BAHAN AJAR

K om unikasi efektif dalamhubung an dokter/drg -pasien dr erly S pMK

Mengatasi kendala kedua pihak,pasien dan dokter Opini lama: mengembangkan komunikasi dengan pasien menyita waktu harus diluruskan! Komunikasi efektif dokter pasienmenghindari hal negatif

Dokter dapat mengetahui dengan baik kondisi pasien dan keluarganya Pasien percaya sepenuhnya kepada dokter berpengaruh pada proses penyembuhan pasien Pasien merasa tenang dan aman ditangani oleh dokterpatuh menjalankan petunjuk dan nasihat dokter Pasien percaya dokter tersebut dapat membantu menyelesaikan masalah kesehatannya

 KURTZ (1998) Komunikasi efektif tidak memerlukan waktu lamadokter terampil mengenali kebutuhan pasien. Pelayanan medis dengan komunikasi efektif dokter melakukan manajemen pengelolaan masalah kesehatan bersama pasien berdasarkan kebutuhan pasien

Pemahaman tentang komunikasi efektif dokter-pasien diharapkan terjadi perubahan sikap dalam hubungan dokter-pasien

Dua pendekatan komunikasi(KURTZ )

1. Doctor centered communication style Komunikasi berdasarkan kepentingan dokter diagnosis penyakit 2. Patient centered communication style. Komunikasi berdasarkan apa yg dirasakan pasien tentang penyakitnya T ermasuk pendapat pasien,kekhawatirannya, harapannya,serta apa yg dipikirkannya.

Kemampuan dokter memahami harapan,kepentingan,kecemasan,serta kebutuhan pasien, pendekatan no 2 tidak perlu waktu lebih lama dari pada no 1.

 Keberhasilan komunikasi dokter-pasien kenyamanan dan kepuasan bagi kedua pihak empati Empati dapat dikembangkan apabila dokter memiliki ketrampilan mendengarkan dan berbicara (dapat dilatih).

Pentingnya empati ini di komunikasikan. EMPATI: 1. Kemampuan kognitigf dokter dalam mengerti kebutuhan pasien 2. Menunjukkan sensitifitas dokter terhadap perasaan pasien 3. Kemampuan perilaku dokter dalam memperlihatkan empatinya kepada pasien

Emphatic Communication in PhysicianPatient Encounter(Bylund&Makoul 2002)

The Emphaty Communication Coding System(ECCS)levels Bylund&Macoul

Level 0 :dokter menolak sudut pandang pasien Level 1 :mengenali sudut pandang pasien sambil lalu Level 2 :mengenali sudut pandang pasien secara implisit

Level 3 :dokter menghargai pendapat pasien Level 4 :dokter mengkonfirmasi pada pasien Level 5 :dokter berbagi perasaan dan pengalaman dengan pasien Level 3 sampai 5 :dokter mengenal sudut pandang pasien tentang penyakitnya secara eksplisit

H ost Defenses Ag aints Viral Infection erly

Objectives Describe three mechanisms of immune responses to viral infection.

Human are protected from viral infection by: 1. Natural barriers 2. Non spesific immune defenses 3. Antigen-spesific immune responses

 The ultimate goal of the immune response to eliminate . The virus . The cells harboring . Replicating the virus The immune response the best of controlling a virus infection Humoral and cellular immune responses are important for antiviral immunity

Non spesific Immune Defenses

Fever and body temp Infected cells and macrophages - IFN - other cytokine MN Phagocyte system NK cellls Local rapid response to viral infection Activated the spesific immune responses

 IFNtrigger local and systemic responses Fever can limit the replication viruses MN Phagocyte phagocytize virus and cell debris Kuppfers cells and spleen rapidly clear many viruses from the blood

Antibody and Complemen opsonization Macrophages present antigen to T cellIL1& IFNinitiate the antigen spesific immune response NK cells to kill viral-infected cells

Biological Effects of IFN

Inhibition of multiplication of viruses Inhibition of cell division Immunomodulation Increased MHC antigens & Fc receptors NK cell Activation and maturation T cell Proliferation ,suppressed lymphokine release

DTH(CD4) modulation of DTH CTL(CD8) cytotoxicity Macrophage activation

Antigen-Spesific Immunity
Humoral and CMI play different roles in resolving viral infection Antibody act mainly on extracellular virions CMI directed at the virus-producing cells

Humoral Immunity
Viral proteins immunogenic(eliciting an antibody response),but not all Protective humoral immunity antigen at the surface of the virus(protein capsid,glycoproteins)

 Antibody block the progression of disease by: netralization&opsonization of cell-free virus - binding viral attachment proteins - preventing interaction with target cells - destabilizing the virus - degradation

Antiviral role of antibody preventing a viremia Antibody most effective at resolving cytolytic infections. Resolution occure because: - The virus kills the cell factory and - Antibody eliminate the extracellular virus Antibody is the primary defense initiated by vaccination

T-cell Immunity
Promote Antibody ,inflamatory responses and kills infected cells CMI. - especially important for resolving infections by: . Syncytia-forming viruses . Non cytolytic viruses . Controlling latent viruses

Immune response to viral challenge

Natural immune response to infection is determined by : Host,viral and other factors Host: - genetic - immunity - age - general health

 Viral: - strain - infectious dose - route of entry

Viral Escaping the Immune response

Evading detection Preventing activation Blocking immune response Suppress the immune response

Viral Immunopathogenesis
Flu-like symptoms (IFN) DTH and inflamation(T cell) Immune-complex disease Hemorrhagic disease Post infection cytolysis Immunosuppression

 1.Medical Mcrobiology 2. Medical Microbiology and Immunology

Fungal infection erly

F ocus point: Describe some of the virulence determinants of fungi

Pathogenesis of fungi involve : colonization evasion of host defenses,and damage to the host The mechanisms,however,are generally not well understood.

Eukaryotic Parasites
Attach to host cells via spesific receptors Use a variety mechanisms to avoid antibodies Some can produce enzymes that digest host tissue,causing direct damage Damage is due to the immune response

Classification Fungal Infection

1. Superficial fungal infection 2. Cutaneus fungal infection 3. Deep/systemic fungal infection

 In general ,intact skin and mucosal surface barrier to infection - Fatty acid - pH -Turn over of the skin - Normal bacterial flora

Pityriasis versicolor
=Tinea versicolor Causal: Malassezia furfur ,yeast like Lipophilic Generally harmless In some people,cause scally face rash,dandruff Common skin disease patchy scallines and increased or decrease in pigment in skin people.

 Skin scrapping: yeast form and short filaments mi bakso Unknown factors,probably relating to the host

Tinea nigra Piedra The infections cosmetic problems Easily diagnosed and treated Infections of the skin are limited to the outer most layers of str. Corneum Do not elicit a cellular response

Cutaneus mycoses
Disease of the skin,hair and nail keratinized layers Cellular immune response may be evoke in cutaneous infections pathological changes expressed in the deeper tissues of the skin

Clinical manifestation ring worm or tinea Tinea capitis,corpooris,cruris,manus,pedis and unguium Favus T okelau Tinea snake like and annularlesions

Dermatophytes
1. Microsporum 2. Trichophyton 3. Epidermophyton Geophilic (soil) Z oophilic( animal and birds) Anthropophilic(human)

Anthropophilic chronic infectiondificult to cure Geophilic and zoophilic respons well to therapy and healm spontaneously

 Adelicate balance between host and fungi keratophilic fungi Keratinases have been isolated from some of these fungi Unable to invade organs other than the keratinazed layers of the skin,hair and nails

The bacteria invade the epithelium are transported by M cells Invasion of and multiplication within intestinal epithelial cells Death of cells ,intense inflamation and ulcerations of intestinal lining Bloody and mucus diarrhea