BACKGROUND: Head and neck cancers (HNC) are associated with high rates of anxiety. Anxiety has been linked to biological pathways implicated in cancer progression, though little is known about its effects on overall survival. We hypothesized that higher pretreatment anxiety levels in patients with HNC would predict poorer 2-year overall survival and expected this relationship to be mediated by both systemic inflammation and tumor response to treatment.
METHODS: Patients (N = 394) reported anxiety symptomatology via the GAD-7 at treatment planning. Pre-treatment hematology workup provided an index of systemic inflammation (SII; N = 292). Clinical data review yielded tumor response and overall survival. Logistic and multiple regressions and Cox proportional hazard models tested hypothesized relationships.
RESULTS: Higher pretreatment anxiety levels were significantly associated with poorer 2-year survival (hazard ratio [HR], 1.039; 95% confidence interval [CI], 1.014-1.066, p = 0.002). The association between anxiety and SII was not significant, though anxiety was associated with poorer tumor response (odds ratio [OR], 1.033; 95% CI, 1.001-1.066, p = 0.043). Tumor response fully mediated the relationship between anxiety symptoms and 2-year survival (HR, 9.290, 95% CI, 6.152-14.031, p < 0.001).
CONCLUSIONS: Anxiety was associated with overall survival. Tumor response, but not systemic inflammation, emerged as a potential biological pathway mediating this effect. Screening for anxiety may be beneficial to help prospectively address these concerns and ameliorate potentially detrimental impact on clinically meaningful cancer outcomes.

Infants and children with intestinal failure are at risk for pediatric feeding disorders, which challenge their oral feeding development. This article explores these challenges and offers several practical strategies that can be used by multidisciplinary care teams and at-home caregivers to help support the development of oral feeding in these children and eventually lead to their attaining enteral autonomy.

BACKGROUND: Multidisciplinary teams (MDTs) are integral to healthcare provision. However, healthcare has historically adopted a hierarchical power structure meaning some voices within the MDT have more influence than others. While power dynamics can influence interprofessional communication and care coordination, the field\'s understanding of these power structures during the COVID-19 pandemic is limited.
METHODS: Adopting a narrative inquiry methodology, this research addresses this knowledge gap and provides an in-depth understanding of MDT power dynamics during COVID-19. Using semi-structured interviews (n = 35) and inductive thematic analysis, this research explores staff perspectives of changing power dynamics in MDTs during the pandemic response.
RESULTS: An in-depth analysis generated three overarching themes: (1) Healthcare: a deeply embedded hierarchy reveals that while a hierarchical culture prevails within the Irish health system, staff perceptions of influence in MDTs and \'real\' experiences of autonomy differ significantly. (2) Team characteristics: the influence of team structure on MDT power dynamics highlights the impact of organisational structures (e.g., staff rotations) and local processes (e.g., MDT meeting structure) on collaborative practice. (3) Ongoing effort to stimulate true collaboration underscores the importance of ongoing interprofessional education to support collaborative care.
CONCLUSIONS: By offering a greater understanding of MDT power dynamics throughout the COVID-19 pandemic, this research supports the development of more appropriate strategies to promote the provision of interprofessional care in practice.

Addiction medicine consultation teams [AMCTs] are a promising strategy for improving hospital care for patients with substance use disorders. Yet very little research has examined AMCT implementation in acute care settings. To address this gap, we conducted a process evaluation of a novel harm reduction-oriented AMCT. Our specific aims included examining patients\' perspectives on factors that facilitated or hindered AMCT delivery, and its impact on their hospital care and outcomes.
The AMCT provided integrated addiction medicine, harm reduction services, and wraparound health and social supports for patients of a large, urban acute care hospital in Western Canada. We adopted a focused ethnographic design and recruited 21 patients into semi-structured interviews eliciting their views on the care they received from the team.
Participants highlighted the AMCT\'s harm reduction approach; reputation amongst peers; and specialized training as especially important intervention facilitators. Key barriers that constrained the impact of the team included unmet expectations; difficulty accessing follow-up care; and residual conflicts between the AMCT\'s harm reduction approach and the abstinence-only orientation of some hospital staff. For a few participants these conflicts led to negative experiences. Despite this, participants reported that the AMCT had positive impacts overall, including declines in substance use, enhanced mental and emotional wellbeing, and improved socio-economic circumstances.
A novel harm reduction-oriented AMCT led to better hospital experiences and perceived outcomes for patients. However, further efforts are needed to ensure adequate post-discharge follow-up, and a consistent approach to substance use disorder care amongst all hospital staff.

Despite advances in the management of sudden cardiac arrest, mortality for patients admitted to hospital is still greater than 50 %. Lack of familiarity and experience with post-cardiac arrest patients and lack of interdisciplinary collaboration between emergency and ICU staff have been highlighted as potential barriers to optimal care. To address these barriers, a specialized Post Arrest Consult Team (PACT) was implemented at two urban academic centers. Our objective was to describe the PACT implementation from the participant perspective in order to explore potentially mitigating factors on effectiveness of the intervention and inform other institutions who may be considering a similar approach.
Using an ethnographic style approach, we collected data throughout the implementation period using both key informant interviews and non-participant observation. The data were analyzed using interpretive descriptive analysis techniques.
The PACT intervention was taken up differently in each of the two participating institutions. Participants spoke about the difficulty in maintaining a dynamic interaction between the team members and a shared sense of purpose, the challenge of off-service consulting and the impact of the lack of data feedback to support whether the project was effecting change.
It appears that purposefully creating a \"sense of team,\" the team composition and organizational culture and provision of performance feedback are important facilitators to ensuring uptake of a team-based intervention like the PACT model. Reporting of the intervention design and actual implementation experience like we have done here is crucial to allow readers to judge the quality of the study, to properly replicate it, and to contemplate how various factors may influence the outcome of a complex intervention.

BACKGROUND: Interprofessional collaboration improves patient care, especially for those patients with complex and/or chronic conditions. Many studies examining collaborative practice in primary care settings have been undertaken, yet identification of essential elements of effective interprofessional collaboration in primary care settings remains obscure.
OBJECTIVE: To examine the nature of interprofessional collaboration (including interprofessional collaborative practice) and the key influences that lead to successful models of interprofessional practice in primary care teams, as reported in studies using direct observation methods.
METHODS: Integrative review using Whittemore and Knafl\'s (2005) five stage framework: problem identification, literature search, data evaluation, data analysis and presentation. Data sources and review method: Primary research studies meeting the search criteria were accessed from MEDLINE, PsycINFO, Scopus, King\'s Fund and Informit Health Collection databases, and by hand-searching reference lists. From 2005 to 2013, 105 studies closely examining elements of interprofessional collaboration were identified. Of these, 11 studies were identified which incorporated a range of \'real time\' direct observation methods where the collaborative practice of health professionals was closely observed.
RESULTS: Constant opportunity for effective, frequent, informal shared communication emerged as the overarching theme and most critical factor in achieving and sustaining effective interprofessional collaboration and interprofessional collaborative practice in this review. Multiple channels for repeated (often brief) informal shared communication were necessary for shared knowledge creation, development of shared goals, and shared clinical decision making. Favourable physical space configuration and \'having frequent brief time in common\' were key facilitators.
CONCLUSIONS: This review highlights the need to look critically at the body of research purported to investigate interprofessional collaboration in primary care settings and suggests the value of using direct observational methods to elucidate this. Direct observation of collaborative practice in everyday work settings holds promise as a method to better understand and articulate the complex phenomena of interprofessional collaboration, yet only a small number of studies to date have attempted to directly observe such practice. Despite methodological challenges, findings suggest that observation data may contribute in a unique way to the teamwork discourse, by identifying elements of interprofessional collaborative practice that are not so obvious to individuals when asked to self-report.