Интегративный подход как вектор персонализации образовательных практик в медицинском вузе

Introduction. The article discusses the formation of a model of a high quality educational process in a medical university in order to prepare a highly qualified specialist and a versatile educated person. Purpose setting. The objective of the study was to analyze the process of formation of clinical thinking, intellectual and communicative competencies in the process of preparing future specialists for professional activities in a medical university, based on the use of an integrative approach, assessment of the type of thinking and learning; constitutional features of the student and teacher; semantic differential method. Methodology and methods of the study. The methodology of the material presented in the article is based on the introduction of a systematic (holistic) approach to study the individual constitutional (mental and physical) characteristics of teachers and medical students in connection with training and further professional activities. Results. The article analyzes current trends and problematic issues of the educational process in pedagogy and andragogy, due to technological progress, the development of digital technologies, distance types and forms of education, the formation of the so-called «digital generation» of students, requiring the development and implementation of innovative methodological approaches and methods in the educational process training of specialists in medical universities. The necessity of forming not only intellectual and communicative competencies in the process of mastering a profession, but also conceptual and logical schemes of clinical thinking using the method of semantic differential is demonstrated. The role of the constitutional features of the teacher and student in the training of future specialists is shown. The relationship between the professional and personal qualities of a high school teacher and students is illustrated.Conclusion. The use of an integrative approach greatly contributes to improving the quality of the educational process in the professional training of a future medical specialist.Введение. Обсуждается формирование модели качественного образовательного процесса в медицинском вузе с целью подготовки высококвалифицированного специалиста и разносторонне образованной личности. Постановка задачи. Задача исследования – проанализировать процесс формирования клинического мышления, интеллектуальных и коммуникативных компетенций в процессе подготовки будущих специалистов к профессиональной деятельности в медицинском вузе на основе применения интегративного подхода, оценки типа мышления и обучения, конституциональных особенностей обучающегося и преподавателя, метода семантического дифференциала. Методика и методология исследования. Методология материала, представленного в статье, базируется на внедрении системного (целостного) подхода для изучения индивидуальных конституциональных (психических и физических) особенностей педагогов и студентов-медиков в связи с обучением и дальнейшей профессиональной деятельностью. Результаты. В статье проанализированы современные тенденции и проблемные вопросы образовательного процесса в педагогике и андрагогике, обусловленные технологическим прогрессом, развитием цифровых технологий, дистанционных видов и форм обучения, формированием так называемого «цифрового поколения» студентов, требующие разработки и внедрения инновационных методологических подходов и методов в образовательный процесс подготовки специалистов в медицинских вузах. Продемонстрирована необходимость формирования не только интеллектуальных и коммуникативных компетенций в процессе овладения профессией, но и понятийно-логических схем клинического мышления с использованием метода семантического дифференциала. Показана роль конституциональных особенностей преподавателя и студента в подготовке будущих специалистов. Проиллюстрирована зависимость между профессиональными и личными качествами преподавателя высшей школы и обучающихся. Выводы. Применение интегративного подхода в значительной степени способствует повышению качества образовательного процесса при профессиональной подготовке будущего специалиста медицинского профиля

Quantification of the loudness of snoring according to Watch-PAT-200 and its relationship with the severity of obstructive sleep apnea syndrome

Purpose of the study: Evaluate the capabilities of Watch-PAT-200 in obtaining data to determine the relationship between the loudness of snoring and the severity of obstructive sleep apnea syndrome (OSAS). Material and methods: From 2017 to 2019, 208 patients with complaints of nocturnal snoring were examined. Apnea / hypopnea indices (AHI) and respiratory distress index (RDI) were assessed. The study was carried out on a Watch-PAT-200 portable device (Itamar Medical, Israel). The average volume of snoring (dB) and the proportion (%) of sleep time with the intensity of snoring over 50.60 and 70 dB were measured. The correlation of the obtained data with the AHI and RDI indices is estimated. Results: During the study, it was found that the volume of snoring increases as the severity of OSAS increases, therefore, the volume of snoring can be an indicator of the severity of OSAS. There are ample opportunities for screening diagnostics of the loudness of snoring with the subsequent consultation of a somnologist and timely prescription of treatment. Due to the objectivity of the obtained data and ease of use, the Watch-PAT-200 device can be used in outpatient practice for screening diagnostics of snoring and OSAS in the population

Clinical Validation of Stimulated Raman Histology for Rapid Intraoperative Diagnosis of CNS Tumors

Stimulated Raman histology (SRH) is an ex-vivo optical imaging method that enables microscopic examination of fresh tissue intraoperatively. The conventional intraoperative method uses frozen section analysis, which is labor and time intensive, introduces artifacts that limit diagnostic accuracy, and consumes tissue. SRH-imaging allows rapid microscopic imaging of fresh tissue, avoids tissue loss, and enables remote telepathology review. This improves access to expert neuropathology consultation in both low- and high-resource practices. We clinically validated SRH by performing a blinded, retrospective two-arm telepathology study to clinically validate SRH for telepathology at our institution. Using surgical specimens from 47 subjects, we generated a dataset composed of 47 SRH-images and 47 matched whole slide images (WSIs) of FFPE tissue stained with H&E, with associated intraoperative clinicoradiological information and structured diagnostic questions. We compared diagnostic concordance between WSI and SRH-rendered diagnoses. Also, we compared the 1-year median turn-around-time (TAT) of intraoperative conventional neuropathology frozen sections with prospectively rendered SRH-telepathology TAT. All SRH-images were of sufficient quality for diagnostic review. A review of SRH-images showed high accuracy in distinguishing glial from non-glial tumors (96.5% SRH vs 98% WSIs) and predicting final diagnosis (85.9% SRH vs 93.1% WSIs). SRH-based diagnosis and WSI-permanent section diagnosis had high concordance (κ=0.76). The median TAT for prospectively SRH-rendered diagnosis was 3.7 minutes, approximately 10-fold shorter than median frozen section TAT (31 minutes). The SRH-imaging procedure did not affect ancillary studies. SRH generates diagnostic virtual histologic images with accuracy comparable to conventional H&E-based methods in a rapid manner. Our study represents the largest and most rigorous clinical validation of SRH to date. It supports the feasibility of implementing SRH as a rapid method for intraoperative diagnosis complementary to conventional pathology laboratory methods. Keywords: Stimulated Raman histology; artificial intelligence; brain tumors; frozen section; glioma; intraoperative diagnosis

Clinical utility of whole-genome DNA methylation profiling as a primary molecular diagnostic assay for central nervous system tumors-A prospective study and guidelines for clinical testing

Background: Central nervous system (CNS) cancer is the 10th leading cause of cancer-associated deaths for adults, but the leading cause in pediatric patients and young adults. The variety and complexity of histologic subtypes can lead to diagnostic errors. DNA methylation is an epigenetic modification that provides a tumor type-specific signature that can be used for diagnosis. Methods: We performed a prospective study using DNA methylation analysis as a primary diagnostic method for 1921 brain tumors. All tumors received a pathology diagnosis and profiling by whole genome DNA methylation, followed by next-generation DNA and RNA sequencing. Results were stratified by concordance between DNA methylation and histopathology, establishing diagnostic utility. Results: Of the 1602 cases with a World Health Organization histologic diagnosis, DNA methylation identified a diagnostic mismatch in 225 cases (14%), 78 cases (5%) did not classify with any class, and in an additional 110 (7%) cases DNA methylation confirmed the diagnosis and provided prognostic information. Of 319 cases carrying 195 different descriptive histologic diagnoses, DNA methylation provided a definitive diagnosis in 273 (86%) cases, separated them into 55 methylation classes, and changed the grading in 58 (18%) cases. Conclusions: DNA methylation analysis is a robust method to diagnose primary CNS tumors, improving diagnostic accuracy, decreasing diagnostic errors and inconclusive diagnoses, and providing prognostic subclassification. This study provides a framework for inclusion of DNA methylation profiling as a primary molecular diagnostic test into professional guidelines for CNS tumors. The benefits include increased diagnostic accuracy, improved patient management, and refinements in clinical trial design. Keywords: DNA methylation; central nervous system tumors; guidelines; molecular; tumor classification

ANALYSIS OF CAUSES OF DEVELOPING COMPLICATED FORMS OF ACUTE OTITIS MEDIA IN CHILDREN

The complicated course of acute otitis media in children not vaccinated against Streptococcus pneumoniae is progressively increasing. Up to 95% of children suffer at least one episode of acute otitis media during the first 7 years of life. Complications of this disease become a heavy burden for both patients, often leading to disability, and healthcare in general. The errors in antibiotic therapy of acute otitis media at the outpatient stage continue to be a serious problem. We present an analysis of the complications of acute otitis media in children and demonstrate the ways of solving this difficult problem