LEMBAR JAWABAN

SKILLAB EVIDENCE BASED MEDICINE (EBM)

Nama
NIM

: Dita Triyasa
: 04011181320090

1. Nilai Abnormalitas
Paramater
SGOT/SGPT
Hemoglobin
Trigliserid
Total Kolesterol
HDL
LDL

Rata-rata + 2SD
26,29 + 2 (13,92)
12,47 - 2 (0,32)
115,30 + 2 (20,04)
137,24 + 2 (32,40)
89,44 - 2 (17,11)
74,64 + 2 (13,63)

Nilai Abnormalitas
54,13 + 0,05 = 54,18
11,83 0,05 = 11,78
155,38 + 0,05 = 155,43
202,04 + 0,05 = 202,09
55,22 0,05 = 55,17
101,9 + 0,05 = 101,95

2. Clinical Scenario
2.1
Tabel P.I.C.O
P
I
C
O

2.2

Older adults with early signs/symptoms of cognitive impairment

Mini-Cog screening test
Mini-Mental State Examination (MMSE)
Accurate diagnosis of dementia or Alzheimers Disease

Clinical Question
In older adults with early signs/symptoms of cognitive impaiment is the Minicog test as accurate ass the Mini-Mental State Examination (MMSE) in
diagnosis dementia or Alzheimers Disease.

2.3

Search term/search keyword/search strategy

(Mini-cog OR minicog) AND (Mini-Mental State Exa* OR MMSE OR
SMMSE) AND (Alzheimer* OR dementia).
Tanda (*) berarti kepanjangan nya.

2.4
2.5

Searching
Using internet www.tripdatabase.com
Abstract Artikel
Background Dementia is considered widely under-detected in primary care,
and general practitioners (GPs) frequently ask for easy to use tools to assist in
its early detection.
Aim To determine the degree of correlation between the Mini-Cog
Assessment (Mini-Cog) as performed by GPs and the Mini-Mental State
Examination (MMSE).

Design of study This was a prospective study (2005, 2006) comparing two
cognitive screening instruments. Setting Ten general practices in Austria, with
patients with a hitherto undiagnosed suspicion of dementia seen consecutively.
Method Sensitivity, specificity and positive and negative predictive values
(PPVs and NPVs) of the Mini-Cog (applying both a colour-coded and the
original rating method) were assessed for degree of correlation with the
MMSE. In phase one GPs examined patients suspected of having dementia
using the Mini-Cog; in phase two a neurologist retested them applying the
MMSE, a clock-drawing test (CDT) and a routine clinical examination. A
questionnaire on the practicability of the Mini-Cog was answered by GPs.
Results Of the 107 patients who participated 86 completed the whole study
protocol. The Mini-Cog, as performed by the ten GPs, displayed a sensitivity
of 0.85 (95% CI: 0.71, 0.98), a specificity of 0.58 (95% CI: 0.46, 0.71), a PPV
of 0.47 (95% CI: 0.33, 0.61) and an NPV of 0.90 (95% CI: 0.80, 0.99) as
against the MMSE carried out by neurologists. The GPs judged the Mini-Cog
useful and time saving.
Conclusion The Mini-Cog has a high sensitivity and acceptable specificity in
the general practice setting and has proved to be a practicable tool for the
diagnosis of dementia in primary care.
2.6

Critical Appraisal

Tahap 1 : Apakah hasil dari uji diagnostik valid?

Apakah ada uji baku standard Ya, dalam hal ini baku standar adalah Mini-Mental
yang dapat dibandingkan dengan State Examination (MMSE).
uji diagnostik?
Apakah uji baku standar juga Ya, test dilakukan pada pasien yang dicurigai
diaplikasikan

pada

sampel menderita gangguan memori dan kognitif.

penelitian?
Apakah sampel termasuk dalam Ya, sampel adalah pasien yang dicurigai menderita
spektrum yang sesuai dengan gangguan memori dan kognitif.
pasien yang akan dilakukan uji
diagnostik?
Apakah

cara

dan

teknik Ya, pasien didiagnosis dengan Mini-cog screening

melakukan uji diagnostik yang test kemudian dihitung berapa jumlah pasien dengan
sedang diteliti dijelaskan?

gangguan memori dan kognitif yang ada. Jumlah

pasien dengan ganguan memori dan kognitif yang

ada dibandingkan dengan jumlah pasien dengan
gangguan gangguan memori dan kognitif yang
didapat

menggunakan

Mini-Mental

State

Examination (MMSE).
Kesimpulan step 1: Hasil uji diagnostik valid

Step 2: Apakah hasil uji diagnostik memiliki kepentingan klinis untuk mendiagnosis
demensia atau penyakit Alzheimer?
Target disorder (impaired memory Totals
or cognitif decline)
Yes
No
Diagnostic test Positive

47

16

63

result

39

44

86

21

107

Negative

Totals

Sensitivity = a/ (a+c) = 0,55 = 55%

Specifity = d/ (b+d) = 0,24 = 24 %
Of the 107 patients who participated 86 completed the whole study protocol. The Mini-Cog,
as performed by the ten GPs, displayed a sensitivity of 0.85 (95% CI: 0.71, 0.98), a
specificity of 0.58 (95% CI: 0.46, 0.71), a PPV of 0.47 (95% CI: 0.33, 0.61) and an NPV of
0.90 (95% CI: 0.80, 0.99) as against the MMSE carried out by neurologists.
Kesimpulan step2: Hasil uji diagnostik ini penting dan memiliki kepentingan klinis
dimana Mini-Cog memiliki sensitivitas dan spesifitas yang tinggi untuk
mendiagnosis gangguan memori dan kognitif.

Step 3: Dapatkah kamu mengaplikasikan uji diagnostik yang valid dan penting ini ke
pasien mu?
Apakah hasil test dan interpretasinya dapat Ya, karena sensitivitas dan spesifitasnya
memuaskan dalam diagnosis?

tinggi.

Apakah hasilnya dapat diaplikasikan pada Ya,

pasien kita?

hasil

uji

diagnostik

ini

dapat

diaplikasikan ke pasien kita.

Apakah hasilnya dapat membantu pasien Ya, karena sensitivitasnya tinggi dan
jadi lebih baik?

spesifitasnya yang dapat diterima, sehingga

kesalahan diagnosis dapat diperkecil.

Kesimpulan step3 & Kesimpulan keseluruhan:

Hasil uji diagnostik ini valid dalam mendiagnosis gangguan memori dan kognitif
dan dapat diaplikasikan di rumah sakit karena mudah digunakan, efektif dan tidak
menyebabkan reaksi negatif pada pasien.

3. Data Diagnostik
3.1
Grafik Titik Potong
Classification: MCI
100
90
80
70
60

Sensitivity (%)
Specificity (%)

50
40
30
20
10
0
40

3.2

50
60
70
KretaininKinase

Interpretasi
Secara visual, grafik menunjukan bahwa nilai kreatininkinase 80-90 atau nilai
dari kreatininkinase >80 dan <90 .

3.3

80

Nilai diagnostik

KretaininKinase
100

Sensitivity: 100,0
Specificity: 92,0
Criterion : >69,1098

Sensitivity

80
60
40
20
0
0

20

40
60
80
100-Specificity

100

ROC curve
Variable

KretaininKinase

Classification variable

KretaininKinase
MCI

Sample size
Positive group :
Negative group :

100
13
87

MCI = 1
MCI = 0

Disease prevalence (%)

unknown

Area under the ROC curve (AUC)

Area under the ROC curve (AUC

0,973

)
Standard Errora
95% Confidence intervalb
z statistic
Significance level P (Area=0.5)

0,0140
0,919 to 0,995
33,901
<0,0001
a

DeLong et al., 1988

b

Binomial exact

Youden index
Youden index J
Associated criterion

0,9195
>69,1098

Criterion values and coordinates of the ROC curve [Hide]

Criterion
40,0886

Sensitivity
100,00

95% CI
75,3 - 100,0

Specificity
0,00

95% CI
0,0 - 4,2

+LR
1,00

-LR

>69,1098
>70,1641
>72,9038
>73,2495
>75,2407
>76,5148
>76,8872
>77,4574
>77,995
>78,6751

100,00
92,31
76,92
69,23
69,23
61,54
53,85
38,46
30,77
0,00

75,3 - 100,0
64,0 - 99,8
46,2 - 95,0
38,6 - 90,9
38,6 - 90,9
31,6 - 86,1
25,1 - 80,8
13,9 - 68,4
9,1 - 61,4
0,0 - 24,7

91,95
93,10
93,10
94,25
96,55
97,70
98,85
98,85
100,00
100,00

84,1 - 96,7
85,6 - 97,4
85,6 - 97,4
87,1 - 98,1
90,3 - 99,3
91,9 - 99,7
93,8 - 100,0
93,8 - 100,0
95,8 - 100,0
95,8 - 100,0

12,43
13,38
11,15
12,05
20,08
26,77
46,85
33,46

0,00
0,083
0,25
0,33
0,32
0,39
0,47
0,62
0,69
1,00

Kreatininkinase dapat mendiagnosis MCI dengan titik potong sensitivitas nya >69,1098 dan
spesifitas >77,995
4. Randomized clinical trial / control trial Ace Inhibitor
4.1
Nilai-nilai Importance
KelompokPerlakuan * Outcome Crosstabulation
Count

KelompokPerlakuan

ACE Inhibitor
Placebo

Total

Outcome
Alive
Dead
44
6
37
13
81
19

Total
50
50
100

EER = 0,88
CER = 0,74
ARR = 0,14 = 14%
RRR = 1- RR = 1-1,189 = 0,189 = 19%
ABI = 0,14
RBI = 0,189
RR = 0,189 = 19%
NNT = 7,14
4.2

Kesimpulan
Ace Inhibitor dalam mencegah kematian MCI hanya 19%.

5. Data Therapy Effectiveness

5.1
Nilai Importance
Kelompok * Outcome Crosstabulation
Count
Outcome
Non
Kelompok

Enalapril + ASA
Isosorbid dinitrat
10mg

Total

EER = 0,52

Efektif
26

efektif
24

Total

41

50

35

65

100

50

CER = 0,18
ARR = 0,34
RRR = 1,89 = 189 %
ABI = 0,34
RBI = 1,89
RR = 2,89
NNT = 2,94
5.2

Kesimpulan
Enalapril + ASA sangat efektif dalam mencegah kematian MCI.