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"Clinical classification"
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Clinical text classification with rule-based features and knowledge-guided convolutional neural networks
Background
Clinical text classification is an fundamental problem in medical natural language processing. Existing studies have cocnventionally focused on rules or knowledge sources-based feature engineering, but only a limited number of studies have exploited effective representation learning capability of deep learning methods.
Methods
In this study, we propose a new approach which combines rule-based features and knowledge-guided deep learning models for effective disease classification. Critical Steps of our method include recognizing trigger phrases, predicting classes with very few examples using trigger phrases and training a convolutional neural network (CNN) with word embeddings and Unified Medical Language System (UMLS) entity embeddings.
Results
We evaluated our method on the 2008 Integrating Informatics with Biology and the Bedside (i2b2) obesity challenge. The results demonstrate that our method outperforms the state-of-the-art methods.
Conclusion
We showed that CNN model is powerful for learning effective hidden features, and CUIs embeddings are helpful for building clinical text representations. This shows integrating domain knowledge into CNN models is promising.
Journal Article
A new understanding of ADHD in children and adults : executive function impairments
\"For over 100 years, ADHD has been seen as essentially a behavior disorder. Recent scientific research has developed a new paradigm which recognizes ADHD as a developmental disorder of the cognitive management system of the brain, its executive functions. This cutting-edge book pulls together key ideas of this new understanding of ADHD, explaining them and describing in understandable language scientific research that supports this new model. It addresses questions like: - Why can those with ADHD focus very well on some tasks while having great difficulty in focusing on other tasks they recognize as important? - How does brain development and functioning of persons with ADHD differ from others?- How do impairments of ADHD change from childhood through adolescence and in adulthood?- What treatments help to improve ADHD impairments? How do they work? Are they safe?- Why do those with ADHD have additional emotional, cognitive, and learning disorders more often than most others?- What commonly-held assumptions about ADHD have now been proven wrong by scientific research?Psychiatrists, psychologists, social workers, and other medical and mental health professionals, as well as those affected by ADHD and their families, will find this to be am insightful and invaluable resource\"-- Provided by publisher.
BOOK
Analysis of dengue cases and severity classifications in Cavite Province, Philippines
Background & objectives: Dengue is considered endemic in many countries in the world including the Philippines, and factors associated with dengue infections have not been adequately explored in the Philippines. The aim of this study was to assess demographic and location-related factors associated with different classifications of dengue: mild dengue, dengue fever, and hemorrhage dengue fever.
Methods: This study used consolidated dengue reports of 18482 individual cases from the Provincial Hospital (PH) of Cavite province from 2009-2014 and clinical classifications of dengue used by the Philippine Integrated Disease Surveillance and Response (PIDSR). Multinomial logistic regression and marginal effects were used to analyze factors associated with different dengue classifications.
Results: Living in densely populated cities and municipalities, individuals aged 19 years and below, and being female were closely associated with severe dengue (DHF) type, while being male and older (above 19 years old) decreased the risk of contracting severe dengue.
Interpretation & conclusion: Our study provides a preliminary assessment of association between demographic factors (gender and age-group), locations (municipalities and cities); and three classifications of dengue (mild, moderate, and severe) in Cavite province in the Philippines. To establish whether dengue is linked to populated areas, age and gender will require further assessments.
Journal Article
Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future
Recently, the International Association for the Study of Pain (IASP) released clinical criteria and a grading system for nociplastic pain affecting the musculoskeletal system. These criteria replaced the 2014 clinical criteria for predominant central sensitization (CS) pain and accounted for clinicians’ need to identify (early) and correctly classify patients having chronic pain according to the pain phenotype. Still, clinicians and researchers can become confused by the multitude of terms and the variety of clinical criteria available. Therefore, this paper aims at (1) providing an overview of what preceded the IASP criteria for nociplastic pain (‘the past’); (2) explaining the new IASP criteria for nociplastic pain in comparison with the 2014 clinical criteria for predominant CS pain (‘the present’); and (3) highlighting key areas for future implementation and research work in this area (‘the future’). It is explained that the 2021 IASP clinical criteria for nociplastic pain are in line with the 2014 clinical criteria for predominant CS pain but are more robust, comprehensive, better developed and hold more potential. Therefore, the 2021 IASP clinical criteria for nociplastic pain are important steps towards precision pain medicine, yet studies examining the clinimetric and psychometric properties of the criteria are urgently needed.
Journal Article
Development and Validation of an Indicator System for Evaluating Clinical Nursing Process Quality Using Mobile Nursing Information Systems
This study aimed to develop and validate a standardized indicator system to assess clinical nursing process quality, leveraging a mobile nursing information system to enhance care efficiency and safety.
A Delphi method was employed, with indicator weights assigned via a precedence ordering chart. Data from three distinct clinical departments were analyzed to test the system, focusing on 20 indicators spanning assessment, execution, guidance, and management domains.
Both rounds of expert consultation achieved 100% response rates, with high authority coefficients (0.89 and 0.90). Kendall's concordance coefficients indicated moderate agreement among experts (W = 0.21, P < 0.05; W = 0.129, P < 0.05). The mean importance scores for each indicator ranged from 3.85 to 5.00, with coefficients of variation ranging from 0.00 to 0.24. The final system included 4 primary indicators (assessment [weight: 0.438], execution [0.313], guidance [0.125], management [0.125]) and 44 secondary indicators. Significant variations emerged across departments. One department demonstrated significantly lower execution rates for subcutaneous, intradermal, intramuscular, and intravenous injections, nebulization inhalation, oral medication, and intravenous infusion compared to the other two departments (
< 0.05). Similarly, another department exhibited a significantly lower rate of timely submission of blood, urine, stool, and sputum specimens compared to the other departments (
< 0.05).
The indicator system developed for evaluating the quality of clinical nursing processes within a mobile nursing information system demonstrated scientific reliability and validity, with appropriately assigned indicator weights. This system shows promise as a potentially effective means of evaluating the quality of clinical nursing processes. Future research could build on the results of this study to further validate the timeliness and objectivity of this indicator system in assessing the quality of the nursing process.
Journal Article
Assessment of Spinal and Pelvic Kinematics Using Inertial Measurement Units in Clinical Subgroups of Persistent Non-Specific Low Back Pain
Inertial measurement units (IMUs) offer a portable and quantitative solution for clinical movement analysis. However, their application in non-specific low back pain (NSLBP) remains underexplored. This study compared the spine and pelvis kinematics obtained from IMUs between individuals with and without NSLBP and across clinical subgroups of NSLBP. A total of 81 participants with NSLBP with flexion (FP; n = 38) and extension (EP; n = 43) motor control impairment and 26 controls (No-NSLBP) completed 10 repetitions of spine movements (flexion, extension, lateral flexion). IMUs were placed on the sacrum, fourth and second lumbar vertebrae, and seventh cervical vertebra to measure inclination at the pelvis, lower (LLx) and upper (ULx) lumbar spine, and lower cervical spine (LCx), respectively. At each location, the range of movement (ROM) was quantified as the range of IMU orientation in the primary plane of movement. The ROM was compared between NSLBP and No-NSLBP using unpaired t-tests and across FP-NSLBP, EP-NSLBP, and No-NSLBP subgroups using one-way ANOVA. Individuals with NSLBP exhibited a smaller ROM at the ULx (p = 0.005), LLx (p = 0.003) and LCx (p = 0.01) during forward flexion, smaller ROM at the LLx during extension (p = 0.03), and a smaller ROM at the pelvis during lateral flexion (p = 0.003). Those in the EP-NSLBP group had smaller ROM than those in the No-NSLBP group at LLx during forward flexion (Bonferroni-corrected p = 0.005), extension (p = 0.013), and lateral flexion (p = 0.038), and a smaller ROM at the pelvis during lateral flexion (p = 0.005). Those in the FP-NSLBP subgroup had smaller ROM than those in the No-NSLBP group at the ULx during forward flexion (p = 0.024). IMUs detected variations in kinematics at the trunk, lumbar spine, and pelvis among individuals with and without NSLBP and across clinical NSLBP subgroups during flexion, extension, and lateral flexion. These findings consistently point to reduced ROM in NSLBP. The identified subgroup differences highlight the potential of IMU for assessing spinal and pelvic kinematics in these clinically verified subgroups of NSLBP.
Journal Article
Imaging classification and surgical strategy of retroperitoneal vascular leiomyosarcoma: experience from a single medical center
Background
Retroperitoneal vascular leiomyosarcoma (RVLMS), which originates from vascular wall smooth muscle cells, typically requires inferior vena cava (IVC) reconstruction during radical surgery.
Methods
A retrospective cohort study was conducted on 24 patients who underwent primary resection of RVLMS from June 2015 to November 2023 in one institution. The patient details, operative management, and follow-up data were assessed.
Results
Regarding the imaging classification of RVLMS, 6 patients were intraluminal type, 9 patients were intermediate type, 4 patients were extraluminal type, and 5 patients were peripheral type. The median tumor size was 80 mm (interquartile range, IQR 63–105 mm). The median operative time was 294 min. The median blood loss was 650 ml. There were significant differences in operation time, blood loss, blood transfusion, and Intensive Care Unit admission rate among the four types of RVLMS. The procedures of vascular reconstruction included primary repair (
n
= 15), patch angioplasty (
n
= 2), and IVC ligation (
n
= 4). 3 patients suffered an R1/R2 margin. With a median follow-up time of 12.5 months, 5 patients developed local recurrence while 7 patients developed distant metastasis. 1 patient had both local recurrence and distant metastasis. The median disease-free survival was 19.0 months (IQR 7.0–59.0 months).
Conclusion
A reasonable surgical strategy of vascular resection and reconstruction in the context of RVLMS surgery was of value in achieving good postoperative outcomes and long-term survival. The imaging classification of RVLMS might help to evaluate the surgical complexity and the prognosis.
Journal Article
Prediction of baseline oral microbiota for clinical classification post Omicron variant of SARS-CoV-2 infection
Oral microbiota is related to the severity and recovery of SARS-CoV-2 infection. This study aims to predict clinical classification after SARS-CoV-2 infection using oral microbiota before infection. Herein, we collected tongue-coating samples before infection and then monitored clinical information after infection. Oral microbiota was detected by MiSeq sequencing. We randomly assigned participants from Zhengzhou into discovery and validation cohorts to develop a predictive model and conducted cross-region verification using Xinyang and Hangzhou cohorts. Sixteen asymptomatic patients (AP), 257 mild patients (MP), 106 common patients (CP), and 7 severe patients (SP) were enrolled. Oral microbiota diversity was decreased in CP versus MP. At
genus
level, 11 microorganisms, including
Rothia
and
Gemella
, were increased, while 5 microorganisms, including
Selenomonas
and
Lachnoanaerobaculum
, were decreased in CP versus MP. Moreover, the classifier based on 15 optimal markers showed high prediction efficiency in discovery cohort (area under the curve [AUC]: 98.35%), validation cohort (AUC: 81.91%), Xinyang cohort (AUC: 74.34%), and Hangzhou cohort (AUC: 94.44%). Interestingly, a higher abundance of
Selenomonas
was associated with milder clinical symptoms. In conclusion, our study established a good model to predict clinical classification after SARS-CoV-2 infection using oral microbiota before infection, providing a novel strategy for precise prevention and treatment.
Journal Article
Mismatch between clinically defined classification of ALS stage and the burden of cerebral pathology
This study aimed to investigate the clinical stratification of amyotrophic lateral sclerosis (ALS) patients in relation to in vivo cerebral degeneration. One hundred forty-nine ALS patients and one hundred forty-four healthy controls (HCs) were recruited from the Canadian ALS Neuroimaging Consortium (CALSNIC). Texture analysis was performed on T1-weighted scans to extract the texture feature “autocorrelation” (autoc), an imaging biomarker of cerebral degeneration. Patients were stratified at baseline into early and advanced disease stages based on criteria adapted from ALS clinical trials and the King’s College staging system, as well as into slow and fast progressors (disease progression rates, DPR). Patients had increased autoc in the internal capsule. These changes extended beyond the internal capsule in early-stage patients (clinical trial-based criteria), fast progressors, and in advanced-stage patients (King’s staging criteria). Longitudinal increases in autoc were observed in the postcentral gyrus, corticospinal tract, posterior cingulate cortex, and putamen; whereas decreases were observed in corpus callosum, caudate, central opercular cortex, and frontotemporal areas. Both longitudinal increases and decreases of autoc were observed in non-overlapping regions within insula and precentral gyrus. Within-criteria comparisons of autoc revealed more pronounced changes at baseline and longitudinally in early- (clinical trial-based criteria) and advanced-stage (King’s staging criteria) patients and fast progressors. In summary, comparative patterns of baseline and longitudinal progression in cerebral degeneration are dependent on sub-group selection criteria, with clinical trial-based stratification insufficiently characterizing disease stage based on pathological cerebral burden.
Journal Article