TUGAS EVIDENCE BASED MEDICINE

Influence of smoking cessation after diagnosis of early

stage lung cancer on prognosis : systematic review of observational studies with
meta-analysis

PUTRI MAULINA

(1102012217)

FAKULTAS KEDOKTERAN
UNIVERSITAS YARSI
JAKARTA
2013/2014

Skenario
Ny Macora, seorang wanita 27 tahun datang dengan kehamilan 28 minggu. Keluarganya dan
riwayat klinis tidak ada yang bermakna dan dia melaporkan perilaku hidup sehatnya. Pasien
mengaku telah menjadi vegetarian selama 5 tahun terakhir. Pada pemeriksaan lab pertama,
ibu di diagnosis anemia ringan (Hematokrit 32%, Hb 10,8 gr/dl). Dokter menyarankan pasien
untuk mengonsumsi suplemen multiple micronutrien (MMN) lalu pasien menanyakan apakah
terapi tersebut memiliki efek yang sama dengan penggunaan suplemen iron.
Pertanyaan (foregroud question)
Untuk pasien dengan prenatal anemia, apakah penggunaan MMN lebih baik daripada
iron/folat suplemen ?
PICO

Population
: wanita hamil dengan prenatal anemia
Intervention : Multiple micro nutrien
Comparison : Iron folat suplement
Outcomes
: MMN lebih baik dari pada IFA dalam meningkatkan Hb dan
menurunkan resiko anemi dan pengaruh pada bayi BBLR dan intrauterine growth
Restraction.

Pencarian bukti ilmiah

Alamat website

: www.ebscohost.com

Kata kunci

: Micronutriens AND Iron suplements AND prenatal anemia

Limitasi

: 2011-2015

Hasil Pencarian

: 1-11

Dipilih artikel berjudul :

Is it Time to Replace Iron Folate Supplements in Pregnancy with Multiple
Micronutrients?

Journal Review
Methods
A literature search was conducted on PubMed, the Cochrane Systematic Reviews, the World
Health Organization Regional Databases and hand search of bibliographies of relevant
reviews. The last date of search was 15 September 2011. Studies were included, irrespective
of language and status of publication. Experts were also contacted in the field for unpublished
data. The basic search strategy used was: (Mothers[Mesh] OR Pregnancy[Mesh] OR
mother* OR maternal OR pregnancy) AND (Micronutrients[Mesh] OR multiple
micronutrient* OR multivitamin OR micronutrient*) AND (supplement*). With inclusion
criteria and exclusion criteria.
Result
The literature search revealed 4770 hits (Figure 1) on PubMed. After screening the titles and
abstracts, 43 studies were initially considered eligible and, finally, seven studies were
selected for inclusion in this review. We evaluated the impact of the intervention on the
following outcomes: maternal anaemia and maternal haemoglobin levels. MMN
supplementation had no significant effect on incidence of maternal anaemia in the third
trimester compared with iron folate based on data from seven trials [RR = 1.03, 95% CI 0.94,
1.12] (Figure 2). Similarly, when data were pooled for haemoglobin level, there was no
significant effect between MMN and IFA (standard mean difference = -0.01 [95% CI -0.08,
0.06]). but the use of BMN has other advantages.
Conclusions
MMN and iron folate supplements have similar effects on reducing
maternal anaemia. A plea to scale up iron folate supplements has been
made in view of the beneficial effect for prevention of Intrauterine Growth
Restriction and that of LBW from other studies. However, MMN
supplementation improves these outcomes beyond what iron folate
supplements achieve.49,50 The concern about the potential risk of
increased perinatal and neonatal mortality with the use of MMN in
pregnancy however remains, and the quantum of risk in relation to early
access to prenatal care and availability of obstetric services should be and
is best evaluated in appropriate effectiveness trials.

I.APAKAH HASIL PENELITIAN TERSEBUT VALID?

1. Apakah ada sampel pasien yang representative dan didefinisikan
secara jelas pada titik yang sama/ similar point dalam perjalanan
penyakit / course of the disease ?

2. Apakah follow-up lengkap dan cukuplama ?

3. Apakah digunakan criteria outcome yang obyektif dan tidak berbias?

4. Apakah ada penyesuaian / adjustment terhadap factor prognostik

yang penting?
------

II. APAKAH HASIL PENELITIAN INI PENTING ?

1. Bagaimana gambaran outcome menurut waktu ?

2. Seberapa tepat perkiraan prognosis ?

III. APAKAH HASIL PENELITIAN INI

DAPAT DIAPLIKASIKAN ?
1. Apakah pasien dalam penelitian ini serupa dengan pasien kita?
Ya.
Di dalam jurnal menjelaskan tentang gejala pasien yang sesuai dengan
kasus diatas : ibu hamil dengan anemia ringan
2. Apakah hasil penelitian membantu dalam keputusan pemilihan terapi
?
Ya.
Karena didalam jurnal dijelaskan tentang keuntungan lain dari pemilihan MMN
dalam hal menurunkan kejadian BBLR dan Intrauterine Growth Restriction.

3.

Apakah hasil penelitian berguna untuk

konseling

pada

penderita

atau

keluarganya?
Ya.
Karena di dalam jurnal dijelaskan bahwa MMN memiliki harga/cost yang lebih
mahal daripada penggunaan IFA.