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    Asking AnswerableQuestion

    Anang Endaryanto

    Division of Allergy Immunology, Child Health DepartmentShool of !ediine "niversity of Airlangga # Dr Soetomo Hospital

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    LearningObjectiveSetelah mengikuti perkuliahan inimahasiswa diharapkan mampumemformulasikan pertanyaan

    klinis $ menyusun pertanyaanklinis tersebut dalam answerable

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    Patient /Problem /Population

    Intervention Comparison Outcome

    In a child withfrequent febrileseizures

    wouldanticonvulsanttherapy

    compared to notreatment

    result in seizurereduction?

    4

    &'()* !ampu !enyusun +ertanyaanlinis

    (PICO untuk Track-down)

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    &'(-% !ampu melakukan penarianpustaka dengan struktur umum

    PICO untuk Track-down

    # (Population OR snon!" OR snon!#$) %&'

    # (Intervention OR snon!" OR snon!#$) %&'

    # (Co!parator OR snon!" OR snon!#$) %&'# (Outco!e OR snon!" OR snon!#$)

    5

    earc* (+ealt Cild OR Cild OR Cildren)%&' (Probiotics OR Lactobacillus OR

    ,idobacteriu!) %&' (Placebo) %&' (In.uen/aOR Cold OR Co!!on Cold OR In.uen/a-like)

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    . Population0Proble!dari penelitian yang dilaporkan di /urnaltersebutadalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

    . Intervension0Indicator0Inde1dari penelitian yang dilaporkan di/urnal tersebutadalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

    . Controldari penelitian yang dilaporkan di /urnal tersebutadalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

    . Outco!edari penelitian yang dilaporkan di /urnal tersebutadalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

    &'(0 * !ampu !enyebutkanPICO dari 2urnal untuk Critical

    %ppraisal

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    &'(1* !ampu menyebutkan Disain,2okus dari 2urnal $ 3orksheet yangdigunakan untuk telaah kritis dari

    2urnal ang diperole%Disain dari penelitian yang dilaporkan di /urnal tersebutadalah*A4% Cross sectional%54% Case control3C4% Coort3D4% Eksperimental%

    E4% uasi Eksperimental%

    2okus dari penelitian tersebut adalah*A4% !anifestasi klinik%54% Causation3C4% +rognosis%D4% Diagnosis%E4% 6erapi%

    4orkseetyang paling tepat untuk digunakan untuktelaah kritis laporan penelitian dalam /urnal tersebutadalah workseet*A4% !anifestasi klinik%54% Systemati 7eview8!etaanalysis%C4% +rognosis%

    D4% Diagnosis%E4% 6erapi%

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    . Apakah penelitian yang dilaporkandalam /urnal tersebut 9A&ID:

    . Apakah I!+'76A;C< dalam penelitiantersebut tergambar dalam /urnaltersebut:

    . Apakah hasil penelitian yang dilaporkandalam /urnal tersebut bersifatA++&ICA5&E untuk pasien kita:

    &'(=* !ampu melakukan telaah kritis>9IA4

    (Critical %ppraisal)

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    Contoh kasus:

    +ertanyaan orang tua pasien kepada dokter* Apayang seharusnya saya lakukan untuk mencegah

    anak saya terserang sakit fu?%

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    &angkah pertama>menyusun pertanyaan klinis4

    . Sebelum melangkah ke kegiatan penelusuran pustaka u/iklinis, yang harus dilakukan adalah menentukan masalahapa yang sebenarnya dihadapi oleh pasien yangmemerlukan solusi.

    . 5ila pertanyaan orangtua* Apa yang seharusnya saya

    lakukan untuk mencegah anak saya terserang sakitfu?, maka pertanyaan tersebut sulit diarikan /awabannyadari penarian pustaka dalam u/i klinis%

    . Agar pertanyaan klinis dapat di/awab, maka pertanyaan klinistersebut harus memiliki iri(iri pertanyaan yang baik, yaitu*

    #+ertanyaan klinis harus relevan dengan masalah yangdihadapi%

    # +ertanyaan klinis disusun dalam frasa yang dapatditerapkan untuk penelusuran pustaka

    # +ertanyaan klinis harus fokus pada masalah danterartikulasi dengan baik%

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    +erbaikan pertanyaan klinis

    Harus diper/elas*

    .arakteristik Subyek# Subyeknya siapa:

    . 5ayi, anak, rema/a, atau orang dewasa%# 5agaimana kondisi Subyek:

    . Sehat,menderita penyakit tertentu, atau sehat

    dengan risiko tertentu%

    .Intervensi# Intervensi apa yang ingin dilakukan:%

    . 'bat(obatan, vaksinasi, nutrisi, atau edukasi%

    .!anfaat# !anfaat apa yang kita harapkan: >menegah,

    meredakan atau menyembuhkan ge/ala4%# 5ila manfaat yang dipikirkan adalah menegah,

    bagaimana ara mengukurnya: >kriteria klinis atau

    laboratoris4

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    !enyusun pertanyaan5ila klinisi tertarik untuk menelaah penegahan sakit ?u

    dengan probiotik, maka kalimat pertanyaanApa yang seharusnya saya lakukan untukmencegah anak saya terserang sakit fu?

    harus diperbaiki men/adi pertanyaan yang yang bisadi/awab, ontoh* Pada anak sehat apakah X

    dapat mencegah sakit fu.

    .Sehingga dari pertanyaan tersebut kita dapat membuatsusunan pertanyaan sebagai berikut*

    # P (population/problem) : anak sehat

    # I (intervention) : probiotik

    # C (comparator/control) : tanpa probiotik

    # (outcome) : sakit fu

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    !angkah kedua"mencari bukti terbaik#

    . Setelah /elas susunan pertanyaan yang menerminkan !asala pasiendengan karakteristik tertentu (P)dengan renana penyelesaian masalahdengan !enggunakan intervensi tertentu (I)dengan indikatorkeberasilan tertentu (O)5 maka kita bisa melakukan penarian pustakadengan struktur umum untuk pertanyaan klinis*

    # (Population OR synonym1 OR synonym2) AND# (Intervention OR synonym1 OR synonym2) AND

    # (Comparator OR synonym1 OR synonym2) AND

    # (Outcome OR synonym1 OR synonym2)

    . earc# 1! Probiotics OR "actobacillus OR #i$%obacterium

    # 2! &ealt'y C'il% OR C'il% OR C'il%ren

    # ! Placebo

    # ! In*uen+a OR Col% OR Common Col% OR In*ien+a,li-e

    . earc* (Probiotics OR Lactobacillus OR ,idobacteriu!) %&' (+ealtCild OR Cild OR Cildren) %&' (Placebo) %&' (In.uen/a OR Cold OR

    Co!!on Cold OR In.ien/a-like)

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    !angkah kedua"mencari bukti terbaik#

    earcing*

    (Probiotics OR Lactobacillus OR,idobacteriu!) %&' (+ealt

    Cild OR Cild OR Cildren) %&'

    (Placebo) %&' (In.uen/a OR ColdOR Co!!on Cold OR In.ien/a-like)

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    Asking AnswerableQuestion

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    re0uency o uestions

    Brassey et al. BMJ2001;322:529-530.

    http://www.bmj.com/content/vol322/issue7285/images/large/braj1680.f1.jpeg
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    $o%accurateadiagnostictes

    tis

    invariouspatientgroupsandin

    omparison%ithothera&ailabletests.!easuresoftestaurayinludeits3n43p4"&4PP54N

    P56

    6uestion*@2or women with abdominal pain, isultrasono7rap'yas aurate >ie

    with eual or better sensitivity andspeiBity4 as 8RIfor %ia7nosin7appen%icitis:

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    . An answerable questions

    . 2ormulate researc questions

    . 5reaks down the uestion into 7 keele!ents

    8enyusun pertanyaanpenelitian9

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    :oo% clinical 0uestion!PICO

    .6he Patient or Problem

    .6he Intervention 8 Indiator 8Inde test

    . Comparative intervention >if relevant4

    .6he utome

    'e brie( andspeci)c.....

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    Patient4 Population4(clinical) Problem

    . +atient or patient group >gender, rae,age4

    . Disease or ondition

    . Stage of the illness

    . Care setting

    Penting

    untukgeneralisasiasil

    enelitian

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    Intervention4 In%icator4In%e; drug, proedure, therapy4

    . Intervention level>dosage, freueny4

    . tageof intervention >preventative, early,advaned4

    . 'eliver>who delivers the intervention: where:4

    I*/ICA+-

    . 81posure

    . 2ators that a9ect a ealt outco!e

    I*/,X +,0+* a Diagnosti test

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    Comparison

    . Alternative interventions >standardtreatment, plaebo, anotherintervention4, indiators or diagnosti

    test

    .6here may not always be aomparison

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    Outcome

    6he outome or eets you >and8orpatients4

    .I!prove!ent of symptoms, healing

    .ide e9ects

    .Improved qualit o: li:e

    .Cost e9ectiveness and benetsfor theprovider

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    Patient 1Problem 1Population

    Inter&ention Comparison utcome

    +ada

    penderitadengansindromsyokdenguepadaresusitasiinisial

    apakah

    pemberianairankoloid

    dibandingka

    n kristaloidisotonis

    akan

    memberikan responsterapi yanglebih baik

    8enyusun pertanyaan-linis9

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    6reatment

    Patient 1Problem 1

    Population

    Inter&ention Comparison utcome

    In a hildwithfreuentfebrileseiFures

    wouldantionvulsant therapy

    omparedto notreatment

    result inseiFureredution:

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    Diagnosis

    Patient 1Problem 1

    Population

    Inter&ention Comparison utcome

    In anotherwisehealthy G(year(oldboy withsore throat

    how doesthe linialeam

    ompare tothroatulture

    indiagnosing;roup-%treptococcal infetion:

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    +rognosis

    Patient 1Problem 1

    Population

    Inter&ention Comparison utcome

    In hildrenwith Downsyndrome,

    is IQ animportantprognostifator

    ( inpreditingAlFheimerslater in life:

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    Etiology 8 Harm

    Patient 1Problem 1

    Population

    Inter&ention Comparison utcome

    ontrollingforonfounding fators,dootherwisehealthyhildren

    eposed inutero tooaine,

    omparedto hildrennot eposed

    haveinreasedinidene oflearningdisabilitiesat age siyears:

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    7elevane* +'Es and D'Es

    . D'E 'isease orientedevidene# 'logiesJ >path(, etiol(, pathophys(4

    # ie !ed shool

    . +'E Patient oriented evidene

    # !orbidity, mortality or uality of life# Something a patient would areabout without eplanation

    # Highest uality evidene

    Focused

    Onpatient need

    Focused

    Ondisease

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    Comparing D'Es and+'E!s

    +rostatesreening

    +SA sreeningdetets prostate

    Ca% early

    : whether +SAsreening mortality

    D'E eists, but+'E! unknown

    Antiarrhythmi6herapy

    Antihypertens%

    6herapy

    Drug A +9C'n ECK

    Drug L 5+Drug L mortality

    Drug A Mmortality

    D'E $ +'E!

    ontradits

    +'E! agrees3ith D'E

    Eample D'E +'E! Comment

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    +'E!s

    . +atient 'riented Evidene that!atters

    . !atters beause if it is true,it reuires you to hange yourpratie

    . >Also a review of an artile writtenand published in a speiBed format seondary literature4

    PICO i

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    +itle

    'ackground"Clinical 2uestion#

    'ackground"b3ecti&e#

    4ethod

    -esult

    Conclusion

    P5 I5 "C#5

    0e3auh ini pengaruh I untuk ter3adi pada P "dibanding C# belum 3el

    4engetahui e(ek I dalam hal pada P

    P677I6 777 C67.

    677.

    677

    Pada P5 I berpengaruh padater3adinya

    PICO inResearc

    '

    PIC.8here?

    ili' %i i li i

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    Hierarhy of study designs 5IAS vs

    7ISRandomised controlled trialRandomised controlled trial

    Cohort studiesCohort studies

    Case-control studiesCase-control studies

    Cross-sectional studiesCross-sectional studies(Clinical observation (Case(Clinical observation (Case

    reportcase-series!reportcase-series!

    "nalytical

    #escriptive

    $%periment

    al

    &bserv

    ational

    'east biased

    ost biased

    ost ris)

    'east ris)

    Pemili'an %isain penelitian

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    . 7A;D'!ISA6I';# Alloate sub/ets among study groups randomly >by

    hange4

    . S67A6I2ICA6I';8!"&6I9A7IA6E A;A&ase(ontrol4

    . 7ES67IC6I';

    # admit only those who fall into speiBed atagories of

    eah variable of interest >inlusion8elusion riteria4

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    9...9n6 X. X;. X. X. [email protected]

    9 >'4utome

    9 host

    9 agent

    9 environment

    9 time

    9 plae

    9 et%

    Con(ounder

    9 >I4ntervention, indiator, inde

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    ResearcherInvolvement

    Longitudinal

    Cross-sectional

    ResearchGoal

    ResearchApproach

    Controlled?Randomized?

    ResearchFocus Clinical Manifestation / Diagnosis / Causation/Prognosis / Therapy / Review

    13 2 4

    experim

    ental

    observasional

    Control

    (+)

    Control(-)

    8enetap-an %isainpenelitian

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    8enetap-an %isain penelitian

    8enetap-an %isain penelitian

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    8enetap-an %isain penelitian

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    -A*/4I0A+4A+C$I*10+-A+IBICA+I*

    4A+C$I*

    8en%isain

    penelitian

    P t liti

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    9...9n6 X. X;. X. X. [email protected]

    9 >'4utome

    9 host

    9 agent

    9 environment

    9 time

    9 plae

    9 et%

    Con(ounder

    9 >I4ntervention, indiator, inde

    Pertanaan penelitian siFe of the beneBt4

    # Appliability

    1% Integrate with linial epertise and patient

    values=% Evaluate our eetiveness and eOieny

    # keep a reordP improve the proess45

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    +IC'

    &iterature

    Searhing42

    PICO : T k d

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    earc>"* +ealt Cild OR Cild OR Cildren

    >#* Probiotics OR Lactobacillus OR ,idobacteriu!

    >?* Placebo

    >7* In.uen/a OR Cold OR Co!!on Cold OR In.ien/a-like

    earc* (+ealt Cild OR Cild OR Cildren) %&'

    (Probiotic@ OR Lactobacillus OR ,idobacteriu!) %&'(Placebo) %&' (In.uen/a OR Cold OR Co!!on Cold ORIn.uen/a-like)

    43

    PICO o: Track down

    PICO : T k d

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    >infant '7 newborn '7 neonat '7 pediatri '7paediatri4

    A;D

    >hydrolysed4

    A;D

    >feed '7 food '7 formula '7 protein '7 milk4

    A;D

    >asthma '7 atopi dermatitis '7 eFema '7 allergi rhinitis'7 ows milk intolerane '7 soy protein intolerane '7ows milk allergy '7 soy protein allergy '7 food allergy

    '7 food intolerane '7 urtiaria '7 anaphylais4

    4

    PICO o: Track down

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    +IC'

    Critially appraise

    4

    +IC' of Critially appraise

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    P Population

    CComparator

    I C

    utcomesyes

    no

    I Indicator

    a b

    d

    0ource

    0ub3ects

    -eruitR% 3as a deBnedrepresentati&e sample ofpatients assembled at aommon >usually early4point in the ourse of theirdisease:

    Ad3ustment > How werepatients treated: Didad/ustment for importantprognosti fators takeplae:

    4aintenance 3as theomparable status of thestudy groups maintainedthrough eual managementand ade2uate (ollo%Dup?:

    4easure outomes with *blinded sub/ets $ assessors $

    or

    +IC' of Critially appraise

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    =okusPenelitian

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    +itle

    'ackground"Clinical 2uestion#

    'ackground"b3ecti&e#

    4ethod

    -esult

    Conclusion

    P5 I5 "C#5

    0e3auh ini pengaruh I untuk ter3adi pada P "dibanding C# belum 3el

    4engetahui e(ek I dalam hal pada P

    P677I6 777 C67.

    677.

    677

    Pada P5 I berpengaruh padater3adinya

    +IC' ofCritially

    appraise

    PIC.8here?

    8est C,5 $ammarstrom 4!5 $ernel .

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    A redued mirobial load early in life has been suggested to be linked to the

    inreasing prevalene of allergi diseases in the industrialiFed world% Somestudies have indiated that probiotis may be eetive in the prevention ofeFema% In vitro studies indiate that probiotis have immunomodulatory eets%

    In the present study, we evaluated the eets of feeding &atobaillus 2) duringweaning on the inidene of eFema and 6h)86h- balane%

    In a double(blind, plaebo(ontrolled randomiFed intervention trial, infants werefed ereals with >n T4 or without &atobaillus 2) >n U4 from 1 to )0months of age% 3e assessed the umulative inidene of eFema at )0 months ofage% 6he ratio of interferon(gamma >I2;(gamma4 to interleukin 1 >I&14 m7;Aepression levels in polylonally stimulated peripheral blood 6 ells was used as aproy for immune balane% 6otal and speiB IgE serum levels were also assessed%

    6he umulative inidene of eFema at )0 months was ))V >1()GV, =V CI4 and--V >)0(0)V, =V CI4 in the probioti and plaebo groups, respetively >p WU%U=4% 6he number needed to treat was >X%=())%=, =V CI4% At )0 months of age,

    the I2;(gamma8I&1 m7;A ratio was higher in the probioti ompared with theplaebo group >p W U%U=4% In ontrast, there were no dierenes between groupsin serum onentrations of IgE%

    In summary, feeding &atobaillus 2) during weaning ould be an eetive toolin the prevention of early manifestation of allergy, e%g%, eFema% 6he higher6h)86h- ratio in the probioti ompared with the plaebo group suggestsenhaning eets of &atobaillus 2) on the 6 ell(mediated immune response%

    8est C,5 $ammarstrom 4!5 $ernel .Probiotics during %eaningreduce the incidence o( ecEema.

    +ediatr Allergy Immunol% -UU AugP-U>=4*10U(G

    8est C,5 $ammarstrom 4!5 $ernel .

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    /esign:Double(blind, plaebo(ontrolled randomiFed intervention trial

    PopulationInfant >=ed cereals)Inter&ention&atobaillus 2) >n T4 from 1 to )0 months of age%Control+laebo >or without &atobaillus 2)4 >n U4utcome F -esult

    .6he ratio of interferon(gamma >I2;(gamma4 to interleukin 1 >I&14 m7;Aepression levels in polylonally stimulated peripheral blood 6 ells wasused as a proy for immune balane%

    .6he umulative inidene of eFema at )0 months was ))V >1()GV, =VCI4 and --V >)0(0)V, =V CI4 in the probioti and plaebo groups,respetively >p W U%U=4%

    .6he nu!ber needed to treat was >X%=())%=, =V CI4%

    .At )0 months of age, the I2;(gamma8I&1 m7;A ratio was higher in theprobioti ompared with the plaebo group >p W U%U=4%

    .6here were no dierenes between groups in serum onentrations of IgE%Conclusions. 2eeding &atobaillus 2) during weaning ould be an eetive tool in the

    prevention of early manifestation of allergy, e%g%, eFema%.6he higher 6h)86h- ratio in the probioti ompared with the plaebo group

    suggests enhaning eets of &atobaillus 2) on the 6 ell(mediated

    immune response%

    5 5Probiotics during %eaning reduce the incidence o( ecEema.

    +ediatr Allergy Immunol% -UU AugP-U>=4*10U(G

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    oal Djian

    %kir 8,A

    0oa t pe p an

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    0oa t pe p anberganda

    Petunjuk* pilila " jawaban ang

    paling benar*Disain dari penelitian yang dilaporkan di /urnal tersebutadalah*A4% Cross sectional%54% Case control3C4% Coort3D4% Eksperimental%E4% uasi Eksperimental%

    2okus dari penelitian tersebut adalah*A4% !anifestasi klinik%54% Causation3C4% +rognosis%D4% Diagnosis%E4% 6erapi%

    4orkseetyang paling tepat untuk digunakan untuktelaah kritis laporan penelitian dalam /urnal tersebutadalah workseet*A4% !anifestasi klinik%54% Systemati 7eview8!etaanalysis%C4% +rognosis%D4% Diagnosis%

    E4% 6erapi%

    0oal tipe 3a%aban

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    0oal tipe 3a%abansingkat:

    Petunjuk* 2awabla dengan " kali!at

    saja. Population0Proble!dari penelitian yang dilaporkan di /urnaltersebutadalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

    . Intervension0Indicator0Inde1dari penelitian yang dilaporkan di/urnal tersebutadalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

    . Controldari penelitian yang dilaporkan di /urnal tersebutadalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

    . Outco!edari penelitian yang dilaporkan di /urnal tersebutadalah%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%

    0 l , i i

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    0oal ,sei uraianterbatas.

    Petunjuk* 2awabla dengan sala satu dari ? pilian(EFaG5 ETidakG5 atau ETidak jelasG)5 ang diikutidengan alasan jawaban !aksi!al " paragra:

    dengan isi !aksi!al H kali!at0paragra:)

    . Apakah penelitian yang dilaporkan

    dalam /urnal tersebut 9A&ID:. Apakah I!+'76A;C< dalam penelitian

    tersebut tergambar dalam /urnaltersebut:

    . Apakah hasil penelitian yang dilaporkandalam /urnal tersebut bersifatA++&ICA5&E untuk pasien kita:

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