Radiomic Application for Head and Neck Squamocellular Tumor: Systematic Review.

Abstract: Radiomics represents the convergence of artificial intelligence and radiological data analysis, primarily applied in the diagnosis and treatment of cancer. In the head and neck region, squamous cell carcinoma is the most prevalent type of tumor. Recent radiomics research has revealed that specific bio-imaging characteristics correlate with various molecular features of Head and Neck Squamous Cell Carcinoma (HNSCC), particularly Human Papillomavirus (HPV). These tumors typically present a unique phenotype, often affecting younger patients, and show a favorable response to radiation therapy. This study provides a systematic review of the literature, summarizing the application of radiomics in the head and neck region. It offers a comprehensive analysis of radiomics-based studies on HNSCC, evaluating its potential for tumor evaluation, risk stratification, and outcome prediction in head and neck cancer treatment.

Impact of nursing students on the quality of care perceived by patients: a systematic review of the literature.

OBJECTIVE: The quality assessment process, based on customer satisfaction, is fundamental in the delivery of the best care services. This is most evident in care settings where trainee students are allowed to assist the patients. The purpose of this review is to clarify whether nursing students have an impact on patients' assessment of the quality of their nursing care. MATERIALS AND METHODS: A systematic literature search was carried out using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines in six databases: PubMed, CINAHL, Cochrane, Web of Science, Scopus, and PsycInfo. Two co-authors independently screened titles, abstracts, and full-text articles, following explicit exclusion and inclusion criteria. Analyses included non-randomized and non-homogeneous samples, involving both selected patients and methods for assessing their satisfaction. RESULTS: After full-text screening, 30 articles were identified, but only 11 were considered pertinent to the topic of the review. The trainee-patient relationship is based on mutual help and can improve the patient experience and trainee learning. The instruments used to measure perceived quality were found to be valid and reliable. CONCLUSIONS: The studies under review show high levels of satisfaction among patients when nursing care is delivered through training, particularly when the patients who agree to be treated by nursing trainees have previous experience of hospitalization and relationships with trainees. Educational background and the empathy and communication skills of both professional nurses and trainees influence patients' perception of the quality of care and their satisfaction with it.

Risk of malignancy from thyroid nodular disease as an element of clinical management of patients with Hashimoto's thyroiditis.

BACKGROUND: Many studies have investigated the association between chronic lymphocytic thyroiditis (CLT) and papillary thyroid carcinoma (PTC), but clinical management of this condition has never been addressed specifically, even in recent guidelines. Surprisingly the likelihood of a nodule as being cancerous in a CLT has never been explicitly expressed in terms of relative risk. METHODS: This study was based on a retrospective analysis of 404 patients undergoing total thyroidectomy. RESULTS: Sixty-nine patients (17.1%) had histological findings of true CLT, and 36.2% had concurrent PTC versus 22.6% of patients in the non-CLT group (p < 0.05), with a tumour risk in the CLT group of ×1.6 (95% CI = 1.21-1.94, likelihood ratio = +1.63). CONCLUSIONS: Patients with CLT and a nodular condition have a ×1.6 increased risk of harbouring a PTC. Moreover, these patients develop multicentric PTC more frequently, and, as a result, total thyroidectomy should always be considered.

Commentaries on "Informatics and medicine: from molecules to populations".

OBJECTIVE: To discuss interdisciplinary research and education in the context of informatics and medicine by commenting on the paper of Kuhn et al. "Informatics and Medicine: From Molecules to Populations". METHOD: Inviting an international group of experts in biomedical and health informatics and related disciplines to comment on this paper. RESULTS AND CONCLUSIONS: The commentaries include a wide range of reasoned arguments and original position statements which, while strongly endorsing the educational needs identified by Kuhn et al., also point out fundamental challenges that are very specific to the unusual combination of scientific, technological, personal and social problems characterizing biomedical informatics. They point to the ultimate objectives of managing difficult human health problems, which are unlikely to yield to technological solutions alone. The psychological, societal, and environmental components of health and disease are emphasized by several of the commentators, setting the stage for further debate and constructive suggestions.

Microcarcinoma and incidental carcinoma of the thyroid in a clinical series: clinical behaviour and surgical management.

OBJECTIVES: Papillary thyroid microcarcinomas (PTM) have not yet an agreed clinical management. The Authors compared PTMs with papillary thyroid carcinoma of larger size (LPTC) and incidental and not-incidental carcinomas. MATERIALS AND METHODS: Review of clinical data of 67 patients (54 women, 13 men) prospectively stored in a standardised way in an electronic patient record system. RESULTS: There were 36 cases of microcarcinoma (53.7%). Differences were not significant between PTM and LPTC groups as to patients personal data, TNM and MACIS staging, nodal involvement (8.3% vs 19.3%) and multifocality (25% vs 38.7%) while capsular invasion was significantly higher in LPTC (25% vs 54.8%). Nineteen incidental tumors were detected at pathological examination and they were all microcarcinomas. They were smaller than the remaining 17 not-incidental microcarcinomas but showed a similar clinical behaviour. There were not cancer related deaths nor recurrences in the follow up period in any group. CONCLUSIONS: Despite the excellent prognosis of PTM, a subset of these tumours shows aggressive biological and clinical features, like nodal or capsular invasion and multifocality. Actually, with the exclusion of size, they do not show any relevant difference from differentiated thyroid carcinoma of larger size. Since predictive cytogenetic markers are still missing, their treatment should then be the same as for conventional thyroid cancers.

Altered expression of hMSH2 in sporadic colorectal cancer, surrounding mucosa and at distant colonic mucosa.

BACKGROUND: Mismatch repair gene hMSH2 is involved in correction of mispairing during replication and its mutation is associated both with microsatellite instability and with hereditary colorectal cancer. We evaluated its involvement in sporadic colorectal cancer tumorigenesis too. MATERIALS AND METHODS: The protein expression pattern of hMSH2 was evaluated on 29 cases of resected sporadic adenocarcinoma using an immunohistochemical approach. RESULTS: In 14 cases, lack of hMSH2 protein expression was observed in adenocarcinoma and in peritumoral mucosa. In 12 patients, hMSH2 resulted in strong expression in the tumour as well as in the surrounding mucosa and at distant mucosa. In three cases, hMSH2 protein expression in tumoral, adjacent and at distance normal mucosa resulted negative. CONCLUSION: Repair genes could play an important role in tumour progression and in sporadic colorectal cancer. Detection of protein expression by immunohistochemistry may be a method to select tumours for successive genetic investigations.

Syntactic-semantic tagging as a mediator between linguistic representations and formal models: an exercise in linking SNOMED to GALEN.

Natural language understanding applications are good candidates to solve the knowledge acquisition bottleneck when designing large scale concept systems. However, a necessary condition is that systems are built that transform sentences into a meaning representation that is independent of the subtleties of linguistic structure that nevertheless underly the way language works. The Cassandra II syntactic-semantic tagging system fulfills this goal partially. Within the GALEN-IN-USE project, it is used to transform linguistic representations of surgical procedure expressions into conceptual representations. In this paper, the proctology chapter of the SNOMED V3.1 procedure axis was used as a testbed to evaluate the usefulness of this approach. A quantitative and qualitative analysis of the data obtained is presented, showing that the Cassandra system can indeed complement the manual modelling efforts being conducted in the GALEN-IN-USE project. The different requirements related to linguistic modelling versus conceptual modelling can partly be accounted for by using an interface ontology, of which the fine tuning will however remain an important effort.

Standards to support development of terminological systems for healthcare telematics.

The Technical Committee on "Medical Informatics" of the European Committee for Standardization (CEN/TC251) is supporting developers of terminological systems in healthcare by a series of standards. The dream of "universal" coding system was abandoned in favor of a coherent family of terminologies, diversified according to tasks; two ideas were introduced: (1) the "categorical structure", i.e. a model of semantic categories and their relations within a subject field and (2) the "cross-thesaurus", i.e. a system of descriptors to build a systematic representation (called here "dissection") for each terminological phrase, coherent across diverse terminologies on a given subject field. The goal is to assure coexistence and interoperability (and reciprocal support for development and maintenance) to three generations of systems: (1) traditional paper-based systems (first generation); (2) compositional systems built according to a categorical structure and a cross-thesaurus (second generation) and (3) formal models (third generation). Various scenarios are presented, on the exploitation of computer-based terminological systems. The idea of "operational meaning" of terminological phrases within administrative and organizational contexts and the idea of "task-oriented details" are also introduced, to justify and exploit design constraints on terminological systems.

Toward a general model for the description of multimedia clinical data.

The patient folder integrates information originating from heterogeneous sources. For this reason computerized tools for patient data management should exploit the advantages of multimediality and offer an integrated environment for data presentation, and image and biosignal visualization. Object-oriented modeling is the best approach for designing systems for multimedia patient folder management. We propose an object-oriented model, able to define the entities constituting the patient folder and their logical organization. This model has sufficient flexibility to adapt to the most varied clinical environments. It allows the physician to structure the information needed for his/her patient folder without employing a programming language.

Effect of l-carnitine on lipid pattern in debilitated patients treated with Intralipid.

Ten surgical patients--4 males and 6 females, mean age: 46.7 years--affected by various pathological conditions were selected for this clinical trial. The patients were divided into two groups of 5 as follows: Group I on the third day received 10%. Intralipid (500 mg) + l-carnitine i.v. (100 mg/kg); on the sixth day 10% Intralipid (500 mg) infusion was given alone. Group II on the third day received 10% Intralipid (500 mg) infusion, and on the sixth day 10% Intralipid (500 mg) + l-carnitine (100 mg/kg). The laboratory parameters (cholesterol, triglycerides, HDL, LDL, VLDL, apolipoprotein A and B) showed that the lipids administered with l-carnitine were more rapidly metabolized than those without.

Integration of clinical information across patient records: a comparison of mechanisms used to enforce semantic coherence.

Semantic coherence about clinical information is the bottleneck for true interoperability among applications in health telematics. Healthcare records are in principle made of statements about patient's health and activities performed, organized within attested transactions or messages. Various mechanisms were developed to optimally represent details of statements into a record system, creating de facto three subdivisions: 1) "containers" of clinical information, i.e., section headings, data elements in local records; segments and data fields in messages; 2) their "contents," i.e., coding systems and terminologies; and 3) "transaction context," i.e., circumstances related to document production and message exchange, typically represented in their headers. Details rely on a common semantic background and should therefore, be seen in a continuum; nevertheless, design methodologies and tools for the three subdivisions evolved independently and assignment of details to subdivisions is not predetermined by principles, but depends on implementation issues. Recent developments within the European Committee for Standardization (CEN/TC251/WG II) and in the European Project GALEN-IN-USE provide a new insight on semantics in healthcare. In order to guide harmonization of semantic aspects in the different series of standards--in information models, messages, document markup, terminology systems--we present here a comparison of the various mechanisms they use to enforce semantic coherence on clinical information.

Exploiting the terminological approach from CEN/TC251 and GALEN to support semantic interoperability of healthcare record systems.

We apply the principles included in two CEN standards (ENV 12265, ENV 12264) to the analysis of the semantic structure of health record systems, to support their semantic interoperability. This result was made possible by dramatic methodological progress in the field of terminological systems--due to a worldwide evolution towards a new generation--and by the experience we acquired in the GALEN-IN-USE (formerly GALEN) project. The meaning behind names, content and context of record items and record item complexes can be considered as a 'semantic continuum'. This continuum is made explicit, by building a suitable paraphrase in a controlled language. We can then apply the principles we previously elaborated for the second generation of terminological system. Methodology and tools for generating a controlled language and a second-generation terminological system were developed and successfully used in the GALEN-IN-USE project and promising experiments were performed on elements of record structure listed in LOINC and SDM. In this way, the semantic structures of different record systems can be expressed by the resulting common formalism and thus, information units can be faithfully exchanged among different structures.

Browsing and querying multimedia report collections.

In this paper a system and new methodologies that enable efficient exploration of distributed collections of multimedia reports are described. A conceptual model for the report and a method to semi-automatically create a hypermedia report network have been defined. The main issues addressed in this project were to exploit the textual component of a report to give a more evident semantic meaning to the data produced during the relative exam and to provide users with new interaction paradigms based on Internet technologies.

Structuring clinical information in healthcare records.

We carried out an analytical study about names of clinical documents, titles of generic sections, names of data elements, to prepare the European Prestandard CEN ENV13606-2 on "Health Informatics--Communication of Electronic Health Care Record--Part 2: Domain Termlist". The goal of the standard is to facilitate transmission and/or homogeneous browsing of clinical information from disparate patient records, without any preliminary agreement on coding systems, data elements, record organization. With the assistance of the members of CEN/TC251/PT27 and under the control of CEN/TC251/WG I and WG II, we defined three layers to structure clinical information (structuring records into complexes, complexes into statements, statements into details) and we prepared many lists suitable to represent coarse-grained information about the different constructs used in the above layers.

SMART: a system supporting medical activities in real-time.

This paper describes the system SMART whose goal is real-time assistance to physicians who execute diagnostic or therapeutic protocols in a clinical context. SMART is able to retrieve a protocol from its knowledge base and to monitor its execution step by step for a single patient. Different protocols for different patients can be followed at the same time in a health care structure. The prototype realized supports the execution of protocols for evaluating surgical risks. It has been implemented according to the specifications given by the 4th Surgical Clinic of "Policlinico Umberto I" and reflects the activities actually performed in that hospital. However, the protocol model defined is general purpose and we envisage an easy application to other contexts and therefore to the informatization of other protocols.

A cooperative methodology to build conceptual models in medicine.

We designed a methodology to perform distribute activities on conceptual modelling among cooperating centers. Our methodology assigns responsibilities and tasks and regulates interactions preserving coherence; it passes through the construction of unambiguous paraphrases to make explicit the context within the original sources, and through their compositional representation in an intermediate language. The process is intrinsically iterative, with continuous feedbacks and refinements, alternating analytic view on details and synthetic view on regularities and structures. Our methodology is based on requirements and experience made in the first GALEN project, and was applied in the GALEN-IN-USE project to coordinate modelling activities of three teams of surgeons in Rome with activities of other partners, during the production of an extensive model of surgical procedures.

A second generation of terminological systems is coming.

Diverse achievements by recent computer-based terminological systems are outlining a new generation of systems (i.e. a "second generation"). We collected the relevant features of various advanced terminological systems and we systematized these features into four components of a unique framework. We review a set of systems according to our framework, and we discuss how standardization activities can support the evolution of computer-based terminological systems towards a complete set of new performances.

Relevance of mandates, notifications and threads in the management of continuity of care.

Availability of electronic healthcare records (EHCR) and geographical networks allows nowadays to realise a set of functionalities to support continuity of care. Actual exchange of complete clinical information, common centralised records, common decisions within an agreed protocols are not mandatory. Sub-optimal alternatives, involving easier management, are possible. In fact, the crucial challenge for continuity of care is the mutual awareness of the multiple perspectives by the actors contributing to patient's care. The various actors should timely know changes in the status of: mandates, i.e. who is involved in the care provision and thus is responsible for a "local" record. knowledge about the patient, i.e. active and inactive problems, impressions, relevant findings. provision of healthcare activities, i.e. plans, orders and performed activities. The decisions on the actual implementation depend on the healthcare context, as implemented within the information system. For example, the mechanism for notifications involves decisions on the quality and quantity of information that must be exchanged, as well as on the modalities for the exchange, regulated by individual user's profiles. Each notification could be sent as a message to a central repository, and then each authorized user could select within the repository the pertaining messages. Or a notification could be sent directly to the list of professionals involved in the care of a patient, that asked for it in their profile. Mandates may be used to regulate the access of the users to the patient's information. This approach was embedded in a European standard under development in CEN/TC251 (CONTSYS--"System of concepts to support continuity of care").

[Study on diagnostic and therapeutic behavior in tumors of the medial-lower third of the rectum in 2 Italian regions]. / Indagine sul comportamento diagnostico e terapeutico nei tumori del terzo medio ed inferiore del retto in due regioni italiane.

The authors report about a survey on the behaviour of 51 departments of surgery in Lazio and Lombardia as to diagnosis, staging and therapy of carcinoma of the medium-lower one-third of the rectum. A set of 722 patients treated in 1993 was considered. A questionnaire was distributed and answers collected about the staging protocols, the therapeutic choices and some details of surgical technique as the ligation of the lower mesenteric artery or the extent of the lymphadenectomy. The results indicate some stable trends as to preoperative study (digital examination and fibre optic endoscopy in almost all cases) and as to the choice of the technique of anastomosis (43.1% of termino-terminal stapled anastomosis). Intrarectal ultrasound gains consensus but is still not much diffuse (18.6% of cases). Almost all of the participating Institutions agreed in joining further prospective studies.

[Antibiotic prophylaxis in the control of infections in surgery: comparison of treatment in different types of surgery]. / Profilassi antibiotica per il controllo delle infezioni in chirurgia: confronto tra trattamenti per diversi tipi di chirurgia.

Despite the development of the most recent and powerful antimicrobic agents, surgical infections are to this day a constant threat to surgeons, rendering negative otherwise successful surgical results. It seems therefore essential that during surgical operations--which according to Altemeier's classification are defined as "contaminated" and "potentially contaminated"--patients undergo a perioperative antibiotic prophylaxis in order to assure elevated tissue levels of antibiotic as necessary. A perspective trial of two standard protocols of short term prophylaxis versus cefoperazone has been here outlined, given that in a recent study cefoperazone showed a positive effect in destroying the intestinal flora of patients even though this was carried out in experimental and not in clinical conditions. 177 patients were selected for this study with a breakdown of 26 and 42, that is twenty-six underwent potentially contaminated procedures and 42 contaminated procedures. Selecting at random, fifty percent of the first group was treated with cefoxitin, and the other half with cefoperazone; as far as the second group is concerned half the sample of patients was treated with cefoperazone and then compared with the other half who had been given an association of piperacillin and metronidazole. Primary septic complications amounted to 7.3% (13 cases); 7.6% in the first group (2 cases) and 21% in the second (9 cases). The different of sepsis between the two groups was not statistically significant although cefoperazone showed a higher septic result in contaminated surgery.(ABSTRACT TRUNCATED AT 250 WORDS)