Seorang pasien baru, Ny. A baru pindah ke kota Bandung ingin tinggal dekat anaknya. Ny. A berumur 61 tahun dan punya sejarah medis gagal jantung (congestive heart failure) yang dideritanya setelah beberapa kali kena serangan jantung. Ny. A telah di rawat 2 kali dalam 6 bulan terakhir karena gagal jantungnya bertambah parah. Saat ini jantungnya tetap dalam normal sinus rhythm. Ny. A rajin minum obat (enalapril, aspirin, dan simvastatin) dan sangat ingin agar tidak sampai dirawat di rumah sakit lagi.
Anda berpikir sebaiknya Ny. A juga dapat digoksin
tetapi anda tidak yakin apakah dengan pemberian digoksin dapat membantu supaya Ny. A agar tidak di rawat lagi. Anda memutuskan untuk menyelidiki pertanyaan ini shg pd kunjungan Ny. A berikutnya anda sudah tahu jawabannya Built a good clinical question
Patient/ Congestive heart failure,
elderly Problem Intervention digoxin Comparison, None, placebo if any Outcome Primary: reduce need for hospitalization Secondary: reduce mortality Untuk pasien ini, pertanyaan klinis:
In elderly patients with congestive heat
failure, is digoxin effective in reducing the need for rehospitalization ? Type of Suggested best type of question study Therapy RCT>cohort>case control>case series Diagnosis Prospective, blind comparison to a gold standard Prognosis Cohort study>case control>case series Prevention RCT>cohort study>case control Cost Economic analysis Clinical Clinical MEDLINE Question Scenario Strategy Patient CHF, elderly CHF Population Limit to Aged Intervention digoxin digoxin Comparison None or placebo Outcome Rate of hospitalization hospitalization Type of therapy Question Type of study RTC Limit to RCT as publication type Limitation to RCT and Humans Limited to Free Full Text, Language, Age (Middle Aged : 45 64 years) Read the following article to determine if the article meets the criteria for validity. As stated previously, evaluating the medical literature is a complex undertaking. You will find that the answers to the questions of validity may not always be clearly stated in the article and that you may have to use your own judgment about the importance and significance of each question. Ada 3 pertanyaan dasar yg harus dijawab utk setiap studi
Are the results of the study valid?
What are the results?
Will the results help in caring for my patient?
Are the Result of the Study Valid? a. Were the subjects randomized, and what was the randomization technique? Did the randomization process result in equal baseline characteristics? b. Were all subjects who entered the trial accounted for? Was follow-up complete? If not, how many were lost to follow-up, from which groups did they leave, and why? c. Were subjects analyzed in the groups to which they were randomized? Was intention-totreat, per-protocol, or actual treatment analysis used? d. How was blinding conducted (subject, investigator, etc.), if applicable? e. Were the inclusion and exclusion criteria appropriate, or were they too restrictive or inclusive? Were the groups similar at the start of the trial? f. Was the sample size sufficient, and was a power calculation included? g. Were the groups handled the same way, aside from the intervention(s)? h. Were the statistical tests appropriate and understandable? i. Were surrogate markers or true outcomes assessed? Were a priori subgroup analyses performed?