Enabling Patients to Receive Clinical Practice Guideline Recommendations for Hereditary Cancer Risk Using Chatbots, Family History, Application Programming Interfaces (API), Ontologies, and Owlready2: System Description (Preprint)

2021 ◽  
Author(s):  
Jordon Bryan Ritchie ◽  
Lewis Frey ◽  
Jean-Baptiste Lamy ◽  
Cecelia Bellcross ◽  
Heath Morrison ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Practice ◽  
Cancer Risk ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Hereditary Cancer ◽  
Family Health ◽  
Family Health History ◽  
Health History ◽  
Patients At Risk

BACKGROUND Identifying patients at risk of hereditary cancer based on their family health history is a highly nuanced task. Frequently, patients at risk are not referred for genetic counseling because providers lack time and training to collect and assess family health history. Consequently, patients at risk are not receiving the genetic counseling and testing they need to determine the preventive steps they should take to mitigate their risk. OBJECTIVE Enable patients to receive clinical practice guideline recommendations for their hereditary cancer risk based on their family health history with mobile friendly technology. METHODS We combined chatbots, web application programming interfaces, clinical practice guidelines, and ontologies into a web service oriented system that can automate family health history collection and assessment. We used Owlready2 and Protégé to develop a lightweight, patient-centric, clinical practice guideline domain ontology using hereditary cancer criteria from the American College of Medical Genetics and Genomics and the National Cancer Comprehensive Network. RESULTS The domain ontology has 758 classes, 20 object properties, 23 datatype properties, and 42 individuals and encompasses 44 cancers, 144 genes, and 113 clinical practice guideline criteria. So far, it has been used to assess over 5,000 family health history cases. We created 192 test cases to ensure concordance with clinical practice guidelines. The average test case completes in 4.5 seconds, the longest in 19.6 seconds, and the shortest in 2.9 seconds. CONCLUSIONS By engaging the chatbot, patients can collect and assess their family health history prior to visiting with their provider. Earlier identification of patients at risk of hereditary cancer leads to earlier and more effective preventive actions for managing hereditary cancer risk.

scholarly journals Role of Physical Therapists in the Management of Individuals at Risk for or Diagnosed With Venous Thromboembolism: Evidence-Based Clinical Practice Guideline

2016 ◽  
Vol 96 (2) ◽  
pp. 143-166 ◽  
Author(s):  
Ellen Hillegass ◽  
Michael Puthoff ◽  
Ethel M. Frese ◽  
Mary Thigpen ◽  
Dennis C. Sobush ◽  
...  
Keyword(s):  
Decision Making ◽  
At Risk ◽  
Clinical Practice ◽  
Venous Thromboembolism ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Clinical Decision Making ◽  
Physical Therapists ◽  
Physical Therapist ◽  
Patients At Risk

The American Physical Therapy Association (APTA), in conjunction with the Cardiovascular & Pulmonary and Acute Care sections of APTA, have developed this clinical practice guideline to assist physical therapists in their decision-making process when treating patients at risk for venous thromboembolism (VTE) or diagnosed with a lower extremity deep vein thrombosis (LE DVT). No matter the practice setting, physical therapists work with patients who are at risk for or have a history of VTE. This document will guide physical therapist practice in the prevention of, screening for, and treatment of patients at risk for or diagnosed with LE DVT. Through a systematic review of published studies and a structured appraisal process, key action statements were written to guide the physical therapist. The evidence supporting each action was rated, and the strength of statement was determined. Clinical practice algorithms, based on the key action statements, were developed that can assist with clinical decision making. Physical therapists, along with other members of the health care team, should work to implement these key action statements to decrease the incidence of VTE, improve the diagnosis and acute management of LE DVT, and reduce the long-term complications of LE DVT.

scholarly journals Automated Clinical Practice Guideline Recommendations for Hereditary Cancer Risk Using Chatbots and Ontologies: System Description (Preprint)

JMIR Cancer ◽  
10.2196/29289 ◽  
2021 ◽  
Author(s):  
Jordon Bryan Ritchie ◽  
Lewis Frey ◽  
Jean-Baptiste Lamy ◽  
Cecelia Bellcross ◽  
Heath Morrison ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cancer Risk ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Hereditary Cancer ◽  
System Description

scholarly journals Evaluation and comparison of hereditary Cancer guidelines in the population

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jordon B. Ritchie ◽  
Cecelia Bellcross ◽  
Caitlin G. Allen ◽  
Lewis Frey ◽  
Heath Morrison ◽  
...  
Keyword(s):  
At Risk ◽  
Web Services ◽  
Gene Mutation ◽  
Hereditary Cancer ◽  
Gene Mutations ◽  
Family Health ◽  
Cancer History ◽  
Li Fraumeni Syndrome ◽  
Patients At Risk ◽  
Genetic Consultation

Abstract Background Family health history (FHx) is an effective tool for identifying patients at risk of hereditary cancer. Hereditary cancer clinical practice guidelines (CPG) contain criteria used to evaluate FHx and to make recommendations for genetic consultation. Comparing different CPGs used to evaluate a common set of FHx provides insight into how well the CPGs perform, the extent of agreement across guidelines, and how well they identify patients who should consider a cancer genetic consultation. Methods We compare the American College of Medical Genetics and Genomics (ACMG) and the National Comprehensive Cancer Networks (NCCN) (2019) CPG criteria for FHx collected by a chatbot and evaluated by ontologies and web services in a previous study. Collected FHx met criteria from seven groups: Gene Mutation, Breast and Ovarian, Li-Fraumeni syndrome (LFS), Colorectal and Endometrial, Relative Meets Criteria, ACMG Only Criteria, and NCCN Testing. CPG Criteria were coded and matched across 12 ACMG sub-guidelines and 6 NCCN sub-guidelines for comparison purposes. Results The dataset contains 4915 records, of which 2221 met either ACMG or NCCN criteria and 2694 did not. There was significant overlap—1179 probands met both ACMG and NCCN criteria. The greatest similarities were for Gene Mutation and Breast and Ovarian criteria and the greatest disparity existed among Colorectal and Endometrial criteria. Only 156 positive gene mutations were reported and of the 2694 probands who did not meet criteria, 90.6% of them reported at least one cancer in their personal or family cancer history. Conclusion Hereditary cancer CPGs are useful for identifying patients at risk of developing cancer based on FHx. This comparison shows that with the aid of chatbots, ontologies, and web services, CPGs can be more efficiently applied to identify patients at risk of hereditary cancer. Additionally this comparison examines similarities and differences between ACMG and NCCN and shows the importance of using both guidelines when evaluating hereditary cancer risk.

Utilization of Percentage of Predicted Forced Vital Capacity to Stratify Rib Fracture Patients: An Updated Clinical Practice Guideline

2020 ◽  
pp. 000313482095627
Author(s):  
Abid D. Khan ◽  
Derek R. Marlor ◽  
Joshua D. Billings ◽  
Joe Rodriguez ◽  
Brian E. Leininger ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Forced Vital Capacity ◽  
Practice Guideline ◽  
Vital Capacity ◽  
Analysis Data ◽  
Rib Fractures ◽  
Risk Category ◽  
Risk Patients

Background Rib fractures are the most common injuries diagnosed after blunt thoracic trauma and are a source of significant morbidity and mortality. Early identification of at-risk patients and initiation of effective analgesia are keys to mitigating complications from these injuries. Multiple tools exist to predict pulmonary decompensation after rib fractures; however, none has found a widespread acceptance. A clinical practice guideline (CPG) utilizing Forced vital capacity (FVC) has been in place at a single institution. The goal of this study is to update the CPG to use percentage of predicted FVC (FVC%) instead of FVC to triage patients with rib fractures. Materials and Methods A retrospective study of 266 patients with rib fractures was conducted. Patients were divided into 3 groups based on FVC of <1000 mL, 1001-1500 mL, or >1500 mL for analysis. Data were analyzed with analysis of variance, and Youden’s J Index was used to identify inflection points. Results Patients in the high-risk category were more likely to be women, older than 65 years, admitted to the intensive care unit (ICU), transferred to the ICU, require intubation, and have overall longer hospital and ICU stays. The updated CPG triage cutoffs for admission to ICU, stepdown, and floor were redefined as FVC% values of <25%, 25-45%, and >45%, respectively. Discussion The updated CPG using FVC% may more accurately identify patients with compromised physiology and be a better tool to help predict patients who are at risk for decompensation following rib fractures. A validation study for the updated CPG is in progress.

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