As a crucial component of clinical medicine, the main task of diagnosis is to cultivate students’ ability to master systematic clinical thinking, disease diagnosis process, comprehensive analysis methods, and the ability to solve clinical problems. Introducing case-based clinical reasoning as a novel and advanced teaching method in the diagnosis course, in line with the comprehensive ability teaching objectives of the course, can provide students with a platform to apply learned knowledge in practical cases, enhance the fun and practicality of learning, improve students’ clinical thinking ability and practical skills, enable students to make quick and accurate judgments when facing complex cases, and ultimately enhance their ability to analyze and solve problems comprehensively. This article combines the experience of applying case-based clinical reasoning to undergraduate diagnosis at West China School of Medicine of Sichuan University, and explores the prospects of applying this teaching method in medical diagnostics.
Objective To explore teaching effects of case-based learning (CBL) in abdominal physical examination in diagnostics. Methods Among 83 undergraduates in grade 2007 and in major of 8-year clinical medicine were randomly divided into two groups. Under the same conditions, 41 in the CBL group were taught with CBL method, while the other 42 in the control group were taught with traditional teaching method. Their scores in standard patient (SP) practice assessment of abdominal physical examination, examination of abnormal abdominal signs, ability to analyze and write medical records, and right answers to abdominal examination in final exam were compared. Meanwhile, questionnaire surveys were distributed to them after class. Results There was no significant difference between the two groups in the scores of SP practice assessment or medical record writing and analyzing, but the CBL group was obviously superior to the control group in the tests of abnormal abdominal signs and the right answers to abdominal examination in final exam (Plt;0.05). The questionnaire surveys revealed that the CBL group obviously scored higher in the following 3 items: increase the learning interest and commitment, strengthen the ability to analyze and solve problems, and improve the ability to combine theory and practice (Plt;0.05). Conclusion CBL method has an obvious advantage to improve the teaching quality in abdominal physical examination in diagnostics.
Objective To evaluate the effectiveness and safety of reduced glutathione in the treatment of acute renal failure. Methods Twenty-three patients with acute renal failure were divided into the treatment group (n=10) and the control group (n=13) by simple randomisation. Patients in the treatment group received intravenous reduced glutathione 1200 mg daily. Patients in the control group were not treated with reduced glutathione. The therapeutic course for both groups was 4 weeks. Serum creatinine and urea nitrogen were determined before treatment as well as at the end of each of the 4 weeks. Proximal and distal renal tubular functions were evaluated at the end of the treatment. The time when clinical symptoms were improved was recorded and adverse drug reactions were monitored. Results The durations of nausea and vomiting as well as the oliguria stage were shorter in the treatment group than in the control group. The serum creatinine level in the treatment group decreased more markedly than that in the control group. At the end of the treatment, the renal tubular function was better in the treatment group than in the control group. Conclusion Reduced glutathione contributes to the early recovery of renal function in patients with acute renal failure. However, more high-quality and large-scale randomized controlled trials are needed.
Objective To assess the effectiveness and safety of Shenling granule for lower urinary tract infection （damp-heat in lower-Jiao ） in comparison with Niaoganling Chongji. Methods A double-bhnd, double-dummy, randomized controlled trial was conducted. A total of 96 patients （damp-heat in lower-Jiao） were randomized to the treatment group （n =72, Shenling granule, 1 bag, rid） and the control group （n =24, Niaoganling Chongji, 1 bag, tid）. The therapeutic course for both groups was 1 week. Results ITT （intention-to-treatment） analysis showed that the total effective rates of the treatment group and the controlled group were 92.43% and 91.31% , respectively （P 〉0.05）. PP （perprotocol-population） analysis showed that they were 92.31% and 90.91% , respectively （ P 〉0.05 ）. The effective rates on Chinese medicine symptom of the treatment group and the controlled group were 93.43% and 95, 65% respectively by ITT analysis （ P 〉0.05 ） , 95.38% and 94.45% respectively by PP analysis （ P 〉0.05 ）, No significant difference between the two groups was detected. No adverse effect was found. Conclusions There is no significant difference between Shenling granule and Niaoganling Chongji in the treatment of patients with lower urinary tract infection. No adverse effect was found.