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Sylvia Rianissa Putri

 Type of Questions
Background Foreground
• Questions ask for general • Questions ask for specific
knowledge about a knowledge to inform clinical
condition or thing. decisions or actions.
• Answering the background • Answering the foreground
question.
question.
– excellent review article or
respected evidenced-based – Primary source : journal
textbook. When in need of an – Secondary source : Cochrane
overview on clinical
presentation of a disease,
standard therapies, diagnostic
tools, etc., consult a textbook.
 Background Questions
• Ask for general knowledge about a disease or disease
process
• Have two essential components:
– A question root (who, what, when, etc.) with a verb
– A disorder, test, treatment, or other aspect of healthcare
– Example: What causes DVT? or How often should women
over the age of 40 have a mammogram? Or How do
heparin works?
• The background question is usually asked because of
the need for basic information. It is not normally asked
because of a need to make a clinical decision about a
specific patient.
 Foreground Questions
• Ask for specific knowledge about managing
patients with a disease.
• Have 3 or 4 essential components
– Patient and/or problem.
– Indicator / Intervention.
– Comparative intervention (optional, include if
relevant).
– Clinical outcome.
Type of question depend on
one’s experience

SPECIFIC KNOWLEDGE
Type of
question

GENERAL KNOWLEDGE

Clinical experience
Where to the brackets go?
• If you want
– cheese AND fruit (apple, pear, melon).

• Which do you ask for?

– (cheese AND apple) OR pear OR melon.
– cheese AND (apple OR pear OR melon).
 Time Spent in Critical Appraisal
The Evidence Pyramid
Validity/Strength of Inference
Introduction of Intention-to-Treat
 RR
• The ratio of the probability of an event occurring
in an exposed group to the probability of the
event occurring in a comparison, non-exposed
group.
• RR = [A/(A + B)]/[C/(C + D)]
• Interpretation:
– RR = 1  neutral.
– RR > 1; Confidence Interval (CI) > 1  risk factor.
– RR < 1; Confidence Interval (CI) < 1  protective
factor.
 AR
• Absolute risk of a disease is your risk of
developing the disease over a time period.

• Say the absolute risk of developing a disease is 4

in 100 in non-smokers. Say the relative risk of the
disease is increased by 50% in smokers. The 50%
relates to the 4 - so the absolute increase in the
risk is 50% of 4, which is 2. So, the absolute risk of
smokers developing this disease is 6 in 100.
 RD
• Absolute effect of the risk factor, or the excess
risk of disease in those who have the factor
compared with those who don't
• Merefleksikan kelebihan jumlah kasus karena
suatu faktor (attributable) atau jumlah kasus
yang dapat dicegah oleh pajanan.
• Mengukur besarnya masalah kesehatan
masyarakat yang disebabkan oleh suatu
pajanan
 ARR
• The change in risk of a given activity or
treatment in relation to a control activity or
treatment.
• Absolute risk reduction (ARR) is the absolute
risk in the untreated group minus the absolute
risk in the treated group
• ARR = [C/(C + D)] [A/(A + B)]
• The inverse of the number to treat.
 RRR
• Is a measure calculated by dividing the
absolute risk reduction by the control event
rate.
• RRR = {[C/(C + D)] [A/(A +B)]}/[C/(C + C)]
 NNT
• The average number of patients who need to
be treated to prevent one additional bad
outcome (e.g. the number of patients that
need to be treated for one to benefit
compared with a control in a clinical trial).
• The inverse of the absolute risk reduction.
• The higher the NNT, the less effective is the
treatment.
• If 100 people do not take the medicine, then 4
in those 100 people will get the disease.
• If 100 people do take the medicine, then only
3 in those 100 people will get the disease.
• Therefore, 100 people need to take the
treatment for one person to benefit and not
get the disease.
• So, in this example, the NNT is 100.