Literature Collection

Objectives: Community-based multi-disciplinary teams (MDTs) were among the most widely reported health and care integration initiatives in the Integrated Care Pioneers in England. Such MDTs bring together staff from different sectors to co-ordinate and plan care for patients, who are often older, have multiple long-term conditions and risk hospital admission. As part of our evaluation of MDTs in two contrasting Pioneers, we explored MDT patients' and informal carers' perspectives on health and care services. As the COVID-19 pandemic started during data collection, we also wanted to understand its impact on patients' access to services. Methods: We conducted qualitative interviews with 44 patients aged 60 or over, with long-term conditions, and on the caseload of one of 11 participating MDTs. We also undertook qualitative interviews with 15 carers. Interviews took place between November 2019 and March 2021. Interview transcripts were coded in NVivo-12 and analysed thematically. Results: In addition to formal services, patients often relied on informal care. Valued aspects of care included equipment and home modifications that supported independence, timely access to and continuity in care, effective information-sharing, professionals who made them feel that their needs mattered, and having a named contact. Where challenges were experienced (e.g. with accessing professionals, communication, and care quality), patients and carers sometimes felt abandoned. While some patients mentioned being on an MDT caseload, few reported having a care plan. The impacts of caring on informal carers were sometimes considerable. COVID-19 affected patient and carer wellbeing, but the new ways of accessing care generated by the pandemic were valued by some participants. Conclusions: As long as challenges remain, patients and carers are unlikely to perceive care as joined-up and patient-centred. If truly integrated and holistic care is to be provided, barriers (such as the lack of shared patient records) must be addressed. Even where MDTs function primarily to co-ordinate rather than deliver care, they could better communicate their co-ordinating role, and MDT discussion outcomes, including care decisions, to patients. Informal carers' needs also require greater attention by MDTs.

Access to treatment for opioid use disorder (OUD) in rural areas within the United States remains a challenge. Providers must complete 8-24 h of training to obtain the Drug Addiction Treatment Act (DATA) 2000 waiver to have the legal authority to prescribe buprenorphine for OUD. Over the last 4 years, we executed five dissemination and implementation grants funded by the Agency for Healthcare Research and Quality to study and address barriers to providing Medications for Opioid Use Disorder Treatment (MOUD), including psychosocial supports, in rural primary care practices in different states. We found that obtaining the DATA 2000 waiver is just one component of meaningful treatment using MOUD, and that the waiver provides a one-time benchmark that often does not address other significant barriers that providers face daily. In this commentary, we summarize our initiatives and the common lessons learned across our grants and offer recommendations on how primary care providers can be better supported to expand access to MOUD in rural America.

A game-changing strategy in precision medicine is theranostics, which is the combination of diagnostics and treatments on one platform. Microrobots have drawn a lot of interest as promising agents in theranostic applications because of their small size, agility, and multifunctionality. This anal-ysis highlights the potential of microrobots to transform illness management by examining how they can integrate precise medicine delivery and diagnostic capabilities. Advanced features like imaging for focused diagnostics, payload delivery for precision therapies, and biosensing for real-time disease monitoring can be built into microrobots. These microrobots can navigate intricate biological environ-ments and provide localized intervention at the cellular and subcellular levels. They are propelled by external pressures such as magnetic fields or biological mechanisms. Recent advancements in micro-robots, including biocompatible polymers and stimuli-responsive systems, offer potential for early dis-ease identification and targeted drug release in neurological, cardiovascular, and malignant diseases. Along with solutions, issues like scalability, regulatory approval, and biocompatibility are also cov-ered. With an emphasis on their role in influencing the development of integrated healthcare solutions, this paper offers a thorough summary of technological developments and potential applications of mi-crorobots in theranostics. The study authors examined databases such as PubMed, Scopus, Google Scholar, and Web of Science for peer-reviewed articles published within the last 10 years on theranostic microrobots, diagnostic tools, drug delivery systems, and precision medicine. It comprised empirical research on microrobot design, functioning, therapeutic applications, diagnostic capabilities, treatment results, and safety profiles. This methodical methodology found patterns, gaps, and advances in the discipline.