LEMBAR JAWABAN

OSCE EBM
Nama : Annisa Khaira Ningrum
NIM :04011181320058
No. Soal : 38

I. An 18 year old male with no significant past medical history is brought to emergeny
department.
1.1. Tabel PICO

Person/Problem Laki-laki berusia 18 tahun mengalami kecelakaan sepeda

motor. Mengalami beberapa luka berat, fraktur multiple, dan
trauma kepala.
Intervention Dexamethason
Comparison Steroid
Outcome Pengaruh pemberian dexamethasone terhadap kejadian
edema serebral

1.2. Clinical question

1. Apakah pemberian dexamethasone dapat mengurangi kejadian edema
serebral?
2. Bagaimana pengaruh dexamethasone dalam mengurangi edema serebral?
3. Apa efek samping pemberian dexamethasone dalam mengurangi edema
serebral?
4. Apakah ada alternatif lain dalam mengobati edema serebral?

1.3. (Edema OR eodema) AND (Brain OR Cerebral) AND (Dexamethason) AND

(Steroid)

1.4. Lakukan searching

1.5. Pastekan Abstract Artikel yang didapat pada lembar jawaban

Abstract
PURPOSE:

To compare the safety and efficacy of corticorelin acetate (CrA) and placebo in patients with
malignant brain tumors requiring chronic administration of dexamethasone (DEX) to control
the signs and symptoms of peritumoral brain edema (PBE).

PATIENTS AND METHODS:

Prospective, randomized, double-blind study of 200 patients with PBE on a stable dose of
DEX. Initially, DEX dose was decreased by 50% over a 2-week period and then held at this
level for 3 weeks. The primary end point was the proportion of patients who responded to
treatment-patients who achieved a ≥ 50% DEX reduction from baseline and achieved stable
or improved neurologic examination score and Karnofsky performance score at week 2, and
then continued to respond at week 5.

RESULTS:

One hundred patients received subcutaneous injections of 1 mg twice per day of CrA and 100
patients received placebo for the duration of the study period. Although results did not attain
statistical significance (at the P < .05 level), a clinically important difference in the proportion
of responders between the CrA group (57.0%) and the placebo group (46.0%; P = .12) was
observed. In addition, the maximum percent reduction in DEX dose achieved during the
double-blind 12-week study was significantly greater in the CrA group (62.7%) than in
placebo group (51.4%; P < .001). Patients receiving CrA demonstrated an improvement in
myopathy and were less likely to develop signs of Cushing syndrome.

CONCLUSION:

CrA enables a reduction in steroid requirement for patients with PBE and is associated with a
reduction in the incidence and severity of common steroid adverse effects, including
myopathy.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00088166.

1.6. Lakukan kritikal Appraisal dari Artikel dengan critical appraisal worksheet

II. Suatu penelitian Randomized Controlled Trial yang dilakukan pada penderita Ischemic
Stroke dengan memakai regimen pengobatan baru sebagai experimental group dan
pengobatan sebagai control group.
Dead Alive
Experimental 14% (28) 86% (172)
Control 25% (50) 75% (150)
Jumlah kelompok masing-masing (n) = 200
2.1. Experimental event rate = 28/200 = 0.14
 2.2.Control event rate = 50/200 = 0.25
2.3.Absolute risk reduction = EER – CER = 0.11
2.4.Relative reduction risk = ARR/CER = 0.44
2.5.Relative risk = CER/EER = 0.56
2.6.Number Needed to Treat = 1/ARR = 1/0.11=9.09
2.7.Alternative menghitung RRR = 1-RR
2.8.Kesimpulan
Dari perhitungan diatas didapatlan kelompok experimental efektif dalam mencegah
stroke sebesar 44%

III. Suatu penelitian efektitas pengobatan MCI dengan experimental group

Alive Dead
Stent + CAD 24% (48) 76% (152)
ASA + Atorvastatin 18% (36) 82% (164)
N= 200
3.1.EER = 0.24
3.2.CER = 0.18
3.3.ABI = 0.06
3.4.RBI = (EER-CER)/CER = 0.06/0,18 = 0.3
3.5.RR = EER/CER = 1.3
3.6.NNT = 1/ABI = 16.6
3.7.Alterbative RBI = 1-RR
3.8.Kesimpulan = Stent+CAD dapat mencegah kejadian MCI sebesar 30%
IV. Beda NNT pada trial effectiveness dengan NNT pada trial adverse effect
NNT effectiveness= jumlah sampel yang dibutuhkan untuk menilai efektifitas
suatu experiment

NNT = adverse effect = jumlah sampel yang dibutuhkan untuk menilai efek
samping experiment

5.1. buatlah grafik potong LDL 8

 Classification: PJK
100
90
80
70
60
50
40
30
20
10
0
0 50 100 150 200 250 300
LDL8

Secara visual didapatkan hasil LDL 8 antara 100-150

 LDL8
100

80
Sensitivity

60

40

20

0
0 20 40 60 80 100
100-Specificity

ROC curve

Variable LDL8

Classification variable PJK

Sample size 300

Positive group : PJK = 1 85

Negative group : PJK = 0 215

Disease prevalence (%) unknown

Area under the ROC curve (AUC)

Area under the ROC curve (AUC) 0.502

Standard Errora 0.0355

95% Confidence intervalb 0.444 to 0.560

z statistic 0.0563

Significance level P (Area=0.5) 0.9551

a
DeLong et al., 1988
b
Binomial exact
Youden index
Youden index J 0.1185

Associated criterion ≤69.02

Sensitivity 1.18

Specificity 86.98

Criterion values and coordinates of the ROC curve [Hide]

Criterion Sensitivity 95% CI Specificity 95% CI +LR -LR

<27.61 0.00 0.0 - 4.2 100.00 98.3 - 100.0 1.00

≤27.61 0.00 0.0 - 4.2 99.07 96.7 - 99.9 0.00 1.01

≤42.158 1.18 0.03 - 6.4 99.07 96.7 - 99.9 1.26 1.00

≤69.02 1.18 0.03 - 6.4 86.98 81.7 - 91.2 0.090 1.14

≤71.156 3.53 0.7 - 10.0 86.98 81.7 - 91.2 0.27 1.11

≤71.964 3.53 0.7 - 10.0 84.65 79.1 - 89.2 0.23 1.14

≤72.484 8.24 3.4 - 16.2 84.65 79.1 - 89.2 0.54 1.08

≤73.1 8.24 3.4 - 16.2 83.72 78.1 - 88.4 0.51 1.10

≤76.299 11.76 5.8 - 20.6 83.72 78.1 - 88.4 0.72 1.05

≤77.75 11.76 5.8 - 20.6 80.93 75.0 - 86.0 0.62 1.09

≤79.007 15.29 8.4 - 24.7 80.93 75.0 - 86.0 0.80 1.05

≤81.349 15.29 8.4 - 24.7 79.07 73.0 - 84.3 0.73 1.07

≤81.779 16.47 9.3 - 26.1 79.07 73.0 - 84.3 0.79 1.06

≤83.163 16.47 9.3 - 26.1 76.74 70.5 - 82.2 0.71 1.09

≤85.174 17.65 10.2 - 27.4 76.74 70.5 - 82.2 0.76 1.07

≤87.985 17.65 10.2 - 27.4 73.02 66.6 - 78.8 0.65 1.13

≤89.815 28.24 19.0 - 39.0 73.02 66.6 - 78.8 1.05 0.98

≤90.091 28.24 19.0 - 39.0 72.09 65.6 - 78.0 1.01 1.00

≤90.162 30.59 21.0 - 41.5 72.09 65.6 - 78.0 1.10 0.96

≤94.763 30.59 21.0 - 41.5 66.05 59.3 - 72.3 0.90 1.05

≤95.43 31.76 22.1 - 42.8 66.05 59.3 - 72.3 0.94 1.03

≤96.341 31.76 22.1 - 42.8 62.79 56.0 - 69.3 0.85 1.09

≤96.774 32.94 23.1 - 44.0 62.79 56.0 - 69.3 0.89 1.07

≤98.007 32.94 23.1 - 44.0 60.47 53.6 - 67.0 0.83 1.11

≤99.177 38.82 28.4 - 50.0 60.47 53.6 - 67.0 0.98 1.01

≤100.283 38.82 28.4 - 50.0 57.67 50.8 - 64.4 0.92 1.06

≤100.382 40.00 29.5 - 51.2 57.67 50.8 - 64.4 0.95 1.04

≤102.458 40.00 29.5 - 51.2 54.88 48.0 - 61.7 0.89 1.09

≤102.73 43.53 32.8 - 54.7 54.88 48.0 - 61.7 0.96 1.03

≤105.24 43.53 32.8 - 54.7 52.09 45.2 - 58.9 0.91 1.08

≤106.262 52.94 41.8 - 63.9 52.09 45.2 - 58.9 1.11 0.90

≤106.437 52.94 41.8 - 63.9 50.70 43.8 - 57.6 1.07 0.93

≤108.57 56.47 45.3 - 67.2 50.70 43.8 - 57.6 1.15 0.86

≤114.499 56.47 45.3 - 67.2 48.84 42.0 - 55.7 1.10 0.89

≤114.94 58.82 47.6 - 69.4 48.84 42.0 - 55.7 1.15 0.84

≤115.226 58.82 47.6 - 69.4 46.98 40.2 - 53.9 1.11 0.88

≤115.608 62.35 51.2 - 72.6 46.98 40.2 - 53.9 1.18 0.80

≤117.797 62.35 51.2 - 72.6 42.79 36.1 - 49.7 1.09 0.88

≤118.39 68.24 57.2 - 77.9 42.79 36.1 - 49.7 1.19 0.74

≤122.17 68.24 57.2 - 77.9 37.67 31.2 - 44.5 1.09 0.84

≤123.559 72.94 62.2 - 82.0 37.67 31.2 - 44.5 1.17 0.72

≤130.946 72.94 62.2 - 82.0 32.56 26.3 - 39.3 1.08 0.83

≤131.969 74.12 63.5 - 83.0 32.56 26.3 - 39.3 1.10 0.79

≤132.605 74.12 63.5 - 83.0 32.09 25.9 - 38.8 1.09 0.81

≤132.94 77.65 67.3 - 86.0 32.09 25.9 - 38.8 1.14 0.70

≤137.637 77.65 67.3 - 86.0 28.37 22.5 - 34.9 1.08 0.79

≤138.759 82.35 72.6 - 89.8 28.37 22.5 - 34.9 1.15 0.62

≤146.117 82.35 72.6 - 89.8 20.47 15.3 - 26.5 1.04 0.86

≤148.952 87.06 78.0 - 93.4 20.47 15.3 - 26.5 1.09 0.63

≤160.91 87.06 78.0 - 93.4 9.77 6.1 - 14.5 0.96 1.32

≤163.001 91.76 83.8 - 96.6 9.77 6.1 - 14.5 1.02 0.84

≤172.7 91.76 83.8 - 96.6 3.72 1.6 - 7.2 0.95 2.21

≤186.34 92.94 85.3 - 97.4 3.72 1.6 - 7.2 0.97 1.90

≤190.11 92.94 85.3 - 97.4 2.33 0.8 - 5.3 0.95 3.04

≤191.86 95.29 88.4 - 98.7 2.33 0.8 - 5.3 0.98 2.02

≤210.378 95.29 88.4 - 98.7 1.86 0.5 - 4.7 0.97 2.53

≤215.919 98.82 93.6 - 100.0 1.86 0.5 - 4.7 1.01 0.63

≤253.499 98.82 93.6 - 100.0 1.40 0.3 - 4.0 1.00 0.84

≤260.729 100.00 95.8 - 100.0 1.40 0.3 - 4.0 1.01 0.00

≤264.217 100.00 95.8 - 100.0 0.00 0.0 - 1.7 1.00

Sensitifitas 1.18

Spesifisitas = 86.98

PPV

NPV

LR + =

LR –

LR test

AUC

Pretest odd

Pst test od

Kesimpulan