WORKSHEET CRITICAL APPRAISAL
CHECKLIST FOR case control study Adapted from: ©CASP This work is licensed under the Creative Commons Attribution - NonCommercial-ShareAlike NonCommercial-ShareAlike 3! "nported #icense To view a cop$ of this license% visit http:&&creativecommonsor'&li http:&&creativecommonsor'&licenses&b$-nc-sa&3!& censes&b$-nc-sa&3!& wwwcasp-uknet
How to use this appraisal tool Three broad issues need to be considered c onsidered when appraisin' appraisin' a case control stud$:
Are the results of the trial valid( valid( )Section A*
+hat are the results(
)Section ,*
+ill the results help locall$(
)Section C*
The .uestions on the followin' pa'es pa'es are desi'ned to help $ou think about these issues s$stematicall$ s$stematicall$ The first two .uestions .uestions are screenin' screenin' .uestions .uestions and can be answered .uickl$ .uickl$ /f the answer answer to both is 0$es1% it is worth proceedin' with the remainin' .uestions There is some de'ree of overlap between the .uestions% $ou are asked to record a 0$es1% 0no1 or 0can tell1 to most of the .uestions A number of italicised prompts are 'iven after each .uestion These are desi'ned to remind $ou wh$ the .uestion is important 2ecord $our reasons for $our answers in the spaces provided These checklists were desi'ned to be used as educational tools as part of a workshop settin' settin' There will not not be time in the small 'roups 'roups to answer them all all in detail
Cara menggunakan alat penilaian ini Ti'a isu $an' luas perlu dipertimban'kan ketika menilai sebuah studi kasus kontrol: Apakah hasil dari sidan' valid( ),a'ian A*
•
Apa hasiln$a( ),a'ian ,*
•
Akankah hasil membantu secara lokal( ),a'ian C*
•
pertan$aan pada alat ini dirancan' untuk membantu Anda berpikir tentan' masalah secara sistematis 4ua pertan$aan pertama $an' screenin' pertan$aan dan dapat di5awab den'an cepat 6ika 5awaban untuk kedua adalah 78a7% perlu dilan5utkan den'an pertan$aan $an' tersisaAda beberapa dera5at tumpan' tindih antara pertan$aan% Anda akan diminta untuk men5awab 7$a7% 7tidak7 atau 7dapat memberitahu 7untuk seba'ian besar pertan$a pertan$aan an Se5umlah Se5umlah petun5uk petun5uk dimirin' dimirin'kan kan diberikan diberikan setelah setelah setiap setiap pertan$a pertan$aan an Alat /ni dirancan dirancan'' untuk untuk men'in'atkan Anda men'apa pertan$aann$a adalah pentin' 9erekam alasan Anda untuk 5awaban Anda di tempat tempat $an' tersedia tersedia4afta 4aftar-pe r-pemband mbandin' in' ini dirancan' dirancan' untuk untuk di'unakan di'unakan seba'ai seba'ai alat pendidika pendidikann seba'ai seba'ai ba'ian dari pen'aturan pen'aturan lokakar$a Tidak akan ada waktu di kelompok-kelompok kelompok-kelompok kecil untuk men5awab mereka semua secara rinci
©Critical Appraisal Appraisal Skills Pro'ramme )CASP* Case Control Stud$ Checklist 3!3
Title !udul
"
;$'iene practices and se
#uthor $eneliti " F.N. Amiri, M.H. Rooshan, M.H. Ahmady and M.J. Soliamani
$u%lication %y $u%likasi oleh " =astern 9editerranean ;ealth 6ournal% >ol % No % ?!!@
&OES THIS ST'&( #&&RESS # CLE#R )'ESTIO*+ ,$ICO )uestion +ere the followin' clearl$ stated: $atients& Pasien Intervention& /ntervensi& =ksposure Comparison /ntervention& Pembandin' /ntervensi Outcome)s* & eluaran atau hasil
(es
*o
Can.t Tell
Pregnant women Sexual activity
/ /
/ /
No sexual activity
/
/
rinary tract in!ection
/
/
*o
Can.t Tell
/
/
0#LI&IT( ,#- #re the results o1 the study 2alid+ )A* Apakah hasil penelitian $an' valid(
(es
Screening )uestions 34 &id the study address a clearly 1ocused issue+ HI*T" # 5uestion can %e 1ocused in terms o1 The population studied The risk 1actors studied 6hether the study tried to detect a %ene1icial or harm1ul e11ect+
Pertan$aan skrinin'
8es B on pa'e % title and 1irstline a%stract " Hygiene #ractices and sexual activity associated with urinary
tract in!ection in #regnant women$
Apakah penelitian membahas masalah $an' 5elas terfokus( P=T"N6": Sebuah pertan$aan dapat difokuskan dalam hal Populasi $an' diteliti Daktor risiko $an' diteliti Apakah penelitian mencoba untuk mendeteksi men'untun'kan atau efek berbaha$a( 74 &id the authors use an 8es B on pa'e ?% st line para'raph under 8ethods: / appropriate method to answer their 5uestion+ “%his case&control study was #er!ormed on '(( women with HI*T" Consider #ositive urine culture )cases* and '+( healthy #regnant women Is a case control study )controls*, matched !or age, gestational age, #arity, occu#ation and an appropriate way o1 socioeconomic and education status.$ #nswering the 5uestion under the circumstances+ ,Is the outcome rare or harm1ul&id it address the study 5uestion+
? Apakah penulis men''unakan metode $an' tepat untuk men5awab pertan$aan mereka( P=T"N6": Pertimban'kan Apakah studi kasus kontrol den'an cara $an' tepat 9en5awab pertan$aan dalam situasi( )Apakah hasiln$a 5aran' atau berbaha$a* Apakah itu men5awab pertan$aan penelitian
Is it worth continuing+ &etailed 5uestions 94 6ere the cases recruited in an accepta%le way+ HI*T" 6e are looking 1or selection %ias which
8es B on pa'e ?% first and second para'raph under 8ethods: "%his case&control study was #er!ormed on '(( women with #ositive urine culture )cases* and '+( healthy regnant women )controls*, matched !or age, gestational age, #arity, occu#ation and socioeconomic and education status. %he women were selected
/
might compromise 2alidity o1 the 1indings : #re the cases de1ined precisely+ : 6ere the cases representati2e o1 a de1ined population+ ,geographically andor temporally+: 6as there an esta%lished relia%le system 1or selecting all the cases : #re they incident or pre2alent+ : Is there something special a%out the cases+ : Is the time 1rame o1 the study rele2ant to diseasee;posure+ : 6as there a su11icient num%er o1 cases selected+ : 6as there a power calculation+
3 Apakah kasus direkrut den'an cara $an' dapat diterima( P=T"N6": ami mencari bias seleksi $an' mun'kin membaha$akan validitas temuan Apakah kasus didefinisikan secara te'as( Apakah kasus wakil dari populasi tertentu( )secara 'eo'rafis dan & atau temporal(* Apakah ada sistem $an' handal $an' dibuat untuk memilih semua kasus( Apakah mereka insidens atau prevalens( Apakah ada sesuatu $an' khusus tentan'
consecutively !rom those attending + #ulic clinics at -aol niversity o! Medical Sciences !or #renatal care !rom ' January (( to ( Feruary ((/. %he exclusion criteria were a history o! 0 e#isodes o! %1 #er year, urinary stones or urinary tract anomaly, chronic disease )diaetes mellitus, sic2le3cell anaemia*, consum#tion o! any antiiotic or immune system inhiitory drugs in the #revious 4 months, or the #resence o! any anormal vaginal discharge.$
kasus( Apakah keran'ka waktu studi $an' relevan den'an pen$akit & eksposur( Apakah ada cukup ban$ak kasus dipilih( Apakah ada perhitun'an power penelitian(
<4 6ere the controls selected in an accepta%le way+ HI*T" 6e are looking 1or selection %ias which might compromise The generalisi%ilty o1 the 1indings : 6ere the controls representati2e o1 de1ined population ,geographically andor temporally: 6as there something special a%out the controls+ : 6as the non/response high+ Could non/ respondents %e di11erent in any way+ : #re they matched= population %ased or randomly selected+ : 6as there a su11icient num%er o1 controls selected+ E Apakah kontrol dipilih dalam cara $an' dapat diterima( P=T"N6": ami mencari bias seleksi $an' mun'kin kompromi Temuan "mum Apakah kontrol mewakili dari populasi tertentu
8es B on pa'e 3% third para'raph under 8ethods: "%he women were instructed how to give a clean3catch midstream urine s#ecimen. %he sam#les were sent to -aol Ra5i laoratory and the !resh urine was tested immediately. rinalyses and urine cultures were used !or the detection o! %1. A %1 was de!ined as the #resence o! signi!icant acteriuria 0 '(( ((( colony3!orming units #er m6 o! urine.$
)secara 'eo'rafis dan & atau temporal* Apakah ada sesuatu $an' khusus tentan' kontrol( Apakah non-respon tin''i( ,isa nonresponden berbeda den'an cara apapun( Apakah mereka cocok% populasi berdasarkan atau dipilih secara acak( Apakah ada 5umlah $an' memadai kontrol dipilih(
>4 6as the e;posure accurately measured to minimise %ias+ HI*T" 6e are looking 1or measurement= recall or lassi1ication %ias : 6as the e;posure clearly de1ined and accurately measured+ : &id the authors use su%?ecti2e or o%?ecti2e measurements+ : &o the measures truly re1lect what they are supposed to measure+ ,Ha2e they %een 2alidated+: 6ere the measurement methods similar in the cases and controls+ : &id the study incorporate %linding where 1easi%le+ : Is the temporal relation correct+ ,&oes the e;posure o1 interest precede the outcome+-
Apakah paparan diukur secara akurat untuk
8es B on pa'e ?-3% second para'raph under 8ethods: "7ata on the women8s genital hygiene and sexual #ractices were collected y 9uestionnaire com#leted y the midwives in the clinics. %he 9uestionnaire as2ed aout demogra#hic variales, !re9uency o! coitus )#er wee2 in the #revious 4( days*, genital hygiene #ractices, e.g. whether they usually urinated a!ter coitus )0 '+ minutes:; '+ minutes a!ter*, washing o! genitals #re coitus and #ostcoitus y the woman and her husand )yes:no:sometimes* and other health:hygiene #ractices, e.g. direction o!washing genitals )!ront to ac2:ac2 to !ront*, !re9uency o! changing underwear )numer o! times #er wee2*, !re9uency o! aths )numer o! times #er wee2*, drying a!ter voiding urine )yes:no*, voluntary delay in voiding urine )yes:no*, how much li9uid )0 :'&:; ' 6* drun2 #er day. %he 9uestionnaire also as2ed aout urological sym#toms !rom the eginning o! #regnancy until the interview< !re9uency was de!ined as total numer o! daily voids 0 = >'(? .”
meminimalkan bias( P=T"N6": ami mencari pen'ukuran% recall atau bias pen'elompokan Apakah eksposur 5elas dan akurat diukur( Apakah penulis men''unakan pen'ukuran sub5ektif atau ob5ektif( Apakah lan'kah-lan'kah $an' benar-benar mencerminkan apa $an' seharusn$a mereka untuk men'ukur( )Apakah mereka telah divalidasi(* Apakah metode pen'ukuran $an' sama dalam kasus-kasus dan kontrol( Apakah penelitian pen$amaran pen''abun' $' la$ak( Apakah hubun'an temporal $an' benar( )Apakah paparan mendahului hasiln$a(*
8es B on pa'e ?-3% first and second para'raph under 8ethods: @4 ,a- 6hat con1ounding 1actors ha2e the List" "%his case&control study was #er!ormed on '(( women with authors accounted 1or+ #ositive urine culture )cases* and '+( healthy regnant women HI*T" List the ones you )controls*, matched !or age, gestational age, #arity, occu#ation and think might %e important= socioeconomic and education status. %he women were selected that The author missed4 consecutively !rom those attending + #ulic clinics at -aol : Aenetic niversity o! Medical Sciences !or #renatal care !rom ' January : En2ironmental (( to ( Feruary ((/. %he exclusion criteria were a history o! 0 : Socio/economic e#isodes o! %1 #er year, urinary stones or urinary tract anomaly, ,%- Ha2e the authors chronic disease )diaetes mellitus, sic2le3cell anaemia*, taken account o1 the consum#tion o! any antiiotic or immune system inhiitory drugs in
potential con1ounding 1actors in the design andor in their analysis+ HI*T" Look 1or : Restriction in design= and techni5ues e4g4 modelling strati1ied/= regression/= or sensiti2ity analysis to correct= control or ad?ust 1or con1ounding 1actors
the #revious 4 months, or the #resence o! any anormal vaginal discharge.$
F )a* Apa faktor perancu dari penulis men$umban' didaftar( P=T"N6": 4aftar $an' Anda pikir mun'kin pentin'% $an' penulis melewatkann$a Genetik #in'kun'an Sosial-ekonomi )b* 9emiliki penulis diperhitun'kan potensi faktor pembaur dalam desain dan & atau dalam analisis mereka( P=T"N6": Carilah Pembatasan dalam desain% dan teknik misaln$a pemodelan stratified-% re'ression-% atau analisis sensitivitas untuk memperbaiki% kontrol atau men$esuaikan faktor perancu
H +hat are the results of this stud$( ;/NT: Consider +hat are the bottom line results( /s the anal$sis appropriate to the desi'n( ;ow stron' is the association between
8es B on pa'e ?% para'raph under Statistical analysis #nd Ta%le 7 Association of health and se
"7escri#tive statistics and the chi3s9uared,Fisher exact and t3
/
/
e
tests were used to com#are the grou#s. P ; (.(+ was consideredas signi!icant. A ris2 #ro!ile !or %1 was ex#ressed in the !orm o! odd ratios )@R*with +B con!idence intervals )C1* !or the +( women.$
H Apa hasil dari penelitian ini( P=T"N6": Pertimban'kan Apa hasil bottom line( Apakah analisisn$a tepat untuk desain( Seberapa kuat adalah hubun'an antara paparan dan hasil )melihat rasio odds*( Apakah hasil disesuaikan untuk perancu% dan mun'kin membin'un'kan masih men5elaskan asosiasi( Apakah pen$esuaian membuat perbedaan besar den'an J2(
I8$ORT#*T ,B- 6hat are the results+ ,B- #pa hasilnya+ 4 How precise are the results+ How precise is the estimate o1 risk+ HI*T" Consider : SiDe o1 the $/2alue : SiDe o1 the con1idence inter2als : Ha2e the authors considered all the important 2aria%les+ : How was the e11ect o1 su%?ects re1using to
participate e2aluated+ K ,a'aimana tepat hasiln$a( ,a'aimana tepat adalah estimasi risiko( P=T"N6": Pertimban'kan "kuran P-nilai "kuran interval keperca$aan apakah penulis mempertimban'kan semua variabel pentin'( ,a'aimana pen'aruh mata pela5aran menolak untuk ikut dievaluasi(
4 &o you %elie2e the results+ HI*T" Consider : Big e11ect is hard to ignore : Can it %e due to chance= %ias or con1ounding+ : #re the design and methods o1 this study su11iciently 1lawed to
NN; faktor 0Not washin' 'enitals Precoitus1 adalah H% Artin$a setiap H pasien $an' 0Not washin' 'enitals Precoitus1% akan muncul satu kasus /S pada ibu hamil ? NN; faktor 0;usband not washin' 'enitals precoitus1 adalah K% Artin$a setiap K pasien $an' 0;usband not washin' 'enitals precoitus1% akan muncul satu kasus /S pada ibu hamil 3 NN; faktor 0;usband not washin' 'enitals precoitus1 adalah K% Artin$a setiap K pasien $an' 0;usband not washin' 'enitals precoitus1% akan muncul satu kasus /S pada ibu hamil E NN; faktor 0Not washing genitals #ostcoitus1 adalah ?% Artin$a setiap ? pasien $an' 0Not washing genitals #ostcoitus1% akan muncul satu kasus /S pada ibu hamil NN; faktor 04ela$ in voidin' urine )voluntar$*1 adalah ?% Artin$a setiap 3 pasien $an' 0Dashing genitals !rom ac2 to !ront 1% akan muncul satu kasus /S pada ibu hamil F NN; faktor 0Not voiding urine #ostcoitus1 adalah ?% Artin$a setiap ? pasien $an' 00Not voiding urine #ostcoitus11% akan muncul satu kasus /S pada ibu hamil H NN; faktor 04ela$ in voidin' urine )voluntar$*1 adalah ??% Artin$a setiap ?? pasien $an' 00Not voiding urine #ostcoitus11% akan muncul satu kasus /S pada ibu hamil K NN; faktor "Not drin2ing #lenty o! li9uids$ adalah ?% Artin$a setiap ? pasien $an' 0"Not drin2ing #lenty o! li9uids$, akan muncul satu kasus /S pada ibu hamil 8es B on pa'e E% third para'raph under discussion "Sexual intercourse E 4 times #er wee2 was associated with greater !re9uency o! %1. %his association has een re#orted !or s#oradic and recurrent cystitis >'4,'/,'&'?. %he mechanical action o! sexual intercourse may !acilitate entry o! G. coli strains into the urethra and ladder, ecause sexual intercourse alters the normal lactoacillusdominant vaginal !lora and !acilitate G. coli coloni5ation o! the vagina >(,'?. ro#athogenic G. coli strains may in some cases e ac9uired y sexual transmission >?. %hese ex#osures, y !acilitating entry o! G. coli into the ladder, may initiate events leading to %1s.$
make the results unrelia%le+ : Consider Brad1ord Hills criteria ,e4g4 time se5uence= dose/ response gradient= strength= %iological plausi%ility@ Apakah Anda perca$a hasiln$a( P=T"N6": Pertimban'kan efek besar sulit untuk men'abaikan Apakah bisa karena kebetulan% bias atau membin'un'kan( Apakah desain dan metode penelitian ini cukup cacat untuk membuat hasil tidak dapat diandalkan( Pertimban'kan kriteria ,radford ;ills )misaln$a urutan waktu% dosisrespons 'radien% kekuatan% landasan biolo'is*
#$$LIC#BLE ,C- 6ill the results help locally+ )C* akan hasil membantu secara lokal( 3G4 Can the results %e applied to the local population+ HI*T" Consider whether : The su%?ects co2ered in the study could %e su11iciently di11erent 1rom your population to cause concern : (our local setting is likely to di11er much 1rom that o1 the study : Can you 5uanti1y the local %ene1its and harms+
8es B hasil penelitian ini bisa kita aplikasi kan pada pasien% faktor? $an' telah diteliti dan terbukti men$ebabkan /S perlu di komunikasikan dan diedukasikan ke pasien kita terutama faktor se
! 4apatkah hasil diterapkan untuk penduduk lokal( P=T"N6": Pertimban'kan apakah Sub$ek tercakup dalam studi ini bisa men5adi cukup berbeda dari populasi Anda menimbulkan kekhawatiran pen'aturan lokal Anda kemun'kinan akan berbeda 5auh dari $an' studi 4apatkah Anda men'ukur manfaat lokal dan meru'ikan(
334 &o the results o1 this study 1it with other a2aila%le e2idence+ HI*T" Consider all the a2aila%le e2idence 1rom RCT.s= systematic re2iews= cohort studies and case/control studies as well 1or consistency4
8es on pa'e E% Dourth para'raph under discussion "A history o! %1, any and recent, has een a consistently re#orted ris2 !actor !or suse9uent cystitis in oth young adult and #ostmeno#ausal women >'',','/,4,/?. @ur study con!irmed that a #revious %1 may #redis#ose to suse9uent %1 through ehavioural, microiological or genetic !actors. %hese !indings are consistent with other studies >/,+,+?.$
Apakah hasil penelitian ini sesuai den'an buktibukti lain $an' tersedia( P=T"N6": Pertimban'kan semua bukti $an' tersedia dari 2CT ini% tin5auan sistematis% penelitian kohort dan studi kasuskontrol serta untuk konsistensi
CO*CL'SIO*S 0#LI&IT( I8$ORT#*T #$$LIC#BLE
8=S 8=S 8=S
2emember Jne observational stud$ rarel$ provides sufficientl$ robust evidence to recommend chan'es to clinical practice or within health polic$ decision makin' ;owever% for certain .uestions observational studies provide the onl$ evidence 2ecommendations from observational studies are alwa$s stron'er when supported b$ other evidence
/n'at Satu studi observasional 5aran' memberikan bukti cukup kuat untuk merekomendasikan perubahan praktek klinis atau dalam pen'ambilan keputusan kebi5akan kesehatan Namun% untuk pertan$aan-pertan$aan tertentu studi observasional memberikan satu-satun$a bukti 2ekomendasi dari studi observasional selalu kuat bila didukun' oleh bukti-bukti lainn$a
