Cognitive apprenticeship and reflective practice are fundamental educational theories supporting postgraduate clinical training. Community hospital rotations provide ideal opportunities to apply these theories. However, community hospitals face challenges in securing educational time due to faculty shortages and heavy clinical workloads, leading to on-the-job training becoming the primary educational approach. Consequently, opportunities for structured instruction and reflection may be limited, potentially hindering the implementation of cognitive apprenticeship and reflective practice. To address this mismatch between educational needs and available resources, we implemented a remote educational conference focused on clinical questions (CQs) arising from residents' clinical experiences. Unlike traditional clinical conferences that focus on determining patient management, this initiative centers on reflective dialogue based on CQs formulated by residents themselves. By integrating experiential learning theory and reflective practice theory and focusing specifically on the latter three steps of cognitive apprenticeship, we successfully constructed an effective educational model for remote learning environments. This practice enables high-quality medical education that transcends geographical constraints and is considered valuable for future community-based medical education.

Plasma biomarkers levels, essential for diagnosing cardiovascular diseases, may vary by ethnicity. In this international prospective study, we compared plasma biomarker levels between European and Asian patients with clinically similar acute heart failure (AHF). Data were collected on emergency admission for acute dyspnea. Blood samples were obtainedwithin 4 hrs of presentation and analyzed for N-terminal pro-B-type natriuretic peptide (NTproBNP), high-sensitivity troponin-T, growth differentiation factor 15, interleukin-6, and C-reactive protein levels. Overall, 907 AHF patients were enrolled; of which, 135 (15%) wereJapanese, and 772 (85%) were European. NT-proBNP levels were significantly higher inHôpital Lariboisière, Bat Viggo Petersen, Porte 5 au 2ème étage, 43 boulevard de la chapelle, Paris 75010, FranceJapanese than in Europeans [4,060 ng/L (interquartile range (IQR) 2,081–12,218) vs.3,390 ng/L (IQR 1,410–7,682), P = 0.004]. After propensity score matching (PSM), no bio-marker levels differed significantly. After stratification according to left ventricular ejection fraction (LVEF) at admission, higher NT-proBNP levels were observed in Japanese AHF pa-tients with LVEF > 50% (P = 0.02) than in European patients. After PSM, the difference was insignificant (P = 0.35). In Asian and Caucasian AHF patients with similar clinical profiles, plasma cardiovascular biomarker levels did not differ significantly, regardless of LVEF, sug-gesting that NT-proBNP and related biomarkers can be applied across these ethnicities.

Background: Acute kidney injury (AKI) is a common condition in severely ill patients associated with poor outcomes. We assessed the associations between urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary liver-type fatty acid-binding protein (uLFABP), and urinary cystatin C (uCysC) concentrations and patient outcomes. Methods: We assessed the predictive performances of uNGAL, uLFABP, and uCysC measured in the early phase of intensive care unit (ICU) management and at discharge from the ICU in severely ill patients for short- and long-term outcomes. The primary outcome was the occurrence of AKI during ICU stay; secondary outcomes were 28-day and 1-yr allcause mortality. Results: In total, 1,759 patients were admitted to the ICU, and 728 (41.4%) developed AKI. Median (interquartile range, IQR) uNGAL, uLFABP, and uCysC concentrations on admission were 147.6 (39.9–827.7) ng/mL, 32.4 (10.5–96.0) ng/mL, and 0.33 (0.12–2.05) mg/L, respectively. Biomarker concentrations on admission were higher in patients who developed AKI and associated with AKI severity. Three hundred fifty-six (20.3%) and 647 (37.9%) patients had died by 28 days and 1-yr, respectively. Urinary biomarker concentrations at ICU discharge were higher in non-survivors than in survivors. The areas under the ROC curve (95% confidence interval) of uLFABP for the prediction of AKI, 28-day mortality, and 1-yr mortality (0.70 [0.67–0.72], 0.63 [0.59–0.66], and 0.57 [0.51–0.63], respectively) were inferior to those of the other biomarkers. Conclusions uNGAL, uLFABP, and uCysC concentrations on admission were associated with poor outcomes. However, their predictive performance, individually and in combination, was limited. Further studies are required to confirm our results.