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    Critical Appraisal Artikel terapi

    Oleh

    dr. Evi Nurhayatun,SpPD, MKes

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    Five steps in EBM

    1. Fr!ulate an ans"era#le $uestin

    %.  &rack d"n the #est evidence

    3. Critically appraise the evidence for:

     Relevance  Validity  Importancy  Applicability

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

    +. Evaluate ur eectiveness and e-ciency  keep a recrd i!prve the prcess

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    A. Validity

     /and!i0atin

     lindin)

     E$ual treat!ent #et"een )rups  Sa!ple si0e

     All relevant utc!e cnsidered

     Su-cient 2ll" 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 pada kel!pk kntrl 5 d46c7d8

     E%perimental Event Rate3 risik untuk !en)ala!i bad outcome4hasil pada kel!pk 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 risik relati2 untuk !en)ala!i bad outcome4hasil antara kel!pk

    perlakuan dan kel!pk kntrl 5 6CE/9EE/84CE/

    9 Penurunan risik ter:adinya bad

    outcome pada kel!pk perlakuandi#andin) kel kntrl

    9 Makin #esar ///, !akin #esar e2ek terapi

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    B. Importance

     Absol'te Ris& Red'ction: #eda risik a#slut untuk !en)ala!i #ad utc!e4hasil antara kel!pk

    perlakuan ; kel!pk kntrl 5 CE/9 EE/

    9 erapa persen risik #ad utc!e yan)

    #isa dikuran)i 9 A// > 1

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    Importance

     ?SA, [email protected]

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

    untuk !endapatkan 1 ta!#ahan good outcome

    5 14A//

    9 Makin #esar NN&, !akin &(DAK e2ekti2 terapi

    9 NN& 5 19'  e2ekti2 

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    C. Applicability

      ur "n patient6s83

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

    2actr reectin) h" !uch severeare yur patients c!pared t the avera)e 2 the i!prtant pr)nstic 2actrs 2 the study su#:ects

      ur NN& 5 2 * NN&

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    Applicability

     Deter!ine PEE/ 5 patient e*pected event rate 6event rate 2 yur patient i2 he4she is nt treated "ith the dru) under cnsideratin8

      &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; cncealedG

     (ntentin t treatG

     lindin)G

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

     Irups si!ilar at the start 2 trialG

     (3 Are the results i!prtantG  CE/, EE/, ///, A//, NN&

     A3 Can yu apply this valid ; i!prtantevidenceG  (s yur patient si!ilar t the patientG

     J" )reat the #enetG

     Other aspects

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    E$ample%.

     Fr!ulate ans"era#le $uestinB

    (n a pre)nant "!an "ith hi)h risk 2 preter! delivery, is "eekly ad!inistered 2 antenatal crticsterid #etter than sin)le neG

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    PIC!

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

    (3 "eekly curses 2 antenatal sterid C3 a sin)le curse 2 antenatal sterid

    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; cncealedG  (ntentin t treatG  lindin)G  E$ual treat!ent aside 2r! e*peri!ental /*G  Irups si!ilar at the start 2 trialG

     (3 Are the results i!prtantG  CE/, EE/, ///, A//, NN&  A3 Can yu apply this valid ; i!prtant

    evidenceG  (s yur patient si!ilar t the patientG  J" )reat the #enetG  Other aspects

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    Validity%

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

    rand!i0edG

    cncealedG

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     (ntentin t treatG

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     lindin)G

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

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     Irups si!ilar at 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 dengan randomisasi  !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 to treat

    MET!

    E

    VALIDITY 

    1

    VALIDITY

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    %

     

    *. Apakah kedua kelompok dira%at se&ara sepadan diluar perbedaan 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 cntrl event rate  resik !en:adi #ad utc!e pada kl!p