Evidence Based Medicine: Tugas Mkdu

TUGAS MKDU
EVIDENCE BASED MEDICINE
Oleh :
dr. Putri Dwi Kartini
NIM 04032781923005
Pembimbing
DR. Iche Andriyani Liberty, S.KM. M.Kes
FAKULTAS KEDOKTERAN
UNIVERSITAS SRIWIJAYA PALEMBANG
PERIODE JULI 2019
DIAGNOSIS WORKSHEET
Citation:
Rapid Diagnosis of Childhood Pulmonary Tuberculosis by Xpert MTB/RIF Assay
Using Bronchoalveolar Lavage Fluid.
Are the results of this diagnostic study valid?
Was there an independent, blind Yes, This journal mention that they used
comparison with a reference (“gold”) “gold standart” with Composite Clinical
standard of diagnosis? Reference Standard (CCRS) 8 item
Was the diagnostic test evaluated in an Yes. The diagnostic test evaluated
appropriate spectrum of patients (like
those in whom it would be used in
practice)?
Was the reference standard applied Yes, It was.
regardless of the diagnostic test result?
Was the test (or cluster of tests) validated Yes, they were.
in a second, independent group of
patients?
Are the valid results of this diagnostic study important?

Yes. They are. The results of this diagnostic studi are important because It can
assist in fast diagnosing childhood PTB
YOUR CALCULATIONS
1. Xpert MTB/RIF Assay
Target disorder
(Pulmonary Tuberculosis)
Totals
Present Absent
Diagnostic Positive 44 0 44
test result
(Xpert
MTB/RIF 168 207
Negative 39
assay)
Totals 83 168 251

Sensitivity = a/(a+c) = 44/83 = 53%
Specificity = d/(b+d) = 168/168 = 100%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 53%/0% = ~
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 47%/100% = 0.47
Positive Predictive Value = a/(a+b) = 44/44= 100%
Negative Predictive Value = d/(c+d) = 168/207 = 81.2%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 83/168 = 49.4%
Pre-test odds = prevalence/(1-prevalence) = 49.4%/50.6% = 0.97
Post-test odds = pre-test odds  LR  0.97 x 0.47 = 0.4559
Post-test probability = post-test odds/(post-test odds +1)  0.4559/1.4559 = 0.31
2. MTB Culture
Target disorder
Totals
Present Absent
test result
(MTB
Culture)
Negative 59 168 227
Totals 83 168 251

Sensitivity = a/(a+c) = 24/83 = 28.9%
Specificity = d/(b+d) = 168/168 = 100%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 28.9%/0% = ~
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 71.1%/100% =
0.71
Positive Predictive Value = a/(a+b) = 24/24 = 100%
Negative Predictive Value = d/(c+d) = 186/227 = 74%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 83/251 = 33%
Pre-test odds = prevalence/(1-prevalence) = 33%/67% = 0.49
Post-test odds = pre-test odds  LR  0.49x0.71 = 0.3479
3. AFB Microscopy
Target disorder
Totals
Present Absent
test result
(AFB
micros Negative 76 168 244
copy)
Totals 83 168 251

Sensitivity = a/(a+c) = 7/83 = 8.4%
Specificity = d/(b+d) = 168/168 = 100%
Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 8.4%/0% = ~
Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 91.6%/100% =
0.916
Positive Predictive Value = a/(a+b) = 7/7 = 100%
Negative Predictive Value = d/(c+d) = 168/244 = 68.8%
Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 83/251= 3.2%
Pre-test odds = prevalence/(1-prevalence) = 3.2%/96.8% = 0.03
Post-test odds = pre-test odds  LR  0.03 x 0.916 = 0.02748
Can you apply this valid, important evidence about a diagnostic test in caring for
your patient?
Is the diagnostic test available, affordable, Not All diagnostic test.

accurate, and precise in your setting?
Can you generate a clinically sensible Yes It can.
estimate of your patient’s pre-test probability
(from personal experience, prevalence
statistics, practice databases, or primary
studies)?
Yes. They are.
 Are the study patients similar to your
own? It can be.
 Is it unlikely that the disease possibilities
or probabilities have changed since the
evidence was gathered?
Will the resulting post-test probabilities Yes I agree
affect your management and help your
patient?
 Could it move you across a test- Yes. available, affordable, accurate,
and precise.
treatment threshold?
This is a hope to get fast diagnosis so
 Would your patient be a willing partner we can management earlier.
in carrying it out?
Would the consequences of the test help We can fast diagnosis childhood PTB
your patient?
Additional notes:
PROGNOSIS WORKSHEET
Citation:
PLA1A2 platelet polymorphism predicts mortality in prediabetic subjects of the
population based KORA S4-Cohort
Are the results of this prognosis study valid?
Was a defined, representative sample of Yes, it was. The author mentioned

patients assembled at a common (usually representative sample of patients.
early) point in the course of their disease?
Was patient follow-up sufficiently long Yes,it was. They followed-up within 10
and complete? years
Were objective outcome criteria applied No “blind” fashion in this journal.
in a “blind” fashion?
If subgroups with different prognoses are Yes, it was. Model was adjusted for
identified, was there adjustment for age, sex, waist-hip ratio, blood pressure
important prognostic factors? (diastolic and systolic), cholesterol
(total, HDL, LDL), smoking status
(categorized: non-smoker, former
smoker, current smoker), alcohol intake
categorized: ≥20 g/day for women; ≥40
g/day for men), physical activity
(categorized: >1 h per week)
Was there validation in an independent Yes, There was.
group (“test set”) of patients?
Are the valid results of this prognosis study important?
How likely are the outcomes over time? PLA2 significantly correlates with mortality
in nondiabetics with HbA1c values of
>5.5% (37 mmol/mol) up to 6.5% (48
mmol/mol), including the prediabetic
subjects. Elevated blood glucose levels
beyond the diabetic threshold are a
powerful predictor of 30 day mortality in
acute heart failure patients, emphasizing
the critical role of the prediabetic state
How precise are the prognostic Our results suggest the need for a graded
estimates? interventional hierarchy supporting
antiplatelet therapy in nondiabetics,
maintenance of euglycemia and
antiplatelet therapy in prediabetic AxA2
subjects whereas in manifest diabetes
euglycemia is recommended as the most
important therapeutic aim.
If you want to calculate a confidence interval around the measure of prognosis:
Clinical Measure Standard Error Typical Calculation of CI

(SE)
Proportion (as in the rate of If p = 4261/6640 = 0.64 (or 64%)
some prognostic event, etc.) and n = 6640
where:
√ { p×(1−p )/n } SE =
the number of patients = n
where p is √ {0 .64×(1−0 . 64 )/6640 }
the proportion of these proportion and n = 0.000035 (or 0.0035%)
patients who experience the is number of
event = p patients
n from your evidence: 6640 Your calculation:

p from your evidence: 4261 SE: 0.0035%
95% CI is 64% ±1.96 × 0.0035%
or 63.9932% to 64.0068%
Can you apply this valid, important evidence about prognosis in caring for your
patient?
Were the study patients similar to your Yes. It was

own?
Will this evidence make a clinically Yes. This will make a clinically important
important impact on your conclusions impact.
about what to offer or tell your patient?
Additional notes:

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TUGAS MKDU

EVIDENCE BASED MEDICINE

Are the results of this diagnostic study valid?

Are the valid results of this diagnostic study important?

1. Xpert MTB/RIF Assay

Totals 83 168 251

Totals 83 168 251

Totals 83 168 251

Is the diagnostic test available, affordable, Not All diagnostic test.

Are the results of this prognosis study valid?

Was a defined, representative sample of Yes, it was. The author mentioned

Are the valid results of this prognosis study important?

Clinical Measure Standard Error Typical Calculation of CI

n from your evidence: 6640 Your calculation:

Were the study patients similar to your Yes. It was

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