Reporting results from chemotherapy trials. Does response make a difference in patient survival?

Patients with many common tumors are treated with chemotherapy despite limited evidence of treatment effectiveness. To determine if chemotherapy trials reporting effectiveness actually demonstrated increased survival in treated patients, we reviewed trials published over a two-year period involving four common solid tumors. Of 80 studies, 95% reported response to chemotherapy as an end point. Of 38 studies demonstrating 15% or greater objective response, 76% reported significantly greater survival of responders than of nonresponders. Of 21 studies containing statements supporting treatment effectiveness, 95% based this claim at least in part on the superior survival of responders compared with nonresponders. Because responders may have lived longer without treatment, such comparisons are not valid and may lead to overly optimistic views of chemotherapy effectiveness. Journal editors should be wary of allowing survival comparisons between responders and nonresponders in published reports.     

The early effect of Medicare's prospective payment system on the use of medical intensive care services in three community hospitals

To assess the impact of Medicare's prospective payment system (PPS) on patient care and outcome from the medical intensive care unit (MICU), we reviewed the medical records of 400 MICU patients from three community hospitals: 200 patients were admitted before the PPS and 200 were admitted after the PPS. We sampled Medicare patients, aged 65 years and over, and non-Medicare comparison patients, aged 50 to 64 years, collecting data on case mix, treatment intensity and discharge disposition, hospital and six-month mortality, length of stay, and number of intensive care unit beds. After the PPS, the number of intensive care unit beds decreased 31%, without changes in MICU patients' illness severity or treatment intensity. Hospital length of stay decreased 15% in the Medicare group and 43% in the comparison group. For both Medicare and comparison patients combined, MICU length of stay decreased 14% and patients after the PPS were less likely to be discharged to go home. There were no significant changes in in-hospital or six-month mortality. Thus, clinically meaningful decreases in length of stay among seriously ill patients did not result in a change in in-hospital or six-month mortality.     

Operationalising sexual and reproductive health and rights in sub-Saharan Africa: constraints,dilemmas and strategies

Background

The continued poor sexual and reproductive health (SRH) outcomes in sub-Saharan Africa highlight the difficulties in reforming policies and laws, and implementing effective programmes. This paper uses one international and two national case studies to reflect on the challenges, dilemmas and strategies used in operationalising sexual and reproductive health and rights (SRHR) in different African contexts.

Methods

The international case study focuses on the progress made by African countries in implementing the African Union’s Maputo Plan of Action (for the Operationalisation of the Continental Policy Framework for Sexual and Reproductive Health and Rights) and the experiences of state and non-state stakeholders in this process. The case was developed from an evaluation report of the progress made by nine African countries in implementing the Plan of Action, qualitative interviews exploring stakeholders’ experiences and perceptions of the operationalisation of the plan (carried out as part of the evaluation) in Botswana and Nigeria, and authors’ reflections. The first national case study explores the processes involved in influencing Ghana’s Domestic Violence Act passed in 2007; developed from a review of scientific papers and organisational publications on the processes involved in influencing the Act, qualitative interview data and authors’ reflections. The second national case study examines the experiences with introducing the 2006 Sexual Offences Act in Kenya, and it is developed from organisational publications on the processes of enacting the Act and a review of media reports on the debates and passing of the Act.

Results

Based on the three cases, we argue that prohibitive laws and governments’ reluctance to institute and implement comprehensive rights approaches to SRH, lack of political leadership and commitment to funding SRHR policies and programmes, and dominant negative cultural framing of women’s issues present the major obstacles to operationalising SRH rights. Analysis of successes points to the strategies for tackling these challenges, which include forming and working through strategic coalitions, employing strategic framing of SRHR issues to counter opposition and gain support, collaborating with government, and employing strategic opportunism.

Conclusion

The strategies identified show future pathways through which challenges to the realisation of SRHR in Africa can be tackled.

     

Metabolic and Renal Changes Following the Ingestion of African Mistletoe Extract in Rats

The effect of an aqueous extract of African mistletoe ( Loranthus begwensis ) from two host plants ( Citrus limon [Cl-mistletoe] or Vernonia amygdalina [Va-mistletoe]) was studied in male Wistar rats treated orally with either 1.32, 13.2 or 26.4 g/kg per day for 7 days. A significant dose-dependent reduction ( p <0.01) in the serum glucose and cholesterol was obtained with both extracts, accompanied by a reduction of urine flow rate and serum creatinine. Increases in urinary enzymes and protein excretion were dose-related and dependent on the source of extracts. Mistletoe extract irrespective of source appears to lower the blood sugar level offering the potential for clinical use of the ingredients of its extracts. © 1997 by John Wiley & Sons, Ltd.