Democratic evaluation of clinical clerkship in a medical school. A case study

We report a case study of democratic evaluation of a clinical clerkship for medical students. We used a mixed model combining interviews and questionnaires to students, teachers and nurses involved in 9 weekly clerkship rotations in 7 hospital wards. The main outcome variable in quantitative analysis was the score of perceived usefulness for professional development of 42 Observable Practice Activities (OPAs) that each student should perform during clerkship. Scores were higher when the OPA was performed more consistently, was performed in small groups, and when the teaching and the evaluation methods were perceived as valid. The overall satisfaction for the program of teacher was high and did not correlate with students’ perceptions. The burden for patients was perceived as slightly higher in nurses, and did not correlate with teachers’ perceptions. When returned to students, teachers and nurses, these data could contribute to improve the program. Contrariamente ai tipi di valutazione basati su standard normativi pre-determinati dalla istituzione stessa (valutazione burocratica) o da un corpo professionale esterno (autocratica), la valutazione democratica è un tentativo aperto, indipendente, non normativo (in quanto non vincolante per gli organizzatori né i partecipanti) di dare voce a tutti gli attori coinvolti nel programma valutato. Per questo è più probabile che fornisca una descrizione del programma più dal punto di vista dei partecipanti che da quello delle aspettative degli organizzatori, fornendo così ad entrambi i gruppi suggerimenti utili per svilupparlo e migliorarlo. Abbiamo utilizzato questo approccio per valutare l’impatto della introduzione in un tirocinio clinico del CdL in Medicina di una lista di attività cliniche che gli studenti dovevano effettuare, documentandole su un apposito libretto. Si è costituito un gruppo di valutazione indipendente autorizzato dal Comitato Didattico, costituito da un docente, una specializzanda, ed un gruppo di studenti. Abbiamo utilizzato una metodologia mista, basata su questionari, domande aperte e interviste. Quale principale variabile quantitativa abbiamo scelto la percezione dell’utilità di ognuna delle attività svolte per il proprio sviluppo professionale. Alcune attività non venivano svolte regolarmente. Sono risultate effettuate il 75%, con un massimo di 100% in due reparti ad un minimo del 44%. Limitando l’analisi a queste, la maggior parte delle attività è stata valutata positivamente. Fattori che sono risultati influenzare positivamente i punteggi delle singole attività sono la divisione in piccoli gruppi (6 o meno), la validità delle modalità di presentazione e di valutazione (se previsto), la consistenza di effettuazione fra le varie rotazioni. Questi dati, restituiti ai docenti e agli studenti, possono essere utili per migliorare il programma.

Democratic evaluation of clinical clerkship in a medical school. A case study

We report a case study of democratic evaluation of a clinical clerkship for medical students. We used a mixed model combining interviews and questionnaires to students, teachers and nurses involved in 9 weekly clerkship rotations in 7 hospital wards. The main outcome variable in quantitative analysis was the score of perceived usefulness for professional development of 42 Observable Practice Activities (OPAs) that each student should perform during clerkship. Scores were higher when the OPA was performed more consistently, was performed in small groups, and when the teaching and the evaluation methods were perceived as valid. The overall satisfaction for the program of teacher was high and did not correlate with students’ perceptions. The burden for patients was perceived as slightly higher in nurses, and did not correlate with teachers’ perceptions. When returned to students, teachers and nurses, these data could contribute to improve the program.

Immune Cells and Immunoglobulin Expression in the Mammary Gland Tumors of Dog

Inflammatory cells have a role in tumor progression and have prognostic and therapeutic potential. The immunohistochemical expression for Mast Cell Tryptase, Macrophage Marker, CD79a, IgA, IgM and IgG on 43 cases of canine mammary gland lesions was analyzed. In hyperplasia, a few B cells (BCs) and Tumor-Associated Macrophages (TAMs) were observed, while the number of Tumor-Associated Mast Cells (TAMCs) was the highest. In the peritumoral stroma of malignant lesions, low number of TAMCs and a high number of TAMAs and BCs were present. Immune cells of each type were always lower in the intratumoral than peritumoral stroma. Positivity to CD79a was also detected in the epithelial cells of simple and micropapillay carcinomas. Immunoglobulin reactivity was mainly located in the epithelial cells where an intense positivity to IgA and IgG and a weak positivity for IgM were detectable. On the basis of our preliminary results and literature data, we suggest that such cells and molecules could be directly involved in the biology of canine mammary gland tumors. In breast cancer, stromal inflammatory cells and cancer derived immunoglobulins have been correlated with the progression, malignancy and poor prognosis of the tumor. The results herein reported show that the dog’s mammary gland epithelium also expresses immunoglobulins, and they mostly show a direct relationship with the infiltration of macrophages. In addition, this study shows that the infiltration of mast cells, B-cells and macrophages varies depending on the degree of malignancy of neoplasia

The Role of CT Imaging in Characterization of Small Renal Masses

Small renal masses (SRM) are increasingly detected incidentally during imaging. They vary widely in histology and aggressiveness, and include benign renal tumors and renal cell carcinomas that can be either indolent or aggressive. Imaging plays a key role in the characterization of these small renal masses. While a confident diagnosis can be made in many cases, some renal masses are indeterminate at imaging and can present as diagnostic dilemmas for both the radiologists and the referring clinicians. This review focuses on CT characterization of small renal masses, perhaps helping us understand small renal masses. The following aspects were considered for the review: (a) assessing the presence of fat, (b) assessing the enhancement, (c) differentiating renal tumor subtype, and (d) identifying valuable CT signs

The Role of CT Imaging in Characterization of Small Renal Masses

Small renal masses (SRM) are increasingly detected incidentally during imaging. They vary widely in histology and aggressiveness, and include benign renal tumors and renal cell carcinomas that can be either indolent or aggressive. Imaging plays a key role in the characterization of these small renal masses. While a confident diagnosis can be made in many cases, some renal masses are indeterminate at imaging and can present as diagnostic dilemmas for both the radiologists and the referring clinicians. This review focuses on CT characterization of small renal masses, perhaps helping us understand small renal masses. The following aspects were considered for the review: (a) assessing the presence of fat, (b) assessing the enhancement, (c) differentiating renal tumor subtype, and (d) identifying valuable CT signs

Multidisciplinary management of elderly patients with rectal cancer : recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project

Background and aims Although rectal cancer is predominantly a disease of older patients, current guidelines do not incorporate optimal treatment recommendations for the elderly and address only partially the associated specific challenges encountered in this population. This results in a wide variation and disparity in delivering a standard of care to this subset of patients. As the burden of rectal cancer in the elderly population continues to increase, it is crucial to assess whether current recommendations on treatment strategies for the general population can be adopted for the older adults, with the same beneficial oncological and functional outcomes. This multidisciplinary experts' consensus aims to refine current rectal cancer-specific guidelines for the elderly population in order to help to maximize rectal cancer therapeutic strategies while minimizing adverse impacts on functional outcomes and quality of life for these patients. Methods The discussion among the steering group of clinical experts and methodologists from the societies' expert panel involved clinicians practicing in general surgery, colorectal surgery, surgical oncology, geriatric oncology, geriatrics, gastroenterologists, radiologists, oncologists, radiation oncologists, and endoscopists. Research topics and questions were formulated, revised, and unanimously approved by all experts in two subsequent modified Delphi rounds in December 2020-January 2021. The steering committee was divided into nine teams following the main research field of members. Each conducted their literature search and drafted statements and recommendations on their research question. Literature search has been updated up to 2020 and statements and recommendations have been developed according to the GRADE methodology. A modified Delphi methodology was implemented to reach agreement among the experts on all statements and recommendations. Conclusions The 2021 SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation of rectal cancer.Peer reviewe