Transformations in medical education:A prudential perspective

1 | BACKGROUND.A decade ago we asked the question, “Is there something inmedicine that is eternal or enduring?” Our aim was to writea manuscript entitled, “That which does not change inmedicine.” The publication begins as follows: “The practiceof medicine involves continual change, driven by a constantstream of developments in the understanding of biologicalstructure and function relevant to human diseases, and theparallel improvements in pharmacologic and other technologicalinterventions. This change is also driven by evolvingsocial philosophies, ethical trends, and lifestyles.” [1] Thatpreamble reverberates as strongly now as then, perhapseven more so, given the velocity of technological change.When we deliberated on which aspects of medical practiceshould remain stable, we had few premonitions thatimplantable chips, robotic surgery, virtual reality, andartificial intelligence (AI) would soon become ubiquitous.The needle has clearly moved, propelled by extraordinaryadvances in bioengineering, computer and data sciences;major shifts in the governance and organization of clinicalpractice;and powerful sociocultural trends.

Investigation and analysis of 14034 college students on COVID-19 and its countermeasures and suggestions

Objective:To understand the current situation of college students'knowledge,cognitive attitude and behavior(KAP)towards the prevention and control of Corona Virus Disease 2019(Corona Virus Disease 2019,COVID-19)during the epidemic,so as to provide theoretical basis for college students'resumption of study and campus prevention and control.Methods:A questionnaire survey was conducted among 16,410 college students by using the convenient sampling method of,One-Way ANOVA and Logistic regression analysis of the survey data.Results:The total awareness rate of college students on COVID-19 was 85%,the average knowledge score was(70.4±10.0),and the proportion of high cognition was 74.5%.The average attitude score of college students was(3.78±0.55),and only 3.9%of them held a positive attitude.The average score of college students'protective behaviors was(19.35±1.69),and 48.8%of them took good protective behaviors.Binary logistic regression analysis showed that the proportion of students with high cognition who adopt good protective behaviors is higher than that of students with low cognition(95%CI:0.621-0.752).The proportion of students with a positive attitude to adopt good behaviors was higher than that with a negative attitude(95%CI:1.398-2.009),Spearman rank correlation analysis results showed that there was a weak positive correlation between cognition and attitude(r=0.056,P<0.05),and a weak positive correlation between cognition and behavior(r=0.118,P<0.05),and a weak positive correlation between attitude and behavior(r=0.038,P<0.05).Conclusion:College students have a good overall cognition of COVID-19,but their attitudes and protective behaviors need to be further improved.Therefore,knowledge education,behavioral intervention and psychological counseling on COVID-19 epidemic prevention and control among college students should be strengthened to improve their prevention and control ability and physical quality.

Effect of Soccer Games on Gross Motor Development in Preschoolers

This study investigated the effects of playing soccer on the quality of gross motor skills in preschoolers. A 2-group, pretest-posttest design was adopted, comprising both an experimental and a control group. The participants were recruited from 2 public kindergartens located in New Taipei City, Taiwan. The approval of the legal representatives of the 101 preschoolers enrolled in these kindergartens and aged between 4 years and 6 years and 11 months was obtained, and purposive grouping was subsequently conducted. The experimental group comprised 44 participants from the first kindergarten, whereas the control group comprised 43 participants from the second kindergarten. After the recruitment, the experimental group received a soccer program intervention： a 10-week soccer program with two 40-minute sessions per week. Before and after the experiment, the gross motor quality of both groups was measured using the Preschooler Gross Motor Quality Scale, which covers tests for locomotion, object manipulation, and balance. The results of the 10-week intervention showed significantly higher scores for locomotion, object manipulation, balance, and overall gross motor quality in the experimental group than in the control group. This study confirmed that a 10-week soccer program is beneficial for gross motor development in preschoolers. The research results can serve as a reference for gross motor development in preschool education.

Supportive care in transplantation: A patient-centered care model to better support kidney transplant candidates and recipients

Kidney transplantation(KT),although the best treatment option for eligible patients,entails maintaining and adhering to a life-long treatment regimen of medications,lifestyle changes,self-care,and appointments.Many patients experience uncertain outcome trajectories increasing their vulnerability and symptom burden and generating complex care needs.Even when transplants are successful,for some patients the adjustment to life post-transplant can be challenging and psychological difficulties,economic challenges and social isola-tion have been reported.About 50%of patients lose their transplant within 10 years and must return to dialysis or pursue another transplant or conservative care.This paper documents the complicated journey patients undertake before and after KT and outlines some initiatives aimed at improving patient-centered care in transplantation.A more cohesive approach to care that borrows its philosophical approach from the established field of supportive oncology may improve patient experiences and outcomes.We propose the"supportive care in transplantation"care model to operationalize a patient-centered approach in transplantation.This model can build on other ongoing initiatives of other scholars and researchers and can help advance patient-centered care through the entire care continuum of kidney transplant recipients and candidates.Multi-dimensionality,multi-disciplinarity and evidence-based approaches are proposed as other key tenets of this care model.We conclude by proposing the potential advantages of this approach to patients and healthcare systems.Core Tip:Kidney transplant recipients and candidates face several uncertainties in their care journey and have several expressed unmet healthcare needs.We recommend a structured and comprehensive approach to transplant care across the entire continuum of a transplant patient’s journey similar to what has been developed in the field of oncology.The supportive care in transplantation model can operationalize patient-centered care and build on the efforts of other researchers in the field.We postulate that such a model would significantly improve care delivery and patients’experiences and outcomes and potentially decrease healthcare utilization and cost.INTRODUCTION Patients with kidney failure benefit from(KT)[1,2],and experience improved survival rates when compared with dialysis[3-6].KT studies,using validated instruments,have also consistently demonstrated that kidney transplant recipients(KTRs)experience better health-related quality of life and several improvements in other disease-specific domains when compared with dialysis[7].In countries where dialysis is out of reach for many,the diagnosis of kidney failure would be futile without KT[8].Thus,increasing KT has been a priority for the nephrology and transplant communities.This priority has been reflected in recent global trends:Of the 79 countries where data were available,the International Society of Nephrology’s Global Kidney Atlas reported that the prevalence of KTRs in 2023 was 279 per million population which represented an increase of 9.4%from the data published four years prior[8].Despite this growth,KT can be a challenging journey for many patients and it is sometimes regarded as a‘cure’,which does not conform with the reality that many patients experience[9-13].KTRs must maintain a life-long treatment regimen of medications,lifestyle changes,self-care and medical appointments[14-17].As poignantly stated by a young female transplant recipient,“I thought everything would change once I got my kidney.I thought I would be healthy again”but after experiencing multiple side effects of immunosuppressive medications and graft loss,she stated,“I am just a different kind of patient now”[18].Indeed,a significant proportion of patients experience graft failure and return to dialysis;it is estimated that over 50%return to dialysis within 10 years of KT[19-23].Patients are often not prepared for this outcome and report several psychosocial and physical ramifications of graft failure[24,25].Overall,high symptom burden,adverse effects of immunosuppressants,risk of graft rejection or failure and mortality,contribute to complex needs,vulnerability and uncertainties for patients,increasing their care needs and treatment burden[26-30].In this paper,we highlight the complex journey that KTRs and candidates undertake that can generate varied outcome trajectories and complex healthcare needs.We highlight the need for a comprehensive patient-centered approach to care and conclude with a proposal for a“supportive care in transplantation”care model.

Identification of Newly Diagnosed Diabetes and Prediabetes Using Fasting Plasma Glucose and Urinary Glucose in a Chinese Population： A Multicenter Cross-Sectional Study

Background： Although fasting plasma glucose （FPG） has been highly recommended as the sole test for diabetes screening, the efficacy of FPG alone for diabetes screening is potentially limited due to its low sensitivity. The aim of this study was to improve the efficacy of FPG for diabetes screening using urinary glucose （UG）. Methods： This study was initiated on November 12, 2015, and ended on June 28, 2016. A representative sample of individuals aged between 18 and 65 years, with no history of diabetes, from 6 cities in Jiangsu Province participated in this study. A 75-g oral glucose tolerance test was used to diagnose diabetes. All urine samples were collected within 2 h of oral glucose loading to measure UG. Partial correlation analyses were used to evaluate the associations between UG and other glycemic variables, including FPG, 2-h plasma glucose （2h-PG）, and glycated hemoglobin A 1 c, after adjustment for age. Tile perfbnnance of UG was evaluated using a receiver operating characteristic （ROC） curve analysis. Results： Of the 7485 individuals included, 8% were newly diagnosed with diabetes and 48.7% had prediabetes. The areas under the ROC curves for UG were 0.75 for estimation of 2h-PG ≥7.8 mmol/L and 0,90 for 2h-PG ≥11.1 mmol/L, respectively. The sensitivity and specificity of UG were 52.3% and 87.8%, respectively, for 2h-PG ≥7.8 mmol/L （cutoff point ≥130 mg）, and 83.5% and 87.5%, respectively, for 2h-PG ≥11.1 mmol/L （cutoff point ≥ 178.5 mg）. The combination of FPG and UG demonstrated a significantly higher sensitivity than that of FPG alone for the identification of diabetes （[483/597] 80.9% vs. [335/597] 56.1%, x2 = 85.0, P 〈 0.001） and glucose abnormalities （[2643/4242] 62.3% vs. [2365/4242] 55.8%, x2 = 37.7 P 〈 0.001）. Conclusions： The combination of UG and FPG substantially improves the efficacy of using FPG alone for diabetes screening; this combination might be a practical screening tool and is worth being recommended in the future.