Soal Praktek-EBM-THTKL-Daniel Bramantyo [PDF]

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Skillab Praktikum EBM



Disusun Oleh: dr. Daniel Bramantyo



04092722125003



DEPARTEMEN ILMU KESEHATAN THTKL FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA RSUP DR. MUHAMMAD HOESIN PALEMBANG 2021



SOAL SKIL LAB EBM 2021 PPDS1 1. Dalam file excel tersedia DATA abnormalitas. Data abnormallitas tersebut terdiri dari variabel SGOT/SGPT laki-laki, hemoglobin, trigliceyde, total kolesterol, HDL dan LDL. Hitunglah nilai abnormalitas dari data yang tersedia. 1.1. Hitunglah harga rerata 1.2.Hitunglah standar deviasi Descriptive Statistics N



Minimum



Maximum



Mean



Std. Deviation



SGOT/SGPT Laki-laki



200



1



49



26,29



13,923



Hemoglobin



200



12,0



13,0



12,472



,3238



Trigliserid



200



81



148



115,30



20,047



Total Kolestrol



200



80



199



137,23



32,405



HDL



200



61



119



89,44



17,119



LDL



200



50



98



74,64



13,634



Valid N (listwise)



200



 



N



Minimum



Maximum



Mean



Std. Deviation



Nilai



SGOT/SGPT Laki-laki



200



1



49



26,29



13,923



54,13638



Hemoglobin



200



12,0



13,0



12,472



,3238



11,82442



Trigliserid



200



81



148



115,31



20,047



Total Kolestrol HDL



200



80



199



137,24



32,405



155,4 202,0458



200



61



119



89,44



17,119



LDL



200



50



98



74,64



13,634



Valid N (listwise)



200



 



 



 



55,20132 101,9083



 



2. Rapid breathing is an important clinical manifestation of illness in a young infant. Acute Respiratory Infection especially pneumonia often delay referring to the hospital, especially in a 2-month infant. At a primary health care facility or a crowded paediatric emergency room, respiratory rate counted for one complete minute has been found to be useful in assessing the severity of respiratory infection in infants under 2 months. A respiratory rate of > 60 breaths/ min is used as a predictor of pneumonia in the case management guidelines of the World Health Organisation’s acute respiratory infection control programmes globally. However, very little data on the usefulness of respiratory rate as an indicator of hypoxia and risk of mortality in illnesses other than pneumonia are available.A gold standard for diagnosing hypoxia is oximetry but this is expensive.



2.1.



Buatlah Tabel P.I.C.O P Infants with Pneumonia under 2 months I Respiratory Rate Examination C Oxymetry O Early Hypoxia Diagnostic and



2.1.



Reduce risk of mortality Buatlah Clinical Question Clinical Question:



# 1 # 2



P



I



C



O



Konsep 1



Konsep 2



Konsep 3 Oxymetry



Konsep 4



Infants with Pneumonia under 2 months Infants with Pneumonia under 2 months Neonatal



Respiratory Rate Examination and Oxymetry #3 Respiratory Rate Examination



#4 Oxymetr y



Early Hypoxia diagnosis #5



Early Hypoxia diagnosis



#6



reduce risk of Pneumonia mortality Is respiratory rate examination in infants with pneumonia under 2 months effective as an early hypoxia diagnostic to reduce risk of mortality? 2.2.



Buatlah Search Term/Search/Keyword



2.3.



Lakukan Searching Telah dilakukan pencarian pada database jurnal online www.pubmed.gov, menggunakan search term / search keyword “...AND ....”, ditemukan ... jurnal dan



hanya



2.4.



1



yang



relevan



dengan



clinical



scenario.



Pastekan Abstract Artikel yang didapat pada lembar Jawaban



Am J Perinatol   



. 2020 Nov;37(13):1310-1316.  doi: 10.1055/s-0040-1715862. Epub 2020 Sep 3.



Characteristics of Newborns Born to SARS-CoV-2-Positive Mothers: A Retrospective Cohort Study Mohsen A A Farghaly 1 2, Fernanda Kupferman 1, Fiorella Castillo 1, Roger M Kim 1 Affiliations expand 



PMID: 32882743  







DOI: 10.1055/s-0040-1715862



Abstract Objective: The novel virus known as severe acute respiratory syndrome-coronavirus2 (SARS-CoV-2) has led to a terrifying pandemic. The range of illness severity among



children is variable. This study aims to assess the characteristics of newborns born to SARS-CoV-2-positive women compared with those mothers who tested negative. Study design: This was a retrospective cohort study performed at Brookdale Hospital Medical Center in New York City from March to May 2020. Electronic medical records of mother-baby dyads were reviewed. Results: Seventy-nine mothers tested for SARS-CoV-2 were included, out of which 18.98% of mothers tested SARS-CoV-2 positive. We found a significant association between symptoms and SARS-CoV-2 status. We observed a significant association between newborns of SARS-CoV-2 positive and SARS-CoV-2 negative mothers regarding skin-to-skin contact (p < 0.001). Both groups showed significant differences regarding isolation (p < 0.001). Interestingly, regarding SARS-CoV-2 infection in newborns, only one newborn tested SARS-CoV-2 positive and was unstable in the neonatal intensive care unit (NICU). With the multivariable logistic regression model, babies of SARS-CoV-2 positive mothers were three times as likely to have desaturations in comparison to newborns from negative mothers. Also, newborns of SARS-CoV-2-positive mothers were four times more likely to have poor feeding, compared with newborns of SARS-CoV-2-negative mothers. Finally, babies of SARS-CoV-2-positive mothers were ten times more likely to be symptomatic at the 2-week follow-up. Conclusion: SARS-CoV-2 has caused major morbidity and mortality worldwide. Neonates born to mothers with confirmed or suspected SARS-CoV-2 are most of the time asymptomatic. However, neonatal critical illness due to SARS-CoV-2 is still a possibility; thus, isolation precautions (such as avoiding skin-to-skin contact and direct breastfeeding) and vertical transmission should be studied thoroughly. In addition, testing these newborns by nasopharyngeal swab at least at 24 hours after birth and monitoring them for the development of symptoms for 14 days after birth is needed. Key points: · For SARS-CoV-2-positive mothers, reducing transmission of infection to newborns is crucial.. · Newborns of SARS-CoV-2-positive mothers are usually asymptomatic and may not be easily infected.. · Critical illness in the newborn may still happen, so monitoring is needed..



2.5. No 1.



Lakukan Critical Appraisal dari Artikel dengan critical appraisal worksheet Questions Answers



What is the research question and/or hypothesis?



to assess the characteristics of newborns born to SARS-CoV-2-positive women compared with those mothers who tested negative.



2.



What is the study type?



a retrospective cohort study



3.



What is the reference population ? What are the sampling frame and sampling method ?



Seventy-nine mothers tested for SARSCoV-2 were included, out of which 18.98% of mothers tested SARS-CoV-2 positive



4.



In an experimental study, how are subjects assigned to group ? In a longitudinal study how many reached final follow up ?



5.



What are the study factors and how are they measured?



Also, newborns of SARS-CoV-2-positive mothers were four times more likely to have poor feeding, compared with newborns of SARS-CoV-2-negative mothers. Both groups showed significant differences regarding isolation (p < 0.001). Interestingly, regarding SARS-CoV-2 infection in newborns, only one newborn tested SARS-CoV-2 positive and was unstable in the neonatal intensive care unit (NICU)



6.



What are the outcome factors and how are they measured ?



SARS-CoV-2 has caused major morbidity and mortality worldwide. Neonates born to mothers with confirmed or suspected SARSCoV-2 are most of the time asymptomatic.



7.



What important potential confounders are considered ?



However, neonatal critical illness due to SARS-CoV-2 is still a possibility; thus, isolation precautions (such as avoiding skin-to-skin contact and direct breastfeeding) and vertical transmission should be studied thoroughly. In addition, testing these newborns by nasopharyngeal swab at least at 24 hours after birth and monitoring them for the development of symptoms for 14 days after birth is needed.



8.



Are statistical tests considered ?



All analyses were performed using Stata version 15.0.17 A 2-sided P value of \.05 was considered statistically significant, except for the heterogeneity test, in which a P value of \.1 was used.



9.



Are the results clinically / socially important?



Yes, The network meta-analysis performed in this systematic review enabled treatment ranking, which can be used to support clinicians’ decisions regarding treatment choices



10



What conclusions did the authors reach about the research question ? Did they generate new hypotheses ? Do you agree with the conclusions ?



SARS-CoV-2 has caused major morbidity and mortality worldwide. Neonates born to mothers with confirmed or suspected SARSCoV-2 are most of the time asymptomatic. However, neonatal critical illness due to SARSCoV-2 is still a possibility; thus, isolation precautions (such as avoiding skin-to-skin contact and direct breastfeeding) and vertical transmission should be studied thoroughly. In addition, testing these newborns by nasopharyngeal swab at least at 24 hours after birth and monitoring them for the development of symptoms for 14 days after birth is needed.



3. The patient is a 65 year old male with a long history of type 2 diabetes and obesity. Otherwise his medical history is unremarkable. He does not smoke. He had knee surgery 10 years ago but otherwise has had no other major medical problems. Over the years he has tried numerous diets and exercise programs to reduce his weight but has not been very successful. His granddaughter just started high school and he wants to see her graduate and go on to college. He understands that his diabetes puts him at a high risk for heart disease and is frustrated that he cannot lose the necessary weight. His neighbor told him about a colleague at work who had his stomach stapled and as a result not only lost over 100 lbs. but also "cured" his diabetes. He wants to know if this procedure really works. 3.1 Buatlah Tabel P.I.C.O P Male with Diabetes; Diabetic patient I Stomach stapling ; Bariatric surgery C Standard medical care O Remission of diabetes; weight loss; mortality



3.2 Buatlah Clinical Question Is stomach stapling in a male with diabetes better than standard medical care and diet to reduce weight and remission of diabetes? 3.3 Buatlah Search Term/Search/Keyword P I C



O



Konsep 1



# 1 # 2



Male with Diabetes Diabetic patient Diabetic patient



Konsep 2 Stomach stapling #3 Stomach stapling #4 Bariatric surgery



Konsep 3 Standard Medical Care #5 #6



Standard Medical care Diet



Konsep 4



#8



Remission of diabetes Remission of diabetes Weight loss



#9



Mortality



#7



3.4 Lakukan Searching Telah dilakukan pencarian pada database jurnal online www.pubmed.gov, menggunakan search term / search keyword “...AND ....”, ditemukan ... jurnal dan hanya 1 yang relevan dengan clinical scenario.



3.5 Pastekan Abstract Artikel yang didapat pada lembar Jawaban



Gastric bypass surgery vs intensive lifestyle and medical intervention for type 2 diabetes: the CROSSROADS randomised controlled trial David E Cummings 1, David E Arterburn 2, Emily O Westbrook 2, Jessica N Kuzma 3, Skye D Stewart 4, Chun P Chan 4, Steven N Bock 5, Jeffrey T Landers 6, Mario Kratz 3, Karen E FosterSchubert 7, David R Flum 4



  



PMID: 26983924 PMCID: PMC4826815 DOI: 10.1007/s00125-016-3903-x



Abstract Aims/hypothesis: Mounting evidence indicates that Roux-en-Y gastric bypass (RYGB) ameliorates type 2 diabetes, but randomised trials comparing surgical vs nonsurgical care are needed. With a parallel-group randomised controlled trial (RCT), we compared RYGB vs an intensive lifestyle and medical intervention (ILMI) for type 2 diabetes, including among patients with a BMI 76,514 8 >76,887 2 >77,457 4 >77,995



100,00



30,77



9,1 - 61,4



100,00



>78,675 1



0,00



0,0 - 24,7



100,00



Epical Accuracy



Catmaker



:0,93 [0,86; 0,97]



 



0,083 0,25 0,33 0,32 0,39 0,47 0,62 0,69 1,00



Kesimpulan tes diagnostik Kreatinin Kinase pada pasien MCI : - Sensitivitas 100%, berarti kemampuan Kreatinin Kinase dalam mendeteksi pasien yang menderita penyakit MCI adalah 100%. - Spesifisitas 92%, berarti kemampuan Kreatinin Kinase dalam mendeteksi pasien yang tidak menderita penyakit MCI (tidak sakit) adalah 92%. - Prevalens 13%, berarti probabilitas seseorang dalam studi ini (berdasarkan keadaan demografis dan klinis) untuk menderita penyakit MCI sebelum menjalani tes diagnostik Kreatinin Kinase adalah 13%. - Nilai duga positif 65%, berarti probabilitas seseorang dengan hasil uji diagnostik Kreatinin Kinase positif (> 69,1098 IU) menderita penyakit MCI adalah 65%. - Nilai duga negatif 100%, berarti probabilitas seseorang dengan hasil uji diagnostik Kreatinin Kinase negatif (≤ 69,1098 IU) tidak menderita penyakit MCI adalah 100%. - Positive likelihood ratio 12,43%, berarti proporsi subjek yang menderita MCI dengan Kreatinin Kinase positif (> 69,1098 IU) dengan subjek yang tidak menderita MCI dengan Kreatinin Kinase positif (> 69,1098 IU) pula adalah 12,43%. - Negative likelihood ratio 0%, berarti proporsi subjek yang menderita MCI dengan Kreatinin Kinase negatif (≤ 69,1098 IU) dengan subjek yang tidak menderita MCI dengan Kreatinin Kinase negatif (≤ 69,1098 IU) pula adalah 0%.







LDL Medcal



Variable Classification variabl e



LDL LDL MCI MCI



 



Sample size Positive group :  Negative group : 



  MCI = 1 MCI = 0



100 13 87



 



Disease prevalence (%)



unknown



 



Area under the ROC curve (AUC)   



Area under the ROC curve (AUC)  Standard Errora 95% Confidence intervalb z statistic Significance level P (Area=0.5) a b



0,598 0,0855 0,495 to 0,695 1,143 0,2531



DeLong et al., 1988 Binomial exact



 



Youden index  



Youden index J Associated criterion



0,3174 ≤143,002



 



Criterion values and coordinates of the ROC curve [Hide]  



Criterion 143 mg/dl) menderita penyakit MCI adalah 5%. - Nilai duga negatif 81%, berarti probabilitas seseorang dengan hasil uji diagnostik LDL negatif (≤ 143 mg/dl) tidak menderita penyakit MCI adalah 81%.



- Positive likelihood ratio 0,33%, berarti proporsi subjek yang menderita MCI dengan LDL positif (> 143 mg/dl) dengan subjek yang tidak menderita MCI dengan LDL positif (> 143 mg/dl) pula adalah 0,33%. - Negative likelihood ratio 1,60%, berarti proporsi subjek yang menderita MCI dengan LDL negatif (≤ 143 mg/dl) dengan subjek yang tidak menderita MCI dengan LDL negatif (≤ 143 mg/dl) pula adalah 1,60%.



Kategori Kreatinin Kinase * MCI Crosstabulation Count MCI MCI Negatif Kategori Kreatinin Kinase



MCI Positif



Total



>69,1098



7



13



20



143,002



41



2



43