OBJECTIVES: Question answering (QA) systems have the potential to improve the quality of clinical care by providing health professionals with the latest and most relevant evidence. However, QA systems have not been widely adopted. This systematic review aims to characterize current medical QA systems, assess their suitability for healthcare, and identify areas of improvement. MATERIALS AND METHODS: We searched PubMed, IEEE Xplore, ACM Digital Library, ACL Anthology, and forward and backward citations on February 7, 2023. We included peer-reviewed journal and conference papers describing the design and evaluation of biomedical QA systems. Two reviewers screened titles, abstracts, and full-text articles. We conducted a narrative synthesis and risk of bias assessment for each study. We assessed the utility of biomedical QA systems. RESULTS: We included 79 studies and identified themes, including question realism, answer reliability, answer utility, clinical specialism, systems, usability, and evaluation methods. Clinicians' questions used to train and evaluate QA systems were restricted to certain sources, types and complexity levels. No system communicated confidence levels in the answers or sources. Many studies suffered from high risks of bias and applicability concerns. Only 8 studies completely satisfied any criterion for clinical utility, and only 7 reported user evaluations. Most systems were built with limited input from clinicians. DISCUSSION: While machine learning methods have led to increased accuracy, most studies imperfectly reflected real-world healthcare information needs. Key research priorities include developing more realistic healthcare QA datasets and considering the reliability of answer sources, rather than merely focusing on accuracy.

Abstract Multi-document summarization entails producing concise synopses of collections of inputs. For some applications, the synopsis should accurately synthesize inputs with respect to a key aspect, e.g., a synopsis of film reviews written about a particular movie should reflect the average critic consensus. As a more consequential example, narrative summaries that accompany biomedical systematic reviews of clinical trial results should accurately summarize the potentially conflicting results from individual trials. In this paper we ask: To what extent do modern multi-document summarization models implicitly perform this sort of synthesis? We run experiments over opinion and evidence synthesis datasets using a suite of summarization models, from fine-tuned transformers to GPT-4. We find that existing models partially perform synthesis, but imperfectly: Even the best performing models are over-sensitive to changes in input ordering and under-sensitive to changes in input compositions (e.g., ratio of positive to negative reviews). We propose a simple, general, effective method for improving model synthesis capabilities by generating an explicitly diverse set of candidate outputs, and then selecting from these the string best aligned with the expected aggregate measure for the inputs, or abstaining when the model produces no good candidate.

Medical systematic reviews play a vital role in healthcare decision making and policy.However, their production is time-consuming, limiting the availability of high-quality and up-todate evidence summaries.Recent advances in large language models (LLMs) offer the potential to automatically generate literature reviews on demand, addressing this issue.However, LLMs sometimes generate inaccurate (and potentially misleading) texts by "hallucination" or omission.In healthcare, this can make LLMs unusable at best and dangerous at worst.We conducted 16 interviews with international systematic review experts to characterize the perceived utility and risks of LLMs in the specific context of medical evidence reviews.Experts indicated that LLMs can assist in the writing process by drafting summaries, generating templates, distilling information, and crosschecking information.But they also raised concerns regarding confidently composed but inaccurate LLM outputs and other potential downstream harms, including decreased accountability and proliferation of low-quality reviews.Informed by this qualitative analysis, we identify criteria for rigorous evaluation of biomedical LLMs aligned with domain expert views.

We consider the problem of learning to simplify medical texts. This is important because most reliable, up-to-date information in biomedicine is dense with jargon and thus practically inaccessible to the lay audience. Furthermore, manual simplification does not scale to the rapidly growing body of biomedical literature, motivating the need for automated approaches. Unfortunately, there are no large-scale resources available for this task. In this work we introduce a new corpus of parallel texts in English comprising technical and lay summaries of all published evidence pertaining to different clinical topics. We then propose a new metric based on likelihood scores from a masked language model pretrained on scientific texts. We show that this automated measure better differentiates between technical and lay summaries than existing heuristics. We introduce and evaluate baseline encoder-decoder Transformer models for simplification and propose a novel augmentation to these in which we explicitly penalize the decoder for producing 'jargon' terms; we find that this yields improvements over baselines in terms of readability.

OBJECTIVE: Randomized controlled trials (RCTs) are the gold standard method for evaluating whether a treatment works in health care but can be difficult to find and make use of. We describe the development and evaluation of a system to automatically find and categorize all new RCT reports. MATERIALS AND METHODS: Trialstreamer continuously monitors PubMed and the World Health Organization International Clinical Trials Registry Platform, looking for new RCTs in humans using a validated classifier. We combine machine learning and rule-based methods to extract information from the RCT abstracts, including free-text descriptions of trial PICO (populations, interventions/comparators, and outcomes) elements and map these snippets to normalized MeSH (Medical Subject Headings) vocabulary terms. We additionally identify sample sizes, predict the risk of bias, and extract text conveying key findings. We store all extracted data in a database, which we make freely available for download, and via a search portal, which allows users to enter structured clinical queries. Results are ranked automatically to prioritize larger and higher-quality studies. RESULTS: As of early June 2020, we have indexed 673 191 publications of RCTs, of which 22 363 were published in the first 5 months of 2020 (142 per day). We additionally include 304 111 trial registrations from the International Clinical Trials Registry Platform. The median trial sample size was 66. CONCLUSIONS: We present an automated system for finding and categorizing RCTs. This yields a novel resource: a database of structured information automatically extracted for all published RCTs in humans. We make daily updates of this database available on our website (https://trialstreamer.robotreviewer.net).

We present a corpus of 5,000 richly annotated abstracts of medical articles describing clinical randomized controlled trials. Annotations include demarcations of text spans that describe the Patient population enrolled, the Interventions studied and to what they were Compared, and the Outcomes measured (the 'PICO' elements). These spans are further annotated at a more granular level, e.g., individual interventions within them are marked and mapped onto a structured medical vocabulary. We acquired annotations from a diverse set of workers with varying levels of expertise and cost. We describe our data collection process and the corpus itself in detail. We then outline a set of challenging NLP tasks that would aid searching of the medical literature and the practice of evidence-based medicine.

We propose a method for learning disentangled representations of texts that code for distinct and complementary aspects, with the aim of affording efficient model transfer and interpretability.To induce disentangled embeddings, we propose an adversarial objective based on the (dis)similarity between triplets of documents with respect to specific aspects.Our motivating application is embedding biomedical abstracts describing clinical trials in a manner that disentangles the populations, interventions, and outcomes in a given trial.We show that our method learns representations that encode these clinically salient aspects, and that these can be effectively used to perform aspect-specific retrieval.We demonstrate that the approach generalizes beyond our motivating application in experiments on two multi-aspect review corpora.

We propose a model for tagging unstructured texts with an arbitrary number of terms drawn from a tree-structured vocabulary (i.e., an ontology).We treat this as a special case of sequence-to-sequence learning in which the decoder begins at the root node of an ontological tree and recursively elects to expand child nodes as a function of the input text, the current node, and the latent decoder state.In our experiments the proposed method outperforms state-of-the-art approaches on the important task of automatically assigning MeSH terms to biomedical abstracts.

We consider the task of automatically annotating free texts describing clinical trials with concepts from a controlled, structured medical vocabulary. Specifically, we aim to build a model to infer distinct sets of (ontological) concepts describing complementary clinically salient aspects of the underlying trials: the populations enrolled, the interventions administered and the outcomes measured, i.e., the PICO elements. This important practical problem poses a few key challenges. One issue is that the output space is vast, because the vocabulary comprises many unique concepts. Compounding this problem, annotated data in this domain is expensive to collect and hence sparse. Furthermore, the outputs (sets of concepts for each PICO element) are correlated: specific populations (e.g., diabetics) will render certain intervention concepts likely (insulin therapy) while effectively precluding others (radiation therapy). Such correlations should be exploited. We propose a novel neural model that addresses these challenges. We introduce a Candidate-Selector architecture in which the model considers setes of candidate concepts for PICO elements, and assesses their plausibility conditioned on the input text to be annotated. This relies on a 'candidate set' generator, which may be learned or relies on heuristics. A conditional discriminative neural model then jointly selects candidate concepts, given the input text. We compare the predictive performance of our approach to strong baselines, and show that it outperforms them. Finally, we perform a qualitative evaluation of the generated annotations by asking domain experts to assess their quality.

OBJECTIVES: Identifying all published reports of randomized controlled trials (RCTs) is an important aim, but it requires extensive manual effort to separate RCTs from non-RCTs, even using current machine learning (ML) approaches. We aimed to make this process more efficient via a hybrid approach using both crowdsourcing and ML. METHODS: We trained a classifier to discriminate between citations that describe RCTs and those that do not. We then adopted a simple strategy of automatically excluding citations deemed very unlikely to be RCTs by the classifier and deferring to crowdworkers otherwise. RESULTS: Combining ML and crowdsourcing provides a highly sensitive RCT identification strategy (our estimates suggest 95%-99% recall) with substantially less effort (we observed a reduction of around 60%-80%) than relying on manual screening alone. CONCLUSIONS: Hybrid crowd-ML strategies warrant further exploration for biomedical curation/annotation tasks.

We present a new Convolutional Neural Network (CNN) model for text classification that jointly exploits labels on documents and their constituent sentences.Specifically, we consider scenarios in which annotators explicitly mark sentences (or snippets) that support their overall document categorization, i.e., they provide rationales.Our model exploits such supervision via a hierarchical approach in which each document is represented by a linear combination of the vector representations of its component sentences.We propose a sentence-level convolutional model that estimates the probability that a given sentence is a rationale, and we then scale the contribution of each sentence to the aggregate document representation in proportion to these estimates.Experiments on five classification datasets that have document labels and associated rationales demonstrate that our approach consistently outperforms strong baselines.Moreover, our model naturally provides explanations for its predictions.

OBJECTIVE: To develop and evaluate RobotReviewer, a machine learning (ML) system that automatically assesses bias in clinical trials. From a (PDF-formatted) trial report, the system should determine risks of bias for the domains defined by the Cochrane Risk of Bias (RoB) tool, and extract supporting text for these judgments. METHODS: We algorithmically annotated 12,808 trial PDFs using data from the Cochrane Database of Systematic Reviews (CDSR). Trials were labeled as being at low or high/unclear risk of bias for each domain, and sentences were labeled as being informative or not. This dataset was used to train a multi-task ML model. We estimated the accuracy of ML judgments versus humans by comparing trials with two or more independent RoB assessments in the CDSR. Twenty blinded experienced reviewers rated the relevance of supporting text, comparing ML output with equivalent (human-extracted) text from the CDSR. RESULTS: By retrieving the top 3 candidate sentences per document (top3 recall), the best ML text was rated more relevant than text from the CDSR, but not significantly (60.4% ML text rated 'highly relevant' v 56.5% of text from reviews; difference +3.9%, [-3.2% to +10.9%]). Model RoB judgments were less accurate than those from published reviews, though the difference was <10% (overall accuracy 71.0% with ML v 78.3% with CDSR). CONCLUSION: Risk of bias assessment may be automated with reasonable accuracy. Automatically identified text supporting bias assessment is of equal quality to the manually identified text in the CDSR. This technology could substantially reduce reviewer workload and expedite evidence syntheses.

Systematic reviews underpin Evidence Based Medicine (EBM) by addressing precise clinical questions via comprehensive synthesis of all relevant published evidence. Authors of systematic reviews typically define a Population/Problem, Intervention, Comparator, and Outcome (a PICO criteria) of interest, and then retrieve, appraise and synthesize results from all reports of clinical trials that meet these criteria. Identifying PICO elements in the full-texts of trial reports is thus a critical yet time-consuming step in the systematic review process. We seek to expedite evidence synthesis by developing machine learning models to automatically extract sentences from articles relevant to PICO elements. Collecting a large corpus of training data for this task would be prohibitively expensive. Therefore, we derive distant supervision (DS) with which to train models using previously conducted reviews. DS entails heuristically deriving 'soft' labels from an available structured resource. However, we have access only to unstructured, free-text summaries of PICO elements for corresponding articles; we must derive from these the desired sentence-level annotations. To this end, we propose a novel method -- supervised distant supervision (SDS) -- that uses a small amount of direct supervision to better exploit a large corpus of distantly labeled instances by learning to pseudo-annotate articles using the available DS. We show that this approach tends to outperform existing methods with respect to automated PICO extraction.

Systematic reviews, which summarize the entirety of the evidence pertaining to a specific clinical question, have become critical for evidence-based decision making in healthcare. But such reviews have become increasingly onerous to produce due to the exponentially expanding biomedical literature base. This study proposes a step toward mitigating this problem by automating risk of bias assessment in systematic reviews, in which reviewers determine whether study results may be affected by biases (e.g., poor randomization or blinding). Conducting risk of bias assessment is an important but onerous task. We thus describe a machine learning approach to automate this assessment, using the standard Cochrane Risk of Bias Tool which assesses seven common types of bias. Training such a system would typically require a large labeled corpus, which would be prohibitively expensive to collect here. Instead, we use distant supervision, using data from the Cochrane Database of Systematic Reviews (a large repository of systematic reviews), to pseudoannotate a corpus of 2200 clinical trial reports in PDF format. We then develop a joint model which, using the full text of a clinical trial report as input, predicts the risks of bias while simultaneously extracting the text fragments supporting these assessments. This study represents a step toward automating or semiautomating extraction of data necessary for the synthesis of clinical trials.

Cloud Brokers enable interoperability and portability of applications across multiple Cloud Providers. On the other hand, incoming Cloud Providers start to support more and more unbundled Cloud Instances offerings. Thus, consumers may set up at their will the quantity of CPU, network bandwidth and memory or hard disk capacities their Cloud Instances will have. These facts enable the standardization of interoperable Cloud Instance configurations. In this paper, CompatibleOne is presented as an approach to bring Cloud Computing as a commodity. For this, the requirements to make of a product a commodity have been identified and have been mapped into the CompatibleOne architecture components. Our approach shows the practical feasibility of bringing Cloud Computing as a commodity.

This paper presents a Cloud Networking Gateway (CNG) Manager, to enable networking of distributed cloud resources by authorized customers and to provide network control and configuration capabilities. The CNG Manager interconnects virtual machines, acquired from distributed heterogeneous resources and multiple providers, using generic gateways according to user connectivity requests. The CNG Manager is integrated with a "Cloud Broker" architecture for evaluation in the multiple providers context. The proposed framework extends and supports the current state of the art in cloud and software defined networks technologies with compatible connectivity control and management capabilities.