A new clustering method for detecting rare senses of abbreviations in clinical notes

AbstractAbbreviations are widely used in clinical documents and they are often ambiguous. Building a list of possible senses (also called sense inventory) for each ambiguous abbreviation is the first step to automatically identify correct meanings of abbreviations in given contexts. Clustering based methods have been used to detect senses of abbreviations from a clinical corpus [1]. However, rare senses remain challenging and existing algorithms are not good enough to detect them. In this study, we developed a new two-phase clustering algorithm called Tight Clustering for Rare Senses (TCRS) and applied it to sense generation of abbreviations in clinical text. Using manually annotated sense inventories from a set of 13 ambiguous clinical abbreviations, we evaluated and compared TCRS with the existing Expectation Maximization (EM) clustering algorithm for sense generation, at two different levels of annotation cost (10 vs. 20 instances for each abbreviation). Our results showed that the TCRS-based method could detect 85% senses on average; while the EM-based method found only 75% senses, when similar annotation effort (about 20 instances) was used. Further analysis demonstrated that the improvement by the TCRS method was mainly from additionally detected rare senses, thus indicating its usefulness for building more complete sense inventories of clinical abbreviations

Word Sense Disambiguation for clinical abbreviations

Abbreviations are extensively used in electronic health records (EHR) of patients as well as medical documentation, reaching 30-50% of the words in clinical narrative. There are more than 197,000 unique medical abbreviations found in the clinical text and their meanings vary depending on the context in which they are used. Since data in electronic health records could be shareable across health information systems (hospitals, primary care centers, etc.) as well as others such as insurance companies information systems, it is essential determining the correct meaning of the abbreviations to avoid misunderstandings. Clinical abbreviations have specific characteristic that do not follow any standard rules for creating them. This makes it complicated to find said abbreviations and corresponding meanings. Furthermore, there is an added difficulty to working with clinical data due to privacy reasons, since it is essential to have them in order to develop and test algorithms. Word sense disambiguation (WSD) is an essential task in natural language processing (NLP) applications such as information extraction, chatbots and summarization systems among others. WSD aims to identify the correct meaning of the ambiguous word which has more than one meaning. Disambiguating clinical abbreviations is a type of lexical sample WSD task. Previous research works adopted supervised, unsupervised and Knowledge-based (KB) approaches to disambiguate clinical abbreviations. This thesis aims to propose a classification model that apart from disambiguating well known abbreviations also disambiguates rare and unseen abbreviations using the most recent deep neural network architectures for language modeling. In clinical abbreviation disambiguation several resources and disambiguation models were encountered. Different classification approaches used to disambiguate the clinical abbreviations were investigated in this thesis. Considering that computers do not directly understand texts, different data representations were implemented to capture the meaning of the words. Since it is also necessary to measure the performance of algorithms, the evaluation measurements used are discussed. As the different solutions proposed to clinical WSD we have explored static word embeddings data representation on 13 English clinical abbreviations of the UMN data set (from University of Minnesota) by testing traditional supervised machine learning algorithms separately for each abbreviation. Moreover, we have utilized a transformer-base pretrained model that was fine-tuned as a multi-classification classifier for the whole data set (75 abbreviations of the UMN data set). The aim of implementing just one multi-class classifier is to predict rare and unseen abbreviations that are most common in clinical narrative. Additionally, other experiments were conducted for a different type of abbreviations (scientific abbreviations and acronyms) by defining a hybrid approach composed of supervised and knowledge-based approaches. Most previous works tend to build a separated classifier for each clinical abbreviation, tending to leverage different data resources to overcome the data acquisition bottleneck. However, those models were restricted to disambiguate terms that have been seen in trained data. Meanwhile, based on our results, transfer learning by fine-tuning a transformer-based model could predict rare and unseen abbreviations. A remaining challenge for future work is to improve the model to automate the disambiguation of clinical abbreviations on run-time systems by implementing self-supervised learning models.Las abreviaturas se utilizan ampliamente en las historias clínicas electrónicas de los pacientes y en mucha documentación médica, llegando a ser un 30-50% de las palabras empleadas en narrativa clínica. Existen más de 197.000 abreviaturas únicas usadas en textos clínicos siendo términos altamente ambiguos El significado de las abreviaturas varía en función del contexto en el que se utilicen. Dado que los datos de las historias clínicas electrónicas pueden compartirse entre servicios, hospitales, centros de atención primaria así como otras organizaciones como por ejemplo, las compañías de seguros es fundamental determinar el significado correcto de las abreviaturas para evitar además eventos adversos relacionados con la seguridad del paciente. Nuevas abreviaturas clínicas aparecen constantemente y tienen la característica específica de que no siguen ningún estándar para su creación. Esto hace que sea muy difícil disponer de un recurso con todas las abreviaturas y todos sus significados. A todo esto hay que añadir la dificultad para trabajar con datos clínicos por cuestiones de privacidad cuando es esencial disponer de ellos para poder desarrollar algoritmos para su tratamiento. La desambiguación del sentido de las palabras (WSD, en inglés) es una tarea esencial en tareas de procesamiento del lenguaje natural (PLN) como extracción de información, chatbots o generadores de resúmenes, entre otros. WSD tiene como objetivo identificar el significado correcto de una palabra ambigua (que tiene más de un significado). Esta tarea se ha abordado previamente utilizando tanto enfoques supervisados, no supervisados así como basados en conocimiento. Esta tesis tiene como objetivo definir un modelo de clasificación que además de desambiguar abreviaturas conocidas desambigüe también abreviaturas menos frecuentes que no han aparecido previamente en los conjuntos de entrenaminto utilizando las arquitecturas de redes neuronales profundas más recientes relacionadas ocn los modelos del lenguaje. En la desambiguación de abreviaturas clínicas se emplean diversos recursos y modelos de desambiguación. Se han investigado los diferentes enfoques de clasificación utilizados para desambiguar las abreviaturas clínicas. Dado que un ordenador no comprende directamente los textos, se han implementado diferentes representaciones de textos para capturar el significado de las palabras. Puesto que también es necesario medir el desempeño de cualquier algoritmo, se describen también las medidas de evaluación utilizadas. La mayoría de los trabajos previos se han basado en la construcción de un clasificador separado para cada abreviatura clínica. De este modo, tienden a aprovechar diferentes recursos de datos para superar el cuello de botella de la adquisición de datos. Sin embargo, estos modelos se limitaban a desambiguar con los datos para los que el sistema había sido entrenado. Se han explorado además representaciones basadas vectores de palabras (word embeddings) estáticos para 13 abreviaturas clínicas en el corpus UMN en inglés (de la University of Minnesota) utilizando algoritmos de clasificación tradicionales de aprendizaje automático supervisados (un clasificador por cada abreviatura). Se ha llevado a cabo un segundo experimento utilizando un modelo multi-clasificador sobre todo el conjunto de las 75 abreviaturas del corpus UMN basado en un modelo Transformer pre-entrenado. El objetivo ha sido implementar un clasificador multiclase para predecir también abreviaturas raras y no vistas. Se realizó un experimento adicional para siglas científicas en documentos de dominio abierto mediante la aplicación de un enfoque híbrido compuesto por enfoques supervisados y basados en el conocimiento. Así, basándonos en los resultados de esta tesis, el aprendizaje por transferencia (transfer learning) mediante el ajuste (fine-tuning) de un modelo de lenguaje preentrenado podría predecir abreviaturas raras y no vistas sin necesidad de entrenarlas previamente. Un reto pendiente para el trabajo futuro es mejorar el modelo para automatizar la desambiguación de las abreviaturas clínicas en tiempo de ejecución mediante la implementación de modelos de aprendizaje autosupervisados.Programa de Doctorado en Ciencia y Tecnología Informática por la Universidad Carlos III de MadridPresidente: Israel González Carrasco.- Secretario: Leonardo Campillos Llanos.- Vocal: Ana María García Serran

Disambiguating Clinical Abbreviations Using a One-Fits-All Classifier Based on Deep Learning Techniques

Abbreviations are considered an essential part of the clinical narrative; they are used not only to save time and space but also to hide serious or incurable illnesses. Misreckoning interpretation of the clinical abbreviations could affect different aspects concerning patients themselves or other services like clinical support systems. There is no consensus in the scientific community to create new abbreviations, making it difficult to understand them. Disambiguate clinical abbreviations aim to predict the exact meaning of the abbreviation based on context, a crucial step in understanding clinical notesThis work has been supported by the Madrid Government (Comunidad de Madrid-Spain) under the Multiannual Agreement with UC3M in the line of Excellence of University Professors (EPUC3M17), and in the context of the V PRICIT (Regional Programme of Research and Technological Innovation) and Palestine Technical University - Kadoorie (Palestine). The work was also supported by the PID2020-116527RB-I00 project

Building a high-quality sense inventory for improved abbreviation disambiguation

Motivation: The ultimate goal of abbreviation management is to disambiguate every occurrence of an abbreviation into its expanded form (concept or sense). To collect expanded forms for abbreviations, previous studies have recognized abbreviations and their expanded forms in parenthetical expressions of bio-medical texts. However, expanded forms extracted by abbreviation recognition are mixtures of concepts/senses and their term variations. Consequently, a list of expanded forms should be structured into a sense inventory, which provides possible concepts or senses for abbreviation disambiguation

Intelligent audit code generation from free text in the context of neurosurgery

Clinical auditing requires codified data for aggregation and analysis of patterns. However in the medical domain obtaining structured data can be difficult as the most natural, expressive and comprehensive way to record a clinical encounter is through natural language. The task of creating structured data from naturally expressed information is known as information extraction. Specialised areas of medicine use their own language and data structures; the translation process has unique challenges, and often requires a fresh approach. This research is devoted to creating a novel semi-automated method for generating codified auditing data from clinical notes recorded in a neurosurgical department in an Australian teaching hospital. The method encapsulates specialist knowledge in rules that instantaneously make precise decisions for the majority of the matches, followed up by dictionary-based matching of the remaining text

The biomedical abbreviation recognition and resolution (BARR) track: Benchmarking, evaluation and importance of abbreviation recognition systems applied to Spanish biomedical abstracts

Healthcare professionals are generating a substantial volume of clinical data in narrative form. As healthcare providers are confronted with serious time constraints, they frequently use telegraphic phrases, domain-specific abbreviations and shorthand notes. Efficient clinical text processing tools need to cope with the recognition and resolution of abbreviations, a task that has been extensively studied for English documents. Despite the outstanding number of clinical documents written worldwide in Spanish, only a marginal amount of studies has been published on this subject. In clinical texts, as opposed to the medical literature, abbreviations are generally used without their definitions or expanded forms. The aim of the first Biomedical Abbreviation Recognition and Resolution (BARR) track, posed at the IberEval 2017 evaluation campaign, was to assess and promote the development of systems for generating a sense inventory of medical abbreviations. The BARR track required the detection of mentions of abbreviations or short forms and their corresponding long forms or definitions from Spanish medical abstracts. For this track, the organizers provided the BARR medical document collection, the BARR corpus of manually annotated abstracts labelled by domain experts and the BARR-Markyt evaluation platform. A total of 7 teams submitted 25 runs for the two BARR subtasks: (a) the identification of mentions of abbreviations and their definitions and (b) the correct detection of short form-long form pairs. Here we describe the BARR track setting, the obtained results and the methodologies used by participating systems. The BARR task summary, corpus, resources and evaluation tool for testing systems beyond this campaign are available at: http://temu.inab.org .We acknowledge the Encomienda MINETAD-CNIO/OTG Sanidad Plan TL and Open-Minted (654021) H2020 project for funding.Postprint (published version

The Experience of Burnout in Counselling Psychology Trainees: An Interpretative Phenomenological Analysis

Counselling psychology training consists of many professional, academic and personal demands. Poor management of these demands could lead to burnout and drop out from training (Cornér et al, 2017). The current quantitative literature places emphasis on three-dimensional conceptual frameworks of burnout using measures such as the Maslach Burnout Inventory (MBI) (Maslach & Jackson, 1981) and the Copenhagen Burnout Inventory (CBI) (Kristensen et al, 2005). The qualitative literature outlined only stressors of counselling psychology training and burnout in qualified counselling psychologists. To address a research gap in how trainees experience burnout, this study was designed to explore burnout as part of a wider context. Eight third-year trainee counselling psychologists were recruited from six universities across London. Data was collected using semi-structured interviews. Interpretative Phenomenological Analysis (IPA) was used to analyse the data. Three superordinate themes emerged: A perfect storm: the demands of counselling psychology training, Treading on shaky foundations, and Impact of training on self and others. Participants described the training as an extremely demanding endeavour which led to a disconcerting loss of agency and resentment towards the process. Participants often could not gauge their own progress, and they perceived the training environment as hostile towards difficulties and failure. To disguise their feelings of self-doubt, the participants appeared to foster a form of artificial confidence to give the illusion of self-assurance. Other effects of burnout included upheaval in significant relationships, as well as physical and health-related changes. Burnout was characterised as perseverance through unaddressed difficulties, rather than inability to function. However, participants reported developing greater resilience and self-monitoring to prevent burnout occurring in the future. Recommendations include normalisation of difficulties and burnout by trainers, and development of literature and workshops for prospective trainees to fully understand the training before embarking on the process. Other areas for future research are also discussed

Doctor of Philosophy

dissertationDomain adaptation of natural language processing systems is challenging because it requires human expertise. While manual e ort is e ective in creating a high quality knowledge base, it is expensive and time consuming. Clinical text adds another layer of complexity to the task due to privacy and con dentiality restrictions that hinder the ability to share training corpora among di erent research groups. Semantic ambiguity is a major barrier for e ective and accurate concept recognition by natural language processing systems. In my research I propose an automated domain adaptation method that utilizes sublanguage semantic schema for all-word word sense disambiguation of clinical narrative. According to the sublanguage theory developed by Zellig Harris, domain-speci c language is characterized by a relatively small set of semantic classes that combine into a small number of sentence types. Previous research relied on manual analysis to create language models that could be used for more e ective natural language processing. Building on previous semantic type disambiguation research, I propose a method of resolving semantic ambiguity utilizing automatically acquired semantic type disambiguation rules applied on clinical text ambiguously mapped to a standard set of concepts. This research aims to provide an automatic method to acquire Sublanguage Semantic Schema (S3) and apply this model to disambiguate terms that map to more than one concept with di erent semantic types. The research is conducted using unmodi ed MetaMap version 2009, a concept recognition system provided by the National Library of Medicine, applied on a large set of clinical text. The project includes creating and comparing models, which are based on unambiguous concept mappings found in seventeen clinical note types. The e ectiveness of the nal application was validated through a manual review of a subset of processed clinical notes using recall, precision and F-score metrics

Scaling up health knowledge at European level requires sharing integrated data: An approach for collection of database specification

Computerized health care databases have been widely described as an excellent opportunity for research. The availability of “big data” has brought about a wave of innovation in projects when conducting health services research. Most of the available secondary data sources are restricted to the geographical scope of a given country and present heterogeneous structure and content. Under the umbrella of the European Innovation Partnership on Active and Healthy Ageing, collaborative work conducted by the partners of the group on “adherence to prescription and medical plans” identified the use of observational and large-population databases to monitor medication-taking behavior in the elderly. This article describes the methodology used to gather the information from available databases among the Adherence Action Group partners with the aim of improving data sharing on a European level. A total of six databases belonging to three different European countries (Spain, Republic of Ireland, and Italy) were included in the analysis. Preliminary results suggest that there are some similarities. However, these results should be applied in different contexts and European countries, supporting the idea that large European studies should be designed in order to get the most of already available databases