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Clinical Research
Effects of presenting risk information in different formats to cardiologists. A Latin American survey
Encuesta sobre los efectos de la presentación de los riesgos y beneficios en distintos formatos a cardiólogos latinoamericanos
Raúl A. Borraccia,b,
Corresponding author
raborracci@gmail.com

Corresponding author at: La Pampa 3030, 1428 Buenos Aires, Argentina. Tel.: +54 11 4784 5917; fax: +54 11 4961 6027.
, Daniel J. Piñeiroa, Eduardo B. Arribalzagab,c
a Sociedad Interamericana de Cardiología, México, D.F., Mexico
b Bioestadística, Facultad de Ciencias Biomédicas, Universidad Austral, Argentina
c Facultad de Medicina, Universidad de Ciencias Empresariales y Sociales (UCES), Argentina
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Misinterpretation of numerical data can be induced by the form in which the risks and benefits of clinical trials are reported&#46; These different interpretations influence not only the opinion of medical students and patients&#44; but also the physician care decision-taking process&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;3</span></a> Previous research demonstrated that presenting treatment benefits in terms of relative risk reduction &#40;RRR&#41; rather than in terms of absolute risk reduction &#40;ARR&#41; or number needed to treat &#40;NNT&#41; might favor the perception of outcome effectiveness&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Clinical experience and medical training do not seem to be sufficient to protect physicians against the tendency to interpret data erroneously&#46; A recent meta-analysis by Covey<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> has shown that these framing effects are heterogeneous and seem to be moderated by key differences between the methodologies used in each study&#46; Several authors have speculated that differences in the presentation of outcomes may lead to discrepancies in decision-making and treatments&#44; but previous studies have reported a wide variety of results&#46; Therefore&#44; considering the importance of the problem in cardiological medical practice&#44; a cognitive evaluation study was performed in a group of Latin American cardiologists to assess how the manner in which risks and benefits of screening methods and treatments are presented can affect medical care decision-making&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><p id="par0010" class="elsevierStylePara elsevierViewall">This study was performed in a non-randomized sample of 406 Spanish speaking cardiologists included in the Interamerican Society of Cardiology register&#44; proportionally representing the regional distribution of Cardiology specialists&#46; They underwent <span class="elsevierStyleItalic">via</span> e-mail an anonymous and voluntary assessment on the interpretation of results of several medical investigations&#46; The questionnaire was in Spanish and consisted of nine questions with multiple choice answers&#46; The questions presented the summary of clinical results from different controlled trials&#44; showing the data as relative risk reduction &#40;RRR&#41;&#44; absolute risk reduction &#40;ARR&#41; or number needed to treat &#40;NNT&#41;&#44; with or without associated graphs&#46; Questions were randomly ordered and were associated as follows&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><p id="par0015" class="elsevierStylePara elsevierViewall">Group 1&#58; a question expressed with RRR and NNT&#44; the same question with RRR&#44; the same question with ARR and the same question with NNT&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><p id="par0020" class="elsevierStylePara elsevierViewall">Group 2&#58; a second question expressed with AAR&#44; the same question with RRR and the same question with NNT&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><p id="par0025" class="elsevierStylePara elsevierViewall">Group 3&#58; finally&#44; a third question presented with RRR and the same question with ARR&#44; together with corresponding graphic representations&#46; In this case&#44; the relative proportion of the graphs was biased to favor the choice of RRR&#46; The abridged questions are shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; To compare with other studies&#44; test questions were formulated according to three previous studies on the same subject&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;6&#44;7</span></a> The wording of these questions intended to overcome previous study problems&#44; mainly through the addition of examples containing NNT&#44; the combination of RRR<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>NNT and supporting graphs&#46; At the end of each example&#44; the physician was asked to consider these results as sufficient evidence favoring the proposed treatment&#46; The multiple choice answer to each question could be answered on some occasions with &#8220;yes&#44; no&#44; or I do not have sufficient information&#8221;&#44; and in others with &#8220;very useful&#44; moderately or slightly useful&#44; not useful&#44; or I do not have sufficient information&#8221;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></li></ul></p><p id="par0030" class="elsevierStylePara elsevierViewall">The analysis of results was performed comparing the rate of favorable choice for RRR presentations <span class="elsevierStyleItalic">vs</span>&#46; ARR and NNT&#46; The study hypothesis postulated that respondent cardiologists would choose more easily RRR rather than ARR or NNT as evidence favoring a treatment&#46; Moreover&#44; questions from groups 1 and 2 were conjointly analyzed&#46; Thus&#44; the total number of answers was 812 &#40;406 respondents with 2 questions each&#41; in the case of ARR&#44; 812 &#40;406 respondents with 2 questions each&#41; in the case of RRR and 1218 &#40;406 respondents with 3 questions each&#41; in the case of NNT and RRR<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>NNT &#40;2 questions in group 1 and one question in group 2&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Groups were compared using <span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#46; The odds ratio logarithm &#40;log-OR&#41; with its 95&#37; confidence interval &#40;CI<span class="elsevierStyleInf">95&#37;</span>&#41; was calculated to compare the study results with those previously published with the same format&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> shows the participating countries and the proportion of respondent cardiologists is compared to the total number of cardiologists in each country&#44; except for Brazil&#44; as the proportion of Spanish speaking physicians is negligible in this country&#46; The same graph shows the proportional distribution of cardiologists in the region&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">In the conjoint analysis of group 1 and 2 questions&#44; 62&#46;2&#37; &#40;505&#47;812&#41; of the respondents accepted the proposals as valid when the data were presented as RRR&#44; whereas only 40&#46;4&#37; &#40;328&#47;812&#41; accepted it when the results were presented as ARR&#46; On the other hand&#44; 44&#46;4&#37; &#40;541&#47;1218&#41; cardiologists validated the proposals when the data were expressed as NNT &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#41;&#46; The comparison between answers when the propositions were made with RRR and ARR was log-OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;89&#44; CI<span class="elsevierStyleInf">95&#37;</span> 0&#46;683&#8211;1&#46;092&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#44; and the comparison of NNT <span class="elsevierStyleItalic">vs&#46;</span> ARR was log-OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;17&#44; CI<span class="elsevierStyleInf">95&#37;</span> &#8722;0&#46;020 to 0&#46;351&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;073&#44; indicating that the respondent cardiologists managed the statistical evidence in the same manner both with ARR as with its equivalent NNT&#46; Finally&#44; the comparison between RRR and NNT was log-OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;72&#44; CI<span class="elsevierStyleInf">95&#37;</span> 0&#46;536&#8211;0&#46;908&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#46; In group 3&#44; where questions were presented with biased bar charts&#44; 61&#46;6&#37; &#40;250&#47;406&#41; cardiologists accepted as recommendable the proposed screening method when the data were presented in the first place as RRR&#59; however&#44; when the same problem was presented as ARR&#44; only 14&#46;0&#37; &#40;57&#47;406&#41; cardiologists accepted the method as useful &#40;log-OR<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#46;28&#44; CI<span class="elsevierStyleInf">95&#37;</span> 1&#46;926&#8211;2&#46;643&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0050" class="elsevierStylePara elsevierViewall">Studies on cognitive psychology demonstrate that the possible interpretation of quantitative evidence is deeply affected by the way in which it is presented&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Thus&#44; the interpretation of numerical information may differ depending on the data presentation format&#46; For example&#44; a 25&#37; RRR can be generated both from the difference in event rates between two groups of 40&#37; and 30&#37; as well as from the difference between two groups of 3&#37; and 4&#37;&#59; which in the first case represents an absolute difference of 10&#37; and in the second case only 1&#37;&#46; If the data were only presented as RRR&#44; the tendency would be to accept these differences as having clinical relevance&#44; neglecting or ignoring the real event rate reduction&#46; Although medical journals require in general the publication of the real event rates in terms of ARR and&#47;or NNT&#44; there is no uniform policy in the presentation of clinical study results&#44; either among researchers or in the pharmaceutical industry marketing&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;10</span></a> The &#8220;illusion of benefit&#8221; produced when results are presented as RRR has strong implications in the acceptance and adoption of innovations&#46; In our work&#44; although the respondents must already be trained to identify different measurement presentations of effect magnitude&#44; faults were found in the interpretations of the results&#46; When the benefits were presented in terms of RRR&#44; more than 60&#37; cardiologists accepted as valid evidence which should have been rejected or at least questioned&#46; This percentage was significantly reduced both in the presentation of data as ARR or NNT&#46; Graphics intentionally biased&#44; generated even more significant confusion in the study&#46; The magnification of relative proportions in the bar graphs was easily confused with real data difference&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">It is essential to train students and physicians in the quantitative analysis of statistical techniques in order to correct these issues and improve decision-taking&#46; The results of other studies as well as ours&#44; demonstrate that the current learning process of these methods is apparently inadequate and unsatisfactory&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#8211;13</span></a> The meta-analysis performed by Covey<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> concluded that physicians as well as students and public in general may be equally influenced by the manner in which results are presented&#59; in other words&#44; medical training and clinical experience are not enough to immunize subjects against the tendency to interpret data differently when it is presented in terms of RRR&#44; ARR or NNT&#46; This difficulty to acquire the adequate knowledge in mathematics and statistics to interpret health decision making has been thoroughly studied under the name of <span class="elsevierStyleItalic">numeracy</span>&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a> The importance of this concept is based on the fact that the training and comprehension of statistical tools might not be within the reach of many health-care decision takers&#44; and particularly the patients who might wish to make their own health decisions&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Fourteen former studies analyzing the effects of presenting treatment benefits or therapeutic risks in different formats to physicians belonging to several fields of medicine&#44; have reported a wide dispersion in the results&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6&#44;17&#8211;27</span></a> Grouped together&#44; the weighted log-OR was 1&#46;19 when comparing RRR <span class="elsevierStyleItalic">vs&#46;</span> ARR and 1&#46;08 in the comparison of RRR <span class="elsevierStyleItalic">vs&#46;</span> NNT&#44; which would indicate a higher tendency to accept a result as valid when it is presented in terms of relative risk&#46; Although these overall findings differ slightly from those observed in our work&#44; there were minimal differences when the individual results of Lacy<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> and Ward<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> for RRR <span class="elsevierStyleItalic">vs</span>&#46; ARR and of Bucher&#44;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Nikolajevic<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> and Nexoe<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;26</span></a> for RRR <span class="elsevierStyleItalic">vs&#46;</span> NNT were considered&#46; Specifically&#44; in a study performed by cardiologists in Spain&#44; Brotons et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> reported that presenting clinical trials results in the form of RRR&#44; as compared with presenting results in terms of ARR or NNT&#44; led to overestimation of the efficacy of interventions&#44; without influencing the likelihood of prescribing a given drug therapy&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conclusions</span><p id="par0065" class="elsevierStylePara elsevierViewall">The assessment of a Latin-American sample of cardiologists showed a different decision-taking in the comparison of the therapeutic benefits observed in a series of clinical trials when the presentation was done in terms of relative risks instead of absolute risks&#46; There was a tendency to favor outcomes when the data was presented as RRR&#46; The inclusion of biased graphics was also interpreted as real data difference&#46; This study demonstrated the risk of statistical data misinterpretation and the need to improve cardiologists&#8217; training in quantitative techniques&#44; in order to ameliorate the care decision-making process&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">No endorsement of any kind received to conduct this study&#47;article&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Conflict of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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    "fechaRecibido" => "2013-07-22"
    "fechaAceptado" => "2014-09-02"
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            0 => "Biostatistics"
            1 => "Risks"
            2 => "Decision-taking"
            3 => "Cardiology"
            4 => "Latin America"
            5 => "Argentina"
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          "clase" => "keyword"
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          "palabras" => array:6 [
            0 => "Bioestad&#237;stica"
            1 => "Riesgos"
            2 => "Toma de decisi&#243;n"
            3 => "Cardiolog&#237;a"
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    "resumen" => array:2 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Previous publications demonstrated that the presentation of treatment benefits in terms of relative risk reduction &#40;RRR&#41; rather than in terms of absolute risk reduction &#40;ARR&#41; or number of patients to treat &#40;NNT&#41; might favor the perception of outcome effectiveness&#46; The objective was to perform a cognitive evaluation to assess how the manner in which risks and benefits of screening methods and treatments are presented can affect medical care decision-taking in a sample of cardiologists&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Four-hundred and six Latin American cardiologists answered a questionnaire reporting the results of clinical trials presented as RRR&#44; ARR or NNT&#44; associated or not to biased graphs&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cardiologists&#8217; decision-taking was different when comparing treatment benefits presented as RRR &#40;62&#46;2&#37;&#41; <span class="elsevierStyleItalic">vs&#46;</span> ARR &#40;40&#46;4&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#41;&#44; and as RRR <span class="elsevierStyleItalic">vs&#46;</span> NNT &#40;44&#46;4&#37;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#41;&#46; However&#44; their decision-taking was similar when information was presented as NNT or ARR &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;073&#41;&#46; The inclusion of biased graphs was misinterpreted as an actual data difference &#40;RRR&#58; 61&#46;6&#37; <span class="elsevierStyleItalic">vs&#46;</span> ARR&#58; 14&#46;0&#37;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">This study demonstrated that Latin American cardiologists could misinterpret statistical data when information of clinical trials is presented in terms of RRR&#46; We emphasize the need to enhance cardiologists&#8217; training in quantitative techniques&#44; to improve medical care decision-making&#46;</p></span>"
        "secciones" => array:4 [
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            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
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            "titulo" => "Methods"
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            "titulo" => "Results"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Publicaciones previas demostraron que la presentaci&#243;n de los beneficios terap&#233;uticos en t&#233;rminos de reducci&#243;n del riesgo relativo &#40;RRR&#41; en lugar de en t&#233;rminos de reducci&#243;n del riesgo absoluto &#40;RRA&#41; o n&#250;mero necesario a tratar &#40;NNT&#41; favorecer&#237;a la percepci&#243;n de que los resultados son m&#225;s efectivos&#46; El objetivo fue realizar una evaluaci&#243;n en una muestra de cardi&#243;logos para determinar c&#243;mo afecta a la decisi&#243;n m&#233;dica la manera como se presentan los riesgos y beneficios de m&#233;todos diagn&#243;sticos y terap&#233;uticos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cuatrocientos seis cardi&#243;logos latinoamericanos respondieron a un cuestionario que conten&#237;a los resultados de ensayos cl&#237;nicos como RRR&#44; RRA y&#47;o NNT&#44; asociados o no a gr&#225;ficos sesgados&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La toma de decisi&#243;n de los cardi&#243;logos fue diferente al comparar los beneficios terap&#233;uticos presentados como RRR &#40;62&#46;2&#37;&#41; vs&#46; RRA &#40;40&#46;4&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#41;&#44; y como RRR vs&#46; NNT &#40;44&#46;4&#37;&#41; &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#41;&#59; sin embargo&#44; fue similar cuando la informaci&#243;n se present&#243; como NNT o RRA &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;073&#41;&#46; La inclusi&#243;n de gr&#225;ficos sesgados fue malinterpretada como una diferencia real &#40;RRR&#58; 61&#46;6&#37; vs&#46; RRA&#58; 14&#46;0&#37;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000000&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se demostr&#243; que los cardi&#243;logos latinoamericanos podr&#237;an confundir resultados estad&#237;sticos cuando la informaci&#243;n de los ensayos cl&#237;nicos se presenta como RRR&#46; Hacemos hincapi&#233; en la necesidad de entrenar a los cardi&#243;logos en las t&#233;cnicas cuantitativas para mejorar la toma de decisiones&#46;</p></span>"
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Relative distribution of countries participating in the survey&#44; compared with the proportion of cardiologists in the region &#40;except Brazil&#41;&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Absolute risk reduction &#40;ARR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Relative risk reduction &#40;RRR&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Number needed to treat &#40;NNT&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">NNT<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>RRR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">G1&#46; In a controlled clinical trial&#44; 1900 men receiving a drug to lower their cholesterol level were compared with 1906 men receiving placebo&#46; After 7 years of follow-up&#44; the rate of cardiovascular death was 2&#37; for the placebo group and 1&#46;6&#37; for the group receiving the drug&#44; representing an absolute risk reduction of 0&#46;4&#37; &#40;statistically significant&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&#46; A controlled clinical trial of almost 4&#46;000 men with hypercholesterolemia&#44; treated with a drug or placebo revealed a relative risk reduction of 20&#37; in cardiovascular death rate over 7 years&#46; This difference in favor of the drug was statistically significant&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&#46; In a controlled clinical trial&#44; 3806 patients were divided into two groups to compare a drug <span class="elsevierStyleItalic">vs&#46;</span> placebo&#46; The rate of cardiovascular death evidenced a statistically significant difference favoring the drug&#44; with 250 patients who needed to be treated to prevent one death over 7 years&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G1&#46; Approximately 4000 persons participated in a controlled clinical study to evaluate a drug <span class="elsevierStyleItalic">vs&#46;</span> placebo in hypercholesterolemia&#46; Results over 7 years favored drug treatment&#44; with a relative decrease in the rate of cardiovascular death of 20&#37; &#40;statistically significant&#41;&#44; and 250 patients who needed to be treated to avoid one event&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">G2&#46; A medical intervention resulted in 1&#46;4&#37; absolute reduction in the 5-year incidence of fatal and non-fatal myocardial infarction &#40;2&#46;5&#37; <span class="elsevierStyleItalic">vs&#46;</span> 3&#46;9&#37;&#41; &#40;the study was a controlled clinical trial and the difference was statistically significant&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&#46; A medical intervention reported 36&#37; relative risk reduction of fatal and non-fatal myocardial infarction over 5 years &#40;it was a controlled clinical trial and the difference was statistically significant&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G2&#46; A certain medical intervention requires treating 72 persons during 5 years to prevent one fatal or non-fatal myocardial infarction &#40;the study was a controlled clinical trial and the difference was statistically significant&#41;&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">G3&#46; The use of a certain non-invasive diagnostic method for population screening provided the following survival results<span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx1"></elsevierMultimedia></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">G3&#46; The implementation of a certain non-invasive diagnostic method to screen a population gave the following mortality results in late follow-up<span class="elsevierStyleInlineFigure"><elsevierMultimedia class="elsevierStyleLink" ident="fx2"></elsevierMultimedia></span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
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    "bibliografia" => array:2 [
      "titulo" => "References"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effects of information framing on the practices of physicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "P&#46; McGettigan"
                            1 => "K&#46; Sly"
                            2 => "D&#46; O&#8217;Connell"
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Gen Intern Med"
                        "fecha" => "1999"
                        "volumen" => "14"
                        "paginaInicial" => "633"
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos