An Introduction To Evidence-Based Medical Practise: Dr. Dr. Dyah Kanya Wati, Sp.A (K)

Learning Task
An Introduction to Evidence- Based

Medical Practise
Lecturer Dr. dr. Dyah Kanya Wati, Sp.A(K)
SGD Group A8
Gede Bayu Wedanta Netra (1702511156)

Members Ida Ayu Putu Putri Andari (1702511166)
I Gde Astha Pramana Suta (1702511176)
I Putu Willy Ganang Arta Putra (1702511186)
Putu Mahadevy Pradnyandhari Putri (1702511216)
Kadek Dwi Pradnyawati (1702511007)
Kadek Mercu Narapati Pamungkas (1702511017)
Ni Nyoman Sriwulan Pratiwi (1702511027)
I Made Reza Pramudya (1702511067)
Ni Made Dea Adilla Rathasari (1702511097)
Ni Luh Putu Yunia Dewi (1702511117)
Putu Githa Garbhini (1702511127)
Question Answer
A 25 year old woman was consulted to a nephrologist with lupus
Case GN. The patient had been treated with methyl prednisolon for 3
months à failed to get remission.The patient has not married à
hope to get pregnant in the future (contraindicated for CYP).The
doctor knew MMF, a promising drug for LGN available in the
market. However the doctor was not sure the drug is save and
effective à he would like to find out best evidence in the internet,
but he was not so familiar with EBM and searching in the
internet. Please, help the doctor to find the best evidence to
answer his problem
1. Comprehend above anya

scenario
2. Make clinical mercu

(foreground question)
using acronym PICO
3. Search articles about wulan
therapy (randomized
clinical trial) in internet
(using Highwire or
other addresses)
4. Procure 3 related reza

articles
5. Appraise and select one dea

best article
6. Apply whenever you yunia

find valid and important
best evident article
LECTURE 2
Learning Task Problems identifications with clinical questions
Lecturer Dr. dr. Dewi Sutriani Mahalini, Sp.A
SGD Group A8
Question Answer
Scenario 1:
Case
A medical student, 19 years old, female came to a doctor with chief complaint of
mass in her left breast with 2 cm in diameter. Based on physical examination, the
doctor didn’t sure if the mass was a malignancy or not. The doctor told her to do
mammography but she was worried that mammography will expose her to x ray.
She asked for ultrasonography. She thought that ultrasonography was safer
compared to mammography. The problem was the doctor didn’t know if
ultrasonography can accurately diagnosed breast cancer compared to
mammography.
Can you find the answer for scenario above by search for the best evidence from the
internet?
Scenario 2:
A 40 years old male came to a doctor. He had diabetes mellitus since 5 years ago
but he didn’t attend medical visit regularly. This morning, the patient came to
laboratory; he wanted to check for microalbuminuria, based on his friend’s advice.
His friend also had diabetes mellitus. Apparently, he was positive for
microalbuminuria. He was told by a nephrologists that irbesartan can prevent renal
failure in diabetes mellitus patients with microalbuminuria. He asked this doctor
whether it was true or not, and if it was true what was the estimation for the
preventive effect. The doctor didn’t have data to answer that question. Could you
help this doctor to search for best evidence from the internet?
Scenario 3:
A marketing staff from a well-known laboratory came to a doctor to offer a
homocysteine serum test for diabetes mellitus patients. This staff said that this new
marker, homocysteine, can predict the mortality rate in patients if the level in serum
was high. The doctor asked for an evidence for that statement. The staff didn’t have
the answer for the doctor question. Could you help the marketing staff to search for
the evidence from the internet?
Scenario 4:
A 40 years old man who work as a teacher in department of Agriculture, had

diabetes mellitus for 6 years, came to a doctor. The doctor said that he had mild
decreased of renal function (secondary to diabetic nephropathy). The doctor advised
him to have low protein diet and go to a dietitian to ask for a menu that he needed.
He asked if the low protein diet really necessary because other doctor advised him
to have a low calories and normal protein intake to maintain his nutritional status.
This doctor told him that low protein diet was needed to prevent the progression of
renal failure. He was confused which doctor was right and asked for an evidence.
The doctor didn’t have an evidence to show his patient. Could you help this doctor
to find evidence from the internet?
1. Identify Garbin
what type
of
question
of the
above
scenario?
2. Please, Bayu
build up a
clinical
research
question
using
PICO !
3. Formulat Dayu
e a
clinical
research
question
from
scenario
above !
Learning Task Apply evidence based medicine to search article and

medical record
Lecturer Prof. Dr. dr. I Putu Gede Adiatmika, M.Kes
SGD Group A8

Question Answer
-
Case
1. Discuss some astha
consideration
used for
articles
searching and
choosing the
appropriate
article?
2. Explain the willy

use of medical
record for
comprehensiv
e patient
treatment?
LECTURE 3
Learning Task Association, Causation and Critical

Aprraisal
Lecturer Dr. dr. I.B. Subanada, Sp.A(K)
SGD Group A8

Question Answer
-
Case
1. What is the devy
basic
difference
between
association
and
causation?
2. What are the anya

differentiation
between
contributory
cause and
necessarily
cause?
LECTURE 4
Learning
Study about Prognosis Principle in Critical
Task Appraisal
Lecturer dr. Eka Gunawijaya, Sp.A(K)
SGD Group A8

Question Answer
Is this evidence about prognosis valid?

Case
1. Was a mercu
defined,
representative
sample of
patients
assembled at a
common
(usually early)
point in the
course of their
disease?
2. Was wulan
patient follow-
up sufficiently
long and
complete?
3. Were reza
objective
outcome criteria
applied in a
‘blind’ fashion?
4. If dea
subgroups with
different
prognosis are
identified:
a. Was
there
adjustment for
important
prognostic
factors?
b. Was yunia
there validation
in an
independent
group of ‘test-
set’ patients?
Case 2 Is this valid evidence about prognosis important?

1. How garbin
likely are the
outcomes over
time?
2. How bayu
precise are the
prognostic
estimated?
PROGNOSIS WORKSHEET
Citation: mercu
Are the results of this prognosis study valid?
Was a defined, representative sample of mercu

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

complete?
Were objective outcome criteria applied in a reza

“blind” fashion?
If subgroups with different prognoses are

identified:
• Was there adjustment for important
prognostic factors? dea
• Was there validation in an independent

group (‘test set’) of patients?
Are the valid results of this prognosis study important?
How likely are the outcomes over time? yunia
How precise are the prognostic estimates? garbin
IF YOU WANT TO CALCULATE A CONFIDENCE INTERVAL AROUND THE MEASURE OF

PROGNOSIS
Clinical measure Standard error (SE) Typical calculation of CI
Proportion (as in the rate of If p=24/60=0.4 (or 40%) and

some prognostic event, etc.) n=60:
where:
where p is proportion and
n=the number of patients n is number of patients
p=the proportion of these =0.063 (or 6.3%)

patients who experience the
95% CI is 40%±1.96×6.3% or
event
27.6% to 52.4%
n from your evidence:___ dayu Your calculation:

p from your evidence:___ SE:____________
95% CI:________
bayu asta
Can you apply this valid, important evidence about prognosis in caring your patient?
Do the results apply to our patient?
Is our patient so different from those in the willy

study that its results cannot apply?
Will this evidence make a clinically devy

important impact on our conclusions about
what to offer or tell our patient?
Additional notes: ??
LECTURE 5
Methodological, statistical principles, application in

Learning
Task
analytical studies and critical appraisal
Lecturer Dr. dr. Lanang Sidiartha, Sp.A(K)
SGD Group A8

Question Answer
Case Researcher wants to study effectiveness of probiotic as additional treatment of acute

diarrhea in children. The research question: in children with acute diarrhea, is the
probiotic as additional therapy compare with placebo give faster recovery. Based on
simple randomized, 50 subjects receive probiotic and 50 subjects receive placebo. The
characteristic of subject was presented in table 1 below.
Variable Probiotic Placebo
(N = 50) (N = 50)
Gender, boys, n(%) 24 (48) 25 (50)
girls, n(%) 26 (52) 25 (50)
Age (month), mean (SD) 24 (1,5) 25 (1,4)
Nutritional status, n (%)
Obese 0 (0) 1 (2)
Normal 30 (60) 32 (64)
Malnourished 20 (40) 17 (34)
Body temperature, oC 37,5 (36,1-39,5) 37,8 (36,5-39,4)
Length of stay (days), mean(SD) 3,5 (0,2) 5,5 (0,3)
1. What anya
kind of
statistical
analysis is
used to
compare the
length of
stay between
probiotic
and placebo
group?
2. What mercu
kind of
statistical
analysis is
used to
compare the
proportion
of gender
between
probiotic
and placebo
group?
wulan
3. What
kind of
statistical
analysis is
used to
compare the
different of
nutritional
status
between
probiotic
and placebo
group?
reza
4. What
kind of
statistical
analysis is
used to
compare the
mean body
temperature
between
probiotic
and placebo
group?
LECTURE 6
Learning Effect size, Hypothesis Testing and Confidence

Task
Interval and Critical Appraisal
Lecturer Dr. dr. I.B. Subanada, Sp.A(K)
SGD Group A8

Question Answer
-
Case
1. What
is the
meaning of
effect size?
2. What
is the
principle of
hypothesis
testing?
3. What
is the
principle of
confidence
interval?
4. What
is the
relationship
between
effect size,
hypothesis
testing, and
confidence
interval?
5. How
to report an
abstract
showing
effect size,
confidence
interval, and
effect size?
Case Severe acute malnutrition affects 13 million children worldwide and causes 1–2
million deaths every year. Our aim was to assess the clinical and nutritional
efficacy of a probiotic and prebiotic functional food for the treatment of severe
acute malnutrition in a HIV-prevalent setting. We recruited 795 Malawian
children (age range 5 to 168 months) from July 12, 2006, to March 7, 2007, into
a double-blind, randomized, placebo-controlled efficacy trial. Children were
randomly assigned to ready-to-use therapeutic food either with (n=399) or
without (n=396) Synbiotic2000 Forte. Primary outcome was nutritional cure
(weight-for-height >80% of National Center for Health Statistics median on two
consecutive outpatient visits). Nutritional cure was similar in both Symbiotic
and control groups (53.9% [215 of 399] and 51.3% [203 of 396]; p=0.40). The
characteristic of subjects were presented in table 1 below.
Table 1. Characteristic of subject
Variable Symbiotic (n=399) Placebo

(n=396)
Age in months 22 (15 – 32) 21 (15 – 31)
Gender, boys, n(%) 214 (53.6) 216 (55.0)
Girls, n(%) 185 (46.4) 177 (45.0)
Nutritional status, Marasmic, n(%)

142 (35.6) 146 (36.9)
Kwashiorkor, n(%)
257 (64.4) 250 (63.1)
Status HIV, Seropositive, n(%) 170 (42.6) 192 (48.5)
Seronegative, n(%) 203 (51.0) 190 (48.0)
Unknown, n(%) 26 (6.4) 14 (3.5)
Household water source,piped,

208 (53.9) 217 (56.8)
n(%) Borehold, n(%)
132 (46.1) 117 (43.2)
Primary outcome, cure, n(%)* 215 (53.9) 203 (51.3)
*) p = 0.40
1.
Explain the
type of data
of each
variable
based on
scale of
measurement:
age, gender,
nutritional
status, status
HIV,
household
water source,
and primary
outcome!
2.
Explain the
statistic
testing for
primary
outcome
between
symbiotic
and placebo
group!
3. To BAYU
adjusted
compounding
factors,
explain the
statistic
testing that
was used!
LECTURE 7
Learning Task Diagnostic Test Principles in Critical Appraisal
Lecturer dr. Gede Wira Mahadita, M.Biomed,
Sp.PD
SGD Group A8
Question Answer
-
Case
1.Independent,
blind comparison
with a reference
(gold standard of
diagnosis. What
this way is to
avoid?
2.Appropriate
spectrum of
patients.
3. Reference
standard applied
regardless of the
diagnostic test
result.
What is work-up
bias?
4. Test
validated in
second
independent
group of patients.
Does the study
show an
important ability?
5.
Sensitivity and
specificity?
6. Positive and
negative
predictive value?
7. Likelihood
ratio (multilevel)
8. Pre-test and
post-test
probability
LECTURE 8
Learning Task Clinical Trial Principle in Critical

Appraisal
Lecturer Dr. dr. Lanang Sidiartha, Sp.A(K)
SGD Group A8

Question Answer
Case
devy
1. What question did the study
ask?
1.a . R- Was the assignment of anya

patients to treatments randomised?
1b. R- Were the groups similar mercu

at the start of the trial?
2a. A – Aside from the allocated wulan

treatment, were groups treated
equally?
2b. A – Were all patients who reza

entered the trial accounted for?
And were they analysed in the
groups to which they were
randomised?
3. M - Were measures objective dea

or were the patients and
clinicians kept “blind” to which
treatment was being received?
4. How large was the yunia

treatment effect?
5. How precise was the garbin

estimate of the treatment effect?
6.Will the results help me in

caring for my patient? bayu
(ExternalValidity/Applicability
)
dayu
a. Is my patient so different to
those in the study that the
results cannot apply?
b. Is the treatment feasible in astha
my setting?
c. Will the potential benefits of willy

treatment outweigh the
potential harms of treatment for
my patient?
LECTURE 9
Learning Task Meta Analysis and Critical Appraisal
Lecturer Dr. I Wayan Losen Adnyana, Sp.PD
(KHOM)
SGD Group A8

Question Answer
-
Case
1. Jelaskan dayu
perbedaan
review,
sistematik
review dan
meta
analisis
2. Apabila Astha
ada
beberapa
meta
analisis
dengan
hasil
kesimpula
n yang
berbeda-
beda,
bagaimana
kita
memilih
meta-
analiss
mana yang
kita pakai?
LECTURE 10
Learning Task Evidance Based Case Report and Based on

Critical appraisal
Lecturer dr. Eka Gunawijaya, Sp.A(K)
SGD Group A8
Question Answer
-
Case
1. introduction bayu
2. clinical dayua
scenario of
the case
3. PICO of the Astha

clinical
problem(s)
4. Methods Willy
for tracking
evidence
5. Results of Devy
searching
medical
evidence
6. Discussion Anya
7. Conclusion Mercu
LECTURE 11
Learning Task Value Based Medicine and Critical Appraisal

SGD Group A8

Question Answer
-
Case
VALIDITY
1 Does the
report ask
about
economy in
service by
comparing
clear
alternatives?
2 Is the target
right?
(ministries,
hospitals,
health
centers, etc.)
3 Sufficiently
detailed assess the
costs and their
effects?
4 Same
effectiveness, lower
costs, cost
minimization
analysis
5 Assess the
effects of certain
financing, cost
effectiveness
analysis
6 Effects are
not the same,
and assessed
savings, cost
benefit
analysis
7 Assess quality and

long life / QALY,
cost utility analysis
IMPORTANCE
1. Does it
include clear
references in
diagnosis,
therapy,
practice
guidelines?
2. Does the report

contain the
things we ask?
3. Assessment
of the
importance
of evidence
4. Can the
alternatives
reduce costs
significantly
?
5. Does the evidence

not change much with
our different
circumstances?
APPLICABILITY
1. Is it suitable to be
applied to our
conditions?
2. If applied will give

same result?
3. In the cost
minimization analysis
is the difference
significant?
4. On cost benefit
analysis whether the
difference in clinical
effects is large
enough with the

same cost?
5. In cost
utility analysis how do
you compare it to the
present situation?
CHEERS
CHECKLIST
1.Identify the study

as an economic
evaluation or use
more specific terms
such as “cost-
effectiveness
analysis”, and
describe the
interventions
compared.
2. Provide a structured
summary of objectives,
perspective, setting,
methods (including
study design and
inputs), results
(including base case
and uncertainty
analyses), and
conclusions.
3. Provide an explicit
statement of the
broader context for
the study.
Present the study

question and its
relevance for health
policy or practice
decisions.
4. Describe
characteristics of the
base case population
and subgroups
analysed, including
why they were
chosen.
5. State relevant
aspects of the
system(s) in which the
decision(s) need(s) to
be made.
6. Describe the
perspective of the
study and relate this
to the costs being

evaluated
7. Describe the
interventions or
strategies being
compared and state

why they were
chosen
8. State the time

horizon(s) over
which costs and
consequences are
being evaluated and
say why appropriate
9. Report the choice of

discount rate(s) used
for costs and
outcomes and say why
appropriate.
10. Describe what
outcomes were used
as the measure(s) of
benefit in the
evaluation and their
relevance for the type
of analysis performed.
11a. Single study-

based estimates:
Describe fully the
design features of the
single effectiveness
study and why the
single study was a
sufficient source of
clinical effectiveness
data.
11b. Synthesis-based
estimates: Describe
fully the methods used
for identification of
included studies and
synthesis of clinical
effectiveness data.
12. If applicable,
describe the
population and
methods used to elicit
preferences for
outcomes.
13a. Single study-

based economic
evaluation: Describe
approaches used to
estimate resource use
associated with the
alternative
interventions.
Describe primary or
secondary research
methods for
valuing each resource
item in terms of its
unit cost. Describe
any adjustments
made to approximate
to opportunity costs.
13b. Model-based
economic evaluation:
Describe approaches
and data sources used
to estimate resource
use associated with
model health states.
Describe primary or
secondary research
methods for valuing
each resource item in
terms of its unit cost.
Describe any
adjustments made to
approximate to
opportunity costs.
14. Report the dates

of the estimated
resource quantities
and unit costs.
Describe methods for
adjusting estimated
unit costs to the year
of reported costs if
necessary. Describe
methods for converting
costs into a common
currency base and the
exchange rate.
15. Describe and give

reasons for the specific
type of decision-
analytical model used.
Providing a figure to
show model structure
is strongly
recommended.
16. Describe all

structural or other
assumptions
underpinning the
decision-analytical
model
17. Describe all

analytical methods
supporting the
evaluation. This could
include methods for
dealing with skewed,
missing, or censored
data; extrapolation
methods; methods for
pooling data;
approaches to validate
or make adjustments
(such as half cycle
corrections) to a
model; and methods
for handling population
heterogeneity and
uncertainty.
18. Report the values,

ranges, references,
and, if used,
probability
distributions for all
parameters. Report
reasons or sources for
distributions used to
represent uncertainty
where appropriate.
Providing a table to
show the input values
is strongly
recommended.
19. For each

intervention, report
mean values for the
main categories of
estimated costs and
outcomes of interest,
as well as mean
differences between
the comparator
groups. If applicable,
report incremental
cost-effectiveness
ratios.
20a. Single study-

based economic
evaluation: Describe
the effects of sampling
uncertainty for the
estimated incremental
cost and incremental
effectiveness
parameters, together
with the impact of
methodological
assumptions (such as
discount rate, study
perspective).
20b. Model-based
economic evaluation:
Describe the effects
on the results of
uncertainty for all
input parameters,
and uncertainty
related to the
structure of the
model and
assumptions
21. If applicable,
report differences in
costs, outcomes, or
cost-effectiveness that
can be explained by
variations between
subgroups of patients
with different baseline
characteristics or other
observed variability in
effects that are not
reducible by more
information.
22. Summarise key

study findings and
describe how they
support the
conclusions reached.
Discuss limitations and
the generalisability of
the findings and how
the findings fit with
current knowledge.
23. Describe how the

study was funded and
the role of the funder
in the identification,
design, conduct, and
reporting of the
analysis. Describe
other non- monetary
sources of support.
24. Describe any

potential for conflict of
interest of study
contributors in
accordance with
journal policy. In the
absence of a journal
policy, we recommend
authors comply with
International
Committee of Medical
Journal Editors
recommendations.
CHEC LIST
CHECKLIST
1. Is the study
population
clearly
described?
2. Are
compelling
alternatives
clearly
described?
3.Is a well-defined
research question
posed in answerable
form?
4. Is the
economic
study design
appropriate to
the stated
objective?
5.Is the
chosen time
horizon
appropriate in
order to
include
relevant costs
and
consequences?
6. Is the
actual
perspective
chosen
appropriate?
7. Are all important

and relevant costs for
each alternative
identified
8. Are all costs

measured
appropriately in
physical units
9. Are costs valued

appropriately?
10. Are all important

and relevant
outcomes for each
alternative identified?
11. Are all

outcomes
measured
appropriately
?
12. Are
outcomes
valued
appropriately
?
13 Is an
incremental
analysis of
costs and
outcomes of
alternatives
performed?
14.Are all
future costs
and outcomes
discounted
appropriately
?
15.Are all important

variables, whose
values are uncertain,
appropriately
subjected to
sensitivity analysis?
16. Do the
conclusions follow
from the data
reported?
17. Does the study

discuss the
generalizability of the
results to other
settings and
patient/client groups?
18 18. Does the

article
indicate that
there is no
potential
conflict of
interest of
study
researcher(s) and
funder(s)?
19. Are
ethical and
distributional
issues
discussed
appropriately
?
Learning Task Value Based Medicine and Critical Appraisal
SGD Group A8

Question Answer
Determine the type of analysis

Case from the excerpt.
Case 1
Case 2
Case 3
LECTURE 11 INTRAOPERATIVE NEUROPHYSIOLOGICAL MONITORING IN

SPINAL SURGERIES
Learning Task Value Based Medicine and Critical

Appraisal
SGD Group A8
Members Gede Bayu Wedanta Netra (1702511156)
Ida Ayu Putu Putri Andari (1702511166)

Question Answer
Case -
VALIDITY
1 Does the report ask wulan

about economy in
service by
comparing clear
alternatives?
reza
Is the target right?
(ministries, hospitals, health
centers, etc.)
Yes, karena dari intraoperative neurophysiological

3 Sufficiently detailed monitoting (IOM) pada spinal surgeries ini menghemat
assess the costs and their biaya 2,3 juta dolar.
effects?
yunia
4 Same effectiveness,
lower costs, cost
5 Assess the effects of garbin

certain financing, cost
effectiveness analysis
6 Effects are not the bayu

same, and assessed
savings, cost benefit
analysis
Cost utility yang sesuai dapat meningkatkan quality of
7 Assess quality and long life. Pada jurnal disebutkan untuk orang muda biaya
life / QALY, cost utility spinal cord IOM dapat menghemat biaya operasi
analysis keseluruhan 0,5% dan dapat meningkatan kualitas
hidup. Spinal cord IOM dapat mencegah terjadinya
paraplegia berkelanjutan, pembiayaan medis
berkelanjutan, dan hilangnya kehidupan sosial
mereka (dijelaskan pada bagian pendahuluan jurnal)
IMPORTANCE
astha
1. Does it include clear
references in diagnosis,
therapy, practice guidelines?
willy
2. Does the report contain
the things we ask?
3. Assessment of the devy

importance of evidence
4. Can the alternatives reduce anya

costs significantly?
Tidak banyak berubah pada keadaan pada masa ini. Saat ini
memang sudah banyak rumah sakit tipe A yang memiliki
5. Does the evidence not IOM sebagai alat bantu dalam memonitoring operasi tulang
change much with our belakang. Tapi, jika pada daerah yang masih belum
different circumstances? berkembang, tentunya bukti ilmiah ini banyak berubah
sehingga tidak importance.

APPLICABILITY

1. Is it suitable to be wulan
applied to our conditions?
2. If applied will give reza

same result?
dea
3. In the cost
minimization analysis is
the difference significant?
4. On cost benefit yunia

analysis whether the
difference in clinical
effects is large
enough with the same cost?
garbin
5. In cost utility
analysis how do you
compare it to the present
situation?
LECTURE 11 ALTERNATIVE SMOKING CESSATION IN SPAIN
Learning Task Value Based Medicine

and Critical Appraisal
Lecturer Dr. dr. Dyah Kanya Wati,
Sp.A(K)
SGD Group A8
Members Gede Bayu Wedanta Netra

(1702511156)
Ida Ayu Putu Putri Andari

(1702511166)
I Gde Astha Pramana Suta

(1702511176)
I Putu Willy Ganang Arta Putra

(1702511186)
Putu Mahadevy Pradnyandhari Putri

(1702511216)
Kadek Mercu Narapati Pamungkas

(1702511017)
Ni Nyoman Sriwulan Pratiwi

(1702511027)
Ni Made Dea Adilla Rathasari

(1702511097)
Question Answer
Case -
VALIDITY
1 Does the report ask about economy in bayu
service by comparing clear alternatives?
dayu
Is the target right? (ministries, hospitals, health

centers, etc.)
astha
3 Sufficiently detailed assess the costs and
their effects?
willy
4 Same effectiveness, lower costs, cost
5 Assess the effects of certain financing, devy

cost effectiveness analysis
6 Effects are not the same, and assessed anya

savings, cost benefit analysis
mercu
7 Assess quality and long life / QALY, cost
utility analysis
IMPORTANCE
wulan
1. Does it include clear references in diagnosis,
reza
2. Does the report contain the things we ask?
3. Assessment of the importance of evidence dea
4. Can the alternatives reduce costs significantly? yunia
garbin
5. Does the evidence not change much with

our different circumstances?
APPLICABILITY
1. Is it suitable to be applied to our bayu

conditions?
2. If applied will give same result? dayu
astha
3. In the cost minimization analysis is the

difference significant?

4. On cost benefit analysis whether the willy
difference in clinical effects is large
devy
5. In cost utility analysis how do you

compare it to the present situation?
LECTURE 11 IN THE INDIAN SUBCONTINENT FOR TREATMENT GBS

PATIENTS WITH THERAPUETIC PLASMA EXCHANGE AS COMPARED TO
INTRAVENOUS IMMUNOGLOBULIN
Learning Task Value Based Medicine

and Critical Appraisal
Lecturer Dr. dr. Dyah Kanya Wati,

Sp.A(K)
SGD Group A8
Members Gede Bayu Wedanta Netra
(1702511156)
Ida Ayu Putu Putri Andari

(1702511166)
I Gde Astha Pramana Suta

(1702511176)
I Putu Willy Ganang Arta Putra

(1702511186)
Putu Mahadevy Pradnyandhari Putri

(1702511216)
Kadek Mercu Narapati Pamungkas

(1702511017)
Ni Nyoman Sriwulan Pratiwi

(1702511027)
Ni Made Dea Adilla Rathasari

(1702511097)
Question Answer
Case -
VALIDITY
1 Does the report ask about economy in anya

service by comparing clear alternatives?
mercu
Is the target right? (ministries, hospitals, health

centers, etc.)
wulan
3 Sufficiently detailed assess the costs and
their effects?
reza
4 Same effectiveness, lower costs, cost
5 Assess the effects of certain financing, dea

cost effectiveness analysis
6 Effects are not the same, and assessed yunia

savings, cost benefit analysis
garbin
7 Assess quality and long life / QALY, cost
utility analysis
IMPORTANCE
bayu
1. Does it include clear references in diagnosis,
dayu
2. Does the report contain the things we ask?
3. Assessment of the importance of evidence astha

4. Can the alternatives reduce costs significantly? willy
devy
5. Does the evidence not change much with

our different circumstances?
APPLICABILITY
1. Is it suitable to be applied to our anya

conditions?
2. If applied will give same result? mercu
wulan
3. In the cost minimization analysis is the

difference significant?

4. On cost benefit analysis whether the reza
difference in clinical effects is large
dea
5. In cost utility analysis how do you

compare it to the present situation?

An Introduction To Evidence-Based Medical Practise: Dr. Dr. Dyah Kanya Wati, Sp.A (K)

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An Introduction To Evidence-Based Medical Practise: Dr. Dr. Dyah Kanya Wati, Sp.A (K)

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Learning Task

An Introduction to Evidence- Based

Lecturer Dr. dr. Dyah Kanya Wati, Sp.A(K)

Gede Bayu Wedanta Netra (1702511156)

1. Comprehend above anya

2. Make clinical mercu

4. Procure 3 related reza

5. Appraise and select one dea

6. Apply whenever you yunia

Learning Task Problems identifications with clinical questions

Lecturer Dr. dr. Dewi Sutriani Mahalini, Sp.A

A 40 years old man who work as a teacher in department of Agriculture, had

Learning Task Apply evidence based medicine to search article and

Lecturer Prof. Dr. dr. I Putu Gede Adiatmika, M.Kes

Gede Bayu Wedanta Netra (1702511156)

2. Explain the willy

Learning Task Association, Causation and Critical

Lecturer Dr. dr. I.B. Subanada, Sp.A(K)

Gede Bayu Wedanta Netra (1702511156)

2. What are the anya

Lecturer dr. Eka Gunawijaya, Sp.A(K)

Gede Bayu Wedanta Netra (1702511156)

Is this evidence about prognosis valid?

Case 2 Is this valid evidence about prognosis important?

Was a defined, representative sample of mercu

Was patient follow-up sufficiently long and wulan

Were objective outcome criteria applied in a reza

If subgroups with different prognoses are

• Was there validation in an independent

How likely are the outcomes over time? yunia

How precise are the prognostic estimates? garbin

IF YOU WANT TO CALCULATE A CONFIDENCE INTERVAL AROUND THE MEASURE OF

Clinical measure Standard error (SE) Typical calculation of CI

Proportion (as in the rate of If p=24/60=0.4 (or 40%) and

p=the proportion of these =0.063 (or 6.3%)

n from your evidence:___ dayu Your calculation:

Do the results apply to our patient?

Is our patient so different from those in the willy

Will this evidence make a clinically devy

Methodological, statistical principles, application in

Lecturer Dr. dr. Lanang Sidiartha, Sp.A(K)

Gede Bayu Wedanta Netra (1702511156)

Case Researcher wants to study effectiveness of probiotic as additional treatment of acute

Gender, boys, n(%) 24 (48) 25 (50)

girls, n(%) 26 (52) 25 (50)

Age (month), mean (SD) 24 (1,5) 25 (1,4)

Nutritional status, n (%)

Obese 0 (0) 1 (2)

Normal 30 (60) 32 (64)

Malnourished 20 (40) 17 (34)

Body temperature, oC 37,5 (36,1-39,5) 37,8 (36,5-39,4)

Length of stay (days), mean(SD) 3,5 (0,2) 5,5 (0,3)

Learning Effect size, Hypothesis Testing and Confidence

Lecturer Dr. dr. I.B. Subanada, Sp.A(K)

Gede Bayu Wedanta Netra (1702511156)

Table 1. Characteristic of subject

Variable Symbiotic (n=399) Placebo

Gender, boys, n(%) 214 (53.6) 216 (55.0)

Girls, n(%) 185 (46.4) 177 (45.0)