TUTORIAL CRP A9 BY FIONA

BLOK GUS DK CRP 1

AQIL
FIONA
STELLA
NADIA
ELSA
PURNAMA
TOMMY
SAMUEL
SKENARIO 1
Seorang pemuda, berumur 22 tahun, sudah lebih dari 5 tahun
mengalami kecanduan heroin. Ia dibawa kakak perempuannya ke
dokter keluarga, karena ingin menghentikan kebiasaan buruk
tersebut. Empat tahun yang lalu, ia sudah mencoba untuk berhenti,
tetapi usahanya gagal. Kemudian usaha tersebut diulanginya lagi
satu tahun yang lalu, dan kembali gagal. Dokter keluarga yang
dikunjunginya pernah membaca artikel hasil penelitian tentang
perbandingan ke efektifan diacetylmorphine dan methadone untuk
mengobati kecanduan obat golongan opioid.
Bagaimana hasil penilaian dokter terhadap kedua obat tersebut
dan obat mana yang akan dipilih untuk mengobati kecanduan
heroin yang dialami pasiennya.
DIACETYLMORPHINE VERSUS METHADONE
FOR THE TREATMENT OF OPIOID ADDICTION
THERAPY WORKSHEET
Are the results of this single preventive or therapeutic trial valid?
Was the assignment of patients to
treatments randomized?
Was the randomization list concealed?
Was follow-up patients sufficiently long
and complete?
Yes.
(Patient were assigned to recieve
diacetylmorphine, methadone, pr
hydromorphone in a 45:45:10 ratio)
pg 778
No.
(Method: The North American Opiaten
Medication Initiative (NAOMI) was an
open-label....) pg 778
Yes.
(They obtained 12-months retention data
on 245of 251 participants and response
data on 240 of 251 participants.) pg
779 & table on pg 780
Were all patients analyzed in the
groups to which they were
randomized?
Were patients,clinicians and study
personnel keptblind to treatment?
Were the groups treated
equally,apart from the experimental
treatment?
Were the groups similar at the start of Yes.
the trial apart from the experimental
therapy?
Yes.
(Retention and response rates were
calculated on an intention-to-treat
basis) pg 779
No.
(but diacetylmorphine and
hydromorphine were administered in a
double-blind fashion) pg 778&780
Yes.
(All patients were offer a
comperhensive range of psychological
and primary care service in keeping
with Health Canada best practice) pg
778
(Inclusion and exclusion criteria....) pg
778
ARE THE VALID RESULTS OF THIS RANDOMIZED
TRIAL IMPORTANT?
What is the CEER,EER,RRR,ARR,
magnitude of the NNT
treatment effect?
How precise is the CI
estimate of the
treatment effect?
 Retention in addiction treatment

Yes No Total
Methadone 60 51 111
Diacetylmorphi 101 14 115
ne

RRR ARR NNT

CER EER(b/a+b) CER- CER-EER 1/ARR
(d/c+d) EER/CER
46% 13% 71% 33% 3%
CI (95%) = 1,62 P<0,001
 Reduction in illict-drug use or other illegal

Yes No Total
Methadone 53 58 111
Diacetylmorphi 77 38 115
ne

RRR ARR NNT

CER EER(b/a CER- CER-EER 1/ARR
(d/c+d) +b) EER/CER
46% 13% 71% 33% 3%
CI (95%) = 1,40 P=0,004
CAN YOU APPLY THIS VALID,IMPORTANT EVIDENCE ABOUT THERAPY IN
CARING FOR YOUR PATIENT?
Do this results apply to our patient?
Is our patient so different from those in No
the study that its results cannot apply?
Is the treatment feasible in our setting? No

What are our patients potential benefits and harms from the therapy?
Method I:f Risk of the outcome in out
patient,relative to patients in the trial.
Expressed as a decimal:
NNT/f=125/1=125
(NNT for patients like ours)
Method ii:1/(PEERxRRR) Our patients expected event rate
if they received the control
treatment(PEER)
=
1/(PEERxRRR)=1/ =
(NNT for patients like ours)
Are our patients values and preferences satisfied by the regimen and
its consequences?
Do we and our patient have a No
clear assessment of their values
and preferences?
Are they met by this regimen and No
its consequences?
 TUTORIAL CRP A9 BY TGD
BLOK GUS DK CRP 2
TUTORIAL 1
Seorang dokter di IGD menerima pasien
seorang laki-laki,umur 40 tahun yang
didiagnosa menderita pneumonia.Untuk
pilihan antibiotik yang diberikan dokter
tersebut mempertimbangkan pemberian
Biapenem(obat baru yang dianggap lebih
unggul) dibandingkan pemberian meropenem
sebagai obat yang sudah digunakan selama
ini. Bagaimana pendapat anda,apakah
sudah tepat keputusan tersebut?
BIAPENEM VERSUS MEROPENEM IN
THE TREATMENT OF BACTERIAL
INFECTIONS:A
MULTICENTER,RANDOMIZED,CONTR
OLLED CLINICAL TRIAL
THERAPY WORKSHEET
Are the results of this single preventive or therapeutic trial valid?

Was the assignment of patients to Yes (This

treatments randomized? prospective,multicentered,randomize
d) pg 996

Was the randomization list Yes.(Randomization and

concealed? treatment;Patients were randomly
assigned to receive biapenem or
meropenem as tratified by the
Center.through consecutively opening
sealed computer-generated
envelopes) pg 996
Was follow-up patients sufficiently Yes.(Follow up tp the patients until 72
long and complete? hours after complete.The duration of
theraphy was 7 to 14 days. No more
loss to follow up >20%
Were all patients analyzed in the Yes.(Intention to treat) pg 997
groups to which they were
randomized?

Were patients,clinicians and study No.(The study was not double

personnel keptblind to treatment? blinded,due to the reason that
meropenem should be given 3 times
daily while biapenem could be
administered twice daily) pg 995

Were the groups treated Yes.(For several infections the dose

equally,apart from the experimental was doubled.Biapenem was given
treatment? twice daily while meropenem was give
3 times daily) pg 995
Were the groups similar at the start of Yes.(Criteria inclusion and eclusion of
the trial apart from the experimental the study)
therapy?
ARE THE VALID RESULTS OF THIS RANDOMIZED
TRIAL IMPORTANT?
What is the magnitude CEER,EER,RRR,ARR,NNT
of the treatment
effect?
How precise is the CI
estimate of the
treatment effect?
 Yes No Total
Biapenem 125 11 136
Meropenem 124 12 136

RRR ARR NNT

CER EER(b/a+b) CER- CER-EER 1/ARR
(d/c+d) EER/CER
0,061 0.053 13% 0.008 125
95% CI -0,0048- 16 to inf
-792- 0,064
100%
CAN YOU APPLY THIS VALID,IMPORTANT EVIDENCE ABOUT THERAPY IN
CARING FOR YOUR PATIENT?
Do this results apply to our patient?
Is our patient so different from those in No
the study that its results cannot apply?
Is the treatment feasible in our setting? No

What are our patients potential benefits and harms from the
therapy?
Method I:f Risk of the outcome in out
patient,relative to patients in
the trial.
Expressed as a decimal:
NNT/f=125/1=125
(NNT for patients like ours)
Method ii:1/(PEERxRRR) Our patients expected event rate
if they received the control
treatment(PEER)
=
1/(PEERxRRR)=1/ =
(NNT for patients like ours)
Are our patients values and preferences satisfied by the regimen and
its consequences?
Do we and our patient have a No
clear assessment of their values
and preferences?
Are they met by this regimen and No
its consequences?