Progress of clinical decision support systems in stroke nursing care

Stroke is characterized by high incidence,high recurrence,high disability,and high morbidity and mortality in China,resulting in a heavy social and clinical burden.A clinical decision support system,as an intelli-gent computer system,can assist nurses in decision-mak-ing to collect information quickly,make the most suitable personalized decisions for patients,and improve nurses’decision-making judgment and quality of care.Promoting the development and application of decision support sys-tems in stroke nursing significantly enhances the nursing staff’s work quality and patients’prognosis.Therefore,this paper reviews the research progress of domestic and international clinical decision support systems in stroke nursing care to provide other researchers with specific research directions for developing and applying decision support systems in stroke nursing care.

Modelling an Efficient Clinical Decision Support System for Heart Disease Prediction Using Learning and Optimization Approaches

With the worldwide analysis,heart disease is considered a significant threat and extensively increases the mortality rate.Thus,the investigators mitigate to predict the occurrence of heart disease in an earlier stage using the design of a better Clinical Decision Support System(CDSS).Generally,CDSS is used to predict the individuals’heart disease and periodically update the condition of the patients.This research proposes a novel heart disease prediction system with CDSS composed of a clustering model for noise removal to predict and eliminate outliers.Here,the Synthetic Over-sampling prediction model is integrated with the cluster concept to balance the training data and the Adaboost classifier model is used to predict heart disease.Then,the optimization is achieved using the Adam Optimizer(AO)model with the publicly available dataset known as the Stalog dataset.This flowis used to construct the model,and the evaluation is done with various prevailing approaches like Decision tree,Random Forest,Logistic Regression,Naive Bayes and so on.The statistical analysis is done with theWilcoxon rank-summethod for extracting the p-value of the model.The observed results show that the proposed model outperforms the various existing approaches and attains efficient prediction accuracy.This model helps physicians make better decisions during complex conditions and diagnose the disease at an earlier stage.Thus,the earlier treatment process helps to eliminate the death rate.Here,simulation is done withMATLAB 2016b,and metrics like accuracy,precision-recall,F-measure,p-value,ROC are analyzed to show the significance of the model.

Bibliometrics analysis of clinical decision support systems research in nursing

Objective:Artificial intelligence(AI)has a big impact on healthcare now and in the future.Nurses play an important role in the medical field and will benefit greatly from this technology.AI-Enabled Clinical Decision Support Systems have received a great deal of attention recently.Bibliometric analysis can offer an objective,systematic,and comprehensive analysis of a specific field with a vast background.However,no bibliometric analysis has investigated AI-enabled clinical decision support systems research in nursing.The purpose of research to determine the characteristics of articles about the global performance and development of AI-enabled clinical decision support systems research in nursing.Methods:In this study,the bibliometric approach was used to estimate the searched data on clinical decision support systems research in nursing from 2009 to 2022,and we also utilized CiteSpace and VOSviewer software to build visualizing maps to assess the contribution of different journals,authors,et al.,as well as to identify research hot spots and promising future trends in this research field.Result:From 2009 to 2022,a total of 2,159 publications were retrieved.The number of publications and citations on AI-enabled clinical decision support systems research in nursing has increased obvious ly in recent years.However,they are understudied in the field of nursing and there is a compelling need to develop more high-quality research.Conclusion:AI-Enabled Nursing Decision Support System use in clinical practice is still in its early stages.These analyses and results hope to provide useful information and references for future research directions for researchers and nursing practitioners who use AI-enabled clinical decision support systems.

A clinical decision support system using rough set theory and machine learning for disease prediction

Objective Technological advances have led to drastic changes in daily life,and particularly healthcare,while traditional diagnosis methods are being replaced by technology-oriented models and paper-based patient health-care records with digital files.Using the latest technology and data mining techniques,we aimed to develop an automated clinical decision support system(CDSS),to improve patient prognoses and healthcare delivery.Our proposed approach placed a strong emphasis on improvements that meet patient,parent,and physician expec-tations.We developed a flexible framework to identify hepatitis,dermatological conditions,hepatic disease,and autism in adults and provide results to patients as recommendations.The novelty of this CDSS lies in its inte-gration of rough set theory(RST)and machine learning(ML)techniques to improve clinical decision-making accuracy and effectiveness.Methods Data were collected through various web-based resources.Standard preprocessing techniques were applied to encode categorical features,conduct min-max scaling,and remove null and duplicate entries.The most prevalent feature in the class and standard deviation were used to fill missing categorical and continuous feature values,respectively.A rough set approach was applied as feature selection,to remove highly redundant and irrelevant elements.Then,various ML techniques,including K nearest neighbors(KNN),linear support vector machine(LSVM),radial basis function support vector machine(RBF SVM),decision tree(DT),random forest(RF),and Naive Bayes(NB),were employed to analyze four publicly available benchmark medical datasets of different types from the UCI repository and Kaggle.The model was implemented in Python,and various validity metrics,including precision,recall,F1-score,and root mean square error(RMSE),applied to measure its performance.Results Features were selected using an RST approach and examined by RF analysis and important features of hepatitis,dermatology conditions,hepatic disease,and autism determined by RST and RF exhibited 92.85%,90.90%,100%,and 80%similarity,respectively.Selected features were stored as electronic health records and various ML classifiers,such as KNN,LSVM,RBF SVM,DT,RF,and NB,applied to classify patients with hepatitis,dermatology conditions,hepatic disease,and autism.In the last phase,the performance of proposed classifiers was compared with that of existing state-of-the-art methods,using various validity measures.RF was found to be the best approach for adult screening of:hepatitis with accuracy 88.66%,precision 74.46%,recall 75.17%,F1-score 74.81%,and RMSE value 0.244;dermatology conditions with accuracy 97.29%,precision 96.96%,recall 96.96%,F1-score 96.96%,and RMSE value,0.173;hepatic disease,with accuracy 91.58%,precision 81.76%,recall 81.82%,F1-Score 81.79%,and RMSE value 0.193;and autism,with accuracy 100%,precision 100%,recall 100%,F1-score 100%,and RMSE value 0.064.Conclusion The overall performance of our proposed framework may suggest that it could assist medical experts in more accurately identifying and diagnosing patients with hepatitis,dermatology conditions,hepatic disease,and autism.

Framework for a Computer-Aided Treatment Prediction (CATP) System for Breast Cancer

This study offers a framework for a breast cancer computer-aided treat-ment prediction(CATP)system.The rising death rate among women due to breast cancer is a worldwide health concern that can only be addressed by early diagno-sis and frequent screening.Mammography has been the most utilized breast ima-ging technique to date.Radiologists have begun to use computer-aided detection and diagnosis(CAD)systems to improve the accuracy of breast cancer diagnosis by minimizing human errors.Despite the progress of artificial intelligence(AI)in the medical field,this study indicates that systems that can anticipate a treatment plan once a patient has been diagnosed with cancer are few and not widely used.Having such a system will assist clinicians in determining the optimal treatment plan and avoid exposing a patient to unnecessary hazardous treatment that wastes a significant amount of money.To develop the prediction model,data from 336,525 patients from the SEER dataset were split into training(80%),and testing(20%)sets.Decision Trees,Random Forest,XGBoost,and CatBoost are utilized with feature importance to build the treatment prediction model.The best overall Area Under the Curve(AUC)achieved was 0.91 using Random Forest on the SEER dataset.

To scan or not to scan:Use of transient elastography in an integrated health system

BACKGROUND Non-invasive tests,such as Fibrosis-4 index and transient elastography(com-monly FibroScan),are utilized in clinical pathways to risk stratify and diagnose non-alcoholic fatty liver disease(NAFLD).In 2018,a clinical decision support tool(CDST)was implemented to guide primary care providers(PCPs)on use of FibroScan for NAFLD.AIM To analyze how this CDST impacted health care utilization and patient outcomes.METHODS We performed a retrospective review of adults who had FibroScan for NAFLD indication from January 2015 to December 2017(pre-CDST)or January 2018 to December 2020(post-CDST).Outcomes included FibroScan result,laboratory tests,imaging studies,specialty referral,patient morbidity and mortality.RESULTS We identified 958 patients who had FibroScan,115 before and 843 after the CDST was implemented.The percentage of FibroScans ordered by PCPs increased from 33%to 67.1%.The percentage of patients diagnosed with early F1 fibrosis,on a scale from F0 to F4,increased from 7.8%to 14.2%.Those diagnosed with ad-vanced F4 fibrosis decreased from 28.7%to 16.5%.There were fewer laboratory tests,imaging studies and biopsy after the CDST was implemented.Though there were more specialty referrals placed after the CDST was implemented,multivariate analysis revealed that healthcare utilization aligned with fibrosis score,whereby patients with more advanced disease had more referrals.Very few patients were hospitalized or died.CONCLUSION This CDST empowered PCPs to diagnose and manage patients with NAFLD with appropriate allocation of care towards patients with more advanced disease.

A Study on the Explainability of Thyroid Cancer Prediction:SHAP Values and Association-Rule Based Feature Integration Framework

In the era of advanced machine learning techniques,the development of accurate predictive models for complex medical conditions,such as thyroid cancer,has shown remarkable progress.Accurate predictivemodels for thyroid cancer enhance early detection,improve resource allocation,and reduce overtreatment.However,the widespread adoption of these models in clinical practice demands predictive performance along with interpretability and transparency.This paper proposes a novel association-rule based feature-integratedmachine learning model which shows better classification and prediction accuracy than present state-of-the-artmodels.Our study also focuses on the application of SHapley Additive exPlanations(SHAP)values as a powerful tool for explaining thyroid cancer prediction models.In the proposed method,the association-rule based feature integration framework identifies frequently occurring attribute combinations in the dataset.The original dataset is used in trainingmachine learning models,and further used in generating SHAP values fromthesemodels.In the next phase,the dataset is integrated with the dominant feature sets identified through association-rule based analysis.This new integrated dataset is used in re-training the machine learning models.The new SHAP values generated from these models help in validating the contributions of feature sets in predicting malignancy.The conventional machine learning models lack interpretability,which can hinder their integration into clinical decision-making systems.In this study,the SHAP values are introduced along with association-rule based feature integration as a comprehensive framework for understanding the contributions of feature sets inmodelling the predictions.The study discusses the importance of reliable predictive models for early diagnosis of thyroid cancer,and a validation framework of explainability.The proposed model shows an accuracy of 93.48%.Performance metrics such as precision,recall,F1-score,and the area under the receiver operating characteristic(AUROC)are also higher than the baseline models.The results of the proposed model help us identify the dominant feature sets that impact thyroid cancer classification and prediction.The features{calcification}and{shape}consistently emerged as the top-ranked features associated with thyroid malignancy,in both association-rule based interestingnessmetric values and SHAPmethods.The paper highlights the potential of the rule-based integrated models with SHAP in bridging the gap between the machine learning predictions and the interpretability of this prediction which is required for real-world medical applications.

A Case-Finding Clinical Decision Support System to Identify Subjects with Chronic Obstructive Pulmonary Disease Based on Public Health Data

Chronic obstructive pulmonary disease(COPD)is a serious chronic respiratory disease.Improving the ability to identify patients with COPD in primary medical institutions is important to prevent and treat the disease.With the continuous development of medical digitization,the application of big data informatization in the medical and health fields has become possible.Recently,applying innovative technologies such as big data analysis,machine learning,and artificial intelligence-assisted decision-making in the medical field has become an interdisciplinary research hotspot.Based on the identification and diagnosis of COPD in the high-risk population,this study proposes a convenient and effective clinical decision support system to help identify patients with COPD in primary health institutions.The results of the preliminary experiments show that the proposed method is convenient and effective compared with the existing methods.

Clinical Preceptor’s Role in the Development of Nursing Training Based on Professional and Competency Frameworks in Two Health Care Facilities of Bujumbura

Background: The aim of clinical preceptors is to support the development of expertise related to the preceptorship of groups of trainees among nurses in clinical settings by the acquisition and use of theoretical knowledge, know-how and know-that. The support of students remains a major problem in hospitals, because the requirements of the preceptors according to the standards are not considered. The lack of guidelines on nursing preceptorships, theoretical application based on the professional curriculum, and professional expertise were the main problems assessed in the two Health Care (HUCK, VNC) in this study. The purpose of this study is to assess the knowledge of nurses and learners during their preceptorship practices and to contribute to the direction of evidence-based preceptorship. Method: A descriptive cross-sectional study design was used in this study during the 3-month period. A sample of 121 nurses as well as 56 learners were selected from 381 nurses and 80 learners using Alain Bouchard’s formula. A questionnaire developed according to the guidelines of Ernestine Wiedenbach’s theory of care, was distributed. The data were analyzed using the Microsoft Excel and the software program version 16 (SPSS-16). Results: The current study found that the majority of nurses do not know the importance of the clinical tutor. The results state that students experience clinical practice problems, thus clinical preceptorship is required. Nurses showed that there are different barriers often encountered during their practices. The overall nurse preceptorship process is not optimal and the average of 97.6% of nurses does not have expertise in coaching interns in clinical settings. Conclusion: Although that nurses have some experience at work, they express their weakness based on a low level of education, a lack of knowledge and trained professionals on the job, and clinical preceptorship guidelines.

Towards automated calculation of evidence-based clinical scores

AIM To determine clinical scores important for automated calculation in the inpatient setting.METHODS A modified Delphi methodology was used to create consensus of important clinical scores for inpatient practice. A list of 176 externally validated clinical scores were identified from freely available internet-based services frequently used by clinicians. Scores were categorized based on pertinent specialty and a customized survey was created for each clinician specialty group. Clinicians were asked to rank each score based on importance of automated calculation to their clinical practice in three categories-"not important", "nice to have", or "very important". Surveys were solicited via specialty-group listserv over a 3-mo interval. Respondents must have been practicing physicians with more than 20% clinical time spent in the inpatient setting. Within each specialty, consensus was established for any clinical score with greater than 70% of responses in a single category and a minimum of 10 responses. Logistic regression was performed to determine predictors of automation importance.RESULTS Seventy-nine divided by one hundred and forty-four(54.9%) surveys were completed and 72/144(50%) surveys were completed by eligible respondents. Only the critical care and internal medicine specialties surpassed the 10-respondent threshold(14 respondents each). For internists, 2/110(1.8%) of scores were "very important" and 73/110(66.4%) were "nice to have". For intensivists, no scores were "very important" and 26/76(34.2%) were "nice to have". Only the number of medical history(OR = 2.34; 95%CI: 1.26-4.67; P < 0.05) and vital sign(OR = 1.88; 95%CI: 1.03-3.68; P < 0.05) variables for clinical scores used by internists was predictive of desire for automation. CONCLUSION Few clinical scores were deemed "very important" for automated calculation. Future efforts towards score calculator automation should focus on technically feasible "nice to have" scores.

A Decision Support Model for Predicting Avoidable Re-Hospitalization of Breast Cancer Patients in Kenyatta National Hospital

This study aimed to develop a clinical Decision Support Model (DSM) which is software that provides physicians and other healthcare stakeholders with patient-specific assessments and recommendation in aiding clinical decision-making while discharging Breast cancer patient since the diagnostics and discharge problem is often overwhelming for a clinician to process at the point of care or in urgent situations. The model incorporates Breast cancer patient-specific data that are well-structured having been attained from a prestudy’s administered questionnaires and current evidence-based guidelines. Obtained dataset of the prestudy’s questionnaires is processed via data mining techniques to generate an optimal clinical decision tree classifier model which serves physicians in enhancing their decision-making process while discharging a breast cancer patient on basic cognitive processes involved in medical thinking hence new, better-formed, and superior outcomes. The model also improves the quality of assessments by constructing predictive discharging models from code attributes enabling timely detection of deterioration in the quality of health of a breast cancer patient upon discharge. The outcome of implementing this study is a decision support model that bridges the gap occasioned by less informed clinical Breast cancer discharge that is based merely on experts’ opinions which is insufficiently reinforced for better treatment outcomes. The reinforced discharge decision for better treatment outcomes is through timely deployment of the decision support model to work hand in hand with the expertise in deriving an integrative discharge decision and has been an agreed strategy to eliminate the foreseeable deteriorating quality of health for a discharged breast cancer patients and surging rates of mortality blamed on mistrusted discharge decisions. In this paper, we will discuss breast cancer clinical knowledge, data mining techniques, the classifying model accuracy, and the Python web-based decision support model that predicts avoidable re-hospitalization of a breast cancer patient through an informed clinical discharging support model.

A Novel Krill Herd Based Random Forest Algorithm for Monitoring Patient Health

Artificial Intelligence(AI)is finding increasing application in healthcare monitoring.Machine learning systems are utilized for monitoring patient health through the use of IoT sensor,which keep track of the physiological state by way of various health data.Thus,early detection of any disease or derangement can aid doctors in saving patients’lives.However,there are some challenges associated with predicting health status using the common algorithms,such as time requirements,chances of errors,and improper classification.We propose an Artificial Krill Herd based on the Random Forest(AKHRF)technique for monitoring patients’health and eliciting an optimal prescription based on their health status.To begin with,various patient datasets were collected and trained into the system using IoT sensors.As a result,the framework developed includes four processes:preprocessing,feature extraction,classification,and result visibility.Additionally,preprocessing removes errors,noise,and missing values from the dataset,whereas feature extraction extracts the relevant information.Then,in the classification layer,we updated the fitness function of the krill herd to classify the patient’s health status and also generate a prescription.We found that the results fromthe proposed framework are comparable to the results from other state-of-the-art techniques in terms of sensitivity,specificity,Area under the Curve(AUC),accuracy,precision,recall,and F-measure.

A novel machine learning-assisted clinical diagnosis support model for early identification of pancreatic injuries in patients with blunt abdominal trauma:a cross-national study

Background:The recognition of pancreatic injury in blunt abdominal trauma is often severely delayed in clinical practice.The aim of this study was to develop a machine learning model to support clinical diagnosis for early detection of abdominal trauma.Methods:We retrospectively analyzed of a large intensive care unit database(Medical Information Mart for Intensive Care[MIMIC]-IV)for model development and internal validation of the model,and performed outer validation based on a cross-national data set.Logistic regres-sion was used to develop three models(PI-12,PI-12-2,and PI-24).Univariate and multivariate analyses were used to determine variables in each model.The primary outcome was early detection of a pancreatic injury of any grade in patients with blunt abdominal trauma in the first 24 hours after hospitalization.Results:The incidence of pancreatic injuries was 5.56%(n=18)and 6.06%(n=6)in the development(n=324)and internal validation(n=99)cohorts,respectively.Internal validation cohort showed good discrimination with an area under the receiver operator characteristic curve(AUC)value of 0.84(95%confidence interval[CI]:0.71–0.96)for PI-24.PI-24 had the best AUC,specificity,and positive predictive value(PPV)of all models,and thus it was chosen as the final model to support clinical diagnosis.PI-24 performed well in the outer validation cohort with an AUC value of 0.82(95%CI:0.65–0.98),specificity of 0.97(95%CI:0.91–1.00),and PPV of 0.67(95%CI:0.00–1.00).Conclusion:A novel machine learning-based model was developed to support clinical diagnosis to detect pancreatic injuries in patients with blunt abdominal trauma at an early stage.

Development of Medical Informatization in the Era of Big Data

The purpose of this paper is to discuss the development of medical informatization in the era of big data.Through literature review and theoretical analysis,the development of medical informatization in the era of big data is deeply discussed.The results show that medical informatization has developed rapidly in the era of big data,and its role in clinical decision-making,scientific research,teaching,and management has become increasingly prominent.The development of medical informatization in the era of big data has important purposes and methods,which can produce important results and conclusions and provide strong support for the development of the medical field.

Big Data for Precision Medicine

This article focuses on the potential impact of big data analysis to improve health, prevent and detect disease at an earlier stage, and personalize interventions. The role that big data analytics may have in interrogating the patient electronic health record toward improved clinical decision support is discussed. Weexamine developments in pharmacogenetics that have increased our appreciation of the reasons why patients respond differently to chemotherapy. We also assess the expansion of online health communications and the way in which this data may be capitalized on in order to detect public health threats and control or contain epidemics. Finally, we describe how a new generation of wearable and implantable body sensors may improve wellbeing, streamline management of chronic diseases, and improve the quality of surgical implants.

Endoscopic ultrasound-guided fine-needle aspiration for suspected malignancies adjacent to the gastrointestinal tract

AIM: To investigate the impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in association with a multidisciplinary team evaluation for the detection of gastrointestinal malignancies.

A linked data-based approach for clinical treatment selecting support

Treatment plan selection is a complex process because it sometimes needs sufficient experience and clinical information.Nowadays it is even harder for doctors to select an appropriate treatment plan for certain patients since doctors might encounter difficulties in obtaining the right information and analyzing the diverse clinical data.In order to improve the effectiveness of clinical decision making in complicated information system environments,we first propose a linked data-based approach for treatment plan selection.The approach integrates the patients’clinical records in hospitals with open linked data sources out of hospitals.Then,based on the linked data net,treatment plan selection is carried on aided by similar historical therapy cases.Finally,we reorganize the electronic medical records of 97 colon cancer patients using the linked data model and count the similarity of these records to help treatment selecting.The experiment shows the usability of our method in supporting clinical decisions.

Screening dementia and predicting high dementia risk groups using machine learning

New technologies such as artificial intelligence,the internet of things,big data,and cloud computing have changed the overall society and economy,and the medical field particularly has tried to combine traditional examination methods and new technologies.The most remarkable field in medical research is the technology of predicting high dementia risk group using big data and artificial intelligence.This review introduces:(1)the definition,main concepts,and classification of machine learning and overall distinction of it from traditional statistical analysis models;and(2)the latest studies in mental science to detect dementia and predict high-risk groups in order to help competent researchers who are challenging medical artificial intelligence in the field of psychiatry.As a result of reviewing 4 studies that used machine learning to discriminate high-risk groups of dementia,various machine learning algorithms such as boosting model,artificial neural network,and random forest were used for predicting dementia.The development of machine learning algorithms will change primary care by applying advanced machine learning algorithms to detect high dementia risk groups in the future.

Current applications of artificial intelligence for intraoperative decision support in surgery Allison

Research into medical artificial intelligence(AI)has made significant advances in recent years,including surgical applications.This scoping review investigated AI-based decision support systems targeted at the intraoperative phase of surgery and found a wide range of technological approaches applied across several surgical specialties.Within the twenty-one(n=21)included papers,three main categories of motivations were identified for developing such technologies:(1)augmenting the information available to surgeons,(2)accelerating intraoperative pathology,and(3)recommending surgical steps.While many of the proposals hold promise for improving patient outcomes,important methodological shortcomings were observed in most of the reviewed papers that made it difficult to assess the clinical significance of the reported performance statistics.Despite limitations,the current state of this field suggests that a number of opportunities exist for future researchers and clinicians to work on AI for surgical decision support with exciting implications for improving surgical care.

Design and implementation of a platform for configuring clinical dynamic safety checklist applications

In recent years, it has been demonstrated that checklists can improve patient safety significantly. To facilitate the effective use of checklists in daily practice, both the medical community and the informatics community propose to implement checklists in dynamic checklist applications that can be integrated into the clinical workflow and that is specific to the patient context. However, it is difficult to develop such applications because they are tightly intertwined with the content of specific checklists. We propose a platform that enables access to dynamic checklist applications by configuring the infrastructures provided in the platform. Then, the applications can be developed without time-consuming programming work. We define a number of design criteria regarding point of care and clinical processes by analyzing the existing checklist applications and the lessons learned from implementations.Then, by applying rule-based clinical decision support and workflow management technologies, we design technical mechanisms to satisfy the design criteria. A dynamic checklist application platform is designed based on these mechanisms. Finally, we build a platform in various design cycle iterations, driven by multiple clinical cases. By applying the platform, we develop nine comprehensive dynamic checklist applications with 242 dynamic checklists.The results demonstrate both the feasibility and the overall generic nature of the proposed approach. We propose a novel platform for configuring dynamic checklist applications. This platform satisfies the general requirements and can be easily configured to satisfy different scenarios in which safety checklists are used.