Optimal biopsy approach for detection of clinically significant prostate cancer.

Prostate cancer (PCa) diagnostic and therapeutic work-up has evolved significantly in the last decade, with pre-biopsy multiparametric MRI now widely endorsed within international guidelines. There is potential to move away from the widespread use of systematic biopsy cores and towards an individualised risk-stratified approach. However, the evidence on the optimal biopsy approach remains heterogeneous, and the aim of this review is to highlight the most relevant features following a critical assessment of the literature.

Ethical challenges faced when there is a mismatch between guidelines, patient autonomy and clinical practice.

This editorial reviews the ethical day-to-day challenges faced by pain specialists when managing each patient's unique requirements, in light of guidelines, clinical practice and interpretation of evidence relating to the assessment and management of chronic pain.

British Association of Critical Care Nurses: Evidence-based consensus paper for oral care within adult critical care units.

Background: Patients who are critically ill are at increased risk of hospital acquired pneumonia and ventilator associated pneumonia. Effective evidence based oral care may reduce the incidence of such iatrogenic infection.

Aim: To provide an evidence-based British Association of Critical Care Nurses endorsed consensus paper for best practice relating to implementing oral care, with the intention of promoting patient comfort and reducing hospital acquired pneumonia and ventilator associated pneumonia in critically ill patients.

A Modified Tie Technique for Securing Endotracheal Tubes.

Background: Unintentional extubation is a well-documented and potentially life-threatening phenomenon. There is little research into the factors that lead to unintentional extubation, and therefore how to prevent it. Endotracheal tubes (ETTs) are commonly secured with 1 cm twill tape, but there is little evidence on how to best tie them in place.

Keyboard cleanliness: a controlled study of the residual effect of chlorhexidine gluconate.

A controlled trial of once daily cleaning of computer keyboards in an intensive care unit was performed comparing 2% chlorhexidine gluconate-70% isopropyl alcohol (CHG) and a chlorine dioxide-based product used as a standard in our hospital. A study before and after the introduction of once daily keyboard cleaning with CHG in the wider hospital was also completed. Cleaning with CHG showed a sustained and significant reduction in bacterial colony forming units compared with the chlorine dioxide-based product, demonstrating its unique advantage of maintaining continuous keyboard cleanliness over time.

Pulmonary hypertension and its management in patients undergoing non-cardiac surgery.

Pulmonary hypertension is a complex disorder of the pulmonary vasculature that leads to increased peri-operative morbidity and mortality. Non-cardiac surgery constitutes a significant risk in patients with pulmonary hypertension. The management of right ventricular failure is inherently challenging and fraught with life-threatening consequences.

Wound care and learning disabilities: use of the Avance NPWT system.

Over the past two decades, topical negative pressure wound therapy has gained wide acceptance as a genuine strategy in the treatment algorithm for a wide variety of acute and chronic wounds (Bovill et al, 2008) and over 1000 peer-reviewed publications describing the clinical efficacy and safety of negative pressure wound therapy (NPWT) for all wound types have been published over this period (Vig et al, 2011). Wound care and learning disabilities are very rarely discussed as joint issues. This case study aims to highlight the successful use of topical NPWT on a patient with moderate learning disabilities and examines how wound management should be individualised to meet the needs of the patient.