Electrocardiogram (ECG) reconstruction involves synthesizing specific leads from other recorded leads, addressing cases where standard ECGs have missing, noisy, or unrecorded leads. Traditionally, reconstruction pipelines include a denoising step, which could be time-consuming and may distort the original signal morphology. Recent studies have shown that reconstruction can be successfully performed without denoising by using multiple models tailored to different input noise levels. This paper builds on that approach by evaluating whether a single, unified model can achieve similar performance. The study compares the multiple-model pipeline (MMP) and the single-model pipeline (SMP) using 10,000 normal ECG records from the CODE-15% database (trimmed to 10 s, resampled to 500 Hz, and denoised to act as a reference point for when artificial noise is added prior to reconstruction). Results show that the SMP performs comparably to the MMP, achieving average correlations above 0.85, consistent with previous research, and maintaining stable performance across noise levels (∼0.04 variation). Although the model performs poorly when tested on abnormal ECG, fine-tuning the model through transfer learning with as little as ten seconds data returns its performance to the expected level by making the generic model patient specific. These findings have significant implications for wearable medical devices, where minimizing storage and computational demands is critical. While the MMP requires over five times the memory due to multiple models, the SMP (and transfer learning) offers a more streamlined, efficient, and cost-effective solution by eliminating both the need for multiple models and separate denoising steps.
This paper explores the uniqueness of Canadian Roman Catholic healthcare organizations from theological, strategic, and operational perspectives. By arguing that Canadian Roman Catholic healthcare understands that suffering is inevitable for all people at some point in their lives, the paper indicates that patient and family accompaniment through their experiences of suffering is one of the unique dimensions of a Roman Catholic ethos of care. The paper draws upon concepts and ideas from various traditional Christian sources to articulate a robust theology that can guide the building of this ethos in organizational contexts. Consideration is then given to how this theology can be operationalized, first from a strategic leadership vantagepoint, then within the context of a concrete proposal for palliative care.
Design-Build-Test-Learn (DBTL) cycles are a widely employed engineering framework in metabolic engineering. Nonetheless, their performance depends on a wide range of experimental and algorithmic design choices, whose combined effects on the successful optimization of microbial strains remain an open question. In this study, we performed in silico DBTL cycles based on metabolic kinetic models to quantitatively assess how key process parameters affect strain optimization outcomes across four distinct metabolic pathway models. This includes parameters governing DNA library design, experimental budget limitations, and machine learning configuration. The results show that screening capacity is a dominant driver of optimization success, whereas DNA sequencing capacity has surprisingly little impact, despite its importance for model training. Selecting top-producing strains for sequencing consistently outperforms stratified sampling, highlighting a trade-off between predictive accuracy and optimization efficiency. DNA library structure strongly affects performance: increasing the number of editable positions generally improves outcomes, while expanding the set of gene targets can hinder optimization due to increased dimensionality or sparse sampling. Together, these findings offer actionable guidance for designing more effective DBTL workflows and underscore the value of simulation frameworks for exploring metabolic engineering strategies prior to experimental implementation.
Postoperative delirium (POD) remains a significant, costly complication. Despite increasing awareness in medical specialties, understanding among surgical providers remains unknown. We aimed to (1) understand surgical providers' self-perceived knowledge of and confidence in identifying and managing POD, and (2) define the perceived importance of POD among surgical providers, relative to other complications. An anonymous electronic survey was distributed to surgical providers across three hospitals in an academic medical system. Seventy-six of 267 (28.5%) responded. The majority were somewhat (n=48, 63%) or very confident (n=12, 16%) identifying POD, however, few used validated tools (n=18, 24%). Most were somewhat (n=40, 52.6%) or very confident (n=9, 11.8%) managing POD. Few consulted geriatrics or other fields for co-management (n=23, 30.2%). Among six common complications, delirium consistently ranked third or fourth in importance. Future work should focus on increasing the use of validated tools and building interdisciplinary initiatives for co-management.
The Milwaukee Angler Study was initiated in 2017 as part of the Biomonitoring of Great Lakes Populations Program (BGLP-III) to examine two adult populations at high risk of per- and polyfluoroalkyl substances (PFAS) exposure from consumption of PFAS-contaminated sportfish: licensed anglers near the Milwaukee Estuary Area of Concern (AOC) and Burmese refugees for whom fish is a dietary staple. This study seeks to provide a comprehensive examination of serum PFAS concentrations in these groups and investigate associations with locally caught fish consumption. Licensed urban anglers and Burmese refugees were independently recruited using population-specific sampling strategies. Participants completed questionnaires on demographics and fish consumption and provided biological specimens. Median and 95th percentile concentrations of seven PFAS were compared to 2017-2018 National Health and Nutrition Examination Survey (NHANES) data. Multivariable regression assessed associations between serum PFAS concentrations and self-reported local fish consumption from the Milwaukee AOC. Among the 396 licensed angler participants, serum concentrations of three of the seven PFAS (PFOS, PFHxS, PFNA) were elevated compared to the U.S. population; PFOS, PFDA, PFHxS, PFNA, and total PFAS were significantly associated with increased local fish consumption when controlling for other demographic factors. Among the 103 Burmese refugee participants, four of the seven measured PFAS (PFOS, PFDA, PFUnDA, PFNA) were elevated compared to the U.S. population; PFOA, PFOS, PFDA, and total PFAS were associated with increased local fish consumption when controlling for other demographic factors. The results from this study support an association of local fish consumption with PFAS exposure among high-risk populations with varied demographic and local fish consumption practices in the Milwaukee Estuary AOC. Given that adherence to and awareness of state fish advisories can vary widely, our biomonitoring results underscore the importance of ongoing, tailored efforts to deliver culturally relevant public health interventions to the diverse populations surrounding the Great Lakes basin. Building on the Biomonitoring of Great Lakes Populations program, this study adds PFAS-focused data from Milwaukee's urban anglers and Burmese refugees, two understudied, high-exposure groups in the Milwaukee Estuary Area of Concern. By integrating detailed fish-consumption histories with serum PFAS and NHANES comparisons, the work directly informs Great Lakes Restoration Initiative goals and targeted fish-advisory interventions. These findings offer actionable evidence for exposure scientists, environmental epidemiologists, and public health practitioners.
Mirror bacteria are organisms constructed from mirror-image biomolecules unlike those used by all known life and are moving from theoretical concept to practical feasibility. Their unusual chemistry that makes them resistant to natural degradation and isolated from ecosystems, fuels optimism for applications such as more stable medicines, long-term information storage, and novel platforms for bioengineering. At the same time, these very characteristics raise reservations: they challenge existing definitions of "life," expose gaps in regulation, and risk undermining public trust if deployed without careful oversight. This perspective assesses not only those risks but also the opportunities of mirror bacteria, moving beyond narrow biosafety debates to explore their broader ethical, regulatory, and cultural implications. We argue that mirror bacteria represent a rare testcase for how science and society navigate the responsibilities of creating fundamentally new forms of life. Their development offers not only technical possibilities but also a chance to build more resilient frameworks for governance and ethics in synthetic biology.
WHO's efforts to strengthen pandemic preparedness-grounded in what the world learned during COVID-19 and what today's outbreaks of avian influenza, Hantavirus and Ebola are teaching us.
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Individuals with disabilities face a high risk of physical inactivity, leading to severe mental health challenges and social isolation. Aquatic physical activity, due to its unique physical properties, is considered an intervention with profound psychological potential. Guided by the International Classification of Functioning, Disability, and Health (ICF) framework and Self-Determination Theory (SDT), this study aims to systematically review the psychosocial, mental health, and functional benefits of aquatic physical activity for individuals with disabilities. This study strictly followed the PRISMA guidelines to search for high-quality literature published up to February 2026 in Web of Science, PubMed, Scopus, and SPORTDiscus. Two independent researchers conducted the screening based on strict PICOS criteria. Following the search and screening, 21 core articles were included. The extracted data confirmed that aquatic interventions act as profound psychological facilitators. They significantly reduce depressive symptoms and anxiety (Z = -2.294) and enhance social skills and peer interaction (Cohen's d = 0.76). Furthermore, physiological improvements (e.g., in gross motor function and balance) act as critical mediators that boost perceived competence and autonomy, effectively reducing kinesiophobia (fear of movement). Aquatic physical activity is a safe and highly effective adaptive health intervention. The aquatic medium serves as a "natural de-marginalisation space" that mitigates internal psychological barriers and societal ableism. These findings provide critical, evidence-based insights for sport psychology practitioners, coaches, and policymakers to design inclusive, confidence-building interventions.
Key performance indicators (KPIs) are quantifiable measures that describe critical success factors of an organization. Their vital role in ensuring the delivery of quality health care services necessitates the development of KPIs relevant to inpatient clinical pharmacy practice. This opinion paper from the American College of Clinical Pharmacy (ACCP) Clinical Administration Practice and Research Network (CADM PRN) describes the rationale, methodology, and outcomes of a consensus process to identify a focused set of inpatient/acute care clinical pharmacy KPIs. Leveraging a modified Delphi approach, the CADM PRN convened an Expert Panel of clinical pharmacy leader members to build a consensus-driven set of KPIs reflecting clinical, operational, patient-centered, and financial contributions of clinical pharmacists in the inpatient/acute care setting. From a previous ACCP White Paper, a total of 15 KPIs were identified across four domains: (1) clinical practice and patient safety, (2) clinical outcomes and readmissions, (3) medication education and patient engagement, and (4) financial and operational value. The CADM PRN posits that the establishment and implementation of standardized KPIs are essential for measuring and demonstrating the value of clinical pharmacy services in modern health care, offers pragmatic, consensus-based KPIs for evaluating clinical pharmacy services supporting resource justification, and advancing the visibility and impact of pharmacists in acute care practice. As hospitals shift toward value-based care, robust KPI frameworks will be critical for optimizing patient outcomes, supporting financial sustainability, and justifying appropriate staffing. Future efforts should focus on pilot testing, addressing implementation barriers, and achieving broader acceptance for KPIs across the profession.
Develop and validate subtype-specific, fairness-aware machine learning (ML) models that integrate clinical and social determinants of health (SDoH) information to predict 6-month readmission or mortality after hospitalization among patients with HFpEF or HFrEF, and to evaluate the incremental contribution of SDoH, model explainability, and subgroup error disparities across demographic groups. We used University of Florida Health electronic health record (EHR) data (2016-2022) to identify adult heart failure (HF) hospitalizations and followed patients for 6 months for a composite outcome of readmission or mortality. Features included clinical characteristics, contextual SDoH (eg, neighborhood deprivation), and individual SDoH extracted from clinical notes via natural language processing (NLP). Logistic regression and XGBoost models were trained with random oversampling. Performance metrics included the C statistic, F1-score, and recall. Fairness was evaluated using false negative rate (FNR) parity across sex, race/ethnicity, and age band, and mitigation methods were applied (eg, Disparate Impact Remover, Adversarial Debiasing, and Calibrated Equalized Odds). Adding SDoH improved the C statistic for logistic regression in HFpEF (0.603 vs 0.586) and HFrEF (0.641 vs 0.637). SHapley Additive exPlanations (SHAP) highlighted sodium, financial constraint level, and emergency department visit count in HFpEF, and utilization measures and financial constraint level in HFrEF. FNR ratios indicated race/ethnicity disparities; HFpEF FNRBlack/FNRWhite was 0.7834 (0.8728 after Disparate Impact Remover), and HFrEF FNRHispanic/FNRWhite was 1.2217 (0.9880 after Adversarial Debiasing). SDoH integration and mitigation can modestly improve performance while reducing subgroup error disparities. Subtype-specific, fairness-aware ML models for HFpEF and HFrEF provided interpretable 6-month risk stratification and enabled subgroup fairness assessment. Integrating clinical and SDoH information added modest discrimination gains while strengthening interpretation and fairness assessment. These findings support further validation of explainable, equity-aware HF prediction models.
Trauma-related symptoms are known to be highly prevalent in eating disorder (ED) populations but there has been limited research on complex post-traumatic stress disorder (CPTSD). The current study used latent profile analysis to examine trauma-related subgroups among clients with EDs and associations with ED severity and other outcomes. Participants (N = 378) attending residential, day program, and outpatient ED services completed measures of ED symptoms, body mass index (BMI), ED-related impairment, depression, anxiety, and trauma-related symptoms (based on ICD-11 PTSD and CPTSD criteria, and dissociation) at admission. Latent profile analysis identified four trauma profiles: 1) high disturbances in self-organisation (DSO), 2) CPTSD (high on both PTSD and DSO symptoms, and severe dissociation), 3) general distress (moderate outcomes across all domains), and 4) no/mild trauma-related symptoms. After adjusting for level of care, profiles significantly differed on all outcomes except BMI, ED diagnosis, and objective binges. Groups 1 and 2 reported more severe ED and comorbid symptoms than groups 3 and 4, with group 2 also being more severe than group 1 on total ED psychopathology, eating concerns, purging, and anxiety. Findings support previous research on the high prevalence of trauma-related symptoms in EDs, with DSO symptoms (unique to CPTSD) appearing to drive much of the association with ED symptom severity. ED services may benefit from targeted use of trauma-focused therapies for individuals presenting with high DSO symptoms, both in the presence and absence of severe PTSD symptomatology.
Breast cancer is one of the most commonly diagnosed malignancies in women and remains a leading cause of cancer-related mortality worldwide. Matrix metalloproteinases (MMPs), particularly Matrix Metalloproteinase-2 (MMP-2) and Matrix Metalloproteinase-9 (MMP-9), play critical roles in cancer invasion, metastasis, and angiogenesis, making them attractive therapeutic targets. Theaflavin, a major polyphenolic compound derived from black tea (Camellia sinensis), has demonstrated anticancer properties, notably through modulation of the nuclear factor kappa B (NF-κB) signaling pathway and suppression of MMP expression. This study aims to evaluate the inhibitory potential of theaflavin against MMP-2 and MMP-9 in breast cancer using molecular docking and molecular dynamics (MD) simulations. The ligand and receptor structures were obtained from PubChem and the Protein Data Bank (PDB), respectively. Molecular docking was conducted using AutoDock to predict binding affinities and identify key residue interactions. Thereafter, 200-nanosecond molecular dynamics (MD) simulations were performed using Assisted Model Building with Energy Refinement (AMBER), employing the leap-frog integrator and Linear Constraint Solver (LINCS) constraints to evaluate the dynamic stability of the ligand-protein complexes. Binding free energies were further assessed through Molecular Mechanics Generalized Born Surface Area (MM-GBSA) analysis to estimate thermodynamic contributions to ligand binding. Docking results revealed that theaflavin exhibited a stronger binding affinity toward MMP-9 (-11.91 kcal/mol) compared to MMP-2 (-10.11 kcal/mol), although favorable binding interactions were observed with both targets. In the MMP-9 active site, theaflavin formed stable interactions with key catalytic residues, including HIS226, HIS230, HIS236, and GLU227 within the MMP-9 active site. Theaflavin also demonstrated stable binding within the MMP-2 active site, supporting its potential inhibitory activity against this gelatinase. MD simulations further confirmed the superior stability of the theaflavin-MMP-9 complex, as evidenced by consistent root mean square deviation (RMSD) and root mean square fluctuation (RMSF) fluctuations, compact conformational profiles, and favorable solvent accessibility. MM-GBSA calculations further validated these findings, indicating significant van der Waals and electrostatic contributions to complex stabilization. In addition, predictive toxicity analysis was performed to evaluate the safety profile of theaflavin relative to the native ligands. Hence, theaflavin demonstrates inhibitory potential against both MMP-2 and MMP-9, with stronger and more stable interactions observed for MMP-9, suggesting its role as a promising natural compound for breast cancer therapy. These computational findings support the potential of theaflavin as a candidate for further in vitro and in vivo studies targeting matrix metalloproteinase-driven breast cancer progression.
Biology faces the challenge of articulating general principles capable of organizing and conceptually integrating its immense diversity. Since the operon and allosteric models of the 1960s, the regulatory landscape has expanded dramatically. Building on classical allosteric regulation, I propose the allostery principle, which stipulates that the combinatorial diversity in gene regulation arises from the use of two independent sites that can link any two molecular species within a signaling process, independent of specific mechanistic implementations. I provide empirical evidence that the allostery principle has been implemented repeatedly in six distinct molecular platforms during evolution, generating symbolic genetic explosions that expanded the combinatorial diversity of gene regulation. Four involve bacterial genetic platforms, including protein regulators, promoters, and small RNAs. Two involve eukaryotic platforms: intrinsically disordered proteins coupled with alternative splicing, and the extensive complex multicellular eukaryotic regulation mediated by non-coding RNAs. Remarkably, the central Merge operation within the minimalist generative model of the human language faculty-another symbolic explosion in evolution-conceptually satisfies the allostery principle. I further propose that regulatory signaling fluxes constitute a theory physically instantiated within organisms' architecture, functioning as a compressed representation with a strong explanatory power of its capabilities. The concept of missing regulatability provides the required falsifiability for this theoretical construct. Gene regulation implements physiological capabilities whose global significance derives from alignment with universally encoded biological ends-survival, reproduction, development, and differentiation. A system that responds to the environment making the adequate changes to achieve its final ends is showing the ability to instantiate intelligent actions. Therefore, gene regulation provides a form of intelligence to biological systems. This definition matches with intelligence in physical symbol systems formalized early in artificial intelligence. Adequate interpretations of these results and their implications are discussed. "It is the union of passionate interest in the detailed facts with equal devotion to abstract generalization which forms the novelty in our present society" (Whitehead 1925).
Emerging nanomedicine strategies have established clinical translation and the ability to offset conventional therapeutic challenges. This study aimed to report the development and analysis of a nanoscale material that functioned as both a high-Z radiosensitizer and a prodrug delivery system. In this study, a nanoscale platform using two complementary radiosensitizing mechanisms was designed and developed to overcome nonspecific toxicity, which is a challenge in both chemotherapy and radiotherapy. High-Z physical radiosensitization was coupled with the inhibition of a critical DNA double-strand break repair mechanism, homologous recombination, through a lipid nanoparticle decorated with ultrasmall Hafnia nanoparticles and loaded with an amphiphilic prodrug. In vitro and in vivo studies demonstrated significant enhancement of therapeutic effects, cell killing, or tumor regression, respectively, versus radiation alone. These results support the use of this combination system as a practical strategy for maintaining treatment efficacy at modest doses of radiation and offset associated adverse effects.
Frontier artificial intelligence (AI) models have advanced rapidly through training on internet-scale public data, yet such systems lack access to private clinical data. Neuroimaging is underrepresented in the public domain due to identifiable facial features within magnetic resonance imaging (MRI) and computed tomography (CT) scans, restricting model performance in clinical medicine. Here we show that frontier models underperform on neuroimaging tasks and that learning directly from uncurated data generated during routine clinical care at health systems, a paradigm we call 'health system learning', yields high-performance, generalist neuroimaging models. We introduce NeuroVFM, a visual foundation model trained on 5.24 million clinical MRI and CT volumes using a scalable volumetric predictive architecture. NeuroVFM learns comprehensive representations of brain anatomy and pathology, achieving state-of-the-art performance across multiple clinical tasks, including radiologic diagnosis and report generation. The model embeds MRI and CT scans into a shared neuroanatomic latent space and grounds diagnostic findings. When paired with open-source language models, NeuroVFM generates radiology reports that surpass frontier models in accuracy, clinical triage and expert preference. NeuroVFM reduces hallucinated findings and critical errors, offering safer clinical decision support. These results establish health system learning as a paradigm for building generalist medical AI and provide a scalable framework for clinical foundation models.
Nerve root anomalies (NRAs), including duplicate and conjoined exiting nerve roots, are uncommon lumbar anatomic variants that increase the risk of neural injury during foraminal and extraforaminal surgery. Fully endoscopic descriptions remain limited, with only a small number of prior reports. We present a case and technique note on the endoscopic management of a duplicate exiting nerve root with a concomitant far-lateral disc herniation through a transforaminal approach and build on the existing literature to describe a structured, reproducible intraoperative sequence for safe decompression. A 69-year-old woman presented with right lower-extremity radicular pain and progressive foot drop following a far-lateral disc herniation at L4-L5. She underwent a right L4-L5 far-lateral endoscopic microdiscectomy via a transforaminal approach. A Type IIB duplicate right L4 exiting nerve root was identified on meticulous preoperative imaging review by the operating surgeon (not described on the radiology report) and confirmed intraoperatively within the neural foramen. A structured intraoperative sequence, adapting commonly taught endoscopic approaches but not formally published termed "rotating neural blockade", was employed, in which each limb of the duplicated root was sequentially protected, allowing for safe discectomy and foraminal decompression without neural injury. The patient's radicular pain and dorsiflexion weakness improved postoperatively. This case represents one of the first reports of fully endoscopic transforaminal management of a duplicate exiting nerve root and describes a reproducible intraoperative framework for safe decompression in the setting of a Type IIB NRA.
More than one billion people are exposed to flood risk globally, with this number projected to double by 2050. Global flood models underpin risk assessment and adaptation planning, yet typically assume that river bankfull capacity corresponds to a fixed two-year return period, neglecting spatial and temporal variability in channel characteristics. Here, we evaluate how inundated areas and population exposures respond when forced with empirically-derived bankfull capacities in the Mississippi basin using the Fathom Global Flood Model. We find that present-day bankfull flows generally correspond to return periods of less than one year, leading to systematic underestimation of flood extent (9-152%) and exposure (15-472%) across 5-, 20- and 100-year flood events, with the largest discrepancies for more frequent floods. We further show that historical changes in channel morphology can influence flood impacts at magnitudes comparable to projected climate change over multi-decadal timescales, depending on emission scenarios. Our work highlights a key structural limitation in current global flood modelling frameworks with implications for risk assessments.
Incidental gallbladder cancer (IGBC) is often diagnosed only during or after cholecystectomy, and preoperative identification remains challenging. This study preliminarily explored factors contributing to IGBC missed diagnosis and attempted to develop an ultrasound radiomics‑based identification model. A retrospective cohort of 62 IGBC and 78 non‑incidental GBC (NIGBC) patients who were consecutively enrolled between 2016/01-2025/12 was analyzed. Clinical, laboratory, imaging, pathological, and immunohistochemical features were compared. From ultrasound images, 1220 radiomics features were extracted; after stability (ICC > 0.75), redundancy removal (Spearman |ρ|> 0.90), and LASSO regression, nine features were retained. Seven machine learning algorithms were used to exploratorily build radiomics‑only models. Potential clinical predictors were identified by logistic regression, and a clinical‑only and a combined model were attempted. Performance was preliminarily evaluated using area under the curve (AUC). IGBC showed higher gallstone prevalence (91.9% vs. 53.8%, P < 0.001) and a "benign masquerade" laboratory profile (higher albumin (ALB), high-density lipoprotein cholesterol (HDL‑C); lower ratio of albumin to globulin (RAR); fewer elevated CA19‑9). Pathologically, IGBC was predominantly infiltrative (77.4% vs. 28.2%, P < 0.001), had earlier T stage compared to NIGBC (27.4% vs. 12.8%, P = 0.007), and exhibited lower Ki‑67 high expression (67.7% vs. 83.3%, P = 0.031) and weaker Topoisomerase II-alpha (Topo II) staining (P = 0.005). The extreme gradient boosting (XGB) radiomics model achieved a validation AUC of 0.865 (accuracy 0.833), suggesting potential discriminative ability. Gallstones (OR = 9.484) and growth pattern (OR = 0.230) might be independent clinical predictors. The clinical‑only model had AUC 0.830, and the combined model AUC 0.860, with no significant benefit over radiomics‑only. Preoperative missed diagnosis of IGBC may be associated with gallstone‑related inflammation, infiltrative growth, early T stage, seemingly normal laboratory findings, and low proliferation marker expression. Although conventional ultrasound hardly identifies IGBC, its tumor heterogeneity might be quantified by radiomics. The XGB model showed preliminary ability to distinguish IGBC from NIGBC and holds potential as a non‑invasive tool for preoperative risk stratification, but findings require validation in larger multicenter cohorts.
The harm to patients continues to involve a high burden of injury, disability, social cost, and death worldwide. To improve patient safety (PS) education, the WHO created a PS Curriculum Guide to assist multisectoral institutions. However, not much progress has been made in undergraduate studies. To establish steps and activities to easily and successfully integrate the topics of the WHO PS Curriculum Guide into the existing undergraduate curricula in the medical career. Mixed methods research (MMR), integrating quantitative and qualitative methods (2019-2024) to assess the strategies carried out in the medical faculty of the private Universidad Francisco de Vitoria (Spain) for the proper implementation of the WHO PS Curriculum Guide: curriculum mapping, curricular intervention, implementation, monitoring, evaluation by the academic committee of PS, and assessment. All WHO's PS topics (n=11) were included in the teaching guides of some subjects (n=14) across all academic years in 2019. However, in some years, certain topics were taught but were missing in the teaching guide while others were not taught despite appearing in the guide (topic 10 [PS and invasive procedures] was not taught in any year). These findings promoted changes in the teaching guidelines for all academic years, an expansion of PS matters in some of the 14 subjects, the addition of new teaching activities, and improvements in assessment methods (e.g., new OSCE-4th in 2021). Since its implementation, an increase in the OSCE-4th score was observed. In 2024, all the PS topics included in the teaching guides were taught in the classes and vice versa. Comprehensive and integrated PS education in undergraduate medicine is feasible and impactful without implying an additional burden. It is a necessary foundation for building better healthcare from the early stages.