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Tugas Kuliah Wajib Ilmu Dasar

CRITICAL APPRAISAL

“Incidence and Prevalence of Uveitis: a Cross-Sectional Study.”

Oleh: dr. Ratri Prasetya Ningrum


04032771822002
Program Studi: Ilmu Kesehatan Mata

Pembimbing:
Dr. Achmad Ridwan M O, M.Sc

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA


RSUP DR. MOH. HOESIN PALEMBANG
TAHUN 2018
Title : Incidence and Prevalence of Uveitis in Northern California.

Reference : David C. Gritz, MD, MPH,Ira G. Wong, MD, MS

Citation : ………………………………………..

No PICOS

1. Patients Uveitis

2. Intervention All patients who, during a 12-month period, had the potential

diagnosis of uveitis. Detailed quarterly gender- and age-stratified

population data were available.

3. Comparison Comparison between age stratified and gender

4. Outcome Uveitis

5. Study Design Cross-Sectional Study

Are the results of this harm study valid?

Were there clearly defined groups of Yes, Age Stratified and Genders.

patients, similar in all important ways

other than exposure to the treatment or

other cause?

Were treatments/exposures and Yes, Medical records of patients who

clinical outcomes measured in the potentially had uveitis and who were members

same ways in both groups (was the of the 6 target communities were reviewed by

assessments of outcomes either 2 uveitis subspecialists to confirm the

objective or blinded to exposure)? diagnosis of uveitis and to establish time of


onset. Demographic and clinical data were

gathered for patients meeting the clinical

definition of uveitis. Incidence rates were

calculated by using a dynamic population

model. Prevalence rates were based on the

mid–study period population.

Was the follow-up of study patients No, based on medical records.

complete and long enough?

Do the results satisfy some “diagnostic tests for causation”?

Is it clear that the exposure Yes, it is clear that the exposure preceded the

preceded the onset of the outcome? onset of the outcome.

Is there a dose response gradient  Yes, The incidence and prevalence of

disease were lowest in pediatric age

groups and were highest in patients 65

years or older (P_0.0001). The

prevalence of uveitis was higher in

women than in men (P_0.001), but the

difference in incidence between men

and women was not statistically

significant. Comparison between the

group of patients who had onset of

uveitis before the target period

(ongoing uveitis) and the entire cohort


of uveitis patients showed that women

had a higher prevalence of ongoing

uveitis than men and that this

difference was largest in the older age

groups (P_0.001).

Is there positive evidence from a NO, there were no medical testing protocol in

“dechallenge-rechallenge” study? which a medicine or drug is administered,

withdrawn, then re-administered, while being

monitored for adverse effects at each stage.

Is the association consistent from Yes, In studies that compared the IOP levels

study to study? with respect to caffeine intake in patients with

ocular hypertension, open-angle glaucoma and

healthy volunteers, it was found that those with

glaucoma had a significant greater elevation in

IOP (~ 3 mmHg) with acute caffeine

ingestion.7, 27 Also, in another study among

healthy West Africans,10 who may be

predisposed to glaucoma,28, 29 a transient

IOP elevation of 4 mm Hg occurred with only

30–50 mg of caffeine, a relatively small

caffeine dose.

Does the association make Yes, Some investigators have shown that the

biological sense? incidence of autoimmune disease is increasing


overall.12–14 The reasons for this increase are

not clear. Because many uveitic entities are

immune mediated, the higher rate of uveitis

found in this study may reflect a general rise in

autoimmune disorders.

Future studies of the incidence of autoimmune

disease and uveitis in the KP population that

examine different study periods would be

worthwhile.

For unclear reasons, the higher rate of

inflammatory disease in the elderly population

differs from that found in previous studies. The

incidence of some autoimmune diseases, such

as rheumatoid arthritis, increases with age. An

interesting observation is that, as with

rheumatoid disease, prevalence of disease

was higher in women. Change may be

occurring also in the epidemiology of uveitis

among the elderly population. With the

numbers of older people growing, this trend

may become more apparent. With aging of the

population, this higher incidence of uveitis

could have a major impact on health care.


Because this study and previous studies used

age-stratified rates of disease, the size of the

populations for different age groups does not

affect rate of disease within age strata. Rates

of uveitis were higher.

Are the valid results from this harm study important?

Adverse Outcome Total

Patients with Patients with

Uveitis, Age < 65 Uveitis, Age ≥ 65

Male 313.748 39.223 352.971

Female 329.471 49.447 378.918

Totals 643.219 88.670 731.889

Relative Risk = {(a/a+b) / (c/c+d)}


= {(313.748 / 352.971) / (329.471 / 378.918)}
= 0,8888 / 0,8695
= 1.022
>> A relative risk of 1.5 means that the study population with the exposure have no big
difference (1.022 Times, Male have higer risk than woman) beetwen the two
comparison group. In this study.

Should this valid, potentially important results change the treatment of your

patient?
Is your patients so different from those in No, it is quite the same so the study’s

the study that its results don’t apply? result can be applied.

What are your patient’s risk of the

adverse event? NNH = 1 / (le – lu)

To calculate the NNH (number of patients = 1/ 0.8888 – 0.8695

you need to treat to harm one of them) = 1 / 0.0193

for any RR and your patient’s expected = 51.8134

event rate for this adverse event if they

were not exposed to this treatment:

What are your patient’s preferences, Overall there is no big difference (Risk

concerns and expectations from this Factors) between male and female in

treatment? incidence of uveitis.

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