Adverse Event Signal Detection Using Patients' Concerns in Pharmaceutical Care Records: Evaluation of Deep Learning Models

BACKGROUND

Early detection of adverse events and their management are crucial to improving anticancer treatment outcomes, and listening to patients' subjective opinions (patients' voices) can make a major contribution to improving safety management. Recent progress in deep learning technologies has enabled various new approaches for the evaluation of safety-related events based on patient-generated text data, but few studies have focused on the improvement of real-time safety monitoring for individual patients. In addition, no study has yet been performed to validate deep learning models for screening patients' narratives for clinically important adverse event signals that require medical intervention. In our previous work, novel deep learning models have been developed to detect adverse event signals for hand-foot syndrome or adverse events limiting patients' daily lives from the authored narratives of patients with cancer, aiming ultimately to use them as safety monitoring support tools for individual patients.

OBJECTIVE

This study was designed to evaluate whether our deep learning models can screen clinically important adverse event signals that require intervention by health care professionals. The applicability of our deep learning models to data on patients' concerns at pharmacies was also assessed.

METHODS

Pharmaceutical care records at community pharmacies were used for the evaluation of our deep learning models. The records followed the SOAP format, consisting of subjective (S), objective (O), assessment (A), and plan (P) columns. Because of the unique combination of patients' concerns in the S column and the professional records of the pharmacists, this was considered a suitable data for the present purpose. Our deep learning models were applied to the S records of patients with cancer, and the extracted adverse event signals were assessed in relation to medical actions and prescribed drugs.

RESULTS

From 30,784 S records of 2479 patients with at least 1 prescription of anticancer drugs, our deep learning models extracted true adverse event signals with more than 80% accuracy for both hand-foot syndrome (n=152, 91%) and adverse events limiting patients' daily lives (n=157, 80.1%). The deep learning models were also able to screen adverse event signals that require medical intervention by health care providers. The extracted adverse event signals could reflect the side effects of anticancer drugs used by the patients based on analysis of prescribed anticancer drugs. "Pain or numbness" (n=57, 36.3%), "fever" (n=46, 29.3%), and "nausea" (n=40, 25.5%) were common symptoms out of the true adverse event signals identified by the model for adverse events limiting patients' daily lives.

CONCLUSIONS

Our deep learning models were able to screen clinically important adverse event signals that require intervention for symptoms. It was also confirmed that these deep learning models could be applied to patients' subjective information recorded in pharmaceutical care records accumulated during pharmacists' daily work.

Treatment for developmental dysplasia of the hip using the Pavlik harness

We reviewed the medical records of 115 patients with 130 hips with developmental dysplasia with complete dislocation in the absence of a neuromuscular disorder, spontaneous reduction with a Pavlik harness, and a minimum of 14 years’ follow-up. The mean age at the time of harness application was 4.8 months (1 to 12) and the mean time spent in the harness was 6.1 months (3 to 12). A total of 108 hips (83.1%) were treated with the harness alone and supplementary surgery for residual acetabular dysplasia, as defined by an acetabular index > 30°, was performed in 22 hips (16.9%).

An overall satisfactory outcome (Severin grade I or II) was achieved in 119 hips (91.5%) at a mean follow-up of 16 years (14 to 32) with a follow-up rate of 75%. Avascular necrosis of the femoral head was noted in 16 hips (12.3%), seven of which (44%) underwent supplementary surgery and nine (56%) of which were classified as satisfactory. The acetabular index was the most reliable predictor of residual acetabular dysplasia.

Pharmacological studies on Puerariae Flos. IV: Effects of Pueraria thomsonii dried flower extracts on blood ethanol and acetaldehyde levels in humans

We investigated the effects of extracts from the dried flower of Pueraria thomsonii on blood ethanol and acetaldehyde levels in humans consuming alcoholic beverages. The extracts of Pueraria thomsonii had no influence on blood ethanol and acetaldehyde concentration in humans. However, the extracts increased the elimination rate constant of blood acetaldehyde, although they had no effect on the elimination of blood ethanol in humans. These results suggest that Pueraria thomsonii promotes the elimination of blood acetaldehyde in humans. The present study clinically suggests that a modest stimulatory effect of Pueraria thomsonii on the elimination of blood acetaldehyde may passively mitigate acetaldehyde toxicity, such as flushing, palpitation, headache, etc., associated with excessive alcohol intake.

Four cases of meningeal hemangiopericytoma treated with surgery and radiotherapy

We report our experiences of four cases with meningeal hemangiopericytoma treated with surgery and postoperative radiotherapy and survey the literature to elucidate the efficacy of radiotherapy. Patients were treated with surgical resection and 46-52 Gy postoperative radiotherapy. Three patients had local control for 30, 54 and 138 months, respectively and one patient had local recurrence after 49 months. Distant metastases were observed in two patients; one had multiple bone, liver and lung metastases and the other multiple bone and brain metastases. For bone and brain metastases, better tumor control was obtained with palliative radiotherapy and stereotactic radiotherapy. Literature analyses demonstrated that surgery and postoperative radiotherapy of 50 Gy or more resulted in significantly better local control than surgery alone (p = 0.02). Stereotactic radiosurgery was effective for intracranial recurrence or metastasis, especially when the tumor volume was <8 cm(3) and >15 Gy at the 50% isodose line was used. Radiotherapy for bone metastases was also effective for palliation.

Pancreas: imaging diagnosis with color/power Doppler ultrasonography, endoscopic ultrasonography, and intraductal ultrasonography

Recent advances of ultrasound imaging have made possible to depict various diseases and conditions of the pancreas. Color/power Doppler ultrasonography, endoscopic ultrasonography, and intraductal ultrasonography are feasible to show vascular abnormalities, differentiate the solid and cystic tumors, decide tumor extent, and help to perform interventional treatments of the pancreatic diseases. Those techniques will contribute to the more precise and easier diagnosis and to prompt decision of the treatments of the pancreatic disorders. Radiologists should recognize the diagnostic feasibility and limitations of those techniques in order to avoid unnecessary examinations on the patients, and obtain precise diagnostic images.

Evaluation of the pharmacological activity of extracts from amomi semen on the gastrointestinal tracts

We have investigated the effects of methanolic and alcoholic extracts from Amomi Semen on gastric secretion, as well as gastrointestinal propulsion or the prokinetic activities. The methanolic extract from Amomi Semen dose dependently decreased the volume output, acid output, and pepsin output in rat's gastric juice with increasing pH value, while the alcoholic extract had no influence on basal gastric acid secretion. Furthermore, the alcoholic extract improved the L-dopa to induce a delay of gastrointestinal transit in mice, while the methanolic extract did not improve it. However, both extracts had no influence on gastrointestinal transit in intact mice. These results suggest that Amomi Semen has an inhibitory effect on gastric acid secretion and that it has effects as the gastrointestinal prokinetics rather than propulsion. The present study pharmacologically elucidates a belief that Amomi Semen has been used in Chinese medicine for the treatment of gastrointestinal dyspepsia, which includes hyperchlorhydria, stomachache, abdominal distention, anorexia, gastric atony, etc.

HPLC profile analysis of hepatoprotective oleanene-glucuronides in Puerariae Flos

In order to confirm the constitution of hepatoprotective oleanene glucuronide (OG), HPLC profile analyses of the total OG fractions of both Puerariae Thomsonii Flos (the flowers of Pueraria thomsonii) and Puerariae Lobatae Flos (the flowers of P. lobata) were performed. No remarkable difference in the HPLC profiles with respect to OGs in the flowers was shown, in contrast to those of the roots. By repeated chromatography of the total OG fraction of Puerariae Thomsonii Flos, soyasaponin I (1), kaikasaponin III (2) and kakkasaponin I (3), which had been already isolated from Puerariae Lobatae Flos, were obtained. The hepatoprotective activity of 2 towards immunologically induced liver injury was significantly more effective than that of 1. This information supported previously obtained structure-hepatoprotective relationship data which was measured on another model. The structure-activity relationship information which suggested that the hydroxymethyl group of the galactosyl unit would enhance the hepatoprotective activity was also substantiated.

[Usefulness of directional coronary atherectomy as a bail-out device for acute closure after coronary angioplasty]

The usefulness of directional coronary atherectomy (DCA) as a bail-out device for acute closure (reclosure) after percutaneous transluminal coronary angioplasty (PTCA) was evaluated. PTCA was performed in 1,023 patients (182 with acute myocardial infarction) between January 1993 and January 1994 in our hospital. Thirty-one patients (11 with acute myocardial infarction) suffered acute closure (reclosure) after PTCA. In six patients (five with acute myocardial infarction), DCA was performed as a rescue treatment for acute closure (reclosure). In three of these patients, angioscopy was performed before DCA, which demonstrated intimal tear and some thrombi although coronary angiography showed no evidence of thrombus. Bail-out DCA was successful in all six patients without complications. DCA is useful as a bail-out device for acute closure (reclosure) after PTCA when the thrombus is not massive.

Acetabular remodelling in Perthes' disease after primary healing

We conducted a study to assess the remodelling potential of the acetabulum of 29 children with Perthes' disease. In all but four, the acetabular head index (AHI) increased in the time between primary healing of the femoral head and follow-up at skeletal maturity. We classified 13 cases (44.8%) in which the increase in AHI was more than 10% as group I. In this group, the outcome at follow-up was predictable when subluxation during the active phase of the disease decreased until primary healing. Our observations suggest that the position of the femoral head, rather than sphericity, is the most important factor in acetabular growth and remodelling.

[Ulnar nerve palsy in a RA patient after total knee replacement: a case report]

A 49-year-old housewife had suffered from classical seropositive rheumatoid arthritis for 24 years. The shoulders and hands were involved but the most severs pain and deformity were in both elbows and knees. Consequently, she was unable to sit on wheel chair and was confined to a bed. And then, she was admitted to the Chiba Rehabilitation Center in September, 1986 for bilateral total knee replacement. In April 1987, she had an operation upon the right knee and in June, she had an operation upon the left knee. About 6 weeks after surgery, she felt numbness in bilateral hands. The diagnosis was cubital tunnel syndrome. This was confirmed by electromyographic studies. Surgical release was undertaken without delay. The day following operation the patient remarked on the absence of numbness in bilateral hands.

Novel polyfunctional silanes for improved hydrolytic stability at the polymer-silica interface

Polyfunctional silanes were designed to promote the formation of a stable multisilane layer on the silica surface. The hydrolytic stability of polyfunctional silanes at the interface between silica and polymeric resin was investigated using conventional tensile testing. The specimens were immersed in boiling water and a decrease was observed in the tensile bonding strength of polymeric resin against the silane-treated silica surface as the immersion time increased. The failure mechanism changes from cohesive failure of the matrix resin to failure of the interface. The time necessary to start the interfacial failure is dependent on the silane concentration in the treating solution and the number of silicone functional groups within the silane molecules. The silane with two silicone functional groups is more stable at the interface between silica and polymeric resin than those which have mono- or trisilicone functional groups.

Acetabular cover in congenital dislocation of the hip

The exact measurement of femoral head cover is essential for an assessment of reduction of congenital dislocation of the hip. We have compared standard anteroposterior radiographs with computerised tomograms and thereby classified the shape of the acetabular roof into four types. We found that the CE angle of Wiberg is a more reliable measure of head cover when the lateral point of bony condensation of the roof is chosen as the reference point rather than the edge of the bone, where these two points do not overlap. We conclude that head cover can be more accurately determined in younger children with dysplastic hips by our 'refined' CE angle, than by the original method of Wiberg.

Experimental avascular necrosis of the femoral capital epiphysis and induced subluxation of the hip in young rabbits

We attempted to clarify experimentally the effect of hip joint incongruity on the necrotic femoral head. Twenty-four immature rabbits were divided into three groups: group I (12 rabbits), interruption of the epiphyseal artery and immobilization of the knee in extension for inducing subluxation of the hip; group II (six rabbits), interruption of the epiphyseal artery; group III (six rabbits), opening of the capsule (with preservation of the epiphyseal artery) and immobilization of the knee in extension. Radiographic examination of the hips of the rabbits in group I showed severe deformation of the necrotic femoral head with subluxation. These radiographic findings appeared similar to those of human hip joints affected with Perthes' disease.

Arthrography of early Perthes' disease. Swelling of the ligamentum teres as a cause of subluxation

Hip arthrography was performed in 19 patients in the initial stage of Perthes' disease. Sphericity and subluxation were measured and it was found that subluxation was independent of the femoral head deformity. We therefore tried to identify the cause of early subluxation: in seven patients a swollen ligamentum teres was thought to be responsible, and was associated with medial pooling of the contrast medium. A swollen ligamentum teres was seen in another seven cases; the other five arthrograms were normal. These findings were further clarified by enhanced CT scans, which confirmed that ligament swelling may be an important cause of early subluxation.