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

COMPLEX QUESTION ANSWERING BASED ON A SEMANTIC DOMAIN MODEL OF CLINICAL MEDICINE

Much research in recent years has focused on question answering. Due to significant advances in answering simple fact-seeking questions, research is moving towards resolving complex questions. An approach adopted by many researchers is to decompose a complex question into a series of fact-seeking questions and reuse techniques developed for answering simple questions. This thesis presents an alternative novel approach to domain-specific complex question answering based on consistently applying a semantic domain model to question and document understanding as well as to answer extraction and generation. This study uses a semantic domain model of clinical medicine to encode (a) a clinician's information need expressed as a question on the one hand and (b) the meaning of scientific publications on the other to yield a common representation. It is hypothesized that this approach will work well for (1) finding documents that contain answers to clinical questions and (2) extracting these answers from the documents. The domain of clinical question answering was selected primarily because of its unparalleled resources that permit providing a proof by construction for this hypothesis. In addition, a working prototype of a clinical question answering system will support research in informed clinical decision making. The proposed methodology is based on the semantic domain model developed within the paradigm of Evidence Based Medicine. Three basic components of this model - the clinical task, a framework for capturing a synopsis of a clinical scenario that generated the question, and strength of evidence presented in an answer - are identified and discussed in detail. Algorithms and methods were developed that combine knowledge-based and statistical techniques to extract the basic components of the domain model from abstracts of biomedical articles. These algorithms serve as a foundation for the prototype end-to-end clinical question answering system that was built and evaluated to test the hypotheses. Evaluation of the system on test collections developed in the course of this work and based on real life clinical questions demonstrates feasibility of complex question answering and high accuracy information retrieval using a semantic domain model

Ranking Medical Subject Headings using a factor graph model.

Automatically assigning MeSH (Medical Subject Headings) to articles is an active research topic. Recent work demonstrated the feasibility of improving the existing automated Medical Text Indexer (MTI) system, developed at the National Library of Medicine (NLM). Encouraged by this work, we propose a novel data-driven approach that uses semantic distances in the MeSH ontology for automated MeSH assignment. Specifically, we developed a graphical model to propagate belief through a citation network to provide robust MeSH main heading (MH) recommendation. Our preliminary results indicate that this approach can reach high Mean Average Precision (MAP) in some scenarios

The potential for automated question answering in the context of genomic medicine: an assessment of existing resources and properties of answers

Knowledge gained in studies of genetic disorders is reported in a growing body of biomedical literature containing reports of genetic variation in individuals that map to medical conditions and/or response to therapy. These scientific discoveries need to be translated into practical applications to optimize patient care. Translating research into practice can be facilitated by supplying clinicians with research evidence. We assessed the role of existing tools in extracting answers to translational research questions in the area of genomic medicine. We: evaluate the coverage of translational research terms in the Unified Medical Language Systems (UMLS) Metathesaurus; determine where answers are most often found in full-text articles; and determine common answer patterns. Findings suggest that we will be able to leverage the UMLS in development of natural language processing algorithms for automated extraction of answers to translational research questions from biomedical text in the area of genomic medicine

Automatic summarization of MEDLINE citations for evidence-based medical treatment: A topic-oriented evaluation

AbstractAs the number of electronic biomedical textual resources increases, it becomes harder for physicians to find useful answers at the point of care. Information retrieval applications provide access to databases; however, little research has been done on using automatic summarization to help navigate the documents returned by these systems. After presenting a semantic abstraction automatic summarization system for MEDLINE citations, we concentrate on evaluating its ability to identify useful drug interventions for 53 diseases. The evaluation methodology uses existing sources of evidence-based medicine as surrogates for a physician-annotated reference standard. Mean average precision (MAP) and a clinical usefulness score developed for this study were computed as performance metrics. The automatic summarization system significantly outperformed the baseline in both metrics. The MAP gain was 0.17 (p<0.01) and the increase in the overall score of clinical usefulness was 0.39 (p<0.05)