Prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-analysis.

OBJECTIVES: Prostate artery embolisation (PAE) is a new minimally invasive treatment for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH). The purpose of this study was to review the efficacy and safety of PAE in the treatment of BPH with LUTS. METHODS: A systematic review performed according to the PRISMA guidelines with a pre-specified search strategy for PubMed, Web of Science, Cochrane Library and Embase databases protocol (PROSPERO ID: CRD42017059196). Trials studying the efficacy of prostate artery embolisation to treat LUTS with more than ten participants and follow-up longer than 6 months were included by two independent authors. Outcomes investigated were International Prostate Symptom Score (IPSS), quality of life (QoL), International Index of Erectile Function (IIEF-5), prostate volume (PV), prostate-specific antigen (PSA), peak void flow (Qmax), post-void residual (PVR) and complications. To summarise mean change from baseline, a meta-analysis was done using the random-effects model. RESULTS: The search returned 210 references, of which 13 studies met the inclusion criteria, representing 1,254 patients. Patients in the included studies with data available for meta-analysis had moderate to severe LUTS and a mean IPSS of 23.5. Statistically significant (p value < 0.05) improvements of all investigated outcomes were seen at 12-month follow-up. Major complications were reported in 0.3% of the cases. CONCLUSIONS: Our findings suggest that PAE can reduce moderate to severe LUTS in men with BPH with a low risk of complications. KEY POINTS: • Prostate artery embolisation (PAE) improved International Prostate Symptom Score (IPSS) by 67%. • Major complications after PAE are very rare. • Use of cone-beam CT may reduce risk of non-target embolisation.

Palliative Prostate Artery Embolization for Prostate Cancer: A Case Series.

INTRODUCTION: Prostate artery embolization (PAE) is recognized as a treatment for lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia. LUTS and urinary retention are common in men with prostate cancer (PCa). The purpose of this study was to estimate the efficacy and safety of palliative PAE on LUTS or urinary retention in men with advanced PCa. MATERIALS AND METHODS: This prospective, single-center trial was conducted from March 2017 to November 2018. The trial protocol was registered online (ClinicalTrials.gov Identifier: NCT03104907). Only men with advanced PCa suffering from LUTS or urinary retention were included. The primary outcome was the ability to void without a catheter and International Prostate Symptom Score (IPSS) in non-catheter-dependent patients. The paired t test was used to analyze changes from baseline with 95% confidence intervals (CI). A p value < 0.05 was considered statistically significant. RESULTS: Seventeen patients were assessed for eligibility, and 15 patients with a mean age of 73.8 years were enrolled. Four men did not complete follow-up: cancer-related death (n = 2), lost to follow-up (n = 1), and unsuccessful embolization due to severe atherosclerosis (n = 1). Bilateral embolization was achieved in ten cases, and urinary retention resolved in one of six patients. LUTS improved in the remaining (n = 5) patients by a mean 12.2-point reduction in IPSS (95% CI - 23.53; - 0.87). According to the CIRSE classification, two grade 1 and two grade 3 complications occurred. CONCLUSION: In this study, palliative PAE was safe and efficient for treatment for LUTS associated with PCa. LEVEL OF EVIDENCE: Level 4, Case Series. Trial registration ClinicalTrials.gov Identifier: NCT03104907.

What is the role of the consultant responsible for postgraduate education in the clinical department?

BACKGROUND: The organisation of specialist training is complex and involves many clinical departments. The position of consultants responsible for education (CRE) in specialist training at department level is poorly defined in the literature. AIMS: The aim of the study was to explore expectations of stakeholders concerning the role and position of a CRE in specialist training. METHOD: The role and position of the CRE was explored using focus group and semi-structured individual interviews. RESULTS: Knowledge of tasks and responsibilities was limited in all stakeholders except among CREs. The expectations of stakeholders to the CRE varied according to their position in the hospital hierarchy. In general terms the CRE was expected to assume overall responsibility for specialist training, promote a positive educational climate and secure quality of specialist training along with numerous administrative tasks. All interviewees expressed a wish for a strong leader at the same time they did not consider the position of the CRE influential. CONCLUSION: Along with improved information about the role of the CRE, formal education, proper job-descriptions and clear leadership in the organisation concerning specialist training might increase the influence and power of CREs.

Long-term effect of a course on in-training assessment in postgraduate specialist education.

BACKGROUND: In-training assessment has become an important part of clinical teachers' responsibilities. One way to ensure that clinical teachers are qualified for this role is setting up a course. A "Teach the teachers" course focusing on in-training assessment was designed for anaesthesiologists in Denmark. AIMS: To evaluate short and longer term effects of a course on in-training assessment for clinical teachers in Anaesthesiology. METHOD: Fifty-one anaesthesiologists attended a 2-day interactive course about in-training assessment. Effects of the course on knowledge were assessed using identical pre- and post- tests. Longer- term effects were measured six months after the course using the same test. Self-reported use of in-training assessment methods was evaluated using supplemental questions in the follow-up test. RESULTS: There were significant increases in knowledge about in-training assessment immediately following the course (effect size, Cohens d = 1, 5). The knowledge was retained six months later. Knowledge about assessment by clinical structured observation and by written assignments showed further increases in the follow-up period. Participants used the various assessment methods in their daily practice during the six-month study period. CONCLUSION: A focused "Teach the teachers" course during the implementation phase of a new assessment programme increased participants' knowledge about in-training assessment.

A community-based occupational enrichment program for captive chimpanzees.

The authors describe a cost-effective program for providing chimpanzee enrichment that at the same time educates the local community about the care of these animals in research.

[Malignant neuroleptic syndrome in patients with dementia]. / Malignt neuroleptikasyndrom hos demente.

The neuroleptic malignant syndrome (NMS) is a side-effect of treatment with neuroleptic drugs. It is infrequent, but underdiagnosed. The diagnosis can be especially difficult to verify, in older patients with dementia because they often have symptoms of NMS, as a consequence of age and dementia. The importance of monitoring serum-creatine-kinase is discussed and proposals for treatment are suggested.

[Perioperative treatment of diabetics]. / Perioperativ diabetesbehandling.

The metabolic changes in connection with fasting, anaesthesia and surgery in diabetic patients and non-diabetic patients are reviewed. Various perioperative forms of treatment are described. The forms of treatment most commonly employed are infusion of glucose-insulin-potassium (GIK) and subcutaneous administration of insulin followed by infusion of glucose (KON). The more intensive GIK regime provides the diabetic patient with a biochemical regulation which resembles that found in non-diabetics. It has not been proved whether this marginal regulation influences the well-being, morbidity or mortality of the patients. In critically ill patients or patients with concurrent diseases, the GIK regime is recommended as this provides optimal regulation of the diabetes. In the remaining patients, local conditions will influence the choice of form of treatment.

Impedance measurement in divers during a scuba-diving training programme.

An assessment of the strain on the tympanic membrane caused by diving was performed using impedance measurement of the middle ear in 21 untrained young men going through a scuba-diving training programme (scuba, self-contained under-water breathing apparatus). Tympanometry was carried out just before and after diving. The divers made 104 dives between them (median 5 each, range 2-7) at depths from 2 to 12 m (median 6 m). The results showed a significant increase in middle ear compliance on diving. The increase in compliance was significant at different depths, was transient, and fell to the initial level between the dives. We conclude that the strain exerted on the tympanic membrane and middle ear from barotrauma due to diving results in a reversible impairment of the recoiling capacity of the elastic fibrils of the tympanic membrane. This transient increase in compliance, we think, is the first measurable change in elasticity of the tympanic membrane. If barotrauma continue the changes could be irreversible.

Postanaesthetic arousal time in elderly patients. A double-blind study of glycopyrrolate and atropine.

Postanaesthetic arousal time was studied in elderly patients given either glycopyrrolate 0.01 mg kg-1 or atropine 0.02 mg kg-1 before antagonism of neuromuscular blockade. Forty patients (age greater than or equal to 65 yr) undergoing elective hip replacement were included in a double-blind study. Arousal was scored for 2 h after recovery using a modified scoring system. No difference in arousal time was found between the two groups.

Insulin treatment of the insulin-dependent diabetic patient undergoing minor surgery. Continuous intravenous infusion compared with subcutaneous administration.

In a prospective randomised study in 20 insulin-dependent diabetics who had minor surgery under general anaesthesia we compared the metabolic responses to intravenous glucose-insulin-potassium infusion with those who had conventional subcutaneous insulin administration. The former treatment resulted in lower blood glucose levels both during the infusion period (p less than 0.05) as well as the entire observation period (operative, first and second postoperative days; p less than 0.01). More blood glucose values were within the intended range of 5 to 10 mmol/litre in the glucose-insulin-potassium as compared to the conventional group (48% versus 24%; p less than 0.01). The levels of lactate, 3-hydroxybutyrate, glycerol, alanine, glucagon, insulin and growth hormone did not differ between the two groups. The infusion regimen resulted in better glycaemic control both peri-and postoperatively than the conventional subcutaneous insulin regimen in insulin-dependent diabetic patients who have minor surgery.