Analysing Clinical Notes for Translation Research

2010 ◽  
pp. 357-377
Author(s):  
Jon Patrick ◽  
Pooyan Asgari
Keyword(s):  
Intensive Care ◽  
Translational Research ◽  
Retrospective Studies ◽  
Point Of Care ◽  
Care Service ◽  
Translation Research ◽  
Clinical Notes ◽  
The Past ◽  
High Degree ◽  
Written Materials

There have been few studies of large corpora of narrative notes collected from the health clinicians working at the point of care. This chapter describes the principle issues in analysing a corpus of 44 million words of clinical notes drawn from the Intensive Care Service of a Sydney hospital. The study identifies many of the processing difficulties in dealing with written materials that have a high degree of informality, written in circumstances where the authors are under significant time pressures, and containing a large technical lexicon, in contrast to formally published material. Recommendations on the processing tasks needed to turn such materials into a more usable form are provided. The chapter argues that these problems require a return to issues of 30 years ago that have been mostly solved for computational linguists but need to be revisited for this entirely new genre of materials. In returning to the past and studying the contents of these materials in retrospective studies we can plan to go forward to a future that provides technologies that better support clinicians. They need to produce both lexically and grammatically higher quality texts that can then be leveraged successfully for advanced translational research thereby bolstering its momentum.

Analysing Clinical Notes for Translation Research

2011 ◽  
pp. 1954-1975
Author(s):  
Jon Patrick ◽  
Pooyan Asgari
Keyword(s):  
Intensive Care ◽  
Translational Research ◽  
Retrospective Studies ◽  
Point Of Care ◽  
Care Service ◽  
Translation Research ◽  
Clinical Notes ◽  
The Past ◽  
High Degree ◽  
Written Materials

There have been few studies of large corpora of narrative notes collected from the health clinicians working at the point of care. This chapter describes the principle issues in analysing a corpus of 44 million words of clinical notes drawn from the Intensive Care Service of a Sydney hospital. The study identifies many of the processing difficulties in dealing with written materials that have a high degree of informality, written in circumstances where the authors are under significant time pressures, and containing a large technical lexicon, in contrast to formally published material. Recommendations on the processing tasks needed to turn such materials into a more usable form are provided. The chapter argues that these problems require a return to issues of 30 years ago that have been mostly solved for computational linguists but need to be revisited for this entirely new genre of materials. In returning to the past and studying the contents of these materials in retrospective studies we can plan to go forward to a future that provides technologies that better support clinicians. They need to produce both lexically and grammatically higher quality texts that can then be leveraged successfully for advanced translational research thereby bolstering its momentum.

Some Clinical Notes on Forced Stuttering

1972 ◽  
Vol 37 (2) ◽  
pp. 177-186 ◽  
Author(s):  
Oliver Bloodstein ◽  
Roberta Levy Shogan
Keyword(s):  
Loss Of Control ◽  
Clinical Notes ◽  
High Degree

Stutterers sometimes report that by exerting articulatory pressure they can force themselves to have “real” blocks. A procedure was devised for instructing subjects to force stuttering under various conditions and for recording their introspections. Most subjects were able to force at least a few blocks which they regarded as real. Most of the words on which the attempts were said to succeed were feared or difficult words, and at times subjects assisted the process by “telling” themselves that they would not be able to say the word. Fewer subjects were able to force blocks on isolated sounds than on words, and almost none claimed to succeed on mere articulatory contacts. Subjects repeatedly characterized “real” stuttering as involving feelings of physical tension and loss of control over speech. The nature of the forced block is discussed with reference to a concept of stuttering as a struggle reaction which has acquired a high degree of automaticity.

Point-of-Care Echocardiography and Hemodynamic Monitoring in Cirrhosis and Acute-on-Chronic Liver Failure in the COVID-19 Era

2021 ◽  
pp. 088506662098828
Author(s):  
Madhumita Premkumar ◽  
Kamal Kajal ◽  
Anand V. Kulkarni ◽  
Ankur Gupta ◽  
Smita Divyaveer
Keyword(s):  
Intensive Care ◽  
Liver Failure ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Regional Wall Motion ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Evidenced Based

Point-of-Care (POC) transthoracic echocardiography (TTE) is transforming the management of patients with cirrhosis presenting with septic shock, acute kidney injury, hepatorenal syndrome and acute-on-chronic liver failure (ACLF) by correctly assessing the hemodynamic and volume status at the bedside using combined echocardiography and POC ultrasound (POCUS). When POC TTE is performed by the hepatologist or intensivist in the intensive care unit (ICU), and interpreted remotely by a cardiologist, it can rule out cardiovascular conditions that may be contributing to undifferentiated shock, such as diastolic dysfunction, myocardial infarction, myocarditis, regional wall motion abnormalities and pulmonary embolism. The COVID-19 pandemic has led to a delay in seeking medical treatment, reduced invasive interventions and deferment in referrals leading to “collateral damage” in critically ill patients with liver disease. Thus, the use of telemedicine in the ICU (Tele-ICU) has integrated cardiology, intensive care, and hepatology practices across the spectrum of ICU, operating room, and transplant healthcare. Telecardiology tools have improved bedside diagnosis when introduced as part of COVID-19 care by remote supervision and interpretation of POCUS and echocardiographic data. In this review, we present the contemporary approach of using POC echocardiography and offer a practical guide for primary care hepatologists and gastroenterologists for cardiac assessment in critically ill patients with cirrhosis and ACLF. Evidenced based use of Tele-ICU can prevent delay in cardiac diagnosis, optimize safe use of expert resources and ensure timely care in the setting of critically ill cirrhosis, ACLF and liver transplantation in the COVID-19 era.

scholarly journals Adolescent and adult laryngotracheal stenosis: a review

2021 ◽  
Vol 37 (1) ◽  
Author(s):  
Gerhard Johan Klopper ◽  
Oladele Vincent Adeniyi ◽  
Kate Stephenson
Keyword(s):  
Intensive Care ◽  
Past Century ◽  
Main Body ◽  
Laryngotracheal Stenosis ◽  
Airway Protection ◽  
Interventional Pulmonology ◽  
The Past ◽  
Airway Emergency ◽  
The Individual ◽  
And Function

Abstract Background The larynx has multiple composite functions which include phonation, airway protection, and sensory control of respiration. Stenosis of the larynx and trachea were first recorded by O’Dwyer in 1885 and by Colles in 1886, respectively. Initially, the aetiology of laryngotracheal stenosis was predominantly infective. Currently, the leading cause is iatrogenic injury to the laryngotracheal complex secondary to prolonged ventilation in an intensive care unit. Main body Laryngotracheal stenosis is a complex and diverse disease. It poses a major challenge to the surgeon and can present as an airway emergency. Management typically demands the combined involvement of various disciplines including otorhinolaryngology, cardiothoracic surgery, anaesthesiology, interventional pulmonology, and radiology. Both the disease and its management can impact upon respiration, voice, and swallowing. The incidence of iatrogenic laryngotracheal stenosis has reflected the evolution of airway and intensive care whilst airway surgery has advanced concurrently over the past century. Correction of laryngotracheal stenosis requires expansion of the airway lumen; this is achieved by either endoscopic or open surgery. We review the relevant basic science, aetiopathogenesis, diagnosis, management, and treatment outcomes of LTS. Conclusion The choice of surgical procedure in the management of laryngotracheal stenosis is often dictated by the individual anatomy and function of the larynx and trachea, together with patient factors and available facilities. Regardless of how the surgeon chooses to approach these lesions, prevention of iatrogenic laryngotracheal damage remains of primary importance.

scholarly journals Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Arif Hussain ◽  
Gabriele Via ◽  
Lawrence Melniker ◽  
Alberto Goffi ◽  
Guido Tavazzi ◽  
...  
Keyword(s):  
Lung Ultrasound ◽  
Expert Panel ◽  
Point Of Care ◽  
Expert Consensus ◽  
Future Research ◽  
Point Of Care Ultrasound ◽  
The Past ◽  
Modified Delphi ◽  
Grade Methodology

AbstractCOVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.

scholarly journals Lung ultrasound predicts clinical course but not outcome in COVID-19 ICU patients: a retrospective single-center analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Stephanie-Susanne Stecher ◽  
Sofia Anton ◽  
Alessia Fraccaroli ◽  
Jeremias Götschke ◽  
Hans Joachim Stemmler ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Lung Ultrasound ◽  
Clinical Course ◽  
Point Of Care ◽  
Clinical Deterioration ◽  
Normal Lung ◽  
Icu Patients ◽  
Standardized Protocol ◽  
Ultrasound Score

Abstract Background Point-of-care lung ultrasound (LU) is an established tool in the first assessment of patients with coronavirus disease (COVID-19). Purpose of this study was to evaluate the value of lung ultrasound in COVID-19 intensive care unit (ICU) patients in predicting clinical course and outcome. Methods We analyzed lung ultrasound score (LUS) of all COVID-19 patients admitted from March 2020 to December 2020 to the Internal Intensive Care Unit, Ludwig-Maximilians-University (LMU) of Munich. LU was performed according to a standardized protocol at ICU admission and in case of clinical deterioration with the need for intubation. A normal lung scores 0 points, the worst LUS has 24 points. Patients were stratified in a low (0–12 points) and a high (13–24 points) lung ultrasound score group. Results The study included 42 patients, 69% of them male. The most common comorbidities were hypertension (81%) and obesity (57%). The values of pH (7.42 ± 0.09 vs 7.35 ± 0.1; p = 0.047) and paO2 (107 [80–130] vs 80 [66–93] mmHg; p = 0.034) were significantly reduced in patients of the high LUS group. Furthermore, the duration of ventilation (12.5 [8.3–25] vs 36.5 [9.8–70] days; p = 0.029) was significantly prolonged in this group. Patchy subpleural thickening (n = 38; 90.5%) and subpleural consolidations (n = 23; 54.8%) were present in most patients. Pleural effusion was rare (n = 4; 9.5%). The median total LUS was 11.9 ± 3.9 points. In case of clinical deterioration with the need for intubation, LUS worsened significantly compared to baseline LU. Twelve patients died during the ICU stay (29%). There was no difference in survival in both LUS groups (75% vs 66.7%, p = 0.559). Conclusions LU can be a useful monitoring tool to predict clinical course but not outcome of COVID-19 ICU patients and can early recognize possible deteriorations.

scholarly journals Role of Camel Husbandry in Food Security of the Republic of Kazakhstan

Agriculture ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. 614
Author(s):  
Ayan Orazov ◽  
Liudmila Nadtochii ◽  
Kazybay Bozymov ◽  
Mariam Muradova ◽  
Araigul Zhumayeva
Keyword(s):  
Food Security ◽  
Meat Products ◽  
Daily Consumption ◽  
Low Level ◽  
The Past ◽  
Self Sufficiency ◽  
The Republic ◽  
Food Security Indicators ◽  
Security Indicators ◽  
High Degree

This paper examines the problem of food security in the Republic of Kazakhstan over the past 10 years. Based on statistical data, an assessment was made of the prevalence of malnutrition among the population of the country, including children under 5 years of age. There has been a trend towards for an improvement in the nutrition of the population for a few indicators; however, further optimization of food security indicators is required to achieve the goals of sustainable development (SDGs) of the FAO WHO Agenda for the period up to 2050 in Kazakhstan and in its individual regions. The paper reflects data on demographic changes over the past 10 years and its self-sufficiency in basic foods for 2019. A high degree of self-sufficiency in meat products (117.6%) is revealed in the population of the Republic of Kazakhstan. However, self-sufficiency in dairy products is at an extremely low level (0.1%). Camel breeding has been successfully developing in the country over the past 10 years. However, the number of camels in the country is still at a low level. Camel milk can be considered as a great source of macronutrients, its daily consumption partially facilitates the problem of Food Security in Kazakhstan.

China’s evolving humanitarian diplomacy: Evidence from China’s disaster-related aid to Nepal

2021 ◽  
pp. 205789112110192
Author(s):  
Peng Lin
Keyword(s):  
Humanitarian Assistance ◽  
Underdeveloped Countries ◽  
The Past ◽  
Belt And Road ◽  
High Degree ◽  
The Belt And Road ◽  
Post Disaster ◽  
Effective Channel ◽  
India And China

Engaging in disaster relief and, more recently, post-disaster reconstruction in developing countries with critical geoeconomic and geopolitical interests has become an increasingly regular and institutionalized component of China’s evolving humanitarian diplomacy over the past decade. Drawn upon novel evidence from China’s growing disaster-related humanitarian assistance to Nepal and unprecedented engagement in Nepal’s long-term post-earthquake rebuild since 2015, this article explores the dynamics behind China’s transforming humanitarian diplomacy. The findings of this article suggest that: 1) geopolitical and geoeconomic interests, represented by the Belt-and-Road Initiative, serve as a critical driver for the development of China’s bilateral partnership with other countries in the disaster sector; 2) long-term cooperation with underdeveloped countries like Nepal provides China, both government and non-state actors (NSAs), with an effective channel to engage with the international humanitarian community and to internalize humanitarian norms; 3) although humanitarian missions remain contingent and instrumental in China’s international relations, they are laying the foundations for a specialized humanitarian policy area with more relevant normative assets, more professional actors, and more sophisticated institutions; 4) NSAs, represented by private foundations and civil NGOs, have played active roles in the state-dominant cooperation in disaster management. This article also suggests that intensified geopolitical confrontations, such as military clashes between India and China along their disputed borders over the past year, would lead to a high degree of politicization of humanitarian missions and partnerships counter-conducive to humanitarian goals.

A High Prevalence of Affective Disorder Discovered in a ‘Schizophrenia Clinic’

1977 ◽  
Vol 22 (4) ◽  
pp. 181-183 ◽  
Author(s):  
Morton S. Rapp ◽  
Peggy Edwards
Keyword(s):  
Affective Disorder ◽  
Affective Disorders ◽  
Correct Diagnosis ◽  
Lithium Carbonate ◽  
Case Histories ◽  
Clinical Notes ◽  
The Past ◽  
High Prevalence ◽  
Incorrect Diagnosis

Fifty outpatients in a ‘schizophrenia clinic’ were examined, and sixteen were found to be suffering from periodic affective disorders. Nine of these were given lithium carbonate, and eight responded well. Case histories illustrate three separate reasons for incorrect diagnosis. Examination of extensive old clinical notes of five of these patients suggests that the problems of diagnosis which have been described in the literature in the past, continue to represent obstacles to correct diagnosis. Suggestions for improvement are offered.

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