Scherkl Camilo, Dierkes Theresa, Metzner Michael, Czock David, Seidling Hanna M, Haefeli Walter E, Meid Andreas D
Internal Medicine IX, Department of Clinical Pharmacology and Pharmacoepidemiology, Medical Faculty/Heidelberg University Hospital, Heidelberg, Germany.
Internal Medicine IX, Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Medical Faculty/Heidelberg University Hospital, Heidelberg, Germany.
BMC Med Inform Decis Mak. 2025 Jul 2;25(1):244. doi: 10.1186/s12911-025-03096-3.
BACKGROUND: Medical care can fail for various reasons: diseases can remain undetected and their severity misjudged, therapies can be incorrectly dosed or ineffective, and therapies can trigger new conditions or adverse drug reactions (ADR). To manage the complexity of changing patient circumstances, data-driven techniques play an increasingly important role in monitoring patient safety and treatment success. Therefore, clinical prediction models need to consider longitudinal factors ("Prescribing Monitoring") to ensure clinically meaningful results and avoid misclassification in the dynamic health situation of the individual patient. METHODS: We have conducted a scoping review (OSF registration: https://doi.org/10.17605/OSF.IO/P93TZ ) on prediction models for ADR to collect potential use cases for Prescribing Monitoring. This review identified 2435 relevant studies in English that were published in MEDLINE or EMBASE. Two reviewers screened the records for inclusion, with a third reviewer making the final decision in the event of discrepancies. In order to derive recommendations on the way towards a Prescribing Monitoring system, the following elements were extracted and interpreted: the prediction models used, selection of candidate predictors, use of longitudinal factors, and model performance. RESULTS: A total of 56 studies were included after the screening process. We identified the main areas of current research in ADR prediction, all covering clinically important outcomes. We identified Prescribing Monitoring use cases based on their potential to (i) make individual predictions considering specific patient characteristics, (ii) make longitudinal predictions in a near time frame, and (iii) make dynamic predictions by updating predictions with previous risk predictions and newly available data. As a further aside, we use hyperkalaemia as an example to discuss the framework for developing Prescribing Monitoring in an electronic health record (EHR). CONCLUSION: This scoping review provides an overview of the use of time-varying effects and longitudinal variables in current prediction model research. For application to clinical cases, prediction models should be developed, validated and implemented on this basis, so that time-dependent information can enable continuous monitoring of individual patients.
背景:医疗护理可能因各种原因而失败:疾病可能未被发现,其严重程度被误判,治疗剂量可能不正确或无效,并且治疗可能引发新的病症或药物不良反应(ADR)。为了应对不断变化的患者情况的复杂性,数据驱动技术在监测患者安全和治疗效果方面发挥着越来越重要的作用。因此,临床预测模型需要考虑纵向因素(“处方监测”),以确保临床意义上的结果,并避免在个体患者的动态健康状况中出现错误分类。 方法:我们对ADR预测模型进行了一项范围综述(OSF注册:https://doi.org/10.17605/OSF.IO/P93TZ ),以收集处方监测的潜在用例。该综述在MEDLINE或EMBASE上检索到2435篇以英文发表的相关研究。两名评审员筛选记录以确定是否纳入,如有分歧则由第三名评审员做出最终决定。为了得出关于建立处方监测系统的方法的建议,提取并解释了以下要素:所使用的预测模型、候选预测因子的选择、纵向因素的使用以及模型性能。 结果:筛选过程后共纳入56项研究。我们确定了ADR预测当前研究的主要领域,所有这些领域都涵盖了临床上重要的结果。我们根据其潜力确定了处方监测用例:(i)考虑特定患者特征进行个体预测;(ii)在近时间范围内进行纵向预测;(iii)通过用先前的风险预测和新获得的数据更新预测来进行动态预测。此外,我们以高钾血症为例,讨论在电子健康记录(EHR)中开发处方监测的框架。 结论:本范围综述概述了当前预测模型研究中时变效应和纵向变量的使用情况。为了应用于临床病例,应在此基础上开发、验证和实施预测模型,以便时间相关信息能够对个体患者进行持续监测。
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