Health Care Science最新文献

{"title":"Theranostic aspects of palladium-based bimetallic nanoparticles in biomedical field: A state-of-the-art","authors":"Shwetha B. Nagarajan,&nbsp;Sanjeevi Ramakrishnan,&nbsp;Anuradha Jayaraman","doi":"10.1002/hcs2.96","DOIUrl":"10.1002/hcs2.96","url":null,"abstract":"<p>The exploration of newer antibacterial strategies is driven by antibiotic-resistant microbes that cause serious public health issues. In recent years, nanoscale materials have developed as an alternative method to fight infections. Despite the fact that many nanomaterials have been discovered to be harmful, numerous researchers have shown a keen interest in nanoparticles (NPs) made of noble metals like silver, gold and platinum. To make environmentally safe NPs from plants, green chemistry and nanotechnology have been combined to address the issue of toxicity. The study of bimetallic nanoparticles (BNPs) has increased tremendously in the past 10 years. The production of BNPs mediated by natural extracts is straightforward, low cost and environmentally friendly. Due to their low toxicity, safety and biological stability, noble BNPs with silver, gold, platinum and palladium have the potential to be used in biomedical applications. They have a significant impact on human health and are used in medicine and pharmacy due to their biological characteristics, which include catalytic, antioxidant, antibacterial, antidiabetic, anticancer, hepatoprotective and regenerative activity.</p>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 3","pages":"181-202"},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.96","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141359135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Occupational therapy's role in promoting the “Learn the Signs. Act Early.” developmental monitoring program to public health employees","authors":"Kate Barlow,&nbsp;Kelsey Sullivan,&nbsp;Scott Lauren","doi":"10.1002/hcs2.95","DOIUrl":"10.1002/hcs2.95","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Occupational therapists can play a key role in early identification of delay at the population health level by providing education to public health employees on how to implement developmental monitoring with caregivers of children birth to age 5.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A pretest posttest design was utilized to assess the online education and training that was provided to Department of Public Health employees (<i>N</i> = 339), including Head Start, Special Supplemental Nutrition Program for Women, Infants and Children, Home Visiting, and Early Intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Analysis of pretest-posttest survey data showed significant results for all 12 key learning outcomes. Six out of 12 outcomes were found to have a large effect size (<i>d</i> &gt; 0.8), 4 outcomes indicated a medium effect size (<i>d</i> &gt; 0.5), and 2 outcomes had a small effect size (<i>d</i> &gt; 0.2). Participants gained knowledge of the “Learn the Signs. Act Early.” (LTSAE) developmental monitoring program, the difference between developmental monitoring and screening, the state's referral system and age-appropriate parental engagement activities through knowledge of child development.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Occupational therapists are child development specialists who can provide education on developmental monitoring and activities for parental engagement. The online course proved to be an effective platform to promote LTSAE within state agencies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 3","pages":"163-171"},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11212480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141474389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating rural health outcomes: A methodological approach using population-level data","authors":"Gal Av-Gay,&nbsp;Anshu Parajulee,&nbsp;Kathrin Stoll,&nbsp;Jude Kornelsen","doi":"10.1002/hcs2.94","DOIUrl":"10.1002/hcs2.94","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The sustainability of rural surgical and obstetrical facilities depends on their efficacy and quality of care, which are difficult to measure in a rural context. In an evaluation of rural practice, it is often the case that the only comparators are larger referral facilities, for which facility-level comparisons are difficult due to differences in population demographics, acuity of patients, and services offered. This publication outlines these limitations and highlights a best-practice approach to making facility-level comparisons using population-level data, risk stratification, tests of noninferiority, and Firth logistic regression analysis. This includes an investigation of minimum sample-size requirements through Monte Carlo power analysis in the context of low-acuity rural surgical care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Monte Carlo power analysis was used to estimate the minimum sample size required to achieve a power of 0.8 for both logistic regression and Firth logistic regression models that compare the proportion of surgical adverse events against facility type, among other confounders. We provide guidelines for the implementation of a recommended methodology that uses risk stratification, Firth penalized logistic regression, and tests of noninferiority.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We illustrate limitations in facility-level comparison of surgical quality among patients undergoing one of four index procedures including hernia repair, colonoscopy, appendectomy, and cesarean delivery. We identified minimum sample sizes for comparison of each index procedure that fluctuate depending on the level of risk stratification used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The availability of administrative data can provide an adequate sample size to allow for facility-level comparisons in surgical quality, at the rural level and elsewhere. When they are made appropriately, these comparisons can be used to evaluate the efficacy of general practitioners and nurse practitioners in performing low-acuity procedures.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 3","pages":"151-162"},"PeriodicalIF":0.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.94","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141005580","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Animation-guided family empowerment program on perioperative care after neurosurgery: A randomized controlled trial for preventing respiratory complications","authors":"Yunfen Lv,&nbsp;Ziwei Zhao,&nbsp;Xinyi Wu,&nbsp;Yao Wang,&nbsp;Shanshan Qiu","doi":"10.1002/hcs2.93","DOIUrl":"10.1002/hcs2.93","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to evaluate the effectiveness of using animation as education material for family empowerment program on perioperative care for caregivers whose children were to undergo neurosurgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A total of 204 caregivers were randomly assigned to either the face-to-face oral nursing educated group (Oral Group) or the animation-assisted nursing educated group (Animated Group). The nursing education primarily focused on instructing caregivers about the manual vibration method. The primary outcome of interest in this study was participants' knowledge level, collected by a 10-item questionnaire. Secondary outcomes included child patients' clinical data, including hospitalization days, treatments, and signs of pneumonia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants in the Animated Group exhibited significantly higher accuracy in perioperative care knowledge assessment, and patients in this group had a lower chance of requiring atomization therapy compared to the Oral Group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The animation-assisted nursing education program effectively enhances pediatric caregivers' knowledge, reduces respiratory complications after surgery, and offers valuable insights for future studies on the use of such programs to instruct caregivers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 3","pages":"141-150"},"PeriodicalIF":0.0,"publicationDate":"2024-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11212325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141474387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of community pharmacists and their perception towards antimicrobial stewardship in Baghdad, Iraq","authors":"Akram Alkadhimi,&nbsp;Omar T. Dawood,&nbsp;Amer H. Khan","doi":"10.1002/hcs2.92","DOIUrl":"https://doi.org/10.1002/hcs2.92","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship, in addition to identifying factors influencing their perception and practices in community pharmacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cross-sectional study was carried out among community pharmacists regarding antimicrobial stewardship. Convenience sampling was used to obtain the required sample from a community pharmacy in Baghdad. In total, 381 participants have completed the survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The majority of the participants (85.6%) strongly agreed/agreed that “antimicrobial stewardship programs reduce the problems of antibiotic resistance”; and 85.5% of them strongly agreed/agreed that community pharmacists required adequate training on antibiotics use. In addition, high percent of community pharmacists (88.4%) strongly agreed/agreed that pharmacists have a responsibility to take a prominent role in antimicrobial stewardship programs and infection-control programs in the health system. The total score of perception was significantly influenced by older age groups, postgraduate degrees, and experience of 6–10 years (<i>p</i> &lt; 0.001). This study also showed that 65.4% of pharmacists always/often advise patients to continue the full course of antimicrobials, and 64.9% of them reported always/often considering clinical and safety parameters before dispensing antibiotics. The role of pharmacists was significantly influenced by the younger age group, females, higher degree in pharmacy, experience of 3–5 years, and medical complex pharmacy (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Community pharmacists have a good perception toward antimicrobial stewardship programs, but their role is still limited. More efforts are needed to design better strategies for antimicrobial stewardship in community pharmacy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 2","pages":"114-123"},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.92","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140639600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The novel hierarchical clustering approach using self-organizing map with optimum dimension selection","authors":"Kshitij Tripathi","doi":"10.1002/hcs2.90","DOIUrl":"https://doi.org/10.1002/hcs2.90","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Data clustering is an important field of machine learning that has applicability in wide areas, like, business analysis, manufacturing, energy, healthcare, traveling, and logistics. A variety of clustering applications have already been developed. Data clustering approaches based on self-organizing map (SOM) generally use the map dimensions (of the grid) ranging from 2 × 2 to 8 × 8 (4–64 neurons [microclusters]) without any explicit reason for using the particular dimension, and therefore optimized results are not obtained. These algorithms use some secondary approaches to map these microclusters into the lower dimension (actual number of clusters), like, 2, 3, or 4, as the case may be, based on the optimum number of clusters in the specific data set. The secondary approach, observed in most of the works, is not SOM and is an algorithm, like, cut tree or the other.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this work, the proposed approach will give an idea of how to select the most optimal higher dimension of SOM for the given data set, and this dimension is again clustered into the lower actual dimension. Primary and secondary, both utilize the SOM to cluster the data and discover that the weight matrix of the SOM is very meaningful. The optimized two-dimensional configuration of SOM is not the same for every data set, and this work also tries to discover this configuration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The adjusted randomized index obtained on the Iris, Wine, Wisconsin diagnostic breast cancer, New Thyroid, Seeds, A1, Imbalance, Dermatology, Ecoli, and Ionosphere is, respectively, 0.7173, 0.9134, 0.7543, 0.8041, 0.7781, 0.8907, 0.8755, 0.7543, 0.5013, and 0.1728, which outperforms all other results available on the web and when no reduction of attributes is done in this work.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is found that SOM is superior to or on par with other clustering approaches, like, k-means or the other, and could be used successfully to cluster all types of data sets. Ten benchmark data sets from diverse domains like medical, biological, and chemical are tested in this work, including the synthetic data sets.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 2","pages":"88-100"},"PeriodicalIF":0.0,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.90","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140639601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Building sustainable capacity for better access to diabetes care in low-resource settings: A critical review of global efforts and integrated strategies","authors":"Emmanuel Lamptey","doi":"10.1002/hcs2.89","DOIUrl":"10.1002/hcs2.89","url":null,"abstract":"<p>The alarming state of global insulin access in low-resource settings presents a major barrier to diabetes care. A comprehensive review of these challenges is lacking at the global level. To address this weakness, enhance affordability and build capacity for a more sustainable approach to scaling up access. This review analyzes the specific issue of inconsistent access to insulin in low- and middle-income countries. Using this analysis, we mapped the scope and intensity of issues such as the unaffordability and unavailability of insulin. We also identified six innovative and integrative strategies for increasing and securing accessibility in the areas of policy making, marketing, clinical practice, health education, domestication, and multisectoral approaches.</p>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 2","pages":"131-139"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.89","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140384281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic support, quality of life, and prognosis of frailty among the older adults","authors":"Huai-Yu Wang,&nbsp;Yuming Huang,&nbsp;Meng-Ru Zhou,&nbsp;Hao-Yue Jiang,&nbsp;Yu-Han Zong,&nbsp;Xi-Huan Zhu,&nbsp;Xiaojing Sun","doi":"10.1002/hcs2.88","DOIUrl":"10.1002/hcs2.88","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although socioeconomic support is recommended for frailty management, its association with the prognosis of frailty is unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using data from participants aged ≥65 years in the Chinese Longitudinal Healthy Longevity Survey (2008–2018), the associations between socioeconomic support (source of income, medical insurance, community support, living status), onset of prefrailty/frailty, and worsening of prefrailty, were analyzed using multinominal logistic regression models. The associations between self-reported low quality of life (QoL) and reversion of prefrailty/frailty were analyzed using multivariate logistic regression models. Associations with mortality risk were analyzed using Cox proportional hazard regression models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 13,859 participants (mean age: 85.8 ± 11.1 years) containing 2056 centenarians were included. Financial dependence was a risk factor for low QoL among prefrail/frail individuals, but not among robust individuals. Having commercial or other insurance, and receiving social support from the community were protective factors for low QoL among prefrail/frail individuals and for the worsening of prefrailty. Continuing to work was a risk factor for low QoL, but a protective factor for worsening of prefrailty. A negative association between continuing to work and mortality existed in prefrail individuals aged &lt;85 years and ≥85 years. Living alone was a risk factor for low QoL, but was not significantly associated with frailty prognosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prefrail and frail individuals were vulnerable to changes in socioeconomic support and more sensitive to it compared with robust individuals. Preferential policies regarding financial support, social support, and medical insurance should be developed for individuals with frailty.</p>\u0000 </section>\u0000 </div>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 2","pages":"101-113"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.88","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140381654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The importance of public engagement in clinical xenotransplantation","authors":"Daniel J. Hurst,&nbsp;David K. C. Cooper","doi":"10.1002/hcs2.91","DOIUrl":"10.1002/hcs2.91","url":null,"abstract":"<p>Over the past several decades, significant scientific progress in xenotransplantation has brought the field to the threshold of clinical trials. In the past 3 years in the United States, experimental pig kidney and heart xenotransplantation have been performed on human subjects recently declared dead by neurological criteria (decedents). In addition, two pig heart transplants have been carried out in living patients under the United States Food and Drug Administration's expanded access guidelines. However, though there has been a flurry of activity there remain unanswered questions regarding how the public views xenotransplantation, what concerns may exist, and how to address these concerns in a meaningful way. This paper aims to underscore the importance of public engagement in xenotransplantation, emphasizing the ongoing need for studies to assess public opinions. The current evidence on public engagement studies is reviewed and gaps in our understanding are identified. We propose practical steps to advance this field. Additional studies to determine the extent of racial/ethnic differences in attitudes to xenotransplantation should be conducted. Empirical and descriptive analysis of certain religious viewpoints—especially minority faiths—would be valuable. As public engagement is an important aspect of public acceptance of novel research that is accompanied by risk, we suggest that xenotransplantation biotechnology companies might consider leading the way in funding this research.</p>","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 2","pages":"124-130"},"PeriodicalIF":0.0,"publicationDate":"2024-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.91","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140381572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transformations in medical education: A prudential perspective","authors":"Donald Boudreau,&nbsp;Abraham Fuks","doi":"10.1002/hcs2.86","DOIUrl":"10.1002/hcs2.86","url":null,"abstract":"<p>A decade ago we asked the question, “Is there something in medicine that is eternal or enduring?” Our aim was to write a manuscript entitled, “That which does not change in medicine.” The publication begins as follows: “The practice of medicine involves continual change, driven by a constant stream of developments in the understanding of biological structure and function relevant to human diseases, and the parallel improvements in pharmacologic and other technological interventions. This change is also driven by evolving social philosophies, ethical trends, and lifestyles.” [<span>1</span>] That preamble reverberates as strongly now as then, perhaps even more so, given the velocity of technological change. When we deliberated on which aspects of medical practice should remain stable, we had few premonitions that implantable chips, robotic surgery, virtual reality, and artificial intelligence (AI) would soon become ubiquitous. The needle has clearly moved, propelled by extraordinary advances in bioengineering, computer and data sciences; major shifts in the governance and organization of clinical practice; and powerful sociocultural trends.</p><p>As we explore current transformative developments we are reminded of our earlier conclusions: that certain dimensions of medical practice are, indeed, immutable. Most importantly, the relationship between physician and patient depends on moral obligations, characterized by a compassionate response best described as clinical engagement [<span>2</span>]. The requisite virtues are affective as much as cognitive. The challenge for educators, physicians, and policymakers is to accommodate the benefits of transformational change, both technological and conceptual, whilst remaining true to the fundamental, dyadic clinical relationship. Thus, pedagogic change should welcome innovations but do so with restraint that is, with an attitudinal disposition that is neither cynical nor inhibitory but rather alert and mindful, especially when faced with announcements that a given innovation will solve the problems of an overburdened hospital system. By insisting on a cautious approach we may avoid the pendulum that swings too far, resulting in unintended consequences and costly backtracking to undo the damage of untrammeled enthusiasms.</p><p>We consider two illustrative innovations germane to healthcare delivery: one in medical education and one in technology. We try to anticipate and understand impacts and conclude by posing a set of questions that may be useful to those who manage systemic changes.</p><p>An innovation, unfolding in medical schools world-wide and often regarded as “transformative,” is competency-based medical education (CBME). We analyze this trend, relying on a hierarchy of knowledge as a frame of reference.</p><p>The historian Jill Lepore, using the metaphor of a filing cabinet with four drawers, proposed a categorization of knowledge [<span>3</span>]. Each drawer contains knowledge of a different ","PeriodicalId":100601,"journal":{"name":"Health Care Science","volume":"3 2","pages":"73-77"},"PeriodicalIF":0.0,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/hcs2.86","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140233516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}