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Automatic identification of recent high impact clinical articles in PubMed to support clinical decision making using time-agnostic features.

ABSTRACT: OBJECTIVES:Finding recent clinical studies that warrant changes in clinical practice ("high impact" clinical studies) in a timely manner is very challenging. We investigated a machine learning approach to find recent studies with high clinical impact to support clinical decision making and literature surveillance. METHODS:To identify recent studies, we developed our classification model using time-agnostic features that are available as soon as an article is indexed in PubMed®, such as journal impact factor, author count, and study sample size. Using a gold standard of 541 high impact treatment studies referenced in 11 disease management guidelines, we tested the following null hypotheses: (1) the high impact classifier with time-agnostic features (HI-TA) performs equivalently to PubMed's Best Match sort and a MeSH-based Naïve Bayes classifier; and (2) HI-TA performs equivalently to the high impact classifier with both time-agnostic and time-sensitive features (HI-TS) enabled in a previous study. The primary outcome for both hypotheses was mean top 20 precision. RESULTS:The differences in mean top 20 precision between HI-TA and three baselines (PubMed's Best Match, a MeSH-based Naïve Bayes classifier, and HI-TS) were not statistically significant (12% vs. 3%, p?=?0.101; 12% vs. 11%, p?=?0.720; 12% vs. 25%, p?=?0.094, respectively). Recall of HI-TA was low (7%). CONCLUSION:HI-TA had equivalent performance to state-of-the-art approaches that depend on time-sensitive features. With the advantage of relying only on time-agnostic features, the proposed approach can be used as an adjunct to help clinicians identify recent high impact clinical studies to support clinical decision-making. However, low recall limits the use of HI-TA for literature surveillance.

SUBMITTER: Bian J

PROVIDER: S-EPMC6342626 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Automatic identification of recent high impact clinical articles in PubMed to support clinical decision making using time-agnostic features.

Bian Jiantao J Abdelrahman Samir S Shi Jianlin J Del Fiol Guilherme G

Journal of biomedical informatics 20181122

<h4>Objectives</h4>Finding recent clinical studies that warrant changes in clinical practice ("high impact" clinical studies) in a timely manner is very challenging. We investigated a machine learning approach to find recent studies with high clinical impact to support clinical decision making and literature surveillance.<h4>Methods</h4>To identify recent studies, we developed our classification model using time-agnostic features that are available as soon as an article is indexed in PubMed®, su ...[more]

PMID: 30468912

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Project description:Involvement of many variables, uncertainty in treatment response, and inter-patient heterogeneity challenge objective decision-making in dynamic treatment regime (DTR) in oncology. Advanced machine learning analytics in conjunction with information-rich dense multi-omics data have the ability to overcome such challenges. We have developed a comprehensive artificial intelligence (AI)-based optimal decision-making framework for assisting oncologists in DTR. In this work, we demonstrate the proposed framework to Knowledge Based Response-Adaptive Radiotherapy (KBR-ART) applications by developing an interactive software tool entitled Adaptive Radiotherapy Clinical Decision Support (ARCliDS). ARCliDS is composed of two main components: Artifcial RT Environment (ARTE) and Optimal Decision Maker (ODM). ARTE is designed as a Markov decision process and modeled via supervised learning. Given a patient's pre- and during-treatment information, ARTE can estimate treatment outcomes for a selected daily dosage value (radiation fraction size). ODM is formulated using reinforcement learning and is trained on ARTE. ODM can recommend optimal daily dosage adjustments to maximize the tumor local control probability and minimize the side effects. Graph Neural Networks (GNN) are applied to exploit the inter-feature relationships for improved modeling performance and a novel double GNN architecture is designed to avoid nonphysical treatment response. Datasets of size 117 and 292 were available from two clinical trials on adaptive RT in non-small cell lung cancer (NSCLC) patients and adaptive stereotactic body RT (SBRT) in hepatocellular carcinoma (HCC) patients, respectively. For training and validation, dense data with 297 features were available for 67 NSCLC patients and 110 features for 71 HCC patients. To increase the sample size for ODM training, we applied Generative Adversarial Networks to generate 10,000 synthetic patients. The ODM was trained on the synthetic patients and validated on the original dataset. We found that, Double GNN architecture was able to correct the nonphysical dose-response trend and improve ARCliDS recommendation. The average root mean squared difference (RMSD) between ARCliDS recommendation and reported clinical decisions using double GNNs were 0.61 [0.03] Gy/frac (mean [sem]) for adaptive RT in NSCLC patients and 2.96 [0.42] Gy/frac for adaptive SBRT HCC compared to the single GNN's RMSDs of 0.97 [0.12] Gy/frac and 4.75 [0.16] Gy/frac, respectively. Overall, For NSCLC and HCC, ARCliDS with double GNNs was able to reproduce 36% and 50% of the good clinical decisions (local control and no side effects) and improve 74% and 30% of the bad clinical decisions, respectively. In conclusion, ARCliDS is the first web-based software dedicated to assist KBR-ART with multi-omics data. ARCliDS can learn from the reported clinical decisions and facilitate AI-assisted clinical decision-making for improving the outcomes in DTR.

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Automatic identification of recent high impact clinical articles in PubMed to support clinical decision making using time-agnostic features.

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Automatic identification of recent high impact clinical articles in PubMed to support clinical decision making using time-agnostic features.

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