SKENARIO PLENNARY TUTORIAL 3

BLOK 17 TAHUN 2010/2011

A. Case
Seorang laki-laki 35 tahun dirawat di bangsal RSUD karena kecelakaan lalu lintas
dengan fraktur femur bagian proksimal. Pasien telah menjalani operasi 4 hari yang lalu.
Karena kondisi fisiknya, pasien dipasang kateter selama 4 hari sejak operasi dan belum
diganti. Keluarga pasien khawatir dengan kondisi pasien karena sejak sehari yang lalu
mengeluh agak panas untuk kencing. Keluarga pasien melaporkan keluhan tersebut
kepada dokter jaga bangsal yang sedang jaga sore itu dan menanyakan kemungkinan
terjadinya penyakit lain. Menghadapi hal tersebut, Dokter Jaga berusaha menjawab
berdasar teori yang diketahuinya selama ini, dan untuk menjawab permasalahan pasien
lebih baik, Dokter akan berusaha mencari jawaban yang terbaik.

B. Problem definition and Analyzing Problems
1. What is the PICO?
P : man 35 years old
I : chateter use in post operative periode
C : non catheter use post operative periode
O : Post operative urinary tract infection

2. What are the clinical question?
a. How much the prevalence of UTI in catheter using post operative periode ?
b. What are the complication of catheter using post operative periode?
c. When the onset of UTI appear in catheter using post operative periode ?
d. The correlation between age and gender of patient with the prevalence of UTI
?
3. What are the research methode, dependent and independent variable and
outcome indication to answer the patient problem based on the journal?
a. Methode : Retrospective cohort study.
b. Dependent variable : post operative UTI
c. Independent variable : catheter use in post operative periode
d. Outcome : post operative UTI

4. What are the keywords ?
postoperative and indwelling catheter and risk factor and urinary tract infection
and cohort

5. What is the level evidance of the journal?
a postoperative catheterization longer

than 2 days was associated with an
increased likelihood of in-hospital

urinary tract infection (hazard ratio, 1.21; 95%
confidence

interval [CI], 1.04-1.41)
Level Therapy /
Prevention,
Aetiology /
Harm
Prognosis Diagnosis Differential
diagnosis /
symptom
prevalence
study
Economic and decision
analyses
1a SR (with
homogeneity*)
of RCTs
SR (with homogeneity*)
of inception cohort
studies; CDR"
validated in
different
populations
SR (with homogeneity*)
of Level 1
diagnostic studies;
CDR" with 1b
studies from
different clinical
centres
SR (with
homogeneity*)
of prospective
cohort studies
SR (with homogeneity*)
of Level 1 economic
studies
1b Individual RCT (with
narrow
Confidence
Interval")
Individual inception
cohort study with >
80% follow-up;
CDR" validated in
a single population
Validating** cohort
study with
good" " "
reference
standards; or
CDR" tested
within one clinical
centre
Prospective cohort
study with good
follow-up****
Analysis based on
clinically sensible
costs or alternatives;
systematic review(s)
of the evidence; and
including multi-way
sensitivity analyses
1c All or none All or none case-series Absolute SpPins and
SnNouts" "
All or none case-
series
Absolute better-value or
worse-value
analyses " " " "
2a SR (with
homogeneity*)
of cohort studies
SR (with homogeneity*)
of either
retrospective cohort
studies or untreated
control groups in
RCTs
SR (with homogeneity*)
of Level >2
diagnostic studies
SR (with
homogeneity*)
of 2b and better
studies
SR (with homogeneity*)
of Level >2
economic studies
2b Individual cohort
study (including
low quality RCT;
e.g., <80%
follow-up)
Retrospective cohort
study or follow-up
of untreated control
patients in an RCT;
Derivation of
CDR" or validated
on split-sample
only
Exploratory** cohort
study with
good" " "
reference
standards; CDR"
after derivation, or
validated only on
split-sample or
databases
Retrospective cohort
study, or poor
follow-up
Analysis based on
clinically sensible
costs or alternatives;
limited review(s) of
the evidence, or
single studies; and
including multi-way
sensitivity analyses
2c "Outcomes" Research;
Ecological
studies
"Outcomes" Research Ecological studies Audit or outcomes
research
3a SR (with
homogeneity*)
of case-control
studies
SR (with homogeneity*)
of 3b and better
studies
SR (with
homogeneity*)
of 3b and better
studies
SR (with homogeneity*)
of 3b and better
studies
3b Individual Case-
Control Study
Non-consecutive study;
or without
consistently
applied reference
standards
Non-consecutive
cohort study, or
very limited
population
Analysis based on limited
alternatives or costs,
poor quality
estimates of data, but
including sensitivity
analyses
incorporating
clinically sensible
variations.
4 Case-series (and poor
quality cohort
and case-control
studies)
Case-series (and poor
quality prognostic
cohort studies***)
Case-control study, poor
or non-independent
reference standard
Case-series or
superseded
reference
standards
Analysis with no
sensitivity analysis
5 Expert opinion
without explicit
critical appraisal,
or based on
physiology,
bench research
or "first
principles"
Expert opinion without
explicit critical
appraisal, or based
on physiology,
bench research or
"first principles"
Expert opinion without
explicit critical
appraisal, or based
on physiology,
bench research or
"first principles"
Expert opinion
without explicit
critical appraisal,
or based on
physiology,
bench research
or "first
principles"
Expert opinion without
explicit critical
appraisal, or based
on economic theory
or "first principles"
Based the table above, our journal in the second level (cohort study).

6. What are the conclusion from the journal?
Indwelling urinary catheters are routinely

in place longer than 2 days
postoperatively and may result in

excess nosocomial infections. The association
with adverse outcomes

makes postoperative catheter duration a reasonable
target of

infection control and surgical quality-improvement initiatives.

7. Link journal : http://archsurg.ama-assn.org/cgi/content/full/143/6/551