Critical Appraisal

Artikel Diagnostik

Fakultas Kedokteran Universitas YARSI

Practicing EBM: Five Steps

Step 1: convert need for information in to
an answerable question
Step 2: track down the best evidence with
which to answer that question
Step 3: critically appraise the evidence for
its validity, impact and applicability
Step 4: integrate the critical appraisal with
our clinical expertise and patients unique
circumstances
Step 5: evaluate our effectiveness and
efficiency in steps 1-4 and seeking ways to
improve
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Critical Appraisal
is the process of systematically
examining research evidence to
assess its validity, results and
relevance before using it to inform
a decision.

QUANTITATIVE
QUANTITATIVE RESEARCH
RESEARCH METHOD
METHOD
OBSERVATIONAL
OBSERVATIONAL

Descriptive
Descriptive

Exposures
Exposures&&
outcomes
outcomesare
are
measured
at
measured atthe
the
same
time
same time

Case
Casereport
report
Case
series
Case series
CrossCrosssectional
sectional

EXPERIMENTAL
EXPERIMENTAL

Analytic
Analytic

Outcome
Outcome

Exposure
Exposure

Cause
Cause

Disease
Disease

Case
CaseControl
Control
Study
Study

Cohort
CohortStudy
Study

Pure
Pure

Semi
Semi

RCT
RCT
Quasi
Quasi
experiexperimental
mental

Kohort

prospektif

Paparan

Paparan

retrospektif

Outcome

Kasus Kontrol
Outcome

Paparan

Potong lintang
Outcome
Saat sekarang

Article About Diagnostic

Article About Diagnostic

Ideal Study Design:
Cross-sectional study
Cross-sectional study
A study that examines the relationship between
disease (or other health-related characteristics) and
other variables of interest as they exist in a defined
population at a single point in time.
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Skenario
Suatu Rumah Sakit Khusus Anak mewajibkan pemeriksaan
urine untuk mendeteksi bakteriuria yang menunjukkan
adanya ISK.
Pemeriksaan dilakukan pada setiap pasien-anak yang datang
ke UGD Rumah Sakit tersebut.
Untuk menghemat biaya, perawat UGD tidak memeriksa
urine pasien yang tampak jernih dalam botol tampung,
karena berdasarkan pengalaman mereka hasilnya akan
negatif.
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Focusing Answerable
Questions
Populatio Interventio
n
n or
Exposure
Pasien
anak
dengan
spesimen
urine
tampung
midstrea
m atau
kateter

Alternative
Interventio
n or
Exposure

Urine
jernih pada
pengamata
n langsung

Outcomes

Kultur
urine
negatif

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Article About Diagnostic

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Article About Diagnostic

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Article About Diagnostic

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Users' Guides
for an Article About Diagnostic
I.

Are the results of the study

valid?

II. What were the results?

III. Will the results help me in
caring for my patients?
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Users' Guides
for an Article About diagnostic
I. Are the results in the study valid?
Primary Guides
Was there an independent, blind comparison with a reference
standard?
Did the patient sample include an appropriate spectrum of
patients to whom the diagnostic test will be applied in
clinical practice?

Secondary Guides
Did the results of the test being evaluated influence the
decision to perform the reference standard?
Were the methods for performing the test described in
sufficient detail to permit replication?
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Users' Guides
for an Article About Diagnostic
I. Are the results in the study
valid?
Primary Guides
Was there an independent, blind
comparison with a reference standard?

17

18

Users' Guides
for an Article About Diagnostic
I. Are the results in the study
valid?
Primary Guides
Did the patient sample include an
appropriate spectrum of patients to
whom the diagnostic test will be
applied in clinical practice?
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Users' Guides
for an Article About Diagnostic
I. Are the results in the study
valid?
Secondary Guides
Were the methods for performing the test
described in sufficient detail to permit
replication?

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Users' Guides
for an Article About Diagnostic
II. What are the results?
Are likelihood ratios for the test
results presented or data necessary
for their calculation provided?

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Users' Guides
for an Article About Diagnostic
Jangan hanya melihat:
Sensitivitas, atau
Spesifisitas
Perhatikan nilai:
Likelihood Ratio,
Pre-test probabilty
Post-test probability

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Users' Guides
for an Article About Diagnostic
Sensitivitas
Spesifisitas
Likelihood ratio
Sensitivitas
Spesifisitas
Likelihood ratio

80%
20%
1
35%
65%
1

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Likelihood ratio
>10 atau < 0,1, menghasilkan
perubahan yg besar dari pre dan post
test probability sering konklusif
5-10 dan 0.1-0.2, perubahan sedang
2-5 daan 0,5-0,2, perubahan kecil
(kadang-kadang penting)
1-2 dan 0,5-1, mengubah probability
kecil sekali (dan jarang penting)
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Users' Guides
for an Article About Diagnostic
III. Will the results help me in
caring for my patients?
Will the reproducibility of the test
result and its interpretation be
satisfactory in my setting?

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Users' Guides
for an Article About Diagnostic
III. Will the results help me in
caring for my patients?
Are the results applicable to my
patient?

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Users' Guides
for an Article About Diagnostic
III. Will the results help me in
caring for my patients?
Will the results change my
management?

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Users' Guides
for an Article About Diagnostic
III. Will the results help me in
caring for my patients?
Will patients be better off as a result
of the test?

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Terima Kasih

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