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 focu...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.展开更多
Basis of seventy-seven case records of twenty-six diseases in Linzheng Zhinan Yi'an(Guide to Clinical Practice),analyze and distinguish them into four types.They are disorder of the mother-organ affecting the chil...Basis of seventy-seven case records of twenty-six diseases in Linzheng Zhinan Yi'an(Guide to Clinical Practice),analyze and distinguish them into four types.They are disorder of the mother-organ affecting the child-organ,disorder of the child-organ affecting the mother-organ,over restraint and reverse restraint.The essence of this article is to recognize the pathological transmission among the Zang-fu organs according to the theory of five elements.展开更多
The medical case records are an important carrier for the inheritance of traditional Chinese medicine(TCM)diagnosis and treatment experience,the standardization construction of which contributes to promoting TCM moder...The medical case records are an important carrier for the inheritance of traditional Chinese medicine(TCM)diagnosis and treatment experience,the standardization construction of which contributes to promoting TCM modernization.This article reviewed the development process of TCM medical case records,and pointed out that the main problems restricting the standardization of medical case records are complex formats,confusing terminology,and scattered experience.Suggestions have been proposed to standardize the format and content of medical case records,and unify terminology standards to promote the in-depth exploration of medical case record experience,and the sustainable development of clinical medical case record databases,to provide reference for promoting the standardization of TCM and improving the international influence of TCM diagnosis and treatment.展开更多
<strong>Background:</strong> Zimbabwe started HIV case-based surveillance in April 2017. Rapid testing for HIV recent infection was introduced into routine HIV and testing services in 2019 along with the I...<strong>Background:</strong> Zimbabwe started HIV case-based surveillance in April 2017. Rapid testing for HIV recent infection was introduced into routine HIV and testing services in 2019 along with the Impilo Electronic Health Record System. For the period January-June 2020, only 1 out of 13 health facilities in Mutare district reported seven newly diagnosed HIV patients through the electronic health record system compared to 483 in the District Health Information System (DHIS-2) recorded from paper-based registers. We evaluated the case-based surveillance system attributes, usefulness and reasons for under-reporting from January-December 2020. <strong>Methods:</strong> We conducted a descriptive cross-sectional study using updated Centres for Disease Control guidelines for evaluating public health surveillance systems. Questionnaires were administered to 36 health workers involved in HIV testing services. Facility checklists were used to collect data on knowledge, system attributes and usefulness of the system. Completed HIV case-based surveillance forms were assessed for completeness. Epi Info Version 7 was used to generate frequencies, means and proportions. <strong>Results:</strong> The reasons for under-reporting of patients in the electronic health record system were lack of reporting guidelines 26/36 (72%), limited coordination between technical staff and health facilities 24/36 (67%) and limited competency on the Electronic health record system 22/36 (61%). Timeliness, completeness, and validity were 88%, 82% and 100% respectively. The stability of the system was affected by the lack of standard operating procedures during system interruptions. Overall representativeness was 45% despite increasing from 3/226 (1%) to 224/303 (73%) between Quarter-1 and Quarter-4 of 2020. Acceptability was 100% due to reduced paperwork and the ability to generate simple reports. The information generated was used to identify new infection hotspots 28/36 (78%). <strong>Conclusion:</strong> The HIV cases based surveillance system was timely, acceptable with good data quality. Representativeness was poor due to limited competency on the electronic health record system. As a result, health workers received further training.展开更多
目的解决当前中医医案命名实体识别模型识别效果欠佳的问题,提升中医医案结构化的效率与精准度。方法构建融合多维度信息的BDM-CRF命名实体识别神经网络模型,融合双向长短期记忆网络模型(Bidirectional long short-term memory,BiLSTM)...目的解决当前中医医案命名实体识别模型识别效果欠佳的问题,提升中医医案结构化的效率与精准度。方法构建融合多维度信息的BDM-CRF命名实体识别神经网络模型,融合双向长短期记忆网络模型(Bidirectional long short-term memory,BiLSTM)、门控空洞卷积神经网络模型(Gated-dilated convolutional neural networks,DGCNN)和多头注意力机制模型(Multi-head attention,MHA)进行多维度特征抽取,通过条件随机场(Conditional random field,CRF)模型对特征抽取结果进行约束输出;通过对比实验、消融实验、预训练模型对比实验及神经网络结构对比实验验证该模型的有效性,通过个案分析验证并展示模型的提取效果。结果本研究提出的模型比对照模型精确率平均提升2.30%、召回率平均提升4.73%、F1值平均提升3.53%。个案分析结果表明,本研究模型能正确识别出中医医案文本中的大部分实体内容。结论本研究提出的融合多维度信息的中医医案命名实体识别模型能取得更佳的识别效果,可有效提升中医医案结构化的精准度及效率,促进中医医案处理智能化。展开更多
Objective:To analyze misdiagnosis features in clinical cases of“Classified Medical Cases of Famous Physicians”and“Supplement to Classified Case Records of Celebrated Physicians.”Materials and Methods:Two hundred a...Objective:To analyze misdiagnosis features in clinical cases of“Classified Medical Cases of Famous Physicians”and“Supplement to Classified Case Records of Celebrated Physicians.”Materials and Methods:Two hundred and five ancient misdiagnosed cases were analyzed in aspects of locations(exterior-interior type,qi-blood type and Zang‑Fu organs type)and patterns(heat-cold type and deficiency-excess type)by Apriori Algorithm Method.Results:The main types of misdiagnosis in those medical casesare as follows::Zang‑Fu location misjudgment,misjudging the interior as the exterior,misjudging deficiency pattern as excess pattern,and misjudging cold pattern as heat pattern.Among them,the most outstanding type is the misjudgment of deficiency–cold pattern as excess–heat pattern.Conclusions:(1)Accurate judgment of location and differentiation of deficiency and excess patterns are the key points in diagnosing the diseases correctly.The confusion of true deficiency–cold and pseudo‑excess–heat pattern should be taken seriously.(2)Data mining on ancient clinical cases offers a new methodology for assisting clinical diagnosis of traditional Chinese medicine.展开更多
Recorded stories of the clinical encounter stretch back to ancient times.Throughout their history,these narratives have been called by different names,reflecting changes in format,function,and audience.This paper exam...Recorded stories of the clinical encounter stretch back to ancient times.Throughout their history,these narratives have been called by different names,reflecting changes in format,function,and audience.This paper examines and explains the differences in two related forms of clinical writing as practiced by East Asian Medicine clinicians in the United States today-the case study and the case report.Each has its strengths and weaknesses;each is suited to different roles.The case study is ideal for education and the practice of narrative medicine,whereas the case report has played a vital role in propelling East Asian Medicine into the arena of modern scientific research.展开更多
Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face ...Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.展开更多
基金This study is financed by the grants from Israel Science Foundation(No.ISF-1199/16)Chiang Ching-kuo Foundation for International Scholarly Exchange(No.RG001-U-19).
文摘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.
文摘Basis of seventy-seven case records of twenty-six diseases in Linzheng Zhinan Yi'an(Guide to Clinical Practice),analyze and distinguish them into four types.They are disorder of the mother-organ affecting the child-organ,disorder of the child-organ affecting the mother-organ,over restraint and reverse restraint.The essence of this article is to recognize the pathological transmission among the Zang-fu organs according to the theory of five elements.
基金National Public Welfare Industry Special Research Fund Project-Demonstration Research on the Protection of Ancient Healthrelated Books and Knowledge Mining Based on the Chinese Medical Collection(201507006-2).
文摘The medical case records are an important carrier for the inheritance of traditional Chinese medicine(TCM)diagnosis and treatment experience,the standardization construction of which contributes to promoting TCM modernization.This article reviewed the development process of TCM medical case records,and pointed out that the main problems restricting the standardization of medical case records are complex formats,confusing terminology,and scattered experience.Suggestions have been proposed to standardize the format and content of medical case records,and unify terminology standards to promote the in-depth exploration of medical case record experience,and the sustainable development of clinical medical case record databases,to provide reference for promoting the standardization of TCM and improving the international influence of TCM diagnosis and treatment.
文摘<strong>Background:</strong> Zimbabwe started HIV case-based surveillance in April 2017. Rapid testing for HIV recent infection was introduced into routine HIV and testing services in 2019 along with the Impilo Electronic Health Record System. For the period January-June 2020, only 1 out of 13 health facilities in Mutare district reported seven newly diagnosed HIV patients through the electronic health record system compared to 483 in the District Health Information System (DHIS-2) recorded from paper-based registers. We evaluated the case-based surveillance system attributes, usefulness and reasons for under-reporting from January-December 2020. <strong>Methods:</strong> We conducted a descriptive cross-sectional study using updated Centres for Disease Control guidelines for evaluating public health surveillance systems. Questionnaires were administered to 36 health workers involved in HIV testing services. Facility checklists were used to collect data on knowledge, system attributes and usefulness of the system. Completed HIV case-based surveillance forms were assessed for completeness. Epi Info Version 7 was used to generate frequencies, means and proportions. <strong>Results:</strong> The reasons for under-reporting of patients in the electronic health record system were lack of reporting guidelines 26/36 (72%), limited coordination between technical staff and health facilities 24/36 (67%) and limited competency on the Electronic health record system 22/36 (61%). Timeliness, completeness, and validity were 88%, 82% and 100% respectively. The stability of the system was affected by the lack of standard operating procedures during system interruptions. Overall representativeness was 45% despite increasing from 3/226 (1%) to 224/303 (73%) between Quarter-1 and Quarter-4 of 2020. Acceptability was 100% due to reduced paperwork and the ability to generate simple reports. The information generated was used to identify new infection hotspots 28/36 (78%). <strong>Conclusion:</strong> The HIV cases based surveillance system was timely, acceptable with good data quality. Representativeness was poor due to limited competency on the electronic health record system. As a result, health workers received further training.
文摘目的解决当前中医医案命名实体识别模型识别效果欠佳的问题,提升中医医案结构化的效率与精准度。方法构建融合多维度信息的BDM-CRF命名实体识别神经网络模型,融合双向长短期记忆网络模型(Bidirectional long short-term memory,BiLSTM)、门控空洞卷积神经网络模型(Gated-dilated convolutional neural networks,DGCNN)和多头注意力机制模型(Multi-head attention,MHA)进行多维度特征抽取,通过条件随机场(Conditional random field,CRF)模型对特征抽取结果进行约束输出;通过对比实验、消融实验、预训练模型对比实验及神经网络结构对比实验验证该模型的有效性,通过个案分析验证并展示模型的提取效果。结果本研究提出的模型比对照模型精确率平均提升2.30%、召回率平均提升4.73%、F1值平均提升3.53%。个案分析结果表明,本研究模型能正确识别出中医医案文本中的大部分实体内容。结论本研究提出的融合多维度信息的中医医案命名实体识别模型能取得更佳的识别效果,可有效提升中医医案结构化的精准度及效率,促进中医医案处理智能化。
基金Budget Foundation of Shanghai University of TCM(A1-GY010130)Philosophy and Social Science Foundation of Shanghai(2019BTQ005)。
文摘Objective:To analyze misdiagnosis features in clinical cases of“Classified Medical Cases of Famous Physicians”and“Supplement to Classified Case Records of Celebrated Physicians.”Materials and Methods:Two hundred and five ancient misdiagnosed cases were analyzed in aspects of locations(exterior-interior type,qi-blood type and Zang‑Fu organs type)and patterns(heat-cold type and deficiency-excess type)by Apriori Algorithm Method.Results:The main types of misdiagnosis in those medical casesare as follows::Zang‑Fu location misjudgment,misjudging the interior as the exterior,misjudging deficiency pattern as excess pattern,and misjudging cold pattern as heat pattern.Among them,the most outstanding type is the misjudgment of deficiency–cold pattern as excess–heat pattern.Conclusions:(1)Accurate judgment of location and differentiation of deficiency and excess patterns are the key points in diagnosing the diseases correctly.The confusion of true deficiency–cold and pseudo‑excess–heat pattern should be taken seriously.(2)Data mining on ancient clinical cases offers a new methodology for assisting clinical diagnosis of traditional Chinese medicine.
文摘Recorded stories of the clinical encounter stretch back to ancient times.Throughout their history,these narratives have been called by different names,reflecting changes in format,function,and audience.This paper examines and explains the differences in two related forms of clinical writing as practiced by East Asian Medicine clinicians in the United States today-the case study and the case report.Each has its strengths and weaknesses;each is suited to different roles.The case study is ideal for education and the practice of narrative medicine,whereas the case report has played a vital role in propelling East Asian Medicine into the arena of modern scientific research.
基金Supported by the National Major Scientific and Technological Special Project for"Significant New Drugs Development’’(No.2018ZX09201008)Special Fund Project for Information Development from Shanghai Municipal Commission of Economy and Information(No.201701013)
文摘Regional healthcare platforms collect clinical data from hospitals in specific areas for the purpose of healthcare management.It is a common requirement to reuse the data for clinical research.However,we have to face challenges like the inconsistence of terminology in electronic health records (EHR) and the complexities in data quality and data formats in regional healthcare platform.In this paper,we propose methodology and process on constructing large scale cohorts which forms the basis of causality and comparative effectiveness relationship in epidemiology.We firstly constructed a Chinese terminology knowledge graph to deal with the diversity of vocabularies on regional platform.Secondly,we built special disease case repositories (i.e.,heart failure repository) that utilize the graph to search the related patients and to normalize the data.Based on the requirements of the clinical research which aimed to explore the effectiveness of taking statin on 180-days readmission in patients with heart failure,we built a large-scale retrospective cohort with 29647 cases of heart failure patients from the heart failure repository.After the propensity score matching,the study group (n=6346) and the control group (n=6346) with parallel clinical characteristics were acquired.Logistic regression analysis showed that taking statins had a negative correlation with 180-days readmission in heart failure patients.This paper presents the workflow and application example of big data mining based on regional EHR data.
