The primacy of multiparametric MRI in men with suspected prostate cancer

Background: Multiparametric MRI (mpMRI) became recognised in investigating those with suspected prostate cancer between 2010 and 2012; in the USA, the preventative task force moratorium on PSA screening was a strong catalyst. In a few short years, it has been adopted into daily urological and oncological practice. The pace of clinical uptake, born along by countless papers proclaiming high accuracy in detecting clinically significant prostate cancer, has sparked much debate about the timing of mpMRI within the traditional biopsy-driven clinical pathways. There are strongly held opposing views on using mpMRI as a triage test regarding the need for biopsy and/or guiding the biopsy pattern. Objective: To review the evidence base and present a position paper on the role of mpMRI in the diagnosis and management of prostate cancer. Methods: A subgroup of experts from the ESUR Prostate MRI Working Group conducted literature review and face to face and electronic exchanges to draw up a position statement. Results: This paper considers diagnostic strategies for clinically significant prostate cancer; current national and international guidance; the impact of pre-biopsy mpMRI in detection of clinically significant and clinically insignificant neoplasms; the impact of pre-biopsy mpMRI on biopsy strategies and targeting; the notion of mpMRI within a wider risk evaluation on a patient by patient basis; the problems that beset mpMRI including inter-observer variability. Conclusions: The paper concludes with a set of suggestions for using mpMRI to influence who to biopsy and who not to biopsy at diagnosis. Key Points: • Adopt mpMRI as the first, and primary, investigation in the workup of men with suspected prostate cancer. • PI-RADS assessment categories 1 and 2 have a high negative predictive value in excluding significant disease, and systematic biopsy may be postponed, especially in men with low-risk of disease following additional risk stratification. • PI-RADS assessment category lesions 4 and 5 should be targeted; PI-RADS assessment category lesion 3 may be biopsied as a target, as part of systematic biopsies or may be observed depending on risk stratification

The relationship between self-blame for the onset of a chronic physical health condition and emotional distress : a systematic literature review

Objective: Past literature presents contrasting perspectives regarding the potential influence of self-blame on adjustment to illness. This systematic literature review aimed to summarise findings from all investigations to date that have explored the relationship between self-blame for the onset of a chronic physical health condition and emotional distress. Method: Between November 2014 and February 2015 electronic databases were searched for relevant literature. Only those studies which assessed self-blame directly and related specifically to illness onset were included within the review. The methodological and reporting quality of all eligible articles was assessed and themes within the findings were discussed using a narrative synthesis approach. Results: The majority of studies found self-blame to be associated with increased distress. However, several concerns with the quality of the reviewed articles may undermine the validity of their conclusions. Conclusions: It is important for professionals supporting people with chronic physical health conditions to have an understanding of how of self-critical causal attributions might relate to emotional distress. Further research is required to understand the concept of self-blame, the factors that may encourage this belief and to develop reliable and valid measures of this experience

Cannabinoid use among Americans with MS : Current trends and gaps in knowledge

Acknowledgements: The National Multiple Sclerosis Society (NMSS) provided participant recruitment support. The Michigan Institute for Clinical & Health Research (MICHR:NIH award number UL1TR002240) provided participant recruitment support through UMHealthResearch.org. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or NMSS. The investigators thank Shubha Kulkarni for her assistance with data collection.Peer reviewedPublisher PD

Advancements in Standardising Patient-Reported Outcomes Measurement

Patient-reported outcomes (PRO) data can deliver crucial information for diagnostic purposes and regarding benefits and possible harms of medical interventions. Recognising the potential of the patient’s voice, PRO data are increasingly integrated in clinical practice and clinical research, and they play an increasingly important role in medical and health policy decision making. With the growing focus on patient centeredness, the requirements towards the quality of PRO data are steadily increasing as well, and outcomes researchers and other stakeholders working in related disciplines such as academia, the pharmaceutical industry and the not-for-profit sector have a growing ethical responsibility to use only those PRO instruments that generate robust data and allow for valid inferences from PRO scores. To achieve high quality PRO data, standardised processes spanning from PRO instrument development and content validation, translation and cultural adaptation, statistical analysis and interpretation of PRO data are key to ensure that data collected via patient self-report can be trusted. This habilitation thesis focuses on PRO standardisation efforts worldwide, including an overview of PRO projects that were run in the context of two key PRO measurement systems, i.e., the PRO instruments of 1) the Patient-Reported Outcomes Measurement Information System (PROMIS) initiative and 2) the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Group. In conclusion, international initiatives aimed at standardised PRO assessment are well underway all of which contribute to ensuring that high quality PRO data can be generated. It is expected that both the PROMIS and EORTC suites of PRO instruments will continue to grow, consolidate the PRO field and be a benchmark for standardised PRO assessment, validation and interpretation