Virtual reality for preoperative patient education: Impact on satisfaction, usability, and burnout from the perspective of new nurses

BACKGROUND Traditional paper-based preoperative patient education is a struggle for new nurses and requires extensive training.In this situation,virtual reality technology can help the new nurses.Despite its potential benefits,there are studies on patient satisfaction but there is limited information on the usability of virtual reality(VR)technology for new nurses in giving preoperative education to patients.AIM To investigate the impact on satisfaction,usability,and burnout of a system using VR technology in preoperative patient education.METHODS The study involved 20 nurses from the plastic surgery ward and 80 patients admitted between April and May 2019.Each nurse taught four patients:Two using traditional verbal education and two using virtual reality.The System Usability Scale,After-Scenario Questionnaire,and Maslach Burnout Inventory(MBI)were employed to evaluate the impact of these education methods.RESULTS The VR education groups showed a statistically higher satisfaction than the traditional verbal education groups.Among the three subscales of the MBI,emotional exhaustion and personal accomplishment improved statistically significantly.VR was also better in terms of usability.CONCLUSION This study suggests VR enhances usability and reduces burnout in nurses,but further research is needed to assess its impact on depersonalization and objective measures like stress and heart rate.

Effect of health education based on information-motivationbehavioral skills model on patients with unilateral vestibular dysfunction

BACKGROUND Vestibular dysfunction(VH)is a common concomitant symptom of late peri-pheral vestibular lesions,which can be trauma,poisoning,infection,heredity,and neurodegeneration,but about 50%of the causes are unknown.The study uses the information-motivation-behavioral skills(IMB)model for health education,effectively improve the quality of life,increase their self-confidence,reduce anxiety and depression,and effectively improve the psychological state of patients.AIM To explore the effect of health education based on the IMB model on the degree of vertigo,disability,anxiety and depression in patients with unilateral vestibular hypofunction.METHODS The clinical data of 80 patients with unilateral vestibular hypofunction from January 2019 to December 2021 were selected as the retrospective research objects,and they were divided into the control group and the observation group with 40 cases in each group according to different nursing methods.Among them,the control group was given routine nursing health education and guidance,and the observation group was given health education and guidance based on the IMB model.The changes in self-efficacy,anxiety and depression,and quality of life of patients with unilateral VH were compared between the two groups.RESULTS There was no significant difference in General Self-Efficacy Scale(GSES)scale scores between the two groups of patients before nursing(P>0.05),which was comparable;after nursing,the GSES scale scores of the two groups were higher than those before nursing.The nursing group was higher than the control group,and the difference was statistically significant(P<0.05).There was no significant difference in the scores of Hospital Anxiety and Depression Scale(HADS)and anxiety and depression subscales between the two groups before nursing(P>0.05).After nursing,the HADS score,anxiety,and depression subscale scores of the two groups of patients were lower than those before nursing,and the nursing group was lower than the control group,and the difference was statistically significant(P<0.05).After nursing,the Dizziness Handicap Inventory(DHI)scale and DHI-P,DHI-E and DHI-F scores in the two groups were decreased,and the scores in the nursing group were lower than those in the control group,and the difference was statistically significant(P<0.05).CONCLUSION Health education based on the IMB model can effectively improve patients'quality of life,increase self-efficacy of patients with unilateral vestibular hypofunction,enhance patients'confidence,enable patients to resume normal work and life as soon as possible,reduce patients'anxiety and depression,and effectively improve patients'psychological status.

Impact of stage-specific limb function exercises guided by a selfmanagement education model on arteriovenous fistula maturation status

BACKGROUND The exercise of limb function is the most economical and safe method to promote the maturation of arteriovenous fistula(AVF).However,due to the lack of a uni-fied exercise standard in China,many patients have insufficient awareness of the importance of AVF,leading to poor effectiveness of limb function exercise.The self-management education model can effectively promote patients to take pro-active health-related actions.This study focuses on the characteristics of patients during the peri-AVF period and conducts a phased limb function exercise under the guidance of the self-management education model to observe changes in fac-tors such as the maturity of AVF.AIM To assess the impact of stage-specific limb function exercises,directed by a self-management education model,on the maturation status of AVFs.METHODS This study is a randomized controlled trial involving 74 patients with forearm AVFs from the Nephrology Department of a tertiary hospital in Sichuan Province,China.Patients were randomly divided into an observation group and a control group using a random number table method.The observation group underwent tailored stage-specific limb func-tion exercises,informed by a self-management education model which took into account the unique features of AVF at various stages,in conjunction with routine care.Conversely,the control group was given standard limb function exercises along with routine care.The assessment involves the maturity of AVFs post-intervention,post-operative complications,and the self-management level of the fistula in both groups patients.Analyses were conducted using SPSS version 23.0.Count data were represented by frequency and percentage and subjected to chi-square test comparisons.Measurement data adhering to a normal distribution were presented as mean±SD.The independent samples t-test was utilized for inter-group comparisons,while the paired t-test was used for intra-group comparisons.For measurement data not fitting a normal distribution,the median and interquartile range were presented and analyzed using the Wilcoxon rank sum test.RESULTS At the 8-wk postoperative mark,the observation group demonstrated significantly higher scores in AVF symptom recognition,symptom prevention,and self-management compared to the control group(P<0.05).However,the variance in symptom management scores between the observation and control groups lacked statistical signi-ficance(P>0.05).At 4 wk after the operation,the observation group displayed a superior vessel diameter and depth from the skin of the drainage vessels in comparison to the control group(P<0.05).While the observation group did manifest elevated blood flow rates in the drainage vessels relative to the control group,this distinction was not statistically significant(P>0.05).By the 8-wk postoperative interval,the observation group outperformed the control group with notable enhancements in blood flow rates,vessel diameter,and depth from the skin of drainage vessels(P<0.01).Seven days following the procedure,the observation group manifested significantly diminished limb swelling and an overall reduced complication rate in contrast to the control group(P<0.05).The evaluation of infection,thrombosis,embolism,arterial aneurysm stenosis,and incision bleeding showed no notable differences between the two groups(P>0.05).By the 4-wk postoperative juncture,complications between the observation and control groups were statistically indistinguishable(P>0.05).CONCLUSION Stage-specific limb function exercises,under the guidance of a self-management education model,amplify the capacity of AVF patients to discern and prevent symptoms.Additionally,they expedite AVF maturation and miti-gate postoperative limb edema,underscoring their efficacy as a valuable method for the care and upkeep of AVF in hemodialysis patients.

Evaluation of the effects of health education interventions for hypertensive patients based on the health belief model

BACKGROUND Hypertension is a major risk factor for cardiovascular disease and stroke,and its prevalence is increasing worldwide.Health education interventions based on the health belief model(HBM)can improve the knowledge,attitudes,and behaviors of patients with hypertension and help them control their blood pressure.AIM To evaluate the effects of health education interventions based on the HBM in patients with hypertension in China.METHODS Between 2021 and 2023,140 patients with hypertension were randomly assigned to either the intervention or control group.The intervention group received health education based on the HBM,including lectures,brochures,videos,and counseling sessions,whereas the control group received routine care.Outcomes were measured at baseline,three months,and six months after the intervention and included blood pressure,medication adherence,self-efficacy,and perceived benefits,barriers,susceptibility,and severity.RESULTS The intervention group had significantly lower systolic blood pressure[mean difference(MD):-8.2 mmHg,P<0.001]and diastolic blood pressure(MD:-5.1 mmHg,P=0.002)compared to the control group at six months.The intervention group also had higher medication adherence(MD:1.8,P<0.001),self-efficacy(MD:12.4,P<0.001),perceived benefits(MD:3.2,P<0.001),lower perceived barriers(MD:-2.6,P=0.001),higher perceived susceptibility(MD:2.8,P=0.002),and higher perceived severity(MD:3.1,P<0.001)than the control group at six months.CONCLUSION Health education interventions based on the HBM effectively improve blood pressure control and health beliefs in patients with hypertension and should be implemented in clinical practice and community settings.

Parental Educational Expectations,Academic Pressure,and Adolescent Mental Health:An Empirical Study Based on CEPS Survey Data

Background:This study aimed to investigate the relationship between parental educational expectations and adolescent mental health problems,with academic pressure as a moderating variable.Methods:This study was based on the baseline data of the China Education Panel Survey,which was collected within one school year during 2013–2014.It included 19,958 samples from seventh and ninth graders,who ranged from 11 to 18 years old.After removing missing values and conducting relevant data processing,the effective sample size for analysis was 16344.The OLS(Ordinary Least Squares)multiple linear regression analysis was used to examine the relationship between parental educational expectations,academic pressure,and adolescents’mental health problems.In addition,we established an interaction term between parents’educational expectations and academic pressure to investigate the moderating effect of academic stress.Results:The study found that adolescents whose parents had high educational expectations reported less mental health problems.(β=−0.195;p<0.001).Additionally,adolescents who had high academic pressure reported more mental health problems.(β=0.649;p<0.001).Furthermore,the study found that academic pressure had a significant moderating effect on the relationship between parental educational expectations and adolescents’mental health problems(β=0.082;p<0.001).Conclusion:Parental educational expectations had a close relationship with adolescents’mental health problems,and academic pressure moderated this relationship.For those adolescents with high levels of academic pressure,the association between high parental educational expectations and mental health problems became stronger.On the contrary,for those adolescents with low levels of academic pressure,the association between high parental educational expectations and mental health problems became weaker.These findings shed new light on how parental educational expectations affected adolescent mental health problems and had significant implications for their healthy development.

Exclusive breastfeeding greater than 50%, success of education in a university hospital in Bogotá: Case-control study

BACKGROUND Maintenance rates of exclusive breastfeeding(EBF)worldwide are low,thus,one of the objectives of the summary of policies on breastfeeding(BF)in world nutrition goals for 2025 are that at least 50%of infants under six months of age receive EBF that year.The Objective of this study is to document the rates of EBF in children born in San Ignacio University Hospital(HUSI)and identify factors associated with maintenance.AIM To document the percentages of EBF in those that were born at HUSI and identify factors associated to their maintenance.METHODS This is a study of cases and controls in an analytic,retrospective cohort that took children born alive between January 2016 and January 2019 at HUSI located in the city of Bogotá,Colombia.RESULTS Receiving information about BF at HUSI was able to maintain EBF up until 4 mo(OR=1.65;95%CI:1.02-2.66).The presence of gynecologic and obstetric comorbidities(OR=0.32;95%CI:0.12-0.83),having mastitis(OR=0.56;95%CI:0.33-0.94),and receiving information from mass media(OR=0.52;95%CI:0.31-0.84)are factors associated with not maintaining EBF.CONCLUSION Receiving education at a Women-and Child-Friendly Institution was the only significant factor to achieve EBF until 4 mo,with a frequency greater than the one reported in the country,which matches multiple studies where counseling and individualized support on BF achieve this purpose.Knowledge about BF and early detection of obstetric/gynecologic complications must be strengthened among the healthcare staff in charge of mothers during post-partum.Additionally,strategies must be promoted to continue BF such as creating milk banks with the objective of increasing BF rates even when mothers return to work.

Making the case for the evolving role of social media in health professions education and a literature review on the application of some in ophthalmology

Background and Objective:Social media(SoMe)has emerged as a tool in health professions education(HPE),particularly amidst the challenges posed by the coronavirus disease 2019(COVID-19)pandemic.Despite the academia’s initial skepticism SoMe has been gaining traction in supporting learning communities,and offering opportunities for innovation in HPE.Our study aims to explore the integration of SoMe in HPE.Four key components were outlined as necessary for a successful integration,and include designing learning experiences,defining educator roles,selecting appropriate platforms,and establishing educational objectives.Methods:This article stemmed from the online Teaching Skills Series module on SoMe in education from the Ophthalmology Foundation,and drew upon evidence supporting learning theories relevant to SoMe integration and models of education.Additionally,we conducted a literature review considering Englishlanguage articles on the application of SoMe in ophthalmology from PubMed over the past decade.Key Content and Findings:Early adopters of SoMe platforms in HPE have leveraged these tools to enhance learning experiences through interaction,dialogue,content sharing,and active learning strategies.By integrating SoMe into educational programs,both online and in-person,educators can overcome time and geographical constraints,fostering more diverse and inclusive learning communities.Careful consideration is,however,necessary to address potential limitations within HPE.Conclusions:This article lays groundwork for expanding SoMe integration in HPE design,emphasizing the supportive scaffold of various learning theories,and the need of furthering robust research on examining its advantages over traditional educational formats.Our literature review underscores an ongoing multifaceted,random application of SoMe platforms in ophthalmology education.We advocate for an effective incorporation of SoMe in HPE education,with the need to comply with good educational practice.

Reform of Hospitality English Teaching Based on the Educational Concept of Outcome-Based Education(OBE)

The Outcome-Based Education(OBE)educational concept,proposed by renowned American educator Spady,aims to guide students in mastering learning laws and ultimately achieving expected learning outcomes.The application of OBE educational concept in Hospitality English curriculum not only can effectively enhance the learning effect but also promote the reform of the Hospitality English curriculum,thus improving students’learning enthusiasm.Therefore,taking the Hospitality English curriculum as an example,this paper points out the existing problems in the teaching of this course and suggests the reform measures based on the OBE teaching concept,hoping to provide guidelines for related educational work.

Improving innovation and entrepreneurship education in higher institutions: the impact of "Mass Entrepreneurship and Innovation" education on undergraduates' entrepreneurial intentions

The exploration of the way"mass entrepreneurship and innovation"(MEI)education influences students'aspirations to become entrepreneurs has grown into an important area of analysis in studies related to higher education.This research intends to examine the consequences of MEI education on students'tendency towards entrepreneurship,and to put forward methods for augmenting the teaching of innovation and entrepreneurship in private higher educational establishments.To achieve this objective,questionnaires and semi-structured interviews were employed in the study,which involved a total of 197 students and five education experts.The statistical analysis of the questionnaire data revealed that MEI education was positively related to students'entrepreneurial intentions,and that both entrepreneurial experience and family entrepreneurial background played moderating roles in this relationship.The interview findings indicated that private universities could enhance educational reforms by designing talent training programs,developing diversified curricula,and developing more professional entrepreneurial platforms to encourage students'entrepreneurial intentions.This study offers fresh insights for improving and perfecting the mechanism of innovation and entrepreneurship education in private universities.

Analysis of the Reform of Ideological and Political Education in College English Curriculum from the Perspective of“Cultural Confidence”

With the rapid development of the education industry,higher requirements have been put forward for college English education and teaching,accelerating the pace of college English reform.Issues such as how to integrate knowledge transmission,language expression skill improvement,cultural element extraction,and ideological and political education,and present the role of curriculum education function have attracted attention.In the era of informatization,college students’thinking has undergone certain changes and gradually developed towards diversification.Therefore,universities should start from the perspective of cultural confidence,extract valuable ideological and political elements,and explore effective tourism ideological and political teaching methods.While helping college students enhance their cultural confidence,it is also beneficial for them to better inherit traditional Chinese culture.This article conducts an in-depth exploration of ideological and political education in college English courses from the perspective of“cultural confidence”and uses scientific and effective measures to solve the problems encountered,aiming to provide valuable guidelines for relevant researchers.

Can the Educational Metaverse Enter the Real Classroom?-From the Perspective of Frontline Teachers

This article dissects the challenges faced and the integration strategies for embracing the educational metaverse from existing research,preparing for the new educational trend-the educational metaverse-by controlling the target direction,technical direction,teacher training direction,and ethical direction.Starting from the origin,it analyzes the reasons for the entry of the metaverse into the educational field and summarizes the three characteristics of the educational metaverse supported by current technical means.Combining the current situation of classroom teaching and the advantages of the educational metaverse,it analyzes the inevitability of the metaverse entering the classroom.Subsequently,it analyzes the four major challenges of the current stage:the pressure of college entrance examinations,the challenge of technical implementation,the limited ability of teachers,and the digital ethical risks brought by the metaverse.It prescribes the right remedy,giving strategies for integrating the educational metaverse into the classroom from the four directions of reducing the burden of college entrance examinations,technology research,teacher ability development,and rule formulation.It is hoped that in the future,while the metaverse lands in the educational field,it can overcome challenges at various levels and achieve breakthroughs at the target level,technical level,teacher training level,and ethical level to truly realize the entry of the educational metaverse into the classroom.

Transforming education:Developing a practice-ready workforce

The well-known question,why do people keep doing the same thing but expect a different result,applies to nursing education.Healthcare delivery systems are in constant evolution yet much of nursing education operates with traditional teaching approaches expecting to produce graduates suitable for rapidly changing healthcare delivery systems.Nursing is a practice-based discipline with its own body of knowledge situated within the context of dy-namic nursing practice.It is the responsibility of nursing academia to prepare graduates suitable for practice.If we are to change prac-tice,we must rethink education.The impact and interruptions of the global COVID-19 pandemic gave rise to questions on best prac-tices to guide nursing education into the future.

Big data challenge for monitoring quality in higher education institutions using business intelligence dashboards

As big data becomes an apparent challenge to handle when building a business intelligence(BI)system,there is a motivation to handle this challenging issue in higher education institutions(HEIs).Monitoring quality in HEIs encompasses handling huge amounts of data coming from different sources.This paper reviews big data and analyses the cases from the literature regarding quality assurance(QA)in HEIs.It also outlines a framework that can address the big data challenge in HEIs to handle QA monitoring using BI dashboards and a prototype dashboard is presented in this paper.The dashboard was developed using a utilisation tool to monitor QA in HEIs to provide visual representations of big data.The prototype dashboard enables stakeholders to monitor compliance with QA standards while addressing the big data challenge associated with the substantial volume of data managed by HEIs’QA systems.This paper also outlines how the developed system integrates big data from social media into the monitoring dashboard.

Research on Risk Identification and Industrial Governance of Digital Education Products Based on Data Annotation Technology

The social transformation brought aboutby digital technology is deeply impacting various industries.Digital education products, with core technologiessuch as 5G, AI, IoT (Internet of Things),etc., are continuously penetrating areas such as teaching,management, and evaluation. Apps, miniprograms,and emerging large-scale models are providingexcellent knowledge performance and flexiblecross-media output. However, they also exposerisks such as content discrimination and algorithmcommercialization. This paper conducts anevidence-based analysis of digital education productrisks from four dimensions: “digital resourcesinformationdissemination-algorithm design-cognitiveassessment”. It breaks through corresponding identificationtechnologies and, relying on the diverse characteristicsof governance systems, explores governancestrategies for digital education products from the threedomains of “regulators-developers-users”.

Flexner's legacy and the future of medical education:Embracing challenge and opportunity

This editorial comments on the article by Alzerwi.We focus on the development course,present challenges,and future perspectives of medical education.Modern medical education is gradually undergoing significant and profound changes worldwide.The emergence of new ideas,methodologies,and techniques has created opportunities for medical education developments and brought new concerns and challenges,ultimately promoting virtuous progress in medical education reform.The sustainable development of medical education needs joint efforts and support from governments,medical colleges,hospitals,researchers,administrators,and educators.

Association of education with cholelithiasis and mediating effects of cardiometabolic factors:A Mendelian randomization study

BACKGROUND Education,cognition,and intelligence are associated with cholelithiasis occurrence,yet which one has a prominent effect on cholelithiasis and which cardiometabolic risk factors mediate the causal relationship remain unelucidated.AIM To explore the causal associations between education,cognition,and intelligence and cholelithiasis,and the cardiometabolic risk factors that mediate the associations.METHODS Applying genome-wide association study summary statistics of primarily European individuals,we utilized two-sample multivariable Mendelian randomization to estimate the independent effects of education,intelligence,and cognition on cholelithiasis and cholecystitis(FinnGen study,37041 and 11632 patients,respectively;n=486484 participants)and performed two-step Mendelian randomization to evaluate 21 potential mediators and their mediating effects on the relationships between each exposure and cholelithiasis.RESULTS Inverse variance weighted Mendelian randomization results from the FinnGen consortium showed that genetically higher education,cognition,or intelligence were not independently associated with cholelithiasis and cholecystitis;when adjusted for cholelithiasis,higher education still presented an inverse effect on cholecystitis[odds ratio:0.292(95%CI:0.171-0.501)],which could not be induced by cognition or intelligence.Five out of 21 cardiometabolic risk factors were perceived as mediators of the association between education and cholelithiasis,including body mass index(20.84%),body fat percentage(40.3%),waist circumference(44.4%),waist-to-hip ratio(32.9%),and time spent watching television(41.6%),while time spent watching television was also a mediator from cognition(20.4%)and intelligence to cholelithiasis(28.4%).All results were robust to sensitivity analyses.CONCLUSION Education,cognition,and intelligence all play crucial roles in the development of cholelithiasis,and several cardiometabolic mediators have been identified for prevention of cholelithiasis due to defects in each exposure.

Enhancing preoperative patient education through virtual reality:A leap forward in nursing practice

Integration of virtual reality(VR)technology into preoperative patient education has shown potential to improve nursing practice.The study by Kim et al examines the impact of VR on nurse satisfaction,usability,and burnout.A prospective study involving 20 nurses and 80 patients was conducted,comparing traditional paper-based education with VR-based education in the plastic surgery ward at Chungnam National University Hospital.Findings demonstrated that VR significantly enhanced satisfaction and usability among nurses,while also reducing emotional exhaustion,a critical factor in nurse burnout.Consistency in education quality was also improved,ensuring uniform patient care.These results underscore the importance of VR in reducing the stress of repetitive tasks,improving job satisfaction,and potentially enhancing nurse retention.Future research should explore the broader applications of VR in healthcare and address the logistical challenges of integrating this technology into routine clinical practice.The study by Kim et al highlights VR’s transformative potential in preoperative education for both patients and healthcare providers.

Advancement of Nursing Education in Psychosocial Oncology Care:Perspectives and Experiences of Nurses

Introduction:The main objective of this study was to fill the gap between the knowledge nurses have about psychosocial care and what they do about cancer patients’needs.It also aimed to devise ways to improve nursing education for nurses who could provide enhanced psychosocial support in such areas.Methods:This qualitative study relied on 18 in-depth interviews with nurses,with a focus on the difference between their understanding of psychosocial care and its application in helping cancer patients.This involved analyzing the transcribed interviews using thematic analysis.Data were collected from February to March 2024.Results:The verbal accounts of 18 participants were analyzed.These include theme 1“holistic approach to cancer care”with the subtheme“navigating resource constraints:”theme 2“nurses well-being and emotional input”with the subtheme“positive impact of psychosocial care:”theme 3“Care for patients’well-being”with subtheme“resourcefulness and resilience in psychosocial care:”theme 4“adapting care and building connections:”theme 5“ideal and reality in psychosocial care”with subtheme“challenges in delivering comprehensive cancer care:”and theme 6“empowering nurses for effective psychosocial care”with subtheme“building a strong foundation for psychosocial care.”Conclusion:From the nurses’perspective,this study indicates a need for more inclusive cancer treatment.Therefore,in addition to physical interventions,emotions and social welfare must also be addressed.Although emotionally invested,health workers may offer assistance along psychosocial lines,thus aiding both patients and caretakers.Although individualized care with personal connections is crucial for effective services,this approach can make it difficult to ensure that all clients receive adequate psychological assistance.Hence,there has been a call to enhance the training to produce nurses who offer high-quality services.This study emphasizes a more holistic approach toward the emotional needs of patients while supporting those responsible for them in their sickness journey.

Integrating the health belief model into health education programs in a clinical setting

The article demonstrates that health belief model(HBM)-based health education in hypertensive patients effectively improves blood pressure control and medication adherence at 3 months and 6 months.The HBM addresses perceived barriers,benefits,susceptibility,severity,and self-efficacy,leading to better health behaviors.HBM-based education has been effective in various contexts,including managing chronic diseases,promoting cancer screenings,and preventing infectious diseases.However,the model has limitations,such as cultural applicability and addressing complex health behaviors influenced by environmental factors.Future research should integrate HBM with other theories and conduct longitudinal studies to assess long-term impacts.Despite these limitations,HBM-based education significantly improves patient outcomes,highlighting its potential in health education and promotion when appropriately adapted and implemented.This reinforces the model's value in designing effective health interventions and advancing public health.

Virtual reality:The bridge between medical education and clinical practice

After perusing the paper by Kim et al,I discovered that this is an interesting manuscript and a successful study.Virtual reality(VR)is an emerging and promising technology employed in the domain of medical practice and medical education over the past decade.In the era of big data,VR is constantly progressing in the fields of medical education and clinical diagnosis and treatment.As a novel scientific and technological tool,VR not only overcomes multiple limitations of the traditional medical teaching mode but also reduces the reliance on personnel and equipment.VR can simulate the real clinical situation,stimulate the enthusiasm of young doctors and nurses for clinical study,and simultaneously safeguard and promote medical safety and doctor-patient harmony.Favorable outcomes have been attained in clinical teaching and diagnosis and treatment activities.While enhancing the training conditions of medical cosmetics and elevating the level of clinical practice and teaching,the risks resulting from improper clinical diagnosis and treatment have been circumvented.All of this is evident and comprehensible.