Medicine Team Research Articles

An Integrative Pause for Healthcare Personnel Challenged by the War: A Personal Perspective.

As the war in the Middle East intensifies, the support and well-being of healthcare practitioners (HCPs) become paramount to sustaining an effective healthcare system capable of serving the diverse Israeli population. In collaboration with the integrative medicine (IM) team, we initiated a treatment intervention with the goal to relieve war-related HCPs concerns. This trilogy of narratives highlights the multifaceted experiences of HCPs in Israel during times of conflict. The director of internal medicine ward with his conventional medical and leadership expertise, provides stability and order. The IM practitioner offers holistic healing and care. The nurse reflects on her experience of being cared for. These narratives illustrate the adaptability and resilience of healthcare professionals who navigate their roles with dedication and compassion, ensuring that amidst the strife, the human spirit remains cared for and supported.

Improving access to syphilis screening among unhoused people in Yolo County

Background: This study aimed to increase syphilis screening rates amongst unhoused residents of Yolo County, California, through the implementation of plan-do-study-act (PDSA) cycles. Yolo County has a strategic goal to eliminate congenital syphilis cases. Homelessness is a known risk factor for syphilis. Methods: The primary researcher was embedded in a street medicine team. Using quality improvement tools like stakeholder interviews, workflow diagrams, and best practices from literature, we outlined the team's workflow for syphilis screening and developed ideas to improve uptake and expand capacity. The most effective cycle implemented gift card incentives for syphilis screening. During the patient intake we offered the option to receive a syphilis test, informing the patient of the gift card incentive. Results: Prior to gift card incentives, the team screened 1.6 patients on average per clinic for a total of 30 patients screened in April to June of 2022. After the gift card incentive was implemented, the team screened 3.0 patients on average per clinic, screening a total of 223 patients from July 2022 to May 2023. The intervention produced an 87.5% increase in screening rates (P=0.0094). The data showed a significant increase in syphilis testing upon implementing the gift card incentive program. Conclusion: These findings contribute to evidence supporting the use of patient incentives for public health prevention measures. This model could be applied to other populations to increase health screening participation. More research is needed on the effect of gift card incentives on confirmatory testing and treatment rates for syphilis.

Best Patient Care Practices for Administering PSMA-Targeted Radiopharmaceutical Therapy.

Optimal patient management protocols for metastatic castration-resistant prostate cancer (mCRPC) are poorly defined and even further complexified with new therapy approvals, such as radiopharmaceuticals. The prostate-specific membrane antigen (PSMA)-targeted agent 177Lu vipivotide tetraxetan ([177Lu]Lu-PSMA-617), approved after the phase III VISION study, presents physicians with additional aspects of patient management, including specific adverse event (AE) monitoring and management, as well as radiation safety. Drawing on our experience as VISION study investigators, here we provide guidance on best practices for delivering PSMA-targeted radiopharmaceutical therapy (RPT) to patients with mCRPC. After a comprehensive review of published evidence and guidelines on RPT management in prostate cancer, we identified educational gaps in managing the radiation safety and AEs associated with [177Lu]Lu-PSMA-617. Our results showed that providing sufficient education on AEs (e.g., fatigue and dry mouth) and radiation safety principles is key to effective delivery and management of patient expectations. Patient counseling by health care professionals, across disciplines, is a cornerstone of optimal patient management during PSMA-targeted RPT. Multidisciplinary collaboration is crucial, and physicians must adhere to radiation safety protocols and counsel patients on radiation safety considerations. Treatment with [177Lu]Lu-PSMA-617 is generally well tolerated; however, additional interventions may be required, such as dosing modification, medications, or transfusions. Urinary incontinence can be challenging in the context of radiation safety. Multidisciplinary collaboration between medical oncologists and nuclear medicine teams ensures that patients are monitored and managed safely and efficiently. In clinical practice, the benefit-to-risk ratio should always be evaluated on a case-by-case basis.

Clinical features and outcomes of patients diagnosed with diabetic ketoacidosis (DKA) who were hospitalized for conditions outside of internal medicine

AimsTo assess the clinical features and outcomes of patients diagnosed with DKA who were hospitalized for conditions outside of internal medicine. MethodsRetrospective analysis of admissions for DKA in adult patients between 2005 and 2022 at a tertiary hospital in Israel. Patients with DKA were stratified into medical vs non-medical groups, the primary outcome was in-hospital mortality. Results429 patients were included in the study, 385 patients (89.7 %) were treated by an internal medicine team, while 44 patients (10.3 %) were hospitalized with surgical or obstetrical conditions. Patients in the non-internal medicine group were older (52 ± 18.9 vs 43.6 ± 20.4, p < 0.005) and had higher rates of diabetes complications such as chronic ischemic heart disease (20.5 % vs. 4.2 %, p < 0.0001) and chronic kidney disease (50 % vs. 3.4 %, p < 0.001). Glucose level on presentation was lower for non-internal medicine patients (398 ± 221 mg/dL vs 551 ± 180 mg/dL) and outcomes of mechanical ventilation and length of hospitalization were more severe (29.5 % vs. 6 %, p < 0.001 and 8.0 vs. 3.0, p < 0.001). Multivariate analysis demonstrated that composite outcome of in-hospital mortality, ICU admission and longer hospitalization was more likely in the non-internal medicine group (OR 3.99, CI 1.89–8.4, p < 0.001). ConclusionDKA is a universal pathology that concerns various medical fields. It is essential for every clinician to be familiar with this condition. Patients diagnosed with DKA who were hospitalized for conditions outside of internal medicine may be at high risk and may present with lower glycemic levels. Future research is needed to characterize the unique features of subgroups of patients with DKA.

Assessing the effects of interprofessional education by hospital pharmacists on pharmaceutical students using a self-evaluation scale

BackgroundUnderstanding the roles and competencies of professions outside of one’s specialty is essential for providing efficient healthcare. However, it is difficult for medical professionals to understand the roles and competencies of other related professions while performing their duties. This study examined the impact of clinical practice-based interprofessional education (IPE) on pharmacy students, who are future medical professionals.MethodsSixty-eight pharmaceutical students undergoing clinical practice were divided into non-IPE or IPE groups, with the IPE group attending an educational program with medical students conducted by doctors, pharmacists, and teachers during the clinical practice period. The effect was evaluated through a group survey using self-administered questionnaires focusing on contributing to multidisciplinary team medicine based on the Readiness for Interprofessional Learning Scale. The survey included specific behavioral objectives (SBOs), the Readiness for Interpersonal Learning Scale (RIPLS), and Kikuchi’s Scale of Social Skills (KiSS-18).ResultsRegardless of group, SBOs [non-IPE: 3.2, 95% CI (2.6–3.8), p < 0.001; IPE: 3.7, 95% CI (2.5–4.9), p < 0.001] and social skills [non-IPE: 4.0, 95% CI (2.5–6.1), p < 0.001; IPE: 6.7 95% CI (3.0–10.4), p < 0.001] showed improvement after the clinical practice. In RIPLS Factor 3, pharmacy students with IPE awareness scored significantly higher by 1.5 points [95% CI (0.2–2.8), p = 0.025] post-practice than those without IPE awareness.ConclusionsThis study suggests that IPE for students during clinical practice could enhance their expertise in multidisciplinary medicine and facilitate the development of seamless team care in the future.Trial registrationThis study was retrospectively registered and conducted in compliance with the “Ethical Guidelines for Medical Research Involving Human Subjects” and was approved by The Ethics Committee of Tokushima University Hospital (approval number: 3544).

To Print or Not to Print - Sustainable Practice in Geriatric Integrated Care Clinics

Abstract Background The Comprehensive Geriatric Assessment (CGA) is a cornerstone of geriatric medicine and is frequently carried out in integrated care clinics using a paper document (1). The expansion of integrated care services occurs alongside climate change, an increasingly challenging public health crisis at a local and national level (2). Paper waste is a contributor to deforestation and carbon emissions. We aimed to assess the environmental impact of paper use within our geriatric integrated care service. Methods 12 months of Geriatric Integrated Care attendances were included between 1st January 2023 to 1st January 2024. We measured the number of CGAs performed and A4 pages used in documentation. Environmental impact was evaluated based on carbon emissions per A4 page (3). Results A CGA was completed on 780 patients in a 12-month period which included in-hospital, frailty at the front door and 2 community specialist teams' assessments. This resulted in 11,700 pages of A4 paper in documentation. Estimated carbon emissions are 70.2kg CO2 emissions for the 12-month period. Extrapolating this solely to the 32 ICPOP teams in geriatric medicine in Ireland it would result in the equivalent of 22 trees per year, emitting 1,123.2 Kg of CO2 emissions per year from these assessments alone or equivalent to driving 8028.6km (4). Conclusion The benefits for patients and staff of integrated digital healthcare records are well established. The environmental impact of how we provide healthcare is not. Paperless solutions are required for both patient safety, seamless record keeping and environmental sustainability in keeping with UN sustainable development goals.

Goals of Care Discussions Among Patients Who Suffer Cardiac Arrest

Abstract Background Outcomes following in-hospital cardiac arrest remain poor despite advances in resuscitation techniques. Establishing “goals of care” is crucial to optimizing patient care and avoiding burdensome interventions in those who are unlikely to benefit from resuscitation. Doctors often avoid discussions regarding ‘goals of care’ with patients in whom cardiac arrest is not deemed likely at the time of admission. Methods All cardiac arrest team activations for non-pregnant, adult inpatients on medical and surgical wards at our institution from December 2022 – June 2023 were prospectively analysed. Qualitative analysis of inpatient charts was performed to assess; incidence of cardiac arrest, demographic and clinical data, and the degree to which discussions regarding escalation of care had taken place. Results 66 cardiac arrest team activations were screened, of which 23 calls were included for analysis. The estimated incidence of cardiac arrest was 1.11-1.67 events per 1,000 patient discharges. 18 patients (78.2%) were under the care of general medicine or geriatric teams at the time of arrest call. 12 (52%) patients were older than 70 and 4 (17%) were older than 80. Falls were the most common reason for admission (22.7%) among patients for whom the cardiac arrest team was activated. 2 patients (12.5%) with confirmed cardiac arrest survived to hospital discharge. Discussions regarding goals of care were documented for 8/23 patients (34.7%). Conclusion Cardiac arrests were uncommon in our institution. Discussions regarding goals of care were documented in only a third of cases, possibly because many patients presented with issues not typically associated with a risk of subsequent arrest. Given the low survival rates to discharge, routine discussion of goals of care should be considered at the point of admission in all patients who are unlikely to benefit from resuscitation, regardless of the presenting complaint.

Burn Care in the Street: A Survey of the Current Landscape of Burn Care Provided by Street Medicine Teams.

People experiencing homelessness are at increased risk for serious burn injuries and face additional barriers to care such as inability to perform wound care and difficulty with follow-up. Although not burn-specific, street medicine programs provide direct medical care to people experiencing unsheltered homelessness in their own environment and may be well positioned to bridge this gap in burn care for this population. We conducted a cross-sectional survey to characterize the burn care experience of street medicine teams with providing burn care for people experiencing homelessness. The 60 respondents included 18 (30%) physicians, 15 (25%) nurse practitioners or physician assistants, 15 (25%) registered nurses, and 6 (10%) medical students, and 6 (10%) other team members. The most common reported barriers to care were prior negative experiences with emergency departments, and transportation to burn centers. There was regional variability in frequency of providing burn care, which was reflected in respondent comfort with assessing and treating burns. Burns were most often dressed with daily dressings such as a non-adherent dressing over silver sulfadiazine or bacitracin. Silver-based contact dressings were rarely used. Street medicine teams in the United States are treating burn injuries among people experiencing homelessness, though management practices and experience treating burns was variable. As street medicine programs continue to grow, burn-related education, training, and connections to local burn centers for team members is important. Through strengthened partnerships between burn centers and street medicine teams, these programs may be well positioned to bridge the gap in burn care for people experiencing homelessness.

ThP7.16 - Multidisciplinary management of elderly patients undergoing emergency laparotomy: an audit at a small district general hospital

Abstract Aims The National Emergency Laparotomy Audit (NELA) suggests early involvement of the multidisciplinary geriatrician team for preoperative care of elderly patients aged over 80, or 65 and frail. Methods we audited our unit against the NELA guidelines for elderly patients. We looked at all emergency laparotomies carried out at our hospital over a 6 month period against the audit standards as set out by NELA. Results A total of 55 laparotomies were carried out in 6 months. 17 patients fit the criteria of patients needing early geriatrician involvement. Of the 34 patients aged 65 and above, 22 patients had their frailty score recorded in the notes (64%). Less than 10% of patients had early geriatrician input. Overall, six patients (11%) died within 30 days of their initial operation, and all were aged over 65. Conclusions we must take the perioperative care of elderly patients seriously and work with the Geriatric Medicine teams for early perioperative review, including accurate clinical frailty score assessments. We will initiate a project with the Geriatric Medicine department to implement an Elderly Laparotomy Perioperative Pathway for these patients.

Perceptions and Behaviors of Nurses and Physicians During Bedside Rounds in Medical-Surgical Units.

Communication and collaboration among health care professionals during bedside rounds improve patient outcomes and nurses' and physicians' satisfaction. To determine barriers to nurse-physician communication during bedside rounds and identify opportunities to improve nurse-physician collaboration at an academic medical center. A survey with Likert-scale and open-ended questions regarding professional attitudes toward nurse-physician communication was administered to 220 nurses and physicians in medical-surgical units to assess perceptions of participation in bedside rounds. After the survey was given, observational data from 1007 bedside rounds were collected via a standardized data collection tool. Nurses and physicians perceived different barriers to including nurses in bedside rounds. Nurses most often cited being unaware that bedside rounds were occurring (38 of 46 nurses [83%]); physicians most often cited nurse unavailability (43 of 52 physicians [83%]). Of 1007 observed rounds, 602 (60%) involved in-person contact of nurses and physicians; 418 (69%) of the 602 included a conversation between the nurse and physician about the nurse's concerns. Of 355 rounds with no in-person or telephone contact between nurses and physicians, the medicine team did not contact the nurse in 284 (80%). Conversations about nurses' concerns occurred more often after physician-initiated contacts (73% of 369 contacts) and nurse-initiated contacts (74% of 93 contacts) than after chance encounters (57% of 140 contacts). Initiating discussions of care between nurses and physicians and discussing nurses' concerns during bedside rounds have multiple benefits.

Platform Design for Optical Screening and Conditioning for Injury Resilience.

Musculoskeletal injuries (MSKIs) among active duty soldiers result in more than 10 million limited duty days each year and account for more than 70% of the medically nondeployable population. Overuse injuries in lower limbs from running, foot marching long distances with heavy loads, and lifting heavy objects are the most common types of injuries in the military. Physical training and rehabilitation exercises for greater resiliency through aerobic, muscle strength, endurance, and agility conditioning programs can prevent or reduce the effects of MSKIs if Soldiers adhere to proper biomechanics and training techniques. We are introducing a three-dimensional (3D) camera-based platform for Optical Screening and Conditioning for Injury Resilience (OSCIR) that is designed to identify and correct high-risk movement patterns based on quantifiable biomechanical measurements in clinical or field settings. Our goal is to improve resilience to MSKI by offering greater access to quality of movement skills in warfighters through an autonomous device that can be used in Sports Medicine and Reconditioning Team (SMART) clinics and High-Intensity Tactical Training (HITT) sites. OSCIR fuses four pairs of Kinect Azure cameras into a concise footprint to achieve suitable sampling rates and an unobstructed field of view for accurate dynamic movement tracking using a custom point cloud solution. We designed a unique multistage 3D joint tracking algorithm architecture to methodically isolate the human body point cloud from the background, identify individual limb segments, and perform iterative joint optimization at the global and local joint levels. We evaluated the feasibility of our prototype system among N = 12 control participants (6 M/6 F; 21-37 years) in compliance with the Western Institutional Review Board (Tracking #20225920, approved on November 4, 2022). Five task-specific MSKI outcome metrics identified by end-user physical therapists and athletic trainers as indicators for movement quality were assessed across 7 lower-extremity exercises derived from standardized MSK assessment/conditioning batteries used in the military. Data were recorded concurrently by OSCIR and a reference standard Vicon motion capture system for validating system accuracy. Task-specific MSKI indicators for knee flexion and hip flexion range of motion achieved an average error of 4.05 ± 2.34°, while 3D position-based postural outcomes of left-right foot distance, left-right hand distance, and step length obtained mean absolute errors of 2.58 ± 2.30 cm. Results support the feasibility of our system in achieving outcomes that are comparable to currently accepted laboratory standards. Our study describes the integration process for a 3D camera-based clinical system for MSKI conditioning and rehabilitation. The impact of our system will enable key stakeholders in the military to manage MSKIs in warfighters by automating key assessment and rehabilitation test batteries; making tests more readily accessible, and interpretations more accurate by providing objective biomechanical measures. OSCIR is undergoing turn-key design features to serve as a screening tool for warfighters to readily assess susceptibility to MSKI or as a training platform to help guide exercise techniques to achieve resiliency against future injuries.

Implementation of the Acute InpatientMedicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) in rural Veterans Health Administration hospitals: A mixed methods evaluation protocol.

Few rural hospital medicine programs include workforce development training that provides social and professional support for interdisciplinary teams. Even fewer include training that creates supportive learning environments that result in higher staff satisfaction, lower burnout, and reduced turnover. The Acute Inpatient Medicine-High Reliability, Learning Environment, and Workforce Development Initiative (AIM-HI) aims to create supportive learning environments in Veterans Health Administration (VA) rural hospital medicine teams. AIM-HI is a type II hybrid implementation study utilizing a convergent mixed methods approach to evaluate the Relational Playbook, a workforce development intervention, and three implementation strategies: behavioral nudges, learning and leadership collaboratives, and leadership coaching. AIM-HI implementation will occur in waves, enrolling additional hospitals every 12 months. In the first wave, AIM-HI will be implemented at three tertiary VA hospitals that treat at least 1000 rural Veterans annually and have an active inpatient hospital medicine program. The primary outcomes in year 1 will be the acceptability, appropriateness, and feasibility of AIM-HI assessed through participant surveys and interviews. In subsequent years, trends in the learning environment, job satisfaction, burnout, and turnover scores will be assessed using a linear mixed-effect model. The anticipated impact of AIM-HI is to evaluate the utility of the implementation strategies and assess trends in Playbook intervention outcomes. The Playbook has strong face validity; however, before large-scale adoption across the VA enterprise, it is essential to establish the acceptability, appropriateness, and feasibility of the Playbook and implementation strategies, as well as to gather data on AIM-HI effectiveness.

The impact of comorbidities and functional status on outcomes in the older adult emergency general surgery patient

BackgroundThe aim of this study is to quantify the relative contribution of comorbidities and pre-operative functional status on outcomes in geriatric emergency general surgery (EGS) patients. MethodsThis is a retrospective study of older-adult EGS patients at an academic medical center between 2017 and 2018. Patients ≥65 years were included. The primary outcomes examined were 30-day mortality, 30-day morbidity, and length of stay (LOS). Results734 patients were included. The mean age was 76, and 48.9 ​% received non-operative management. The median LOS was 6.8 days; 11.8 ​% of patients died within 30 days, and 40.6 ​% developed morbidities. Lacking capacity to consent on admission was independently associated with 30-day mortality (OR: 2.63, [1.32–5.25], p ​= ​0.006). Comorbidities associated with developing morbidity were CVA with neurologic deficit (OR: 2.29, [1.20–4.36], p ​= ​0.012), CHF (OR: 2.60, [1.64–4.11], p ​< ​0.001), in addition to pre-operative delirium (OR: 3.42, [1.43–8.14], p ​= ​0.006). ConclusionsA significant contribution to outcomes is determined by pre-admission comorbidities and cognitive and functional status. Opportunities exist for collaboration between Acute Care Surgery and geriatric medicine teams for the optimization of comorbidities.

2317 Geriatrician-led perioperative services: an example of value-based care

Abstract Background Perioperative services must adapt to the needs of an increasingly older surgical population. Perioperative medicine for Older People undergoing Surgery (POPS) services integrate geriatric medicine teams into surgical pathways to provide quality and cost-effective medical care. This project aims to examine value-based outcomes (clinical and financial impact) of embedding a POPS service at a district general hospital. Methods Following a period of implementation on an acute Trauma and Orthopaedic (T&amp;O) ward, a two-week pilot was undertaken. All emergency fragility fracture admissions aged over 65 years with Clinical Frailty Scores (CFS) of ≥5 were included. Patients with hip fractures were excluded. The POPS service provided medical consultation, medicine rationalisation, proactive treatment escalation planning and shared decision making, as well as leading multidisciplinary team meetings. Outcome metrics: geriatric medicine consults, medical emergency team (MET)/cardiac arrest calls, staff/patient satisfaction and clinical coding. The REDUCE trial cost calculator was used to estimate savings. Results 35 patients were included, mean age 84 years, mean CFS score 7. Ward MET calls and cardiac arrest calls were reduced from a weekly average of 2.5 to 0, and weekly referrals to geriatric medicine reduced from 3 to 0. Experience-based design surveys identified thematic improvements relating to leadership, communication, dignity and respect. Improved quality of documentation resulted in the comorbidity score tariff increasing from £3325 to £6096 per patient. For services introduced by POPS including Comprehensive Geriatric Assessment and delirium assessments, the REDUCE trial cost calculator estimated an additional saving of £2926 per patient totalling hospital savings of £2 million per year (for an estimated 700 patients per year). Conclusion Implementation of a POPS service at a district general hospital can lead to cost savings, improved patient and staff experience, and improved clinical outcomes within a sustainable workforce model.

Creating a postgraduate syllabus for a team care diploma examination: a Delphi study

ObjectivesThere is no agreed standard assessment of the minimum knowledge and skills that are required to provide healthcare to participants in individual or team sports. This study aims to develop...

A Reliability Study of the Load Distribution Percentage While Walking Using Curalgia Feet Sx Smart Insoles.

Background Gait analysis has evolved through many years of research. Many methods are used to analyze the gait of a subject. Recent times have showna high demand for wearable sensor-based insoles integrated with smartphone-based devices used for gait analysis due to ease of use. This study utilized Curalgia Feet Sx Smart Insoles and its software toolset, Gait Analysis+, designed and manufactured in India making it an accessible and cost-effective option. The Curalgia Feet Sx Smart Insoles allow for a broad range of biofeedback-based rehabilitation and recovery training for several patients and have many applications, such as sports performance enhancement and neurological disorder rehab (e.g., brain stroke rehab). The system also significantly delays the onset of neurodegenerative illnesses by providing balance and proprioceptive training. The smart insole can help the athlete, the coach, and the sports medicine team get the on-field data in real-time, which will help them understand if any technical or biomechanical alterations are required. This may help in performance enhancement. This study aimed to determine the interrater reliability of the load distribution percentage parameter of the Curalgia Feet Sx Smart Insole for both feet while walking in a controlled setting. Methodology A total of 120 subjects were enrolled in the study. In total, 90 subjects were randomly selected using Research Randomizer which included male and female students and staff at Sardar Bhagwan Singh University. The subjects were asked to come to the research lab of the physiotherapy department wearing their sports shoes. Curalgia Feet Sx insoles were inserted into the shoe firmly to fit properly. Two assessors took two readings after the smart insole was connected to the smartphone-based application, GaitAnalysis+, via Bluetooth. The dynamic analysis option was selected, and each subject's analysis was done one after another with a desirable break in between. Each subject walked for three minutes at their normal speed after pressing "Start Analysis." At the three-minute mark, the subjects were asked to press "Stop Analysis" and the investigator downloaded the report on the smartphone. The data collected was compiled as the cumulative weight in kg (load distribution) borne and the % weight (load distribution %) borneby each foot for the duration of the walk. Statistical analysis was done using Karl Pearson's test and interclass correlation calculation. Results Assessor 1 and Assessor 2 collected readings for the left foot as "L" and the right foot as "R." Assessor 1 readings were L1-R1 for load distribution and L1% and R1% for load distribution %. Assessor 2 readings were L2-R2 for load distribution and L2% and R2% for load distribution %. The r value (correlation coefficient) was calculated using the load distribution. The mean value of L1 was 337.46 (SD=94.16). The mean L2 was 313.6 (SD=104.40). The R1 mean was 229.03 (SD=112.88), and the R2 mean was 233.011 (SD=79.84). The r was 0.7171 for the left foot and 0.7502 for the right foot, suggesting an excellent correlation. The ICC was calculated for load distribution %. The means of L1% was 55.94, L2% was 57.59, R1% was 44.06, and R2% was 42.41. The ICC was found to be 0.91 for both feet, suggesting high interrater reliability for the tested parameter. Conclusions The findings confirmed that the Curalgia Feet Sx Smart Insoles presented good interrater reliability for the load distribution % parameter.

Phenotypic Plasticity and Cancer: A System Biology Perspective.

Epithelial-to-mesenchymal transition (EMT) is a major axis of phenotypic plasticity not only in diseased conditions such as cancer metastasis and fibrosis but also during normal development and wound healing. Yet-another important axis of plasticity with metastatic implications includes the cancer stem cell (CSCs) and non-CSC transitions. However, in both processes, epithelial (E) and mesenchymal (M) phenotypes are not merely binary states. Cancer cells acquire a spectrum of phenotypes with traits, properties, and markers of both E and M phenotypes, giving rise to intermediary hybrid (E/M) phenotypes. E/M cells play an important role in tumor initiation, metastasis, and disease progression in multiple cancers. Furthermore, the hybrid phenotypes also play a major role in causing therapeutic resistance in cancer. Here, we discuss how a systems biology perspective on the problem, which is implicit in the 'Team Medicine' approach outlined in the theme of this Special Issue of The Journal of Clinical Medicine and includes an interdisciplinary team of experts, is more likely to shed new light on EMT in cancer and help us to identify novel therapeutics and strategies to target phenotypic plasticity in cancer.

The Quality of Family Medicine Team Conferences Through the Lens of a Director: An Autoethnography.

Introduction In rural medical settings, team conferences are essential for effective patient care, especially given the challenges of limited resources and personnel. These conferences promote collaborative discussions on patient management and serve as vital educational sessions. This study explores the dynamics and efficacy of team conferences in the family medicine department of a rural hospital to optimize patient care and educational outcomes. Methods This qualitative study used autoethnography at Unnan City Hospital, Unnan, Japan. Data collection included semi-structured interviews, direct observation, reflective field notes, and informal conversations with medical students, junior residents, and general medicine trainees. The focus was on conference interactions, educational content, and operational challenges. Data analysis involved coding and theming, with ongoing discussions among researchers and participants to refine findings. Results Three key themes emerged. First, patient outcomes suffered from a lack of professional awareness. Second, mutual understanding and individual autonomy enhanced team quality. Third, team healthcare quality improved through diverse and inclusive learning experiences. Effective facilitation, structured time management, and integrating practical bedside learning with theoretical discussions were crucial for optimizing team conferences. Psychological safety, respect for individual differences, and maintaining motivation were essential for productive team interactions. Conclusion The study highlights the importance of effective facilitation, time management, and integrating practical and theoretical learning in enhancing team conferences in rural medical settings. Psychological safety and mutual respect are vital for fostering a collaborative and motivated team environment. Addressing these factors can improve patient care and educational experiences. Future research should include diverse settings and quantitative measures to validate and refine these insights, enhancing team conferences in rural healthcare environments.

Quality Improvement Study Using a Machine Learning Mortality Risk Prediction Model Notification System on Advance Care Planning in High-Risk Patients

Background: Advance care planning (ACP) is an important aspect of patient care that is underutilized. Machine learning (ML) models can help identify patients appropriate for ACP. The objective was to evaluate the impact of using provider notifications based on an ML model on the rate of ACP documentation and patient outcomes. Methods: This was a pre-post QI intervention study at a tertiary academic hospital. Adult patients admitted to general medicine teams identified to be at elevated risk of mortality using an ML model were included in the study. The intervention consisted of notifying a provider by email and page for a patient identified by the ML model. Results: A total of 479 encounters were analyzed of which 282 encounters occurred post-intervention. The covariate-adjusted proportion of higher-risk patients with documented ACP rose from 6.0% at baseline to 56.5% (Risk Ratio (RR)= 9.42, 95% CI: 4.90 - 18.11). Patients with ACP were more than twice as likely to have code status reduced when ACP was documented (29.0% vs. 10.8% RR=2.69, 95% CI: 1.64 – 4.27). Additionally, patients with ACP had twice the odds of hospice referral (22.2% vs. 12.6% Odds Ratio=2.16, 95% CI: 1.16 – 4.01). However, patients with ACP documented had a longer mean LOS (9.7 vs. 7.6 days, Event time ratio = 1.29, 95% CI: 1.10 - 1.53). Conclusion: Provider notifications using an ML model can lead to an increase in completion of ACP documentation by frontline clinicians in the inpatient setting.

Relationship of Demographic Profile to Satisfaction in Interprofessional Collaboration among Medical-Surgical Ward Nurses in Selected Hospitals of Shandong, China: A Cross-Sectional Study

With the spread of the concept of team medicine, active nurse-doctor collaboration is closely related to nursing quality. Nursing standards recognize that collaborative practice is a necessary condition for high-quality patient care, but many nurses are often reluctant to participate in interprofessional teams, indicating that challenges in nurse-doctor collaboration still exist. This study aimed to investigate the relationship between demographic data and nurse interprofessional satisfaction of medical and surgical nurses in tertiary hospitals in Shandong Province, and to provide a reference direction for improving teamwork. Methods: The research method was a cross-sectional study. Medical and surgical nurses in three tertiary hospitals in Shandong Province were surveyed. Medical and surgical nurses who were officially registered in the hospital and had been engaged in internal medicine or surgery for at least one year were selected. They were aged 18 to 45 years. The researchers used SPSS software to analyze the data, and descriptive statistics (frequency percentage distribution, mean score, and standard deviation) were used to present the satisfaction scores. If the data did not follow a normal distribution, nonparametric tests were used. Results: The average scores of the interprofessional collaboration satisfaction scale for the participating nurses were: "overall expectation" 2.67; "perception dimension of professional collaboration" 3.78; "The overall relationship satisfaction of professional cooperation" 3.83; "Communication and tolerance of interprofessional collaboration" 3.80; "Equality of interprofessional collaboration" 3.81; "Satisfaction with interprofessional collaboration" 2.98. The results of non-parametric tests showed that there was a significant difference between marriage and nurses' satisfaction with interprofessional collaboration (P&lt;0.05). Conclusion: The overall satisfaction of nurses with interprofessional collaboration in three tertiary hospitals in Shandong Province was generally average. The three hospitals should improve the management model and care about the mental health of nurses according to factors such as the marital status of nurses. Nurses should make a good distinction and plan between work and life to promote interprofessional collaboration.