Webinar 2 Menelaah Makalah SR – Mengidentifikasi Masalah Penelitian ProDi S3 FK UGM 22 April 2016 13:00 – 14:00

Alur Menulis Pra-Proposal Masalah Praktis Topik Kata-kata Kunci Mencari Makalah SR Menelaah Makalah SR Masalah & Tujuan Penelitian (awal)

Menelaah Makalah SR Sudah ditelaah organisasi yg kompeten. Contoh: Health Evidence, The Cochrane Library, The Campbell Collaboration. Ditelaah/dinilai sendiri. Contoh: dgn Quality Assessment Tool dari Health Evidence, McMaster University (http://healthevidence.org/documents/our-appraisal-tools/QA_tool&dictionary_18.Mar.2013.pdf)

Contoh Makalah SR yg belum dinilai (ditemukan melalui Google Scholar): Tetzlaff, W., Okon, E. B., Karimi-Abdolrezaee, S., Hill, C. E., Sparling, J. S., Plemel, J. R., ... & Kawaja, M. D. (2011). A systematic review of cellular transplantation therapies for spinal cord injury. Journal of neurotrauma, 28(8), 1611-1682. Contoh Makalah PE yg sudah dinilai (Ditemukan melalui Health Evidence): Cushing C.C., Brannon E.E., Suorsa K.I., & Wilson D.K. (2014). Systematic review and meta-analysis of health promotion interventions for children and adolescents using an ecological framework. Journal of Pediatric Psychology, 39(8), 949-962. (Quality Rating: 8 - Strong)

10 butir penilaian Makalah SR (modifikasi QAT McMaster) Permasalahan penelitian menyebutkan Intervensi, Outcome & Populasi? Tujuan SR? Kriteria inklusi pencarian makalah Penelitian Empirik (PE) primer sesuai tujuan? Cara pencarian komprehensif? (data base, manual, referensi, yg tidak dipublikasi, bahasa) Jangka waktu makalah2 PE yg dicari cukup lama (mulai ... s/d ...)?

Penyaringan Makalah2 PE – pengumpulan & pengolahan data valid? Penyaringan Makalah2 PE – penafsiran data valid? (inferensi statistik, validitas luar, validitas dalam) Makalah2 PE yg lolos penyaringan sesuai tujuan? Kesepakatan reviewer? Sinthesis temuan makalah2 PE yg lolos penyaringan? (narasi, meta-analisis) Kesimpulan & rekomendasi sesuai dengan hasil sintesis?

Kriteria inklusi: menyebutkan transplantasi substrat cell ke model traumatik (tajam atau tumpul) in-vio SCI (cedera medula spinalis)  162 makalah PE. Sel2 yg diujicoba: Schwann cells, olfactory ensheathing glial cells, embryonic and adult neural stem/progenitor cells, fate-restricted neural/glial precursor cells, and bone-marrow stromal cells

Menidentifikasi Masalah & Tujuan Penelitian utk Pra-Proposal Berdasarkan kesimpulan & rekomendasi dalam Makalah SR. Contoh Makalah Tetzlaff dkk, 2011: ada tabel2 utk masing2 jenis sel transplantasi yg menyebutkan Pros & Cons dan Knowledge Gaps (apa yg masih harus diteliti).

Table 3. Summary Statement for Schwann Cell Transplantation Pros Cons Arguably the most extensively studied cell type, with beneficial effects after transplantation into thoracic SCI demonstrated by numerous investigators. Schwann cells provoke a more robust astrocytic reaction, resulting in less effective integration into the host spinal cord compared to neural precursors such as oligodendrocyte precursors or neural precursor/stem cells. Can be harvested from patients for an autologous transplantation approach An autologous transplantation approach requires in vitro amplification which may take several weeks and imposes a delay on the intervention. Behavioral efficacy in “chronic” rodent contusion models has been reported. In many cases, appears to require adjuvant treatment to increase efficacy (e.g. Matrigel, rolipram, cAMP, neurotrophic factors)

Knowledge Gaps Long axon regeneration through Schwann cell bridges and reentry into the host spinal cord still poses a challenge, and some fiber tracts like CST axons are not stimulated by SCs. More preclinical data using clinically relevant (blunt) cervical injury models are desirable (only one study). It is still necessary to address different injury severities – only one study with behavioral assessment used severe contusions, representing the most likely clinical treatment group. The optimal source of Schwann cells, i.e. isolating them from nerves versus other tissues progenitors is yet to be determined. A confirmation that human Schwann cells behave in the same way as rodent Schwann cells is implied, but direct demonstrations are still highly desirable prior to translation.

Contoh Makalah Cushing dkk, 2013: OBJECTIVE: To evaluate and quantify the evidence for health promotion interventions in children and adolescents. METHOD: 96 independent samples of smoking, physical activity, and diet studies were included. Outcomes included both objective and self-reports of health behavior, as well as proxy measures such as fitness.

RESULTS: ... The greatest risk of bias was failure to blind outcome assessment, which occurred in 21% of studies. Most studies lacked sufficient detail to determine the quality of their randomization sequence (58%). Additional concerns about risk of bias for individual studies were minimal. Overall, the quality of this finding was moderate using the Grading of Recommendations Assessment, Development, and Evaluation criteria.

CONCLUSION: Health promotion interventions are effective for modifying health behavior; however, effect sizes are small. The aggregated effect was significant (g = .20, 95% confidence interval [CI] = 0.08-0.32, n = 96). A significant effect of intervention was observed at approximately 1-year follow-up (g = .07, 95% CI = 0.02-0.14, n = 20).

Practical Meta-Analysis -- D. B. Wilson Effect Size kecil? 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

Mengapa ES kecil? Pelaksanaan penelitian tidak sesuai proposal. Rancangan penelitiannya lemah – pengumpulan, pengolahan dan penfasiran data tidak valid. Teorinya salah – Promosi kesehatan tidak mencegah anak dan remaja merokok.

Materi Teleconference Tanggal 1 Masalah Praktis – Makalah SR 2 Menelaah Makalah SR – Masalah Penelitian 3 Tujuan, Manfaat & Keaslian Penelitian 26 April 2016 4 Telaah Pustaka 5 Landasan Teori, Kerangka Konsep, Hipotesis 6 Rancangan & Metoda Penelitian 7 Pengumpulan Data 8 Pengolahan Data 9 Penafsiran Data 10 Rencana Pelaksanaan Penelitian