1
|
Ruiz-Botella M, Manrique S, Gomez J, Bodí M. Advancing ICU patient care with a Real-Time predictive model for mechanical Power to mitigate VILI. Int J Med Inform 2024; 189:105511. [PMID: 38851133 DOI: 10.1016/j.ijmedinf.2024.105511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Invasive Mechanical Ventilation (IMV) in Intensive Care Units (ICU) significantly increases the risk of Ventilator-Induced Lung Injury (VILI), necessitating careful management of mechanical power (MP). This study aims to develop a real-time predictive model of MP utilizing Artificial Intelligence to mitigate VILI. METHODOLOGY A retrospective observational study was conducted, extracting patient data from Clinical Information Systems from 2018 to 2022. Patients over 18 years old with more than 6 h of IMV were selected. Continuous data on IMV variables, laboratory data, monitoring, procedures, demographic data, type of admission, reason for admission, and APACHE II at admission were extracted. The variables with the highest correlation to MP were used for prediction and IMV data was grouped in 15-minute intervals using the mean. A mixed neural network model was developed to forecast MP 15 min in advance, using IMV data from 6 h before the prediction and current patient status. The model's ability to predict future MP was analyzed and compared to a baseline model predicting the future value of MP as equal to the current value. RESULTS The cohort consisted of 1967 patients after applying inclusion criteria, with a median age of 63 years and 66.9 % male. The deep learning model achieved a mean squared error of 2.79 in the test set, indicating a 20 % improvement over the baseline model. It demonstrated high accuracy (94 %) in predicting whether MP would exceed a critical threshold of 18 J/min, which correlates with increased mortality. The integration of this model into a web platform allows clinicians real-time access to MP predictions, facilitating timely adjustments to ventilation settings. CONCLUSIONS The study successfully developed and integrated in clinical practice a predictive model for MP. This model will assist clinicians allowing for the adjustment of ventilatory parameters before lung damage occurs.
Collapse
Affiliation(s)
- M Ruiz-Botella
- Departament of Chemical Engineering, Universitat Rovira I Virgili, Tarragona, Spain; Instituto de Investigación Sanitaria Pere i Virgili, Universidad Rovira i Virgili, Tarragona, Spain.
| | - S Manrique
- Instituto de Investigación Sanitaria Pere i Virgili, Universidad Rovira i Virgili, Tarragona, Spain; Critical Care department, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - J Gomez
- Instituto de Investigación Sanitaria Pere i Virgili, Universidad Rovira i Virgili, Tarragona, Spain; Critical Care department, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - M Bodí
- Instituto de Investigación Sanitaria Pere i Virgili, Universidad Rovira i Virgili, Tarragona, Spain; Critical Care department, Hospital Universitario Joan XXIII, Tarragona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Spain
| |
Collapse
|
2
|
Al-Dorzi HM, Arabi YM. Quality Indicators in Adult Critical Care Medicine. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:75-84. [PMID: 38725886 PMCID: PMC11077517 DOI: 10.36401/jqsh-23-30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 05/12/2024]
Abstract
Quality indicators are increasingly used in the intensive care unit (ICU) to compare and improve the quality of delivered healthcare. Numerous indicators have been developed and are related to multiple domains, most importantly patient safety, care timeliness and effectiveness, staff well-being, and patient/family-centered outcomes and satisfaction. In this review, we describe pertinent ICU quality indicators that are related to organizational structure (such as the availability of an intensivist 24/7 and the nurse-to-patient ratio), processes of care (such as ventilator care bundle), and outcomes (such as ICU-acquired infections and standardized mortality rate). We also present an example of a quality improvement project in an ICU indicating the steps taken to attain the desired changes in quality measures.
Collapse
Affiliation(s)
- Hasan M. Al-Dorzi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Yaseen M. Arabi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Bodí M, Samper MA, Sirgo G, Esteban F, Canadell L, Berrueta J, Gómez J, Rodríguez A. Assessing the impact of real-time random safety audits through full propensity score matching on reliable data from the clinical information system. Int J Med Inform 2024; 184:105352. [PMID: 38330523 DOI: 10.1016/j.ijmedinf.2024.105352] [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: 11/15/2023] [Revised: 01/21/2024] [Accepted: 01/27/2024] [Indexed: 02/10/2024]
Abstract
BACKGROUND Evidence-based care processes are not always applied at the bedside in critically ill patients. Numerous studies have assessed the impact of checklists and related strategies on the process of care and patient outcomes. We aimed to evaluate the effects of real-time random safety audits on process-of-care and outcome variables in critical care patients. METHODS This prospective study used data from the clinical information system to evaluate the impact of real-time random safety audits targeting 32 safety measures in two intensive care units during a 9-month period. We compared endpoints between patients attended with safety audits and those not attended with safety audits. The primary endpoint was mortality, measured by Cox hazard regression after full propensity-score matching. Secondary endpoints were the impact on adherence to process-of-care measures and on quality indicators. RESULTS We included 871 patients; 228 of these were attended in ≥ 1 real-time random safety audits. Safety audits were carried out on 390 patient-days; most improvements in the process of care were observed in safety measures related to mechanical ventilation, renal function and therapies, nutrition, and clinical information system. Although the group of patients attended in safety audits had more severe disease at ICU admission [APACHE II score 21 (16-27) vs. 20 (15-25), p = 0.023]; included a higher proportion of surgical patients [37.3 % vs. 26.4 %, p = 0.003] and a higher proportion of mechanically ventilated patients [72.8 % vs. 40.3 %, p < 0.001]; averaged more days on mechanical ventilation, central venous catheter, and urinary catheter; and had a longer ICU stay [12.5 (5.5-23.3) vs. 2.9 (1.7-5.9), p < 0.001], ICU mortality did not differ significantly between groups (19.3 % vs. 18.8 % in the group without safety rounds). After full propensity-score matching, Cox hazard regression analysis showed real-time random safety audits were associated with a lower risk of mortality throughout the ICU stay (HR 0.31; 95 %CI 0.20-0.47). CONCLUSIONS Real-time random safety audits are associated with a reduction in the risk of ICU mortality. Exploiting data from the clinical information system is useful in assessing the impact of them on the care process, quality indicators, and mortality.
Collapse
Affiliation(s)
- Maria Bodí
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain; CIBERES, Spain.
| | - Manuel A Samper
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Gonzalo Sirgo
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Federico Esteban
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Laura Canadell
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Julen Berrueta
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Josep Gómez
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain
| | - Alejandro Rodríguez
- Hospital Universitari de Tarragona Joan XXIII. Universitat Rovira I Virgili. Institut d'Investigació Sanitària Pere I Virgili. Tarragona Spain; CIBERES, Spain
| |
Collapse
|
4
|
Bernardi FA, Alves D, Crepaldi N, Yamada DB, Lima VC, Rijo R. Data Quality in Health Research: Integrative Literature Review. J Med Internet Res 2023; 25:e41446. [PMID: 37906223 PMCID: PMC10646672 DOI: 10.2196/41446] [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: 08/18/2022] [Revised: 04/18/2023] [Accepted: 07/14/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Decision-making and strategies to improve service delivery must be supported by reliable health data to generate consistent evidence on health status. The data quality management process must ensure the reliability of collected data. Consequently, various methodologies to improve the quality of services are applied in the health field. At the same time, scientific research is constantly evolving to improve data quality through better reproducibility and empowerment of researchers and offers patient groups tools for secured data sharing and privacy compliance. OBJECTIVE Through an integrative literature review, the aim of this work was to identify and evaluate digital health technology interventions designed to support the conducting of health research based on data quality. METHODS A search was conducted in 6 electronic scientific databases in January 2022: PubMed, SCOPUS, Web of Science, Institute of Electrical and Electronics Engineers Digital Library, Cumulative Index of Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist and flowchart were used to visualize the search strategy results in the databases. RESULTS After analyzing and extracting the outcomes of interest, 33 papers were included in the review. The studies covered the period of 2017-2021 and were conducted in 22 countries. Key findings revealed variability and a lack of consensus in assessing data quality domains and metrics. Data quality factors included the research environment, application time, and development steps. Strategies for improving data quality involved using business intelligence models, statistical analyses, data mining techniques, and qualitative approaches. CONCLUSIONS The main barriers to health data quality are technical, motivational, economical, political, legal, ethical, organizational, human resources, and methodological. The data quality process and techniques, from precollection to gathering, postcollection, and analysis, are critical for the final result of a study or the quality of processes and decision-making in a health care organization. The findings highlight the need for standardized practices and collaborative efforts to enhance data quality in health research. Finally, context guides decisions regarding data quality strategies and techniques. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1101/2022.05.31.22275804.
Collapse
Affiliation(s)
| | - Domingos Alves
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Nathalia Crepaldi
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Diego Bettiol Yamada
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Vinícius Costa Lima
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
| | - Rui Rijo
- Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, Brazil
- Polytechnic Institute of Leiria, Leiria, Portugal
- Institute for Systems and Computers Engineering, Coimbra, Portugal
- Center for Research in Health Technologies and Services, Porto, Portugal
| |
Collapse
|
5
|
Lewis AE, Weiskopf N, Abrams ZB, Foraker R, Lai AM, Payne PRO, Gupta A. Electronic health record data quality assessment and tools: a systematic review. J Am Med Inform Assoc 2023; 30:1730-1740. [PMID: 37390812 PMCID: PMC10531113 DOI: 10.1093/jamia/ocad120] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/16/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE We extended a 2013 literature review on electronic health record (EHR) data quality assessment approaches and tools to determine recent improvements or changes in EHR data quality assessment methodologies. MATERIALS AND METHODS We completed a systematic review of PubMed articles from 2013 to April 2023 that discussed the quality assessment of EHR data. We screened and reviewed papers for the dimensions and methods defined in the original 2013 manuscript. We categorized papers as data quality outcomes of interest, tools, or opinion pieces. We abstracted and defined additional themes and methods though an iterative review process. RESULTS We included 103 papers in the review, of which 73 were data quality outcomes of interest papers, 22 were tools, and 8 were opinion pieces. The most common dimension of data quality assessed was completeness, followed by correctness, concordance, plausibility, and currency. We abstracted conformance and bias as 2 additional dimensions of data quality and structural agreement as an additional methodology. DISCUSSION There has been an increase in EHR data quality assessment publications since the original 2013 review. Consistent dimensions of EHR data quality continue to be assessed across applications. Despite consistent patterns of assessment, there still does not exist a standard approach for assessing EHR data quality. CONCLUSION Guidelines are needed for EHR data quality assessment to improve the efficiency, transparency, comparability, and interoperability of data quality assessment. These guidelines must be both scalable and flexible. Automation could be helpful in generalizing this process.
Collapse
Affiliation(s)
- Abigail E Lewis
- Division of Computational and Data Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Nicole Weiskopf
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Zachary B Abrams
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Randi Foraker
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Albert M Lai
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Philip R O Payne
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Aditi Gupta
- Institute for Informatics, Data Science and Biostatistics, Washington University in St. Louis, St. Louis, Missouri, USA
| |
Collapse
|
6
|
Garlejo A, Bonner J, Paddock A, Park J, Lyda N, Zaky A, McMullan S. Assessing and Improving Provider Knowledge for a Cardiothoracic Intensive Care Unit Electronic Dashboard Initiative. Healthcare (Basel) 2023; 11:healthcare11081136. [PMID: 37107970 PMCID: PMC10138414 DOI: 10.3390/healthcare11081136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Electronic dashboards measure intensive care unit (ICU) performance by tracking quality indicators, especially pinpointing sub-standard metrics. This helps ICUs scrutinize and change current practices in an effort to improve failing metrics. However, its technological value is lost if end users are unaware of its importance. This results in decreased staff participation, leading to unsuccessful initiation of the dashboard. Therefore, the purpose of this project was to improve cardiothoracic ICU providers' understanding of electronic dashboards by providing an educational training bundle in preparation for an electronic dashboard initiation. METHODS A Likert survey assessing providers' knowledge, attitudes, skills, and application of electronic dashboards was conducted. Subsequently, an educational training bundle, consisting of a digital flier and laminated pamphlets, was made available to providers for four months. After bundle review, providers were assessed using the same pre-bundle Likert survey. RESULTS A comparison of summated scores from pre-bundle (mean = 38.75) and post-bundle surveys (mean = 46.13) yielded an increased summated score overall (mean = 7.38, p ≤ 0.001). CONCLUSION An educational bundle improved providers' understanding and increased their likelihood of using electronic dashboards upon its initiation. Further studies are needed to continue increasing staff participation such as providing specific education to navigate the interface for data retrieval and interpretation.
Collapse
Affiliation(s)
- April Garlejo
- Post-BSN to DNP Nurse Anesthesia, School of Nursing, University of Alabama at Birmingham, 1701 University Blvd., Birmingham, AL 35294, USA
| | - Jacob Bonner
- Post-BSN to DNP Nurse Anesthesia, School of Nursing, University of Alabama at Birmingham, 1701 University Blvd., Birmingham, AL 35294, USA
| | - Ashley Paddock
- Post-BSN to DNP Nurse Anesthesia, School of Nursing, University of Alabama at Birmingham, 1701 University Blvd., Birmingham, AL 35294, USA
| | - John Park
- Post-BSN to DNP Nurse Anesthesia, School of Nursing, University of Alabama at Birmingham, 1701 University Blvd., Birmingham, AL 35294, USA
| | - Nolan Lyda
- Department of Cardiac Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham Hospital, 1802 6th Avenue S., Birmingham, AL 35233, USA
| | - Ahmed Zaky
- Department of Cardiac Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham Hospital, 1802 6th Avenue S., Birmingham, AL 35233, USA
| | - Susan McMullan
- Post-BSN to DNP Nurse Anesthesia, School of Nursing, University of Alabama at Birmingham, 1701 University Blvd., Birmingham, AL 35294, USA
| |
Collapse
|
7
|
Syed R, Eden R, Makasi T, Chukwudi I, Mamudu A, Kamalpour M, Kapugama Geeganage D, Sadeghianasl S, Leemans SJJ, Goel K, Andrews R, Wynn MT, Ter Hofstede A, Myers T. Digital Health Data Quality Issues: Systematic Review. J Med Internet Res 2023; 25:e42615. [PMID: 37000497 PMCID: PMC10131725 DOI: 10.2196/42615] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/07/2022] [Accepted: 12/31/2022] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND The promise of digital health is principally dependent on the ability to electronically capture data that can be analyzed to improve decision-making. However, the ability to effectively harness data has proven elusive, largely because of the quality of the data captured. Despite the importance of data quality (DQ), an agreed-upon DQ taxonomy evades literature. When consolidated frameworks are developed, the dimensions are often fragmented, without consideration of the interrelationships among the dimensions or their resultant impact. OBJECTIVE The aim of this study was to develop a consolidated digital health DQ dimension and outcome (DQ-DO) framework to provide insights into 3 research questions: What are the dimensions of digital health DQ? How are the dimensions of digital health DQ related? and What are the impacts of digital health DQ? METHODS Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a developmental systematic literature review was conducted of peer-reviewed literature focusing on digital health DQ in predominately hospital settings. A total of 227 relevant articles were retrieved and inductively analyzed to identify digital health DQ dimensions and outcomes. The inductive analysis was performed through open coding, constant comparison, and card sorting with subject matter experts to identify digital health DQ dimensions and digital health DQ outcomes. Subsequently, a computer-assisted analysis was performed and verified by DQ experts to identify the interrelationships among the DQ dimensions and relationships between DQ dimensions and outcomes. The analysis resulted in the development of the DQ-DO framework. RESULTS The digital health DQ-DO framework consists of 6 dimensions of DQ, namely accessibility, accuracy, completeness, consistency, contextual validity, and currency; interrelationships among the dimensions of digital health DQ, with consistency being the most influential dimension impacting all other digital health DQ dimensions; 5 digital health DQ outcomes, namely clinical, clinician, research-related, business process, and organizational outcomes; and relationships between the digital health DQ dimensions and DQ outcomes, with the consistency and accessibility dimensions impacting all DQ outcomes. CONCLUSIONS The DQ-DO framework developed in this study demonstrates the complexity of digital health DQ and the necessity for reducing digital health DQ issues. The framework further provides health care executives with holistic insights into DQ issues and resultant outcomes, which can help them prioritize which DQ-related problems to tackle first.
Collapse
Affiliation(s)
- Rehan Syed
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Rebekah Eden
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Tendai Makasi
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Ignatius Chukwudi
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Azumah Mamudu
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Mostafa Kamalpour
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Dakshi Kapugama Geeganage
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Sareh Sadeghianasl
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Sander J J Leemans
- Rheinisch-Westfälische Technische Hochschule, Aachen University, Aachen, Germany
| | - Kanika Goel
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Robert Andrews
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Moe Thandar Wynn
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Arthur Ter Hofstede
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| | - Trina Myers
- School of Information Systems, Faculty of Science, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
8
|
Validation of an Automated System for the Extraction of a Wide Dataset for Clinical Studies Aimed at Improving the Early Diagnosis of Candidemia. Diagnostics (Basel) 2023; 13:diagnostics13050961. [PMID: 36900105 PMCID: PMC10001256 DOI: 10.3390/diagnostics13050961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
There is increasing interest in assessing whether machine learning (ML) techniques could further improve the early diagnosis of candidemia among patients with a consistent clinical picture. The objective of the present study is to validate the accuracy of a system for the automated extraction from a hospital laboratory software of a large number of features from candidemia and/or bacteremia episodes as the first phase of the AUTO-CAND project. The manual validation was performed on a representative and randomly extracted subset of episodes of candidemia and/or bacteremia. The manual validation of the random extraction of 381 episodes of candidemia and/or bacteremia, with automated organization in structured features of laboratory and microbiological data resulted in ≥99% correct extractions (with confidence interval < ±1%) for all variables. The final automatically extracted dataset consisted of 1338 episodes of candidemia (8%), 14,112 episodes of bacteremia (90%), and 302 episodes of mixed candidemia/bacteremia (2%). The final dataset will serve to assess the performance of different ML models for the early diagnosis of candidemia in the second phase of the AUTO-CAND project.
Collapse
|
9
|
Mashoufi M, Ayatollahi H, Khorasani-Zavareh D, Talebi Azad Boni T. Data Quality in Health Care: Main Concepts and Assessment Methodologies. Methods Inf Med 2023; 62:5-18. [PMID: 36716776 DOI: 10.1055/s-0043-1761500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION In the health care environment, a huge volume of data is produced on a daily basis. However, the processes of collecting, storing, sharing, analyzing, and reporting health data usually face with numerous challenges that lead to producing incomplete, inaccurate, and untimely data. As a result, data quality issues have received more attention than before. OBJECTIVE The purpose of this article is to provide an insight into the data quality definitions, dimensions, and assessment methodologies. METHODS In this article, a scoping literature review approach was used to describe and summarize the main concepts related to data quality and data quality assessment methodologies. Search terms were selected to find the relevant articles published between January 1, 2012 and September 31, 2022. The retrieved articles were then reviewed and the results were reported narratively. RESULTS In total, 23 papers were included in the study. According to the results, data quality dimensions were various and different methodologies were used to assess them. Most studies used quantitative methods to measure data quality dimensions either in paper-based or computer-based medical records. Only two studies investigated respondents' opinions about data quality. CONCLUSION In health care, high-quality data not only are important for patient care, but also are vital for improving quality of health care services and better decision making. Therefore, using technical and nontechnical solutions as well as constant assessment and supervision is suggested to improve data quality.
Collapse
Affiliation(s)
- Mehrnaz Mashoufi
- Department of Health Information Management, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.,Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Department of Health in Emergencies and Disasters, Safety Promotion and Injury Prevention Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahere Talebi Azad Boni
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.,Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| |
Collapse
|
10
|
Manrique S, Ruiz-Botella M, Rodríguez A, Gordo F, Guardiola JJ, Bodí M, Gómez J. Secondary use of data extracted from a clinical information system to assess the adherence of tidal volume and its impact on outcomes. Med Intensiva 2022; 46:619-629. [PMID: 36344013 DOI: 10.1016/j.medine.2022.03.003] [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: 11/04/2021] [Accepted: 03/09/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To extract data from clinical information systems to automatically calculate high-resolution quality indicators to assess adherence to recommendations for low tidal volume. DESIGN We devised two indicators: the percentage of time under mechanical ventilation with excessive tidal volume (>8mL/kg predicted body weight) and the percentage of patients who received appropriate tidal volume (≤8mL/kg PBW) at least 80% of the time under mechanical ventilation. We developed an algorithm to automatically calculate these indicators from clinical information system data and analyzed associations between them and patients' characteristics and outcomes. SETTINGS This study has been carried out in our 30-bed polyvalent intensive care unit between January 1, 2014 and November 30, 2019. PATIENTS All patients admitted to intensive care unit ventilated >72h were included. INTERVENTION Use data collected automatically from the clinical information systems to assess adherence to tidal volume recommendations and its outcomes. MAIN VARIABLES OF INTEREST Mechanical ventilation days, ICU length of stay and mortality. RESULTS Of all admitted patients, 340 met the inclusion criteria. Median percentage of time under mechanical ventilation with excessive tidal volume was 70% (23%-93%); only 22.3% of patients received appropriate tidal volume at least 80% of the time. Receiving appropriate tidal volume was associated with shorter duration of mechanical ventilation and intensive care unit stay. Patients receiving appropriate tidal volume were mostly male, younger, taller, and less severely ill. Adjusted intensive care unit mortality did not differ according to percentage of time with excessive tidal volume or to receiving appropriate tidal volume at least 80% of the time. CONCLUSIONS Automatic calculation of process-of-care indicators from clinical information systems high-resolution data can provide an accurate and continuous measure of adherence to recommendations. Adherence to tidal volume recommendations was associated with shorter duration of mechanical ventilation and intensive care unit stay.
Collapse
Affiliation(s)
- S Manrique
- Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain; Instituto de Investigación Sanitaria Pere i Virgili, Rovira i Virgili University, Tarragona, Spain.
| | - M Ruiz-Botella
- Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - A Rodríguez
- Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain; Instituto de Investigación Sanitaria Pere i Virgili, Rovira i Virgili University, Tarragona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Spain
| | - F Gordo
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Grupo de Investigación en Patología Crítica, Grado de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain
| | | | - M Bodí
- Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain; Instituto de Investigación Sanitaria Pere i Virgili, Rovira i Virgili University, Tarragona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Spain
| | - J Gómez
- Intensive Care Unit, Hospital Universitario Joan XXIII, Tarragona, Spain; Instituto de Investigación Sanitaria Pere i Virgili, Rovira i Virgili University, Tarragona, Spain
| |
Collapse
|
11
|
Secondary use of data extracted from a clinical information system to assess the adherence of tidal volume and its impact on outcomes. Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
12
|
Methods and measures to quantify ICU patient heterogeneity. J Biomed Inform 2021; 117:103768. [PMID: 33839305 DOI: 10.1016/j.jbi.2021.103768] [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] [Received: 10/09/2020] [Revised: 02/21/2021] [Accepted: 03/29/2021] [Indexed: 11/22/2022]
Abstract
Patients in intensive care units are heterogeneous and the daily prediction of their days to discharge (DTD) a complex task that practitioners and computers are not always able to solve satisfactorily. In order to make more precise DTD predictors, it is necessary to have tools for the analysis of the heterogeneity of the patients. Unfortunately, the number of publications in this field is almost non-existent. In order to alleviate this lack of tools, we propose four methods and their corresponding measures to quantify the heterogeneity of intensive patients in the process of determining the DTD. These new methods and measures have been tested with patients admitted over four years to a tertiary hospital in Spain. The results deepen the understanding of the intensive patient and can serve as a basis for the construction of better DTD predictors.
Collapse
|
13
|
Claverias L, Gómez J, Rodríguez A, Albiol J, Esteban F, Bodí M. Support to the organization of the Intensive Care Units during the pandemic through maps created from the Clinical Information Systems. MEDICINA INTENSIVA (ENGLISH EDITION) 2021. [PMCID: PMC7700764 DOI: 10.1016/j.medine.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Automatic generation of minimum dataset and quality indicators from data collected routinely by the clinical information system in an intensive care unit. Int J Med Inform 2020; 145:104327. [PMID: 33220573 DOI: 10.1016/j.ijmedinf.2020.104327] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/27/2020] [Accepted: 11/01/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Quality indicators (QIs) are being increasingly used in medicine to compare and improve the quality of care delivered. The feasibility of data collection is an important prerequisite for QIs. Information technology can improve efforts to measure processes and outcomes. In intensive care units (ICU), QIs can be automatically measured by exploiting data from clinical information systems (CIS). OBJECTIVE To describe the development and application of a tool to automatically generate a minimum dataset (MDS) and a set of ICU quality metrics from CIS data. METHODS We used the definitions for MDS and QIs proposed by the Spanish Society of Critical Care Medicine and Coronary Units. Our tool uses an extraction, transform, and load process implemented with Python to extract data stored in various tables in the CIS database and create a new associative database. This new database is uploaded to Qlik Sense, which constructs the MDS and calculates the QIs by applying the required metrics. The tool was tested using data from patients attended in a 30-bed polyvalent ICU during a six-year period. RESULTS We describe the definitions and metrics, and we report the MDS and QI measurements obtained through the analysis of 4546 admissions. The results show that our ICU's performance on the QIs analyzed meets the standards proposed by our national scientific society. CONCLUSIONS This is the first step toward using a tool to automatically obtain a set of actionable QIs to monitor and improve the quality of care in ICUs, eliminating the need for professionals to enter data manually, thus saving time and ensuring data quality.
Collapse
|
15
|
Claverías L, Gómez J, Rodríguez A, Albiol J, Esteban F, Bodí M. Support to the organization of the Intensive Care Units during the pandemic through maps created from the Clinical Information Systems. Med Intensiva 2020; 45:59-61. [PMID: 33020015 PMCID: PMC7531993 DOI: 10.1016/j.medin.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Laura Claverías
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España
| | - Josep Gómez
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España
| | - Alejandro Rodríguez
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España
| | - Jordi Albiol
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España
| | - Federico Esteban
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España
| | - María Bodí
- Unidad de Cuidados Intensivos. Hospital Universitario Joan XXIII, Tarragona, España; Instituto de Investigación Sanitaria Pere Virgili. Universidad Rovira i Virgili, Tarragona, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES). Instituto de Salud Carlos III, Madrid, España.
| |
Collapse
|
16
|
Pérez-Benito FJ, Sáez C, Conejero JA, Tortajada S, Valdivieso B, García-Gómez JM. Temporal variability analysis reveals biases in electronic health records due to hospital process reengineering interventions over seven years. PLoS One 2019; 14:e0220369. [PMID: 31390350 PMCID: PMC6685618 DOI: 10.1371/journal.pone.0220369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To evaluate the effects of Process-Reengineering interventions on the Electronic Health Records (EHR) of a hospital over 7 years. MATERIALS AND METHODS Temporal Variability Assessment (TVA) based on probabilistic data quality assessment was applied to the historic monthly-batched admission data of Hospital La Fe Valencia, Spain from 2010 to 2016. Routine healthcare data with a complete EHR was expanded by processed variables such as the Charlson Comorbidity Index. RESULTS Four Process-Reengineering interventions were detected by quantifiable effects on the EHR: (1) the hospital relocation in 2011 involved progressive reduction of admissions during the next four months, (2) the hospital services re-configuration incremented the number of inter-services transfers, (3) the care-services re-distribution led to transfers between facilities (4) the assignment to the hospital of a new area with 80,000 patients in 2015 inspired the discharge to home for follow up and the update of the pre-surgery planned admissions protocol that produced a significant decrease of the patient length of stay. DISCUSSION TVA provides an indicator of the effect of process re-engineering interventions on healthcare practice. Evaluating the effect of facilities' relocation and increment of citizens (findings 1, 3-4), the impact of strategies (findings 2-3), and gradual changes in protocols (finding 4) may help on the hospital management by optimizing interventions based on their effect on EHRs or on data reuse. CONCLUSIONS The effects on hospitals EHR due to process re-engineering interventions can be evaluated using the TVA methodology. Being aware of conditioned variations in EHR is of the utmost importance for the reliable reuse of routine hospitalization data.
Collapse
Affiliation(s)
- Francisco Javier Pérez-Benito
- Biomedical Data Science Lab, Instituto Universitario de Tecnologías de Información y Comunicaciones Avanzadas (ITACA), Univeritat Politécnica de València, València, Spain
- Instituto Universitario de Matemática Pura y Aplicada, Universitat Politécnica de València, València, Spain
| | - Carlos Sáez
- Biomedical Data Science Lab, Instituto Universitario de Tecnologías de Información y Comunicaciones Avanzadas (ITACA), Univeritat Politécnica de València, València, Spain
| | - J. Alberto Conejero
- Instituto Universitario de Matemática Pura y Aplicada, Universitat Politécnica de València, València, Spain
- * E-mail:
| | - Salvador Tortajada
- Biomedical Data Science Lab, Instituto Universitario de Tecnologías de Información y Comunicaciones Avanzadas (ITACA), Univeritat Politécnica de València, València, Spain
- Unidad conjunta de investigación en reingeniería de procesos socio-sanitarios, Instituto de Investigación Sanitaria La Fe, Hospital Universitario La Fe, València, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), València, Spain
| | - Bernardo Valdivieso
- Unidad conjunta de investigación en reingeniería de procesos socio-sanitarios, Instituto de Investigación Sanitaria La Fe, Hospital Universitario La Fe, València, Spain
| | - Juan M. García-Gómez
- Biomedical Data Science Lab, Instituto Universitario de Tecnologías de Información y Comunicaciones Avanzadas (ITACA), Univeritat Politécnica de València, València, Spain
- Unidad conjunta de investigación en reingeniería de procesos socio-sanitarios, Instituto de Investigación Sanitaria La Fe, Hospital Universitario La Fe, València, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), València, Spain
| |
Collapse
|
17
|
Read KB. Adapting data management education to support clinical research projects in an academic medical center. J Med Libr Assoc 2019; 107:89-97. [PMID: 30598653 PMCID: PMC6300223 DOI: 10.5195/jmla.2019.580] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 09/01/2018] [Indexed: 02/07/2023] Open
Abstract
Background Librarians and researchers alike have long identified research data management (RDM) training as a need in biomedical research. Despite the wealth of libraries offering RDM education to their communities, clinical research is an area that has not been targeted. Clinical RDM (CRDM) is seen by its community as an essential part of the research process where established guidelines exist, yet educational initiatives in this area are unknown. Case Presentation Leveraging my academic library's experience supporting CRDM through informationist grants and REDCap training in our medical center, I developed a 1.5 hour CRDM workshop. This workshop was designed to use established CRDM guidelines in clinical research and address common questions asked by our community through the library's existing data support program. The workshop was offered to the entire medical center 4 times between November 2017 and July 2018. This case study describes the development, implementation, and evaluation of this workshop. Conclusions The 4 workshops were well attended and well received by the medical center community, with 99% stating that they would recommend the class to others and 98% stating that they would use what they learned in their work. Attendees also articulated how they would implement the main competencies they learned from the workshop into their work. For the library, the effort to support CRDM has led to the coordination of a larger institutional collaborative training series to educate researchers on best practices with data, as well as the formation of institution-wide policy groups to address researcher challenges with CRDM, data transfer, and data sharing.
Collapse
Affiliation(s)
- Kevin B Read
- Data Services Librarian and Data Discovery Lead, NYU Health Sciences Library, New York University School of Medicine, 577 First Avenue, New York, NY 10016,
| |
Collapse
|
18
|
Cuadrado D, Riaño D, Gómez J, Bodí M, Sirgo G, Esteban F, García R, Rodríguez A. Pursuing Optimal Prediction of Discharge Time in ICUs with Machine Learning Methods. Artif Intell Med 2019. [DOI: 10.1007/978-3-030-21642-9_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
19
|
Núñez Reiz A, Martínez Sagasti F, Álvarez González M, Blesa Malpica A, Martín Benítez JC, Nieto Cabrera M, Del Pino Ramírez Á, Gil Perdomo JM, Prada Alonso J, Celi LA, Armengol de la Hoz MÁ, Deliberato R, Paik K, Pollard T, Raffa J, Torres F, Mayol J, Chafer J, González Ferrer A, Rey Á, González Luengo H, Fico G, Lombroni I, Hernandez L, López L, Merino B, Cabrera MF, Arredondo MT, Bodí M, Gómez J, Rodríguez A, Sánchez García M. Big data and machine learning in critical care: Opportunities for collaborative research. Med Intensiva 2018; 43:52-57. [PMID: 30077427 DOI: 10.1016/j.medin.2018.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/23/2018] [Accepted: 06/09/2018] [Indexed: 01/25/2023]
Abstract
The introduction of clinical information systems (CIS) in Intensive Care Units (ICUs) offers the possibility of storing a huge amount of machine-ready clinical data that can be used to improve patient outcomes and the allocation of resources, as well as suggest topics for randomized clinical trials. Clinicians, however, usually lack the necessary training for the analysis of large databases. In addition, there are issues referred to patient privacy and consent, and data quality. Multidisciplinary collaboration among clinicians, data engineers, machine-learning experts, statisticians, epidemiologists and other information scientists may overcome these problems. A multidisciplinary event (Critical Care Datathon) was held in Madrid (Spain) from 1 to 3 December 2017. Under the auspices of the Spanish Critical Care Society (SEMICYUC), the event was organized by the Massachusetts Institute of Technology (MIT) Critical Data Group (Cambridge, MA, USA), the Innovation Unit and Critical Care Department of San Carlos Clinic Hospital, and the Life Supporting Technologies group of Madrid Polytechnic University. After presentations referred to big data in the critical care environment, clinicians, data scientists and other health data science enthusiasts and lawyers worked in collaboration using an anonymized database (MIMIC III). Eight groups were formed to answer different clinical research questions elaborated prior to the meeting. The event produced analyses for the questions posed and outlined several future clinical research opportunities. Foundations were laid to enable future use of ICU databases in Spain, and a timeline was established for future meetings, as an example of how big data analysis tools have tremendous potential in our field.
Collapse
Affiliation(s)
- Antonio Núñez Reiz
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España.
| | | | | | - Antonio Blesa Malpica
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
| | | | - Mercedes Nieto Cabrera
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
| | | | | | - Jesús Prada Alonso
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España
| | - Leo Anthony Celi
- MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
| | - Miguel Ángel Armengol de la Hoz
- MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States; Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States; Harvard Medical School, Boston, Massachusetts, United States; Biomedical Engineering and Telemedicine Group, Biomedical Technology Centre CTB, ETSI Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Rodrigo Deliberato
- MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
| | - Kenneth Paik
- MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
| | - Tom Pollard
- MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
| | - Jesse Raffa
- MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
| | - Felipe Torres
- MIT Critical Data, Laboratory for Computational Physiology, Harvard-MIT Health Sciences & Technology, MIT, Cambridge, Massachusetts, United States
| | - Julio Mayol
- Department of Surgery, Hospital Clinico San Carlos de Madrid, Instituto de Investigación Sanitaria San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Joan Chafer
- Unidad de Innovación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Arturo González Ferrer
- Unidad de Innovación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Ángel Rey
- Unidad de Innovación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Henar González Luengo
- Unidad de Innovación, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Giuseppe Fico
- Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
| | - Ivana Lombroni
- Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
| | - Liss Hernandez
- Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
| | - Laura López
- Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
| | - Beatriz Merino
- Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
| | - María Fernanda Cabrera
- Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
| | - María Teresa Arredondo
- Life Supporting Technologies, epartamento de Tecnología Fotónica y Bioingeniería, Universidad Politècnica de Madrid, Madrid, Spain
| | - María Bodí
- Service of Intensive Care Medicine, Hospital Universitari Joan XXIII, IISPV-URV, Tarragona, Spain
| | - Josep Gómez
- Service of Intensive Care Medicine, Hospital Universitari Joan XXIII, IISPV-URV, Tarragona, Spain; Department of Electronic Engineering, Metabolomics Platform, Rovira i Virgili University, IISPV, Tarragona
| | - Alejandro Rodríguez
- Service of Intensive Care Medicine, Hospital Universitari Joan XXIII, IISPV-URV, Tarragona, Spain
| | - Miguel Sánchez García
- Servicio de Medicina Intensiva, Hospital Universitario Clínico San Carlos, Madrid, España.
| |
Collapse
|