| 1. |
- Agvall, B., et al.
(författare)
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Characteristics, management and outcomes in patients with CKD in a healthcare region in Sweden: a population-based, observational study
- 2023
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Ingår i: Bmj Open. - London : BMJ Publishing Group Ltd. - 2044-6055. ; 13:7
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo describe chronic kidney disease (CKD) regarding treatment rates, comorbidities, usage of CKD International Classification of Diseases (ICD) diagnosis, mortality, hospitalisation, evaluate healthcare utilisation and screening for CKD in relation to new nationwide CKD guidelines. DesignPopulation-based observational study. SettingHealthcare registry data of patients in Southwest Sweden. ParticipantsA total cohort of 65 959 individuals aged >18 years of which 20 488 met the criteria for CKD (cohort 1) and 45 470 at risk of CKD (cohort 2). Primary and secondary outcome measuresData were analysed with regards to prevalence, screening rates of blood pressure, glucose, estimated glomerular filtration rate (eGFR), Urinary-albumin-creatinine ratio (UACR) and usage of ICD-codes for CKD. Mortality and hospitalisation were analysed with logistic regression models. ResultsOf the CKD cohort, 18% had CKD ICD-diagnosis and were followed annually for blood pressure (79%), glucose testing (76%), eGFR (65%), UACR (24%). UACR follow-up was two times as common in hypertensive and cardiovascular versus diabetes patients with CKD with a similar pattern in those at risk of CKD. Statin and renin-angiotensin-aldosterone inhibitor appeared in 34% and 43%, respectively. Mortality OR at CKD stage 5 was 1.23 (CI 0.68 to 0.87), diabetes 1.20 (CI 1.04 to 1.38), hypertension 1.63 (CI 1.42 to 1.88), atherosclerotic cardiovascular disease (ASCVD) 1.84 (CI 1.62 to 2.09) associated with highest mortality risk. Hospitalisation OR in CKD stage 5 was 1.96 (CI 1.40 to 2.76), diabetes 1.15 (CI 1.06 to 1.25), hypertension 1.23 (CI 1.13 to 1.33) and ASCVD 1.52 (CI 1.41 to 1.64). ConclusionsThe gap between patients with CKD by definition versus those diagnosed as such was large. Compared with recommendations patients with CKD have suboptimal follow-up and treatment with renin-angiotensin-aldosterone system inhibitor and statins. Hypertension, diabetes and ASCVD were associated with increased mortality and hospitalisation. Improved screening and diagnosis of CKD, identification and management of risk factors and kidney protective treatment could affect clinical and economic outcomes.
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| 2. |
- Ashfaq, Awais, 1990-, et al.
(författare)
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Data resource profile : Regional healthcare information platform in Halland, Sweden
- 2020
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Ingår i: International Journal of Epidemiology. - Oxford : Oxford University Press. - 0300-5771 .- 1464-3685. ; 49:3, s. 738-739f
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Tidskriftsartikel (refereegranskat)abstract
- Accurate and comprehensive healthcare data coupled with modern analytical tools can play a vital role in enabling care providers to make better-informed decisions, leading to effective and cost-efficient care delivery. This paper describes a novel strategic healthcare analysis and research platform that encapsulates 360-degree pseudo-anonymized data covering clinical, operational capacity and financial data on over 500,000 patients treated since 2009 across all care delivery units in the county of Halland, Sweden. The over-arching goal is to develop a comprehensive healthcare data infrastructure that captures complete care processes at individual, organizational and population levels. These longitudinal linked healthcare data are a valuable tool for research in a broad range of areas including health economy and process development using real world evidence.Key messagesStructured and standardized variables have been linked from different regional healthcare sources into a research information platform including all healthcare visits in the county of Halland in Sweden, from 2009 to date.Since 2015, the regional information platform integrates a cost component to each healthcare visit: thus being able to quantify patient level value, safety and cost efficiency across the continuum of care. © The Author(s) 2020; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association
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| 3. |
- Ashfaq, Awais, 1990-, et al.
(författare)
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DEED : DEep Evidential Doctor
- 2023
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Ingår i: Artificial Intelligence. - Amsterdam : Elsevier. - 0004-3702 .- 1872-7921. ; 325
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Tidskriftsartikel (refereegranskat)abstract
- As Deep Neural Networks (DNN) make their way into safety-critical decision processes, it becomes imperative to have robust and reliable uncertainty estimates for their predictions for both in-distribution and out-of-distribution (OOD) examples. This is particularly important in real-life high-risk settings such as healthcare, where OOD examples (e.g., patients with previously unseen or rare labels, i.e., diagnoses) are frequent, and an incorrect clinical decision might put human life in danger, in addition to having severe ethical and financial costs. While evidential uncertainty estimates for deep learning have been studied for multi-class problems, research in multi-label settings remains untapped. In this paper, we propose a DEep Evidential Doctor (DEED), which is a novel deterministic approach to estimate multi-label targets along with uncertainty. We achieve this by placing evidential priors over the original likelihood functions and directly estimating the parameters of the evidential distribution using a novel loss function. Additionally, we build a redundancy layer (particularly for high uncertainty and OOD examples) to minimize the risk associated with erroneous decisions based on dubious predictions. We achieve this by learning the mapping between the evidential space and a continuous semantic label embedding space via a recurrent decoder. Thereby inferring, even in the case of OOD examples, reasonably close predictions to avoid catastrophic consequences. We demonstrate the effectiveness of DEED on a digit classification task based on a modified multi-label MNIST dataset, and further evaluate it on a diagnosis prediction task from a real-life electronic health record dataset. We highlight that in terms of prediction scores, our approach is on par with the existing state-of-the-art having a clear advantage of generating reliable, memory and time-efficient uncertainty estimates with minimal changes to any multi-label DNN classifier. © 2023 The Author(s)
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| 4. |
- Ashfaq, Awais, 1990-
(författare)
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Deep Evidential Doctor
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Recent years have witnessed an unparalleled surge in deep neural networks (DNNs) research, surpassing traditional machine learning (ML) and statistical methods on benchmark datasets in computer vision, audio processing and natural language processing (NLP). Much of this success can be attributed to the availability of numerous open-source datasets, advanced computational resources and algorithms. These algorithms learn multiple levels of simple to complex abstractions (or representations) of data resulting in superior performances on downstream applications. This has led to an increasing interest in reaping the potential of DNNs in real-life safety-critical domains such as autonomous driving, security systems and healthcare. Each of them comes with their own set of complexities and requirements, thereby necessitating the development of new approaches to address domain-specific problems, even if building on common foundations.In this thesis, we address data science related challenges involved in learning effective prediction models from structured electronic health records (EHRs). In particular, questions related to numerical representation of complex and heterogeneous clinical concepts, modelling the sequential structure of EHRs and quantifying prediction uncertainties are studied. From a clinical perspective, the question of predicting onset of adverse outcomes for individual patients is considered to enable early interventions, improve patient outcomes, curb unnecessary expenditures and expand clinical knowledge.This is a compilation thesis including five articles. It begins by describing a healthcare information platform that encapsulates clinical, operational and financial data of patients across all public care delivery units in Halland, Sweden. Thus, the platform overcomes the technical and legislative data-related challenges inherent to the modern era's complex and fragmented healthcare sector. The thesis presents evidence that expert clinical features are powerful predictors of adverse patient outcomes. However, they are well complemented by clinical concept embeddings; gleaned via NLP inspired language models. In particular, a novel representation learning framework (KAFE: Knowledge And Frequency adapted Embeddings) has been proposed that leverages medical knowledge schema and adversarial principles to learn high quality embeddings of both frequent and rare clinical concepts. In the context of sequential EHR modelling, benchmark experiments on cost-sensitive recurrent nets have shown significant improvements compared to non-sequential networks. In particular, an attention based hierarchical recurrent net is proposed that represents individual patients as weighted sums of ordered visits, where visits are, in turn, represented as weighted sums of unordered clinical concepts. In the context of uncertainty quantification and building trust in models, the field of deep evidential learning has been extended. In particular for multi-label tasks, simple extensions to current neural network architecture are proposed, coupled with a novel loss criterion to infer prediction uncertainties without compromising on accuracy. Moreover, a qualitative assessment of the model behaviour has also been an important part of the research articles, to analyse the correlations learned by the model in relation to established clinical science.Put together, we develop DEep Evidential Doctor (DEED). DEED is a generic predictive model that learns efficient representations of patients and clinical concepts from EHRs and quantifies its confidence in individual predictions. It is also equipped to infer unseen labels.Overall, this thesis presents a few small steps towards solving the bigger goal of artificial intelligence (AI) in healthcare. The research has consistently shown impressive prediction performance for multiple adverse outcomes. However, we believe that there are numerous emerging challenges to be addressed in order to reap the full benefits of data and AI in healthcare. For future works, we aim to extend the DEED framework to incorporate wider data modalities such as clinical notes, signals and daily lifestyle information. We will also work to equip DEED with explainability features.
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| 5. |
- Ashfaq, Awais, 1990-, et al.
(författare)
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KAFE : Knowledge and Frequency Adapted Embeddings
- 2022
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Ingår i: Machine Learning, Optimization, and Data Science. - Cham : Springer. - 9783030954697 - 9783030954703 ; , s. 132-146
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Konferensbidrag (refereegranskat)abstract
- Word embeddings are widely used in several Natural Language Processing (NLP) applications. The training process typically involves iterative gradient updates of each word vector. This makes word frequency a major factor in the quality of embedding, and in general the embedding of words with few training occurrences end up being of poor quality. This is problematic since rare and frequent words, albeit semantically similar, might end up far from each other in the embedding space.In this study, we develop KAFE (Knowledge And Frequency adapted Embeddings) which combines adversarial principles and knowledge graph to efficiently represent both frequent and rare words. The goal of adversarial training in KAFE is to minimize the spatial distinguishability (separability) of frequent and rare words in the embedding space. The knowledge graph encourages the embedding to follow the structure of the domain-specific hierarchy, providing an informative prior that is particularly important for words with low amount of training data. We demonstrate the performance of KAFE in representing clinical diagnoses using real-world Electronic Health Records (EHR) data coupled with a knowledge graph. EHRs are notorious for including ever-increasing numbers of rare concepts that are important to consider when defining the state of the patient for various downstream applications. Our experiments demonstrate better intelligibility through visualisation, as well as higher prediction and stability scores of KAFE over state-of-the-art. © Springer Nature Switzerland AG 2022
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| 6. |
- Ashfaq, Awais, 1990-, et al.
(författare)
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Machine learning in healthcare - a system’s perspective
- 2019
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Ingår i: Proceedings of the ACM SIGKDD Workshop on Epidemiology meets Data Mining and Knowledge Discovery (epiDAMIK). - Arlington. ; , s. 14-17
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Konferensbidrag (refereegranskat)abstract
- A consequence of the fragmented and siloed healthcare landscape is that patient care (and data) is split along multitude of different facilities and computer systems and enabling interoperability between these systems is hard. The lack interoperability not only hinders continuity of care and burdens providers, but also hinders effective application of Machine Learning (ML) algorithms. Thus, most current ML algorithms, designed to understand patient care and facilitate clinical decision-support, are trained on limited datasets. This approach is analogous to the Newtonian paradigm of Reductionism in which a system is broken down into elementary components and a description of the whole is formed by understanding those components individually. A key limitation of the reductionist approach is that it ignores the component-component interactions and dynamics within the system which are often of prime significance in understanding the overall behaviour of complex adaptive systems (CAS). Healthcare is a CAS.Though the application of ML on health data have shown incremental improvements for clinical decision support, ML has a much a broader potential to restructure care delivery as a whole and maximize care value. However, this ML potential remains largely untapped: primarily due to functional limitations of Electronic Health Records (EHR) and the inability to see the healthcare system as a whole. This viewpoint (i) articulates the healthcare as a complex system which has a biological and an organizational perspective, (ii) motivates with examples, the need of a system's approach when addressing healthcare challenges via ML and, (iii) emphasizes to unleash EHR functionality - while duly respecting all ethical and legal concerns - to reap full benefits of ML.
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| 7. |
- Ashfaq, Awais, 1990-
(författare)
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Predicting clinical outcomes via machine learning on electronic health records
- 2019
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The rising complexity in healthcare, exacerbated by an ageing population, results in ineffective decision-making leading to detrimental effects on care quality and escalates care costs. Consequently, there is a need for smart decision support systems that can empower clinician's to make better informed care decisions. Decisions, which are not only based on general clinical knowledge and personal experience, but also rest on personalised and precise insights about future patient outcomes. A promising approach is to leverage the ongoing digitization of healthcare that generates unprecedented amounts of clinical data stored in Electronic Health Records (EHRs) and couple it with modern Machine Learning (ML) toolset for clinical decision support, and simultaneously, expand the evidence base of medicine. As promising as it sounds, assimilating complete clinical data that provides a rich perspective of the patient's health state comes with a multitude of data-science challenges that impede efficient learning of ML models. This thesis primarily focuses on learning comprehensive patient representations from EHRs. The key challenges of heterogeneity and temporality in EHR data are addressed using human-derived features appended to contextual embeddings of clinical concepts and Long-Short-Term-Memory networks, respectively. The developed models are empirically evaluated in the context of predicting adverse clinical outcomes such as mortality or hospital readmissions. We also present evidence that, surprisingly, different ML models primarily designed for non-EHR analysis (like language processing and time-series prediction) can be combined and adapted into a single framework to efficiently represent EHR data and predict patient outcomes.
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| 8. |
- Ashfaq, Awais, 1990-, et al.
(författare)
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Readmission prediction using deep learning on electronic health records
- 2019
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Ingår i: Journal of Biomedical Informatics. - Maryland Heights, MO : Elsevier BV. - 1532-0464 .- 1532-0480. ; 97
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Tidskriftsartikel (refereegranskat)abstract
- Unscheduled 30-day readmissions are a hallmark of Congestive Heart Failure (CHF) patients that pose significant health risks and escalate care cost. In order to reduce readmissions and curb the cost of care, it is important to initiate targeted intervention programs for patients at risk of readmission. This requires identifying high-risk patients at the time of discharge from hospital. Here, using real data from over 7500 CHF patients hospitalized between 2012 and 2016 in Sweden, we built and tested a deep learning framework to predict 30-day unscheduled readmission. We present a cost-sensitive formulation of Long Short-Term Memory (LSTM) neural network using expert features and contextual embedding of clinical concepts. This study targets key elements of an Electronic Health Record (EHR) driven prediction model in a single framework: using both expert and machine derived features, incorporating sequential patterns and addressing the class imbalance problem. We evaluate the contribution of each element towards prediction performance (ROC-AUC, F1-measure) and cost-savings. We show that the model with all key elements achieves higher discrimination ability (AUC: 0.77; F1: 0.51; Cost: 22% of maximum possible savings) outperforming the reduced models in at least two evaluation metrics. Additionally, we present a simple financial analysis to estimate annual savings if targeted interventions are offered to high risk patients. © 2019 The Authors
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| 9. |
- Blom, Mathias Carl, et al.
(författare)
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Training machine learning models to predict 30-day mortality in patients discharged from the emergency department: A retrospective, population-based registry study
- 2019
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Ingår i: BMJ Open. - London : BMJ. - 2044-6055. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this work was to train machine learning models to identify patients at end of life with clinically meaningful diagnostic accuracy, using 30-day mortality in patients discharged from the emergency department (ED) as a proxy. Design Retrospective, population-based registry study. Setting Swedish health services. Primary and secondary outcome measures All cause 30-day mortality. Methods Electronic health records (EHRs) and administrative data were used to train six supervised machine learning models to predict all-cause mortality within 30 days in patients discharged from EDs in southern Sweden, Europe. Participants The models were trained using 65 776 ED visits and validated on 55 164 visits from a separate ED to which the models were not exposed during training. Results The outcome occurred in 136 visits (0.21%) in the development set and in 83 visits (0.15%) in the validation set. The model with highest discrimination attained ROC-AUC 0.95 (95% CI 0.93 to 0.96), with sensitivity 0.87 (95% CI 0.80 to 0.93) and specificity 0.86 (0.86 to 0.86) on the validation set. Conclusions Multiple models displayed excellent discrimination on the validation set and outperformed available indexes for short-term mortality prediction interms of ROC-AUC (by indirect comparison). The practical utility of the models increases as the data they were trained on did not require costly de novo collection but were real-world data generated as a by-product of routine care delivery.
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| 10. |
- Cooney, Martin, 1980-, et al.
(författare)
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Avoiding Improper Treatment of Persons with Dementia by Care Robots
- 2019
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Konferensbidrag (refereegranskat)abstract
- The phrase “most cruel and revolting crimes” has been used to describe some poor historical treatment of vulnerable impaired persons by precisely those who should have had the responsibility of protecting and helping them. We believe we might be poised to see history repeat itself, as increasingly humanlike aware robots become capable of engaging in behavior which we would consider immoral in a human–either unknowingly or deliberately. In the current paper we focus in particular on exploring some potential dangers affecting persons with dementia (PWD), which could arise from insufficient software or external factors, and describe a proposed solution involving rich causal models and accountability measures: Specifically, the Consequences of Needs-driven Dementia-compromised Behaviour model (C-NDB) could be adapted to be used with conversation topic detection, causal networks and multi-criteria decision making, alongside reports, audits, and deterrents. Our aim is that the considerations raised could help inform the design of care robots intended to support well-being in PWD.
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