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Digital Health Research Symposium: Opening Panel Commentary 数字健康研究研讨会:开幕小组评论
Pub Date : 2024-09-01 DOI: 10.1016/j.mcpdig.2024.06.002
Elizabeth Krupinski PhD, Renee Pekmezaris PhD, Amirala S. Pasha DO, JD
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引用次数: 0
Artificial Intelligence, Clinical Decision Support Algorithms, Mathematical Models, Calculators Applications in Infertility: Systematic Review and Hands-On Digital Applications 人工智能、临床决策支持算法、数学模型、计算器在不孕症中的应用:系统回顾和数字应用实践
Pub Date : 2024-08-26 DOI: 10.1016/j.mcpdig.2024.08.007
Carlo Bulletti MD , Jason M. Franasiak MD , Andrea Busnelli MD , Romualdo Sciorio BSc, Msc , Marco Berrettini PhD , Lusine Aghajanova MD, PhD , Francesco M. Bulletti MD , Baris Ata MD

The aim of this systematic review was to identify clinical decision support algorithms (CDSAs) proposed for assisted reproductive technologies (ARTs) and to evaluate their effectiveness in improving ART cycles at every stage vs traditional methods, thereby providing an evidence-based guidance for their use in ART practice. A literature search on PubMed and Embase of articles published between 1 January 2013 and 31 January 2024 was performed to identify relevant articles. Prospective and retrospective studies in English on the use of CDSA for ART were included. Out of 1746 articles screened, 116 met the inclusion criteria. The selected articles were categorized into 3 areas: prognosis and patient counseling, clinical management, and embryo assessment. After screening, 11 CDSAs were identified as potentially valuable for clinical management and laboratory practices. Our findings highlight the potential of automated decision aids to improve in vitro fertilization outcomes. However, the main limitation of this review was the lack of standardization in validation methods across studies. Further validation and clinical trials are needed to establish the effectiveness of these tools in the clinical setting.

本系统性综述旨在确定为辅助生殖技术(ART)提出的临床决策支持算法(CDSA),并评估其在改善 ART 周期各个阶段与传统方法的对比方面的有效性,从而为其在 ART 实践中的应用提供循证指导。我们在 PubMed 和 Embase 上对 2013 年 1 月 1 日至 2024 年 1 月 31 日期间发表的文章进行了文献检索,以确定相关文章。纳入了有关在抗逆转录病毒疗法中使用 CDSA 的前瞻性和回顾性英文研究。在筛选出的 1746 篇文章中,有 116 篇符合纳入标准。所选文章分为 3 个方面:预后和患者咨询、临床管理和胚胎评估。经过筛选,有 11 篇 CDSA 被认为对临床管理和实验室实践具有潜在价值。我们的研究结果凸显了自动决策辅助工具在改善体外受精结果方面的潜力。然而,本综述的主要局限性在于各研究的验证方法缺乏标准化。要确定这些工具在临床环境中的有效性,还需要进一步的验证和临床试验。
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引用次数: 0
Color Fundus Photography and Deep Learning Applications in Alzheimer Disease 阿尔茨海默病中的彩色眼底摄影和深度学习应用
Pub Date : 2024-08-26 DOI: 10.1016/j.mcpdig.2024.08.005
Oana M. Dumitrascu MD, MSc , Xin Li MS , Wenhui Zhu MS , Bryan K. Woodruff MD , Simona Nikolova PhD , Jacob Sobczak , Amal Youssef MD , Siddhant Saxena , Janine Andreev , Richard J. Caselli MD , John J. Chen MD, PhD , Yalin Wang PhD

Objective

To report the development and performance of 2 distinct deep learning models trained exclusively on retinal color fundus photographs to classify Alzheimer disease (AD).

Patients and Methods

Two independent datasets (UK Biobank and our tertiary academic institution) of good-quality retinal photographs derived from patients with AD and controls were used to build 2 deep learning models, between April 1, 2021, and January 30, 2024. ADVAS is a U-Net–based architecture that uses retinal vessel segmentation. ADRET is a bidirectional encoder representations from transformers style self-supervised learning convolutional neural network pretrained on a large data set of retinal color photographs from UK Biobank. The models’ performance to distinguish AD from non-AD was determined using mean accuracy, sensitivity, specificity, and receiving operating curves. The generated attention heatmaps were analyzed for distinctive features.

Results

The self-supervised ADRET model had superior accuracy when compared with ADVAS, in both UK Biobank (98.27% vs 77.20%; P<.001) and our institutional testing data sets (98.90% vs 94.17%; P=.04). No major differences were noted between the original and binary vessel segmentation and between both eyes vs single-eye models. Attention heatmaps obtained from patients with AD highlighted regions surrounding small vascular branches as areas of highest relevance to the model decision making.

Conclusion

A bidirectional encoder representations from transformers style self-supervised convolutional neural network pretrained on a large data set of retinal color photographs alone can screen symptomatic AD with high accuracy, better than U-Net–pretrained models. To be translated in clinical practice, this methodology requires further validation in larger and diverse populations and integrated techniques to harmonize fundus photographs and attenuate the imaging-associated noise.

患者和方法在 2021 年 4 月 1 日至 2024 年 1 月 30 日期间,我们使用两个独立数据集(英国生物库和我们的三级学术机构)的高质量视网膜照片构建了两个深度学习模型,这些数据集分别来自 AD 患者和对照组。ADVAS 是一种基于 U-Net 的架构,使用视网膜血管分割。ADRET 是一种双向编码器表征,来自变压器风格的自监督学习卷积神经网络,在英国生物库的视网膜彩色照片大数据集上进行了预训练。利用平均准确率、灵敏度、特异性和接收操作曲线确定了模型区分注意力缺失症与非注意力缺失症的性能。结果在英国生物库(98.27% vs 77.20%; P<.001)和我们的机构测试数据集(98.90% vs 94.17%; P=.04)中,自监督 ADRET 模型与 ADVAS 相比具有更高的准确性。在原始血管分割与二元血管分割之间,以及双眼模型与单眼模型之间,均未发现重大差异。从注意力缺失症患者身上获得的注意力热图突出显示了小血管分支周围的区域,这些区域与模型决策的相关性最高。 结论:仅用视网膜彩色照片的大型数据集预处理变压器式自监督卷积神经网络的双向编码器表征,就能高精度筛查有症状的注意力缺失症,其效果优于 U-Net 预处理模型。要将这一方法应用于临床实践,还需要在更多不同人群中进行进一步验证,并采用综合技术来协调眼底照片和减弱成像相关噪声。
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引用次数: 0
Telemedicine-Enabled Ambulances for Prehospital Acute Stroke Management: A Pilot Study 远程医疗救护车用于院前急性中风管理:试点研究
Pub Date : 2024-08-24 DOI: 10.1016/j.mcpdig.2024.08.006
Ehab Harahsheh MBBS , Stephen W. English Jr. MD, MBA , Bart M. Demaerschalk MD , Kevin M. Barrett MD , William D. Freeman MD

Objective

To assess the feasibility and potential scalability of telemedicine-enabled ambulances for the prehospital evaluation of patients with suspected acute stroke symptoms.

Patients and Methods

A pilot study of telemedicine-enabled ambulances for evaluating patients with suspected acute stroke symptoms en route at 2 tertiary academic comprehensive stroke centers from January 1, 2018, to February 5, 2024. Charts of included patients were reviewed for demographic data, vascular risk factors, final diagnosis, time from arrival to neuroimaging, door-to–needle and door-to-puncture times in patients eligible for acute treatment, and any reported technical challenges during audio-video consultations.

Results

Forty-seven patients (mean age, 68.0 years; 62% men) were evaluated via telemedicine-enabled ambulances, of which 35 (74%) where for hospital-to-hospital transferred patients. Mean time from arrival to neuroimaging was 11.8 minutes. Twenty-nine patients (62%) were diagnosed with acute ischemic stroke, and the remainder were diagnosed with intracranial hemorrhage (n=13), seizure (n=2), brain mass (n=1), or other diagnoses (n=3). Four patients (9%) received intravenous thrombolysis with alteplase (mean door to needle, 30.3 minutes), and 15 patients (32%) underwent mechanical thrombectomy (mean door to puncture, 72 minutes). Technical challenges were reported in 15 of the 42 (36%) cases, of which 10 (67%) were related to poor internet connectivity.

Conclusion

Telemedicine-enabled ambulances in emergency medical services systems are novel, feasible, and potentially scalable options for evaluating patients with suspected acute stroke in the prehospital setting. However, optimization of infrastructure, staffing models, and internet connectivity is necessary, and larger studies evaluating the clinical and cost effectiveness of this approach are needed before widespread implementation.

目的评估远程医疗救护车对疑似急性卒中症状患者进行院前评估的可行性和潜在可扩展性。患者和方法从 2018 年 1 月 1 日至 2024 年 2 月 5 日,在 2 个三级综合学术卒中中心对远程医疗救护车对途中疑似急性卒中症状患者进行评估的试点研究。对纳入患者的病历进行了审查,包括人口统计学数据、血管风险因素、最终诊断、从到达到神经影像学检查的时间、符合急性治疗条件患者的门到针和门到穿刺时间,以及在音频视频会诊过程中报告的任何技术问题。从到达医院到进行神经成像的平均时间为 11.8 分钟。29 名患者(62%)被诊断为急性缺血性中风,其余患者被诊断为颅内出血(13 人)、癫痫发作(2 人)、脑肿块(1 人)或其他诊断(3 人)。4名患者(9%)接受了阿替普酶静脉溶栓治疗(从进针到出针的平均时间为30.3分钟),15名患者(32%)接受了机械血栓切除术(从进针到穿刺的平均时间为72分钟)。42例中有15例(36%)存在技术问题,其中10例(67%)与网络连接不畅有关。然而,有必要对基础设施、人员配置模式和网络连接进行优化,并且在广泛实施前需要进行更大规模的研究,评估该方法的临床和成本效益。
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引用次数: 0
Can Artificial Intelligence Make the Cut? Dissecting Large Language Model’s Surgical Exam Performance 人工智能能否胜任?剖析大型语言模型的外科检查表现
Pub Date : 2024-08-17 DOI: 10.1016/j.mcpdig.2024.07.004
Shankargouda Patil BDS, MDS, PhD, Frank W. Licari MBA, DDS, MPH
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引用次数: 0
In Reply: Can Artificial Intelligence Make the Cut? Dissecting Large Language Model’s Surgical Exam Performance 回复人工智能能否胜任?剖析大型语言模型的外科检查表现
Pub Date : 2024-08-13 DOI: 10.1016/j.mcpdig.2024.08.003
Adam M. Ostrovsky BS, Joshua R. Chen BS, Vishal N. Shah DO, Babak Abai MD
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引用次数: 0
Experience With an Optical Character Recognition Search Application for Review of Outside Medical Records 使用光学字符识别搜索应用程序审查外部医疗记录的经验
Pub Date : 2024-08-10 DOI: 10.1016/j.mcpdig.2024.08.001
Jose K. James MD, PhD , Tharana Maran MS , Mindy P. Rice MBA , Tanner S Hunt MHA , Kevin J. Peterson PhD, MS , William J. Hogan MBBCh , Shivam Damani BS , Alexander J. Ryu MD
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引用次数: 0
Implementation of a Tiered Cardiac Telemetry System: An Operational Blueprint at Mayo Clinic 实施分级心脏遥测系统:梅奥诊所的运行蓝图
Pub Date : 2024-08-08 DOI: 10.1016/j.mcpdig.2024.07.003
Levi W. Disrud , Tara A. Gosse MS , Zach D. Linn MS , Anthony H. Kashou MD , Peter A. Noseworthy MD, MBA , Angela Fink MSN , Dawn Griffin MA, MBA , Blade Faust

Objective

To investigate the operational outcomes and implementation effects of tiered cardiac telemetry monitoring in a hospital environment using an innovative technology.

Patients and Methods

The research focuses on assessing the precision, speed, and reliability of alerts generated by a wireless device in adult patients aged 18 and above, concurrently monitored by a hardwired, continuous cardiac monitor. Using an agile methodology, we tested and validated a nonhardwired, cellular-connected continuous cardiac monitor (InfoBionic MoMe) in 162 patients. A comparison was made between the wireless device and the standard hardwired system, conducted at Mayo Clinic Hospital with Institutional Review Board approval from June 6, 2022, to December 15, 2022.

Results

The study revealed a high correlation of events captured compared with the standard care model. Differences in algorithms, alarm parameters, and operational considerations impacting clinical implementation were observed. Connectivity improvements during the study reduced latency from 3-5 minutes to 30 seconds. Delayed alarms were attributed to device damage (4.5% of cases) and poor cellular connections (29% within 31-60 seconds).

Conclusion

The implementation of tiered cardiac telemetry in hospital environments, coupled with advancements in remote cardiac monitoring, supports expanded bedside telemetry capabilities and near real-time remote monitoring postdischarge. Although the study successfully validated the wireless device concept, improvements are needed before implementation for inpatient cardiac monitoring. Further research and technological enhancements can build on these findings to enhance health care practices in this domain.

研究重点是评估无线设备在 18 岁及以上的成年患者中生成警报的精度、速度和可靠性,这些患者同时受到硬连线连续心脏监护仪的监测。我们采用敏捷方法,在 162 名患者中测试并验证了一种非硬线、与蜂窝连接的连续心脏监护仪(InfoBionic MoMe)。在 2022 年 6 月 6 日至 2022 年 12 月 15 日期间,经机构审查委员会批准,我们在梅奥诊所医院对无线设备和标准硬线系统进行了比较。观察到算法、警报参数和影响临床实施的操作注意事项存在差异。研究期间连接性的改善将延迟时间从 3-5 分钟缩短到 30 秒。警报延迟的原因是设备损坏(4.5% 的病例)和蜂窝网络连接不良(29% 的病例在 31-60 秒内)。虽然这项研究成功验证了无线设备的概念,但在用于住院病人心脏监护之前还需要改进。进一步的研究和技术改进可以在这些发现的基础上加强这一领域的医疗实践。
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引用次数: 0
Assessing Artificial Intelligence Solution Effectiveness: The Role of Pragmatic Trials 评估人工智能解决方案的有效性:实用性试验的作用
Pub Date : 2024-08-06 DOI: 10.1016/j.mcpdig.2024.06.010
Mauricio F. Jin MD , Peter A. Noseworthy MD , Xiaoxi Yao PhD

The emergence of artificial intelligence (AI) and other digital solutions in health care has considerably altered the landscape of medical research and patient care. Rigorous evaluation in routine practice settings is fundamental to the ethical use of AI and consists of 3 stages of evaluations: technical performance, usability and acceptability, and health impact evaluation. Pragmatic trials often play a key role in the health impact evaluation. The current review introduces the concept of pragmatic trials, their role in AI evaluation, the challenges of conducting pragmatic trials, and strategies to mitigate the challenges. We also examined common designs used in pragmatic trials and highlighted examples of published or ongoing AI trials. As more health systems advance into learning health systems, where outcomes are continuously evaluated to refine processes and tools, pragmatic trials embedded into everyday practice, leveraging data and infrastructure from delivering health care, will be a critical part of the feedback cycle for learning and improvement.

人工智能(AI)和其他数字解决方案在医疗保健领域的出现极大地改变了医学研究和患者护理的格局。在常规实践环境中进行严格评估是合乎伦理地使用人工智能的基础,评估包括三个阶段:技术性能、可用性和可接受性以及健康影响评估。实用性试验通常在健康影响评估中发挥关键作用。本综述介绍了实用性试验的概念、实用性试验在人工智能评估中的作用、开展实用性试验所面临的挑战以及应对挑战的策略。我们还研究了实用性试验中常用的设计,并重点介绍了已发表或正在进行的人工智能试验实例。随着越来越多的医疗系统向学习型医疗系统迈进,对结果进行持续评估以完善流程和工具,利用提供医疗保健的数据和基础设施将实用性试验嵌入日常实践中,这将成为学习和改进反馈循环的关键部分。
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引用次数: 0
Deep Learning–Based Prediction of Hepatic Decompensation in Patients With Primary Sclerosing Cholangitis With Computed Tomography 基于深度学习的计算机断层扫描预测原发性硬化性胆管炎患者的肝功能失代偿情况
Pub Date : 2024-07-31 DOI: 10.1016/j.mcpdig.2024.07.002
Yashbir Singh PhD , Shahriar Faghani MD , John E. Eaton MD , Sudhakar K. Venkatesh MD , Bradley J. Erickson MD, PhD

Objective

To investigate a deep learning model for predicting hepatic decompensation using computed tomography (CT) imaging in patients with primary sclerosing cholangitis (PSC).

Patients and Methods

Retrospective cohort study involving 277 adult patients with large-duct PSC who underwent an abdominal CT scan. The portal venous phase CT images were used as input to a 3D-DenseNet121 model, which was trained using 5-fold crossvalidation to classify hepatic decompensation. To further investigate the role of each anatomic region in the model’s decision-making process, we trained the model on different sections of 3-dimensional CT images. This included training on the right, left, anterior, posterior, inferior, and superior halves of the image data set. For each half, as well as for the entire scan, we performed area under the receiving operating curve (AUROC) analysis.

Results

Hepatic decompensation occurred in 128 individuals after a median (interquartile range) of 1.5 years (142-1318 days) after the CT scan. The deep learning model exhibited promising results, with a mean ± SD AUROC of 0.89±0.04 for the baseline model. The mean ± SD AUROC for left, right, anterior, posterior, superior, and inferior halves were 0.83±0.03, 0.83±0.03, 0.82±0.09, 0.79±0.02, 0.78±0.02, and 0.76±0.04, respectively.

Conclusion

The study illustrates the potential of examining CT imaging using 3D-DenseNet121 deep learning model to predict hepatic decompensation in patients with PSC.

患者和方法回顾性队列研究涉及 277 名接受腹部 CT 扫描的大导管 PSC 成年患者。门静脉相 CT 图像被用作 3D-DenseNet 121 模型的输入,该模型经过 5 倍交叉验证训练,可对肝功能失代偿进行分类。为了进一步研究每个解剖区域在模型决策过程中的作用,我们在三维 CT 图像的不同切面上对模型进行了训练。这包括对图像数据集的右半部、左半部、前半部、后半部、下半部和上半部进行训练。结果128 人在 CT 扫描后 1.5 年(142-1318 天)中位数(四分位间范围)后出现肝功能失代偿。深度学习模型显示出良好的结果,基线模型的平均±标準AUROC为0.89±0.04。左侧、右侧、前侧、后侧、上半部和下半部的平均 ± SD AUROC 分别为 0.83±0.03、0.83±0.03、0.82±0.09、0.79±0.02、0.78±0.02 和 0.76±0.04。
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引用次数: 0
期刊
Mayo Clinic Proceedings. Digital health
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