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PubMed1998

An evaluation of natural language processing methodologies.

Medical language processing (MLP) systems that codify information in textual patient reports have been developed to help solve the data entry problem. Some systems have been evaluated in order to assess performance, but there has been little evaluation of the underlying technology. Various methodologies are used by the different MLP systems but a comparison of the methods has not been performed although evaluations of MLP methodologies would be extremely beneficial to the field. This paper describes a study that evaluates different techniques. To accomplish this task an existing MLP system MedLEE was modified and results from a previous study were used. Based on confidence intervals and differences in sensitivity and specificity between each technique and all the others combined, the results showed that the two methods based on obtaining the largest well-formed segment within a sentence had significantly higher sensitivity than the others by 5% and 6%. The method based on recognizing a complete sentence had a significantly worse sensitivity than the others by 7% and a better specificity by .2%. None of the methods had significantly worse specificity.

Evaluation Studies as Topic↗
PubMed1993

Natural language processing of asthma discharge summaries for the monitoring of patient care.

A technique for monitoring healthcare via the processing of routinely collected narrative documentation is presented. A checklist of important details of asthma management in use in the Glasgow Royal Infirmary (GRI) was translated into SQL queries and applied to a database of 59 GRI discharge summaries analyzed by the New York University Linguistic String Project medical language processor. Tables of retrieved information obtained for each query were compared with the text of the original documents by physician reviewers. Categories (unit = document) were: (1) information present, retrieved correctly; (2) information not present; (3) information present, retrieved with minor or major error; (4) information present, retrieved with minor or major omissions. Category 2 (physician "documentation score") could be used to prioritize manual review and guide feedback to physicians to improve documentation. The semantic structuring and relative completeness of retrieved data suggest their potential use as input to further quality assurance procedures.

Asthma↗
PubMed2003

MedScan, a natural language processing engine for MEDLINE abstracts.

MOTIVATION: The importance of extracting biomedical information from scientific publications is well recognized. A number of information extraction systems for the biomedical domain have been reported, but none of them have become widely used in practical applications. Most proposals to date make rather simplistic assumptions about the syntactic aspect of natural language. There is an urgent need for a system that has broad coverage and performs well in real-text applications. RESULTS: We present a general biomedical domain-oriented NLP engine called MedScan that efficiently processes sentences from MEDLINE abstracts and produces a set of regularized logical structures representing the meaning of each sentence. The engine utilizes a specially developed context-free grammar and lexicon. Preliminary evaluation of the system's performance, accuracy, and coverage exhibited encouraging results. Further approaches for increasing the coverage and reducing parsing ambiguity of the engine, as well as its application for information extraction are discussed.

Abstracting and Indexing↗
PubMedDate not supplied

Structuring medical information into a language-independent database.

We describe one approach for natural language processing and database representation of medical information. The method is based in the semantic analysis of the statements and in the identification of patterns. The processed information is indexed and structured into a frame format containing semantic slots into the database. We tested our method analysing sentences describing symptoms extracted from case reports presented in the volume 328 of the New England Journal of Medicine. The results are: 73.41% of the sentences were formatted; 81.05% of the analysed words were identified; and 95.33% of the medical terms were indexed. We conclude that this semantic approach is not only efficient for processing natural language texts, but it can also be used for the organization of medical information using a language-independent format. This interlingua that is set into the database can be applied to semantic data retrieval; serving as a basis to organize a problem-orientated medical record; displaying simultaneously the DB information into two or more languages; information interchanging among different human languages and computers; and automatic translation, among others.

Abstracting and Indexing↗
PubMed2003

Processing of natural language queries to a relational database.

MOTIVATION: A new method is developed to query a relational database in natural language (NL). RESULTS: The method, based on a semantic approach, interprets grammatical and lexical units of a natural language into concepts of subject domain, which are given in a conceptual scheme. The conceptual scheme is mapped formally onto the logical scheme. We applied the method to query the FlyEx database in natural language. FlyEx contains information on the expression of segmentation genes in Drosophila melanogaster. The method allows formulation of queries in various natural languages simultaneously, and is adaptive to changes in the knowledge domain and user's views. It provides optimal transformation of queries from natural language to SQL, as well as visualization of information as a hyperscheme. The method does not require specification of all possible language constructions as well as a standard grammar accuracy in formulation of NL queries.

Animals↗
PubMed1997

Towards a comprehensive medical language processing system: methods and issues.

Natural language processing (NLP) systems can help solve the data entry problem by providing coded data from textual reports for clinical applications. A number of NLP systems have shown promise, but have not yet achieved wide-spread use for practical applications. In order to achieve such use, a system must have broad coverage of the clinical domain and not be restricted to limited applications. In addition, an NLP system must perform satisfactorily for real-world applications. This paper describes methods and issues associated with an ongoing extension of MedLEE, an operational NLP system, from a limited domain to a domain that encompasses comprehensive clinical information.

Humans↗
PubMedDate not supplied

Automatic detection of acute bacterial pneumonia from chest X-ray reports.

OBJECTIVE: To evaluate the performance of a natural language processing system in extracting pneumonia-related concepts from chest x-ray reports. METHODS DESIGN: Four physicians, three lay persons, a natural language processing system, and two keyword searches (designated AAKS and KS) detected the presence or absence of three pneumonia-related concepts and inferred the presence or absence of acute bacterial pneumonia from 292 chest x-ray reports. Gold standard: Majority vote of three independent physicians. Reliability of the gold standard was measured. OUTCOME MEASURES: Recall, precision, specificity, and agreement (using Finn's R: statistic) with respect to the gold standard. Differences between the physicians and the other subjects were tested using the McNemar test for each pneumonia concept and for the disease inference of acute bacterial pneumonia. RESULTS: Reliability of the reference standard ranged from 0.86 to 0.96. Recall, precision, specificity, and agreement (Finn R:) for the inference on acute bacterial pneumonia were, respectively, 0.94, 0.87, 0.91, and 0.84 for physicians; 0.95, 0.78, 0.85, and 0.75 for natural language processing system; 0.46, 0.89, 0.95, and 0.54 for lay persons; 0.79, 0.63, 0.71, and 0.49 for AAKS; and 0.87, 0.70, 0.77, and 0.62 for KS. The McNemar pairwise comparisons showed differences between one physician and the natural language processing system for the infiltrate concept and between another physician and the natural language processing system for the inference on acute bacterial pneumonia. The comparisons also showed that most physicians were significantly different from the other subjects in all pneumonia concepts and the disease inference. CONCLUSION: In extracting pneumonia related concepts from chest x-ray reports, the performance of the natural language processing system was similar to that of physicians and better than that of lay persons and keyword searches. The encoded pneumonia information has the potential to support several pneumonia-related applications used in our institution. The applications include a decision support system called the antibiotic assistant, a computerized clinical protocol for pneumonia, and a quality assurance application in the radiology department.

Acute Disease↗
PubMed2026

Natural language processing-based model to predict radiation pneumonitis in patients with locally advanced non-small cell lung cancer undergoing chemoradiotherapy: a retrospective cohort study.

BACKGROUND: Radiation pneumonitis (RP) remains a significant treatment-related toxicity in patients with unresectable, locally advanced non-small cell lung cancer (NSCLC) undergoing chemoradiotherapy (CRT). Most existing predictive models rely on static baseline demographic or dosimetry variables and lack real-time clinical applicability. We developed a novel predictive framework that integrates longitudinal symptom data extracted from clinical notes using natural language processing (NLP) with clinical and dosimetry features to improve early RP prediction. METHODS: We retrospectively identified 227 patients with locally advanced NSCLC treated with definitive CRT at a high-volume cancer center in the United States. We included all patients older than 18 years who were diagnosed between Jan 1, 2006, and Dec 31, 2022 with histologically or cytologically confirmed unresectable Stage 2 or 3 NSCLC and treated with conformal radiotherapy to a minimum dose of ≥45 Gy with or without chemotherapy. Of these, 31 RP events were identified through manual adjudication using radiologic criteria and chart review. NLP was used to extract the temporal relationship of 16 pre-specified symptoms with treatment from over 100,000 clinical notes spanning pre- and during-treatment intervals. We trained and validated machine learning models on combinations of baseline clinical data, radiation dosimetry, and NLP-derived symptom features. Model performance was evaluated using a nested cross-validation framework, with an outer cross-validation loop reserved for performance assessment and an inner cross-validation loop used for model training and integration, and summarized using area under the receiver operating characteristic curve (AUC) and partial AUC (pAUC) at high specificity thresholds. Clinical utility was evaluated using decision curve analysis (DCA). FINDINGS: The best-performing model incorporated longitudinal NLP features and achieved a median AUC of 0.759 (90% confidence interval 0.753-0.766), significantly outperforming baseline models using only dosimetry (AUC 0.613) or clinical variables (AUC 0.635). NLP-based features such as cough trajectory, shortness of breath, and wheezing were among the most important predictors. Inclusion of NLP-derived symptom data improved early identification of high-risk patients, particularly in the clinically relevant high-specificity range (pAUC 0.021 vs. 0.010 for dosimetry alone). DCA showed that the calibrated MLP model provided greater net benefit than default strategies of treating all or no patients across clinically relevant threshold possibilities. INTERPRETATION: In this early work, NLP-based extraction of longitudinal symptoms from routine clinical documentation meaningfully enhances RP prediction in patients undergoing CRT for NSCLC. This approach leverages existing electronic health record infrastructure to deliver real-time, scalable, and interpretable risk estimates, offering a pathway toward potential early intervention and personalized toxicity management. The model and DCA requires external and prospective validation before clinical deployment; as such, future work should focus on this validation and integration into clinical decision support systems. FUNDING: AstraZeneca.

Chemoradiotherapy↗
PubMed2000

Structured representation of drug indications: lexical and semantic analysis and object-oriented modeling.

No standardized representation of drug indications is currently available that could be used in drug knowledge bases. We describe an object-oriented representation of indications that should make it possible to develop new tools for selecting drugs and checking prescriptions in computerized drug prescription systems. The model was developed using the results of a lexical and semantic analysis of drug indications, collected into a single file and processed using natural language processing software. It distinguishes both the diseases for which the drug may be given and the efficiency of the drug for a given indication. Two aspects of the model were evaluated: the differences if two independent evaluators filled the attributes independently and the loss of information induced by the use of the model. A system based on this model, making it possible for the physician to select all the drugs satisfying various criteria, is also presented.

Artificial Intelligence↗
PubMed2004

Case-based medical informatics.

BACKGROUND: The "applied" nature distinguishes applied sciences from theoretical sciences. To emphasize this distinction, we begin with a general, meta-level overview of the scientific endeavor. We introduce the knowledge spectrum and four interconnected modalities of knowledge. In addition to the traditional differentiation between implicit and explicit knowledge we outline the concepts of general and individual knowledge. We connect general knowledge with the "frame problem," a fundamental issue of artificial intelligence, and individual knowledge with another important paradigm of artificial intelligence, case-based reasoning, a method of individual knowledge processing that aims at solving new problems based on the solutions to similar past problems. We outline the fundamental differences between Medical Informatics and theoretical sciences and propose that Medical Informatics research should advance individual knowledge processing (case-based reasoning) and that natural language processing research is an important step towards this goal that may have ethical implications for patient-centered health medicine. DISCUSSION: We focus on fundamental aspects of decision-making, which connect human expertise with individual knowledge processing. We continue with a knowledge spectrum perspective on biomedical knowledge and conclude that case-based reasoning is the paradigm that can advance towards personalized healthcare and that can enable the education of patients and providers. We center the discussion on formal methods of knowledge representation around the frame problem. We propose a context-dependent view on the notion of "meaning" and advocate the need for case-based reasoning research and natural language processing. In the context of memory based knowledge processing, pattern recognition, comparison and analogy-making, we conclude that while humans seem to naturally support the case-based reasoning paradigm (memory of past experiences of problem-solving and powerful case matching mechanisms), technical solutions are challenging.Finally, we discuss the major challenges for a technical solution: case record comprehensiveness, organization of information on similarity principles, development of pattern recognition and solving ethical issues. SUMMARY: Medical Informatics is an applied science that should be committed to advancing patient-centered medicine through individual knowledge processing. Case-based reasoning is the technical solution that enables a continuous individual knowledge processing and could be applied providing that challenges and ethical issues arising are addressed appropriately.

Decision Support Systems, Clinical↗
PubMed1998

Automatic extraction of PIOPED interpretations from ventilation/perfusion lung scan reports.

Free-text documents are the main type of data produced by a radiology department in a hospital information system. While this type of data is readily accessible for clinical data review it can not be accessed by other applications to perform medical decision support, quality assurance, and outcome studies. In an attempt to solve this problem, natural language processing systems have been developed and tested against chest x-rays reports to extract relevant clinical information and make it accessible to other computer applications. We have used a natural language processing tool called SymText to extract relevant clinical information from a different type of radiology report, the Ventilation/Perfusion lung scan report. Results of this effort can be analyzed in terms of precision and recall. The overall precision was 0.88 and recall was 0.92. In addition, the natural language processing system functions differently in reports with and without an impression section. If this type of information can be successfully extracted from radiology reports, one can develop quality monitors for the diagnostic performance of the radiologist by correlating the impressions with gold standard data present in a hospital information system. Avoiding the manual effort previously necessary to create quality assurance data, can lead to a higher frequency of quality review in a radiology department.

Bayes Theorem↗
PubMed1998

Alternative ways for knowledge collection, indexing and robust language retrieval.

Definitions are provided of the key entities in knowledge representation for Natural Language Processing (NLP). Starting from the words, which are the natural components of any sentence, both the role of expressions and the decomposition of words into their parts are emphasized. This leads to the notion of concepts, which are either primitive or composite depending on the model where they are created. The problem of finding the most adequate degree of granularity for a concept is studied. From this reflection on basic Natural Language Processing components, four categories of linguistic knowledge are recognized, that are considered to be the building blocks of a Medical Linguistic Knowledge Base (MLKB). Following on the tracks of a recent experience in building a natural language-based patient encoding browser, a robust method for conceptual indexing and query of medical texts is presented with particular attention to the scheme of knowledge representation.

Abstracting and Indexing↗
PubMed2003

Language processing during natural sleep in a 6-year-old boy, as assessed with functional MR imaging.

Functional MR imaging for language lateralization was performed in a 6-year-old child before neurosurgical intervention. A passive story-listening task was used; this revealed a bilateral language network. The task was repeated during the same session when the child had fallen asleep and surprisingly yielded strong activation in similar language areas. Our findings suggest that language processing does occur during natural sleep, even in young children. This potentially allows for an assessment of language functions, even in sleeping children.

Brain Mapping↗
PubMed2006

Argument-predicate distance as a filter for enhancing precision in extracting predications on the genetic etiology of disease.

BACKGROUND: Genomic functional information is valuable for biomedical research. However, such information frequently needs to be extracted from the scientific literature and structured in order to be exploited by automatic systems. Natural language processing is increasingly used for this purpose although it inherently involves errors. A postprocessing strategy that selects relations most likely to be correct is proposed and evaluated on the output of SemGen, a system that extracts semantic predications on the etiology of genetic diseases. Based on the number of intervening phrases between an argument and its predicate, we defined a heuristic strategy to filter the extracted semantic relations according to their likelihood of being correct. We also applied this strategy to relations identified with co-occurrence processing. Finally, we exploited postprocessed SemGen predications to investigate the genetic basis of Parkinson's disease. RESULTS: The filtering procedure for increased precision is based on the intuition that arguments which occur close to their predicate are easier to identify than those at a distance. For example, if gene-gene relations are filtered for arguments at a distance of 1 phrase from the predicate, precision increases from 41.95% (baseline) to 70.75%. Since this proximity filtering is based on syntactic structure, applying it to the results of co-occurrence processing is useful, but not as effective as when applied to the output of natural language processing. In an effort to exploit SemGen predications on the etiology of disease after increasing precision with postprocessing, a gene list was derived from extracted information enhanced with postprocessing filtering and was automatically annotated with GFINDer, a Web application that dynamically retrieves functional and phenotypic information from structured biomolecular resources. Two of the genes in this list are likely relevant to Parkinson's disease but are not associated with this disease in several important databases on genetic disorders. CONCLUSION: Information based on the proximity postprocessing method we suggest is of sufficient quality to be profitably used for subsequent applications aimed at uncovering new biomedical knowledge. Although proximity filtering is only marginally effective for enhancing the precision of relations extracted with co-occurrence processing, it is likely to benefit methods based, even partially, on syntactic structure, regardless of the relation.

Genetic Diseases, Inborn↗
PubMed2000

GALEN: a third generation terminology tool to support a multipurpose national coding system for surgical procedures.

Generalised architecture for languages, encyclopedia and nomenclatures in medicine (GALEN) has developed a new generation of terminology tools based on a language independent model describing the semantics and allowing computer processing and multiple reuses as well as natural language understanding systems applications to facilitate the sharing and maintaining of consistent medical knowledge. During the European Union 4 Th. framework program project GALEN-IN-USE and later on within two contracts with the national health authorities we applied the modelling and the tools to the development of a new multipurpose coding system for surgical procedures named CCAM in a minority language country, France. On one hand, we contributed to a language independent knowledge repository and multilingual semantic dictionaries for multicultural Europe. On the other hand, we support the traditional process for creating a new coding system in medicine which is very much labour consuming by artificial intelligence tools using a medically oriented recursive ontology and natural language processing. We used an integrated software named CLAW (for classification workbench) to process French professional medical language rubrics produced by the national colleges of surgeons domain experts into intermediate dissections and to the Grail reference ontology model representation. From this language independent concept model representation, on one hand, we generate with the LNAT natural language generator controlled French natural language to support the finalization of the linguistic labels (first generation) in relation with the meanings of the conceptual system structure. On the other hand, the Claw classification manager proves to be very powerful to retrieve the initial domain experts rubrics list with different categories of concepts (second generation) within a semantic structured representation (third generation) bridge to the electronic patient record detailed terminology.

Abstracting and Indexing↗
PubMed2005

Determining prominent subdomains in medicine.

We discuss an automated method for identifying prominent subdomains in medicine. The motivation is to enhance the results of natural language processing by focusing on sublanguages associated with medical specialties concerned with prevalent disorders. At the core of our approach is a statistical system for topical categorization of medical text. A method based on epidemiological evidence is compared to another that considers frequency of occurrence of Medline citations. We suggest the isolation of UMLS terminology peculiar to individual medical specialties as a way of enhancing natural language processing systems in the biomedical domain.

Abstracting and Indexing↗