Predicting Postoperative Nausea And Vomiting Using Machine Learning: A Model Development and Validation Study

Background: Postoperative nausea and vomiting (PONV) is a frequently observed complication in patients undergoing surgery under general anesthesia. Moreover, it is a frequent cause of distress and dissatisfaction during the early postoperative period. The tools used for predicting PONV at present have not yielded satisfactory results. Therefore, prognostic tools for the prediction of early and delayed PONV were developed in this study with the aim of achieving satisfactory predictive performance. Methods: The retrospective data of adult patients admitted to the post-anesthesia care unit after undergoing surgical procedures under general anesthesia at the Sheba Medical Center, Israel, between September 1, 2018, and September 1, 2023, were used in this study. An ensemble model of machine learning algorithms trained on the data of 54848 patients was developed. The k-fold cross-validation method was used followed by splitting the data to train and test sets that optimally preserve the sociodemographic features of the patients, such as age, sex, and smoking habits, using the Bee Colony algorithm. Findings: Among the 54848 patients, early and delayed PONV were observed in 2706 (4.93%) and 8218 (14.98%) patients, respectively. The proposed PONV prediction tools could correctly predict early and delayed PONV in 84.0% and 77.3% of cases, respectively, outperforming the second-best PONV prediction tool (Koivuranta score) by 13.4% and 12.9%, respectively. Feature importance analysis revealed that the performance of the proposed prediction tools aligned with previous clinical knowledge, indicating their utility. Interpretation: The machine learning-based tools developed in this study enabled improved PONV prediction, thereby facilitating personalized care and improved patient outcomes.

Predicting Lung Cancer's Metastats' Locations Using Bioclinical Model

Lung cancer is a leading cause of cancer-related deaths worldwide. The spread of the disease from its primary site to other parts of the lungs, known as metastasis, significantly impacts the course of treatment. Early identification of metastatic lesions is crucial for prompt and effective treatment, but conventional imaging techniques have limitations in detecting small metastases. In this study, we develop a bioclinical model for predicting the spatial spread of lung cancer's metastasis using a three-dimensional computed tomography (CT) scan. We used a three-layer biological model of cancer spread to predict locations with a high probability of metastasis colonization. We validated the bioclinical model on real-world data from 10 patients, showing promising 74% accuracy in the metastasis location prediction. Our study highlights the potential of the combination of biophysical and ML models to advance the way that lung cancer is diagnosed and treated, by providing a more comprehensive understanding of the spread of the disease and informing treatment decisions.

Investigation Toward The Economic Feasibility of Personalized Medicine For Healthcare Service Providers: The Case of Bladder Cancer

In today's complex healthcare landscape, the pursuit of delivering optimal patient care while navigating intricate economic dynamics poses a significant challenge for healthcare service providers (HSPs). In this already complex dynamics, the emergence of clinically promising personalized medicine based treatment aims to revolutionize medicine. While personalized medicine holds tremendous potential for enhancing therapeutic outcomes, its integration within resource-constrained HSPs presents formidable challenges. In this study, we investigate the economic feasibility of implementing personalized medicine. The central objective is to strike a balance between catering to individual patient needs and making economically viable decisions. Unlike conventional binary approaches to personalized treatment, we propose a more nuanced perspective by treating personalization as a spectrum. This approach allows for greater flexibility in decision-making and resource allocation. To this end, we propose a mathematical framework to investigate our proposal, focusing on Bladder Cancer (BC) as a case study. Our results show that while it is feasible to introduce personalized medicine, a highly efficient but highly expensive one would be short-lived relative to its less effective but cheaper alternative as the latter can be provided to a larger cohort of patients, optimizing the HSP's objective better.

Mathematical Modeling of BCG-based Bladder Cancer Treatment Using Socio-Demographics

Cancer is one of the most widespread diseases around the world with millions of new patients each year. Bladder cancer is one of the most prevalent types of cancer affecting all individuals alike with no obvious prototypical patient. The current standard treatment for BC follows a routine weekly Bacillus Calmette-Guerin (BCG) immunotherapy-based therapy protocol which is applied to all patients alike. The clinical outcomes associated with BCG treatment vary significantly among patients due to the biological and clinical complexity of the interaction between the immune system, treatments, and cancer cells. In this study, we take advantage of the patient's socio-demographics to offer a personalized mathematical model that describes the clinical dynamics associated with BCG-based treatment. To this end, we adopt a well-established BCG treatment model and integrate a machine learning component to temporally adjust and reconfigure key parameters within the model thus promoting its personalization. Using real clinical data, we show that our personalized model favorably compares with the original one in predicting the number of cancer cells at the end of the treatment, with 14.8% improvement, on average.

Optimizing SMS Reminder Campaigns for Pre- and Post-Diagnosis Cancer Check-Ups using Socio-Demographics: An In-Silco Investigation Into Bladder Cancer

Timely pre- and post-diagnosis check-ups are critical for cancer patients, across all cancer types, as these often lead to better outcomes. Several socio-demographic properties have been identified as strongly connected with both cancer's clinical dynamics and (indirectly) with different individual check-up behaviors. Unfortunately, existing check-up policies typically consider only the former association explicitly. In this work, we propose a novel framework, accompanied by a high-resolution computer simulation, to investigate and optimize socio-demographic-based SMS reminder campaigns for cancer check-ups. We instantiate our framework and simulation for the case of bladder cancer, the 10th most prevalent cancer today, using extensive real-world data. Our results indicate that optimizing an SMS reminder campaign based solely on simple socio-demographic features can bring about a statistically significant reduction in mortality rate compared to alternative campaigns by up to 5.8%.