LEMBAR JAWABAN

SKILL LAB EVIDENCE BASED MEDICINE (EBM)

Nama : ARYATI FADHILA
NIM : 04082722024004
Prodi : Dermatologi Venereologi

1. Nilai rerata, standard deviasi, abnormalitas

Parameter Rerata SD Rerata 2SD Nilai Abnormalitas
SGOT/SGPT 26.29 13.923 54.136 54.136 + 0.05 = 54,186
Abnormal: >54.18
Hemoglobin 12.472 0.3238 12,472 12,472 – 0.05 = 12,422
Abnormal: <11.78
Trigliserida 115.30 20.047 155.404 155.404 + 0.05 = 155.454
Abnormal: >155.45
Total kolesterol 137.23 32.405 202.05 202.05 + 0.05 = 202.10
Abnormal : >202.10
HDL 89.44 17.119 55.202 55.202 – 0.05 = 55.152
Abnormal: <55.17
LDL 74.64 13.634 101.908 101.908 + 0.05 = 101.952
Abnormal : >101.95

2. a. Tabel PICO
P 2 months infant
I Tachypnea
C Oximetry
O Hypoxia

b. Clinical question:
In 2 month infant, is tachypnea as accurate as oximetry in diagnosis hyoxia?

c. Search term
A 2 month old AND tachypnea And oximetry AND hypoxia

d. Searching
https://www.ncbi.nlm.nih.gov/pubmed/10630912
 Medicine (Baltimore). 2018 Jun;97(22):e10966. doi: 10.1097/MD.0000000000010966.

e. Critical appraisal

VALIDITY: Are the results of this diagnostic study valid?

Was there an independent, blind
comparison with a reference (Gold
Standard) of diagnosis?
No. The comparison is not done
independently, not blinded, the patients were
divided into groups MCI and non-MCI
according to the final evaluation by a
neurologist. There is comparison with
reference diagnosis (MMSE), the data
collected by 4 trained physicians.

Was the diagnostic test evaluated in an
appropriate spectrum of patients (like
those in whom it would be used in
practice?)
Yes. It was evaluated in 229 patients with
suspected MCI who visited the Cangzhou
Central Hospital between March 2012 and
April 2016 and consulted a first-line physician
at the outpatient department.

Was the reference standard applied Yes. MMSE was applied in all patients.
regardless of the diagnostic test result?

Was the test (or cluster of tests) validated No. the test is done in all patients, same as the
in a second, independent group of MMSE test.
patients?

Note: The study is a retrospective study, comparing the Mini-cog test and MMSE in all of the
patients, MCI group and non-MCI groups. The study results are still valid, although the
evidence level is not as good as prospective studies.

IMPORTANCE: Are the valid results of this diagnostic study important?

Table 1. Mini-Cog test for identifying MCI

MCI Total

Positive Negative

Diagnostic test Mini-Cog 90 15 105

results positive

Mini-Cog 21 81 102
negative

Total 111 96 207

Sensitivity (sn) a/(a+c) = 90/111 = 81.08%

Specificity (sp) d/(b+d) = 81/96 = 84.38%

Positive predictive value (PPV) a/(a+b) = 90/105 = 85.71%

Negative predictive value (NPV) d/(c+d) = 81/102 = 79,41%

Likelihood ratio positive (LR+) sn/(1-sp) = 81.08/15.62 = 5.19

Likelihood ratio negative (LR-) (1-sn)/sp = 18.92/84.38 = 0.22

Pre-test probability (prevalence) (a+c)/(a+b+c+d) = 111/207 = 53.6%

Pre-test odds prevalence/ (1-prevalence) = 0.54/0.46 = 1.17

Post-test odds Pre-test odds x LR+ = 1.17 x 5.19 = 6.07

Post-test probability Post-test odds/(post-test odds+1)= 6.07/7.07 =
85.8%

Table 2. MMSE test for identifying MCI

MCI Total

Positive Negative

Diagnostic test MMSE positive 68 37 105

results
MMSE negative 29 73 102

Total 97 110 207

Sensitivity (sn) a/(a+c) = 68/97 = 70.10%

Specificity (sp) d/(b+d) = 73/110 = 66.36%

Positive predictive value (PPV) a/(a+b) = 68/105 = 64.76%

Negative predictive value (NPV) d/(c+d) = 73/102 = 71.56%

Likelihood ratio positive (LR+) sn/(1-sp) = 70.10/33.64 = 2.08

Likelihood ratio negative (LR-) (1-sn)/sp = 29.90/66.36 = 0.45

Pre-test probability (prevalence) (a+c)/(a+b+c+d) = 97/207 = 46.86%

Pre-test odds prevalence/ (1-prevalence) = 0.47/0.53 = 0.88

Post-test odds Pre-test odds x LR+ = 0.88 x 2.14 = 1.88

Post-test probability Post-test odds/(post-test odds+1)= 1.88/2.88 =

65.28%

Note:

Quoted from the study:

“There were significant differences in Mini-Cog (P < .05) and MMSE (P < .05)
between the MCI and non-MCI groups. The sensitivity, specificity, positive
predictive value, negative predictive value, and Youden index (85.71%, 79.41%,
0.8108, 0.8438, and 0.6550) of Mini-Cog were all higher than those of MMSE
(64.76%, 71.57%, 0.7010, 0.6364, and 0.3370) in identifying MCI, but there was
no significant difference in specificity (P>.05). Mini-Cog was better than MMSE
(P<.05) for MCI patients with different ages and education levels.

These results showed that the Mini-Cog was superior to MMSE in identifying MCI
patients.”

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

Is the diagnostic test available, affordable,
accurate, and precise in your setting?
Yes. The Mini-cog is available and affordable
(no cost) can be done in short time (3-4
minutes) and easily accepted by the patients,
could be more suitable for application in
outpatient department in primary hospital or
RSMH.

Can you generate a clinically sensible

estimation 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?  Yes the study patients are similar to RSMH
 Is it unlikely that the disease
patients.
possibilities or probabilities has  It is possible the disease has changed.
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-

 Yes it could.
treatment threshold?
 Perhaps.
 Would your patient be a willing partner
in carrying it out?

Would the consequences of the test help Yes, the consequences of the Mini-Cog will
your patient? help our patients.

Note: The Mini-cog test is applicable in RSMH, because it is affordable, accepted by the
patients of the study, and can be done in short time.

3. a. Grafik titik potong diagnostik

b. titik potong diagnostik kreatinin kinase x MCI adalah 70 IU.

c. MedCalc diagnostic values.

d. Cat maker diagnostic values.
e. EpiCalc diagnostic values.
f. Stats calculator diagnostic values
 Secara klinis:
- EER : 0,12 artinya kejadian kematian 12 % pada penggunaan ACE-Inhibitor
- CER : 0,26 artinya kejadian kematian pada kelompok penggunaan placebo
sebesar 26%
- RR: 0,46 artinya ACE inhibitor merupakan factor proteksi terjadinya kematian
- ARR: 0,14 artinya peluang kematian penggunaan ACE inhibitor dapat
mengurangi kematian sebesar 14%
- RRR: 0,538 artinya pengurangan kematian pada penggunaan ACE Inhibitor
sebesar 53,8% di bandingkan Placebo
- NNT : 7,14 artinya diperlukan pengobatan dengan ACE inhibitor sebanyak 7- 8
orang untuk mencegah 1 kematian selama 2 tahun

Secara statistic pada uji Chi square

4. Importance for bad outcome

 CER = 0.260

 EER = 0.120

 RRR = 54%

 ARR = 0.140

 NNT=7

Kesimpulan

 RRR = 54% berarti sangat bermakna secara klinis

 95% CI = -4% sampai 100% berarti tidak bermakna secara statistik

 NNT = 7 berarti untuk mencegah 1 kematian, perlu pengobatan dengan ACE

inhibitor terhadap 7 pasien.

4. a. Importance effectiveness of therapy

 CER = 0.180
 EER = 0.520
 RBI = -189%
 ABI = -0.340
 NNT = -3

b. Kesimpulan:

 RRR = -189% berarti sangat bermakna secara klinis

 95% CI = -286% hingga -92% berarti tidak bermakna secara statistik
 NNT = -3 berarti untuk memperoleh kesembuhan pada 1 pasien hipertensi, perlu
pengobatan dengan enalapril + ASA pada 3 pasien.