Download - Critical Appraisal EBM-Therapy Journal I
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
1/29
CRITICAL APPRAISAL
EBM THERAPY I
KELOMPOK A13
GENITOURINARY SYSTEM2012
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
2/29
Optimal Duration of AntibioticTherapy for Uncomplicated UrinaryTract Infection in Older Women : A
Double-Blind Randomized ControlledTrial
Thomas Voge! Re"e Ve##ea$%! Ma#&e Go$#'ea$!M&(hee Mo#&"! L&sa G#e"&e#)Gosse&"! Lo$&s
Ro(he%%e
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
3/29
ABSTRACT
Ba(*g#o$"' The o+%&ma '$#a%&o" o, a"%&-&o%&( %he#a+. &" o'e#
+a%&e"%s /&%h $"(om+&(a%e' $#&"a#. %#a(% &",e(%&o" UTI&s s%& a ma%%e# o, 'e-a%e The a&m o, %h&s #a"'om&e'(o"%#oe' 'o$-e)-&"' "o")&",e#&o#&%. %#&a /as %o(om+a#e %ha% e4(a(. a"' sa,e%. o, 3)'a. a"' 5)'a.(o$#ses o, o#a (&+#o6o7a(&" ,o# $"(om+&(a%e's.m+%oma%&( UTI &" o'e# /ome"
Me%ho's
A %o%a o, 183 /ome" a% eas% 9: .ea#s o' o, age /&%ha($%e $"(om+&(a%e' UTI /e#e #e(#$&%e' ,#omam-$a%o#. (&"&(s a"' hos+&%a a($%e (a#e $"&%s Pa%&e"%s/&%h +.eo"e+h#&%&s! (o"%#a&"'&(a%&o"s %o6$o#o;$&"oo"es! #e(e"% $se o, a"%&-&o%&(s! $#&"a#. %#a(%
a-"o#ma&%&es! a"' '&a-e%es me&%$s /e#e e7($'e'
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
4/29
ABSTRACT
Res$%s The +#o+o#%&o" o, +a%&e"%s /&%h -a(%e#&a e#a'&(a%&o"
a% 2 'a.s a,%e# %#ea%me"% /as =8> &" %he 3)'a.g#o$+ a"' =3> &" %he 5)'a. g#o$+ The ,#e;$e"(.o, a'?e#se e?e"%s! &"($'&"g '#o/s&"ess! hea'a(he!"a$sea o# ?om&%&"g! a"' oss o, a++e%&%e! /ass&g"&@(a"%. o/e# &" %he 3)'a. g#o$+
I"%e#+#e%a%&o" These #es$%s s$gges% %ha% 3)'a. (o$#se o,
a"%&-&o%&( %he#a+. &s "o% &",e#&o# %o a 5)'a. (o$#se,o# %#ea%me"% o, $"(om+&(a%e' s.m+%oma%&( UTI &"o'e# /ome"! a"' %ha% %he sho#%e# (o$#se &s -e%%e#%oe#a%e'
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
5/29
EBM THERAPY
ORKSHEET
Va&'&%. Im+o#%a"(e )
A++&(a-&&%.
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
6/29
AR T! R"U#T" O$ T!I" "I%'R(%TI( OR T!RA'UTIC TRIA#(A#ID )
EBM The#a+. o#*shee% ) Va&'&%.
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
7/29
as %he ass&g"me"% o, +a%&e"%s
%o %#ea%me"%s #a"'om&e'
Yes The %#&a /as $s&"g a(om+$%e#)ge"e#a%e'
#a"'om&a%&o"
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
8/29
as %he #a"'om&a%&o" &s%
(o"(eae'
Yes The s$-De(%s (o'es /e#e seae'
&" &"'&?&'$a e"?eo+es! /h&(h /e#e*e+% -. %he s%$'. s%a%&s%&(&a" a"'
#e?eae' %o %he #esea#(he#s o". a,%e##e(#$&%me"%! 'a%a (oe(%&o" a"'
a-o#a%o#. a"a.ses /e#e (om+e%eNo e"?eo+e ha' %o -e o+e"e' ,o#
sa,e%. #easo"s '$#&"g 'a%a (oe(%&o"
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
9/29
as ,oo/)$+ o, +a%&e"%s
s$4(&e"%. o"g a"' (om+e%e
Yes The#e &s a ,oo/)$++#o%o(o %ha% /as he' 2 'a.s
a,%e# (om+e%&o" o, %#ea%me"%
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
10/29
e#e a +a%&e"%s a"a.e' &"
%he g#o$+s %o /h&(h %he. /e#e#a"'om&e'
Yes The %#&a &s $s&"g a"&"%e"%&o")%o)%#ea% a"a.s&s!
e?e" %he#e /as 1 s$-De(% -e&"g
e7($'e' soo" a,%e##a"'om&a%&o" -e(a$se o,&mm$"os$++#ess&o"
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
11/29
e#e +a%&e"%s! (&"&(&a"s! a"'
s%$'. +e#so""e *e+% F-&"' %o%#ea%me"%
No I" Methods! &% /as /#&%%e"%ha% %he s%$'. 'es&g" o, %he
%#&a /as 'o$-e)-&"'e'!#a"'om&e' (o"%#oe' %#&a
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
12/29
e#e %he g#o$+s %#ea%e'
e;$a.! a+a#% ,#om %hee7+e#&me"%a %#ea%me"%
Yes To e?a$a%e %he o"g)%e#m #&s* o,
#ea+se! s$-De(%s /e#e ?&s&%e' 9 /ee*sa,%e# #a"'om&a%&o" Th&s ?&s&%&"($'e' (oe(%&o" o, $#&"e ,o#
$#&"a.s&s a"' ($%$#e! as /e as as
sho#% &"%e#?&e/ a-o$% +#ese"(e o,$#&"a#. s.m+%oms a"' h&s%o#. o, UTIa"' a"%&-&o%&( $se &" %he +#e(e'&"g
/ee*s
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
13/29
e#e %he g#o$+s s&m&a# a% %he
s%a#% o, %he %#&a a+a#% ,#om %hee7+e#&me"%a %he#a+.
Yes The#e a#e -ase&"e(ha#a(%e#&s%&(s ,o# s$-De(%s %o
-e &"($'e' &"%o %he %#&a
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
14/29
AR T! (A#ID R"U#T"O$ T!I" RA%DO*I+DTRIA# I*'ORTA%T )
EBM The#a+. o#*shee% ) Im+o#%a"(e
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
15/29
," %O TOTA#
EPERIMENTAL
SUBECTS88 : =3
CONTROLSUBECTS 81 8 8=
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
16/29
ha% &s %he mag"&%$'e o, %he
%#ea%me"% eJe(%
Mos% o,%e" #es$%s a#e
+#ese"%e' as '&(ho%omo$so$%(omes
RR ./.012./.34 ./56
The %#ea%me"% 'e(#eases %he#&s* o, 'ea%h
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
17/29
Ho/ +#e(&se &s %he es%&ma%e o,
%he %#ea%me"% eJe(% The %#$e #&s* o, %he o$%(ome &" %he+o+$a%&o" &s "o% *"o/" a"' %he -es%
/e (a" 'o &s %o es%&ma%e %he %#$e #&s*-ase' o" %he sam+e o, %he +a%&e"%s &"
%he %#&a! /h&(h &s (ae' %hepointestimate, -. oo*&"g %h#o$gh %he
(o"@'e"(e &"%e#?a I, %he (o"@'e"(e&"%e#?a &s ,a. "a##o/ %he" /e (a" -e(o"@'e"% %ha% o$# +o&"% es%&ma%e &s a+#e(&se #e6e(%&o" o, %he +o+$a%&o"
?a$e
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
18/29
Ca($a%&o"s
Relative Risk Reduction (RRR)R&s* o, %he o$%(ome &" %he %#ea%me"% g#o$+ #&s* o,%he o$%(ome &" %he (o"%#o g#o$+The RRR &s %he (om+eme"% o, %he RR a"' &s+#o-a-. %he mos% (ommo". #e+o#%e' meas$#e o,
%#ea%me"% eJe(%s I% %es $s %he #e'$(%&o" &" %he#a%e o, %he o$%(ome &" %he %#ea%me"% g#o$+ #ea%&?e%o %ha% &" %he (o"%#o g#o$+
Absolute Risk Reduction (ARR)
R&s* o, %he o$%(ome &" %he (o"%#o g#o$+ #&s* %heo$%(ome &" %he %#ea%me"% g#o$+ Aso *"o/" asAbsolute Risk Diferences.The ARR %es $s %hea-so$%e '&Je#e"(e &" %he #a%es o, e?e"%s -e%/ee"%he %/o g#o$+s a"' g&?es a" &"'&(a%&o" o, %he-ase&"e #&s* a"' %#ea%me"% eJe(%s A" ARR o, 0mea"s %ha% %he#e &s "o '&Je#e"(e -e%/ee" %he %/o
g#o$+ %h$s! %he %#ea%me"% ha' "o eJe(%
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
19/29
Ca($a%&o"s
Number Needed to Treat
I"?e#se o, %he ARR a"' &s (a($a%e' as 1ARRThe NNT #e+#ese"%s %he "$m-e# o, +a%&e"%s /e "ee'%o %#ea% /&%h %he e7+e#&me"%a %he#a+. &" o#'e# %o+#e?e"% 1 -a' o$%(ome a"' &"(o#+o#a%es %he '$#a%&o"o, %#ea%me"%
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
20/29
CALCULATIONS
RRR ARR %%T
CER EER CER EERCER
CER )EER
1ARR
0!08= 8!=>
0!0: :!>
0> 0039 28
=:> CI
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
21/29
INTERPRETATION
RRR = 0.40 = 40%The %#ea%me"% #e'$(e' %he #&s* o,
'ea%h -. 0> #ea%&?e %o %ha%o(($##&"g &" %he (o"%#o g#o$+
ARR = 0,036 = 3,6%
The a-so$%e -e"e@% o, %he%#ea%me"% &s 3!9> #e'$(%&o" &" %he
'ea%h #a%eNNT = !
e /o$' "ee' %o %#ea% 28 +eo+e&" o#'e# %o +#e?e"% 1 'ea%h
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
22/29
CA% ,OU A''#, T!I" (A#ID7
I*'ORTA%T (ID%C ABOUT T!RA',I% CARI%& $OR ,OUR 'ATI%T )
EBM THERAPY ORKSHEET ) APPLICABILITY
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
23/29
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
24/29
Is %he %#ea%me"% ,eas&-e &" o$#se%%&"g
Yes
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
25/29
ha% a#e o$# +a%&e"%s +o%e"%&a
-e"e@%s a"' ha#ms ,#om %he%he#a+.
"et#od $ = R&s* o, %he o$%(ome &" o$#+a%&e"%! #ea%&?e %o +a%&e"%s &"
%he %#&aE7+#esse' as a 'e(&ma 1NNT , 281 83
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
26/29
ha% a#e o$# +a%&e"%s +o%e"%&a
-e"e@%s a"' ha#ms ,#om %he%he#a+.
"et#od $$ = &'(R * RRR)
O$# +a%&e"%s e7+e(%e' e?e"%#a%e &, %he. #e(e&?e' %he (o"%#o%#ea%me"% PEER .7.01
1PEER 7 RRR 100: 0 15NNT ,o# +a%&e"%s &*e o$#s
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
27/29
A#e o$# +a%&e"%s ?a$es a"'
+#e,e#e"(es sa%&s@e' -. %he#eg&me" a"' &%s (o"se;$e"(es
Yes
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
28/29
A#e %he. me% -. %h&s #eg&me"
a"' &%s (o"se;$e"(es
Yes
-
7/21/2019 Critical Appraisal EBM-Therapy Journal I
29/29
T!A%9 ,OU