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Loutati R, Ben-Yehuda A, Rosenberg S, Rottenberg Y. Multimodal Machine Learning for Prediction of 30-Day Readmission Risk in Elderly Population. Am J Med 2024; 137:617-628. [PMID: 38588939 DOI: 10.1016/j.amjmed.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 04/01/2024] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Readmission within 30 days is a prevalent issue among elderly patients, linked to unfavorable health outcomes. Our objective was to develop and validate multimodal machine learning models for predicting 30-day readmission risk in elderly patients discharged from internal medicine departments. METHODS This was a retrospective cohort study which included elderly patients aged 75 or older, who were hospitalized at the Hadassah Medical Center internal medicine departments between 2014 and 2020. Three machine learning algorithms were developed and employed to predict 30-day readmission risk. The primary measures were predictive model performance scores, specifically area under the receiver operator curve (AUROC), and average precision. RESULTS This study included 19,569 admissions. Of them, 3258 (16.65%) resulted in 30-day readmission. Our 3 proposed models demonstrated high accuracy and precision on an unseen test set, with AUROC values of 0.87, 0.89, and 0.93, respectively, and average precision values of 0.76, 0.78, and 0.81. Feature importance analysis revealed that the number of admissions in the past year, history of 30-day readmission, Charlson score, and admission length were the most influential variables. Notably, the natural language processing score, representing the probability of readmission according to a textual-based model trained on social workers' assessment letters during hospitalization, ranked among the top 10 contributing factors. CONCLUSIONS Leveraging multimodal machine learning offers a promising strategy for identifying elderly patients who are at high risk for 30-day readmission. By identifying these patients, machine learning models may facilitate the effective execution of preventive actions to reduce avoidable readmission incidents.
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Affiliation(s)
- Ranel Loutati
- Department of Military Medicine and "Tzameret", Faculty of Medicine, Hebrew University of Jerusalem; and the Medical Corps, Israel Defense Forces, Israel; Gaffin Center for Neuro-Oncology, Sharett Institute for Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; The Wohl Institute for Translational Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel.
| | - Arie Ben-Yehuda
- Department of Internal Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Shai Rosenberg
- Gaffin Center for Neuro-Oncology, Sharett Institute for Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel; The Wohl Institute for Translational Medicine, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Yakir Rottenberg
- Sharett Institute of Oncology, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
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Kachman MM, Brennan I, Oskvarek JJ, Waseem T, Pines JM. How artificial intelligence could transform emergency care. Am J Emerg Med 2024; 81:40-46. [PMID: 38663302 DOI: 10.1016/j.ajem.2024.04.024] [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: 03/03/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 06/07/2024] Open
Abstract
Artificial intelligence (AI) in healthcare is the ability of a computer to perform tasks typically associated with clinical care (e.g. medical decision-making and documentation). AI will soon be integrated into an increasing number of healthcare applications, including elements of emergency department (ED) care. Here, we describe the basics of AI, various categories of its functions (including machine learning and natural language processing) and review emerging and potential future use-cases for emergency care. For example, AI-assisted symptom checkers could help direct patients to the appropriate setting, models could assist in assigning triage levels, and ambient AI systems could document clinical encounters. AI could also help provide focused summaries of charts, summarize encounters for hand-offs, and create discharge instructions with an appropriate language and reading level. Additional use cases include medical decision making for decision rules, real-time models that predict clinical deterioration or sepsis, and efficient extraction of unstructured data for coding, billing, research, and quality initiatives. We discuss the potential transformative benefits of AI, as well as the concerns regarding its use (e.g. privacy, data accuracy, and the potential for changing the doctor-patient relationship).
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Affiliation(s)
- Marika M Kachman
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Virginia Hospital Center, Arlington, VA, United States of America
| | - Irina Brennan
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Inova Alexandria Hospital, Alexandria, VA, United States of America
| | - Jonathan J Oskvarek
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, Summa Health, Akron, OH, United States of America
| | - Tayab Waseem
- Department of Emergency Medicine, George Washington University, Washington, DC, United States of America
| | - Jesse M Pines
- US Acute Care Solutions, Canton, OH, United States of America; Department of Emergency Medicine, George Washington University, Washington, DC, United States of America.
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Salvioli S, Basile MS, Bencivenga L, Carrino S, Conte M, Damanti S, De Lorenzo R, Fiorenzato E, Gialluisi A, Ingannato A, Antonini A, Baldini N, Capri M, Cenci S, Iacoviello L, Nacmias B, Olivieri F, Rengo G, Querini PR, Lattanzio F. Biomarkers of aging in frailty and age-associated disorders: State of the art and future perspective. Ageing Res Rev 2023; 91:102044. [PMID: 37647997 DOI: 10.1016/j.arr.2023.102044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/01/2023]
Abstract
According to the Geroscience concept that organismal aging and age-associated diseases share the same basic molecular mechanisms, the identification of biomarkers of age that can efficiently classify people as biologically older (or younger) than their chronological (i.e. calendar) age is becoming of paramount importance. These people will be in fact at higher (or lower) risk for many different age-associated diseases, including cardiovascular diseases, neurodegeneration, cancer, etc. In turn, patients suffering from these diseases are biologically older than healthy age-matched individuals. Many biomarkers that correlate with age have been described so far. The aim of the present review is to discuss the usefulness of some of these biomarkers (especially soluble, circulating ones) in order to identify frail patients, possibly before the appearance of clinical symptoms, as well as patients at risk for age-associated diseases. An overview of selected biomarkers will be discussed in this regard, in particular we will focus on biomarkers related to metabolic stress response, inflammation, and cell death (in particular in neurodegeneration), all phenomena connected to inflammaging (chronic, low-grade, age-associated inflammation). In the second part of the review, next-generation markers such as extracellular vesicles and their cargos, epigenetic markers and gut microbiota composition, will be discussed. Since recent progresses in omics techniques have allowed an exponential increase in the production of laboratory data also in the field of biomarkers of age, making it difficult to extract biological meaning from the huge mass of available data, Artificial Intelligence (AI) approaches will be discussed as an increasingly important strategy for extracting knowledge from raw data and providing practitioners with actionable information to treat patients.
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Affiliation(s)
- Stefano Salvioli
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy; IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | | | - Leonardo Bencivenga
- Department of Translational Medical Sciences, University of Naples Federico II, Napoli, Italy
| | - Sara Carrino
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Maria Conte
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Sarah Damanti
- IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milano, Italy
| | - Rebecca De Lorenzo
- IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milano, Italy
| | - Eleonora Fiorenzato
- Parkinson's Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padova, Italy
| | - Alessandro Gialluisi
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy; EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Assunta Ingannato
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Angelo Antonini
- Parkinson's Disease and Movement Disorders Unit, Center for Rare Neurological Diseases (ERN-RND), Department of Neurosciences, University of Padova, Padova, Italy; Center for Neurodegenerative Disease Research (CESNE), Department of Neurosciences, University of Padova, Padova, Italy
| | - Nicola Baldini
- IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Miriam Capri
- Department of Medical and Surgical Science, University of Bologna, Bologna, Italy
| | - Simone Cenci
- IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milano, Italy
| | - Licia Iacoviello
- Department of Epidemiology and Prevention, IRCCS NEUROMED, Pozzilli, Italy; EPIMED Research Center, Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica Delle Marche, Ancona, Italy; Clinic of Laboratory and Precision Medicine, IRCCS INRCA, Ancona, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples Federico II, Napoli, Italy; Istituti Clinici Scientifici Maugeri IRCCS, Scientific Institute of Telese Terme, Telese Terme, Italy
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Wang Z, Meng D, He S, Guo H, Tian Z, Wei M, Yang G, Wang Z. The Effectiveness of a Hybrid Exercise Program on the Physical Fitness of Frail Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11063. [PMID: 36078781 PMCID: PMC9517902 DOI: 10.3390/ijerph191711063] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Frailty is a serious physical disorder affecting the elderly all over the world. However, the frail elderly have low physical fitness, which limits the effectiveness of current exercise programs. Inspired by this, we attempted to integrate Baduanjin and strength and endurance exercises into an exercise program to improve the physical fitness and alleviate frailty among the elderly. Additionally, to achieve the goals of personalized medicine, machine learning simulations were performed to predict post-intervention frailty. METHODS A total of 171 frail elderly individuals completed the experiment, including a Baduanjin group (BDJ), a strength and endurance training group (SE), and a combination of Baduanjin and strength and endurance training group (BDJSE), which lasted for 24 weeks. Physical fitness was evaluated by 10-meter maximum walk speed (10 m MWS), grip strength, the timed up-and-go test (TUGT), and the 6 min walk test (6 min WT). A one-way analysis of variance (ANOVA), chi-square test, and two-way repeated-measures ANOVA were carried out to analyze the experimental data. In addition, nine machine learning models were utilized to predict the frailty status after the intervention. RESULTS In 10 m MWS and TUGT, there was a significant interactive influence between group and time. When comparing the BDJ group and the SE group, participants in the BDJSE group demonstrated the maximum gains in 10 m MWS and TUGT after 24 weeks of intervention. The stacking model surpassed other algorithms in performance. The accuracy and precision rates were 75.5% and 77.1%, respectively. CONCLUSION The hybrid exercise program that combined Baduanjin with strength and endurance training proved more effective at improving fitness and reversing frailty in elderly individuals. Based on the stacking model, it is possible to predict whether an elderly person will exhibit reversed frailty following an exercise program.
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Affiliation(s)
- Ziyi Wang
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Changchun 130024, China
| | - Deyu Meng
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Changchun 130024, China
| | - Shichun He
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Changchun 130024, China
| | - Hongzhi Guo
- Graduate School of Human Sciences, Waseda University, Tokorozawa 169-8050, Japan
- AI Group, Intelligent Lancet LLC, Sacramento, CA 95816, USA
| | - Zhibo Tian
- College of Physical Education and Health, Guangxi Normal University, Guilin 541006, China
| | - Meiqi Wei
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Changchun 130024, China
| | - Guang Yang
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Changchun 130024, China
| | - Ziheng Wang
- Chinese Center of Exercise Epidemiology, Northeast Normal University, Changchun 130024, China
- AI Group, Intelligent Lancet LLC, Sacramento, CA 95816, USA
- Advanced Research Center for Human Sciences, Waseda University, Tokorozawa 169-8050, Japan
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Predicting drug toxicity at the intersection of informatics and biology: DTox builds a foundation. PATTERNS 2022; 3:100586. [PMID: 36124303 PMCID: PMC9481942 DOI: 10.1016/j.patter.2022.100586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Hao et al. (2022) present DTox (deep learning for toxicology), a neural network designed to predict and probe the sites and potential mechanisms underlying chemical toxicity; results provide a map to facilitate modular testing and improvements across multiple disparate applications.
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Mollaei N, Fujao C, Silva L, Rodrigues J, Cepeda C, Gamboa H. Human-Centered Explainable Artificial Intelligence: Automotive Occupational Health Protection Profiles in Prevention Musculoskeletal Symptoms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159552. [PMID: 35954919 PMCID: PMC9368597 DOI: 10.3390/ijerph19159552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 02/05/2023]
Abstract
In automotive and industrial settings, occupational physicians are responsible for monitoring workers’ health protection profiles. Workers’ Functional Work Ability (FWA) status is used to create Occupational Health Protection Profiles (OHPP). This is a novel longitudinal study in comparison with previous research that has predominantly relied on the causality and explainability of human-understandable models for industrial technical teams like ergonomists. The application of artificial intelligence can support the decision-making to go from a worker’s Functional Work Ability to explanations by integrating explainability into medical (restriction) and support in contexts of individual, work-related, and organizational risk conditions. A sample of 7857 for the prognosis part of OHPP based on Functional Work Ability in the Portuguese language in the automotive industry was taken from 2019 to 2021. The most suitable regression models to predict the next medical appointment for the workers’ body parts protection were the models based on CatBoost regression, with an RMSLE of 0.84 and 1.23 weeks (mean error), respectively. CatBoost algorithm is also used to predict the next body part severity of OHPP. This information can help our understanding of potential risk factors for OHPP and identify warning signs of the early stages of musculoskeletal symptoms and work-related absenteeism.
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Affiliation(s)
- Nafiseh Mollaei
- LIBPhys, Physics Department, Faculty of Sciences and Technology, Nova University of Lisbon, 2825-149 Caparica, Portugal; (L.S.); (J.R.); (C.C.); (H.G.)
- Correspondence:
| | - Carlos Fujao
- Volkswagen Autoeuropa, Industrial Engineering and Lean Management, Quinta da Marquesa, 2954-024 Quinta do Anjo, Portugal;
| | - Luis Silva
- LIBPhys, Physics Department, Faculty of Sciences and Technology, Nova University of Lisbon, 2825-149 Caparica, Portugal; (L.S.); (J.R.); (C.C.); (H.G.)
| | - Joao Rodrigues
- LIBPhys, Physics Department, Faculty of Sciences and Technology, Nova University of Lisbon, 2825-149 Caparica, Portugal; (L.S.); (J.R.); (C.C.); (H.G.)
| | - Catia Cepeda
- LIBPhys, Physics Department, Faculty of Sciences and Technology, Nova University of Lisbon, 2825-149 Caparica, Portugal; (L.S.); (J.R.); (C.C.); (H.G.)
| | - Hugo Gamboa
- LIBPhys, Physics Department, Faculty of Sciences and Technology, Nova University of Lisbon, 2825-149 Caparica, Portugal; (L.S.); (J.R.); (C.C.); (H.G.)
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7
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Oliosi E, Guede-Fernández F, Londral A. Machine Learning Approaches for the Frailty Screening: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148825. [PMID: 35886674 PMCID: PMC9320589 DOI: 10.3390/ijerph19148825] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 12/16/2022]
Abstract
Frailty characterizes a state of impairments that increases the risk of adverse health outcomes such as physical limitation, lower quality of life, and premature death. Frailty prevention, early screening, and management of potential existing conditions are essential and impact the elderly population positively and on society. Advanced machine learning (ML) processing methods are one of healthcare’s fastest developing scientific and technical areas. Although research studies are being conducted in a controlled environment, their translation into the real world (clinical setting, which is often dynamic) is challenging. This paper presents a narrative review of the procedures for the frailty screening applied to the innovative tools, focusing on indicators and ML approaches. It results in six selected studies. Support vector machine was the most often used ML method. These methods apparently can identify several risk factors to predict pre-frail or frailty. Even so, there are some limitations (e.g., quality data), but they have enormous potential to detect frailty early.
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Affiliation(s)
- Eduarda Oliosi
- Value for Health CoLAB, 1150-190 Lisboa, Portugal; (E.O.); (F.G.-F.)
- LIBPhys (Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics), NOVA School of Science and Technology, NOVA University of Lisbon, 2829-516 Caparica, Portugal
| | - Federico Guede-Fernández
- Value for Health CoLAB, 1150-190 Lisboa, Portugal; (E.O.); (F.G.-F.)
- LIBPhys (Laboratory for Instrumentation, Biomedical Engineering and Radiation Physics), NOVA School of Science and Technology, NOVA University of Lisbon, 2829-516 Caparica, Portugal
| | - Ana Londral
- Value for Health CoLAB, 1150-190 Lisboa, Portugal; (E.O.); (F.G.-F.)
- Comprehensive Health Research Center, NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Correspondence:
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Navigating an early career in genomics and data science, written from the perspective of a current PhD student. PATTERNS 2022; 3:100548. [PMID: 35845831 PMCID: PMC9278496 DOI: 10.1016/j.patter.2022.100548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rebecca Tooze, a PhD student in the Oxford Clinical Genetics’ group, discusses the importance and application for data science in her field. Using bioinformatic approaches, she analyzes whole-genome sequencing data from patients with craniosynostosis. In this paper, she comments on her current research and her opportunity as an editorial intern with Patterns.
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Sepúlveda M, Arauna D, García F, Albala C, Palomo I, Fuentes E. Frailty in Aging and the Search for the Optimal Biomarker: A Review. Biomedicines 2022; 10:1426. [PMID: 35740447 PMCID: PMC9219911 DOI: 10.3390/biomedicines10061426] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/07/2022] [Accepted: 06/07/2022] [Indexed: 01/09/2023] Open
Abstract
In the context of accelerated aging of the population worldwide, frailty has emerged as one of the main risk factors that can lead to loss of self-sufficiency in older people. This syndrome is defined as a reduced state of physiological reserve and functional capacity. The main diagnostic tools for frailty are based on scales that show deficits compared to their clinical application, such as the Fried frailty phenotype, among others. In this context, it is important to have one or more biomarkers with clinical applicability that can objectively and precisely determine the degree or risk of frailty in older people. The objective of this review was to analyze the biomarkers associated with frailty, classified according to the pathophysiological components of this syndrome (inflammation, coagulation, antioxidants, and liver function, among others). The evidence demonstrates that biomarkers associated with inflammation, oxidative stress, skeletal/cardiac muscle function, and platelet function represent the most promising markers of frailty due to their pathophysiological association with this syndrome. To a lesser extent but with the possibility of greater innovation, biomarkers associated with growth factors, vitamins, amino acids, and miRNAs represent alternatives as markers of this geriatric syndrome. Likewise, the incorporation of artificial intelligence represents an interesting approach to strengthening the diagnosis of frailty by biomarkers.
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Affiliation(s)
- Magdalena Sepúlveda
- Thrombosis Research Center, Medical Technology School, Faculty of Health Sciences, Interuniversity Center for Healthy Aging, Universidad de Talca, Talca 3480094, Chile; (M.S.); (D.A.)
| | - Diego Arauna
- Thrombosis Research Center, Medical Technology School, Faculty of Health Sciences, Interuniversity Center for Healthy Aging, Universidad de Talca, Talca 3480094, Chile; (M.S.); (D.A.)
| | - Francisco García
- Department of Geriatric Medicine, Complejo Hospitalario de Toledo, 45007 Toledo, Spain;
| | - Cecilia Albala
- Unidad de Nutrición Pública, Instituto de Nutrición y Tecnología de los Alimentos, Interuniversity Center for Healthy Aging, Universidad de Chile, Santiago 8320000, Chile;
| | - Iván Palomo
- Thrombosis Research Center, Medical Technology School, Faculty of Health Sciences, Interuniversity Center for Healthy Aging, Universidad de Talca, Talca 3480094, Chile; (M.S.); (D.A.)
| | - Eduardo Fuentes
- Thrombosis Research Center, Medical Technology School, Faculty of Health Sciences, Interuniversity Center for Healthy Aging, Universidad de Talca, Talca 3480094, Chile; (M.S.); (D.A.)
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