Temporal Design Patterns for Digital Phenotype Cohort Selection in Critical Care: Systematic Literature Assessment and Qualitative Synthesis.

BACKGROUND: Inclusion criteria for observational studies frequently contain temporal entities and relations. The use of digital phenotypes to create cohorts in electronic health record-based observational studies requires rich functionality to capture these temporal entities and relations. However, such functionality is not usually available or requires complex database queries and specialized expertise to build them. OBJECTIVE: The purpose of this study is to systematically assess observational studies reported in critical care literature to capture design requirements and functionalities for a graphical temporal abstraction-based digital phenotyping tool. METHODS: We iteratively extracted attributes describing patients, interventions, and clinical outcomes. We qualitatively synthesized studies, identifying all temporal and nontemporal entities and relations. RESULTS: We extracted data from 28 primary studies and 367 temporal and nontemporal entities. We generated a synthesis of entities, relations, and design patterns. CONCLUSIONS: We report on the observed types of clinical temporal entities and their relations as well as design requirements for a temporal abstraction-based digital phenotyping system. The results can be used to inform the development of such a system.

Is augmentation with folate effective for major depressive disorder? / ¿Es efectiva la potenciación con folato para el trastorno depresivo mayor?

INTRODUCTION: Antidepressant treatment does not lead to a satisfactory response in a significant proportion of patients with depression. It has been postulated that co-administration of pharmacologically standardized nutrients (nutraceuticals), such as folate, would potentiate the effect of antidepressants. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews including nine studies overall, of which eight were randomized trials. We concluded augmentation with folate for the treatment of major depressive disorder probably results in little or no difference in depressive symptoms. It would be interesting to evaluate the effects of specific presentation forms of folate or in population with objective folate deficit.

INTRODUCCIÓN: En una proporción importante de los pacientes con depresión, el tratamiento antidepresivo no lleva a una respuesta satisfactoria. Actualmente se postula que la coadministración de nutrientes estandarizados farmacológicamente (nutracéuticos), como el folato en este caso, podrían potenciar los efectos de los antidepresivos. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyen nueve estudios primarios, de los cuales, ocho son ensayos aleatorizados. Concluimos que la potenciación con folato en el tratamiento del trastorno depresivo mayor probablemente resulta en poca o nula diferencia en los síntomas depresivos. Pudiese ser interesante evaluar el efecto de formas de presentación específicas del folato o en población con déficit objetivado.

¿Es efectiva la potenciación con folato para el trastorno depresivo mayor? / Is augmentation with folate effective for major depressive disorder?

INTRODUCCIÓN: En una proporción importante de los pacientes con depresión, el tratamiento antidepresivo no lleva a una respuesta satisfactoria. Actualmente se postula que la coadministración de nutrientes estandarizados farmacológicamente (nutracéuticos), como el folato en este caso, podrían potenciar los efectos de los antidepresivos. MÉTODOS: Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos cuatro revisiones sistemáticas que en conjunto incluyen nueve estudios primarios, de los cuales, ocho son ensayos aleatorizados. Concluimos que la potenciación con folato en el tratamiento del trastorno depresivo mayor probablemente resulta en poca o nula diferencia en los síntomas depresivos. Pudiese ser interesante evaluar el efecto de formas de presentación específicas del folato o en población con déficit objetivado.

INTRODUCTION: Antidepressant treatment does not lead to a satisfactory response in a significant proportion of patients with depression. It has been postulated that co-administration of pharmacologically standardized nutrients (nutraceuticals), such as folate, would potentiate the effect of antidepressants. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified four systematic reviews including nine studies overall, of which eight were randomized trials. We concluded augmentation with folate for the treatment of major depressive disorder probably results in little or no difference in depressive symptoms. It would be interesting to evaluate the effects of specific presentation forms of folate or in population with objective folate deficit.

ClinicalTime: Identification of Patients with Acute Kidney Injury using Temporal Abstractions and Temporal Pattern Matching.

INTRODUCTION: The rising cost of providing healthcare services creates an extreme pressure to know what works best in medicine. Traditional methods of generating clinical evidence are expensive and time consuming. The availability of electronic clinical data generated during routine patient encounters provides an opportunity to use that information to generate new clinical evidence. However, electronic clinical data is frequently marred by inadequate quality that impedes such secondary uses. This study provides a proof-of-concept and tests the classification accuracy of ClinicalTime-a temporal query system-to identify patient cohorts in clinical databases. METHODS: we randomly selected a sample of medical records from the MIMIC-II database, an anonymized database of intensive care patients. Records were manually classified as having an acute kidney injury or not according to the AKIN criteria. Those records were then blindly classified using ClinicalTime to represent the AKIN criteria. Classification accuracy was measured. RESULTS: ClinicalTime correctly classified 88% of all patients, with a sensitivity of 0.93 and specificity of 0.84. Its performance was superior to simply using ICD-9 codes, which correctly classified 66% of all patients. CONCLUSIONS: ClinicalTime, a temporal query system, is a valid method to add to the currently available ones to identify patient phenotypes in patient databases and, thus, improving our ability to re-use routinely collected electronic clinical data for secondary purposes.