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Li B, Shaikh F, Zamzam A, Syed MH, Abdin R, Qadura M. A machine learning algorithm for peripheral artery disease prognosis using biomarker data. iScience 2024; 27:109081. [PMID: 38361633 PMCID: PMC10867451 DOI: 10.1016/j.isci.2024.109081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 01/11/2024] [Accepted: 01/26/2024] [Indexed: 02/17/2024] Open
Abstract
Peripheral artery disease (PAD) biomarkers have been studied in isolation; however, an algorithm that considers a protein panel to inform PAD prognosis may improve predictive accuracy. Biomarker-based prediction models were developed and evaluated using a model development (n = 270) and prospective validation cohort (n = 277). Plasma concentrations of 37 proteins were measured at baseline and the patients were followed for 2 years. The primary outcome was 2-year major adverse limb event (MALE; composite of vascular intervention or major amputation). Of the 37 proteins tested, 6 were differentially expressed in patients with vs. without PAD (ADAMTS13, ICAM-1, ANGPTL3, Alpha 1-microglobulin, GDF15, and endostatin). Using 10-fold cross-validation, we developed a random forest machine learning model that accurately predicts 2-year MALE in a prospective validation cohort of PAD patients using a 6-protein panel (AUROC 0.84). This algorithm can support PAD risk stratification, informing clinical decisions on further vascular evaluation and management.
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Affiliation(s)
- Ben Li
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Temerty Centre for Artificial Intelligence Research and Education in Medicine (T-CAIREM), University of Toronto, Toronto, ON, Canada
| | - Farah Shaikh
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Abdelrahman Zamzam
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Muzammil H. Syed
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
| | - Rawand Abdin
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Mohammad Qadura
- Department of Surgery, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, University of Toronto, Toronto, ON, Canada
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The association between elevated body mass index and wide blood chemistry panel results in apparently healthy individuals. Am J Med Sci 2022. [DOI: 10.1016/j.amjms.2022.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Thyroid function assessment before and after diagnosis of schizophrenia: A community-based study. Psychiatry Res 2020; 293:113356. [PMID: 32890863 DOI: 10.1016/j.psychres.2020.113356] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/26/2020] [Accepted: 08/01/2020] [Indexed: 01/31/2023]
Abstract
Alterations in thyroid hormone levels may affect brain and mental disorders. Conversely, schizophrenia and its antipsychotic treatments can affect thyroid hormone levels. However, data on thyroid hormone levels during the course of schizophrenia disorder are scant. The aim of the study was to assess the rate of thyroid hormone disorders in outpatients before and after diagnosis of schizophrenia. A retrospective matched-control design was used. The cohort included 1252 patients suffering from ICD-10 schizophrenia, and 3756 control subjects matched for gender, age, socioeconomic status, and origin. All were identified from the database of a large health management organization. The pertinent clinical data were collected from the electronic medical records. There was no significant between-group difference in the distribution of thyroid-stimulating hormone levels. Before diagnosis, both groups had a similar rate of hypothyroidism. After diagnosis of schizophrenia and initiation of antipsychotic treatment, the rate of hypothyroidism was significantly higher in the patient group. It remained significantly higher after exclusion of patients receiving lithium. The increased rate of hypothyroidism in patients with schizophrenia after, but not before, the diagnosis of schizophrenia suggests that antipsychotic medications may affect thyroid hormone levels. Screening for thyroid disorders is warranted in patients with schizophrenia under antipsychotic treatment.
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Kamposioras K, Casazza G, Mauri D, Lakiotis V, Cortinovis I, Xilomenos A, Peponi C, Golfinopoulos V, Milousis A, Kakaridis D, Zacharias G, Karathanasi I, Ferentinos G, Proiskos A. Screening chest radiography: results from a Greek cross-sectional survey. BMC Public Health 2006; 6:113. [PMID: 16646992 PMCID: PMC1513384 DOI: 10.1186/1471-2458-6-113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2005] [Accepted: 04/29/2006] [Indexed: 11/25/2022] Open
Abstract
Background Public health authorities worldwide discourage the use of chest radiography as a screening modality, as the diagnostic performance of chest radiography does not justify its application for screening and may even be harmful, since people with false positive results may experience anxiety and concern. Despite the accumulated evidence, various reports suggest that primary care physicians throughout the world still prescribe chest radiography for screening. We therefore set out to index the use of chest radiography for screening purposes among the healthy adult population and to analyze its relationship with possible trigger factors. Methods The study was designed as a cross-sectional survey. Five thousand four hundred and ninety-nine healthy adults, coming from 26 Greek provinces were surveyed for screening practice habits in the nationwide anticancer study. Data were obtained for the use of screening chest radiography. Impact of age, gender, tobacco exposure, family history positive for malignancies and professional-risk for lung diseases was further analyzed. Results we found that 20% (n = 1099) of the surveyed individuals underwent chest radiography for screening purposes for at least one time during the previous three years. Among those, 24% do so with a frequency equal or higher than once yearly, and 48% with a frequency equal or higher than every three years. Screening for chest radiography was more commonly adopted among males (OR 1.130, 95% CI 0.988–1.292), pensioners (OR 1.319, CI 1.093–1.593) and individuals with a positive family history for lung cancer (OR 1.251, CI 0.988–1.583). Multivariate analysis confirmed these results. Conclusion Despite formal recommendations, chest radiography for screening purposes was a common practice among the analyzed sample of Greek adults. This practice is of questionable value since the positive predictive value of chest radiography is low. The implementation of even a relatively inexpensive imaging study on a national scale would greatly burden health economics and the workload of radiology departments.
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Affiliation(s)
- Konstantinos Kamposioras
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Giovanni Casazza
- Istituto di Statistica Medica e Biometria, Università degli studi di Milano Via Venezian 1, CAP 20133 Milano, Italy
| | - Davide Mauri
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Velisarios Lakiotis
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Ivan Cortinovis
- Istituto di Statistica Medica e Biometria, Università degli studi di Milano Via Venezian 1, CAP 20133 Milano, Italy
| | - Apostolos Xilomenos
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Christina Peponi
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Vassilis Golfinopoulos
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Athanasios Milousis
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Dimitrios Kakaridis
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Georgios Zacharias
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Ioanna Karathanasi
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Georgios Ferentinos
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
| | - Anastasios Proiskos
- Panhellenic Association for Continual Medical Research (PACMeR) Sections of Public-Health 28, Karolou st, 10438 Athens, Greece
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Ghosh AK, Ghosh K. Translating evidence-based information into effective risk communication: Current challenges and opportunities. ACTA ACUST UNITED AC 2005; 145:171-80. [PMID: 15962835 DOI: 10.1016/j.lab.2005.02.006] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent medical advances and the easy availability of evidence-based information at the point of care are believed to provide physicians with improved tools for risk communication. However, evidence indicates that physicians still display marked variability in ordering tests. Factors that determine a physician's test-ordering tendencies vary by specialization, practice, geographical location, defensive practice, and tolerance of uncertainty and are also modified by patient requests. Understanding of statistical terms on the part of both physicians and patients remains limited. Physicians may display limited ability to assess pretest and posttest probabilities, especially in low- and intermediate-risk patients, even after attending short courses in epidemiology, or may find the process impractical. Presentation of diagnostic-test results in a natural-frequency format might improve understanding. Both physicians and patients have difficulty grasping the term "number needed to treat" compared with "relative risk reduction" when comparing therapeutic options. Other patient-related factors that limit understanding include low literacy, individual risk tolerance, and framing patterns of the problem (potential gains vs losses). Despite numerous available modalities (quantitative and qualitative) of risk communication, consensus over the advantage of any single modality in translating evidence into risk communication is limited. It is essential that physicians remain patient-centered, generate trust, and build a partnership with the patient to achieve consensus for medical decision-making. Future studies are indicated to assess the effectiveness of novel risk-communication modalities based on patients' and physicians' characteristics and identify appropriate modality of translating evidence (quantitative or qualitative information).
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Affiliation(s)
- Amit Kumar Ghosh
- Division of General Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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Panou C, Alevizaki P, Mauri D, Ioakimidou A, Vittoraki A, Spiliopoulou A, Chasioti D, Loukidou E, Kouris G, Pentheroudakis G. Urinary test use for cancer screening: an underestimated health economics pitfall? ACTA ACUST UNITED AC 2004; 143:366-7. [PMID: 15192653 DOI: 10.1016/j.lab.2004.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vinker S, Fogelman Y, Elhayany A, Nakar S, Kahan E. Usefulness of electronic databases for the detection of unrecognized diabetic patients. Cardiovasc Diabetol 2003; 2:13. [PMID: 14614779 PMCID: PMC305363 DOI: 10.1186/1475-2840-2-13] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2003] [Accepted: 11/14/2003] [Indexed: 01/22/2023] Open
Abstract
Background Even mild hyperglycemia is associated with future acute and chronic complications. Nevertheless, many cases of diabetes in the community go unrecognized. The aim of the study was to determine if national electronic patient records could be used to identify patients with diabetes in a health management organization. Methods The central district databases of Israel's largest health management organization were reviewed for all patients over 20 years old with a documented diagnosis of diabetes mellitus (DM) in the chronic disease register or patient file (identified diabetic patients) or a fasting serum glucose level of >126 mg/100 ml according to the central laboratory records (suspected diabetic patients). The family physicians of the patients with suspected diabetes were asked for a report on their current diabetic status. Results The searches yielded 1,694 suspected diabetic patients; replies from the family physicians were received for 1,486. Of these, 575 (38.7%) were confirmed to have diabetes mellitus. Their addition to the identified patient group raised the relative rate of diabetic patients in the district by 3.2%. Conclusion Cross-referencing existing databases is an efficient, low-cost method for identifying hyperglycemic patients with unrecognized diabetes who require preventive treatment and follow-up. This model can be used to advantage in other clinical sites in Israel and elsewhere with fully computerized databases.
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Affiliation(s)
- Shlomo Vinker
- Clalit Health Services, Central District, POB 15043 Rishon Le Zion 75232, Israel.
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