What is EBM?

Dr. Sofyan Suri SH, Sp. THT

Fakultas Kedokteran Universitas Gadjahmada
Yogyakarta
 Pasien
Ditanya Ilmu berkembang
Diperiksa
Didiagnosis
Diobati
Dll

ILMIAH Tepat - bertanggungjawab

 KASUS

Seorang anak, usia Sekolah Dasar, menderita NYERI

TENGGOROKAN dan demam, kemungkinan akibat
infeksi.

Dokter di Poliklinik mengatakan bahwa anak tersebut

harus diberikan obat-ANTIBIOTIK golongan
PENISILIN supaya cepat sembuh.
 How do we make
clinical decisions?
(keputusan secara klinik)

Diagnosis
Terapi
Prognosis
Harm
 How do we make
clinical decisions?
(keputusan secara klinik)

Toss coins------ gambler

Guess------ think about
"Do no harm." ----/kerugian
(Hippocrates)
Ask colleagues ----– ts dll
Text books?------ dkt perpust
Browse journals -----– terpencil..??
Searching bibliographic databases
 ‘Tidak ada hukum
bagi yang tidak-tau,
namun diwajibkan
untuk mencari tau’

‘jujur & bertanggung-jawab’

 What is EBM?

‘The process of systematically finding,

appraising and using
contemporaneous research findings
as a basis for clinical decisions’.
Practicing EBM: Five Steps
Step 1: convert need for information in to an
answerable question
Step 2: track down the best evidence with which
to answer that question
Step 3: critically appraise the evidence for its
validity, impact and applicability
Step 4: integrate the critical appraisal with our
clinical expertise and patient’s unique
circumstances
Step 5: evaluate our effectiveness and efficiency
in steps 1-4 and seeking ways to improve
Its practice requires:

Asking
Acquiring
Appraising
Applying
Assessing
 LANGKAH KE-1 EBM

Menyusun Pertanyaan Klinis

 PERTANYAAN

Apakah antibiotika golongan PENISILIN bermanfaat

untuk mengobati anak yang menderita NYERI
TENGGOROKAN akibat infeksi?
 P.I.C.O

Pasien / Populasi = anak penderita nyeri tenggorokan

Intervention / Intervensi = antibiotika golongan penisilin

Comparison / Pembanding = - (plasebo /tidak diberi antibiotika)

Objective / Hasil = kesembuhan

 KATA KUNCI
Anak = child
Nyeri Tenggorokan = “sore throat”
Penisilin = penicillin
LANGKAH KE-2 EBM

Mencari Bukti Ilmiah

 Types of Information Databases

Primary sources
– PubMed, MedLine
– Require more work to validate
Secondary sources
– Cochrane, Best Evidence, InfoPoems
– Already reviewed- less work to validate
– Limited amount of information studied
Hierarchy of study
designs:
Systematic review
Meta-analysis
RCT (DB/SB)
Cohort study
Case controlled study
Cross sectional study
Case series
 Kategori Evidence

Ia
Meta analisis & Syst Rev
Ib
Randomized Controlled Trial
IIa
Non-Randomized Trial
IIb
Quasi Experimental
III
Observational study
IV
Expert opinion, clinical experience

Uji pra-klinik

Uji in vitro
http://www.nlm.nih.gov
http://highwire.stanford.edu
http://www.bmj.com
http://www.cochrane.org
http://ebm.bmjjournals.com
http://guideline.gov
 LANGKAH KE-3 EBM

Melakukan Telaah Kritis Artikel

Pertanyaan:

Apakah antibiotika golongan PENISILIN bermanfaat

untuk mengobati anak yang menderita NYERI
TENGGOROKAN akibat infeksi?
Jawab:

Berdasarkan penelitian dari:

Sjoerd Zwart, Maroeska M Rovers, Ruut A de Melker and
Arno W Hoes
Yang dimuat di majalah / jurnal:
bmj.com 2003;327:1324
Dengan judul:
Penicillin for acute sore throat in children: randomised,
double blind trial
 STATEMENTS OF EVIDENCE
Ia Evidence obtained from meta-analysis of randomised controlled trials.

Ib Evidence obtained from at least one randomised controlled trial.

IIa Evidence obtained from at least one well-designed controlled study without
randomisation.

IIb Evidence obtained from at least one other type of well-designed quasi-
experimental study.

III Evidence obtained from well-designed non-experimental descriptive studies, such

as comparative studies, correlation studies and case studies.

IV Evidence obtained from expert committee reports or opinions and/or clinical

experiences of respected authorities.
 Monitoring & evaluasi
Implementasi SPM

Monitoring terhadap sistem mikro

pelayanan klinis
Self assessment: menggunakan check
list
Peer-review: menggunakan check-list
 RESUME
Kelola pasien Ada dasarnya
•RESPONSIBILITY

Dari pendapat ahli --- sampai penelitian

Caranya…???
 Matur Nuwun

Allohumma innii as aluka

‘ilman naafi’an
wa ‘auuzubika
min ‘ilmin laa yan fa’
 Terima Kasih
semoga bermanfaat

sofyandrtht@yahoo.com