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Chase JG, Preiser JC, Dickson JL, Pironet A, Chiew YS, Pretty CG, Shaw GM, Benyo B, Moeller K, Safaei S, Tawhai M, Hunter P, Desaive T. Next-generation, personalised, model-based critical care medicine: a state-of-the art review of in silico virtual patient models, methods, and cohorts, and how to validation them. Biomed Eng Online 2018; 17:24. [PMID: 29463246 PMCID: PMC5819676 DOI: 10.1186/s12938-018-0455-y] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/12/2018] [Indexed: 01/17/2023] Open
Abstract
Critical care, like many healthcare areas, is under a dual assault from significantly increasing demographic and economic pressures. Intensive care unit (ICU) patients are highly variable in response to treatment, and increasingly aging populations mean ICUs are under increasing demand and their cohorts are increasingly ill. Equally, patient expectations are growing, while the economic ability to deliver care to all is declining. Better, more productive care is thus the big challenge. One means to that end is personalised care designed to manage the significant inter- and intra-patient variability that makes the ICU patient difficult. Thus, moving from current "one size fits all" protocolised care to adaptive, model-based "one method fits all" personalised care could deliver the required step change in the quality, and simultaneously the productivity and cost, of care. Computer models of human physiology are a unique tool to personalise care, as they can couple clinical data with mathematical methods to create subject-specific models and virtual patients to design new, personalised and more optimal protocols, as well as to guide care in real-time. They rely on identifying time varying patient-specific parameters in the model that capture inter- and intra-patient variability, the difference between patients and the evolution of patient condition. Properly validated, virtual patients represent the real patients, and can be used in silico to test different protocols or interventions, or in real-time to guide care. Hence, the underlying models and methods create the foundation for next generation care, as well as a tool for safely and rapidly developing personalised treatment protocols over large virtual cohorts using virtual trials. This review examines the models and methods used to create virtual patients. Specifically, it presents the models types and structures used and the data required. It then covers how to validate the resulting virtual patients and trials, and how these virtual trials can help design and optimise clinical trial. Links between these models and higher order, more complex physiome models are also discussed. In each section, it explores the progress reported up to date, especially on core ICU therapies in glycemic, circulatory and mechanical ventilation management, where high cost and frequency of occurrence provide a significant opportunity for model-based methods to have measurable clinical and economic impact. The outcomes are readily generalised to other areas of medical care.
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Affiliation(s)
- J. Geoffrey Chase
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
| | - Jean-Charles Preiser
- Department of Intensive Care, Erasme University of Hospital, 1070 Brussels, Belgium
| | - Jennifer L. Dickson
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
| | - Antoine Pironet
- GIGA In Silico Medicine, University of Liege, 4000 Liege, Belgium
| | - Yeong Shiong Chiew
- Department of Mechanical Engineering, School of Engineering, Monash University Malaysia, 47500 Selangor, Malaysia
| | - Christopher G. Pretty
- Department of Mechanical Engineering, Centre for Bio-Engineering, University of Canterbury, Private Bag 4800, Christchurch, New Zealand
| | - Geoffrey M. Shaw
- Department of Intensive Care, Christchurch Hospital, Christchurch, New Zealand
| | - Balazs Benyo
- Department of Control Engineering and Information Technology, Budapest University of Technology and Economics, Budapest, Hungary
| | - Knut Moeller
- Department of Biomedical Engineering, Institute of Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany
| | - Soroush Safaei
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Merryn Tawhai
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Peter Hunter
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Thomas Desaive
- GIGA In Silico Medicine, University of Liege, 4000 Liege, Belgium
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Taussky P, Hanel RA, Meyer FB. Clinical considerations in the management of asymptomatic carotid artery stenosis. Neurosurg Focus 2012; 31:E7. [PMID: 22133180 DOI: 10.3171/2011.9.focus11222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Incidental findings pose considerable management dilemmas for the treating physician and psychological burden for the respective patient. With an aging population, more patients will be diagnosed with asymptomatic internal carotid artery stenosis. Patients will have to be counseled with regard to treatment options according to their individual risk profile and according to professionals' knowledge of evidence-based data derived from large randomized control trials. Treatment consensus has long been lacking for patients with asymptomatic carotid artery stenosis prior to any randomized controlled trials. Additionally, an individual's risk profile may be hard to assess according to knowledge gained from randomized controlled trials. Moreover, while earlier studies compared carotid endarterectomy and medical therapy, in the past years, a new therapeutic modality, carotid artery angioplasty and stenting, has emerged as a possible alternative. This has been evaluated in a recent randomized controlled trial, the Carotid Revascularization Endarterectomy versus Stenting Trial (CREST), which compared carotid endarterectomy with angioplasty and stenting in both symptomatic and asymptomatic patients. The following review summarizes current knowledge of the natural history, diagnosis, and treatment strategies to counsel patients with asymptomatic carotid artery stenosis.
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Affiliation(s)
- Philipp Taussky
- Department of Neurosurgery, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA
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Woo K, Garg J, Hye RJ, Dilley RB. Contemporary Results of Carotid Endarterectomy for Asymptomatic Carotid Stenosis. Stroke 2010; 41:975-9. [DOI: 10.1161/strokeaha.110.578856] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karen Woo
- From the Division of Vascular Surgery (K.W.), University of Southern California, Los Angeles, Calif; the Division of Vascular Surgery (J.G., R.B.D.), Scripps Green Hospital, La Jolla, Calif; and the Southern California Permanente Medical Group (R.J.H.), San Diego, Calif
| | - Joy Garg
- From the Division of Vascular Surgery (K.W.), University of Southern California, Los Angeles, Calif; the Division of Vascular Surgery (J.G., R.B.D.), Scripps Green Hospital, La Jolla, Calif; and the Southern California Permanente Medical Group (R.J.H.), San Diego, Calif
| | - Robert J. Hye
- From the Division of Vascular Surgery (K.W.), University of Southern California, Los Angeles, Calif; the Division of Vascular Surgery (J.G., R.B.D.), Scripps Green Hospital, La Jolla, Calif; and the Southern California Permanente Medical Group (R.J.H.), San Diego, Calif
| | - Ralph B. Dilley
- From the Division of Vascular Surgery (K.W.), University of Southern California, Los Angeles, Calif; the Division of Vascular Surgery (J.G., R.B.D.), Scripps Green Hospital, La Jolla, Calif; and the Southern California Permanente Medical Group (R.J.H.), San Diego, Calif
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Peeters W, Hellings W, de Kleijn D, de Vries J, Moll F, Vink A, Pasterkamp G. Carotid Atherosclerotic Plaques Stabilize After Stroke. Arterioscler Thromb Vasc Biol 2009; 29:128-33. [DOI: 10.1161/atvbaha.108.173658] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- W. Peeters
- From the Experimental Cardiology Laboratory (W.P., W.E.H., D.P.V.d.K., G.P.), the Department of Vascular Surgery (W.E.H., F.L.M.), and the Department of Pathology (A.V.), University Medical Centre Utrecht; Interuniversity Cardiology Institute of the Netherlands (W.P., D.P.V.d.K.); and the Department of Vascular Surgery (J.P.P.M.d.V.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - W.E. Hellings
- From the Experimental Cardiology Laboratory (W.P., W.E.H., D.P.V.d.K., G.P.), the Department of Vascular Surgery (W.E.H., F.L.M.), and the Department of Pathology (A.V.), University Medical Centre Utrecht; Interuniversity Cardiology Institute of the Netherlands (W.P., D.P.V.d.K.); and the Department of Vascular Surgery (J.P.P.M.d.V.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - D.P.V. de Kleijn
- From the Experimental Cardiology Laboratory (W.P., W.E.H., D.P.V.d.K., G.P.), the Department of Vascular Surgery (W.E.H., F.L.M.), and the Department of Pathology (A.V.), University Medical Centre Utrecht; Interuniversity Cardiology Institute of the Netherlands (W.P., D.P.V.d.K.); and the Department of Vascular Surgery (J.P.P.M.d.V.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J.P.P.M. de Vries
- From the Experimental Cardiology Laboratory (W.P., W.E.H., D.P.V.d.K., G.P.), the Department of Vascular Surgery (W.E.H., F.L.M.), and the Department of Pathology (A.V.), University Medical Centre Utrecht; Interuniversity Cardiology Institute of the Netherlands (W.P., D.P.V.d.K.); and the Department of Vascular Surgery (J.P.P.M.d.V.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - F.L. Moll
- From the Experimental Cardiology Laboratory (W.P., W.E.H., D.P.V.d.K., G.P.), the Department of Vascular Surgery (W.E.H., F.L.M.), and the Department of Pathology (A.V.), University Medical Centre Utrecht; Interuniversity Cardiology Institute of the Netherlands (W.P., D.P.V.d.K.); and the Department of Vascular Surgery (J.P.P.M.d.V.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A. Vink
- From the Experimental Cardiology Laboratory (W.P., W.E.H., D.P.V.d.K., G.P.), the Department of Vascular Surgery (W.E.H., F.L.M.), and the Department of Pathology (A.V.), University Medical Centre Utrecht; Interuniversity Cardiology Institute of the Netherlands (W.P., D.P.V.d.K.); and the Department of Vascular Surgery (J.P.P.M.d.V.), St. Antonius Hospital, Nieuwegein, The Netherlands
| | - G. Pasterkamp
- From the Experimental Cardiology Laboratory (W.P., W.E.H., D.P.V.d.K., G.P.), the Department of Vascular Surgery (W.E.H., F.L.M.), and the Department of Pathology (A.V.), University Medical Centre Utrecht; Interuniversity Cardiology Institute of the Netherlands (W.P., D.P.V.d.K.); and the Department of Vascular Surgery (J.P.P.M.d.V.), St. Antonius Hospital, Nieuwegein, The Netherlands
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