案例推理对中医临床案例研究的认识和启示

中医医案作为专家经验的载体,对指导中医临床实践、提升中医学者临证水平具有重要意义,人工智能领域案例推理技术有望弥补现有中医医案研究情境化特征缺失的遗憾.但由于不同类型的中医医案研究要点不同,因此,本文通过分析中医医案的分类、特点及研究现状,并通过考察案例推理的理论内涵及在中医医案方向的应用现状,探讨案例推理对中医临床案...     

《黄帝内经》修辞英译之“情理交融”

《黄帝内经》(以下简称《内经》)是我国现存较早的一部重要医学文献,其语言深奥典雅,风格隽秀,是中医古籍中运用修辞的典范。其修辞现象既是文字运用的一大特色,又是翻译的难点所在。故基于比喻、摹声、讳饰、谐韵等辞格角度,探讨如何依据题旨情境,在英译中实现本体与喻体、声象与物象、词形与韵律的有机结合,从而一方面清楚表达语义和逻辑关系,创建合理的结构形态和组织形式,另一方面又能充分展示中医内涵与文化意蕴,在译语中构建出鲜明的民族文化和情感意境,实现“形与意”“情与理”的符号转换,具有良好的学理价值与实践意义。     

CBL联合PACS教学模式在本科生骨科临床带教中的应用

目的探索Case-based learning(CBL)联合PACS (Picture Achieving & Communication System)、影像存档与传输系统教学模式在本科生临床带教中的应用效果。方法选取广西中医药大学第一附属医院骨科接受临床带教的80名本科生,随机分为2组。试验组为结合PACS的CBL教学组;对照组为PBL(Problem-based learning)组,通过2组学生的客观考核成绩与主观效果评价,对比2种方法在“股骨粗隆间骨折”教学中的应用效果。结果与对照组相比,试验组在客观考核成绩及主观效果评价的多个指标中均优于对照组,二者差异具有统计学意义(P<0.05)。结论结合了PACS的CBL模式教学可有效提高临床带教的效率,提升临床带教效果,具有很好的推广潜力。     

A narrative reasoning course to promote patient-centred practice in a physiotherapy undergraduate programme: a qualitative study of final year students

Abstract

Background: Narrative reasoning has been presented as a core component of the health professionals’ competencies.

Aim of the study: This study aimed to explore the students’ perspectives about the contribution of a narrative reasoning course to promote patient-centred practice.

Methods: An interpretative phenomenological analysis (IPA) was undertaken through focus groups. Eighteen volunteer final year students participated in three focus groups. Data analysis followed the IPA principles.

Findings: Three themes emerged: (1) “developing distinctive competencies”; (2) “shifting students’ focus” and (3) “challenging students’ professional identity”. In the first theme, students distinguished their capability to better understand patients’ experiences and needs and to be aware of the importance of a collaborative therapeutic relationship. In the second theme, students emphasized a shift from themselves as clinicians towards their patients. Finally, in the third theme participants shared the perspective that they have developed a different clinical profile, and that their reasoning and clinical actions have changed.

Conclusions: Students recognized the contribution of the course in developing competencies to facilitate patient-centred practice. Future research is needed to inform lecturers on how to best integrate narrative reasoning within the physiotherapy undergraduate curricula.     

Is problem-based learning an ideal format for developing ethical decision skills?

Ethical decision making is a complex process, which involves the interaction of knowledge, skills, and attitude. To enhance the teaching and learning on ethics reasoning, multiple teaching strategies have to be applied. A medical ethical reasoning (MER) model served as a framework of the development of ethics reasoning and their suggested instructional strategies. Problem-based learning (PBL), being used to facilitate students' critical thinking, self-directed learning, collaboration, and communication skills, has been considered effective on ethics education, especially when incorporated with experiential experience. Unlike lecturing that mainly disseminates knowledge and activates the left brain, PBL encourages “whole-brain” learning. However, PBL has several disadvantages, such as its inefficiency, lack of adequately trained preceptors, and the in-depth, silo learning within a relatively small number of cases. Because each school tends to utilize PBL in different ways, either the curriculum designer or the learning strategy, it is important to maximize the advantages of a PBL session, PBL then becomes an ideal format for refining students' ethical decisions and behaviors.     

Bricolage in action: learning about,making sense of,and discussing,issues about genetically modified crops and food

Making sense of new technologies and their associated risks entails lay people in utilizing various modes of reasoning and making use of a range of interpretative resources at hand to interrogate evidence. Such sense making is accomplished collectively in ways that are sometimes playfully inventive, and which have regard to ideas of accountability and morally acceptability. In practice, such bricolage-like processes appear to have certain similarities with the work of everyday scientific investigation. This paper examines these processes of lay practical reasoning by adopting an analytic stance that is concerned with examining the fine detail of what people demonstrably do in accomplishing such work. It draws on data generated by number of reconvened discussion groups, which formed a component part of the recent public debate in the UK about the possible commercialization of genetically modified crops.     

案例教学法在医学物理学教学中的应用

从案例教学法的优势、特点、预期达到的结果、效果、案例的设计思想、案例编写遵循的原则、实施过程、作用,以及存在的问题和注意事项等方面系统地阐述了案例教学法在医学物理学教学中的应用。将案例教学法引入到医学物理学课堂中来,它改变传统的教学模式,不改变现有的教学体制,其教学核心内容不变。案例引导教学能丰富教学内容,提高学习效率,是保证教学质量、增强学生实践能力和与就业岗位尽快尽早接轨的有效途径;同时案例教学法也是适应目前高等医学院校的教育现状、提高医学教学质量,培养具有创新精神和创新能力医学人才的重要途径。     

Seven characteristics of medical evidence

This paper outlines seven essential characteristics of medical evidence and describes the implications of these for both the theory of evidence-based medicine and clinical practice. The seven characteristics are: (1) Provisional; (2) Defeasible; (3) Emergent; (4) Incomplete; (5) Constrained; (6) Collective and (7) Asymmetric. It is argued that the epistemological theory that best fits medical evidence is that of fallibilism.     

Teaching Diagnostic Skills: Clinical Vignettes or Chief Complaints?

Two formats of case presentation are traditionally used for teaching problem-solving skills: clinical vignette or chief complaint formats. While the first one is more commonly used, it does not completely reflect the actual problem-solving process during a real encounter, which may hamper the learners to integrate separately acquired data gathering skills into their reasoning process and affect their diagnostic performance in practice. The present study compared diagnostic accuracy when the reasoning stimulus was a case vignette containing all diagnostic information versus the patient's chief complaint only. Forty-two medical students, 53 residents and 60 general internists participated in the study. Diagnostic accuracy was significantly lower for the chief complaint format at the student, resident, and practitioner levels. Analysis of the data gathered in the chief-complaint format revealed that faulty diagnostic decisions resulted from a failure to gather critical data. The results suggest that data gathering techniques, semiology, and medical reasoning should be trained in association and that this effort should be pursued beyond medical school.This revised version was published online in October 2005 with corrections to the Cover Date.     

Exploring Alternative Models of Complex Patient Management with Artificial Neural Networks

This study applied an unsupervised neural network modeling process to test data of the National Board of Medical Examiners (NBME) Computer-based Clinical Scenarios (CCS) to identify new performance categories and validate this process as a scoring technique. The classifications resulting from this neural network modeling were consistent with the NBME model in that highly rated NMBE performances (ratings of 7 or 8)were clustered together on the neural network output grid. Very low performance ratings appeared to share few common features and were accordingly classified at isolated nodes. This clustering was reproducible across three separately trained networks with greater than 80% agreement in two of the three network strained. However, the neural network also contained performance clusters where disparate NBME-based ratings ranged from 1 (worst) to 8 (best). Here,agreement between networks was less than 60%. Through visualization of the search strategies (search path mapping), this neural network clustering was found to be sensitive to quantitative and qualitative test selections such as excessive usage of irrelevant tests reflecting broader behavioral classification in some instances. A disparity between NBME ratings and an independent human rating system was detected by the neural network model since disagreement among raters was also reflected by a lack of neural network performance clustering. Agreement between rating systems, however, was correlated with neural network clustering for 92% of the highly rated performances.This revised version was published online in October 2005 with corrections to the Cover Date.