Mitigation of adverse interactions in pairs of clinical practice guidelines using constraint logic programming

Szymon Wilk, Wojtek Michalowski, Martin Michalowski, Ken Farion, Marisela Mainegra Hing, Subhra Mohapatra

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

We propose a new method to mitigate (identify and address) adverse interactions (drug-drug or drug-disease) that occur when a patient with comorbid diseases is managed according to two concurrently applied clinical practice guidelines (CPGs). A lack of methods to facilitate the concurrent application of CPGs severely limits their use in clinical practice and the development of such methods is one of the grand challenges for clinical decision support. The proposed method responds to this challenge.We introduce and formally define logical models of CPGs and other related concepts, and develop the mitigation algorithm that operates on these concepts. In the algorithm we combine domain knowledge encoded as interaction and revision operators using the constraint logic programming (CLP) paradigm. The operators characterize adverse interactions and describe revisions to logical models required to address these interactions, while CLP allows us to efficiently solve the logical models - a solution represents a feasible therapy that may be safely applied to a patient.The mitigation algorithm accepts two CPGs and available (likely incomplete) patient information. It reports whether mitigation has been successful or not, and on success it gives a feasible therapy and points at identified interactions (if any) together with the revisions that address them. Thus, we consider the mitigation algorithm as an alerting tool to support a physician in the concurrent application of CPGs that can be implemented as a component of a clinical decision support system. We illustrate our method in the context of two clinical scenarios involving a patient with duodenal ulcer who experiences an episode of transient ischemic attack.

Original languageEnglish (US)
Pages (from-to)341-353
Number of pages13
JournalJournal of Biomedical Informatics
Volume46
Issue number2
DOIs
StatePublished - Apr 1 2013

Fingerprint

Logic programming
Practice Guidelines
Clinical Decision Support Systems
Drug interactions
Decision support systems
Transient Ischemic Attack
Duodenal Ulcer
Drug Interactions
Pharmaceutical Preparations
Physicians
Therapeutics

Keywords

  • Clinical decision support
  • Clinical practice guideline
  • Comorbid diseases
  • Constraint logic programming
  • Domain knowledge

Cite this

Mitigation of adverse interactions in pairs of clinical practice guidelines using constraint logic programming. / Wilk, Szymon; Michalowski, Wojtek; Michalowski, Martin; Farion, Ken; Hing, Marisela Mainegra; Mohapatra, Subhra.

In: Journal of Biomedical Informatics, Vol. 46, No. 2, 01.04.2013, p. 341-353.

Research output: Contribution to journalArticle

Wilk, Szymon ; Michalowski, Wojtek ; Michalowski, Martin ; Farion, Ken ; Hing, Marisela Mainegra ; Mohapatra, Subhra. / Mitigation of adverse interactions in pairs of clinical practice guidelines using constraint logic programming. In: Journal of Biomedical Informatics. 2013 ; Vol. 46, No. 2. pp. 341-353.
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