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Pain Medicine, a field that was once considered primarily a specialty of opioid medication management, evolved into a multimodal care model with the goal of limiting reliance on pain medications. Now, we see another revolution-the advancement from percutaneous procedures to minimally invasive surgical procedures. Despite these changes, Pain Medicine fellowships have consistently been recognized as a competitive subspecialty with more applicants than the number of available positions - until now. The most recent pain fellowship match suggests an abrupt change to the popularity of the specialty (with over 61 unmatched positions and over 35 unfilled programs) for applicants expected to matriculate in the year 2024 [1]. Unfilled positions have risen from 5% to 15% in the past three years. Similarly, unfilled programs have risen from 10% to 30% in the past three years. Several reasons for this sudden change in popularity have been proposed, including a lucrative general anesthesiology market, increasing difficulties with insurance coverage and reimbursement for procedures, and a dearth of advanced pain procedures performed at academic medicine programs. The field is at a critical juncture, necessitating ongoing discussions and collaboration among stakeholders to ensure that trainees are attracted to this dynamic field and are ultimately equipped to meet the evolving needs of patients.

The genetic ataxias have no cures and no proven ways to delay progression (no disease-modifying therapies). The acquired ataxias may have treatments that address the underlying cause and may slow or stop progression, but will not reverse damage already sustained. The idiopathic ataxias (of unknown genetic or acquired cause) also have no proven disease-modifying therapies. However, for all patients with ataxia of any cause, there is always something that can be done to improve quality of life-treat associated symptoms, provide information and resources, counsel patient and family, help with insurance and disability concerns, be available to listen and answer the many questions they will have.

Modernising engineering education demands integrating diverse perspectives through multidisciplinary, collaborative approaches. In developing countries, collaboration with stakeholders presents a significant challenge. This study aimed to develop a novel collective approach to establish priorities for modernising engineering education. A workshop was conducted by the Modernisation of Undergraduate Education Program at the Pontifical Catholic University of Paraná in a Southern Brazilian metropolis, with 63 stakeholders from various sectors (education, experts, government, industry, and civil society organisations). The workshop consisted of three rounds discussions, including two rounds with stakeholders of the same sector and one round with stakeholders of different sectors mixed in discussion tables. Each table, comprising 3–7 participants, aimed to reach a consensus. Several topics were addressed in the discussions, including curricularization of extension, updating outdated curricular bases, and integrating soft skills and entrepreneurship into engineering programs. The resulting goals emphasised the integration of engineering education with society and industry. Participants agreed on short to medium-term deadlines for achieving these goals. This approach connected stakeholders, fostering an extensive collaborative, multisectoral network supporting engineering education modernisation. [ABSTRACT FROM AUTHOR]

Objectives Paragangliomas of the lateral skull base are rare, largely benign, neuroendocrine tumors. Little evidence exists to support clinicians in the management of these tumors. The present study evaluates considerations in the multidisciplinary workup and management of paragangliomas affecting the lateral skull base. Methods A STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist compliant retrospective review of adult patients with lateral skull base paragangliomas over 20 years (2002–2021) was performed. Patient and tumor data were collected from patient health care records. Results Seventy patients were identified including 21 (30.0%) males and 49 (70.0%) females. The mean length of follow-up was 87.3 months (range: 12–239 months). Twenty-nine (41.4%) patients had Fisch A or B tumors. Overall, 57 patients (81.4%) were offered treatment upfront, with 13 patients (18.6%) initially undergoing active surveillance. Younger age and reduced American Society of Anesthesiologists (ASA) grade was significantly associated with a decision to offer treatment at presentation (both p = 0.03), while all patients with succinate dehydrogenase (SDH) mutations (n = 10) and tumor secretion (n = 4) were offered treatment. Patients with Fisch A/B tumors (p = 0.01), cranial neuropathies (p = 0.01), and smaller tumors (p = 0.01) were more likely to undergo surgical resection. At the time of the last follow-up, the proportion of patients with a cranial neuropathy was notably lower in the observation (3/12, 25.0%) and radiotherapy (1/6, 16.7%) groups. Conclusion In our series, younger, fitter patients with SDH mutations, cranial neuropathies, or tumor secretion were more likely to be offered upfront treatment. There was a low incidence of new cranial neuropathy in the patients selected for observation during long-term follow-up. [ABSTRACT FROM AUTHOR]

Purpose: Appropriate early intervention is beneficial but dependent on accurate and timely diagnoses. This has been affected by long waiting lists for face-to-face clinical services, in part due to pandemic lockdowns, with telehealth introduced in many services to continue clinical services. This pilot clinical study investigated the feasibility of integrating a specially-designed telepractice autism assessment tool into a tertiary diagnostic service. Method: Eighteen boys (2;4–5;1) participated in the study. Assessment was undertaken as per standard practice (parent interview, questionnaires, review of reports), with an additional telepractice assessment, included in place of face-to-face assessment, to provide clinicians with an observation of the children's communication, behaviours, and interests. Ten parents provided feedback via semi-structured interviews. Result: The TELE-ASD-PEDS was a feasible assessment tool in terms of administration, clinical experience, and information gained through the assessment process. Parents reported mostly positive experiences of the TELE-ASD-PEDS and made suggestions for improvements for future use of this tool. Conclusion: It is possible to obtain useful information about a child's autism-specific behaviours using the activities in the TELE-ASD-PEDS. This information can be combined with clinical history from parents using the DSM-5 framework to provide a gold standard assessment for autism. [ABSTRACT FROM AUTHOR]

Purpose: The rapid adoption of telepractice services by health professionals was necessary to maintain service continuity for children with paediatric feeding disorders during the COVID-19 pandemic, during periods where in-person therapy was restricted. The aim of this study was to explore clinical perspectives and reflections on the use of telepractice for managing paediatric feeding disorders during the pandemic. Method: A post-positivist qualitative approach using thematic analysis was adopted. This study seeks to understand participants' experiences and thoughts from allied health professionals from speech-language pathology, occupational therapy, and dietetics working with paediatric feeding in Western Australia. All participants delivered at least 10 telepractice sessions to children from birth to 12 years with a paediatric feeding disorder. Braun and Clarke's six-step thematic analysis process was used to analyse the data inductively. Result: Eleven allied health professionals representing eight clinical settings in Western Australia, including speech-language pathology, occupational therapy, and dietetics, working with paediatric feeding were recruited. The results revealed four themes: families becoming the catalyst of change, clinician comfort over confidence, insights into authentic mealtimes, and the paradox of choice. Conclusion: This study highlighted the need to build clinicians' confidence and competence, and the provision of service guidelines and training. Although many clinicians had positive experiences with telepractice, most returned to in-person delivery once COVID-19 restrictions were lifted, emphasising the importance of comfort in service delivery selection. We recognise that the findings of this study are constrained by the fact that it was conducted in a single geographical region and utilised a small qualitative sample. While telepractice was successful in managing paediatric feeding disorders, further development and implementation of telepractice guidelines are needed for telepractice to be a viable service delivery option for families and children with feeding disorders. [ABSTRACT FROM AUTHOR]

This study explores how design research encompassing multiple disciplines is accomplished. Such work is highly challenging. Even if information systems (IS) research generally shows an interest in reflecting on its research practice and celebrates work involving multiple disciplines as an ideal and a necessity, sufficient attention has not been paid to the challenges of such an approach or their resolution. This study introduces a situated perspective on design research entailing multiple disciplines. "Doing design research" is approached as a complex and skilful interactional accomplishment in situ with extensive and ongoing identity and agency articulation and negotiation. The study demonstrates that "doing design research" and "being a design researcher" with multiple disciplines involve a delicate dance. The study renews our discourse on design research and enables serious reconsideration and development of IS research methods education. The research also has implications for digitally augmenting research. [ABSTRACT FROM AUTHOR]

Frailty is a syndrome that can inform clinical treatments and interventions for older adults. Although implementation of frailty across medical subspecialties has the potential to improve care for the aging population, its uptake has been heterogenous. While frailty assessment is highly integrated into certain medical subspecialties, other subspecialties have only recently begun to consider frailty in the context of patient care. In order to advance the field of frailty‐informed care, we aim to detail what is known about frailty within the subspecialties of internal medicine. In doing so, we highlight cross‐disciplinary approaches that can enhance our understanding of frailty, focusing on ways to improve the implementation of frailty measures, as well as develop potential interventional strategies to mitigate frailty within these subspecialties. This has important implications for the clinical care of the aging population and can help guide future research. [ABSTRACT FROM AUTHOR]

Introduction Aim Methods Results Conclusion 2022 was a landmark year with two adeno‐associated viral vectors (AAVs) receiving conditional marketing authorization from EMA for the treatment of persons with severe haemophilia A and severe to moderately severe haemophilia B and a third in 2024. Gene therapy is a transformative, irreversible treatment with long‐lasting effects, necessitating development of new clinical pathways to ensure optimal outcomes.To develop a consensus framework and service specification for delivery of AAV gene therapy for haemophilia in adults within the UK using the hub‐and‐spoke model proposed by the European Association of Haemophilia and Allied Disorders and the European Haemophilia Consortium.The UK Haemophilia Centre Doctors Organisation (UKHCDO) set up a working party to develop expert consensus guidance, working with NHS England to ensure alignment with NHS England commissioning and the national service specification.These guidelines detail the patient pathway, counselling and governance requirements for the hub‐and‐spoke model. The national service specification requires the hub site to manage governance for AAV‐based gene therapy. Proposed regional and national multidisciplinary teams will harmonize clinical practices incorporating expertise from various specialities and professional groups. Key requirements identified include standardized documentation and multidisciplinary collaboration. Nationally agreed patient information and counselling checklists will streamline the informed consent process and facilitate data collection for long‐term safety and efficacy monitoring.These guidelines provide a structured framework for the delivery of liver‐directed gene therapy. Whilst specific to the United Kingdom they provide a framework for the implementation of gene therapy in other countries for haemophilia and other monogenic disorders. [ABSTRACT FROM AUTHOR]

Most follicular cell-derived differentiated thyroid carcinomas are regarded as low-risk neoplasms prompting conservative therapeutic management. Here, we provide consensus recommendations reached by a multidisciplinary group of endocrinologists, medical oncologists, pathologists, radiation oncology specialists, a surgeon and a medication reimbursement specialist, addressing more challenging forms of this malignancy, focused on radioactive iodine (RAI)-resistant or -refractory differentiated thyroid carcinoma (RAIRTC). In this document we highlight clinical, radiographic, and molecular features providing the basis for these management plans. We distinguish differentiated thyroid cancers associated with more aggressive behavior from thyroid cancers manifesting as poorly differentiated and/or anaplastic carcinomas. Treatment algorithms based on risk-benefit assessments of different multimodal therapy approaches are also discussed. Given the scarcity of data supporting management of this rare yet aggressive disease entity, these consensus recommendations provide much needed guidance for multidisciplinary teams to optimally manage RAIRTC. [ABSTRACT FROM AUTHOR]

AbstractObjectivesMethodResultsConclusionThis qualitative study aimed to: (1) identify socio-ecological barriers to behavior change-oriented dementia (AD/ADRD) prevention from the perspectives of healthcare professionals, and (2) propose strategies to address these barriers during a clinical trial for an AD/ADRD prevention program (My Healthy Brain).Multidisciplinary healthcare professionals involved in geriatric care (N = 26, M experience > 17 years) from diverse clinics within a medical center participated in focus groups. Using the Socio-Ecological Model (SEM), 5 focus groups were conducted to identify individual, interpersonal, institutional, community, and societal barriers. The Expert Recommendations for Implementing Change (ERIC) framework informed evidence-based strategies to overcome these barriers.Healthcare professionals identified barriers, including limited resources, language and technological barriers, provider dismissiveness, competing institutional priorities, underrepresentation of minority groups, and biases towards biomedical treatments. Strategies to address these barriers involved enhancing accessibility, increasing provider training and support, integrating interventions within clinic operations, fostering community partnerships, and addressing societal misconceptions and biases.Integrating SEM and ERIC frameworks yielded strategies that will be used in My Healthy Brain trial to enhance equity and responsiveness to diverse older adults. Our results can inform efforts to address multi-level barriers to AD/ADRD prevention and the larger contexts influencing risk factors. [ABSTRACT FROM AUTHOR]

The article discusses a novel model for integrated prostate cancer diagnostics that combines MRI, prostate biopsy, and pathology reports. Developed by a multi-professional group in Sweden, the model aims to streamline data collection, improve patient outcomes, and enhance quality assessment. The model was tested in a pilot study with positive feedback from urologists, radiologists, and pathologists, showing potential for widespread implementation and validation in clinical practice. The structured approach offers a concise summary of relevant information, benefiting both healthcare providers and patients. [Extracted from the article]

Research is critical for uncovering new and effective therapies for better health outcomes, yet there remains a significant lag between identifying evidence-based interventions and implementing them into practice. Research teams can often be experienced in evidence generation, but less so in evidence implementation, underscoring the need for more customized tools to support them in this latter step. The implementation stage can be especially challenging given how strategies must be tailored to the unique end users and contexts of a given intervention. Therefore, our patient-oriented kidney research network sought to create an "Implementation Toolkit" and "Pathway to Implementation" guide to help research teams and their operational and clinical partners in implementing their interventions. Importantly, the tools were created using input and feedback from diverse groups, including patient partners, implementation science experts, researchers, operational leaders, and policymakers, all of whom play role in supporting the implementation of health interventions. Our tools are widely applicable to diverse teams, regardless of the intervention or innovation being implemented. [ABSTRACT FROM AUTHOR]

Research on resilience and posttraumatic growth (PTG) has significantly advanced our understanding of human adaptability to adversity, reflecting a widespread belief in the United States that such adaptability is commonplace. However, recent studies have highlighted conceptual and methodological limitations in these fields. These limitations call into question the credibility of existing research and underscore the need for multidisciplinary perspectives in understanding adaptive responses to adversity. This special issue aims to provide a foundation for a new generation of resilience and PTG research. It brings together innovative theoretical and empirical work that focuses on several key areas: the multifaceted nature and impacts of adversity, the importance of clarifying resilience and PTG in marginalized communities, methodological advancements in the field, and challenges to core theoretical and methodological assumptions underlying our scientific practice. Public Significance Statement: This introduction provides an overview of key themes that emerged across the included articles in the special issue. We envision this special issue to be a foundation for the next generation of research on resilience and posttraumatic growth, one that is simultaneously more inclusive and more rigorous. [ABSTRACT FROM AUTHOR]

Objective: In the present study we aimed to review the evolution and function of the maternal medicine multidisciplinary team (MMMDT) meeting of a maternal medicine service of a tertiary level stand‐alone maternity hospital. Methods: We conducted a retrospective descriptive study of all minutes of MMMDT meetings from 2014 to 2020, with the aim of evaluating meeting characteristics and patient demographics. Results: There were 575 multidisciplinary team (MDT) discussions of 486 women during 43 meetings in the 7 year period. On average, 13 (range 3–23; SD = 5.28) women were discussed at each meeting, attended by 17 (range: 11–27; SD = 4.26) attendees. There were 18 women discussed during successive pregnancies. When analyzing the 2017–2020 data, preconceptual discussions made up 7.3% (n = 42) of patients discussed, with 5.7% (n = 33) being postnatal. The mean maternal age was 32.5 years (range 15–48 years) and women were most likely to be discussed in the mid‐trimester period (21–24 weeks gestation). The top five primary specialities involved were hematology, neurology, rheumatology, neurosurgery and gastroenterology; however, 22 specialities were represented overall when classified by the primary medical condition. When examining the MDT input, hematology input was required in 144 patients (25.0%), radiology in 161 (28.0%) patients, and 117 in anesthesiology (20.3%). When examining the number of teams required to manage the patient, 80 women required the input of three specialities, with 16 women requiring the input of four specialities. Conclusion: We demonstrate the value and role of the MDT in the management of complex patients, providing a forum to discuss care in all phases of the obstetric journey. Synopsis: The maternal medicine MDT has evolved to become an essential part of practice, caring from women throughout the reproductive cycle. [ABSTRACT FROM AUTHOR]

Aim: To understand the status quo of multiprofessional and multidisciplinary collaboration for early mobilization of mechanically ventilated patients in Chinese ICUs and identify any factors that may influence this practice. Design: A multi‐centre cross‐sectional survey. Methods: From October to November 2022, the convenience sampling method was used to select ICU multiprofessional and multidisciplinary early mobility members (including physicians, nurses and physiotherapists) from 27 tertiary general hospitals in 14 provinces, cities and autonomous regions of China. They were asked to complete an author‐developed questionnaire on the status of collaboration and the Assessment of Inter‐professional Team Collaboration Scale. A multiple linear regression model was used to analyse the factors associated with the level of collaboration. Results: Physicians, nurses and physiotherapists mostly suffered from the lack of normative protocols, unclear division of responsibilities and unclear multiprofessional and multidisciplinary teams when using a collaborative approach to early activities. Multiple linear regression analysis showed that the number of ICU patients managed, the existence of norms and processes, the attitude of colleagues around them, the establishment of a team, communication methods and activity leaders were significant influences on the level of collaboration among members of the multiprofessional and multidisciplinary early activities. Conclusion: The collaboration of multiprofessional and multidisciplinary early activity members for mechanically ventilated patients in the ICU remains unclear, and the collaboration strategy needs to be constructed and improved, taking into account China's human resources and each region's economic development level. Impact: This study investigates the collaboration status of multiprofessional and multidisciplinary activity members from the perspective of teamwork, analyses the reasons affecting the level of collaboration and helps to develop better teamwork strategies to facilitate the implementation of early activities. Patient or Public Contribution: The participants in this study were multiprofessional and multidisciplinary medical staff who performed early activities for ICU patients. [ABSTRACT FROM AUTHOR]

Surgical treatments are promising for the treatment of lymphedema. It is important for patients, healthcare providers, and lymphedema community to understand that surgical treatments currently are not a cure for lymphedema but have provided promising options for patients. Post-operative care for patients following surgical treatment of lymphedema is vital to optimize and sustain patient outcomes. This expert-consensus statement addresses current practice and research needs for standardized post-operative care, a core set of outcome measures, quality of care, and training of healthcare providers. Current research and clinical practice support non-surgical lymphedema therapy, also known as conservative therapy of lymphedema (e.g., compression therapy, or manual lymph drainage, or Complete Decongestive Therapy) as an essential part of post-operative care. Importantly, patient education should focus on patients' understanding that surgery is not a cure and the importance to adhere to post-operative care and life-long self-monitoring to sustain surgical results of limb volume reduction, relief of symptoms, and mitigate known or ongoing risk factors for recurrence of lymphedema. To optimize patient outcomes, it is crucial to have a multidisciplinary professional team consisting of well-qualified and credentialed healthcare providers participating in ongoing training and education. The essentials recommended by this expert-consensus are an initial and foundational step to build clinical standards for best practice and provide directions for future research. [ABSTRACT FROM AUTHOR]

Genetic testing in patients with ovarian carcinoma (OC) is crucial, as around 10–15% of these women have a genetic predisposition to OC. Although guidelines have recommended universal germline testing for all patients with OC for a decade, implementation has proved challenging, thus resulting in low germline-testing rates (around 30–50%). Many new initiatives to improve genetic-testing rates have emerged, but most have been carried out at the local level, leading to differences in workflows within and between countries. We present an example of a nationwide implementation project that has successfully led to a uniform, high-quality genetic-testing workflow for women with OC. Nationwide multidisciplinary meetings generated consensus on the preferred workflow for OC genetic testing: the "Tumor-First" workflow. This workflow means starting by testing the tumor DNA for the presence of pathogenic variants in OC-risk genes, thus providing a prescreen to germline testing while yielding information on the effectiveness of treatment with PARP inhibitors. This new workflow efficiently stratifies genetic counseling and germline testing and reduces healthcare costs. Although challenging, the nationwide implementation of this workflow was successful, resulting in tumor-DNA testing rates exceeding 80%. In this article, we present our structured implementation approach, illustrate our implementation strategies—which were tailored to identified factors important to implementation—and share the lessons learned from the Tumor-First implementation project. This knowledge could facilitate the future implementation of workflows aimed at optimizing the recognition of hereditary cancers. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONPeople with Persistent Physical Symptoms experience physical symptoms that are not wholly explained by a medical disorder or disease. Multidisciplinary treatment is recommended for people with severe difficulties and is provided in a small number of specialist centres in the UK. Only brief descriptions of this treatment are available, and the experiences of people receiving this treatment as an inpatient have not been explored. This study aimed to explore how people with persistent physical symptoms experience inpatient treatment from a specialist multidisciplinary team, and to identify which factors facilitated their engagement in the rehabilitation.18 people who had received inpatient multidisciplinary treatment for persistent physical symptoms participated in semi-structured interviews. The transcripts were analysed using reflexive thematic analysis.Participants’ experiences were influenced by whether they felt believed by the healthcare team, and whether they could place their own trust and belief in the staff team and the treatment approach. Their experiences involved a series of transitions; both in environment and understanding.Improvements are possible for people receiving inpatient multidisciplinary treatment for severe PPS. Trusting relationships between patients and staff members take time to develop but play a major role in patients’ experiences of treatment.People with persistent physical symptoms view the building of trusting relationships with rehabilitation professionals as a vital component of specialist treatmentPatients value the interpersonal style of the professional as much as the content of the intervention delivered.Developing an alliance and a shared understanding of symptoms takes time, high levels of tailoring, and a skilled multidisciplinary teamPatients found abrupt discharge difficult, and desire easier access to appropriate follow upPeople with persistent physical symptoms view the building of trusting relationships with rehabilitation professionals as a vital component of specialist treatmentPatients value the interpersonal style of the professional as much as the content of the intervention delivered.Developing an alliance and a shared understanding of symptoms takes time, high levels of tailoring, and a skilled multidisciplinary teamPatients found abrupt discharge difficult, and desire easier access to appropriate follow up [ABSTRACT FROM AUTHOR]

Background: Inappropriate use of antimicrobials can push the environment out of balance, and cause unnecessary waste that can contaminate our soil, animals and waterways. Health professional education is committed to preparing students for antimicrobial stewardship (AMS) and supporting planetary health, but a more multidisciplinary action is needed to curb the expansion of antimicrobial resistance (AMR). The aim of this scoping review is to showcase the current antimicrobial knowledge of undergraduate students across the disciplines of medicine, pharmacy, nursing, dentistry and veterinary. This will consequently showcase the gaps and trends across the different disciplines and countries to help inform planetary health multidisciplinary undergraduate curriculums. Methods: A search of the existing literature published prior to December 2023 was conducted using CINAHL, EMBASE, MEDLINE, SCOPUS, and ERIC databases. Studies were excluded if they included postgraduate students or discussed the knowledge, attitude and practice (KAP) of students towards antimicrobial prescribing, AMR and AMS related to a specific learning activity. Results: A total of 144 articles were included. The most represented countries were India and Pakistan accounting for 17% and 8% of the studies, respectively. Single-disciplinary research accounted for approximately 80% of the studies. Medicine was the most represented discipline in both single-disciplinary and multidisciplinary research, appearing in approximately 62% of the studies, followed by pharmacy appearing in approximately 30% of the studies and dentistry appearing in approximately 18% of the studies. Three major priority themes were identified: students are more familiar with the term AMR compared to AMS; inappropriate use of antimicrobials is seen as the main driver of AMR; and the need for more training and education in the field of appropriate antimicrobial prescribing, AMR and AMS. Conclusion: This review has highlighted that there is a need for more AMS interprofessional education (IPE) activities in all five disciplines, and especially within the disciplines of nursing, veterinary and dentistry, as shown by a lack of multidisciplinary research in this area. Most of the knowledge assessments have just touched the surface of AMS and focused on inappropriate antimicrobial use alone. Interdisciplinary planetary health education needs to go beyond these skills and broaden the understanding of other factors that can contribute to AMR such as inappropriate disposal, environmental contamination, monitoring and surveillance, one health, false allergies, and more importantly, how each health professional can contribute to a team. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion Unplanned readmissions in general surgery are an important quality indicator of patient care and are associated with increased costs to healthcare services. This study aims to implement a multidisciplinary protocol in a single institution in a tertiary referral hospital to monitor and reduce unplanned readmission rates.A prospective cohort study using an institution‐based protocol was conducted over an 18‐month period including patients undergoing a general surgical procedure. The protocol included: (i) implementation of a surgical readmissions nurse–patient liaison; (ii) access to a surgical walk‐in clinic; and (iii) early post‐discharge phone contact. Data included demographic details, index procedure, hospital length of stay (LOS), and whether contact between patient/nurse occurred upon discharge. The primary outcome was the cause and rate of 30‐day readmissions. Secondary outcomes were mortality, use of surgical clinic, emergency department presentations, and complications.After protocol implementation, 874 patients underwent a general surgical procedure, with 354 (49%) being male and an overall median age of 53.0 years (interquartile range: 36.0–67.0). The overall readmission rate was 5.6% (n = 49), with a median LOS after readmission of 4 days. Compared with historical pre‐protocol ACS‐NSQIP data, this reflects a 30% reduction compared to that of readmission rate of 7.9%, P = 0.03.The multidisciplinary protocol was efficacious in significantly reducing unplanned readmissions. Continued audits and monitoring of factors associated with readmissions are required to help design targeted projects that may lead to improved outcomes, lower costs, increased patient satisfaction, and better efficiency within our healthcare system. [ABSTRACT FROM AUTHOR]

ABSTRACT Background/Objectives Methods Results Conclusions Integrated care models, like combined rheumatology/dermatology clinics (RDCs), facilitate efficient coordination between specialists and provide comprehensive care. Given the limited literature on pediatric RDC logistics, outcomes, benefits and, challenges, we comprehensively characterized our patient cohort at the UCSF Benioff Children's Hospital RDC and surveyed pediatric dermatologists participating in RDCs.We retrospectively reviewed 71 patients new to the UCSF Pediatric RDC between September 2017 and September 2023. A survey was distributed in 2024 to 17 dermatologists in North America, each representing a unique pediatric RDC.69% of patients (49/71) were female. Seventeen (24%) presented without a known diagnosis; the first RDC visit established a diagnosis for 7 of them (41%). Of patients with a previously established diagnosis, initial RDC evaluation confirmed it in 52 (96%) and revised it for 2 (4%). The most encountered diagnoses were linear morphea (33%), lupus (23%), and psoriasis (13%). New systemic therapy was prescribed for 23% of patients, and additional work‐up was recommended via skin biopsy (8%) and imaging (28%). Survey results revealed all pediatric RDCs include trainees, but only 59% (10/17) receive administrative support. All agreed that RDCs are valuable for patient care and most (15/17, 88%) felt that the RDC was a valuable use of their time.Pediatric RDCs are valuable for consensus diagnosis, streamlined evaluation, and management of complex patients. Though clinical and administrative support for RDCs is generally poor, RDCs are valuable to patients, a good use of time for clinicians, and offer educational opportunities for team members. [ABSTRACT FROM AUTHOR]

ABSTRACT Elimination of HCV infection as a public health concern by the end of this decade will require a concerted effort in all target populations, including drug‐users in the inner‐city. Several strategies have been proposed to identify, engage and provide HCV‐infected residents with antiviral therapy and maximise treatment and cure achievement. This study aims to assess the effectiveness of a multidisciplinary approach in delivering HCV treatment to people who inject drugs (PWID) within Vancouver's inner city. We have evaluated a novel approach, the Community Pop‐Up Clinic, for its ability to promote access to care and uptake of HCV therapy, with additional analyses of HCV reinfection and opioid‐related mortality. From January 2021 to August 2023, we evaluated 1968 individuals. 620 (31.5%) were found to carry HCV antibodies and of these, 474 (76.5%) were found to be viremic. Treatment engagement has been secured in 387 (81.6%). 326 (84.2%) have started treatment, 60 in the pre‐treatment phase and 1 died of an overdose in pre‐treatment. Of 326, 302 completed treatments, 18 are currently on treatment and 1 died of an overdose. Of 302 who completed treatment, 286 confirmed as cured (SVR 12), 16 are awaiting SVR 4, 2 had documented virologic relapse and 1 was reinfected. Three patients withdrew from treatment. By mITT, the cure rate is 286/288 (99.3%). We documented 2 overdose deaths over 326 PY. The data presented validates multidisciplinary programs such as ours aimed at treating HCV in inner‐cities and highlights societal benefits that could be achieved including lower overdose death rates. [ABSTRACT FROM AUTHOR]

In this prospective observational cohort study, we provide preliminary findings from a same-day multidisciplinary fast-tracked normal pressure hydrocephalus (NPH) clinic; incorporating the expertise of movement disorders neurologists, emphasizing the clinical characteristics, consensus classification, and management of patients referred for suspected NPH. We evaluated 111 patients (male/female: 67/44) from April 2022 to May 2023. Based on the multidisciplinary team consensus, 52 (46.8%) were classified as "probable" idiopathic NPH (iNPH), 14 (12.6%) as "possible" NPH, 42 (37.8%) as "unlikely" NPH, and three (2.7%) as secondary NPH. While parkinsonian syndromes were recognized in 19.2% of "probable" iNPH patients (vs. 7.1% in "possible" and 26.2% in "unlikely" NPH), no significant group differences were noted in the scores of the UPDRS-III scale. Degenerative spine pathologies were prevalent across all NPH categories, affecting at least 50% of patients. In the "probable" iNPH group, 78.8% received programmable ventriculoperitoneal shunts, with clinical improvement identified in 87.8% at 12-month follow-up. Our findings underscore the high prevalence of overlapping and competing movement and spinal disorders in patients with suspected NPH. Further, our novel approach, incorporating movement disorder neurologists in NPH multidisciplinary evaluation, improved diagnostic precision and streamlined personalized plans, including further neurological workups, necessary spinal interventions, and medical management or rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Hospital‐acquired pressure injuries (HAPIs) pose significant challenges in healthcare and cause increased patient suffering, longer hospital stays, and higher healthcare costs. Paediatric patients face unique risks, but evidence remains scarce. This study aimed to identify and describe HAPI admission incidence and severity predictors in a large Australian children's hospital. Methods: This retrospective cohort study investigated all paediatric patients between January 2020 and December 2021 using a census approach. Demographic and clinical data including HAPI‐related data were accessed from the incident monitoring and hospital administration databases. The incidence rate (per 1000 patient admissions) was calculated based on all admissions. Predictors of HAPI severity were identified using multivariable multinomial logistic regression. The study adhered to the STROBE guidelines for retrospective cohort studies. Results: The HAPI incidence rate was 6.96 per 1000 patient admissions. Of the age groups, neonates had the highest HAPI incidence (15.5 per 1000 admissions). Critically ill children had the highest rate for admission location (12.8 per 1000 patient admissions). Most reported cases were stage I (64.2%). Age was associated with injury severity, with older paediatric patients more likely to develop higher‐stage HAPIs. Additionally, Aboriginal and/or Torres Strait Islander patients had a higher HAPI severity risk. Conclusion: HAPI injuries in paediatric patients are unacceptably high. Prevention should be prioritized, and the quality of care improved in Australia and beyond. Further research is needed to develop targeted prevention strategies for these vulnerable populations. Implications for the Profession and Patient Care: This research emphasizes the need for standardized reporting, culturally sensitive care and tailored prevention strategies. Impact: The research has the potential to influence healthcare policies and practices, ultimately enhancing the quality of patient care. Reporting Method: STROBE guidelines. No Patient or Public Contribution: There was no patient or public contribution to the conduct of this study. [ABSTRACT FROM AUTHOR]

This paper discusses understanding the purpose of Islamic education in a multi, inter and transdisciplinary approach. This issue is very urgent, given the importance of understanding the teachings of Islam in a comprehensive manner. Islam as a religion does not only teach the realm of ubudiyah, but also mu'amalah. It is in the realm of mu'amalah that humanity is faced with the complexity of life problems that must be resolved. Especially in modern times like today, an approach from various scientific angles is needed. This research is in the form of library research with a qualitative descriptive approach. After the study, it is concluded that Islamic education is not just a transfer of knowledge, but also a holistic process that forms individuals with noble character. In the context of an increasingly advanced life, Islamic education as a scientific discipline cannot stand alone in solving problems in society. There is a need for multi, inter and transdisciplinary science, so scientific integration here is very necessary. [ABSTRACT FROM AUTHOR]

Simple Summary: Geographic Information Systems provide the means to examine the distribution of insect species that recycle nutrients in our environment. Blow flies were trapped using liver-baited bottle traps across Windsor–Essex County (Ontario, Canada), with sites randomly chosen using geospatial mapping technology, and compared to land-use types. In the spring (mid-June), the number of blow fly species was lower near residential, commercial, wooded areas, roads, and wheat/corn fields, but higher near streams and tomato fields. Waste areas both increased and decreased the number of blow fly species, depending on whether land-use categories were considered at distances of 0.5, 1, or 2 km from the trapping site. In the summer (late August), the number of blow fly species was lower near roads, waste, and wheat/corn fields but higher near commercial, residential, orchards/vineyards, and streams. In both spring and summer, the highest overall number of blow flies were trapped near streams, orchards/vineyards, and specifically in summer, near sugar beets/other vegetable fields. This study provides baseline methods to examine blow fly use of different foods across time and space as influenced by humans, and initial insights into how our choices to modify the landscape impact the distribution of these important insects. Geographic Information Systems provide the means to explore the spatial distribution of insect species across various land-use types to understand their relationship with shared or overlapping spatiotemporal resources. Blow fly species richness and total fly abundance were correlated among six land-use types (residential, commercial, waste, woods, roads, and agricultural crop types) and distance to streams. To generate multivariate models of species richness and total fly abundance, blow fly trapping sites were chosen across the land-use gradient of Windsor–Essex County (Ontario, Canada) using a stratified random sampling approach. Sampling occurred in mid-June (spring), late August (summer), and late October (fall). Spring species richness correlated highest to residential (−), woods (−), distance to streams (+), and tomato fields (+) in models across all three land-use buffer scale distances (0.5, 1, 2 km), with waste (+/−), roads (−), wheat/corn (−), and commercial (−) correlating at only two of the three scales. Spring total fly abundance correlated with all but one land-use variable across all buffer scale distances, but the distance to streams (+), followed by orchards/vineyards (+) exhibited the greatest importance to these models. Summer blow fly species richness correlated with roads (−) and commercial (+) across all buffer distances, whereas at two of three buffer distances wheat/corn (−), residential (+), distance to streams (+), waste (−), and orchards/vineyards (+) were also important. Summer total fly abundance correlated to models with distance to streams (+), orchards/vineyards (+), and sugar beets/other vegetables (+) at the 2 km scale. Species richness and total abundance models at the 0.5 km buffer distance exhibited the highest correlation, lowest root mean square error, and similar prediction error to those derived at larger buffer distances. This study provides baseline methods and models for future validation and expansion of species-specific knowledge regarding adult blow fly relationships with spatiotemporal resources across land-use types and landscape features. [ABSTRACT FROM AUTHOR]

This article explores the key themes of current research on anger and to identify challenges to address in future studies. More research on anger across diverse cultural contexts is needed, particularly in non-Western societies, and for comparative studies that consider both historical and cross-cultural perspectives. Some widely held beliefs about anger must be challenged, including the idea that it is the primary driver of social action against injustice, without acknowledging the potential role of positive emotions in motivating such action. There is also a need for contemporary studies that examine the intersections between anger and gender, as well as the social and political implications of anger. Finally, an important area of study involves the links between anger and illness from the standpoint of modern medicine. Addressing these challenges requires the development of multidisciplinary approaches that can capture the complexity and nuance of anger from various perspectives—historical, literary, philosophical, anthropological, gender studies, sociology, politics, psychology, and medicine, among others—using both qualitative and quantitative methodologies. [ABSTRACT FROM AUTHOR]

Achondroplasia, the most common form of inherited disproportionate short stature, is caused by mutations in the fibroblast growth factor receptor 3 gene. The typical clinical features of achondroplasia include short stature, rhizomelic disproportion, joint hyperlaxity, spinal deformity and deformity of the upper and lower limbs. The latter are among the challenges of state-of-the-art orthopaedic treatment plans and significantly contribute to the burden of the disease in individuals with achondroplasia. Multidisciplinary preoperative individual decision-making concerning surgical interventions should be considered. New medical treatments for achondroplasia have been developed and (some) have been approved for clinical use in several countries. While the number of research articles on achondroplasia is increasing rapidly, many unknown or controversial orthopaedic topics remain. Furthermore, in view of new medical developments with improvements in growth and potentially other effects, the timing and algorithms of orthopaedic treatments (e.g. guided growth, limb lengthening and deformity correction) need to be re-evaluated. While standing height is the primary research focus in medical therapy, it is crucial to comprehensively assess orthopaedic parameters in this multifactorial disease. The current treatment of patients with achondroplasia requires specialised multidisciplinary centres with transitional care and individual orthopaedic counselling. [ABSTRACT FROM AUTHOR]

This study challenges the conventional perception of waste as a discarded object devoid of use and aims to redefine its nature by dissociating it from the boundaries of value. To achieve this, the term sslgi (sweeping) is proposed to shift the focus of waste management from relegation to obsolescence to active disposition that retains latent value. This conceptual shift redefines "reuse" in design as the activation of the inherent value in objects. This research also explores the creation of novel materials, exemplified by the extraterrestrial material StarCrete, which is composed of dust, soil, and minimal organic additives, along with designers' use of new materials derived from limestone dust and material-driven speculative design that experiments with synthetic (plastic) and natural substances. These cases illuminate the inherent [re]usability of material entities that are ready for activation in multiple interconnected contexts. From this perspective, we can re-view the role of the designer as [re]assembling existing materials and negotiating various influencing factors. Ultimately, this research demonstrates that transcending the binary perceptions of value and worthlessness allows designers to approach [re]use beyond the confines of the production-consumption-disposal paradigms, thereby decoupling objects from the deterministic use values imposed on them. [ABSTRACT FROM AUTHOR]

Dental disease remains the most common non-communicable disease worldwide. It predisposes patients to significant morbidities following bone modifying agents or radiation therapy to the head and neck. Preventative dental regimes effectively reduce the risk of both medication-related osteonecrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) in these patients. Co-ordination of routine dental care as a component of mainstream oncology treatment optimises long term outcomes for oncology patients. This case series offers insights into patient, institutional and social difficulties that challenge the dental-oncology interface. These obstacles and subsequent resolutions experienced whilst establishing a dental-oncology service in a cancer centre highlight the importance of effective multidisciplinary lead care for oncology patients. It reinforces the need for structured, supported dental pathways for these oncology patients. [ABSTRACT FROM AUTHOR]

Drug shortages can cause ethical dilemmas when no systematic, equitable allocation, or utilization schema is in place. During the COVID-19 pandemic, an ethical framework outlining moral values was proposed as way to approach allocating limited resources to patients. In addition to an ethical perspective, it is prudent to consider costs. Examining existing economic frameworks and combining them with an ethical perspective may provide a practical, systematic process for decision makers when allocating drugs in short supply. Drug shortages continue to impact multiple areas across different subspecialties of medicine due to multiple factors, including limited manufacturers, regulatory issues, and costs. All of these factors make it difficult to anticipate and manage drug shortages effectively, but developing a combined framework may reduce some of the ethical and equitable ambiguity with regards to patient care. [ABSTRACT FROM AUTHOR]

Objective: The American College of Surgeons recommends structured family meetings (FM) for high-risk surgical patients. We hypothesized that goals of care discussions (GOCD) in the form of an FM, multidisciplinary family meeting (MDFM), or palliative care consult (PCC) would be underutilized in imminently dying thoracic surgery patients. Methods: A retrospective chart review at a tertiary academic medical center was performed on all inpatient mortalities and discharges to hospice after any thoracic surgery operation. The utilization of GOCDs was compared between the 2 groups. Secondary outcomes were length-of-stay, comatose status and ventilator dependence during initial GOCD, and timing of code status change. Results: In total, 56 patients met inclusion criteria: 44 of 56 (78.6%) died and 12 of 56 (21.4%) were discharged to hospice. Most patients had a FM (79.5% mortality vs 100% hospice, P =.29) and few had an MDFM (25.0% mortality vs 25.0% hospice, P = 1.00). Patients discharged to hospice were more likely to have a PCC (66.7% vs 31.2%, P =.03) and less likely to be comatose (16.7% vs 59.1%, P =.009) or ventilator dependent during initial GOCD (16.7% vs 70.5%, P =.001). Among patients who died and were DNR-CC (do not resuscitate—comfort care; 37 of 44), 75.7% died the same day of code status change and 67.6% died within 48 h of initial GOCD. Discussion: Although FMs were common, MDFMs were infrequent. Patients discharged to hospice were more likely to have a PCC. Most deaths occurred shortly after initial GOCD and most code status changes occurred on day-of-death. This data suggest an opportunity to improve GOCDs in critically ill thoracic surgery patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: The thyroid gland can represent the seat of development for giant tumors exceeding 10 cm in diameter. A retrospective analysis on 21 cases of giant thyroid tumors with comorbidities, operated in the ENT Department of the Bucharest University Emergency Hospital has been conducted. Methods: Giant benign tumors accounted for 28.57% of the cases studied and reached gigantic volumes in an average time interval of 3 years, with an average resection piece weight of 318 g. Malignant tumors accounted for 71.43%, with an average duration of evolution of 7 years, with an average resection piece weight of 581 g. Results: Dysphagia was present in all patients, dyspnea in 47.61% and dysphonia in 38.09% of cases. Total thyroidectomy is the gold standard in giant thyroid tumors, associated with radical neck dissection, extended to groups VI and VII in malignant tumors. In 10 of 11 cases of giant malignant thyroid tumors (90.90%), without anaplastic thyroid carcinoma, the survival at 5 years after multimodal oncologic treatment was favorable. Anticoagulant treatment increased the risk of postoperative reversible recurrent laryngeal nerve lesion. Conclusions: The management of giant thyroid tumors in patients with multiple comorbidities needs a multidisciplinary team including endocrinologist, radiologist, anesthesiologist, pathologist, ENT surgeon, thoracic surgeon, oncologist and radiotherapist. [ABSTRACT FROM AUTHOR]

Introduction: Congenital immunodeficiency is named primary immunodeficiency (PID), and more recently inborn errors of immunity (IEI). There are more than 485 conditions classified as IEI, with a wide spectrum of clinical and laboratory manifestations. Areas covered: Regardless of the developing knowledge of IEI, many physicians do not think of IEI when approaching the patient's complaint, which leads to delayed diagnosis, misdiagnosis, serious infectious and noninfectious complications, permanent end-organ damage, and even death. Due to the various manifestations of IEI and the wide spectrum of associated conditions, patients refer to specialists in different disciplines of medicine and undergo – mainly symptomatic – treatments, and because IEI are not included in physicians' differential diagnosis, the main disease remains undiagnosed. Expert opinion: A multidisciplinary approach may be a proper solution. Manifestations and the importance of a multidisciplinary approach in the diagnosis of main groups of IEI are discussed in this article. [ABSTRACT FROM AUTHOR]

Treacher Collins syndrome is a rare genetic disorder that affects the bone development, resulting in significant craniofacial deformities. The syndrome is characterized by cleft palate, micrognathia, low-set or small ears, and sparse eyelashes. These characteristic symptoms guide for the diagnosis. However, the manifestations may resemble other diseases, which makes the clinical diagnosis difficult. Although the majority of cases are clearly diagnosed at birth, genetic counseling and imaging scans, such as x-ray or computed tomography, may help to confirm the diagnosis. The severity of the disease varies among patients, ranging from mild undiagnosed cases to severe marked deformities. Nevertheless, airway difficulty at birth represents a significant challenge for anesthesiologists since these patients have abnormal development of zygomatic arch, which may result in airway complications. Therefore, proper management requires multidisciplinary departments, including pediatrics, neurosurgery, otolaryngology, audiology, plastic surgery, and genetics. Hence, it can be inherited in an autosomal dominant manner; genetic counseling is also needed.

Eduardo N Naranjo,1 Indershini Pillay,1 Sandra J Squire,2 Agnes T Black,1 Manu Gill3 1Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada; 2Vancouver General Hospital and UBC Hospital, Vancouver, British Columbia, Canada; 3Providence Health Care, Vancouver, British Columbia, CanadaCorrespondence: Eduardo N Naranjo, Providence Health Care, Room 432, Comox Building 4th Floor, St. Paul’s Hospital, 1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada, Email enaranjo@providencehealth.bc.caPurpose: The Independence Model (TIM) is a new rehabilitative model of care implemented in an acute care hospital to address patients’ functional decline and a high vacancy rate for rehabilitation therapists.Methods: TIM was developed by a team with expertise in evidence, scope of practice and roles, population care needs, and current state related to rehabilitation. TIM utilizes rehabilitation assistants, supervised by physical therapists, occupational therapists or speech-language pathologists, to assist patients in functional areas such as ambulation, activities of daily living (ADLs), cognition and communication. The planning team ensured patient engagement, utilized change management principles, and evaluated the effectiveness of care.Results: Preliminary evaluation of TIM was positive, with staff reporting improved caseload quality and patients feeling more prepared for discharge.Conclusion: This study suggests innovative models of care, such as TIM, can help address the functional needs of patients while navigating the global health human resource crisis.Keywords: multidisciplinary, optimization, health human resource crisis, model of care, function, hospital

This article explores the key themes of current research on anger and to identify challenges to address in future studies. More research on anger across diverse cultural contexts is needed, particularly in non-Western societies, and for comparative studies that consider both historical and cross-cultural perspectives. Some widely held beliefs about anger must be challenged, including the idea that it is the primary driver of social action against injustice, without acknowledging the potential role of positive emotions in motivating such action. There is also a need for contemporary studies that examine the intersections between anger and gender, as well as the social and political implications of anger. Finally, an important area of study involves the links between anger and illness from the standpoint of modern medicine. Addressing these challenges requires the development of multidisciplinary approaches that can capture the complexity and nuance of anger from various perspectives—historical, literary, philosophical, anthropological, gender studies, sociology, politics, psychology, and medicine, among others—using both qualitative and quantitative methodologies.

Abstract Leading digital innovation projects in smart cities requires the right human resources with the right set of competencies. Such requirement is challenging because city managers and built environment professionals are traditionally trained and work in disciplinary and professional silos. This results in a lack of knowledge, abilities, and tools to produce optimal outcomes for communities across multiple sectors. Guided by a socio‐technical and multidisciplinary approach, the DC2‐CF framework is proposed to help urban planners identify, develop and expand the competencies they need to effectively steer responsible digital innovation and ensure public value creation. The DC2‐CF proposes a digital innovation process model to facilitate the delivery of successful urban digital innovation projects based on the lessons learned from working with city digital leaders. In addition, the DC2‐CF provides a delivery structure which identifies specific tasks, competencies, and roles necessary to enable the use off the innovation process model in practice and break down the professional silos currently existing in cities. The framework is envisioned to assist city planners in fostering leadership capacity in local authorities and the private sector in digital city development, contributing to enhancing collaborative working and effective public value creation.

Abstract Background In Germany, around 2.250 children and adolescents are diagnosed with cancer each year. Despite generally positive long-term survival rates, many patients must cope with late effects of the disease and its treatment. This highlights the need for a well-structured, long-term approach addressing both physical and mental health issues. Currently, the German healthcare system lacks such comprehensive structures. Our study aims to evaluate the effectiveness of a structured, multidisciplinary long-term approach compared to conventional “treatment as usual” (TAU). Methods A prospective, multicenter study with ten pediatric university clinics in Germany will be conducted. The cluster-randomization takes place at the clinic level. Children and adolescents who completed their cancer treatment at least five years ago and their parents will be eligible to participate. While the control group (CG) receives TAU, the intervention group (IG) participates in a structured program. This program includes risk-based medical treatment and psychosocial interventions tailored to each patient’s individual needs within a two-month timeframe. The primary outcome is the improvement of self-efficacy. Secondary outcomes are satisfaction with health care, improvement of health-related quality of life (HRQoL), reduction of mental health problems, and improvement of transition readiness. Discussion This approach has the potential to optimize the health care for individuals who survived cancer during childhood or adolescence. It addresses the challenges of overuse, underuse, and misuse of health care resources. By considering both medical and psychosocial factors and promoting increased self-efficacy, independent from parental involvement, it may facilitate a smoother transition to adult medicine and enhance adherence to lifelong aftercare. If proven successful, this approach will contribute to the integration of multidisciplinary strategies into standard healthcare practice. Trial registration German Clinical Trials Register DRKS00029269. Registered on December 23, 2022.

Nicole Adams,1 Carol A Ott,2 Cody J Mullen,3 Yitong Wang4 1Purdue Regenstrief Center for Healthcare Engineering, West Lafayette, IN, USA; 2Purdue Department of Pharmacy Practice, West Lafayette, IN, USA; 3Purdue Department of Public Health, West Lafayette, IN, USA; 4Purdue School of Nursing, West Lafayette, IN, USACorrespondence: Nicole Adams, Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA, 47907, Email adams417@purdue.eduAbstract: The opioid crisis in the United States continues to take the lives of tens of thousands of Americans each year. Opioid medications are important components of acute pain management and opioid stewardship is necessary to mitigate opioid misuse while providing adequate pain control for patients with severe medical needs. The definition of opioid stewardship includes the use of evidence-based guidelines, policies, and patient-centered practices to promote appropriate prescribing, use, and deprescribing of opioids to optimize treatment and minimize adverse consequences. There is little concrete guidance about how to achieve these goals or define the role and importance of various healthcare professionals in opioid stewardship programs. An integrative review process was used to evaluate and collate best practices in opioid stewardship from a variety of published papers. The integrative review was chosen to be inclusive of papers outside of quantitative research, allowing for interpretation of qualitative research, position statements, reports, editorials, and opinions. Data extraction included 71 publications that revealed common characteristics that can improve and coalesce opioid stewardship programs. Top characteristics and themes developed include prescribing guidelines, patient and provider education, referral and consultation, prescribing audits, barriers to opioid stewardship, the use of multidisciplinary teams and non-physician healthcare providers, accountability, risk of misuse, access to care, and patient-centeredness. The use of electronic health record tools, decision support tools, patient screening and discharge standards, and opioid tapering were recommended. Open and consistent communication between patients and healthcare providers is deemed essential. Staffing resources were found to be a significant barrier to opioid stewardship. This integrative review of publications related to opioid stewardship seeks to provide a comprehensive list of best practices that can be incorporated into programs to streamline processes and contribute to an organized foundation that can be used in research to illuminate practices that lead to enhanced outcomes.Keywords: opioid, stewardship, multidisciplinary, education, patient-centered, barriers

Abstract Background Increases in migration patterns in the recent years have led to a continuously growing number of unaccompanied foreign minors (UFMs) entering Italy. As part of processing and integration, age assessment is performed by pediatricians upon request of regulatory bodies. Updated guidelines for age estimation procedures were published in 2020 in order to prioritize the well-being of the minors and the accuracy of the assessment. Nonetheless, literature suggests that the recently established multidisciplinary approach has not yet been widely adopted by physicians. Methods A cross-sectional exploratory survey was distributed to pediatricians in Italy in order to gauge their range of experience with UFMs and age assessment protocols. Results In total 344 pediatricians participated in the survey, originating from varied regions in Italy. Out of pediatricians who reported conducting age assessment procedures (38.9%), only a small fraction (14.2%) confirmed being knowledgeable about the methodology. Instead, a significant portion (28.8% and 56.4%) either had partial awareness or lacked knowledge of these procedures. These responses significantly differed when comparing hospital and outpatient pediatricians or according to their geographical area of work (p

Integration of Interprofessional Education (IPE) into the health sciences curriculum has been recommended over the past several decades to prepare healthcare professionals for future collaborative practice. However, due to the disparity in the adoption of IPE, this literature review attempted to examine the development of IPE and its implementation in global and Indian contexts. IPE has evolved from being fragmented and isolated initiatives to entering into the mainstream of professional education. In terms of IPE implementation, the global scan revealed that IPE was implemented in several countries to varying degrees; however, developing countries lagged behind developed countries in implementing and sustaining IPE. Scarce evidence was found regarding the implementation of IPE in India. The literature review elaborates on the transformation of health professions education from the traditional system to IPE and discusses the gap in the adoption and implementation of IPE in developing countries, including India.

A text generation based multidisciplinary problem identification method is proposed, which does not rely on a large amount of data annotation.

Elexis Hollingsworth,1,2 Benjamin H Shields,2,* Christopher Rutter,2,3,* Lynn Fox,4 Kelly N Evans,5 Jay Paul Willging,6 Amelia F Drake2 1School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Department of Otolaryngology/Head and Neck Surgery, UNC Hospitals, Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA; 3University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA; 4Adams School of Dentistry, UNC Craniofacial Center, University of North Carolina, Chapel Hill, NC, USA; 5Division of Craniofacial Medicine, Seattle Children’s Hospital, Seattle, WA, USA; 6Division of Pediatric Otolaryngology - Head and Neck Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA*These authors contributed equally to this workCorrespondence: Elexis Hollingsworth, UVA Health, Department of Anesthesiology, 1215 Lee St. Box 800710, Charlottesville, VA, 22908‐0816, USA, Fax +1 434‐982‐0019, Email eh6cm@uvahealth.orgObjective: In the USA, the American Cleft Palate Association-Craniofacial Association (ACPA-CPF) specifies guidelines to ensure craniofacial teams function in a multidisciplinary fashion to provide care in a sequence that mirrors the patient’s needs. Among these guidelines is the expectation that teams hold regular multidisciplinary team meetings to discuss patient care. The purpose of this study was to identify factors that contribute to optimal team functioning during these meetings. The impact of the virtual format on meetings was also evaluated.Design: One-hour semi-structured interviews of craniofacial team members, queried on current and ideal team meetings, were conducted from December 2020 – January 2021. Interviews were recorded, transcribed, and coded to identify common themes until thematic saturation was achieved.Setting/Participants: Sixteen team members from three major American craniofacial centers were interviewed virtually.Results: Three major categories were identified as integral to successful meetings: (1) meeting content, (2) meeting processes, and (3) team dynamics. Within these categories are several factors that participants reported as important to optimize their multidisciplinary meetings: key content for discussions, integration of patient perspective, recognition of collaboration in determining proper sequence of treatments, an attentive discussion leader promoting equitable discussions, managing absences, and team diversity. Participants also identified benefits and pitfalls of hosting meetings in the virtual setting, including lack of engagement and awkward communication.Conclusion: Diverse groups of disciplines are expected to come together during craniofacial multidisciplinary meetings to formulate intricate care plans for complex patients. In this study, craniofacial team members have identified several key factors to optimize these meetings. The research group used these factors to propose a self-evaluation instrument for meeting quality improvement, provided in printable format. Further studies should evaluate how implementation of these factors affects meetings and ultimately guides patient care.Keywords: cleft lip-palate, multidisciplinary, interdisciplinary, teamwork, self-evaluation, virtual

Abstract In this paper, I advocate for a radical expansion of computational urban science to encompass a multidisciplinary, human-centered approach, addressing the inadequacies of traditional methodologies in capturing the complexities of urban life. Building on insights from Jane M. Jacobs and others, I argue that integrating computational tools with disciplines like sociology, anthropology, and urban planning can significantly enhance our understanding and management of urban environments. This integration facilitates a deeper analysis of cultural phenomena, improves urban policy design, and promotes more sustainable, inclusive urban development. By embracing qualitative research methods—such as ethnography and participatory observations—alongside computational analysis, I highlight the importance of capturing the nuanced social fabrics and subjective experiences that define urban areas. I also stress the necessity of including community stakeholders in the research process to ensure that urban science not only analyzes but also improves the lived experiences of urban populations. Furthermore, I underscore the need for ethical governance and the mitigation of biases inherent in computational tools, proposing rigorous model auditing and the inclusion of diverse perspectives in model development. Overall, this work champions a holistic approach to urban science, aiming to make cities smarter, more equitable, and responsive to their residents’ needs.

Background: In Germany, around 2.250 children and adolescents are diagnosed with cancer each year. Despite generally positive long-term survival rates, many patients must cope with late effects of the disease and its treatment. This highlights the need for a well-structured, long-term approach addressing both physical and mental health issues. Currently, the German healthcare system lacks such comprehensive structures. Our study aims to evaluate the effectiveness of a structured, multidisciplinary long-term approach compared to conventional "treatment as usual" (TAU). Methods: A prospective, multicenter study with ten pediatric university clinics in Germany will be conducted. The cluster-randomization takes place at the clinic level. Children and adolescents who completed their cancer treatment at least five years ago and their parents will be eligible to participate. While the control group (CG) receives TAU, the intervention group (IG) participates in a structured program. This program includes risk-based medical treatment and psychosocial interventions tailored to each patient's individual needs within a two-month timeframe. The primary outcome is the improvement of self-efficacy. Secondary outcomes are satisfaction with health care, improvement of health-related quality of life (HRQoL), reduction of mental health problems, and improvement of transition readiness. Discussion: This approach has the potential to optimize the health care for individuals who survived cancer during childhood or adolescence. It addresses the challenges of overuse, underuse, and misuse of health care resources. By considering both medical and psychosocial factors and promoting increased self-efficacy, independent from parental involvement, it may facilitate a smoother transition to adult medicine and enhance adherence to lifelong aftercare. If proven successful, this approach will contribute to the integration of multidisciplinary strategies into standard healthcare practice. Trial registration: German Clinical Trials Register DRKS00029269. Registered on December 23, 2022. [ABSTRACT FROM AUTHOR]