173 research outputs found
SYNTHNOTES: TOWARDS SYNTHETIC CLINICAL TEXT GENERATION
SynthNotes is a statistical natural language generation tool for the creation of realistic medical text notes for use by researchers in clinical language processing. Currently, advancements in medical analytics research face barriers due to patient privacy concerns which limits the numbers of researchers who have access to valuable data. Furthermore, privacy protections restrict the computing environments where data can be processed. This often adds prohibitive costs to researchers. The generation method described here provides domain-independent statistical methods for learning to generate text by extracting and ranking templates from a training corpus. The primary contribution in this work is automating the process of template selection and generation of text through classic machine learning methods. SynthNotes removes the need for human domain experts to construct templates, which can be time intensive and expensive. Furthermore, by using machine learning methods, this approach leads to greater realism and variability in the generated notes than could be achieved through classical language generation methods
Methods to Facilitate the Capture, Use, and Reuse of Structured and Unstructured Clinical Data.
Electronic health records (EHRs) have great potential to improve quality of care and to support clinical and translational research. While EHRs are being increasingly implemented in U.S. hospitals and clinics, their anticipated benefits have been largely unachieved or underachieved. Among many factors, tedious documentation requirements and the lack of effective information retrieval tools to access and reuse data are two key reasons accounting for this deficiency. In this dissertation, I describe my research on developing novel methods to facilitate the capture, use, and reuse of both structured and unstructured clinical data.
Specifically, I develop a framework to investigate potential issues in this research topic, with a focus on three significant challenges. The first challenge is structured data entry (SDE), which can be facilitated by four effective strategies based on my systematic review. I further propose a multi-strategy model to guide the development of future SDE applications. In the follow-up study, I focus on workflow integration and evaluate the feasibility of using EHR audit trail logs for clinical workflow analysis. The second challenge is the use of clinical narratives, which can be supported by my innovative information retrieval (IR) technique called “semantically-based query recommendation (SBQR)”. My user experiment shows that SBQR can help improve the perceived performance of a medical IR system, and may work better on search tasks with average difficulty. The third challenge involves reusing EHR data as a reference standard to benchmark the quality of other health-related information. My study assesses the readability of trial descriptions on ClinicalTrials.gov and found that trial descriptions are very hard to read, even harder than clinical notes.
My dissertation has several contributions. First, it conducts pioneer studies with innovative methods to improve the capture, use, and reuse of clinical data. Second, my dissertation provides successful examples for investigators who would like to conduct interdisciplinary research in the field of health informatics. Third, the framework of my research can be a great tool to generate future research agenda in clinical documentation and EHRs. I will continue exploring innovative and effective methods to maximize the value of EHRs.PHDInformationUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/135845/1/tzuyu_1.pd
Ontology-Based Clinical Information Extraction Using SNOMED CT
Extracting and encoding clinical information captured in unstructured clinical documents with standard medical terminologies is vital to enable secondary use of clinical data from practice. SNOMED CT is the most comprehensive medical ontology with broad types of concepts and detailed relationships and it has been widely used for many clinical applications. However, few studies have investigated the use of SNOMED CT in clinical information extraction.
In this dissertation research, we developed a fine-grained information model based on the SNOMED CT and built novel information extraction systems to recognize clinical entities and identify their relations, as well as to encode them to SNOMED CT concepts. Our evaluation shows that such ontology-based information extraction systems using SNOMED CT could achieve state-of-the-art performance, indicating its potential in clinical natural language processing
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Supporting Clinical Decision Making in Cancer Care Delivery
Background: Cancer treatment and management require complicated clinical decision making to provide the highest quality of care for an individual patient. This is facilitated in part with ever-increasing availability of medications and treatments but hindered due to barriers such as access to care, cost of medications, clinician knowledge, and patient preferences or clinical factors. Although guidelines for cancer treatment and many symptoms have been developed to inform clinical practice, implementation of these guidelines into practice is often delayed or does not occur. Informatics-based approaches, such as clinical decision support, may be an effective tool to improve guideline implementation by delivering patient-specific and evidence-based knowledge to the clinician at the point of care to allow shared decision making with a patient and their family. The large amount of data in the electronic health record can be utilized to develop, evaluate, and implement automated approaches; however, the quality of the data must first be examined and evaluated.
Methods: This dissertation addresses gaps the literature about clinical decision making for cancer care delivery. Specifically, following an introduction and review of the literature for relevant topics to this dissertation, the researcher presents three studies. In Study One, the researcher explores the use of clinical decision support in cancer therapeutic decision making by conducting a systematic review of the literature. In Study Two, the researcher conducts a quantitative study to describe the rate of guideline concordant care provided for prevention of acute chemotherapy-induced nausea and vomiting (CINV) and to identify predictors of receiving guideline concordant care. In Study Three, the researcher conducts a mixed-methods study to evaluate the completeness, concordance, and heterogeneity of clinician documentation of CINV. The final chapter of this dissertation is comprised of key findings of each study, the strengths and limitations, clinical and research implications, and future research.
Results: In Study One, the systematic review, the researcher identified ten studies that prospectively studied clinical decision support systems or tools in a cancer setting to guide therapeutic decision making. There was variability in these studies, including study design, outcomes measured, and results. There was a trend toward benefit, both in process and patient-specific outcomes. Importantly, few studies were integrated into the electronic health record.
In Study Two, of 180 patients age 26 years or less, 36% received guideline concordant care as defined by pediatric or adult guidelines, as appropriate. Factors associated with receiving guideline concordant care included receiving a cisplatin-based regimen, being treated in adult oncology compared to pediatric oncology, and solid tumor diagnosis.
In Study Three, of the 127 patient records reviewed for the documentation of chemotherapy-induced nausea and vomiting, 75% had prescriber assessment documented and 58% had nursing assessment documented. Of those who had documented assessments by both prescriber and nurse, 72% were in agreement of the presence/absence of chemotherapy-induced nausea and vomiting. After mapping the concept through the United Medical Language System and developing a post-coordinated expression to identify chemotherapy-induced nausea and vomiting in the text, 85% of prescriber documentation and 100% of nurse documentation could be correctly categorized as present/absent. Further descriptors of the symptoms, such as severity or temporality, however, were infrequently reported.
Conclusion: In summary, this dissertation provides new knowledge about decision making in cancer care delivery. Specifically, in Study One the researcher describes that clinical decision support, one potential implementation strategy to improve guideline concordant care, is understudied or under published but a promising potential intervention. In Study Two, I identified factors that were associated with receipt of guideline concordant care for CINV, and these should be further explored to develop interventions. Finally, in Study Three, I report on the limitations of the data quality of CINV documentation in the electronic health record. Future work should focus on validating these results on a multi-institutional level
A Model-Based Approach to Comprehensive Risk Management for Medical Devices
The European medical technology industry consists of around 27,000 companies, more than 95% of them small and medium-sized enterprises (SMEs), with over 675,000 employees [MEDT17]. In the European Union (EU) alone, medical devices constituted by far the biggest part of the medical technology (MedTech) sector with a market of 95 billion euros in annual sales in 2015 [EURO15].The European medical technology industry consists of around 27,000 companies, more than 95% of them small and medium-sized enterprises (SMEs), with over 675,000 employees [MEDT17]. In the European Union (EU) alone, medical devices constituted by far the biggest part of the medical technology (MedTech) sector with a market of 95 billion euros in annual sales in 2015 [EURO15]
Towards a system of concepts for Family Medicine. Multilingual indexing in General Practice/ Family Medicine in the era of Semantic Web
UNIVERSITY OF LIÈGE, BELGIUM
Executive Summary
Faculty of Medicine
Département Universitaire de Médecine Générale.
Unité de recherche Soins Primaires et Santé
Doctor in biomedical sciences
Towards a system of concepts for Family Medicine.
Multilingual indexing in General Practice/ Family Medicine in the era
of SemanticWeb
by Dr. Marc JAMOULLE
Introduction
This thesis is about giving visibility to the often overlooked work of family
physicians and consequently, is about grey literature in General Practice
and Family Medicine (GP/FM). It often seems that conference organizers
do not think of GP/FM as a knowledge-producing discipline that deserves
active dissemination. A conference is organized, but not much is done with
the knowledge shared at these meetings. In turn, the knowledge cannot be
reused or reapplied. This these is also about indexing. To find knowledge
back, indexing is mandatory. We must prepare tools that will automatically
index the thousands of abstracts that family doctors produce each year in
various languages. And finally this work is about semantics1. It is an introduction
to health terminologies, ontologies, semantic data, and linked
open data. All are expressions of the next step: Semantic Web for health
care data. Concepts, units of thought expressed by terms, will be our target
and must have the ability to be expressed in multiple languages. In turn,
three areas of knowledge are at stake in this study: (i) Family Medicine as a
pillar of primary health care, (ii) computational linguistics, and (iii) health
information systems.
Aim
• To identify knowledge produced by General practitioners (GPs) by
improving annotation of grey literature in Primary Health Care
• To propose an experimental indexing system, acting as draft for a
standardized table of content of GP/GM
• To improve the searchability of repositories for grey literature in GP/GM.
1For specific terms, see the Glossary page 257
x
Methods
The first step aimed to design the taxonomy by identifying relevant concepts
in a compiled corpus of GP/FM texts. We have studied the concepts
identified in nearly two thousand communications of GPs during
conferences. The relevant concepts belong to the fields that are focusing
on GP/FM activities (e.g. teaching, ethics, management or environmental
hazard issues).
The second step was the development of an on-line, multilingual, terminological
resource for each category of the resulting taxonomy, named
Q-Codes. We have designed this terminology in the form of a lightweight
ontology, accessible on-line for readers and ready for use by computers of
the semantic web. It is also fit for the Linked Open Data universe.
Results
We propose 182 Q-Codes in an on-line multilingual database (10 languages)
(www.hetop.eu/Q) acting each as a filter for Medline. Q-Codes are also available
under the form of Unique Resource Identifiers (URIs) and are exportable
in Web Ontology Language (OWL). The International Classification of Primary
Care (ICPC) is linked to Q-Codes in order to form the Core Content
Classification in General Practice/Family Medicine (3CGP). So far, 3CGP is
in use by humans in pedagogy, in bibliographic studies, in indexing congresses,
master theses and other forms of grey literature in GP/FM. Use by
computers is experimented in automatic classifiers, annotators and natural
language processing.
Discussion
To the best of our knowledge, this is the first attempt to expand the ICPC
coding system with an extension for family physician contextual issues,
thus covering non-clinical content of practice. It remains to be proven that
our proposed terminology will help in dealing with more complex systems,
such as MeSH, to support information storage and retrieval activities.
However, this exercise is proposed as a first step in the creation of an ontology
of GP/FM and as an opening to the complex world of Semantic Web
technologies.
Conclusion
We expect that the creation of this terminological resource for indexing abstracts
and for facilitating Medline searches for general practitioners, researchers
and students in medicine will reduce loss of knowledge in the
domain of GP/FM. In addition, through better indexing of the grey literature
(congress abstracts, master’s and doctoral theses), we hope to enhance
the accessibility of research results and give visibility to the invisible work
of family physicians
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Electronic Health Record Summarization over Heterogeneous and Irregularly Sampled Clinical Data
The increasing adoption of electronic health records (EHRs) has led to an unprecedented amount of patient health information stored in an electronic format. The ability to comb through this information is imperative, both for patient care and computational modeling. Creating a system to minimize unnecessary EHR data, automatically distill longitudinal patient information, and highlight salient parts of a patient’s record is currently an unmet need. However, summarization of EHR data is not a trivial task, as there exist many challenges with reasoning over this data. EHR data elements are most often obtained at irregular intervals as patients are more likely to receive medical care when they are ill, than when they are healthy. The presence of narrative documentation adds another layer of complexity as the notes are riddled with over-sampled text, often caused by the frequent copy-and-pasting during the documentation process.
This dissertation synthesizes a set of challenges for automated EHR summarization identified in the literature and presents an array of methods for dealing with some of these challenges. We used hybrid data-driven and knowledge-based approaches to examine abundant redundancy in clinical narrative text, a data-driven approach to identify and mitigate biases in laboratory testing patterns with implications for using clinical data for research, and a probabilistic modeling approach to automatically summarize patient records and learn computational models of disease with heterogeneous data types. The dissertation also demonstrates two applications of the developed methods to important clinical questions: the questions of laboratory test overutilization and cohort selection from EHR data
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Leveraging Knowledge-Based Approaches to Promote Antiretroviral Toxicity Monitoring in Underserved Settings
As access and use of antiretroviral therapy continue to increase, the need to improve antiretroviral toxicity monitoring becomes more critical. This is particularly so in underserved settings, where patterns of antiretroviral toxicities possibly alter the need for and frequency of antiretroviral toxicity monitoring. However, barriers such as few skilled healthcare providers and poor infrastructure make antiretroviral toxicity monitoring in underserved settings difficult. The purpose of this dissertation was to investigate how standard clinical guidelines, knowledge-based clinical decision support, and task delegation could be leveraged to overcome barriers to antiretroviral toxicity monitoring in underserved settings.
The strategy adopted in this dissertation was guided by the Design Science Research Methodology that emphasizes the generation of scientific knowledge through building novel artifacts. Two qualitative descriptive studies were conducted to characterize the contextual factors associated with antiretroviral toxicity monitoring in underserved settings. Supported by the findings from these studies, a knowledge-based software application prototype that implements clinical practice guidelines for antiretroviral toxicity monitoring was developed. Next, a quantitative validation study was used to evaluate the structure and behavior of the prototype’s knowledge base. Lastly, a quantitative usability study was conducted to assess lay health worker perceptions of the satisfaction and mental effort associated with the use of checklists generated by the prototype.
This dissertation research produced empirical evidence about the broad motives and strategies for promoting medication adherence, safety, and effectiveness in underserved settings. It also identified barriers and facilitators of antiretroviral toxicity monitoring within ambulatory HIV care workflows in underserved settings. Additionally, it provided evidence about the extent to which antiretroviral toxicity domain knowledge could be implemented in a knowledge-based application for supporting point-of-care antiretroviral toxicity monitoring. Lastly, the research provided previously unavailable empirical evidence about the perceptions of lay peer health workers on the use of checklists for the documentation of antiretroviral toxicities
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