Lamongan Rafa-Rafi kian membaik. Tidak ditemukan tanda-tanda infeksi pada luka bekas operasi. Keadaan keduanya juga sudah mulai stabil dan Jumat, 01/10/2010 11:34 WIB – surabaya.detik.com (http://surabaya.detik.com)

Mungkinkah Tidak Lolos Tes Doping Gara-gara Makan Steak? (http://www.detikhealth.com/read/2010/10/01/110048/1452889/763/mungkinkah-tidak-lolos-tes-doping-gara-garamakan-steak) Bantahan serta dugaan ini pun mendapat tanggapan dari para pakar kesehatan di London. Dr Andrew Franklyn-Miller, ahli kesehatan olahraga dari Centre of Human Performance mengatakan Jumat, 01/10/2010 11:00 WIB – www.detikhealth.com (http://www.detikhealth.com)

Mungkinkah Tidak Lolos Tes Doping Gara-gara Makan Steak? (http://www.detikhealth.com/read/2010/10/01/110048/1452889/763/mungkinkah-tidak-lolos-tes-doping-gara-garamakan-steak) Bantahan serta dugaan ini pun mendapat tanggapan dari para pakar kesehatan di London. Dr Andrew Franklyn-Miller, ahli kesehatan olahraga dari Centre of Human Performance mengatakan Jumat, 01/10/2010 11:00 WIB – www.detikhealth.com (http://www.detikhealth.com)

Baju Lebaran Dorong Inflasi September 0,44% (http://www.detikfinance.com/read/2010/10/01/101859/1452858/4/baju-lebaran-dorong-inflasi-september-044) Setelah itu diikuti oleh makanan 0,44%, minuman dan rokok 0,52%, perumahan air dan listrik 0,25%, kesehatan 0,23%, pendidikan 0,26%, serta transportasi dan komunikasi 0,57%. “Pakaian itu naik tinggi karena banyak Jumat, 01/10/2010 10:18 WIB – www.detikfinance.com (http://www.detikfinance.com)

Beberapa Perwakilan Negara Sahabat Pingsan Saat Upacara di Lubang Buaya (http://www.detiknews.com/read/2010/10/01/095212/1452844/10/beberapa-perwakilan-negara-sahabat-pingsansaat-upacara-di-lubang-buaya) Petugas pun langsung membopong pria yang mengenakan jas tersebut ke posko kesehatan. Peristiwa ini terjadi saat upacara mulai memasuki pembacaan doa. Suasana di lokasi memang cukup panas. Jumat, 01/10/2010 09:52 WIB – www.detiknews.com (http://www.detiknews.com) 2. kamis 22 sept 2010

Seribu Lebih Veteran di DIY Belum Terima Tunjangan Kehormatan (http://www.detiknews.com/read/2010/09/30/144330/1452253/10/seribu-lebih-veteran-di-diy-belum-terimatunjangan-kehormatan) Termasuk juga pelayanan kesehatan di usia pensiun. “Saat ini telah diserahkan 164 SK Gelar Kehormatan, Dana Kehormatan, Tunjangan Veteran serta Kartu Askes dan Sosialisasi Hak Veteran/Jaminan Pemeliharaan Kamis, 30/09/2010 14:43 WIB – www.detiknews.com (http://www.detiknews.com)

Satu Tahun Masa Kerja DPR, Anggaran Hanya untuk Kepentingan Sendiri (http://www.detiknews.com/read/2010/09/30/143416/1452243/10/satu-tahun-masa-kerja-dpr-anggaran-hanyauntuk-kepentingan-sendiri) “DPR tidak responsif terhadap permasalahan rakyat, khususnya yang bersifat urgen seperti kebutuhan pokok, kesehatan, pendidikan dan infrastruktur,” kata Sebastian. Sebastian menilai, DPR akhirnya hanya sebagai Kamis, 30/09/2010 14:34 WIB – www.detiknews.com (http://www.detiknews.com)

Menakertrans Masuk RS karena Kelelahan (http://www.detiknews.com/read/2010/09/30/142112/1452241/10/menakertrans-masuk-rs-karena-kelelahan) Menteri Tenaga Kerja dan Transmigrasi (Menakertrans), Muhaimin Iskandar, menjalani perawatan kesehatan di RS Abdi Waluyo, Menteng, Jakarta Pusat, sejak Rabu (29/9/) malam. Muhaimin mengalami kelelahan setelah melakukan Kamis, 30/09/2010 14:21 WIB – www.detiknews.com (http://www.detiknews.com)

Wanita Terjangkung Punya Anak Balita Setinggi 1,3 Meter (http://www.detikhealth.com/read/2010/09/30/133023/1452172/763/wanita-terjangkung-punya-anak-balita-setinggi13-meter) Namun di luar kesulitan-kesulitan yang dihadapi tadi, baik Karan maupun Shweatlana tidak mengalami masalah lain terkait dengan kesehatan. Shweatlana bahkan yakin, suatu saat nanti anaknya akan mendapat manfaat dari Kamis, 30/09/2010 13:30 WIB – www.detikhealth.com (http://www.detikhealth.com)

Menkes Puji Semangat Tenaga Kesehatan di Papua (http://www.detiknews.com/read/2010/09/30/132133/1452162/10/menkes-puji-semangat-tenaga-kesehatan-dipapua) Tidak mudah untuk menjadi tenaga kesehatan di tanah Papua. Menteri Kesehatan Endang Rahayu Sedyaningsih yang pernah bekerja sebagai peneliti di Papua pun menyadari hal itu. “Saya sudah Kamis, 30/09/2010 13:21 WIB – www.detiknews.com (http://www.detiknews.com)

Ketombe Pertanda Sedang Stres (http://www.detikhealth.com/read/2010/09/30/124521/1452137/766/ketombepertanda-sedang-stres) Stres yang berulang dapat menyebabkan kelelahan, yang berarti juga dapat mempengaruhi kesehatan dan kesejahteraan tubuh. Perubahan negatif yang dapat tercermin adalah dengan memburuknya ketombe. Dilansir dari Kamis, 30/09/2010 12:45 WIB – www.detikhealth.com (http://www.detikhealth.com)

Pentingnya Kepercayaan Diri Untuk Mendapatkan Orgasme (http://www.wolipop.com/read/2010/09/30/121215/1452116/227/pentingnya-kepercayaan-diri-untuk-mendapatkanorgasme) “Pria jauh lebih tertarik pada wanita yang menunjukkan tanda-tanda kesehatan dan kesuburan, daripada (wanita yang) khawatir tentang bentuk pinggang dan pinggulnya. (Pria) Khawatir tentang tingkat energi, antusiasme Kamis, 30/09/2010 12:12 WIB – www.wolipop.com (http://www.wolipop.com)

Viagra Obat Jantung yang Berubah Jadi Obat Kuat (http://www.detikhealth.com/read/2010/09/30/095100/1451974/763/viagra-obat-jantung-yang-berubah-jadi-obatkuat) Dalam kesehatan seksual, pelepasan NO oleh sel-sel di dalam penis mengaktifkan enzim yang disebut guanylate cyclase. Reaksi ini membuat molekul lain cyclic guanosine monophosphate (cGMP) melemaskan otot polos penis, Kamis, 30/09/2010 09:51 WIB – www.detikhealth.com (http://www.detikhealth.com)

Bayi Tabung Terlalu Banyak Hasilkan Bayi Laki-laki (http://www.detikhealth.com/read/2010/09/30/081741/1451911/764/bayi-tabung-terlalu-banyak-hasilkan-bayi-lakilaki) Ketidakseimbangan jenis kelamin pada bayi hasil IVF dikhawatirkan dapat memicu dampak sosial maupun kesehatan. Salah satunya seperti yang terjadi di China, tingkat kelahiran bayi perempuan yang lebih sedikit telah Kamis, 30/09/2010 08:17 WIB – www.detikhealth.com (http://www.detikhealth.com) 2.Rabu 21 Sept.2010 Hasil Pencarian : “kesehatan” ditemukan dalam 20309 dokumen

Bayi Kembar Siam Asal Lamongan Jalani Operasi Pemisahan (http://surabaya.detik.com/read/2010/09/29/095336/1450968/466/bayi-kembar-siam-asal-lamongan-jalani-operasipemisahan) Rangkaian pemeriksaan kesehatan itu antara lain pemeriksaan jantung, pemeriksaan jaringan pada perut hingga dada dan pemeriksaan bakteri. Pada pemeriksaan itu, kedua bayi tidak mengidap kemungkinan risiko besar ketika Rabu, 29/09/2010 09:53 WIB – surabaya.detik.com (http://surabaya.detik.com)

Berantas Kosmetika Palsu, BPOM Perketat Screening (http://www.detiknews.com/read/2010/09/28/193608/1450710/10/berantas-kosmetika-palsu-bpom-perketatscreening) Untuk produk kosmetik dalam negeri, Bpom akan berkoordinasi dengan kementerian kesehatan dan kementerian perdagangan. Sementara untuk produk impor, BPOM senantiasa berkoordinasi dengan bea cukai. Hal tersebut Selasa, 28/09/2010 19:36 WIB – www.detiknews.com (http://www.detiknews.com)

Ratusan Kosmetik Ilegal Disita Dinkes Mojokerto (http://surabaya.detik.com/read/2010/09/28/182500/1450664/475/ratusan-kosmetik-ilegal-disita-dinkes-mojokerto) Balai Besar Pengawasan Obat dan Makanan (BBPOM) Surabaya beserta Dinas Kesehatan Kota Mojokerto, merazia sejumlah toko penjual kosmetik dan salon di Kota Mojokerto. Hasilnya, ditemukan ratusan produk kosmetik ilegal. Selasa, 28/09/2010 18:25 WIB – surabaya.detik.com (http://surabaya.detik.com)

Wanita asal Bangkalan Melahirkan di Atas Kereta Kahuripan (http://surabaya.detik.com/read/2010/09/28/165003/1450595/475/wanita-asal-bangkalan-melahirkan-di-ataskereta-kahuripan) Menurut Petugas Kesehatan di Stasiun Kertosono, Joko Heru Prastyo Badriyah melahirkan di atas kereta dengan sejumlah penyebab. Diantaranya adanya getaran gerbong hingga menjadikan kontraksi, serta sirkulasi udara yang Selasa, 28/09/2010 16:50 WIB – surabaya.detik.com (http://surabaya.detik.com)

39th IVU World Vegetarian Congress , Hadir di Jakarta! (http://www.detikfood.com/read/2010/09/28/144821/1450460/900/39th-ivu-world-vegetarian-congress-hadir-dijakarta) Kongres vegetarian tingkat dunia yang diadakan setiap dua tahun sekali ini berisi tentang seminar-seminar dengan topik Kesehatan & Gizi, Lingkungan, Etika & Hak Asasi Hewan, Pemanasan Global, pameran produk Selasa, 28/09/2010 14:48 WIB – www.detikfood.com (http://www.detikfood.com)

Calon Jamaah Haji Diimbau Konsumsi Air Agar Terhindar High Stroke (http://surabaya.detik.com/read/2010/09/28/141610/1450428/466/calon-jamaah-haji-diimbau-konsumsi-air-agarterhindar-high-stroke) Dinas Kesehatan (Dinkes) Surabaya mengimbau kepada calon jamaah haji (CJH) selama menjalankan ibadah agar tetap memperhatikan keseimbangan kondisi tubuh dengan memperbanyak mengkonsumi air mineral dan buah-buahan. Selasa, 28/09/2010 14:16 WIB – surabaya.detik.com (http://surabaya.detik.com)

Gerak Mata dan Bibir Sering Tak Terkontrol (http://www.detikhealth.com/read/2010/09/28/134021/1450361/887/gerak-mata-dan-bibir-sering-tak-terkontrol) Dok, saya mempunyai masalah kesehatan pada wajah sebelah kanan, yaitu mata dan bibir bergerak di luar kontrol (Hemifacial Spasm). Pertanyaan saya, bagaimana cara mengobatinya? Dan di mana tempat dokter yang dapat Selasa, 28/09/2010 13:40 WIB – www.detikhealth.com (http://www.detikhealth.com)

50% Calon Jamaah Haji asal Surabaya Divaksin Meningitis (http://surabaya.detik.com/read/2010/09/28/123026/1450291/466/50-calon-jamaah-haji-asal-surabaya-divaksinmeningitis) Hampir separuh lebih calon jamaah haji (CJH) embarkasih Surabaya sudah menjalani pemeriksaan kesehatan dan pemberian vaksinasi meningitis. Pemberian vaksin ini merupakan salah satu syarat wajib dari Pemerintah Arab Selasa, 28/09/2010 12:30 WIB – surabaya.detik.com (http://surabaya.detik.com)

Manfaat Kesehatan dari Kacang-kacang (http://www.detikhealth.com/read/2010/09/28/123033/1450299/766/manfaat-kesehatan-dari-kacang-kacang) Tak disangka bahwa kacang-kacangan yang kecil dapat memberi banyak manfaat kesehatan pada tubuh, mulai dari mengobati penyakit jantung, kolesterol, diabetes, kanker hingga menurunkan berat badan. Kacang merupakan Selasa, 28/09/2010 12:30 WIB – www.detikhealth.com (http://www.detikhealth.com)

Calhaj 2010 Asal Solo Divaksinasi Meningitis (http://www.detiknews.com/read/2010/09/28/122635/1450298/10/calhaj-2010-asal-solo-divaksinasi-meningitis) Calon Jamaah Haji di masing-masing daerahnya mulai mendapatkan vaksinasi untuk mencegah kemungkinan tertular penyakit meningitis selama melaksanakan ibadah haji. Meskipun sempat menimbulkan polemik terkait kehalalannya, tim Selasa, 28/09/2010 12:26 WIB – www.detiknews.com (http://www.detiknews.com)

Health Concerns

Cegah Infeksi dengan ASI (http://health.kompas.com/read/xml/2010/09/29/07334190/Cegah.Infeksi.dengan.ASI) (http://health.kompas.com/read/xml/2010/09/29/07334190/Cegah.Infeksi.dengan.ASI)

Health Concerns

Luka Bakar, 30 Menit yang… (http://health.kompas.com/read/xml/2010/09/29/06513953/Luka.Bakar..30.Menit.yang.Menentukan) (http://health.kompas.com/read/xml/2010/09/29/06513953/Luka.Bakar..30.Menit.yang.Menentukan)

Health Concerns

Diabetes, Mengapa BB Turun… (http://health.kompas.com/read/xml/2010/09/29/07071989/Diabetes..Mengapa.BB.Turun.Drastis) (http://health.kompas.com/read/xml/2010/09/29/07071989/Diabetes..Mengapa.BB.Turun.Drastis)

EDITOR’S CHOICE

Penyakit yang Ditimbulkan oleh Stres (http://health.kompas.com/read/2010/09/28/10162114/Penyakit.yang.Ditimbulkan.oleh.Stres)

Respon terhadap stres berfungsi melindungi…

Duh, Tubuh Wanita Ini “Meleleh” (http://health.kompas.com/read/2010/09/28/09282978/Duh..Tubuh.Wanita.Ini..quot.Meleleh.quot..)

Akibat mengidap suatu penyakit yang…

Diabetes Gestasional Bisa Diprediksi (http://health.kompas.com/read/2010/09/28/09463145/Diabetes.Gestasional.Bisa.Diprediksi)

Jika tidak dikendalikan dengan baik…

LATEST

Rabu, 29 September 2010 | 08:57 WIB

Obat Herbal Belum Efektif Atasi Diabetes (http://health.kompas.com/read/2010/09/29/0857248/Obat.Herbal.Belum.Efektif.Atasi.Diabetes) Obat herbal di pasaran umumnya belum diteliti dengan baik. Ada yang mampu menurunkan gula darah, tapi berefek samping sehingga tak bisa digunakan. (http://health.kompas.com/read/2010/09/29/0857248/Obat.Herbal.Belum.Efektif.Atasi.Diabetes)

Rabu, 29 September 2010 | 08:25 WIB

Plastik “Sandwich” Selamatkan Bayi Ini (http://health.kompas.com/read/2010/09/29/08250589/Plastik..quot.Sandwich.quot..Selamatkan.Bayi.Ini) Bayi mungil ini berhasil melewati masa-masa kritis setelah diselamatkan sebuah kantong plastik pembungkus sandwich. (http://health.kompas.com/read/2010/09/29/08250589/Plastik..quot.Sandwich.quot..Selamatkan.Bayi.Ini)

Rabu, 29 September 2010 | 07:37 WIB

Karbohidrat “Haram” untuk Diabetesi? (http://health.kompas.com/read/2010/09/29/07371752/Karbohidrat..quot.Haram.quot..untuk.Diabetesi.) Jangan dikira dengan pengaturan makan, diabetesi hanya makan sedikit. Karbohidrat dan gula pun sebenarnya bukan hal yang “haram”. (http://health.kompas.com/read/2010/09/29/07371752/Karbohidrat..quot.Haram.quot..untuk.Diabetesi.) 1 (http://health.kompas.com/welcome/index/1#latest)2 (http://health.kompas.com/welcome/index/2#latest)3 (http://health.kompas.com/welcome/index/3#latest)4 (http://health.kompas.com/welcome/index/4#latest)5 (http://health.kompas.com/welcome/index/5#latest)6 (http://health.kompas.com/welcome/index/6#latest)
–>

PSIKOLOGI (http://health.kompas.com/psikologi)

Anak Berbakat Belum… (http://health.kompas.com/read/2010/09/28/10443849/Anak.Berbakat.Belum.Tentu.Sukses) Anak-anak dengan bakat luar biasa ternyata sama… SELENGKAPNYA » (http://health.kompas.com/read/2010/09/28/10443849/Anak.Berbakat.Belum.Tentu.Sukses)

KONSULTASI (http://health.kompas.com/konsultasi)

Cedera Kepala pada Anak (http://health.kompas.com/konsultasi) Waktu umur 7 bulan anak s 2.Selasa 28 Sept.2010

Hindari Gigitan Anjing (http://www.detikhealth.com/read/2010/09/28/095352/1450090/763/hindari-gigitan-anjing) Bertepatan dengan ‘Hari Rabies Sedunia’ yang oleh Alliance for Rabies Control diperingati setiap 28 September sejak tahun 2006, Kementerian Kesehatan Indonesia turut menyampaikan tiga pesan utama di hari rabies ini. Selasa, 28/09/2010 09:53 WIB – www.detikhealth.com (http://www.detikhealth.com)

Apa Saja Fitur dan Spesifikasi BlackBerry PlayBook? (http://www.detikinet.com/read/2010/09/28/093130/1450078/317/apa-saja-fitur-dan-spesifikasi-blackberryplaybook) Neutrino telah banyak digunakan pada perangkat kesehatan, otomotif hingga router internet. Piranti lunak PlayBook mendukung Flash 10.1, WebKit dan HTML 5, OpenGL (untuk grafis 3D ) Selasa, 28/09/2010 09:31 WIB – www.detikinet.com (http://www.detikinet.com)

Fakta Tentang Tumor Otak (http://www.detikhealth.com/read/2010/09/28/092232/1450065/763/fakta-tentangtumor-otak) Tumor otak primer berasal dari otak itu sendiri dan terdapat lebih dari 126 tumor yang terdaftar oleh badan kesehatan dunia (WHO). 3. Glioma adalah tumor otak primer yang paling umum dan berasal dari sel otak Selasa, 28/09/2010 09:22 WIB – www.detikhealth.com (http://www.detikhealth.com)

Jaga Kedaulatan, Personel TNI Tak Boleh Gemuk (http://www.detiknews.com/read/2010/09/28/082132/1450023/10/jaga-kedaulatan-personel-tni-tak-boleh-gemuk) Widjanarko menambahkan setiap anggota TNI wajib mengikuti kesamaptaan 2 kali seminggu untuk menjaga kesehatan tubuhnya. Di luar itu, para prajurit pun diminta rajin berolah raga. “Saya saja masih rajin push up 1. Selasa, 21/09/2010 12:29 WIB Polisi Indikasikan Pejabat Kemenkes Terlibat ‘Korupsi’ Ayat Rokok Indra Subagja – detikNews Jakarta – Polisi terus menyidik kasus dugaan ‘korupsi’ ayat tembakau di RUU Kesehatan. Diindikasikan ada keterlibatan oknum pejabat Kemenkes dalam penghilangan salah satu ayat di aturan yang telah menjadi UU tersebut. “Pada 11 September 2009, F dan BS datang ke Sekretariat Komisi IX dan meminta ayat 2 pasal 113 dihilangkan,” kata Kabareskrim Mabes Polri Komjen Pol Ito Sumardi saat dihubungi detikcom, Selasa (21/9/2010). Saat itu, F telah membawa konsep tulisan tangan sendiri, yang diserahkan kepada staf di Sekretariat Komisi IX. Dan pada 12 September 2009, F juga menelepon salah satu anggota Komisi IX meminta untuk menghilangkan ayat 2 itu. “Tapi Anggota Komisi IX itu tidak setuju dihapus,” ujar Ito. Kemudian, pada 14 September 2009, rapat paripurna mengesahkan RUU Kesehatan. Untuk pasal 113 tetap memiliki 3 ayat. Namun pada 25 September 2009, Sekretariat Komisi IX mengirim berkas RUU itu ke Setneg untuk dimasukkan ke Lembaran Negara. Namun pasal 113 yang seharusnya 3 ayat telah berkurang menjadi 2 ayat, ayat 2 tak tercantum. “Itu sebagaimana permintaan F, bukan yang disahkan dalam rapat paripurna tanggal 14 September 2009,” jelas Ito. Pada 13 Oktober 2009, dibuat berita acara adanya kesalahan pengetikan pasal 113 tersebut, lalu dikirimkan lagi ke Setneg. Dua dari 3 pasal 133 berbunyi: (1): pengamanan penggunaan bahan yang mengandung zat adiktif diarahkan agar tidak mengganggu dan membahayakan kesehatan perseorangan, keluarga, masyarakat dan lingkungan. (2) : zat adiktif sebagaman dimaksud pada ayat (1) meliputi tembakau, produk yang mengandung tembakau, padat, cairan dan gas yang bersifat adiktif yang penggunaannya dapat menimbulkan kerugian bagi dirinya dan atau masyarakat sekelilingnya. Ayat 2 inilah yang sempat lenyap, yang setelah heboh di media massa kemudian dimasukkan kembali ke UU. (ndr/nrl) B.INFOKES INTERNATIONAL Oktober 1st 2010 FEATURES

NEWS

(http://www.healthtoday.net/main_section.CFM? ID=900§ion=FEATURES)

Pregnancy mistakes even smart women make (http://www.healthtoday.net/main_section.CFM? ID=900§ion=FEATURES) When it comes to your baby, knowledge is safety.

Long-term aspirin and death risk for women: new study (http://www.healthtoday.net/main_section.CFM? section=NEWS&ID=898)Better chances for women at risk

(http://www.healthtoday.net/main_section.CFM? ID=899§ion=FEATURES)

Understanding asthma (http://www.healthtoday.net/main_section.CFM? ID=899§ion=FEATURES) The whys and the hows of this wheezing ailment.

Pot impairs learning in adolescent rats: study (http://www.healthtoday.net/main_section.CFM? section=NEWS&ID=881)Another reason for people not to smoke pot

(http://www.healthtoday.net/main_section.CFM? ID=897§ion=FEATURES)

The buzz on brittle bones (http://www.healthtoday.net/main_section.CFM? ID=897§ion=FEATURES) Osteoporosis need not be a big problem anymore.

(http://www.healthtoday.net/main_section.CFM? ID=894§ion=FEATURES)

The winning goal (http://www.healthtoday.net/main_section.CFM? ID=894§ion=FEATURES) Kick your kids’ future with football!

New test spots bird flu in birds within 4 hours, official says (http://www.healthtoday.net/main_section.CFM? section=NEWS&ID=880)Procedure aims to prevent the entry of the deadly disease in North America Harvard scientists begin experiments to clone human embryos (http://www.healthtoday.net/main_section.CFM? section=NEWS&ID=879)Stem cell harvesting from clones could save lives.

sept 30th 2010 Dietary Supplements

The days of Carter’s Little Liver Pills, and the infamous bread, that “helps build strong bodies 12 ways,” may be gone, but it was not all that long ago that consumers filled their shopping baskets with these and similarly marketed products. And none came away with cured livers nor enhanced physiques for their trouble. We may chuckle at the specter of a tall, handlebar-mustached huckster peddling his patent medicines, but to watch modern consumers at the dietary supplements counter, one has to wonder who is having the last laugh. Food supplements are a $20 billion business in North America alone, and we continue to purchase and consume these products as though we have discovered the Holy Grail. Have you ever wondered if the products you purchase will make you live forever, or is it just so much snake oil? Sept.29Th 2010 Health care today need patients to be awake and cautious Generally people waste a hell lot of cash on medications. If we work down properly and open our minds before using these medications, we can save nearly half the amount that we waste on the medications in our whole life. Medicines are one of the factors that lead us to spend more than half of the earnings of our lifetime and hence it is important to analyse all the aspects properly before wasting our money on these things. There are many professional who work on various projects on health care today and hence report back that if people follow orders of the doctors, a considerable number of lives can be saved. The whole medical system, can change totally if the prescriptions of the doctors are followed properly but usually it does not happens as people do not follow the prescriptions and poke their own nose in the decisions of the doctors. If people are not cautious enough and do not follow the prescription of the doctors, there are chances that they will not be able to regain their health in proper time. Not following the prescriptions will increase the level of the sickness and also the patient will take more time to revert back to the normal condition. There are also chances that the situation may get worse and the patients may face severe consequences if the prescriptions are not followed properly. Also this provides higher business to the doctors as more you fall ill, more you will consult them and they will supply you medications which you will not follow. Again these processes will continue and thus their business will grow by the help of your carelessness. You physical cost will increase more than anything around you. Eventually you will fall in the trap and will end up suffering form some deadly disease and pricy treatments. Hence you are required to be conscious in health care today and do not get swayed away by the carelessness. Do complete all the prescriptions by time or else you will face to face severe consequence s in your nearest future. Sometimes even the drug corporations motivate the patients to get indulged in such careless activities by offering them life saving drugs which can used at the last moment however the chances are low that you will receive them and they will be as effective as mentioned. Also you budget will be severely damaged. It should be noted that the patients are the key parts of this equation and hence it is important for them to remain awakened if they want to save themselves form falling in such dangerous situations. First of all, patients should have a deeper level of appreciation for the job that they follow and also should be aware of the importance of the medications and the overall contentment of this job. health care today has become a serious job and the people involved in this business should be fair. The patients should remember the fact that taking the drugs and following the prescriptions is a win-win situation for them and hence they should keep their eyes and ears open to save their health.

Healthcare Today

(http://www.righthealth.com/corp/advertising_policy.html) Cardiovascular Health Renew You Cardiovascular Health Fast, Safe & Effective. Guaranteed. HealthyHeartCare.net/cardiovascular (http://rc12.overture.com/d/sr/? xargs=15KPjg1%2DpSn5amwrqqdLnJTeuLwl4axca59sxrBpl4H9Rf5iMxXOF7babBmcJwROVxv1PdxfCV9acfK%5FTzmP6PGweNRVKKHPWugoHGz4k0NamoWW1xvuwhwu3pnI5 // (http://www.righthealth.com/topic/healthcare_today/overview/wiki)Encyclopedia: Healthcare Today from Wikipedia (http://www.righthealth.com/topic/healthcare_today/overview/wiki) Healthcare Today is a monthly newsmagazine published in the United Kingdom by Mayden Publishing. The style and layout of the magazine is similar to that of The Week but its focus is purely on health-related news. Healthcare Today is read by healthcare professionals and those with a particular interest in health current affairs. More from Wikipedia.org » (http://en.wikipedia.org/wiki/Healthcare_Today) // //

Basics (http://www.righthealth.com/topic/healthcare_today/Basics) (http://www.righthealth.com/topic/healthcare_today/overview/health_websearch_trusted_sources)Editor’s Picks from RightHealth (http://www.righthealth.com/topic/healthcare_today/overview/health_websearch_trusted_sources)

Healthcare Administrative Simplification Coalition describes how … (http://www.aafp.org/online/en/home/media/releases/newsreleases-statements-2009/healthcare-administrativesimplification-coalition.html) Jul 20, 2009 … The overwhelming number and complexity of processes in healthcare administration today are adding little or no value to patient care, … American Academy of Family Physicians More from RightHealth » (http://www.righthealth.com/topic/healthcare_today/overview/health_websearch_trusted_sources) // //

Patient Experiences (http://www.righthealth.com/topic/healthcare_today/Patient-Experiences) (http://answers.yahoo.com/search/search_result;_ylt=Aj.eRrUsGc0gwIZ.RL6v4m3py6IX;_ylv=3?p=healthcare+today)Question and Answer from Yahoo! Answers (http://answers.yahoo.com/search/search_result;_ylt=Aj.eRrUsGc0gwIZ.RL6v4m3py6IX;_ylv=3?p=healthcare+today)

(http://answers.yahoo.com/question/?qid=20080209194743AAMQaS1) Lily (http://answers.yahoo.com/question/?qid=20080209194743AAMQaS1) Q: What do you think there is a shortage of healthcare personnel today? What professions are most affected? What do you think there is a shortage of healthcare personnel today? What professions are most affected? (http://answers.yahoo.com/question/?qid=20080209194743AAMQaS1) A: I believe it is nursing. Nurses provide the bulk of the primary care in hospital, nursing homes and emergency rooms. Doctors prescribe and write orders, but it is up to the nurses to carry out the orders. If there are too few nurses, the ones who are working put in too many hours and may make mistakes. They measure up dosages of powerful …

(http://answers.yahoo.com/question/?qid=20090726194657AAzqrgB) avalent… (http://answers.yahoo.com/question/?qid=20090726194657AAzqrgB) Q: How important is Spanish in healthcare today? How important is knowing Spanish in healthcare? As a physician, will Spanish be critical? I will be … (http://answers.yahoo.com/question/?qid=20090726194657AAzqrgB) A: You should know at least one other language besides English. Our population is very diverse, and to build a successful practice, you will need to be able to communicate with your patients. If you don’t know Spanish yourself, you will need to depend on the sometimes unreliable medical terminology of your office staff or a telephone interpreting service. Or depending on your location … More from Yahoo! Answers » (http://answers.yahoo.com/search/search_result;_ylt=Aj.eRrUsGc0gwIZ.RL6v4m3py6IX;_ylv=3?p=healthcare+today) // //

Images (http://www.righthealth.com/topic/healthcare_today/Images) From: Google (http://images.google.com/images?q=healthcare+today) • Yahoo! (http://images.search.yahoo.com/search/images;_ylt=A0oGkm0XiDVJhUIAFz9XNyoA? p=healthcare+today) (http://images.google.com/images?q=healthcare+today)Images from Google (http://images.google.com/images?q=healthcare+today)

(http://www.aflcio.org/issues/healthcare/survey/2008results.cfm)

(http://www.aflcio.org/issues/healthcare/survey/2008results.cfm)

(http://latimesblogs.latimes.com/washington/2009/12/senate-health-care-vote-obama-lawsuits.html)

(http://latimesblogs.latimes.com/washington/2009/12/senate-health-care-vote-obama-lawsuits.html)

(http://www.insideronline.org/blogarchive.cfm?month=9&year=2009)

(http://www.insideronline.org/blogarchive.cfm?month=9&year=2009)

(http://www.tcdailyplanet.net/blog/jelston/would-you-fix-health-care-today)

(http://www.tcdailyplanet.net/blog/jelston/would-you-fix-health-care-today) (http://www.rediscoveringhealthcare.com/media/) (http://www.rediscoveringhealthcare.com/media/) (http://www.zazzle.com/legalize_healthcare_t_shirt-235394782926937434) (http://www.zazzle.com/legalize_healthcare_t_shirt-235394782926937434) //
Guides & Articles (http://www.righthealth.com/topic/healthcare_today/Guides-and-Articles) From: Articlesbase (http://www.articlesbase.com/find-articles.php?q=healthcare+today) • Helium.com (http://www.helium.com/search/search?search_query=healthcare today) (http://www.articlesbase.com/find-articles.php?q=healthcare+today)Articles from Articlesbase (http://www.articlesbase.com/find-articles.php?q=healthcare+today)

Occupational Therapy Jobs in Today’s Healthcare Industry (http://www.articlesbase.com/medicine-articles/occupationaltherapy-jobs-in-todays-healthcare-industry-426460.html) May 25, 2008 … he could sustain himself for a fruitful existence and contribute to his family and society in order to live life to its fullest. Occupational therapy jobs in todayâs healthcare …

Best Healthcare Jobs (http://www.articlesbase.com/career-management-articles/best-healthcare-jobs-615056.html) October 24, 2008 The healthcare industry is todayâs booming service sector, opening up a wide range of challenges and opportunities before us. If you are passionate about helping and caring for … More from Articlesbase » (http://www.articlesbase.com/find-articles.php?q=healthcare+today) // // (http://www.helium.com/search/search?search_query=healthcare today)Articles from Helium.com (http://www.helium.com/search/search?search_query=healthcare today)

How diversity affects quality health care (http://www.helium.com/items/1927113-quality-of-life-and-quality-of-healthcaremust-exist-together) Thu Aug 19, 2010 12:00 AM GMT Author: Dennis Aubuchon … there are available treatments either to cure them or reduce the progression of them. This is great. Healthcare is something that everyone needs whether you are rich or poor. The quality of healthcare we have today cannot compare to that we had in the 1,800’s or even when our country began.& …

Why its so hard to find affordable medical insurance in … (http://www.helium.com/items/888649-why-its-so-hard-to-findaffordable-medical-insurance-in-the-us) Mon Feb 25, 2008 12:00 AM GMT Author: Frank Kendall …We know the problem is real but do we really understand why. There are many reasons why we are in this crisis today and we will examine some of those reasons here. Ask anyone what they think is wrong with healthcare today and they will tell you the cost of healthcare and healthcare insurance, the quality of service and the lack of human compassion. These perceptions … More from Helium.com » (http://www.helium.com/search/search?search_query=healthcare today) // //

Video (http://www.righthealth.com/topic/healthcare_today/Video) (http://www.videosurf.com/videos/healthcare+today)Video Search from Videosurf (http://www.videosurf.com/videos/healthcare+today)

(http://www.videosurf.com/video/what-to-do-about-high-blood-pressure-rex-healthcare-today-1212551135?vlt=kosmix)

What To Do About High Blood Pressure … (http://www.videosurf.com/video/what-to-do-about-high-blood-pressure-rexhealthcare-today-1212551135?vlt=kosmix) 03:35 (http://www.videosurf.com/video/sprint-mobillity-in-healthcare-today-1201586940?vlt=kosmix)

Sprint Mobillity In Healthcare Today … (http://www.videosurf.com/video/sprint-mobillity-in-healthcare-today-1201586940? vlt=kosmix) 01:53 (http://www.videosurf.com/video/town-hall-meeting-on-health-care-reform-today-75445717?vlt=kosmix)

Town Hall Meeting On Health Care Reform … (http://www.videosurf.com/video/town-hall-meeting-on-health-care-reformtoday-75445717?vlt=kosmix) 01:55 (http://www.videosurf.com/video/hutchison-on-nbc%27s-the-today-show-to-talk-healthcare98190505?vlt=kosmix)

Hutchison On Nbc’s The Today Show … (http://www.videosurf.com/video/hutchison-on-nbc%27s-the-today-show-to-talkhealthcare-98190505?vlt=kosmix) 03:48 Read more: http://www.righthealth.com/topic/healthcare_today#ixzz10stsoWEH (http://www.righthealth.com/topic/healthcare_today#ixzz10stsoWEH)SEPT.28th2010. A. REASERCH INFO I PSHYCHIATIC

Hopkins: What Teen Social Skills Tell Us March 24, 2000 BALTIMORE (Johns Hopkins) – Want to know what’s really going on with teen-agers? Watch how they interact — or don’t — with other people. Most people know that such common warning signs as dropping out of school or getting into trouble with the law can alert society to a teen’s state of mind, or even signal the presence of a psychiatric disorder. But Johns Hopkins researchers think that problems can be identified and treated much sooner, by observing how teens relate to others in a variety of social settings. “Girls and boys who have depression and anxiety, and often those things go together, are likely to not be doing the normal things that teen-agers do. Not getting along with their peers, staying alone a lot, not engaged in organizations,” says Hopkins clinical psychologist Dr. Anne Riley, who led a study of nearly 300 teen-agers. Dr. Riley says the persistence of social isolation can help parents tell the difference between a psychiatric disorder and normal teen-age moodiness. Copyright 1998 The Johns Hopkins University. All rights reserved. Now you can get the latest health news and information just the way you want it. Choose from InteliHealth’s FREE daily e-mail (http://www.intelihealth.com/signup?r=WSCHN000), our new FREE once-a-week news roundup (http://www.intelihealth.com/signup?r=WSCHN000) and more than a dozen new FREE weekly e-mails by topic (http://www.intelihealth.com/signup? r=WSCHN000) including allergy, women’s health, men’s health, fitness, nutrition and much more. Click here (http://www.intelihealth.com/signup?r=WSCHN000) to subscribe. InteliHealth (http://www.intelihealth.com/IH/ihtIH?r=WSCHN000), a joint venture with the Johns Hopkins University and Health System, is your trusted source for health information on the Web. You can search the InteliHealth Web page (http://www.intelihealth.com/IH/ihtIH?r=WSCHN000&t=2391)for answers to your medical questions, look up drug and medication information (http://www.intelihealth.com/IH/ihtIH?r=WSCHN000&t=8124), find the fast facts in our Disease And Condition Center (http://www.intelihealth.com/IH/ihtIH? r=WSCHN000&t=9339), even ask (http://www.intelihealth.com/IH/ihtIH?r=WSCHN000&t=4581)a physician a question B. preventive health Info Tuesday – September 28, 2010

Supplements in The News REMOVED COMMENT TERMINATOR 3 of 6 < 17 Jul 10 There were no new alerts for the week ending July 17, 2010. 16 Feb 10 The U.S. Federal Trade Commission has warned 11 companies promoting Omega-3 fatty acid supplements about potentially deceptive advertising. See Alerts (alerts.html). 4 Jun 09 Health Canada is advising consumers not to use the unauthorized product Slim Magic Herbal, as it was found to contain an undeclared pharmaceutical ingredient. See Alerts (alerts.html). 1 May 09 The U.S. Food and Drug Administration is warning consumers to immediately stop using Hydroxycut products by Iovate Health Sciences. See Alerts (alerts.html). 27 Apr 09 The U.S. Federal Trade Commission (FTC) has charged the suppliers of supposed Hoodia gordonii, also known as hoodia, with deceptive advertising. See Alerts (alerts.html).




Some dietary supplements and herbals can be very dangerous. Please take a moment to see the latest supplement advisories and warnings (http://www.preventivehealthtoday.com/alerts.html)…

Contaminated food occasionally finds its way to market shelves. Here are a few general food warnings currently in the news (//www.fda.gov/opacom/7alerts.html', 616, 330, 'scrollbars', 'cen', -55)) from the U.S. FDA…

Cholesterol may increase the risk of cardiovascular disease. Maintain safe cholesterol levels and reduce your risk for this #1 killer. More on cholesterol (http://www.preventivehealthtoday.com/nutrition/chol.html) …

Explore the many issues involved in the process of losing weight and the challenging task of keeping it off. More on weight management (http://www.preventivehealthtoday.com/prevention/weight_mgt.html)…

Here is everything you need to know about the basic essentials of vitamins (http://www.preventivehealthtoday.com/nutrition/vitamins.html) and minerals (http://www.preventivehealthtoday.com/nutrition/minerals.html) in human nutrition…

Homeopathic drugs are a safe, natural, non-toxic, and effective alternative to traditional medical therapy. More on homeopathy… (http://www.preventivehealthtoday.com/prevention/homeopathy.html)

Can dietary supplements really make a difference in improving nutrition and your overall health? See these important facts about dietary supplements (http://www.preventivehealthtoday.com/prevention/d_supplements.html), as well as some basic information about selected herbal supplements (http://www.preventivehealthtoday.com/prevention/herbals.html).

Find out about the relationship between lifestyle habits and the most common health challenges facing society today. Review the details about a few selected medical conditions (http://www.preventivehealthtoday.com/prevention/conditions.html).

Arthritis Overview How The Joint Works (http://www.intelihealth.com/IH/ihtIH/WSPEP000/9071/9076/204927.html?d=dmtContent#jwork) How Arthritis Affects The Joints (http://www.intelihealth.com/IH/ihtIH/WSPEP000/9071/9076/204927.html?d=dmtContent#affectj) We all have mornings when we wake up a bit stiff. We all know the achy feeling that comes from working too hard in the garden, sitting too long at the computer or sleeping in an awkward position. And, from time to time, we have all suffered pain because we’ve lifted a heavy object in a slightly wrong way. Even a particularly ferocious sneeze can cause a twinge of discomfort. But arthritis goes far beyond these occasional aches and pains. The condition that we commonly refer to as arthritis includes a number of diseases that result in inflammation, pain and stiffness, primarily in the joints and connective tissues. Connective tissues are the supporting structures for joints, such as muscles, cartilage, ligaments and tendons. In many cases, these diseases affect other parts of the body as well. Arthritic disorders may be are chronic, but some, such as gout, are intermittent. The conditions that are truly inflammatory (that is, with actual joint inflammation present) cause warmth and swelling, whereas others are degenerative, in which cartilage lining the joint wears out and the amount of inflammation is minor.

How The Joint Works The ends of bones meet at the joint, where they are cushioned by cartilage, a layer of smooth pliable tissue. Around many of the larger joints, such as the knee, hip and shoulder, there is a pad-like sac or cavity called the bursa, which is lined with cells similar to those lining the joint. In addition to acting as a buffer to reduce friction between the muscle, tendon tissue and bone, this inner lining produces a fluid, synovial fluid, that keeps the joints lubricated and provides nutrients. Ligaments connect and support bones to keep them in proper alignment, whereas tendons connect muscles to bones. Joints move when a muscle on one side of a joint contracts and pulls on the tendons that attach to a bone on the other side of the joint.

How Arthritis Affects The Joints The word arthritis means joint inflammation. Inflammation, a natural part of the body’s response to injury and infection, is a complex process that produces swelling, pain, warmth and redness. But inflammation is not only a response to injury, it may perpetuate injury as well. Significant problems arise when inflammation is persistent, intense or recurrent or spreads to other areas of the body. Joints and the surrounding areas become inflamed for a number of reasons, including trauma, disease, infection or merely wear and tear, which naturally occurs over time. Many forms of arthritis are thought to result from the uncontrolled inflammation of an autoimmune disease, in which the body’s defense mechanism malfunctions and attacks its own tissues. At other times, the joint area becomes inflamed and tender for no apparent reason. When joints become arthritic, swelling causes stiffness, rigidity and tissue damage. Pain, which is the body’s signal that something is wrong, occurs as the joint is moved to the brink of its own limits. As mobility decreases, the muscles surrounding the joint also weaken, allowing for further injury to the joint. Over time, the cartilage breaks down, the bone erodes and the joints become misshapen. It is this process, regardless of the source, that may develop in the worst forms of arthritis. There are more than 100 different types of arthritis, and each has its own characteristic symptoms and its own course. In addition, the way in which the disease progresses varies from individual to individual. If you suffer from an arthritic condition, you will most likely experience pain and limited movement at the involved sites. In chronic forms of arthritis, there may be times when the disease is active (flares) and times when it is inactive (remission). Depending on the specific condition and how severe it is, arthritis can interfere with even the most ordinary activities, such as walking, dressing or bathing. In the most inflammatory types of arthritis, such as rheumatoid arthritis, pain and stiffness are more severe in the morning or on certain days. Sometimes symptoms disappear completely for considerable stretches of time, only to flare up again later. Last updated April 03, 2009 2.flu burung Monday, September 27, 2010

(;)

Visit HealthToday Thailand (http://www.healthtoday.net/thailand) HOME

FEATURES

NEWS

PROFILES

CHANNELS (http://www.healthtoday.net/sect_channels1.CFM? ID=902&category=Wellness Zone§ion=Channels)

HEALTH TOOLS (;)

DIRECTORY

New test spots bird flu in birds within 4 hours, official says Procedure aims to prevent the entry of the deadly disease in North America(prosedur mencegah masuknya penyakit yang mematikan di Amerika Urara) U.S. Agriculture Secretary Mike Johanns said Tuesday that scientists have a new test that can tell within four hours if a bird is infected with bird flu, but it still will take about a week to know if it has the deadly Asian strain.(Sekretaris menteri Pertanian Amerika Mike Johanns hari rabu yl berkata bahwa ilmuwan telah memiliki suatu Test baru yang dpat memberikan hasil dalam empat jam jika seekor burung kean infeksi flu burung, tetapi tetap memerlukan waktu satu minggu untuk mengetahui jika binatang yang mati karena strain dari Asia. Bird flu hasn’t yet reached North America, but testing of migrating wild birds has begun in an attempt to catch it early if it does, Johanns told the Associated Press, in a joint interview with U.S. Health and Human Services Secretary Mike Leavitt.(Flu burung belum mencapai Amerika Utara, tetapi testing pada burung yang migrasi telah dimulai dalam upaya untuk menemukan sedini mungkin, Johan mengatakan bahwa Assoiciated Press, bekerja sma dengan Mike Leavitt,sekretaris Kesehatan dan Pelayan Manusia USA) Leavitt added that four hours also is how long it takes to get preliminary results in people infected with the H5N1 virus, too. But if bird flu ever begins spreading easily among people, that’s too long, he told the AP. “If it occurs anywhere in the world, it’s just a matter of weeks until it appears in the United States,” Leavitt said.(Leavit menambah empat jam juga sebagaimana waktu untuk memperoleh hasil pada Manusia yang terinfeksi H5N1. tetapi Flu burung dapat dengan mudah menimbulkan infeksi pada manusia. Leavit berkata”hal tersebut dapat terjadi dimanapun di dunia, dalam beberapa minggu akan muncul Di Amerika Serikat) Bird flu has killed at least 127 people worldwide since it began spreading in Asia in late 2003. Though it is difficult for people to catch the virus, experts fear it could mutate into a form easily spread between people, potentially sparking a worldwide outbreak. (Flu Burung telah membunuh sekitar 127 orang sejak mulai menjalar di Asia tahun 2003. Kendatipun sulit bagi manuisia untuk menangkap Virus itu, pakar tahut akan terjadi mutasi dalam bentuk yang gampang menjalar pada manusia dan potential menimbulkan ledakan keseluruh dunia. Copyright (c) 2006 ScoutNews, LLC. All rights reserved. Last updated 6/7/2006 selesai. edit oleh Dr Iwan Suwandy,MHA

(http://www.intelihealth.com/IH/ihtIH/WSPEP000/356/356/236954.html? d=dmtContent)















//









selesai@edit (mailto:selesai@edit) oleh Dr Iwan suwandy,MHA .









(http://www.intelihealth.com/IH/ihtIH/WSPEP000/23741/23741.html)







Alzheimers Disease

(http://www.intelihealth.com/IH/ihtIH/WSPEP000/8303/8303.html)

Special Harvard Commentary: The Potential of Stem Cells (http://www.intelihealth.com/IH/ihtIH/WSPEP000/8303/31904/399141.html? d=dmtICNNews)POTENSIAL DARI SEL PUNCA pENELITIAN sEL pUNCA YANG KONTAVERSIAL telah menjadi cerita halaman depan.The controversy over stem cell research has become a front page story. Penenuan apa yang berisi adalah segala tentang penemuan apa yang dikatakan Mencuri waktu.. Find out what the contention is all about. Thief of Time (http://www.intelihealth.com/IH/ihtIH/WSPEP000/8303/24299.html) Penyakit Alzhaemer pencuri waktu, dan tidak ada waktu untuk memperhatikan kekuasaan, posisi . Disini apa yang dapat dipelajari dari pengalaan Ronal Reagan dan keluarganya. Alzheimer’s disease is a thief of time, and it is no respecter of power, position or privilege. Here’s what we can learn from the experience of Ronald Reagan and his family. .

.

pusat infokes dr iwan

PUSAT INFOKES KESharini DIVISI”INFOihfro” September 26, 2010November 13, 2010 iwansuwandy PUSAT INFORMASI KESEHATAN Dr IWAN “KESharini”

Leave a comment

information sheet no. 3. The new Ihfro Congress info(Milan info special for the ihfro congress milan 2010 participant)the complete info click hhtp ://www.Driwancybermuseum.wordpress.com

SHOWCASE :

“The Milan Collections Exhibitions”

THE EXHIBITION DEDICATED THE ALL IFHRO CONGRESS MILAN 2010 PARTICIPANT

FRAME ONE : INTRODUCTION. The Indonesian ‘s IFHRO South East asia President and Team will join the Milan IFHRO Congress 2010 in November 2010(one of the member of that team is Mrs Lily W ,SKM,MM is the wife of Dr Iwan s ) .this is the new info of the congress. 1. Location of congress is moved New Venue: the Congress has been moved to Milan downtown MIC Milano Convention Centre, the most important congress centre in the north of Italy! BETTER INFORMATION FOR BETTER HEALTH IFHRO The International Federation of Health Records Organizations is affiliated with the World Health Organization (WHO) and it supports national associations to implement and improve health records and the systems which support them. . AIDOS The Associazione Italiana Documentazione Sanitaria is the Italian representative of IFHRO.

The ultimate news about: Health Information Management and Patient Safety Electronic Health Records, Electronic Medical Records, Patient Health Records Privacy and Security Health Information Management and Scientific Research Management and Integration of Care Monitoring and Evaluation of Health Classification systems, Clinical Coding and Data Quality Management and Quality of Medical Records

2. IHFRO Education day schedule IFHRO Education Day November 15, 2010 Milan, Italy 0900 am Welcome – Leonardo la Pietra, President AIDOS, Italy Introductions and Overview – Claire Dixon

Lee, USA and Kelly Abrams, Canada0920 am Panel Presentation – Exploration of Global Health Information Professional Education Yoo

kyung Boo, President, KMRA; Associate Professor, Eulji University, KoreaVicki Bennett, President, HIMAA, School of Population Health, University of Queensland, Australia Kelly Abrams, LOHIM Project, Canada Claire Dixon

Lee, Executive Director, CAHIIM, Global Model Curriculum1045 am Break 1100 am Mervat Abdelhak , University of Pittsburgh, USA– Computational Thinking andGenomics – Emerging Topics in Health Information Education 1130 am Leslie Gordon, Sitka, Alaska and Lynette Williamson, Oley, Pennsylvania, USA

Buildand Enhance an Online Course 1200 pm Lunch on your own 1315 pm Jennifer Nicol, School of Public Health, Queensland University of Technology, Australia Education and Training Framework for HIS 1415 pm Break 1430 pm Discussion on Global Health Information Education and Workforce Needs Participantsbreak into small groups with Education Day faculty to respond to key questions, identify issues and suggest action steps: a) Global issues in education and workforce b) Recommendations for IFHRO and member nations 1515 pm Groups report back and compile results 1600 pm Adjourn

National Standards for the structure and content of medical records.

The Medical Record Keeping Standards Programme of the Health Informatics Unit at the Royal College of Physicians, London. Prof. Iain Carpenter, Health Informatics Unit, Royal College of Physicians, London/Centre for Health Service Studies, University of Kent, Canterbury Mala Bridgelal Ram, Health Informatics Unit, Royal College of Physicians, London Professor John Williams, Director, Health Informatics Unit, Royal College of Physicians, London/ School of Medicine, Swansea University Patient medical records serve two principal purposes. The first is to support direct patient care by acting as an aide memoir for clinicians and supporting clinical decision making. The second is to provide a reliable source of data to support clinical audit, research, resource allocation and performance planning. In the UK, the link between the two is the coding of diagnoses and procedures during a hospital stay that is then returned centrally for analysis and publication in the Hospital Episode Statistics. We describe how the Health Informatics Unit at the Royal College of Physicians in London has co-ordinated the development of nationally agreed standards for the structure and content of medical records that have been agreed for all hospital specialties. The programme emerged from a project aiming to compare the performance of gastro-enterology services between hospitals by analysing Hospital Episode Statistics (HES). The study concluded that it was impossible, possibly because of errors in the coding of diagnoses and procedures imprecisely recorded in medical notes. An audit of 149 sets of medical notes from 5 hospitals found that there was such variability between hospitals in how records are structured and organised that a comparative audit was not possible. A subsequent literature search for evidence of the benefits of standardised medical notes, though patchy in coverage, demonstrated benefits to patient safety and care outcomes, as well as likely improvement in ease and accuracy of clinical coding. This initiated the Record Standards programme at the Health Informatics Unit (HIU). The national programme to develop an Electronic Patient Record (EPR) for the National Health Service (NHS) in England gave added weight and urgency to the work, as an EPR requires standardisation of data, ideally reflecting best clinical practice rather than requirements of a computer system. The goal was to develop consensus and evidence based structure and content standards for medical notes that would reflect professional best practice and be acceptable to all medical and surgical hospital services. Our first step was to draft content and process standards for medical records from both the literature review and a review of standards published by medical professional bodies. The standards covered generic issues applicable to all medical notes as well as headings to standardise the structure of admission, handover and discharge records. The HIU separated the generic and content standards and consulted widely, seeking the views of practising doctors and professional and policy bodies. Generic Medical Record Keeping standards were published by the College in 2007[1] (https://iwansuwandy.wordpress.com/wp-admin/post.php?post=3857&action=edit#_ftn1). The development of the admission, handover and discharge record keeping standards started with a poll of practising hospital doctors to gauge the enthusiasm for standardising notes structure. The question asked was ‘Should the same, standardised headings be used in the proforma for acute medical admissions in all NHS hospitals?’. In the first of these, conducted by Doctors.net, 2:1 responded in favour, a second poll, of Members and Fellows of the RCP found 4:1 in favour. Both polls were closed at 1,000 responses (Carpenter et al, 2007). With evident support for the proposal confirmed, examples of admission clerking documents from 36 NHS hospitals were used to produce draft headings which were then revised in a series of workshops and then put out to consultation in on-line questionnaire. The workshops and on-line questionnaires included patients and carers from the RCP Patient Carer Network. Over 3,000 doctors responded to the questionnaire and contributed over 1,500 written comments. Of those who responded to the questionnaire, over 90% were in favour of a common structure for the whole NHS. A further series of workshops and an updated literature review developed headings for use in documents to support handover between medical teams and in discharge documents for when patients leave hospital, the latter with specific input from General Practitioners in primary care. The on-line handover and discharge consultations each generated around 1,500 completed questionnaires. At the same time, the Presidents of the all the UK Medical Royal Colleges and specialist societies were contacted and asked to identify nominees who would examine, with their colleagues, the headings for the different types of records from the perspective of their own specialty. Their responses were fed into revised headings which were then used to structure paper proformas to test the headings in practice. The product of the exercise was piloted in hospitals [admission (10), handover(11) and discharge(8)], the discharge summary pilot included GPs who received discharge summaries using the standardised headings. On April 17th 2008, the final revised standards were ‘signed off’ by the Academy of Medical Royal Colleges, attended by the Presidents from all colleges, including surgical, mental health and child health. They were passed as fit for purpose with observations from psychiatry and paediatrics that although the information that they required was different from and additional to that covered by the standardised headings, their requirements could be accommodated within the proposed structure standards. The standards have now been submitted to NHS Connecting for Health which is responsible for the development of the EPR in England. Work on definitions that will meet the rigorous requirements for IT implementation is underway. Once completed they will be submitted to the NHS Information Standards Board for Health and Social Care following which all IT system suppliers will be required to use them for their EPR solutions. Many hospitals and IT suppliers are already implementing them in both paper and electronic format. The project has been enthusiastically received by a very wide range of organisations including the IT industry which see them as the means for rationalising their clinical information system applications. The NHS Litigation Authority, which provides the clinical incident indemnity for NHS providers, are incorporating them into their Risk Management Standards for providers and the NHS Care Quality Commission who register all NHS providers will reference them in their standards required for registration. They are being incorporated into the medical undergraduate and post graduate training curricula and will likely be referenced in the General Medical Council ‘Tomorrow’s Doctors’ standards document that describes the standards for knowledge, skills, attitudes and behaviours that medical students should learn at UK medical schools. The standards are recommended for use in IT systems in Scotland and are being introduced in Wales. The NHS Digital and Health Information Policy Directorate has published a two part clinician’s guide to the standards. v Part 1 describes the rationale for the process of developing and introducing the national professional record keeping standards. It also lists the expected benefits from their introduction. v Part 2 contains the Generic Medical Record Keeping Standards and the structure and content standards for admission, handover and discharge documents. The Guide can be downloaded as pdf’s or free hardcopies ordered on line at : www.rcplondon.ac.uk/clinical-standards/hiu/medical-records/Pages/clinicians-guides.aspx (http://www.rcplondon.ac.uk/clinical-standards/hiu/medical-records/Pages/clinicians-guides.aspx)

[1] (https://iwansuwandy.wordpress.com/wp-admin/post.php?post=3857&action=edit#_ftnref1) Carpenter, Iain; Bridgelal Ram, Mala; Croft, Giles P; Williams, John G, 2007. Medical records and record-keeping standards. Clinical Medicine: 7(4):328-331 3. Milan flea Market Info (happy shooping) Milan Markets / Mercato (Milan, Italy) // // Full of character and real life, the busy markets in Milan, Italy are an integral part of Milanese local life. They provide a great place to find bargains in Milan or just browse around the wide variety of stalls and enjoy the exciting atmosphere and local market banter. Milan’s bustling markets range from the very large to the small, discreet collection of stalls, situated in small squares in Milan. They are held in many districts of Milan and provide a fun way to shop, for both experienced and novice bargain hunters alike. Here are some of the main markets in Milan that are worth a visit. Fiera di Senigallia – Via Calatafimi, Milan, Italy Every Saturday along the small lake of Darsena is the long established Fiera di Senigallia flea market. Here you will find many bargains, including clothes, military items, jewellery and much more besides DrIwan cybermuseum will add the historic collections of Milan which found before and after the meetings for all the Health Information’s Experxt and Practitioner which join the IHFRO congress Milan 201o. Dr Iwan s hope this info of the Milan collections exhibitions will help all the IHFRO MIlan congress participant to know more info about MIlan City and they will seen that famous and legend city with city tour. Greeting dan happry congress from the founder of cybermuseum Dr Iwan Suwandy,MHA FRAME : THE MILAN HISTORIC COLLECTIONS EXHIBITION Milan Milano — Comune (http://en.wikipedia.org/wiki/Comune) — Comune di Milano

(http://en.wikipedia.org/wiki/File:Milano_1.jpg) A collage of Milan: A characteristic tramway to the top left, followed by a panorama of the city seen from the top of the Duomo, the FieraMilano (http://en.wikipedia.org/wiki/FieraMilano) complex, the Palazzo Lombardia (http://en.wikipedia.org/wiki/Palazzo_Lombardia), the exterior of the Duomo, the Naviglio Grande (http://en.wikipedia.org/wiki/Naviglio_Grande) neighborhood, the Teatro alla Scala and the triumphal arch of the Galleria Vittorio Emanuele II (http://en.wikipedia.org/wiki/Galleria_Vittorio_Emanuele_II).

(http://en.wikipedia.org/wiki/File:Flag_of_Milan.svg) Flag (http://en.wikipedia.org/wiki/Flag_of_Milan) (http://en.wikipedia.org/wiki/File:CoA_Citt%C3%A0_di_Milano.svg) Coat of arms

(http://en.wikipedia.org/wiki/File:Italy_location_map.svg) Milan Location of Milan in Italy Coordinates: 45°27¢51²N 09°11¢25²E / 45.46417°N 9.19028°E / 45.46417; 9.19028 (http://toolserver.org/~geohack/geohack.php? pagename=Milan¶ms=45_27_51_N_09_11_25_E_)Coordinates (http://en.wikipedia.org/wiki/Geographic_coordinate_system): 45°27¢51²N 09°11¢25²E / 45.46417°N 9.19028°E / 45.46417; 9.19028 (http://toolserver.org/~geohack/geohack.php?pagename=Milan¶ms=45_27_51_N_09_11_25_E_) Country

Italy (http://en.wikipedia.org/wiki/Italy)

Region (http://en.wikipedia.org/wiki/Regions_of_Italy)

Lombardy (http://en.wikipedia.org/wiki/Lombardy)

Province (http://en.wikipedia.org/wiki/Provinces_of_Italy)

Milan (http://en.wikipedia.org/wiki/Province_of_Milan) (MI)

Government – Mayor

Letizia Moratti (PdL (http://en.wikipedia.org/wiki/List_of_political_parties_in_Italy))

Area (http://en.wikipedia.org/wiki/Area) 183.77 km2 (71 sq mi)

– Total

Elevation (http://en.wikipedia.org/wiki/Elevation) 120 m (394 ft) Population (31 March 2010)[1] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-0) – Total

1,310,320

– Density (http://en.wikipedia.org/wiki/Population_density)

7,130.2/km2 (18,467.2/sq mi)

Demonym (http://en.wikipedia.org/wiki/Demonym)

Milanès/Milanese

Time zone (http://en.wikipedia.org/wiki/Time_zone)

CET (http://en.wikipedia.org/wiki/Central_European_Time) (UTC+1)

– Summer (DST (http://en.wikipedia.org/wiki/Daylight_saving_time))

CEST (http://en.wikipedia.org/wiki/Central_European_Summer_Time) (UTC+2)

Postal code

20100, 20121-20162

Dialing code (http://en.wikipedia.org/wiki/Area_codes_in_Italy)

02

Patron saint

Ambrose (http://en.wikipedia.org/wiki/Ambrose)

Saint day

December 7 (http://en.wikipedia.org/wiki/December_7)

Website

Official website (http://www.comune.milano.it/)

Milan (Italian (http://en.wikipedia.org/wiki/Italian_language): Milano, (http://en.wikipedia.org/wiki/File:It-Milano.ogg) listen (http://upload.wikimedia.org/wikipedia/commons/e/ed/ItMilano.ogg) (help (http://en.wikipedia.org/wiki/Wikipedia:Media_help)·info (http://en.wikipedia.org/wiki/File:It-Milano.ogg)) Italian pronunciation: [mila()no] (http://en.wikipedia.org/wiki/Wikipedia:IPA_for_Italian); Western Lombard: Milan, (http://en.wikipedia.org/wiki/File:Milan.ogg) listen (http://upload.wikimedia.org/wikipedia/en/1/15/Milan.ogg) (help (http://en.wikipedia.org/wiki/Wikipedia:Media_help)·info (http://en.wikipedia.org/wiki/File:Milan.ogg))) is a city (http://en.wikipedia.org/wiki/City) in Italy (http://en.wikipedia.org/wiki/Italy) and the capital (http://en.wikipedia.org/wiki/Capital_city) of the region (http://en.wikipedia.org/wiki/Regions_of_Italy) of Lombardy (http://en.wikipedia.org/wiki/Lombardy) and of the province of Milan (http://en.wikipedia.org/wiki/Province_of_Milan). The city proper has a population of about 1,310,000, while the urban area is the largest in Italy and the fifth largest (http://en.wikipedia.org/wiki/Largest_urban_areas_of_the_European_Union) in the European Union (http://en.wikipedia.org/wiki/European_Union) with a population of 4,345,000 over an area of 2,370 km2 (915 sq mi).[2] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-1) The Milan metropolitan area (http://en.wikipedia.org/wiki/Milan_metropolitan_area), by far the largest in Italy, is estimated by the OECD (http://en.wikipedia.org/wiki/Organisation_for_Economic_Co-operation_and_Development) to have a population of 7,400,000.[3] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-2) The city was founded under the name of Medhlan,[4] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-InternationalStudent-3) by the Insubres (http://en.wikipedia.org/wiki/Insubres), Celtic (http://en.wikipedia.org/wiki/Celts) people. It was later captured by the Romans in 222 BC, and the city became very successful under the Roman Empire (http://en.wikipedia.org/wiki/Roman_Empire). Later Milan was ruled by the Visconti (http://en.wikipedia.org/wiki/Visconti), the Sforza (http://en.wikipedia.org/wiki/House_of_Sforza), the Spanish (http://en.wikipedia.org/wiki/Spain) in the 16th century and the Austrians (http://en.wikipedia.org/wiki/Austria) in the 18th century. In 1796, Milan was conquered by Napoleon I (http://en.wikipedia.org/wiki/Napoleon_I) and he made it the capital of his Kingdom of Italy (http://en.wikipedia.org/wiki/Kingdom_of_Italy_(Napoleonic)) in 1805.[5] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-britannica.com-4)[6] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-World-5) During the Romantic period (http://en.wikipedia.org/wiki/Romanticism), Milan was a major cultural centre in Europe, attracting several artists, composers and important literary figures. Later, during World War II (http://en.wikipedia.org/wiki/World_War_II), the city was badly affected by Allied bombings, and after German occupation in 1943, Milan became the main hub of the Italian resistance.[5] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-britannica.com-4) Despite this, Milan saw a post-war economic growth, attracting thousands of immigrants from Southern Italy and abroad.[5] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-britannica.com-4)

An international (http://en.wikipedia.org/wiki/International) and cosmopolitan (http://en.wikipedia.org/wiki/Cosmopolitanism) city, 13.9% of Milan’s population is foreign born.[7] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-Official_ISTAT_estimates-6) The city remains one of Europe’s main transportation[8] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-7) and industrial hubs, and Milan is the EU (http://en.wikipedia.org/wiki/European_Union)‘s 10th most important centre for business (http://en.wikipedia.org/wiki/Business) and finance (http://en.wikipedia.org/wiki/Finance) (2009)[9] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-8) with its economy (see economy of Milan (http://en.wikipedia.org/wiki/Economy_of_Milan)) being the world’s 26th richest by purchasing power,.[10] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-9) The Milan metropolitan area (http://en.wikipedia.org/wiki/Milan_metropolitan_area) has Europe’s 7th GDP in 2008.[11] (http://en.wikipedia.org/wiki/History_of_Milan#cite_notehttp:.2F.2Fen.wikipedia.org.2Fwiki.2FList_of_metropolitan_areas_in_the_European_Union_by_GDP-10) The province of Milan (which increasingly is becoming a single administrative urban unit to supersede the limited commune) had a GDP pp per capita of around €40,000 in 2007 (161% of the EU 27 average) which was the highest of any Italian province [12] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-ilsole24ore.com-11) (Il Sole 24 Ore Quality of life survey 2008) and the city’s workers have the highest average income rates in Italy,[12] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-ilsole24ore.com-11) and 26th in the world.[13] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-citymayors.com12) In addition, Milan is the world’s 11th most expensive city for expatriate employees,[14] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-13) and according to a 2010 study by the Economist Intelligence Unit (http://en.wikipedia.org/wiki/Economist_Intelligence_Unit), the city is the world’s 12th most expensive to live in.[15] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-14) Its economic environment has made it, according to several studies, the world’s 20th and Europe’s 10th top business and financial centre,[16] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-ReferenceB-15)[17] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-citymayors1-16) having been highly successful in terms of city branding.[18] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-citymayors2-17) Milan is recognised as a world fashion (http://en.wikipedia.org/wiki/Fashion_in_Milan) and design (http://en.wikipedia.org/wiki/Design) capital, with a major global influence in commerce (http://en.wikipedia.org/wiki/Commerce), industry (http://en.wikipedia.org/wiki/Industry), music (http://en.wikipedia.org/wiki/Music_of_Milan), sport (http://en.wikipedia.org/wiki/Sport), literature (http://en.wikipedia.org/wiki/Literature), art (http://en.wikipedia.org/wiki/Art) and media (http://en.wikipedia.org/wiki/Mass_media), making it one of GaWC (http://en.wikipedia.org/wiki/Global_city)‘s major Alpha world cities (http://en.wikipedia.org/wiki/Global_city).[19] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-lboro.ac.uk-18) The Lombard metropolis is especially famous for its fashion (http://en.wikipedia.org/wiki/Fashion) houses and shops (such as along Via Monte Napoleone (http://en.wikipedia.org/wiki/Via_Monte_Napoleone)) and the Galleria Vittorio Emanuele (http://en.wikipedia.org/wiki/Galleria_Vittorio_Emanuele_II) in the Piazza Duomo (reputed to be the world’s oldest shopping mall (http://en.wikipedia.org/wiki/Shopping_mall)). The city has a rich cultural (http://en.wikipedia.org/wiki/Culture_of_Milan) heritage and legacy, a vibrant nightlife (http://en.wikipedia.org/wiki/Nightlife),[20] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-Milan_Nightlife-19)[21] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-20) and has a unique cuisine; it is home to numerous famous dishes, such as the Panettone (http://en.wikipedia.org/wiki/Panettone) Christmas cake and the risotto (http://en.wikipedia.org/wiki/Risotto) alla Milanese. The city has a particularly famous musical, particularly operatic, tradition, being the home of several important composers (such as Giuseppe Verdi (http://en.wikipedia.org/wiki/Giuseppe_Verdi)) and theatres (such as the Teatro alla Scala (http://en.wikipedia.org/wiki/La_Scala)). Milan is also well-known for containing several important museums, universities, academies, palaces, churches and libraries (such as the Academy of Brera (http://en.wikipedia.org/wiki/Brera_Academy) and the Castello Sforzesco (http://en.wikipedia.org/wiki/Castello_Sforzesco)) and two renowned football teams: A.C. Milan (http://en.wikipedia.org/wiki/A.C._Milan) and F.C. Internazionale Milano (http://en.wikipedia.org/wiki/F.C._Internazionale_Milano). This makes Milan the 52th Europe’s tourist destination, with over 1.914 million foreign arrivals to the city in 2008.[22] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-euromonitor1-21) The city hosted the 1906 World Exposition and will host the 2015 Universal Exposition(complete info look at dr iwan Cybermuseum ,please click hhtp://www.Driwancybermuseum.wordpress.com).[23] (http://en.wikipedia.org/wiki/History_of_Milan#cite_note-MilanTourist-22) DIVISI INFORMASI IHFRO (INFOihfro)

(https://iwansuwandy.files.wordpress.com/2010/09/ihfro-logo.jpg)logo IHFRO KETUA DIVISI : Lily Widjaya,AMdPK,SKM,M INFO no 002 KONGRESS IFHRO MILANO 2010 LOCATION OF THE CONGREES MOVE TO MILAN CONVENTION CENTER The 16th IFHRO Congress “in collaboration with the World Health Organization” New Venue: the Congress has been moved to Milan downtown MIC Milano Convention Centre, the most important congress centre in the north of Italy! BETTER INFORMATION FOR BETTER HEALTH IFHRO The International Federation of Health Records Organizations is affiliated with the World Health Organization (WHO) and it supports national associations to implement and improve health records and the systems which support them. . AIDOS The Associazione Italiana Documentazione Sanitaria is the Italian representative of IFHRO.

The ultimate news about: Health Information Management and Patient Safety Electronic Health Records, Electronic Medical Records, Patient Health Records Privacy and Security Health Information Management and Scientific Research Management and Integration of Care Monitoring and Evaluation of Health Classification systems, Clinical Coding and Data Quality Management and Quality of Medical Records

Under the Auspices of: (http://www.salute.gov.it/) (http://www.federsanita.it/)

(http://www.innovazionepa.gov.it/)

(http://www.anmdo.org/)

(http://www.comune.milano.it/)

(http://www.fism.it/)

(http://www.regionelombardia.it/)

(http://www.aiom.it/)

(http://www.sitinazionale.it/)

Supporting Partners: (http://www.ahima.org/)

(http://www.clinicalmatrix.com/)

(http://www.ihrim.co.uk/) (http://www.imia.org/) (http://www.nchirt.qut.edu.au/)

(http://www.cocir.org/)

(http://www.worldofhealthit.org/)

(http://www.dvmd.de/)

(http://www.ehtel.org/)

(http://www.sph.uq.edu.au/)

(http://www.himaa.org.au/)

(http://www.kmra.or.kr/)

(http://www.medinfo2010.org/)

INFO NO 001 KONGRES IHFRO MILANO 2010

(https://iwansuwandy.files.wordpress.com/2010/09/ihfro-congress-2010.jpg) TEMPAT : GEDUNG STELLA FOLARE KOTA MILAN

(https://iwansuwandy.files.wordpress.com/2010/09/stella-folare-convention-building.jpg) (https://iwansuwandy.files.wordpress.com/2010/09/interrior-conference-room-milan-stellafolare.jpg)

Peta gedung konperensi stella Folare Milan

(https://iwansuwandy.files.wordpress.com/2010/09/fieramilano_map_en.jpg)

(https://iwansuwandy.files.wordpress.com/2010/09/stella-folare-convention-ihfro-milan.jpg) TANGGAL: 15-19 NOPEMBER 2010 DELEGASI INDONESIA YANG DIRENCANAKAN: DIREKTUR DAN SEKRETARIS IHFRO SOUTHEASTASIA REGION. INFO PESERTA LAIN AKAN DIINFORMASIKAN LEBIH LANJUT. info sheet 002 : ihfro educations informations 1. The cause of death info CORE CURRICULUM UNDERLYING CAUSE OF DEATH CODERS INCLUDING LEARNING OBJECTIVES This core international curriculum describes entry-level requirements. Its purpose is to provide a basis for education for all countries. Availability of resource materials and essential references needed for coding Full set of ICD-10 (Tabular List, Instructions, and Index) (current edition as updated by WHO) Periodic official WHO updates to ICD-10 Medical dictionary Training materials relevant to core curriculum Drug references Abbreviation list Contact person to ask questions 1. Knowledge of basic medical science Intent: To develop an understanding of medical terminology that will be encountered in cause of death statements, the structure and function of the human body and the nature of disease Medical terminology (A study of common medical terms related to major disease processes.) Basic anatomy (A study of the structure of the human body utilizing a system approach.) Basic physiology (A study of the functions affecting the human body.) Concept of etiology and risk factors Basic pathology (A study of the causes and nature and effects of diseases.) At the conclusion of this module, the coder should be able to: spell and define medical terms as well as explain the concepts of root/suffix/prefix word builds identify the normal structure and function of all human body systems name the typical causes, diagnosis, and treatment of common diseases define the concept of etiology and its relationship to risk factors state the nature and course of alterations in structure produced by etiological agents and mechanisms of the body 2. Legal/Ethical issues relevant to the country in which coding is being done Intent: To introduce legal and ethical issues applicable to health information, its collection and release. Privacy and confidentiality principles (see appended proposed principles) Use of person-identifiable information Adherence to relevant laws and regulations Access to person-identifiable information Release of information Professional ethics At the conclusion of this module, the coder should be able to: apply policies and procedures for access and disclosure of personal health information utilize current laws and regulations related to health information initiatives release patient-specific data to authorized users practice and promote ethical standards of practice 3. General uses of underlying cause of death data Intent: To explain the purposes for which underlying cause of death data are collected and how they are used. Context in which coding is done Purposes for coding Statistical outputs Evidence for health policy Planning and evaluating health services and programs Medical and public health research Clinical education At the conclusion of this module, the coder should be able to: list the common reasons underlying cause data are collected describe the general uses of underlying cause of death data 4. Specific uses of underlying cause of death data Intent: To introduce the specific uses of coded mortality data Health situation and trend analysis Leading causes of death Definition of policies and priorities Planning health programs and services Health indicators Trend analyses A critical element to identify: Public health problems Groups at risk Needs of medical and sanitary research First or main source of information for certain diseases At local level, investigation of cases, disease control measures Specific population groups/problems (e.g., maternal and infant mortality, adolescents, elderly) Quality of care Outcomes of specific programs Different technologies Epidemiological surveillance (all listed causes) Evaluation in health At the conclusion of this module, the coder should be able to: enumerate specific uses for underlying cause of death data 5. Users of mortality data Intent: To explain the different groups and stakeholders who are users of mortality data. Epidemiologists Statisticians Program managers Actuaries Policy makers Researchers Demographers Educators and students International organizations (World Health Organization, United Nations) At the conclusion of this module, the coder should be able to: name specific users of underlying cause of death data 6. Sources of Mortality Data Intent: To explain the roles of the different persons responsible for reporting data on the deceased and the sources of that data. Providers of data (e.g., medical officers, coroners, medical examiners, funeral directors, and other informants) Source documents (e.g., death certificates, police reports, coroner reports, and other reports) At the conclusion of this module, the coder should be able to: state the various roles of the individuals reporting data on the deceased relate the provider of data with the source verify completeness, accuracy, and appropriateness of data and data sources 7. The International Classification of Diseases (ICD) Intent: To develop an understanding of the ICD and to develop the knowledge and skills that are necessary to assign valid codes for causes of death. Nomenclature and Classification International context WHO Family of International Classifications Reference Classifications (ICD and International Classification of Functioning, Disability and Health [ICF]) Derived and related classifications Standardization and comparability History of the classification Structure of classification Updating mechanisms of classification At the conclusion of this module, the coder should be able to: distinguish a nomenclature from a classification describe the WHO Family of International Classifications and their relationships to each other discuss the history of the classification state the structure of the classification explain the classification’s update process 8. How to code Intent: to provide detailed instruction and experience on how to apply the coding rules and assign codes. How to use different volumes of the ICD Concept of underlying cause of death Definition International format of medical certificate of cause of death Rules, instructions and conventions for coding underlying cause of death Appropriate exercises in selection and coding At the conclusion of this module, the coder should be able to: apply diagnosis codes using ICD-10 adhere to current established guidelines in code assignment 9. Quality Assurance Intent: To raise awareness about the various factors that influence the quality of coded data and describe techniques for assuring the highest quality data possible. Quality of source documents Querying processes (e.g., sequencing on certificate, what and how to query) Editing and validation Timeliness, completeness and accuracy Responsibility for data quality Processes for accessing expert advice At the conclusion of this module, the coder should be able to: conduct analysis to ensure documentation in the record supports the diagnosis validate coding accuracy using clinical information found on certificates resolve discrepancies between coded data and supporting documentation the end @copyright Dr iwan suwandy,MHA 2010 pusat infokes dr iwan

PUSAT INFOKES DIVISI “KESpormiki” September 26, 2010October 15, 2010 iwansuwandy PUSAT INFORMASI KESEHATAN Dr IWAN( KESharini)

Leave a comment

DIVISI PORMIKI (KESpormiki)

(https://iwansuwandy.files.wordpress.com/2010/09/logo-pormiki.jpg) KEPALA DIVISI ; Lily Widjaya,Amdpk,SKM,MM 1.Info No, 003 Pada hari ini juma’t 15 Oktober 2010, Direktur program Apikes EsaUnggul Jakarta ulang Tahun, Pimpinan Dan staf PUSINFOKES Harini mwngucapkan selamat uang Tahun, semoga panjang Umur dan tambah rezeki serta tetap awet muda. 2.Info no 002 Pada hari kemis tanggal 14 Oktober, Universitas Esa unggul tealh memwisuda lulusan Apikes dengan gelar AMdPK ,Dir Program Ibu Liliy Widjaya,AMDPk,SKM,MM menyerahkan ijazah stelah diambil sumpah sebemumnya, dihadiri rektor Esa Unggul dan pembantu Rektor Ibu DR Roro MHA,PhD. 3. INFO NO.001 RAPAT KURIKULUM KBK TANGGAL : 1-3 OKTOBER 2010. TEMPAT : JOGYA PESERTA : a. PORMIKI PUSAT : Ketua Pormiki Pusat dengan staf, b. APIKES SE-INDONESIA ALAMAT PANITIA RAPAT : ACARA : a. Rapat Kurikulum Apikes berdasarkan KBK, 2. INFO NO.002 Rapat Panitia JUKNIS Rekam Medis TANGGAL DAN TEMPAT : SAMA DENGAN RAPAT APIKES(Peserta dan lokal berbeda) 3. info no.3 : Pertanyaan Tentang Tugas Keprwatan dalm rekak medis dalm bahasa Inggris dan sudah dietrjemahkan secara bebas. Q: What do you think there is a shortage of healthcare personnel today? What professions are most affected? What do you think there is a shortage of healthcare personnel today? What professions are most affected? (http://answers.yahoo.com/question/?qid=20080209194743AAMQaS1) P Apakah yang anda pikir tentang kekurangan personisl pelayan kesehatan hari ini? Profesi apa yang terbanyak timbulkan kendala? A: I believe it is nursing. Nurses provide the bulk of the primary care in hospital, nursing homes and emergency rooms. Doctors prescribe and write orders, but it is up to the nurses to carry out the orders. If there are too few nurses, the ones who are working put in too many hours and may make mistakes. They measure up dosages of powerful , including to do the Medical record health information inpu daat in the heelth information komputer paperless sistem, can done the mistake too. J: Saya yakin adalah Perawat. Perawat meyediakan selumlah besar pelayan primier di Rumash sakit, perawatan kerumah dan rawatan Gawat darurat emergensi. Dokter menulis resep dan memberikan perintah, tetapi tergantung pada perawat dalam melaksankan perintah tersebut,mereka akan bekerja dalam waktu yang lama dan dapt membuat kesalahan. Mereka mengukur kekuatan dosis.termasuk juga tugas menginput data rekam medis ke dalam sistem komputerisasi informasi kesehatan tanpa kertas RS, kadang-kadang dapat juga membaut kesalahan. (perlu mendapat perhatian bagi Rumah sakit yang baru mengembangkan sistem infomasi kesehata”paperless’ tersebut, sejogyanya mengunakan tenaga komsultan ahli, jangan dibuarkan petugas rekam medis lulusan Apikes yang yunior dan belum menguasai teknologi tersebut melaksanaknnya, pasti akan menimbnulkan kesulitan dan timbunan rekam medis secara tertulis,juga adanya pihak medis yang kurang senang akan teknologi tersebut akibat tidak mau mengikuti perkembangan sistem Informasi kesewhatn rumah sakit paperless, kendatipun demikian beberapa RS besar dijakarta sudah mulai memanfaat tenaga ah;i dibidang tersebut, bila masih binggung hubungi kepala devisi KESformiki ini, sebagi pakar pertama lulusan Indonesia-Dr Iwan spenemu KESharini pusinfokes duniamaya) selesai. pusat infokes dr iwan

PUSINFOKES DR IWAN”KESharini” Divisi INFOAutism September 26, 2010September 26, 2010 PUSAT INFOKES Dr IWAN ” KEasharini”

iwansuwandy

6 Comments

DIVISI INFOautism INFORMASI INFO NO. 1.(kode RM – IA-IW-001) I. AUTISM MEMBUAT ORANG TUA BINGGUNG oleh Dr Iwan Suwandy@hakcipta (mailto:Suwandy@hakcipta) 2010. I. PENDAHULUAN AUTISM MEMBUAT ORANG TUA BINGUNG Autism suatu kelainan yang membaut orang tua di Indonesia jadi binggung, penelitian penyebab kelainan tersebut sudah mulai ada hasilnya, oleh karena itu Dr Iwan telah mendirikan Pusat Informasi Autism di dunia maya dengan latarbelakang , Hasil Penelitian dan Metode Penangulangan sebagai berikut : I.LATAR BELAKANG 1. Autism menyebabkan banyak Orang Tua di Indonesia jadi binggung. menurut penelitian satu dari dua ratus anak didunia mengalami Autism,para peneliti dunia berusaha keras untuk menjawab pertanyaan apakah penyebab dan cara mengatasinya . Kontak mata antara Ibu dan anak Autism adalah langkah pertama yang segera dan harus dimulai sedini mungkin ,lihat illustrasi *il 001, maaf seluruh illustrasi autism bule , sulit diperoleh dari bangsa Indonesia (courtecy Autism today,Pimpinan Karen Simmons) *ill 001

*ILL 001 2. Oleh karena keluarga besar ada yang mengalami Autism, Dr Iwan S telah melakukan penelitian pribadi selama tujuh tahun. Tahun ini memeproleh komunikasi didunia maya dengan Karen Simmons pemimpin lembaga penerbit “Autism Today” , akhirnya tahun 2010 ditemukan oleh para pakar didumia dan Dr IWAN S proses perkembangandan telah metode modern mengatasi AUTISM. 3. Mekanisme proses perkembangan dan Metode modern mengatasi Autism tersebut telah di sebarluaskan didunia maya oleh Karen simmons “Autism Today” dan juga oleh Dr IWAN S web blog nya dengan alamat hhtp://www.iwansuwandy.wordpress.com ,judul PUSAT INFORMASI AUTISM Dr IWAN SUWANDY, cari (search) ”pusat info autism” 4. Pusat Informasi tersebut bila mendapatkan response akan ditingkatkan menjadi blog sendiri, sementara informasi di sampaikan liwat web blog Dr Iwan Suwandy,MHA dengan info (1) ,(2) dan seterusnya. II PERKEMBANGAN PUSAT INFORMASI AUTISM 1.Dr Iwan S. melakukan penelitian kepustakaan dan liwat info Autism Today secara pribadi dan langsung memberikan info kepada keluarga besar, agar secepat mungkin upaya dimulai karena bila terlambat sangat sulit untuk berhasil. 2. Setelah memperoleh hasil dalam keluarga besar, timbul ide untuk mensosialisasikan liwan dunia maya, dan pada tanggal 17 September 2010 secara resmi Pusat Informasi dibuka (sof opening) selama satu tahun, bial banyak tanggapan dan dukungan maka akan dibuat satu blog dunia maya khusus. III. HASIL PENELITIAN PROSES PERKEMBANGAN AUTISM .1.Pendapat Pakar anggota “ Autism Today” Autism adalah suatu perkembangan yang tidak biasa dari fungsi otak yang terjadi satu dari 166 anak., akar permasalahan belum diketahui, dan perlu penelitian lebih lanjut dalam bidang ini untuk mambantu ribuan keluarga yang mengalami situasi ini. 2. Pendapat Dr Iwan S (sesuai dengan tulisan yang sudah diterima Autism Today melalui Karen Simmons) a.Permeriksaan Ilimiah adalah tahap pertama mengatasi autism Batang otak pusat pengaturan segalia umpan balik reaksi manusia terhadapt rangasangan baik dari luar dan dalam tubuh dalam keadaan normal. b. Alat anatomi autism normal ,Funsi berbeda dengan anak normal. Autism tidak abnormal tetapi memiliki sistem yang berbeda , lebih cangih dari manusia biasa, sistem umpan baliknya berfungsi lebih cepat sehingga bila Info yang banyak tiba sekaligus dipusat umpan baliknya di batang otak *ill 002

*ill 002 , ia masih belum memiliki pengalaman, ibarat seorang anak di perlihatkan sekaligus bermacam-macam jenis hewan dan tanaman sekaligus,tentu ia jadi binggung mau komentar yang mana, anak autism memilih diam dan bergerak hiperaktif ,aksi kekesalan. .V. HASIL PENELITIAN METODE PENANGULANGAN AUTISM Autism bukan Penyakit ,tetapi Perbedaan fungsi sistem Batang Otak.Dr Iwan penganut paham ini berpendapat : 1.Lebih dini lebih mudah diatasi karena bila terlambat , sistem elektronik di otaknya sudah macet alias hang . 2.Deteksi sedini sejak bayi, perilaku autism lebih aneh , bila tidur nyenyak sekali, tapi bila sadar nangis dan gerakannya luar biasa, ibarat mobil dia mobil balap seluruhnya serba cangih dan cepat. 3. langkah pertama sesuaikan diri, tataplah matanya dengan langsung secara kasih sayang*ill 003 untuk membangun komunikasi.



*ill 003

4. lakukan permainan bersama dan bila sukses beri hadiah tepukan tanggan dengan tatapan mata mesra. Jenis permainan antara lain memilih warna bola, jenis kotak-kotak, berbagai huruf serta angka-angka. Dapat juga dengan alat permainan sketeboard * ill 004



*ill 004

Bila permainan gembira itu secara kontiniu dilaksanakan pasti ada banyak kemajuan. bila sudah berumur lima tahun permainan games yang cepat dan sulit sangat memberikan kesenangan pada mereka*ill 005

*il 005 5. Jangan sekolah dengan murid banyak , timbul rasa kesal dan teman diserang atau teriak-teriak. Harus belajar dalam kelompok terbatas maksimal sepuluh oramg , tak perlu disekolah luar biasa seprti mendidik anak cacat. 6.Anak Autism adalah manusia luarbiasa, umumnya bila ditangani sejak dini memiliki kecerdasan khusus yang super , seprti main musik piano,biola atau harpa serta gitar sebab perasaan hatinya disalurkan liwat instrumen itu atau dapat juga liwat melukis, hitung matematik sangat luarbiasa , sangat tepat untuk profesi akuntansi, sekuriti dimana motonya sedikit bicara banyak aksi, diluar negeri adanya yang lulus S3. VI.CONTOH KASUS AUTISM YANG SANGAT CERDAS DAN HIPERAKTIF Seorang anak lelaki umur empat tahun telah membuat orang tuanya menyerah karena sangat bawel dengan berbagai pertanyaan singkat dan sulit serta tidak setaraf dengan umurnya, sampai dibawa ke psikiater dan psikolog anak, diperiksa tak ada kelainan, oleh para pakar tersebut diminta sabar-sabar bu anaknya punya I Q seratus enam puluh ,sangat luar biasa, ia selalu tanya hal sulit untuk dijawab orang tuanya. Suatu hari Sang cilik cerdas itu bertemu Dr iwan, aneh tiga hari dua malam, ia jadi tenang malah bisa tidur nyenyak, kendatipun selama ini sulit tidur sampai sang ibu dan bapa bergantian bercerita sampai ketiduran sedang si anak masih melek. Apa rahasianya, ceritakan dan tanya hal yang istimewa ,pertanyaan dan cerita yang tidak semua orang dewasa dapat memahaminya seperti : (a) Mengapa pesawat ulang alik luar angkasa , terbang keliling dunia tidak membawa bahan bakar? Sang cilik cerdas tersebut tertegun , kontak matanya mulai ada sebab ada yang ia inginkan ,hal ini penting sebab setiap misteri pasti mengundang perhatian.Setelah dijelaskan, baru sang cilik kagum dan mulai sayang pada opa (b) Malam hari mau tidur bareng, untuk minta cerita lain lagoi. Malamnya ditempat tidur, Opa bertanya , apa beda Tokek dengan Cecak ? ia tak tahu jadi komunikasi sangat erat, setelah diceritakan perbedaannya ia sangat senang sampai senyum-senyum , lalu saat opa Iwan berkata tidur dulu ya, opa sudah cape ,mau tidur biar kuat besok sambung cerita lagi, dengan perlahan ia meninggalkan kamar dan tidur nyenyak , Keesokan hari , pagi sudah bangunkan opa untuk cerita versi baru, Ia sangat Pintar ,namanya Ega,cucu saudara isteri Dr iwan, sikapnya seperti umur lebih dari 12 tahun. Waktu Opa waktu mau pulang , Ega mau ikut, tapi dibujuk bahwa nanti ke Jakarta buat ketemu opa lagi, baru senyum dan ucapkan selamat jalan , Ega sayang opa . Selesai @Hakcipta Dr Iwan Suwandy,MHA 2010. VII.INFO BARU DARI “AUTISM TODAY” courtecy Karen Smmons I. Komunikasi dengan Karen dsrti Autism Today . Bulan Agustus 2010, pemimpin Autism Today mengirim SMS ke e-mail Dr Iwan s. untuk menulis artikel tentang Autism lihatlah dua SMS tersebut : a. Dapatkah anda menulis? Karen simmons menyatakan dala e.mailnya bahwa suara anda sangat diperlukan untuk didengar oleh keluarga Penderita dan para pakar autism. kami merasa terhormat anda sebagai bagian dari perkembangan anggota. Juga, jika anda telah bertanya apa yang anda akan tulis, kemudian secara senang hati, sepanjang memberikan bantuan kepada komunitas kami dan Tamu kami, kami ingin Suara Anda untuk didengar oleh semau orang ! dan diberikan beberapa contoh topik yang perlu ditulis. Can you write?(dapatkah Anda menulis?) InboxX Reply |Karen to me (Balas/ Karen kepada saya) show details Aug 24 Dear iwansuwandy, Thank you, you have helped us realize how much your voice counts and really needs to be heard by all the parents and professionals in the special needs community.(terima kasih, anda telah membantu kami merealisasikan betapa banyaknya suara dihitung dan benar-benar diperlukan untuk mendengar dari seluruh orang tua dam profesional dalm suatu komunitas yang diperlukan) You’ve told us you’re honoured to have been asked, and honestly, we’re quite honoured to have you as part of our expanding membership. Also, if you’ve asked what you should write about, then honestly, as long as it’s helpful to our community and appropriate for our audience, we want YOUR voice to be heard by all!( Anda telah memberitahu kami bahwa anda merasa terhormat untuk ditanya, kami merasa terhormat anda sebagai bagian dari perkembangan anggota. Juga, jika anda telah bertanya apa yang anda akan tulis, kemudian secara senag hati, sepanjang memberikan bantuan kepada komunitas kami dan tamu kami, kami meninginkan Suara Anda untuk didengan oleh semau orang !, maaf kalau kurang tepat-pen) Here are some examples of topics:(Ini beberapa contoh topik ) · Appreciating my child for who they are(Memperhatikan Pura saya sebagaimana adanya) · Anything pertaining to special needs( Segala sesuatu yang dibutuhkan) · Meeting the challenges of dietary restrictions(Menemukan tantangan dari Diet yang dibatasi) · Successful method of treatment for autism(Metode pengobatan Autism Yang berhasil) · Supplements that have worked for my child(Makanan tambahan yang telah bekerja untuk Anak saya) · enter your article/story. Don’t forget to checkmark the permission block if you are in agreement with the terms and conditions.(kirimkan artikel anda/kisah. Jangan lupa mengisi blok izin bila anda setuju denga persyaratan) Hopefully we (and many others) will be able to benefit a great deal by reading your words of wisdom and experience.(sepnuh harapan kami (dan banyak lainnya akan dapt memeproleh keuntungan dengan membaca kata-kata anda tentang pengalaman dan harapan.) With Great Gratitude, Karen Simmons CEO, Founder, Autism Today Autism Today 2016 Sherwood Drive Sherwood Park, AB T8A 3X3 b.. Surat Tanda Terima kiriman Tulisan Dr Iwan oleh Larry Draut atas nama Karen simmons karena keluarganya tiba-tiba sakit, untuk memeberitahu bahwa artikel dan kisah yang dikirim Dr iwan sudah diterima dan meminta surat pernyataan izin untuk diterbitkan. E-mail asli seperti dibawah ini dengan terjemahan pribadi,harap maaf bila kurang tepat maklum penulis tidak ahli bahasa) all of you writers who have submitted an article InboxX Reply |Karen at Autism Today to me show details Sep 14 (2 days ago) Dear Dr, I am writing on behalf of Karen Simmons who wanted to let you know personallly that she was amazed and overwhelmed by the wonderful response she received regarding the article and story submissions. She wanted to respond to you directly and had a sudden emergency in her family that she had to attend to. She asked me to reach out to you and thank you if you were someone who did send articles and stories.(saya menulis atas nama karen simmons yang ingin memeberi tahu anda secara pribadi bahwa ia takjub oleh rospons anda yang menakjubkan berupa artikel dan kisah. Ia ingin menghub unggi anda secara langsung dan mengalami keadaan darurat dalam keluarganya sehinga ia meminta saya. Ia meminta saya mencapai anda dan terima kasih jika anda adalah seseorang yang telah mengirim artikel dan kisah) The best way to submit your article is to submit it online at: http://autismtoday.com/article-submit.asp (http://autismtoday.com/article-submit.asp) If you have sent your story already as an attachment, or in the body of an email because you didn’t know how to submit it online then we will need you to email me your story again to [email protected] (mailto:[email protected]) along with the permission to use as follows: Permission to Publish Article: I agree to give permission to Autism Today to use my article in any way that they feel is appropriate, including, but not limited to, website content, newsletters, article sharing sites, and blog postings. I understand and agree that there is no remuneration for the article I am submitting in the form of revenue to me and I am submitting because I would like to contribute knowledge and information to other people and families who share my area of interest. _____________________________ TYPE YOUR FULL NAME AND REPLY to [email protected] (mailto:[email protected]) It would help a great deal if you could put the words “Story and Permission” in the subject line. Sincerely, Larry Draut Autism Today Support ___________________________________________________________________________ INFO KODE IA-AT-002 NO.2.JUNE.24TH2010 Stem Cell Treatment for Autism – Restoring Brain



(https://iwansuwandy.files.wordpress.com/2010/06/autismbrain.jpg)

Autism is an abnormal development of brain function that affects 1 in 166 children. The actual cause of autism is believed to be a combination of genetic and environmental factors that makes some kids to be more likely to develop this condition. However, the root culprit for autism remains unknown, scientists can only guess at this point and carry out more research in this field to help thousands of affected families. Despite stem cells controversy and obvious opposition to such treatments expressed by some religious and public organizations, stem cells treatment for autism is a necessary direction of modern scientific research that can potentially help reverse brain damage caused by multiple factors. There are two major malfunctions that need to be corrected with the help of stem cell treatment for autism, shortage of oxygen that reaches the brain and chronic autoimmune response attacking patient’s own immune systems. Modern advances in clinical studies allow autism affected children to greatly benefit from the pros of stem cell research that offer great prospects of finally finding a cure for this life-shattering disease.

During a course of a stem cell treatment for autism a patient goes through a lumbar puncture to collect bone marrow for the purpose of harvesting mesenchymal stem cells that later get processed in a lab. Patient’s own umbilical cord stem cell specimen could also be used to obtain a dose of the stem cells. The last stage of stem cell treatment for autism involves an injection of the stem cells back into the patient’s spinal fluid that will later reach the brain and trigger a process of brain cell regeneration. At this point it’s hard to judge if the stem cell treatment for autism is going to be possible at a large scale and even successful at all, but let’s hope that this unique procedure can help restore health to millions of autistic children in the world. Stem cell treatment for diabetes is another innovative approach that can potentially restore function to the pancreas cells responsible for producing insulin and take millions of people off daily insulin drug therapy. We can not help mentioning that stem cell therapy does not limit itself to a single disease or condition, it can virtually restore function to any living tissue and cell in the body, like for example stem cell treatment for heart disease (http://www.healtharticles101.com/stem-cell-treatment-for-heart-disease/), that can revive damaged heart cells after a heart attack or grow a new heart if necessary to save lives of many more people.The information provided herein is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. _______________________________________________________________________________ INFO NO 3

What is Autism?

Autism is a severe developmental disorder that begins at birth or within the first two-and-a-half years of life. Most autistic children are perfectly normal in appearance, but spend their time engaged in puzzling and disturbing behaviors which are markedly different from those of typical children. Less severe cases may be diagnosed with Pervasive Developmental Disorder (PDD) or with Asperger’s Syndrome (these children typically have normal speech, but they have many “autistic” social and behavioral problems). It used to be thought that autism is just a fate that you accept.The good news is that there are now a wide variety of treatment options which can be very helpful. Some treatments may lead to great improvement, and others may have little or no effect, but a good starting point would be the parent ratings of biomedical interventions, which presents the responses of over 25,000 parents in showing the effectiveness of various interventions on their own child. ARI’s Diagnostic Checklist, Form E-2 (http://www.autism.com/pro_e2description.asp), was developed by Dr. Bernard Rimland to diagnose children with Kanner’s syndrome (which is also known as ‘classical autism’). Many parents and professionals have also used the E-2 checklist to assist in the diagnosis of autism spectrum disorder (ASD). You can print out, complete the checklist, and then mail it to ARI for scoring. Our staff will analyze the responses and send you a score along with an interpretation. The checklist is available in 17 different languages. There is no charge for this service. How Common is it? For many years autism was rare – occurring in just five children per 10,000 live births. However, since the early 1990¢s, the rate of autism has increased exponentially around the world with figures as high as 60 per 10,000. Boys outnumber girls four to one. The Centers for Disease Control estimates that 1 in 110 children is diagnosed with an ASD. What is the Outlook? Age at intervention has a direct impact on outcome–typically, the earlier a child is treated, the better the prognosis will be. In recent years there has been a marked increase in the percentage of children who can attend school in a typical classroom and live semi-independently in community settings. However, the majority of autistic persons remain impaired in their ability to communicate and socialize. ARI Webcasts – information about effective treatments and the latest research presented by speakers from around the world __________________________________________________________________ info no.4 Skateboard Safe Autism Skateboarding saves lives. That statement has been repeated millions of times because it’s plain and it’s true. Whether it serves as an escape from a life of drugs and violence, a sanctuary from a rough home life or a means of overcoming poverty, skateboarding has a way of making people’s lives better. And the most beautiful thing about people who discover skateboarding? They pay it forward. I can think of dozens of examples of skaters giving back. To name a few: There’s the Skatepark of Tampa’s Boards For Bros (http://www.skateparkoftampa.com/spot/a.aspx? ID=1304)program giving underprivileged kids skateboards, Etnies donating thousands of shoes (http://etnies.com/blog/2009/4/10/etnies-annual-skid-row-shoe-donation/) to downtown L.A. homeless and Deluxe Distribution (http://www.dlxsf.com/) donating proceeds from decks designed for special causes in their Actions REALized (http://skateboardermag.com/skateboardernews-features/news/Actions_Realized/) series.

Courtesy of A.Skate15-year-old Justin gets his first taste of skateboarding through A.Skate.One cause that Deluxe has recently championed is treatment for autism. Last year, Deluxe’s Jim Thiebaud teamed up with longtime Eastern Skateboard Supply (http://www.easternskatesupply.com/) sales representative, John Pike. “When it becomes personal is when I get drawn in,” said Deluxe’s Brand Manager, Jim Thiebaud. It got personal real quick. Pike is 41, and he’s been skating for 30 years. His son, Gianni, 7, has autism. “He wasn’t developing like a typical kid; he wasn’t speaking when he was diagnosed at age 2,” Pike said. “We had a pediatrician that didn’t blow us off. A lot of pediatricians will be like, ‘He’s a boy, and he’s just developing late. Don’t worry about it.’ She put up a red flag and got the help we needed.””Speaking with Pike about his son a year or so ago really gave me a sense of what kids with autism go through, and lending a hand was easy,” Thiebaud said. Real issued an Action’s REAlized deck for autism (http://business.transworld.net/6642/news/eastern-skate-supply-supports-autism-speaks-with-actions-realized-deck/) and sold over 1,000 of them, raising $9,000 for Autism Speaks (http://www.autismspeaks.org/), a non-profit dedicated to autism awareness and fundraising for research into the causes, prevention, treatment and eventual cure. For as many skateboarders as there are in the world, our community is quite small. The world got a little smaller when Pike found out that the girlfriend of Faith Skate Supply (http://www.faithskatesupply.com/) owner Peter Karvonen has a 7-year-old daughter with autism named Sasha. Pike has been Karvonen’s sales rep for 14 years now. Since both have a connection to autism, it began to click together. Before long, Karvonen’s girlfriend — Chrys Worley — and Pike had teamed to form the non-profit 501c3 organization, A.Skate (http://www.askate.org/), dedicated to raising awareness about autism in the skateboard community.

Courtesy of A.SkateA.Skate co-founder Chrys Worley works with autistic kids at an A.Skate event. Autism, as defined by Autism Speaks (http://www.autismspeaks.org/), is “a general term used to describe a group of complex developmental brain disorders known as Pervasive Developmental Disorders (PDD).” Basically, it’s like a switch is flipped in the brain and suddenly the child is unable to develop or communicate in a traditional way. The statistics on autism are staggering:

1 out of 70 boys is diagnosed with autism. 1 out of 101 children is diagnosed with autism. It’s more common than childhood cancer, juvenile diabetes and pediatric AIDS, combined. It’s an growing problem. No one knows what causes it. And, there’s no cure or real explanation for why kids have autism yet. It’s a mystery. The goal of A.Skate (http://www.askate.org/) is no mystery, though: teach kids with autism to skateboard and teach awareness to a demographic that might not otherwise know about autism. It is believed skateboarding and board sports are a good fit for autistic kids because they are not social creatures. “The reason autism and skateboarding fit is you don’t need a coach or a team,” Pike explains. “You can skateboard on your own. What’s great about skaters is that they’re an eclectic group of people that are accepting of all different demographics of people. Our kids are different, and we know they will be accepted into this society and they’ll have fun.” It’s been proven hundreds of times over with every skate clinic A.Skate (http://www.askate.org/) offers along the Eastern seaboard. “Peter put Sasha on a board one day and it just worked. She was instantly happy,” Worley remembers. Ever since, Worley has been getting autistic kids together every weekend in places all over the Southeast. A.Skate clinics give kids a chance to try skateboarding out. The sounds and feel of a skateboard calm many of them and they’re drawn to it. Most kids are first-timers and just sit down and cruise on their butts but the joy is evident at all stages. Worley boasts A.Skate’s (http://www.askate.org/) success rate. ”We have yet to have even one child that doesn’t respond well to the clinics,” she said. “Hundreds of kids … and every one of them has had a positive experience. There is one tiny child in the Veteran’s Park video (http://www.askate.org/video_gallery) that Peter was skating with and [the child] was talking up a storm. At the end of the video you can hear him saying, “Again! Again!” His mom told us he hadn’t spoken in five months prior to that. It is therapeutic for them. I wouldn’t know the child had little to no language if his mom hadn’t told me because he didn’t stop talking the whole time Peter was working with him.”

Courtesy of A.SkateJohn Pike works with an autistic first-time skater at an A.Skate event in Knoxville, Tennesse. It says a lot about the mettle of these two parents to give so much of themselves for the happiness of kids across the country. I learned from talking to them that many insurance companies do not cover a penny for autism treatment. “I’ve almost gone bankrupt and re-mortgaged my house three times,” Worley said. “Insurance hasn’t helped with one thing.” ”All of the money most families have with kids on the spectrum is spent out of their pocket for therapy. So buying a skateboard is not in their budget,” Pike said. To combat this obstacle, A.Skate is trying to create a grant program in which, if the child wants to continue to skate, the foundation can write a check to the local skateshop for that child to get a quality board. “One of our big things is supporting the skate industry through the grants,” Pike said. “The kid or the parent doesn’t get the check, NJ Skateshop (http://www.njskateshop.com/) or Faith Skate Supply (http://www.faithskatesupply.com/) or wherever gets the check. My background is in skating and surfing so my way of dealing with [this condition] was to use my experience in this business to give back and help other people, along with me and my son.”

The coolest thing about A.Skate (http://www.askate.org/) is the campaign they introduced Monday on Go Skateboarding Day (http://www.goskateboardingday.org/). GSD is skateboarding’s version of Valentine’s Day, a “holiday” to remind people they love their spouse, or in this case, skateboarding. This year I looked forward to GSD thanks to A.Skate (http://www.askate.org/). Their Go Skateboarding Day Campaign (http://www.askate.org/gsd_campaign) was to literally grab a kid with autism and help them participate in skateboarding. No money involved, just a spare cruiser to let a kid push around on your board. Maybe these small acts will get a kid speaking that hasn’t said a word in months. ____________________________________________________________________________ info no 5 Non-Verbal or Trouble Communicating? A note from Karen Simmons, Founder of Autism Today Communication was always a challenge for my son Jonny, even though he could speak. If you’re a parent of a non-verbal child with autism, I know you must have a lot of pain in your heart. Being in your shoes is not easy! Over the years people have said “Karen, your son can speak, you really don’t know what were going through with our non-verbal children. What do you recommend for those of us who have children that may never learn to talk?” My answer until now has been, very little. Finally though, I found a convenient device called “Go Talk”. What is really nice about this is that its easy to carry in the palm of the hand. Pictures can easily be switched out for other pictures and the voice will say the word or phrase associated with the picture. Its also similar in size and shape to a PDA or cell phone so your child will more readily fit in socially with other children. The voice will also help the child so they can begin to associate the picture with the words and may learn to speak the words. ________________________________________________________________________

INFO NO.6:The Language of Music: Working with Children on the Autism Spectrum Boston University • School of Education Journal of Education • Volume 183 • Number 2 • 2002 Autism impairs the capacity for interaction and communication, to greater or lesser degrees. But where mere words prove unavailing or insufficient, music can still succeed. Stephen M. Shore Stephen M. Shore is the author of Beyond the Wall: Personal Experiences with Autism and Asperger Syndrome. He holds a master’s degree in music education and is completing a doctorate in special education, with a focus on autism. Diagnosed as severely autistic and beyond the reach of professional interventions, he was the beneficiary of intensive music-based and other therapies by his parent; he brings those personal experiences, as well as his academic training, to his work with individuals on the autism spectrum around the world. He also teaches special education at Lesley University. Zack Zack was five-and-a-half when I first met him. His diagnosis was Pervasive Development Disorder-Not Otherwise Specified (PDD-NOS), along with apraxia of speech. Many professionals consider autism to be a spectrum disorder ranging from severe to light. At the severe end is what we generally think of as autism: a withdrawn, nonverbal child sitting in a corner, rocking, hand-flapping and possibly exhibiting self-abusive behaviors. A lack of awareness of the relationship of the body to the environment makes it difficult to perceive distant objects or discern where their body ends and the environment begins (Miller & Eller-Miller, 1989, 2000). This is why many children with autism may not respond to a verbal request but suddenly become aware of your existence if you touch them. Children diagnosed with PDD-NOS are slightly less affected by these problems, may have more understanding of language (receptive language ability) and perhaps a few words they can speak (expressive language ability). Speech will probably never be Zack’s primary mode of expressive communication. He is nonverbal, except for about five words. Individuals with autism have difficulty with expressive verbal communication due to the neural setup (or perhaps mis-setup) in their brain, and for Zack, the pathways from the brain to the muscles for speech are also miswired. His father, I believe, is also somewhere on the autistic spectrum. Initially resistant to this possibility, Zack’s father now recognizes his own autistic tendencies and believes that he was on the autism spectrum as a child, if not still on it at the lighter end. My first meeting with Zack was uneventful. I chose a set of tom-toms and a cymbal, while deciding against a snare drum because it creates too many complex high-pitched sounds. (I was wary about the cymbal for the same reason but took the risk.) I played the piano while his mother attempted to get him to beat time on a drum using drum sticks. While on task, which was about 10 percent of the time, Zack beat the drums in a musically sensitive way. What he did with the cymbals was fascinating: instead of bashing them with the sticks and making a horrendous sound, Zack gently scraped the drum stick across the cymbal to make a soft sound. When I played the piano, Zack would remove my hands from the keys and play the first three white keys on the left over and over. “OK Zack” I thought, “you play the piano and I’ll play the drums.” When I played the drums, he would also remove my hands from it. Zack’s mother explained that he did not like anyone else to play an instrument, not just me. Frequent requests by Zack to go to the bathroom appeared to be an escape mechanism. The three following meetings went similarly, with little meaningful communication between Zack and me. We each did our own things, side by side, in the same room. Such parallel actions are a common trait of autistic play. Zack seemed to have no idea of what I wanted him to do. Frustrated, I talked with his mother. The parents of a child spend more time with him or her than any therapist or doctor can. They know their child’s preferences, dislikes, strengths, and weaknesses. Zack’s mother came up with the idea of using an activity board and a time board. An activity board contains a Velcro strip, to which one can attach pictures of various activities; an additional square with the words “do this” is placed below the picture of the initial task. A time board is fashioned in a similar way, but with the numbers 1, 2, and 3, and a sign for “all done.” The tasks were broken down into tiny steps: picking up the stick, tapping the drum four times, stopping, and putting the stick down. Suddenly Zack demonstrated his ability to understand and do as I had asked. Mirroring what I did, he picked up the stick, tapped the drum four times, and put the stick down. I communicated with Zack! The activity and time boards visually communicated to him exactly what was expected, and the tasks were broken down into discrete portions that he could understand. Zack was very happy during that session, giving me hugs and generally showing great pleasure. There were many fewer trips to the bathroom. Like all of us, when Zack understood what was expected and was able to do it, he overflowed with infectious happiness. Sam Sam is a 12-year old boy with Asperger Syndrome. People with High Functioning Autism (HFA) and Asperger Syndrome (AS) are considered to be at the lighter end of the autism spectrum, are often very verbal, and commonly average to above average IQs. For example, instead of being nonverbal, the communication challenge may present itself in carrying on monologues about their favorite interests and not perceiving the nonverbal cues, such as the listener looking at the watch, that it is time to stop. However, no matter where the individual with autism lies, there are still challenges in communication and social interaction, restricted interests, and repetitive motions (APA, 2000) as well as a degree of sensory integration dysfunction (Smith-Myles, Cook, Miller, Rinner, & Robbins, 2000; Huebner & Dunn, 2001). Sam had recently been rejected from a private school specializing in Asperger Syndrome for being “too low functioning.” His mother, a professional musician, knew Sam had much musical talent but had yet to find anyone who could teach him how to read music. At our first meeting, she also expressed concerns about the difficulties Sam would begin to face as he entered adolescence. As with all the children I work with, I requested that a parent (or significant caretaker) join in the lessons. Not only are parents the experts on their child. The lessons give them another way to relate to their child, and they can do additional work with the child between lessons. Occasionally, though, the presence of the parent distracts the child from learning. In these cases I start by working only with the child and then gradually involve the parent. In my first lesson with Sam I made gridlines on a notebook-sized piece of paper, resulting in a 7-row by 10-column matrix. After placing a few A’s on the first line, B’s on the second, down to G on the last line, I asked Sam if he would like to continue. Eager to do so, he quickly took the paper and started filling in the blank spaces with letters. Many people on the autism spectrum have a strong need for order and completion. A piece of paper that looked like this… A

A



















B



B













C









C

















D

































F





















G















… soon looked like… A

A

A

A

A

A

A

A

A

A

B

B

B

B

B

B

B

B

B

B

C

C

C

C

C

C

C

C

C

C

D

D

D

D

D

D

D

D

D

D

E

E

E

E

E

E

E

E

E

E

F

F

F

F

F

F

F

F

F

F

G

G

G

G

G

G

G

G

G

G

Sam’s need for order and completion enabled him to complete an assigned task, and in the process work on fine-motor control and penmanship. Arranging his environment to take advantage of this characteristic worked much better than treating this need for order and completion as aberrant behavior. Later on during the lesson, I started cutting the individual squares from the piece of paper and then passed the job over to an eager Sam. While he worked on this project, I drew a treble clef and staff on a larger piece of paper along with a lighter dashed line for middle C. Then I drew a B on the middle line and asked Sam if he knew where C went. He responded with an anxietyfilled no! I drew the letter in the space above the B. A query about where D belonged elicited the same response. I now asked if Sam could just guess where the letter D might go. Now he answered correctly, and I had him writing the letters in the right places on the staff. With the letters placements marked out Sam was now able to place those lettered squares he previously cut out onto the staff in the right locations upon my request. Soon we were spelling words such as “bag, dad, eat, and ace,” followed by simple songs such as “Twinkle, twinkle little star,” and “Mary had a little lamb” which I then played on a musical recorder. Shortly thereafter we ran out of space on that sheet of paper and it was time to make another sheet of staff paper. Sam’s anxiety rose dramatically at my request that he draw the staff lines and the treble clef this time. However, his reluctance melted away just as quickly when I offered him assistance in drawing. During the second lesson we progressed to writing the note letters on yellow Post-It notes and sticking them on both the staff paper and the piano keyboard. As Sam began to play “Hot Cross Buns,” at first with the yellow stickies bearing note names and then without, his mother was so overwhelmed with emotions that she broke down in tears. Sam looked over at her and with just a bit of nudging from me gave his mother a big hug. Who said that those with Asperger syndrome are emotionless? It appeared that Sam was very anxious about failing at tasks. When he understood that he was in a safe environment without penalties for making mistakes, he did very well. I suspect that Sam’s behavioral challenges in school were a result of not feeling safe academically. During my first lesson with Sam much of the conversation centered on his concern for what an F grade meant and that it was not good to get such a grade. But the next time I saw Sam, there was no mention of grades. Sometimes Sam would immediately reject a request with “no!” only to commence the task a few seconds later. Perhaps his “no!” was in reality a bid for more processing time. Other than easily being overwhelmed with anxiety over failing, Sam seems to enjoy the continuing sessions and is a pleasure to work with. By placing the notes on this staff in this manner Sam learned how to read music and apply it to a piano keyboard. The difference between this approach and traditional music education is that the primary goal of decoding musical notation was incidental to the activity from Sam’s point of view. In other words, a more traditional way to teach music would involve spending a lot of time sitting in a chair, explaining and showing Sam the names for the lines of the staff, notes, and their relationships. Using a kinesthetic approach engaged Sam in the creation of his own learning materials, which served to reinforce the physical activities of putting the notes in the right place on the staff, followed by placing them on the piano keyboard. For people on the autism spectrum, it seems important for the physical aspect of the body to be in order before attending to the emotional and cognitive aspects. Additionally, by assisting in the creation of his own resources Sam probably felt ownership of the learning materials and the activity. I was able to work with him not only on music, but on communication, taking turns, and fine-motor control. When the time comes for Sam to get his first piano book, he will have a good background in the musical concepts presented in the text, having already ascended the initial learning curve involved in reading, understanding, and converting notation to music on the piano keyboard. He also now has a skill that will help him to interact with others. Perhaps the school that rejected Sam was too low functioning for him. Other Cases For some children music is the means of communication and developing a relationship. For others, less severely affected, music can be the medium for enhancing verbal communication. One child I worked with, while having no functional communication, had a storehouse of holiday and children’s songs in her head, as I found out one day when I didn’t play the last note of a song. Not only did she say the correct word, she sang it at the right pitch. With limited verbal children of this nature, it is often possible to get them to supply the missing words to a song they know by suddenly stopping the song and accompaniment at points of maximal tension. These places of “maximal tension” (Miller & Eller-Miller, 1989, p. 65, 93) occur during the last few notes of a cadence. An example would be to sing “twinkle, twinkle, little…” and wait for the child to fill in the missing word “star.” Another person I worked with used facilitated communication (FC). FC depends on another person providing arm or wrist support to someone typing on a keyboard or touching pictures on a communication board. This does raise difficulties in separating the intentions of the person being helped from those of the helper. But be that as it may, when I supported this person’s arm to play a piano keyboard, he was able to sing, indeed sing well, old songs he must have heard as a child. This seemed to be the only way that he could sing these songs. With one particular child with Asperger syndrome, all of my communications are sung. If I mistakenly lapse into a typical conversational tone, he loses focus, engages in self-stimulatory activities, and drifts away. The music helps to organize verbal communication skills that already exist. And by holding the child’s interest, I can turn the sessions into fairly typical music lessons. During the first session with this child, I created a system where the child asked me for pieces of paper that had the letter names of the notes. Once this series of events was internalized, I expanded the routine by having him place the notes on the appropriate place on the music staff. This system was expanded further by having him draw a circle on the staff where the note belonged and write in the letter of the note. Then he would give the note to his mother. Fine motor problems were present, and drawing a circle first helped confine where the note should go. Asking him on which space or line the note should go on (as opposed to a generic “Where does the note go?”) also helped. The system was expanded yet again by having the child guess which note I had in my hand. After guessing correctly he then had to write the note on the staff before receiving the piece of paper. We then took turns with his holding the notes, with either his mother or me having to guess which note he had in his hand. When it came time for me to write the note in the staff I would ask him in a singing voice on which line or space it went. Other parts of the session were spent in imitative drumming, and later, work on the recorder. I made certain that we took turns in leading the imitation. This was a good activity to do when he seemed to be fading away and losing focus. His mother quickly caught on to our activities; she participated very well in the session, and we all had a pleasurable experience. The child has a lot of musical ability and using the Miller Method (Miller & Eller-Miller, 1989; Miller, 2000), he was taught to play the recorder and later the piano, which he now plays well. With the child that already plays an instrument, I will introduce myself into his world by sharing the instrument via turn taking. When I play the instrument the child accompanies me on percussion. Then we will switch roles. The turns start out short and gradually lengthen to where I work on other issues such as verbal skills, writing, and motor control as needed. To establish equality between us, I must also take my turns doing anything I require of him or her. I too, for example, need to ask for permission to use the keyboard if the child is already using it. Music can also be used to organize behavior when working with a group of children, by having them walk or otherwise move to the rhythm of the music. Often I will have them march in a circle as I play music on a keyboard. With the help of aides, I will have the students stop when I stop playing and continue when I resume. When the children understand when to stop and start, I will turn this into a game similar to “musical chairs” where the person who stops last is “out” and has to sit down. Realizing that it is unreasonable to expect these children to sit still with their hands folded while the game plays itself out, I give them a shaker — but not before they ask for it and identify the piece of fruit the shaker represents, if appropriate. The worst possible thing, which I have too often seen, is children sitting in a circle around a large instrument with nothing to do while they wait to take a turn on the instrument. Typically, the children fall into a disorganized mass of self-stimulatory and challenging behaviors. This situation, caused by failing to engage all the children in a classroom, is entirely preventable. For the child at the high-functioning end of the autism spectrum, the school band may or provide an important avenue for development. The trombone requires a good kinesthetic sense of where one’s arm is in order to place the trombone slide in the right place for a note to be in tune. Other instruments, except for the stringed ones, require less ear-to-arm coordination as the pitches are obtained with the assistance of keys or valves. The French horn, however, demands much coordination of the embouchure. Percussion may be another avenue. If complex rhythms present a challenge, the bass drum may be a good choice as the musical patterns are relatively simple. Additionally, the bass drum with its low and relatively simple sound waves is often easier for a person with sound sensitivities to handle. Finally, being at the rear of a potentially cacophonous musical ensemble may be of help, as it is less noisy there. Location in the ensemble may have to take sensory sensitivities into account. If a student with autism insists on playing a certain instrument and it is clear that there will be problems with sound sensitivities, allowing the child to sit in a different location may be easier than rearranging the ensemble in a non-standard manner. I skipped many jazz band rehearsals in high school because the director was unwilling to let me sit elsewhere than right in front of the blaring trumpets. In addition to the purely musical benefits, playing in an ensemble is good for working on cooperation with others, coordination, and a sense of accomplishment. Conclusion Music has many benefits in working with learners on the autism spectrum. Music provides an alternate means of communication for those who are nonverbal, and for others it can help to organize verbal communication. Music can improve self-esteem, as the child is given an activity he or she can potentially excel in. Finally, playing a musical instrument gives persons with autism a typical means for engaging in social interaction in school and in the community, centered on their strength. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders of the American Psychiatric Association (4th. ed., Text Revised). Washington, DC: Author. Huebner, R. & Dunn, W. (2001). Chapter one: Introduction and basic concepts. In Autism: A sensorimotor approach to management. Edited by Ruth A. Huebner. Gaithersburg, MD: Aspen Publishers. P. 3-40. Miller, A. & Eller-Miller, E. (1989). From ritual to repertoire: A cognitive-developmental systems approach with behavior-disordered children. New York: Wiley-Interscience. Miller, A. (2000). Chapter 15. The Miller Method©: A Cognitive-Developmental Systems Approach with Children Having Body Organization, Social and Communication Disorders. In Guide to Best Practices (Eds) Greenspan and Wieder, Interdisciplinary Council for Developmental Disorders, Unicorn Foundation. Schlaug, G., Jäncke, L., Huang, Y., Stagier, J. and Steinmetz, H. (1995). Increased corpus collusum size in musicians. Neuropsychologia, vol. 33 (8), p. 1047-1055. Shore, S. (2003). Beyond the wall: Personal experiences with autism and Asperger Syndrome, 2nd ed. Shawnee Mission, KS: Autism Asperger Publishing Company. Smith-Myles, B., Cook, K., Miller, N., Rinner, L., & Robbins, L. (2000). Asperger Syndrome and sensory issues: Practical solutions for making sense of the world. Shawnee Mission, KS: Autism Asperger Publishing Company.

________________________________________________________________________ info no 7 One More Time – this is your opportunity to obtain this collection of teaching tools. These are the Best Communication Tools For Teaching A Child with Autism, Aspergers, PDD-NOS, Speech & Language Delays that We’ve Seen. #1 – QUESTION SERIES – IN THE HOME 40 Laminated Photo Cards Size: 5²x3.5² Example Front of card Example Back of card Other picture cards in this sequence: (1 of 5) Where do you take a bath? In the bathtub (2 of 5) Why do you wash your hair? To make it clean (pictured above) (3 of 5) When do you rinse your hair? After you shampoo it (4 of 5) What do you dry yourself with? (5 of 5) Which one says quack? (bath toys depicted) Why do I need these?

Always a best seller! Your student will understand and answer all the “WH” questions. “WHAT”, “WHEN”, “WHERE”, “WHY” AND “WHO”. This unique system gives excellent results! Children are finally able to make sense of “WH” questions using these expertly designed question sequences. Stand back in amazement as your child begins to answer questions about all the things we do at home. What’s in th is pack? Excellent quality laminated photo cards for teaching children question comprehension. The back of each card clearly teaches children how to answer questions with these specifically designed question sequences. Examples in this pack are taking a bath, eating breakfast, brushing teeth, playing hide and go seek and baking cookies. This pack has a track record of success! Who benefits from this pack? These cards are perfect if you are teaching a child with autism, pdd nos, speech and language delays or Aspergers. Perfect pack to teach children question comprehension. Suggested methods of use are included in the product. “The Question Cards are the best one’s I’ve ever worked with. I can’t say enough good things about them.” – Rita NJ ____________________________________________________________ info no 8

Dietary Supplements and Herbs

The following excerpt is taken from Chapter 7 of Pervasive Developmental Disorders: Finding a Diagnosis and Getting Help by Mitzi Waltz, copyright 1999 by O’Reilly & Associates, Inc. For book orders/information, call (800) 998-9938. Permission is granted to print and distribute this excerpt for noncommercial use as long as the above source is included. The information in this article is meant to educate and should not be used as an alternative for professional medical care. Minerals (http://oreilly.com/medical/autism/news/supps_herbs.html#minerals) Enzymes and sulfates (http://oreilly.com/medical/autism/news/supps_herbs.html#enzymes) Essential fatty acids (http://oreilly.com/medical/autism/news/supps_herbs.html#essential) DMG (http://oreilly.com/medical/autism/news/supps_herbs.html#dmg) Melatonin (http://oreilly.com/medical/autism/news/supps_herbs.html#melatonin) Probiotics (http://oreilly.com/medical/autism/news/supps_herbs.html#probiotics) Octocosanol (http://oreilly.com/medical/autism/news/supps_herbs.html#octocosanol) Lecithin (http://oreilly.com/medical/autism/news/supps_herbs.html#lecithin) Herbal neurological remedies (http://oreilly.com/medical/autism/news/supps_herbs.html#herbal) Herbal antibiotics (http://oreilly.com/medical/autism/news/supps_herbs.html#anti) Sphingolin (http://oreilly.com/medical/autism/news/supps_herbs.html#sphingolin) Evaluating supplement claims (http://oreilly.com/medical/autism/news/supps_herbs.html#evaluating) Dietary supplements and herbal remedies are big business these days, thanks to articles and books touting the benefits of everything from garlic to herbal antidepressants. Here are some that you may hear about in relation to pervasive developmental disorders.

Minerals Several minerals are essential for optimal health. Some are also necessary for utilizing certain vitamins. Calcium is important for the regulation of impulses in the nervous system and for neurotransmitter production. However, excessive levels of calcium (hypercalcinuria) can result in stupor and have been reported to occur naturally in some autistic people. Magnesium lowers blood pressure and is also important for the regulation of impulses in the nervous system and neurotransmitter production. If you are supplementing with vitamin B6, you will need to add magnesium as well. Iron (ferrous sulfate) deficiency in infants can inhibit mental and motor-skills development. Most children do not need an iron supplement, however, and too much iron can cause digestive and elimination problems. Adult women and some older adults may need to add a small amount of iron to their diet in supplement form.

Enzymes and sulfates Enzymes are produced in the human digestive tract to digest various types of food. Protease acts on protein, amylase on carbohydrates, lipase on fats, pectinase on pectins (found in some fruits and other foods), and cellulase on fiber. Other enzymes are produced to detoxify the body. One study, and some subsequent clinical research, has shown that many people with autism have lower than normal detoxification enzyme activity.1 (http://oreilly.com/medical/autism/news/supps_herbs.html#notes) This activity, which relies on a steady supply of sulfate, is essential for maintaining the GI tract’s mucous membrane and for moving toxins out of the body through hydrolation. If the mucous membrane in the gut is in good shape, the brain will be protected from a buildup of phenolic compounds, which can interfere with neurotransmission. If it is not, nervous-system problems can ensue. 2 (http://oreilly.com/medical/autism/news/supps_herbs.html#notes) Some people with a documented sulfation problem take the enzyme methyl-sulphonyl-methane (MSM, or sulfur), which they believe may help them produce the sulfate. It is hard to digest, however. In addition, commercially available MSM is derived from dimethylsulfoxide (DMSO), a substance that has been touted as a boon for so many conditions that one might rightfully be cautious about trying a derivative. Others have added the amino acid N-Acetyl-Cysteine (NAC), which is also said to have antispasmodic qualities. Another recommendation is taking frequent Epsom salts (hydrated magnesium sulfate) baths. Neither of these approaches is proven to work, but the baths are certainly relaxing and harmless, and some patients do seem to improve as a result. For those who would like to try the Epsom salts approach, one parent who achieved positive results with her child (reduced oppositional behavior and improved language skills) recommends using one and a half to two cups of Epsom salts per daily bath. “Sulfur (Epsom salts) improved socialization,” says Holly, mother of three-year-old Max (diagnosed PDD-NOS). Researchers have noted that dairy and gluten digestion difficulties would be expected in people with low sulfation, lending credence to the gluten-free/casein-free diet approach for these individuals. Food items that are high in phenols might also be removed from the diet with beneficial results. Among the many phenols are tannin, which gives tea and persimmons their tang; quercitin, found in green beans and rhubarb; and coumarin, found in cabbage, radishes, and spinach. Other items high in phenols include apples, grapes, avocados, and other fruits; some artificial food colorings; many spices, such as cloves and sassafras; some preservatives, particularly the ubiquitous BHA and BHT; some herbs used in antioxidant compounds and teas, including grapeseed oil and comfrey tea; chocolate, coffee, and red wine. Phenols are also used in many manufacturing processes, cleaning products, insecticides, plastics, and chemical compounds. These products and their fumes should be avoided by people with extreme sensitivity to phenols.

Essential fatty acids The essential fatty acid (EFA) linoleic acid and its derivatives, including gammalinolenic acid (GLA), dihomogamma-linolenic acid (DGLA), and arachidonic acid (AA), are also called omega-6 fatty acids. These substances come from animal fats and some plants. Another type of EFAs, omega-3 fatty acids, are found almost exclusively in fish oils. As the “essential” in their name implies, these substances are needed to build cells and also to support the body’s anti-inflammatory response. They are the “good” polyunsaturated fats that improve cardiovascular health when substituted for the “bad” saturated fats. The heart and blood vessels aren’t the only beneficiaries of EFAs, however. People with autoimmune diseases that involve the nervous system say EFAs are very helpful in reducing symptoms, and there is some research to back them up. EFAs appear to help the GI tract resist and repair damage, probably by restoring the lipid cells. Recent research in psychiatry has even found that omega-3 fatty acids can act as a mood stabilizer for some people with bipolar disorder. Researchers believe that a proper balance between omega-3 and omega-6 fatty acids is also important for optimal health. Evening primrose oil (EPO) is one of the best EFA sources around, and has become a very popular supplement as a result. Other plant sources for omega-6 fatty acids include borage oil, flax-seed oil, and black current seed oil. The omega-6 fatty acids in evening primrose oil have been reported to lower the threshold for frontal-lobe seizures, however, so people who have seizures should exercise caution. All are available as gelatin caps. Efamol and Efalex are brand-name EFA supplements made by Efamol Neutriceuticals, Inc. Efalex was specifically created to treat developmental dyspraxia in the UK and is widely touted as a supplement for people with ADD or ADHD as well. Efalex contains a mix of omega-3 fish oil, omega-6 EPO and thyme oil, and vitamin E. Efamol, marketed as a treatment for PMS, combines EPO; vitamins B6, C, and E; niacin zinc and magnesium. Both of these commercial EFA supplements are now available in the US and Canada as well, and can be purchased by mail order. Unlike many supplements manufacturers, Efamol adheres to strict standards and also sponsors reputable research. EicoPro, made by Eicotec, Inc., is another brand-name EFA supplement you may hear about. It combines omega-3 fish oils and omega-6 linoleic acid. Eicotec is another supplements manufacturer known for its high manufacturing standards. Monolaurin is made by the body from lauric acid, another medium-chain fatty acid that is found in abundance in coconuts and some other foods, including human breast milk. It is known to have antibacterial and antiviral properties. Monolaurin may be the active ingredient in colostrum, the “pre-milk” all mammals produce to jump-start a newborn’s immune system. Cow colostrum is actually available in supplement form in some areas. NutriVene-D is a supplement, created for people with Down’s syndrome, that mixes EFAs, vitamins, and other substances. It’s great if you can get your EFAs in food. Low-fat diets are part of the reason some people, especially those who are trying to lose weight, may not get enough. Many cold-pressed salad oils, including safflower, sunflower, corn, and canola oils, do contain EFA. When these oils are processed with heat, however, it may destroy or change the fatty acids. Oily fish are another great source, although, again, cooking may be a problem (and not everyone is a sushi fan). It is possible to have lab tests done that can discern EFA levels. Our son’s essential fatty acids were abnormal. Some were too high and others too low. His iron and copper levels were high. Supplements include evening primrose oil, laktoferron, many vitamins, etc. Our son’s supplements cost about $250 per month. –Joe, father of seven-year-old Kyle (diagnosed PDD-NOS with autistic features) Diabetics may experience adverse effects from too much EFA, and should consult their physician before supplementing with EFA products.

DMG Dimethylglycine (DMG, calcium pangamate, pangamic acid, “vitamin B15²) is a naturally occurring amino acid that may help some people with autistic spectrum disorders with speech production, increased stress tolerance, seizure reduction, and immune-system strengthening. Studies have been done in Russia and Korea with positive results for between half and 80 percent of the children given DMG, although they were not double-blind studies. New research results about the efficacy of DMG for people with autism are expected to be released soon. We have only used DMG for speech, and B6/magnesium. We are seeing improvements in both Nicole’s articulation and in her ability to put sentences together. She has gained quite a few new words, and is attempting to place them in short sentences, whereas before she only used single words and more of a pull-and-point method. She definitely is trying harder to “say the words!” –Robin, mother of five-year-old Nicole (diagnosed mild autism) DMG changes the way your body uses folic acid, so you may need to supplement it with that vitamin. Increased hyperactivity may result from a lack of folic acid when taking DMG.

Melatonin Melatonin (MLT) is produced by the pineal gland and is responsible for helping the body maintain sleep and other biochemical rhythms. Studies have shown a deficiency or aberrant production of this hormone in autistic subjects, 3 (http://oreilly.com/medical/autism/news/supps_herbs.html#notes) and indeed, at least half of all people with autism have sleep disorders. Melatonin supplements given about half an hour before bed may be useful for addressing these problems. The effect may not be lasting, however. “Using melatonin for sleep worked awesome at first; now it is iffy,” says Lesley, mother of three-year-old Danielle (diagnosed PDD-NOS).

Probiotics As the name indicates, probiotics are intended to counteract the harmful affects of antibiotics. As most people who have taken a course of penicillin know, these valuable medications can cause digestive distress even as they heal infection. Probiotics are substances that attempt to restore the friendly intestinal cultures that help us digest our food. Among other things, these cultures (and other probiotics) keep the growth of Candida albicans yeast in balance. Commercial probiotic supplements may combine a number of substances, sometimes including digestive enzymes as well as helpful bacteria, garlic, and the like. Lactobacillus acidophilus, Bifidobacterium bifidum, and Lactobacillus bulgaricus are friendly bacteria more familiar to most of us as the “active cultures” found in some yogurts. Yogurt itself is a good probiotic for those who eat dairy products. Soil-based organisms (SBOs) are microbes found in organic soils that are believed to help the body produce important enzymes. Some people believe that modern food-processing techniques have left people deficient in these, so they take SBO supplements. These are increasingly added to probiotic supplements. No information about benefits of use by people with PDDs is available at this time. Garlic is said to be active against yeast in the digestive tract. You can swallow whole cloves raw or take it in a supplement. Caprylic acid is a fatty acid said to be active against yeast in the digestive tract. Medium chain triglycerides (MCT oil, also called caprylic/capric triglycerides) are a liquid source of caprylic acid. Biotin, a vitamin related to the Bs, is normally produced by friendly bacteria in the digestive tract. Replenishing these flora should ensure enough biotin, but some people do choose to take it directly.

Octocosanol Octocosanol, usually derived from wheat germ, is supposed to increase stamina, reduce cholesterol, and address neuromuscular deficits. It appears on some lists of supplements that may reduce autistic symptoms, but its method of action is unknown, and it doesn’t seem to have much of a track record with parents.

Lecithin Lecithin (phosphatidyl choline) is a phospholipid found mostly in high-fat foods. It is much ballyhooed for its ability to improve memory and brain processes. Lecithin is necessary for normal brain development; however, double-blind studies of patients with Alzheimer’s disease did not substantiate claims that it can help people recover lost brain function. However, it’s possible that increased amounts of lecithin may be one of the keys to the ketogenic diet’s success in some cases of hard-to-treat epilepsy. Some people with epilepsy have also reported reduced number and severity of seizures from taking lecithin as a supplement. It is possible that extra lecithin might be needed to rebuild damaged myelin protein. There’s no hard evidence that lecithin is a good idea for people with autism, but it does not appear to cause harm, and there are some logical reasons to think it might help–especially for patients who have seizures or who test positive for anti-MBP, the autoimmune agent believed to destroy myelin basic protein. Lecithin is oil-based, and it gets rancid easily. It should be refrigerated. Lecithin capsules are available, but many people prefer the soft lecithin granules. These are a nice addition to fruit-juice smoothies, adding a thicker texture. Choline is one of the active ingredients in lecithin. It is needed by the brain for processes related to memory, learning, and mental alertness, as well as for the manufacture of cell membranes and the neurotransmitter acetylcholine. Inosital is one of the active ingredients in lecithin. It may help in cases of nerve damage and is required by the neurotransmitters serotonin and acetylcholine. Clinical studies have indicated that inositol supplements may be helpful for some people with obsessive-compulsive disorder,4 (http://oreilly.com/medical/autism/news/supps_herbs.html#notes) depression, and panic disorder.5 (http://oreilly.com/medical/autism/news/supps_herbs.html#notes) Benefits specific to autistic spectrum disorders have not been officially documented.

Herbal neurological remedies Quite a few herbs have been used to treat neurological disorders through the ages. These substances are referred to as nervines, and some may prove useful for treating specific symptoms associated with autistic spectrum disorders. Of all the herbal remedies, this group of plant extracts are among the strongest, and the most likely to cause serious side effects. Aloe vera gel is sometimes recommended for GI tract problems. It’s a traditional remedy for ulcers. It has anti-inflammatory (steroidal), hormonal, antioxidant, laxative, and other effects. Many people find it hard to take internally. Black cohosh (Cimicifuga racemosa, squaw root), a nervous system depressant and sedative, is often used by people with autoimmune conditions for its anti-inflammatory effects. Its active ingredient appears to bind to estrogen receptor sites, so it may cause hormonal activity. Chamomile is a mild but effective sedative traditionally used to treat sleep disorders or stomach upsets. Damiana is a traditional remedy for depression. Gingko biloba, an extract of the gingko tree, is advertised as an herb to improve memory. There is some clinical evidence for this claim. It is an antioxidant, and is prescribed in Germany for treatment of dementia. It is believed to increase blood flow to the brain. Gotu kola is a stimulant sometimes recommended for depression. Licorice is not just for candy or sore throats–it boosts hormone production, including hormones active in the GI tract and brain. Passion flower is recommended by some herbalists for depression, anxiety, and seizure disorders. Sarsaparilla, like licorice, seems to affect hormone production as well as settling the stomach and calming the nerves. Skullcap, an antispasmodic and sedative, is found in both European and Ayurvedic herbals. It has traditionally been used to treat tic disorders and muscle spasms, as well as seizure disorders, insomnia, and anxiety. St. John’s wort (hypericum) has gained popularity as an herbal antidepressant. It has the backing of a decent amount of research, but, as noted in Chapter 5, Medical Interventions, those choosing to use this remedy should follow the same precautions as with SSRIs and MAOIs, two families of pharmaceutical antidepressants. It can cause increased sensitivity to light. It is available by prescription in Germany, where it is the most widely used antidepressant. Valerian is a strong herbal sedative. It should not be given to young children.

Herbal antibiotics Several herbs appear to have antiseptic, antiviral, antifungal, or antibiotic properties. Obviously, if these substances are active, they should be used carefully and sparingly, despite the claims of certain manufacturers who encourage daily use for disease prevention. Those who prefer herbal remedies might want to try cat’s claw and grapeseed oil, both mentioned in the previous section on antioxidants, or one of the following: Bitter melon (momordica charantia), an antiviral from the Chinese herbal pharmacopoeia, is the plant from which the active ingredient in some protease inhibitors (the powerful drugs used to combat AIDS) is derived. Echinacea purpurea, another herbal antiseptic, also dilates blood vessels and is said to have antispasmodic qualities as well. Goldenseal, an alkaloid isoquinoline derivative related to the minor opium alkaloids. Its active ingredient, hydrastine, elevates blood pressure. This is a very strong herb with antiseptic properties when taken internally or applied topically in powder or salve form. It acts on the mucous membranes of the GI tract when taken internally. SPV-30, derived from the European boxwood tree, is a fairly new item in this category. It apparently includes some antiviral and steroidal (anti-inflammatory) compounds, and has become very popular among people with AIDS as an alternative to pharmaceutical antivirals.

Sphingolin Sphingolin is a glandular supplement made from cow spinal-corn myelin, repackaged in pill form. Some practitioners recommend it for children who have tested positive for myelin sheath proteins in the bloodstream. It is used by quite a number of people with multiple sclerosis and other neurological disorders that involve demyelinization. Although anecdotal reports indicate that some people with PDDs have had symptom reductions when taking sphingolin, there could be a hidden problem with this supplement. It could contain particles that cause the deadly neurological disorder spongiform encephalopathy, “mad cow disease.” It is not available in the UK for this very reason–and there’s no reason to believe that this disease exists only in UK cattle or UK humans.

Evaluating supplement claims No matter what kind of alternative practitioner or therapy you choose, it’s just as important to be a smart consumer in this area as it is with traditional medicine. Unfortunately, it can be more difficult. Medications with approval from the FDA or similar government bodies undergo rigorous testing. Study results and detailed information about these compounds are available in numerous books, online, or directly from the manufacturers. With “natural” remedies, that’s not always the case. It seems like every week another paperback book appears making wild claims for a “new” antioxidant compound, herbal medication, or holistic therapy. The online bookstore Amazon.com (//Amazon.com) lists nearly twenty titles about St. John’s wort alone! These books–not to mention magazine articles, Web sites, and semiinformed friends–sometimes wrap conjecture up in a thin veneer of science. They may reference studies that are misinterpreted, that appeared in disreputable journals, or that were so poorly designed or biased that no journal would publish them. Supplement salespeople, and particularly those who take part in multilevel marketing schemes, seem to have taken lessons from their predecessors in the days of the traveling medicine show. They have little to lose by making outrageous claims for their products and much to gain financially. Here are just a few of the unsupported claims found in a single five-minute sweep of supplement-sales sites on the Internet: “Glutathione slows the aging clock, prevents disease and increases life.” “Pycogenol … dramatically relieves ADD/ADHD, improves skin smoothness and elasticity, reduces prostate inflammation and other inflammatory conditions, reduces diabetic retinopathy and neuropathy, improves circulation and enhances cell vitality … ” [and, according to this site, cures almost anything else that might ail you!] “Sage and bee pollen nourish the brain.” “Soybean lecithin has been found to clean out veins and arteries–dissolve the gooey sludge cholesterol–and thus increase circulation, relieve heart, vein and artery problems. It has cured many diabetics–cured brain clots, strokes, paralyzed legs, hands and arms!” Take the time to browse your local health-food or vitamin store’s shelves, and you’ll probably spot a number of products that are deceptively advertised. Some companies try to deceive you with “sound-alike” names, packaging that mimics other products, or suggestive names that hint at cures. Other colorful bottles of pills contain substances that can’t actually be absorbed by the body in oral form–for example, “DNA” (deoxyribonucleic acid, the building block of human genetic material) graces the shelves of some shops. One site for a manufacturer of this useless “supplement” claims that “it is the key element in the reprogramming and stimulation of lazy cells to avoid, improve, or correct problems in the respiratory, digestive, nervous, or glandular systems.” It also notes that this “DNA” is extracted from fetal cells. Other brands are apparently nothing but capsules of brewer’s yeast. As the previous section on vitamins and supplements indicates, some other supplements provide end products of internal procedures, such as glutathione, instead of the precursors needed for the body to make a sufficient supply on its own, such as vitamin E. This approach may not work. When in doubt, consult with your doctor or a competent nutritionist. How can you assess supplement claims? Start by relying primarily on reputable reference books for your basic information, rather than on advertisements or the popular press. Watch out for any product whose salespeople claim it will “cure” anything. Supplements and vitamins may enhance health and promote wellness, but they rarely effect cures. Be wary of universal usefulness claims. The worst offenders in supplement advertising tout their wares as cure-alls for a multitude of unrelated conditions in an effort to make the most sales. There are a few other sales pitches that should make you wary. If a product’s literature references the myth of the long-lived Hunzas, someone’s trying to pull the wool over your eyes. This tale of hardy Russian mountain folk who supposedly all live to be well over 100 years old was refuted long ago by reputable researchers. If it’s a natural substance but a particular company claims to be the only one to know the secret of its usefulness, that really doesn’t make much sense. Be especially cautious when sales pitches are written in pseudoscientific language that doesn’t hold up under close examination with a dictionary. This is a popular ploy. For example, one product that has occasionally been peddled to parents of children with PDDs claims to “support cellular communication through a dietary supplement of monosaccharides needed for glycoconjugate synthesis.” Translated into plain English, this product is a sugar pill. Even when you have seen the science behind a vitamin or supplement treatment, there’s still the problem of quality and purity. It’s almost impossible for consumers to know for sure that a tablet or powder contains the substances advertised at the strength and purity promised. Whenever possible, do business with reputable manufacturers that back up their products with potency guarantees or standards. In most European countries, potency is governed by government standards; in the US, it’s a matter of corporate choice. “Natural” does not mean “harmless.” Vitamins and supplements can have the power to heal, and the power to harm. Be sure to work closely with your physician or a nutritionist if you’re using anything more complex than a daily multivitamin.

Notes: 1. Dr. Rosemary Waring, “Biochemical Parameters in Autistic Subgroups,” October 1995 presentation to 4th Consensus Conference on Biological Basis and Clinical Perspectives in Autism, Troina, Sicily, based on ongoing studies at the University of Birmingham (UK) Biochemistry Department. 2. Dr. Robert J. Sinaiko, “The Biochemistry of Attentional/Behavioral Problems,” presentation to the 1996 Feingold Association Conference (http://www.feingold.org/sinaiko.shtml (http://www.feingold.org/sinaiko.shtml)). 3. R. S. Chamberlain and B. H. Herman, “A Novel Biochemical Model Linking Dysfunction in the Brain, Melatonin, Proopiomelanocortin Peptides, and Serotonin in Autism,” Biological Psychiatry 28 (1990): 773-793. 4. M. Fux et al., “Inositol Treatment of Obsessive-Compulsive Disorder,” American Journal of Psychiatry 153 (1996): 1219-1221. 5. J. Levine, “Controlled Trials of Inositol in Psychiatry,” European Neuropsychopharmacology 7 (May 1997): 147-155. HAK CIPTA@Dr (mailto:CIPTA@Dr) Iwan Suwandy ,MHA 2010 The Autism pusat info autism, pusat infokes dr iwan Iwansuwandy's Blog

Create a free website or blog at WordPress.com.