Journal of Medical Systems最新文献

This study aimed to develop and validate a cost-effective, customizable patient-specific phantom for simulating external ventricular drain placement, combining image segmentation, 3-D printing and molding techniques. Two variations of the phantom were created based on patient MRI data, integrating a realistic skin layer with anatomical landmarks, a 3-D printed skull, an agarose polysaccharide gel brain, and a ventricular cavity. To validate the phantom, 15 neurosurgeons, residents, and physician assistants performed 30 EVD placements. The effectiveness of the phantom as a training tool was assessed through a standardized user experience questionnaire, which evaluated the physical attributes, realism, and overall satisfaction. The mechanical properties of the phantom brain were quantified by measuring catheter insertion forces using a linear force tester to compare them to those experienced in real brain tissue. The study participants successfully completed EVD placements with a 76.7% optimal placement rate, which aligns with rates observed in clinical practice. Feedback highlighted the anatomical accuracy of the phantom and its value in enhancing surgical skills, though it also identified areas for improvement, particularly in the realism of the skin layer. Mechanical testing demonstrated that the insertion forces required were comparable to those encountered in actual brain tissue. The developed phantom offers a realistic, low-cost, and adaptable model for EVD simulation. This tool is particularly beneficial for both training and research, with future enhancements planned to improve the realism of the skin and incorporate more anatomical features to increase the fidelity of the simulation.

Suicide constitutes a public health issue of major concern. Ongoing progress in the field of artificial intelligence, particularly in the domain of large language models, has played a significant role in the detection, risk assessment, and prevention of suicide. The purpose of this review was to explore the use of LLM tools in various aspects of suicide prevention. PubMed, Embase, Web of Science, Scopus, APA PsycNet, Cochrane Library, and IEEE Xplore-for studies published were systematically searched for articles published between January 1, 2018, until April 2024. The 29 reviewed studies utilized LLMs such as GPT, Llama, and BERT. We categorized the studies into three main tasks: detecting suicidal ideation or behaviors, assessing the risk of suicidal ideation, and preventing suicide by predicting attempts. Most of the studies demonstrated that these models are highly efficient, often outperforming mental health professionals in early detection and prediction capabilities. Large language models demonstrate significant potential for identifying and detecting suicidal behaviors and for saving lives. Nevertheless, ethical problems still need to be examined and cooperation with skilled professionals is essential.

The success of large language models (LLMs) in general areas have sparked a wave of research into their applications in the medical field. However, enhancing the medical professionalism of these models remains a major challenge. This study proposed a novel model training theoretical framework, the M-KAT framework, which integrated domain-specific training methods for LLMs with the unique characteristics of the medical discipline. This framework aimed to improve the medical professionalism of the models from three perspectives: general knowledge acquisition, specialized skill development, and alignment with clinical thinking. This study summarized the outcomes of medical LLMs across four tasks: clinical diagnosis and treatment, medical question answering, medical research, and health management. Using the M-KAT framework, we analyzed the contribution to enhancement of professionalism of models through different training stages. At the same time, for some of the potential risks associated with medical LLMs, targeted solutions can be achieved through pre-training, SFT, and model alignment based on cultivated professional capabilities. Additionally, this study identified main directions for future research on medical LLMs: advancing professional evaluation datasets and metrics tailored to the needs of medical tasks, conducting in-depth studies on medical multimodal large language models (MLLMs) capable of integrating diverse data types, and exploring the forms of medical agents and multi-agent frameworks that can interact with real healthcare environments and support clinical decision-making. It is hoped that predictions of work can provide a reference for subsequent research.

Hospitals around the world are deploying increasingly advanced systems to collect and store high-resolution physiological patient data for quality improvement and research. However, data accuracy, completeness, consistency, and contextual validity remain issues. This report highlights a data artifact known as waveform clipping in our hospital's physiological data capture system that went unnoticed for years, limiting data analysis and delaying several research projects. We aim to raise awareness in the medical informatics community about the importance of careful system setup, ongoing data validation, and close cooperation between clinicians and data scientists.

Feedback on cognitive workload may reduce decision-making mistakes. Machine learning-based models can produce feedback from physiological data such as electroencephalography (EEG) and electrocardiography (ECG). Supervised machine learning requires large training data sets that are (1) relevant and decontaminated and (2) carefully labeled for accurate approximation, a costly and tedious procedure. Commercial over-the-counter devices are low-cost resolutions for the real-time collection of physiological modalities. However, they produce significant artifacts when employed outside of laboratory settings, compromising machine learning accuracies. Additionally, the physiological modalities that most successfully machine-approximate cognitive workload in everyday settings are unknown. To address these challenges, a first-ever hybrid implementation of feature selection and self-supervised machine learning techniques is introduced. This model is employed on data collected outside controlled laboratory settings to (1) identify relevant physiological modalities to machine approximate six levels of cognitive-physical workloads from a seven-modality repository and (2) postulate limited labeling experiments and machine approximate mental-physical workloads using self-supervised learning techniques.

In recent years, Electronic health records (EHR) has gradually become the mainstream in the healthcare field. However, due to the fact that EHR systems are provided by different vendors, data is dispersed and stored, which leads to the phenomenon of data silos, making medical information too fragmented and bringing some challenges to current medical services. Therefore, in view of the difficulties in sharing EHR between medical institutions, the risk of privacy leakage, and the lack of EHR usage control by patients, an EHR sharing model based on consortium blockchain is proposed in this paper. Firstly, the Interplanetary File System is combined with consortium blockchain, which forms a hybrid storage scheme of EHR, this technology effectively improves data security, privacy protection, and operational efficiency. Secondly, the model combines unidirectional multi-hop conditional proxy re-encryption based on type and identity with distributed key generation technology to achieve secure EHR sharing with fine grained control. At the same time, users are required to link the operation records of EHR, so as to realize the traceability of EHR usage. A dynamic Byzantine fault-tolerant algorithm based on reputation and clustering is then proposed to solve the problems of arbitrary master node selection, high latency and low throughput of PBFT, enabling the nodes to reach consensus more efficiently. Finally, the model is analyzed in terms of security and user control, showing that the model is less energy intensive in terms of communication overhead and time consumption, and can effectively achieve secure sharing between medical data.