3 research outputs found
Aberrant crypt foci in colorectal carcinogenesis. Cell and crypt dynamics
Aberrant crypt foci (ACF) have been identified on the colonic mucosal surface of rodents treated with colon carcinogens and of humans after methylene-blue staining and observation under a light microscope. Several lines of evidence strongly suggest that ACF with certain morphological, histological, cell kinetics, and genetic features are precursor lesions of colon cancer both in rodents and in humans. Thus, ACF represent the earliest step in colorectal carcinogenesis. This paper has the main purpose of reviewing the evidence supporting this view, with particular emphasis on cell and crypt dynamics in ACF. ACF have been used as intermediate biomarkers of cancer development in animal studies aimed at the identification of colon carcinogens and chemopreventive agents. Recently, evidence has also shown that ACF can be effectively employed in chemopreventive studies also in humans
Measuring empathy in pediatrics: validation of the Visual CARE measure
Background: Empathy is a key element of “Patient and Family Centered Care”, a clinical approach recommended
by the American Academy of Pediatrics. However, there is a lack of validated tools to evaluate paediatrician
empathy. This study aimed to validate the Visual CARE Measure, a patient rated questionnaire measuring physician
empathy, in the setting of a Pediatric Emergency Department (ED).
Methods: The empathy of physicians working in the Pediatric ED of the University Hospital of Udine, Italy, was
assessed using an Italian translation of the Visual Care Measure. This test has three versions suited to different age
groups: the 5Q questionnaire was administered to children aged 7–11, the 10Q version to those older than 11, and
the 10Q–Parent questionnaire to parents of children younger than 7.
The internal reliability, homogeneity and construct validity of the 5Q and 10Q/10Q–Parent versions of the Visual
Care Measure, were separately assessed. The influence of family background on the rating of physician empathy
and satisfaction with the clinical encounter was also evaluated.
Results: Seven physicians and 416 children and their parents were included in the study. Internal consistency
measured by Cronbach’s alpha was 0.95 for the 10Q/10Q–Parent versions and 0.88 for the 5Q version. The
item-total correlation was > 0.75 for each item. An exploratory factor analysis showed that all the items load
onto the first factor.
Physicians’ empathy scores correlated with patients’ satisfaction for both the 10Q and 10Q–Parent questionnaires
(Spearman’s rho = 0.7189; p < 0.001) and for the 5Q questionnaire (Spearman’s rho = 0.5968; p < 0,001). Trust in the
consulting physician was lower among immigrant parents (OR 0.43. 95% CI 0.20–0.93).
Conclusions: The Visual Care Measure is a reliable second-person test of physician empathy in the setting of a
Pediatric Emergency Room. More studies are needed to evaluate the reliability of this instrument in other pediatric
settings distinct from the Emergency Room and to further evaluate its utility in measuring the impact of
communication and empathy training programmes for healthcare professionals working in pediatrics