BMC Medical Informatics and Decision Making最新文献

Background: Despite improvement in treatment strategies for atrial fibrillation (AF), a significant proportion of patients still experience recurrence after ablation. This study aims to propose a novel algorithm based on Transformer using surface electrocardiogram (ECG) signals and clinical features can predict AF recurrence.

Methods: Between October 2018 to December 2021, patients who underwent index radiofrequency ablation for AF with at least one standard 10-second surface ECG during sinus rhythm were enrolled. An end-to-end deep learning framework based on Transformer and a fusion module was used to predict AF recurrence using ECG and clinical features. Model performance was evaluated using areas under the receiver operating characteristic curve (AUROC), sensitivity, specificity, accuracy and F1-score.

Results: A total of 920 patients (median age 61 [IQR 14] years, 66.3% male) were included. After a median follow-up of 24 months, 253 patients (27.5%) experienced AF recurrence. A single deep learning enabled ECG signals identified AF recurrence with an AUROC of 0.769, sensitivity of 75.5%, specificity of 61.1%, F1 score of 55.6% and overall accuracy of 65.2%. Combining ECG signals and clinical features increased the AUROC to 0.899, sensitivity to 81.1%, specificity to 81.7%, F1 score to 71.7%, and overall accuracy to 81.5%.

Conclusions: The Transformer algorithm demonstrated excellent performance in predicting AF recurrence. Integrating ECG and clinical features enhanced the models' performance and may help identify patients at low risk for AF recurrence after index ablation.

Objective: To develop a machine learning-based risk prediction model for postoperative parastomal hernia (PSH) in colorectal cancer patients undergoing permanent colostomy, assisting nurses in identifying high-risk groups and devising preventive care strategies.

Methods: A case-control study was conducted on 495 colorectal cancer patients who underwent permanent colostomy at the Second Affiliated Hospital of Anhui Medical University from June 2017 to June 2023, with a 1-year follow-up period. Patients were categorized into PSH and non-PSH groups based on PSH occurrence within 1-year post-operation. Data were split into training (70%) and testing (30%) sets. Variable selection was performed using Least Absolute Shrinkage and Selection Operator (LASSO) regression, and binary classification prediction models were established using Logistic Regression (LR), Support Vector Classification (SVC), K Nearest Neighbor (KNN), Random Forest (RF), Light Gradient Boosting Machine (LGBM), and Extreme Gradient Boosting (XgBoost). The binary classification label denoted 1 for PSH occurrence and 0 for no PSH occurrence. Parameters were optimized via 5-fold cross-validation. Model performance was evaluated using Area Under Curve (AUC), specificity, sensitivity, accuracy, positive predictive value, negative predictive value, and F1-score. Clinical utility was evaluated using decision curve analysis (DCA), model explanation was enhanced using shapley additive explanation (SHAP), and model visualization was achieved using a nomogram.

Results: The incidence of PSH within 1 year was 29.1% (144 patients). Among the models tested, the RF model demonstrated the highest discrimination capability with an AUC of 0.888 (95% CI: 0.881-0.935), along with superior specificity, accuracy, sensitivity, and F1 score. It also showed the highest clinical net benefit on the DCA curve. SHAP analysis identified the top 10 influential variables associated with PSH risk: body mass index (BMI), operation duration, history and status of chronic obstructive pulmonary disease (COPD), prealbumin, tumor node metastasis (TNM) staging, stoma site, thickness of rectus abdominis muscle (TRAM), C-reactive protein CRP, american society of anesthesiologists physical status classification (ASA), and stoma diameter. These insights from SHAP plots illustrated how these factors influence individual PSH outcomes. The nomogram was used for model visualization.

Conclusion: The Random Forest model demonstrated robust predictive performance and clinical relevance in forecasting colonic PSH. This model aids in early identification of high-risk patients and guides preventive care.

Lung and colon cancers are leading contributors to cancer-related fatalities globally, distinguished by unique histopathological traits discernible through medical imaging. Effective classification of these cancers is critical for accurate diagnosis and treatment. This study addresses critical challenges in the diagnostic imaging of lung and colon cancers, which are among the leading causes of cancer-related deaths worldwide. Recognizing the limitations of existing diagnostic methods, which often suffer from overfitting and poor generalizability, our research introduces a novel deep learning framework that synergistically combines the Xception and MobileNet architectures. This innovative ensemble model aims to enhance feature extraction, improve model robustness, and reduce overfitting.Our methodology involves training the hybrid model on a comprehensive dataset of histopathological images, followed by validation against a balanced test set. The results demonstrate an impressive classification accuracy of 99.44%, with perfect precision and recall in identifying certain cancerous and non-cancerous tissues, marking a significant improvement over traditional approach.The practical implications of these findings are profound. By integrating Gradient-weighted Class Activation Mapping (Grad-CAM), the model offers enhanced interpretability, allowing clinicians to visualize the diagnostic reasoning process. This transparency is vital for clinical acceptance and enables more personalized, accurate treatment planning. Our study not only pushes the boundaries of medical imaging technology but also sets the stage for future research aimed at expanding these techniques to other types of cancer diagnostics.

Background: The accuracy of spelling in Electronic Health Records (EHRs) is a critical factor for efficient clinical care, research, and ensuring patient safety. The Persian language, with its abundant vocabulary and complex characteristics, poses unique challenges for real-word error correction. This research aimed to develop an innovative approach for detecting and correcting spelling errors in Persian clinical text.

Methods: Our strategy employs a state-of-the-art pre-trained model that has been meticulously fine-tuned specifically for the task of spelling correction in the Persian clinical domain. This model is complemented by an innovative orthographic similarity matching algorithm, PERTO, which uses visual similarity of characters for ranking correction candidates.

Results: The evaluation of our approach demonstrated its robustness and precision in detecting and rectifying word errors in Persian clinical text. In terms of non-word error correction, our model achieved an F1-Score of 90.0% when the PERTO algorithm was employed. For real-word error detection, our model demonstrated its highest performance, achieving an F1-Score of 90.6%. Furthermore, the model reached its highest F1-Score of 91.5% for real-word error correction when the PERTO algorithm was employed.

Conclusions: Despite certain limitations, our method represents a substantial advancement in the field of spelling error detection and correction for Persian clinical text. By effectively addressing the unique challenges posed by the Persian language, our approach paves the way for more accurate and efficient clinical documentation, contributing to improved patient care and safety. Future research could explore its use in other areas of the Persian medical domain, enhancing its impact and utility.

Performing data augmentation in medical named entity recognition (NER) is crucial due to the unique challenges posed by this field. Medical data is characterized by high acquisition costs, specialized terminology, imbalanced distributions, and limited training resources. These factors make achieving high performance in medical NER particularly difficult. Data augmentation methods help to mitigate these issues by generating additional training samples, thus balancing data distribution, enriching the training dataset, and improving model generalization. This paper proposes two data augmentation methods-Contextual Random Replacement based on Word2Vec Augmentation (CRR) and Targeted Entity Random Replacement Augmentation (TER)-aimed at addressing the scarcity and imbalance of data in the medical domain. When combined with a deep learning-based Chinese NER model, these methods can significantly enhance performance and recognition accuracy under limited resources. Experimental results demonstrate that both augmentation methods effectively improve the recognition capability of medical named entities. Specifically, the BERT-BiLSTM-CRF model achieved the highest F1 score of 83.587%, representing a 1.49% increase over the baseline model. This validates the importance and effectiveness of data augmentation in medical NER.

Purpose: This study aimed to create and validate robust machine-learning-based prediction models for antipsychotic drug (risperidone) continuation in children and teenagers suffering from mania over one year and to discover potential variables for clinical treatment.

Method: The study population was collected from the national claims database in China. A total of 4,532 patients aged 4-18 who began risperidone therapy for mania between September 2013 and October 2019 were identified. The data were randomly divided into two datasets: training (80%) and testing (20%). Five regularly used machine learning methods were employed, in addition to the SuperLearner (SL) algorithm, to develop prediction models for the continuation of atypical antipsychotic therapy. The area under the receiver operating characteristic curve (AUC) with a 95% confidence interval (CI) was utilized.

Results: In terms of discrimination and robustness in predicting risperidone treatment continuation, the generalized linear model (GLM) performed the best (AUC: 0.823, 95% CI: 0.792-0.854, intercept near 0, slope close to 1.0). The SL model (AUC: 0.823, 95% CI: 0.791-0.853, intercept near 0, slope close to 1.0) also exhibited significant performance. Furthermore, the present findings emphasize the significance of several unique clinical and socioeconomic variables, such as the frequency of emergency room visits for nonmental health disorders.

Conclusions: The GLM and SL models provided accurate predictions regarding risperidone treatment continuation in children and adolescents with episodes of mania and hypomania. Consequently, applying prediction models in atypical antipsychotic medicine may aid in evidence-based decision-making.

Background: Intraoperative neurophysiological monitoring (IOM) plays a pivotal role in enhancing patient safety during neurosurgical procedures. This vital technique involves the continuous measurement of evoked potentials to provide early warnings and ensure the preservation of critical neural structures. One of the primary challenges has been the effective documentation of IOM events with semantically enriched characterizations. This study aimed to address this challenge by developing an ontology-based tool.

Methods: We structured the development of the IOM Documentation Ontology (IOMDO) and the associated tool into three distinct phases. The initial phase focused on the ontology's creation, drawing from the OBO (Open Biological and Biomedical Ontology) principles. The subsequent phase involved agile software development, a flexible approach to encapsulate the diverse requirements and swiftly produce a prototype. The last phase entailed practical evaluation within real-world documentation settings. This crucial stage enabled us to gather firsthand insights, assessing the tool's functionality and efficacy. The observations made during this phase formed the basis for essential adjustments to ensure the tool's productive utilization.

Results: The core entities of the ontology revolve around central aspects of IOM, including measurements characterized by timestamp, type, values, and location. Concepts and terms of several ontologies were integrated into IOMDO, e.g., the Foundation Model of Anatomy (FMA), the Human Phenotype Ontology (HPO) and the ontology for surgical process models (OntoSPM) related to general surgical terms. The software tool developed for extending the ontology and the associated knowledge base was built with JavaFX for the user-friendly frontend and Apache Jena for the robust backend. The tool's evaluation involved test users who unanimously found the interface accessible and usable, even for those without extensive technical expertise.

Conclusions: Through the establishment of a structured and standardized framework for characterizing IOM events, our ontology-based tool holds the potential to enhance the quality of documentation, benefiting patient care by improving the foundation for informed decision-making. Furthermore, researchers can leverage the semantically enriched data to identify trends, patterns, and areas for surgical practice enhancement. To optimize documentation through ontology-based approaches, it's crucial to address potential modeling issues that are associated with the Ontology of Adverse Events.

Aim: Exercise stress ECG is a common diagnostic test for stable coronary artery disease, but its sensitivity and specificity need to be further improved. In this paper, we construct a machine learning model for the prediction of angiographic coronary artery disease by HFQRS analysis of cycling exercise ECG.

Methods and results: This study prospectively included 140 inpatients and 59 healthy volunteers undergoing cycling exercise ECG. The CHD group (N=104) and non-CHD group (N=95) were determined by coronary angiography gold standard. Automated HF QRS analysis was performed by the blinded method. The coronary group was predominantly male, with a higher prevalence of age, BMI, hypertension, and diabetes than the non-coronary group ( $P<0.001$ ), higher lipid levels in the coronary group ( $P<0.005$ ), significantly longer QRS duration during exercise testing ( $P<0.005$ ), more positive leads ( $P<0.001$ ), and a greater proportion of significant changes in HFQRS ( $P<0.001$ ). Age, Gender, Hypertension, Diabetes, and HF QRS Conclusions were screened by correlation analysis and multifactorial retrospective analysis to construct the machine learning models of the XGBoost Classifier, Logistic Regression, LightGBM Classifier, RandomForest Classifier, Artificial Neural Network and Support Vector Machine, respectively.

Conclusion: Male, elderly, with hypertension, diabetes mellitus, and positive exercise stress test HFQRS conclusions suggested a high risk of CHD. The best performance of the Logistic Regression model was compared, and a column line graph for assessing the risk of CHD was further developed and validated.

Background: Most Chinese joint entity and relation extraction tasks in medicine involve numerous nested entities, overlapping relations, and other challenging extraction issues. In response to these problems, some traditional methods decompose the joint extraction task into multiple steps or multiple modules, resulting in local dependency in the meantime.

Methods: To alleviate this issue, we propose a joint extraction model of Chinese medical entities and relations based on RoBERTa and single-module global pointer, namely RSGP, which formulates joint extraction as a global pointer linking problem. Considering the uniqueness of Chinese language structure, we introduce the RoBERTa-wwm pre-trained language model at the encoding layer to obtain a better embedding representation. Then, we represent the input sentence as a third-order tensor and score each position in the tensor to prepare for the subsequent process of decoding the triples. In the end, we design a novel single-module global pointer decoding approach to alleviate the generation of redundant information. Specifically, we analyze the decoding process of single character entities individually, improving the time and space performance of RSGP to some extent.

Results: In order to verify the effectiveness of our model in extracting Chinese medical entities and relations, we carry out the experiments on the public dataset, CMeIE. Experimental results show that RSGP performs significantly better on the joint extraction of Chinese medical entities and relations, and achieves state-of-the-art results compared with baseline models.

Conclusion: The proposed RSGP can effectively extract entities and relations from Chinese medical texts and help to realize the structure of Chinese medical texts, so as to provide high-quality data support for the construction of Chinese medical knowledge graphs.

Background: Falls in multiple sclerosis can result in numerous problems, including injuries and functional loss. Therefore, determining the factors contributing to falls in people with Multiple Sclerosis (PwMS) is crucial. This study aims to investigate the contributing factors to falls in multiple sclerosis using a machine learning approach.

Methods: This cross-sectional study was conducted with 253 PwMS admitted to the outpatient clinic of a university hospital between February and August 2023. A sociodemographic data collection form, Fall Efficacy Scale (FES-I), Berg Balance Scale (BBS), Fatigue Severity Scale (FSS), Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale (MSIS-29), and Timed 25 Foot Walk Test (T25-FW) were used for data collection. Gradient-boosting algorithms were employed to predict the important variables for falls in PwMS. The XGBoost algorithm emerged as the best performed model in this study.

Results: Most of the participants (70.0%) were female, with a mean age of 40.44 ± 10.88 years. Among the participants, 40.7% reported a fall history in the last year. The area under the curve value of the model was 0.713. Risk factors of falls in PwMS included MSIS-29 (0.424), EDSS (0.406), marital status (0.297), education level (0.240), disease duration (0.185), age (0.130), family type (0.119), smoking (0.031), income level (0.031), and regular exercise habit (0.026).

Conclusions: In this study, smoking and regular exercise were the modifiable factors contributing to falls in PwMS. We recommend that clinicians facilitate the modification of these factors in PwMS. Age and disease duration were non-modifiable factors. These should be considered as risk increasing factors and used to identify PwMS at risk. Interventions aimed at reducing MSIS-29 and EDSS scores will help to prevent falls in PwMS. Education of individuals to increase knowledge and awareness is recommended. Financial support policies for those with low income will help to reduce the risk of falls.