Lampiran 1 LEMBARAN PENJELASAN KEPADA CALON SUBJEK

  Lampiran 1 LEMBARAN PENJELASAN KEPADA CALON SUBJEK Selamat pagi/siang Bapak/Ibu, saya Dr.Zainal Abdi, pada hari ini akan

melakukan penelitian yang berjudul : “ Perbandingan Status koagulasi Penderita

  

Stroke Iskemik dengan non Stroke “. Penelitian ini bertujuan untuk mendapatkan

informasi tentang hiperkoagulasi yang menjadi faktor resiko terjadinya trombosis

pada penderita stroke iskemik.

  Pada Bapak/Ibu akan dilakukan pemeriksaan penyaring hemostasis untuk

mengetahui adanya hiperkoagulasi. Pemeriksaan dilakukan dengan mengambil

sampel darah sebanyak ±10 ml melalui pembuluh darah vena yang terdapat di

lipatan siku tangan.

  Dengan pemeriksaan penyaring hemostasis ini dapat dideteksi gambaran

hiperkoagulasi yang nantinya dapat menjadi panduan pemberian obat untuk

mencegah atau mengurangi terjadinya trombosis.

  Keikutsertaan Bapak/Ibu dalam penelitian ini adalah sukarela dan tidak dipungut biaya apapun. Bila ada keterangan yang saya berikan masih belum jelas

atau masih ada hal-hal yang hendak ditanyakan, maka Bapak/ Ibu dapat

menghubungi saya :

  Nama : Dr. Zainal Abdi Alamat : Jl.Lembaga Pemasyarakatan, Tj.Gusta No.Telp : 081376045344

  Lampiran 2

FORMULIR PERSETUJUAN SETELAH PENJELASAN

(Informed Consent)

  

Nama Instansi : Divisi hematologi-Onkologi Medik, Departemen Ilmu

Penyakit Dalam Fakultas Kedokteran Universitas Sumatera Utara Surat Persetujuan Ikut Penelitian

  Saya yang bertandatangan dibawah ini : Nama : ..........................................................................................

  Umur : ........................................................................................... Jenis Kelamin : Laki-laki / Perempuan Pekerjaan : .............................................................................................

  Alamat : ............................................................................................. Setelah mendapat penjelasan secukupnya serta menyadari manfaat dan resiko dari

penelitian tentang “ Perbandingan status koagulasi penderita stroke iskemik

dengan non stroke “. Saya dengan sukarela menyatakan bersedia untuk

diikutsertakan dalam penelitian diatas. Bila sewaktu waktu saya sebagai pihak

yang diteliti merasa dirugikan oleh pihak peneliti maka saya berhak membatalkan persetujuan ini tanpa menuntut ganti rugi.

  Medan,......................2009 Peserta Penelitian

  Lampiran 5

Uji Statistik

Npar Tests (stroke Iskemik) _{Umur (tahun) KGD Ureum N Mean Std. Deviation Absolute Positive Negative Kolmogorov-Smirnov Z As ymp. Sig. (2-tailed) 21 21 21 153.43 63.500 .198 .198 -.171 .908 .382 Normal Parameters Most Extreme Differences 26.10 4.898 .132 .132 -.121 .604 .859 60.48 11.869 .188 .116 -.188 .862 .447} One-Sample Kolmogorov-Smirnov Test _a,b

  Kreatinin _{Rasio PT TD D SGOT TD S INR SGPT 21 152.86 23.694 .142 .078 -.142 .652 .789 21} ^{21 1.014 .1931 .165 .104 -.165 .757 .615} _{21 21 21 .9962 .14682 .129 .129 -.112 .592 .875 25.43 5.600 .146 .146 -.126 .668 .764 25.25 7.960 .134 .088 -.134 .612 .848 86.19 10.713 .353 .218 -.353 1.619 .011 Fibrinogen Rasio aPTT D-Dimer a. b. Calculated from data. Test distribution is Normal.} 21 1.1486 .18826 .127 .127 -.075 .583 .886 _{21 .8848 .11285 .173 .173 -.115 .795 .553 21 314.71 125.560 .210 .210 -.118 .963 .311 21 385.33 864.011 .394 .394 -.370 1.808 .003}

  Npar Tests (kontrol) _{Ureum KGD Umur (tahun) N Mean Std. Deviation Absolute Positive Negative Kolmogorov-Smirnov Z As ymp. Sig. (2-tailed) 21 130.76 21.482 .096 .096 -.081 .440 .990 21 21 Normal Parameters Most Extreme Differences 59.14 10.795 .125 .100 -.125 .571 .901 26.48 6.630 .133 .131 -.133 .611 .849} One-Sample Kolmogorov-Smirnov Test _{a,b Rasio PT TD D TD S SGPT SGOT} Kreatinin _{21 1.0186 .12515 .127 .127 -.089 .583 .886 21 21 110.95 13.002 .181 .181 -.138 .830 .496 21 21 21 .957 .2271 .136 .136 -.116 .625 .829 70.95 7.684 .216 .216 -.214 .990 .281 28.19 5.164 .151 .093 -.151 .690 .727 25.57 5.706 .115 .115 -.115 .528 .943}

  INR _{Fibrinogen D-Dimer Rasio aPTT b. a. Calculated from data. Test distribution is Normal. 21 21 293.90 111.308 .180 .180 -.143 .826 .503 21 .9596 .09834 .183 .094 -.183 .838 .484} ^{21 .9686 .17934 .119 .113 -.119 .545 .928} _{99.00 .000 c} c. _{The dis tribution has no variance for this variable. One-Sample Kolmogorov-Smirnov Test cannot be performed.}

  _{Equality of Variances t-test for Equality of Means Levene's Test for F Sig. t df Sig. (2-tailed) Difference Difference Lower Upper} Independent Samples Test _{Mean Std. Error 95% Confidence Interval of the Difference Ureum Equal variances} KGD Equal variances _{Equal variances as sumed as sumed not ass umed Equal variances 15.262 .000 1.550 4.526 .040 -.212 1.550 24.519 .134 22.667 14.628 -7.491 52.824 -.212 36.820 .833 -.381 1.799 -4.026 3.264 40 .129 22.667 14.628 -6.898 52.232 40 .833 -.381 1.799 -4.017 3.255 Kreatinin Equal variances SGOT Equal variances as sumed Equal variances not ass umed as sumed} not ass umed _{1.054 .311 .878 .024 .878 -.082 .878 38.992 .385 .0571 .0650 -.0744 .1887 40 .935 -.143 1.745 -3.669 3.383 40 .385 .0571 .0650 -.0743 .1886 TD S Equal variances SGPT Equal variances not ass umed} Equal variances _{not ass umed Equal variances as sumed 6.030 .019 7.105 1.079 .305 -1.419 -1.419 34.299 .165 -2.938 2.071 -7.145 1.268 -.082 39.986 .935 -.143 1.745 -3.669 3.383 40 .164 -2.938 2.071 -7.123 1.247 40 .000 41.905 5.898 29.985 53.825 TD D Equal variances not ass umed Equal variances as sumed not ass umed Equal variances} as sumed _{1.706 .199 5.297 5.297 36.273 .000 15.238 2.877 9.405 21.071 7.105 31.043 .000 41.905 5.898 29.877 53.933 40 .000 15.238 2.877 9.424 21.053} Mann Whitney Test Ranks

  Kelompok pengamatan N Mean Rank Sum of Ranks TD D Pasien 21 29.14 612.00 Kontrol 21 13.86 291.00 Total

  42 a Test Statistics

  TD D Mann-Whitney U 60.000 Wilcoxon W 291.000

  Z

• 4.163 As ymp. Sig. (2-tailed) .000 a.

  Grouping Variable: Kelompok pengamatan Ranks

  

Kelompok pengamatan N Mean Rank Sum of Ranks

D-Dimer Pasien

21

28.00 588.00 Kontrol

21

15.00 315.00 Total

  

42

  a Test Statistics D-Dimer Mann-Whitney U 84.000

  Wilcoxon W 315.000 Z

• 4.206 As ymp. Sig. (2-tailed) .000

a. Grouping Variable: Kelompok pengamatan

  Group Statistics Std. Error Kelompok pengamatan N Mean Std. Deviation Mean

  Rasio PT Pasien 21 .9962 .14682 .03204 Kontrol 21 1.0186 .12515 .02731

  INR Pasien 21 1.1486 .18826 .04108 Kontrol 21 .9686 .17934 .03914 Rasio aPTT Pasien 21 .8848 .11285 .02463 Kontrol 21 .9596 .09834 .02146 Fibrinogen Pasien

21

2.14 .359 .078 Kontrol

21

2.14 .359 .078 D-Dimer Pasien 21 385.33 864.011 188.543 Kontrol

21

99.00 .000 .000 _{Equality of Variances t-test for Equality of Means Levene's Test for F Sig. t df Sig. (2-tailed) Difference Difference Lower Upper} Independent Samples Test _{Mean Std. Error 95% Confidence Interval of the Difference INR Equal variances} Rasio PT Equal variances _{as sumed Equal variances Equal variances as sumed not ass umed .162 .690 -.532 .014 .907 3.172 3.172 39.906 .003 .18000 .05674 .06532 .29468 -.532 39.022 .598 -.02238 .04210 -.10753 .06277 40 .003 .18000 .05674 .06533 .29467 40 .598 -.02238 .04210 -.10746 .06270 Rasio aPTT Equal variances Fibrinogen Equal variances Equal variances not ass umed as sumed as sumed} not ass umed _{.000 1.000 .000 .196 .660 -2.292 -2.292 39.266 .027 -.07486 .03267 -.14092 -.00880 40 1.000 .000 .111 -.224 .224 40 .027 -.07486 .03267 -.14088 -.00884 D-Dimer Equal variances not ass umed Equal variances as sumed not ass umed} Equal variances _{7.658 .009 1.519 1.519 20.000 .144 286.333 188.543 -106.960 679.626 .000 40.000 1.000 .000 .111 -.224 .224 40 .137 286.333 188.543 -94.725 667.392}

  Jenis Kelamin * Kelompok pengamatan Crosstab Kelompok pengamatan

  Pasien Kontrol Total Jenis k elamin Laki-laki Count

  14

  13

  27 Ex pec ted Count

  13.5

  13.5

  27.0 % within Jenis kelamin 51.9% 48.1% 100.0% % within K elompok 66.7% 61.9% 64.3% pengamatan

  % of Total 33.3% 31.0% 64.3% Perempuan Count

  7

  8

  15 Ex pec ted Count

  7.5

  7.5

  15.0 % within Jenis kelamin 46.7% 53.3% 100.0% % within K elompok 33.3% 38.1% 35.7% pengamatan

  % of Total 16.7% 19.0% 35.7% Total Count

  21

  21

  42 Ex pec ted Count

  21.0

  21.0

  42.0 % within Jenis kelamin 50.0% 50.0% 100.0% % within K elompok

  100.0% 100.0% 100.0% pengamatan % of Total 50.0% 50.0% 100.0%

  Chi-Square Tests As ymp. Sig. Exact Sig. Exact Sig.

  Value df (2-sided) (2-sided) (1-sided) b

  Pearson Chi-Square .104 1 .747 a

  Continuity Correction .000 1 1.000 Likelihood Ratio

  .104 1 .747 Fis her's Exact Test 1.000 .500 Linear-by-Linear

  .101 1 .750 As sociation N of Valid Cases

  42

a. Computed only for a 2x2 table b. 0 cells (.0%) have expected count less than 5. The minimum expected count is 7.

  50.

  Ju mla h Hi perkoag ula si * Kelo mp ok p eng ama tan Cro ssta bul atio n Kelom pok pengam atan

  Pasien Kontrol Total Jumlah Count

  11

  16

  27 Hiperk oagulasi Ex pec ted Count

  13.5

  13.5

  27.0 % within Jumlah 40.7% 59.3% 100.0% Hiperk oagulasi

  % within K elom pok 52.4% 76.2% 64.3% pengam atan % of Total

  26.2% 38.1% 64.3%

  1 Count

  8

  2

  10 Ex pec ted Count

  5.0

  5.0

  10.0 % within Jumlah 80.0% 20.0% 100.0% Hiperk oagulasi

  % within K elom pok 38.1% 9.5% 23.8% pengam atan % of Total 19.0% 4.8% 23.8%

  2 Count

  1

  1

  2 Ex pec ted Count

  1.0

  1.0

  2.0 % within Jumlah 50.0% 50.0% 100.0% Hiperk oagulasi

  % within K elom pok 4.8% 4.8% 4.8% pengam atan % of Total

  2.4% 2.4% 4.8% >= 3 Count

  1

  2

  3 Ex pec ted Count

  1.5

  1.5

  3.0 % within Jumlah 33.3% 66.7% 100.0% Hiperk oagulasi

  % within K elom pok 4.8% 9.5% 7.1% pengam atan % of Total

  2.4% 4.8% 7.1% Total Count

  21

  21

  42 Ex pec ted Count

  21.0

  21.0

  42.0 % within Jumlah 50.0% 50.0% 100.0% Hiperk oagulasi

  % within K elom pok 100.0% 100.0% 100.0% pengam atan % of Total 50.0% 50.0% 100.0%

  Chi-Square Te sts As ymp. Sig.

  Value df (2-sided) a

  Pearson Chi-S quare 4.859 3 .182 Lik elihood Ratio 5.126 3 .163 Linear-by-Linear

  .271 1 .603 As soc iation N of V alid Cases

  42

a. 4 c ells (50.0%) have ex pec ted c ount les s than 5. The minimum expected count is 1.00.

  Two-Sample Kolmogorov-Smirnov Test Frequencies Kelompok pengamatan N Jumlah Hiperkoagulasi Pasien

  21 Kontrol

  21 Total

  42 a Test Statistics

  Jumlah Hiperkoa gulasi Most Extreme Absolute

  .238 Differences Positive .048 Negative

• .238 Kolmogorov-Smirnov Z .772 As ymp. Sig. (2-tailed) .591

a. Grouping Variable: Kelompok pengamatan

  Lampiran 6

DAFTAR RIWAYAT HIDUP

I.DATA PRIBADI

  Nama : Dr. Zainal abdi Tempat/Tanggal Lahir : Medan / 28 Agustus 1977 Status : Peserta PPDS-1 Ilmu Penyakit Dalam FK USU Alamat : Jl. Lembaga Pemasyarakatan ,Tj.Gusta Istri : Prima Irani Ibra S.Si, Apt Anak : 1. Aurellia Zahrany

  

2. Athallia Zaliany

  3. Aylani Puteri

  4. Anasya Zahira Telp/ HP : 081376045344

II. RIWAYAT PENDIDIKAN

  1. SDN 20 Banda Aceh : Ijazah tahun 1989

  2. SMPN 4 Banda Aceh : Ijazah tahun 1992

  3. SMAN 11 Medan : Ijazah tahun 1995

  4. Fakultas Kedokteran USU : Ijazah tahun 2001

  5. PPDS-1 Ilmu Penyakit Dalam FK USU : Juli 2005 – sekarang

  III. RIWAYAT PEKERJAAN

  1. Dokter PTT Depkes RI di Puskesmas Tanjung Batu, Kepulauan Riau 2002-2004

  IV.KEANGGOTAAN PROFESI

  1. Ikatan Dokter Indonesia (IDI)

  2. Persatuan Ahli Penyakit Dalam Indonesia (PAPDI)

  V. KARYA ILMIAH DI BAGIAN PENYAKIT DALAM

  1. Zainal Abdi, Refli Hasan, Peripartum Dilated Kardiomiopati, Kongres Nasional XIV Perhimpunan Penyakit Dalam Indonesia . Jakarta 11-14 November 2009

  2.Zainal Abdi, Abdurrahim Rasyid Lubis, Salli Roseffi Nasution, Lupus Nephritis with Manifestation of Nephrotic Syndrome in SLE Patient, Pertemuan Tahunan Perhimpunan Nefrologi Indonesia (PERNEFRI) Semarang 22-24 Oktober 2010.

  VI.PARTISIPASI DALAM KEGIATAN ILMIAH

  1.Peserta Gastroentero-Hepatologi Update IV 2006,Convention Hall Hotel Danau Toba Medan, 08-09 September 2006.

  

2.Peserta Simposium The Scientific Evidence to Date : Reduction of

Events in Cardiovascular Disease ,Hotel Emeral Garden 9 Desember

2006.

  

3.Peserta Road Show PAPDI ‘ Which anti Hypertension’s Giving The

  Smart Solution for Asian?, Hotel Tiara Medan 14 April 2007.

  4.Peserta simposium Trombosis-Hemostasis regional pertama, Tema :

Meningkatkan Peran Trombosis-Hemostasis Dalam Multi Disiplin Ilmu

Kedokteran, Hotel Danau Toba Medan 1-2 Mei 2007.

  5.Peserta Workshop ECG in Daily Practice, Hotel Tiara Medan 14 April 2007.

  6.Peserta Simposium DHF Course II, Ruang Prof.Ildrem Medan 24 Februari 2007.

  7.Panitia Pelatihan Penatalaksanaan diabetes Melitus Bagi edukator Diabetes, Uplatda Telkom Medan 12-15 Desember 2007.

  8. Peserta simposium Astasantin, The Only Strongest and Safest antioxidant Without Any Pro-oxidant,Hotel Emeral Garden 20 Juni 2007.

  

9. Panitia Pertemuan ilmiah Tahunan VIII 2007 Departemen ilmu Penyakit

Dalam FK USU. Medan, 8-10 maret 2007.

  10. Peserta Simposium era Baru Pengunaan Probiotic. Medan, 28 April 2007.

  11. Peserta Simposium Diabetes, The Vitamin & Mineral Antioxidans Connection. Medan, 26 Mei 2007. th

  12.Peserta The 4 new trend in cardiovascular management. Medan, 15-16 Juni 2007.

  13.Peserta Simposium Current Issues in the Management of Gastritis and Gastropathy. Medan 9 Juni 2007.

  14. Peserta PAPDI Road Show 2008 Eli Lilly Training For Excellence. Medan, 26 Januari 2008.

  15. Peserta Simposium On Hypertension Medan 19 januari 2008.

  16.Peserta Simposium OnTarget : A land Mark Trial in Cardio & Vascular Protection. Grand angkasa Hotel 5 Juli 2008.

  17. Peserta dan Panitia Pertemuan Ilmiah Tahunan IX 2008 Departemen Penyakit Dalam Fakultas Kedokteran Universitas Sumatera Utara New Era In Therapeutic Options. Medan, 17-19 April 2008.

  18.Peserta Fucoidan, Nature’s way for faster peptic ulcer healing. Medan,14 Juni 2008.

  19.Peserta Symposium of Venous Thromboembolism. Medan, 26 Juli 2008.

  20.Peserta Festschrift Prof. Dr. Harun Rasyid Lubis, SpPD-KGH. Medan 10 November 2008.

  

21. Peserta Road Show Nutrisi Klinik PB PAPDI, Nutrisi Klinik : dari Ilmu

Dasar Hingga Aplikasi, Medan 21-22 Februari 2009.

  22.Peserta Simposium Early Insulin Inisiation, how, when and what insulin according to daily practice need, Grand Swiss-Bel hotel 21 November 2009.

  23.Peserta dan presentasi pada Kongres Perhimpunan Penyakit Dalam Indonesia (KOPAPDI XIV)Hotel kempinski, Hotel Grand-Hyatt , Hotel Sahid Jaya Jakarta 11-14 November 2009.

  24.Peserta simposium Enercore :Finding the Missing Link Energy Metabolism. Hotel JW Marriot 17 maret 2009.

  25. Peserta Simposium PIT X. Medan 23-25 April 2009.

  26.Peserta Simposium 11th Annual Scientific Meeting Internal Medicine Department of Internal Medicine , Medan 1-3 April 2010.

  27.Presentasi pada PERNEFRI Semarang 22-24 Oktober 2010.

  28. Peserta Simposium Reumatology Update 2010 medan Grand Aston Hotel 1 Agustus 2010.

  29.Peserta workshop Injeksi kortikosteroid Intra Lesion dan Visco Suplement . RSU.Prof Boloni Medan 30 Juli 2010.

  30.Peserta Simposium Annual Meeting of Indonesian society of Nephrology (InaSN) 2010 Semarang 22-24 Oktober 2010.

  31.Peserta Simposium Hiperglicemia of patients with Diabetes Mellitus in

clinical practice.PAPDI Sumut. Hotel Grand Aston Medan 28 november

2010.

  32.Peserta Pelatihan Program pengembangan Pendidikan Keprofesian Berkelanjutan Ultrasonografi tahap I PUSKI. Medan 21-24 Maret 2011.

  33.Peserta Simposium Pertemuan Ilmiah Tahunan X , Medan 28-30 April 2011.

  34. Peserta Simposium Gastro Update IX, Medan 4-5 November 2011.

  35.Peserta Simposium Infection Update VI. Medan 5-7 september 2012.

  36.Peserta Simposium PIT XII dan Gastro Update XII , Medan 12-14 September 2013.