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


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


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'


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'


5/29

EBM THERAPY

ORKSHEET

Va&'&%. Im+o#%a"(e )

A++&(a-&&%.


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&'&%.


7/29

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"


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"


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"%


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"


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


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


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


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


15/29

," %O TOTA#

EPERIMENTAL

SUBECTS88 : =3

CONTROLSUBECTS 81 8 8=


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


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


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(%


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"%


20/29

CALCULATIONS

RRR ARR %%T

CER EER CER EERCER

CER )EER

1ARR

0!08= 8!=>

0!0: :!>

0> 0039 28

=:> CI


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


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


23/29


24/29

Is %he %#ea%me"% ,eas&-e &" o$#se%%&"g

Yes


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


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


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


28/29

A#e %he. me% -. %h&s #eg&me"

a"' &%s (o"se;$e"(es

Yes


29/29

T!A%9 ,OU

critical appraisal ebm-therapy journal i

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