Advances in clinical applications of bioceramics in the new regenerative medicine era

In this editorial,we comment on the hard and soft tissue applications of different ceramic-based scaffolds prepared by different mechanisms such as 3D printing,sol-gel,and electrospinning.The new concept of regenerative medicine relies on biomaterials that can trigger in situ tissue regeneration and stem cell recruitment at the defect site.A large percentage of these biomaterials is ceramic-based as they provide the essential requirements of biomaterial principles such as tailored multisize porosity,antibacterial properties,and angiogenic properties.All these previously mentioned properties put bioceramics on top of the hierarchy of biomaterials utilized to stimulate tissue regeneration in soft and hard tissue wounds.Multiple clinical applications registered the use of these materials in triggering soft tissue regeneration in healthy and diabetic patients such as bioactive glass nanofibers.The results were promising and opened new frontiers for utilizing these materials on a larger scale.The same results were mentioned when using different forms and formulas of bioceramics in hard defect regeneration.Some bioceramics were used in combination with other polymers and biological scaffolds to improve their regenerative and mechanical properties.All this progress will enable a larger scale of patients to receive such services with ease and decrease the financial burden on the government.

Teaching Research and Effect Observation on the Integration of Clinical Medicine Integrated Course and Ideological and Political Elements from the Perspective of“Sanquan Education”

Purpose:To analyze the application path of the integration of clinical medicine integrated courses with the elements of ideology and politics under the theory of“Sanquan Education,”and to provide references for the promotion of educational reform in medical schools.Methods:60 clinical medicine undergraduates at Jiamusi University in 2018 and 2019 were randomly selected as research subjects.On the basis of the analysis of students’characteristics and pre-study content,the students were divided into the integration group and the traditional group,each with 30 students.Students in the integration group carried out clinical medicine integrated class with the integration of ideological and political elements.Students in the traditional group carried out the traditional clinical medicine integrated class.Classroom evaluation scales,anonymous questionnaires,and interviews were used to conduct research,collect data,and compare and observe the application effects.Results:After carrying out different modes of clinical medicine integrated courses,the undergraduates of the Excellent Physician Class in the integration group were higher than those in the traditional group in terms of teaching satisfaction,comprehensive quality,basic knowledge test,and case analysis scores through questionnaire analysis(P<0.05).In the evaluation of the effect of ideological education,the undergraduates of the Excellent Physician Class of the integration group were higher than the traditional group in terms of the acceptance of doctor-patient communication,the correct rate of mastering the history of the discipline,and the correct rate of mastering the frontiers and policies(P<0.05).Conclusion:Through the integration of clinical medicine integrated course and ideological and political elements,we can help students establish correct values while teaching them professional knowledge,improve the implementation of moral education in medical schools,cultivate excellent medical workers with high morality and firm beliefs for the society,and realize the fundamental educational task of establishing morality and educating people in medical schools in the context of“Sanquan Education.”

Mission of the National Cancer Center Hospital in Japan to promote clinical trials for precision medicine

Precision medicine is a growing field worldwide.Despite its potential benefit to many patients,several major obstacles must be overcome before precision medicine can be more widely used in clinical practice.The main obstacles are associated with the quality of samples used for genomic analysis。

Viral Hepatitis B and C: Epidemiological, Clinical and Paraclinical Aspects in the Internal Medicine Department of KARA University Hospital in Togo

Introduction: Viral hepatitis B and C constitute real public health problems worldwide. The objective of this work was to describe the epidemiological, clinical and paraclinical aspects of viral hepatitis B and c in the internal medicine department of Kara University Hospital. Method: this was a retrospective descriptive study carried out in the Internal Medicine department of Kara University Hospital, over a period of 3 years from March 2020 to April 2023. It included all patients seen in consultation or hospitalized for hepatitis viral B and/or C. Results: A total of 57 patients were included in our study. The average age was 44.30 years ± 16.75 and the M/F sex ratio was 1.38. Married people were in the majority 63.2%. The circumstances of the discovery of viral hepatitis B and C were dominated by abdominal pain in 35.1% of cases and hepatomegaly in 29.8% of cases and in 33.3% of cases, it was during screening voluntary. Patients with viral hepatitis B only accounted for 64.9% of cases;those with only viral hepatitis C represented 31.6% of cases and 3.5% of cases had HVB/HCV co-infection. We recorded 36.8% complications including 52.4% liver cirrhosis and 47.6% hepatocellular carcinomas. During the evolution, there were 03 deaths. Conclusion: the prevalence of hepatitis B and C virus carriage in patients followed in internal medicine at Kara University Hospital is high. It is therefore essential to put in place treatment and prevention strategies against these viruses.

Analysis of the Clinical Effect of Chinese Medicine Combined with Acupuncture and Moxibustion on Insomnia

Objective:To explore and analyze the clinical efficacy of Chinese medicine combined with acupuncture and moxibustion in the treatment of insomnia.Method:80 patients with primary insomnia were selected as the study sample,with 20 cases randomly selected as the control group and the rest as the observation group.The control group was treated with ordinary western medicine,while the observation group patients were treated with traditional Chinese medicine combined with acupuncture and moxibustion based on this syndrome differentiation.The comparison items were treatment effect,sleep quality,mental health,quality of life,specific sleep indicators,cerebral blood flow and neurotransmitters.Result:The treatment effectiveness showed that the observation group had a higher treatment effectiveness rate than the control group(P<0.05);The results of sleep quality showed that after treatment,the scores of the observation group were lower than those of the control group in seven dimensions:sleep quality,sleep time,sleep onset time,sleep efficiency,sleep disorders,hypnotic drugs,and daytime dysfunc‐tion score(P<0.05);The quality of life results showed that after treatment,the observa‐tion group had higher scores than the control group in eight dimensions:physiological function,physiological function,physical pain,health status,energy,social function,emotional function,and mental health(P<0.05);The results of slow wave sleep time and fast eye movement sleep time showed that after treatment,the HAMA and HAMD scores of the physiological mechanism in the observation group were lower than those in the control group(P<0.05);The results of cerebral blood flow and neurotransmitter indica‐tors show that after treatment,glutamateγ-The peak systolic blood flow velocity of ami‐nobutyric acid,vertebral artery,and basilar artery in the observation group was higher than that in the control group(P<0.05).Conclusion:The clinical treatment of Chinese medicine combined with acupuncture and moxibustion in the treatment of insomnia patients can significantly improve the clinical treatment effect,and improve the cerebral hemorrhage and neurotransmitter status of patients,promote the improvement of their physical and mental status,can more significantly improve the quality of sleep,reduce sleep difficulties,reduce the dosage of sleeping pills,which has important clinical application value.

Effectiveness and safety of traditional Chinese medicine for diabetic retinopathy:A systematic review and network meta-analysis of randomized clinical trials

BACKGROUND Diabetic retinopathy(DR)is currently recognized as one of the most serious diabetic microangiopathies and a major cause of adult blindness.Commonly used clinical approaches include etiological control,microvascular improvement,and surgical intervention,but they are ineffective and have many side effects.Oral Chinese medicine(OCM)has been used for thousands of years to treat DR and is still widely used today,but it is unclear which OCM is more effective for DR.AIM To estimate relative effectiveness and safety profiles for different classes of OCMs for DR,and provide rankings of the available OCMs.METHODS The search time frame was from the creation of the database to January 2023.RevMan 5.3 and Stata 14.0 software were used to perform the systematic review and Network meta-analyses(NMA).RESULTS A total of 107 studies and 9710 patients were included,including 4767 cases in the test group and 4973 cases in the control group.Based on previous studies and clinical reports,and combined with the recommendations of Chinese guidelines for the prevention and treatment of DR,9 OCMs were finally included in this study,namely Compound Xueshuantong Capsules,Qiming Granules,Compound Danshen Dripping Pills,Hexue Mingmu Tablets(HXMM),Qiju Dihuang Pills(QJDH),Shuangdan Mingmu Capsules(SDMM),Danggui Buxue Decoction(DGBX),Xuefu Zhuyu Decoction and Buyang Huanwu Decoction.When these nine OCMs were analyzed in combination with conventional western medicine treatment(CT)compared with CT alone,the NMA results showed that HXMM+CT has better intervention effect on the overall efficacy of DR patients,HXMM+CT has better effect on improving patients'visual acuity,SDMM+CT has better effect on inhibiting vascular endothelial growth factor,DGBX+CT has better effect on reducing fundus hemorrhage area,HXMM+CT has better effect on reducing fasting blood glucose,and QJDH+CT has better effect on reducing glycated hemoglobin.When there are not enough clinical indicators for reference,SDMM+CT or HXMM+CT treatments can be chosen because they are effective for more indicators and demonstrate multidimensional efficacy.CONCLUSION This study provides evidence that combining OCMs with CT leads to better outcomes in all aspects of DR compared to using CT alone.Based on the findings,we highly recommend the use of SDMM or HXMM for the treatment of DR.These two OCMs have demonstrated outstanding efficacy across multiple indicators.

Summary and clinical application of Zhuang medicine medicated thread moxibustion

Zhuang medicine medicated thread moxibustion is a kind of external therapy with ethnic medicine characteristics that spreads in Guangxi Zhuang region.It has a wide range of clinical application and significant curative effect,and can be used to treat diseases such as internal medicine,surgery,dermatology,gynecology,pediatrics,and five sense organs.Through reviewing and combing the literature on the Zhuang medicine medicated thread moxibustion in recent years,this paper summarizes and prospects its clinical application,with a view to further explaining the basic principles and application rules of Zhuang medicine medicated thread moxibustion and digging its clinical value.

Exploring the Application Effect of Flipped Classroom Combined with Problem-Based Learning Teaching Method in Clinical Skills Teaching of Standardized Training for Resident Doctors of Traditional Chinese Medicine

Objective: To explore the application effect of flipped classroom combined with problem-based learning teaching method in clinical skills teaching of standardized training for resident doctors of traditional Chinese Medicine. Methods: The study used the experimental control method. The study lasted from September to November 2022. The subjects of this study were 49 students of standardized training for resident doctors of traditional Chinese Medicine from grades 2020, 2021 and 2022 of Dazhou integrated TCM & Western Medicine Hospital. They were randomly divided into experiment group (25) and control group (24). The experiment group adopted flipped classroom combined with problem-based learning teaching method, and the control group adopted traditional teaching method. The teaching content was 4 basic clinical skill projects, including four diagnoses of traditional Chinese Medicine, cardiopulmonary resuscitation, dressing change procedure, acupuncture and massage. The evaluation method was carried out by comparing the students’ performance and a self-designed questionnaire was used to investigate the students’ evaluation of the teaching method. Results: The test scores of total scores in the experimental group (90.12 ± 5.89) were all higher than those in the control group (81.47 ± 7.96) (t = 4.53, P P Conclusions: The teaching process of the flipped classroom combined with problem-based learning teaching method is conducive to improving the efficiency of classroom teaching, cultivating students’ self-learning ability, and enhancing students’ willingness to learn.

Epidemiological, Clinical, Bacteriological Profile of Urinary Tract Infection in the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes

Introduction: Urinary tract infection is one of the most frequent public health problems in the world and concerns all ages. Objective: To describe the epidemiological, clinical and biological profile of urinary tract infection in the internal medicine unit of the Fousseyni Daou hospital in Kayes. Methodology: It was a descriptive and cross-sectional study with retrospective data collection which took place from January 1 to December 31, 2020 at the Internal Medicine Unit of the Fousseyni Daou Hospital in Kayes. It covered all outpatients and hospitalized patients presenting with a urinary tract infection during the study period. Results: We identified 79 cases of urinary tract infection out of 145 requests for ECBU, that is a positivity rate of 53.10% and out of a total of 1883 admissions that is a hospital prevalence of 4.19%. The age groups of 36 to 45 years and 46 to 55 years were more represented in 28 cases (35.44%) and 25 cases (31.64%) with an average age of 45 years ± 10. The female sex was predominant, 42 cases (53.16%) with a sex ratio of 0.88. Housewives were more represented 28 cases (34.44%). The majority of patients resided in rural areas 49 cases (62.03%). The history was dominated by the following pathologies: hypertension 48.10%, diabetes 36.70% and gastropathy 30.37%. The main clinical manifestations were: Urinary burning 67 cases (84.81%), Dysuria 65 cases (82.27%), Pelvic pain 59 cases (74.68%), Fever 57 cases (72.15%). The epidemiological profile of the isolated strains was dominated by enterobacteriaceae, followed by gram-positive cocci and gram-negative bacilli. The main bacteria responsible for urinary tract infections in order of frequency: Escherichia coli (45.56%), Klebsiella pneumoniae (11.39%), Pseudomonas aeruginosa (8.86%), Staphylococcus aureus (7.59%), Streptococcus sp (6.33%), Enterobacter cloacae (3.79%), Acinetobacter sp (3.79%). The study of the susceptibility and resistance profiles of the isolated strains showed significant sensitivity of enterobacteriaceae to colistin and resistance to amoxicillin and to the amoxicillin + clavulanic acid combination. Conclusion: Urinary tract infections are a major public health problem since they are responsible for significant morbidity and mortality and a high cost of care. Knowledge of the epidemiological-clinical and bacteriological profile of these infections is essential for efficient management.

Clinical Observation of Warm Needling Acupuncture of Mongolian Medicine in the Treatment of Lumbar Disc Herniation

[Objectives]To observe the clinical efficacy of warm needling acupuncture of Mongolian medicine in the treatment of lumbar disc herniation(LDH).[Methods]120 patients with lumbar disc herniation hospitalized in Inner Mongolia International Mongolian Hospital from June 2019 to June 2022 were randomly divided into observation group(n=60)and control group(n=60).The observation group was treated with warm needling acupuncture of Mongolian medicine,and the control group was treated with common acupuncture of Mongolian medicine,with two weeks as a course of treatment.The pain visual analogue scale(VAS)and Japanese orthopaedic association(JOA)score were observed before and after treatment,and the clinical efficacy was evaluated by the changes of clinical symptoms and signs of Mongolian medicine.[Results]The cure rate of the observation group was 71.7%,which was better than that of the control group(53.3%).The difference in the cure rate between the two groups was statistically significant,X 2=4.302,P=0.038.The total markedly effective rate(cured+markedly effective)of the observation group was 90.0%,while that of the control group was 83.3%.There was no significant difference in the total markedly effective rate between the two groups,X 2=1.154,P=0.283.The total effective rate(cured+markedly effective+effective)of the observation group was 100%,while that of the control group was 95.0%.There was no significant difference in the total effective rate between the two groups,and the continuous corrected chi-square value was 1.368 and 0.242.After treatment,the degree of low back pain,lower limb pain and dyskinesia were significantly improved in the two groups,the observation group was better than the control group,and the difference was statistically significant(P<0.05).[Conclusions]The warm needling acupuncture of Mongolian medicine was effective in the treatment of lumbar disc herniation,which is worth popularizing.

Clinical Observation and Safety Evaluation of Zhuang Medicine Xiaoyan Zhiyang Formula for Dermatosis

[Objectives]To observe the clinical efficacy and safety of Zhuang Medicine Xiaoyan Zhiyang Formula by retrospective analysis of clinical use.[Methods]A total of 225 cases were collected,including 117 males and 108 females,115 cases of contact dermatitis and 110 cases of acute eczema.Zhuang Medicine Xiaoyan Zhiyang Formula was administered to 225 patients with contact dermatitis and acute eczema and the clinical efficacy was evaluated.[Results]After one week of treatment,among 225 patients with contact dermatitis and acute eczema,76 cases were cured(33.78%),133 cases showed marked response(59.11%),16 cases(7.11%)were improved,0 case was ineffective,and the overall response rate was 92.89%.After one week of Zhuang Medicine Xiaoyan Zhiyang Formula treatment,the symptoms of itching,pain and swelling were significantly improved in all patients,and the rash was partially crusted without new symptom,and there were no complications and adverse reactions.[Conclusions]Zhuang Medicine Xiaoyan Zhiyang Formula therapy has a remarkable effect in the treatment of contact dermatitis and acute eczema.

CSCO guidelines for metastatic colorectal cancer:personalized medicine in clinical practice

Colorectal cancer(CRC)is the second most common cancer in China,the morbidity and mortality rates of which are rapidly increasing1,2.Among newly-diagnosed CRC patients,20%have metastatic disease at the time of presentation and an additional 25%present with localized disease and will subsequently develop metastases3.The treatment of metastatic colorectal cancer(mCRC)is gradually moving towards the era of precision therapy,which involves guided treatment based on individual genetic characteristics4.Since the first edition of the Chinese Society of Clinical Oncology(CSCO)guidelines was published in 2017,the guidelines have been updated annually according to the latest clinical trial findings5-9.Herein we summarize how the CSCO guidelines enable tailor-made treatments of mCRC with different molecular characteristics(Figure 1).

Application of Heuristic Method to the Clinical Teaching of Internal Medicine

There is an old saying,“Give a man a fish,and he will eat for a day.Teach a man to fish,and he will eat for the rest of his life.”In clinical teaching,students should not only be taught about diseases,but their intelligence should also be cultivated,along with their analytical,comprehension,and independent learning skills.The ability to solve problems enables students to think independently and acquire knowledge.This is known as the heuristic method of teaching.In this study,we mainly analyze the application value of the heuristic method in the clinical teaching of internal medicine.

Clinical Evaluation of the Safety and Efficacy of the Phytomedicine APIVIRINE Based on Aqueous Extracts of Dichrostachys glomerata (Forssk.). Chiov. (D. cinerea) in COVID-19 Patients without Signs of Severity

Background: Since the appearance of the COVID-19 pandemic, several drugs have also been proposed for the treatment of the COVID-19, but the therapeutic effectiveness of those drugs is not satisfactory. This situation has led to the search for therapeutic solutions based on recipes from traditional medicine. Aims: This study aimed to evaluate the clinical safety, efficacy and tolerability of the phytomedicine APIVIRINE in patients with non-severe COVID-19. Methods: Patients were included following defined criteria and followed on an outpatient basis until recovery in accordance with national guidelines for the management of single cases of COVID-19 in Burkina Faso. Vital signs, anthropometric parameters as well as electrocardiographic, hematological and biochemical examinations were measured on D4, D7, D14 and D21. Adverse events were recorded during maintenance. Results: The present study included 45 patients. The clinical signs present at inclusion were mostly cough (44.44%), asthenia (42.22%), headache (40%), and anosmia (35.55%). Dyspnoea and chest pain were less represented in 05 (11.11%) and 06 (13.33%) patients. Cough, dyspnoea, chest pain, fever, sore throat, headache, and nasal obstruction present at inclusion disappeared before Day 4 of treatment. Anosmia and asthenia disappeared before Day 7. At the inclusion visit (Day 1), CRP, WBC, and blood glucose were abnormal in 15 (33.33%), 13 (28.89%), and 11 (24.44%) patients respectively. In addition, 3 (6.66%) patients had elevated creatinine levels. Transaminases Alanine aminotransferase (ALAT) were elevated in 05 (11.11%) patients while Aspartate aminotransferase (ASAT) was elevated in 04 (8.89%) patients. After 4 days of treatment, the cure rate was 33.33% of patients and 48.89% after 7 days. The cumulative cure rate was 86.67% after 14 days of treatment. Conclusion: No serious side effects or allergic reactions were observed during treatment. No clinical complications were observed and all symptoms present resolved on the 7th day of treatment.

Clinical Study on External Use of Chinese Medicine in Treating Children with Herpetic Stomatitis

Background: Pediatric herpetic stomatitis is a common pediatric disease, the course of the disease is about 1 - 2 weeks, and it usually occurs in 1 - 3 years old children, due to infection of herpes simplex virus I and onset. Objective: To observe the curative effect of Chinese medicine prescription (Yueshi, Zhongbai, Qingdai, Phelloderma phelloderma and glycyrrhiza) on children with herpetic stomatitis. Methods: 90 patients were divided into 2 groups by random number table method. 45 patients in the observation group were treated with traditional Chinese medicine, and 45 patients in the control group were treated with iodine glycerin. The total effective rate after treatment was compared between the two groups. Results: The total effective rate of the treatment group was 95.55%;the total effective rate of the control group was 71.11%;the total effective rate of the two groups after treatment was compared;the treatment group was significantly better than the control group;the difference was significant (P 0.05). Conclusion: The external use of Chinese medicine in the treatment of pediatric herpetic stomatitis has achieved good results, improving the condition of children, and significantly improving the clinical efficacy.

The evolution of cancer genomic medicine in Japan and the role of the National Cancer Center Japan

The journey to implement cancer genomic medicine(CGM)in oncology practice began in the 1980s,which is considered the dawn of genetic and genomic cancer research.At the time,a variety of activating oncogenic alterations and their functional significance were unveiled in cancer cells,which led to the development of molecular targeted therapies in the 2000s and beyond.Although CGM is still a relatively new discipline and it is difficult to predict to what extent CGM will benefit the diverse pool of cancer patients,the National Cancer Center(NCC)of Japan has already contributed considerably to CGM advancement for the conquest of cancer.Looking back at these past achievements of the NCC,we predict that the future of CGM will involve the following:1)A biobank of paired cancerous and non-cancerous tissues and cells from various cancer types and stages will be developed.The quantity and quality of these samples will be compatible with omics analyses.All biobank samples will be linked to longitudinal clinical information.2)New technologies,such as whole-genome sequencing and artificial intelligence,will be introduced and new bioresources for functional and pharmacologic analyses(e.g.,a patient-derived xenograft library)will be systematically deployed.3)Fast and bidirectional translational research(bench-to-bedside and bedside-to-bench)performed by basic researchers and clinical investigators,preferably working alongside each other at the same institution,will be implemented;4)Close collaborations between academia,industry,regulatory bodies,and funding agencies will be established.5)There will be an investment in the other branch of CGM,personalized preventive medicine,based on the individual's genetic predisposition to cancer.

Epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China:a hospital-based retrospective study

Traumatic spinal cord injury is potentially catastrophic and can lead to permanent disability or even death.China has the largest population of patients with traumatic spinal cord injury.Previous studies of traumatic spinal cord injury in China have mostly been regional in scope;national-level studies have been rare.To the best of our knowledge,no national-level study of treatment status and economic burden has been performed.This retrospective study aimed to examine the epidemiological and clinical features,treatment status,and economic burden of traumatic spinal cord injury in China at the national level.We included 13,465 traumatic spinal cord injury patients who were injured between January 2013 and December 2018 and treated in 30 hospitals in 11 provinces/municipalities representing all geographical divisions of China.Patient epidemiological and clinical features,treatment status,and total and daily costs were recorded.Trends in the percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department and cost of care were assessed by annual percentage change using the Joinpoint Regression Program.The percentage of traumatic spinal cord injuries among all hospitalized patients and among patients hospitalized in the orthopedic department did not significantly change overall(annual percentage change,-0.5%and 2.1%,respectively).A total of 10,053(74.7%)patients underwent surgery.Only 2.8%of patients who underwent surgery did so within 24 hours of injury.A total of 2005(14.9%)patients were treated with high-dose(≥500 mg)methylprednisolone sodium succinate/methylprednisolone(MPSS/MP);615(4.6%)received it within 8 hours.The total cost for acute traumatic spinal cord injury decreased over the study period(-4.7%),while daily cost did not significantly change(1.0%increase).Our findings indicate that public health initiatives should aim at improving hospitals’ability to complete early surgery within 24 hours,which is associated with improved sensorimotor recovery,increasing the awareness rate of clinical guidelines related to high-dose MPSS/MP to reduce the use of the treatment with insufficient evidence.

A multi-modal clustering method for traditonal Chinese medicine clinical data via media convergence

Media convergence is a media change led by technological innovation.Applying media convergence technology to the study of clustering in Chinese medicine can significantly exploit the advantages of media fusion.Obtaining consistent and complementary information among multiple modalities through media convergence can provide technical support for clustering.This article presents an approach based on Media Convergence and Graph convolution Encoder Clustering(MCGEC)for traditonal Chinese medicine(TCM)clinical data.It feeds modal information and graph structure from media information into a multi-modal graph convolution encoder to obtain the media feature representation learnt from multiple modalities.MCGEC captures latent information from various modalities by fusion and optimises the feature representations and network architecture with learnt clustering labels.The experiment is conducted on real-world multimodal TCM clinical data,including information like images and text.MCGEC has improved clustering results compared to the generic single-modal clustering methods and the current more advanced multi-modal clustering methods.MCGEC applied to TCM clinical datasets can achieve better results.Integrating multimedia features into clustering algorithms offers significant benefits compared to single-modal clustering approaches that simply concatenate features from different modalities.It provides practical technical support for multi-modal clustering in the TCM field incorporating multimedia features.

An Exploration of How Practitioners Make Meaning in a Chinese Medicine Consultation and Treatment

In Chinese medicine, practitioners assess patients’ complaints, analyze their underlying problems, identify causes and come to a diagnosis, which then directs treatment. What is not obvious and not recorded in a consultation is the clinical reasoning process that practitioners use. The research filmed three practitioners in the UK while they conducted a consultation and treatment on new patients. The practitioners and researchers viewed the films and used them as aide-memoirs while the reasoning process throughout was discussed. In order to determine the pattern, practitioners used the four examinations to gather information from the patient in an iterative process;their aesthetic reasoning was highly developed. Through triangulation they checked the information they received against a detailed understanding of the qi-dynamic. They used highly analytical strategies of forward(inductive) and backward(deductive) reasoning against the prototypes of the signs and symptoms that indicate a specific Zheng. This was achieved through an abductive process that linked description with explanation and causal factors with pathological mechanisms. The feedback loop with the patient continued through the consultation and into the treatment. A process of translation and interpretation was needed to turn the patient’s story into the practitioner’s story of qi-dynamics that then directed the treatment. Awareness of our clinical reasoning process will mitigate against biases, improve our diagnoses and treatment choices and support the training of students.

Are case reports valuable?Exploring their role in evidence based medicine and patient care

Case reports,often overlooked in evidence-based medicine(EBM),play a pivotal role in healthcare research.They provide unique insights into rare conditions,novel treatments,and adverse effects,serving as valuable educational tools and generating new hypothesis.Despite their limitations in generalizability,case reports contribute significantly to evidence-based practice by offering detailed clinical information and fostering critical thinking among healthcare professionals.By acknowledging their limitations and adhering to reporting guidelines,case reports can contribute significantly to medical knowledge and patient care within the evolving landscape of EBM.This editorial explores the intrinsic value of case reports in EBM and patient care.