Skillab Praktikum EBM

Disusun Oleh:
dr. Daniel Bramantyo 04092722125003

DEPARTEMEN ILMU KESEHATAN THTKL

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA
RSUP DR. MUHAMMAD HOESIN
PALEMBANG
2021
 SOAL SKIL LAB EBM 2021 PPDS1

1. Dalam file excel tersedia DATA abnormalitas. Data abnormallitas tersebut terdiri dari
variabel SGOT/SGPT laki-laki, hemoglobin, trigliceyde, total kolesterol, HDL dan
LDL. Hitunglah nilai abnormalitas dari data yang tersedia.
1.1. Hitunglah harga rerata
1.2.Hitunglah standar deviasi

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

SGOT/SGPT Laki-laki 200 1 49 26,29 13,923

Hemoglobin 200 12,0 13,0 12,472 ,3238
Trigliserid 200 81 148 115,30 20,047
Total Kolestrol 200 80 199 137,23 32,405
HDL 200 61 119 89,44 17,119
LDL 200 50 98 74,64 13,634
Valid N (listwise) 200

  N Minimum Maximum Mean Std. Nilai

Deviation
SGOT/SGPT 200 1 49 26,29 13,923 54,13638
Laki-laki

Hemoglobin 200 12,0 13,0 12,472 ,3238 11,82442

Trigliserid 200 81 148 115,31 20,047 155,4

Total 200 80 199 137,24 32,405 202,0458
Kolestrol
HDL 200 61 119 89,44 17,119 55,20132
LDL 200 50 98 74,64 13,634 101,9083
Valid N 200        
(listwise)

2. Rapid breathing is an important clinical manifestation of illness in a young infant.

Acute Respiratory Infection especially pneumonia often delay referring to the
hospital, especially in a 2-month infant. At a primary health care facility or a crowded
paediatric emergency room, respiratory rate counted for one complete minute has
been found to be useful in assessing the severity of respiratory infection in infants
under 2 months. A respiratory rate of > 60 breaths/ min is used as a predictor of
pneumonia in the case management guidelines of the World Health Organisation’s
acute respiratory infection control programmes globally. However, very little data
on the usefulness of respiratory rate as an indicator of hypoxia and risk of
mortality in illnesses other than pneumonia are available.A gold standard for
diagnosing hypoxia is oximetry but this is expensive.
 2.1. Buatlah Tabel P.I.C.O
P Infants with Pneumonia under 2 months
I Respiratory Rate Examination
C Oxymetry
O Early Hypoxia Diagnostic and
Reduce risk of mortality
2.1. Buatlah Clinical Question

Clinical Question:
P I C O

Konsep 1 Konsep 2 Konsep 3 Konsep 4

Oxymetry
Infants with Respiratory Rate Early Hypoxia
Pneumonia Examination and diagnosis
under 2 months Oxymetry
# Infants with #3 Respiratory Rate #4 Oxymetr #5 Early Hypoxia
1 Pneumonia Examination y diagnosis
under 2 months
# Neonatal #6 reduce risk of
2 Pneumonia mortality
Is respiratory rate examination in infants with pneumonia under 2 months
effective as an early hypoxia diagnostic to reduce risk of mortality?

2.2. Buatlah Search Term/Search/Keyword

2.3. Lakukan Searching

Telah dilakukan pencarian pada database jurnal online www.pubmed.gov,
menggunakan search term / search keyword “...AND ....”, ditemukan ... jurnal dan
 hanya 1 yang relevan dengan clinical scenario.

2.4. Pastekan Abstract Artikel yang didapat pada lembar Jawaban

Am J Perinatol




. 2020 Nov;37(13):1310-1316.

 doi: 10.1055/s-0040-1715862. Epub 2020 Sep 3.

Characteristics of Newborns Born to SARS-CoV-2-Positive

Mothers: A Retrospective Cohort Study
Mohsen A A Farghaly 1 2, Fernanda Kupferman 1, Fiorella Castillo 1, Roger M Kim 1

Affiliations expand

 PMID: 32882743

 DOI: 10.1055/s-0040-1715862

Abstract

Objective: The novel virus known as severe acute respiratory syndrome-coronavirus-

2 (SARS-CoV-2) has led to a terrifying pandemic. The range of illness severity among
children is variable. This study aims to assess the characteristics of newborns born to
SARS-CoV-2-positive women compared with those mothers who tested negative.

Study design: This was a retrospective cohort study performed at Brookdale

Hospital Medical Center in New York City from March to May 2020. Electronic
medical records of mother-baby dyads were reviewed.

Results: Seventy-nine mothers tested for SARS-CoV-2 were included, out of which

18.98% of mothers tested SARS-CoV-2 positive. We found a significant association
between symptoms and SARS-CoV-2 status. We observed a significant association
between newborns of SARS-CoV-2 positive and SARS-CoV-2 negative mothers
regarding skin-to-skin contact (p < 0.001). Both groups showed significant
differences regarding isolation (p < 0.001). Interestingly, regarding SARS-CoV-2
infection in newborns, only one newborn tested SARS-CoV-2 positive and was
unstable in the neonatal intensive care unit (NICU). With the multivariable logistic
regression model, babies of SARS-CoV-2 positive mothers were three times as likely
to have desaturations in comparison to newborns from negative mothers. Also,
newborns of SARS-CoV-2-positive mothers were four times more likely to have poor
feeding, compared with newborns of SARS-CoV-2-negative mothers. Finally, babies
of SARS-CoV-2-positive mothers were ten times more likely to be symptomatic at
the 2-week follow-up.

Conclusion: SARS-CoV-2 has caused major morbidity and mortality worldwide.

Neonates born to mothers with confirmed or suspected SARS-CoV-2 are most of the
time asymptomatic. However, neonatal critical illness due to SARS-CoV-2 is still a
possibility; thus, isolation precautions (such as avoiding skin-to-skin contact and
direct breastfeeding) and vertical transmission should be studied thoroughly. In
addition, testing these newborns by nasopharyngeal swab at least at 24 hours after
birth and monitoring them for the development of symptoms for 14 days after birth
is needed.

Key points: · For SARS-CoV-2-positive mothers, reducing transmission of infection to

newborns is crucial.. · Newborns of SARS-CoV-2-positive mothers are usually
asymptomatic and may not be easily infected.. · Critical illness in the newborn may
still happen, so monitoring is needed..

2.5. Lakukan Critical Appraisal dari Artikel dengan critical appraisal worksheet
No Questions Answers

1. What is the research to assess the characteristics of newborns

question and/or hypothesis? born to SARS-CoV-2-positive women
compared with those mothers who tested
negative.
2. What is the study type?
3. What is the reference
population ? What are the
sampling frame and
sampling method ?
4. In an experimental study,
how are subjects assigned to
group ? In a longitudinal
study how many reached
final follow up ?
5. What are the study factors
and how are they measured?
6. What are the outcome
factors and how are they
measured ?
7. What important potential
confounders are
considered ?
8. Are statistical tests
considered ?
9. Are the results clinically /
socially important?
a retrospective cohort study
Seventy-nine mothers tested for SARS-
CoV-2 were included, out of which 18.98%
of mothers tested SARS-CoV-2 positive
Also, newborns of SARS-CoV-2-positive
mothers were four times more likely to
have poor feeding, compared with
newborns of SARS-CoV-2-negative
mothers.
Both groups showed significant differences
regarding isolation (p < 0.001).
Interestingly, regarding SARS-CoV-2
infection in newborns, only one newborn
tested SARS-CoV-2 positive and was
unstable in the neonatal intensive care unit
(NICU)
SARS-CoV-2 has caused major morbidity and
mortality worldwide. Neonates born to
mothers with confirmed or suspected SARS-
CoV-2 are most of the time asymptomatic.
However, neonatal critical illness due to
SARS-CoV-2 is still a possibility; thus,
isolation precautions (such as avoiding
skin-to-skin contact and direct
breastfeeding) and vertical transmission
should be studied thoroughly. In addition,
testing these newborns by nasopharyngeal
swab at least at 24 hours after birth and
monitoring them for the development of
symptoms for 14 days after birth is needed.
All analyses were performed using Stata
version 15.0.17 A 2-sided P value of \.05 was
considered statistically significant, except for
the heterogeneity test, in which a P value of \.1
was used.
Yes, The network meta-analysis performed in
this systematic review enabled treatment
ranking, which can be used to support
clinicians’ decisions regarding treatment
choices
10 What conclusions did the
authors reach about the
research question ? Did they
generate new hypotheses ?
Do you agree with the
conclusions ?
SARS-CoV-2 has caused major morbidity and
mortality worldwide. Neonates born to
mothers with confirmed or suspected SARS-
CoV-2 are most of the time asymptomatic.
However, neonatal critical illness due to SARS-
CoV-2 is still a possibility; thus, isolation
precautions (such as avoiding skin-to-skin
contact and direct breastfeeding) and vertical
transmission should be studied thoroughly. In
addition, testing these newborns by
nasopharyngeal swab at least at 24 hours after
birth and monitoring them for the
development of symptoms for 14 days after
birth is needed.

3. The patient is a 65 year old male with a long history of type 2 diabetes and obesity.
Otherwise his medical history is unremarkable. He does not smoke. He had knee
surgery 10 years ago but otherwise has had no other major medical problems. Over
the years he has tried numerous diets and exercise programs to reduce his weight but
has not been very successful. His granddaughter just started high school and he wants
to see her graduate and go on to college. He understands that his diabetes puts him at
a high risk for heart disease and is frustrated that he cannot lose the necessary weight.
His neighbor told him about a colleague at work who had his stomach stapled and as a
result not only lost over 100 lbs. but also "cured" his diabetes. He wants to know if
this procedure really works.

3.1 Buatlah Tabel P.I.C.O

P Male with Diabetes; Diabetic patient
I Stomach stapling ; Bariatric surgery
C Standard medical care
O Remission of diabetes; weight loss;
mortality

3.2 Buatlah Clinical Question

Is stomach stapling in a male with diabetes better than standard medical care and
diet to reduce weight and remission of diabetes?

3.3 Buatlah Search Term/Search/Keyword

P I C O
 Konsep 1 Konsep 2 Konsep 3 Konsep 4
Standard
Male with Stomach Medical Care Remission of
Diabetes stapling diabetes
# Diabetic #3 Stomach #5 Standard #7 Remission of
1 patient stapling Medical care diabetes
# Diabetic #4 Bariatric #6 Diet #8 Weight loss
2 patient surgery
#9 Mortality

3.4 Lakukan Searching

Telah dilakukan pencarian pada database jurnal online www.pubmed.gov,
menggunakan search term / search keyword “...AND ....”, ditemukan ... jurnal dan
hanya 1 yang relevan dengan clinical scenario.

3.5 Pastekan Abstract Artikel yang didapat pada lembar Jawaban

 Gastric bypass surgery vs intensive lifestyle and medical
intervention for type 2 diabetes: the CROSSROADS
randomised controlled trial
David E Cummings 1, David E Arterburn 2, Emily O Westbrook 2, Jessica N Kuzma 3, Skye D
Stewart 4, Chun P Chan 4, Steven N Bock 5, Jeffrey T Landers 6, Mario Kratz 3, Karen E Foster-
Schubert 7, David R Flum 4

 PMID: 26983924
 PMCID: PMC4826815
 DOI: 10.1007/s00125-016-3903-x

Abstract

Aims/hypothesis: Mounting evidence indicates that Roux-en-Y gastric bypass

(RYGB) ameliorates type 2 diabetes, but randomised trials comparing surgical vs
nonsurgical care are needed. With a parallel-group randomised controlled trial (RCT),
we compared RYGB vs an intensive lifestyle and medical intervention (ILMI) for type 2
diabetes, including among patients with a BMI <35 kg/m(2).

Methods: By use of a shared decision-making recruitment strategy targeting the

entire at-risk population within an integrated community healthcare system, we
screened 1,808 adults meeting inclusion criteria (age 25-64, with type 2 diabetes and
a BMI 30-45 kg/m(2)). Of these, 43 were allocated via concealed, computer-
generated random assignment in a 1:1 ratio to RYGB or ILMI. The latter involved ≥45
min of aerobic exercise 5 days per week, a dietitian-directed weight- and glucose-
lowering diet, and optimal diabetes medical treatment for 1 year. Although treatment
allocation could not be blinded, outcomes were determined by a blinded adjudicator.
The primary outcome was diabetes remission at 1 year (HbA1c <6.0% [<42.1
mmol/mol], off all diabetes medicines).

Results: Twenty-three volunteers were assigned to RYGB and 20 to ILMI. Of these, 11

withdrew before receiving any intervention. Hence 15 in the RYGB group and 17 in
the IMLI group were analysed throughout 1 year. The groups were equivalent
regarding all baseline characteristics, except that the RYGB cohort had a longer
diabetes duration (11.4 ± 4.8 vs 6.8 ± 5.2 years, p = 0.009). Weight loss at 1 year was
25.8 ± 14.5% vs 6.4 ± 5.8% after RYGB vs ILMI, respectively (p < 0.001). The ILMI
exercise programme yielded a 22 ± 11% increase in [Formula: see text] (p<0.0001),
whereas [Formula: see text] after RYGB was unchanged. Diabetes remission at 1 year
was 60.0% with RYGB vs 5.9% with ILMI (p = 0.002). The HbA1c decline over 1 year
was only modestly more after RYGB than ILMI: from 7.7 ± 1.0% (60.7 mmol/mol) to
6.4 ± 1.6% (46.4 mmol/mol) vs 7.3 ± 0.9% (56.3 mmol/mol) to 6.9 ± 1.3% (51.9
mmol/mol), respectively (p = 0.04); however, this drop occurred with significantly
fewer or no diabetes medications after RYGB. No life-threatening complications
occurred.

Conclusions/interpretation: Compared with the most rigorous ILMI yet tested

against surgery in a randomised trial, RYGB yielded greater type 2 diabetes remission
in mild-to-moderately obese patients recruited from a well-informed, population-
based sample.

Trial registration: ClinicalTrials.gov NCT01295229.

Keywords: Bariatric surgery; Diabetes; Intensive lifestyle; Metabolic surgery;

Randomised controlled trial.

3.6 Lakukan Critical Appraisal dari Artikel dengan critical appraisal worksheet
No Questions Answers

1. What is the research to compared Gastric Bypass vs an intensive

question and/or hypothesis? lifestyle and medical intervention (ILMI) for
type 2 diabetes, including among patients
with a BMI <35 kg/m(2)
2. What is the study type? a case control study

3. What is the reference Candidates were considered eligible if they

population ? What are the
sampling frame and
sampling method ?
4. In an experimental study,
how are subjects assigned to
group ? In a longitudinal
study how many reached
final follow up ?
were 25–64 years old, had a BMI of 30–45
kg/m2, were currently taking diabetes
medications, were covered by insurance
that had a bariatric surgery rider (if BMI
35–45 kg/m2), and were willing to accept
randomisation into either intervention
group and then follow the full protocol for
≥1 year.
The randomised RYGB and ILMI groups were
assessed for demographic and baseline health
differences using the Mann–Whitney test or
Fisher’s exact test as applicable. By using an
intention-to-treat approach, we tested for
differences in health outcomes between
baseline and follow-up within each intervention
group, and also for differences in the
magnitude of change in outcomes between
intervention groups. There was no loss to
follow-up for our primary outcome at 1 year.
5. What are the study factors
and how are they measured?
6. What are the outcome
factors and how are they
measured ?
7. What important potential The size of the sample was too small.
confounders are considered?
8. Are statistical tests
considered ?
9. Are the results clinically /
socially important?
10 What conclusions did the
authors reach about the
research question ? Did they
generate new hypotheses ?
Do you agree with the
conclusions ?
4. File SPSS ada Data diagnosis td data LDL dan kreatinine
kinase
a. Buatlah grafik titik potong diagnostik, pastekan pada lembar jawaban.
Diabetes remission at 1 year was 60.0% with
RYGB vs 5.9% with ILMI (p=0.002)
The primary outcome was the percentage of
participants in each group who achieved
diabetes remission at 1 year, defined as an
HbA1c of <6.0% (<42.1 mmol/mol), off all
diabetes medications. Secondary outcomes
included changes in fasting glucose and insulin
levels, estimated insulin sensitivity, body
weight, waist circumference, body composition,
blood pressure, plasma lipids, aerobic fitness,
medication usage, quality of life and safety.
Given the sample size, there was not enough
statistical power to defend normality
assumptions necessary to use parametric
analysis methods such as a t test; instead, we
used the nonparametric Wilcoxon Signed Rank
test and Mann–Whitney tests.
Yes, knowing gastric bypass yielded greater
type 2 diabetes remission, standard medical
care or ILMI is the best option to the diabetic
patient.
Compared with the most rigorous ILMI yet
tested against surgery in a randomised trial,
RYGB yielded greater type 2 diabetes
remission in mild-tomoderately obese patients
recruited from a well-informed, population
based sample.
 Kreatinin Kinase
100
Sensitivity: 100,0
Specificity: 92,0
Criterion : >69,1098
80

Sensitivity
60

40

20

0
0 20 40 60 80 100
100-Specificity

LDL
100

80 Sensitivity: 84,6
Specificity: 47,1
Criterion : ≤143,002
Sensitivity

60

40

20

0
0 20 40 60 80 100
100-Specificity

b. Perkirakan secara visual nilai titik potong diagnostik dan interpretasinya.

Jawab:
Titik potong diagnostik MCI dan kreatinin kinase adalah sekitar 70 IU
Titik potong diagnostik MCI dan LDL adalah sekitar 143 mg/dl
c. Hitunglah seluruh nilai diagnostik menggunakan MedCalc dan Epi calc, buat
kesimpulan
 Kreatinin Kinase
Medcalc
Variable Kreatinin_kinase
Kreatinin Kinase
Classification variabl MCI
e 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

Epical
Accuracy :0,93 [0,86; 0,97]

Catmaker
Kesimpulan tes diagnostik Kreatinin Kinase pada pasien MCI :
- Sensitivitas 100%, berarti kemampuan Kreatinin Kinase dalam mendeteksi pasien
yang menderita penyakit MCI adalah 100%.
- Spesifisitas 92%, berarti kemampuan Kreatinin Kinase dalam mendeteksi pasien
yang tidak menderita penyakit MCI (tidak sakit) adalah 92%.
- Prevalens 13%, berarti probabilitas seseorang dalam studi ini (berdasarkan keadaan
demografis dan klinis) untuk menderita penyakit MCI sebelum menjalani tes
diagnostik Kreatinin Kinase adalah 13%.
- Nilai duga positif 65%, berarti probabilitas seseorang dengan hasil uji diagnostik
Kreatinin Kinase positif (> 69,1098 IU) menderita penyakit MCI adalah 65%.
- Nilai duga negatif 100%, berarti probabilitas seseorang dengan hasil uji diagnostik
Kreatinin Kinase negatif (≤ 69,1098 IU) tidak menderita penyakit MCI adalah
100%.
- Positive likelihood ratio 12,43%, berarti proporsi subjek yang menderita MCI
dengan Kreatinin Kinase positif (> 69,1098 IU) dengan subjek yang tidak
menderita MCI dengan Kreatinin Kinase positif (> 69,1098 IU) pula adalah
12,43%.
- Negative likelihood ratio 0%, berarti proporsi subjek yang menderita MCI dengan
Kreatinin Kinase negatif (≤ 69,1098 IU) dengan subjek yang tidak menderita MCI
dengan Kreatinin Kinase negatif (≤ 69,1098 IU) pula adalah 0%.
  LDL
Medcal
Variable LDL
LDL
Classification variabl MCI
e 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)  0,598
Standard Errora 0,0855
95% Confidence intervalb 0,495 to 0,695
z statistic 1,143
Significance level P (Area=0.5) 0,2531
a
DeLong et al., 1988
b
Binomial exact
 
Youden index
 

Youden index J 0,3174
Associated criterion ≤143,002
 
Criterion values and coordinates of the ROC curve [Hide]
 

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

<96,389 0,00 0,0 - 24,7 100,00 95,8 - 100,   1,00
6 0
≤105,596 0,00 0,0 - 24,7 97,70 91,9 - 99,7 0,00 1,02
≤110,394 7,69 0,2 - 36,0 97,70 91,9 - 99,7 3,35 0,94
≤113,405 7,69 0,2 - 36,0 95,40 88,6 - 98,7 1,67 0,97
≤114,336 15,38 1,9 - 45,4 95,40 88,6 - 98,7 3,35 0,89
≤118,88 15,38 1,9 - 45,4 89,66 81,3 - 95,2 1,49 0,94
≤121,168 23,08 5,0 - 53,8 89,66 81,3 - 95,2 2,23 0,86
≤124,449 23,08 5,0 - 53,8 83,91 74,5 - 90,9 1,43 0,92
≤124,98 30,77 9,1 - 61,4 83,91 74,5 - 90,9 1,91 0,83
≤135,632 30,77 9,1 - 61,4 62,07 51,0 - 72,3 0,81 1,12
≤135,713 38,46 13,9 - 68,4 62,07 51,0 - 72,3 1,01 0,99
≤136,431 38,46 13,9 - 68,4 58,62 47,6 - 69,1 0,93 1,05
≤140,212 69,23 38,6 - 90,9 58,62 47,6 - 69,1 1,67 0,52
≤142,734 69,23 38,6 - 90,9 48,28 37,4 - 59,2 1,34 0,64
≤142,787 76,92 46,2 - 95,0 48,28 37,4 - 59,2 1,49 0,48
≤142,907 76,92 46,2 - 95,0 47,13 36,3 - 58,1 1,45 0,49
≤143,002 84,62 54,6 - 98,1 47,13 36,3 - 58,1 1,60 0,33
≤158,411 84,62 54,6 - 98,1 17,24 10,0 - 26,8 1,02 0,89
≤158,868 92,31 64,0 - 99,8 17,24 10,0 - 26,8 1,12 0,45
≤185,206 92,31 64,0 - 99,8 1,15 0,03 - 6,2 0,93 6,69
≤187,68 100,00 75,3 - 100, 1,15 0,03 - 6,2 1,01 0,00
0
≤192,217 100,00 75,3 - 100, 0,00 0,0 - 4,2 1,00  
 0
 

 
Epicalc
Accuracy : 0,48 [0,38; 0,58]

Catmaker

Kesimpulan tes diagnostik LDL pada pasien MCI :

- Sensitivitas 15%, berarti kemampuan LDL dalam mendeteksi pasien yang
menderita penyakit MCI adalah 15%.
- Spesifisitas 53%, berarti kemampuan LDL dalam mendeteksi pasien yang tidak
menderita penyakit MCI (tidak sakit) adalah 53%.
- Prevalens 13%, berarti probabilitas seseorang dalam studi ini (berdasarkan keadaan
demografis dan klinis) untuk menderita penyakit MCI sebelum menjalani tes
diagnostik LDL adalah 13%.
- Nilai duga positif 5%, berarti probabilitas seseorang dengan hasil uji diagnostik
LDL positif (> 143 mg/dl) menderita penyakit MCI adalah 5%.
- Nilai duga negatif 81%, berarti probabilitas seseorang dengan hasil uji diagnostik
LDL negatif (≤ 143 mg/dl) tidak menderita penyakit MCI adalah 81%.
 - Positive likelihood ratio 0,33%, berarti proporsi subjek yang menderita MCI
dengan LDL positif (> 143 mg/dl) dengan subjek yang tidak menderita MCI
dengan LDL positif (> 143 mg/dl) pula adalah 0,33%.
- Negative likelihood ratio 1,60%, berarti proporsi subjek yang menderita MCI
dengan LDL negatif (≤ 143 mg/dl) dengan subjek yang tidak menderita MCI
dengan LDL negatif (≤ 143 mg/dl) pula adalah 1,60%.

Kategori Kreatinin Kinase * MCI Crosstabulation

Count

MCI

MCI Negatif MCI Positif Total

Kategori Kreatinin Kinase >69,1098 7 13 20

<=69,1098 80 0 80
Total 87 13 100

Kategori LDL * MCI Crosstabulation

Count

MCI

MCI Negatif MCI Positif Total

Kategori LDL >143,002 41 2 43

<=143,002 46 11 57
Total 87 13 100

5. Dalam file SPSS tersedia data Therapy Bad Outcome. Hasil Randomized clinical trial/
control trial ACE inhibitor

Kelompok * Outcome Crosstabulation

Count

Outcome

Hidup Meninggal Total

Kelompok Ace Inhibitor 44 6 50

Placebo 37 13 50
Total 81 19 100

3.1. Hitunglah nilai—nilai Importancy

 3.2. Buat kesimpulan
EER = 0,12; berarti kejadian kematian dalam penggunaan ACE inhibitor pada
pasien dalam studi ini adalah sebesar 12%.
CER = 0,26; berarti kejadian kematian dalam penggunaan plasebo pada pasien
dalam studi ini adalah sebesar 26%.
RR = 0,46; berarti kemungkinan kematian pasien yang menggunakan ACE
inhibitor adalah sebanyak 0,46 kali dibandingkan dengan pasien yang
menggunakan placebo; artinya ACE inhibitor dapat mencegah kematian.
ARR = 0,14; artinya dalam penggunaan ACE inhibitor, selisih jumlah insidens
kematian pada pasien dengan penggunaan placebo adalah sebesar 14%.
RRR = 0,54; artinya apabila ACE inhibitor digunakan sebagai terapi, maka
insidens kematian pada pasien dapat diturunkan sebesar 54% dari
insidens sebelumnya.
NNT = 7,14; artinya dibutuhkan terapi ACE Inhibitor sebanyak antara 7-8
pasien untuk mencegah kematian 1 orang pasien.

Kesimpulan :
Secara klinis, hasil penelitian ini penting dan sangat bermakna secara klinis.

6. Dalam file SPSS tersedia Data Therapy Effectiveness

 6.1. Hitunglah nilai—nilai Importancy
Kelompok * Outcome Crosstabulation
Count

Outcome

Sembuh Tidak Sembuh Total

Kelompok Enalapril + ASA 26 24 50

Isossorbid Prodiprogrel +
9 41 50
Deuretik
Total 35 65 100

6.2. Buat kesimpulan

EER = 0,52; berarti kejadian kesembuhan dalam penggunaan Enalapril + ASA
pada pasien dalam studi ini adalah sebesar 52%.
CER = 0,18; berarti kejadian kesembuhan dalam penggunaan Isosorbid +
Diuretik pada pasien dalam studi ini adalah sebesar 18%.
RR = 2,89; berarti kemungkinan kesembuhan pasien yang menggunakan
Enalapril + ASA adalah sebanyak 2,89 kali dibandingkan dengan
kelompok Isosorbid + Diuretik; artinya kombinasi Enalapril + ASA lebih
dapat menyembuhkan pasien.
ARR = 0,34; artinya dalam penggunaan Enalapril + ASA, selisih jumlah
kesembuhan dengan pasien yang menggunakan Isosorbid + Diuretik
adalah sebesar 34%.
RRR = 1,89; artinya apabila Enalapril + ASA digunakan sebagai terapi, maka
angka kesembuhan pada pasien akan meningkat sebesar 189% dari
insidens sebelumnya.
NNT = 2,94; artinya dibutuhkan terapi Enalapril + ASA sebanyak antara 2-3
orang untuk menyembuhkan 1 orang pasien.

Kesimpulan :
Secara klinis, hasil penelitian ini penting dan sangat bermakna secara klinis.