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1. NILAI ABNORMALITAS
PARAMETER RATA-RATA +2 SD NILAI ABNORMALITAS
SGOT/SGPT 26.29 + 2(13.92) = 54.13 54.13 + 0.05 = 54.18
HEMOGLOBIN 12.47 - 2(0.32) = 11.83 11.83 0.05 = 11.78
TRIGLESERID 115.30 + 2(20.05) = 155.38 155.38 + 0.05 = 115.43
TOTAL KOLESTEROL 137.24 +2(32.40) = 202.04 202.04 + 0.05 = 202.09
HDL 89.44 - 2(17.11) = 55.22 55.22 0.05 = 55.17
LDL 74.64 + 2(13.63) = 101.9 101.90 + 0.05 =101.95
2. PICO
2.1 PICO
Tabel PICO
P Older adults with early sign/symptoms of cognitive impairment
I Mini-Cog test
C MMSE
O Accurate diagnosis of dementia or Alzheimers disease
A OR a AND B OR b AND C OR c
2.4 Searching
2.5 Artikel (Lampiran Abstrak)
Evid Based Mental Health 2004;7:38 doi:10.1136/ebmh.7.2.38
Diagnosis
METHODS
Design:
Prospective cohort study.
Setting:
23 rural communities, Pennsylvania, USA; recruitment initiated early 1990s.
Patients:
A subset of 1119 elderly people (mean age 73 years) randomly drawn from an age stratified random sample of
17 000 people from the Monongahela Valley Independent Elders Survey (MoVIES). Participants were aged >65
years, had a minimum of 6 years of formal education, and were living in the community.
Test:
The Mini-Cog is a rapid screening test comprising two cognitive tasks: a three item word memory test
and clock drawing. The scores were combined with an empirical algorithm to yield a dementia screen
score for each person as either possibly impaired or probably normal.
Diagnostic standard:
The Mini-Mental State Examination (MMSE).
Outcomes:
Sensitivity and specificity of the Mini-Cog.
MAIN RESULTS
Seventy six people (6.4%) met criteria for dementia (DSM-III-R). The Mini-Cog had higher
sensitivity but lower specificity than the MMSE using the generally applied MMSE cut off of 24.
Specificity and sensitivity were similar when the MMSE cut off was raised to 25 (see table). The
Mini-Cog had a shorter administration time.
CONCLUSIONS
Sensitivity and specificity of the Mini-Cog compared well with that of the MMSE, and longer
screening tests.
Step 3: Can you apply this valid, important evidence about a diagnostic for caring your
patient?
Was the results and interpretations Yes, because Mini-Cog are more sensitive than
satisfying for diagnosis? MMSE.
(Apakah hasil tes dan interpretasinya Ya, karena Mini-Cog lebih sensitif
dapat memuaskan dalam diagnosis?) dibandingkan MMSE.
Could we apply the results to our Yes, Mini-Cog could be used as MMSEs
patients? alternative.
(Apakah hasilnya dapat diaplikasikan (Ya, Mini-Cog dapat digunakan sebagai
pada pasien kita?) alternatif MMSE.)
Could the results help the patients better? It could be, although the Mini-Cog is lack of
(Apakah hasilnya dapat membantu pasien specitifity compared to MMSE
menjadi lebih baik?) Bisa saja walaupun tes Mini-Cog kurang
spesifik dibanding MMSE
Conclusion: The results of diagnostic was valid and Mini- Cog could be applied to the
patients as an alternative test for diagnosing dementia.
Kesimpulan: Hasil uji diagnostic kini valid dan Mini-Cog dapat diaplikasikan ke pasien
sebagai uji alternatif untuk mendiagnosis demensia.
3. DATA
3.1 Grafik Titik Potong/ cut-off point
Classification: MCI
100
90
80
70
60
Sensitivity (%)
50
Specificity (%)
40
30
20
10
0
40 50 60 70 80
KretaininKinase
3.2 Perkiraan Visual Nilai Titik Potong dan Interpretasi
Antara kreatinin kinase dari 65-70, nilai spesifisitas dan sensitivitas ada di antara 90-
100.
Secara visual grafik menunjukkan nilai kreatinin kinase 80-90 atau nilai dari kreatinin
kinase lebih besar dari 80 atau lebih kecil dari 90 pada cut-off point.
3.3 Nilai Diagnostik
KretaininKinase
100
Sensitivity: 100.0
Specificity: 92.0
Criterion : >69.1098
80
Sensitivity
60
40
20
0
0 20 40 60 80 100
100-Specificity
KretaininKinase
100
80
Sensitivity
60
40
20
0
0 20 40 60 80 100
100-Specificity
ROC curve
Variable KretaininKinase
KretaininKinase
Classification variable MCI
Youden index
Kesimpulan
Bahwa kreatinin kinase dapat mendiagnosa MCI dengan titik potong sensitifitas dan
spesifitas sebesar >69
1. Sensitivitas
2. Spesifisitas
3. LR +
4. LR likelihood ratio
5. Area under curve
Outcome
KelompokPerlakuan ACE 44 6 50
Placebo 37 13 50
Total 81 19 100
4.4 Kesimpulan
ACE Inhibitor tidak signifikan dalam mencegah kematian MCI
ARR=0,14 = 14%
NNT=7,14
5.1 Tabel
Kelompok * Outcome Crosstabulation
Count
Outcome
Sembuh Tidak sembuh Total
Kelompok Enalapril + ASA 26 24 50
Isosorbit dinitrat 10 mg 9 41 50
Total 35 65 100
5.2 Kesimpulan:
Kombinasi enalapril asa terbukti lebih efektif dalam menyembuhkan pasien MCI
dibanding isosorbit dinitrat sebesar 189%