Prognostic Models in Dengue

Reliable prediction models in dengue would facilitate early identification of patients likely to progress to more severe disease, potentially improving patient management. However, most published studies have limitations with respect to their modelling strategy, sample size, and Chosen clinical outcomes, and to date none have exploited longitudinal data. Moreover, only a few studies have examined outcomes in patients presenting with dengue shock syndrome (DSS), the most severe form of the disease. This thesis aims to overcome these limitations by using two large prospective datasets describing a) 1719 children with established DSS and b) 2598 children hospitalized with dengue. First, the population of children with DSS was characterized, and profound DSS, a composite outcome reflecting the need for intensive supportive care, was established as a suitable outcome for prognostic research in this population. Second, risk factors for profound DSS were identified and included in a robust prediction model. Based on this model, a simple score chart for use in clinical practice was derived. Third, risk factors for progression to DSS among children hospitalized with dengue were identified, and a prognostic model for progression to DSS was carefully developed. However, this model displayed only moderate performance and had limited clinical utility. Lastly, differences between acute and chronic diseases, and the implications for dynamic prediction modeling based on longitudinal data, are discussed. A case study of dynamic prediction modeling for development of DSS suggested that (1) the current platelet count can be used to improve baseline models that rely on enrolment values only, and (2) simple conditional dynamic models displayed similar performance to more complex joint models in this situation

Hospital Capacity Management & Optimization in Covid-19

A hospital is an institute in the healthcare system that provides us with services like patient treatment focusing on specialized medical staff, including doctors, nurses and other healthcare workers, medical equipment, and procedures. The hospital is the first line of defence against any type of illness or a pandemic; it is the sector that has been the most devastated and is the most vulnerable. There are now more than 513 million reported cases of covid worldwide since the epidemic began in December 2019, with even more than 6.2 million casualties. The tremendous rise in cases, which quickly outpaced the restricted infrastructure of many of these hospitals, is among the most serious issues encountered throughout the epidemic. This led to a hospital capacity crisis due to the huge difference in the number of patients and the limited hospital resources. The purpose of this dissertation is to examine all elements and propose advice for dealing with healthcare capacities issues, with a particular emphasis on the covid-19 epidemic. That the very first section of the study is a comprehensive review of literature on healthcare strategic planning. The literature survey includes the challenges faced during the pandemic and the optimization models and techniques related to hospital capacity management. It is followed by analytical research with a data-driven simulation package. It includes picking a resource planning tool most suitable for hospital capacity management. The resource management tool's difficulties and prospects are also highlighted. This would point the way toward incorporating the capacity project management tool into healthcare facilities

DySurv: Dynamic Deep Learning Model for Survival Prediction in the ICU

Survival analysis helps approximate underlying distributions of time-to-events which in the case of critical care like in the ICU can be a powerful tool for dynamic mortality risk prediction. Extending beyond the classical Cox model, deep learning techniques have been leveraged over the last years relaxing the many constraints of their counterparts from statistical methods. In this work, we propose a novel conditional variational autoencoder-based method called DySurv which uses a combination of static and time-series measurements from patient electronic health records in estimating risk of death dynamically in the ICU. DySurv has been tested on standard benchmarks where it outperforms most existing methods including other deep learning methods and we evaluate it on a real-world patient database from MIMIC-IV. The predictive capacity of DySurv is consistent and the survival estimates remain disentangled across different datasets supporting the idea that dynamic deep learning models based on conditional variational inference in multi-task cases can be robust models for survival analysis

Machine learning approaches to optimise the management of patients with sepsis

The goal of this PhD was to generate novel tools to improve the management of patients with sepsis, by applying machine learning techniques on routinely collected electronic health records. Machine learning is an application of artificial intelligence (AI), where a machine analyses data and becomes able to execute complex tasks without being explicitly programmed. Sepsis is the third leading cause of death worldwide and the main cause of mortality in hospitals, but the best treatment strategy remains uncertain. In particular, evidence suggests that current practices in the administration of intravenous fluids and vasopressors are suboptimal and likely induce harm in a proportion of patients. This represents a key clinical challenge and a top research priority. The main contribution of the research has been the development of a reinforcement learning framework and algorithms, in order to tackle this sequential decision-making problem. The model was built and then validated on three large non-overlapping intensive care databases, containing data collected from adult patients in the U.S.A and the U.K. Our agent extracted implicit knowledge from an amount of patient data that exceeds many-fold the life-time experience of human clinicians and learned optimal treatment by having analysed myriads of (mostly sub-optimal) treatment decisions. We used state-of-the-art evaluation techniques (called high confidence off-policy evaluation) and demonstrated that the value of the treatment strategy of the AI agent was on average reliably higher than the human clinicians. In two large validation cohorts independent from the training data, mortality was the lowest in patients where clinicians’ actual doses matched the AI policy. We also gained insight into the model representations and confirmed that the AI agent relied on clinically and biologically meaningful parameters when making its suggestions. We conducted extensive testing and exploration of the behaviour of the AI agent down to the level of individual patient trajectories, identified potential sources of inappropriate behaviour and offered suggestions for future model refinements. If validated, our model could provide individualized and clinically interpretable treatment decisions for sepsis that may improve patient outcomes.Open Acces

Mortality prediction models in the adult critically ill : A scoping review

Background Mortality prediction models are applied in the intensive care unit (ICU) to stratify patients into different risk categories and to facilitate benchmarking. To ensure that the correct prediction models are applied for these purposes, the best performing models must be identified. As a first step, we aimed to establish a systematic review of mortality prediction models in critically ill patients. Methods Mortality prediction models were searched in four databases using the following criteria: developed for use in adult ICU patients in high-income countries, with mortality as primary or secondary outcome. Characteristics and performance measures of the models were summarized. Performance was presented in terms of discrimination, calibration and overall performance measures presented in the original publication. Results In total, 43 mortality prediction models were included in the final analysis. In all, 15 models were only internally validated (35%), 13 externally (30%) and 10 (23%) were both internally and externally validated by the original researchers. Discrimination was assessed in 42 models (98%). Commonly used calibration measures were the Hosmer-Lemeshow test (60%) and the calibration plot (28%). Calibration was not assessed in 11 models (26%). Overall performance was assessed in the Brier score (19%) and the Nagelkerke's R-2 (4.7%). Conclusions Mortality prediction models have varying methodology, and validation and performance of individual models differ. External validation by the original researchers is often lacking and head-to-head comparisons are urgently needed to identify the best performing mortality prediction models for guiding clinical care and research in different settings and populations.Peer reviewe