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Verboven L, Callens S, Black J, Maartens G, Dooley KE, Potgieter S, Cartuyvels R, Laukens K, Warren RM, Van Rie A. A machine-learning based model for automated recommendation of individualized treatment of rifampicin-resistant tuberculosis. PLoS One 2024; 19:e0306101. [PMID: 39241084 DOI: 10.1371/journal.pone.0306101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 06/11/2024] [Indexed: 09/08/2024] Open
Abstract
BACKGROUND Rifampicin resistant tuberculosis remains a global health problem with almost half a million new cases annually. In high-income countries patients empirically start a standardized treatment regimen, followed by an individualized regimen guided by drug susceptibility test (DST) results. In most settings, DST information is not available or is limited to isoniazid and fluoroquinolones. Whole genome sequencing could more accurately guide individualized treatment as the full drug resistance profile is obtained with a single test. Whole genome sequencing has not reached its full potential for patient care, in part due to the complexity of translating a resistance profile into the most effective individualized regimen. METHODS We developed a treatment recommender clinical decision support system (CDSS) and an accompanying web application for user-friendly recommendation of the optimal individualized treatment regimen to a clinician. RESULTS Following expert stakeholder meetings and literature review, nine drug features and 14 treatment regimen features were identified and quantified. Using machine learning, a model was developed to predict the optimal treatment regimen based on a training set of 3895 treatment regimen-expert feedback pairs. The acceptability of the treatment recommender CDSS was assessed as part of a clinical trial and in a routine care setting. Within the clinical trial setting, all patients received the CDSS recommended treatment. In 8 of 20 cases, the initial recommendation was recomputed because of stock out, clinical contra-indication or toxicity. In routine care setting, physicians rejected the treatment recommendation in 7 out of 15 cases because it deviated from the national TB treatment guidelines. A survey indicated that the treatment recommender CDSS is easy to use and useful in clinical practice but requires digital infrastructure support and training. CONCLUSIONS Our findings suggest that global implementation of the novel treatment recommender CDSS holds the potential to improve treatment outcomes of patients with RR-TB, especially those with 'difficult-to-treat' forms of RR-TB.
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Affiliation(s)
- Lennert Verboven
- Torch Consortium FAMPOP Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
- Department of Computer Science, ADReM Data Lab, University of Antwerp, Antwerpen, Belgium
| | - Steven Callens
- Department of Internal Medicine & Infectious diseases, Ghent University Hospital, Ghent, Belgium
| | - John Black
- Department of Internal Medicine, University of Cape Town and Livingstone Hospital, Port Elizabeth, South Africa
| | - Gary Maartens
- Department of Medicine, Division of Clinical Pharmacology, University of Cape Town, Cape Town, South Africa
| | - Kelly E Dooley
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Samantha Potgieter
- Department of Internal Medicine, Division of Infectious Diseases, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | | | - Kris Laukens
- Department of Computer Science, ADReM Data Lab, University of Antwerp, Antwerpen, Belgium
| | - Robin M Warren
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, SAMRC Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Annelies Van Rie
- Torch Consortium FAMPOP Faculty of Medicine and Health Sciences, University of Antwerp, Antwerpen, Belgium
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Ouanes K, Farhah N. Effectiveness of Artificial Intelligence (AI) in Clinical Decision Support Systems and Care Delivery. J Med Syst 2024; 48:74. [PMID: 39133332 DOI: 10.1007/s10916-024-02098-4] [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: 05/04/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024]
Abstract
This review aims to assess the effectiveness of AI-driven CDSSs on patient outcomes and clinical practices. A comprehensive search was conducted across PubMed, MEDLINE, and Scopus. Studies published from January 2018 to November 2023 were eligible for inclusion. Following title and abstract screening, full-text articles were assessed for methodological quality and adherence to inclusion criteria. Data extraction focused on study design, AI technologies employed, reported outcomes, and evidence of AI-CDSS impact on patient and clinical outcomes. Thematic analysis was conducted to synthesise findings and identify key themes regarding the effectiveness of AI-CDSS. The screening of the articles resulted in the selection of 26 articles that satisfied the inclusion criteria. The content analysis revealed four themes: early detection and disease diagnosis, enhanced decision-making, medication errors, and clinicians' perspectives. AI-based CDSSs were found to improve clinical decision-making by providing patient-specific information and evidence-based recommendations. Using AI in CDSSs can potentially improve patient outcomes by enhancing diagnostic accuracy, optimising treatment selection, and reducing medical errors.
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Affiliation(s)
- Khaled Ouanes
- Department of Health Informatics, College of Health Sciences, Saudi Electronic University, Dammam, Saudi Arabia.
| | - Nesren Farhah
- Department of Health Informatics, College of Health Sciences, Saudi Electronic University, 11673, Riyadh, Saudi Arabia
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Shaikh F, Wynne R, Castelino RL, Davidson PM, Inglis SC, Ferguson C. Effect of Obesity on the Use of Antiarrhythmics in Adults With Atrial Fibrillation: A Narrative Review. Clin Cardiol 2024; 47:e24336. [PMID: 39169682 PMCID: PMC11339320 DOI: 10.1002/clc.24336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/23/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) and obesity coexist in approximately 37.6 million and 650 million people globally, respectively. The anatomical and physiological changes in individuals with obesity may influence the pharmacokinetic properties of drugs. AIM This review aimed to describe the evidence of the effect of obesity on the pharmacokinetics of antiarrhythmics in people with AF. METHODS Three databases were searched from inception to June 2023. Original studies that addressed the use of antiarrhythmics in adults with AF and concomitant obesity were included. RESULTS A total of 4549 de-duplicated articles were screened, and 114 articles underwent full-text review. Ten studies were included in this narrative synthesis: seven cohort studies, two pharmacokinetic studies, and a single case report. Samples ranged from 1 to 371 participants, predominately males (41%-85%), aged 59-75 years, with a body mass index (BMI) of 23-66 kg/m2. The two most frequently investigated antiarrhythmics were amiodarone and dofetilide. Other drugs investigated included diltiazem, flecainide, disopyramide, propafenone, dronedarone, sotalol, vernakalant, and ibutilide. Findings indicate that obesity may affect the pharmacokinetics of amiodarone and sodium channel blockers (e.g., flecainide, disopyramide, and propafenone). Factors such as drug lipophilicity may also influence the pharmacokinetics of the drug and the need for dose modification. DISCUSSION Antiarrhythmics are not uniformly affected by obesity. This observation is based on heterogeneous studies of participants with an average BMI and poorly controlled confounding factors such as multimorbidity, concomitant medications, varying routes of administration, and assessment of obesity. Controlled trials with stratification at the time of recruitment for obesity are necessary to determine the significance of these findings.
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Affiliation(s)
- Fahad Shaikh
- Centre for Chronic & Complex Care ResearchBlacktown Hospital, Western Sydney Local Health DistrictBlacktownNew South WalesAustralia
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Rochelle Wynne
- School of Nursing & Midwifery, Centre for Quality & Patient Safety in the Institute for Health TransformationDeakin UniversityBurwoodVictoriaAustralia
- Deakin‐Western Health PartnershipWestern HealthSt AlbansVictoriaAustralia
| | - Ronald L. Castelino
- Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Pharmacy DepartmentBlacktown Hospital, Western Sydney Local Health DistrictBlacktownNew South WalesAustralia
| | - Patricia M. Davidson
- University of WollongongWollongongNew South WalesAustralia
- School of NursingJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Sally C. Inglis
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyNew South WalesAustralia
| | - Caleb Ferguson
- Centre for Chronic & Complex Care ResearchBlacktown Hospital, Western Sydney Local Health DistrictBlacktownNew South WalesAustralia
- School of Nursing, Faculty of Science, Medicine & HealthUniversity of WollongongWollongongNew South WalesAustralia
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López B, Raya O, Baykova E, Saez M, Rigau D, Cunill R, Mayoral S, Carrion C, Serrano D, Castells X. APPRAISE-RS: Automated, updated, participatory, and personalized treatment recommender systems based on GRADE methodology. Heliyon 2023; 9:e13074. [PMID: 36798764 PMCID: PMC9925880 DOI: 10.1016/j.heliyon.2023.e13074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/04/2023] [Accepted: 01/16/2023] [Indexed: 01/26/2023] Open
Abstract
Purpose Clinical practice guidelines (CPGs) have become fundamental tools for evidence-based medicine (EBM). However, CPG suffer from several limitations, including obsolescence, lack of applicability to many patients, and limited patient participation. This paper presents APPRAISE-RS, which is a methodology that we developed to overcome these limitations by automating, extending, and iterating the methodology that is most commonly used for building CPGs: the GRADE methodology. Method APPRAISE-RS relies on updated information from clinical studies and adapts and automates the GRADE methodology to generate treatment recommendations. APPRAISE-RS provides personalized recommendations because they are based on the patient's individual characteristics. Moreover, both patients and clinicians express their personal preferences for treatment outcomes which are considered when making the recommendation (participatory). Rule-based system approaches are used to manage heuristic knowledge. Results APPRAISE-RS has been implemented for attention deficit hyperactivity disorder (ADHD) and tested experimentally on 28 simulated patients. The resulting recommender system (APPRAISE-RS/TDApp) shows a higher degree of treatment personalization and patient participation than CPGs, while recommending the most frequent interventions in the largest body of evidence in the literature (EBM). Moreover, a comparison of the results with four blinded psychiatrist prescriptions supports the validation of the proposal. Conclusions APPRAISE-RS is a valid methodology to build recommender systems that manage updated, personalized and participatory recommendations, which, in the case of ADHD includes at least one intervention that is identical or very similar to other drugs prescribed by psychiatrists.
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Affiliation(s)
- Beatriz López
- Control Engineering and Intelligent Systems (eXiT), University of Girona, Spain,Corresponding author.
| | - Oscar Raya
- Control Engineering and Intelligent Systems (eXiT), University of Girona, Spain
| | | | - Marc Saez
- Research Group on Statistics, Econometrics and Health, University of Girona, Spain,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Ruth Cunill
- Sant Joan de Deu-Numancia Health Park, Barcelona, Spain
| | | | - Carme Carrion
- Health Lab Research Group, Universitat Oberta de Catalunya, Spain
| | | | - Xavier Castells
- TransLab Research Group, Dept. of Medical Sciences, University of Girona, Spain
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Tu PHT, Anlay DZ, Dippenaar A, Conceição EC, Loos J, Van Rie A. Bedaquiline resistance probability to guide treatment decision making for rifampicin-resistant tuberculosis: insights from a qualitative study. BMC Infect Dis 2022; 22:876. [PMID: 36418994 PMCID: PMC9682818 DOI: 10.1186/s12879-022-07865-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bedaquiline (BDQ) is a core drug for rifampicin-resistant tuberculosis (RR-TB) treatment. Accurate prediction of a BDQ-resistant phenotype from genomic data is not yet possible. A Bayesian method to predict BDQ resistance probability from next-generation sequencing data has been proposed as an alternative. METHODS We performed a qualitative study to investigate the decision-making of physicians when facing different levels of BDQ resistance probability. Fourteen semi-structured interviews were conducted with physicians experienced in treating RR-TB, sampled purposefully from eight countries with varying income levels and burden of RR-TB. Five simulated patient scenarios were used as a trigger for discussion. Factors influencing the decision of physicians to prescribe BDQ at macro-, meso- and micro levels were explored using thematic analysis. RESULTS The perception and interpretation of BDQ resistance probability values varied widely between physicians. The limited availability of other RR-TB drugs and the high cost of BDQ hindered physicians from altering the BDQ-containing regimen and incorporating BDQ resistance probability in their decision-making. The little experience with BDQ susceptibility testing and whole-genome sequencing results, and the discordance between phenotypic susceptibility and resistance probability were other barriers for physicians to interpret the resistance probability estimates. Especially for BDQ resistance probabilities between 25% and 70%, physicians interpreted the resistance probability value dynamically, and other factors such as clinical and bacteriological treatment response, history of exposure to BDQ, and resistance profile were often considered more important than the BDQ probability value for the decision to continue or stop BDQ. In this grey zone, some physicians opted to continue BDQ but added other drugs to strengthen the regimen. CONCLUSIONS This study highlights the complexity of physicians' decision-making regarding the use of BDQ in RR-TB regimens for different levels of BDQ resistance probability.. Ensuring sufficient access to BDQ and companion drugs, improving knowledge of the genotype-phenotype association for BDQ resistance, availability of a rapid molecular test, building next-generation sequencing capacity, and developing a clinical decision support system incorporating BDQ resistance probability will all be essential to facilitate the implementation of BDQ resistance probability in personalizing treatment for patients with RR-TB.
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Affiliation(s)
- Pham Hien Trang Tu
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium.
| | - Degefaye Zelalem Anlay
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium
- Department of Community Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Anzaan Dippenaar
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium
| | - Emilyn Costa Conceição
- Department of Science and Innovation, National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jasna Loos
- Dean's Office, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annelies Van Rie
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium
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