LATIHAN EBM DEASY NATALIANI

1. Data abnormalitas

Parameter Rerata Simpangan Deviasi Rerata + - 2 SD Nilai Abnormalitas Abnormalitas

SGOT/SGPT 26.29 13.932 54.154 54.204 > 54.204
Hemoglobin 12.472 0.3238 11.8244 11.774 < 11.774
Trigliserid 115.31 20.047 155.404 155.454 > 155.454
Total Kolesterol 137.24 32.405 202.05 202.1 > 202.1
HDL 89.44 17.119 55.202 55.152 < 55.152
LDL 74.64 13.634 101.908 101.958 > 101.958

2. Skenario klinis
a. Tabel P.I.C.O
P Older adult with sign and symptom of cognitive impairment or dementia
I Mini-cog test
C Mini-Mental State Examination(MMSE)
O Accurate diagnosis of dementia or Alzheimer’s disease
b. Clinical question
In older adults with sign and symptom of cognitive impairment or dementia, is Mini-
Cog test is accurate as Mini-Mental State Examination for diagnosis of dementia or
Alzheimer’s disease?
c. Search term : (Mini-cog OR minicog) AND (Mini-Mental State Examination OR
MMSE) AND (dementia OR Alzheimer)
d. Serching pada website : http://www.tripdatabase.com
e. Abstract artikel
Background Dementia is considered widely under-detected in primary care, and
general practitioners (GPs) frequently ask for easy to use tools to assist in its early
detection.
Aim To determine the degree of correlation between the Mini-Cog Assessment (Mini-
Cog) as performed by GPs and the Mini-Mental State Examination (MMSE).
Design of study This was a prospective study (2005, 2006) comparing two cognitive
screening instruments. Setting Ten general practices in Austria, with patients with a
hitherto undiagnosed suspicion of dementia seen consecutively.
 Method Sensitivity, specificity and positive and negative predictive values (PPVs and
NPVs) of the Mini-Cog (applying both a colour-coded and the original rating method)
were assessed for degree of correlation with the MMSE. In phase one GPs examined
patients suspected of having dementia using the Mini-Cog; in phase two a neurologist
retested them applying the MMSE, a clock-drawing test (CDT) and a routine clinical
examination. A questionnaire on the practicability of the Mini-Cog was answered by
GPs.
Results Of the 107 patients who participated 86 completed the whole study protocol.
The Mini-Cog, as performed by the ten GPs, displayed a sensitivity of 0.85 (95% CI:
0.71, 0.98), a specificity of 0.58 (95% CI: 0.46, 0.71), a PPV of 0.47 (95% CI: 0.33,
0.61) and an NPV of 0.90 (95% CI: 0.80, 0.99) as against the MMSE carried out by
neurologists. The GPs judged the Mini-Cog useful and time saving.
Conclusion The Mini-Cog has a high sensitivity and acceptable specificity in the
general practice setting and has proved to be a practicable tool for the diagnosis of
dementia in primary care.

f. Critical appraisal

DIAGNOSIS WORKSHEET

Are the results of this diagnostic study valid?

Was there an independent, blind Yes, Mini-Mental State Examination

comparison with a reference (“gold”) (MMSE) is an independent and blind
standard of diagnosis? comparison with a reference “gold”
standard of diagnosis.

Was the diagnostic test evaluated in an Yes, the Mini-cog test evaluated in an
appropriate spectrum of patients (like appropriate spectrum of patients that is
those in whom it would be used in patient having dementia
practice)?

Was the reference standard applied No, the reference standard was not
regardless of the diagnostic test result? applied regardless of the diagnostic test
result

Was the test (or cluster of tests) validated Yes, the test was validated in a second,
in a second, independent group of independent group of patients
patients?
Conclusion : the result of diagnostic test is valid

Are the valid results of this diagnostic study important?

SAMPLE CALCULATIONS
Target disorder
(cognitive impairment)
Totals
Present Absent
Positive a b a+b
Diagnostic
test result
(Mini-cog Negative c d c+d
test)

a+c b+d a+b+c+d

Totals

Sensitivity = a/(a+c)

Specificity = d/(b+d)

Likelihood ratio for a positive test result = LR+ = sens/(1-spec)

Likelihood ratio for a negative test result = LR - = (1-sens)/spec

Positive Predictive Value = a/(a+b)

Negative Predictive Value = d/(c+d)

Pre-test probability (prevalence) = (a+c)/(a+b+c+d)

Pre-test odds = prevalence/(1-prevalence)
Post-test odds = pre-test odds  LR
Post-test probability = post-test odds/(post-test odds +1)

Can you apply this valid, important evidence about a diagnostic test in caring for your
patient?

Is the diagnostic test available, affordable, Yes, the diagnostic test is available,
accurate, and precise in your setting? affordable, accurate, and precise in my
setting
 Can you generate a clinically sensible
estimate of your patient’s pre-test probability
(from personal experience, prevalence
statistics, practice databases, or primary
studies)?
 Are the study patients similar to your
own?
 Is it unlikely that the disease possibilities
or probabilities have changed since the
evidence was gathered?
Will the resulting post-test probabilities
affect your management and help your
patient?
 Could it move you across a test-
treatment threshold?
 Would your patient be a willing partner
in carrying it out?
Would the consequences of the test help
your patient?
Conclusion : the diagnostic test can be applied to my patient
- yes
- yes, the study patients are
similar to my own
- no, the disease possibelities or
probabilities is likely have
changed since the evidence of
the new diagnostic test is more
spesific and sensitive.
- Yes it will
- Yes, since it was more
sensitive and spesific, it move
me across to it
- Yes
Yes, since it was more sensitive and
spesific, it can help my pasient