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PICO AND CRITICAL APPRAISAL The effect of adjuvant vitamin C after varicocele surgery on sperm quality and quantity in infertile men: a double blind placebo controlled clinical trial



dr. A.A Gde Agung Anom Arie Wiradana, S. Ked dr. Sunanda Naibaho, S.Ked dr. Ochti, S.Ked



Pembimbing Dr.dr. Made Wardhana, Sp.KK (K) FINS-DV Rumah Sakit Umum Pusat Sanglah Denpasar - Bali



I. Are the results of this single preventive or therapeutic trial Valid? Was the assignment of patients to treatments randomised? And Was the randomisation list concealed? Yes



Was follow-up of patients sufficiently long and complete? Yes



Were all patients analysed in the groups to which they were randomised? yes



Were patients and clinicians kept "blind" to treatment? yes



Were the groups treated equally, apart from the experimental treatment? yes



Were the groups similar at the start of the trial ? yes



CONCLUSION : VALID



IMPORTANT 1



What is the magnitude of the treatment effect? MOTILITY



normal



Tidak normal



Total



vit c



27



14



41



placebo



27



34



61



EER = a/a+b = 27/41=0,66 CER = c/c+d = 27/61=0,44 ARR = CER- EER = 0,44-0,66= -0,22 (bukan 0) RRR = 1-RR= -0,5 NNT = 1/ARR = -4,54 RR=EER/CER=1.5 OR= AD/BC=918/378=2,42 2



WAS NOT MENTIONED Morfologi



normal



Tidak normal



Total



vit c



41



0



41



placebo



60



1



61



EEQ: a/a+b=41/41=1 CER: c/c+d= 60/61=0,98 RR= EER/CER=1,02 (>1) RRR= 1-RR= -0,02 ARR: CER-EER= 0,98-1= -0,02 (bukan 0) NNT: 1/-0,02= -50



CONCLUSION : IMPORTANT



 1 2



Applicable to our patient



Is our patient so different from those in the RCT that its results cannot apply? No Is the treatment feasible in our setting? Yes



3 4



What are our patient’s potential benefits and harms from the therapy? Can’t tell What are our patients values and expectations for both the outcome we are trying to prevent and the treatment we are offering? Can’t tell



CONCLUSION : APPLICABLE