LEMBAR JAWABAN

SKILLAB EVIDENCE BASED MEDICINE (EBM)

Nama : Ressy Felisa Raini

NIM : 04011181320038

1. NILAI ABNORMALITAS
PARAMETER RATA-RATA +2 SD NILAI ABNORMALITAS
SGOT/SGPT 26.29 + 2(13.92) = 54.13 54.13 + 0.05 = 54.18
HEMOGLOBIN 12.47 - 2(0.32) = 11.83 11.83 0.05 = 11.78
TRIGLESERID 115.30 + 2(20.05) = 155.38 155.38 + 0.05 = 115.43
TOTAL KOLESTEROL 137.24 +2(32.40) = 202.04 202.04 + 0.05 = 202.09
HDL 89.44 - 2(17.11) = 55.22 55.22 0.05 = 55.17
LDL 74.64 + 2(13.63) = 101.9 101.90 + 0.05 =101.95

2. PICO
2.1 PICO
Tabel PICO
P Older adults with early sign/symptoms of cognitive impairment
I Mini-Cog test
C MMSE
O Accurate diagnosis of dementia or Alzheimers disease

2.2 Clinical Question

Is Mini-cog test as accurate as MMSE for diagnosing dementia or Alzheimers
disease in older adults with early sign/symptoms of cognitive impairment?

2.3 Search term/Search Keyword/ Search Strategy

(Mini-cog OR minicog) AND (Mini-mental State Examination OR MMSE OR
SMMSE) AND (Alzheimer OR dementia)

A OR a AND B OR b AND C OR c

2.4 Searching
2.5 Artikel (Lampiran Abstrak)
Evid Based Mental Health 2004;7:38 doi:10.1136/ebmh.7.2.38
Diagnosis

The Mini-Cog compares well with longer screening tests

for detecting dementia in older people
Borson S, Scanlan JM, Chen P, Ganguli M. The Mini-Cog as a screen for dementia: validation in a population-
based sample. J Am Geriatr Soc 2003;51:14514.
[CrossRef][Medline][Web of Science]
Q Does the Mini-Cog, a rapid cognitive screening test, accurately detect dementia in older people?

METHODS
Design:
Prospective cohort study.

Setting:
23 rural communities, Pennsylvania, USA; recruitment initiated early 1990s.

Patients:
A subset of 1119 elderly people (mean age 73 years) randomly drawn from an age stratified random sample of
17 000 people from the Monongahela Valley Independent Elders Survey (MoVIES). Participants were aged >65
years, had a minimum of 6 years of formal education, and were living in the community.

Test:
The Mini-Cog is a rapid screening test comprising two cognitive tasks: a three item word memory test
and clock drawing. The scores were combined with an empirical algorithm to yield a dementia screen
score for each person as either possibly impaired or probably normal.

Diagnostic standard:
The Mini-Mental State Examination (MMSE).

Outcomes:
Sensitivity and specificity of the Mini-Cog.
MAIN RESULTS
Seventy six people (6.4%) met criteria for dementia (DSM-III-R). The Mini-Cog had higher
sensitivity but lower specificity than the MMSE using the generally applied MMSE cut off of 24.
Specificity and sensitivity were similar when the MMSE cut off was raised to 25 (see table). The
Mini-Cog had a shorter administration time.
CONCLUSIONS
Sensitivity and specificity of the Mini-Cog compared well with that of the MMSE, and longer
screening tests.

2.6 Critical Appraisal Worksheet dari Artikel

Step 1: Are the results of diagnostic study valid?

Was there any gold standard Yes, there was gold standard test that can be compared
test that can be compared with which was the Mini-Mental State Examination
with diagnostic test? (MMSE) test
(Apakah ada uji baku (Ya, terdapat uji baku standar yang dapat dibandingkan
standard yang dapat yakni tes Mini-Mental State Examination (MMSE))
dibandingkan dengan uji
diagnostik?)
Was the gold standard Yes, the gold standard was applied to the sample in the
applied to the sample in diagnostic study.
diagnostic study? (Ya, uji baku standar diaplikasikan pada sampel penelitian)
(Apakah uji baku standar juga
diaplikasikan pada sampel
penelitian?)
Was the sample included Yes, the sample for diagnostic test are older patients with
inappropriate spectrum for cognitive mild impairment?
the patients to do the (Ya, sampel untuk uji diagnostic adalah pasien berusia tua
diagnostic test? dengan gangguan kognisi ringan)
(Apakah sampel termasuk
dalam spektrum yang sesuai
dengan pasien yang akan
dilakukan uji diagnostik?)
Were the method and Yes, the method and techniques used were explained. It is
techniques in diagnostic test told that mini-cog used as a rapid screening test comprising
explained? two cognitive tasks: a three item word memory test and clock
drawing. The scores were combined with an empirical algorithm
to yield a dementia screen score for each person as either
possibly impaired or probably normal.

Conclusion Step 1: The results of diagnostic study was valid.

Kesimpulan Step 1: Hasil uji diagnostik valid

Step 2: Are the valid results of this diagnostic important?

Yes. The results stated that Mini-Cog had higher sensitivity but lower specificity than the
MMSE using the generally applied MMSE cut off of 24. Specificity and sensitivity were
similar when the MMSE cut off was raised to 25 (see table). The Mini-Cog had a shorter
administration time

Step 3: Can you apply this valid, important evidence about a diagnostic for caring your
patient?
Was the results and interpretations Yes, because Mini-Cog are more sensitive than
satisfying for diagnosis? MMSE.
(Apakah hasil tes dan interpretasinya Ya, karena Mini-Cog lebih sensitif
dapat memuaskan dalam diagnosis?) dibandingkan MMSE.
Could we apply the results to our Yes, Mini-Cog could be used as MMSEs
patients? alternative.
(Apakah hasilnya dapat diaplikasikan (Ya, Mini-Cog dapat digunakan sebagai
pada pasien kita?) alternatif MMSE.)
Could the results help the patients better? It could be, although the Mini-Cog is lack of
(Apakah hasilnya dapat membantu pasien specitifity compared to MMSE
menjadi lebih baik?) Bisa saja walaupun tes Mini-Cog kurang
spesifik dibanding MMSE
Conclusion: The results of diagnostic was valid and Mini- Cog could be applied to the
patients as an alternative test for diagnosing dementia.
Kesimpulan: Hasil uji diagnostic kini valid dan Mini-Cog dapat diaplikasikan ke pasien
sebagai uji alternatif untuk mendiagnosis demensia.

3. DATA
3.1 Grafik Titik Potong/ cut-off point
Classification: MCI
100
90
80
70
60
Sensitivity (%)
50
Specificity (%)
40
30
20
10
0
40 50 60 70 80
KretaininKinase
3.2 Perkiraan Visual Nilai Titik Potong dan Interpretasi
Antara kreatinin kinase dari 65-70, nilai spesifisitas dan sensitivitas ada di antara 90-
100.

Secara visual grafik menunjukkan nilai kreatinin kinase 80-90 atau nilai dari kreatinin
kinase lebih besar dari 80 atau lebih kecil dari 90 pada cut-off point.
 3.3 Nilai Diagnostik

KretaininKinase
100
Sensitivity: 100.0
Specificity: 92.0
Criterion : >69.1098
80
Sensitivity

60

40

20

0
0 20 40 60 80 100
100-Specificity

KretaininKinase
100

80
Sensitivity

60

40

20

0
0 20 40 60 80 100
100-Specificity

ROC curve

Variable KretaininKinase
 KretaininKinase
Classification variable MCI

Sample size 100

Positive group : MCI = 1 13
Negative group : MCI = 0 87

Disease prevalence (%) Unknown

Area under the ROC curve (AUC)

Area under the ROC curve (AUC) 0.973

Standard Errora 0.0140
95% Confidence intervalb 0.919 to 0.995
z statistic 33.901
Significance level P (Area=0.5) <0.0001
a
DeLong et al., 1988
b
Binomial exact

Youden index

Youden index J 0.9195

Associated criterion >69.1098

Criterion values and coordinates of the ROC curve [Hide]

Criterion Sensitivity 95% CI Specificity 95% CI +LR -LR

40.0886 100.00 75.3 - 100.0 0.00 0.0 - 4.2 1.00
>69.1098 100.00 75.3 - 100.0 91.95 84.1 - 96.7 12.43 0.00
>70.1641 92.31 64.0 - 99.8 93.10 85.6 - 97.4 13.38 0.083
>72.9038 76.92 46.2 - 95.0 93.10 85.6 - 97.4 11.15 0.25
>73.2495 69.23 38.6 - 90.9 94.25 87.1 - 98.1 12.05 0.33
>75.2407 69.23 38.6 - 90.9 96.55 90.3 - 99.3 20.08 0.32
>76.5148 61.54 31.6 - 86.1 97.70 91.9 - 99.7 26.77 0.39
>76.8872 53.85 25.1 - 80.8 98.85 93.8 - 100.0 46.85 0.47
>77.4574 38.46 13.9 - 68.4 98.85 93.8 - 100.0 33.46 0.62
>77.995 30.77 9.1 - 61.4 100.00 95.8 - 100.0 0.69
>78.6751 0.00 0.0 - 24.7 100.00 95.8 - 100.0 1.00

Kesimpulan
Bahwa kreatinin kinase dapat mendiagnosa MCI dengan titik potong sensitifitas dan
spesifitas sebesar >69
1. Sensitivitas
2. Spesifisitas
3. LR +
4. LR likelihood ratio
5. Area under curve

4. Data Bad Outcome

4.1 Nilai-nilai Importance
Tabel 1 Angka Kematian MCI Kelompok Placebo dan ACE Inhibitor
 Treatment Alive Dead Total
Ace Inhibitor 44 6 50
Placebo 37 13 50
Total 81 19 100

KelompokPerlakuan * Outcome Crosstabulation

Count

Outcome

Alive Dead Total

KelompokPerlakuan ACE 44 6 50

Placebo 37 13 50
Total 81 19 100

4.4 Kesimpulan
ACE Inhibitor tidak signifikan dalam mencegah kematian MCI

RRR= 0,189= 19% UNTUK MELIHAT MENCEGAH BAD OUTCOME

ARR=0,14 = 14%
NNT=7,14

5. Data Terapi Efektif

5.1 Tabel
Kelompok * Outcome Crosstabulation
Count
Outcome
Sembuh Tidak sembuh Total
Kelompok Enalapril + ASA 26 24 50
Isosorbit dinitrat 10 mg 9 41 50
Total 35 65 100

5.2 Kesimpulan:

RRR= 1,89 = 189% RBI

ARR= 0,34 = 34% ABI
NNT= 2,94

Kombinasi enalapril asa terbukti lebih efektif dalam menyembuhkan pasien MCI
dibanding isosorbit dinitrat sebesar 189%