Absolute Risk Reduction

2007 ◽  
Author(s):  
Robert G. Newcombe
Keyword(s):  
Risk Reduction ◽  
Absolute Risk ◽  
Absolute Risk Reduction

Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

2021 ◽  
pp. 1-6
Author(s):  
A S Khatiwada ◽  
A S Harris
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Clinical Trials ◽  
Total Thyroidectomy ◽  
Risk Reduction ◽  
Operative Treatment ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Vitamin D Supplementation ◽  
Absolute Reduction

Abstract Objective This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy. Method This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy. Results Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13–59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11–40 per cent) following pre-operative supplementation. Conclusion Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

scholarly journals Amblyopia screening effectiveness at 3–4 years old: a cohort study

2021 ◽  
Vol 6 (1) ◽  
pp. e000599
Author(s):  
Sandra Guimaraes ◽  
Andreia Soares ◽  
Cristina Freitas ◽  
Pedro Barros ◽  
Ricardo Dourado Leite ◽  
...  
Keyword(s):  
Risk Reduction ◽  
Treatment Effectiveness ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Number Needed To Screen ◽  
History Of ◽  
Disease Study ◽  
New Diagnosis ◽  
Screening Effectiveness ◽  
Timely Referral

ObjectiveTo study the effectiveness of amblyopia screening at ages 3–4.Methods and AnalysisFrom a population with no previous screening, a cohort of 2300 children with 3–4 years old attending school (91% of children this age attend school in Portugal), were submitted to a complete ophthalmological evaluation. Amblyopia was diagnosed, treated and followed. Amblyopia prevalence, treatment effectiveness, absolute risk reduction (ARR), number needed to screen (NNS) and relative risk reduction (RRR) were estimated.ResultsPast/present history of amblyopia was higher than 3.1%–4.2%, depending on amblyopia definition normatives. Screening at age 3–4, had estimated ARR=2.09% (95% CI 1.50% to 2.68%) with a reduced risk of amblyopia in adulthood of 87% (RRR). NNS was 47.8 (95% CI 37.3 to 66.7). Treatment effectiveness of new diagnosis was 88% (83% if we include children already followed). 91% of new amblyopia diagnoses were refractive (of which 100% surpassed amblyopia Multi-Ethnic Pediatric Eye Disease Study criteria after treatment), while most strabismic amblyopias were already treated or undertreatment. Only 30% of children with refractive amblyopia risk factors that were not followed by an ophthalmologist, ended up having amblyopia at age 3–4. Eye patch was needed equally in new-diagnosis versus treated-earlier refractive amblyopia.ConclusionsScreening amblyopia in a whole-population setting at age 3–4 is highly effective. For each 48 children screened at age 3–4, one amblyopia is estimated to be prevented in the future (NNS). Screening earlier may lead to overdiagnosis and overtreatments: Treating all new diagnosis before age 3–4 would have a maximal difference in ARR of 0.3%, with the possible burden of as much as 70% children being unnecessary treated before age 3–4.Involving primary care, with policies for timely referral of suspicious/high-risk preverbal children, plus whole screening at age 3–4 seems a rational/effective way of controlling amblyopia.

Abstract P297: Long-Term Benefit Comparison of Absolute Risk Reduction versus Absolute Risk to Prioritize Statin Therapy

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Ciaran N Kohli-Lynch ◽  
Andrew E Moran ◽  
George Thanassoulis ◽  
Allan D Sniderman ◽  
Yiyi Zhang ◽  
...  
Keyword(s):  
Risk Factor ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Treatment Initiation ◽  
Absolute Risk ◽  
Treatment Strategies ◽  
Absolute Risk Reduction ◽  
Statin Treatment ◽  
Policy Model

Introduction: Individuals with no established cardiovascular disease (CVD) are currently recommended preventive statin therapy based on 10-year absolute risk (AR) of CVD, and individuals with a 10-year AR ≥7.5% are recommended statins. However, individuals with elevated LDL cholesterol experience greater absolute CVD absolute risk reduction (ARR) from statin therapy compared with those with the same 10-year AR but with lower LDL. A previous study showed that ARR-based statin treatment would prevent more CVD events than AR-based treatment in the 10 years following treatment initiation. Objective: This study aimed to quantify the long-term benefits of treating patients based on ARR rather than AR. Methods: A microsimulation version of the CVD Policy Model, a decision-analytic state transition model, simulated intermediate-strength statin therapy in 40,000 CVD-free US adults (50% female) under a variety of treatment strategies. The model predicts health outcomes for individuals based on their age, sex, and risk factor profile, accounting for the competing risk of non-CVD mortality. Individuals entered the model aged 40 years, and a time horizon of 40 years was employed. Life year gains and CVD events prevented compared to no treatment were estimated for a range of 10-year ARR and AR treatment initiation thresholds. Results: At the same numbers of patient-years of treatment (PYoT), ARR consistently produced more life year gains than AR (Figure). A 10-year ARR threshold of ≥2.62% would lead to approximately the same PYoT as standard of care (10-year AR ≥7.5%) while preventing 60 additional CVD events and producing 421 additional life year gains in the cohort. Conclusion: Treating patients with statins based on ARR would yield significant health gains in the U.S. population compared to standard AR-based treatment strategies. The ARR strategy may also achieve greater adherence and uptake as it focuses on individuals with elevated levels of a modifiable risk factor.

Folic Acid and Folinic Acid for Reducing Side Effects in Patients Receiving Methotrexate for Rheumatoid Arthritis

2014 ◽  
Vol 41 (6) ◽  
pp. 1049-1060 ◽  
Author(s):  
Beverley Shea ◽  
Michael V. Swinden ◽  
Elizabeth Tanjong Ghogomu ◽  
Zulma Ortiz ◽  
Wanruchada Katchamart ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Trials ◽  
Folic Acid ◽  
Side Effects ◽  
Folinic Acid ◽  
Risk Reduction ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Risk Of Bias ◽  
Serum Transaminase

Objective.To perform a systematic review of the benefits and harms of folic acid and folinic acid in reducing the mucosal, gastrointestinal, hepatic, and hematologic side effects of methotrexate (MTX); and to assess whether folic or folinic acid supplementation has any effect on MTX benefit.Methods.We searched the Cochrane Library, MEDLINE, EMBASE, and US National Institutes of Health clinical trials registry from inception to March 2012. We selected all double-blind, randomized, placebo-controlled clinical trials in which adult patients with rheumatoid arthritis (RA) were treated with MTX (dose ≤ 25 mg/week) concurrently with folate supplementation. We included only trials using low-dose folic or folinic acid (a starting dose of ≤ 7 mg weekly) because the high dose is no longer recommended or used. Data were extracted from the trials, and the trials were independently assessed for risk of bias using a predetermined set of criteria.Results.Six trials with 624 patients were eligible for inclusion. Most studies had low or unclear risk of bias for key domains. The quality of the evidence was rated as “moderate” for each outcome as assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) working group, with the exception of hematologic side effects, which were rated as “low.” There was no significant heterogeneity between trials, including where folic acid and folinic acid studies were pooled. For patients supplemented with any form of exogenous folate (either folic or folinic acid) while receiving MTX therapy for RA, a 26% relative (9% absolute) risk reduction was seen for the incidence of gastrointestinal side effects such as nausea, vomiting, or abdominal pain (RR 0.74, 95% CI 0.59 to 0.92; p = 0.008). Folic and folinic acid also appear to be protective against abnormal serum transaminase elevation caused by MTX, with a 76.9% relative (16% absolute) risk reduction (RR 0.23, 95% CI 0.15 to 0.34; p < 0.00001), as well as reducing patient withdrawal from MTX for any reason [60.8% relative (15.2% absolute) risk reduction, RR 0.39, 95% CI 0.28 to 0.53; p < 0.00001].Conclusion.The results support a protective effect of supplementation with either folic or folinic acid for patients with RA during treatment with MTX. There was a clinically important significant reduction shown in the incidence of GI side effects and hepatic dysfunction (as measured by elevated serum transaminase levels), as well as a clinically important significant reduction in discontinuation of MTX treatment for any reason.

scholarly journals Preterm neonates benefit from low prophylactic platelet transfusion threshold despite varying risk of bleeding or death

Blood ◽  
2019 ◽  
Vol 134 (26) ◽  
pp. 2354-2360
Author(s):  
Susanna F. Fustolo-Gunnink ◽  
Karin Fijnvandraat ◽  
David van Klaveren ◽  
Simon J. Stanworth ◽  
Anna Curley ◽  
...  
Keyword(s):  
Risk Reduction ◽  
Major Bleeding ◽  
Platelet Transfusion ◽  
Risk Group ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Baseline Risk ◽  
Multivariate Logistic Regression Model ◽  
Preterm Neonates ◽  
Transfusion Threshold

Abstract The Platelets for Neonatal Thrombocytopenia (PlaNeT-2) trial reported an unexpected overall benefit of a prophylactic platelet transfusion threshold of 25 × 109/L compared with 50 × 109/L for major bleeding and/or mortality in preterm neonates (7% absolute-risk reduction). However, some neonates in the trial may have experienced little benefit or even harm from the 25 × 109/L threshold. We wanted to assess this heterogeneity of treatment effect in the PlaNet-2 trial, to investigate whether all preterm neonates benefit from the low threshold. We developed a multivariate logistic regression model in the PlaNet-2 data to predict baseline risk of major bleeding and/or mortality for all 653 neonates. We then ranked the neonates based on their predicted baseline risk and categorized them into 4 risk quartiles. Within these quartiles, we assessed absolute-risk difference between the 50 × 109/L- and 25 × 109/L-threshold groups. A total of 146 neonates died or developed major bleeding. The internally validated C-statistic of the model was 0.63 (95% confidence interval, 0.58-0.68). The 25 × 109/L threshold was associated with absolute-risk reduction in all risk groups, varying from 4.9% in the lowest risk group to 12.3% in the highest risk group. These results suggest that a 25 × 109/L prophylactic platelet count threshold can be adopted in all preterm neonates, irrespective of predicted baseline outcome risk. Future studies are needed to improve the predictive accuracy of the baseline risk model. This trial was registered at www.isrctn.com as #ISRCTN87736839.

scholarly journals P.150 Use of Antibacterial Envelopes for Prevention of Infection in Neuromodulation

2021 ◽  
Vol 48 (s3) ◽  
pp. S63-S63
Author(s):  
A Persad ◽  
S Ahmed ◽  
R Mercure-Cyr ◽  
K Waterhouse ◽  
A Vitali
Keyword(s):  
Risk Reduction ◽  
Infection Rate ◽  
Pulse Generator ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Historical Cohort ◽  
Cardiac Devices ◽  
Pump Placement ◽  
Substantial Risk ◽  
The Absolute

Background: Neuromodulation unit placement carries a historic infection rate as high as 12%. TYRX antibacterial envelopes (Medtronic Inc., Minneapolis, MN), which are absorbable mesh envelopes that elute minocycline and rifampin, have been used in implantable cardiac devices with substantial risk reduction for infection. Methods: We conducted a retrospective cohort study of consecutive implantable pulse generator (IPG) and intrathecal pump unit implantation with a TYRX antibacterial envelope©. This cohort was then compared to a historical cohort of consecutive patients undergoing IPG or pump placement or revision prior to the use of the envelopes. Results: In the pre-envelope cohort of 151 IPGs in 116 patients, the infection rate was 18/151 (11.9%). In the antibacterial envelope cohort of 233 IPGs in 185 patients, the infection rate was (2.1%). The absolute risk reduction was 4.6% (95% CI, 0.045-0.048), The pre-envelope cohort of 41 pumps in 39 patients, the infection rate was 6/41 (14.6%). In the antibacterial envelope cohort of 59 pumps in 54 patients, the infection rate was (1.7%). The absolute risk reduction was 12.9% (95% CI 1.6-24.3). Conclusions: Usage of an antibacterial envelope for neuromodulation has resulted in a lower infection rate at our center. Based on these results, we recommend the use of antimicrobial envelopes.

scholarly journals Reduced cardiovascular morbidity in patients with hemophilia: results of a 5-year multinational prospective study

2021 ◽  
Author(s):  
Paul Van Der Valk ◽  
Michael Makris ◽  
Kathelijn Fischer ◽  
Robert C Tait ◽  
Pratima Chowdary ◽  
...  
Keyword(s):  
Risk Reduction ◽  
Risk Model ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Clotting Factor ◽  
Cvd Risk ◽  
Multicenter Observational Study ◽  
Clotting Factor Concentrates ◽  
Prospective Multicenter Observational Study

Hemophilia is a congenital bleeding disorder caused by low clotting factor VIII or IX levels. Life expectancy of people with hemophilia (PWH) has increased with the availability of clotting factor concentrates. At the same time, the incidence of cardiovascular disease (CVD) has increased. In retrospective studies there are conflicting data if, despite this increase, the incidence is still lower than in the general population. We prospectively compared the incidence of CVD in PWH with the predicted incidence. This prospective, multicenter, observational study included adult PWH (&gt;30y) from the Netherlands and United Kingdom (UK). They were followed for a 5-year period and CVD incidence was compared with a predicted event rate based on the QRISK2-2011 CVD risk model. The primary endpoint was the observed fatal and nonfatal CVD incidence after 5 years compared to the estimated events and in relation to severity of hemophilia. The study included 709 patients, of whom 687 (96.9%) completed 5 years follow up or reached an endpoint. For 108 patients the QRISK score could not be calculated at inclusion. For the remaining 579 fewer CVD events were observed than predicted: 9 versus 24 (RR 0.38; 95% CI: 0.18 - 0.80 p=0.01), corresponding with an absolute risk reduction of 2.4%. Severe hemophilia treated on demand had the highest risk reduction. There was no statistical significant relation between severity of hemophilia and incidence of CVD. In hemophilia a lower than predicted CVD incidence was found, supporting the theory that hemophilia protects against CVD. The study is registered at www.clinicaltrials.gov (identification number NCT01303900).

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