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      Active neural networks to detect mentions of changes to medication treatment in social media

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          Abstract

          Objective

          We address a first step toward using social media data to supplement current efforts in monitoring population-level medication nonadherence: detecting changes to medication treatment. Medication treatment changes, like changes to dosage or to frequency of intake, that are not overseen by physicians are, by that, nonadherence to medication. Despite the consequences, including worsening health conditions or death, 50% of patients are estimated to not take medications as indicated. Current methods to identify nonadherence have major limitations. Direct observation may be intrusive or expensive, and indirect observation through patient surveys relies heavily on patients’ memory and candor. Using social media data in these studies may address these limitations.

          Methods

          We annotated 9830 tweets mentioning medications and trained a convolutional neural network (CNN) to find mentions of medication treatment changes, regardless of whether the change was recommended by a physician. We used active and transfer learning from 12 972 reviews we annotated from WebMD to address the class imbalance of our Twitter corpus. To validate our CNN and explore future directions, we annotated 1956 positive tweets as to whether they reflect nonadherence and categorized the reasons given.

          Results

          Our CNN achieved 0.50 F 1-score on this new corpus. The manual analysis of positive tweets revealed that nonadherence is evident in a subset with 9 categories of reasons for nonadherence.

          Conclusion

          We showed that social media users publicly discuss medication treatment changes and may explain their reasons including when it constitutes nonadherence. This approach may be useful to supplement current efforts in adherence monitoring.

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          Most cited references39

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          Interrater reliability: the kappa statistic

          The kappa statistic is frequently used to test interrater reliability. The importance of rater reliability lies in the fact that it represents the extent to which the data collected in the study are correct representations of the variables measured. Measurement of the extent to which data collectors (raters) assign the same score to the same variable is called interrater reliability. While there have been a variety of methods to measure interrater reliability, traditionally it was measured as percent agreement, calculated as the number of agreement scores divided by the total number of scores. In 1960, Jacob Cohen critiqued use of percent agreement due to its inability to account for chance agreement. He introduced the Cohen’s kappa, developed to account for the possibility that raters actually guess on at least some variables due to uncertainty. Like most correlation statistics, the kappa can range from −1 to +1. While the kappa is one of the most commonly used statistics to test interrater reliability, it has limitations. Judgments about what level of kappa should be acceptable for health research are questioned. Cohen’s suggested interpretation may be too lenient for health related studies because it implies that a score as low as 0.41 might be acceptable. Kappa and percent agreement are compared, and levels for both kappa and percent agreement that should be demanded in healthcare studies are suggested.
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            Adherence to Medication

            New England Journal of Medicine, 353(5), 487-497
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              A new taxonomy for describing and defining adherence to medications.

              Interest in patient adherence has increased in recent years, with a growing literature that shows the pervasiveness of poor adherence to appropriately prescribed medications. However, four decades of adherence research has not resulted in uniformity in the terminology used to describe deviations from prescribed therapies. The aim of this review was to propose a new taxonomy, in which adherence to medications is conceptualized, based on behavioural and pharmacological science, and which will support quantifiable parameters. A systematic literature review was performed using MEDLINE, EMBASE, CINAHL, the Cochrane Library and PsycINFO from database inception to 1 April 2009. The objective was to identify the different conceptual approaches to adherence research. Definitions were analyzed according to time and methodological perspectives. A taxonomic approach was subsequently derived, evaluated and discussed with international experts. More than 10 different terms describing medication-taking behaviour were identified through the literature review, often with differing meanings. The conceptual foundation for a new, transparent taxonomy relies on three elements, which make a clear distinction between processes that describe actions through established routines ('Adherence to medications', 'Management of adherence') and the discipline that studies those processes ('Adherence-related sciences'). 'Adherence to medications' is the process by which patients take their medication as prescribed, further divided into three quantifiable phases: 'Initiation', 'Implementation' and 'Discontinuation'. In response to the proliferation of ambiguous or unquantifiable terms in the literature on medication adherence, this research has resulted in a new conceptual foundation for a transparent taxonomy. The terms and definitions are focused on promoting consistency and quantification in terminology and methods to aid in the conduct, analysis and interpretation of scientific studies of medication adherence. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.
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                Author and article information

                Journal
                J Am Med Inform Assoc
                J Am Med Inform Assoc
                jamia
                Journal of the American Medical Informatics Association : JAMIA
                Oxford University Press
                1067-5027
                1527-974X
                December 2021
                06 October 2021
                06 October 2021
                : 28
                : 12
                : 2551-2561
                Affiliations
                [1 ] Perelman School of Medicine, University of Pennsylvania , Philadelphia, Pennsylvania, USA
                [2 ] Department of Electronic Engineering, Tsinghua University , Beijing, China
                Author notes
                Corresponding Author: Davy Weissenbacher, PhD, Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, 404 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA ( dweissen@ 123456pennmedicine.upenn.edu )
                Author information
                https://orcid.org/0000-0001-8331-3675
                https://orcid.org/0000-0003-4802-6392
                https://orcid.org/0000-0002-8281-3464
                https://orcid.org/0000-0001-7709-3813
                https://orcid.org/0000-0001-6066-1159
                https://orcid.org/0000-0003-4726-9413
                https://orcid.org/0000-0002-6416-9556
                Article
                ocab158
                10.1093/jamia/ocab158
                8633624
                34613417
                25de05f5-9736-485a-94c3-2ee42c105f2e
                © The Author(s) 2021. Published by Oxford University Press on behalf of the American Medical Informatics Association.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 09 December 2020
                : 13 April 2021
                : 23 July 2021
                : 24 November 2021
                Page count
                Pages: 11
                Funding
                Funded by: National Library of Medicine, DOI 10.13039/100000092;
                Award ID: R01LM011176
                Funded by: National Library of Medicine, DOI 10.13039/100000092;
                Categories
                Research and Applications
                AcademicSubjects/MED00580
                AcademicSubjects/SCI01060
                AcademicSubjects/SCI01530

                Bioinformatics & Computational biology
                social media,pharmacovigilance,medication non-adherence,active learning,text classification

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