Machine Learning and Clinical Text. Supporting Health Information Flow

Fluent health information flow is critical for clinical decision-making. However, a considerable part of this information is free-form text and inabilities to utilize it create risks to patient safety and cost-­effective hospital administration. Methods for automated processing of clinical text are emerging. The aim in this doctoral dissertation is to study machine learning and clinical text in order to support health information flow.First, by analyzing the content of authentic patient records, the aim is to specify clinical needs in order to guide the development of machine learning applications.The contributions are a model of the ideal information flow,a model of the problems and challenges in reality, and a road map for the technology development. Second, by developing applications for practical cases,the aim is to concretize ways to support health information flow. Altogether five machine learning applications for three practical cases are described: The first two applications are binary classification and regression related to the practical case of topic labeling and relevance ranking.The third and fourth application are supervised and unsupervised multi-class classification for the practical case of topic segmentation and labeling.These four applications are tested with Finnish intensive care patient records.The fifth application is multi-label classification for the practical task of diagnosis coding. It is tested with English radiology reports.The performance of all these applications is promising. Third, the aim is to study how the quality of machine learning applications can be reliably evaluated.The associations between performance evaluation measures and methods are addressed,and a new hold-out method is introduced.This method contributes not only to processing time but also to the evaluation diversity and quality. The main conclusion is that developing machine learning applications for text requires interdisciplinary, international collaboration. Practical cases are very different, and hence the development must begin from genuine user needs and domain expertise. The technological expertise must cover linguistics,machine learning, and information systems. Finally, the methods must be evaluated both statistically and through authentic user-feedback.Siirretty Doriast

Qualitative Research and Narrative Sources in the Context of Critical and Renal Cares

The objective of this study is to clarify the relevance of qualitative research in the context of critical care and renal dialysis requires using narrative sources. Also specific objectives are to identify the phases or cultural moments that are distinguished in these processes. Research Question: How can the narrative materials contribute to the study of the processes of critical care and/or qualitative research in nephrology? Method and Sources: There have been studies focusing on the narrative of patients who have written their experiences building a literature experience ill (Siles et al., 1997, 1999, 2000). Sources have been used to extract testimony retrospective autobiographies written by people who have experienced the experiences of different diseases (Allué, 1996, 1997, Zorn, 1991, Gilbert, 1993; Comas, 2009; Gracia Armendáriz, 2010; Sampedro, 1996, Sacks, 2010). The analysis was developed by categorizing units of meaning, meaning families and networks. To identify the cultural moments we have followed the criteria established by Siles and Solano (2009): Multiculturalism, interculturalism and transculturalism. To identify rites of passage and liminality states have followed the principles outlined by Van Gennep (2013) and Turner (1990, 2008). Results: We identified cultural moments and characteristic states of liminality in critical care and kidney. Conclusions: narrative sources are effective for analyzing the meanings and experiences of patients in critical care and nephrology tool

New kernel functions and learning methods for text and data mining

Recent advances in machine learning methods enable increasingly the automatic construction of various types of computer assisted methods that have been difficult or laborious to program by human experts. The tasks for which this kind of tools are needed arise in many areas, here especially in the fields of bioinformatics and natural language processing. The machine learning methods may not work satisfactorily if they are not appropriately tailored to the task in question. However, their learning performance can often be improved by taking advantage of deeper insight of the application domain or the learning problem at hand. This thesis considers developing kernel-based learning algorithms incorporating this kind of prior knowledge of the task in question in an advantageous way. Moreover, computationally efficient algorithms for training the learning machines for specific tasks are presented. In the context of kernel-based learning methods, the incorporation of prior knowledge is often done by designing appropriate kernel functions. Another well-known way is to develop cost functions that fit to the task under consideration. For disambiguation tasks in natural language, we develop kernel functions that take account of the positional information and the mutual similarities of words. It is shown that the use of this information significantly improves the disambiguation performance of the learning machine. Further, we design a new cost function that is better suitable for the task of information retrieval and for more general ranking problems than the cost functions designed for regression and classification. We also consider other applications of the kernel-based learning algorithms such as text categorization, and pattern recognition in differential display. We develop computationally efficient algorithms for training the considered learning machines with the proposed kernel functions. We also design a fast cross-validation algorithm for regularized least-squares type of learning algorithm. Further, an efficient version of the regularized least-squares algorithm that can be used together with the new cost function for preference learning and ranking tasks is proposed. In summary, we demonstrate that the incorporation of prior knowledge is possible and beneficial, and novel advanced kernels and cost functions can be used in algorithms efficiently.Siirretty Doriast

Modes of acquisition of health literacy skills in informal learning contexts

Neste artigo procuramos analisar os modos e processo de aprendizagem de competências de literacia em saúde em contextos informais. Pretendemos ampliar a compreensão dos processos de aprendizagem para além dos contextos formais, contribuindo para a elucidação dos profissionais de saúde sobre a forma como os indivíduos adquirem e gerem o conhecimento em saúde. Face ao nosso objetivo, recorremos um corpus analítico constituído por cem narrativas autobiográficas elaboradas, entre 2006 e 2011, em contextos educativos mas com reconhecido potencial para a utilização em diferentes campos científicos, incluindo a saúde. Os resultados obtidos evidenciam a existência de três diferentes características dos modos de aprendizagem de competências de literacia em saúde em contextos informais: i) aprendizagens que decorrem na ação, na concretização de tarefas quotidianas; ii) aprendizagens que resultam de processos de resolução de problemas; iii) aprendizagens que ocorrem de forma não planeada, fruto do fortuito e, em alguns casos, desprovidas de intencionalidade. ...En este artículo se analizan los modos y procesos de aprendizaje de competencias de literacia en salud en los contextos informales. Tenemos la intención de ampliar la comprensión del proceso de aprendizaje más allá de los contextos formales, contribuyendo a la elucidación de los profesionales de salud sobre cómo las personas adquieren y gestionan el conocimiento en salud. Teniendo en cuenta nuestro objetivo, utilizamos un corpus de análisis que consiste en cien relatos autobiográficos producidos, entre 2006 y 2011, en contextos educativos, pero con reconocido potencial para uso en diferentes campos científicos, incluyendo la salud. Los resultados demuestran la existencia de tres tipos diferentes de modos de aprendizaje de competencias de literacia de salud en contextos informales: i) el aprendizaje que tiene lugar en la acción en la consecución de las tareas diarias; ii) aprendizajes que derivan de procesos de resolución de problemas; iii) aprendizajes que se ocurren de modo no planificado, resultado del fortuito y, en algunos casos, carente de intencionalidad.In this article we try to analyze the learning processes of health literacy skills in informal contexts. We intend to broaden the understanding of the learning process beyond the formal contexts, thus contributing to the elucidation of health professionals on how individuals acquire and manage their knowledge in health matters. Given our goal, we use an analytic corpus constituted by one hundred autobiographical narratives written between 2006 and 2011, in educational contexts but with recognized potential for use in different scientific fields, including health. The results reveal the existence of three different types of modes of learning health literacy skills in informal context: : i) learning that takes place in action, in achieving daily tasks; ii) learning processes that result from problem solving; iii) learning that occurs in an unplanned manner, resulting from accidental circumstances and, in some cases, devoid of intentionality

Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care:Recommendations based on a methodological systematic review

BACKGROUND: The Delphi technique is widely used for the development of guidance in palliative care, having impact on decisions with relevance for patient care. AIM: To systematically examine the application of the Delphi technique for the development of best practice guidelines in palliative care. DESIGN: A methodological systematic review was undertaken using the databases PubMed, CINAHL, Web of Science, Academic Search Complete and EMBASE. DATA SOURCES: Original articles (English language) were included when reporting on empirical studies that had used the Delphi technique to develop guidance for good clinical practice in palliative care. Data extraction included a quality appraisal on the rigour in conduct of the studies and the quality of reporting. RESULTS: A total of 30 empirical studies (1997-2015) were considered for full-text analysis. Considerable differences were identified regarding the rigour of the design and the reporting of essential process and outcome parameters. Furthermore, discrepancies regarding the use of terms for describing the method were observed, for example, concerning the understanding of a 'round' or a 'modified Delphi study'. CONCLUSION: Substantial variation was found concerning the quality of the study conduct and the transparency of reporting of Delphi studies used for the development of best practice guidance in palliative care. Since credibility of the resulting recommendations depends on the rigorous use of the Delphi technique, there is a need for consistency and quality both in the conduct and reporting of studies. To allow a critical appraisal of the methodology and the resulting guidance, a reporting standard for Conducting and REporting of DElphi Studies (CREDES) is proposed

A novel tool for organisational learning and its impact on safety culture in a hospital dispensary

Incident reporting as a key mechanism for organisational learning and the establishment of a stronger safety culture are pillars of the current patient safety movement. Studies have suggested that incident reporting in healthcare does not achieve its full potential due to serious barriers to reporting and that sometimes staff may feel alienated by the process. The aim of the work reported in this paper was to prototype a novel approach to organisational learning that allows an organisation to assess and to monitor the status of processes that often give rise to latent failure conditions in the work environment, and to assess whether and through which mechanisms participation in this approach affects local safety culture. The approach was prototyped in a hospital dispensary using Plan-Do-Study-Act (PDSA) cycles, and the effect on safety culture was described qualitatively through semi-structured interviews. The results suggest that the approach has had a positive effect on the safety culture within the dispensary, and that staff perceive the approach to be useful and usable

Modes of acquisition of health literacy skills in informal learning contexts

In this article we try to analyze the learning processes of health literacy skills in informal contexts. We intend to broaden the understanding of the learning process beyond the formal contexts, thus contributing to the elucidation of health professionals on how individuals acquire and manage their knowledge in health matters. Given our goal, we use an analytic corpus constituted by one hundred autobiographical narratives written between 2006 and 2011, in educational contexts but with recognized potential for use in different scientific fields, including health. The results reveal the existence of three different types of modes of learning health literacy skills in informal context: : i) learning that takes place in action, in achieving daily tasks; ii) learning processes that result from problem solving; iii) learning that occurs in an unplanned manner, resulting from accidental circumstances and, in some cases, devoid of intentionality

Resilience, moorings and international student mobilities - exploring biographical narratives of social science students in the UK

Whilst research into the changing landscape of the UK Higher Education (HE) has produced a burgeoning literature on ‘internationalisation’ and ‘transnational student mobility’ over the past few years, still fairly little is known about international students’ experiences on their way to and through the UK higher and further education. Frequently approaching inter- and transnational education as ‘neutral’ by-products of neoliberal globalisation, elitism and power flows, much HE policy and scholarly debate tend to operate with simplistic classifications of ‘international students’ and therefore fail to account for the multifaceted nature of students’ aspirations, mobilities and life experiences. Drawing on the notion of ‘resilience’ and insights from the ‘new mobilities paradigm’, this paper envisages alternative student mobilities which run parallel or counter to the dominant flows of power, financial and human capital commonly associated with an emerging global knowledge economy. Engaging with ‘resilient’ biographies of social science students studying at three UK HE institutions, the paper challenges narrow student classification regimes and calls for a critical re-evaluation of the relationship between international student mobility and other contemporary forms of migration, displacement and diaspora