Supporting Acute Appendicitis Diagnosis: A Pre-Clustering-Based Classification Technique

Service quality and cost containment represent two critical challenges in healthcare management. Toward that end, acute appendicitis, a common surgical condition, is important and requires timely, accurate diagnosis. The diverse and atypical symptoms make such diagnoses difficult, thus resulting in increased morbidity and negative appendectomy. While prior research has recognized the use of classification analysis to support acute appendicitis diagnosis, the skewed distribution of the cases pertaining to positive or negative acute appendicitis has significantly constrained the effectiveness of the existing classification techniques. In this study, we develop a pre-clustering-based classification (PCC) technique to address the skewed distribution problem common to acute appendicitis diagnosis. We empirically evaluate the proposed PCC technique with 574 clinical cases of positive and negative acute appendicitis obtained from a tertiary medical center in Taiwan. Our evaluation includes tradition support vector machine, a prevalent resampling classification technique, Alvarado scoring system, and a multi-classifier committee for performance benchmark purposes. Our results show the PCC technique more effective and less biased than the benchmark techniques, without favoring the positive or negative class

Proteomics in cardiovascular disease: recent progress and clinical implication and implementation

Introduction: Although multiple efforts have been initiated to shed light into the molecular mechanisms underlying cardiovascular disease, it still remains one of the major causes of death worldwide. Proteomic approaches are unequivocally powerful tools that may provide deeper understanding into the molecular mechanisms associated with cardiovascular disease and improve its management. Areas covered: Cardiovascular proteomics is an emerging field and significant progress has been made during the past few years with the aim of defining novel candidate biomarkers and obtaining insight into molecular pathophysiology. To summarize the recent progress in the field, a literature search was conducted in PubMed and Web of Science. As a result, 704 studies from PubMed and 320 studies from Web of Science were retrieved. Findings from original research articles using proteomics technologies for the discovery of biomarkers for cardiovascular disease in human are summarized in this review. Expert commentary: Proteins associated with cardiovascular disease represent pathways in inflammation, wound healing and coagulation, proteolysis and extracellular matrix organization, handling of cholesterol and LDL. Future research in the field should target to increase proteome coverage as well as integrate proteomics with other omics data to facilitate both drug development as well as clinical implementation of findings

The use of knowledge discovery databases in the identification of patients with colorectal cancer

Colorectal cancer is one of the most common forms of malignancy with 35,000 new patients diagnosed annually within the UK. Survival figures show that outcomes are less favourable within the UK when compared with the USA and Europe with 1 in 4 patients having incurable disease at presentation as of data from 2000.Epidemiologists have demonstrated that the incidence of colorectal cancer is highest on the industrialised western world with numerous contributory factors. These range from a genetic component to concurrent medical conditions and personal lifestyle. In addition, data also demonstrates that environmental changes play a significant role with immigrants rapidly reaching the incidence rates of the host country.Detection of colorectal cancer remains an important and evolving aspect of healthcare with the aim of improving outcomes by earlier diagnosis. This process was initially revolutionised within the UK in 2002 with the ACPGBI 2 week wait guidelines to facilitate referrals form primary care and has subsequently seen other schemes such as bowel cancer screening introduced to augment earlier detection rates. Whereas the national screening programme is dependent on FOBT the standard referral practice is dependent upon a number of trigger symptoms that qualify for an urgent referral to a specialist for further investigations. This process only identifies 25-30% of those with colorectal cancer and remains a labour intensive process with only 10% of those seen in the 2 week wait clinics having colorectal cancer.This thesis hypothesises whether using a patient symptom questionnaire in conjunction with knowledge discovery techniques such as data mining and artificial neural networks could identify patients at risk of colorectal cancer and therefore warrant urgent further assessment. Artificial neural networks and data mining methods are used widely in industry to detect consumer patterns by an inbuilt ability to learn from previous examples within a dataset and model often complex, non-linear patterns. Within medicine these methods have been utilised in a host of diagnostic techniques from myocardial infarcts to its use in the Papnet cervical smear programme for cervical cancer detection.A linkert based questionnaire of those attending the 2 week wait fast track colorectal clinic was used to produce a ‘symptoms’ database. This was then correlated with individual patient diagnoses upon completion of their clinical assessment. A total of 777 patients were included in the study and their diagnosis categorised into a dichotomous variable to create a selection of datasets for analysis. These data sets were then taken by the author and used to create a total of four primary databases based on all questions, 2 week wait trigger symptoms, Best knowledge questions and symptoms identified in Univariate analysis as significant. Each of these databases were entered into an artificial neural network programme, altering the number of hidden units and layers to obtain a selection of outcome models that could be further tested based on a selection of set dichotomous outcomes. Outcome models were compared for sensitivity, specificity and risk. Further experiments were carried out with data mining techniques and the WEKA package to identify the most accurate model. Both would then be compared with the accuracy of a colorectal specialist and GP.Analysis of the data identified that 24% of those referred on the 2 week wait referral pathway failed to meet referral criteria as set out by the ACPGBI. The incidence of those with colorectal cancer was 9.5% (74) which is in keeping with other studies and the main symptoms were rectal bleeding, change in bowel habit and abdominal pain. The optimal knowledge discovery database model was a back propagation ANN using all variables for outcomes cancer/not cancer with sensitivity of 0.9, specificity of 0.97 and LR 35.8. Artificial neural networks remained the more accurate modelling method for all the dichotomous outcomes.The comparison of GP’s and colorectal specialists at predicting outcome demonstrated that the colorectal specialists were the more accurate predictors of cancer/not cancer with sensitivity 0.27 and specificity 0.97, (95% CI 0.6-0.97, PPV 0.75, NPV 0.83) and LR 10.6. When compared to the KDD models for predicting the same outcome, once again the ANN models were more accurate with the optimal model having sensitivity 0.63, specificity 0.98 (95% CI 0.58-1, PPV 0.71, NPV 0.96) and LR 28.7.The results demonstrate that diagnosis colorectal cancer remains a challenging process, both for clinicians and also for computation models. KDD models have been shown to be consistently more accurate in the prediction of those with colorectal cancer than clinicians alone when used solely in conjunction with a questionnaire. It would be ill conceived to suggest that KDD models could be used as a replacement to clinician- patient interaction but they may aid in the acceleration of some patients for further investigations or ‘straight to test’ if used on those referred as routine patients

Pancreatic cancer : prevention through improved diagnostics in individuals at risk

With the intent of timely detecting malignant precursors or pancreatic cancer (PC) in an early stage, current guidelines recommend surveillance for patients with pancreatic cystic neoplasms (PCNs), such as intraductal papillary mucinous neoplasms (IPMN), and individuals at risk (IAR) for familiar/hereditary pancreatic cancer (PC). This surveillance is mainly performed with magnetic resonance imaging (MRI). However, despite the associated examination time and costs, MRI is still suboptimal regarding its accuracy in predicting malignancy. This thesis aims to contribute towards improved secondary prevention of PC through more efficient and accurate diagnostic methods in patients with IPMN and familiar/hereditary PC through (i) a shorter MRI protocol, (ii) new imaging features and radiomics models for the prediction of malignancy, (iii) a better understanding of the surveillance program for IAR. In Study I, we compared a short (SP) and a comprehensive pancreatic MRI protocol (CP), with an acquisition time of approximately 8 and 35 minutes, respectively, in a cohort of 154 patients with PCNs. Our results showed that the SP provided equivalent clinical information in evaluating mural nodules, as well as cystic and main pancreatic duct diameters, compared to the more time-consuming and expensive CP in the surveillance of PCNs. In Study II, we assessed whether two novel features, such as volumetry and elongation value (EV) and other routinely used resection criteria, could predict malignancy in a cohort of 106 patients operated for BD- and mixed-type IPMN. Cases with mass-forming PC were excluded as a possible cause of main pancreatic duct (MPD) dilatation. Our results showed that volumetry and EV were not predictive for malignancy. Only elevated serum levels of CA19-9, mural nodules and dilated MPD (in the absence of stricturing masses) were associated with malignancy. In Study III, we evaluated the performance of MRI-based radiomics models in the preoperative prediction of malignancy in 130 patients operated for BD and mixed-type IPMN after exclusion of mass-forming PC. The radiomics models were internally cross-validated. Our results showed that a “pure” radiomics model outperformed a model including standard clinical and imaging features, suggesting that it might effectively predict malignancy in BD-IPMN even without standard clinical/imaging information. In Study IV, we described the imaging findings and the performance of a mainly MRI-based surveillance program in a cohort of 278 individuals at risk (IAR) for familial/hereditary PC. Our results showed that focal pancreatic lesions were identified in over half of IAR, the vast majority being small cysts. No lesions with high-grade dysplasia were detected. Five patients had PC, with the same prevalence of stage I and stage IV. The sensitivity and positive predictive values for detecting PC and its precursors were low (60% and 37%, respectively). In conclusion, a short pancreatic MRI protocol can be safely used in the surveillance of PCNs without losing relevant clinical information. Although novel imaging features cannot predict malignancy in IPMN, radiomics have shown its potentiality. In the context of individuals at risk for familial or hereditary PC undergoing surveillance, the early diagnosis of PC is still challenging with “traditional” cross-imaging methods such as MRI

Information technologies for pain management

Millions of people around the world suffer from pain, acute or chronic and this raises the importance of its screening, assessment and treatment. The importance of pain is attested by the fact that it is considered the fifth vital sign for indicating basic bodily functions, health and quality of life, together with the four other vital signs: blood pressure, body temperature, pulse rate and respiratory rate. However, while these four signals represent an objective physical parameter, the occurrence of pain expresses an emotional status that happens inside the mind of each individual and therefore, is highly subjective that makes difficult its management and evaluation. For this reason, the self-report of pain is considered the most accurate pain assessment method wherein patients should be asked to periodically rate their pain severity and related symptoms. Thus, in the last years computerised systems based on mobile and web technologies are becoming increasingly used to enable patients to report their pain which lead to the development of electronic pain diaries (ED). This approach may provide to health care professionals (HCP) and patients the ability to interact with the system anywhere and at anytime thoroughly changes the coordinates of time and place and offers invaluable opportunities to the healthcare delivery. However, most of these systems were designed to interact directly to patients without presence of a healthcare professional or without evidence of reliability and accuracy. In fact, the observation of the existing systems revealed lack of integration with mobile devices, limited use of web-based interfaces and reduced interaction with patients in terms of obtaining and viewing information. In addition, the reliability and accuracy of computerised systems for pain management are rarely proved or their effects on HCP and patients outcomes remain understudied. This thesis is focused on technology for pain management and aims to propose a monitoring system which includes ubiquitous interfaces specifically oriented to either patients or HCP using mobile devices and Internet so as to allow decisions based on the knowledge obtained from the analysis of the collected data. With the interoperability and cloud computing technologies in mind this system uses web services (WS) to manage data which are stored in a Personal Health Record (PHR). A Randomised Controlled Trial (RCT) was implemented so as to determine the effectiveness of the proposed computerised monitoring system. The six weeks RCT evidenced the advantages provided by the ubiquitous access to HCP and patients so as to they were able to interact with the system anywhere and at anytime using WS to send and receive data. In addition, the collected data were stored in a PHR which offers integrity and security as well as permanent on line accessibility to both patients and HCP. The study evidenced not only that the majority of participants recommend the system, but also that they recognize it suitability for pain management without the requirement of advanced skills or experienced users. Furthermore, the system enabled the definition and management of patient-oriented treatments with reduced therapist time. The study also revealed that the guidance of HCP at the beginning of the monitoring is crucial to patients' satisfaction and experience stemming from the usage of the system as evidenced by the high correlation between the recommendation of the application, and it suitability to improve pain management and to provide medical information. There were no significant differences regarding to improvements in the quality of pain treatment between intervention group and control group. Based on the data collected during the RCT a clinical decision support system (CDSS) was developed so as to offer capabilities of tailored alarms, reports, and clinical guidance. This CDSS, called Patient Oriented Method of Pain Evaluation System (POMPES), is based on the combination of several statistical models (one-way ANOVA, Kruskal-Wallis and Tukey-Kramer) with an imputation model based on linear regression. This system resulted in fully accuracy related to decisions suggested by the system compared with the medical diagnosis, and therefore, revealed it suitability to manage the pain. At last, based on the aerospace systems capability to deal with different complex data sources with varied complexities and accuracies, an innovative model was proposed. This model is characterized by a qualitative analysis stemming from the data fusion method combined with a quantitative model based on the comparison of the standard deviation together with the values of mathematical expectations. This model aimed to compare the effects of technological and pen-and-paper systems when applied to different dimension of pain, such as: pain intensity, anxiety, catastrophizing, depression, disability and interference. It was observed that pen-and-paper and technology produced equivalent effects in anxiety, depression, interference and pain intensity. On the contrary, technology evidenced favourable effects in terms of catastrophizing and disability. The proposed method revealed to be suitable, intelligible, easy to implement and low time and resources consuming. Further work is needed to evaluate the proposed system to follow up participants for longer periods of time which includes a complementary RCT encompassing patients with chronic pain symptoms. Finally, additional studies should be addressed to determine the economic effects not only to patients but also to the healthcare system

A Novel Ontology and Machine Learning Driven Hybrid Clinical Decision Support Framework for Cardiovascular Preventative Care

Clinical risk assessment of chronic illnesses is a challenging and complex task which requires the utilisation of standardised clinical practice guidelines and documentation procedures in order to ensure consistent and efficient patient care. Conventional cardiovascular decision support systems have significant limitations, which include the inflexibility to deal with complex clinical processes, hard-wired rigid architectures based on branching logic and the inability to deal with legacy patient data without significant software engineering work. In light of these challenges, we are proposing a novel ontology and machine learning-driven hybrid clinical decision support framework for cardiovascular preventative care. An ontology-inspired approach provides a foundation for information collection, knowledge acquisition and decision support capabilities and aims to develop context sensitive decision support solutions based on ontology engineering principles. The proposed framework incorporates an ontology-driven clinical risk assessment and recommendation system (ODCRARS) and a Machine Learning Driven Prognostic System (MLDPS), integrated as a complete system to provide a cardiovascular preventative care solution. The proposed clinical decision support framework has been developed under the close supervision of clinical domain experts from both UK and US hospitals and is capable of handling multiple cardiovascular diseases. The proposed framework comprises of two novel key components: (1) ODCRARS (2) MLDPS. The ODCRARS is developed under the close supervision of consultant cardiologists Professor Calum MacRae from Harvard Medical School and Professor Stephen Leslie from Raigmore Hospital in Inverness, UK. The ODCRARS comprises of various components, which include: (a) Ontology-driven intelligent context-aware information collection for conducting patient interviews which are driven through a novel clinical questionnaire ontology. (b) A patient semantic profile, is generated using patient medical records which are collated during patient interviews (conducted through an ontology-driven context aware adaptive information collection component). The semantic transformation of patients’ medical data is carried out through a novel patient semantic profile ontology in order to give patient data an intrinsic meaning and alleviate interoperability issues with third party healthcare systems. (c) Ontology driven clinical decision support comprises of a recommendation ontology and a NICE/Expert driven clinical rules engine. The recommendation ontology is developed using clinical rules provided by the consultant cardiologist from the US hospital. The recommendation ontology utilises the patient semantic profile for lab tests and medication recommendation. A clinical rules engine is developed to implement a cardiac risk assessment mechanism for various cardiovascular conditions. The clinical rules engine is also utilised to control the patient flow within the integrated cardiovascular preventative care solution. The machine learning-driven prognostic system is developed in an iterative manner using state of the art feature selection and machine learning techniques. A prognostic model development process is exploited for the development of MLDPS based on clinical case studies in the cardiovascular domain. An additional clinical case study in the breast cancer domain is also carried out for the development and validation purposes. The prognostic model development process is general enough to handle a variety of healthcare datasets which will enable researchers to develop cost effective and evidence based clinical decision support systems. The proposed clinical decision support framework also provides a learning mechanism based on machine learning techniques. Learning mechanism is provided through exchange of patient data amongst the MLDPS and the ODCRARS. The machine learning-driven prognostic system is validated using Raigmore Hospital's RACPC, heart disease and breast cancer clinical case studies

Prediction of persistent post-surgery pain by preoperative cold pain sensitivity : biomarker development with machine-learning-derived analysis

Background. To prevent persistent post-surgery pain, early identification of patients at high risk is a clinical need. Supervised machine-learning techniques were used to test how accurately the patients' performance in a preoperatively performed tonic cold pain test could predict persistent post-surgery pain. Methods. We analysed 763 patients from a cohort of 900 women who were treated for breast cancer, of whom 61 patients had developed signs of persistent pain during three yr of follow-up. Preoperatively, all patients underwent a cold pain test (immersion of the hand into a water bath at 2-4 degrees C). The patients rated the pain intensity using a numerical ratings scale (NRS) from 0 to 10. Supervised machine-learning techniques were used to construct a classifier that could predict patients at risk of persistent pain. Results. Whether or not a patient rated the pain intensity at NRS=10 within less than 45 s during the cold water immersion test provided a negative predictive value of 94.4% to assign a patient to the "persistent pain" group. If NRS=10 was never reached during the cold test, the predictive value for not developing persistent pain was almost 97%. However, a low negative predictive value of 10% implied a high false positive rate. Conclusion. Results provide a robust exclusion of persistent pain in women with an accuracy of 94.4%. Moreover, results provide further support for the hypothesis that the endogenous pain inhibitory system may play an important role in the process of pain becoming persistent.Peer reviewe

Hybrid model for early identification post-Covid-19 sequelae

Artificial Intelligence techniques based on Machine Learning algorithms, Neural Networks and Naïve Bayes can optimise the diagnostic process of the SARS-CoV-2 or Covid-19. The most significant help of these techniques is analysing data recorded by health professionals when treating patients with this disease. Health professionals' more specific focus is due to the reduction in the number of observable signs and symptoms, ranging from an acute respiratory condition to severe pneumonia, showing an efficient form of attribute engineering. It is important to note that the clinical diagnosis can vary from asymptomatic to extremely harsh conditions. About 80% of patients with Covid-19 may be asymptomatic or have few symptoms. Approximately 20% of the detected cases require hospital care because they have difficulty breathing, of which about 5% may require ventilatory support in the Intensive Care Unit. Also, the present study proposes a hybrid approach model, structured in the composition of Artificial Intelligence techniques, using Machine Learning algorithms, associated with multicriteria methods of decision support based on the Verbal Decision Analysis methodology, aiming at the discovery of knowledge, as well as exploring the predictive power of specific data in this study, to optimise the diagnostic models of Covid-19. Thus, the model will provide greater accuracy to the diagnosis sought through clinical observation.info:eu-repo/semantics/publishedVersio

Aerospace medicine and biology: A continuing bibliography with indexes

This bibliography lists 138 reports, articles, and other documents introduced into the NASA scientific and technical information system in Jun. 1980