LEMBAR JAWABAN

SKILLAB EVIDENCE BASED MEDICINE (EBM)

Nama :
NIM :

1. Nilai abnormalitas
Dalam file excel tersedia DATA abnormalitas, terdiri dari variabel SGOT/SGPT laki-
laki, hemoglobin, total kolesterol, HDL dan LDL. Hitunglah nilai abnormalitas dari
data yang tersedia :
1.1. Hitung harga rerata
1.2. Hitung standar deviasi
1.3. Nilai abnormalitas adalah > rerata + 2SD, kecuali Hb < rerata + 2SD

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

Statistic Statistic Statistic Statistic Std. Error Statistic

SGOT/SGPT Laki-laki 200 1 49 26.29 .985 13.923

Hemoglobin 200 12.0 13.0 12.472 .0229 .3238
Trigliserid 200 81 148 115.30 1.418 20.047
Total Kolestrol 200 80 199 137.23 2.291 32.405
HDL 200 61 119 89.44 1.211 17.119
LDL 200 50 98 74.64 .964 13.634
Valid N (listwise) 200

Parameter Rerata SD Rerata + 2 SD Nilai Abnormalitas

SGOT/SGPT 26,29 13,923 26,29 + 2 x (13,923) = 54,136 54,136 + 0,05 = 54,19
Abnormalitas > 54,19
Hemoglobin 12,472 0,3238 12,47 - 2 x (0,3238) = 11,83 11,83 – 0,05 = 11,78
Trigliserid 115,30 20,047 115,31 + 2 x (20,047) = 155,39 155,39 + 0,05 = 155,46
Total Kolestrol 137,23 32,405 137,24 + 2 x (32,405) = 202,04 202,04 + 0,05 = 202,09
HDL 89,44 17,119 89,44 - 2 x (17,119) = 55,22 55,22 – 0,05 = 55,17
LDL 74,64 13,634 74,64 + 2 x (13,634) = 101,90 101,90 + 0,05 = 101.95
2. Tersedia Clinical Scenario sebagai berikut :
Patients presenting to clinical doctor with a sore throat should not automatically be
prescribed antibiotics as many sore throat are non-bacterial in origin. The gold standard
for diagnosing bacterial sore throat is throat swab and culture but this is expensive and
time-consuming. Clinical doctor need a quick, easy diagnostic tool (e.g. a checklist or
scorecard) to help them to decide whether a sore throat is bacterial or non-bacterial in
origin.

Dari Clinical Scenario di atas buatlah :

2.1. Tabel P.I.C.O
P Patient with sore throat
I Checkist or scorecard
C Throat swab and cuture
O Accurate diagnosis

2.2. Buatlah clinical question

Does a sore throat checklist/scorecard different with throat swab to diagnosing
bacterial infection or non bacterial infection in sore throat patients?

2.3. Buatlah search term / search keyword

Sore throat AND (checklist OR scorecard) AND throat swab AND accurate
diagnosis

2.4. Lakukan searching

www.pubmed.gov
2.5. Paste-kan abstrak artikel yang didapat pada lembar jawaban
The usefulness of a clinical 'scorecard' in managing patients with sore throat in
general practice.

Bakare TM, Schattner F

ABSTRACT

BACKGROUND

OBJECTIVE: To evaluate the usefulness of a clinical scorecard in managing sore

throat in general practice.

DESIGN: Validation study of scorecard for sore throat with a throat swab culture
used as the 'gold standard'.

SETTING: A solo family practice in rural New South Wales, AustraliaParticipants:

Patients attending with sore throat.

METHODS: Patients from the age of 5 years and above presenting with the main
symptom of a sore throat, and who have not had any antibiotic treatment in the
previous two weeks, were invited to participate in the study. The doctor completed
a scorecard for each patient participating and took a throat swab for culture. Adult
patients (> 16 yrs) were asked to complete a patient satisfaction questionnaire,
while guardians accompanying children (5 yr to < 16 yrs old) were asked to
complete a similar, guardian questionnaire.

MAIN OUTCOME MEASURES:

1. Ability of a new scorecard to differentiate between bacterial and non-bacterial

sore throat.2. Patients' trust in the scorecard.

RESULTS: The scorecard has a sensitivity of 93.33%, a specificity of 63.16%, a

positive predictive value of 50% and a negative predictive value of 96%. The
 sensitivity is better than other sore throat scorecards that have been published but
with a slightly lower specificity.There was a high level of patient trust in the
scorecard was (85.8% agreement). Patients also trusted their doctor's judgement
based on the scorecard (90.6% agreement).

CONCLUSIONS: As the scorecard has a high sensitivity but only a moderate

specificity, this means that it is more reliable for negative results, i.e. when the
result suggests a viral infection. When the result favours a bacterial sore throat,
then a high sensitivity can mean that there are a number of false positives. GPs can
be confident in withholding antibiotics when the scorecard indicates a viral
infection.

2.6. Lakukan critical appraisal dari artikel dengan critical appraisal worksheet
VIA

3. Dalam file excel tersedia DATA diagnostik. Data diagnostik terdiri dari variabel LDL
dan kreatinin kinase.
3.1. Buatlah grafik titik potong diagnostik, paste-kan pada lembar jawaban

Classification: MCI
100
90
80
70
60
Sensitivity (%)
50
Specificity (%)
40
30
20
10
0
40 50 60 70 80
Kreatinin Kinase
 3.2. Perkirakan secara visual niai titik potong diagnostik dan interpretasikan
Titik potong kreatinin kinase adalah 69,1098 IU

3.3. Hitunglah seluruh nilai diagnostik memakai MedCalc, EpiCal, dan CATMaker,
buatlah kesimpulan

MedCalc

Kreatinin Kinase
100

80
Sensitivity

60

40

20

0
0 20 40 60 80 100
100-Specificity

ROC curve
Variable Kreatinin_kinase
Kreatinin Kinase
Classification variable MCI
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

EpiCal
Tables - 2-by-2 unstratified
11:06:38, 06/03/2019

| + - | Total
-------+-------------+-------
+ | 13 9 | 22
- | 0 78 | 78
-------+-------------+-------
Total | 13 87 | 100

Tests of significance
Fisher exact test (one tailed) : 0.000000
Fisher exact test (two tailed) : 0.000000
Uncorrected chi-square : 52.98
p-value : 0.000001
Yates corrected Chi-square : 47.88
p-value : 0.000001
Measures of exposure effect [95% CI]
Risk ratio : **** [****, ****]
Odds ratio : **** [****, ****]
Risk difference : 0.59 [0.39, 0.80]
Proportional attributable risk : **** [****, ****]
Population proportional attr. risk : **** [****, ****]

Vaccine efficacy [95% CI]

Vaccine efficacy : **** [****, ****]

Screening [95% CI]

Prevalence : 0.13 [0.07, 0.22]
Sensitivity : 1.00 [0.72, 0.99]
Specificity : 0.90 [0.81, 0.95]
Accuracy : 0.91 [0.83, 0.96]
Predictive value of +ve result : 0.59 [0.37, 0.79]
Predictive value of -ve result : 1.00 [0.94, 1.00]

Matched data
Z : 2.67
One-sided p-value : 0.003830
Two-sided p-value : 0.007661
McNemar Chi-square : 7.11
p-value : 0.007661
McNemar odds ratio [95% CI] : **** [1.69, 96.56]
Difference in proportions [95% CI] : 0.09 [0.03, 0.15]

CATMaker
4. Dalam file excel tersedia DAT Therapy Bad Outcome
4.1. Hitunglah nilai-nilai Importance

Kelompok * Outcome Crosstabulation

Count

Outcome Total

Hidup Meninggal

Ace Inhibitor 44 6 50
Kelompok
Placebo 37 13 50
Total 81 19 100
 CER
EER
RR
ARR
RRR
NNT = 7,14; artinya dibutuhkan terapi ACE Inhibitor sebanyak antara 7-8 orang
untuk mencegah 1 kematian pada pasien MCI

4.2. Buatlah kesimpulan

5. Dalam file excel tersedia DATA Therapy Effectiveness

5.1. Hitunglah nilai-nilai Importance
Kelompok * Outcome Crosstabulation

Outcome Total

Sembuh Tidak Sembuh

Count 26 24 50
Enalapril + ASA
% within Kelompok 52.0% 48.0% 100.0%
Kelompok
Isossorbid Prodiprogrel + Count 9 41 50
Deuretik % within Kelompok 18.0% 82.0% 100.0%
Count 35 65 100
Total
% within Kelompok 35.0% 65.0% 100.0%
 CER
EER
RR
ARR
RRR
NNT = 2,94; artinya dibutuhkan terapi Enalapril + ASA sebanyak antara 2-3
orang untuk menyembuhkan 1 pasien
Kemaknaan secara klinis
Kemaknaan secara statistik

5.2. Buatlah kesimpulan