Probability Of Benefit Research Articles

Desempenho de indivíduos com Síndrome de Down nos testes de consciência fonológica aplicados com e sem apoio visual de figuras

OBJETIVO: avaliar o desempenho dos indivíduos com Síndrome de Down, com e sem estímulo visual na consciência fonológica. MÉTODOS: participaram 40 sujeitos com Síndrome de Down de ambos os sexos, que se encontravam em uma das fases do processo de apropriação da linguagem escrita, separados em dois grupos aleatórios, com números similares a partir das mesmas fases. Foram aplicadas nove provas de consciência fonológica do nível de sílaba do teste CONFIAS como proposto originalmente, no primeiro grupo e as mesmas provas adaptadas com figuras de apoio para todas as palavras, no segundo grupo. RESULTADOS: os resultados mostraram que a média total de acerto dos 20 sujeitos que fizeram os testes com apoio visual de figuras é significativamente melhor se comparado com a média de acerto dos 20 sujeitos que fizeram o teste sem o apoio visual de figuras. Com o uso de figuras como apoio na avaliação da consciência fonológica, observou-se que os resultados referem-se a real habilidade que o individuo apresenta sem a interferência de um possível déficit na memória auditiva de curto prazo. CONCLUSÃO: os achados permitem afirmar que, com 95% de probabilidade, a aplicação de figuras nos testes de consciência fonológica consiste em um benefício aos indivíduos com Síndrome de Down.

Understanding breast cancer screening: should the intellectually non-disabled make decisions for the intellectually disabled?

In the USA, 70% of women without a cervix have cervicalcancer screening (Sirovich & Welch 2004). According to arecent survey most individuals would overrule a physicianwho recommended against cancer screening, 60% want tobe tested even for cancers that would never cause problemsduring the person’s lifetime if untreated, and 40% believethat an 80-year old woman who chose not to have a screen-ing mammogram was irresponsible (Schwartz et al. 2004).In another recent survey in the US, UK, Italy, and Switzer-land widespread misconceptions about mammographyscreening were found: 60 to 70% of women believed thatscreening prevents or reduces the risk of contracting breastcancer and that screening at least halves breast cancer mor-tality (Domenighetti 2003). Evidence is overwhelming thatunderstanding of cancer screening is poor among the intel-lectually non-disabled.“All screening programmes do harm; some can do good aswell. The harm from a screening programme starts immedi-ately; the good takes longer to appear. Therefore, the firststep of any programme, even an effective one, is to impairthe health of the population.” (Muir-Gray 1997) As to breastcancer screening the scientific controversy about the benefit-harm ratio has not been resolved (Olsen & Gotzsche 2001).But, even if effective, breast cancer screening will benefitvery few and many more will be harmed.Under such circumstances informed decision making by theindividual becomes an ethical issue. Criteria have been defined for consumer information on screening interven-tions (General Medical Council 1999). The informationshould be evidence-based. It should communicate prognosiswithout intervention, probability of benefit, risk of failureand harm, likelihood of positive and negative findings andpossibility of false test results. Since framing of data has animportant influence on risk perception results should be presented in natural frequencies (Hoffrage et al. 2000). Theinformation must not be withheld because of the possibilitythat the person might refuse the screening test (General Medical Council 1999). Information on breast cancer screening does not fulfil thesecriteria. The material is poor and severely biased in favourof screening (Slaytor & Ward 1998; Jorgensen & Gotzsche2004). Public health officials, physicians and disease advo-cacy groups use powerful campaigns to convince individualsof the importance of cancer screening. The messages are unbalanced, misleading and prescriptive (Schwartz et al.2004). From a public health perspective screening pro-grammes are cost effective only at high participation rates.Hence, increasing awareness and attendance rates are considered good practice whereas a woman who declines is a failure. Sullivan et al. (2004) investigated why women with intellec-tual disabilities are among the least frequent users of mam-mography screening services. Barriers identified by carersincluded a need to motivate people to attend, the belief thatwomen with intellectual disability would not understand whythe procedure needs to be done and therefore would experi-ence fear and anxiety, and severe medical problems.Motivating women with learning disabilities to participate in breast cancer screening raises particular ethical concerns.A proactive and persuasive approach is not justified in caseof preventive interventions that target healthy people andthat may do more harm than good to the individual. Goodpractice guidelines on breast screening for women withlearning disabilities have been issued (NHSBPS 2000). One

Epidemiology and demographics of prostatitis.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a multifactorial problem affecting men of all ages and demographics. Currently, there is a relative dearth of epidemiological information on CPPS. It is clear that patients with CPPS have a dismal quality of life and many have benefited only minimally from empiric, goal-directed therapy. Long-term follow-up of the CPPS cohort will answer important questions about the natural and treated history of this syndrome. Similarly, ongoing and future studies will provide community-based and prevalence estimates for CPPS, morbidity rates for men with CPPS, and the rates of symptom improvement and symptom deterioration for these men, as well as the probability of benefits and harm from different treatments. Although men with CP routinely receive anti-inflammatory and antimicrobial therapy, recent studies suggest that leucocyte and bacterial counts do not correlate with severity of symptoms. These findings suggest that factors other than leucocytes and bacteria contribute to the symptoms associated with CPPS. The probability of benefits and harm from different treatments for CPPS, and reliable and valid measures to define these outcomes are eagerly awaited.

Defining patient-based minimal clinically important effect sizes: a study in palliative radiotherapy for painful unresectable pelvic recurrences from rectal cancer

Purpose : To measure patient-based minimal clinically important effect sizes (minimal incremental benefit that an individual would require to accept one treatment option over another) for pain relief between two contrasting palliative radiotherapy regimens for painful pelvic recurrences from rectal cancer. Methods and Materials : Forty-three patients with a history of cancer pain without prior pelvic radiotherapy participated in decision aid-facilitated trade-off exercises. The clinical scenario and treatment options of a 5-day vs. a 20-day course of radiotherapy were described. The duration of pain relief for the 20-day regimen was increased until the respondents’ preferences switched to the 20-day regimen. The exercises were repeated for different probabilities of benefit and pain intensity at the time of decision making. Results : When the probability of pain relief was unchanged, the median switch point for the duration of pain relief was 6.7 and 7.2 months for severe and mild pain, respectively. The cumulative percentage frequency curve for the switch points approximated a sigmoid distribution. Conclusion : Determining the minimal clinically important effect sizes for symptom relief for palliative therapies is feasible. This type of information can be used to incorporate patient values into clinical trial designs. Modification of this method can be used to improve our understanding of shared (physician and patient) decision making.

Breast Cancer Screening Discussions for Women in Their Forties

Studies of the effectiveness of breast cancer screening for women in their forties show that the probability of benefit is relatively small and, for some women, may be outweighed by the probability of harm. Thus, screening for breast cancer in this age group is a "close call" on which reasonable women may disagree. Many women in their forties, however, are being screened. We suggest that few truly understand the issues involved in this decision. In this paper, we examine the potential benefits and harms of breast cancer screening for women ages 40-49 and consider a strategy for helping women make informed decisions about screening: shared decision making. Shared decision making involves framing breast cancer screening as a decision that could reasonably be decided either for or against screening; giving the patient evidence-based information about the decision in an understandable format; and assisting the patient to use her values to close on a decision. We believe that this approach will eventually become the standard of care not only for breast cancer screening for women in their forties, but for older women (and other issues), as well.

General Practice

In a study of 60 patients with communicating hydrocephalus, sources of error included lumbar cerebrospinal fluid (CSF) leakage, epidural infusion, and cerebrovascular reactions during the CSF infusion test; a high...

Risks, Benefits, and Generic Substitution

Consumers would save on prescriptions if pharmacists dispensed generic drugs more frequently. This study examined the relationship between pharmacists' perceptions of risks and benefits of generic substitution and their substitution behavior. Data gathered by a mail survey indicated that pharmacists' perceptions of probabilities of benefits and risks were significantly related to substitution behaviors. Pharmacists were most concerned with performance and psychological risks and financial and psychological benefits.

Radiation risk of tissue late effects, a net consequence of probabilities of various cellular responses

Late effects from the exposure to low doses of ionizing radiation are hardly or not at all observed in man probably due to the low values of risk coefficients that preclude statistical analyses of data from populations that are exposed to doses less than 0.2 Gy. In order to arrive at an assessment of potential risk from radiation exposure in the low dose range, the microdosimetry approach is essential. In the low dose range, ionizing radiation generates particle tracks, mainly electrons, which are distributed rather heterogenously within the exposed tissue. Taking the individual cell as the elemental unit of life, observations and calculations of cellular responses to being hit by energy deposition events from low LET type are analysed. It emerges that besides the probability of a hit cell to sustain a detrimental effect with the consequence of malignant transformation there are probabilities of various adaptive responses that equip the hit cell with a benefit. On the one hand, an improvement of cellular radical detoxification was observed in mouse bone marrow cells; another adaptive response pertaining to improved DNA repair, was reported for human lymphocytes. The improved radical detoxification in mouse bone marrow cells lasts for a period of 5-10 hours and improved DNA repair in human lymphocytes was seen for some 60 hours following acute irradiation. It is speculated that improved radical detoxification and improved DNA repair may reduce the probability of spontaneous carcinogenesis. Thus it is proposed to weigh the probability of detriment for a hit cell within a multicellular system against the probability of benefit through adaptive responses in other hit cells in the same system per radiation exposure. In doing this, the net effect of low doses of low LET radiation in tissue with individual cells being hit by energy deposition events could be zero or even beneficial. Since there was no simple additivity of equal effects from repeated exposures to equal doses and because of the potential effect of adaptive cell responses on the spontaneous evolution of malignancy in tissue, the extrapolation of risk with absorbed dose reaching down to zero, does not appear to be generally valid.

Comment on Shrader-Frechette's "Parfit and Mistakes in Moral Mathematics

In a recent article in this journal' Shrader-Frechette discusses Parfit's arguments in Reasons and Persons2 with respect to issues in moral calculation. Although her analysis is reasonable, aspects of it need elaboration. The present note is an attempt to flesh out her response to Parfit. The issues are best illustrated with an example such as the one used by Parfit. He describes a scenario in which a thousand wounded soldiers in the desert need water, while in a second group of one thousand each individual is deciding whether or not to contribute his or her pint of water to be divided equally among the thirsty men. The effect of the equal division is that the pint contributed by a given altruist adds one thousandth of a pint to the amount each man receives. If it is assumed that this tiny fraction of the pint each person has to contribute is too small to be perceived by even a very thirsty individual, then each contributor may feel that his or her pint would avail nothing if distributed. The fact that many soldiers would each get slightly more water is irrelevant if none of them perceives any change. One thousand non-effects still constitute a non-effect. Yet, the benefit from the full contribution of the second thousand would certainly produce a noticeable alleviation of thirst. In a manner reminiscent of the Sorites problem, this is a situation in which each additional fraction of a pint makes at most an difference, but the sum of all such differences is quite perceptible. Parfit argues that there are indeed imperceptible benefits and that they must be counted as benefits in spite of this property. ShraderFrechette suggests that an analysis in terms of thresholds and probabilities of benefit would avoid the need to count them in this way. I agree, but I find her discussion somewhat preliminary. She does not spell out clearly how this might work.

Choice Criteria Model for Selecting Live-case Marketing Research Class Projects

This article provides a two-stage model for selecting clients for live-case marketing research class projects. After research design requirements have been met, the impor tance and probability of benefit to students, clients, instructors and the institution can be calculated to derive a weighted expected value score for potential projects. Ex amples are evaluated.

Communicating hydrocephalus in adults. Diagnostic tests and results of treatment with medium pressure shunts.

In a study of 60 patients with communicating hydrocephalus, sources of error included lumbar cerebrospinal fluid (CSF) leakage, epidural infusion, and cerebrovascular reactions during the CSF infusion test; a high frequency of failing shunts; and initially undetected tumors in the group whose hydrocephalus was idiopathic. Though no sharp distinction could be made between positive and negative diagnositc tests, each variable indicated a certain probability of benefit, ranging from high to low, from shunting. CSF opening pressure in the lateral and sitting positions, the CSF infusion test, and cisternography were helpful in selecting patients for shunting. If clinical improvement was to take place, it did so within 3 months of shunting. Only patients with an opening pressure at or within the upper half of supposedly normal CSF pressure improved from a medium-pressure shunt. Improvement occurred in all patients having pressures of 580 mm H2O or more during an infusion test at a rate of 1.5 ml per minute. Neither preoperative signs and symptoms nor a single electroencephalogram had predictive value.

Medical screening of patients with coronary artery disease: Criteria for entrance into exercise conditioning programs

Although considerable emphasis has been placed on stress testing and physical training of patients with coronary artery disease, data on safe and thorough preliminary medical evaluation are scarce. Because the routine history and physical examination are not sufficient to protect the exercising subject, medical screening attempts a thorough analysis of the patient's motivation, physical status, possible risk factors and the probability of benefit. Motivation is a critical factor since training for prolonged periods of time at high levels of heart rate and oxygen consumption may be required. Patients who have unstable angina or who may be harmed by increased myocardial oxygen requirements must be excluded. Concomitant influencing diseases and certain medications may also be causes for rejecting a patient. Valvular heart disease and severe systemic hypertension are not associated with benefit from exercise conditioning. The screening physician must exclude patients with certain abnormal electrocardiographic patterns, such as bilateral bundle branch block and type II second degree atrioventricular block, and he must be assured that he is dealing with coronary artery disease, not a pathologic process that mimics it. When these principles are applied, few persons in organized programs of exercise conditioning should suffer, and the yield of good results should be enhanced.