LEMBAR JAWABAN

SKILLAB EVIDENCE BASED MEDICINE (EBM)

Nama : Desi Mareta Alfina

NIM : 04011181320040

1. NILAI ABNORMALITAS
NO PARAMETER RATA-RATA+- 2SD NILAI ABNORMALITAS
1 SGOT/SGPT 26.29 + 2(13,92)= 54.13 54.13 + 0.05= 54.18
2 HEMOGLOBIN 12.47- 2(0.32)= 11.82 11.82 – 0.05= 11.77
3 TRIGLISERID 115.30+ 2(20.04)= 155.4 155.4 + 0.5= 155.9
4 TOTAL 137.23+ 2(32.40)= 202.04 202.04 + 0.05= 202.09
KOLESTEROL
5 HDL 89.44- 2(17.11)= 55.20 55.20 – 0.05= 55.15
6 LDL 74.64+2(13.63)= 101.90 101.90 + 0.05= 101.95

2. PICO
a. Tabel PICO
P Older patients reporting memory loss and concerned about the onset of
dementia
Young patients with Systemic Lupus Eriotmatosus
Infant patients with allergic to egg
Older patients with a stroke and moderate carotid stenosis
Young women with solitary thyroid nodule and normal thyroid function
I Mini-Cog screening test
Patiens with development of heart failure
Administration of MMR vaccine
Enalapril + ASA
Ultrasound
C Mini Mental State Examination
Compared with no heart failure patient
-
Placebo
-
O Accurate diagnosis of dementia or Alzheimer’s
Lead to increase mortality
Cause significant allergic reaction
Prevent stroke insidens
In excluding malignancy

b. Clinical Question
i. In older patients reporting memory loss and concerned about the onset of
dementia, is Mini-Cog screening test as accurate as MMSE in diagnosing
dementia or Alzheimer’s?
 ii. In young patients with Systemic Lupus Eritomatosus, will patients with
the development of heart failure lead to increase mortality compare with
no heart failure patients?
iii. In infant patients with allergic to egg, might administration of MMR
vaccine cause specific allergic reaction?
iv. In older patients with a stroke and moderate carotid stenosis, will the
treatment with ASA + enalapril be more effective than placebo in
preventing stroke incidens?
v. In young women with solitary thyroid nodule and normal thyroid function,
could the using of ultrasound excluding malignancy?

c. Search Term/Keyword
i. Mini-Cog AND MMSE AND Dementia OR Alzheimer disease
ii. Young women AND SLE AND heart failure OR not heart failure
iii. Infant AND allergic egg AND administration MMR
iv. Stroke AND ASA+Enalapril AND placebo
v. Young women AND solitary thyroid nodule AND normal thyroid function
AND ultrasound

d. Melakukan Searching

e. Abstract Article

f. Critical Appraisal dengan Worksheet

3. DATA DIAGNOSTIK
a. Grafik titik potong
Keratin kinase & MCI
Classification: MCI
100
90
80
70
60
Sensitivity (%)
50
Specificity (%)
40
30
20
10
0
40 50 60 70 80
KretaininKinase
 Classification: MCI
100
90
80
70
60
Sensitivity (%)
50
Specificity (%)
40
30
20
10
0
40 50 60 70 80
KretaininKinase

KretaininKinase
100
Sensitivity: 100.0
Specificity: 92.0
Criterion : >69.1098
80
Sensitivity

60

40

20

0
0 20 40 60 80 100
100-Specificity

ROC curve
Variable KretaininKinase
 KretaininKinase
Classification variable MCI

Sample size 100

Positive group : MCI = 1 13
Negative group : MCI = 0 87

Disease prevalence (%) 13.0

Area under the ROC curve (AUC)
Area under the ROC curve (AUC) 0.973
Standard Errora 0.0140
95% Confidence intervalb 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
Criterion values and coordinates of the ROC curve [Hide]
Criterio Sensitiv 95% Specific 95% +LR 95% -LR 95% +PV 95% -PV 95%
n ity CI ity CI CI CI CI CI
≥40.08 100.00 75.3 - 0.00 0.0 - 1.00 1.0 - 13.0 7.1 -
86 100. 4.2 1.0 21.2
0
>69.10 100.00 75.3 - 91.95 84.1 - 12.4 6.1 - 0.00 65.0 40.8 - 100. 95.5 -
98 100. 96.7 3 25.3 84.6 0 100.
0 0
>70.16 92.31 64.0 - 93.10 85.6 - 13.3 6.1 - 0.08 0.01 - 66.7 41.0 - 98.8 93.3 -
41 99.8 97.4 8 29.4 3 0.5 86.7 100.
0
>72.90 76.92 46.2 - 93.10 85.6 - 11.1 4.9 - 0.25 0.09 - 62.5 35.4 - 96.4 89.9 -
38 95.0 97.4 5 25.5 0.7 84.8 99.3
>73.24 69.23 38.6 - 94.25 87.1 - 12.0 4.8 - 0.33 0.1 - 64.3 35.1 - 95.3 88.5 -
95 90.9 98.1 5 30.4 0.7 87.2 98.7
>75.24 69.23 38.6 - 96.55 90.3 - 20.0 6.2 - 0.32 0.1 - 75.0 41.2 - 95.5 88.8 -
07 90.9 99.3 8 64.7 0.7 95.0 98.7
>76.51 61.54 31.6 - 97.70 91.9 - 26.7 6.4 - 0.39 0.2 - 80.0 42.2 - 94.4 87.5 -
48 86.1 99.7 7 112. 0.8 97.9 98.2
5
>76.88 53.85 25.1 - 98.85 93.8 - 46.8 6.3 - 0.47 0.3 - 87.5 44.0 - 93.5 86.3 -
72 80.8 100. 5 350. 0.8 99.8 97.6
0 6
>77.45 38.46 13.9 - 98.85 93.8 - 33.4 4.2 - 0.62 0.4 - 83.3 31.1 - 91.5 83.9 -
74 68.4 100. 6 264. 1.0 99.8 96.3
0 2
>77.99 30.77 9.1 - 100.00 95.8 - 0.69 0.5 - 100. 39.8 - 90.6 82.9 -
5 61.4 100. 1.0 0 100. 95.6
0 0
>78.67 0.00 0.0 - 100.00 95.8 - 1.00 1.0 - 87.0 78.8 -
51 24.7 100. 1.0 92.9
0

LDL & MCI

SALAH
b. Visualisasi nilai titik potong dan interpretasi
Titik potong keratin kinase terhadap sensitivitas dan spesifisitas MCI berada pada
nilai 65 sampai 75
c. Menghitung seluruh nilai diagnostic
Sensitivitas : 100
Spesifisitas : 92
PV + : 59
PV - : 100
LR + : 12.43
LR - : 0.00
LR Test : 12.43/0.00
AUC : 0.973
Akurasi : 0.91

Kesimpulan :
Kreatinin kinase bisa mendiagnosis MCI dengan sensitifitas 100%. Kreatinin
kinase bisa mendiagnosis MCI sebesar 97% artinya jika diandaikan ada 100
pasien yang diperiksa terdapat 97 orang yang hasil diagnosanya benar

4. DATA THERAPY BAD OUTCOME

KelompokPerlakuan * Outcome Crosstabulation

Outcome

alive dead Total

KelompokPerlakuan ACE inhibitor Count 44 6 50

% within
88.0% 12.0% 100.0%
KelompokPerlakuan

placebo Count 37 13 50

% within
74.0% 26.0% 100.0%
KelompokPerlakuan
Total Count 81 19 100

% within
81.0% 19.0% 100.0%
KelompokPerlakuan

EER : 0.12
CER : 0.26
ARR : 0.14
 RRR : 0.53
NNT : 7.14
Kesimpulan :
Ace inhibitor efektif dalam menurunkan kematian pada MCI ???

5. DATA THERAPY EFFECTIVENESS

Kelompok * Outcome Crosstabulation

Outcome

sembuh tidak sembuh Total

Kelompok Enalapril + ASA Count 26 24 50

% within Kelompok 52.0% 48.0% 100.0%

Isosorbid popidogrel + Count 9 41 50

diuretik % within Kelompok 18.0% 82.0% 100.0%
Total Count 35 65 100

% within Kelompok 35.0% 65.0% 100.0%

EER : 0.52
CER : 0.18
ARR : 0.34
RRR : 1.88
NNT : 2.94
ABI : EER-CER = 0.34
RBI : ABI/CER = 1.88

Pemberian Enalapril + ASA lebih efektif dalam menyembuhkan pasien MCI sebesar
188% disbanding pemberian Isosorbid