Comparing effectiveness with efficacy: outcomes of palliative chemotherapy for non-small-cell lung cancer in routine practice.

INTRODUCTION: Randomized controlled trials (rcts) are the "gold standard" for establishing treatment efficacy; however, efficacy does not automatically translate to a comparable level of effectiveness in routine practice. Our objectives were to □ describe outcomes of palliative platinum-doublet chemotherapy (ppdc) in non-small-cell lung cancer (nsclc) in routine practice, in terms of survival and well-being; and□ compare the effectiveness of ppdc in routine practice with its efficacy in rcts. METHODS: Electronic treatment records were linked to the Ontario Cancer Registry to identify patients who underwent ppdc for nsclc at Ontario's regional cancer centres between April 2008 and December 2011. At each visit to the cancer centre, a patient's symptoms are recorded using the Edmonton Symptom Assessment System (esas). Score on the esas "well-being" item was used here as a proxy for quality of life (qol). Survival in the cohort was compared with survival in rcts, adjusting for differences in case mix. Changes in the esas score were measured 2 months after treatment start. The proportion of patients having improved or stable well-being was compared with the proportion having improved or stable qol in relevant rcts. RESULTS: We identified 906 patients with pre-ppdcesas records. Median survival was 31 weeks compared with 28-48 weeks in rcts. After accounting for deaths and cases lost to follow-up, we estimated that, at 2 months, 62% of the cohort had improved or stable well-being compared with 55%-63% who had improved or stable qol in rcts. CONCLUSIONS: The effectiveness of ppdc for nsclc in routine practice in Ontario is consistent with its efficacy in rcts, both in terms of survival and improvement in well-being.

Drug use in the high intensity drug trafficking area of the US Southwest border.

This paper examines the prevalence of alcohol, tobacco and illicit drug use in the Southwest border region of the United States. Based on the seriousness of drug trafficking in the area, the Southwest border has been designated a "High Intensity Drug Trafficking Area." Yet there is little quantitative data on the nature and magnitude of drug use in the Southwest border region. This paper examines the prevalence of drug use in the area by extracting data from the National Household Survey on Drug Abuse. The data show that drug use rates in the Southwest border area are very similar to those found throughout the remainder of the United States. Hispanics, who constitute about 41% of the Southwest border population, have lower prevalence rates for most classes of drugs than non-Hispanics. The border Hispanics exhibit even lower prevalence rates than Hispanics in the remainder of the United States. However, many of these differences are attributable to the lower levels of drug use among women, and youth and older adults. As these demographic subgroups become increasingly acculturated, their drug use could come to more closely resemble that of their peers in the remainder of the United States.

Trends in illicit drug use in the United States: conflicting results from national surveys.

Data from several national studies lead to divergent conclusions regarding trends in illicit drug use in the United States. Two major population studies point to a downturn in drug use dating to the late 1970s. However, a study of drug-related deaths and hospital emergency room visits shows increases in these events in recent years. Studies also show drug use, especially cocaine, continuing to increase among criminals. Additionally, drugs were identified as the most important problem facing the nation in a Gallup poll conducted during the summer of 1989. This paper offers some possible explanations for the divergent trends. Most notably, we suggest that methodological differences in the studies being compared, and lags between trends in the general population and certain subgroups, account for most of the variation in the trend estimates. The paper concludes that illicit drug use is decreasing in the United States.

The drugs-violence nexus among American and Canadian youth.

This paper examines the relationship between drug use and violence among representative samples of students in the United States and Ontario, Canada. Canada has significantly lower levels of violent crime than the United States, but students report similar rates of drug use. Using logistic regression analysis, we find a similar relationship between drug use and violence among adolescents in the two countries. All the drugs considered--cannabis, cocaine, and alcohol binge drinking--are significantly related to violent behavior; whether the perpetrator or the victim. The most noteworthy difference may be that in Ontario, drug use appears to be even more highly correlated with violence than in the United States.

Comfortable loudness judgments for discrete frequency signals.

The test-retest reliability of Most Comfortable Loudness Level (MCL) was examined in three experiments using young normal-hearing adults unsophisticated in audiometric testing. Test stimuli included pure tones, narrow-band noise, and damped wave trains, with presentation by ascending, descending, and Bekesy procedures. Intersubject reliability was found to be very poor and intrasubject reliability to be only fair. Although instructions to Ss and subjects interpretation of instructions probably affect MCL reliability, the task appears to be inherently variable.