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EVIDENCE BASED MEDICINE SIGIT W IDYATMOK O FAKULTAS KEDOKT ERAN UMS SIGIT WIDYATMOKO FAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAH SURAKARTA

Evidence

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EVIDENCE BASED MEDICINESIGIT WIDYATMOKOFAKULTAS KEDOKTERAN UMSSIGIT WIDYATMOKOFAKULTAS KEDOKTERAN UNIVERSITAS MUHAMMADIYAHSURAKARTAScienceCartoonsPlus.comWasiat saat wisuda..IntroductionWit!"ut clinical expertise# $%a&ti&' %is(s )'&"*i+, t-%a++i.'d )- '/t'%+a0 '1id'+&'# 2"% '1'+ '/&'00'+t '/t'%+a0 '1id'+&' *a- )' i+a$$0i&a)0' t" "% i+a$$%"$%iat' 2"% a+ i+di1idua0 $ati'+t. Wit!"ut current best external evidence# $%a&ti&' %is(s )'&"*i+, %a$id0- "ut "2 dat'# t" t!' d't%i*'+t "2 $ati'+ts. W!at is '1id'+&' )as'd *'di&i+' 4EBM567t!' &"+s&i'+ti"us# '/$0i&it a+d 8udi&i"us us' "2 &u%%'+t )'st '1id'+&' i+ *a(i+, d'&isi"+s a)"ut t!' &a%' "2 i+di1idua0 $ati'+ts.9T!' i+t',%ati"+ "2 i+di1idua0 &0i+i&a0 '/$'%tis' wit! t!' )'st a1ai0a)0' '/t'%+a0 &0i+i&a0 '1id'+&' 2%"* s-st'*ati& %'s'a%&!.I+itia00- $%"$"s'd )- D%. Da1id Sa&('tt a+d &"00'a,u's at M&Mast'%s U+i1'%sit- i+ O+ta%i"# Ca+ada.Sa&('tt DL# 't a0.E1id'+&':Bas'd M'di&i+'; W!at it is a+d w!at it is+??@A B>C;D>:C.Ada$t'd 2%"*; Sa&('tt D.L.# R"s'+)'%, M.C.# G%a- =.A.# Ha-+'s R.B.# Ri&!a%ds"+ W.S. 4>??@5. E1id'+&' )as'd *'di&i+'; w!at it is a+d w!at it is+Et. BMJ, B>C# D>:DC.W!- is EBM i*$"%ta+t6U$:t":dat' (+"w0'd,' a+d &0i+i&a0 $'%2"%*a+&' &a+ d't'%i"%at' wit! ti*'T!'%' is a statisti&a00- a+d &0i+i&a00- si,+iF&a+t +',ati1' &"%%'0ati"+ )'tw''+ a $!-si&ia+??JACDK;DHH:J. T%aditi"+a0 &"+ti+ui+, *'di&a0 'du&ati"+ $%",%a*s !a1' +"t )''+ s!"w+ t" i*$%"1' &0i+i&a0 $'%2"%*a+&'S-st'*ati& %'1i'ws "2 t!' %'0'1a+t %a+d"*i.'d t%ia0s !a1' s!"w+ t!at t%aditi"+a0# i+st%u&ti"+a0 CME 2ai0s t" *"di2- &0i+i&a0 $'%2"%*a+&' a+d is i+'I'&ti1' i+ i*$%"1i+, t!' !'a0t! "ut&"*'s "2 $ati'+ts.Do we know the right things? GP beliefs about prevention for a 52 yr male0 20 40 60 80 100*Screen for colon cancer*Tetanus immunisationScreen for lung cancerScreen for prostate cancer*Measure cholesterol Measure glucose level*Advise heavy driners*Advise smoers to !uit*Measure "lood pressureReally DoShould DoEUROPREV Network Europe.Prev Med. 2005:595-601Croatia Eto!ia "eor#ia "ree$e %re&a!d Ma&ta Po&a!d '&ovakia '&ove!ia 'pai! 'wede!EffectiveEffectiveEffectiveProbableEffectiveIneffectiveIneffectiveProbableEffectiveG'ts w"%s' wit! 7du%ati"+ i+ $%a&ti&'9W!at is EBM6Evidenced-based medicine is the concept of formalizing the scientifc approach to the practice of medicine for identifcation of evidence to support our clinical decisions. It requires an understanding of critical appraisal and the basic epidemiologic principles of study design, point estimates, relative ris, odds ratios, confdence intervals, bias, and confounding. !y using this information, clinicians can categorize evidence, assess causality, and mae evidence-based recommendations. Evidence-based medicine allo"s analysis of complicated material so that "e can mae the best possible clinical decisions for the populations "e serve.Wi00ia*s =K. U+d'%sta+di+, '1id'+&':)as'd *'di&i+'; a $%i*'%.A* = O)st't G-+'&"0 CHH>;>LJ:CDJ:CDL.Sta+da%d *'di&a0 $%a&ti&' 2"% !"t# *"ist dis'as'sThe patients preferences MUST be considered!An important rule in !idence "ased Medicine#$t STARTS %ith the patient and &DS %ith the patient.#n the practice of $vidence %ased Medicine& it is the physician's duty to find the "est and most current information and apply it (udiciously for the "enefit of the patient)A %*#$+ ,#ST-*.1/80's0 McMasters 1niversity in -ntario& 2anada3r) 3avid Sacett and colleagues proposed $vidence %ased Medicine 4$%M5 as a ne6 6ay of teaching& learning and practicing medicine)3r) Sacett defines $%M as0The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.7AT#$8T7,.S#2#A8#8+-*MAT#-89uestionor 7ro"lemT,*$$ MA:-* 2-M7-8$8TS of $%M7AT#$8T;alues& 2oncerns 7references& $ $LCD5; ,0"*'%u0"+'2%itis Wi00ia* H')'%d'+ 4>DDC5; sa(it dada a+,i+a $'(t"%is La$"%a+ s'%i (asus J ta!u+ $ada !"*"s'(sua0 -a+, *'+d'%itaG+'u*"&-sti& Ca%i+ii 4>?LH:>?L>5; AIDSFi+di+, t!' E1id'+&''enelitian cross sectionalG'+'0iti *'0a(u(a+ ")s'%1asi atau 1a%ia)'0 $ada satu saatTia$ su)-'( !a+-a di")s'%1asi satu (a0i sa8aG'+,u(u%a+ 1a%ia)'0 saat $'*'%i(saa+ ts)G'+'0iti tida( *'0a(u(a+ ti+da( 0a+8utHasi0 $'+,u(u%a+ )iasa+-a disa8i(a+ da0a* ta)'0 C/C# di0i!at $%'1a0'+si $'+-a(it $ada ('0"*$"( d'+,a+ atau ta+$a FRC"+t"!;G'+'0itia+ $'%s'+tasi )a-i -a+, *'+da$at ASI '(s(0usi2G'+'0itia+ $%'1a0'+si as*a $ada a+a( s'("0a!G'+'0itia+ +i0ai 0a)"%at"%iu* +"%*a0 $ada %'*a3tudi asus ontrol%O)s'%1asi atau $'+,u(u%a+ 1a%ia)'0 )')as da+ t'%,a+tu+, tida( di0a(u(a+ $ada saat -a+, sa*aG'+'0itia+ *'0a(u(a+ $'+,u(u%a+ 1a%ia)'0 t'%,a+ tu+, -a(+i '2'( s'da+, 1a%ia)'0 )')as di&a%i %'t%"s$'(ti2Dia+,,a$ s')a,ai studi 0"+,itudi+a0Va%ia)'0 su)-'( tida( !a+-a di")s'%1asi $ada satu saat t'ta$i dii(utisa*$ai $'%i"d' t'%t'+tuS')a,ai ("+t%"0 di$i0i! su)-'( -a+,)'%asa0 da%i $"$u0asi -a+,(a%a(t'%isti(+-a sa*a d'+,a+ (asusDisa8i(a+ da0a* ta)'0 C/C# di+-ata(a+ s')a,ai %asi" "ddsNi0ai M >; 2a(t"% $%"t'(ti2T,$ T#M$ +A2T-*Dhen 6as the study doneF#n 6hat time direction is it headedFDhat 6as its durationF*$T*-S7$2T#;$ 7*-S7$2T#;$Fi+di+, t!' E1id'+&''enelitian ohortYa+, diid'+tiF(asi du0u ada0a! (ausa+-a# ('*udia+ su)-'( dii(uti s'&a%a $%"s$'(ti2 s'0a*a $'%i"d' t'%t'+tu u+tu( *'+&a%i ada tida(+-a '2'(Su)-'( -a+, t'%$a8a+ *'+8adi('0"*$"( -a+, dit'0iti s'da+,(a+ su)-'( -a+, tida( t'%$a8a+ *'+8adi ("+t%"0Disa8i(a+ da0a* ta)'0 C/C# di!itu+, %isi(" %'0ati2# -a(+i $'%)a+di+,a+ a+ta%a i+sid'+si '2'($ad ('0"*$"( FR d'+,a+ ta+$a FRRRN ># )u(a+ FRRR M ># 2a(t"% $%"t'(ti2 Fi+di+, t!' E1id'+&'U=I KLINIS/(i linis merupaan penelitian esperimental terencana yang dilauan pada manusia'eneliti memberian perlauan atau intervensipada subye penelitian emudian efe tsb diuur dan dianalisis3ering dilasanaan untu membandingan satu (enis pengobatan dengan pengobatan yang lain3tandar optimal u(i linis% 6&*. 0alam istilah tsb termasu aspe esamaran atau pembutaan +masing, blinding, hal yang amat penting disamping randomisasi7ulley dan &umming lebih menyuai istilah% 6!* randomized blinded trial!ervariasi mulai dari u(i efetivitas obat yang sederhana, yang hanya melibatan beberapa puluh asus dan dapat dier(aan oleh 8 orang peneliti sd u(i linis multisenterGDas there a similar comparison groupFHCONTROLLED vs UNCONTROLLED STUDIES$PC "2 Q1a0id< '1id'+&' t"da- is "ut "2 dat' i+ J -'a%sScienceCartoonsPlus.coma)"ut >PC "2 1a0id '1id'+&' is +"t i*$0'*'+t'd-lhamdulillah