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Collaborative chronic care models (CCMs) are an evidence-based way to structure care in outpatient mental health settings. This project investigated whether implementation facilitation (IF) can enhance CCM-consistent outpatient mental health care and reduce mental health hospitalizations compared with centralized technical assistance (CTA). This was a stepped wedge hybrid 2 implementation-effectiveness trial in outpatient mental health clinics at eight US Department of Veterans Affairs (VA) medical centers (four waves, two sites each) conducted from 2022 to 2024. Staff participants included clinicians involved in delivering team-based outpatient mental health care. The patient sample consisted of US military veterans treated by 42 participating mental health teams. IF was used for 8-9 months to increase alignment with CCM principles at each participating site. All the sites (including eight comparison sites that were nonrandomized but matched on key variables) had access to CTA. The coprimary outcomes were (a) alignment with CCM-based care evaluated using the Role Clarity and Team Primacy subscales of the Team Development Measure [TDM], and (b) mental health hospitalizations extracted from the electronic health record during the year following initiation of IF. The sample included n = 20,835 patients at participating sites and n = 60,221 patients at comparison sites. The pre-implementation TDM was completed by 134 staff members, and post-implementation TDM was completed by 109 staff members. Role Clarity and Team Primacy subscales of the TDM demonstrated small, nonstatistically significant improvement after completing IF (p = 0.33[t-value: 0.97] and 0.14 [t-value: 1.48], respectively). Multivariate generalized linear mixed models indicated participating sites had similar mental health hospitalization rates following IF initiation compared to sites receiving CTA alone. This trial revealed that IF to enhance CCM-consistent clinical practices in outpatient mental health teams was associated with small improvements in team functioning that did not achieve statistical significance. Mental health hospitalization rates did not differ for sites using IF versus CTA. TDM-based assessments of team functioning at baseline were similar to post-implementation results from a prior trial, suggesting that CTA to support team-based care may have increased team functioning in these settings prior to trial initiation. NCT05997836. Retrospectively registered 18 August 2023: https://clinicaltrials.gov/study/NCT05997836?term=NCT05997836%26rank=1. Ethical approval: This evaluation was conducted as a quality improvement activity for VA and was deemed by the R&D Committee at the VA Boston Healthcare System not to be research; therefore, it was not subject to IRB review.

Severe hypertension (HTN) during pregnancy is highly associated with adverse perinatal outcomes, yet many cases occur in outpatient settings where standardized management is lacking. We used a community-engaged approach to adapt an evidence-based inpatient HTN bundle for outpatient care, creating the Outpatient HTN (O-HTN) Bundle. This study aimed to evaluate the feasibility, acceptability, and impact of three implementation strategies (1) identifying and preparing champions, (2) providing ongoing training, and (3) simulation. We conducted a pre-post pilot study in three Federally Qualified Health Centers (FQHCs) from 9/2021-6/2022. Multidisciplinary clinical teams comprised of a medical assistant, nurse, provider (midwife or physician), and pharmacy staff received training on the O-HTN Bundle and participated in pre- and post-training simulations. Simulations involved a patient actor presenting with severe HTN during a prenatal visit. Trained observers used a checklist to evaluate clinical team fidelity to the O-HTN Bundle algorithm. Observers, clinical team members, and the patient actor assessed provision of respectful care via a Respectful Care Reflection Tool. The primary outcome was fidelity to the O-HTN Bundle; secondary outcomes included respectful care and feasibility and acceptability of the implementation strategies. Feasibility was defined by engagement in trainings/simulations. Acceptability was assessed with a study-specific survey. Paired t-tests compared fidelity and respectful care scores pre- and post-training. Descriptive statistics summarized acceptability and feasibility data. The implementation strategies were feasible; 19 clinical teams participated, representing 59% of all prenatal providers across the three FQHCs. All 19 teams participated in the O-HTN Bundle training and pre- and post-training simulations. The strategies were also effective: mean fidelity scores improved from 78% pre-training to 95% post-training (p = 0.006). Significant gains were made on severe HTN identification, treatment, and escalation to higher level of care. Respectful care scores also improved, though not significantly. Survey results indicated acceptability of the training and simulation model. In this pilot study, clinic champions, training, and simulation were feasible, acceptable, and effective strategies to improve fidelity to the O-HTN Bundle and thus response to severe HTN in pregnancy. These findings support broader implementation of the O-HTN Bundle.

Scoping reviews are used to map the literature within a field or discipline, summarize existing evidence, and identify gaps in knowledge. Conducting a scoping review is often labor-intensive, requiring significant human resources. Artificial intelligence (AI) tools may offer efficiencies in stages of the review process; however, their accuracy and impact on rigor remain uncertain. This study used a retrospective cross-sectional agreement design to compare title and abstract screening decisions made by ChatGPT 3.5 with decisions made by human reviewers. Of the 3154 articles initially retrieved, 3148 were screened by both the research team and ChatGPT 3.5, with 6 articles excluded due to incomplete data or upload errors. During title and abstract screening, the human research team excluded 2661 articles (84.5%), whereas ChatGPT 3.5 excluded 1533 articles (48.7%). Our findings suggest that although AI-assisted screening may reduce time by filtering out a portion of irrelevant studies early in the process, these efficiencies must be balanced against the depth of understanding gained through review among the human team. Furthermore, the dialogue and consensus-building among research team members may be diminished when AI tools are used. This reduction in scholarly engagement may limit opportunities for critical appraisal, learning, and deeper comprehension of the evidence.

Interprofessional collaborative practice (ICP) benefits patients with complex conditions such as osteoporosis that require care from multiple professions. ICP is not consistently applied in osteoporosis management in primary healthcare today. To explore how an ICP intervention promoting co-creation of osteoporosis management was conducted and how it was experienced by nurses and physicians in primary healthcare. The intervention part was guided by participatory health research approach. In total, 12 nurses and physicians from five primary healthcare centres participated in three workshops aimed at supporting co-creation of local osteoporosis management. The evaluation part consisted of group and individual interviews and surveys capturing self-reported experiences. Data were analysed using qualitative content analysis with inductive approach. Participants reviewed local osteoporosis management and co-created work procedures tailored to their settings. The analysis generated three categories with seven subcategories. The categories were innovative learning processes, perceived effects, and factors influencing changes in work procedures. Innovative learning processes described shared learning, reflection, and adaptation in developing work procedures. Perceived effects included expected benefits for patients, changes in professional roles, and increased interprofessional collaboration. Participants described a strengthened role for nurses in osteoporosis management. Factors influencing changes in work procedures included organizational, professional, and resource-related conditions. The survey findings supported those from the interviews. A participatory approach facilitated collaborative revision of osteoporosis management by leveraging local knowledge and promoting interprofessional learning. Participatory health research appears useful for developing ICP in managing complex conditions such as osteoporosis in primary healthcare. The treatment of osteoporosis often requires several healthcare professions to work together, but this kind of collaboration is uncommon in primary healthcare. This study explored an approach in which nurses and doctors at five primary healthcare centres collaborated to improve osteoporosis management. The teams participated in three online workshops designed to help them review existing procedures and co-create new working methods. The process involved active dialogue and adapting routines to local contexts. Participants described how teamwork helped them to learn from one another. They reported that the new procedures made it easier to identify patients at risk and improved the overall quality of osteoporosis management. Participants at some primary healthcare centres also noted that nurses now had an expanded role, with broader responsibility and more involvement in care delivery. The surveys supported these impressions. Participants also highlighted factors that supported the process, including knowledge sharing and teamwork, and others that undermined it, such as staff shortages and limited resources. In summary, involving health professionals in co-creating procedures could strengthen teamwork and improve the management of complex conditions such as osteoporosis.

Community health workers (CHWs), most of whom are women, are the bedrock of primary health care provision in much of the world. CHWs are often employed at the bottom of health hierarchies where they have little voice; in state programs and vertical initiatives, accountability has generally flowed downwards. Yet many programs might function better if CHWs' needs and ideas were considered in program design. From 2020-2022, we implemented a human-centered design process called IMPACT with CHWs working on polio vaccination in one district of Pakistan. The name IMPACT draws from the steps in the process: Identify problems and brainstorm innovations; Make and refine ideas; Present and evaluate ideas; and ACT to disseminate and implement. We held a facilitated competition for teams of CHWs, all of whom were women, to propose policy improvements to polio vaccination. In total, 417 CHWs participated in the design process facilitated by our team, and more than 500 additional CHWs participated in sessions facilitated by local supervisors. We worked with local policymakers to short-list the best ideas. Teams of CHWs presented the short-listed ideas to a panel of provincial and national-level policymakers, who selected ideas for implementation. We conducted interviews with CHWs and policymakers throughout the process to understand their experiences (n=82). We received 181 idea submissions over two rounds of the process; 9 ideas were chosen for implementation. CHWs valued the process enormously; most said it was the first time their insights had been considered, and they wanted more opportunities for such input. The second round of the process was more effective than the first, with workers generating more complex ideas and program staff running workshops themselves. We heard, across management levels, that the process had positively impacted CHW motivation and confidence. Overall, the innovations selected for implementation were in the form of adjustments rather than major programmatic changes. Yet CHWs reported that the changes made were helpful and that it was very meaningful to have contributed to program policy. IMPACT facilitated substantive engagement and collaboration from both male supervisors and frontline female workers in a highly gender-stratified setting. Structured processes can allow the least powerful actors in global health interventions to draw on their frontline experience to suggest policy innovations.

To investigate the incidence and risk factors of endoscopic retrograde cholangiopancreatography (ERCP) post-ERCP pancreatitis (PEP) from the perspective of nursing practice, and to provide evidence for developing refined prevention and control strategies. A single-center retrospective study was conducted on 658 patients who underwent diagnostic or therapeutic ERCP between January 2020 and December 2025. Using a nested case-control design, 45 patients who developed PEP were assigned to the case group, and 180 patients without PEP were matched at a 1:4 ratio as the control group. Baseline characteristics, procedural variables, and perioperative nursing-related factors were collected. Multivariable logistic regression analysis was performed to identify independent risk factors, and a combined prediction model was constructed to evaluate its performance. The overall incidence of PEP was 6.8%, with mild cases accounting for 71.1%. The case group had significantly higher proportions of difficult cannulation and pancreatic duct opacification&#x2009;&#x2265;&#x2009;3 times, but significantly lower proportions of receiving comprehensive nursing interventions and cooperation by a dedicated ERCP team. A higher proportion of patients in the case group were assessed as high risk preoperatively. Difficult cannulation (AOR&#x2009;=&#x2009;6.70, 95% CI: 2.79-16.09, p&#x2009;<&#x2009;0.001), pancreatic duct opacification&#x2009;&#x2265;&#x2009;3 times (AOR&#x2009;=&#x2009;3.38, 95% CI: 1.40-8.17, p&#x2009;=&#x2009;0.007), and preoperative high-risk assessment (AOR&#x2009;=&#x2009;3.98, 95% CI: 1.72-9.20, p&#x2009;=&#x2009;0.001) were identified as independent risk factors, while comprehensive nursing interventions (AOR&#x2009;=&#x2009;0.20, 95% CI: 0.09-0.47, p&#x2009;<&#x2009;0.001) and dedicated ERCP team cooperation (AOR&#x2009;=&#x2009;0.14, 95% CI: 0.05-0.37, p&#x2009;<&#x2009;0.001) were protective factors. The combined prediction model showed good discriminative ability (AUC&#x2009;=&#x2009;0.856) and model fit (Hosmer-Lemeshow test, p&#x2009;=&#x2009;0.145). Comprehensive nursing interventions and dedicated ERCP team cooperation were associated with a lower risk of PEP in this retrospective study. These findings suggest that nursing-related factors may play a role in PEP prevention. We therefore recommend integrating nursing assessment and intervention into standardized ERCP management protocols to enhance overall procedural safety.

Fatigue is a predictable operational hazard in air medical transport, impairing vigilance, reaction time, decision making, and communication-capabilities essential for both aviation and critical care. Despite widespread emphasis on team communication and risk management, fatigue is often managed informally at the individual level. We propose a practical fatigue-readiness framework for rotor- and fixed-wing air medical programs centered on 2 checkpoints: a routine readiness check at the start of shift and a premission "Safety Pause" for elevated-risk operations. The framework optionally incorporates objective alertness assessment (eg, brief psychomotor vigilance testing [PVT]) to complement subjective self-assessment and uses a green/amber/red ladder to guide mitigation and documentation in a nonpunitive manner. Drawing on air medical experience with PVT, established aviation fatigue countermeasures, and health care fatigue risk management literature, we discuss implementation considerations, governance needs, and limitations. A single, standard operating procedures-ready figure summarizes the workflow and provides a shared vocabulary for team-based readiness decisions. Implementation requires explicit nonpunitive governance, protected reporting, and careful attention to privacy to avoid unintended deterrence of fatigue disclosure. The intent is to shift fatigue management from "endurance" to "readiness" while preserving operational feasibility and psychological safety for crew members.

Plain language summaryCelebrating the legacy of two decades of Parkinson's disease research in South AfricaParkinson's disease (PD) has been well-studied in Western Countries, but there are far fewer studies in other parts of the world, especially in Africa. This lack of research is partly because there are insufficient neurologists in many African countries, leading to missed or incorrect diagnoses. Stigma around PD and the absence of national disease registries also make research more difficult. To help fill this gap, our team has spent the past 20 years studying PD in South Africa. We have built a collection of almost 2,000 South African participants and report our main findings here. Overall, we found only 20 PD-causing variants in our collection of 689 unrelated PD cases. Interestingly, some of these genetic findings appear to be unique to South Africans, likely due to the unique genetic composition of the country's population. Our functional studies showed how variants in genes, such as PRKN and LRRK2, disrupt the function of mitochondria. Mitochondria are tiny structures in cells that supply the energy required for the cells to function. Cells die when they do not have the necessary energy, potentially explaining why brain cells die in PD. A third part of our research focuses on curcumin, a natural compound found in turmeric known for its antioxidant and anti-inflammatory effects. Using cell models, including cells from individuals with PD, we found that curcumin can protect cells from damage caused by paraquat, a harmful chemical which has been linked to the development of PD. However, this rescue is only seen when curcumin is given before the damage occurs. This suggests that curcumin may help prevent neuronal loss in PD. In summary, our work adds to global knowledge about the genetics, disease processes, and possible treatments for PD. It also shows what a small African laboratory can achieve, despite limited personnel and resources. Celebrating the legacy of two decades of Parkinson's disease research in South AfricaParkinson's disease (PD) has been well-studied in Western Countries, but there are far fewer studies in other parts of the world, especially in Africa. This lack of research is partly because there are insufficient neurologists in many African countries, leading to missed or incorrect diagnoses. Stigma around PD and the absence of national disease registries also make research more difficult. To help fill this gap, our team has spent the past 20 years studying PD in South Africa. We have built a collection of almost 2,000 South African participants and report our main findings here. Overall, we found only 20 PD-causing variants in our collection of 689 unrelated PD cases. Interestingly, some of these genetic findings appear to be unique to South Africans, likely due to the unique genetic composition of the country's population. Our functional studies showed how variants in genes, such as PRKN and LRRK2, disrupt the function of mitochondria. Mitochondria are tiny structures in cells that supply the energy required for the cells to function. Cells die when they do not have the necessary energy, potentially explaining why brain cells die in PD. A third part of our research focuses on curcumin, a natural compound found in turmeric known for its antioxidant and anti-inflammatory effects. Using cell models, including cells from individuals with PD, we found that curcumin can protect cells from damage caused by paraquat, a harmful chemical which has been linked to the development of PD. However, this rescue is only seen when curcumin is given before the damage occurs. This suggests that curcumin may help prevent neuronal loss in PD. In summary, our work adds to global knowledge about the genetics, disease processes, and possible treatments for PD. It also shows what a small African laboratory can achieve, despite limited personnel and resources.

Effective collaboration among nurses is essential for delivering safe and high-quality patient care, particularly in high-acuity environments such as emergency departments. Ineffective collaboration may lead to poor communication, mistrust among team members, and an increased risk of medical errors. Millennials currently comprise a substantial proportion of the global nursing workforce and bring unique communication styles, work values, and career expectations into clinical practice. However, limited evidence exists regarding nurse-nurse collaboration among millennial emergency room nurses in the Philippine healthcare setting. A quantitative descriptive cross-sectional study was conducted among millennial emergency room nurses working in five government hospitals in Metro Manila, Philippines. A total of 173 respondents were selected from 194 eligible nurses through simple random sampling, yielding a response rate of 89.2%. Data were collected using the Nurse-Nurse Collaboration (NNC) Scale, a validated 22-item instrument measuring four domains: conflict management, common goals, communication and coordination, and professionalism and autonomy. Descriptive statistics, weighted mean, Fisher's exact test, and Pearson correlation were used to analyze the data. The largest proportion of respondents were 30 years old and below (38.7%), female (68.8%), and had 2-9 years of clinical experience (76.9%). Respondents reported favorable perceptions of nurse-nurse collaboration across all domains including conflict management (M&#x2009;=&#x2009;1.556), common goals (M&#x2009;=&#x2009;1.550), communication and coordination (M&#x2009;=&#x2009;1.633), and professionalism and autonomy (M&#x2009;=&#x2009;1.586). No significant relationship was found between collaboration and demographic factors such as age and gender (p&#x2009;>&#x2009;.05). However, length of experience showed weak but statistically significant negative correlations with collaboration in terms of common goals (r&#x2009;=&#x2009;-&#x2009;.161, p = .034) and professionalism and autonomy (r&#x2009;=&#x2009;-&#x2009;.178, p = .019). Millennial emergency room nurses demonstrated favorable perceptions of nurse-nurse collaboration across all domains. While age and gender were not significantly associated with collaboration, clinical experience demonstrated weak negative relationships with selected domains of nurse-nurse collaboration. The findings may support efforts to strengthen collaborative workplace cultures and professional development initiatives within emergency nursing environments.

Implementation science bridges the gap between research and practice by using structured strategies to integrate evidence-based interventions into clinical care. Physician associates, with their unique roles in team-based care, are well suited to address gaps in delivery of evidence-based interventions and to lead change initiatives. The purpose of this article is to introduce key principles of implementation science and identify opportunities for PA-driven practice change. Clinical vignettes illustrate both practical application of implementation science and the deimplementation of low-value care. By understanding implementation science principles, physician associates can enhance patient outcomes and drive system-level improvements.

To explore what works for whom, how and why when implementing women's sexual and reproductive health interventions in prisons to understand the barriers and facilitators to implementation and to generate recommendations for policymakers. Realist review using the Realist And Meta-narrative Evidence Synthesis: Evolving Standards guidelines. We systematically searched Ovid MEDLINE, Global Health, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the American Psychological Association (APA) PsycINFO databases and hand-searched unpublished literature and reference lists, January-June 2025. Primary studies of implementing women's sexual and/or reproductive health interventions, including those addressing sexually transmitted infections, cervical health, breast screening, contraception and women's health holistically. Study populations included people in prisons that detain women in high-income countries. We extracted and analysed data relating to implementation processes using a grounded theory approach and retroductive inference to articulate cross-case Intervention-Context-Actor-Mechanism-Outcome configurations (ICAMOCs) and refine programme theory. We discussed findings in relation to existing theories from the literature to elicit recommendations for policymakers. Of 4617 deduplicated records, 26 met the inclusion criteria. Ten ICAMOCs were constructed from cross-case analyses, grouped into three themes: (1) planning (teaming, team leadership, assessing needs and capacity, tailoring and planning), (2) doing (piloting, standardisation and support, trauma-informed engagement and peer advocacy) and (3) sustaining (evaluation-adaptation cycles). The ICAMOCs indicated three overarching mechanisms as being key to effective implementation, namely, perceived utility of the intervention, motivation and empowerment. For women's sexual and reproductive health interventions to be effective in prisons, everyone involved in implementation needs to perceive the intervention's benefit and be both motivated and empowered to take action. We recommend policymakers build a resilient and empowered delivery workforce, invest in research partnerships to increase awareness and understanding and promote trauma-informed approaches to women's healthcare in prisons.

Effective transition from pediatric to adult care is essential in Duchenne muscular dystrophy (DMD), but evidence on how transition is delivered in everyday practice remains limited. In Turkey, no clinical framework specifies how transition should occur, although national regulation requires completion of transfer by age 23. This study aimed to describe current practice, identify barriers and facilitators from physician and patient perspectives, and compare findings with international frameworks to inform a national guideline. As part of the AIM-DMD (National plan of action to raise Awareness and Improve Medical care of Duchenne Muscular Dystrophy) initiative, we conducted a national cross-sectional survey between June and December 2025, comprising parallel sub-studies of physicians and patients with DMD and their caregivers. Two structured online questionnaires were developed, guided by the Got Transition Six Core Elements framework and international Delphi consensus statements. The physician survey was distributed through professional networks; the patient and caregiver survey through the DMD Families Association and neuromuscular reference centers. Sixty-two physicians (43 pediatric and 19 adult neurologists) from 28 cities and 48 patients and caregivers from 24 of these cities responded. Only 17.7% of physicians reported a systematic institutional transition program, 38.7% prepared individualized transition plans, and 9.7% described true readiness assessment. Joint pretransition consultations were held regularly by only 6.5% of physicians. Among transitioned patients, 72.4% first heard about transition at age 17 or later, and 62.1% considered their preparation inadequate. All physicians reported transferring medical data at transition, most commonly through institutional electronic health records (80.6%); however, 41.4% of patients and caregivers were unaware that any information had been conveyed to the adult team. Physicians, patients, and caregivers all identified the lack of a formal transition protocol, joint pediatric and adult consultations, multidisciplinary integration, and a designated coordinator role as priority areas for improvement. DMD transition care across Turkey lacks consistent structure. Key gaps include limited readiness assessment, delayed discussions, poor patient and caregiver awareness of the transition process, and lack of coordinated multidisciplinary structures. Our study identified common priorities raised by physicians, patients, and caregivers that need to be improved and could inform the development of standardized protocols.

Heart failure (HF) commonly coexists with type 2 diabetes mellitus (T2DM), and this combination is linked to a heavier symptom burden and less favorable clinical outcomes. In this retrospective single-center study, a total of 958 consecutive patients were included, among whom 453 had T2DM, with a mean age of 68.23&#x2005;&#xb1;&#x2005;5.76 years. The diagnosis of HF was confirmed by a multidisciplinary team in accordance with the European Society of Cardiology criteria, and 232 patients were found to have both T2DM and HF. Relative to diabetic patients without HF, those with HF more often presented with dyspnea or fatigue, paroxysmal nocturnal dyspnea/orthopnea, and ankle swelling or nocturia (all P&#x2005;<&#x2005;.001). They also showed higher rates of wheezing/rhonchi (P&#x2005;=&#x2005;.021), fluid and sodium retention (P&#x2005;=&#x2005;.008), ST-T abnormalities (P&#x2005;=&#x2005;.033), abnormal Q-waves (P&#x2005;=&#x2005;.001), and NT-proBNP levels&#x2005;&#x2265;&#x2005;15 pmol/L (approximately 125 pg/mL; P&#x2005;<&#x2005;.001). Potential predictors were first selected using least absolute shrinkage and selection operator (LASSO) regression, after which multivariable logistic regression was performed to construct a nomogram for predicting HF risk in patients with T2DM. The multivariable model indicated that ST-T abnormalities, NT-proBNP, ischemic heart disease, and atrial fibrillation were independently related to HF (all P&#x2005;<&#x2005;.05). The nomogram exhibited strong apparent discriminatory ability together with satisfactory calibration, suggesting that NT-proBNP-based risk stratification may be useful for HF screening in individuals with T2DM.

This paper aims to promote international collaboration among air medical organizations and provide an overview of the Japanese Society for Aeromedical Services (JSAS) Annual Congress. In 2025, the 32nd Annual Congress of the JSAS was held in Numazu City from November 13 to 15 under the theme "Toward a Shared Vision: A New Era in Aeromedical Care." The congress included 220 presentations and was attended by 980 participants. It remains the only national conference in Japan dedicated exclusively to air medical care. The meeting provided a comprehensive overview of current air medical services and future directions. Key topics included the status of helicopter emergency medical services in Europe, lifesaving cases involving Japan's doctor-helicopter (DH) system, helicopter underwater escape training, international air medical evacuation, and operations of the US Air Force Critical Care Air Transport Team. Sessions also addressed challenges related to prehospital blood product administration, ventilator requirements, safety management, and aircraft maintenance systems. Additional discussions focused on the standardization of clinical protocols, dispatch criteria, and flight physician education, as well as the development of quality indicators through multidisciplinary collaboration. The program further highlighted nationwide public awareness initiatives, nursing practices in air medical settings, responses to large-scale disasters, activities of related organizations, and international air medical evacuation. We believe that the face-to-face relationships fostered through the JSAS Annual Congress play a vital role in strengthening collaboration among DH teams and other aerospace-related organizations.

To evaluate the application value of recurrent laryngeal nerve tunnel dissection combined with mesangectomy in en-bloc resection for thyroid cancer. A retrospective analysis was conducted on 174 patients with thyroid cancer diagnosed by preoperative fine-needle aspiration cytology who underwent surgery at Shaoxing Central Hospital from January 2020 to May 2024. These patients (modified surgery group) received en-bloc resection using recurrent laryngeal nerve tunnel dissection combined with mesangectomy, including 143 cases of unilateral radical thyroidectomy, 24 cases of bilateral radical thyroidectomy, and 7 cases of isthmus thyroidectomy. A total of 178 patients diagnosed by preoperative fine-needle aspiration cytology who underwent conventional two-step surgery by the same surgical team during the same period were selected as the conventional surgery group, including 160 cases of unilateral radical thyroidectomy and 18 cases of bilateral radical thyroidectomy. All surgeries were completed successfully. Compared with the conventional surgery group, the modified surgery group showed superior outcomes in terms of operation time, intraoperative blood loss, postoperative drainage duration, and postoperative drainage volume in patients undergoing unilateral radical thyroidectomy; temporary recurrent laryngeal nerve palsy and autologous parathyroid gland transplantation rate in patients undergoing bilateral radical thyroidectomy; as well as length of hospital stay, number of central lymph nodes dissected, and number of level IVB lymph nodes dissected (all P<0.05). As of May 25, 2026, the follow-up period ranged from 15 to 77 months. No adverse events such as recurrence of thyroid cancer were reported in any patient. The modified en-bloc resection of thyroid cancer using recurrent laryngeal nerve tunnel dissection combined with mesangectomy is convenient to perform, achieves thorough lymph node dissection with less intraoperative bleeding, and provides reliable protection of the recurrent laryngeal nerve and parathyroid glands. 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ICU ward rounds are a high-leverage coordination process in a complex and resource-intensive care environment. Bundles combining checklists, structured team communication, and digital decision support may reduce omissions and accelerate de-escalation, yet health economic considerations are rarely integrated at an early stage. We conducted an early economic assessment from a hospital perspective. A health-economic programme theory was developed to structure the analysis. Model inputs were parameterized using published German ICU daily cost estimates and published evidence on ward-round interventions, including a meta-analytic estimate reporting a mean ICU length-of-stay (LOS) reduction of 0.27 days. We performed (i) a cost-offset threshold analysis, (ii) an illustrative one-year budget impact analysis for an ICU with 1,000 annual admissions, and (iii) scenario analyses distinguishing cash-releasable savings from opportunity value due to released ICU capacity. In addition, we outline a pragmatic real-world evaluation framework combining interrupted time series analysis with process evaluation. For an intervention cost of EUR 50 per ICU admission, break-even was achieved with an average ICU LOS reduction of only 0.03-0.05 days, depending on the ICU day cost applied. Under base-case assumptions (80% adoption, 0.27-day LOS reduction, average ICU day cost EUR 1,237), the estimated annual capacity value amounted to EUR 267,192 for a 1,000-admission ICU. Assuming that 30% of average ICU costs are cash-releasable in the short run, the corresponding annual cash impact was EUR 40,158. Even small reductions in ICU length of stay may offset realistic implementation costs of a standardized rounding bundle. Explicitly distinguishing cash-releasable savings from capacity value and integrating implementation outcomes into early economic evaluation enhances decision relevance for hospitals considering scale-up of this complex intervention.