Soal nomor 1

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

Jawab :
 Masukkan data abnormalitas ke SPSS
 Analize Deskriptif Frekuensi masukkan seluruh variabel pilih statistik centang
standar deviasi dan mean

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 12.472 115.31 137.24 89.44 74.64
Std. Deviation 13.923 .3238 20.047 32.405 17.119 13.634

Parameter Rerata SD Rerata 2 ± SD Nilai Abnormalitas

SGOT/SGPT 26,29 13,923 26,29+2(13,923)=54,13 54,13+0,05=54,18 Keatas ≥
HB 12,47 0,324 12,47-2(0,324)=11,83 11,83-0,05=11,78
Kebawah ≤
Trigliserid 115,30 20,047 115,30+2(20,047)=155,39 155,394+0,05= 155,399
4
Keatas ≥
Total Kolestrol 137,24 32,405 137,24+2(32,405)= 202,05 = 202,05+0,05= 202,1
Keatas ≥
HDL 89,44 17,119 89,44-2(17,119)=55,22 55,22-0,05=55,17
Kebawah ≤
LDL 74,64 13,634 74,64+2(13,63)=101,9 101,9+0,05=101,95
Keatas ≥

Ket : jika angka rerata melebihi nilai normal dikurangi

Jika angka rerata kurang dari nilai normal ditambah
HDL dan Hb (-)
SGOT/SGPT, Trigliserid, total kolestrol, LDL (+)
2.PICO
2.1 Tabel PICO
 P Older adults with early sign/symptom of Cognitive impairment
I Mini-Cog screening test (index test)
C Mini-Mental State Examination (the reference standard)
O Accurate diagnosis of the dementia or Alzheimer's disease

2.2 Clinical Question

In older adults with early signs/symptoms of cognitive impairment, is the Mini-Cog Test is as
accurate as MMSE in diagnosing dementia or Alzheimer's disease

2.3 Search Term/Search Keyword/Search Strategy

(Mini-cog OR minicog) AND (Mini-Mental State Exam* OR MMSE OR SMMSE) AND (A
lzheimer* OR Dementia)

2.4 Searching di www.tripdatabase.com

- Buka pubmed
- Hasil: https://www.ncbi.nlm.nih.gov/pubmed/28607210
2.5 Abstrak
SS abstraknya saja

2.6 Critical Appraisal

SOAL NO 3
BUKA DATA FILE DIAGNOSTIK EXCELL MASUKKAN DI SPSS
1. Analize ROC.Curvetest variabel= kreatinin kinasi, State variabel= MCI value isi 1
display centang semuaoption large parameter= ganti binegatif OK

Area Under the Curve

Test Result Variable(s): KretaininKinase
Asymptotic 95% Confidence
Interval
a b
Area Std. Error Asymptotic Sig. Lower Bound Upper Bound
c
,973 . . . .
The test result variable(s): KretaininKinase has at least one tie between the
positive actual state group and the negative actual state group. Statistics may be
biased.
a. Under the bi-negative exponential distribution assumption
b. Null hypothesis: true area = 0.5
c. Number of valid observations of the positive actual state group is not equal to
that of the negative actual state group. Therefore, under the bi-negative
exponential distribution assumption, Std. Error, Asymptotic Sig., and Asymptotic
Confidence Interval cannot be computed.

Coordinates of the Curve

Test Result Variable(s): KretaininKinase
Positive if
Greater Than or
Equal Toa Sensitivity 1 - Specificity
39,088600 1,000 1,000
41,161050 1,000 ,977
43,083850 1,000 ,954
44,230350 1,000 ,931
44,933400 1,000 ,908
45,666650 1,000 ,885
46,268400 1,000 ,862
46,627550 1,000 ,839
46,767250 1,000 ,816
48,195200 1,000 ,793
50,384450 1,000 ,770
51,317550 1,000 ,747
51,468800 1,000 ,724
51,551700 1,000 ,701
52,438550 1,000 ,678
53,365200 1,000 ,655
53,508750 1,000 ,632
53,607550 1,000 ,609
53,776900 1,000 ,586
54,348000 1,000 ,563
55,207250 1,000 ,540
56,025200 1,000 ,517
56,556400 1,000 ,494
56,734750 1,000 ,471
56,841900 1,000 ,448
57,167500 1,000 ,425
59,475150 1,000 ,402
61,600600 1,000 ,379
61,913100 1,000 ,356
62,752850 1,000 ,333
 63,806850 1,000 ,310
64,809450 1,000 ,287
65,388350 1,000 ,264
65,523700 1,000 ,241
65,760700 1,000 ,218
66,496550 1,000 ,195
67,507500 1,000 ,172
68,161400 1,000 ,149
68,738250 1,000 ,126
69,082200 1,000 ,103
69,636950 1,000 ,080
71,533950 ,923 ,069
73,076650 ,769 ,069
74,245100 ,692 ,057
75,877750 ,692 ,034
76,701000 ,615 ,023
77,172300 ,538 ,011
77,726200 ,385 ,011
78,178450 ,308 ,000
78,518500 ,154 ,000
79,675100 ,000 ,000
The test result variable(s): KretaininKinase has
at least one tie between the positive actual state
group and the negative actual state group.
a. The smallest cutoff value is the minimum
observed test value minus 1, and the largest
cutoff value is the maximum observed test value
plus 1. All the other cutoff values are the
averages of two consecutive ordered observed
test values.
TRANSFORM record into different variable kriatinin kinase jadiin kreatiningrp dengan
memasukkan di old new
Highest=71,53 = 1
All others=2 continue

TRANSFORM record into different variable mci jadiin grupmci old value 0=2 1=1
Untuk buat tabel silang
AnalizeDeskriptif crosstab atas kreatingrp bawah=
mcigrp

grupkreatinin * grupmci Crosstabulation

Count
grupmci
1,00 2,00 Total
grupkreatinin 1,00 12 6 18
2,00 1 81 82
Total 13 87 100
 Kesimpulan:
- Akurasi 0,973 (excellent, artinya pada cut off point kreatinin kinase 71,53, dapat didi
agnosis MCI sebesar 0,973)
- Validitas: valid  sen 92%, spec 98%

LDL

Area Under the Curve

Test Result Variable(s): LDL
Asymptotic 95% Confidence
Interval
a b
Area Std. Error Asymptotic Sig. Lower Bound Upper Bound
c
,402 . . . .
a. Under the bi-negative exponential distribution assumption
b. Null hypothesis: true area = 0.5
c. Number of valid observations of the positive actual state group is not equal to
that of the negative actual state group. Therefore, under the bi-negative
exponential distribution assumption, Std. Error, Asymptotic Sig., and Asymptotic
Confidence Interval cannot be computed.

Coordinates of the Curve

Test Result Variable(s): LDL
Positive if
Greater Than or
Equal Toa Sensitivity 1 - Specificity
95,3900 1,000 1,000
100,9950 1,000 ,989
107,9950 1,000 ,977
111,5750 ,923 ,977
113,0850 ,923 ,966
113,8750 ,923 ,954
114,6750 ,846 ,954
115,9450 ,846 ,943
117,5450 ,846 ,931
118,5200 ,846 ,920
118,8550 ,846 ,908
120,0250 ,846 ,897
121,7450 ,769 ,897
122,4800 ,769 ,885
123,0300 ,769 ,874
123,8750 ,769 ,862
124,3900 ,769 ,851
124,7150 ,769 ,839
125,1300 ,692 ,839
125,2950 ,692 ,828
126,6650 ,692 ,816
128,2250 ,692 ,805
128,4900 ,692 ,793
129,0850 ,692 ,782
129,8200 ,692 ,770
130,0500 ,692 ,759
130,3100 ,692 ,747
130,6550 ,692 ,736
131,4900 ,692 ,724
132,5450 ,692 ,713
132,9550 ,692 ,701
133,1450 ,692 ,690
133,3700 ,692 ,678
133,9450 ,692 ,667
134,8000 ,692 ,655
135,2550 ,692 ,644
135,4750 ,692 ,632
135,6700 ,692 ,621
135,7450 ,615 ,621
135,8600 ,615 ,609
136,1850 ,615 ,598
136,4800 ,615 ,586
136,7500 ,538 ,586
138,1850 ,462 ,586
139,8050 ,385 ,586
140,2750 ,308 ,586
140,5100 ,308 ,575
140,7050 ,308 ,563
140,8900 ,308 ,552
141,3150 ,308 ,540
141,6200 ,308 ,529
141,6700 ,308 ,517
141,7850 ,308 ,506
142,3100 ,308 ,494
142,7600 ,308 ,483
142,8500 ,231 ,483
142,9550 ,231 ,471
143,3300 ,154 ,471
143,7250 ,154 ,460
144,1900 ,154 ,448
144,7350 ,154 ,437
145,0850 ,154 ,425
145,4850 ,154 ,414
145,7350 ,154 ,402
145,9250 ,154 ,391
146,1800 ,154 ,379
146,5550 ,154 ,368
148,0300 ,154 ,356
149,4850 ,154 ,345
150,0750 ,154 ,333
150,4600 ,154 ,322
150,8200 ,154 ,310
151,6900 ,154 ,299
152,3150 ,154 ,287
153,4850 ,154 ,276
154,5900 ,154 ,264
154,7850 ,154 ,253
155,0550 ,154 ,241
155,8250 ,154 ,230
156,6350 ,154 ,218
157,1050 ,154 ,207
 157,5500 ,154 ,195
158,0350 ,154 ,184
158,6400 ,154 ,172
158,9400 ,077 ,172
159,4250 ,077 ,161
160,2350 ,077 ,149
160,7500 ,077 ,138
160,9750 ,077 ,126
161,2550 ,077 ,115
161,6750 ,077 ,103
162,4400 ,077 ,092
165,4650 ,077 ,080
168,4450 ,077 ,069
169,6500 ,077 ,057
174,6250 ,077 ,046
181,8150 ,077 ,034
184,9850 ,077 ,023
186,4450 ,077 ,011
189,9500 ,000 ,011
193,2200 ,000 ,000
a. The smallest cutoff value is the minimum
observed test value minus 1, and the largest
cutoff value is the maximum observed test value
plus 1. All the other cutoff values are the
averages of two consecutive ordered observed
test values.
Langkah di oda

grupldl * grupmci Crosstabulation

Count
grupmci
1,00 2,00 Total
grupldl 1,00 5 51 56
2,00 8 36 44
Total 13 87 100
 Chi-Square Tests
Asymptotic
Significance (2- Exact Sig. (2- Exact Sig. (1-
Value df sided) sided) sided)
a
Pearson Chi-Square 1,865 1 ,172
b
Continuity Correction 1,137 1 ,286
Likelihood Ratio 1,854 1 ,173
Fisher's Exact Test ,233 ,143
Linear-by-Linear Association 1,847 1 ,174
N of Valid Cases 100
a. 0 cells (0,0%) have expected count less than 5. The minimum expected count is 5,72.
b. Computed only for a 2x2 table

Kesimpulan:
- Akurasi: AUC 0,402 (dibawah batas bawah nilai AUC, LDL dengan cut-off point 13
9,805 tidak dapat mendiagnosis MCI—uji diagnostik tidak berguna)
- Validitas: tidak valid  sen 46%, spec 41%
- BACA IT AREA UNDER CURVE
 4. Dalam file excell tersedia Data Therapy Effectiveness RCT/control trial ACE inhibitor trhdp
mci. Outcome hidup dan meninggal

Kelompok * MCI Crosstabulation

Count
MCI
death alive Total
Kelompok ace inhibitor 6 44 50
palcebo 13 37 50
Total 19 81 100

Chi-Square Tests
Asymptotic Signi Exact Sig. (2-sid Exact Sig. (1-sid
Value df ficance (2-sided) ed) ed)
Pearson Chi-Square 3.184a 1 .074
b
Continuity Correction 2.339 1 .126
Likelihood Ratio 3.246 1 .072
Fisher's Exact Test .125 .062
Linear-by-Linear Association 3.152 1 .076
N of Valid Cases 100
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 9.50.
b. Computed only for a 2x2 table
 Nilai importancy
Secara statistik: p value 0,126  tidak bermakna secara statistik
Secara klinis:
 EER: 0,12 (12%)
 CER: 0,26  (26%)

 RR= 0,46 artinya ACE inhibitor sebagai factor proteksi terhadap kematian kar
ena MCI
 ARR 0,14 (14%) artinya selisih perbedaan kematian MCI antara ACE Inhibito
r dan placebo sebesar 14%
 RRR 0,59 (59%), artinya ACE Inhibitor dapat mencegah kematian MCI sebes
ar 59% dibandingkan placebo dalam pengobatan sekian…tahun
 NNT 7,14 artinya diperlukan pengobatan ACE Inhibitor untuk mencegah kem
atian 1 orang

Kesimpulannya:
Penggunaan ACE Inhibitor penting dan sangat bermakna secara klinis tetapi tidak bermakna s
ecara statistic.
Sangat bermakna? Karena nilai RRR lebih dari 50%

SOAL NO 5
5. Dalam file excell tersedia Data Therapy Effectiveness RCT/control trial ACE inhibitor trhd
p mci. Outcome hidup dan meninggal

Kelompok * MCI Crosstabulation

MCI

death alive Total

Kelompok ace inhibitor Count 6 44 50

Expected Count 9.5 40.5 50.0

% within Kelompok 12.0% 88.0% 100.0%

% of Total 6.0% 44.0% 50.0%

palcebo Count 13 37 50

Expected Count 9.5 40.5 50.0

% within Kelompok 26.0% 74.0% 100.0%

% of Total 13.0% 37.0% 50.0%

Total Count 19 81 100

Expected Count 19.0 81.0 100.0

% within Kelompok 19.0% 81.0% 100.0%

% of Total 19.0% 81.0% 100.0%

Chi-Square Tests
Asymptotic Signi Exact Sig. (2-sid Exact Sig. (1-sid
Value df ficance (2-sided) ed) ed)
Pearson Chi-Square 3.184a 1 .074
b
Continuity Correction 2.339 1 .126
Likelihood Ratio 3.246 1 .072
Fisher's Exact Test .125 .062
Linear-by-Linear Association 3.152 1 .076
N of Valid Cases 100
a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 9.50.
b. Computed only for a 2x2 table
 Nilai importancy
Secara statistik: p value 0,126  tidak bermakna secara statistik
Secara klinis:
 EER: 0,12 (12%)
 CER: 0,26  (26%)

 RR= 0,46 artinya ACE inhibitor sebagai factor proteksi terhadap kematian kar
ena MCI
 ARR 0,14 (14%) artinya selisih perbedaan kematian MCI antara ACE Inhibito
r dan placebo sebesar 14%
 RRR 0,59 (59%), artinya ACE Inhibitor dapat mencegah kematian MCI sebes
ar 59% dibandingkan placebo dalam pengobatan sekian…tahun
 NNT 7,14 artinya diperlukan pengobatan ACE Inhibitor untuk mencegah kem
atian 1 orang

Kesimpulannya:
Penggunaan ACE Inhibitor penting dan sangat bermakna secara klinis tetapi tidak bermakna s
ecara statistic.
Sangat bermakna? Karena nilai RRR lebih dari 50%

1. NILAI IMPORTANCY EBM THERAPY YANG EFECTIVE OUTCOME

 Apa bedanya sama yang no 5? Penyebutnya ARR diganti dengan ABI. RRR diganti R
BI
Analyzed --> deskritif statistik --> crosstab -->

Kelompok * MCI Crosstabulation

MCI

sembuh tidak sembuh Total

Kelompok ENALAPRIR + ASA Count 26 24 50

Expected Count 17.5 32.5 50.0

 ISOSIRBID PRODIPROGEL Count 9 41 50
+ DIURETIL
Expected Count 17.5 32.5 50.0

Total Count 35 65 100

Expected Count 35.0 65.0 100.0

Chi-Square Tests

Asymptotic Signi Exact Sig. (2-sid Exact Sig. (1-sid

Value df ficance (2-sided) ed) ed)

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 Cases 100

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 17.50.

b. Computed only for a 2x2 table

Nilai Importancy
Secara Statistik: chi square nilai p value = 0,001 à bermakna secara statistik
Secara Klinis
  EER: 0,18
 CER: 0,52
 RR 2,89 artinya jika enalapril digunakan sebagai terapi peluang kesembuhan sebesar 2,89 kali
dibandingkan penggunaan isosorbide prodiprogrel+diuretic
 ABI 0,34 (34%) apabila enalapril + ASA digunakan sebagai terapi, maka selisih insiden kese
mbuhan antara enalapril +ASA dan isosorbide prodiprogrel+diuretic sebesar 34%
 RBI 1,89 (189%) artinya bahwa pemberian enalapril dan ASA dapat meningkatkan kesembuh
an sebesar 189% dibandingkan isosorbide prodiprogrel+diuretic (> 50% artinya sangat berma
kna)
 NNT 2,94 kita membutuhkan terapi sebanyak 2-3 orang untuk mendapatkan satu kesembuhan.

KESIMPULAN:
Terapi enalapril dan ASA dalam kesembuhan MCI adalah penting secara klinis maupun secar
a statistic.
IMPORTANCY  Sangat penting dan bermakna !!!!