Attitudes and experience of urology trainees in interpreting prostate magnetic resonance imaging

IntroductionMultiparametric magnetic resonance imaging (mpMRI) has resulted in accurate prostate cancer localization and image-guided targeted sampling for biopsy. Despite its more recent uptake, knowledge gaps in interpretation and reporting exist. Our objective was to determine the need for an educational intervention among urology residents working with mpMRIs.MethodsWe administered an anonymous, cross-sectional, self-report questionnaire to a convenience sample of urology residents in U.S. and Canadian training programs. The survey included both open- and closed-ended questions employing a five-point Likert scale. It was designed to assess familiarity, exposure, experience, and comfort with interpretation of mpMRI.ResultsFifty-three surveys were completed by residents in postgraduate years (PGY) 1–5 and of these, only 12 (23%) reported any formal training in mpMRI interpretation. Most residents’ responses demonstrated significant experience with prostate biopsies, as well as familiarity with reviewing mpMRI for these patients. However, mean (± standard deviation [SD]) Likert responses suggested a relatively poor understanding of the components of Prostate Imaging-Reporting and Data System (PI-RADS) v2 scoring for T2-weighted films (2.45±1.01), diffusion-weighted imaging (DWI) films (2.26±0.90), and dynamic contrast-enhanced (DCE) films (2.21±0.99). Similar disagreement scores were observed for questions around interpretation of the different functional techniques of MRI images. Residents reported strong interest (4.21±0.91) in learning opportunities to enhance their ability to interpret mpMRI.ConclusionsWhile mpMRI of the prostate is a tool frequently used by care teams in teaching centers to identify suspicious prostate cancer lesions, there remain knowledge gaps in the ability of trainees to interpret images and understand PI-RADS v2 scoring. Online modules were suggested to balance the needs of trainee education with the residency workflow.     

Comparative effectiveness of robotic and open radical prostatectomy

Radical prostatectomy (RP) has undergone a remarkable transformation from open to minimally-invasive surgery over the last two decades. However, it is important to recognize there is still conflicting evidence regarding key outcomes. We aimed to summarize current literature on comparative effectiveness of robotic and open RP for key outcomes including oncologic results, health-related quality of life (HRQOL) measures, safety and postoperative complications, and healthcare costs. The bulk of the paper will discuss and interpret limitations of current data. Finally, we will also highlight future directions of both surgical approaches and its potential impact on health care delivery.     

Risky Sexual Behavior Among Street Children,Adolescents, and Young People Living on the street in southern Brazil

Although adolescents living on the street tend to have unprotected sex with many partners and substance abuse, little is known about this reality in Brazil. To estimate the prevalence and factors associated with risky sexual behavior among children and adolescents living on the street in Porto Alegre and Rio Grande. A cross-sectional study was carried out using the Respondent-Driven Sampling (RDS) sampling method to quickly and efficiently access populations of difficult access. Poisson regression with robust adjustment of variance was used in the multivariate analysis. The sample consisted of 231 participants aged 10–21 years. Most were male and aged 16- 21 years. More than half (66.7%) of the respondents did not have a school bond, and 64.5% did not live with the family. Half of the sample had been living on the street for at least four years, spending 15 h or more on the street. Most (86.6%) responded that they had already used illicit drugs in their lives, and unprotected sex prevalence was 61.9%. The variables independently associated with unprotected sex were years living on the street, hours spent on the street, having a steady partner, illicit drug use, and sexual intercourse without a condom under the influence of drugs. The high prevalence of unprotected sex points to the need for intervention policies for this population to prevent the main risk factors.

     

Association between food patterns and difficulties in falling asleep among adolescents in Norway — a descriptive Young-Hunt3 study

Journal of Public Health - Adolescents’ sleep duration has decreased over the past century; this is mainly caused by problems with falling asleep. Short sleep duration, poor sleep quality,...     

Evidence for the involvement of the opioid system in the agmatine antidepressant-like effect in the forced swimming test

This study investigated the involvement of the opioid system in the antidepressant-like effect of agmatine in the mouse forced swimming test (FST). The antidepressant-like effects of agmatine (10 mg/kg, i.p.), as well as those of fluoxetine (32 mg/kg, i.p, a selective serotonin reuptake inhibitor, SSRI) or morphine (5 mg/kg, s.c., a nonselective opioid receptor agonist) in the FST was completely blocked by pretreatment of mice with naloxone (1 mg/kg, i.p., a nonselective opioid receptor antagonist). Pretreatment of mice with naltrindole (3 mg/kg, i.p., a selective delta-opioid receptor antagonist), clocinnamox (1 mg/kg, i.p., an irreversible mu-opioid receptor antagonist), but not with 2-(3,4-dichlorophenyl)-N-methyl-N-[(1S)-1-(3-isothiocyanatophenyl)-2-(1-pyrrolidinyl)ethyl]acetamide (DIPPA; 1 mg/kg, i.p., a selective kappa-opioid receptor antagonist) completely blocked the anti-immobility effect of agmatine (10 mg/kg, i.p.) in the FST. These results firstly demonstrate that the antidepressant-like effects of agmatine in the FST seem to be mediated, at least in part, by an interaction with the opioid system, that involves an activation of delta- and mu-opioid receptors.     

Reduction of cell proliferative activities of gastric stump adenomatous hyperplasias after bile reflux diversion in rats

Previously we reported the majority of lesions induced by bilereflux, in the absence of chemical carcinogens, in the rat remnantstomach to consist primarily of gastric type and secondarilyof intestinal type cells, and that they are reversible afterdiversion of bile reflux. The present study was designed toevaluate changes in proliferative activities in cells of eachtype under these conditions. The frequency of adenomatous hyperplasia(AH) induced in the gastric stump mucosa by duodenal contentreflux after Billroth II partial gastrectomy (BII) increaseduntil the 54th week of the experiment. Roux-en-Y (RY) surgicalprocedure which prevents duodenal reflux performed at the 24thor 36th week after BII led to a decrease in AH. Cell contentof the lesions was analyzed using routine H&E staining,immunohistochemical staining for pepsinogen isoenzyme 1 andhistochemical procedures for mucins (paradoxical concanavalinA, galactose oxidase Schiff and sialidase galactose oxidaseSchiff reactions) and proliferation in each compartment evaluatedby an immunohistochemical method using bromodeoxyuridine (BrdU)and a monoclonal antibody against BrdU. At the 54th week thenumber of BrdU-labeled cells per normal pyloric column was significantly(P < 0.05) increased to 10.63/pit after the BII operation,while it diminished to 5.23/pit after RY diversion, this beingthe same level as with the RY procedure alone. AH maintaineda high rate of BrdU incorporation at 12.7% after BII operation,which was also significantly reduced (P < 0.01) to 7.0% bythe RY surgery. The intestinal type cell showed highest (22.2%),the surface mucous type cell showed the next (16.5%) and thepyloric gland type cell showed lowest (5.2%) BrdU labeling indicesafter BII operation. All the cell types in AH showed similarproportional decreases in BrdU incorporation after RY diversion.Thus surgical intervention reverses the cell proliferation causedby bile reflux in the gastric stump.     

Diagnostic accuracy of physician review, expert algorithms and data-derived algorithms in adult verbal autopsies

BACKGROUND: The verbal autopsy (VA) is used to collect information on cause-specific mortality from bereaved relatives. A cause of death may be assigned by physician review of the questionnaires, or by an algorithm. We compared the diagnostic accuracy of physician review, an expert algorithm, and data-derived algorithms. METHODS: Data were drawn from a multicentre validation study of 796 adult deaths that occurred in hospitals in Tanzania, Ethiopia, and Ghana. A 'gold standard' cause of death was assigned using hospital records and death certificates. The VA interviews were carried out by trained fieldworkers 1-21 months after the subject's death. A cause of death was assigned by physician review and an expert algorithm. Data-derived algorithms that most accurately estimated the cause-specific mortality fraction (CSMF) for each cause of death were identified using logistic regression. RESULTS: The most common causes of death were tuberculosis/AIDS (CSMF = 18.6%), malaria (CSMF = 10.7%), meningitis (CSMF = 8.3%), and cardiovascular disorders (CSMF = 8.2%). The CSMF obtained using physician review was within +/-20% of the gold standard value for 12 causes of death including the four common causes. The CSMF obtained using the expert algorithm was within +/-20% of the gold standard for eight causes of death, including tuberculosis/AIDS, malaria, and meningitis. The CSMF obtained using the data-derived algorithms was within +/-20% of the gold standard for seven causes of death, including tuberculosis/ AIDS, meningitis, and cardiovascular disorders. All three methods yielded a specificity of at least 80% for all causes of death, and a sensitivity of at least 80% for deaths due to injuries and rabies. CONCLUSIONS: For those settings where physician review is not feasible, expert and data-derived algorithms provide an alternative approach for assigning many causes of death. We recommend that the algorithms proposed herein are validated further.     

Investigation of under-ascertainment in epidemiological studies based in general practice

BACKGROUND: One of the aims of the Study of Infectious Intestinal Disease (IID) in England is to estimate the incidence of IID presenting to general practice. This sub-study aims to estimate and correct the degree of under-ascertainment in the national study. METHODS: Cases of presumed IID which presented to general practice in the national study had been ascertained by their GP. In 26 general practices, cases with computerized diagnoses suggestive of IID were identified retrospectively. Cases which fulfilled the case definition of IID and should have been ascertained to the coordinating centre but were not, represented the under-ascertainment. Logistic regression modelling was used to identify independent factors which influenced under-ascertainment. RESULTS: The records of 2021 patients were examined, 1514 were eligible and should have been ascertained but only 974 (64%) were. There was variation in ascertainment between the practices (30% to 93%). Patient-related factors independently associated with ascertainment were: i) vomiting only as opposed to diarrhoea with and without vomiting (OR 0.37) and ii) consultation in the surgery as opposed to at home (OR 2.18). Practice-related factors independently associated with ascertainment were: i) participation in the enumeration study component (OR 1.78), ii) a larger number of partners (OR 0.3 for 7-8 partners); iii) rural location (OR 2.27) and iv) previous research experience (OR 1.92). Predicted ascertainment percentages were calculated according to practice characteristics. CONCLUSION: Under-ascertainment of IID was substantial (36%) and non-random and had to be corrected. Practice characteristics influencing variation in ascertainment were identified and a multivariate model developed to identify adjustment factors which could be applied to individual practices. Researchers need to be aware of factors which influence ascertainment in acute epidemiological studies based in general practice.