Toward a National Conversation on Health: Disruptive Intervention and the Transformation from Health Care to Health.

Over a century ago, Abraham Flexner's landmark report on medical education resulted in the most extensive reforms of medical training in history. They led to major advances in the diagnosis and treatment of disease and the relief of suffering. His prediction that "the physician's function is fast becoming social and preventive, rather than individual and curative," however, was never realized.Instead, with the rise of biomedical science, the scientific method and the American Medical Association, the health care system became increasingly distanced from a holistic approach to life that recognizes the critical role social determinants play in people's health. These developments created the beginning of the regulatory controls that have come to define and shape American health care - and our unhealthy obsession with illness, disease and curative medicine that has resulted in a system that has little to do with health.To realize Flexner's prediction, and to transform health care into a holistic system whose primary goals are focused on health outcomes, six disruptive interventions are proposed. First, health needs to be placed in the context of community. Second, the model of primary care needs to be revised. Third, big data need to be harnessed to provide personalized, consumable, and actionable health knowledge. Fourth, there needs to greater patient engagement, but with fewer face-to-face encounters.Fifth, we need revitalized, collaborative medical training for physicians. And finally, true transformation will require market-driven, not regulatory-constrained, innovation. The evolution from health care to health demands consumer-driven choices that only a deregulated, free market can provide.

Comparative Assessment of a New Holistic-Oriented and an Old Specialty-Specific Undergraduate Curriculum in Removable Prosthodontics: A Study Based on Senior Students' Perceptions.

PURPOSE: A survey was conducted in the Dental School, Aristotle University, Thessaloniki, Greece, (i) to assess the perceptions and experiences of senior dental students, Classes of 2014 and 2015, toward the old, specialty-specific (OC) and new, holistic-oriented (NC) undergraduate curriculum, respectively, in removable prosthodontics and (ii) to identify areas of improvement in prosthodontic training. MATERIALS AND METHODS: Structural components of both curricula were collected, including the total number of (i) laboratory/lecture/clinical training hours, (ii) written examinations, (iii) mandatory clinical cases, and (iv) European Credit Transfer and Accumulation System (ECTS) credits. A 20-item closed-type questionnaire using a five-point Likert scale was distributed in two consecutive groups of seniors, Classes of 2014 (n = 54) and 2015 (n = 57); 54 OC and 57 NC senior students filled out the questionnaire. RESULTS: A greater percentage of NC students stated that (i) they felt less confident to carry out jaw relation recording and removable partial denture metal framework design and (ii) the time allocated for clinical training was less sufficient. Students of both curricula reported that the laboratory courses and lectures contributed little to their clinical performance. Implant restorations and prosthetic management of patients with craniomandibular disorders were the most popular treatment options that the respondents felt that should be incorporated in the undergraduate curriculum. CONCLUSIONS: As a general trend, students completing the revised curriculum reported more difficulties during their training and felt more insecure about their clinical competences. To enhance students' self-confidence in prosthodontics, more effective preclinical training methods, introduction of additional treatment options, and alternative educational methods should be considered.

Visión holística de nuevos desafíos: paradigmas tecnológicos y fundamentos bioéticos en la Medicina futurista / Holistic view of new challenges: technological paradigms and bioethical basis of Futuristic Medicine

Introducción.La medicina del siglo XXI será un punto de fusión de numerosas nuevas tecnologías. Surgirán transformaciones en los paradigmas de la atención médica. Objetivo: Ofrecer una visión de lo que podría ser la atención médica futura. Material y Métodos: Se revisa en la literatura médica las ultimas y nuevas herramientas tecnológicas al servicio de la Medicina, sus posibles transformaciones y aplicación futura a través de la exploración en las principales bases de datos indexadas en los últimos 7 años, que originarán un cambio en el pensamiento científico y una visión predictiva en la atención médica a nivel mundial que realizaran reflexiones sobre enfoques médicos que origina la medicina traslacional. Se analiza el papel de la nanotecnología en la farmacología futurista, así como la genética y robótica, y se establecen comparaciones entre la cantidad de investigaciones por países y el estado actual en la América Latina y cómo influirán los nuevos adelantos científicos en la bioética lo que pudiera dar origen al transhumanismo. Resultados: El influjo de las nuevas tecnologías está ligado con el desarrollo económico y social, por lo que su aplicación no será equitativa, existiendo una diferencia importante en la formulación de patentes, investigaciones indexadas y citaciones entre países desarrollados y subdesarrollados, donde ningún país latinoamericano se encuentra entre los primeros 10 lugares del ranking mundial. Conclusiones: La tecnología actual le da solución a algunos problemas, pero no ha sido capaz de dominar muchas enfermedades. La utilización de la nanotecnología, la genética y la robótica provocarán cambios en los paradigmas de enfrentamiento a las enfermedades. Pudieran ocasionar deshumanización y problemas bioéticos(AU)

Introduction: Medicine in the 21st century will be a fusion point of numerous new technologies. Changes in the paradigms of medical attention will emerge. Objective:To present a view of what future medical attention could be. Material and methods:A review of the last and new technological tools at the service of Medicine is made, and their possible transformations and future implementation are studied through the search of the main databases of the data indexed during the last seven years, which will make a change in the scientific thought and a predictive view of the medical attention worldwide, and make reflections on the medical approaches that arise from translational medicine. The role of nanotechnology in the futuristic pharmacology is analyzed, as well as genetics and robotics; and comparisons are made regarding the amount of research by countries and the current condition in Latin America, and the way the new scientific innovations will influence in the Bioethics, which could give rise to transhumanism. Results:The influence of the new technologies is linked to the economic and social development. Therefore, its implementation will not be equitable, existing an important difference in establishment of patents, indexed research, and quotations between developed and underdeveloped countries, where no Latin American country is among the 10 first places in the world ranking. Conclusions:Current technology gives solution to some problems, but it has not been able to be acquainted with many diseases. The use of nanotechnology, genetics, and robotics will provoke changes in the confrontation paradigms of diseases, which could cause dehumanization and bioethical issues(AU)