Browsing by Author "Duncan, William D."
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Item ACLRO: An Ontology for the Best Practice in ACLR Rehabilitation(2020-10) Phalakornkule, Kanitha; Jones, Josette F.; Boukai, Ben; Liu, Xiaowen; Purkayatha, Saptarshi; Duncan, William D.With the rise of big data and the demands for leveraging artificial intelligence (AI), healthcare requires more knowledge sharing that offers machine-readable semantic formalization. Even though some applications allow shared data interoperability, they still lack formal machine-readable semantics in ICD9/10 and LOINC. With ontology, the further ability to represent the shared conceptualizations is possible, similar to SNOMED-CT. Nevertheless, SNOMED-CT mainly focuses on electronic health record (EHR) documenting and evidence-based practice. Moreover, due to its independence on data quality, the ontology enhances advanced AI technologies, such as machine learning (ML), by providing a reusable knowledge framework. Developing a machine-readable and sharable semantic knowledge model incorporating external evidence and individual practice’s values will create a new revolution for best practice medicine. The purpose of this research is to implement a sharable ontology for the best practice in healthcare, with anterior cruciate ligament reconstruction (ACLR) as a case study. The ontology represents knowledge derived from both evidence-based practice (EBP) and practice-based evidence (PBE). First, the study presents how the domain-specific knowledge model is built using a combination of Toronto Virtual Enterprise (TOVE) and a bottom-up approach. Then, I propose a top-down approach using Open Biological and Biomedical Ontology (OBO) Foundry ontologies that adheres to the Basic Formal Ontology (BFO)’s framework. In this step, the EBP, PBE, and statistic ontologies are developed independently. Next, the study integrates these individual ontologies into the final ACLR Ontology (ACLRO) as a more meaningful model that endorses the reusability and the ease of the model-expansion process since the classes can grow independently from one another. Finally, the study employs a use case and DL queries for model validation. The study's innovation is to present the ontology implementation for best-practice medicine and demonstrate how it can be applied to a real-world setup with semantic information. The ACLRO simultaneously emphasizes knowledge representation in health-intervention, statistics, research design, and external research evidence, while constructing the classes of data-driven and patient-focus processes that allow knowledge sharing explicit of technology. Additionally, the model synthesizes multiple related ontologies, which leads to the successful application of best-practice medicine.Item Coordinated Evolution of Ontologies of Informed Consent(ICBO, 2018) Vajda, Jonathan; Otte, J. Neil; Stansbury, Cooper; Manion, Frank J.; Umberfield, Elizabeth; He, Yongqun; Harris, Marcelline; Obeid, Jihad; Brochhausen, Mathias; Duncan, William D.; Tao, Cui; Health Policy and Management, School of Public HealthInformed consent, whether for health or behavioral research or clinical treatment, rests on notions of voluntarism, information disclosure and understanding, and the decisionmaking capacity of the person providing consent. Whether consent is for research or treatment, informed consent serves as a safeguard for trust that permissions given by the research participant or patient are upheld across the informed consent (IC) lifecycle. The IC lifecycle involves not only documentation of the consent when originally obtained, but actions that require clear communication of permissions from the initial acquisition of data and specimens through handoffs to, for example, secondary researchers, allowing them access to data or biospecimens referenced in the terms of the original consent.Item Leveraging Electronic Dental Record Data for Clinical Research in the National Dental PBRN Practices(Thieme, 2020-03) Thyvalikakath, Thankam Paul; Duncan, William D.; Siddiqui, Zasim; LaPradd, Michelle; Eckert, George; Schleyer, Titus; Rindal, Donald Brad; Jurkovich, Mark; Shea, Tracy; Gilbert, Gregg H.; Pediatrics, School of MedicineObjectives: The aim of this study is to determine the feasibility of conducting clinical research using electronic dental record (EDR) data from U.S. solo and small-group general dental practices in the National Dental Practice-Based Research Network (network) and evaluate the data completeness and correctness before performing survival analyses of root canal treatment (RCT) and posterior composite restorations (PCR). Methods: Ninety-nine network general dentistry practices that used Dentrix or EagleSoft EDR shared de-identified data of patients who received PCR and/or RCT on permanent teeth through October 31, 2015. We evaluated the data completeness and correctness, summarized practice, and patient characteristics and summarized the two treatments by tooth type and arch location. Results: Eighty-two percent of practitioners were male, with a mean age of 49 and 22.4 years of clinical experience. The final dataset comprised 217,887 patients and 11,289,594 observations, with the observation period ranging from 0 to 37 years. Most patients (73%) were 18 to 64 years old; 56% were female. The data were nearly 100% complete. Eight percent of observations had incorrect data, such as incorrect tooth number or surface, primary teeth, supernumerary teeth, and tooth ranges, indicating multitooth procedures instead of PCR or RCT. Seventy-three percent of patients had dental insurance information; 27% lacked any insurance information. While gender was documented for all patients, race/ethnicity was missing in the dataset. Conclusion: This study established the feasibility of using EDR data integrated from multiple distinct solo and small-group network practices for longitudinal studies to assess treatment outcomes. The results laid the groundwork for a learning health system that enables practitioners to learn about their patients' outcomes by using data from their own practice.Item An ontology for formal representation of medication adherence-related knowledge : case study in breast cancer(2018-08-02) Sawesi, Suhila; MacDorman, Karl F.; Jones, Josette F.; Carpenter, Janet S.; Kharrazi, Hadi; Duncan, William D.Medication non-adherence is a major healthcare problem that negatively impacts the health and productivity of individuals and society as a whole. Reasons for medication non-adherence are multi-faced, with no clear-cut solution. Adherence to medication remains a difficult area to study, due to inconsistencies in representing medicationadherence behavior data that poses a challenge to humans and today’s computer technology related to interpreting and synthesizing such complex information. Developing a consistent conceptual framework to medication adherence is needed to facilitate domain understanding, sharing, and communicating, as well as enabling researchers to formally compare the findings of studies in systematic reviews. The goal of this research is to create a common language that bridges human and computer technology by developing a controlled structured vocabulary of medication adherence behavior—“Medication Adherence Behavior Ontology” (MAB-Ontology) using breast cancer as a case study to inform and evaluate the proposed ontology and demonstrating its application to real-world situation. The intention is for MAB-Ontology to be developed against the background of a philosophical analysis of terms, such as belief, and desire to be human, computer-understandable, and interoperable with other systems that support scientific research. The design process for MAB-Ontology carried out using the METHONTOLOGY method incorporated with the Basic Formal Ontology (BFO) principles of best practice. This approach introduces a novel knowledge acquisition step that guides capturing medication-adherence-related data from different knowledge sources, including adherence assessment, adherence determinants, adherence theories, adherence taxonomies, and tacit knowledge source types. These sources were analyzed using a systematic approach that involved some questions applied to all source types to guide data extraction and inform domain conceptualization. A set of intermediate representations involving tables and graphs was used to allow for domain evaluation before implementation. The resulting ontology included 629 classes, 529 individuals, 51 object property, and 2 data property. The intermediate representation was formalized into OWL using Protégé. The MAB-Ontology was evaluated through competency questions, use-case scenario, face validity and was found to satisfy the requirement specification. This study provides a unified method for developing a computerized-based adherence model that can be applied among various disease groups and different drug categories.Item An Ontology For Formal Representation Of Medication Adherence-Related Knowledge: Case Study In Breast Cancer(2018-08) Sawesi, Suhila; Jones, Josette F.; Duncan, William D.; BioHealth Informatics, School of Informatics and ComputingItem Survival analysis of posterior composite restorations in National Dental PBRN general dentistry practices(Elsevier, 2024) Thyvalikakath, Thankam; Siddiqui, Zasim Azhar; Eckert, George; LaPradd, Michelle; Duncan, William D.; Gordan, Valeria V.; Rindal, D. Brad; Jurkovich, Mark; Gilbert, Gregg H.; National Dental PBRN Collaborative Group; Biostatistics and Health Data Science, Richard M. Fairbanks School of Public HealthObjective: Quantify the survival of posterior composite restorations (PCR) placed during the study period in permanent teeth in United States (US) general dental community practices and factors predictive of that survival. Methods: A retrospective cohort study was conducted utilizing de-identified electronic dental record (EDR) data of patients who received a PCR in 99 general dentistry practices in the National Dental Practice-Based Research Network (Network). The final analyzed data set included 700,885 PCRs from 200,988 patients. Descriptive statistics and Kaplan Meier (product limit) estimator were performed to estimate the survival rate (defined as the PCR not receiving any subsequent treatment) after the first PCR was observed in the EDR during the study time. The Cox proportional hazards model was done to account for patient- and tooth-specific covariates. Results: The overall median survival time was 13.3 years. The annual failure rates were 4.5-5.8 % for years 1-5; 5.3-5.7 %, 4.9-5.5 %, and 3.3-5.2 % for years 6-10, 11-15, and 16-20, respectively. The failure descriptions recorded for < 7 % failures were mostly caries (54 %) and broken or fractured tooth/restorations (23 %). The following variables significantly predicted PCR survival: number of surfaces that comprised the PCR; having at least one interproximal surface; tooth type; type of prior treatment received on the tooth; Network region; patient age and sex. Based on the magnitude of the multivariable estimates, no single factor predominated. Conclusions: This study of Network practices geographically distributed across the US observed PCR survival rates and predictive factors comparable to studies done in academic settings and outside the US.