scholarly journals Correlational Dueling Bandits with Application to Clinical Treatment in Large Decision Spaces

2017 ◽  
Author(s):  
Yanan Sui ◽  
Joel W. Burdick
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Sequential Decision Making ◽  
Sequential Decision ◽  
Decision Space ◽  
Cord Injury ◽  
Effectiveness And Efficiency ◽  
Comparative Feedback

We consider sequential decision making under uncertainty, the optimization over large decision space with noisy comparative feedback. This problem can be formulated as a K-armed Dueling Bandits problem where K is the total number of decisions. When K is very large, existing dueling bandits algorithms suffer huge cumulative regret before converging on the optimal arm. This paper studies the dueling bandits problem with a large number of dependent arms. Our problem is motivated by a clinical decision making process in large decision space. We propose an efficient algorithm CorrDuel for the problem which makes decisions to simultaneously deliver effective therapy and explore the decision space. Many sequential decision making problems with large and structured decision space could be facilitated by our algorithm. After evaluated the fast convergence of CorrDuel in analysis and simulation experiments, we applied it on a live clinical trial of therapeutic spinal cord stimulation. It is the first applied algorithm towards spinal cord injury treatments and experimental results show the effectiveness and efficiency of our algorithm.

scholarly journals Optimizing Clinical Decision Making in Acute Traumatic Spinal Cord Injury

2017 ◽  
Vol 34 (20) ◽  
pp. 2841-2842 ◽  
Author(s):  
Michael G. Fehlings ◽  
Vanessa K. Noonan ◽  
Derek Atkins ◽  
Anthony S. Burns ◽  
Christiana L. Cheng ◽  
...  
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Traumatic Spinal Cord Injury ◽  
Cord Injury

scholarly journals Clinical decision-making on spinal cord injury-associated pneumonia: a nationwide survey in Germany

Spinal Cord ◽  
2020 ◽  
Vol 58 (8) ◽  
pp. 873-881 ◽  
Author(s):  
Claudia Druschel ◽  
Ramin R. Ossami Saidy ◽  
Ulrike Grittner ◽  
Claus P. Nowak ◽  
Andreas Meisel ◽  
...  
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Clinical Decision Making ◽  
Nationwide Survey ◽  
Clinical Decision ◽  
Cord Injury

scholarly journals A day in the life: a qualitative study of clinical decision-making and uptake of neurorehabilitation technology

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Courtney Celian ◽  
Veronica Swanson ◽  
Maahi Shah ◽  
Caitlin Newman ◽  
Bridget Fowler-King ◽  
...  
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
New Technologies ◽  
Clinical Decision ◽  
Relative Advantage ◽  
Personal Attributes ◽  
Design Work ◽  
Cognitive Limitations ◽  
Knowledge And Beliefs ◽  
Cord Injury

Abstract Background Neurorehabilitation engineering faces numerous challenges to translating new technologies, but it is unclear which of these challenges are most limiting. Our aim is to improve understanding of rehabilitation therapists’ real-time decision-making processes on the use of rehabilitation technology (RT) in clinical treatment. Methods We used a phenomenological qualitative approach, in which three OTs and two PTs employed at a major, technology-encouraging rehabilitation hospital wrote vignettes from a written prompt describing their RT use decisions during treatment sessions with nine patients (4 with stroke, 2 traumatic brain injury, 1 spinal cord injury, 1 with multiple sclerosis). We then coded the vignettes using deductive qualitative analysis from 17 constructs derived from the RT literature and the Consolidated Framework for Implementation Research (CFIR). Data were synthesized using summative content analysis. Results Of the constructs recorded, the five most prominent are from CFIR determinants of: (i) relative advantage, (ii) personal attributes of the patients, (iii) clinician knowledge and beliefs of the device/intervention, (iv) complexity of the devices including time and setup, and (v) organizational readiness to implement. Therapists characterized candidate RT as having a relative disadvantage compared to conventional treatment due to lack of relevance to functional training. RT design also often failed to consider the multi-faceted personal attributes of the patients, including diagnoses, goals, and physical and cognitive limitations. Clinicians’ comfort with RT was increased by their previous training but was decreased by the perceived complexity of RT. Finally, therapists have limited time to gather, setup, and use RT. Conclusions Despite decades of design work aimed at creating clinically useful RT, many lack compatibility with clinical translation needs in inpatient neurologic rehabilitation. New RT continue to impede the immediacy, versatility, and functionality of hands-on therapy mediated treatment with simple everyday objects.

scholarly journals Return to Play after Cervical Spine Injuries: A Consensus of Opinion

2016 ◽  
Vol 6 (8) ◽  
pp. 792-797 ◽  
Author(s):  
John C. France ◽  
Michael Karsy ◽  
James S. Harrop ◽  
Andrew T. Dailey
Keyword(s):  
Decision Making ◽  
Cervical Spine ◽  
Clinical Decision Making ◽  
Clinical Symptoms ◽  
Clinical Decision ◽  
Return To Play ◽  
Spine Injury ◽  
Cervical Cord ◽  
Clinical Scenarios ◽  
Cord Injury

Study Design Survey. Objective Sports-related spinal cord injury (SCI) represents a growing proportion of total SCIs but lacks evidence or guidelines to guide clinical decision-making on return to play (RTP). Our objective is to offer the treating physician a consensus analysis of expert opinion regarding RTP that can be incorporated with the unique factors of a case for clinical decision-making. Methods Ten common clinical scenarios involving neurapraxia and stenosis, atlantoaxial injury, subaxial injury, and general cervical spine injury were presented to 25 spine surgeons from level 1 trauma centers for whom spine trauma is a significant component of their practice. We evaluated responses to questions about patient RTP, level of contact, imaging required for a clinical decision, and time to return for each scenario. The chi-square test was used for statistical analysis, with p < 0.05 considered significant. Results Evaluation of the surgeons’ responses to these cases showed significant consensus regarding return to high-contact sports in cases of cervical cord neurapraxia without symptoms or stenosis, surgically repaired herniated disks, and nonoperatively healed C1 ring or C2 hangman's fractures. Greater variability was found in recommendations for patients showing persistent clinical symptomatology. Conclusion This survey suggests a consensus among surgeons for allowing patients with relatively normal imaging and resolution of symptoms to return to high-contact activities; however, patients with cervical stenosis or clinical symptoms continue to be a challenge for management. This survey may serve as a basis for future clinical trials and consensus guidelines.

scholarly journals Towards a Mobile Gait Analysis for Patients with a Spinal Cord Injury: A Robust Algorithm Validated for Slow Walking Speeds

Sensors ◽  
2021 ◽  
Vol 21 (21) ◽  
pp. 7381
Author(s):  
Charlotte Werner ◽  
Chris Awai Awai Easthope ◽  
Armin Curt ◽  
László Demkó
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Gait Analysis ◽  
Clinical Decision Making ◽  
Inertial Sensors ◽  
Clinical Decision ◽  
Cord Injury ◽  
Spatio Temporal ◽  
The Individual ◽  
Walking Speeds

Spinal cord injury (SCI) patients suffer from diverse gait deficits depending on the severity of their injury. Gait assessments can objectively track the progress during rehabilitation and support clinical decision making, but a comprehensive gait analysis requires far more complex setups and time-consuming protocols that are not feasible in the daily clinical routine. As using inertial sensors for mobile gait analysis has started to gain ground, this work aimed to develop a sensor-based gait analysis for the specific population of SCI patients that measures the spatio-temporal parameters of typical gait laboratories for day-to-day clinical applications. The proposed algorithm uses shank-mounted inertial sensors and personalized thresholds to detect steps and gait events according to the individual gait profiles. The method was validated in nine SCI patients and 17 healthy controls walking on an instrumented treadmill while wearing reflective markers for motion capture used as a gold standard. The sensor-based algorithm (i) performed similarly well for the two cohorts and (ii) is robust enough to cover the diverse gait deficits of SCI patients, from slow (0.3 m/s) to preferred walking speeds.

scholarly journals Accessing Artificial Intelligence for Clinical Decision-Making

2021 ◽  
Vol 3 ◽  
Author(s):  
Chris Giordano ◽  
Meghan Brennan ◽  
Basma Mohamed ◽  
Parisa Rashidi ◽  
François Modave ◽  
...  
Keyword(s):  
Artificial Intelligence ◽  
Decision Making ◽  
Patient Care ◽  
Clinical Decision Making ◽  
Clinical Medicine ◽  
Clinical Decision ◽  
Disruptive Innovation ◽  
Decision Makers ◽  
Data Sets ◽  
Sequential Decision

Advancements in computing and data from the near universal acceptance and implementation of electronic health records has been formative for the growth of personalized, automated, and immediate patient care models that were not previously possible. Artificial intelligence (AI) and its subfields of machine learning, reinforcement learning, and deep learning are well-suited to deal with such data. The authors in this paper review current applications of AI in clinical medicine and discuss the most likely future contributions that AI will provide to the healthcare industry. For instance, in response to the need to risk stratify patients, appropriately cultivated and curated data can assist decision-makers in stratifying preoperative patients into risk categories, as well as categorizing the severity of ailments and health for non-operative patients admitted to hospitals. Previous overt, traditional vital signs and laboratory values that are used to signal alarms for an acutely decompensating patient may be replaced by continuously monitoring and updating AI tools that can pick up early imperceptible patterns predicting subtle health deterioration. Furthermore, AI may help overcome challenges with multiple outcome optimization limitations or sequential decision-making protocols that limit individualized patient care. Despite these tremendously helpful advancements, the data sets that AI models train on and develop have the potential for misapplication and thereby create concerns for application bias. Subsequently, the mechanisms governing this disruptive innovation must be understood by clinical decision-makers to prevent unnecessary harm. This need will force physicians to change their educational infrastructure to facilitate understanding AI platforms, modeling, and limitations to best acclimate practice in the age of AI. By performing a thorough narrative review, this paper examines these specific AI applications, limitations, and requisites while reviewing a few examples of major data sets that are being cultivated and curated in the US.

scholarly journals A new severity scoring system designed for the management of adult spinal tuberculosis—a retrospective case series study

2020 ◽  
Author(s):  
Qi Wang ◽  
Xiaobo Luo ◽  
Chi Wang ◽  
Wenhao Hu ◽  
Litao Li ◽  
...  
Keyword(s):  
Decision Making ◽  
Spinal Cord ◽  
Scoring System ◽  
Clinical Decision Making ◽  
Spinal Tuberculosis ◽  
Case Series ◽  
Reliability And Validity ◽  
Clinical Decision ◽  
Severity Scoring ◽  
Case Series Study

Abstract Background: Surgeons have been successfully handle with spinal tuberculosis via conservative or surgical treatment. However, There are quite few classifications or scoring systems concerning spinal tuberculosis to guide the surgeons to manage the complicated pattern of spinal tuberculosis. The purpose of this study is to design a practical, yet comprehensive, severity scoring system for spinal tuberculosis that helps in clinical decision-making in terms of the need for operative versus non-operative management.Methods: A group of 129 spinal tuberculosis cases (70 male and 59 female patients) successfully treated and followed up for at least 2 years were retrospectively reviewed. Clinical spine experts from our institutions were gathered to confirm the information they considered pivotal in the communication of spinal tuberculosis and the clinical decision-making process. Typical spinal tuberculosis patterns were reviewed and reconsidered in view of these essential characteristics. An initial validation process to determine the reliability and validity of this system was also undertaken. Results: A new severity scoring system was designed based on three essential characteristics: 1) the stability of spinal infectious segments determined by imaging appearance, 2) the cause of spinal cord compression and the severity of neurologic deficit, and 3) the efficacy of the anti-tuberculosis drug therapy. A severity score was calculated from these characteristics, which divided patients into surgical and nonsurgical treatment groups. Conclusions: The severity scoring system comprehensively considers features cited in the literature including prediction of spinal stability and kyphosis deformity progression, identification of neurologic compromise and characteristics of mechanical compression of spinal cord. This classification system is intended to facilitate clinical decision-making in the management of adult spinal tuberculosis (from C3 to L5 segments) . The severity scoring system may help to improve the communication among spine surgeons. Further studies are needed to determine the reliability and validity of this system.

scholarly journals A Clinical Practice Guideline for the Management of Patients With Acute Spinal Cord Injury: Recommendations on the Role of Baseline Magnetic Resonance Imaging in Clinical Decision Making and Outcome Prediction

2017 ◽  
Vol 7 (3_suppl) ◽  
pp. 221S-230S ◽  
Author(s):  
Michael G. Fehlings ◽  
Allan R. Martin ◽  
Lindsay A. Tetreault ◽  
Bizhan Aarabi ◽  
Paul Anderson ◽  
...  
Keyword(s):  
Decision Making ◽  
Outcome Prediction ◽  
Clinical Decision Making ◽  
Surgical Intervention ◽  
Clinical Decision ◽  
Clinical Expertise ◽  
Resonance Imaging ◽  
Cord Injury

Introduction: The objective of this guideline is to outline the role of magnetic resonance imaging (MRI) in clinical decision making and outcome prediction in patients with traumatic spinal cord injury (SCI). Methods: A systematic review of the literature was conducted to address key questions related to the use of MRI in patients with traumatic SCI. This review focused on longitudinal studies that controlled for baseline neurologic status. A multidisciplinary Guideline Development Group (GDG) used this information, their clinical expertise, and patient input to develop recommendations on the use of MRI for SCI patients. Based on GRADE (Grading of Recommendation, Assessment, Development and Evaluation), a strong recommendation is worded as “we recommend,” whereas a weaker recommendation is indicated by “we suggest.” Results: Based on the limited available evidence and the clinical expertise of the GDG, our recommendations were: (1) “We suggest that MRI be performed in adult patients with acute SCI prior to surgical intervention, when feasible, to facilitate improved clinical decision-making” (quality of evidence, very low) and (2) “We suggest that MRI should be performed in adult patients in the acute period following SCI, before or after surgical intervention, to improve prediction of neurologic outcome” (quality of evidence, low). Conclusions: These guidelines should be implemented into clinical practice to improve outcomes and prognostication for patients with SCI.

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