4.7 Article

Towards an automated multimodal clinical decision support system at the post anesthesia care unit

Journal

COMPUTERS IN BIOLOGY AND MEDICINE
Volume 101, Issue -, Pages 15-21

Publisher

PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.compbiomed.2018.07.018

Keywords

Post anesthesia care unit; Random forest; Machine learning; Vital signs; Patient monitoring; Early warning system

Funding

  1. Danish Cancer Society, Bohringer Ingelheim, Germany

Ask authors/readers for more resources

Background: The aim of this study was to develop a predictive algorithm detecting early signs of deterioration (ESODs) in the post anesthesia care unit (PACU), thus being able to intervene earlier in the future to avoid serious adverse events. The algorithm must utilize continuously collected cardiopulmonary vital signs and may serve as an alternative to current practice, in which an alarm is activated by single parameters. Methods: The study was a single center, prospective cohort study including 178 patients admitted to the PACU after major surgical procedures. Peripheral blood oxygenation, arterial blood pressure, perfusion index, heart rate and respiratory rate were monitored continuously. Potential ESODs were automatically detected and scored by two independent experts with regards to the severity of the observation. Based on features extracted from the obtained measurements, a random forest classifier was trained, classifying each event being either an ESOD or not an ESOD. The algorithm was evaluated and compared to the automated single modality alarm system at the PACU. Results: The algorithm detected ESODs with an accuracy of 92.2% (99% CI: 89.6%-94.8%), sensitivity of 90.6% (99% CI: 85.7%-95.5%), specificity of 93.0% (99% CI: 89.9%-96.2%) and area under the receiver operating characteristic curve of 96.9% (99% CI: 95.3%-98.5%). The number of false alarms decreased by 85% (99% CI: 77%-93%) and the number of missed ESODs decreased by 73% (99% CI: 61%-85%) as compared to the currently used alarm system in the hospital. The algorithm was able to detect an ESOD in average 26.4 (99% CI: 1.1-51.7) minutes before the current single parameter system used in the PACU. Conclusion: In conclusion, the proposed biomedical classification algorithm, when compared to the currently used single parameter alarm system of the hospital, showed significantly increased performance in both detecting ESODs fast and classifying these correctly. The clinical effect of the predictive system must be evaluated in future trials.

Authors

I am an author on this paper
Click your name to claim this paper and add it to your profile.

Reviews

Primary Rating

4.7
Not enough ratings

Secondary Ratings

Novelty
-
Significance
-
Scientific rigor
-
Rate this paper

Recommended

Article Anesthesiology

Continuous wireless pre- and postoperative vital sign monitoring reveal new, severe desaturations after vascular surgery

Jesper Molgaard, Soren Straarup Rasmussen, Jonas Eiberg, Helge Bjarup Dissing Sorensen, Christian Sylvest Meyhoff, Eske Kvanner Aasvang

Summary: Deviating physiology is common before and after vascular surgery. Severe desaturation had a longer duration on the first postoperative day compared to preoperatively, while moderate desaturations were reflected in postoperative desaturations. Cumulative duration outside thresholds is, in some cases, exacerbated after surgery.

ACTA ANAESTHESIOLOGICA SCANDINAVICA (2023)

Article Medicine, General & Internal

Effect of Dexamethasone on Myocardial Injury After Total Knee Arthroplasty: A Substudy of the Randomized Clinical DEX-2-TKA Trial

Asger K. Molgaard, Kasper S. Gasbjerg, Christian S. Meyhoff, Troels H. Lunn, Janus C. Jakobsen, Ismail Gogemur, Ole Mathiesen, Daniel Hagl-Pedersen

Summary: This study compared the effects of dexamethasone and placebo on the concentration of cardiac troponin I and T after total knee arthroplasty. The results showed that dexamethasone had no effect on the postoperative troponin levels on the first morning after surgery.

AMERICAN JOURNAL OF MEDICINE (2023)

Article Clinical Neurology

Ambulatory Detection of Isolated Rapid-Eye-Movement Sleep Behavior Disorder Combining Actigraphy and Questionnaire

Andreas Brink-Kjaer, Niraj Gupta, Eric Marin, Jennifer Zitser, Oliver Sum-Ping, Anahid Hekmat, Flavia Bueno, Ana Cahuas, James Langston, Poul Jennum, Helge B. D. Sorensen, Emmanuel Mignot, Emmanuel During

Summary: The study aimed to develop a high-frequency actigraphy and questionnaire-based machine learning classifier for detecting isolated rapid-eye-movement sleep behavior disorder (iRBD). The results showed that both the actigraphy and questionnaire classifiers achieved high accuracy and precision, and the combination of actigraphy and questionnaire had the best predictive performance.

MOVEMENT DISORDERS (2023)

Article Engineering, Biomedical

A Flexible Deep Learning Architecture for Temporal Sleep Stage Classification Using Accelerometry and Photoplethysmography

Mads Olsen, Jamie M. Zeitzer, Risa N. Richardson, Polina Davidenko, Poul J. Jennum, Helge B. D. Sorensen, Emmanuel Mignot

Summary: Wrist-worn consumer sleep technologies with accelerometers and photoplethysmography have potential to be sleep monitoring systems. A deep neural network with a strong temporal core was developed to predict sleep stages using ACC and PPG signals. The network achieved high accuracy and kappa values on both internal and external datasets.

IEEE TRANSACTIONS ON BIOMEDICAL ENGINEERING (2023)

Article Clinical Neurology

Automatic scoring of drug-induced sleep endoscopy for obstructive sleep apnea using deep learning

Umaer Hanif, Eva Kirkegaard Kiaer, Robson Capasso, Stanley Y. Liu, Emmanuel J. M. Mignot, Helge B. D. Sorensen, Poul Jennum

Summary: This study proposes a deep learning approach for automatic scoring of obstructive sleep apnea using drug-induced sleep endoscopy (DISE) videos. With an average F1 score of 70% across 281 DISE videos, the automated scoring shows high validity and feasibility in assessing the degree of upper airway collapse.

SLEEP MEDICINE (2023)

Article Anesthesiology

Experiences of isolation in patients in the intensive care unit during the COVID-19 pandemic

Allan Koster, Christian Sylvest Meyhoff, Lars Peter Kloster Andersen

Summary: During the COVID-19 pandemic in Denmark, COVID-19-positive patients in the ICU experienced self-alienation, a sense of captivity, surrealism, extreme loneliness, and intercorporeal deprivation. This study provides valuable insights into the experiences of isolated patients through in-depth interviews and observations.

ACTA ANAESTHESIOLOGICA SCANDINAVICA (2023)

Article Anesthesiology

Continuous monitoring is superior to manual measurements in detecting vital sign deviations in patients with COVID-19

Katja Kjaer Gronbaek, Soren Moller Rasmussen, Natasha Hemicke Langer, Mette Vincentz, Anne-Britt Oxboll, Marlene Sogaard, Hussein Nasser Awada, Tomas O. Jensen, Magnus Thorsten Jensen, Helge B. D. Sorensen, Eske Kvanner Aasvang, Christian Sylvest Meyhoff

Summary: Continuous monitoring of vital signs in COVID-19 patients can detect deviations earlier and provides more accurate information compared to intermittent measurements. Patients admitted to ICU or having fatal outcomes tend to have longer durations of vital sign deviations.

ACTA ANAESTHESIOLOGICA SCANDINAVICA (2023)

Article Chemistry, Analytical

Wireless Single-Lead versus Standard 12-Lead ECG, for ST-Segment Deviation during Adenosine Cardiac Stress Scintigraphy

Luna Fabricius Ekenberg, Dan Eik Hofsten, Soren M. Rasmussen, Jesper Molgaard, Philip Hasbak, Helge B. D. Sorensen, Christian S. Meyhoff, Eske K. Aasvang

Summary: This study assessed the accuracy of wearable wireless electrocardiographic (ECG) monitoring in detecting myocardial ischemia, and found that there was a difference in ST-segment deviation between single-lead and 12-lead ECG. Both methods had low sensitivity for detecting reversible myocardial ischemia.

SENSORS (2023)

Article Anesthesiology

Deviations in continuously monitored electrodermal activity before severe clinical complications: a clinical prospective observational explorative cohort study

Andreas Ohrt Johansen, Jesper Molgaard, Soren Straarup Rasmussen, Ying Gu, Katja Kjaer Gronbaek, Helge B. D. Sorensen, Eske Kvanner Aasvang, Christian Sylvest Meyhoff

Summary: Monitoring of high-risk patients in hospital wards is crucial in identifying and preventing clinical deterioration. Sympathetic nervous system activity measured by Electrodermal activity (EDA) may be related to complications, but its clinical use remains untested. This study found significant associations between specific deviations of EDA and subsequent serious adverse events (SAE), suggesting that EDA patterns could be indicators of upcoming clinical deterioration in high-risk patients.

JOURNAL OF CLINICAL MONITORING AND COMPUTING (2023)

Article Anesthesiology

Workload associated with manual assessment of vital signs as compared with continuous wireless monitoring

Emilie Sigvardt, Katja Kjaer Gronbaek, Mia Lind Jepsen, Marlene Sogaard, Louise Haahr, Ana Inacio, Eske Kvanner Aasvang, Christian Sylvest Meyhoff

Summary: Continuous monitoring of vital signs significantly reduces workload compared to manual assessment.

ACTA ANAESTHESIOLOGICA SCANDINAVICA (2023)

Article Anesthesiology

A survey of preferences for respiratory support in the intensive care unit for patients with acute hypoxaemic respiratory failure

Tayyba N. Aslam, Thomas L. Klitgaard, Christian A. O. Ahlstedt, Finn H. Andersen, Michelle S. Chew, Marie O. Collet, Maria Cronhjort, Stine Estrup, Ole K. Fossum, Shirin K. Frisvold, Hans-Joerg Gillmann, Anders Granholm, Trine M. Gundem, Kristin Hauss, Jacob Hollenberg, Maria E. Huanca Condori, Johanna Hastbacka, Bror A. Johnstad, Eric Keus, Maj-Brit N. Kjaer, Pal Klepstad, Mette Krag, Reidar Kvale, Manu L. N. G. Malbrain, Christian S. Meyhoff, Matt Morgan, Anders Moller, Carmen A. Pfortmueller, Lone M. Poulsen, Andrew C. Robertson, Joerg C. Schefold, Olav L. Schjorring, Martin Siegemund, Martin I. Sigurdsson, Fredrik Sjoevall, Kristian Strand, Thomas Stueber, Wojciech Szczeklik, Rebecka R. Wahlin, Helge L. Wangberg, Karl-Andre Wian, Sine Wichmann, Kristin Hofso, Morten H. Moller, Anders Perner, Bodil S. Rasmussen, Jon H. Laake, SVALBARD Investigators

Summary: This study reveals the uncertainty among clinicians when choosing ventilator modes for patients with acute hypoxaemic respiratory failure. The survey indicates that there is clinical equipoise for the preferred ventilator mode in moderate AHRF patients.

ACTA ANAESTHESIOLOGICA SCANDINAVICA (2023)

Article Anesthesiology

Near-infrared spectroscopy to measure brain oxygenation: A comparison of measurements on the skin, skull and dura mater

Sofie S. Pedersen, Martin Kryspin Sorensen, Markus Harboe Olsen, Zara R. Stisen, Anton Lund, Kirsten Moller, Jane Skjoth-Rasmussen, Finn B. Moltke, Christian S. Meyhoff

Summary: By comparing the ScO2 values measured in different locations, the study found no significant difference in ScO2 values measured on the forehead skin and on the dura mater, while the ScO2 values on the skull were lower than those on the skin, indicating an influence from scalp tissue on the signal.

ACTA ANAESTHESIOLOGICA SCANDINAVICA (2023)

Review Medicine, General & Internal

Benefits and harms of perioperative high fraction inspired oxygen for surgical site infection prevention: a protocol for a systematic review and meta-analysis of individual patient data of randomised controlled trials

Stijn W. de Jonge, Rick H. Hulskes, Maedeh Zokaei Nikoo, Robert P. Weenink, Christian S. Meyhoff, Kate Leslie, Paul Myles, Andrew Forbes, Robert Greif, Ozan Akca, Andrea Kurz, Daniel Sessler, Janet Martin, Marcel G. W. Dijkgraaf, Kane Pryor, F. Javier Belda, Carlos Ferrando, Gabriel M. Gurman, Christina M. Scifres, David S. McKenna, Matthew T. Chan, Pascal Thibon, Jannicke Mellin-Olsen, Benedetta Allegranzi, Marja Boermeester, Markus W. Hollmann

Summary: The use of high fraction of inspired oxygen (FiO(2)) intraoperatively for the prevention of surgical site infection (SSI) remains controversial. Published data lacks participant level details to test hypotheses. The purpose of this meta-analysis is to evaluate the benefits and harms of high FiO(2) and its effect modifiers.

BMJ OPEN (2023)

Article Biology

Multimodal pre-screening can predict BCI performance variability: A novel subject-specific experimental scheme

Seyyed Bahram Borgheai, Alyssa Hillary Zisk, John McLinden, James Mcintyre, Reza Sadjadi, Yalda Shahriari

Summary: This study proposed a novel personalized scheme using fNIRS and EEG as the main tools to predict and compensate for the variability in BCI systems, especially for individuals with severe motor deficits. By establishing predictive models, it was found that there were significant associations between the predicted performances and the actual performances.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Exploring a novel HE image segmentation technique for glioblastoma: A hybrid slime mould and differential evolution approach

Hongliang Guo, Hanbo Liu, Ahong Zhu, Mingyang Li, Helong Yu, Yun Zhu, Xiaoxiao Chen, Yujia Xu, Lianxing Gao, Qiongying Zhang, Yangping Shentu

Summary: In this paper, a BDSMA-based image segmentation method is proposed, which improves the limitations of the original algorithm by combining SMA with DE and introducing a cooperative mixing model. The experimental results demonstrate the superiority of this method in terms of convergence speed and precision compared to other methods, and its successful application to brain tumor medical images.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Semi-supervised point consistency network for retinal artery/vein classification

Jingfei Hu, Linwei Qiu, Hua Wang, Jicong Zhang

Summary: This study proposes a novel semi-supervised point consistency network (SPC-Net) for retinal artery/vein (A/V) classification, addressing the challenges of specific tubular structures and limited well-labeled data in CNN-based approaches. The SPC-Net combines an AVC module and an MPC module, and introduces point set representations and consistency regularization to improve the accuracy of A/V classification.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

ConTraNet: A hybrid network for improving the classification of EEG and EMG signals with limited training data

Omair Ali, Muhammad Saif-ur-Rehman, Tobias Glasmachers, Ioannis Iossifidis, Christian Klaes

Summary: This study introduces a novel hybrid model called ConTraNet, which combines the strengths of CNN and Transformer neural networks, and achieves significant improvement in classification performance with limited training data.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

A novel mobile phone and tablet application for automatized calculation of pain extent

Juan Antonio Valera-Calero, Dario Lopez-Zanoni, Sandra Sanchez-Jorge, Cesar Fernandez-de-las-Penas, Marcos Jose Navarro-Santana, Sofia Olivia Calvo-Moreno, Gustavo Plaza-Manzano

Summary: This study developed an easy-to-use application for assessing the diagnostic accuracy of digital pain drawings (PDs) compared to the classic paper-and-pencil method. The results demonstrated that digital PDs have higher reliability and accuracy compared to paper-and-pencil PDs, and there were no significant differences in assessing pain extent between the two methods. The PAIN EXTENT app showed good convergent validity.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Radial magnetic resonance image reconstruction with a deep unrolled projected fast iterative soft-thresholding network

Biao Qu, Jialue Zhang, Taishan Kang, Jianzhong Lin, Meijin Lin, Huajun She, Qingxia Wu, Meiyun Wang, Gaofeng Zheng

Summary: This study proposes a deep unrolled neural network, pFISTA-DR, for radial MRI image reconstruction, which successfully preserves image details using a preprocessing module, learnable convolution filters, and adaptive threshold.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Improving mixed-integer temporal modeling by generating synthetic data using conditional generative adversarial networks: A case study of fluid overload prediction in the intensive care unit

Alireza Rafiei, Milad Ghiasi Rad, Andrea Sikora, Rishikesan Kamaleswaran

Summary: This study aimed to improve machine learning model prediction of fluid overload by integrating synthetic data, which could be translated to other clinical outcomes.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Densely connected convolutional networks for ultrasound image based lesion segmentation

Jinlian Ma, Dexing Kong, Fa Wu, Lingyun Bao, Jing Yuan, Yusheng Liu

Summary: In this study, a new method based on MDenseNet is proposed for automatic segmentation of nodular lesions from ultrasound images. Experimental results demonstrate that the proposed method can accurately extract multiple nodules from thyroid and breast ultrasound images, with good accuracy and reproducibility, and it shows great potential in other clinical segmentation tasks.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Multi-omics fusion with soft labeling for enhanced prediction of distant metastasis in nasopharyngeal carcinoma patients after radiotherapy

Jiabao Sheng, SaiKit Lam, Jiang Zhang, Yuanpeng Zhang, Jing Cai

Summary: Omics fusion is an important preprocessing approach in medical image processing that assists in various studies. This study aims to develop a fusion methodology for predicting distant metastasis in nasopharyngeal carcinoma by mitigating the disparities in omics data and utilizing a label-softening technique and a multi-kernel-based neural network.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Regularity and variability of functional brain connectivity characteristics between gyri and sulci under naturalistic stimulus

Zhenxiang Xiao, Liang He, Boyu Zhao, Mingxin Jiang, Wei Mao, Yuzhong Chen, Tuo Zhang, Xintao Hu, Tianming Liu, Xi Jiang

Summary: This study systematically investigates the functional connectivity characteristics between gyri and sulci in the human brain under naturalistic stimulus, and identifies unique features in these connections. This research provides novel insights into the functional brain mechanism under naturalistic stimulus and lays a solid foundation for accurately mapping the brain anatomy-function relationship.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Unraveling the allosteric inhibition mechanism of PARP-1 CAT and the D766/770A mutation effects via Gaussian accelerated molecular dynamics and Markov state model

Qianqian Wang, Mingyu Zhang, Aohan Li, Xiaojun Yao, Yingqing Chen

Summary: The development of PARP-1 inhibitors is crucial for the treatment of various cancers. This study investigates the structural regulation of PARP-1 by different allosteric inhibitors, revealing the basis of allosteric inhibition and providing guidance for the discovery of more innovative PARP-1 inhibitors.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

DualAttNet: Synergistic fusion of image-level and fine-grained disease attention for multi-label lesion detection in chest X-rays

Qing Xu, Wenting Duan

Summary: In this paper, a dual attention supervised module, named DualAttNet, is proposed for multi-label lesion detection in chest radiographs. By efficiently fusing global and local lesion classification information, the module is able to recognize targets with different sizes. Experimental results show that DualAttNet outperforms baselines in terms of mAP and AP50 with different detection architectures.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Searching for significant reactions and subprocesses in models of biological systems based on Petri nets

Kaja Gutowska, Piotr Formanowicz

Summary: The primary aim of this research is to propose algorithms for identifying significant reactions and subprocesses within biological system models constructed using classical Petri nets. These solutions enable two analysis methods: importance analysis for identifying critical individual reactions to the model's functionality and occurrence analysis for finding essential subprocesses. The utility of these methods has been demonstrated through analyses of an example model related to the DNA damage response mechanism. It should be noted that these proposed analyses can be applied to any biological phenomenon represented using the Petri net formalism. The presented analysis methods extend classical Petri net-based analyses, enhancing our comprehension of the investigated biological phenomena and aiding in the identification of potential molecular targets for drugs.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

LDP-GAN : Generative adversarial networks with local differential privacy for patient medical records synthesis

Hansle Gwon, Imjin Ahn, Yunha Kim, Hee Jun Kang, Hyeram Seo, Heejung Choi, Ha Na Cho, Minkyoung Kim, Jiye Han, Gaeun Kee, Seohyun Park, Kye Hwa Lee, Tae Joon Jun, Young-Hak Kim

Summary: Electronic medical records have potential in advancing healthcare technologies, but privacy issues hinder their full utilization. Deep learning-based generative models can mitigate this problem by creating synthetic data similar to real patient data. However, the risk of data leakage due to malicious attacks poses a challenge to traditional generative models. To address this, we propose a method that employs local differential privacy (LDP) to protect the model from attacks and preserve the privacy of training data, while generating medical data with reasonable performance.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)

Article Biology

Phase retrieval for X-ray differential phase contrast radiography with knowledge transfer learning from virtual differential absorption model

Siwei Tao, Zonghan Tian, Ling Bai, Yueshu Xu, Cuifang Kuang, Xu Liu

Summary: This study proposes a transfer learning-based method to address the phase retrieval problem in grating-based X-ray phase contrast imaging. By generating a training dataset and using deep learning techniques, this method improves image quality and can be applied to X-ray 2D and 3D imaging.

COMPUTERS IN BIOLOGY AND MEDICINE (2024)