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Cervical cancer mortality by neighbourhood income in urban Canada from 1971 to 1996.

https://arctichealth.org/en/permalink/ahliterature17719
Source
CMAJ. 2004 May 11;170(10):1545-9
Publication Type
Article
Date
May-11-2004
Author
Edward Ng
Russell Wilkins
Michael Fung Kee Fung
Jean-Marie Berthelot
Author Affiliation
Health Analysis and Measurement Group, Statistics Canada, Ottawa, Ont.
Source
CMAJ. 2004 May 11;170(10):1545-9
Date
May-11-2004
Language
English
Publication Type
Article
Keywords
Adult
Age Distribution
Canada - epidemiology
Female
France - epidemiology
Great Britain - epidemiology
Humans
Norway - epidemiology
Prevalence
Residence Characteristics
Socioeconomic Factors
United States - epidemiology
Urban Population
Uterine Cervical Neoplasms - mortality
Uterine Neoplasms - mortality
Abstract
BACKGROUND: The reduction of socioeconomic inequalities in health is an explicit objective of health policy in Canada, yet rates of death from cervical cancer are known to be higher among women of low socioeconomic status than among those of higher socioeconomic status. To evaluate progress toward the World Health Organization's goal of "Health for All," we examined whether income-related differentials in cervical cancer mortality diminished from 1971 to 1996. METHODS: Death registration data for Canada's census metropolitan areas in 1971, 1986, 1991 and 1996 were assigned to census tracts through postal code, and the tracts were in turn assigned to income quintiles based on their proportion of the population below the Statistics Canada low-income cutoff values. We compared age-standardized death rates (using the 1966 world population standard) in the female population (excluding those in institutions) across the 5 income quintiles and calculated interquintile rate ratios (poorest over richest) and interquintile rate differences (poorest minus richest). RESULTS: From 1971 to 1996, the overall age-standardized cervical cancer death rate per 100 000 women (and 95% confidence interval) declined from 5.0 (4.5-5.6) to 1.9 (1.7-2.1), the interquintile rate ratio diminished from 2.7 (1.8-4.2) to 1.7 (1.1- 2.6), and the interquintile rate difference decreased from 4.6 (2.8- 6.4) to 1.1 (0.2-1.9). INTERPRETATION: The income-related disparity in rates of death from cervical cancer as measured by rate ratios and rate differences diminished markedly in urban Canada from 1971 to 1996. Among the numerous factors that may have contributed to the decline (including decline in fertility and improvement in diet), one important factor was probably the implementation of effective screening programs.
Notes
Erratum In: CMAJ. 2004 Aug 31;171(5):432
PubMed ID
15136547 View in PubMed
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Cervical screening: a guideline for clinical practice in Ontario.

https://arctichealth.org/en/permalink/ahliterature124702
Source
J Obstet Gynaecol Can. 2012 May;34(5):453-8
Publication Type
Article
Date
May-2012
Author
Joan Murphy
Erin B Kennedy
Sheila Dunn
C Meg McLachlin
Michael Fung Kee Fung
Danusia Gzik
Michael Shier
Lawrence Paszat
Author Affiliation
Division of Gynecologic Oncology, University Health Network, Toronto ON.
Source
J Obstet Gynaecol Can. 2012 May;34(5):453-8
Date
May-2012
Language
English
Publication Type
Article
Keywords
Early Detection of Cancer
Female
Humans
Ontario
Uterine Cervical Neoplasms - diagnosis
Abstract
To develop guidelines to inform the Ontario Cervical Screening Program's invitations to women in the target population, provide evidence-based clinical practice guidance for practitioners, and inform policy decisions.
A systematic review was conducted of relevant websites, the Medline and EMBASE databases (2005 to November 2010), and the Cochrane Library (2005 to 2010). No guidelines or systematic reviews were located that addressed the topics of interest. The evidence base consisted of seven randomized controlled trials, three case-control studies, one cohort study, and one review article. A methodologist performed data identification and extraction. Review of the data and quality assessment was carried out by the authors, who have expertise in methodology, gynaecologic oncology, pathology, and family medicine. The systematic review methods and resulting recommendations were reviewed by an internal panel with clinical, methodological, and oncology expertise. External review was provided by Ontario clinicians and other experts.
The guideline development process led to recommendations for the optimal primary cervical screening method, screening interval, and age of screening cessation for Ontario women in the target population. There was insufficient evidence to provide a recommendation for age of initiation of cervical screening with HPV testing. The creation of an organized screening program in the province will allow the implementation of evidence-based recommendations. We provide interim recommendations for cervical screening until HPV testing has been funded.
Notes
Comment In: J Obstet Gynaecol Can. 2012 May;34(5):411-222555131
PubMed ID
22555138 View in PubMed
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Development of communities of practice to facilitate quality improvement initiatives in surgical oncology.

https://arctichealth.org/en/permalink/ahliterature157643
Source
Qual Manag Health Care. 2008 Apr-Jun;17(2):174-85
Publication Type
Article
Author
Michael Fung-Kee-Fung
Elena Goubanova
Karen Sequeira
Arifa Abdulla
Rose Cook
Claire Crossley
Bernard Langer
Andrew J Smith
Hartley Stern
Author Affiliation
Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada. MFUNG@Ottawahospital.on.ca
Source
Qual Manag Health Care. 2008 Apr-Jun;17(2):174-85
Language
English
Publication Type
Article
Keywords
Humans
Models, organizational
Oncology Service, Hospital - standards
Ontario
Organizational Case Studies
Quality Assurance, Health Care - organization & administration
Surgery Department, Hospital - standards
Abstract
The process of developing clinical guidelines and standards for cancer treatment and screening is well established in the Ontario health care system; however, the dissemination and implementation of such guidelines and standards are more recent undertakings. Traditional implementation strategies to improve surgical practice and the delivery of cancer care have not been consistently effective. There is a recognized need to develop integrated models that offer direct support for implementation strategies. Such a model should be feasible, adaptable, and open to evaluation across diverse surgical settings.
Research suggests that successful implementation should consider tools and expertise from other disciplines. This article considers a community of practice (COP) model to provide a supportive infrastructure for quality improvements in cancer surgery. The COP model was adapted for cancer surgeons. It is supported by 5 enablers referred to as tools: communication system, project development support, access to data, access to evidence review, and accreditation with continued medical education and continued professional development. These tools need to be part of an infrastructure that is both provided and supported by a team of administrators and health care professionals, who have active roles and responsibilities. Therefore, the primary objective of this article is to describe our COP model in cancer surgery including the key success factors necessary for providing the infrastructure and tools. The secondary objective is to offer the integrated COP model as a basis for future research and the evaluation of various collaborative improvement projects.
Building on knowledge management concepts, we identified the 4 essential processes that should be targeted by implementation strategies. A common COP evaluation framework uses the outcomes of 4 knowledge conversion modes-organizational memory, social capital, innovation, and knowledge transfer-as proxies for actual provider and organizational behavior. Insights from different collaborative improvement projects described in a consistent way could inform future research and assist in the collation of systematic reviews on this topic.
PubMed ID
18425031 View in PubMed
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Evaluating contemporary radiotherapy approaches in the primary treatment of cervical cancer.

https://arctichealth.org/en/permalink/ahliterature141743
Source
Int J Gynecol Cancer. 2010 Aug;20(6):1087-91
Publication Type
Article
Date
Aug-2010
Author
Rajiv Samant
Sofya Kobeleva
Choan E
Khalid Balaraj
Tien Le
Michael Fung-Kee-Fung
Author Affiliation
Division of Radiation Oncology, The Ottawa Hospital, Ottawa, Ontario, Canada. rsamant@ottawahospital.on.ca
Source
Int J Gynecol Cancer. 2010 Aug;20(6):1087-91
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Brachytherapy - adverse effects - methods
Cisplatin - administration & dosage
Cohort Studies
Combined Modality Therapy
Dose Fractionation
Dose-Response Relationship, Radiation
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Middle Aged
Neoplasm Staging
Ontario
Radiotherapy Dosage
Retrospective Studies
Statistics, nonparametric
Survival Analysis
Treatment Outcome
Uterine Cervical Neoplasms - drug therapy - mortality - pathology - radiotherapy
Abstract
Radiotherapy with concurrent cisplatinum-based chemotherapy became a standard recommendation for the management of advanced cervical cancer in 1999. We reviewed our experience with this approach to determine the impact on patient outcomes.
A retrospective review of all cervical cancer patients treated with curative intent using radical radiotherapy +/- chemotherapy from 1992 to 2005 was performed. Survival and relapse rates were analyzed using the Kaplan-Meier method and were compared using the log-rank test.
During this period, 224 treated patients were identified: 153 (68%) were treated between 1992 and 1999 (group 1) and 71 (32%) were treated after 1999 (group 2). The median age was 53 and 55 years with a median follow-up of 49 and 34 months for groups 1 and 2, respectively. Stage classification and histological diagnosis were similar for both groups. Treatment usually consisted of external beam pelvic radiotherapy (40-45 Gy in 20-25 fractions) followed by low-dose rate brachytherapy (35-40 Gy to point A). Chemotherapy consisted of weekly intravenous cisplatinum (40 mg/m2) given concurrently with pelvic radiation. The proportion of patients receiving chemotherapy increased significantly after 1999, 12% in group 1 compared with 79% in group 2 (P
PubMed ID
20683423 View in PubMed
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Ontario cervical cancer screening clinical practice guidelines.

https://arctichealth.org/en/permalink/ahliterature163807
Source
J Obstet Gynaecol Can. 2007 Apr;29(4):344-53
Publication Type
Article
Date
Apr-2007
Author
C Meg McLachlin
Verna Mai
Joan Murphy
Michael Fung-Kee-Fung
Alexandra Chambers
Thomas K Oliver
Author Affiliation
London Health Sciences Centre, University of Western Ontario, London ON.
Source
J Obstet Gynaecol Can. 2007 Apr;29(4):344-53
Date
Apr-2007
Language
English
Publication Type
Article
Keywords
Cervical Intraepithelial Neoplasia - epidemiology - etiology - prevention & control
Female
Humans
Mass Screening
Ontario - epidemiology
Uterine Cervical Neoplasms - epidemiology - etiology - prevention & control
Abstract
To develop clinical practice guidelines for cervical screening and the primary management of abnormal cytology in Ontario, using an established methodological process.
Primary data sources were relevant articles listed in the Medline (1998 to July 2004), Embase (1998 to July 2004), and Cochrane Library (2004, Issue 2) databases.
Studies addressing quality or the optimization of cervical screening were considered eligible in the systematic review of the evidence. Specifically, clinical practice guidelines, technology assessments, systematic reviews, and randomized controlled trials were of primary interest. Given the variability of the data, other information sources were considered eligible if there was a demonstrated gap in the published literature.
Data were identified and extracted by a methodologist and reviewed by four authors. Results were reviewed and discussed by members of an expert working group consisting of a diverse group of health professionals with expertise in cervical cancer. Data audits were conducted by independent reviewers.
recommendations with evidence ratings were developed through a review of the evidence with expert consensus and were approved by more than 80% of 40 external practitioners who reviewed the document and responded to a standardized survey.
The development of comprehensive recommendations on cervical screening in Ontario was feasible using a rigorous methodological process. Recommendations for practice are provided.
PubMed ID
17475128 View in PubMed
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Risk-reducing salpingectomy in Canada: a survey of obstetrician-gynaecologists.

https://arctichealth.org/en/permalink/ahliterature108538
Source
J Obstet Gynaecol Can. 2013 Jul;35(7):627-34
Publication Type
Article
Date
Jul-2013
Author
Clare J Reade
Sarah Finlayson
Jessica McAlpine
Alicia A Tone
Michael Fung-Kee-Fung
Sarah E Ferguson
Author Affiliation
Department of Obstetrics and Gynaecology, University of Toronto, Toronto, ON, Canada.
Source
J Obstet Gynaecol Can. 2013 Jul;35(7):627-34
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Cystadenocarcinoma, Serous - epidemiology - prevention & control
Female
Gynecologic Surgical Procedures - psychology - statistics & numerical data
Gynecology - methods - statistics & numerical data
Health Care Surveys
Humans
Hysterectomy - methods - statistics & numerical data
Physician's Practice Patterns
Professional Practice
Qualitative Research
Risk assessment
Salpingectomy - methods - statistics & numerical data
Abstract
Performing risk-reducing salpingectomy (RRS) at the time of hysterectomy or as a method of tubal ligation has been suggested as a way to reduce the incidence of high grade serous carcinoma (HGSC) of the ovary, since this type of cancer is hypothesized to originate in the fallopian tube. We conducted a survey of Canadian obstetrician-gynaecologists to better understand the uptake and knowledge of implementing this procedure, and to identify barriers to doing so.
An anonymous, web-based survey using both quantitative and qualitative methods was sent to obstetrician-gynaecologist members of the Society of Obstetricians and Gynaecologists of Canada and the Society of Gynecologic Oncology of Canada. The survey contained questions about demographics, knowledge and beliefs about RRS, and possible barriers to its implementation in women at average risk for ovarian cancer.
One hundred ninety-two physicians responded to the survey, a response rate of 25%. Respondents varied in their duration in practice, came from all provinces, and spent a large proportion of their time practising gynaecology. Ninety percent of respondents had heard of RRS; however, 37% were unaware of the evidence supporting the hypothesis that HGSC originates in the fallopian tube, and 38% were unsure whether there would be any population benefit from performing RRS at the time of other gynaecologic surgery. Multiple barriers to implementation were identified.
Most Canadian obstetrician-gynaecologists responding to our survey were aware of RRS as a possible method to prevent ovarian cancer in women at average risk; however, barriers still exist to widespread implementation. Further research is needed to quantify the population benefit of this procedure.
PubMed ID
23876640 View in PubMed
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6 records – page 1 of 1.