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Critical appraisal

Ibu Lusi mengantar Aurora. Aurora adalah anaknya yang


baru berusia 6 bulan ke poliklinik anak RSUD dr.moewardi.
Dari anamnesis, Ibu Lusi mengeluhkan sudah 3 hari ini
frekuensi BAB bayinya >3x sehari dan disertai muntah.
kemudian dokter melakukan pemeriksaan dari inspeksi bayi
tampak pucat dan rewel, matanya cekung dan bibirnya
kering. Turgor kulitnya <3 Dokter mengatakan bahwa
Aurora mengalami diare dengan dehidrasi sedang. Dokter
pernah membaca untuk mengatasi dehidrasi perlu diberikan
probiotik. Untuk memastikannya dokter melakukan
searching dan critical appraisal.

Scenario
Apakah efektif penggunaan probiotik untuk mengatasi
dehidrasi pada diare anak?

Clinical Question
P : infantile
I : Probiotic
C : plasebo
O : reduce dehidration

ANALISIS PICO
P: population/problem I: intervention C: comparison O: outcome
Was the assignments of patients to
treatments randomized ?
Was the randomization concealed?
Were all groups similar at the start of the
trial?
Was follow-up of patients sufficiently long
and complete
Were all patients analyzed in the groups to
which they were randomized?

but if not actually is not a problem because the number of


droup out is under 20% of the size of sample ( the drop out
samples were 12/160X 100%=7,5%
Were patients, cliniciants, and study
personal kept blind to treatment

but there was not evidence if it was blind to the


statistical analyzer as well, but it is not a
problem.
Were group treated equally , apart from the
experimental therapy ?
Are the results of
this study is
important?
Out come Out come
(ada) (tidak ada)

E 70 A 8B 78

C 58 C 12 D 70

Importancy
CER (control event rate)= d/ (c+d) = 12/(58+12)= 0,17=17%
EER (experimental event rate)= b/ (a+b) = 8/ (70+8) = 0,10-
10%
Baik karena EER< CER
RRR (relative risk reduction) = (CER-EER)/CER = (0,17-
0,10)/0,17 = 41 %
Makin besar RRR makin besar efek terapi
ARR= CER-EER = 0,17-0,10 = 0,07=7%
Makin besar ARR makin besar efek terapi
NNT = 1/ARR = 1/7% = 14

Penghitungan
importancy
95% CI NNT=

1,96 CER(1-CER)/ n(kontrol) + EER(1-EER)/n(ekperimen)

= 1,96 0,17(1-0,17)/70 + 0,1 (1-0,1)/70

= 1,96 0,002 + 0,0013

= 11,3 %
Is our patient so different from those in the study that its results cannot
apply?

No. the characteristic of the patient in the study is same with our patient.
aged between 6 and
24 months, who suffered from dehydrating acute watery
diarrhoea of less than 3 days duration and had clinical
signs and symptoms of some dehydration (thirst or
eagerness to drink, sunken eyes, dry mouth and tongue and
loss of skin elasticity) were assessed for eligibility (WHO
2006).

Applicability
Is the treatment feasible in our setting?

yes, it is feasible in our setting. This probiotic preparation has


been marketed in many countries, because it is cheap to produce,
easy to prepare,
robust to production process and has a long shelf life over
wide range of temperatures; it is quite stable in formulation
of powder, granules, dry syrup, tablets, capsule, resistant to
high moisture and oxygen, and compatible with pharmaceutical
ingredients such as vitamins, minerals, amino acids
(Vecchi & Drago 2006)
What are our patient s potential benefits and harms
from the therapy?

Based on this study, probiotic is saved for diarrhea in


children
What are our patient s values and expectations for both
the outcome we are trying to prevent and the treatment
we are offering?

it meet the patient values and expectations


This study show that probiotics can speed healing and
reduce the degree of dehydration in diarrhea

Conclusion
www.ncbi.nih.gov./pubmed
Dutta, P, et al. (2011). Randomised controlled clinical
trial of Lactobacillus sporogenes (Bacillus coagulans),
used as probiotic in clinical practice, on acute watery
diarrhoea in children.Tropical Medicine and international
health, 2011. May.

Referention

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