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    EBM Terapi

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    Arum Ardisa Rini
    This document discusses the principles of evidence-based medicine and how to evaluate clinical studies. It covers topics such as: - Ensuring randomization of patients to treatment groups to prevent bias - Using blinding and placebos to ensure equal treatment of groups - Calculating treatment effects through absolute and relative risk reductions - Considering whether study results are statistically and clinically significant - Interpreting results based on a patient's individual circumstances and priorities

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    EBM Terapi

    Uploaded by

    Arum Ardisa Rini
    120 views23 pages
    This document discusses the principles of evidence-based medicine and how to evaluate clinical studies. It covers topics such as: - Ensuring randomization of patients to treatment groups to prevent bias - Using blinding and placebos to ensure equal treatment of groups - Calculating treatment effects through absolute and relative risk reductions - Considering whether study results are statistically and clinically significant - Interpreting results based on a patient's individual circumstances and priorities

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    EBM-Terapi

    Original Title

    EBM-Terapi

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    This document discusses the principles of evidence-based medicine and how to evaluate clinical studies. It covers topics such as: - Ensuring randomization of patients to treatment groups to prevent bias - Using blinding and placebos to ensure equal treatment of groups - Calculating treatment effects through absolute and relative risk reductions - Considering whether study results are statistically and clinically significant - Interpreting results based on a patient's individual circumstances and priorities

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    120 views23 pages

    EBM Terapi

    Uploaded by

    Arum Ardisa Rini
    This document discusses the principles of evidence-based medicine and how to evaluate clinical studies. It covers topics such as: - Ensuring randomization of patients to treatment groups to prevent bias - Using blinding and placebos to ensure equal treatment of groups - Calculating treatment effects through absolute and relative risk reductions - Considering whether study results are statistically and clinically significant - Interpreting results based on a patient's individual circumstances and priorities

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    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 23

    Evidence based medicine:

    Pelayanan kesehatan dengan berdasar buktibukti penelitian yang terbaik atau


    mengintegrasikan bukti-bukti penelitian
    terbaik dengan pengalaman klinik dan
    keadaan atau kondisi tertentu pasien.

    I.
    II.
    III.

    Are the results of the study valid?


    What were the results?
    Are these valid, important results
    applicable to our patient?

    Primary Guides:
    Was the assignment of patients
    to treatments randomized?
    Was follow-up of patients
    sufficiently long and complete?
    Were patients analyzed in the
    groups to which they were
    randomized?

    1. Apakah dilakukan randomisasi?

    Tujuan randomisasi

    Cara randomisasi

    Mencegah risiko bias


    Tiap subyek memiliki
    kesempatan yang
    sama
    Balans karakteristik
    subyek
    Toast/coin
    Table random
    Random allocation
    Simple random sampling
    Cluster random
    sampling
    Multistage random
    sampling

    Randomized

    Randomisasi
    Inclusion

    Controlled

    Prosedur
    Outcome
    Intervensi

    Clinical Trial

    Vs. control group

    Patient

    eligible

    treatment A

    Random
    treatment B

    O
    U
    T
    C
    O
    M
    E

    Patient

    washe
    d
    out

    eligible
    Treatment A

    Treatment B

    Treatment B

    Treatment A

    Random

    O
    U
    T
    C
    O
    M
    E

    Menetapkan terapi yang


    terbaik

    Uncontrolled trial
    Tanpa pembanding
    Tanpa randomisasi
    Tanpa blinding
    Before-after
    treatment

    RCT
    Pembanding
    Randomisasi
    Blinding
    Serial vs. parallel design

    Secondary Guides:
    Were patients, health workers, and

    study personnel "blind" to treatment?


    Were the groups similar at the start of
    the trial?
    Aside from the experimental
    intervention, were the groups treated
    equally?

    Apakah perlakuan sama/seimbang?

    Obat/intervensi

    Sama dalam hal


    bentuk
    rupa
    warna
    rasa
    bau
    konsistensi
    cara
    pemberian

    What is the magnitude of the


    treatment effect?
    How precise was the estimate of the
    treatment effect?

    20 % group control (X)


    15% group terapi (Y)
    ARR (Absolute risk reduction ) : X-Y =
    0,20-0,15 = 0,05
    Relative risk : Y/X = 0,15/0,20 = 0,75
    RRR (relative risk reduction ) =
    1- (Y/X) x 100 = (1-0,75) x 100 = 25 %

    6. Apakah bermakna secara klinik/statistik?


    Obat
    p

    Rata-2 penurunan
    tekanan darah

    Antihipertensi A
    14 mmHg
    0.025
    Antihipertensi
    B
    6 mmHg
    Mana yang harus
    dipenuhi:

    Bermakna secara statistik ?


    Atau
    Bermakna secara klinik?

    RRR = (|CER
    CER
    : Control Event Rate (tanpa terapi dimaksud/plasebo)
    EER|/CER)
    EER : Experimental Event Rate (dengan terapi dimaksud)

    CER (plasebo)
    EER (interferon)
    RRR (CER-EER/CER)
    ARR (|CER-EER|)
    NNT (1/ARR)

    50%
    39%
    ?
    ?
    ?

    Event rate= progresivitas kecacatan dalam 33 bulan


    CER = control event rate
    EER = experimental event rate
    RRR = relative risk reduction
    ARR = absolute risk reduction
    NNT = number needed to treat

    CER (plasebo)
    EER (interferon)

    50%
    39%

    RRR (CER-EER/CER)
    ARR (|CER-EER|)
    NNT (1/ARR)

    (50% - 39%)/50% = 22%


    50% - 39% = 11 %
    1/11% = 9

    Table 5.4 EBM-Sacket

    95% Confidence
    interval

    Merokok

    RR = 2,45; 95% CI (1,85:2,92)


    RR = 1,85; 95% CI (0,95-2,25)

    Ca. pulmo

    95% Confidence interval

    Antibiotika profilaksi pada SC mencegah endometritis

    RR untuk elective SC
    : 0.24 (95% CI: 0.11 0.48)
    RR untuk non-elective SC : 0.30 (95% CI:
    0.25 - 0.35)

    1.
    2.
    3.
    4.

    Is our patient so different from those in the


    study that its results cannot apply?
    Is the treatment feasible in our setting?
    What are our patients potential benefits and
    harms from the therapy?
    What are our patients values and
    expectations for both the outcome we are
    trying to prevent and the treatment we are
    offering?

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