EBM Guidleine for Causation.pptx

7/29/2019 EBM Guidleine for Causation.pptx

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EBM Guidleine for Causation

Hamsu Kadriyan


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Tabel 1. Users Guide for article about Harm

Are the result study valid ?

Primary guides:

Were there clearly identified comparison groups that were similar with respect toimportant determinants of outcome, other than the one of interest ?

Were the outcomes and exposures measured in the same way in the groups being

compared ?

Was follow- up sufficiently long and complete ?

Secondary guides:

Is the temporal relationship correct ?Is there a dose-response gradient ?

What are the resul ?

How strong is the association between exposure and outcome ?

How precise is the estimate risk ?

Will the results help me in caring for my patients ?

Are the results applicable to my practice ?

What is the magnitude of the risk ?

Should I attempt to stop the exposure ?


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Are the results of the study valid ?

Primary guides:Were there clearly identified comparison groups that were

similarwith respect to important determinants of outcome,

other than the one of interest ?

pemilihan grup pembanding:

- berpengaruh terhadap kredibilitas hasil

dinilai berdasarkan al: design studi yang dipakai


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Tabel 2. Directions of inquiry and key methodologic strengths and weakness

for different study design

Design Starting point Assessment Strength Weaknesses

RCT exposure status adverse event status internal validity feasibility,

generalizability

Cohort exposure status adverse event status feasibility when susceptibility to

randomization threats to interal

of exposure not validity

possible

Case adverse event exposure status overcomes tem- susceptibility to

control status poral delays, threats to inter-

may only require nal validity

small sample

size


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Were the exposures & outcomes measured inthe same way in the group being compared ?

- pada CCs exposure: terpenting

- blinding subyek & interviewer: minimisasi bias

- kesempatan exposure: sama

- pada RCT & Cohort, outcome: terpenting


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Was follow-up sufficiently long & complete ?

Follow-up harus adekuat

Follow-up:

- hilang : validitas hasil menurun

- makin lama : sampel DO makin besar


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SECONDARY GUIDE

Is the temporal relationship correct ?

Exposure terhadap faktor kausal mendahului outcome

contoh:

- hubungan kasus bunuh diri dan obat antidepresi:

- bunuh diri pasca pemakaian obat ?

- menggunakan obat oleh karena gejala psikis

memburuk ?


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Is there a dose response gradient ?

Kuantitas/durasi exposure terhadap kausal tinggi:

risiko outcome meningkat

contoh:- risiko kematian Ca paru pria perokok meningkat

- 50% : 14 batang/hari

- 132%: 15-24 batang/hari

- 220%: 25 batang/hari


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What are the result ?

How strong is the association between

exposure & outcome ?

1. Risiko relatif (: cohort study):

- risiko/insidensi efek pada grup exposed dibagi

risiko efek dalam grup non exposed- nilai RR > 1: peningkatan risiko

- nilai RR < 1: penurunan risiko

contoh: 23/289 pria hipertensi (HT) meninggal

dibanding 3/185 non HT

RR pria HT: 4,9 dibanding non HT


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How precise is the estimate of the risk ?

- evaluasi ketepatan estimasi: confidence interval

- berdasar artikel-artikel tentang risiko


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What are the implications for my practice ?

Are the results applicable to my practice ?

Jika hasil valid extrapolasi: pasien/bidang kita Pasien/sampel kita similar ?

Ada beda penting ?

Contoh: - peningkatan Ca uteri pada pemakai hormon

estrogen pasca menstruasi


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What is the magnitude of the risk ?

RR atau OR: efek terjadi > atau

EBM Guidleine for Causation.pptx

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