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The urological literature grows immensely by the day. Identifying practice-changing papers poses further difficulties. The purpose of this paper is to provide a common, case-based approach to applying the findings of some key papers in functional urology over the last 24 months. The cases described encompass: an elderly female with overactive bladder (OAB), a male patient with storage symptoms, a female patient with ulcerative interstitial cystitis, and a post-menopausal woman with recurrent urinary tract infections (UTI).

Laynor reviews Structural Competency in Mental Health and Medicine: A Case-Based Approach to Treating the Social Determinants of Health edited by Helena Hansen and Jonathan Metzl.

International audience; We present, in this paper, teaching material and experience report on teaching software testing to 3rd year bachelor's degree students. Our approach covers a wide range of techniques from unit testing, to functional testing, through test-first design and black-box testing. To motivate students, we rely on the use of a running case study, that is developed and tested all the way through. This paper presents both teaching material and experience report based on the feedback that we get from the students, and the observations we made regarding the discovery of the software testing aspects.

In cardiology practice, anticoagulation and antiplatelet therapies are essential for most patients. As of yet, there is no high quality evidence regarding these treatments in thrombocytopenic patients, which continues to be an issue. Thrombocytopenia is defined as a platelet count of 50x109/L, a half-dose of LMWH is recommended in patients with thrombocytopenia between 25 and 50x109/L. According to the current guidelines, avoiding antiplatelet and anticoagulant treatment should be restricted to patients with very severe thrombocytopenia (i.e., a platelet count

Persistent pupillary membranes (PPMs) are a common congenital anomaly seen in 95% of neonates. Extensive PPMs, occluding the visual axis and resulting in reduced visual acuity, are relatively uncommon. We describe a case of bilateral total PPM in a 36-year-old female who presented with complaints of blurred vision in both the eyes. Dense pupillary membranes obscuring the visual axis need early surgical treatment. It is essential that the lens status remains clear along the visual axis both before and after pupilloplasty.

Anticholinergic medication remains integral in the management of women with Overactive Bladder syndrome although there is increasing evidence to support a link with the impairment of cognitive function. This editorial will review the available evidence and discuss the management of patients in order to minimise anticholinergic burden with a particular focus on the elderly., Highlights • What is Anticholinergic Burden? • Why is Anticholinergic Burden important? • How is Anticholinergic Burden assessed? • How do we manage patients in clinical practice?

Highlights • A “drug holiday” can be considered for patients at low fracture risk • It is optimal after completion of five years of alendronate and three years of zoledronic acid or risedronate use • The “drug holiday” strategy should not be implemented for denosumab, estrogen, SERMs or teriparatide.

Treating people as cases that are proximate in a behavior space—representing lifestyles—rather than as markers of single variables has a long history in sociology. Yet, because it is difficult to find analytically tractable ways to implement this idea, this approach is rarely used. We take seriously the idea that people are whole packages, and we use household spending to identify groups who occupy similar positions in social space. Using detailed data on household consumption, we identify eight positions that are clearly similar in lifestyle. We then study how the lifestyles we identify are associated with saving, an important measure of household well-being. We find that households cluster into distinct lifestyles based on similarities and differences in consumption. These lifestyles are meaningfully related in social space and save in distinct ways that have important implications for understanding inequality and stratification.

The present study reports the findings of a 10-day neuronavigated continuous theta burst stimulation (cTBS) over the right pars triangularis for two individuals with chronic aphasia after a single left hemispheric stroke. Baseline language and quality of life measures were collected prior to the treatment study, post-treatment and at 3-month follow up. Therapy was tolerated well by both participants and no side effects were noticed during and after treatment. Results from one individual showed potential for positive change in performance in comprehension and expressive language both post-treatment and at the follow-up stage. Also, a trend towards improvement post-treatment was noticed in discourse and sentence productivity, and grammatical accuracy. In the follow up stage, grammatical accuracy showed a trend towards improvement; discourse productivity decreased and; sentence productivity skills showed mixed results. Results from the other participant showed potential for positive change in comprehension post-treatment, that was maintained at the follow-up stage. However, a decline in expressive language post-treatment and at follow-up, stronger post-treatment, was noticed. Regarding quality of life measurements, participant one appeared to have improved as his performance increased in the overall, physical and communication domains, but decreased slightly in the psychosocial domain. The second participant improved in the physical and communication domains and declined overall and in the psychosocial domains. Findings from this study indicate that cTBS over the right pars triangularis may have the potential to improve various language skills in patients suffering from chronic aphasia post-stroke. However, the potential benefits of this fast, non-invasive brain stimulation protocol on improvement of language abilities post-stroke need further exploration. Refereed/Peer-reviewed

It is well known that the dimensions of the pelvic bones depend on the gender and vary with the age of the individual. Indeed, and as a matter of fact, this work will focus on the development of an intelligent decision support system to predict individual's age based on pelvis' dimensions criteria. On the one hand, some basic image processing technics were applied in order to extract the relevant features from pelvic X-rays. On the other hand, the computational framework presented here was built on top of a Logic Programming approach to knowledge representation and reasoning, that caters for the handling of incomplete, unknown, or even self-contradictory information, complemented with a Case Base approach to computing., This work has been supported by COMPETE: POCI-01-0145-FEDER-007043 and FCT - Fundação para a Ciência e Tecnologia within the Project Scope: UID/CEC/00319/2013., info:eu-repo/semantics/publishedVersion

Objective To present a case series of patients previously diagnosed as multiple sclerosis (MS) which were later confirmed as an alternative diagnosis, and describe the clinical and paraclinical signs that led to this change. Method Nine patients are described. We reviewed the patient’s clinical chart, magnetic resonance images (MRI) and cerebrospinal fluid. Results There was a mean of three typical symptoms of MS and four clinical red flags per patient. MRI red flags were found in 88,9% of all referrals, with a mean of 3 encountered per patient. Conclusion We identified that, not only the misdiagnosed patients did not fulfill MS diagnosis criteria, but also how the described red flags are a useful tool in the differentiation of MS from other diseases. This data is important for guiding future diagnosis, especially for general clinicians and neurologists, which directly interfere with the patient’s management, treatment, prognosis and quality of life. Objetivo Apresentar uma série de casos de pacientes previamente diagnosticados como esclerose múltipla (EM) que tiveram um diagnóstico final alternativo, e descrever os sinais clínicos e paraclínicos que levaram à esta mudança. Método Nove pacientes encaminhados para confirmação diagnóstica de EM. Revisamos os prontuários, imagens de ressonância magnética (MRI) e líquido cefalorraquidiano. Resultados Houve uma média de três sintomas típicos de EM e quatro sinais de alerta por paciente. Sinais de alerta de ressonância magnética foram encontrados em 88,9% dos casos, com média de 3 por paciente. Conclusão Identificou-se que, não só os pacientes com diagnóstico incorreto não cumprem critérios de diagnóstico, mas também como os sinais de alerta já descritos são uma ferramenta útil na diferenciação de EM de outras doenças. Esta informação é importante para orientar a assertividade diagnóstica, especialmente para os clínicos e neurologistas gerais, com interferencia direta no tratamento, prognóstico e qualidade de vida do paciente.

In this paper we suggest a behavioral approach to decision making under ambiguity based on available information. A decision situation is characterized by a set of actions, a set of outcomes, and data consisting of action-outcome pairs. Decision-makers express preferences over actions and data sets. We derive a representation of preferences, which separates utility and beliefs. While the utility function is purely subjective, the beliefs of the decision maker combine objective characteristics of the data (number and frequency of observations) with subjective features of the decision maker (similarity of observations and perceived ambiguity). We identify the subjectively perceived degree of ambiguity and separate it into ambiguity due to a limited number of observations and ambiguity due to data heterogeneity. We also determine the decision maker’s attitude towards ambiguity. The special case of no ambiguity represents beliefs as similarity-weighted frequencies and provides a behavioral foundation for Billot, Gilboa, Samet and Schmeidler’s (2005) representation.

Introduction Any method to enhance patient care and safety is of great significance to those putting their trust in physicians charged with caring for the ill. Simulation is an effective tool for teaching the complexities of caring for critically ill patients because it allows for the development of the cognitive skills necessary to quickly analyze a situation and intervene in a timely manner to avoid patient harm. This resource describes the approach to a multistage didactic for training critical care fellows using simulation on typical scenarios encountered in the intensive care unit (ICU). Methods The resource comprises seven sessions, each one building upon events encountered in the prior session. The patient in the case, given the severity of her/his condition at the time of admission, would be expected to respond poorly to treatment and have a multitude of complications while being cared for in the ICU. Each session consists of a 25-minute practical part and a 25-minute debriefing. In addition to the trainees, a faculty facilitator, embedded nurse educator (at the bedside to convey information and implement orders), and simulator technician (to monitor the manikin and adjust settings accordingly) are necessary to complete the endeavor. The curriculum is best implemented via monthly sessions and completed over a 7-month period. Results This curriculum has been in place at our medical center for 3 years and has been well received by trainees and facilitators. It was originally implemented in July 2010 with first-year critical care fellows. During the first year of its use, fellows found engaging in the situation easier with each passing month and actually commented on the reality of each session. In July 2011, the case was again used, with minor adjustments based upon feedback from the initial group, including changes to the patient's physiology, laboratory data, and feedback mechanisms to further enhance the learning experience. In July 2012, a third pair of fellows participated in these learning sessions, and the process evolved to incorporate multiple-choice questions for each session (as a mode of objectively testing learners' understanding) plus assigned reading prior to each session. Discussion The simulation format promotes a learning-centered environment encouraging trainees to actively engage in their education and allowing teachers to adjust the educational experience to better address trainees' learning needs. We continue to refine this curriculum based on trainee feedback. The latest iteration has the trainees take on more responsibility, reinforcing the active learning approach the curriculum embraces. In the future, we plan to start collecting data from trainees' pre- and postcurriculum performances in the ICU to better evaluate the effectiveness of this resource.

Introduction Creative approaches to chair development are needed, especially for new college of medicine chairs who confront a host of unique challenges when they assume their roles. This resource was developed and implemented to provide a case-based approach to chair development for a new chairs' retreat. Methods This resource contains the four cases, each of which was developed and facilitated by a content expert who was an experienced chair or a senior dean. Small groups of new chairs plus one experienced chair discussed each case, and then came together to define the issues the case raised for the new chair, and possible approaches to solutions. Results A postretreat anonymous evaluation survey showed that the participants found the case-based structure of the retreat very valuable, the cases highly effective at promoting meaningful discussion, and the involvement of experienced chairs to be an important component. The participants' survey comments highlighted the opportunity for collegial and collaborative chair interactions as being the most valuable aspect of the retreat. Discussion Little has been written about chair development, thus highlighting the significance of the work. The development of the retreat was based on evidence from educational research that suggests that people learn best in an interactive format, and that relationship building is key to creating effective leadership teams.

Teaching is a complex activity that requires one to make many decisions in a short span of time. Decision making by teachers in their daily lives is therefore inevitable. Most of the decisions made are mostly based on teachers‘personal belief system which are usually related to educational theories and principles but the issue is most teachers are not aware of such relationships. They have actually put these thoeries into in their daily decision making practices. In view of this situation, this study intends to explore the preservice teachers‘use of educational theories, principles and concept in making decisions to solve problems in the classroom using a case analysis model. This model was used by the preservice teachers as a framework for analysing classroom and behavior management cases. In addition, this study also evaluated the attitude of preservice teachers towards the course after using a case based approach.

Introduction Professionalism is a key attribute for health professionals. Yet, it is unknown how much faculty development is directed toward skills and behaviours of faculty professionalism. Faculty professionalism includes boundaries in teacher-student relationships, self-reflection, assuring one’s own fitness for duty, and maintaining confidentiality when appropriate. Methods For five years, we have incorporated faculty professionalism as a routine agenda item for the monthly Physician Assistant Programme faculty meetings, allowing faculty members to introduce issues they are comfortable sharing or have questions about. We also have case discussions of faculty professionalism within faculty meetings every three months. Results Faculty professionalism is important in the daily work lives of faculty members and including this as part of routine agendas verifies its importance. A faculty survey showed that a majority look forward to the quarterly faculty professionalism case discussions. These have included attempted influence in the admissions process, student/faculty social boundaries, civic professionalism, students requesting medical advice, and self-disclosure. Conclusion A preventive approach works better than a reactionary approach to faculty missteps in professionalism. Routine discussion of faculty professionalism normalizes the topic and is helpful to both new and experienced faculty members. We recommend incorporation of faculty professionalism as a regular agenda item in faculty meetings.