搜索结果：Frontiers in clinical diabetes and healthcare

Diabetes is a chronic metabolic disease that can lead to serious health problems if not diagnosed and managed early. Big Data Analytics (BDA) and machine learning offer practical tools for analyzing large health datasets and supporting early detection and better treatment decisions. However, their use in routine clinical practice is still limited. This study examines the readiness of Rwanda's healthcare system to adopt big data analytics for diabetes management. As the country continues to expand its use of electronic medical records and health information systems, new opportunities arise for improving prediction, monitoring, and clinical decision-making. A five-day workshop involving 25 key stakeholders, including clinicians, data managers, policymakers, medical researchers, nutritionists, and technology providers, was conducted to assess preparedness and identify existing gaps. The findings highlight both the potential and the main challenges of BDA implementation. Based on these results, the paper proposes a practical BDA framework to support diabetes management strategies using explainable machine learning models.

Large language models (LLMs) have made significant progress in various domains, including healthcare. However, the specialized nature of clinical language understanding tasks presents unique challenges and limitations that warrant further investigation. In this study, we conduct a comprehensive evaluation of state-of-the-art LLMs, namely GPT-3.5, GPT-4, and Bard, within the realm of clinical language understanding tasks. These tasks span a diverse range, including named entity recognition, relation extraction, natural language inference, semantic textual similarity, document classification, and question-answering. We also introduce a novel prompting strategy, self-questioning prompting (SQP), tailored to enhance LLMs' performance by eliciting informative questions and answers pertinent to the clinical scenarios at hand. Our evaluation underscores the significance of task-specific learning strategies and prompting techniques for improving LLMs' effectiveness in healthcare-related tasks. Additionally, our in-depth error analysis on the challenging relation extraction task offers valuable insights into error distribution and potential avenues for improvement using SQP. Our study sheds

We introduce SoftTiger, a clinical large language model (CLaM) designed as a foundation model for healthcare workflows. The narrative and unstructured nature of clinical notes is a major obstacle for healthcare intelligentization. We address a critical problem of structuring clinical notes into clinical data, according to international interoperability standards. We collect and annotate data for three subtasks, namely, international patient summary, clinical impression and medical encounter. We then supervised fine-tuned a state-of-the-art LLM using public and credentialed clinical data. The training is orchestrated in a way that the target model can first support basic clinical tasks such as abbreviation expansion and temporal information extraction, and then learn to perform more complex downstream clinical tasks. Moreover, we address several modeling challenges in the healthcare context, e.g., extra long context window. Our blind pairwise evaluation shows that SoftTiger outperforms other popular open-source models and GPT-3.5, comparable to Gemini-pro, with a mild gap from GPT-4. We believe that LLMs may become a step-stone towards healthcare digitalization and democratization.

The Internet of Things (IoT) revolutionizes smart city domains such as healthcare, transportation, industry, and education. The Internet of Medical Things (IoMT) is gaining prominence, particularly in smart hospitals and Remote Patient Monitoring (RPM). The vast volume of data generated by IoMT devices should be analyzed in real-time for health surveillance, prognosis, and prediction of diseases. Current approaches relying on Cloud computing to provide the necessary computing and storage capabilities do not scale for these latency-sensitive applications. Edge computing emerges as a solution by bringing cloud services closer to IoMT devices. This paper introduces SmartEdge, an AI-powered smart healthcare end-to-end integrated edge and cloud computing system for diabetes prediction. This work addresses latency concerns and demonstrates the efficacy of edge resources in healthcare applications within an end-to-end system. The system leverages various risk factors for diabetes prediction. We propose an Edge and Cloud-enabled framework to deploy the proposed diabetes prediction models on various configurations using edge nodes and main cloud servers. Performance metrics are evaluated us

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

Current clinical artificial intelligence (AI) systems are evaluated almost exclusively on clean, standardised, English-language inputs, conditions that do not reflect the realities of healthcare delivery in low-resource settings. This study presents the first systematic dual audit of two orthogonal safety vulnerabilities in clinical AI: adversarial image fragility and cross-lingual diagnostic drift. Using DenseNet121, the architecture underlying CheXNet, fine-tuned on the COVID-QU-Ex chest X-ray dataset (85,318 images; COVID-19, Non-COVID Pneumonia, Normal), we demonstrate that diagnostic accuracy collapses from 89.3% to 62.0% under a Fast Gradient Method (FGM) perturbation of epsilon=0.021, a magnitude imperceptible to the human eye. Standard defensive strategies including Gaussian smoothing and ensemble voting failed to restore clinical safety. In a parallel language fragility experiment, we tested Llama3.1:8b and NatLAS (N-ATLAS) on 20 COVID-19 clinical cases presented in Standard English, Nigerian Pidgin (Naija), and Yoruba-inflected English. Both models exhibited significant accuracy degradation: Llama3.1:8b dropped from 80.0% to 65.0% on Pidgin; NatLAS, an African-context mod

The COVID-19 pandemic and other ongoing health crises have underscored the need for prompt healthcare services worldwide. The traditional healthcare system, centered around hospitals and clinics, has proven inadequate in the face of such challenges. Intelligent wearable devices, a key part of modern healthcare, leverage Internet of Things technology to collect extensive data related to the environment as well as psychological, behavioral, and physical health. However, managing the substantial data generated by these wearables and other IoT devices in healthcare poses a significant challenge, potentially impeding decision-making processes. Recent interest has grown in applying data analytics for extracting information, gaining insights, and making predictions. Additionally, machine learning, known for addressing various big data and networking challenges, has seen increased implementation to enhance IoT systems in healthcare. This chapter focuses exclusively on exploring the hurdles encountered when integrating ML methods into the IoT healthcare sector. It offers a comprehensive summary of current research challenges and potential opportunities, categorized into three scenarios: IoT

The data mining along with emerging computing techniques have astonishingly influenced the healthcare industry. Researchers have used different Data Mining and Internet of Things (IoT) for enrooting a programmed solution for diabetes and heart patients. However, still, more advanced and united solution is needed that can offer a therapeutic opinion to individual diabetic and cardio patients. Therefore, here, a smart data mining and IoT (SMDIoT) based advanced healthcare system for proficient diabetes and cardiovascular diseases have been proposed. The hybridization of data mining and IoT with other emerging computing techniques is supposed to give an effective and economical solution to diabetes and cardio patients. SMDIoT hybridized the ideas of data mining, Internet of Things, chatbots, contextual entity search (CES), bio-sensors, semantic analysis and granular computing (GC). The bio-sensors of the proposed system assist in getting the current and precise status of the concerned patients so that in case of an emergency, the needful medical assistance can be provided. The novelty lies in the hybrid framework and the adequate support of chatbots, granular computing, context entity

Agentic AI systems are increasingly capable of autonomous data science workflows, yet clinical prediction tasks demand domain expertise that purely automated approaches struggle to provide. We investigate how human guidance of agentic AI can improve multimodal clinical prediction, presenting our approach to all three AgentDS Healthcare benchmark challenges: 30-day hospital readmission prediction (Macro-F1 = 0.8986), emergency department cost forecasting (MAE = $465.13), and discharge readiness assessment (Macro-F1 = 0.7939). Across these tasks, human analysts directed the agentic workflow at key decision points, multimodal feature engineering from clinical notes, scanned PDF billing receipts, and time-series vital signs; task-appropriate model selection; and clinically informed validation strategies. Our approach ranked 5th overall in the healthcare domain, with a 3rd-place finish on the discharge readiness task. Ablation studies reveal that human-guided decisions compounded to a cumulative gain of +0.065 F1 over automated baselines, with multimodal feature extraction contributing the largest single improvement (+0.041 F1). We distill three generalizable lessons: (1) domain-informe

Recently natural language processing (NLP) tools have been developed to identify and extract salient risk indicators in electronic health records (EHRs). Sentiment analysis, although widely used in non-medical areas for improving decision making, has been studied minimally in the clinical setting. In this study, we undertook, to our knowledge, the first domain adaptation of sentiment analysis to psychiatric EHRs by defining psychiatric clinical sentiment, performing an annotation project, and evaluating multiple sentence-level sentiment machine learning (ML) models. Results indicate that off-the-shelf sentiment analysis tools fail in identifying clinically positive or negative polarity, and that the definition of clinical sentiment that we provide is learnable with relatively small amounts of training data. This project is an initial step towards further refining sentiment analysis methods for clinical use. Our long-term objective is to incorporate the results of this project as part of a machine learning model that predicts inpatient readmission risk. We hope that this work will initiate a discussion concerning domain adaptation of sentiment analysis to the clinical setting.

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

Conversational AI has significant potential in the healthcare sector, but many existing systems fall short in emotional intelligence, fairness, and politeness, which are essential for building patient trust. This gap reduces the effectiveness of digital health solutions and can increase user anxiety. This study addresses the challenge of integrating ethical communication principles by designing and evaluating LunaAI, a healthcare chatbot prototype. Using a user-centered design approach informed by a structured literature review, we developed conversational scenarios that handle both routine and hostile user interactions. The system was implemented using the Google Gemini API and deployed as a mobile-first Progressive Web App built with React, Vite, and Firebase. Preliminary user testing was conducted with a small participant group, and responses were evaluated using established frameworks such as the Godspeed Questionnaire. In addition, a comparative analysis was performed between LunaAI's tailored responses and the baseline outputs of an uncustomized large language model. The results indicate measurable improvements in key interaction qualities, with average user ratings of 4.7 ou

We evaluate the impact of large language model-based clinical decision support in live care. In partnership with Penda Health, a network of primary care clinics in Nairobi, Kenya, we studied AI Consult, a tool that serves as a safety net for clinicians by identifying potential documentation and clinical decision-making errors. AI Consult integrates into clinician workflows, activating only when needed and preserving clinician autonomy. We conducted a quality improvement study, comparing outcomes for 39,849 patient visits performed by clinicians with or without access to AI Consult across 15 clinics. Visits were rated by independent physicians to identify clinical errors. Clinicians with access to AI Consult made relatively fewer errors: 16% fewer diagnostic errors and 13% fewer treatment errors. In absolute terms, the introduction of AI Consult would avert diagnostic errors in 22,000 visits and treatment errors in 29,000 visits annually at Penda alone. In a survey of clinicians with AI Consult, all clinicians said that AI Consult improved the quality of care they delivered, with 75% saying the effect was "substantial". These results required a clinical workflow-aligned AI Consult i

Machine learning (ML) transforms healthcare by enabling predictive analytics, personalized treatments, and improved patient outcomes. However, traditional ML workflows often require specialized skills, infrastructure, and resources, limiting accessibility for many healthcare professionals. This paper explores how BigQuery ML Cloud service helps healthcare researchers and data analysts to build and deploy models using SQL, without need for advanced ML knowledge. Our results demonstrate that the Boosted Tree model achieved the highest performance among the three models making it highly effective for diabetes prediction. BigQuery ML directly integrates predictive analytics into their workflows to inform decision-making and support patient care. We reveal this capability through a case study on diabetes prediction using the Diabetes Health Indicators Dataset. Our study underscores BigQuery ML's role in democratizing machine learning, enabling faster, scalable, and efficient predictive analytics that can directly enhance healthcare decision-making processes. This study aims to bridge the gap between advanced machine learning and practical healthcare analytics by providing detailed insig

Clinical practice guidelines are designed to guide clinical practice and involve causal language. Sometimes guidelines make or require stronger causal claims than those in the references they rely on, a phenomenon we refer to as 'causal language jump'. We evaluated the strength of expressed causation in diabetes guidelines and the evidence they reference to assess the pattern of jumps. We randomly sampled 300 guideline statements from four diabetes guidelines. We rated the causation strength in the statements and the dependence on causation in recommendations supported by these statements using existing scales. Among the causal statements, the cited original studies were similarly assessed. We also assessed how well they report target trial emulation (TTE) components as a proxy for reliability. Of the sampled statements, 114 (38.0%) were causal, and 76 (66.7%) expressed strong causation. 27.2% (31/114) of causal guideline statements demonstrated a "causal language jump", and 34.9% (29/83) of guideline recommendations cannot be effectively supported. Of the 53 eligible studies for TTE rating, most did not report treatment assignment and causal contrast in detail. Our findings sugges

Healthcare is one of the most promising areas for machine learning models to make a positive impact. However, successful adoption of AI-based systems in healthcare depends on engaging and educating stakeholders from diverse backgrounds about the development process of AI models. We present a broadly accessible overview of the development life cycle of clinical AI models that is general enough to be adapted to most machine learning projects, and then give an in-depth case study of the development process of a deep learning based system to detect aortic aneurysms in Computed Tomography (CT) exams. We hope other healthcare institutions and clinical practitioners find the insights we share about the development process useful in informing their own model development efforts and to increase the likelihood of successful deployment and integration of AI in healthcare.

Purpose: Understanding how the pancreas changes is critical for detecting deviations in type 2 diabetes and other pancreatic disease. We measure pancreas size and shape using morphological measurements from ages 0 to 90. Our goals are to 1) identify reliable clinical imaging modalities for AI-based pancreas measurement, 2) establish normative morphological aging trends, and 3) detect potential deviations in type 2 diabetes. Approach: We analyzed a clinically acquired dataset of 2533 patients imaged with abdominal CT or MRI. We resampled the scans to 3mm isotropic resolution, segmented the pancreas using automated methods, and extracted 13 morphological pancreas features across the lifespan. First, we assessed CT and MRI measurements to determine which modalities provide consistent lifespan trends. Second, we characterized distributions of normative morphological patterns stratified by age group and sex. Third, we used GAMLSS regression to model pancreas morphology trends in 1350 patients matched for age, sex, and type 2 diabetes status to identify any deviations from normative aging associated with type 2 diabetes. Results: When adjusting for confounders, the aging trends for 10 of

With Artificial Intelligence (AI) increasingly permeating various aspects of society, including healthcare, the adoption of the Transformers neural network architecture is rapidly changing many applications. Transformer is a type of deep learning architecture initially developed to solve general-purpose Natural Language Processing (NLP) tasks and has subsequently been adapted in many fields, including healthcare. In this survey paper, we provide an overview of how this architecture has been adopted to analyze various forms of data, including medical imaging, structured and unstructured Electronic Health Records (EHR), social media, physiological signals, and biomolecular sequences. Those models could help in clinical diagnosis, report generation, data reconstruction, and drug/protein synthesis. We identified relevant studies using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We also discuss the benefits and limitations of using transformers in healthcare and examine issues such as computational cost, model interpretability, fairness, alignment with human values, ethical implications, and environmental impact.

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.