Performance of ChatGPT on Chinese Master's Degree Entrance Examination in Clinical Medicine.

BACKGROUND: ChatGPT is a large language model designed to generate responses based on a contextual understanding of user queries and requests. This study utilised the entrance examination for the Master of Clinical Medicine in Traditional Chinese Medicine to assesses the reliability and practicality of ChatGPT within the domain of medical education. METHODS: We selected 330 single and multiple-choice questions from the 2021 and 2022 Chinese Master of Clinical Medicine comprehensive examinations, which did not include any images or tables. To ensure the test's accuracy and authenticity, we preserved the original format of the query and alternative test texts, without any modifications or explanations. RESULTS: Both ChatGPT3.5 and GPT-4 attained average scores surpassing the admission threshold. Noteworthy is that ChatGPT achieved the highest score in the Medical Humanities section, boasting a correct rate of 93.75%. However, it is worth noting that ChatGPT3.5 exhibited the lowest accuracy percentage of 37.5% in the Pathology division, while GPT-4 also displayed a relatively lower correctness percentage of 60.23% in the Biochemistry section. An analysis of sub-questions revealed that ChatGPT demonstrates superior performance in handling single-choice questions but performs poorly in multiple-choice questions. CONCLUSION: ChatGPT exhibits a degree of medical knowledge and the capacity to aid in diagnosing and treating diseases. Nevertheless, enhancements are warranted to address its accuracy and reliability limitations. Imperatively, rigorous evaluation and oversight must accompany its utilization, accompanied by proactive measures to surmount prevailing constraints.

Applied Research of Case-based Learning Teaching in Nephrology Medicine for Professional Postgraduate Students in Clinical Medicine.

Objective: To explore the influence of case-based learning (CBL) teaching methods in comparison to the traditional lecture-based learning (LBL) model in clinical teaching of nephrology for master's degree students in clinical medicine. Methods: Clinical medicine master's degree students who were trained in the Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University from December 2015 to December 2021 were selected as the study objects. The selected students were divided into two groups: the LBL group comprised 16 graduate students who received the traditional LBL model from December 2015 to December 2018, and the CBL group comprised 18 graduate students who received the CBL teaching methods from January 2019 to December 2021. Both groups participated in the professional theoretical knowledge assessment, including objective and subjective questions and calculating the total score), and the examination of clinical skills communication ability, preparation of handling materials, anesthesia techniques, operational skills, aseptic techniques, and postoperative management), at the time of discharge from the department. The independent learning ability (self-management ability, information ability, and learning ability) of students of the two groups after teaching was then assessed, and the satisfaction of the two groups with their respective teaching mode (including satisfaction with the teaching format, teaching effectiveness, interest stimulation, independent learning and the improvement of teamwork ability) was assessed by the questionnaire on the degree of satisfaction of the two groups. Results: The assessment scores of professional theoretical knowledge in the CBL group were significantly higher than those in the LBL group in objective questions, subjective questions, and total scores (P1 = .028; P2 = .036; P3 = .041). The CBL group scored higher than the LBL group in the assessment of communication skills, preparation of operative items, anesthesia technique, operative skills, aseptic technique, and postoperative handling skills, but the differences were not statistically significant (P1 = .071; P2 = .260; P3 = .184; P4 = .127; P5 = .352; P6 = .584). The self-management ability, information ability, and learning ability scores of students in the CBL group were significantly higher than those in the LBL group (P1 = .006; P2 = .013; P3 = .003). Students in the CBL group were significantly higher than those in the LBL group in terms of satisfaction with teaching form, teaching effect, interest stimulation, improvement of independent learning ability, and satisfaction with teamwork ability (P1 = .015; P2 = .008; P3 = .010; P4 = .024; P5 = .022). Conclusions: The CBL teaching model can improve and enhance the clinical thinking ability of clinical medicine master's degree students in nephrology, and stimulate their interest in learning. Professional master's degree students have a high degree of satisfaction with the CBL model.

How Did the Clinical Medicine Progress during the Unified Silla Era: Installment of the Medical Education Center 'Uihak', and Its Effects.

In this research, I aimed to recognize the historical meaning of installing the medical education center, 'Uihak', during the Silla dynasty. 'Uihak' was installed in 692, in the first year of King Hyoso 's rule. 'Uihak' was founded by using various Chinese medical classics as its textbooks for medical education, such as the Classic of Plain Questions. The wooden prescriptions excavated from Anapji, which is thought to have been created in the middle of the 8th century, and the Chinese medical book Prescriptions for Universal Benefit, which the envoy of Silla tried to acquire in 803, reflect the idea on medicine during that period in Silla. By this time, the field of medicine began to develop the idea to discern the locations and mechanism of disease patterns by centering on the viscera and bowels while making use of the herbal prescriptions based on various drugs. This means that clinical medicine founded upon the medical education achieved in 'Uihak' was being realized in the medical fields as well. According to the Chronicles of the Three States, for the illness of Queen Sunduk in 636, medicine, praying, and the method of esoteric Buddhism was tried out as a means of her cure. Comparatively, for the treatment of the first rank Chunggong in 822, the Kingdom's representative doctor with professional medical knowledge was sought out to fine a cure. The analyses of the human disease, diagnosis, treatment method, etc., given by the kingdom's representative doctor were identical to those recommended in the medical textbooks used in 'Uihak'. As such, we can posit that his academic background was 'Uihak' and the education given there. The Classic of Materia Medica, which was also used in 'Uihak', was a book professionally centered on the drug branch of medicine. The Classic of Materia Medica is a terminology referring to various books on drugs, including the Shennong's Classic of Materia Medica, the Variorum of the Classic of Materia Medica, the Newly Revised Materia Medica, etc. Thus, we cannot specify what the classic of Materia Medica actually taught, based on only its terminology. However, based on the wooden prescriptions excavated from Anapji, and from the terminology of drugs recorded in the drug trading document Purchase List for Silla goods preserved in Shosoin of Japan, we can hypothesize that in the middle of the 8th century, the Newly Revised Materia Medica was indeed being circulated. Based on these evidences, we can also hypothesize that Silla was part of the network of drug trading that encompassed the entire region of Asia. After unifying the Korean peninsula, the Kingdom of Silla actively adopted the medical educational system of Tang China. By using the obtained medical knowledge, Silla cured illnesses and used the medical knowledge on various drugs recorded in the Newly Revised Materia Medica to pursue trade with China, Japan, and other countries. Through the installation of 'Uihak', the same medicine has now begun to be officially used in East Asia, including Silla.

[High-intensity laser therapy in clinical medicine: scientometric analysis of evidence of effectiveness]. / Vysokointensivnaya lazeroterapiya v klinicheskoi meditsine: naukometricheskii analiz dokazatel'stv effektivnosti.

INTRODUCTION: High-intensity laser technologies are widely used in modern restorative medicine, and indications for their use are expanding annually. These technologies are effective, potentially safe methods of treating many diseases. with pronounced therapeutic effects. PURPOSE OF RESEARCH: Analysis of scientific evidence of the effectiveness and safety of high-intensity laser therapy in patients with various diseases. MATERIAL AND METHODS: A comprehensive scientometric analysis of evidence-based studies of the effectiveness and safety of high-intensity laser therapy methods was carried out according to electronic databases (Google scholar, PEDro, PubMed, Cochrane DATABASE) for the period from 2006 to 2021. RESULTS: High-intensity laser therapy has a wide range of significantly pronounced therapeutic effects. and it is an effective method of treating patients with various diseases. Various technologies and methods of its application are widely used in various fields of clinical medicine. Individually developed therapy protocols are needed, with optimal exposure parameters for each patient, intervals between procedures. CONCLUSION: It is advisable to develop more reliable and standard evaluation criteria, regular generalization and analysis of existing evidence, careful planning and implementation of further large-scale randomized controlled trials to study the effects of high-intensity laser radiation both as a single effect and as part of combinations with other treatment methods. The effectiveness of combination therapy requires further analysis in the course of conducting new benign clinical trials.

Therapeutically important bioactive compounds of the genus Polygonum L. and their possible interventions in clinical medicine.

OBJECTIVES: Increasing literature data have suggested that the genus Polygonum L. possesses pharmacologically important plant secondary metabolites. These bioactive compounds are implicated as effective agents in preclinical and clinical practice due to their pharmacological effects such as anti-inflammatory, anticancer, antidiabetic, antiaging, neuroprotective or immunomodulatory properties among many others. However, elaborate pharmacological and clinical data concerning the bioavailability, tissue distribution pattern, dosage and pharmacokinetic profiles of these compounds are still scanty. KEY FINDINGS: The major bioactive compounds implicated in the therapeutic effects of Polygonum genus include phenolic and flavonoid compounds, anthraquinones and stilbenes, such as quercetin, resveratrol, polydatin and others, and could serve as potential drug leads or as adjuvant agents. Data from in-silico network pharmacology and computational molecular docking studies are also highly helpful in identifying the possible drug target of pathogens or host cell machinery. SUMMARY: We provide an up-to-date overview of the data from pharmacodynamic, pharmacokinetic profiles and preclinical (in-vitro and in-vivo) investigations and the available clinical data on some of the therapeutically important compounds of genus Polygonum L. and their medical interventions, including combating the outbreak of the COVID-19 pandemic.

Challenges to delivering evidence-based palliative medicine.

Established as a medical specialty in 1987, palliative medicine approaches middle age facing existential questions of identity, purpose and vision. Time has weakened strong foundations laid by Dame Cicely Saunders in research, education and clinical excellence. Clinical knowledge gaps are wide, and widening. Palliative medicine research is underfunded and underrepresented in discourse. Despite huge advances in modern medicine, there is still clinical uncertainty about simple interventions, such as whether artificial hydration at the end of life is helpful or harmful. Where good quality data do exist, the pace of change is slow, if change is happening at all. Trial design often fails to assess the holistic impact of interventions, using primary endpoints that are inconsistent with outcomes most valued to the patient. Recent years have seen a rapid expansion in innovation and investment in digital technologies, embraced by many in palliative medicine. Experience shows that caution must be applied where the evidence base is sparse. While as a specialty we must remain forward looking and progressive in our mindset, it cannot be assumed that these new interventions alone will provide the solutions to the old problems that exist in palliative medicine.This review summarises the key points presented in the Palliative Medicine section of the RCP Clinical Medicine Conference, 2022.

A five-year review of prevalence and treatment outcomes of pre-extensively drug-resistant plus additional drug-resistant tuberculosis in the Henan Provincial Tuberculosis Clinical Medicine Research Centre.

OBJECTIVES: This study investigated the prevalence and significant clinical outcomes of pre-extensively drug-resistant plus additional drug-resistant tuberculosis (pre-XDR-plus) in Henan Provincial Chest Hospital between 2017 and 2021. METHODS: We analysed and summarized the drug sensitivity test (DST) results of clinical Mycobacterium tuberculosis (MTB) strains in TB patients seeking care in the Tuberculosis Clinical Medical Research Centre of Henan Province between 2017 and 2021. Medical records of pre-extensively drug-resistant plus additional drug-resistant TB patients were statistically analysed, including demographic characteristics, regimens, and outcomes. RESULTS: Of the 3689 Mycobacterium tuberculosis strains, 639 (17.32%), 353 (9.56%), and 109 (2.95%), multidrug-resistant tuberculosis (MDR-TB), pre-extensively drug-resistant tuberculosis (pre-XDR), and pre-XDR-plus, respectively. The proportion of MDR decreased from 19.1% in 2017 to 17.5% in 2021 (χ2 = 0.686, P = 0.407), the proportion of pre-XDR from 11.4% in 2017 to 9.0% in 2021 (χ2 = 2.39, P = 0.122), and pre-XDR-plus from 4.7% in 2017 to 1.8% in 2020, with the declining trend was significant (χ2 = 9.348, P = 0.002). The most commonly used anti-TB drugs were pyrazinamide (PZA, 37/46, 80.43%) and cycloserine (CS, 32/46, 69.57%), followed by linezolid (LZD, 25/46, 54.35%), protionamide (TH, 25/46, 54.35%), and para-aminosalicylic acid (PAS, 23/46, 50.00%). Patients receiving the LZD regimen were 5 times more likely to have a favourable outcome than those not receiving LZD (OR = 6.421, 95% CI 2.101-19.625, P = 0.001). Patients receiving a regimen containing CS were 4 times more likely to have a favourable outcome compared to those not taking CS (OR = 5.444, 95% CI 1.650-17.926, P = 0.005). CONCLUSIONS: Our data suggest that the population of pre-XDR-plus had significantly decreased over the past five years in the Henan Provincial Chest Hospital. The COVID-19 and flood disaster affect TB patients' selection of medical services. In addition, the pre-XDR-plus patients whose regimens contain LZD or CS were more likely to have favourable outcomes.

Avaliação da motivação e da aprendizagem em estudantes de medicina: Estudo comparativo entre aula tradicional contextualizada por discussão de casos clínicos e aula tradicional contextualizada por casos clínicos gamificados / Evaluation of motivation and learning in medical students: Comparative study between traditional classes contextualized by clinical discussions cases, and traditional classes contextualized by gamified clinical cases

Introdução: Gamificação é a utilização de mecanismos baseados em games, sua estética e lógica para engajar pessoas, motivar atitudes, promover aprendizado e solucionar problemas. Assim, uma forma de incentivar a elaboração, o aprendizado em grupo, bem como a colaboração e a interatividade, é a utilização de jogos educacionais integrados às aulas e seminários. A participação em um jogo incentiva o aprofundamento no objetivo de aprendizagem, possibilitando que o aluno elabore os conceitos que estão sendo abordados e os aplique. Além dos benefícios de memória e desempenho, os jogos e os outros métodos de aprendizagem interativa têm importantes benefícios sociais para os alunos. Objetivo: Avaliar os efeitos da adição de gamificação, nas aulas tradicionais contextualizadas por discussão de casos clínicos, para grupos grandes de estudantes de medicina. Metodologia: Trata-se de pesquisa experimental, aplicada a 39 alunos do terceiro período do curso de medicina do Centro Universitário Presidente Tancredo de Almeida Neves, em São João Del Rei (MG), no primeiro semestre de 2019. Foi ministrada aula comum a todos os participantes versando sobre o diagnóstico diferencial das tireotoxicoses e, posteriormente, a amostra foi randomizada em dois grupos: um grupo para discussão de casos clínicos e o outro grupo para gamificação de casos clínicos. Ao final das intervenções, foram avaliadas a motivação dos estudantes, a retenção do conhecimento (curto e longo prazo) e a transferência do conhecimento para resolução de casos clínicos de tireotoxicose. Resultados: A análise dos grupos revelou maior atenção, confiança e satisfação, dentre os domínios da motivação, dos estudantes que utilizaram o jogo proposto quando comparados aos estudantes do grupo submetido à discussão tradicional de casos clínicos. A retenção do conhecimento, no curto e longo prazo, bem como a transferência do conhecimento foi semelhante entre os dois grupos, mostrando que o jogo educacional, nesse contexto, não é inferior ao método tradicionalmente utilizado. Conclusão: Logo, a introdução da gamificação, como reforço do aprendizado, nas aulas tradicionais, contextualizas por casos clínicos, pode gerar os efeitos próprios do aumento da motivação na atividade instrucional

Introduction: Gamification is the use of mechanisms based on video games, their design and elements of logic in order to engage and motivate people towards better learning and problem solving. Thus, one way to encourage engagement, group learning, collaboration and interaction is the use of educational games integrated into classes and seminars. Being part of a game encourages greater approximation to the learning aim, enabling the student to establish and apply the concepts that are being dealt with. As well as benefiting memory and performance, games and other interactive learning methods have important social benefits for the students. Aim: To assess the affects of adding gamification to traditional lessons that are contextualized through clinical case discussions for large groups of medical students. Methodology: This is an experimental study, given to 39 students from the third period of the medical school at the Presidente Tancredo de Almeida Neves University Center in São João Del Rei (MG), during the first semester of 2019. The same class was given to all the participants, dealing with the diagnostic differentials of Thyrotoxicosis and, following this, the sample was randomized into two groups: one group for clinical cases discussion and another for gamification of the clinical cases. At the end of the activities, assessment was made of student motivation, knowledge retention (short and long term) and knowledge transfer for the resolution of the Thyrotoxicosis clinical cases. Results: Analysis of the groups showed greater attention, confidence and satisfaction, among the motivation constructs, in the students that used the game compared with the students that were submitted to traditional clinical case discussion. Knowledge retention, in the short and long term, as well as knowledge transfer had similar levels between the two groups, showing that the educational game, in this context, is not inferior to the traditional method used. Conclusion: Therefore, the introduction of gamification, for learning reinforcement in traditional classes contextualized by clinical cases, may generate its own effects in increasing motivation in instructional activities

[Franciscus Sylvius: A Life for Clinic, Research, Teaching And a Little Gin]. / Franciscus Sylvius: Ein Leben für Klinik, Forschung, Lehre und ein bisschen Gin.

Franciscus Sylvius, latinized from Franz de le Boë (*15 March 1614 in Hanau; † 14 November 1672 in Leiden), was a Hessian-Dutch physician, anatomist, and natural scientist of Flemish descent. He was an important clinician and iatrochemist, and is considered the founder of scientifically oriented medicine and clinical chemistry. Sylvius introduced the concept of affinity and dealt with digestive processes and body fluids. He was one of the leading exponents of the concept of blood circulation developed by William Harvey. As the person responsible for practical medicine in Leiden, Sylvius established bedside teaching as part of the medical curriculum, and he introduced his students to clinical medicine in an experimental way, both contrary to the rules of the time. He was also interested in pharmacology, herbalism and botany. For heartburn and digestive disorders, Sylvius mixed juniper berries, herbs and alcohol to create a medicine. According to legend, Sylvius marketed this medicine as Genever, for which the name Gin was later adopted in the British Isles, but not only used for medical purposes. Accordingly, the city of birth of Sylvius today calls itself a "birthplace of gin".

Efficacy and Safety of Integrated Traditional Chinese and Western Medicine for Corona Virus Disease 2019 (COVID-19): a systematic review and meta-analysis.

Corona virus disease (COVID-19) has now spread to all parts of the world and almost all countries are battling against it. This study aimed to assess the efficacy and safety of Integrated Traditional Chinese and Western Medicine (Hereinafter referred to as "Integrated Medicine") to COVID-19. We searched six major Chinese and English databases to identify randomized controlled trials (RCTs) and case-control studies (CCSs) of Integrated Medicine on COVID-19. Two reviewers independently screened, identified studies, and extracted data. Cochrane Risk of Bias tool and the Newcastle-Ottawa Scale were used to assess the quality of included RCTs and CCSs, respectively. Stata (version 13.0; StataCorp) was used to perform meta-analyses with the random-effects model. Risk ratio (RR) was used for dichotomous data while the weighted mean difference (WMD) was adopted for continuous variables as effect size, both of which were demonstrated in effect size and 95% confidence intervals (CI). A total of 11 studies were included. Four were RCTs and seven were CCSs. The sample size of including studies ranged from 42 to 200 (total 982). The traditional Chinese medicine included Chinese medicine compound drugs (QingFei TouXie FuZhengFang) and Chinese patent medicine (e.g. Shufeng Jiedu Capsule, Lianhua Qingwen granules). Compared with the control group, the overall response rate [RR = 1.230, 95%CI (1.113, 1.359), P = 0.000], cure rate [RR = 1.604, 95%CI (1.181, 2.177), P = 0.002], severity illness rate [RR = 0.350, 95%CI (0.154, 0.792), P = 0.012], and hospital stay [WMD = -1.991, 95%CI (-3.278, -0.703), P = 0.002] of the intervention group were better. In addition, Integrated Medicine can improve the disappearance rate of fever, cough, expectoration, fatigue, chest tightness and anorexia and reduce patients' fever, and fatigue time (P < 0.05). This review found that Integrated Medicine had better effects and did not increase adverse drug reactions for COVID-19. More high-quality RCTs are needed in the future.

[200 years of history of National clinic of internal diseases: issues of periodization (stages 1-3)].

The main development of the clinical internal medicine in Russia took place over the past 200 years. To understand the pattern of this process, we explored its possible subdivision into phases (periods). This article presents the first part of the proposed periodization describing the characteristics and time frame of the first three stages (from the beginning of the 19th century to the late 1910s).

Integrating clinical medicine and population health: where to from here?

Efforts to contain healthcare costs have led a renewed clinician interest in addressing population-level outcomes, with some proposing that the integration of population health into clinical practice represents a novel concept entitled "clinical population medicine" (CPM). This commentary offers an examination of the function and utility of CPM. In reviewing relevant literature, we note several inconsistencies in CPM's purported mandate, which ranges from simply incorporating the social determinants of health into clinical practice to broad involvement in community health planning. The latter of these seems to overlap, and potentially conflict, with the work of public health practitioners, and cited examples of activities used to define "CPM" seem to apply a label to established clinician activities around the determinants of health that would be captured more simply as research, evaluation, or advocacy undertaken by clinicians in other areas of practice. Our analysis suggests that CPM may have value in encouraging clinicians to incorporate community determinants and contextual considerations into their practices, but must take care to remain complementary and distinct from public health practice.

Clinical and pharmacological application of multiscale multiphysics heart simulator, UT-Heart

A heart simulator, UT-Heart, is a finite element model of the human heart that can reproduce all the fundamental activities of the working heart, including propagation of excitation, contraction, and relaxation and generation of blood pressure and blood flow, based on the molecular aspects of the cardiac electrophysiology and excitation-contraction coupling. In this paper, we present a brief review of the practical use of UT-Heart. As an example, we focus on its application for predicting the effect of cardiac resynchronization therapy (CRT) and evaluating the proarrhythmic risk of drugs. Patient-specific, multiscale heart simulation successfully predicted the response to CRT by reproducing the complex pathophysiology of the heart. A proarrhythmic risk assessment system combining in vitro channel assays and in silico simulation of cardiac electrophysiology using UT-Heart successfully predicted druginduced arrhythmogenic risk. The assessment system was found to be reliable and efficient. We also developed a comprehensive hazard map on the various combinations of ion channel inhibitors. This in silico electrocardiogram database (now freely available at http://ut-heart.com/) can facilitate proarrhythmic risk assessment without the need to perform computationally expensive heart simulation. Based on these results, we conclude that the heart simulator, UT-Heart, could be a useful tool in clinical medicine and drug discovery.

[Recent Trends of Trace Element Studies in Clinical Medicine in Japan].

The deficiency or excess intake of trace elements, including zinc, copper, selenium and iodine, has often been reported. Zinc deficiency is often observed in infants fed breast milk with low zinc concentration, individuals administered chelating medicines, athletes and patients with diabetes mellitus, hepatic cirrhosis or nephrosis syndrome. Menkes disease is associated with severe copper deficiency, and there is no effective treatment. Deficiencies of selenium and iodine are observed in patients who receive special formulas of milk and enteral formula with low selenium and iodine concentrations, respectively. In contrast, neonatal transient hypothyroidism due to excess intake of iodine in pregnant women has also reported in Japan. It is expected that collaborative studies by researchers and clinicians will contribute to clarify the detail mechanism, diagnosis and treatment of these abnormalities.

Impaired Bioenergetics in Clinical Medicine: A Target to Tackle.

Mitochondrial energy deficit is considered a key element of different clinical pathologies - from inherited disorders of energy metabolism to drug-induced mitochondrial toxicity, to cardiometabolic and neurodegenerative diseases. However, clinical manifestations of impaired bioenergetics are not easy to recognize, with patient-reported features usually include non-pathognomonic fatigue and weakness, or exercise intolerance, while specific lab tests are missing. Although it is not clear whether poor energetics is a primary deficit or a secondary consequence of specific disorders, improving mitochondrial viability remains a challenging task in both experimental and clinical medicine. In this review, biochemical and clinical evidence of energy deficits were reviewed, along with possible therapeutic options to tackle energy failure and restore bioenergetics.