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Wang F, Li X, Wen R, Luo H, Liu D, Qi S, Jing Y, Wang P, Deng G, Huang C, Du T, Wang L, Liang H, Wang J, Liu C. Pneumonia-Plus: a deep learning model for the classification of bacterial, fungal, and viral pneumonia based on CT tomography. Eur Radiol 2023; 33:8869-8878. [PMID: 37389609 DOI: 10.1007/s00330-023-09833-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/17/2023] [Accepted: 03/30/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES This study aims to develop a deep learning algorithm, Pneumonia-Plus, based on computed tomography (CT) images for accurate classification of bacterial, fungal, and viral pneumonia. METHODS A total of 2763 participants with chest CT images and definite pathogen diagnosis were included to train and validate an algorithm. Pneumonia-Plus was prospectively tested on a nonoverlapping dataset of 173 patients. The algorithm's performance in classifying three types of pneumonia was compared to that of three radiologists using the McNemar test to verify its clinical usefulness. RESULTS Among the 173 patients, area under the curve (AUC) values for viral, fungal, and bacterial pneumonia were 0.816, 0.715, and 0.934, respectively. Viral pneumonia was accurately classified with sensitivity, specificity, and accuracy of 0.847, 0.919, and 0.873. Three radiologists also showed good consistency with Pneumonia-Plus. The AUC values of bacterial, fungal, and viral pneumonia were 0.480, 0.541, and 0.580 (radiologist 1: 3-year experience); 0.637, 0.693, and 0.730 (radiologist 2: 7-year experience); and 0.734, 0.757, and 0.847 (radiologist 3: 12-year experience), respectively. The McNemar test results for sensitivity showed that the diagnostic performance of the algorithm was significantly better than that of radiologist 1 and radiologist 2 (p < 0.05) in differentiating bacterial and viral pneumonia. Radiologist 3 had a higher diagnostic accuracy than the algorithm. CONCLUSIONS The Pneumonia-Plus algorithm is used to differentiate between bacterial, fungal, and viral pneumonia, which has reached the level of an attending radiologist and reduce the risk of misdiagnosis. The Pneumonia-Plus is important for appropriate treatment and avoiding the use of unnecessary antibiotics, and provide timely information to guide clinical decision-making and improve patient outcomes. CLINICAL RELEVANCE STATEMENT Pneumonia-Plus algorithm could assist in the accurate classification of pneumonia based on CT images, which has great clinical value in avoiding the use of unnecessary antibiotics, and providing timely information to guide clinical decision-making and improve patient outcomes. KEY POINTS • The Pneumonia-Plus algorithm trained from data collected from multiple centers can accurately identify bacterial, fungal, and viral pneumonia. • The Pneumonia-Plus algorithm was found to have better sensitivity in classifying viral and bacterial pneumonia in comparison to radiologist 1 (5-year experience) and radiologist 2 (7-year experience). • The Pneumonia-Plus algorithm is used to differentiate between bacterial, fungal, and viral pneumonia, which has reached the level of an attending radiologist.
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Affiliation(s)
- Fang Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gao Tan Yan St, Chongqing, 400038, China
| | - Xiaoming Li
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gao Tan Yan St, Chongqing, 400038, China
| | - Ru Wen
- Medical College, Guizhou University, Guiyang, Guizhou Province, 550000, China
| | - Hu Luo
- No 1. Intensive Care Unit, Huoshenshan Hospital, Wuhan, China
- Department of Respiratory and Critical Care Medicine, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Dong Liu
- Huiying Medical Technology Co., Ltd, Dongsheng Science and Technology Park, Haidian District, Beijing, China
| | - Shuai Qi
- Huiying Medical Technology Co., Ltd, Dongsheng Science and Technology Park, Haidian District, Beijing, China
| | - Yang Jing
- Huiying Medical Technology Co., Ltd, Dongsheng Science and Technology Park, Haidian District, Beijing, China
| | - Peng Wang
- Medical Big Data and Artificial Intelligence Center, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Gang Deng
- Department of Radiology, Maternal and Child Health Hospital of Hubei Province, Guanggu District, Wuhan, China
| | - Cong Huang
- Department of Radiology, The 926 Hospital of PLA, Kaiyuan, China
| | - Tingting Du
- Department of Radiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, China
| | - Limei Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gao Tan Yan St, Chongqing, 400038, China
| | - Hongqin Liang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gao Tan Yan St, Chongqing, 400038, China.
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gao Tan Yan St, Chongqing, 400038, China.
| | - Chen Liu
- Department of Radiology, Southwest Hospital, Third Military Medical University (Army Medical University), 30 Gao Tan Yan St, Chongqing, 400038, China.
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Tang Q, Yuan M, Wu W, Wu H, Wang C, Chen G, Li C, Lu J. Health Status and Individual Care Needs of Disabled Elderly at Home in Different Types of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811371. [PMID: 36141656 PMCID: PMC9517395 DOI: 10.3390/ijerph191811371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 05/13/2023]
Abstract
For the disabled, paying attention to their health status is the starting point to discovering their survival problems, while meeting their care needs is the end point to solving their survival problems. As the country with the largest number of disabled elderly in the world, how to ensure this group could obtain appropriate home care is a major public health issue facing China. Thus, we conducted a cross-sectional study from October to December 2020 to explore the basic characteristics and health status of disabled elderly in different types of care who are living at home in 37 streets in Shanghai, as well as the individual care needs and its relevance. We observed the significant differences in the number of diagnoses (p = 0.03), smoking (p = 0.009), drinking (p = 0.016), exercise (p = 0.001), activity of daily living (p < 0.0001), and the quality of life (p < 0.0001) across care types. The care needs of the disabled elderly are diversified, of which a vast majority of them have not been fully guaranteed. The urgent need for improving the identification accuracy of care needs of disabled elderly, as well as the development of elaborate and personalized care programs for them, is needed.
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Affiliation(s)
- Qi Tang
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Min Yuan
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Wenhui Wu
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Huanyun Wu
- Shanghai Jinshan District Health Service Management Center, Shanghai Jinshan District Municipal Health Commission, Shanghai 200540, China
| | - Cao Wang
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
| | - Chengyue Li
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
- Correspondence: (C.L.); (J.L.)
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai 200032, China
- China Research Center on Disability, Fudan University, Shanghai 200032, China
- Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai 200032, China
- Correspondence: (C.L.); (J.L.)
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Tang Q, Wan L, Lu J, Wu W, Wu H, Liu Z, Zhao S, Li C, Chen G, Lu J. Rational medication management mode and its implementation effect for the elderly with multimorbidity: A prospective cohort study in China. Front Public Health 2022; 10:992959. [PMID: 36148363 PMCID: PMC9486462 DOI: 10.3389/fpubh.2022.992959] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/15/2022] [Indexed: 01/26/2023] Open
Abstract
Background As one of the countries with the most serious degree of aging, the incidence of potentially inappropriate drug use among the elderly is as high as 30. 4% in Chinese communities, and the lack of effective medication management and poor medication compliance at home are the main factors. Given these situations, we constructed a Rational Medication Management Mode based on family physician service, carried out an empirical research and evaluated the implementation effect. Methods A prospective cohort study was conducted from September to December 2021 to analyze the implementation effect of the Rational Medication Management Mode by comparing the outcome indicators between the intervention group and control group. The primary outcome of this study was medication number and polypharmacy (taking 5 or more medications) at 90 days. The secondary outcomes included the situation for behavioral self-management and knowledge-belief-behavior of rational medication use. Results A total of 618 elderly patients (309 in the intervention group and 309 in the control group) with multimorbidity were included in this study, those were all available at follow-up at 90 days. At 90 days, the number of medications was achieved by 3.88 (1.48), and patients with polypharmacy were reduced by 59.55% in the intervention group, having a significant difference compared with the control group (P < 0.001). Patients with medication reminders, intermittent medication and adverse drug reactions were achieved in 294 (95.15%), 47 (15.21%), and 51 (16.51%) respectively in the intervention group (P < 0.001). The knowledge, belief, behavior security and behavior compliance of rational medication use of elderly patients were all greatly improved in the intervention group at 90 days (P < 0.0001). Conclusion The Rational Medication Management Mode based family physician service, which provides the support of manuals and pillboxes, can decrease the elderly patients' number of drugs with multimorbidity, reduce the incidence of polypharmacy, enhance behavioral self-management, increase the knowledge and belief of rational medication use, and improve the security and compliance of medication usage behavior. In order to provide a practical basis for rational medication management of elderly patients with multimorbidity under the background of long-term prescriptions in China.
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Affiliation(s)
- Qi Tang
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Litao Wan
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Jing Lu
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Wenhui Wu
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Huanyun Wu
- Shanghai Jinshan District Health Service Management Center, Shanghai Jinshan District Municipal Health Commission, Shanghai, China
| | - Zhenwei Liu
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Sitang Zhao
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Chengyue Li
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China
| | - Gang Chen
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China,Gang Chen
| | - Jun Lu
- School of Public Health, Fudan University, Shanghai, China,China Research Center on Disability, Fudan University, Shanghai, China,Key Laboratory of Health Technology Assessment, National Health Commission, Fudan University, Shanghai, China,*Correspondence: Jun Lu
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