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PEMICU 1 EBM

KELOMPOK DISKUSI 2

Tutor : dr. Noor Diah Erlinawati, M.Gizi

Anggota Kelompok:
Lovina Falendini Andri
Thomas Erickson
Vidia Meila Ningsih
Case 3 : Therapeutic

 P : Anak dengan demam tinggi selama 5 hari


 I : Antibiotik profilaksis
 C : Tidak diberikan antibiotik profilaksis
 O : Efektivitas antibiotik profilaksis
 Q : Bagaimana pengaruh antibiotik profilaksis
terhadap efektivitasnya dalam mencegah
komplikasi campak?
Validitas

 Representatives :  Maintenance :
Subjek penelitian Accounted for 
sebanyak 1263 anak sebanyak 654 anak
dengan usia <18 tahun. dengan measles yang
diberikan antibiotik
 Allocation :
sebagai kelompok
intervensi dan 609 anak
Similar  subjek dengan measles sebagai
penelitian berusia <18 kelompok kontol.
tahun.
Validitas (2)

 Measurement :
Objective  penilaian
terhadap subjek
penelitian dilakukan
dengan temuan klinis
dan pemeriksaan
penunjang.
Validitas (3)

 Randomisasi :  Pada penelitian tersebut,


Dua dari 7 penelitian semua sampel yang
terrandomisasi diambil diikut sertakan
(Garly 2006; Prasad 1967). hingga akhir penelitian,
In the remaining five sehingga total sampel
diawal dan akhir
penelitian tetap sama.
studies (Anderson 1939;
Gibel 1942; Hogarth 1939;
Karelitz
1951; Karelitz 1954) it was
not very clear.
Validitas (4)

 Blinding  Efek Samping :


Dari tujuh penelitian yang - Erythema nodosum
blinding dilakukan pada - Vomiting
dua penelitian. (12) - Diarrhea
(Garly 2006; Prasad 1967).

studies (Anderson 1939;


Gibel 1942; Hogarth 1939;
Karelitz
1951; Karelitz 1954) it was
not very clear.
Validitas (5)

 Kriteria Inklusi :  Kriteria Ekslusi :


We included seven controlled Three published studies were
clinical trials on the use of excluded from the review
antibiotics because
to prevent complications in they were not controlled trials
children with measles. Five
studies
were conducted in Glasgow,
London and New York between
1939 and 1954. One study was
conducted in India in the 1960s
and a more recent one in Bissau,
Guinea-Bissau, West Africa, was
published in 2006.
The magnitude of effect is usually expressed as one of the following, where:

Yes No
Exposed a b
Not
c d
Exposed

Control event rate (CER) = c/c+d


Experimental event rate (EER) = a/a+b
(a) Relative Risk (RR) = EER/CER=(a/a+b)/(c/c+d)
(b) Relative Risk Reduction (RRR) = CER-EER/CER
(commonest reported measure of dichotomous treatment effect)
(c) Absolute Risk Reduction (ARR) = CER-EER
(d) Number Needed to Treat (NNT) = 1/ARR
A certain risk reduction may appear impressive but how many patients would you
have to treat before seeing a benefit? This concept is called "number need to treat"
and is one of the most intuitive statistics for clinical practice.
For example if:
Diberi antibiotik Tidak diberi
antibiotik
Pneumonia 27 59

Tidak Pneumonia 627 550

The RR = (27/654) / (59/609) = 0.4 making the RRR =


(0,097-0.043/0,097)=0.55 or 55%. Although this sounds
impressive, the absolute risk reduction is only 0.097-
0.043=0.054 or 5.4%. Thus the NNT is 1/0.054= 19
patients. It is obvious that on an individual patient basis the
pre-intervention risk or probability is a major determinant of
the degree of possible post-intervention benefit, yield, or
risk reduction.