EBM&Critical Appraisal

Definisi EBM
Process of systematically reviewing,
appraising and using clinical research
findings to aid the delivery of optimum
clinical care to patients
Treat where there is evidence of benefit
No treat where there is evidence of no
benefit (or harm)

Case study
Ibu hamil 30 minggu datang ke tempat praktik
anda, ia mengeluh seminggu terakhir sering
sekali kembung dan sedikit mual sehingga tidak
nafsu makan. Ia kemudian menanyakan
mengenai keamanan penggunaan air jahe untuk
meredakan gejala tersebut, seperti yang ia baca
di artikel kesehatan yang ditulis seorang
obstetrist terkenal di kota anda

The Five Steps of Evidence Based Practice

1.
2.
3.
4.
5.

Asking focused questions

Finding the evidence
Critical appraisal
Making a decision
Evaluating performance

Common sources of evidence

Personal experience
Reasoning and intituition
Colleagues
Published evidence

Published evidence

Textbook
Artikel Jurnal
Pendidikan berkelanjutan
Berita kesehatan

Standar kualitas informasi medis

Penulis : pendidikan, profesi, institusi
Keterangan pendukung : referensi, tanggal
update
Tingkat kebenaran : didukung bukti mengenai
temuan
Transparansi penanggung jawab isi : contact
person
Transparansi sponsor

 Kebijakan iklan dan editorial

Unsur pelengkap
Kerahasiaan

SIGN classification for grading evidence

1++ : high quality meta analysis, systemic
review RCT, RCT with very low risk bias
1+ : Well Conducted Meta Analyses, Systemic
review, RCT with low risk bias
1-

: Meta analyses, systemic review, RCT with

high risk bias

2++ : High quality systemic review of case

control or cohort studies and a high
probability that the relationship is causal
2+

: well conducted case control or cohort

studies with low risk of confounding or
bias and a moderate probability that the
relationship is causal

2-

: case control or cohort with high risk of

confounding or bias and a significant risk that
the relationship is causal
3
: non analytic studies; case reports, case
series
4
: Expert opinion

Artikel dan Jurnal

Artikel : karya tulis dalam majalah, surat kabar
Jurnal :
surat kabar atau majalah yang membahas
mengenai subyek atau profesi tertentu
Jurnal penelitian, literature review

Referensi kedokteran
Emedicine
Medscape
PubMed

Jurnal kedokteran

BMJ (British Medical Journal)

NEJM (New England Medical Journal)
AMJ (American Medical Journal)
Journal of Hypertension
Cardiology Journal
etc

Critical appraisal
Systematic process used to identify the strength
and weaknesses of a research article in order to
assess usefulnes and validity of research
findings
Appropriateness of the study design
Suitability of statistical methods used and their
subsequent interpretation
Potential conflict of interest
Relevance of search

EBP and critical appraisal

Scientific research and circumstances of
individual patients
Elicit patients own preferences
Develop appropriate management plan based
this combination
Criteria used to assess must evolve with
improvements

Selection and critical appraisal research literature

Is the study question relevant?
Does the study add anything new?
What type of research question being asked?
Was the study design appropriate for the
research question?
Did the study methods address the most
important potential source of bias?
Was the study performed according to original
protocol?

Does the study stated a hypothesis

Was the statistical analyses performed correctly?
Do the data justify the conclusions?
Are there any conflict of interest?

Key points appraising systemic reviews and meta

analysis
Were all relevant studies included
Were selected articles appraised and data
extracted by two independent reviewers?
Was sufficient detail provided about the primary
studies, including descriptions of the patients,
interventions and outcomes?
Was the quality of the primary studies assessed?
Did the researchers assess the appropriateness
of combining results to calculate a summary
measure?

Key points appraising RCT

Was the process of treatment allocation truly random?
Would participants have been able to know or guess
their treatment allocation
Were participants and researchers 'blinded' to
participants' treatment group?
Were outcomes assessed objectively?
Were all participants who were randomly allocated a
treatment accounted for in the final analysis?
Were all participants' data analyzed in the group to
which they were randomly allocated?

Key points appraising cohort studies

Is the study prospective or retrospective?
Is the cohort representative of a defined group or
population?
Were all important confounding factors identified?
Were all important exposures and/or treatments,
potential confounding factors and outcomes measured
accurately and objectively in all members of the cohort?
Were there important losses to follow-up?
Were participants followed up for a sufficient length of
time?

Key points appraising case control studies

Were the cases clearly defined?
Were the cases representative of a defined
population?
How were the controls selected and were they
drawn from the same population as the cases?
Were study measures identical for cases and
controls?
Were study measures objective or subjective and
is recall bias likely if they were subjective?

Key points appraising cross sectional

analysis
Was the study sample clearly defined?
Was a representative sample achieved (e.g. was
the response rate sufficiently high)?
Were all relevant exposures, potential
confounding factors and outcomes measured
accurately?
Were patients with a wide range of severity of
disease assessed?

Keypoints appraising diagnostic accuracy

Does the sample of patients represent the full spectrum
of patients with and without the diagnosis of interest?
Was there a comparison with an appropriate 'goldstandard' test?
Did all patients receive both the test under evaluation
and the same 'gold-standard' test?
Were the tests performed independently with blinding of
assessors to the results of the 'gold-standard' test?
Were the cut-offs that were used to classify patients as
having a positive test result clearly described?

Case study A
Efektivitas asetaminofen dibandingkan
ibuprofen sbg antipiretik pada anak
Vaksin MMR dapat menyebabkan autisme
Teh hijau dapat menurunkan berat badan
Pengaruh makanan/diet pada acne vulgaris
Zat pengawet makanan dan kanker

Case Study B
Efektivitas isotretinoin oral dibandingkan
isotretinoin topikal untuk terapi acne vulgaris
Efektivitas olahraga dibandingkan dengan diet
makanan sehat untuk penurunan berat badan
Pengaruh makanan/diet pada migraine
MSG dapat menyebabkan kanker
Air teroksigenasi dan kesehatan

Penilaian Critical Appraisal

Deskripsi

Persentase

Kognitif
Penguasaan materi
kemampuan menjawab pertanyaan saat diskusi

50%
20%

Motorik
Bahasa tubuh/nonverbal saat presentasi

10%

Afektif
Attitude saat presentasi, cara berpakaian, cara bicara,
cara berdiskusi

20%

Thank you for your attention