Browsing by Author "Lusk, Sam"
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Item Open Access Evaluation of ML-Based Clinical Decision Support Tool to Replace an Existing Tool in an Academic Health System: Lessons Learned.(Journal of personalized medicine, 2020-08-27) Woo, Myung; Alhanti, Brooke; Lusk, Sam; Dunston, Felicia; Blackwelder, Stephen; Lytle, Kay S; Goldstein, Benjamin A; Bedoya, ArmandoThere is increasing application of machine learning tools to problems in healthcare, with an ultimate goal to improve patient safety and health outcomes. When applied appropriately, machine learning tools can augment clinical care provided to patients. However, even if a model has impressive performance characteristics, prospectively evaluating and effectively implementing models into clinical care remains difficult. The primary objective of this paper is to recount our experiences and challenges in comparing a novel machine learning-based clinical decision support tool to legacy, non-machine learning tools addressing potential safety events in the hospitals and to summarize the obstacles which prevented evaluation of clinical efficacy of tools prior to widespread institutional use. We collected and compared safety events data, specifically patient falls and pressure injuries, between the standard of care approach and machine learning (ML)-based clinical decision support (CDS). Our assessment was limited to performance of the model rather than the workflow due to challenges in directly comparing both approaches. We did note a modest improvement in falls with ML-based CDS; however, it was not possible to determine that overall improvement was due to model characteristics.Item Open Access Markers of Tissue Repair and Cellular Aging Are Increased in the Liver Tissue of Patients With HIV Infection Regardless of Presence of HCV Coinfection.(Open forum infectious diseases, 2018-07) Naggie, Susanna; Swiderska-Syn, Marzena; Choi, Steve; Lusk, Sam; Lan, Audrey; Ferrari, Guido; Syn, Wing-Kin; Guy, Cynthia D; Diehl, Anna MaeLiver disease is a leading cause of HIV-related mortality. Hepatitis C virus (HCV)-related fibrogenesis is accelerated in the setting of HIV coinfection, yet the mechanisms underlying this aggressive pathogenesis are unclear. We identified formalin-fixed paraffin-embedded liver tissue for HIV-infected patients, HCV-infected patients, HIV/HCV-coinfected patients, and controls at Duke University Medical Center. De-identified sections were stained for markers against the wound repair Hedgehog (Hh) pathway, resident T-lymphocytes, and immune activation and cellular aging. HIV infection was independently associated with Hh activation and markers of immune dysregulation in the liver tissue.