“Family Medicine: Who, Why and How”. L’esperienza dell’attività didattica elettiva in medicina generale degli studenti del II anno dell’Humanitas University

Introduction There is ample evidence to support the importance of general medicine as a field of study in ensuring both individual and collective health, as well as the necessity of including general medicine teaching in degree programs in Medicine and Surgery. Additionally, Early Clinical Exposure (ECE) is an effective and widely recommended learning method. The feasibility, acceptability and applicability of an Elective Teaching Activity in general medicine for second year Medicine and Surgery students were verified.   Methods With the aim of increasing student awareness of the function of general medicine in the NHS and encouraging future conscious decision-making, the initiative called for four theoretical-practical sessions on the GP's skills followed by a two-week clerkship at their clinic. The project's development was tracked through closed-ended and open-ended surveys.   Results The conclusion that the experience has exceeded expectations and that the view of many things has improved comes out in the exit questionnaires nearly unanimously, and represents an indirect measure of learning. Additionally, results show that, even in the second year, it is possible to acquire comprehension of the clinical situation in the field, aiding in the application of previously retained theoretical information and inspiring students to pursue the profession.   Discussion The learning environment of the second year of the degree course in Medicine and Surgery has proven to be viable, appreciated, and relevant for this mixed classroom/clinical setting of learning.Introduzione Numerose evidenze sottolineano il ruolo chiave che la medicina generale, disciplina accademica, svolge nel garantire la salute individuale e collettiva, e la necessità di inserire il suo insegnamento nei curricula del corso di laurea in medicina e chirurgia. Inoltre, il coinvolgimento precoce degli studenti di medicina nella pratica clinica (ECE) è un metodo di apprendimento efficace e consigliato. Si è pertanto attuata una Attività Didattica Elettiva (ADE) in medicina generale, della quale si è voluta verificare la fattibilità, l'accettabilità e l’applicabilità nei contesti formativi agli studenti del secondo anno del corso di laurea.   Metodi Il progetto ha previsto quattro lezioni teorico-pratiche sulle competenze del MMG seguite da un tirocinio di due settimane presso il suo ambulatorio, con l’obiettivo di rendere gli studenti più consapevoli del ruolo della Medicina Generale nel SSN e favorire la futura scelta consapevole di tale percorso professionale. L’andamento del progetto è stato monitorato attraverso questionari a domande chiuse e aperte.   Risultati Nei questionari di uscita risalta la quasi unanime considerazione che l’esperienza ha superato le aspettative, e che la percezione di molti aspetti è migliorata, e ciò è un indicatore indiretto di un apprendimento. Inoltre, si nota come anche al secondo anno sia possibile avere una comprensione della situazione clinica sul campo, aiutando nel calare nella pratica le conoscenze teoriche apprese, e motivando gli studenti alla professione.   Discussione Questa modalità di apprendimento misto aula/setting clinico si è dimostrata fattibile, gradita, e applicabile nel contesto di apprendimento del secondo anno del corso di laurea in Medicina e Chirurgia

Sclerobanding Is a Novel Technique for the Treatment of Second- and Third-Degree Hemorrhoidal Disease. Reply to Jongen et al. Comment on “Pata et al. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J. Clin. Med. 2022, 11, 218”

We thank Johannes Jongen and colleagues for their correspondence [...

Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes

Background: Sclerobanding is a novel technique combining rubber band ligation with 3% polidocanol foam sclerotherapy for the treatment of hemorrhoidal disease (HD). The aim of this study is to evaluate the feasibility, safety and short-term outcomes of sclerobanding in the treatment of second- and third-degree HD. Methods: A retrospective analysis of second- and third-degree HD cases from November 2017 to August 2021 was performed. Patients on anticoagulants or with other HD degrees were excluded. Follow-up was conducted at 1 month, 3 months, 6 months, 1 year and then every 12 months. Results: 97 patients with second- (20 pts; 20.6%) and third-degree (77 pts; 79.4%) HD with a mean age of 52 years (20–84; SD ± 15.5) were included. Fifty-six patients were men (57.7%) and forty-one women (42.3%). Median follow-up was 13 months (1–26 months). No intraoperative adverse events or drug-related side effects occurred. Minor complications occurred in four patients (4.1%) in the first 30 postoperative days and all resolved after conservative treatment at the 3-month follow-up visit. No mortality or readmissions were observed. Conclusions: Sclerobanding is a safe technique with a low rate of minor postoperative complications. Further studies on larger samples are necessary to establish the effectiveness and long-term outcomes of the technique

E-consensus on telemedicine in proctology: A RAND/UCLA-modified study

Background: Coronavirus disease 2019 is revolutionizing healthcare delivery. The aim of this study was to reach a consensus among experts as to the possible applications of telemedicine in the proctologic field. Methods: A group of 55 clinical practice recommendations was developed by a clinical guidance group based on coalescence of evidence and expert opinion. The Telemedicine in Proctology Italian Working Group included 47 Italian Society of Colorectal Surgery nominated experts evaluating the appropriateness of each clinical practice recommendations based on published RAND/UCLA methodology in 2 rounds. Results: Stakeholder median age was 53 years (interquartile range limits 40-60), and 38 (81%) were men. Nine (19%) panelists reported no experience with telemedicine before the pandemic. Agreement was obtained on a minimum of 3 to 5 years of practice in the proctologic field before starting teleconsultations, which should be regularly paid, with advice and prescriptions incorporated into a formal report sent to the patient by e-mail along with a receipt. Of the panelists, 35 of 47 (74%) agreed that teleconsultation carries the risk of misdiagnosis of cancer, thus recommending an in-person assessment before scheduling any surgery. Fifteen additional clinical practice recommendations were re-elaborated in the second round and assessed by 44 of 47 (93.6%) panelists. The application of telemedicine for the diagnosis of common proctologic conditions (eg, hemorrhoidal disease, anal abscess and fistula, anal condylomas, and anal fissure) and functional pelvic floor disorders was generally considered inappropriate. Teleconsultation was instead deemed appropriate for the diagnosis and management of pilonidal disease. Conclusion: This e-consensus revealed the boundaries of telemedicine in Italy. Standardization of infrastructures, logistics, and legality remain to be better elucidated