Mri of Complicated Anal Fistulas - Comparison With Digital Examination

Objectives: The assessment of complicated anal fistulae is based on digital examination. Our objective was to study the potential role of MRI in this setting by comparing preoperative digital examination with MRI. Materials and Methods: Digital examination and MRI were prospectively and blindly interpreted in 13 patients with complicated anal fistulae. Surgical findings were used as standard. Results: Complete agreement between the results of digital examination and the surgical findings was observed in 8 patients and between the results of MRI and the surgical findings in 12 patients. Digital examination misclassified two low transsphincteric fistulae as high transsphincteric and missed high secondary extensions or abscesses in three other patients. Magnetic resonance misclassified only one suprasphincteric fistula as low transsphincteric and did not overlook high secondary extensions or abscesses. Conclusion: These findings suggest that MRI may show abnormalities not detected by preoperative digital examination

Conflict of interest policies at Belgian medical faculties: Cross-sectional study indicates little oversight.

BackgroundMedical students encounter pharmaceutical promotion from the very start of their training. Medical schools have an important role to play in educating medical students regarding the interactions between healthcare professionals (HCPs) and industry and in protecting them from commercial influence and conflict of interest (COI). In 2019, medical student associations in Belgium and abroad called for more preparation in dealing with COI and for a more independent medical training. As little information is available on the situation in our country, we undertook an assessment of conflict of interest policies at Belgium's medical schools. We relied on a methodology already used in studies from USA, Canada, Australia, France and Germany and adapted it to the Belgian context.MethodsWe identified 10 medical schools in Belgium. We searched the website of each medical school in November 2019 with standardized keywords for COI policies and learning activities on COI in the curriculum. The deans of medicine were invited to participate by sending us information that we could have overlooked during our web-based searches. We also consulted personal contacts within faculties among students and teachers. Based on a list of 15 criteria adapted from North American and French studies, we calculated a total for each faculty of medicine with a maximum score of 30 points.ResultsBy December 2019, we had gathered a set of written documents for four faculties of medicine (40%) containing policies with varying degrees of precision and relevance to our survey. We found elements of the curriculum addressing the COI issue for one faculty (10%). In all cases, these policies consisted of "moderate" initiatives with little or no "restrictive" elements. Only one faculty showed interest in our study by providing us with relevant information (10%). Half of the faculty notified us of their refusal to participate in the study (50%) and the other faculties either did not respond or did not provide us with any information (40%). The maximum score obtained was 3 out of 30 points with six faculties scoring 0 (60%).ConclusionThere is little transparency regarding interactions between medical students and pharmaceutical companies at Belgian medical faculties, which may create COI issues. Initiatives to protect students from pharmaceutical promotion and to train them to manage their future interaction with pharmaceutical companies have a limited scope and are isolated. This is inconsistent with international recommendations from Health Action International, World Health Organization or the American Medical Students' Association. The Belgian government has legislated in favor of more transparency in the relation between HCPs and pharmaceutical industry. Indeed, it made the disclosure of benefits granted by the industry compulsory and limited their value. Our results show that there is still some way to go to ensure an independent medical training for future Belgian physicians