scholarly journals Lifestyle Medicine

2016 ◽  
Vol 11 (2) ◽  
pp. 134-136
Author(s):  
George E. Guthrie
Keyword(s):  
Relative Risk ◽  
Treatment Effectiveness ◽  
Absolute Risk ◽  
Relative Effectiveness ◽  
Number Needed To Treat ◽  
Lifestyle Interventions ◽  
Lifestyle Medicine ◽  
Present Practice ◽  
Lifestyle Related Diseases ◽  
Number Needed To Harm

Patients are often not aware of the reversibility of chronic lifestyle-related diseases and most physicians are not telling them. The present practice of communicating treatment effectiveness with relative risk reductions does not allow clinicians or patients to evaluate the relative effectiveness of our technotherapies or lifestyle interventions. Clinicians should use the clarity of “number needed to treat,” “number needed to harm,” and absolute risk in communicating with patients about all available therapies and then empower the patient to make the choices that fit their needs best.

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

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.

scholarly journals Efficacy and safety parameters of a novel COVID-19 vaccine

2021 ◽  
Vol 2 (1) ◽  
pp. 13-15
Author(s):  
Bozena Riedel-Baima ◽  
◽  
Roman Zielinski ◽  
Kornelia Polok ◽  
◽  
...  
Keyword(s):  
Relative Risk ◽  
Risk Reduction ◽  
Health Care Providers ◽  
Absolute Risk ◽  
Real Life ◽  
Published Data ◽  
Number Needed To Treat ◽  
Care Providers ◽  
Efficacy And Safety ◽  
Safety Parameters

Considering the fact that vaccine efficacy may be a difficult concept for physicians and health officials alike, we decided to explain it using data from the first publication on the efficacy and safety of a COVID-19 vaccine produced by Pfizer/BioNTech. We examined the published data and calculated common epidemiological parameters such as RRR (relative risk reduction), RR (relative risk), ARR (absolute risk reduction) and NNT (number needed to treat) for 3 groups of patients as described in the original paper. Further, we calculated safety parameters for the vaccine as NNH (number needed to harm) for any, related and severe side effects as mentioned by the investigators. We argue that both NNT and NNH are necessary estimates of how a vaccine might perform in real life and that a robust understanding of efficacy is vital for patients and health care providers as well as health officials in order to make responsible and balanced policy decisions regarding vaccination.

Nonvitamin-K-antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke or transient ischemic attack: An updated systematic review and meta-analysis of randomized controlled trials

2017 ◽  
Vol 12 (6) ◽  
pp. 589-596 ◽  
Author(s):  
George Ntaios ◽  
Vasileios Papavasileiou ◽  
Hans-Chris Diener ◽  
Konstantinos Makaritsis ◽  
Patrik Michel
Keyword(s):  
Atrial Fibrillation ◽  
Relative Risk ◽  
Risk Reduction ◽  
Relative Risk Reduction ◽  
Absolute Risk ◽  
Meta Analysis ◽  
Oral Anticoagulants ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
Ischemic Attack

Background In a previous systematic review and meta-analysis, we assessed the efficacy and safety of nonvitamin-K antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and stroke or transient ischemic attack. Since then, new information became available. Aim The aim of the present work was to update the results of the previous systematic review and meta-analysis. Methods We searched PubMed until 24 August 2016 for randomized controlled trials using the following search items: “atrial fibrillation” and “anticoagulation” and “warfarin” and “previous stroke or transient ischemic attack.” Eligible studies had to be phase III trials in patients with atrial fibrillation comparing warfarin with nonvitamin-K antagonist oral anticoagulants currently on the market or with the intention to be brought to the market in North America or Europe. The outcomes assessed in the efficacy analysis included stroke or systemic embolism, stroke, ischemic or unknown stroke, disabling or fatal stroke, hemorrhagic stroke, cardiovascular death, death from any cause, and myocardial infarction. The outcomes assessed in the safety analysis included major bleeding, intracranial bleeding, and major gastrointestinal bleeding. We performed fixed effects analyses on intention-to-treat basis. Results Among 183 potentially eligible articles, four were included in the meta-analysis. In 20,500 patients, compared to warfarin, nonvitamin-K antagonist oral anticoagulants were associated with a significant reduction of stroke/systemic embolism (relative risk reduction: 13.7%, absolute risk reduction: 0.78%, number needed to treat to prevent one event: 127), hemorrhagic stroke (relative risk reduction: 50.0%, absolute risk reduction: 0.63%, number needed to treat: 157), any stroke (relative risk reduction: 13.1%, absolute risk reduction: 0.7%, number needed to treat: 142), and intracranial hemorrhage (relative risk reduction: 46.1%, absolute risk reduction: 0.88%, number needed to treat: 113) over 1.8–2.8 years. Conclusions This updated meta-analysis in 20,500 atrial fibrillation patients with previous stroke or transient ischemic attack shows that compared to warfarin non-vitamin-K antagonist oral anticoagulants are associated with a significant reduction of stroke, stroke or systemic embolism, hemorrhagic stroke, and intracranial bleeding.

Adjuvant Chemotherapy for Breast Cancer: How Presentation of Recurrence Risk Influences Decision-Making

2003 ◽  
Vol 21 (23) ◽  
pp. 4299-4305 ◽  
Author(s):  
Celia Chao ◽  
Jamie L. Studts ◽  
Troy Abell ◽  
Terence Hadley ◽  
Lynne Roetzer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Relative Risk ◽  
Risk Reduction ◽  
Survival Benefit ◽  
Relative Risk Reduction ◽  
Absolute Risk ◽  
Treatment Decision ◽  
Absolute Risk Reduction ◽  
Number Needed To Treat ◽  
The Impact

Purpose: The purpose of this study was to examine the impact of four methods of communicating survival benefits on chemotherapy decisions. We hypothesized that the four methods of communicating mathematically equivalent risk information would lead to different chemotherapy decisions. Methods: Each participant received two hypothetical scenarios regarding their mother (a postmenopausal woman with an invasive, lymph node-negative, hormone receptor-positive breast cancer) and was asked to decide whether they would encourage their mother to take chemotherapy in addition to surgery and tamoxifen. In the part 1, participants received one of four methods of describing the chemotherapy survival benefit: (1) relative risk reduction, (2) absolute risk reduction, (3) absolute survival benefit, or (4) number needed to treat. In part 2, each participant received all four methods. Following each decision, participants were asked to rate their confidence and confusion regarding their decision. Results: Participants included 203 preclinical medical students. In part 1, participants who received relative risk reduction information were significantly more likely to endorse chemotherapy. In part 2, there were no treatment decision differences when participants received all four methods of communicating survival benefits of chemotherapy. However, receiving all four methods led to significantly higher ratings of confusion. In deciding on endorsing chemotherapy, participants understood the information best when presented with data in the absolute survival benefit format. Conclusion: These results support the hypothesis that the method used to present information about chemotherapy influences treatment decisions. Absolute survival benefit is the most easily understood method of conveying the information regarding benefit of treatment.

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