2024
Detection of Gastrointestinal Bleeding with Large Language Models to Aid Quality Improvement and Appropriate Reimbursement
Zheng N, Keloth V, You K, Kats D, Li D, Deshpande O, Sachar H, Xu H, Laine L, Shung D. Detection of Gastrointestinal Bleeding with Large Language Models to Aid Quality Improvement and Appropriate Reimbursement. Gastroenterology 2024 PMID: 39304088, DOI: 10.1053/j.gastro.2024.09.014.Peer-Reviewed Original ResearchElectronic health recordsOvert gastrointestinal bleedingGastrointestinal bleedingRecurrent bleedingMachine learning modelsHealth recordsClinically relevant applicationsNursing notesLanguage modelAcute gastrointestinal bleedingQuality improvementLearning modelsDetection of gastrointestinal bleedingReimbursementIdentification of clinical conditionsSeparate hospitalsQuality measuresHospitalBleedingClinical conditionsPatient managementEarly identificationPatientsReimbursement codesCoding algorithmValidation of an Electronic Health Record–Based Machine Learning Model Compared With Clinical Risk Scores for Gastrointestinal Bleeding
Shung D, Chan C, You K, Nakamura S, Saarinen T, Zheng N, Simonov M, Li D, Tsay C, Kawamura Y, Shen M, Hsiao A, Sekhon J, Laine L. Validation of an Electronic Health Record–Based Machine Learning Model Compared With Clinical Risk Scores for Gastrointestinal Bleeding. Gastroenterology 2024, 167: 1198-1212. PMID: 38971198, PMCID: PMC11493512, DOI: 10.1053/j.gastro.2024.06.030.Peer-Reviewed Original ResearchElectronic health recordsGlasgow-Blatchford scoreEmergency departmentVery-low-risk patientsRisk scoreOakland scoreMachine learning modelsStructured data fieldsClinical risk scoreGastrointestinal bleedingAll-cause mortalityHealth recordsLearning modelsManual data entrySecondary analysisRisk stratification scoresAssess proportionRed blood-cell transfusionPrimary outcomeProportion of patientsData entryOvert gastrointestinal bleedingPrimary analysisReceiver-operating-characteristic curveVery-low-riskMo1066 LARGE LANGUAGE MODEL-BASED SIMULATED PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING FOR MEDICAL EDUCATION – A PILOT STUDY WITH EMPATHGPT
Rajashekar N, Chan C, Laine L, Shung D. Mo1066 LARGE LANGUAGE MODEL-BASED SIMULATED PATIENTS WITH UPPER GASTROINTESTINAL BLEEDING FOR MEDICAL EDUCATION – A PILOT STUDY WITH EMPATHGPT. Gastroenterology 2024, 166: s-933. DOI: 10.1016/s0016-5085(24)02628-3.Peer-Reviewed Original ResearchGastrointestinal bleedingSimulated patients
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 savingsManagement of Bleeding Due to Small-Intestinal Angiodysplasias
Laine L. Management of Bleeding Due to Small-Intestinal Angiodysplasias. New England Journal Of Medicine 2023, 389: 1718-1720. PMID: 37913510, DOI: 10.1056/nejme2310338.Commentaries, Editorials and LettersTrends 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
Deprescription of aspirin for primary prevention is uncommon at discharge in hospitalised patients with gastrointestinal bleeding
Li D, Ong S, Hughes M, Hung K, Agarwal R, Alexis J, Damianos J, Sharma S, Pires J, Nanna M, Laine L. Deprescription of aspirin for primary prevention is uncommon at discharge in hospitalised patients with gastrointestinal bleeding. Alimentary Pharmacology & Therapeutics 2022, 57: 94-102. PMID: 36394111, DOI: 10.1111/apt.17278.Peer-Reviewed Original ResearchConceptsMajor adverse cardiovascular eventsGastrointestinal bleedingPrimary preventionCardiovascular eventsRisk of MACEYale-New Haven HospitalPrimary cardiovascular preventionAdverse cardiovascular eventsKaplan-Meier curvesLong-term outcomesRisk-benefit ratioLog-rank testAspirin 81Hospitalised patientsPrimary endpointSecondary endpointsCardiovascular preventionSubsequent hospitalisationMedian ageDeprescriptionHigh riskAspirinHospitalisationPatientsPreventionTrends in characteristics, management, and outcomes of patients presenting with gastrointestinal bleeding to emergency departments in the United States from 2006 to 2019
Zheng NS, Tsay C, Laine L, Shung DL. Trends in characteristics, management, and outcomes of patients presenting with gastrointestinal bleeding to emergency departments in the United States from 2006 to 2019. Alimentary Pharmacology & Therapeutics 2022, 56: 1543-1555. PMID: 36173090, PMCID: PMC9669230, DOI: 10.1111/apt.17238.Peer-Reviewed Original ResearchConceptsGastrointestinal bleedingLength of stayEmergency departmentMultivariable analysisIncidence of GIBRed blood cell transfusionNationwide Emergency Department SampleBlood cell transfusionIncidence of patientsOutcomes of patientsSex-adjusted incidenceEmergency Department SampleCase fatality rateRecent epidemiologic studiesProportion of casesED dischargeMore comorbiditiesCell transfusionRBC transfusionMore patientsComorbid populationEpidemiological evaluationInpatient costsPrimary diagnosisEpidemiologic studiesAssociation 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 modalityMortalityAmerican College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period
Abraham NS, Barkun AN, Sauer BG, Douketis J, Laine L, Noseworthy PA, Telford JJ, Leontiadis GI. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. The American Journal Of Gastroenterology 2022, 117: 542-558. PMID: 35297395, PMCID: PMC8966740, DOI: 10.14309/ajg.0000000000001627.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsDirect oral anticoagulantsP2Y12 receptor inhibitorsAcute gastrointestinal bleedingProthrombin complex concentrateSecondary preventionAcetylsalicylic acidGastrointestinal bleedingPCC administrationReceptor inhibitorsTemporary interruptionEndoscopy settingTarget patientsGastroenterology Clinical Practice GuidelineFresh frozen plasma administrationAdministration of idarucizumabManagement of anticoagulantsDual antiplatelet therapyAcute GI bleedingGrading of RecommendationsClinical practice guidelinesFresh frozen plasmaAcute GIASA monotherapyPeriendoscopic managementAntiplatelet therapyAmerican College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period
Abraham NS, Barkun AN, Sauer BG, Douketis J, Laine L, Noseworthy PA, Telford JJ, Leontiadis GI. American College of Gastroenterology-Canadian Association of Gastroenterology Clinical Practice Guideline: Management of Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Periendoscopic Period. Journal Of The Canadian Association Of Gastroenterology 2022, 5: 100-101. PMID: 35368325, PMCID: PMC8972207, DOI: 10.1093/jcag/gwac010.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsDirect oral anticoagulantsAcute gastrointestinal bleedingProthrombin complex concentrateSecondary preventionAcetylsalicylic acidGastrointestinal bleedingPCC administrationReceptor inhibitorsTemporary interruptionEndoscopy settingTarget patientsGastroenterology Clinical Practice GuidelineFresh frozen plasma administrationAdministration of idarucizumabManagement of anticoagulantsDual antiplatelet therapyAcute GI bleedingGrading of RecommendationsClinical practice guidelinesFresh frozen plasmaAcute GIASA monotherapyPeriendoscopic managementAntiplatelet therapyGI bleedingManagement of Patients on Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Peri-Endoscopic Period: A Clinical Practice Guideline Dissemination Tool
Barkun AN, Douketis J, Noseworthy PA, Laine L, Telford JJ, Abraham NS. Management of Patients on Anticoagulants and Antiplatelets During Acute Gastrointestinal Bleeding and the Peri-Endoscopic Period: A Clinical Practice Guideline Dissemination Tool. The American Journal Of Gastroenterology 2022, 117: 513-519. PMID: 35354773, DOI: 10.14309/ajg.0000000000001688.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus Statements
2021
Acute gastrointestinal bleeding: proposed study outcomes for new randomised controlled trials
Jensen DM, Barkun A, Cave D, Gralnek IM, Jutabha R, Laine L, Lau JYW, Saltzman JR, Soetikno R, Sung JJY. Acute gastrointestinal bleeding: proposed study outcomes for new randomised controlled trials. Alimentary Pharmacology & Therapeutics 2021, 54: 616-626. PMID: 34288017, PMCID: PMC9385213, DOI: 10.1111/apt.16483.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsAcute gastrointestinal bleedingGastrointestinal bleedingPrimary endpointRed blood cell transfusionRelevant outcomesHealth care resource utilisationLength of hospitalisationSerious adverse eventsTrial of patientsBlood cell transfusionPeer-reviewed fundingMeaningful primary endpointCell transfusionAcute bleedingAdverse eventsComposite outcomeSecondary outcomesFuture RCTsNew RCTsPrimary outcomeHemostatic outcomesClinical trialsCommon causeOutcome measuresGI sourceACG 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 approachNeural network predicts need for red blood cell transfusion for patients with acute gastrointestinal bleeding admitted to the intensive care unit
Shung D, Huang J, Castro E, Tay JK, Simonov M, Laine L, Batra R, Krishnaswamy S. Neural network predicts need for red blood cell transfusion for patients with acute gastrointestinal bleeding admitted to the intensive care unit. Scientific Reports 2021, 11: 8827. PMID: 33893364, PMCID: PMC8065139, DOI: 10.1038/s41598-021-88226-3.Peer-Reviewed Original ResearchConceptsAcute gastrointestinal bleedingRed blood cell transfusionBlood cell transfusionGastrointestinal bleedingHigh-risk patientsCell transfusionRed blood cellsPatient cohortIntensive Care III (MIMIC-III) critical care databaseIntensive care unit staySevere acute gastrointestinal bleedingPacked red blood cellsBlood cellsCommon gastrointestinal causesLaboratory test featuresTime-updated dataIntensive care unitValidation patient cohortCritical care databaseLarge urban hospitalMedical Information MartInternal validation setGastrointestinal causesUnit stayCare unitTowards 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 strategiesGuidelinesBleedingHaemostasisLesionsEarly identification of patients with acute gastrointestinal bleeding using natural language processing and decision rules
Shung D, Tsay C, Laine L, Chang D, Li F, Thomas P, Partridge C, Simonov M, Hsiao A, Tay JK, Taylor A. Early identification of patients with acute gastrointestinal bleeding using natural language processing and decision rules. Journal Of Gastroenterology And Hepatology 2021, 36: 1590-1597. PMID: 33105045, DOI: 10.1111/jgh.15313.Peer-Reviewed Original ResearchConceptsNatural language processingElectronic health recordsLanguage processingNLP algorithmSystematized NomenclatureReal timeAcute gastrointestinal bleedingBidirectional Encoder RepresentationsDecision rulesEHR-based phenotyping algorithmsGastrointestinal bleedingRisk stratification scoresEncoder RepresentationsData elementsPhenotyping algorithmStratification scoresHealth recordsAlgorithmPhenotyping of patientsEmergency department patientsTime of presentationRisk stratification modelED reviewDeploymentExternal validation
2020
ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study
Laursen SB, Oakland K, Laine L, Bieber V, Marmo R, Redondo-Cerezo E, Dalton HR, Ngu J, Schultz M, Soncini M, Gralnek I, Jairath V, Murray IA, Stanley AJ. ABC score: a new risk score that accurately predicts mortality in acute upper and lower gastrointestinal bleeding: an international multicentre study. Gut 2020, 70: 707-716. PMID: 32723845, DOI: 10.1136/gutjnl-2019-320002.Peer-Reviewed Original ResearchConceptsLower gastrointestinal bleedingABC scoreLower riskHigher ABC scoresGastrointestinal bleedingRisk scoreMortality rateHospital mortality rateInternational cohort studyManagement of patientsNew risk scoreInternational multicentre studyLower ABC scoreLGIB patientsUGIB patientsComorbidity scoreCohort studyMulticentre studyBlood testsValidation cohortDevelopment cohortLGIBUGIBHigh riskPatientsMachine Learning Prognostic Models for Gastrointestinal Bleeding Using Electronic Health Record Data.
Shung D, Laine L. Machine Learning Prognostic Models for Gastrointestinal Bleeding Using Electronic Health Record Data. The American Journal Of Gastroenterology 2020, 115: 1199-1200. PMID: 32530828, PMCID: PMC7415736, DOI: 10.14309/ajg.0000000000000720.Commentaries, Editorials and LettersConceptsRisk assessment toolGastrointestinal bleedingIntensive care unit patientsClinical risk assessment toolCare unit patientsElectronic health record dataHealth record dataLevel of careAssessment toolElectronic health recordsAPACHE IVaHospital mortalityHospital courseUnit patientsPrognostic toolClinical practicePrognostic modelHealth recordsRecord dataBleedingExternal validationPatientsLack of generalizabilityMortalityCare