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Gupta RS, Epstein E, Wood RA. The role of pediatricians in the diagnosis and management of IgE-mediated food allergy: a review. Front Pediatr 2024; 12:1373373. [PMID: 38873581 PMCID: PMC11169649 DOI: 10.3389/fped.2024.1373373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/13/2024] [Indexed: 06/15/2024] Open
Abstract
Importance Food allergy can often cause a significant burden on patients, families, and healthcare systems. The complexity of food allergy management requires a multidisciplinary approach involving different types of healthcare providers, including allergists, dieticians, psychologists, nurses, family practitioners and, of particular relevance for this article, pediatric primary caretakers. Pediatricians may be the first-line healthcare providers for food allergy: strategies for management and guideline adherence have been highlighted. Observations This review article summarizes the up-to-date recommendations on the role of pediatricians in the diagnosis, management, and prevention of IgE-mediated food allergy. Early introduction of allergenic foods like peanut is known to be of importance to reduce the development of peanut allergy in infants, and pediatricians are essential for educating and supporting parents in this decision. In scenarios of limited allergist availability, as is often the case among rural, Medicaid and minority populations, pediatricians can assist in the evaluation and management of food allergy, and provide action plans, education and counselling for patients and families. Conclusions and relevance Pediatric primary caretakers play a key role in the diagnosis, management, and prevention of IgE-mediated food allergy. As more diagnostic tools and therapies in food allergy become available, the need for a multidisciplinary team is paramount to optimize patient care.
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Affiliation(s)
- Ruchi S. Gupta
- Institute for Public Health and Medicine, Center for Food Allergy & Asthma, Northwestern University, Chicago, IL, United States
| | - Ellen Epstein
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, United States
| | - Robert A. Wood
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Gholamzadeh M, Abtahi H, Safdari R. The Application of Knowledge-Based Clinical Decision Support Systems to Enhance Adherence to Evidence-Based Medicine in Chronic Disease. JOURNAL OF HEALTHCARE ENGINEERING 2023; 2023:8550905. [PMID: 37284487 PMCID: PMC10241579 DOI: 10.1155/2023/8550905] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/07/2023] [Accepted: 02/19/2023] [Indexed: 06/08/2023]
Abstract
Among the technology-based solutions, clinical decision support systems (CDSSs) have the ability to keep up with clinicians with the latest evidence in a smart way. Hence, the main objective of our study was to investigate the applicability and characteristics of CDSSs regarding chronic disease. The Web of Science, Scopus, OVID, and PubMed databases were searched using keywords from January 2000 to February 2023. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, an analysis was done to determine the characteristics and applicability of CDSSs. The quality of the appraisal was assessed using the Mixed Methods Appraisal Tool checklist (MMAT). A systematic database search yielded 206 citations. Eventually, 38 articles from sixteen countries met the inclusion criteria and were accepted for final analysis. The main approaches of all studies can be classified into adherence to evidence-based medicine (84.2%), early and accurate diagnosis (81.6%), identifying high-risk patients (50%), preventing medical errors (47.4%), providing up-to-date information to healthcare providers (36.8%), providing patient care remotely (21.1%), and standardizing care (71.1%). The most common features among the knowledge-based CDSSs included providing guidance and advice for physicians (92.11%), generating patient-specific recommendations (84.21%), integrating into electronic medical records (60.53%), and using alerts or reminders (60.53%). Among thirteen different methods to translate the knowledge of evidence into machine-interpretable knowledge, 34.21% of studies utilized the rule-based logic technique while 26.32% of studies used rule-based decision tree modeling. For CDSS development and translating knowledge, diverse methods and techniques were applied. Therefore, the development of a standard framework for the development of knowledge-based decision support systems should be considered by informaticians.
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Affiliation(s)
- Marsa Gholamzadeh
- Medical Informatics, Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical Care Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Health Information Management and Medical Informatics Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Abtahi H, Amini S, Gholamzadeh M, Gharabaghi MA. Development and evaluation of a mobile-based asthma clinical decision support system to enhance evidence-based patient management in primary care. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
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Blumenthal KG, Rider NL. Topics in Quality Improvement and Patient Safety. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:3145-3148. [PMID: 36496210 DOI: 10.1016/j.jaip.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Kimberly G Blumenthal
- Division of Rheumatology Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
| | - Nicholas L Rider
- Division of Clinical Informatics, Pediatrics, Allergy and Immunology, Liberty University College of Osteopathic Medicine and the Liberty Mountain Medical Group, Lynchburg, Va
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Ramisetty K, Christopher J, Panda S, Lazarus BS, Dayalan J. An Explainable Knowledge-Based System Using Subjective Preferences and Objective Data for Ranking Decision Alternatives. Methods Inf Med 2022; 61:111-122. [PMID: 36220110 DOI: 10.1055/s-0042-1756650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Allergy is a hypersensitive reaction that occurs when the allergen reacts with the immune system. The prevalence and severity of the allergies are uprising in South Asian countries. Allergy often occurs in combinations which becomes difficult for physicians to diagnose. OBJECTIVES This work aims to develop a decision-making model which aids physicians in diagnosing allergy comorbidities. The model intends to not only provide rational decisions, but also explainable knowledge about all alternatives. METHODS The allergy data gathered from real-time sources contain a smaller number of samples for comorbidities. Decision-making model applies three sampling strategies, namely, ideal, single, and complete, to balance the data. Bayes theorem-based probabilistic approaches are used to extract knowledge from the balanced data. Preference weights for attributes with respect to alternatives are gathered from a group of domain-experts affiliated to different allergy testing centers. The weights are combined with objective knowledge to assign confidence values to alternatives. The system provides these values along with explanations to aid decision-makers in choosing an optimal decision. RESULTS Metrics of explainability and user satisfaction are used to evaluate the effectiveness of the system in real-time diagnosis. Fleiss' Kappa statistic is 0.48, and hence the diagnosis of experts is said to be in moderate agreement. The decision-making model provides a maximum of 10 suitable and relevant pieces of evidence to explain a decision alternative. Clinicians have improved their diagnostic performance by 3% after using CDSS (77.93%) with a decrease in 20% of time taken. CONCLUSION The performance of less-experienced clinicians has improved with the support of an explainable decision-making model. The code for the framework with all intermediate results is available at https://github.com/kavya6697/Allergy-PT.git.
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Affiliation(s)
- Kavya Ramisetty
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science, Pilani-Hyderabad Campus, Telangana, India
| | - Jabez Christopher
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science, Pilani-Hyderabad Campus, Telangana, India
| | - Subhrakanta Panda
- Department of Computer Science and Information Systems, Birla Institute of Technology and Science, Pilani-Hyderabad Campus, Telangana, India
| | | | - Julie Dayalan
- Good Samaritan Kilpauk Lab and Allergy Testing Centre, Chennai, Tamil Nadu, India
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AI Models for Predicting Readmission of Pneumonia Patients within 30 Days after Discharge. ELECTRONICS 2022. [DOI: 10.3390/electronics11050673] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A model with capability for precisely predicting readmission is a target being pursued worldwide. The objective of this study is to design predictive models using artificial intelligence methods and data retrieved from the National Health Insurance Research Database of Taiwan for identifying high-risk pneumonia patients with 30-day all-cause readmissions. An integrated genetic algorithm (GA) and support vector machine (SVM), namely IGS, were used to design predictive models optimized with three objective functions. In IGS, GA was used for selecting salient features and optimal SVM parameters, while SVM was used for constructing the models. For comparison, logistic regression (LR) and deep neural network (DNN) were also applied for model construction. The IGS model with AUC used as the objective function achieved an accuracy, sensitivity, specificity, and area under ROC curve (AUC) of 70.11%, 73.46%, 69.26%, and 0.7758, respectively, outperforming the models designed with LR (65.77%, 78.44%, 62.54%, and 0.7689, respectively) and DNN (61.50%, 79.34%, 56.95%, and 0.7547, respectively), as well as previously reported models constructed using thedata of electronic health records with an AUC of 0.71–0.74. It can be used for automatically detecting pneumonia patients with a risk of all-cause readmissions within 30 days after discharge so as to administer suitable interventions to reduce readmission and healthcare costs.
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Parent report of physician diagnosis in pediatric food allergy: An update. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:542-546.e2. [PMID: 33010522 DOI: 10.1016/j.jaip.2020.09.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/11/2020] [Accepted: 09/16/2020] [Indexed: 11/20/2022]
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Dramburg S, Marchante Fernández M, Potapova E, Matricardi PM. The Potential of Clinical Decision Support Systems for Prevention, Diagnosis, and Monitoring of Allergic Diseases. Front Immunol 2020; 11:2116. [PMID: 33013892 PMCID: PMC7511544 DOI: 10.3389/fimmu.2020.02116] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/05/2020] [Indexed: 12/11/2022] Open
Abstract
Clinical decision support systems (CDSS) aid health care professionals (HCP) in evaluating large sets of information and taking informed decisions during their clinical routine. CDSS are becoming particularly important in the perspective of precision medicine, when HCP need to consider growing amounts of data to create precise patient profiles for personalized diagnosis, treatment and outcome monitoring. In allergy care, several CDSS are being developed and investigated, mainly for respiratory allergic diseases. Although the proposed solutions address different stakeholders, the majority aims at facilitating evidence-based and shared decision-making, incorporating guidelines, and real-time clinical data. We offer here an overview on existing tools, new developments and novel concepts and discuss the potential of digital CDSS in improving prevention, diagnosis and monitoring of allergic diseases.
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Affiliation(s)
- Stephanie Dramburg
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - María Marchante Fernández
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ekaterina Potapova
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paolo Maria Matricardi
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Huang Z, Liang Y. Research of data mining and web technology in university discipline construction decision support system based on MVC model. LIBRARY HI TECH 2019. [DOI: 10.1108/lht-09-2018-0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeTaking the discipline construction in colleges and universities as the application background, based on the research on data mining technology and decision support system technology, the data generated by university management information system are effectively utilized. The paper aims to discuss these issues.Design/methodology/approachBased on the Beijing Key Discipline Information Platform as the data source, the decision tree algorithm of data mining is studied. On the basis of decision tree C4.5, the Bayesian theory is applied to the post-pruning operation of the decision tree.FindingsA decision tree post-pruning algorithm based on the Bayesian theory is studied and put forward in order to simplify the decision tree, which improves the generalization ability of the whole algorithm. Finally, the algorithm is used to build the prediction model of key disciplines. Combined with the decision support system architecture, data warehouse and the data mining algorithm constructed by university discipline, based on J2EE standard enterprise system specification, MVC model is applied. Moreover, a prototype system of decision support system for discipline construction in colleges and universities with browser/server (B/S) structure is completed and implemented.Originality/valueA decision tree post-pruning algorithm based on the Bayesian theory is studied and put forward in order to simplify the decision tree, which improves the generalization ability of the whole algorithm. Finally, the algorithm is used to build the prediction model of key disciplines. Combined with the decision support system architecture, data warehouse and the data mining algorithm constructed by university discipline, based on J2EE standard enterprise system specification, MVC model is applied. Moreover, a prototype system of decision support system for discipline construction in colleges and universities with B/S structure is completed and implemented.
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Clark S, Boggs KM, Balekian DS, Hasegawa K, Vo P, Rowe BH, Camargo CA. Changes in Emergency Department Concordance with Guidelines for the Management of Food-Induced Anaphylaxis: 1999-2001 versus 2013-2015. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2262-2269. [PMID: 30974210 DOI: 10.1016/j.jaip.2019.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Awareness about food allergy and food-induced anaphylaxis (FIA) has increased dramatically over the past decade. It remains unclear, however, whether concordance with guidelines for FIA management has improved over time. OBJECTIVE Our objective was to describe changes in emergency department (ED) concordance with guidelines for FIA management. METHODS We analyzed data from 2 multicenter retrospective studies of patients with food-related acute allergic reactions seen in 1 of 17 EDs during 2 time periods: 1999 to 2001 and 2013 to 2015. Visits were identified similarly across years-for example, using International Classification of Diseases, Ninth Revision, Clinical Modification codes 693.1, 995.60, 995.61-995.69, 995.0, and 995.3. Anaphylaxis was defined as an acute allergic reaction with involvement of 2+ organ systems or hypotension. We compared concordance between time periods for 4 guideline recommendations: (1) treatment with epinephrine, (2) discharge prescription for an epinephrine autoinjector (EAI), (3) referral to an allergist/immunologist, and (4) instructions to avoid offending allergen. RESULTS We compared 290 patients with FIA during 1999 to 2001 and 459 during 2013 to 2015. Any treatment with epinephrine (pre-ED or in the ED) for patients with FIA increased over time (38% vs 56%; P < .001). Prescriptions for EAI at discharge (24% vs 54%; P < .001) and documentation for referral to an allergist/immunologist (14% vs 24%; P = .001) approximately doubled, whereas instructions to avoid the offending allergen did not change significantly (37% vs 43%; P = .08). Receipt of 3+ guideline recommendations remained low but almost quadrupled over the study interval (6% vs 23%; P < .001). CONCLUSIONS Over the nearly 15-year study interval, we observed clinically and statistically significant increases in ED concordance with epinephrine-related guidelines for FIA. Management gaps remain and interventions to standardize care still appear warranted.
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Affiliation(s)
- Sunday Clark
- Department of Emergency Medicine, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, NY.
| | - Krislyn M Boggs
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | - Diana S Balekian
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass; Department of Pediatrics, Asthma and Allergy Affiliates, Salem, Mass
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
| | | | - Brian H Rowe
- Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Mass
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Clark S, Boggs KM, Balekian DS, Hasegawa K, Vo P, Rowe BH, Camargo CA. Changes in emergency department concordance with guidelines for the management of stinging insect-induced anaphylaxis: 1999-2001 vs 2013-2015. Ann Allergy Asthma Immunol 2018; 120:419-423. [PMID: 29407420 DOI: 10.1016/j.anai.2018.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Changes in emergency department (ED) concordance with guidelines for the management of stinging insect-induced anaphylaxis (SIIA) are not known. OBJECTIVE To describe temporal changes in ED concordance with guidelines for the management of SIIAs. METHODS We analyzed data from 2 multicenter retrospective studies of patients with stinging insect-related acute allergic reactions seen in 1 of 14 North American EDs during 2 periods: 1999 through 2001 and 2013 through 2015. Visits were identified similarly across studies (eg, using International Classification of Diseases, Ninth Revision, Clinical Modification codes 989.5, 995.0, and 995.3). Anaphylaxis was defined as an acute allergic reaction with involvement of at least 2 organ systems or hypotension. We compared concordance between periods with 4 guideline recommendations: (1) treatment with epinephrine, (2) discharge prescription for epinephrine auto-injector, (3) referral to an allergist/immunologist, and (4) instructions to avoid the offending allergen. RESULTS We compared 182 patients with SIIA during 1999 to 2001 with 204 during 2013 to 2015. Any treatment with epinephrine (before arrival to the ED or in the ED) increased over time (30% vs 49%; P < .001). Prescriptions for epinephrine auto-injector at discharge increased significantly (34% vs 57%; P < .001), whereas documentation of referral to an allergist/immunologist decreased (28% vs 12%; P = .002), and instructions to avoid the offending allergen did not change (23% vs 24%; P = .94). Receipt of at least 3 guideline recommendations increased over time; however, the comparison was not statistically significant (10% vs 16%; P = .15). CONCLUSION During the nearly 15-year study interval, we observed increased ED concordance with epinephrine-related guideline recommendations for the management of SIIA. Reasons for the decrease in allergy/immunology referrals merit further study.
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Affiliation(s)
- Sunday Clark
- NewYork-Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
| | | | - Diana S Balekian
- Massachusetts General Hospital, Boston, Massachusetts; Asthma and Allergy Affiliates, Salem, Massachusetts
| | | | - Phuong Vo
- Boston Medical Center, Boston, Massachusetts
| | - Brian H Rowe
- Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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Pereira AM, Jácome C, Almeida R, Fonseca JA. How the Smartphone Is Changing Allergy Diagnostics. Curr Allergy Asthma Rep 2018; 18:69. [PMID: 30361774 DOI: 10.1007/s11882-018-0824-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Evidence-based clinical diagnosis of allergic disorders is increasingly challenging. Clinical decision support systems implemented in mobile applications (apps) are being developed to assist clinicians in diagnostic decisions at the point of care. We reviewed apps for allergic diseases general diagnosis, diagnostic refinement and diagnostic personalisation. Apps designed for specific medical devices are not addressed. RECENT FINDINGS Apps with potential usefulness in the initial diagnosis and diagnostic refinement of respiratory, food, skin and drug allergies are described. Apps to support diagnostic personalisation are not yet available. There is an urgent need to increase the scientific evidence on the real usefulness of these apps, as well as to develop new scientifically grounded apps designed and validated to support all allergic diseases and diagnostic levels. Apps have the potential to change the diagnosis of allergic diseases becoming part of the routine diagnostics toolset, but its usefulness needs to be established.
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Affiliation(s)
- Ana Margarida Pereira
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal.,CINTESIS- Center for Health Technologies and Information Systems Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Cristina Jácome
- CINTESIS- Center for Health Technologies and Information Systems Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rute Almeida
- CINTESIS- Center for Health Technologies and Information Systems Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - João Almeida Fonseca
- Allergy Unit, Instituto and Hospital CUF, Porto, Portugal. .,CINTESIS- Center for Health Technologies and Information Systems Research, Faculty of Medicine, University of Porto, Porto, Portugal. .,MEDCIDS - Department of Community Medicine, Health Information and Decision, Faculty of Medicine, University of Porto, Porto, Portugal. .,MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal.
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Design of a Clinical Decision Support System for Fracture Prediction Using Imbalanced Dataset. JOURNAL OF HEALTHCARE ENGINEERING 2018; 2018:9621640. [PMID: 29765586 PMCID: PMC5885339 DOI: 10.1155/2018/9621640] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/11/2018] [Accepted: 01/23/2018] [Indexed: 11/18/2022]
Abstract
More than 1 billion people suffer from chronic respiratory diseases worldwide, accounting for more than 4 million deaths annually. Inhaled corticosteroid is a popular medication for treating chronic respiratory diseases. Its side effects include decreased bone mineral density and osteoporosis. The aims of this study are to investigate the association of inhaled corticosteroids and fracture and to design a clinical support system for fracture prediction. The data of patients aged 20 years and older, who had visited healthcare centers and been prescribed with inhaled corticosteroids within 2002-2010, were retrieved from the National Health Insurance Research Database (NHIRD). After excluding patients diagnosed with hip fracture or vertebrate fractures before using inhaled corticosteroid, a total of 11645 patients receiving inhaled corticosteroid therapy were included for this study. Among them, 1134 (9.7%) were diagnosed with hip fracture or vertebrate fracture. The statistical results showed that demographic information, chronic respiratory diseases and comorbidities, and corticosteroid-related variables (cumulative dose, mean exposed daily dose, follow-up duration, and exposed duration) were significantly different between fracture and nonfracture patients. The clinical decision support systems (CDSSs) were designed with integrated genetic algorithm (GA) and support vector machine (SVM) by training and validating the models with balanced training sets obtained by random and cluster-based undersampling methods and testing with the imbalanced NHIRD dataset. Two different objective functions were adopted for obtaining optimal models with best predictive performance. The predictive performance of the CDSSs exhibits a sensitivity of 69.84-77.00% and an AUC of 0.7495-0.7590. It was concluded that long-term use of inhaled corticosteroids may induce osteoporosis and exhibit higher incidence of hip or vertebrate fractures. The accumulated dose of ICS and OCS therapies should be continuously monitored, especially for patients with older age and women after menopause, to prevent from exceeding the maximum dosage.
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Flokstra-de Blok BM, van der Molen T, Christoffers WA, Kocks JW, Oei RL, Oude Elberink JN, Roerdink EM, Schuttelaar ML, van der Velde JL, Brakel TM, Dubois AE. Development of an allergy management support system in primary care. J Asthma Allergy 2017; 10:57-65. [PMID: 28352197 PMCID: PMC5359130 DOI: 10.2147/jaa.s123260] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Management of allergic patients in the population is becoming more difficult because of increases in both complexity and prevalence. Although general practitioners (GPs) are expected to play an important role in the care of allergic patients, they often feel ill-equipped for this task. Therefore, the aim of this study was to develop an allergy management support system (AMSS) for primary care. Methods Through literature review, interviewing and testing in secondary and primary care patients, an allergy history questionnaire was constructed by allergists, dermatologists, GPs and researchers based on primary care and specialists’ allergy guidelines and their clinical knowledge. Patterns of AMSS questionnaire responses and specific immunoglobulin E (sIgE)-test outcomes were used to identify diagnostic categories and develop corresponding management recommendations. Validity of the AMSS was investigated by comparing specialist (gold standard) and AMSS diagnostic categories. Results The two-page patient-completed AMSS questionnaire consists of 12 (mainly) multiple choice questions on symptoms, triggers, severity and medication. Based on the AMSS questionnaires and sIgE-test outcome of 118 patients, approximately 150 diagnostic categories of allergic rhinitis, asthma, atopic dermatitis, anaphylaxis, food allergy, hymenoptera allergy and other allergies were identified, and the corresponding management recommendations were formulated. The agreement between the allergy specialists’ assessments and the AMSS was 69.2% (CI 67.2–71.2). Conclusion Using a systematic approach, it was possible to develop an AMSS that allows for the formulation of diagnostic and management recommendations for GPs managing allergic patients. The AMSS thus holds promise for the improvement of the quality of primary care for this increasing group of patients.
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Affiliation(s)
| | | | | | | | | | | | - Emmy M Roerdink
- Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen
| | | | | | - Thecla M Brakel
- Department of General Practice; Teaching Unit, Department of Social Psychology, University of Groningen, Groningen, The Netherlands
| | - Anthony Ej Dubois
- GRIAC Research Institute; Department of Pediatric Pulmonology and Pediatric Allergy, University of Groningen, University Medical Center Groningen
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