7786 research outputs found
Sort by
Transperineal prostate biopsy with freehand technique under local anaesthetic: a systematic review and meta-analysis
No full textBackground: Transperineal prostate biopsy (TPPB) under local anaesthesia is a widely employed biopsy method, and is currently endorsed by the European Association of Urology (EAU). This review aimed to assess the pooled detection rates of clinically significant prostate cancer using TPPB under local anaesthetic. Additionally, pain scores and complications were also reported.Methods: Our search was conducted in line with the most recent Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations up to August 2024. The study was registered on PROSPERO under the ID: CRD42024588824. An electronic search was conducted of the PubMed, Embase and Cochrane Central Register of Controlled Trials databases along with grey literature using the Google search engine.Results: In total, there were 2881 patients included in this review. Biopsy histology results were reported in 11 studies comprising 2781 cases. We observed a clinically significant prostate cancer rate of 52% (95% CI 44%-60%) for studies that employed both a mix of systematic and targeted biopsies and 26% (95% CI 23%-30%) when systematic biopsies alone were taken. The pooled rate was 48% (95% CI 37%-59%), overall. Complications after prostate biopsies were reported by 9 studies with a combined 2688 patients. There were 61 patients (2.3%) who had Clavien-Dindo (CD) 1-2 complications and three patients (0.1%) who had CD 3-5 complications. The pooled rate of CD 1 and 2 complications was 2% (95% CI 1%-4%).Conclusions: TPPB under local anaesthetic is a safe, efficacious and well-tolerated method of prostate biopsy when compared with other methods. Undertaking the procedure under local anaesthesia does not seem to lower cancer detection rates.</p
A network analysis of alcohol-related harms: an exploratory study in United Kingdom adolescents
No full textBackground: This study applied a network analysis approach to the study of individual self-reported alcohol-related harms (ARHs) across four waves of data.Methods: Data were from a large clustered randomised control trial (N = 12,738) involving 105 schools. Data were collected at 4 time points over 4 academic years (mean age 12.5 [Time 0], 13.5 [T1], 14.5 [T2], and 15.3 years [Time 3]). Data were gathered on the experience of 16 separate ARHs experienced during the previous six months, and these were dichotomised (yes/no). We estimated cross-lagged panel networks for the 16 ARHs, capturing both the auto-regressive relationships (a harm predicting itself at follow up) and the cross-lagged relationships (a harm predicting another harm at follow-up) across the study (T0 → T1; T1 → T2; T2 →T3).Results: Exposure to all ARHs increased with age. However, the most serious ARHs (e.g., getting in trouble with the police because of your drinking) remained relatively rare, even at age 15. Actively planning to get drunk, coupled with an inability to control levels of intoxication (drinking more than planned) appeared central to each network, facilitating the emergence of all other ARHs. While the prevalence of ARHs increased with age, network complexity declined, and networks becoming more stable.Conclusions: Interventions aimed at improving the capacity to self-regulate alcohol consumption, and actively challenging the planning of drunken episodes, may be pivotal in reducing the emergence of both acute and chronic ARHs in adolescence.</p
Neoadjuvant chemotherapy with chemoradiotherapy for patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma - retrospective review from a tertiary care hospital
No full textAim: Patients diagnosed with borderline resectable pancreatic cancer (BRPC) or locally advanced pancreatic cancer (LAPC) have historically worse survival rates compared to those with resectable pancreatic cancer. The study aimed to assess the feasibility and efficacy of neoadjuvant chemotherapy and chemoradiotherapy in BRPC/LAPC. Additionally, we evaluated the R0 resection rates for patients who progressed to surgery.Methods: This retrospective study included patients diagnosed with BRPC/LAPC between January 2019 and December 2023 at The Canberra Hospital (TCH), a tertiary care setting. A total of 115 patients were screened, of whom 37 were eligible for inclusion. Demographic data, CA19-9 levels, treatment regimens, surgical outcomes, resection rates, disease-free survival (DFS), and overall survival were analysed.Results: A total of 20 (54%) patients (15 FOLFIRINOX and 5 gemcitabine/nab-paclitaxel) completed their planned chemotherapy, and 17 (46%) of these patients had chemoradiotherapy, majority receiving 45-50 Gy of conventional radiation with capecitabine. Tumor marker Ca19-9 normalized after chemotherapy in seven patients (19%). In total, 23 patients (62.2%) progressed to surgery. The median DFS for all patients was 12.7 months (95% CI 5.5-15.9), and the median OS was 21 months (95% CI 13.7-44.9).Conclusion: This study suggests that neoadjuvant treatment is feasible for BRPC/LAPC, allowing patients to undergo surgery and achieve R0 resection. However, further randomized controlled trials with larger cohorts are needed to validate these findings and refine treatment protocols.</p
Trained immunity causes myeloid cell hypercoagulability
No full textThe pathogenic basis for increased thrombotic risk in individuals with inflammatory diseases is poorly understood. Myeloid cell "trained immunity" describes persistent innate immune cell memory arising from prior exposure to an inflammatory stimulus, leading to an enhanced immune response to subsequent unrelated stimuli. We identify enhanced myeloid cell prothrombotic activity as a maladaptive consequence of trained immunity. Lipopolysaccharide (LPS) stimulation of macrophages trained previously with β-glucan or heme exhibited significantly enhanced procoagulant activity compared to macrophages stimulated with LPS alone, which was mediated by enhanced acid sphingomyelinase-mediated tissue factor decryption. Furthermore, splenic monocytes isolated from β-glucan-trained mice revealed enhanced procoagulant activity up to 4 weeks after β-glucan administration compared to monocytes from control mice over the same time period. Moreover, hematopoietic progenitor cells and bone marrow interstitial fluid from β-glucan-trained mice had enhanced procoagulant activity compared to control mice. Trained immunity and associated metabolic perturbations may therefore represent an opportunity for targeted intervention in immunothrombotic disease development.</p
What is new in altitude- and cold-related illnesses of travel: appraisal and summary of the updated guidelines from the Wilderness Medical Society
No full textWilderness medicine is a rapidly evolving field and has benefited from expanded research efforts. Moreover, with an escalating occurrence of severe and cataclysmic global climatologic events, human illness arising from interaction with wilderness and recreational environments warrants increasing consideration. Within the last decade, the Wilderness Medical Society (WMS) has aggregated research findings and created guidelines on prevention measures and therapeutic options for acute altitude illness, frostbite injuries, and avalanche and non-avalanche snow burials. As new research emerges, some guidelines have been updated to reflect the most current and sound scientific conclusions. In this review, we have synthesized the evidence-based guidelines and have reviewed the quality of the guidelines according to the Appraisal of Guidelines for Research and Evaluation (AGREE) II framework. Further research efforts can expand the scope of evidence-based practice in travel medicine and ideally standardize the implementation of recommendations within both pre-travel and post-travel medical practices.</p
Medical professionalism education: a systematic review of interventions, outcomes, and sustainability
No full textIntroduction: Medical professionalism (MP) is a vital competency in undergraduate medical students as it enhances the quality and safety of patient care as it includes professional values, attitudes and professional behaviours (PB). However, medical institutes are uncertain about how optimally it can be learnt and assessed. This review aims to systematically provide a summary of evidence from systematic reviews reporting MP educational interventions, their outcomes and sustainability to foster PB.Methods: Eight major databases (CINAHL, EMBASE, ERIC, Health business, Medline, OVID, PsycINFO, SCOPUS and Web of Science) and grey literature were systematically searched from database inception to June 2024. The inclusion criteria were (1) systematic review studies (2) of educational interventions of any type; (3) targeting any aspect of MP; (4) provided to undergraduate medical students; and (5) with no restrictions on comparator group or outcomes assessed. A qualitative narrative summary of included reviews was conducted as all included reviews did not conduct quantitative nor meta-analysis of results but rather a qualitative summary. Methodological quality of included reviews was assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 tool.Results: The search identified 397 references for eligibility screening. Ultimately, eight systematic reviews were deemed eligible for inclusion. The majority of these reviews have reported a successful improvement in various aspects of MP (i.e., MP as a whole, empathy and compassion) through teaching and exposure to hidden curriculum. The included studies displayed significant methodological heterogeneity, with varying study designs and assessment methodologies to professional outcomes. A gap remains in reporting the sustainable effect on professionalism traits and on a standardised approach to MP teaching.Conclusion: This review suggests that more interventions are needed in this area with a focus on methodological quality and teaching methods in a multicultural context to support PB and professional identity formation.Clinical trial registration: PROSPERO [CRD42024495689].</p
Optimising vaccination strategies to prevent invasive pneumococcal disease in the elderly. Which vaccine should come first?
No full textStreptococcus pneumoniae infection can lead to serious and potentially life-threatening illness, referred to as invasive pneumococcal disease (IPD). This includes bloodstream infection, bacteraemic pneumonia, empyema, and meningitis. The impact is greatest among young children, patients with immunosuppression and chronic diseases, and in older adults [1].</p
The impact of a secondary, rare, non-pathogenic <i>PKD1 </i>variant on disease progression in autosomal dominant polycystic kidney disease
No full textBackground: Autosomal dominant polycystic kidney disease (ADPKD) is caused primarily by pathogenic variants in the PKD1 and PKD2 genes. Although the type of ADPKD variant can influence disease severity, rare, hypomorphic PKD1 variants have also been reported to modify disease severity or cause biallelic ADPKD. This study examines whether rare, additional, potentially protein-altering, non-pathogenic PKD1 variants contribute to ADPKD phenotypic outcomes.Methods: We investigated the prevalence of rare, additional, potentially protein-altering PKD1 variants in patients with PKD1-associated ADPKD. The association between rare, additional, potentially protein-altering variants and phenotypic outcomes, including progression to kidney failure, age at onset of hypertension and urological events, height-adjusted total kidney volume, and predicting renal outcomes in PKD (PROPKD) score, were examined.Results: Rare, additional, potentially protein-altering variants were detected in 6% of the 932 ADPKD patients in the study. The presence of rare, additional, potentially protein-altering variants was associated with 4 years earlier progression to kidney failure (hazard ratio (HR): 1.66; 95% confidence interval (CI): 1.18–2.34; P = 0.003), with in-trans rare, additional, potentially protein-altering variants (n = 13/894) showing a greater risk of kidney failure (HR: 1.83; 95% CI 1.00–3.33; P = 0.049). We did not detect statistically significant differences between rare, additional, potentially protein-altering variants and other phenotypic outcomes compared to those without rare, additional, potentially protein-altering variants.Conclusions: In patients with PKD1-associated ADPKD, our findings suggest that rare, additional, potentially protein-altering variants in PKD1 may influence disease severity. These findings have potential clinical implications in counselling and treating patients with rare, additional, potentially protein-altering variants, but further investigation of such variants in larger, longitudinal cohorts with detailed, standardised phenotype data is required.</p
A qualitative analysis of the relationship between simulated and clinical learning environments in obstetrics and gynaecology
No full textIntroduction: Clinical placement on the labour ward is an essential component of Obstetrics and Gynaecology curricula in medical schools worldwide. This clinical learning environment (CLE) provides students with a formative opportunity for experiential learning around labour and delivery. However, the CLE presents challenges to learning, in particular diversity of experiences and opportunities. The simulated learning environment (SLE) has been adopted by medical schools worldwide in order to address such issues. The SLE provides a safe space for students to practise clinical skills around care in labour and delivery. These learning experiences form the sole exposure for many students to labour and delivery. This study examines the learner experience of these environments and the relationship between them.Methods: A qualitative research study was performed in the Royal College of Surgeons Ireland. Fourth year undergraduate medical students undertaking their obstetrics and gynaecology rotation were invited to participate. Students attend a labour ward simulation and a week-long clinical placement as part of this rotation. Focus groups were conducted following the simulation and students completed audio diaries during their clinical placement which underwent inductive content analysis.Results: Four major concepts emerged from analysis of the data from 29 participating students. Simulation was viewed by students as preparation for the CLE. Learner safety within the simulated learning space was highly valued by students. Learner roles in the SLE were often assigned, while student identity on the labour ward developed from their own engagement, patient interactions, and interprofessional staff. Students identified the emotional aspect of the CLE of the labour ward as a significant impact on their learning experience.Conclusion: The SLE was valued as a stepping-stone to prepare for the CLE. The safety afforded by the simulated labour ward was important to the student learning experience. The CLE was conducive to the formation of learner identities and students valued the emotional engagement with patients. These two areas require further exploration within the simulated learning space.</p
Preserving the antimicrobial arsenal: exploring alternatives to carbapenems in ESBL battles within the southeast of Ireland
No full textIntroduction: Carbapenems are usually employed as first-line antimicrobials against bacteria harbouring extended-spectrum beta-lactamases (ESBLs). These enzymes confer resistance often to multiple classes of antimicrobials.Hypothesis/Gap Statement: This indiscriminate use of carbapenems and the inevitable development of carbapenem resistance have prompted the need for carbapenem-sparing strategies.Methodology: The non-carbapenem antimicrobial susceptibility patterns of 60 ESBL-producing Enterobacterales (ESBL-PE) isolates responsible for bloodstream infections, in 2022-2023 inclusive, processed at our institution were reviewed.Results: The non-carbapenem antimicrobial susceptibility patterns of 60 ESBL-PE isolates from bloodstream infections during the study period were determined. Escherichia coli was the most common species isolated (87%, n=52), with the majority of cases (73.3%, n=44) originating from a presumed urinary source. Temocillin (TMC), mecillinam (MEC), cefiderocol (FDC), amikacin and fosfomycin (FOS) displayed excellent activity against all ESBL-PE isolates tested, with susceptibility rates of≥85%. Ciprofloxacin and amoxicillin-clavulanic acid were the least efficacious agents, with susceptibility rates≤20%.Conclusions: TMC, MEC, FDC and FOS offer promising alternatives to carbapenems, demonstrating efficacy against ESBL-PE. The use of these agents not only broadens the therapeutic arsenal against ESBL-PE but also mitigates the potential for escalating carbapenem resistance, especially in regions where the incidence of carbapenem resistance is increasing.</p