Medical research, particularly in predicting patient outcomes, heavily relies on medical time series data extracted from Electronic Health Records (EHR), which provide extensive information on patient histories. Despite rigorous examination, labeling errors are inevitable and can significantly impede accurate predictions of patient outcome. To address this challenge, we propose an \textbf{A}ttention-based Learning Framework with Dynamic \textbf{C}alibration and Augmentation for \textbf{T}ime series Noisy \textbf{L}abel \textbf{L}earning (ACTLL). This framework leverages a two-component Beta mixture model to identify the certain and uncertain sets of instances based on the fitness distribution of each class, and it captures global temporal dynamics while dynamically calibrating labels from the uncertain set or augmenting confident instances from the certain set. Experimental results on large-scale EHR datasets eICU and MIMIC-IV-ED, and several benchmark datasets from the UCR and UEA repositories, demonstrate that our model ACTLL has achieved state-of-the-art performance, especially under high noise levels.
The integration of Large Language Models (LLMs) into healthcare holds significant potential to enhance diagnostic accuracy and support medical treatment planning. These AI-driven systems can analyze vast datasets, assisting clinicians in identifying diseases, recommending treatments, and predicting patient outcomes. This study evaluates the performance of a range of contemporary LLMs, including both open-source and closed-source models, on the 2024 Portuguese National Exam for medical specialty access (PNA), a standardized medical knowledge assessment. Our results highlight considerable variation in accuracy and cost-effectiveness, with several models demonstrating performance exceeding human benchmarks for medical students on this specific task. We identify leading models based on a combined score of accuracy and cost, discuss the implications of reasoning methodologies like Chain-of-Thought, and underscore the potential for LLMs to function as valuable complementary tools aiding medical professionals in complex clinical decision-making.
Cancer prognosis is a critical task that involves predicting patient outcomes and survival rates. To enhance prediction accuracy, previous studies have integrated diverse data modalities, such as clinical notes, medical images, and genomic data, leveraging their complementary information. However, existing approaches face two major limitations. First, they struggle to incorporate newly arrived data with varying distributions into training, such as patient records from different hospitals, thus rendering sub-optimal generalizability and limited utility in real-world applications. Second, most multimodal integration methods rely on simplistic concatenation or task-specific pipelines, which fail to capture the complex interdependencies across modalities. To address these, we propose a continually evolving multi-modal foundation model. Extensive experiments on the TCGA dataset demonstrate the effectiveness of our approach, highlighting its potential to advance cancer prognosis by enabling robust and adaptive multimodal integration.
Generating realistic images to accurately predict changes in the structure of brain MRI is a crucial tool for clinicians. Such applications help assess patients' outcomes and analyze how diseases progress at the individual level. However, existing methods for this task present some limitations. Some approaches attempt to model the distribution of MRI scans directly by conditioning the model on patients' ages, but they fail to explicitly capture the relationship between structural changes in the brain and time intervals, especially on age-unbalanced datasets. Other approaches simply rely on interpolation between scans, which limits their clinical application as they do not predict future MRIs. To address these challenges, we propose a Temporally-Aware Diffusion Model (TADM), which introduces a novel approach to accurately infer progression in brain MRIs. TADM learns the distribution of structural changes in terms of intensity differences between scans and combines the prediction of these changes with the initial baseline scans to generate future MRIs. Furthermore, during training, we propose to leverage a pre-trained Brain-Age Estimator (BAE) to refine the model's training process, enhancing its ability to produce accurate MRIs that match the expected age gap between baseline and generated scans. Our assessment, conducted on the OASIS-3 dataset, uses similarity metrics and region sizes computed by comparing predicted and real follow-up scans on 3 relevant brain regions. TADM achieves large improvements over existing approaches, with an average decrease of 24% in region size error and an improvement of 4% in similarity metrics. These evaluations demonstrate the improvement of our model in mimicking temporal brain neurodegenerative progression compared to existing methods. Our approach will benefit applications, such as predicting patient outcomes or improving treatments for patients.
Multi-omics research has enhanced our understanding of cancer heterogeneity and progression. Investigating molecular data through multi-omics approaches is crucial for unraveling the complex biological mechanisms underlying cancer, thereby enabling more effective diagnosis, treatment, and prevention strategies. However, predicting patient outcomes through the integration of all available multi-omics data is still an under-study research direction. Here, we present SeNMo, a foundation model that has been trained on multi-omics data across 33 cancer types. SeNMo is particularly efficient in handling multi-omics data characterized by high-width and low-length attributes. We trained SeNMo for the task of overall survival of patients using pan-cancer multi-omics data involving 33 cancer sites from the GDC. The training multi-omics data includes gene expression, DNA methylation, miRNA expression, DNA mutations, protein expression modalities, and clinical data. SeNMo was validated on two independent cohorts: Moffitt Cancer Center and CPTAC lung squamous cell carcinoma. We evaluated the model's performance in predicting patient's overall survival using the C-Index. SeNMo performed consistently well in the training regime, reflected by the validation C-Index of 0.76 on GDC's public data. In the testing regime, SeNMo performed with a C-Index of 0.758 on a held-out test set. The model showed an average accuracy of 99.8% on the task of classifying the primary cancer type on the pan-cancer test cohort. SeNMo demonstrated robust performance on the classification task of predicting the primary cancer type of patients. SeNMo further demonstrated significant performance in predicting tertiary lymph structures from multi-omics data, showing generalizability across cancer types, molecular data types, and clinical endpoints.
Machine learning enables extracting clinical insights from large temporal datasets. The applications of such machine learning models include identifying disease patterns and predicting patient outcomes. However, limited interpretability poses challenges for deploying advanced machine learning in digital healthcare. Understanding the meaning of latent states is crucial for interpreting machine learning models, assuming they capture underlying patterns. In this paper, we present a concise algorithm that allows for i) interpreting latent states using highly related input features; ii) interpreting predictions using subsets of input features via latent states; and iii) interpreting changes in latent states over time. The proposed algorithm is feasible for any model that is differentiable. We demonstrate that this approach enables the identification of a daytime behavioral pattern for predicting nocturnal behavior in a real-world healthcare dataset.
Human tissue and its constituent cells form a microenvironment that is fundamentally three-dimensional (3D). However, the standard-of-care in pathologic diagnosis involves selecting a few two-dimensional (2D) sections for microscopic evaluation, risking sampling bias and misdiagnosis. Diverse methods for capturing 3D tissue morphologies have been developed, but they have yet had little translation to clinical practice; manual and computational evaluations of such large 3D data have so far been impractical and/or unable to provide patient-level clinical insights. Here we present Modality-Agnostic Multiple instance learning for volumetric Block Analysis (MAMBA), a deep-learning-based platform for processing 3D tissue images from diverse imaging modalities and predicting patient outcomes. Archived prostate cancer specimens were imaged with open-top light-sheet microscopy or microcomputed tomography and the resulting 3D datasets were used to train risk-stratification networks based on 5-year biochemical recurrence outcomes via MAMBA. With the 3D block-based approach, MAMBA achieves an area under the receiver operating characteristic curve (AUC) of 0.86 and 0.74, superior to 2D traditional single-slice-based prognostication (AUC of 0.79 and 0.57), suggesting superior prognostication with 3D morphological features. Further analyses reveal that the incorporation of greater tissue volume improves prognostic performance and mitigates risk prediction variability from sampling bias, suggesting the value of capturing larger extents of heterogeneous 3D morphology. With the rapid growth and adoption of 3D spatial biology and pathology techniques by researchers and clinicians, MAMBA provides a general and efficient framework for 3D weakly supervised learning for clinical decision support and can help to reveal novel 3D morphological biomarkers for prognosis and therapeutic response.
Heart failure is a syndrome which occurs when the heart is not able to pump blood and oxygen to support other organs in the body. Identifying the underlying themes in the diagnostic codes and procedure reports of patients admitted for heart failure could reveal the clinical phenotypes associated with heart failure and to group patients based on their similar characteristics which could also help in predicting patient outcomes like length of stay. These clinical phenotypes usually have a probabilistic latent structure and hence, as there has been no previous work on identifying phenotypes in clinical notes of heart failure patients using a probabilistic framework and to predict length of stay of these patients using data-driven artificial intelligence-based methods, we apply natural language processing technique, topic modeling, to identify the themes present in diagnostic codes and in procedure reports of 1,200 patients admitted for heart failure at the University of Illinois Hospital and Health Sciences System (UI Health). Topic modeling identified twelve themes each in diagnostic codes and procedure reports which revealed information about different phenotypes related to various perspectives about heart failure, to study patients' profiles and to discover new relationships among medical concepts. Each theme had a set of keywords and each clinical note was labeled with two themes - one corresponding to its diagnostic code and the other corresponding to its procedure reports along with their percentage contribution. We used these themes and their percentage contribution to predict length of stay. We found that the themes discovered in diagnostic codes and procedure reports using topic modeling together were able to predict length of stay of the patients with an accuracy of 61.1% and an Area under the Receiver Operating Characteristic Curve (ROC AUC) value of 0.828.
Molecular and genomic properties are critical in selecting cancer treatments to target individual tumors, particularly for immunotherapy. However, the methods to assess such properties are expensive, time-consuming, and often not routinely performed. Applying machine learning to H&E images can provide a more cost-effective screening method. Dozens of studies over the last few years have demonstrated that a variety of molecular biomarkers can be predicted from H&E alone using the advancements of deep learning: molecular alterations, genomic subtypes, protein biomarkers, and even the presence of viruses. This article reviews the diverse applications across cancer types and the methodology to train and validate these models on whole slide images. From bottom-up to pathologist-driven to hybrid approaches, the leading trends include a variety of weakly supervised deep learning-based approaches, as well as mechanisms for training strongly supervised models in select situations. While results of these algorithms look promising, some challenges still persist, including small training sets, rigorous validation, and model explainability. Biomarker prediction models may yield a screening method to determine when to run molecular tests or an alternative when molecular tests are not possible. They also create new opportunities in quantifying intratumoral heterogeneity and predicting patient outcomes.
Oral Food Challenges (OFCs) are essential to accurately diagnosing food allergy due to the limitations of existing clinical testing. However, some patients are hesitant to undergo OFCs, while those willing suffer from limited access to allergists in rural/community healthcare settings. Despite its success in predicting patient outcomes in other clinical settings, few applications of machine learning to food allergy have been developed. Thus, in this study, we seek to leverage machine learning methodologies for OFC outcome prediction. Retrospective data was gathered from 1,112 patients who collectively underwent a total of 1,284 OFCs, and consisted of clinical factors including serum-specific Immunoglobulin E (IgE), total IgE, skin prick tests (SPTs), comorbidities, sex, and age. Using these features, multiple machine learning models were constructed to predict OFC outcomes for three common allergens: peanut, egg, and milk. The best performing model for each allergen was an ensemble of random forest (egg) or Learning Using Concave and Convex Kernels (LUCCK) (peanut, milk) models, which achieved an Area under the Curve (AUC) of 0.91, 0.96, and 0.94, in predicting OFC outcomes for peanut, egg, and milk, respectively. Moreover, all such models had sensitivity and specificity values 89%. Model interpretation via SHapley Additive exPlanations (SHAP) indicates that specific IgE, along with wheal and flare values from SPTs, are highly predictive of OFC outcomes. The results of this analysis suggest that ensemble learning has the potential to predict OFC outcomes and reveal relevant clinical factors for further study.
Computer-aided methods have shown added value for diagnosing and predicting brain disorders and can thus support decision making in clinical care and treatment planning. This chapter will provide insight into the type of methods, their working, their input data - such as cognitive tests, imaging and genetic data - and the types of output they provide. We will focus on specific use cases for diagnosis, i.e. estimating the current 'condition' of the patient, such as early detection and diagnosis of dementia, differential diagnosis of brain tumours, and decision making in stroke. Regarding prediction, i.e. estimation of the future 'condition' of the patient, we will zoom in on use cases such as predicting the disease course in multiple sclerosis and predicting patient outcomes after treatment in brain cancer. Furthermore, based on these use cases, we will assess the current state-of-the-art methodology and highlight current efforts on benchmarking of these methods and the importance of open science therein. Finally, we assess the current clinical impact of computer-aided methods and discuss the required next steps to increase clinical impact.
We develop Temporal Quantile Adjustment (TQA), a general method to construct efficient and valid prediction intervals (PIs) for regression on cross-sectional time series data. Such data is common in many domains, including econometrics and healthcare. A canonical example in healthcare is predicting patient outcomes using physiological time-series data, where a population of patients composes a cross-section. Reliable PI estimators in this setting must address two distinct notions of coverage: cross-sectional coverage across a cross-sectional slice, and longitudinal coverage along the temporal dimension for each time series. Recent works have explored adapting Conformal Prediction (CP) to obtain PIs in the time series context. However, none handles both notions of coverage simultaneously. CP methods typically query a pre-specified quantile from the distribution of nonconformity scores on a calibration set. TQA adjusts the quantile to query in CP at each time $t$, accounting for both cross-sectional and longitudinal coverage in a theoretically-grounded manner. The post-hoc nature of TQA facilitates its use as a general wrapper around any time series regression model. We validate TQA's performance through extensive experimentation: TQA generally obtains efficient PIs and improves longitudinal coverage while preserving cross-sectional coverage.
Recent work on predicting patient outcomes in the Intensive Care Unit (ICU) has focused heavily on the physiological time series data, largely ignoring sparse data such as diagnoses and medications. When they are included, they are usually concatenated in the late stages of a model, which may struggle to learn from rarer disease patterns. Instead, we propose a strategy to exploit diagnoses as relational information by connecting similar patients in a graph. To this end, we propose LSTM-GNN for patient outcome prediction tasks: a hybrid model combining Long Short-Term Memory networks (LSTMs) for extracting temporal features and Graph Neural Networks (GNNs) for extracting the patient neighbourhood information. We demonstrate that LSTM-GNNs outperform the LSTM-only baseline on length of stay prediction tasks on the eICU database. More generally, our results indicate that exploiting information from neighbouring patient cases using graph neural networks is a promising research direction, yielding tangible returns in supervised learning performance on Electronic Health Records.
The pressure of ever-increasing patient demand and budget restrictions make hospital bed management a daily challenge for clinical staff. Most critical is the efficient allocation of resource-heavy Intensive Care Unit (ICU) beds to the patients who need life support. Central to solving this problem is knowing for how long the current set of ICU patients are likely to stay in the unit. In this work, we propose a new deep learning model based on the combination of temporal convolution and pointwise (1x1) convolution, to solve the length of stay prediction task on the eICU and MIMIC-IV critical care datasets. The model - which we refer to as Temporal Pointwise Convolution (TPC) - is specifically designed to mitigate common challenges with Electronic Health Records, such as skewness, irregular sampling and missing data. In doing so, we have achieved significant performance benefits of 18-68% (metric and dataset dependent) over the commonly used Long-Short Term Memory (LSTM) network, and the multi-head self-attention network known as the Transformer. By adding mortality prediction as a side-task, we can improve performance further still, resulting in a mean absolute deviation of 1.55 days (eICU) and 2.28 days (MIMIC-IV) on predicting remaining length of stay.
Invasive ductal carcinoma (IDC) comprises nearly 80% of all breast cancers. The detection of IDC is a necessary preprocessing step in determining the aggressiveness of the cancer, determining treatment protocols, and predicting patient outcomes, and is usually performed manually by an expert pathologist. Here, we describe a novel algorithm for automatically detecting IDC using semi-supervised conditional generative adversarial networks (cGANs). The framework is simple and effective at improving scores on a range of metrics over a baseline CNN.
We present a proxy dataset of vital signs with class labels indicating patient transitions from the ward to intensive care units called Ward2ICU. Patient privacy is protected using a Wasserstein Generative Adversarial Network to implicitly learn an approximation of the data distribution, allowing us to sample synthetic data. The quality of data generation is assessed directly on the binary classification task by comparing specificity and sensitivity of an LSTM classifier on proxy and original datasets. We initialize a discussion of unintentionally disclosing commercial sensitive information and propose a solution for a special case through class label balancing
Simulating images representative of neurodegenerative diseases is important for predicting patient outcomes and for validation of computational models of disease progression. This capability is valuable for secondary prevention clinical trials where outcomes and screening criteria involve neuroimaging. Traditional computational methods are limited by imposing a parametric model for atrophy and are extremely resource-demanding. Recent advances in deep learning have yielded data-driven models for longitudinal studies (e.g., face ageing) that are capable of generating synthetic images in real-time. Similar solutions can be used to model trajectories of atrophy in the brain, although new challenges need to be addressed to ensure accurate disease progression modelling. Here we propose Degenerative Adversarial NeuroImage Net (DaniNet) --- a new deep learning approach that learns to emulate the effect of neurodegeneration on MRI by simulating atrophy as a function of ages, and disease progression. DaniNet uses an underlying set of Support Vector Regressors (SVRs) trained to capture the patterns of regional intensity changes that accompany disease progression. DaniNet produces whole output images, consisting of 2D-MRI slices that are constrained to match regional predictions from the SVRs. DaniNet is also able to maintain the unique brain morphology of individuals. Adversarial training ensures realistic brain images and smooth temporal progression. We train our model using 9652 T1-weighted (longitudinal) MRI extracted from the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset. We perform quantitative and qualitative evaluations on a separate test set of 1283 images (also from ADNI) demonstrating the ability of DaniNet to produce accurate and convincing synthetic images that emulate disease progression.
Extracting actionable insight from Electronic Health Records (EHRs) poses several challenges for traditional machine learning approaches. Patients are often missing data relative to each other; the data comes in a variety of modalities, such as multivariate time series, free text, and categorical demographic information; important relationships among patients can be difficult to detect; and many others. In this work, we propose a novel approach to address these first three challenges using a representation learning scheme based on message passing. We show that our proposed approach is competitive with or outperforms the state of the art for predicting in-hospital mortality (binary classification), the length of hospital visits (regression) and the discharge destination (multiclass classification).
Imputing incomplete medical tests and predicting patient outcomes are crucial for guiding the decision making for therapy, such as after an Achilles Tendon Rupture (ATR). We formulate the problem of data imputation and prediction for ATR relevant medical measurements into a recommender system framework. By applying MatchBox, which is a collaborative filtering approach, on a real dataset collected from 374 ATR patients, we aim at offering personalized medical data imputation and prediction. In this work, we show the feasibility of this approach and discuss potential research directions by conducting initial qualitative evaluations.
Medical practitioners use survival models to explore and understand the relationships between patients' covariates (e.g. clinical and genetic features) and the effectiveness of various treatment options. Standard survival models like the linear Cox proportional hazards model require extensive feature engineering or prior medical knowledge to model treatment interaction at an individual level. While nonlinear survival methods, such as neural networks and survival forests, can inherently model these high-level interaction terms, they have yet to be shown as effective treatment recommender systems. We introduce DeepSurv, a Cox proportional hazards deep neural network and state-of-the-art survival method for modeling interactions between a patient's covariates and treatment effectiveness in order to provide personalized treatment recommendations. We perform a number of experiments training DeepSurv on simulated and real survival data. We demonstrate that DeepSurv performs as well as or better than other state-of-the-art survival models and validate that DeepSurv successfully models increasingly complex relationships between a patient's covariates and their risk of failure. We then show how DeepSurv models the relationship between a patient's features and effectiveness of different treatment options to show how DeepSurv can be used to provide individual treatment recommendations. Finally, we train DeepSurv on real clinical studies to demonstrate how it's personalized treatment recommendations would increase the survival time of a set of patients. The predictive and modeling capabilities of DeepSurv will enable medical researchers to use deep neural networks as a tool in their exploration, understanding, and prediction of the effects of a patient's characteristics on their risk of failure.