] on the use of PDAs at the point of care found that hardware constraints, such as memory capability limited their usefulness, however, they were used frequently for accessing medical references and drug information [The Constellation Project: experience and evaluation of personal digital assistants in the clinical environment, in:

IMPORTANCE Little information is available regarding the minimum number of lymph nodes needed to accurately stage patients when performing a mesenteric lymphadenectomy for small-bowel neuroendocrine tumors. OBJECTIVES To determine the prognostic role of lymph node positivity and the ideal number of lymph nodes for accurately staging patients with small-bowel neuroendocrine tumors. DESIGN, SETTING, AND PARTICIPANTS This case series from the US Neuroendocrine Tumor Study Group, a collaboration among 8 US-based, academic tertiary care referral centers, obtained demographic, perioperative, and pathologic data from the group's database, Social Security Death Index, and publicly available obituaries. All patients in these institutions with small-bowel neuroendocrine tumors who underwent curative-intent surgical resection of a primary tumor between January 1, 2000, and December 31, 2015, were included (n = 199). Patients with duodenal or ampullary tumors, other nonneuroendocrine concurrent malignant neoplasms, mortality of fewer than 30 days after the surgical procedure, and distant metastatic disease were excluded. Data analysis was conducted from September 1, 2017, to December 1, 2017. MAIN OUTCOMES AND MEASURES Primary study outcome was recurrence-free survival. Hypothesis was generated after data collection and data entry into the US Neuroendocrine Tumor Study Group database. RESULTS Of the 199 patients included, 112 (56.3%) were male and 87 (43.7%) female with a mean (SD) age of 60.3 (12.5) years and a mean (SD) body mass index of 29.5 (6.0). One hundred fifty-four patients (77.4%) had lymph node-positive disease. No difference in 3-year recurrence-free survival was found between patients with lymph node-positive and lymph node-negative disease. Patients with 4 positive lymph nodes had a worse 3-year recurrence-free survival compared with those with 1 to 3 or 0 positive lymph nodes (81.6% vs 91.4% vs 92.1%; P = .01). When examining patients with fewer than 8 resected lymph nodes, no difference in 3-year recurrence-free survival was observed among patients with 4 or more, 1 to 3, or 0 positive lymph nodes (100% vs 93.8% vs 91.7%; P = .87). Retrieval of 8 or more lymph nodes, however, accurately discriminated patients with 4 or more, 1 to 3, or 0 positive lymph nodes (3-year recurrence-free survival: 79.9% vs 89.6% vs 92.9%; P = .05). CONCLUSIONS AND RELEVANCE The findings from this study suggest that, for patients undergoing curative-intent resection of small-bowel neuroendocrine tumors, accurate lymph node staging requires a minimum of 8 lymph nodes for examination, and 4 or more positive lymph nodes are associated with decreased 3-year recurrence-free survival compared with 1 to 3 or 0 positive lymph nodes; a thorough regional lymphadenectomy may be critical for accurate staging and management of this disease.

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-A pilot of core medical training (CMT) was conducted in 2006-7 with 160 trainees and 130 supervisors in the 10 hospitals within the Mersey Deanery. Questionnaires and focus groups were used to gain feedback from trainees and supervisors in relation to the components of CMT (the curricula, workplace-based assessments, appraisal, and the e-portfolio). There was generally a positive attitude to the CMT package. In particular the opportunities to give and receive feedback were appreciated; the e-portfolio was identified as helpful for recording assessment outcomes and supporting educational development for the trainees. The workplace-based assessments were well received. Many of the benefits of the components of CMT depended on the skill of the supervisor. The time required for effective training supervision and workplace-based assessments was identified as an important issue. This pilot was invaluable in informing the widespread implementation of CMT in 2007. KEY WORDS: curricula, postgraduate assessment, postgraduate training IntroductionThis study aims to demonstrate the components of the core medical training (CMT) programme, and describe the pilot that was conducted to inform its widespread launch. The Federation of Royal Colleges of Physicians has produced two medical curricula for early postgraduate training. The general internal medicine (acute) (GIM(A)) and generic curricula have been approved by the Postgraduate Medical Education and Training Board (PMETB). The GIM(A) curriculum defines the knowledge, skills and attitudes that trainees successfully completing a CMT programme must acquire before proceeding into further training in any of the physicianly specialties. The generic curriculum defines the competencies that must be acquired by the end of specialist training to facilitate clinical practice on a sound moral, legal, ethical and professional framework.The Mersey Deanery School of Medicine (MDSM) and the Federation of the Royal Colleges of Physicians collaborated to conduct a pilot of CMT from August 2006 to August 2007. The new curricula and an electronic (e) portfolio were used by 160 trainees and 130 supervisors in this deanery. This paper describes the methods of using feedback from trainees and supervisors to evaluate the effectiveness of the CMT package (curricula, appraisal, assessment and the e-portfolio), and reports the results and conclusions that have informed the nationwide launch of the CMT programme. MethodsAll trainees attended a session introducing the CMT package soon after assuming their posts in the MDSM CMT rotation in August 2006. All supervisors were invited to attend one of several training days introducing the CMT package. Feedback from trainees and supervisors was gathered using separate focus groups, and on-line questionnaires. The data gathering was scheduled to coincide with the end of the trainees' four-month attachments (end of November, March and July), and is summarised in Fig 1. E-portfolio usage statistics were also analysed as part of the evaluation.Feedba...

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