Search

Physicians' empathy and ambiguity tolerance have recently become a focus of medical education. However, the association between the two concepts remains unclear. This study examined the association between empathy and ambiguity tolerance in the clinical context among medical trainees. We conducted a multicenter cross-sectional study in 12 institutions: 2 universities for medical students and 10 hospitals for residents. We assessed ambiguity tolerance using the Japanese version of the Tolerance of Ambiguity in Medical Students and Doctors scale. The outcome variable was empathy, measured using the Japanese translation of the Jefferson Scales of Empathy (JSE). Data from 100 medical students and 135 residents were analyzed. After adjustment for possible confounders, the factor scores of 'tolerance for things that are not black or white in medicine' showed a dose-dependent association with the JSE. There was no clear trend in the association between the total scores or other factor scores and empathy. This nationwide multicenter study showed that the factor scores of 'tolerance for things that are not black or white in medicine' were associated with empathy among medical trainees. Our findings may be helpful for developing interventions in the field of medical education to nurture empathy. [ABSTRACT FROM AUTHOR]

The concept of social accountability in medical schools is globally accepted, but data regarding Japanese medical schools are lacking and unclear. This study aimed to elucidate the perception of social accountability of medical schools in Japan and compare this to global frameworks. A document on Japanese medical accreditation standards (Basic Medical Education: Japanese Specifications WFME Global Standards for Quality Improvement) was used for this study. We included 45 medical schools in a qualitative content analysis done via inductive category formation. The documents were also assessed using the social obligation scale. Three main categories and 15 categories were identified. The three main categories were as follows: Issues in society, Quality assurance of medical school, and Improvement of individual quality. Most categories were common to those in global frameworks, but some were characteristic of the Japanese context. The distribution of schools on the social obligation scale in six elements varied mainly 'from responsibility to responsiveness' or equal unless the elements were promoted by national policy. The social accountability of Japanese medical schools is mostly common with the global frameworks. Our findings will help the social accountability of medical schools to become better understood and developed beyond contextual borders. [ABSTRACT FROM AUTHOR]

Mechanical forces and the activation of the renin-angiotensin system (RAS) may alter the NO/O2•- balance, imparing endothelial nitric oxide (NO) availability. This study investigates the link between RAS and NO/O2•- balance in human aortic endothelial cells (HAEC) exposed to pulsatile stretch with and without ACE inhibitor quinaprilat or angiotensin II type 1 (AT1) receptor antagonist losartan. Pulsatile stretch increased Ang II levels and O2•- production, reducing NO release. RAS blockade with quinaprilat or losartan restored the balance between NO and O2•-. These results provide a molecular basis for understanding the vascular protective effects of ACE inhibition and AT1 receptor antagonism. [ABSTRACT FROM AUTHOR]

Activation of the coagulation pathway and the inhibition of the fibrinolytic pathway play a pivotal role in the pathogenesis of thrombotic vascular disease such as acute coronary syndromes. Statins have been proved to be effective in patients with acute coronary syndromes in terms of reduction of cardiovascular events. It is assumed that the direct effects on vascular cells, which are independent of lipid-lowering, particularly the alterations in coagulation and fibrinolytic pathways, may contribute to these benefits. Indeed, in endothelial cells and vascular smooth muscle cells as well as in monocytes/macrophages, stains reduce tissue factor and plasminogen activator-1 expression and activity and increase tissue plasminogen activator expression and activity. These effects are mainly mediated by the inhibition of the Rho pathway, whereas the activation of Akt by statins plays a role in the suppression of tissue factor expression. These effects on coagulation and fibrinolytic pathways may be particularly important in patients with acute coronary syndromes. [ABSTRACT FROM AUTHOR]