INTROEK-EBM 2015_@ - Copy

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    Curriculum Vitae

    Name: Joewono Soeroso MD, MSc PhD, Internist-Rheumatologist-ClinicalEpiemiologist

    D!" : Purwo#erto $ Jul% $&'(

    Eucations:

    ) MD: Diponegoro *ni+ersit% $&

    ) Internist: irlangga *n+ersit% $&./

    ) MSc 0Clinical-Epiemiologi 1 E+ience "ase Meicine2: College o3Meicine *ni+4 o3 5he Philippines Manila $&&'

    ) Rheumatologist: $&&&

    ) 6re 7utchinson Research Center, Seattle 8((8) PhD: irlangga *n+ersit% 8((9

    ) " irlangga *n+ersit% 8($9

    5eaching Sa33 at 6; *nair $&&$- now

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    INTRODUKSI

    EVIDENCE BASED MEDICINEJoewono SoerosoUnit Epidemiologi Klinis FK Unir

    S!"#Bgin Re!mtologi#$"#SMF I% &en'(it DlmFK Unir#RSUD Dr% S!tomo

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    Subject Tutor

    1. Intro & Basics of EBM Prof. Dr. Joewono Soeroso dr. MSc, SpPD!"

    #. $%erap & 'arm J. E(o )a%ono "a%ard*o dr M.!es.,SpS+!

    -. Pronosis & Metaanalsis 'eru Purwanto dr M.!es., SpB/n(

    0. 'ow to ind Current BestE2idence +t%eor & practice

    Dr. 3nan Endaranto dr. Sp3+!

    4. Critical 3ppraisal 3rticle on

    $%erap +t%eor & practice

    Dr. Cita "osita SP dr. Sp!!+!

    5. 6$S Critical 3ppraisal Paper 7 Screenin, "is(actor, Dianosis, $%erap +8roups

    9. 63S Indi2idual

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    )A*t lo*l

    )T+in( glo"l

    ) Do not +esitte

    ) Do , do nd do%

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    B3SIS D3"I EBM

    : Metode Penelitian

    : Epidemioloi

    : Biostatisti(a

    : E(onomi (linis

    : Ilmu sosial

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    Implementation of the best evidenceImplementation of the best evidenceobtained from clinical research toobtained from clinical research to

    clinical practiceclinical practice

    What is EBM?What is EBM?

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    Other Names of EBMOther Names of EBM

    Clinical epidemioloClinical epidemiolo +einstein, 1;94, Sac(ett 1;

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    /=*ecti2e of EBM

    : $o efficientl impro2in patients> %ealt%$o efficientl impro2in patients> %ealt%

    : $o (eep up to date$o (eep up to date: $o en%ance ?ualit researc%$o en%ance ?ualit researc%+Sac(ett 1;;1, Di@on, 1;;9 Sac(ett 1;;;+Sac(ett 1;;1, Di@on, 1;;9 Sac(ett 1;;;,8lasAiou #9,8lasAiou #9

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    EBM is a =ottomup approac%, not aEBM is a =ottomup approac%, not a

    coo(=oo( approac%coo(=oo( approac%

    E@ternal e2idence can inform, =ut ne2erE@ternal e2idence can inform, =ut ne2er

    replace clinical e@pertisereplace clinical e@pertise +Sac(ett et al, 1;;;+Sac(ett et al, 1;;;

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    Reser*+

    Better -!lit' o.$i.e

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    /+t is in t+e rel world0

    *!red

    not *!red

    A new nti"ioti* .or t+e tretment t'p+oid .e1er

    Does t+is nti"ioti* wor( well0

    ptient 2 ptient 3 ptient 4 ptient 5 ptient 6

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    /+t is in t+e rel world0

    7ood res!lts p!"lis+ed

    &oor res!ltsnot p!"lis+ed

    &!"li*tion Bis

    Reser*+ 2 Reser*+ 6Reser*+ 5Reser*+ 4Reser*+ 3

    A8R- 59: medi*l reser*+were not p!"lis+ed

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    /+t is in t+e rel world0

    T+e *se o. gstri* .ree;ing m*+ine

    ) In t+e s? 36== gstri* .ree;ing

    m*+ines .or tretment o. gstri* "leeding

    were sold

    ) Until rndomi;ed tril s+owed t+is

    m*+ine ws not "etter t+n *on1entionl

    tretment

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    1lid onl' @:

    ) Reid JAMA 1995; 274: 651 24== reser*+rti*les on **!r*' o. dignosti* tools .rom

    !rinedipsti*( to MRI nd CT s*n

    /+t is in t+e rel world0

    ) Co+rne Coll"ortion 2@ 2@?=== st!dies on t o. mild +'pertension 1lid onl' 33 st!dies

    ) 8'nes An Intern Med 1986; 309 :105 9== reser*+ rti*les in 5 .mo!s Go!rnls 1lid onl' 2:

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    Epidemiolog't+e st!d' o. t+e distri"!tion nd

    determinnts o. +elt+ relted

    e1ents? nd t+e ppli*tion o. t+is

    st!d' to *ontrol +elt+ pro"lems

    $st? 299

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    Mening(t(n eHsiensi dignosis? terpidn prognosisTetp mengi(!ti per(em"ngnI&TEKDOKMening(t(n (!ntits dn (!litspenelitin

    T!G!n

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    biologic onset

    (patobiology)

    Prognostic

    FactorsDiagnostic

    test

    +Dx

    early diagnosis

    possible

    usual clinical

    diagnosis sembuhkomplikasi

    cacadmatiRisk factors

    (Causation)Screening

    Clinical Trials

    Preention !

    area penelitian

    "Clinical Trials

    T#erapyClinical Trials

    Preention !!

    Diagnostic

    test

    $nd Points

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    ) C!stion

    ) S*reening

    ) Dignosis

    )T+erp') &rognosis

    ) -!lit' o. Cre Clini*l!diting

    ) E*onomi* Anl'sis

    Criti*l Apprissl

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    original articlesoriginal articles(we dont know the !alit" "et#(we dont know the !alit" "et#

    $alid evidence$alid evidence

    critical appraisalcritical appraisal

    Implement to patientsImplement to patients ((%&' & ' )r%&' & ' )r

    EEvidence based g!idelines ()vidence based g!idelines ()edomanedoman %%iagnosis *iagnosis * erapierapi##

    evidence based consens!sevidence based consens!s

    +linical e&pertise+linical e&pertise

    ,cience,cience-.ogics.ogics-/nowledge/nowledge-E&perienceE&perience

    +linical e&pertise+linical e&pertise

    0rt0rt-BeliefsBeliefs-1!dgments1!dgments-Int!itionInt!ition

    ,!mmar",!mmar"of EBMof EBM

    2!antitative methods2!antitative methods

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    CONTO8 &ENERA&ANEFISIENSI DIA7NOSIS

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    ) t(% Be*(? 4= t+

    ) le!(emi (!t

    ) trom"osit 6%===mm4

    ) Sepsis (md tim"!l

    (omdn lterlissi

    )&erl! CTS*n0

    St!di Ks!s

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    ) pri 53 t+!n

    ) splenomegli#sites

    ) "ili totl 3%6 mg:

    ) l"!min 2%9 mg:

    glo"!lin 5%< mg:

    )&erl!US70

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    &i!tng RSUD Dr% Soetomo

    ) 2%6 M t+ se"el!m (rismon

    ) 33 : pi!tng tes pen!nGng

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    Metode nili predi(ti.

    )nmnesis pem% Hsis cermat) t+! sensiti1its Sn dn spesiHsits

    Sp

    tes D ter+dp gold standard) pengol+n dlm tabel 2 x 2

    K!ntiH(si Dignosis

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    ) pri 66 t+? n'eri dd (iri? menGlr

    ) mero(o( 3 p( +ri

    ) T 29=22=? gllop

    ) (olesterol 469 mg:

    ) pro""ilits prtes menderit &JK

    )&erl! tredmill000

    Ks!s I

    (90%)

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    %!&'! PR$D!T!F

    dari T$S D!'%*ST!Positie predictie alue

    Probabilitas untuk enderita suatu

    penyakit,ika#asil tes positif

    %egatie predictie alue

    Probabilitas untuk tidak enderita

    suatu penyakit,ika#asil tes negatif

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    asus!

    tredil

    P-(angiografi koroner . gold standard)

    prob/ pascates+

    +

    0

    0

    540

    1000

    360

    9

    91

    549

    451

    123

    00000

    124

    .

    probab (prates) P- (pascates)

    +8%98%

    98%

    900 100

    Sn tredil 536dan Sp tredil 476

    90%

    47

    00000

    217

    21%

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    ) pri 46 t+? n'eri epigstri!m

    ) tid( mero(o(

    ) T 23=9= Hsi( d%"%n%) l" norml

    ) pro""ilits prtes menderit &JK

    Kasus II

    ( 5 %)

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    KasusII

    tredmil

    PJK(angiografi oroner!

    "ro#$ "asates+

    +

    0

    0

    30

    1000

    20

    86

    864

    116 30&116

    884 864&884 ' 98% + 48%

    '

    "ro#a# ("rates! PJK ("asates!

    +21%' 26%

    26%

    50 950

    Sn tredil 536dan Sp tredil 476

    5 %

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    ) pri 56 t+? n'eri dd (iri#tid( (+s

    ) mero(o( 2 p( +ri

    ) T 23=9=) l" norml

    ) pro""ilits prtes &JK

    Kasus III

    ( 50%)

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    KasusIII

    tredmil

    PJK(angiografi oroner!

    "ro#$ "asates+

    +

    0

    0

    300

    1000

    200

    45

    455

    345 300&345

    655 455&655 ' 85 % + 35%

    '

    "ro#a# ("rates! PJK ("asates!

    +3)%' 8)%

    8)%

    500 500

    Sn tredil 536dan Sp tredil 476

    50%

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    ) Ks!s I pro""ilits menderit &JK

    dri =: (e 9:? tid( perl! tredmil

    ) Ks!s IIpro""ilits menderit &JK

    dri 6: (e 3@:? tid( perl! tredmil

    ) Ks!s III pro""ilits mender!t &JK

    dri6=: (e 9< :?

    Kesimp!ln

    &redi*ti1e Vl!e Met+od

    perl!tredmil

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    tredil 8 Rp 733/3339

    asus ! : tidak perlu tredil9 langsung tx

    asus !!: Rp 733/333 ; 7333

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    T#res#old >odel

    of Pauker ? assirer

    1

    DONT TEST

    DONT TREAT

    TEST & TREAT IF

    THE RESULT POSITIVE TREATTREAT

    PRETEST PROBABILITY

    #4 54

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    )8n' (s!s 'ng

    'ng memerl!(n tes dignosti(

    meragukan

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    Pitono Soeparto et al Epiemiologi ;linis4 Seri rami# 6; *nair $&&.

    Sac#ett D: