Case Records as Medical Stories: A Song-dynasty Doctor’s Narration of His Own Medicine-Xu Shuwei (1080-1154)

The key point in studying or teaching the history of Chinese medicine is on the doctrines underlying it and on its perception of the body,physiology,pathology,and its treatment.Namely,there is often a tendency to focus on reading and analysing the classical canons and therapy-related texts including formularies and materia medica collections.However,focusing on these sources provides us with a one-sided presentation of Chinese medicine.These primary sources lack the clinical down-to-earth know-how that encompasses medical treatment,which are represented,for instance,in the clinical rounds of modern medical schools.Our traditional focus on the medical canons and formularies provides almost no clinical knowledge,leaving us with a one-sided narrative that ignores how medicine and healing are actually practiced in the field.This paper focuses on the latter aspect of medicine from a historical perspective.Using written and visual sources dating to the Song dynasty,clinical encounters between doctors and patients including their families are depicted based on case records recorded by a physician,members of the patient’s family,and bystanders.This array of case records or case stories will enable us to narrate the interaction between physicians and patients both from the clinical perspective and from the social interaction.This paper will also discuss visual depictions of the medical encounter to provide another perspective for narrating medicine during the Song dynasty.Medical case records and paintings depicting medical encounters are exemplary of the potential of Chinese primary sources for narrative medicine.

Rethinking Yi’an(Medical Cases)as a Tool for Narrative Medicine in China

When narrative medicine(NM)was introduced into China,traditional Chinese medicine scholars found that the core concepts advocated by NM are manifested in Chinese yi’an.But why NM echoes with ancient Chinese yi’an?How can we better integrate NM into Chinese medical practices?To answer those questions,this article first investigates how NM establishes itself as a remedy to biomedicine by taking traditional healing models including TCM as its ideal Other.Then,the narrative traditions of both case histories and yi’an are examined respectively.This article argues that NM is searching for a lost tradition of narrative case histories,but yi’an functions as a living tradition of TCM.The Parallel Chart in NM,designed as a complement to the dehumanized hospital chart,is still based on a dichotomy of science and art and a conflictual doctor-patient model.But yi’an exemplifies the holistic and humane healthcare that NM hopes to achieve.A comparison of both genres also inspired us to rethink the genre of yi’an in NM.Thus,it is concluded that yi’an should be viewed as an epistemic genre integrating individualization and generalization,a bridge linking medicine and literature.And narrative yi’an can well serve as a tool for NM in China.It is also proposed that a thick description of yi’an be encouraged to further promote a pluralistic NM in China.

The Practice and Exploration of Applying EBM to Bilingual Teaching of Medical Genetics at OSBCM

In the process of teaching medical genetics of undergraduate clinical medicine, the practice and exploration of applying EBM to the bilingual teaching of OSBCM medical genetics are carried out. Using CBL and PBL as the carrier can make up for the shortcomings of a single teaching mode, synthesize the advantages of multiple teaching modes. It starts from integrating the basic theoretical knowledge of medicine and clinical practice knowledge, improving students’ bilingual level of medical genetics, cultivating students’ literature retrieval ability, and promoting early clinical, multi-clinical and repeated clinical consciousness for medical students. Therefore, it is more conducive to cultivate students’ ability to learn independently, accurately analyze and solve problems, improve medical students’ clinical thinking ability and scientific research awareness, improve medical students’ ability of international communication, and lay a solid foundation for improving medical students’ future post competence, innovative spirit and lifelong learning ability.

Medical Legal Dispute in Hospitals of Different Grades： A Retrospective Study on 206 Cases

Objective To analyze the characteristics of medical malpractice from different grades of hospitals and to explore forensic investigation strategies in assessing medical dispute. Methods A total of206 cases of medical dispute from 2009 to 2010 investigated by the Department of Forensic Medicine in Nanjing Medical University were selected and analyzed according to fault incidence, fault-prone part,and degree of causality in the treatment. Results Among the 206 cases analyzed, tertiary hospitals, secondary hospitals and primary hospitals showed medium, high and low error rate, respectively. A majority of medical malpractice cases were distributed in the departments of surgery, medicine and gynecology.Conclusion The frequency and severity of medical malpractice in primary hospitals were high, which were gradually reduced in tertiary and secondary hospitals.

External Association Analysis of Famous Doctors' Dysmenorrhea Medical Cases Based on Data Mining

Objective:Dysmenorrhea is a common gynecological disease.Some severe symptoms affect the quality of life,causing physical and psychological discomfort.To analyze the dysmenorrhea cases of famous Senior traditional Chinese medicine(TCM)doctors and TCM masters through the data mining technology and explore core related rules between the symptoms,pathogenesis,coated tongue,pulse condition,so as to deeply deconstruct the law of TCM clinical differentiation and treatment of dysmenorrhea,verify the effectiveness of the law,and optimize the clinical TCM diagnosis and treatment scheme.Methods:The external correlation analysis of dysmenorrhea medical cases through the Medcase data processing platform and the algorithm of FP-Growth enhanced association analysis was applied.Results:Altogether 171 medical records were studied,which included 171 female patients and 483 clinical visits.The age of the oldest patient was 49,the age of the youngest was 14,the average age was 28 years old.The medical cases involoved 41 kinds of pathogenesis,147 clinical symptoms,16 types of pulse condition,84 types of coated tongue and 292 traditional Chinese medicine.The external correlation processing revealed that there were 25 groups of clinical symptoms and TCM association rules;17 groups of clinical symptoms and secondary TCM association rules;21 groups of pathogenesis and Chinese medicine association rules;34 rules of coated tongue and Chinese medicine association rules;19 rules of pulse condition and Chinese medicine association rules;28 rules of clinical symptoms and pathogenesis associations.Conclusion:When treating dysmenorrhea according to the differentiation and treatment of TCM,the viscera location of the core pathogenesis mainly are kidney,spleen and liver,the pathological factors focus on blood deficiency,blood stasis and qi stagnation.The highly-related TCM include Danggui(Radix Angelicae Sinensis),Baishao(Radix Paeoniae Alba),Chuanxiong(Rhizoma Ligustici),Yanhusuo(Rhizoma Corydalis),Xiangfu(Rhizoma Cyperi).The study of these rules has reference value for the acquisition of the core pathogenesis,the clinical differentiation and the medication.

Operating in Tandem Chinese experts in Sao Tome and Principe cooperate with local farmers to raise medical standards in the breeding industry

Santomean pig farmer Simao Vicente was hopeful when he came to ask Zou Rui for help. His pig was suffering from hernia, and Zou, a 42-year-old Chinese agricultural expert working in Sao Tomé and Príncipe, was the only person on the island who could provide emergency surgery.

A Medical Case of Acne Vulgaris Treated with Danggui Shaoyao Powder Combined with Sini Powder

Acne vulgaris is a chronic inflammatory skin disease damaging face,and the incidence of acne vulgaris is increasing year by year in China.Acne falls into the category of pimple in traditional Chinese medicine,and there are many dialectical understandings of acne in modern traditional Chinese medicine.Dr.He Aijuan has a unique diagnosis and treatment thinking in treating acne vulgaris(liver stagnation and spleen deficiency type)with traditional Chinese medicine in her clinical work for many years.Her application of Danggui Shaoyao Powder combined with Sini Powder has a remarkable effect in the clinical treatment process,so a clinical medical case is selected for discussion.

Using the Delphi method to propose foods for special medical purposes health effect evaluation indicators

Objective:The Delphi method was used to propose health effect evaluation indicators to assess foods for special medical purposes(FSMPs).This lays the foundation for the formation of a big data model for human health testing,as well as a big data platform for the health and safety evaluation of special medical foods.Methods:The Delphi method was used to conduct two rounds of expert consultation on the constructed FSMP health effect evaluation indicators.Results:Ten major items were identified after two rounds of expert consultation.Among these,there were 10 primary entries,32 secondary entries,50 tertiary entries,and 28 quaternary entries.Conclusion:The complete list of evaluation indicators contains 10 entries,which can comprehensively and systematically monitor adverse reactions to the use of FSMPs.The present findings lay the foundation for a big data platform to evaluate the health and safety of special foods.

Severe hypoxemia after radiofrequency ablation for atrial fibrillation in palliatively repaired tetralogy of Fallot: A case report

BACKGROUND Patients with tetralogy of Fallot(TOF)often have arrhythmias,commonly being atrial fibrillation(AF).Radiofrequency ablation is an effective treatment for AF and does not usually cause severe postoperative hypoxemia,but the risk of complications may increase in patients with conditions such as TOF.CASE SUMMARY We report a young male patient with a history of TOF repair who developed severe hypoxemia after radiofrequency ablation for AF and was ultimately confirmed to have a new right-to-left shunt.The patient subsequently underwent atrial septal occlusion and eventually recovered.CONCLUSION Radiofrequency ablation may cause iatrogenic atrial septal injury;thus possible complications should be predicted in order to ensure successful treatment and patient safety.

Impact of specialized nursing outpatient case management on postcoronary artery bypass grafting patients

BACKGROUND Some patients with coronary atherosclerotic heart disease experience major adverse cardiac events(MACE)and require readmission after Coronary Artery Bypass Grafting(CABG)surgery.This is often attributed to patients'unhealthy lifestyles and dietary habits,inadequate understanding of the disease,and poor disease management compliance.Thus,searching for more targeted nursing intervention models that can enhance patients'self-management abilities and reduce the risk of readmission after CABG surgery is significant.AIM To observe the impact of specialized nursing outpatient case management on patients after CABG surgery.METHODS A total of 103 patients who underwent CABG surgery in our hospital between April 2021 and April 2022 comprised the study sample.The patients were divided into two groups using an odd-even number grouping method.The control group received routine nursing care,while the case management group received specialized nursing outpatient case management.The differences in psychological status,adherence to medical treatment,self-care ability,knowledge mastery,quality of life scores,and the occurrence rate of MACE were compared between the two groups.RESULTS After the intervention,the case management group had lower scores on the selfrating depression scale and self-rating anxiety scale and lower MACE rate,as well as higher scores for adherence to a healthy diet,medication adherence,good lifestyle habits,regular exercise,and timely follow-up,higher scores on the Coronary Heart Disease Self-Management Scale,higher scores for managing adverse habits,symptoms,emotional cognition,emergency response,disease knowledge,general lifestyle,and treatment adherence,higher scores for understanding coronary heart disease,recognizing the importance of medication adherence,understanding selfcare points after CABG surgery,and being aware of post-CABG precautions,higher scores for physical well-being,disease condition,general health,social-psychological well-being,and work-related aspects(P<0.05).CONCLUSION Specialized nursing outpatient case management can enhance patient adherence to medical treatment,knowledge mastery,psychological well-being,and overall quality of life in patients after CABG surgery.

Medical Diagnosis Expert System for Malaria and Related Diseases for Developing Countries

There is a strong need for cost-effective technologies to manage disease processes and thus reduce morbidity and mortality in the developing countries. Yet bringing intelligent healthcare informatics to bear on the dual problems of reducing healthcare costs and improving quality and outcomes is a challenge even in countries with a reasonably developed technology infrastructure. This paper focused at how appropriate an ap-plication of Medical Diagnosis Expert System (MDES) is to manage diseases in developing countries. MDES is usually designed to enable clinicians to identify diseases and describe methods of treatment to be carried out taking into account the user capability. The MDES described here is implemented using the C Language Integrated Production System (CLIPS). The CLIPS is an expert system, which has a shell composed of four modules: the user interface, the explanation system, the inference engine and the knowledge base editor. In the system, a number of patient cases will be selected as prototypes and stored in a separate database. The knowledge is acquired from literature review, human experts and the internet of the specific domain and is used as a base for analysis, diagnosis and recommendations.

Examination of Three Case Studies of Caring for Psychiatric Patients on a Medical Surgical Unit

Medical surgical nurses frequently care for patients with psychiatric disorders as one in four people have a diagnosed psychiatric disorder. Since these nurses specialize in medical surgical nursing, they often feel they lack the expertise to care for patients with co-morbid psychiatric problems. This article presents three case studies and delineates nursing care strategies which could assist the medical-surgical nurses in caring for this population.

Clinical diagnosis,treatment,and medical identification of specific pulmonary infection in naval pilots:Four case reports

BACKGROUND Specific pulmonary infection could seriously threaten the health of pilots and their companions.The consequences are serious.We investigated the clinical diagnosis,treatment,and medical identification of specific pulmonary infections in naval pilots.CASE SUMMARY We analyzed the medical waiver and clinical data of four pilots with specific pulmonary infections,who had accepted treatment at the Naval Medical Center of Chinese People’s Liberation Army between January 2020 and November 2021,including three cases of tuberculosis and one of cryptococcal pneumonia.All cases underwent a series of comprehensive treatment courses.Three cases successfully obtained medical waiver for flight after being cured,while one was grounded after reaching the maximum flight life after being cured.CONCLUSION Chest computed tomography scanning should be used instead of chest radiography in pilots’physical examination.Most pilots with specific pulmonary infection can be cured and return to flight.

Study on medication regularity of traditional Chinese medicine cases in treatment of neoplastic fever based on data mining

Objective:To analyze the medication regularity of traditional Chinese medicine cases in treatment of neoplastic fever in order to guide clinical medication.Methods:The database of China National Knowledge Infrastructure,Vip database and WanFang medical network were searched.The cases involving traditional Chinese medicine prescription in the treatment of neoplastic fever were screened.After extracting the prescriptions and Chinese medicines,make statistics according to frequency analysis,cluster analysis and association analysis.Results:79 literatures were included which involving 123 decoctions.221 traditionalChinese medicines were included in the statistics,the most frequently used traditional Chinese medicines were Gancao,Chaihu,Huangqi and Shengdihuang.The proportion of heat-clearing drugs in Chinese medicines was the largest(23.98%).The most common property of the Chinese medicines is cold property,accounting for 51.13%.The higher frequencies of flavors of the Chinese medicines are bitter,sweet and acrid,the sum of which is 84.66%.The most common meridian of Chinese medicines is liver meridian,accounting for 19.82%.The cluster analysis and association analysis of high frequency Chinese medicines showed that high frequency Chinese medicines could form three clustering formulas,and could get 18 pairs of high frequency drug combinations.Conclusion:Traditional Chinese medicines for heat-clearing,deficiencytonifying,phlegm-resolving,blood stasis-dispeling are mostly used to the treatment of neoplastic fever.The results of cluster analysis and association analysis of high frequency traditional Chinese medicines can provide certain reference and guidance for clinical medication.

The Design and Implementation of a Medical Parasitology Teaching Case Database Based on the Online and Offline Hybrid Teaching Model

The purpose of this paper is to comprehensively develop high-quality medical talents with strong clinical skills and innovativeness.By constructing and applying the medical parasitology teaching case database,students can gain access to various educational tools.The goal is to assist them in their progress from passive to active learning,as well as to develop their autonomous learning ability,critical thinking skills,communication skills,teamwork,and innovation skills.Besides,the goal is also to improve the overall hygiene perspective as well as digest and integrate their knowledge and skills.

Feature Selection Method Based on Class Discriminative Degree for Intelligent Medical Diagnosis

By using efficient and timely medical diagnostic decision making,clinicians can positively impact the quality and cost of medical care.However,the high similarity of clinical manifestations between diseases and the limitation of clinicians’knowledge both bring much difficulty to decision making in diagnosis.Therefore,building a decision support system that can assist medical staff in diagnosing and treating diseases has lately received growing attentions in the medical domain.In this paper,we employ a multi-label classification framework to classify the Chinese electronic medical records to establish corresponding relation between the medical records and disease categories,and compare this method with the traditional medical expert system to verify the performance.To select the best subset of patient features,we propose a feature selection method based on the composition and distribution of symptoms in electronic medical records and compare it with the traditional feature selection methods such as chi-square test.We evaluate the feature selection methods and diagnostic models from two aspects,false negative rate(FNR)and accuracy.Extensive experiments have conducted on a real-world Chinese electronic medical record database.The evaluation results demonstrate that our proposed feature selection method can improve the accuracy and reduce the FNR compare to the traditional feature selection methods,and the multi-label classification framework have better accuracy and lower FNR than the traditional expert system.

A review of medical artificial intelligence

Since the concept of“artificial intelligence”was introduced in 1956,it has led to numerous technological innovations in human medicine and completely changed the traditional model of medicine.In this study,we mainly explain the application of artificial intelligence in various fields of medicine from four aspects:machine learning,intelligent robot,image recognition technology,and expert system.In addition,we discuss the existing problems and future trends in these areas.In recent years,through the development of globalization,various research institutions around the world has conducted a number of researches on this subject.Therefore,medical artificial intelligence has attained significant breakthroughs and will demonstrate wide development prospection in the future.

Evaluation of the safety and quality of day-case cataract surgery based on 4151 cases

AIM: To evaluate the safety, quality and prospects of day-case cataract surgery performed in a Jiangsu public tertiary hospital METHODS: The general and clinical data for patients who underwent day-case cataract surgery between August 1, 2014 and December 31, 2016 at this hospital were collected. The incidences of intraoperative and postoperative complications, preoperative and postoperative bestcorrected visual acuities(BCVAs), delayed discharge rate, rate of unplanned re-admission to hospital, and patient satisfaction were analyzed. RESULTS: A total of 4151 patients received cataract phacoemulsification surgery to correct age-related, congenital, traumatic, or complicated cataracts. Of these, age-related cataracts were the most frequently occurring. Patient age ranged from 18 to 101 y and the vast majority of patients were between 60 and 80 years old. Of the 4151 patients, 64.73%(2687/4151) had a systemic disease. The number of patients increased over the years, with the average number of patients per month being 90.4, 124.83, and 183.42 in 2014, 2015 and 2016, respectively. The average preoperative BCVA was 0.102±0.057 and average postoperative BCVAs at 1 d, 1 wk, and 1 mo post surgery were 0.453±0.264, 0.657±0.285, and 0.734±0.244, respectively. For intraoperative complications, 4.12%(171/4151) had posterior capsule rupture, 0.79%(33/4151) had iris or ciliary body injury, and 0.048%(2/4151) had suprachoroidal hemorrhage. For postoperative complications, 4.38%(182/4151) had cornea edema, 7.78%(323/4151) had intraocular hypertension, 0.096%(4/4151) had IOL toxicity syndrome, 0.28%(12/4151) had retained lens cortex, and 0.048%(2/4151) had hyphema. The delayed discharge rate was 0.82%(44/4151) and the unplanned re-admission to the hospital was 0(0/4151). The patient satisfaction rate was 91.42%(3795/4151). CONCLUSION: Day-case cataract surgery is safe and effective with good prospects for development.

Three Cases of Treating Diseases with Tiaozhong Yiqi Decoction

This paper introduced three cases of treating diseases with Tiaozhong Yiqi Decoction.Tiaozhong Yiqi Decoction,first proposed in Treatise on the Spleen and Stomach written by Li Gao,is an effective prescription for treating the syndrome of dampness stagnancy due to spleen deficiency.The authors sorted out the treatment of some difficult and complicated diseases with this prescription and the curative effect is remarkable.Tiaozhong Yiqi Decoction is evolved from Buzhong Yiqi Decoction by removing ATRACTYLODIS MACROCEPHALAE RHIZOMA and ANGELICAE SINENSIS RADIX,and adding ATRACTYLODIS RHIZOMA and AUCKLANDIAE RADIX.It uses ASTRAGALI RADIX,GINSENG RADIX ET RHIZOMA,and GLYCYRRHIZAE RADIX ET RHIZOMA to benefit qi and invigorate spleen,so as to treat the deficiency of spleen;it uses BUPLEURI RADIX and CIMICIFUGAE RHIZOMA to raise the clear yang;it also uses ATRACTYLODIS RHIZOMA,CITRI RETICULATAE PERICARPIUM,and AUCKLANDIAE RADIX to harmonize the middle to dispel the dampness.In this paper,the case of tinnitus and deafness belongs to the syndrome of dampness stagnancy due to spleen deficiency,dampness obstruction due to qi block,and dampness accumulation affecting clear orifices.The case of red vaginal discharge belongs to the syndrome of sunken spleen qi due to spleen deficiency and sunken yin fire.The case of cough belongs to the spleen deficiency combined with earth not engendering metal.All cases were treated with Tiaozhong Yiqi Decoction,fully proving the mechanism of the same treatment for different diseases.Only by identifying disease causes and syndromes,may it be able to obtain remarkable curative effect.

How reliable is online diffusion of medical information targeting patients and families?

AIM: To determine whether online diffusion of the "Ten Warning Signs of Primary Immunodeficiency Diseases(PID)'' adheres to accepted scientific standards.METHODS: We analyzed how reproducible is online diffusion of a unique instrument, the "Ten Warning Signs of PID", created by the Jeffrey Modell Foundation(JMF),by Google-assisted searches among highly visited sites from professional, academic and scientific organizations;governmental agencies; and patient support/advocacy organizations. We examined the diffusion, consistency of use and adequate referencing of this instrument.Where applicable, variant versions of the instrument were examined for changes in factual content that would have practical impact on physicians or on patients and their families.RESULTS: Among the first 100 sites identified by Google search, 85 faithfully reproduced the JMF model, and correctly referenced to its source. By contrast, the other15 also referenced the JMF source but presented one or more changes in content relative to their purported model and therefore represent uncontrolled variants, of unknown origin. Discrepancies identified in the latter included changes in factual content of the original JMF list(C), as well as removal(R) and introduction(I) of novel signs(Table 2), all made without reference to any scientific publications that might account for the drastic changes in factual content. Factual changes include changes inthe number of infectious episodes considered necessary to raise suspicion of PID, as well as the inclusion of various medical conditions not mentioned in the original.Together, these changes will affect the way physicians use the instrument to consult or to inform patients,and the way patients and families think about the need for specialist consultation in view of a possible PID diagnosis.CONCLUSION: The retrieved adaptations and variants,which significantly depart from the original instrument,raise concerns about standards for scientific information provided online to physicians, patients and families.