User-centred design of a clinical decision support system for palliative care: Insights from healthcare professionals.

Objective: Although clinical decision support systems (CDSS) have many benefits for clinical practice, they also have several barriers to their acceptance by professionals. Our objective in this study was to design and validate The Aleph palliative care (PC) CDSS through a user-centred method, considering the predictions of the artificial intelligence (AI) core, usability and user experience (UX). Methods: We performed two rounds of individual evaluation sessions with potential users. Each session included a model evaluation, a task test and a usability and UX assessment. Results: The machine learning (ML) predictive models outperformed the participants in the three predictive tasks. System Usability Scale (SUS) reported 62.7 ± 14.1 and 65 ± 26.2 on a 100-point rating scale for both rounds, respectively, while User Experience Questionnaire - Short Version (UEQ-S) scores were 1.42 and 1.5 on the -3 to 3 scale. Conclusions: The think-aloud method and including the UX dimension helped us to identify most of the workflow implementation issues. The system has good UX hedonic qualities; participants were interested in the tool and responded positively to it. Performance regarding usability was modest but acceptable.

Complementary frailty and mortality prediction models on older patients as a tool for assessing palliative care needs.

Palliative care (PC) has demonstrated benefits for life-limiting illnesses. Bad survival prognosis and patients' decline are working criteria to guide PC decision-making for older patients. Still, there is not a clear consensus on when to initiate early PC. This work aims to propose machine learning approaches to predict frailty and mortality in older patients in supporting PC decision-making. Predictive models based on Gradient Boosting Machines (GBM) and Deep Neural Networks (DNN) were implemented for binary 1-year mortality classification, survival estimation and 1-year frailty classification. Besides, we tested the similarity between mortality and frailty distributions. The 1-year mortality classifier achieved an Area Under the Curve Receiver Operating Characteristic (AUC ROC) of 0.87 [0.86, 0.87], whereas the mortality regression model achieved an mean absolute error (MAE) of 333.13 [323.10, 342.49] days. Moreover, the 1-year frailty classifier obtained an AUC ROC of 0.89 [0.88, 0.90]. Mortality and frailty criteria were weakly correlated and had different distributions, which can be interpreted as these assessment measurements are complementary for PC decision-making. This study provides new models that can be part of decision-making systems for PC services in older patients after their external validation.

A user-centered chatbot to identify and interconnect individual, social and environmental risk factors related to overweight and obesity.

The objective of this study was to assess the feasibility of using a user-centered chatbotfor collecting linked data to study overweight and obesity causes ina target population. In total 980 people participated in the feasibility study organized in three studies: (1) within a group of university students (88 participants), (2) in a small town (422 participants), and (3) within a university community (470 participants). We gathered self-reported data through the Wakamola chatbot regarding participants diet, physical activity, social network, living area, obesity-associated diseases, and sociodemographic data. For each study, we calculated the mean Body Mass Index (BMI) and number of people in each BMI level. Also, we defined and calculated scores (1-100 scale) regarding global health, BMI, alimentation, physical activity and social network. Moreover, we graphically represented obesity risk for living areas and the social network with nodes colored by BMI. Students group results: Mean BMI 21.37 (SD 2.57) (normal weight), 8 people underweight, 5 overweight, 0 obesity, global health status 78.21, alimentation 63.64, physical activity 65.08 and social 26.54, 3 areas with mean BMI level of obesity, 17 with overweight level. Small town´s study results: Mean BMI 25.66 (SD 4.29) (overweight), 2 people underweight, 63 overweight, 26 obesity, global health status 69.42, alimentation 64.60, physical activity 60.61 and social 1.14, 1 area with mean BMI in normal weight; University´s study results: Mean BMI 23.63 (SD 3.7) (normal weight), 22 people underweight, 86 overweight, 28 obesity, global health status 81.03, alimentation 81.84, physical activity 70.01 and social 1.47, 3 areas in obesity level, 19 in overweight level. Wakamola is a health care chatbot useful to collect relevant data from populations in the risk of overweight and obesity. Besides, the chatbot provides individual self-assessment of BMI and general status regarding the style of living. Moreover, Wakamola connects users in a social network to help the study of O&O´s causes from an individual, social and socio-economic perspective.

Deep ensemble multitask classification of emergency medical call incidents combining multimodal data improves emergency medical dispatch.

The objective of this work was to develop a predictive model to aid non-clinical dispatchers to classify emergency medical call incidents by their life-threatening level (yes/no), admissible response delay (undelayable, minutes, hours, days) and emergency system jurisdiction (emergency system/primary care) in real time. We used a total of 1 244 624 independent incidents from the Valencian emergency medical dispatch service in Spain, compiled in retrospective from 2009 to 2012, including clinical features, demographics, circumstantial factors and free text dispatcher observations. Based on them, we designed and developed DeepEMC2, a deep ensemble multitask model integrating four subnetworks: three specialized to context, clinical and text data, respectively, and another to ensemble the former. The four subnetworks are composed in turn by multi-layer perceptron modules, bidirectional long short-term memory units and a bidirectional encoding representations from transformers module. DeepEMC2 showed a macro F1-score of 0.759 in life-threatening classification, 0.576 in admissible response delay and 0.757 in emergency system jurisdiction. These results show a substantial performance increase of 12.5 %, 17.5 % and 5.1 %, respectively, with respect to the current in-house triage protocol of the Valencian emergency medical dispatch service. Besides, DeepEMC2 significantly outperformed a set of baseline machine learning models, including naive bayes, logistic regression, random forest and gradient boosting (α = 0.05). Hence, DeepEMC2 is able to: 1) capture information present in emergency medical calls not considered by the existing triage protocol, and 2) model complex data dependencies not feasible by the tested baseline models. Likewise, our results suggest that most of this unconsidered information is present in the free text dispatcher observations. To our knowledge, this study describes the first deep learning model undertaking emergency medical call incidents classification. Its adoption in medical dispatch centers would potentially improve emergency dispatch processes, resulting in a positive impact in patient wellbeing and health services sustainability.

How the Wakamola chatbot studied a university community's lifestyle during the COVID-19 confinement.

This work aimed to study the effect of confinement on weight and lifestyle using the Wakamola chatbot to collect data from 739 adults divided into two groups (341 case-control, 398 confinement). Nutrition score (0-100 scale) improved for men (medians 81.77-82.29, p < 0.05), with no difference for women (medians 82.29 in both cases). Both genders reduced the consumption of sweetmeats and sugared drinks (p < 0.01); men increased their consumption of vegetables, salad, and legumes (p < 0.01). Both genders reduced their physical activity score (men 100-40.14, p < 0.01, women 80.42-36.12, p < 0.01). Women sat less hours/week, men's medians 28.81-28.27, women's medians 35.97-23.33, p = 0.03. Both genders slept longer (hours/day), men 7-7.5, women 7-8 (p < 0.01) (medians). Their overall health score was significantly reduced (men 85.06-74.05, p < 0.01, women 84.47-72.42, p < 0.01), with no significant weight difference in either gender. Wakamola helped to contact participants and confirm changes in their lifestyle during confinement.

A User-Centered Chatbot (Wakamola) to Collect Linked Data in Population Networks to Support Studies of Overweight and Obesity Causes: Design and Pilot Study.

BACKGROUND: Obesity and overweight are a serious health problem worldwide with multiple and connected causes. Simultaneously, chatbots are becoming increasingly popular as a way to interact with users in mobile health apps. OBJECTIVE: This study reports the user-centered design and feasibility study of a chatbot to collect linked data to support the study of individual and social overweight and obesity causes in populations. METHODS: We first studied the users' needs and gathered users' graphical preferences through an open survey on 52 wireframes designed by 150 design students; it also included questions about sociodemographics, diet and activity habits, the need for overweight and obesity apps, and desired functionality. We also interviewed an expert panel. We then designed and developed a chatbot. Finally, we conducted a pilot study to test feasibility. RESULTS: We collected 452 answers to the survey and interviewed 4 specialists. Based on this research, we developed a Telegram chatbot named Wakamola structured in six sections: personal, diet, physical activity, social network, user's status score, and project information. We defined a user's status score as a normalized sum (0-100) of scores about diet (frequency of eating 50 foods), physical activity, BMI, and social network. We performed a pilot to evaluate the chatbot implementation among 85 healthy volunteers. Of 74 participants who completed all sections, we found 8 underweight people (11%), 5 overweight people (7%), and no obesity cases. The mean BMI was 21.4 kg/m2 (normal weight). The most consumed foods were olive oil, milk and derivatives, cereals, vegetables, and fruits. People walked 10 minutes on 5.8 days per week, slept 7.02 hours per day, and were sitting 30.57 hours per week. Moreover, we were able to create a social network with 74 users, 178 relations, and 12 communities. CONCLUSIONS: The Telegram chatbot Wakamola is a feasible tool to collect data from a population about sociodemographics, diet patterns, physical activity, BMI, and specific diseases. Besides, the chatbot allows the connection of users in a social network to study overweight and obesity causes from both individual and social perspectives.

Design of 1-year mortality forecast at hospital admission: A machine learning approach.

Palliative care is referred to a set of programs for patients that suffer life-limiting illnesses. These programs aim to maximize the quality of life (QoL) for the last stage of life. They are currently based on clinical evaluation of the risk of 1-year mortality. The main aim of this work is to develop and validate machine-learning-based models to predict the exitus of a patient within the next year using data gathered at hospital admission. Five machine-learning techniques were applied using a retrospective dataset. The evaluation was performed with five metrics computed by a resampling strategy: Accuracy, the area under the ROC curve, Specificity, Sensitivity, and the Balanced Error Rate. All models reported an AUC ROC from 0.857 to 0.91. Specifically, Gradient Boosting Classifier was the best model, producing an AUC ROC of 0.91, a sensitivity of 0.858, a specificity of 0.808, and a BER of 0.1687. Information from standard procedures at hospital admission combined with machine learning techniques produced models with competitive discriminative power. Our models reach the best results reported in the state of the art. These results demonstrate that they can be used as an accurate data-driven palliative care criteria inclusion.

Machine Learning-Based Identification of Obesity from Positive and Unlabelled Electronic Health Records.

INTRODUCTION: Prevalence of overweight and obesity are increas- ing in the last decades, and with them, diseases and health conditions such as diabetes, hypertension or cardiovascular diseases. However, hos- pital databases usually do not record such conditions in adults, neither anthropomorfic measures that facilitate their identification. METHODS: We implemented a machine learning method based on PU (Positive and Unlabelled) Learning to identify obese patients without a diagnose code of obesity in the health records. RESULTS: The algorithm presented a high sensitivity (98%) and predicted that around 18% of the patients without a diagnosis were obese. This result is consistent with the report of the WHO.