1

Tugas Mata Kuliah KIE

Program Profesi Apoteker, Fakultas Farmasi, Universitas Jember

Critical Review of A Pharmacoepidemiology Study

Angkatan V Semester, TA Ganjil, 2016/2017

Anggota kelompok (NIM) 1. Khurmatul Walidah Tahta Alfina (162211101003) 2.
3. 4.
5.
Judul artikel Randomized Controlled Trial of Oral Antifungal Treatment for Severe Asthma with Fungal Sensitization
Tautan (link URL)
Penulis David W. Denning, B. Ronan ODriscoll, Georgina Powell, Fiona Chew, Tahun 2009
Graham T. Atherton, Aashish Vyas, John Miles, Julie Morris, and publikasi
Robert M. Niven
Kesimpulan

Reference (if any)

This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63

Page of article showing the quote or evidence of your answer


RUBRIC
PARTS OF ARTICLE
Authors/Introduction
If potential conflicts of interest exist, did
they appear to influence the studys
objective, methods, or conclusions?
This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63
Page of article showing the quote or evidence of your answer
2
QUOTES PAGE COMMENTS
Conict of Interest Statement: In the past 5 years, D.W.D has received grant support Dalam penelitian ini tidak ditemukan adanya konflik kepentingan
from Astellas, Merck, Pzer, F2G, AstraZeneca, Indevus, and Basilea; he has been an 11, 12,
yang mempengaruhi objektivitas, metode, dan kesimpulan
advisor/consultant to Basilea, Vicuron (now Pzer), Pzer, Schering Plough, Indevus,
F2G, Nektar, Daiichi, Sigma Tau, Astellas, Gilead, and York Pharma; he has been paid
17, 18 penelitian. Pada akhir penelitian penulis menyampaikan terima kasih
for talks on behalf of Schering, Astellas, Merck, and Pzer; he holds founder shares in
F2G, Ltd. and Myconostica, Ltd. B.R.O. does not have a nancial relationship with a
kepada beberapa pihak yang telah membantu dalam penelitian. Pada
commercial entity that has an interest in the subject of this manuscript. G.P. does not akhir penelitian juga disebutkan bahwa penulis (B. Ronan
have a nancial relationship with a commercial entity that has an interest in the
subject of this manuscript. F.C. does not have a nancial relationship with a
ODriscoll, Georgina Powell, Fiona Chew, Aashish Vyas, dan
commercial entity that has an interest in the subject of this manuscript. Fees for Robert M. Niven) tidak memiliki hubungan nancial dengan entitas
attendance by G.T.A. at the 18th ECCMID were paid for by Pzer. A.V. does not have a komersial yang memiliki minat dalam subjek manuskrip ini.
nancial relationship with a commercial entity that has an interest in the subject of
this manuscript. J.M. has received speaker fees in 2008 for meetings sponsored by Sedangkan beberapa penulis lainnya (David W. Denning, Graham T.
Novartis (1,000), GlaxoSmithKline (500), and AstraZeneca (1,500). J.M. serves as a Atherton, dan Julie Morris) disebutkan memiliki hubungan financial
consultant to Myconostica Ltd. R.M.N. does not have a nancial relationship with a
commercial entity that has an interest in the subject of this manuscript.
dengan beberapa perusahaan yaitu David W. Denning telah
menerima dukungan hibah dari Astellas, Merck, Pfizer, F2G,
Acknowledgment: The authors are indebted to their colleagues who referred AstraZeneca, Indevus, dan Basilea; menjadi kolnsultan pada Basilea,
patients, in particular Gillian Miller in Congleton, Dr. McAndrew at Wrexham, Dr.
Jenny Hoyle, and Dr. Rob Angus at Aintree and Newton Fold GP practice in Vicuron, Pfizer, Schering Plough, Indevus, F2G, Nektar, Daiichi,
Pendlebury, Manchester. The authors are also indebted to Susie Rushton (Pharmacy, Sigma Tau, Atellas, Gilead, dan York Pharma; menjadi pembicara
Wythenshawe Hospital) for arranging and supervising blinded drug supplies; to the
staff at the Regional Mycology Laboratory, Manchester for itraconazole assays and
atas nama Schering, Astellas, Merck, dan Pfizer; serta memegang
susceptibility tests; and to the staff of the Immunology Laboratory at St Marys saham pendiri F2G Ltd dan Myconostica Ltd. Graham T. Atherton
Hospital for IgE and RAST testing. dibiayai oleh Pfizer pada acara 18th ECCMID. Sedangkan Julie
Methods: At four U.K. hospitals, patients with severe asthma (British Thoracic Society Morris merupakan konsultan Myconostica Ltd dan sebagai
level 4 or 5 [8]) who were taking high-dose inhaled corticosteroids (beclometasone pembicara yang disponsori oleh Novartis, GlaxoSmithKline, dan
equivalent dose, 1000 mg/d or more; uticasone, 500 mg/d or more), continuous oral
corticosteroids (at least 5 mg of prednisolone or its equivalent for at least 6 mo), or at AstraZeneca. Meskipun ada beberapa penulis yang memiliki
least four or six courses of oral/intravenous corticosteroids over the previous 12 or 24 hubungan financial dengan beberapa perusahaan yang telah
months, were screened for fungal sensitization by skin prick testing and RAST to the
following fungi: Aspergillus fumigatus, Cladosporium herbarum, Penicillium
disebutkan namun tidak ditemukan adanya konflik kepentingan
chrysogenum (notatum), Candida albicans, Trichophyton mentagrophytes, Alternaria dengan perusahaan-perusahaan tersebut. Hal ini juga dapat dilihat
alternata, and Botrytis cinerea. Skin test reagents were obtained from Allergopharma dari tujuan dan kesimpulan naskah atau jurnal ini, dimana antara
(Reinbeck, Germany) and RAST tests from Phadia (Uppsala, Sweden). Those who were
positive by skin prick (wheal at least 3 mm in diameter) or RAST (at least 0.4 IU/ml) tujuan dan kesimpulan penelitian cukup rasional dan kesimpulan
testing were eligible if they had total circulating IgE less than 1,000 IU/ml, were telah menjawab tujuan dari penelitian ini.
negative for Aspergillus precipitin (IgG), did not have recurrent bacterial lung
infections that would preclude evaluation, did not have a current respiratory infection
(entry deferred), had not received itraconazole in the prior 8 months, were not
pregnant, had liver function tests less than three times the upper limit of normal,
were not allergic to azoles, were not taking any interacting drugs that could not be
stopped, were not immunosuppressed other than by corticosteroids, and did not
have left ventricular dysfunction (ejection fraction less than 40% on
echocardiography). The local ethics committees approved the protocol and all
patients gave written informed consent. The study is registered as a clinical study as
number ISRCTN61552714 at www.controlled-trials.com.

Was an appropriate scientific background
and rationale provided?
Is the stated objective or hypothesis
consistent with the research question that
needed to be addressed?
This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63
Page of article showing the quote or evidence of your answer
3
Data Collection: After screening (Figure 1), baseline data were collected including
asthma, medical, and sinusitis history; and physical examination including skin for
fungal infection, pulmonary function tests and peak expiratory ow (PEF), total
corticosteroid dose, other asthma and other treatment data, and basic biochemistry
and hematology as well as total serum IgE. Participating patients were seen at 2 and 4
weeks and then monthly for the 32-week treatment period, when information about
clinical status, adverse events, exacerbations, additional medication, and compliance
(pill counting) was assessed. They were seen once for follow-up at 48 weeks. AQLQ
score, rhinitis score (11), FEV1, and self-recorded PEF readings were assessed at
Weeks 4, 16, and 32 and at 4 months of follow-up. Serum IgE and RAST tests were
done at Weeks 16 and 32, and at 4 months of follow-up
The primary aim of this proof-of-concept study was to contribute key data to the
long-standing debate about whether there is any direct link between fungal exposure
and asthma. Our data are most consistent with an important and poorly understood
relationship. Our study results indicate that a new treatment approach using
antifungal therapy in severe asthma is clinically useful, and that we have much to
understand about the daily interaction between fungi and humans.
Fungi interact directly with the human host in numerous ways. There is daily Iya, latar belakang dan tujuan dari penelitian ini telah sesuai secara
exposure to conidia, spores, hyphae, fragments of hyphae, cell wall constituents such 11
as glucan, and volatile organic compounds, usually with little or no consequence. rasional. Latar belakang penelitian ini yaitu adanya beberapa
However, numerous studies over the last 100 years have linked worsening asthma interaksi antara jamur dengan manusia, salah satunya dikaitkan
with fungal exposure. Whether fungal exposure is directly relevant to the
pathogenesis of asthma and its severity, or is simply a paraphenomenon, has been
dengan memburuknya kondisi pasien asma yang terkena kontak
difcult to ascertain. A direct demonstration of efcacy of antifungal therapy for dengan jamur, selain itu pengaruh pengobatan anti jamur
asthma would directly implicate fungal exposure in the pathogenesis of asthma. A (itraconazole) terhadap pasien dengan asma berat. Rasionalitas pada
specic disease entity exists in which massively increased allergic response to the
ubiquitous fungus Aspergillus fumigatus is associated with long-term colonization of penelitian ini mengacu pada penelitian sebelumnya yaitu
the respiratory tract with this fungus, namely allergic bronchopulmonary aspergillosis itraconazole oral efektif dalam pengobatan aspergilosis
(ABPA). Most of these patients have asthma, although not all. In 1991 we showed
that oral itraconazole was effective in the treatment of ABPA. Subsequently, two bronkopulmoner (ABPA). Selain itu ada juga penelitian yang
randomized controlled studies extended these early observations. However, most menyatakan kebanyakan pasien asma berat tidak terserang ABPA
patients with severe asthma do not have ABPA and are not demonstrably colonized
with fungi in the respiratory tract, yet many are sensitized to fungi such as
dan tidak terpapar jamur pada saluran pernafasan, namun banyak
Cladosporium species, Alternaria species, Penicillium species, Candida species, yang peka terhadap jamur seperti Cladosporium species, Alternaria
Trichophyton species, and others. As most of these fungi are common in air, we species, Penicillium species, Candida species, Trichophyton species,
hypothesized that direct external exposure or low levels of colonization are sufcient
to induce an allergic response and pulmonary inammation in many patients with dan lainnya. Sehingga peneliti ingin mengetahui apakah ada
severe asthma. Support for this concept came from a small randomized study of pengaruh paparan jamur secara langsung dapat menginduksi respon
Trichophyton sensitization with uconazole and our own empirical experiences. We
coined the term severe asthma with fungal sensitization, or SAFS, to provide a simple
alergi dan peradangan paru pada banyak pasien dengan asma berat,
clinical label for a particular phenotype of severe asthma, with possible therapeutic serta mengevaluasi penggunaan anti jamur (itraconazole) terhadap
implications. We report here the results of this randomized, blinded study, which was terapi pada pasien dengan asma berat.
designed as a proof-of-concept study; some of these results were presented in
abstract form in late 2007
As most of these fungi are common in air, we hypothesized that direct external Iya, terdapat hipotesis pada penelitian ini bahwa dengan adanya
exposure or low levels of colonization are sufcient to induce an allergic response and 11, 12,
paparan jamur secara langsung atau dengan rendahnya tingkat
pulmonary inammation in many patients with severe asthma (1).
16, 17 kolonisasi dapat menginduksi respon alergi dan peradangan paru
The null hypothesis was as follows: Itraconazole has no effect as an adjunctive
treatment in patients with severe asthma with a skin prick test or RAST test positive
pada banyak pasien dengan asma berat. Selain itu juga terdapat
to one or more tested fungal allergens, who do not fulll the criteria for ABPA. A hipotesis null yang menyatakan bahwa itraconazole tidak
statistically signicant improvement in quality of life as measured by the AQLQ score memberikan efek ketika dijadikan sebagai terapi adjuvan pada
at 32 weeks was the primary end point.
penyakit asma berat yang positif terhadap pengujian skin prick test

MethodsDesign
Is study design appropriate and optimal to
fulfill objective/hypothesis?
Was method used to assign patients to
treatment groups appropriate and clearly
described?
This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63
Page of article showing the quote or evidence of your answer
4
atau RAST test pada satu atau lebih allergen (jamur). Hasil dari
Itraconazole plasma concentrations were determined in 58 patients at 2 weeks and in
41 patients at 20 weeks. Placebo subjects showed no detectable concentration. The penelitian ini sesuai dengan tujuan dan hipotesis yang dinyatakan
25 itraconazole subjects who received at least 4 weeks of treatment all had peneliti yaitu penelitian yang dilakukan menunjukkan adanya
detectable levels, with individual means (over first 4 wk) ranging from 0.65 to 26.1
mg/L with a median of 8.9 mg/L. There were no significant relationships between
hubungan langsung antara paparan jamur dengan asma dan
the mean itraconazole level per patient and the AQLQ score at Week 32 for the menunjukkan bahwa pemberian pengobatan dengan menggunakan
itraconazole group (Spearman correlation, 0.15; P 5 0.48) or the change in AQLQ terapi antijamur (itraconazol) pada pasien dengan asma parah
from Week 1 to Week 32 (Spearman correlation, 20.26; P 5 0.22)
memberikan pengaruh pada kondisi pasien. Sehingga pernyataan
Possibly there are two populations within SAFS, a responder population and a tujuan dan hipotesis dalam penelitian ini disampaikan secara
nonresponder population, as the 54% of antifungal-treated patients who responded
did so with large improvements in symptoms, whereas the other group of 46% were konsisten dari awal hingga akhir naskah atau jurnal penelitian ini.
relatively unchanged or worse. There was also a significant adverse event rate, with
itraconazole implicated in some cases. Exacerbation rates were equivalent (and
low) in both groups over the trial period.
The primary aim of this proof-of-concept study was to contribute key data to the
long-standing debate about whether there is any direct link between fungal exposure
and asthma. Our data are most consistent with an important and poorly understood
relationship. Our study results indicate that a new treatment approach using
antifungal therapy in severe asthma is clinically useful, and that we have much to
understand about the daily interaction between fungi and humans.
Each patient received two capsules, corresponding to 200 mg of itraconazole or Iya, desain penelitian ini sudah tepat dan optimal karena pada desain
placebo, twice daily. A randomization schedule in 4 blocks of 16 and subsequent 12
blocks of 8 was prepared, using a computer-generated block randomization tersebut pasien yang masuk kriteria dan perlakuan atau pengobatan
procedure, and amounts of either placebo or itraconazole equivalent to 32 weeks of yang diterima sudah di acak secara acak (randomized) dengan
treatment were packaged in tubs in 30-day supply boxes. Enrolled patients were
allocated sequential numbers by one of the four hospital pharmacies, without
prosedur computer-generated block randomization. Selain itu juga
knowledge of the randomization sequence, which was held centrally. Plasma for pasien tidak mengetahui masuk dalam kelompok placebo/active
itraconazole assays was collected at Weeks 2, 4, 12, and 20. Treating physicians were (tidak mengetahui komponen pengobatan yang diberikan) begitu
not informed about these results, but they were made available to the principal
investigator on a monthly basis by spreadsheet to make dosage adjustments, if juga dengan dokter atau perawat yang berinteraksi dengan pasien
required. (single-blind)
At four U.K. hospitals, patients with severe asthma (British Thoracic Society level 4 or Iya, metode yang digunakan untuk menetapkan pasien pada
5) who were taking high-dose inhaled corticosteroids (beclometasone equivalent 11, 12
dose, 1000 mg/d or more; fluticasone, 500 mg/d or more), continuous oral kelompok perlakuan sudah tepat dan jelas. Pada penelitian ini,
corticosteroids (at least 5 mg of prednisolone or its equivalent for at least 6 mo), or at terdapat beberapa kriteria yang harus dipenuhi oleh semua pasien
least four or six courses of oral/intravenous corticosteroids over the previous 12 or 24
months, were screened for fungal sensitization by skin prick testing and RAST to the
agar dapat masuk dalam penelitian sehingga semua pasien memiliki
following fungi: Aspergillus fumigatus, Cladosporium herbarum, Penicillium kondisi yang sama sebelum diberikan perlakuan. Selanjutnya semua
chrysogenum (notatum), Candida albicans, Trichophyton mentagrophytes, Alternaria pasien yang memenuhi kriteria akan secara acak mendapatkan satu
alternata, and Botrytis cinerea. Skin test reagents were obtained from Allergopharma
(Reinbeck, Germany) and RAST tests from Phadia (Uppsala, Sweden). Those who were dari dua pilihan pengobatan yaitu selulosa (kelompok placebo) dan
positive by skin prick (wheal at least 3 mm in diameter) or RAST (at least 0.4 IU/ml) itraconazole (kelompok active).
testing were eligible if they had total circulating IgE less than 1,000 IU/ml, were
negative for Aspergillus precipitin (IgG), did not have recurrent bacterial lung
infections that would preclude evaluation, did not have a current respiratory infection
(entry deferred), had not received itraconazole in the prior 8 months, were not
pregnant, had liver function tests less than three times the upper limit of normal,
were not allergic to azoles, were not taking any interacting drugs that could not be
stopped, were not immunosuppressed other than by corticosteroids, and did not
have left ventricular dysfunction (ejection fraction less than 40% on
 5

echocardiography). The local ethics committees approved the protocol and all
patients gave written informed consent.

Each patient received two capsules, corresponding to 200 mg of itraconazole or

placebo, twice daily. A randomization schedule in 4 blocks of 16 and subsequent
blocks of 8 was prepared, using a computer-generated block randomization
procedure, and amounts of either placebo or itraconazole equivalent to 32 weeks of
treatment were packaged in tubs in 30-day supply boxes. Enrolled patients were
allocated sequential numbers by one of the four hospital pharmacies, without
knowledge of the randomization sequence, which was held centrally. Plasma for
itraconazole assays was collected at Weeks 2, 4, 12, and 20. Treating physicians were
not informed about these results, but they were made available to the principal
investigator on a monthly basis by spreadsheet to make dosage adjustments, if
required.
Were all involved with study appropriately
blinded? Was success of blinding
determined? Was unblinding unlikely?

Semua yang terlibat dengan studi

tepat buta? Apakah keberhasilan
membutakan ditentukan? Apakah
Unblinding tidak mungkin?

MethodsPatients/Subjects
Were there any problems with how or from
where patients were enrolled?

Apakah ada masalah dengan

bagaimana atau dari mana pasien
diikutsertakan?
Were the inclusion and exclusion criteria
appropriate and representative of the
population of interest? What additional
criteria, if any, would have strengthened
the study?

Apakah kriteria inklusi dan eksklusi

tepat dan mewakili populasi
kepentingan? Kriteria apa

This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63

Page of article showing the quote or evidence of your answer

 6

tambahan, jika ada, akan

memperkuat penelitian?
How was sample size determined? Was the
initial sample size adequate for each
primary outcome measure?

Bagaimana ukuran sampel

ditentukan? Adalah ukuran sampel
awal yang memadai untuk setiap
ukuran hasil utama?
MethodsTreatment Regiments
If an active control used, was it an
appropriate selection?
Jika kontrol ActiveX yang digunakan,
apakah itu pilihan yang tepat?
Were the study drug(s) and any active
control(s) dosed and administered
appropriately and in a comparable
manner?

yang obat studi (s) dan setiap kontrol aktif)

dosis dan mengelola secara tepat dan
dengan cara yang sebanding?
Were the drug(s) administered for a
sufficient duration?

Apakah obat) diberikan untuk

jangka waktu yang cukup?
Were the different groups handled
similarly except for treatments studied?

Apakah kelompok yang berbeda

ditangani sama kecuali untuk

This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63

Page of article showing the quote or evidence of your answer

 7

perawatan belajar?
MethodsOutcome Measures
Were primary and secondary outcome
measures clearly defined? Were any
methods needed to enhance their quality
(e.g., training of investigators or patients,
standardization among multicenter sites,
etc.) and were these performed?
Were outcome measures appropriate and
optimal given the study objective?
Yang ukuran hasil yang tepat dan
optimal diberikan tujuan stud

Was timing of outcome measurements

appropriate and of adequate frequency
and duration?
Adalah waktu pengukuran hasil
yang tepat dan frekuensi dan durasi
yang memada
MethodsData Handling
Was it clear how many patients were in
each analysis? Did the data handling
method used significantly affect
interpretation of study findings?
Apakah itu jelas berapa banyak
pasien berada dalam analisis
masing-masing? Apakah data
metode penanganan digunakan
secara signifikan mempengaruhi
interpretasi temuan studi?
Was the number of patients accounted for
at each step of the study? Could the
reasons for dropout affect the clinical

This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63

Page of article showing the quote or evidence of your answer

 8

usefulness of therapy?
Apakah jumlah pasien menyumbang
pada setiap langkah dari penelitian?
Bisa alasan untuk putus sekolah
mempengaruhi kegunaan klinis
terapi?
MethodsStatistics
Were appropriate statistical tests used for
all primary outcomes? Were secondary
outcomes analyzed appropriately?
Yang tes statistik yang sesuai
digunakan untuk semua hasil
utama? yang sekunder
Was the power appropriate for all primary
and secondary outcome analyses,
considering dropouts? If subgroup analyses
performed, was power sufficient?
Adalah kekuatan yang sesuai untuk
semua analisis hasil primer dan
sekunder, mempertimbangkan
hasil? Subkelompok analisis
dilakukan, adalah daya yang cukup?
Results
Were any significant differences apparent
among groups at baseline that could
influence study results?
Apakah perbedaan yang signifikan
terlihat antara kelompok-kelompok
pada awal yang dapat
mempengaruhi hasil penelitian?
Were results reported for each measure
described in Methods section?

This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63

Page of article showing the quote or evidence of your answer

 9

Yang hasil yang dilaporkan setiap

langkah yang digambarkan dalam
bagian Metode?
Were the measure(s) of variability used
appropriate and sufficient?
Apakah ukuran (s) variabilitas yang
digunakan sudah tepat dan
memadai?
Were findings statistically and clinically
significant?
apakah temuan statistik dan klinis
yang signifikan?

Was Type II error likely for non-statistically

significant findings?
Apakah Jenis type II kemungkinan
untuk temuan non-signifikan secara
statistik?
Was compliance addresed and could this
have influenced study results?
Apakah kepatuhan diatasi dan bisa
ini mempengaruhi hasil penelitian?
Were there factors (e.g., study setting, diet,
other confounding variables) besides the
treatments used that could have affected
the results observed? If so, were they
accounted for or controlled for in the study?
Apakah ada faktor (misalnya,
pengaturan studi, diet, variabel
pengganggu lainnya) selain
perawatan bekas yang bisa
mempengaruhi hasil diamati? Jika

This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63

Page of article showing the quote or evidence of your answer

 10

demikian, apakah mereka

menyumbang atau dikendalikan
dalam penelitian ini?
Were differences in adverse effects among
groups statistically analyzed?
Yang perbedaan efek samping
antara kelompok-kelompok
dianalisis secara statistik?
Discussion/Conclusion
Were results interpreted appropriately by
authors?
Yang hasil diinterpretasikan dengan
tepat oleh penulis?
Did authors adequately explain key study
limitations and any discrepancies from other
similar studies?
Apakah penulis cukup menjelaskan
keterbatasan studi kunci dan setiap
perbedaan dari penelitian serupa
lain?
Were authors conclusions consistent with
the results and study limitations and
extrapolated appropriately?
Apakah kesimpulan penulis
'konsisten dengan hasil dan batasan
studi dan ekstrapolasi sudah tepat?
2005, 2006 West Virginia University School of Pharmacy (Abate MZ, Blommel ML)

This rubric is developed based on Blommel, ML, Abate, MA, 2007, A Rubric to Assess Critical Literature Evaluation Skills, American Journal of
Pharmaceutical Education, 71 (4) Article 63

Page of article showing the quote or evidence of your answer