Abdou K. Chamssuddin *, Seyed H. Saadat, Kusay Deiri, Mohamed Y.

Zarzar,
Naji Abdouche, Omar Deeb, Loauy Alia

Critical appraisal by Deviyanti Aulia (012106121)

IDENTITY OF THE JOURNAL
Title : Evaluation of grade and stage in patients with
bladder cancer among smokers and non-smokers
Author : Abdou K. Chamssuddin *, Seyed H. Saadat,
Kusay Deiri, Mohamed Y. Zarzar, Naji Abdouche, Omar
Deeb, Loauy Alia
Publisher : Arab Journal of Urology
Year : 2013
BACKGROUND
strong association
 2-
naphthyla
nitrosamin mine
es
These amines cause oxidative DNA
damage in the normal urothelium and
4- induce bladder cancer
aminobiphenyl
Patients and methods
 smokers (defined as Low dose10–29
smoking of P10 cigarettes/day,
cigarettes/day for the last
3 years),
Moderate dose 30–59
cigarettes/day,

categorised into two High dose P60

cigarettes/day,
groups

non-smokers, who had no

previous history of
cigarette smoking
Objective
 To evaluate the role of smoking as a risk
factor for higher stages and grades of
bladder cancer,
 for although smoking is considered to be one
of the most important risk factors for
bladder cancer, its relationship to grade and
stage is not clear.
Result
 The smokers and non-smokers had no
significant difference in tumour grade or
stage
 the high-dose group had significantly higher
grades and stages than the other groups
Discustion
The link between ??
Conclution
 Smoking has a potential dose-dependent
effect on the grade and stage of bladder
cancer, with high-dose smokers having more
aggressive disease.
 The equality in the aggressiveness of the
cancer between smokers in general and
nonsmokers might be a result of the
hazardous effect of passive smoking in
countries where smoking is a common habit.
PICO ANALYSIS
 Population
300 patients had undergone transurethral
resection of a bladder tumour and were
diagnosed with bladder cancer
 Intervention
smoker
 Comparation
non-smoker
 Outcome
evaluate the role of smoking as a risk
factor for higher stages and grades of
bladder cancer
CRITICAL APPRAISAL (1)
The structure & content of the journal
 The Title of Journal
1. Describe the whole of the journal : Yes
2. Interest : Yes
3. The structure : contain dependent and
independent variable

 The Author & Institution

1. Appropriate with the guidelines : Yes
 Abstrak
1. The structure
Consist of 4 part (objective, method, result, conclusion)
appropiate with guideline
1. Informative : Yes
2. Less than 250 word : yes (189 word)

 Introduction
1. Consist of 2 paragraph or part : No (4 paragraph)
2. The first paragraph explain background of the
research : No (on paragraph 1-3)
3. The second paragraph explain hypothesis or
objective : No (on paragraph 4)
4. Less than 1 page : No
 Method
1. Design, place & time of the research
 Design: Not writen
 Place: Not writen
 Time: Not writen
2. The population
 Achieved population : Not writen
 Target population : Not writen
3. Inclussion & exclusion criteria : Not writen
4. Sampling technique : Not writen
5. Calculation of sampling : Not writen
6. Detail of observation, calculation & intervention
for application in other research/clinical : Not
writen
7. Blind method : Not writen
8. Reliabilitas : no data
9. Definition of technical term : Not writen
10. Ethical clearance : Not writen
12. Analytic computer program : Not writen
 Result
1. Characteristic subject table : Not writen
2. Characteristic subject before intervention that
was compared with the result : Not writen
3. Total subject in intervention : Not writen
4. Drop out / withdrawal : Not writen
5. Accuracy of numeric data : non data
6. Accuracy & compatibility of Analytic computer
program : no data
7. Include the result of the analysis, degree of
fredom & P value : was written
 Discussion
1. All of relevan thing are discuss : yes
2. Not repeated : repeated on some of part
3. The limitation : Not writen
4. The previous research : included
5. The relation of result & clinical practices : yes
6. Side effect : Not writen
7. Addition of the research : no data
8. Statistics analysis that addition : not written
 Literature
1. The structure : appropiate with guideline
2. Appropriate with any citation : yes
 CRITICAL APPRAISAL (2)
“Cause-Effect” relationship study
A. General description
1. Design : Not writen
2. Population & sample
 Achieved population : Not writen
 Target population : Not writen
3. Sampling technique : Not writen
4. Variable
 Dependen variable : smoking
 Indepeden variable : higher stages and grades of bladder cancer
5. Subjective : not clearly writen
B. Internal validity (non-causal relationship)
1. Was the result influenced by bias?
 On subject selection
 Prevalens bias (Neyman’s Bias)
can’t be assesed (no prevalens data)
 Admission rate bias (Berkson’s fallacy)
can’t be assesed (no data for indication to
hospitalization)
 Non-respons bias
can’t be assesed (no data)
 Membership bias
there is bias on the research, so many factor that can
influence the presenting illness
 Procedure selection bias
yes there are
 On measurement & observation
 Procedure bias
yes there are
 Recall bias
the bias was not found in this research. This bias only
match for case-control study
 Insensitie measurement
yes there are
 Detection bias (change of the value)
yes there are
 Compliance bias
there no data
2. Was the result influenced by opportunity factor?
manyn bias was found In the research, so the
hypothesis was influenced by opportunity
factor
3. Was the observation influenced by confounding
factor?
yes it is, because the research was not writen
the sampling technique
C. Internal validity (causal relationship)
1. Was the time relationship right?
no data
2. Was the association strong?
maybe yes, because the P value present low value
3. Had it relationship with the dosage?
can’t be assesed (no data)
4. Was the result consistent in this research?
yes
5. Was the result have coherency with the fact on
the society? yes
6. Was the result same with other research? yes
7. Was the result biologically plausible? yes
D. Eksternal validity
1. Can the result be applicated on the subject of
this research?
Can not be assesed, because calculation
of the sample not writen (no data of the
minimal sample)
2. Can the result be applicated on achieved
population?
No, it can’t. Because the subject selection
not use randomized sampling technique
3. Can the result be applicated on target
population?
No, it can’t.
 THANK YOU…
SYUKRON KATSIR…
SUWUN…