Laporan Skill Lab EBM

Disusun Oleh :

dr. Riris Putri Marito Sinaga

NIM : 04022722125001

DEPARTEMEN ILMU KESEHATAN ANAK

FAKULTAS KEDOKTERAN UNIVERSITAS SRIWIJAYA

RSUP DR. MUHAMMAD HOESIN PALEMBANG

2021
 SOAL SKIL LAB EBM 2021 PPDS1

1. Dalam file excel tersedia DATA abnormalitas. Data abnormallitas tersebut terdiri dari
variabel SGOT/SGPT laki-laki, hemoglobin, trigliserid, total kolesterol, HDL dan
LDL. Hitunglah nilai abnormalitas dari data yang tersedia.
1.1. Hitunglah harga rerata
1.2.Hitunglah standar deviasi

Descriptive Statistics

N Minimum Maximum Mean Std. Deviation

SGOT/SGPT Laki-laki 200 1 49 26,29 13,923

Hemoglobin 200 12,0 13,0 12,472 ,3238
Trigliserid 200 81 148 115,30 20,047
Total Kolestrol 200 80 199 137,23 32,405
HDL 200 61 119 89,44 17,119
LDL 200 50 98 74,64 13,634
Valid N (listwise) 200

  N Minimum Maximum Mean Std. Nilai

Deviation
SGOT/SGPT 200 1 49 26,29 13,923 54,13638
Laki-laki

Hemoglobin 200 12,0 13,0 12,472 ,3238 11,82442

Trigliserid 200 81 148 115,31 20,047 155,4

Total 200 80 199 137,24 32,405 202,0458
Kolestrol
HDL 200 61 119 89,44 17,119 55,20132
LDL 200 50 98 74,64 13,634 101,9083
Valid N 200        
(listwise)

2. Rapid breathing is an important clinical manifestation of illness in a young infant.

Acute Respiratory Infection especially pneumonia often delay referring to the
hospital, especially in a 2-month infant. At a primary health care facility or a crowded
paediatric emergency room, respiratory rate counted for one complete minute has
been found to be useful in assessing the severity of respiratory infection in infants
under 2 months. A respiratory rate of > 60 breaths/ min is used as a predictor of
pneumonia in the case management guidelines of the World Health Organisation’s
acute respiratory infection control programmes globally. However, very little data
on the usefulness of respiratory rate as an indicator of hypoxia and risk of
 mortality in illnesses other than pneumonia are available.A gold standard for
diagnosing hypoxia is oximetry but this is expensive.

2.1. Buatlah Tabel P.I.C.O

P 2 month infant with Pneumonia
I Respiratory Rate Examination
C Oxymetry
O as an indicator of hypoxia and risk of
mortality in pneumonia

2.2. Buatlah Clinical Question

Clinical Question:
Is respiratory rate examination in infants with pneumonia effective as an indicator
of hypoxia and risk of mortality in pneumonia?

2.3. Buatlah Search Term/Search/Keyword

1. Search  Infants or children with pneumonia
2. Search (infant OR Children with pneumonia) AND Respiratory rate examination
3. Search  (infant OR Children with pneumonia) AND Respiratory rate examination AND
Oxymetry
4. Search   (infant OR Children with pneumonia) AND Respiratory rate examination AND
Oxymetry AND hypoxia

2.4. Lakukan Searching

 Pencarian dilakukan dengan menggunakan situs www.pubmed.gov
a. Search  Infants or children with pneumonia

b. Search  (infant OR Children with pneumonia) AND Respiratory rate examination

c. Search  (infant OR Children with pneumonia) AND Respiratory rate examination AND
Oxymetry
d. Search  Search   (infant OR Children with pneumonia) AND Respiratory rate
examination AND Oxymetry AND hypoxia
2.5. Pastekan Abstract Artikel yang didapat pada lembar Jawaban
Pediatr Infect Dis J. 2012 Aug;31(8):863-5.

 doi: 10.1097/INF.0b013e318257f8ec.

Frequency and trajectory of abnormalities in respiratory rate,

temperature and oxygen saturation in severe pneumonia in
children
Rasa Izadnegahdar 1, Matthew P Fox, Donald M Thea, Shamim A Qazi, Pneumonia Studies Group

Affiliations expand

 PMID: 22531236

 PMCID: PMC3399926

 DOI: 10.1097/INF.0b013e318257f8ec

Free PMC article

Abstract

The frequency or trajectory of vital sign abnormalities in children with pneumonia

has not been described. In a cohort of 2714 patients with severe pneumonia
identified and treated as per the World Health Organization definition and
recommendations, tachypnea, fever and hypoxia were found in 68.9%, 23.6% and
15.5% of children, respectively. Median oxygen saturation returned to a normal range
by 10 hours following initiation of treatment, followed by temperature at 12 hours
and respiratory rate at 22 hours for subjects <12 months and at 48 hours for those ≥
12 months of age.

2.1. Lakukan Critical Appraisal dari Artikel dengan critical appraisal worksheet
No Questions Answers

1. What is the research we set out to demonstrate the ranges of

question and/or hypothesis?
2. What is the study type?
abnormalities seen in respiratory rate,
temperature and oxygen saturation in a
population of children with
severe pneumonia.
This study is an observational cohort study using a

3. What is the reference
population ? What are the
sampling frame and
sampling method ?
4. In an experimental study,
how are subjects assigned to
group ? In a longitudinal
study how many reached
final follow up ?
5. What are the study factors
and how are they measured?
6. What are the outcome
factors and how are they
measured ?
7. What important potential
confounders are
considered ?
8. Are statistical tests
considered ?
pooled, individual level data set from 2714 subjects
enrolled in 2 randomized clinical trials of therapeutic
interventions for severe pneumonia
Seventy-nine mothers tested for SARS-
CoV-2 were included, out of which 18.98%
of mothers tested SARS-CoV-2 positive
 Subjects were recruited from 16 sites
within 8 countries: Colombia, Ghana, India,
Mexico, Pakistan, South Africa, Vietnam
and Zambia. Recruitment spanned from
May 1999 to May 2002 for the first study
and February 2005 to August 2006 for the
second study. Both trials recruited patients
aged 2–59 months with WHO-defined
severe pneumonia from pediatric referral
hospitals and used standardized clinical
methods which were intentionally similar.
respiratory rate, axillary temperature and
oxygen saturation over time and present
them with a distribution plot identifying the
5th, 25th, 75th and 95th percentiles.
Analyses were limited to children with the
condition at baseline (eg, temperature
measurements limited to those with fever
at baseline). Children were stratified by
whether or not they had the outcome of
interest (eg, tachypnea, fever, low oxygen
saturation) to assess when median results
fell within normal ranges.
Among the 3 investigated vital sign
abnormalities, oxygen saturation was the first
to correct from the abnormal range, despite
median values not returning to expected norms
of 97%–100% within the 48 hour follow-up.
Although the WHO definition of
severe pneumonia does not rely on the
presence of tachypnea, we found that the
majority of subjects (68.9%) were
tachypneic on enrollment. Significantly
smaller proportions, however, presented
with fever (23.6%) or hypoxia (15.5%),
2 vital signs that commonly increase the
clinical suspicion of pneumonia and have
been shown to contribute to specificity of
the diagnosis when a radiographic infiltrate
is taken as the standard
Yes, They are.
9. Are the results clinically / Yes, They are
socially important?

10 What conclusions did the fever and hypoxia in response

authors reach about the
research question ? Did they
generate new hypotheses ?
Do you agree with the
conclusions ?
to pneumonia can both increase the respiratory
drive and lead to tachypnea. Conversely,
resolution of tachypnea may require the initial
resolution of hypoxia and fever as
demonstrated in the attached figure

3. The patient is a 65 year old male with a long history of type 2 diabetes and obesity.
Otherwise his medical history is unremarkable. He does not smoke. He had knee
surgery 10 years ago but otherwise has had no other major medical problems. Over
the years he has tried numerous diets and exercise programs to reduce his weight but
has not been very successful. His granddaughter just started high school and he wants
to see her graduate and go on to college. He understands that his diabetes puts him at
a high risk for heart disease and is frustrated that he cannot lose the necessary weight.
His neighbor told him about a colleague at work who had his stomach stapled and as a
result not only lost over 100 lbs. but also "cured" his diabetes. He wants to know if
this procedure really works.

3.1 Buatlah Tabel P.I.C.O

P Patient with obesity and type 2 diabetes
I Stapled stomach procedure
C No Stapled stomach procedure
O Weight reduction
Normalize blood glucose

3.2 Buatlah Clinical Question

Is staple stomach procedure for obesity and type 2 diabetes patient effective to
reduce body weight and normalize blood glucose level?

3.3 Buatlah Search Term/Search/Keyword

P I C O

Konsep 1 Konsep 2 Konsep 3 Konsep 4

No stapled
Patient with obesity Stapled stomach Weight LOSS and
and type 2 diabetes stomach procedure normalize blood
procedure
glucose
# Diabetes type 2 # Bariatric #3 Weight Loss
1 2 surgery
 #4 Normal blood
glucose levels

3.4 Lakukan Searching

3.5 Pastekan Abstract Artikel yang didapat pada lembar Jawaban

JAAPA. 2020 Jan;33(1):28-32. doi: 10.1097/01.JAA.0000615484.77430.1b.

Bariatric surgery and type 2 diabetes

Jennifer Stewart 1, Sarah Allen, Emily Weidman-Evans

Affiliations expand

 PMID: 31880647 
 DOI: 10.1097/01.JAA.0000615484.77430.1b

Abstract

Type 2 diabetes is primarily managed with lifestyle modifications, self-monitoring of

blood glucose, and medication. The goal is to maintain A1C less than 7% in most
patients and prevent damage to other organs such as the kidneys and heart. Patients
who are obese and cannot achieve normal blood glucose levels despite diet, exercise,
and multiple medications may be considered for bariatric surgery. The Roux-en-Y
gastric bypass and laparoscopic sleeve gastrectomy have been shown to improve
A1C, reduce weight, and reduce the number of medications patients need for
diabetes management. Comorbidities such as hyperlipidemia and hypertension also
may improve. This article describes types of bariatric surgery, proper selection of
surgical candidates, patient education, and the postoperative patient management
necessary for long-term success in improving blood glucose control.

3.6 Lakukan Critical Appraisal dari Artikel dengan critical appraisal worksheet
No Questions Answers

1. What is the research The purpose is to maintain A1C less than 7% in

question and/or hypothesis? most patients and prevent damage to other
 organs such as the kidneys and heart.
2. What is the study type? The study type is review articles

3. What is the reference Patients who are obese and cannot achieve
population ? What are the normal blood glucose levels despite diet,
sampling frame and exercise, and multiple medications may be
sampling method ? considered for bariatric surgery

4. In an experimental study, The Roux-en-Y gastric bypass and

how are subjects assigned to laparoscopic sleeve gastrectomy have been
group ? In a longitudinal shown to improve A1C, reduce weight, and
study how many reached reduce the number of medications patients need
final follow up ? for diabetes management.

5. What are the study factors This article describes types of bariatric surgery,
and how are they measured? proper selection of surgical candidates, patient
education, and the postoperative patient
management necessary for long-term success in
improving blood glucose control.
6. What are the outcome Comorbidities such as hyperlipidemia and
factors and how are they hypertension also may improve
measured ?

7. What important potential Associated risk factors include endocrine,

confounders are behavioral, cultural, genetic, metabolic, and
considered ? social components

8. Are statistical tests All analyses were performed using Stata

considered ? version 15.0.17 A 2-sided P value of \.05 was
considered statistically significant, except for
the heterogeneity test, in which a P value of \.1
was used.

9. Are the results clinically / Yes, The network meta-analysis performed in

socially important? this systematic review enabled treatment
ranking, which can be used to support
clinicians’ decisions regarding treatment
choices
10 What conclusions did the Bariatric surgery has been shown to improve
authors reach about the A1C, BP, and lipid levels as well as reduce
research question ? Did they weight and the number of medications patients
generate new hypotheses ? need for diabetes management. Consider
Do you agree with the bariatric surgery in patients with diabetes who
conclusions ? have a BMI of 35 or greater after treatment
failure with lifestyle changes and
pharmacologic regimens. Many factors
contribute to the choice of which procedure is
optimal for each patient. Because of the
potentially rapid improvement in blood glucose
levels after bariatric surgery, close medical
management is key to preventing
 hypoglycemia and other adverse reactions.

4. File SPSS ada Data diagnosis td data LDL dan kreatinine

kinase
a. Buatlah grafik titik potong diagnostik, pastekan pada lembar jawaban.

Kreatinin Kinase
100
Sensitivity: 100,0
Specificity: 92,0
Criterion : >69,1098
80
Sensitivity

60

40

20

0
0 20 40 60 80 100
100-Specificity

LDL
100

80 Sensitivity: 84,6
Specificity: 47,1
Criterion : ≤143,002
Sensitivity

60

40

20

0
0 20 40 60 80 100
100-Specificity

b. Perkirakan secara visual nilai titik potong diagnostik dan interpretasinya.

Jawab:
Titik potong diagnostik MCI dan kreatinin kinase adalah sekitar 70 IU
Titik potong diagnostik MCI dan LDL adalah sekitar 143 mg/dl
c. Hitunglah seluruh nilai diagnostik menggunakan MedCalc dan Epi calc, buat
kesimpulan
 Kreatinin Kinase
Medcalc
Variable Kreatinin_kinase
Kreatinin Kinase
Classification variabl MCI
e MCI
 

Sample size   100
Positive group :  MCI = 1 13
Negative group :  MCI = 0 87
 

Disease prevalence (%) unknown
 
Area under the ROC curve (AUC) 
 

Area under the ROC curve (AUC)  0,973
Standard Errora 0,0140
95% Confidence intervalb 0,919 to 0,995
z statistic 33,901
Significance level P (Area=0.5) <0,0001
a
DeLong et al., 1988
b
Binomial exact
 
Youden index
 

Youden index J 0,9195
Associated criterion >69,1098
 
Criterion values and coordinates of the ROC curve [Hide]
 

Criterion Sensitivity 95% CI Specificity 95% CI +LR -LR

≥40,0886 100,00 75,3 - 100, 0,00 0,0 - 4,2 1,00  
0
>69,109 100,00 75,3 - 100, 91,95 84,1 - 96,7 12,4 0,00
8 0 3
>70,164 92,31 64,0 - 99,8 93,10 85,6 - 97,4 13,3 0,083
1 8
>72,903 76,92 46,2 - 95,0 93,10 85,6 - 97,4 11,1 0,25
8 5
>73,249 69,23 38,6 - 90,9 94,25 87,1 - 98,1 12,0 0,33
5 5
>75,240 69,23 38,6 - 90,9 96,55 90,3 - 99,3 20,0 0,32
7 8
>76,514 61,54 31,6 - 86,1 97,70 91,9 - 99,7 26,7 0,39
8 7
>76,887 53,85 25,1 - 80,8 98,85 93,8 - 100, 46,8 0,47
2 0 5
>77,457 38,46 13,9 - 68,4 98,85 93,8 - 100, 33,4 0,62
4 0 6
>77,995 30,77 9,1 - 61,4 100,00 95,8 - 100,   0,69
0
>78,675 0,00 0,0 - 24,7 100,00 95,8 - 100,   1,00
1 0

Epical
Accuracy :0,93 [0,86; 0,97]
Catmaker

Kesimpulan tes diagnostik Kreatinin Kinase pada pasien MCI :

- Sensitivitas 100%, berarti kemampuan Kreatinin Kinase dalam mendeteksi pasien
yang menderita penyakit MCI adalah 100%.
- Spesifisitas 92%, berarti kemampuan Kreatinin Kinase dalam mendeteksi pasien
yang tidak menderita penyakit MCI (tidak sakit) adalah 92%.
- Prevalens 13%, berarti probabilitas seseorang dalam studi ini (berdasarkan keadaan
demografis dan klinis) untuk menderita penyakit MCI sebelum menjalani tes
diagnostik Kreatinin Kinase adalah 13%.
- Nilai duga positif 65%, berarti probabilitas seseorang dengan hasil uji diagnostik
Kreatinin Kinase positif (> 69,1098 IU) menderita penyakit MCI adalah 65%.
- Nilai duga negatif 100%, berarti probabilitas seseorang dengan hasil uji diagnostik
Kreatinin Kinase negatif (≤ 69,1098 IU) tidak menderita penyakit MCI adalah
100%.
- Positive likelihood ratio 12,43%, berarti proporsi subjek yang menderita MCI
dengan Kreatinin Kinase positif (> 69,1098 IU) dengan subjek yang tidak
menderita MCI dengan Kreatinin Kinase positif (> 69,1098 IU) pula adalah
12,43%.
 - Negative likelihood ratio 0%, berarti proporsi subjek yang menderita MCI dengan
Kreatinin Kinase negatif (≤ 69,1098 IU) dengan subjek yang tidak menderita MCI
dengan Kreatinin Kinase negatif (≤ 69,1098 IU) pula adalah 0%.
 LDL
Medcal
Variable LDL
LDL
Classification variabl MCI
e MCI
 

Sample size   100
Positive group :  MCI = 1 13
Negative group :  MCI = 0 87
 

Disease prevalence (%) unknown
 
Area under the ROC curve (AUC) 
 

Area under the ROC curve (AUC)  0,598
Standard Errora 0,0855
95% Confidence intervalb 0,495 to 0,695
z statistic 1,143
Significance level P (Area=0.5) 0,2531
a
DeLong et al., 1988
b
Binomial exact
 
Youden index
 

Youden index J 0,3174
Associated criterion ≤143,002
 
Criterion values and coordinates of the ROC curve [Hide]
 

Criterion Sensitivity 95% CI Specificity 95% CI +LR -LR

<96,389 0,00 0,0 - 24,7 100,00 95,8 - 100,   1,00
6 0
≤105,596 0,00 0,0 - 24,7 97,70 91,9 - 99,7 0,00 1,02
≤110,394 7,69 0,2 - 36,0 97,70 91,9 - 99,7 3,35 0,94
≤113,405 7,69 0,2 - 36,0 95,40 88,6 - 98,7 1,67 0,97
≤114,336 15,38 1,9 - 45,4 95,40 88,6 - 98,7 3,35 0,89
≤118,88 15,38 1,9 - 45,4 89,66 81,3 - 95,2 1,49 0,94
≤121,168 23,08 5,0 - 53,8 89,66 81,3 - 95,2 2,23 0,86
≤124,449 23,08 5,0 - 53,8 83,91 74,5 - 90,9 1,43 0,92
≤124,98 30,77 9,1 - 61,4 83,91 74,5 - 90,9 1,91 0,83
≤135,632 30,77 9,1 - 61,4 62,07 51,0 - 72,3 0,81 1,12
≤135,713 38,46 13,9 - 68,4 62,07 51,0 - 72,3 1,01 0,99
≤136,431 38,46 13,9 - 68,4 58,62 47,6 - 69,1 0,93 1,05
≤140,212 69,23 38,6 - 90,9 58,62 47,6 - 69,1 1,67 0,52
≤142,734 69,23 38,6 - 90,9 48,28 37,4 - 59,2 1,34 0,64
≤142,787 76,92 46,2 - 95,0 48,28 37,4 - 59,2 1,49 0,48
≤142,907 76,92 46,2 - 95,0 47,13 36,3 - 58,1 1,45 0,49
≤143,002 84,62 54,6 - 98,1 47,13 36,3 - 58,1 1,60 0,33
≤158,411 84,62 54,6 - 98,1 17,24 10,0 - 26,8 1,02 0,89
 ≤158,868 92,31 64,0 - 99,8 17,24 10,0 - 26,8 1,12 0,45
≤185,206 92,31 64,0 - 99,8 1,15 0,03 - 6,2 0,93 6,69
≤187,68 100,00 75,3 - 100, 1,15 0,03 - 6,2 1,01 0,00
0
≤192,217 100,00 75,3 - 100, 0,00 0,0 - 4,2 1,00  
0
 

 
Epicalc
Accuracy : 0,48 [0,38; 0,58]

Catmaker

Kesimpulan tes diagnostik LDL pada pasien MCI :

- Sensitivitas 15%, berarti kemampuan LDL dalam mendeteksi pasien yang
menderita penyakit MCI adalah 15%.
- Spesifisitas 53%, berarti kemampuan LDL dalam mendeteksi pasien yang tidak
menderita penyakit MCI (tidak sakit) adalah 53%.
- Prevalens 13%, berarti probabilitas seseorang dalam studi ini (berdasarkan keadaan
demografis dan klinis) untuk menderita penyakit MCI sebelum menjalani tes
diagnostik LDL adalah 13%.
- Nilai duga positif 5%, berarti probabilitas seseorang dengan hasil uji diagnostik
LDL positif (> 143 mg/dl) menderita penyakit MCI adalah 5%.
 - Nilai duga negatif 81%, berarti probabilitas seseorang dengan hasil uji diagnostik
LDL negatif (≤ 143 mg/dl) tidak menderita penyakit MCI adalah 81%.
- Positive likelihood ratio 0,33%, berarti proporsi subjek yang menderita MCI
dengan LDL positif (> 143 mg/dl) dengan subjek yang tidak menderita MCI
dengan LDL positif (> 143 mg/dl) pula adalah 0,33%.
- Negative likelihood ratio 1,60%, berarti proporsi subjek yang menderita MCI
dengan LDL negatif (≤ 143 mg/dl) dengan subjek yang tidak menderita MCI
dengan LDL negatif (≤ 143 mg/dl) pula adalah 1,60%.

Kategori Kreatinin Kinase * MCI Crosstabulation

Count

MCI

MCI Negatif MCI Positif Total

Kategori Kreatinin Kinase >69,1098 7 13 20

<=69,1098 80 0 80
Total 87 13 100

Kategori LDL * MCI Crosstabulation

Count

MCI

MCI Negatif MCI Positif Total

Kategori LDL >143,002 41 2 43

<=143,002 46 11 57
Total 87 13 100

5. Dalam file SPSS tersedia data Therapy Bad Outcome. Hasil Randomized clinical trial/
control trial ACE inhibitor

Kelompok * Outcome Crosstabulation

Count

Outcome

Hidup Meninggal Total

Kelompok Ace Inhibitor 44 6 50

Placebo 37 13 50
Total 81 19 100
 3.1. Hitunglah nilai—nilai Importancy

3.2. Buat kesimpulan

EER = 0,12; berarti kejadian kematian dalam penggunaan ACE inhibitor pada
pasien dalam studi ini adalah sebesar 12%.
CER = 0,26; berarti kejadian kematian dalam penggunaan plasebo pada pasien
dalam studi ini adalah sebesar 26%.
RR = 0,46; berarti kemungkinan kematian pasien yang menggunakan ACE
inhibitor adalah sebanyak 0,46 kali dibandingkan dengan pasien yang
menggunakan placebo; artinya ACE inhibitor dapat mencegah kematian.
ARR = 0,14; artinya dalam penggunaan ACE inhibitor, selisih jumlah insidens
kematian pada pasien dengan penggunaan placebo adalah sebesar 14%.
RRR = 0,54; artinya apabila ACE inhibitor digunakan sebagai terapi, maka
insidens kematian pada pasien dapat diturunkan sebesar 54% dari
insidens sebelumnya.
NNT = 7,14; artinya dibutuhkan terapi ACE Inhibitor sebanyak antara 7-8
pasien untuk mencegah kematian 1 orang pasien.

Kesimpulan :
Secara klinis, hasil penelitian ini penting dan sangat bermakna secara klinis.

6. Dalam file SPSS tersedia Data Therapy Effectiveness

 6.1. Hitunglah nilai—nilai Importancy
Kelompok * Outcome Crosstabulation
Count

Outcome

Sembuh Tidak Sembuh Total

Kelompok Enalapril + ASA 26 24 50

Isossorbid Prodiprogrel +
9 41 50
Deuretik
Total 35 65 100

6.2. Buat kesimpulan

EER = 0,52; berarti kejadian kesembuhan dalam penggunaan Enalapril + ASA
pada pasien dalam studi ini adalah sebesar 52%.
CER = 0,18; berarti kejadian kesembuhan dalam penggunaan Isosorbid +
Diuretik pada pasien dalam studi ini adalah sebesar 18%.
RR = 2,89; berarti kemungkinan kesembuhan pasien yang menggunakan
Enalapril + ASA adalah sebanyak 2,89 kali dibandingkan dengan
kelompok Isosorbid + Diuretik; artinya kombinasi Enalapril + ASA lebih
dapat menyembuhkan pasien.
ARR = 0,34; artinya dalam penggunaan Enalapril + ASA, selisih jumlah
kesembuhan dengan pasien yang menggunakan Isosorbid + Diuretik
adalah sebesar 34%.
RRR = 1,89; artinya apabila Enalapril + ASA digunakan sebagai terapi, maka
angka kesembuhan pada pasien akan meningkat sebesar 189% dari
insidens sebelumnya.
NNT = 2,94; artinya dibutuhkan terapi Enalapril + ASA sebanyak antara 2-3
orang untuk menyembuhkan 1 orang pasien.

Kesimpulan :
Secara klinis, hasil penelitian ini penting dan sangat bermakna secara klinis.