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.

Abstract 001: Effects of Intensive Blood Pressure Control in Adults With and Without Albuminuria: Results From the SPRINT Trial

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Alex Chang
Keyword(s):  
Blood Pressure ◽  
High Risk ◽  
Primary Outcome ◽  
Absolute Risk ◽  
Absolute Risk Reduction ◽  
High Risk Population ◽  
Number Needed To Treat ◽  
Cvd Risk ◽  
Intensive Blood Pressure

Background: Albuminuria is strongly associated with elevated risk of cardiovascular disease (CVD). While the Systolic Blood Pressure Intervention Trial (SPRINT) showed that intensive blood pressure (BP) lowering reduces CVD in high-risk non-diabetic adults, it is unclear whether this effect varies by albuminuria status. Methods: SPRINT randomized non-diabetic adults with elevated blood pressure and increased CVD risk to a systolic BP (SBP) goal of <120 or <140 mmHg. Albuminuria (>=30 mg/g) was measured by albumin/creatinine ratio (ACR) at baseline. Outcomes examined included the primary composite CVD outcome (myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from CVD) and all-cause death. Results: A total of 8913/9361 (95.2%) participants had baseline ACR data; 51.9%, 28.7%, and 19.4% had baseline ACR < 10, 10-29.9, and >=30 mg/g, respectively. The primary composite outcome occurred in 4.0%, 6.7%, and 11.2% of individuals with baseline ACR <10, 10-29.9, and >=30 mg/g, respectively. The effect of intensive BP lowering on the primary outcome was similar in patients with albuminuria (HR 0.74, 95% CI: 0.55-0.99) and without albuminuria (HR 0.73, 95% CI: 0.59-0.91; p for interaction = 0.77). Intensive BP lowering reduced risk of stroke in patients with albuminuria (HR 0.45, 95% CI: 0.24-0.85) but not patients without albuminuria (1.13, 95% CI: 0.73-1.74; p for interaction = 0.03). Absolute risk reduction was particularly high in those with albuminuria, with a number needed to treat (NNT) of 32 to prevent 1 primary outcome and a NNT of 37 to prevent 1 death from any cause at 3 years of follow-up. By comparison, the NNT to prevent 1 primary outcome was 72 for ACR < 30 mg/g at 3 years of follow-up. Conclusions: The effect of Intensive BP lowering reduces CVD risk similarly in non-diabetic adults with and without albuminuria. Given the high CVD risk in patients with albuminuria, this high-risk population may particularly benefit from efforts to intensify BP control.

Comparison of the clinical benefit of an adjuvant therapy in gastrointestinal stromal tumors (GIST) with other adjuvant cancer therapies.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 129-129 ◽  
Author(s):  
Morgan Deflin ◽  
Anju Parthan ◽  
Douglas Taylor ◽  
John Coombs ◽  
Medha Sasane ◽  
...  
Keyword(s):  
Absolute Risk ◽  
Controlled Trial ◽  
Absolute Risk Reduction ◽  
Study Groups ◽  
Number Needed To Treat ◽  
Cancer Therapies ◽  
Adjuvant Imatinib ◽  
Cancer Types ◽  
Over Time

129 Background: Imatinib in the adjuvant setting for GIST has shown significant improvements in recurrence- free survival (RFS) vs placebo. Number needed to treat (NNT) is a useful measure to compare effectiveness across treatments (txts) from a health policy or population perspective. The objective of this study is to compare the NNT for adjuvant imatinib in GIST with other adjuvant cancer txts at both 1 and 3 yrs of follow-up using RFS. Methods: In the absence of a placebo controlled trial for 3 yr imatinib, data from ACOSOG Z9001 and SSGXVIII/AIO trials were used to indirectly estimate NNT for adjuvant imatinib in GIST. Adjuvant txts in other cancer types were identified from published literature. Studies meeting the following criteria were included in the analysis: (1) study population consisted of cancer patients (pts) who underwent surgical resection of the primary tumor and considered cancer-free, (2) a randomized clinical trial conducted in pts in the US or Europe, (3) comparators were either placebo or no txt (4) RFS was reported and showed benefit with the experimental txt. NNT is defined as the number needed to treat to prevent 1 recurrence or death. NNT was calculated as the inverse of the absolute risk reduction (difference in event rate) between the study groups in each trial. Results: 24 adjuvant txts in 8 different cancer types were identified. With longer follow-up (3 yrs vs 1 yr), 62.5% of txts showed a decreased NNT, including imatinib which decreased from 7 (1 yr) to 4 (3 yrs). The largest relative decrease in NNT over time was 91% for trastuzumab & cyclophosphamide (both used for breast cancer). About 25.0% of the txts had an increase in NNT over time. NNT for imatinib was lower than all other txts at 3 yrs of follow-up and lower than all but 2 txts at 1 yr of follow-up (mitomycin + tegafur [gastric cancer, NNT = 5] and gemcitabine [pancreatic cancer, NNT = 4]). About 28.0% and 41.7% of txts had an NNT less than 10 at 1 and 3 yrs of follow up, respectively. Conclusions: Imatinib has one of the lowest NNTs among other adjuvant txts, at 1 and 3 yrs of follow-up. With longer follow-up duration, most adjuvant cancer txts show a decreased NNT.

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

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 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 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.

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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