Infectious complications after transrectal MRI-targeted and systematic prostate biopsy

Purpose To compare infectious complications after transrectal systematic prostate biopsy (SB) and magnetic resonance imaging (MRI)-targeted biopsy (TB) in a large retrospective cohort to assess whether one technique is superior to the other regarding infectious complications. Methods A total of 4497 patients underwent 5288 biopsies, 2875 (54%) SB and 2413 (46%) MRI-TB only. On average, 12 SB cores and 3.7 MRI-TB cores were taken per biopsy session during the study period. Infection-related complications within 30 days were compared. The primary endpoint was a positive urine culture. Secondary endpoints were positive blood cultures, urine tests with elevated leukocytes >= 100 E6/L and elevated C-reactive protein (CRP) >= 100 mg/L. Chi-square test was used to compare the cohorts. Results Positive urine cultures were found in 77 (2.7%) after SB and in 42 (1.7%) after MRI-TB (p = 0.022). In total, 46 (0.9%) blood culture positive infections were found, 23 (0.9%) occurred after SB and 23 (1.0%) after MRI-TB, (p = 0.848). Urine tests with elevated leukocytes >= 100 E6/L were found in 111 (3.9%) after SB and in 61 (2.5%) after MRI-TB (p = 0.006). Elevated CRP >= 100 mg/L was found in 122 (4.2%) after SB and in 72 (3.0%) after MRI-TB (p = 0.015). Blood cultures were drawn more often after SB than after MRI-TB, but the difference was not statistically significant. However, urine cultures and CRP were taken more often after SB than MRI-TB. Conclusion Blood culture positive infections were equally rare after SB and MRI-TB. However, all other infectious complications were more common after SB than MRI-TB.Peer reviewe

The governors of school markets? : Local education authorities, school choice and equity in Finland and Sweden

As one of the key elements of the Nordic welfare model, education systems are based on the idea of providing equal educational opportunities, regardless of gender, social class and geographic origin. Since the 1990s, Nordic welfare states have undergone a gradual but wide-ranging transformation towards a more market-based mode of public service delivery. Along this trajectory, the advent of school choice policy and the growing variation in the between-school achievement results have diversified the previously homogenous Nordic education systems. The aim of our paper is to analyse how Finnish and Swedish local education authorities comprehend and respond to the intertwinement of the market logic of school choice and the ideology of equality. The data consist of two sets of in-depth thematic interviews with staff from the local providers of education, municipal education authorities. The analysis discloses the ways in which national legislation has authorized municipal authorities to govern the provision of education.Peer reviewe

The art of governing local education markets : Municipalities and school choice in Finland

Since the 1980s, numerous education reforms in Europe and beyond have sought to dismantle centralised bureaucracies and replace them with devolved systems of schooling that emphasise parental choice and competition between diversified types of schools. Despite this general trend, Finland continues to emphasise the municipal assignment of school places, albeit with the possibility of locally controlled choice. The aim of this paper is to elaborate on the ways in which Finnish local education authorities – involving both officials and politicians – define themselves in relation to the changing conceptions of the Nordic welfare state model. The paper discusses the social costs and benefits of school choice in addition to the kinds of techniques these authorities use when aiming to control and manage the social costs and benefits of school choice. Based on nine in-depth thematic interviews with local education authorities, the modalities – having to, being-able, wanting and knowing how – will be analysed.Peer reviewe

Does Protocol Make a Difference? Comparison of Two Prostate Cancer Active Surveillance Cohorts : A Non-protocol-based Follow-up and a Protocol-based Contemporary Follow-up

Background: Active surveillance (AS) is the preferred option for initial management for low-risk prostate cancer (PC). Although many AS protocols exist, there is little evidence to support one over another. Objective: To assess whether there is difference in overall (OS), prostate cancer-specific (CSS), metastasis-free (MFS), or treatment-free (TFS) survival between a strict (Prostate cancer Research International: Active Surveillance [PRIAS]) and a loose (European Randomized study of Screening for Prostate Cancer [ERSPC]) AS protocol. Design, setting, and participants: This study included two cohorts of men (n = 518) with low-risk, localized, Gleason scorePeer reviewe