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Objective: Taking into account patients' preferences has become an essential requirement in health decision-making. Even in evidence-based settings where directions are summarized into clinical practice guidelines, there might exist situations where it is important for the care provider to involve the patient in the decision. In this paper we propose a unified framework to promote the shift from a traditional, physician-centered, clinical decision process to a more personalized, patient-oriented shared decision-making (SDM) environment., Methods: We present the theoretical, technological and architectural aspects of a framework that encapsulates decision models and instruments to elicit patients' preferences into a single tool, thus enabling physicians to exploit evidence-based medicine and shared decision-making in the same encounter., Results: We show the implementation of the framework in a specific case study related to the prevention and management of the risk of thromboembolism in atrial fibrillation. We describe the underlying decision model and how this can be personalized according to patients' preferences. The application of the framework is tested through a pilot clinical evaluation study carried out on 20 patients at the Rehabilitation Cardiology Unit at the IRCCS Fondazione Salvatore Maugeri hospital (Pavia, Italy). The results point out the importance of running personalized decision models, which can substantially differ from models quantified with population coefficients., Conclusions: This study shows that the tool is potentially able to overcome some of the main barriers perceived by physicians in the adoption of SDM. In parallel, the development of the framework increases the involvement of patients in the process of care focusing on the centrality of individual patients., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: Process model comparison and similar process retrieval is a key issue to be addressed in many real-world situations, and a particularly relevant one in medical applications, where similarity quantification can be exploited to accomplish goals such as conformance checking, local process adaptation analysis, and hospital ranking. In this paper, we present a framework that allows the user to: (i) mine the actual process model from a database of process execution traces available at a given hospital; and (ii) compare (mined) process models. The tool is currently being applied in stroke management., Methods: Our framework relies on process mining to extract process-related information (i.e., process models) from data. As for process comparison, we have modified a state-of-the-art structural similarity metric by exploiting: (i) domain knowledge; (ii) process mining outputs and statistical temporal information. These changes were meant to make the metric more suited to the medical domain., Results: Experimental results showed that our metric outperforms the original one, and generated output closer than that provided by a stroke management expert. In particular, our metric correctly rated 11 out of 15 mined hospital models with respect to a given query. On the other hand, the original metric correctly rated only 7 out of 15 models. The experiments also showed that the framework can support stroke management experts in answering key research questions: in particular, average patient improvement decreased as the distance (according to our metric) from the top level hospital process model increased., Conclusions: The paper shows that process mining and process comparison, through a similarity metric tailored to medical applications, can be applied successfully to clinical data to gain a better understanding of different medical processes adopted by different hospitals, and of their impact on clinical outcomes. In the future, we plan to make our metric even more general and efficient, by explicitly considering various methodological and technological extensions. We will also test the framework in different domains., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: Information about medications is critical in supporting decision-making during the prescription process and thus in improving the safety and quality of care. In this work, we propose a methodology for the automatic recognition of drug-related entities (active ingredient, interaction effects, etc.) in textual drug descriptions, and their further location in a previously developed domain ontology., Methods and Material: The summary of product characteristics (SPC) represents the basis of information for health professionals on how to use medicines. However, this information is locked in free-text and, as such, cannot be actively accessed and elaborated by computerized applications. Our approach exploits a combination of machine learning and rule-based methods. It consists of two stages. Initially it learns to classify this information in a structured prediction framework, relying on conditional random fields. The classifier is trained and evaluated using a corpus of about a hundred SPCs. They have been hand-annotated with different semantic labels that have been derived from the domain ontology. At a second stage the extracted entities are added in the domain ontology corresponding concepts as new instances, using a set of rules manually-constructed from the corpus., Results: Our evaluations show that the extraction module exhibits high overall performance, with an average F1-measure of 88% for contraindications and 90% for interactions., Conclusion: SPCs can be exploited to provide structured information for computer-based decision support systems., (Copyright © 2012 Elsevier B.V. All rights reserved.)

Objective: The purpose of this study was to assess the performance of a real-time ("open-end") version of the dynamic time warping (DTW) algorithm for the recognition of motor exercises. Given a possibly incomplete input stream of data and a reference time series, the open-end DTW algorithm computes both the size of the prefix of reference which is best matched by the input, and the dissimilarity between the matched portions. The algorithm was used to provide real-time feedback to neurological patients undergoing motor rehabilitation., Methods and Materials: We acquired a dataset of multivariate time series from a sensorized long-sleeve shirt which contains 29 strain sensors distributed on the upper limb. Seven typical rehabilitation exercises were recorded in several variations, both correctly and incorrectly executed, and at various speeds, totaling a data set of 840 time series. Nearest-neighbour classifiers were built according to the outputs of open-end DTW alignments and their global counterparts on exercise pairs. The classifiers were also tested on well-known public datasets from heterogeneous domains., Results: Nonparametric tests show that (1) on full time series the two algorithms achieve the same classification accuracy (p-value =0.32); (2) on partial time series, classifiers based on open-end DTW have a far higher accuracy (kappa=0.898 versus kappa=0.447;p<10(-5)); and (3) the prediction of the matched fraction follows closely the ground truth (root mean square <10%). The results hold for the motor rehabilitation and the other datasets tested, as well., Conclusions: The open-end variant of the DTW algorithm is suitable for the classification of truncated quantitative time series, even in the presence of noise. Early recognition and accurate class prediction can be achieved, provided that enough variance is available over the time span of the reference. Therefore, the proposed technique expands the use of DTW to a wider range of applications, such as real-time biofeedback systems.