Gambaran Risiko Trombosit Berdasarkan Caprini Skor Pada Pasien Kanker Di Rumah Sakit Umum Pemerintah Haji Adam Malik
DAFTAR RIWAYAT HIDUP
Curriculum Vitae
I. Data Pribadi
1. Nama
: Raja Arif Kurnia Manik
2. Tempat dan Tanggal Lahir
: Sidikalang, 19 September 1994
3. Jenis Kelamin
: Laki-Laki
4. Agama
: Islam
5. Warga Negara
: Indonesia
6. Alamat
: Jalan Eka Bakti no.40 Kecamatan Medan
Johor
7. Nomor Telephone
: 089647745529
8. Riwayat Pendidikan
: SD 030281 Sidikalang
MTsN Sidikalang
MAN Sidikalang
9. Riwayat Organisasi
: 1. Pramuka MAN Sidikalang
2. OSIS MAN Sidikalang
3. SCORA FK USU
Demikian CV ini saya buat dengan sebenar benarnya.
Raja Arif Kurnia Manik
120100031
LEMBAR PENJELASAN TERHADAP SUBYEK PENELITIAN
Assalamu’alaikum,
Saya adalah mahasiswa semester VII Fakultas Kedokteran Universitas
Sumatera Utara yang sedang melakukan penelitian berjudul Gambaran Risiko
Trombosis Berdasarkan Caprini Score pada Pasien Kanker di RSUP. Haji
Adam Malik
Trombosis adalah suatu penyakit dimana terdapat gumpalan darah pada
saluran pembuluh darah. Penyakit ini merupakan komplikasi yang paling sering
terjadi pada pasien kanker. Penyakit ini juga meningkatkan risiko kematian dan
kesakitan pada pasien kanker. Maka dari itu, perlu untuk diketahui seberapa besar
risiko seorang pasien kanker mengalami penyakit trombosis vena dalam ini.
Tujuan dari penelitian ini adalah untuk mengetahui bagaimana gambaran
risiko trrombosis pada pasien kanker di RSUP Haji Adam Malik Medan.
Oleh karena itu, saya meminta kesediaan Ibu/Bapak untuk ikut serta
menjadi subyek penelitian ini dengan menjawab pertanyaan yang diajukan saat
wawancara dan melalui pengamatan yang dilakukan saat pemeriksaan fisik.
Adapun data individu dalam penelitian ini tidak akan dipublikasikan.
Apabila di kemudian hari terjadi hal-hal yang tidak diinginkan sehubungan
dengan keikutsertaan Ibu/Bapak dalam penelitian ini maka Ibu/Bapak dapat
menghubungi saya, Raja Arif Kurnia Manik (nomor telepon: 089647745529).
LEMBAR PERSETUJUAN UNTUK MENJADI SUBJEK PENELITIAN
Saya yang bertandatangan dibawah ini:
Nama :
Umur :
Alamat :
NO HP :
Setelah membaca semua keterangan dan mendapat penjelasan tentang
keuntungan dan hak-hak saya sebagai subjek penelitian yang berjudul Gambaran
Resiko Trombosis Berdasarkan Caprini Score pada Pasien Kanker dan saya
telah memahaminya, maka saya dengan sadar dan tanpa paksaan bersedia
berpartisipasi dalam penelitian ini untuk diteliti.
Medan, ………………2015
Peneliti,
Yang membuat pernyataan,
Raja Arif Kurnia Manik
………………………………
Lembar Scoring
Nama
:
Jenis Kelamin :
TTL
:
Lokasi Kanker :
Add 1 point for each of the following statements
● Age 41-60 years
● Minor surgery less than 45 minutes is planned
● Past Major surgery more than 45 minutes within last month
● Visible varicose vein
● A history of Inflammatory Bowel Disease
● Swoollen legs
● Obese mass index above 25
● Heart Attack
● Congestive heart failure
● Serious infection
● Lung disease
● On bed rest or restricted mobility less than 72 hours
Add 2 point for each of the following statements
● Age 61-74
● Curret or past malignancies
● Planed major surgery lasting longer than 45 minutes
● Non removable paster cast or mold that has kept from moving lesgs within a
month
● Tube in blood vessel in neck or chest
● Confined to a bed for 72 hours or more
Add 3 point for each of the following statements
● Age 75 or over
● History of blood clots
● Family history of blood clots
● Personal or family history of positive blood test indicating an increased risk
of blood cloting
Add 5 point for each of the following statements
● Elective hip or knee joint replacement surgery
● Broken hips, pelvis or leg
● Serious trauma
● Spinal cord injury in resulting paralysis
● Experienced a stroke
For women only Add 1 point for each of the following statements
● Current use of birth control or hormone replacement theraphy
● Pregnant or had baby within last month
● History of unexplained stillborn infants, recurrent spontaneous abortion
Total skor
:
Interpretasi
:
TABULASI SPSS
Jenis Kelamin
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
Laki-laki
30
48.4
48.4
48.4
Perempuan
32
51.6
51.6
100.0
Total
62
100.0
100.0
Lokasi Kanker
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
Lymphoma
12
19.4
19.4
19.4
Ovarium
22
35.5
35.5
54.8
Paru
28
45.2
45.2
100.0
Total
62
100.0
100.0
Usia 41-60
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
29
46.8
46.8
46.8
1
33
53.2
53.2
100.0
Total
62
100.0
100.0
Minor surgery less than 45 minutes planned
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Past major surgery more than 45 minutes within last month
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
59
95.2
95.2
95.2
1
3
4.8
4.8
100.0
Total
62
100.0
100.0
Visible varicose vein
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
57
91.9
91.9
91.9
1
5
8.1
8.1
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
55
88.7
88.7
88.7
1
7
11.3
11.3
100.0
Total
62
100.0
100.0
Inflammatory bowel syndrome
Valid
Swollen legs
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
56
90.3
90.3
90.3
1
6
9.7
9.7
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
44
71.0
71.0
71.0
1
18
29.0
29.0
100.0
Total
62
100.0
100.0
Obese mass index above 25
Valid
Heart Attack
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
59
95.2
95.2
95.2
1
3
4.8
4.8
100.0
Total
62
100.0
100.0
Congestive heart failure
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
58
93.5
93.5
93.5
1
4
6.5
6.5
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
57
91.9
91.9
91.9
1
5
8.1
8.1
100.0
Total
62
100.0
100.0
Serious Infection
Valid
Lung disease
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
58
93.5
93.5
93.5
1
4
6.5
6.5
100.0
Total
62
100.0
100.0
On bed rest or restricted mobility less than 72 hours
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
53
85.5
85.5
85.5
1
9
14.5
14.5
100.0
Total
62
100.0
100.0
age 61-74
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
50
80.6
80.6
80.6
1
1
1.6
1.6
82.3
2
11
17.7
17.7
100.0
Total
62
100.0
100.0
Current or past malignancies
Valid
2
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Planed major surgery lasting longer than 45 minutes
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Non removable paster cast or mold
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Tube in blood vessel in neck or chest
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
56
90.3
90.3
90.3
2
6
9.7
9.7
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
60
96.8
96.8
96.8
3
2
3.2
3.2
100.0
Total
62
100.0
100.0
0
Confined to a bed for 72 hours
Valid
Age 75 or more
Valid
History of blood clots
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
61
98.4
98.4
98.4
3
1
1.6
1.6
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
55
88.7
88.7
88.7
3
7
11.3
11.3
100.0
Total
62
100.0
100.0
Family history of blood clots
Valid
personal of positive blood test indicating an increased risk of blood cloting
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
54
87.1
87.1
87.1
3
8
12.9
12.9
100.0
Total
62
100.0
100.0
Elective hip or knee joint replacement surgery
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
61
98.4
98.4
98.4
5
1
1.6
1.6
100.0
Total
62
100.0
100.0
Broken hips pelvis or leg
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Serious trauma
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Spinal cord injury resulting paralysis
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
60
96.8
96.8
96.8
5
2
3.2
3.2
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
61
98.4
98.4
98.4
5
1
1.6
1.6
100.0
Total
62
100.0
100.0
Experienced a stroke
Valid
Current use of birth controle
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Pregnant or had baby in last month
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
History of unexplained stillborn infants, recurrent spontaneous abortion
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
58
93.5
93.5
93.5
5
4
6.5
6.5
100.0
Total
62
100.0
100.0
Total Skor
Valid
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
2.0
4
6.5
6.5
6.5
3.0
11
17.7
17.7
24.2
4.0
15
24.2
24.2
48.4
5.0
14
22.6
22.6
71.0
6.0
3
4.8
4.8
75.8
7.0
5
8.1
8.1
83.9
8.0
2
3.2
3.2
87.1
9.0
3
4.8
4.8
91.9
10.0
2
3.2
3.2
95.2
11.0
1
1.6
1.6
96.8
14.0
2
3.2
3.2
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Moderate
4
6.5
6.5
High
26
42
42
Highest
32
51,5
51,5
Total
62
100.0
100.0
Curriculum Vitae
I. Data Pribadi
1. Nama
: Raja Arif Kurnia Manik
2. Tempat dan Tanggal Lahir
: Sidikalang, 19 September 1994
3. Jenis Kelamin
: Laki-Laki
4. Agama
: Islam
5. Warga Negara
: Indonesia
6. Alamat
: Jalan Eka Bakti no.40 Kecamatan Medan
Johor
7. Nomor Telephone
: 089647745529
8. Riwayat Pendidikan
: SD 030281 Sidikalang
MTsN Sidikalang
MAN Sidikalang
9. Riwayat Organisasi
: 1. Pramuka MAN Sidikalang
2. OSIS MAN Sidikalang
3. SCORA FK USU
Demikian CV ini saya buat dengan sebenar benarnya.
Raja Arif Kurnia Manik
120100031
LEMBAR PENJELASAN TERHADAP SUBYEK PENELITIAN
Assalamu’alaikum,
Saya adalah mahasiswa semester VII Fakultas Kedokteran Universitas
Sumatera Utara yang sedang melakukan penelitian berjudul Gambaran Risiko
Trombosis Berdasarkan Caprini Score pada Pasien Kanker di RSUP. Haji
Adam Malik
Trombosis adalah suatu penyakit dimana terdapat gumpalan darah pada
saluran pembuluh darah. Penyakit ini merupakan komplikasi yang paling sering
terjadi pada pasien kanker. Penyakit ini juga meningkatkan risiko kematian dan
kesakitan pada pasien kanker. Maka dari itu, perlu untuk diketahui seberapa besar
risiko seorang pasien kanker mengalami penyakit trombosis vena dalam ini.
Tujuan dari penelitian ini adalah untuk mengetahui bagaimana gambaran
risiko trrombosis pada pasien kanker di RSUP Haji Adam Malik Medan.
Oleh karena itu, saya meminta kesediaan Ibu/Bapak untuk ikut serta
menjadi subyek penelitian ini dengan menjawab pertanyaan yang diajukan saat
wawancara dan melalui pengamatan yang dilakukan saat pemeriksaan fisik.
Adapun data individu dalam penelitian ini tidak akan dipublikasikan.
Apabila di kemudian hari terjadi hal-hal yang tidak diinginkan sehubungan
dengan keikutsertaan Ibu/Bapak dalam penelitian ini maka Ibu/Bapak dapat
menghubungi saya, Raja Arif Kurnia Manik (nomor telepon: 089647745529).
LEMBAR PERSETUJUAN UNTUK MENJADI SUBJEK PENELITIAN
Saya yang bertandatangan dibawah ini:
Nama :
Umur :
Alamat :
NO HP :
Setelah membaca semua keterangan dan mendapat penjelasan tentang
keuntungan dan hak-hak saya sebagai subjek penelitian yang berjudul Gambaran
Resiko Trombosis Berdasarkan Caprini Score pada Pasien Kanker dan saya
telah memahaminya, maka saya dengan sadar dan tanpa paksaan bersedia
berpartisipasi dalam penelitian ini untuk diteliti.
Medan, ………………2015
Peneliti,
Yang membuat pernyataan,
Raja Arif Kurnia Manik
………………………………
Lembar Scoring
Nama
:
Jenis Kelamin :
TTL
:
Lokasi Kanker :
Add 1 point for each of the following statements
● Age 41-60 years
● Minor surgery less than 45 minutes is planned
● Past Major surgery more than 45 minutes within last month
● Visible varicose vein
● A history of Inflammatory Bowel Disease
● Swoollen legs
● Obese mass index above 25
● Heart Attack
● Congestive heart failure
● Serious infection
● Lung disease
● On bed rest or restricted mobility less than 72 hours
Add 2 point for each of the following statements
● Age 61-74
● Curret or past malignancies
● Planed major surgery lasting longer than 45 minutes
● Non removable paster cast or mold that has kept from moving lesgs within a
month
● Tube in blood vessel in neck or chest
● Confined to a bed for 72 hours or more
Add 3 point for each of the following statements
● Age 75 or over
● History of blood clots
● Family history of blood clots
● Personal or family history of positive blood test indicating an increased risk
of blood cloting
Add 5 point for each of the following statements
● Elective hip or knee joint replacement surgery
● Broken hips, pelvis or leg
● Serious trauma
● Spinal cord injury in resulting paralysis
● Experienced a stroke
For women only Add 1 point for each of the following statements
● Current use of birth control or hormone replacement theraphy
● Pregnant or had baby within last month
● History of unexplained stillborn infants, recurrent spontaneous abortion
Total skor
:
Interpretasi
:
TABULASI SPSS
Jenis Kelamin
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
Laki-laki
30
48.4
48.4
48.4
Perempuan
32
51.6
51.6
100.0
Total
62
100.0
100.0
Lokasi Kanker
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
Lymphoma
12
19.4
19.4
19.4
Ovarium
22
35.5
35.5
54.8
Paru
28
45.2
45.2
100.0
Total
62
100.0
100.0
Usia 41-60
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
29
46.8
46.8
46.8
1
33
53.2
53.2
100.0
Total
62
100.0
100.0
Minor surgery less than 45 minutes planned
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Past major surgery more than 45 minutes within last month
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
59
95.2
95.2
95.2
1
3
4.8
4.8
100.0
Total
62
100.0
100.0
Visible varicose vein
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
57
91.9
91.9
91.9
1
5
8.1
8.1
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
55
88.7
88.7
88.7
1
7
11.3
11.3
100.0
Total
62
100.0
100.0
Inflammatory bowel syndrome
Valid
Swollen legs
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
56
90.3
90.3
90.3
1
6
9.7
9.7
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
44
71.0
71.0
71.0
1
18
29.0
29.0
100.0
Total
62
100.0
100.0
Obese mass index above 25
Valid
Heart Attack
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
59
95.2
95.2
95.2
1
3
4.8
4.8
100.0
Total
62
100.0
100.0
Congestive heart failure
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
58
93.5
93.5
93.5
1
4
6.5
6.5
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
57
91.9
91.9
91.9
1
5
8.1
8.1
100.0
Total
62
100.0
100.0
Serious Infection
Valid
Lung disease
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
58
93.5
93.5
93.5
1
4
6.5
6.5
100.0
Total
62
100.0
100.0
On bed rest or restricted mobility less than 72 hours
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
53
85.5
85.5
85.5
1
9
14.5
14.5
100.0
Total
62
100.0
100.0
age 61-74
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
50
80.6
80.6
80.6
1
1
1.6
1.6
82.3
2
11
17.7
17.7
100.0
Total
62
100.0
100.0
Current or past malignancies
Valid
2
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Planed major surgery lasting longer than 45 minutes
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Non removable paster cast or mold
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Tube in blood vessel in neck or chest
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
56
90.3
90.3
90.3
2
6
9.7
9.7
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
60
96.8
96.8
96.8
3
2
3.2
3.2
100.0
Total
62
100.0
100.0
0
Confined to a bed for 72 hours
Valid
Age 75 or more
Valid
History of blood clots
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
61
98.4
98.4
98.4
3
1
1.6
1.6
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
55
88.7
88.7
88.7
3
7
11.3
11.3
100.0
Total
62
100.0
100.0
Family history of blood clots
Valid
personal of positive blood test indicating an increased risk of blood cloting
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
54
87.1
87.1
87.1
3
8
12.9
12.9
100.0
Total
62
100.0
100.0
Elective hip or knee joint replacement surgery
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
61
98.4
98.4
98.4
5
1
1.6
1.6
100.0
Total
62
100.0
100.0
Broken hips pelvis or leg
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Serious trauma
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Spinal cord injury resulting paralysis
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
60
96.8
96.8
96.8
5
2
3.2
3.2
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Cumulative
Percent
0
61
98.4
98.4
98.4
5
1
1.6
1.6
100.0
Total
62
100.0
100.0
Experienced a stroke
Valid
Current use of birth controle
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
Pregnant or had baby in last month
Valid
0
Frequency
Percent
Valid Percent
Cumulative
Percent
62
100.0
100.0
100.0
History of unexplained stillborn infants, recurrent spontaneous abortion
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
0
58
93.5
93.5
93.5
5
4
6.5
6.5
100.0
Total
62
100.0
100.0
Total Skor
Valid
Valid
Frequency
Percent
Valid Percent
Cumulative
Percent
2.0
4
6.5
6.5
6.5
3.0
11
17.7
17.7
24.2
4.0
15
24.2
24.2
48.4
5.0
14
22.6
22.6
71.0
6.0
3
4.8
4.8
75.8
7.0
5
8.1
8.1
83.9
8.0
2
3.2
3.2
87.1
9.0
3
4.8
4.8
91.9
10.0
2
3.2
3.2
95.2
11.0
1
1.6
1.6
96.8
14.0
2
3.2
3.2
100.0
Total
62
100.0
100.0
Frequency
Percent
Valid Percent
Moderate
4
6.5
6.5
High
26
42
42
Highest
32
51,5
51,5
Total
62
100.0
100.0