Tugas

EVIDENCED BASED LEARNING

Oleh:

Deo Rafael Asnawie, S.Ked 04084821820035

M. Ananda Triansyah Putra. S.Ked 04084841820002

M Andika Ginting 04084841820006

Pembimbing:

dr. Achmad Ridwan, MO, M.Sc

BAGIAN ILMU KESEHATAN MASYARAKAT

ILMU KEDOKTERAN KOMUNITAS

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA

2019
Scenario
You are a general practitioner working in a primary health care team who
frequently sees older patients reporting memory loss and concerned about the onset
of dementia. You routinely use the Mini Mental State Examination (MMSE)
screening tool with these patients to evaluate their cognitive function as you know
this tool to be sensitive, valid and reliable. Recently, you have heard of a tool called
the Mini-Cog which is considered quicker to administer and better for patients who
are older, less educated, or from culturally and linguistically diverse (CALD)
communities. You wish to find out if the Mini-Cog test is as accurate as the MMSE
in detecting Alzheimer’s disease or dementia.

A. Clinical Problem
1) Population
Older patients reporting memory loss and concerned about the onset of
dementia.
2) Intervention
Using MMSE and Mini-Cog to evaluate cognitive functions.
3) Comparison
Mini-Cog test compared to MMSE in detecting Alzheimer’s disease or
dementia.
4) Outcome
Mini-Cog is as accurate as MMSE in detecting Alzheimer’s disease or
dementia.

B. Answerable Question
Is Mini-Cog as accurate as MMSE in detecting Alzheimer’s disease or
dementia?

C. Search Key
 (Mini-Cog vs MMSE) AND (detecting Alzheimer’s disease or dementia) AND
(cognitive impairment).
D. Abstract Article

E. Critical Appraisal
CRITICAL APPRAISAL THERAPY STUDY (Randomized Controlled Trial)
VALIDITY: Are the results of the trial valid? (Internal Validity)
Yang dinilai FRISBEC
F: Patient Follow-Up Ya
 Were all patients who entered
the trial properly accounted
for at its conclusion? Losses to
follow-up should be less than
20% and reasons for drop-out
given.
 Was follow-up long enough?

R: Randomization Tidak
 Were the recruited patients
representative of the target
population?
 Was the allocation
(assignment) of patients to
treatment randomized and
concealed?
I: Intention to Treat Analysis Ya
 Were patients analyzed in the
groups to which they were
randomized?
  Were all randomized patient
data analyzed? If not, was a
sensitivity or “worst case
scenario” analysis done?
S: Similar Baseline Characteristics of Ya
Patients
 Were groups similar at the
start of the trial?
B: Blinding Monoblinding
 Were patients, health
workers, and study personnel
“blind” to treatment?
 If blinding was impossible,
were blinded
raters and/or objective
outcome measures used?
E: Equal Treatment Ya
 Aside from the experimental
intervention, were the groups
treated equally?
Conflict of Interest Tidak
 Are the sources of support
and other potential conflicts
of interest acknowledged and
addressed?
Summary of Article’s Validity Penelitian ini valid, namun sampel
 Notable study strengths or tidak random dan tidak representatif.
weaknesses or concerns?
 How serious are the threats to
validity and in what direction
could they bias the study
outcomes?
IMPORTANCY (What were the results?)
Yang dinilai/dihitung
CER 0,810
EER 0,840
RR 1,037
RRR/RRI 0,0374
ARR/ARI 0,0303
NNT 33
C. APPLICABILIITY
Will the results help me in caring for my patient? (External Validity/
Applicability)
Is my patient so different to those in Tidak
the study that the result cannot
apply?
Is the treatment feasible in my Ya
setting?
Will the potential benefits of Ya
treatment outweigh the potential
harms of treatment for my patient?