搜索结果：Kidney research and clinical practice

Background and Objectives: Clinical Practice Guidelines (CPGs) represent the foremost methodology for sharing state-of-the-art research findings in the healthcare domain with medical practitioners to limit practice variations, reduce clinical cost, improve the quality of care, and provide evidence based treatment. However, extracting relevant knowledge from the plethora of CPGs is not feasible for already burdened healthcare professionals, leading to large gaps between clinical findings and real practices. It is therefore imperative that state-of-the-art Computing research, especially machine learning is used to provide artificial intelligence based solution for extracting the knowledge from CPGs and reducing the gap between healthcare research/guidelines and practice. Methods: This research presents a novel methodology for knowledge extraction from CPGs to reduce the gap and turn the latest research findings into clinical practice. First, our system classifies the CPG sentences into four classes such as condition-action, condition-consequences, action, and not-applicable based on the information presented in a sentence. We use deep learning with state-of-the-art word embedding, im

Automatic segmentation of kidney and kidney tumour in Computed Tomography (CT) images is essential, as it uses less time as compared to the current gold standard of manual segmentation. However, many hospitals are still reliant on manual study and segmentation of CT images by medical practitioners because of its higher accuracy. Thus, this study focuses on the development of an approach for automatic kidney and kidney tumour segmentation in contrast-enhanced CT images. A method based on Convolutional Neural Network (CNN) was proposed, where a 3D U-Net segmentation model was developed and trained to delineate the kidney and kidney tumour from CT scans. Each CT image was pre-processed before inputting to the CNN, and the effect of down-sampled and patch-wise input images on the model performance was analysed. The proposed method was evaluated on the publicly available 2021 Kidney and Kidney Tumour Segmentation Challenge (KiTS21) dataset. The method with the best performing model recorded an average training Dice score of 0.6129, with the kidney and kidney tumour Dice scores of 0.7923 and 0.4344, respectively. For testing, the model obtained a kidney Dice score of 0.8034, and a kidney

The morphometry of a kidney tumor revealed by contrast-enhanced Computed Tomography (CT) imaging is an important factor in clinical decision making surrounding the lesion's diagnosis and treatment. Quantitative study of the relationship between kidney tumor morphology and clinical outcomes is difficult due to data scarcity and the laborious nature of manually quantifying imaging predictors. Automatic semantic segmentation of kidneys and kidney tumors is a promising tool towards automatically quantifying a wide array of morphometric features, but no sizeable annotated dataset is currently available to train models for this task. We present the KiTS19 challenge dataset: A collection of multi-phase CT imaging, segmentation masks, and comprehensive clinical outcomes for 300 patients who underwent nephrectomy for kidney tumors at our center between 2010 and 2018. 210 (70%) of these patients were selected at random as the training set for the 2019 MICCAI KiTS Kidney Tumor Segmentation Challenge and have been released publicly. With the presence of clinical context and surgical outcomes, this data can serve not only for benchmarking semantic segmentation models, but also for developing an

Demographic data collection is essential in education research, as demographic data allows researchers to better describe the participant population they study and to contextualize findings. However, current research practices for neurodiversity demographics often rely on prescriptive methods (e.g., requiring participants to report official diagnoses) rather than allowing participants to self-identify. This approach can: a) not allow participants to express their intersecting identities in ways that are authentic; and b) limit trustworthiness and reliability of the data and interpretation. In addition, inconsistent dissemination and representation of demographic data across studies hinder the accessibility and usability of this work. Through a literature review of neurodivergent student experiences with learning and performing STEM, we identified widespread discrepancies in how demographic information is collected and reported. This paper explores how neurodivergent identities can be more accurately and inclusively represented in education research. We present findings of a thematic analysis on the ways neurodivergent demographic data collection is done in the literature using data

Kidney exchange is a transplant modality that has provided new opportunities for living kidney donation in many countries around the world since 1991. It has been extensively studied from an Operational Research (OR) perspective since 2004. This article provides a comprehensive literature survey on OR approaches to fundamental computational problems associated with kidney exchange over the last two decades. We also summarise the key integer linear programming (ILP) models for kidney exchange, showing how to model optimisation problems involving only cycles and chains separately. This allows new combined ILP models, not previously presented, to be obtained by amalgamating cycle and chain models. We present a comprehensive empirical evaluation involving all combined models from this paper in addition to bespoke software packages from the literature involving advanced techniques. This focuses primarily on computation times for 49 methods applied to 4,320 problem instances of varying sizes that reflect the characteristics of real kidney exchange datasets, corresponding to over 200,000 algorithm executions. We have made our implementations of all cycle and chain models described in this

This paper assesses whether using clinical characteristics in addition to imaging can improve automated segmentation of kidney cancer on contrast-enhanced computed tomography (CT). A total of 300 kidney cancer patients with contrast-enhanced CT scans and clinical characteristics were included. A baseline segmentation of the kidney cancer was performed using a 3D U-Net. Input to the U-Net were the contrast-enhanced CT images, output were segmentations of kidney, kidney tumors, and kidney cysts. A cognizant sampling strategy was used to leverage clinical characteristics for improved segmentation. To this end, a Least Absolute Shrinkage and Selection Operator (LASSO) was used. Segmentations were evaluated using Dice and Surface Dice. Improvement in segmentation was assessed using Wilcoxon signed rank test. The baseline 3D U-Net showed a segmentation performance of 0.90 for kidney and kidney masses, i.e., kidney, tumor, and cyst, 0.29 for kidney masses, and 0.28 for kidney tumor, while the 3D U-Net trained with cognizant sampling enhanced the segmentation performance and reached Dice scores of 0.90, 0.39, and 0.38 respectively. To conclude, the cognizant sampling strategy leveraging th

Objectives: Electronic health records (EHRs) are only a first step in capturing and utilizing health-related data - the challenge is turning that data into useful information. Furthermore, EHRs are increasingly likely to include data relating to patient outcomes, functionality such as clinical decision support, and genetic information as well, and, as such, can be seen as repositories of increasingly valuable information about patients' health conditions and responses to treatment over time. Methods: We describe a case study of 423 patients treated by Centerstone within Tennessee and Indiana in which we utilized electronic health record data to generate predictive algorithms of individual patient treatment response. Multiple models were constructed using predictor variables derived from clinical, financial and geographic data. Results: For the 423 patients, 101 deteriorated, 223 improved and in 99 there was no change in clinical condition. Based on modeling of various clinical indicators at baseline, the highest accuracy in predicting individual patient response ranged from 70-72% within the models tested. In terms of individual predictors, the Centerstone Assessment of Recovery Le

The competency of any intelligent agent is bounded by its formal account of the world in which it operates. Clinical AI lacks such an account. Existing frameworks address evaluation, regulation, or system design in isolation, without a shared model of the clinical world to connect them. We introduce the Clinical World Model, a framework that formalizes care as a tripartite interaction among Patient, Provider, and Ecosystem. To formalize how any agent, whether human or artificial, transforms information into clinical action, we develop parallel decision-making architectures for providers, patients, and AI agents, grounded in validated principles of clinical cognition. The Clinical AI Skill-Mix operationalizes competency through eight dimensions. Five define the clinical competency space (condition, phase, care setting, provider role, and task) and three specify how AI engages human reasoning (assigned authority, agent facing, and anchoring layer). The combinatorial product of these dimensions yields a space of billions of distinct competency coordinates. A central structural implication is that validation within one coordinate provides minimal evidence for performance in another, re

Chronic Kidney Disease (CKD) constitutes a major global medical burden, marked by the gradual deterioration of renal function, which results in the impaired clearance of metabolic waste and disturbances in systemic fluid homeostasis. Owing to its substantial contribution to worldwide morbidity and mortality, the development of reliable and efficient diagnostic approaches is critically important to facilitate early detection and prompt clinical management. This study presents a deep convolutional neural network (CNN) for early CKD detection from CT kidney images, complemented by class balancing using Synthetic Minority Over-sampling Technique (SMOTE) and interpretability via Gradient-weighted Class Activation Mapping (Grad-CAM). The model was trained and evaluated on the CT KIDNEY DATASET, which contains 12,446 CT images, including 3,709 cyst, 5,077 normal, 1,377 stone, and 2,283 tumor cases. The proposed deep CNN achieved a remarkable classification performance, attaining 100% accuracy in the early detection of chronic kidney disease (CKD). This significant advancement demonstrates strong potential for addressing critical clinical diagnostic challenges and enhancing early medical i

Clinical transfusion-outcomes research faces unique methodological challenges compared with other areas of clinical research. These challenges arise because patients frequently receive multiple transfusions, each unit originates from a different donor, and the probability of receiving specific blood product characteristics is influenced by external, often uncontrollable, factors. These complexities complicate causal inference in observational studies of transfusion effectiveness and safety. This guide addresses key challenges in observational transfusion research, with a focus on time-varying exposure, time-varying confounding, and treatment-confounder feedback. Using the example of donor sex and pregnancy history in relation to recipient mortality, we illustrate the strengths and limitations of commonly used analytical approaches. We compare restriction-based analyses, time-varying Cox regression, and inverse probability weighted marginal structural models using a large observational dataset of male transfusion recipients. In the applied example, restriction and conventional time-varying approaches suggested an increased mortality risk associated with transfusion of red blood cell

Clinical Pathways (CP) are medical management plans developed to standardize patient treatment activities, optimize resource usage, reduce expenses, and improve the quality of healthcare services. Most CPs currently in use are paper-based documents (i.e., not computerized). CP computerization has been an active research topic since the inception of CP use in hospitals. This literature review research aims to examine studies that focused on CP computerization and offers recommendations for future research in this important research area. Some critical research suggestions include centralizing computerized CPs in Healthcare Information Systems (HIS), CP term standardization using international medical terminology systems, developing a global CP-specific digital coding system, creating a unified CP meta-ontology, developing independent Clinical Pathway Management Systems (CPMS), and supporting CPMSs with machine learning sub-systems.

Empiric antibiotic prescribing in high-risk clinical contexts often requires decision making under conditions of incomplete information, where inappropriate coverage or unjustified escalation may compromise safety and antimicrobial stewardship. While clinical decision-support systems have been proposed to assist in this process, many approaches lack explicit governance and evaluation mechanisms defining scope, abstention conditions, recommendation permissibility, and expected system behavior. This work specifies a governance and evaluation framework for deterministic clinical decision-support systems operating under explicitly constrained scope. Deterministic behavior is adopted to ensure that identical inputs yield identical outputs, supporting transparency, auditability, and conservative decision support in high-risk prescribing contexts. The framework treats governance as a first-class design component, separating clinical decision logic from rule-based mechanisms that determine whether a recommendation may be issued. Explicit abstention, deterministic stewardship constraints, and exclusion rules are formalized as core constructs. The framework defines an evaluation methodology

We introduce Clinical ModernBERT, a transformer based encoder pretrained on large scale biomedical literature, clinical notes, and medical ontologies, incorporating PubMed abstracts, MIMIC IV clinical data, and medical codes with their textual descriptions. Building on ModernBERT the current state of the art natural language text encoder featuring architectural upgrades such as rotary positional embeddings (RoPE), Flash Attention, and extended context length up to 8,192 tokens our model adapts these innovations specifically for biomedical and clinical domains. Clinical ModernBERT excels at producing semantically rich representations tailored for long context tasks. We validate this both by analyzing its pretrained weights and through empirical evaluation on a comprehensive suite of clinical NLP benchmarks.

Kidney stone disease poses a major burden to patients and healthcare systems around the world. The formation of kidney stones may occur over months or years, but many patients are diagnosed at a late stage, suffer excruciating pain, and require surgical intervention to physically remove the stones. The prevalence of kidney stones has increased during recent decades to over 10% in many developed countries, suggesting a link with environmental and behavioral factors. Recurrence rates are also high. In terms of their impact and scale, kidney stones are an ongoing pandemic. The causes and mechanisms of kidney stone formation are diverse and often unknown, resulting in varied compositions and different anatomical locations being affected. A better understanding of these processes could enable earlier diagnoses through more sensitive and scalable biomarkers, as well as more effective preventives and therapeutics.

Automated segmentation of kidneys and kidney tumors is an important step in quantifying the tumor's morphometrical details to monitor the progression of the disease and accurately compare decisions regarding the kidney tumor treatment. Manual delineation techniques are often tedious, error-prone and require expert knowledge for creating unambiguous representation of kidneys and kidney tumors segmentation. In this work, we propose an end-to-end boundary aware fully Convolutional Neural Networks (CNNs) for reliable kidney and kidney tumor semantic segmentation from arterial phase abdominal 3D CT scans. We propose a segmentation network consisting of an encoder-decoder architecture that specifically accounts for organ and tumor edge information by devising a dedicated boundary branch supervised by edge-aware loss terms. We have evaluated our model on 2019 MICCAI KiTS Kidney Tumor Segmentation Challenge dataset and our method has achieved dice scores of 0.9742 and 0.8103 for kidney and tumor repetitively and an overall composite dice score of 0.8923.

Developing AI models that are useful in clinical practice, requires efficient collaboration between clinicians and AI developers. This poses a practical challenge: clinicians must repeatedly communicate and refine their requirements with AI developers before those requirements can be translated into executable model development. This iterative process is time-consuming, and even after repeated discussion, misalignment may still exist because the two sides do not fully share each other's expertise. Coding agents may help close this gap. They can write and refine code on their own, and they carry working knowledge of both medicine and AI to understand commands formulated by both medical experts and developers. We present a prototype that lets clinicians drive AI development directly. A clinician describes the task in plain language, and the system turns the description into a working pipeline, refines it through repeated experiments together with the clinician, and returns a model that meets the stated clinical objective. Across five clinical tasks, the system reliably produces models that matched the clinician's request and reached competitive performance. Most notably, on chest rad

Over the last years, civic technology projects have emerged around the world to advance open government and community action. Although Computer-Supported Cooperative Work (CSCW) and Human-Computer Interaction (HCI) communities have shown a growing interest in researching issues around civic technologies, yet most research still focuses on projects from the Global North. The goal of this workshop is, therefore, to advance CSCW research by raising awareness for the ongoing challenges and open questions around civic technology by bridging the gap between researchers and practitioners from different regions. The workshop will be organized around three central topics: (1) discuss how the local context and infrastructure affect the design, implementation, adoption, and maintenance of civic technology; (2) identify key elements of the configuration of trust among government, citizenry, and local organizations and how these elements change depending on the sociopolitical context where community engagement takes place; (3) discover what methods and strategies are best suited for conducting research on civic technologies in different contexts. These core topics will be covered across session

Objective: Our objective is to develop and validate TrajVis, an interactive tool that assists clinicians in using artificial intelligence (AI) models to leverage patients' longitudinal electronic medical records (EMR) for personalized precision management of chronic disease progression. Methods: We first perform requirement analysis with clinicians and data scientists to determine the visual analytics tasks of the TrajVis system as well as its design and functionalities. A graph AI model for chronic kidney disease (CKD) trajectory inference named DEPOT is used for system development and demonstration. TrajVis is implemented as a full-stack web application with synthetic EMR data derived from the Atrium Health Wake Forest Baptist Translational Data Warehouse and the Indiana Network for Patient Care research database. A case study with a nephrologist and a user experience survey of clinicians and data scientists are conducted to evaluate the TrajVis system. Results: The TrajVis clinical information system is composed of four panels: the Patient View for demographic and clinical information, the Trajectory View to visualize the DEPOT-derived CKD trajectories in latent space, the Clini

The concurrent effect of various internal and external factors on IT Outsourcing (ITO) decision making has seldom been investigated in a single study. Furthermore, research on external factors is scarce and there is no comprehensive theory that can fully explain ITO decisions made in practice. This paper explains how key decision factors, both internal and external, influence ITO decision making in a large Australian University. We also tested the feasibility of a highly regarded descriptive model of ITO decisions as the basic foundation of an ITO decision theory. The model failed to fully explain ITO decisions in our case organisation. We draw researchers' attention to the need for more exploration of external factors as well as clarification of contingency factors that may explain inconsistencies between ITO decision theories and practice, and call for more research for 'practicable' ITO decision aids. Implications for practice are also discussed in the paper.