Greg, ML – Machine Learning for Healthcare at a Scale

This paper introduces the Greg, ML platform, a machine-learning engine and toolset conceived to generate automatic diagnostic suggestions based on patient profiles. Greg, ML departs from many other experiences in machine learning for healthcare in the fact that it was designed to handle a large number of different diagnoses, in the order of the hundreds. We discuss the architecture that stands at the core of Greg, ML, designed to handle the complex challenges posed by this ambitious goal, and confirm its effectiveness with experimental results based on the working prototype we have developed. Finally, we discuss challenges and opportunities related to the use of this kind of tools in medicine, and some important lessons learned while developing the tool. In this respect, we underline that Greg, ML should be conceived primarily as a support for expert doctors in their diagnostic decisions, and can hardly replace humans in their judgment

Dietary acrylamide and physical performance tests: a cross-sectional analysis

Background- Dietary acrylamide is found in certain foods, such as deep frying, baking and roasting, and is associated with higher inflammatory and oxidative stress parameters. The association between dietary acrylamide and physical performance has not yet been explored. The aim of the study was to investigate the relationship between dietary acrylamide intake and physical performance tests in a large cohort of North American individuals affected by knee osteoarthritis or at high risk for this condition. Methods- Dietary acrylamide intake was obtained through a food frequency questionnaire and reported in quartiles and as an increase in deciles. Physical performance was explored using the 20-meter usual pace test, the 400-meter walking distance, and the chair stands time. The association between dietary acrylamide and physical performance tests was explored using linear regression analysis, adjusted for potential confounders. Results- 4,436 participants (2,578 women, mean age: 61.3) were enrolled. People in the highest quartile of dietary acrylamide reported significantly longer 20-meter walking (15.53±3.32 vs. 15.15±2.91 s), 400-meter walking (312±54 vs. 305±58 s) and chair stands (11.36±4.08 vs. 10.67±3.50 s) times than their counterparts in Q1. In adjusted linear regression analyses, each increase in one decile in dietary acrylamide was associated with a longer time in walking for 20 meters (beta = 0.032; 95%CI: 0.016–0.048; p = 0.04), 400 meters (beta = 0.048; 95%CI: 0.033–0.063; p = 0.002) and chair stands (beta = 0.016; 95%CI: 0.005–0.037; p = 0.04) times. Conclusion- Higher dietary acrylamide intake was significantly associated with poor physical performance, also after accounting for potential confounders, suggesting a role for this food contaminant as a possible risk factor for sarcopenia

Greg, ML: Automatic diagnostic suggestions humanity is overrated. Or not

Recently machine-learning techniques have been applied in a variety of fields. One of the most promising and challenging is handling medical records. In this paper we present Greg, ML, a machine-learning tool for generating automatic diagnostic suggestions based on patient profiles. At the core of our system there are two machine learning classifiers: a natural-language module that handles reports of instrumental exams, and a profile classifier that outputs diagnostic suggestions to the doctor. After discussing the architecture we present some experimental results based on the working prototype we have developed. Finally, we examine challenges and opportunities related to the use of this kind of tools in medicine, and some important lessons learned developing the tool. In this respect, despite the ironic title of this paper, we underline that Greg should be conceived primarily as a support for expert doctors in their diagnostic decisions, and can hardly replace humans in their judgment

Validation of Abbreviated Form of the Multidimensional Prognostic Index (MPI): The BRIEF-MPI Project

Purpose: To screen multidimensional frailty in older people, using a comprehensive geriatric assessment (CGA) tool such as the multidimensional prognostic index (MPI), is a public health priority. Unfortunately, the screening tools available are not able to capture multidimensional frailty. In this work, we aimed to evaluate in a population of hospitalized and ambulatory older patients, the agreement between an abbreviated form of the MPI (ie, BRIEF-MPI) and the standard/full version. Participants and Methods: All participants included in the study completed both versions of the MPI, brief and full, which share the following domains: 1) basic and 2) instrumental activities of daily living, 3) mobility/risk of pressure sores, 4) cognition, 5) nutrition, 6) comorbidity, 7) social and 8) number of medications. The agreement between the two instruments was reported using either the mean comparisons with a t-test matched sample, a simple correlation analysis and the Bland???Altman methodology. Results: The study sample included 110 participants (mean age=83.2 years, 51.8% women). The mean difference was statistically and clinically irrelevant (mean difference=0.01??0.10; p=0.27). The correlation between brief and full MPI versions was optimal (R=0.82, p 0.0001). Using the Bland???Altman methodology, we observed that only three participants over 110 (=2.73%) were outside the limits of agreement. The accuracy of BRIEF-MPI in predicting multidimensional frailty, as full MPI 0.66, was optimal (area under the curve=0.92, p<0.0001). A BRIEF-MPI value of 0.59 yielded the highest sensitivity and specificity in predicting multidimensional frailty. Conclusion: BRIEF-MPI had a good agreement with the full/standard version of the MPI, making this tool as ideal for the screening of multidimensional frailty in older people

Suicide risk in caregivers of people with dementia: a systematic review and meta-analysis

Background- Interest in physical and mental health outcomes in caregivers of patients with dementia is increasing. However, there is limited data available on the prevalence of suicidal ideation, suicidal attempts, and suicide rates among caregivers of those with dementia. Therefore, we aimed to systematically review these outcomes to address this gap in the literature and thus provide information to inform future policy and intervention for the benefit of caregivers of dementia patients. Methods- We searched several databases from inception to the 10th November 2021, for studies investigating suicidal ideation, suicidal attempts, and suicide rates of caregivers of patients with dementia. We report data regarding suicidal ideation as prevalence, with the 95% confidence intervals (CIs), applying a random-effect model; since less than three studies were available for suicide attempt and suicide, these data are reported descriptively. Results- Among 194 articles, eight comprising 1,209 informal caregivers of people with dementia (mean age: 63.9 years, 74% females) were included. The prevalence of suicide ideation was 32.32% (95% CI: 16.01–48.64%; I2 = 98.5%, p < 0.0001). The prevalence of suicide ideation varied between studies from 4.69% to 77.78%. Two studies reported the rate of suicidal attempt in caregivers of patients with dementia, with the prevalence ranging from 5.9% to 16.1%. One study reported one in 17 caregivers of patients with dementia died by suicide. Conclusions- The prevalence of suicide ideation is high, affecting several caregivers of patients with dementia. These findings suggest intervention and/or policy are urgently needed to address suicidal behavior in this at-risk population

Suicide risk in caregivers of people with dementia: a systematic review and meta-analysis

Background Interest in physical and mental health outcomes in caregivers of patients with dementia is increasing. However, there is limited data available on the prevalence of suicidal ideation, suicidal attempts, and suicide rates among caregivers of those with dementia. Therefore, we aimed to systematically review these outcomes to address this gap in the literature and thus provide information to inform future policy and intervention for the benefit of caregivers of dementia patients. Methods We searched several databases from inception to the 10(th) November 2021, for studies investigating suicidal ideation, suicidal attempts, and suicide rates of caregivers of patients with dementia. We report data regarding suicidal ideation as prevalence, with the 95% confidence intervals (CIs), applying a random-effect model; since less than three studies were available for suicide attempt and suicide, these data are reported descriptively. Results Among 194 articles, eight comprising 1,209 informal caregivers of people with dementia (mean age: 63.9 years, 74% females) were included. The prevalence of suicide ideation was 32.32% (95% CI: 16.01-48.64%; I-2 = 98.5%, p &lt; 0.0001). The prevalence of suicide ideation varied between studies from 4.69% to 77.78%. Two studies reported the rate of suicidal attempt in caregivers of patients with dementia, with the prevalence ranging from 5.9% to 16.1%. One study reported one in 17 caregivers of patients with dementia died by suicide. Conclusions The prevalence of suicide ideation is high, affecting several caregivers of patients with dementia. These findings suggest intervention and/or policy are urgently needed to address suicidal behavior in this at-risk population

Association between multidimensional prognostic index (MPI) and infections in a population of older people affected by COVID-19

Background: Only limited studies analyzed a possible relationship between frailty and infections. Our aim was to investigate the possible association between higher multidimensional prognostic index (MPI) values, a tool for evaluating multidimensional frailty, and the prevalence of infectious diseases, including antibiotics' cost and the prevalence of MDR (multidrug resistance) pathogens. Methods: Older patients, affected by COVID-19, were enrolled in the hospital of Palermo over four&nbsp;months. Results: 112 participants (mean age 77.6, 55.4% males) were included. After adjusting for potential confounders, frailer participants had a higher odds of any positivity to pathogens (prevalence: 61.5%, odds ratio = 15.56, p &lt; 0.0001) compared to a prevalence of 8.6% in more robust, including MDR, and a higher costs in antibiotics. Conclusions: Higher MPI values, indicating frailer subjects, were associated with a higher prevalence of infections, particularly of MDR pathogens, and a consequent increase in antibiotics' cost

Validation of a Brief Form of the Self-Administered Multidimensional Prognostic Index: The SELFY-BRIEF-MPI Project

In clinical practice, self-administered and brief tools to promptly identify older people at risk of frailty are required. The Multidimensional Prognostic Index (MPI), derived from the Comprehensive Geriatric Assessment (CGA) seems reliable enough to serve this purpose, but despite the several versions developed over the past 15 years, it lacks a self-administered and brief version. In this study, we aimed to evaluate the agreement between an abbreviated form of the SELFY-MPI (i.e., SELFY-BRIEF-MPI) and the standard version of the MPI. Four Italian hospitals consecutively enrolled outpatients and inpatients >65 years. The sample included 105 participants (mean age = 78.8 years, 53.3% females). Overall, the two versions showed non-statistically significant differences (Standard-MPI 0.42 ± 0.19 vs.. SELFY-BRIEF-MPI 0.41 ± 0.18; p = 0.104) and a very strong correlation (R = 0.86, p 0.66) was optimal (area under the curve, AUC = 0.90, p < 0.001). To predict multidimensional frailty, a SELFY-BRIEF-MPI score of 0.60 exhibited the greatest sensitivity/specificity ratio. In conclusion, the SELFY-BRIEF-MPI reported a good agreement with the standard version of the MPI, indicating its application in the screening of multidimensional frailty among older people