TUGAS EVIDENCE BASED MIDWIFERY

REVIEW LITERATUR

Disusun Oleh:

Serli Oktavuani (Nim: 1915301115)

Dosen Mata Kuliah:

Vedjia Medhyna,S.ST.M.Keb

UNIVERSITAS FORT DE KOCK BUKITTINGGI

PRODI DIV KEBIDANAN
TAHUN 2019

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 KATA PENGANTAR

Puji syukur kehadirat Allah SWT yang telah memberikan rahmat dan hidayah-Nya
sehingga penulis dapat menyelesaikan tugas Evidence Based Midwifery tentang perumusan
masalah klinis yang dapat dijawab dalam tahapan EBM dan mencari jurnal di
www.pubmed.gov.

Dalam tugas ini terdapat rumusan pertanyaan tentang intervensi, etiologi, diagnosis,
prognosis, frekwensi dan fenomena. Kami menggunakan analisis PICO yaitu menentukan
Populasi dan masalah klinis terlebih dahulu, dilanjutkan dengan indikator, kemudian
Comparator dan menentukan outcomenya. Kemudian dari rumusan tersebut kami mencoba
mencari jurnal di sesuai materi kuliah sebelumnya.

Kami berharap mudah-mudahan tugas ini dapat berguna untuk pembelajaran EBM di
kelas dan menjadi pengetahuan baru bagi kita semua.. Kami menyadari bahwa penulisan
tugas ini masih perlu disempurnakan. Oleh sebab itu kami mengharapkan segala saran dan
kritik yang membangun sehubungan dengan tugas EBM ini.

Pariaman, September 2019

Penulis

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 PERUMUSAN PERTANYAAN KLINIS YANG DAPAT DIJAWAB DALAM
TAHAPAN EBM

PICO merupakan sarana yang dapat digunakan untuk membantu dalam pencarian
informasi klinis. PICO merupakan metode pencarian informasi klinis yang merupakan
akronim dari 4 komponen: P (patient, population, problem), I (intervention, prognostic factor,
exposure), C (comparison, control), dan O (outcome)

PROGNOSIS

a. Kasus
Giska Berusia 18 tahun saat melahirkan bayinya. Ia memilih menikah muda
dan tidak melanjutkan sekolahnya. Persalinan giska di tolong oleh bidan. Bayi lahir
dengan berat 2500 gram. Setelah bayinya lahir giska terlihat sangat canggung,
begitupun dengan suaminya, karena dari segi usia giska termasuk primipara yang
masih berusia remaja.
Masalah dimulai ketika ASI giska tidak keluar saat bayinya menyusu. Bidan
menjelaskan itu adalah hal yang wajar, dan mengajarkan giska teknik menyusui
yang benar. Melihat bayinya yang terus menangis dan susah untuk didiamkan
giska mulai gundah. Kadang sampai ikut menangis. Hari kedua giska sudah
diperbolehkan pulang dari klinik bidan. Tapi suami giska mengatakan kalau istrinya
tidak tidur dari kemarin,dan mengeluh nyeri kepala. Bidanpun memutuskan untuk
memberikan psikoedukasi pada giska dan suami sebelum pulang.

b. Analisa dengan PICO

Populasi dan Masalah Klinis Ibu Primipara Usia Remaja Post Partum 1 hari
Intervensi / Indikator Psikoedukasi
Comparator / control Tidak diberikan Psikoedukasi

Terjadinya Baby Blues,

Outcome
Depresi Post Partum

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c. Pertanyaan Klinis
 Pada ibu primipara usia remaja apakah pemberian psikoedukasi dapat
mencegah terjadinya baby blues dibanding yang tidak mendapatkannya?
 Pada ibu yang mengalami baby blues apa efek selanjutnya jika tidak
diantisipasi?

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LANGKAH LANGKAH PENELUSURAN JURNAL YANG BERHUBUNGAN
DENGAN KASUS DIATAS, di SITUS https://www.pubmed.gov

Berikut cara untuk menelusuri jurnal di situs https://www.pubmed.gov

1. Masuk ke situs https://www.pubmed.gov, kemudian klik Advanced

2. Muncul pilihan pencarian seperti gambar dibawah

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3. Klik pada All fields, Pilih Title / Abstract, Isikan keyword pertama sesuai PICO
beserta sinonimnya dalam bahasa inggris. Dan ganti pilihan AND menjadi OR.
Contoh pada kasus in: Psichoeducation, psichology.

4. Selanjutnya klik Add to history. Pada bagian history akan muncul keyword yang
kita masukkan tadi dengan jumahnya.
Kemudian lakukan hal yang sama pada keyword kedua, pada kasus diatas
keywordnya primipara dan primiparous.

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5. Lakukan hal yang sama seperti pada langkah diatas klik Add to history. Dan
sekarang sudah ada dua history pada bagian bawah

6. Masukkan keyword ketiga : postnatal, post partum. Keyword keempat: mental

disorders, baby blues. Ubah AND jadi OR dan klik Add to history.

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7. Sekarang sudah muncul 4 buah history pada tabel. Jumlah angka yang terlihat
menunjukkan abstract yang similar dengan pencarian kita. Kemudian gabungkan
dengan klik tanda pagar dan angka pada kolom search (#2 #3 #4 #5 ) pilih AND in
builder

8. Setelah semua kita klik , history tadi akan muncul otomatis pada fields Builder.
Kemudian klik Add to history.

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9. Kemudian pada tabel history muncul gabungan dari semua keyword yang kita cari
tadi dengan jumlah items found paling sedikit dari query lainnya. Dan jumlah itu
adalah hasil pencarian yang paling mendekati dengan yang kita maksud. Klik angka
tersebut untuk menuju link Abstract.

10. Klik judul yang paling kita cari. Kita juga bisa klik similar articles untuk
mendapatkan hasil pencarian yang lebih banyak.

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11. Pada pilihan Similar articles, judul yang mendekati jadi lebih banyak.

12. Klik link judul dan artikel atau abstract yang dicari sudah bisa dilihat. Bisa
download file ataupun request send to email.

13. Hasil Jurnal

Dari pencarian diatas saya memilih judul yang paling sesuai yaitu pada artikel no
2,4 dan 5 (terlampir)

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Lampiran jurnal

1. BMJ Open. 2016 Nov 18;6(11):e012086. doi: 10.1136/bmjopen-2016-012086.

Preventing postnatal maternal mental health problems using a

psychoeducational intervention: the cost-effectiveness of What
Were We Thinking.

Ride J(1), Lorgelly P(1)(2), Tran T(3), Wynter K(3), Rowe H(3), Fisher J(3).

Author information:
(1)Centre for Health Economics, Monash University, Clayton, Victoria, Australia.
(2)Office of Health Economics, London, UK.
(3)Jean Hailes Research Unit, Monash University, Melbourne, Victoria, Australia.

OBJECTIVES: Postnatal maternal mental health problems, including depression and anxiety,
entail a significant burden globally, and finding cost-effectivepreventive solutions is a public
policy priority. This paper presents acost-effectiveness analysis of the intervention, What
Were We Thinking (WWWT), for the prevention of postnatal maternal mental health
problems.

DESIGN: The economic evaluation, including cost-effectiveness and cost-utility analyses, was
conducted alongside a cluster-randomised trial.

SETTING: 48 Maternal and Child Health Centres in Victoria, Australia. PARTICIPANTS:

Participants were English-speaking first-time mothers attending participating Maternal and
Child Health Centres. Full data were collected for 175 participants in the control arm and
184 in the intervention arm.

INTERVENTION: WWWT is a psychoeducational intervention targeted at the partner

relationship, management of infant behaviour and parental fatigue.

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OUTCOME MEASURES: The evaluation considered public sector plus participant out-of-
pocket costs, while outcomes were expressed in the 30-day prevalence of depression,
anxiety and adjustment disorders, and quality-adjusted life years (QALYs). Incremental costs
and outcomes were estimated using regression analyses to account for relevant
sociodemographic, prognostic and clinical characteristics.

RESULTS: The intervention was estimated to cost $A118.16 per participant. The analysis
showed no statistically significant difference between the intervention and control groups
in costs or outcomes. The incremental cost-effectiveness ratios were $A36 451 per QALY
gained and $A152 per percentage-point reduction in 30-day prevalence of depression,
anxiety and adjustment disorders. The estimate lies under the unofficial cost-effectiveness
threshold of $A55 000 per QALY; however, there was considerable uncertainty surrounding
the results, with a 55% probability that WWWT would be considered cost-effective at that
threshold.

CONCLUSIONS: The results suggest that, although WWWT shows promise as a

preventive intervention for postnatal maternal mental health problems, further research is
required to reduce the uncertainty over its cost-effectiveness as there were no statistically
significant differences in costs or outcomes.
TRIAL REGISTRATION NUMBER: ACTRN12613000506796; results.

Published by the BMJ Publishing Group Limited. For permission to use (where not already
granted under a licence) please go to http://www.bmj.com/company/products-
services/rights-and-licensing/.

DOI: 10.1136/bmjopen-2016-012086
PMCID: PMC5128834
PMID: 27864246 [Indexed for MEDLINE]
Conflict of interest statement: Conflicts of Interest: None declared.

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1. BMC Public Health. 2010 Jul 23;10:432. doi: 10.1186/1471-2458-10-432.

Innovative psycho-educational program to prevent common

postpartum mental disorders in primiparous women: a before and
after controlled study.

Fisher JR(1), Wynter KH, Rowe HJ.

Author information:
(1)Centre for Women's Health, Gender and Society, Melbourne School of Population
Health, University of Melbourne, Victoria 3010, Australia. jrwf@unimelb.edu.au

BACKGROUND: Universal interventions to prevent postnatal mental disorders in women

have had limited success, perhaps because they were insufficiently theorized, not gender-
informed and overlooked relevant risk factors. This study aimed to determine whether an
innovative brief psycho-educational program formothers, fathers and first newborns, which
addressed salient learning needs about infant behaviour management and adjustment tasks
in the intimate partnerrelationship, prevented postpartum mental health problems in
primiparous women.

METHODS: A before and after controlled study was conducted in primary care in seven local
government areas in Victoria, Australia. English-speaking couples with one-week old infants
were invited consecutively to participate by the maternal and child health nurse at the
universal first home visit. Two groups were recruited and followed sequentially: both
completed telephone interviews at four weeks and six months postpartum and received
standard health care. Intervention group participants were also invited to attend a half-day
program with up to five couples and one month old infants, facilitated by trained,
supervised nurses. The main outcome was any Composite International Diagnostic Interview
(CIDI) diagnosis of Depression or Anxiety or Adjustment Disorder with Depressed Mood,
Anxiety, or Mixed Anxiety and Depressed Mood in the first six months postpartum. Factors
associated with the outcome were established by logistic regression controlling for potential
confounders and analysis was by intention to treat.

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RESULTS: In total 399/646 (62%) women were recruited; 210 received only standard care
and 189 were also offered the intervention; 364 (91%) were retained at follow up six
months postpartum. In women without a psychiatric history (232/364; 64%), 36/125 (29%)
were diagnosed with Depression or Anxiety or Adjustment Disorder with Depressed Mood,
Anxiety, or Mixed Anxiety and Depressed Mood in the control group, compared with 16/107
(15%) in the intervention group. In those without a psychiatric history, the adjusted odds
ratio for diagnosis of a common postpartum mental disorder was 0.43 (95% CI 0.21, 0.89) in
the intervention group compared to the control group.

CONCLUSIONS: A universal, brief psycho-educational group program for English-speaking

first time parents and babies in primary care reduces de novo postpartum mental disorders
in women. A universal approach supplemented by an additional program may improve
effectiveness for women with a psychiatric history.
TRIAL REGISTRATION: ACTRN 12605000567628.

DOI: 10.1186/1471-2458-10-432
PMCID: PMC2920889
PMID: 20653934 [Indexed for MEDLINE]

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1. BMJ Open. 2016 Mar 7;6(3):e009396. doi: 10.1136/bmjopen-2015-009396.

Gender-informed, psychoeducational programme for couples to

prevent postnatal common mental disorders among primiparous
women: cluster randomised controlled trial.

Fisher J(1), Rowe H(1), Wynter K(1), Tran T(1), Lorgelly P(2), Amir LH(3),
Proimos J(4), Ranasinha S(5), Hiscock H(6), Bayer J(7), Cann W(8).

Author information:
(1)Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash
University, Melbourne, Victoria, Australia.
(2)Centre for Health Economics, Monash Business School, Monash University, Melbourne,
Victoria, Australia.
(3)Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia.
(4)Victorian Department of Education and Training, Melbourne, Victoria, Australia.
(5)Monash Centre for Health Research and Implementation, School of Public Health and
Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
(6)Murdoch Childrens Research Institute, Melbourne, Victoria, Australia Department of
Paediatrics, Centre for Community Child Health, The Royal Children's Hospital, University of
Melbourne, Melbourne, Victoria, Australia.
(7)Murdoch Childrens Research Institute, Melbourne, Victoria, Australia School
ofPsychological Science, La Trobe University, Melbourne, Victoria, Australia.
(8)Parenting Research Centre, Melbourne, Victoria, Australia.

OBJECTIVES: Interventions to prevent postpartum common mental disorders (PCMD)

among unselected populations of women have had limited success. The aim was to
determine whether What Were We Thinking (WWWT) a gender-informed,
psychoeducational programme for couples and babies can prevent PCMD among
primiparous women 6 months postpartum.

DESIGN: Cluster-randomised controlled trial.

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SETTING: 48 Maternal and Child Health Centres (MCHCs) from 6 Local Government Areas in
Melbourne, Australia were allocated randomly to usual care (24) or usualcare plus WWWT
(24). PARTICIPANTS: English-speaking primiparous women receiving primary care at trial
MCHCs were recruited to the intervention (204) and control (196) conditions. Ofthese, 187
(91.7%) and 177 (90.3%) provided complete data.

INTERVENTION: WWWT is a manualised programme comprising primary care from atrained

nurse, print materials and a face-to-face seminar. MAIN OUTCOME MEASURES: Data
sources were standardised and study-specific measures collected in blinded computer-
assisted telephone interviews at 6 and 26 weeks postpartum. The primary outcome was
PCMD assessed by Composite International Diagnostic Interviews and Patient Health
Questionnaire (PHQ) Depression and Generalised Anxiety Disorder modules.

RESULTS: In intention-to-treat analyses the adjusted OR (AOR) of PCMD in the intervention

compared to the usual care group was 0.78 (95% CI 0.38 to 1.63, ns), but mild to moderate
anxiety symptoms (AOR 0.58, 95% CI 0.35 to 0.97) and poor self-rated health (AOR 0.46, 95%
CI 0.22 to 0.97) were significantly lower. In a per protocol analysis, comparing the full (three
component) intervention and usual care groups, the AOR of PCMD was 0.36, (95% CI 0.14 to
0.95). The WWWTseminar was appraised as salient, comprehensible and useful by >85%
participants. No harms were detected.

CONCLUSIONS: WWWT is readily integrated into primary care, enables inclusion of fathers
and addresses modifiable risks for PCMD directly. The full intervention appears a promising
programme for preventing PCMD, optimising family functioning, and as the first component
of a stepped approach to mental healthcare.
TRIAL REGISTRATION NUMBER: ACTRN12613000506796; Results.
Published by the BMJ Publishing Group Limited. For permission to use (where not
already granted under a licence) please go to
http://www.bmj.com/company/products-services/rights-and-licensing/
DOI: 10.1136/bmjopen-2015-009396
PMCID: PMC4785308
PMID: 26951210 [Indexed for MEDLINE]

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Daftar Pustaka

https://www.ncbi.nlm.nih.gov/pubmed/26951210

https://www.ncbi.nlm.nih.gov/pubmed/20653934

https://www.ncbi.nlm.nih.gov/pubmed/27864246

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