• Strategy of targeted biopsies alone at pre-biopsy MRI-suspicious areas is an attractive potential alternative to extended systematic biopsies for detection of significant prostate cancer. •Further studies are necessary to validate the strategy of targeted biopsies alone.

In this outbreak of tuberculosis, the growth characteristics of the strain involved greatly exceeded those of other clinical isolates of M. tuberculosis. The extensive transmission of tuberculosis may have been due to the increased virulence of the strain rather than to environmental factors or patient characteristics.

Objective:To evaluate the effect of cartoon illustrations on patient comprehension of and compliance with ED release instructions.Methods: A prospective, randomized, controlled study of consecutive patients who presented to the ED of a community teaching hospital with lacerations necessitating wound repair during a three-month study period. At ED release, the patients were randomly assigned to receive wound care instructions with or without cartoon illustrations. Three days later, the patients were followed up by telephone. A blinded investigator asked a series of questions designed to test the patient's recall of, understanding of, and compliance with wound care instructions.Results: A total of 234 patients were successfully contacted by telephone; 105 (45%) had been given ED release instructions with cartoons, 129 (55%), without cartoons. There was no significant difference in age, gender, level of education, or satisfaction with the ED visit between the two groups. The patients given cartoon instructions were more likely to have read the instructions (98% vs 7996, p c 0.001), were more likely to answer all wound care questions correctly (46% vs 6%, p < 0.001), and were more compliant with daily wound care (77% vs 54% p c 0.01). Subset analysis of those patients who had less than a high school education (n = 57) demonstrated even larger differences between the two treatment groups in terms of comprehension of and compliance with ED release instructions. Conclusion:Cartoon illustrations are an effective strategy for conveying information and may improve patient compliance with ED release instructions.Key words: illustrations; patient instructions; patient follow-up; compliance; discharge instructions; cartoons.Acad. Emerg. Med. 1996; 3:264-270.I The outcome of minor illness and injury managed in the ED is largely dependent on care rendered after release from the ED. However, the ED team has little control over what patients do after they leave. Many patients follow up with their own physicians or clinics, usually at a time related more to convenience than to necessity. Some patients choose their own follow-up care. Others completely ignore ED release and follow-up instructions, often with serious results. Only a fraction of patients recall everything they are told and follow instructions exactly. Identifying which patients will heed ED release and follow up instructions and which ones will not is never an easy task for the emergency physician (EP).'Studies indicate that patient satisfaction and compliance with the aftercare plan are related to the amount and quality of information given to the patient and the ability of the patient to comprehend it.'-' Efforts to improve ED release and follow-up instructions include verbal teaching techniques, behavior modification, emergency care clinics, postal notification and reminder systems, and ED follow-up While these methods have significant effects on compliance rates, each method has cost-related drawbacks.

Purpose The DOCUMENT multicenter trial in the United States validated the performance of an epigenetic test as an independent predictor of prostate cancer risk to guide decision making for repeat biopsy. Confirming an increased negative predictive value could help avoid unnecessary repeat biopsies. Materials and Methods We evaluated the archived, cancer negative prostate biopsy core tissue samples of 350 subjects from a total of 5 urological centers in the United States. All subjects underwent repeat biopsy within 24 months with a negative (controls) or positive (cases) histopathological result. Centralized blinded pathology evaluation of the 2 biopsy series was performed in all available subjects from each site. Biopsies were epigenetically profiled for GSTP1, APC and RASSF1 relative to the ACTB reference gene using quantitative methylation specific polymerase chain reaction. Predetermined analytical marker cutoffs were used to determine assay performance. Multivariate logistic regression was used to evaluate all risk factors. Results The epigenetic assay resulted in a negative predictive value of 88% (95% CI 85–91). In multivariate models correcting for age, prostate specific antigen, digital rectal examination, first biopsy histopathological characteristics and race the test proved to be the most significant independent predictor of patient outcome (OR 2.69, 95% CI 1.60–4.51). Conclusions The DOCUMENT study validated that the epigenetic assay was a significant, independent predictor of prostate cancer detection in a repeat biopsy collected an average of 13 months after an initial negative result. Due to its 88% negative predictive value adding this epigenetic assay to other known risk factors may help decrease unnecessary repeat prostate biopsies.

The UroVysion FISH assay provides high sensitivity and specificity to detect transitional cell carcinoma in cytologically equivocal and negative urine samples. These results emphasize the important role of this assay in the management of bladder cancer.

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