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Zare S, Meidani Z, Ouhadian M, Akbari H, Zand F, Fakharian E, Sharifian R. Identification of data elements for blood gas analysis dataset: a base for developing registries and artificial intelligence-based systems. BMC Health Serv Res 2022; 22:317. [PMID: 35260155 PMCID: PMC8902269 DOI: 10.1186/s12913-022-07706-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Background One of the challenging decision-making tasks in healthcare centers is the interpretation of blood gas tests. One of the most effective assisting approaches for the interpretation of blood gas analysis (BGA) can be artificial intelligence (AI)-based decision support systems. A primary step to develop intelligent systems is to determine information requirements and automated data input for the secondary analyses. Datasets can help the automated data input from dispersed information systems. Therefore, the current study aimed to identify the data elements required for supporting BGA as a dataset. Materials and methods This cross-sectional descriptive study was conducted in Nemazee Hospital, Shiraz, Iran. A combination of literature review, experts’ consensus, and the Delphi technique was used to develop the dataset. A review of the literature was performed on electronic databases to find the dataset for BGA. An expert panel was formed to discuss on, add, or remove the data elements extracted through searching the literature. Delphi technique was used to reach consensus and validate the draft dataset. Results The data elements of the BGA dataset were categorized into ten categories, namely personal information, admission details, present illnesses, past medical history, social status, physical examination, paraclinical investigation, blood gas parameter, sequential organ failure assessment (SOFA) score, and sampling technique errors. Overall, 313 data elements, including 172 mandatory and 141 optional data elements were confirmed by the experts for being included in the dataset. Conclusions We proposed a dataset as a base for registries and AI-based systems to assist BGA. It helps the storage of accurate and comprehensive data, as well as integrating them with other information systems. As a result, high-quality care is provided and clinical decision-making is improved.
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Affiliation(s)
- Sahar Zare
- Health Information Management Research Center (HIMRC), Kashan University of Medical Sciences, Kashan, Iran
| | - Zahra Meidani
- Health Information Management Research Center (HIMRC), Kashan University of Medical Sciences, Kashan, Iran.,Department of Health Information Management & Technology, School of Allied Health Professions, Kashan University of Medical Sciences, Kashan, Iran
| | - Maryam Ouhadian
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hosein Akbari
- Department of Epidemiology and Biostatistics, School of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Farid Zand
- Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Department of Anesthesia and Critical Care Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Esmaeil Fakharian
- Department of Neurosurgery, Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Roxana Sharifian
- Health Human Resources Research Center, Department of Health Information Management and Technology, Shiraz University of Medical Sciences, Shiraz, Iran
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van de Sande D, Van Genderen ME, Smit JM, Huiskens J, Visser JJ, Veen RER, van Unen E, Ba OH, Gommers D, Bommel JV. Developing, implementing and governing artificial intelligence in medicine: a step-by-step approach to prevent an artificial intelligence winter. BMJ Health Care Inform 2022; 29:bmjhci-2021-100495. [PMID: 35185012 PMCID: PMC8860016 DOI: 10.1136/bmjhci-2021-100495] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/24/2022] [Indexed: 12/23/2022] Open
Abstract
Objective Although the role of artificial intelligence (AI) in medicine is increasingly studied, most patients do not benefit because the majority of AI models remain in the testing and prototyping environment. The development and implementation trajectory of clinical AI models are complex and a structured overview is missing. We therefore propose a step-by-step overview to enhance clinicians’ understanding and to promote quality of medical AI research. Methods We summarised key elements (such as current guidelines, challenges, regulatory documents and good practices) that are needed to develop and safely implement AI in medicine. Conclusion This overview complements other frameworks in a way that it is accessible to stakeholders without prior AI knowledge and as such provides a step-by-step approach incorporating all the key elements and current guidelines that are essential for implementation, and can thereby help to move AI from bytes to bedside.
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Affiliation(s)
- Davy van de Sande
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michel E Van Genderen
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jim M Smit
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.,Pattern Recognition and Bioinformatics group, EEMCS, Delft University of Technology, Delft, The Netherlands
| | | | - Jacob J Visser
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Information Technology, Chief Medical Information Officer, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert E R Veen
- Department of Information Technology, theme Research Suite, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Oliver Hilgers Ba
- Active Medical Devices/Medical Device Software, CE Plus GmbH, Badenweiler, Germany
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jasper van Bommel
- Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands
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53
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Bertini A, Salas R, Chabert S, Sobrevia L, Pardo F. Using Machine Learning to Predict Complications in Pregnancy: A Systematic Review. Front Bioeng Biotechnol 2022; 9:780389. [PMID: 35127665 PMCID: PMC8807522 DOI: 10.3389/fbioe.2021.780389] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/10/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: Artificial intelligence is widely used in medical field, and machine learning has been increasingly used in health care, prediction, and diagnosis and as a method of determining priority. Machine learning methods have been features of several tools in the fields of obstetrics and childcare. This present review aims to summarize the machine learning techniques to predict perinatal complications.Objective: To identify the applicability and performance of machine learning methods used to identify pregnancy complications.Methods: A total of 98 articles were obtained with the keywords “machine learning,” “deep learning,” “artificial intelligence,” and accordingly as they related to perinatal complications (“complications in pregnancy,” “pregnancy complications”) from three scientific databases: PubMed, Scopus, and Web of Science. These were managed on the Mendeley platform and classified using the PRISMA method.Results: A total of 31 articles were selected after elimination according to inclusion and exclusion criteria. The features used to predict perinatal complications were primarily electronic medical records (48%), medical images (29%), and biological markers (19%), while 4% were based on other types of features, such as sensors and fetal heart rate. The main perinatal complications considered in the application of machine learning thus far are pre-eclampsia and prematurity. In the 31 studies, a total of sixteen complications were predicted. The main precision metric used is the AUC. The machine learning methods with the best results were the prediction of prematurity from medical images using the support vector machine technique, with an accuracy of 95.7%, and the prediction of neonatal mortality with the XGBoost technique, with 99.7% accuracy.Conclusion: It is important to continue promoting this area of research and promote solutions with multicenter clinical applicability through machine learning to reduce perinatal complications. This systematic review contributes significantly to the specialized literature on artificial intelligence and women’s health.
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Affiliation(s)
- Ayleen Bertini
- Metabolic Diseases Research Laboratory (MDRL), Interdisciplinary Center for Research in Territorial Health of the Aconcagua Valley (CIISTe Aconcagua), Center for Biomedical Research (CIB), Universidad de Valparaíso, Valparaiso, Chile
- PhD Program Doctorado en Ciencias e Ingeniería para La Salud, Faculty of Medicine, Universidad de Valparaíso, Valparaiso, Chile
| | - Rodrigo Salas
- School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Valparaiso, Chile
- Centro de Investigación y Desarrollo en INGeniería en Salud – CINGS, Universidad de Valparaíso, Valparaiso, Chile
- Instituto Milenio Intelligent Healthcare Engineering, Valparaíso, Chile
| | - Steren Chabert
- School of Biomedical Engineering, Faculty of Engineering, Universidad de Valparaíso, Valparaiso, Chile
- Centro de Investigación y Desarrollo en INGeniería en Salud – CINGS, Universidad de Valparaíso, Valparaiso, Chile
- Instituto Milenio Intelligent Healthcare Engineering, Valparaíso, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Department of Physiology, Faculty of Pharmacy, Universidad de Sevilla, Seville, Spain
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine and Biomedical Sciences, University of Queensland, Herston, QLD, Australia
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
- Medical School (Faculty of Medicine), São Paulo State University (UNESP), São Paulo, Brazil
- Tecnologico de Monterrey, Eutra, The Institute for Obesity Research, School of Medicine and Health Sciences, Monterrey, Mexico
| | - Fabián Pardo
- Metabolic Diseases Research Laboratory (MDRL), Interdisciplinary Center for Research in Territorial Health of the Aconcagua Valley (CIISTe Aconcagua), Center for Biomedical Research (CIB), Universidad de Valparaíso, Valparaiso, Chile
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynaecology, School of Medicine, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- School of Medicine, Campus San Felipe, Faculty of Medicine, Universidad de Valparaíso, San Felipe, Chile
- *Correspondence: Fabián Pardo,
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Okawa T, Mizuno T, Hanabusa S, Ikeda T, Mizokami F, Koseki T, Takahashi K, Yuzawa Y, Tsuboi N, Yamada S, Kameya Y. Prediction model of acute kidney injury induced by cisplatin in older adults using a machine learning algorithm. PLoS One 2022; 17:e0262021. [PMID: 35041690 PMCID: PMC8765666 DOI: 10.1371/journal.pone.0262021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/15/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early detection and prediction of cisplatin-induced acute kidney injury (Cis-AKI) are essential for the management of patients on chemotherapy with cisplatin. This study aimed to evaluate the performance of a prediction model for Cis-AKI. METHODS Japanese patients, who received cisplatin as the first-line chemotherapy at Fujita Health University Hospital, were enrolled in the study. The main metrics for evaluating the machine learning model were the area under the curve (AUC), accuracy, precision, recall, and F-measure. In addition, the rank of contribution as a predictive factor of Cis-AKI was determined by machine learning. RESULTS A total of 1,014 and 226 patients were assigned to the development and validation data groups, respectively. The current prediction model showed the highest performance in patients 65 years old and above (AUC: 0.78, accuracy: 0.77, precision: 0.38, recall: 0.70, F-measure: 0.49). The maximum daily cisplatin dose and serum albumin levels contributed the most to the prediction of Cis-AKI. CONCLUSION Our prediction model for Cis-AKI performed effectively in older patients.
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Affiliation(s)
- Takaya Okawa
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomohiro Mizuno
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shogo Hanabusa
- Department of Information Engineering, Meijo University, Nagoya, Japan
| | - Takeshi Ikeda
- Department of Information Engineering, Meijo University, Nagoya, Japan
| | - Fumihiro Mizokami
- Department of Pharmacy, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Takenao Koseki
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kazuo Takahashi
- Department of Biomedical Molecular Sciences, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yukio Yuzawa
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Naotake Tsuboi
- Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shigeki Yamada
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Toyoake, Japan
| | - Yoshitaka Kameya
- Department of Information Engineering, Meijo University, Nagoya, Japan
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Abstract
This article deals with the optimization of the operation of hybrid microgrids. Both the problem of controlling the management of load sharing between the different generators and energy storage and possible solutions for the integration of the microgrid into the electricity market will be discussed. Solar and wind energy as well as hybrid storage with hydrogen, as renewable sources, will be considered, which allows management of the energy balance on different time scales. The Machine Learning method of Decision Trees, combined with ensemble methods, will also be introduced to study the optimization of microgrids. The conclusions obtained indicate that the development of suitable controllers can facilitate a competitive participation of renewable energies and the integration of microgrids in the electricity system.
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Precision Medicine for Hypertension Patients with Type 2 Diabetes via Reinforcement Learning. J Pers Med 2022; 12:jpm12010087. [PMID: 35055402 PMCID: PMC8781402 DOI: 10.3390/jpm12010087] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 11/25/2022] Open
Abstract
Precision medicine is a new approach to understanding health and disease based on patient-specific data such as medical diagnoses; clinical phenotype; biologic investigations such as laboratory studies and imaging; and environmental, demographic, and lifestyle factors. The importance of machine learning techniques in healthcare has expanded quickly in the last decade owing to the rising availability of vast multi-modality data and developed computational models and algorithms. Reinforcement learning is an appealing method for developing efficient policies in various healthcare areas where the decision-making process is typically defined by a long period or a sequential process. In our research, we leverage the power of reinforcement learning and electronic health records of South Koreans to dynamically recommend treatment prescriptions, which are personalized based on patient information of hypertension. Our proposed reinforcement learning-based treatment recommendation system decides whether to use mono, dual, or triple therapy according to the state of the hypertension patients. We evaluated the performance of our personalized treatment recommendation model by lowering the occurrence of hypertension-related complications and blood pressure levels of patients who followed our model’s recommendation. With our findings, we believe that our proposed hypertension treatment recommendation model could assist doctors in prescribing appropriate antihypertensive medications.
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Olivato M, Rossetti N, Gerevini AE, Chiari M, Putelli L, Serina I. Machine Learning Models for Predicting Short-Long Length of Stay of COVID-19 Patients. PROCEDIA COMPUTER SCIENCE 2022; 207:1232-1241. [PMID: 36275377 PMCID: PMC9578942 DOI: 10.1016/j.procs.2022.09.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
During 2020 and 2021, managing limited healthcare resources and hospital beds has been a fundamental aspect of the fight against the COVID-19 pandemic. Predicting in advance the length of stay, and in particular identifying whether a patient is going to stay in the hospital longer or less than a week, can provide important support in handling resources allocation. However, there have been significant changes in terms of containment measures, virus diffusion, new treatments, vaccines, and new variants of SARS-CoV-2 during the last period. These changes pose several conceptual drift issues that can limit the usefulness of machine learning in this context. In this work, we present a machine learning system trained and tested using data from more than 6000 hospitalised patients in northern Italy, distributed over almost two years of pandemic. We show how machine learning can be effective even by analysing data over this long period of time, also exploiting a model that predicts the patient's outcome in terms of discharge or death. Furthermore, learning from data that also consider deceased patients is a common issue in predicting the length of stay because they have severe conditions similar to patients with a long stay period, but may actually have a very short duration of hospitalisation. For this purpose, we present a method for handling data from alive and deceased patients, exploiting more patient records, increasing the robustness of the model and its performance in this task. Finally, we investigate the features that are most relevant to the prediction of the simplified length of stay.
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Affiliation(s)
- Matteo Olivato
- Università degli Studi di Brescia, Via Branze 38, Brescia, Italy
| | | | | | - Mattia Chiari
- Università degli Studi di Brescia, Via Branze 38, Brescia, Italy
| | - Luca Putelli
- Università degli Studi di Brescia, Via Branze 38, Brescia, Italy
| | - Ivan Serina
- Università degli Studi di Brescia, Via Branze 38, Brescia, Italy
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Iaboni A, Spasojevic S, Newman K, Schindel Martin L, Wang A, Ye B, Mihailidis A, Khan SS. Wearable multimodal sensors for the detection of behavioral and psychological symptoms of dementia using personalized machine learning models. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2022; 14:e12305. [PMID: 35496371 PMCID: PMC9043905 DOI: 10.1002/dad2.12305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 11/15/2022]
Abstract
Introduction Behavioral and psychological symptoms of dementia (BPSD) signal distress or unmet needs and present a risk to people with dementia and their caregivers. Variability in the expression of these symptoms is a barrier to the performance of digital biomarkers. The aim of this study was to use wearable multimodal sensors to develop personalized machine learning models capable of detecting individual patterns of BPSD. Methods Older adults with dementia and BPSD (n = 17) on a dementia care unit wore a wristband during waking hours for up to 8 weeks. The wristband captured motion (accelerometer) and physiological indicators (blood volume pulse, electrodermal activity, and skin temperature). Agitation or aggression events were tracked, and research staff reviewed videos to precisely annotate the sensor data. Personalized machine learning models were developed using 1‐minute intervals and classifying the presence of behavioral symptoms, and behavioral symptoms by type (motor agitation, verbal aggression, or physical aggression). Results Behavioral events were rare, representing 3.4% of the total data. Personalized models classified behavioral symptoms with a median area under the receiver operating curve (AUC) of 0.87 (range 0.64–0.95). The relative importance of the different sensor features to the predictive models varied both by individual and behavior type. Discussion Patterns of sensor data associated with BPSD are highly individualized, and future studies of the digital phenotyping of these behaviors would benefit from personalization.
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Affiliation(s)
- Andrea Iaboni
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Psychiatry University of Toronto Toronto Ontario Canada
| | - Sofija Spasojevic
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Kristine Newman
- Daphne Cockwell School of Nursing, Ryerson University Toronto Ontario Canada
| | | | - Angel Wang
- Daphne Cockwell School of Nursing, Ryerson University Toronto Ontario Canada
| | - Bing Ye
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Alex Mihailidis
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Department of Occupational Science and Occupational Therapy University of Toronto Toronto Ontario Canada
| | - Shehroz S. Khan
- KITE Research Institute Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
- Institute of Biomaterials & Biomedical Engineering University of Toronto Toronto Ontario Canada
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A Machine Learning Model for Predicting Unscheduled 72 h Return Visits to the Emergency Department by Patients with Abdominal Pain. Diagnostics (Basel) 2021; 12:diagnostics12010082. [PMID: 35054249 PMCID: PMC8775134 DOI: 10.3390/diagnostics12010082] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 12/28/2021] [Accepted: 12/29/2021] [Indexed: 12/12/2022] Open
Abstract
Seventy-two-hour unscheduled return visits (URVs) by emergency department patients are a key clinical index for evaluating the quality of care in emergency departments (EDs). This study aimed to develop a machine learning model to predict 72 h URVs for ED patients with abdominal pain. Electronic health records data were collected from the Chang Gung Research Database (CGRD) for 25,151 ED visits by patients with abdominal pain and a total of 617 features were used for analysis. We used supervised machine learning models, namely logistic regression (LR), support vector machine (SVM), random forest (RF), extreme gradient boosting (XGB), and voting classifier (VC), to predict URVs. The VC model achieved more favorable overall performance than other models (AUROC: 0.74; 95% confidence interval (CI), 0.69–0.76; sensitivity, 0.39; specificity, 0.89; F1 score, 0.25). The reduced VC model achieved comparable performance (AUROC: 0.72; 95% CI, 0.69–0.74) to the full models using all clinical features. The VC model exhibited the most favorable performance in predicting 72 h URVs for patients with abdominal pain, both for all-features and reduced-features models. Application of the VC model in the clinical setting after validation may help physicians to make accurate decisions and decrease URVs.
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Singh J, Sato M, Ohkuma T. On Missingness Features in Machine Learning Models for Critical Care: Observational Study. JMIR Med Inform 2021; 9:e25022. [PMID: 34889756 PMCID: PMC8701717 DOI: 10.2196/25022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 02/17/2021] [Accepted: 09/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background Missing data in electronic health records is inevitable and considered to be nonrandom. Several studies have found that features indicating missing patterns (missingness) encode useful information about a patient’s health and advocate for their inclusion in clinical prediction models. But their effectiveness has not been comprehensively evaluated. Objective The goal of the research is to study the effect of including informative missingness features in machine learning models for various clinically relevant outcomes and explore robustness of these features across patient subgroups and task settings. Methods A total of 48,336 electronic health records from the 2012 and 2019 PhysioNet Challenges were used, and mortality, length of stay, and sepsis outcomes were chosen. The latter dataset was multicenter, allowing external validation. Gated recurrent units were used to learn sequential patterns in the data and classify or predict labels of interest. Models were evaluated on various criteria and across population subgroups evaluating discriminative ability and calibration. Results Generally improved model performance in retrospective tasks was observed on including missingness features. Extent of improvement depended on the outcome of interest (area under the curve of the receiver operating characteristic [AUROC] improved from 1.2% to 7.7%) and even patient subgroup. However, missingness features did not display utility in a simulated prospective setting, being outperformed (0.9% difference in AUROC) by the model relying only on pathological features. This was despite leading to earlier detection of disease (true positives), since including these features led to a concomitant rise in false positive detections. Conclusions This study comprehensively evaluated effectiveness of missingness features on machine learning models. A detailed understanding of how these features affect model performance may lead to their informed use in clinical settings especially for administrative tasks like length of stay prediction where they present the greatest benefit. While missingness features, representative of health care processes, vary greatly due to intra- and interhospital factors, they may still be used in prediction models for clinically relevant outcomes. However, their use in prospective models producing frequent predictions needs to be explored further.
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Diéguez-Santana K, González-Díaz H. Towards machine learning discovery of dual antibacterial drug-nanoparticle systems. NANOSCALE 2021; 13:17854-17870. [PMID: 34671801 DOI: 10.1039/d1nr04178a] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Artificial Intelligence/Machine Learning (AI/ML) algorithms may speed up the design of DADNP systems formed by Antibacterial Drugs (AD) and Nanoparticles (NP). In this work, we used IFPTML = Information Fusion (IF) + Perturbation-Theory (PT) + Machine Learning (ML) algorithm for the first time to study of a large dataset of putative DADNP systems composed by >165 000 ChEMBL AD assays and 300 NP assays vs. multiple bacteria species. We trained alternative models with Linear Discriminant Analysis (LDA), Artificial Neural Networks (ANN), Bayesian Networks (BNN), K-Nearest Neighbour (KNN) and other algorithms. IFPTML-LDA model was simpler with values of Sp ≈ 90% and Sn ≈ 74% in both training (>124 K cases) and validation (>41 K cases) series. IFPTML-ANN and KNN models are notably more complicated even when they are more balanced Sn ≈ Sp ≈ 88.5%-99.0% and AUROC ≈ 0.94-0.99 in both series. We also carried out a simulation (>1900 calculations) of the expected behavior for putative DADNPs in 72 different biological assays. The putative DADNPs studied are formed by 27 different drugs with multiple classes of NP and types of coats. In addition, we tested the validity of our additive model with 80 DADNP complexes experimentally synthetized and biologically tested (reported in >45 papers). All these DADNPs show values of MIC < 50 μg mL-1 (cutoff used) better that MIC of AD and NP alone (synergistic or additive effect). The assays involve DADNP complexes with 10 types of NP, 6 coating materials, NP size range 5-100 nm vs. 15 different antibiotics, and 12 bacteria species. The IFPTML-LDA model classified correctly 100% (80 out of 80) DADNP complexes as biologically active. IFPMTL additive strategy may become a useful tool to assist the design of DADNP systems for antibacterial therapy taking into consideration only information about AD and NP components by separate.
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Affiliation(s)
- Karel Diéguez-Santana
- Department of Organic and Inorganic Chemistry, University of Basque Country UPV/EHU, 48940 Leioa, Spain
| | - Humberto González-Díaz
- Department of Organic and Inorganic Chemistry, University of Basque Country UPV/EHU, 48940 Leioa, Spain
- Basque Center for Biophysics CSIC-UPVEH, University of Basque Country UPV/EHU, 48940 Leioa, Spain.
- IKERBASQUE, Basque Foundation for Science, 48011 Bilbao, Biscay, Spain
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Falconer N, Abdel-Hafez A, Scott IA, Marxen S, Canaris S, Barras M. Systematic review of machine learning models for personalised dosing of heparin. Br J Clin Pharmacol 2021; 87:4124-4139. [PMID: 33835524 DOI: 10.1111/bcp.14852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022] Open
Abstract
AIM To identify and critically appraise studies of prediction models, developed using machine learning (ML) methods, for determining the optimal dosing of unfractionated heparin (UFH). METHODS Embase, PubMed, CINAHL, Web of Science, International Pharmaceutical Abstracts and IEEE Xplore databases were searched from inception to 31 January 2020 to identify relevant studies using key search terms synonymous with artificial intelligence or ML, 'prediction', 'dose', 'activated partial thromboplastin time (aPTT)' and 'UFH.' Studies had to have used ML methods for developing models that predicted optimal dose of UFH or target therapeutic aPTT levels in the hospital setting. The CHARMS Checklist was used to assess quality and risk of bias of included studies. RESULTS Of 8393 retrieved abstracts, 61 underwent full text review and eight studies met inclusion criteria. Four studies described models for predicting aPTT, three studies described models predicting optimal dose of heparin during dialysis and one study described a model that used surrogate outcomes of clotting and bleeding to predict a therapeutic aPTT. Studies varied widely in reporting of study participants, feature characterisation and selection, handling of missing data, sample size calculations and the intended clinical application of the model. Only one study conducted an external validation and no studies evaluated model impacts in clinical practice. CONCLUSION Studies of ML models for UFH dosing are few and none report a model ready for routine clinical use. Existing studies are limited by low methodological quality, inadequate reporting of study factors and absence of external validation and impact analysis.
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Affiliation(s)
- Nazanin Falconer
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Queensland, 4102, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, 4102, Australia
- Centre for Health Services Research, The University of Queensland, Level two, Building 33, Princess Alexandra Hospital, Brisbane, 4102, Australia
| | - Ahmad Abdel-Hafez
- Clinical Informatics, Princess Alexandra Hospital, Brisbane, Queensland, 4102, Australia
| | - Ian A Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- School of Clinical Medicine, Faculty of Medicine, The University of Queensland, 4102, Australia
| | - Sven Marxen
- Department of Pharmacy, Logan and Beaudesert Hospitals, Meadowbrook, Metro South Health, Brisbane, QLD, 4131, Australia
| | - Stephen Canaris
- Clinical Informatics, Princess Alexandra Hospital, Brisbane, Queensland, 4102, Australia
| | - Michael Barras
- Department of Pharmacy, Princess Alexandra Hospital, Brisbane, Queensland, 4102, Australia
- School of Pharmacy, The University of Queensland, Brisbane, Queensland, 4102, Australia
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Machine Learning Prediction Models for Mortality in Intensive Care Unit Patients with Lactic Acidosis. J Clin Med 2021; 10:jcm10215021. [PMID: 34768540 PMCID: PMC8584535 DOI: 10.3390/jcm10215021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/24/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Lactic acidosis is the most common cause of anion gap metabolic acidosis in the intensive care unit (ICU), associated with poor outcomes including mortality. We sought to compare machine learning (ML) approaches versus logistic regression analysis for prediction of mortality in lactic acidosis patients admitted to the ICU. Methods: We used the Medical Information Mart for Intensive Care (MIMIC-III) database to identify ICU adult patients with lactic acidosis (serum lactate ≥4 mmol/L). The outcome of interest was hospital mortality. We developed prediction models using four ML approaches consisting of random forest (RF), decision tree (DT), extreme gradient boosting (XGBoost), artificial neural network (ANN), and statistical modeling with forward stepwise logistic regression using the testing dataset. We then assessed model performance using area under the receiver operating characteristic curve (AUROC), accuracy, precision, error rate, Matthews correlation coefficient (MCC), F1 score, and assessed model calibration using the Brier score, in the independent testing dataset. Results: Of 1919 lactic acidosis ICU patients, 1535 and 384 were included in the training and testing dataset, respectively. Hospital mortality was 30%. RF had the highest AUROC at 0.83, followed by logistic regression 0.81, XGBoost 0.81, ANN 0.79, and DT 0.71. In addition, RF also had the highest accuracy (0.79), MCC (0.45), F1 score (0.56), and lowest error rate (21.4%). The RF model was the most well-calibrated. The Brier score for RF, DT, XGBoost, ANN, and multivariable logistic regression was 0.15, 0.19, 0.18, 0.19, and 0.16, respectively. The RF model outperformed multivariable logistic regression model, SOFA score (AUROC 0.74), SAP II score (AUROC 0.77), and Charlson score (AUROC 0.69). Conclusion: The ML prediction model using RF algorithm provided the highest predictive performance for hospital mortality among ICU patient with lactic acidosis.
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Williams S, Layard Horsfall H, Funnell JP, Hanrahan JG, Khan DZ, Muirhead W, Stoyanov D, Marcus HJ. Artificial Intelligence in Brain Tumour Surgery-An Emerging Paradigm. Cancers (Basel) 2021; 13:cancers13195010. [PMID: 34638495 PMCID: PMC8508169 DOI: 10.3390/cancers13195010] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/02/2021] [Accepted: 10/03/2021] [Indexed: 01/01/2023] Open
Abstract
Artificial intelligence (AI) platforms have the potential to cause a paradigm shift in brain tumour surgery. Brain tumour surgery augmented with AI can result in safer and more effective treatment. In this review article, we explore the current and future role of AI in patients undergoing brain tumour surgery, including aiding diagnosis, optimising the surgical plan, providing support during the operation, and better predicting the prognosis. Finally, we discuss barriers to the successful clinical implementation, the ethical concerns, and we provide our perspective on how the field could be advanced.
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Affiliation(s)
- Simon Williams
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
- Correspondence:
| | - Hugo Layard Horsfall
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Jonathan P. Funnell
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - John G. Hanrahan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Danyal Z. Khan
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - William Muirhead
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Danail Stoyanov
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
| | - Hani J. Marcus
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London WC1N 3BG, UK; (H.L.H.); (J.P.F.); (J.G.H.); (D.Z.K.); (W.M.); (H.J.M.)
- Wellcome/Engineering and Physical Sciences Research Council (EPSRC) Centre for Interventional and Surgical Sciences (WEISS), London W1W 7TY, UK;
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Abstract
Supplemental Digital Content is available in the text. Pao2 is the gold standard to assess acute hypoxic respiratory failure, but it is only routinely available by intermittent spot checks, precluding any automatic continuous analysis for bedside tools.
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66
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Alami H, Lehoux P, Denis JL, Motulsky A, Petitgand C, Savoldelli M, Rouquet R, Gagnon MP, Roy D, Fortin JP. Organizational readiness for artificial intelligence in health care: insights for decision-making and practice. J Health Organ Manag 2021; ahead-of-print. [PMID: 33258359 DOI: 10.1108/jhom-03-2020-0074] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE Artificial intelligence (AI) raises many expectations regarding its ability to profoundly transform health care delivery. There is an abundant literature on the technical performance of AI applications in many clinical fields (e.g. radiology, ophthalmology). This article aims to bring forward the importance of studying organizational readiness to integrate AI into health care delivery. DESIGN/METHODOLOGY/APPROACH The reflection is based on our experience in digital health technologies, diffusion of innovations and healthcare organizations and systems. It provides insights into why and how organizational readiness should be carefully considered. FINDINGS As an important step to ensure successful integration of AI and avoid unnecessary investments and costly failures, better consideration should be given to: (1) Needs and added-value assessment; (2) Workplace readiness: stakeholder acceptance and engagement; (3) Technology-organization alignment assessment and (4) Business plan: financing and investments. In summary, decision-makers and technology promoters should better address the complexity of AI and understand the systemic challenges raised by its implementation in healthcare organizations and systems. ORIGINALITY/VALUE Few studies have focused on the organizational issues raised by the integration of AI into clinical routine. The current context is marked by a perplexing gap between the willingness of decision-makers and technology promoters to capitalize on AI applications to improve health care delivery and the reality on the ground, where it is difficult to initiate the changes needed to realize their full benefits while avoiding their negative impacts.
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Affiliation(s)
- Hassane Alami
- Center for Public Health Research (CreSP), Université de Montréal, Montreal, Canada.,Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Institute for Excellence in Health and Social Services (INESSS), Montreal, Canada
| | - Pascale Lehoux
- Center for Public Health Research (CreSP), Université de Montréal, Montreal, Canada.,Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada
| | - Jean-Louis Denis
- Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Aude Motulsky
- Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Cecile Petitgand
- Department of Health Management, Evaluation and Policy, École de Santé Publique de l'Université de Montréal, Montreal, Canada.,Carrefour de l'innovation et de l'évaluation en santé, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | | | - Ronan Rouquet
- Service SI de Santé
- Direction de la Stratégie et des Territoires, Agence régionale de santé (ARS) Hauts-de-France, Amiens, France
| | - Marie-Pierre Gagnon
- Faculty of Nursing Science, Université Laval, Quebec, Canada.,Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care, Université Laval, Quebec, Canada
| | - Denis Roy
- Institute for Excellence in Health and Social Services (INESSS), Montreal, Canada
| | - Jean-Paul Fortin
- Research Center on Healthcare and Services in Primary Care, Institute of Health and Social Services in Primary Care, Université Laval, Quebec, Canada.,Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, Canada
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Yin Y, Chou CA. A Novel Switching State-Space Model for Post-ICU Mortality Prediction and Survival Analysis. IEEE J Biomed Health Inform 2021; 25:3587-3595. [PMID: 33755571 DOI: 10.1109/jbhi.2021.3068357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Predicting mortality risk in patients accurately during and after intensive care unit (ICU) stay is an essential component for supporting critical care decision-making. To date, various scoring systems have been designed for survival analysis and mortality prediction by providing risk scores based on patient's vital signs and lab results. However, it is challenging using these universal scores to represent the overall severity level of illness and to look into patient's deterioration leading to high mortality risk during ICU stay. Thus, a close monitoring of the severity level over time during ICU stay is more preferable. In this study, we design a new switching state-space model by correlating patient's condition dynamics in last hours of ICU stay to the risk probabilities in a short time period (1-6 days) after ICU discharge. More specifically, we propose to integrate a cumulative hazard function estimating survival probability into the autoregressive hidden Markov model using time-interval sequential SAPS II scores as features. We demonstrate the significant improvement of mortality prediction comparing to SAPS I, SAPS II, and SOFA scoring systems for the PhysioNet MIMIC II Challenge data.
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68
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Ghanad Poor N, West NC, Sreepada RS, Murthy S, Görges M. An Artificial Neural Network-Based Pediatric Mortality Risk Score: Development and Performance Evaluation Using Data From a Large North American Registry. JMIR Med Inform 2021; 9:e24079. [PMID: 34463636 PMCID: PMC8441599 DOI: 10.2196/24079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 04/06/2021] [Accepted: 07/10/2021] [Indexed: 11/22/2022] Open
Abstract
Background In the pediatric intensive care unit (PICU), quantifying illness severity can be guided by risk models to enable timely identification and appropriate intervention. Logistic regression models, including the pediatric index of mortality 2 (PIM-2) and pediatric risk of mortality III (PRISM-III), produce a mortality risk score using data that are routinely available at PICU admission. Artificial neural networks (ANNs) outperform regression models in some medical fields. Objective In light of this potential, we aim to examine ANN performance, compared to that of logistic regression, for mortality risk estimation in the PICU. Methods The analyzed data set included patients from North American PICUs whose discharge diagnostic codes indicated evidence of infection and included the data used for the PIM-2 and PRISM-III calculations and their corresponding scores. We stratified the data set into training and test sets, with approximately equal mortality rates, in an effort to replicate real-world data. Data preprocessing included imputing missing data through simple substitution and normalizing data into binary variables using PRISM-III thresholds. A 2-layer ANN model was built to predict pediatric mortality, along with a simple logistic regression model for comparison. Both models used the same features required by PIM-2 and PRISM-III. Alternative ANN models using single-layer or unnormalized data were also evaluated. Model performance was compared using the area under the receiver operating characteristic curve (AUROC) and the area under the precision recall curve (AUPRC) and their empirical 95% CIs. Results Data from 102,945 patients (including 4068 deaths) were included in the analysis. The highest performing ANN (AUROC 0.871, 95% CI 0.862-0.880; AUPRC 0.372, 95% CI 0.345-0.396) that used normalized data performed better than PIM-2 (AUROC 0.805, 95% CI 0.801-0.816; AUPRC 0.234, 95% CI 0.213-0.255) and PRISM-III (AUROC 0.844, 95% CI 0.841-0.855; AUPRC 0.348, 95% CI 0.322-0.367). The performance of this ANN was also significantly better than that of the logistic regression model (AUROC 0.862, 95% CI 0.852-0.872; AUPRC 0.329, 95% CI 0.304-0.351). The performance of the ANN that used unnormalized data (AUROC 0.865, 95% CI 0.856-0.874) was slightly inferior to our highest performing ANN; the single-layer ANN architecture performed poorly and was not investigated further. Conclusions A simple ANN model performed slightly better than the benchmark PIM-2 and PRISM-III scores and a traditional logistic regression model trained on the same data set. The small performance gains achieved by this two-layer ANN model may not offer clinically significant improvement; however, further research with other or more sophisticated model designs and better imputation of missing data may be warranted.
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Affiliation(s)
- Niema Ghanad Poor
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Electrical Engineering and Computer Science, Technische Hochschule Lübeck, Lübeck, Germany
| | - Nicholas C West
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Rama Syamala Sreepada
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
| | - Srinivas Murthy
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada
| | - Matthias Görges
- Research Institute, BC Children's Hospital, Vancouver, BC, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, Vancouver, BC, Canada
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Yoo J, Kim SH, Hur S, Ha J, Huh K, Cha WC. Candidemia Risk Prediction (CanDETEC) Model for Patients With Malignancy: Model Development and Validation in a Single-Center Retrospective Study. JMIR Med Inform 2021; 9:e24651. [PMID: 34309570 PMCID: PMC8367162 DOI: 10.2196/24651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/09/2020] [Accepted: 06/17/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Appropriate empirical treatment for candidemia is associated with reduced mortality; however, the timely diagnosis of candidemia in patients with sepsis remains poor. OBJECTIVE We aimed to use machine learning algorithms to develop and validate a candidemia prediction model for patients with cancer. METHODS We conducted a single-center retrospective study using the cancer registry of a tertiary academic hospital. Adult patients diagnosed with malignancies between January 2010 and December 2018 were included. Our study outcome was the prediction of candidemia events. A stratified undersampling method was used to extract control data for algorithm learning. Multiple models were developed-a combination of 4 variable groups and 5 algorithms (auto-machine learning, deep neural network, gradient boosting, logistic regression, and random forest). The model with the largest area under the receiver operating characteristic curve (AUROC) was selected as the Candida detection (CanDETEC) model after comparing its performance indexes with those of the Candida Score Model. RESULTS From a total of 273,380 blood cultures from 186,404 registered patients with cancer, we extracted 501 records of candidemia events and 2000 records as control data. Performance among the different models varied (AUROC 0.771- 0.889), with all models demonstrating superior performance to that of the Candida Score (AUROC 0.677). The random forest model performed the best (AUROC 0.889, 95% CI 0.888-0.889); therefore, it was selected as the CanDETEC model. CONCLUSIONS The CanDETEC model predicted candidemia in patients with cancer with high discriminative power. This algorithm could be used for the timely diagnosis and appropriate empirical treatment of candidemia.
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Affiliation(s)
- Junsang Yoo
- Department of Nursing, College of Nursing, Sahmyook University, Seoul, Republic of Korea
| | - Si-Ho Kim
- Division of Infectious Disease, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Sujeong Hur
- Department of Patient Experience Management, Samsung Medical Center, Seoul, Republic of Korea.,Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Juhyung Ha
- Department of Computer Science, Indiana University Bloomington, Bloomington, IN, United States
| | - Kyungmin Huh
- Division of Infectious Disease, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Digital Innovation Center, Samsung Medical Center, Seoul, Republic of Korea
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70
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Bourcier S, Klug J, Nguyen LS. Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence. World J Gastroenterol 2021; 27:4088-4103. [PMID: 34326613 PMCID: PMC8311528 DOI: 10.3748/wjg.v27.i26.4088] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/25/2021] [Accepted: 06/18/2021] [Indexed: 02/06/2023] Open
Abstract
Acute mesenteric ischemia (AMI) is a severe condition associated with poor prognosis, ultimately leading to death due to multiorgan failure. Several mechanisms may lead to AMI, and non-occlusive mesenteric ischemia (NOMI) represents a particular form of AMI. NOMI is prevalent in intensive care units in critically ill patients. In NOMI management, promptness and accuracy of diagnosis are paramount to achieve decisive treatment, but the last decades have been marked by failure to improve NOMI prognosis, due to lack of tools to detect this condition. While real-life diagnostic management relies on a combination of physical examination, several biomarkers, imaging, and endoscopy to detect the possibility of several grades of NOMI, research studies only focus on a few elements at a time. In the era of artificial intelligence (AI), which can aggregate thousands of variables in complex longitudinal models, the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought. In the following work, we bring you a state-of-the-art literature review regarding NOMI, its presentation, its mechanics, and the pitfalls of routine work-up diagnostic exams including biomarkers, imaging, and endoscopy, we raise the perspectives of new biomarker exams, and finally we discuss what AI may add to the field, after summarizing what this technique encompasses.
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Affiliation(s)
- Simon Bourcier
- Department of Intensive Care Medicine, University Hospital of Geneva, Geneva 1201, Switzerland
| | - Julian Klug
- Department of Internal Medicine, Groupement Hospitalier de l’Ouest Lémanique, Nyon 1260, Switzerland
| | - Lee S Nguyen
- Department of Intensive Care Medicine, CMC Ambroise Paré, Neuilly-sur-Seine 92200, France
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van de Sande D, van Genderen ME, Huiskens J, Gommers D, van Bommel J. Moving from bytes to bedside: a systematic review on the use of artificial intelligence in the intensive care unit. Intensive Care Med 2021; 47:750-760. [PMID: 34089064 PMCID: PMC8178026 DOI: 10.1007/s00134-021-06446-7] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 05/23/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE Due to the increasing demand for intensive care unit (ICU) treatment, and to improve quality and efficiency of care, there is a need for adequate and efficient clinical decision-making. The advancement of artificial intelligence (AI) technologies has resulted in the development of prediction models, which might aid clinical decision-making. This systematic review seeks to give a contemporary overview of the current maturity of AI in the ICU, the research methods behind these studies, and the risk of bias in these studies. METHODS A systematic search was conducted in Embase, Medline, Web of Science Core Collection and Cochrane Central Register of Controlled Trials databases to identify eligible studies. Studies using AI to analyze ICU data were considered eligible. Specifically, the study design, study aim, dataset size, level of validation, level of readiness, and the outcomes of clinical trials were extracted. Risk of bias in individual studies was evaluated by the Prediction model Risk Of Bias ASsessment Tool (PROBAST). RESULTS Out of 6455 studies identified through literature search, 494 were included. The most common study design was retrospective [476 studies (96.4% of all studies)] followed by prospective observational [8 (1.6%)] and clinical [10 (2%)] trials. 378 (80.9%) retrospective studies were classified as high risk of bias. No studies were identified that reported on the outcome evaluation of an AI model integrated in routine clinical practice. CONCLUSION The vast majority of developed ICU-AI models remain within the testing and prototyping environment; only a handful were actually evaluated in clinical practice. A uniform and structured approach can support the development, safe delivery, and implementation of AI to determine clinical benefit in the ICU.
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Affiliation(s)
- Davy van de Sande
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Room Ne-413, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Michel E van Genderen
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Room Ne-413, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Joost Huiskens
- SAS Institute, Health Care Analytics, Huizen, The Netherlands
| | - Diederik Gommers
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Room Ne-413, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jasper van Bommel
- Department of Adult Intensive Care, Erasmus MC University Medical Center, Room Ne-413, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Kim M, Yang J, Ahn WY, Choi HJ. Machine Learning Analysis to Identify Digital Behavioral Phenotypes for Engagement and Health Outcome Efficacy of an mHealth Intervention for Obesity: Randomized Controlled Trial. J Med Internet Res 2021; 23:e27218. [PMID: 34184991 PMCID: PMC8277339 DOI: 10.2196/27218] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 04/28/2021] [Accepted: 05/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The digital health care community has been urged to enhance engagement and clinical outcomes by analyzing multidimensional digital phenotypes. OBJECTIVE This study aims to use a machine learning approach to investigate the performance of multivariate phenotypes in predicting the engagement rate and health outcomes of digital cognitive behavioral therapy. METHODS We leveraged both conventional phenotypes assessed by validated psychological questionnaires and multidimensional digital phenotypes within time-series data from a mobile app of 45 participants undergoing digital cognitive behavioral therapy for 8 weeks. We conducted a machine learning analysis to discriminate the important characteristics. RESULTS A higher engagement rate was associated with higher weight loss at 8 weeks (r=-0.59; P<.001) and 24 weeks (r=-0.52; P=.001). Applying the machine learning approach, lower self-esteem on the conventional phenotype and higher in-app motivational measures on digital phenotypes commonly accounted for both engagement and health outcomes. In addition, 16 types of digital phenotypes (ie, lower intake of high-calorie food and evening snacks and higher interaction frequency with mentors) predicted engagement rates (mean R2 0.416, SD 0.006). The prediction of short-term weight change (mean R2 0.382, SD 0.015) was associated with 13 different digital phenotypes (ie, lower intake of high-calorie food and carbohydrate and higher intake of low-calorie food). Finally, 8 measures of digital phenotypes (ie, lower intake of carbohydrate and evening snacks and higher motivation) were associated with a long-term weight change (mean R2 0.590, SD 0.011). CONCLUSIONS Our findings successfully demonstrated how multiple psychological constructs, such as emotional, cognitive, behavioral, and motivational phenotypes, elucidate the mechanisms and clinical efficacy of a digital intervention using the machine learning method. Accordingly, our study designed an interpretable digital phenotype model, including multiple aspects of motivation before and during the intervention, predicting both engagement and clinical efficacy. This line of research may shed light on the development of advanced prevention and personalized digital therapeutics. TRIAL REGISTRATION ClinicalTrials.gov NCT03465306; https://clinicaltrials.gov/ct2/show/NCT03465306.
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Affiliation(s)
- Meelim Kim
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jaeyeong Yang
- Department of Psychology, Seoul National University, Seoul, Republic of Korea
| | - Woo-Young Ahn
- Department of Psychology, Seoul National University, Seoul, Republic of Korea.,Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Hyung Jin Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Anatomy and Cell Biology, Neuroscience Research Institute, Wide River Institute of Immunology, Gangwon-do, Republic of Korea
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Foy BH, Sundt T, Carlson JCT, Aguirre AD, Higgins JM. White Blood Cell and Platelet Dynamics Define Human Inflammatory Recovery. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.06.19.21259181. [PMID: 34189534 PMCID: PMC8240689 DOI: 10.1101/2021.06.19.21259181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Inflammation is the physiologic reaction to cellular and tissue damage caused by pathologic processes including trauma, infection, and ischemia 1 . Effective inflammatory responses integrate molecular and cellular functions to prevent further tissue damage, initiate repair, and restore homeostasis, while futile or dysfunctional responses allow escalating injury, delay recovery, and may hasten death 2 . Elevation of white blood cell count (WBC) and altered levels of other acute phase reactants are cardinal signs of inflammation, but the dynamics of these changes and their resolution are not established 3,4 . Patient responses appear to vary dramatically with no clearly defined signs of good prognosis, leaving physicians reliant on qualitative interpretations of laboratory trends 4,5 . We retrospectively, observationally studied the human acute inflammatory response to trauma, ischemia, and infection by tracking the longitudinal dynamics of cellular and serum markers in hospitalized patients. Unexpectedly, we identified a conserved pattern of recovery defined by co-regulation of WBC and platelet (PLT) populations. Across all inflammatory conditions studied, recovering patients followed a consistent WBC-PLT trajectory shape that is well-approximated by exponential WBC decay and delayed linear PLT growth. This recovery trajectory shape may represent a fundamental archetype of human physiologic response at the cellular population scale, and provides a generic approach for identifying high-risk patients: 32x relative risk of adverse outcomes for cardiac surgery patients, 9x relative risk of death for COVID-19, and 5x relative risk of death for myocardial infarction.
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Affiliation(s)
- Brody H Foy
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Systems Biology, Harvard Medical School, Boston, USA
| | - Thor Sundt
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, USA
| | - Jonathan C T Carlson
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Aaron D Aguirre
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - John M Higgins
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- Department of Systems Biology, Harvard Medical School, Boston, USA
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Zoli M, Staartjes VE, Guaraldi F, Friso F, Rustici A, Asioli S, Sollini G, Pasquini E, Regli L, Serra C, Mazzatenta D. Machine learning-based prediction of outcomes of the endoscopic endonasal approach in Cushing disease: is the future coming? Neurosurg Focus 2021; 48:E5. [PMID: 32480364 DOI: 10.3171/2020.3.focus2060] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/04/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Machine learning (ML) is an innovative method to analyze large and complex data sets. The aim of this study was to evaluate the use of ML to identify predictors of early postsurgical and long-term outcomes in patients treated for Cushing disease (CD). METHODS All consecutive patients in our center who underwent surgery for CD through the endoscopic endonasal approach were retrospectively reviewed. Study endpoints were gross-tumor removal (GTR), postsurgical remission, and long-term control of disease. Several demographic, radiological, and histological factors were assessed as potential predictors. For ML-based modeling, data were randomly divided into 2 sets with an 80% to 20% ratio for bootstrapped training and testing, respectively. Several algorithms were tested and tuned for the area under the curve (AUC). RESULTS The study included 151 patients. GTR was achieved in 137 patients (91%), and postsurgical hypersecretion remission was achieved in 133 patients (88%). At last follow-up, 116 patients (77%) were still in remission after surgery and in 21 patients (14%), CD was controlled with complementary treatment (overall, of 131 cases, 87% were under control at follow-up). At internal validation, the endpoints were predicted with AUCs of 0.81-1.00, accuracy of 81%-100%, and Brier scores of 0.035-0.151. Tumor size and invasiveness and histological confirmation of adrenocorticotropic hormone (ACTH)-secreting cells were the main predictors for the 3 endpoints of interest. CONCLUSIONS ML algorithms were used to train and internally validate robust models for all the endpoints, giving accurate outcome predictions in CD cases. This analytical method seems promising for potentially improving future patient care and counseling; however, careful clinical interpretation of the results remains necessary before any clinical adoption of ML. Moreover, further studies and increased sample sizes are definitely required before the widespread adoption of ML to the study of CD.
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Affiliation(s)
- Matteo Zoli
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,2Department of Biomedical and Motor Sciences (DIBINEM), University of Bologna, Italy
| | - Victor E Staartjes
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Switzerland.,4Neurosurgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, The Netherlands
| | - Federica Guaraldi
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,2Department of Biomedical and Motor Sciences (DIBINEM), University of Bologna, Italy
| | - Filippo Friso
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna
| | - Arianna Rustici
- 5Department of Neuroradiology, IRCCS Istitute of Neurological Sciences of Bologna.,6Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna
| | - Sofia Asioli
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,2Department of Biomedical and Motor Sciences (DIBINEM), University of Bologna, Italy.,7Section of Anatomic Pathology 'M. Malpighi' at Bellaria Hospital, Bologna; and
| | - Giacomo Sollini
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,8ENT Department, Bellaria Hospital, Bologna, Italy
| | - Ernesto Pasquini
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,8ENT Department, Bellaria Hospital, Bologna, Italy
| | - Luca Regli
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Switzerland
| | - Carlo Serra
- 3Department of Neurosurgery, Clinical Neuroscience Center, University Hospital of Zurich, University of Zurich, Switzerland
| | - Diego Mazzatenta
- 1Pituitary Unit, Center for the Diagnosis and Treatment of Hypothalamic-Pituitary Diseases, IRCCS Institute of Neurological Sciences of Bologna.,2Department of Biomedical and Motor Sciences (DIBINEM), University of Bologna, Italy
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75
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Higgins AM, Neto AS, Bailey M, Barrett J, Bellomo R, Cooper DJ, Gabbe BJ, Linke N, Myles PS, Paton M, Philpot S, Shulman M, Young M, Hodgson CL. Predictors of death and new disability after critical illness: a multicentre prospective cohort study. Intensive Care Med 2021; 47:772-781. [PMID: 34089063 DOI: 10.1007/s00134-021-06438-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/15/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This study aimed to determine the prevalence and predictors of death or new disability following critical illness. METHODS Prospective, multicentre cohort study conducted in six metropolitan intensive care units (ICU). Participants were adults admitted to the ICU who received more than 24 h of mechanical ventilation. The primary outcome was death or new disability at 6 months, with new disability defined by a 10% increase in the WHODAS 2.0. RESULTS Of 628 patients with the primary outcome available (median age of 62 [49-71] years, 379 [61.0%] had a medical admission and 370 (58.9%) died or developed new disability by 6 months. Independent predictors of death or new disability included age [OR 1.02 (1.01-1.03), P = 0.001], higher severity of illness (APACHE III) [OR 1.02 (1.01-1.03), P < 0.001] and admission diagnosis. Compared to patients with a surgical admission diagnosis, patients with a cardiac arrest [OR (95% CI) 4.06 (1.89-8.68), P < 0.001], sepsis [OR (95% CI) 2.43 (1.32-4.47), P = 0.004], or trauma [OR (95% CI) 6.24 (3.07-12.71), P < 0.001] diagnosis had higher odds of death or new disability, while patients with a lung transplant [OR (95% CI) 0.21 (0.07-0.58), P = 0.003] diagnosis had lower odds. A model including these three variables had good calibration (Brier score 0.20) and acceptable discriminative power with an area under the receiver operating characteristic curve of 0.76 (95% CI 0.72-0.80). CONCLUSION Less than half of all patients mechanically ventilated for more than 24 h were alive and free of new disability at 6 months after admission to ICU. A model including age, illness severity and admission diagnosis has acceptable discriminative ability to predict death or new disability at 6 months.
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Affiliation(s)
- A M Higgins
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - A Serpa Neto
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Health, Melbourne, VIC, Australia.,Department of Critical Care Medicine, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - M Bailey
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
| | - J Barrett
- Intensive Care Unit, Epworth Healthcare, Melbourne, VIC, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - R Bellomo
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia.,Department of Intensive Care, Austin Health, Melbourne, VIC, Australia
| | - D J Cooper
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - B J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - N Linke
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia
| | - P S Myles
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Anaesthesiology and Perioperative Medicine, The Alfred, Melbourne, VIC, Australia
| | - M Paton
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia.,Department of Physiotherapy, Monash Health, Melbourne, VIC, Australia
| | - S Philpot
- Intensive Care Unit, Cabrini Health, Melbourne, VIC, Australia
| | - M Shulman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Department of Anaesthesiology and Perioperative Medicine, The Alfred, Melbourne, VIC, Australia
| | - M Young
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia
| | - C L Hodgson
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC, 3004, Australia. .,Department of Intensive Care and Hyperbaric Medicine, The Alfred, Melbourne, VIC, Australia.
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76
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Predicting need for hospital-specific interventional care after surgery using electronic health record data. Surgery 2021; 170:790-796. [PMID: 34090676 DOI: 10.1016/j.surg.2021.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND A significant proportion of surgical inpatients is often admitted longer than necessary. Early identification of patients who do not need care that is strictly provided within hospitals would allow timely discharge of patients to a postoperative nursing home for further recovery. We aimed to develop a model to predict whether a patient needs hospital-specific interventional care beyond the second postoperative day. METHODS This study included all adult patients discharged from surgical care in the surgical oncology department from June 2017 to February 2020. The primary outcome was to predict whether a patient still needs hospital-specific interventional care beyond the second postoperative day. Hospital-specific care was defined as unplanned reoperations, radiological interventions, and intravenous antibiotics administration. Different analytical methods were compared with respect to the area under the receiver-operating characteristics curve, sensitivity, specificity, positive predictive value, and negative predictive value. RESULTS Each model was trained on 1,174 episodes. In total, 847 (50.5%) patients required an intervention during postoperative admission. A random forest model performed best with an area under the receiver-operating characteristics curve of 0.88 (95% confidence interval 0.83-0.93), sensitivity of 79.1% (95% confidence interval 0.67-0.92), specificity of 80.0% (0.73-0.87), positive predictive value of 57.6% (0.45-0.70) and negative predictive value of 91.7% (0.87-0.97). CONCLUSION This proof-of-concept study found that a random forest model could successfully predict whether a patient could be safely discharged to a nursing home and does not need hospital care anymore. Such a model could aid hospitals in addressing capacity challenges and improve patient flow, allowing for timely surgical care.
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77
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Predicting the 9-year course of mood and anxiety disorders with automated machine learning: A comparison between auto-sklearn, naïve Bayes classifier, and traditional logistic regression. Psychiatry Res 2021; 299:113823. [PMID: 33667949 DOI: 10.1016/j.psychres.2021.113823] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 02/20/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Predicting the onset and course of mood and anxiety disorders is of clinical importance but remains difficult. We compared the predictive performances of traditional logistic regression, basic probabilistic machine learning (ML) methods, and automated ML (Auto-sklearn). METHODS Data were derived from the Netherlands Study of Depression and Anxiety. We compared how well multinomial logistic regression, a naïve Bayes classifier, and Auto-sklearn predicted depression and anxiety diagnoses at a 2-, 4-, 6-, and 9-year follow up, operationalized as binary or categorical variables. Predictor sets included demographic and self-report data, which can be easily collected in clinical practice at two initial time points (baseline and 1-year follow up). RESULTS At baseline, participants were 42.2 years old, 66.5% were women, and 53.6% had a current mood or anxiety disorder. The three methods were similarly successful in predicting (mental) health status, with correct predictions for up to 79% (95% CI 75-81%). However, Auto-sklearn was superior when assessing a more complex dataset with individual item scores. CONCLUSIONS Automated ML methods added only limited value, compared to traditional data modelling when predicting the onset and course of depression and anxiety. However, they hold potential for automatization and may be better suited for complex datasets.
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79
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Fitzgerald O, Perez-Concha O, Gallego B, Saxena MK, Rudd L, Metke-Jimenez A, Jorm L. Incorporating real-world evidence into the development of patient blood glucose prediction algorithms for the ICU. J Am Med Inform Assoc 2021; 28:1642-1650. [PMID: 33871017 PMCID: PMC8324237 DOI: 10.1093/jamia/ocab060] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/10/2021] [Accepted: 03/22/2021] [Indexed: 12/20/2022] Open
Abstract
Objective Glycemic control is an important component of critical care. We present a data-driven method for predicting intensive care unit (ICU) patient response to glycemic control protocols while accounting for patient heterogeneity and variations in care. Materials and Methods Using electronic medical records (EMRs) of 18 961 ICU admissions from the MIMIC-III dataset, including 318 574 blood glucose measurements, we train and validate a gradient boosted tree machine learning (ML) algorithm to forecast patient blood glucose and a 95% prediction interval at 2-hour intervals. The model uses as inputs irregular multivariate time series data relating to recent in-patient medical history and glycemic control, including previous blood glucose, nutrition, and insulin dosing. Results Our forecasting model using routinely collected EMRs achieves performance comparable to previous models developed in planned research studies using continuous blood glucose monitoring. Model error, expressed as mean absolute percentage error is 16.5%–16.8%, with Clarke error grid analysis demonstrating that 97% of predictions would be clinically acceptable. The 95% prediction intervals achieve near intended coverage at 93%–94%. Discussion ML algorithms built on observational data sources, such as EMRs, present a promising approach for personalization and automation of glycemic control in critical care. Future research may benefit from applying a combination of methodologies and data sources to develop robust methodologies that account for the variations seen in ICU patients and difficultly in detecting the extremes of observed blood glucose values. Conclusion We demonstrate that EMRs can be used to train ML algorithms that may be suitable for incorporation into ICU decision support systems.
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Affiliation(s)
- Oisin Fitzgerald
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Oscar Perez-Concha
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Manoj K Saxena
- The George Institute for Global Health, UNSW Sydney, Sydney, NSW, Australia
| | - Lachlan Rudd
- Data and Analytics, eHealth NSW, Chatswood, NSW, Australia
| | | | - Louisa Jorm
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, NSW, Australia
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80
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Velmovitsky PE, Bevilacqua T, Alencar P, Cowan D, Morita PP. Convergence of Precision Medicine and Public Health Into Precision Public Health: Toward a Big Data Perspective. Front Public Health 2021; 9:561873. [PMID: 33889555 PMCID: PMC8055845 DOI: 10.3389/fpubh.2021.561873] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 03/10/2021] [Indexed: 12/23/2022] Open
Abstract
The field of precision medicine explores disease treatments by looking at genetic, socio-environmental, and clinical factors, thus trying to provide a holistic view of a person's health. Public health, on the other hand, is focused on improving the health of populations through preventive strategies and timely interventions. With recent advances in technology, we are able to collect, analyze and store for the first-time large volumes of real-time, diverse and continuous health data. Typically, the field of precision medicine deals with a huge amount of data from few individuals; public health, on the other hand, deals with limited data from a population. With the coming of Big Data, the fields of precision medicine and public health are converging into precision public health, the study of biological and genetic factors supported by large amounts of population data. In this paper, we explore through a comprehensive review the data types and use cases found in precision medicine and public health. We also discuss how these data types and use cases can converge toward precision public health, as well as challenges and opportunities provided by research and analyses of health data.
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Affiliation(s)
| | - Tatiana Bevilacqua
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Paulo Alencar
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, ON, Canada.,Waterloo Artificial Intelligence Institute (Waterloo.ai), Waterloo, ON, Canada
| | - Donald Cowan
- David R. Cheriton School of Computer Science, University of Waterloo, Waterloo, ON, Canada.,Waterloo Artificial Intelligence Institute (Waterloo.ai), Waterloo, ON, Canada
| | - Plinio Pelegrini Morita
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.,Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
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81
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Yun K, Oh J, Hong TH, Kim EY. Prediction of Mortality in Surgical Intensive Care Unit Patients Using Machine Learning Algorithms. Front Med (Lausanne) 2021; 8:621861. [PMID: 33869245 PMCID: PMC8044535 DOI: 10.3389/fmed.2021.621861] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/12/2021] [Indexed: 12/03/2022] Open
Abstract
Objective: Predicting prognosis of in-hospital patients is critical. However, it is challenging to accurately predict the life and death of certain patients at certain period. To determine whether machine learning algorithms could predict in-hospital death of critically ill patients with considerable accuracy and identify factors contributing to the prediction power. Materials and Methods: Using medical data of 1,384 patients admitted to the Surgical Intensive Care Unit (SICU) of our institution, we investigated whether machine learning algorithms could predict in-hospital death using demographic, laboratory, and other disease-related variables, and compared predictions using three different algorithmic methods. The outcome measurement was the incidence of unexpected postoperative mortality which was defined as mortality without pre-existing not-for-resuscitation order that occurred within 30 days of the surgery or within the same hospital stay as the surgery. Results: Machine learning algorithms trained with 43 variables successfully classified dead and live patients with very high accuracy. Most notably, the decision tree showed the higher classification results (Area Under the Receiver Operating Curve, AUC = 0.96) than the neural network classifier (AUC = 0.80). Further analysis provided the insight that serum albumin concentration, total prenatal nutritional intake, and peak dose of dopamine drug played an important role in predicting the mortality of SICU patients. Conclusion: Our results suggest that machine learning algorithms, especially the decision tree method, can provide information on structured and explainable decision flow and accurately predict hospital mortality in SICU hospitalized patients.
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Affiliation(s)
- Kyongsik Yun
- Computation and Neural Systems, California Institute of Technology, Pasadena, CA, United States
| | - Jihoon Oh
- Department of Psychiatry, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Tae Ho Hong
- Division of Hepato-Biliary and Pancreas Surgery, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Eun Young Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Schvetz M, Fuchs L, Novack V, Moskovitch R. Outcomes prediction in longitudinal data: Study designs evaluation, use case in ICU acquired sepsis. J Biomed Inform 2021; 117:103734. [PMID: 33711544 DOI: 10.1016/j.jbi.2021.103734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Abstract
Outcomes' prediction in Electronic Health Records (EHR) and specifically in Critical Care is increasingly attracting more exploration and research. In this study, we used clinical data from the Intensive Care Unit (ICU), focusing on ICU acquired sepsis. Looking at the current literature, several evaluation approaches are reported, inspired by epidemiological designs, in which some do not always reflect real-life application's conditions. This problem seems relevant generally to outcomes' prediction in longitudinal EHR data, or generally longitudinal data, while in this study we focused on ICU data. Unlike in most previous studies that investigated all sepsis admissions, we focused specifically on ICU-Acquired Sepsis. Due to the sparse nature of the longitudinal data, we employed the use of Temporal Abstraction and Time Interval-Related Patterns discovery, which are further used as classification features. Two experiments were designed using three different outcomes prediction study designs from the literature, implementing various levels of real-life conditions to evaluate the prediction models. The first experiment focused on predicting whether a patient would suffer from ICU-acquired sepsis and when during her admission, given a sliding observation time window, and the comparison of the three study designs behavior. The second experiment focused only on predicting whether the patient will suffer from ICU-acquired sepsis, based on data taken relatively to his admission start time. Our results show that using Temporal Discretization for Classification (TD4C) led to better performance than using the Equal-Width Discretization, Knowledge-Based, or SAX. Also, using two states abstraction was better than three or four. Using the default Binary TIRP representation method performed better than Mean Duration, Horizontal Support, and horizontally normalized horizontal support. Using XGBoost as a classifier performed better than Logistic Regression, Neural Net, or Random Forest. Additionally, it is demonstrated why the use of case-crossover-control is most appropriate for real life application conditions evaluation, unlike other incomplete designs that may even result in "better performance".
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Affiliation(s)
- Maya Schvetz
- Department of Software and Information Systems Engineering, Ben Gurion University of the Negev, Beer-Sheva, Israel.
| | - Lior Fuchs
- Medical Intensive Care Unit and Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Robert Moskovitch
- Department of Software and Information Systems Engineering, Ben Gurion University of the Negev, Beer-Sheva, Israel.
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Lee C. PREDICTING LAND PRICES AND MEASURING UNCERTAINTY BY COMBINING SUPERVISED AND UNSUPERVISED LEARNING. INTERNATIONAL JOURNAL OF STRATEGIC PROPERTY MANAGEMENT 2021. [DOI: 10.3846/ijspm.2021.14293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Despite the popularity deep learning has been gaining, measuring the uncertainty within the result has not met expectations in many deep learning applications and this includes property valuation. In real-world tasks, however, rather than simply requiring predictions, assurance of the certainty of the predictions is also demanded. In this study, supervised learning is combined with unsupervised learning to bridge this gap. A method based on principal component analysis, a popular tool of unsupervised learning, was developed and used to represent the uncertainty in property valuation. Then, a neural network, a representative algorithm to implement supervised learning, was constructed, and trained to predict land prices. Finally, the uncertainty that was measured using principal component analysis was incorporated into the price predicted by the neural network. This hybrid approach is shown to be likely to improve the credibility of the valuation work. The findings of this study are expected to generate interest in the integration of the two learning approaches, thereby promoting the rapid adoption of deep learning tools in the property valuation industry.
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Affiliation(s)
- Changro Lee
- Department of Real Estate, Kangwon National University, Chuncheon, Republic of Korea
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84
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Megjhani M, Terilli K, Weiss M, Savarraj J, Chen LH, Alkhachroum A, Roh DJ, Agarwal S, Connolly ES, Velazquez A, Boehme A, Claassen J, Choi HA, Schubert GA, Park S. Dynamic Detection of Delayed Cerebral Ischemia: A Study in 3 Centers. Stroke 2021; 52:1370-1379. [PMID: 33596676 DOI: 10.1161/strokeaha.120.032546] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage negatively impacts long-term recovery but is often detected too late to prevent damage. We aim to develop hourly risk scores using routinely collected clinical data to detect DCI. METHODS A DCI classification model was trained using vital sign measurements (heart rate, blood pressure, respiratory rate, and oxygen saturation) and demographics routinely collected for clinical care. Twenty-two time-varying physiological measures were computed including mean, SD, and cross-correlation of heart rate time series with each of the other vitals. Classification was achieved using an ensemble approach with L2-regularized logistic regression, random forest, and support vector machines models. Classifier performance was determined by area under the receiver operating characteristic curves and confusion matrices. Hourly DCI risk scores were generated as the posterior probability at time t using the Ensemble classifier on cohorts recruited at 2 external institutions (n=38 and 40). RESULTS Three hundred ten patients were included in the training model (median, 54 years old [interquartile range, 45-65]; 80.2% women, 28.4% Hunt and Hess scale 4-5, 38.7% Modified Fisher Scale 3-4); 101 (33%) developed DCI with a median onset day 6 (interquartile range, 5-8). Classification accuracy before DCI onset was 0.83 (interquartile range, 0.76-0.83) area under the receiver operating characteristic curve. Risk scores applied to external institution datasets correctly predicted 64% and 91% of DCI events as early as 12 hours before clinical detection, with 2.7 and 1.6 true alerts for every false alert. CONCLUSIONS An hourly risk score for DCI derived from routine vital signs may have the potential to alert clinicians to DCI, which could reduce neurological injury.
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Affiliation(s)
- Murad Megjhani
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Kalijah Terilli
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Miriam Weiss
- Department of Neurosurgery, RWTH Aachen University, Germany (M.W., G.A.S.)
| | - Jude Savarraj
- Department of Neurology, McGovern Medical School, UT Health, Houston, TX (J.S., H.A.C.)
| | - Li Hui Chen
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | | | - David J Roh
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Sachin Agarwal
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - E Sander Connolly
- Department of Neurosurgery (E.S.C.), Columbia University Irving Medical Center, New York
| | - Angela Velazquez
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Amelia Boehme
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - Jan Claassen
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
| | - HuiMahn A Choi
- Department of Neurology, McGovern Medical School, UT Health, Houston, TX (J.S., H.A.C.)
| | - Gerrit A Schubert
- Department of Neurosurgery, RWTH Aachen University, Germany (M.W., G.A.S.)
| | - Soojin Park
- Department of Neurology (M.M., K.T., H.C., D.J.R., S.A., A.V., A.B., J.C., S.P.), Columbia University Irving Medical Center, New York
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An R, Chang GM, Fan YY, Ji LL, Wang XH, Hong S. Machine learning-based patient classification system for adult patients in intensive care units: A cross-sectional study. J Nurs Manag 2021; 29:1752-1762. [PMID: 33565196 DOI: 10.1111/jonm.13284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to develop a patient classification system that stratifies patients admitted to the intensive care unit based on their disease severity and care needs. BACKGROUND Classifying patients into homogenous groups based on clinical characteristics can optimize nursing care. However, an objective method for determining such groups remains unclear. METHODS Predictors representing disease severity and nursing workload were considered. Patients were clustered into subgroups with different characteristics based on the results of a clustering algorithm. A patient classification system was developed using a partial least squares regression model. RESULTS Data of 300 patients were analysed. Cluster analysis identified three subgroups of critically patients with different levels of clinical trajectories. Except for blood potassium levels (p = .29), the subgroups were significantly different according to disease severity and nursing workload. The predicted value ranges of the regression model for Classes A, B and C were <1.44, 1.44-2.03 and >2.03. The model was shown to have good fit and satisfactory prediction efficiency using 200 permutation tests. CONCLUSIONS Classifying patients based on disease severity and care needs enables the development of tailored nursing management for each subgroup. IMPLICATIONS FOR NURSING MANAGEMENT The patient classification system can help nurse managers identify homogeneous patient groups and further improve the management of critically ill patients.
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Affiliation(s)
- Ran An
- Nursing School, Harbin Medical University, Harbin, China
| | - Guang-Ming Chang
- The Party Committee, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yu-Ying Fan
- Nursing School, Harbin Medical University, Harbin, China
| | - Ling-Ling Ji
- Department of Pediatrics, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Hui Wang
- Department of Intensive Care Unit, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Su Hong
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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86
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Kirrane MD, Shrapnel S, Ramanan M, Clement P, Fraser JF, Laupland KB, Sullivan CM, Shekar K. Intensive care digital health response to emerging infectious disease outbreaks such as COVID-19. Anaesth Intensive Care 2021; 49:105-111. [PMID: 33504171 DOI: 10.1177/0310057x20975777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The COVID-19 pandemic has required intensive care units to rapidly adjust and adapt their existing practices. Although there has a focus on expanding critical care infrastructure, equipment and workforce, plans have not emphasised the need to increase digital capabilities. The objective of this report was to recognise key areas of digital health related to the COVID-19 response. We identified and explored six focus areas relevant to intensive care, including using digital solutions to increase critical care capacity, developing surge capacity within an electronic health record, maintenance and downtime planning, training considerations and the role of data analytics. This article forms the basis of a framework for the intensive care digital health response to COVID-19 and other emerging infectious disease outbreaks.
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Affiliation(s)
- Marianne D Kirrane
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Digital Metro North, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sally Shrapnel
- Australian Research Council Centre of Excellence for Engineered Quantum Systems, University of Queensland, Brisbane, Australia
| | - Mahesh Ramanan
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Intensive Care Unit, Caboolture Hospital, Caboolture, Australia.,Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.,Critical Care Division, University of New South Wales, Sydney, Australia
| | - Pierre Clement
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - John F Fraser
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.,Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Clair M Sullivan
- Digital Metro North, Metro North Hospital and Health Service, Brisbane, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kiran Shekar
- Faculty of Medicine, University of Queensland, Brisbane, Australia.,Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, Australia.,Critical Care Research Group, The Prince Charles Hospital, Brisbane, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Faculty of Health, Queensland University of Technology, Brisbane, Australia
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87
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A Decision Support System for the Prediction of Drug Predisposition Through Personality Traits. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1338:39-46. [DOI: 10.1007/978-3-030-78775-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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88
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Ranti D, Valliani AAA, Costa A, Oermann EK. Artificial intelligence as applied to clinical neurological conditions. Artif Intell Med 2021. [DOI: 10.1016/b978-0-12-821259-2.00020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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89
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An artificial intelligence–based decision support and resource management system for COVID-19 pandemic. DATA SCIENCE FOR COVID-19 2021. [PMCID: PMC8138119 DOI: 10.1016/b978-0-12-824536-1.00029-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
COVID-19 crisis has shown that the World is not ready for such a rapid spread of a virus resulting in a catastrophic pandemic. Effective use of information technologies is one of the key aspects in reducing the adverse effects of any epidemic or pandemic. Existing management systems have failed to fulfill requirements for curbing the rapid spread of the virus. This chapter firstly describes the current solutions by giving real-world examples. Then, we propose an epidemic management system (EMS) that relies on unimpeded and timely information flow between nations and organizations to ensure resources are distributed effectively. This system will use mobile technology, blockchain, epidemic modeling, and artificial intelligence technologies. We used the Multiplatform Interoperable Scalable Architecture (MPISA) model that allows the integration of multiple platforms and provides a solution for scalability and interoperability problems. Open data repositories and the MiPasa blockchain are also described. These relevant data can be used to predict the potential future spread of the epidemic. Selecting the correct methods for epidemic modeling is discussed as well. Another challenge is deciding on allocating resources where they are most necessary; we propose deploying automated machine learning and stochastic epidemic model-based decision support systems for such purposes. Citizens should not have privacy concerns about the information systems. These trust issues and privacy concerns can be solved by using decentralized identity and zero-knowledge proof-based mechanisms. These mechanisms will ensure that users are in control of their data. In this chapter, we also discuss choosing the right machine learning method, privacy measures, and how the performance challenges can be addressed. This chapter concludes on a discussion of how we can design and deploy better EMSs and possible future studies.
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90
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Deasy J, Liò P, Ercole A. Dynamic survival prediction in intensive care units from heterogeneous time series without the need for variable selection or curation. Sci Rep 2020; 10:22129. [PMID: 33335183 PMCID: PMC7747558 DOI: 10.1038/s41598-020-79142-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 11/24/2020] [Indexed: 11/09/2022] Open
Abstract
Extensive monitoring in intensive care units (ICUs) generates large quantities of data which contain numerous trends that are difficult for clinicians to systematically evaluate. Current approaches to such heterogeneity in electronic health records (EHRs) discard pertinent information. We present a deep learning pipeline that uses all uncurated chart, lab, and output events for prediction of in-hospital mortality without variable selection. Over 21,000 ICU patients and tens of thousands of variables derived from the MIMIC-III database were used to train and validate our model. Recordings in the first few hours of a patient's stay were found to be strongly predictive of mortality, outperforming models using SAPS II and OASIS scores, AUROC 0.72 and 0.76 at 24 h respectively, within just 12 h of ICU admission. Our model achieves a very strong predictive performance of AUROC 0.85 (95% CI 0.83-0.86) after 48 h. Predictive performance increases over the first 48 h, but suffers from diminishing returns, providing rationale for time-limited trials of critical care and suggesting that the timing of decision making can be optimised and individualised.
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Affiliation(s)
- Jacob Deasy
- Computer Laboratory, University of Cambridge, William Gates Building, 15 JJ Thomson Ave, Cambridge, CB3 0FD, UK.
| | - Pietro Liò
- Computer Laboratory, University of Cambridge, William Gates Building, 15 JJ Thomson Ave, Cambridge, CB3 0FD, UK
| | - Ari Ercole
- Division of Anaesthesia, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
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91
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DMAKit: A user-friendly web platform for bringing state-of-the-art data analysis techniques to non-specific users. INFORM SYST 2020. [DOI: 10.1016/j.is.2020.101557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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92
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Rank N, Pfahringer B, Kempfert J, Stamm C, Kühne T, Schoenrath F, Falk V, Eickhoff C, Meyer A. Deep-learning-based real-time prediction of acute kidney injury outperforms human predictive performance. NPJ Digit Med 2020; 3:139. [PMID: 33134556 PMCID: PMC7588492 DOI: 10.1038/s41746-020-00346-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 09/17/2020] [Indexed: 12/29/2022] Open
Abstract
Acute kidney injury (AKI) is a major complication after cardiothoracic surgery. Early prediction of AKI could prompt preventive measures, but is challenging in the clinical routine. One important reason is that the amount of postoperative data is too massive and too high-dimensional to be effectively processed by the human operator. We therefore sought to develop a deep-learning-based algorithm that is able to predict postoperative AKI prior to the onset of symptoms and complications. Based on 96 routinely collected parameters we built a recurrent neural network (RNN) for real-time prediction of AKI after cardiothoracic surgery. From the data of 15,564 admissions we constructed a balanced training set (2224 admissions) for the development of the RNN. The model was then evaluated on an independent test set (350 admissions) and yielded an area under curve (AUC) (95% confidence interval) of 0.893 (0.862-0.924). We compared the performance of our model against that of experienced clinicians. The RNN significantly outperformed clinicians (AUC = 0.901 vs. 0.745, p < 0.001) and was overall well calibrated. This was not the case for the physicians, who systematically underestimated the risk (p < 0.001). In conclusion, the RNN was superior to physicians in the prediction of AKI after cardiothoracic surgery. It could potentially be integrated into hospitals' electronic health records for real-time patient monitoring and may help to detect early AKI and hence modify the treatment in perioperative care.
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Affiliation(s)
- Nina Rank
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Boris Pfahringer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, P.O. Box 65 21 33, 13316 Berlin, Germany
| | - Christof Stamm
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, P.O. Box 65 21 33, 13316 Berlin, Germany
| | - Titus Kühne
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, P.O. Box 65 21 33, 13316 Berlin, Germany
- Institute for Computer-assisted Cardiovascular Medicine, Charité–Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- Berlin Institute of Health, Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, P.O. Box 65 21 33, 13316 Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, P.O. Box 65 21 33, 13316 Berlin, Germany
- Berlin Institute of Health, Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
- Department of Cardiothoracic Surgery, Charité – Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Department of Health Sciences and Technology, ETH Zürich, Leopold-Ruzicka-Weg 4, 8093 Zürich, Switzerland
| | - Carsten Eickhoff
- Center for Biomedical Informatics, Brown University, 233 Richmond Street, Providence, RI 02912 USA
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, P.O. Box 65 21 33, 13316 Berlin, Germany
- Berlin Institute of Health, Anna-Louisa-Karsch-Str. 2, 10178 Berlin, Germany
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van de Sande D, van Genderen ME, Rosman B, Diether M, Endeman H, van den Akker JPC, Ludwig M, Huiskens J, Gommers D, van Bommel J. Predicting thromboembolic complications in COVID-19 ICU patients using machine learning. J Clin Transl Res 2020; 6:179-186. [PMID: 33501388 PMCID: PMC7821745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/01/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is a challenge for intensive care units (ICU) in part due to the failure to identify risks for patients early and the inability to render an accurate prognosis. Previous reports suggest a strong association between hypercoagulability and poor outcome. Factors related to hemostasis may, therefore, serve as tools to improve the management of COVID-19 patients. AIM The purpose of this report is to develop a model to determine whether it is possible to early identify COVID-19 patients at risk for thromboembolic complications (TCs). METHODS We analyzed electronic health record data of 108 consecutive COVID-19 patients admitted to the adult ICU of the Erasmus University Medical Center between February 27 and May 20, 2020. By training a decision tree classifier on 66% of the available data, a model for the prediction of TCs was developed. RESULTS The median (interquartile range) age was 62 (53-70) years and 73% were male. Forty-three patients (40%) developed a TC during their ICU stay. Mortality was higher for patients in the TCs group compared to the control group (26% vs. 8%, P=0.03). Lactate dehydrogenase, standardized bicarbonate, albumin, and leukocytes were identified by the Decision Tree classifier as the most powerful predictors for TCs 2 days before the onset of the TC, with a sensitivity of 73% and a positive likelihood ratio of 2.7 on the test dataset. CONCLUSIONS Clinically relevant TCs frequently occur in critically ill COVID-19 patients. These can successfully be predicted using a decision tree model. Although this model could be of special importance to aid clinical decision making, its generalizability and clinical impact should be determined in a larger population. RELEVANCE FOR PATIENTS Recently, severe TCs were observed in COVID-19 patients with progressive respiratory failure warranting ICU treatment. Timely identification of patients at risk of developing TCs is critical inasmuch as it would enable clinicians to initiate potentially salvaging therapeutic anticoagulation.
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Affiliation(s)
- Davy van de Sande
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Michel E. van Genderen
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands,
Corresponding author: Michel E. van Genderen Department of Adult Intensive Care, Erasmus Medical Center, Room Ne-411, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Babette Rosman
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Maren Diether
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands,2Deloitte Netherlands, Analytics and Cognitive, Amsterdam, the Netherlands
| | - Henrik Endeman
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Martijn Ludwig
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands,2Deloitte Netherlands, Analytics and Cognitive, Amsterdam, the Netherlands
| | - Joost Huiskens
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands,3SAS Institute, Health Care Analytics, Huizen, the Netherlands
| | - Diederik Gommers
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jasper van Bommel
- 1Department of Adult Intensive Care, Erasmus University Medical Center, Rotterdam, the Netherlands
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95
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Sampling methods and feature selection for mortality prediction with neural networks. J Biomed Inform 2020; 111:103580. [PMID: 33031938 DOI: 10.1016/j.jbi.2020.103580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/05/2020] [Accepted: 09/25/2020] [Indexed: 11/20/2022]
Abstract
Along with digitization, automatic data-driven decision support systems become increasingly popular. Mortality prediction is a vital part of that decision process. With more data available, sophisticated machine learning models like (Artificial) Neural Networks (NNs) can be applied and promise favorable performance. We evaluate the reproducibility of a published mortality prediction approach using NNs along with the possibility to generalize it to a bigger and more generic dataset. We describe an extensive preprocessing pipeline, as well as the evaluation of different sampling techniques and NN architectures. Through training on a loss function that optimizes both, precision and recall, in combination with a good set of hyperparameters and a set of new features, we use a NN to predict in-hospital mortality with accuracy, sensitivity, and area under the receiver operating characteristic score of greater than 0.8.
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96
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Hyun S, Kaewprag P, Cooper C, Hixon B, Moffatt-Bruce S. Exploration of critical care data by using unsupervised machine learning. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 194:105507. [PMID: 32403049 DOI: 10.1016/j.cmpb.2020.105507] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 03/05/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Identification of subgroups may be useful to understand the clinical characteristics of ICU patients. The purposes of this study were to apply an unsupervised machine learning method to ICU patient data to discover subgroups among them; and to examine their clinical characteristics, therapeutic procedures conducted during the ICU stay, and discharge dispositions. METHODS K-means clustering method was used with 1503 observations and 9 types of laboratory test results as features. RESULTS Three clusters were identified from this specific population. Blood urea nitrogen, creatinine, potassium, hemoglobin, and red blood cell were distinctive between the clusters. Cluster Three presented the highest blood products transfusion rate (19.8%), followed by Cluster One (15.5%) and cluster Two (9.3%), which was significantly different. Hemodialysis was more frequently provided to Cluster Three while bronchoscopy was done to Cluster One and Two. Cluster Three showed the highest mortality (30.4%), which was more than two-fold compared to Cluster One (14.1%) and Two (12.2%). CONCLUSION Three subgroups were identified and their clinical characteristics were compared. These findings may be useful to anticipate treatment strategies and probable outcomes of ICU patients. Unsupervised machine learning may enable ICU multi-dimensional data to be organized and to make sense of the data.
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Affiliation(s)
- Sookyung Hyun
- College of Nursing, Pusan National University, 49 Busandaehak-ro Mulgeum-eup, Yangsan-si, 50612, South Korea.
| | - Pacharmon Kaewprag
- Department of Computer Engineering, Ramkhamhaeng University, Bangkok, Thailand
| | - Cheryl Cooper
- Central Quality and Education, The Ohio State University Wexner Medical Center, Ohio, United States
| | - Brenda Hixon
- Department of Health Services Nursing Education, The Ohio State University Wexner Medical Center, Ohio, United States
| | - Susan Moffatt-Bruce
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, United States
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Nagaraj S, Harish V, McCoy LG, Morgado F, Stedman I, Lu S, Drysdale E, Brudno M, Singh D. From Clinic to Computer and Back Again: Practical Considerations When Designing and Implementing Machine Learning Solutions for Pediatrics. CURRENT TREATMENT OPTIONS IN PEDIATRICS 2020; 6:336-349. [PMID: 38624409 PMCID: PMC7490206 DOI: 10.1007/s40746-020-00205-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of review Machine learning (ML), a branch of artificial intelligence, is influencing all fields in medicine, with an abundance of work describing its application to adult practice. ML in pediatrics is distinctly unique with clinical, technical, and ethical nuances limiting the direct translation of ML tools developed for adults to pediatric populations. To our knowledge, no work has yet focused on outlining the unique considerations that need to be taken into account when designing and implementing ML in pediatrics. Recent findings The nature of varying developmental stages and the prominence of family-centered care lead to vastly different data-generating processes in pediatrics. Data heterogeneity and a lack of high-quality pediatric databases further complicate ML research. In order to address some of these nuances, we provide a common pipeline for clinicians and computer scientists to use as a foundation for structuring ML projects, and a framework for the translation of a developed model into clinical practice in pediatrics. Throughout these pathways, we also highlight ethical and legal considerations that must be taken into account when working with pediatric populations and data. Summary Here, we describe a comprehensive outline of special considerations required of ML in pediatrics from project ideation to implementation. We hope this review can serve as a high-level guideline for ML scientists and clinicians alike to identify applications in the pediatric setting, generate effective ML solutions, and subsequently deliver them to patients, families, and providers.
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Affiliation(s)
- Sujay Nagaraj
- Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Department of Computer Science, University of Toronto, Toronto, Ontario Canada
| | - Vinyas Harish
- Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - Liam G. McCoy
- Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario Canada
| | - Felipe Morgado
- Faculty of Medicine, University of Toronto, Toronto, Ontario Canada
- Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
| | - Ian Stedman
- School of Public Policy and Administration, York University, Toronto, Ontario Canada
| | - Stephen Lu
- Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Erik Drysdale
- Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
| | - Michael Brudno
- Department of Computer Science, University of Toronto, Toronto, Ontario Canada
- Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
- University Health Network, Toronto, Ontario Canada
- Vector Institute for Artificial Intelligence, Toronto, Ontario Canada
| | - Devin Singh
- Department of Computer Science, University of Toronto, Toronto, Ontario Canada
- Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario Canada
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Abstract
Supplemental Digital Content is available in the text. Influenza virus is a major cause of acute hypoxemic respiratory failure. Early identification of patients who will suffer severe complications can help stratify patients for clinical trials and plan for resource use in case of pandemic.
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99
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Hong S, Lee S, Lee J, Cha WC, Kim K. Prediction of Cardiac Arrest in the Emergency Department Based on Machine Learning and Sequential Characteristics: Model Development and Retrospective Clinical Validation Study. JMIR Med Inform 2020; 8:e15932. [PMID: 32749227 PMCID: PMC7435618 DOI: 10.2196/15932] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 12/30/2019] [Accepted: 07/14/2020] [Indexed: 11/28/2022] Open
Abstract
Background The development and application of clinical prediction models using machine learning in clinical decision support systems is attracting increasing attention. Objective The aims of this study were to develop a prediction model for cardiac arrest in the emergency department (ED) using machine learning and sequential characteristics and to validate its clinical usefulness. Methods This retrospective study was conducted with ED patients at a tertiary academic hospital who suffered cardiac arrest. To resolve the class imbalance problem, sampling was performed using propensity score matching. The data set was chronologically allocated to a development cohort (years 2013 to 2016) and a validation cohort (year 2017). We trained three machine learning algorithms with repeated 10-fold cross-validation. Results The main performance parameters were the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). The random forest algorithm (AUROC 0.97; AUPRC 0.86) outperformed the recurrent neural network (AUROC 0.95; AUPRC 0.82) and the logistic regression algorithm (AUROC 0.92; AUPRC=0.72). The performance of the model was maintained over time, with the AUROC remaining at least 80% across the monitored time points during the 24 hours before event occurrence. Conclusions We developed a prediction model of cardiac arrest in the ED using machine learning and sequential characteristics. The model was validated for clinical usefulness by chronological visualization focused on clinical usability.
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Affiliation(s)
- Sungjun Hong
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sungjoo Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Jeonghoon Lee
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.,Health Information and Strategy Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyunga Kim
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea.,Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
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Abstract
The rising burden of healthcare costs suggests that the healthcare system could benefit from novel methods that allow for continuous learning to provide more data-driven, individualised care at lower costs and with improved outcomes. Here, we present our synergistic Learning approach for Prediction, Interpretation/Inference and Communication (Learning PIC) framework to address the challenges hindering the successful implementation of learning healthcare systems and to enable the effective delivery of evidence-based medicine.
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Affiliation(s)
- Shannon Wongvibulsin
- Johns Hopkins University School of Medicine, Department of Biomedical Engineering, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Scott L. Zeger
- Biostatistics, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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