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Introduction: Natural language processing (NLP) uses various computational methods to analyse and understand human language, and has been applied to data acquired at Emergency Department (ED) triage to predict various outcomes. The objective of this scoping review is to evaluate how NLP has been applied to data acquired at ED triage, assess if NLP based models outperform humans or current risk stratification techniques when predicting outcomes, and assess if incorporating free-text improve predictive performance of models when compared to predictive models that use only structured data. Methods: All English language peer-reviewed research that applied an NLP technique to free-text obtained at ED triage was eligible for inclusion. We excluded studies focusing solely on disease surveillance, and studies that used information obtained after triage. We searched the electronic databases MEDLINE, Embase, Cochrane Database of Systematic Reviews, Web of Science, and Scopus for medical subject headings and text keywords related to NLP and triage. Databases were last searched on 01/01/2022. Risk of bias in studies was assessed using the Prediction model Risk of Bias Assessment Tool (PROBAST). Due to the high level of heterogeneity between studies and high risk of bias, a metanalysis was not conducted. Instead, a narrative synthesis is provided. Results: In total, 3730 studies were screened, and 20 studies were included. The population size varied greatly between studies ranging from 1.8 million patients to 598 triage notes. The most common outcomes assessed were prediction of triage score, prediction of admission, and prediction of critical illness. NLP models achieved high accuracy in predicting need for admission, triage score, critical illness, and mapping free-text chief complaints to structured fields. Incorporating both structured data and free-text data improved results when compared to models that used only structured data. However, the majority of studies (80%) were assessed to have a high risk of bias, and only one study reported the deployment of an NLP model into clinical practice. Conclusion: Unstructured free-text triage notes have been used by NLP models to predict clinically relevant outcomes. However, the majority of studies have a high risk of bias, most research is retrospective, and there are few examples of implementation into clinical practice. Future work is needed to prospectively assess if applying NLP to data acquired at ED triage improves ED outcomes when compared to usual clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Surveys conducted internationally have found widespread interest in artificial intelligence (AI) amongst medical students. No similar surveys have been conducted in Western Australia (WA) and it is not known how medical students in WA feel about the use of AI in healthcare or their understanding of AI. We aim to assess WA medical students' attitudes towards AI in general, AI in healthcare, and the inclusion of AI education in the medical curriculum. Methods: A digital survey instrument was developed based on a review of available literature and consultation with subject matter experts. The survey was piloted with a group of medical students and refined based on their feedback. We then sent this anonymous digital survey to all medical students in WA (approximately 1539 students). Responses were open from the 7th of September 2021 to the 7th of November 2021. Students' categorical responses were qualitatively analysed, and free text comments from the survey were qualitatively analysed using open coding techniques. Results: Overall, 134 students answered one or more questions (8.9% response rate). The majority of students (82.0%) were 20–29 years old, studying medicine as a postgraduate degree (77.6%), and had started clinical rotations (62.7%). Students were interested in AI (82.6%), self-reported having a basic understanding of AI (84.8%), but few agreed that they had an understanding of the basic computational principles of AI (33.3%) or the limitations of AI (46.2%). Most students (87.5%) had not received teaching in AI. The majority of students (58.6%) agreed that AI should be part of medical training and most (72.7%) wanted more teaching focusing on AI in medicine. Medical students appeared optimistic regarding the role of AI in medicine, with most (74.4%) agreeing with the statement that AI will improve medicine in general. The majority (56.6%) of medical students were not concerned about the impact of AI on their job security as a doctor. Students selected radiology (72.6%), pathology (58.2%), and medical administration (44.8%) as the specialties most likely to be impacted by AI, and psychiatry (61.2%), palliative care (48.5%), and obstetrics and gynaecology (41.0%) as the specialties least likely to be impacted by AI. Qualitative analysis of free text comments identified the use of AI as a tool, and that doctors will not be replaced as common themes. Conclusion: Medical students in WA appear to be interested in AI. However, they have not received education about AI and do not feel they understand its basic computational principles or limitations. AI appears to be a current deficit in the medical curriculum in WA, and most students surveyed were supportive of its introduction. These results are consistent with previous surveys conducted internationally. [ABSTRACT FROM AUTHOR]

Background: Chest pain is amongst the most common reason for presentation to the emergency department (ED). There are many causes of chest pain, and it is important for the emergency physician to quickly and accurately diagnose life threatening causes such as acute myocardial infarction (AMI). Multiple clinical decision tools have been developed to assist clinicians in risk stratifying patients with chest. There is growing recognition that machine learning (ML) will have a significant impact on the practice of medicine in the near future and may assist with diagnosis and risk stratification. This systematic review aims to evaluate how ML has been applied to adults presenting to the ED with undifferentiated chest pain and assess if ML models show improved performance when compared to physicians or current risk stratification techniques. Methods and findings: We conducted a systematic review of journal articles that applied a ML technique to an adult patient presenting to an emergency department with undifferentiated chest pain. Multiple databases were searched from inception through to November 2020. In total, 3361 articles were screened, and 23 articles were included. We did not conduct a metanalysis due to a high level of heterogeneity between studies in both their methods, and reporting. The most common primary outcomes assessed were diagnosis of acute myocardial infarction (AMI) (12 studies), and prognosis of major adverse cardiovascular event (MACE) (6 studies). There were 14 retrospective studies and 5 prospective studies. Four studies reported the development of a machine learning model retrospectively then tested it prospectively. The most common machine learning methods used were artificial neural networks (14 studies), random forest (6 studies), support vector machine (5 studies), and gradient boosting (2 studies). Multiple studies achieved high accuracy in both the diagnosis of AMI in the ED setting, and in predicting mortality and composite outcomes over various timeframes. ML outperformed existing risk stratification scores in all cases, and physicians in three out of four cases. The majority of studies were single centre, retrospective, and without prospective or external validation. There were only 3 studies that were considered low risk of bias and had low applicability concerns. Two studies reported integrating the ML model into clinical practice. Conclusions: Research on applications of ML for undifferentiated chest pain in the ED has been ongoing for decades. ML has been reported to outperform emergency physicians and current risk stratification tools to diagnose AMI and predict MACE but has rarely been integrated into practice. Many studies assessing the use of ML in undifferentiated chest pain in the ED have a high risk of bias. It is important that future studies make use of recently developed standardised ML reporting guidelines, register their protocols, and share their datasets and code. Future work is required to assess the impact of ML model implementation on clinical decision making, patient orientated outcomes, and patient and physician acceptability. Trial registration: International Prospective Register of Systematic Reviews registration number: CRD42020184977. [ABSTRACT FROM AUTHOR]

Background: The prediction of readmission or death after a hospital discharge for heart failure (HF) remains a major challenge. Modern healthcare systems, electronic health records, and machine learning (ML) techniques allow us to mine data to select the most significant variables (allowing for reduction in the number of variables) without compromising the performance of models used for prediction of readmission and death. Moreover, ML methods based on transformation of variables may potentially further improve the performance. Objective: To use ML techniques to determine the most relevant and also transform variables for the prediction of 30-day readmission or death in HF patients. Methods: We identified all Western Australian patients aged 65 years and above admitted for HF between 2003–2008 in linked administrative data. We evaluated variables associated with HF readmission or death using standard statistical and ML based selection techniques. We also tested the new variables produced by transformation of the original variables. We developed multi-layer perceptron prediction models and compared their predictive performance using metrics such as Area Under the receiver operating characteristic Curve (AUC), sensitivity and specificity. Results: Following hospital discharge, the proportion of 30-day readmissions or death was 23.7% in our cohort of 10,757 HF patients. The prediction model developed by us using a smaller set of variables (n = 8) had comparable performance (AUC 0.62) to the traditional model (n = 47, AUC 0.62). Transformation of the original 47 variables further improved (p<0.001) the performance of the predictive model (AUC 0.66). Conclusions: A small set of variables selected using ML matched the performance of the model that used the full set of 47 variables for predicting 30-day readmission or death in HF patients. Model performance can be further significantly improved by transforming the original variables using ML methods. [ABSTRACT FROM AUTHOR]

Background: Epidemiological analyses demonstrate that pneumonia survivors have a higher risk of myocardial infarction than people with similar load of risk factors for atherosclerotic cardiovascular disease (ASCVD) but without pneumonia. This may be due to a higher baseline burden of ASCVD in patients with pneumonia that is not captured by the accounting of known ASCVD risk factors in epidemiological analyses or to unfavorable accelerating effects of pneumonia on atherosclerosis. Methods: We analyzed data from the Multi-Ethnic Study of Atherosclerosis. We identified 54 participants that were hospitalized for pneumonia during study follow-up and that also had assessment of coronary artery calcium (CAC, an objective marker of coronary atherosclerotic burden) before and after this hospitalization. We matched them to 54 participants who were not hospitalized for pneumonia but that had CAC assessments at the same study visits as the pneumonia cases. We compared baseline CAC scores and their progression between groups. Results: Baseline CAC scores were similar in both groups (median [IQR]; 6.3 [0–356.8] in pneumonia participants vs. 10.8 [0–178.3] in controls; p = 0.25). After a median of 4.8 years, the direction and magnitude of CAC score change, and the slope of CAC score progression between groups was also similar (median change [IQR], 21.8 [0 to 287.29] in participants with pneumonia versus 15.8 [0 to 140.94] in controls, p = 0.28; difference in slope, 7.7, 95% CI -9.0 to 24.6, p = 0.18). However, among participants with high baseline ASCVD risk (i.e. ACC/AHA 10-year risk estimate ≥7.5%), participants with pneumonia showed a larger increase in CAC scores (median change [IQR]; 159.10 [38.55–407.34] versus 48.72 [0.97–246.99] in controls; p = 0.02) and a trend towards a steeper slope of CAC score progression (difference in slope, 19.7, 95% CI -6.6 to 45.6, p = 0.07). Conclusion: Pneumonia may accelerate the progression of atherosclerosis in people with high baseline ASCVD risk. [ABSTRACT FROM AUTHOR]

The article presents a study of myocardial perfusion assessment after myocardial infarction through a case study of acute myocardial infarction. The article begins with describing the case like symptoms of the patient at the time of admission in the emergency department, clinical diagnosis with electrocardiograph, and treatment involving various drugs. The article discusses myocardial contrast echocardiography (MCH) technique as effective modality for assessing myocardial perfusion.