187 research outputs found
Le mouvement social au Havre, 1912-1923 : John Barzman, Dockers, métallos, ménagères. Mouvements sociaux et cultures militantes au Havre, 1912-1913, 1997
No full textConcato Francis. Le mouvement social au Havre, 1912-1923 : John Barzman, Dockers, métallos, ménagères. Mouvements sociaux et cultures militantes au Havre, 1912-1913, 1997. In: Études Normandes, 47e année, n°2, 1998. Mai 68 à Rouen. pp. 68-70
Le mouvement social au Havre, 1912-1923 : John Barzman, Dockers, métallos, ménagères. Mouvements sociaux et cultures militantes au Havre, 1912-1913, 1997
No full textConcato Francis. Le mouvement social au Havre, 1912-1923 : John Barzman, Dockers, métallos, ménagères. Mouvements sociaux et cultures militantes au Havre, 1912-1913, 1997. In: Études Normandes, 47e année, n°2, 1998. Mai 68 à Rouen. pp. 68-70
Key Indexing Terms: RISK COMMUNICATION NUMERACY DRUG TOXICITY RHEUMATOID ARTHRITIS Personal, non-commercial use only
No full textEffectively communicating the risk and benefits of available treatment alternatives is an essential component of medical care. This is particularly true regarding the treatment of rheumatoid arthritis (RA), where there are now multiple treatment options available, each with distinct risk profiles. Effective communication of risk is difficult, however, in part because of limitations associated with both the provision and interpretation of probabilistic information 1-8 . At the most basic level, there is little agreement on how to present risk information in clinical practice, with some investigators arguing for the use of verbal phrases such as "rare" or "frequent" and others advocating the use of quantitative estimates (e.g., proportions or percentages). Use of words is limited by the wide range of values that patients and physicians assign to verbal expressions of probability 12 . People with protected values believe that certain objects should be protected from any and all trade-offs with other values no matter how small the risk. For example, people with protected values for forest conservation believe that forests should be protected from loggers no matter how small the threat to the forest. Studies have shown that protected values often result from incorrect assumptions and may therefore lead to poor decision-making. To test our hypothesis, we examined whether using several strategies to facilitate risk-communication, patients alter their willingness to take medications as the risk of toxicity is substantially decreased, and whether increased willingness to accept the risk of toxicity varies depending on the specific AE. MATERIALS AND METHODS Patients. Consecutive patients with RA belonging to a community rheumatology practice serving New Haven, Connnecticut, and surrounding areas were asked to participate in a study examining the importance patients attach Risk Communication in Rheumatoid Arthritis LIANA FRAENKEL, SIDNEY BOGARDUS, JOHN CONCATO, and DAVID FELSON ABSTRACT. Objective. Some people believe that certain issues should be protected from all trade-offs. These issues are referred to as "protected values." We investigated whether some patients with rheumatoid arthritis (RA) treat the risk of adverse effects (AE) as "protected values," i.e., as unacceptable regardless of how small the risk. Methods. Patients with RA rated willingness to risk 17 different AE on a visual analog scale, where 0 = not willing under any circumstances and 100 = definitely willing. Participants then rated willingness to take medication as the risk of each AE was progressively decreased by 2 levels from its actual risk, using a 5 level scale ranging from 10 in 100 to 1 in 100,000. Results. Between 32% and 39% of participants were not more willing to accept a risk of AE causing reversible cosmetic changes (e.g., acne), between 35% and 47% were not more willing to accept a risk of AE causing reversible discomfort (e.g., rash), and between 41% and 45% were not more willing to accept a risk of AE causing potential irreversible damage (e.g., pneumonitis) as the probability of each of these AE was substantially decreased. Unwillingness to accept risk of toxicity was especially evident for cancer, where 66% of patients refused to accept a risk of cancer occurring in 1 in 100,000 persons. Conclusion. Among patients particularly concerned with the risk of drug toxicity, many remain unwilling to accept the risk of AE even when their probability is decreased to levels far below their actual risk. These results suggest that patients may treat particularly worrisome AE as protected values, which may lead to poor decision-making in clinical practice
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