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PubMed1995

Integration of information-seeking skills and activities into a problem-based curriculum.

Recent trends in medical education include a shift from the traditional, didactic, lecture-oriented approach to a more student-driven, problem-based approach to learning. This trend provides librarians with an opportunity to develop programs to teach information-gathering skills that support and are integrated into problem-based learning (PBL). In 1992, the University of Pittsburgh School of Medicine implemented the initial phase of a curriculum revision that emphasizes PBL. Since that time, Falk Library of the Health Sciences has provided a large-scale, intensive program integrating information-seeking skills and activities into the first-year Patient-Doctor Relationship course, a sequence that initiates medical school. A multimodal approach to information seeking and sources is emphasized, utilizing print and audiovisual materials, computerized resources, and subject experts. The Falk Library program emphasizes the gathering and use of information as central to both PBL and student skills development. An informal, post-course evaluation was conducted to gauge which information resources were used and valued most by students. This article presents evaluation results, including data on the use of information sources and services, and student perceptions of the librarian's role in the PBL sessions.

Curriculum↗
PubMed1997

Normal fusion for three-dimensional integrated visualization of SPECT and magnetic resonance brain images.

UNLABELLED: Multimodality visualization aims at efficiently presenting integrated information obtained from different modalities, usually combining a functional modality (SPECT, PET, functional magnetic resonance imaging) with an anatomical modality [CT, magnetic resonance imaging (MRI)]. This paper presents a technique for three-dimensional integrated visualization of SPECT and magnetic resonance brain images, where MRI is used as a framework of reference for the display of the SPECT data. METHODS: A novel technique for three-dimensional integrated visualization of functional and anatomical information, called normal fusion, is presented. With this technique, local functional information is projected onto an anatomic structure. RESULTS: The normal fusion technique is applied to three cases of SPECT/MRI integration. The results are presented, discussed and evaluated for clinical relevance. CONCLUSION: The results for three-dimensional integrated display of SPECT and MR brain images indicate that the normal fusion technique provides a potentially comprehensive and diagnostically valuable presentation of cerebral blood perfusion in relation to the anatomy of the brain.

Autistic Disorder↗
PubMed1993

Multimodality therapy for stage IIIA (N2) lung cancer. An overview.

Disappointing results of surgery and postoperative adjuvant chemotherapy or chemoradiotherapy in stage IIIA (N2) lung cancer have led to a number of phase II trials of induction (neoadjuvant) chemotherapy given prior to surgery. Preliminary results of 2 such studies indicate that mitomycin, vinca alkaloid, and platinum (MVP) given before surgical excision induces an overall response rate of 70% (9 complete responses and 71 partial responses in 112 patients). Of 80 patients who ultimately underwent surgery, complete resection was achieved in 62 (55%). Survival data reflect a median survival of 19.5 months for the entire cohort of 112 patients and 27 months for those who had complete resection. The 5-year-survival rate is expected to reach 15%. Randomized trials are now under way to establish whether this aggressive approach to therapy represents the most appropriate form of treatment for patients with stage IIIA (N2) lung cancer.

Carcinoma, Non-Small-Cell Lung↗
PubMed2006

Pharmacological treatment of Alzheimer's Disease.

BACKGROUND AND AIMS: The treatment of Alzheimer's disease (AD) is a challenge for physician, families, and patients. An individualized, multimodal treatment plan addressing the treatment of cognitive, behavioural and functional decline is essential. Aim of the paper is to describe the principal components of the treatment plan of AD patients. METHODS: A review of the recent literature was performed. RESULTS: Acetylcholinesterase inhibitors (AChEIs) play an important role in the improvement of cognitive decline in mild to moderate AD, even if the improvement is not permanent. Data obtained from the CRONOS project (involving about 500 Alzheimer Evaluation Units) replicate in the real world those obtained in controlled trials, confirming that AD patients may benefit from AChEI treatment. Treatment of behavioral and psychological symptoms of dementia (BPSD) requires education of caregivers, non pharmacological interventions, identification and treatment of medical illnesses or environmental precipitating conditions, specific pharmacological treatment. Traditional neuroleptics are widely used for BPSD treatment, but limited data support their use, and side-effects are frequent and severe. Atypical antipsychotics are effective in treating BPSD, and safer than traditional neuroleptics. However, the increased risk of cerebrovascular accident in patients taking risperidone or olanzapine limited currently their use in demented subjects. The use of antidepressant drugs, as well as behavioral approach, may improve depressive symptoms frequently accompanying AD. CONCLUSIONS: Although at present there is no cure for AD, several drug treatments and care strategies may improve or stabilize cognitive and behavioral symptoms, and improve the quality of life of patients and families.

Aged↗
PubMedDate not supplied

Crossmodal integration for perception and action.

The integration of information from different sensory modalities has many advantages for human observers, including increase of salience, resolution of perceptual ambiguities, and unified perception of objects and surroundings. Several behavioral, electrophysiological and neuroimaging data collected in various tasks, including localization and detection of spatial events, crossmodal perception of object properties and scene analysis are reviewed here. All the results highlight the multiple faces of crossmodal interactions and provide converging evidence that the brain takes advantages of spatial and temporal coincidence between spatial events in the crossmodal binding of spatial features gathered through different modalities. Furthermore, the elaboration of a multimodal percept appears to be based on an adaptive combination of the contribution of each modality, according to the intrinsic reliability of sensory cue, which itself depends on the task at hand and the kind of perceptual cues involved in sensory processing. Computational models based on bayesian sensory estimation provide valuable explanations of the way perceptual system could perform such crossmodal integration. Recent anatomical evidence suggest that crossmodal interactions affect early stages of sensory processing, and could be mediated through a dynamic recurrent network involving backprojections from multimodal areas as well as lateral connections that can modulate the activity of primary sensory cortices, though future behavioral and neurophysiological studies should allow a better understanding of the underlying mechanisms.

Animals↗
PubMedDate not supplied

Computer-based imaging and interventional MRI: applications for neurosurgery.

Advances in computer technology and the development of open MRI systems definitely enhanced intraoperative image-guidance in neurosurgery. Based upon the integration of previously acquired and processed 3D information and the corresponding anatomy of the patient, this requires computerized image-processing methods (segmentation, registration, and display) and fast image integration techniques. Open MR systems equipped with instrument tracking systems, provide an interactive environment in which biopsies and minimally invasive interventions or open surgeries can be performed. Enhanced by the integration of multimodal imaging these techniques significantly improve the available treatment options and can change the prognosis for patients with surgically treatable diseases.

Biopsy↗
PubMed1997

Prognostic factors in malignant glioma: influence of the overexpression of oncogene and tumor-suppressor gene products on survival.

Despite the use of multimodal therapy, higher-grade glioma is still uniformly fatal in the adult population. There is a considerable difference between the length of survival in each given patient, even within the same tumor type and malignancy grade group, suggesting that there are factors that might differentially influence outcome. To identify such factors, 107 patients with anaplastic or malignant glioma were retrospectively investigated. Clinical parameters and paraclinical data on the p53, mdm2, and EGFR genes at the DNA or protein level were evaluated by univariate analysis and Cox proportional hazards regression modeling. Kaplan-Meier survival estimation demonstrated that immunohistochemical positivity for mdm2 protein in patients with anaplastic astrocytoma or with glioblastoma multiforme was associated with a shorter survival time (p = 0.02). P53 gene mutations and immunopositivity for the epidermal growth factor receptor (EGFR) protein were not significantly related to poor prognosis. The Cox proportional hazards model revealed immunohistochemical positivity for p53, mdm2, or for both of them, the presence of postoperative irradiation, and the extent of surgical resection of tumor to be variables significantly associated with prolonged survival. EGFR overexpression, age over 60 years, and Karnofsky performance score below 40 points did not significantly shorten survival time. In conclusion, the present study identified immunohistochemically detected mdm2-protein overexpression as a statistically significant negative prognostic parameter in patients bearing anaplastic or malignant glioma. Association analysis of variables revealed a possible correlation between mdm2 and p53, which is also consistent with the biological interaction mode of both proteins in vivo.

Analysis of Variance↗
PubMedDate not supplied

Evaluation of new treatment methods for head and neck cancer: a challenge.

Surgery and radiotherapy are still the best local and regional treatments for the majority of head and neck cancer patients, each alone having an impressive cure rate. However, it appears that surgery and radiotherapy have reached their upper limits. To improve the results obtained by surgery and radiotherapy, combined approaches with chemotherapy or immunotherapy must be further explored. Prospective randomized trials are essential for the evaluation of the efficacy of such multimodality treatments. Although there is an increasing commitment to this type of clinical research amongst otolaryngologists/head and neck surgeons, we still lag considerably behind other surgical and medical disciplines. Broad peer support is the conditio sine qua non that prospective randomized studies will be successfully conducted in head and neck oncology. Such studies, irrespective of their outcome in terms of which treatment is best, will provide data on important issues like that of failure sites. Accurate evaluation of the magnitude of the failure problem at respectively the local, the regional and the distant level are essential for estimating the potential for gains and establishing priorities for clinical research.

Clinical Trials as Topic↗
PubMedDate not supplied

Clinical aspects of inflammatory breast cancer.

Inflammatory breast cancer (IBC), accounting for 1-5% of all breast cancers, is the most aggressive form of breast cancer. Its biologically aggressive nature is identified by the rapid time to progression, its tendency to affect younger women, the high proportion of local and distant metastases present at diagnosis, and lower overall survival despite the use of multimodality therapy. With epidemiologic and molecular evidence now suggesting that IBC may represent a distinct disease entity rather than part of the spectrum of locally advanced breast cancer (LABC), accurate differentiation of these two disease processes has never been more crucial to ensure appropriate treatment. This review addresses the historical milestones and clinical characteristics involved in the differentiation of IBC and briefly discusses the emerging molecular data that may facilitate the distinction of IBC from LABC.

Adenocarcinoma↗
PubMed2006

[Uniform calculation of local recurrence rates--requirement for quality management in rectal carcinoma].

The local recurrence rate is an important indicator in the quality management of rectal carcinoma. The data of the German Study Group for Colorectal Carcinoma (SGCRC) and the Erlangen Registry for Colorectal Carcinoma (ERCRC) were used to demonstrate the influence of different calculation methods on the level of local recurrence rates. The application of uniform definitions, rules and presentations is necessary to enable national and international comparisons. Only 5-year local recurrence rates allow treatment quality to be definitely judged, especially when multimodal treatment was applied.

Combined Modality Therapy↗
PubMed1996

The National Cancer Data Base report on soft tissue sarcoma.

BACKGROUND: Discernible improvements have taken place in soft tissue sarcoma patient survivorship and quality of life over the past 20 years, with overall 5-year survival currently at approximately 50%. Shifts in treatment have taken place over the past decade, from single-modality treatment involving radical surgery to sophisticated limb-salvage strategies combined with radiation therapy and protocol-administered chemotherapy. METHODS: To identify patterns of treatment and outcome, all soft tissue sarcoma cases diagnosed in 1988 and 1993 as recorded in the National Cancer Data Base were analyzed on the basis of histology and anatomic site. RESULTS: There was an increase in sarcomas originating in the pleura with a concurrent increase in mesotheliomas. A shift toward more advanced disease was also noted. Limb-sparing surgical procedures are now standard. However, it appears from stage subset analysis that many Stage II and III patients are undertreated due to lack of multimodality therapy usage. CONCLUSIONS: Use of pretreatment multimodality planning conferences will increase the likelihood that stage-appropriate combinations of surgery, radiation therapy, and chemotherapy will be used. In turn, election of multimodality approaches should increase the possibility of improved overall and disease free survival in the future.

Databases, Factual↗
PubMed1997

[The natural history of breast cancer. The impact of prevention and therapy].

Four periods are recognizable in breast carcinoma treatment: the first period can be called as "era of the incurable disease". It begins at the arising of the mankind and lasts up to the end of the 19th century. During this period the disease was usually diagnosed in far advanced stage and any therapeutical attempt was unable to cure a significant percentage of patients. The second period begins with Halsted and ends in the late 60's. It should be considered as the "eve of the surgical treatment of the breast cancer". In these years an increasing number of patients was diagnosed in earlier, curable stage and about half of them was definitively cured. In the early 70's several multimodality treatments of breast cancer were proposed by different Cancer Centers worldwide. Usually a local treatment (surgery+radiotherapy) was adopted combined with a systemic treatment (chemotherapy or monotherapy), commonly in N+ patients. Such approach cured a further 25% of patients that the local treatment alone could not cure. Moreover conservative surgical procedures were extensively carried up. In the last ten years the increasing amount of clinical data leads us to adopt a tailored therapeutical plan for nearly every patient. Numerous subgroups of patients with different level of risk were identified (patients with inflammatory carcinoma, young women at high risk, elderly patients etc.). The early data show that some further advantages in survival rates, in cost saving policy and in cosmetic outcome can be achieved.

Breast Neoplasms↗
PubMed2005

[Risk factors for substance abuse and dependence in opioid therapy for chronic noncancer-related pain].

Opioids are valuable analgesics, capable of providing pain relief and functional improvement not only in patients with cancer-related pain, but also in chronic noncancer-related pain patients. However, recent data have shown that the increasing prescription of opioids is associated with a rise in aberrant drug-related behaviour. The causes of this behaviour are multifactorial. Some pharmacotherapeutic, but in particular psychosocial risk and etiologic pain factors have been identified. The indication for the prescription of opioids must be very carefully weighed in the presence of any risk factors. In these cases the integration into a multimodal, interdisciplinary therapy programme is mandatory. A contractual agreement on the opioid therapy including goals, side effects, controls including urine drug testing and criteria to finish the opioid therapy are advisable. Assessment of the progress of therapy is based on the following factors: analgesic efficacy, adverse side effects, functional status and aberrant drug-related behaviour. In the absence of a successful opioid therapy, the treatment must be discontinued to avoid iatrogenic damage, substance abuse and illegal diversion. After discontinuation of the therapy, a comprehensive interdisciplinary re-evaluation is required.

Analgesics, Opioid↗
PubMed2001

Intracardiac echocardiography.

This article describes currently available intracardiac ultrasound (ICE) technology contrasting it with intravascular ultrasound (IVUS), highlighting their differences. General and specific clinical applications, limitations and future developments of ICE are addressed. ICE is possible because lower frequency transducers (in contrast to higher frequency IVUS devices) have been miniaturized and mounted onto catheters capable of percutaneous insertion into the heart. Since the recent availability of a steerable, 5.5--10MHz phased-array catheter with full Doppler capability, these lower frequency transducers are not only capable of enhanced penetration, permitting high-resolution two-dimensional (2D) imaging but can also provide haemodynamic data. ICE facilitates electrophysiologic procedures by guiding trans-septal catheterization, enabling endocardial anatomy visualization, ensuring ablation electrode/tissue contact and promptly diagnosing procedural complications. Promising non-electrophysiologic applications include guidance of percutaneous closure of septal defects, percutaneous mitral balloon valvuloplasty and complex cardiac biopsy. Current limitations include monoplanar imaging and narrow field of view. Expanded diagnostic techniques such as tissue Doppler, multiplane, three dimensional (3D) and multimodality imaging represent future refinements. ICE is now a clinical tool. With the introduction of the newest phased-array transducer, with full Doppler capability, ICE has the potential to play an important role in diagnostic and therapeutic interventional procedures. Further refinement and miniaturization hold the key to primary operator controlled, integrated ultrasound-guided interventional devices.

Arrhythmias, Cardiac↗
PubMed2000

Multiparameter brain tissue monitoring--correlation between parameters and identification of CPP thresholds.

Continuous monitoring of brain interstitial gas concentrations allows direct regional evaluation of the pathophysiology of cerebral tissues. We have incorporated the Paratrend 7 (P7) multiparameter sensor into our established multimodal monitoring of head injured patients, to investigate the relationship between brain and arterial pO2, pCO2, and pH, as well as defining thresholds for cerebral perfusion pressure (CPP). A P7 sensor was inserted into the brain tissue of 40 adult head injured patients via a modified Camino bolt or triple lumen bolt. A second sensor was placed in the femoral artery for continuous monitoring of blood gases. Data signals from 19 monitored parameters were collected onto computer at the bedside for up to 14 days. No complications were seen. For individual patients the changes in brain tissue parameters showed large variations over 24 hours and the relationship between parameters varied considerably both between patients and during the period of monitoring any one individual. Changes related to periods of arterial desaturation, cerebral hypoperfusion and therapeutic manoeuvres could be seen. Good correlation was seen between brain pCO2 and arterial pCO2 (r = 0.58). Poor correlation was seen between CPP and brain pO2, and between brain pO2 and ICP. However, by grouping values for intracranial pressure (ICP) and CPP, thresholds for brain tissue pO2 were identified in 16 patients where CPP fell below 60 mmHg. No patients where CPP was always > 60 mmHg showed a significant threshold for a drop in brain pO2 (n = 16). In conclusion, the P7 shows potential as a monitor of regional brain oxygenation and for detection of potentially damaging secondary insults. The results must be interpreted whilst considering catheter position, autoregulation and systemic arterial changes for each individual.

Adolescent↗
PubMed2004

The insular lobe of Reil--its anatamico-functional, behavioural and neuropsychiatric attributes in humans--a review.

There is considerable clinical and experimental research to explore the anatamico-functional correlations of the limbic lobe to establish its relevance in modern neuroscience. The insula being a pivotal structure in the concept of the greater limbic lobe, we have attempted to highlight in this review the topographical anatomy and development, the remarkable heterogeneity of the insular cortical architecture, the widespread multifaceted spectrum of functional connectivity patterns and how this is translated to its behavioural specialisation in humans. The insula serves as an intergration cortex for multimodal convergence of distributed neural networks such as the somesthetic-limbic, insulo-limbic, insulo-orbito-temporal and the prefrontal-striato-pallidal-basal forebrain. This provides the conceptual framework to facilitate functional and clinical considerations relevant to the various behavioural and neuropsychiatric disorders outlined in this review. The functional role of the insula in these disorders with particular reference to the current functional neuroimaging data has been also reviewed in this article.

Cerebral Cortex↗
PubMed1994

Combined modality treatment for carcinomas of the uterine cervix and vulva.

Several attempts have been made during the preceding year to apply multimodality approaches to the treatment of carcinomas of the uterine cervix and the vulva. Neoadjuvant chemotherapy may render more cervical tumors resectable, but it does not necessarily improve curability when compared with similarly staged patients treated with definitive pelvic irradiation alone. Neither concurrent chemoradiotherapy nor adjuvant chemotherapy following hysterectomy have been shown to be superior to definitive radiotherapy in prospective randomized trials of cervical cancer patients. Exciting data continue to be reported for the integration of chemotherapy, radiotherapy, and conservative surgery in the management of vulvar cancer. Such initiatives are contingent on the close cooperation of oncologists during the design and implementation of prospective trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2026

Artificial Intelligence for Colorectal Surgeons-Part II: Research Applications, Challenges in Adoption, and Practical Resources.

BACKGROUND: This is part II of a 2-part series examining artificial intelligence in colorectal surgery. Part I established foundational concepts and clinical applications. Implementation, however, requires understanding research methodologies, available resources, and the specific challenges currently limiting widespread adoption. These topics are the focus of part II. OBJECTIVE: To examine artificial intelligence's transformation of surgical research, provide practical implementation resources, address adoption challenges, and explore future directions in colorectal surgery. METHODS: Comprehensive literature review focusing on artificial intelligence research methodology, implementation barriers, educational resources, and emerging technologies relevant to colorectal surgeons. RESULTS: Artificial intelligence streamlines clinical trial design through predictive modeling and natural language processing, reducing enrollment challenges that contribute to failed or inadequate trial accrual. Machine learning enables heterogeneity analysis within clinical trials, identifying treatment-responsive subgroups. Foundation models unlock analysis of unstructured electronic health record data at scale. Professional societies and universities offer specialized artificial intelligence education programs, with open-access data sets facilitating research participation. However, implementation faces multifaceted challenges: technical infrastructure demands, with real-time processing requiring dedicated graphics processing unit clusters; regulatory frameworks struggling with continuously evolving algorithms; undefined liability distribution for artificial intelligence-assisted decisions; algorithmic bias risking health care disparities; and the "black box" problem limiting clinical trust. Economic barriers include substantial initial costs without clear reimbursement pathways. Future directions include multimodal artificial intelligence integrating imaging, genomics, and histopathology; cognitive robotic systems with real-time decision support; digital twin technology for patient-specific surgical simulation; and global surgical artificial intelligence networks enabling distributed learning across institutions. CONCLUSIONS: Although artificial intelligence offers transformative potential for colorectal surgery research and practice, successful implementation requires addressing technical, regulatory, ethical, and economic challenges. The surgeon's evolving role demands both traditional expertise and computational fluency. Future advances in multimodal integration, autonomous systems, and global collaboration will fundamentally reshape surgical practice but will require thoughtful implementation prioritizing patient benefit and clinical value.

Humans↗