Pulmonary Metastasectomy versus Continued Active Monitoring in Colorectal Cancer (PulMiCC): a multicentre randomised clinical trial.

Background: Lung metastasectomy in the treatment of advanced colorectal cancer has been widely adopted without good evidence of survival or palliative benefit. We aimed to test its effectiveness in a randomised controlled trial (RCT).

Methods: Multidisciplinary teams in 13 hospitals recruited participants with potentially resectable lung metastases to a multicentre, two-arm RCT comparing active monitoring with or without metastasectomy.

The STRAND Chart: A survival time control chart.

The STRAND Chart (Survival Time, Risk-Adjusted, N-Division Chart) is a new tool for online risk-adjusted (RA) monitoring of survival outcomes. The chart is drawn in continuous time, making it responsive to change in the process of interest, for example, performance over time of a surgical unit and the procedures that they employ. Though it is difficult to achieve with charts designed for the purpose described, we show that our suggested chart keeps patient ordering intact.

Risk-adjusted sequential probability ratio tests: applications to Bristol, Shipman and adult cardiac surgery.

Objective: To investigate the use of the risk-adjusted sequential probability ratio test in monitoring the cumulative occurrence of adverse clinical outcomes.

Design: Retrospective analysis of three longitudinal datasets.

Subjects: Patients aged 65 years and over under the care of Harold Shipman between 1979 and 1997, patients under 1 year of age undergoing paediatric heart surgery in Bristol Royal Infirmary between 1984 and 1995, adult patients receiving cardiac surgery from a team of cardiac surgeons in London,UK.