Clinical Disciplines Research Articles

Implications of Immunogenicity Testing for Therapeutic Monoclonal Antibodies: A Quantitative Pharmacology Framework

The interpretation of immunogenicity results for a mAb product and prediction of its clinical consequences remain difficult, despite enormous advances in methodologies and efforts toward the best practice for consistent data generation and reporting. To this end, the contribution from the clinical pharmacology discipline has been largely limited to comparing descriptively the pharmacokinetic (PK) profiles by antidrug antibodies (ADA) status or testing the significance of ADA as a covariate in a population PK setting, similar to the practice for small-molecule drugs in investigating the effect of an intrinsic/extrinsic factor on the drug disposition. There is a need for a mAb disposition framework that captures the dynamics of ADA formation and drug’s interactions with the ADA and target as parts of the drug distribution and elimination. Here we describe such a framework and examine it against the PK, ADA, and clinical response data from a phase 3 trial in patients treated with adalimumab. The proposed framework offered a generalized understanding of how the dose, target affinity, and drug/ADA analyte forms affects the manifestation of ADA response with regard to its detections and alterations of drug disposition and effectiveness. Furthermore, as an example, its utility for dose considerations was demonstrated through predicting for late-stage trials of a PCSK9 inhibitor in terms of development in ADA incidence and titers, and consequences on the drug disposition, interaction with target, and downstream lowering effect on LDL-C.Graphical

Systematic analysis of ChatGPT, Google search and Llama 2 for clinical decision support tasks

It is likely that individuals are turning to Large Language Models (LLMs) to seek health advice, much like searching for diagnoses on Google. We evaluate clinical accuracy of GPT-3·5 and GPT-4 for suggesting initial diagnosis, examination steps and treatment of 110 medical cases across diverse clinical disciplines. Moreover, two model configurations of the Llama 2 open source LLMs are assessed in a sub-study. For benchmarking the diagnostic task, we conduct a naïve Google search for comparison. Overall, GPT-4 performed best with superior performances over GPT-3·5 considering diagnosis and examination and superior performance over Google for diagnosis. Except for treatment, better performance on frequent vs rare diseases is evident for all three approaches. The sub-study indicates slightly lower performances for Llama models. In conclusion, the commercial LLMs show growing potential for medical question answering in two successive major releases. However, some weaknesses underscore the need for robust and regulated AI models in health care. Open source LLMs can be a viable option to address specific needs regarding data privacy and transparency of training.

Distance education in the field of obstetrics, gynaecology, and ultrasound diagnostics in the conditions of quarantine restrictions and hostilities: A literature review

Forced distancing in the context of the COVID-19 pandemic has necessitated the transition of medical education to distance learning. The problem was exacerbated by the outbreak of full-scale hostilities, which necessitated further research in this area. The purpose of the study was to comprehensively review current scientific materials and consolidate existing knowledge on educational activities in obstetrics, gynaecology, and ultrasound diagnostics in the context of the coronavirus pandemic and full-scale hostilities. The following methods were used for the study: bibliographic, analysis, synthesis, induction, generalization, analogy, systematization, and categorization. The article presents a comprehensive analysis of the current literature on overcoming pedagogical challenges in the context of the COVID-19 pandemic and military operations through the achievements of distance education. The methodological foundations of distance education, the peculiarities of applying this practice in a pandemic and military operations, the similarities, and differences between them, especially in the context of obstetrics, gynaecology and ultrasound diagnostics, are considered. The connection between telemedicine and distance learning is presented both at the level of theory and practice. The practice of distance learning in obstetrics and gynaecology is compared with some other clinical disciplines. The result of the study was to solve the problem of the lack of a systematic view of the adaptation of the educational process to the conditions of a pandemic and military operations as emergency distance learning, rather than the classical practice of distance education, which contributes to the formation of an adequate assessment of pedagogical activities conducted in such conditions, in particular, in the field of obstetrics, gynaecology, and ultrasound diagnostics. The results of the study are of practical importance in the field of medical education, where they can be used to develop recommendations for the organization of training in obstetrics and gynaecology or other medical disciplines in conditions of forced distance learning

On becoming of nephrology in the USSR: The role of Moscow therapists M. I. Vihert and E. M. Tareev

The article considers stages of becoming of Soviet nephrology as independent scientific educational clinical discipline. The role of M. I. Vikhert in becoming of nephrology as independent clinical direction within the framework of the clinic of internal diseases is demonstrated. Also the role of E. M. Tareev as the founder of nephrology in the USSR as institutionalized clinical discipline is revealed.

Case Report on a Multidisciplinary Approach to Address Malnutrition and Improve a Patient’s Fitness for Treatment

Approximately 5,700 people are diagnosed with myeloma each year in the UK. The standard of care is to receive an autologous stem cell transplant after completion of induction therapy. There are no specific dietary recommendations for people with myeloma, however they are at risk of malnutrition due to symptoms and side effects of treatments. This report describes the journey of a 73-year-old male diagnosed with immunoglobulin A (IgA) lambda myeloma in April 2021. The patient lost 23% of his body weight during 6 months of systemic anti-cancer treatment (SACT), resulting in postponing his transplant twice due to reduced fitness. This report describes an effective, although late, multidisciplinary intervention which was successful for the patient who managed to reestablish a healthy weight and good quality of life. The patient received his transplant in January 2023. This case highlights two important aspects of patient care that should not be underestimated in dietetic clinical practice: early screening and multidisciplinary collaboration. Monitoring the nutritional status of patients and providing early nutrition support can prevent hospital admissions, treatment delays and reduce the associated costs. Multidisciplinary teamwork can improve patient care and clinical outcomes, and it is fundamental to strengthen communication and collaboration among clinical disciplines.

Difficulties in the differential diagnosis of focal lung lesions in a patient with rheumatoid arthritis who has received anti-B-cell therapy with rituximab. Description of a clinical case

We present a clinical case of a patient treated with rituximab and methotrexate for rheumatoid arthritis with progressive focal lung lesions that were difficult to interpret. The complexity of the problem of focal lung lesions in rheumatic diseases, which involves a broad spectrum of clinical medical disciplines, is emphasized.

The outcomes of team-based learning vs small group interactive learning in the obstetrics and gynecology course for undergraduate students.

Team-based learning (TBL) is a well-established active teaching method which has been shown to have pedagogical advantages in some areas such as business education and preclinical disciplines in undergraduate medical education. Increasingly, it has been adapted to clinical disciplines. However, its superiority over conventional learning methods used in clinical years of medical school remains unclear. The aim of this study was to compare TBL with traditional seminars delivered in small group interactive learning (SIL) format in terms of knowledge acquisition and retention, satisfaction and engagement of undergraduate medical students during the 6-week obstetrics and gynecology clerkship. The study was conducted at Karolinska Institutet, a medical university in Sweden, and had a prospective, crossover design. All fifth-year medical students attending the obstetrics and gynecology clerkship, at four different teaching hospitals in Stockholm (approximately 40 students per site), in the Autumn semester of 2022 were invited to participate. Two seminars (one in obstetrics and one in gynecology) were designed and delivered in two different formats, ie TBL and SIL. The student:teacher ratio was approximately 10:1 in the traditional SIL seminars and 20:1 in the TBL. All TBL seminars were facilitated by a single teacher who had been trained and certified in TBL. Student knowledge acquisition and retention were assessed by final examination scores, and the engagement and satisfaction were assessed by questionnaires. For the TBL seminars, individual and team readiness assurance tests were also performed and evaluated. Of 148 students participating in the classrooms, 132 answered the questionnaires. No statistically significant differences were observed between TBL and SIL methods with regard to student knowledge acquisition and retention, engagement and satisfaction. We found no differences in student learning outcomes or satisfaction using TBL or SIL methods. However, as TBL had a double the student to teacher ratio as compared with SIL, in settings where teachers are scarce and suitable rooms are available for TBL sessions, the method may be beneficial in reducing faculty workload without compromising students' learning outcomes.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ ЦИТОТОКСИЧНОСТИ СИЛЕРОВ ДЛЯ ПРОВЕДЕНИЯ ПЛОМБИРОВАНИЯ КОРНЕВЫХ КАНАЛОВ (IN VITRO)

Endodontics, being a part of the discipline "Dentistry", includes sections on the study of morphology, physiology and pathology of dental pulp and human periapical tissues, as well as the prevention and treatment of diseases and injuries associated with these tissues. Its scope of application includes the diagnosis and treatment of pain of pulpar and/or periapical origin, vital pulp therapy, regenerative endodontic procedures, non-surgical root canal treatment, surgical or non-surgical re-treatment of teeth with persisting infection and intracanal teeth whitening with discoloration. Ultimately, the main goal is to preserve the natural dentition.
 Like other dental specialties, endodontics combines two inseparable parts in its practical part: art and science. The art lies in performing technical procedures during root canal treatment. The scientific part includes fundamental and clinical disciplines, studying.
 Objectives. To study the cytotoxicity of epoxy resin-based silers in laboratory conditions on human cell lines and conduct their comparative analysis.
 Methodology. The article presents an analysis of the results of in vitro cytotoxicity of silers by assessing cell viability with direct injection of the studied materials into human cell culture.
 Conclusion. It has been experimentally proven that samples 1 (AH plus, Dentsply Sirona, Germany) and 3 (Epoxidin DUO, TecnoDent, Russia) do not have cytotoxic properties, unlike 2 samples (Sealart, Dentac, Turkey).

Integrating a Categorial Structure for Clinical Practice into EHRs.

A continuing global desire to be using clinical systems within a digital health ecosystem, able to facilitate data flows and information exchange as required to support person-centred, predictive, preventative, participatory and precision (5p) health and medical care can best be supported through the use of the standard categorial structure able to represent not only the clinical nursing practice domain but also other clinical disciplines by the generic labelling of some high-level categories. It is hypothesised that adoption of this generic clinical categorial structure within any electronic health/medical record within a well connected digital health ecosystem, supported by a cloud based openEHR platform, will enable the 5p support to be realized. This presentation provides the results of the latest update of this technical standard based on the 20+ year nursing practice categorial structure development process adopted to achieve this aim and a summary about linking this categorial structure to standard terminologies and to standard EHR/EMR system architectures.

Pedagogical methods of professionally-oriented training of medical faculty students in the field of medical biophysics

Relevance. The higher education system is primarily founded on pedagogical goal-oriented processes which are closely logically connected. These processes enable to teach specialists fundamentals-based and clinical knowledge, fully-applied theoretical and professional skills and train them to conduct research work and to independently enhance their knowledge. These are the first principles of training future specialists. Purpose. This article aims to examine the pedagogical methods of teaching medical technologies for specific purposes in the discipline �Medical Biophysics� at medical higher education institutions. Methodology. The analysis of the curriculum and textbooks on the disciplines �Internal Diseases�, �Surgical Diseases�, �Diseases of Children�, and �Obstetrics and Gynecology� studied by the students of the 3rd-5th years of medicine faculty was conducted during the work. Results. From the results of the research it follows that the majority of diagnostic methods observed in the clinical disciplines for senior students are based on physical phenomena and laws, and these findings should be taken into consideration in teaching physics for specific purposes. Conclusions. The research highlights the importance of teaching physics to medical students. By focusing on the application of physical phenomena in medicine, diagnostics, and medical equipment, students are motivated to study physics. Keywords: medical equipment; pedagogics; diagnostics; biopotential; training program

Team-based learning (TBL) in clinical disciplines for undergraduate medical students—a scoping review

BackgroundTeam-based learning (TBL) is an evidence-based pedagogical method that has been used in undergraduate medical education since 2001. However, its use in clinical disciplines is rarely reported, and the impact of its implementation is not known. The aim of this study was to explore and map the published literature on the impact of implementing TBL in clinical disciplines in undergraduate medical education.MethodsA comprehensive search of Medline, Education Resources Information Center (ERIC), and Web of Science databases was performed on November 24, 2021 and updated April 6, 2023, using relevant Medical Subject Headings (MeSH) and free-text terms. Original research studies reporting on the implementation of TBL in clinical disciplines in undergraduate medical education published in peer-reviewed English language journals were included irrespective of their methodological design.ResultsThe initial search identified 2,383 records. Of these, 49 met the inclusion criteria. Most of the studies (n = 44, 90%) described the implementation of a modified version of TBL in which one or more TBL steps were missing, and one study had undefined protocol for the implementation. The most reported outcomes were knowledge acquisition (n = 38, 78%) and students’ satisfaction or attitudes toward TBL (n = 34, 69%). Despite some differences in their results, the studies found that implementing TBL is associated with increased knowledge acquisition (n = 19, 39%), student engagement (n = 6, 12%), and student satisfaction (n = 31, 63%).ConclusionsMost of the studies reported positive results in students’ satisfaction and students’ engagement, whilst the results on knowledge acquisition and retention were more contradictory. In most of the studies, TBL was implemented in a modified form and diverse comparators were used. The methodological quality also varied. Thus, no unequivocal conclusions could be drawn regarding the value of implementing TBL in clinical disciplines. More studies with rigorous methodologies are needed in this field.

History of Social Medicine and Public Health - a Review

Background: The Social Medicine and organization of health is science organized on the application of modern medicine principles in the health care of human groups and nations. The significant difference of social medicine from clinical disciplines is that the clinical medicine deals with problems of individuals and social medicine is devoted to community health and illness of the family, schools and work organizations from population groups to the overall people of one area or country. Public health refers to all organized measures (whether public or private) to prevent disease, promote health and prolong life among the population as a whole. Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases . Objective: The aims of this article are to show, based on the available literature: a) The development of Social medicine and Public health in the World and Bosnia and Herzegovina from the medieval period until the today. b) The most significant historical events that marked the development of Social medicine and Public health with emfesized most important scientists and discoverers with their achievements. Methods: The subject of this study was the development of Social medicine and Public health in the world and in the areas of Bosnia and Herzegovina from the uncient peertiod until today. In order to achieve the set goals, a) Retreival of professional and scientific literature; and b) Search of scientific databases and web pages on the Internet that offer adequate and relevant data and historical facts related to the subject of studies were carried out. Most of the facts are covered in previously published articles by the author of this paper and deposited in the PubMed and PubMed Central databases, as well as in books and monographs by the author of this text. Results and Discussion: Social medicine with the organization of the health care system is the scientific discipline, defined by the huge contents, clear goal and specific methodology. It has been presented flow of socio-medical development and implementation on worldwide during the past. Public health was defined by Charles-Edward A. Winslow, in 1920. as „the science and art of preventing disease, prolonging life, and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of community infections, the education of the individual in principles of personal hygiene, the organization of medical and nursing service for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual in the community a standard of living adequate for the maintenance of health“. The names of those who are deserved for socio-medical development and its insufficiency on the organization on health system and some specific parts of it. Social medicine, and Public health as sciences and profession had high level among other disciplines, but also as profession per se, specially at the international level. There is huge evidence of numerous projects, books, papers, recognized by indigenous and international audience. Conclusion: The most importants role in organizatiionn and realization of all kind of public health activities and measures at every healthcare protection levels has World Health Organization (WHO) with its brench offices at all continents and all countries in the world. The author described information flow how it was happened during the history of its development.

On clinical elites and their role in institutionalization of new national clinical disciplines (the second half of XX century)

The development of national clinical medicine in Russia in XX century is related not only to evolution of scientific schools, but also to such historical phenomenon as clinical elites. In the article definition of therapeutic elites is proposed. The destiny of therapeutic elites and their role in institutionalization of national clinical disciplines is discussed.

LATIN'S ROLE AND FUTURE PROSPECTS IN MEDICAL TERMINOLOGY

The current paper provides a contemporary perspective on Latin's role as the language of medicine, specifically focusing on its terminological aspect. It delves into the essential terminological vocabularies indispensable for medical practitioners, with particular emphasis on three fundamental categories. Foremost among these is anatomical terminology, which continues to predominantly utilize Latin on an international scale. Clinical disciplines present a more diverse scenario, where alongside Latin terms, expressions from ancient origins, often in ethnic languages, are extensively employed. Additionally, driven partly by the demands of digitization, there have been repeated efforts to promote English as a potential successor in the realm of clinical medicine, owing to its widespread adoption. In pharmaceutical terminology, Latin persists as a vital means of global communication, upheld by the European Pharmacopoeia (2014) and the International Non-proprietary Names corpus (2013, 2017). Nonetheless, future considerations should acknowledge the growing competition from national languages in this domain.

Attitude toward career development in Japanese medical students: a questionnaire survey

ObjectivesThe study aimed to evaluate attitudes of Japanese medical students toward career development, including the acquisition of medical specialty and doctorate degree qualifications.DesignThis involved a web-based questionnaire survey.SettingWe asked medical...

AZAT SHIBANOVA – LIFE DEDICATED TO MEDICINE. DEVOTED TO THE 90th ANNIVERSARY

Azat Ilyasovna Shibanova – a veteran of Kazakhstan’s oncology service, the founder of the Clinical Cytology discipline in the Republic of Kazakhstan, Doctor of Medical Sciences, Professor, Honorary President of the Association of Clinical Cytologists of the Republic of Kazakhstan, Honorary Member of the International Academy of Cytology, the founder of the Association of Clinical Cytologists of the Republic of Kazakhstan. During her career, she trained a whole galaxy of cytologists and cytotechnicians currently working across Kazakhstan.

UNDERSTANDING THE ROLE OF CERTIFICATION IN MEDICAL EDUCATION: PERSPECTIVES OF EDUCATORS

Objectives: To explore the perception of the medical faculty attending Certifi cate course in Health professional education (CHPE); to identify its benefi cial factors & those domains which need further improvement. Materials and Methods: A cross sectional study was done including participants of three CHPE courses organized by Khyber medical University. This study was conducted at the Institute of Health Professions Education and Research (IHPER), Khyber Medical University Peshawar. A pre-validated questionnaire was fi lled by the participants. Duration of study was three weeks. The first of the questionnaire was regarding age, gender, teaching experience & teaching disciplines of participants. Second portion comprised of perceptions regarding teaching needs, methodology, assessment, communication skills & diff erent aspects of course content. Results: Amongst the participants there were 36 males (61%) & 23 females (39%). The age of the participants ranged from 25 – 55 years with a mean of 43 years. Amongst teaching disciplines 40 (67.8%) participants were from diff erent clinical disciplines & 19 (32.2%) were from basic sciences. The motivation factor for attending CHPE was personal interest in professional growth (55.90%). Majority of the participants reported the course relevant to their needs and helpful in improving their capabilities as a teacher. Conclusion: The study showed the importance of CHPE for faculty development for clinical & basic science health professionals. The strategies used for instructions during the course were valued by the respondents. Participants reported a positive change in their knowledge of teaching methods & improvement in communication skill.

AZAT ILYASOVNA SHIBANOVA – A LIFE DEDICATED TO MEDICINE. TO THE 90TH JUBILEE

Azat Ilyasovna Shibanova – a veteran of Kazakhstan’s oncology service, the founder of the Clinical Cytology discipline in the Republic of
 Kazakhstan, Doctor of Medical Sciences, Professor, Honorary President of the Association of Clinical Cytologists of the Republic of Kazakhstan,
 Honorary Member of the International Academy of Cytology, the founder of the Association of Clinical Cytologists of the Republic of Kazakhstan.
 During her career, she trained a whole galaxy of cytologists and cytotechnicians currently working across Kazakhsta

CULTIVATING CRITICAL THINKING IN PRACTICAL CLASSES DURING PATHOMORPHOLOGY AS AN INTEGRAL PART OF THE EDUCATIONAL PROCESS

The aim of this study is to explore and suggest methods for cultivating critical thinking in medical students during practical classes at a higher education institution.
 Results and discussion. Critical thinking is recognised as skilled thinking that makes good judgements because it is criterion-based, self-improving and context-sensitive. The process of developing critical thinking has the ultimate goal of teaching how to solve situational problems, persevere in solving problems, have flexible communication skills in teamwork, learn to listen to the interlocutor, be able to consider problems from different perspectives and consider multiple connections between phenomena, build logical conclusions, reflect on their feelings and thoughts, set goals and achieve goals. Thus, cultivating critical thinking in practical classes over the course of Pathomorphology is an integral part of the educational process.
 Considering the role that Pathomorphology plays as a bridge between theoretical and clinical disciplines, the faculty of departments teaching this subject confronts the challenge of fostering critical thinking in medical students. This article is dedicated to exploring various methods for developing critical thinking in medical students within higher education institutions. The following methods are considered: development of critical thinking through reading and writing, cluster, Fishbone method, question cube, Daisy of Questions, syncreate, Lotus Flower and Tree of Predictions (Decisions). It is extremely important to introduce training to foster critical thinking (solving real problems and making decisions by students in various situations); to create reasonable grounds for choosing the most appropriate methods, techniques, forms and means of teaching. The considered methods of forming critical thinking in medical students have effectively proved themselves in practical classes in pathomorphology at the higher education institution "Bukovinian State Medical University". In the future, there is a need to study other methods of critical thinking, such as "six hats of thinking", essay, etc.
 Conclusion. Cultivating critical thinking in medical students stands as one of the paramount responsibilities for the teaching staff in any higher education medical institution. Critical thinking is the skill of analyzing and making well-considered decisions independently. It represents a distinct form of thinking marked by activity, purposefulness, independence, discipline, and reflection

Binary Practical Lessons as an Innovative Approach to Increase Motivation and Develop Students Professional Competencies

Article presents the use and effectiveness of an interactive form of training, using the example of binary classes as an innovative pedagogical approach to conducting practical classes, which enable students to see the prospects for using the acquired theoretical knowledge in real life and increasing motivation among students, which helps to improve knowledge acquisition. A binary practical lesson allows generating interest in understanding the profession and implementing new educational standards, as it contributes to achieving positive results in the educational process and improving professional competencies among students. During binary practical classes, two specialists, a theorist and a practitioner consider the analysis of clinical situations using practical skills on a specific case. This paper presents the experience of conducting binary practical classes in clinical disciplines, by teachers of the Clinical Disciplines 3 Department at international medical faculty in Osh State University, M.D., associate professor B. O. Abdurakhmanov, M.D., G. K Kenzhebaeva, graduate students of the department, senior teacher A. E. Omurzakova and Zh. U. Kadyrkulova for the periods from 2021-2023 academic years. This work aimed at studying the effectiveness of binary practical classes on the formation and development of practical skills, as well as improving the quality of knowledge acquisition. The results of this study showed that the use of binary practical exercises has a positive effect on the formation and development of practical skills and helps improve the quality of the educational process. This teaching method contributes to a deeper and better mastery of the material compared to traditional methods and helps students take a fresh look at theoretical training and realize that their study is necessary for better mastery of the profession, since it provides the opportunity to see how theoretical knowledge is applied in practice.