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LAMPIRAN
1. Personil Penelitian
1. Ketua penelitian : dr. Wahyu Ningsih Lestari
2. Supervisor / Anggota : Prof.dr. Atan Baas Sinuhaji, Sp.A(K) dr. Supriatmo, M.Ked(Ped)Sp.A (K) dr. Emil Azlin, M.Ked(Ped)Sp.A(K) dr. Ade Rachmat, M.ked(Ped) Sp.A 3. Anggota penelitian : dr. Mislina Munir
dr. Mega Oktariena
2. Anggaran
No Uraian Jumlah
1. Honorarium Tenaga Administrasi Rp 200.000,-
2. Fotokopi (200 lbr x @ Rp 150) Rp 30.000,- 3. Bahan :
Probiotik (Lacidofil TM ®
sebanyak 14 btl, @ 60 caps/btl no reg POM : SI.114602931,Exp date: April 2016 (Rp. 235.000)
Agar-agar Swallow Globe, sebanyak 834 ktk, @ 12bks/ktk (Rp.10.000)
Rp 3.290.000,-
Rp 8.340.000,-
4. Transportasi dan Akomodasi Rp 50.000,- 5. Pembuatan Proposal dan Laporan Penelitian Rp 200.000,- 6. Penggandaan Proposal dan Laporan Penelitian Rp 500.000,-
Total Rp 12.610.000,-
3. Jadwal Penelitian
Maret April Mei Juni
Persiapan
Pelaksanaan
Penyusunan Laporan
4. Naskah Penjelasan Kepada Kepala Sekolah Madrasah Tsanawiyah Yayasan Amal Sosial Al Washliyah gedung Johor Medan dan orang tua/wali
Yth. Bapak / Ibu ………..……….
1. Sebelumnya kami ingin memperkenalkan diri (dengan menunjukkan surat tugas dari Departemen Ilmu Kesehatan Anak FK USU). Nama saya dr. Wahyu Ningsih Lestari, bertugas di divisi Gastroenterologi Departemen Ilmu Kesehatan Anak FK USU/RSU Haji Adam Malik. Saat ini, kami sedang melaksanakan penelitian tentang manfaat pemberian gabungan agar-agar ditambah probiotik pada anak yang menderita konstipasi fungsional.
2. Berdasarkan hasil pemeriksaan kami, anak Bapak/Ibu menderita konstipasi fungsional yang berdampak pada proses pembelajaran.
3. Untuk itu, kami berencana untuk mengobati anak Bapak/Ibu dengan memberikan obat agar-agar dan probiotik. Dari penelitian didapatkan bahwa pemberian terapi agar-agar ditambah probiotik selama satu bulan akan memberikan efek yang baik dalam memperbaiki frekuensi dan konsistensi tinja pada anak dengan konstipasi fungsional. Saat ini saya mencoba untuk melakukan penelitian untuk melihat manfaat jika pemberian agar-agar dan probiotik digabungkan dalam mengobati konstipasi fungsional pada anak. 4. Pada penelitian ini akan dilakukan pengukuran tinggi badan, penimbangan
pengukuran tinggi badan, berat badan dan kuisioner dibandingkan pengukuran sebelum diberi obat.
5. Jika Bapak/Ibu bersedia agar anaknya diobati dengan obat tersebut, maka kami akan mengharapkan Bapak/Ibu menandatangani lembar Persetujuan Setelah Penjelasan (PSP).
6. Bapak/Ibu serta anak anda bebas menolak ikut atau mengundurkan diri dalam penelitian ini. Semua data penelitian akan diperlakukan secara rahasia, sehingga tidak memungkinkan orang lain mengetahui data penderita. Semua biaya penelitian akan ditanggung oleh peneliti.
7. Bila ada keterangan yang kurang jelas dan bila muncul keluhan selama pengobatan konstipasi fungsional pada anak anda, maka dapat menghubungi saya a/n dr.wahyu ningsih lestari, no HP : 085260571898.
