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Article: Additional Value From Free-Text Diagnoses in Electronic Health Records: Hybrid Dictionary and Machine Learning Classification Study.

Mehra, Tarun / Wekhof, Tobias / Keller, Dagmar Iris

2024 Volume 12, Page(s) e49007

Abstract: Background: Physicians are hesitant to forgo the opportunity of entering unstructured clinical notes for structured data entry in electronic health records. Does free text increase informational value in comparison with structured data?: Objective: ... ...

Abstract	Background: Physicians are hesitant to forgo the opportunity of entering unstructured clinical notes for structured data entry in electronic health records. Does free text increase informational value in comparison with structured data? Objective: This study aims to compare information from unstructured text-based chief complaints harvested and processed by a natural language processing (NLP) algorithm with clinician-entered structured diagnoses in terms of their potential utility for automated improvement of patient workflows. Methods: Electronic health records of 293,298 patient visits at the emergency department of a Swiss university hospital from January 2014 to October 2021 were analyzed. Using emergency department overcrowding as a case in point, we compared supervised NLP-based keyword dictionaries of symptom clusters from unstructured clinical notes and clinician-entered chief complaints from a structured drop-down menu with the following 2 outcomes: hospitalization and high Emergency Severity Index (ESI) score. Results: Of 12 symptom clusters, the NLP cluster was substantial in predicting hospitalization in 11 (92%) clusters; 8 (67%) clusters remained significant even after controlling for the cluster of clinician-determined chief complaints in the model. All 12 NLP symptom clusters were significant in predicting a low ESI score, of which 9 (75%) remained significant when controlling for clinician-determined chief complaints. The correlation between NLP clusters and chief complaints was low (r=-0.04 to 0.6), indicating complementarity of information. Conclusions: The NLP-derived features and clinicians' knowledge were complementary in explaining patient outcome heterogeneity. They can provide an efficient approach to patient flow management, for example, in an emergency medicine setting. We further demonstrated the feasibility of creating extensive and precise keyword dictionaries with NLP by medical experts without requiring programming knowledge. Using the dictionary, we could classify short and unstructured clinical texts into diagnostic categories defined by the clinician.
Language	English
Publishing date	2024-01-17
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2798261-0
ISSN	2291-9694
ISSN	2291-9694
DOI	10.2196/49007
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Additional Value From Free-Text Diagnoses in Electronic Health Records

Tarun Mehra / Tobias Wekhof / Dagmar Iris Keller

JMIR Medical Informatics, Vol 12, p e

Hybrid Dictionary and Machine Learning Classification Study

2024 Volume 49007

Abstract: BackgroundPhysicians are hesitant to forgo the opportunity of entering unstructured clinical notes for structured data entry in electronic health records. Does free text increase informational value in comparison with structured data? ObjectiveThis study ...

Abstract	BackgroundPhysicians are hesitant to forgo the opportunity of entering unstructured clinical notes for structured data entry in electronic health records. Does free text increase informational value in comparison with structured data? ObjectiveThis study aims to compare information from unstructured text-based chief complaints harvested and processed by a natural language processing (NLP) algorithm with clinician-entered structured diagnoses in terms of their potential utility for automated improvement of patient workflows. MethodsElectronic health records of 293,298 patient visits at the emergency department of a Swiss university hospital from January 2014 to October 2021 were analyzed. Using emergency department overcrowding as a case in point, we compared supervised NLP-based keyword dictionaries of symptom clusters from unstructured clinical notes and clinician-entered chief complaints from a structured drop-down menu with the following 2 outcomes: hospitalization and high Emergency Severity Index (ESI) score. ResultsOf 12 symptom clusters, the NLP cluster was substantial in predicting hospitalization in 11 (92%) clusters; 8 (67%) clusters remained significant even after controlling for the cluster of clinician-determined chief complaints in the model. All 12 NLP symptom clusters were significant in predicting a low ESI score, of which 9 (75%) remained significant when controlling for clinician-determined chief complaints. The correlation between NLP clusters and chief complaints was low (r=−0.04 to 0.6), indicating complementarity of information. ConclusionsThe NLP-derived features and clinicians’ knowledge were complementary in explaining patient outcome heterogeneity. They can provide an efficient approach to patient flow management, for example, in an emergency medicine setting. We further demonstrated the feasibility of creating extensive and precise keyword dictionaries with NLP by medical experts without requiring programming knowledge. Using the dictionary, we could classify short and unstructured ...
Keywords	Computer applications to medicine. Medical informatics ; R858-859.7
Subject code	006
Language	English
Publishing date	2024-01-01T00:00:00Z
Publisher	JMIR Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: [Polymedication and oral antitumour therapies - which drug interactions should be considered?]

Späni, Selina N / Mehra, Tarun / Dongre, Kanchan / Leuppi-Taegtmeyer, Anne B

Therapeutische Umschau. Revue therapeutique

2023 Volume 80, Issue 8, Page(s) 373–376

Abstract: Introduction: Oral anticancer therapies offer various advantages but also entail risks due to their toxicity and narrow therapeutic ranges. Since these drugs are increasingly prescribed in patients with existing polypharmacy, identifying and assessing ... ...

Abstract	Introduction: Oral anticancer therapies offer various advantages but also entail risks due to their toxicity and narrow therapeutic ranges. Since these drugs are increasingly prescribed in patients with existing polypharmacy, identifying and assessing potential drug interactions is of great importance for safe and effective therapy. This article provides an overview of the most common pharmacokinetic and pharmacodynamic drug-drug interactions of targeted anticancer therapies, with focus on protein kinase inhibitors.
MeSH term(s)	Humans ; Polypharmacy ; Drug Interactions
Language	German
Publishing date	2023-11-16
Publishing country	Switzerland
Document type	English Abstract ; Journal Article
ZDB-ID	82044-1
ISSN	1664-2864 ; 0040-5930
ISSN (online)	1664-2864
ISSN	0040-5930
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Article: [No title information]

Mehra, Tarun / Schaer, Dominik

Praxis

2017 Volume 106, Issue 20, Page(s) 1091–1097

Title translation	CME: Das Schweizer Fallpauschalensystem.
Language	German
Publishing date	2017
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	209026-0
ISSN	1661-8165 ; 1661-8157 ; 0369-8394
ISSN (online)	1661-8165
ISSN	1661-8157 ; 0369-8394
DOI	10.1024/1661-8157/a002785
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Article: [No title information]

Mehra, Tarun / Schaer, Dominik

Praxis

2017 Volume 106, Issue 21, Page(s) 1197

Title translation	CME-Antworten.
Language	German
Publishing date	2017
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	209026-0
ISSN	1661-8165 ; 1661-8157 ; 0369-8394
ISSN (online)	1661-8165
ISSN	1661-8157 ; 0369-8394
DOI	10.1024/1661-8157/a002786
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Article ; Online: Olaparib not cost-effective as maintenance therapy for platinum-sensitive, BRCA1/2 germline-mutated metastatic pancreatic cancer.

Mehra, Tarun / Lupatsch, Judith E / Kössler, Thibaud / Dedes, Konstantin / Siebenhüner, Alexander Reinhard / von Moos, Roger / Wicki, Andreas / Schwenkglenks, Matthias E

PloS one

2024 Volume 19, Issue 4, Page(s) e0301271

Abstract: Objective: To assess the cost-effectiveness and budget impact of olaparib as a maintenance therapy in platinum-responsive, metastatic pancreatic cancer patients harboring a germline BRCA1/2 mutation, using the Swiss context as a model.: Methods: ... ...

Abstract	Objective: To assess the cost-effectiveness and budget impact of olaparib as a maintenance therapy in platinum-responsive, metastatic pancreatic cancer patients harboring a germline BRCA1/2 mutation, using the Swiss context as a model. Methods: Based on data from the POLO trial, published literature and local cost data, we developed a partitioned survival model of olaparib maintenance including full costs for BRCA1/2 germline testing compared to FOLFIRI maintenance chemotherapy and watch-and-wait. We calculated the incremental cost-effectiveness ratio (ICER) for the base case and several scenario analyses and estimated 5-year budget impact. Results: Comparing olaparib with watch-and wait and maintenance chemotherapy resulted in incremental cost-effectiveness ratios of CHF 2,711,716 and CHF 2,217,083 per QALY gained, respectively. The 5-year costs for the olaparib strategy in Switzerland would be CHF 22.4 million, of which CHF 11.4 million would be accounted for by germline BRCA1/2 screening of the potentially eligible population. This would amount to a budget impact of CHF 15.4 million (USD 16.9 million) versus watch-and-wait. Conclusions: Olaparib is not a cost-effective maintenance treatment option. Companion diagnostics are an equally important cost driver as the drug itself.
MeSH term(s)	Female ; Humans ; BRCA1 Protein/genetics ; Ovarian Neoplasms/genetics ; Platinum/therapeutic use ; BRCA2 Protein/genetics ; Phthalazines/therapeutic use ; Pancreatic Neoplasms/drug therapy ; Pancreatic Neoplasms/genetics ; Pancreatic Neoplasms/pathology ; Germ Cells/pathology ; Cost-Benefit Analysis ; Piperazines
Chemical Substances	BRCA1 protein, human ; BRCA1 Protein ; olaparib (WOH1JD9AR8) ; Platinum (49DFR088MY) ; BRCA2 protein, human ; BRCA2 Protein ; Phthalazines ; Piperazines
Language	English
Publishing date	2024-04-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0301271
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Article: Effect of customized vibratory device on orthodontic tooth movement: A prospective randomized control trial.

Khera, Amit K / Raghav, Pradeep / Mehra, Varun / Wadhawan, Ashutosh / Gupta, Navna / Phull, Tarun S

Journal of orthodontic science

2022 Volume 11, Page(s) 18

Abstract: Aims: The primary purpose of the present trial was to evaluate the effect of low-frequency (30Hz) vibrations on the rate of canine retraction.: Setting and design: Single-center, split mouth prospective randomized controlled clinical trial.: ... ...

Abstract	Aims: The primary purpose of the present trial was to evaluate the effect of low-frequency (30Hz) vibrations on the rate of canine retraction. Setting and design: Single-center, split mouth prospective randomized controlled clinical trial. Methods and material: 100 screened subjects (aged18-25 years) were selected; out of which 30 subjects having Class I bimaxillary protrusion or Class II div 1 malocclusion, requiring upper 1 Statistical analysis used: Independent "t" test. Results: There was no statistically significant differencein the rate of individual canine retraction among the experimental and control groups when the intergroup comparison was done using independent "t" test at T1-T0, ( Conclusion: The low-frequency vibratory stimulation of 30 Hz using a customized vibratory device did not significantly accelerate the rate of orthodontic tooth movement. Trial registration: Registered at ctri.nic.in (CTRI/2019/05/019043).
Language	English
Publishing date	2022-05-04
Publishing country	India
Document type	Journal Article
ZDB-ID	2733594-X
ISSN	2278-0203 ; 2278-1897
ISSN (online)	2278-0203
ISSN	2278-1897
DOI	10.4103/jos.jos_127_21
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Article ; Online: Pre-treatment comorbidities, C-reactive protein and eosinophil count, and immune-related adverse events as predictors of survival with checkpoint inhibition for multiple tumour entities.

Mehra, Tarun / Dongre, Kanchan / Boesing, Maria / Frei, Patricia / Suenderhauf, Claudia / Zippelius, Alfred / Leuppi, Joerg D / Wicki, Andreas / Leuppi-Taegtmeyer, Anne B

Cancer medicine

2023 Volume 12, Issue 11, Page(s) 12253–12262

Abstract: Background: The development of immune-related adverse events (irAEs) may be associated with clinical efficacy of checkpoint inhibitors (CPIs) in patients with cancer. We therefore investigated the effect of irAEs and pre-treatment parameters on outcome ... ...

Abstract	Background: The development of immune-related adverse events (irAEs) may be associated with clinical efficacy of checkpoint inhibitors (CPIs) in patients with cancer. We therefore investigated the effect of irAEs and pre-treatment parameters on outcome in a large, real-life patient cohort. Methods: We performed a single-centre, retrospective, observational study including patients who received CPIs from 2011 to 2018 and followed until 2021. The primary outcome was overall survival, and the secondary outcome was the development of irAEs. Results: In total, 229 patients with different tumour entities (41% non-small cell lung cancer [NSCLC], 29% melanoma) received a total of 282 CPI treatment courses (ipilimumab, nivolumab, pembrolizumab or atezolizumab). Thirty-four percent of patients developed irAEs (of these 17% had CTCAE Grade ≥3). Factors independently associated with mortality were pre-treatment CRP ≥10 mg/L (hazard ratio [HR] 2.064, p = 0.0003), comorbidity measured by Charlson comorbidity index (HR 1.149, p = 0.014) and irAEs (HR 0.644, p = 0.036) (age-adjusted, n = 216). Baseline eosinophil count ≤0.2 × 10 Conclusions: We found an independent association between irAE occurrence and improved overall survival in a real-life cohort spanning multiple tumour entities and treatment regimens. Pre-treatment comorbidities, CRP and eosinophil count represent potential markers for predicting treatment response.
MeSH term(s)	Humans ; Carcinoma, Non-Small-Cell Lung/pathology ; C-Reactive Protein ; Lung Neoplasms/pathology ; Retrospective Studies ; Eosinophils ; Comorbidity
Chemical Substances	C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2023-04-21
Publishing country	United States
Document type	Observational Study ; Journal Article
ZDB-ID	2659751-2
ISSN	2045-7634 ; 2045-7634
ISSN (online)	2045-7634
ISSN	2045-7634
DOI	10.1002/cam4.5919
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Article ; Online: Experts vs. machine - comparison of machine learning to expert-informed prediction of outcome after major liver surgery.

Staiger, Roxane D / Mehra, Tarun / Haile, Sarah R / Domenghino, Anja / Kümmerli, Christoph / Abbassi, Fariba / Kozbur, Damian / Dutkowski, Philipp / Puhan, Milo A / Clavien, Pierre-Alain

HPB : the official journal of the International Hepato Pancreato Biliary Association

2024

Abstract: Background: Machine learning (ML) has been successfully implemented for classification tasks (e.g., cancer diagnosis). ML performance for more challenging predictions is largely unexplored. This study's objective was to compare machine learning vs. ... ...

Abstract	Background: Machine learning (ML) has been successfully implemented for classification tasks (e.g., cancer diagnosis). ML performance for more challenging predictions is largely unexplored. This study's objective was to compare machine learning vs. expert-informed predictions for surgical outcome in patients undergoing major liver surgery. Methods: Single tertiary center data on preoperative parameters and postoperative complications for elective hepatic surgery patients were included (2008-2021). Expert-informed prediction models were established on 14 parameters identified by two expert liver surgeons to impact on postoperative outcome. ML models used all available preoperative patient variables (n = 62). Model performance was compared for predicting 3-month postoperative overall morbidity. Temporal validation and additional analysis in major liver resection patients were conducted. Results: 889 patients included. Expert-informed models showed low average bias (2-5 CCI points) with high over/underprediction. ML models performed similarly: average prediction 5-10 points higher than observed CCI values with high variability (95% CI -30 to 50). No performance improvement for major liver surgery patients. Conclusion: No clinical relevance in the application of ML for predicting postoperative overall morbidity was found. Despite being a novel hype, ML has the potential for application in clinical practice. However, at this stage it does not replace established approaches of prediction modelling.
Language	English
Publishing date	2024-02-13
Publishing country	England
Document type	Journal Article
ZDB-ID	2131251-5
ISSN	1477-2574 ; 1365-182X
ISSN (online)	1477-2574
ISSN	1365-182X
DOI	10.1016/j.hpb.2024.02.006
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Article: Stigma Experienced by the Caregivers of Patients with Chronic Plaque Psoriasis.

Grover, Sandeep / Mehra, Aseem / Dogra, Sunil / Hazari, Nandita / Malhora, Nidhi / Narang, Tarun / Sahoo, Swapanjeet / Sharma, Sunil / Handa, Sanjeev / Avasthi, Ajit

Indian dermatology online journal

2021 Volume 12, Issue 1, Page(s) 110–115

Abstract: Background: Psoriasis is a chronic inflammatory dermatosis associated with psychological morbidity. Very few studies have evaluated stigma among caregivers of patients with psoriasis.: Objective: This study aimed to evaluate the prevalence of stigma ... ...

Abstract	Background: Psoriasis is a chronic inflammatory dermatosis associated with psychological morbidity. Very few studies have evaluated stigma among caregivers of patients with psoriasis. Objective: This study aimed to evaluate the prevalence of stigma and its correlates among the caregivers of patients with psoriasis. Methodology: Forty-nine caregivers of patients with psoriasis were evaluated on psoriasis adapted version of caregiver of people with mental illness (CPMI) to assess internalized stigma, Explanatory Model Interview Catalogue Stigma Scale, Family Burden Inventory (FBI), Multidimensional aspect of perceived social support scale (PSS), Cognitive behavioral avoidance scale (CBAS), and Coping checklist. Results: Majority of the caregivers were either spouse (42.8%) or parents (36.7%) of the patients. The caregivers were involved in the care of the patients for a mean duration of 6.5(SD; 4.8) years. On CPMI, the mean score was highest for the affective domain (3.1), this was followed by affective (2.9), and behavioral (2.9) domain. Very few (12.2%) caregivers reported significantly high caregiver burden. A higher level of stigma was associated with more often use of avoidance coping. Presence of higher social support was associated with higher level of stigma as assessed by using CPMI. A higher level of caregiver burden in all the domains of FBI was associated with higher level of stigma. Conclusion: Stigma is highly prevalent among the caregivers of patients with psoriasis. These findings suggest that there is an urgent need to identify the stigma and address the same.
Language	English
Publishing date	2021-01-16
Publishing country	India
Document type	Journal Article
ZDB-ID	2585814-2
ISSN	2249-5673 ; 2229-5178
ISSN (online)	2249-5673
ISSN	2229-5178
DOI	10.4103/idoj.IDOJ_358_20
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