15 New Messages
Digest #20111
Messages
Wed Jun 12, 2013 10:15 am (PDT) . Posted by:
"Purnamawati, SpAK"
Intinya sih
1. Roseola tidak butuh anti virus meski merah2nya sedikit atau banyak
2. Isoprinosin bukan antivirus
Isoprinosin tidak bisa menyembuhkan roseola atau penyakit virus
lainnya (mulai dari cc, flu, hepatitis, dst dst)
Galaunya kenapa ya? Kalau sudah browsing roseola mestinya gak galau
karena sudah tahu bintik2nya tidak bahaya
Kalau sudah baca, pasti gak galau. Kan gak ada kegawat daruratan ya?!
Kalau sudah baca juga tahu soal mandi dll
soal kaldu, saya justru mau jawabnya dari "angle" yang lain yaitu:
Pada dasarnya, alergi makanan itu jarang!
soal kaldu, memangnya kandungan nutrisinya banyak ya? bukannya
fungsinsinya lebih utk penyedap?
btw, kalau infeksi virus mah, pastilah gak nafsu makan
wati
Quoting acc_milis <acc_milis@yahoo.com >:
> Makasi banyak atas pencerahannya Mbak Ruli, sedikit lega. Soalnya
> udh panik dulu kok makin banyak aza bintik2nya. Galau jg nih obat
> harus dikasi ato gak. Takut gara2 mau RUM, malah anak jd korban
> gara2 telat ambil action >.<
> Jadi diobservasi dulu dlm 8hari ini ya Mbak? jaga asupan cairan trs
> apalagi mbak buat perawatannya? Ada perhitungan minimal berapa ml
> asupan air yg hrs diminum gk ya?
> Anaknya sih aktif, makan ms mau, tp gk banyak. Dalam kondisi begini,
> bole kasi kaldu ayam gk ya? Soalnya sebelumnya blm pernah, jd takut
> nanti alergi, tambah parah lagi sakitnya >.<
> Mandi sama tidur diruangan AC bole? Soalnya anaknya kuat maen n
> gampang keringatan. Yg pasti kondisinya skrg jd suka teriak2 >.< (jd
> curcol panjang lg d)
>
>
>
1. Roseola tidak butuh anti virus meski merah2nya sedikit atau banyak
2. Isoprinosin bukan antivirus
Isoprinosin tidak bisa menyembuhkan roseola atau penyakit virus
lainnya (mulai dari cc, flu, hepatitis, dst dst)
Galaunya kenapa ya? Kalau sudah browsing roseola mestinya gak galau
karena sudah tahu bintik2nya tidak bahaya
Kalau sudah baca, pasti gak galau. Kan gak ada kegawat daruratan ya?!
Kalau sudah baca juga tahu soal mandi dll
soal kaldu, saya justru mau jawabnya dari "angle" yang lain yaitu:
Pada dasarnya, alergi makanan itu jarang!
soal kaldu, memangnya kandungan nutrisinya banyak ya? bukannya
fungsinsinya lebih utk penyedap?
btw, kalau infeksi virus mah, pastilah gak nafsu makan
wati
Quoting acc_milis <acc_milis@yahoo.
> Makasi banyak atas pencerahannya Mbak Ruli, sedikit lega. Soalnya
> udh panik dulu kok makin banyak aza bintik2nya. Galau jg nih obat
> harus dikasi ato gak. Takut gara2 mau RUM, malah anak jd korban
> gara2 telat ambil action >.<
> Jadi diobservasi dulu dlm 8hari ini ya Mbak? jaga asupan cairan trs
> apalagi mbak buat perawatannya? Ada perhitungan minimal berapa ml
> asupan air yg hrs diminum gk ya?
> Anaknya sih aktif, makan ms mau, tp gk banyak. Dalam kondisi begini,
> bole kasi kaldu ayam gk ya? Soalnya sebelumnya blm pernah, jd takut
> nanti alergi, tambah parah lagi sakitnya >.<
> Mandi sama tidur diruangan AC bole? Soalnya anaknya kuat maen n
> gampang keringatan. Yg pasti kondisinya skrg jd suka teriak2 >.< (jd
> curcol panjang lg d)
>
>
>
Wed Jun 12, 2013 12:33 pm (PDT) . Posted by:
"Sandra Sibarani" sc_sib
Hi dr Wati....
Sy mamanya Minerva, pasien di rspi..
Sy udah join milis nih Dok, mau hai2 sesuai janji tempo hari hehe..
Smoga bs tambah pinter & ga gampang bingung kl anak sakit.
Salam
Sandra
"Purnamawati, SpAK" <purnamawati.spak@cbn.net.id > wrote:
>Intinya sih
>
>1. Roseola tidak butuh anti virus meski merah2nya sedikit atau banyak
>2. Isoprinosin bukan antivirus
>Isoprinosin tidak bisa menyembuhkan roseola atau penyakit virus
>lainnya (mulai dari cc, flu, hepatitis, dst dst)
>
>Galaunya kenapa ya? Kalau sudah browsing roseola mestinya gak galau
>karena sudah tahu bintik2nya tidak bahaya
>Kalau sudah baca, pasti gak galau. Kan gak ada kegawat daruratan ya?!
>
>Kalau sudah baca juga tahu soal mandi dll
>soal kaldu, saya justru mau jawabnya dari "angle" yang lain yaitu:
>Pada dasarnya, alergi makanan itu jarang!
>soal kaldu, memangnya kandungan nutrisinya banyak ya? bukannya
>fungsinsinya lebih utk penyedap?
>
>btw, kalau infeksi virus mah, pastilah gak nafsu makan
>
>wati
>
>
>
>Quoting acc_milis <acc_milis@yahoo.com >:
>
>> Makasi banyak atas pencerahannya Mbak Ruli, sedikit lega. Soalnya
>> udh panik dulu kok makin banyak aza bintik2nya. Galau jg nih obat
>> harus dikasi ato gak. Takut gara2 mau RUM, malah anak jd korban
>> gara2 telat ambil action >.<
>> Jadi diobservasi dulu dlm 8hari ini ya Mbak? jaga asupan cairan trs
>> apalagi mbak buat perawatannya? Ada perhitungan minimal berapa ml
>> asupan air yg hrs diminum gk ya?
>> Anaknya sih aktif, makan ms mau, tp gk banyak. Dalam kondisi begini,
>> bole kasi kaldu ayam gk ya? Soalnya sebelumnya blm pernah, jd takut
>> nanti alergi, tambah parah lagi sakitnya >.<
>> Mandi sama tidur diruangan AC bole? Soalnya anaknya kuat maen n
>> gampang keringatan. Yg pasti kondisinya skrg jd suka teriak2 >.< (jd
>> curcol panjang lg d)
>>
>>
>>
>
>
>
[Non-text portions of this message have been removed]
Sy mamanya Minerva, pasien di rspi..
Sy udah join milis nih Dok, mau hai2 sesuai janji tempo hari hehe..
Smoga bs tambah pinter & ga gampang bingung kl anak sakit.
Salam
Sandra
"Purnamawati, SpAK" <purnamawati.
>Intinya sih
>
>1. Roseola tidak butuh anti virus meski merah2nya sedikit atau banyak
>2. Isoprinosin bukan antivirus
>Isoprinosin tidak bisa menyembuhkan roseola atau penyakit virus
>lainnya (mulai dari cc, flu, hepatitis, dst dst)
>
>Galaunya kenapa ya? Kalau sudah browsing roseola mestinya gak galau
>karena sudah tahu bintik2nya tidak bahaya
>Kalau sudah baca, pasti gak galau. Kan gak ada kegawat daruratan ya?!
>
>Kalau sudah baca juga tahu soal mandi dll
>soal kaldu, saya justru mau jawabnya dari "angle" yang lain yaitu:
>Pada dasarnya, alergi makanan itu jarang!
>soal kaldu, memangnya kandungan nutrisinya banyak ya? bukannya
>fungsinsinya lebih utk penyedap?
>
>btw, kalau infeksi virus mah, pastilah gak nafsu makan
>
>wati
>
>
>
>Quoting acc_milis <acc_milis@yahoo.
>
>> Makasi banyak atas pencerahannya Mbak Ruli, sedikit lega. Soalnya
>> udh panik dulu kok makin banyak aza bintik2nya. Galau jg nih obat
>> harus dikasi ato gak. Takut gara2 mau RUM, malah anak jd korban
>> gara2 telat ambil action >.<
>> Jadi diobservasi dulu dlm 8hari ini ya Mbak? jaga asupan cairan trs
>> apalagi mbak buat perawatannya? Ada perhitungan minimal berapa ml
>> asupan air yg hrs diminum gk ya?
>> Anaknya sih aktif, makan ms mau, tp gk banyak. Dalam kondisi begini,
>> bole kasi kaldu ayam gk ya? Soalnya sebelumnya blm pernah, jd takut
>> nanti alergi, tambah parah lagi sakitnya >.<
>> Mandi sama tidur diruangan AC bole? Soalnya anaknya kuat maen n
>> gampang keringatan. Yg pasti kondisinya skrg jd suka teriak2 >.< (jd
>> curcol panjang lg d)
>>
>>
>>
>
>
>
[Non-text portions of this message have been removed]
Wed Jun 12, 2013 5:09 pm (PDT) . Posted by:
ni.nugroho
Amiiin,
Didoakan juga. Sharing tentu boleh, tp harap diingat bahwa belum tentu pengalaman sama berarti diagnosisnya juga sama. Khawatirnya nanti malah keliru dan menimbulkan kebingungan lebih lanjut.
Jadi yang paling penting ya diskusikan kemungkinan diagnosisnya dengan dokter yg menangani. Jika sudah lebih jelas bisa disharing lagi di sini.
Salam,
Rini
*sengaja nggak potek biar nyambung
Powered by Telkomsel BlackBerry®
-----Original Message-----
From: "ega" <ega_duonk@yahoo.com >
Sender: sehat@yahoogroups.com
Date: Wed, 12 Jun 2013 15:07:38
To: <sehat@yahoogroups.com >
Reply-To: sehat@yahoogroups.com
Subject: [sehat] Re: Help Newborn masuk NICU
Iya bu dok, saya juga sadar itu, hanya keluarga sepertinya butuh sharing dan penguatan mungkin ada member yg pernah mengalami hal seperti ini atau dokter-dokter yg pernah menangani kasus ini. Semoga bayinya bisa sehat dan berkumpul dengan keluarganya.
Salam,
Ega
[Non-text portions of this message have been removed]
Didoakan juga. Sharing tentu boleh, tp harap diingat bahwa belum tentu pengalaman sama berarti diagnosisnya juga sama. Khawatirnya nanti malah keliru dan menimbulkan kebingungan lebih lanjut.
Jadi yang paling penting ya diskusikan kemungkinan diagnosisnya dengan dokter yg menangani. Jika sudah lebih jelas bisa disharing lagi di sini.
Salam,
Rini
*sengaja nggak potek biar nyambung
Powered by Telkomsel BlackBerry®
-----Original Message-----
From: "ega" <ega_duonk@yahoo.
Sender: sehat@yahoogroups.
Date: Wed, 12 Jun 2013 15:07:38
To: <sehat@yahoogroups.
Reply-To: sehat@yahoogroups.
Subject: [sehat] Re: Help Newborn masuk NICU
Iya bu dok, saya juga sadar itu, hanya keluarga sepertinya butuh sharing dan penguatan mungkin ada member yg pernah mengalami hal seperti ini atau dokter-dokter yg pernah menangani kasus ini. Semoga bayinya bisa sehat dan berkumpul dengan keluarganya.
Salam,
Ega
[Non-text portions of this message have been removed]
Dear Docs & Sp's
selamat pagi...
gejala awal sekitar bulan mei 2013 sy(28thn) sakit flu +/- 1 minggu
lamanya. dengan gejala tambahan
sakit kepala sebelah,telinga agak sakit. Sebelum2nya sy tidak pernah sakit
kepala sebelah.
ke dokter awalnya ingin memastikan diagnosanya apa. oleh dokter untuk
sakit kepala
di oleh2i : ANALSIK (methampyrone 500mg, Diazepam 2mg) Amankah obat tsb??
Sebetulnya Migrain dengan sakit kepala sebelah itu memang adakah? dengan
keyword apa sy bisa cari info nya..
atau adakah yang berkenan memberi link tentang sakit kepala sebelah..??
apakah hal ini berkaitan dengan rutinitas sy yg bekerja di depan kompoter
dengan waktu yg lama??
terimakasih
Mauren
[Non-text portions of this message have been removed]
selamat pagi...
gejala awal sekitar bulan mei 2013 sy(28thn) sakit flu +/- 1 minggu
lamanya. dengan gejala tambahan
sakit kepala sebelah,telinga agak sakit. Sebelum2nya sy tidak pernah sakit
kepala sebelah.
ke dokter awalnya ingin memastikan diagnosanya apa. oleh dokter untuk
sakit kepala
di oleh2i : ANALSIK (methampyrone 500mg, Diazepam 2mg) Amankah obat tsb??
Sebetulnya Migrain dengan sakit kepala sebelah itu memang adakah? dengan
keyword apa sy bisa cari info nya..
atau adakah yang berkenan memberi link tentang sakit kepala sebelah..??
apakah hal ini berkaitan dengan rutinitas sy yg bekerja di depan kompoter
dengan waktu yg lama??
terimakasih
Mauren
[Non-text portions of this message have been removed]
Wed Jun 12, 2013 8:06 pm (PDT) . Posted by:
ni.nugroho
Dear mbak mauren,
Migraine itu ada, saya juga penderita migraine. keywordnya ya migraine, boleh ditambahin headache jadi migraine headache.
HTH,
Rini
Powered by Telkomsel BlackBerry®
Migraine itu ada, saya juga penderita migraine. keywordnya ya migraine, boleh ditambahin headache jadi migraine headache.
HTH,
Rini
Powered by Telkomsel BlackBerry®
Halo mba sharing ya.
Aku 2x melahirkan normal. Yg pertama induksi, yg kedua tanpa induksi.
Pengalamanku hamil ke-2 aku ikut yoga, lalu sering latihan *goyang inul* menggunakan birthing ball di rumah, latihan putaran sufi dan pernafasan jg dan jg hypnobirthing.
Alhamdulilah lahiran yg kedua lebih lancar. Pagi keluar flek. Siang jam 2 cek sudah bukaan 2-3. Jam 19.30 melahirkan.
Regards
Idah
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
Aku 2x melahirkan normal. Yg pertama induksi, yg kedua tanpa induksi.
Pengalamanku hamil ke-2 aku ikut yoga, lalu sering latihan *goyang inul* menggunakan birthing ball di rumah, latihan putaran sufi dan pernafasan jg dan jg hypnobirthing.
Alhamdulilah lahiran yg kedua lebih lancar. Pagi keluar flek. Siang jam 2 cek sudah bukaan 2-3. Jam 19.30 melahirkan.
Regards
Idah
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...
Wed Jun 12, 2013 7:52 pm (PDT) . Posted by:
"bunda syahda"
Dear Mba Dewi,
Sharing saya, anak pertama SC, kdua alhamdulillah bs normal spontan. Utk
anak prtm, jalan kaki, ngepel jongkok, jengking, sujud lama, bhkan diputer
sm dsog jg gk ngefek..hehe..anak saya asik dgn posisinya kepala di atas,
akhrnya SC deh.
Tp utk yg kdua, kbetulan saya tdk bs cuti melahirkan krn sdg tugas belajar,
smp shari sblm melahirkan saya msh praktikum. Maghrib bukaan 1, msh pulang
ke rmh. Tengah mlm udh mulai lmyn mulesnya, tp msh bs saya tahan. Trs trg
saya takut klo pas ke RS trnyt bukaannya msh 1-2. Ba'da Shubuh ke RS trnyt
sudah bukaan 8, 05.40 lahirlah tnp kehadiran dsog..hehe..
Alhamdulillah..lancar, bhkn blom smpt mengejan.
Anak kdua ini saya gk smpt jalan2 pagi/sore krn repot kuliah. Tp weekend
saya usahakan senam hamil. Klo mnrt saya, aktivitas yg lmyn banyak jg bs jd
memperlancar. Tp itu trgntung kondisi masing2.
Semoga lancar jg ya mba
>
> Dear bunda2 yg pernah pengalaman melahirkan normal maupun yg berhasil
> vbac, bolehkah membagi tips nya agar bisa melahirkan scr normal mendapat
> kontraksi sealami-alami mungkin tnpa induksi.. ??
>
> Apa saja yg harus dilakukan ya ?
> Terimakasih..
>
> Powered by Telkomsel BlackBerry®
>
> ------------------------------------
>
> Milis SEHAT mengucapkan terima kasih kepada HANSAPLAST selaku sponsor
> kegiatan PESAT Balikpapan (4-5 Mei 2013), PESAT SUA Bali (18-19 Mei 2013),
> dan PESAT SUA Bandung, Juni 2013.
> Hansaplast, "Sembuh Lebih Cepat, Ceria Setiap Saat"
>
> Terima kasih & penghargaan sedalam-dalamnya kepada HBTLaw dan PT.Intiland
> yang telah dan konsisten mensponsori program kami, PESAT (Program Edukasi
> Kesehatan Anak Untuk Orang Tua)."
>
> "Milis SEHAT didukung oleh : CBN Net Internet Access & Website.
> =================================================================
> Milis Sehat thanks to HANSAPLAST as sponsor for PESAT Balikpapan (May 4-5,
> 2013), PESAT SUA Bali (May 18-19, 2013), dan PESAT SUA Bandung in June 2013.
> Hansaplast, "Sembuh Lebih Cepat, Ceria Setiap Saat"
>
> Our biggest gratitude to HBTLaw and PT. Intiland, who have consistently
> sponsored our program, PESAT (Program Edukasi Kesehatan Anak Untuk Orang
> Tua)."
> "SEHAT mailing list is supported by CBN Net for Internet Access &Website.
>
> Kunjungi kami di (Visit us at):
> Official Web : http://milissehat.web.id/
> FB : http://www.facebook.com/pages/Milissehat/131922690207238
> Twitter : @milissehat <http://twitter.com/milissehat/ >
> ==================================================================
> Donasi (donation):
> Rekening Yayasan Orang Tua Peduli
> Bank Mandiri
> Cabang Kemang Raya Jakarta
> Account Number: 126.000.4634514
> ==================================================================Yahoo!
> Groups Links
>
>
>
>
[Non-text portions of this message have been removed]
Sharing saya, anak pertama SC, kdua alhamdulillah bs normal spontan. Utk
anak prtm, jalan kaki, ngepel jongkok, jengking, sujud lama, bhkan diputer
sm dsog jg gk ngefek..hehe.
akhrnya SC deh.
Tp utk yg kdua, kbetulan saya tdk bs cuti melahirkan krn sdg tugas belajar,
smp shari sblm melahirkan saya msh praktikum. Maghrib bukaan 1, msh pulang
ke rmh. Tengah mlm udh mulai lmyn mulesnya, tp msh bs saya tahan. Trs trg
saya takut klo pas ke RS trnyt bukaannya msh 1-2. Ba'da Shubuh ke RS trnyt
sudah bukaan 8, 05.40 lahirlah tnp kehadiran dsog..hehe..
Alhamdulillah.
Anak kdua ini saya gk smpt jalan2 pagi/sore krn repot kuliah. Tp weekend
saya usahakan senam hamil. Klo mnrt saya, aktivitas yg lmyn banyak jg bs jd
memperlancar. Tp itu trgntung kondisi masing2.
Semoga lancar jg ya mba
>
> Dear bunda2 yg pernah pengalaman melahirkan normal maupun yg berhasil
> vbac, bolehkah membagi tips nya agar bisa melahirkan scr normal mendapat
> kontraksi sealami-alami mungkin tnpa induksi.. ??
>
> Apa saja yg harus dilakukan ya ?
> Terimakasih.
>
> Powered by Telkomsel BlackBerry®
>
> ------------
>
> Milis SEHAT mengucapkan terima kasih kepada HANSAPLAST selaku sponsor
> kegiatan PESAT Balikpapan (4-5 Mei 2013), PESAT SUA Bali (18-19 Mei 2013),
> dan PESAT SUA Bandung, Juni 2013.
> Hansaplast, "Sembuh Lebih Cepat, Ceria Setiap Saat"
>
> Terima kasih & penghargaan sedalam-dalamnya kepada HBTLaw dan PT.Intiland
> yang telah dan konsisten mensponsori program kami, PESAT (Program Edukasi
> Kesehatan Anak Untuk Orang Tua)."
>
> "Milis SEHAT didukung oleh : CBN Net Internet Access & Website.
> ============
> Milis Sehat thanks to HANSAPLAST as sponsor for PESAT Balikpapan (May 4-5,
> 2013), PESAT SUA Bali (May 18-19, 2013), dan PESAT SUA Bandung in June 2013.
> Hansaplast, "Sembuh Lebih Cepat, Ceria Setiap Saat"
>
> Our biggest gratitude to HBTLaw and PT. Intiland, who have consistently
> sponsored our program, PESAT (Program Edukasi Kesehatan Anak Untuk Orang
> Tua)."
> "SEHAT mailing list is supported by CBN Net for Internet Access &Website.
>
> Kunjungi kami di (Visit us at):
> Official Web : http://milissehat.
> FB : http://www.facebook
> Twitter : @milissehat <http://twitter.
> ============
> Donasi (donation):
> Rekening Yayasan Orang Tua Peduli
> Bank Mandiri
> Cabang Kemang Raya Jakarta
> Account Number: 126.000.4634514
> ============
> Groups Links
>
>
>
>
[Non-text portions of this message have been removed]
Wed Jun 12, 2013 6:07 pm (PDT) . Posted by:
"Ghozansehat" ghozansehat
fyi buat sarapan pagi....
Antibiotic prophylaxis for urinary tract infections after removal of
urinary catheter: meta-analysis
BMJ 2013; 346 doi: http://dx.doi.
June 2013)
Cite this as: BMJ 2013;346:f3147
* Infectious diseases
<http://www.bmj.
* Urological surgery <http://www.bmj.
* Urology <http://www.bmj.
* Clinical diagnostic tests
<http://www.bmj.
* Clinical trials (epidemiology)
<http://www.bmj.
* Internet <http://www.bmj.
More topics
* Article <http://www.bmj.
* Related content <http://www.bmj.
* Article metrics <http://www.bmj.
1. Jonas Marschall, internist and infectious disease specialist1
<http://www.bmj.
<http://www.bmj.
2. Christopher R Carpenter, internist and emergency medicine
specialist3 <http://www.bmj.
3. Susan Fowler, medical librarian4
<http://www.bmj.
4. Barbara W Trautner, internist and infectious disease specialist5
<http://www.bmj.
<http://www.bmj.
5. for the CDC Prevention Epicenters Program
Author Affiliations
1. Correspondence to: J Marschall jmarscha@dom.
<mailto:jmarscha@dom.
* Accepted 13 May 2013
Abstract
*Objective* To determine whether antibiotic prophylaxis at the time of
removal of a urinary catheter reduces the risk of subsequent symptomatic
urinary tract infection*.*
*Design* Systematic review and meta-analysis of studies published before
November 2012 identified through PubMed, Embase, Scopus, and the
Cochrane Library; conference abstracts for 2006-12 were also reviewed.
*Inclusion criteria* Studies were included if they examined antibiotic
prophylaxis administered to prevent symptomatic urinary tract infection
after removal of a short term (?14 days) urinary catheter.
*Results* Seven controlled studies had symptomatic urinary tract
infection after catheter removal as an endpoint; six were randomized
controlled trials (five published; one in abstract form) and one was a
non-randomized controlled intervention study. Five of these seven
studies were in surgical patients. Studies were heterogeneous in the
type and duration of antimicrobial prophylaxis and the period of
observation. Overall, antibiotic prophylaxis was associated with benefit
to the patient, with an absolute reduction in risk of urinary tract
infection of 5.8% between intervention and control groups. The risk
ratio was 0.45 (95% confidence interval 0.28 to 0.72). The number needed
to treat to prevent one urinary tract infection was 17 (12 to 30).
*Conclusions* Patients admitted to hospital who undergo short term
urinary catheterization might benefit from antimicrobial prophylaxis
when the catheter is removed as they experience fewer subsequent urinary
tract infections. Potential disadvantages of more widespread
antimicrobial prophylaxis (side effects and cost of antibiotics,
development of antimicrobial resistance) might be mitigated by the
identification of which patients are most likely to benefit from this
approach.
Introduction
Urinary catheterization is common in patients in hospital, particularly
for surgical patients in the perioperative period when physiological
mechanisms of bladder emptying are suspended. Catheterization of the
urinary tract, however, is associated with an increased risk of
bacteriuria and symptomatic urinary tract infection, the risk being
associated with the duration of catheterization.
<http://www.bmj.
recommend removal of urinary catheters once they are no longer needed,2
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
advocate discontinuation of catheterization as early as 24-48 hours
postoperatively.
Bacteriuria in a patient with a catheter, however, can persist after the
catheter is removed and can develop into a symptomatic urinary tract
infection. Manipulation of the catheter itself during removal might also
predispose to infection.6
<http://www.bmj.
from the National Healthcare Safety Network (NHSN) for catheter
associated urinary tract infection (CAUTI) reflect this by identifying
infections up to 48 hours after catheter removal as catheter associated
(www.cdc.gov/
<http://www.cdc.
<http://www.bmj.
Whether administration of prophylactic antibiotics when the catheter is
removed will prevent subsequent symptomatic urinary tract infection is
unclear. Randomized trials have yielded conflicting results,7
<http://www.bmj.
<http://www.bmj.
meta-analysis. Also, there is considerable heterogeneity in the
management of antimicrobial prophylaxis around removal of a urinary
catheter.9 <http://www.bmj.
Infectious Diseases Society of America (IDSA) guidelines for the
diagnosis, management, and prevention of catheter associated urinary
tract infection determined that there was insufficient evidence to
recommend widespread antibiotic prophylaxis after catheterization.
<http://www.bmj.
2008 best practice policy statement the American Urological Association
(AUA) concluded that antibiotic prophylaxis should be considered for
patients with bacteriuria at time of catheter removal, particularly for
those with certain risk factors (such as advanced age, immunodeficiency,
or anatomic abnormalities of the urinary tract).10
<http://www.bmj.
We performed a meta-analysis of controlled trials to clarify whether
antibiotic prophylaxis at the time of urinary catheter removal confers a
benefit in terms of preventing subsequent symptomatic urinary tract
infections.
Methods
Search strategy and selection criteria
We followed the PRISMA guidelines for conducting and reporting
meta-analyses.
did two separate queries. First, we performed a systematic review of
randomized and non-randomized controlled trials that compared antibiotic
prophylaxis with placebo or a control group at the time of removal of a
transurethral urinary catheter and tracked the occurrence of symptomatic
urinary tract infections in the subsequent period (JM). For this
purpose, we screened the medical literature in PubMed from 1947 up to
November 2012 with the search terms urinary catheter, removal,
prophylaxis, antibiotic prophylaxis randomized, and trial, and evaluated
conference abstracts from 2006-2012 (from Infectious Diseases Society of
America (IDSA) annual meeting, Interscience Conference on Antimicrobial
Agents and Chemotherapy (ICAAC), Society for Healthcare Epidemiology of
America (SHEA) annual meeting, and the European Congress of Clinical
Microbiology and Infectious Diseases (ECCMID)). In addition, we used
Google to search for the same terms. Next, a medical librarian (SF)
created a systematic search strategy that included a combination of
standardized index terms and straight keywords. She ran that search in
Embase, Scopus, the Cochrane Library (including CENTRAL), and
clinicaltrials.
lists of all potentially relevant studies to identify additional
research data. We included non-English language and unpublished studies
(fig 1).? <http://www.bmj.
<http://www.bmj.
View larger version:
* In a new window
<http://www.bmj.
* Download as PowerPoint Slide
<http://www.bmj.
*Fig 1* Selection of studies for meta-analysis of trials investigating
antibiotic prophylaxis for urinary tract infections after removal of
urinary catheter
Eligible studies were randomized and non-randomized controlled trials of
short term catheterization in adults with symptomatic urinary tract
infection as an endpoint. We defined short term catheterization as a
maximum duration of 14 days. The endpoint of symptomatic urinary tract
infection required the detection of measureable bacteriuria plus the
presence of at least one symptom or sign compatible with urinary tract
infection.2 <http://www.bmj.
studies, however, specified which clinical criteria were fulfilled for
this endpoint. We did not include the endpoint bacteriuria because
antibiotic treatment of asymptomatic bacteriuria is not indicated.12
<http://www.bmj.
prophylaxis was directed specifically at the prevention of symptomatic
urinary tract infections, we did not assess additional outcomes such as
survival. Subsequent symptomatic urinary tract infections caused by
antibiotic resistant organisms would have been a meaningful secondary
endpoint but none of the included studies assessed it.
One reviewer (JM) screened the titles and abstracts of eligible studies
originating from the primary search. Two independent reviewers (JM, BWT)
screened the titles and abstracts of eligible studies identified in the
secondary search. Potentially relevant papers were obtained, and these
reviewers assessed the full manuscript for possible inclusion. There
were no restrictions with regard to the antibiotics used for prophylaxis
or the length of follow-up after antibiotic prophylaxis in the reviewed
studies.
Data extraction and meta-analysis
We extracted information about the study design, inclusion criteria for
patients, sample size, antimicrobial agents used for prophylaxis, and
the duration of administration. We also noted the duration of
catheterization until removal in intervention and control groups.
Finally, we extracted the number of endpoints in intervention and
control groups in relation to the patients assigned to each of the groups.
We assessed the internal validity of individual trials using a
modification of the Cochrane Handbook quality assessment
recommendations.
investigators (JM, CRC) independently rated each trial across four
domains of bias: selection, performance, attrition, and detection. A
priori, both investigators agreed to evaluate selection bias based on
adequacy of randomization and allocation concealment for each study,
while performance bias was judged on the probability for systematic
differences in care after randomization. Investigators judged attrition
bias based on any systematic difference in withdrawals between
intervention and control groups. Detection bias was assessed on the
timing and methods used to ascertain the primary outcome for each study.
The reliability of quality assessment between raters was evaluated with
Cohen's ?,14 <http://www.bmj.
statistical package SPSS version 20 (IBM Corporation, Armonk, NY).
Discrepancies between raters were resolved by consensus.
All data were entered into the free online analysis tool "Meta-Analyst&
(http://tuftscaes.
was assessed with ?^2 and I^2 statistics (25%, 50%, and 75% representing
low, moderate, and high heterogeneity)
<http://www.bmj.
of studies using random effects models, if appropriate, after
consideration of heterogeneity among trials. We calculated individual
and pooled statistics as relative risks and 95% confidence intervals. We
conducted a sensitivity analysis of the pooled relative risk by
sequentially excluding the non-randomized study and the unpublished
study from the analysis. We also performed subgroup analyses of studies
in surgical patients and mixed hospital populations. We evaluated
potential publication bias with a funnel plot.16
<http://www.bmj.
Results
The two literature searches identified 246 and 221 potentially relevant
abstracts (fig 1? <http://www.bmj.
primary search, we identified 27 abstracts that led to full article
review and two further studies by reviewing bibliographies or through
conference abstracts. In the secondary search, two reviewers
independently determined that 17 of 221 abstracts required review of the
full manuscript. After review, we excluded studies in which the patients
had suprapubic catheters,17
<http://www.bmj.
<http://www.bmj.
symptomatic bacteriuria,
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
prophylaxis was started shortly after catheter insertion rather than at
the time of removal.22 <http://www.bmj.
23 <http://www.bmj.
studies that lacked a concurrent control group.24
<http://www.bmj.
eligibility criteria.
This meta-analysis includes five published randomized controlled
trials,7 <http://www.bmj.
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
randomized controlled trial,28
<http://www.bmj.
controlled study29 <http://www.bmj.
(table 1? <http://www.bmj.
indicated that prophylaxis is associated with lower incidence of urinary
tract infection,7 <http://www.bmj.
<http://www.bmj.
<http://www.bmj.
published studies8 <http://www.bmj.
<http://www.bmj.
<http://www.bmj.
unpublished randomized study28
<http://www.bmj.
benefit with prophylaxis. The quality of the included studies was
variable: there was a low risk of detection bias and performance bias
and a high risk of selection and attrition bias in most studies.
Specifically, randomization and adequate allocation were inadequate in
all studies except those by Wazait and colleagues,27
<http://www.bmj.
colleagues,7 <http://www.bmj.
Hees and colleagues.8 <http://www.bmj.
Attrition bias was a concern across all of the studies except those by
Wazait and colleagues27
<http://www.bmj.
colleagues.8 <http://www.bmj.
inter-rater ? to describe study quality was between 0.7 (attrition bias)
and 1.0 (selection and performance bias). For the detection bias, we
could not calculate ? because one rater's assessment was constant across
studies (that is, ?=0). Both raters resolved all discrepancies and
achieved consensus (table 2).? <http://www.bmj.
View this table:
* View Popup
<http://www.bmj.
* View Inline <http://www.bmj.
Table 1
Summary of studies on effect of antibiotic prophylaxis for urinary tract
infections after removal of urinary catheter included in this meta-analysis
View this table:
* View Popup
<http://www.bmj.
* View Inline <http://www.bmj.
Table 2
Assessment of quality in studies on effect of antibiotic prophylaxis for
urinary tract infections after removal of urinary catheter included in
this meta-analysis
Sample size calculations were missing for some studies,25
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
were based on the endpoint bacteriuria rather than symptomatic urinary
tract infection for another study.8
<http://www.bmj.
achieve the required sample size.7
<http://www.bmj.
there were no missing data and no crossovers were reported.
The conference abstract of an unpublished study described a randomized
controlled trial from the Netherlands.
<http://www.bmj.
patients were randomized to either nitrofurantoin prophylaxis or placebo
at time of catheter removal. Symptomatic urinary tract infections
occurred in 18/151 (11.9%) of the intervention group and 12/137 (8.8%)
of the control group; these rates were not significantly different. The
one non-randomized prospective study evaluated antibiotic prophylaxis in
729 consecutive patients who underwent laparoscopic radical
prostatectomy. In this study, patients were given antibiotic prophylaxis
(a three day course of ciprofloxacin starting the day before catheter
removal) if they were seen by surgeon A or no prophylaxis if the
procedure was done by surgeon B.29
<http://www.bmj.
intervention group experienced urinary tract infections (3.1% /v/ 7.3%;
P=0.02). Additionally, the numbers of urinary tract infections in the
various arms in the study reported by Harding and colleagues26
<http://www.bmj.
discern from the published text and were therefore confirmed via email
with one of Harding'
Five out of seven included studies focused on surgical patients,
including two studies in urology patients.
The meta-analysis indicated an overall reduction in symptomatic urinary
tract infection when antibiotic prophylaxis was given, with a risk ratio
of 0.45 (95% confidence interval 0.28 to 0.72) compared with controls7
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
<http://www.bmj.
of symptomatic urinary tract infection was 5.8% (31/665 (4.7%) in the
antibiotic prophylaxis group /v/ 90/855 (10.5%) in the control group).
The number needed to treat to prevent one symptomatic urinary tract
infection was 17 (95% confidence interval 12-30), with low heterogeneity
(I^2 =16%).
<http://www.bmj.
View larger version:
* In a new window
<http://www.bmj.
* Download as PowerPoint Slide
<http://www.bmj.
*Fig 2*: Forest plot of seven included studies with 1520 participants on
effect of antibiotic prophylaxis on urinary tract infections after
removal of urinary catheter
We repeated the meta-analysis without the single non-randomized study29
<http://www.bmj.
remaining six studies was 0.45 (95% confidence interval 0.23 to 0.86)
and not different from the main analysis. The meta-analysis was also
repeated without the single unpublished trial28
<http://www.bmj.
was only slightly changed with 0.36 (0.22 to 0.59), again pointing to a
benefit of antibiotic prophylaxis. Finally, we limited the analysis to
studies conducted with surgical patients, and the risk ratio remained
unchanged (0.45; 0.29 to 0.70). In contrast, when we pooled results from
the two studies in mixed hospital populations26
<http://www.bmj.
<http://www.bmj.
significant advantage of the intervention (0.44; 0.02 to 9.40).
There was significant variation in the duration of monitoring after
catheter removal, ranging from about four days in the study of
Pfefferkorn and colleagues7
<http://www.bmj.
study by Pinochet and colleagues.29
<http://www.bmj.
antimicrobial agents were used (trimethoprim/
ciprofloxacin, nitrofurantoin, and a cephalosporin)
prophylaxis ranged from single dose administration8
<http://www.bmj.
<http://www.bmj.
courses.29 <http://www.bmj.
by Harding and colleagues also had an arm in which patients were given a
10 day course of antibiotics26
<http://www.bmj.
considered in our meta-analysis because 10 days was thought to represent
pre-emptive treatment rather than prophylaxis.
The funnel plot (fig 3? <http://www.bmj.
suggests some publication bias, but funnel plots can be difficult to
interpret if the number of included studies is small.16
<http://www.bmj.
asymmetrical funnel plots are not sufficient proof of publication bias.
Alternative explanations for asymmetry include heterogeneity between
studies with the intervention fidelity or outcome assessment, as well as
improved standard of care in the control groups as routine management
evolves over time, which reduces the observed effect size. It is also
possible that an asymmetric funnel plot is the result of chance alone.30
<http://www.bmj.
<http://www.bmj.
View larger version:
* In a new window
<http://www.bmj.
* Download as PowerPoint Slide
<http://www.bmj.
*Fig 3 *Funnel plot of seven included studies with 1520 participants on
effect of antibiotic prophylaxis on urinary tract infections after
removal of urinary catheter
Discussion
In our meta-analysis of pooled data from seven studies (six of which
were randomized), there were significantly fewer symptomatic urinary
tract infections in patients receiving prophylaxis during removal of a
urinary catheter than in those not receiving prophylaxis. Our finding in
favor of antibiotic prophylaxis, however, must be tempered by possible
publication bias toward positive studies, the limitations of the
included studies, and practical considerations about encouraging more
widespread antibiotic use.
Indwelling urinary catheters pose several risks to patients, including
urethral trauma, discomfort, and urinary tract infection.31
<http://www.bmj.
increasingly constrained fiscal resources and evolving antibiotic
resistance, evidence based antimicrobial prescribing is essential to
promote antimicrobial stewardship.
<http://www.bmj.
is no consensus on whether clinicians should prescribe antibiotic
prophylaxis to patients when an indwelling urinary catheter is removed.
Current practice and variation in study designs
Administration of prophylactic antibiotics at the time of removal of a
catheter might already be common practice, particularly among
urologists. In a survey by Wazait and colleagues, conducted in 2004,
antibiotic prophylaxis at the time of catheter removal was practiced by
60% of respondents from various medical specialties, and 40% of
urologists indicated that they used antibiotic prophylaxis in all
patients.9 <http://www.bmj.
of that survey, however, little objective evidence was available to
guide management of bacteriuria after catheterization.
<http://www.bmj.
<http://www.bmj.
practice is therefore not surprising given the inconclusive evidence at
that time.33 <http://www.bmj.
addition, the survey by Wazait and colleagues showed that there was
heterogeneity in the selection and duration of prophylactic
antimicrobial agents.9 <http://www.bmj.
This variation in practice was also evident in the trials included in
our meta-analysis and precludes any formal recommendations about choice
of antibiotics or duration of treatment. Ciprofloxacin and
trimethoprim/
by nitrofurantoin (one study) and cefotaxime (in the oldest study). Dose
varied from single dose to multiple day administration. Of note, current
patterns of antimicrobial resistance in uropathogens clearly argue
against the promotion of the use of both trimethoprim/ sulfamethoxazole
and ciprofloxacin.
35 <http://www.bmj.
<http://www.bmj.
although its activity is limited to the lower urinary tract, has broad
activity against Gram positive and Gram negative pathogens and an
acceptable toxicity profile and is not associated with important
resistance issues.28 <http://www.bmj.
Implications of promoting antibiotic prophylaxis and ideal target
population
Antibiotic prophylaxis at the time of catheter removal could lead to a
dramatic increase in consumption of antibiotics in hospital, based on
the assumption that at least 20% of patients are catheterized at some
point during their hospital stay.37
<http://www.bmj.
antibiotic prophylaxis to those patients who are bacteriuric would be
logistically challenging because all catheterized patients would need to
be screened, and the cost of these screening cultures would be
substantial. Certain populations of patients, however, are most likely
to benefit from antibiotic prophylaxis on catheter removal, and
prophylaxis should be focused on these groups, as acknowledged in the
AUA guidelines.10 <http://www.bmj.
Future studies should attempt to identify specific populations at risk
for the development of urinary tract infections after catheter removal
that would be appropriate targets for antibiotic prophylaxis. Also, the
results of our meta-analysis are largely driven by data on surgical
patients and short term urinary catheters. Only two studies included
non-surgical patients,26
<http://www.bmj.
<http://www.bmj.
findings indicated no significant difference between intervention and
control group. Additional studies should examine medical patients,
including those living in long term care facilities, who might be
catheterized for longer. Lastly, the benefit of preventing urinary tract
infections should be carefully weighed against the additional cost to
the hospital of prophylactic antibiotics, the potential for adverse
antibiotic effects, and the impact on resistance patterns of
uropathogens. Stochastic modeling and cost effectiveness analyses might
be ways to guide future decision making.
Limitations inherent to this meta-analysis include the potential for
publication bias, although we also included unpublished abstracts in our
search. Their quality grading was based on the subjective assessment of
two authors. Furthermore, the included studies were distinctly different
in design---with diverse populations of patients, choices of
antibiotics, durations of prophylaxis, and a heterogeneous observation
period after removal of the catheter---so that standardized
recommendations are difficult to make. The largest included study was
not randomized but instead compared patients of surgeon A (who gave
prophylactic antibiotics) with patients of surgeon B (who did not give
prophylactic antibiotics)
could have differed in many other ways. Also, some of the studies did
not use a placebo in the control arm, and patients' assessment and
reporting of urinary symptoms could have been affected by their
knowledge of treatment status. Lastly, only two of the included studies
recorded information on adverse events associated with the antibiotics,
such as drug toxicities, allergic reactions, or infections with
/Clostridium difficile/.7
<http://www.bmj.
<http://www.bmj.
looked at the costs of antibiotic prophylaxis or at emerging
antimicrobial resistance. Clinicians must assimilate these uncertainties
when weighing advantages and disadvantages of implementing antibiotic
prophylaxis after urethral catheterization.
Conclusions
This meta-analysis of available data indicates an overall benefit of
antibiotic prophylaxis at the time of removal of a urinary catheter to
prevent subsequent urinary tract infections. The number needed to treat
indicates that 17 patients would need to receive prophylaxis to prevent
one symptomatic urinary tract infection. We know little, however, about
the potential negative consequences of implementing antibiotic
prophylaxis in this setting in a wider frame or indeed which types of
patients would be most likely to benefit. Increasing antimicrobial
resistance, healthcare costs for antibiotics, and the potential for side
effects of antibiotic administration are disadvantages that merit
careful review. From a public health standpoint, we should be careful
not to encourage antibiotic use when it might not be necessary. The
healthcare provider of a catheterized patient, however, might consider
antibiotic prophylaxis before catheter removal, after taking individual
risk factors into account. Future studies should better characterize who
is at risk of developing symptomatic urinary tract infection after
catheter removal (whether bacteriuric or not) and then examine
antibiotic prophylaxis in those at greatest risk.
What is already known on this topic
*
Catheterization of the urinary tract is associated with an increased
risk of bacteriuria and symptomatic urinary tract infection
*
Antibiotic administration at the time of removal of a urinary
catheter might effectively reduce urinary tract infections, but
guidelines for catheter associated infections note insufficient
evidence to support this practice
What this study adds.
*
Antibiotic prophylaxis at the time of urinary catheter removal in
general surgery, prostatectomy, and medical patients effectively
reduced the incidence of symptomatic urinary tract infections with a
number needed to treat of 17
*
The effect size of antibiotic prophylaxis in this meta-analysis was
stable to sensitivity analyses with exclusion of non-randomized
trials and two studies in non-surgical patients
Notes
*Cite this as:* /BMJ/ 2013;346:f3147
Footnotes
*
We thank Afke Brandenburg, Leeuwarden, Netherlands, for providing
additional details for their study, and Graham Colditz, Division of
Public Health Sciences, Washington University in St Louis, for his
review of the analyses.
*
Contributors: JM and BWT designed the study. JM and SF did the
literature search. JM and BWT reviewed studies with regard to
inclusion/exclusion criteria and identified the studies that were
eventually included in this meta-analysis. JM and CRC assessed the
quality of included studies. JM, CRC, and BWT analyzed the data. JM
wrote the draft manuscript with input regarding the study
methodology from SF and CRC. All authors reviewed the final
manuscript critically and authorized the submission. JM is guarantor.
*
Funding: This research received no specific grant from any funding
agency in the public, commercial, or not-for-profit sectors. BWT was
funded during the time of manuscript preparation by a VA Career
Development Award from rehabilitation research and development
(B4623), by VA HSR&D IIR 09-104, and NIDDK R21 092293. BWT's work is
also partially supported by the resources and facilities at the
Houston VA Health Services Research and Development Center of
Excellence (HFP90-020) at the Michael E DeBakey VA Medical Center.
JM received support from the Building Interdisciplinary Research
Careers in Women's Health (BIRCWH) award through the NIH NCATS, a
career development award (5K12HD001459-
leader for a subproject of the CDC Prevention Epicenters Program
grant (U54 CK000162; PI Fraser). In addition, JM is funded by the
Barnes-Jewish Hospital Patient Safety and Quality Fellowship Program
and by a research grant from the Barnes-Jewish Hospital Foundation
and Washington University&#
Science.
*
Competing interests: All authors have completed the ICMJE uniform
disclosure form at www.icmje.org/
<http://www.icmje.
from any organization for the submitted work; no financial
relationships with any organizations that might have an interest in
the submitted work in the previous three years; no other
relationships or activities that could appear to have influenced the
submitted work.
*
Ethical approval: Not required. Because we did not have access to
protected health information from patients included in the analyzed
studies, review by the Human Research Protection Office at
Washington University was not required.
*
Data sharing: No additional data are available.
This is an Open Access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license,
which permits others to distribute, remix, adapt, build upon this work
non-commercially, and license their derivative works on different terms,
provided the original work is properly cited and the use is
non-commercial. See: http://creativecomm
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following radical prostatectomy. Urol Oncol2012, Jan 25 epub ahead
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Kelsey M, et al. A pilot randomized double-blind placebo-controlled
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Leuck AM, Wright D, Ellingson L, Kraemer L, Kuskowski MA, Johnson
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[Non-text portions of this message have been removed]
Wed Jun 12, 2013 7:45 pm (PDT) . Posted by:
amianakbinus
Alo mba Mia
Silahkan browsing mengenai micropenis di situs webmd, aap.org, babycenter.com, mayoclinic.com
Your BFF,
Ami
BreastFeeding Friends-Klasi YOP
Stop judging, start supporting
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
Silahkan browsing mengenai micropenis di situs webmd, aap.org, babycenter.com, mayoclinic.com
Your BFF,
Ami
BreastFeeding Friends-Klasi YOP
Stop judging, start supporting
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...
Semangat pagi,
Maaf ikutan nimbrung,
Tetangga depan rumah,anaknya 6tahun mau dikhitan, tp oleh "ahli khitan"nya dibilang penisnya kecil, jd harus terapi dulu agar penisnya bisa ukuran minimal tdk terlalu kecil, dgn obat(saya tdk tahu,krn neneknya tdk menyebutkan), baru bisa dikhitan.
Anaknya mmg overweight, gendut. Apakah memang sdh benar tatalaksananya untuk anak tersebut. Maaf jika numpang tritnya.
Yuli,
Baru belajar lagi..
Powered by Telkomsel BlackBerry®
Maaf ikutan nimbrung,
Tetangga depan rumah,anaknya 6tahun mau dikhitan, tp oleh "ahli khitan"
Anaknya mmg overweight, gendut. Apakah memang sdh benar tatalaksananya untuk anak tersebut. Maaf jika numpang tritnya.
Yuli,
Baru belajar lagi..
Powered by Telkomsel BlackBerry®
Wed Jun 12, 2013 7:50 pm (PDT) . Posted by:
amianakbinus
Alo mba cicih
Utk bahan bacaan bs googling "burn first aid"
Kalau mau lihat spt apa derajat luka bakarnya, googling lgsg di youtube.
Silahkan kalau mau ke dokter :)
Cmiiw all
Your BFF,
Ami
Breastfeeding Friends-Klasi YOP
Stop judging, start supporting
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...!
Utk bahan bacaan bs googling "burn first aid"
Kalau mau lihat spt apa derajat luka bakarnya, googling lgsg di youtube.
Silahkan kalau mau ke dokter :)
Cmiiw all
Your BFF,
Ami
Breastfeeding Friends-Klasi YOP
Stop judging, start supporting
Sent from my BlackBerry® smartphone from Sinyal Bagus XL, Nyambung Teruuusss...
Wed Jun 12, 2013 8:50 pm (PDT) . Posted by:
"Livia" metoyou_lipi
Dear Mba Cicih,
Tentang luka bakar bisa dibaca disini : http://milissehat.web.id/?p=81
HTH
Big Hugs,
Livia Suryanata, S.Psi
t : @livilovy || f : livia suryanata
Sent from MyJavePhi ® on 3
Tentang luka bakar bisa dibaca disini : http://milissehat.
HTH
Big Hugs,
Livia Suryanata, S.Psi
t : @livilovy || f : livia suryanata
Sent from MyJavePhi ® on 3
Wed Jun 12, 2013 8:29 pm (PDT) . Posted by:
"Mommy Nyl" mommynyl
Dear SPs & Docs,
Anakku (2tahun 6 bulan) di mulut sekeliling bibir bagian dalam ada bercak-bercak putih.
Kalau aku browsing namanya Oral Trush.
Mau tanya treatment yang tepat apa ya ?
Apa perlu diobati atau cukup dibersihkan dengan air putih / kumur2 ?
Kelihatannya kalau kena makanan agak pedih, jadinya dia males makan. Makanya aku banyakin jus & makanan yang lembut.
Terima kasih.
Best regards,
Erly
[Non-text portions of this message have been removed]
Anakku (2tahun 6 bulan) di mulut sekeliling bibir bagian dalam ada bercak-bercak putih.
Kalau aku browsing namanya Oral Trush.
Mau tanya treatment yang tepat apa ya ?
Apa perlu diobati atau cukup dibersihkan dengan air putih / kumur2 ?
Kelihatannya kalau kena makanan agak pedih, jadinya dia males makan. Makanya aku banyakin jus & makanan yang lembut.
Terima kasih.
Best regards,
Erly
[Non-text portions of this message have been removed]
Wed Jun 12, 2013 9:20 pm (PDT) . Posted by:
"F.B. Monika" f_monika_b
Dear Mba Warih,
Terimakasih ya sudah share+nanya, sebenarnya saran teman2 Sps sudah Ok
semua saya coba tambahi beberapa hal.
1. Saya ga akan banyak membahas soal tindakan frenotomy kasus TT n Lip tie
bayi Mba. Tapi tugas saya sebagai Konselor membantu Ibu mendapatkan
informasi dari sumber2 yg terpercaya , men support Ibu agar tidak terburu2
memutuskan menyetujui suatu tindakan dan opsi untuk 2nd, 3rd dst bisa
dipilih/dilakukan.
2. " Slm suplementasi sy dilarang perah oleh DSA krn utk menjaga kecukupan
ASI di PD skaligus dia diberi porsi asi tambahan (donor asi). Krn minggu
ini suplementasi akan selesai, sy dibolehkan memerah lg. Tnyata hasil perah
sy sedikit sekali hanya 10 ml/perah selama 15 menit. Oleh DSA sy hny boleh
perah stelah nenen dan maks 4x/hari."
Monik : ASI itu AKAN selalu cukup selama Manajemen Laktasinya benar.
Saya repost jawaban saya di thread kasus yg mirip:
Sempatkan yuk baca2 soal mekanisme produksi & pengeluaran ASI , bisa dari
kellymom, la leche league website. Saya pernah nulis juga bisa dibaca di
sini :
http://theurbanmama.com/articles/hormon-prolaktin-dan-oksitosin.html
Berdasarkan penelitian kadar hormon Prolaktin tinggi saat malam smp dini
hari tepatnya jam 2-4 dini hari . Maka pergunakan waktu2 ini untuk memerah
di sela2 menyusui langsung.
Yang terakhir menambahi sedikit soal memerah, coba kombinasikan warm
compress, breast massage , perah pakai alat / hand expression , dan bila
memakai alat pompa, tetap di akhir sesi perah memakai alat pompa LANJUTKAN
dengan hand expression karena pengosongan PD melalui hand expression jauh
lebih maksimal. Dan setelah tidak keluar tetesan terakhir, LANJUTKAN perah
sekitar 2 menit.
Bisa pelajari di sini, kebetulan baru saya twit kemarin, ada videonya juga
mengenai Maximizing Milk Production with Hands On Pumping dari Stanford :
http://newborns.stanford.edu/Breastfeeding/MaxProduction.html
Tetap semangat ya Mba :)
Your BFF,
F.B.Monika , @f_monika_b
Your Breastfeeding Friend, KLASI YOP
[Non-text portions of this message have been removed]
Terimakasih ya sudah share+nanya, sebenarnya saran teman2 Sps sudah Ok
semua saya coba tambahi beberapa hal.
1. Saya ga akan banyak membahas soal tindakan frenotomy kasus TT n Lip tie
bayi Mba. Tapi tugas saya sebagai Konselor membantu Ibu mendapatkan
informasi dari sumber2 yg terpercaya , men support Ibu agar tidak terburu2
memutuskan menyetujui suatu tindakan dan opsi untuk 2nd, 3rd dst bisa
dipilih/dilakukan.
2. " Slm suplementasi sy dilarang perah oleh DSA krn utk menjaga kecukupan
ASI di PD skaligus dia diberi porsi asi tambahan (donor asi). Krn minggu
ini suplementasi akan selesai, sy dibolehkan memerah lg. Tnyata hasil perah
sy sedikit sekali hanya 10 ml/perah selama 15 menit. Oleh DSA sy hny boleh
perah stelah nenen dan maks 4x/hari."
Monik : ASI itu AKAN selalu cukup selama Manajemen Laktasinya benar.
Saya repost jawaban saya di thread kasus yg mirip:
Sempatkan yuk baca2 soal mekanisme produksi & pengeluaran ASI , bisa dari
kellymom, la leche league website. Saya pernah nulis juga bisa dibaca di
sini :
http://theurbanmama
Berdasarkan penelitian kadar hormon Prolaktin tinggi saat malam smp dini
hari tepatnya jam 2-4 dini hari . Maka pergunakan waktu2 ini untuk memerah
di sela2 menyusui langsung.
Yang terakhir menambahi sedikit soal memerah, coba kombinasikan warm
compress, breast massage , perah pakai alat / hand expression , dan bila
memakai alat pompa, tetap di akhir sesi perah memakai alat pompa LANJUTKAN
dengan hand expression karena pengosongan PD melalui hand expression jauh
lebih maksimal. Dan setelah tidak keluar tetesan terakhir, LANJUTKAN perah
sekitar 2 menit.
Bisa pelajari di sini, kebetulan baru saya twit kemarin, ada videonya juga
mengenai Maximizing Milk Production with Hands On Pumping dari Stanford :
http://newborns.
Tetap semangat ya Mba :)
Your BFF,
F.B.Monika , @f_monika_b
Your Breastfeeding Friend, KLASI YOP
[Non-text portions of this message have been removed]
Wed Jun 12, 2013 11:08 pm (PDT) . Posted by:
"Sophie Gunawan" sophie_gunawan
Dear docs and sps,
Baby saya (8 months), sudah 2 bulan ini dicobain mpasi dengan 4 days rule. Setiap diberikan protein hewani (ayam, daging sapi, dan terutama ikan ikanan seperti gurame, bawal dan salmon), langsung muncul ruam merah di lehernya. Ruam tersebut saya treatment dgn cream. Dan hilang dalam bbrp hari (dengan diberhentikannya pemberian protein hewani tsb).
Info tambahan, masih asi exclusive juga. Dan sebelum mpasi, jaman asi, tdk pernah ruam begitu.
Pertanyaan saya, kalau memang sdh alergi begitu, apa harus dihindari total, dan menunggu usia bayi lebih besar untuk dicobakan lagi? Atau tetap diberikan protein hewani dgn konsekuensi ruam tsb?
Concern saya, jika tdk makan protein hewani, meskipun saya sudah mencoba dengan protein nabati spt tahu tempe, saya khwatir bahwa gizi nya kurang mencukupi.
Mohon sharing and infonya.
Thank you in advance.
Rgds,
Sophie
Sent from my BlackBerry®
powered by Sinyal Kuat INDOSAT
Baby saya (8 months), sudah 2 bulan ini dicobain mpasi dengan 4 days rule. Setiap diberikan protein hewani (ayam, daging sapi, dan terutama ikan ikanan seperti gurame, bawal dan salmon), langsung muncul ruam merah di lehernya. Ruam tersebut saya treatment dgn cream. Dan hilang dalam bbrp hari (dengan diberhentikannya pemberian protein hewani tsb).
Info tambahan, masih asi exclusive juga. Dan sebelum mpasi, jaman asi, tdk pernah ruam begitu.
Pertanyaan saya, kalau memang sdh alergi begitu, apa harus dihindari total, dan menunggu usia bayi lebih besar untuk dicobakan lagi? Atau tetap diberikan protein hewani dgn konsekuensi ruam tsb?
Concern saya, jika tdk makan protein hewani, meskipun saya sudah mencoba dengan protein nabati spt tahu tempe, saya khwatir bahwa gizi nya kurang mencukupi.
Mohon sharing and infonya.
Thank you in advance.
Rgds,
Sophie
Sent from my BlackBerry®
powered by Sinyal Kuat INDOSAT
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Hansaplast, "Sembuh Lebih Cepat, Ceria Setiap Saat"
Terima kasih & penghargaan sedalam-dalamnya kepada HBTLaw dan PT.Intiland yang telah dan konsisten mensponsori program kami, PESAT (Program Edukasi Kesehatan Anak Untuk Orang Tua)."
"Milis SEHAT didukung oleh : CBN Net Internet Access & Website.
=================================================================
Milis Sehat thanks to HANSAPLAST as sponsor for PESAT Balikpapan (May 4-5, 2013), PESAT SUA Bali (May 18-19, 2013), dan PESAT SUA Bandung in June 2013.
Hansaplast, "Sembuh Lebih Cepat, Ceria Setiap Saat"
Our biggest gratitude to HBTLaw and PT. Intiland, who have consistently sponsored our program, PESAT (Program Edukasi Kesehatan Anak Untuk Orang Tua)."
"SEHAT mailing list is supported by CBN Net for Internet Access &Website.
Kunjungi kami di (Visit us at):
Official Web : http://milissehat.web.id/
FB : http://www.facebook.com/pages/Milissehat/131922690207238
Twitter : @milissehat <http://twitter.com/milissehat/>
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Donasi (donation):
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Bank Mandiri
Cabang Kemang Raya Jakarta
Account Number: 126.000.4634514
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