Nomogram for predicting the probability of the positive outcome of prostate biopsies among Ghanaian men

Introduction and objectives: Several existing models have been developed to predict positive prostate biopsy among men undergoing evaluation for prostate cancer (PCa). However, most of these models have come from industrialized countries. We therefore, developed a prostate disease nomogram model to provide a basis for predicting a prostate biopsy outcome by correlating clinical indicators and diagnostic parameters among Ghanaian men.Subjects and methods: The study was a hospital-based cross-sectional prospective one which was under- taken at the Department of Surgery (Urology Unit) Komfo Anokye Teaching Hospital (KATH) from December, 2014 to March, 2016. In all a total of 241 patients suspected of having a prostate disorder due based on an abnormal digital rectal examination (DRE) findings and, or elevated prostate specific antigen (PSA) level underwent Trans-Rectal Ultrasonography (TRUS) guided biopsy of the prostate. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostatespecific antigen (PSA), digital rectal examination (DRE) status, prostate specific antigen density (PSAD), history of alcohol consumption and history of smoking findings were included in the analysis. Two nomogram models were developed that were based on these independent predictors to estimate the probability of a positive initial prostate biopsy. Receiver-operating characteristic curves (ROC) were used to assess the accuracy of using the nomograms and PSA and PSAD levels for predicting positive a prostate biopsy outcome. Results: Prostate cancer was diagnosed in 63 out of 241 patients (26.1%). Benign prostatic hyperplasia was diagnosed in 172 (71.4%) of patients and the remaining 6 patients (2.48%) had chronic inflammation. Significantly elevated levels of PSA and PSAD were observed among patients with PCa compared to patients without PCa (p < 0.05). Furthermore, it was observed that age, DRE, PSA, PSAD, history of smoking, and history of alcohol consumption were significantly independent predictors (p < 0.05) of prostate cancer. The area under the receiver operating characteristic curve (AUC) of nomogram I and II were 87.3 and 84.8 respectively which were greater than that of total PSA (AUC = 75.8) and PSAD (AUC = 77.8) alone for predicting a positive initial prostate biopsy. Conclusion: We conclude that, nomograms offer a better and accurate assessment for predicting a positive outcome of prostate biopsies than the use of traditional tools of PSA, DRE and PSAD alone

What types of home are closing? The characteristics of homes which closed between 1996 and 2001

Closures of care homes have received considerable public attention. Fee levels and the cost of upgrading homes to meet the national minimum standards have been identified as the main factors influencing closures. The present paper compares private residential homes, dual-registered homes and nursing homes for older people which have closed between 1996 and 2001 with homes which have remained open. Homes which closed tended to be: smaller; to have had lower occupancy levels in 1996; to be the only home run by the organisation; to occupy converted buildings; to occupy multi-storey buildings, and if so, to have no lift; to have more shared bedrooms; and to have en suite facilities in none or only some of the bedrooms. These factors were interrelated and the effect of these variables in combination was examined using multivariate (logistic regression) analysis. Among the homes which remained open, only 34% provided at least 80% of places in single rooms, which was to have become the national minimum standard for existing homes until the standards were amended in March 2003. A separate analysis of data on social climate found that the homes with a more positive social environment were those most likely to have closed. The findings support the view that there is likely to be an increase in the importance of homes run by corporate providers relative to homes run as single, owner-managed homes, with a consequent reduction in choice for potential residents. At the same time, projections of future demand in a range of countries indicate that a considerable increase in provision will be required to meet the expected growth in the population of dependent older people, while developments in alternative forms of accommodation are unlikely to meet the growth in demand in the foreseeable future

Nomogram for predicting the probability of the positive outcome of prostate biopsies among Ghanaian men

Introduction and objectives: Several existing models have been developed to predict positive prostate biopsy among men undergoing evaluation for prostate cancer (PCa). However, most of these models have come from industrialized countries. We therefore, developed a prostate disease nomogram model to provide a basis for predicting a prostate biopsy outcome by correlating clinical indicators and diagnostic parameters among Ghanaian men. Subjects and methods: The study was a hospital-based cross-sectional prospective one which was undertaken at the Department of Surgery (Urology Unit) Komfo Anokye Teaching Hospital (KATH) from December, 2014 to March, 2016. In all a total of 241 patients suspected of having a prostate disorder due based on an abnormal digital rectal examination (DRE) findings and, or elevated prostate specific antigen (PSA) level underwent Trans-Rectal Ultrasonography (TRUS) guided biopsy of the prostate. Stepwise logistic regression was used to determine the independent predictors of a positive initial biopsy. Age, prostate-specific antigen (PSA), digital rectal examination (DRE) status, prostate specific antigen density (PSAD), history of alcohol consumption and history of smoking findings were included in the analysis. Two nomogram models were developed that were based on these independent predictors to estimate the probability of a positive initial prostate biopsy. Receiver-operating characteristic curves (ROC) were used to assess the accuracy of using the nomograms and PSA and PSAD levels for predicting positive a prostate biopsy outcome. Results: Prostate cancer was diagnosed in 63 out of 241 patients (26.1%). Benign prostatic hyperplasia was diagnosed in 172 (71.4%) of patients and the remaining 6 patients (2.48%) had chronic inflammation. Significantly elevated levels of PSA and PSAD were observed among patients with PCa compared to patients without PCa (p < 0.05). Furthermore, it was observed that age, DRE, PSA, PSAD, history of smoking, and history of alcohol consumption were significantly independent predictors (p < 0.05) of prostate cancer. The area under the receiver operating characteristic curve (AUC) of nomogram I and II were 87.3 and 84.8 respectively which were greater than that of total PSA (AUC = 75.8) and PSAD (AUC = 77.8) alone for predicting a positive initial prostate biopsy Conclusion: We conclude that, nomograms offer a better and accurate assessment for predicting a positive outcome of prostate biopsies than the use of traditional tools of PSA, DRE and PSAD alone. Keywords: Nomogram, Prostate biopsy, Prostate specific antigen (PSA), Prostate specific antigen density (PSAD

Self-replication, Evolvability and Asynchronicity in Stochastic Worlds

Peer reviewe