Procedural approach to mitigating concurrently applied clinical practice guidelines
Bibliographic record
Abstract
There is a pressing need in clinical practice to mitigate (identify and address) adverse interactions that occur when a comorbid patient is managed according to multiple concurrently applied disease-specific clinical practice guidelines (CPGs). We describe an automatic algorithm for mitigating undesirable interactions for pairs of CPGs. The algorithm constructs logical models of processed CPGs and employs constraint logic programming to solve them. It handles two important issues frequently occurring in CPGs – iterative actions forming a cycle and numerical measurements. Dealing with these two issues in practice relies on a physician’s knowledge and the manual analysis of CPGs. Yet for guidelines to be considered stand-alone and an easy to use clinical decision support tool this process needs to be automated. In this paper we present our algorithm that aims to build such a tool by mitigating multiple CPGs while handling cycles and numerical measurements. The application of the mitigation algorithm is illustrated with a clinical case study involving a comorbid patient suffering from atrial fibrillation in the setting of WolffParkinsons-White syndrome.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.085 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.004 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.005 | 0.003 |
| Open science | 0.004 | 0.005 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.006 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".