Multimorbidity refers to the coexistence of two or more chronic diseases in one person. Therefore, patients with multimorbidity have multiple and special care needs. However, in practice it is difficult to meet these needs because the organizational processes of current healthcare systems tend to be tailored to a single disease. To improve clinical decision making and patient care in multimorbidity, a radical change in the problem-solving approach to medical research and treatment is needed. In addition to the traditional reductionist approach, we propose interactive research supported by artificial intelligence (AI) and advanced big data analytics. Such research approach, when applied to data routinely collected in healthcare settings, provides an integrated platform for research tasks related to multimorbidity. This may include, for example, prediction, correlation, and classification problems based on multiple interaction factors. However, to realize the idea of this paradigm shift in multimorbidity research, the optimization, standardization, and most importantly, the integration of electronic health data into a common national and international research infrastructure is needed. Ultimately, there is a need for the integration and implementation of efficient AI approaches, particularly deep learning, into clinical routine directly within the workflows of the medical professionals.

Certain post-thoracic surgery complications are monitored in a standard manner using methods that employ ionising radiation. A need to automatise the diagnostic procedure has now arisen following the clinical trial of a novel lung ultrasound examination procedure that can replace X-rays. Deep learning was used as a powerful tool for lung ultrasound analysis. We present a novel deep-learning method, automated M-mode classification, to detect the absence of lung sliding motion in lung ultrasound. Automated M-mode classification leverages semantic segmentation to select 2D slices across the temporal dimension of the video recording. These 2D slices are the input for a convolutional neural network, and the output of the neural network indicates the presence or absence of lung sliding in the given time slot. We aggregate the partial predictions over the entire video recording to determine whether the subject has developed post-surgery complications. With a 64-frame version of this architecture, we detected lung sliding on average with a balanced accuracy of 89%, sensitivity of 82%, and specificity of 92%. Automated M-mode classification is suitable for lung sliding detection from clinical lung ultrasound videos. Furthermore, in lung ultrasound videos, we recommend using time windows between 0.53 and 2.13 s for the classification of lung sliding motion followed by aggregation.

This systematic review provides a comprehensive overview of tsunami evacuation models. The review covers scientific studies from the last decade (2012–2021) and is explicitly focused on models using an agent-based approach. The PRISMA methodology was used to analyze 171 selected papers, resulting in over 53 studies included in the detailed full-text analysis. This review is divided into two main parts: (1) a descriptive analysis of the presented models (focused on the modeling tools, validation, and software platform used, etc.), and (2) model analysis (e.g., model purpose, types of agents, input and output data, and modeled area). Special attention was given to the features of these models specifically associated with an agent-based approach. The results lead to the conclusion that the research domain of agent-based tsunami evacuation models is quite narrow and specialized, with a high degree of variability in the model attributes and properties. At the same time, the application of agent-specific methodologies, protocols, organizational paradigms, or standards is sparse.

Background: This study aimed to identify the clustering of comorbidities, cognitive, and mental factors associated with in- creased risk of pre-frailty and frailty in patients >= 60 years in a primary healthcare setting in eastern Croatia. Material/Methods: There were 159 patients included in the cluster analysis who were >= 60 years and who underwent four-month follow-up. The first cluster contained 50 patients, the second cluster contained 74 patients, and the third cluster contained 35 patients. Clinical parameters were identified from electronic health records and patient questionnaires. Laboratory tests, anthropometric measurements, the number of chronic diseases, the number of prescribed medications were recorded. Frailty was determined using the five criteria of Fried's phenotype model. Levels of anxiety and depression were recorded using the Geriatric Anxiety Scale (GAS) and the Geriatric Depression Scale (GDS), and the Mini-Mental State Examination (MMSE) score assessed cognitive impairment. Logistic regression models were used to identify predictors of frailty and pre-frailty. Results: Three overlapping clusters of phenotypes predicted frailty, and included obesity (n=50), multimorbidity with mental impairment (n=74), and decline in renal function with cognitive impairment (n=35). The predictors of outcome included increasing age, number of chronic diseases, inflammation, anemia, anxiety, and cognitive impairment, and reduced muscle mass. Conclusions: In patients >= 60 years in a primary healthcare setting, multimorbidity predictors of pre-frailty and frailty included a decline in cognitive function and renal function.

There is potential for medical research on the basis of routine data used from general practice electronic health records (GP eHRs), even in areas where there is no common GP research platform. We present a case study on menopausal women with hypertension and metabolic syndrome (MS). The aims were to explore the appropriateness of the standard definition of MS to apply to this specific, narrowly defined population group and to improve recognition of women at high CV risk. We investigated the possible uses offered by available data from GP eHRs, completed with patients interview, in goal of the study, using a combination of methods. For the sample of 202 hypertensive women, 47–59 years old, a data set was performed, consisted of a total number of 62 parameters, 50 parameters used from GP eHRs. It was analysed by using a mixture of methods: analysis of differences, cutoff values, graphical presentations, logistic regression and decision trees. The age range found to best match the emergency of MS was 51–55 years. Deviations from the definition of MS were identified: a larger cut-off value of the waist circumference measure (89 vs 80 cm) and parameters BMI and total serum cholesterol perform better as components of MS than the standard parameters waist circumference and HDL-cholesterol. The threshold value of BMI at which it is expected that most of hypertensive menopausal women have MS, was found to be 25.5. The other best means for recognision of women with MS include triglycerides above the threshold of 1.7 mmol/L and information on statins use. Prevention of CVD should focus on women with a new onset diabetes and comorbidities of a long-term hypertension with anxiety/depression. The added value of this study goes beyond the current paradigm on MS. Results indicate characteristics of MS in a narrowly defined, specific population group. A comprehensive view has been enabled by using heterogenoeus data and a smart combination of various methods for data analysis. The paper shows the feasibility of this research approach in routine practice, to make use of data which would otherwise not be used for research.