将叙述性证据表示为临床证据逻辑陈述。

Representing narrative evidence as clinical evidence logic statements.

作者信息

Lacson Ronilda, Eskian Mahsa, Cochon Laila, Gujrathi Isha, Licaros Andro, Zhao Anna, Vetrano Nicole, Schneider Louise, Raja Ali, Khorasani Ramin

机构信息

Department of Radiology, Center for Evidence-Based Imaging, Brigham and Women's Hospital, Boston, Massachusetts, USA.

Harvard Medical School, Boston, Massachusetts, USA.

出版信息

JAMIA Open. 2022 Apr 11;5(2):ooac024. doi: 10.1093/jamiaopen/ooac024. eCollection 2022 Jul.

DOI:10.1093/jamiaopen/ooac024

PMID:35474718

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9030217/

Abstract

OBJECTIVE

Clinical evidence logic statements (CELS) are shareable knowledge artifacts in a semistructured "If-Then" format that can be used for clinical decision support systems. This project aimed to assess factors facilitating CELS representation.

MATERIALS AND METHODS

We described CELS representation of clinical evidence. We assessed factors that facilitate representation, including authoring instruction, evidence structure, and educational level of CELS authors. Five researchers were tasked with representing CELS from published evidence. Represented CELS were compared with the formal representation. After an authoring instruction intervention, the same researchers were asked to represent the same CELS and accuracy was compared with that preintervention using McNemar's test. Moreover, CELS representation accuracy was compared between evidence that is structured versus semistructured, and between CELS authored by specialty-trained versus nonspecialty-trained researchers, using χ analysis.

RESULTS

261 CELS were represented from 10 different pieces of published evidence by the researchers pre- and postintervention. CELS representation accuracy significantly increased post-intervention, from 20/261 (8%) to 63/261 (24%, value < .00001). More CELS were assigned for representation with 379 total CELS subsequently included in the analysis (278 structured and 101 semistructured) postintervention. Representing CELS from structured evidence was associated with significantly higher CELS representation accuracy ( = .002), as well as CELS representation by specialty-trained authors ( = .0004).

DISCUSSION

CELS represented from structured evidence had a higher representation accuracy compared with semistructured evidence. Similarly, specialty-trained authors had higher accuracy when representing structured evidence.

CONCLUSION

Authoring instructions significantly improved CELS representation with a 3-fold increase in accuracy. However, CELS representation remains a challenging task.

摘要

目的

临床证据逻辑陈述（CELS）是以半结构化“如果-那么”格式呈现的可共享知识产物，可用于临床决策支持系统。本项目旨在评估促进CELS呈现的因素。

材料与方法

我们描述了临床证据的CELS呈现。我们评估了促进呈现的因素，包括编写说明、证据结构以及CELS作者的教育水平。五名研究人员负责根据已发表的证据呈现CELS。将呈现的CELS与正式呈现进行比较。在进行编写说明干预后，要求相同的研究人员再次呈现相同的CELS，并使用McNemar检验将准确性与干预前进行比较。此外，使用χ分析比较结构化证据与半结构化证据之间以及由经过专业培训的研究人员与未经专业培训的研究人员编写的CELS之间的CELS呈现准确性。

结果

研究人员在干预前后从10篇不同的已发表证据中呈现了261条CELS。干预后CELS呈现准确性显著提高，从20/261（8%）提高到63/261（24%，P值<0.00001）。干预后分配了更多的CELS进行呈现，随后共有379条CELS纳入分析（278条结构化和101条半结构化）。从结构化证据中呈现CELS与显著更高的CELS呈现准确性相关（P = 0.002），以及由经过专业培训的作者呈现CELS（P = 0.0004）。