PETRUSHKA shared variable specifications

System components

This is a list of the variables that are shared by two or more parts of the system. The parts of the system that have distinct data requirements are:

Sentry -- the Sentry API gateway to the OpenClinica database
Django -- the web front-end that faces the clinician and the patient and acts as a go-between for the Sentry and Algorithm components
Algorithm -- the machine learning algorithm that helps clinicians match patients to drugs by adverse effect profile
- OBS -- Subcomponent of the algorithm
- RCT -- Subcomponent of the algorithm

Workflow

participant Algorithm
participant Django
participant Sentry

hnote over Django : Clinican login

Django -> Sentry : Request available and active patient overviews\n(""{clinician}"")
hnote over Sentry : Identify patients accessible by\nclinician via surgery group
Sentry -> Django : Send available (basic demographic) patient data\n(""[{token, age, male_at_birth, ...}, ...]"")

hnote over Django : Clinician selects patient by\ntoken/basic demographic info
hnote over Django : Clinician selects excluded drug options for patient
hnote over Django : Patient selected to rank adverse effects

Django -> Sentry : Request patient data\n(""{clinician, token}"")
hnote over Sentry : Identify patient is accessible by\nclinician via surgery group
Sentry -> Django : Send patient data\n(""{token, age, male_at_birth, ...}"")

Django -> Algorithm : Send data to Algorithm 1\n""patient_data, excluded_drugs""
hnote over Algorithm : Select adverse effect options
Algorithm -> Django : ""[ adverse effect options ]""
hnote over Django : Patient ranks and scores\nadverse effects

Django -> Sentry : Request patient data\n(""{clinician, token}"")
hnote over Sentry : Identify patient is accessible by\nclinician via surgery group
Sentry -> Django : Send patient data\n(""{token, age, male_at_birth, ...}"")

Django -> Algorithm : Send data to Algorithm 2\n""patient_data,""\n""excluded_drugs""\n""ae_preferences""
hnote over Algorithm : Identify drug options 
Algorithm -> Django : ""[ drug options ]""
hnote over Django : Patient selects preferred drug\nin consultation with clinician

Django -> Sentry : Send patient choice\n(""{token, clinician, session_info}"")

Interfaces

There are two key interfaces -- Sentry<-->Django and Django<-->Algorithm. Data exchanged between Sentry and Django will be in json format. Data exchanged between Django and Algorithm will be in python format, either dict or a list of dicts -- keys will be the variable name and values the variable value. The details of these requests are specified below the Variables list.

Variables

Version: 0.1.1

Variable	Type	Used by	Description
token	string	Sentry, Django	Patient unique identifier. In the form `^[PS][0-9]{4}$`
clinician	string	Sentry, Django	Username of the clinician to whom this patient is assigned
male_at_birth	bool	All	Whether patient was assigned male at birth
age	int	All	Patient age in years
first_episode	bool	Sentry, OBS	Whether this is the patient's first episode of depression
fluoxetine_history	bool	Sentry, OBS	Whether this patient has been prescribed fluoxetine before
ssri_history	bool	Sentry, OBS	Whether this patient has been prescribed SSRIs before
antidepressant_history	bool	Sentry, OBS	Whether this patient has been prescribed antidepressants before
bmi	double	Sentry, OBS	Patient's body mass index (kg/m^2)
smoking_history	bool	Sentry, OBS	Whether patient has ever been a smoker
phq_9	int	Sentry, OBS	Patient Health Questionnaire (PHQ-9) baseline depression severity score, 0-27
psychotherapy_history	bool	Sentry, OBS	Whether this patient has previously had psychotherapy
secondary_care_history	bool	Sentry, OBS	Whether this patient has previously been referred to secondary care
childhood_maltreatment_history	bool	Sentry, OBS	Whether this patient has a history of child maltreatment
coronary_heart_disease_comorbidity	bool	Sentry, OBS	Whether this patient has comorbid coronary heart disease
stroke_tia_comorbidity	bool	Sentry, OBS	Whether this patient has comorbid stroke or transient ischaemic attack
diabetes_comorbidity	bool	Sentry, OBS	Whether this patient has comorbid diabetes
epilepsy_seizure_comorbidity	bool	Sentry, OBS	Whether this patient has comorbid epilepsy or seizures
hypothyroidism_comorbidity	bool	Sentry, OBS	Whether this patient has comorbid hypothyroidism
chronic_inflamatory_disease_comorbidity	bool	Sentry, OBS	Whether this patient has comorbid chronic inflamatory disease
anxiety_ocd_comorbidity	bool	Sentry, OBS	Whether this patient has comorbid anxiety or Obsessive-compulsive disorder
migrane_comorbidity	bool	Sentry, OBS	Whether this patient has comorbid migrane
antihypertensive_drug_use	bool	Sentry, OBS	Whether this patient is currently using antihypertensive drugs
asprin_use	bool	Sentry, OBS	Whether this patient is currently using asprin
statins_use	bool	Sentry, OBS	Whether this patient is currently using statins
non_steroidal_anti_inflamatory_drug_use	bool	Sentry, OBS	Whether this patient is currently using non-steroidal anti-inflamatory drugs
anticoagulants_use	bool	Sentry, OBS	Whether this patient is currently using anti-coagulant drugs
anticonvulsant_use	bool	Sentry, OBS	Whether this patient is currently using anticonvulsant
hypnotics_anxiolytics_use	bool	Sentry, OBS	Whether this patient is currently using hypnotics or anxiolytics
bisphosphonates_use	bool	Sentry, OBS	Whether this patient is currently using bisphosphonates
oral_contraceptive_hrt_use	bool	Sentry, OBS	Whether this patient is currently using oral contraceptives or hormone replacement therapy
ethnicity	bool	Sentry, OBS	Ethnicity (0 white/Caucasian, 1 African/Caribbean, 2 Asian, 3 Other), one-shot encoding
townsend_quintile	bool	Sentry, OBS	Townsend quintile (from 1-least deprived to 5-most deprived), one-shot encoding
hamd_3	int	Sentry, RCT	Patient's score on Hamilton Depression Rating Scale - Question 3 (0-4)
hamd_4	int	Sentry, RCT	Patient's score on Hamilton Depression Rating Scale - Question 4 (0-2)
hamd_6	int	Sentry, RCT	Patient's score on Hamilton Depression Rating Scale - Question 6 (0-2)
hamd_10	int	Sentry, RCT	Patient's score on Hamilton Depression Rating Scale - Question 10 (0-4)
hamd_11	int	Sentry, RCT	Patient's score on Hamilton Depression Rating Scale - Question 11 (0-4)
hamd_13	int	Sentry, RCT	Patient's score on Hamilton Depression Rating Scale - Question 13 (0-2)
hamd_17	int	Sentry, RCT	Patient's score on Hamilton Depression Rating Scale - Question 17 (0-2)
hamd	int	Sentry, RCT	Patient's total overall score on Hamilton Depression Rating Scale (0-52)
ae_probs	Array	Django, Algorithm	Probabilities of adverse effects. Each probability represents an intersection between a drug and an adverse effect
preference	Array	Django, Algorithm	Patient's preferences for adverse effects. Each adverse effect is a dictionary with keys 'name', 'rank', and 'score'
drug_options	Array	Django, Algorithm	List of drug options to present to the patient. Each drug is presented as a dictionary with keys and values specified below
drug_chosen	string	Django, Sentry	Drug chosen by patient in consultation with clinician
petrushka_output	string	Django, Sentry	JSON string of all petrushka output

bold names indicate variables that come from users. We should discuss a validation strategy for these variables -- who will validate them for security and how.

Interchange formats

There are 9 interactions between components. The details for each of these requests are as follows:

Django Request available patient data from Sentry

{
  "authorisation": "string",  // Access token
  "action": "ptlist",         // Requested operation
  "clinician": "string"       // Clinician identifier
}

Sentry Send patient data to Django

[
  {
    "token": "string",              // Patient identifier
    "creating_clinician": "string", // Clinician who created the patient's record in OpenClinica
    "initials": "string",           // Patient initials
    "age": "int",                   // Patient age
    "male_at_birth": "boolean",     // Whether patient was assigned male at birth
    "time_created": "timestamp"     // When the patient OpenClinica record was created
  },
  // ... etc. for each patient accessible by clinician and not yet completed (i.e. no session data present)
]

Django Request specific patient data from Sentry

{
  "authorisation": "string",  // Access token
  "action": "ptdata",         // Requested operation
  "clinician": "string",      // Clinician identifier
  "token": "string"           // Patient identifier matching RegExpr ^[PS][0-9]{4}$
}

Sentry Send specific patient data to Django

{
  "token": "string",              // Patient identifier
  "creating_clinician": "string", // Clinician who created the patient's record in OpenClinica
  "initials": "string",           // Patient initials
  "age": "int",                   // Patient age
  "male_at_birth": "boolean",     // Whether patient was assigned male at birth
  "time_created": "timestamp"     // When the patient OpenClinica record was created
  // ...etc. for patient information keys listed in the Variables section
}

Django Send patient data to Algorithm

patient_data = {
  "age": "int",                 # Patient age
  "male_at_birth": "boolean",   # Whether patient was assigned male at birth
  # ...etc. for patient information keys listed in the Variables section
}
excluded_drugs = [
  'Amitriptyline',
  'Escitalopram',
  # ...etc. for any other drugs excluded for patient by clinician
]
petrushka_backend.get_adverse_effect_options(patient_data, excluded_drugs)

Algorithm Send adverse effect options to Django

# List of adverse effect names. Should be length 5, and the order is not important.
adverse_effect_options = [
  'Tremor', 
  'Pain', 
  'Visual disorder or impairment',
  # ... etc. for the other 2 adverse effect options
]

The Algorithm should also expose a list of possible reasons to exclude a drug:

# List of potential exclusion reasons.
petrushka_backend.drug_exclusion_reasons = [
    'Incompatible demographic',
    'Not believed to be effective',
    'Incompatible with current medication',
    'Incompatible with patient medical history',
    'Really rather expensive and the NHS has no money anymore'
]

Algorithm: Adverse effect details

The Algorithm should also expose a dictionary of adverse effect details:

petrushka_backend.adverse_effect_details = {
  'SE_1': {  # Adverse effect identifier
    'name': 'ae_1_name',  # Adverse effect display name
    'probs': (  # Tuple of low, high probabilities
      0.01, 
      0.10  
    ),
    'description': 'You probably don\t want this.'  # Description
  },    
  'SE_2': {
    'name': 'ae_2_name',
    'probs': (0.05, 0.25),
    'description': 'You probably don\t want this.'
  },
  # ...etc. for all adverse effects
}

Django Send adverse effect preferences to Algorithm

preference = pandas.DataFrame(
  data={
    'Tremor': [90],
    'Pain': [73],
    # ... etc. for the other 3 adverse effects
  },
  index=['weight']
)
petrushka_backend.get_drug_options(patient_data, excluded_drugs, preference)

patient_data and excluded_drugs as defined in [Django Send patient data to Algorithm](#Django Send patient data to Algorithm).

Algorithm Send drug options to Django

drug_options = pandas.DataFrame(
  data={
    'score': [0.92, 0.84, 0.77],
    'efficacy': [0.62, 0.22, 0.39],
    'acceptability': [0.22, 0.40, 0.13],
    'Tremor': [0.03, 0.07, 0.21],
    'Pain': [0.05, 0.01, 0.13],
    # ... etc. for the other 3 adverse effects
  },
  index=['Agomelatine', 'Amitriptyline', 'Escitalopram']  # Indexes are drug names
)

Algorithm: Drug details

The Algorithm should also expose a dictionary of drug details:

petrushka_backend.drug_details = {
  'D_1': {  # Drug identifier
    'name': 'Agomelatine',  # Drug display name
    'url': 'https://link-to-offical.nhs/descrition',  # Link to details,
    'prescription': """
        Initially 15-30 mg daily for 2-4 weeks, dose to be taken at baseline,
        then adjusted according to response up to 45 mg once daily,
        alternatively up to 45 mg daily in 2 divided doses.
        """
  },    
  'D_2': {
    'name': 'Amitriptyline',
    'description': 'https://link-to-offical.nhs/descrition',
    'prescription': '...'  # Details of how drug is prescribed
  },
  # ...etc. for all drugs
}

Django Send patient choice to Sentry

{
  "authorisation": "string",      // Access token
  "action": "ptsession",          // Requested operation
  "clinician": "string",          // Clinician identifier
  "token": "string",              // Patient identifier matching RegExpr ^[PS][0-9]{4}$
  "session": {
    "drug_chosen": "string",      // Name of the drug chosen
    "petrushka_output": "string"  // JSON of all PETRUSHKA output
  }
}

Updates

We all need to agree on this specification and be responsible for ensuring that our own components follow it. It's entirely possible that the specification will need updating. When updates are made, whoever makes the updates must notify the maintainers of other components that require updating as a result.

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