CLINICAL EVALUATION OF THERAPEUTICAL MANAGEMENT IN PEDIATRIC WARD OF USM HOSPITAL MALAYSIA

Rita, Astuti (2013) CLINICAL EVALUATION OF THERAPEUTICAL MANAGEMENT IN PEDIATRIC WARD OF USM HOSPITAL MALAYSIA. Masters thesis, UNIVERSITAS ANDALAS.

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Abstract

Children health is an indicator for the health of a nation (Egerter, et al., 2008). Health problem in children will affect their growth. WHO(Anonymous, 2004) described that almost 11 million children die before the age of 5 years old. World Vision Asian Pacific (Anonymous, 2009a) report the same case accurred in Camboja, India, and Laos. In United States, 200 from 1000 childern died before the age of 1 years old (Anonymous, 2006a). The cause of this problem is vary, such as acute respiratory disease, malaria, diarrhea, measles, malnutrition, dysentery, pneumonia, diphtheria, and cough ( Anonymous, 2006a; Kliegman et al., 2007; Anonymous, 2009a). In fact, death can be avoided through rapid handling (Anonymous, 2006a). From the above data, the possibility of the children to be hospitalized is very hight. Hospital should give special notice for handling pediatric patients. Pediatric particulary neonates with a rudimentary organ metabolism can’t accept the treatment as similar as those for adult. Drug treatment for pediatric need perfect management, start from enforcement of diagnosis, drug selection, dosage plan, until monitoring of drug use (Agalu & Mekonnen, 2012). ii Special attention is needed from health professionals for pediatric patient in terms of drug interactions, because children have a different response to the drug as compaire to adult. Parts of the body which is responsible for the excretion has not fully developed until the age of 1 year, so that the half-life of the drug is longer, that lead to it’s toxicity (Novaes & Gomes, 2006). The use of drugs requires a clear understanding of the set targets to achieve the effect, and the relative risk appears to the drug of choice. The need for a safe and effective drug for use in the sick neonates, infants, children and teens need drug treatment strategy formation wise (Kliegman et al., 2007). The aim of the study is to evaluate the patient drugs therapy management and its outcome in the pediatric ward HUSM Kelantan Malaysia. The research was carried out for two months from April 2012 to Mei 2012 on the Pediatric Ward Hospital University Sains Malaysia (HUSM). An amount of 59 pediatric patients consist of male (57.63%) and female (37.29%) were involved in this study. Data was collected from patient medical records in Pediatric Ward HUSM, includes age, sex, body weigh, diagnostic, physical examination, therapy, and laboratory investigation. The research was conducted using a prospective longitudinal methode. Anova. The relationship between diagnosis and the patient age, diagnosis, body weight were analysed using one way anova, diagnosis and gender using Chy- Square. The relationship between diagnosis with therapy using Chy-Square methode. The relationship between diagnosis and data laboratory and diagnosis iii with lenght of stay using one way anova methode. And the relationship between diagnosis with outcome using chy-Square methode. The average weight and age of the patient were 14.65±11.44 kg and 4.94±4.05 year old, respectively. The average lenght of stay of the patient of about 3 days. Most of the patient during hospitalization were suffered from respiratory tract infection 52,5%, were 64,5% patient among them with bronchopneumonia. The most drug therapy of the patient was the combination of amoxicillin and clavulanic acid. From the data of management of therapy at the pediatric ward of HUSM Malaysia conducted in April to June 2012, the several conductions can be generated as followers is most common disease suffered by pediatric patients is bronchopneumonia infection. The followed by most widely drugs used at the pediatric ward is amoxicillin and clavulanic acid for antibiotics, carbamazepine for anticonvulsants, nifedipine for antihypertensives, prednisone and combination of prednisone and hydrocortisone for steroids, ravin enema and combination of ravin enema with lactulose for laxatives, and ORS (Oral Rehydration Salt) for antidehydration. The average length of stay of the patients is 2-4 days, except for nephrotic syndrome which is about 5-6 days. The clinical outcome of the patients at the children's ward of HUSM shows that patients are generally discharged without complications, except for chronic hydrocephalus, cerebral pseudotumor and nephrotic syndrome, the patient discharged with complication. iv Based on the statistical analysis, there is a significant correlation between renal disease, with uses patient suffered nephrotic syndrom at the age of 11.7±0.494 years old, while with AGN (Acute Glomerulus Nepritis) were at the age of 7.6 ± 5.027. There is also a significant correlation between renal disease and other disease groups, with their body weigth most of the patient suffer from neprhotic syndrom were of 40.7 ± 16.546 kg , and AGN (Acute Glomerulus Nephritis) were of 28.5 ± 17.677 kg, While the averege of body weight of the patient suffer from chronic Hydrocephalus were of 20.5 kg, Alleged Insect of 14.0 ± 5.656 kg, AVSD of 10.5kg, Syncope 20.0kg, and Pseudotumor Cerebri of 62.0kg. There is a significant relationship between the disease of RTI (Respiratory Tract Infection), most of antibiotic drug treatment for the patient with RTI were amoxicillin and clavulanic acid. The relationship between the infection diseases with antibiotic drugs there is significant, the most of antibiotic drug treatment is amoxicillin and clavulanic acid. Relationship between the neuronal diseases with anti convulsant drugs there is significant, the most of antibiotic drug treatment is carbamazepine. The relationship between renal disease with anti hypertension there is significant, the most of antibiotic drug treatment is nifedipine and HCT. The relationship between and gastrointestinal disease with anti dehydration and laxative drugs there is significant, the most of antibiotic drug treatment is ravin enema, lactulosa and ORS (Oral Rehydration Salt). v There is also a significant relationship between the diagnosis and patient laboratory data of the disease of RTI with urea, infectious diseases with potassium and urea, renal disease with creatinine and albumin, neurological disease with sodium, gastrointestinal disease with sodium, creatinine and urea for there more P<0.05. There is a significant relationship between the length of stay with patient diagnoses. The relationship between diagnosis and patients outcome was also significant.

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