Identification of Suicidal Ideation in the Canadian Community Health Survey—Mental Health Component Using Deep Learning

Introduction: Suicidal ideation (SI) is prevalent in the general population, and is a risk factor for suicide. Predicting which patients are likely to have SI remains challenging. Deep Learning (DL) may be a useful tool in this context, as it can be used to find patterns in complex, heterogeneous, and incomplete datasets. An automated screening system for SI could help prompt clinicians to be moreattentive to patients at risk for suicide.Methods: Using the Canadian Community Health Survey - Mental Health Component, we trained a DL model based on 23,859 survey responses to classify patients with and without SI. Models were created to classify both lifetime and last 12 month SI. From 582 possible parameters we produced 96 and 21 feature versions of the models. Models were trained using an undersampling procedure that balanced the training set between SI and non-SI; validation was done on held-out data.Results: For lifetime SI, the 96 feature model had an AUC of 0.79 and the 21 feature model had an AUC of 0.77. For SI in the last 12 months the 96 feature model had an AUC of 0.71 and the 21 feature model had an AUC of 0.68. In addition, sensitivity analyses demonstrated feature relationships in line with existing literature. Discussion: Although requiring further study to ensure clinical relevance and sample generalizability, this study is an initial proof of concept for the use of DL to improve identification of SI. Sensitivity analyses can help improve the interpretability of DL models. This kind of model would help start conversations with patients which could lead to improved care and a reduction in suicidal behavior

Quantifying cognitive deficits in the human immunodeficeincy virus: a Rasch analysis

With a prevalence rate of 30-60%, cognitive deficits are one of the most predominant comorbidities in people with the Human Immunodeficiency Virus1. As a result it is common for patients to present themselves at the clinic reporting problems with their cognition, however these perceived deficits don't always agree with what their screening and neuropsychological tests are reporting2. Patient reported outcomes are poorly understood, and the literature is inconclusive about their clinical significance3, 4. Some studies conclude they are simply a reflection of a patient's affective state instead of a true reflection of a cognitive deficit.3 Understanding this source of information is crucial in a clinical setting where there are an increasing number of patients reporting problems, and neuropsychological testing is costly and time consuming. Therefore the objective of this study was to contribute evidence that the latent construct of cognitive ability does include items from both the patient perspective and neuropsychological test results. More specifically, the goal was to estimate the extent to which items of patient reported cognitive difficulties and items from direct measures of cognition form a unidimensional construct. Using Rasch Measurement Theory, a measure was created containing a total of 26-items, which incorporate both sources of information; that from the patient and that from neuropsychological testing. The measure covers a reasonable spectrum of difficulty, with an excess of items too easy for this sample, and the easiest and hardest items of the measure being items of perceived deficit. This provides preliminary evidence that combining these two sources of information is possible, and with further validation, could allow clinicians to better understand the meaning of perceived deficits.Avec un prévalence de 30 à 60 %, des déficits cognitifs sont parmi les comorbidités les plus importantes chez les personnes atteintes du Virus de l'immunodéficience humaine (VIH)1. En clinique, il est fréquent que les patients se plaignent des problèmes cognitifs, bien que les résultats de leurs examens neuropsychologique ne confirment pas toujours ces plaintes2. Les déterminants de ces plaintes sont mal comprises, et la littérature quant à leur importance clinique n'est pas concluante 3, 4 ; certaines études concluent qu'elles sont le reflet d'un état affectif et non pas un vrai reflet d'un déficit cognitif 3. Une meilleure compréhension de cette source d'information est essentielle dans un environnement clinique où ces plaintes sont de plus en plus fréquentes et les examens neuropsychologiques sont coûteux et long à administrer. L'objectif de cette étude était donc de démontrer qu'un concept latent de capacités cognitives peut inclure à la fois des éléments de la perspective du patient en plus des tests neuropsychologiques. Plus précisément, l'objectif était d'estimer dans quelle mesure les plaintes cognitives et les mesures directes de la cognition forment un concept unidimensionel. En utilisant la théorie de mesure Rasch, une mesure a été créée contenant un total de 26 questions intégrant les deux sources d'information (plaintes du patient et tests cognitifs). La mesure couvre un spectre de difficulté raisonnable, avec un excès d'items trop faciles pour cet échantillon ; et les questions plus faciles et les plus difficiles de la mesure sont des questions du patient. Ceci constitue une preuve préliminaire qu'il est possible de combiner ces deux sources d'information et, avec une validation additionnelle, cette méthode pourrait permettre aux cliniciens de mieux comprendre ce que signifie les déficits rapportés par le patient

Quantifying cognition at the bedside: a novel approach combining cognitive symptoms and signs in HIV

Up to half of all people with HIV infection have some degree of cognitive impairment. This impairment is typically mild, but nonetheless often disabling. Although early detection of cognitive impairment offers the greatest hope of effective intervention, there are important barriers to this goal in most clinical settings. These include uncertainty about how self-reported cognitive symptoms relate to objective impairments, and the paucity of bedside measurement tools suitable for mild deficits. Clinicians need guidance in interpreting cognitive symptoms in this population, and a brief cognitive measurement tool targeted to mild impairment. We addressed these two problems together here. The objective of this study was to determine the extent to which performance on cognitive tests and self-reported cognitive symptoms form a unidimensional construct

A European collaborative study of treatment outcomes in 346 patients with cardiac stage III AL amyloidosis

Treatment outcomes of patients with cardiac stage III light chain (AL) amyloidosis remain poorly studied. Such cases have been excluded from most clinical studies due to perceived dismal prognosis. We report treatment outcomes of 346 patients with stage III AL amyloidosis from the United Kingdom, Italy, Germany, and Greece. Median overall survival (OS) was 7 months with OS at 3, 6, 12, and 24 months of 73%, 55%, 46%, and 29%, respectively; 42% died before first response evaluation. On an intention-to-treat basis, the overall hematologic response rate was 33%, including a complete response rate of 12%. OS rates at 12 and 24 months, respectively, for 201 response evaluable patients were 88% and 85% for complete responders, 74% and 53% for partial responders, and 39% and 22% for nonresponders. Forty-five percent of responders achieved an organ response. Amino-terminal fragment of brain-type natriuretic peptide (NT-proBNP) >8500 ng/L and systolic blood pressure (SBP) <100 mm Hg were the only factors that independently impacted OS and identified an especially poor prognosis subgroup of patients with a median OS of only 3 months. Outcome and organ function of stage III AL amyloidosis without very elevated NT-proBNP and low SBP is improved by a very good hematologic response to chemotherapy