Critical Appraisal of Observational Study in Epidemiology

dr. YUDHI WIBOWO, M.PH

OUTLINE
BACKGROUND MEMAHAMI LAPORAN JURNAL OBSERVATIONAL STUDY in EPIDEMIOLOGY STROBE CA JURNAL OBSERVATIONAL STUDY IN EPIDEMIOLOGY KESIMPULAN

Bailey et al. (2005) Introduction to Epidemiology. London:McGraw-Hill

Background
Much biomedical research (9 of 10) is observational. The reporting of such research is often inadequate, Which hampers the assessment of its strengths and weaknesses and of a studys generalizability. However, in published observational research important information is often missing or unclear. (Erik et al., 2007)

 An analysis of epidemiological studies published in general medical and specialist journals found that the rationale behind the choice of potential confounding variables was often not reported (Pockok et al., 2004). Only few reports of case-control studies in psychiatry explained the methods used to identify cases and controls (Lee et al., 2007). In a survey of longitudinal studies in stroke research, 17 of 49 articles (35%) did not specify the eligibility criteria (Tooth et al., 2005).

STROBE
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). What should be included in an accurate and complete report of an observational study. Covered three main study designs: cohort, case-control and cross-sectional studies

 A checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results and discussion sections of articles. Eighteen items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. To improve the quality of reporting of observational studies

Introduction
1. Background/rationale:
besar masalah: prevalensi/insidensi/jumlah, dibandingkan dengan sebelumnya, di tempat lain, target program & dampak Elaborasi: substansi & metodologis Kesenjangan: substansi, metodologis, konfirmasi penelitian sebelumnya

2. Tujuan Utama penelitian (primary outcome): paling diminati peneliti, desain dirancang utk menjawab pertanyaan, sbg dasar perhitungan besar sampel

CA OBSERVATIONAL STUDY IN EPIDEMIOLOGY

1. DESKRIPSI UMUM
Desain Populasi target, populasi terjangkau, sampel Teknik sampling Variabel bebas, tergantung Hasil utama (primary outcome)

2. Validitas interna, hubungan non-kausal

Pengaruh bias Pengaruh perancu Pengaruh peluang

3. Vaiditas interna, hubungan kausal

Temporabilitas Asosiasi kuat Dosis respon Konsistensi Spesifik Koherensi Biologically plausible

4. Validitas eksterna
Apakah hasil dapat diterapkan pada subyek terpilih Apakah hasil dapat diterapkan pada populasi terjangkau Apakah hasil dapat diterapkan pada populasi luas

Kriteria Kausasi

Machin, D. & Campbell, M.J. (2005) The Design of Studies for Medical Research. England: John Wiley & Sons Ltd.

CA MASIH DIPERLUKAN KOMPONEN:

1. IMPORTANCY : kepentingan hasil penelitian secara klinis (effect size) 2. APPLICABILITY : transportability, kondisi pasien, kemampuan pelayanan, ekonomi, sosial budaya, agama.

Kesimpulan
Dokter harus mampu melakukan telaah jurnal dengan baik. Observational Study in Epidemiology STROBE CA ada 3 komponen (VIA):
Validitasvaliditas interna non-kausal, validitas interna kausal (eksternaBradfold-Hill criteria), validitas. Importancy Applicability

Reference
Erik von Elm,a Douglas G Altman,b Matthias Egger,a,c Stuart J Pocock,d Peter C Gtzsche e & Jan P Vandenbrouckef for the STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Bulletin of the World Health Organization 2007;85:867872. Pocock SJ, Collier TJ, Dandreo KJ, de Stavola BL, Goldman MB, Kalish LA, et al. Issues in the reporting of epidemiological studies: a survey of recent practice. BMJ 2004;329:883 Lee W, Bindman J, Ford T, Glozier N, Moran P, Stewart R, et al. Bias in psychiatric case-control studies: literature survey. Br J Psychiatry 2007;190:204-9. Tooth L, Ware R, Bain C, Purdie DM, Dobson A. Quality of reporting of observational longitudinal research. Am J Epidemiol 2005;161:280-8. Bonita, R., Beaglehole, R. & Kjellstrom, T. (2006) Basic pidemiology Ed.2.WHO.

 Dahlan, M.S. (2010) Membaca dan menelaah jurnal uji klinis. Jakarta:Salemba Medika. Sastroasmoro, S. & Ismael, S. (2010) Dasardasar Meodologi Penelitian Klinis Ed.3.Jakarta:Sagung Seto. Machin, D. & Campbell, M.J. (2005) The Design of Studies for Medical Research. England: John Wiley & Sons Ltd