Statistical methods for preventive trials in mental health.
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For many cancers, five-year survival is used as a synonym for cure. For some sites, such as breast, this is inappropriate since there is still considerable excess mortality 5-15 years following diagnosis. We propose using the probability of not dying prematurely as a surrogate for the probability of being cured. This is estimated without the need for information on the cause of death by comparing all-cause-mortality rates in patients with cancer to those in the general population. We also consider the probability of 'cure' in those who have survived a certain number of years since diagnosis. These quantities are estimated for various cancer sites using SEER data. The proportion not dying prematurely varies considerably for common cancers from 12% for lung cancer to 84% for prostate cancer. In women, the percentage 'cured' for colon and breast cancer are very similar at 56% and 58% respectively, but in those who survive 5 years, they are quite different--91% and 78% respectively. The proposed statistic is useful. For diseases in which excess mortality is primarily within five years of diagnosis, it agrees well with 5-year relative survival. Interpretation of differences between countries or over time is complicated and requires consideration of incidence and mortality data.
Statistical analysis of lipoprotein and non-lipoprotein signal peptides reveals that the two classes differ significantly only in the region close to the signal peptidase cleavage site. This region is apolar and has the consensus sequence LA(G,A) decreases C in the lipoproteins, but is polar and has small, uncharged residues in positions -3 and -1 in the non-lipoproteins. A simple search for matches to the lipoprotein consensus cleavage site suffices to discriminate between the two groups with close to 100% reliability.
Medical research projects that involve any aspect of the collection, summarization, analysis and/or interpretation of clinical quantitative information require statistical support. This input may be provided by the clinicians themselves if properly trained, but is most appropriately and commonly achieved by a relationship with a biostatistician. The biostatistician can be an assistant, a consultant, or a colleague co-investigator. The role of the biostatistician in the research endeavor is one that is partially dictated by the nature of this relationship, but also is one that has evolved considerably in the recent past. This paper reviews the role of the biostatistician in terms of the potential contribution to the research, with special attention to the evolution of this role in light of the fast changes in computation and in statistical methodology. Finally, a method for biostatistical critical appraisal of the biomedical literature is proposed.