EVIDENCE BASED MEDICINE

Memberikan layanan kesehatan dg kualitas yang

terbaik (EBM), yg komprehensif dan
berkesinambungan kepada setiap pasien.

Perlu kepemimpinan moral (moral leadership) oleh

profesi dan seruan untuk kembali ke humanisme
melalui peningkatan kemampuan berkomunikasi,
seni mengajar dan pemanfaatan informasi.
 Evidence Based
Medicine is the
integration of best
research evidence
•Patient
with clinical
Concern
expertise and
personal values
Best
(Dave Sackett)
Research
evidence
Clinical
Expertise
 Evidence-based medicine

Pemanfaatan bukti mutakhir dari penelitian yang

sahih dalam tata laksana pasien’. EBM merupakan
integrasi antara bukti-bukti tersahih dari hasil
penelitian terkini dengan ekspertis klinis dan nilai-
nilai pasien. Bukti tersahih yang dimaksud adalah
laporan hasil penelitian dasar dan penelitian klinis
yang relevan. (Sudigdo)
 KUANSU (Buah Merah)
 Pandanus conoideus
 Kuansu
 Papua, t.u. Jayawijaya, Ayamaru (Sorong)
 Length up to 1,5 m

Sumber http://www.westpapua.org/images/bua_merah.jpg
 Compositions
Chemicals
Carotenoid 12.000 ppm
Tocopherol 11.000 ppm Antioxydan
Betacaroten 700 ppm
Alfa tocopherol 500 ppm
Oleic acid 58%
Linoleic acid 8,8% Fatty acids
Linolenoic acid 7,8%
Decanoat 2,0%
 ANTI OKSIDAN
 Antioksidan melindungi sel dari kerusakan akibat molekul tidak
stabil yg disebut radikal bebas
 Penelitian lab dan binatang menunjukkan antioksidan
mencegah kerusakan sel oleh radikal bebas, namun uji klinik
tidak konsisten
 Contoh: beta karoten, lycopene, vitamins C, E, and A
 Antioksidan terdapat pada makanan yang mengandung sayur
dan buah (tomat, mangga, wortel, bayem, jeruk, jambu,
semangka, papaya, kacang)
 “Indications”

 Cancer
 Cholesterol
 Hyperuricaemia
 AIDS
 Hepatitis
 etc.
 No Evidence
 PROBLEMS
Terima kasih

1. Some patients with lupus (SLE), Breast cancer

and AIDS stop the standar treatment and
replaced them with Kuansu
2. Those patienrs died
3. What is Kuansu?
 JAMA 1999 281: 138

38,000 US male health professionals over eight years.

The other collected data from 80,000 US nurses for 14
years.  Consumption of up to 1 egg per day is unlikely
to have substantial overall impact on the risk of CHD or
stroke among healthy men and women.
 Wang X, Ouyang Y, Liu J et el: Fruit and vegetable
consumption and mortality from all causes, cardiovascular
disease, and cancer: systematic review and dose-response
meta-analysis of prospective cohort studies. BMJ 2014;349

 Results 16 prospective cohort studies were eligible in this

meta-analysis. During follow-up periods ranging from 4.6
to 26 years there were 56 423 deaths (11 512 from
cardiovascular disease and 16 817 from cancer) among
833 234 participants.
 Conclusions This meta-analysis provides further evidence
that a higher consumption of fruit and vegetables is
associated with a lower risk of all cause mortality,
particularly cardiovascular mortality.
TV - TIMUN
 Terima
Ampuh: kasih
Kanker, AIDS, Hepatitis

 Buah Merah
 Daun Makuta dewa
 Air Seni
 Susu Kuda Liar
 Kayu Putih
 Jaket Warsito
 Obat COVID-19
Terima kasih

 Oseltamivir

 Chloroquine

 Plasma Konvalesen

 Azithromycin

 Ivermectin
 CHLOROQUINE

TERBUKTI
Hydroxychloroquine tidak mengurangi angka kematian COVID-19
Efek samping lebih dari plasebo.
Para peneliti: tidak perlu penelitian lagi
 IVERMECTIN

 FDA TIDAK MEMBERI IZIN tuk mengobati COVID-19

 Ivermectin disetujui untuk mengobati penyakit parasit n rosacea.
 Data yg ada tidak bermanfaat
 Efek samping membahayakan, apalagi dosis tinggi
 Ada animal- ivermectin, yang tidak boleh digunakan untuk
pengobatan manusia.
 Pengobatn COVID-19 dg ivermectin berbahaya
 Chloroquine or hydroxychloroquine for
Terima
prevention kasihof COVID‐19
and treatment
Bhagteshwar SinghHannah RyanTamara KredoMarty ChaplinTom Fletcher

 Diteliti 12 penelitian uji klinik yg mengikut seratakan 8.569

partisipan dewasa. Penelitian berasal dari China (4); Brazil,
Egypt, Iran, Spain, Taiwan, Inggris dan Amerika serta 1
penelitian global berarsal dari 30 negara
 9 penelitian pasien rawat inap RS, 3 berobat jalan
 Berat ringan penyakit, prevalensi komorbid, dan ko intervensi
bervariasi
 Kesimpulan: HCQ ftidak mengurangi angka kematian
 Mungkin sekali juga tidak mengurangi perlu ventilator o
 Efek samping 3x plasebo
Systematic review and meta-analysis of the
efficacy and safety of oseltamivir (Tamiflu) in the
treatment of Coronavirus Disease 2019 (COVID-
19).
PLoS One. 2022; 17(12):e0277206.

5 penelitian
8 penelitian observasi
Random-effects model dipakai
Kesimpulan: survival tidak berbeda
Respon pengobatan tidak bermanfaat, baik dari virological,
WHY WE NEED EBM

 Too many patients

 Too many problems
 Too many journals
 Informations +++++
 Limited time to read
 Hoax in Social Media
 Thinking logically
is not enough
 Smoking causes cancers
 Antioxydant prevents cancer
 Antioxydant prevent cancer in smokers
 WRONG!
 Finnish ATBC study: 29,000 male smokers, 20 mg beta-carotene
supplements taken over six years were linked to lung cancer
 U.S. CARET study: > 18,000 male and female smokers and male
asbestos workers, 30 mg beta-carotene suppl over four ys were
linked to a 28% higher risk of lung cancer; 17% higher risk of
deaths from all causes compared with smokers taking a placebo.
Tidak hanya masalah kesehatan

Dukungan
Sosial

Harapan

Sosial
Psiko
Kanker Pengobatan
COVID-19
Klinis
Medis
Dukungan
Psikologis
 Beta carotene dan Kanker Paru
NEJM, 334:1150-1155, 1996 Effects of a Combination of Beta Carotene and
Vitamin A on Lung Cancer and Cardiovascular Disease

 Kombinasi beta carotene dan vitamin A tidak ada

gunanya buat perokok.
 Bahkan mungkin dapat menyebabkan peningkatan
insiden kanker paru dan peningkatan insiden kematian
akibat penyakit kardiovaskular dan cardiovascular
disease, and any cause in smokers and workers exposed
to asbestos
 Level of Evidence*
I. Randomized controlled trial (RCT)
i)Double blind (gold standard)
ii)Non-blinded

II. Nonrandomized controlled clinical trial

III. Case series

i) Population-based, consecutive series
ii) Consecutive cases (not population-based)
iii) Nonconsecutive cases
*National Cancer Institute, USA
A. Kompetensi B. Kompetensi
Terintegrasi Klinik
•Humanism I.Peny Dalam
Bedah
•Profesionalism
Obs Gyn
Lifelong study •Medical Ethics
IKA
Clinical method •Social Protection Mata
Clinical reasoning THT
Public Health
Diagnostic- •Home care IKK
.Process Kardio
• Rehabilitation Pulmo
•Management of Practice

•Medical Informatics

•EVIDENCE BASED MEDICINE

KESIMPULAN
 Terima kasih
EBM : CONCLUSIONS

• EBM is needed because it provides us in providing

healthcare with acceptable framework for making complex
decisions when effective decision making is needed
• EBM enables us to be confident in decision making
• EBM enables us to communicate these effectively to
colleagues and patients
• EBM requires institutional support by way of specialist skills,
supply of evidence, and widely accepted standards, which
will take some time to be widely available.
• (https://www.medscape.com/viewarticle/430709_13)
Dokter teruslah Belajar
Cakrawala ilmu kedokteran amat luas. Para dokter
seharusnya selalu belajar terus menerus.

Seorang dokter harus bersedia menyesuaikan

konsep dan kebiasaan kerja mereka dengan
perkembangan baru dan dg munculnya bukti baru.

Dokter perlu belajar dari pengalaman, dari

kesalahan yg mereka bikin, dan bersedia
memperbaiki praktek kedokteran melalui inovasi
dan perbaikan kualitas.
Kompetensi untuk lifelong Learning

Mengembangkan sendiri tehnik agar tidak

ketinggalan dg kemajuan pengetahuan dan penemuan
baru.

Berpartisipasi aktif dalam program CPD/CME yang

diselenggarakan pusat pendidikan / organisasi profesi

Menjaga rasa ingin tahu dg sering bertanya , belajar

mandiri dan analisa kritis thd hasil publikasi.