A hybrid knowledge-based approach to supporting the medical prescription for general practitioners: Real case in a Hong Kong medical center

RECOMED: A comprehensive pharmaceutical recommendation system

OBJECTIVES

To build datasets containing useful information from drug databases and recommend a list of drugs to physicians and patients with high accuracy by considering a wide range of features of people, diseases, and chemicals.

METHODS

A comprehensive pharmaceutical recommendation system was designed based on the features of people, diseases, and medicines extracted from two major drug databases and the created datasets of patients and drug information. Then, the recommendation was given based on recommender system algorithms using patient and caregiver ratings and the knowledge obtained from drug specifications and interactions. Sentiment analysis was employed by natural language processing approaches in pre-processing, along with neural network-based methods and recommender system algorithms for modelling the system. Patient conditions and medicine features were used to make two models based on matrix factorization. Then, we used drug interaction criteria to filter drugs with severe or mild interactions with other drugs. We developed a deep learning model for recommending drugs using data from 2304 patients as a training set and 660 patients as our validation set. We used knowledge from drug information and combined the model's outcome into a knowledge-based system with the rules obtained from constraints on taking medicine.

RESULTS

Our recommendation system can recommend an acceptable combination of medicines similar to the existing prescriptions available in real life. Compared with conventional matrix factorization, our proposed model improves the accuracy, sensitivity, and hit rate by 26 %, 34 %, and 40 %, respectively. In addition, it improves the accuracy, sensitivity, and hit rate by an average of 31 %, 29 %, and 28 % compared to other machine learning methods. We have open-sourced our implementation in Python.

CONCLUSION

Compared to conventional machine learning approaches, we obtained average accuracy, sensitivity, and hit rates of 31 %, 29 %, and 28 %, respectively. Compared to conventional matrix factorisation our proposed method improved the accuracy, sensitivity, and hit rate by 26 %, 34 %, and 40 %, respectively. However, it is acknowledged that this is not the same as clinical accuracy or sensitivity, and more accurate results can be obtained by gathering larger datasets.

Insight Extraction From E-Health Bookings by Means of Hypergraph and Machine Learning

New technologies are transforming medicine, and this revolution starts with data. Usually, health services within public healthcare systems are accessed through a booking centre managed by local health authorities and controlled by the regional government. In this perspective, structuring e-health data through a Knowledge Graph (KG) approach can provide a feasible method to quickly and simply organize data and/or retrieve new information. Starting from raw health bookings data from the public healthcare system in Italy, a KG method is presented to support e-health services through the extraction of medical knowledge and novel insights. By exploiting graph embedding which arranges the various attributes of the entities into the same vector space, we are able to apply Machine Learning (ML) techniques to the embedded vectors. The findings suggest that KGs could be used to assess patients' medical booking patterns, either from unsupervised or supervised ML. In particular, the former can determine possible presence of hidden groups of entities that is not immediately available through the original legacy dataset structure. The latter, although the performance of the used algorithms is not very high, shows encouraging results in predicting a patient's likelihood to undergo a particular medical visit within a year. However, many technological advances remain to be made, especially in graph database technologies and graph embedding algorithms.

Clinical Decision Support System Based on Hybrid Knowledge Modeling: A Case Study of Chronic Kidney Disease-Mineral and Bone Disorder Treatment

Clinical decision support systems (CDSSs) represent the latest technological transformation in healthcare for assisting clinicians in complex decision-making. Several CDSSs are proposed to deal with a range of clinical tasks such as disease diagnosis, prescription management, and medication ordering. Although a small number of CDSSs have focused on treatment selection, areas such as medication selection and dosing selection remained under-researched. In this regard, this study represents one of the first studies in which a CDSS is proposed for clinicians who manage patients with end-stage renal disease undergoing maintenance hemodialysis, almost all of whom have some manifestation of chronic kidney disease-mineral and bone disorder (CKD-MBD). The primary objective of the system is to aid clinicians in dosage prescription by levering medical domain knowledge as well existing practices. The proposed CDSS is evaluated with a real-world hemodialysis patient dataset acquired from Kyung Hee University Hospital, South Korea. Our evaluation demonstrates overall high compliance based on the concordance metric between the proposed CKD-MBD CDSS recommendations and the routine clinical practice. The concordance rate of overall medication dosing selection is 78.27%. Furthermore, the usability aspects of the system are also evaluated through the User Experience Questionnaire method to highlight the appealing aspects of the system for clinicians. The overall user experience dimension scores for pragmatic, hedonic, and attractiveness are 1.53, 1.48, and 1.41, respectively. A service reliability for the Cronbach's alpha coefficient greater than 0.7 is achieved using the proposed system, whereas a dependability coefficient of the value 0.84 reveals a significant effect.

PARS, a system combining semantic technologies with multiple criteria decision aiding for supporting antibiotic prescriptions

OBJECTIVE

Motivated by the well documented worldwide spread of adverse drug events, as well as the increased danger of antibiotic resistance (caused mainly by inappropriate prescribing and overuse), we propose a novel recommendation system for antibiotic prescription (PARS).

METHOD

Our approach is based on the combination of semantic technologies with MCDA (Multiple Criteria Decision Aiding) that allowed us to build a two level decision support model. Given a specific domain, the approach assesses the adequacy of an alternative/action (prescription of antibiotic) for a specific subject (patient) with an issue (bacterial infection) in a given context (medical). The goal of the first level of the decision support model is to select the set of alternatives which have the potential to be suitable. Then the second level sorts the alternatives into categories according to their adequacy using an MCDA sorting method (MR-Sort with Veto) and a structured set of description logic queries.

RESULTS

We applied this approach in the domain of antibiotic prescriptions, working closely with the EpiCura Hospital Center (BE). Its performance was compared to the EpiCura recommendation guidelines which are currently in use. The results showed that the proposed system is more consistent in its recommendations when compared with the static EpiCura guidelines. Moreover, with PARS the antibiotic prescribing workflow becomes more flexible. PARS allows the user (physician) to update incrementally and dynamically a patient's profile with more information, or to input knowledge modifications that accommodate the decision context (like the introduction of new side effects and antibiotics, the development of germs that are resistant, etc). At the end of our evaluation, we detail a number of limitations of the current version of PARS and discuss future perspectives.

Max-margin weight learning for medical knowledge network

BACKGROUND AND OBJECTIVE

The application of medical knowledge strongly affects the performance of intelligent diagnosis, and method of learning the weights of medical knowledge plays a substantial role in probabilistic graphical models (PGMs). The purpose of this study is to investigate a discriminative weight-learning method based on a medical knowledge network (MKN).

METHODS

We propose a training model called the maximum margin medical knowledge network (M³KN), which is strictly derived for calculating the weight of medical knowledge. Using the definition of a reasonable margin, the weight learning can be transformed into a margin optimization problem. To solve the optimization problem, we adopt a sequential minimal optimization (SMO) algorithm and the clique property of a Markov network. Ultimately, M³KN not only incorporates the inference ability of PGMs but also deals with high-dimensional logic knowledge.

RESULTS

The experimental results indicate that M³KN obtains a higher F-measure score than the maximum likelihood learning algorithm of MKN for both Chinese Electronic Medical Records (CEMRs) and Blood Examination Records (BERs). Furthermore, the proposed approach is obviously superior to some classical machine learning algorithms for medical diagnosis. To adequately manifest the importance of domain knowledge, we numerically verify that the diagnostic accuracy of M³KN is gradually improved as the number of learned CEMRs increase, which contain important medical knowledge.

CONCLUSIONS

Our experimental results show that the proposed method performs reliably for learning the weights of medical knowledge. M³KN outperforms other existing methods by achieving an F-measure of 0.731 for CEMRs and 0.4538 for BERs. This further illustrates that M³KN can facilitate the investigations of intelligent healthcare.