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8/9/2019 contoh critical appraisal terapi.ppt
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Critical AppraisalArtikel terapi
Oleh
dr. Evi Nurhayatun,SpPD, MKes
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Five steps in EBM
1. Fr!ulate an ans"era#le $uestin
%. &rack d"n the #est evidence
3. Critically appraise the evidence for:
Relevance Validity Importancy Applicability
'. (nte)rate "ith clinical e*pertise and patientvalues
+. Evaluate ur eectiveness and e-ciency keep a recrd i!prve the prcess
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A. Validity
/and!i0atin
lindin)
E$ual treat!ent #et"een )rups Sa!ple si0e
All relevant utc!e cnsidered
Su-cient 2ll" up
METH!"
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B. Importance
Y N
E a b
C c d
RE"#$T"
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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
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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!
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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
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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
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Importance
?SA, 1@
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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
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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
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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&
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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
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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
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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
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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
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#EARCH THE EVI&E'CE%.
Pu#!ed clinical $uery
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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
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Validity%
Are t(e res)lts o* t(is trialvalid+ Has the assi)n!ent
rand!i0edG
cncealedG
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(ntentin ttreatG
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lindin)G
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E$ual treat!ent aside 2r!e*peri!ental /*G
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Irups si!ilarat the start 2
trialG
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Importance,Are t(e res)lts important+
CE/, EE/, ///, A//, NN&
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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%
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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&
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Applicability..
ur NN& 5 2 * NN&
251
Our NN& 5 1L
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%L
TELAAH KRITIS
(Critical Appraisal )
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%@
1. Apakah pemberian terapi pada pasien dilakukan denganrandomisasi !an apakah randomisasi disegel "a
#. Apakah dilakukan masking "a
VALIDITY
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<
3. Apakah kelompok $ang diperbandingkan setara pada
a%al per&obaaan "a
VALIDITY
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'. 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
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%
*. Apakah kedua kelompok dira%at se&ara sepadan diluarperbedaan pemberian terapi "a
+. Apakah kedua kelompok $ang diteliti mirip "a
VALIDITY
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IMPORTANT
(E$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
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'
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
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+
TELAAH KRITIS
(Critical Appraisal )Contoh 3
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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
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Validity
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Importancy
""".the!e)allery.c!
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Applicability
""".the!e)allery.c!
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Concl)sion
less validImportant
Applicable
the st'dy inthis 5'rnal