Learning How to Order Imaging Tests and Make Subsequent Clinical Decisions: a Randomized Study of the Effectiveness of a Virtual Learning Environment for Medical Students.

RATIONALE AND OBJECTIVES: Two critical skills that medical students must acquire during undergraduate education are the ability to order imaging tests and make clinical decisions based on their results. We implemented an e-learning course in Moodle specifically designed to teach these skills to medical students. The aim of this study was to assess the effectiveness of our course. MATERIAL AND METHODS: We randomized 26 undergraduate medical students to an experimental group that had access to the virtual learning environment and a control group that did not. Three weeks after the course, we evaluated its effectiveness through a blinded objective structured clinical examination. To avoid any bias in favor of the experimental group, the assessment considered scores on two pre-specified subscales: one related to the contents of the course and the other to new clinical scenarios. RESULTS: Students that completed the e-course performed better overall than controls (mean score ± standard deviation 59.3 ± 6.2 vs 41.8 ± 10.2, p = 0.0020). This better performance was observed in both types of skills assessed (ordering imaging tests, and making diagnostic and therapeutic decisions based on test results). More importantly, this better performance of the experimental group was observed consistently both with items related to the course content (1.7 times higher, p = 0.0034) and new scenarios (1.3 times higher, p = 0.0098). CONCLUSIONS: Through an ad - hoc e-course, undergraduate medical students learned effectively how to order imaging tests and make optimal subsequent decisions. Moreover, they were able to apply these skills to new clinical scenarios.

Waxing and waning pattern of mTOR inhibitor-associated pneumonitis in renal cell carcinoma patients: A retrospective observational study.

OBJECTIVE: mTOR inhibitor-associated pneumonitis is common and often asymptomatic. We describe a waxing and waning pattern of pneumonitis observed on computed tomography (CT) scans of patients with renal cell carcinoma who were being treated with mTOR inhibitor molecular targeted therapy. MATERIALS AND METHODS: In this HIPAA-compliant, IRB-approved retrospective single-institution study, 25 renal cell carcinoma patients were identified who received single-therapy temsirolimus or everolimus between January 2011 and June 2015 and who had chest CT scans available for review both before and after initiation of mTOR inhibitor treatment. A detailed review of the electronic medical record and serial chest CT examinations was performed. RESULTS: Radiologic findings compatible with pneumonitis were identified in 13/25 (52%) patients on mTOR inhibitors in our study. Of the patients with CT findings of pneumonitis, 8/13 (62%) demonstrated a waxing and waning pattern; of whom 7 had clinical symptoms of pneumonitis. Of the 17 patients who received temsirolimus, 9/17 (53%) developed radiologic findings compatible with pneumonitis and 4/9 (44%) developed a waxing and waning pattern. Of the 8 patients who received everolimus, 4/8 (50%) had radiologic findings compatible with pneumonitis and 4/4 (100%) developed a waxing and waning pattern. CONCLUSION: Waxing and waning is an unrecognized pattern of mTOR inhibitor-associated pneumonitis. Recognition of this pattern will promote clinical-radiologic concordance and may facilitate patient management.

Scar Sarcoidosis 10 Years After Videothoracoscopy: Incidental Diagnosis at 18FDG-PET-CT / Sarcoidosis en una cicatriz 10 años después de una videotoracoscopia: diagnostico incidental con 18FDG-PET-CT

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Inyección ilegal de silicona en las mamas / Illegal injection of silicone in both breasts

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