Taguchi versus Lich-Grégoir Extravesical Ureteroneocystostomy in Kidney Transplantation: A Systematic Review.

INTRODUCTION: Ureteric implantation of the transplanted ureter into native urinary bladder tissue in kidney transplantation recipients is essential for post-operative kidney function. We aimed to determine the effects of Taguchi versus Lich-Grégoir extravesical ureteroneocystostomy in kidney transplantation. METHODS: We searched multiple databases (MEDLINE, Cochrane Library, and Web of Science), trial registries, and conference proceedings until March 2021. We included prospective studies comparing Taguchi and Lich-Grégoir ureteroneocystostomy in kidney transplantation. Two review authors independently screened the identified records, extracted data, evaluated the risk of bias using ROBINS-I, and assessed the certainty of evidence according to GRADE. RESULTS: We identified 3 prospective studies with serious or critical risk of bias, leading to low-certainty evidence. We downgraded the risk of bias due to study limitations. Assessment and/or reporting of baseline imbalances, co-interventions, and confounding factors was insufficient in all included studies. The effect of Taguchi ureteroneocystostomy remains unclear. CONCLUSION: Currently available evidence is not useful to determine the effect of Taguchi versus Lich-Grégoir ureteroneocystostomy in kidney transplantation. There is a need for methodologically better designed and executed studies, such as randomized controlled trials with long-term follow-up reporting baseline imbalances, co-interventions, and confounding factors.

The effects of diverse fidelity scenarios on stress in medical students when taking patients' medical histories: A longitudinal study.

Taking patients' medical history correctly is the basis of diagnosis and therapy. Medical students as a vulnerable group may perceive patient-physician interactions as stressful. This study examines stress among medical students in different degrees of fidelity when taking a patient's medical history. In this longitudinal study, students' stress levels were assessed during scenarios with different degrees of fidelity (role-play, simulated patient encounters and real patient encounters) using standardised questionnaires (State-Trait Anxiety Inventory and a distress scale) and the physiological measurement of heart rate variability. The stress level of participating medical students (N = 128) was expected to significantly increase during scenarios of increasing fidelity (Mroleplay  = 2.08 ± 0.92; SPEs: Msimulatedpatient  = 2.68 ± 1.08; RPEs: Mrealpatient  = 3.35 ± 1.08; p < 0.001). Whereas physiological stress was significantly higher with real patients (N = 106), psychological stress was not affected by the fidelity of the scenarios (N = 85). Medical students experienced stress when taking patients' medical history. Medical students might be unaware of their perceived stress based on the results. Thus, they should know how to cope with stress in such situations.