Search

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.

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 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]

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]

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]

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]

Cephalo is presented as a series of multimodal vision large language models (V‐LLMs) designed for materials science applications, integrating visual and linguistic data for enhanced understanding. A key innovation of Cephalo is its advanced dataset generation method. Cephalo is trained on integrated image and text data from thousands of scientific papers and science‐focused Wikipedia data demonstrates it can interpret complex visual scenes, generate precise language descriptions, and answer queries about images effectively. The combination of a vision encoder with an autoregressive transformer supports multimodal natural language understanding, which can be coupled with other generative methods to create an image‐to‐text‐to‐3D pipeline. To develop more capable models from smaller ones, both mixture‐of‐expert methods and model merging are reported. The models are examined in diverse use cases that incorporate biological materials, fracture and engineering analysis, protein biophysics, and bio‐inspired design based on insect behavior. Generative applications include bio‐inspired designs, including pollen‐inspired architected materials, as well as the synthesis of bio‐inspired material microstructures from a photograph of a solar eclipse. Additional model fine‐tuning with a series of molecular dynamics results demonstrate Cephalo's enhanced capabilities to accurately predict statistical features of stress and atomic energy distributions, as well as crack dynamics and damage in materials. [ABSTRACT FROM AUTHOR]

There have been repeated calls to train conservationists capable of transcending disciplinary boundaries. However, little empirical work has been done to document conservation teaching. We investigate the content taught in conservation higher education across the United Kingdom and Australia. Using data from an online survey and content analysis of module descriptions, we assess the prevalence of subject areas in 146 conservation modules and topics in 368 conservation modules and 62 conservation degrees. Biological sciences subject areas were represented in 92% of the modules, whereas social sciences subject areas only featured in 60% and humanities in 24%. Of the modules teaching biological sciences subject areas, 84% included biological sciences faculty but only 31% of the modules covering social sciences subject areas included faculty from the social sciences. Who teaches matters. The disciplinary expertise in conservation education needs to diversify to train conservationists capable of addressing conservation challenges. This requires institutional changes and support from prominent societies to promote interdisciplinary education. [ABSTRACT FROM AUTHOR]

• The need for continuing professional development spans all disciplines within CF. • Online education platforms are used widely by the CF health professional community. • The ECFS education platform is rated favourably as a source of education. • Results will help improve the delivery of high quality and accessible content. Continuing professional development (CPD) is a component of practice that spans all disciplines within cystic fibrosis (CF). E-learning resources theoretically represent flexible, low cost and time efficient methods of CPD. We aimed to explore European Cystic Fibrosis Society (ECFS) members' and CF health professional communities' current views, experiences and perceptions of e-learning and the ECFS education platform (ECFS-EP). An online cross-sectional survey was developed by the ECFS Education Committee and circulated via the ECFS conference, emails and within the society subgroups between June and September 2023. 547 responses were received from 58 countries; 57 % of responders were ECFS members. A wide range of specialities were represented from the multidisciplinary team including 36 % clinicians. The majority of respondents (63 %) spent 6 or more hours a week on their professional education. Online platforms were used either weekly (34 %) or monthly (37 %); 54 % of respondents had used the ECFS-EP and this was rated favourably overall, specifically for content quality. Preferred formats for education were articles and medium length (15–30 min) webinars. This multidisciplinary cohort survey illustrates contemporary practice and opinion relating to e-learning and the ECFS-EP. Strengths include the high number of responses and the wide range of countries and specialities represented. Results suggest the ECFS-EP is valued and highlights priority topics, preferred formats and opportunities to optimise awareness. Results support continued provision and oversight of high quality education via an online platform. Continued success will rely on learning from user experience and feedback to inform future practice. [ABSTRACT FROM AUTHOR]

Background Chat Generative Pre-trained Transformer (ChatGPT) and other ChatBots have emerged as tools for interacting with information in manners resembling natural human speech. Consequently, the technology is used across various disciplines, including business, education, and even in biomedical sciences. There is a need to better understand how ChatGPT can be used to advance gerontology research. Therefore, we evaluated ChatGPT responses to questions on specific topics in gerontology research, and brainstormed recommendations for its use in the field. Methods We conducted semistructured brainstorming sessions to identify uses of ChatGPT in gerontology research. We divided a team of multidisciplinary researchers into 4 topical groups: (a) gero-clinical science, (b) basic geroscience, (c) informatics as it relates to electronic health records, and (d) gero-technology. Each group prompted ChatGPT on a theory-, methods-, and interpretation-based question and rated responses for accuracy and completeness based on standardized scales. Results ChatGPT responses were rated by all groups as generally accurate. However, the completeness of responses was rated lower, except by members of the informatics group, who rated responses as highly comprehensive. Conclusions ChatGPT accurately depicts some major concepts in gerontological research. However, researchers have an important role in critically appraising the completeness of its responses. Having a single generalized resource like ChatGPT may help summarize the preponderance of evidence in the field to identify gaps in knowledge and promote cross-disciplinary collaboration. [ABSTRACT FROM AUTHOR]

A 16‐year‐old pony gelding presented with epistaxis and a head tilt. Referral skull radiographs suggested an ethmoid hematoma. Concurrent neurologic abnormalities prompted contrast‐enhanced CT of the head and cranial neck, revealing numerous hyperattenuating masses throughout the brain and paranasal sinuses, along with a large osteolytic mass in the second cervical vertebra. The vertebral mass extended into the vertebral canal, causing focal extradural compressive myelopathy. These findings were inconsistent with ethmoid hematoma and metastatic hemangiosarcoma or malignant melanoma were prioritized as potential causes for the clinical signs. Postmortem examination confirmed the sinonasal, intracranial, and vertebral masses as hemangiosarcoma, and additionally revealed innumerable thoracoabdominal metastatic lesions and hemorrhagic foci. A final diagnosis of disseminated hemangiosarcoma was made. In this study, CT proved invaluable for evaluating the severity and characterizing regional disease and neural involvement, directly affecting case management decisions. [ABSTRACT FROM AUTHOR]

The development of digital platforms and business ecosystems has led to the emergence of new business models and has transformed the competitive landscape. The exponential growth of digital technologies has created new challenges for managers and academics. A multidisciplinary approach is required to understand and manage digital platforms and business ecosystems, which involve complex and interrelated phenomena. A comprehensive and nuanced understanding of these platforms and ecosystems can lead to more effective and sustainable business models that create value for customers and stakeholders, as well as identify and address potential risks and challenges. This special issue aims to promote a multi- and interdisciplinary approach to the study of these topics, which are a multi-faceted and evolving field of research. This approach provides a holistic understanding of the complex interrelationships between digital platforms, business ecosystems and new and sustainable business models. The findings contribute to both academic research and management practice, providing valuable insights and recommendations for organizations seeking to navigate and thrive in the digital economy. Overall, this special issue aims to provide novel research that can contribute to a more informed debate in the field. [ABSTRACT FROM AUTHOR]

In the presence of globalization and advancing clinical knowledge, there is a paradigm shift from a single patient care sector to a multidisciplinary-collaborated health care team. In pursuit of favorable postoperative outcomes, reduced length of hospital stay, minimized complications and morbidity, and accelerated recovery, prehabilitation strategies assume a prominent role following preoperative assessment. Fundamental to prehabilitation are physical activity, nutrition, and psychological interventions, aimed at enhancing preoperative functional reserve through expert-designed program sessions spanning various specialties. Enhanced Recovery After Surgery (ERAS) serves as an intra- and postoperative strategy to facilitate the smooth return of patients to their baseline status postoperation by mitigating surgical stress. Integrating prehabilitation into ERAS protocols holds promise for optimizing postoperative outcomes. Protocols for prehabilitation across diverse patient groups have been proposed, paving the way for the routine incorporation of prehabilitation into patient care. [ABSTRACT FROM AUTHOR]

Objective: To explore the attitudes, facilitators and barriers in providing oral care for inpatients with dysphagia post‐stroke as perceived by healthcare professionals. Background: Dysphagia is a common complication of stroke and is associated with a higher incidence of aspiration pneumonia, malnutrition and dehydration. In the acute phase of stroke recovery, a dental professional is not usually part of the multidisciplinary team caring for the patient and oral care is the responsibility of the healthcare professionals in the stroke unit. There is a lack of high‐quality evidence to demonstrate the most effective method of providing oral care for patients with dysphagia post‐stroke. Materials and methods: This was a single‐site study conducted with healthcare professionals working in the Stroke Unit of Cork University Hospital in Ireland, using focus groups and a qualitative thematic analysis approach. Results: A total of three focus groups were conducted in the Stroke Unit with 17 healthcare professionals. The focus groups included representation from all healthcare professional groups providing direct clinical care to patients on the Stroke Unit including geriatric medicine, dietetics, speech and language therapy, healthcare assistance, nursing, occupational therapy and physiotherapy. A qualitative thematic analysis was carried out and seven overarching themes emerged from the data. Three themes related to facilitators to providing oral care for this patient group: (i) a focus on oral care in both policy and practice, (ii) expanding professional roles in the provision of oral care, (iii) perceived importance of oral care in recovery and rehabilitation. Four themes related to barriers to the provision of oral care for this patient group: (i) lack of confidence and concerns related to the perceived risk for patients with dysphagia, (ii) unique challenges of patient and stroke‐related factors, (iii) lack of resources and time and (iv) perceived importance of oral care in recovery and its relative importance with competing demands. Conclusion: Members of the stroke multidisciplinary team believe that they all have a part to play in the delivery of oral care for patients with dysphagia post‐stroke. Opportunities exist for the development of multidisciplinary interventions to improve the oral cavity assessment and oral care provided in the Stroke Unit. [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.

PURPOSE: National mandates require cancer centers provide comprehensive survivorship care. We created an 8-session, group intervention, the Survivorship Wellness Group Program (SWGP), that covered 8 topics: nutrition, physical activity, stress, sleep/fatigue, sexuality/body image, emotional wellbeing/fear of cancer recurrence, spirituality/meaning, and health promotion/goal setting. This study examined the acceptability and preliminary outcomes of SWGP. METHODS: We evaluated SWGP using questionnaire data collected at program entry and 15-week follow-up. Questionnaires assessed acceptability and impact on anxiety, depression, quality of life, and perceived knowledge of topics. Enrollees who consented to participate in research and completed the baseline and 15-week follow-up were included in the analysis (N = 53). We assessed acceptability and preliminary outcomes using paired-samples t-tests. Due to the COVID-19 pandemic, SWGP transitioned to telehealth partway through data collection. Post-hoc analyses compared outcomes by intervention delivery. RESULTS: Participants completed an average of 7.44/8 classes. Participants reported a mean response of 3.42/4 regarding overall program satisfaction and 90.6% reported being very likely to recommend SWGP. SWGP was associated with decreases in anxiety and depression; increases in physical, emotional, functional, and overall quality of life; and increases in knowledge of all health behavior domains. No outcomes differed significantly between delivery in person versus telehealth. CONCLUSIONS: SWGP offers an acceptable and replicable model for cancer centers to meet national survivorship care guidelines. IMPLICATION FOR CANCER SURVIVORS: SWGP provides a comprehensive service for cancer survivors post-treatment, and was associated with better quality of life, fewer mental health symptoms, and increased knowledge in multiple domains of wellness.

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]

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.