Learning classification models from multiple experts

Building classification models from clinical data using machine learning methods often relies on labeling of patient examples by human experts. Standard machine learning framework assumes the labels are assigned by a homogeneous process. However, in reality the labels may come from multiple experts and it may be difficult to obtain a set of class labels everybody agrees on; it is not uncommon that different experts have different subjective opinions on how a specific patient example should be classified. In this work we propose and study a new multi-expert learning framework that assumes the class labels are provided by multiple experts and that these experts may differ in their class label assessments. The framework explicitly models different sources of disagreements and lets us naturally combine labels from different human experts to obtain: (1) a consensus classification model representing the model the group of experts converge to, as well as, and (2) individual expert models. We test the proposed framework by building a model for the problem of detection of the Heparin Induced Thrombocytopenia (HIT) where examples are labeled by three experts. We show that our framework is superior to multiple baselines (including standard machine learning framework in which expert differences are ignored) and that our framework leads to both improved consensus and individual expert models.     

多种微量元素注射液临床应用中国专家共识（2021）

多种微量元素注射液可以提供铁、锌、铜、锰、钴、氟、碘、硒、钼、铬等多种人体微量元素，广泛应用于需要肠外营养 治疗的患者。为了进一步提高临床医师对多种微量元素注射液的认识，更好地指导其临床合理用药，特邀请全国专家组成员， 在系统性文献检索的基础上，参考欧洲临床营养与代谢学会（ESPEN）、美国肠外与肠内营养学会（ASPEN）指南，结合我国临床 实践，经多次交流讨论，达成此共识。本共识基于临床研究证据和专家经验，为多种微量元素注射液临床用于危重症、中重度 烧伤、围手术期、肿瘤、老年、透析、肠瘘及短肠综合征等提供参考。     

Asian Thoracic Oncology Research Group Expert Consensus Statement on Optimal Management of Stage III NSCLC

Stage III NSCLC represents a heterogeneous disease for which optimal treatment continues to pose a clinical challenge. Recent changes in the American Joint Commission on Cancer staging to the eighth edition has led to a shift in TNM stage grouping and redefined the subcategories (IIIA–C) in stage III NSCLC for better prognostication. Although concurrent chemoradiotherapy has remained standard-of-care for stage III NSCLC for almost 2 decades, contemporary considerations include the impact of different molecular subsets of NSCLC, and the roles of tyrosine kinase inhibitors post-definitive therapy and of immune checkpoint inhibitors following chemoradiotherapy. With rapid evolution of diagnostic algorithms and expanding treatment options, the need for interdisciplinary input involving multiple specialists (medical oncologists, radiation oncologists, pulmonologists, radiologists, pathologists and thoracic surgeons) has become increasingly important. The unique demographics of Asian NSCLC pose further challenges when applying clinical trial data into clinical practice. This includes differences in smoking rates, prevalence of oncogenic driver mutations, and access to health care resources including molecular testing, prompting the need for critical review of existing data and identification of current gaps. In this expert consensus statement by the Asian Thoracic Oncology Research Group, an interdisciplinary group of experts representing Hong Kong, Korea, Japan, Taiwan, Singapore, Thailand, Malaysia, and Mainland China was convened. Standard clinical practices for stage III NSCLC across different Asian countries were discussed from initial diagnosis and staging through to multi-modality approaches including surgery, chemotherapy, radiation, targeted therapies, and immunotherapy.     

An update of the expert consensus statement of the Czech Hypertension Society on renal denervation in resistant hypertension

In the spring of 2012, the Czech Society of Cardiology and Czech Hypertension Society issued a joint expert consensus statement on catheter-based renal denervation (RDN) in the Czech Republic. On the basis of new information from the Symplicity HTN-3, PRAGUE-15 and other studies, there is no reason to introduce RDN into clinical practice. New modalities for RDN, such as radiofrequency ablation, are investigated.     

【开放获取】特应性皮炎湿包疗法临床应用专家共识

【摘要】 湿包疗法治疗特应性皮炎安全有效，但如何合理、有效、安全地使用已经成为临床工作中受关注的问题。为此，我国皮炎湿疹领域部分专家依据国内外研究数据和临床经验，结合中国患者的特点，在深入讨论的基础上制定本共识，涉及湿包疗法的作用机制、适应证和禁忌证、治疗方法、疗效与安全性、特殊人群以及家庭湿包疗法等方面，为临床医生提供具体的指导意见。     

Global burn care and the ideal burn dressing reloaded — A survey of global experts

PurposeBurn care is a highly relevant medical specialty in every part of the world. Different infrastructure, healthcare systems and access to medical supplies lead to different needs, treatment strategies and outcomes. A fundamental tool in a burn care provider’s armamentarium is the use of different dressings. Several studies have investigated the question of the ideal burn dressing, but none could achieve a proper global perspective. With advanced dressings being on the rise, we conducted this study to get a global understanding of the actual use and idea of the ideal burn dressing.ObjectiveThe objective of this study was to investigate the understanding of an ‘ideal burn dressing’ on a global scale.Materials and methodsA questionnaire about burn care and the ideal burn dressing has been created and translated to five of the most spoken languages world-wide (English, Spanish, French, Chinese, Indonesian). It has been uploaded to an online survey platform and sent out to burn experts worldwide. The voluntary participation was possible for a period of four weeks.ResultsIn total, 196 respondents from 49 countries participated in the study, yielding a response rate of 24.5%. The most important burn dressing characteristics in a cumulative ranking were (1) lack of adhesion (80.54%), (2) pain-free dressing change (79.87%), (3) requirement of fewer dressing changes, while in a linear ranking they were (1) anti-infective (35.14% 1st), pain-reduction (24.14% 2nd), and high absorbency (23.49% 3rd). Silver-based dressings are the most used dressings for superficial (45.21%) and deep (52.78%). 94.81% believe that the choice of burn dressing affects the outcome.ConclusionThis investigation has delivered valuable insights into the global perspective of the ideal burn dressing. Yet, the question of the ideal burn dressing is still inconclusive. Wound dressing research is of fundamental interest for patients, healthcare providers and healthcare systems.     

运用德尔菲法制定北京居民心理健康评价指标

目的:制定北京居民心理健康评价指标体系。方法:在文献回顾基础上运用德尔菲法,通过对全国范围内相关领域专家进行3轮函询制定出适用于北京居民的心理健康评价指标体系。结果:3轮专家咨询的积极系数分别为93.5%、100%、80%,权威程度分别为0.83、0.85、0.85,所有指标重要性协调系数分别为0.137、0.224、0.221,对其进行检验P0.05,专家意见具有一致性。制定出北京居民心理健康评价指标体系包括自我意识、自觉性、情绪和情感、人际关系、环境适应、挫折应对6个一级维度及19个二级维度。结论:专家的代表性强,权威程度高,协调性较好,对此研究关心程度较高,制定了较为科学可靠的北京居民心理健康评价指标体系。此外,德尔菲法在心理健康评价指标制定中得到了创新性的运用。     

Fracture-related infection: A consensus on definition from an international expert group

Fracture-related infection (FRI) is a common and serious complication in trauma surgery. Accurately estimating the impact of this complication has been hampered by the lack of a clear definition. The absence of a working definition of FRI renders existing studies difficult to evaluate or compare. In order to address this issue, an expert group comprised of a number of scientific and medical organizations has been convened, with the support of the AO Foundation, in order to develop a consensus definition.The process that led to this proposed definition started with a systematic literature review, which revealed that the majority of randomized controlled trials in fracture care do not use a standardized definition of FRI. In response to this conclusion, an international survey on the need for and key components of a definition of FRI was distributed amongst all registered AOTrauma users. Approximately 90% of the more than 2000 surgeons who responded suggested that a definition of FRI is required. As a final step, a consensus meeting was held with an expert panel. The outcome of this process led to a consensus definition of FRI.Two levels of certainty around diagnostic features were defined. Criteria could be confirmatory (infection definitely present) or suggestive. Four confirmatory criteria were defined: Fistula, sinus or wound breakdown; Purulent drainage from the wound or presence of pus during surgery; Phenotypically indistinguishable pathogens identified by culture from at least two separate deep tissue/implant specimens; Presence of microorganisms in deep tissue taken during an operative intervention, as confirmed by histopathological examination. Furthermore, a list of suggestive criteria was defined. These require further investigations in order to look for confirmatory criteria.In the current paper, an overview is provided of the proposed definition and a rationale for each component and decision. The intention of establishing this definition of FRI was to offer clinicians the opportunity to standardize clinical reports and improve the quality of published literature. It is important to note that the proposed definition was not designed to guide treatment of FRI and should be validated by prospective data collection in the future.