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DISAGREEMENT

Bambang Udji Djoko Rianto

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CLINICAL EXAMINATION(CE)

- !"#i$a%- !i#to&"

DIAGNOSIS

'ROGNOSIS

 TERA'

PENDAHULUAN

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'RINSI'

* ob#+&,a#i k%inik b+&+&an ada diagno#i# &ogn

. t+&ai* b+#a& +&&o& . inkon#i#t+n#i CE m+n/&/nkan k+tan

* k+t+atan CE d+ngan0 minimi#a#i +&&o& . inkon

t+n#i

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* $%ini$a% +1amination (CE) 

- %+bi! b+&+&an da&iada %abo&ato&i/- tajam- kon#i#t+n

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CE di!a&akan0

- data "ang di+&%/kan dan "ang tidak- m+ndaatkan data ak/&at dan &+%iab+%- jika tak ak/&at . tak &+%iab+%  ⇒ IN2ONSISTEN

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Inkon#i#t+n#i CE t+&!ada #am+% "ang #ama0

- 3 +m+&ik#a ⇒ int&a-ob#+&,+&

- 4 3 +m+&ik#a ⇒ int+&-ob#+&,+&

CLINICAL DISAGREEMENT

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BAGAIMANA CLINICAL DISAGREEMENT (CD) TER5A

37 CD 'ADA 'ATIENT8 ISTORIES

  mi#a%0 - a#i+n ton#i%iti# k&oni# ⇒ +&%/ o+&a#i- b+&da#a& o+&a#i ada a#i+n %ain

  - m+ng!i%angkan g+ja%a 6  - m+tod+ ba&/ m+m+&baiki a#i+n 6  - a#i+n daat k+mba%i b+&akti,ita# no&m

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E#tima#i ak/&a#i !a#i% o+&a#i b+&da#a&0

- !i#to&i+# a#i+n #+$a&a m+n"+%/&/!- kon#i#t+n#i !i#to&i+# "ang didaat- #ki%% ob"+$ti,it"

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97 CLINICAL DISAGREEMENT 'ADA 'SICAL :INDING

  +m#a II  &+tinoati (R) &+tinoati (R)

 

N-&ingan #+dang-b+&atm

  R N-&ingan ;< 3= ><

+m#a I  R #dng-b&t 39 ?9 ;;

 j/m%a! >@ ;9

 N3==

- ob#+&,+d ag&++m+nt0 ;< ?9 3== @

a7 int+&-ob#+&,+& ag&++m+nt

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  +mk#n II  &+tinoati (R) &+tinoati (R)  N-&ingan #+dang-b+&at

m

  R N-&ingan <F 33 @=+mk#n I

  R #dng-b&t 3 3F 9=

 j/m%a! = ?= 

N3==

b7 int&a-ob#+&,+& ag&++m+nt

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INDEX CLINICAL AGREEMENT (2A''A)0

- ob#+&,+d ag&++m+nt- $!an$+ ag&++m+nt- ag&++m+nt +1+$t+d on t!+ ba#i#  o $!an$+

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* C!an$+ ag&++m+nt anta&a 9 +m+&ik#a

  +m+&ik#aan II  &+tinoati (R) &+tinoati

(R)

  N-&ingan#+dang-b+&at

  R N-&ingan => 1 ><9@ =>

1><9@+m+&ik#aan I

  R #+dang-b+&at => 1 ;;99 =>1;;99

/m%a! >= >=

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* Ag&++m+nt +1+$t+d on t!+ ba#i# o $!an$+

  +m+&ik#aan II

  &+tinoati (R) &+tinoati(R)

  N-&ingan#+dang-b+&at

 R N-&ingan >@ 1 ><?9>  ;9 1

><9?>

+m+&ik#aan I

 R #+dang-b+&at >@ 1 ;;9>>  ;91;;3@> 

 j/m%a! >@3==

;93==  

Ag&++m+nt +1+$t+d on t!+ ba#i# o $!an$+ ?9>3@>

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* ind+1 $%ini$a% di#ag&++m+nt (kaa)

ag&++m+nt

= 3==

Ob#+&,+d ag&++m+nt @

Ag&++m+nt +1+$t+d ba#+d o $!an$+ ?9>3@>>3

A$t/a% ag&++m+nt b+"ond $!an$+ @->39

'ot+ntia% ag&++m+nt b+"ond $!an$ 3== - >3 ;F

* 2aa 9 ;F =><

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?7 CD 'ADA INTER'RETASI TES DIAGNOSTI2 

- !/man- +&a%atan t+# diagno#tik- #+#im+n #am+% +m+&ik#aan

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Diagno#tik +&tan"aan +m+&ik#a ob#+&,+d ag&++m+ntkaa

  k%ini# +1+$t+db" $!an$+

mammo +&%/ o+&a#i 6 9 F F3 =<g&am0393;

+kg0?@ ST-T0 NabN 6 9 > ?F =?=3 ; ?? =<3

+&i+&a% d+H#i+n#i :+ 6 9 <F ;F =?Fb%ood H%m 3 @? >3 =<>0 9F

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;7 CD 'ENENTUAN DIAGNOSIS DAN TERA'I

- !a#i% t+# diagno#tik0

- !/man- a%at . m+tod+- #+#im+n

- +m+&ik#a +n+nt/ t+&ai

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Conto!0 &+kom+nda#i ton#i%+ktomi

- ?@F #am+% ton#i% /t/!

- 3; (;>) &+kom+nda#i TE- 93> (>>) tidak TE

- &+kom+nda#i TE0 FF (;<)- tidak TE0 33< (>;)

- &+kom+nda#i TE0 >3 (;;)

G&/ dokt+& I

G&/ dokt+& II

G&/ dokt+& III

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2+#im/%an $onto!0

- ag&++m+nt0 ;> - ;< - ;;

- inkon#i#t+n#i0- da%am diagno#i#

- da%am &+kom+nda#i t+&ai

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>7 CD DALAM UALIT O: MEDICAL CARE

- +n+%itian B&ook +t a% (3F?)0

- &+,i+J &+$o&ding- ka#/# UTI T /%k/# d/od+ni . ga#t+

 ⇒ ag&++m+nt0 3> - >< (m+dian0 9)

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2AUSA CLINICAL DISAGREEMENT

37 :akto& +m+&ik#a0

  a7 bio%ogi$ ,a&iation in t!+ #+n#+- +ng%i!atan (tajam b/taJa&na)- +nd+nga&an- +ng!id/

- +ng+$a- #+nt/!an

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b7 k+$+nd+&/ngan b+&da#a& +nga%aman .  b/kan b+&da#a& b/kti

- diagno#ti$ +&&o&- t!+&a" ina&o&iat+

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$7 Si#t+m #k+ma k%a#iHka#i diagno#i#0

  3)7 2ak/ tak j+%a# inkon#i#t+n0

mi#a%0 k%a#iHka#i- t+kanan da&a!- BB #tat/# giKi- kada& g%/ko#a d%%

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9)7 B+da k&it+&ia diagno#i#

  Mi#a%0 /nt/k diagno#i# +n"akit jant/ng

- !a&/# ada +&/ba!an mioka&d ('A)- !a&/# ada +&/ba!an +n#imatik (biokimi- !a&/# ada +&/ba!an gamba&an E2G

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d7 '+&ki&aan #+b+%/mn"a

- !a&aan m+ndaatkan t+m/an k%ini#

+7 2+tidak mam/an

- k+%ainan +ngind+&aan

- #ki%%- +ng+ta!/an

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97 :akto& #am+% a#i+n

  a7 ,a&ia#i bio%ogi#0

- BB- B' nadi ⇒ o#i#i Jakt/- di+t- #t&+## +1+&$i#+ d%%

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b7 akibat ++k +n"akit dan +ngobatan  m+mb+&ikan0

- !i#to&" ak/&at dan m+"akinkan- +&/ba!an mani+#ta#i +n"akit⇒ #t&ok+ m+m+nga&/!i kom/nika#i⇒ obat ana%g+#ik m+m+nga&/!i tanda H

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$7 ingatan a#i+n #am+%

- b+&!/b/ngan d+ngan !i#to&" #am+%- k+%/a&ga- &+$o&d#⇒ +&/ba!an !i#to&i+#⇒ di#ag&++m+nt

d7 adan"a /nd+&%"ing di#+a#+ ⇒ di#ag&++m+nt m+n+j+m+n

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?7 :akto& +m+&ik#aan

  a7 +nga&/! %ingk/ngan t+&!ada +m+&ik#a

- %ingk/ngan bi#ing  ⇒ m+nggangg/ a/#k/%ta#i a/diom+t&i- #/!/ &/ang t+&%a%/ dingin ana#

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b7 +&an !/b/nganint+&ak#i +m+&ik#a . a#i

  - #ika +&i%ak/ k+bia#aan

  - m+dia kom/nika#i ba!a#a  - &a#  - +ndidikan  - #tat/# +konomi #o#ia% d%%

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$7 +ngg/naan a%at diagno#tik "ang tidak t+

  - mi#a%0- ka%ib&a#i "ang tak b+na&  ⇒ a/diom+t+& t+n#im+t+& E2G d#b7

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CARA MENCEGAH DAN MINIMALISASI CD

37 S+#/aikan a%at t+mat . %ingk/ngan diagno#ti97 M+n$a&i b/kti k%ini# #+bagai t+m/an k/n$i  a7 /%angi +%+m+n +nting +m+&ik#aan k%ini#  b7 +n$atatan b/kti t+m/an k%ini#

  $7 konH&ma#i t+m/an k%ini# k/n$i d+ngan t+# "  t+atd7 $+k #+$a&a b%ind d+ngan +m+&ik#a %ain

SIM'ULAN

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?7 Lao&an k+#im/%an b+&da#a& b/kti;7 M+ngg/nakan t+knik m+tod+ #+#/ai>7 '+&ki&aan data t+# diagno#tik ka#a& #+$a&a b%in<7 M+nga%ika#ikan i%m/ m+di# . bio%ogi b+&da#a

  #o#ia%

CARA MENCEGAH DAN MINIMALISASI CD (lanjutan