5,847 research outputs found
Natural Language Processing of Clinical Notes on Chronic Diseases: Systematic Review
Novel approaches that complement and go beyond evidence-based medicine are required in the domain of chronic diseases, given the growing incidence of such conditions on the worldwide population. A promising avenue is the secondary use of electronic health records (EHRs), where patient data are analyzed to conduct clinical and translational research. Methods based on machine learning to process EHRs are resulting in improved understanding of patient clinical trajectories and chronic disease risk prediction, creating a unique opportunity to derive previously unknown clinical insights. However, a wealth of clinical histories remains locked behind clinical narratives in free-form text. Consequently, unlocking the full potential of EHR data is contingent on the development of natural language processing (NLP) methods to automatically transform clinical text into structured clinical data that can guide clinical decisions and potentially delay or prevent disease onset
Enhance Representation Learning of Clinical Narrative with Neural Networks for Clinical Predictive Modeling
Medicine is undergoing a technological revolution. Understanding human health from clinical data has major challenges from technical and practical perspectives, thus prompting methods that understand large, complex, and noisy data. These methods are particularly necessary for natural language data from clinical narratives/notes, which contain some of the richest information on a patient. Meanwhile, deep neural networks have achieved superior performance in a wide variety of natural language processing (NLP) tasks because of their capacity to encode meaningful but abstract representations and learn the entire task end-to-end. In this thesis, I investigate representation learning of clinical narratives with deep neural networks through a number of tasks ranging from clinical concept extraction, clinical note modeling, and patient-level language representation. I present methods utilizing representation learning with neural networks to support understanding of clinical text documents.
I first introduce the notion of representation learning from natural language processing and patient data modeling. Then, I investigate word-level representation learning to improve clinical concept extraction from clinical notes. I present two works on learning word representations and evaluate them to extract important concepts from clinical notes. The first study focuses on cancer-related information, and the second study evaluates shared-task data. The aims of these two studies are to automatically extract important entities from clinical notes. Next, I present a series of deep neural networks to encode hierarchical, longitudinal, and contextual information for modeling a series of clinical notes. I also evaluate the models by predicting clinical outcomes of interest, including mortality, length of stay, and phenotype predictions. Finally, I propose a novel representation learning architecture to develop a generalized and transferable language representation at the patient level. I also identify pre-training tasks appropriate for constructing a generalizable language representation. The main focus is to improve predictive performance of phenotypes with limited data, a challenging task due to a lack of data.
Overall, this dissertation addresses issues in natural language processing for medicine, including clinical text classification and modeling. These studies show major barriers to understanding large-scale clinical notes. It is believed that developing deep representation learning methods for distilling enormous amounts of heterogeneous data into patient-level language representations will improve evidence-based clinical understanding. The approach to solving these issues by learning representations could be used across clinical applications despite noisy data. I conclude that considering different linguistic components in natural language and sequential information between clinical events is important. Such results have implications beyond the immediate context of predictions and further suggest future directions for clinical machine learning research to improve clinical outcomes. This could be a starting point for future phenotyping methods based on natural language processing that construct patient-level language representations to improve clinical predictions. While significant progress has been made, many open questions remain, so I will highlight a few works to demonstrate promising directions
Clinical narrative analytics challenges
Precision medicine or evidence based medicine is based on
the extraction of knowledge from medical records to provide individuals
with the appropriate treatment in the appropriate moment according to
the patient features. Despite the efforts of using clinical narratives for
clinical decision support, many challenges have to be faced still today
such as multilinguarity, diversity of terms and formats in different services,
acronyms, negation, to name but a few. The same problems exist
when one wants to analyze narratives in literature whose analysis would
provide physicians and researchers with highlights. In this talk we will
analyze challenges, solutions and open problems and will analyze several
frameworks and tools that are able to perform NLP over free text to
extract medical entities by means of Named Entity Recognition process.
We will also analyze a framework we have developed to extract and validate
medical terms. In particular we present two uses cases: (i) medical
entities extraction of a set of infectious diseases description texts provided
by MedlinePlus and (ii) scales of stroke identification in clinical
narratives written in Spanish
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Discovering body site and severity modifiers in clinical texts
Objective: To research computational methods for discovering body site and severity modifiers in clinical texts. Methods: We cast the task of discovering body site and severity modifiers as a relation extraction problem in the context of a supervised machine learning framework. We utilize rich linguistic features to represent the pairs of relation arguments and delegate the decision about the nature of the relationship between them to a support vector machine model. We evaluate our models using two corpora that annotate body site and severity modifiers. We also compare the model performance to a number of rule-based baselines. We conduct cross-domain portability experiments. In addition, we carry out feature ablation experiments to determine the contribution of various feature groups. Finally, we perform error analysis and report the sources of errors. Results: The performance of our method for discovering body site modifiers achieves F1 of 0.740–0.908 and our method for discovering severity modifiers achieves F1 of 0.905–0.929. Discussion Results indicate that both methods perform well on both in-domain and out-domain data, approaching the performance of human annotators. The most salient features are token and named entity features, although syntactic dependency features also contribute to the overall performance. The dominant sources of errors are infrequent patterns in the data and inability of the system to discern deeper semantic structures. Conclusions: We investigated computational methods for discovering body site and severity modifiers in clinical texts. Our best system is released open source as part of the clinical Text Analysis and Knowledge Extraction System (cTAKES)
A Multi-Label Machine Learning Approach to Support Pathologist\u27s Histological Analysis
This paper proposes a new tool in the field of telemedicine, defined as a specific branch where IT supports medicine, in case distance impairs the proper care to be delivered to a patient. All the information contained into medical texts, if properly extracted, may be suitable for searching, classification, or statistical analysis. For this reason, in order to reduce errors and improve quality control, a proper information extraction tool may be useful. In this direction, this work presents a Machine Learning Multi-Label approach for the classification of the information extracted from the pathology reports into relevant categories. The aim is to integrate automatic classifiers to improve the current workflow of medical experts, by defining a Multi-Label approach, able to consider all the features of a model, together with their relationships.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.</p
Towards a New Science of a Clinical Data Intelligence
In this paper we define Clinical Data Intelligence as the analysis of data
generated in the clinical routine with the goal of improving patient care. We
define a science of a Clinical Data Intelligence as a data analysis that
permits the derivation of scientific, i.e., generalizable and reliable results.
We argue that a science of a Clinical Data Intelligence is sensible in the
context of a Big Data analysis, i.e., with data from many patients and with
complete patient information. We discuss that Clinical Data Intelligence
requires the joint efforts of knowledge engineering, information extraction
(from textual and other unstructured data), and statistics and statistical
machine learning. We describe some of our main results as conjectures and
relate them to a recently funded research project involving two major German
university hospitals.Comment: NIPS 2013 Workshop: Machine Learning for Clinical Data Analysis and
Healthcare, 201
Extracting detailed oncologic history and treatment plan from medical oncology notes with large language models
Both medical care and observational studies in oncology require a thorough
understanding of a patient's disease progression and treatment history, often
elaborately documented in clinical notes. Despite their vital role, no current
oncology information representation and annotation schema fully encapsulates
the diversity of information recorded within these notes. Although large
language models (LLMs) have recently exhibited impressive performance on
various medical natural language processing tasks, due to the current lack of
comprehensively annotated oncology datasets, an extensive evaluation of LLMs in
extracting and reasoning with the complex rhetoric in oncology notes remains
understudied. We developed a detailed schema for annotating textual oncology
information, encompassing patient characteristics, tumor characteristics,
tests, treatments, and temporality. Using a corpus of 10 de-identified breast
cancer progress notes at University of California, San Francisco, we applied
this schema to assess the abilities of three recently-released LLMs (GPT-4,
GPT-3.5-turbo, and FLAN-UL2) to perform zero-shot extraction of detailed
oncological history from two narrative sections of clinical progress notes. Our
team annotated 2750 entities, 2874 modifiers, and 1623 relationships. The GPT-4
model exhibited overall best performance, with an average BLEU score of 0.69,
an average ROUGE score of 0.72, and an average accuracy of 67% on complex tasks
(expert manual evaluation). Notably, it was proficient in tumor characteristic
and medication extraction, and demonstrated superior performance in inferring
symptoms due to cancer and considerations of future medications. The analysis
demonstrates that GPT-4 is potentially already usable to extract important
facts from cancer progress notes needed for clinical research, complex
population management, and documenting quality patient care.Comment: Source code available at:
https://github.com/MadhumitaSushil/OncLLMExtractio
Using data-driven sublanguage pattern mining to induce knowledge models: application in medical image reports knowledge representation
Background: The use of knowledge models facilitates information retrieval, knowledge base development, and therefore supports new knowledge discovery that ultimately enables decision support applications. Most existing works have employed machine learning techniques to construct a knowledge base. However, they often suffer from low precision in extracting entity and relationships. In this paper, we described a data-driven sublanguage pattern mining method that can be used to create a knowledge model. We combined natural language processing (NLP) and semantic network analysis in our model generation pipeline.
Methods: As a use case of our pipeline, we utilized data from an open source imaging case repository, Radiopaedia.org, to generate a knowledge model that represents the contents of medical imaging reports. We extracted entities and relationships using the Stanford part-of-speech parser and the “Subject:Relationship:Object” syntactic data schema. The identified noun phrases were tagged with the Unified Medical Language System (UMLS) semantic types. An evaluation was done on a dataset comprised of 83 image notes from four data sources.
Results: A semantic type network was built based on the co-occurrence of 135 UMLS semantic types in 23,410 medical image reports. By regrouping the semantic types and generalizing the semantic network, we created a knowledge model that contains 14 semantic categories. Our knowledge model was able to cover 98% of the content in the evaluation corpus and revealed 97% of the relationships. Machine annotation achieved a precision of 87%, recall of 79%, and F-score of 82%.
Conclusion: The results indicated that our pipeline was able to produce a comprehensive content-based knowledge model that could represent context from various sources in the same domain
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