Apa itu EBM

• “Evidence-based medicine is the integration of

best research evidence with clinical expertise
and patient values”
Prof. Carl Heneghan Director CEBM University of
Oxford (2014)
 Klarifikasi istilah
• Deep Vein Thrombosis / DVT : Deep vein thrombosis
(DVT) is a condition in which a blood clot forms in one
of the deep veins of the body, usually in the leg. An
emboli is formed if the blood clot or part of the blood
clot detaches and travels through the venous system. If
the clot lodges in the lung, this is termed a pulmonary
embolism (PE) and this may be fatal. DVT and PE are
collectively known as venous thromboembolism (VTE)
(Wade R et al., 2016)
• elastic compression stocking
• evidence based medicine (EBM)
Apa itu deep vein trombosis
 Penyebab DVT
Clarke MJ, Broderick C, Hopewell S, Juszczak E,
Eisinga A, 2016
Occurs where there is a partial or
total blockage of the deep venous system of the body by blood
clot, usually in the legs.
causes of any
increase in the risk of developing DVT when flying (Adi 2003).
These can be classified as:
• travel-related: for example, prolonged immobilisation in
narrow economy class seats with limited leg room, insufficient
fluid intake, dehydration and low humidity (Giangrande 2001;
Milne 1992); coagulation activation caused by immobilisation
(Kuipers 2007),
• person-related: for example, hereditary or acquired
prothrombotic clotting disorders, previous DVT, older age,
recent surgery or trauma (particularly orthopaedic), cancer,
smoking, pregnancy, chronic heart disease, obesity, extremes of
height and use of oral contraceptives (Bihari 2001; Cannegieter
2006; Geroulakos 2001; Landgraf 1999).
• Microtrombus itu sll terjadi, tetapi seimbang
dengan fisiologis fibrinogen dan fobrinolisis
• stasisaliran darah tdk lancarakumulasi
darahvenodilasiepitel regang dan endotel
terksposaktivasi faktor koagulasitrombus
 Resiko DVT
Clarke MJ, Broderick C, Hopewell S, Juszczak E,
Eisinga A, 2016
If left untreated, people with DVT are at risk of
developing
a pulmonary embolism (when part of the
clot/thrombus breaks
away and lodges in the lungs), which can be fatal

Clarke MJ, Broderick C, Hopewell S, Juszczak E,

Eisinga A. 2016
 Sign symptom DVT
Clarke MJ, Broderick C, Hopewell S, Juszczak E,
Eisinga A, 2016
However, typical signs and symptoms of DVT,
and associated superficial thrombophlebitis
(tenderness caused by inflamed veins), may
include redness of the lower legs, a swollen or
painful calf or thigh, fever and discolouration
of the skin over the affectedarea
leg pain, swelling and increased temperature

Clarke MJ, Broderick C, Hopewell S, Juszczak E,

Eisinga A. 2016
Dupras D, Institude of clinical system improvement, 2013
 Bagaimana tinjauan secara EBM
mengenai DVT dan stoking?
• Pressure combined with legmovement helps
blood in superficial (surface) veins to move to
the deep veins and back to the heart
Clarke MJ, Broderick C, Hopewell S, Juszczak E,
Eisinga A. 2016
Jurnal kan banyak, apa saja jenis
penelitiannya?
 Kelas jurnal

Dupras D, Institude of clinical system improvement, 2013

 Bagaimanakah cara mencari jurnal
ebm?
1. Menyusun pertanyaan yang dapat dijawab
2. Mencari bukti terbaik
3. Telaah kritis (critical appraisal) bukti yang didapat
4. Integrasi dengan keterampilan klinis dan nilai-nilai
pasien
 1. Menyusun pertanyaan
• Pertanyaan yang baik merupakan tulang punggung
dalam penerapan EBM. Perlu latihan untuk dapat
menyusun pertanyaan yang terformulasi dengan baik.
• Question
– Population
– Indicator (intervention, test, etc)
– Comparator
– Outcome
• General structure of question
– (Population OR synonym1 OR synonym2…) AND
– (Intervention OR synonym1 OR synonym2…) AND
– (Comparator OR synonym1 OR synonym2…) AND
– (Outcome OR synonym1 OR synonym2…)
• P: passenger travelling on flights lasting at
least four hours.
• I: compression stocking
• C: not wearing stocking
• O: Deep vein trombosis
 Dimana mencari jurnal?
• PubMed : http://www.pubmed.gov
• The Cochrane Library :
http://www.cochrane.org
• Clinical Evidence :
http://www.clinicalevidence.com
• Other useful places to search :
http://www.embase.com