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Leveraging digital technologies to reduce cancer disparities in low-income and middle-income countries 利用数字技术缩小低收入和中等收入国家的癌症差距。
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100937
Judy W Gichoya MD , Rogers Mwavu MS , Frank Minja MD , Nadi Kaonga MD PhD , Saptarshi Purkayastha PhD , Janice Newsome MD
In a rural clinic in southwestern Uganda, Dr Sarah examines cervical images on her smartphone, receiving real-time artificial intelligence-powered guidance from a gynaecologic oncologist located hundreds of miles away. Once imaginary, this scenario now represents a highly probable future of digital health innovation transforming cancer care globally. With over 35 million new cases of cancer estimated by 2050, and up to 70% of deaths anticipated to disproportionately occur in low-income and middle-income countries (LMICs), digital solutions can be leveraged to accelerate the closure of these cancer care gaps. The global oncology community has responded to this imminent crisis by proposing several interventions, including promoting workforce education, mentorship, and task shifting; supporting early diagnosis and referrals through integrated diagnostics; prioritising and implementing prevention strategies such as tobacco cessation, cervical cancer screening, and vaccination; standardising and personalising treatment through increased participation in clinical trials and provision of essential cancer medications; and strengthening health-care systems. Across all these strategic pillars, digital health tools are crucial for advancing cancer care and narrowing existing global and geographical disparities in LMICs. In this Series paper, we evaluate the current status of these digital innovations in the context of cancer care.
在乌干达西南部的一家乡村诊所里,Sarah医生用智能手机检查宫颈图像,并接受数百英里外妇科肿瘤学家的实时人工智能指导。这一场景曾经是想象出来的,但现在它代表了数字健康创新极有可能改变全球癌症治疗的未来。到2050年,估计将有3500多万新发癌症病例,高达70%的死亡预计将不成比例地发生在低收入和中等收入国家,因此可以利用数字解决方案来加速缩小这些癌症治疗差距。全球肿瘤学界对这一迫在眉睫的危机做出了回应,提出了一些干预措施,包括促进劳动力教育、指导和任务转移;通过综合诊断支持早期诊断和转诊;优先考虑并实施戒烟、宫颈癌筛查和疫苗接种等预防战略;通过增加参与临床试验和提供基本癌症药物,使治疗标准化和个性化;加强卫生保健系统。在所有这些战略支柱中,数字卫生工具对于推进癌症治疗和缩小中低收入国家现有的全球和地域差距至关重要。在本系列论文中,我们评估了这些数字创新在癌症治疗方面的现状。
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引用次数: 0
Application of artificial intelligence and digital tools in cancer pathology 人工智能和数字工具在癌症病理学中的应用。
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100933
Lawrence A Shaktah MS , Zunamys I Carrero PhD , Katherine Jane Hewitt MBChB , Marco Gustav MSc , Matthew Cecchini MD PhD , Sebastian Foersch MD , Sabina Berezowska MD , Prof Jakob Nikolas Kather MD
Artificial intelligence (AI) is on the verge of reshaping cancer diagnostics through integration into digital pathology workflows. Despite the progression of AI towards real-world deployment, challenges in interpretability, validation, and clinical integration persist. AI models support the interpretation of stains including haematoxylin and eosin, enabling tumour classification, grading, and biomarker quantification, with clinical applications for targets such as HER2 and PD-L1. In addition, AI models enable the quantification of subtle microscopic patterns with prognostic and predictive values across tumour types. Herein, we provide an overview of the applications of AI in pathology and address emerging regulatory and ethical considerations. We also discuss the disparities in adoption across care settings and emphasise the importance of validation, human oversight, and post-deployment monitoring for the responsible implementation of AI in pathology-driven workflows. Furthermore, we highlight the technical advancements driving these developments, particularly the transition from hand-crafted machine learning workflows to deep learning, self-supervised learning for foundation models, multimodal models, and agentic AI.
人工智能(AI)即将通过整合到数字病理工作流程中来重塑癌症诊断。尽管人工智能在现实世界中的应用取得了进展,但在可解释性、验证性和临床整合方面的挑战仍然存在。人工智能模型支持解释包括血红素和伊红在内的染色,实现肿瘤分类、分级和生物标志物量化,并在临床应用于HER2和PD-L1等靶点。此外,人工智能模型能够量化细微的微观模式,具有跨肿瘤类型的预后和预测价值。在此,我们概述了人工智能在病理学中的应用,并解决了新兴的监管和伦理问题。我们还讨论了在不同护理环境中采用人工智能的差异,并强调了在病理驱动的工作流程中负责任地实施人工智能的验证、人为监督和部署后监测的重要性。此外,我们强调了推动这些发展的技术进步,特别是从手工机器学习工作流程到深度学习、基础模型的自监督学习、多模态模型和代理人工智能的转变。
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引用次数: 0
Transforming liver care with artificial intelligence 用人工智能改造肝脏护理
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100948
The Lancet Digital Health
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引用次数: 0
Digital cognitive behavioural self-management programme for fatigue, pain, and faecal incontinence in inflammatory bowel disease (IBD-BOOST): a multicentre, parallel, randomised controlled trial 炎症性肠病患者疲劳、疼痛和大便失禁的数字认知行为自我管理程序(IBD-BOOST):一项多中心、平行、随机对照试验
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100906
Prof Rona Moss-Morris PhD , Prof Christine Norton PhD , Prof Ailsa Hart PhD , Fionn Cléirigh Büttner PhD , Thomas Hamborg MSc , Laura Miller BSc , Imogen Stagg MSc , Prof Qasim Aziz PhD , Wladyslawa Czuber-Dochan PhD , Prof Lesley Dibley PhD , Megan English-Stevens , Julie Flowers , Serena McGuinness MSc , Prof Borislava Mihaylova DPhil , Prof Richard Pollok PhD , Chris Roukas MSc , Prof Sonia Saxena MD , Louise Sweeney PhD , Prof Stephanie Taylor MD , Vari Wileman PhD

Background

Fatigue, pain, and faecal urgency or incontinence are common, debilitating symptoms in inflammatory bowel disease (IBD). We developed IBD-BOOST, a digital, interactive, facilitator-supported, self-management intervention, and aimed to assess its effects compared with care as usual in relieving these symptoms and improving quality of life.

Methods

This multicentre, parallel, randomised controlled trial was conducted online in the UK, with allocation concealment maintained. Participants aged 18 years or older with IBD who rated the impact of fatigue, pain, and faecal urgency or incontinence as 5 or more on a 0–10 scale in a UK national survey were invited. Participants were randomly assigned (1:1) to the online IBD-BOOST programme or care as usual for 6 months via computer-generated randomisation. Primary outcomes were UK Inflammatory Bowel Disease Questionnaire (UK-IBDQ) and Global Rating of Symptom Relief at 6 months post-randomisation. All randomly assigned participants were included in the intention-to-treat and harms analysis. This trial is registered with ISRCTN.com (ISRCTN71618461) and is closed.

Findings

Between Jan 20, 2020, and July 27, 2022, 4449 participants were invited to participate, and 780 participants were randomly assigned: 391 to IBD-BOOST and 389 to care as usual. 524 (67%) of 780 participants were female and 253 (32%) were male. At 6 months, there were no statistically significant differences for UK-IBDQ between the care as usual group (unadjusted mean 62·09 [SD 14·42]) and the IBD-BOOST group (unadjusted mean 60·85 [SD 16·08]; treatment effect estimate: adjusted mean difference –1·67 [95% CI –4·13 to 0·80], p=0·19) or for Global Rating of Symptom Relief (unadjusted mean 3·65 [2·75] vs 4·13 [2·81]; adjusted mean difference 0·44 [95% CI –0·56 to 1·44], p=0·39). Complier-averaged causal effects analysis demonstrated that participants who complied with IBD-BOOST reported lower UK-IBDQ scores than those who would have complied in the care as usual group (mean difference –2·39 [95%CI –4·34 to –0·45], p=0·016). Adverse events and serious adverse events were similar between the IBD-BOOST group (55 [14%] of 391) and care as usual group (79 [20%] of 389). There was one possible treatment-related serious adverse event in the IBD-BOOST group (recurrent sleep disorder) and no deaths.

Interpretation

IBD-BOOST did not statistically significantly improve disease-specific quality of life or Global Rating of Symptom Relief in patients with IBD with fatigue, pain, or faecal urgency or incontinence compared with care as usual. People who complied with the intervention appeared to derive benefit. Future research should focus on enhancing compliance with interventions and targeting them to individuals most likely to benefit.

Funding

UK National Institute for Health and Care Research.
背景:炎症性肠病(IBD)常见的衰弱症状是疲劳、疼痛、大便急迫或大小便失禁。我们开发了IBD-BOOST,这是一种数字化、互动式、辅助工具支持的自我管理干预,旨在评估其与常规护理相比在缓解这些症状和改善生活质量方面的效果。方法:该多中心、平行、随机对照试验在英国在线进行,分配保密。在英国的一项全国性调查中,年龄在18岁或以上的IBD患者将疲劳、疼痛、大便急促或大小便失禁的影响评定为5分或以上(0-10分)。通过计算机生成的随机化,参与者被随机分配(1:1)到在线IBD-BOOST项目或像往常一样护理6个月。主要结局是英国炎症性肠病问卷调查(UK- ibdq)和随机分组后6个月症状缓解的全球评分。所有随机分配的参与者都被纳入意向治疗和危害分析。该试验已在ISRCTN.com注册(ISRCTN71618461),目前已结束。研究结果:在2020年1月20日至2022年7月27日期间,4449名参与者被邀请参加,780名参与者被随机分配:391名参与者接受IBD-BOOST治疗,389名接受常规护理。780名参与者中有524名(67%)是女性,253名(32%)是男性。6个月时,照护组(未校正平均值62.09 [SD 14.42])与IBD-BOOST组(未校正平均值605.85 [SD 16.08];治疗效果估计:校正平均差值- 1.67 [95% CI - 4.13至0.80],p= 0.19)或症状缓解总体评分(未校正平均值3.65[2.75]对4.13[2.81];校正平均差值0.44 [95% CI - 0.56至1.44],p= 0.39)之间无统计学差异。编者平均因果效应分析表明,遵守IBD-BOOST的参与者报告的UK-IBDQ得分低于照护组(平均差值为-2·39 [95%CI - 4.34至- 0.45],p= 0.016)。不良事件和严重不良事件在IBD-BOOST组(391例中55例[14%])和常规护理组(389例中79例[20%])之间相似。IBD-BOOST组有1例可能与治疗相关的严重不良事件(复发性睡眠障碍),无死亡。解释:与常规治疗相比,IBD- boost对伴有疲劳、疼痛、大便急症或尿失禁的IBD患者的疾病特异性生活质量或症状缓解的全球评分没有统计学意义上的显著改善。遵守干预措施的人似乎从中获益。未来的研究应侧重于加强对干预措施的依从性,并针对最有可能受益的个人。资助:英国国家卫生和保健研究所。
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引用次数: 0
How can artificial intelligence transform the training of medical students and physicians? 人工智能如何改变医学生和医生的培训?
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100900
Yilin Ning PhD , Jasmine Chiat Ling Ong PharmD , Haoran Cheng MPH , Haibo Wang MPH , Daniel Shu Wei Ting MD PhD , Yih Chung Tham PhD , Prof Tien Yin Wong MD PhD , Nan Liu PhD
Advances in artificial intelligence (AI), particularly generative AI, hold promise for transforming medical education and physician training in response to increasing health-care demands and shortages in the global health-care workforce. Meanwhile, challenges remain in the effective and equitable integration of AI technology into medical education and physician training worldwide. This Viewpoint explores the opportunities and challenges of such an integration. We study the evolving role of AI in medical education, its potential to enhance high-fidelity clinical training, and its contribution to research training using real-world examples. We also highlight ethical concerns, particularly the unclear boundaries of appropriate use of AI and call for clear guidelines to govern the integration of AI into medical education and physician training. Furthermore, this Viewpoint discusses practical constraints, including human, financial, and resource constraints, in AI integration, and emphasises the need for comprehensive cost evaluations and collaborative funding models to support the sustainable implementation of AI integration. A tight collaborative network between health-care institutions and systems, medical schools and universities, industry partners, and education and health-care regulatory agencies could lead to an AI-transformed medical education and physician training scheme that ultimately supports the adoption and integration of AI into clinical medicine and potentially brings about tangible improvements in global health-care delivery.
人工智能,特别是生成式人工智能的进步有望改变医学教育和医生培训,以应对日益增长的保健需求和全球保健人力短缺。与此同时,在有效和公平地将人工智能技术融入全球医学教育和医生培训方面仍然存在挑战。本观点探讨了这种整合的机遇和挑战。我们研究了人工智能在医学教育中的不断发展的作用,它在提高高保真临床培训方面的潜力,以及它对研究培训的贡献。我们还强调了伦理问题,特别是适当使用人工智能的界限不明确,并呼吁制定明确的指导方针,以管理将人工智能纳入医学教育和医生培训。此外,本观点还讨论了人工智能集成中的实际限制,包括人力、财务和资源限制,并强调需要进行全面的成本评估和协作资助模式,以支持人工智能集成的可持续实施。在卫生保健机构和系统、医学院和大学、行业合作伙伴以及教育和卫生保健监管机构之间建立紧密的协作网络,可能导致人工智能转化的医学教育和医生培训计划,最终支持将人工智能采用和整合到临床医学中,并有可能为全球卫生保健服务带来切实改善。
{"title":"How can artificial intelligence transform the training of medical students and physicians?","authors":"Yilin Ning PhD ,&nbsp;Jasmine Chiat Ling Ong PharmD ,&nbsp;Haoran Cheng MPH ,&nbsp;Haibo Wang MPH ,&nbsp;Daniel Shu Wei Ting MD PhD ,&nbsp;Yih Chung Tham PhD ,&nbsp;Prof Tien Yin Wong MD PhD ,&nbsp;Nan Liu PhD","doi":"10.1016/j.landig.2025.100900","DOIUrl":"10.1016/j.landig.2025.100900","url":null,"abstract":"<div><div>Advances in artificial intelligence (AI), particularly generative AI, hold promise for transforming medical education and physician training in response to increasing health-care demands and shortages in the global health-care workforce. Meanwhile, challenges remain in the effective and equitable integration of AI technology into medical education and physician training worldwide. This Viewpoint explores the opportunities and challenges of such an integration. We study the evolving role of AI in medical education, its potential to enhance high-fidelity clinical training, and its contribution to research training using real-world examples. We also highlight ethical concerns, particularly the unclear boundaries of appropriate use of AI and call for clear guidelines to govern the integration of AI into medical education and physician training. Furthermore, this Viewpoint discusses practical constraints, including human, financial, and resource constraints, in AI integration, and emphasises the need for comprehensive cost evaluations and collaborative funding models to support the sustainable implementation of AI integration. A tight collaborative network between health-care institutions and systems, medical schools and universities, industry partners, and education and health-care regulatory agencies could lead to an AI-transformed medical education and physician training scheme that ultimately supports the adoption and integration of AI into clinical medicine and potentially brings about tangible improvements in global health-care delivery.</div></div>","PeriodicalId":48534,"journal":{"name":"Lancet Digital Health","volume":"7 10","pages":"Article 100900"},"PeriodicalIF":24.1,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Extension of the GRACE score for non-ST-elevation acute coronary syndrome: a development and validation study in ten countries 非st段抬高急性冠状动脉综合征GRACE评分的扩展:10个国家的发展和验证研究
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100907
Florian A Wenzl MD , Klaus F Kofoed DMSc , Moa Simonsson MD , Gareth Ambler PhD , Niels M R van der Sangen MD , Erik Lampa PhD , Francesco Bruno MD , Mark A de Belder MD , Jiri Hlasensky PhD , Matthias Mueller-Hennessen MD , Maria A Smolle MD , Peizhi Wang BMed , José P S Henriques MD , Wouter J Kikkert MD , Henning Kelbæk DMSc , Luboš Bouček MD , Sergio Raposeiras-Roubín MD , Emad Abu-Assi MD , Jaouad Azzahhafi MD , Matthijs A Velders PhD , Thomas F Lüscher
<div><h3>Background</h3><div>The Global Registry of Acute Coronary Events (GRACE) scoring system guides the management of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) according to current guidelines. However, broad validation of the sex-specific GRACE 3.0 in-hospital mortality model, and corresponding models for predicting long-term mortality and the personalised effect of early invasive management, are still needed.</div></div><div><h3>Methods</h3><div>We used data of 609 063 patients with NSTE-ACS from ten countries between Jan 1, 2005, and June 24, 2024. A machine learning model for 1-year mortality was developed in 400 054 patients from England, Wales, and Northern Ireland. Both the in-hospital mortality model and the new 1-year mortality model were externally validated in patients from Sweden, Switzerland, Germany, Denmark, Spain, the Netherlands, and Czechia. A separate machine learning model to predict the individualised effect of early versus delayed invasive coronary angiography and revascularisation on a composite primary outcome of all-cause death, non-fatal recurrent myocardial infarction, hospital admission for refractory myocardial ischaemia, or hospital admission for heart failure at a median follow-up of 4·3 years was developed and externally validated in participants from geographically different sets of hospitals in the Danish VERDICT trial.</div></div><div><h3>Findings</h3><div>The in-hospital mortality model (area under the receiver operating characteristic curve [AUC] 0·90, 95% CI 0·89–0·91) and the 1-year mortality model (time-dependent AUC 0·84, 95% CI 0·82–0·86) showed excellent discriminative abilities on external validation across all countries. Both models were well calibrated and decision curve analyses suggested favourable clinical utility. Compared with score version 2.0, both models provided improved discrimination and risk reclassification. The individualised treatment effect model effectively identified patients who would benefit from early invasive management on external validation. Patients with high predicted benefit had reduced risk of the composite outcome when randomly assigned to early invasive management (hazard ratio 0·60, 95% CI 0·41–0·88), whereas patients with no-to-moderate predicted benefit did not (1·06, 0·80–1·40; p<sub>interaction</sub>=0·014). The individualised treatment effect model suggested that the group of patients with NSTE-ACS who benefit from early intervention might be incompletely captured by current treatment strategies.</div></div><div><h3>Interpretation</h3><div>The updated GRACE 3.0 scoring system provides a validated, practical tool to support personalised risk assessment in patients with NSTE-ACS. Prediction of an individual’s long-term cardiovascular benefit from early invasive management could refine future trial design.</div></div><div><h3>Funding</h3><div>Swiss Heart Foundation, University of Zurich Foundation, Kurt and Senta Herrmann Foundation, Theodor
背景:全球急性冠状动脉事件登记(GRACE)评分系统根据现行指南指导非st段抬高急性冠状动脉综合征(NSTE-ACS)患者的管理。然而,性别特异性GRACE 3.0住院死亡率模型,以及预测长期死亡率和早期有创治疗的个性化效果的相应模型,仍然需要广泛的验证。方法:我们使用了2005年1月1日至2024年6月24日来自10个国家的609063例NSTE-ACS患者的数据。对来自英格兰、威尔士和北爱尔兰的40054名患者开发了1年死亡率的机器学习模型。住院死亡率模型和新的1年死亡率模型在瑞典、瑞士、德国、丹麦、西班牙、荷兰和捷克的患者中进行了外部验证。一个单独的机器学习模型,用于预测早期与延迟侵入性冠状动脉造影和血运重建对全因死亡、非致死性复发性心肌梗死、难治性心肌缺血住院、在丹麦的VERDICT试验中,研究人员在来自不同地区医院的参与者中开发并外部验证了中位随访时间为4.3年的心力衰竭住院治疗方法。结果:住院死亡率模型(受试者工作特征曲线下面积[AUC] 0.90, 95% CI 0.89 - 0.91)和1年死亡率模型(时间相关AUC 0.84, 95% CI 0.82 - 0.86)在所有国家的外部验证中都显示出出色的判别能力。两种模型都经过了很好的校准,决策曲线分析显示了良好的临床应用。与评分2.0版本相比,两种模型都提供了更好的识别和风险再分类。个体化治疗效果模型在外部验证中有效识别了早期有创治疗的受益患者。当随机分配到早期有创治疗时,预测获益高的患者的综合结局风险降低(风险比0.60,95% CI 0.41 - 0.88),而预测获益无至中度的患者则没有(1.06,0.80 - 1.40;p相互作用= 0.014)。个体化治疗效果模型表明,受益于早期干预的NSTE-ACS患者群体可能未被当前的治疗策略完全捕获。解释:更新后的GRACE 3.0评分系统为NSTE-ACS患者的个性化风险评估提供了一个经过验证的实用工具。预测早期侵入性治疗对个体心血管的长期益处可以完善未来的试验设计。资助:瑞士心脏基金会、苏黎世大学基金会、Kurt and Senta Herrmann基金会、Theodor and Ida Herzog-Egli基金会、心血管研究基金会-苏黎世心脏之家。
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引用次数: 0
Characterising the design and methods of continuous glucose monitoring used in behavioural interventions to inform future research in prediabetes 描述用于行为干预的连续血糖监测的设计和方法,为未来的前驱糖尿病研究提供信息。
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100904
Prof David S Black PhD , Alaina P Vidmar MD , Braden Barnett MD
Digital health feedback technologies are expected to help address the projected 630 million individuals with prediabetes worldwide by 2045. This Viewpoint article characterises the historical use of continuous glucose monitoring (CGM) systems in behavioural research with a focus on the prediabetic population. We identified 19 peer-reviewed studies through a pragmatic literature review and reported key methodological features, including study design, sensor wear protocols, data masking strategies, the role of CGM in behavioural interventions, and approaches to generate CGM metrics. Based on our literature review, we propose four directions to advance CGM in behavioural intervention research in prediabetes: refining sampling strategies to focus recruitment on individuals with prediabetes to better understand metrics in this population; improving transparency in CGM feedback delivery protocols; reporting a comprehensive and targeted set of CGM metrics; and articulating principles that account for the effects of CGM use within behavioural interventions. This methodological characterisation of CGM is a starting point to enhance research quality and behavioural intervention effectiveness, particularly when integrating CGM systems aimed at supporting dietary, physical activity, or lifestyle modifications among people with prediabetes.
预计到2045年,数字健康反馈技术将帮助解决全球6.3亿糖尿病前期患者的问题。这篇观点文章描述了连续血糖监测(CGM)系统在行为研究中的历史应用,重点是糖尿病前期人群。我们通过实用的文献综述确定了19项同行评议的研究,并报告了关键的方法学特征,包括研究设计、传感器佩戴方案、数据屏蔽策略、CGM在行为干预中的作用,以及生成CGM指标的方法。基于我们的文献综述,我们提出了在前驱糖尿病行为干预研究中推进CGM的四个方向:改进抽样策略,将招募重点放在前驱糖尿病患者身上,以更好地了解这一人群的指标;提高CGM反馈交付协议的透明度;报告一套全面和有针对性的CGM指标;阐明在行为干预中使用CGM的影响的原则。CGM的方法学特征是提高研究质量和行为干预有效性的起点,特别是在整合旨在支持糖尿病前期患者饮食、身体活动或生活方式改变的CGM系统时。
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引用次数: 0
Development and validation of a machine-learning model to reduce futile procurements in donations after circulatory death in liver transplantation in the USA: a multicentre study 开发和验证机器学习模型,以减少美国肝移植循环死亡后捐赠的无效采购:一项多中心研究。
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100918
Rintaro Yanagawa , Kazuhiro Iwadoh PhD , Toshihiro Nakayama MD , Daniel J Firl MD , Chase J Wehrle MD , Yuki Bekki PhD , Daiki Soma MD , Jiro Kusakabe MD , Yuzuru Sambommatsu MD , Yutaka Endo PhD , Kliment K Bozhilov MD , Jenny H Pan MD , Masaru Kubota PhD , Koji Tomiyama PhD , Masato Fujiki PhD , Magdy Attia MD , Prof Marc L Melcher PhD , Prof Kazunari Sasaki MD
<div><h3>Background</h3><div>The number of liver transplants from donors after the circulatory determination of death continues to increase, helping to alleviate the existing organ shortage. However, the rate of attempted but subsequently terminated procurements, known as futile procurements, remains high—mainly because many potential donors do not progress to death within a timeframe after extubation that maintains the suitability of the organ for donation. Futile procurements pose considerable financial and workload burdens to the transplant system. We aimed to develop and validate a machine-learning model to better predict progression to death and reduce futile procurements in cases of donation after circulatory death (DCD).</div></div><div><h3>Methods</h3><div>This study included data from 2221 donors from six centres in the USA. Using a retrospective dataset obtained from 1616 donors between December 1, 2022, and June 30, 2023, we developed a prediction model using the Light Gradient Boosting Machine (LightGBM) framework, with neurological, biochemical, respiratory, and circulatory parameters as predictors. The model was validated retrospectively with data from 398 donors (July 1–Aug 31, 2023) and prospectively with data from 207 donors (March 1–Sept 30, 2024). The performance of the model was evaluated through the area under the receiver operating characteristic curve (AUC), accuracy, futile procurement rate, and missed opportunity rate. We also compared the performance of the model with that of two existing risk-prediction tools (the DCD-N score and the Colorado Calculator) and surgeon predictions.</div></div><div><h3>Findings</h3><div>Of the 2221 DCD donors in this study, 1260 progressed to death, 927 of whom died within 30 min after extubation. Cross-validation of the LightGBM model yielded AUCs for predicting donor progression to death of 0·833 (95% CI 0·798–0·868) at 30 min, 0·801 (0·767–0·834) at 45 min, and 0·805 (0·770–0·841) at 60 min after extubation. This performance was maintained in both retrospective (0·834 [0·772–0·891], 0·819 [0·757–0·870], and 0·799 [0·737–0·855]) and prospective (0·831 [0·768–0·885], 0·812 [0·749–0·874], and 0·805 [0·740–0·868]) validation cohorts. Compared with surgeon predictions, the LightGBM model had lower futile procurement rates (0·195 <em>vs</em> 0·078, respectively), higher accuracy in cases of poor intersurgeon agreement (0·08 <em>vs</em> 0·29) at 30 min, and similar missed opportunity rates (0·155 <em>vs</em> 0·167). By contrast, the DCD-N score had AUCs of 0·799 (95% CI 0·730–0·860) at 30 min, 0·760 (0·695–0·824) at 45 min, and 0·739 (0·668–0·801) at 60 min, and the Colorado Calculator had AUCs of 0·694 (0·616–0·768), 0·669 (0·596–0·742), and 0·663 (0·585–0·736) at the same timepoints.</div></div><div><h3>Interpretation</h3><div>We show that, compared with surgeon predictions and existing risk-prediction tools, our machine-learning model can enhance the accuracy of the prediction of progression
背景:供体在循环确定死亡后进行肝脏移植的数量不断增加,有助于缓解现有的器官短缺。然而,尝试采购但随后终止的比率,即所谓的无效采购,仍然很高,主要是因为许多潜在的捐赠者在拔管后维持器官适合捐赠的时间范围内没有进展到死亡。无效的采购给移植系统带来了相当大的财政和工作量负担。我们的目标是开发和验证一个机器学习模型,以更好地预测死亡进程,并减少循环性死亡(DCD)后捐赠的无效采购。方法:本研究包括来自美国六个中心的2221名献血者的数据。利用从2022年12月1日至2023年6月30日期间获得的1616名供体的回顾性数据集,我们使用光梯度增强机(LightGBM)框架开发了一个预测模型,以神经、生化、呼吸和循环参数作为预测因子。该模型通过398名捐赠者(2023年7月1日至8月31日)的回顾性数据和207名捐赠者(2024年3月1日至9月30日)的前瞻性数据进行了验证。通过受者工作特征曲线下面积(AUC)、准确率、无效采购率和错失机会率来评价模型的性能。我们还将该模型的性能与两种现有的风险预测工具(DCD-N评分和Colorado Calculator)和外科医生的预测进行了比较。结果:在本研究的2221例DCD供者中,1260例进展至死亡,其中927例在拔管后30分钟内死亡。交叉验证LightGBM模型得出预测供体进展至死亡的auc,拔管后30分钟为0.833 (95% CI 0.798 - 0.868), 45分钟为0.801(0.767 - 0.834),60分钟为0.805(0.770 - 0.841)。在回顾性(0.834[0.772 - 0.891]、0.819[0.757 - 0.870]和0.799[0.737 - 0.855])和前瞻性(0.831[0.768 - 0.885]、0.812[0.749 - 0.874]和0.805[0.740 - 0.868])验证队列中均保持这种效果。与外科医生预测相比,LightGBM模型具有较低的无效采购率(分别为0.195和0.078),在30分钟内外科医生间一致性差的情况下准确性更高(0.08和0.29),错失机会率相似(0.155和0.167)。相比之下,DCD-N评分在30分钟、45分钟和60分钟的auc分别为0.799 (95% CI 0.730 - 0.860)、0.760(0.695 - 0.824)和0.739(0.668 - 0.801),科罗拉多计算器在同一时间点的auc分别为0.694(0.616 - 0.768)、0.669(0.596 - 0.742)和0.663(0.585 - 0.736)。解释:我们表明,与外科医生的预测和现有的风险预测工具相比,我们的机器学习模型可以提高预测DCD供者死亡进展的准确性,并减少徒劳的采购。这种改进有可能减轻移植界的一些财政和操作负担。需要进一步改进以减少错失的机会并提高此类模型的整体准确性。资金:没有。
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引用次数: 0
Reducing futile donation after circulatory death procurement with machine learning 通过机器学习减少循环死亡采购后的无效捐赠。
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100932
Bima J Hasjim , Mamatha Bhat
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引用次数: 0
The Jevons Paradox in global health: efficiency, demand, and the AI dilemma 全球健康中的杰文斯悖论:效率、需求和人工智能困境。
IF 24.1 1区 医学 Q1 MEDICAL INFORMATICS Pub Date : 2025-10-01 DOI: 10.1016/j.landig.2025.100928
Michael JA Reid , Bilal Mateen
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引用次数: 0
期刊
Lancet Digital Health
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