The utility of a gross dissection anatomical model for simulation-based learning in pathology.

INTRODUCTION: The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. METHODS: Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). RESULTS: The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1-5) (range 3.4-4.7, σ0.89). The categories 'knowledge of resection margins' and 'macroscopic diagnosis' received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by 'understanding of handling and gross examination of the surgical specimen' (4.5, σ0.49), 'prognosis' (4.3, σ0.67) and 'understanding of a tumor resection' (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15'39″ (σ2'12″), 16'50″ (σ3'45″), and 17'52″ (σ2'12″), respectively (p<0.05). Gross dissection marks (0-5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). CONCLUSIONS: This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.

The utility of a gross dissection anatomical model for simulation-based learning in pathology

Introduction: The examination of morphological alterations in tissues is fundamental in Pathology. Traditional training in gross dissection has several limitations, including the risk of transmissible diseases, formaldehyde exposure and limited specimen availability. We describe a teaching method using anatomical simulators. Methods: Liquid silicone-based artisan neoplastic anatomical models were used in conjunction with clinical scenarios. Eighty-five medical students participated in a gross dissection experience and were asked to complete a feedback questionnaire. Additionally, a workshop was organized for students to compare three different teaching methods. The first one used still images (Group1-G1), the second a video explanation (Group2-G2), and the third directly observed a pathologist while grossing (Group3-G3). Results: The knowledge acquisition questionnaire showed an average value of 4.4 out of 5 (1–5) (range 3.4–4.7, σ0.89). The categories ‘knowledge of resection margins’ and ‘macroscopic diagnosis’ received the highest values (4.8, σ0.11 and 4.7, σ0.32, respectively), followed by ‘understanding of handling and gross examination of the surgical specimen’ (4.5, σ0.49), ‘prognosis’ (4.3, σ0.67) and ‘understanding of a tumor resection’ (3.9, σ0.96) (p<0.05). Regarding teaching methods, G3 spent less time than G2 and G1 with mean times of 15′39″ (σ2′12″), 16′50″ (σ3′45″), and 17′52″ (σ2′12″), respectively (p<0.05). Gross dissection marks (0–5) showed statistically significant differences (p<0.05). G2 obtained better results (3.7;σ0.54) than G3 (3.4;σ0.94) or G1 (3.1;σ0.8). Conclusions: This preliminary study demonstrates that it is possible to implement a gross dissection simulation module at medical school and thus enable the acquisition of skills in a secure environment.(AU)

Introducción: En Anatomía Patológica el examen macroscópico y la disección resultan fundamentales para alcanzar un diagnóstico correcto. Los métodos tradicionales de enseñanza de esta habilidad presentan limitaciones, como el riesgo de enfermedad transmisible, la exposición al formol y la disponibilidad de especímenes. Describimos aquí un método de enseñanza en disección utilizando simuladores anatómicos. Material y métodos: Se usaron modelos anatómicos neoplásicos artesanales que utilizan silicona líquida. Ochenta y cinco estudiantes de medicina participaron en una experiencia de examen macroscópico y disección y cumplimentaron un cuestionario sobre su percepción de aprendizaje adquirido. Además, se organizó un taller para comparar 3 metodologías distintas: imágenes estáticas (Grupo 1), vídeo (Grupo 2) y observación directa de un patólogo tallando (Grupo 3). Resultados: El cuestionario de conocimientos adquiridos mostró una valoración media de 4,4 sobre 5 (1-5) (rango 3,4-4,7, σ=0,89). Las categorías de «conocimiento sobre márgenes quirúrgicos» y «diagnóstico macroscópico» obtuvieron las mejores valoraciones (4,8, σ=0,11 y 4,7, σ=0,32, respectivamente), seguidas del «manejo de una pieza quirúrgica y su disección» (4,5, σ=0,49), el «pronóstico» (4,3, σ=0,67) y la «comprensión de una cirugía tumoral» (3,9, σ=0,96) (p<0,05). En relación con el método de enseñanza, el Grupo 3 realizó la disección en menos tiempo que el Grupo 2 y el Grupo 1, con unos tiempos medios de 15′39″ (σ=2′12″), 16′50″ (σ=3′45″), y 17′52″ (σ=2′12″), respectivamente (p<0,05). Por otra parte, se encontraron resultados estadísticamente significativos en función de la metodología utilizada (0-5) (p<0,05). El Grupo 2 obtuvo mejores resultados (3,7; σ=0,54) comparado con el Grupo 3 (3,4; σ=0,94) y el Grupo 1 (3,1; σ=0,8). Conclusiones: Este estudio preliminar demuestra que es posible implementar un módulo de simulación en disección en el Grado en Medicina, permitiendo esta metodología adquirir la habilidad en un entorno seguro.(AU)

Circulating tumor necrosis factor-α levels in non-alcoholic fatty liver disease: A systematic review and a meta-analysis.

BACKGROUND AND AIM: To synthesize data on circulating tumor necrosis factor (TNF)-α levels between patients with histologically confirmed non-alcoholic fatty liver disease (NAFLD) (simple steatosis or non-alcoholic fatty liver [NAFL] and/or non-alcoholic steatohepatitis [NASH]) and controls. METHODS: We performed a systematic search in PubMed, Scopus, and Cochrane Library. Fifty-six studies, published between 2003 and 2019, were finally included, reporting data from 5848 individuals (1634 controls and 4214 NAFLD patients). RESULTS: Higher circulating TNF-α levels were observed in NAFLD patients than controls (standardized mean difference [SMD] 0.84; 95% confidence interval [95% CI] 0.59-1.09), NAFL patients than controls (SMD 0.56; 95% CI 0.27-0.85), NASH patients than controls (SMD 0.93; 95% CI 0.64-1.22), and NASH than NAFL patients (SMD 0.31; 95% CI 0.16-0.46). There were only minimal changes in the comparisons between groups after excluding studies with morbidly obese populations (n = 11), or pediatric/adolescent populations (n = 6), or other than enzyme-linked immunosorbent assay method of TNF-α measurement (n = 8). There was high heterogeneity among studies in all comparisons, which was not essentially affected after sensitivity analyses. The meta-regression analysis revealed that the male ratio was positively associated with TNF-α SMD in the comparison between patients with NASH and NAFL (beta = 0.809; 95% CI 0.052-1.566) and accounted for 36% (P = 0.037) of the heterogeneity in this pair of comparison. TNF-α SMD was not associated with age, body mass index, and alanine aminotransferase in any pair of comparisons. CONCLUSIONS: Circulating TNF-α levels were higher in patients with NAFLD compared with controls. Higher levels of circulating TNF-α were also associated with the severity of NAFLD.