搜索结果：Journal of multidisciplinary healthcare

The prevalence of pulmonary diseases, including chronic obstructive pulmonary diseases, in Saudi Arabia is high, and pulmonary rehabilitation is not available in most Saudi hospitals. The causes that prevent hospitals in Saudi Arabia are still unclear and need more investigation. Thus, the aim of this study is to determine why pulmonary rehabilitation is not part of the usual COPD and respiratory disease management in Saudi Arabia. A cross-sectional study was conducted in Saudi Arabia with two questionnaires: the first for the healthcare providers and the second for pulmonary patients. About 349 healthcare providers completed the first questionnaire. The three highest barriers for establishing pulmonary rehabilitation in Saudi Arabia were shortage of healthcare providers (n = 183), followed by reduction of funds (n = 146) and lack of hospital room and capacity, respectively (n = 101 and n = 78). From the healthcare provider's point of view, the two highest barriers to preventing patients from attending pulmonary rehabilitation were transportation (n = 151), followed by lack of perceived benefits (n = 142). Almost half of healthcare providers (44%) intended to implement percentage a pulmonary rehabilitation program in Saudi Arabia. About 269 pulmonary patients filled out the second questionnaire. The three highest barriers from the patients' point of view to attend the pulmonary rehabilitation were being consistent with the program, lack of transportation, and wasting time in the program. The main barriers that prevent the implementation of a pulmonary rehabilitation program were lack of healthcare professionals and funds and low hospital capacity. The most barriers that prevent pulmonary patients from attending pulmonary rehabilitation programs were transportation challenges and lack of perceived benefits. About half of the healthcare providers intended to implement a pulmonary rehabilitation program in Saudi Arabia.

The National Association for Healthcare Quality (NAHQ ® ) has refreshed its Healthcare Quality Competency Framework ™ , ensuring health care professionals are equipped with essential skills to navigate the complexities of modern health care systems. Originally introduced in 2016, these competencies have served as the industry standard for defining the knowledge and capabilities required to advance quality and safety across health care environments. The framework emphasizes the necessity of competencies that enhance quality, safety, and strategic objectives within health care organizations. Through collaborative efforts involving subject matter experts and leadership interviews, the process addressed the present-day challenges faced by practitioners and health care entities. The framework revisions further defined each domain, consolidated overlapping competencies, and strengthened the integration of patient experience and engagement throughout all domains. The changes were implemented to support broader application of quality and safety competencies across all health care professions. The update emphasizes the importance of continuously refining competencies to adapt to the evolving demands of health care, which may help promote an environment that enhances patient outcomes. The framework serves as a central reference for health care professionals at all levels, nurturing effective collaboration across multidisciplinary teams, and promoting a culture of continuous learning and improvement. This article explores the evolution of the framework, the historical context of health care quality, and the importance of aligning standard competencies to elevate patient care standards in an increasingly complex environment.

Healthcare policy in the United Kingdom recognizes that teenagers and young adults (TYAs: 16-24 years at diagnosis) require specialist care. In England, Principal Treatment Centers (PTCs) exist, delivering enhanced care exclusively within the PTC or as 'joint care' with designated hospitals (DHs). Central to this is the TYA multidisciplinary team (MDT) and an outreach model coordinating care between hospitals. We previously reported similar outcomes regardless of care location. To compare TYA experiences of care with healthcare professionals' perspectives of the service they deliver. Mixed methods across England and Wales were used. The TYA-MDT identified TYAs who then received a postal invite to a cross-sectional survey capturing experiences of places of care, treatment, healthcare professional support (HCP), mental health, sexuality/fertility, clinical trials and care coordination. Comparisons were made based on exposure to care in a specialist TYA environment within 6 months of diagnosis: all-TYA-PTC (all care in the TYA-PTC, n = 70, 28%), no-TYA-PTC (no care in the TYA-PTC (n = 87, 35%): care delivered in a children/adult unit only), and joint care (care in a TYA-PTC and in a children's/adult unit, n = 91, 36%). HCP perspectives were captured by rapid ethnography. A total of 250/1056 (24%) TYAs participated. Overall, 200 (80%) rated their teams as excellent/good for helping them prepare for treatment. No evidence of significant differences existed between categories of care for proportions receiving support from key TYA-related professionals: TYA cancer nurse specialists (all-TYA-PTC n = 58, 91%; joint care n = 71, 88%; no-TYA-PTC n = 64, 82%) and social workers (all-TYA-PTC n = 30, 55%; joint care n = 36, 48%; no-TYA-PTC n = 28, 38%). A trend of diminishing support from youth support co-coordinators existed (all-TYA-PTC 63%; joint care 49%; no-TYA-PTC 40%, p = 0.069). This may explain why few differences in patient experiences existed across categories of care. Forty-nine HCPs participated. They were more critical in their interpretation of care, highlighting inequity in resources and challenges in some pathways and coordination. Similar access to age-appropriate support across care settings is likely to reflect recruitment methods. When TYAs are known to the MDT, age-appropriate care can be mobilized beyond TYA units, which could explain the equitable outcomes observed across different care locations in young people who responded to the survey. Nevertheless, gaps persist in communication and coordination, particularly within joint care models, and in the involvement of allied health professionals such as dieticians and physiotherapists, whose input is essential for rehabilitation and return to normal life. Strengthening these areas will require continued investment in workforce capacity and digital infrastructure to support genuinely coordinated, developmentally appropriate TYA cancer care.

As the effectiveness of artificial intelligence (AI) in enhancing various facets of healthcare delivery becomes more apparent, it is anticipated that AI will soon find its way into standard clinical practices, even in low and middle-income countries. The objective of this study was to create an action plan for integrating AI into medical education, research, and clinical practices utilizing the SWITCH model of change integrating both rational and emotional aspects. This exploratory qualitative study employed reflexive thematic analysis of semi-structured interviews and a co-design workshop, followed by the collaborative development of an action plan. The study was conducted from May 2023 to May 2024, at the Aga Khan University, Karachi, Pakistan. The development of an action plan was informed by interviews, co-design workshop, and discussions with diverse group of academic leaders, healthcare professionals and medical students. All interviews, workshop sessions, and planning meetings were audio recorded, transcribed verbatim, and anonymized. Data management was conducted manually using Microsoft Word and Excel. Findings after thematic analysis of the qualitative interviews and findings from the co-design workshop were gradually, and inductively transformed into the content for the action plan for integrating AI into healthcare. The content analysis of interviews identified following four themes: AI opportunities, apprehensions toward AI-induced changes, pushing change through leadership styles, and importance of AI related capacity building. During the workshop, participants discussed aligning current AI knowledge with future requirements by identifying clear instructions, emotional motivators, and environmental changes required on the path of AI integration. The proposed action plan conceptualized AI integration as multidimensional change process comprising three domains: strategic actions, change pathway enablement and environmental readiness and human motivation operationalized through twenty actionable components. The study findings provide a context specific conceptual action plan for healthcare professionals to integrate AI into medical education, clinical service and research, Future work should focus on pilot implementation and empirical validations of the action plan across diverse healthcare settings to assess feasibility, effectiveness and scalability.

Black adults experience diabetes complications and mortality in disproportionate rates in the United States, with barriers to care driven by factors such as limited access to quality healthcare, socioeconomic disparities, racial discrimination contributing to mistrust and health misperceptions, and social determinants of health such as food insecurity. Poor diabetes outcomes occur, in part due to insufficient access to novel diabetes medications and technologies, and low participation in diabetes management education programs. Within care teams across various healthcare settings, limited health literacy, and poor patient-provider communication, often influenced by implicit bias, further hinders effective diabetes management. Peer support, especially when integrated effectively into a multidisciplinary care team, is a promising approach to address these challenges. Peer supporters, individuals with shared lived experience and cultural backgrounds can foster trust, translate medical guidance in lay terms, and provide ongoing and sustained emotional, social, and tangible support. Peer-led interventions reduce diabetes distress and improve self-efficacy, medication adherence, and clinical outcomes, especially when tailored for Black adults. To effectively integrate peer supporters into care teams, defined roles, structured workflows, and strategically engaging them in patient care planning and team meetings is needed. Comprehensive and robust training, certifications, and continuing education ensure their competence, while maintaining role authenticity. Visibility within clinic and healthcare spaces, role clarity, administrative support, funding and continuous evaluation enhance the sustainability of peer supporters. Facilitators of their role include policy advocacy and funding avenues including Medicaid and Medicare reimbursements. Future efforts should focus on policy reforms to address structural inequities, support the expansion of peer supporters within care teams, including focused roles to thrive professionally, and establish sustainable models through participatory designs and robust evaluations. To address diabetes inequities in Black adults, culturally tailored peer support within multidisciplinary teams is critical, requiring collaborative engagement of healthcare systems, communities, and policy makers.

Cancer impacts patients, families, and healthcare systems. The journey of a cancer patient is marked by delays in diagnosis and treatment which exacerbate their physical and emotional burdens and significantly impact prognosis. This work aimed at establishing a structured cancer care pathway and assessing its effect on the timeliness of care and patient satisfaction and quality of life. This project comprised the development and implementation of a cancer care pathway at Al Hada Armed Forces Hospital (Taif, Saudi Arabia) which was assessed using timeline mapping of cancer care road maps and quasi-experimental pre- and post-evaluation design. The intervention incorporated a multidisciplinary team, nurse case managers as cancer navigators, engaging patients/families in the care journey, spreading awareness via social media for early diagnosis of cancer, and the use of virtual clinics for follow-up. This project, conducted from the January 2023 to August 2024, resulted in a remarkable reduction in the average treatment interval of cancer patients (114.3-59.6, P&#x2009;=&#x2009;.002), improvement in the average FACT-G7 (Functional Assessment of Cancer Therapy-General 7) score as a measure of patient quality of life (13.1-25.2 90&#x2009;days after discharge, P&#x2009;<&#x2009;.001), a positive impact on patient satisfaction (46%-95%, P&#x2009;=&#x2009;.013), and simulated cost savings of $10&#xa0;918&#xa0;600 (SAR 40&#xa0;944&#xa0;750) secondary to decreased hospital utilization and enhanced patient outcomes. This work highlights the crucial role of a multidisciplinary-cancer navigator approach to improving the oncology patient journey in terms of the timeliness of care and patient satisfaction and quality of life.

Integrated Youth Services (IYS) are increasingly implemented across Canada to address the intersecting mental, physical and social needs of young people, yet the integration of primary care within IYS remains under-documented. This article presents a qualitative, practice-based case study of Aire ouverte Montr&#xe9;al-M&#xe9;tro Berri, an urban IYS site where family physicians have been embedded as permanent members of a multidisciplinary team since 2022. Serving diverse youth aged 12-25 in a downtown context, this site offers an exemplar of integrating family medicine within a publicly funded youth service model. Drawing on an ongoing evaluation, the paper describes the implementation model, roles of family physicians and enabling organizational conditions, based on document analysis and perspectives from clinicians, managers and team members. Findings highlight how co-location, collaborative practices, shared care planning and flexible administrative arrangements supported the integration of family physicians. Reported impacts include timely access to primary and mental healthcare, improved care coordination, enhanced team capacity to manage risk and earlier engagement of youth who might otherwise not access services or access care through crisis-driven pathways. This case offers transferable insights into integrating family physicians within IYS, at a time of rapid national scaling and persistent challenges in youths' access to primary care.

Medical aid in dying (MAiD) is a practice that enables eligible individuals with a terminal, life-limiting illness to end their lives in a self-directed way. Multidisciplinary care teams play a vital role in facilitating discussions and patient decision making about MAiD in cancer care settings. However, little is known about how multidisciplinary care teams navigate MAiD discussions to provide effective, person-centered care. To identify the communication priorities and processes that cancer care clinicians believe are most critical for multidisciplinary care teams when discussing MAiD with patients who have cancer. Cross-sectional online survey. Multidisciplinary clinicians who participated in a communication training program supported by the National Cancer Institute (N&#x2009;=&#x2009;160) responded to five open-ended survey questions about communication considerations when working with a hypothetical patient with glioblastoma considering MAiD. Participants were presented with a case scenario and invited to describe how they would communicate with that patient as a member of a multidisciplinary team. A thematic analysis of responses using an iterative, inductive approach was conducted until saturation was reached. Four themes were identified as communication priorities and processes critical for multidisciplinary teams when discussing MAiD with cancer patients: (1) addressing complexity of MAiD in GBM; (2) thorough palliative care assessment; (3) strategies for clinicians and healthcare systems to optimize MAiD discussions; and (4) person-centered care that de-stigmatizes MAiD. Findings underscore the distinct complexity of MAiD discussions in oncology and highlight the need for tailored, person-centered approaches that go beyond standard end-of-life communication.

This study investigated whether job satisfaction and perceptions of respect for human rights among healthcare workers and patients improved in the post-COVID period compared to during the pandemic in 2021. Conducted in October 2025 across five outpatient hospital units in Sardinia, Italy, this cross-sectional survey involved 97 healthcare professionals and 129 patients recruited voluntarily based on service requirements attendance. The "Well-Being at Work and Respect for Human Rights" questionnaire (WWRR) was used to assess job satisfaction, organizational climate, respect for human rights, and perceived adequacy of resources. Chi-square tests were used to compare categorical variables, and one-way ANOVA with Bonferroni correction was used to analyze mean WWRR scores. Results indicated that, compared to 2021, healthcare workers' scores remained largely unchanged, reflecting modest satisfaction and ongoing concerns about organizational factors, staffing, and resource availability. Conversely, patients reported significantly higher satisfaction, particularly in areas of care quality, organizational efficiency, and respect for rights, with notable improvements in organizational satisfaction since 2021 (p&#x202f;<&#x202f;0.0001 for all comparisons). The greatest perception gap was observed in organizational aspects, where patient scores exceeded staff scores by nearly two points. Both groups continued to express dissatisfaction with resource adequacy. Additionally, staffing needs evolved, with increased demand for administrative support, security personnel, and multidisciplinary care providers. In 2025, compared to 2021, healthcare professionals reported a significantly greater need for administrative or HR managers (14.4% vs. 0%; p&#x202f;<&#x202f;0.0001), security personnel (5.1% vs. 0.6%; p&#x202f;=&#x202f;0.023), and an increase in all professional figures or multiple types of workers (14.4% vs. 0%; p&#x202f;<&#x202f;0.0001). Similarly, user responses showed a higher perceived need for administrative or staff-managing professionals (8.5% vs. 0%; p&#x202f;<&#x202f;0.0001) and occupational therapists, educators, or rehabilitation technicians (8.5% vs. 2.1%; p&#x202f;=&#x202f;0.017). While patient trust in healthcare services has largely rebounded in the post-pandemic period, this masks ongoing challenges in restoring healthcare workers' morale and satisfaction. Persistent systemic issues strain staff well-being and threaten the quality, efficiency, and sustainability of care. Bridging the gap between renewed patient confidence and the unresolved difficulties faced by healthcare workers must become a central priority for policymakers and administrators. By improving workplace conditions, fostering supportive organizational cultures, and investing in staff development and well-being, healthcare systems can secure a durable, post-crisis recovery.

Type 1 diabetes (T1D) is a lifelong condition typically diagnosed in childhood. Clinical practice guidelines recommend comprehensive multidisciplinary team (MDT)-based care led by paediatric endocrinologists. However, experiences and opinions of health professionals about the implementation of T1D MDTs in Australia are currently unknown. To describe health service teams caring for children and youth with T1D in Australia and to identify opportunities for service improvements from providers' perspectives. Mixed-methods study co-designed with clinicians and consumers, including a survey of clinic leaders and semi-structured interviews. Survey questions covered modes of care delivery, team composition and outreach. Interview transcripts were thematically analysed using a hybrid inductive/deductive approach. Thirty-two T1D services leaders completed the survey; 16 were from major cities and 16 were from regional/rural areas across all Australian states and territories. The services provided care for ~51% of all <19-year-olds living with T1D. T1D services were multidisciplinary and commonly included dieticians (n&#x2009;=&#x2009;29, 94%), nurse diabetes educators (n&#x2009;=&#x2009;22, 71%) and general paediatricians (n&#x2009;=&#x2009;21, 68%). Eight (29%) services had a dedicated psychologist. A quarter (25%) of regional/rural services had a paediatric endocrinologist compared with 100% of major city services (&#x3c7;2&#x2009;=&#x2009;18.355; p < 0.001). All services offered telehealth consultations. Interviews revealed that services placed high value on having established cohesive teams skilled in T1D. Service leaders had concerns regarding workforce capacity and shortages, limited access to psychologists, inequitable access to insulin pumps and limited links with general practitioners. This mixed-methods study is the first Australia-wide exploration of T1D models of care that describes care provision from the clinicians' perspectives. A need exists to address current gaps to achieve the recommended MDT models of care for T1D. Understanding existing models of care will be essential to determine the future impacts of changes in policies, therapies and demands on paediatric T1D services.

Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, requires consistent high-quality care to reduce variation in patient experience and improve outcomes. The IBD Standards previously published in 2009, 2013 and 2019 have provided an aspirational framework for best practice. Since 2019, two rounds of national benchmarking with patient engagement, healthcare professional (HCP) consultation and new evidence have highlighted areas for quality improvement (QI). We aimed to develop the 2026 IBD UK Standards of healthcare for adults and children, ensuring they reflect current and aspirational best practice and to support future QI initiatives. A multidisciplinary working group of 18 HCPs and 4 people with lived experience assessed the 59 IBD standards from 2019, categorising them as needing no change, minor or major amendment or deletion. New standards were developed through iterative drafting and consensus review, with feedback incorporated from 47 external HCPs and a patient workshop. The 2026 standards remain aspirational, structured across seven domains: the IBD service, pre-diagnosis, newly diagnosed, flare management, surgery, inpatient care and ongoing care. The 2026 IBD UK Standards comprise 60 statements: 6 unchanged from 2019, 48 updated, 7 deleted and 6 new. Key themes include multidisciplinary, coordinated care with defined leadership; age-appropriate transition pathways; timely referral from primary care, access to diagnostic tests, treatments and surgery; patient-centred care, including better communication, personalised care plans, shared decision-making and support for self-management; holistic assessment and management of physical, nutritional and psychological need; QI and audit supported by electronic systems; research participation and innovation. The 2026 IBD UK Standards provide a contemporary aspirational framework to drive consistent, high-quality, personalised care across the UK. They aim to reduce inequality, improve experience and outcomes through support for patient-centred shared decision-making, national benchmarking, service development, patient involvement and QI.

Cancer remains a major global public health problem. A key aspect of cancer care among survivors is sexual health. Cancer patients experience a range of sexual dysfunctions, including erectile dysfunction, vaginal dryness, dyspareunia, and reduced libido. Psychological symptoms such as anxiety, fatigue, and body image issues often exacerbate these problems, leading to impaired emotional and relational functioning. Despite their profound impact on quality of life, these concerns are not systematically addressed in routine cancer care. Oncosexology fits into this context, addressing the profound impact of cancer and its treatments on sexual health and intimacy. This narrative review provides an overview of the current evidence on sexual dysfunction in adult cancer patients, including psychosocial correlates and available interventions, to help clinicians understand the scope, challenges, and management strategies related to sexual health in oncology. The study was conducted by searching major scientific databases using search terms related to sexual health in cancer patients. Inclusion criteria were studies involving adult cancer patients, focusing on sexual health outcomes, therapeutic interventions, or care models, and published in peer-reviewed journals. Articles were selected based on the relevance of their findings and the quality of their presentation. Data published in the literature show that sexual dysfunctions are common in cancer populations and often co-occur with psychological problems such as anxiety, fatigue, and altered body image. Interventions range from pharmacological treatments to psychosocial and psychosexual counseling and multidisciplinary care models. The results also highlight that, despite the difficulties patients and healthcare providers encounter in communicating about these topics, multidisciplinary interventions can help reduce these dysfunctions. Integrating sexual health into cancer care is essential to promoting overall well-being and supporting long-term survival. Further high-quality, cancer-specific research is needed to support evidence-based, patient-centered interventions across diverse cancer populations.

The Victorian Allied Health Assistant Workforce Project delivered eighteen recommendations and accompanying resources supporting optimal utilization of allied health assistants (AHAs) across health, aged care, and disability sectors, in late 2022. Uptake of these evidence-based, ready-to-use resources in public health settings was yet to be evaluated. This was the impetus for an implementation coaching program, delivered to enhance application of the developed recommendations and resources. The aim of this project was to design, deliver and evaluate the impact of a pilot implementation coaching program to embed and put into practice the Victorian Allied health assistant workforce recommendations and resources in a public health setting. A non-experimental, pre- and post- mixed methods design was used to evaluate the outcomes of the tailored implementation coaching program. Measures included Organizational Readiness for Implementing Change (ORIC) scale survey, a bespoke workforce survey, the Goal Attainment Scale (GAS), post implementation interviews, and research team reflections on the process. Six Victorian public health organizations participated in the pilot implementation program. Findings indicate attainment of positive change in GAS scores following the sixteen-week implementation program (p=0.001), with pre-intervention ORIC scores an unreliable indicator of potential change success. Factors pertaining to size and geography of coaching participant (CP) pair's organization, local managerial or executive support of the change, experience and influence of the CPs and the project coaching team's (PCT) experience and credibility, all have impact on successful implementation coaching outcomes for the optimization of the AHA workforce in a Victorian context. This research provides new insights into the value of coaching to support the implementation of statewide workforce recommendations and resources in public health settings. This study provides a model for other organizations to consider and to reference when embarking on the process of implementing workforce recommendations and resources, directed at workforce optimization.

To evaluate the effect of individualized dietary guidance based on the prehabilitation concept on nutritional outcomes and quality of life (QoL) in patients with locally advanced gastric cancer (LAGC) undergoing surgery. This is a single-center randomized controlled trial (RCT). Patients who underwent radical gastrectomy following neoadjuvant therapy were included at the First Affiliated Hospital of Soochow University between January 2023 and October 2025 and randomly assigned to either the control group or the intervention group. Both groups received standard perioperative care. The control group received nutritional support, while the intervention group received individualized dietary guidance based on the Patient-Generated Subjective Global Assessment (PG-SGA) in combination with the prehabilitation concept. Nutritional parameters [albumin (Alb), prealbumin (PA), and hemoglobin (Hb)] and Prognostic Nutritional Index (PNI) were assessed at preoperative baseline and postoperative day 5-7 (before discharge). Quality of life (QoL) was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) at baseline and 3 months post-intervention. Postoperative safety and short-term outcomes, including length of stay (LOS), complications (classified by Clavien-Dindo grade), mortality, and readmission within 3 months, were also recorded. A total of 120 patients were eligible for the study between January 2023 and October 2025, of whom 72 were approached and enrolled (response rate: 60%), with 36 in each group. Compared with the control group, the intervention group showed significantly better nutritional indices after the intervention. In contrast, the control group showed significant decreases in PNI (52.64&#xb1;4.98 vs 43.28&#xb1;4.73), Alb (42.87&#xb1;4.73 vs 36.67&#xb1;6.28 g/L), PA (229.12&#xb1;39.43 vs 179.32&#xb1;32.72 mg/L), and Hb (134.92&#xb1;21.63 vs 113.54&#xb1;18.21 g/L), whereas no significant within-group changes were observed in the intervention group. EORTC QLQ-C30 scores for all functional domains (except cognitive functioning and financial difficulties) significantly increased, while scores for all symptom domains and single items (except financial difficulties) significantly decreased in both groups. Following the intervention, the intervention group demonstrated significantly higher PNI (51.21&#xb1;5.27 vs 43.28&#xb1;4.73, P<0.001) and peripheral blood levels of Alb (40.78&#xb1;6.91 vs 36.67&#xb1;6.28 g/L, P=0.01), PA (223.83&#xb1;37.32 vs 179.32&#xb1;32.72 mg/L, P<0.001), and Hb (129.93&#xb1;20.74 vs 113.54&#xb1;18.21 g/L, P=0.001) compared with the control group. Additionally, the intervention group had significantly higher scores in four of the five functional domains (physical function: 56.84&#xb1;4.37 vs 51.73&#xb1;4.02, P<0.001; emotional function: 57.63&#xb1;4.82 vs 53.82&#xb1;4.77, P=0.001; role function: 64.93&#xb1;3.76 vs 59.86&#xb1;4.39, P<0.001; social function: 63.91&#xb1;4.63 vs 59.64&#xb1;5.21, P<0.001) and significantly lower scores in all symptom domains and in five of the six single items (fatigue: 26.12&#xb1;3.65 vs 30.49&#xb1;3.87, P<0.001; appetite loss: 14.28&#xb1;3.02 vs 18.02&#xb1;3.29, P<0.001) than the control group. Regarding postoperative safety, no severe complications (Clavien-Dindo grade &#x2265;III) or deaths occurred in either group during hospitalization or the 3-month follow-up. The incidence of minor complications (Clavien-Dindo grade I-II) was similar between groups (3 vs 2). The intervention group had a numerically shorter postoperative LOS (7.6&#xb1;1.8 vs 8.2&#xb1;2.1 days), but the difference was not statistically significant. No readmissions within 3 months were recorded in either group. Prehabilitation-based individualized dietary guidance effectively improves short-term nutritional outcomes and enhances QoL in patients with LAGC undergoing surgery following neoadjuvant therapy. The intervention demonstrated a favorable safety profile, with no increase in complications, mortality, or readmissions. This single-center study provides preliminary evidence, and long-term outcomes (e.g. survival, readmission) were not evaluated.

The growing number of heart failure patients with cardiac implantable electronic devices (CIEDs) requires a systematic integration of telemonitoring data into a multidisciplinary care pathway. This review critically appraises the emerging evidence on the latest predictive algorithms embedded in CIEDs and delineates the pivotal roles of nurses/technicians remote-monitoring specialists and case managers as the operational interface between the patient and the clinical team. This review also proposes an organizational model that integrates the pacemaker/device clinic with the heart failure clinic, aiming to detect the subclinical phase of the disease, improve quality of life, reduce hospitalizations, and optimize healthcare system costs.

Oligometastatic cancer is characterised by a low volume of metastases to a small number of anatomical sites. However, evaluating the impact of metastases-directed therapies (MDTs) on overall survival or quality of life is often challenging. Current clinical trials use a wide range of primary endpoints that might not be validated or suited to MDT. To address this issue, we did a systematic review of international trial registries, alongside a Delphi consensus process involving 30 experts and five patient representatives. The aim was to identify preferred primary endpoints for MDT trials in oligometastatic disease, regardless of tumour type. Overall survival and progression-free survival were the most frequently used endpoints across the 121 comparative trials reviewed. Over four Delphi consensus rounds, overall survival had the highest level of agreement, although its limitations as a sole endpoint were emphasised. In addition to the widely used progression-free survival endpoint, polymetastatic progression-free survival and start-or-switch of systemic therapy-free survival also reached consensus, particularly for trials integrating systemic therapies. Both polymetastatic progression-free survival and systemic therapy-free survival permit repeat MDT without classifying it as treatment failure. Patient representatives highlighted the importance of time-to-deterioration of quality of life. This consensus supports overall survival as a primary endpoint and, in addition to progression-free survival, recommends polymetastatic progression-free survival and systemic therapy-free survival, especially in combination with systemic therapies. Adopting these endpoints will make MDT trials more relevant, comparable, and patient-centred, thereby empowering future clinical and policy decisions.

This study aims to investigate the implementation and outcomes of the Multidisciplinary Treatment (MDT) outpatient model in two pediatric tertiary hospitals, guided by the standardized "Three Fixed Elements and Four Dedicated Processes" operational plan. A retrospective analysis was conducted on the MDT outpatient services at the Children's Hospital of Fudan University and Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, from 2018 to 2025. During the study period, MDT outpatient services at two pediatric hospitals showed substantial growth, serving 15,813 patients with complex and rare conditions. Annual service volume increased from 304 to 5,174, and the number of MDT clinics expanded from 13 to 53, reflecting enhanced service capacity and efficiency. Specialty coverage developed in three phases, incorporating core clinical departments and integrated supportive services. Operational consistency was maintained through a "Three Fixed Elements and Four Dedicated Processes" framework, with performance monitored via a five-dimension management system tracking clinic volume, protocol standardization, expert participation, record quality, and patient satisfaction. The management model effectively enhances multidisciplinary focus, strengthens outpatient clinic construction, and facilitates continuous patient management and successful interdisciplinary collaboration. The study demonstrates the model's success in building a scalable, standardized, and patient-centered MDT system for pediatric complex care.

Abdominal pain, gastrointestinal symptoms and pelvic pain are common complaints of young females seeking healthcare. These symptoms can co-exist and become recurrent, impacting on quality of life. This study investigated the relationships between abdominal pain and gastrointestinal symptoms at 17-years of age and pelvic pain bothersomeness (PPB) at 22-years of age in young females. A cross-sectional observational study utilising 17 and 22-year Gen2 female data of the Raine Study (n&#x2009;=&#x2009;584). Abdominal pain and gastrointestinal symptoms at 17&#x2009;years were: frequency, consistency and/or pain of bowel movements, bloating, nausea, vomiting, analgesia for cramps and laxative use in the preceding 3&#x2009;months. At 22&#x2009;years, PPB was determined by the Urogenital Distress Inventory Short Form (UDI-6). Additional health-related variables were analysed to understand the symptom patterns of participants. 17-year-old females, with abdominal pain and gastrointestinal data who answered the UDI-6 for PPB (n&#x2009;=&#x2009;450); 347 (77%) were not bothered by PPB, 64 (14%) reported mild PPB and 39 (9%) reported moderate-severe PPB at 22-years (p&#x2009;=&#x2009;0.168). Symptoms of varied stool consistency, vomiting, nausea and laxative use, but not isolated abdominal pain, at 17-years were significantly associated with PPB at 22-years. Co-variants of depression, anxiety, bullying, living with a partner, poor sleep and smoking showed increased prevalence with severity of PPB. Gastrointestinal symptoms in adolescence were associated with pelvic pain bothersomeness (PPB) in young adulthood. Early detection of abdomino-pelvic symptoms may be useful to allow early, targeted and multi-disciplinary management to optimise physical and mental health outcomes.

According to the 2025 ESC/EACTS guidelines for the management of valvular heart disease, transcatheter tricuspid valve interventions (TTVI) have received a Class IIa recommendation (Level of Evidence: A) for the treatment of patients with severe symptomatic tricuspid regurgitation. However, in patients with severe left ventricular dysfunction (LVD) or right ventricular dysfunction (RVD) or precapillary pulmonary hypertension (pcPH), optimal medical therapy (OMT) is preferred because of the potential risk for futility. The aim of this study was to evaluate clinical and symptomatic outcomes in such "OMT candidate" patients. Using data from EuroTR (European Registry of Transcatheter Repair for Tricuspid Regurgitation), guideline-based thresholds for LVD, RVD, and pcPH were applied to patients undergoing tricuspid valve transcatheter edge-to-edge repair (T-TEER). Patients meeting &#x2265;1 exclusion criterion ("OMT candidates") were compared with those meeting current recommendations ("TTVI appropriate") regarding NYHA functional class improvement and 2-year survival free from heart failure hospitalization (HFH). Among 1,626 T-TEER patients, 213 (13.1%) met &#x2265;1 exclusion criterion (4.2% of those with LVD, 6.8% of those with RVD, and 3.6% of those with pcPH). Severe LVD, RVD, and pcPH were each associated with significantly lower 1-year HFH-free survival (LVD, 54.6% vs 72.9% [P < 0.001]; RVD, 59.0% vs 73.2% [P = 0.003]; pcPH, 56.2% vs 73.4% [P = 0.021]; median survival follow-up 446 days [Q1-Q3: 192-805 days]). Despite higher NYHA functional class at baseline and follow-up, the rate of &#x2265;1-class improvement was comparable across subgroups (LVD, 51.1% vs 59.4% [P = 0.25]; RVD, 59.7% vs 59.0% [P = 0.90]; pcPH, 51.3% vs 59.4% [P = 0.31]). Overall, "OMT candidates" had lower HFH-free survival than "TTVI-appropriate" patients (58.7% vs 74.3%; P < 0.001) but showed comparable symptomatic relief (&#x2265;1 NYHA functional class in 56.2% vs 59.5%; P = 0.68). T-TEER may provide symptomatic benefit in selected high-risk patients with severe LVD, RVD, or pcPH. In the absence of randomized evidence, multidisciplinary evaluation at experienced heart valve centers remains essential to balance potential benefit against procedural futility. Further studies are warranted to refine patient selection and optimize outcomes in this challenging cohort.