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In this closing conversation, updated MASLD CPG co-authors Frank Tacke and Elisabetta Bugianesi and podcast co-hosts Louise Campbell and Roger Green consider what the guidelines might foretell in changes in provider education, structure of patient visits and treatment in less affluent or medically advanced countries.

The last set of questions begins with Roger asking what kinds of changes the authors would like to see in the healthcare system.  Frank likes Louise's idea of cardiometabolic pathological nursing and, more broadly, motivating physicians and nurses to view MASLD holistically. Elisabetta envisions a world where not only are there multidisciplinary teams, but each physician asks what they can do for the "liver/kidney/metabolic alliance." Frank describes this as "like a dream" and would like a world where the patient comes to the hepatologist for a cardiac workout, endocrine workout, nutritional counseling and other holistic support. It would also help get the correct patients triaged in primary care or referred to specialists.
 
 Roger asks whether Tumor Boards in oncology serve as a model for integrated metabolic disease treatment. Frank says in his institution, boards exist for cirrhosis patients but will never be realistic for the number of patients needing treatment.
 
As the episode winds down, several issues emerge. Louise wonders how these guidelines might be used in less affluent countries or those with less advanced/resourced healthcare systems. Elisabetta stresses the importance of generating awareness. Roger asks how the guidelines will incorporate updates for future drugs and bariatric surgery data; Frank feels this will not be a particular challenge and cites the upcoming data on obesity drugs and the SPECIAL study as information that might drive updates. Frank also suggests that all listeners should download the guidelines (the link is listed on the Surfing the MASH Tsunami web page.) And with one final set of congratulations to the authors, the episode ends.