Situasi COVId-19 di Jawa Timur sampai 5 Januari 2021
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Situasi COVId-19 di Jawa Timur sampai 5 Januari 2021 1
dan strategi Pengendaliannya
Satuan Gugus Tugas Kuratif Pengendalian COVID-19 Provinsi Jawa Timur
Satuan Gugus Tugas Percepatan Penanganan COVID-19 Jawa Timur
1
IG: @jatimpemprov | web: infocovid19.jatimprov.go.id
Sumber data : www.endcoronavirus.org BEATING COVID-19 Situasi Pandemi Covid-19 International Desember 2020 NEARLY THERE NEED TO TAKE ACTION
COVID-19
18
Specific Tx
NATURAL HISTORY of DISEASE
And MODE OF TREATMENT ANTIVIRAL …?
. Infeksi
Skunder
SUPPORTIVE . Pemberatan
RECEPTOR
PROKES TX …? Co Morbid
ACE-2 TISSUE . Gagal Napas
? DAMAGE . Gagal Organ
IMMUNE
RESPONSE
IMUNOMODULATOR…?
IMUNOSUPRESOR…….?
STEM CELL….?
Reff;
.New England journal of medicine, Sep 23-2020
.American society for microbiology, Agt 2020 ,
.P3 Covid -19 Kemkes Ed v Jnw 2020
PROKES DOMINAN
Satgas Penanganan Covid-
11/5/2020 19: Bidang Perubahan 7
Perilaku
Manajemen Perawatan Covid-19
Supervisi Nakes
Release Release Release
01 • Swab PCR/ TCM (-) • Swab PCR/ TCM (-)
• Swab PCR/ TCM (-)
tanpa Gejala tanpa Gejala
tanpa Gejala
02
Isolasi Mandiri R. Karantina
03
RS Lapangan
04 RS Rujukan
• Swab (+) PCR/
• Swab (+) PCR • Swab (+) PCR /
TCM tanpa gejala
Rujuk • Swab (+) PCR Rujuk Rujuk
Rumah /TCM Gejala TCM,Probable,
/TCM tanpa
memenuhi syarat ringan, non- Suspect dengan
gejala, rumah
isolasi komorbid. Gejala sedang-
tidak memenuhi
. Rapid (+) Ag/AB • Discarded gejala Berat-Kritis (Rujukan
Rm Memenuhi
syarat isolasi
Utama)
sarat • Rapid Ag/Ab(+) minimal
• Discarded tanpa
Tx Tx
Tx: gejala
• Isolasi • Isolasi • Isolasi
• Monitor Tx • Treatment • Treatment
• Isolasi • Monitor • Monitor
Pelaksana
• Masyarakat • Monitor
Pelaksana Discarded
Pelaksana Discarded
Pelaksana • Pemerintah
• Pemerintah
• Swab PCR/ TCM (+)
• Masyarakat • Swab PCR/ TCM (+) Gejala minimal /
Reff . PPPC Kemkes ed. V • Pemerintah tanpa Gejala tanpa gejala
UU PRAKTIK KEDOKTERAN
(29 th 2004)
PASAL 50
Dokter atau dokter gigi dalam melaksanakan praktik
kedokteran mempunyai hak dan kwajiban :
a. Memperoleh perlindungan hukum sepanjang melaksanakan
tugas sesuai dengan standar profesi dan standar prosedur
operasional;
b. Memberikan pelayanan medis menurut standar profesi dan
standar prosedur operasional ;
Standard Profesi = Panduan Praktek Klinik
UU 44 RS th 2009 Pasal 32 Hak Pasien
q.Menggugat dan/atau menuntut Rumah Sakit apabila Rumah Sakit
diduga memberikan pelayanan yang tidak sesuai dengan standar
baik secara perdata ataupun pidana; dan
Pasal 29: Kewajiban RS
s. Melindungi dan memberikan bantuan hukum bagi semua petugas Rumah Sakit dalam melaksanakan tugas
Clinical Guideline ( CG ) :
(SPO Medik / PPK)
Is : Systematically develop statements to assist practitioner and
patient decisions about appropriate heath care
for specific clinical circumstances.
( Guideline are suggestions for care, not rules )
The aim CG is to Improve Patient Outcome with
Base on Clinical Evidence ( EBM )
Best Clinical Quality
So, the C.G are a tool to assist in the art of decision making,
do not constrain practitioners.
Richard Bowker et al. 2008 , Paul Shekelle,et al. 2015
Template PPK RS.Dr Soetomo
11. Penelaah Kritis a. ........................................................................
Panduan Praktik Klinis b. ........................................................................
c. dst
SMF : ......................................... 12. Indikator Medis .......................................................................................................
RSUD Dr Soetomo, Surabaya .......................................................................................................
Tahun : .....................................................................................
13. Kepustakaan a) ........................................................................
DIAGNOSA PENYAKIT (ICD-10) .......................................... b) ........................................................................
c) ........................................................................
1. Pengertian ....................................................................................................... d) ........................................................................
(Definisi) ........................................................................................... e) ........................................................................
2. Anamnesis .......................................................................................................
.......................................................................................................
...............................
3. Pemeriksaan .......................................................................................................
Fisik ....................................................................................................... Komite Medik Disahkan
............................... Direktur R.S
4. Kriteria a. ........................................................................
Diagnosis b. ........................................................................
c. dst
5. Diagnosis ....................................................................................................... ……………….. . ……………….
Kerja ......................................................
6. Diagnosis a) ........................................................................
Banding b) ........................................................................
c) ........................................................................
d) ........................................................................
e) ........................................................................
Ket :
7. Pemeriksaan 1. .................. GR: ...
Penunjang 2. .................. GR: ...
3. .................. GR: ... GR : grade of recommendation
8. Terapi 1. .................. GR: ...
2. .................. GR: ... 1.A s/d 11. D
3. .................. GR: ...
9. Edukasi 1. ........................................................................
2. ........................................................................
3. dst
10. Prognosis Ad vitam (hidup) : Dubia ad bonam/malam
Ad Sanationam (sembuh) : Dubia ad bonam/malam
Ad Fungsionam (fungsi) : Dubia ad bonam/malam
EBM-VBM
Making
RECOMMENDATIONS
Komponen yang dipertimbangkan dalam menentukan Rekomendasi
berbasis EB M / V B M
Clinical Evidence ( including
consensus ) Patient Views Health Economics
Clinical Judgement
Recommendation
Making Recommendation is an Art, not a Precise science .It is not Easy
Monica lakhanpaul,2008Quality of evidence - Meta Analisis RCT
GRADE System ( th 2015 )
have two components :
a. Two-level representation of the strength of recommendation : strong ( 1 ) and weak ( 2 )
b. Four-level or three representation of the quality of the evidence
(high, moderate, low, and very low or high, moderate and low-very low )
● Strength of the recommendation:
a. Strong recommendation ( number 1 ) :
is to do (or not do) something, where the benefits clearly outweigh the risks
(or vice versa) for nearly all patients.
b. Weak/conditional recommendation ( number 2 ) :
is made either when risks and benefits are more closely balanced or are more uncertain.
● Quality of evidence ( tingkat pembuktian ):
Assessment of evidence quality reflects confidence in the estimates of benefits, harms, and burdens can be implemented
with either four levels of evidence quality, or with three levels such that the “low” and “very low” categories are combined.
Three levels and uses a letter (A, B, or C) for high, moderate, or low/very low quality evidence.
High quality of evidence typically comes from well-performed randomized controlled trials or other overwhelming evidence (such as well-
executed observational studies with very large effects). Moderate-quality evidence typically comes from randomized trials with important
limitations, or from other study designs with special strength. Low-quality evidence typically comes from observational studies, or from controlled
trials with very serious limitations. Very low-quality evidence typically comes from nonsystematic observations, biologic reasoning, or
observational studies with serious limitations.
Clinical practice guidelines : Paul Shekelle et al, 2015Grade of Recommendation
( GRADE System )
Grade of recommendation* Clarity of risk/benefit Quality of supporting evidence Implications
1A Benefits clearly outweigh risk and Consistent evidence from well performed Strong recommendation, can
Strong recommendation burdens, or vice versa randomized, controlled trials or apply to most patients in most
High quality evidence overwhelming evidence of some other circumstances without
form. Further research is unlikely to change reservation
our confidence in the estimate of benefit
and risk.
1B Benefits clearly outweigh risk and Evidence from randomized, controlled trials Strong recommendation, likely
Strong recommendation burdens, or vice versa with important limitations (inconsistent to apply to most patients
Moderate quality evidence results, methodologic flaws, indirect or
imprecise), or very strong evidence of some
other form. Further research (if performed)
is likely to have an impact on our
confidence in the estimate of benefit and
risk and may change the estimate.
1C Benefits appear to outweigh risk and Evidence from observational studies, Relatively strong
Strong recommendation burdens, or vice versa unsystematic clinical experience, or from recommendation; might
Low quality evidence randomized, controlled trials with serious change when higher quality
flaws. Any estimate of effect is uncertain. evidence becomes available
Clinical practice guidelines : Paul Shekelle et al, 2015Grade of recommendation* Clarity of risk/benefit Quality of supporting evidence Implications
2A Benefits closely balanced with risks and Consistent evidence from well performed Weak recommendation, best
Weak recommendation burdens randomized, controlled trials or overwhelming action may differ depending on
High quality evidence evidence of some other form. Further research circumstances or patients or
is unlikely to change our confidence in the societal values
estimate of benefit and risk.
2B Benefits closely balanced with risks and Evidence from randomized, controlled trials Weak recommendation,
Weak recommendation burdens, some uncertainty in the with important limitations (inconsistent alternative approaches likely to
Moderate quality evidence estimates of benefits, risks and burdens results, methodologic flaws, indirect or be better for some patients under
imprecise), or very strong evidence of some some circumstances
other form. Further research (if performed) is
likely to have an impact on our confidence in
the estimate of benefit and risk and may
change the estimate.
2C Uncertainty in the estimates of benefits, Evidence from observational studies, Very weak recommendation;
Weak recommendation risks, and burdens; benefits may be unsystematic clinical experience, or from other alternatives may be equally
Low quality evidence closely balanced with risks and burdens randomized controlled trials with serious reasonable
flaws. Any estimate of effect is uncertain.
*GRADE : Grading of Recommendations, Assessment, Development an Evaluation Clinical practice guidelines : Paul Shekelle et al, 2015TERIMA KASIH
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