Judul artikel Frequency and prevention of symptomless deep-vein

thrombosis in long-haul flights: a randomised trial

Penulis John H Scurr, Samuel J Machin, Sarah Bailey-King, Ian J
Mackie, Sally McDonald, Philip D Coleridge Smith
Jurnal The Lancet
Tahun Penerbitan 2001
Validity: Are the result of the trial valid ? ( Internal Validity)
Yang dinilai FRIBEC
F: Patient Follow-Up
 Were all patient who entered Ya, terdapat 31 orang dari sampel
the trial properly accounted for mengalami drop-out dikarenakan tidak
at its conclusion? Losses to menghadiri pemeriksaan sebelum dan
follow-up should be less than sesudah keberangkatan
20% and reasons for drop-out
given
 Was follow-up long enough? Ya
R: Randomization
 Were the recruited patients Ya dari 479 populasi yang
representative of the target dipertimbangkan diambil 231 orang
population? yang dibagi menjadi 2 grup secara
acak
 Was the allocation Ya, tiap orang diberikan amplop
(assignment) of patients to tertutup yang diisi dengan stocking
treatment randomized and biasa atau stoking kompresi kelas-I di
concealed? bawah lutut (standar kompresi
Hohenstein Jerman; 20–30 mm Hg)
I: Intention to Treat Analysis
 Were patients analyzed in the Ya
groups to which they were
randomized?
 Were all randomized patient Tidak, terdapat 31 orang drop-out
data analyzed? If not, was a sehingga hanya 100 orang pada
sensivity or “worst case masing-masing grup kontrol dan grup
scenario” analysis done? perlakuan yang dianalisis
S: Similar Baseline Characteristics
of Patients
 Were groups similiar at start of Ya, kriteria adalah penumpang
the trial? pesawat kelas ekonomi berusia diatas
50 tahun dengan durasi penerbangan
minimal 8 jam dalam 6 minggu.
Pasien di ekslusi apabila pernah
mengalami trombosis vena, memakan
obat antikoagulan, rutin memakai
stoking kompresi, mempunyai
penyakit cardiorespiratory atau
penyakit berbahaya lainya.
B: Blinding
 Were patients, health workers, Tidak dapat diketahui
an study personnel “blind” to
treatment?
 If blinding was impossibel, Tidak
were blinded raters and/or
objective outcome measures
used?
E: Equal Treatment
 Aside from the experimental Tidak, dikarenakan pasien mengatur
intervention, were the group sendiri perjalanannya dan juga tidak
treated equally? dapat dinilainya perilaku pasien saat
diperjalanan.
C: Conflict of Interest
 Are the sources of support and Tidak dapat diketahui
other potential conflicts of
interest acknowledged and
addressed?
Summary of Article’s Validity
 Notable study strengths or  Strength
weaknesses or concerns? Penelitian ini menunjukan bahwa
pemakaian stoking berpengaruh
terhadap kejadian DVT
 Weakness
Pada penelitian belum dapat
menunjukan DVT tanpa gejala dan
juga terdapat bias pada kebiasaan
pasien

 How serious are the threats to Bias pada kebiasaan pasien saat
validity and in what direction diperjalanan seperti latihan kaki,
could they bias the study berjalan, atau minum air yang dapat
outcomes? mencegah trombosis
IMPORTANCY : What were the results?
Yang dinilai/dihitung
DVT No-DVT
Stoking 0 100 100
Non-Stoking 12 88 100
12 188 200

CER 12/100 = 0,12

EER 0/100 = 0
RR 0/0,12 = 0
RRR 1–0=1
ARR 0,12 – 0 = 0,12
NNT 1/0,12 = 8,3
APPLICABILITY: Will the results help me in caring for my patient?
(External Validity/Applicability)
Is my patient so different to those in  Disesuaikan apakah pasien
the study that the result cannot apply? memenuhi kriteria inklusi
 Perhatikan perbedaan kuantitatif
(umur, status ekonomi, derajat
risiko, dan respon terhadap terapi)
Is the treatment feasible in my setting? Pada penelitian menggunakan stoking
khusus yaitu stoking kompresi kelas-I
di bawah lutut (standar kompresi
Hohenstein Jerman; 20–30 mm Hg)
Will the potential benefits of treatment Potensi bahaya dari penggunaan
outweigh the potential harm of stoking sangat rendah apabila kondisi
treatment for my patient? dan kebersihan dari pemakaian stoking
dijaga dengan baik
Judul artikel Comparison of the value of Mini-Cog and MMSE
screening in the rapid identification of Chinese
outpatients with mild cognitive impairment
Penulis Xueyan Li, MS, Jie Dai, MS, Shasha Zhao, MS,
Wangen Liu, MS, Haimei Li, BS
Jurnal Medicine
Tahun Penerbitan 2018
Validity: Are the result of the trial valid ? ( Internal Validity)
Was there an independent, blind Ya, pada penelitian pasien MCI
comparison with a reference (“gold”) didiagnosis menggunakan kriteria
standard of diagnosis? Petersen dan juga disertakan indeks
CDR dan MMSE

Was the diagnostic test evaluated in an
appropriate spectrum of patients (like
those in whom it would be used in
practice)?
Was the reference standard applied
regardless of the diagnostic test result?
Was the test (or cluster of tests)
validated in a second, independent
group of patients?
Ya, dimana 229 pasien dengan suspec
MCI diambil dengan kriteria eksklusi
adalah pasien dengan retardasi mental,
pasien dengan riwayat konsumsi
antipsikotik jangka lama, pasien
dengan neurosis depresi atau ansietas,
pasien dengan disfungsi penglihatan,
pendengaran dan bicara atau tidak
dapat mengerti bahasanya dan pasien
dengan penyakit mental.
Ya
Ya, sampel dibagi menjadi 2
kelompok dengan MCI dan tidak ada
MCI. Seluruh pasien dilakukan
pemeriksaan MMSE dan Mini-Cog

IMPORTANCY : What were the results?

Yang dinilai/dihitung
MCI Non-MCI
Mini- Positif 90 21 111
cog Negatif 15 81 96
105 102 207

Sensitivity = a/(a+c) 90/105= 0,85 = 85%

Specificity = d/(b+d) 81/102= 0,79 = 79%
Positive Predictive Value = a/(a+b) 90/111= 0,81 = 81%
Negative Predictive Value = d/(c+d) 81/96= 0,84 = 84%
Likelihood ratio for a positive test 0,85/(1-0,79)= 0,85/0,21 = 4,04
result = LR+ = sens/(1-spec)
Likelihood ratio for a negative test (1-0,85)/0,79= 0,15/0,7 = 0,18
result = LR - = (1-sens)/spec
Pre-test probability (prevalence) = 105/207 = 0,5
(a+c)/(a+b+c+d)
Pre-test odds = prevalence/(1- 0,5/(1-0,5) = 1
prevalence)
Post-test odds = pre-test odds  LR 1 x 0,18 = 0,18
Post-test probability = post-test 0,18/(0,18+1)= 0,18/1,18 = 0,15
odds/(post-test odds +1)

Yang dinilai/dihitung
MCI Non-MCI
MMSE Positif 68 29 97
Negatif 37 73 110
105 102 207

Sensitivity = a/(a+c) 68/105 =0,64 = 64%

Specificity = d/(b+d) 73/102 = 0,71 = 71%
Positive Predictive Value = a/(a+b) 68/97 = 0,70 = 70%
Negative Predictive Value = d/(c+d) 73/110 = 0,66 = 66%
Likelihood ratio for a positive test 0,64/(1-0,71) = 0,64/0,29 = 2,20
result = LR+ = sens/(1-spec)
Likelihood ratio for a negative test (1-0,64)/0,71 = 0,36/0,71 = 0,5
result = LR - = (1-sens)/spec
Pre-test probability (prevalence) = 105/207 = 0,5
(a+c)/(a+b+c+d)
Pre-test odds = prevalence/(1- 0,5/(1-0,5) = 1
prevalence)
Post-test odds = pre-test odds  LR 1 x 2,20 = 2,20
Post-test probability = post-test 2,2/(2,2+1) = 2,2/3,2 = 0,68
odds/(post-test odds +1)

APPLICABILITY: Will the results help me in caring for my patient?

(External Validity/Applicability)
Is the diagnostic test available, Ya, Mini-Cog terdiri dari 3 objek
affordable, accurate, and precise in pengingat ulang dan Clock Drawing
your setting? Test (CDT)

Can you generate a clinically sensible

estimate of your patient’s pre-test
probability (from personal experience,
prevalence statistics, practice
database, or primary studies)?
 Are the study patients similar Ya, kasus MCI sangat banyak
to your own? ditemukan dimana harus diperhatikan
kondisi pasien itu sendiri
  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?
Perubahan yang dapat terjadi yaitu
perburukan kondisi pasien akibat dari
progesifitas penyakit
Tidak, Mini-Cog belum bisa dipakai
sendiri dalam menilai tingkat kognitif
pasien. Kombinasi dengan tes lain
sangat direkomendasikan.
Ya, Mini-cog lebih sederhana, cepat,
murah , dan dapat lebih mudah
dimengerti serta diterima oleh pasien
Ya, dikarenakan Mini-Cog tidak
dipengaruhi oleh bahasa serta tingkat
pendidikan pasien.