Clinical Lecture Research Articles

Establishment of seven lung ultrasound phenotypes: a retrospective observational study of an LUS registry

BackgroundLung phenotypes have been extensively utilized to assess lung injury and guide precise treatment. However, current phenotypic evaluation methods rely on CT scans and other techniques. Although lung ultrasound (LUS) is widely employed in critically ill patients, there is a lack of comprehensive and systematic identification of LUS phenotypes based on clinical data and assessment of their clinical value.MethodsOur study was based on a retrospective database. A total of 821 patients were included from September 2019 to October 2020. 1902 LUS examinations were performed in this period. Using a dataset of 55 LUS examinations focused on lung injuries, a group of experts developed an algorithm for classifying LUS phenotypes based on clinical practice, expert experience, and lecture review. This algorithm underwent validation and refinement with an additional 140 LUS images, leading to five iterative revisions and the generation of 1902 distinct LUS phenotypes. Subsequently, a validated machine learning algorithm was applied to these phenotypes. To assess the algorithm’s effectiveness, experts manually verified 30% of the phenotypes, confirming its efficacy. Using K-means cluster analysis and expert image selection from the 1902 LUS examinations, we established seven distinct LUS phenotypes. To further explore the diagnostic value of these phenotypes for clinical diagnosis, we investigated their auxiliary diagnostic capabilities.ResultsA total of 1902 LUS phenotypes were tested by randomly selecting 30% to verify the phenotypic accuracy. With the 1902 LUS phenotypes, seven lung ultrasound phenotypes were established through statistical K-means cluster analysis and expert screening. The acute respiratory distress syndrome (ARDS) exhibited gravity-dependent phenotypes, while the cardiogenic pulmonary edema exhibited nongravity phenotypes. The baseline characteristics of the 821 patients included age (66.14 ± 11.76), sex (560/321), heart rate (96.99 ± 23.75), mean arterial pressure (86.5 ± 13.57), Acute Physiology and Chronic Health Evaluation II (APACHE II)score (20.49 ± 8.60), and duration of ICU stay (24.50 ± 26.22); among the 821 patients, 78.8% were cured. In severe pneumonia patients, the gravity-dependent phenotype accounted for 42% of the cases, whereas the nongravity-dependent phenotype constituted 58%. These findings highlight the value of applying different LUS phenotypes in various diagnoses.ConclusionsSeven sets of LUS phenotypes were established through machine learning analysis of retrospective data; these phenotypes could represent the typical characteristics of patients with different types of critical illness.

Editorial Comment on "Learning by clinical reasoning versus interactive lecture: an analytical and experimental study of teaching urological emergencies"

Editorial Comment on "Learning by clinical reasoning versus interactive lecture: an analytical and experimental study of teaching urological emergencies"

Chronic prostatitis. Clinical lecture No. 3: Basic principles of treatment and prevention

Chronic prostatitis. Clinical lecture No. 3: Basic principles of treatment and prevention

Fostering young talents for surgery : Laparoscopy in preclinical education-Too early or exactly right?

Due to the declining interest among medical students in pursuing asurgical career, the impact of demographic changes and the technical challenges, there is an increasing need to attract medical students to the surgical profession. Against this backdrop, ateaching project was developed to familiarize medical students with minimally invasive surgical techniques early in the preclinical education, thereby increasing the interest in surgery. Within the framework of the regular anatomical dissection course the following modules on laparoscopic surgery were integrated: (1)clinical lecture on the technique and application of laparoscopy, (2)exploratory live laparoscopy on abody donor and (3)practical exercises on laparoscopic trainers. The impact of this teaching project on the interest in asurgical career and on the clinical anatomical understanding was evaluated among 295 participating medical students. The evaluation revealed apronounced gender-independent interest in learning surgical skills early in the preclinical study phase. The teaching project led to asignificantly increased interest in pursuing asurgical career. Moreover, the incorporation of laparoscopic teaching modules into the preclinical anatomy course enhanced the learning motivation and understanding of clinically relevant topographic anatomy. The integration of practical surgical content into preclinical anatomical education can increase the attractiveness of surgical disciplines and simultaneously optimize teaching of anatomy. Longitudinal studies are required to examine the sustainability of these clinical teaching modules in career decisions of medical students.

Skin manifestations in diseases of the gastrointestinal tract. A clinical lecture

Skin manifestations in diseases of the gastrointestinal tract. A clinical lecture

Хронический простатит. Клиническая лекция № 2: диагностика и терапия

Хронический простатит. Клиническая лекция № 2: диагностика и терапия

Model for an Academic Medicine Interest Group: A student-led initiative

Academic physicians are responsible for the education of medical students, residents, and other practicing physicians through clinical rotations lectures, seminars, research, and conferences. Therefore, the increasing need to recruit academic physicians holds immense value within the healthcare system. Academic Medicine Interest Group (AMIG) is a collective made up of students who share an interest in the growth and advancement of academic medicine. We present a guide and model on establishing an AMIG. We found that AMIG fostered professional growth by providing leadership, research, and teaching opportunities. Strategic planning, effective leadership, and group organization were all necessary for the success of the group.

Core needs and diverse opportunity: A survey of academic clinical lecturers and the effects of the COVID-19 pandemic

During a clinical lecturer role, parallel clinical and academic training is undertaken. The anticipation is that a lectureship represents an exciting and expansive time. However, a national crisis has been declared at the clinical lecturer level with a leaky pipeline of clinical academics resulting in dwindling numbers. Clinical lecturers are infrequently represented as a group partly due to their distributed nature and diverse job plans. We conducted a survey of clinical lecturers in the UK. Responses (n = 107) revealed a motivated but divided workforce. A content analysis revealed core elements that sculpt an individual’s success or failure, but these were variably present. COVID-19 had a negative effect on many with various strategies reported to try and reset academic trajectories. Feelings of isolation and anxiety about a viable future in academia were significant findings. This echoes calls for a greater number of secure longer-term grants to ensure that clinical academics and their skills are retained within the research workforce. A continued effort to analytically appraise whether supportive elements are in place for all lecturers will help focus initiatives to foster excellence in clinical academic training for everyone.

Undergraduate nursing students’ perception of bullying behavior and its relation to their academic achievement

Background Bullying among students is certainly not a new notion, however, due to its high incidence rates and the short-term and long-term implications. Students were subjected to a lot of factors during their study, either academic or clinical, that revealed them suffering high levels of depression, anxiety, and stress. Aim Assess undergraduate nursing students’ perception of bullying behavior and its relation to their academic achievement. Design A descriptive correlational research design was used. Sample A convenience sample (n=1255) of undergraduate nursing student out of N=3108. Setting The study was conducted in an accredited Faculty of Nursing which is affiliated to Cairo University. Tools Three tools were used personal characteristics data sheet, Bullying Behavior in Nursing Education Questionnaire, and academic achievement checklist Grade Point Average form. Results The main findings indicated that the bullying highest mean percent (58.33 and 55.14%) as perceived by the study sample was regarded as direct negative behaviors domains and attack on academic achievement domains, respectively. While the lowest mean percent (8.7%) was in regard to types of bullying domain. Data added that there was no statistically significant relationship (P=0.72) between the total perception of bullying in nursing education and students’ academic achievement. Conclusion The study concluded that there was no statistically significant relationship between total bullying as perceived by undergraduate nursing students in nursing education and their academic achievement. Recommendations Develop training programs to educate clinical instructors and assistant lecturers on how to achieve the academic objectives and advocate students’ rights. Design educational workshops to inform nursing students how to report bullying and how to overcome it.

HPNA Clinical Lecture Series - Advanced Practice Clinician Palliative Care Fellowship: A Leading-Edge Program

HPNA Clinical Lecture Series - Advanced Practice Clinician Palliative Care Fellowship: A Leading-Edge Program

Experiences of Clinical Lecturers in Providing a Supportive Learning Atmosphere Required for the Development of the Medical Students' Professional Identity

Experiences of Clinical Lecturers in Providing a Supportive Learning Atmosphere Required for the Development of the Medical Students' Professional Identity

Reflective capacity and context of reflections: qualitative study of second-year medical students’ learning diaries related to a general practice course

BackgroundReflective capacity is a prerequisite for transformative learning. It is regarded as an essential skill in professional competence in the field of medicine. Our aim was to investigate the reflective capacity and the objects of action (themes) which revealed reflective writing of medical students during a general practice/family medicine course.MethodsSecond-year medical students were requested to write learning diaries during a compulsory course in general practice/family medicine consisting of the principles of the physician-patient relationship. The course included a group session supervised by a clinical lecturer and a 3-day training period in a local health centre. We conducted data-driven content analysis of the learning diaries. In the learning diaries, student observations were most commonly directed to events during the training period and to group sessions. Occasionally, observation was directed at inner experience.ResultsThe following themes were related to reflective writing: feelings towards the end of life, demanding situations in practice, physician’s attitude to patient, student’s inner experiences, and physician’s well-being. The entries indicated different types of reflective capacity. Three subgroups were identified: ‘simple reporting,’ ‘reflective writing,’ and ‘advanced reflective writing.’ConclusionProfessional growth requires the development of reflective capacity, as it is essential for successful patient care and better clinical outcomes. To develop and enhance the reflective capacity of medical students during their education, the curriculum should provide frequent opportunities for students to assess and reflect upon their various learning experiences.

Exploring the declared and the formal and informal taught curricula at a UK dental school through the lens of pulp management.

Introduction This paper explores the declared and formal and informal taught endodontic curriculum within an undergraduate dental programme in the UK as part of a wider study, which also investigates the learned curriculum. Management of the dental pulp was chosen due to the availability of clear internationally recognised guidelines.Method The declared curriculum was identified through existing course guides and seminar and practical session plans. The formal taught curriculum was identified by cataloguing all lectures, practical teaching sessions, seminars and handouts available to dental students. Questionnaires using clinical vignettes were used to explore the informal taught curriculum.Results Valid responses to the questionnaire were received from 25/40 (62.5%) clinical supervisors. Disparities between national guidelines and the declared and taught curriculum were primarily due to broad learning objectives and disparate information from lectures and supervising clinicians. Although the majority of formal teaching aligned with national guidelines, the main deviation occurred within the informal taught curriculum.Conclusion This study highlights disparities between current evidence-based guidelines and the declared and taught curriculum in relation to pulp management in a UK dental school. Recommendations are that all policies, procedures and protocols are updated and aligned to a contemporaneous evidence base annually, plus engagement with clinical lecturers, to enable more standardised teaching.

Dreams: Charcot's Last Words on Hysteria.

Jean-Martin Charcot (1825-1893), the leading neurologist of his time, is best remembered for his studies on hysteria presented in clinical lectures at the Paris Salpêtrière hospital. Developing the concept of traumatic male hysteria after accidents in which patients suffered slight physical damage led him to advance a psychological explanation for hysteria. Traumatic hysteria is the context for a close reading of Charcot's "last words" based upon a final unpublished lesson in 1893. This case history concerns a seventeen-year-old Parisian artisan whose various signs of hysteria developed following a dream in which he imagined himself the victim of a violent assault. Charcot identifies the dream/nightmare as the "original" feature determining traumatic hysteria. The dream sets in motion an overwhelming consciousness followed by a susceptibility to "autosuggestion" producing somatic signs of hysteria. Charcot's final lesson on dreams thus culminates his study of the psychological basis of traumatic hysteria.

Clinical Lectures

Clinical Lectures

Exploration of Clinical Clerkship Remediation in Undergraduate Medical Programme during the COVID-19 Pandemic

Medical students in their clinical phase face various academic and non-academic challenges affecting their achievement of expected competencies. Medical students who fail competency assessments are encouraged to enrol in a remediation programme. Due to COVID-19, remediation learning activities have been altered to distance learning. Unfortunately, studies on clinical remediation programmes are scarce. This study aims to explore the clinical clerkship remediation process during the COVID-19 pandemic to provide a reference for developing appropriate remediation programmes. This is a qualitative study with a phenomenological design. The remediation process was explored through focus group discussions (FGDs) and in-depth interviews. Five FGDs with regular students, five FGDs with remedial students, five in-depth interviews with clinical lecturers and five in-depth interviews with education coordinators were completed. Four themes were identified from the gathered data: academic and non-academic factors influencing the need for remediation, planning, learning activities and assessment, and evaluation of learning processes and outcomes. Remediation during the clinical phase comprises several critical steps, and following the remediation process, students demonstrated improved performance. To improve the quality of the remediation process, the factors underlying the need for remediation should be determined.

A Qualitative Approach on Impacts of Online Learning Towards University of Cyberjaya Clinical Years Medical Students

The recent COVID-19 pandemic has taken a toll and impacted most sectors, including the academic field. With this sudden shift away from the classroom in many parts of the globe, some are wondering whether the adoption of online learning will continue to persist post-pandemic, and how such a shift would impact the worldwide education market. Most countries have shifted to online learning in adaptation to the new normal. In this study, we aimed to study perceptions towards the impact of online learning on University of Cyberjaya (UoC) clinical year medical students through a comprehensive interview. A total of 23 participants had joined this study including 13 students with a focus group of another five students, four clinical years lecturers, and an IT staff in UoC. As various people may have different perceptions, a focus group was organised so that students could discuss their experiences in greater depth. The information was gathered through in-depth semistructured questionnaire interviews done via Microsoft Teams. The results were arranged based on topics that were covered, including interactions between lecturers and students during online courses, students’ experiences impacting the effectiveness of online learning, impediments to online learning, and effective approaches to improve online learning. There were 32 codes and 16 themes altogether. Through this study, we conclude that online learning is still beneficial but has limitations due to various factors. Therefore, more efforts still need to be made to improve the quality of online learning, especially for clinical years students.

Clinical and laboratory diagnostics of drug-induced liver injury by antibiotics

Liver damage in a patient can precede the prescribing of antibiotics for the treatment of an infectious disease, may occur during their use or after their discontinuation. Liver damage before the start of treatment limits the choice and affects the dosage of antimicrobial agents. The occurrence of liver damage during antimicrobial treatment or after discontinuation of antibiotics can be both a consequence of this intake and independent of treatment with antibacterial drugs. Diagnosis of such lesions requires the use of many clinical, laboratory and instrumental investigations. The key element of diagnosis is the determination of the biochemical variant of liver damage, which makes it possible to plan the sequence of differential diagnosis. In case of suspicion of drug-induced damage to the liver, it is necessary to stop taking immediately the drugs that allegedly caused it. The next step is finding out the connection between the use of the antibiotic and the occurrence of the disease, taking into account the data of the literature regarding this possibility. Then it is necessary to estimate compatibility in time between the start of the use of drugs and the appearance of signs of liver damage, to assess the severity of the injury and, if possible, to prescribe appropriate medicines. There are several methods to assess causality between drugs and liver injury with RUCAM on the head. LiverTox is a well-known database on medicines, which are capable to cause liver damage. Antimicrobial agents belong to the most frequent causes of drug-induced liver injury. Most of such injuries are idiosyncratic. There was used a clinical example of possible drug-induced liver damage to illustrate decisions and difficulties in proving the etiological role of an antibiotic in a case, when liver damage arose during management of a patient with community-acquired pneumonia. This artic­le is a clinical lecture. Keywords: toxic action, biochemical variant, antimicrobials.

Spasticity Matters: A Call to Action Following an Acute Stroke

More than half of survivors of stroke experience some degree of motor impairment, and spasticity can develop within days of the initial event. Patients with post-stroke spasticity (PSS) report a lower quality of life than those without spasticity, and they require regular long-term follow-up and monitoring within the healthcare system. This symposium supported a non-promotional discussion regarding the prevalence, burden, consequences, and need for identification of PSS. The benefits of PSS identification within 3 months of stroke were discussed by a panel of key opinion leaders, including Ted Wein, Neurologist and Assistant Professor of Neurology and Neurosurgery at McGill University, Montréal, Quebec, Canada; Ganesh Bavikatte, Consultant and Clinical Lead in rehabilitation medicine at the Walton Centre, Liverpool, and Honorary Senior Clinical Lecturer at the University of Liverpool, UK; and Sean Savitz, Professor of Neurology and Physical Medicine and Rehabilitation, Frank M. Yatsu MD Chair in Neurology, and Director of the Institute for Stroke and Cerebrovascular Diseases, University of Texas Health Science Center at Houston (UTHealth), Texas, US. These key opinion leaders explained that early prediction of PSS could be improved by increased awareness of the associated risk factors and tools, such as the Post-Stroke Checklist (PSC), the Spasticity Screening Tool, and the PSS Referral Tool. Finally, potential barriers to the early identification of PSS were presented, alongside strategies to overcome these barriers.

Testicular diffuse large B-cell lymphoma. Clinical lecture and case report

Testicular diffuse large B-cell lymphoma. Clinical lecture and case report