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1.
Stud Health Technol Inform ; 264: 616-619, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437997

RESUMO

The Portable Health Clinic (PHC) system endeavors to take healthcare facilities along with remote doctors' consultancy to the doorsteps of the unreached people using an advanced telemedicine system. Thus, the necessity of having physical healthcare peripheries specially in the developing countries can be mitigated. The PHC system promotes preventive healthcare by encouraging regular health checkups so that diseases can be prevented as well as their severity can be mitigated, leading to a reduction on healthcare expenses. Thus, the number of patients along with excessive workload on existing healthcare human resources can be minimized. The current project in rural Bangladesh alone has served more than 41,000 people so far by the PHC system and a simple analysis of this data shows some significant findings on regional health status. A simple expansion of this program, covering a wider service area, can produce a big data to reflect the whole country's health profile.


Assuntos
Assistência à Saúde , Instituições de Assistência Ambulatorial , Bangladesh , Países em Desenvolvimento , Humanos , Telemedicina
2.
Stud Health Technol Inform ; 264: 1562-1563, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438232

RESUMO

Data standardiztion an important aspect to ensure data quality for utilizing large-scale, medical information databases such as the Medical Information Database Network (MID-NET) Project in Japan. We established a governance center to assess the consistency of standard codes across MID-NET-cooperating medical institutions. Moreover, we developed a real-time validation tool and determined its effect in improving data quality in medical institutions by providing a central feedback on the detected differences in standard disease-name codes.


Assuntos
Bases de Dados Factuais , Japão , Informática Médica , Padrões de Referência
3.
Stud Health Technol Inform ; 264: 1578-1579, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438240

RESUMO

Medical insurance claims are useful data to offer a big-picture view and insight of a nation-wide healthcare system. Yet, formal description of the logic to analyze the claims has not been established. So far, we proposed a description scheme of analytics logic over claims database. In this paper, we propose a novel analytics framework based on the description scheme. By showing a case study, we demonstrate the effectiveness of the framework.


Assuntos
Assistência à Saúde , Bases de Dados Factuais
4.
Stud Health Technol Inform ; 264: 1498-1499, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438200

RESUMO

We aimed to develop rhabdomyolysis (RB) phenotyping algorithms using machine learning techniques and to create subphenotyping algorithms to identify RB patients who lack RB diagnosis. Two pattern algorithms, one with a focus on improving predictive value and one focused on improving sensitivity, were finally created and had a high area under the curve value of 0.846. Although we were unable to create subphenotyping algorithms, an attempt to detect unknown RB patients is important for epidemiological studies.


Assuntos
Registros Eletrônicos de Saúde , Rabdomiólise , Algoritmos , Bases de Dados Factuais , Humanos , Aprendizado de Máquina
5.
J Orthop Surg (Hong Kong) ; 27(3): 2309499019866965, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31466509

RESUMO

PURPOSE: Fragility hip fractures (FHFs) are associated with a high risk of mortality, but the relative contribution of various factors remains controversial. This study aimed to evaluate predictive factors of mortality at 1 year after discharge in Japan. METHODS: A total of 497 patients aged 60 years or older who sustained FHFs during follow-up were included in this study. Expected variables were finally assessed using multivariable Cox proportional hazards models. RESULTS: The 1-year mortality rate was 9.1% (95% confidence interval: 6.8-12.0%, n = 45). Log-rank test revealed that previous fractures (p = 0.003), Barthel index (BI) at discharge (p = 0.011), and place-to-discharge (p = 0.004) were significantly associated with mortality for male patients. Meanwhile, body mass index (BMI; p = 0.023), total Charlson comorbidity index (TCCI; p = 0.005), smoking (p = 0.007), length of hospital stay (LOS; p = 0.009), and BI (p = 0.004) were the counterparts for females. By multivariate analyses, previous vertebral fractures (hazard ratio (HR) 3.33; p = 0.044), and BI <30 (HR 5.42, p = 0.013) were the predictive variables of mortality for male patients. BMI <18.5 kg/m2 (HR 2.70, p = 0.023), TCCI ≥5 (HR 2.61, p = 0.032), smoking history (HR 3.59, p = 0.018), LOS <14 days (HR 13.9; p = 0.007), and BI <30 (HR 2.76; p = 0.049) were the counterparts for females. CONCLUSIONS: Previous vertebral fractures and BI <30 were the predictive variables of mortality for male patients, and BMI <18.5 kg/m2, TCCI ≥5, smoking history, LOS <14 days, and BI <30 were those for females. Decreased BI is one of the independent and preventable risk factors. A comprehensive therapeutic approach should be considered to prevent deterioration of activities of daily living and a higher risk of mortality.

6.
Artigo em Inglês | MEDLINE | ID: mdl-31464008

RESUMO

PURPOSE: To establish a new medical information database network (designated MID-NET® ) to provide real-world data for drug safety assessments in Japan. METHODS: This network was designed and developed by the Ministry of Health, Labour and Welfare and the Pharmaceuticals and Medical Devices Agency in collaboration with 23 hospitals from 10 healthcare organizations across Japan. MID-NET® is a distributed and closed network system that connects all collaborative organizations through a central data center. A wide variety of data are available for analyses, including clinical and administrative information. Several coding standards are used to standardize the data stored in MID-NET® to allow the integration of information originating from different hospitals. A rigorous and consistent quality management system was implemented to ensure that MID-NET® data are of high quality and meet Japanese regulatory standards (good post-marketing study practice and related guidelines). RESULTS: MID-NET® was successfully established as a reliable and valuable medical information database and was officially launched in April 2018. High data quality with almost 100% consistency was confirmed between original data in hospitals and the data stored in MID-NET® . A major advantage is that approximately 260 clinical laboratory test results are available for analysis. CONCLUSIONS: MID-NET® is expected to be a major data source for drug safety assessments in Japan. Experiences and best practices established in MID-NET® may provide a model for the future development of similar database networks.

7.
J Clin Pharm Ther ; 44(5): 788-795, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31282013

RESUMO

WHAT IS KNOWN AND OBJECTIVE: Since its introduction in April 2012, denosumab has been administered to approximately 7,300 patients as of August 2012, and 32 cases of serious hypocalcaemia after denosumab administration, including two deaths, have been reported in Japan. A Dear Healthcare Professional Letter of Rapid Safety Communication ('Blue letter') was released to warn about the risks of hypocalcaemia associated with denosumab. The goal of this study therefore was to measure the impact of regulatory action on denosumab-induced hypocalcaemia in Japan by using an electronic medical information database (MID). METHODS: We used two different aggregated data sets based on MIDs (data sets one and two). The patients studied were those who were newly prescribed denosumab or zoledronic acid between April 2012 and September 2014. We assessed four indicators: (a) the proportion of patients with calcium supplementation at the initial denosumab treatment, (b) the proportion of patients who underwent a serum calcium test, (c) the average number of serum calcium tests performed and (d) the prevalence of hypocalcaemia. All indices were aggregated by every 3 months. To evaluate the impact of regulatory action, we used difference in difference (DID) analysis. RESULTS AND DISCUSSION: The proportion of patients with calcium supplementation at the initial denosumab treatment increased year by year in both data sets. The average number of serum calcium tests increased year by year in data set two. There was a significant difference in the prevalence of hypocalcaemia in data set two. This suggests that the estimate of impact of the regulatory action may vary according to the database. In DID analysis, however, significant influences of the regulatory action on combination use with a calcium supplement were detected in both data sets. WHAT IS NEW AND CONCLUSION: There was a significant influence on combination use of denosumab with vitamin D and/or calcium supplement in both data sets. That there was no apparent increase in the prevalence of denosumab-induced hypocalcaemia, suggests that the regulatory action had an impact in the clinical setting studied. Such regulatory actions may play an important role in the promotion of drug safety.

8.
J Diabetes Investig ; 10(3): 868-875, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31020808

RESUMO

It is expected that a large amount of data related to diabetes and other chronic diseases will be generated. However, databases constructed without standardized data item sets can be limited in their usefulness. To address this, the Collaborative Committee of Clinical Informatization in Diabetes Mellitus was established in 2011 by the Japan Diabetes Society and Japan Association for Medical Informatics. The committee has developed core item sets and self-management item sets for diabetes mellitus, hypertension, dyslipidemia, and chronic kidney disease in collaboration with the Japanese Society of Hypertension, Japan Atherosclerosis Society, Japanese Society of Nephrology, and Japanese Society of Laboratory Medicine, as well as a mapping table that aligns the self-management item sets with the Japanese standardized codes for laboratory testing. The committee also determined detailed specifications for implementing the four self-management item sets in personal health record (PHR) applications to facilitate risk stratification, the generation of alerts using information and communications technology systems, the avoidance of data input errors, and the generation of reminders to input the self-management item set data. The approach developed by the committee may be useful for combining databases for various purposes (such as for clinical studies, patient education, and electronic medical record systems) and for facilitating collaboration between PHR administrators.


Assuntos
Doença Crônica/epidemiologia , Diabetes Mellitus/fisiopatologia , Registros Eletrônicos de Saúde/estatística & dados numéricos , Registros Eletrônicos de Saúde/normas , Registros de Saúde Pessoal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Criança , Feminino , Seguimentos , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Relatório de Pesquisa , Adulto Jovem
9.
Pharmacoepidemiol Drug Saf ; 28(5): 601-608, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30945387

RESUMO

PURPOSE: To examine the potential role of Medical Information Database Network (MID-NET® ), a newly established Japanese medical information database network, in postmarketing drug safety assessments through the characterization of its advantages and limitations in five pilot studies. METHODS: The pilot studies were designed to address three major objectives in postmarketing drug safety assessments, ie, the examination of actual drug utilization, the impact of safety-related regulatory actions, and drug-associated risks. The five studies were conducted on the following topics: (a) utilization of codeine-containing products and its relationship with respiratory depression, (b) impact of a Dear Healthcare Professional letter on hypocalcemia incidence associated with denosumab (Ranmark® ) use, (c) risk of acute myocardial infarction associated with antidiabetic drug use, (d) risk of glucose metabolism disorders associated with atypical antipsychotic drug use, and (e) prospective monitoring of abnormal laboratory test results during new drug prescriptions. RESULTS: The pilot studies were successfully conducted and demonstrated the value of MID-NET® in postmarketing drug safety assessments. In particular, the ability to utilize laboratory test results as objective clinical indicators is a major advantage of this database. Potential limitations include a relatively small sample size and a lack of patient-level data linkages among hospitals. CONCLUSIONS: MID-NET® was confirmed to be a valuable database for postmarketing drug safety assessments. The use of laboratory test results to define clinical outcomes may allow more objective and accurate analyses to be conducted. These studies furthered our understanding of the characteristics of MID-NET® , including its advantages and limitations.

10.
Int Heart J ; 60(2): 264-270, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799376

RESUMO

The utilization of electronic medical records and multimodal medical data is an ideal approach to build a real-time and precision registry type study with a smaller effort and cost, which may fill a gap between evidence-based medicine and the real-world clinical practice. The Japan Ischemic heart disease Multimodal Prospective data Acquisition for preCision Treatment (J-IMPACT) project aimed to build an clinical data registry system that electronically collects not only medical records, but also multimodal data, including coronary angiography and percutaneous coronary intervention (PCI) report, in standardized data formats for clinical studies.The J-IMPACT system comprises the standardized structured medical information exchange (SS-MIX), coronary angiography and intervention reporting system (CAIRS), and multi-purpose clinical data repository system (MCDRS) interconnected within the institutional network. In order to prove the concept, we acquired multimodal medical data of 6 consecutive cases that underwent PCI through the J-IMPACT system in a single center. Data items regarding patient background, laboratory data, prescriptions, and PCI/cardiac catheterization report were correctly acquired through the J-IMPACT system, and the accuracy of the multimodal data of the 4 categories was 100% in all 6 cases.The application of J-IMPACT system to clinical studies not only fills the gaps between randomized clinical trials and real-world medicine, but may also provide real-time big data that reinforces precision treatment for each patient.


Assuntos
Angiografia Coronária/estatística & dados numéricos , Confiabilidade dos Dados , Sistemas Computadorizados de Registros Médicos , Isquemia Miocárdica , Intervenção Coronária Percutânea/estatística & dados numéricos , Idoso , Medicina Baseada em Evidências/métodos , Feminino , Humanos , Japão/epidemiologia , Masculino , Sistemas Computadorizados de Registros Médicos/organização & administração , Sistemas Computadorizados de Registros Médicos/normas , Pessoa de Meia-Idade , Isquemia Miocárdica/epidemiologia , Isquemia Miocárdica/terapia , Estudos Prospectivos , Melhoria de Qualidade , Sistema de Registros/estatística & dados numéricos , Resultado do Tratamento
11.
Conf Proc IEEE Eng Med Biol Soc ; 2018: 4042-4045, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30441244

RESUMO

Estimating individual causal effect is important for decision making in many fields especially for medical interventions. We propose an interpretable and accurate algorithm for estimating causal effects from observational data. The proposed scheme is combining multiple predictors' outputs by an interpretable predictor such as linear predictor and if then rules. We secure interpretability using the interpretable predictor and balancing scores in causal inference studies as meta-features. For securing accuracy, we adapt machine learning algorithms for calculating balancing scores. We analyze the effect of t-PA therapy for stroke patients using real-world data, which has 64,609 records with 362 variables and interpret results. The results show that cross validation AUC of the proposed scheme is little less than original machine learning scheme; however, the proposed scheme provides interpretability that t-PA therapy is effective for severe patients.

12.
PLoS One ; 13(6): e0198829, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29889894

RESUMO

In South-East Asia, the maternal and child mortality rate has declined over the past decades; however, it varies among and within the countries in the region, including Cambodia. The continuum of care is an integrated series of care that women and children are required to avail continuously from pregnancy to the child/motherhood period. This study aimed to assess the completion rate of the continuum of care and examine the factors associated with the continuum of care in Ratanakiri, Cambodia. A cross-sectional study was conducted in Ratanakiri. Overall, 377 women were included, and data were collected via face-to-face interviews using a semi-structured questionnaire. Among them, 5.0% completed the continuum of care (antenatal care at least four times, delivery by skilled birth attendant, and postnatal care at least once). Meanwhile, 18.8% did not receive any care during pregnancy, delivery, and after birth. The highest discontinuation rate was at the postnatal care stage (73.6%). Not receiving any perinatal care was associated with neonatal complications at 6 weeks after birth (adjusted odds ratio [AOR]: 3.075; 95% confidence interval [CI]: 1.310-7.215). Furthermore, a long distance to the health center was negatively associated with completion of the continuum of care (AOR: 0.877; 95% CI: 0.791-0.972). This study indicates the need for efforts to reduce the number of women who discontinue from the continuum of care, as well as who do not receive any care to avoid neonatal complications. Since the discontinuation rate was highest at the postnatal care, postnatal care needs to be promoted more through the antenatal care and delivery services. Furthermore, given that long distance to health facilities was a barrier for receiving the care continuously, our findings suggest the need for a village-based health care system that can provide the basic continuum of care in remote areas.

13.
Biosci Trends ; 12(2): 116-125, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29760355

RESUMO

Reproductive, maternal, newborn, and child health (RMNCH) care services could be critical entry points for preventing non-communicable diseases in women and children. In high-income countries, non-communicable diseases screening has been integrated into both the medical and public health systems. To integrate these services in low- and middle-income countries, it is necessary to closely examine its effectiveness and feasibility. In this systematic review, we evaluated the effectiveness of integrating gestational and non-gestational non-communicable diseases interventions and RMNCH care among women and children in low- and middle-income countries. This systematic review included randomized and quasi-randomized controlled trials published from 2000 to 2015. Participants included reproductive-age women, children < 5 years old, and RMNCH care providers. The included interventions comprised packaged care/services that integrated RMNCH services with non-communicable disease care. The outcomes were maternal and/or infant mortality and complications, as well as health care service coverage. We analyzed six studies from 7,949 retrieved articles. Yoga exercise (p < 0.01) and nutritional improvements (p < 0.05) were effective in reducing gestational hypertension and diabetes. Additionally, integrating cervical cancer and RMNCH services was useful for identifying potential cervical cancer cases. Interventions that integrate non-communicable disease care/screening and RMNCH care may positively impact the health of women and children in low- and middle-income countries. However, as primary evidence is scarce, further research on the effectiveness of integrating non-communicable disease prevention and RMNCH care is warranted. (Review Registration: PROSPERO International prospective register of systematic reviews (CRD42015023425).).


Assuntos
Serviços de Saúde da Criança/organização & administração , Bem-Estar do Lactente , Serviços de Saúde Materna/organização & administração , Doenças não Transmissíveis/prevenção & controle , Serviços de Saúde Reprodutiva/organização & administração , Criança , Serviços de Saúde da Criança/tendências , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/tendências , Países em Desenvolvimento , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Serviços de Saúde Materna/tendências , Serviços de Saúde Reprodutiva/tendências
14.
J Bone Miner Metab ; 36(5): 596-604, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29027045

RESUMO

Osteoporosis has become a worldwide public health problem, in part due to the fact that it increases the risk of fragility hip fractures (FHFs). The epidemiological assessment of FHFs is critical for their prevention; however, datasets for FHFs in Japan remain scarce. This was a multicenter, prospective, observational study in the northern district of Kyushu Island. Inclusion criteria were age > 60 years with a diagnosis of FHF and acquisition of clinical data by an electronic data capture system. Of 1294 registered patients, 1146 enrolled in the study. Nearly one third of patients (31.8%) had a history of previous fragility fractures. The percentage of patients receiving osteoporosis treatment on admission was 21.5%. Almost all patients underwent surgical treatment (99.1%), though fewer than 30% had surgery within 48 h after hospitalization. Bone mineral density (BMD) was evaluated during hospitalization in only 50.4% of patients. The rate of osteoporosis treatment increased from 21.5% on admission to 39.3% during hospitalization. The main reasons that prescribers did not administer osteoporosis treatment during hospitalization were forgetfulness (28.4%) and clinical judgment (13.6%). Age and female ratio were significantly higher in patients with previous FHFs than in those without. There was a significant difference in the rate of osteoporosis treatment or L-spine BMD values in patients with or without previous FHFs on admission. In conclusion, this study confirmed that the evaluation and treatment of osteoporosis and FHFs is still suboptimal in Japan, even in urban districts.


Assuntos
Registros Eletrônicos de Saúde , Fraturas do Quadril/epidemiologia , Osteoporose/epidemiologia , Sistema de Registros , Idoso de 80 Anos ou mais , Densidade Óssea , Feminino , Fraturas do Quadril/fisiopatologia , Hospitalização , Humanos , Japão/epidemiologia , Masculino , Osteoporose/tratamento farmacológico , Osteoporose/fisiopatologia , Estudos Prospectivos
15.
Methods Inf Med ; 56(7): e92-e104, 2017 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-28925415

RESUMO

BACKGROUND: For more than 30 years, there has been close cooperation between Japanese and German scientists with regard to information systems in health care. Collaboration has been formalized by an agreement between the respective scientific associations. Following this agreement, two joint workshops took place to explore the similarities and differences of electronic health record systems (EHRS) against the background of the two national healthcare systems that share many commonalities. OBJECTIVES: To establish a framework and requirements for the quality of EHRS that may also serve as a basis for comparing different EHRS. METHODS: Donabedian's three dimensions of quality of medical care were adapted to the outcome, process, and structural quality of EHRS and their management. These quality dimensions were proposed before the first workshop of EHRS experts and enriched during the discussions. RESULTS: The Quality Requirements Framework of EHRS (QRF-EHRS) was defined and complemented by requirements for high quality EHRS. The framework integrates three quality dimensions (outcome, process, and structural quality), three layers of information systems (processes and data, applications, and physical tools) and three dimensions of information management (strategic, tactical, and operational information management). CONCLUSIONS: Describing and comparing the quality of EHRS is in fact a multidimensional problem as given by the QRF-EHRS framework. This framework will be utilized to compare Japanese and German EHRS, notably those that were presented at the second workshop.


Assuntos
Registros Eletrônicos de Saúde/normas , Gestão da Informação/normas , Congressos como Assunto , Registros Eletrônicos de Saúde/economia , Alemanha , Humanos , Japão , Software
16.
Geriatr Gerontol Int ; 17(5): 708-713, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27255203

RESUMO

AIM: Atrial fibrillation (AF)-related cardioembolic stroke is a serious problem in the aging society. The present study examined the clinical characteristics and outcomes of AF-related cardioembolic stroke in patients aged ≥80 years. METHODS: Between September 2011 and April 2014, consecutive patients with ischemic stroke and AF were retrospectively extracted from the multicenter database. Clinical characteristics were compared between patients aged ≥80 years and <80 years. Multivariate cox proportional hazard models were used to estimate hazard ratios and 95% confidential intervals on 90-day mortality for age of ≥80 years. RESULTS: A total of 253 patients aged ≥80 years (87 men, 86.4 ± 5.0 years) and 196 patients aged <80 years (134 men, 70.4 ± 7.1 years) were included. Patients aged ≥80 years were more frequently female, and more likely to have higher premorbid modified Rankin Scale score (mRS), lower body mass index, previous history of stroke, prior antiplatelet therapy, congestive heart failure, and persistent AF. Patients aged ≥80 years had higher initial National Institutes of Health Stroke Scale score and were more likely to have occlusion of the cervicocephalic arteries, but less likely to receive thrombolysis. Patients aged ≥80 years had a higher mRS and mortality after 3 months. Age of ≥80 years was a significant predictor of 90-day mortality after adjustment for sex (hazard ratio 2.20, 95% confidential interval 1.25-4.09), but was no longer significant after further adjustment for other clinical characteristics and stroke severity. CONCLUSIONS: In AF-related cardioembolic stroke, patients aged ≥80 years had different clinical characteristics and poorer outcome compared with patients aged <80 years. Geriatr Gerontol Int 2017; 17: 708-713.


Assuntos
Fibrilação Atrial/complicações , Procedimentos Endovasculares/métodos , Avaliação Geriátrica/métodos , Embolia Intracraniana/complicações , Acidente Vascular Cerebral/etiologia , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Idoso de 80 Anos ou mais , Fibrilação Atrial/diagnóstico , Artérias Cerebrais/diagnóstico por imagem , Eletrocardiografia Ambulatorial , Feminino , Fibrinolíticos/administração & dosagem , Seguimentos , Humanos , Incidência , Infusões Intravenosas , Embolia Intracraniana/tratamento farmacológico , Embolia Intracraniana/epidemiologia , Japão/epidemiologia , Angiografia por Ressonância Magnética , Masculino , Prognóstico , Estudos Prospectivos , Proteínas Recombinantes/administração & dosagem , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Taxa de Sobrevida/tendências , Taquicardia Paroxística/complicações , Taquicardia Paroxística/diagnóstico , Taquicardia Paroxística/terapia , Fatores de Tempo
17.
Stud Health Technol Inform ; 245: 403-407, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29295125

RESUMO

The World Health Organization has declared Bangladesh one of 58 countries facing acute Human Resources for Health (HRH) crisis. Artificial intelligence in healthcare has been shown to be successful for diagnostics. Using machine learning to predict pharmaceutical prescriptions may solve HRH crises. In this study, we investigate a predictive model by analyzing prescription data of 4,543 subjects in Bangladesh. We predict the function of prescribed drugs, comparing three machine-learning approaches. The approaches compare whether a subject shall be prescribed medicine from the 21 most frequently prescribed drug functions. Receiver Operating Characteristics (ROC) were selected as a way to evaluate and assess prediction models. The results show the drug function with the best prediction performance was oral hypoglycemic drugs, which has an average AUC of 0.962. To understand how the variables affect prediction, we conducted factor analysis based on tree-based algorithms and natural language processing techniques.


Assuntos
Inteligência Artificial , Países em Desenvolvimento , Registros Médicos , Algoritmos , Bangladesh , Humanos , Processamento de Linguagem Natural , Curva ROC
18.
Stud Health Technol Inform ; 245: 649-652, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29295176

RESUMO

The progressive digitization of medical records has resulted in the accumulation of large amounts of data. Electronic medical data include structured numerical data and unstructured text data. Although text-based medical record processing has been researched, few studies contribute to medical practice. The analysis of unstructured text data can improve medical processes. Hence, this study presents a clustering approach for detecting typical patient's condition from text-based medical record of clinical pathway. In this approach, the sentences in a cluster are merged to generate a "sentence graph" of the cluster after classified feature word by Louvain method. An analysis of real text-based medical records indicates that sentence graphs can represent the medical treatment and patient's condition in a medical process. This method could help the standardization of text-based medical records and the recognition of feature medical processes for improving medical treatment.


Assuntos
Procedimentos Clínicos , Mineração de Dados , Registros Eletrônicos de Saúde , Análise por Conglomerados , Humanos
19.
Stud Health Technol Inform ; 245: 1280, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29295365

RESUMO

Identifying important predicative indicators for prognosis is useful since these factors help for understanding diseases and determining treatments for patients. We extracted important factors for prognosis of cerebral infarction from EHR. We analyzed EHR data of 1,697 patients with 1,602 variables using gradient boosting decision tree. Extracted factors include not only well-known factors such as NIHSS but also new factors such as albumin-globulin ratio.


Assuntos
Infarto Cerebral , Aprendizado de Máquina , Árvores de Decisões , Humanos , Prognóstico
20.
PLoS One ; 11(8): e0161439, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27552225

RESUMO

Preterm low-birth-weight infants remain difficult to manage based on adequate laboratory tests. The aim of this study was to establish blood reference intervals (RIs) in those newborns who were admitted to and survived in the neonatal intensive care unit (NICU). A multicenter prospective study was conducted among all infants admitted to 11 affiliated NICUs from 2010 to 2013. The clinical information and laboratory data were registered in a network database designed for this study. The RIs for 26 items were derived using the parametric method after applying the latent abnormal values exclusion method. The influence of birth weight (BW) and gestational age (GA) on the test results was expressed in terms of the standard deviation ratio (SDR), as SDRBW and SDRGA, respectively. A total of 3189 infants were admitted during the study period; 246 were excluded due to a lack of blood sampling data, and 234 were excluded for chromosomal abnormalities (n = 108), congenital anomalies requiring treatment with surgical procedures (n = 76), and death or transfer to another hospital (n = 50). As a result, 2709 infants were enrolled in this study. Both the SDRGA and SDRBW were above 0.4 in the test results for total protein (TP), albumin (ALB), alanine aminotransferase (ALT), and red blood cells (RBC); their values increased in proportion to the BW and GA. We derived 26 blood RIs for infants who were admitted to NICUs. These RIs should help in the performance of proper clinical assessments and research in the field of perinatal-neonatal medicine.


Assuntos
Biomarcadores/sangue , Recém-Nascido de Baixo Peso/sangue , Recém-Nascido Prematuro/sangue , Vigilância em Saúde Pública , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Japão , Masculino , Estudos Prospectivos , Valores de Referência
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