Second primary cancer among 217702 colorectal cancer survivors: An analysis of national German cancer registry data.

With improvements in survival after colorectal cancer (CRC), more survivors are at risk of developing a second cancer, particularly in younger populations where CRC incidence is increasing. We estimated the incidence of second primary cancer (SPC) in CRC survivors and its potential risk factors. We identified CRC cases diagnosed between 1990 and 2011 and SPCs until 2013 from nine German cancer registries. Standardized incidence ratios (SIR) and absolute excess risk (AER) per 10 000 person-years were calculated and were stratified by index site: colon cancer (CC) and rectal cancer (RC), age and sex. Cox regression assessed potential SPC risk factors, including primary tumor-related therapy considering death as a competing risk. We included 217 202 primary CRC cases. SPC occurred in 18 751 CRC survivors (8.6%; median age: 69 years). Risk of cancer was significantly higher in CRC survivors than in the general population (SIR males 1.14, 95% confidence interval [CI] 1.12-1.17, AER = 24.7; SIR females 1.20, 95% CI 1.17-1.23, AER = 22.8). Increased risks of SPCs were observed for the digestive system, urinary system and female and male reproductive organs. CRC incidence increased in younger persons (<50 years) and SPC incidence was 4-fold in this group (SIR males 4.51, 95% CI 4.04-5.01, AER = 64.2; SIR females 4.03, 95% CI 3.62-4.48, AER = 77.0). Primary tumor-related factors associated with SPC risk were right-sided cancer and smaller primary tumor size. Treatment and risk of SPC differed for CC (no effect) and RC (lower risk after chemotherapy). CRC survivors have excess risk of developing SPC, with particular characteristics that could guide targeted surveillance.

A Practical Curriculum Design and Learning Effectiveness Evaluation of Competence-Oriented Instruction Strategy Integration: A Case Study of Taiwan Skills-Based Senior High School.

The 12-Year Basic Education Curricula not only follow the objectives of previous curriculum syllabus development, but they place more focus on competence-oriented instruction, which aims to emphasize the importance of combining the curriculum with life situations that are not solely based on learning knowledge and skills. This study aims to investigate the results of the students' learning effectiveness and learning engagement after adding competence-oriented instructional strategies into electrical engineering practical subjects offered by the Department of Electrical Engineering in skills-based senior high schools, and, at the same time, to figure out the difference in learning effectiveness using different instructional strategies. Two classes of students from the Department of Electrical Engineering major in electrical engineering practical subjects in one skills-based senior high school in Central Taiwan were chosen as the participants for this study. By way of pre-test-post-test research design and heterogeneous grouping, a 10-week instruction experiment consisting of two groups and occurring over the course of 30 classes was conducted, wherein competence-oriented instructional strategies were used in an experimental group, while traditional didactic instructional strategies were used in a control group. By analyzing the collection of quantitative and qualitative data through competence-oriented instructional strategies, the instruction effectiveness and feasibility of the basic electricity practical curriculum were developed as the study topic for understanding how competence-oriented instruction can be implemented into the practical curriculum of the electrical engineering and electronic engineering group. According to the research objective, the results were concluded as follows: (1) Students of the Department of Electrical Engineering have a slightly better learning effectiveness in electrical engineering practice under competence-oriented instructional strategies compared with those who learned under the traditional didactic instructional strategies; (2) there is a significant difference in the students' learning engagement in electrical engineering practice from the Department of Electrical Engineering under competence-oriented instructional strategies compared with those who learned under the traditional didactic instructional strategies. The conclusion of this study emphasizes designing questions based on life situations, thereby applying what students have learned to solve problems they encounter in their daily lives. Compared with traditional didactic instructional strategies, competence-oriented instructional strategies not only have a better learning effectiveness and provide flexibility for the students to solve problems and provide analysis for situations, they also have broader applicability and an increased number of positive benefits when it comes to students' group interactions and sharing.