Understanding and Communicating Risk: Assessing both Relative and Absolute Risk Is Absolutely Necessary

Objective: To evaluate clinical and echocardiographic outcomes for the semi-flexible Carpentier-Edwards Physio and the rigid Classic mitral annuloplasty ring. Methods: Ninety-six patients were randomized for either a Classic (n = 53) or a Physio (n = 43) ring from October 1995 through July 1997. Mean follow-up was 5.1 years (range .1-6.6). We included standard patient characteristics at baseline and during follow-up. Analyses were adjusted for age and gender, and for factors that differed across groups at baseline. In 2002, echocardiography was performed in 74% of the survivors. Results: We found a 16% difference in mortality: 14% in the Physio group (n = 6) and 30% in the Classic group (n = 16) (adjusted P = .41). Life table analysis shows that the absolute risk of death after 30 months is lower in the Physio group. Intra-operative repair failure occurred in 3 patients (6%) of the Classic group, and in 4 (9%) of the Physio group, resulting in mitral valve replacement. Late failure occurred in 1 patient (2%) in the Classic group, and in 4 (9%) in the Physio group. At follow-up, left ventricular function did not differ across groups (ejection fraction 45% and 48% (adjusted P = .65)). The combined NYHA class III-IV had improved for the Classic group in 42% and for the Physio group in 34%. Conclusion: Although the 16% difference in mortality did not reach statistical significance, it is considered clinically important. No differences in morbidity, valve function, and left ventricular function were found. Further research to explain the difference in mortality is required.

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BREAST CANCER PATIENTS AT INCREASED RISK OF DEVELOPING TYPE II ENDOMETRIAL CANCER; RELATIVE AND ABSOLUTE RISK ESTIMATION AND IMPLICATIONS FOR GENETIC COUNSELLING

10.26226/morressier.5fa3ee5d55b1fd4cc4dd93a8 ◽

2020 ◽

Author(s):

Alexandros Laios

Keyword(s):

Breast Cancer ◽

Endometrial Cancer ◽

Cancer Patients ◽

Genetic Counselling ◽

Risk Estimation ◽

Absolute Risk ◽

Type Ii ◽

Breast Cancer Patients ◽

Increased Risk

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Is it Worth CANVASing for CREDENCE? A Benefit-risk Analysis

Current Diabetes Reviews ◽

10.2174/1573399815666191025094733 ◽

2020 ◽

Vol 16 (5) ◽

pp. 509-514

Author(s):

Binayak Sinha ◽

Samit Ghosal

Keyword(s):

Adverse Events ◽

Fungal Infections ◽

Absolute Risk ◽

Pooled Analysis ◽

Major Adverse Cardiovascular Events ◽

Number Needed To Treat ◽

Pooled Data ◽

The Individual ◽

Fracture Risks ◽

Number Needed To Harm

Background and Aims: A number of significant positive and negative signals emerged from the CANVAS Program and CREDENCE trial with the use of canagliflozin. These signals are confusing. A Likelihood of being Helped of Harmed (LHH) analysis was conducted to determine the risk, benefit ratio associated with canagliflozin use and address the signals as a continuum. Materials &Methods: LHH was calculated from the number needed to treat (NNT) and number needed to harm (NNH) available from the absolute risk reductions reported with the outcomes of interest, in these two trials. Results: In the CANVAS Program, LHH for major adverse cardiovascular events (MACE) points at a significant benefit with canagliflozin use in comparison to amputation (1.65), fractures (1.65) and euglycaemic diabetic ketoacidosis (euDKA) (16.67) risks. Only genital fungal infections were significant more in both sexes (0.21-M and 0.1-F) when LHH was matched against the positive outcomes. In contrast, the hHF benefits were outweighed by amputation (0.95) and fracture risks (0.95). : In CREDENCE trial, the LHH for Primary composite, Renal composite and MACE, all supported the benefits in comparison to any adverse events encountered in the trial. : The LHH from pooled data (CANVAS Program and CREDENCE trial) was in favour of all the benefits (hHF and renal composites) except for MACE matched against amputation (0.66). Conclusion: The outcome benefits were in favour of canagliflozin in comparison to all reported adverse events, when hHF and renal composite were under consideration, in both the individual and pooled LHH analysis. However, the MACE benefits were overwhelmed by amputation risk in the pooled analysis.

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Constant Absolute Risk Aversion, Bankruptcy, and Wealth-Dependent Decisions

The Journal of Business ◽

10.1086/296086 ◽

1980 ◽

Vol 53 (3) ◽

pp. 285 ◽

Cited By ~ 17

Author(s):

Steven A. Lippman ◽

John J. McCall ◽

Wayne L. Winston

Keyword(s):

Risk Aversion ◽

Absolute Risk ◽

Absolute Risk Aversion ◽

Constant Absolute Risk Aversion

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Fine‐Gray subdistribution hazard models to simultaneously estimate the absolute risk of different event types: Cumulative total failure probability may exceed 1

Statistics in Medicine ◽

10.1002/sim.9023 ◽

2021 ◽

Author(s):

Peter C. Austin ◽

Ewout W. Steyerberg ◽

Hein Putter

Keyword(s):

Failure Probability ◽

Absolute Risk ◽

Hazard Models ◽

Subdistribution Hazard ◽

Total Failure ◽

The Absolute

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The Impact of NORTH STAR on Suicidality, Substance Problems, Intimate Partner Violence, and Child Abuse

Military Medicine ◽

10.1093/milmed/usaa380 ◽

2020 ◽

Author(s):

Amy M Smith Slep ◽

Richard E Heyman ◽

Michael F Lorber ◽

David J Linkh

Keyword(s):

Intimate Partner Violence ◽

Child Abuse ◽

Air Force ◽

Partner Violence ◽

Absolute Risk ◽

Intimate Partner ◽

Institutional Review Board ◽

Cross Sectional ◽

Institutional Review ◽

The Impact

Abstract Introduction We evaluated the effectiveness of New Orientation for Reducing Threats to Health from Secretive-problems That Affect Readiness (NORTH STAR), a community assessment, planning, and action framework to reduce the prevalence of suicidality, substance problems, intimate partner violence, and child abuse. Materials and Methods One-third of U.S. Air Force bases worldwide were randomly assigned to NORTH STAR (n = 12) or an assessment-and-feedback-only condition (n = 12). Two Air Force-wide, cross-sectional, anonymous, web-based surveys were conducted of randomly selected samples assessing risk/protective factors and outcomes. This study was reviewed and approved by the institutional review board at the investigators’ university and by the institutional review board at Fort Detrick. Results NORTH STAR, relative to control, bases experienced a 33% absolute risk reduction in hazardous drinking rates and cumulative risk, although, given the small number of bases, these effects were not statistically significant. Conclusions Given its relatively low cost, use of empirically supported light-touch interventions, and emphasis on sustainability with existing resources, NORTH STAR may be a useful system for prevention of a range of adult behavioral health problems that are difficult to impact.

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