LEMBAR JAWABAN

SKILL LAB EVIDENCE BASED MEDICINE (EBM)

NAMA : SELLI NOVITA BELINDA

NIM :

1. Data abnormalitas

Statistics
SGOT_SGP Total
T HB Trigliserida Koresterol HDL LDLq
N Valid 200 200 200 200 200 200
Missing 0 0 0 0 0 0
Mean 26.29 12.47 115.30 137.24 89.44 74.64
Std. Deviation 13.923 .324 20.047 32.405 17.119 13.634

Parameter Rerata SD Rerata± 2 SD Nilai Abnormalitas

SGOT/SGPT 26,29 13,92 26,29+(2x13,92)=54,13 54.13+0,05=54,18
Abnormal: >54,18
Hemoglobin 12,47 0,32 12,47-(2x0,32)=11,83 11,83-0,05≤11,78
Abnormal: ≤11,78
Triglyceride 115,30 20,05 115,30+(2x20,05)=155,4 155,4+0,05=155,45
Abnormal: >155,45
Total 137,24 32,40 137,24+(2x32,40)=202,04 202,04+0,05=202,09
Kolesterol Abnormal: >202,09

HDL 89,44 17,12 89,44-(2x17,12)=55,22 55,22-0,05=55,17

Abnormal: ≤55,17
LDL 74,64 13,63 74,64+(2x13,63)=101,9 101,9+0,05=101,95
Abnormal: >101,95

2. EBM DIAGNOSIS

2.1. TABEL PICO

 P A 2 months infants
I Tachypnea
C Oxymetry
O Hypoxia

2.2. Clinical question:

Apakah takipnea sama efektifnya dengan oximetri dalam mengukur hipoksia pada anak
usia 2 bulan.

In young infant, is tachypnea as accurate as oxymetry to diagnose hypoxia.

2.3. key word (Search Strategy)

- A 2 month infant AND tachypnea AND oximetry AND hypoxia

Coba yang singkat dulu;

- A 2 month infant AND tachypnea

2.4. search:

https://www.ncbi.nlm.nih.gov/pubmed/?
term=Tachypnoea+is+a+good+predictor+of+hypoxia+in+acutely+ill+infants+under+2
+months.

Tachypnoea is a good predictor of hypoxia in acutely ill infants under 2 months.
Rajesh VT1, Singhi S, Kataria S.
Author information
Abstract
OBJECTIVE:
To evaluate the respiratory rate as an indicator of hypoxia in infants < 2 months of age.
SETTING:
Pediatric emergency unit of an urban teaching hospital.
SUBJECTS:
200 infants < 2 months, with symptom(s) of any acute illness.
METHODS:
Respiratory rate (by observation method), and oxygen saturation (SaO(2)) by means of
a pulse oximeter were recorded at admission. Infants were categorised by presence or
absence of hypoxia (SaO(2) </= 90%).
 RESULTS:
The respiratory rate was >/= 50/min in 120 (60%), >/= 60/min in 101 (50. 5%), and >/=
70/min in 58 (29%) infants. Hypoxia (SaO(2) </= 90%) was seen in 77 (38.5%) infants.
Respiratory rate and SaO(2) showed a significant negative correlation (r = -0.39).
Respiratory rate >/= 60/min predicted hypoxia with 80% sensitivity and 68%
specificity.
CONCLUSION:
These results indicates that a respiratory rate > 60/min is
a good predictor of hypoxia in infants under 2 months of age brought to the emergency
service of an urban hospital for any symptom(s) of acute illness.
Comment in
 ACP J Club. 2000 Sep-Oct;133(2):69.
 Response to Duke et Al. [Arch Dis Child. 2003]
PMID:
10630912
 
PMCID:
 
PMC1718185
 
DOI:

10.1136/adc.82.1.46
[Indexed for MEDLINE] 
Free PMC Article

VIA di worksheet

A. VALIDITAS; Apakah Uji diagnostik ini valid?(Are the results of this diagnostic
study valid?)

Apakah pemeriksaan uji dan baku emas

dilakukan secara tersamar?

Apakah uji diagnstoik ini mencakup

spektrum yg sesuai seperti dalam
praktek?
 Apakah baku emas tetap diperiksa tanpa
melihat hasil uji diagnostik?

B. IMPORTANCE (Apakahh uji diagnstik ini penting? (Are the valid results of this
diagnostic study important?)

Sensitivity = a/(a+c)

Specificity = d/(b+d)

Positive Predictive Value = a/(a+b)

Negative Predictive Value = d/(c+d)

Likelihood ratio for a positive test

result = LR+ = sens/(1-spec)

Likelihood ratio for a negative test

result = LR - = (1-sens)/spec

Pre-test probability (prevalence) =

(a+c)/(a+b+c+d)
Pre-test odds = prevalence/(1-
prevalence)
Post-test odds = pre-test odds  LR
Post-test probability = post-test
odds/(post-test odds +1)

CALCULATIONS
Target disorder

Present Absent Totals

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

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

Totals

C.APLICABILITY: DAPATKAN KITA MENERAPKAN HASIL STUDI INI PADA

PASIEN KITA?

Apakah pasien kita mirip dengan pasien

pada studi diagnostik ini?

Apakah kita dapat memperkkirakan

prevalensi (pre-test probability) pasin kita?
(berdasakan pengalaman, pustaka, dll)

Apakaha hasil uji diagnostik ini, khususnya

nilai rediksi positif (NPP) nya membantu
tata laksana terhadap paien kita?

Apakah secara keselruhan uji ini membantu

pasien kita?

3. EBM TERAPI

3.1. TABEL PICO

P
I
C
O
3.2. Clinical question:

3.3. key word (Search Strategy)

3.4. search:

4. DATA EBM DIAGNOSTIK PENILAIAN IMPORTANCY

SPSS ROC curve

Stat ca;lc

4.1. Cut off point kreatinin kinase

4.2. AUC = 0.973

Sensitivity =

Specificity =

LR (–) =

LR (+) =

PPV =

NPV=

Variable Kreatinin_kinase
Kreatinin Kinase
Classification variabl MCI
e MCI
 

Sample size 100
Positive group a 13 (13.00%)
Negative group b 87 (87.00%)

a
MCI = 1
b
MCI = 0
 

Disease prevalence (% 13.0
)

Area under the ROC curve (AUC)

Area under the ROC curve (AUC)  0.973
a
Standard Error 0.0140
b
95% Confidence interval 0.919 to 0.995
z statistic 33.901
Significance level P (Area=0.5) <0.0001
a
DeLong et al., 1988
b
Binomial exact

Youden index
Youden index J 0.9195
Associated criterion >69.1098
Sensitivity 100.00
Specificity 91.95
Criterion values and coordinates of the ROC curve [Hide]
Criterio Sensitivi 95%  Specifici 95%  +LR 95%  -LR 95%  +PV 95%  -PV 95% 
n ty CI ty CI CI CI CI CI
≥40.08 100.00 75.3 -  0.00 0.0 -  1.00 1.0 -      13.0 13.0 -     
86 100.0 4.2 1.0 13.0
>40.08 100.00 75.3 -  2.30 0.3 -  1.02 1.0 -  0.00   13.3 12.9 -  100.  
86 100.0 8.1 1.1 13.6 0
>42.23 100.00 75.3 -  4.60 1.3 -  1.05 1.0 -  0.00   13.5 13.0 -  100.  
35 100.0 11.4 1.1 14.1 0
>43.93 100.00 75.3 -  6.90 2.6 -  1.07 1.0 -  0.00   13.8 13.2 -  100.  
42 100.0 14.4 1.1 14.5 0
>44.52 100.00 75.3 -  9.20 4.1 -  1.10 1.0 -  0.00   14.1 13.3 -  100.  
65 100.0 17.3 1.2 15.0 0
>45.34 100.00 75.3 -  11.49 5.7 -  1.13 1.0 -  0.00   14.4 13.5 -  100.  
03 100.0 20.1 1.2 15.4 0
>45.99 100.00 75.3 -  13.79 7.3 -  1.16 1.1 -  0.00   14.8 13.7 -  100.  
3 100.0 22.9 1.3 15.9 0
>46.54 100.00 75.3 -  16.09 9.1 -  1.19 1.1 -  0.00   15.1 14.0 -  100.  
38 100.0 25.5 1.3 16.3 0
>46.71 100.00 75.3 -  18.39 10.9 -  1.23 1.1 -  0.00   15.5 14.2 -  100.  
13 100.0 28.1 1.4 16.8 0
>46.82 100.00 75.3 -  20.69 12.7 -  1.26 1.1 -  0.00   15.9 14.5 -  100.  
32 100.0 30.7 1.4 17.3 0
>49.56 100.00 75.3 -  22.99 14.6 -  1.30 1.2 -  0.00   16.3 14.7 -  100.  
72 100.0 33.2 1.5 17.9 0
>51.20 100.00 75.3 -  25.29 16.6 -  1.34 1.2 -  0.00   16.7 15.0 -  100.  
17 100.0 35.7 1.5 18.4 0
>51.43 100.00 75.3 -  27.59 18.5 -  1.38 1.2 -  0.00   17.1 15.3 -  100.  
34 100.0 38.2 1.6 19.0 0
>51.50 100.00 75.3 -  29.89 20.5 -  1.43 1.2 -  0.00   17.6 15.7 -  100.  
42 100.0 40.6 1.6 19.6 0
>51.59 100.00 75.3 -  32.18 22.6 -  1.47 1.3 -  0.00   18.1 16.0 -  100.  
92 100.0 43.1 1.7 20.3 0
>53.27 100.00 75.3 -  34.48 24.6 -  1.53 1.3 -  0.00   18.6 16.4 -  100.  
79 100.0 45.4 1.8 21.0 0
>53.45 100.00 75.3 -  36.78 26.7 -  1.58 1.3 -  0.00   19.1 16.8 -  100.  
25 100.0 47.8 1.9 21.7 0
>53.56 100.00 75.3 -  39.08 28.8 -  1.64 1.4 -  0.00   19.7 17.2 -  100.  
5 100.0 50.1 1.9 22.5 0
>53.65 100.00 75.3 -  41.38 30.9 -  1.71 1.4 -  0.00   20.3 17.6 -  100.  
01 100.0 52.4 2.0 23.3 0
>53.90 100.00 75.3 -  43.68 33.1 -  1.78 1.5 -  0.00   21.0 18.1 -  100.  
37 100.0 54.7 2.1 24.2 0
>54.79 100.00 75.3 -  45.98 35.2 -  1.85 1.5 -  0.00   21.7 18.6 -  100.  
23 100.0 57.0 2.2 25.1 0
>55.62 100.00 75.3 -  48.28 37.4 -  1.93 1.6 -  0.00   22.4 19.1 -  100.  
22 100.0 59.2 2.4 26.1 0
>56.42 100.00 75.3 -  50.57 39.6 -  2.02 1.6 -  0.00   23.2 19.6 -  100.  
82 100.0 61.5 2.5 27.2 0
>56.68 100.00 75.3 -  52.87 41.9 -  2.12 1.7 -  0.00   24.1 20.2 -  100.  
46 100.0 63.7 2.7 28.4 0
>56.78 100.00 75.3 -  55.17 44.1 -  2.23 1.8 -  0.00   25.0 20.9 -  100.  
49 100.0 65.9 2.8 29.6 0
>56.89 100.00 75.3 -  57.47 46.4 -  2.35 1.8 -  0.00   26.0 21.6 -  100.  
89 100.0 68.0 3.0 31.0 0
>57.43 100.00 75.3 -  59.77 48.7 -  2.49 1.9 -  0.00   27.1 22.3 -  100.  
61 100.0 70.1 3.2 32.4 0
>61.51 100.00 75.3 -  62.07 51.0 -  2.64 2.0 -  0.00   28.3 23.1 -  100.  
42 100.0 72.3 3.4 34.0 0
>61.68 100.00 75.3 -  64.37 53.4 -  2.81 2.1 -  0.00   29.5 24.0 -  100.  
7 100.0 74.4 3.7 35.7 0
>62.13 100.00 75.3 -  66.67 55.7 -  3.00 2.2 -  0.00   31.0 25.0 -  100.  
92 100.0 76.4 4.0 37.6 0
>63.36 100.00 75.3 -  68.97 58.1 -  3.22 2.4 -  0.00   32.5 26.0 -  100.  
65 100.0 78.5 4.4 39.7 0
>64.24 100.00 75.3 -  71.26 60.6 -  3.48 2.5 -  0.00   34.2 27.2 -  100.  
72 100.0 80.5 4.8 42.0 0
>65.37 100.00 75.3 -  73.56 63.0 -  3.78 2.7 -  0.00   36.1 28.5 -  100.  
17 100.0 82.4 5.4 44.5 0
>65.40 100.00 75.3 -  75.86 65.5 -  4.14 2.9 -  0.00   38.2 29.9 -  100.  
5 100.0 84.4 6.0 47.3 0
>65.64 100.00 75.3 -  78.16 68.0 -  4.58 3.1 -  0.00   40.6 31.5 -  100.  
24 100.0 86.3 6.8 50.5 0
>65.87 100.00 75.3 -  80.46 70.6 -  5.12 3.3 -  0.00   43.3 33.3 -  100.  
9 100.0 88.2 7.8 53.9 0
>67.11 100.00 75.3 -  82.76 73.2 -  5.80 3.7 -  0.00   46.4 35.4 -  100.  
41 100.0 90.0 9.2 57.9 0
>67.90 100.00 75.3 -  85.06 75.8 -  6.69 4.1 -  0.00   50.0 37.7 -  100.  
09 100.0 91.8 11.0 62.3 0
>68.42 100.00 75.3 -  87.36 78.5 -  7.91 4.6 -  0.00   54.2 40.5 -  100.  
19 100.0 93.5 13.7 67.2 0
>69.05 100.00 75.3 -  89.66 81.3 -  9.67 5.2 -  0.00   59.1 43.8 -  100.  
46 100.0 95.2 17.9 72.8 0
>69.10 100.00 75.3 -  91.95 84.1 -  12.4 6.1 -  0.00   65.0 47.7 -  100.  
98 100.0 96.7 3 25.3 79.1 0
>70.16 92.31 64.0 -  93.10 85.6 -  13.3 6.1 -  0.08 0.01 -  66.7 47.6 -  98.8 92.5 - 
41 99.8 97.4 8 29.4 3 0.5 81.5 99.8
>72.90 76.92 46.2 -  93.10 85.6 -  11.1 4.9 -  0.25 0.09 -  62.5 42.1 -  96.4 90.9 - 
38 95.0 97.4 5 25.5 0.7 79.2 98.6
>73.24 69.23 38.6 -  94.25 87.1 -  12.0 4.8 -  0.33 0.1 -  64.3 41.7 -  95.3 90.1 - 
95 90.9 98.1 5 30.4 0.7 81.9 97.9
>75.24 69.23 38.6 -  96.55 90.3 -  20.0 6.2 -  0.32 0.1 -  75.0 48.2 -  95.5 90.3 - 
07 90.9 99.3 8 64.7 0.7 90.6 97.9
>76.51 61.54 31.6 -  97.70 91.9 -  26.7 6.4 -  0.39 0.2 -  80.0 48.8 -  94.4 89.5 - 
48 86.1 99.7 7 112.5 0.8 94.4 97.1
>76.88 53.85 25.1 -  98.85 93.8 -  46.8 6.3 -  0.47 0.3 -  87.5 48.3 -  93.5 88.8 - 
72 80.8 100.0 5 350.6 0.8 98.1 96.3
>77.45 38.46 13.9 -  98.85 93.8 -  33.4 4.2 -  0.62 0.4 -  83.3 38.8 -  91.5 87.5 - 
74 68.4 100.0 6 264.2 1.0 97.5 94.3
>77.99 30.77 9.1 -  100.00 95.8 -      0.69 0.5 -  100.   90.6 87.1 - 
5 61.4 100.0 1.0 0 93.3
>78.36 15.38 1.9 -  100.00 95.8 -      0.85 0.7 -  100.   88.8 86.3 - 
19 45.4 100.0 1.1 0 90.9
>78.67 0.00 0.0 -  100.00 95.8 -      1.00 1.0 -      87.0 87.0 - 
51 24.7 100.0 1.0 87.0

4.3. Kesimpulan:

4b. Kerjakan untuk LDL

5. EBM TERAPI PENILAIAN IMPORTANCY: BAD OUT COME

Case Processing Summary

Cases
Valid Missing Total
N Percent N Percent N Percent
Kelompok *
100 100.0% 0 .0% 100 100.0%
MCI

Kelompok * MCI Crosstabulation

MCI
DEAD ALIVE Total
Kelompok Ace Count 6 44 50
Inhibitor % within
12.0% 88.0% 100.0%
Kelompok
Placebo Count 13 37 50
% within
26.0% 74.0% 100.0%
Kelompok
Total Count 19 81 100
% within
19.0% 81.0% 100.0%
Kelompok
 Chi-Square Tests
Asymp. Sig. Exact Sig. (2- Exact Sig. (1-
Value df (2-sided) sided) sided)
Pearson Chi-Square 3.184a 1 .074
Continuity Correctionb 2.339 1 .126
Likelihood Ratio 3.246 1 .072
Fisher's Exact Test .125 .062
Linear-by-Linear
3.152 1 .076
Association
N of Valid Casesb 100
a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 9.50.
b. Computed only for a 2x2 table

Nilai Importancy

Secara klinis:

EER = 0,12 artinya kejadian kematian 12 % pada penggunaan ACE-Inhibitor

CER = 0,26 artinya kejadian kematian pada kelompok penggunaan placebo sebesar 26%
RR =0,46 artinya ACE inhibitor merupakan factor proteksi terjadinya kematian

ARR = 0,14 artinya peluang kematian penggunaan

RRR = 0,538 artinya pengurangan kematian pada penggunaan ACE Inhibitor sebesar 53,8%
di bandingkan Placebo.

Bermakna secara klinis bila RRR≥25%, sangat bermakna jika lebih dari 50%.

NNT = 7,14 artinya diperlukan pengobatan dengan ACE-i sevesar 7-8 orang untuk mencegah
satu kematian selama 2 tahun.

Secara statistic: pada uji Chi-square p = 0,126 >0,05 artinya perbedaan kematian antara
penggunaan ACE-i dan placebo tidak bermakna.

5.2.kesimpulan

Hasil penelitian penting dan bermakna secara klinis sebab kareba RRR>50% , hasil penelitian
tidak bermakna secara statistic.

6. NILAI IMPORTANCY EBM TERAPY YG EFECTIVE OUTCOME

Case Processing Summary

Cases

Valid Missing Total

N Percent N Percent N Percent

Kelompok * Outcome 100 100.0% 0 .0% 100 100.0%

 Kelompok * Outcome Crosstabulation

Outcome

Sembuh Tidak Sembuh Total

Kelompok Enalapril + ASA Count 26 24 50

% within Kelompok 52.0% 48.0% 100.0%

Isossorbid Prodiprogrel + Count 9 41 50

Deuretik
% within Kelompok 18.0% 82.0% 100.0%

Total Count 35 65 100

% within Kelompok 35.0% 65.0% 100.0%

Chi-Square Tests

Asymp. Sig. (2- Exact Sig. (2- Exact Sig. (1-

Value df sided) sided) sided)

Pearson Chi-Square 12.703a 1 .000

Continuity Correctionb 11.253 1 .001

Likelihood Ratio 13.115 1 .000

Fisher's Exact Test .001 .000

Linear-by-Linear Association 12.576 1 .000

N of Valid Casesb 100

a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 17.50.

b. Computed only for a 2x2 table

Stat Calc
Nilai importancy

Secara klinis

EER

CER

RR artinya

ABI artinya

RBI 1 (100%) artinya peluang sembuh pengguna enalapril+ASA 100% dibandingkan dengan
penggunaan isosorbid progerpi+diuretik

NNT artinya

Secara statistic chi square nilai p 0,001

6.2. Kesimpulan: