Tugas

EVIDENCED BASED LEARNING

Oleh:

Puspa Anggraini, S.Ked 04054821820013

Pembimbing:

dr. Achmad Ridwan, MO, M.Sc

BAGIAN ILMU KESEHATAN MASYARAKAT

ILMU KEDOKTERAN KOMUNITAS

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA

2019
Scenario
In infants with large VSD and CHF, would administration of digoxin or
other inotropic agent delay the need for surgery?

A. Clinical Problem
1) Population
Infants dengan VSD besar dan CHF
2) Intervention
Pemberian digoxin atau agen inotropik lain
3) Comparison
-
4) Outcome
Digoxin atau agen inotropik lain dapat menunda keperluan operasi

B. Answerable Question
Apakah pemberian digoxin atau agen inotropik lain pada infant dengan VSD
besar dan CHF dapat menunda keperluan operasi?

C. Search Key
(Infant with large VSD and CHF) AND (administration digoxin OR
inotropic agent) AND (delay for surgery)
D. Abstract Article

E. Critical Appraisal
CRITICAL APPRAISAL THERAPY STUDY (Randomized Controlled Trial)

VALIDITY:Are the results of the trial valid? (Internal Validity)

Yang dinilai FRISBEC
F: Patient Follow-Up Ya, jumlah pasien yang dianalisis dari awal
 Were all patients who entered the hingga akhir penelitian adalah 21 orang.
trial properly accounted for at its
conclusion? Losses to follow-up
should be less than 20% and
reasons for drop-out given.
 Was follow-up long enough? Durasi penelitian ini dilakukan selama 2
bulan untuk melihat efek dari digoxin.
R: Randomization Ya, subjek penelitian ini adalah infantil
 Were the recruited patients dengan VSD dan CHF
representative of the target
population?
 Was the allocation (assignment) of Tidak, subjek pada penelitian ini hanya
patients to treatment randomized diintervensi dengan digoxin selama
and concealed? periode penelitian
I: Intention to Treat Analysis
 Were patients analyzed in the Tidak, subjek penelitian ini tidak
groups to which they were dirandomisasi
randomized?
 Were all randomized patient data Ya, data penelitian yang diperoleh
analyzed? If not, was a sensitivity or dianalisis.
“worst case scenario” analysis done?
S: Similar Baseline Characteristics of
Patients
 Were groups similar at the start of Tidak, diawal penelitian, subjek tidak
the trial? dibagi kelompok. Namun setelah
diintervensi, subjek dikelompokkan
berdasarkan respon terhadap intervensi
B: Blinding
 Were patients, health workers, Monoblinding, hanya pasien yang blinding
and study personnel “blind” to
treatment?
 If blinding was impossible, were
blinded
raters and/or objective outcome
measures used?
E: Equal Treatment
 Aside from the experimental Ya, setiap kelompok diperlakukan sama
intervention, were the groups treated
equally?
Conflict of Interest
 Are the sources of support and Tidak
other potential conflicts of
interest acknowledged and
addressed?
Summary of Article’s Validity
 Notable study strengths or Penelitian ini valid
weaknesses or concerns?
 How serious are the threats to
validity and in what direction
could they bias the study
outcomes?
IMPORTANCY (What were the results?)
Yang dinilai/dihitung
CER 0,4
EER 0,29
RR 0,71
RRR (/RBI 0,29
ARI/ABI 0,11
NNT 8,75
C.APPLICABILIITY
Will the results help me in caring for my patient? (ExternalValidity/Applicability)
Is my patient so different to those in the Tidak
study that the result cannot apply?
Is the treatment feasible in my setting? Ya
Will the potenntial benefits of treatment Tidak
outweigh the potential harms of
treatment for my patient?

B. IMPORTANCE: apakah hasil

studi ini secara klinis penting?
Statstik yg dihitung Hitungan kita Interval kepercayaan
95%
CER (d/c+d) 9/(6+9) = 0,6
EER(b/a+b) 15/(6+15) = 0,7
RRR (CER-EER/CER (0,6-0,7)
ARR(CER-EER)
NNT (1/ARR)