scholarly journals LO066: H1-antihistamine administration is associated with a lower likelihood of progression to anaphylaxis among emergency department patients with allergic reactions

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S53-S53
Author(s):  
T. Kawano ◽  
B.E. Grunau ◽  
K. Gibo ◽  
F.X. Scheuermeyer ◽  
R. Stenstrom
Keyword(s):  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
Allergic Reactions ◽  
Severe Anaphylaxis ◽  
Number Of Patients ◽  
Lower Likelihood ◽  
H1 Antihistamines ◽  
Secondary Outcomes ◽  
Propensity Score Adjustment

Introduction: H1-antihistamines are often used to treat allergic reactions, however, the influence of H1-antihistamines on progression to anaphylaxis remains unclear. Among patients initially presenting with allergic reactions, we investigated whether H1-antihistamines were associated with a lower proportion of patients progressing to anaphylaxis during observation. Methods: This was a retrospective cohort study conducted at two urban EDs from 2007 to 2012. We included adult patients with allergy and excluded those who met criteria of anaphylaxis at first evaluation by medical professionals and/or received antihistamines before the evaluation. Primary outcomes of interest were the number of patients who developed anaphylaxis during observation at ED and/or transportation by EMS. Secondary outcomes were the number of biphasic reactions and severe anaphylaxis (defined as sBP<90; SpO2<92%; and/or confusion, collapse, loss of conscious, or incontinence). Logistic regression was performed comparing primary and secondary outcomes between H1-antihistamine treated and non-treated groups with propensity score adjustment of the baseline covariates. Number needed to treat (NNT) was calculated by adjusted absolute risk reduction of H1-antihistamine compared to non H1-antihistamine use on primary outcome. Results: This study included 1717 patients with allergic reactions, of whom 1228 were treated with H1-antihistamines. In the H1-antihistamine group 1.0% and 0.2% developed anaphylaxis and severe anaphylaxis, respectively; in the non-H1-antihistamine group 2.6% and 0.6% developed anaphylaxis and severe anaphylaxis, respectively. There were no biphasic reactions (0%, 95% confidence interval [CI] 0 to 0.17%). Administration of H1-antihistamines was associated with a lower incidence of subsequent anaphylaxis (adjusted odds ratio [OR] 0.23, 95% CI 0.10 to 0.53; NNT to benefit 49.1, 95% CI 41.6 to 83.3). There were no significant associations between H1-histamines administration and secondary outcomes. Conclusion: Among ED patient with allergic reactions, H1-antihistamine administration was associated with a lower likelihood of progression to anaphylaxis. These findings suggest that H1-antihistamines should be administered early in the care of patients with allergic reactions.

scholarly journals Anti-VEGF intervention in neovascular AMD: benefits and risks restated as natural frequencies

2019 ◽  
Vol 4 (1) ◽  
pp. e000257
Author(s):  
Louis Clearkin ◽  
Balasubramanian Ramasamy ◽  
James Wason ◽  
Stephenie Tiew
Keyword(s):  
Natural Frequencies ◽  
Absolute Risk ◽  
Visual Outcome ◽  
Absolute Risk Reduction ◽  
Medical Intervention ◽  
Age Related Macular Degeneration ◽  
Number Needed To Treat ◽  
Anti Vegf ◽  
Age Related ◽  
Number Of Patients

ObjectiveClear information is essential to properly determine preference in medical intervention. In neovascular age-related macular degeneration, patients need to understand the balance of risk and benefit of anti-vascular endothelial growth factor (VEGF) treatment. This balance is altered by the number of injections administered.MethodsNatural frequencies, displayed as pictographically as icon arrays, are used to show material outcomes from the MARINA and HARBOR (12 months) trials. We also calculated the number needed to treat (NNT) and number needed to harm (NNH).ResultsMARINA 24-month data show the absolute risk reduction is 37% and the NNT is 3; meaning for one patient to benefit three need to be treated.12 months’ HARBOR data show that compared with as-needed treatment, scheduled monthly injection treatment increases the number of patients achieving a better visual outcome. The number of patients suffering harm is also increased by the additional injections.ConclusionDisplaying MARINA and HARBOR trial data as natural frequencies, with numbers needed to treat and harm, communicates complimentary information on the positive and negative aspects of anti-VEGF treatment.

scholarly journals OP0240 EPIDEMIOLOGY, PREDICTORS OF MORTALITY AND ROLE OF PROPHYLAXIS FOR PNEUMOCYSTITIS JIROVECI PNEUMONIA AMONG RHEUMATIC PATIENTS: A TERRITORY-WIDE STUDY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 147-147
Author(s):  
C. W. S. Chan ◽  
H. Y. Chung ◽  
W. Y. Yeung ◽  
C. S. Lau ◽  
P. H. LI
Keyword(s):  
Lupus Erythematosus ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
Healthcare Database ◽  
Pneumocystis Jiroveci ◽  
Predictors Of Mortality ◽  
Prednisolone Dose ◽  
Rheumatic Patients

Background:Pneumocystis jiroveci pneumonia (PJP) is an opportunistic infection affecting immunocompromised individuals. Due to its high mortality, PJP prophylaxis is commonly recommended for many immunocompromising conditions. However, evidence regarding the burden and role of prophylaxis in PJP among rheumatic patients remains limited. There is lack of consensus for when and for whom to initiate prophylaxis. Delineating the epidemiology, predictors of mortality and efficacy of prophylaxis in PJP among rheumatic patients is urgently needed.Objectives:To delineate the epidemiology of PJP, identify predictors of mortality and evaluate the usefulness of prophylaxis in rheumatology patients.Methods:We performed a big-data cohort study based on the territory-wide healthcare database of the Hong Kong Hospital Authority. All patients with a diagnosis of anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), immune-mediated myositis (IMM), rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis (SSc), or spondyloarthritis (SpA) between 2015-2019 were included. PJP were identified based on physician diagnosis and/or positive microbiological results from deep respiratory tract specimens. Prophylaxis was defined as prescription of a prophylactic dose of co-trimoxazole for at least 2 weeks and/or inhaled pentamidine. Prevalence of PJP, prophylaxis and mortality among rheumatic patients were calculated. Demographics, blood parameters and immunosuppressants use was also collected for multivariate analysis. Number needed to treat (NNT) analysis was performed based on absolute risk reduction of PJP in patients with and without prior PJP prophylaxis.Results:A total of 21,587 unique rheumatic patients were analysed (54% RA, 25% SLE, 13% SpA, 5% IMM, 2% AAV and 1% SSc). Between 2015-2019, 1141 (5.3%) patients were prescribed PJP prophylaxis and 48 (0.2%) developed PJP. None of those patients who developed PJP had received prophylaxis prior to infection. The risk of PJP was highest among SSc (1.8%), AAV (1.4%) and IMM (0.7%) patients, with NNT of SSc 36, AAV 48 and IMM 114. Within these disease entities, the majority of PJP occurred at prednisolone dose of 15mg/day (P15) or above (100% in SSc and IIM, 66.7% in AAV). Overall, PJP was associated with a mortality-rate of 39.6%. Glucocorticoid dose (daily prednisolone dose equivalent 29.1±23.5mg vs 11.4±7.2mg, P<0.01) and lymphopenia (0.44x109/L vs 0.90x109/L, P= 0.04) at PJP diagnosis were associated with PJP mortality in rheumatic patients.Conclusion:PJP is an uncommon but important infection in rheumatic patients associated with significant mortality. PJP prophylaxis is effective and should be considered in patients with SSc, AAV and IMM, especially in those receiving a steroid dose above P15.Disclosure of Interests:None declared

Prevalence of underlying malignancies in complex cysts of the breast

2021 ◽  
pp. 1-7
Author(s):  
J.C.W.L. Gerets ◽  
M. Kool ◽  
P.C.G. Simons ◽  
F. Aarts ◽  
F.J. Vogelaar
Keyword(s):  
Healthcare Costs ◽  
Disease Burden ◽  
Watchful Waiting ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Patient Characteristics ◽  
Number Needed To Treat ◽  
Single Center ◽  
Underlying Malignancy

INTRODUCTION: The management of complex cysts of the breast is an ongoing topic of discussion. The aim of this study was to determine the prevalence of underlying malignancy in radiologically diagnosed complex cysts, and to assess whether watchful waiting could be the preferred method to safely manage complex cysts of the breast. SUBJECTS AND METHODS: A single-center retrospective study was performed between May 2003 and November 2019 in the VieCuri Medical Centre. Women with a radiologically diagnosed complex cyst of the breast were included. Prevalence of underlying malignancy was calculated, as were absolute risk reduction and number needed to treat in order to diagnose malignancy. In addition, patient characteristics were compared to determine characteristics associated with malignancy. RESULTS: Of 78 radiologically diagnosed complex cysts of the breast, five (6,4%) were found to be malignant. The number needed to treat was calculated at 12,8 (absolute riks reduction 0,078). Age (P = 0,003) was associated with malignancy. CONCLUSION: Complex cysts of the breast could be managed more conservatively. Patient characteristics can be used to assess the eligibility for radiological follow-up. This, in turn, would lead to a lower NNT and possibly a decrease in disease burden and healthcare costs.

scholarly journals Effect of Using a Safety Checklist on Patient Complications after Surgery

2014 ◽  
Vol 120 (6) ◽  
pp. 1380-1389 ◽  
Author(s):  
Brigid M. Gillespie ◽  
Wendy Chaboyer ◽  
Lukman Thalib ◽  
Melinda John ◽  
Nicole Fairweather ◽  
...  
Keyword(s):  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Cochrane Library ◽  
Number Needed To Treat ◽  
Complication Rates ◽  
Random Effects Models ◽  
Fixed And Random Effects ◽  
Before And After ◽  
Meta Analyses ◽  
The Cochrane Library

Abstract Background: Previous before-and-after studies indicate that the use of safety checklists in surgery reduces complication rates in patients. Methods: A systematic review of studies was undertaken using MEDLINE, CINAHL, Proquest, and the Cochrane Library to identify studies that evaluated the effects of checklist use in surgery on complication rates. Study quality was assessed using the Methodological Index for Nonrandomized Studies. The pooled risk ratio (RR) was estimated using both fixed and random effects models. For each outcome, the number needed to treat (NNT) and the absolute risk reduction (ARR) were also computed. Results: Of the 207 intervention studies identified, 7 representing 37,339 patients were included in meta-analyses, and all were cohort studies. Results indicated that the use of checklists in surgery compared with standard practice led to a reduction in any complication (RR, 0.63; 95% CI, 0.58 to 0.72; P &lt; 0.0001; ARR, 3.7%; NNT, 27) and wound infection (RR, 0.54; 95% CI, 0.40 to 0.72; P = 0.0001; ARR, 2.9%; NNT, 34) and also reduction in blood loss (RR, 0.56; 95% CI, 0.45 to 0.70; P = 0.0001; ARR, 3.8%; NNT, 33). There were no significant reductions in mortality (RR, 0.79; 95% CI, 0.57 to 1.11; P = 0.191; ARR, 0.44%; NNT, 229), pneumonia (RR, 1.03; 95% CI, 0.73 to 1.4; P = 0.857; ARR, 0.04%; NNT, 2,512), or unplanned return to operating room (RR, 0.75; 95% CI, 0.56 to 1.02; P = 0.068; ARR, 0.52%; NNT, 192). Conclusion: Notwithstanding the lack of randomized controlled trials, synthesis of the existing body of evidence suggests a relationship between checklist use in surgery and fewer postoperative complications.

scholarly journals Effectiveness of blood pressure-lowering drug treatment by levels of absolute risk: post hoc analysis of the Australian National Blood Pressure Study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e017723 ◽  
Author(s):  
Chau Le Bao Ho ◽  
Monique Breslin ◽  
Jenny Doust ◽  
Christopher M Reid ◽  
Mark R Nelson
Keyword(s):  
Blood Pressure ◽  
Drug Treatment ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
Absolute Benefit ◽  
All Cause Mortality ◽  
Pressure Lowering ◽  
Lowering Drug ◽  
Post Hoc

ObjectivesIn many current guidelines, blood pressure (BP)-lowering drug treatment for primary prevention of cardiovascular disease (CVD) is based on absolute risk. However, in clinical practice, therapeutic decisions are often based on BP levels alone. We sought to investigate which approach was superior by conducting a post hoc analysis of the Australian National Blood Pressure (ANBP) cohort, a seminal study establishing the efficacy of BP lowering in ‘mild hypertensive’ persons.DesignA post hoc subgroup analysis of the ANBP trial results by baseline absolute risk tertile.Setting and participants3244 participants aged 35–69 years in a community-based randomised placebo controlled trial of blood pressure-lowering medication.InterventionsChlorothiazide500 mg versus placebo.Primary outcome measuresAll-cause mortality and non-fatal events (non-fatal CVD, congestive cardiac failure, renal failure, hypertensive retinopathy or encephalopathy).ResultsTreatment effects were assessed by HR, absolute risk reduction and number needed to treat. Participants had an average 5-year CVD risk in the intermediate range (10.5±6.5) with moderately elevated BP (mean 159/103 mmHg) and were middle aged (52±8 years). In a subgroup analysis, the relative effects (HR) and absolute effects (absolute risk reduction and number needed to treat) did not statistically differ across the three risk groups except for the absolute benefit in all-cause mortality (p for heterogeneity=0.04). With respect to absolute benefit, drug treatment significantly reduced the number of events in the high-risk group regarding any event with a number needed to treat of 18 (10 to 64), death from any cause with 45 (25 to 196) and major CVD events with 23 (12 to 193).ConclusionOur analysis confirms that the benefit of treatment was substantial only in the high-risk tertile, reaffirming the rationale of treating elevated blood pressure in the setting of all risk factors rather than in isolation.

Interpreting survival outcomes for African-American (AA) patients (pts) with metastatic castration-resistant prostate cancer (mCRPC) treated with sipuleucel-T (SIP-T) with number needed to treat to benefit (NNTB).

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 222-222
Author(s):  
Kelvin A. Moses ◽  
Scott C. Flanders ◽  
Matthew Harmon ◽  
Nancy N. Chang ◽  
Walter Rayford ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Absolute Risk ◽  
Performance Status ◽  
Absolute Risk Reduction ◽  
Phase Iii ◽  
Cellular Immunotherapy ◽  
Number Needed To Treat ◽  
Castration Resistant Prostate Cancer ◽  
Kaplan Meier ◽  
Receive Treatment

222 Background: AA men often present with more aggressive prostate cancer and are less likely to receive treatment, negatively affecting quality-of-life and overall survival (OS). Sipuleucel-T is an autologous cellular immunotherapy approved for asymptomatic or minimally symptomatic mCRPC. Data from the PROCEED registry showed that OS for AA pts treated with SIP-T was 9.3 mo longer than OS for Caucasian pts. In a prior subgroup analysis of Phase III data, AA pts realized a 30.7-mo difference in OS with SIP-T vs. placebo (PBO). We calculated the NNTB to further interpret the OS benefit in AA pts. Methods: Data were pooled from 3 Phase III mCRPC SIP-T trials (D9901, D9902A, and IMPACT). The absolute risk reduction (ARR) is calculated from Kaplan-Meier estimates at 12-, 24-, and 36-mo for all SIP-T subjects, and an AA cohort, receiving ≥1 infusion. NNTB, the inverse of the ARR, represents the number of pts needed to be treated with SIP-T to prevent 1 additional death compared to PBO. All NNTB values are rounded up. Results: Of the 737 pooled mCRPC pts enrolled, 488 men were randomized to SIP-T (n=33 AA), and 249 to PBO. Baseline clinical characteristics between the SIP-T and PBO groups were well balanced; however, compared to overall SIP-T and PBO, AA SIP-T pts were more likely to have received prior chemotherapy, lower hemoglobin, and better performance status. The NNTB at 12-mo was the same (13) for both the pooled SIP-T and AA treated cohort. At 24-mo, the NNTB values were 10 for pooled and 5 for AA. At 36-mo, an NNTB of 8 (pooled) and 3 (AA) SIP-T treatments prevented 1 additional death (Table). Conclusions: This NNTB analysis shows a favorable survival benefit for AA men treated with SIP-T and all treated SIP-T subjects. NNTB values declined over 3-years, suggesting durability of clinical benefit with SIP-T, and that it may address a known survival disparity in AA with prostate cancer. Studies with larger sample sizes may confirm if AA pts derive a greater OS benefit from SIP-T. Clinical trial information: NCT00065442. [Table: see text]

Abstract 02: Distribution Of Predicted Cardiovascular And All-cause Mortality Benefit Of Intensive Vs Standard Blood Pressure Control Among Us Adults Eligible For The Systolic Blood Pressure Intervention Trial

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Catherine G Derington ◽  
Brandon Bellows ◽  
Gabriel S Tajeu ◽  
Jennifer S Herrick ◽  
Ransmond O Berchie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Risk Reduction ◽  
Racial Differences ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Pressure Control ◽  
Number Needed To Treat ◽  
Health And Nutrition ◽  
Population Sizes ◽  
Event Rates

Introduction: If resources are scarce, achieving national SBP control goals will require prioritizing treatment among those likely to benefit. To identify patients with greatest predicted benefit with intensive SBP treatment and estimate population sizes, we applied algorithms to community samples who met the SPRINT enrollment criteria. Methods: The published algorithms separately predict the absolute risk reduction in CVD events and mortality at 3.26 years with intensive (<120 mm Hg) vs standard (<140 mm Hg) SBP lowering. We applied and calibrated the algorithms to SPRINT standard arm participants (n=4 399) and samples meeting SPRINT enrollment criteria from the National Health and Nutrition Examination Survey (NHANES, n=1 297) and the Reasons for Geographic And Racial Differences in Stroke (REGARDS, n=2 785). Predicted absolute risk reduction estimated number needed to treat (NNT), categorized as <50, 50-100, and ≥100. Observed 3.26 year CVD event (SPRINT, REGARDS) and mortality rates (all cohorts) were calculated. Results: The median ages were 67 (SPRINT), 69 (NHANES), and 72 (REGARDS). Greater proportions of NHANES and REGARDS vs SPRINT had predicted NNT <100 for CVD events (NHANES 94.8%, REGARDS 99.2%, SPRINT 87.8%) and mortality (NHANES 64.3%, REGARDS 63.7%, SPRINT 38.8%) ( Table ). Event rates were comparable within NNT groups. Conclusions: Predicted NNT distributions differ between cohorts but event rates are similar. Most adults who meet SPRINT enrollment criteria have predicted NNT <100 for CVD and mortality with intensive SBP treatment. These results suggest that published algorithms can identify those most likely to benefit and can guide implementation.

Higher Doses of Prophylactic Anticoagulation Is More Effective in Preventing Venous Thromboembolism in Morbidly Obese Inpatients.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2268-2268
Author(s):  
Tzu-Fei Wang ◽  
Paul Milligan ◽  
Catherine A Wong ◽  
Mark S Thoelke ◽  
Eli N Deal ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Healthcare System ◽  
Conflicts Of Interest ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
Optimal Dose ◽  
Morbidly Obese ◽  
Number Needed To Treat ◽  
Prophylactic Anticoagulation ◽  
Higher Doses

Abstract Abstract 2268 Background: Obesity increases the risk for venous thromboembolism (VTE), and the optimal dose of prophylactic anticoagulation to prevent VTE in morbidly obese inpatients is unknown. Objectives: To quantify the efficacy and safety of higher doses of prophylactic heparin or enoxaparin for VTE prevention in morbidly obese inpatients with a body mass index (BMI) ≥ 40 kg/m2and/or weight >100 kg within the BJC HealthCare system. Patients/Methods: We analyzed 10,239 inpatients with weight > 100 kg and/or morbid obesity (BMI ≥ 40 kg/m2) discharged from the three major hospitals in the BJC HealthCare system from January 1st, 2010 through February 29th, 2012. We used logistic regression to calculate odds ratios (OR) and 95% confidence intervals (CI) and Wald's chi-square to compare proportions. The primary efficacy outcome was an ICD-9 diagnosis code for VTE. The primary safety outcome was an ICD-9 diagnosis codes for bleeding. Results: On-treatment analysis showed higher doses of prophylactic anticoagulation (heparin 7500 units three times daily instead of 5000 units two or three times daily or enoxaparin 40 mg twice daily instead of 40 mg once daily) halved the risk (OR 0.52, 95% CI 0.27–1.00; p = 0.05) of symptomatic VTE in the 3928 morbidly obese inpatients (weight > 100kg and BMI ≥ 40 kg/m2). The rate of VTE was 1.48% (35/2369) in these morbidly obese inpatients who received standard prophylactic doses of unfractionated heparin or enoxaparin, compared to 0.77% (12/1559) in those who received higher doses, with an absolute risk reduction of 0.71% and a number needed to treat (NNT) of approximately 140. Intention-to-treat analysis failed to show reduction in VTE rate due to low (< 40%) physician compliance in prescribing the higher doses. Increased doses of prophylactic anticoagulation were not associated with bleeding (OR 0.84, 95% CI 0.66–1.07, p = 0.15). Conclusions: Higher doses of prophylactic anticoagulation nearly halve the rate of VTE in morbidly obese inpatients (with BMI ≥ 40 kg/m2 and weight > 100 kg), but do not increase bleeding. Given their safety and ease of implementation, higher doses of prophylactic heparin or enoxaparin should be considered in morbidly obese inpatients. Clinicians' compliance and awareness need to be improved to prevent VTE in this vulnerable population. Disclosures: No relevant conflicts of interest to declare.

Sign in / Sign up

Export Citation Format

Share Document