2025
Autores
Santos, CS; Amorim-Lopes, M;
Publicação
BMC MEDICAL RESEARCH METHODOLOGY
Abstract
Background This scoping review systematically maps externally validated machine learning (ML)-based models in cancer patient care, quantifying their performance, and clinical utility, and examining relationships between models, cancer types, and clinical decisions. By synthesizing evidence, this study identifies, strengths, limitations, and areas requiring further research. Methods The review followed the Joanna Briggs Institute's methodology, Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, and the Population, Concept, and Context mnemonic. Searches were conducted across Embase, IEEE Xplore, PubMed, Scopus, and Web of Science (January 2014-September 2022), targeting English-language quantitative studies in Q1 journals (SciMago Journal and Country Ranking > 1) that used ML to evaluate clinical outcomes for human cancer patients with commonly available data. Eligible models required external validation, clinical utility assessment, and performance metric reporting. Studies involving genetics, synthetic patients, plants, or animals were excluded. Results were presented in tabular, graphical, and descriptive form. Results From 4023 deduplicated abstracts and 636 full-text reviews, 56 studies (2018-2022) met the inclusion criteria, covering diverse cancer types and applications. Convolutional neural networks were most prevalent, demonstrating high performance, followed by gradient- and decision tree-based algorithms. Other algorithms, though underrepresented, showed promise. Lung and digestive system cancers were most frequently studied, focusing on diagnosis and outcome predictions. Most studies were retrospective and multi-institutional, primarily using image-based data, followed by text-based and hybrid approaches. Clinical utility assessments involved 499 clinicians and 12 tools, indicating improved clinician performance with AI assistance and superior performance to standard clinical systems. Discussion Interest in ML-based clinical decision-making has grown in recent years alongside increased multi-institutional collaboration. However, small sample sizes likely impacted data quality and generalizability. Persistent challenges include limited international validation across ethnicities, inconsistent data sharing, disparities in validation metrics, and insufficient calibration reporting, hindering model comparison reliability.
2025
Autores
Amorim-Lopes, M; Cruz-Gomes, S; Doldi, E; Almada-Lobo, B;
Publicação
HEALTH POLICY
Abstract
The specialization of Health Human Resources (HHR) is increasingly recognized as essential for addressing evolving healthcare demands. This paper presents a comprehensive policy framework for assisting with the implementation of Clinical Nurse Specialist (CNS) roles at the national or regional level, integrating key dimensions including barriers and enablers, regulation and governance, education and training requirements, career development, workforce planning, and economic analysis. The framework was applied to the implementation of CNS roles in Portugal, resulting in the issuance of a decree-law by the government. Our findings demonstrate that the economic analysis step was critical in addressing concerns from government authorities and health system funders regarding the potential budgetary impact of CNS implementation. By providing evidence-based projections of costs and benefits, the economic analysis facilitated smoother negotiations and consensus-building among stakeholders, including nursing unions. Furthermore, the integration of workforce planning ensured the alignment of educational capacity with workforce needs, thus avoiding potential implementation bottlenecks. The application of the framework also revealed important feedback relationships between its dimensions, highlighting the interdependent nature of the implementation process. This dynamic approach, which adapts to real-time feedback and stakeholder input, underscores the necessity of a holistic and iterative strategy for successful CNS role integration. The insights gained from the Portuguese case underscore the utility of this policy framework in guiding the implementation of advanced nursing roles in diverse healthcare contexts.
2025
Autores
Reza, S; Ferreira, MC; Machado, JJM; Tavares, JMRS;
Publicação
EXPERT SYSTEMS
Abstract
An autonomous vehicle can sense its environment and operate without human involvement. Its adequate management in an intelligent transportation system could significantly reduce traffic congestion and overall travel time in a network. Adaptive traffic signal controller (ATSC) based on multi-agent systems using state-action-reward-state-action (SARSA (lambda)) are well-known state-of-the-art models to manage autonomous vehicles within urban areas. However, this study found inefficient weights updating mechanisms of the conventional SARSA (lambda) models. Therefore, it proposes a Gaussian function to regulate the eligibility trace vector's decay mechanism effectively. On the other hand, an efficient understanding of the state of the traffic environment is crucial for an agent to take optimal actions. The conventional models feed the state values to the agents through the MinMax normalization technique, which sometimes shows less efficiency and robustness. So, this study suggests the MaxAbs scaled state values instead of MinMax to address the problem. Furthermore, the combination of the A-star routing algorithm and proposed model demonstrated a good increase in performance relatively to the conventional SARSA (lambda)-based routing algorithms. The proposed model and the baselines were implemented in a microscopic traffic simulation environment using the SUMO package over a complex real-world-like 21-intersections network to evaluate their performance. The results showed a reduction of the vehicle's average total waiting time and total stops by a mean value of 59.9% and 17.55% compared to the considered baselines. Also, the A-star combined with the proposed controller outperformed the conventional approaches by increasing the vehicle's average trip speed by 3.4%.
2025
Autores
Martins, AR; Ferreira, MC; Fernandes, CS;
Publicação
International Journal of Medical Informatics
Abstract
2025
Autores
Martins, AR; Ferreira, MC; Fernandes, CS;
Publicação
INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS
Abstract
Purpose:To synthesizethe availableevidenceaboutthe use of HealthInformationTechnology(HIT)to supportpatientsduringhemodialysis.Methods:TheJoannaBriggsInstitute's methodologicalguidelinesfor scopingreviewsandthe PRISMA-ScRchecklistwereemployed.BibliographicsearchesacrossMEDLINE (R), CINAHL (R), PsychologyandBehavioralSciencesCollection,Scopus,MedicLatina,and Cochraneyielded932 records.Results:Eighteenstudiespublishedbetween2003and2023wereincluded.Theyexploreda rangeof HITs,includingvirtualreality,exergames,websites,and mobileapplications,all specificallydevelopedfor use duringthe intradialyticperiod.Conclusion:Thisstudyhighlightsthe HITsdevelopedfor use duringhemodialysistreatment,supportingphysicalexercise,diseasemanagement,and enhancementof self-efficacyand self-care.
2025
Autores
Botelho, TC; Duarte, SP; Ferreira, MC; Ferreira, S; Lobo, A;
Publicação
EUROPEAN TRANSPORT RESEARCH REVIEW
Abstract
The evolution of transport technologies, marked by integrating connectivity and automation, has led to innovative approaches such as truck platooning. This concept involves linking multiple trucks through automated driving and vehicle-to-vehicle communication, promising to revolutionize the freight industry by enhancing efficiency and reducing operational costs. This systematic review explores the current state of truck platooning testing literature, focusing on simulator and on-road tests. The objective is to identify key scenarios and requirements for successfully developing and implementing the truck platooning concept. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) guidelines, we searched the Web of Science and Scopus databases, leading to the inclusion of thirty pertinent articles encompassing simulation-based, on-road, and mixed-environment experiments. In addition to the type of testing environment, these articles were assorted into three groups corresponding to their main thematic scope, human-centered, technology-centered, and energy efficiency studies, each providing unique insights into core themes for the development of truck platooning. The results reveal a commonly preferred platoon formation consisting of three trucks maintaining a constant speed of 80 km/h and a stable distance of 10 m between them. Simulator-based studies have predominantly concentrated on human factors, examining driver behavior and interaction within the platooning framework. In contrast, on-road trials have yielded tangible data, offering a more technology-driven perspective and contributing practical insights to the field. While the literature on truck platooning has grown considerably, this review recognizes some limitations in the existing literature and suggests paths for future research. Overall, this systematic review provides valuable insights to the ongoing development of robust and effective truck platooning systems.
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