Midland College

Prostate biopsy is central to the accurate histological diagnosis of prostate cancer. In current practice, the biopsy procedure can be performed using a transrectal or transperineal route with different technologies available for targeting of lesions within the prostate. Historically, the biopsy procedure was performed solely by urologists, but with the advent of image-guided techniques, the involvement of radiologists in prostate biopsy has become more common. Herein, we discuss the pros, cons and future considerations regarding their ongoing role. A narrative review regarding the current evidence was completed. PubMed and Cochrane central register of controlled trials were search until January 2024. All study types were of consideration if published after 2000 and an English language translation was available. There are no published studies that directly compare outcomes of prostate biopsy when performed by a urologist or radiologist. In all published studies regarding the learning curve for prostate biopsy, the procedure was performed by urologists. These studies suggest that the learning curve for prostate biopsy is between 10 and 50 cases to reach proficiency in terms of prostate cancer detection and complications. It is recognised that many urologists are poorly able to accurately interpret multi parametric (mp)-MRI of theprostate. Collaboration between the specialities is of importance with urology offering the advantage of being involved in prior and future care of the patient while radiology has the advantage of being able to expertly interpret preprocedure MRI. There is no evidence to suggest that prostate biopsy should be solely performed by a specific specialty. The most important factor remains knowledge of the relevant anatomy and sufficient volume of cases to develop and maintain skills.

Is the mathematical description of the Universe quantum, classical, both or neither? The mandated assumption of rationalism is that if an argument is inconsistent, it is flawed for a conclusion. However, suppose the structural basis of the Universe is fundamentally inconsistent. In that case, paradoxes in the frameworks of logic and mathematics would not be anomalies. A geometric model with a counter-rational framework of inconsistent relationships is applied to analyze Hardy’s paradox, the fine structure constant, and the general relationship between the correlated quantum and classical EPR-type structures. The model conjectures that the well-studied paradoxes found in theoretical arguments and empirically in EPR phenomena are not anomalies and instead point to a new framework for modelling universal structures that incorporates inconsistency.

A 5-year-old female presents with headache, increased eye rubbing and occasional vomiting. The vital signs and limited laboratory testing (complete blood count, basic metabolic panel) are within reference limits. Physical examination reveals mild focal protrusion over the anterior cranium and no focal tenderness. Height (43 in., 39th percentile) and weight (46 lb, 69th percentile) are age appropriate. However, the head is small with circumference measuring at 47 cm, 2.7 standard deviations below the mean. Radiographs of the skull are obtained (Fig. 1a,b). What is the most likely diagnosis? What is the next step in management? (Answer on page 339)

Chronic disease places an enormous economic burden on both individuals and the healthcare system, and existing fee-for-service models of healthcare prioritize symptom management, medications, and procedures over treating the root causes of disease through changing health behaviors. Value-based care is gaining traction, and there is a need for value-based care models that achieve the quadruple aim of (1) improved population health, (2) enhanced patient experience, (3) reduced healthcare costs, and (4) improved work life and decreased burnout of healthcare providers. Lifestyle medicine (LM) has the potential to achieve these four aims, including promoting health and wellness and reducing healthcare costs; however, the economic outcomes of LM approaches need to be better quantified in research. This paper demonstrates proof of concept by detailing four cases that utilized an intensive, therapeutic lifestyle intervention change (ITLC) to dramatically reverse disease and reduce healthcare costs. In addition, priorities for lifestyle medicine economic research related to the components of quadruple aim are proposed, including conducting rigorously designed research studies to adequately measure the effects of ITLC interventions, modeling the potential economic cost savings enabled by health improvements following lifestyle interventions as compared to usual disease progression and management, and examining the effects of lifestyle medicine implementation upon different payment models.

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PurposeImproved perception and compliance with timely completion of the shift summary tool by bedside critical care nurses, and standardization of reported patient condition and treatment variables can be accomplished through collaboration and evidence-based modifications.Materials and MethodsThe IOWA Model was used as a framework to implement change in the population of practicing bedside nurses. In accordance with the AACN Healthy Work Environment standards, the population was given opportunity to complete surveys on a Likert scale to construct a best-fit instrument specific to the nurses’ home units.ResultsEmployee satisfaction with the report process increased, compliance with completion of the form increased, and satisfaction with consistency and facilitation was noted by nursing managers.ConclusionFocusing on frequently used items, or identifiable bottlenecks in communications, are likely to have the fastest and most impactful results for change. Workflows can be streamlined by using stakeholder input and feedback to clearly define the desired parameters and outcomes from the process.