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It is a common practice to control efficacy of pharmacological treatment with a placebo group. However, placebo itself may affect subjective and even objective results. The purpose of this study was to evaluate the placebo effect on symptoms of CP/CPPS to improve future clinical trials.A search at three databases (Scopus, MEDLINE, and Web of Science) was conducted to identify double-blind placebo-controlled clinical trials on the treatment of CP/CPPS published until April 2021. The primary outcome - National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score.Qmax, PVR, IPSS, and prostate volume.A total of 3502 studies were identified. Placebo arms of 42 articles (5512 patients, median 31 patients) were included in the systematic review. Systematic review identified positive changes in the primary endpoint, meta-analysis of 10 articles found that NIH-CPSI total score results were significantly influenced by placebo, mean difference -4.2 (95% confidence interval [CI]: -6.31, -2.09). Mean difference of NIH-CPSI pain domain was -2.31 (95% CI: -3.4, -1.21), urinary domain -1.12 (95% CI: -1.62, -0.62), quality of life domain -1.67 (95% CI: -2.38, -0.96); p 0.001 for all. In case of the objective indicator - Qmax, there were three articles included in the meta-analysis. Qmax mean change from baseline was 0.68 (95% CI: -0.85, 2.22, p = 0.38). Systematic review showed no significant changes in pain, measured by VAS or other scores, IPSS and PVR.Placebo significantly affected the subjective parameters (NIH-CPSI) and limitedly affected various other measurements of pain (visual analog scale, McGill pain questionnaire). There was no long-term effect on IPSS and objective measurements (Qmax, PVR). This study can be used in further clinical trials to develop general rules of CPPS treatment assessment.

Introduction Vaporization of the prostate (VP) and endoscopic enucleation of the prostate (EEP) are reliable and frequently used methods for BPO relief. Both surgeries utilize lasers and EAU recommends them in similar patient cohorts. Our objective was to compare intra- and perioperative results of patients who had undergone VP and EEP. Evidence acquisition A systematic literature search was performed in three databases (MEDLINE, Web of Science and Scopus). The detailed search strategy is available at Prospero, CRD42020204739. Primary outcomes were functional results (IPSS, QoL, PVR, Qmax), and secondary outcomes were intraoperative results, postoperative PSA and prostate volume, complications, and recurrence rate. Evidence synthesis VP required less operative time compared to EEP, mean difference=-5.51 (95%CI -7.52; -3.50). IPSS and Qmax for VP were worse after 12-month follow-up, mean difference=0.89 (95%CI 0.52; 1.27) and -3.7 (95%CI -4.56; -2.85), respectively, while QoL did not differ significantly. Postoperative PSA level was higher in the VP group, mean difference=2.28 (95%CI 2.00; 2.55). VP was associated with reduced Clavien-Dindo grade I (OR=4.16; 95%CI 2.96; 5.84) and grade II (OR=3.79; 95%CI 2.25; 6.39) complication rate, especially in terms of the percentage of blood transfusion and transient urinary incontinence. The rate of complications grade IIIa and higher was similar (3 - 6%). Reoperation rate was only estimated in one study and was significantly higher in the PVP group at 60 months of follow-up, 2.7% vs 0%, p Conclusions EEP and VP share the efficacy and safety in BPH management. Our meta-analysis shows comparable complication rate in Clavien-Dindo III, VP superiority in operation time, and EEP superiority in long-term functional outcomes and PSA reduction.

Introduction: Robot-assisted devices have been recently developed for use in prostate biopsy. However, it is possible advantages over standard biopsy remain unclear. We aimed to assess the diagnostic performance and safety of robot-assisted targeted (RA-TB) and systematic prostate biopsies (RA-SB). Methods: A systematic literature search was performed in MEDLINE and Scopus databases. The detailed search strategy is available at Prospero (CRD42021269290). The primary outcome was the clinically significant prostate cancer (PCa) detection rate. The secondary outcomes included the overall detection rate of PCa, cancer detection rate per core, and complications. Results: The clinically significant cancer detection rate, overall cancer detection rate, and “per patient” did not significantly differ between RA-TB and RA-SB [OR = 1.02 (95% CI 0.83; 1.26), p = 0.05, I2 = 62% and OR = 0.95 (95% CI 0.78; 1.17), p = 0.17, I2 = 40%, respectively]. There were no differences in the clinically insignificant cancer detection rate “per patient” between RA-TB and RA-SB [OR = 0.81 (95% CI 0.54; 1.21), p = 0.31, I2 = 0%]. RA-TB had a significantly higher cancer detection rate “per core” [OR = 3.01 (95% CI 2.77; 3.27), p < 0.0001, I2 = 96%]. Conclusion: RA-TB and RA-SB are both technically feasible and have comparable clinical significance and overall PCa detection rates.

Wherever the art of Medicine is loved, there is also a love of Humanity (Hippocrates 2018)What is Medical Humanities (MH) and why is it important for medical education today? In this Commentary, we...

In the present context of medical science and technology advances, growing cultural diversity and the internationalisation of higher medical education, the problem of refresher training for Medical English teachers is becoming ever more relevant. The aim of the paper is to provide a scientific basis for creation of a relevant advanced training programme for Russian university teachers of Medical English. The results of the content-analysis of both national and international higher educational docu­ments, a review of research, theory, and current foreign language teaching practice in Prof. V. F. Voino-Yasenetsky Krasnoyarsk State Medical University (KrasSMU) and I. M. Sechenov First Moscow State Medical University (Sechenov University) allowed us to determine five principles that formed the basis for the design of a relevant advanced training programme for teachers of Medical English. Among the core principles of the programme development we suggested the principles of teacher’s autonomy, professionalisation, problem-based training, innovation, and internationalisation. Within the scope of these principles, characteristics of the proposed novel approach to the organisation of professional development courses for Medical English teachers make this approach effective and relevant to the modern educational context. The proposed approach to an advanced training course design is based on the use of some novel professionally focused forms of communication between students, teachers, experts and clinicians. Our findings indicate that this approach is beneficial for modern teachers of Medical English.

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This article was migrated. The article was marked as recommended. The undergraduate medical curriculum, together with many of the other healthcare curricula, is under a constant state of change. Sometimes that change is for the better, very occasionally less so. Many physicians who graduated more than forty years ago may agree that the humanities were a strong component of the hidden curriculum; the humanities were just there and enhanced many teaching activities (mainly lectures) to a variable state. They were used by a certain proportion of faculty to make their lectures "more exciting", "more real" and "to put them in context". Over time and as new teaching and learning technologies took the place of formal teaching (such as lectures), these humanities approaches and enhancements appeared to become less prominent.This new AMEE MedEdPublish theme - The Importance of the Humanities in Medical Education - has not only demonstrated that the humanities are not gone and lost forever, they were just hidden, but the number of papers received demonstrated that the subject is certainly healthier than expected and suggests the inclusion of the Humanities within all forms of healthcare curricula and training opportunities. This concluding commentary provides an overview of the large number of papers received, explores the various reasons that support the presence of the humanities in the curriculum, provides insight into the ways that the humanities are being taught and finally, provides some direction of the way forward.