Risk Calculator Strategy Before Magnetic Resonance Imaging Stratification for Biopsy-naïve Men with Suspicion for Prostate Cancer: A Cost-effectiveness Analysis.

Background And Objective: Current guidelines on prostate cancer (PCa) diagnosis recommend risk stratification before prostate biopsy, using either a risk calculator (RC) or magnetic resonance imaging (MRI). The aim of our study was to assess the effectiveness and cost effectiveness of an RC strategy and a direct MRI (dMRI) strategy.

Methods: Data for biopsy-naïve men suspected of having PCa on the basis of elevated prostate specific antigen (PSA) and/or abnormal digital rectal examination (DRE) were retrospectively collected from two large teaching hospitals.

An Magnetic Resonance Imaging-directed Targeted-plus-perilesional Biopsy Approach for Prostate Cancer Diagnosis: "Less Is More".

Background: Considering that most men benefit diagnostically from increased sampling of index lesions, limiting systematic biopsy (SBx) to the region around the index lesion could potentially minimize overdetection while maintaining the detection of clinically significant prostate cancer (csPCa).

Objective: To evaluate the diagnostic performance of a hypothetical magnetic resonance imaging (MRI)-directed targeted-plus-perilesional biopsy approach.

Design Setting And Participants: This single-center, retrospective analysis of prospectively generated data included all biopsy-naïve men with unilateral MRI-positive lesions (Prostate Imaging Reporting and Data System category ≥3), undergoing both MRI-directed targeted biopsies and SBx.

Intraoperative Strategies to Reduce Catheter-Related Bladder Discomfort in the Early Postoperative Period after Robot-Assisted Radical Prostatectomy.

Purpose: Catheter-related bladder discomfort occurs in up to 63% of patients following robot-assisted radical prostatectomy. The optimal intraoperative anesthesia regime to prevent patients from catheter-related bladder discomfort is unknown.

Materials And Methods: A prospective cohort analysis was conducted.

AAA-ATPase FIDGETIN-LIKE 1 and Helicase FANCM Antagonize Meiotic Crossovers by Distinct Mechanisms.

Meiotic crossovers (COs) generate genetic diversity and are critical for the correct completion of meiosis in most species. Their occurrence is tightly constrained but the mechanisms underlying this limitation remain poorly understood. Here we identified the conserved AAA-ATPase FIDGETIN-LIKE-1 (FIGL1) as a negative regulator of meiotic CO formation.

Multiple mechanisms limit meiotic crossovers: TOP3α and two BLM homologs antagonize crossovers in parallel to FANCM.

Meiotic crossovers (COs) have two important roles, shuffling genetic information and ensuring proper chromosome segregation. Despite their importance and a large excess of precursors (i.e.

FANCM-associated proteins MHF1 and MHF2, but not the other Fanconi anemia factors, limit meiotic crossovers.

Genetic recombination is important for generating diversity and to ensure faithful segregation of chromosomes at meiosis. However, few crossovers (COs) are formed per meiosis despite an excess of DNA double-strand break precursors. This reflects the existence of active mechanisms that limit CO formation.

Transesophageal echocardiographic screening before atrial flutter ablation: is it necessary for patient safety?

Background: Transesophageal echocardiography (TEE) is commonly used before atrial flutter (AFl) ablation to detect atrial thrombus (AT) and thereby identify a heightened risk for systemic embolism both in patients with their initial episodes of AFl and in those with prior episodes whose anticoagulation has been inadequate. This treatment strategy has been extrapolated from guidelines for atrial fibrillation. In fact, limited data exist regarding the prevalence or clinical associations of AT and spontaneous echocardiographic contrast (SEC) in patients with AFl.

Effect of early diagnosis and treatment with percutaneous lead extraction on survival in patients with cardiac device infections.

Cardiac device infections (CDIs) represent a serious complication after the implantation of pacemakers and defibrillators. In addition to antimicrobials, complete hardware removal, mostly with percutaneous lead extraction (PLE), is necessary to limit recurrences. However, CDI diagnosis is often difficult and is sometimes delayed, and scarce data exist on how the timing of PLE may affect clinical outcomes.

What should urologists know about evidence-based medicine?

Objectives: This article outlines the basic principles of evidence-based medicine (EBM) and provides urologists with some tools to further explore, understand, and work with EBM.

Materials And Methods: A narrative review was conducted illustrating several aspects of EBM.

Results: Based on the definition of EBM, the aspects of evidence are clarified and a systematic approach is presented for integrating the evidence with individual patient values and circumstances.

[The practice guideline 'Acne' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The strength of the second revision of the practice guideline 'Acne' from the Dutch College of General Practitioners (NHG) lies mainly in bringing its therapy up to date. The guideline also points out psychosocial problems that can arise with acne, but discounts stress and diet as the possible cause. Schedules showing a medical plan of action and information on medications complete this clear and practical guideline.

[The practice guideline 'The red eye' (first revision) of the Dutch College of General Practitioners; a response from the perspective of the general practitioner].

The revised version of the practice guideline 'The red eye' of the Dutch College ofGeneral Practitioners gives the general practitioner useful information on new insights into diagnosis and therapy for a red eye. An important therapeutic advice is prescribing chloramphenicol ointment instead of fusidic acid ointment in the case of bacterial conjunctivitis after one-week treatment without positive results, since 80% of the conjunctivitis causing bacteria does not react to fusidic acid. A slit lamp is helpful in the diagnosis of a case of red eye, but is not present in every general practitioner's office.

Perceptions and competence in evidence-based medicine: Are surgeons getting better? A questionnaire survey of members of the Dutch Orthopaedic Association.

Background: The Journal of Bone and Joint Surgery, American Volume (The Journal) recently initiated a section called "Evidence-Based Orthopaedics." Furthermore, a level-of-evidence rating is now used in The Journal to help readers in clinical decision-making. Little is known about whether this recent emphasis has influenced surgeons' perceptions about and competence in evidence-based medicine.

[The practice guideline 'Otitis media with effusion' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The usefulness of tympanotomy tubes in children with otitis media with effusion who also have speech and language retardation is doubtful in view of the natural development. The second revision of the practice guideline 'Otitis media with effusion' from the Dutch College of General Practitioners is still not in complete agreement with this. The indications for performing an adenoidectomy are now more limited.

[The practice guideline 'Depressive disorder' (first revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The revised Dutch College of General Practitioners' practice guideline 'Depressive disorder' no longer distinguishes between mild and severe depression because the management in both cases is identical. This guideline focuses much attention on diagnosis, support and information, all of this in dialogue with the patient. The choice between the antidepressants, a tricyclic antidepressant or a specific serotonin reuptake inhibitor is based on the contraindications of these drugs.

[The treatment of tobacco dependence in clinical practice is promising but difficult to implement].

According to the Dutch interdisciplinary guideline 'Treatment of tobacco dependence', medical practitioners in The Netherlands should play a more active role in discouraging the use of tobacco. They should try to motivate their patients to stop smoking and offer their support. The various treatments aimed at helping people to stop smoking require large amounts of personnel, time and money.

[The practice guideline 'Stable angina pectoris' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The Dutch College of General Practitioners' (Dutch acronym: NHG) practice guideline 'Stable angina pectoris' (second revision) provides clear guidelines for the diagnosis and treatment of patients who experience chest pains as a result of angina pectoris, especially if coronary artery disease is the underlying cause of the complaints. The practice guideline clearly indicates for which complaints the general practitioner should suspect angina pectoris and which information from the anamnesis, family history and risk factors can contribute to distinguishing between stable and unstable angina pectoris. However, the physical examination should not be omitted because this can provide important indications for coronary or pulmonary dysfunction.

[The practice guideline 'Hormonal contraception' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The second revision of the Dutch College of General Practitioners' practice guideline on hormonal contraception discusses the various methods of hormonal birth control and can help the general practitioner to inform the patient when choosing the most desirable method. A thorough anamnesis is necessary with regard to the increased risks for breast cancer, uterine cancer and cardiovascular diseases in women using hormonal contraception, especially in those who smoke. The guideline also discusses non-hormonal methods briefly.

[The practice guideline 'Dementia' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

With growing numbers of older adults in the population, the number suffering from dementia will increase. The general practitioner has to try to determine the difference between Alzheimer's disease and vascular dementia on the one hand, and fronto-temporal dementia and dementia with Lewy bodies on the other hand, while also considering the therapeutic options now and in the future. Support for patients and their family is the responsibility of the general practitioner, who must also consider the patient's driving proficiency and the wishes for euthanasia of the demented older adult.

[The practice guideline 'Hypertension' (third revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

In the revised practice guideline on hypertension from the Dutch College of General Practitioners, some changes have been made in the areas of diagnosis and therapy in comparison to the previous edition. Finding people with hypertension is a major goal for the prevention of cardiovascular disease. A systolic blood pressure > 140 mmHg (> 160 mmHg in patients > 60 years) necessitates non-pharmaceutical advice and antihypertensive therapy with diuretics, beta-blockers, angiotensin-converting-enzyme (ACE) inhibitors or calcium antagonists, either as monotherapy or in combination.

[Marked similarity between the Dutch Institute for Health Care Improvement guideline 'Aspecific low back pain complaints' and the Dutch College of General Practitioners guideline 'Low back pain'].

The Dutch Institute for Healthcare Improvement's (CBO) guideline on the diagnosis and treatment of aspecific, acute and chronic, low back complaints corresponds in general to the Dutch College of General Practitioners' guideline with regard to the following topics: time-contingent treatment, restricted use of X-ray examination, and the options for non-medical treatment. A noteworthy exception in the CBO-guideline is the suggestion of manipulation of the spine as a possible treatment although there is no mention of proof of effectiveness.

[Fitness to drive in people with diabetes mellitus; a recommendation from the Health Council of the Netherlands].

The Health Council of the Netherlands published a medical fitness-to-drive recommendation in December 2002 for people suffering from diabetes mellitus. This applies to all types of driver's licenses. General restrictions for people suffering from diabetes mellitus cannot be applied.

[The Dutch College of General Practitioners' practice guideline, "Vaginal bleeding"; reaction from a general practice perspective].

The most important changes in the first revised version of the Dutch College of General Practitioners' practice guideline 'Vaginal bleeding' are the passages about the progesterone-containing 'intra-uterine device' (IUD), the combination of progesterone and oestrogen by prescribing, for example, a sub-50-pill for the treatment of menorrhagia, and advising the patient to undergo a transvaginal ultrasound to determine the amount of build-up in the endometrium. Vacuum aspiration of the endometrium to establish the cause of menorrhagia is not mentioned. This first revised version can contribute to the quality of care in general practice.