27 Januari 2016 ProDi S3 FK UGM http://rossisanusi.wordpress.com Critical Appraisal 27 Januari 2016 ProDi S3 FK UGM http://rossisanusi.wordpress.com

Critical Appraisal (CA)? CA makalah penelitian empirik (PE) = memeriksa apakah kesimpulannya valid (berbobot). Kesimpulan PE: hipotesis penelitian didukung/ tidak? Hipotesis Penelitian: Effect Size bermakna (kuat) a. r ≥ rmin b. d ≥ dmin c. OR ≥ ORmin

Practical Meta-Analysis -- D. B. Wilson Manafsirkan ES Cohen’s “Rules-of-Thumb” standardized mean difference effect size small = 0.20 medium = 0.50 large = 0.80 correlation coefficient small = 0.10 medium = 0.25 large = 0.40 odds-ratio small = 1.50 medium = 2.50 large = 4.30 Sumber: http://mason.gmu.edu/~dwilsonb/downloads/interpretation.ppt Practical Meta-Analysis -- D. B. Wilson

Kesimpulan PE berbobot jika Kerangka konsep valid. Rancangan penelitian kokoh (robust). Pelaksanaan penelitian seksama (high fidelity). CA laporan PE: No 1, 2 dan 3 dipenuhi?  “YA”, “TIDAK” atau “TIDAK DAPAT DINILAI”. Bagaimana jika kesimpulan yg berbobot mengatakan bahwa Hipotesis Penelitian tidak didukung?

(Praktisi, Perencana, Pembuat Keputusan, Anggota Masyarakat) PENGGUNA (Praktisi, Perencana, Pembuat Keputusan, Anggota Masyarakat) Menghadapi Masalah Praktis dan membutuhkan bukti yg valid ttg intervensi efikasius pengendalian penyakit2 prioritas PENGHASIL (Peneliti) Menghadapi Masalah Penelitian dalam menyediakan bukti yg valid ttg intervensi efikasius pengendalian penyakit2 prioritas

Sumber: http://evidencebasedliving. human. cornell

Hirarki Bukti Sumber: http://www.mededirect.org/faculty.cfm

Contoh Systematic Review: Klinik: Houwert, R. M., Wijdicks, F. J., Bisschop, C. S., Verleisdonk, E. J., & Kruyt, M. (2012). Plate fixation versus intramedullary fixation for displaced mid-shaft clavicle fractures: a systematic review. International Orthopaedics, 36(3), 579-585.

1. Kerangka Kosep Valid. Definisi operasional 1. Kerangka Kosep Valid? Definisi operasional konstruk2 valid menurut para ahli dan hasil penelitian sebelumnya. Mediator? (Mengapa, Bagaimana) Prediktor? (Intervensi) Kriterion? (Hasil) Moderator? (Ciri-ciri & keadaan Unit Analisis

Rancangan Penelitian Kuat? a. Rancangan Pengumpulan Data: Menggunakan alat atau prosedur yang valid? (berdasarkan hasil penelitian sebelumnya dan hasil validasi penelitian sekarang). Alat/prosedur digunakan secara konsisten? (berdasarkan hasil uji reliabilitas intra- dan inter- pengumpul data)

Pengumpulan Data Konstruk Variabel2 Skala Unit Penga-matan Perlakuan Prediktor Kriterion Mediator Moderator: Spesifik Confound-ing.

b. Rancangan Pengolahan data: Menggunakan metoda statistik diskriptif dan statistik inferensial yg tepat? (memenuhi syarat-syarat penggunaan metoda yg bersangkutan) c. Rencangan Penafsiran data: Validitas Dalam rendah? (Effect Size kebetulan karena sampling error besar; Effect Size semu karena moderator2 spesifik dan variabel2 confounding diabaikan). Validitas Luar rendah? (banyak moderator2 spesifik dikendalikan)

Penafsiran Data Pop Sasaran Pop yg Disampel Validitas Luar Inferensi statistik Sampel Validitas Dalam

3. Pelaksanaan Penelitian Seksama 3. Pelaksanaan Penelitian Seksama? (penggunaan sumberdaya sesuai dengan metoda pengumpulan, pengolahan dan penafsiran data yang dirancang)

Contoh Makalah SR: Bergs, J. , Hellings, J. , Cleemput, I. , Zurel, O Contoh Makalah SR: Bergs, J., Hellings, J., Cleemput, I., Zurel, O., De Troyer, V., Van Hiel, M., Demeere, J.-L, Claeys, D., & Vandijck, D. (2014). Systematic review and meta-analysis of the effect of the World Health Organization surgical safety checklist on postoperative complications. British Journal of Surgery, 101: 150-158.

Masalah penelitian (awal): Apakah penerapan SSC WHO pada pembedahan mayor menurunkan komplikasi dan kematian pasca operasi? Karena diperlukan bukti yg lebih kuat, maka Tujuan Penelitian (awal): Melakukan RCT – pembedahan mayor ditempatkan secara acak ke Kelompok SSC dan ke kelompok kendali (prosedur biasanya/tanpa SSC atau checklist yg lain).

Untuk telaah makalah2 PE selanjutnya peneliti melacak dan mengCA makalah2 PE yg terbit setelah makalah PE terakhir yg direview penulis2 SR tsb. Contoh: Molina, G., Jiang, W., Edmondson, L., Gibbons, L., Huang, L. C., Kiang, M. V., ... & Singer, S. J. (2016). Implementation of the Surgical Safety Checklist in South Carolina Hospitals Is Associated with Improvement in Perceived Perioperative Safety. Journal of the American College of Surgeons.

Background Prior research suggests surgical safety checklists (SSCs) are associated with reductions in postoperative morbidity and mortality as well as improvement in teamwork and communication. These findings stem from evaluations of individual or small groups of hospitals. Studies with more hospitals have assessed the relationship of checklists with teamwork at a single point in time. The objective of this study was to evaluate the impact of a large-scale implementation of SSCs on staff perceptions of perioperative safety in the operating room.

Study Design As part of the Safe Surgery 2015 initiative to implement SSCs in South Carolina hospitals, we administered a validated survey designed to measure perception of multiple dimensions of perioperative safety among clinical operating room personnel before and after implementation of an SSC.

Results Thirteen hospitals administered baseline and follow-up surveys, separated by one to two years. Response rates were 48.4% at baseline (929/1921) and 42.7% (815/1909) at follow-up. Results suggest improvement in five of the five dimensions of teamwork (relative percent improvement ranged from +2.9% for coordination to +11.9% for communication). These were significant after adjusting for respondent characteristics, hospital fixed-effects, and multiple comparisons, and clustering robust standard errors by hospital (all p<0.05). More than half of respondents (54.1%) said their surgical teams always used checklists effectively; 73.6% said checklists had averted problems or complications.

Conclusions A large-scale initiative to implement SSCs is associated with improved staff perceptions of mutual respect, clinical leadership, assertiveness on behalf of safety, team coordination and communication, safe practice, and perceived checklist outcomes.