LEMBAR JAWABAN

SKILLAB EVIDENCE BASED MEDICINE (EBM)

Nama : Annisa Khaira Ningrum

NIM : 04011181320058

1. Dalam file excel tersedia Data Abnormalitas. Data abnormalitas terdiri dari variable
SGOT/SGPT laki-laki, hemoglobin, trigliserid, total kolesterol, HDL, dan LDL.
Hitunglah nilai abnormalitas dari data tersedia.
1.1. Hitung Harga Rerata dan Standar Deviasi
Statistics
SGOT/SGPT Hemoglobin Trigliserid TotalKolestrol HDL LDL
N Valid 200 200 200 200 200 200
Missing 0 0 0 0 0 0
Mean 26.290 12.472 115.305 137.235 89.440 74.640
Std. Deviation 13.9232 .3238 20.0475 32.4054 17.1193 13.6341

1.2. Nilai Abnormalitas

Parameter Rata-Rata + 2SD Nilai Abnormalitas
SGOT/SGPT 26.290+ 2(13.9232) = 54.13 54.13 + 0.05 = 54.18
Hemoglobin 12.472 - 2(0.3238) = 11.8244 11.82 – 0.05 = 11.77
Trigliserid 115.305 + 2(20.0475) = 155.38 155.38 + 0.05 = 155.43
Total Kolesterol 137.235 + 2(32.4054) = 202.04 202.04 + 0.05 = 202.09
HDL 89.440 - 2(17.1193) = 55.20 55.20 - 0.05 = 55.15
LDL 74.640 + 2(13.6341) = 101.90 101.90 + 101.95

2. Tersedia clinical scenario sebagai berikut:

You are a general practitioner working in a primary health care team who frequently
sees older patients reporting memory loss and concerned about the onset of dementia.
You routinely use the Mini-Mental State Examination (MMSE) screening tool with these
patients to evaluate their cognitive function as you know this tool to be sensitive, valid,
and reliable. Recently, you have heard of a tool called the Mini-cog which is considered
quicker to administer and better for patients who or older, less educated, or from
culturally and linguistically diverse (CALD) communities. You wish to find out if the
Mini-Cog test is as accurate as the MMSE in detecting Alzheimer’s disease or dementia.
Dari clinical scenario buatlah:

2.1. Tabel P.I.C.O

P Older adults with early signs/symptoms of cognitive impairment; Older
patients with loss memory and dementia
 I Mini-Cog
C MMSE
O Accurate diagnosis of dementia or Alzheimer’s disease; Mini-Cog is as
sensitive as MMSE

2.2. Clinical Question

In older adults with early signs/symptoms of cognitive impairment is the Mini-Cog
test as accurate as the Mini-Mental State Examination (MMSE) in diagnosing
dementia or Alzheimer’s disease

2.3. Search Term/Search/Keyword

(Mini-cog OR minicog) AND (Mini-mental state Exa* OR MMSE OR SMMSE)
AND (Alzheimer* OR dementia).

2.4. Lakukan searching dan paste Abstract

ABSTRACT
Importance  Dementia is a global public health problem. The Mini-Mental State
Examination (MMSE) is a proprietary instrument for detecting dementia, but
many other tests are also available.
Objective  To evaluate the diagnostic performance of all cognitive tests for the
detection of dementia.
Data Sources  Literature searches were performed on the list of dementia
screening tests in MEDLINE, EMBASE, and PsychoINFO from the earliest
available dates stated in the individual databases until September 1, 2014. Because
Google Scholar searches literature with a combined ranking algorithm on citation
counts and keywords in each article, our literature search was extended to Google
Scholar with individual test names and dementia screening as a supplementary
search.
Study Selection  Studies were eligible if participants were interviewed face to
face with respective screening tests, and findings were compared with criterion
standard diagnostic criteria for dementia. Bivariate random-effects models were
used, and the area under the summary receiver-operating characteristic curve was
used to present the overall performance.
Main Outcomes and Measures  Sensitivity, specificity, and positive and
negative likelihood ratios were the main outcomes.
 Results  Eleven screening tests were identified among 149 studies with more than
49 000 participants. Most studies used the MMSE (n = 102) and included 10 263
patients with dementia. The combined sensitivity and specificity for detection of
dementia were 0.81 (95% CI, 0.78-0.84) and 0.89 (95% CI, 0.87-0.91),
respectively. Among the other 10 tests, the Mini-Cog test and Addenbrooke’s
Cognitive Examination–Revised (ACE-R) had the best diagnostic performances,
which were comparable to that of the MMSE (Mini-Cog, 0.91 sensitivity and 0.86
specificity; ACE-R, 0.92 sensitivity and 0.89 specificity). Subgroup analysis
revealed that only the Montreal Cognitive Assessment had comparable
performance to the MMSE on detection of mild cognitive impairment with 0.89
sensitivity and 0.75 specificity.
Conclusions and Relevance  Besides the MMSE, there are many other tests with
comparable diagnostic performance for detecting dementia. The Mini-Cog test
and the ACE-R are the best alternative screening tests for dementia, and the
Montreal Cognitive Assessment is the best alternative for mild cognitive
impairment.

1.1. Lakukan critical appraisal

1. Validity Padapenelitianini, variable yang
diukuryaituberdasarkanskrinninguntukmendapatkankriteriad
iagnostik dementia.
Pengumpulan data
dilakukandenganmelakukanwawancaratatapmukasecaralang
sung.
Kesimpulan: Penelitianinimemilikivaliditas yang baik.
2. Importance Penelitianinipentingkarenahasilujidiagnostikinimenunjukkan
hasilbahwasensitivitas Mini-Cog dan ACE-R
lebihtinggidaripada MMSE. Sedangkan, spesifisitas Mini-
Cog lebihrendahdibandingkan MMSE dansamadengan
ACE-R.
Kesimpulan:Melihattujuanpenelitianmakadapatdisimpulkan
bahwapenelitianinipenting.
3. Applicability Penelitianinidapatditerapkandalamkehidupansehari-
hariuntukskrinningdementia
karenaberdasarkanhasilpemelitianMini-Cog dan ACE-R
lebihsensitifdanbisadijadikanalternatif MMSE.
 Kesimpulan: Hasilpenelitianditerapkan.

2.5. Critical Aprraisal dari artikel dengan critical appraisal worksheet

3. Dalam file excel tersedia Data Diagnostik. Data diagnostik terdiri dari variable LDL dan
kreatinin kinase.
3.1. Buatlah grafik Titik Potong Diagnostik

Classification: MCI
100
90
80
70
60
Sensitivity (%)
50
Specificity (%)
40
30
20
10
0
40 50 60 70 80
KretaininKinase

3.2. Perkirakan secara visual nilai titik potong diagnostic dan interpretasikan
Secara visual grafik kreatinin kinase antara 80-90 atau nilai kreatinin kinase >80
dan <90

3.3. Hitunglah seluruh nilai diagnostik memakai MedCalc, buatlah kesimpulan.

 KretaininKinase
100
Sensitivity: 100.0
Specificity: 92.0
Criterion : >69.1098
80
Sensitivity
60

40

20

0
0 20 40 60 80 100
100-Specificity

ROC curve
Variable KretaininKinase
KretaininKinase
Classification variable MCI
 

Sample size   100
Positive group :  MCI = 1 13
Negative group :  MCI = 0 87
 

Disease prevalence (%) Unknown
 

Area under the ROC curve (AUC)
 

Area under the ROC curve (AUC)  0.973
Standard Errora 0.0140
95% Confidence intervalb 0.919 to 0.995
z statistic 33.901
Significance level P (Area=0.5) <0.0001
a
DeLong et al., 1988
b
Binomial exact
 

Youden index
 
 Youden index J 0.9195
Associated criterion >69.1098
 

Criterion values and coordinates of the ROC curve [Hide]
 

Criterion Sensitivity 95% CI Specificity 95% CI +LR -LR

≥40.0886 100.00 75.3 - 100. 0.00 0.0 - 4.2 1.00  
0
>69.109 100.00 75.3 - 100. 91.95 84.1 - 96.7 12.4 0.00
8 0 3
>70.164 92.31 64.0 - 99.8 93.10 85.6 - 97.4 13.3 0.083
1 8
>72.903 76.92 46.2 - 95.0 93.10 85.6 - 97.4 11.1 0.25
8 5
>73.249 69.23 38.6 - 90.9 94.25 87.1 - 98.1 12.0 0.33
5 5
>75.240 69.23 38.6 - 90.9 96.55 90.3 - 99.3 20.0 0.32
7 8
>76.514 61.54 31.6 - 86.1 97.70 91.9 - 99.7 26.7 0.39
8 7
>76.887 53.85 25.1 - 80.8 98.85 93.8 - 100. 46.8 0.47
2 0 5
>77.457 38.46 13.9 - 68.4 98.85 93.8 - 100. 33.4 0.62
4 0 6
>77.995 30.77 9.1 - 61.4 100.00 95.8 - 100.   0.69
0
>78.675 0.00 0.0 - 24.7 100.00 95.8 - 100.   1.00
1 0
 

Kesimpulan: Kreatinin Kinase dapat mendiagnosis MCI dengan sensitifitas 100%,

Spesifisitas 92.0% dan titik potong >69.11%

4. Dalam file excel tersedia Data Therapy Bad Outcome

4.1. Nilai-nilai Impotance
KelompokPerlakuan * Outcome Crosstabulation
Count
Outcome
Alive Dead Total
KelompokPerlakuan Ace Inhibitor 44 6 50
Placebo 37 13 50
Total 81 19 100

Teratment Alive Dead Total

Ace Inhibitor 44 6 50
Placebo 37 13 50
Total 81 19 100
 Relative Risk (RR) 1.189189189

   

Odds Ratio (OR)

2.576576577
(i.e. Relative Odds)

   
Absolute Risk Reduction (ARR) |
0.14
Absolute Risk Increase (ARI)
Relative Risk Reduction (RRR) | 0.189189189
Relative Risk Increase (RRI)  
Number Needed to Treat (NNT) |
7.142857143
Number Needed to Harm (NNH)
RRR = 0.189 = 19%
ARR = 0.14 = 14%
NNT = 7.14
4.2. Kesimpulan
ACE Inhibitor tidak efektif dalam mencegah kematian MCI hanya 19%
5. Dalam file excel tersedia Data Therapy Effectiveness
5.1. Nilai-nilai Importance
Teratment Effective Non-effective Total
Ace Inhibitor 26 24 50
Placebo 9 41 50
Total 81 19 100

Kelompok * Outcome Crosstabulation

Count
Outcome
Effective Non-effevtive Total
Kelompok Enalapril + ASA 26 24 50
Isosorbit Dinitrat 10mg 9 41 50
Total 35 65 100

ABI = 0.52-0.18
0.34 = 34%
RBI = 0.34/0/18
= 1.888 = 189%
NNT = 1/0.34
= 2.94
Kesimpulan = Enalapril + ASA sangat efektif