The coronavirus disease 2019 (COVID-19) pandemic is unlike anything seen before by modern science-based medicine. Health systems across the world are struggling to manage it. Added to this struggle are the effects of social confinement and isolation. This brings into question whether the latest guidelines are relevant in this crisis. We aim to support urologists in this difficult situation by providing tools that can facilitate decision making, and to minimise the impact and risks for both patients and health professionals delivering urological care, whenever possible. We hope that the revised recommendations will assist urologist surgeons across the globe to guide the management of urological conditions during the current COVID-19 pandemic.

Background: There is uncertainty in deferred active treatment (DAT) programmes, regarding patient selection, follow-up and monitoring, reclassification, and which outcome measures should be prioritised. Objective: To develop consensus statements for all domains of DAT. Design, setting, and participants: A protocol-driven, three phase study was undertaken by the European Association of Urology (EAU)-European Association of Nuclear Medicine (EANM)-European Society for Radiotherapy and Oncology (ESTRO)-European Association of Urology Section of Urological Research (ESUR)-International Society of Geriatric Oncology (SIOG) Prostate Cancer Guideline Panel in conjunction with partner organisations, including the following: (1) a systematic review to describe heterogeneity across all domains; (2) a two-round Delphi survey involving a large, international panel of stakeholders, including healthcare practitioners (HCPs) and patients; and (3) a consensus group meeting attended by stakeholder group representatives. Robust methods regarding what constituted the consensus were strictly followed. Results and limitations: A total of 109 HCPs and 16 patients completed both survey rounds. Of 129 statements in the survey, consensus was achieved in 66 (51%); the rest of the statements were discussed and voted on in the consensus meeting by 32 HCPs and three patients, where consensus was achieved in additional 27 statements (43%). Overall, 93 statements (72%) achieved consensus in the project. Some uncertainties remained regarding clinically important thresholds for disease extent on biopsy in low-risk disease, and the role of multiparametric magnetic resonance imaging in determining disease stage and aggressiveness as a criterion for inclusion and exclusion. Conclusions: Consensus statements and the findings are expected to guide and inform routine clinical practice and research, until higher levels of evidence emerge through prospective comparative studies and clinical trials. Patient summary: We undertook a project aimed at standardising the elements of practice in active surveillance programmes for early localised prostate cancer because currently there is great variation and uncertainty regarding how best to conduct them. The project involved large numbers of healthcare practitioners and patients using a survey and face-to-face meeting, in order to achieve agreement (ie, consensus) regarding best practice, which will provide guidance to clinicians and researchers.

Bladder stones (BS) constitute 5% of urinary stones. Currently, there is no systematic review on their treatment. Objective: To assess the efficacy (primary outcome: stone-free rate; SFR) and morbidity of BS treatments.

Abstract:Various forms of assurance are being demanded by different constituencies in the federal public administration. One form of assurance is that of financial accountability, and spending reviews are an essential input to processes that contribute to federal budgetary and expenditure management decisions. Program evaluation has also been an important contributor, but it may be the case that this federal function is over-extended in that contribution. It may be time to consider removing this responsibility and attaching it to other functions, thereby affording the function to better focus on what it does best: contribute to program improvement, including effectiveness. This would also mean a shift in evaluation culture to one of learning, rather than accountability. Résumé :Diverses formes d’imputabilité sont exigées des différents groupes de l'administration publique fédérale dont la responsabilité financière. Les exercices de révision budgétaire sont une composante essentielle contribuant aux décisions du gouvernement fédéral en matière de gestion budgétaire et de dépenses. L'évaluation du programme a joué un rôle important à ce niveau, mais il se peut que le fédéral ait des attentes trop élevées concernant sa contribution. Il serait peut-être temps d'envisager enlever cette responsabilité à l’évaluation et de la rattacher à d'autres fonctions, ce qui lui permettrait de se concentrer sur ce qu'elle fait le mieux: contribuer à l'amélioration de programme, ce qui inclut l’analyse de l'efficacité. Cela signifierait aussi que la culture de l'évaluation évolue vers une culture d'apprentissage plutôt que vers la reddition de comptes.

PurposeAccording to the traditional view of public administration, a critical component of good policy formulation is the provision of frank and fearless advice to elected decision-makers. This advice can be provided by permanent public officials or by the people selected by the elected governments to fill key and continuing posts. However, there are major questions as to whether new Governor-in-Council (GIC) appointment processes rooted in new public governance (NPG) are yielding the expected results promised, such as less partisanism, as a consideration for appointment.Design/methodology/approachThe paper uses a mixed methods approach to examine the GIC process as it is used in Canada. In using these methods, the authors employed interviews with senior officials, governmental documents review and expert validation interviews to triangulate its main findings.FindingsThe paper uses the case of the revised appointment process for GIC appointments in Canada and suggests that the new arrangements do not deliver on merit-based criteria that ensures independence is protected between political executive and senior bureaucratic officials. Although new processes may be more open and transparent than past processes, the paper suggests that such processes are more susceptible to partisan influence under the guise of being merit-based.Research limitations/implicationsThe research was limited to one country context, Canada. As such, it will be necessary to expand this to other Westminster countries. Testing whether manifestations of new public governance in appointment processes elsewhere will be important to validate whether Canada is unique or not.Practical implicationsThe authors are left to wonder if this innovation of merit-based appointments in the new administrative state is obscuring the lines of accountability and whether it forms the basis for good policy advice despite promises to the contrary.Social implicationsTrust in the government is affected by decisions behind closed doors. They appear partisan, even when they may not be. Process matters if only to highlight increased value placed on meritorious appointments.Originality/valuePrevious studies on GIC appointments have generally been to explore representation as a value. That is, studies have questioned whether diversity is maintained, for example. However, few studies have explored appointment processes using institutional approaches to examine whether reforms to such processes have respected key principles, such as merit and accountability.