The script clinical reasoning test An internal medicine educational practice perspective

One of the main skills in internal medicine is clinical decision making. To make clinical decisions, physicians in training reorganize their knowledge in order to optimally perform their clinical functions (diagnosis, research methods and treatment), which are organized according to disease scripts. This ability develops with experience and is acquired during their academic training. The script concordance test has been described as an innovative evaluation tool, designed to evaluate clinical decision making (clinical reasoning) in addition to the degree of knowledge. The script theory, understood as the organization of knowledge, is the basis for decision making. Disease scripts play a key role in supporting and developing clinical reasoning skills, which should be acquired in order to produce differential diagnoses and interpret clinical data. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2569).

Application of auto-importing of CT images and structures into treatment planning system based on UiBot software / 中华放射肿瘤学杂志

Objective:To build a systemic and automatic importing scheme for importing CT images and structures into the treatment planning systems (TPSs) of Eclipse and Monaco.Methods:Based on two TPSs of Eclipse and Monaco, the files of CT images and structures were automatically transported from OAR auto-delineation system to the importing directory of these two TPSs using batch script in Windows system. Following the standard importing procedures of these two TPSs, the automatically importing script of CT images and structures were developed using the application of UiBot. Finally, the CT images and structures were imported into these two TPSs opportunely.Results:By comparing the importing time using script and manual methods, the script not only achieved auto-importing CT images and structures into TPSs, but also yielded almost the same efficiency to manual method. The number of imaging layers in most patients was between 130 and 180, and the average manual and automatic importing time within this interval was 76 s and 75 s.Conclusions:Automatic scripts can be developed by using the automation function of UiBot combined with the actual problems of radiotherapy and repeated workflow. The efficiency of radiotherapy work can be significantly improved. Manual and time costs can be saved. It provides a novel alternative for the automation of radiotherapy procedures.

The study of automatic treatment planning of prostate cancer based on DVH prediction models of organs at risk / 中华放射肿瘤学杂志

Objective To evaluate the feasibility of utilizing dose-volume histogram (DVH) prediction models of organs at risk (OARs) to deliver automatic treatment planning of prostate cancer.Methods The training set included 30 cases randomly selected from a database of 42 cases of prostate cancer receiving treatment planning.The bladder and rectum were divided into sub-volumes (Ai) of 3 mm in layer thickness according to the spatial distance from the boundary of planning target volume (PTV).A skewed normal Gaussian function was adopted to fit the differential DVH of Ai,and a precise mathematical model was built after optimization.Using the embedded C++ subroutine of Pinnacle scripa,ahe volume of each Ai of the remaining validation set for 12 patients was obtained to predict the DVH parameters of these OARa,ahich were used as the objective functions to create personalized Pinnacle script.Finalla,automatic plans were generated using the script.The dosimetric differences among the original clinical plannina,aredicted value and the automatic treatment planning were statistically compared with paired t-test.Results DVH residual analysis demonstrated that predictive volume fraction of the bladder and rectum above 6 000 cGy were lower than those of the original clinical planning.The automatic treatment planning significantly reduced the V70,V60,V50 of the bladder and the V70 and V60 of the rectum than the original clinical planning (all P＜0.05),the coverage and conformal index (CI) of PTV remained unchangea,and the homogeneity index (HI) was slightly decreased with no statistical significance (P＞ 0.05).Conclusion The automatic treatment planning of the prostate cancer based on the DVH prediction models can reduce the irradiation dose of OARs and improve the treatment planning efficiency.

Study on optogenetics technology and the design of its script for virtual simulation experiment / 中华医学教育探索杂志

Optogenetics is one of the biggest breakthroughs in neurobiology in recent decades,which is a revolutionary approach to precise intervention of specific cell functions through the combination of optical and genetic engineering techniques.However,this technique involves the interdisciplinary theoretical knowledge and methods,and it requires expensive equipments and long experimental period.Thus,it is not convenient to carry out widely in experiment teaching for undergraduates except the virtual simulation teaching.In present virtual simulation experiment,we aim to learn the basic principle,operation and application of optogenetics and achieve the desired teaching effects by simulating the process of the virus package,simulating the process of the animal selection,surgery and virus stereotactic microinjection,simulating the expression process of photosensitive channel,the extracellular verification process of photosensitive channel function in vivo,and simulating the observation process that optogenetic inhibition of glutamate neurons in the amygdala affect animal fear behavior.In this paper,the content design of the script making of the virtual experiment has been discussed in the above ways.

The Two Medical Prescriptions Treating Miscellaneous Diseases Written in Tangut Script Excavated from Heishui City / 浙江中医药大学学报

[Objective]To discuss the medical development situation of Tangut and the medicine cultural communication and fusion of the Central Plains, it decoded the medical prescriptions treating miscellaneous diseases in Heishui town. [Methods]It is done by arranging, decoding and translating the excavated Heishui town Tangut script which treats the people who can't swallow food and the pharyngitis and treats the constipation of men and women. Besides it can connect with the medical theory of Central Plains to discuss from the pathology dosage and eating aspects. [Results]The two medical prescriptions of Tangut which treating miscellaneous diseases are imbued with strong folk features. So it should be recorded by Tangut doctor. [Conslusion]Most of the Tangut medical pathology come from the traditional Chinese medicine theory. But it also has its own uniqe national features. So the medical culture of Central Plains has a deep influence on other peripheral ethnomedicine.

The Pinnacle system increases the speed of searching for patient functionality / 中华放射肿瘤学杂志

Objective To propose a method to improve the efficiency and accuracy of the Pinnacle treatment planning system in searching for a certain patient. Methods The original Pinnacle system was modified by adding a button of"Search Patient" in the window of"Patient Select" to call a self-built window of"Search Patient by MRN or Name". After inputting the patient′s Medical Record Number or Name, a self-built script file was called to quickly find and locate the patient′s record. Results The patient′s MRN or Name was input in the window of"Search Patient by MRN or Name",and then input"Enter" or clicked the button of Search to rapidly identify the patient and enhance the search efficiency. Conclusion The openness and script of the Pinnacle system can be utilized to modify and improve and supplement the existing func-tions.

Calculating the Hausdorff distance based on the scripting in RayStation treatment planning system / 中华肿瘤杂志

Objective@#To calculate out the Hausdorff distance based on the scripting in RayStation treatment planning system, which was then applied in measuring the deformation error of brain stem during image automatic registration between CT and MR.@*Methods@#Scripting was edited in RayStation system (version 4.7) by using IronPython. The set of point coordinates on the contour of any two region of interest (ROI) had been found firstly, then the Hausdorff distance between the two point sets was calculated out. A graphical user interface (GUI) was designed by using XAML to acquire the visualized output of Hausdorff distance. GUI appeared when the script was run, where two ROIs was selected, then the corresponding Hausdorff distance and the running time were displayed by pressing the "Calculate" button.@*Results@#The mean Hausdorff distance of brain stem in 20 patients with head and neck neoplasms was 1.20 cm while the mean elapsed time was 11.01s.@*Conclusions@#Hausdorff distance of any two ROIs can be calculated out by using the developed method. GUI is designed to realize the visual interaction with RayStation system. Therefore, the RayStation system satisfies the demands of Hausdorff distance calculation in both clinical and research work.

Script-based automated placement of gantry angles for tangential beams of breast cancer / 中华放射医学与防护杂志

Objective To reduce the dose to organ at risk ( OAR) by script-based optimizing the gantry angles of tangential beams for forward-planned intensity-modulated breast radiotherapy ( fIMRT ) plans. Methods A total of 46 patients with breast cancer (26 in left and 20 in right) after conservative surgery who were treated with manually planned fIMRT were retrospectively re-planned using a script to place the tangential beams automatically. The script program was developed using Pinnacle3 scripting language as imbedded in the Pinnacle3 treatment planning system, and the Python scripting language. Dosimetric indices, including V20 of the ipsilateral lung, D1 of the contralateral breast and V10 of the heart were extracted by the script for plans of different gantry angles. Then the optimal tangential angles were selected by a penalty function. Results For the 26 left breast cancer cases, V20 of the ipsilateral lung for manual and script were (18.2 ±3.4)% and (18.1 ±3.4)%, respectively(P>0.05), while D1 of the contra-lateral breast(249. 2 ± 88. 4) cGy and (230. 4 ± 80. 2) cGy, respectively( t=2. 27, P<0. 05), V10 of the heart (13. 7 ± 5. 7)% and (13. 1 ± 5. 7)%(t=2. 82, P<0. 05). The V20 of the ipsilateral lung of the 20 right breast cancer cases were (19. 8 ± 3. 8)% and (19. 8 ± 3. 9)%, respectively(P>0. 05). The script plans achieved better V10 of the heart[(298. 0 ± 239. 7) cGy] than the manual plans[(340. 0 ± 286. 2) cGy] (t =2. 53, P <0. 05). Conclusions Compared with the manualmethod, the script can assess of the impact of tangential beam angles on the OAR dose, patient-specifically and quantitatively, hence make better trade-offs and improve the plan quality.

Script-based automated placement of gantry angles for tangential beams of breast cancer / 中华放射医学与防护杂志

Objective To reduce the dose to organ at risk ( OAR) by script-based optimizing the gantry angles of tangential beams for forward-planned intensity-modulated breast radiotherapy ( fIMRT ) plans. Methods A total of 46 patients with breast cancer (26 in left and 20 in right) after conservative surgery who were treated with manually planned fIMRT were retrospectively re-planned using a script to place the tangential beams automatically. The script program was developed using Pinnacle3 scripting language as imbedded in the Pinnacle3 treatment planning system, and the Python scripting language. Dosimetric indices, including V20 of the ipsilateral lung, D1 of the contralateral breast and V10 of the heart were extracted by the script for plans of different gantry angles. Then the optimal tangential angles were selected by a penalty function. Results For the 26 left breast cancer cases, V20 of the ipsilateral lung for manual and script were (18.2 ±3.4)% and (18.1 ±3.4)%, respectively(P>0.05), while D1 of the contra-lateral breast(249. 2 ± 88. 4) cGy and (230. 4 ± 80. 2) cGy, respectively( t=2. 27, P<0. 05), V10 of the heart (13. 7 ± 5. 7)% and (13. 1 ± 5. 7)%(t=2. 82, P<0. 05). The V20 of the ipsilateral lung of the 20 right breast cancer cases were (19. 8 ± 3. 8)% and (19. 8 ± 3. 9)%, respectively(P>0. 05). The script plans achieved better V10 of the heart[(298. 0 ± 239. 7) cGy] than the manual plans[(340. 0 ± 286. 2) cGy] (t =2. 53, P <0. 05). Conclusions Compared with the manualmethod, the script can assess of the impact of tangential beam angles on the OAR dose, patient-specifically and quantitatively, hence make better trade-offs and improve the plan quality.

Assessing clinical reasoning skills of final year medical students using the scrip tconcordance test

Background: Clinical reasoning is the name given to the cognitive processes by which doctors evaluate and analyse information from patients. It is a skill developed by experiential learning and is difficult to assess objectively. The script concordance test, an assessment tool introduced into the health sciences about 15 years ago, is a way of assessing clinical reasoning ability in an objective manner and allows comparisons of the decisions made by medical students and experts in situations of uncertainty. Methods: Twenty-six final year medical students from the International Medical University, Kuala Lumpur, were tested on their decision making skills regarding a young febrile patient. The students evaluated different pieces of information in five different scenarios and made decisions on a five-point Likert scale in the standard format of the script concordance test. Their decisions were compared to the decisions of a panel of experienced clinicians in Internal Medicine. Results: The script concordance test scores for the different scenarios were calculated with higher scores being indicative of greater concordance between the reasoning of students and doctors. The students showed poor concordance with doctors in evaluating clinical information. Overall, only 20 percent of the choices made by students were the same as the choices made by the majority of doctors. Conclusion: Medical students vary in their ability to interpret the significance of clinical information. Using the script concordance test, this preliminary study looked at the ability of final year medical students to interpret information about a patient with a febrile illness. The results showed poor concordance between students and doctors in the way they interpreted clinical information. The script concordance test has the potential to be a tool for teaching and assessing clinical reasoning.

Validation of the Script Concordance Test as an instrument to assess clinical reasoning of residents in pediatric emergency medicine in Mexico

Background. Clinical reasoning is a crucial skill to be acquired during a residency training program. In pediatric emergency medicine, physicians are challenged by diagnostic, investigative, and treatment uncertainties. The Script Concordance Test (SCT) uses authentic clinical scenarios to compare trainee’s judgement skills with those of experts. The purpose of this study was to evaluate the clinical reasoning using a pediatric emergency medicine SCT and to determine if it would be able to differentiate between different levels of residency training, validating it in Mexico. Methods. A SCT containing 58 questions nested in 14 cases was administered to pediatric and senior residents at one academic institution. Fourteen experienced emergency medicine pediatricians were part of a reference panel to establish the basis for the scoring process. Results. Ninety six residents consented to participate. Thirteen residents were fellows of pediatric intensive care medicine or pediatric emergency medicine, and there were 83 pediatric residents. Overall, there was a significant difference in performance across levels of training. The difference between all levels was significant. Conclusions. This pediatric emergency medicine Script Concordance Test was useful to assess the progression of clinical reasoning during residency training in Mexico.

Metodología para escribir el guión de una videoclase para las carreras de la salud / Methodology to write the script of a videoclase for the races of the health

Con la introducción, en la enseñanza de las carreras de la salud, el video y la computadora, y la aplicación del Proyecto Policlínico Universitario se hizo necesaria la incorporación al trabajo en la televisión y el video de un grupo de profesores de las diferentes carreras de la salud, del ISCM-Habana, que requiere un nivel de preparación en aspectos propios del lenguaje de este importante medio para cumplir de manera satisfactoria la tarea encomendada. Este material tiene como objetivo acercar nuestro claustro al mundo del audiovisual y a la construcción de guiones, y proporciona un algoritmo de trabajo que facilita la creación de guiones para la filmación de videoclases en las carreras de la salud (AU)

With the introduction in the education of the races of the Health of the video and the computer, the application of the Policlínico Project in the Medical University, was necessary the incorporation to the work in the television took of a group of professors of UCMH, which require a level of preparation in own aspects of the language of this important one half to fulfill of satisfactory way the entrusted task. This material must as objective approach our teaching cloister to the world of the audio-visual one and the construction of scripts for the shooting of videoclases and provides one a work algorithm that facilitates the creation of scripts for the shooting of videoclases in the races of the health (AU)