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Christou CD, Tsoulfas G. Challenges and opportunities in the application of artificial intelligence in gastroenterology and hepatology. World J Gastroenterol 2021; 27:6191-6223. [PMID: 34712027 PMCID: PMC8515803 DOI: 10.3748/wjg.v27.i37.6191] [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: 01/31/2021] [Revised: 05/06/2021] [Accepted: 08/31/2021] [Indexed: 02/06/2023] Open
Abstract
Artificial intelligence (AI) is an umbrella term used to describe a cluster of interrelated fields. Machine learning (ML) refers to a model that learns from past data to predict future data. Medicine and particularly gastroenterology and hepatology, are data-rich fields with extensive data repositories, and therefore fruitful ground for AI/ML-based software applications. In this study, we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their application. Specifically, we refer to the applications of AI/ML-based models in prevention, diagnosis, management, and prognosis of gastrointestinal bleeding, inflammatory bowel diseases, gastrointestinal premalignant and malignant lesions, other nonmalignant gastrointestinal lesions and diseases, hepatitis B and C infection, chronic liver diseases, hepatocellular carcinoma, cholangiocarcinoma, and primary sclerosing cholangitis. At the same time, we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome them. Notably, we elaborate on the concerns regarding intrinsic biases, data protection, cybersecurity, intellectual property, liability, ethical challenges, and transparency. Even at a slower pace than anticipated, AI is infiltrating the healthcare industry. AI in healthcare will become a reality, and every physician will have to engage with it by necessity.
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Affiliation(s)
- Chrysanthos D Christou
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
| | - Georgios Tsoulfas
- Organ Transplant Unit, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki 54622, Greece
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152
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Moorman LP. Principles for Real-World Implementation of Bedside Predictive Analytics Monitoring. Appl Clin Inform 2021; 12:888-896. [PMID: 34553360 PMCID: PMC8458037 DOI: 10.1055/s-0041-1735183] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A new development in the practice of medicine is Artificial Intelligence-based predictive analytics that forewarn clinicians of future deterioration of their patients. This proactive opportunity, though, is different from the reactive stance that clinicians traditionally take. Implementing these tools requires new ideas about how to educate clinician users to facilitate trust and adoption and to promote sustained use. Our real-world hospital experience implementing a predictive analytics monitoring system that uses electronic health record and continuous monitoring data has taught us principles that we believe to be applicable to the implementation of other such analytics systems within the health care environment. These principles are mentioned below:• To promote trust, the science must be understandable.• To enhance uptake, the workflow should not be impacted greatly.• To maximize buy-in, engagement at all levels is important.• To ensure relevance, the education must be tailored to the clinical role and hospital culture.• To lead to clinical action, the information must integrate into clinical care.• To promote sustainability, there should be periodic support interactions after formal implementation.
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Affiliation(s)
- Liza Prudente Moorman
- Clinical Implementation Specialist, Advanced Medical Predictive Devices, Diagnostics, and Displays (AMP3D), Charlottesville, Virginia, United States
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153
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Bougeard A, Guay Hottin1 R, Houde V, Jean T, Piront T, Potvin S, Bernard P, Tourjman V, De Benedictis L, Orban P. Le phénotypage digital pour une pratique clinique en santé mentale mieux informée. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1081513ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectifs Cette revue trouve sa motivation dans l’observation que la prise de décision clinique en santé mentale est limitée par la nature des mesures typiquement obtenues lors de l’entretien clinique et la difficulté des cliniciens à produire des prédictions justes sur les états mentaux futurs des patients. L’objectif est de présenter un survol représentatif du potentiel du phénotypage digital couplé à l’apprentissage automatique pour répondre à cette limitation, tout en en soulignant les faiblesses actuelles.
Méthode Au travers d’une revue narrative de la littérature non systématique, nous identifions les avancées technologiques qui permettent de quantifier, instant après instant et dans le milieu de vie naturel, le phénotype humain au moyen du téléphone intelligent dans diverses populations psychiatriques. Des travaux pertinents sont également sélectionnés afin de déterminer l’utilité et les limitations de l’apprentissage automatique pour guider les prédictions et la prise de décision clinique. Finalement, la littérature est explorée pour évaluer les barrières actuelles à l’adoption de tels outils.
Résultats Bien qu’émergeant d’un champ de recherche récent, de très nombreux travaux soulignent déjà la valeur des mesures extraites des senseurs du téléphone intelligent pour caractériser le phénotype humain dans les sphères comportementale, cognitive, émotionnelle et sociale, toutes étant affectées par les troubles mentaux. L’apprentissage automatique permet d’utiles et justes prédictions cliniques basées sur ces mesures, mais souffre d’un manque d’interprétabilité qui freinera son emploi prochain dans la pratique clinique. Du reste, plusieurs barrières identifiées tant du côté du patient que du clinicien freinent actuellement l’adoption de ce type d’outils de suivi et d’aide à la décision clinique.
Conclusion Le phénotypage digital couplé à l’apprentissage automatique apparaît fort prometteur pour améliorer la pratique clinique en santé mentale. La jeunesse de ces nouveaux outils technologiques requiert cependant un nécessaire processus de maturation qui devra être encadré par les différents acteurs concernés pour que ces promesses puissent être pleinement réalisées.
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Affiliation(s)
- Alan Bougeard
- Étudiant, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Rose Guay Hottin1
- Étudiante, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Valérie Houde
- M.D., étudiante, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Thierry Jean
- Étudiant, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Thibault Piront
- Professionnel de recherche, Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Stéphane Potvin
- Ph. D., chercheur, Centre de recherche de l’Institut universitaire en santé mentale de Montréal – professeur sous octroi titulaire, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Paquito Bernard
- Ph. D., chercheur, Centre de recherche de l’Institut universitaire en santé mentale de Montréal – professeur régulier, Département des sciences de l’activité physique, Université du Québec à Montréal
| | - Valérie Tourjman
- M.D., psychiatre, Institut universitaire en santé mentale de Montréal – professeure agrégée de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Luigi De Benedictis
- M.D., psychiatre, Institut universitaire en santé mentale de Montréal – professeur adjoint de clinique, Département de psychiatrie et d’addictologie, Université de Montréal
| | - Pierre Orban
- Ph. D., chercheur, Centre de recherche de l’Institut universitaire en santé mentale de Montréal – professeur sous octroi adjoint, Département de psychiatrie et d’addictologie, Université de Montréal
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Sullivan BA, Keim-Malpass J. BARRIERS to Early Detection of Deterioration in Hospitalized Infants Using Predictive Analytics. Hosp Pediatr 2021; 11:e195-e198. [PMID: 34348998 DOI: 10.1542/hpeds.2020-004382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Brynne A Sullivan
- Division of Neonatology, Department of Pediatrics, School of Medicine
| | - Jessica Keim-Malpass
- Department of Acute and Specialty Care, School of Nursing, University of Virginia, Charlottesville, Virginia
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Burrus S, Hall M, Tooley E, Conrad K, Bettenhausen JL, Kemper C. Factors Related to Serious Safety Events in a Children's Hospital Patient Safety Collaborative. Pediatrics 2021; 148:peds.2020-030346. [PMID: 34408092 DOI: 10.1542/peds.2020-030346] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Serious safety events (SSEs) occur infrequently at individual hospitals, making it difficult to establish trends to improve patient care. Patient safety organizations, such as the Child Health Patient Safety Organization (CHILDPSO), can identify trends and support learning across children's hospitals. We aim to describe longitudinal trends in SSE rates among CHILDPSO member hospitals and describe their sources of harm. METHODS SSEs from 44 children's hospitals were assigned severity and reported to CHILDPSO from January 1, 2015, to December 31, 2018. SSEs were classified into groups and subgroups based on analysis. Events were then tagged with up to 3 contributing factors. Subgroups with <5 events were excluded. RESULTS There were 22.5 million adjusted patient days included. The 12-month rolling average SSE rate per 10 000 adjusted patient days decreased from 0.71 to 0.41 (P < .001). There were 830 SSEs reported to CHILDPSO. The median hospital volume of SSEs was 12 events (interquartile range: 6-23), or ∼3 SSEs per year. Of the 830 events, 21.0% were high severity (SSE 1-3) and approximately two-thirds (67.0%, n = 610) were patient care management events, including subgroups of missed, delayed, or wrong diagnosis or treatment; medication errors; and suboptimal care coordination. The most common contributing factor was lack of situational awareness (17.9%, n = 382), which contributed to 1 in 5 (20%) high-severity SSEs. CONCLUSIONS Hospitals sharing SSE data through CHILDPSO have seen a decrease in SSEs. Patient care management was the most frequently seen. Future work should focus on investigation of contributing factors and risk mitigation strategies.
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Affiliation(s)
- Stephanie Burrus
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
| | - Matthew Hall
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri.,Children's Hospital Association, Lenexa, Kansas
| | | | - Kate Conrad
- Children's Hospital Association, Lenexa, Kansas
| | | | - Carol Kemper
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
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156
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Stewart J, Lu J, Goudie A, Bennamoun M, Sprivulis P, Sanfillipo F, Dwivedi G. Applications of machine learning to undifferentiated chest pain in the emergency department: A systematic review. PLoS One 2021; 16:e0252612. [PMID: 34428208 PMCID: PMC8384172 DOI: 10.1371/journal.pone.0252612] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/26/2021] [Indexed: 12/13/2022] Open
Abstract
Background Chest pain is amongst the most common reason for presentation to the emergency department (ED). There are many causes of chest pain, and it is important for the emergency physician to quickly and accurately diagnose life threatening causes such as acute myocardial infarction (AMI). Multiple clinical decision tools have been developed to assist clinicians in risk stratifying patients with chest. There is growing recognition that machine learning (ML) will have a significant impact on the practice of medicine in the near future and may assist with diagnosis and risk stratification. This systematic review aims to evaluate how ML has been applied to adults presenting to the ED with undifferentiated chest pain and assess if ML models show improved performance when compared to physicians or current risk stratification techniques. Methods and findings We conducted a systematic review of journal articles that applied a ML technique to an adult patient presenting to an emergency department with undifferentiated chest pain. Multiple databases were searched from inception through to November 2020. In total, 3361 articles were screened, and 23 articles were included. We did not conduct a metanalysis due to a high level of heterogeneity between studies in both their methods, and reporting. The most common primary outcomes assessed were diagnosis of acute myocardial infarction (AMI) (12 studies), and prognosis of major adverse cardiovascular event (MACE) (6 studies). There were 14 retrospective studies and 5 prospective studies. Four studies reported the development of a machine learning model retrospectively then tested it prospectively. The most common machine learning methods used were artificial neural networks (14 studies), random forest (6 studies), support vector machine (5 studies), and gradient boosting (2 studies). Multiple studies achieved high accuracy in both the diagnosis of AMI in the ED setting, and in predicting mortality and composite outcomes over various timeframes. ML outperformed existing risk stratification scores in all cases, and physicians in three out of four cases. The majority of studies were single centre, retrospective, and without prospective or external validation. There were only 3 studies that were considered low risk of bias and had low applicability concerns. Two studies reported integrating the ML model into clinical practice. Conclusions Research on applications of ML for undifferentiated chest pain in the ED has been ongoing for decades. ML has been reported to outperform emergency physicians and current risk stratification tools to diagnose AMI and predict MACE but has rarely been integrated into practice. Many studies assessing the use of ML in undifferentiated chest pain in the ED have a high risk of bias. It is important that future studies make use of recently developed standardised ML reporting guidelines, register their protocols, and share their datasets and code. Future work is required to assess the impact of ML model implementation on clinical decision making, patient orientated outcomes, and patient and physician acceptability. Trial registration International Prospective Register of Systematic Reviews registration number: CRD42020184977.
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Affiliation(s)
- Jonathon Stewart
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- * E-mail:
| | - Juan Lu
- Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Adrian Goudie
- Department of Emergency Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Mohammed Bennamoun
- School of Physics, Mathematics and Computing, University of Western Australia, Crawley, Western Australia, Australia
| | - Peter Sprivulis
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Department of Health Western Australia, East Perth, Western Australia, Australia
| | - Frank Sanfillipo
- School of Population and Global Health, University of Western Australia, Crawley, Western Australia, Australia
| | - Girish Dwivedi
- School of Medicine, The University of Western Australia, Crawley, Western Australia, Australia
- Harry Perkins Institute of Medical Research, Murdoch, Western Australia, Australia
- Department of Cardiology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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157
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Suwanvecho S, Suwanrusme H, Jirakulaporn T, Issarachai S, Taechakraichana N, Lungchukiet P, Decha W, Boonpakdee W, Thanakarn N, Wongrattananon P, Preininger AM, Solomon M, Wang S, Hekmat R, Dankwa-Mullan I, Shortliffe E, Patel VL, Arriaga Y, Jackson GP, Kiatikajornthada N. Comparison of an oncology clinical decision-support system's recommendations with actual treatment decisions. J Am Med Inform Assoc 2021; 28:832-838. [PMID: 33517389 PMCID: PMC7973455 DOI: 10.1093/jamia/ocaa334] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Indexed: 12/02/2022] Open
Abstract
Objective IBM(R) Watson for Oncology (WfO) is a clinical decision-support system (CDSS) that provides evidence-informed therapeutic options to cancer-treating clinicians. A panel of experienced oncologists compared CDSS treatment options to treatment decisions made by clinicians to characterize the quality of CDSS therapeutic options and decisions made in practice. Methods This study included patients treated between 1/2017 and 7/2018 for breast, colon, lung, and rectal cancers at Bumrungrad International Hospital (BIH), Thailand. Treatments selected by clinicians were paired with therapeutic options presented by the CDSS and coded to mask the origin of options presented. The panel rated the acceptability of each treatment in the pair by consensus, with acceptability defined as compliant with BIH’s institutional practices. Descriptive statistics characterized the study population and treatment-decision evaluations by cancer type and stage. Results Nearly 60% (187) of 313 treatment pairs for breast, lung, colon, and rectal cancers were identical or equally acceptable, with 70% (219) of WfO therapeutic options identical to, or acceptable alternatives to, BIH therapy. In 30% of cases (94), 1 or both treatment options were rated as unacceptable. Of 32 cases where both WfO and BIH options were acceptable, WfO was preferred in 18 cases and BIH in 14 cases. Colorectal cancers exhibited the highest proportion of identical or equally acceptable treatments; stage IV cancers demonstrated the lowest. Conclusion This study demonstrates that a system designed in the US to support, rather than replace, cancer-treating clinicians provides therapeutic options which are generally consistent with recommendations from oncologists outside the US.
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Affiliation(s)
| | - Harit Suwanrusme
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
| | | | | | | | | | - Wimolrat Decha
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
| | - Wisanu Boonpakdee
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
| | - Nittaya Thanakarn
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
| | | | | | | | - Suwei Wang
- IBM Watson Health, Cambridge, Massachusetts, USA
| | | | | | - Edward Shortliffe
- IBM Watson Health, Cambridge, Massachusetts, USA
- Columbia University, New York, New York, USA
| | - Vimla L Patel
- IBM Watson Health, Cambridge, Massachusetts, USA
- New York Academy of Medicine, New York, New York, USA
| | - Yull Arriaga
- IBM Watson Health, Cambridge, Massachusetts, USA
| | - Gretchen Purcell Jackson
- IBM Watson Health, Cambridge, Massachusetts, USA
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Narongsak Kiatikajornthada
- Bumrungrad International Hospital, Khlong Toei Nuea, Bangkok, Thailand
- Corresponding Author: Narongsak Kiatikajornthada, MD, Bumrungrad International Hospital, 33 Soi Sukhumvit 3, Khlong Toei Nuea, Watthana, Bangkok 10110, Thailand;
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158
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Gao J, Merchant AM. A Machine Learning Approach in Predicting Mortality Following Emergency General Surgery. Am Surg 2021; 87:1379-1385. [PMID: 34378431 DOI: 10.1177/00031348211038568] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND There is a significant mortality burden associated with emergency general surgery (EGS) procedures. The objective of this study was to develop and validate the use of a machine learning approach to predict mortality following EGS. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients who underwent EGS between 2012 and 2017. We developed a machine learning algorithm to predict mortality following EGS and compared its performance with existing risk-prediction models of American Society of Anesthesiologists (ASA) classification, American College of Surgeon Surgical Risk Calculator (ACS-SRC), and the modified frailty index (mFI) using the area under receiver operative curve (AUC), sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS The machine learning algorithm had a very high performance for predicting mortality following EGS, and it had superior performance compared to the ASA classification, ACS-SRC, and the mFI, as measured by the AUC, sensitivity, specificity, PPV, and NPV. DISCUSSION Machine learning approaches may be a promising tool to predict outcomes for EGS, aiding clinicians in surgical decision-making and counseling of patients and family, improving clinical outcomes by identifying modifiable risk factors than can be optimized, and decreasing treatment costs through resource allocation.
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Affiliation(s)
- Jeff Gao
- Department of Surgery, 12286Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Aziz M Merchant
- Department of Surgery, 12286Rutgers New Jersey Medical School, Newark, NJ, USA
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Damoiseaux-Volman BA, van der Velde N, Ruige SG, Romijn JA, Abu-Hanna A, Medlock S. Effect of Interventions With a Clinical Decision Support System for Hospitalized Older Patients: Systematic Review Mapping Implementation and Design Factors. JMIR Med Inform 2021; 9:e28023. [PMID: 34269682 PMCID: PMC8325084 DOI: 10.2196/28023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 01/25/2023] Open
Abstract
Background Clinical decision support systems (CDSSs) form an implementation strategy that can facilitate and support health care professionals in the care of older hospitalized patients. Objective Our study aims to systematically review the effects of CDSS interventions in older hospitalized patients. As a secondary aim, we aim to summarize the implementation and design factors described in effective and ineffective interventions and identify gaps in the current literature. Methods We conducted a systematic review with a search strategy combining the categories older patients, geriatric topic, hospital, CDSS, and intervention in the databases MEDLINE, Embase, and SCOPUS. We included controlled studies, extracted data of all reported outcomes, and potentially beneficial design and implementation factors. We structured these factors using the Grol and Wensing Implementation of Change model, the GUIDES (Guideline Implementation with Decision Support) checklist, and the two-stream model. The risk of bias of the included studies was assessed using the Cochrane Collaboration’s Effective Practice and Organisation of Care risk of bias approach. Results Our systematic review included 18 interventions, of which 13 (72%) were effective in improving care. Among these interventions, 8 (6 effective) focused on medication review, 8 (6 effective) on delirium, 7 (4 effective) on falls, 5 (4 effective) on functional decline, 4 (3 effective) on discharge or aftercare, and 2 (0 effective) on pressure ulcers. In 77% (10/13) effective interventions, the effect was based on process-related outcomes, in 15% (2/13) interventions on both process- and patient-related outcomes, and in 8% (1/13) interventions on patient-related outcomes. The following implementation and design factors were potentially associated with effectiveness: a priori problem or performance analyses (described in 9/13, 69% effective vs 0/5, 0% ineffective interventions), multifaceted interventions (8/13, 62% vs 1/5, 20%), and consideration of the workflow (9/13, 69% vs 1/5, 20%). Conclusions CDSS interventions can improve the hospital care of older patients, mostly on process-related outcomes. We identified 2 implementation factors and 1 design factor that were reported more frequently in articles on effective interventions. More studies with strong designs are needed to measure the effect of CDSS on relevant patient-related outcomes, investigate personalized (data-driven) interventions, and quantify the impact of implementation and design factors on CDSS effectiveness. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews): CRD42019124470; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=124470.
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Affiliation(s)
- Birgit A Damoiseaux-Volman
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Nathalie van der Velde
- Section of Geriatric Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Sil G Ruige
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Johannes A Romijn
- Department of Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Stephanie Medlock
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Kim W, Park JJ, Lee HY, Kim KH, Yoo BS, Kang SM, Baek SH, Jeon ES, Kim JJ, Cho MC, Chae SC, Oh BH, Kook W, Choi DJ. Predicting survival in heart failure: a risk score based on machine-learning and change point algorithm. Clin Res Cardiol 2021; 110:1321-1333. [PMID: 34259921 DOI: 10.1007/s00392-021-01870-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/04/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Machine learning (ML) algorithm can improve risk prediction because ML can select features and segment continuous variables effectively unbiased. We generated a risk score model for mortality with ML algorithms in East-Asian patients with heart failure (HF). METHODS From the Korean Acute Heart Failure (KorAHF) registry, we used the data of 3683 patients with 27 continuous and 44 categorical variables. Grouped Lasso algorithm was used for the feature selection, and a novel continuous variable segmentation algorithm which is based on change-point analysis was developed for effectively segmenting the ranges of the continuous variables. Then, a risk score was assigned to each feature reflecting nonlinear relationship between features and survival times, and an integer score of maximum 100 was calculated for each patient. RESULTS During 3-year follow-up time, 32.8% patients died. Using grouped Lasso, we identified 15 highly significant independent clinical features. The calculated risk score of each patient ranged between 1 and 71 points with a median of 36 (interquartile range: 27-45). The 3-year survival differed according to the quintiles of the risk score, being 80% and 17% in the 1st and 5th quintile, respectively. In addition, ML risk score had higher AUCs than MAGGIC-HF score to predict 1-year mortality (0.751 vs. 0.711, P < 0.001). CONCLUSIONS In East-Asian patients with HF, a novel risk score model based on ML and the new continuous variable segmentation algorithm performs better for mortality prediction than conventional prediction models. CLINICAL TRIAL REGISTRATION Unique identifier: INCT01389843 https://clinicaltrials.gov/ct2/show/NCT01389843 .
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Affiliation(s)
- Wonse Kim
- Department of Mathematical Sciences, Seoul National University, Gwanak Ro 1, Gwanak-Gu, Seoul, Republic of Korea.,MetaEyes, 41, Yonsei-ro 5da-gil, Seodaemun-gu, Seoul, Republic of Korea
| | - Jin Joo Park
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hae-Young Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kye Hun Kim
- Heart Research Center, Chonnam National University, Gwangju, Republic of Korea
| | - Byung-Su Yoo
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Seok-Min Kang
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sang Hong Baek
- Department of Internal Medicine, the Catholic University of Korea, Seoul, Republic of Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University College of Medicine, Daegu, Republic of Korea
| | - Byung-Hee Oh
- Department of Internal Medicine, Mediplex Sejong Hospital, Incheon, Republic of Korea
| | - Woong Kook
- Department of Mathematical Sciences, Seoul National University, Gwanak Ro 1, Gwanak-Gu, Seoul, Republic of Korea.
| | - Dong-Ju Choi
- Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. .,Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gumiro 166, Bundang, Gyeonggi-do, Seongnam, Republic of Korea.
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Bakeer N, Dover S, Babyn P, Feldman BM, von Drygalski A, Doria AS, Ignas DM, Abad A, Bailey C, Beggs I, Chang EY, Dunn A, Funk S, Gibikote S, Goddard N, Hilliard P, Keshava SN, Kruse-Jarres R, Li Y, Lobet S, Manco-Johnson M, Martinoli C, O'Donnell JS, Papakonstantinou O, Pergantou H, Poonnoose P, Querol F, Srivastava A, Steiner B, Strike K, Timmer M, Tyrrell PN, Vidarsson L, Blanchette VS. Musculoskeletal ultrasound in hemophilia: Results and recommendations from a global survey and consensus meeting. Res Pract Thromb Haemost 2021; 5:e12531. [PMID: 34268464 PMCID: PMC8271584 DOI: 10.1002/rth2.12531] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/18/2021] [Accepted: 04/24/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction For persons with hemophilia, optimization of joint outcomes is an important unmet need. The aim of this initiative was to determine use of ultrasound in evaluating arthropathy in persons with hemophilia, and to move toward consensus among hemophilia care providers regarding the preferred ultrasound protocols for global adaptation. Methods A global survey of hemophilia treatment centers was conducted that focused on understanding how and why ultrasound was being used and endeavored to move toward consensus definitions of both point‐of‐care musculoskeletal ultrasound (POC‐MSKUS) and full diagnostic ultrasound, terminology to describe structures being assessed by ultrasound, and how these assessments should be interpreted. Next, an in‐person meeting of an international group of hemophilia health care professionals and patient representatives was held, with the objective of achieving consensus regarding the acquisition and interpretation of POC‐MSKUS and full diagnostic ultrasound for use in the assessment of musculoskeletal (MSK) pathologies in persons with hemophilia. Results The recommendations were that clear definitions of the types of ultrasound examinations should be adopted and that a standardized ultrasound scoring/measurement system should be developed, tested, and implemented. The scoring/measurement system should be tiered to allow for a range of complexity yet maintain the ability for comparison across levels. Conclusion Ultrasound is an evolving technology increasingly used for the assessment of MSK outcomes in persons with hemophilia. As adoption increases globally for clinical care and research, it will become increasingly important to establish clear guidelines for image acquisition, interpretation, and reporting to ensure accuracy, consistency, and comparability across groups.
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Affiliation(s)
- Nihal Bakeer
- Indiana Hemophilia & Thrombosis Center Indianapolis IN USA
| | - Saunya Dover
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Paul Babyn
- Department of Medical Imaging University of Saskatchewan and Saskatchewan Health Authority Saskatoon City Hospital SK Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada.,Department of Pediatrics Faculty of Medicine University of Toronto Toronto ON Canada.,Institute of Health Policy, Management and Evaluation The Dalla Lana School of Public Health University of Toronto Toronto ON Canada.,Division of Rheumatology The Hospital for Sick Children Toronto ON Canada
| | | | - Andrea S Doria
- Department of Medical Imaging University of Toronto The Hospital for Sick Children Toronto ON Canada
| | - Danial M Ignas
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Audrey Abad
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Cindy Bailey
- Los Angeles Orthopaedic Treatment Centre Los Angeles CA USA
| | - Ian Beggs
- Department of Radiology Royal Infirmary of Edinburgh NHS Lothian Edinburgh UK
| | - Eric Y Chang
- University of California San Diego Medical Center San Diego CA USA
| | - Amy Dunn
- Division of Pediatric Hematology, Oncology & Marrow Transplant Department of Pediatrics Nationwide Children's Hospital The Ohio State University College of Medicine Columbus OH USA
| | - Sharon Funk
- Hemophilia and Thrombosis Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Sridhar Gibikote
- Division of Clinical Radiology Christian Medical College Vellore India
| | - Nicholas Goddard
- Katherine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Pamela Hilliard
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | | | - Rebecca Kruse-Jarres
- University of Washington and Washington Center for Bleeding Disorders Seattle WA USA
| | - Yingjia Li
- Ultrasound Department Manfang Hospital Guangzhou China
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit Division of Haematology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Marilyn Manco-Johnson
- Hemophilia & Thrombosis Center Department of Pediatrics University of Colorado Anschutz Medical Center Aurora CO USA
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL) Università di Genova IRCCS Ospedale Policlinico San Martino Genova Italy
| | - James S O'Donnell
- Irish Centre for Vascular Biology Royal College of Surgeons in Ireland Dublin Ireland
| | | | - Helen Pergantou
- Pediatric Hemophilia Centre/Haemostatis and Thrombosis Unit Aghia Sophia Children's Hospital Athens Greece
| | - Pradeep Poonnoose
- Department of Orthopedics Unit 2 Christian Medical College Vellore India
| | - Felipe Querol
- Haemostasis and Thrombosis Unit Hospital LA FE Universidad de Valencia Valencia Spain
| | - Alok Srivastava
- Department of Hematology Christian Medical College Vellore India
| | - Bruno Steiner
- Department of Rehabilitation Medicine Physical Therapy and MSKUS Program Washington Center for Bleeding Disorders University of Washington Seattle WA USA
| | - Karen Strike
- School of Rehabilitation Science Faculty of Health Science Hamilton Niagara Regional Hemophilia Program Hamilton Health Sciences McMaster University Hamilton ON Canada
| | - Merel Timmer
- van Creveldkliniek University Medical Center Utrecht Utrecht The Netherlands
| | - Pascal N Tyrrell
- Department of Medical Imaging Institute of Medical Science Toronto ON Canada.,Department of Statistical Sciences University of Toronto Toronto ON Canada
| | - Logi Vidarsson
- Diagnostic Imaging The Hospital for Sick Children Toronto ON Canada
| | - Victor S Blanchette
- Department of Pediatrics Division of Hematology/Oncology University of Toronto The Hospital for Sick Children Toronto ON Canada
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162
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Elhage SA, Deerenberg EB, Ayuso SA, Murphy KJ, Shao JM, Kercher KW, Smart NJ, Fischer JP, Augenstein VA, Colavita PD, Heniford BT. Development and Validation of Image-Based Deep Learning Models to Predict Surgical Complexity and Complications in Abdominal Wall Reconstruction. JAMA Surg 2021; 156:933-940. [PMID: 34232255 DOI: 10.1001/jamasurg.2021.3012] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Image-based deep learning models (DLMs) have been used in other disciplines, but this method has yet to be used to predict surgical outcomes. Objective To apply image-based deep learning to predict complexity, defined as need for component separation, and pulmonary and wound complications after abdominal wall reconstruction (AWR). Design, Setting, and Participants This quality improvement study was performed at an 874-bed hospital and tertiary hernia referral center from September 2019 to January 2020. A prospective database was queried for patients with ventral hernias who underwent open AWR by experienced surgeons and had preoperative computed tomography images containing the entire hernia defect. An 8-layer convolutional neural network was generated to analyze image characteristics. Images were batched into training (approximately 80%) or test sets (approximately 20%) to analyze model output. Test sets were blinded from the convolutional neural network until training was completed. For the surgical complexity model, a separate validation set of computed tomography images was evaluated by a blinded panel of 6 expert AWR surgeons and the surgical complexity DLM. Analysis started February 2020. Exposures Image-based DLM. Main Outcomes and Measures The primary outcome was model performance as measured by area under the curve in the receiver operating curve (ROC) calculated for each model; accuracy with accompanying sensitivity and specificity were also calculated. Measures were DLM prediction of surgical complexity using need for component separation techniques as a surrogate and prediction of postoperative surgical site infection and pulmonary failure. The DLM for predicting surgical complexity was compared against the prediction of 6 expert AWR surgeons. Results A total of 369 patients and 9303 computed tomography images were used. The mean (SD) age of patients was 57.9 (12.6) years, 232 (62.9%) were female, and 323 (87.5%) were White. The surgical complexity DLM performed well (ROC = 0.744; P < .001) and, when compared with surgeon prediction on the validation set, performed better with an accuracy of 81.3% compared with 65.0% (P < .001). Surgical site infection was predicted successfully with an ROC of 0.898 (P < .001). However, the DLM for predicting pulmonary failure was less effective with an ROC of 0.545 (P = .03). Conclusions and Relevance Image-based DLM using routine, preoperative computed tomography images was successful in predicting surgical complexity and more accurate than expert surgeon judgment. An additional DLM accurately predicted the development of surgical site infection.
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Affiliation(s)
- Sharbel Adib Elhage
- Department of Surgery, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | | | - Sullivan Armando Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | | | - Jenny Meng Shao
- Department of Surgery, University of Pennsylvania, Philadelphia
| | - Kent Williams Kercher
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Neil James Smart
- Department of Colorectal Surgery, Royal Devon and Exeter NHS Foundation Trust, Royal Devon and Exeter Hospital, Exeter, United Kingdom
| | - John Patrick Fischer
- Division of Plastic Surgery, Department of Surgery, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Vedra Abdomerovic Augenstein
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - Paul Dominick Colavita
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, North Carolina
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163
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Design of English hierarchical online test system based on machine learning. JOURNAL OF INTELLIGENT SYSTEMS 2021. [DOI: 10.1515/jisys-2020-0150] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Abstract
Large amount of data are exchanged and the internet is turning into twenty-first century Silk Road for data. Machine learning (ML) is the new area for the applications. The artificial intelligence (AI) is the field providing machines with intelligence. In the last decades, more developments have been made in the field of ML and deep learning. The technology and other advanced algorithms are implemented into more computational constrained devices. The online English test system based on ML breaks the shackles of the traditional paper English test and improves the efficiency of the English test. At the same time, it also maintains the fairness of English test and improves the marking speed. In order to realize an online English test system based on ML and facilitate the assessment of students’ college English courses, this paper mainly adopts relevant research and design on the main functional modules, key technologies, and functional realization of the online English test. The brand-new powerful teaching software and the online examination system can help schools to conduct more systematic and scientific management. The conclusion shows that as brand-new and powerful teaching software, the online examination system can help schools to conduct more systematic and scientific management.
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164
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Giang C, Calvert J, Rahmani K, Barnes G, Siefkas A, Green-Saxena A, Hoffman J, Mao Q, Das R. Predicting ventilator-associated pneumonia with machine learning. Medicine (Baltimore) 2021; 100:e26246. [PMID: 34115013 PMCID: PMC8202554 DOI: 10.1097/md.0000000000026246] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/02/2021] [Indexed: 01/04/2023] Open
Abstract
Ventilator-associated pneumonia (VAP) is the most common and fatal nosocomial infection in intensive care units (ICUs). Existing methods for identifying VAP display low accuracy, and their use may delay antimicrobial therapy. VAP diagnostics derived from machine learning (ML) methods that utilize electronic health record (EHR) data have not yet been explored. The objective of this study is to compare the performance of a variety of ML models trained to predict whether VAP will be diagnosed during the patient stay.A retrospective study examined data from 6126 adult ICU encounters lasting at least 48 hours following the initiation of mechanical ventilation. The gold standard was the presence of a diagnostic code for VAP. Five different ML models were trained to predict VAP 48 hours after initiation of mechanical ventilation. Model performance was evaluated with regard to the area under the receiver operating characteristic (AUROC) curve on a 20% hold-out test set. Feature importance was measured in terms of Shapley values.The highest performing model achieved an AUROC value of 0.854. The most important features for the best-performing model were the length of time on mechanical ventilation, the presence of antibiotics, sputum test frequency, and the most recent Glasgow Coma Scale assessment.Supervised ML using patient EHR data is promising for VAP diagnosis and warrants further validation. This tool has the potential to aid the timely diagnosis of VAP.
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165
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Rowe M, Nicholls DA, Shaw J. How to replace a physiotherapist: artificial intelligence and the redistribution of expertise. Physiother Theory Pract 2021; 38:2275-2283. [PMID: 34081573 DOI: 10.1080/09593985.2021.1934924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The convergence of large datasets, increased computational power, and enhanced algorithm design has led to the increased success of machine learning (ML) and artificial intelligence (AI) across a wide variety of healthcare professions but which, so far, have eluded formal discussion in physiotherapy. This is a concern as we begin to see accelerating performance improvements in AI research in general, and specifically, an increase in competence within narrow domains of practice in clinical AI. In this paper we argue that the introduction of AI-based systems within the health sector is likely to have a significant influence on physiotherapy practice, leading to the automation of tasks that we might consider to be core to the discipline. We present examples of some of these AI-based systems in clinical practice, specifically video analysis, natural language processing (NLP), robotics, personalized healthcare, expert systems, and prediction algorithms. We address some of the key ethical implications of these emerging technologies, discuss the implications for physiotherapists, and explore how the resultant changes may challenge some long-held assumptions about the status of the profession in society.
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Affiliation(s)
- Michael Rowe
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, Cape Town, South Africa
| | - David A Nicholls
- School of Clinical Sciences, A-12, Faculty of Health and Environmental Sciences, Auckland University of Technology, Northcote, Auckland New Zealand
| | - James Shaw
- Artificial Intelligence, Ethics and Health, Joint Centre for Bioethics, Women's College, Toronto, Ontario, Canada
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166
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Boniolo F, Dorigatti E, Ohnmacht AJ, Saur D, Schubert B, Menden MP. Artificial intelligence in early drug discovery enabling precision medicine. Expert Opin Drug Discov 2021; 16:991-1007. [PMID: 34075855 DOI: 10.1080/17460441.2021.1918096] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Precision medicine is the concept of treating diseases based on environmental factors, lifestyles, and molecular profiles of patients. This approach has been found to increase success rates of clinical trials and accelerate drug approvals. However, current precision medicine applications in early drug discovery use only a handful of molecular biomarkers to make decisions, whilst clinics gear up to capture the full molecular landscape of patients in the near future. This deep multi-omics characterization demands new analysis strategies to identify appropriate treatment regimens, which we envision will be pioneered by artificial intelligence.Areas covered: In this review, the authors discuss the current state of drug discovery in precision medicine and present our vision of how artificial intelligence will impact biomarker discovery and drug design.Expert opinion: Precision medicine is expected to revolutionize modern medicine; however, its traditional form is focusing on a few biomarkers, thus not equipped to leverage the full power of molecular landscapes. For learning how the development of drugs can be tailored to the heterogeneity of patients across their molecular profiles, artificial intelligence algorithms are the next frontier in precision medicine and will enable a fully personalized approach in drug design, and thus ultimately impacting clinical practice.
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Affiliation(s)
- Fabio Boniolo
- Institute of Computational Biology, Helmholtz Zentrum München - German Research Centre for Environmental Health, Munich, Germany.,School of Medicine, Chair of Translational Cancer Research and Institute for Experimental Cancer Therapy, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Emilio Dorigatti
- Institute of Computational Biology, Helmholtz Zentrum München - German Research Centre for Environmental Health, Munich, Germany.,Statistical Learning and Data Science, Department of Statistics, Ludwig Maximilian Universität München, Munich, Germany
| | - Alexander J Ohnmacht
- Institute of Computational Biology, Helmholtz Zentrum München - German Research Centre for Environmental Health, Munich, Germany.,Department of Biology, Ludwig-Maximilians University Munich, Martinsried, Germany
| | - Dieter Saur
- School of Medicine, Chair of Translational Cancer Research and Institute for Experimental Cancer Therapy, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Benjamin Schubert
- Institute of Computational Biology, Helmholtz Zentrum München - German Research Centre for Environmental Health, Munich, Germany.,Department of Mathematics, Technical University of Munich, Garching, Germany
| | - Michael P Menden
- Institute of Computational Biology, Helmholtz Zentrum München - German Research Centre for Environmental Health, Munich, Germany.,Department of Biology, Ludwig-Maximilians University Munich, Martinsried, Germany.,German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany
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167
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Vinny PW, Takkar A, Lal V, Padma MV, Sylaja PN, Narasimhan L, Dwivedi SN, Nair PP, Iype T, Gupta A, Vishnu VY. Mobile application as a complementary tool for differential diagnosis in Neuro-ophthalmology: A multicenter cross-sectional study. Indian J Ophthalmol 2021; 69:1491-1497. [PMID: 34011726 PMCID: PMC8302325 DOI: 10.4103/ijo.ijo_1929_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose: Drawing differential diagnoses to a Neuro-ophthalmology clinical scenario is a difficult task for a neurology trainee. The authors conducted a study to determine if a mobile application specialized in suggesting differential diagnoses from clinical scenarios can complement clinical reasoning of a neurologist in training. Methods: A cross-sectional multicenter study was conducted to compare the accuracy of neurology residents versus a mobile medical app (Neurology Dx) in drawing a comprehensive list of differential diagnoses from Neuro-ophthalmology clinical vignettes. The differentials generated by residents and the App were compared with the Gold standard differential diagnoses adjudicated by experts. The prespecified primary outcome was the proportion of correctly identified high likely gold standard differential diagnosis by residents and App. Results: Neurology residents (n = 100) attempted 1500 Neuro-ophthalmology clinical vignettes. Frequency of correctly identified high likely differential diagnosis by residents was 19.42% versus 53.71% by the App (P < 0.0001). The first listed differential diagnosis by the residents matched with that of the first differential diagnosis adjudicated by experts (gold standard differential diagnosis) with a frequency of 26.5% versus 28.3% by the App, whereas the combined output of residents and App scored a frequency of 41.2% in identifying the first gold standard differential correctly. The residents correctly identified the first three and first five gold standard differential diagnosis with a frequency of 17.83% and 19.2%, respectively, as against 22.26% and 30.39% (P < 0.0001) by the App. Conclusion: A ruled based app in Neuro-ophthalmology has the potential to complement a neurology resident in drawing a comprehensive list of differential diagnoses.
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Affiliation(s)
| | - Aastha Takkar
- Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - P N Sylaja
- Neurology, Sree Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Sada Nand Dwivedi
- Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Pradeep P Nair
- Neurology, Jawaharlal Nehru Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Thomas Iype
- Neurology, Government Medical College Trivandrum, Kerala, India
| | - Anu Gupta
- Neurology, Govind Ballabh Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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168
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Sharma V, Kulkarni V, Eurich DT, Kumar L, Samanani S. Safe opioid prescribing: a prognostic machine learning approach to predicting 30-day risk after an opioid dispensation in Alberta, Canada. BMJ Open 2021; 11:e043964. [PMID: 34039572 PMCID: PMC8160164 DOI: 10.1136/bmjopen-2020-043964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 05/18/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To develop machine learning models employing administrative health data that can estimate risk of adverse outcomes within 30 days of an opioid dispensation for use by health departments or prescription monitoring programmes. DESIGN, SETTING AND PARTICIPANTS This prognostic study was conducted in Alberta, Canada between 2017 and 2018. Participants included all patients 18 years of age and older who received at least one opioid dispensation. Pregnant and cancer patients were excluded. EXPOSURE Each opioid dispensation served as an exposure. MAIN OUTCOMES/MEASURES Opioid-related adverse outcomes were identified from linked administrative health data. Machine learning algorithms were trained using 2017 data to predict risk of hospitalisation, emergency department visit and mortality within 30 days of an opioid dispensation. Two validation sets, using 2017 and 2018 data, were used to evaluate model performance. Model discrimination and calibration performance were assessed for all patients and those at higher risk. Machine learning discrimination was compared with current opioid guidelines. RESULTS Participants in the 2017 training set (n=275 150) and validation set (n=117 829) had similar baseline characteristics. In the 2017 validation set, c-statistics for the XGBoost, logistic regression and neural network classifiers were 0.87, 0.87 and 0.80, respectively. In the 2018 validation set (n=393 023), the corresponding c-statistics were 0.88, 0.88 and 0.82. C-statistics from the Canadian guidelines ranged from 0.54 to 0.69 while the US guidelines ranged from 0.50 to 0.62. The top five percentile of predicted risk for the XGBoost and logistic regression classifiers captured 42% of all events and translated into post-test probabilities of 13.38% and 13.45%, respectively, up from the pretest probability of 1.6%. CONCLUSION Machine learning classifiers, especially incorporating hospitalisation/physician claims data, have better predictive performance compared with guideline or prescription history only approaches when predicting 30-day risk of adverse outcomes. Prescription monitoring programmes and health departments with access to administrative data can use machine learning classifiers to effectively identify those at higher risk compared with current guideline-based approaches.
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Affiliation(s)
- Vishal Sharma
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Luke Kumar
- Alberta Machine Intelligence Institute, Edmonton, Alberta, Canada
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169
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Dagi TF, Barker FG, Glass J. Machine Learning and Artificial Intelligence in Neurosurgery: Status, Prospects, and Challenges. Neurosurgery 2021; 89:133-142. [PMID: 34015816 DOI: 10.1093/neuros/nyab170] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- T Forcht Dagi
- Queen's University Belfast and The William J. Clinton Leadership Institute, Belfast, UK
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Fred G Barker
- Department of Neurosurgery, Harvard Medical School, Boston, Massachusetts, USA
- The Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jacob Glass
- Center for Epigenetics Research, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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170
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Ronquillo CE, Peltonen LM, Pruinelli L, Chu CH, Bakken S, Beduschi A, Cato K, Hardiker N, Junger A, Michalowski M, Nyrup R, Rahimi S, Reed DN, Salakoski T, Salanterä S, Walton N, Weber P, Wiegand T, Topaz M. Artificial intelligence in nursing: Priorities and opportunities from an international invitational think-tank of the Nursing and Artificial Intelligence Leadership Collaborative. J Adv Nurs 2021; 77:3707-3717. [PMID: 34003504 PMCID: PMC7612744 DOI: 10.1111/jan.14855] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/21/2021] [Indexed: 01/23/2023]
Abstract
Aim To develop a consensus paper on the central points of an international invitational think‐tank on nursing and artificial intelligence (AI). Methods We established the Nursing and Artificial Intelligence Leadership (NAIL) Collaborative, comprising interdisciplinary experts in AI development, biomedical ethics, AI in primary care, AI legal aspects, philosophy of AI in health, nursing practice, implementation science, leaders in health informatics practice and international health informatics groups, a representative of patients and the public, and the Chair of the ITU/WHO Focus Group on Artificial Intelligence for Health. The NAIL Collaborative convened at a 3‐day invitational think tank in autumn 2019. Activities included a pre‐event survey, expert presentations and working sessions to identify priority areas for action, opportunities and recommendations to address these. In this paper, we summarize the key discussion points and notes from the aforementioned activities. Implications for nursing Nursing's limited current engagement with discourses on AI and health posts a risk that the profession is not part of the conversations that have potentially significant impacts on nursing practice. Conclusion There are numerous gaps and a timely need for the nursing profession to be among the leaders and drivers of conversations around AI in health systems. Impact We outline crucial gaps where focused effort is required for nursing to take a leadership role in shaping AI use in health systems. Three priorities were identified that need to be addressed in the near future: (a) Nurses must understand the relationship between the data they collect and AI technologies they use; (b) Nurses need to be meaningfully involved in all stages of AI: from development to implementation; and (c) There is a substantial untapped and an unexplored potential for nursing to contribute to the development of AI technologies for global health and humanitarian efforts.
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Affiliation(s)
- Charlene Esteban Ronquillo
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada.,School of Nursing, Faculty of Health and Social Development, University of British Columbia Okanagan, Kelowna, BC, Canada.,International Medical Informatics Association, Student and Emerging Professionals Special Interest Group
| | - Laura-Maria Peltonen
- International Medical Informatics Association, Student and Emerging Professionals Special Interest Group.,Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Charlene H Chu
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Suzanne Bakken
- School of Nursing, Department of Biomedical Informatics, Data Science Institute, Columbia University, New York, NY, USA.,Precision in Symptom Self-Management (PriSSM) Center, Reducing Health Disparities Through Informatics Training Program (RHeaDI), Columbia University, New York, NY, USA
| | | | - Kenrick Cato
- School of Nursing, Department of Biomedical Informatics, Data Science Institute, Columbia University, New York, NY, USA
| | - Nicholas Hardiker
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Alain Junger
- Nursing Direction, Nursing Information System Unit, Centre Hospitalier Universitaire Vaudois (CHUV) Lausanne, Lausanne, Switzerland
| | | | - Rune Nyrup
- Leverhulme Centre for the Future of Intelligence, University of Cambridge, Cambridge, UK
| | - Samira Rahimi
- Department of Family Medicine, McGill University, Lady Davis Institute for Medical Research of Jewish General Hospital, Mila Quebec Artificial Intelligence Institute, Montreal, QC, Canada
| | | | - Tapio Salakoski
- Department of Mathematics and Statistics, University of Turku, Turku, Finland
| | - Sanna Salanterä
- Department of Nursing Science, University of Turku and Turku University Hospital, Turku, Finland
| | - Nancy Walton
- Daphne Cockwell School of Nursing, Faculty of Community Services, Ryerson University, Toronto, ON, Canada.,Research Ethics Board, Women's College Hospital, Toronto, ON, Canada.,Health Canada and Public Health Agency of Canada's Research Ethics Board, Toronto, ON, Canada
| | - Patrick Weber
- NICE Computing SA, Lausanne, Switzerland.,European Federation for Medical Informatics (EFMI)
| | - Thomas Wiegand
- ITU/WHO Focus Group on Artificial Intelligence for Health (FG-AI4H).,Fraunhofer Heinrich Hertz Institute, Berlin, Germany.,Berlin Institute of Technology, Berlin, Germany
| | - Maxim Topaz
- International Medical Informatics Association, Student and Emerging Professionals Special Interest Group.,School of Nursing, Department of Biomedical Informatics, Data Science Institute, Columbia University, New York, NY, USA
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171
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Geary B, Peat E, Dransfield S, Cook N, Thistlethwaite F, Graham D, Carter L, Hughes A, Krebs MG, Whetton AD. Discovery and Evaluation of Protein Biomarkers as a Signature of Wellness in Late-Stage Cancer Patients in Early Phase Clinical Trials. Cancers (Basel) 2021; 13:cancers13102443. [PMID: 34069985 PMCID: PMC8157875 DOI: 10.3390/cancers13102443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/07/2021] [Accepted: 05/12/2021] [Indexed: 12/22/2022] Open
Abstract
TARGET (tumour characterisation to guide experimental targeted therapy) is a cancer precision medicine programme focused on molecular characterisation of patients entering early phase clinical trials. Performance status (PS) measures a patient's ability to perform a variety of activities. However, the quality of present algorithms to assess PS is limited and based on qualitative clinician assessment. Plasma samples from patients enrolled into TARGET were analysed using the mass spectrometry (MS) technique: sequential window acquisition of all theoretical fragment ion spectra (SWATH)-MS. SWATH-MS was used on a discovery cohort of 55 patients to differentiate patients into either a good or poor prognosis by creation of a Wellness Score (WS) that showed stronger prediction of overall survival (p = 0.000551) compared to PS (p = 0.001). WS was then tested against a validation cohort of 77 patients showing significant (p = 0.000451) prediction of overall survival. WS in both sets had receiver operating characteristic curve area under the curve (AUC) values of 0.76 (p = 0.002) and 0.67 (p = 0.011): AUC of PS was 0.70 (p = 0.117) and 0.55 (p = 0.548). These signatures can now be evaluated further in larger patient populations to assess their utility in a clinical setting.
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Affiliation(s)
- Bethany Geary
- Stoller Biomarker Discovery Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9NQ, UK;
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (F.T.); (L.C.); (A.H.)
| | - Erin Peat
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; (E.P.); (S.D.); (N.C.); (D.G.)
| | - Sarah Dransfield
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; (E.P.); (S.D.); (N.C.); (D.G.)
| | - Natalie Cook
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; (E.P.); (S.D.); (N.C.); (D.G.)
| | - Fiona Thistlethwaite
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (F.T.); (L.C.); (A.H.)
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; (E.P.); (S.D.); (N.C.); (D.G.)
| | - Donna Graham
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; (E.P.); (S.D.); (N.C.); (D.G.)
| | - Louise Carter
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (F.T.); (L.C.); (A.H.)
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; (E.P.); (S.D.); (N.C.); (D.G.)
| | - Andrew Hughes
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (F.T.); (L.C.); (A.H.)
| | - Matthew G. Krebs
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (F.T.); (L.C.); (A.H.)
- The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M20 4BX, UK; (E.P.); (S.D.); (N.C.); (D.G.)
- Correspondence: (M.G.K.); (A.D.W.); Tel.: +44-(0)161-275-6267 (A.D.W.)
| | - Anthony D. Whetton
- Stoller Biomarker Discovery Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9NQ, UK;
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK; (F.T.); (L.C.); (A.H.)
- Manchester National Institute for Health Research Biomedical Research Centre, Manchester M13 9WL, UK
- Correspondence: (M.G.K.); (A.D.W.); Tel.: +44-(0)161-275-6267 (A.D.W.)
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172
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Abdulkareem M, Petersen SE. The Promise of AI in Detection, Diagnosis, and Epidemiology for Combating COVID-19: Beyond the Hype. Front Artif Intell 2021; 4:652669. [PMID: 34056579 PMCID: PMC8160471 DOI: 10.3389/frai.2021.652669] [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: 01/12/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022] Open
Abstract
COVID-19 has created enormous suffering, affecting lives, and causing deaths. The ease with which this type of coronavirus can spread has exposed weaknesses of many healthcare systems around the world. Since its emergence, many governments, research communities, commercial enterprises, and other institutions and stakeholders around the world have been fighting in various ways to curb the spread of the disease. Science and technology have helped in the implementation of policies of many governments that are directed toward mitigating the impacts of the pandemic and in diagnosing and providing care for the disease. Recent technological tools, artificial intelligence (AI) tools in particular, have also been explored to track the spread of the coronavirus, identify patients with high mortality risk and diagnose patients for the disease. In this paper, areas where AI techniques are being used in the detection, diagnosis and epidemiological predictions, forecasting and social control for combating COVID-19 are discussed, highlighting areas of successful applications and underscoring issues that need to be addressed to achieve significant progress in battling COVID-19 and future pandemics. Several AI systems have been developed for diagnosing COVID-19 using medical imaging modalities such as chest CT and X-ray images. These AI systems mainly differ in their choices of the algorithms for image segmentation, classification and disease diagnosis. Other AI-based systems have focused on predicting mortality rate, long-term patient hospitalization and patient outcomes for COVID-19. AI has huge potential in the battle against the COVID-19 pandemic but successful practical deployments of these AI-based tools have so far been limited due to challenges such as limited data accessibility, the need for external evaluation of AI models, the lack of awareness of AI experts of the regulatory landscape governing the deployment of AI tools in healthcare, the need for clinicians and other experts to work with AI experts in a multidisciplinary context and the need to address public concerns over data collection, privacy, and protection. Having a dedicated team with expertise in medical data collection, privacy, access and sharing, using federated learning whereby AI scientists hand over training algorithms to the healthcare institutions to train models locally, and taking full advantage of biomedical data stored in biobanks can alleviate some of problems posed by these challenges. Addressing these challenges will ultimately accelerate the translation of AI research into practical and useful solutions for combating pandemics.
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Affiliation(s)
- Musa Abdulkareem
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
| | - Steffen E. Petersen
- Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- National Institute for Health Research (NIHR) Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Health Data Research UK, London, United Kingdom
- The Alan Turing Institute, London, United Kingdom
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173
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Gill MJ, Powell M, Vu Q, Krentz HB. Economic impact on direct healthcare costs of missing opportunities for diagnosing HIV within healthcare settings. HIV Med 2021; 22:723-731. [PMID: 33979022 DOI: 10.1111/hiv.13121] [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: 01/11/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND The economic consequences of a missed opportunity for HIV testing at an earlier stage of infection within a healthcare setting are poorly described. METHODS For all newly diagnosed HIV patients followed at the Southern Alberta HIV/AIDS Clinic (SAC), Calgary, Canada, between 1 April 2011 and 1 April 2016, all clinical encounters occurring < 3 years prior to diagnosis within the region were obtained. The direct costs of HIV care after diagnosis to 31 March 2019 were determined from a payers' perspective and reported as mean cost per patient per month (PPPM) in 2019 Canadian dollars (CDN$). Patients with no encounters for 3 years prior to diagnosis were compared with patients with encounters, with special attention to patients with HIV clinical indicator conditions (HCICs). RESULTS Of 388 patients, 60% had one or more prior encounter without HIV testing; 14% had been treated for an HCIC. Females, older patients and heterosexuals were more likely to have prior encounters. At diagnosis, patients with previous encounters presented with lower CD4 counts and higher rates of AIDS. The mean PPPM costs for patients with any prior encounter or for an HCIC-based encounter were 16% and 33% higher, respectively, than for patients with no prior encounters. While mean PPPM costs for antiretroviral drugs and outpatient visits were slightly higher, in-patient costs were 10 times higher for people with HIV who had a previous HCIC encounter vs. those with no encounters (CDN$316 vs. $31, respectively). CONCLUSIONS Any healthcare visit, especially for an HCIC, represents relatively easy opportunities for HIV testing. Not testing can result in poorer health and higher costs. Targeted clinical testing and novel interventions to correct overlooked testing opportunities within healthcare settings may be an easy way to implement cost savings.
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Affiliation(s)
- M J Gill
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - M Powell
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Q Vu
- Southern Alberta Clinic, Calgary, AB, Canada
| | - H B Krentz
- Southern Alberta Clinic, Calgary, AB, Canada.,Department of Medicine, University of Calgary, Calgary, AB, Canada
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174
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Chua IS, Gaziel-Yablowitz M, Korach ZT, Kehl KL, Levitan NA, Arriaga YE, Jackson GP, Bates DW, Hassett M. Artificial intelligence in oncology: Path to implementation. Cancer Med 2021; 10:4138-4149. [PMID: 33960708 PMCID: PMC8209596 DOI: 10.1002/cam4.3935] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 12/21/2022] Open
Abstract
In recent years, the field of artificial intelligence (AI) in oncology has grown exponentially. AI solutions have been developed to tackle a variety of cancer‐related challenges. Medical institutions, hospital systems, and technology companies are developing AI tools aimed at supporting clinical decision making, increasing access to cancer care, and improving clinical efficiency while delivering safe, high‐value oncology care. AI in oncology has demonstrated accurate technical performance in image analysis, predictive analytics, and precision oncology delivery. Yet, adoption of AI tools is not widespread, and the impact of AI on patient outcomes remains uncertain. Major barriers for AI implementation in oncology include biased and heterogeneous data, data management and collection burdens, a lack of standardized research reporting, insufficient clinical validation, workflow and user‐design challenges, outdated regulatory and legal frameworks, and dynamic knowledge and data. Concrete actions that major stakeholders can take to overcome barriers to AI implementation in oncology include training and educating the oncology workforce in AI; standardizing data, model validation methods, and legal and safety regulations; funding and conducting future research; and developing, studying, and deploying AI tools through multidisciplinary collaboration.
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Affiliation(s)
- Isaac S Chua
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michal Gaziel-Yablowitz
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Zfania T Korach
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kenneth L Kehl
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | - Gretchen P Jackson
- IBM Watson Health, Cambridge, MA, USA.,Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael Hassett
- Harvard Medical School, Boston, MA, USA.,Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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175
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Voigt I, Inojosa H, Dillenseger A, Haase R, Akgün K, Ziemssen T. Digital Twins for Multiple Sclerosis. Front Immunol 2021; 12:669811. [PMID: 34012452 PMCID: PMC8128142 DOI: 10.3389/fimmu.2021.669811] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/16/2021] [Indexed: 12/16/2022] Open
Abstract
An individualized innovative disease management is of great importance for people with multiple sclerosis (pwMS) to cope with the complexity of this chronic, multidimensional disease. However, an individual state of the art strategy, with precise adjustment to the patient's characteristics, is still far from being part of the everyday care of pwMS. The development of digital twins could decisively advance the necessary implementation of an individualized innovative management of MS. Through artificial intelligence-based analysis of several disease parameters - including clinical and para-clinical outcomes, multi-omics, biomarkers, patient-related data, information about the patient's life circumstances and plans, and medical procedures - a digital twin paired to the patient's characteristic can be created, enabling healthcare professionals to handle large amounts of patient data. This can contribute to a more personalized and effective care by integrating data from multiple sources in a standardized manner, implementing individualized clinical pathways, supporting physician-patient communication and facilitating a shared decision-making. With a clear display of pre-analyzed patient data on a dashboard, patient participation and individualized clinical decisions as well as the prediction of disease progression and treatment simulation could become possible. In this review, we focus on the advantages, challenges and practical aspects of digital twins in the management of MS. We discuss the use of digital twins for MS as a revolutionary tool to improve diagnosis, monitoring and therapy refining patients' well-being, saving economic costs, and enabling prevention of disease progression. Digital twins will help make precision medicine and patient-centered care a reality in everyday life.
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Affiliation(s)
| | | | | | | | | | - Tjalf Ziemssen
- Center of Clinical Neuroscience, Department of Neurology, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany
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176
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Pedersen JS, Laursen MS, Rajeeth Savarimuthu T, Hansen RS, Alnor AB, Bjerre KV, Kjær IM, Gils C, Thorsen AF, Andersen ES, Nielsen CB, Andersen LC, Just SA, Vinholt PJ. Deep learning detects and visualizes bleeding events in electronic health records. Res Pract Thromb Haemost 2021; 5:e12505. [PMID: 34013150 PMCID: PMC8114029 DOI: 10.1002/rth2.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Bleeding is associated with a significantly increased morbidity and mortality. Bleeding events are often described in the unstructured text of electronic health records, which makes them difficult to identify by manual inspection. OBJECTIVES To develop a deep learning model that detects and visualizes bleeding events in electronic health records. PATIENTS/METHODS Three hundred electronic health records with International Classification of Diseases, Tenth Revision diagnosis codes for bleeding or leukemia were extracted. Each sentence in the electronic health record was annotated as positive or negative for bleeding. The annotated sentences were used to develop a deep learning model that detects bleeding at sentence and note level. RESULTS On a balanced test set of 1178 sentences, the best-performing deep learning model achieved a sensitivity of 0.90, specificity of 0.90, and negative predictive value of 0.90. On a test set consisting of 700 notes, of which 49 were positive for bleeding, the model achieved a note-level sensitivity of 1.00, specificity of 0.52, and negative predictive value of 1.00. By using a sentence-level model on a note level, the model can explain its predictions by visualizing the exact sentence in a note that contains information regarding bleeding. Moreover, we found that the model performed consistently well across different types of bleedings. CONCLUSIONS A deep learning model can be used to detect and visualize bleeding events in the free text of electronic health records. The deep learning model can thus facilitate systematic assessment of bleeding risk, and thereby optimize patient care and safety.
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Affiliation(s)
- Jannik S. Pedersen
- The Maersk Mc‐Kinney Moller InstituteUniversity of Southern DenmarkOdenseDenmark
| | - Martin S. Laursen
- The Maersk Mc‐Kinney Moller InstituteUniversity of Southern DenmarkOdenseDenmark
| | | | - Rasmus Søgaard Hansen
- Department of Clinical Biochemistry and PharmacologyOdense University HospitalOdenseDenmark
| | - Anne Bryde Alnor
- Department of Clinical Biochemistry and PharmacologyOdense University HospitalOdenseDenmark
| | - Kristian Voss Bjerre
- Department of Clinical Biochemistry and PharmacologyOdense University HospitalOdenseDenmark
| | - Ina Mathilde Kjær
- Department of Clinical Biochemistry and ImmunologyLillebaelt HospitalDenmark
| | - Charlotte Gils
- Department of Clinical Biochemistry and PharmacologyOdense University HospitalOdenseDenmark
| | | | | | | | | | | | - Pernille Just Vinholt
- Department of Clinical Biochemistry and PharmacologyOdense University HospitalOdenseDenmark
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177
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Mehta N, Born K, Fine B. How artificial intelligence can help us 'Choose Wisely'. Bioelectron Med 2021; 7:5. [PMID: 33879255 PMCID: PMC8057918 DOI: 10.1186/s42234-021-00066-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/24/2021] [Indexed: 11/24/2022] Open
Abstract
The overuse of low value medical tests and treatments drives costs and patient harm. Efforts to address overuse, such as Choosing Wisely campaigns, typically rely on passive implementation strategies- a form of low reliability system change. Embedding guidelines into clinical decision support (CDS) software is a higher leverage approach to provide ordering suggestions through an interface embedded within the clinical workflow. Growth in computing power is increasingly enabling artificial intelligence (AI) to augment such decision making tools. This article offers a roadmap of opportunities for AI-enabled CDS to reduce overuse, which are presented according to a patient’s journey of care.
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Affiliation(s)
- Nishila Mehta
- Temerty Faculty of Medicine, King's College Cir, Toronto, ON, M5S 1A8, Canada. .,Unity Health Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
| | - Karen Born
- Unity Health Toronto, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Benjamin Fine
- Temerty Faculty of Medicine, King's College Cir, Toronto, ON, M5S 1A8, Canada.,Department of Diagnostic Imaging and Institute for Better Health, Trillium Health Partners, 2200 Eglinton Ave W, Mississauga, ON, L5M 2N1, Canada.,WCH Institute for Health System Solutions and Virtual Care (WIHV), Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada
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178
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Standiford TC, Farlow JL, Brenner MJ, Conte ML, Terrell JE. Clinical Decision Support Systems in Otolaryngology-Head and Neck Surgery: A State of the Art Review. Otolaryngol Head Neck Surg 2021; 166:35-47. [PMID: 33874795 DOI: 10.1177/01945998211004529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To offer practical, evidence-informed knowledge on clinical decision support systems (CDSSs) and their utility in improving care and reducing costs in otolaryngology-head and neck surgery. This primer on CDSSs introduces clinicians to both the capabilities and the limitations of this technology, reviews the literature on current state, and seeks to spur further progress in this area. DATA SOURCES PubMed/MEDLINE, Embase, and Web of Science. REVIEW METHODS Scoping review of CDSS literature applicable to otolaryngology clinical practice. Investigators identified articles that incorporated knowledge-based computerized CDSSs to aid clinicians in decision making and workflow. Data extraction included level of evidence, Osheroff classification of CDSS intervention type, otolaryngology subspecialty or domain, and impact on provider performance or patient outcomes. CONCLUSIONS Of 3191 studies retrieved, 11 articles met formal inclusion criteria. CDSS interventions included guideline or protocols support (n = 8), forms and templates (n = 5), data presentation aids (n = 2), and reactive alerts, reference information, or order sets (all n = 1); 4 studies had multiple interventions. CDSS studies demonstrated effectiveness across diverse domains, including antibiotic stewardship, cancer survivorship, guideline adherence, data capture, cost reduction, and workflow. Implementing CDSSs often involved collaboration with health information technologists. IMPLICATIONS FOR PRACTICE While the published literature on CDSSs in otolaryngology is finite, CDSS interventions are proliferating in clinical practice, with roles in preventing medical errors, streamlining workflows, and improving adherence to best practices for head and neck disorders. Clinicians may collaborate with information technologists and health systems scientists to develop, implement, and investigate the impact of CDSSs in otolaryngology.
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Affiliation(s)
| | - Janice L Farlow
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Marisa L Conte
- Department of Research and Informatics, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jeffrey E Terrell
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
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179
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Secinaro S, Calandra D, Secinaro A, Muthurangu V, Biancone P. The role of artificial intelligence in healthcare: a structured literature review. BMC Med Inform Decis Mak 2021; 21:125. [PMID: 33836752 PMCID: PMC8035061 DOI: 10.1186/s12911-021-01488-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/01/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND/INTRODUCTION Artificial intelligence (AI) in the healthcare sector is receiving attention from researchers and health professionals. Few previous studies have investigated this topic from a multi-disciplinary perspective, including accounting, business and management, decision sciences and health professions. METHODS The structured literature review with its reliable and replicable research protocol allowed the researchers to extract 288 peer-reviewed papers from Scopus. The authors used qualitative and quantitative variables to analyse authors, journals, keywords, and collaboration networks among researchers. Additionally, the paper benefited from the Bibliometrix R software package. RESULTS The investigation showed that the literature in this field is emerging. It focuses on health services management, predictive medicine, patient data and diagnostics, and clinical decision-making. The United States, China, and the United Kingdom contributed the highest number of studies. Keyword analysis revealed that AI can support physicians in making a diagnosis, predicting the spread of diseases and customising treatment paths. CONCLUSIONS The literature reveals several AI applications for health services and a stream of research that has not fully been covered. For instance, AI projects require skills and data quality awareness for data-intensive analysis and knowledge-based management. Insights can help researchers and health professionals understand and address future research on AI in the healthcare field.
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Affiliation(s)
| | - Davide Calandra
- Department of Management, University of Turin, Turin, Italy.
| | | | - Vivek Muthurangu
- Institute of Child Health, University College London, London, UK
| | - Paolo Biancone
- Department of Management, University of Turin, Turin, Italy
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180
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Park S, Park BS, Lee YJ, Kim IH, Park JH, Ko J, Kim YW, Park KM. Artificial intelligence with kidney disease: A scoping review with bibliometric analysis, PRISMA-ScR. Medicine (Baltimore) 2021; 100:e25422. [PMID: 33832141 PMCID: PMC8036048 DOI: 10.1097/md.0000000000025422] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 02/27/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI) has had a significant impact on our lives and plays many roles in various fields. By analyzing the past 30 years of AI trends in the field of nephrology, using a bibliography, we wanted to know the areas of interest and future direction of AI in research related to the kidney. METHODS Using the Institute for Scientific Information Web of Knowledge database, we searched for articles published from 1990 to 2019 in January 2020 using the keywords AI; deep learning; machine learning; and kidney (or renal). The selected articles were reviewed manually at the points of citation analysis. RESULTS From 218 related articles, we selected the top fifty with 1188 citations in total. The most-cited article was cited 84 times and the least-cited one was cited 12 times. These articles were published in 40 journals. Expert Systems with Applications (three articles) and Kidney International (three articles) were the most cited journals. Forty articles were published in the 2010s, and seven articles were published in the 2000s. The top-fifty most cited articles originated from 17 countries; the USA contributed 16 articles, followed by Turkey with four articles. The main topics in the top fifty consisted of tumors (11), acute kidney injury (10), dialysis-related (5), kidney-transplant related (4), nephrotoxicity (4), glomerular disease (4), chronic kidney disease (3), polycystic kidney disease (2), kidney stone (2), kidney image (2), renal pathology (2), and glomerular filtration rate measure (1). CONCLUSIONS After 2010, the interest in AI and its achievements increased enormously. To date, AIs have been investigated using data that are relatively easy to access, for example, radiologic images and laboratory results in the fields of tumor and acute kidney injury. In the near future, a deeper and wider range of information, such as genetic and personalized database, will help enrich nephrology fields with AI technology.
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Affiliation(s)
| | | | | | | | | | | | | | - Kang Min Park
- Department of Neurology, Inje University Haeundae Paik Hospital, Busan, Korea
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181
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Identification of variation in nutritional practice in neonatal units in England and association with clinical outcomes using agnostic machine learning. Sci Rep 2021; 11:7178. [PMID: 33785776 PMCID: PMC8009880 DOI: 10.1038/s41598-021-85878-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/02/2021] [Indexed: 02/01/2023] Open
Abstract
We used agnostic, unsupervised machine learning to cluster a large clinical database of information on infants admitted to neonatal units in England. Our aim was to obtain insights into nutritional practice, an area of central importance in newborn care, utilising the UK National Neonatal Research Database (NNRD). We performed clustering on time-series data of daily nutritional intakes for very preterm infants born at a gestational age less than 32 weeks (n = 45,679) over a six-year period. This revealed 46 nutritional clusters heterogeneous in size, showing common interpretable clinical practices alongside rarer approaches. Nutritional clusters with similar admission profiles revealed associations between nutritional practice, geographical location and outcomes. We show how nutritional subgroups may be regarded as distinct interventions and tested for associations with measurable outcomes. We illustrate the potential for identifying relationships between nutritional practice and outcomes with two examples, discharge weight and bronchopulmonary dysplasia (BPD). We identify the well-known effect of formula milk on greater discharge weight as well as support for the plausible, but insufficiently evidenced view that human milk is protective against BPD. Our framework highlights the potential of agnostic machine learning approaches to deliver clinical practice insights and generate hypotheses using routine data.
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182
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Durán JM, Jongsma KR. Who is afraid of black box algorithms? On the epistemological and ethical basis of trust in medical AI. JOURNAL OF MEDICAL ETHICS 2021:medethics-2020-106820. [PMID: 33737318 DOI: 10.1136/medethics-2020-106820] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/11/2021] [Accepted: 02/08/2021] [Indexed: 05/07/2023]
Abstract
The use of black box algorithms in medicine has raised scholarly concerns due to their opaqueness and lack of trustworthiness. Concerns about potential bias, accountability and responsibility, patient autonomy and compromised trust transpire with black box algorithms. These worries connect epistemic concerns with normative issues. In this paper, we outline that black box algorithms are less problematic for epistemic reasons than many scholars seem to believe. By outlining that more transparency in algorithms is not always necessary, and by explaining that computational processes are indeed methodologically opaque to humans, we argue that the reliability of algorithms provides reasons for trusting the outcomes of medical artificial intelligence (AI). To this end, we explain how computational reliabilism, which does not require transparency and supports the reliability of algorithms, justifies the belief that results of medical AI are to be trusted. We also argue that several ethical concerns remain with black box algorithms, even when the results are trustworthy. Having justified knowledge from reliable indicators is, therefore, necessary but not sufficient for normatively justifying physicians to act. This means that deliberation about the results of reliable algorithms is required to find out what is a desirable action. Thus understood, we argue that such challenges should not dismiss the use of black box algorithms altogether but should inform the way in which these algorithms are designed and implemented. When physicians are trained to acquire the necessary skills and expertise, and collaborate with medical informatics and data scientists, black box algorithms can contribute to improving medical care.
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Affiliation(s)
- Juan Manuel Durán
- Technology, Policy and Management, Delft University of Technology, Delft, The Netherlands
| | - Karin Rolanda Jongsma
- Julius Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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183
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Zegers C, Posch J, Traverso A, Eekers D, Postma A, Backes W, Dekker A, van Elmpt W. Current applications of deep-learning in neuro-oncological MRI. Phys Med 2021; 83:161-173. [DOI: 10.1016/j.ejmp.2021.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/01/2021] [Accepted: 03/02/2021] [Indexed: 12/18/2022] Open
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184
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Schreiber MJ, Chatoth DK, Salenger P. Challenges and Opportunities in Expanding Home Hemodialysis for 2025. Adv Chronic Kidney Dis 2021; 28:129-135. [PMID: 34717858 DOI: 10.1053/j.ackd.2021.06.009] [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] [Indexed: 12/11/2022]
Abstract
The Advancing American Kidney Health Initiative has set an aggressive target for home dialysis growth in the United States, and expanding both peritoneal dialysis and home hemodialysis (HHD) will be required. While there has been a growth in HHD across the United States in the last decade, its value in controlling specific risk factors has been underappreciated and as such its appropriate utilization has lagged. Repositioning how nephrologists incorporate HHD as a critical renal replacement therapy will require overcoming a number of barriers. Advancing education of both nephrology trainees and nephrologists in practice, along with increasing patient and family education on the benefits and requirements for HHD, is essential. Implementation of a transitional care unit design coupled with an intensive patient curriculum will increase patient awareness and comfort for HHD; patients on peritoneal dialysis reaching a modality transition point will benefit from Experience the Difference programs acclimating them to HHD. In addition, the potential link between HHD program size and patient outcomes will necessitate an increase in the size of the average HHD program to more consistently deliver quality dialysis results. Addressing the implications of the nursing shortage and need for designing in scope staffing models are necessary to safeguard HHD growth. Seemingly, certain government payment policy changes and physician documentation requirements deserve further examination. Future HHD innovations must result in decreasing the burden of care for HHD patients, optimize the level of device and biometric data flow, facilitate a more functional centralized patient management care approach, and leverage computerized clinical decision support for modality assignment.
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185
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Schwartz JM, Moy AJ, Rossetti SC, Elhadad N, Cato KD. Clinician involvement in research on machine learning-based predictive clinical decision support for the hospital setting: A scoping review. J Am Med Inform Assoc 2021; 28:653-663. [PMID: 33325504 PMCID: PMC7936403 DOI: 10.1093/jamia/ocaa296] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/30/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The study sought to describe the prevalence and nature of clinical expert involvement in the development, evaluation, and implementation of clinical decision support systems (CDSSs) that utilize machine learning to analyze electronic health record data to assist nurses and physicians in prognostic and treatment decision making (ie, predictive CDSSs) in the hospital. MATERIALS AND METHODS A systematic search of PubMed, CINAHL, and IEEE Xplore and hand-searching of relevant conference proceedings were conducted to identify eligible articles. Empirical studies of predictive CDSSs using electronic health record data for nurses or physicians in the hospital setting published in the last 5 years in peer-reviewed journals or conference proceedings were eligible for synthesis. Data from eligible studies regarding clinician involvement, stage in system design, predictive CDSS intention, and target clinician were charted and summarized. RESULTS Eighty studies met eligibility criteria. Clinical expert involvement was most prevalent at the beginning and late stages of system design. Most articles (95%) described developing and evaluating machine learning models, 28% of which described involving clinical experts, with nearly half functioning to verify the clinical correctness or relevance of the model (47%). DISCUSSION Involvement of clinical experts in predictive CDSS design should be explicitly reported in publications and evaluated for the potential to overcome predictive CDSS adoption challenges. CONCLUSIONS If present, clinical expert involvement is most prevalent when predictive CDSS specifications are made or when system implementations are evaluated. However, clinical experts are less prevalent in developmental stages to verify clinical correctness, select model features, preprocess data, or serve as a gold standard.
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Affiliation(s)
| | - Amanda J Moy
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Sarah C Rossetti
- School of Nursing, Columbia University, New York, New York, USA
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, New York, USA
| | - Kenrick D Cato
- School of Nursing, Columbia University, New York, New York, USA
- Department of Emergency Medicine, Columbia University, New York, New York, USA
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186
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Shashikumar SP, Josef CS, Sharma A, Nemati S. DeepAISE - An interpretable and recurrent neural survival model for early prediction of sepsis. Artif Intell Med 2021; 113:102036. [PMID: 33685592 PMCID: PMC8029104 DOI: 10.1016/j.artmed.2021.102036] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 01/13/2021] [Accepted: 02/09/2021] [Indexed: 12/29/2022]
Abstract
Sepsis, a dysregulated immune system response to infection, is among the leading causes of morbidity, mortality, and cost overruns in the Intensive Care Unit (ICU). Early prediction of sepsis can improve situational awareness among clinicians and facilitate timely, protective interventions. While the application of predictive analytics in ICU patients has shown early promising results, much of the work has been encumbered by high false-alarm rates and lack of trust by the end-users due to the 'black box' nature of these models. Here, we present DeepAISE (Deep Artificial Intelligence Sepsis Expert), a recurrent neural survival model for the early prediction of sepsis. DeepAISE automatically learns predictive features related to higher-order interactions and temporal patterns among clinical risk factors that maximize the data likelihood of observed time to septic events. A comparative study of four baseline models on data from hospitalized patients at three different healthcare systems indicates that DeepAISE produces the most accurate predictions (AUCs between 0.87 and 0.90) at the lowest false alarm rates (FARs between 0.20 and 0.25) while simultaneously producing interpretable representations of the clinical time series and risk factors.
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Affiliation(s)
| | | | - Ashish Sharma
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, USA
| | - Shamim Nemati
- Division of Biomedical Informatics, University of California San Diego, La Jolla, USA.
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187
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Felmingham CM, Adler NR, Ge Z, Morton RL, Janda M, Mar VJ. The Importance of Incorporating Human Factors in the Design and Implementation of Artificial Intelligence for Skin Cancer Diagnosis in the Real World. Am J Clin Dermatol 2021; 22:233-242. [PMID: 33354741 DOI: 10.1007/s40257-020-00574-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Artificial intelligence (AI) algorithms have been shown to diagnose skin lesions with impressive accuracy in experimental settings. The majority of the literature to date has compared AI and dermatologists as opponents in skin cancer diagnosis. However, in the real-world clinical setting, the clinician will work in collaboration with AI. Existing evidence regarding the integration of such AI diagnostic tools into clinical practice is limited. Human factors, such as cognitive style, personality, experience, preferences, and attitudes may influence clinicians' use of AI. In this review, we consider these human factors and the potential cognitive errors, biases, and unintended consequences that could arise when using an AI skin cancer diagnostic tool in the real world. Integrating this knowledge in the design and implementation of AI technology will assist in ensuring that the end product can be used effectively. Dermatologist leadership in the development of these tools will further improve their clinical relevance and safety.
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Affiliation(s)
- Claire M Felmingham
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
- Victorian Melanoma Service, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Nikki R Adler
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Zongyuan Ge
- Monash eResearch Centre, Monash University, Clayton, Australia
- Department of Electrical and Computer Systems Engineering, Faculty of Engineering, Monash University, Melbourne, VIC, Australia
- Monash-Airdoc Research Centre, Monash University, Melbourne, VIC, Australia
| | - Rachael L Morton
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Victoria J Mar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Victorian Melanoma Service, Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
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188
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Scott I, Carter S, Coiera E. Clinician checklist for assessing suitability of machine learning applications in healthcare. BMJ Health Care Inform 2021; 28:bmjhci-2020-100251. [PMID: 33547086 PMCID: PMC7871244 DOI: 10.1136/bmjhci-2020-100251] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/12/2021] [Indexed: 12/13/2022] Open
Abstract
Machine learning algorithms are being used to screen and diagnose disease, prognosticate and predict therapeutic responses. Hundreds of new algorithms are being developed, but whether they improve clinical decision making and patient outcomes remains uncertain. If clinicians are to use algorithms, they need to be reassured that key issues relating to their validity, utility, feasibility, safety and ethical use have been addressed. We propose a checklist of 10 questions that clinicians can ask of those advocating for the use of a particular algorithm, but which do not expect clinicians, as non-experts, to demonstrate mastery over what can be highly complex statistical and computational concepts. The questions are: (1) What is the purpose and context of the algorithm? (2) How good were the data used to train the algorithm? (3) Were there sufficient data to train the algorithm? (4) How well does the algorithm perform? (5) Is the algorithm transferable to new clinical settings? (6) Are the outputs of the algorithm clinically intelligible? (7) How will this algorithm fit into and complement current workflows? (8) Has use of the algorithm been shown to improve patient care and outcomes? (9) Could the algorithm cause patient harm? and (10) Does use of the algorithm raise ethical, legal or social concerns? We provide examples where an algorithm may raise concerns and apply the checklist to a recent review of diagnostic imaging applications. This checklist aims to assist clinicians in assessing algorithm readiness for routine care and identify situations where further refinement and evaluation is required prior to large-scale use.
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Affiliation(s)
- Ian Scott
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia .,School of Clinical Medicine, Univeristy of Queensland, Brisbane, Queensland, Australia
| | - Stacey Carter
- Australian Centre for Health Engagement Evidence and Values, University of Woolloongong, Woollongong, New South Wales, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Macquarie University, Sydney, New South Wales, Australia
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189
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Xu W, Sun NN, Gao HN, Chen ZY, Yang Y, Ju B, Tang LL. Risk factors analysis of COVID-19 patients with ARDS and prediction based on machine learning. Sci Rep 2021; 11:2933. [PMID: 33536460 PMCID: PMC7858607 DOI: 10.1038/s41598-021-82492-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 01/11/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 is a newly emerging infectious disease, which is generally susceptible to human beings and has caused huge losses to people's health. Acute respiratory distress syndrome (ARDS) is one of the common clinical manifestations of severe COVID-19 and it is also responsible for the current shortage of ventilators worldwide. This study aims to analyze the clinical characteristics of COVID-19 ARDS patients and establish a diagnostic system based on artificial intelligence (AI) method to predict the probability of ARDS in COVID-19 patients. We collected clinical data of 659 COVID-19 patients from 11 regions in China. The clinical characteristics of the ARDS group and no-ARDS group of COVID-19 patients were elaborately compared and both traditional machine learning algorithms and deep learning-based method were used to build the prediction models. Results indicated that the median age of ARDS patients was 56.5 years old, which was significantly older than those with non-ARDS by 7.5 years. Male and patients with BMI > 25 were more likely to develop ARDS. The clinical features of ARDS patients included cough (80.3%), polypnea (59.2%), lung consolidation (53.9%), secondary bacterial infection (30.3%), and comorbidities such as hypertension (48.7%). Abnormal biochemical indicators such as lymphocyte count, CK, NLR, AST, LDH, and CRP were all strongly related to the aggravation of ARDS. Furthermore, through various AI methods for modeling and prediction effect evaluation based on the above risk factors, decision tree achieved the best AUC, accuracy, sensitivity and specificity in identifying the mild patients who were easy to develop ARDS, which undoubtedly helped to deliver proper care and optimize use of limited resources.
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Affiliation(s)
- Wan Xu
- Hangzhou Xiaoshan District Center for Disease Control and Prevention, Hangzhou, China
| | - Nan-Nan Sun
- Hangzhou Wowjoy Information Technology Co., Ltd, Hangzhou, China
| | - Hai-Nv Gao
- Department of Infectious Diseases, ShuLan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China
| | - Zhi-Yuan Chen
- Hangzhou Wowjoy Information Technology Co., Ltd, Hangzhou, China
| | - Ya Yang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Centre for Infectious Diseases, Collaborative Innovation Centre for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang Province, China
| | - Bin Ju
- Hangzhou Wowjoy Information Technology Co., Ltd, Hangzhou, China.
| | - Ling-Ling Tang
- Department of Infectious Diseases, ShuLan (Hangzhou) Hospital Affiliated to Zhejiang Shuren University Shulan International Medical College, Hangzhou, China.
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190
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Brintz BJ, Haaland B, Howard J, Chao DL, Proctor JL, Khan AI, Ahmed SM, Keegan LT, Greene T, Keita AM, Kotloff KL, Platts-Mills JA, Nelson EJ, Levine AC, Pavia AT, Leung DT. A modular approach to integrating multiple data sources into real-time clinical prediction for pediatric diarrhea. eLife 2021; 10:63009. [PMID: 33527894 PMCID: PMC7853717 DOI: 10.7554/elife.63009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/17/2021] [Indexed: 11/13/2022] Open
Abstract
Traditional clinical prediction models focus on parameters of the individual patient. For infectious diseases, sources external to the patient, including characteristics of prior patients and seasonal factors, may improve predictive performance. We describe the development of a predictive model that integrates multiple sources of data in a principled statistical framework using a post-test odds formulation. Our method enables electronic real-time updating and flexibility, such that components can be included or excluded according to data availability. We apply this method to the prediction of etiology of pediatric diarrhea, where 'pre-test’ epidemiologic data may be highly informative. Diarrhea has a high burden in low-resource settings, and antibiotics are often over-prescribed. We demonstrate that our integrative method outperforms traditional prediction in accurately identifying cases with a viral etiology, and show that its clinical application, especially when used with an additional diagnostic test, could result in a 61% reduction in inappropriately prescribed antibiotics.
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Affiliation(s)
- Ben J Brintz
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, United States.,Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | - Benjamin Haaland
- Population Health Sciences, University of Utah, Salt Lake City, United States
| | - Joel Howard
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, United States
| | - Dennis L Chao
- Institute of Disease Modeling, Bill and Melinda Gates Foundation, Seattle, United States
| | - Joshua L Proctor
- Institute of Disease Modeling, Bill and Melinda Gates Foundation, Seattle, United States
| | - Ashraful I Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Sharia M Ahmed
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | - Lindsay T Keegan
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | - Tom Greene
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, United States
| | | | - Karen L Kotloff
- Division of Infectious Disease and Tropical Pediatrics, University of Maryland, Baltimore, United States
| | - James A Platts-Mills
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, United States
| | - Eric J Nelson
- Departments of Pediatrics, University of Florida, Gainesville, United States.,Departments of Environmental and Global Health, University of Florida, Gainesville, United States
| | - Adam C Levine
- Department of Emergency Medicine, Brown University, Providence, United States
| | - Andrew T Pavia
- Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, United States
| | - Daniel T Leung
- Division of Infectious Diseases, Department of Internal Medicine, University of Utah, Salt Lake City, United States.,Division of Microbiology and Immunology, Department of Internal Medicine, University of Utah, Salt Lake City, United States
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191
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Zhang J. Reform and innovation of artificial intelligence technology for information service in university physical education. JOURNAL OF INTELLIGENT & FUZZY SYSTEMS 2021. [DOI: 10.3233/jifs-189372] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This article analyzes the reform of information services in university physical education based on artificial intelligence technology and conducts in-depth and innovative research on it. In-depth analysis of the relationship between big data and the development and application of information technology such as the Internet, Internet of Things, cloud computing, to clarify the difference and connection between big data, informatization and intelligence. Artificial intelligence will bring opportunities for changes in data collection, management decision-making, governance models, education and teaching, scientific research services, evaluation and evaluation of physical education in our university. At the same time, big data education management in colleges and universities faces many challenges such as the balance of privacy and freedom, data hegemony, data junk, data standards, and data security, and they have many negative effects. In accordance with the requirements of educational modernization, centering on the goal of intelligent and humanized education management, it aims existing issues in college physical education management.
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192
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Pescatello LS, Wu Y, Panza GA, Zaleski A, Guidry M. Development of a Novel Clinical Decision Support System for Exercise Prescription Among Patients With Multiple Cardiovascular Disease Risk Factors. Mayo Clin Proc Innov Qual Outcomes 2021; 5:193-203. [PMID: 33718793 PMCID: PMC7930885 DOI: 10.1016/j.mayocpiqo.2020.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Cardiovascular disease (CVD) risk factors cluster in an individual. Exercise is universally recommended to prevent and treat CVD. Yet, clinicians lack guidance on how to design an exercise prescription (ExRx) for patients with multiple CVD risk factors. To address this unmet need, we developed a novel clinical decision support system to prescribe exercise (prioritize personalize prescribe exercise [P3-EX]) for patients with multiple CVD risk factors founded upon the evidenced-based recommendations of the American College of Sports Medicine (ACSM) and American Heart Association. To develop P3-EX, we integrated (1) the ACSM exercise preparticipation health screening recommendations; (2) an adapted American Heart Association Life's Simple 7 cardiovascular health scoring system; (3) adapted ACSM strategies for designing an ExRx for people with multiple CVD risk factors; and (4) the ACSM frequency, intensity, time, and time principle of ExRx. We have tested the clinical utility of P3-EX within a university-based online graduate program in ExRx among students that includes physicians, physical therapists, registered dietitians, exercise physiologists, kinesiologists, fitness industry professionals, and kinesiology educators in higher education. The support system P3-EX has proven to be an easy-to-use, guided, and time-efficient evidence-based approach to ExRx for patients with multiple CVD risk factors that has applicability to other chronic diseases and health conditions. Further evaluation is needed to better establish its feasibility, acceptability, and clinical utility as an ExRx tool.
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Key Words
- 1-RM, one repetition maximum
- ACSM, American College of Sports Medicine
- AHA, American Heart Association
- AHA7CVH, American Heart Association Life’s Simple 7 cardiovascular health scoring system
- BG, blood glucose
- BMI, body mass index
- BP, blood pressure
- CV, cardiovascular
- CVD, cardiovascular disease
- CVH, cardiovascular health
- DBP, diastolic blood pressure
- Ex Rx, exercise prescription
- FITT, frequency, intensity, time, and type
- HDL-C, high-density lipoprotein cholesterol
- HR, heart rate
- HRR, heart rate reserve
- HTN, hypertension
- LDL-C, low-density lipoprotein cholesterol
- P3-EX, prioritize personalize prescribe exercise clinical decision support system
- PNF, proprioceptive neuromuscular facilitation
- RPE, rating of perceived exertion
- SBP, systolic blood pressure
- SOB, shortness of breath
- T1DM, type 1 diabetes mellitus
- T2DM, type 2 diabetes mellitus
- TC, total cholesterol
- VO2R, oxygen uptake reserve
- WC, waist circumference
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Affiliation(s)
| | - Yin Wu
- Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Gregory A. Panza
- Department of Kinesiology, University of Connecticut, Storrs, CT
| | - Amanda Zaleski
- Department of Kinesiology, University of Connecticut, Storrs, CT
- Department of Preventive Cardiology, Hartford Hospital, Hartford, CT
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193
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Winter MC, Day TE, Ledbetter DR, Aczon MD, Newth CJL, Wetzel RC, Ross PA. Machine Learning to Predict Cardiac Death Within 1 Hour After Terminal Extubation. Pediatr Crit Care Med 2021; 22:161-171. [PMID: 33156210 DOI: 10.1097/pcc.0000000000002612] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES Accurate prediction of time to death after withdrawal of life-sustaining therapies may improve counseling for families and help identify candidates for organ donation after cardiac death. The study objectives were to: 1) train a long short-term memory model to predict cardiac death within 1 hour after terminal extubation, 2) calculate the positive predictive value of the model and the number needed to alert among potential organ donors, and 3) examine associations between time to cardiac death and the patient's characteristics and physiologic variables using Cox regression. DESIGN Retrospective cohort study. SETTING PICU and cardiothoracic ICU in a tertiary-care academic children's hospital. PATIENTS Patients 0-21 years old who died after terminal extubation from 2011 to 2018 (n = 237). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The median time to death for the cohort was 0.3 hours after terminal extubation (interquartile range, 0.16-1.6 hr); 70% of patients died within 1 hour. The long short-term memory model had an area under the receiver operating characteristic curve of 0.85 and a positive predictive value of 0.81 at a sensitivity of 94% when predicting death within 1 hour of terminal extubation. About 39% of patients who died within 1 hour met organ procurement and transplantation network criteria for liver and kidney donors. The long short-term memory identified 93% of potential organ donors with a number needed to alert of 1.08, meaning that 13 of 14 prepared operating rooms would have yielded a viable organ. A Cox proportional hazard model identified independent predictors of shorter time to death including low Glasgow Coma Score, high Pao2-to-Fio2 ratio, low-pulse oximetry, and low serum bicarbonate. CONCLUSIONS Our long short-term memory model accurately predicted whether a child will die within 1 hour of terminal extubation and may improve counseling for families. Our model can identify potential candidates for donation after cardiac death while minimizing unnecessarily prepared operating rooms.
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Affiliation(s)
- Meredith C Winter
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Travis E Day
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA
- Department of Computer Science, University of Southern California Viterbi School of Engineering, Los Angeles, CA
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - David R Ledbetter
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA
| | - Melissa D Aczon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA
| | - Christopher J L Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Randall C Wetzel
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Patrick A Ross
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA
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194
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Improving prediction for medical institution with limited patient data: Leveraging hospital-specific data based on multicenter collaborative research network. Artif Intell Med 2021; 113:102024. [PMID: 33685587 DOI: 10.1016/j.artmed.2021.102024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Clinical decision support assisted by prediction models usually faces the challenges of limited clinical data and a lack of labels when the model is developed with data from a single medical institution. Accordingly, research on multicenter clinical collaborative networks, which can provide external medical data, has received increasing attention. With the increasing availability of machine learning techniques such as transfer learning, leveraging large-scale patient data from multiple hospitals to build data-driven predictive models with clinical application potential provides an alternative solution to address the problem of limited patient data. METHODS A multicenter hybrid semi-supervised transfer learning model (MHSTL) is proposed in this study on the basis of unified common data model to ensure multicenter data standardized representation. Then the hospital-specific features, along with the co-occurrence features across domains, are aligned through a representation learning architecture that is built based on deep neural networks and the newly proposed neural decision forest model. In this process, limited patient data from the target hospital, both labeled and unlabeled, are incorporated during the feature adaptation process, thereby contributing to better model performance. Without patient-level data sharing, the proposed model learning strategy which overcomes feature misalignment and distribution divergence, enables the multi-source transfer learning process in the case of insufficient and unlabeled patient data at target hospital. RESULTS The effectiveness of the proposed transfer learning model was evaluated on a collaborative research network of colorectal cancer patients in the US and China. The results demonstrate that the proposed model can achieve much better performance for predicting target risk with limited resources on patient data than baseline models . Better discrimination and calibration ability are also observed when sufficient labeled data are not available in the target hospital for prognosis prediction tasks . Further exploratory experiments show that the proposed approach exhibits good model generalizability regardless of the data heterogeneity. With the help of the SHapley Additive exPlanations for model interpretation, the effectiveness of incorporating hospital-specific features in the transfer learning model is shown. CONCLUSIONS In this study, the proposed method can develop prediction models from multiple source hospitals and exhibit good performance by leveraging cross-domain hospital-specific feature information, therefore enhancing the model prediction when applied to single medical institution with limited patient data.
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195
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Zhang Y, Wang S, Hermann A, Joly R, Pathak J. Development and validation of a machine learning algorithm for predicting the risk of postpartum depression among pregnant women. J Affect Disord 2021; 279:1-8. [PMID: 33035748 PMCID: PMC7738412 DOI: 10.1016/j.jad.2020.09.113] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/18/2020] [Accepted: 09/25/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE There is a scarcity in tools to predict postpartum depression (PPD). We propose a machine learning framework for PPD risk prediction using data extracted from electronic health records (EHRs). METHODS Two EHR datasets containing data on 15,197 women from 2015 to 2018 at a single site, and 53,972 women from 2004 to 2017 at multiple sites were used as development and validation sets, respectively, to construct the PPD risk prediction model. The primary outcome was a diagnosis of PPD within 1 year following childbirth. A framework of data extraction, processing, and machine learning was implemented to select a minimal list of features from the EHR datasets to ensure model performance and to enable future point-of-care risk prediction. RESULTS The best-performing model uses from clinical features related to mental health history, medical comorbidity, obstetric complications, medication prescription orders, and patient demographic characteristics. The model performances as measured by area under the receiver operating characteristic curve (AUC) are 0.937 (95% CI 0.912 - 0.962) and 0.886 (95% CI 0.879-0.893) in the development and validation datasets, respectively. The model performances were consistent when tested using data ending at multiple time periods during pregnancy and at childbirth. LIMITATIONS The prevalence of PPD in the study data represented a treatment prevalence and is likely lower than the illness prevalence. CONCLUSIONS EHRs and machine learning offer the ability to identify women at risk for PPD early in their pregnancy. This may facilitate scalable and timely prevention and intervention, reducing negative outcomes and the associated burden.
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Affiliation(s)
- Yiye Zhang
- Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA; Department of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
| | - Shuojia Wang
- School of Public Health, Zhejiang University, HangZhou, Zhejiang, China,Tencent Jarvis Lab, Shenzhen, China
| | - Alison Hermann
- Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Rochelle Joly
- Weill Cornell Medicine, Cornell University, New York, NY, USA
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Clayton EW, Appelbaum PS, Chung WK, Marchant GE, Roberts JL, Evans BJ. Does the law require reinterpretation and return of revised genomic results? Genet Med 2021; 23:833-836. [PMID: 33420344 PMCID: PMC8107115 DOI: 10.1038/s41436-020-01065-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Ellen Wright Clayton
- Center for Biomedical Ethics and Society, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA. .,School of Law, Vanderbilt University, Nashville, TN, USA.
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Wendy K Chung
- Departments of Pediatrics and Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Gary E Marchant
- Departments of Pediatrics and Medicine, Columbia University Irving Medical Center, New York, NY, USA.,Sandra Day O'Connor School of Law, Arizona State University, Tempe, AZ, USA
| | - Jessica L Roberts
- University of Houston Law Center, Houston, TX, USA.,University of Houston College of Medicine, Houston, TX, USA
| | - Barbara J Evans
- University of Florida Levin College of Law, Gainesville, FL, USA.,University of Florida Wertheim College of Engineering, Gainesville, FL, USA
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Faqar-Uz-Zaman SF, Filmann N, Mahkovic D, von Wagner M, Detemble C, Kippke U, Marschall U, Anantharajah L, Baumartz P, Sobotta P, Bechstein WO, Schnitzbauer AA. Study protocol for a prospective, double-blinded, observational study investigating the diagnostic accuracy of an app-based diagnostic health care application in an emergency room setting: the eRadaR trial. BMJ Open 2021; 11:e041396. [PMID: 33419909 PMCID: PMC7798704 DOI: 10.1136/bmjopen-2020-041396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Occurrence of inaccurate or delayed diagnoses is a significant concern in patient care, particularly in emergency medicine, where decision making is often constrained by high throughput and inaccurate admission diagnoses. Artificial intelligence-based diagnostic decision support system have been developed to enhance clinical performance by suggesting differential diagnoses to a given case, based on an integrated medical knowledge base and machine learning techniques. The purpose of the study is to evaluate the diagnostic accuracy of Ada, an app-based diagnostic tool and the impact on patient outcome. METHODS AND ANALYSIS The eRadaR trial is a prospective, double-blinded study with patients presenting to the emergency room (ER) with abdominal pain. At initial contact in the ER, a structured interview will be performed using the Ada-App and both, patients and attending physicians, will be blinded to the proposed diagnosis lists until trial completion. Throughout the study, clinical data relating to diagnostic findings and types of therapy will be obtained and the follow-up until day 90 will comprise occurrence of complications and overall survival of patients. The primary efficacy of the trial is defined by the percentage of correct diagnoses suggested by Ada compared with the final discharge diagnosis. Further, accuracy and timing of diagnosis will be compared with decision making of classical doctor-patient interaction. Secondary objectives are complications, length of hospital stay and overall survival. ETHICS AND DISSEMINATION Ethical approval was received by the independent ethics committee (IEC) of the Goethe-University Frankfurt on 9 April 2020 including the patient information material and informed consent form. All protocol amendments must be reported to and adapted by the IEC. The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER DRKS00019098.
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Affiliation(s)
- S Fatima Faqar-Uz-Zaman
- Department for General, Visceral and Transplant Surgery, Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Germany
| | - Natalie Filmann
- Institute of Biostatistics and Mathematical Modeling, Goethe-University, Frankfurt/Main, Frankfurt, Germany
| | - Dora Mahkovic
- Ljubljana Central Medical School, Ljubljana, Slovenia
| | | | - Charlotte Detemble
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Ulf Kippke
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | | | - Luxia Anantharajah
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Philipp Baumartz
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Paula Sobotta
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Wolf O Bechstein
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
| | - Andreas A Schnitzbauer
- Hospital of the Goethe University Frankfurt Surgery Centre, Frankfurt am Main, Hessen, Germany
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198
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Analysis of Health Screening Records Using Interpretations of Predictive Models. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-77211-6_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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199
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Pichon A, Schiffer K, Horan E, Massey B, Bakken S, Mamykina L, Elhadad N. Divided We Stand: The Collaborative Work of Patients and Providers in an Enigmatic Chronic Disease. PROCEEDINGS OF THE ACM ON HUMAN-COMPUTER INTERACTION 2021; 4:261. [PMID: 33981961 PMCID: PMC8112593 DOI: 10.1145/3434170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In chronic conditions, patients and providers need support in understanding and managing illness over time. Focusing on endometriosis, an enigmatic chronic condition, we conducted interviews with specialists and focus groups with patients to elicit their work in care specifically pertaining to dealing with an enigmatic disease, both independently and in partnership, and how technology could support these efforts. We found that the work to care for the illness, including reflecting on the illness experience and planning for care, is significantly compounded by the complex nature of the disease: enigmatic condition means uncertainty and frustration in care and management; the multi-factorial and systemic features of endometriosis without any guidance to interpret them overwhelm patients and providers; the different temporal resolutions of this chronic condition confuse both patients and provides; and patients and providers negotiate medical knowledge and expertise in an attempt to align their perspectives. We note how this added complexity demands that patients and providers work together to find common ground and align perspectives, and propose three design opportunities (considerations to construct a holistic picture of the patient, design features to reflect and make sense of the illness, and opportunities and mechanisms to correct misalignments and plan for care) and implications to support patients and providers in their care work. Specifically, the enigmatic nature of endometriosis necessitates complementary approaches from human-centered computing and artificial intelligence, and thus opens a number of future research avenues.
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Affiliation(s)
| | | | - Emma Horan
- Columbia University, Department of Biomedical Informatics
| | - Bria Massey
- Columbia University, Department of Biomedical Informatics
| | - Suzanne Bakken
- Columbia University, Department of Biomedical Informatics and School of Nursing
| | - Lena Mamykina
- Columbia University, Department of Biomedical Informatics
| | - Noémie Elhadad
- Columbia University, Department of Biomedical Informatics
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Harish V, Morgado F, Stern AD, Das S. Artificial Intelligence and Clinical Decision Making: The New Nature of Medical Uncertainty. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2021; 96:31-36. [PMID: 32852320 DOI: 10.1097/acm.0000000000003707] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Estimates in a 1989 study indicated that physicians in the United States were unable to reach a diagnosis that accounted for their patient's symptoms in up to 90% of outpatient patient encounters. Many proponents of artificial intelligence (AI) see the current process of moving from clinical data gathering to medical diagnosis as being limited by human analytic capability and expect AI to be a valuable tool to refine this process. The use of AI fundamentally calls into question the extent to which uncertainty in medical decision making is tolerated. Uncertainty is perceived by some as fundamentally undesirable and thus, for them, optimal decision making should be based on minimizing uncertainty. However, uncertainty cannot be reduced to zero; thus, relative uncertainty can be used as a metric to weigh the likelihood of various diagnoses being correct and the appropriateness of treatments. Here, the authors make the argument, using as examples the experiences of 2 AI systems, IBM Watson on Jeopardy and Watson for Oncology, that medical decision making based on relative uncertainty provides a better lens for understanding the application of AI to medicine than one that minimizes uncertainty. This approach to uncertainty has significant implications for how health care leaders consider the benefits and trade-offs of AI-assisted and AI-driven decision tools and ultimately integrate AI into medical practice.
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Affiliation(s)
- Vinyas Harish
- V. Harish is a fourth-year MD-PhD student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-6364-2439
| | - Felipe Morgado
- F. Morgado is a fourth-year MD-PhD student, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0003-3000-9455
| | - Ariel D Stern
- A.D. Stern is associate professor, Technology and Operations Management Unit, Harvard Business School, Harvard University, Cambridge, Massachusetts; ORCID: https://orcid.org/0000-0002-3586-1041
| | - Sunit Das
- S. Das is associate professor, Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0002-2146-4168
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