EBM prognostic ujian

Embed Size (px)

Citation preview

  • 8/10/2019 EBM prognostic ujian

    1/21

    R . P R I N D J A T I P R A K A S AH 2 A 0 1 0 0 4 2

    EBM prognostic

    DHF

  • 8/10/2019 EBM prognostic ujian

    2/21

    Skenario klinis

    Seorang anak 15 tahun datang ke dokter denganmimisan. Dari anamnesis didapatkan riwayat trauma (-),demam 3 hari, mual muntah (+), hepatomegali, tesptekie (+). Dokter mencurigai pasien menderita DBD.

    Dokter menyarankan pasien untuk pemeriksaan serologiuntuk memastikan penyebab penyakitnya dan darahrutin untuk memberi keputusan rawat inap.

    Setelah dilakukan pemeriksaan pasien (+) DBD danditemukan trombositopenia.

    Pasien disarankan rawat inap dan Dokter ingin tahu apakah profil transfusi (menerima

    transfusi trombosit) dan manifestasi klinis DBDmenghasilkan karakteristik klinik dan laborat yang baik?

  • 8/10/2019 EBM prognostic ujian

    3/21

    Practice of EBM

    3

    Step 1: Converting the need for information (aboutprevention, diagnosis, prognosis, therapy, causation, etc.)into an answerable question

    Step 2: Tracking down the best evidence with which toanswer that question

    Step 3: Critically appraise that evidence for the validity(closeness to the truth), impact (size of the effect), andapplicability (usefulness in our clinical practice)

    Step 4: Integrating the critical appraisal with our clinical

    expertise and with our patients unique biology, values,and circumstances

    Step 5: Evaluating our effectiveness and efficiency inexecuting steps 1-4 and seeking ways to improve themboth for next time

  • 8/10/2019 EBM prognostic ujian

    4/21

    Clinical question about prognosis

    Patient or

    Problem

    Intervention Comparison Outcomes

    Pasien

    anak 15

    tahun

    Manifestasi

    klinik DBD &

    profil

    transfusi

    (menerimatransfusitrombosit)

    - karakteristikklinik danhasillaboratorium

    yang baik

    4

  • 8/10/2019 EBM prognostic ujian

    5/21

    Pertanyaan klinis

    Apakah manifestasi klinik DBD & profil transfusi(menerima transfusi trombosit) pada pasien anak15 tahun dapat menghasilkan karakteristik klinik

    dan hasil laboratorium yang baik?

  • 8/10/2019 EBM prognostic ujian

    6/21

    Practice of EBM

    6

    Step 1: Converting the need for information (aboutprevention, diagnosis, prognosis, therapy, causation, etc.)into an answerable question

    Step 2: Tracking down the best evidence with which toanswer that question

    Step 3: Critically appraise that evidence for the validity(closeness to the truth), impact (size of the effect), andapplicability (usefulness in our clinical practice)

    Step 4: Integrating the critical appraisal with our clinical

    expertise and with our patients unique biology, values,and circumstances

    Step 5: Evaluating our effectiveness and efficiency inexecuting steps 1-4 and seeking ways to improve themboth for next time

  • 8/10/2019 EBM prognostic ujian

    7/21

    Search Strategy

    Medline database:

    http://www.ncbi.nlm.nih.gov/pubmed/

    Using the Clinical Queries function of PubMed:

    Key words: dengue hemorragic

    Clinical Study Categories: prognosis

    Scope: Narrow

    http://www.ncbi.nlm.nih.gov/pubmed/http://www.ncbi.nlm.nih.gov/pubmed/
  • 8/10/2019 EBM prognostic ujian

    8/21

    Searching the Evidence8

    Clinical and laboratory characteristics ofpatients with dengue hemorrhagic fevermanifestations and their transfusion profile

    Fujimoto, D. E., Koifman S. Rev Bras Hematol Hemoter. 2014: 36(2):115-

    120

  • 8/10/2019 EBM prognostic ujian

    9/21

    Practice of EBM

    9 Step 1: Converting the need for information (about

    prevention, diagnosis, prognosis, therapy, causation, etc.)into an answerable question

    Step 2: Tracking down the best evidence with which toanswer that question

    Step 3: Critically appraise that evidence for the validity(closeness to the truth), impact (size of the effect), andapplicability (usefulness in our clinical practice)

    Step 4: Integrating the critical appraisal with our clinicalexpertise and with our patients unique biology, values,

    and circumstances Step 5: Evaluating our effectiveness and efficiency in

    executing steps 1-4 and seeking ways to improve themboth for next time

  • 8/10/2019 EBM prognostic ujian

    10/21

    Is this evidence about prognosis valid?10

    1. Was a defined, representative sample of patients assembled at acommon point in the course of their disease?

    Penelitian ini menggunakan metode studi deskriptifretrospektif

    Sample penelitian ini diambil dari satu tempat yaitu di

    daerah Rio Branco

  • 8/10/2019 EBM prognostic ujian

    11/21

    Is this evidence about prognosis valid?11

    2. Was follow-up of study patients sufficiently long and complete?

    Dari 90.553 kasus dengue, follow-upterhadap 14.985 pasien (pemeriksaanserologi dilakukan) yang diambil dari3 Januari 2007 14 Juni 2011

    dengan kematian pasien sebanyak 14orang

  • 8/10/2019 EBM prognostic ujian

    12/21

    Is this evidence about prognosis valid?12

    2. Was follow-up of study patients sufficiently long andcomplete? (contd) Pada akhir pengamatan penelitian ini jumlah sampel semuanya

    utuh karena pengambilan data menggunakan metode

    retrospektif dimana menggunakan rekam medis

  • 8/10/2019 EBM prognostic ujian

    13/21

    Is this evidence about prognosis valid?13

    3. Were objective outcome criteria applied in a blindfashion? Pada penelitian ini ,

    total akhir dari

    karakteristik klinik danlaborat tidak dijelaskansecara rinci.

    Penyebab karakteristik

    klinik dan laboratdilihat melalui rekammedis dari pelayanankesehatan

  • 8/10/2019 EBM prognostic ujian

    14/21

    Is this evidence about prognosis valid?14

    3. Were objective outcome criteria applied in ablind fashion?

    Pada penelitian ini , karakteristik klinik dijelaskan

    sebagian kecil sedanagkan karakteristik laboratdijelaskan secara detail

  • 8/10/2019 EBM prognostic ujian

    15/21

    Is this evidence about prognosis valid?15

    4. If subgroups with different prognoses are identified: Was there adjustment for important prognostic factors?

  • 8/10/2019 EBM prognostic ujian

    16/21

    Was there validation in an independent group oftest-set patients?

    Tidak ada test-set pasien dalam penelitian ini

  • 8/10/2019 EBM prognostic ujian

    17/21

    Is this valid evidence about prognosisimportant?

    17

    1. How likely are the outcomes over time?

    2. How precise are the prognostic estimates? Dari kasus ini, ditemukan bahwa follow up dilakukanselama 3 Januari 2007 14 Juni 2011 dengan ditemukankasus sebanyak 90.553. dan kematian sebesar 7,3%

    Dari 90.553 kasus DBD, dibagi 2 kelompok yaitu dengan

    tes serologi dan tanpa tes serologi. Pasien dengan tesserologi dikelompokkan kembali menjadi positif, negatifdan tak tergolongkan. Dari pasien serologi (+)didapatkan 267 pasien dengan DBD dimana mereka yangakan dijadikan sampel penelitan

  • 8/10/2019 EBM prognostic ujian

    18/21

  • 8/10/2019 EBM prognostic ujian

    19/21

    Can we apply this valid, important evidence aboutprognosis to our patient?

    19

    1. Is our patient so different from those in the studythat its results cannot apply?

    Ya, karena dari kesimpulan penelitan ini tidak adahubungan antara pemberian transfusi dengankarakteristik klinik dan hasil laboratorium

    2. Will this evidence make a clinically importantimpact on our conclusions about what to offer ortell our patient?

    tidak

  • 8/10/2019 EBM prognostic ujian

    20/21

    Practice of EBM

    20

    Step 1: Converting the need for information (aboutprevention, diagnosis, prognosis, therapy, causation, etc.)into an answerable question

    Step 2: Tracking down the best evidence with which to

    answer that question Step 3: Critically appraise that evidence for the validity

    (closeness to the truth), impact (size of the effect), andapplicability (usefulness in our clinical practice)

    Step 4: Integrating the critical appraisal with our clinical

    expertise and with our patients unique biology, values,and circumstances

    Step 5: Evaluating our effectiveness and efficiency inexecuting steps 1-4 and seeking ways to improve themboth for next time

  • 8/10/2019 EBM prognostic ujian

    21/21

    Resolution of the Case21

    Pasien anak usia 15 tahun yang terdiagnosa DBD yangdiberikan transfusi trombosit tidak menurunkan risikodari karakteristik klinik maupun hasil laboratoriumyang mengakibatkan kematian