Predicting Clinical Events by Combining Static and Dynamic Information Using Recurrent Neural Networks

In clinical data sets we often find static information (e.g. patient gender, blood type, etc.) combined with sequences of data that are recorded during multiple hospital visits (e.g. medications prescribed, tests performed, etc.). Recurrent Neural Networks (RNNs) have proven to be very successful for modelling sequences of data in many areas of Machine Learning. In this work we present an approach based on RNNs, specifically designed for the clinical domain, that combines static and dynamic information in order to predict future events. We work with a database collected in the Charit\'{e} Hospital in Berlin that contains complete information concerning patients that underwent a kidney transplantation. After the transplantation three main endpoints can occur: rejection of the kidney, loss of the kidney and death of the patient. Our goal is to predict, based on information recorded in the Electronic Health Record of each patient, whether any of those endpoints will occur within the next six or twelve months after each visit to the clinic. We compared different types of RNNs that we developed for this work, with a model based on a Feedforward Neural Network and a Logistic Regression model. We found that the RNN that we developed based on Gated Recurrent Units provides the best performance for this task. We also used the same models for a second task, i.e., next event prediction, and found that here the model based on a Feedforward Neural Network outperformed the other models. Our hypothesis is that long-term dependencies are not as relevant in this task

Standardisierte Messung des Alkoholgebrauchs: Übersetzung, kulturelle Adaptation und kognitive Testung der Alkohol-Itembank der Patient-Reported Outcomes Measurement Information System (PROMIS®) Initiative

Backround: Patient-reported outcomes (PROs) are all ready established in many areas and are becoming increasingly important. In 2004, National Institutes of Health cross funded the PROMIS®-initiative in the United States. The goal was or rather is the standardization of PRO measuring instruments and to establish them on an international level. Thus, comparable and valid instruments were developed to be used flexibly and integratively. For an international use the translation of the English instruments is a requirement. The important area for recording alcohol consumption is not yet available in German. This work deals with the translation, cultural adaptation and cognitive testing of the alcohol item bank. Method: The translation process was based on the specifications of the PROMIS®-initiative, which takes internationally recognized recommendations into account. The individual steps include forward and backward translation, interlingual adaptation, cognitive debriefings and reviews by appropriate experts. The required cognitive debriefings were carried out on 15 patients for whom an alcohol diagnosis had been coded in the last two years. Results: The complete PROMIS®-itembank V1.0 - Alcohol use with its 108 items and a screening question was successfully translated into German. The main part, approx. 70 % of the items, was easy to translate. Difficulties in the translation process arose due to idiomatic expressions, colloquial language or different tenses. In the further course, 10 items had to be adapted as a result of the cognitive debriefings. Conclusion: The alcohol item bank of the PROMIS®-initiative is now available in German-speaking countries. According to the PROMIS® Maturity Model the translation can now be use for empirical studies and further psychometric evaluation.Hintergrund: Messinstrumente zur Erfassung von patientenberichteten Endpunkten (patient-reported outcomes, PROs) sind bereits in vielen Bereichen etabliert und nehmen an Bedeutung zu. Im Jahr 2004 wurde in den USA gemeinsam durch alle National Institutes of Health die PROMIS®-Initiative ins Leben gerufen. Ziel war bzw. ist die Standardisierung von PRO-Messinstrumenten und diese auf internationaler Ebene zu etablieren. Somit soll ein vergleichbares und valides Messsystem entstehen, welches flexibel und integrativ eingesetzt werden kann. Die Übersetzung der englischsprachigen Messinstrumente ist dafür eine der Voraussetzungen. Der Bereich zur Erfassung des Alkoholkonsums stand in deutscher Sprache bislang noch nicht zu Verfügung. Somit befasst sich diese Arbeit mit der Übersetzung, kulturellen Adaptation und kognitiven Testung der Alkohol-Itembank. Methoden: Der Übersetzungsprozess richtete sich nach den Vorgaben der PROMIS®-Initiative, welche international anerkannte Empfehlungen berücksichtigt. Dabei beinhalten die einzelnen Schritte unter anderem eine Vorwärts- und Rückübersetzung, eine interlinguale Anpassung, kognitive Debriefings sowie die jeweilige Überprüfung durch entsprechende Experten. Die erforderlichen kognitiven Debriefings erfolgten an 15 Probanden, bei denen in den letzten zwei Jahren eine Diagnose für Alkoholerkrankungen verschlüsselt wurde. Ergebnisse: Die komplette PROMIS®-Itembank V1.0 – Alcohol use mit 108 Items und einer Screening-Frage wurde erfolgreich in die deutsche Sprache übersetzt. Dabei zeigte sich der Hauptteil (ca. 70 % der Items) als leicht zu übersetzten. Schwierigkeiten im Rahmen des Übersetzungsprozesses ergaben sich unter anderem durch Redewendungen, Umgangssprache oder unterschiedliche Zeitformen. Im weiteren Verlauf mussten infolge der kognitiven Debriefings 10 Items abschließend angepasst werden. Fazit: Die Alkohol-Itembank der PROMIS®-Initiative steht nun dem deutschsprachigen Raum zur Verfügung und kann entsprechend dem PROMIS® Maturity Model ab sofort verwendet werden. Die empirische Validität wird sich in den Folgestudien zeigen

Einflussfaktoren auf das Outcome nach Nierentransplantation

Diese Habilitationsarbeit entwickelt Konzepte zur Erweiterung des Donor-Pools und zur Verbesserung des Langzeit-Transplantatüberlebens. Eine Kompensation der sinkenden Zahl von post mortem Spenden kann nicht nur durch eine Steigerung der Lebendspenden, sondern auch durch eine kluge Nutzung von marginalen Spendernieren, durch eine optimale Allokation mit dem besten immunologischen und funktionellem Match und durch eine individuelle Transplantationsnachsorge insbesondere der Risikopatienten erreicht werden

Lotne związki organiczne (VOCs) w wydychanym powietrzu pacjentek z rakiem piersi w warunkach klinicznych

Background: Carcinogenic products in the exhaled breath of cancer patients are of growing medical interest as they can serve as noninvasive disease markers. Breath analysis can be used as an alternative or complementary diagnostic tool in breast cancer patients who have a different pattern of chemical composition in their breath. This study aims to verify the existence of specific volatile organic compounds (VOCs) in the breath of breast cancer patients. Methods: This prospective study included ten patients suffering from breast cancer and ten healthy pair-matched women. Breath samples of each member of the two respective groups were taken and scanned by gas chromatography/mass spectometry for the presence of volatile organic compounds such as alkanes, ketones, halogenated hydrocarbon, aldehydes, and esters. Results: The spectrum of VOCs differed significantly within the two groups. Five specific VOCs could be identified as typical discriminatory markers in the breath samples. Four VOCs were elevated in the healthy controls, one specific VOC was found to be elevated in women affected by breast cancer. Conclusions: This pilot study revealed a specific VOC pattern using gas chromatography in the breath of breast cancer patients. Five specific breast cancer-VOCs were identified. At relatively low cost the identification of VOCs may be used to detect breast cancer.Streszczenie Cel: Coraz bardziej rośnie zainteresowanie medycyny produktami karcinogenezy w wydychanym powietrzu pacjentów chorych na raka jako możliwych nieinwazyjnych markerów choroby. Analiza powietrza wydychanego może być wykorzystana jako alternatywne lub pomocnicze narzędzie w raku piersi u pacjentek, które mają odmienny skład chemiczny oddechu. Celem tego badania była weryfikacja obecności lotnych związków organicznych (VOCs) w wydychanym powietrzu pacjentek z rakiem piersi. Metoda: Przeprowadzono prospektywne badanie, do którego włączono 10 pacjentek cierpiących na raka piersi i 10 zdrowych dobranych do pary kobiet. Pobrano próbki wydychanego powietrza od każdego uczestnika badania i poddano gazowej chromatografii/spektrometrii masowej na obecność następujących lotnych związków organicznych: alkanów, ketonów, halogenowanych wodorowęglanów, aldehydów i estrów. Wyniki: Spektrum VOCs różniło się istotnie w obu grupach. Pięć specyficznych VOCs zdefiniowano jako typowe markery w wydychanych próbkach. Cztery VOCs były podwyższone w grupie kontrolnej, natomiast jeden specyficzny VOC był podwyższony w grupie kobiet z rakiem piersi. Wnioski: To badanie pilotażowe, przy pomocy gazowej chromatografii, wykazało specyficzny wzór VOC w wydychanym powietrzu u pacjentek chorych na raka piersi. Zidentyfikowano pięć specyficznych dla raka piersi VOCs. Przy relatywnie niskich kosztach identyfikacja VOCs może być wykorzystana do wykrywania raka piersi

Innovative moments in low-intensity, telephone-based cognitive-behavioral therapy for depression

BackgroundInnovative moments (IMs), defined as moments in psychotherapy when patients’ problematic patterns change toward more elaborated and adaptive patterns, have been shown to be associated with a clinical change in patients with depression. Thus, far IMs have been studied in face-to-face settings but not in telephone-based cognitive-behavioral therapy (t-CBT). This study investigates whether IMs occur in t-CBT and examines the association between IMs and symptom improvement, and reconceptualization and symptom improvement.MethodsThe therapy transcripts of n = 10 patients with mild to moderate depression (range: 7–11 sessions, in total 94 sessions) undergoing t-CBT were qualitatively and quantitatively analyzed. Symptom severity (Patient Health Questionnaire-9) and IMs (levels and proportions) were assessed for each therapy session. Hierarchical linear models were used to test the prediction models.ResultsThe rating of IMs was shown to be feasible and reliable using the Innovative Moments Coding System (IMCS) (84.04% agreement in words coded), which is indicative of the applicability of the concept of IMs in t-CBT. Only reconceptualization IMs were shown to have a predictive value for treatment success (R$^{2}$ = 0.05, p = 0.01).DiscussionThe results should be interpreted with caution due to the exploratory nature of this study. Due to the telephone setting, it was necessary to adapt the IMCS. Nonetheless, the extent of IMs identified in the low-intensity t-CBT investigated was comparable to IMs in face-to-face therapy. Further studies are needed to clarify the association between IMs and treatment success as a change process, especially for low-intensity treatments

Innovative moments in low-intensity, telephone-based cognitive-behavioral therapy for depression.

BACKGROUND Innovative moments (IMs), defined as moments in psychotherapy when patients' problematic patterns change toward more elaborated and adaptive patterns, have been shown to be associated with a clinical change in patients with depression. Thus, far IMs have been studied in face-to-face settings but not in telephone-based cognitive-behavioral therapy (t-CBT). This study investigates whether IMs occur in t-CBT and examines the association between IMs and symptom improvement, and reconceptualization and symptom improvement. METHODS The therapy transcripts of n = 10 patients with mild to moderate depression (range: 7-11 sessions, in total 94 sessions) undergoing t-CBT were qualitatively and quantitatively analyzed. Symptom severity (Patient Health Questionnaire-9) and IMs (levels and proportions) were assessed for each therapy session. Hierarchical linear models were used to test the prediction models. RESULTS The rating of IMs was shown to be feasible and reliable using the Innovative Moments Coding System (IMCS) (84.04% agreement in words coded), which is indicative of the applicability of the concept of IMs in t-CBT. Only reconceptualization IMs were shown to have a predictive value for treatment success (R2 = 0.05, p = 0.01). DISCUSSION The results should be interpreted with caution due to the exploratory nature of this study. Due to the telephone setting, it was necessary to adapt the IMCS. Nonetheless, the extent of IMs identified in the low-intensity t-CBT investigated was comparable to IMs in face-to-face therapy. Further studies are needed to clarify the association between IMs and treatment success as a change process, especially for low-intensity treatments

Acceptance of E-Mental Health Services for Different Application Purposes Among Psychotherapists in Clinical Training in Germany and Switzerland: Secondary Analysis of a Cross-Sectional Survey

Background: Despite solid evidence supporting the efficacy of electronic mental health (EMH) services, their acceptance among psychotherapists is limited and uptake rates remain low. However, the acceptance of different EMH services has yet barely been examined in future generations of psychotherapists in a differentiated manner. The aims of this study were (1) to elaborate the intention to use various EMH services for different application purposes and (2) to determine predictors of EMH service acceptance among psychotherapists in clinical training (PiT). Materials and Methods: Our paper is based on a secondary data analysis of a cross-sectional survey. Respondents were recruited via recognized educational institutions for psychotherapy within Germany and the German-speaking part of Switzerland between June and July of 2020. The survey contained items on the intention to use different EMH services (i.e., guided and unguided programs, virtual reality, psychotherapy by telephone and videoconference) for various application purposes (i.e., prevention, treatment addition, treatment substitute, aftercare). Potential predictors of EMH service acceptance (e.g., barriers and advantages) were examined based on an extension of the Unified Theory of Acceptance and Use of Technology (UTAUT). Results: Most of the n = 216 respondents were female (88.4%) and located in Germany (72.2%). General acceptance of EMH was moderate (M = 3.4, SD = 1.12, range 1–5), while acceptance of psychotherapy via videoconference was highest (M = 3.7, SD = 1.15) and acceptance of unguided programs was lowest (M = 2.55, SD = 1.14). There was an interaction effect of EMH service and application purpose (η2 = 0.21). Barriers and advantages both had a uniform influence on EMH service acceptance (Pr > 0.999), while impersonality, legal concerns, concerns about therapeutic alliance, simplified information provision, simplified contact maintenance, time flexibility, and geographic flexibility were significant predictors (all p 0.999). Conclusions: The intention to use different EMH services varied between application purposes among PiT. To increase acceptance of EMH services and reduce misconceptions, we identified predictors that should be addressed in future acceptance-facilitating interventions when educating PiT

Gesunde Ärztinnen und Ärzte für eine gesunde Versorgung

Einführung In den letzten Jahren ist das Wohlbefinden der Ärzteschaft vermehrt in den Vordergrund gerückt. Dies unter anderem, weil Ärztinnen und Ärzte ein höheres Risiko für psychische Erkrankungen, Suizid und stressbedingte Probleme haben als die Allgemeinbevölkerung [1–3]. Die Arbeitsbedingungen der Ärzteschaft ist seit Jahren geprägt von langen Schichten, Konkurrenzkampf und Leistungsdruck [4]. Dabei haben stressbedingte Erkrankungen wie beispielweise Burnout nicht nur eine Auswirkung auf das betroffene Individuum, sondern auch auf die Versorgungsqualität, die Arbeitssicherheit und die Zufriedenheit der Patientinnen und Patienten [5]. Dies zeigt sich im Spital beispielhaft durch mehr vermeidbare Fehler und eine höhere Mortalitätsrate der Patientinnen und Patienten [6]. Ausserdem kann es sein, dass Ärztinnen und Ärzte stressbedingt ausfallen oder im schlimmsten Fall den Beruf aufgeben [7], was das Gesundheitssystem vor ernsthafte Herausforderungen stellt [8]. Durch COVID-19 hat sich diese Problematik noch verschärft, aber auch an Bedeutung gewonnen, und daher wird dem ärztlichen Wohlbefinden vermehrt Aufmerksamkeit geschenkt [9, 10]