BACKGROUND: For an interoperable Intelligent Tutoring System (ITS), we used resources from Fast Healthcare Interoperability Resources (FHIR) and mapped learning content with Unified Medical Language System (UMLS) codes to enhance healthcare education. This study addresses the need to enhance the interoperability and effectiveness of ITS in healthcare education.
BACKGROUND: The current state of the art in ITS involves advanced personalized learning and adaptability techniques, integrating technologies such as machine learning to personalize the learning experience and to create systems that dynamically respond to individual learner needs. However, existing ITS architectures face challenges related to interoperability and integration with healthcare systems.
METHODS: Our system maps learning content with UMLS codes, each scored for similarity, ensuring consistency and extensibility. FHIR is used to standardize the exchange of medical information and learning content.
METHODS: Implemented as a microservice architecture, the system uses a recommender to request FHIR resources, provide questions, and measure learner progress.
CONCLUSIONS: Using international standards, our ITS ensures reproducibility and extensibility, enhancing interoperability and integration with existing platforms.

Ontologies play a key role in representing and structuring domain knowledge. In the biomedical domain, the need for this type of representation is crucial for structuring, coding, and retrieving data. However, available ontologies do not encompass all the relevant concepts and relationships. In this paper, we propose the framework SiMHOMer (Siamese Models for Health Ontologies Merging) to semantically merge and integrate the most relevant ontologies in the healthcare domain, with a first focus on diseases, symptoms, drugs, and adverse events. We propose to rely on the siamese neural models we developed and trained on biomedical data, BioSTransformers, to identify new relevant relations between concepts and to create new semantic relations, the objective being to build a new merging ontology that could be used in applications. To validate the proposed approach and the new relations, we relied on the UMLS Metathesaurus and the Semantic Network. Our first results show promising improvements for future research.

Biomedical data analysis and visualization often demand data experts for each unique health event. There is a clear lack of automatic tools for semantic visualization of the spread of health risks through biomedical data. Illnesses such as coronavirus disease (COVID-19) and Monkeypox spread rampantly around the world before governments could make decisions based on the analysis of such data. We propose the design of a knowledge graph (KG) for spatio-temporal tracking of public health event propagation. To achieve this, we propose the specialization of the Core Propagation Phenomenon Ontology (PropaPhen) into a health-related propagation phenomenon domain ontology. Data from the UMLS and OpenStreetMaps are suggested for instantiating the proposed knowledge graph. Finally, the results of a use case on COVID-19 data from the World Health Organization are analyzed to evaluate the possibilities of our approach.

Our novel Intelligent Tutoring System (ITS) architecture integrates HL7 Fast Healthcare Interoperability Resources (FHIR) for data exchange and Unified Medical Language System (UMLS) codes for content mapping.

This article presents experience in construction the National Unified Terminological System (NUTS) with an ontological structure based on international Unified Medical Language System (UMLS). UMLS has been adapted and enriched with formulations from national directories, relationships, extracted from the texts of scientific articles and electronic health records, and weight coefficients.

This article presents our experience in development an ontological model can be used in clinical decision support systems (CDSS) creating. We have used the largest international biomedical terminological metathesaurus the Unified Medical Language System (UMLS) as the basis of our model. This metathesaurus has been adapted into Russian using an automated hybrid translation system with expert control. The product we have created was named as the National Unified Terminological System (NUTS). We have added more than 33 million scientific and clinical relationships between NUTS terms, extracted from the texts of scientific articles and electronic health records. We have also computed weights for each relationship, standardized their values and created symptom checker in preliminary diagnostics based on this. We expect, that the NUTS allow solving task of named entity recognition (NER) and increasing terms interoperability in different CDSS.

OBJECTIVE: Traditional knowledge-based and machine learning diagnostic decision support systems have benefited from integrating the medical domain knowledge encoded in the Unified Medical Language System (UMLS). The emergence of Large Language Models (LLMs) to supplant traditional systems poses questions of the quality and extent of the medical knowledge in the models\' internal knowledge representations and the need for external knowledge sources. The objective of this study is three-fold: to probe the diagnosis-related medical knowledge of popular LLMs, to examine the benefit of providing the UMLS knowledge to LLMs (grounding the diagnosis predictions), and to evaluate the correlations between human judgments and the UMLS-based metrics for generations by LLMs.
METHODS: We evaluated diagnoses generated by LLMs from consumer health questions and daily care notes in the electronic health records using the ConsumerQA and Problem Summarization datasets. Probing LLMs for the UMLS knowledge was performed by prompting the LLM to complete the diagnosis-related UMLS knowledge paths. Grounding the predictions was examined in an approach that integrated the UMLS graph paths and clinical notes in prompting the LLMs. The results were compared to prompting without the UMLS paths. The final experiments examined the alignment of different evaluation metrics, UMLS-based and non-UMLS, with human expert evaluation.
RESULTS: In probing the UMLS knowledge, GPT-3.5 significantly outperformed Llama2 and a simple baseline yielding an F1 score of 10.9% in completing one-hop UMLS paths for a given concept. Grounding diagnosis predictions with the UMLS paths improved the results for both models on both tasks, with the highest improvement (4%) in SapBERT score. There was a weak correlation between the widely used evaluation metrics (ROUGE and SapBERT) and human judgments.
CONCLUSIONS: We found that while popular LLMs contain some medical knowledge in their internal representations, augmentation with the UMLS knowledge provides performance gains around diagnosis generation. The UMLS needs to be tailored for the task to improve the LLMs predictions. Finding evaluation metrics that are aligned with human judgments better than the traditional ROUGE and BERT-based scores remains an open research question.

BACKGROUND: Vaccines have revolutionized public health by providing protection against infectious diseases. They stimulate the immune system and generate memory cells to defend against targeted diseases. Clinical trials evaluate vaccine performance, including dosage, administration routes, and potential side effects.
RESULTS: gov is a valuable repository of clinical trial information, but the vaccine data in them lacks standardization, leading to challenges in automatic concept mapping, vaccine-related knowledge development, evidence-based decision-making, and vaccine surveillance.
RESULTS: In this study, we developed a cascaded framework that capitalized on multiple domain knowledge sources, including clinical trials, the Unified Medical Language System (UMLS), and the Vaccine Ontology (VO), to enhance the performance of domain-specific language models for automated mapping of VO from clinical trials. The Vaccine Ontology (VO) is a community-based ontology that was developed to promote vaccine data standardization, integration, and computer-assisted reasoning. Our methodology involved extracting and annotating data from various sources. We then performed pre-training on the PubMedBERT model, leading to the development of CTPubMedBERT. Subsequently, we enhanced CTPubMedBERT by incorporating SAPBERT, which was pretrained using the UMLS, resulting in CTPubMedBERT + SAPBERT. Further refinement was accomplished through fine-tuning using the Vaccine Ontology corpus and vaccine data from clinical trials, yielding the CTPubMedBERT + SAPBERT + VO model. Finally, we utilized a collection of pre-trained models, along with the weighted rule-based ensemble approach, to normalize the vaccine corpus and improve the accuracy of the process. The ranking process in concept normalization involves prioritizing and ordering potential concepts to identify the most suitable match for a given context. We conducted a ranking of the Top 10 concepts, and our experimental results demonstrate that our proposed cascaded framework consistently outperformed existing effective baselines on vaccine mapping, achieving 71.8% on top 1 candidate\'s accuracy and 90.0% on top 10 candidate\'s accuracy.
CONCLUSIONS: This study provides a detailed insight into a cascaded framework of fine-tuned domain-specific language models improving mapping of VO from clinical trials. By effectively leveraging domain-specific information and applying weighted rule-based ensembles of different pre-trained BERT models, our framework can significantly enhance the mapping of VO from clinical trials.

BACKGROUND: Biomedical entity linking (BEL) is the task of grounding entity mentions to a given knowledge base (KB). Recently, neural name-based methods, system identifying the most appropriate name in the KB for a given mention using neural network (either via dense retrieval or autoregressive modeling), achieved remarkable results for the task, without requiring manual tuning or definition of domain/entity-specific rules. However, as name-based methods directly return KB names, they cannot cope with homonyms, i.e. different KB entities sharing the exact same name. This significantly affects their performance for KBs where homonyms account for a large amount of entity mentions (e.g. UMLS and NCBI Gene).
RESULTS: We present BELHD (Biomedical Entity Linking with Homonym Disambiguation), a new name-based method that copes with this challenge. BELHD builds upon the BioSyn model with two crucial extensions. First, it performs pre-processing of the KB, during which it expands homonyms with a specifically constructed disambiguating string, thus enforcing unique linking decisions. Second, it introduces candidate sharing, a novel strategy that strengthens the overall training signal by including similar mentions from the same document as positive or negative examples, according to their corresponding KB identifier. Experiments with 10 corpora and 5 entity types show that BELHD improves upon current neural state-of-the-art approaches, achieving the best results in 6 out of 10 corpora with an average improvement of 4.55pp recall@1. Furthermore, the KB preprocessing is orthogonal to the prediction model and thus can also improve other neural methods, which we exemplify for GenBioEL, a generative name-based BEL approach.
METHODS: The code to reproduce our experiments can be found at: https://github.com/sg-wbi/belhd.

To date, symptom documentation has mostly relied on clinical notes in electronic health records or patient-reported outcomes using disease-specific symptom inventories. To provide a common and precise language for symptom recording, assessment, and research, a comprehensive list of symptom codes is needed. The International Classification of Diseases, Ninth Revision or its clinical modification ( International Classification of Diseases, Ninth Revision, Clinical Modification ) has a range of codes designated for symptoms, but it does not contain codes for all possible symptoms, and not all codes in that range are symptom related. This study aimed to identify and categorize the first list of International Classification of Diseases, Ninth Revision, Clinical Modification symptom codes for a general population and demonstrate their use to characterize symptoms of patients with type 2 diabetes mellitus in the Cerner database. A list of potential symptom codes was automatically extracted from the Unified Medical Language System Metathesaurus. Two clinical experts in symptom science and diabetes manually reviewed this list to identify and categorize codes as symptoms. A total of 1888 International Classification of Diseases, Ninth Revision, Clinical Modification symptom codes were identified and categorized into 65 categories. The symptom characterization using the newly obtained symptom codes and categories was found to be more reasonable than that using the previous symptom codes and categories on the same Cerner diabetes cohort.