1.

DIAGNOSIS WORKSHEET

Judul

Diagnostic accuracy of a rapis PT-PCR assay for point-of-care detection of influenza

A/B virus at emergency department admission: A prospective evaluation during the
2017/2018 influenza season.

A. Apakah uji diagnostic ini valid ?

Apakah uji diagnostik dibandingka Baku emas dari jurnal ini uji asam nukleat
n dengan baku emas yang benar? dengan alat ini lebih cepat <30 mnt.

Apakah pemeriksaan uji dan baku e Dikatakan independen karena memunuhi

mas dilakukan secara independen? syarat pada pasien yang berusia 18 tahun
(samplimg).

Dikatakn independen karena pemeriksaan alat

uji spesimen melalui perawat. Tes ini
dikatakan independen.

Apakah uji diagnostik dilakukan ter Subjek dalam uji diagnostik memenuhi kriteria
hadap spektrum pasien seperti dala pasien >18 thn, suhu tubuh 38, dengan gejala
m praktik sehari hari ? batu, rinore, dispnea atau sakit tenggorokan.

Apakah pemeriksaan baku emas dil Pemeriksaan baku emas dilakukan pada
akukan kepada seluruh subyek tanp seluruh subyek tanpa melihat hasil uji
a melihat hasil uji diagnostik? diagnostik.

Apakah uji diagnostik ini penting ? Ya

Sensitivitas : influenza A/B sebesar 0,98

Spesifisitas : 0,99

NPV : 0,99

PPV : 0,99

B. Are the valid results of this diagnostic study important?

SAMPLE CALCULATIONS

Target disorder

(iron deficiency anemia)

Present Absent Totals

Positive 731 270 1001

Diagnostic (< 65 mmol/L) a b a+b

test result
Negative 78 1500 1578
(serum
( 65 mmol/L) c d c+d
ferritin)

809 1770 2579

Totals a+c b+d a+b+c+d

Sensitivity = a/(a+c) = 731/809 = 90%

Specificity = d/(b+d) = 1500/1770 = 85%

Likelihood ratio for a positive test result = LR+ = sens/(1-spec) = 90%/15% = 6

Likelihood ratio for a negative test result = LR - = (1-sens)/spec = 10%/85% = 0.12

Positive Predictive Value = a/(a+b) = 731/1001 = 73%

Negative Predictive Value = d/(c+d) = 1500/1578 = 95%

Pre-test probability (prevalence) = (a+c)/(a+b+c+d) = 809/2579 = 32%

Pre-test odds = prevalence/(1-prevalence) = 31%/69% = 0.45

Post-test odds = pre-test odds  LR

Post-test probability = post-test odds/(post-test odds +1)

C. Dapatkah kita menerapkan hasil study pada pasien kita?

apakah pasien kita mirip dengan pasien pada Mirip karena sesuai dengan kriteria
studi uji diagnostik ini ? sesuai dengan gejala. Tes pcr ini bisa
juga dilakukan di indonesia

Apakah kita dapat memperkirakan prevalens Bisa

penyakit pada pasien kita

Apakah hasil uji diagnostik khususnya denga Sangat bisa

n nilai duga positif yang diperoleh membant
u tatalaksana pada pasien kita

Apakah secara keseluruhan uji ini membantu Membantu sekali

pasien kita?
2. Terapi Worksheet

A. Validity

Apakah peserta penelitian dirandomisasi? Dan apakah t Tidak

abel randomisasi disembunyikan?

Apakah karakteristik kedua kelompok sebanding sebel Sebanding

um dilakukan intervensi?

Apakah pasien dan peneliti tidak mengetahui perlakuan Mengetahui

yang diberikan

Selain obat atau pengobatan yang diberikan, apakah kel Sama, hanya teknik yang berbeda
ompok kelompok tersebut mendapat perlakuan yang sa
ma

Apakah semua pasien yang ikut dalam uji klinis diikuts Diikutsertakan sampai analisis akhir,
ertakan dalam analisis akhir? Dan apakah mereka diana
lisi dalam kelompok awal saat randomisasi?

B. Important

◦ Control event rate (CER) :

◦ Experimental event rate (EER) :
◦ Relative risk reduction :
◦ Absolute risk reduction :
◦ Number need to treat (NNT) :

Cara menghitungnya:
 BAKU EMAS

YA TIDAK

HASIL UJI POSITIF a b a+b

NEGATIF c d c+d

Total a+c b+d a+b+c+d

◦ Control event rate (CER) : d/c+d

◦ Experimental event rate (EER) : b/a+b
◦ Relative risk reduction : CER-EER/CER
◦ Absolute risk reduction : CER- EER
◦ Number need to treat (NNT) : 1/AAR

C. Applicablity

Apakah karakteristik pasien kita mirip dengan pasien p Karakteristik mirip

enelitian ?

Apakah tersedia obat, keahlian, fasilitas, dan biaya yan Tersedia dan terbatas
g diperlukan?

Apakah pasien dan keluarga dapat menerima pemberia

n obat/ pengobatan atas dasar nilai nilai sosial, budaya,
dan agama?
3. HARM WORKSHEET

Citation:

A. Are the results of this harm study valid?

Were there clearly defined groups of

patients, similar in all important ways other
than exposure to the treatment or other
cause?

Were treatments/exposures and clinical

outcomes measured in the same ways in both
groups (was the assessment of outcomes
either objective or blinded to exposure)?

Was the follow-up of study patients

sufficiently long and complete?

Do the results satisfy some “diagnostic tests for causation”?

Is it clear that the exposure preceded the

onset of the outcome?

Is there a dose-response gradient?

Is there positive evidence from a

“dechallenge-rechallenge” study?

Is the association consistent from study to

study?

Does the association make biological sense?

B. Are the valid results from this harm study important?

What is the magnitude of the association

between the exposure and outcome?

What is the precision of the estimate of the

association between exposure and
outcome?

Adverse outcome

Present (case) Absent (control) Totals

Yes a B a+b
(cohort)

No c D c+d
Exposed to (cohort)
the treatment
Totals a+c b+d a+b+c+d

In a randomised trial or cohort study: relative risk = RR = {a/(a+b)}/{c/(c+d)}

In a case-control study: odds ratio (or relative odds) = OR = (a/b) / (c/d) = ad/bc

C. Should these valid, potentially important results change the treatment of your
patient (Applicability)?

Do the results apply to our patient?

Is our patient so different from those in

the study that its results don’t apply?

What are our patient’s risks of the adverse

event?
To calculate the NNH (number of patients
we need to treat to harm one of them) for
any odds ratio (OR) and our patient’s
expected event rate for this adverse event
if they were not exposed to this treatment
(PEER):

PEER (OR−1)+1
NNH=
PEER(OR−1)×(1−PEER )
What are our patient’s preferences,
concerns and expectations from this
treatment?

What alternative treatments are available?

Additional notes:

4. PROGNOSIS WORKSHEET

Citation:

A. Are the results of this prognosis study valid?

Was a defined, representative sample of

patients assembled at a common (usually
early) point in the course of their disease?
 Was patient follow-up sufficiently long
and complete?

Were objective outcome criteria applied

in a “blind” fashion?

If subgroups with different prognoses are

identified:

 Was there adjustment for

important prognostic factors?

 Was there validation in an

independent group (‘test set’) of
patients?

B. Are the valid results of this prognosis study important?

How likely are the outcomes over time?

How precise are the prognostic

estimates?

C. Can you apply this valid, important evidence about prognosis in caring for your
patient (Applicability)?
 Do the results apply to our patient?

Is our patient so different from those in

the study that its results cannot apply?

Will this evidence make a clinically

important impact on our conclusions
about what to offer or tell our patient?

Additional notes:

LI

1. Definisi uji diagnostik dan EBM diagnostik

2. Langkah langkah penentuan EBM

3. Uji penilian validitas

4. Struktur dan morfologi virus influenza

5. Apa yang dimaksud sensitivitas, spesitivitas, npv, dan ppv?

6. Manifestasi klinis influenza

7. Cara pengambilan swab nasofaring khusus pada influenza

8. Tujuan penelitian