2024
Human-Algorithmic Interaction Using a Large Language Model-Augmented Artificial Intelligence Clinical Decision Support System
Rajashekar N, Shin Y, Pu Y, Chung S, You K, Giuffre M, Chan C, Saarinen T, Hsiao A, Sekhon J, Wong A, Evans L, Kizilcec R, Laine L, Mccall T, Shung D. Human-Algorithmic Interaction Using a Large Language Model-Augmented Artificial Intelligence Clinical Decision Support System. 2024, 1-20. DOI: 10.1145/3613904.3642024.Peer-Reviewed Original ResearchClinical decision support systemsHuman-computer interactionDecision support systemArtificial intelligenceAI-CDSSIntelligent clinical decision support systemSupport systemIntegration of artificial intelligenceHuman-algorithm interactionsEase-of-useLanguage modelHuman algorithmAI systemsSocio-technological challengesHealth-care providersMedical student participationQualitative themesClinical simulationClinical expertiseUpper gastrointestinal bleedingUsabilityBorderline decisionsLanguageClinical intuitionTrustReview article: Upper gastrointestinal bleeding – review of current evidence and implications for management
Shung D, Laine L. Review article: Upper gastrointestinal bleeding – review of current evidence and implications for management. Alimentary Pharmacology & Therapeutics 2024, 59: 1062-1081. PMID: 38517201, DOI: 10.1111/apt.17949.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsUpper gastrointestinal bleedingManagement of upper gastrointestinal bleedingAcute upper gastrointestinal bleedingPeptic ulcer diseaseOver-the-scope clipPre-endoscopicVariceal bleedingManagement of acute upper gastrointestinal bleedingTreated with prophylactic antibioticsTransjugular intrahepatic portosystemic shuntUpper gastrointestinal bleeding patientsRed blood cell transfusion policyPre-endoscopic managementHigh-risk stigmataSeverity of bleedingEarly enteral feedingHigh-risk patientsMeta-analysisIntrahepatic portosystemic shuntProton pump inhibitorsEvidence-based updateOver-the-scopeHospital-based carePhase of careRandom-effects method
2023
Achieving Value by Risk Stratification With Machine Learning Model or Clinical Risk Score in Acute Upper Gastrointestinal Bleeding: A Cost Minimization Analysis
Shung D, Lin J, Laine L. Achieving Value by Risk Stratification With Machine Learning Model or Clinical Risk Score in Acute Upper Gastrointestinal Bleeding: A Cost Minimization Analysis. The American Journal Of Gastroenterology 2023, 119: 371-373. PMID: 37753930, PMCID: PMC10872988, DOI: 10.14309/ajg.0000000000002520.Peer-Reviewed Original ResearchUpper gastrointestinal bleedingCost-minimization analysisGastrointestinal bleedingUsual careTriage strategiesAcute upper gastrointestinal bleedingClinical risk scoreLow-risk patientsHealthcare payer perspectiveMinimization analysisRisk assessment toolRisk stratificationEmergency departmentPayer perspectiveRisk scoreBleedingAssessment toolCareRisk assessment modelMachine-learning strategiesPatientsCumulative savingsTrends in Upper Gastrointestinal Bleeding in Patients on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis, 2016-2020
Li D, Laine L, Shung D. Trends in Upper Gastrointestinal Bleeding in Patients on Primary Prevention Aspirin: A Nationwide Emergency Department Sample Analysis, 2016-2020. The American Journal Of Medicine 2023, 136: 1179-1186.e1. PMID: 37696350, PMCID: PMC10841721, DOI: 10.1016/j.amjmed.2023.08.010.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingGastrointestinal bleedingRed blood cell transfusionNationwide Emergency Department SamplePrimary cardiovascular preventionRecent guideline recommendationsBlood cell transfusionProportion of hospitalizationsEmergency Department SampleMedicare reimbursementInternational Statistical ClassificationRelated Health ProblemsCardiovascular preventionCell transfusionOlder patientsHospital admissionCommon etiologyGuideline recommendationsMajor complicationsUlcer diseaseEndoscopic interventionRevision codesAppropriate indicationsRecent guidelinesCardiovascular disease
2022
Association of Antisecretory Drugs with Upper Gastrointestinal Bleeding in Patients Using Oral Anticoagulants: A Systematic Review and Meta-Analysis
Kurlander JE, Barnes GD, Fisher A, Gonzalez JJ, Helminski D, Saini SD, Sengupta N, Yang YX, Scheiman J, Laine L. Association of Antisecretory Drugs with Upper Gastrointestinal Bleeding in Patients Using Oral Anticoagulants: A Systematic Review and Meta-Analysis. The American Journal Of Medicine 2022, 135: 1231-1243.e8. PMID: 35679879, PMCID: PMC10031639, DOI: 10.1016/j.amjmed.2022.05.031.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingProton pump inhibitorsGastrointestinal bleedingH2-receptor antagonistsObservational studyOral anticoagulantsAntisecretory drugsRelative riskLower riskNonsteroidal anti-inflammatory drug useSystematic reviewAnti-inflammatory drug useOvert upper gastrointestinal bleedingLow statistical heterogeneitySingle observational studyGreater treatment effectRandom-effects modelWeb of ScienceConcomitant aspirinRandomized trialsCochrane LibraryPump inhibitorsBias assessmentStatistical heterogeneityBleedingInternational multicenter study comparing demographics, therapy and outcomes in bleeding from Mallory Weiss tears and peptic ulcers
Tham JE, Lynch L, Laursen SB, Laine L, Dalton HR, Ngu J, Redondo-Cerezo E, Schultz M, Murray I, Michell N, Morris AJ, Nielsen MM, Stanley AJ. International multicenter study comparing demographics, therapy and outcomes in bleeding from Mallory Weiss tears and peptic ulcers. Endoscopy International Open 2022, 10: e653-e658. PMID: 35571482, PMCID: PMC9106442, DOI: 10.1055/a-1784-0655.Peer-Reviewed Original ResearchMallory-Weiss tearUpper gastrointestinal bleedingPeptic ulcer bleedingEndoscopic therapyEndoscopic stigmataEpinephrine injectionAcute upper gastrointestinal bleedingInternational multicenter studyPUB patientsGastrointestinal bleedingUlcer bleedingUncommon causeMulticenter studyPeptic ulcerPoor outcomeScope clipInternational cohortClean baseLower riskBaseline parametersPatientsTherapyBleedingCommon modalityMortality
2021
ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding
Laine L, Barkun AN, Saltzman JR, Martel M, Leontiadis GI. ACG Clinical Guideline: Upper Gastrointestinal and Ulcer Bleeding. The American Journal Of Gastroenterology 2021, 116: 899-917. PMID: 33929377, DOI: 10.14309/ajg.0000000000001245.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsUpper gastrointestinal bleedingEndoscopic therapyGastrointestinal bleedingHigh-dose proton pump inhibitor therapyOvert upper gastrointestinal bleedingOral proton pump inhibitorsProton pump inhibitor therapyRed blood cell transfusionAbsolute ethanol injectionWeeks of therapyBlood cell transfusionLow-quality evidenceLow-risk patientsManagement of patientsProton pump inhibitorsArgon plasma coagulationActive spurtingErythromycin infusionTC-325Cell transfusionRecurrent bleedingRecurrent ulcersUlcer bleedingEndoscopic hemostasisGRADE approachTowards personalised management for non-variceal upper gastrointestinal bleeding
Sung JJY, Laine L, Kuipers EJ, Barkun AN. Towards personalised management for non-variceal upper gastrointestinal bleeding. Gut 2021, 70: 818-824. PMID: 33649044, DOI: 10.1136/gutjnl-2020-323846.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsIndividual patientsNon-variceal upper gastrointestinal bleedingPre-endoscopic assessmentUpper gastrointestinal bleedingImportant clinical issuePostendoscopic managementGastrointestinal bleedingPatient characteristicsEndoscopic evaluationPoint of careOptimal treatmentInternational guidelinesClinical issuesInternational professional societiesClinical settingSpecific management strategiesStages of managementPatientsTreatmentProfessional societiesManagement strategiesGuidelinesBleedingHaemostasisLesions
2020
Timing of Endoscopy in Patients Hospitalized with Upper Gastrointestinal Bleeding
Laine L. Timing of Endoscopy in Patients Hospitalized with Upper Gastrointestinal Bleeding. New England Journal Of Medicine 2020, 382: 1361-1363. PMID: 32242363, DOI: 10.1056/nejme2002121.Commentaries, Editorials and LettersConceptsGastrointestinal bleedingUpper gastrointestinal bleedingTiming of endoscopyCommon gastrointestinal diagnosisMost patientsGastrointestinal diagnosesPatientsBleedingEndoscopyDiagnosis
2019
The Shock Index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding
Saffouri E, Blackwell C, Laursen SB, Laine L, Dalton HR, Ngu J, Shultz M, Norton R, Stanley AJ. The Shock Index is not accurate at predicting outcomes in patients with upper gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics 2019, 51: 253-260. PMID: 31642558, DOI: 10.1111/apt.15541.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAged, 80 and overArea Under CurveBlood TransfusionCohort StudiesEndoscopy, GastrointestinalFemaleGastrointestinal HemorrhageHospitalizationHumansMaleMiddle AgedMortalityPredictive Value of TestsPrognosisProspective StudiesReproducibility of ResultsRisk AssessmentSeverity of Illness IndexShockSurvival AnalysisUpper Gastrointestinal TractYoung AdultConceptsUpper gastrointestinal bleedingGlasgow-Blatchford scoreShock indexGastrointestinal bleedingABC scoreMajor transfusionAcute upper gastrointestinal bleedingUK National Confidential EnquiryAdmission Rockall scoreSevere gastrointestinal bleedingMajor clinical endpointsPredictors of outcomeNational Confidential EnquiryRockall scoreBlatchford scoreEndoscopic therapyConsecutive patientsHospital admissionConfidential EnquiryProspective studyClinical endpointsPatient outcomesRisk scoreDeath reportsBleedingManagement of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group.
Barkun AN, Almadi M, Kuipers EJ, Laine L, Sung J, Tse F, Leontiadis GI, Abraham NS, Calvet X, Chan FKL, Douketis J, Enns R, Gralnek IM, Jairath V, Jensen D, Lau J, Lip GYH, Loffroy R, Maluf-Filho F, Meltzer AC, Reddy N, Saltzman JR, Marshall JK, Bardou M. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group. Annals Of Internal Medicine 2019, 171: 805-822. PMID: 31634917, PMCID: PMC7233308, DOI: 10.7326/m19-1795.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsUpper gastrointestinal bleedingNonvariceal upper gastrointestinal bleedingHigh-risk stigmataPPI therapyGastrointestinal bleedingEndoscopic therapyCardiovascular diseaseHigh-dose proton pump inhibitor therapyEvidence profilesProton pump inhibitor therapyGlasgow-Blatchford scoreOral PPI therapyPrevious ulcer bleedingHigh-risk patientsHours of presentationManagement of patientsSuccessful endoscopic therapyStrength of recommendationsQuality of evidenceInternational consensus recommendationsInternational multidisciplinary groupInternational Consensus GroupElectronic bibliographic databasesTC-325Blatchford scoreValidation of a Machine Learning Model That Outperforms Clinical Risk Scoring Systems for Upper Gastrointestinal Bleeding
Shung DL, Au B, Taylor RA, Tay JK, Laursen SB, Stanley AJ, Dalton HR, Ngu J, Schultz M, Laine L. Validation of a Machine Learning Model That Outperforms Clinical Risk Scoring Systems for Upper Gastrointestinal Bleeding. Gastroenterology 2019, 158: 160-167. PMID: 31562847, PMCID: PMC7004228, DOI: 10.1053/j.gastro.2019.09.009.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingHospital-based interventionsComposite endpointScoring systemRockall scoreGastrointestinal bleedingClinical riskConsecutive unselected patientsLow-risk patientsClinical scoring systemRisk-scoring systemExternal validation cohortCharacteristic curve analysisInternal validation setOutpatient managementUnselected patientsValidation cohortEmergency departmentMedical CenterGreater AUCPatientsAbstractTextCurve analysisEndpointAUCMAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding
Redondo‐Cerezo E, Vadillo‐Calles F, Stanley AJ, Laursen S, Laine L, Dalton HR, Ngu JH, Schultz M, Jiménez‐Rosales R. MAP(ASH): A new scoring system for the prediction of intervention and mortality in upper gastrointestinal bleeding. Journal Of Gastroenterology And Hepatology 2019, 35: 82-89. PMID: 31359521, DOI: 10.1111/jgh.14811.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingGastrointestinal bleedingEndoscopic interventionGlasgow-Blatchford scoreSystolic blood pressureNew scoring systemBlatchford scoreProspective databaseBlood pressureRisk stratificationValidation cohortDevelopment cohortOriginal cohortEmergency roomMental statusRisk scoreClinical practiceFair discriminationScoring systemPatientsMortalityCohortNew scoreInterventionBleedingMachine Learning to Predict Outcomes in Patients with Acute Gastrointestinal Bleeding: A Systematic Review
Shung D, Simonov M, Gentry M, Au B, Laine L. Machine Learning to Predict Outcomes in Patients with Acute Gastrointestinal Bleeding: A Systematic Review. Digestive Diseases And Sciences 2019, 64: 2078-2087. PMID: 31055722, DOI: 10.1007/s10620-019-05645-z.Peer-Reviewed Original ResearchConceptsClinical risk scoreUpper gastrointestinal bleedingGastrointestinal bleedingOutcomes of mortalityRisk scoreSystematic reviewOvert gastrointestinal bleedingAcute gastrointestinal bleedingPrognosis Studies toolRisk of biasFull-text studiesCurrent risk assessment toolsRisk assessment toolHospital stayHemostatic interventionRisk stratificationInclusion criteriaPrognostic performanceHigh riskIndependent reviewersConference abstractsLower riskMedian AUCPatientsMortalityManagement of acute upper gastrointestinal bleeding
Stanley AJ, Laine L. Management of acute upper gastrointestinal bleeding. The BMJ 2019, 364: l536. PMID: 30910853, DOI: 10.1136/bmj.l536.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsMeSH KeywordsAnti-Bacterial AgentsBlood TransfusionDisease ManagementEndoscopy, GastrointestinalEsophageal and Gastric VaricesGastrointestinal HemorrhageHumansLiver CirrhosisPortasystemic Shunt, Transjugular IntrahepaticPractice Guidelines as TopicProton Pump InhibitorsResuscitationSeverity of Illness IndexConceptsUpper gastrointestinal bleedingProton pump inhibitorsVariceal bleedingUlcer bleedingGastrointestinal bleedingEndoscopic therapyVasoactive drugsPump inhibitorsHigh-dose proton pump inhibitorsAcute upper gastrointestinal bleedingDose proton pump inhibitorsTransjugular intrahepatic portosystemic shuntNon-variceal bleedingRecurrent ulcer bleedingRecurrent variceal bleedingRed cell transfusionCommon medical emergencyIntrahepatic portosystemic shuntEarly endoscopyCell transfusionHemodynamic instabilityHemoglobin thresholdEndoscopic treatmentIntravenous fluidsPortosystemic shunt
2018
Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding
Dunne P, Laursen SB, Laine L, Dalton HR, Ngu JH, Schultz M, Rahman A, Anderloni A, Murray IA, Stanley AJ. Previous Use of Antithrombotic Agents Reduces Mortality and Length of Hospital Stay in Patients With High-risk Upper Gastrointestinal Bleeding. Clinical Gastroenterology And Hepatology 2018, 17: 440-447.e2. PMID: 29705263, DOI: 10.1016/j.cgh.2018.04.046.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingAnti-thrombotic agentsAnti-thrombotic drugsGlasgow-Blatchford scoreRockall scoreHospital stayGastrointestinal bleedingEndoscopic therapyAcute upper gastrointestinal bleedingAnesthesiologists classification scoreBleeding-related mortalityFull Rockall scoreMean hospital stayOutcomes of patientsHigher American SocietyLength of hospitalShorter hospital staySystolic blood pressureMean American SocietyFrequency of malignancyLevels of hemoglobinHigher mean American SocietyAmerican SocietyAIMS65 scoreAnesthesiologists classificationEffects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials
Scally B, Emberson JR, Spata E, Reith C, Davies K, Halls H, Holland L, Wilson K, Bhala N, Hawkey C, Hochberg M, Hunt R, Laine L, Lanas A, Patrono C, Baigent C. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials. The Lancet Gastroenterology & Hepatology 2018, 3: 231-241. PMID: 29475806, PMCID: PMC5842491, DOI: 10.1016/s2468-1253(18)30037-2.Peer-Reviewed Original ResearchConceptsProton pump inhibitorsUpper gastrointestinal bleedingPeptic ulcer diseaseAcute upper gastrointestinal bleedingGastrointestinal bleedingUlcer diseasePrevention trialsHealing trialsBlood transfusionClinical circumstancesProstaglandin analoguesHistamine-2 receptor antagonistsParticular proton pump inhibitorsNon-steroidal anti-inflammatory drugsEndoscopic ulcer healingDifferent clinical circumstancesUK Medical Research CouncilBritish Heart FoundationDifferent clinical settingsAnti-inflammatory drugsSmall study biasFurther endoscopic interventionMedical Research CouncilLarge protective effectEndoscopic ulcersSeverity and Outcomes of Upper Gastrointestinal Bleeding With Bloody Vs. Coffee-Grounds Hematemesis
Laine L, Laursen SB, Zakko L, Dalton HR, Ngu JH, Schultz M, Stanley AJ. Severity and Outcomes of Upper Gastrointestinal Bleeding With Bloody Vs. Coffee-Grounds Hematemesis. The American Journal Of Gastroenterology 2018, 113: 358. PMID: 29380820, DOI: 10.1038/ajg.2018.5.Peer-Reviewed Original ResearchMeSH KeywordsAgedBlood PreservationBlood TransfusionEsophageal and Gastric VaricesFemaleGastrointestinal HemorrhageHeart RateHematemesisHemoglobinsHemostasis, EndoscopicHumansMaleMelenaMiddle AgedMortalityProspective StudiesRecurrenceRisk AssessmentSeverity of Illness IndexUpper Gastrointestinal TractConceptsCoffee ground emesisBloody emesisHemostatic interventionUpper gastrointestinal bleedingComposite end pointRisk stratification scoresSystolic blood pressureTiming of endoscopyPredictors of outcomeBeats/minGastrointestinal bleedingConsecutive patientsPrimary outcomeSevere bleedingStratification scoresBlood pressureProspective studyHematemesisMelenaEmesisHigh mortalityEnd pointMortalityOutcomesSeverity
2017
Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study
Stanley AJ, Laine L, Dalton HR, Ngu JH, Schultz M, Abazi R, Zakko L, Thornton S, Wilkinson K, Khor CJ, Murray IA, Laursen SB. Comparison of risk scoring systems for patients presenting with upper gastrointestinal bleeding: international multicentre prospective study. The BMJ 2017, 356: i6432. PMID: 28053181, PMCID: PMC5217768, DOI: 10.1136/bmj.i6432.Peer-Reviewed Original ResearchConceptsUpper gastrointestinal bleedingRockall scoreGastrointestinal bleedingInternational multicentre prospective studyAdmission Rockall scoreFull Rockall scoreGlasgow-Blatchford scoreHigh-risk patientsMulticentre prospective studyAssessment of patientsPNED scoreHospital stayBlatchford scoreDay mortalityConsecutive patientsRisk patientsComposite endpointEndoscopic treatmentProspective studyClinical endpointsClinical utilityLower riskPatientsLarge hospitalsBleeding
2016
No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents
Zakko L, Rustagi T, Douglas M, Laine L. No Benefit From Platelet Transfusion for Gastrointestinal Bleeding in Patients Taking Antiplatelet Agents. Clinical Gastroenterology And Hepatology 2016, 15: 46-52. PMID: 27464591, DOI: 10.1016/j.cgh.2016.07.017.Peer-Reviewed Original ResearchConceptsGastrointestinal bleedingAntiplatelet agentsPlatelet transfusionsCardiovascular eventsNon-variceal upper gastrointestinal bleedingYale-New Haven HospitalRecurrent gastrointestinal bleedingSerious gastrointestinal bleedingMajor cardiovascular eventsRetrospective cohort studySevere gastrointestinal bleedingUpper gastrointestinal bleedingLower blood pressureMultivariable regression analysisHigher heart rateLack of benefitRecurrent bleedingBaseline characteristicsCohort studyBlood pressurePrimary outcomeSuch patientsHemoglobin levelsMultivariable analysisIntensive care