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  • 文章类型: Journal Article
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  • 文章类型: Journal Article
    进行高质量的评论概述(OoR)非常耗时。因为系统评价(SRs)的质量各不相同,在进行OoR时,有必要批判性地评估SR。一个完善的评估工具是评估系统审查的测量工具(AMSTAR)2,每次申请大约需要15-32分钟。为了节省时间,我们开发了两个快速节俭的决策树(FFT),用于在全文筛选阶段(筛选FFT)或最终的SR库(快速评估FFT)评估OoR的SR的方法学质量。要构建用于开发FFT的数据集,我们确定了已发表的AMSTAR2评估。AMSTAR2的总体置信度等级被用作标准,16个项目被用作线索。从24种出版物中获得了一千五百十九种评估,并分为培训和测试数据集。产生的筛选FFT由三个项目组成,并正确识别所有非临界低质量SR(灵敏度为100%),但有59%的阳性预测值。三项快速评估FFT正确识别80%的高质量SR,正确识别97%的低质量SR,导致95%的准确度。FFT需要16个AMSTAR2项目中的约10%。可以在全文筛选期间应用筛选FFT以排除具有严重低质量的SR。快速评估FFT可以应用于最终SR池以识别可能具有高方法质量的SR。
    Conducting high-quality overviews of reviews (OoR) is time-consuming. Because the quality of systematic reviews (SRs) varies, it is necessary to critically appraise SRs when conducting an OoR. A well-established appraisal tool is A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, which takes about 15-32 min per application. To save time, we developed two fast-and-frugal decision trees (FFTs) for assessing the methodological quality of SR for OoR either during the full-text screening stage (Screening FFT) or to the resulting pool of SRs (Rapid Appraisal FFT). To build a data set for developing the FFT, we identified published AMSTAR 2 appraisals. Overall confidence ratings of the AMSTAR 2 were used as a criterion and the 16 items as cues. One thousand five hundred and nineteen appraisals were obtained from 24 publications and divided into training and test data sets. The resulting Screening FFT consists of three items and correctly identifies all non-critically low-quality SRs (sensitivity of 100%), but has a positive predictive value of 59%. The three-item Rapid Appraisal FFT correctly identifies 80% of the high-quality SRs and correctly identifies 97% of the low-quality SRs, resulting in an accuracy of 95%. The FFTs require about 10% of the 16 AMSTAR 2 items. The Screening FFT may be applied during full-text screening to exclude SRs with critically low quality. The Rapid Appraisal FFT may be applied to the final SR pool to identify SR that might be of high methodological quality.
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  • 文章类型: Journal Article
    目的:使用来自受影响UE的残余自愿性EMG信号,在意向驱动的机器人手训练后,得出并验证上肢(UE)运动功能的最小临床重要差异(MCID)的预测模型。
    方法:前瞻性纵向多中心队列研究。我们收集了干预前的候选预测因子:人口统计学,临床特征,UE的Fugl-Meyer评估(FMAUE),行动研究手臂测试成绩,在最大自愿收缩(MVC)期间通过EMG测量的趾屈肌和趾伸肌(ED)的运动意图。对于EMG措施,认识到中风幸存者移动瘫痪手的挑战,在MVC-EMG(0.1s-5s)期间,从八个时间窗口中提取峰值信号,以识别受试者的运动意图。采用分类和回归树算法预测具有FMAUEMCID的幸存者。进一步研究了预测因子与运动改善之间的关系。
    方法:9个康复中心。
    方法:慢性卒中幸存者(N=131),包括87个派生样本,44为验证样本。
    方法:所有参与者都接受了20次机器人手训练(40分钟/次,3-5次/周)。
    方法:通过受试者工作特征曲线下面积(AUC)评估模型的预测效果。最佳有效模型是最终模型,并使用AUC和总体准确性进行验证。
    结果:最佳模型包括FMAUE(截止分数:46)和一秒MVC-EMG的ED峰值活动(MVC-EMG比静息EMG高4.604倍),与其他时间窗口或仅使用临床评分(AUC:0.595)相比,其预测准确性(AUC:0.807)显着提高。在外部验证中,该模型显示出稳健的预测(AUC:0.916)。在ED-EMG和FMAUE增加之间观察到显着的二次关系。
    结论:本研究为慢性卒中幸存者的意向驱动机器人手训练提供了一个预测模型。它强调了通过1秒EMG窗口捕获运动意图的重要性,作为20次机器人训练后UE运动功能MCID改善的预测指标。两种情况下的幸存者表现出很高的临床运动改善百分比:中度至高度运动意图和低度至中度功能;以及高意图和高功能。
    OBJECTIVE: To derive and validate a prediction model for minimal clinically important differences (MCID) in upper extremity (UE) motor function after intention-driven robotic-hand training using residual voluntary EMG signals from affected UE.
    METHODS: A prospective longitudinal multicenter cohort study. We collected pre-intervention candidate predictors: demographics, clinical characteristics, Fugl-Meyer assessment of UE (FMAUE), Action Research Arm Test scores, and motor-intention of flexor digitorum and extensor digitorum (ED) measured by EMG during maximal voluntary contraction (MVC). For EMG measures, recognizing challenges for stroke survivors to move paralyzed hand, peak signals were extracted from eight time-windows during MVC-EMG (0.1s-5s) to identify subjects\' motor-intention. Classification And Regression Tree algorithm was employed to predict survivors with MCID of FMAUE. Relationship between predictors and motor-improvements was further investigated.
    METHODS: Nine rehabilitation centers.
    METHODS: Chronic stroke survivors (N=131), including 87 for Derivation-sample, and 44 for Validation-sample.
    METHODS: All participants underwent 20-session robotic-hand training (40min/session, 3-5sessions/week).
    METHODS: Prediction efficacies of models were assessed by area under the receiver operating characteristic curve (AUC). The best effective model was final model and validated using AUC and overall accuracy.
    RESULTS: The best model comprised FMAUE (cut-off score: 46) and peak activity of ED from one-second MVC-EMG (MVC-EMG 4.604 times higher than resting-EMG), which demonstrated significantly higher prediction accuracy (AUC: 0.807) than other time-windows or solely using clinical-scores (AUC: 0.595). In external validation, this model displayed robust prediction (AUC: 0.916). Significant quadratic relationship was observed between ED-EMG and FMAUE increases.
    CONCLUSIONS: This study presents a prediction model for intention-driven robotic-hand training in chronic stroke survivors. It highlights significance of capturing motor-intention through 1-second EMG-window as a predictor for MCID improvement in UE motor-function after 20-session robotic-training. Survivors in two conditions showed high percentage of clinical motor-improvement: moderate-to-high motor-intention and low-to-moderate function; as well as high-intention and high-function.
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  • 文章类型: Journal Article
    肥胖是由体内脂肪积累过多引起的异常和潜在危险状况。世界范围内肥胖的人数正在增加。肥胖是各种疾病的主要原因;因此,努力控制体重至关重要。确定影响肥胖男性试图控制和不控制体重的因素至关重要。这项研究的目的是为韩国男性在30岁和40岁时的体重控制经验创建一个预测模型。我们分析了2022年社区健康调查的数据,包括12,311名超重或肥胖的男性。根据他们的体重控制经验,将男性分为两组:(1)是组(n=9405)和(2)没有组(n=2906)。使用卡方检验和独立t检验来比较组间的一般特征和健康相关特征。采用决策树分析法建立体重控制经验预测模型。进行了分裂样本测试以验证该模型。从这项研究的结果来看,得出了各种预测体重控制经验的模型。从没有设置第一个节点的决策树模型中,那些体重低于平均水平的人,有高中文凭或更少,并且不知道他们的血糖水平没有将体重控制在55.3%的可能性最高。在第一个节点设置为年龄的预测模型中,那些40多岁的人认为自己的体重低于平均水平并且不知道自己的血糖水平,他们不试图控制体重的比例最高,为50.1%。在第一个节点设置为BMI的预测模型中,那些超重,但认为自己的体重低于平均水平,高中文凭或更低的人不努力控制体重的比例最高,为51.5%。迫切需要对没有体重控制经验的人进行肥胖预防和管理教育,特别是那些高风险的人,正如在这项研究中确定的那样。
    Obesity is an abnormal and potentially dangerous condition caused by excess body fat accumulation. The number of people with obesity is increasing worldwide. Obesity is the primary cause of various diseases; therefore, it is crucial to make efforts to control body weight. Identifying the factors that influence men with obesity to attempt to control and not control their weight is essential. The objective of this study was to create a prediction model for weight control experience among Korean men in their 30 s and 40 s. We analyzed data from the 2022 Community Health Survey and included 12,311 men who were overweight or obese. The men were divided into two groups based on their weight control experience: (1) Yes group (n = 9405) and (2) No group (n = 2906). Chi-square and independent t-tests were used to compare general and health-related characteristics between the groups. Decision tree analysis was used to build a prediction model for weight control experience. A split-sample test was conducted to validate the model. From the results of this study, various models predicting weight control experience were derived. From the decision tree model without setting the first node, those who weighed below average, had a high school diploma or less, and did not know their blood sugar levels had the highest probability of not controlling their weight at 55.3%. In the prediction model where the first node was set to age, those in their 40 s who thought their weight was below average and were unaware of their blood sugar levels had the highest rate of not trying to control their weight at 50.1%. In the prediction model where the first node was set to BMI, those who were overweight but thought their weight was below average and had a high school diploma or less had the highest rate of not trying to control their weight at 51.5%. There is an urgent need to provide obesity prevention and management education to those who have no weight control experience, particularly those at high risk, as identified in this study.
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  • 文章类型: Journal Article
    中风是危险的,这种威胁生命的疾病主要影响65岁以上的人,但不健康的饮食也有助于年轻时中风的发展。如果中风被及早发现,可以成功治疗,和适当的治疗是可用的。这项研究的目的是开发一种中风预测模型,以提高中风预测的有效性和准确性。使用所提出的机器学习算法可以实现预测某人是否患有中风。在这项研究中,评估了各种机器学习技术,用于在医疗保健中风数据集上预测中风。这里使用的特征选择算法是梯度提升和随机森林,分类器包括决策树分类器,支持向量机(SVM)分类器,逻辑回归分类器,梯度增强分类器,随机森林分类器,K个邻居分类器,和Xtreme梯度增强分类器。在这个过程中,不同的机器学习方法被用来测试不同数据样本的预测方法。从应用的不同方法中获得的结果,以及不同分类模型的比较,随机森林模型的准确率为98%。
    A stroke is a dangerous, life-threatening disease that mostly affects people over 65, but an unhealthy diet is also contributing to the development of strokes at younger ages. Strokes can be treated successfully if they are identified early enough, and suitable therapies are available. The purpose of this study is to develop a stroke prediction model that will improve stroke prediction effectiveness as well as accuracy. Predicting whether someone is suffering from a stroke or not can be accomplished with this proposed machine learning algorithm. In this research, various machine learning techniques are evaluated for predicting stroke on the healthcare stroke dataset. The feature selection algorithms used here are gradient boosting and random forest, and classifiers include the decision tree classifier, Support Vector Machine (SVM) classifier, logistic regression classifier, gradient boosting classifier, random forest classifier, K neighbors classifier, and Xtreme gradient boosting classifier. In this process, different machine-learning approaches are employed to test predictive methods on different data samples. As a result obtained from the different methods applied, and the comparison of different classification models, the random forest model offers an accuracy rate of 98%.
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  • 文章类型: Journal Article
    背景:皮肤点刺试验(SPT),或者表皮内检查,通常是疑似过敏患者的第一种诊断方法。加上临床病史,SPT允许医生根据过敏模式得出结论。这项研究的目的是调查采用基于计算机视觉的SPT后瑞士大学医院可能产生的潜在成本后果。
    方法:我们从医院的角度进行了成本后果分析,以评估使用基于计算机视觉的系统读取SPT结果的潜在成本后果。患者人群由转诊到瑞士五所大学医院之一的变态反应科的个人组成,性器官,他的变态反应科平均每周100次。我们开发了一种比较两种SPT技术的早期成本后果模型;在NexkinDSPT和标准全手动SPT的帮助下进行的基于计算机视觉的SPT。使用概率敏感性分析和其他单变量敏感性分析来解释不确定性。
    结果:从医院的角度来看,两种替代方案之间的平均成本差异估计为每SPT7瑞士法郎,支持基于计算机的SPT。蒙特卡罗概率仿真还表明,与标准的完全手动SPT相比,使用基于计算机视觉的系统进行的SPT节省成本。敏感性分析还证明了基本情况结果的鲁棒性,这些结果受所有输入参数的合理变化的影响,参数表示与两种SPT技术相关的成本,对增量成本影响最大。然而,更高的致敏患病率似乎有利于更准确的标准全手动SPT.
    结论:在医疗保健费用上涨的背景下,尤其是在瑞士,使用计算机辅助或(半)自动化诊断系统可以在医疗保健成本控制工作中发挥重要作用.然而,由于我们分析的早期性质和本研究采用的具体瑞士背景存在不确定性,因此应谨慎对待结果.
    BACKGROUND: Skin prick tests (SPTs), or intraepidermal tests, are often the first diagnostic approach for people with a suspected allergy. Together with the clinical history, SPTs allow doctors to draw conclusions on allergies based on the sensitization pattern. The purpose of this study is to investigate the potential cost consequences that would accrue to a Swiss University hospital after the adoption of computer vision-based SPTs.
    METHODS: We conducted a cost-consequence analysis from a hospital\'s perspective to evaluate the potential cost consequences of using a computer vision-based system to read SPT results. The patient population consisted of individuals who were referred to the allergology department of one of the five university hospitals in Switzerland, Inselspital, whose allergology department averages 100 SPTs a week. We developed an early cost-consequence model comparing two SPT techniques; computer vision-based SPTs conducted with the aid of Nexkin DSPT and standard fully manual SPTs. Probabilistic sensitivity analysis and additional univariate sensitivity analyses were used to account for uncertainty.
    RESULTS: The difference in average cost between the two alternatives from a hospital\'s perspective was estimated to be CHF 7 per SPT, in favour of the computer vison-based SPTs. Monte Carlo probabilistic simulation also indicated that SPTs conducted using the computer vision-based system were cost saving compared to standard fully manual SPTs. Sensitivity analyses additionally demonstrated the robustness of the base case result subject to plausible changes in all the input parameters, with parameters representing the costs associated with both SPT techniques having the largest influence on the incremental cost. However, higher sensitization prevalence rates seemed to favour the more accurate standard fully manual SPTs.
    CONCLUSIONS: Against the backdrop of rising healthcare costs especially in Switzerland, using computer-aided or (semi) automated diagnostic systems could play an important role in healthcare cost containment efforts. However, results should be taken with caution because of the uncertainty associated with the early nature of our analysis and the specific Swiss context adopted in this study.
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  • 文章类型: Journal Article
    人工智能(AI)的前景引起了患者的热情,医疗保健专业人员,以及寻求利用其潜力来增强越来越多的慢性和急性疾病的诊断和管理的技术开发人员。现场护理测试(POCT)增加了获得护理的机会,因为它使传统医疗环境之外的护理成为可能。开发人员之间的合作,临床医生,和最终用户是解决临床问题的有效最佳实践。一组通用的明确定义的术语很容易被研究团队理解,是促进这些合作的有价值的工具。我们提出简短的,准确,以及用于开发新设备和决策支持技术的术语和技术的明确描述,这些技术与POCT最常见的应用相关。这个用于描述AI和机器学习技术的术语词典是医疗保健专业人员的快速参考。研究人员,开发者,和病人。常用的方法和技术被制成表格,并带有文本,提供其常用用法和所需数据特征的上下文。最后,我们总结了模型有效性测量和组件特征贡献的评估。人工智能(AI)是指从数据集推断意义的非人类技术。它可以产生概括,分类,预测,并且可以使用自动学习方法识别关联。本指南概述了这些方法及其在即时测试中的应用。
    The promise of artificial intelligence (AI) has generated enthusiasm among patients, healthcare professionals, and technology developers who seek to leverage its potential to enhance the diagnosis and management of an increasing number of chronic and acute conditions. Point-of-care testing (POCT) increases access to care because it enables care outside of traditional medical settings. Collaboration among developers, clinicians, and end users is an effective best practice for solving clinical problems. A common set of clearly defined terms that are easily understood by research teams is a valuable tool that fosters these collaborations. We present brief, accurate, and clear descriptions of terms and techniques used to develop new device and decision support technologies in association with their most common applications to POCT. This lexicon of terms used to describe AI and machine learning techniques is quick reference for healthcare professionals, researchers, developers, and patients. Commonly used methods and techniques are tabulated and presented with text providing the context of their common usage and required data characteristics. Finally, we summarize model effectiveness measurement and the assessment of component features contributions. Artificial intelligence (AI) refers to non-human techniques that infer meaning from sets of data. It can produce generalizations, classifications, predictions, and can identify associations using automated learning methods. This guide provides an overview of these methods and their application to point-of-care testing.
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  • 文章类型: Journal Article
    喉偏瘫(LH)是赛马的主要上呼吸道(URT)并发症。马喉的内窥镜成像是URT评估的金标准。然而,目前的人工评估面临着几个挑战,源于内窥镜检查视频质量差和手动分级的主观性。为了克服这些限制,我们提出了一种基于机器学习(ML)的可解释解决方案,用于高效的URT评估。具体来说,级联YOLOv8架构用于分割每帧的关键语义区域和地标。然后从关键地标点提取几个时空特征,并将其提供给决策树(DT)模型,以将LH分类为1、2、3或4级,表示不存在LH。温和,中度,和严重的LH,分别。所提出的方法,通过107个视频的5倍交叉验证进行验证,在以100%对不同LH等级进行分类方面显示出有希望的性能,91.18%,1至4级灵敏度值分别为94.74%和100%。对72例外部数据集的进一步验证证实了其90%的泛化能力,80.95%,100%,和100%灵敏度值分别为1到4级。我们介绍了几个与可解释性相关的评估函数,包括:(I)可视化YOLOv8输出,以检测可能影响最终分类的界标估计误差,(Ii)时间序列可视化以评估视频质量,和(iii)回溯数字孪生输出以识别边界案例。我们纳入了领域知识(例如,兽医诊断程序)纳入拟议的机器学习框架。这提供了一种具有临床相关性和可解释性的辅助工具,可以缓解和加快兽医的URT评估。
    Laryngeal hemiplegia (LH) is a major upper respiratory tract (URT) complication in racehorses. Endoscopy imaging of horse throat is a gold standard for URT assessment. However, current manual assessment faces several challenges, stemming from the poor quality of endoscopy videos and subjectivity of manual grading. To overcome such limitations, we propose an explainable machine learning (ML)-based solution for efficient URT assessment. Specifically, a cascaded YOLOv8 architecture is utilized to segment the key semantic regions and landmarks per frame. Several spatiotemporal features are then extracted from key landmarks points and fed to a decision tree (DT) model to classify LH as Grade 1,2,3 or 4 denoting absence of LH, mild, moderate, and severe LH, respectively. The proposed method, validated through 5-fold cross-validation on 107 videos, showed promising performance in classifying different LH grades with 100%, 91.18%, 94.74% and 100% sensitivity values for Grade 1 to 4, respectively. Further validation on an external dataset of 72 cases confirmed its generalization capability with 90%, 80.95%, 100%, and 100% sensitivity values for Grade 1 to 4, respectively. We introduced several explainability related assessment functions, including: (i) visualization of YOLOv8 output to detect landmark estimation errors which can affect the final classification, (ii) time-series visualization to assess video quality, and (iii) backtracking of the DT output to identify borderline cases. We incorporated domain knowledge (e.g., veterinarian diagnostic procedures) into the proposed ML framework. This provides an assistive tool with clinical-relevance and explainability that can ease and speed up the URT assessment by veterinarians.
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  • 文章类型: Journal Article
    SARS-CoV-2病毒,导致通常被称为COVID-19的急性呼吸道疾病,由于其高度传染性和它在全球造成的相关公共卫生风险,已被世界卫生组织指定为大流行。确定预测死亡率的关键因素对于改善患者治疗至关重要。与其他数据类型不同,比如计算机断层扫描,x辐射,和超声波,基础血液检测结果可广泛获取,有助于预测死亡率.本研究提倡利用机器学习(ML)方法通过利用血液测试数据来预测COVID-19死亡率等传染病的可能性。年龄,LDH(乳酸脱氢酶),淋巴细胞,中性粒细胞,和hs-CRP(高敏C反应蛋白)是五个非常有效的特征,当合并时,可以准确预测96%病例的死亡率。通过将XGBoost特征重要性与神经网络分类相结合,最佳方法可以预测传染病的死亡率,在事件发生前16天内达到90%的准确率。研究表明,通过使用三个取决于结果日期的实例进行测试,证实了模型的出色预测性能和实用性。通过仔细分析和识别这些重要的生物标志物中的模式,已经获得了简单应用的有见地的信息。这项研究提供了潜在的补救措施,可以加速医疗保健系统内针对性医疗治疗的决策,利用及时的,准确,方法可靠。
    The SARS-CoV-2 virus, which induces an acute respiratory illness commonly referred to as COVID-19, had been designated as a pandemic by the World Health Organization due to its highly infectious nature and the associated public health risks it poses globally. Identifying the critical factors for predicting mortality is essential for improving patient therapy. Unlike other data types, such as computed tomography scans, x-radiation, and ultrasounds, basic blood test results are widely accessible and can aid in predicting mortality. The present research advocates the utilization of machine learning (ML) methodologies for predicting the likelihood of infectious disease like COVID-19 mortality by leveraging blood test data. Age, LDH (lactate dehydrogenase), lymphocytes, neutrophils, and hs-CRP (high-sensitivity C-reactive protein) are five extremely potent characteristics that, when combined, can accurately predict mortality in 96% of cases. By combining XGBoost feature importance with neural network classification, the optimal approach can predict mortality with exceptional accuracy from infectious disease, along with achieving a precision rate of 90% up to 16 days before the event. The studies suggested model\'s excellent predictive performance and practicality were confirmed through testing with three instances that depended on the days to the outcome. By carefully analyzing and identifying patterns in these significant biomarkers insightful information has been obtained for simple application. This study offers potential remedies that could accelerate decision-making for targeted medical treatments within healthcare systems, utilizing a timely, accurate, and reliable method.
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  • 文章类型: Journal Article
    没有关于严重哮喘(SA)管理的有效决策算法。未来风险是关键因素,可以从SA轨迹中得出。
    未来的严重哮喘决策树应该重新审视当前的知识和差距。已进行了重点文献检索。
    哮喘的严重程度目前是先验定义的,因此排除了早期干预措施的作用,旨在预防加重(全身皮质类固醇暴露)和肺功能下降等结果。哮喘“高危”可能代表最终范式,但值得考虑现代干预措施的纵向研究。真正的恶化,严重的气道高反应性,过度的T2相关生物标志物,有害的环境和病人的行为,OCS和高剂量吸入性糖皮质激素(ICS)的危害以及含ICS的吸入器的低依从性-有效性比率是未来风险的预测因素.成像等新工具,应使用遗传和表观遗传特征。逻辑和数值人工智能可用于生成一致的风险评分。对治疗反应的实用定义将允许开发经过验证和适用的算法。生物制品有最大的潜力,以尽量减少风险,但成本仍然是个问题。我们提出了一种简化的六步决策算法,最终旨在实现哮喘缓解。
    UNASSIGNED: There are no validated decision-making algorithms concerning severe asthma (SA) management. Future risks are crucial factors and can be derived from SA trajectories.
    UNASSIGNED: The future severe asthma-decision trees should revisit current knowledge and gaps. A focused literature search has been conducted.
    UNASSIGNED: Asthma severity is currently defined a priori, thereby precluding a role for early interventions aiming to prevent outcomes such as exacerbations (systemic corticosteroids exposure) and lung function decline. Asthma \'at-risk\' might represent the ultimate paradigm but merits longitudinal studies considering modern interventions. Real exacerbations, severe airway hyperresponsiveness, excessive T2-related biomarkers, noxious environments and patient behaviors, harms of OCS and high-doses inhaled corticosteroids (ICS), and low adherence-to-effectiveness ratios of ICS-containing inhalers are predictors of future risks. New tools such as imaging, genetic, and epigenetic signatures should be used. Logical and numerical artificial intelligence may be used to generate a consistent risk score. A pragmatic definition of response to treatments will allow development of a validated and applicable algorithm. Biologics have the best potential to minimize the risks, but cost remains an issue. We propose a simplified six-step algorithm for decision-making that is ultimately aiming to achieve asthma remission.
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