Telaah Kritis

Jurnal yang diakses dari Journal of Institute of Medicineini merupakan

bagian dari kedokteran berbasis bukti (evidence-based medicine) diartikan sebagai
suatu proses evaluasi secara cermat dan sistematis suatu artikel penelitian untuk
menentukan reabilitas, validitas, dan kegunaannya dalam praktik klinis.
Komponen utama yang dinilai dalam critical appraisal adalah validity,
importancy, applicability. Tingkat kepercayaan hasil suatu penelitian sangat
bergantung dari desain penelitian dimana uji klinis menempati urutan tertinggi.
Telaah kritis meliputi semua komponen dari suatu penelitian dimulai dari
komponen pendahuluan, metodologi, hasil, dan diskusi. Masing-masing
komponen memiliki kepentingan yang sama besarnya dalam menentukan apakah
hasil penelitian tersebut layak atau tidak digunakan sebagai referensi.

Penilaian PICO VIA (Population, Intervention, Comparison, Outcome,

Validity, Importancy, Applicability)
I. Population
Penelitian ini dilakukan pada bayi premature usia 30 hari yang lahir <30
minggu kehamilan (22-29 minggu) yang dirawat di NICU Universitas Lowa
antara 1 Juli 2012 sampai 30 Juni 2015 yang memenuhi kriteria untuk
diikutsertakan. Kriteria ekslusi bayi meninggal dunia <30 hari, masuk NICU
setelah usia 30 hari, atau keluar dari < 30 hari, dan neonatus dengan multiple
congenital anomali.

II. Intervention
Pada penelitian ini tidak dilakukan intervensi, karena penelitian ini menggunakan
kohort retrospektif sehingga hanya menggunakan data sekunder yang diperoleh
dari data yang ada di NICU Universitas Lowa dari tahun 2012 sampai 2015.

III. Comparison
Pada penelitian ini tidak dilakukan analisis antar kelompok karena tujuan
penelitian ini hanya untuk mengetahui prevalensi kelainan tiroid pada bayi
premature <30 minggu pada usia kelahiran 30 hari, untuk mengidentifikasi faktor
ibu dan bayi yang berhubungan dengan congenital hipotiroidisme.

IV. Outcome
We analyzed a total of 1,117 pediatric subjects of the PTP cohort between
the ages of 2 and 18 years, of whom 20% (n = 220) developed diabetes. Median
first BMI percentile was 63.8% with 14% overweight (BMI ≥ 85th to < 95th
percentile) and 11% obese (≥ 95th percentile). ceBMI ranged from -10 to 15.1
kg/m2. Nearly 25% of subjects had ceBMI values ≥ 0 kg/m2 representing
sustained excess BMI above the Centers for Disease Control and Prevention
thresholds of overweight/obesity (Supplementary Table 1).
Higher ceBMI was associated with significantly greater risk of
progression to type 1 diabetes, which persisted after adjusting for age at first
BMI evaluation, antibody number, and sex. For each 1-kg/m2 increase in
ceBMI, there was a 6.3% increased relative risk of type 1 diabetes
progression (hazard ratio [HR]: 1.063 [95% CI 1.03–1.10]; P = 0.0006).
Individuals who, on average, were persistently overweight or obese (ceBMI ≥
0) had a 63% greater type 1 diabetes risk, adjusted for age, sex, and antibody
number (HR: 1.63 [95% CI: 1.22–2.18]; P = 0.0009).
Age at baseline was a significant independent risk factor for type 1
diabetes progression (HR: 0.94; P = 0.0006), adjusted for ceBMI, sex, and
antibody status. A significant interaction between age and sex, together with
ceBMI in relation to time to diabetes (P = 0.072) triggered investigation of age-
and sex-specific strata. By recursive partitioning algorithms, we first identified
12 years as the age cut point that best discriminated risk for type 1 diabetes
progression for the combined cohort and for males or females independently.
Recursive partitioning analysis as well as multivariable model-based diagnostics
identified cut points for ceBMI that best differentiated risk for disease progression
(ceBMI diabetes risk threshold). The ceBMI diabetes risk threshold was lower
in children < 12 years, regardless of sex (-1.4 kg/m2) than older children (4.6

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kg/m2). That is, the increase in type 1 diabetes risk occurs at lower levels of
sustained excess BMI in younger children.
Males overall had a higher ceBMI diabetes risk threshold influencing
progression to type 1 diabetes than females, suggesting an increased sensitivity
to BMI in female subjects. Males ≥ 12 years of age were least affected by ceBMI
and had a risk threshold (5 kg/m2) much higher than the threshold defining
overweight/obese. In contrast, females < 12 years old appeared to be most
influenced by body weight, as the ceBMI risk threshold was -1.35 kg/m2,
suggesting that BMI percentiles below the overweight/ obese threshold still
increase type 1 diabetes risk in this subgroup (Fig. 1).

V. Study Validity
Research question
Is the research question well-defined that can be answered using this study
design?
Ya. Metode penelitian dengan Longitudinally accumulated BMI above the
85th age- and sex-adjusted percentile generated a cumulative excess BMI
(ceBMI) index. Recursive partitioning and multivariate analyses yielded sex and
age- specific ceBMI thresholds for greatest type 1 diabetes risk.

Does the author use appropriate methods to answer their question?

Ya. Metode digunakan dalam penulisan penelitian ini sesuai untuk
menjawab pertanyaan penelitian to determine the effect of elevated BMI over time
on the progression to type 1 diabetes in youth.

Is the data collected in accordance with the purpose of the research?

Ya. Data yang diambil sesuai dengan tujuan penelitian yaitu untuk
mengetahui the effect of elevated BMI over time on the progression to type 1
diabetes in youth.

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Randomization
Was the randomization list concealed from patients, clinicians, and
researchers?
Tidak dijelaskan mengenai randomisasi pada studi ini.

Interventions and co-interventions

Were the performed interventions described in sufficient detail to be
followed by others? Other than intervention, were the two groups cared for in
similar way of treatment?
Penelitian ini tidak melakukan intervensi.

VI. Importance
Is this study important?
Ya, penelitian ini penting karena hasil penelitian ini dapat
mengetahui prevalensi kelainan tiroid pada bayi premature <30 minggu
pada usia kelahiran < 30 hari dan untuk mengidentifikasi faktor ibu dan bayi
yang berhubungan dengan kejadian congenital hipotiroidisme.

VII. Applicability
Are your patient so different from these studied that the results may not
apply to them?
Tidak, responden penelitian ini tidak cukup berbeda dengan pasien di
tempat saya.

Is your environment so different from the one in the study that the methods
could not be use there?
Tidak, penelitian dengan metode penelitian ini dapat diterapkan di
Indonesia.

Kesimpulan: Jurnal ini valid, penting, dan dapat diterapkan sehingga jurnal
ini dapat digunakan sebagai referensi.

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