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P
a
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sa
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a
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s,
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m
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ip
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d
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ro
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In
Ja
k
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wh
e
re
d
e
m
a
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d
fo
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e
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g
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b
a
se
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e
d
a
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o
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th
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se
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ra
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ters
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re
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k
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g
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y
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to
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ti
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m
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q
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a
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d
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ld
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g
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s.
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h
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c
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d
t
h
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o
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s:
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u
m
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u
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s,
fa
c
il
it
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a
n
d
e
q
u
ip
m
e
n
t
,
a
n
d
p
r
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to
c
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n
tern
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li
a
b
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sin
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C
ro
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a
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tary
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s.
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lo
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wo
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k
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y
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m
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o
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%
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r
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to
o
h
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h
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h
u
m
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ters
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ly
(m
e
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ian
4
/5
),
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u
t
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c
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a
sic
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it
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d
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a
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ircu
lat
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,
a
n
d
tem
p
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tu
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wa
s
li
m
it
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.
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ro
to
c
o
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c
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s
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e
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ra
ll
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ig
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(
m
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ian
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-
5
/
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),
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h
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h
a
sm
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ll
m
in
o
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o
f
in
stit
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ti
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k
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t
re
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rt
in
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p
a
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s,
p
a
ti
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n
t
ris
k
a
ss
e
ss
m
e
n
t,
a
n
d
p
o
st
-
su
r
g
ica
l
re
c
o
v
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ry
r
o
o
m
s.
I
m
p
ro
v
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n
g
p
a
ti
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n
t
sa
fe
ty
i
n
Ja
k
a
rta
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q
u
ires
e
n
su
rin
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ss
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n
ti
a
l
m
o
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it
o
r
in
g
e
q
u
i
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m
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t,
o
p
ti
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izi
n
g
sta
ffi
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o
m
a
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a
g
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rk
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d
,
a
n
d
m
a
n
d
a
ti
n
g
fu
l
l
p
e
ri
o
p
e
ra
ti
v
e
sa
fe
ty
p
ro
to
c
o
ls ac
ro
ss
fa
c
il
it
ies
.
K
ey
w
o
r
d
s
:
An
ae
s
th
esia
Hea
lth
ca
r
e
q
u
ality
im
p
r
o
v
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e
n
t
Patien
t saf
ety
Su
r
v
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s
W
o
r
k
lo
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T
h
is i
s
a
n
o
p
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n
a
c
c
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ss
a
rticle
u
n
d
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r th
e
CC B
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SA
li
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se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
An
d
i A
d
e
W
ijay
a
R
am
lan
Dep
ar
tm
en
t o
f
An
esth
esio
lo
g
y
an
d
I
n
ten
s
iv
e
C
ar
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C
ip
to
Ma
n
g
u
n
k
u
s
u
m
o
Ho
s
p
ital
St
.
Pan
g
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an
Dip
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7
1
,
C
en
tr
al
J
ak
ar
ta,
I
n
d
o
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esia
E
m
ail:
an
d
i.a
d
e@
u
i.a
c.
id
1.
I
NT
RO
D
UCT
I
O
N
Patien
t
s
af
ety
,
th
e
p
r
ev
en
tio
n
o
f
ad
v
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r
s
e
ev
en
ts
ar
is
in
g
f
r
o
m
h
ea
lth
ca
r
e
p
r
o
ce
s
s
es
[
1
]
,
is
a
g
r
o
win
g
co
n
ce
r
n
in
J
ak
a
r
ta,
wh
er
e
th
e
d
em
an
d
f
o
r
an
esth
etic
ca
r
e
in
b
o
th
s
u
r
g
ical
an
d
o
u
t
-
of
-
o
p
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a
tin
g
-
r
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o
m
s
ettin
g
s
co
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tin
u
es
to
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is
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W
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s
p
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if
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ata
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an
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lo
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s
ca
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ce
,
p
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p
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m
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p
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b
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p
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to
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wo
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k
,
a
n
d
in
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f
f
ec
tiv
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co
m
m
u
n
icatio
n
[
2
]
-
[
4
]
.
T
h
ese
s
y
s
tem
ic
is
s
u
es
m
ay
also
af
f
ec
t
an
esth
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v
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ass
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en
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s
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am
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s
h
as
b
e
en
co
n
d
u
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in
th
is
s
ettin
g
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2252
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8
8
0
6
I
n
flu
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fa
cto
r
s
o
f p
a
tien
t s
a
fety
in
a
n
esth
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ervices in
a
…
(
A
ld
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Heriw
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d
ito
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1827
Glo
b
ally
,
th
e
W
o
r
ld
Hea
lth
Or
g
an
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n
(
W
HO)
esti
m
ates
th
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m
o
r
tality
r
is
k
f
r
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m
p
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ev
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tab
le
m
ed
ical
ac
cid
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at
1
in
3
0
0
,
with
lo
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m
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ies
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L
MI
C
s
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ac
co
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f
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1
3
4
m
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2
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6
m
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ch
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[
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Sp
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ld
wid
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[
5
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,
[
6
]
.
Fu
r
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,
a
d
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b
etwe
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ig
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An
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ates
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n
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s
[
7
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,
wh
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[
8
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[
9
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I
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7
6
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1
0
0
,
0
0
0
p
o
p
u
latio
n
,
w
ell
b
elo
w
th
e
r
e
co
m
m
e
n
d
ed
f
o
u
r
p
er
1
0
0
,
0
0
0
[
5
]
,
[
6
]
,
[
1
0
]
.
B
ey
o
n
d
wo
r
k
f
o
r
ce
s
ca
r
city
,
s
tu
d
ies
h
ig
h
lig
h
t
o
th
er
r
is
k
s
to
p
atien
t
s
af
ety
,
in
clu
d
in
g
in
ef
f
ec
tiv
e
co
m
m
u
n
icatio
n
an
d
p
o
o
r
s
af
et
y
s
tan
d
ar
d
s
[
1
1
]
.
An
esth
esia
s
er
v
ices
co
m
p
r
is
e
m
u
ltip
le
s
tag
es,
i.e
.
,
p
r
e
-
a
n
esth
esia
p
r
ep
ar
atio
n
,
in
d
u
ctio
n
a
n
d
air
way
m
an
ag
em
en
t,
m
ain
ten
a
n
ce
,
a
n
d
p
o
s
t
-
s
u
r
g
ical
ca
r
e,
ea
ch
o
f
wh
ich
ca
r
r
ies
d
is
tin
ct
s
af
ety
r
is
k
s
.
I
n
ter
n
atio
n
al
an
e
s
th
esia
g
u
id
elin
es
[
1
2
]
,
[
1
3
]
em
p
h
asize
p
atien
t
s
af
ety
m
ea
s
u
r
es
at
ev
er
y
s
tag
e.
T
h
ese
g
u
id
elin
es
u
n
d
er
lin
e
th
e
im
p
o
r
tan
ce
o
f
h
u
m
an
r
eso
u
r
ce
in
p
atien
t saf
ety
,
en
co
m
p
ass
in
g
p
h
y
s
ician
wo
r
k
lo
ad
,
cl
ea
r
jo
b
d
escr
ip
tio
n
s
,
an
d
an
esth
esio
lo
g
is
ts
'
s
k
ills
.
F
u
r
th
er
m
o
r
e,
e
q
u
ip
m
e
n
t
r
eq
u
ir
e
m
en
ts
,
esp
ec
ially
th
o
s
e
f
o
r
p
atien
t
m
o
n
ito
r
in
g
,
ar
e
also
o
u
tlin
ed
[
1
2
]
,
[
1
3
]
.
L
astl
y
,
p
r
o
to
co
ls
an
d
s
tan
d
ar
d
o
p
er
at
io
n
al
p
r
o
ce
d
u
r
e
(
SOP)
g
u
id
eli
n
es,
s
u
ch
as
p
r
o
p
e
r
p
atien
t id
en
tific
atio
n
,
i
n
f
o
r
m
e
d
co
n
s
en
t,
a
n
d
th
e
u
s
e
o
f
m
e
d
i
ca
l r
ec
o
r
d
s
,
ar
e
r
eq
u
i
r
ed
in
e
v
er
y
h
o
s
p
ital [
1
2
]
.
Desp
ite
th
ese
r
ec
o
m
m
en
d
atio
n
s
,
s
tu
d
ies
ev
alu
atin
g
p
atien
t
s
af
ety
in
an
esth
esia
r
em
a
in
lim
ited
.
Av
ailab
le
d
ata
ar
e
lar
g
ely
d
r
a
wn
f
r
o
m
r
eg
io
n
al
s
tu
d
ies
in
o
t
h
er
L
MI
C
s
,
with
v
ar
iab
le
f
in
d
in
g
s
.
C
h
ar
u
lu
x
a
n
an
a
n
et
a
l.
[
1
4
]
in
T
h
ailan
d
f
o
u
n
d
th
at
is
s
u
es
r
elate
d
to
p
a
tien
t
s
af
ety
in
clu
d
e
th
e
in
a
d
eq
u
ate
n
u
m
b
e
r
o
f
an
esth
esio
lo
g
is
ts
,
lack
o
f
s
u
p
er
v
is
io
n
d
u
r
in
g
p
r
o
ce
d
u
r
es,
in
ef
f
ec
tiv
e
co
m
m
u
n
icatio
n
,
an
d
l
ac
k
o
f
ad
h
e
r
en
ce
to
p
r
o
to
co
ls
.
Sin
h
a
et
a
l.
[
1
5
]
in
I
n
d
ia
r
ev
ea
led
th
at
th
e
r
e
is
s
till
a
lack
o
f
m
o
n
ito
r
in
g
eq
u
ip
m
en
t
av
ailab
ilit
y
,
em
er
g
en
cy
eq
u
i
p
m
en
t,
a
n
d
i
n
cid
en
t
-
r
ep
o
r
tin
g
p
r
o
t
o
co
ls
.
Da
ta
r
eg
ar
d
i
n
g
th
e
q
u
ality
o
f
a
n
e
s
th
esia
s
er
v
ices
an
d
p
atien
t
s
af
ety
in
I
n
d
o
n
esia
a
r
e
s
ca
r
ce
.
On
e
s
tu
d
y
b
y
R
am
lan
et
a
l.
r
ev
ea
le
d
th
e
lim
ited
u
tili
za
tio
n
o
f
ca
p
n
o
g
r
ap
h
y
f
o
r
in
tr
a
o
p
er
ativ
e
m
o
n
ito
r
in
g
in
I
n
d
o
n
esia,
b
u
t
o
th
er
f
ac
to
r
s
in
f
lu
e
n
cin
g
p
ati
en
t
s
af
ety
wer
e
n
o
t
ad
d
r
ess
ed
[
1
6
]
.
T
h
e
I
n
d
o
n
esian
So
ciety
o
f
An
ae
s
th
esio
lo
g
y
an
d
I
n
ten
s
iv
e
C
ar
e
in
J
ak
ar
ta
(
PERDATI
N
J
AYA)
h
as
in
itiated
p
r
o
g
r
am
s
to
im
p
r
o
v
e
awa
r
en
ess
o
f
p
atien
t
s
af
ety
a
m
o
n
g
its
m
em
b
e
r
s
.
Yet,
th
e
s
tatu
s
o
f
an
esth
esia
s
er
v
ice
s
af
ety
in
J
ak
a
r
ta
r
em
ain
s
u
n
k
n
o
wn
.
T
h
is
s
tu
d
y
ad
d
r
ess
es
th
is
k
n
o
wled
g
e
g
ap
b
y
ass
ess
in
g
h
u
m
an
r
eso
u
r
ce
s
,
eq
u
ip
m
en
t
av
ailab
i
lity
,
an
d
p
r
o
to
co
l
a
d
h
er
en
ce
,
to
in
f
o
r
m
tar
g
eted
s
tr
ateg
ies
to
en
h
an
ce
p
atien
t
s
af
ety
in
I
n
d
o
n
esia’
s
ca
p
ital.
2.
M
E
T
H
O
D
2
.
1
.
Q
u
e
s
t
i
o
n
n
a
i
re
d
e
v
e
l
o
p
me
n
t
Qu
esti
o
n
s
d
esig
n
ed
to
ev
alu
ate
th
e
p
ar
am
eter
s
o
f
s
er
v
ice
q
u
ality
an
d
p
atien
t
s
af
ety
in
an
es
th
esia
wer
e
d
ev
elo
p
e
d
th
r
o
u
g
h
a
f
o
cu
s
g
r
o
u
p
d
is
cu
s
s
io
n
[
1
7
]
with
a
p
a
n
el
o
f
an
esth
esio
lo
g
is
ts
wh
o
h
ad
p
r
ac
ticed
f
o
r
at
least
ten
y
ea
r
s
.
T
h
is
ex
p
er
t
p
an
el
r
ev
iew
also
s
er
v
ed
to
estab
lis
h
f
ac
e
v
alid
ity
[
1
8
]
,
en
s
u
r
in
g
th
at
th
e
q
u
esti
o
n
n
air
e
item
s
wer
e
co
m
p
r
eh
en
s
iv
e
in
ad
d
r
ess
in
g
th
e
in
ten
d
ed
d
o
m
ain
s
.
T
h
e
q
u
esti
o
n
n
air
e
was
d
ev
elo
p
e
d
in
I
n
d
o
n
esian
.
T
h
e
f
ir
s
t
d
r
af
t
o
f
q
u
esti
o
n
s
was
th
en
d
is
tr
ib
u
ted
to
ten
in
itial
r
esp
o
n
d
en
ts
.
Feed
b
ac
k
r
eg
a
r
d
in
g
q
u
esti
o
n
clar
ity
,
len
g
th
,
a
n
d
o
t
h
er
co
m
m
e
n
ts
was c
o
llected
,
an
d
r
ev
is
io
n
s
wer
e
m
a
d
e
ac
co
r
d
in
g
ly
.
T
h
e
f
in
al
d
r
af
t
o
f
t
h
e
q
u
e
s
ti
o
n
n
air
e
c
o
m
p
r
is
es
5
0
q
u
esti
o
n
s
.
T
h
e
f
ir
s
t
q
u
esti
o
n
en
q
u
ir
es
ab
o
u
t
p
ar
ticip
an
ts
'
ag
r
ee
m
en
t
to
p
ar
ticip
ate
in
th
e
s
tu
d
y
,
an
d
th
e
r
est
o
f
th
e
s
u
r
v
ey
is
d
iv
id
ed
in
to
th
r
ee
m
ain
p
ar
ts
:
1
3
q
u
esti
o
n
s
ab
o
u
t
h
u
m
a
n
r
e
s
o
u
r
ce
s
,
2
5
q
u
esti
o
n
s
ab
o
u
t
a
v
ailab
le
eq
u
ip
m
e
n
t
(
1
8
q
u
esti
o
n
s
f
o
r
m
o
n
ito
r
in
g
eq
u
ip
m
en
t
an
d
7
q
u
esti
o
n
s
f
o
r
o
p
er
atin
g
r
o
o
m
e
q
u
ip
m
e
n
t)
,
a
n
d
1
1
q
u
esti
o
n
s
ab
o
u
t
av
ailab
le
h
o
s
p
ital
p
r
o
t
o
co
ls
.
Par
ticip
an
ts
ar
e
also
allo
wed
to
ad
d
c
o
m
m
en
ts
o
r
n
o
tes th
at
t
h
ey
d
ee
m
r
elev
an
t to
th
eir
an
s
wer
s
.
2
.
2
.
Study
des
ig
n,
s
a
m
pli
ng
,
a
nd
bia
s
co
ntr
o
l
T
h
is
s
tu
d
y
is
a
cr
o
s
s
-
s
ec
tio
n
al
s
tu
d
y
aim
in
g
to
e
v
alu
ate
th
e
p
ar
am
eter
s
o
f
an
esth
esia
-
r
elate
d
s
er
v
ice
q
u
ality
an
d
p
atien
t
s
af
ety
i
n
J
ak
ar
ta.
T
h
e
s
tu
d
y
in
cl
u
d
es
all
an
esth
esio
lo
g
is
ts
ac
tiv
ely
p
r
ac
ticin
g
in
th
e
ca
p
ital
city
d
u
r
i
n
g
2
0
2
3
.
T
h
e
lis
t
o
f
an
esth
esio
lo
g
is
ts
was
o
b
tain
ed
f
r
o
m
th
e
d
atab
ase
o
f
th
e
I
n
d
o
n
esian
So
ciety
o
f
An
ae
s
th
esio
lo
g
y
an
d
I
n
ten
s
iv
e
C
ar
e
in
J
ak
ar
ta
(
PERDATI
N
J
AYA)
.
An
esth
esio
lo
g
is
ts
wh
o
d
ec
lin
ed
t
o
f
ill
o
u
t
th
e
s
u
r
v
e
y
an
d
t
h
o
s
e
wh
o
f
aile
d
to
co
m
p
lete
th
e
s
u
r
v
ey
wer
e
ex
clu
d
e
d
f
r
o
m
th
e
s
tu
d
y
.
Sev
er
al
m
ea
s
u
r
es
wer
e
im
p
lem
en
ted
to
m
in
im
ize
b
ias
in
th
is
s
u
r
v
ey
-
b
ased
s
tu
d
y
.
T
o
p
r
ev
en
t
s
elec
tio
n
b
ias,
[
1
9
]
th
e
s
u
r
v
ey
lin
k
was
d
is
tr
ib
u
ted
to
all
a
n
esth
esio
lo
g
is
ts
lis
ted
in
th
e
af
o
r
em
e
n
tio
n
ed
d
atab
ase.
Fu
r
th
e
r
,
t
h
e
s
u
r
v
ey
allo
wed
an
o
n
y
m
o
u
s
r
esp
o
n
s
es to
m
in
i
m
ize
s
o
cial
d
esira
b
ilit
y
b
ias [
2
0
]
.
2
.
3
.
Su
rv
ey
dis
t
ributio
n
T
h
e
s
u
r
v
ey
was
d
ev
elo
p
ed
u
s
in
g
th
e
web
-
b
ased
s
o
f
twar
e
p
la
tf
o
r
m
R
esear
ch
E
lectr
o
n
ic
Dat
a
C
ap
tu
r
e
(
R
E
DC
ap
;
ac
ce
s
s
ed
f
r
o
m
r
ed
ca
p
.
f
k
.
u
i.a
c.
id
)
h
o
s
ted
at
th
e
Facu
lty
o
f
Me
d
icin
e,
Un
iv
er
s
itas
I
n
d
o
n
esia
[
2
1
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
8
26
-
1
8
36
1828
An
elec
tr
o
n
ic
lin
k
co
n
tain
in
g
th
e
s
u
r
v
ey
was
th
en
d
is
tr
ib
u
te
d
to
an
esth
esio
lo
g
is
ts
v
ia
W
h
atsAp
p
(
W
h
atsAp
p
I
n
c.
;
Me
n
l
o
Par
k
,
C
alif
o
r
n
ia,
Un
ited
States
)
,
a
c
o
m
m
o
n
ly
u
s
ed
co
m
m
u
n
icatio
n
p
latf
o
r
m
[
2
2
]
,
t
o
m
a
x
im
ize
r
ea
ch
an
d
p
ar
ticip
atio
n
o
n
J
an
u
ar
y
1
3
th
,
2
0
2
4
,
with
a
r
em
i
n
d
er
s
en
t
o
n
J
an
u
ar
y
1
5
th
,
2
0
2
4
.
No
f
in
a
n
cial
o
r
m
ater
ial
in
ce
n
tiv
es we
r
e
p
r
o
v
i
d
ed
.
2
.
4
.
St
a
t
is
t
ica
l a
na
ly
s
is
T
h
e
r
esp
o
n
s
es
o
b
tain
e
d
wer
e
d
ir
ec
tly
ex
p
o
r
ted
f
r
o
m
R
E
D
C
ap
as
a
Mic
r
o
s
o
f
t
E
x
ce
l
f
il
e.
Gr
o
s
s
ly
in
co
m
p
lete
r
esp
o
n
s
es
wer
e
ex
clu
d
ed
.
Statis
tical
an
aly
s
is
is
p
er
f
o
r
m
ed
u
s
in
g
th
e
s
o
f
twar
e
Statis
t
ical
Pack
ag
e
f
o
r
So
cial
Scien
tis
t
(
SP
SS
)
.
No
m
in
al
v
ar
ia
b
les
ar
e
p
r
esen
ted
as
p
r
o
p
o
r
tio
n
s
,
o
r
d
in
al
d
a
ta
as
m
ed
ian
s
,
a
nd
n
u
m
er
ical
d
ata
as
m
ea
n
s
alo
n
g
with
th
eir
s
tan
d
ar
d
d
ev
iatio
n
s
.
Descr
ip
tiv
e
s
tat
is
tic
s
wer
e
ch
o
s
en
g
iv
en
th
e
s
tu
d
y
’
s
ex
p
lo
r
at
o
r
y
d
esig
n
.
I
n
ter
n
al
r
eliab
ilit
y
o
f
th
e
q
u
esti
o
n
n
air
e
item
s
was
ass
ess
ed
s
ep
ar
ately
f
o
r
two
d
o
m
ai
n
s
:
h
u
m
an
r
eso
u
r
ce
-
r
elate
d
a
n
d
p
r
o
to
co
l
-
r
elate
d
p
atien
t
s
af
ety
p
ar
am
et
er
s
.
Fo
r
ea
ch
d
o
m
ai
n
,
C
r
o
n
b
a
ch
’
s
alp
h
a
[
2
3
]
was
ca
lcu
lated
to
d
eter
m
in
e
t
h
e
d
e
g
r
ee
o
f
in
ter
n
al
co
n
s
is
ten
cy
am
o
n
g
item
s
.
C
r
o
n
b
ac
h
’
s
alp
h
a
v
alu
es
≥
0
.
7
0
wer
e
co
n
s
id
er
ed
ac
ce
p
tab
le,
v
al
u
e
s
b
etwe
en
0
.
6
0
–
0
.
6
9
wer
e
co
n
s
id
er
ed
b
o
r
d
er
lin
e,
a
n
d
v
alu
es
<0
.
6
0
wer
e
in
ter
p
r
eted
as
in
d
icatin
g
l
o
w
i
n
ter
n
al
c
o
n
s
is
ten
cy
.
T
h
e
“Cro
n
b
ac
h
’
s
al
p
h
a
if
item
d
elete
d
”
s
tatis
tic
was
also
r
ev
iewe
d
to
ass
ess
wh
eth
er
th
e
r
em
o
v
al
o
f
an
y
item
wo
u
l
d
i
m
p
r
o
v
e
th
e
o
v
er
all
r
eliab
ilit
y
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
S
S
I
O
N
3
.
1
.
B
a
s
eline
cha
ra
ct
er
is
t
ics
T
h
e
s
u
r
v
e
y
was
d
is
tr
ib
u
ted
t
o
4
2
2
a
n
esth
esio
lo
g
is
ts
,
an
d
1
5
9
r
esp
o
n
s
es
(
3
9
.
7
5
%)
wer
e
o
b
tain
e
d
.
Fo
r
ty
-
f
o
u
r
r
esp
o
n
s
es
(
2
7
.
6
7
%
)
wer
e
ex
clu
d
ed
d
u
e
to
g
r
o
s
s
ly
in
co
m
p
lete
d
ata
,
a
n
d
a
to
tal
o
f
1
1
5
r
esp
o
n
s
es
(
7
2
.
3
3
%)
wer
e
an
aly
s
ed
as
s
h
o
wn
in
T
ab
le
1
.
Ov
er
all,
6
5
.
2
%
o
f
r
esp
o
n
d
e
n
ts
ar
e
m
ale
an
d
3
4
.
8
%
ar
e
f
em
ale.
T
h
e
r
esp
o
n
d
en
ts
'
av
er
ag
e
ag
e
i
s
4
8
.
4
2
±
1
0
.
9
3
y
ea
r
s
o
ld
.
Pro
f
ess
io
n
al
ex
p
er
ien
ce
as
an
an
es
th
esio
lo
g
is
t
v
ar
ies,
with
1
7
.
4
%
h
a
v
in
g
wo
r
k
e
d
f
o
r
1
to
5
y
ea
r
s
,
3
0
.
4
%
f
o
r
6
to
1
0
y
ea
r
s
,
2
0
.
9
%
f
o
r
1
1
to
1
5
y
ea
r
s
,
9
.
6
%
f
o
r
1
6
to
2
0
y
ea
r
s
,
a
n
d
2
1
.
7
% f
o
r
m
o
r
e
th
an
2
0
y
ea
r
s
.
T
ab
le
1
.
So
cio
d
em
o
g
r
ap
h
ic
a
n
d
p
r
o
f
ess
io
n
al
h
is
to
r
y
o
f
r
esp
o
n
d
en
ts
Q
u
e
st
i
o
n
n
a
i
r
e
i
t
e
m
R
e
s
u
l
t
S
o
c
i
o
d
e
m
o
g
r
a
p
h
i
c
d
a
t
a
A
g
e
,
m
e
a
n
±
S
D
,
y
e
a
r
s
4
8
.
4
2
±
1
0
.
9
3
M
a
l
e
,
n
(
%)
7
5
(
6
5
.
2
)
Ex
p
e
r
i
e
n
c
e
a
s
a
n
a
n
e
s
t
h
e
si
o
l
o
g
i
s
t
,
n
(
%)
1
t
o
5
y
e
a
r
s
2
0
(
1
7
.
4
)
6
t
o
1
0
y
e
a
r
s
3
5
(
3
0
.
4
)
1
1
t
o
1
5
y
e
a
r
s
2
4
(
2
0
.
9
)
1
6
t
o
2
0
y
e
a
r
s
1
1
(
9
.
6
)
>
2
0
y
e
a
r
s
2
5
(
2
1
.
7
)
3
.
2
.
H
u
m
a
n r
eso
urce
s
Fig
u
r
e
1
(
a
)
r
e
v
ea
ls
th
e
d
u
r
ati
o
n
o
f
ac
tiv
e
wo
r
k
f
o
r
an
esth
e
s
io
lo
g
is
ts
ev
er
y
wee
k
.
Mo
s
t
(
4
7
.
8
%)
o
f
r
esp
o
n
d
en
t
’
s
r
ep
o
r
t
wo
r
k
in
g
2
0
-
4
0
h
o
u
r
s
p
er
wee
k
,
f
o
llo
wed
b
y
th
o
s
e
wo
r
k
in
g
4
0
-
6
0
h
o
u
r
s
p
er
wee
k
at
3
7
.
4
%
.
A
m
in
o
r
ity
o
f
a
n
esth
esio
lo
g
is
ts
(
7
.
8
%)
wo
r
k
f
o
r
less
th
an
2
0
h
o
u
r
s
p
er
wee
k
,
an
d
,
s
im
ilar
l
y
,
o
n
th
e
o
th
er
e
n
d
o
f
th
e
s
p
ec
tr
u
m
,
7
.
0
%
wo
r
k
f
o
r
m
o
r
e
th
an
6
0
h
o
u
r
s
p
er
wee
k
.
Fig
u
r
e
1
(
b
)
illu
s
tr
ates
th
e
d
u
r
atio
n
o
f
wee
k
ly
s
tan
d
b
y
wo
r
k
,
with
m
o
s
t
an
e
s
th
esio
lo
g
is
ts
(
4
1
.
7
%)
wo
r
k
in
g
f
o
r
2
0
-
4
0
h
o
u
r
s
p
er
wee
k
,
f
o
llo
wed
b
y
th
o
s
e
wo
r
k
in
g
f
o
r
less
th
an
2
0
h
o
u
r
s
/wee
k
,
4
0
-
6
0
h
o
u
r
s
/wee
k
,
an
d
m
o
r
e
th
a
n
6
0
h
o
u
r
s
/wee
k
at
3
1
.
3
%,
2
0
.
9
%,
a
n
d
6
.
1
%,
r
esp
ec
tiv
ely
.
T
ab
le
2
s
u
m
m
a
r
izes
r
esp
o
n
d
en
ts
’
o
p
in
i
o
n
s
r
eg
a
r
d
in
g
h
u
m
an
r
eso
u
r
ce
-
r
elate
d
p
atie
n
t
s
af
ety
p
ar
am
eter
s
.
Mo
s
t
r
esp
o
n
d
en
ts
ten
d
e
d
to
ag
r
ee
th
at
th
e
n
u
m
b
er
o
f
a
n
esth
esio
lo
g
is
ts
av
ailab
le
in
th
eir
h
o
s
p
ital
was
ad
eq
u
ate,
with
a
m
ed
ian
s
co
r
e
o
f
4
o
n
a
5
-
p
o
in
t
s
ca
le
(
I
QR
3
-
5
)
.
Similar
ly
,
r
esp
o
n
d
en
ts
g
en
er
ally
ag
r
ee
d
th
at
jo
b
d
iv
is
io
n
b
etwe
en
h
ea
l
th
ca
r
e
p
r
o
f
ess
io
n
als
was
clea
r
(
m
ed
ian
4
,
I
QR
3
-
4
)
,
ad
e
q
u
a
te
s
u
p
er
v
is
io
n
was
p
r
o
v
id
e
d
d
u
r
i
n
g
an
esth
esia
p
r
o
ce
d
u
r
es
(
m
ed
ian
4
,
I
QR
3
-
5
)
,
an
esth
esia
-
r
elate
d
k
n
o
wled
g
e
was
co
n
tin
u
o
u
s
ly
u
p
d
ated
in
ac
co
r
d
an
ce
with
ev
id
en
ce
-
b
ased
m
e
d
icin
e
(
m
e
d
ian
4
,
I
QR
4
-
5
)
,
an
d
ef
f
ec
ti
v
e
co
m
m
u
n
icatio
n
o
cc
u
r
r
e
d
b
etwe
en
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
d
u
r
i
n
g
a
n
esth
esia
p
r
o
ce
d
u
r
es
(
m
e
d
ian
4
,
I
Q
R
4
-
5
)
.
I
n
c
o
n
tr
ast,
p
er
ce
p
tio
n
s
o
f
wo
r
k
l
o
ad
wer
e
less
f
av
o
r
ab
le,
with
a
m
e
d
ian
s
co
r
e
o
f
3
(
I
QR
2
–
3
)
,
an
d
2
2
.
7
%
o
f
r
esp
o
n
d
en
ts
s
tr
o
n
g
ly
ag
r
ee
d
th
at
wo
r
k
lo
a
d
was to
o
h
ig
h
.
I
n
ter
n
al
c
o
n
s
is
ten
cy
o
f
th
e
s
ix
-
item
wo
r
k
s
atis
f
ac
tio
n
q
u
esti
o
n
n
air
e
was
ass
ess
ed
u
s
in
g
C
r
o
n
b
ac
h
’
s
alp
h
a.
T
h
e
in
itial
an
aly
s
is
y
ield
ed
a
C
r
o
n
b
ac
h
’
s
alp
h
a
o
f
0
.
5
3
5
,
in
d
icatin
g
lo
w
i
n
ter
n
al
co
n
s
is
ten
cy
.
Evaluation Warning : The document was created with Spire.PDF for Python.
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lth
Sci
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ervices in
a
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ld
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1829
E
x
am
in
atio
n
o
f
th
e
co
r
r
e
cted
item
–
to
tal
co
r
r
elatio
n
s
r
ev
ea
le
d
th
at
f
iv
e
item
s
h
ad
p
o
s
itiv
e
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r
r
elatio
n
s
r
an
g
i
n
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m
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5
1
6
,
w
h
ile
th
e
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r
k
lo
a
d
item
(
“An
esth
esio
lo
g
is
ts
’
wo
r
k
lo
ad
is
to
o
h
i
g
h
”)
h
ad
a
n
eg
ativ
e
co
r
r
ec
ted
item
–
to
tal
co
r
r
elati
o
n
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–
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.
1
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)
.
T
h
e
“Cro
n
b
ac
h
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s
alp
h
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elete
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al
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is
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icate
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at
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em
o
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al
o
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th
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u
ld
i
n
cr
ea
s
e
th
e
o
v
er
all
C
r
o
n
b
ac
h
’
s
alp
h
a
to
0
.
6
6
8
.
Fig
u
r
e
1
.
W
o
r
k
d
u
r
atio
n
f
o
r
a
n
esth
esio
lo
g
is
ts
o
n
a
wee
k
ly
b
asis
:
(
a)
ac
tiv
e
wo
r
k
d
u
r
atio
n
,
in
clu
d
in
g
o
p
er
atin
g
r
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o
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p
r
o
ce
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u
r
es,
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C
U
v
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o
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tp
atien
t c
lin
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d
(
b
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tan
d
b
y
wo
r
k
d
u
r
atio
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,
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clu
d
i
n
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ll
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r
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at
d
o
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o
t n
ec
ess
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e
r
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o
n
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en
t to
b
e
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r
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t a
t th
e
h
o
s
p
ital
T
ab
le
2
.
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in
i
o
n
o
f
r
esp
o
n
d
en
ts
r
eg
ar
d
in
g
h
u
m
a
n
r
eso
u
r
ce
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r
elate
d
p
atien
t saf
ety
p
ar
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m
eter
s
Q
u
e
st
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o
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n
a
i
r
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o
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3
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F
a
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ipm
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As
s
h
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wn
in
T
ab
le
3
,
alm
o
s
t
all
r
esp
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d
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ts
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≥
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r
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ted
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Ab
b
r
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s
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MA
C
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VP
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p
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lar
y
n
g
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l m
ask
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SG: u
ltra
s
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n
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r
ap
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ab
le
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Av
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l
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I
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8
8
0
6
I
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fa
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T
h
is
s
tu
d
y
f
o
u
n
d
t
h
at
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n
u
m
b
er
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a
n
esth
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ies
b
etwe
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s
titu
tio
n
s
,
with
m
o
s
t
h
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s
p
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h
av
in
g
2
to
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an
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s
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R
esp
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d
to
ag
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u
m
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a
lack
o
f
a
n
esth
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p
er
s
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n
el
[
1
4
]
.
Acc
o
r
d
in
g
to
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p
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s
s
tu
d
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ly
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as
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[
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.
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[
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6
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m
p
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n
d
d
e
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n
[
2
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]
.
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im
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D
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4
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m
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[
2
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]
.
T
h
is
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n
d
i
ca
t
es
th
a
t
alt
h
o
u
g
h
J
ak
ar
ta
a
n
est
h
es
i
o
l
o
g
is
ts
m
a
y
n
o
t
f
ac
e
e
x
t
r
e
m
e
wo
r
k
lo
a
d
s
o
n
a
v
e
r
a
g
e,
h
ig
h
-
r
is
k
s
u
b
g
r
o
u
p
s
r
em
ai
n
v
u
l
n
e
r
a
b
le
.
Po
lic
y
e
f
f
o
r
ts
s
h
o
u
ld
c
o
n
s
i
d
e
r
n
o
t
o
n
l
y
s
ta
f
f
i
n
g
r
a
tio
s
b
u
t
als
o
w
o
r
k
l
o
a
d
r
e
g
u
l
ati
o
n
.
Mo
r
eo
v
er
,
r
esp
o
n
d
en
ts
r
ep
o
r
ted
clea
r
jo
b
d
iv
is
io
n
s
,
ad
eq
u
ate
s
u
p
e
r
v
is
io
n
,
an
d
ef
f
ec
tiv
e
co
m
m
u
n
icatio
n
b
etwe
en
p
er
s
o
n
n
el.
T
h
ey
also
r
ep
o
r
t
co
n
tin
u
o
u
s
ly
u
p
d
atin
g
th
eir
k
n
o
wled
g
e,
r
ef
lectin
g
th
e
s
u
cc
ess
o
f
co
n
tin
u
i
n
g
m
e
d
ical
ed
u
ca
tio
n
(
C
ME
)
p
r
o
g
r
a
m
m
e
s
in
I
n
d
o
n
esia
[
2
8
]
,
i
n
clu
d
in
g
th
o
s
e
o
r
g
a
n
ized
b
y
PERDATI
N
J
AY
A.
Ov
er
all,
th
ese
f
in
d
in
g
s
i
n
d
icate
a
m
o
r
e
p
o
s
itiv
e
o
u
tlo
o
k
,
as
p
r
e
v
io
u
s
s
tu
d
ies
s
h
o
w
th
at
th
ese
f
ac
to
r
s
im
p
r
o
v
e
th
e
q
u
al
ity
o
f
h
ea
lth
ca
r
e
an
d
p
atien
t sa
f
ety
[
2
9
]
.
E
q
u
ip
m
en
t
a
v
ailab
ilit
y
p
r
esen
ted
g
r
ea
ter
ch
allen
g
es.
W
h
ile
p
u
ls
e
o
x
im
etr
y
,
E
C
Gs,
an
d
n
o
n
-
in
v
asiv
e
b
lo
o
d
p
r
ess
u
r
e
m
o
n
ito
r
s
wer
e
n
ea
r
ly
u
n
i
v
er
s
al,
E
T
C
O
2
(
5
1
%)
an
d
tem
p
er
atu
r
e
m
o
n
ito
r
i
n
g
(
4
5
%)
r
em
ain
ed
in
co
n
s
is
ten
t.
T
h
e
Am
er
ican
So
ciety
o
f
An
esth
esio
lo
g
is
ts
(
ASA)
an
d
o
th
er
g
u
id
elin
e
s
r
ec
o
m
m
en
d
th
at
o
x
y
g
e
n
atio
n
,
v
e
n
tilatio
n
,
cir
c
u
latio
n
,
a
n
d
b
o
d
y
tem
p
er
atu
r
e
s
h
o
u
ld
alwa
y
s
b
e
r
ea
d
ily
m
o
n
ito
r
ed
[
1
3
]
,
[
2
9
]
,
[
3
0
]
.
T
h
ese
g
ap
s
r
ef
lect
u
n
d
er
i
n
v
estme
n
t
in
b
asic
m
o
n
ito
r
in
g
in
f
r
astru
ctu
r
e,
wh
ic
h
h
as
b
ee
n
lin
k
ed
to
av
o
id
ab
le
p
er
i
o
p
er
ativ
e
m
o
r
b
id
ity
an
d
m
o
r
tality
in
L
MI
C
s
.
Prio
r
i
tizin
g
u
n
i
v
er
s
al
p
r
o
v
is
io
n
o
f
ca
p
n
o
g
r
a
p
h
y
an
d
tem
p
er
atu
r
e
m
o
n
ito
r
i
n
g
s
h
o
u
ld
b
e
co
n
s
id
er
ed
a
b
aselin
e
p
atien
t saf
ety
in
ter
v
en
tio
n
in
I
n
d
o
n
esia [
3
1
]
,
[
3
2
]
.
Mo
r
e
ad
v
an
ce
d
m
o
n
ito
r
s
ar
e
s
o
m
etim
es
n
ee
d
ed
to
g
iv
e
m
o
r
e
in
f
o
r
m
atio
n
an
d
in
cr
ea
s
ed
s
af
ety
in
h
i
g
h
-
r
is
k
s
itu
atio
n
s
.
E
n
d
-
tid
al
an
est
h
etic
ag
en
t
co
n
ce
n
tr
atio
n
m
o
n
ito
r
in
g
is
s
u
g
g
ested
wh
en
v
o
latile
ag
en
ts
ar
e
u
s
ed
[
1
3
]
,
[
2
9
]
.
I
n
v
asiv
e
b
lo
o
d
p
r
ess
u
r
e
o
f
f
er
s
b
ea
t
-
to
-
b
ea
t
m
o
n
ito
r
in
g
in
u
n
s
tab
le
p
atien
ts
.
T
h
ese
m
o
n
ito
r
s
ar
e
alwa
y
s
av
ailab
le
in
o
n
ly
5
2
%
an
d
2
7
%,
r
esp
ec
tiv
ely
.
Mo
r
e
th
an
6
0
%
o
f
r
esp
o
n
d
en
ts
r
ep
o
r
ted
t
h
at
n
eu
r
o
m
u
s
cu
lar
b
lo
c
k
ad
e
a
n
d
d
ep
th
o
f
an
esth
esia
m
o
n
ito
r
s
ar
e
n
ev
e
r
av
ailab
le
to
th
em
.
C
o
r
e
tem
p
er
atu
r
e
m
o
n
ito
r
s
,
r
eq
u
ir
ed
f
o
r
ca
s
es
at
r
is
k
o
f
b
ec
o
m
in
g
h
y
p
o
th
er
m
ic
[
3
3
]
,
ar
e
o
n
ly
alwa
y
s
av
ailab
le
in
1
7
%
o
f
r
esp
o
n
s
es.
T
h
e
lack
o
f
s
u
ch
m
o
n
ito
r
s
m
ay
lim
it
an
esth
esio
lo
g
is
ts
’
ab
ilit
y
to
s
af
ely
m
an
ag
e
h
ig
h
-
r
is
k
p
atien
ts
,
co
n
tr
ib
u
tin
g
to
o
u
tco
m
e
d
is
p
ar
ities
co
m
p
ar
ed
with
h
i
g
h
-
in
c
o
m
e
co
u
n
tr
ies
[
3
4
]
.
Oth
er
th
an
m
o
n
ito
r
in
g
d
e
v
ice
s
,
ce
r
tain
eq
u
ip
m
en
t
is
also
im
p
o
r
tan
t
t
o
en
s
u
r
in
g
s
af
ety
i
n
em
er
g
e
n
t
ca
s
es
.
Air
way
d
ev
ices,
s
u
ch
a
s
v
id
eo
lar
y
n
g
o
s
co
p
y
,
h
a
v
e
b
e
en
s
h
o
wn
to
im
p
r
o
v
e
in
tu
b
atio
n
s
u
cc
ess
[
3
5
]
.
I
n
m
o
r
e
s
p
ec
if
ic
ca
s
es,
in
tu
b
atio
n
ca
n
o
n
ly
b
e
ac
h
iev
e
d
b
y
u
s
in
g
a
f
ib
er
o
p
tic
b
r
o
n
ch
o
s
co
p
e
(
FOB
)
.
I
t
is
wo
r
r
y
in
g
th
at
2
0
%
o
f
r
esp
o
n
d
en
ts
r
e
p
o
r
ted
n
o
t h
av
in
g
a
v
i
d
eo
lar
y
n
g
o
s
co
p
e
in
th
eir
p
r
ac
tice,
a
n
d
e
v
en
m
o
r
e
s
o
o
n
FOB
(
5
4
%).
Alth
o
u
g
h
th
e
in
cid
e
n
ce
is
n
o
t
h
ig
h
,
u
n
p
r
ed
icte
d
d
if
f
icu
lt
in
tu
b
atio
n
ca
n
ca
u
s
e
ca
tast
r
o
p
h
ic
co
n
s
eq
u
en
ce
s
.
E
v
e
r
y
h
o
s
p
ital
n
ee
d
s
to
h
av
e
a
s
y
s
tem
to
d
ea
l
with
th
is
s
itu
atio
n
,
an
d
th
e
av
ailab
ilit
y
o
f
alter
n
at
iv
e
air
way
d
ev
ices
is
cr
itical.
Alth
o
u
g
h
s
u
p
r
a
g
lo
t
tic
air
way
d
ev
ices
ar
e
av
ail
ab
le
in
alm
o
s
t
all
r
esp
o
n
d
en
ts
'
d
aily
p
r
ac
tice,
m
o
r
e
th
an
5
0
%
r
ep
o
r
ted
n
o
t
h
a
v
in
g
em
er
g
en
c
y
cr
ico
th
y
r
o
id
o
t
o
m
y
k
its
.
B
y
co
n
tr
ast,
d
ef
ib
r
illato
r
s
wer
e
n
ea
r
l
y
u
n
iv
er
s
al
(
9
7
.
9
%),
d
em
o
n
s
tr
atin
g
t
h
at
p
r
o
v
is
io
n
is
p
o
s
s
ib
le
wh
en
s
y
s
tem
s
p
r
io
r
itize
ce
r
tain
eq
u
ip
m
en
t.
T
h
ese
f
in
d
in
g
s
h
ig
h
lig
h
t
th
e
u
r
g
e
n
t
n
e
ed
f
o
r
n
atio
n
al
m
in
im
u
m
eq
u
ip
m
en
t
s
tan
d
a
r
d
s
,
co
u
p
led
with
i
n
s
titu
tio
n
al
m
ec
h
an
is
m
s
to
en
s
u
r
e
co
m
p
lian
ce
.
R
eg
io
n
al
an
esth
esia
s
af
ety
was
m
ix
ed
:
u
ltra
s
o
u
n
d
,
u
s
ed
in
p
er
f
o
r
m
in
g
n
er
v
e
b
lo
c
k
s
[
3
6
]
,
wa
s
av
ailab
le
in
6
7
.
7
%
o
f
h
o
s
p
itals
,
r
ef
lectin
g
p
o
s
itiv
e
ad
o
p
tio
n
tr
e
n
d
s
,
b
u
t
p
er
ip
h
er
al
n
er
v
e
s
tim
u
lato
r
s
wer
e
av
ailab
le
in
o
n
ly
less
th
an
3
0
%
o
f
r
esp
o
n
d
en
ts
.
T
h
is
d
is
cr
ep
an
cy
ca
n
b
e
ex
p
lain
ed
b
y
th
e
u
ltra
s
o
u
n
d
'
s
v
er
s
atility
:
it
ca
n
g
u
id
e
n
er
v
e
b
lo
c
k
s
,
ass
is
t
i
n
ce
n
tr
al
v
en
o
u
s
ac
ce
s
s
,
an
d
,
with
p
r
o
b
e
m
o
d
if
icatio
n
,
ev
en
s
er
v
e
as
an
ec
h
o
ca
r
d
io
g
r
am
.
E
v
id
en
ce
s
h
o
ws
th
at
u
ltra
s
o
n
o
g
r
a
p
h
y
im
p
r
o
v
es
s
u
cc
ess
r
ates
an
d
r
ed
u
ce
s
co
m
p
licatio
n
s
co
m
p
ar
ed
to
p
e
r
ip
h
er
a
l
n
e
r
v
e
s
tim
u
lato
r
s
,
wh
ich
ASR
A
n
o
w
r
ec
o
m
m
en
d
s
as
ad
ju
n
cts
r
ath
er
th
an
p
r
im
ar
y
to
o
ls
.
Similar
ly
,
lip
id
e
m
u
ls
io
n
s
wer
e
alwa
y
s
av
ailab
le
in
less
th
an
a
th
ir
d
o
f
r
esp
o
n
d
e
n
ts
[
3
6
]
,
[
3
7
]
.
W
ith
o
u
t
lip
id
em
u
ls
io
n
s
,
lo
ca
l
an
esth
etic
s
y
s
tem
ic
to
x
icity
r
em
ain
s
a
p
o
t
en
tially
f
atal
co
m
p
licatio
n
[
3
8
]
.
E
n
s
u
r
in
g
its
av
ailab
ilit
y
is
a
lo
w
-
c
o
s
t,
h
i
g
h
-
im
p
ac
t
in
ter
v
e
n
tio
n
th
at
p
r
o
f
ess
io
n
al
s
o
cieties
s
h
o
u
l
d
u
r
g
e
n
tly
a
d
v
o
ca
te.
Fu
r
th
er
,
d
ata
r
eg
ar
d
in
g
o
th
er
a
g
en
ts
,
s
u
ch
as
n
alo
x
o
n
e
an
d
f
l
u
m
az
en
il
f
o
r
o
p
io
id
a
n
d
b
en
zo
d
iaze
p
in
e
to
x
icity
,
r
esp
ec
tiv
ely
,
wer
e
n
o
t c
o
llecte
d
an
d
s
h
o
u
ld
b
e
in
clu
d
e
d
in
f
u
tu
r
e
s
tu
d
ies.
Gap
s
in
d
ia
g
n
o
s
tic
to
o
l
av
aila
b
ilit
y
wer
e
also
n
o
ted
.
E
c
h
o
c
ar
d
io
g
r
a
p
h
y
is
o
n
ly
alwa
y
s
a
v
ailab
le
in
3
6
%
o
f
r
esp
o
n
s
es.
Po
in
t
-
of
-
c
ar
e
(
POC
)
test
s
,
s
u
ch
as
in
tr
a
o
p
er
ativ
e
b
lo
o
d
g
lu
co
s
e
m
o
n
i
to
r
in
g
f
o
r
d
ia
b
etic
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
14
,
No
.
4
,
Dec
em
b
er
20
25
:
1
8
26
-
1
8
36
1832
p
atien
ts
[
1
3
]
,
a
r
e
o
n
l
y
alwa
y
s
av
ailab
le
f
o
r
5
0
%
o
f
r
esp
o
n
d
e
n
ts
.
Oth
er
POC
test
s
,
i.e
.
,
h
em
o
g
lo
b
in
,
lacta
te,
an
d
AB
G,
o
f
f
er
q
u
ick
er
r
esu
lts
th
an
tr
ad
itio
n
al
test
s
,
p
o
ten
tially
im
p
r
o
v
in
g
clin
ical
o
u
tc
o
m
e
s
,
th
o
u
g
h
r
eliab
ilit
y
r
eq
u
ir
es
f
u
r
th
e
r
r
esear
ch
[
3
9
]
-
[
4
2
]
.
Ho
wev
e
r
,
o
n
ly
a
m
in
o
r
ity
o
f
r
esp
o
n
d
e
n
ts
(
1
2
-
2
1
%)
co
n
s
is
ten
tly
h
av
e
th
ese
POC
te
s
ts
av
ailab
le.
Pro
to
co
l
ad
h
er
en
ce
was
g
e
n
er
ally
h
ig
h
,
with
p
r
e
-
a
n
esth
etic
ev
alu
atio
n
,
in
f
o
r
m
ed
co
n
s
en
t,
p
er
io
p
er
ativ
e
s
af
ety
c
h
ec
k
s
,
a
n
d
p
o
s
to
p
er
ativ
e
m
o
n
ito
r
in
g
c
o
n
s
is
ten
tly
r
ep
o
r
te
d
.
Alm
o
s
t
a
ll
an
esth
esio
lo
g
is
ts
u
p
h
o
ld
p
atien
t
au
to
n
o
m
y
.
R
esp
o
n
d
e
n
ts
r
ep
o
r
t
th
at,
i
n
m
o
s
t
ca
s
es,
p
atien
ts
k
n
o
w
th
e
ch
o
ic
e
o
f
an
esth
esia
an
d
its
alter
n
ativ
es;
ca
n
ch
o
o
s
e
t
h
e
ty
p
e
o
f
an
esth
esia;
an
d
ar
e
ed
u
ca
ted
r
eg
a
r
d
in
g
its
r
is
k
s
.
T
h
ese
alig
n
with
in
ter
n
atio
n
al
ac
cr
e
d
itatio
n
s
ta
n
d
ar
d
s
[
1
2
]
,
[
4
3
]
.
Ho
wev
er
,
th
e
lack
o
f
u
n
iv
er
s
al
ad
o
p
tio
n
in
a
m
in
o
r
ity
o
f
h
o
s
p
itals
r
em
ain
s
co
n
ce
r
n
in
g
,
as lap
s
es in
id
en
tity
ch
ec
k
s
o
r
in
f
o
r
m
e
d
co
n
s
en
t c
an
r
esu
lt in
s
er
io
u
s
h
ar
m
[
4
4
]
.
T
h
i
s
s
u
g
g
ests
th
at
wh
ile
p
o
licies ex
is
t,
en
f
o
r
ce
m
en
t a
n
d
m
o
n
ito
r
in
g
r
em
ai
n
in
co
n
s
is
ten
t.
I
n
cid
en
t
r
ep
o
r
tin
g
p
at
h
way
s
ar
e
also
av
ailab
le
in
m
o
s
t
an
esth
esio
lo
g
is
ts
'
wo
r
k
s
ettin
g
s
,
y
et
n
o
t
u
n
iv
er
s
ally
.
Su
ch
s
y
s
tem
s
ar
e
cr
itical
f
o
r
lear
n
in
g
f
r
o
m
er
r
o
r
s
an
d
p
r
ev
e
n
tin
g
r
ec
u
r
r
en
ce
,
esp
ec
ially
in
an
esth
esia
[
4
5
]
.
Fu
r
th
er
,
h
o
s
p
i
tal
ac
cr
ed
itatio
n
m
an
u
als
also
n
ec
ess
itate
it
s
ad
o
p
tio
n
in
ev
er
y
h
o
s
p
ital
[
1
2
]
.
T
h
e
ab
s
en
ce
o
f
in
cid
en
t
r
ep
o
r
tin
g
p
ath
way
s
in
s
o
m
e
in
s
titu
ti
o
n
s
s
u
g
g
ests
cu
ltu
r
al
o
r
ad
m
in
is
tr
ativ
e
b
ar
r
ier
s
,
po
s
s
ib
ly
lin
k
ed
to
p
u
n
itiv
e
ap
p
r
o
ac
h
es o
r
u
n
d
er
d
e
v
elo
p
e
d
g
o
v
er
n
a
n
ce
s
tr
u
ctu
r
es
[
4
6
]
.
T
h
e
in
ter
n
al
r
eliab
ilit
y
o
f
th
e
q
u
esti
o
n
n
air
e
v
ar
ie
d
:
th
e
p
r
o
t
o
co
l
d
o
m
ain
s
h
o
wed
s
tr
o
n
g
c
o
n
s
is
ten
cy
(
C
r
o
n
b
ac
h
’
s
α
=
0
.
8
0
7
)
,
wh
ile
th
e
h
u
m
an
r
eso
u
r
ce
d
o
m
ain
was
wea
k
er
(
α
=
0
.
5
3
5
)
.
T
h
is
lim
itatio
n
s
h
o
u
ld
b
e
co
n
s
id
er
ed
wh
en
in
ter
p
r
etin
g
th
e
f
in
d
in
g
s
,
as
it
r
e
d
u
ce
s
th
e
co
n
f
id
en
ce
with
wh
ich
co
n
clu
s
io
n
s
ab
o
u
t
h
u
m
an
r
eso
u
r
ce
a
d
eq
u
ac
y
ca
n
b
e
g
en
er
alize
d
.
Nev
er
th
eless
,
th
e
r
esu
lts
h
ig
h
lig
h
t
th
e
n
ee
d
f
o
r
m
o
r
e
p
r
ec
is
e
m
ea
s
u
r
em
en
t
to
o
l
s
in
th
is
d
o
m
ain
.
Fu
tu
r
e
s
tu
d
ies
m
ay
b
e
n
ef
it
f
r
o
m
r
ef
in
in
g
s
u
r
v
e
y
in
s
tr
u
m
en
ts
th
r
o
u
g
h
q
u
alitativ
e
in
ter
v
iews
o
r
Delp
h
i
co
n
s
en
s
u
s
m
eth
o
d
s
[
4
7
]
to
en
s
u
r
e
item
s
ca
p
tu
r
e
th
e
f
u
ll
s
p
ec
tr
u
m
o
f
h
u
m
an
r
eso
u
r
ce
is
s
u
es
in
an
esth
esio
lo
g
y
.
Ad
d
itio
n
ally
,
s
u
r
v
e
y
c
o
n
s
tr
u
cts
s
h
o
u
ld
b
e
cu
ltu
r
all
y
an
d
co
n
tex
tu
all
y
r
elev
an
t,
r
ef
lectin
g
n
o
t
o
n
ly
in
ter
n
atio
n
al
s
tan
d
ar
d
s
b
u
t
also
th
e
r
ea
liti
es
o
f
I
n
d
o
n
esia’
s
h
ea
lth
c
ar
e
s
y
s
tem
,
s
u
ch
as
th
e
u
n
ev
en
d
is
tr
ib
u
tio
n
o
f
an
esth
esio
lo
g
is
ts
ac
r
o
s
s
p
r
o
v
in
ce
s
.
B
y
ad
d
r
ess
in
g
th
ese
m
eth
o
d
o
lo
g
ical
g
ap
s
,
f
u
tu
r
e
r
esear
ch
co
u
l
d
p
r
o
d
u
ce
m
o
r
e
r
eliab
le
d
ata
th
at
b
etter
in
f
o
r
m
wo
r
k
f
o
r
ce
p
la
n
n
in
g
an
d
p
o
licy
d
ev
elo
p
m
e
n
t.
T
h
is
s
tu
d
y
h
as
co
m
p
le
ted
its
o
b
jectiv
e
o
f
o
b
tain
in
g
d
ata
r
eg
a
r
d
in
g
t
h
e
p
ar
a
m
eter
s
o
f
p
atien
t
s
af
ety
in
J
ak
ar
ta,
wh
ich
wer
e
p
r
e
v
io
u
s
ly
lack
in
g
.
Ho
wev
er
,
s
o
m
e
li
m
itatio
n
s
o
f
th
is
s
tu
d
y
in
clu
d
e
its
r
elativ
ely
lo
w
r
esp
o
n
s
e
r
ate
(
3
9
.
7
5
%)
an
d
,
c
o
n
s
eq
u
en
tly
,
its
s
m
all
s
am
p
le
s
ize.
T
h
e
lo
w
r
esp
o
n
s
e
r
ate
m
ay
b
e
attr
ib
u
ted
to
th
e
lack
o
f
f
o
llo
w
-
u
p
an
d
m
et
h
o
d
s
o
f
c
o
n
tactin
g
,
t
h
e
r
elativ
ely
lo
n
g
s
u
r
v
ey
,
a
n
d
r
esp
o
n
d
e
n
ts
'
p
er
ce
p
tio
n
o
f
th
e
s
u
r
v
ey
'
s
im
p
o
r
tan
ce
[
4
8
]
.
T
h
ese
f
ac
to
r
s
in
tr
o
d
u
ce
r
is
k
o
f
n
o
n
r
esp
o
n
s
e
b
ias
[
4
9
]
,
as
an
esth
esio
lo
g
is
ts
m
o
s
t
en
g
ag
ed
with
p
atien
t
s
af
ety
m
ay
h
av
e
b
ee
n
m
o
r
e
lik
el
y
to
p
ar
ticip
ate,
p
o
ten
tially
in
f
latin
g
p
o
s
itiv
e
f
i
n
d
in
g
s
.
Mo
r
eo
v
er
,
J
ak
ar
ta,
as
a
ca
p
it
al
city
,
h
as
o
n
e
o
f
th
e
h
ig
h
est
n
u
m
b
er
s
o
f
h
ea
lth
ca
r
e
wo
r
k
er
s
an
d
f
ac
ilit
ies
in
I
n
d
o
n
esia,
wh
ich
s
u
g
g
ests
th
at
i
t
m
ay
n
o
t
r
e
p
r
esen
t
all
I
n
d
o
n
esian
p
r
o
v
i
n
ce
s
.
Fu
r
th
er
,
th
e
s
t
u
d
y
'
s
s
u
r
v
ey
-
b
ased
d
esig
n
in
cr
ea
s
es
th
e
r
is
k
o
f
r
ec
all
b
iases
.
Fu
tu
r
e
s
tu
d
ies
ca
n
in
co
r
p
o
r
ate
a
lar
g
e
r
s
am
p
le
s
ize,
s
u
ch
as
a
n
atio
n
wid
e
s
u
r
v
ey
;
u
s
e
f
ac
e
-
to
-
f
ac
e
in
ter
v
iews
to
g
ain
m
o
r
e
ac
cu
r
ate
d
ata;
p
er
f
o
r
m
an
o
n
-
s
ite
ev
alu
atio
n
r
eg
ar
d
in
g
th
e
av
ailab
ilit
y
o
f
h
u
m
an
r
eso
u
r
ce
s
,
eq
u
ip
m
e
n
t,
a
n
d
p
r
o
to
co
ls
to
p
r
ev
e
n
t
r
ec
all
b
ias;
an
d
ca
r
r
y
o
u
t
an
an
aly
tical
s
tu
d
y
th
at
co
m
p
ar
es
p
atien
t
s
af
ety
p
ar
am
eter
s
b
etwe
en
s
u
b
g
r
o
u
p
s
,
s
u
ch
as
h
o
s
p
ital
ty
p
es
an
d
ar
ea
s
.
T
h
ese
s
tr
ateg
ies
s
h
o
u
ld
p
r
o
v
i
d
e
m
o
r
e
co
m
p
r
eh
e
n
s
iv
e
d
ata,
allo
win
g
a
clea
r
er
u
n
d
e
r
s
tan
d
in
g
r
e
g
ar
d
in
g
th
e
s
tate
o
f
p
atien
t saf
ety
an
d
h
o
w
to
im
p
r
o
v
e
it.
4.
CO
NCLU
SI
O
N
T
o
co
n
clu
d
e,
th
is
s
tu
d
y
s
h
e
d
s
lig
h
t
o
n
th
e
p
ar
am
eter
s
o
f
p
atien
t
s
af
ety
in
an
esth
esia
c
ar
e
with
in
I
n
d
o
n
esia'
s
ca
p
ital,
h
ig
h
lig
h
tin
g
s
ev
er
al
ar
ea
s
f
o
r
im
p
r
o
v
em
e
n
t.
An
esth
esio
lo
g
is
ts
r
ep
o
r
ted
wo
r
k
in
g
p
r
o
lo
n
g
ed
h
o
u
r
s
,
a
n
d
p
o
s
s
ib
le
is
s
u
es r
eg
ar
d
in
g
e
x
ce
s
s
iv
e
wo
r
k
lo
a
d
we
r
e
r
aised
.
Ho
wev
e
r
,
r
esp
o
n
d
en
ts
ten
d
to
ag
r
ee
th
at
o
th
er
asp
ec
ts
o
f
h
u
m
an
r
eso
u
r
ce
s
wer
e
ad
eq
u
ate.
Gap
s
in
e
q
u
ip
m
en
t
a
v
ailab
ilit
y
ar
e
also
r
ep
o
r
ted
,
in
clu
d
i
n
g
lim
ited
ac
ce
s
s
to
es
s
en
tial
m
o
n
ito
r
s
an
d
air
way
d
ev
ices,
wh
ic
h
m
ay
co
m
p
r
o
m
is
e
s
af
e
p
r
ac
tic
e
.
Fu
r
th
er
,
p
r
o
to
co
l
an
d
SOP ad
h
er
en
ce
w
er
e
g
en
e
r
ally
s
tr
o
n
g
,
y
et
v
ar
iab
ilit
y
am
o
n
g
in
s
titu
tio
n
s
s
u
g
g
ests
th
at
s
tan
d
ar
d
izatio
n
ca
n
s
till
b
e
im
p
r
o
v
ed
.
T
h
ese
f
in
d
in
g
s
ca
r
r
y
im
p
o
r
tan
t
im
p
licatio
n
s
f
o
r
h
ea
lth
p
o
licy
an
d
p
r
ac
tice.
E
n
s
u
r
in
g
eq
u
itab
le
d
is
tr
ib
u
tio
n
o
f
a
n
e
s
th
esio
lo
g
is
ts
,
in
v
esti
n
g
in
ess
en
tial
m
o
n
ito
r
in
g
an
d
air
w
ay
eq
u
ip
m
en
t,
an
d
ma
n
d
atin
g
m
in
im
u
m
p
atien
t
s
af
ety
s
tan
d
ar
d
s
ac
r
o
s
s
all
h
o
s
p
itals
s
h
o
u
ld
b
e
p
r
io
r
itized
.
Pr
o
f
ess
io
n
al
s
o
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[
1
]
Th
e
La
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,
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P
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[
2
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V
e
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n
y
,
E
.
K
.
A
d
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y
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a
m
a
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s’
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t
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s,
t
h
e
r
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o
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t
e
a
mw
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k
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st
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3
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4
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5
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P
.
K
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e
,
W
.
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.
M
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J.
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[
6
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T.
J
.
L
a
w
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.
,
“
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7
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I
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A
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8
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n
e
sth
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sio
l
o
g
ist
su
b
sp
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c
ializin
g
in
p
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d
iatric
a
n
e
sth
e
sia
.
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h
e
is
c
u
rre
n
tl
y
th
e
h
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a
d
o
f
th
e
De
p
a
rtme
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t
o
f
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sth
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g
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n
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ten
si
v
e
Ca
re
in
th
e
F
a
c
u
l
ty
o
f
M
e
d
icin
e
,
Un
i
v
e
rsitas
In
d
o
n
e
sia
a
n
d
Ci
p
to
M
a
n
g
u
n
k
u
s
u
m
o
Ho
sp
i
tal.
He
r
re
se
a
rc
h
fo
c
u
se
s
o
n
p
e
d
iatric
a
n
e
sth
e
sia
,
e
m
e
rg
e
n
c
y
m
e
d
icin
e
,
a
irwa
y
m
a
n
a
g
e
m
e
n
t,
a
n
d
m
e
d
ica
l
e
d
u
c
a
ti
o
n
.
S
h
e
h
a
s
p
u
b
li
sh
e
d
n
u
m
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ro
u
s
p
a
p
e
rs
o
n
t
h
e
t
o
p
ic
o
f
a
n
e
sth
e
sia
in
m
u
lt
ip
le
p
e
e
r
-
re
v
iew
e
d
jo
u
rn
a
ls.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
n
d
i
.
a
d
e
@u
i.
a
c
.
i
d
.
Ra
ih
a
n
ita
Z
a
h
r
a
is
a
p
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d
iatri
c
a
n
e
sth
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sio
lo
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ist
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n
d
a
n
a
c
ti
v
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f
a
c
u
lt
y
m
e
m
b
e
r
in
th
e
De
p
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rtme
n
t
o
f
An
e
sth
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sio
l
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g
y
a
n
d
In
te
n
siv
e
Ca
re
a
t
th
e
F
a
c
u
lt
y
o
f
M
e
d
ici
n
e
,
Un
iv
e
rsitas
In
d
o
n
e
sia
a
n
d
C
ip
t
o
M
a
n
g
u
n
k
u
su
m
o
Ho
sp
i
tal.
S
h
e
is
in
v
o
lv
e
d
in
m
u
lt
i
p
le
p
r
o
fe
ss
io
n
a
l
o
rg
a
n
iza
ti
o
n
s,
in
c
lu
d
i
n
g
t
h
e
In
d
o
n
e
sia
n
S
o
c
iety
o
f
An
a
e
sth
e
sio
l
o
g
y
a
n
d
In
te
n
siv
e
Ca
re
in
Ja
k
a
rta
a
n
d
th
e
In
d
o
n
e
sia
n
S
o
c
iety
o
f
An
e
st
h
e
sio
lo
g
ists
fo
r
P
a
ti
e
n
t
S
a
fe
ty
a
n
d
Qu
a
li
t
y
(INA
S
Qu
a
).
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h
e
a
ls
o
h
a
s
m
u
l
ti
p
le
p
u
b
li
c
a
ti
o
n
s
i
n
p
e
e
r
-
re
v
iew
e
d
jo
u
rn
a
ls
o
n
th
e
to
p
ic
o
f
a
n
e
sth
e
sio
lo
g
y
.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
z
ra
ih
a
n
it
a
@g
m
a
il
.
c
o
m
.
Am
e
li
a
M
a
r
tira
is
a
n
a
n
e
sth
e
sio
lo
g
ist
a
t
th
e
Un
i
v
e
rsity
o
f
I
n
d
o
n
e
sia
Ho
s
p
it
a
l,
De
p
o
k
.
S
h
e
h
a
s
a
stro
n
g
p
a
ss
io
n
f
o
r
m
e
d
ico
leg
a
l
issu
e
s,
p
a
rti
c
u
larly
in
re
lati
o
n
to
p
a
ti
e
n
t
sa
fe
ty
.
He
r
re
se
a
r
c
h
fo
c
u
se
s
o
n
a
n
e
st
h
e
sio
lo
g
y
a
n
d
p
a
ti
e
n
t
sa
fe
ty
,
with
m
u
lt
ip
le
p
u
b
li
c
a
ti
o
n
s
i
n
p
e
er
-
re
v
iew
e
d
jo
u
r
n
a
ls.
In
a
d
d
it
i
o
n
t
o
h
e
r
c
li
n
ica
l
a
n
d
a
c
a
d
e
m
ic
wo
rk
,
s
h
e
is
a
n
a
c
ti
v
e
m
e
m
b
e
r
o
f
th
e
In
d
o
n
e
sia
n
S
o
c
iety
o
f
A
n
a
e
sth
e
sio
lo
g
y
a
n
d
I
n
ten
si
v
e
Ca
re
in
Ja
k
a
rta.
S
h
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
iras
jafii@g
m
a
il
.
c
o
m
.
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