RESUMO
Sporadic Burkitt's lymphoma can have a variety of clinical manifestations, including a constellation of gastrointestinal symptoms that can masquerade as other conditions and lead to a delay in diagnosis. Here we review a case of Burkitt's lymphoma in a patient with a history of Crohn's disease, initially thought to be a Crohn's flare on initial presentation. This case highlights the importance of keeping a broad differential and ruling out Crohn's mimics in the process of treating a presumed exacerbation of inflammatory bowel disease.
RESUMO
OBJECTIVE: The Morbidity and Mortality (M&M) conference is both a quality improvement and an educational conference. We sought to evaluate the educational and quality improvement value of different learners who attend the surgical M&M conference. Furthermore, we sought to evaluate if an educational intervention directed at medical students (MS) would improve their experience at this conference. DESIGN: Over a 2-month period, we used a third party, real-time audience polling software during 4 M&M conferences using questions concerning medical error, loop closure, learning value, applicability, and professionalism. After baseline data were obtained in Phase 1, MS attended a seminar on the subject of error as part of their orientation. Additionally, to facilitate their preparation, MS were supplied the cases to be presented at that week's conference, a few days before M&M. After this intervention, 3 additional M&M conferences were polled, as described above, as part of Phase 2. Differences between faculty (FAC) and MS experience were assessed by chi-square and ANOVA analyses as appropriate. Study was reviewed and received a waiver from the IRB. SETTING: Rhode Island Hospital, Providence, Rhode Island, a tertiary care academic teaching hospital of Brown University. PARTICIPANTS: Audience participants were informed of the voluntary nature of this survey and asked to self-identify as MS, PA/NPs, junior residents, senior residents, or FAC. In phase 1, there were an average of 289 ± 18.7 responses per session, while in phase 2 there were an average of 267 ± 9.29 responses per session. RESULTS: In Phase 1, when asked to characterize the error as practitioner, system, both practitioner and system or neither, FAC were more likely to assign error as practitioner error than MS (15/38 - 39.5% vs 6/41 - 14.6%, p = 0.021). This trend continued in Phase 2, FAC (19/33 - 57.6%) vs MS (8/29 - 27.6%), p = 0.011. In terms of whether learners felt the conference was useful to their education (5 point scale - strongly agree to strongly disagree) the FAC felt conference more useful than MS (4.0 vs 3.63 p = 0.005). This trend continued even after intervention (4.24 vs 3.71 p < 0.001). The FAC and MS had the same opinion as to the closure of the case being "education at conference," change in policy/procedure, both, neither, no response - average: 75, 3, 9, 6, 7%. Both the FAC and the MS felt the environment was professional (Phase 1: 4.42 v 4.18, p = 0.321)(Phase 2: 4.43 v 4.37, p = 0.1002). CONCLUSION: Despite an educational intervention, we found FAC and MS maintained very divergent opinions as to what is practitioner error, and system error, and FAC found the M&M discussion more educational than MS. To maximize learning for MS during surgical M&M more interventions are needed.