Evidence Based Medicine

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  KELOMPOK : 1.   AHMAD SYAIFUL FAESAL 2.   RINAIMAH ZAHRA 3.   ANDI ZUHRA 4.   CITRA DEWILIAH EVIDENCE BASED MEDICINE Report : Simulated Clinical Problem A.   General Appraisal 1. Judul : Short Report: Automated Detection of Malaria-Associated Pseudoeosinophilia and Abnormal WBC Scattergram by the Sysmex XE-2100 Hematology Analyzer: A Clinical Study with 1,801 Patients and Real-Time Quantitative PCR Analysis in Vivax Malaria-Endemic Area 2. Pengarang : Jong-Ha Yoo, Jaewoo Song, Kyung-A Lee, Young-Kyu Sun, Young-Ah Kim, Tae Sung Park, Jong Rak Choi 3. Penerbit : The American Society of Trophical Medicine and Hygiene 4. Tahun : 2010 B.   Critical Appraisal 1.   Citation    Short Report: Automated Detection of Malaria-Associated Pseudoeosinophilia and Abnormal WBC Scattergram by the Sysmex XE-2100 Hematology Analyzer: A Clinical Study with 1,801 Patients and Real-Time Quantitative PCR Analysis in Vivax Malaria-Endemic Area 2.   Validitas Studi Diagnosis  Apakah terdapat variabel independen, perbandingan buta terhadap gold standar dari diagnosis? Ya, terdapat variabel independen berupa diagnosis penyakit malaria Dengan menggunakan gold standar berupa  pemeriksaan apusan darah (pemeiksaan mikroskopik) Apakah evaluasi tes diagnosis sesuai dengan spektrum pasien? Ya, pasien yang diteliti adalah 1801 pasien  pada daerah endemik malaria Apakah standar referensi yang digunakan sesuai dengan hasil diagnosis? Ya, Studinya sudah direview dan disetujui oleh Research Ethics Board of the National Health Insurance Corporation at Ilsan Hospital. Apakah tes yang digunakan valid, terdapat grup independen pasien? Ya Ya, terdapat grup pasien malaria sebanyak 413 (276 laki-laki dan 137 wanita)  3.   Sample Calculation  Pemeriksaan apusan darah (Gold Standar) Total Positif Negatif WBC Scattergrams Positif 65 4 69  Negatif 348 1384 1732 Total 413 1388 1801 a.   Sensitivitas = a/(a+c) = 65/(65+348) = 15.7%  b.   Spesifitas = d/(b+d) = 1384/(1384+4) = 99.7% c.   LR + = Sensitivitas/(1-spesifitas) = 15.7% / (1-99.7%) = 52.33 d.   LR - = (1-sensitivitas) / spesifitas = (1-15.7%) / 99.7% = 0.84 e.   PPV = a/(a+b) = 65/(65+4) = 94.2% f.   MPV = d/(c+d) = 1384/(348+1384) = 79.9% g.   Pre-rest probability (Prevalence) = (a+c) / (a+b+c+d) = (413) / (1801) = 22.9% h.   Pre-test odds = prevalence/(1-prevalence) = 22.9% / 77.1% = 0.29 i.   Post-test odds = Pre-test odds x LR+ = 0.29 x 52.33 = 15.17  j.   Post-test probability = Post-test odds/(Post-test odds + 1) = 15.17 / 16.17 = 0.93
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