Search Results (476)

Synchronous multiple parathyroid carcinoma is a rare condition within the already uncommon landscape of parathyroid malignancies, which comprise less than 1% of sporadic primary hyperparathyroidism cases. To date, only seven cases of synchronous multiple parathyroid carcinoma in sporadic primary hyperparathyroidism have been documented. This exceptional rarity complicates both the diagnostic process and therapeutic decision-making. Clinically, parathyroid carcinoma typically presents as a single mass determining severe symptoms. However, no single clinical, biochemical, or imaging feature allows for definitive preoperative diagnosis. Imaging modalities such as ultrasound and sestamibi scans exhibit variable sensitivity and may overlook multi-gland involvement. Histopathological examination remains the only reliable diagnostic method. Management strategies are also controversial: while some advocate for conservative surgery, en bloc resection is generally recommended for its association with improved local control and disease-free survival. Given the exceptional occurrence of synchronous multiple parathyroid carcinoma, there is a lack of standardized protocols for managing parathyroid carcinoma in cases of synchronous and multiple gland involvement. Early multidisciplinary evaluation and individualized treatment planning are therefore crucial. This review aims to synthesize the presently available knowledge about synchronous multiple parathyroid carcinoma, assist clinicians with the limited data available, and discuss the main challenges in the management of this rare entity. Full article

In the era of precision medicine, effective data visualisation plays a pivotal role in supporting clinical decision-making by translating complex, multidimensional datasets into intuitive and actionable insights. This paper explores the foundational principles of visual perception, with a specific focus on pre-attentive attributes such as colour, shape, size, orientation, and spatial position, which are processed automatically by the human visual system. Drawing from cognitive psychology and perceptual science, we demonstrate how these attributes can enhance the clarity and usability of medical visualisations, reducing cognitive load and improving interpretive speed in high-stakes clinical environments. Through detailed case studies and visual examples, particularly within the field of oncology, we highlight best practices and common pitfalls in the design of dashboards, nomograms, and interactive platforms. We further examine the integration of advanced tools—such as genomic heatmaps and temporal timelines—into multidisciplinary workflows to support personalised care. Our findings underscore that visually intelligent design is not merely an aesthetic concern but a critical factor in clinical safety, efficiency, and communication, advocating for user-centred and evidence-based approaches in the development of health data interfaces. Full article

Background: Assessing pancreatic ductal adenocarcinoma (PDAC) resectability after neoadjuvant therapy (NAT) remains a diagnostic challenge. Traditional computed tomography (CT) criteria often fail to distinguish viable tumor from fibrosis, necessitating a reassessment of imaging-based standards. Methods: A comprehensive literature review was conducted using PubMed, focusing on prospective and retrospective studies over the past 25 years that evaluated the role of CT and complementary imaging modalities (MRI, PET-CT) in predicting resectability post-NAT in non-metastatic PDAC. Studies with small sample sizes or case reports were excluded. Results: Across studies, conventional CT parameters—particularly >180° vascular encasement—showed a limited correlation with histologic invasion or surgical outcomes after NAT. Persistent vessel contact on CT often reflected fibrosis, rather than active tumor. Dynamic changes, such as regression in the tumor–vessel interface and vessel lumen restoration, correlated more accurately with R0 resection. Adjunct markers like CA 19-9 response and patient performance status further improved resectability prediction. Conclusions: CT-based resectability assessment after NAT should transition from static morphologic criteria to response-based interpretation. Multidisciplinary evaluation integrating radiologic, biochemical, and clinical findings is essential to guide surgical decision-making and improve patient outcomes. Full article

Extracranial metastases from meningiomas are extremely rare, with an incidence of <1%, and their prognosis is poor. Moreover, there is currently no gold standard for their treatment; therefore, the decision-making process is strictly dependent on multidisciplinary discussions. In this report, we describe the case of a 73-year-old patient who was diagnosed with a solitary lung metastasis more than 20 years after the initial treatment for a low-grade meningioma. Molecular characterization of this metastasis was performed using the Oncomine Comprehensive Assay Plus, which identified multiple functional mutations in the beta2-microglobulin (β2M) and ATM genes, both of which may contribute to immune evasion and genomic instability. A short overview of the literature is also reported. To our knowledge, no previous reports exist on single pulmonary metastasis from low-grade meningioma occurring more than 20 years after diagnosis. Full article

The advent of immune checkpoint inhibitors (ICIs) has revolutionized cancer treatment, significantly improving patient outcomes across multiple malignancies. Nonetheless, these therapies are associated with immune-related adverse effects, including cardiotoxicity, which remains a critical concern. This review provides a comprehensive analysis of ICI-related cardiotoxicity, encompassing its pathophysiological mechanisms, risk factors, diagnostic modalities, and management strategies. The onset of cardiotoxicity varies widely, ranging from acute myocarditis to long-term cardiovascular complications. Early identification through clinical assessment, biomarkers, and advanced imaging techniques is crucial for timely intervention. Management strategies include high-dose corticosteroids, other immunosuppressive agents, and supportive therapies, with a focus on balancing oncologic efficacy and cardiovascular safety. Additionally, rechallenging patients with ICIs following cardiotoxic events remains a complex clinical decision requiring multidisciplinary evaluation. As immunotherapy indications expand to include high-risk populations in a curative setting too, optimizing screening, prevention, and treatment strategies is essential to mitigate cardiovascular risks. A deep understanding of the molecular and clinical aspects of ICI-related cardiotoxicity will enhance patient safety and therapeutic decision-making, underscoring the need for ongoing research in this rapidly evolving field. Full article

Background: Awake craniotomy (AC) surgeries are less common in the pediatric population in comparison to their adult counterparts. Nonetheless, they can be considered for selected cases whereby speech preservation is paramount during maximal safe resection of intracranial lesions. We describe a case of AC for the excision of a brain arteriovenous malformation (bAVM) with language mapping in a pediatric patient. Methods: A previously well 16-year-old male presented with a spontaneous left frontal intracranial hemorrhage. Neuroimaging confirmed the cause to be a left antero-temporal bAVM centered in the insula. A decision was made for AC bAVM excision with language mapping for speech preservation. Results: As part of the pre-operative preparation, the patient and his caregivers were reviewed by a multidisciplinary team. For the conduct of the AC, the asleep–awake–asleep technique was used with processed EEG to guide anesthesia management. Additional modifications to make the patient comfortable included the avoidance of rigid cranial skull pins, urinary catheterization and central line insertion at the start of the surgery. Conclusions: Our experience concurs with the evidence that AC in children is a feasible option for select individuals. To our knowledge, this is the first detailed case description of a pediatric patient undergoing AC with language mapping for a bAVM. Emphases include a strong rapport between the patient and the managing multidisciplinary team, flexibility to adjust conventional workflows and limitations of neuroimaging adjuncts. Full article

Upper extremity amputations significantly impact an individual’s physical capabilities, psychosocial well-being, and overall quality of life. The level at which an amputation is performed influences residual limb function, prosthetic compatibility, and long-term patient satisfaction. While surgical guidelines traditionally emphasize maximal limb preservation, prosthetists often advocate for amputation sites that optimize prosthetic fit and function, highlighting the need for a collaborative approach. This review examines the discrepancies between surgical and prosthetic recommendations for optimal amputation levels, from digit amputations to shoulder disarticulations, and explores their implications for prosthetic design, functionality, and patient outcomes. Various prosthetic options, including passive functional, body-powered, myoelectric, and hybrid devices, offer distinct advantages and limitations based on the level of amputation. Prosthetists emphasize the importance of residual limb length, not only for mechanical efficiency but also for achieving symmetry with the contralateral limb, minimizing discomfort, and enhancing control. Additionally, emerging technologies such as targeted muscle reinnervation (TMR) and advanced myoelectric prostheses are reshaping rehabilitation strategies, further underscoring the need for precise amputation planning. By integrating insights from both surgical and prosthetic perspectives, this review highlights the necessity of a multidisciplinary approach involving surgeons, prosthetists, rehabilitation specialists, and patients in the decision-making process. A greater emphasis on preoperative planning and interprofessional collaboration can improve prosthetic outcomes, reduce device rejection rates, and ultimately enhance the functional independence and well-being of individuals with upper extremity amputations. Full article

Iterative decision making is deeply embedded in the design process of healthcare facilities. A significant body of literature and practices, most notably Evidence-based Design, explicitly seeks to better inform decisions as a key pathway to achieving improved outcomes. The objective of this systematic review is to explore multiple dimensions of decision making in the healthcare design literature, including interprofessional stakeholder engagement, decision flow elements, and multidisciplinary methodologies aimed at improving decision quality during healthcare facility design processes. This review offers a comprehensive review of 114 papers from the Web of Science, CINAHL, MEDLINE, and Art and Architecture Source. Decisions made during healthcare facility design processes are characterized as complex, highly interdependent, and difficult to reverse with significant implications for human and operational outcomes. The published literature emphasizes decision support generated from ex ante or ex post research. Despite numerous references to the importance of decision making, there are considerable gaps in the study of interprofessional group decision-making dynamics. The adoption and application of decision analysis tools and integrated decision flows are emerging. This review synthesizes current perspectives and methods aimed at improving decision making during the design of healthcare facilities and proposes a potential framework for future investigations of design decision quality. Full article

Background: The management of difficult airways is one of the most critical and challenging aspects of emergency and ICU care. Despite technological advances, unanticipated airway difficulty can result in serious complications, including hypoxia, brain injury, and death. This comprehensive narrative review aims to consolidate current algorithms and evidence-based strategies to guide clinicians in the assessment and management of difficult airways. Methods: A comprehensive literature review was conducted using PubMed, Embase, and Google Scholar to identify relevant studies, clinical guidelines, and expert consensus documents related to difficult airway management. The focus was placed on both pre-intubation assessment tools and intervention strategies used in various clinical contexts. Results: Airway difficulty is best anticipated through a combination of history, physical examination, and validated tools such as the Mallampati score. Several algorithms, including those from the American Society of Anesthesiologists (ASA) and the Difficult Airway Society (DAS), provide structured approaches that emphasize preoxygenation, preparedness for failed intubation, and the use of adjuncts such as video laryngoscopy, supraglottic airway devices, and awake intubation techniques. Crisis algorithms such as the Vortex approach help simplify decision-making during emergencies. It is important to have adjuncts available in cases of anticipated difficult airways, such as fiberoptic intubation, while surgical airway access is an important component of a stepwise airway management algorithm when critical scenarios are encountered. Conclusions: Effective difficult airway management requires anticipation, a structured plan, familiarity with advanced airway tools, and adherence to validated algorithms. Training in crisis resource management and multidisciplinary rehearsal of airway scenarios are essential to improving outcomes. Full article

Aim: This study aimed to explore the attitudes of family caregivers toward truth-telling practices in palliative care in Türkiye, a Muslim-majority context where disclosure is often mediated by relatives. Methods: Using a convergent parallel mixed-methods design, data were collected from 100 unpaid family caregivers of terminally ill patients at a palliative care unit. Quantitative data were gathered via a structured questionnaire, and qualitative data through in-depth interviews with a purposively selected subsample of 10 participants. Chi-square tests were used to analyze associations, and p < 0.05 was considered statistically significant. Results: The mean age of caregivers was 47.4 ± 16.5 years, 67% were female. Notably, 67% of participants did not prefer that the patient be informed of irreversible deterioration, while 71% stated they would want to be informed if they were in the patient’s position (p < 0.05). Most preferred a multidisciplinary disclosure process involving physicians, psychologists, and spiritual counselors. Qualitative analysis revealed four themes: emotional conflict, protective family-centered decision-making, spiritual readiness for death, and preference for multidisciplinary communication approach. The participants expressed cultural concerns about psychological harm to the patient and emphasized the family’s role as emotional guardians. Conclusions: The findings highlight a gap between caregivers’ attitudes when acting as family members versus imagining themselves as patients. These results underscore the critical need for culturally sensitive and family-inclusive communication strategies in palliative care settings. Full article

Purpose: The objective of this study was to evaluate the implementation of a Multidisciplinary Tumor Board (MDTB) strategy in the treatment of patients with uveal melanoma. Methods: A retrospective analysis was conducted on the implementation of MDTB meetings over a 24-month period. During this time, 72 intraocular tumors were discussed, including 59 confirmed cases of uveal melanoma. The MDTB involved a core group of specialists (e.g., ophthalmologists, oncologists, and radiologists), with other experts included when clinically appropriate. To assess patient satisfaction with the MDTB approach, a structured questionnaire was administered, including items on clarity of communication, perceived quality of care, and overall satisfaction, which were ranked on a 5-point scale. Results: A total of 319 patients with ocular, periocular, or orbital tumors were discussed during the study period, of which, 72 had intraocular tumors. A total of 13 (18%) were diagnosed to have choroidal metastases, whereas 59 (82%) had uveal melanomas. The average time between patient care and MDTB discussion was 15.9 days (IQR: 7.5–16.5). The mean time between the case discussion and the implementation of recommendations (diagnostic, therapeutic, or referral decisions) was 14.8 days (IQR: 6.0–23.75). Overall, 4 (7%) patients were classified as Stage I, 16 (27%) as Stage IIa, 18 (31%) as Stage IIb, 7 (12%) as Stage IIIa, 2 (3%) as Stage IIIb, and 12 (20%) as Stage IV. Regarding the satisfaction questionnaire, all patients (100%) agreed to have the clinical case discussed at the TB even though this could result in a delay in diagnostic/therapeutic implementation. However, only 60% of patients perceived they had been directly involved in the decision-making process. Conclusions: In selected cases of uveal melanoma and other types of cancer, MDTBs should be recognized as a gold standard in cancer care, allowing for comprehensive decision-making that draws on a wide range of highly specialized expertise. Full article

Oncoplastic breast-conserving surgery (OBCS), or oncoplastic surgery, has revolutionized the surgical management of breast cancer by integrating oncologic principles with reconstructive techniques to optimize both cancer control and aesthetic outcomes following breast-conserving surgery (BCS). Since its inception in the 1980s, the field has evolved significantly, incorporating a range of volume displacement and volume replacement strategies to restore breast contour after partial mastectomy. This review explores the current practices and key surgical considerations of OBCS. It highlights the role of preoperative multidisciplinary planning, patient selection, anatomical and vascular knowledge, and intraoperative technique in optimizing results. Barriers to access—including disparities in training, insurance, and geographic availability—are addressed, alongside efforts by professional societies like the American Society of Breast Surgeons (ASBS) to standardize definitions and practices. The review also outlines strategies for minimizing complications and enhancing oncologic, reconstructive, and patient-reported outcomes. By offering a comprehensive framework for clinical decision-making, this paper aims to support broader adoption and refinement of OBCS as a standard component of breast cancer care. Full article

A conflict is a situation where multiple stakeholders have different evaluations over possible scenarios or states. Conflict analysis is an essential tool for understanding and resolving complex conflicts, especially in scenarios involving multiple stakeholders and uncertainties. Confrontation analysis (ConAna) and graph model for conflict resolution (GMCR) have been integrated for dilemma reasoning and conflict resolution in region crisis analysis. This paper discusses the application of decision-theoretic rough sets (DTRS) to three-way decisions (3WD) in dilemma reasoning and conflict resolution. Three-way decisions are a strategy for making decisions under uncertain conditions, which compensates for the shortcomings of traditional two-way decisions (such as accept or reject) by introducing a “delayed decision” option. In terms of dilemma reasoning, we try to address incomplete or conflicting information and provide a more reasonable decision path for decision-makers through comprehensive evaluation of multi-criteria. In terms of conflict resolution, the DTRS model seeks a compromising solution that is acceptable to all parties by analyzing the game relationship between different stakeholders. The DTRS model combines decision-making theory and rough set theory to determine the balanced decision region by constructing a game between multiple criteria. This dynamic integration is of great significance for the study of complex international conflicts, providing a cross-disciplinary perspective for related research. In this paper, we demonstrate the application of DTRS in 3WD and discuss the relationship between DTRS and probabilistic rough sets. The research shows that the DTRS model has significant advantages in dealing with complex decision problems and can effectively deal with the conflicts and uncertainties in multi-criteria decision-making. Full article

Postamputation pain (PAP), including residual limb pain (RLP) and phantom limb pain (PLP), remains a significant and debilitating complication after limb loss. Despite advances in pharmacological management, many patients experience inadequate pain relief, underscoring the need for alternative therapeutic strategies. Objective: This narrative review critically synthesizes current interventional therapies for PAP, focusing on mechanisms, clinical efficacy and practical application. Methods: A literature search was conducted in PubMed, EMBASE, Scopus and Web of Science databases for studies published between 2015 and 2025. Relevant articles on peripheral nerve interventions as well as different neuromodulation techniques were included. Results: Peripheral interventions (such as alcohol neurolysis, radiofrequency ablation (RFA) and cryoneurolysis (CNL)) and neuromodulation techniques (including spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation and cauda equina stimulation (CES)) demonstrate promising outcomes for PAP. Peripheral nerve stimulation (PNS) shows favorable safety and efficacy profiles and may help prevent the chronification of pain. Conclusions: Contemporary interventional therapies represent valuable options in the multidisciplinary management of PAP. Nevertheless, further research is required to standardize clinical algorithms, optimize therapeutic decision-making and improve long-term outcomes and quality of life for individuals with PAP. Full article

As global energy consumption continues to rise, it is essential to adopt measures that regulate electricity use while still meeting the demands of modern society. These efforts align with the United Nations Sustainable Development Goals and are supported by various organizations. This study applies a methodology that combines the implementation of a Level 2 Energy Audit with the evaluation of the Electricity Consumption Index (ECI) at the Department of English of the Multidisciplinary Academic Unit of the Altiplano Region, Universidad Autónoma de San Luis Potosí. The study identifies strategies to reduce electricity consumption related to lighting systems and equipment operation throughout the department. Additionally, it assesses the percentage of users who promote and practice energy-saving habits. Key recommendations include transitioning the lighting system to LED technology, expected to reduce electricity consumption by 15, and implementing power factor correction measures, projected to yield an additional 6.17% in energy and cost savings. Together, these strategies could result in an estimated annual electricity savings of 21.17%, making them attractive to institutional decision-makers. Furthermore, by comparing the department’s ECI with a reference index established for educational institutions in temperate climate regions of Mexico, the study determines whether the proposed strategies should be implemented immediately or planned for the medium to long term. This decision-making framework represents the main contribution of the case study. Full article