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Military Medicine May 2023An objective of undergraduate medical education is to teach students how to think like physicians through a process called clinical reasoning. Currently, clerkship...
INTRODUCTION
An objective of undergraduate medical education is to teach students how to think like physicians through a process called clinical reasoning. Currently, clerkship directors often feel that students enter their clinical years with a marginal comprehension of clinical reasoning concepts; instruction in this area could be improved. Although there have been previous educational studies assessing curricular interventions to improve the instruction of clinical reasoning, it is not yet known what happens at an individual level between an instructor and a small group of students in the teaching of clinical reasoning. This research will identify how clinical reasoning is being taught in a longitudinal clinical reasoning course.
METHODS
The Introduction to Clinical Reasoning course is a 15-month-long case-based course held in the preclinical curriculum of the USU. Individual sessions involve small-group learning with approximately seven students per group. Throughout the academic year of 2018-2019, 10 of these sessions were videotaped and transcribed. All participants provided informed consent. A thematic analysis was performed using a constant comparative approach. Transcripts were analyzed until thematic sufficiency was reached.
RESULTS
Over 300 pages of text were analyzed; new themes ceased to be identified after the eighth session. Topics included obstetrics, general pediatric issues, jaundice, and chest pain; these sessions were taught either by attendings, fellows, or fourth-year medical students with attending supervision. The thematic analysis revealed themes associated with clinical reasoning processes, themes associated with knowledge organization, and a theme associated with clinical reasoning in the military. The clinical reasoning process themes included problem list construction and refinement, differential diagnosis, naming and defending a leading diagnosis, and clinical reasoning heuristics. The knowledge organization themes included illness script development and refinement and semantic competence. The final theme was military relevant care.
CONCLUSIONS
In individual teaching sessions, preceptors emphasized problem lists, differential diagnoses, and leading diagnoses in a course designed to strengthen diagnostic reasoning in preclerkship medical students. The use of illness scripts was more often implicitly used rather than explicitly stated, and students used these sessions to use and apply new vocabularies related to a clinical presentation. Instruction in clinical reasoning could be improved by encouraging faculty to provide further context to their thinking, by encouraging the comparing and contrasting of illness scripts, and by using a shared vocabulary for clinical reasoning. Limitations of this study include that it was done in the context of a clinical reasoning course and that it was done at a military medical school, which may limit generalizability. Future studies could determine if faculty development could improve the frequency of references to the clinical reasoning processes that could improve student readiness for clerkship.
Topics: Humans; Child; Learning; Curriculum; Problem Solving; Students, Medical; Education, Medical, Undergraduate; Clinical Competence; Clinical Reasoning; Teaching
PubMed: 37201489
DOI: 10.1093/milmed/usad036 -
BMC Medical Informatics and Decision... Apr 2022Bio-entity Coreference Resolution (CR) is a vital task in biomedical text mining. An important issue in CR is the differential representation of identical mentions as...
BACKGROUND
Bio-entity Coreference Resolution (CR) is a vital task in biomedical text mining. An important issue in CR is the differential representation of identical mentions as their similar representations may make the coreference more puzzling. However, when extracting features, existing neural network-based models may bring additional noise to the distinction of identical mentions since they tend to get similar or even identical feature representations.
METHODS
We propose a context-aware feature attention model to distinguish similar or identical text units effectively for better resolving coreference. The new model can represent the identical mentions based on different contexts by adaptively exploiting features, which enables the model reduce the text noise and capture the semantic information effectively.
RESULTS
The experimental results show that the proposed model brings significant improvements on most of the baseline for coreference resolution and mention detection on the BioNLP dataset and CRAFT-CR dataset. The empirical studies further demonstrate its superior performance on the differential representation and coreferential link of identical mentions.
CONCLUSIONS
Identical mentions impose difficulties on the current methods of Bio-entity coreference resolution. Thus, we propose the context-aware feature attention model to better distinguish identical mentions and achieve superior performance on both coreference resolution and mention detection, which will further improve the performance of the downstream tasks.
Topics: Data Mining; Humans; Neural Networks, Computer; Semantics
PubMed: 35501781
DOI: 10.1186/s12911-022-01862-1 -
Frontiers in Psychology 2021We addressed an understudied topic in the literature of language disorders, that is, processing of derivational morphology, a domain which requires integration of...
We addressed an understudied topic in the literature of language disorders, that is, processing of derivational morphology, a domain which requires integration of semantic and syntactic knowledge. Current psycholinguistic literature suggests that word processing involves morpheme recognition, which occurs immediately upon encountering a complex word. Subsequent processes take place in order to interpret the combination of stem and affix. We investigated the abilities of individuals with agrammatic (PPA-G) and logopenic (PPA-L) variants of primary progressive aphasia (PPA) and individuals with stroke-induced agrammatic aphasia (StrAg) to process pseudowords which violate either the syntactic (word class) rules (*) or the semantic compatibility (argument structure specifications of the base form) rules (*). To this end, we quantified aspects of word knowledge and explored how the distinct deficits of the populations under investigation affect their performance. Thirty brain-damaged individuals and 10 healthy controls participated in a lexical decision task. We hypothesized that the two agrammatic groups (PPA-G and StrAg) would have difficulties detecting syntactic violations, while no difficulties were expected for PPA-L. Accuracy and Reaction Time (RT) patterns indicated: the PPA-L group made fewer errors but yielded slower RTs compared to the two agrammatic groups which did not differ from one another. Accuracy rates suggest that individuals with PPA-L distinguish * from *, reflecting access to and differential processing of syntactic vs. semantic violations. In contrast, the two agrammatic groups do not distinguish between * and *. The lack of difference stems from a particularly impaired performance in detecting syntactic violations, as they were equally unsuccessful at detecting * and *. Reduced grammatical abilities assessed through language measures are a significant predictor for this performance, suggesting that the "hardware" to process syntactic information is impaired. Therefore, they can only judge violations semantically where both * and * fail to pass as semantically ill-formed. This finding further suggests that impaired grammatical knowledge can affect word level processing as well. Results are in line with the psycholinguistic literature which postulates the existence of various stages in accessing complex pseudowords, highlighting the contribution of syntactic/grammatical knowledge. Further, it points to the worth of studying impaired language performance for informing normal language processes.
PubMed: 34912261
DOI: 10.3389/fpsyg.2021.701802 -
American Journal of Audiology Sep 2022Speech recognition in noise is a ubiquitous problem in older listeners. Speech, the most commonly encountered noise in the real world, causes greater masking than noise...
PURPOSE
Speech recognition in noise is a ubiquitous problem in older listeners. Speech, the most commonly encountered noise in the real world, causes greater masking than noise maskers, a phenomenon called informational masking (IM). This is due to the lexical-semantic and/or acoustic-phonetic information present in speech maskers. In this study, we aimed to observe the age-related differences in speech recognition and the magnitudes of IM when the maskers varied in the type of linguistic information.
METHOD
In 30 young and 30 older individuals, we measured the signal-to-noise ratio required to obtain 50% correct identification under four-talker babble (lexical-semantic and acoustic-phonetic information), four-talker reverse babble (predominantly acoustic-phonetic information), and speech-shaped noise (SSN; energetic).
RESULTS
In both groups, the four-talker babble caused the greatest masking effect (worst performances), whereas the SSN resulted in the least masking effect (best performances). The effectiveness of IM due to the lexical-semantic information was comparable between the two groups. However, the effectiveness of IM due to the acoustic-phonetic information was significantly higher in the older listeners, causing worse performances.
CONCLUSIONS
The greater effectiveness of IM due to the acoustic-phonetic information (worse performance) could be due to the minimal-to-mild high-frequency hearing loss and the consequent temporal processing deficits observed in the older listeners. However, it is possible that the older listeners can employ compensatory mechanisms (such as life experiences, contextual cues, employing higher listening efforts, among many possible other mechanisms) to overcome some of these deficits.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.20405730.
Topics: Aged; Humans; Noise; Perceptual Masking; Phonetics; Semantics; Speech Perception
PubMed: 35926084
DOI: 10.1044/2022_AJA-22-00029 -
Neuropsychological Rehabilitation Sep 2023This is the first study to estimate the prevalence and predictors of spouse and patient perceptions of global/overall personality change (PC) in patients with multiple...
OBJECTIVES
This is the first study to estimate the prevalence and predictors of spouse and patient perceptions of global/overall personality change (PC) in patients with multiple sclerosis (MS).
METHODS
69 clinic patients and their spouses completed parallel measures of perceived PC and semantic differential scales measuring pre-MS and current specific behaviours. We correlated perceived personality changes with the following measures of perceived physical, cognitive, emotional, and social functioning: MS Impact Scale, MS Neuropsychological Questionnaire, Beck Depression Inventory-FastScreen; Hospital Anxiety and Depression Scale; Family Questionnaire, McMaster Assessment Device; and Social Provisions Scale.
RESULTS
Spouses and patients reported comparable levels of substantial change. Both associated PC with patient distress, perceived cognitive impairment, spouse distress, and poorer family functioning. Spouse, but not patient, PC ratings predicted severity of physical symptoms and social support. Principal component analysis of semantic differential ratings yielded a Compassionate Empathy component correlating with PC within spouse, but not patient, data.
CONCLUSIONS
These partially overlapping potential triggers for spouse and patient PC judgments raise questions about the extent they overlap with clinicians' criteria for PC, since spouses did not link impulsivity with PC. It is also suggested that the initial focus of treatment of PC should focus on partner-agreed changes.
Topics: Humans; Spouses; Judgment; Social Support; Personality; Multiple Sclerosis
PubMed: 35857651
DOI: 10.1080/09602011.2022.2101478 -
NeuroImage. Clinical 2022Multiple sclerosis (MS) is a progressive disease characterized by widespread white matter lesions in the brain and spinal cord. In addition to well-characterized motor...
Multiple sclerosis (MS) is a progressive disease characterized by widespread white matter lesions in the brain and spinal cord. In addition to well-characterized motor deficits, MS results in cognitive impairments in several domains, notably in episodic autobiographical memory. Recent studies have also revealed that patients with MS exhibit deficits in episodic future thinking, i.e., our capacity to imagine possible events that may occur in our personal future. Both episodic memory and episodic future thinking have been shown to share cognitive and neural mechanisms with a related kind of hypothetical simulation known as episodic counterfactual thinking: our capacity to imagine alternative ways in which past personal events could have occurred but did not. However, the extent to which episodic counterfactual thinking is affected in MS is still unknown. The current study sought to explore this issue by comparing performance in mental simulation tasks involving either past, future or counterfactual thoughts in relapsing-remitting MS. Diffusion weighted imaging (DWI) measures were also extracted to determine whether changes in structural pathways connecting the brain's default mode network (DMN) would be associated with group differences in task performance. Relative to controls, patients showed marked reductions in the number of internal details across all mental simulations, but no differences in the number of external and semantic-based details. It was also found that, relative to controls, patients with relapsing-remitting MS reported reduced composition ratings for episodic simulations depicting counterfactual events, but not so for actual past or possible future episodes. Additionally, three DWI measures of white matter integrity-fractional anisotropy, radial diffusivity and streamline counts-showed reliable differences between patients with relapsing-remitting MS and matched healthy controls. Importantly, DWI measures associated with reduced white matter integrity in three association tracts on the DMN-the right superior longitudinal fasciculus, the left hippocampal portion of the cingulum and the left inferior longitudinal fasciculus-predicted reductions in the number of internal details during episodic counterfactual simulations. Taken together, these results help to illuminate impairments in episodic simulation in relapsing-remitting MS and show, for the first time, a differential association between white matter integrity and deficits in episodic counterfactual thinking in individuals with relapsing-remitting MS.
Topics: Humans; Imagination; Memory, Episodic; Multiple Sclerosis; Multiple Sclerosis, Relapsing-Remitting; Nerve Net
PubMed: 35561552
DOI: 10.1016/j.nicl.2022.103033 -
Frontiers in Medicine 2022COVID-19 pandemic is disaster to public health worldwide. Better perspective on COVID's features early in its course-prior to the development of vaccines and widespread...
BACKGROUND
COVID-19 pandemic is disaster to public health worldwide. Better perspective on COVID's features early in its course-prior to the development of vaccines and widespread variants-may prove useful in the understanding of future pandemics. Ontology provides a standardized integrative method for knowledge modeling and computer-assisted reasoning. In this study, we systematically extracted and analyzed clinical phenotypes and comorbidities in COVID-19 patients found at different countries and regions during the early pandemic using an ontology-based bioinformatics approach, with the aim to identify new insights and hidden patterns of the COVID-19 symptoms.
RESULTS
A total of 48 research articles reporting analysis of first-hand clinical data from over 40,000 COVID-19 patients were surveyed. The patients studied therein were diagnosed with COVID-19 before May 2020. A total of 18 commonly-occurring phenotypes in these COVID-19 patients were first identified and then classified into different hierarchical groups based on the Human Phenotype Ontology (HPO). This meta-analytic approach revealed that fever, cough, and the loss of smell and taste were ranked as the most commonly-occurring phenotype in China, the US, and Italy, respectively. We also found that the patients from Europe and the US appeared to have more frequent occurrence of many nervous and abdominal symptom phenotypes (e.g., loss of smell, loss of taste, and diarrhea) than patients from China during the early pandemic. A total of 22 comorbidities, such as diabetes and kidney failure, were found to commonly exist in COVID-19 patients and positively correlated with the severity of the disease. The knowledge learned from the study was further modeled and represented in the Coronavirus Infectious Disease Ontology (CIDO), supporting semantic queries and analysis. Furthermore, also considering the symptoms caused by new viral variants at the later stages, a spiral model hypothesis was proposed to address the changes of specific symptoms during different stages of the pandemic.
CONCLUSIONS
Differential patterns of symptoms in COVID-19 patients were found given different locations, time, and comorbidity types during the early pandemic. The ontology-based informatics provides a unique approach to systematically model, represent, and analyze COVID-19 symptoms, comorbidities, and the factors that influence the disease outcomes.
PubMed: 35155491
DOI: 10.3389/fmed.2022.770031 -
Frontiers in Human Neuroscience 2023Prior work has shown positive effects of High Definition transcranial direct current stimulation (HD-tDCS) over the dorsolateral prefrontal cortex (DLPFC) on semantic...
BACKGROUND
Prior work has shown positive effects of High Definition transcranial direct current stimulation (HD-tDCS) over the dorsolateral prefrontal cortex (DLPFC) on semantic memory performance and metamemory monitoring accuracy. However, HD-tDCS requires setup by a trained researcher, which is not always feasible. Few studies have used remotely supervised (rs) tDCS in healthy populations, and remote supervision has strong practical benefits.
OBJECTIVE/HYPOTHESIS
The goal of the current study was to test if previously shown effects of HD-tDCS over the left DLPFC on semantic memory performance and metamemory monitoring accuracy extended to conventional rs-tDCS, which is less focal than HD-tDCS, and to episodic memory and metamemory tasks.
MATERIALS AND METHODS
A total of 36 healthy participants completed 6 weeks of rs-tDCS sessions, with either active left or right anodal DLPFC stimulation, or sham. Participants completed semantic and episodic memory and metamemory tasks, which each lasted for three consecutive sessions, and session order was counterbalanced across participants.
RESULTS
Overall, there were no main effects of rs-tDCS on metamemory monitoring accuracy or memory performance for either the semantic or the episodic tasks. However, there were effects of rs-tDCS that depended on the order of completing the episodic and semantic task sessions. When participants completed the semantic task sessions after the episodic task sessions, semantic recognition was greater in the left anodal DLPFC condition. In a parallel effect, when participants completed the episodic task sessions after the semantic task sessions, episodic recognition was greater in the right anodal DLPFC condition.
CONCLUSION
Prior experience with tDCS is a factor for effects of rs-tDCS on cognition. Additionally, the current experiment provides evidence for the feasibility of fully remotely supervised tDCS in healthy participants.
PubMed: 37635805
DOI: 10.3389/fnhum.2023.1239126 -
Military Medicine Sep 2023Developing the clinical reasoning skills necessary to becoming an astute diagnostician is essential for medical students. While some medical schools offer longitudinal...
INTRODUCTION
Developing the clinical reasoning skills necessary to becoming an astute diagnostician is essential for medical students. While some medical schools offer longitudinal opportunities for students to practice clinical reasoning during the preclinical curriculum, there remains a paucity of literature fully describing what that curriculum looks like. As a result, medical educators struggle to know what an effective clinical reasoning curriculum should look like, how it should be delivered, how it should be assessed, or what faculty development is necessary to be successful. We present our Introduction to Clinical Reasoning course that is offered throughout the preclinical curriculum of the Uniformed Services University of the Health Sciences. The course introduces clinical reasoning through interactive lectures and 28 case-based small group activities over 15 months.The curriculum is grounded in script theory with a focus on diagnostic reasoning. Specific emphasis is placed on building the student's semantic competence, constructing problem lists, comparing and contrasting similar diagnoses, constructing a summary statement, and formulating a prioritized differential diagnosis the student can defend. Several complementary methods of assessment are utilized across the curriculum. These include assessments of participation, knowledge, and application. The course leverages clinical faculty, graduate medical education trainees, and senior medical students as small group facilitators. Feedback from students and faculty consistently identifies the course as a highly effective and engaging way to teach clinical reasoning.
CONCLUSION
Our Introduction to Clinical Reasoning course offers students repeated exposure to well-selected cases to promote their development of clinical reasoning. The course is an example of how clinical reasoning can be taught across the preclinical curriculum without extensive faculty training in medical education or clinical reasoning theory. The course can be adapted into different instructional formats to cover a variety of topics to provide the early learner with sequential exposure and practice in diagnostic reasoning.
PubMed: 37738179
DOI: 10.1093/milmed/usad370 -
International Journal of Older People... May 2022The aims of the study were to investigate the four-factor structure of the German version of the Aging Semantic Differential (ASD) and to gain initial insights into the...
INTRODUCTION
The aims of the study were to investigate the four-factor structure of the German version of the Aging Semantic Differential (ASD) and to gain initial insights into the attitudes of nursing, medical and humanities students towards older people in Austria.
METHOD
A cross-sectional study design with a convenience sample was chosen.
RESULTS
The ASD was completed by 255 Austrian nursing, medicine, and humanities students, who described their attitudes towards persons who are 80 years of age and older. The applicability of the four-factor structure (instrumentality, autonomy, acceptability and integrity) of the German version was confirmed by performing a confirmatory factor analysis. The mean age of students in our sample was 23.6 years; 79% of these were female. The sample displayed negative attitudes regarding the factors of autonomy and instrumentality, but more positive attitudes regarding the factors integrity and acceptability. The attitudes of the students in the three study programmes differed, with the medical students displaying the most negative attitudes. Students who displayed positive attitudes had statistically significantly higher levels of knowledge about ageism and better possibilities to hold personal conversations with older people (80+) in the family or circle of friends.
CONCLUSION
We conclude that having more knowledge about ageism and close personal contacts to older persons can support positive attitudes towards older individuals.
Topics: Aged; Aged, 80 and over; Aging; Attitude; Attitude of Health Personnel; Austria; Cross-Sectional Studies; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Semantic Differential; Students, Medical; Students, Nursing; Surveys and Questionnaires
PubMed: 34719117
DOI: 10.1111/opn.12430