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Principal Investigator: Vijay Ramakrishnan
Organization: INDIANA UNIVERSITY INDIANAPOLIS
Fiscal Year: 2024
Award: $752,420
Funding agency: National Institute of Allergy and Infectious Diseases
SUMMARY: Chronic rhinosinusitis (CRS) is a highly prevalent disease that inflicts a severe quality-of-life
(QOL) impairment, with local symptoms of nasal blockage, congestion, loss of smell, nasal drainage,
headache, and recurrent infections. CRS is also appreciated for its prominent role as a compounding factor in
other respiratory diseases such as allergic rhinitis, asthma/COPD, and cystic fibrosis. General health concerns
including fatigue, sleep dysfunction, anxiety/depression, excessive medication usage, frequent physician visits,
and productivity loss often accompany nasal symptoms and contribute to overall health detriment. As a result
of local symptom burden and overall health disturbance, CRS has been ranked among the most severe health
ailments, alongside congestive heart failure and end-stage renal disease.
Among existing therapeutic options for CRS, outcomes vary widely. The stepwise approach to CRS
management results in slow and measured escalation of care only after repeated attempts at various medical
therapies. As nuanced understanding of disease trajectories are uncovered through deep phenotyping of
individuals with CRS, a precision approach to this chronic disease is on the horizon. A patient’s decision to
commit to aggressive CRS treatment, such as surgery, includes many personal factors but inherently relies on
the likelihood for symptom improvement. Not surprisingly, the degree of symptom improvement gained is the
primary contributor to patient satisfaction with the intervention. Though numerous risk factors have been
associated with symptom severity and outcomes in CRS, there is a notable void in translation of these
observations to real-world, clinical decision-making. This is due to the many possible predictor variables,
unclear disease natural history, and weakness of traditional statistical approaches in dealing with noisy data.
Indeed, weighing these many considerations is a complex clinical task.
Our long-term goal is to create a personalized predictive model that can help individual patients understand
their likely outcomes with available therapeutic options. Translating research observations into a
comprehensible platform for shared decision-making, precision medicine, and rational allocation of system
resources (i.e., cost-benefit analyses) would be truly innovative in CRS. Our central hypothesis is that machine
learning and artificial intelligence approaches can be applied to myriad demographic and clinical data to infer
clinical outcomes for individuals deciding when to pursue surgical treatment for CRS. The proposed research is
significant because of its potential to: (1) illuminate how disease manifestations occur in some but not all CRS
patients, (2) predict patient trajectories and inform clinical interventions, (3) support real-time clinical decision
making, (4) develop new patient-centered treatment algorithms, and (5) serve as an initial study of predictive
analytics informing the decision for elective surgical therapies in chronic disease.
Terms: <21+ years old><AI system><Accessory Sinuses><Adoption><Adult><Adult Human><Affect><After Care><After-Treatment><Aftercare><Airway Disease><Algorithms><Allergic rhinitis><Allergic rhinitis due to allergen><Allergic rhinosinusitis><American><Anosmia><Anxiety><Artificial Intelligence><Asthma><Atopic rhinitis><Bronchial Asthma><COPD><Cardiac Failure Congestive><Caring><Cephalalgia><Cephalgia><Cephalodynia><Characteristics><Chronic><Chronic Disease><Chronic Illness><Chronic Obstruction Pulmonary Disease><Chronic Obstructive Lung Disease><Chronic Obstructive Pulmonary Disease><Client satisfaction><Clinical><Clinical Data><Cognitive Disturbance><Cognitive Impairment><Cognitive decline><Cognitive function abnormal><Complex><Computer Reasoning><Congestive Heart Failure><Cost-Benefit Analysis><Cranial Pain><Cystic Fibrosis><Data><Data Science><Data Set><Decision Making><Development><Disease><Disease Management><Disorder><Disorder Management><Disturbance in cognition><Drainage><Drainage procedure><Drugs><ESRD><Effectiveness><End stage renal failure><End-Stage Kidney Disease><End-Stage Renal Disease><Fatigue><Financial Hardship><Goals><Head Pain><Headache><Health><Heart Decompensation><Human><Impaired cognition><Impairment><Individual><Intervention><Intervention Strategies><Interview><Kidney Diseases><Knowledge><Lack of Energy><Machine Intelligence><Machine Learning><Measures><Medical><Medical Care Costs><Medication><Mental Depression><Methods><Mission><Modern Man><Mucoviscidosis><NIH><Nasal><Nasal Passages Nose><Nasal Sinuses><Nasal cavity/Paranasal><Nasal cavity/Paranasal sinuses><National Institutes of Health><Nephropathy><Nose><Observation research><Observation study><Observational Study><Observational research><Operative Procedures><Operative Surgical Procedures><Otolaryngology><Outcome><Outcome Study><Paranasal Sinuses><Patient Care><Patient Care Delivery><Patient Satisfaction><Patients><Pattern><Personalized medical approach><Pharmaceutical Preparations><Phenotype><Physicians><Population><Predictive Analytics><QOL><Quality of life><Renal Disease><Reporting><Research><Research Resources><Resources><Respiration Disorders><Respiratory Disease><Respiratory Disorder><Respiratory System Disease><Respiratory System Disorder><Respiratory System, Nose, Nasal Passages><Rhinitis allergic atopic><Risk><Risk Factors><Role><Severities><Severity of illness><Sinus><Sleep Disorders><Structure><Surgical><Surgical Interventions><Surgical Procedure><Symptom Burden><Symptoms><System><Techniques><Testing><Therapeutic><Time><Translating><Translations><Treatment outcome><Trust><United States><United States National Institutes of Health><Visit><Work><adulthood><alleviate symptom><ameliorating symptom><anosphrasia><breathing disorder><care for patients><care of patients><caring for patients><chronic disorder><chronic heart failure><chronic obstructive pulmonary disorder><chronic rhinosinusitis><clinical applicability><clinical application><clinical care><clinical decision support><clinical decision-making><clinical practice><clinical predictors><clinically actionable><cognitive dysfunction><cognitive loss><computer based prediction><cost><cost benefit economics><cost benefit effectiveness><customized therapy><customized treatment><data visualization><decrease symptom><depression><developmental><disability><disease natural history><disease phenotype><disease severity><disparities in treatment><drug/agent><expectation><experience><fewer symptoms><financial adversity><financial burden><financial distress><financial insecurity><financial strain><financial stress><head ache><human-in-the-loop><implementation facilitation><implementation science><improve symptom><improved><individual patient><individualized approach><individualized clinical decision><individualized decision><individualized management><individualized medicine><individualized patient management><individualized patient treatment><individualized predictions><individualized therapeutic><individualized therapeutic strategy><individualized therapy><individualized treatment><inequality in treatment><infection recurrence><informatics tool><innovate><innovation><innovative><interventional strategy><iterative design><kidney disorder><learning activity><learning method><learning strategies><learning strategy><loss of smell><machine based learning><medical costs><medical expenses><multidisciplinary><novel><olfactory loss><otorhinolaryngology><outcome prediction><patient centered><patient expectation><patient oriented><patient specific therapies><patient specific treatment><personalization of treatment><personalized approach><personalized clinical decision><personalized clinical management><personalized data-driven decision><personalized decision><personalized disease management><personalized management><personalized medicine><personalized predictions><personalized therapeutic><personalized therapy><personalized treatment><post treatment><precision approach><precision management><precision medicine><precision-based medicine><prediction algorithm><predictive modeling><preference><productivity loss><prospective><prototype><recurrent infection><recurring infection><reduce symptoms><relieves symptoms><renal disorder><respiratory dysfunction><response><shareable platform><shared decision making><sharing platform><skills><sleep difficulty><sleep diseases><sleep dysfunction><sleep illness><sleep problem><social role><support tools><surgery><symptom alleviation><symptom improvement><symptom reduction><symptom relief><symptomatic improvement><tailored approach><tailored medical treatment><tailored therapy><tailored treatment><translation><translational impact><treatment center><treatment disparity><treatment inequality><treatment inequity><treatment planning><unique treatment><user centered design>