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Kim SH, Park SY, Seo H, Woo J. Feature selection integrating Shapley values and mutual information in reinforcement learning: An application in the prediction of post-operative outcomes in patients with end-stage renal disease. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 257:108416. [PMID: 39342877 DOI: 10.1016/j.cmpb.2024.108416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 08/28/2024] [Accepted: 09/06/2024] [Indexed: 10/01/2024]
Abstract
BACKGROUND In predicting post-operative outcomes for patients with end-stage renal disease, our study faced challenges related to class imbalance and a high-dimensional feature space. Therefore, with a focus on overcoming class imbalance and improving interpretability, we propose a novel feature selection approach using multi-agent reinforcement learning. METHODS We proposed a multi-agent feature selection model based on a comprehensive reward function that combines classification model performance, Shapley additive explanations values, and the mutual information. The definition of rewards in reinforcement learning is crucial for model convergence and performance improvement. Initially, we set a deterministic reward based on the mutual information between variables and the target class, selecting variables that are highly dependent on the class, thus accelerating convergence. We then prioritized variables that influence the minority class on a sample basis and introduced a dynamic reward distribution strategy using Shapley additive explanations values to improve interpretability and solve the class imbalance problem. RESULTS Involving the integration of electronic medical records, anesthesia records, operating room vital signs, and pre-operative anesthesia evaluations, our approach effectively mitigated class imbalance and demonstrated superior performance in ablation analysis. Our model achieved a 16% increase in the minority class F1 score and an 8.2% increase in the overall F1 score compared to the baseline model without feature selection. CONCLUSION This study contributes important research findings that show that the multi-agent-based feature selection method can be a promising approach for solving the class imbalance problem.
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Affiliation(s)
- Seo-Hee Kim
- Soonchunhyang University, Department of ICT Convergence, Asan, 31538, Republic of Korea
| | - Sun Young Park
- Soonchunhyang University Seoul Hospital, Anesthesiology and Pain Medicine, Seoul, 04401, Republic of Korea.
| | - Hyungseok Seo
- Kyung Hee University Hospital at Gangdong, Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul, 05278, Republic of Korea
| | - Jiyoung Woo
- Soonchunhyang University, Department of AI and Big Data, Asan, 31538, Republic of Korea.
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Elefterion B, Cirenei C, Kipnis E, Cailliau E, Bruandet A, Tavernier B, Lamer A, Lebuffe G. Intraoperative Mechanical Power and Postoperative Pulmonary Complications in Noncardiothoracic Elective Surgery Patients: A 10-Year Retrospective Cohort Study. Anesthesiology 2024; 140:399-408. [PMID: 38011027 DOI: 10.1097/aln.0000000000004848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Postoperative pulmonary complications is a major issue that affects outcomes of surgical patients. The hypothesis was that the intraoperative ventilation parameters are associated with occurrence of postoperative pulmonary complications. METHODS A single-center retrospective cohort study was conducted at the Lille University Hospital, France. The study included 33,701 adults undergoing noncardiac, nonthoracic elective surgery requiring general anesthesia with tracheal intubation between January 2010 and December 2019. Intraoperative ventilation parameters were compared between patients with and without one or more postoperative pulmonary complications (respiratory infection, respiratory failure, pleural effusion, atelectasis, pneumothorax, bronchospasm, and aspiration pneumonitis) within 7 days of surgery. RESULTS Among 33,701 patients, 2,033 (6.0%) had one or more postoperative pulmonary complications. The lower tidal volume to predicted body weight ratio (odds ratio per -1 ml·kgPBW-1, 1.08; 95% CI, 1.02 to 1.14; P < 0.001), higher mechanical power (odds ratio per 4 J·min-1, 1.37; 95% CI, 1.26 to 1.49; P < 0.001), dynamic respiratory system compliance less than 30 ml·cm H2O (1.30; 95% CI, 1.15 to 1.46; P < 0.001), oxygen saturation measured by pulse oximetry less than 96% (odds ratio, 2.42; 95% CI, 1.97 to 2.96; P < 0.001), and lower end-tidal carbon dioxide (odds ratio per -3 mmHg, 1.06; 95% CI, 1.00 to 1.13; P = 0.023) were independently associated with postoperative pulmonary complications. Patients with postoperative pulmonary complications were more likely to be admitted to the intensive care unit (odds ratio, 12.5; 95% CI, 6.6 to 10.1; P < 0.001), had longer hospital length of stay (subhazard ratio, 0.43; 95% CI, 0.40 to 0.45), and higher in-hospital (subhazard ratio, 6.0; 95% CI, 4.1 to 9.0; P < 0.001) and 1-yr mortality (subhazard ratio, 2.65; 95% CI, 2.33 to 3.02; P < 0.001). CONCLUSIONS In the study's population, decreased rather than increased tidal volume, decreased compliance, increased mechanical power, and decreased end-tidal carbon dioxide were independently associated with postoperative pulmonary complications. EDITOR’S PERSPECTIVE
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Affiliation(s)
- Bertrand Elefterion
- Lille University Hospital, Surgical Critical Care, Department of Anesthesiology and Critical Care, Lille, France
| | - Cedric Cirenei
- Lille University Hospital, Surgical Critical Care, Department of Anesthesiology and Critical Care, Lille, France
| | - Eric Kipnis
- Lille University Hospital, Surgical Critical Care, Department of Anesthesiology and Critical Care, Lille, France
| | - Emeline Cailliau
- Lille University Hospital, Biostatistics Department, Lille, France
| | - Amélie Bruandet
- Lille University Hospital, Medical Information Department, Lille, France
| | - Benoit Tavernier
- Lille University Hospital, Surgical Critical Care, Department of Anesthesiology and Critical Care, Lille, France; and Lille University F-59000, ULR 2694-METRICS: Health Technology Assessment and Medical Practices Evaluation, Lille, France
| | - Antoine Lamer
- Lille University, Lille University Hospital, ULR 2694-METRICS: Health Technology Assessment and Medical Practices Evaluation, Lille, France
| | - Gilles Lebuffe
- Lille University Hospital, Surgical Critical Care, Department of Anesthesiology and Critical Care, Lille, France: Lille University F-59000, ULR 7365-Research Group on Injectable Forms and Associated Technologies, Lille, France
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Lamer A, Moussa MD, Marcilly R, Logier R, Vallet B, Tavernier B. Development and usage of an anesthesia data warehouse: lessons learnt from a 10-year project. J Clin Monit Comput 2023; 37:461-472. [PMID: 35933465 PMCID: PMC10068662 DOI: 10.1007/s10877-022-00898-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022]
Abstract
This paper describes the development and implementation of an anesthesia data warehouse in the Lille University Hospital. We share the lessons learned from a ten-year project and provide guidance for the implementation of such a project. Our clinical data warehouse is mainly fed with data collected by the anesthesia information management system and hospital discharge reports. The data warehouse stores historical and accurate data with an accuracy level of the day for administrative data, and of the second for monitoring data. Datamarts complete the architecture and provide secondary computed data and indicators, in order to execute queries faster and easily. Between 2010 and 2021, 636 784 anesthesia records were integrated for 353 152 patients. We reported the main concerns and barriers during the development of this project and we provided 8 tips to handle them. We have implemented our data warehouse into the OMOP common data model as a complementary downstream data model. The next step of the project will be to disseminate the use of the OMOP data model for anesthesia and critical care, and drive the trend towards federated learning to enhance collaborations and multicenter studies.
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Affiliation(s)
- Antoine Lamer
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France.
- InterHop, Rennes, France.
| | | | - Romaric Marcilly
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, CIC-IT 1403 - Investigation Center, Lille, France
| | - Régis Logier
- CHU Lille, CIC-IT 1403 - Investigation Center, Lille, France
| | - Benoit Vallet
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Benoît Tavernier
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, Pôle d'Anesthésie-Réanimation, 59000, Lille, France
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Lamer A, Fruchart M, Paris N, Popoff B, Payen A, Balcaen T, Gacquer W, Bouzille G, Cuggia M, Doutreligne M, Chazard E. Enhancing Data Reuse: Standardized Description of the Feature Extraction Process to Transform Raw Data into Meaningful Information (Preprint). JMIR Med Inform 2022; 10:e38936. [DOI: 10.2196/38936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/19/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
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End-tidal Carbon Dioxide for Diagnosing Anaphylaxis in Patients with Severe Postinduction Hypotension. Anesthesiology 2022; 136:472-481. [PMID: 35041738 DOI: 10.1097/aln.0000000000004123] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Perioperative hypersensitivity reactions may be difficult to diagnose during general anesthesia. Postinduction hypotension is the most common sign but is not specific. It was recently suggested that low end-tidal carbon dioxide (ETco2) might be a marker of anaphylaxis (Ring and Messmer grades III to IV immediate hypersensitivity reactions) in hypotensive patients under mechanical ventilation. To test this hypothesis, the authors compared ETco2 in patients with a diagnosis of anaphylaxis and in patients with severe hypotension from any other cause after the induction of anesthesia. METHODS This was a retrospective single-center case-control study in which two groups were formed from an anesthesia data warehouse. The anaphylaxis group was formed on the basis of tryptase/histamine assay data and allergy workup data recorded over the period 2010 to 2018. The control (hypotension) group consisted of all patients having experienced severe hypotension (mean arterial pressure less than 50 mmHg for 5 min or longer) with a cause other than anaphylaxis after anesthesia induction in 2017. RESULTS The anaphylaxis and hypotension groups comprised 49 patients (grade III: n = 38; grade IV: n = 11) and 555 patients, respectively. The minimum ETco2 value was significantly lower in the anaphylaxis group (median [interquartile range]: 17 [12 to 23] mmHg) than in the hypotension group (32 [29 to 34] mmHg; P < 0.001). The area under the receiver operating characteristic curve (95% CI) for ETco2 was 0.95 (0.91 to 0.99). The sensitivity and specificity (95% CI) for the optimal cutoff value were 0.92 (0.82 to 0.98) and 0.94 (0.92 to 0.99), respectively. In multivariable analysis, minimum ETco2 was associated with anaphylaxis after adjusting for confounders and competing predictors, including arterial pressure, heart rate, and peak airway pressure (odds ratio [95% CI] for ETco2: 0.51 [0.38 to 0.68]; P < 0.001). CONCLUSIONS In case of severe hypotension after anesthesia induction, a low ETco2 contributes to the diagnosis of anaphylaxis, in addition to the classical signs of perioperative immediate hypersensitivity. EDITOR’S PERSPECTIVE
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Lamer A, Abou-Arab O, Bourgeois A, Parrot A, Popoff B, Beuscart JB, Tavernier B, Moussa MD. Transforming Anesthesia Data Into the Observational Medical Outcomes Partnership Common Data Model: Development and Usability Study. J Med Internet Res 2021; 23:e29259. [PMID: 34714250 PMCID: PMC8590192 DOI: 10.2196/29259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Electronic health records (EHRs, such as those created by an anesthesia management system) generate a large amount of data that can notably be reused for clinical audits and scientific research. The sharing of these data and tools is generally affected by the lack of system interoperability. To overcome these issues, Observational Health Data Sciences and Informatics (OHDSI) developed the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to standardize EHR data and promote large-scale observational and longitudinal research. Anesthesia data have not previously been mapped into the OMOP CDM. OBJECTIVE The primary objective was to transform anesthesia data into the OMOP CDM. The secondary objective was to provide vocabularies, queries, and dashboards that might promote the exploitation and sharing of anesthesia data through the CDM. METHODS Using our local anesthesia data warehouse, a group of 5 experts from 5 different medical centers identified local concepts related to anesthesia. The concepts were then matched with standard concepts in the OHDSI vocabularies. We performed structural mapping between the design of our local anesthesia data warehouse and the OMOP CDM tables and fields. To validate the implementation of anesthesia data into the OMOP CDM, we developed a set of queries and dashboards. RESULTS We identified 522 concepts related to anesthesia care. They were classified as demographics, units, measurements, operating room steps, drugs, periods of interest, and features. After semantic mapping, 353 (67.7%) of these anesthesia concepts were mapped to OHDSI concepts. Further, 169 (32.3%) concepts related to periods and features were added to the OHDSI vocabularies. Then, 8 OMOP CDM tables were implemented with anesthesia data and 2 new tables (EPISODE and FEATURE) were added to store secondarily computed data. We integrated data from 5,72,609 operations and provided the code for a set of 8 queries and 4 dashboards related to anesthesia care. CONCLUSIONS Generic data concerning demographics, drugs, units, measurements, and operating room steps were already available in OHDSI vocabularies. However, most of the intraoperative concepts (the duration of specific steps, an episode of hypotension, etc) were not present in OHDSI vocabularies. The OMOP mapping provided here enables anesthesia data reuse.
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Affiliation(s)
- Antoine Lamer
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- InterHop, Paris, France
- Univ. Lille, Faculté Ingénierie et Management de la Santé, Lille, France
| | - Osama Abou-Arab
- Department of Anaesthesiology and Critical Care Medicine, Amiens Picardie University Hospital, Amiens, France
| | - Alexandre Bourgeois
- Department of Anesthesiology and Critical Care Medicine, Regional University Hospital of Nancy, Nancy, France
| | | | - Benjamin Popoff
- Department of Anaesthesiology and Critical Care, Rouen University Hospital, Rouen, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Benoît Tavernier
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
- Department of Anesthesiology and Critical Care, CHU Lille, Lille, France
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Moussa MD, Lamer A, Labreuche J, Brandt C, Mass G, Louvel P, Lecailtel S, Mesnard T, Deblauwe D, Gantois G, Nodea M, Desbordes J, Hertault A, Saddouk N, Muller C, Haulon S, Sobocinski J, Robin E. Mid-Term Survival and Risk Factors Associated With Myocardial Injury After Fenestrated and/or Branched Endovascular Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2021; 62:550-558. [PMID: 33846076 DOI: 10.1016/j.ejvs.2021.02.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Myocardial injury after non-cardiac surgery (MINS) is an independent predictor of post-operative mortality in non-cardiac surgery patients and may increase health costs. Few data are available for MINS in vascular surgery patients, in general, and those undergoing fenestrated/branched endovascular aortic repairs (F/BEVAR), in particular. The incidence of MINS after F/BEVAR, the associated risk factors, and prognosis have not been determined. The aim of the present study was to help fill these knowledge gaps. METHODS A single centre, retrospective study was carried out at a high volume F/BEVAR centre in a university hospital. Adult patients who underwent F/BEVAR between October 2010 and December 2018 were included. A high sensitivity troponin T (HsTnT) assay was performed daily in the first few post-operative days. MINS was defined as a HsTnT level ≥ 14 ng/L (MINS14) or ≥ 20 ng/L (MINS20). After assessment of the incidence of MINS, survival up to two years was estimated in a Kaplan-Meier analysis and the groups were compared according to MINS status. A secondary aim was to identify predictors of MINS. RESULTS Of the 387 included patients, 240 (62.0%) had MINS14 and 166 (42.9%) had MINS20. In multivariable Cox models, both conditions were significantly associated with poor two year survival (MINS14: adjusted hazard ratio [aHR] 2.15, 95% confidence interval [CI] 1.10 - 4.19; MINS20: aHR 2.43, 95% CI 1.36 - 4.34). In a multivariable logistic regression, age, revised cardiac risk index, duration of surgery, pre-operative estimated glomerular filtration rate (eGFR), and haemoglobin level were independent predictors of MINS. CONCLUSION After F/BEVAR surgery, the incidence of MINS was particularly high, regardless of the definition considered (MINS14 or MINS20). MINS was significantly associated with poor two year survival. The modifiable predictors identified were duration of surgery, eGFR, and haemoglobin level.
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Affiliation(s)
- Mouhamed D Moussa
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France.
| | - Antoine Lamer
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France; Université Lille, INSERM, CHU Lille, CIC-IT 1403, Lille, France; Université Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, Lille, France
| | - Julien Labreuche
- Université Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, Lille, France; Université Lille, CHU Lille, Department of Biostatistics, Lille, France
| | - Caroline Brandt
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Guillaume Mass
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Paul Louvel
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Sylvain Lecailtel
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Thomas Mesnard
- CHU Lille, Aortic Centre, Vascular Surgery, Lille, France
| | - Delphine Deblauwe
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Guillaume Gantois
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Madalina Nodea
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Jacques Desbordes
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | | | - Noredine Saddouk
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Christophe Muller
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
| | - Stéphan Haulon
- CHU Lille, Aortic Centre, Vascular Surgery, Lille, France; Aortic Centre, Hôpital Marie Lannelongue, Université Paris Sud, Le Plessis-Robinson, France
| | - Jonathan Sobocinski
- CHU Lille, Aortic Centre, Vascular Surgery, Lille, France; Université Lille, INSERM U1008, CHU Lille, Lille, France
| | - Emmanuel Robin
- CHU Lille, Service d'Anesthésie-Réanimation cardiovasculaire et thoracique, pôle d'Anesthésie-Réanimation, Lille, France
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Laurent G, Moussa MD, Cirenei C, Tavernier B, Marcilly R, Lamer A. Development, implementation and preliminary evaluation of clinical dashboards in a department of anesthesia. J Clin Monit Comput 2020; 35:617-626. [PMID: 32418147 PMCID: PMC7229430 DOI: 10.1007/s10877-020-00522-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/05/2020] [Indexed: 12/15/2022]
Abstract
Clinical dashboards summarize indicators of high-volume patient data in a concise, user-friendly visual format. There are few studies of the use of dashboards to improve professional practice in anesthesiology. The objective of the present study was to describe the user-centered development, implementation and preliminary evaluation of clinical dashboards dealing with anesthesia unit management and quality assessment in a French university medical center. User needs and technical requirements were identified in end user interviews and then synthesized. Several representations were then developed (according to good visualization practice) and submitted to end users for appraisal. Lastly, dashboards were implemented and made accessible for everyday use via the medical center’s network. After a period of use, end user feedback on the dashboard platform was collected as a system usability score (range 0 to 100). Seventeen themes (corresponding to 29 questions and 42 indicators) were identified. After prioritization and feasibility assessment, 10 dashboards were ultimately implemented and deployed. The dashboards variously addressed the unit’s overall activity, compliance with guidelines on intraoperative hemodynamics, ventilation and monitoring, and documentation of the anesthesia procedure. The mean (standard deviation) system usability score was 82.6 (11.5), which corresponded to excellent usability. We developed clinical dashboards for a university medical center’s anesthesia units. The dashboards’ deployment was well received by the center’s anesthesiologists. The dashboards’ impact on activity and practice after several months of use will now have to be assessed.
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Affiliation(s)
- Géry Laurent
- INSERM, CHU Lille, CIC-IT/Evalab 1403 - Centre d'Investigation Clinique, 59000, Lille, France.,Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, 59000, Lille, France.,Univ. Lille, Faculté Ingénierie et Management de la Santé, 59000, Lille, France
| | | | - Cédric Cirenei
- CHU Lille, Pôle d'Anesthésie-Réanimation, 59000, Lille, France
| | - Benoît Tavernier
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, 59000, Lille, France.,CHU Lille, Pôle d'Anesthésie-Réanimation, 59000, Lille, France
| | - Romaric Marcilly
- INSERM, CHU Lille, CIC-IT/Evalab 1403 - Centre d'Investigation Clinique, 59000, Lille, France.,Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, 59000, Lille, France
| | - Antoine Lamer
- INSERM, CHU Lille, CIC-IT/Evalab 1403 - Centre d'Investigation Clinique, 59000, Lille, France. .,Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de santé et des Pratiques médicales, 59000, Lille, France. .,Univ. Lille, Faculté Ingénierie et Management de la Santé, 59000, Lille, France.
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Maïer B, Dargazanli C, Bourcier R, Kyheng M, Labreuche J, Mosimann PJ, Puccinelli F, Taylor G, Le Guen M, Riem R, Desilles JP, Boisseau W, Fahed R, Redjem H, Smajda S, Ciccio G, Escalard S, Blanc R, Piotin M, Lapergue B, Mazighi M. Effect of Steady and Dynamic Blood Pressure Parameters During Thrombectomy According to the Collateral Status. Stroke 2020; 51:1199-1206. [PMID: 32156204 DOI: 10.1161/strokeaha.119.026769] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Guidelines regarding blood pressure (BP) management during endovascular therapy (EVT) for anterior circulation strokes are questionable since the optimal BP target is a matter of debate. To evaluate the importance of hemodynamic control during EVT, we investigated the impact of dynamic and steady BP parameters during EVT on functional outcome (part 1) and according to the collateral status (CS; part 2). Methods- We performed a post hoc analysis of the ASTER trial (Contact Aspiration Versus Stent Retriever for Successful Recanalization). BP was measured noninvasively during EVT and CS assessed on the angiographic run before EVT. We studied dynamic BP parameter using BP variability (coefficient of variation) and steady BP parameter (hypotension time defined as systolic BP <140 mm Hg and mean arterial pressure <90 mm Hg). The primary outcome was favorable outcome defined as a 3-month modified Rankin Scale score between 0 and 2. Results- Among the 381 patients of the ASTER study, 172 patients were included in part 1 and 159 in part 2. Systolic BP, diastolic BP, and mean arterial pressure variability were negatively associated with favorable outcome regardless of CS: per 10-unit increase, adjusted odds ratios were 0.45 (95% CI, 0.20-0.98), 0.37 (95% CI, 0.19-0.72), and 0.35 (95% CI, 0.16-0.76), respectively. According to CS, the hypotension time with periprocedural mean arterial pressure <90 mm Hg was negatively associated with favorable outcome in patients with poor CS (adjusted odds ratio, 0.88 [95% CI, 0.72-1.09]) but not in patients with good CS (adjusted odds ratio, 1.24 [95% CI, 0.91-1.67]; Phet=0.047). Conclusions- The CS did not modify the association between dynamic parameters and functional outcomes, but some findings suggest that the CS modifies the association between steady parameter and functional outcomes. Hypotension time according to the CS was not statistically predictive of poor outcomes but displayed a trend toward worse outcomes for patients with poor CS only.
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Affiliation(s)
- Benjamin Maïer
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Cyril Dargazanli
- Diagnostic and Interventional Neuroradiology Department, Guy de Chauliac Hospital, Montpellier, France (C.D.).,Laboratory of Cerebrovascular Mechanisms of Brain Disorders, Department of Neuroscience, Institute of Functional Genomics (UMR 5203 CNRS- U1191 INSERM), University of Montpellier, France (C.D.)
| | - Romain Bourcier
- Interventional Neuroradiology Department (R.B.), Nantes Hospital, France
| | - Maëva Kyheng
- CHU Lille, EA 2694 Santé publique: épidémiologie et qualité des soins, University of Lille, France (M.K., J.L.)
| | - Julien Labreuche
- CHU Lille, EA 2694 Santé publique: épidémiologie et qualité des soins, University of Lille, France (M.K., J.L.)
| | - Pascal J Mosimann
- Diagnostic and Interventional Neuroradiology Department, Bern University Hospital, Switzerland (P.J.M.)
| | - Francesco Puccinelli
- Diagnostic and Interventional Neuroradiology Department, Lausanne Hospital, Switzerland (F.P.)
| | - Guillaume Taylor
- Intensive Care Unit Department, Fondation Rothschild, Paris, France (G.T.)
| | - Morgan Le Guen
- Intensive Care Unit Department (M.L.G.), Foch Hospital, Suresnes, France
| | - Romuald Riem
- Intensive Care Unit Department (R.R.), Nantes Hospital, France
| | - Jean-Philippe Desilles
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | - William Boisseau
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Robert Fahed
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Hocine Redjem
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Stanislas Smajda
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Gabriele Ciccio
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Simon Escalard
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.)
| | - Raphaël Blanc
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | - Michel Piotin
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.)
| | | | - Mikael Mazighi
- From the Interventional Neuroradiology Department, Fondation Rothschild, Paris, France (B.M., J.-P.D., W.B., R.F., H.R., S.S., G.C., S.E., R.B., M.P., M.M.).,Laboratory of Vascular Translational Science, INSERM U1148, Paris, France (J.-P.D., R.B., M.P., M.M.).,Paris University, France (M.M.)
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Lu R, Wu CC, Yang HC, Jack Li YC. Metabolomics processing made easier. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2016; 129:A1-A2. [PMID: 27084327 DOI: 10.1016/s0169-2607(16)30330-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Richard Lu
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taiwan
| | - Chieh-Chen Wu
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Hsuan-Chia Yang
- Institute of Biomedical Informatics, National Yang-Ming University, Taiwan; Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Yu-Chuan Jack Li
- Graduate Institute of Biomedical Informatics, College of Medicine Science and Technology, Taipei Medical University, Taipei, Taiwan; International Center for Health Information Technology (ICHIT), Taipei Medical University, Taiwan; Department of Dermatology, Wan Fang Hospital, Taipei, Taiwan.
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