10 research outputs found
Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)
BACKGROUND:
Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control.
METHODS:
Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights.
FINDINGS:
5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease.
INTERPRETATION:
International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems
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Applications of interpretive structural modelling and related methods within the context of interactive management
This thesis is about the application of Interpretive Structural Modelling (ISM) and two supporting idea-generation methods, Ideawriting and Nominal Group Technique. Taken together, the three methods, which are all designed for use with participant groups, may be employed in various ways to provide a process of inquiry within the context of Interactive Management.
The applications focus on fifteen planning workshops conducted by the author. In these workshops the methods were used to assist groups from a range of public sector organisations in planning activities such as setting and structuring objectives. Full details of the applications are given in the published papers and reports which are reproduced in the Supporting Papers section of the thesis. A summary of the sequence of methods used in each workshop and the resulting outcomes is given in Chapter 7.
In order to give coherence to the applications, Chapters 2 to 6 present a framework for Interactive Management as a means of exploring complex issues and consider the principles and process of each of the three methods. Five components that help to make work with groups productive are examined: the participant group, the facilitator, the methods, the computer support and the decision support room. The way in which the last two have been implemented at City University is described. In Chapter 4, the principles of ISM as a modelling tool are explained and the operation of the ISM computer software developed at City University for a personal computer is outlined. Chapters 5 and 6 focus on the processes of Ideawriting and Nominal Group Technique and summarise ways in which they have been applied and, in the case of Ideawriting, extended; their benefits and limitations are also discussed. The incorporation of Ideawriting and the concepts of Interactive Management into a process of model building and computer software development is explained.
Chapters 8 and 9 discuss lessons for ISM, Interactive Management and Systems Science which are drawn from the applications. With regard to ISM, these include the creation of a new type of ISM priority structure, called here the composite priority structure. Other lessons for ISM concern ways of making the best use of the method in practice; its benefits and limitations are also assessed. In the case of lessons for Interactive Management, the activities in a complete intervention are analysed and methods for idea categorisation and writing mission statements are explained. With regard to Systems Science, the lessons focus on those aspects of complexity that are addressed by ISM and upon ISM as a modelling tool.
Finally, the conclusions in Chapter 10 show the extent to which the objectives stated at the start of the thesis have been achieved and explain the author's contribution to the knowledge of the subject. Possible areas for future work are also outlined
Promoting global research excellence in severe sepsis (PROGRESS): Lessons from an international sepsis registry
SCOPUS: ar.jinfo:eu-repo/semantics/publishe