Why Do We Need Maths in Medicine?

Maths is a crucial part of medicine. All the graphs, equations, statistics, and general maths we learn at school help us to understand important aspects of human and veterinary medicine, biology, and science in general. People always think that biology and chemistry are important for doctors, nurses, midwives, scientists, and all the other people involved in medicine and healthcare-related jobs, but in fact maths is also vital. So, whether you are thinking of becoming a doctor, hoping to invent medical technologies, or just wishing to understand treatments you get as a patient, understanding the maths behind medicine is crucial. This article explores how we check whether someone has a disease such as coronavirus or heart disease, how we predict and measure how many people will be affected by various diseases, and how maths is used to treat patients and prevent the spread of contagious diseases. While people are generally aware that sciences like biology and chemistry are important for jobs in the medical field, many may not realize that maths is also vital for most of these jobs. This article looks at some of the ways we use maths in medicine. If you want to become a doctor, veterinary surgeon, nurse, midwife, medical scientist, or to have any job related to healing people and animals, or even if you just want to be an informed patient, knowledge of maths is quite important!

Quality prescribing in early psychosis: key pharmacotherapy principles

Objective: To present a practical, easy-to-implement clinical framework designed to support evidence-based quality prescribing for people with early psychosis. Method: Identification and explanation of key principles relating to evidence-based pharmacotherapy for people with early psychosis. These were derived from the literature, practice guidelines and clinical experience. Results: Key principles include (1) medication choice informed by adverse effects; (2) metabolic monitoring at baseline and at regular intervals; (3) comprehensive and regular medication risk–benefit assessment and psychoeducation; (4) early consideration of long-acting injectable formulations (preferably driven by informed patient choice); (5) identification and treatment of comorbid mood disorders and (6) early consideration of clozapine when treatment refractory criteria are met. Conclusions: Current prescribing practices do not align with the well-established evidence for quality pharmacotherapy in early psychosis. Adopting evidence-based prescribing practices for people with early psychosis will improve outcomes.

Mini-laparoscopic cholecystectomy: evolution of a new technique

Background Since the first laparoscopic cholecystectomy (LC) in 1985, there has been much advancement in laparoscopic surgery in terms of reduction in number and size of ports. We report a new technique of performing mini laparoscopic cholecystectomy using only three ports, 5 mm each. The indications of this procedure include GB polyps, GB dyskinesia, microlithiasis, and idiopathic pancreatitis. Case presentation In this case report, we present a new technique that has been performed safely in a 49-year-old male patient with pancreatitis caused by microlithiasis. This was performed using a novel three port procedure consisting of only 5 mm ports, and he was discharged as a day case without complications. Informed patient consent was obtained. Conclusions The fundamentals of this mini-LC technique remain the same as that of a standard laparoscopic cholecystectomy throughout the procedure. It is a feasible option in selected cases, and it has the potential to further augment the inherent benefits of minimal access surgery namely less analgesia, improved cosmesis and faster recovery. Further trials will help ascertain its potential advantages.

Making Patient-Specific Treatment Decisions Using Prognostic Variables and Utilities of Clinical Outcomes

We argue that well-informed patient-specific decision-making may be carried out as three consecutive tasks: (1) estimating key parameters of a statistical model, (2) using prognostic information to convert these parameters into clinically interpretable values, and (3) specifying joint utility functions to quantify risk–benefit trade-offs between clinical outcomes. Using the management of metastatic clear cell renal cell carcinoma as our motivating example, we explain the role of prognostic covariates that characterize between-patient heterogeneity in clinical outcomes. We show that explicitly specifying the joint utility of clinical outcomes provides a coherent basis for patient-specific decision-making.

A thematic analysis of the prevention of future deaths reports in healthcare from HM coroners in England and Wales 2016–2019

Background The Coroners and Justice Act allows coroners in England or Wales to issue reports after inquest, if they believe that action should be taken to prevent a future death. Coroners are under a statutory duty to issue a Prevention of Future Death (PFD) report to persons or organisations that they believe have the power to act. Cumulatively, these reports may contain useful intelligence for patient safety. The aim of this study was to examine the feasibility of extracting data from these reports and to evaluate if learning was possible from any common themes. Methods Reports were extracted from 2016 to 2019 for deaths in hospitals, care homes and the community in England and Wales. These were subjected to descriptive statistics and thematic analysis of coroner’s concerns. Application of data mining techniques was not possible due to data quality. Results 710 reports were examined, with 3469 concerns being raised (mean 4.88, range 1–33). 36 reports expressed concern about having to issue repeat PFDs to the same organisation for the same or similar concerns. Thematic analysis reliability was high ( κ 0.89 unweighted) with five emerging primary themes: deficit in skill or knowledge, missed, delayed or uncoordinated care, communication and cultural issues, systems issues and lack of resources. A codebook of 53 subthemes were identified. Conclusions PFD reports offer valuable insight. Aggregation and continued analysis of these reports could offer more informed patient safety, workforce development and organisational policy. Improved data quality would allow for possible automation of analysis and faster feedback into practice.

Personalized Single-Cell Proteogenomics to Distinguish Acute Myeloid Leukemia from Non-Malignant Clonal Hematopoiesis

Genetic mutations associated with acute myeloid leukemia can also be detected in age-related clonal hematopoiesis, making confident assignment of detected variants to malignancy challenging particularly in the post-treatment setting. This has implications for measurable residual disease monitoring, where the relationship between sequencing and flow cytometry is also imperfect. We show, using whole-genome-sequencing informed patient-personalized single-cell DNA and antibody-oligonucleotide sequencing, that it is possible to resolve immunophenotypic identity of clonal architecture.

A Modest Proposal for Restoration Ecology

Restoration ecology struggles to mitigate human-caused ecological damage. Non-native species are a particular challenge. This article describes two restoration attempts following introduced species in California and then makes a radical culling proposal. Environmental regulations, legal protections, and restoration projects are necessary to preserve ecosystem services, but such policies are often unpopular. Restorers often struggle when public opinion opposes evidence-based practice, and this occurs particularly when the interventions involve killing mammals. Therefore, restoration efforts may benefit from more attention to how individuals perceive the acceptability of environmental policies and how to communicate policy options effectively for individuals to make informed decisions. Restoration ecology can follow the recent shift of medicine away from imperatives and towards informed patient choice. Restoration projects may benefit from recent advances in psychology and communication that help individuals make policy decisions that align with their personal values.

Remember the law: managing patients who decline two-week rule appointments because of COVID-19

Concerns about contracting COVID-19 have led to many patients with suspected cancers becoming reluctant to attend appointments and investigations, putting clinicians in a difficult position. Thomas Hayes explains the importance of a well-informed patient in securing both the best clinical outcomes and the clinician's legal position.