Federico di Montefeltro's hyperkyphosis: a visual-historical case report

<p>Abstract</p> <p>Introduction</p> <p>The literature contains several publications describing the use of visual arts to develop observational skills in medical students. Portraits of individuals of the Italian Renaissance can be used to enhance these skills and stimulate the development of differential diagnoses in medical students. The Duke of Urbino, Federico di Montefeltro (1422–1482), lost his right eye and nasal bridge during a jousting accident in 1450. Consequently, almost every profile of him in existence today depicts his face in a left lateral view. Although some authors have described the Duke's missing nasal bridge, none have described his prominent thoracic hyperkyphosis, which is clearly discernible in two paintings by Piero della Francesca. The purpose of this report is to describe the Duke's hyperkyphosis, develop relevant differential diagnoses, and suggest a possible etiology of the convexity.</p> <p>Case presentation</p> <p>We have examined two paintings of the Duke by Piero della Francesca – the diptych, <it>The Duke and Duchess of Urbino </it>(1465), and the <it>Madonna of the Egg </it>(1472). A MEDLINE search revealed 2 articles that were relevant to this study. This search was complemented by a search of the collection at the library of Seton Hall University, and the first author's experience studying at the University of Urbino. The historical data obtained from these searches were incorporated with the visual analysis to formulate a plausible etiology of the Duke's thoracic hyperkyphosis.</p> <p>Conclusion</p> <p>Differential diagnoses of the Duke's thoracic hyperkyphosis include Scheuermann disease, osteoporosis, and trauma-related spinal changes. Based on the available evidence, the Duke's thoracic hyperkyphosis could have been caused by repetitive trauma to the spine due to numerous hours on horseback with heavy armor. The role that osteoporosis played in the development of the hyperkyphosis is unclear, as is whether the Duke had the convexity during childhood. The hyperkyphosis as a stylistic variant by Piero della Francesca is unlikely. This report is an example of a teaching strategy that can be used to enhance the observational skills of medical students in evidence-based medical education.</p

Student feedback on the use of paintings in Sparshanam, the Medical Humanities module at KIST Medical College, Nepal

<p>Abstract</p> <p>Background</p> <p>Paintings have been used in Medical Humanities modules in Nepal at Manipal College of Medical Sciences and KIST Medical College. Detailed participant feedback about the paintings used, the activities carried out, problems with using paintings and the role of paintings in future modules has not been previously done. Hence the present study was carried out.</p> <p>Methods</p> <p>The present module for first year medical students was conducted from February to August 2010 at KIST Medical College, Nepal. Paintings used were by Western artists and obtained from the Literature, Arts and Medicine database. The activities undertaken by the students include answering the questions 'What do you see' and 'What do you feel' about the painting, creating a story of 100 words about the scene depicted, and interpreting the painting using role plays and poems/songs. Feedback was not obtained about the last two activities. In August 2010 we obtained detailed feedback about the paintings used.</p> <p>Results</p> <p>Seventy-eight of the 100 students (78%) participated. Thirty-four students (43.6%) were male. The most common overall comments about the use of paintings were "they helped me feel what I saw" (12 respondents), "enjoyed the sessions" (12 respondents), "some paintings were hard to interpret" (10 respondents) and "were in tune with module objectives" (10 respondents). Forty-eight (61.5%) felt the use of western paintings was appropriate. Suggestions to make annotations about paintings more useful were to make them shorter and more precise, simplify the language and properly introduce the artist. Forty-one students (52.6%) had difficulty with the exercise 'what do you feel'. Seventy-four students (94.9%) wanted paintings from Nepal to be included.</p> <p>Conclusions</p> <p>Participant response was positive and they were satisfied with use of paintings in the module. Use of more paintings from Nepal and South Asia can be considered. Further studies may be required to understand whether use of paintings succeeded in fulfilling module objectives.</p

Using Stories to Disseminate Research: The Attributes of Representative Stories

When researchers communicate their findings to patients, clinicians, policy-makers, or media, they may find it helpful to supplement quantitative data with stories about individuals who represent themes in their research. Whether such stories are gathered during the research itself or identified from other sources, researchers must develop strategies for assessing their representativeness. This paper proposes 5 attributes of representative stories: (1) expression of important themes in the research, (2) explicit location in the “distribution” of stories that exemplify the theme, (3) verifiability, (4) acknowledgment of uncertainty, and (5) compelling narration. This paper summarizes research on substance abuse among physicians, and uses these 5 attributes to assess the representativeness of a published case report and a fictional short story about addicted physicians. While neither story is fully representative of the research, the process of evaluating these stories illustrates an approach to identifying representative stories for use in disseminating research