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Crp critical appraisal group 9 cohort

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crp critical appraisal cohort

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Crp critical appraisal group 9 cohort

  1. 1. Group 9
  2. 2. Group 9  Puveraj Gunasekaran 130110132026  Nor Adira Eliany Binti Alias 130110113053  Michelle Ann Sheridan Daniel 130110132017  Visalakshi Ramanathan 130110132042  Muhammad Ikhlas Abdian Putra 130110130126  Raka Ghufran Wibowo 130110130170  Ahsani Rahma Rudibianti 130110130073  Muhammad Nuur Fauzi 130110130049  Renita Dewi Supiyana 130110130115  Amalia Ahsani 130110130061  Evi Anugrah Arumningsih 130110130074  Fatimah Amalia 130110130140  Nabila Nauli Asriputri 130110130155  Jasmine Maulinda Utami 130110130195
  3. 3. Answerable question based on the scenario above according to PICO scheme.  Patient or problem : 60-year old female newly diagnosed with peripheral arterial disease  Intervention : type 2 diabetes  Comparison : -  Outcome : peripheral arterial disease.
  4. 4. Critical Appraisal based on Tool Kit 1. Did the study address a clearly focused issue?  Yes, The population studied were clearly described and the risk factors were also mentioned. Besides that, the outcomes were considered in two ways where there was a primary outcome and a secondary outcome. It’s clear that the study tried to detect a beneficial effect.
  5. 5. Critical Appraisal based on Tool Kit 2. Did the authors use an appropriate method to answer their question?  Is a cohort study a good way of answering the question under the circumstances? Yes  Did it address the study question? We have addressed these gaps in knowledge by establishing a large prospective cohort using linked electronic health records,8,9 which combine information about diabetes diagnosis, risk factors, and medication use with future cardiovascular events. Our objective was to investigate and compare associations between type 2 diabetes and future risk of 12 of the most common initial cardiovascular presentations in men and women.
  6. 6. Critical Appraisal based on Tool Kit 3. Were the cohort recruited in an acceptable way?  No, because not all subjects are classified into expose group using the same procedure this study used multivariable cox regression they also used multiple imputation to account missing covariate data
  7. 7. Critical Appraisal based on Tool Kit 4. Was the exposure accurately measured to minimize bias? Yes HINT: We are looking for measurement or classification bias: - Did they use subjective or objective measurements? Objective. We defined individuals as having diabetes at baseline (type 1, type 2, or uncertain type) on the basis of coded diagnoses recorded in CPRD or hospital episode statistics at or before study entry (appendix). - Do the measures truly reflect what you want them to (have they been validated)? : Cant tell. - Were all the subjects classified into exposure groups using the same procedure? : Yes We defined individuals as having diabetes at baseline (type 1, type 2, or uncertain type) on the basis of coded diagnoses recorded in CPRD or hospital episode statistics at or before study entry (appendix).
  8. 8. Critical Appraisal based on Tool Kit5. Was the outcome accurately measured to minimize bias?  Yes - Did they use subjective or objective measurements? objective measurement - Do the measures truly reflect what you want them to (have they been validated)? they have been validated - Has a reliable system been established for detecting all the cases (for measuring disease occurrence)? reliable system has been established for detecting all the case - Were the measurement methods similar in the different groups? measurement were similar in different group - Were the subjects and/or the outcome assessor blinded to exposure (does this matter)? no blinded to exposure
  9. 9. Critical Appraisal based on Tool Kit 6. A. Have the authors identified all important confounding factors? Yes List the ones you think might be important, that the authors missed. B. Have they taken account of the confounding factors in the design and/or analysis? Yes  Modeling : Social deprivation was included in models as quintiles of the index of multiple deprivation, a score calculated for each participant’s neighbourhood on the basis of social indices such as income, education, and employment  Stratified : Data recorded before study entry were used to classify participants as never smokers, ex-smokers, or current smokers at baseline. The baseline hazard function of each model was stratifi ed by general practice and sex, and we used multiple imputation to account for missing covariate data (appendix). We also did analyses adjusted for age and sex only, and analyses adjusted for age, sex, and cardiovascular risk factors. We assessed interactions with age and sex.
  10. 10. Critical Appraisal based on Tool Kit  Regression : We used multivariable Cox regression to calculate cause- specific hazards for associations between type 2 diabetes and initial presentations of cardiovascular disease.  Sensitivity : We did a sensitivity analysis comparing individuals with any diabetes diagnosis to those without diabetes (most patients with diabetes in a cohort of this age would have type 2 diabetes). We did sensitivity analyses ignoring endpoints recorded only in primary care (CPRD), restricted to fatal endpoints, or restricted to individuals who entered the study after 2004. We did analyses using R 2.15. This trial is registered with ClinicalTrials.gov, number NCT01804439.
  11. 11. Critical Appraisal based on Tool Kit 7. A. Was the follow up of subjects complete enough? Yes B. Was the follow up of subjects long enough? Yes Because the long of the interval is 5,5 years
  12. 12. Critical Appraisal based on Tool Kit 8. What are the results of this study? -This study includes 1921260 individuals whereby 1887062 did not have diabetes and 34198 had DM Type 2. -There were 113638 cardiovascular events over 11.6million person-years of follow up. -6137 were DM Type 2 individuals, where 992 individual with peripheral arterial disease and 866 individual with heart failure was the first presentation. -107501 were individual without DM Type 2, where 10074 with peripheral arterial disease and 13072 individual with heart failure was the first presentation.
  13. 13. Critical Appraisal based on Tool Kit -For individual aged 40 years without cardiovascular disease, risk of getting CD by 80years old :- -No other statistically significant differences between sexes. -In DM Type2 individual, risk of cardiovascular disease was highest for those with HbA1c concentration of 58 mmol/mol or higher. -Individual with DM Type2 and HbA1c concentration less than 48mmol/mol had an increased risk of peripheral arterial disease and ischaemic stroke, but no greater risk of any of the other 12 cardiovascular diseases.
  14. 14. Critical Appraisal based on Tool Kit 9. How precise are the results?  How precise is the estimate of the risk? By looking at the value of confidence interval HINT: - Size of the confidence intervals The prevalence of any type of diabetes in all individuals in CALIBER aged 40–50 years (with or without previous cardiovascular disease) was 1·52% (95% CI 1·47–1·57) in women and 2·25% (2·19–2·32) in men (appendix).
  15. 15. Critical Appraisal based on Tool Kit 10. Do you believe the results?  HINT: -Big effect is hard to ignore! (???) -Can it be due to bias, chance or confounding? No -Are the design and methods of this study sufficiently flawed to make the results unreliable? No. This study used records from the CALIBER programme, which links data for people in England recorded in four electronic health data sources. They define individuals as having diabetes using CPRD record and also check the HbA measurements for diabetic patients. And also they use cumulative incidence curves for comparing the initial presentation of cardiovascular disease and used Cox models to estimate cause-specific hazard ratios. And overall, the result were robust to a range of modifications explored in sensitivity analyses, which is type 2 diabetes was strongly associated with composite cardiovascular mortality and all-cause mortality. -Consider Bradford-Hills criteria!
  16. 16. Critical Appraisal based on Tool Kit  11. Can the results be applied to the local population? YES  HINT: consider whether: 1. the subjects covered in the study could be sufficiently different from your population to cause concern 2. your local setting is likely to differ much from that of the study 3. can you quantify local benefit and harm? benefit: because this research take subjects from wide range of population in UK, obviously it can represent local population there. so, the benefit for local people are they can prevent cardiovascular disease if they have DM type 2 harm: wide range of cardiovascular disease that might occur could confusing us, it could lead us to wrong preventive action with harmful effect.
  17. 17. Critical Appraisal based on Tool Kit  12. Do the results of this study fit with other available evidence? Yes
  18. 18. Thank You

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