Soal nomor 1

Dalam File Excell tersedia Data abnormalitas. Data pada pria : SGOT/SGPT, Hb,
Trigliceride, tota kolesterol, HDL, LDL
Hitunglah nilai:
 Hitung harga rerata
 Hitung standard deviasi
 Nilai abnormalitas: X± 2 SD

Statistics
SGOT/SGPT Hemoglobin Trigliserid TotalKolestrol HDL LDL
N Valid 200 200 200 200 200 200
Missing 0 0 0 0 0 0
Mean 26.29 12.472 115.30 137.23 89.44 74.64
Std. Error of Mean .985 .0229 1.418 2.291 1.211 .964
Median 27.00 12.500 116.50 137.50 89.00 74.00
Std. Deviation 13.923 .3238 20.047 32.405 17.119 13.634
Minimum 1 12.0 81 80 61 50
Maximum 49 13.0 148 199 119 98

Data Rata-rata Standar X±2SD Nilai

Deviasi abnormalitas
SGOT/SGPT 26.290 13.923 26.290+2(13.923)=54.136 ≥54.136+0.05=
≥54.186
Hemoblobin 12.472 0.3238 12.472-2(0.3238)=11.8244 ≤11.8244-0.05=
≥11.8744
Trigliserid 115.300 20.047 115.300+2(20.047)=155.394 ≥155.394+0.05=
155.444
Total kolestrol 137.230 32.405 137.230+2(32.405)=202.04 ≥202.04+0.05=
≥202.09
HDL 89.440 17.119 89.440-2(17.119)=55.202 ≤55.202-0.05=
≤55.152
LDL 74.640 13.634 74.640+2(13.634)=101.908 ≥101.908+0.05=
≥101.958
Soal Nomor 2
Soal di Notes line
• Buatlah Tabel P.I.C.O
Patient/problem Old patient with memory loss
Intervention Mini-cog test
Comparison MMSE
Outcome Detecting alzheimer’s disease or dementia

• Buatlah Clinical Question

In old patient with memory loss, is Mini-cog test as accurate as MMSE to detecting
alzheimer’s disease or dementia?
• Buatlah Search Term/Search/Keyword
Mini-cog AND MMSE AND (alzheimer’s disease OR dementia)
• Lakukan Searching
Hasil: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5179268/
• Pastekan Abstract Artikel yang didapat pada lembar Jawaban

• Lakukan Critical Appraisal dari Artikel dengan critical appraisal worksheet

Are the results of this diagnostic study valid?

Was there an independent, blind

comparison with a reference (“gold”)
standard of diagnosis?

Was the diagnostic test evaluated in an

appropriate spectrum of patients (like
those in whom it would be used in
practice)?

Was the reference standard applied

regardless of the diagnostic test result?

Was the test (or cluster of tests)

validated in a second, independent
group of patients?

Are the valid results of this diagnostic study important?

SAMPLE CALCULATIONS
Target disorder
(iron deficiency anemia)
Present Absent Totals
Positive 731 270 1001
Diagnostic (< 65 mmol/L) a b a+b
test result
(serum Negative 78 1500 1578
ferritin) ( 65 mmol/L) c d c+d

809 1770 2579

Totals a+c b+d a+b+c+d

Sensitivity = a/(a+c) = 731/809 = 90%

Specificity = d/(b+d) = 1500/1770 = 85%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 90%/15% = 6
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 10%/85% = 0.12
Positive Predictive Value = a/(a+b) = 731/1001 = 73%
Negative Predictive Value = d/(c+d) = 1500/1578 = 95%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 809/2579 = 32%
Pre-test odds = prevalence/(1-prevalence) = 31%/69% = 0.45
Post-test odds = pre-test odds  LR
Post-test probability = post-test odds/(post-test odds +1)

YOUR CALCULATIONS
Target disorder

Present Absent Totals

Positive a b a+b
Diagnostic
test result
Negative c d c+d

a+c b+d a+b+c+d

Totals

Can you apply this valid, important evidence about a diagnostic test in caring for your patient?

Is the diagnostic test available, affordable,

accurate, and precise in your setting?
Can you generate a clinically sensible estimate
of your patient’s pre-test probability (from
personal experience, prevalence statistics,
practice databases, or primary studies)?
 Are the study patients similar to your own?
 Is it unlikely that the disease possibilities or
probabilities have changed since the
evidence was gathered?
 Will the resulting post-test probabilities affect
your management and help your patient?
 Could it move you across a test-treatment
threshold?
 Would your patient be a willing partner in
carrying it out?

Would the consequences of the test help your

patient?

Additional notes:

• Lampirkan full Text PDF

Soal no 3
Dalam file excell tersedia data diagnosis tdri dari LDL,kreaninkinase

 Buatlah grafik titik potong diagnostik pastekan pada lembar jawaban

 Perhatikan secara visual nilai titik potong diagnostik dan interpretasikan
 Hitunglah seluruh nilai diagnostik memakai MedCalc dan Epical, buatlah kesimpulan
KreatininKinase
 Coordinates of the Curve 54.35 .437 .000
Test Result Variable(s): Kretainin Kinase 55.21 .460 .000
Positive if Less 56.03 .483 .000
Than or Equal 56.56 .506 .000
Toa Sensitivity 1 - Specificity
56.73 .529 .000
39.09 .000 .000
56.84 .552 .000
41.16 .023 .000
57.17 .575 .000
43.08 .046 .000
59.48 .598 .000
44.23 .069 .000
61.60 .621 .000
44.93 .092 .000
61.91 .644 .000
45.67 .115 .000
62.75 .667 .000
46.27 .138 .000
63.81 .690 .000
46.63 .161 .000
64.81 .713 .000
46.77 .184 .000
65.39 .736 .000
48.20 .207 .000
65.52 .759 .000
50.38 .230 .000
65.76 .782 .000
51.32 .253 .000
66.50 .805 .000
51.47 .276 .000
67.51 .828 .000
51.55 .299 .000
68.16 .851 .000
52.44 .322 .000
68.74 .874 .000
53.37 .345 .000
69.08 .897 .000
53.51 .368 .000
69.64 .920 .000
53.61 .391 .000
71.53 .931 .077
53.78 .414 .000
73.08 .931 .231
 74.25 .943 .308 The test result variable(s): Kretainin Kinase has

75.88 .966 .308 at least one tie between the positive actual state

76.70 .977 .385 group and the negative actual state group.

77.17 .989 .462 a. The smallest cutoff value is the minimum

observed test value minus 1, and the largest
77.73 .989 .615
cutoff value is the maximum observed test value
78.18 1.000 .692
plus 1. All the other cutoff values are the
78.52 1.000 .846
averages of two consecutive ordered observed
79.68 1.000 1.000
test values.

Cut-off point=71.53
Dengan sensitivitas 0.931 dan spesifisitas 0.923

- Tabel chi-square

Pake yang fisher’s exact test 0.000 p value<0.005 signifikan

Nilai diagnostik:
Sensitivity = a/(a+c) = 0.923
Specificity = d/(b+d) = 0.931
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 13.384
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 0.082
Likelihood test=163.2
Accuracy=0.93
Positive Predictive Value = a/(a+b) = 731/1001 = 73%
Negative Predictive Value = d/(c+d) = 1500/1578 = 95%
Accuracy=0.973
Kesimpulan
Accuracy 0.973 (excellent, artinya pada cut off point kreatinin kinase 71.53, dapat didiagnosis MCI
sebesar 0.973)
Validitas valid sensitivitas 92%, spec: 93%
LDL

1. Grafik

Coordinates of the Curve

Test Result Variable(s): LDL 100.9950 .011 .000

Positive if Less 107.9950 .023 .000
Than or Equal 111.5750 .023 .077
Toa Sensitivity 1 - Specificity 113.0850 .034 .077
95.3900 .000 .000 113.8750 .046 .077
114.6750 .046 .154 139.8050 .414 .615
115.9450 .057 .154 140.2750 .414 .692
117.5450 .069 .154 140.5100 .425 .692
118.5200 .080 .154 140.7050 .437 .692
118.8550 .092 .154 140.8900 .448 .692
120.0250 .103 .154 141.3150 .460 .692
121.7450 .103 .231 141.6200 .471 .692
122.4800 .115 .231 141.6700 .483 .692
123.0300 .126 .231 141.7850 .494 .692
123.8750 .138 .231 142.3100 .506 .692
124.3900 .149 .231 142.7600 .517 .692
124.7150 .161 .231 142.8500 .517 .769
125.1300 .161 .308 142.9550 .529 .769
125.2950 .172 .308 143.3300 .529 .846
126.6650 .184 .308 143.7250 .540 .846
128.2250 .195 .308 144.1900 .552 .846
128.4900 .207 .308 144.7350 .563 .846
129.0850 .218 .308 145.0850 .575 .846
129.8200 .230 .308 145.4850 .586 .846
130.0500 .241 .308 145.7350 .598 .846
130.3100 .253 .308 145.9250 .609 .846
130.6550 .264 .308 146.1800 .621 .846
131.4900 .276 .308 146.5550 .632 .846
132.5450 .287 .308 148.0300 .644 .846
132.9550 .299 .308 149.4850 .655 .846
133.1450 .310 .308 150.0750 .667 .846
133.3700 .322 .308 150.4600 .678 .846
133.9450 .333 .308 150.8200 .690 .846
134.8000 .345 .308 151.6900 .701 .846
135.2550 .356 .308 152.3150 .713 .846
135.4750 .368 .308 153.4850 .724 .846
135.6700 .379 .308 154.5900 .736 .846
135.7450 .379 .385 154.7850 .747 .846
135.8600 .391 .385 155.0550 .759 .846
136.1850 .402 .385 155.8250 .770 .846
136.4800 .414 .385 156.6350 .782 .846
136.7500 .414 .462 157.1050 .793 .846
138.1850 .414 .538 157.5500 .805 .846
 158.0350 .816 .846 174.6250 .954 .923
158.6400 .828 .846 181.8150 .966 .923
158.9400 .828 .923 184.9850 .977 .923
159.4250 .839 .923 186.4450 .989 .923
160.2350 .851 .923 189.9500 .989 1.000
160.7500 .862 .923 193.2200 1.000 1.000
160.9750 .874 .923 a. The smallest cutoff value is the minimum
161.2550 .885 .923 observed test value minus 1, and the largest

161.6750 .897 .923 cutoff value is the maximum observed test value

162.4400 .908 .923 plus 1. All the other cutoff values are the

165.4650 .920 .923 averages of two consecutive ordered observed

test values.
168.4450 .931 .923
169.6500 .943 .923
Titik potong diagnostik: 136.185 dengan sensitivitas 40% dan spesifisitas 61.5%

Soal no 4
Dalam file excell tersedia Data Therapy bad outcome RCT/control trial ACE inhibitor trhdp mci.
Outcome hidup dan meninggal
0=hidup
1=meninggal
• Hitunglah nilai—nilai Importancy

Pake continuity correction= pvalue >0.05 tidak signifikan secara statistik

 Nilai importancy:
EER=0.67
CER=0.12
RR=0.461 ace inhibitor sebagai faktor proteksi terhadap kematian (>1, faktor risiko. <1, faktor
protektif, 1=netral)
ARR=0.65 perbedaan kematian antara ace inhibitor dan placebo sebesar 65%
RRR=53.8 >50%  sangat bermakna secara klinis
NNT=7 diperlukan 7 orang pengobatan dengan ace inhibitor untuk mencegah kematian satu
orang.

• Buat kesimpulan
Penggunaan ace inhibitor penting dan bermakna secara klinis namun tidak bermakna secara
statistic.
Soal no 5
Dalam file excell tersedia Data Therapy bad outcome RCT/control trial ACE inhibitor trhdp mci.
Outcome hidup dan meninggal
0=hidup
1=meninggal

Pvalue pake continui contingencypvalue <0.05 bermakna secara statistik

• Hitunglah nilai—nilai Importancy
 EER=0.52
CER=0.18
RR=2.89 jika enalapril+ASA digunakan sebagai terapi MCI, peluang kesembuhannya 2.89 kali
disbanding isoborbid+prodiprogel+diuretik
ABI=0.34 apabila enalapril dan ASA digunakan sebagai terapi, maka perbedaan insiden
kesembuhannya antara enalapril+ASA dan isosorbid prodiprogel+diuretic sebesar 0.34
RBI=1.89% dibandingkan dengan obat isosorbid+prodprogel+diuretik
NNT=2-3 membutuhkan 2-3 orang yang diterapi untuk mendapatkan 1 kesembuhan

• Buatlah kesimpulan
Enalapril+ASA dalam kesembuhan MCI sangat penting secara klinis dan secara statistik