Just for anyone who was curious, I was thinking along these lines: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655946/, for overall experiment, not necessarily for methods, as I haven't had time to look at theirs.
On Thu, Oct 31, 2013 at 1:53 PM, Finan, Sean < [email protected]> wrote: > I don't know if what I write below truly applies to the discussion, but > here it is. > > >much of a problem list definition may already be contained to varying > degrees > > in existing cTakes databases. > The UMLS does provide a problem list, but I haven't looked at it. > http://www.nlm.nih.gov/research/umls/Snomed/core_subset.html > > This might be a paper of interest to you: > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655994/ > It discusses the use of nlp to create something like a problem list. > > Sean > > > > ________________________________________ > From: John Green [[email protected]] > Sent: Thursday, October 31, 2013 12:02 PM > To: [email protected] > Subject: Re: Sundry > > Pei and Tim - Good questions. > > The bottom line is that OPQRST is the algorithm that every clinician uses > to characterize the history of a sign, symptom or constellation of > symptoms. Each letter has multiple meanings, but generally they're grouped. > O for onset, was it quick or slow in onset, P for palliative or provoking > phenomenon, that is, does tylenol make it better? Does it feel better when > you lean forward? Is it worse with standing? Q is the quality, generally, > though I could give more examples of each Ill keep it brief from here, R is > generally region or radiation of the pain and or sign, S is the severity, > and T is the time course, is it intermittent? When it happens, how long > does it last for? I could send documents used to teach new clinicians to > better comprehend for anyone interested. > > OPQRST, while most residents would assume it is only for teaching new > clinicians, as Tim said, is a useful tool at all levels. Great clinicians, > and I work with some great senior folks, use this everyday. The idea that > it is only for teaching is founded on two things: one, that it doubles as a > structured mnemonic for characterizing signs and symptoms and two, that > everyone so far ingrains this into their clinical skill set, unless they > are geared toward teaching, they, after the basic level, never think about > it again! Caveat: many good clinicians will tell you to keep it algorithmic > so that you're systematic and do not overlook details. > > What is it's application to ML? Obviously the furthest desired end-state > for NLP like cTakes would be understanding a clinical encounter to such a > nuanced level that detailed diagnoses could be considered along with > treatment plans. While I only know what I've read in Artificial > Intelligence: A Modern Approach and picked up from friends over the years > who were good knowledgeable in this field, I feel that OPQRST would be a > huge benefit toward beginning to outline the problem of more rigorous ML > characterization of the clinical narrative. > > The utility of OPQRST may not still be entirely clear to those who have > never been presented with a clinical encounter. Let me try one more stab: > Take the classic example of chest pain. A man comes to the ER with chest > pain. Is the onset quick? Yes doc, it was all of a sudden. This might > support a diagnosis of, say, MI, aortic dissection, pulmonary embolism, but > less likely someone would call GERD sudden. Palliative or provoking > features? Well, when I take 8 antacids it gets better (GERD), or, When I > take my wifes nitroglycerine it got better for a little while (angina), or, > when I took my wifes nitroglycerine it did nothing (pericarditis?). > Quality: Is it stabbing? Ya doc, its stabbing (less likely MI). Is it > crushing? Like an elephant on your chest? Ya doc, that's it. (more likely > MI), and so on. > > Now of course, cTakes could be used for a real life encounter like this > (middleware) at some point, but likely it would be taking a history and > proposing a diagnosis (middleware again Tim, yes). But the point is, the > first steps toward knowing what were dealing with at the historical level > is centered around OPQRST, and it just occurred to me to ask what we > thought about the feasibility of something like that. > > In retrospect, it may be too tough, but at some point it would need done, > just as much as a clinician must learn it. > > One final point: problem lists. These are absolutely essential to any > clinician in making a diagnosis. Again, often times, they dont think about > it, but they use them. When writing the above it occurred to me: much of a > problem list definition may already be contained to varying degrees in > existing cTakes databases. It would be an interesting and worthwhile paper, > I think, to see how well cTakes compiled problem lists matched Medical > Students, Residents, and Attending physician's problem lists. If anyone is > interested in this line of thought, I would be interested in collaborating. > It would be very easy, and the data may actually already exist to compare. > Forgive me if its already been done, but, if it hasnt, then it would go a > long way toward proving cTakes efficacy in regards to high-order processes. > And if it hasnt been done and someone does it at a later date, please, send > me an email to the paper! > > JG > > > On Wed, Oct 30, 2013 at 10:08 AM, Tim Miller < > [email protected]> wrote: > > > Thanks for bumping this Pei, it reminds me I meant to respond to it. > > > > The OPQRST does sound like a great ML project. At a glance I might think > a > > sequence model over sentences (like a CRF) would be a good model. > > But I'm wondering what the end use case is? Is it for teaching OPQRST to > > new clinicians? Or maybe as a sort of middleware for other projects where > > it might be a useful feature? Without a physician's intuition I sometimes > > suffer from a failure of imagination on these things. > > > > Tim > > > > > > > > On 10/30/2013 09:59 AM, Chen, Pei wrote: > > > >> Hi John, > >> I was away for a little bit and finally got a chance to catch up on > >> emails... > >> > >> 2) I work for the DoD and have latched on to several IRB approved > >>> projects > >>> within that community where Ill be using cTakes, though minimally at > >>> first. > >>> This is just a statement, a bug in the ear of the community of what > >>> people > >>> are up to. > >>> > >> This is really news! Looking forward to hearing more... > >> > >> has anyone considered (and maybe the components already do this in some > >>> way I > >>> haven't explored yet - time is ever limited) adding an OPQRST > classifier? > >>> > >> I'm not too familiar on how OPQRST would be determined from the > patient's > >> record. > >> Just curious, how is it currently determined manually now? Is it a > >> single score determined by a formula/rule(s)? > >> Seems like another good use case for cTAKES output-- clinically focused. > >> --Pei > >> > > > > >
