Medicine and Surgery "A" - Roma Azienda Policlinico Umberto I

Activity type

Fisiopatologia, metodologia clinica, propedeutica clinica e sistematica medico-chirurgica

SSD

M-PSI/08

Year

3rd year

Semester

1st semester

CFU

1

Hours distribution

12.5 classroom hours

Lecturers

CRISTINA MAZZA

Activity type

Clinica generale medica e chirurgica, Fisiopatologia, metodologia clinica, propedeutica clinica e sistematica medico-chirurgica

SSD

MED/09, MED/09

Year

3rd year

Semester

1st semester

CFU

4

Hours distribution

50 classroom hours

Lecturers

JESSICA PEPE

Activity type

Clinica generale medica e chirurgica, Fisiopatologia, metodologia clinica, propedeutica clinica e sistematica medico-chirurgica

SSD

MED/18, MED/18

Year

3rd year

Semester

1st semester

CFU

3

Hours distribution

37.5 classroom hours

Lecturers

MARIARITA TARALLO
NICOLA DI LORENZO

Activity type

Inglese scientifico e abilità linguistiche, informatiche e relazionali, pedagogia medica, tecnologie avanzate e a distanza di informazione e comunicazione

SSD

L-LIN/12

Year

3rd year

Semester

2nd semester

CFU

4

Hours distribution

50 classroom hours

Lecturers

CARLA BRUSCHELLI

Activity type

Clinica generale medica e chirurgica, Tirocini formativi e di orientamento

SSD

MED/09, MED/09

Year

3rd year

Semester

2nd semester

CFU

2

Hours distribution

12.5 classroom hours, 5 training hours, 20 others hours

Lecturers

MARIA GISELLA CAVALLO
GIORGIO GRANI
DANIELE PASTORI
LAURA D'ERASMO
FLAMINIA FERRI

Activity type

Clinica generale medica e chirurgica, Tirocini formativi e di orientamento

SSD

MED/18, MED/18

Year

3rd year

Semester

2nd semester

CFU

3

Hours distribution

25 classroom hours, 5 training hours, 20 others hours

Lecturers

ANNAMARIA PRONIO
QUIRINO LAI
GIOIA BRACHINI
GIANLUCA MENNINI
BRUNO CIRILLO
ALESSANDRO DARIO MAZZOTTA

Activity type

Fisiopatologia, metodologia clinica, propedeutica clinica e sistematica medico-chirurgica

SSD

MED/12

Year

3rd year

Semester

2nd semester

CFU

1

Hours distribution

12.5 classroom hours

Lecturers

SILVIA NARDELLI
ILARIA BARCHETTA

Activity type

Inglese scientifico e abilità linguistiche, informatiche e relazionali, pedagogia medica, tecnologie avanzate e a distanza di informazione e comunicazione, Attività formative affini o integrative

SSD

MED/01, MED/01

Year

3rd year

Semester

2nd semester

CFU

2

Hours distribution

25 classroom hours

Lecturers

ANNA RITA VESTRI

MMS CLINICA (I)
Provide the student with the means to carry out a careful and detailed medical history and an accurate clinical examination of the patient, with the detection and critical evaluation of symptoms and signs of diseases and of pathophysiological alterations. Knowledge of instrumental methods with their possibilities and limits.

MMS CLINICA (II)
• Be able to identify the patient's anamnestic, antropometric, instrumental and laboratory data and methodologies to detect them; to be good at to understand these data from a pathophysiological point of view and use them for diagnosis and prognosis. Collect and evaluate epidemiological and statistical data for health promotion and disease prevention.
• Be able to collect the patient's medical history and to compile the medical record as well as to perform clinical examination and know the basic diagnostic-therapeutic techniques. Learn the use of epidemiological data in order to formulate a correct diagnosis and prognosis. Use the statistical, probabilistic and informatic elements with a view to managing the uncertainty linked to the random nature of the medical process.
• Be aware that the data collection must be used not only in order to formulate a correct diagnosis but also to establish an adequate relationship between patient and medical doctor.

At the end of the course

1. Knowledge and Understanding
The student must demonstrate:
Knowledge of the structure of the medical history (personal, family, recent, and remote pathological, pharmacological, etc.) and its collection methods
Knowledge of the fundamental clinical findings (anamnestic, physical-anthropometric, instrumental, and laboratory) and the standardized methodologies for their collection (e.g., physical examination procedures, laboratory techniques)
Understanding of the pathophysiological and biochemical principles underlying alterations in clinical findings (e.g., the relationship between a given symptom, a laboratory abnormality, and the disease mechanism).
Knowledge of the structure of the medical record and the procedures for its compilation
Understanding the methodological principles, study designs, and key outcome measures of diagnostic studies (sensitivity, specificity, predictive values, ROC curves) and Randomized Clinical Trials (RCTs) (randomization, blinding, intention-to-treat analysis).
Knowledge: The fundamental concepts of Artificial Intelligence (AI) in medicine, particularly the principles of machine learning, distinguishing between supervised and unsupervised approaches, and understanding the role of big data in the clinical setting.
Identify and describe issues related to bias and validity (internal and external) specific to each type of study (diagnostic, RCT).

2. Ability to Apply Knowledge and Understanding
The student must be able to:
Accurately perform a complete general and local history and physical examination.
Consistently and systematically apply pathophysiological knowledge to interpret collected clinical and instrumental data, identifying disease patterns.
Use historical, physical, and instrumental findings to formulate a differential diagnosis and establish an initial prognosis.
Perform basic diagnostic and therapeutic techniques (e.g., measuring vital signs, preparing IV drips).
Apply and calculate diagnostic accuracy measures (sensitivity, specificity, LR+, LR-, etc.) to interpret diagnostic test results, including reading the confidence intervals of the measures.
Use the principles of Evidence-Based Medicine (EBM) to critically read and summarize the scientific literature related to RCTs, assessing the strength of the evidence and the generalizability of clinical results.
Critically evaluate the development and validation methodology of an Artificial Intelligence algorithm in a clinical setting (e.g., distinguishing between training, validation, and test sets) and its potential applicability in clinical practice.

3. Making Judgments
The student must be able to:
Critically select the most relevant clinical information for diagnosis and patient management, distinguishing significant data from secondary data.
Evaluate the appropriateness and reliability of data collection methodologies and the results obtained (e.g., recognize the limitations of an instrumental examination or an uncertain anamnestic finding).
Develop an ethical and professional judgment regarding the use of clinical data, recognizing their centrality not only for diagnosis but also for establishing an appropriate doctor-patient relationship based on trust and transparency.
Formulate a reasoned judgment on the reliability and methodological validity of an RCT or a published diagnostic study, identifying potential confounding factors and residual biases.
Select and justify the most appropriate study design (RCT, diagnostic, etc.) to answer a specific clinical question, considering available resources and ethical implications.
Develop critical thinking about the scientific validity, ethics, and clinical and social impact of integrating AI-based tools into medical decision-making.

4. Communication Skills
The student must demonstrate the ability to:
Communicate clearly, empathetically, and non-judgmentally with the patient to conduct the medical history, establish the care relationship, and collect sensitive data.
Document clinical findings, the diagnosis, and the treatment plan in a complete, concise, and structured manner by properly completing the medical record (written communication).
Present the clinical case effectively to colleagues, using appropriate and concise medical terminology.
Communicate the results of an RCT clearly and effectively, translating statistical measures (e.g., risk ratio, number needed to treat) into understandable clinical information.

5. Learning Skills
Students must possess the ability to:
Independently research and continuously update their knowledge of new diagnostic methodologies, new guidelines, and emerging pathophysiological interpretations.
Evaluate their clinical performance in data collection and interpretation, identifying areas for improvement in history-taking, physical examination, and basic techniques.
Use practical experience in collecting and analyzing clinical findings for self-learning and to refine diagnostic reasoning.
The ability to independently and continuously update their knowledge on new frontiers in research methodology (e.g., new RCT designs, validation methodologies for AI-based predictive models).
The skills necessary to undertake further studies or professional activity with a high degree of autonomy, applying methodological foundations to new clinical problems.
The ability to self-directly research, evaluate, and integrate new scientific and technological information (such as rapid developments in AI) to improve their clinical practice.

Scientific English Understand the lexical, grammatical, and syntactic elements underlying the language
of medical and scientific texts; be able to recognize and apply this knowledge to the critical reading of
various types of documents in medical literature, including historical and bioethical documents, with a
particular focus on "Evidence-Based Medicine"; apply reading techniques that lead to efficient, rapid
information decoding; understand the potential and risks of using AI and chatbots; learn bibliographic
research methods that allow students to formulate relevant questions about studies and search for
answers using Medline and the Internet; be aware of the essential role of literature in the cultural and
professional development of physicians; master the tools and skills needed to write scientific articles and
guidelines with critical thinking skills.

An essential tool for making the most of the course is knowledge of anatomy, physiology, and pathophysiology, tools that enable clinical reasoning.

Module: Clinical Scientific Methods I - CLINICAL PSYCHOLOGY
The Clinical Interview
• The Therapeutic Alliance
• The Sense of Security
• The Patient's (Pathogenic) Beliefs and Implicit Expectations



Module: Clinical Scientific Methods I - INTERNAL MEDICINE
Family history (hereditary diseases), physiological (risk factors), social (work activity and disease risk, remote and proximal pathology (identification of guiding symptoms).
General physical examination: vital signs, general appearance, eyes, neck, oral cavity and rhino-pharynx.
Breast examination (introduction to the integration with instrumental examinations: ultrasound and mammography).
Physical semiotics of the respiratory system; pneumonia guide symptoms with particular reference to acute and chronic dyspnea and cough; functional and instrumental exploration of the respiratory system (introduction to laboratory and instrumental diagnostics of the respiratory system).
Semeiotics of the mediastinum. Clinical and instrumental cardiac semeiotics. Introduction to the role of the ECG and the echocardiogram as integrative tools of the objective examination.
Abdomen: signs and symptoms and main syndromes; functional and instrumental investigations of the digestive system. Functional semeiotics of the liver, gallbladder, biliary tract and pancreas; functional and instrumental semeiotics of the spleen.
Urinary system: signs and symptoms, with particular reference to hematuria and dysuria. Urine examination, functional exploration of the kidney (introduction to the integration of the objective examination with ultrasound).
Clinical psychology: interview with the patient, technical purposes and methods of execution, compliance, how to inform the patient, patient attitudes and motivations, placebo and placebo effect, Evidence Based Medicine, meta-analysis, evaluation of the effectiveness of therapeutic interventions.










Module: Clinical Scientific Methods I - GENERAL SURGERY

Medical Record
• Informed Consent
• Vital Signs
• Fever
• Peripheral Pulses
• Physical Examination of Swellings
• Physical Examination of Swellings 2
• Hypovolemic Shock
• Clinical and Instrumental Examination of the Esophagus. Dysphagia
• Physical Examination of the Abdomen
• Clinical and Instrumental Examination of the Digestive System 1
• Clinical and Instrumental Examination of the Digestive System 2
• Digestive Hemorrhages
• Clinical and Instrumental Examination of the Anorectum
• Physical Examination of the Neck. Thyroid
• Hematuria
Medical history: family, physiological, social, past and present pathological history.
• General physical examination: Multidimensional Assessment. Young patient: FIT, Elderly patient: "FIT and FRAIL"; ASA score
• Abdomen: signs and symptoms; functional and instrumental investigations of the digestive system.
• Functional semiology of the liver, gallbladder, bile ducts, pancreas; spleen
• Gallstones
• Primary and secondary malignant tumors of the liver;
• Primary and secondary malignant tumors of the pancreas. Clinical, semiological and instrumental investigations
• Breast physical examination. Clinical and radiological instrumental investigations




Module: Clinical Scientific Methods II - Medical Statistics
N/D
Module: Clinical Scientific Methods II - INTERNAL MEDICINE
N/D
Module: Clinical Scientific Methods II - GENERAL SURGERY
Role and method of collecting a problem-based medical history: proximate pathology, remote pathology, family history, personal history, physiological and pharmacological history
Use and meaning of the main medical terms in collecting anamnestic data and compiling a medical record
Evaluation of the normal subject: history taking and physical examination
General physical examination - chest EO - cardiovascular system - abdomen - lymph node system
Pathophysiology of pain: its description
Anamysical history in the prevention of cardiovascular risk
General physical examination: role in the clinical assessment
Anamysical history and description of
- Dyspnea
- Chest pain
- Abdominal pain
- Biliary colic
- Intestinal obstruction
- Constipation and diarrhea
- Swelling
- Jaundice
- Digestive hemorrhages of medical and surgical interest
Classification in the main clinical pictures
Classification of chest pain
Classification of dyspnea
Classification of Abdominal pain
Proctological pathology classification
Surgical patient classification
Diabetic patient classification
Liverpool patient classification
Nephropathy patient classification

Rudiments of the main instrumental diagnostics used in medicine and surgery
ECG
Radiology: Chest and abdominal X-ray - Chest and abdominal CT/MRI
Abdominal ultrasound
Digestive endoscopy



Module: Clinical Scientific Methods II - GASTROENTEROLOGY
N/D
Module: Clinical Scientific Methods II - MEDICAL ENGLISH
PROGRAMME
Diagnostic Study Design.Structure of a diagnostic accuracy study. The gold standard and the
problem of verification bias.
Accuracy Measures: Sensitivity and Specificity, Positive Predictive Values (PPV) and Negative
Predictive Values (NPV).Likelihood Ratios (LRs): Positive LR (LR+) and Negative LR (LR-).
Confidence intervals for accuracy measures. ROC Curves (Receiver Operating Characteristic).
Application: Integrating diagnostic results into clinical practice.
Practical Exercise: Critical appraisal of a diagnostic study article. Identifying the strengths and
limitations in a real-world study.
RCT Design and Structure. The role of RCTs in the hierarchy of evidence.
Randomization (types, methods). Blinding (single, double, triple) and the problem of attrition bias.
Selection and classification of endpoints (primary, secondary, composite).
RCT Data Analysis. Intention-to-Treat (ITT) analysis vs. Per-Protocol analysis.
Efficacy measures: Absolute Risk Reduction (ARR), Relative Risk Reduction (RRR), and Number
Needed to Treat (NNT), and their confidence intervals.
Practical Exercise: Critical appraisal of an RCT article. Evaluating its transferability to clinical
practice (external validity).
Systematic Reviews and Meta-Analysis.
Ethical implications: informed consent and the role of the ethics committee.
Introduction to AI in Medicine. Definitions: AI, Machine Learning (ML), Deep Learning.
The role of Big Data and the necessity of high-quality data. Algorithm Development and Training
Study designs for AI: training, validation, and test data sets.
Specific performance measures for AI (e.g., Area Under the Curve - AUC).
AI in Decision-Making and Ethics in Healthcare.

Module: Clinical Scientific Methods I - CLINICAL PSYCHOLOGY
Gazzillo, F. (a cura di). (2023). La Control-Mastery Theory nella pratica clinica. Roma: Carocci Editore.


Module: Clinical Scientific Methods I - INTERNAL MEDICINE
Bates - Esame obiettivo e Anamnesi - Piccin


Module: Clinical Scientific Methods I - GENERAL SURGERY

N/D
Module: Clinical Scientific Methods II - Medical Statistics
N/D
Module: Clinical Scientific Methods II - INTERNAL MEDICINE
N/D
Module: Clinical Scientific Methods II - GENERAL SURGERY
Semeiotica Pratica - Sussidio multimediale per l' apprendimento e la verifica delle principali manovre semeiologiche - con CD Rom allegato. Autori: Amoroso - Riggio - Afeltra - Costantino - Picardi – Vettore. Editore: Delfino. Edizione:II 2013
R. Bellantone, G. De Toma, M. Montorsi Metodologia Chirurgica. Semeiotica e Sistematica. Minerva Medica Ed.
Bates. Esame obiettivo e anamnesi di Lynn S. Bickley e N. Montano, Piccin Ed. 2018
Macleod Manuale di semeiotica e metodologia clinica. Edra Masson Ed.
Minni, Chirurgia Generale, Casa editrice ambrosiano



Module: Clinical Scientific Methods II - GASTROENTEROLOGY
N/D
Module: Clinical Scientific Methods II - MEDICAL ENGLISH
N/D

Module: Clinical Scientific Methods I - CLINICAL PSYCHOLOGY
N/D
Module: Clinical Scientific Methods I - INTERNAL MEDICINE
N/D
Module: Clinical Scientific Methods I - GENERAL SURGERY

N/D
Module: Clinical Scientific Methods II - Medical Statistics
N/D
Module: Clinical Scientific Methods II - INTERNAL MEDICINE
Oxford Medical Education videos:
- https://www.youtube.com/channel/UCh4bLGk7imxI7fWyk01c8fA
- https://www.youtube.com/watch?v=_rHRPjsCu8U&ab_channel=OxfordMedicalEducation

Stanford School of Medicine resources
- https://www.youtube.com/c/StanfordMedicine25/featured



Module: Clinical Scientific Methods II - GENERAL SURGERY
N/D
Module: Clinical Scientific Methods II - GASTROENTEROLOGY
N/D
Module: Clinical Scientific Methods II - MEDICAL ENGLISH
N/D

The course is divided into two types of activities:
● LECTURES (ADF) and ELECTIVE EDUCATIONAL ACTIVITIES (ADE) for Methodology I and II (first and second semesters)
● PRACTICAL ACTIVITIES (APP) for Methodology II (second semester)

Lectures will be held for Methodology I in the first semester and for Methodology II in the second semester, for all students in the course, in the classroom every Tuesday.

Lectures will be taught by all instructors and will cover the following topics:

Medical Scientific Clinical Methodology I - General Surgery, Internal Medicine Modules
General physical examination: vital signs, general appearance, eyes, neck, oral cavity, and nasopharynx.
• Physical examination of the respiratory system
• Acute and chronic dyspnea
• Cough
• Functional and instrumental examination of the respiratory system (introduction to laboratory and instrumental diagnostics of the respiratory system).
• Mediastinal examination
• Clinical and instrumental examination of the cardiac system
• Introduction to the role of the ECG and echocardiogram as complementary tools to the physical examination
• Urinary system: signs and symptoms
• Hematuria, dysuria
• Urine analysis, functional examination of the kidney (introduction to the integration of the physical examination with ultrasound)
Medical Record
• Informed Consent
• Vital Signs
• Fever
• Peripheral Pulses
• Physical Examination of Swellings.
• Physical Examination of Swellings. 2
• Hypovolemic Shock
• Clinical and Instrumental Semiotics of the Esophagus. Dysphagia
• Physical Examination of the Abdomen
• Clinical and Instrumental Semiotics of the Digestive System. 1
• Clinical and Instrumental Semiotics of the Digestive System. 2
• Digestive Hemorrhages
• Clinical and Instrumental Semiotics of the Anorectum
• Physical Examination of the Neck. Thyroid


General Surgery II, Internal Medicine II, Gastroenterology Modules

Pain
Anamnesis in the Prevention of Cardiovascular Risk
Chest Pain Assessment
Dyspnea Assessment
Abdominal Pain Assessment
Constipation and Diarrhea
Precancerous Lesions of the Colorectal Region
Proctological Pathology Assessment
Surgical Patient Assessment
Diabetic Patient Assessment
History Assessment of Patients with Nephropathy
Liverpotence Assessment
Jaundice Assessment
Nephropathic Patient Assessment
Digestive Bleeding

Medical Statistics Module
Clinical Epidemiology:
Diagnostic Studies: Measures of Diagnostic Accuracy, Sensitivity, Specificity, Predictive Values, Likelihood Ratios, and Odds.
EBM SnNout and SpPin Rules
Clinical Epidemiology Methodology
Diagnostic Studies: The ROC Curve
RCTs: Randomization, Endpoints, Study Size. Data Analysis (Intention to Treat, Per Protocol)
Clinical Trials: Critical Reading of Scientific Articles
Systematic Review and Meta-Analysis Overview
Introduction to Artificial Intelligence
What is Artificial Intelligence? The Functions and Uses of Artificial Intelligence for Health
Journal Club: Exam Preparation

Professionalizing Practical Activities (APP) - MMSC II Modules: General Surgery, Internal Medicine, Gastroenterology

They will be conducted in small groups (maximum 8-10 students per instructor) over 2-3 weekly meetings throughout the second semester. They will be held in outpatient clinics, inpatient wards, and skill labs. The aim is to deepen and apply what was learned in the first semester and use this data to develop clinical reasoning and diagnostic hypotheses.

In-depth analysis of the value of the medical history and the role of epidemiology and statistics in formulating diagnostic hypotheses.
Evaluation of the normal subject: history taking and physical examination.
Use of collected data to establish the most likely diagnosis.
Performance of a physical examination (PPE), including:
Patient's general PPE, description of the findings in the medical record
Cardiovascular PPE and its general interpretation
Respiratory PPE and its general interpretation
Abdominal PPE and its general interpretation
Palpation of the lymph nodes
Learning basic diagnostic and therapeutic techniques: blood pressure measurement, preparation of intravenous drips,
Knowledge of the main instrumental diagnostic methods used in surgery and internal medicine.
Proper management of the doctor-patient relationship
Blood pressure measurement
Preparation of intravenous drips
Proper execution of the PPE will be certified in the patient's record

Mandatory attendance at lectures and PPE

Methodology I
Written exam: 30 multiple-choice quizzes. Time limit: 60 minutes. Marked out of 30.
Methodology II
Oral exam: Questions on the course syllabus aimed at assessing knowledge of semiotics, main clinical syndromes, and the main diagnostic methods, as well as the ability to use them to develop a methodological approach leading to a diagnostic hypothesis. Marked out of 30.
Written exam:
Quiz with single-choice answers. Duration: 40 minutes.
Analysis of abstracts of scientific papers: questions related to study design, outcome measures, and their clinical interpretation. Marked out of 30.

The final grade will be the weighted average of the three exams.

Scientific english
Plenary presentation in English of a PowerPoint presentation by small groups, to be
developed based on the topics covered in the course, in an original manner and entirely of the group's
choosing. For example, comparing two similar articles or two guidelines, or interpreting a guideline of your
choice, or inventing and describing a scientific study according to a clinical trial protocol, or inventing a
short article following the compilation guidelines, etc.
Google Classroom will be used to share all teaching materials, related
literature, and exam schedules.

Methodological Approach to Chest Pain
Abdominal Physical Examination
Anamysical History in Abdominal Pain
General Physical Examination and Main Pathological Changes
Microuton Disorders
Evaluation of Vital Signs
Pain in the Right Upper Abdomen: Methodological Approach
How to Take the History in Rectal Bleeding
Cardiac Rhythm Changes
Choice of Instrumental Tests Based on the Diagnostic Question


Azithromycin in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatory actions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.
Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospital with COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients were randomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once per day by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatment groups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment and were twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants and local study staff were not masked to the allocated treatment, but all others involved in the trial were masked to the outcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treat population.

1. Is the study multicenter? Yes No
2. Is there a comparator treatment? Yes No
3. Is the study blinded? Yes No
4. Is the primary endpoint all-cause mortality at 28 days? Yes No


What is meant by the gold standard?
a) the cheapest and least invasive diagnostic test
b) an index that evaluates the concordance between diagnostic tests

Module: Clinical Scientific Methods I - CLINICAL PSYCHOLOGY
N/D
Module: Clinical Scientific Methods I - INTERNAL MEDICINE
N/D
Module: Clinical Scientific Methods I - GENERAL SURGERY

N/D
Module: Clinical Scientific Methods II - Medical Statistics
N/D
Module: Clinical Scientific Methods II - INTERNAL MEDICINE
N/D
Module: Clinical Scientific Methods II - GENERAL SURGERY

• pain
  • Books: teacher's teaching materials


• abdominal pain
  • Books: teacher's teaching materials


• the surgical patient
  • Books: teacher's teaching materials


• evaluation anorectal disease
  • Books: teacher's teaching materials


• precancerous colorectal disease
  • Books: teacher's teaching materials


• Anamnesis inthe kidney disease
  • Books: teacher's teaching materials


• obstuctive jaudice
  • Books: teacher's teaching materials


• • Books: teacher's teaching materials


• • Books: teacher's teaching materials


• • Books: teacher's teaching materials


• • Books: teacher's teaching materials