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Special Issue:Digital Intelligence for Healthcare

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1. The Utilization and Influencing Factors of Community Electronic Health Records
HE Meiliang, LIU Xiuliang, ZHAO Meigui, GUO Yanfang, XU Ying
Chinese General Practice    2025, 28 (13): 1628-1634.   DOI: 10.12114/j.issn.1007-9572.2024.0125
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Background

Since its implementation, residents' electronic health records have achieved phased results. The target of the filing rate in Shenzhen, Guangdong Province has been achieved, and the utilization rate has become the core index of theoptimization management of this work.

Objective

To understand the use of electronic health records of residents in Bao'an District, Shenzhen, and to analyze the influencing factors. It provides a basis for improving the utilization rate of health records and optimizing the allocation of community health resources.

Methods

As of 2022-12-31, Shenzhen Community Health Service information system had a total of 4 077 665 electronic health records of Bao 'an District residents. 403 700 electronic health records were selected by systematic sampling method, and 401 853 meeting the requirements of the study were selected for analysis.

Results

The utilization rates of health records in 1 year, 2 years and 3 years were 59.30% (238 131/401 853), 74.90% (301 032/401 853) and 80.10% (321 853/401 853). The results of multivariate Logistic regression analysis showed that age, nationality, resident type, marital status, education level, profession, payment methods for medical expenses, duration of filing, as well as whether the health records were signed by a family doctor, the elderly, the hypertension and the diabetes were residents' electronic health records influencing factors of 1, 2 and 3 years use (P<0.05). Among them, compared with residents aged 21-45, the use rate of electronic health records in 1, 2 and 3 years was higher for residents aged 0-1, 2-3 and 4-6 years (OR>1.00, P<0.05) ; the usage rate of electronic health records for residents aged 46-60 and ≥61 years was lower in 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with non-resident residents of Shenzhen, the use rate of electronic health records of residents with permanent residence in Shenzhen was higher at 1, 2 and 3 years (OR>1.00, P<0.05) ; compared with the residents participating in the basic medical insurance for urban employees, the use rate of electronic health records of residents with basic medical insurance, full self-payment and other medical expenses payment methods for urban residents was lower in 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with residents with a filing period of<1 year, the use rate of electronic health records of residents with a filing period of≥1 year was lower at 1, 2 and 3 years (OR<1.00, P<0.05) ; compared with the residents without the corresponding project identification, the 1-year utilization rate of electronic health records with family doctor contract identification, elderly project identification, hypertension project identification, and diabetes project identification was higher[OR (95%CI) was 3.77 (3.70-3.84), 2.73 (2.53-2.94), 4.40 (4.11-4.72), 3.10 (2.78-3.47), P<0.05], respectively, and the 2-years and 3-years usage rates were also higher (OR>1.00, P<0.05) .

Conclusion

The usage rate of electronic health records among residents in Bao'an District has risen compared to previous levels, but there is still potential for further enhancement. Priority should be given to non-elderly people, middle-aged and elderly people identified by the hypertension/diabetes program, and residents who have not signed a family doctor, basic medical insurance for urban residents, payment methods for self-payment and other medical expenses, and non-household registration residents.

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2. Application of Artificial Intelligence in Nutritional Management of Patients with Inflammatory Bowel Disease: a Scoping Review
LI Yiting, TU Wenjing, YIN Tingting, MEI Ziqi, ZHANG Sumin, WANG Meng, XU Guihua
Chinese General Practice    2025, 28 (14): 1709-1716.   DOI: 10.12114/j.issn.1007-9572.2024.0276
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Background

Diet plays a critical role in the development, progression and prognosis of inflammatory bowel disease (IBD) . Given that specific nutritional guidelines are limited, nutritional management for patients with IBD remains challenging and fraught with uncertainty. Although previous studies have demonstrated that artificial intelligence (AI) shows promising applications in the nutritional management of patients with chronic diseases, research specifically focused on its application in the nutritional management of patients with IBD remains limited.

Objective

To conduct a scoping review of studies on AI in nutrition management of patients with IBD.

Methods

Following the methodology of scoping reviews, the databases of PubMed, Web of Science, Embase, Cochrane Library, CINAHL, IEEE Xplore, Association for Computing Machinery Digital Library, SinoMed, CNKI, Wanfang Data, and VIP were systematically searched from inception to March 2024 for studies on the application of AI in the nutritional management of patients with IBD. According to the established inclusion and exclusion criteria, two investigators independently screened the literature, and the basic characteristics of the selected studies were extracted.

Results

A total of 15 studies were included. The applications of AI in this field include exploring the relationship between diet and IBD, assisting in nutritional assessment, and aiding nutritional interventions. The majority of utilization AI technologies in the included studies are machine learning, with some also employing additional techniques such as natural language processing and deep neural networks.

Conclusion

AI is beneficial for exploring healthy dietary patterns for patients with IBD and providing personalized nutritional guidance. However, its application in the field of nutritional management in patients with IBD is still in its infancy. Future efforts should focus on strengthening multidisciplinary collaboration, emphasizing the integration of clinical guidelines, and assessing the effectiveness of AI applications in clinical settings to enhance the rigor and accuracy of the results.

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3. Application of GIS-based Information Service Platform for Family Doctors
YANG Danhong, LI Jun, LI Feng, LI Junlei, HE Fang, LU Yehua, WANG Jinzhen, JIANG Yan
Chinese General Practice    2025, 28 (10): 1243-1248.   DOI: 10.12114/j.issn.1007-9572.2023.0901
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Background

With the development of society and the aging of the population, the demand for community medical services is increasing. As an important part of community medical service, the informationization level and information service ability of family doctors are of great significance to improve the quality and efficiency of community medical service.

Objective

To investigate the effect of the WeChat applet "Intelligent geographic information system (GIS) Family Doctor Information Platform" based on GIS in the application of family doctor contracting service.

Methods

from March to April 2023, among 27 family doctor teams in Zhujing Town, Jinshan District, Shanghai, 185 residents served by two neighbourhood family doctor teams and two rural family doctor teams were selected as the control group using stratified random sampling method, and 186 residents served by the same two neighbourhood family doctor teams and two rural family doctor teams were selected as the intervention group; the control group adopted the existing family doctor contracting management mode, and the intervention group adopted the existing family doctor contracting management mode. The control group adopts the existing family doctor contracting management model, while the intervention group develops a contracting service management model based on the "Intelligent GIS Family Doctor Information Platform" WeChat app on the basis of the existing management model. A retrospective data collection method was used to compare the family doctor contracting service before and after the use of the "Smart GIS Family Doctor Information Platform" WeChat app in the intervention group, as well as the knowledge, belief and behaviour of the residents in the control group and the intervention group, in order to analyse the "Smart GIS Family Doctor Information Platform" WeChat app to analyse the application effect of "Intelligent GIS Family Doctor Information Platform".

Results

The municipal contracting service assessment score of the intervention group was higher after using the "Smart GIS Family Doctor Information Platform" WeChat app (87.76±4.60) than before (63.65±4.53) (P<0.05) ; the score of the control group was higher than that of the intervention group after using the "Smart GIS Family Doctor Information Platform" WeChat app (63.65±4.53) (P<0.05) ; the score of the intervention group was higher than that of the control group after using the "Smart GIS Family Doctor Information Platform" WeChat app. The signing rate, community visit rate, family doctor visit rate, and the physical examination rate for signed individuals aged 65 and above for the control group are 41.70%, 26.67%, 3.30% and 71.43%, respectively. The contracting rate, community consultation rate, family doctor consultation rate, and contracted medical examination rate of people over 65 years old in the intervention group were 44.48%, 28.89%, 6.15%, and 74.02% respectively, and all the indicators of the intervention group were higher than those of the intervention group before the use of the WeChat applet of the "Intelligent GIS Family Physician Information Platform" (P<0.05). In the control group, the scores of knowledge, attitude and behaviour of family doctor contracting service were (8.14±1.46) (22.47±2.78) and (4.57±1.35), while in the intervention group, the scores of knowledge, attitude and behaviour of family doctor contracting service were (8.77±1.28) (23.54±1.98) and (4.97±1.17), respectively. The intervention group's scores on knowledge, attitude and behaviour of family doctor contracting service were higher than those of the control group (P<0.05) .

Conclusion

The application of "Intelligent GIS Family Doctor Information Platform" can improve the quality of the work of family doctor contracting service and enhance the residents'adherence to family doctor contracting service.

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4. Construction of an Artificial Intelligence Model and Application for an Automatic Recognition of Traditional Chinese Medicine Herbals Based on Convolutional Neural Networks
WANG Ganhong, ZHANG Zihao, XI Meijuan, XIA Kaijian, ZHOU Yanting, CHEN Jian
Chinese General Practice    2025, 28 (09): 1128-1136.   DOI: 10.12114/j.issn.1007-9572.2024.0394
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Background

Conventional methods for identifying traditional Chinese medicine (TCM) herbals mainly rely on subjective experiences, making it difficult to meet the needs for accurate classification and identification.

Objective

This study aims to develop an artificial intelligence model and a desktop application capable of automatically recognizing 163 types of TCM herbals based on convolutional neural networks (CNN) .

Methods

From January 2020 to June 2024, data from two datasets of 163 TCM herbals were collected for training, validation, and testing of the deep learning model. The performance of the CNN model was evaluated for the accuracy, sensitivity, specificity, precision, area under the receiver operating characteristic (ROC) curve (AUC), and F1 score. After model training, an application was developed using PyQt5 technology for convenient clinical use.

Results

A total of 276 767 images were included in this study. Five models, including EfficientNetB0, ResNet50, MobileNetV3, VGG19, and ResNet18, were developed. After comparing their performance, the EfficientNetB0 model achieved the highest accuracy (99.0%) and AUC (0.994 2) in the validation dataset, and it was selected as the optimal model. In the test dataset, the EfficientNetB0 model achieved an accuracy of 99.0%, sensitivity of 99.0%, specificity of 100.0%, and an AUC of 1.0 across all categories, demonstrating an excellent performance.

Conclusion

The deep learning model developed based on CNN can quickly and accurately recognize 163 types of TCM herbals with high sensitivity and recognition capability, thus providing a robust support for physicians to accurately identify TCM herbals.

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5. Design of an Intelligent Health Management Platform
CHEN Penggang, SUN Guoqiang, ZHANG Xi, LI Xiaoze, QIN Panpan, GAO Xing, HU Hongpu
Chinese General Practice    2025, 28 (05): 619-623.   DOI: 10.12114/j.issn.1007-9572.2024.0338
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Intelligent health management is a crucial countermeasure to solving public health problems. By utilizing high-quality medical resources from a Third-Grade First Class Hospital, this study is able to solve prominent health problems in China, and it also creates medical knowledge bases and model bases. By taking advantage of intelligent additional features including self-testing health, risk estimation, health education, assessment, intelligent consultation, comprehensive intervention, and contracted doctor services, 40 statutory infectious diseases are monitored and warned early, and 260 common diseases are managed intelligently. The insured population can access health assessment, intelligent consultation, comprehensive intervention, and contracted doctor services through this research platform. The service management process is completed by these functions, which include health assessments, health classification management, personalized health plans, and health intervention to improve health status, decrease disease incidence rates, and improve health levels.

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6. Application and Challenges of Intelligent Robots in Grassroots Chronic Disease Management
ZHANG Xuan, ZHANG Fei, LI Minglin, WANG Jiahe
Chinese General Practice    2025, 28 (01): 7-12.   DOI: 10.12114/j.issn.1007-9572.2023.0811
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The increasing prevalence of chronic diseases globally poses major challenges to the health of societies and individuals. Managing chronic diseases requires long-term treatment and monitoring, placing demands on patients' lifestyles. With the aging of the population and changes in lifestyle, chronic disease prevention and control are becoming more and more important. In recent years, as scientific and technological innovation in the field of healthcare develops in depth, and the application of artificial intelligence in healthcare has gradually become one of the important strategic directions of the country, the traditional method of chronic disease management relies too much on the offline communication between the doctor and the patient, which leads to the doctor not being able to maintain long-term and effective communication and follow up with the patient, and the patient may not be able to be detected and monitored by the doctor in a timely manner when his or her condition changes. In addition, the traditional chronic disease management approach is usually a generalized approach that fails to adequately consider the individual differences of each patient. Given the limitations of traditional chronic disease management methods, this study aims to provide more convenient and efficient primary care services using intelligent robots. Through personalized health management plans, assisted medical diagnosis, and timed medication reminders, the intelligent robot is committed to improving patients' quality of life, reducing the pressure on healthcare resources, and promoting the development of intelligent healthcare management globally.

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7. The Application of Large Language Models in Primary Healthcare Services and the Challenges
YAN Wenxin, HU Jian, ZENG Huatang, LIU Min, LIANG Wannian
Chinese General Practice    2025, 28 (01): 1-6.   DOI: 10.12114/j.issn.1007-9572.2024.0277
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The primary healthcare system is key to achieving a health equity. In China, great obstacles are challenged by imbalanced medical resources, shortage of primary healthcare providers, and the prevention and treatment of chronic diseases. Artificial intelligence large language models have demonstrated strong advantages in the medical system. This article deeply explored the application of large language models in the primary healthcare system and the challenges. The large language models are expected to assist the diagnosis and treatment of common diseases in grassroot medical institutions, promote intelligent health education and chronic disease management, underpin primary health services in the undeveloped and remote areas, stimulate the leapfrog development of general medicine, and accelerate the industrialization of large language models in general diagnosis and treatment and primary health services, thus providing important support for the construction of healthy China.

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8. Chinese Expert Consensus on Artificial Intelligence General Practitioner (AIGP)
Tsinghua University Vanke School of Public Health, Peking University School of Public Health, Chinese Association of General Practitioners of Chinese Medical Doctor Association
Chinese General Practice    2025, 28 (02): 135-142.   DOI: 10.12114/j.issn.1007-9572.2024.0453
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The rapid development of new technologies such as artificial intelligence and large language models has brought new transformations to clinical medical practice. Both domestically and internationally, research and practical exploration of intelligent general practitioners have begun, but a consensus has yet to be formed. Against this backdrop, experts and scholars from Tsinghua University Vanke School of Public Health, Peking University School of Public Health, Chinese Association of General Practitioners of Chinese Medical Doctor Association and several other domestic institutions collaboratively developed a consensus. The background of these experts spans multiple disciplines, including general medicine, public health, artificial intelligence, and evidence-based medicine. Based on extensive literature review both domestically and internationally and through multiple rounds of expert discussions, the Chinese Expert Consensus on Artificial Intelligent General Practitioner (AIGP) was finally formulated. It includes 17 core consensus concerning the definition, characteristics, applications, challenges and recommendations of AIGP. This consensus aims to provide scientific references to promote the empowerment of general practitioners with intelligent technology and enhance the smart service level of primary healthcare.

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9. Construction of an Artificial Intelligence-assisted System for Automatic Detection of Pressure Injury Based on the YOLO Neural Network
WANG Zhenni, XU Yueping, XIA Kaijian, XU Xiaodan, GU Lihua
Chinese General Practice    2024, 27 (36): 4582-4590.   DOI: 10.12114/j.issn.1007-9572.2024.0168
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Background

With the aging population, the incidence of pressure injury (PI) is gradually increasing. This not only severely impacts the quality of life for patients but also increases healthcare expenditures. However, the early detection and accurate staging of PI heavily depend on specialized training.

Objective

To construct and validate an artificial intelligence model for the automatic detection and staging of PI aimed at enhancing the real-time nature, accuracy, and objectivity of PI diagnostics.

Methods

A total of 693 PI images from the electronic management system of pressure ulcers at Changshu No.1 People's Hospital were selected from January 2021 to February 2024, the images were randomly divided into a training set (551 images) and a test set (142 images), and categorized into six stages according to National Pressure Ulcer Advisory Panel (NPUAP) guidelines: StageⅠ (154 images), StageⅡ (188 images), StageⅢ (160 images), StageⅣ (82 images), deep tissue injury (57 images), and unstageable (52 images). A deep learning object detection model for PI was established using five different versions of the YOLOv8 [nano (n), small (s), medium (m), large (l) and extra large (x) ] neural network and transfer learning. The model evaluation metrics included accuracy, sensitivity, specificity, false positive rate, and detection speed. Finally, the model was deployed to a mobile application via the Ultralytics Hub platform, facilitating the application of the AI model in clinical practice.

Results

During the evaluation of a test set containing 142 PI images, the YOLOv8l version demonstrated high accuracy (0.827) and fast inference speed (68.49 fps), achieving the best balance between precision and speed among the YOLO versions. Specifically, it achieved an overall accuracy of 93.18% across all categories, a sensitivity of 76.52%, a specificity of 96.29%, and a false positive rate of 3.72%. Among the six stages of PI, the model achieved the highest accuracy for StageⅠat 95.97%. The accuracies for StageⅡ, StageⅢ, StageⅣ, deep tissue injury, and unstageable were 91.28%, 91.28%, 91.95%, 95.30%, and 93.29%, respectively. In terms of processing speed, YOLOv8l took a total of 2.07 seconds to process 142 images, averaging 68.49 PI images per second.

Conclusion

The AI model based on the YOLOv8l network can quickly and accurately detect and stage PI. Deploying this model to a mobile app allows for portable use in clinical practice, demonstrating significant potential for clinical application.

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10. Interpretation of the Use of Artificial Intelligence in Improving Outcomes in Heart Disease:a Scientific Statement from the American Heart Association
ZHOU Yiheng, YANG Ziyu, LYU Yao, LIU Lidi, SHEN Can, LIAO Xiaoyang, JIA Yu
Chinese General Practice    2024, 27 (35): 4353-4357.   DOI: 10.12114/j.issn.1007-9572.2024.0192
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Artificial Intelligence (AI) is an emerging technology to improve healthcare services. With the joint promotion of government agencies and academic departments around the world, a large number of studies have demonstrated that AI can improve the diagnosis, treatment and prevention of cardiovascular disease. However, there are still some limitations in its development and application, and it has not yet been widely used in clinical practice. Based on this, the American Heart Association (AHA) published the Use of Artificial Intelligence in Improving Outcomes in Heart Disease: a Scientific Statement from the American Heart Association in Circulation on April 2, 2024. This statement reviews the research progress of AI in the diagnosis, classification and treatment of cardiovascular disease, puts forward the existing problems and potential solutions, and builds a framework for the future application of AI in the cardiovascular disease. This article aims to interpret the statement for providing advice and direction for the application and research of AI in cardiovascular disease in China.

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11. Exploration and Practice of Smart Combination of Medicine and Nursing Service Model
LI Liguo, FU Hongguang, GAO Na, ZHAO Yonghong, LI Wei, ZHENG Pengyuan
Chinese General Practice    2024, 27 (34): 4322-4326.   DOI: 10.12114/j.issn.1007-9572.2023.0211
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At present, the aging situation in China is becoming increasingly severe. The elderly are facing difficulties in acquiring elderly service and medical care in the process, in which the elderly need digital service of the combination between medical and nursing care urgently. However, there still exist some problems of the combination of medical and nursing care in the present stage, such as imperfect models, low level of intelligence, inefficient integration mechanism of resources related to "medical care" and "nursing care", and the inadequate phenomenon in which the service of combination of medical and nursing care leads to "the castle in the air". In view of the current difficulties and blocking points in the combination of medical and nursing care, the research team of this paper use digital and intelligent methods to construct 5 types of smart medical and nursing service models, including "full chain" "multi-subject integration" "active health" of traditional Chinese medicine, "return to the community" and "return to the home". Furthermore, the research team issused 6 group standards, seted up 2 landmark projects, and established more than 20 demonstration application bases across the country in the meantime as well as incorporate 500 community/township promotion plans of Henan Provincial government, which achieve good demonstration effects. This paper briefly introduces five types of model specifications from four aspects of model conception, model composition, model operation mechanism and model function, so as to facilitate the further study and popularization of the five models.

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12. Development and Application of an AI-based Empathic Language Teaching and Evaluation System for Doctor-patient Communication
SHAO Jianwen, LIU Huan, ZHANG Yue, ZHENG Aiming, CHEN Songyu, WANG Jinfan
Chinese General Practice    2024, 27 (34): 4315-4321.   DOI: 10.12114/j.issn.1007-9572.2023.0544
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Background

Under the background of new medical science, the deep integration of information technology and medical education is encouraged to train first-class medical talents to serve the construction of healthy China.Currently, empathy training in doctor-patient communication mainly consists of simulated communication and group discussion, with less reliance on artificial intelligence technology for learning.

Objective

To develop a system for teaching and evaluating doctor-patient communication empathy language. This system will be used in course teaching to pave the way for future doctor-patient communication empathy teaching methods. Carry out teaching applications to enhance the communication and empathy language expression skills of medical students and doctors, and gather feedback to optimize and improve the system.

Methods

Between September 2021 and February 2022, the research group focus on utilizing iFlytek speech recognition technology and the empathy semantic recognition algorithm. A system called the "Doctor-patient Communication Virtual Simulation Teaching and Evaluation System of empathic language" was developed using 10 typical cases of doctor-patient communication, demonstrations of empathic language, a semantic database of empathic language, empathic language skills, and an overall scoring standard.A total of 950 students from Nanjing Medical University, including 515 undergraduates, 102 medical doctoral students, and 333 clinicians participating in doctor-patient communication courses or training, were selected as the research subjects from March to May 2022. Based on this system, the Doctor-patient Communication Skills Course (2 class hours) teaching experiment was conducted at Nanjing Medical University. A self-designed questionnaire was used to gather information on the subjects' understanding of empathetic language connotations, their improved empathetic language skills, their perception of system ease of use, and their perception of how the system integrates into the rationality of teaching. NVivo software was used to analyze the subjects' feedback, comments, and suggestions.

Results

Following the implementation of the system, there were statistically significant differences in the mastery of empathic language connotation, the degree of enhancement of empathic language ability, the degree of convenience of the system, and the degree of integration of the system into teaching rationality among undergraduate students, clinicians, and medical doctoral students (P<0.05). 76.1% (723/950) of the participants evaluated that they had "fully mastered" or "highly mastered" the connotation of empathic language. 93.8% (891/950) of the study subjects indicated that the system could "significantly enhance" or "somewhat enhance" the empathic language ability, and 89.5% (850/950) of the study subjects rated the convenience of the system as "very convenient" or "relatively convenient". 95.1% (903/950) of the study subjects rated the degree of cognition of the rationality of integrating the system into teaching as "very reasonable" or "relatively reasonable". The top five words mentioned in the feedback and suggestions are communication, pronunciation, teaching, program, and standard.

Conclusion

This system can help improve medical student and doctors'ability to empathize in doctor-patient communication by learning from individual cases and applying those lessons more broadly. Additionally, the use of an autonomous teaching evaluation system frees up the constraints of time and space in teacher-student interactions. The system's standardized teaching method has received positive and rational feedback from participants, indicating its potential for a wide range of applications. However, the system is still in the early stages of exploration and requires further refinement.

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13. The Application of AI in Primary Care General Practitioners' Practice: a Perspective on Skin Disease Diagnosis and Disease Course Management
LIU Huan, ZHU Shifei, CHEN Fayu, WANG Jinghua
Chinese General Practice    2024, 27 (31): 3884-3889.   DOI: 10.12114/j.issn.1007-9572.2024.0121
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Background

Primary care general practitioners encounter significant challenges in diagnosing and managing skin diseases, highlighting the urgent need for artificial intelligence (AI) assisted systems. Although AI has the potential to improve diagnostic and treatment efficiency, research on its application in primary care settings remains limited.

Objective

To investigate the effectiveness and impact of an AI-assisted system in supporting primary care general practitioners with the diagnosis and management of skin diseases.

Methods

From December 2022 to March 2024, 19 general practitioners from community health centers in Hangzhou were voluntarily recruited for this study. They were randomly divided into two groups: an AI group with 10 physicians and a control group with 9 physicians. During this period, these physicians treated a total of 90 patients with skin diseases: 50 in the AI group and 40 in the control group. Physicians in the AI group utilized the Ruifu AI-assisted system for diagnosing and managing dermatological diseases, whereas those in the control group followed standard treatment protocols without AI assistance. Both groups compiled patients' medical records, auxiliary examination reports, and photographs of skin lesions during consultations. Two skin disease experts were invited to conduct remote consultations to evaluate the diagnostic accuracy of the two groups. On the first day (1 d) and the fourteenth day (14 d) of treatment, patients underwent assessments using the Dermatology Life Quality Index (DLQI), and satisfaction surveys were conducted separately for patients in the AI and control groups. A questionnaire survey was administered to doctors in the AI group to assess their experience with the Ruifu AI-assisted system.

Results

No significant differences were observed in gender, age, or education level among patients in the AI and control groups (P>0.05), nor among physicians in terms of gender, age, education, and professional titles (P>0.05). The AI group's general practitioners achieved higher diagnostic accuracy for skin diseases than those in the control group (64.0% vs 37.5%, P=0.012). Fourteen days post-treatment, improvements in the DLQI scores were observed in both the AI and control groups, with significant differences (P<0.05), and the improvement in the AI group was more significant (P<0.05). The satisfaction level of the AI group was higher than that of the control group (P=0.024), and there was a positive correlation between the 14 d DLQI score and patient satisfaction in the AI group (rs=0.471, 95%CI=0.186-0.683, P=0.002), the correlation between the improvement in DLQI score and patient satisfaction was even more significant (rs=0.816, 95%CI=0.676-0.899, P<0.001). The results of the questionnaire survey revealed that a majority of physicians demonstrated a positive attitude towards their use of the AI-assisted system, acknowledging its practical value in several areas: diagnosis selection (70.0%), auxiliary diagnosis (80.0%), treatment recommendations (60.0%), and the provision of professional knowledge (90.0%). Remarkably, 90.0% of the physicians indicated their intention to continue utilizing the AI-assisted system.

Conclusion

In the primary care setting, the application of AI-assisted systems has enhanced the diagnostic accuracy of general practitioners in identifying skin diseases, improves the quality of life for patients, and increases patient satisfaction. The majority of general practitioners report positive experiences with the use of AI-assisted systems.

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14. Translation of Selected Passage of AI in General Practice: a Tale of Pragmatism, Caution, and Optimism
YANG Hui
Chinese General Practice    2024, 27 (32): 0-B.   DOI: 10.3760/cma.j.issn.1007-9572.2024.32.101
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15. The Hotspots and Frontier Trends of Artificial Intelligence in the Clinical Diagnosis and Treatment of Alzheimer's Disease: Bibliometric Analysis of the Past 20 Years
YU Ruxia, JIANG Jing, WANG Qiucheng, WANG Yue, ZHAO Xiaoyue
Chinese General Practice    2024, 27 (26): 3218-3226.   DOI: 10.12114/j.issn.1007-9572.2023.0704
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Background

Currently, the number of research papers on the application of artificial intelligence to the field of Alzheimer's disease (AD) has increased significantly. It is important to clarify the latest research hotspots and future development trends in this field.

Objective

To summarize the relevant research on the application of artificial intelligence to AD through bibliometric analysis, and clarify the research hotspots and trends from 2004 to 2023.

Methods

Literature on the application of artificial intelligence to AD from January 2004 to June 2023 was searched for in the Web of Science core database, and Microsoft Office Excel, CiteSpace, and VOSviewer software were used to visually analyze the number of publications, countries, authors, institutions, keywords, and co-citation networks of the literature.

Results

Ultimately 3 189 articles were included. The number of literature on the application of artificial intelligence to AD has steadily increased since 2004 and has grown rapidly since 2015, with a maximum of over 600 articles. A total of 94 countries, 3 930 institutions, 13 563 authors, and 52 019 cited authors participated in this study. Among them, the United States and China were in a leading position in this field; Republic of Korea universities ranked first in terms of the number of publications; In addition, ZHANG DAOQIANG, LIU MINGXIA, SUK HEUNG-IL, and CLIFFORD R. JACK Jr were not only prolific authors but also the authors with the most citations. The visualization analysis of keywords and literature citations revealed that regarding the application of artificial intelligence to AD, the diagnosis and disease course classification of AD, as well as the prediction of its risk factors, are current research hotspots and that task analysis are future research trends.

Conclusion

The application of artificial intelligence to AD has attracted widespread attention from researchers worldwide. The diagnosis and classification of AD, as well as the prediction of its risk factors, are current research hotspots. Developing adjunctive drugs in task analysis, personalized treatment and care, and improving the algorithm performance of artificial intelligence may be research trends in the future.

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16. Application of Artificial Intelligence-assisted Chromosome Karyotyping Analysis in Prenatal Diagnosis
GUO Caiqin, WANG Junfeng, YANG Lan, SHI Jinping, TANG Ye, ZHAO Di, WU Xiao
Chinese General Practice    2024, 27 (23): 2883-2887.   DOI: 10.12114/j.issn.1007-9572.2023.0549
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Background

Chromosomal abnormalities are one of the common causes of birth defects, and karyotype analysis is still an important method for prenatal diagnosis of chromosomal abnormalities as well as an effective way to prevent and control birth defects. However, karyotype analysis, especially chromosomal image segmentation and classification mainly depends on manual work at present, which is laborious and time-consuming. As an emerging approach to karyotype analysis, it is of great significance to investigate the application value of artificial intelligence (AI) in prenatal chromosomal karyotype diagnosis.

Objective

To investigate the application effect and clinical value of AI in prenatal karyotype diagnosis.

Methods

A total of 1 000 pregnant women who received interventional prenatal diagnosis and karyotype analysis of amniotic fluid cells in the department of medical genetics and prenatal diagnosis of Wuxi Maternity and Child Health Care Hospital between 2020 and 2022 were selected as the study subjects. The karyotype analysis of all cases was performed using two-line mode, the results of the AI reading were reviewed by one geneticist in the first line, and another geneticist analyzed the karyotypes by Ikaros karyotype analysis workstation in the second line, the diagnostic results and time were recorded respectively. The final diagnosis of the samples were based on the manual review of the first line and the manual reading of the second line.

Results

Among the 1 000 amniotic fluid samples, 735 cases were diagnosed as normal karyotype, 233 cases as aneuploidy, 0 case as structural abnormality and 32 cases as mosaicism by AI. The numbers of normal karyotype, aneuploidy, structural abnormality and mosaicism assessed by AI-assisted geneticist were 689, 233, 45 and 33, which were completely consistent with those evaluated by geneticist using Ikaros system. Compared with AI-assisted geneticist, AI-based diagnosis had strong consistency (Kappa=0.895, 95%CI=0.866-0.924, P<0.01). The diagnostic accuracy, sensitivity and positive predictive value of AI-based diagnosis was 95.4%, 95.4% and 100.0%, respectively, among which the normal karyotype, aneuploidy, structural abnormality and mosaicism were detected with a sensitivity of 100.0%, 100.0%, 0 and 97.0%, and the positive predictive value of 100.0%, 100.0%, 0 and 100.0%. The average diagnostic time of AI was shorter than that of AI-assisted geneticist and Ikaros-assisted geneticist (P<0.001), and AI-assisted geneticist took less time on average to diagnose than the Ikaros-assisted geneticist (P<0.001) .

Conclusion

AI-assisted karyotype analysis of amniotic fluid cells has a high degree of automation, but its ability to recognize chromosomal structural abnormalities needs to be improved. It is suggested that AI be combined with the geneticist for karyotype analysis in clinical application to ensure the quality of prenatal diagnosis and improve efficiency.

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17. How is the Psycho-Cardiology Developing: from Theoretical Research to Disease Diagnosis and Screening
CHEN Shuyan, ZHAO Taihong, XU Jing
Chinese General Practice    2024, 27 (19): 2388-2394.   DOI: 10.12114/j.issn.1007-9572.2023.0726
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There is an induced or concurrent relationship between cardiovascular disease and psychological illness, which occurred and developed into Psycho-Cardiology. It is necessary to assist the treatment of cardiovascular disease from the perspective of psychology, the resulting is the Psycho-Cardiology. This article briefly summarized the research status at home and abroad about Psycho-Cardiology. Firstly, analyzing the internal mechanism and external influencing factors to establish theoretical mechanism, and determine the high incidence risk index of the Psycho-Cardiology disease. Baseline information, including age, gender, BMI, diet, smoking, alcohol consumption, physical exercise, social status, family history, comorbidity including hypertension. Hematological indicators, including ion concentration, blood cell, inflammatory factor, hormone. Biochemical indicators, including myocardial enzyme spectrum, blood glucose, blood lipid, uric acid, cysteine. Structural and functional indicators, including resting heart rate (RHR) , heart rate variability (HRV) , left ventricular ejection fraction (LVEF) , left ventricular end diastolic diameter (LVDd) . These factors have a relevance between cardiovascular disease and psychological illness. Then, exploring two diagnosis models of this disease, including a traditional model of multi-axis, multi-grade, and multi-scale diagnosis methods, and a intelligent diagnosis section system based on the risk indexes. From the clinical practice, aiming to help clinicians achieve early psychological screening and accurate diagnosis of Psycho-Cardiology disease patients, and implement effective intervention measures.

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18. Design Features and Methodological Quality of Researches about Prediction Models Based on Machine Learning in Primary Care: a Scoping Review
ZHONG Jinjia, LI Wentao, HUANG Yafang, WU Hao
Chinese General Practice    2024, 27 (10): 1271-1276.   DOI: 10.12114/j.issn.1007-9572.2023.0561
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Background

Researches about prediction models based on machine learning in primary care developed rapidly in recent years, but there are few researches about the design features and methodological quality.

Objective

To systematacially summarize and analyze the design features and methodological quality of researches about prediction models based on machine learning in primary care.

Methods

Researches about prediction models based on machine learning in primary care was searched in PubMed, Embase, CNKI, Wanfang Data published from base-building to 2023-02-21, descriptive summary and description methods were used to analyze the basic characteristics of the included literature, types of prediction models, sample size, handling method of missing value, types of machine learning algorithms, model performance evaluation index and prediction efficiency, and model verification method.

Results

Totally 30 literature were enrolled, involving 106 prediction models, thereinto 17 literature were published between 2021 and 2023; research topics: respiratory disease in 6 literature, tumour in 4 literature, outpatient appointment in 3 literature; sample size over 1 000 in 26 literature (accounting for 86.67%, 95%CI=68.36%-95.64%) ; using machine learning methods to hand missing value in 7 literature; 65 prediction models used tree-based machine learning algorithm, in which random forest was the most frequently used (accounting for 32.08%, 95%CI=23.53%-41.95%) ; 61 prediction models used AUC of ROC or consistency (C statistic) as the differentiation evaluation index (accounting for 57.55%, 95%CI=47.57%-66.97%), but only 14 prediction models reported prediction models (accounting for 13.21%, 95%CI=7.67%-21.50%) ; the differentiation of most of the 106 prediction models was good, but bias risk assessment results of 92 prediction models were high-risk (accounting for 86.79%, 95%CI=78.50%-92.33%) ; only 7 literature involved prediction models conducted the external validation.

Conclusion

Researches about prediction models based on machine learning in primary care increase gradually in the past three years, in which the topics mainly involve respiratory disease, tumour, outpatient appointment and so on; there are significant difference in sample size and handling method of missing value in the 106 prediction models, most of the 106 prediction models are with good differentiation, but most of them did not conducted the external validation, and the overall risk of bias is relatively high.

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19. Transparent Reporting of the Early-stage Clinical Evaluation of Clinical Decision Support Systems Based on Artificial Intelligence
LEI Fang, DU Liang, DONG Min, LIU Xuemei
Chinese General Practice    2024, 27 (10): 1267-1270.   DOI: 10.12114/j.issn.1007-9572.2023.0668
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With the wide application of artificial intelligence (AI) in the medical field, more and more AI-based clinical decision support systems have been applied in the clinical diagnosis, screening, and other fields. Early-stage clinical evaluation is important for evaluating the clinical performance, safety, and human factors of AI-based clinical decision support systems, and laying the foundation for large-scale trials. However, the transparency and integrity of the clinical reports need to be improved. The Developmental and Exploratory Clinical Investigations of DEcision Support Systems Driven by Artificial Intelligence (DECIDE-AI) was officially published online in May 2022. Based on this guideline and relative literature, this paper explores the transparent reporting of early-stage clinical evaluation of AI-based clinical decision support systems, in order to help developers and researchers better understand and apply the relevant guidelines, and improve the reporting transparency of early-stage clinical evaluation of AI-based clinical decision support systems.

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20. Predictive Value of Machine Learning Based on Retinal Structural Changes for Early Parkinson's Disease Diagnosis
LIANG Keke, GUO Qingge, LI Xiaohuan, MA Jianjun, YANG Hongqi, SHI Xiaoxue, FAN Yongyan, YANG Dawei, GUO Dashuai, DONG Linrui, GU Qi, LI Dongsheng
Chinese General Practice    2024, 27 (09): 1102-1108.   DOI: 10.12114/j.issn.1007-9572.2023.0450
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Background

The diagnosis of Parkinson disease (PD) is mainly based on clinical symptoms, and there is a lack of objective methods for correct diagnosis. At present, there have been studies on retinal structural changes as a biomark for early diagnosis of PD, but machine learning based on retinal structural changes for predicting early PD has not yet been studied.

Objective

To construct a machine learning model based on the characteristics of retinal structural changes, explore its value in early PD diagnosis, and the accuracy of different machine learning algorithms for early PD diagnosis.

Methods

From October 2021 to September 2022, 49 PD patients aged 40 to 70 years old (PD group) who attended outpatient clinics and were hospitalized in the department of neurology of Henan Provincial People's Hospital (PD group) and 39 healthy people with matching age and sex (healthy control group) who came to the hospital for physical examination were collected. All study subjects underwent swept-source optical coherence tomography and swept-source optical coherence tomography angiography, the thickness and vessel density of the macular retina were also quantitatively analyzed. The 88 subjects were randomly divided into the 62 training sets and 26 validation set according to the ratio of 7∶3. Variables with significant differences between the PD group and healthy control group were selected as the characteristic variables for inclusion in the machine learning model, and Logistic regression (LR) , K-nearest neighbor algorithm (KNN) , decision tree (DT) , random forest (RF) and extreme gradient boosting (XGboost) models were constructed in the training set. The area under the curve (AUC) , accuracy, sensitivity and specificity of the receiver operating characteristic (ROC) curve were used to evaluate the predictive value of the machine learning model based on retinal structural changes for early PD.

Results

Compared with the healthy control group, the density of the upper outer ring (A6) , the outer temporal outer ring (A7) , the lower outer ring (A8) and the outer nasal ring (A9) of the superficial capillaries in the PD group were reduced, the thickness of the upper inner ring (A2) , the inner temporal inner ring (A3) , the inferior inner ring (A4) , the inner ring of the nasal side (A5) of the retinal layer, A6, A7, A8 and A9, the thickness of A6 of the ganglion cell complex layer, the thickness of A7 of the nerve fiber layer, A2 and A4, A5, A6, A7, A8, A9 became thinner (P<0.05) . The reductions in A2 thickness of the retinal layer (OR=0.781, 95%CI=0.659-0.926) , A3 thickness of the retinal layer (OR=1.190, 95%CI=1.019-1.390) , A2 thickness of the outer retina (OR=0.748, 95%CI=0.603-0.929) , A6 thickness of the outer retina (OR=2.264, 95%CI=1.469-3.490) , A8 thickness of the outer retina (OR=0.723, 95%CI=0.576-0.906) , and A7 thickness of the nerve fiber layer (OR=0.592, 95%CI=0.454-0.773) , and the decrease in A7 density of the superficial capillaries (OR=1.966, 95%CI=1.399-2.765) were independent risk factors for the occurrence of early PD (P<0.05) . The above variables were involved to construct the machine learning model, the results showed that among the five models constructed, the LR model had the highest overall performance, with an AUC of 0.841, while the DT model has the highest accuracy at 0.846.

Conclusion

Machine learning model based on retinal features can accurately predict early PD, among which the DT model has high accuracy for early PD diagnosis.

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21. Telemedicine Management in Stabilized Respiratory Rehabilitation of Elderly Patients with Moderate-to-severe Chronic Obstructive Pulmonary Disease: a Randomized Controlled Trial
YUAN Quan, LU Haiying, WANG Yi, LIU Yunxiao, YU Jiaqin, TIAN Fengzhao, LI Yao
Chinese General Practice    2024, 27 (06): 711-716.   DOI: 10.12114/j.issn.1007-9572.2023.0333
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Background

The number of chronic obstructive pulmonary disease (COPD) patients in China is huge, and respiratory rehabilitation training, as an important part of the management of COPD patients in the stabilization period, can effectively improve their lung function and quality of life, as well as reduce the burden on their families and society. Current data from Europe and the United States have shown that the implementation of respiratory rehabilitation under telemedicine management can improve the lung function and QOL of patients, however, there is a lack of relevant practice in China, especially in the west.

Objective

To assess the impact of respiratory rehabilitation training via telemedicine management in combination with conventional therapy on improving ventilatory capacity and lung function in elderly patients with moderate-to-severe COPD.

Methods

This study was a prospective randomized controlled study, enrolling consecutive COPD patients who attended the Fourth People's Hospital of Sichuan Province and five joint community clinics from June 2021 to June 2022. The included patients were randomly divided into the experimental group and control group by simple randomized grouping method using random number table. The control group received traditional long-term regular inhalation bronchodilator and oral medication, and the experimental group was guided by telemedicine on the basis of the treatment plan of the control group. A six-month study was conducted on two groups of patients, lung function, Borg score, 6MWT, and quality of life score (QOL score) were recorded at 1 month before and 1, 3, 6 months after intervention.

Results

The study subjects were divided into 72 cases in the control group and 73 cases in the experimental group, and there was no significant difference in gender, age and lung function at baseline [the forced expiratory volume in one second/predicted value ratio (FEV1%pred) , and the ratio of the forced expiratory volume in one second to the forced vital capacity (FEV1/FVC) ] between the two groups (P>0.05) . There was an interaction between time and group for dyspnea and mood in FEV1%pred, FEV1/FVC, 6MWT level and QOL score (P<0.05) . After 1, 3, and 6 months of intervention, FEV1%pred, FEV1/FVC, 6MWT, Borg score, and QOL score of the experimental group were better than those of the control group (P<0.05) ; FEV1%pred, FEV1/FVC, Borg score, 6MWT, and QOL scores at 3 and 6 months post-intervention were better than those at 1 month post-intervention in the experimental group (P<0.05) .

Conclusion

The use of telemedicine technology for respiratory rehabilitation of elderly moderate-to-severe COPD patients in the stable stage can effectively improve the pulmonary function, quality of life and the quality of survival of this group of patients after 3, 6-months intervention.

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22. Research Trends in Artificial Intelligence in Gastric Cancer Diagnosis and Treatment: a 20-year Bibliometric Analysis
DONG Na, CUI Ting, WANG Lulu, SHI Ronghui, FENG Jie, HUANG Xiaojun
Chinese General Practice    2024, 27 (04): 493-501.   DOI: 10.12114/j.issn.1007-9572.2022.0902
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Background

The number of researches on the application of artificial intelligence (AI) to diagnosis and treatment of gastric cancer has been increasing in recent years, but no researcher has systematically analyzed it using bibliometric analysis.

Objective

To analyze the researches on the application of AI to diagnosis and treatment of gastric cancer, explore the research hotspots and development trends from 2003 to 2022. Methods On November 06, 2022, Web of Science (WOS) core collection database was searched by computer to obtain studies on the application of AI to gastric cancer diagnosis and treatment, and VOSviewer 1.6.18 software was used to visualize and analyze inter-country (region), inter-institution, and inter-author collaborations, co-cited authors, keyword co-occurrences and overlays through bibliometric analysis. CiteSpace 5.7.R5 software was used to perform institutional betweenness centrality analysis, journal biplot overlay, cluster analysis of co-cited literature for the last 6 years, co-cited literature clustering timeline graph analysis and reference bursting analysis. Excel 2019 software was used to plot bar graphs of the volume of publications and descriptive analysis tables of countries (regions), institutions, journals, authors, cited references and keywords.

Results

A total of 703 papers were included, and the annual publication volume of the application of AI to gastric cancer diagnosis and treatment showed an overall increasing trend from 2003-2022, with a rapid increase after 2017 and the most rapid growth from 2019-2021. The top publishing country, institution and author was China, Chinese Academy of Sciences and TADA TOMOHIRO, respectively. The top three co-cited authors of BRAY FREDDIE, HIRASAWA TOSHIAKI and JIANG YUMING had made significant contributions to the field. Frontiers in Oncology was the journal with the highest publication volume, and Gastrointestinal Endoscopy was the most influential journal among the top ten journals for researches related to the application of AI to the diagnosis and treatment of gastric cancer. The citing journals mainly focused on the two fields of "Medicine, Medical, Clinical" and "Molecular, Biology, Immunology". And the cited journals mainly focused on the two fields of "Molecular, Biology, Genetics" and "Health, Nursing, Medicine". The top-ranked literature in terms of total citations titled Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. All keywords were classified into 4 categories based on keyword clustering results, including AI-assisted biological research of gastric cancer, AI-assisted endoscopic diagnosis of gastric cancer, AI-assisted pathological diagnosis of gastric cancer, and AI-assisted non-endoscopic treatment and prognosis prediction of gastric cancer. Deep learning, convolutional neural network, imaging histology, gastrointestinal endoscopy, pathology and immunotherapy were the current research hotspots.

Conclusion

AI has a broad application prospect in gastric cancer diagnosis and treatment, and more and more scholars are devoted to AI in gastric cancer diagnosis and treatment. Currently, AI has been widely studied in the biology, diagnosis, staging, efficacy assessment and prognosis prediction of gastric cancer. The results of this study can provide a reference for scholars engaged in research work related to AI and gastric cancer.

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23. Bibliometric Analysis of Advances in mHealth Technology Application in Chronic Disease Management
SHI Bowen, MA Huimin, PAN Yanzhi, MA He, YANG Chen, XIONG Juyang
Chinese General Practice    2024, 27 (04): 485-492.   DOI: 10.12114/j.issn.1007-9572.2023.0137
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Background

The research related to mHealth technology in chronic disease management has developed rapidly in recent years, however, the research trends, hotspots and cutting-edge issues in this field remain unclear.

Objective

To systematically review the application and development of mHealth technology in chronic disease management and provide reference for future research.

Methods

Using Web of Science Core Collection and PubMed as the source of literature data, the relevant literature was searched from 1997 to 2022 by CiteSpace 6.1.R 3 software on October 18, 2022, restricting the language to English, and excluding conference papers, conference abstracts, online publications, editorials, letters, book chapters, news, and other non-compliant contents. National regions, disciplinary intersections and keywords were analyzed to grasp the current status and hotspots of related research internationally, and the cutting-edge issues and research trends of mHealth technology in chronic disease management were comprehensively analyzed using keywords clustering analysis, keywords bursting analysis and timeline views.

Results

A total of 7 622 papers were finally included in the study, with a significant growth trend in the volume of publications starting from 2011, in which the United States contributed the most with a total of 2 645 (34.70%). The journals in which the papers were published were mainly in the fields of medicine, psychology and health; and the top five high-frequency keywords were chronic disease (711 times), nursing (695 times), management (544 times), intervention (502 times) and health (448 times). A total of 10 meaningful clusters were formed, which can be categorized into 4 dimensions of research tools, research theories and methods, research objects, and research factors; combining with keywords bursting and timeline view, the hot issues mainly focus on telemedicine, telecare, and digital health.

Conclusion

The international research fervor for the application of mHealth technology in chronic disease management has continued, and the field of research has shifted from medicine to health science, with the focus on intervention research on chronic diseases through mHealth technology and the use of digital technology to provide integrated telehealth services for chronic diseases. It is suggested that our scholars should pay attention to the application of mHealth and digital technologies in chronic disease management, find high-quality health services for patients with chronic diseases in China through intervention studies, and provide strategies and suggestions for the high-quality development of chronic disease services and management in China.

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24. Application of Modified SEIR Model in Epidemic Prevention and Control: a Real World Study
YANG Lichao, ZENG Huatang, HU Mengzhi, WU Liqun, TIAN Qiannan, WEI Liangzhou, ZHU Jiming, LIANG Wannian
Chinese General Practice    2024, 27 (01): 118-124.   DOI: 10.12114/j.issn.1007-9572.2023.0292
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Background

The Severe Acute Respiratory Syndrome Coronavirus 2 Omicron variant (SARS-CoV-2, Omicron) has been widely spread around the world. Since February 2022, Shenzhen was continuously affected by it as a major hub connecting domestic and international transportation, resulting in rapidly increasing number of infected cases.

Objective

To construct a modified susceptible-exposed-infected-recovered (SEIR) model for providing policy references and suggestions with applied value for epidemic prevention and control in Shenzhen, China, so as to alleviate the pressure of prevention and control.

Methods

This study developed a modified SEIR model targeting the epidemiological characteristics of the Omicron variant such as rapid transmission, high concealment, and general susceptibility of the population, introducing groups with policy characteristics as close contacts, secondary contacts, quarantined individuals and carriers, based on traditional SEIR model of infectious disease dynamics. The relevant parameters of the modified model were determined by fitting the Shenzhen epidemic data of February 18 to 28, 2022.

Results

The predicted data of the model were basically consistent with the actual data from March 01 to 04, 2022, providing a reliable basis for predicting the subsequent development of the epidemic. Subsequently, the Omicron variant outbreak in Shenzhen between 5 to 19 March 2022 was forecasted through this modified model to provide guidance for epidemic prevention and control measures in terms of the degree and time of manual intervention in epidemic prevention and control, and healthcare resource requirements such as patient beds and isolation rooms.

Conclusion

The modified SEIR model developed in this study has proved its practical value in forecasting epidemic development, formulating and adjusting epidemic control measures, and allocating health resources.

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25. The Applications of Big Data and Artificial Intelligence in the Prevention and Control of COVID-19 from the Perspective of Haddon Model
GAO Jinghong, WANG Yanyan, JIANG Shuai, FU Hang, DUAN Yanran, WANG Sufan, WANG Chengzeng
Chinese General Practice    2024, 27 (01): 111-117.   DOI: 10.12114/j.issn.1007-9572.2023.0288
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Big data and artificial intelligence technologies have played a positive role in the prevention and control of COVID-19 outbreaks. However, its application and future trends has not been comprehensively discussed. Starting from the problems faced by the prevention and control of COVID-19, this study provided an overview of the common big data and artificial intelligence technologies and their practical application cases in the prevention and control of COVID-19 based on the introduction of the advantages of big data and artificial intelligence technologies, then discussed the application of big data and artificial intelligence technologies focusing on three elements of infectious source, route of transmission and susceptible population from the three stages that before, during, and after the COVID-19 outbreak based on the Haddon model perspective. The results of the study are important for clarifying the positive role of big data and artificial intelligence technologies in each stage of COVID-19 epidemic as well as their directions of development and application, further improving the efficiency and quality of the prevention and control of COVID-19, and effectively responding to new infectious diseases in the future.

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26. Investigation on Platform for Evaluation Management and Consultation Services of Polypharmacy among Older Patients Needs of Healthcare Professionals
WEI Lan, HUANG Yue, SONG Yanan, HOU Lihong, WANG Yani, PAN Dongchen, FEI Xiaolu
Chinese General Practice    2023, 26 (25): 3157-3162.   DOI: 10.12114/j.issn.1007-9572.2023.0235
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Background

Polypharmacy is common among older patients with common diseases. There is a strong need for evaluation management and consultation services of polypharmacy among older patients from medical workers, patients and their families. However, the functional design of how to scientifically and accurately manage services and consultations based on Internet technology for different categories of users has not been adequately studied.

Objective

To conduct investigation on the design of the service functions and methods of platform for evaluation management and consultation services of polypharmacy among older patients for healthcare professionals, taking the Internet services oriented to improve irrational drug use and reduce drug-related adverse events in older patients as a new idea.

Methods

Healthcare professionals from medical institutions participating in the National Key Research and Development Program (Multiple Drug Use Risk Management for Common Diseases of the Elderly) from 2021-02-20 to 2021-03-06 were selected as research subjects, the self-designed Questionnaire on Platform for Evaluation Management and Consultation Services of Polypharmacy among Older Patients Needs of Healthcare Professionals focusing on the necessity, operation mode and function of the platform were distributed. Principal component analysis was used to extract common factors for each platform function, and further factor rotation was performed using Kaiser's normalized maximum variance method, and the mean values of each factor score were ranked to explain the relative importance of each factor.

Results

A total of 548 valid research questionnaires were collected in this study with recovery rate of 100.00%. The cumulative total variance explained by the third factor in the sum of squared factor extracted for the 8 platform functions (patient compliance evaluation, prescription appropriateness evaluation, prescription economy evaluation, medication administration notification and reminder, medication administration precautions, medication administration record management, potential medication problem reminder, adverse drug reactions record and analysis) was 77.036%. The 8 platform functions were finally extracted into 3 factors, named as reminder factor (F1) , evaluation factor (F2) , and adverse analysis factor (F3) , and the ranking of the mean values of the 3 factors in descending order was F1 (mean factor score of 2.977) , F2 (mean factor score of 0.118) , and F3 (mean factor score of 0.112) .

Conclusion

From the perspective of healthcare professionals, reminder, evaluation and adverse analysis are the main operation modes and core functions of the platform for evaluation management and consultation services of polypharmacy among older patients, with reminder-related functions as the most important functions, which will provide substantial help to ensure the effective contribution of the platform to the construction of polypharmacy risk monitoring and control system for common diseases of the elderly in China.

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27. Investigation on Platform for Evaluation Management and Consultation Services of Polypharmacy among Older Patients Needs of General Population
WEI Lan, HUANG Yue, SONG Yanan, HOU Lihong, WANG Yani, PAN Dongchen, FEI Xiaolu
Chinese General Practice    2023, 26 (25): 3163-3169.   DOI: 10.12114/j.issn.1007-9572.2023.0236
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Background

Our research team has previously conducted investigation on platform for evaluation management and consultation services of polypharmacy among older patients needs of healthcare professionals to ensure a close association between the design and development of the platform and actual needs. However, the awareness of the risks associated with polypharmacy in the elderly and needs of manage services and consultations based on Internet among general population have been rarely reported in China.

Objective

To understand the awareness of platform for evaluation management and consultation services of polypharmacy among older patients of general population, so as to further explore the operation mode of the platform and provide guidance for its improvement and refinement.

Methods

The self-designed Questionnaire on Platform for Evaluation Management and Consultation Services of Polypharmacy among Older Patients Needs of General Population focusing on the operation mode and importance of each function were distributed to the users of HeFen Club platform of China Mobile from 2021-09-29 to 2021-10-09, using HeFen Club WeChat public platform of China Mobile as the investigation platform and web-based questionnaire survey for general population as the investigation method. Principal component analysis was used to extract common factors for each platform function, and Kaiser's normalized maximum variance method was further used to rotate the factors and rank the mean scores of each factor to explain the relative importance of each factor.

Results

A total of 29 502 valid questionnaires were collected in this study with a recovery rate of 94.89%. The cumulative total variance explained by the fourth factor in the sum of squared factor extracted for the 12 platform functions (patient compliance evaluation, prescription appropriateness evaluation, prescription economy evaluation, medication administration notification and reminder, medication administration precautions, medication administration record management, potential medication problem reminder, manual real-time consultation, manual non-real-time consultation, self-service query, medication administration reminder, and record analysis) was 76.791%; The 12 platform functions were finally extracted into 4 factors, named as reminder factor (F1) , evaluation factor (F2) , query and record factor (F3) and consultation factor (F4) , and the ranking of the mean values of the 4 factors in descending order was F2 (mean factor score of 0.507) , F1 (mean factor score of 0.457) , F3 (mean factor score of 0.430) , and F4 (mean factor score of 0.253) .

Conclusion

Nearly 90.00% of the respondents believe that older adults with multiple common diseases are at risk of polypharmacy and need a platform for management and consultation services of polypharmacy. From a public perspective, reminder, evaluation, querying and record, consultation are the main operation modes and core functions of the platform for evaluation management and consultation services of polypharmacy among older patients.

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28. Expert Consensus on Construction and Application of the Internet Medical Intelligent Auxiliary Prescription Review System
Chinese Medical Association Clinical Pharmacy Branch, Shanghai Medical Association Clinical Pharmacy Branch, Shanghai Pharmacy Association Hospital Pharmacy Professional Committee
Chinese General Practice    2023, 26 (25): 3079-3090.   DOI: 10.12114/j.issn.1007-9572.2023.0222
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With the prosperous development of Internet medical care and increasing flow of electronic prescriptions, electronic prescription review has become an important guarantee for rational drug use in the online medication environment. However, in the Internet scenario, inefficient manual review with low quality increases the risk of adverse drug events. The application of the intelligent auxiliary prescription review system can significantly reduce the working pressure of pharmacists reviewing prescriptions and improve the efficiency of review, but there is a lack of setting standards and standardized management measures in the system architecture, system functions and prescription review rules setting of the Internet medical intelligent auxiliary prescription review system at present, which cannot meet the rapidly developing needs of Internet medical care. Using the construction experience of the prescription review system in medical institutions as a reference, this expert consensus makes recommendations on the construction and application of the Internet medical intelligent auxiliary prescription review system based on the functions and methods of formulating prescription review rules of the existing prescription review system, to further promote the standardization of the Internet medical prescription review work and ensure rational drug use.

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29. Recent Developments in the Application of Artificial Intelligence in the Diagnosis and Treatment of Osteoarthritis
GUO Tianci, CHEN Jixin, YU Weijie, LIU Aifeng
Chinese General Practice    2023, 26 (19): 2428-2433.   DOI: 10.12114/j.issn.1007-9572.2023.0019
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Osteoarthritis (OA) is a degenerative disease frequently encountered clinically, which can lead to loss of joint function in the late stage and is associated with a high disability rate. There is still no available cure for OA. Therefore, early diagnosis and precise treatment are the key to improving the therapeutic effect. Being an interdisciplinary research focus, artificial intelligence (AI) has been increasingly used in the diagnosis and treatment of OA recently, as it improves the diagnostic accuracy as well as clinical treatment and prognosis of OA. We summarized and systematically reviewed the literature on the application of AI in the diagnosis and treatment of OA, in which the application potential in assisting imaging diagnosis, surgical treatment, progression prediction and postoperative rehabilitation of OA was indicated, yet some limitations including non-standardized data collection and unstable algorithmic system were also identified. In the future, it is expected to establish a standardized clinical sample database and continuously optimize the algorithmic model, so as to better incorporate AI technologies in the diagnosis and treatment process of OA.

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30. Causes and Countermeasures of Algorithmic Bias and Health Inequity
CHEN Long, ZENG Kai, LI Sha, TAO Lu, LIANG Wei, WANG Haocen, YANG Rumei
Chinese General Practice    2023, 26 (19): 2423-2427.   DOI: 10.12114/j.issn.1007-9572.2023.0007
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With the development of information technology, artificial intelligence shows great potentials for clinical diagnosis and treatment. Nevertheless, bias in algorithms derived by artificial intelligence can lead to problems such as unequal distribution of healthcare resources, which significantly affect patients' health equity. Algorithmic bias is a technical manifestation of human bias, whose formation strongly correlates with the entire development process of artificial intelligence, starting from data collection, model training and optimization to output application. Healthcare providers, as the key direct participants in ensuring patients' health, should take corresponding measures to prevent algorithmic bias to avoid its related health equity issues. It is important for healthcare providers to ensure the authenticity and unbiasedness of health data, optimize the fairness of artificial intelligence, and enhance the transparency of its output application. In addition, healthcare providers need to consider how to tackle bias-related health inequity, so as to comprehensively ensure patients' health equity. In this study, we reviewed the causes and coping strategies related to algorithmic bias in healthcare, with the aim of improving healthcare providers' awareness and ability to identify and address algorithmic bias, and laying a foundation for ensuring patients' health equity in the information age.

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31. Precise Thrombolytic Treatment for Stroke Using AI-based Algorithms: a Real-world Study
SHEN Huiwen, LIN Yongzhong, CHEN Shuliang, ZHANG Lihong, MA Chunye, MA Deyuan, ZHANG Ce
Chinese General Practice    2023, 26 (17): 2070-2077.   DOI: 10.12114/j.issn.1007-9572.2023.0048
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Background The thrombolytic effect for ischemic stroke (IS) is affected by complex factors, such as acute onset of stroke, short therapeutic time window, various individual patient factors, treatment model, types and doses of medicines as well as mode of administration. To identify the influencing factors of thrombolytic effect, most existing studies adopt statistical methods, while rare studies use artificial intelligence (AI) -based algorithms.Objective To establish models using AI-based algorithms for IS patients based on the real-world data including general patient characteristics, medication model and recovery effects, to achieve precise individualized thrombolytic treatment and provide data support for clinical prescription decisions.Methods A retrospective design was used. The clinical information of IS patients (n=55 621) was extracted from the Yidu Cloud scientific research big data server system of the Second Affiliated Hospital of Dalian Medical University from January 1, 2001 to December 31, 2021, among whom 1 855 with complete information were enrolled according to the inclusion criteria. Thrombolysis effect was evaluated by comparing the National Institutes of Health Stroke Scale (NIHSS) score measured at admission and discharge, and those with an improvement in the NIHSS score by ≥4 points and <4 points were assigned to neurological improvement group (n=1 236) , and control group (n=619) , respectively. Factors possibly associated with post-IS thrombolytic effect (including general patient characteristics, medication indicators, examination indicators, test indicators, and treatment methods) were obtained by summarizing the factors suggested separately by three neurology experts with a senior title, and reviewing relevant guidelines and literature, then were screened using univariate analysis, and the identified ones were treated by dimensionality reduction using principal component analysis (PCA) . Models of Logistic, support vector machine (SVM) , C5.0 decision tree arithmetic, classification and regression tree (CART) , deep neural network (DNN) , and Wide&Deep, were built and compared to find the one with the best performance in predicting thrombolytic effect, then to determine its parameters. Then by use of two randomly generated two numbers, 7 and 11, the 1 855 patients were randomly assigned to three datasets, training (n=1 113, for building and practicing models to discover rules) , validation (n=371, for adjusting model parameters) , and test (n=371, for evaluating the generalization ability of the final model) . Feature engineering was used to construct a simplified model and evaluate its accuracy. The clinical information of IS patients (n=3 925) was extracted from the Yidu Cloud scientific research big data server system of Dalian Central Hospital for external verification of the model.

Results

Twenty-six patients characteristics associated with thrombolytic effect were included for establishing models. The dimensionalities were reduced to two principal components by PCA, explaining 93.1% of the total variance. Comparison analysis revealed that the Wide&Deep model had the best predictive performance with an accuracy of 0.815, and an F-index of 0.871. Furthermore, the values of the area under the receiver operating characteristic (AUC) curve of the Wide&Deep model in predicting the thrombolytic effect in patients in the training set and test set were 0.753 and 0.793, respectively. The number of hidden layers and neurons in each layer of the model was 7 and 15, respectively. Using sigmoid as the activation function showed that the model parameters were optimal. The feature-engineering analysis of factors influencing the improvement of neurological function showed that the importance of medication type, administration mode and dosage ranked high, and the importance ranking in a descending order was: cerebrovascular disease history, type of medication, mode of administration, single dose, atherosclerosis, therapeutic time window of thrombolytic therapy, prevalence of use of anticoagulant drugs and drugs for promoting blood circulation and removing blood stasis. After simplifying the independent variables of the model, the accuracy of the Wide&Deep model was 0.819, and its accuracy was 0.801 suggested by the external verification after model simplification, indicating good predictive performance and generalizability.Conclusion The Wide&Deep model has proven to have excellent evaluation indicators. The importance of influencing factors of thrombolytic effect in a descending order is: cerebrovascular disease history, type of medication, administration mode, single dose, atherosclerosis, therapeutic time window of thrombolytic therapy, prevalence of use of anticoagulants and blood-activating and stasis-removing drugs. It provides clinicians with timely and effective thrombolysis treatment support involving thrombolysis related factors and individualized administration using AI-based algorithms.

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32. Analysis of the Effect of Human-computer Interaction Intelligent Management on Blood Glucose Control in New-onset Type 2 Diabetes Mellitus Patients
WANG Lingxiao, DONG Rongna, ZHOU Bing, GUO Lina, LI Jing
Chinese General Practice    2023, 26 (15): 1817-1823.   DOI: 10.12114/j.issn.1007-9572.2022.0784
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Background

Early intervention of blood glucose control in patients with new-onset type 2 diabetes mellitus (T2DM) can help delay the progression of diabetes. As a new form of health management, the effect of human-computer interaction intelligent blood glucose monitoring management on the progression of new-onset T2DM patients has not been clarified.

Objective

To explore the effect of human-computer interaction intelligent management on blood glucose control and self management capability in new-onset T2DM patients, so as to provide the reference for optimizing the control strategy in new-onset T2DM patients.

Methods

From June 2016 to December 2016, 200 patients with new-onset T2DM admitted to the Tianjin Medical University, Chu Hsien-I Memorial Hospital were selected by convenient sampling and randomly divided into the control group (n=100) and the monitoring group (n=100). The interventions in the monitoring group were the same as those in the control group except for the human-computer interaction intelligent monitoring. Blood glucose indexes〔fasting blood glucose (FBG), 2 h postprandial glucose (2 hPG) and glycated hemoglobin (HbA1c) 〕and self-management capability indexes〔diabetes management self-efficacy scale (DMSES), summary of diabetes self-care activities (SDSCA), diabetes self-care scale (2-DSCS) 〕were recorded at the time of enrollment and after 3 months of follow-up in the two groups.

Results

After 3 months of follow-up, the monitoring group included 95 cases, the control group included 97 cases. Compared with the pre-intervention period, FBG, 2 hPG and HbA1c levels decreased in both groups after the intervention (P<0.05), and the scores of DMSES scores increased in both groups (P<0.05). FBG, 2 hPG and HbA1c were significantly lower in the post-intervention period of glucose monitoring group compared with the control group (P<0.05). 67 patients (70.5%) in the monitoring group reached the target level of FBG, 31 patients (32.0%) in the control group as well; besides 49 patients (51.6%) in the monitoring group reached the target level of 2 hPG, 30 patients (30.9%) in the control group as well; moreover, 67 patients (70.5%) in the monitoring group reached the target level of HbA1c, 29 cases (29.9%) in the control group as well, all the above rates of reaching in the monitoring group was higher than those in the control group (P<0.05). The total DMSES score, 2-DSCS score and SDSCA score in the monitoring group were higher than those in the control group (P<0.05). The score of DMSES in new-onset T2DM patients was positively correlated with the scores of 2-DSCS and SDSCA (rs=0.909, 0.872, P<0.01). The 2-DSCS scale score was positively correlated with the SDSCA scale score (rs=0.917, P<0.01). Multiple regression analysis showed that diet control, regular exercise, taking medication as instructed, blood glucose monitoring, prevention and management of high and low blood glucose behaviors were favorable factors for HbA1c reduction (P<0.05). The general diet, special diet and taking medication as instructed were the favorable factors for FBG and 2 hPG levels reduction (P<0.05), and the blood glucose monitoring was positive for 2 hPG levels reduction.

Conclusion

Human-computer interaction intelligent management was able to improve blood glucose control of new-onset T2DM patients effectively, which can promote the reaching to target blood glucose level, the subjective initiative of health behavior mainly through improving compliance of blood glucose monitoring, healthy diet, exercise and taking medication as instructed, which provide advice on effective intervention methods for new-onset T2DM patient management.

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33. Bibliometric Analysis of Artificial Intelligence in Diabetic Retinopathy
LIU Chun, JIAN Wenyuan, DUAN Junguo
Chinese General Practice    2023, 26 (15): 1847-1856.   DOI: 10.12114/j.issn.1007-9572.2022.0851
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Background

In recent years, artificial intelligence (AI) has shown rapid development in the medical field, and its application in diabetic retinopathy (DR) has been expanding.

Objective

To summarize the application of AI in DR through bibliometric analysis and elucidate the current status, hot spots and emerging trends of AI-related research in DR, with a view to providing ideas for future research.

Methods

The research was performed on the Web of Science database for the researches related to AI applications in DR from inception to 2022-11-04 and used CiteSpace software to conduct bibliometric analysis of the number of articles, countries, institutions, authors, co-citation and keywords in the literature.

Results

A total of 1 770 papers were obtained, with an overall increasing trend in the number of publications and a peak of 402 papers in 2021. China was the top country in terms of the number of publications (440), and the UK was the country with the highest intermediary centrality (0.26). A total of 436 institutions were included in the institutional collaboration network mapping, represented by Sun Yat-sen University and Capital Medical University. A total of 601 authors were included in the author collaboration network mapping, represented by JIA Y L and HWANG T. Three highly cited authors, GULSHAN V, ABRàMOFF M D and TING D W, have made important contributions to the field. Ophthalmology, Invest Ophth Vis Sci and Ieee T Med Imaging are the three most influential journals in the field of AI applied to DR. The research hot spots were mainly focused on lesion segmentation and DR diagnosis. The future research trends may be efficacy prediction of diabetic macular edema as a complication of DR, disease management and improvement of AI algorithm performance.

Conclusion

Researchers can refer to the research hot spots and trends shown by this bibliometric analysis, focusing on AI in DR diagnosis, disease management and improvement of AI algorithm performance.

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34. Discussion on the Difficulties and Bottlenecks in the Management of Remote ECG-based Screening for Cardiovascular Disease Risk in Hierarchical Diagnosis and Treatment
ZHANG Haicheng, YU Xinyan, WANG Hongyu, XUE Tao, LIAO Xiaoyang, FAN Yongmei, ZHANG Qinghong
Chinese General Practice    2023, 26 (05): 525-531.   DOI: 10.12114/j.issn.1007-9572.2022.L0002
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In China, the overall prevalence and incidence of cardiovascular disease (CVD) continues to increase, and the mortality rate from CVD in rural areas has exceeded that in urban areas recently. Remote ECG-based screening for CVD risk is a beneficial supplement for CVD risk screening in primary hospitals, but there are many difficulties during its implementation, which mainly include the following aspects: how to improve the awareness and credibility of remote ECG-based screening for CVD risk and sense of gain in residents? How to incentivize primary physicians to actively participate in the screening? How to improve insufficient management ability and experience of primary physicians who can only provide single screening and communication services? How to build a collaborative mechanism between primary and higher level hospitals involved in delivering referral services, and to provide continuous services by establishing multiple teams consisting of screening team, diagnosis team, evaluation team, treatment team and follow-up management team? To address these issues, we invited a group of experts to attend discussions, in which the following recommended solutions were put forward: using various resources rationally and efficiently; strengthening the division of labor and cooperation between team members to improve hierarchical diagnosis and treatment; giving full play to the capacities of nursing and public health teams to develop different screening programmes; strengthening the technical support of experts from higher level medical institutions for primary doctors, and increasing the social benefits of primary hospitals; carrying out workplace training to improve the professional level of primary care workers; integrating Internet technologies into primary care to enable referrals; building a big data database of cases; constructing medical and health groups with clear defined division of labor and cooperation.

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35. Development of a New Remote Diagnosis and Treatment Model for Obstructive Sleep Apnea: a Non-inferiority Randomized Controlled Trial Protocol
YI Huijie, LIAO Xinyi, PI Mengyuan, XU liyue, ZHANG Chi, DONG Xiaosong, HAN Fang
Chinese General Practice    2023, 26 (03): 380-385.   DOI: 10.12114/j.issn.1007-9572.2022.0485
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Obstructive sleep apnea (OSA) is a high prevalent chronic disease that may lead to many complications, and cause great potential harm to health. Epidemiological studies have showed that OSA is closely related to the development of various cardiovascular diseases. There are about 66 million patients with moderate to severe OSA in China, but 80% of potential OSA patients have not been diagnosed and treated in time. OSA is mainly diagnosed and treated in a hospital-based sleep center currently, as the process is time-consuming and laborious, which may be lead to a delay in diagnosis and treatment of many patients. Supported by the development of Internet of Things, Internet technologies and other emerging technologies, remote medicine has been increasingly used in the diagnosis and management of chronic diseases owing to its advantages of easy access, interactivity, high efficiency, resource sharing, service continuity and without space-time constraints. Our center has initially built a management system for remote diagnosis and treatment of OSA, but its clinical efficacy and economic value need to be further verified. We designed a randomized controlled trial protocol to assess whether the clinical benefits of the low-cost remote healthcare model are similar to those of the traditional healthcare model by comparing them in terms of clinical efficacy and health economic benefits, hoping to provide a reference for the efficient use of medical resources and further promotion of remote diagnosis and treatment of chronic diseases.

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36. Machine Learning-based Gait Analysis for Recognition of Amnestic Mild Cognitive Impairment and Alzheimer's Disease
TAO Shuai, HAN Xing, KONG Liwen, WANG Zumin, XIE Haiqun
Chinese General Practice    2022, 25 (31): 3857-3865.   DOI: 10.12114/j.issn.1007-9572.2022.0437
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Background

The prevalence of age-related cognitive impairment, including dementia, has significantly increased with population aging. It has been shown that cognitive function is associated with gait status. Previously, researchers used statistical analysis methods instead of machine learning methods to study the gait of amnestic mild cognitive impairment (aMCI) and Alzheimer's disease (AD) .

Objective

To develop a model to identify aMCI and AD based on gait status using machine learning methods, explore gait markers differentiating between aMCI and AD, and to assess their possible values as aided tools in diagnosing aMCI and AD.

Methods

We recruited 102 cases from the Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical Aids, the First People's Hospital of Foshan, and Affiliated Zhongshan Hospital of Dalian University from December 2018 to December 2020, and included 98 of them according to the screening criteria, including 55 patients with aMCI, 10 patients with AD, and 33 healthy controls (HC) . The gait parameters of the participants were collected during performing single-task (free walking) , dual-task (counting backwards in sevens) and another dual-task (counting backwards from 100) using a wearable device. Random forest (RF) algorithm and gradient boosting decision tree (GBDT) algorithm were separately used to establish a model to compare the effect of two algorithms in recognizing three groups, with 10 gait parameters as predictive variables and the physical status (healthy, aMCI, AD) as response variables. Then important features were chosen using a machine learning algorithm combined with recursive feature elimination (RFE) .

Results

No statistically significant differences were found among the three groups in terms of sex ratio, average age, height, body weight or shoe size (P>0.05) , while the differences in terms of average MMSE score and MoCA score were statistically significant (P<0.05) . In the free walking test, aMCI group and AD group had shorter average stride length and smaller average heel-to-ground angle (HtA) than HC group (P<0.05) . AD group had slower average gait speed and smaller average toe-off angle (ToA) than both HC group and aMCI group (P<0.05) . In performing the dual-task of counting backwards in sevens, compared with HC group, aMCI group and AD group had slower average gait speed and smaller average ToA and HtA (P<0.05) . AD group had longer average stance phase than HC group (P<0.05) . AD group had average smaller ToA than aMCI group (P<0.05) .In performing the dual-task of counting backwards from 100, AD group had slower average gait speed and smaller average HtA and ToA than both HC group and aMCI group (P<0.05) . Moreover, AD group had shorter average stride length than HC group (P<0.05) . The average HtA in aMCI group was smaller than that in HC group (P<0.05) . Using the GBDT-RFE method, we found important gait features in distinguishing between aMCI and AD to be the stride length, ToA and HtA, and the model using the RF algorithm performed better in identifying aMCI and AD, with an accuracy as high as 87.69%.

Conclusion

Stride length, ToA and HtA are important gait markers to identify aMCI and AD. These findings could help clinicians diagnose aMCI and AD in the future.

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37. Visualization Analysis of Artificial Intelligence in Global Esophageal Cancer Research, 2000-2022
TU Jiaxin, YE Huiqing, ZHANG Xiaoqiang, LIN Xueting, YANG Shanlan, DENG Lifang, WU Lei
Chinese General Practice    2023, 26 (06): 760-768.   DOI: 10.12114/j.issn.1007-9572.2022.0461
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Background

The past nearly 20-year period has seen a sudden increase in the use of artificial intelligence (AI) in esophageal cancer research, and an emergence of many systematic reviews and meta-analyses of the research. However, most of the reviews and meta-analyses only address a single aspect in summary, making it difficult for researchers to gain a comprehensive understanding of the latest developments and research hotspots in the field.

Objective

To perform a bibliometric analysis of the use of AI in esophageal cancer research, and the development, hotspots and emerging trend in this field.

Methods

All literature in English regarding esophageal cancer research using AI included in the Science Citation Index Expanded database of the Web of Science Core Collection was searched from 2000-01-01 to 2022-04-06. Microsoft Excel 2019, CiteSpace (5.8R3-64bit) and VOSviewer (1.6.18) were used to analyze the literature for annual number of publications, country, author, institution, co-citation and keywords.

Results

Nine hundred and eighteen studies were retrieved, with a total of 23 490 times of being cited. The number of studies published between 2000 and 2016 grew slowly (from 6 to 40), but increased rapidly between 2017 and 2022 (from 62 to 216). Sixty countries, 118 institutions and 5 979 authors were involved in the studies. China (306 articles), the United States (238 articles) and the United Kingdom (113 articles) ranked the top three in terms of number of studies published. The top three institutions in terms of intensity of cooperation were University of Amsterdam (TLS=72), Catherine Hospital (TLS=64) and Eindhoven University of Technology (TLS=53). The top three authors in terms of number of publications were Jacques J G H M Bergman from the Netherlands (n=16), Tomohiro Tada from Japan (n=12), and Fons Van Der Sommen from the Netherlands (n=12). There were 39 962 co-cited authors and 42 992 co-cited studies. Thirty-three burst keywords were identified: the major burst keywords were p53 and mutations in 2001-2008 (early stage), and were esophageal cancer classification, new examination techniques (tomography), differentiation, identification and comparison between esophageal cancer and other cancers in 2013-2018 (middle stage), and were deep learning, convolutional neural network, and machine learning in esophageal cancer examination and diagnosis applications in 2019-2022 (late stage). Among which deep learning had the highest burst intensity (burst intensity of 13.89) .

Conclusion

AI application in esophageal cancer research has entered a new phase, moving gradually from genes and mutations toward accurate examination, diagnosis, and treatment. The latest major burst keywords in recent years (2019-2022) are deep learning, convolutional neural network, and machine learning in esophageal cancer examination and diagnosis. The future challenges to the use of AI in esophageal cancer research may include individual data collection, data quality assurance, data processing specifications, AI code reproduction, and reliability assurance of AI-assisted diagnostic decision-making.

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38. Efficacy of Remote Rehabilitation Combined with Outpatient Treatment in Mild Adolescent Idiopathic Scoliosis
DONG Jiaxing, WANG Liancheng, ZHANG Jinchai, WANG Shuai, ZHANG Yajie
Chinese General Practice    2022, 25 (32): 4065-4071.   DOI: 10.12114/j.issn.1007-9572.2022.0418
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Background

Scoliosis is a common abnormal curvature of the spine. Patients with mild scoliosis are usually treated with outpatient physiotherapy, but satisfactory efficacy is associated with appropriate treatment time and frequency. The efficacy of offline physiotherapy may be affected by limited medical resources and patients' treatment time and geographical location. Remote rehabilitation may save patients' treatment time and increase the geographical accessibility of physiotherapy, making the therapy more simple and convenient.

Objective

To explore the efficacy of remote rehabilitation combined with outpatient treatment in mild adolescent idiopathic scoliosis (AIS) .

Methods

Fifty-eight eligible mild AIS patients were selected from Department of Rehabilitation Medicine, Tianjin Hospital from September 2020 to September 2021, and divided into three groups according to patients and their parents' selection of treatment: online group (n=18), combined group (n=20) and offline group (n=20). The online group received WeChat- and Tencent Video-based physiotherapeutic scoliosis specific exercise (PSSE), the combined group received both outpatient and WeChat- and Tencent Video-based PSSE treatment, and the offline group received outpatient PSSE treatment. Data of three groups were collected, including the main curve Cobb angle, coronal balance (CB), thoracic kyphosis (TK) angle, lumbar lordosis (LL) angle, sagittal vertical axis (SVA), angle of axial trunk rotation (ATR), parietal vertebra rotation (Raimondi), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), muscle activation rate (MAR) on both sides of paraspinal vertebrae, root mean square ratio (RMSR) of paraspinal muscles on both sides of paraspinal vertebrae, and the score of SRS-22 before and after treatment.

Results

The main curve Cobb angle, TK, SVA, ATR, Raimondi, SS, MAR on paraspinal vertebrae, RMSR on the concave side of the parietal vertebra and SRS-22 self-image and mental health domain scores were significantly different from those before treatment in all groups (P<0.05). Specifically, the combined group was superior to the other two groups in improved ATR and treatment satisfaction. The combined group had significantly improved main curve Cobb angle after treatment than the online group. The improvement of the concave MAR in either the combined group or offline group was significantly better than that in the online group (P<0.05) .

Conclusion

In mild AIS patients, remote rehabilitation combined with outpatient treatment could effectively slow down the progression of AIS curve, improve sagittal abnormality of spine, abnormal posture and vertebral rotation, increase the activation rate of paraspinal muscles on the concave side of paraspinal vertebra and improve the balance of paraspinal muscles on both sides of paraspinal vertebrae. Moreover, the combined therapy also improved the quality of life.

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39. Inflencing Factors for Pulmonary Nodular Growth Predicted by Artificial Intelligence-based Follow-up
Jiuchun WU, Tian LI, Xiaodong LI, Yue ZHUO, Yujiao ZHANG, Jingyu LIU
Chinese General Practice    2022, 25 (17): 2115-2120.   DOI: 10.12114/j.issn.1007-9572.2022.0005
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Background

Lung cancer ranks first in terms of incidence and mortality rates among cancers, with a 5-year survival rate of less than 20%. Many ways have been used to screen for early lung cancer, among which artificial intelligence (AI) has greatly improved the detection rate. However, how to use AI technologies to effectively manage atypical lung nodules to timely find early lung cancer, and to identify associated factors of lung nodule growth, which is an issue significantly associated with the guidance of clinical management of lung nodules.

Objective

To investigate the influencing factors of pulmonary nodules growth identified by AI-based follow-up and relevant clinical value.

Methods

A total of 175 patients with pulmonary nodules admitted to the Third Affiliated Hospital of Jinzhou Medical University in April 2019 were selected for a retrospective study. General clinical data, and AI-based analysis of imaging information related to pulmonary nodules was collected. The growth of pulmonary nodules〔solid nodules (in 82 cases) and ground-glass nodules (in 93 cases) classified by AI-based analysis〕 were observed by regular follow-ups. The influencing factors of pulmonary nodules growth were explored by Cox regression analysis.

Results

Patients with solid nodules had higher prevalence of solid components, and mean CT quantitative parameters of nodules than those with ground-glass nodules (P<0.001) . Multivariate Cox regression analysis showed that average diameter〔HR=2.185, 95%CI (1.079, 4.425) , P=0.030〕, volume〔HR=1.001, 95%CI (1.000, 1.001) , P=0.022〕, malignant probability〔HR=2.232, 95%CI (1.036, 4.806) , P=0.040〕and surface signs〔HR=2.125, 95%CI (1.006, 4.489) , P=0.048〕 of the nodule were associated with solid nodular growth. The average diameter〔HR=2.458, 95%CI (1.053, 5.739) , P=0.038〕, volume〔HR=1.001, 95%CI (1.000, 1.002) , P=0.010〕, prevalence of solid components〔HR=1.022, 95%CI (1.002, 1.041) , P=0.030〕, malignant probability〔HR=2.386, 95%CI (1.174, 4.850) , P=0.016〕, surface signs〔HR=3.026, 95%CI (1.492, 6.136) , P=0.002〕, mean CT quantitative parameters〔HR=1.002, 95%CI (1.000, 1.003) , P=0.045〕 of the nodule were associated with the growth of ground-glass nodules.

Conclusion

The growth of pulmonary nodules was affected by many factors, such as original nodule size, mean CT quantitative parameters, presence of surface signs and malignant probability. It is suggested that clinicians determine the effective follow-up time based on the inflencing factors of pulmonary nodules growth identified by AI technologies, so as to detect the growth of pulmonary nodules as soon as possible and deliver treatment measures timely.

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40. Creation and Utilization of the Health Records in Residents: a Demand-side Survey in Three Eastern, Central and Western Chinese Provinces
Zhongshi JIANG, Lili YOU, Siqi YANG, Zixuan FAN, Yuanli LIU
Chinese General Practice    2022, 25 (13): 1539-1544.   DOI: 10.12114/j.issn.1007-9572.2022.00.010
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Background

The creation of health records for Chinese residents is a key task for deepening the reform of the pharmaceutical and healthcare system, and an important action for promoting the equity of essential public health services. However, domestic studies on resident health records are mainly using the data from a city or community, and those using the national data from a demand-side perspective are rather scarce.

Objective

To understand the creation and utilization of health records in Chinese residents.

Methods

From November to December 2019, multistage sampling was used to select three provinces/municipality (Zhejiang, Shanxi and Chongqing) from eastern, central and western China (one was extracted from each geographical region) , then from each of them, one urban district and one county were extracted. Randomly selected 2 community health centers/stations, township health centers/village clinics in the corresponding districts (counties) . Finally, 20 community health service centers/township health centers were selected, the visitors of these institutions were invited to attend a questionnaire survey for understanding their information about the creation of health records, and the access to the health records, as well as satisfaction with the services. For ease of analysis, the visitors were classified into six categories (0-6-year-olds, pregnant women, over 65-year-olds, hypertensioners, diabetics, and general population) in accordance with the population groups defined in the Essential Public Health Service Programs.

Results

Altogether, 10 067 residents were included for final analysis. Among them, 9 119 (90.58%) self-reported that they had received health records creation services. The rates of creation of health records in 0-6-year-olds, pregnant women, over 65-year-olds without hypertension/diabetes, over 65-year-olds with hypertension, under 65-year-olds with hypertension, over 65-year-olds with diabetes, and under 65-year-olds with diabetes, as well as general population were 94.09% (2 787/2 962) , 95.60% (956/1 000) , 87.87% (616/701) , 88.87% (1 414/1 591) , 92.91% (747/804) , 89.41% (895/1 001) , 92.72% (471/508) , and 82.20% (1 233/1 500) , respectively. Among those with health records created, 67.02% (5 990 / 8 938) could access to their health records at any time, and the health records accessed by most of them were printed〔75.76% (4 538/5 990) 〕. However, 12.40% (1 108/8 938) of residents reported that they had no access to their health records, and other 20.59% (1 840/8 938) indicated that they had never tried to gain access to their health records. The rate of satisfaction with health records services in residents was 83.31% (4 352/5 224) . The rate of health records creation and rate of accessing the health records differed significantly by province, district or country, household monthly income per person, education level, and category of population (P<0.05) . The rates of satisfaction with the creation of and access to health records differed significantly by province, type of visited health institution, district or country, household monthly income per person, education level, and category of population (P<0.05) .

Conclusion

Generally, the rate of creation of health records in Chinese residents has significantly increased. The rate of utilization of the records has also enhanced, but needs further improvement. Moreover, residentssatisfaction with health records services may be at a moderate level.

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