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Surgical site infections (SSIs) remain a significant source of postoperative morbidity despite established guidelines for perioperative antibiotic prophylaxis. Current protocols emphasize fixed preoperative timing and interval-based intraoperative redosing, yet fail to account for patient heterogeneity, pharmacokinetic variability, and uncertainty in procedure duration. This study proposes a hierarchical reinforcement learning (HRL) framework for personalized optimization of antibiotic prophylaxis across the perioperative timeline. The framework decomposes decision-making into two coordinated levels: a high-level policy that determines optimal preoperative antibiotic timing based on predicted procedure duration and patient-specific infection risk, and a low-level policy that adaptively manages intraoperative redosing using real-time updates on elapsed time, remaining duration, and cumulative drug exposure. Procedure duration is estimated using machine learning models that provide both point predictions and uncertainty intervals, enabling risk-sensitive decision-making. The problem is formalized as a Markov decision process with a reward structure balancing SSI prevention against antibiotic stewardship, incorporating penalties for unnecessary dosing and suboptimal timing. Off-policy evaluation using historical surgical data is proposed to assess performance relative to guideline-based and clinician-driven strategies. By integrating predictive modeling with multi-timescale decision optimization, the framework aims to reduce SSI incidence while minimizing antibiotic overuse. This approach highlights the potential of reinforcement learning to advance precision perioperative care and improve clinical outcomes through adaptive, data-driven prophylaxis strategies.

Extracorporeal membrane oxygenation (ECMO) is used to support patients with severe cardiac or respiratory failure, requiring constant manual adjustments of pump flow, sweep gas flow, and oxygen fraction. However, current ECMO management lacks a real-time optimization system tailored to individual patient needs. This manuscript proposes an offline reinforcement learning framework for dynamic ECMO optimization, utilizing real-time measurements of blood gases, hemodynamics, and pump flow. The framework includes a state encoder for various patient data, an action space for adjustments to ECMO settings, and a reward function that balances oxygenation, hemodynamic support, and complication avoidance. A safety shield filters unsafe recommendations before clinician review. The system aims to provide personalized, proactive, and safety-constrained ECMO management, with the goal of guiding future research validation rather than claiming experimental results.

Personalized rehabilitation exercise prescriptions are essential for recovery after neurological injury, orthopedic surgery, and chronic decline. While physical therapists have valuable expertise, translating it into scalable computational systems is challenging. Standard deep reinforcement learning relies on manually defined reward functions, but in rehabilitation, clinically significant goals like movement quality, fatigue, pain, safety, motivation, and adherence are difficult to quantify. This paper introduces a framework combining inverse reinforcement learning (IRL) and deep reinforcement learning (DRL) to learn personalized rehabilitation prescriptions from therapist demonstrations. IRL would derive expert-aligned rewards, and DRL would use these to create adaptive exercise plans. The framework encompasses therapist demonstration collection, movement trajectory representation, reward inference, policy learning, safety constraints, and clinical oversight. Demonstrations would include exercise selection, progression decisions, and therapist responses to patient fatigue, pain, or adherence issues. IRL could capture implicit clinical priorities, while DRL would adjust prescriptions based on patient conditions such as fatigue, progress, and engagement. The framework aims to create scalable, personalized rehabilitation prescriptions, offering a conceptual model for future rehabilitation robotics, exergaming, and home-based digital rehabilitation systems.