Answering clinical questions with knowledge-based and statistical techniques

The combination of recent developments in question-answering research and the availability of unparalleled resources developed specifically for automatic semantic processing of text in the medical domain provides a unique opportunity to explore complex question answering in the domain of clinical medicine. This article presents a system designed to satisfy the information needs of physicians practicing evidence-based medicine. We have developed a series of knowledge extractors, which employ a combination of knowledge-based and statistical techniques, for automatically identifying clinically relevant aspects of MEDLINE abstracts. These extracted elements serve as the input to an algorithm that scores the relevance of citations with respect to structured representations of information needs, in accordance with the principles of evidencebased medicine. Starting with an initial list of citations retrieved by PubMed, our system can bring relevant abstracts into higher ranking positions, and from these abstracts generate responses that directly answer physicians ’ questions. We describe three separate evaluations: one focused on the accuracy of the knowledge extractors, one conceptualized as a document reranking task, and finally, an evaluation of answers by two physicians. Experiments on a collection of real-world clinical questions show that our approach significantly outperforms the already competitive PubMed baseline. 1

A Study on Agreement in PICO Span Annotations

In evidence-based medicine, relevance of medical literature is determined by predefined relevance conditions. The conditions are defined based on PICO elements, namely, Patient, Intervention, Comparator, and Outcome. Hence, PICO annotations in medical literature are essential for automatic relevant document filtering. However, defining boundaries of text spans for PICO elements is not straightforward. In this paper, we study the agreement of PICO annotations made by multiple human annotators, including both experts and non-experts. Agreements are estimated by a standard span agreement (i.e., matching both labels and boundaries of text spans), and two types of relaxed span agreement (i.e., matching labels without guaranteeing matching boundaries of spans). Based on the analysis, we report two observations: (i) Boundaries of PICO span annotations by individual human annotators are very diverse. (ii) Despite the disagreement in span boundaries, general areas of the span annotations are broadly agreed by annotators. Our results suggest that applying a standard agreement alone may undermine the agreement of PICO spans, and adopting both a standard and a relaxed agreements is more suitable for PICO span evaluation.Comment: Accepted in SIGIR 2019 (Short paper

Are decision trees a feasible knowledge representation to guide extraction of critical information from randomized controlled trial reports?

<p>Abstract</p> <p>Background</p> <p>This paper proposes the use of decision trees as the basis for automatically extracting information from published randomized controlled trial (RCT) reports. An exploratory analysis of RCT abstracts is undertaken to investigate the feasibility of using decision trees as a semantic structure. Quality-of-paper measures are also examined.</p> <p>Methods</p> <p>A subset of 455 abstracts (randomly selected from a set of 7620 retrieved from Medline from 1998 – 2006) are examined for the quality of RCT reporting, the identifiability of RCTs from abstracts, and the completeness and complexity of RCT abstracts with respect to key decision tree elements. Abstracts were manually assigned to 6 sub-groups distinguishing whether they were primary RCTs versus other design types. For primary RCT studies, we analyzed and annotated the reporting of intervention comparison, population assignment and outcome values. To measure completeness, the frequencies by which complete intervention, population and outcome information are reported in abstracts were measured. A qualitative examination of the reporting language was conducted.</p> <p>Results</p> <p>Decision tree elements are manually identifiable in the majority of primary RCT abstracts. 73.8% of a random subset was primary studies with a single population assigned to two or more interventions. 68% of these primary RCT abstracts were structured. 63% contained pharmaceutical interventions. 84% reported the total number of study subjects. In a subset of 21 abstracts examined, 71% reported numerical outcome values.</p> <p>Conclusion</p> <p>The manual identifiability of decision tree elements in the abstract suggests that decision trees could be a suitable construct to guide machine summarisation of RCTs. The presence of decision tree elements could also act as an indicator for RCT report quality in terms of completeness and uniformity.</p

Towards identifying intervention arms in randomized controlled trials: Extracting coordinating constructions

AbstractBackground: Large numbers of reports of randomized controlled trials (RCTs) are published each year, and it is becoming increasingly difficult for clinicians practicing evidence-based medicine to find answers to clinical questions. The automatic machine extraction of RCT experimental details, including design methodology and outcomes, could help clinicians and reviewers locate relevant studies more rapidly and easily. Aim: This paper investigates how the comparison of interventions is documented in the abstracts of published RCTs. The ultimate goal is to use automated text mining to locate each intervention arm of a trial. This preliminary work aims to identify coordinating constructions, which are prevalent in the expression of intervention comparisons. Methods and results: An analysis of the types of constructs that describe the allocation of intervention arms is conducted, revealing that the compared interventions are predominantly embedded in coordinating constructions. A method is developed for identifying the descriptions of the assignment of treatment arms in clinical trials, using a full sentence parser to locate coordinating constructions and a statistical classifier for labeling positive examples. Predicate-argument structures are used along with other linguistic features with a maximum entropy classifier. An F-score of 0.78 is obtained for labeling relevant coordinating constructions in an independent test set. Conclusions: The intervention arms of a randomized controlled trials can be identified by machine extraction incorporating syntactic features derived from full sentence parsing