The association between preoperative cognitive status and surgical outcomes is a critical, yet scarcely explored area of research. Linking intraoperative data with postoperative outcomes is a promising and low-cost way of evaluating long-term impacts of surgical interventions. In this study, we evaluated how preoperative cognitive status as measured by the clock drawing test contributed to predicting length of hospital stay, hospital charges, average pain experienced during follow-up, and 1-year mortality over and above intraoperative variables, demographics, preoperative physical status and comorbidities. We expanded our analysis to 6 specific surgical groups where sufficient data was available for cross-validation. The clock drawing images were represented by 10 constructional features discovered by a semi-supervised deep learning algorithm, previously validated to differentiate between dementia and non-dementia patients. Different machine learning models were trained to classify postoperative outcomes in hold-out test sets. The models were compared to their relative performance, time complexity, and interpretability. Shapley Additive Explanations (SHAP) analysis was used to find the most predictive features for classifying different outcomes in different surgical contexts. Relative classification performances achieved by different feature sets showed that the perioperative cognitive dataset which included clock drawing features in addition to intraoperative variables, demographics, and comorbidities served as the best dataset for 12 of 18 possible surgery-outcome combinations...

Event prediction aims to forecast the time and type of a future event based on a historical event sequence. Despite its significance, several challenges exist, including the irregularity of time intervals between consecutive events, the existence of cycles, periodicity, and multi-scale event interactions, as well as the high computational costs for long event sequences. Existing neural temporal point processes (TPPs) methods do not capture the multi-scale nature of event interactions, which is common in many real-world applications such as clinical event data. To address these issues, we propose the cross-temporal-scale transformer (XTSFormer), designed specifically for irregularly timed event data. Our model comprises two vital components: a novel Feature-based Cycle-aware Time Positional Encoding (FCPE) that adeptly captures the cyclical nature of time, and a hierarchical multi-scale temporal attention mechanism. These scales are determined by a bottom-up clustering algorithm. Extensive experiments on several real-world datasets show that our XTSFormer outperforms several baseline methods in prediction performance.

Intensive Care Units (ICU) provide close supervision and continuous care to patients with life-threatening conditions. However, continuous patient assessment in the ICU is still limited due to time constraints and the workload on healthcare providers. Existing patient assessments in the ICU such as pain or mobility assessment are mostly sporadic and administered manually, thus introducing the potential for human errors. Developing Artificial intelligence (AI) tools that can augment human assessments in the ICU can be beneficial for providing more objective and granular monitoring capabilities. For example, capturing the variations in a patient's facial cues related to pain or agitation can help in adjusting pain-related medications or detecting agitation-inducing conditions such as delirium. Additionally, subtle changes in visual cues during or prior to adverse clinical events could potentially aid in continuous patient monitoring when combined with high-resolution physiological signals and Electronic Health Record (EHR) data. In this paper, we examined the association between visual cues and patient condition including acuity status, acute brain dysfunction, and pain. We leveraged our AU-ICU dataset with 107,064 frames collected in the ICU annotated with facial action units (AUs) labels by trained annotators. We developed a new "masked loss computation" technique that addresses the data imbalance problem by maximizing data resource utilization. We trained the model using our AU-ICU dataset in conjunction with three external datasets to detect 18 AUs. The SWIN Transformer model achieved 0.57 mean F1-score and 0.89 mean accuracy on the test set. Additionally, we performed AU inference on 634,054 frames to evaluate the association between facial AUs and clinically important patient conditions such as acuity status, acute brain dysfunction, and pain.

The past decade has seen an explosion in the amount of digital information stored in electronic health records (EHR). While primarily designed for archiving patient clinical information and administrative healthcare tasks, many researchers have found secondary use of these records for various clinical informatics tasks. Over the same period, the machine learning community has seen widespread advances in deep learning techniques, which also have been successfully applied to the vast amount of EHR data. In this paper, we review these deep EHR systems, examining architectures, technical aspects, and clinical applications. We also identify shortcomings of current techniques and discuss avenues of future research for EHR-based deep learning.