Critical Appraisal

Contoh: untuk terapi

Skenario
 Seorang ibu mengantar bayinya yang
berusia 2 bulan ke IGD karena semalam
bayinya menangis terus. Bayi sebelumnya
sehat, aktif, mendadak menangis kesakitan.
Menangis berlangsung lebih dari 3 jam
dan tak mau berhenti walau pun dibujuk,
digendong dan sebagainya. Serangan
tersebut sudah terjadi berkali-kali.
Scenario (lanjutan)
 Kira-kira sudah lebih dari 3 minggu
terakhir ini, setiap minggunya terjadi lebih
dari 3 hari. Setiap menangis lebih dari 3
jam. Dokter berpikir apakah terjadi
infantile colic karena telah memenuhi
kriteria the rules of threes. Dokter juga
pernah mendengar dari teman sejawat
bahwa kasus infantile colic dapat diobati
dengan lactobacillus.
 Pertanyaan klinis
 Apakah pada bayi yang terjadi infantile colic,
maka pemberian lactobacillus dapat
mengurangi lama menangis?
 ANALISIS PICO
P = infant colic OR baby colic
I = lactobacillus OR lactobacilli
C = plasebo
O = reducing crying OR

P: population/problem I: intervention C: comparison O: outcome

Keyword
 infant colic OR infantile colic, lactobacillus
OR lactobacilli, plasebo, reducing crying OR
effective OR cryiing reduce OR efficacy
Best evidence
 Systematic review/RCT
Pelacakan publikasi Ilmiah
Infant colic OR baby colic
Infant colic OR baby colic
lactobacillus OR lactobacilli
lactobacillus OR lactobacilli
plasebo
plasebo
reducing cryiing OR effective OR
cryiing reduce OR efficacy
reducing cryiing OR effective OR
cryiing reduce OR efficacy
Advance
Add to history
History
Pelacakan gabungan
Hasil
Full text
Full text
Untuk mengetahui apakah artikel diatas dapat
saya pakai apa tidak untuk menjawab pertanyaan,
maka ada beberapa pertanyaan kunci yaitu :
• Apakah hasil penelitian sahih (valid)?
• Apakah hasil penelitian valid ini penting?
• Apakah hasil penelitian berguna bagi
penatalaksanaan pasien saya?
Instrumen
 Diambil dari buku: Evidence Based
Medicine, How to Practice and Teach EBM
(Straus, Richardson, Glasziou, & Haynes,
2005)
Apakah hasil penelitian yang
ini valid?
Validitas (1)
 Was the assignments of patients to
treatments randomized ?
 Answer : yes, the patients were
randomized.
 evidence: next slide
evidence
Validitas 2
 Was the randomization concealed?
 No, the concealment was not mentioned
at the article
Validitas 3
 Were all groups similar at the start of the
trial?
 Yes, both groups were similar at the start
of the trial. It can be seen at the table of
baseline.
 Evidence: next slide
evidence
Validitas 4
 Was follow-up of patients sufficiently
long and complete
 Answer: yes, the primary outcome was
recorded at the next 21 day after the
start of the study. It is sufficient time
referring to the criteria of the diagnosis of
the infantile colic mentioned by Wessel´s
criteria
 Evidence: next slide
evidence
Validitas 5
 Were all patients analyzed in the groups
to which they were randomized?
 Answer : yes, but if not actually is not a
problem because the number of droup
out is under 20% of the size of sample (
the drop out samples were 4/25= 16%)
 Evidence: next slide
evidence
Validitas 6
 Were patients, cliniciants, and study
personel kept blind to treatment
 Answer: yes, the study was conducted
blind both to the patients and to the
clinician, but there was not evidence if it
was blind to the statistical analyzer as
well, but it is not a problem.
 Evidence: next slide
Evidence
Validitas 7
 Were group treated equally , apart from
the experimental therapy
 Answer: yes, both of the groups were
treated equally except the treatment
 Evidence: next slide
evidence
Apakah hasil penelitian
yang valid ini penting?
Untuk menilai kepentingan (sebagai
catatan)
 Pada penelitian ini per protocol analysis
maupun intention to treat analysis sama-
sama dilakukan
 Pada tugas ini perhitungan dilakukan
berdasarkan intention to treat analysis , yang
hasilnya dapat dilihat padfa halaman 529
paragraf paling bawah
Importancy
Y N

E 24 (A) 1(B) 25

C 18 (C) 7 (D) 25
Penghitungan importancy
 CER (control event rate)= c/ (c+d) =18
/(18+7)= 0,72
 EER (experimental event rate)= b/ (a+b)
= 24/ (24+1) = 0,96
 RRR (relative risk reduction) = (|CER-
EER|)/CER = (|0,72-0.96|)/0,28 = 0,86
 ARR= |CER-EER| = 0,72-0.96 = 0,24
 NNT = 1/ARR = 1/0,24 = 4,16
95 % CI (interval kepercayaan)
 95% CI NNT=

± 1,96 CER(1-CER)/ n(kontrol) + EER(1-EER)/n(ekperimen)

= ± 1,96 X 0,098
= ± 0,19208
= ± 19,2 %
Applicability 1
 Is our patient so different from those in
the study that its results cannot apply?
 Answer: our patents are similar with the
study ( refers to the Wessel´s criteria)
Applicability 2
 Is the treatment feasible in our setting?
 Answer: yes, it is feasible in our setting
Applicability 3
 What are our patient´ s potential benefits
and harms from the therapy?>
 Answer: there were no adverse effect in
the study
Applicability 4
 What are our patient´ s values and
expectations for both the outcome we
are trying to prevent and the treatment
we are offering?
 Answer: it meet the patient values and
expectations.
Terima Kasih