contoh critical appraisal terapi.ppt

Upload: toumi-shiddiqi

Post on 01-Jun-2018

309 views

Category:

Documents


3 download

TRANSCRIPT

  • 8/9/2019 contoh critical appraisal terapi.ppt

    1/40

    Critical AppraisalArtikel terapi

    Oleh

    dr. Evi Nurhayatun,SpPD, MKes

  • 8/9/2019 contoh critical appraisal terapi.ppt

    2/40

    Five steps in EBM

    1. Fr!ulate an ans"era#le $uestin

    %.  &rack d"n the #est evidence

    3. Critically appraise the evidence for:

    Relevance Validity Importancy Applicability

    '. (nte)rate "ith clinical e*pertise and patientvalues

    +. Evaluate ur eectiveness and e-ciency keep a recrd i!prve the prcess

  • 8/9/2019 contoh critical appraisal terapi.ppt

    3/40

    A. Validity

    /and!i0atin

    lindin)

    E$ual treat!ent #et"een )rups Sa!ple si0e

    All relevant utc!e cnsidered

    Su-cient 2ll" up

     

    METH!"

  • 8/9/2019 contoh critical appraisal terapi.ppt

    4/40

    B. Importance

    Y N

    E a b

    C c d

      RE"#$T"

  • 8/9/2019 contoh critical appraisal terapi.ppt

    5/40

    B. Importance

    Control Event Rate3 risik untuk!en)ala!i bad outcome4hasil padakel!pk kntrl 5 d46c7d8

    E%perimental Event Rate3 risikuntuk !en)ala!i bad outcome4hasilpada kel!pk perlakuan 5 #46a7#8

  • 8/9/2019 contoh critical appraisal terapi.ppt

    6/40

    Importance

    Y N

    E 40 10 50

    C 30 20 50

    CER= control event rate = 20/50=0.4

    EER= experiment event rate = 10/50=0.2

    RRR = relative risk reduction = (CER-EER/CER = (0.4-0.2/0.4 = 50!

  • 8/9/2019 contoh critical appraisal terapi.ppt

    7/40

    B. Importance

    Relative Ris& Red'ction: #eda risikrelati2 untuk !en)ala!i badoutcome4hasil antara kel!pk

    perlakuan dan kel!pk kntrl 56CE/9EE/84CE/

    9 Penurunan risik ter:adinya bad

    outcome pada kel!pk perlakuandi#andin) kel kntrl

    9 Makin #esar ///, !akin #esar e2ekterapi

  • 8/9/2019 contoh critical appraisal terapi.ppt

    8/40

    B. Importance

    Absol'te Ris& Red'ction: #eda risika#slut untuk !en)ala!i #adutc!e4hasil antara kel!pk

    perlakuan ; kel!pk kntrl 5 CE/9EE/

    9 erapa persen risik #ad utc!e yan)

    #isa dikuran)i9 A// > 1

  • 8/9/2019 contoh critical appraisal terapi.ppt

    9/40

    Importance

    ?SA, 1@

  • 8/9/2019 contoh critical appraisal terapi.ppt

    10/40

    Importance

    Y N

    E 40 10 50

    C 30 20 50

    CER= control event rate = 20/50=0.4

    EER= experiment event rate = 10/50=0.2

     "RR = a#solute risk reduction = (CER-EER = 0.4-0.2 = 0.2

    $$% = 1/"RR = 1/0.2 = 5

  • 8/9/2019 contoh critical appraisal terapi.ppt

    11/40

    Importance

    NN& 5 nu!#er needed t treat

    5 :u!lah pasien yan) perlu di#eri terapi

    untuk !ence)ah 1 bad outcome5 :u!lah pasien yan) perlu di#eri terapi

    untuk !endapatkan 1 ta!#ahangood outcome

    5 14A//

    9 Makin #esar NN&, !akin &(DAKe2ekti2 terapi

    9 NN& 5 19'  e2ekti2 

  • 8/9/2019 contoh critical appraisal terapi.ppt

    12/40

    C. Applicability

     ur "n patient6s83

    6educated )uess8 deter!ine 2, i.e, a

    2actr reectin) h" !uch severeare yur patients c!pared t theavera)e 2 the i!prtant pr)nstic2actrs 2 the study su#:ects

     ur NN& 5 2 * NN&

  • 8/9/2019 contoh critical appraisal terapi.ppt

    13/40

    Applicability

    Deter!ine PEE/ 5 patient e*pectedevent rate 6event rate 2 yur patienti2 he4she is nt treated "ith the dru)under cnsideratin8

     &hen3

     ur NN& 5 PEE/46PEE/9EE/8

  • 8/9/2019 contoh critical appraisal terapi.ppt

    14/40

    THERAPY !R"#HEET

    3 Are the results 2 this trial validG Has the assi)n!ent rand!i0edG; cncealedG

    (ntentin t treatG

    lindin)G

    E$ual treat!ent aside 2r! e*peri!ental /*G

    Irups si!ilar at the start 2 trialG

    (3 Are the results i!prtantG CE/, EE/, ///, A//, NN&

    A3 Can yu apply this valid ; i!prtantevidenceG (s yur patient si!ilar t the patientG

    J" )reat the #enetG

    Other aspects

  • 8/9/2019 contoh critical appraisal terapi.ppt

    15/40

    E$ample%.

    Fr!ulate ans"era#le $uestinB

    (n a pre)nant "!an "ith hi)h risk2 preter! delivery, is "eeklyad!inistered 2 antenatalcrticsterid #etter than sin)le neG

  • 8/9/2019 contoh critical appraisal terapi.ppt

    16/40

    PIC!

    P3 a pre)nant "!an "ith hi)h risk 2preter! delivery

    (3 "eekly curses 2 antenatal steridC3 a sin)le curse 2 antenatal sterid

    O3 reduce !r#idity

  • 8/9/2019 contoh critical appraisal terapi.ppt

    17/40

    #EARCH THE EVI&E'CE%.

    Pu#!ed clinical $uery

  • 8/9/2019 contoh critical appraisal terapi.ppt

    18/40

    Appraisal t(e st)dy%

    ?se therapy "rksheet

    3 Are the results 2 this trial validG Has the assi)n!ent rand!i0edG; cncealedG (ntentin t treatG lindin)G E$ual treat!ent aside 2r! e*peri!ental /*G Irups si!ilar at the start 2 trialG

    (3 Are the results i!prtantG CE/, EE/, ///, A//, NN& A3 Can yu apply this valid ; i!prtant

    evidenceG (s yur patient si!ilar t the patientG J" )reat the #enetG Other aspects

  • 8/9/2019 contoh critical appraisal terapi.ppt

    19/40

    Validity%

     Are t(e res)lts o* t(is trialvalid+ Has the assi)n!ent

    rand!i0edG

    cncealedG

  • 8/9/2019 contoh critical appraisal terapi.ppt

    20/40

    (ntentin ttreatG

  • 8/9/2019 contoh critical appraisal terapi.ppt

    21/40

    lindin)G

  • 8/9/2019 contoh critical appraisal terapi.ppt

    22/40

    E$ual treat!ent aside 2r!e*peri!ental /*G

  • 8/9/2019 contoh critical appraisal terapi.ppt

    23/40

    Irups si!ilarat the start 2

    trialG

  • 8/9/2019 contoh critical appraisal terapi.ppt

    24/40

    Importance,Are t(e res)lts important+

    CE/, EE/, ///, A//, NN&

  • 8/9/2019 contoh critical appraisal terapi.ppt

    25/40

    Importance,Are t(e res)lts important+

    CE/, EE/, ///, A//, NN&

    Y N

    E 78.5% 22.5% 100%

    C 72.0% 28.0% 100%

  • 8/9/2019 contoh critical appraisal terapi.ppt

    26/40

    Importance,Are t(e res)lts important+

    CE/, EE/, ///, A//, NN&

    Y N

    E 78.5% 22.5% 100%

    C 72.0% 28.0% 100%

    CER= control event rate = 2&/100=0.2&

    EER= experiment event rate =

    22.5/100=0.225

     "RR = a#solute risk reduction = (CER-

    EER = 0.2&0-0.225 = 0.055

    $$% = 1/"RR = 1/0.055 = 1&

  • 8/9/2019 contoh critical appraisal terapi.ppt

    27/40

    Applicability..

     ur NN& 5 2 * NN&

    251

    Our NN& 5 1L

  • 8/9/2019 contoh critical appraisal terapi.ppt

    28/40

    %L

    TELAAH KRITIS

    (Critical Appraisal )

  • 8/9/2019 contoh critical appraisal terapi.ppt

    29/40

    %@

    1. Apakah pemberian terapi pada pasien dilakukan denganrandomisasi !an apakah randomisasi disegel "a

    #. Apakah dilakukan masking "a

    VALIDITY 

  • 8/9/2019 contoh critical appraisal terapi.ppt

    30/40

    <

     

    3. Apakah kelompok $ang diperbandingkan setara pada

    a%al per&obaaan "a

    VALIDITY 

  • 8/9/2019 contoh critical appraisal terapi.ppt

    31/40

     '. Apakah semua pasien $ang masuk dalam penelitian

    diperhitungkan dalam simpulan analisis sesuai dengan alokasi

    a%aln$a Tidak %alaupun hasil per proto&ol Intention totreat

    MET!

    E

    VALIDITY 

    1

    VALIDITY

  • 8/9/2019 contoh critical appraisal terapi.ppt

    32/40

    %

     

    *. Apakah kedua kelompok dira%at se&ara sepadan diluarperbedaan pemberian terapi "a

    +. Apakah kedua kelompok $ang diteliti mirip "a

    VALIDITY 

  • 8/9/2019 contoh critical appraisal terapi.ppt

    33/40

     IMPORTANT 

    (E$M)(

    * Cr Cl 3+ , -ml/min0

    "EM1#H TI!A( /

    &ompli&asi*per tah'n0

    bat bar'*rivaro%aban0

    2--+ 3-

    (ontrol *afarin0 2-34 -2

    CE/3 cntrl event rate  resik !en:adi #ad utc!e padakl!pk kntrl 5 %,L =EE/3 E*peri!ental event rate  resik !en:adi #ad utc!epada kel!pk e*peri!ental 5 %,< =/// 6relative risk reductin8 5 1,% =

    A//  #erapa persen resik #ad tc!e #isa dikuran)i

  • 8/9/2019 contoh critical appraisal terapi.ppt

    34/40

    '

     APPLICABLE 

    1. Apakah pasien kita mirip dengan sub$ek

    penelitian "a namun pembagian dera,atinsu-isensi renal tidak sama

    #. Apakah terapi baru tersebut tersedia ter,angkau

    dan dapat diterima pasien Tidak  Ri/aro0aban masuk dalam ASKES dengandiagnosa tertentu tetapi tidak masuk amkesmas

    Harga ri/aro0aban &ukup mahal dan kurangter,angkau untuk terapi ,angka pan,ang

    2ollo% up pasien se&ara rutine diperlukan untukmengontrol e-ek samping

  • 8/9/2019 contoh critical appraisal terapi.ppt

    35/40

    +

    TELAAH KRITIS

    (Critical Appraisal )Contoh 3

  • 8/9/2019 contoh critical appraisal terapi.ppt

    36/40

    II

    CC

    OO

    PP

    Patients "ith chrnic #structive

    pul!nary disease received titrpiu!+ ) nce daily via /espi!at S2t(nhaler 2r "eeks

     !easure physical 2unctin at "eek

    !easure physical 2unctin at #aseline

    (!prve!ent 2 Physical 2unctin 

  • 8/9/2019 contoh critical appraisal terapi.ppt

    37/40

    Validity

  • 8/9/2019 contoh critical appraisal terapi.ppt

    38/40

    Importancy

    """.the!e)allery.c!

  • 8/9/2019 contoh critical appraisal terapi.ppt

    39/40

    Applicability

    """.the!e)allery.c!

  • 8/9/2019 contoh critical appraisal terapi.ppt

    40/40

     Concl)sion

     less validImportant

    Applicable

    the st'dy inthis 5'rnal