Semantic Interoperability Model And Application Study Of Critical Appraisal On Evidence Based Medicine

With the development of information, the standardization and normalization of evidence resources, evaluation and utilization of evidence-based medicine are more and more being focused upon. One of the key issues to practice evidence-based medicine is how to provide convenient and efficient medical evidence to support clinical practitioners and to promote evaluation, utilization and sharing of resources of medical evidence information.As for evidence resources on medical research information, the use of ontology can provide an intelligent search mechanism and can break through the disadvantages of traditional information retrieval technology which really meet the user's needs for information and habits of expression. It can enhance ability to deal with retrieval systems, and reduce the terminal retrieve user's cognitive burden at the same time, which elevate evidence information from keywords-based level to concepts or knowledge-based level. It can also improve the retrieval and use of medical evidence and evaluation information, eventually achieve intelligent information retrieval and use of medical evidence appraisal.We integrated used different research methods, which included literature survey analysis, web information retrieval and comparison, case analysis, synthesis, and expert interviews method. We used different types of information resources for medical research evidence as real examples to study the ontology-based knowledge organization. We used the relevant knowledge of Library and Information Science, from customer service point of view, to construct a knowledge organization model framework of evidence appraisal research system which has the characteristics of evidence-based medicine.We studied on the knowledge expression way for medical evidence appraisal through the construction of evidence appraisal semantic model for evidence-based medicine. The comprehensive demand analysis was performed on the basis of the basic requirements of critical appraisal in evidence-based medicine and under the guidance of the application of ontology engineering principles. Then the related data and information was collected, analysis of the relationship between them was performed and the semantic model and the examples of systematic review were established. A preliminary test and evaluation on applicability of the model was studied through the systematic review and other research examples. The study provided a standardized form for knowledge express of critical appraisal information in evidence-based medicine. It also provided a comprehensive and professional evaluation of the evidence described in information resources for broad masses of medical staff and interested users.During the demand analysis for model, the study comprehensive analyzed the quality and status of medical evidence on every key aspect, taking into account international norms and standards, identified the demands from various aspects, including evidence sources, types, structure, relationship, accuracy and reliability, and built the critical appraisal semantic model.The construction of knowledge ontology was based on the recognized theory of evidence based medicine, followed the basic principles of ontology development and the seven-step method on ontology development provided by School of Medicine, Stanford University, used Protégéontology editing tool to build the hierarchical structure of semantic model, to define the relationship between the concepts, the professional vocabulary of the semantic slots and standard description of other metadata. The critical appraisal ontology of medical evidence included the commonly used indicators and projects, and set up a logical relationship between concepts through the description of the application environment of the indicators and projects. The semantic model contained the basic elements of the critical appraisal of medical evidences. There were 7 categories, 27 sub-categories and 87 semantic slots (properties) and the metadata. The implementation of the model structured and formal expression was accomplished. The model was based on different types of study designs which can be divided into the following sections: The Systematic Review and Meta-analyses (QUORUM) semantic model; The Randomized Controlled Trials (CONSORT) semantic model; The Observational studies in Epidemiology (STROBE) semantic model; The Diagnostic Accuracy (STARD) semantic model; The Clinical guideline (AGREE) semantic model.The study reused and improved the model through the systematic review and other real examples, and at meantime provided an effective evidence for clinical practice. The example of systematic review was focused on the relationship between INR control measures and adverse effects of oral anticoagulation in atrial fibrillation, which had important meaning for clinical practice. We searched MEDLINE, EMBASE and Cochrane Library to 2008 for studies reporting INR control measures as percentage of time in therapeutic range (TTR), percentage of INRs in range and clinical outcomes in patients with AF receiving warfarin therapy. Outcomes analyzed were major haemorrhage and thromboembolic events. From the total 1571 retrieved articles, there were 38 articles meeting the including criteria which included 47 study groups. To obtain optimal benefits of anticoagulation control, individuals need to be maintained within their INR reference range, which requires regular monitoring and appropriate modification of treatment. This study systematically examined the relationship between INR control measurements and the prediction of adverse events in patients with atrial fibrillation on oral anticoagulation. For instance, a small increment in TTR, of 7%, can lead to a reduction in major haemorrhage by 1 event per 100 patient years of treatment. Based on our analysis anticoagulation services ought to aim for a TTR between 70% and 80% to optimize benefits and reduce harms for the patients. TTR and percentage of INRs in range can predict INR control effectively. The results support the relationship between INR control and clinical outcomes of major haemorrhage and thromboembolic events.The process and outcome of systematic review example provided a good environment for the improvement and applicability evaluation of the semantic model. Through the model reuse of different types of studies, the structure and property of the model was adjusted and improved, and the consistency and applicability of the model was verified.The development process of the semantic model was in accordance with corresponding international research standards or norms. The model was also assessed and adjusted with real examples, which made the model have authority, clarity, consistency and applicability. At the same time, the design process of the model took into account the future revision and development requirement, set the corresponding category, semantic slot and metadata, which made the model with expandability.This study also experimentally explored system interoperation of the model. Although there had not achieved intelligent inference retrieval, but the research of ontology-based concept retrieval could provide retrieval based on the intrinsic link of critical appraisal of medical evidences, which improved the overall degree of retrieval, and improved the accuracy through appropriate control on the interaction of search results. The research outcome promoted the informationization of critical appraisal of evidence-based medicine and development of carry out evidence-based practice.On the conclusion, the development of a common critical appraisal semantic model on evidence-based medicine has great importance on effective management, development and utilization of information resources of medical evidences. It also has great importance on the transformation from clinical problem, evidence development and appraisal to clinical practice.