Clinical Medical Knowledge Research Articles

Basic Principles in the Application of Problem-Based Learning in Medical Biochemistry Education

Although the methods of applied education vary, it is well-known that medical faculties are among the faculties with the most intensive curriculum across all universities. In the medical education system applied throughout our country, the aim is to build a strong medical foundation by starting with an intensive theoretical curriculum, with basic science courses predominantly taught during the first three years. Following this, the objective is to provide clinical training through practical rotations in clinics, building on the acquired foundational knowledge. However, some challenges are encountered in the traditional lecture-based approach, particularly in delivering theoretical courses during the first three terms. As an alternative to the traditional teaching method, the problem-based learning (PBL) model, which was first introduced in the 1960s at McMaster University Faculty of Medicine in Canada, has been developed. Today, this model is widely used in medical education globally, either as a standalone method or in combination with traditional approaches. Medical biochemistry, which evolved in the 19th and 20th centuries and has become a significant field that bridges basic and clinical medical knowledge in the 21st century, has a detailed and comprehensive curriculum. Given its importance in medical education, as well as its broad and detailed scope, different teaching methods are required for the effective and long-lasting retention of medical biochemistry knowledge. The problem-based learning method, which promotes interactive learning, encourages students to research and access new information, and motivates them to work collaboratively in a student-centered, brainstorming-based group setting, offers a strong alternative to classical lecture-based teaching in medical biochemistry. Research has also highlighted the numerous benefits of using problem-based learning in medical biochemistry education. Incorporating problem-based learning into the curriculum of faculties offering medical biochemistry education could enhance the quality of education. In this study, it is aimed to discuss the effects of problem-based learning method on medical biochemistry education with the current literature.

Recognition of Chinese Electronic Medical Records for Rehabilitation Robots: Information Fusion Classification Strategy.

Named entity recognition is a critical task in the electronic medical record management system for rehabilitation robots. Handwritten documents often contain spelling errors and illegible handwriting, and healthcare professionals frequently use different terminologies. These issues adversely affect the robot's judgment and precise operations. Additionally, the same entity can have different meanings in various contexts, leading to category inconsistencies, which further increase the system's complexity. To address these challenges, a novel medical entity recognition algorithm for Chinese electronic medical records is developed to enhance the processing and understanding capabilities of rehabilitation robots for patient data. This algorithm is based on a fusion classification strategy. Specifically, a preprocessing strategy is proposed according to clinical medical knowledge, which includes redefining entities, removing outliers, and eliminating invalid characters. Subsequently, a medical entity recognition model is developed to identify Chinese electronic medical records, thereby enhancing the data analysis capabilities of rehabilitation robots. To extract semantic information, the ALBERT network is utilized, and BILSTM and MHA networks are combined to capture the dependency relationships between words, overcoming the problem of different meanings for the same entity in different contexts. The CRF network is employed to determine the boundaries of different entities. The research results indicate that the proposed model significantly enhances the recognition accuracy of electronic medical texts by rehabilitation robots, particularly in accurately identifying entities and handling terminology diversity and contextual differences. This model effectively addresses the key challenges faced by rehabilitation robots in processing Chinese electronic medical texts, and holds important theoretical and practical value.

Family Medicine Clerkship Directors' Perspectives on USMLE Pass/Fail Scoring: A CERA Study.

Reports on the effects of changing the United States Medical Licensing Exam (USMLE) Step 1 examination scoring to pass/fail are evolving in the medical literature. This Council of Academic Family Medicine Educational Research Alliance family medicine clerkship directors' study seeks to describe family medicine clerkship directors' perceptions on the impact of incorporation of Step 1 pass/fail score reporting on students' family medicine clerkship performance. Ninety-six clerkship directors responded (56.8% response rate). After exclusion of Canadian schools, we analyzed 88 clerkship directors' responses from US schools. We used descriptive statistics for demographics and responses to survey questions. We used ꭓ2 analysis to determine statistically significant associations between survey items. Clerkship directors did not observe changes in students' overall clinical performance after Step 1 pass/fail scoring (60.8%). Fifty percent of clerkship directors reported changes in Step 1 timing recommendations in the past 3 years. Reasons included curriculum redesign (30.5%), COVID (4.5%), change in Step 1 to pass/fail (11.0%), and other reasons (3.7%). Forty-five percent of these clerkship directors did not observe a change in students' clinical medical knowledge after Step 1 went to pass/fail. Eighty-four percent of these clerkship directors did not compare student performance on clerkship standardized exams before and after Step 1 score changes. We found no significant relationship between Step 1 timing and student performance. This study represents an early description of family medicine clerkship directors' perceived observations of the impact of Step 1 scoring changes on student performance. Continued investigation of the effects of USMLE Step 1 pass/fail scoring should occur.

Explainable AI Method for Tinnitus Diagnosis via Neighbor-Augmented Knowledge Graph and Traditional Chinese Medicine: Development and Validation Study.

Tinnitus diagnosis poses a challenge in otolaryngology owing to an extremely complex pathogenesis, lack of effective objectification methods, and factor-affected diagnosis. There is currently a lack of explainable auxiliary diagnostic tools for tinnitus in clinical practice. This study aims to develop a diagnostic model using an explainable artificial intelligence (AI) method to address the issue of low accuracy in tinnitus diagnosis. In this study, a knowledge graph-based tinnitus diagnostic method was developed by combining clinical medical knowledge with electronic medical records. Electronic medical record data from 1267 patients were integrated with traditional Chinese clinical medical knowledge to construct a tinnitus knowledge graph. Subsequently, weights were introduced, which measured patient similarity in the knowledge graph based on mutual information values. Finally, a collaborative neighbor algorithm was proposed, which scored patient similarity to obtain the recommended diagnosis. We conducted 2 group experiments and 1 case derivation to explore the effectiveness of our models and compared the models with state-of-the-art graph algorithms and other explainable machine learning models. The experimental results indicate that the method achieved 99.4% accuracy, 98.5% sensitivity, 99.6% specificity, 98.7% precision, 98.6% F1-score, and 99% area under the receiver operating characteristic curve for the inference of 5 tinnitus subtypes among 253 test patients. Additionally, it demonstrated good interpretability. The topological structure of knowledge graphs provides transparency that can explain the reasons for the similarity between patients. This method provides doctors with a reliable and explainable diagnostic tool that is expected to improve tinnitus diagnosis accuracy.

Large-view x-ray imaging for medical applications using the world’s only vertically polarized synchrotron radiation beam and a single asymmetric Si crystal

Objective. X-ray microangiography provides detailed information on the internal structure and function of a biological subject. Its ability to evaluate the microvasculature of small animals is useful for acquiring basic and clinical medical knowledge. The following three conditions are necessary to attain detailed knowledge of biological functions: (1) high temporal resolution with sufficient x-ray intensity, (2) high spatial resolution, and (3) a wide field of view. Because synchrotron radiation microangiography systems provide high sapatial resolution and high temporal resolution as a result of their high x-ray intensity, such systems have been developed at various synchrotron radiation facilities, starting with the photon factory, leading to numerous medical discoveries. However, the three aforementioned functions are incompatible with the use of synchrotron radiation because the x-ray intensity decreases when a wide field of view is obtained. To overcome these problems, we developed a new x-ray optical system for microangiography in rats using synchrotron radiation x-rays. Approach. Instead of using monochromatic synchrotron radiation x-rays with a conventional double-crystal monochromator, we used white synchrotron radiation x-rays and an asymmetric Si crystal to simultaneously monochromatize the beam and widen the field of view. Main results. The intensity profile and spatial resolution of the x-ray images were then evaluated. The proposed x-ray optics increased the x-ray intensity and beam width by factors of 1.3 and 2.7, respectively, compared with those of conventional monochromatic x-rays. In addition, in vivo studies on microangiography in rats were performed to confirm that the images had sufficient intensity, spatial resolution, and field of view. One of a series of images taken at 50 ms frame−1 was shown as an example. Significance. This x-ray optics provides sufficient x-ray intensity, high spatial resolution, and a wide field of view. This technique is expected providing new insights into the evaluation of the vascular system.

Epidemiologia reprodukcyjna i jej użyteczność w rozwiązywaniu wybranych problemów zdrowotnych kobiet – według projektów i badań własnych

The dynamic development of basic and clinical medical knowledge, also in the field of family medicine, makes it difficult for clinicians to keep up with the news. Therefore, clinical management standards are more and more often developed based on the principles of evidence-based medicine and data from the field of epidemiology.The above tendency can also be observed in sexology and family medicine in the context of gender issues, despite the still very poor knowledge of the physiology of sexual reactions and the etiopathology of their dysfunction. Epidemiology is an interdisciplinary field that studies the occurrence and distribution of health-related conditions or events in specific populations, and assesses the factors that influence health, and applies this knowledge to controlling health problems.The research projects carried out by the author and the published results of the conducted research justify the usefulness of the relatively young subdiscipline of epidemiology, which is reproductive epidemiology in solving the problems of reproductive medicine, which is also more important in family medicine.

Flipping the Script – Adopting Autopsy Protocol for Cadaveric Dissection in Gross Anatomy

Autopsy is a postmortem investigation of the body to determine the cause of death or extent of disease, also serving a quality assurance role by evaluating diagnostic and therapeutic procedures and outcomes in clinical medicine. Autopsy also holds promise in medical education as a focal point for integration and correlation of basic & clinical medical knowledge. Unfortunately, the vast educational potential goes unrealized due to several barriers such as clinicolegal risks, potential exposure to biohazardous materials, limited time, space, and negative stigma. On the other hand, cadaveric dissection in gross anatomy is in rapid decline in medical education as sweeping curricular changes continue to reduce contact hours in favor of systemic and clinical integration. The situation was exacerbated by the COVID-19 pandemic, which demanded expeditious online migration of classes and will likely have a long lasting and transformative impact on the educational landscape. At this time, a unique opportunity exists to adopt an autopsy protocol for cadaveric dissection in gross anatomy to actualize the untapped potential of clinical practice. Therefore, in a pilot project, the feasibility and perceived value of adopting autopsy protocol in cadaveric dissection were evaluated. Four students with regional gross anatomy dissection experience and faculty (n=2) completed dissections of four cadavers using an en masse autopsy protocol. First, external examination of the whole body noting all surface anatomy including scars, abrasions, contusions, and tumors, provided an opportunity to make acquaintance with the body donor. Second, thoracic and abdominopelvic organs were removed en masse (Figure 1) with minimal disruption to the musculoskeletal framework, preserving most neurovascular supply and anatomic relationships of multiple organ systems. The en masse organ block was further dissected into organ system blocks to demonstrate relationships of individual organs. Finally, the musculoskeletal system of the main body frame was regionally dissected. Unstructured interviews of faculty and students were conducted to gauge experience and perceptions of autopsy protocol in cadaveric dissection. A survey of student dissectors (n=4) and observers (n=4) was conducted to qualitatively assess educational value. All participants unanimously reported that autopsy protocol and the en masse organ blocks would benefit gross anatomy education. Students reported new knowledge gained on the boundary of the peritoneum, retroperitoneal structures, ligaments of the visceral organs, and spatial relationships of organ systems that are lost in regional dissections. These outcomes suggest that integrating an en masse autopsy protocol in a gross anatomy course is a viable option that offers a clinical approach to learning gross anatomy. Taken together, adopting autopsy protocol in some form in medical education holds ample opportunity to integrate multiple basic science subjects and clinical practice. Educational value of the autopsy protocol in gross anatomy education will be investigated in the future studies.

Master clinical medical knowledge at certificated-doctor-level with deep learning model

Mastering of medical knowledge to human is a lengthy process that typically involves several years of school study and residency training. Recently, deep learning algorithms have shown potential in solving medical problems. Here we demonstrate mastering clinical medical knowledge at certificated-doctor-level via a deep learning framework Med3R, which utilizes a human-like learning and reasoning process. Med3R becomes the first AI system that has successfully passed the written test of National Medical Licensing Examination in China 2017 with 456 scores, surpassing 96.3% human examinees. Med3R is further applied for providing aided clinical diagnosis service based on real electronic medical records. Compared to human experts and competitive baselines, our system can provide more accurate and consistent clinical diagnosis results. Med3R provides a potential possibility to alleviate the severe shortage of qualified doctors in countries and small cities of China by providing computer-aided medical care and health services for patients.

Forensic Pathological Examination on 73 Medical Malpractice Cases of Pediatrics

To analyse 73 medical malpractice cases of pediatrics for discussing the importance of forensic pathology in solving the issues such as medical malpractice of pediatrics. From January 2002 to August 2016, 73 medical malpractice cases of pediatrics with age of death between 28 days old and 10 years old were collected from Institute of Judical Expertise of Nanjing Medical University. The relationship between causes of death and related medical institutions was retrospectively analysed. In 73 cases, the male to female ratio was 1.70∶1, and ages of 28 days old to 1 year old were common （26 cases, 35.62%）, followed by ages between 1 year old and 3 years old （21 cases, 28.77%）. In 71 cases which had been determined the cause of death by postmortem examination, the main cause of death was disease, especially respiratory diseases （33 cases, 46.48%）, followed by cardiovascular diseases （12 cases, 16.90%）. In 75 medical institutes which involved with these medical malpractices, most were tertiary medical institutes （32, 42.67%）, followed by the sub-secondary （excluding the secondary） medical institutions （23, 30.67%）. The clinical diagnosis of 38 cases （52.05%） completely or mostly corresponded with the pathological findings. There were 35 cases （47.95%） undefined or misdiagnosed cases. Autopsy and forensic pathological examination contribute to determine causes of death, which not only provide scientific evidence for medical malpractice of pediatrics, but also enrich and develop clinical medical knowledge, and thus improve diagnosis and treatment level in a certain extent.

A review of medical terminology standards and structured reporting

Much effort has been invested in standardizing medical terminology for representation of medical knowledge, storage in electronic medical records, retrieval, reuse for evidence-based decision making, and for efficient messaging between users. We only focus on those efforts related to the representation of clinical medical knowledge required for capturing diagnoses and findings from a wide range of general to specialty clinical perspectives (e.g., internists to pathologists). Standardized medical terminology and the usage of structured reporting have been shown to improve the usage of medical information in secondary activities, such as research, public health, and case studies. The impact of standardization and structured reporting is not limited to secondary activities; standardization has been shown to have a direct impact on patient healthcare.

A study on the feasibility of increasing the teaching content of nursing education in the stage of rural doctor education

Objective To explore the insertion of the teaching contents of nursing in rural doctors' higher education, so as to increase their understanding of medical knowledge and improve their medical skills. Method 90 rural doctors of Grade 2014 were chosen as the research object, and according to their willingness to participate, they were divided into control group and observation group. The students in the control group were mainly taught by the relevant knowledge of clinical medicine, while nursing teaching content was inserted in the teaching of observation group. In the teaching process, firstly, the teaching contents of nursing were reorganized, and then the teaching content of clinical medicine was taken as the main line, according to the development of teaching content, flexibly inserting nursing teaching part. The results of the final examination of the internal medicine of the two groups were compared and the specific learning experience of rural doctors was investigated. SPSS 20.0 was used to analyze the data, the count data was expressed as percentage, and chi square test was performed. Results The number of students in the con-trol group and the observation group whose subjective score was more than 40 was 17.65% and 48.72% respectively. The number of students scoring <30 points accounted for 23.53% and 5.13% of the total number of students, and there was a statistically significant difference between the two groups (P<0.05) . The ob-servation group had a better learning experience, and had little influence on the learning of clinical medical knowledge. Conclusion In the stage of education for rural doctors, inserting the teaching contents of nursing can improve the teaching effect. Key words: Rural doctor; Nursing teaching; Teaching reform

Benjamin A. Elman (Editor). Antiquarianism, Language, and Medical Philology: From Early Modern to Modern Sino-Japanese Medical Discourses. (Sir Henry Wellcome Asian Series, 12.) viii + 232 pp., figs., index. Leiden/Boston: Brill, 2015. $135 (cloth).

Benjamin A. Elman (Editor). <i>Antiquarianism, Language, and Medical Philology: From Early Modern to Modern Sino-Japanese Medical Discourses</i>. (Sir Henry Wellcome Asian Series, 12.) viii + 232 pp., figs., index. Leiden/Boston: Brill, 2015. $135 (cloth).

Disaster management curricula: strategy to create doctors with disaster resilience in Aceh, Indonesia

Faculty of Medicine of Syiah Kuala University has one special block called Disaster Management block (the last block on the curricula) on Competency-Based Curriculum of Medical Sciences with the Problem-Based Learning method. This block has four credits, allocated seven weeks learning period including one week for evaluation. The placement of disaster management block in the 7th semester (last semester) aims to allow students to implement more easily the complete basic and clinical medical knowledge and then have it integrated with the management capabilities during adisaster. This article evaluates two components: 1) Disaster management module, by comparing the content of modules used in three different academic years, the academic year 2013/2014, 2014/2015 and 2015/2016, 2) The final grade, by comparing the final grade of disaster management block in 4 years (comparing students class of 2008, 2009, 2010 and 2011). The results revealed that on every academic year there were additions and strengthening of the material to ensure that students achieve a complete learning experience, and there was a slight increase in student’s grades where the number of students who receive grades A has increased while the number of students who receive grades E decreased.

The Career of the Doctor of Medicine and Philosophy Stefano Lorenzo Bisio in the Grand Duchy of Lithuania

The doctor of medicine and philosophy Stefano Lorenzo Bisio (1724–1800?) worked in the Grand Duchy of Lithuania between 1762/3 and 1787. During this quarter of a century, he earned renown as a private physician to magnates, an innovator in the science of medicine, and as one of the founders of academic medicine in the Grand Duchy of Lithuania. Regardless of this, only one of the last stages of Bisio’s career has received much attention in historiography so far, his becoming the first head of the College of Medicine, established at Vilnius University in 1781. In this article, I seek to give as comprehensive as possible a presentation of Bisio’s entire career in the Grand Duchy of Lithuania, discussing thoroughly his academic activities and achievements. Through these achievements, I hope to show that he was one of the first to apply West European anatomical, pathological and clinical medical knowledge from the Age of Enlightenment, which itself was undergoing qualitative breakthroughs, in the GDL. In the article, I also correct and present new biographical facts about S.L. Bisio, his birth and death dates, work and education placesfamily, and work relations.

医学生创新思维和临床实践能力培养的医学遗传学教学改革与实践研究

为提高医学生自主学习、临床思维、分析问题和解决问题及临床实践技能，将TBL教学法及临床实践和病例分析引入医学遗传学教学中，学生通过查阅资料、团队讨论、社会实践等途径自主学习、自主研究，整个教学过程中贯穿着启发式、参与式教学，充分调动了学生学习的积极性和主观能动性，让学生成为学习的主体，集师生互动、同学互动和团队讨论、社会实践为一体的教学模式。在该教学模式中，学生对所学知识进行横向联系，纵向渗透，使基础医学知识和临床医学知识有效整合，取得了良好的教学效果。

Applied-Information Technology in Design of Ontology Integration of Clinical Medicine and Diagnosis System Based on Knowledge Management

Study on the clinical medical knowledge engineering, aims to build a large-scale, shared, reusable medical knowledge base, so as to provide the intelligent expert system of medicine, medical information retrieval system, medical education, medical natural language understanding etc.. In this paper, based on ontology integration technology, proposes an ontology integration of clinical medical knowledge management and computer-aided diagnosis system framework based on distributed ontology integration, and the technologies related to the knowledge management system is researched deeply, proposes a distributed ontology integration method based on semantics, in order to solve the information can not be shared between distributed information the distribution system and the problem of ontology integration, build a semantic platform can share the definition, design distributed ontology integration adapter, a reduction algorithm was proposed for distributed ontology integration relation, the ontology integration, reduce the redundant relation integrated ontology language, improving the quality and efficiency of ontology integration.