Hubungan Mean Platelet Volume (MPV) Dan C- Reaktif Protein (CRP) Dengan Mortalitas 14 Hari Pada Pasien Stroke Iskemik Akut

  Lampiran 1

  Lampiran 2: Master Tabel Penelitian

N0. NAMA MR UMUR L/P Hb Leucosit PLT MPV Hs-CRP Mortality

  29 Ujian Tarigan 585248 66 th L 14,2 9410 287 9,6 22,6 Survive

  23 Rosmawati 355700 54 th P 14,8 10,47 344

  9,8 141,59 Survive

  24 Eliper Pakpahan 608160 72 th L 12,0 10,87 190 9,6 185,6 Survive

  25 Ernawati 609083 55 th P 14,6 8770 262 11,1 15,72 Survive

  26 Pokih Tarigan 609041 71 th L 18,6 10,69 184 9,80 30,68 Survive

  27 Parman Sagala 594901 43 th L 11,0 10,95 385

  8,7 52,7 Survive

  28 Emilia Sinaga 588153 59 th P

12,3

  10,97 283 8,9 7,03

  Survive

  30 Penuh Nurdelina 578443 67 th P 11,2 8100 185 10,4 37,8

  22 Daswati 611273 52 th P 12,1 8350

  Exite

  31 Parliatan S 610318 48 th L 16,1 9920 253

  10,00 18,04 Survive

  32 Rizal B Manalu 610491 43 th L 14,5 9820 200 11,1 12,39

  Survive

  33 Asmalia 610004 73 th P 9,2 9710 299 9,9 46,67 Survive

  34 Rohayatik 610314 54 th P 14,9 5460 292 10,4 9,35

  Survive

  35 Sarni 606362 68 th P 9,7 7530

  267 9,2 133,73 Exite

  36 Mangasi Sibarani 609354 58 th L 11,7 10,93

  262 9,3 1,06 Survive

  178 9,9 7,61 Survive

  1 Batur S 606179 74 th L 15,0 7160 148 9,9 662,9 Survive

  11 Nepet G 607526 77 th P 12,6 7750 326 9,7 12,77 Survive

  2 Johanes 416696 69 th L 12,1 9110 209 9,00 289,42 Exite

  3 Syaridah 606469 54 th P 9,7 11,16 428 7,1 286,43 Survive

  4 Parmian LT 381212 47 th L

17,3

  10,7 239 10,5 10,09 Survive

  5 Irba Sihotang 363285 52 th L 16,4 8990 159 10,8 25,94 Survive

  6 Armia Fadli 606514 25 th L 15,5 7630 356 9,7 5,6 Survive

  7 Mursiyah 606748 71 th P 11,6 10,51 157 11,8 156,8 Exite

  8 Duma Br Purba 607164 59 th P 11,00 6570 156 10,2 68,9 Survive

  9 M.Rasyid 607608 60 th L 15,2 11,12 209 9,7 17,2 Survive

  10 Bunga LG 607616 66 th P

13,4

10,52 266 10,10

  8,39 Survive

  12 Jhoni H 607327 59 th L 15,1 8260 159 11,00 62,29 Survive

  21 Edison Manik 583460 54 th L 16,7 8340

  13 Tiram br Simanjuntak 607871 82 th P 11,9 6760 185 10,00 7,60 Survive

  14 Dikson P 611270 53 th L

13,5

  10,02 185 9,5 2,04 Survive

  15 Winarni 611658 51 th P 12,9 7800 282 10,8 18,54 Survive

  16 Syarifudin Ahmad 445842 73 th

L 16,7 9150

163

  10,8 63,5 Exite

  17 Paternus Purba 611464 71 th L 14,5 10,38 190 10,10 54,9 Exite

  18 Ngantan S 612273 76 th L 8,9 8480 143

  10,8 15,70 Exite

  19 Tulo Ariyoga 612246 51 th L 14,7 10,12 268 10,00 16,68 Survive

  20 Jumira 612423 72 th P 9,5 10,900 204 10,7 8,79 Survive

  258 8,4 140,0 Exite

  37 Penimpanen Karo 229337 86 th P 12,1 4000 139 10,3

  8,30 1,74 Survive

  59 Panu S 587139 53 th L 18,4

  10 159 10,4 11,31 Survive

  60 Kusno 614710 62 th L 15,2 10,6 425 9,7 11,,31 Survive

  61 Kabar br Sembiring 614190 72 th P 11,9 9730 296 8,4 5,41 Survive

  62 Syamsudin Sihombing 613115 59 th L 12,00 10,37

  291 9,2 5,79 Survive

  63 Sukirno 613593 56 th L 12,00 10,8 281 10,10 630,9

  Exite

  64 Iskandar Idris 613569 34 th L 14,10 8960

  305 9,3 4,26 Survive

  65 Kasumawati 614198 50 th P 15,00 10,16 296 11,3 51,65 Survive

  66 Rahmadalena 612982 46 th P 15,10 11 375

  10,00 8,73 Survive

  67 Hendra Gusnadi 613506 33 th L 16,00 7290 264

  68 Aida Murni 612992 52 th P 12,20 8675 256 10,4 19,28 Survive

  58 Amran Ginting 616282 52 th L

18,3

11 211 10,4

  10,87 279 8,6 51,31 Survive

  77 Laskar Panggabean 587466 62 th L

13,1

10,68

  26,25 Survive

  76 Sangkot Ritonga 619422 39 th L 17,6 10,86 282 9,3

  75 Pandapotan Hrp 620245 62 th L 15,5 10,43 203 9,6 15,49 Survive

  11 382 9,20 290,2 Exite

  74 Antoni Sagala 605259 38 th L 14,2

  73 Rusli Barus 604539 59 th L

13,8

  69 Hj.Fatimah 614508 69 th P

9,23

10,98

  228 8,50 38,20 Survive

  72 Ria Simatupang 604300 42 th P 9,8 6320

  71 Radu Muli Ginting 488771 61 th L

13,6

9926 184 11,4 171,5 Exite

  14,53 Survive

  70 Puji Rahayu 620222 40 th P 12,2 10,86 397 9,2

  136 11,2 98,6 Exite

  56,3 Exite

  Exite

  0,47 Survive

  43 Rusman 618147 70 th L

13,9

10,5 271 9,6 10,09 Survive

  47 Sudirman Simanjuntak 593234 57 th L 11,8 10,65 243

  7680 189 10,50 16,80 Survive

  46 Johan 618443 71 th L

14,3

  7770 184 10,00 5,26 Survive

  45 A.Malik Mangunsong 618537 57 th L

16,3

  44 Biasa Barus 617867 65 th L 11,7 7510 284 8,9 1,2 Survive

  42 Anwar Kamal S 582478 66 th L 10,9 10,56 296 9,4 2,00 Survive

  48 Suryono 618446 60 th L 12,3 8350 184 9,7

  64 13,6 21,21 Exite

  41 Abdul Sani Barus 582378 60 th L 12,1 8300

  40 Tuti Yuniar R 93599 59 th P 12,6 6850 264 9,2 5,14 Survive

  39 Hasan Ansyari 610754 56 th L 11,8 10,03 289 9,8 81,56 Survive

  Survive

  38 Roswita 610898 53 th P 14,2 10,4 177 12,5 132,5

  11,4 6,93 Survive

  4,93 Survive

  57 Kristina br Pardede 617094 78 th P 12,7 11 155 11,6 43,01

  53 Dapiem 616429 64 th P 10,7 10,85 391 11 25,88 Exite

  338 10,00 10,53 Survive

  56 Zulham 563446 43 th L 9,1 10,24

  300 8,50 12,21 Survive

  55 Sudirman Bakara 616658 61 th L

13,9

9850

  445 7,70 34,8 Exite

  54 Fatimah 613678 71 th P 9,6 10,63

  205 10,2 7,38 Survive

  49 Rasman Ginting 617110 68 th L 16,2 10,37 283 9,7

  52 Amman Sembiring 429573 78 th L 13,2 10,13

  51 Yusuf AB 617764 57 th L 12,1 10,9 189 9,8 10,99 Survive

  8,93 Survive

  

13,5

10,51 373 9,75

  50 Nelta br Sembiring 604473 32 th P

  4,32 Survive

  139 9,8 16,09 Survive Tunas Parsaoran 605224

  

78 Manalu L 10,08 211 10,7 26,40 Survive

33 th 13,00 Chadijah Hanum 596221

79 54 th P 10,9 10,94 10,4 106,00 Exite

  432

  Lampiran 3

OUTPUT ANALISIS

  jk

  Cumulative Frequency Percent Valid Percent Percent

  Valid L

  48

  60.8

  60.8

  60.8 P

  31

  39.2 39.2 100.0 Total 79 100.0 100.0

  Descriptive Statistics

  N Minimum Maximum Mean Std. Deviation umur

  79

  25

  86 58.47 12.633 hb

  79

  8.90 18.60 13.2814 2.34591 leukosit 79 4000 11160 9526.22 1555.808 plt 79 64 445 251.34 82.343 mpv

  79

  7.10 13.60 9.9601 1.02273 Hs_CRP 79 .47 662.90 60.3094 115.25415 Valid N (listwise)

79 Crosstabs

  Case Processing Summary

  Cases Valid Missing Total

  N Percent N Percent N Percent jk * Mortalitas 79 100.0% .0% 79 100.0%

  jk * Mortalitas Crosstabulation

  Mortalitas Meninggal Survive Total jk L Count

  10

  38

  48 Expected Count

  10.9

  37.1

  48.0

  % within jk 20.8% 79.2% 100.0% % within Mortalitas 55.6% 62.3% 60.8%

  P Count

  8

  23

  31 Expected Count

  7.1

  23.9

  31.0 % within jk 25.8% 74.2% 100.0% % within Mortalitas 44.4% 37.7% 39.2%

  Total Count

  18

  61

  79 Expected Count

  18.0

  61.0

  79.0 % within jk 22.8% 77.2% 100.0% % within Mortalitas 100.0% 100.0% 100.0%

  Chi-Square Tests

  Asymp. Sig. (2- Exact Sig. (2- Exact Sig. (1- Value df sided) sided) sided)

  a

  Pearson Chi-Square .265 1 .607

  b

  Continuity Correction .058 1 .810 Likelihood Ratio .262 1 .609 Fisher's Exact Test

  .784 .401 N of Valid Cases

  79 a. 0 cells (,0%) have expected count less than 5. The minimum expected count is 7,06.

  b. Computed only for a 2x2 table

  Risk Estimate

  95% Confidence Interval Value Lower Upper

  Odds Ratio for jk (L / P) .757 .261 2.193 For cohort Mortalitas = .807 .358 1.820 Meninggal For cohort Mortalitas = 1.067 .828 1.375 Survive N of Valid Cases

  79

  Descriptives

  Mortalitas Statistic Std. Error umur Meninggal Mean

  64.22 2.348 95% Confidence Interval for Lower Bound

  59.27 Mean Upper Bound

  69.18 5% Trimmed Mean

  64.91 Median

  67.50 Variance 99.242

  Std. Deviation 9.962

  Minimum

  38 Maximum

  78 Range

  40 Interquartile Range

  14 Skewness

• 1.049 .536 Kurtosis

  1.336 1.038 Survive Mean

  56.77 1.652 95% Confidence Interval for Lower Bound

  53.47 Mean Upper Bound

  60.08 5% Trimmed Mean

  56.86 Median

  57.00 Variance 166.480

  Std. Deviation 12.903 Minimum

  25 Maximum

  86 Range

  61 Interquartile Range

  16 Skewness

• .157 .306 Kurtosis
• .063 .604 hb Meninggal Mean

  12.2072 .59213 95% Confidence Interval for Lower Bound 10.9579 Mean Upper Bound 13.4565 5% Trimmed Mean 12.0525 Median

  11.8500 Variance

  6.311 Std. Deviation 2.51221 Minimum

  8.90 Maximum

  18.30 Range

  9.40 Interquartile Range

  3.30 Skewness .987 .536

  Kurtosis .862 1.038

  Survive Mean 13.5984 .28394

  95% Confidence Interval for Lower Bound 13.0304 Mean

  Upper Bound 14.1663 5% Trimmed Mean 13.5838 Median

  13.5000 Variance

  4.918 Std. Deviation 2.21762 Minimum

  9.10 Maximum

  18.60 Range

  9.50 Interquartile Range

  3.05 Skewness .061 .306

  Kurtosis

• .310 .604 leukosit Meninggal Mean

  9978.67 281.778 95% Confidence Interval for Lower Bound 9384.17 Mean

  Upper Bound 10573.17 5% Trimmed Mean 10057.96 Median

  10570.00 Variance 1429175.529 Std. Deviation 1195.481 Minimum

  7530 Maximum 11000

  Range 3470

  Interquartile Range 1998 Skewness

• .890 .536 Kurtosis
• .752 1.038 Survive Mean

  9392.70 208.909 95% Confidence Interval for Lower Bound 8974.82 Mean

  Upper Bound 9810.59 5% Trimmed Mean 9526.71 Median

  10030.00 Variance 2662232.978 Std. Deviation 1631.635 Minimum

  4000 Maximum

  11160 Range

  7160 Interquartile Range 2365 Skewness

• 1.149 .306 Kurtosis

  .819 .604 plt Meninggal Mean 236.28 25.949

  95% Confidence Interval for Lower Bound 181.53 Mean

  Upper Bound 291.03 5% Trimmed Mean 234.25 Median

  199.50 Variance

  12120.330 Std. Deviation 110.092 Minimum

  64 Maximum 445

  Range 381

  Interquartile Range 150 Skewness

  .731 .536 Kurtosis

• .426 1.038 Survive Mean

  255.79 9.314

  95% Confidence Interval for Lower Bound 237.16 Mean

  Upper Bound 274.42 5% Trimmed Mean 253.19 Median

  264.00 Variance

  5292.137 Std. Deviation 72.747 Minimum

  139 Maximum

  428 Range

  289 Interquartile Range 107 Skewness

  .401 .306 Kurtosis

• .393 .604

  Tests of Normality a

  Kolmogorov-Smirnov Shapiro-Wilk Mortalitas Statistic df Sig. Statistic df Sig.

• umur Meninggal .165

  18 .200 .927 18 .174

• Survive .081

  61 .200 .988 61 .802 hb Meninggal .184 18 .111 .926 18 .164

• Survive .082

  61 .200 .984 61 .627 leukosit Meninggal .243 18 .006 .811 18 .002

  Survive .200 61 .000 .867 61 .000 plt Meninggal .202 18 .051 .904 18 .068

  Survive .108 61 .074 .957 61 .031

  a. Lilliefors Significance Correction *. This is a lower bound of the true significance.

  T-Test Notes

  Output Created 01-Nov-2014 08:32:42

  Comments Input Data D:\PROJECT\STATISTIK\PENY

  DALAM\ISA\data dr Isa.sav Active Dataset DataSet1 Filter <none> Weight <none> Split File <none> N of Rows in Working Data File

  79 Missing Value Handling Definition of Missing User defined missing values are treated as missing.

  Cases Used Statistics for each analysis are based on the cases with no missing or out-of-range data for any variable in the analysis. Syntax

  T-TEST GROUPS=Mortalitas(1 2) /MISSING=ANALYSIS /VARIABLES=umur hb /CRITERIA=CI(.95).

  Resources Processor Time 0:00:00.000 Elapsed Time

  0:00:00.000

  Group Statistics

  Mortalitas N Mean Std. Deviation Std. Error Mean umur Meninggal 18 64.22 9.962 2.348

  Survive

  61 56.77 12.903 1.652 hb Meninggal 18 12.2072 2.51221 .59213

  Survive 61 13.5984 2.21762 .28394

  

Independent Samples Test

  Levene's Test for Equality of

  Variances t-test for Equality of Means 95% Confidence Interval of the Difference

  Sig. (2- Mean Std. Error F Sig. t df tailed) Difference Difference Lower Upper

• 2.118 25.337 .044 -1.39114 .65669 -2.74270 -.03957

  7.70 Maximum

  Lower Bound 9.6104 Upper Bound 10.0536

  95% Confidence Interval for Mean

  Survive Mean 9.8320 .11078

  Kurtosis .799 1.038

  2.05 Skewness .144 .536

  5.90 Interquartile Range

  13.60 Range

  1.898 Std. Deviation 1.37775 Minimum

  umur Equal variances assumed

  5% Trimmed Mean 10.3660 Median 10.4000 Variance

  Lower Bound 9.7093 Upper Bound 11.0796

  10.3944 .32474 95% Confidence Interval for Mean

  mortality Statistic Std. Error mpv Exite Mean

  Descriptives

  .022 .883 -2.269 77 .026 -1.39114 .61316 -2.61210 -.17018 Equal variances not assumed

  2.596 35.529 .014 7.452 2.871 1.626 13.277 hb Equal variances assumed

  1.066 .305 2.256 77 .027 7.452 3.303 .875 14.029 Equal variances not assumed

  5% Trimmed Mean 9.8319

  Interquartile Range 123.43

  18 .841 Survive .116 61 .041 .970 61 .135

  Range 615.20

  15.70 Maximum 630.90

  81.0500 Variance 22494.761 Std. Deviation 149.98253 Minimum

  5% Trimmed Mean 110.3895 Median

  Lower Bound 57.0960 Upper Bound 206.2651

  95% Confidence Interval for Mean

  Hs_CRP Exite Mean 131.6806 35.35122

  mortality Statistic Std. Error

  Descriptives

  a. Lilliefors Significance Correction *. This is a lower bound of the true significance.

  Shapiro-Wilk Statistic df Sig. Statistic df Sig. mpv Exite .138 18 .200

  Median 9.8000

  a

  mortality Kolmogorov-Smirnov

  Tests of Normality

  1.775 .604

  1.00 Skewness -.047 .306 Kurtosis

  5.40 Interquartile Range

  12.50 Range

  7.10 Maximum

  Std. Deviation .86526 Minimum

  Variance .749

• .972

Skewness 2.444 .536

  Kurtosis 7.012 1.038

  Survive Mean 39.2490 12.08981

  95% Confidence Interval for Lower Bound 15.0658 Mean

  Upper Bound 63.4322 5% Trimmed Mean 22.7571 Median

  12.2100 Variance 8915.976 Std. Deviation 94.42445 Minimum

  .47 Maximum

  662.90 Range

  662.43 Interquartile Range

  19.35 Skewness 5.353 .306

  Kurtosis 32.921 .604

  Tests of Normality a

  Kolmogorov-Smirnov Shapiro-Wilk mortality Statistic df Sig. Statistic df Sig. Hs_CRP Exite .229 18 .014 .716 18 .000

  Survive .341 61 .000 .382 61 .000

  a. Lilliefors Significance Correction

  Mann-Whitney Test Ranks

  Mortalitas N Mean Rank Sum of Ranks Hs_CRP Meninggal

  18 62.22 1120.00 Survive

  61 33.44 2040.00 Total

  79

  a Test Statistics

  Hs_CRP Mann-Whitney U 149.000 Wilcoxon W 2040.000 Z -4.675 Asymp. Sig. (2-tailed) .000

  a. Grouping Variable: Mortalitas

  Descriptives

  Statistic Std. Error mpv Mean 9.9601 .11507

  95% Confidence Interval for Lower Bound 9.7310 Mean

  Upper Bound 10.1892 5% Trimmed Mean 9.9416 Median

  9.9000 Variance

  1.046 Std. Deviation 1.02273 Minimum

  7.10 Maximum

  13.60 Range

  6.50 Interquartile Range

  1.20 Skewness .369 .271

  Kurtosis 1.843 .535

  Hs_CRP Mean 60.3094 12.96711

  95% Confidence Interval for Lower Bound 34.4938 Mean

  Upper Bound 86.1249 5% Trimmed Mean 40.8032 Median

  16.8000 Variance 13283.520 Std. Deviation 115.25415 Minimum

  .47 Maximum

  662.90

• .974

  Sig. (2-tailed) . .098 N

  10.4000 Variance

  5% Trimmed Mean 10.3660 Median

  Lower Bound 9.7093 Upper Bound 11.0796

  95% Confidence Interval for Mean

  Statistic Std. Error mpv Meninggal Mean 10.3944 .32474

  79 Descriptives Mortalitas

  79

  N

  79 Hs_CRP Correlation Coefficient .188 1.000 Sig. (2-tailed) .098 .

  79

  mpv Hs_CRP Spearman's rho mpv Correlation Coefficient 1.000 .188

  Range 662.43

  Nonparametric Correlations Correlations

  a. Lilliefors Significance Correction *. This is a lower bound of the true significance.

  79 .099 Hs_CRP .302 79 .000 .512 79 .000

  Shapiro-Wilk Statistic df Sig. Statistic df Sig. mpv .084 79 .200

  a

  Kolmogorov-Smirnov

  Tests of Normality

  Kurtosis 16.260 .535

  46.51 Skewness 3.782 .271

  Interquartile Range

  1.898 Std. Deviation 1.37775 Minimum

  7.70 Maximum

  13.60 Range

  5.90 Interquartile Range

  2.05 Skewness .144 .536

  Kurtosis .799 1.038

  Survive Mean 9.8320 .11078

  95% Confidence Interval for Lower Bound 9.6104 Mean

  Upper Bound 10.0536 5% Trimmed Mean 9.8319 Median

  9.8000 Variance

  .749 Std. Deviation .86526 Minimum

  7.10 Maximum

  12.50 Range

  5.40 Interquartile Range

  1.00 Skewness

• .047 .306 Kurtosis

  1.775 .604 Hs_CRP Meninggal Mean

  131.6806 35.35122 95% Confidence Interval for Lower Bound 57.0960 Mean

  Upper Bound 206.2651 5% Trimmed Mean 110.3895 Median

  81.0500 Variance 22494.761 Std. Deviation 149.98253 Minimum

  15.70 Maximum 630.90

  Range 615.20

  Interquartile Range 123.43 Skewness

  2.444 .536 Kurtosis 7.012 1.038

  Survive Mean 39.2490 12.08981

  95% Confidence Interval for Lower Bound 15.0658 Mean

  Upper Bound 63.4322 5% Trimmed Mean 22.7571 Median

  12.2100 Variance 8915.976 Std. Deviation 94.42445 Minimum

  .47 Maximum

  662.90 Range

  662.43 Interquartile Range

  19.35 Skewness 5.353 .306

  Kurtosis 32.921 .604

  Tests of Normality a

  Kolmogorov-Smirnov Shapiro-Wilk Mortalitas Statistic df Sig. Statistic df Sig.

• mpv Meninggal .138

  18 .200 .972 18 .841 Survive .116 61 .041 .970 61 .135

  Hs_CRP Meninggal .229 18 .014 .716 18 .000 Survive .341 61 .000 .382 61 .000

  a. Lilliefors Significance Correction *. This is a lower bound of the true significance.

  Korelasi MPV dan CRP pada kelompok Pasien yang Meninggal Nonparametric Correlations Correlations

  mpv Hs_CRP Spearman's rho mpv Correlation Coefficient 1.000 -.308

  Sig. (2-tailed) . .214 N

  18

  18 Hs_CRP Correlation Coefficient -.308 1.000 Sig. (2-tailed) .214 .

  N

  18

  18 Korelasi MPV dan CRP pada kelompok Pasien yang Hidup

  Nonparametric Correlations Notes

  Output Created 06-Nov-2014 18:05:59

  Comments Input Data D:\PROJECT\STATISTIK\PENY

  DALAM\ISA\data dr Isa.sav Active Dataset DataSet1 Filter Mortalitas = 2 (FILTER) Weight <none> Split File <none> N of Rows in Working Data

  61 File Missing Value Handling Definition of Missing User-defined missing values are treated as missing.

  Cases Used Statistics for each pair of variables are based on all the cases with valid data for that pair. Syntax

  NONPAR CORR /VARIABLES=mpv Hs_CRP /PRINT=SPEARMAN TWOTAIL NOSIG /MISSING=PAIRWISE.

  Resources Processor Time 0:00:00.000 Elapsed Time 0:00:00.000

  a

  Number of Cases Allowed 174762 cases

  a. Based on availability of workspace memory

  Correlations

  mpv Hs_CRP Spearman's rho mpv Correlation Coefficient 1.000 .203

  Sig. (2-tailed) . .116 N

  61

  61 Hs_CRP Correlation Coefficient .203 1.000 Sig. (2-tailed) .116 .

  N

  61

  61

  Lampiran 4 LEMBAR PENJELASAN KEPADA CALON SUBJEK PENELITIAN Selamat pagi/siang Bapak/Ibu, pada hari ini , saya, dr. M Isa Ansari Hrp akan melakukan penelitian yang berjudul ”Hubungan mean platelet volume (MPV) dan C-reaktif protein (CRP) dengan mortalitas 14 hari pada pasien stroke iskemik akut”. Penelitian ini bertujuan menilai tingkat mortalitas pasien stroke iskemik akut yang dihubungkan dengan marker (petanda) inflamasi dan Mean Platelet Volume.

  Kepada Bapak/Ibu yang bersedia mengikuti penelitian ini nantinya akan diminta mengisi surat persetujuan ikut dalam penelitian, mengikuti wawancara untuk mencari adanya hal-hal yang dapat mengganggu penelitian, dilakukan pemeriksaan fisik, head ct scan, pemeriksaan laboratorium, bila Bapak/Ibu merasa terganggu dapat melaporkan pada kami. Kemudian peserta penelitian akan di follow up selama 14 hari kedepan. Segala biaya pemeriksaan laboratorium dan penyediaan obat menjadi

tanggung jawab peneliti. Bila masih terdapat pertanyaan, maka Bapak/Ibu dapat menghubungi saya pada:

Nama : dr. Mhd Isa Ansari Harahap Alamat : Jl. Kelapa Raya No.4 Comp.Rispa III/IV Gedung Johor Medan Telepon : 081371393560

   Peneliti, (Dr. Mhd Isa Ansari Harahap)

  Lampiran 5 SURAT PERSETUJUAN SETELAH PENJELASAN (INFORMED CONCERN ) Saya yang bertanda tangan dibawah ini :

Nama :...........................................................................................

  

Alamat :...........................................................................................

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

  No Telp/HP : Setelah mendapat penjelasan dari peneliti tentang kebaikan dan keburukan prosedur penelitian ini, menyatakan bersedia ikut serta dalam penelitian tentang ” Hubungan mean platelet volume (MPV) dan C-reaktif protein (CRP) dengan mortalitas 14 hari pada pasien stroke iskemik akut.

  Demikianlah surat persetujuan bersedia ikut dalam penelitian ini saya buat, untuk dapat digunakan seperlunya.

  Medan,...........................2014 Saksi Yang Memberi Pernyataan (.............................................) (.............................................)

  Lampiran 6 Tanggal : MR : No.Peserta :

Data Peserta

I. IDENTITAS PRIBADI.

  Nama : Kode : X / Y Tempat/Tanggal Lahir : Jenis Kelamin : Laki-laki/Perempuan. Pendidikan Terakhir : Pekerjaan : Status : Kawin/Belum Kawin. No Telp/Hp: ……………………… Riwayat Penyakit Terdahulu : Riwayat Pemakaian Obat :

  II.STATUS PRESENTS:

  III. PEMERIKSAAN FISIK:

  IV. PEMERIKSAAN HEAD CT SCAN:

  V. PMERIKSAAN LABORATORIUM:

  Lampiran 7

DAFTAR RIWAYAT HIDUP

  I. Identitas Pribadi Nama : dr. Mhd Isa Ansari Harahap Tempat/Tgl Lahir : Medan / 07 Juli 1974 Suku/Bangsa : Batak / Indonesia Agama : Islam Alamat : Jl.Kelapa Raya No 4 Comp.Rispa III/IV Gedung Johor Medan

  II. Keluarga Istri : Linda Rahmita Panjaitan SH. MKn Anak : 1. Sarah Azzura Desvithania Harahap

  2. Ammara Azzleya Nauli Harahap

  3. Amira Khalisya Nauli Harahap

  III. Pendidikan SDN 060959 Medan Tamat Tahun 1987 SLTPN 24 Medan Tamat Tahun 1990 SMAN 09 Medan Tamat Tahun 1993 Fakultas Kedokteran Universitas Sumatera Utara Tamat Tahun 1999

  IV. Riwayat Pekerjaan Dokter PTT di Puskesmas Kuala KamparKab.Pelalawan tahun 2001-2002.

  Dokter PNS di Puskesmas Kec. Tanah Putih Rokan Hilir Riau 2003-2009

  V. Perkumpulan Profesi Anggota IDI Cabang Riau

  VI. Tulisan Ilmiah:

  1. A.Rahim Rasyid Lubis, M.Fahmi Hidayat. Penyakit Ginjal Polikistik Dominan Autosomal. KOPAPDI XV, Medan 12-15 Desember 2012.

  2. Zuhrial Zubir, M.Fahmi Hidayat. Syndroma Hyper Immunoglobulin-E (HIES).

  KONKER PERALMUNI VIII, Yogyakarta 17-19 Mei 2013.

VII. Partisipasi Dalam Kegiatan Ilmiah

1. Peserta Simposium Rheumatology Update 2011, Clinical Rheumatology in Daily

  Practice. Medan 9 – 10 Juli 2011

  2. Panitia Seminar Sehari Lymphoma Update : Deteksi Dini dan Penatalaksanaan. Medan

  9. Presenter Poster Kongres Nasional XV Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia (KOPAPDI XV). Medan 12-15 Desember 2012

  Medan 5 – 7 Desember 2013

  

14. Panitia Simposium & Workshop Medan Chest And Clinical Immunology (MCCI) 2013.

  13. Peserta Presentasi Makalah Bebas Oral, Konferensi Kerja Perhimpunan Alergi Dan

Imunologi Ke-8 2013 (KONKER PERALMUNI VIII). Yogyakarta 17-19 Mei 2013

  12. Peserta Simposium Konferensi Kerja Perhimpunan Alergi Dan Imunologi ke-8 2013 (KONKER PERALMUNI VIII). Yogyakarta 17-19 Mei 2013

  

11. Peserta Simposium Recent Management in Helicobacter pylori Infection, Irritable Bowel

Syndrome and Hepatic Encephalopathy. Medan 20 April 2013

  

10. Peserta Pertemuan Ilmiah Tahnan Ilmu Penyakit Dalam XIV & Gastroentero Hepatologi

Update XI 2013. Medan 12 – 14 September 2013.

  

8. Peserta Kongres Nasional XV Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia

(KOPAPDI XV). Medan 12-15 Desember 2012

  16 Juli 2011

  

7. Panitia Kongres Nasional XV Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia

(KOPAPDI XV). Medan 12-15 Desember 2012

  6. Peserta Workshop Terapi Insulin. Update on Diagnosis & Management of Common Clinical Problems. Medan 11 September 2012

  Medan 1 Desember 2012

  5. Peserta Simposium Penatalaksanaan Disfungsi Ereksi Pada Pasien Diabetes Mellitus.

  4. Peserta Simposium Diabetic Neuropathy. Medan 8 September 2012.

  3. Peserta Simposium The New Era in Antithrombotic Therapy 2012. Medan 14 Oktober 2012

  15. Panitia Workshop dan Symposium The Metabolic & Endocrine Diseases and It’s Analysis-1 (MEDAN-1). 12-15 Februari 2014