kuliah ,ebm,apraisal1,2,3 ,4

8/13/2019 KULIAH ,EBM,APRAISAL1,2,3 ,4

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Critical Appraisal

Unit Pengembangan & Evaluasi Pendidikan ( UPEP )

FacultY of MedicinEUniversitY of SriwijayA

Palembang


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UPEP FK UNSRIClinical appraisal

The Utility of Diagnostic

The effect of Therapy

Prognosis of disease

Causative / Harm (etiology of disorders)


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UPEP FK UNSRIHow to appraisal ?

Valid ?

Important ?

Aplicable ?


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UPEP FK UNSRIEvidence-Based Guidelines

Effectiveness of Clinical InterventionLevel Type of evidence

Ia Meta-analysis of randomized trial

Ib At least one randomized trial

IIa Well-designed, controlled study

IIb Well-designed, quasi-experimental studyIII Descriptive and comparative studies.

IV Non random study.

V Case serial, expert panel / committee


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UPEP FK UNSRIRecommendations On Clinical Intervention

Grade Nature of Recommendation

A Ia + Ib / ( > I )

B Ia / Ib

C IIa / IIbD III

E IV / V


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UPEP FK UNSRIAppraisal

Prognosis Is this evidence about prognosis valid ?

1. Was a defined, representative sample of patientsassembled at a common (usual early) point in the

course of their disease ?

2. Was patient follow-up sufficiently long and complete ?

3. Were objective outcome criteria applied in a blind

fashion ?4. If sub groups with different prognosis are identified:

- Was there adjustment for important prognostic factors?

- Was there validation in an independent group of test-set patients?


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UPEP FK UNSRIIs this evidence about therapy

(from an individual randomized trial) valid?1. Was the assignment of patients to treatment randomized?

2. Was the randomization concealed?

3. Were the groups similar at the start of the trial?

4. Was follow-up of patients sufficiently long and complete?5. Were all patients analyzed in the groups to which they were

randomized?

Some finer points:

6. Were patients, clinicians, and study personnel kept blind totreatment?

7. Were groups treated equally, apart from the experimentaltherapy?

Elsevier Ltd 2005. Straus et al.: Evidence-based medicine


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UPEP FK UNSRIValid ?

1. Was a defined, representative sample of patients assembledat a common (usual early) point in the course of theirdisease ?

Ideally : entire population who ever live who developed thedisease

How Close the report approaches to Ideal ?

How the disease was defined ?

How the participants were assembled ? From what point in the disease should patients be followed ?

Inception cohort

Exception if only learn about late stage in the disease


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2. Was patient follow-up sufficiently long

and complete ?

Ideally : every patient in the inception cohort would be followed until

they fully recover or develop one of the other disease outcomes

Study prognosis 100 patients, 4 die, 16 lost to follow up

A Crude case-fatality rate 4,8 % (4/84 x100%)


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3. Were objective outcome criteria applied

in a blind fashion ?

Diseases affect patients; some are easy to spot and some are moresubtle.

Extreme outcomes ; death or full recovery. (easy to detect)More difficult between them; rediness to work, intensity of residualpaint.


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4. If sub groups with different prognosis are

identified:

- Was there adjustment for importantprognostic factors?

- Was there validation in an

independent group of test-setpatients?


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UPEP FK UNSRI Is This valid evidence about prognosis

important?

How likely are the outcomes over time ?


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UPEP FK UNSRI

Important ?

How pricise are the prognostic estimates ?The text, tables, graphis of a proper

prognostic study include the confidence

intervals for estimates of prognosis


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UPEP FK UNSRI

Can we applythis valid, important evidenceabout prognosis to our patient?

Are the study patients similar to our own ?

Are the study patients so different from ours that we should not

use the result at all in making prediction for our patients?


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UPEP FK UNSRI

Apply ?

Will this evidence make a clinically important

impact on our conclusions about what to offer or

tell our patient ?


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UPEP FK UNSRI


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UPEP FK UNSRI

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