EVIDENCE BASED PRACTICE

STUDI KASUS EBM

Seorang pasien baru, Ny. A baru
pindah ke kota Bandung ingin tinggal
dekat anaknya. Ny. A berumur 61
tahun dan punya sejarah medis gagal
jantung (congestive heart failure)
yang dideritanya setelah beberapa
kali kena serangan jantung.
Ny. A telah di rawat 2 kali dalam 6
bulan terakhir karena gagal
jantungnya bertambah parah. Saat
ini jantungnya tetap dalam normal
sinus rhythm.
Ny. A rajin minum obat (enalapril, aspirin, dan
simvastatin) dan sangat ingin agar tidak sampai
dirawat di rumah sakit lagi.

Anda berpikir sebaiknya Ny. A juga dapat digoksin

tetapi anda tidak yakin apakah dengan
pemberian digoksin dapat membantu supaya
Ny. A agar tidak di rawat lagi.
Anda memutuskan untuk menyelidiki
pertanyaan ini shg pd kunjungan Ny. A
berikutnya anda sudah tahu jawabannya
 Built a good clinical question

Patient/ Congestive heart failure,

elderly
Problem
Intervention digoxin
Comparison, None, placebo
if any
Outcome Primary: reduce need for
hospitalization
Secondary: reduce mortality
Untuk pasien ini, pertanyaan klinis:

In elderly patients with congestive heat

failure, is digoxin effective in reducing
the need for rehospitalization ?
 Type of Suggested best type of
question study
Therapy RCT>cohort>case
control>case series
Diagnosis Prospective, blind comparison
to a gold standard
Prognosis Cohort study>case
control>case series
Prevention RCT>cohort study>case
control
Cost Economic analysis
Clinical Clinical MEDLINE
Question Scenario Strategy
Patient CHF, elderly CHF
Population Limit to Aged
Intervention digoxin digoxin
Comparison None or
placebo
Outcome Rate of hospitalization
hospitalization
Type of therapy
Question
Type of study RTC Limit to RCT as
publication type
Limitation to RCT and Humans
Limited to Free Full Text, Language, Age (Middle
Aged : 45 64 years)
Read the following article to determine if the
article meets the criteria for validity. As stated
previously, evaluating the medical literature is a
complex undertaking. You will find that the
answers to the questions of validity may not
always be clearly stated in the article and that you
may have to use your own judgment about the
importance and significance of each question.
 Ada 3 pertanyaan dasar yg harus
dijawab utk setiap studi

Are the results of the study valid?

What are the results?

Will the results help in caring for my patient?

Are the Result of the Study
Valid?
a. Were the subjects randomized, and what was
the randomization technique? Did the
randomization process result in equal
baseline characteristics?
b. Were all subjects who entered the trial
accounted for? Was follow-up complete? If
not, how many were lost to follow-up, from
which groups did they leave, and why?
c. Were subjects analyzed in the groups to which they were
randomized? Was intention-totreat, per-protocol, or
actual treatment analysis used?
d. How was blinding conducted (subject, investigator,
etc.), if applicable?
e. Were the inclusion and exclusion criteria appropriate, or
were they too restrictive or inclusive? Were the groups
similar at the start of the trial?
f. Was the sample size sufficient, and was a power
calculation included?
g. Were the groups handled the same way, aside from the
intervention(s)?
h. Were the statistical tests appropriate and
understandable?
i. Were surrogate markers or true outcomes assessed?
Were a priori subgroup analyses performed?