Статті в журналах: "Specialized nursing language"

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Duarte, Fernando Hiago da Silva, Wenysson Noleto dos Santos, Francisca Simone da Silva, Dhyanine Morais de Lima, Sâmara Fontes Fernandes, and Richardson Augusto Rosendo da Silva. "Terms of specialized nursing language for people with pressure injury." Revista Brasileira de Enfermagem 72, no. 4 (August 2019): 1028–35. http://dx.doi.org/10.1590/0034-7167-2018-0492.

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ABSTRACT Objective: to validate the terms of the specialized nursing language used in care for hospitalized patients with Pressure Injury, identified in nurses’ records, mapping them with the terms of the International Classification for Nursing Practice (ICNP® 2017). Methods: methodological study, carried out at a School Hospital in 2018. It was performed: extraction of terms of medical records; normalization; cross-mapping between extracted terms and those in ICNP®; distribution in the seven axes; theoretical definition and validation of terms. Results: 27,756 terms were extracted. The normalization resulted in 370 relevant terms, being: 225 listed and 145 not listed in the ICNP®, being 60 similar, 13 more comprehensive, 38 more restricted and 34 without agreement, all of which are validated. Conclusion: this study identified and validated terms used by nurses to assist people with Pressure Injury. These may contribute to the unification of professional nursing language in care for these clients.

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Carvalho, Carina Maris Gaspar, Marcia Regina Cubas, and Maria Miriam Lima da Nóbrega. "Terms of the specialized nursing language for the care of ostomates." Revista Brasileira de Enfermagem 70, no. 3 (June 2017): 461–67. http://dx.doi.org/10.1590/0034-7167-2015-0058.

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ABSTRACT Objectives: to identify terms of the specialized nursing language for the care of ostomates from the literature of the area, and to map the identified terms with terms of the International Classification for Nursing Practice (ICNP®). Method: descriptive study of quantitative approach guided by the guidelines for the elaboration of terminology subsets of the ICNP®. The terms were collected in 49 scientific articles, extracted using a computational tool, selected according to the relevance for the theme, and normalized and mapped with the ICNP®. Results: 20,668 terms were extracted. The standardization process resulted in 425 relevant terms (151 were constant in ICNP® and 274 were not contained in ICNP®), of which 154 were similar, 19 were more comprehensive, 50 were more restricted, and 51 were not in concordance. Conclusion: the use of standardized language can minimize the ambiguities and redundancies identified in the mapping. The existence of terms not in concordance with the ICNP® reinforces the need for constant updating of this classification.

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Ìkò̩tún, Reuben Olúwáfé̩mi. "The Semantic Expansion of ‘Wife’ and ‘Husband’ among the Yorùbá of Southwestern Nigeria." Journal of Language and Education 3, no. 4 (December 31, 2017): 36–43. http://dx.doi.org/10.17323/2411-7390-2017-3-4-36-43.

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Although one of the existing studies on Nigerian or African kinship terms has argued that semantic expansion of such words constitutes an absurdity to the English society, none has argued for the necessity of a specialized dictionary to address the problem of absurdity to the English society, the custodian of the English language. This is important especially now that the language has become an invaluable legacy which non-native speakers of the language use to express their culture as well as the fact that the English people now accept the Greek and Hebrew world-views through Christianity. This paper provides additional evidence in support of semantic expansion of kingship terms like ‘wife’ and ‘husband’ not only in a Nigerian or an African language but also in Greek and Hebrew languages. The paper argues that if English is to play its role as an international language, it will be desirable if our lexicographers can publish a specialized dictionary that will take care of kinship terms, as it is the case in some other specialized dictionaries on the different professions such as medicine, nursing, linguistics and agriculture, to mention but a few, so as to guide against ambiguity or absurdity that may arise in language use in social interactions.

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Godfrey, Nelda. "New Language for the Journey: Embracing a Professional Identity of Nursing." Journal of Radiology Nursing 41, no. 1 (March 2022): 15–17. http://dx.doi.org/10.1016/j.jradnu.2021.12.001.

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Handayani, Fitri. "Mini Nurse Lite, Medical Tool Quiz and More: Smartphone Apps as Interactive English Medical Materials for Nursing Students." Elsya : Journal of English Language Studies 3, no. 2 (June 27, 2021): 106–16. http://dx.doi.org/10.31849/elsya.v3i2.6423.

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Gaining medical knowledge in English is challenging for nursing students due to the various challenging necessities such as possessing specialized vocabulary, diagnosing symptoms clearly, and writing health reports. To overcome these classical and practical language barriers, this study tries to establish the effects of using selected smartphone apps, i.e., Mini Nurse Lite, Disease Dictionary, Surgical & Medical Instruments, and Medical Tool Quiz, to increase nursing students’ ability in understanding English medical materials. This research employed a quasi-experimental pre-test and post-test design. The participants were 76 first-year nursing students of a selected university in Solok. The experimental treatment was teaching English medical materials through smartphone applications followed by discussion class, while the control group did not receive training in nursing with smartphone applications as only lecture-based education was performed. The results of the study showed that there was a higher mean score in levels of satisfaction by students in the experimental group (88.53) compared to the control group (82.27). It indicates that smartphone applications were effective for improving nursing students’ ability in understanding English medical materials. The findings suggest optimal conditions for designing smartphone-based learning to be applied in a nursing class and contributed to the lack of studies on smartphone-based instruction in nursing within the context of overcoming English language barriers.

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Fairus Nor Mohamad, Alif, and Sharifah Nor Puteh. "A Corpus-Based Evaluation on Two Different English for Nursing Purposes (ENP) Course Books." Advances in Language and Literary Studies 8, no. 2 (April 30, 2017): 196. http://dx.doi.org/10.7575//aiac.alls.v.8n.2p.196.

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It is difficult for most of the second language learners in Malaysia to function proficiently in English language due to limited vocabulary knowledge. It has also been challenging for TESL graduates to fit in as ENP teachers due to the lack of specialized vocabulary knowledge in nursing field. Thus, a course books has always been a highly dependable aid in facilitating the teaching and learning in an ENP classroom. The objective of this research is to identify the possible pedagogical aspects of two ENP commercial course books (Oxford English for Careers Nursing 1” (OEFCN1) written by Tony Grice and “Nursing Your English Second Edition” (NYE) by Siti Salina Salim and Mazura Mastura Muhammad) in socializing learners into their discourse communities. The present research looks at the extent of vocabulary coverage in comparison with General Service List (GSL), Academic Word List (AWL), Nursing Education Word List (NEWL) and the 2,000 most frequent nursing words. These course books were photocopied, scanned and converted into computer text files before they were analyzed using WordSmith 4.0 as it is able to provide elemental knowledge on the vocabulary coverage in both course books. The results indicated that both books showed significant result in terms of their coverage based on the three word lists. On the other hand, it is proven that the 2000 most frequent nursing words wordlist is not able to cover as much tokens as compared to GSL, AWL and NEWL combined.

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Houghton, Carl, and Ann Taylor. "Stigma and social barriers to accessing timely healthcare for alcohol dependence and misuse: a narrative review." Gastrointestinal Nursing 19, Sup10 (December 1, 2021): S12—S17. http://dx.doi.org/10.12968/gasn.2021.19.sup10.s12.

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This narrative review looks at how alcohol misuse can be distinguished from unproblematic alcohol consumption, and it considers the extent of alcohol use in the UK, along with the cost of alcohol, financial and otherwise, to individuals and wider society. It focuses on the perceived public stigma and personal stigma associated with alcohol misuse and dependence and how this can discourage people from seeking help from healthcare services. This includes the negative impact of stigmatising language in reinforcing stereotypes and creating expectations. The article explores alcohol-related readmissions and the emotional consequences of ‘revolving-door syndrome’ for patients and professionals. Recommendations are made for hospital screening for risky lifestyle factors, as well as professional education on alcohol screening and interventions. The article concludes with recommendations for further study, to not lose sight of the patient and to destigmatise language to break down barriers to treatment access.

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Huang, Mingru. "The Application of 3+1 Holistic Rehabilitation Nursing in Patients with Alzheimer’s Disease." Journal of Clinical and Nursing Research 6, no. 2 (February 23, 2022): 84–93. http://dx.doi.org/10.26689/jcnr.v6i2.3609.

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Objective: The objective of this study is to determine the effectiveness of the 3+1 holistic rehabilitation nursing in terms of self-care ability, cognition, language, and emotional regulation of AD patients. This study also summarizes the advantages and disadvantages of current studies to guide future studies. Methods: Literatures on 3+1 holistic rehabilitation nursing as an intervention for patients with Alzheimer’s disease were searched from three Chinese databases in January 2021: CNKI, VIP, and Wang Fang Database. Two reviewers independently screened the identified studies by title and abstract. Thereafter, the full text of all 28 studies were reviewed. Finally, 24 studies were included after excluding duplicates, non-3+1 holistic rehabilitation mursing studies, non-experimental studies, studies with inconsistent sample size, wrong data analysis, and unclear outcomes, etc. Results: Upon reviewing the 24 literatures, all the included studies were clinical studies that made comparisons between 3+1 holistic rehabilitation mursing groups and traditional nursing groups. The age of the participants were between 60 and 80 years, and the total number of participates were 2,790. However, there were some studies that did not report the average age (5/24), average duration (14/24), and the ratio of male to female patients (3/24). Only a few studies reported the intervention time (7/24) and classified the disease by severity (4/24). The outcomes included activities of daily living (ADL), Mini-Mental State Examination (MMSE), and Chinese Rehabilitation Research Center Aphasia Examination (CRRCAE). A total of 19 studies showed that 3+1 holistic rehabilitation nursing is effective in improving patients’ self-care ability; 14 studies showed that this rehabilitation nursing has a significant curative effect for the cognitive function of patients; 7 studies showed that this nursing model can promote the recovery of language function in AD patients; 5 studies showed the model can significantly reduce the incidence of adverse events and complications upon receiving treatment; 2 studies showed that the nursing model is helpful for depression and emotional indifference. Conclusion: Compared with the traditional nursing mode, 3+1 holistic rehabilitation nursing is more effective in improving self-care ability, cognitive function, language function, emotional state, and so on. In addition, this nursing model can significantly reduce the incidence of adverse events, falls, pressure sores, and other complications during hospitalization. However, the inclusion criteria and duration of intervention for the included studies need to be further standardized, and more experimental studies on the efficacy of 3+1 holistic rehabilitation nursing on severe AD patients as well as the complications caused by AD are required. The cost of 3+1 holistic rehabilitation nursing, which is specialized and personalized, is high. Therefore, the value of this nursing model still requires much research.

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Bastien, C., M. Roux, and L. Pellegrin. "Representation of Medical Concepts of the Thyroid Gland by Physicians in Anatomy and Pathology." Methods of Information in Medicine 33, no. 04 (1994): 382–89. http://dx.doi.org/10.1055/s-0038-1635045.

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Abstract:An experimental study in cognitive psychology is described, concerning the categorization of medical concepts into specific classes, expressed by physicians specialized in anatomic pathology consultations of the thyroid gland. This study belongs to a medical computer science project, called ARISTOTLE, concerning Natural Language Processing of specialized medical reports in anatomic pathology of the thyroid gland. This research has been done for two reasons: first, to specify the characteristics of human expert categorization in an area of medical knowledge and, secondly, to validate the hierarchical organization of a prototype declarative knowledge base. In this experiment, physicians were asked to categorize 121 concepts into 10 proposed classes. These classes and concepts belong to expert knowledge represented in a conceptual graph that was constructed before the experiment. Results show variable semantic distances between concepts of a same class, and dynamic variations of these distances due to contextual representation.

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Tremper, Galina, Torben Brenner, Florian Stampe, Andreas Borg, Martin Bialke, David Croft, Esther Schmidt, and Martin Lablans. "MAGICPL: A Generic Process Description Language for Distributed Pseudonymization Scenarios." Methods of Information in Medicine 60, no. 01/02 (May 2021): 021–31. http://dx.doi.org/10.1055/s-0041-1731387.

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Abstract Objectives Pseudonymization is an important aspect of projects dealing with sensitive patient data. Most projects build their own specialized, hard-coded, solutions. However, these overlap in many aspects of their functionality. As any re-implementation binds resources, we would like to propose a solution that facilitates and encourages the reuse of existing components. Methods We analyzed already-established data protection concepts to gain an insight into their common features and the ways in which their components were linked together. We found that we could represent these pseudonymization processes with a simple descriptive language, which we have called MAGICPL, plus a relatively small set of components. We designed MAGICPL as an XML-based language, to make it human-readable and accessible to nonprogrammers. Additionally, a prototype implementation of the components was written in Java. MAGICPL makes it possible to reference the components using their class names, making it easy to extend or exchange the component set. Furthermore, there is a simple HTTP application programming interface (API) that runs the tasks and allows other systems to communicate with the pseudonymization process. Results MAGICPL has been used in at least three projects, including the re-implementation of the pseudonymization process of the German Cancer Consortium, clinical data flows in a large-scale translational research network (National Network Genomic Medicine), and for our own institute's pseudonymization service. Conclusions Putting our solution into productive use at both our own institute and at our partner sites facilitated a reduction in the time and effort required to build pseudonymization pipelines in medical research.

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Epstein, Richard H., Yuel-Kai Jean, Roman Dudaryk, Robert E. Freundlich, Jeremy P. Walco, Dorothee A. Mueller, and Shawn E. Banks. "Natural Language Mapping of Electrocardiogram Interpretations to a Standardized Ontology." Methods of Information in Medicine 60, no. 03/04 (September 2021): 104–9. http://dx.doi.org/10.1055/s-0041-1736312.

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Abstract Background Interpretations of the electrocardiogram (ECG) are often prepared using software outside the electronic health record (EHR) and imported via an interface as a narrative note. Thus, natural language processing is required to create a computable representation of the findings. Challenges include misspellings, nonstandard abbreviations, jargon, and equivocation in diagnostic interpretations. Objectives Our objective was to develop an algorithm to reliably and efficiently extract such information and map it to the standardized ECG ontology developed jointly by the American Heart Association, the American College of Cardiology Foundation, and the Heart Rhythm Society. The algorithm was to be designed to be easily modifiable for use with EHRs and ECG reporting systems other than the ones studied. Methods An algorithm using natural language processing techniques was developed in structured query language to extract and map quantitative and diagnostic information from ECG narrative reports to the cardiology societies' standardized ECG ontology. The algorithm was developed using a training dataset of 43,861 ECG reports and applied to a test dataset of 46,873 reports. Results Accuracy, precision, recall, and the F1-measure were all 100% in the test dataset for the extraction of quantitative data (e.g., PR and QTc interval, atrial and ventricular heart rate). Performances for matches in each diagnostic category in the standardized ECG ontology were all above 99% in the test dataset. The processing speed was approximately 20,000 reports per minute. We externally validated the algorithm from another institution that used a different ECG reporting system and found similar performance. Conclusion The developed algorithm had high performance for creating a computable representation of ECG interpretations. Software and lookup tables are provided that can easily be modified for local customization and for use with other EHR and ECG reporting systems. This algorithm has utility for research and in clinical decision-support where incorporation of ECG findings is desired.

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Denecke, K. "Semantic Structuring of and Information Extraction from Medical Documents Using the UMLS." Methods of Information in Medicine 47, no. 05 (2008): 425–34. http://dx.doi.org/10.3414/me0508.

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Summary Objectives: This paper introduces SeReMeD (Semantic Representation of Medical Documents), a method for automatically generating knowledge representations from natural language documents. The suitability of the Unified Medical Language System (UMLS) as domain knowledge for this method is analyzed. Methods: SeReMeD combines existing language engineering methods and semantic transformation rules for mapping syntactic information to semantic roles. In this way, the relevant content of medical documents is mapped to semantic structures. In order to extract specific data, these semantic structures are searched for concepts and semantic roles. A study is carried out that uses SeReMeD to detect specific data in medical narratives such as documented diagnoses or procedures. Results: The system is tested on chest X-ray reports. In first evaluations of the system’s performance, the generation of semantic structures achieves a correctness of 80%, whereas the extraction of documented findings obtains values of 93% precision and 83% recall. Conclusions: The results suggest that the methods described here can be used to accurately extract data from medical narratives, although there is also some potential for improving the results. The proposed methods provide two main benefits. By using existing language engineering methods, the effort required to construct a medical information extraction system is reduced. It is also possible to change the domain knowledge and therefore to create a more (or less) specialized system, capable of handling various medical sub-domains.

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Brady, Marian C., Myzoon Ali, Kathryn VandenBerg, Linda J. Williams, Louise R. Williams, Masahiro Abo, Frank Becker, et al. "Dosage, Intensity, and Frequency of Language Therapy for Aphasia: A Systematic Review–Based, Individual Participant Data Network Meta-Analysis." Stroke 53, no. 3 (March 2022): 956–67. http://dx.doi.org/10.1161/strokeaha.121.035216.

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Background and Purpose: Optimizing speech and language therapy (SLT) regimens for maximal aphasia recovery is a clinical research priority. We examined associations between SLT intensity (hours/week), dosage (total hours), frequency (days/week), duration (weeks), delivery (face to face, computer supported, individual tailoring, and home practice), content, and language outcomes for people with aphasia. Methods: Databases including MEDLINE and Embase were searched (inception to September 2015). Published, unpublished, and emerging trials including SLT and ≥10 individual participant data on aphasia, language outcomes, and time post-onset were selected. Patient-level data on stroke, language, SLT, and trial risk of bias were independently extracted. Outcome measurement scores were standardized. A statistical inferencing, one-stage, random effects, network meta-analysis approach filtered individual participant data into an optimal model examining SLT regimen for overall language, auditory comprehension, naming, and functional communication pre-post intervention gains, adjusting for a priori–defined covariates (age, sex, time poststroke, and baseline aphasia severity), reporting estimates of mean change scores (95% CI). Results: Data from 959 individual participant data (25 trials) were included. Greatest gains in overall language and comprehension were associated with >20 to 50 hours SLT dosage (18.37 [10.58–26.16] Western Aphasia Battery–Aphasia Quotient; 5.23 [1.51–8.95] Aachen Aphasia Test–Token Test). Greatest clinical overall language, functional communication, and comprehension gains were associated with 2 to 4 and 9+ SLT hours/week. Greatest clinical gains were associated with frequent SLT for overall language, functional communication (3–5+ days/week), and comprehension (4–5 days/week). Evidence of comprehension gains was absent for SLT ≤20 hours, <3 hours/week, and ≤3 days/week. Mixed receptive-expressive therapy, functionally tailored, with prescribed home practice was associated with the greatest overall gains. Relative variance was <30%. Risk of trial bias was low to moderate; low for meta-biases. Conclusions: Greatest language recovery was associated with frequent, functionally tailored, receptive-expressive SLT, with prescribed home practice at a greater intensity and duration than reports of usual clinical services internationally. These exploratory findings suggest critical therapeutic ranges, informing hypothesis-testing trials and tailoring of clinical services. Registration: URL: https://www.crd.york.ac.uk/PROSPERO/ ; Unique identifier: CRD42018110947.

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Clarke, Liam. "The trouble with specialised language for nursing." Nursing Standard 14, no. 2 (September 29, 1999): 41–43. http://dx.doi.org/10.7748/ns1999.09.14.2.41.c2686.

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Fong, Allan, Nicholas Scoulios, H. Joseph Blumenthal, and Ryan E. Anderson. "Using Machine Learning to Capture Quality Metrics from Natural Language: A Case Study of Diabetic Eye Exams." Methods of Information in Medicine 60, no. 03/04 (September 2021): 110–15. http://dx.doi.org/10.1055/s-0041-1736311.

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Abstract Background and Objective The prevalence of value-based payment models has led to an increased use of the electronic health record to capture quality measures, necessitating additional documentation requirements for providers. Methods This case study uses text mining and natural language processing techniques to identify the timely completion of diabetic eye exams (DEEs) from 26,203 unique clinician notes for reporting as an electronic clinical quality measure (eCQM). Logistic regression and support vector machine (SVM) using unbalanced and balanced datasets, using the synthetic minority over-sampling technique (SMOTE) algorithm, were evaluated on precision, recall, sensitivity, and f1-score for classifying records positive for DEE. We then integrate a high precision DEE model to evaluate free-text clinical narratives from our clinical EHR system. Results Logistic regression and SVM models had comparable f1-score and specificity metrics with models trained and validated with no oversampling favoring precision over recall. SVM with and without oversampling resulted in the best precision, 0.96, and recall, 0.85, respectively. These two SVM models were applied to the unannotated 31,585 text segments representing 24,823 unique records and 13,714 unique patients. The number of records classified as positive for DEE using the SVM models ranged from 667 to 8,935 (2.7–36% out of 24,823, respectively). Unique patients classified as positive for DEE ranged from 3.5 to 41.8% highlighting the potential utility of these models. Discussion We believe the impact of oversampling on SVM model performance to be caused by the potential of overfitting of the SVM SMOTE model on the synthesized data and the data synthesis process. However, the specificities of SVM with and without SMOTE were comparable, suggesting both models were confident in their negative predictions. By prioritizing to implement the SVM model with higher precision over sensitivity or recall in the categorization of DEEs, we can provide a highly reliable pool of results that can be documented through automation, reducing the burden of secondary review. Although the focus of this work was on completed DEEs, this method could be applied to completing other necessary documentation by extracting information from natural language in clinician notes. Conclusion By enabling the capture of data for eCQMs from documentation generated by usual clinical practice, this work represents a case study in how such techniques can be leveraged to drive quality without increasing clinician work.

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Noë, Sofie, Ann Goeleven, Hilde Brouwers, Tom Meurrens, Alexander De Cock, Daphne Kos, and Kris Vanhaecht. "Training for Caregivers and Compliance with Dysphagia Recommendations in a Tertiary Multiple Sclerosis Rehabilitation Center." International Journal of MS Care 23, no. 5 (March 19, 2021): 223–28. http://dx.doi.org/10.7224/1537-2073.2020-019.

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Abstract Background: Dysphagia is common in persons with multiple sclerosis (MS). Speech and language therapists give dysphagia recommendations to persons with MS and caregivers. Nonadherence to these recommendations can increase the risk of aspiration. We investigated current compliance with dysphagia recommendations among caregivers and kitchen staff and assessed improvement in compliance by increasing knowledge through tailored training. Methods: An observational cohort study was conducted over 4 weeks during which the compliance of the caregivers and kitchen staff in a rehabilitation center was monitored. A questionnaire was used to assess reasons for noncompliance. A 2-hour training session was provided for all caregivers and kitchen staff to improve their knowledge and skills. The compliance rate was observed again 1 and 6 months after the training. Compliance was defined by whether recommendations were followed. Results: Results showed a significant improvement after training for overall compliance by caregivers (from 58% to >81%, P < .001). This improvement was still observed 6 months later (80%). After training, significant differences were found in compliance with the following recommendations (P ≤ .001): consistency of soup, consistency of liquids, food preparation, alertness, speed, amount, posture, and supervision. Recommendation for utensils did not improve (P = .44). Compliance with diet modifications made by the kitchen staff improved significantly (from 74% to >86%, P = .002), and even more during follow-up (to >95%, P = .009). Conclusions: Dysphagia training tailored to the needs of caregivers to improve knowledge significantly improves compliance with dysphagia recommendations and the quality of care.

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Hillis, Argye E., Alexander Razumovsky, John A. Ulatowski, Piyush Banker, Kiran Sheikh, and Daniele Rigamonti. "Associations between age, vasospasm, and cognitive deficits after ruptured aneurysm repair." Stroke 32, suppl_1 (January 2001): 357. http://dx.doi.org/10.1161/str.32.suppl_1.357-a.

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P101 Although vasospasm has been postulated as a risk for development of neuropsychological deficits after rupture and repair of intracerebral aneurysms, there is little empirical support for this hypothesis. To determine the risk of vasospasm for persistent cognitive deficits, we studied 16 patients, age 30–77, with daily TCD evaluations after aneurysm clipping, and administered a battery of neuropsychological tests (clusters of language, spatial, and memory tests) 3 months post-operatively. We calculated Pearson correlations between neuropsychological test cluster scores (age-corrected) and: (1) #days in vasospasm by TCD criteria; (2) #vessels in vasospasm by TCD; and (3) maximum velocity in each major vessel. Results: Vasospasm in left or right ICA (C1) or MCA (M1) was negatively correlated with both language ( r =.57-.64; p <.02)and spatial( r =.53-.57; p <.02), but not memory, test scores compared to age norms. Paradoxically, however, both #days in vasospasm (any vessel) and #vessels in vasospasm were positively correlated with both language and spatial scores ( r =.56-.60; p <.03 each). That is, more diffuse/longer duration vasospasm was associated with better scores. This result was entirely accounted for by age. Age was negatively correlated with both #days in vasospasm ( r =-.564; p <.03) and #vessels in vasospasm ( r =-.555; p <.030). Likewise, age was negatively correlated with age-corrected scores on all neuropsychological tests. That is, older patients had less diffuse vasospasm, for fewer days, but nevertheless had more severe cognitive deficits (relative to age norms) at 3 months post surgery. When we controlled for age, there were no significant correlations between #days or #any vessels in vasospasm and neuropsychological scores. Conclusions: Across all ages, severity of vasospasm in left or right ICA (C1) or MCA (M1) was associated with lower age-corrected scores on language and spatial tests. Older patients had fewer vessels and fewer days in vasospasm of any vessel(possibly due to lower vascular reactivity or attenuated inflammatory response associated with aging), but nonetheless showed more significant deficits on neuropsychological tests.

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Daniels, Kisha N., Katrina Yvette Billingsley, Janelle Billingsley, Yolonda Long, and Deja Young. "Impacting resilience and persistence in underrepresented populations through service-learning." Journal for Multicultural Education 9, no. 3 (August 10, 2015): 174–92. http://dx.doi.org/10.1108/jme-02-2015-0005.

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Purpose – The purpose of this paper is to share the research on the use of service-learning pedagogy as a strategy to promote engaged learning that positively impacts resilience. It purports that although often overlooked as a teaching and learning strategy, service-learning offers a viable method for supporting persistence and resiliency in largely minority population. Design/methodology/approach – The research utilizes data from both quantitative and qualitative measures (surveys/questionnaires and open ended responses collected from focus groups). The data were collected over 15 months from undergraduate students who represent 5 different content areas (nursing, public health, psychology, nutrition and physical education). Findings – The data revealed that students positively favor service-learning pedagogy and value the tenets of civic responsibility and social justice. These outcomes contribute to a positive impact on persistence and resiliency. Research limitations/implications – This research highlights the findings from a small group of students enrolled in a specialized program, therefore may lack generalizability. Future research should replicate the study on a larger scale. Practical implications – This paper includes both theoretical foundational knowledge and practical applications to support faculty teaching and learning. Additionally, it seeks to support and increase understanding of strategies that positively impact persistence and resilience constructs. Social implications – The social implications of this research reflect an understanding of the inherent needs of students from underrepresented and/or underserved populations. Originality/value – This paper fills a void in the literature at the higher education level, by offering specific strategies, which focus on methods to support resilience through increased student engagement, civic responsibility and critical thinking. Additionally, historically black colleges and universities are among the least empirically examined institutions in American higher education.

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Lum, Lillie, Mahmoud Alqazli, and Karen Englander. "Academic Literacy Requirements of Health Professions Programs: Challenges for ESL Students." TESL Canada Journal 35, no. 1 (September 9, 2018): 1–28. http://dx.doi.org/10.18806/tesl.v35i1.1282.

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To succeed in Canadian health professions, university education programs students must initially meet a variety of program-specific and English-language admission requirements. For non-native English-speaking (NNES) students, a major challenge can be the demonstration of profession-specific academic literacy and, in particular, adequate language competency prior to admission and throughout the program. Despite the increased numbers in the adult NNES student population in Canada, the current academic literacy requirements within these programs have received minimal research focus. This study explores thecongruency of program requirements and learning supports within three major health professions programs across six Canadian universities. The data analyzed for this qualitative study include program documents on publicly accessible websites and a focused literature review. Findings suggest that in medicine, nursing, and pharmacy programs, discipline-specific academic literacy manifests itself in a wide variety of specialized written genres, ranging from reflections to theoretical analysis. Academic literacy is essential to the socialization of new students into these specialized programs and into the professions. Suggestions are offered to enhance universities’ support of the development of academic literacy of NNES students. Pour réussir comme professionnels de la santé au Canada, les étudiants inscrits aux programmes d’enseignement universitaire doivent d’abord satisfaire à une variété de conditions d’admission relatives au programme qu’ils ont choisi et à leur connaissance de l’anglais. Pour les étudiants dont la langue maternelle n’est pas l’anglais (NNES, pour « non-native English speakers »), la nécessité de faire preuve de littératie académique dans la profession de leur choix et, en particulier, celle d’une compétence langagière suffisante avant leur admission et tout au long du programme choisi peuvent constituer un défi de taille. Bien que la population des étudiants adultes de type NNES ait augmenté au Canada, les exigences actuelles de littératie académique liées à ces programmes n’ont fait l’objet que de travaux de recherche rudimentaires. La présente étude explore la concordance entre les exigences des programmes d’études et les soutiens pédagogiques au sein de trois importants programmes de formation de professionnels de la santé dans six universités canadiennes. Les données analysées pour cette étude qualitative comprennent la documentation sur les programmes concernés disponible sur des sites Web accessibles au grand public ainsi qu’une analyse documentaire ciblée. Les constatations suggèrent que, dans les programmes d’études médicales, infirmières, et pharmaceutiques, la littératie académique liée à une discipline particulière se manifeste dans une grande variété de genres d’écriture spécialisés allant de réflexions à l’analyse théorique. La littératie académique est essentielle à l’insertion des nouveaux étudiants dans ces programmes spécialisés de même que dans les professions. Des suggestions sont offertes pour rehausser le niveau du soutien des universités au développement des étudiants NNES dans le domaine de la littératie académique.

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Evans, R. Scott, Jose Benuzillo, Benjamin D. Horne, James F. Lloyd, Alejandra Bradshaw, Deborah Budge, Kismet D. Rasmusson, et al. "Automated identification and predictive tools to help identify high-risk heart failure patients: pilot evaluation." Journal of the American Medical Informatics Association 23, no. 5 (February 17, 2016): 872–78. http://dx.doi.org/10.1093/jamia/ocv197.

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Abstract Objective Develop and evaluate an automated identification and predictive risk report for hospitalized heart failure (HF) patients. Methods Dictated free-text reports from the previous 24 h were analyzed each day with natural language processing (NLP), to help improve the early identification of hospitalized patients with HF. A second application that uses an Intermountain Healthcare-developed predictive score to determine each HF patient’s risk for 30-day hospital readmission and 30-day mortality was also developed. That information was included in an identification and predictive risk report, which was evaluated at a 354-bed hospital that treats high-risk HF patients. Results The addition of NLP-identified HF patients increased the identification score’s sensitivity from 82.6% to 95.3% and its specificity from 82.7% to 97.5%, and the model’s positive predictive value is 97.45%. Daily multidisciplinary discharge planning meetings are now based on the information provided by the HF identification and predictive report, and clinician’s review of potential HF admissions takes less time compared to the previously used manual methodology (10 vs 40 min). An evaluation of the use of the HF predictive report identified a significant reduction in 30-day mortality and a significant increase in patient discharges to home care instead of to a specialized nursing facility. Conclusions Using clinical decision support to help identify HF patients and automatically calculating their 30-day all-cause readmission and 30-day mortality risks, coupled with a multidisciplinary care process pathway, was found to be an effective process to improve HF patient identification, significantly reduce 30-day mortality, and significantly increase patient discharges to home care.

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Cano, C., A. Blanco, and L. Peshkin. "Automated Identification of Diagnosis and Co-morbidity in Clinical Records." Methods of Information in Medicine 48, no. 06 (2009): 546–51. http://dx.doi.org/10.3414/me0615.

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Summary Objectives: Automated understanding of clinical records is a challenging task involving various legal and technical difficulties. Clinical free text is inherently redundant, unstructured, and full of acronyms, abbreviations and domain-specific language which make it challenging to mine automatically. There is much effort in the field focused on creating specialized ontology, lexicons and heuristics based on expert knowledge of the domain. However, ad-hoc solutions poorly generalize across diseases or diagnoses. This paper presents a successful approach for a rapid prototyping of a diagnosis classifier based on a popular computational linguistics platform. Methods: The corpus consists of several hundred of full length discharge summaries provided by Partners Healthcare. The goal is to identify a diagnosis and assign co-morbidity. Our approach is based on the rapid implementation of a logistic regression classifier using an existing toolkit: LingPipe (http://alias-i.com/lingpipe). We implement and compare three different classifiers. The baseline approach uses character 5-grams as features. The second approach uses a bag-of-words representation enriched with a small additional set of features. The third approach reduces a feature set to the most informative features according to the information content. Results: The proposed systems achieve high performance (average F-micro 0.92) for the task. We discuss the relative merit of the three classifiers. Supplementary material with detailed results is available at: http://decsai.ugr.es/~ccano/LR/supplementary_material/ Conclusions: We show that our methodology for rapid prototyping of a domain-unaware system is effective for building an accurate classifier for clinical records.

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Ballard, C., M. Margallo-Lana, J. T. O'Brien, I. James, R. Howard, and J. Fossey. "TOP CITED PAPERS IN INTERNATIONAL PSYCHOGERIATRICS: 6a. QUALITY OF LIFE FOR PEOPLE WITH DEMENTIA LIVING IN RESIDENTIAL AND NURSING HOME CARE: THE IMPACT OF PERFORMANCE ON ACTIVITIES OF DAILY LIVING, BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS, LANGUAGE SKILLS, AND PSYCHOTROPIC DRUGS." International Psychogeriatrics 21, no. 6 (September 22, 2009): 1026–30. http://dx.doi.org/10.1017/s1041610209990998.

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The majority of people with dementia develop behavioral and psychological symptoms of dementia (BPSD) at some point during their illness (Jeste et al., 2008). These symptoms, which are especially common among care home residents, are frequently distressing for the patients who experience them (Gilley et al., 2006; Jeste et al., 2008) and problematic for their professional and/or family caregivers. The starting point for our paper “Quality of life for people with dementia living in residential and nursing home care: the impact of performance on activities of daily living, behavioral and psychological symptoms, language skills, and psychotropic drugs” (Ballard et al., 2001) was to try and understand the impact of BPSD, function and language skills on quality of life in care home residents with dementia. Although there were frequent statements in previous work referring to the capacity of psychiatric and behavioral symptoms to reduce quality of life, we had been unable to identify any empirical evidence to support this clinical impression in a thorough literature review. The parallel validation of Dementia Care Mapping (DCM), predominantly a practice development tool, as an observational measure of well-being/quality of life (Kitwood and Bredin, 1997; Fossey et al., 2002) provided an excellent opportunity to examine this issue in a care home setting. The study focused on 209 people with dementia living in residential and nursing home care in north-east England in the U.K., who received a detailed assessment of BPSD, function and cognition. A DCM evaluation was completed for 112 of these individuals, providing a detailed observational measure of well-being, activities and social withdrawal as indices of quality of life over a six-hour daytime period. To our surprise, there was actually no association between well-being, social withdrawal or activities and BPSD. In contrast, there was a significant association between antipsychotic medication and reduced well-being, social withdrawal and activities respectively, even after controlling for the severity of behavioral disturbance. Using an arbitrary definition of “ill-being”, defined as a well-being score of less than zero, 5% of people not taking antipsychotics, 10% of people taking atypical antipsychotics and 22% of people taking typical antipsychotics were defined as having ill-being. Lower levels of functional ability were also associated with significantly lower well-being, less activities and more social withdrawal. At first this latter finding appears to be contrary to one of the central principles of DCM – namely, that the assessment should be independent of dementia severity. Although high levels of well-being and engagement are possible for people with severe dementia, this probably requires higher staff numbers and a workforce with more specialized skills in order to achieve this.

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Prieto Santamaría, Lucía, David Fernández Lobón, Antonio Jesús Díaz-Honrubia, Ernestina Menasalvas Ruiz, Sokratis Nifakos, and Alejandro Rodríguez-González. "Towards the Representation of Network Assets in Health Care Environments Using Ontologies." Methods of Information in Medicine 60, S 02 (October 5, 2021): e89-e102. http://dx.doi.org/10.1055/s-0041-1735621.

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Abstract Objectives The aim of the study is to design an ontology model for the representation of assets and its features in distributed health care environments. Allow the interchange of information about these assets through the use of specific vocabularies based on the use of ontologies. Methods Ontologies are a formal way to represent knowledge by means of triples composed of a subject, a predicate, and an object. Given the sensitivity of network assets in health care institutions, this work by using an ontology-based representation of information complies with the FAIR principles. Federated queries to the ontology systems, allow users to obtain data from multiple sources (i.e., several hospitals belonging to the same public body). Therefore, this representation makes it possible for network administrators in health care institutions to have a clear understanding of possible threats that may emerge in the network. Results As a result of this work, the “Software Defined Networking Description Language—CUREX Asset Discovery Tool Ontology” (SDNDL-CAO) has been developed. This ontology uses the main concepts in network assets to represent the knowledge extracted from the distributed health care environments: interface, device, port, service, etc. Conclusion The developed SDNDL-CAO ontology allows to represent the aforementioned knowledge about the distributed health care environments. Network administrators of these institutions will benefit as they will be able to monitor emerging threats in real-time, something critical when managing personal medical information.

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Davis, Kristine A. "AIDS nursing care and standardized nursing language: An application of the nursing intervention classification." Journal of the Association of Nurses in AIDS Care 6, no. 6 (November 1995): 37–44. http://dx.doi.org/10.1016/s1055-3290(05)80012-3.

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Medea, Gitalia Putri, Elly Nurachmah, and Muhamad Adam. "Post-Stroke Quality of Life Perceived by Patients and Caregivers." Jurnal Keperawatan Indonesia 24, no. 3 (December 3, 2021): 165–72. http://dx.doi.org/10.7454/jki.v24i3.962.

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The quality of life (QOL) of post-stroke patients can be assessed from the reports of patients themselves obtained through a structured interview or a questionnaire. However, some individuals are unable to comprehensively describe their QOL because of language disorders, cognitive effects caused by stroke, or pre-existing conditions. This study aims to identify differences in post-stroke QOL perception between patients and caregivers. A cross-sectional design involving 115 stroke patients and 115 caregivers was adopted, and Mann–Whitney test was used for statistical analysis. Results showed no significant difference in QOL perception (p = 0.166; α < 0.05), particularly in the physical (p = 0.278; α < 0.05), psychological (p = 0.068; α < 0.05), social relationship (p = 0.976; α < 0.05), and environmental (p = 0.157; α < 0.05) domains between patients and caregivers. Therefore, information from caregivers can be used to assess QOL when patients are incapable of reporting their condition. AbstrakKualitas Hidup Pasca Stroke yang Dipersepsikan oleh Pasien dan Caregiver. Kualitas hidup pasien pasca stroke dapat diketahui berdasarkan laporan dari pasien stroke dengan wawancara terstruktur atau dengan pengisian kuesioner. Namun, beberapa dari pasien stroke tidak dapat menggambarkan kualitas hidup mereka karena adanya gangguan bahasa dan efek kognitif lainnya akibat stroke atau kondisi yang sudah ada sebelumnya. Penelitian ini bertujuan mengidentifikasi perbedaan persepsi kualitas hidup antara perspektif pasien pasca stroke dan caregiver. Penelitian ini menggunakan desain cross sectional yang melibatkan 115 pasien dan 115 caregiver dengan menggunakan analisis statistik Mann Whitney. Hasil analisis menunjukkan tidak terdapat perbedaan secara signifikan antara persepsi kualitas hidup dari pasien dan caregiver (p = 0,166 ; α < 0,05), khususnya pada domain fisik (p = 0,278; α < 0,05), psikologis (p = 0,068; α < 0,05), hubungan sosial (p = 0,976; α < 0,05), dan lingkungan (p = 0.157; α < 0,05) dari kualitas hidup yang dipersepsikan oleh pasien dan yang dipersepsikan oleh caregiver. Informasi dari caregiver dapat digunakan saat pasien tidak dapat memberikan informasi terkait kualitas hidupnya.Kata Kunci: caregiver, kualitas hidup, persepsi, stroke

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Hotchkiss, J. Blake, and Judy Thompson. "A Critical Appraisal of Variability in Informed Consent for Vascular Access Procedures." Journal of the Association for Vascular Access 26, no. 3 (August 18, 2021): 19–24. http://dx.doi.org/10.2309/java-d-21-00007.

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Highlights Abstract Background: Vascular access device insertion is one of the most performed procedures in healthcare today. With different device types available to provide infusion therapy, there are many different variables to consider, including the process of obtaining informed consent from patients. This literature review aims to discuss common themes present in current evidence-based practice and point out critical areas of variability that exist. Methods: A literature review was conducted searching Cochrane Library, Joanna Briggs Institute for Evidence-Based Practice, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Google Scholar databases for recently published articles in the English language and those written in English. Articles were screened to include those that describe informed consent within the context of vascular access or other invasive procedures. There were 35 articles and 5 systematic reviews identified that met criteria for inclusion in this literature review. Discussion: The topics of ethics, legal responsibility, who provided consent, and how education about procedures was performed demonstrated clear insight into how to improve the consent process. Some areas in current evidence lack clear direction and create variability in the informed consent procedure. These included who should obtain consent from the patient and which vascular access devices required a written consent. Who obtains consent was found to be more related to current legal precedence and not the clinician inserting the device like that found when a nonphysician clinician performed the procedure. Vascular access device related variability in requiring written versus verbal consent was found to be rooted in the degree of complexity of the procedure, need for specialized training, and the inherent risk to the patient. Conclusion: These two areas of variability described in current clinical practice require more research and consensus agreement to standardize the practice of obtaining informed consent in vascular access device insertion.

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Kalkers, K., J. M. G. A. Schols, E. W. van Zwet, and R. A. C. Roos. "Dysphagia, Fear of Choking and Preventive Measures in Patients with Huntington’s Disease: The Perspectives of Patients and Caregivers in Long-Term Care." Journal of nutrition, health & aging 26, no. 4 (February 4, 2022): 332–38. http://dx.doi.org/10.1007/s12603-022-1743-6.

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Abstract Objectives To explore the prevalence of dysphagia and fear of choking in patients with Huntington’s disease (HD) as well as preventive measures, both those applied and those not included in managing dysphagia. Also, to investigate related problems encountered by their formal and informal caregivers. Design A multi-center observational cross-sectional study Setting and Participants 158 HD patients, recruited from six Dutch nursing homes specialized in HD, and their formal and informal caregivers Measurements Patients were assessed by means of questionnaires enquiring about dysphagia, fear of choking and measures to manage dysphagia. Also, questionnaires were administered about awareness of dysphagia symptoms, cognition and anxiety. Because we expected individuals with greater care dependency to have a higher severity of dysphagia, we distinguished between a care-independent and a care-dependent group of HD patients. Results In the total group, 90.5% of HD patients had one or more dysphagia symptoms. The prevalence of FoC in HD patients and the formal and informal caregivers’ fears about choking in HD patients was 45.7%, 19.0% and 59.5%, respectively, for care-independent patients and 58.7%, 50.1% and 77.5% for care-dependent patients. The score on the Huntington’s Disease Dysphagia Scale was a predictor for fear of FoC in care-independent patients. Speech-language therapy, supervision during eating and drinking and adaptation of food and drink consistency were the most frequently applied measures to manage dysphagia, a combination was used in most HD patients. Conclusions In HD patients, the prevalence of dysphagia is high and fear of choking is common among both patients and caregivers. A more severe degree of dysphagia is a predictor of FoC in care-independent HD patients. A combination of measures was used to manage dysphagia in most HD patients.

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Adadey, Asa, Robert Giannini, and Lorraine B. Possanza. "Developing an Analytical Pipeline to Classify Patient Safety Event Reports Using Optimized Predictive Algorithms." Methods of Information in Medicine 60, no. 05/06 (October 31, 2021): 147–61. http://dx.doi.org/10.1055/s-0041-1735620.

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Abstract Background Patient safety event reports provide valuable insight into systemic safety issues but deriving insights from these reports requires computational tools to efficiently parse through large volumes of qualitative data. Natural language processing (NLP) combined with predictive learning provides an automated approach to evaluating these data and supporting the work of patient safety analysts. Objectives The objective of this study was to use NLP and machine learning techniques to develop a generalizable, scalable, and reliable approach to classifying event reports for the purpose of driving improvements in the safety and quality of patient care. Methods Datasets for 14 different labels (themes) were vectorized using a bag-of-words, tf-idf, or document embeddings approach and then applied to a series of classification algorithms via a hyperparameter grid search to derive an optimized model. Reports were also analyzed for terms strongly associated with each theme using an adjusted F-score calculation. Results F1 score for each optimized model ranged from 0.951 (“Fall”) to 0.544 (“Environment”). The bag-of-words approach proved optimal for 12 of 14 labels, and the naïve Bayes algorithm performed best for nine labels. Linear support vector machine was demonstrated as optimal for three labels and XGBoost for four of the 14 labels. Labels with more distinctly associated terms performed better than less distinct themes, as shown by a Pearson's correlation coefficient of 0.634. Conclusions We were able to demonstrate an analytical pipeline that broadly applies NLP and predictive modeling to categorize patient safety reports from multiple facilities. This pipeline allows analysts to more rapidly identify and structure information contained in patient safety data, which can enhance the evaluation and the use of this information over time.

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Yeh, Albert C., Bimalangshu R. Dey, Thomas R. Spitzer, Mafruha Akter, Akhil Biswas, Mohiuddin Ahmed Khan, Tasneem Ara, Jannatul Ferdous, Salma Aforse, and Manirul Islam. "Hematopoeitic Stem Cell Transplantation in the Developing World: A Case Study of Dhaka Medical College, Bangladesh." Blood 126, no. 23 (December 3, 2015): 5626. http://dx.doi.org/10.1182/blood.v126.23.5626.5626.

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Abstract INTRODUCTION While hematopoietic stem cell transplantation has become the standard of care for many patients in developed countries, the significant economic investment, infrastructure, and healthcare provider training that are required has prohibited it from being widely adapted. We describe our experience in developing a transplant program at Dhaka Medical College and Hospital (DMCH) in Bangladesh via a partnership with health care providers at the Massachusetts General Hospital (MGH). In 2011, the Minister of Health in Bangladesh became interested in establishing a transplant program at Dhaka Medical College and Hospital (DMCH). DMCH was established in 1946 and has 2300 beds located in two buildings (DMCH-1 with 1800 beds and DMCH-2 with 500 beds). The Bangladesh government and AK Khan Healthcare trust, an interested non-governmental organization (NGO), provided funding for the endeavor. Despite available funding, we faced significant challenges due to limitations in experienced healthcare personnel. METHODS The DMCH transplantation unit was built on the top floor of DMCH-2 and includes 5 patient rooms, an apheresis area, the hematopathology and general hematology labs, and also includes rooms for leukemia patients who are not currently undergoing transplantation. Three hematologists, two apheresis technicians, one lab technician, and 1 pharmacist from DMCH participated in an exchange program during which they each spent 2-3 months at MGH observing transplantation practices. Additionally, several physicians from MGH traveled to Bangladesh and spent several weeks training DMCH physicians in diagnostics, peripheral blood stem cell collection, transfusion medicine, and management of potential complications. The training of Bangladeshi nurses was an extensive undertaking. In brief, 25 nurses from DMCH were selected to take part in a novel enhanced specialized nurses training program (ESPNTP) run by nurses from MGH, which is described in detail in a separate report. This intensive 12-month program included 3 months of training in English language, 3 months of fundamental nursing training, and 6 months of specialized training in HSCT. Nurses continue to train on an ongoing basis via an advanced curriculum taught by MGH nursing staff. RESULTS The first transplant was performed on March 10, 2014. Since that time, DMCH has performed 14 autologous stem cell transplants (9 multiple myeloma, 2 diffuse large B-cell lymphoma, acute myelogenous leukemia, Hodgkin's lymphoma, and peripheral T-cell lymphoma). Baseline characteristics, transplant protocol, and summary of results are shown in (Table 1). All patients engrafted successfully (range 9-16 days). Remission was achieved in all cases, and so far there has only been one case of relapsed disease in a patient with multiple myeloma. Significant complications include mucositis (grade II-IV: 12), febrile neutropenia (8), bacteremia (S. epi: 2; P. aeurginosa: 2, MRSA/K. pneumonia: 1), one case of acinetobacter pneumonia, and one case of cytomegalovirus reactivation. DISCUSSION We attribute a large part of the program's ability to successfully perform its first transplants within 3 years of conception due not only to available financial support but also logistical and personnel support from collaboration with an established transplant center. A major goal of the current program is to ultimately establish a transplant center capable of performing allogeneic stem cell transplantation, as this would enable treatment of patients with thalassemia, the most common genetic disorder in the country that carries a high burden on the economy. We hope that our experience will encourage more partnership and collaboration between transplant programs in developed countries and those countries who currently lack expertise but could benefit from having this therapeutic modality available. Figure 1. Transplant Characteristics Figure 1. Transplant Characteristics Disclosures No relevant conflicts of interest to declare.

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Li, Linyi, Adela Grando, and Abeed Sarker. "A Data-Driven Iterative Approach for Semi-automatically Assessing the Correctness of Medication Value Sets: A Proof of Concept Based on Opioids." Methods of Information in Medicine 60, S 02 (December 2021): e111-e119. http://dx.doi.org/10.1055/s-0041-1740358.

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Abstract Background Value sets are lists of terms (e.g., opioid medication names) and their corresponding codes from standard clinical vocabularies (e.g., RxNorm) created with the intent of supporting health information exchange and research. Value sets are manually-created and often exhibit errors. Objectives The aim of the study is to develop a semi-automatic, data-centric natural language processing (NLP) method to assess medication-related value set correctness and evaluate it on a set of opioid medication value sets. Methods We developed an NLP algorithm that utilizes value sets containing mostly true positives and true negatives to learn lexical patterns associated with the true positives, and then employs these patterns to identify potential errors in unseen value sets. We evaluated the algorithm on a set of opioid medication value sets, using the recall, precision and F1-score metrics. We applied the trained model to assess the correctness of unseen opioid value sets based on recall. To replicate the application of the algorithm in real-world settings, a domain expert manually conducted error analysis to identify potential system and value set errors. Results Thirty-eight value sets were retrieved from the Value Set Authority Center, and six (two opioid, four non-opioid) were used to develop and evaluate the system. Average precision, recall, and F1-score were 0.932, 0.904, and 0.909, respectively on uncorrected value sets; and 0.958, 0.953, and 0.953, respectively after manual correction of the same value sets. On 20 unseen opioid value sets, the algorithm obtained average recall of 0.89. Error analyses revealed that the main sources of system misclassifications were differences in how opioids were coded in the value sets—while the training value sets had generic names mostly, some of the unseen value sets had new trade names and ingredients. Conclusion The proposed approach is data-centric, reusable, customizable, and not resource intensive. It may help domain experts to easily validate value sets.

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Stein, Joel, Barry M. Rodstein, Steven R. Levine, Ken Cheung, Alyse Sicklick, Brian Silver, Robin Hedeman, Abigail Egan, Pamela Borg-Jensen, and Zainab Magdon-Ismail. "Which Road to Recovery?: Factors Influencing Postacute Stroke Discharge Destinations: A Delphi Study." Stroke 53, no. 3 (March 2022): 947–55. http://dx.doi.org/10.1161/strokeaha.121.034815.

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Background and Purpose: The criteria for determining the level of postacute care for patients with stroke are variable and inconsistent. The purpose of this study was to identify key factors influencing the selection of postacute level of care for these patients. Methods: We used a collaborative 4-round Delphi process to achieve a refined list of factors influencing postacute level of care selection. Our Delphi panel of experts consisted of 32 panelists including physicians, physical therapists, occupational therapists, speech-language pathologists, nurses, stroke survivors, administrators, policy experts, and individuals associated with third-party insurance companies. Results: In round 1, 207 factors were proposed, with subsequent discussion resulting in consolidation into 15 factors for consideration. In round 2, 15 factors were ranked with consensus on 10 factors; in round 3,10 factors were ranked with consensus on 9 factors. In round 4, the final round, 9 factors were rated with Likert scores ranging from 5 (most important) to 1(not important). The percentage of panelists who provided a rating of 4 or above were as follows: likelihood to benefit from an active rehabilitation program (97%), need for clinicians with specialized rehabilitation skills (94%), need for active and ongoing medical management and monitoring (84%), ability to tolerate an active rehabilitation program (74%), need for caregiver training to return to the community (48%), family/caregiver support (39%), likelihood to return to community/home (39%), ability to return to physical home environment (32%), and premorbid dementia (16%). Conclusions: This study provides an expert, consensus-based set of key factors to be considered when determining where stroke patients are discharged for postacute care. These factors may be useful in developing a decision support tool for use in clinical settings.

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Singh, Pushpa, Nicola J. Adderley, Jonathan Hazlehurst, Malcolm Price, Abd A. Tahrani, Krishnarajah Nirantharakumar, and Srikanth Bellary. "Prognostic Models for Predicting Remission of Diabetes Following Bariatric Surgery: A Systematic Review and Meta-analysis." Diabetes Care 44, no. 11 (October 18, 2021): 2626–41. http://dx.doi.org/10.2337/dc21-0166.

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BACKGROUND Remission of type 2 diabetes following bariatric surgery is well established, but identifying patients who will go into remission is challenging. PURPOSE To perform a systematic review of currently available diabetes remission prediction models, compare their performance, and evaluate their applicability in clinical settings. DATA SOURCES A comprehensive systematic literature search of MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) was undertaken. The search was restricted to studies published in the last 15 years and in the English language. STUDY SELECTION All studies developing or validating a prediction model for diabetes remission in adults after bariatric surgery were included. DATA EXTRACTION The search identified 4,165 references, of which 38 were included for data extraction. We identified 16 model development and 22 validation studies. DATA SYNTHESIS Of the 16 model development studies, 11 developed scoring systems and 5 proposed logistic regression models. In model development studies, 10 models showed excellent discrimination with area under the receiver operating characteristic curve ≥0.800. Two of these prediction models, ABCD and DiaRem, were widely externally validated in different populations, in a variety of bariatric procedures, and for both short- and long-term diabetes remission. Newer prediction models showed excellent discrimination in test studies, but external validation was limited. LIMITATIONS While the key messages were consistent, a large proportion of the studies were conducted in small cohorts of patients with short duration of follow-up. CONCLUSIONS Among the prediction models identified, the ABCD and DiaRem models were the most widely validated and showed acceptable to excellent discrimination. More studies validating newer models and focusing on long-term diabetes remission are needed.

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Jose, James H., Saul M. Adler, William G. Keyes, and James M. Bradford. "Clinical Information Systems for Intensive Care, Pediatric Critical Care, and Neonatology." Journal of Intensive Care Medicine 12, no. 2 (March 1997): 79–92. http://dx.doi.org/10.1177/088506669701200203.

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Computer information systems are expected to soon take the place of current paper charting practices, and they offer great promise to assist management of the considerable amounts of data encountered in the information-rich environment of intensive care units (ICUs). Efforts to create an electronic medical record (EMR) have been underway for more than two decades, and major national organizations, such as the Institute of Medicine, have issued recommendations on standards. Benefits of an EMR include a legible patient record, enhanced communication, provision of timely reminders and alerts to clinicians, reduction of calculation errors, access to data bases for quality assurance and research, reduced healthcare costs, and improved patient outcomes. Despite these benefits, successful EMR implementations have been confined to a few committed institutions, and expensive failures have occurred. Practitioners of neonatology and pediatric intensive care are likely to have substantial difficulty implementing an EMR to fit their specialized needs because most experience in this area has been gained through care of adult patients, and systems being developed are oriented toward nonpediatric patients. It is therefore important to examine experience thus far with the functional components of an EMR so practitioners will be able to evaluate systems better as they become available. System components discussed include nursing charting facilities, lab reporting, physician order entry, physician progress notes, structured reports, decision support systems, and problem list management. Other concerns discussed include research and quality assurance functions, data access and confidentiality issues, and electronic mail. Maximizing the “structured data” content, as opposed to narrative content of an EMR, is an important priority, and progress on developing a uniform medical language is discussed. An approach to evaluating clinical information systems for use in the ICU is presented; it should assist practitioners of pediatric critical care and neonatology in identifying computer-based charting solutions that are optimal for infants and children, while cooperating with medical center-wide needs for compatibility and a common data base.

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Carota, Antonio, Alain Nicola, Selma Aybek, Patrice Guex, Florence Ghika-Schmid, Alexandre Berney, Guy van Melle, and Julien Bogousslavsky. "ACUTE Vs LATE POST-STROKE MOOD DISORDERS." Stroke 32, suppl_1 (January 2001): 366. http://dx.doi.org/10.1161/str.32.suppl_1.366-a.

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P149 Background and Methods: We studied emotional behaviors and mood disorders in 165 consecutive patients with acute first-ever hemispheral stroke. In all patients, a specifically designed observational scale for behavioral appraisal (Emotional Behaviour Index Form or EBIF) was assessed daily for four days, starting within 48 hours. The EBIF, which is independent of language abilities, includes 38 rated items, divided in the categories of overt sadness, passivity, aggressiveness, indifference, disinhibition, denial and adaptation. Prospective evaluation, including a standardized neuropsychological battery, Hamilton depression and anxiety rating scales, Rankin scale, Barthel index, and psychiatric interview with DSM-IV diagnosis , was also performed 3 and 12 months after stroke. RESULTS: In the acute phase, observed depressive behaviors and mood verbal scores were not significantly associated with lesion side. However, in patients with left hemispheral lesion, we found a significant relation between aphasia, overt sadness and passivity (p<0.04), while in patients with right lesion, anosognosia was associated with both indifference and depressive behaviors (p<0.04). Only aphasic patients showed catastrophic reactions, and only patients with anosognosia showed extreme indifference reactions. At 3 and 12 months, prevalence of depression was respectively 35% (22/62) and 30% (18/51), while prevalence of anxiety was 33% (16/48) and 27% (12/46). At 12 months, major depression (HDRS>18) was found in 2 patients (3%). Left hemispheral (p=0.05) and subcortical lesions (38% p=0.06) were associated with delayed, but not acute, mood disorders. Anxiety (p=0.05), but not depression (p=0.8), was related to poorer functional impairment (dependency). CONCLUSIONS: In acute stroke, observed emotional behaviors are related to specific cognitive impairment (i.e. aphasia and anosognosia), but not to lesion site and side. Acute mood changes are not a strong indicator of delayed post-stroke depression. Post-stroke depression, which is preferentially associated with left or subcortical involvement, may have a different origin from post-stroke anxiety.

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Menezes, Harlon França de, Alessandra Conceição Leite Funchal Camacho, Silvia Maria de Sá Basílio Lins, Tatiane da Silva Campos, Fillipe Rangel Lima, Andressa Kaline Ferreira Araújo Jales, and Richardson Augusto Rosendo da Silva. "Terms of specialized nursing language for chronic renal patients undergoing conservative treatment." Revista Brasileira de Enfermagem 73, suppl 6 (2020). http://dx.doi.org/10.1590/0034-7167-2019-0820.

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ABSTRACT Objectives: to validate the terms of the specialized nursing language used in the care of people with chronic kidney disease undergoing conservative treatment identified in the literature by mapping them with terms of the International Classification for Nursing Practice, version 2019, and representing them by means of a mandala. Methods: descriptive, documentary and methodological study. The terms were collected in 53 scientific articles, standardized and mapped with the terminology. The validation was performed by six nurses through a focus group. The Content Validity Index was used and terms with a value ≥ 0.80 were validated. Results: the normalization resulted in 957 relevant terms, of which 499 were constant and 458 not included in the terminology. Terms were validated when Content Validity Index was between 0.86 and 1.0. Conclusions: the study allowed the validation of terms that will contribute to unify the professional language of nursing in the care of people with chronic kidney disease.

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Clares, Jorge Wilker Bezerra, Bruna Karen Cavalcante Fernandes, Maria Vilaní Cavalcante Guedes, and Maria Célia de Freitas. "Specialized nursing terminology for the care of people with spinal cord injury." Revista da Escola de Enfermagem da USP 53 (2019). http://dx.doi.org/10.1590/s1980-220x2018014203445.

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ABSTRACT Objective: To develop a bank of terms of specialized nursing language based on the International Classification for Nursing Practice (ICNP®) for the care of the person with spinal cord injury. Method: Descriptive, quantitative study guided by the guidelines of terminological studies. Terms were extracted from an official document of the Ministry of Health through use of a computer tool, and were standardized and mapped with the ICNP® Version 2015. Results: We identified 446 relevant terms, of which 265 were equal, 68 were similar, 23 were more comprehensive, 66 were more restricted, and 24 were not in concordance with terms of the ICNP®. Terms classified as equal and similar were considered as constant. Thus, the bank of terms consisted of 333 constant terms and 113 not contained in the classification. Terms included in the Focus, Action, Means and Location axes predominated. Conclusion: The bank of terms will contribute to the construction of the ICNP® terminology subset for the care of people with spinal cord injury.

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Koleck, Theresa A., and Maichou Lor. "Do Limited English Proficiency and Language Moderate the Relationship Between Mental Health and Pain?" Pain Management Nursing, November 2021. http://dx.doi.org/10.1016/j.pmn.2021.10.005.

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Umar, Muhammad, and Misbah Marryam. "Interprofessional Conflicts in Health: Major barrier to Quality Health Care Practice." Pakistan Journal of Medical and Health Sciences 16, no. 2 (February 26, 2022). http://dx.doi.org/10.53350/pjmhs221621193.

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Interprofessional term has a wide perspective and it includes all professionals from different specialized health departments like nursing, occupational therapy, physical therapy, speech and language pathology, social work, and other health professionals besides the physicians with different specialties1. When different professionals work in collaboration for providing quality care to the patient, it is the patient who is benefited the most; a major goal of all the health care professionals2. But unfortunately whenever health professionals work together as a team, conflict occurs. There are sometimes unnecessary arguments between different professionals for taking the lead.

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Lor, Maichou, and Theresa A. Koleck. "Patient Race, Ethnicity, Language, and Pain Severity in Primary Care: A Retrospective Electronic Health Record Study." Pain Management Nursing, March 2022. http://dx.doi.org/10.1016/j.pmn.2022.01.007.

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Ware, James, Elizabeth Mil, Geri Sanfilipo, Helene Townsend, Kristine Leatherman, Scott Littig, Cheri Weber, and Sandra J. Stein. "Abstract 2128: Development and Impementation of a Nursing Swallow Screen." Stroke 43, suppl_1 (February 2012). http://dx.doi.org/10.1161/str.43.suppl_1.a2128.

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Development and Implementation of a Nursing Swallow Screen Timely and safe administration of medications and PO intake for patients is essential. The goal of Capital Health (CH) was to develop and implement a standard swallowing screen completed by nursing for all patients admitted to a comprehensive stroke center with the confirmed or potential diagnosis of CVA or TIA. A review of literature and communication with other hospitals and the American Speech Language and Hearing Association uncovered a limited amount of information about swallowing screens. The CH Swallowing Screen was designed by the Stroke Team using information from other hospitals and input from the Nursing and Speech Pathology Departments at CH. The Swallowing Screen, comprised of 3 distinct sections, was designed to be sensitive to aspiration and determine the safety of gross swallowing skills or the need for a complete swallowing assessment by a certified Speech Language Pathologist (SLP). An added benefit of this screen was more rapid access to oral medications and PO intake. After screen development and nursing staff education, the form became a standard part of the admission process for all patients admitted to CH with a confirmed or potential diagnosis of CVA/Stroke or TIA. The following variables were selected as key components of the program: - If the patient passed the Swallowing Screen but was referred for a full evaluation, were the findings of the full assessment in agreement with those of the screening? - If a patient failed the Swallowing Screen, was s/he referred for a full evaluation by the SLP? - If the patient passed the Swallowing Screen, was s/he then placed on a diet? Data was collected from January 2008 to December 2010. Results indicate that the CH Swallowing Screen is being used both accurately and effectively. Agreement between the initial screening and full assessment (variable #1) improved from 91% in 2008 to 100% in 2010. During the same time period, effectiveness of the process (variable #2 and #3) improved from 83-98% and 87% to 92% respectively. Patients who pass the screen are now receiving oral medications and an oral diet in a more timely fashion. Patients who do not pass the screen are being referred to the SLP for a full assessment, while maintaining NPO status until that assessment is completed. Finally, the nursing staff has demonstrated proficiency to assess gross swallowing skills, as evidenced by agreement when patients who passed the screen were also evaluated by the SLP and no diet modifications were necessary. The development and implementation of the swallowing screen at CH has enhanced the timeliness and quality of treatment provided to CVA/stroke patients. Finally, use of this screen has fostered increased awareness and facilitated collaboration between Nursing and the Speech Pathology Department, thus improving the effectiveness of patient care and becoming part of the culture at CH.

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Delespierre, T., and A. Pierre. "COVID vaccination efficiency in nursing homes: from nursing home-centred to resident-centred." European Journal of Public Health 31, Supplement_3 (October 1, 2021). http://dx.doi.org/10.1093/eurpub/ckab164.412.

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Abstract Background Korian® group is specialized in care and support for fragile people. Its data warehouse manages 304 French nursing homes (NH). The transmissions' table (TT), daily-fed by caregivers, contains key data about residents' care and health. Following GDPR rules, we could still build residents' life trajectories and detail all the residents' health events using indexes. In the past, we designed syndromes such as falls, flu, and last year, COVID with the standard query language. Now we want to combine ‘hard' data such as sociodemographic profiles and COVID vaccines with ‘soft' textual data such as COVID and emergency calls syndromes to get a better residents vaccine monitoring. Methods First, we selected all residents with at least one transmission, from December 21, to January 11, just before the COVID vaccination start, from 34 NH chosen for their variety of size and geographic location. We followed them for eleven weeks starting January 4, 2021. We selected the residents' age, sex, autonomy level, comorbidities and risks and then, vaccinations (0, 1 or 2), syndromes, hospitalizations and deaths date events. We searched for sample data inconsistencies by filtering COVID textual information in the TT and comparing it with the vaccination table. We described the sample according to the NH size, and then according to the number of vaccinations. Finally, we assessed COVID syndromes, falls, hospitalizations, emergency calls and deaths according to vaccinations followed by Poisson and logistic regressions. Results We built a 2,051 residents cohort with 1,401 vaccinated at least once and 650 not yet vaccinated. Data corrections then added 60 vaccinations. Residents in big structures were more masculine (72,9% vs 75,1%), more vaccinated (77,2% vs 67,2%), younger (86,7 vs 87,5), more autonomous (2,6, vs 2,4). Vaccination rates were also greater among those with comorbidities and risks. Conclusions By focusing on the TT resident's health events, we improved health modelization Key messages By using all the COVID information available in the database, we were able to show both, the beneficial effect of vaccination and the nefarious effect of COVID in a same model with machine learning. Aggregating hard categorical and numerical data with soft textual information about the resident’s health events, dates included, gives a precise and complete resident’s profile and health trajectory.

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Rostanski, Sara K., Olajide Williams, Randolph S. Marshall, Joshua Stillman, and Joshua Z. Willey. "Abstract W P268: Language Discordance Between Patient and Treating Physician Does Not Delay Time to Thrombolysis." Stroke 46, suppl_1 (February 2015). http://dx.doi.org/10.1161/str.46.suppl_1.wp268.

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Introduction: Shorter door-to-needle time (DNT) is associated with better outcomes in acute ischemic stroke. Reducing door-to-CT time is a major focus of national quality improvement initiatives designed to reduce DNT, however time from CT-to-tPA administration has received far less attention. Recent data suggests that the CT-to-tPA interval contributes to significant delays in DNT. We hypothesized that language barriers between patients and treating neurologists would lead to longer CT-to-tPA times at a single stroke center serving a large Spanish-speaking population. Methods: We retrospectively reviewed the electronic medical record (EMR) on all patients who received IV-tPA in the emergency department over 2.5 years (July 2011 to December 2013). Patient’s primary language was obtained from the EMR; language fluency of treating neurologists was self-reported via standardized questionnaire. We compared baseline characteristics and relevant time intervals between encounters where the treating neurologist and patient spoke the same language (concordant group) versus those where they spoke a different language (discordant group). Means were compared with t-tests, medians with Mann-Whitney U tests, and dichotomized variables with Fisher exact tests. Results: A total of 199 patients received IV-tPA during the study period. English was the primary language for 110, Spanish for 83, and other languages for 6; of these, 120 cases were classified as concordant and 79 as discordant. There were no significant differences in mean age (67 vs. 69, p=0.3), male sex (37.5% vs. 24.1%, p=0.06), and median NIHSS (7 vs. 6, p=0.9) between concordant and discordant groups. We found no differences between median onset-to-arrival (68 vs. 71, p=0.3), door-to-CT (25 vs. 25, p=0.8), CT-to-tPA (33 vs. 29, p=0.2) and DNT (61 vs. 60, p=0.3) in minutes. There was a trend towards a greater proportion of patients with CT-to-tPA time under 30 minutes in the discordant group (52% vs. 38%, p=0.08). Conclusion: At our institution, language discordancy did not contribute to delays in CT-to-tPA nor overall DNT. CT-to-tPA time represents a largely unexplored contributor to overall delays in DNT that warrants further investigation.

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Sanossian, Nerses, Sidney Starkman, Latisha K. Ali, Lucas Restrepo, Miguel Valdes-Sueiras, David S. Liebeskind, Fiona Chatfield, T. Keta Hodgson, Samantha Cherin, and Jeffrey L. Saver. "Abstract 129: Enrolling Spanish-Speaking Subjects into Prehospital Research: The FAST-MAG Spanish Line Experience." Stroke 44, suppl_1 (February 2013). http://dx.doi.org/10.1161/str.44.suppl_1.a129.

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Background: Clinical trials should enroll diverse subjects who are representative of the general population. Enrollment in other languages requires substantial effort, including language-specific consent forms and physician-investigators fluent in language of consent. We describe the yield of a dedicated 24-hour Spanish prehospital research enrollment line. Methods: FAST-MAG is a phase 3, NIH-funded, randomized, placebo-control study of prehospital magnesium sulfate within 2 hours of stroke onset. The study is being conducted in Los Angeles and Orange Counties, home to 12.9 million people of whom just under half (44.8%) identify as Hispanic or Latino. Each of the 353 study ambulances carries: 1) 8 consent forms, 4 in English and 4 in Spanish, for the vehicle’s 4 most common destination hospitals; and 2) a cell phone with a quick-dial button for English and Spanish-speaking physician-investigator. Results: Data was available on 854 consecutive enrolments of whom 141 (17%) were via the Spanish and 713 (83%) via the English line. Patients enrolled via the Spanish line were younger (65 vs 70 years, p<0.001), less often women (33% vs. 43%, p=0.040), more often self-identifying as Latino (98% vs 16%, p<0.001), and more likely to be of White race vs other (98% vs 72%, p,0.001). Spanish-line enrollments trended to more severe stroke deficits (NIHSS 13.5 vs 11.7, p=0.08), were far more likely to have intracerebral hemorrhage on initial imaging (35% vs. 20%, p<0.001) and to have higher pre-hospital blood pressure (166/94 vs. 159/90, p=0.012). Spanish-line enrolments were more likely to be diabetic (36% vs. 23%, p=0.003), and less likely to have atrial fibrillation (16% vs 27%, p=0.012). Times from paramedic arrival to start of study infusion were only slightly longer in Spanish-line patients (24.6 vs 22.9 minutes, p=0.045). Conclusions: The FAST-MAG Spanish language enrolling line has accounted for 17% of enrollments and has enrolled a group of subjects distinct from the standard, English language enrolling line. The Spanish language enrollment process has doubled the number of Hispanic/Latino patients enrolled in the trial, allowing the study to more closely reflect the population of Southern California.

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Deng, Xiaofeng, Hu Yin, Yan Zhang, Dong Zhang, Shuo Wang, Yong Cao, Maogui Li, Bo Wang, Fangrong Zong, and Jizong Zhao. "Impairment and Plasticity of Language-Related White Matter in Patients With Brain Arteriovenous Malformations." Stroke, December 2021. http://dx.doi.org/10.1161/strokeaha.121.035506.

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Background and Purpose: Language dysfunction is rarely seen in patients with unruptured brain arteriovenous malformation (AVM) albeit the AVM nidus involving language areas, which provides a unique disease model to study language reorganization. The objective of this study was to investigate the impairment and reorganization patterns and characteristics of language-related white matter in AVMs located at different brain areas. Methods: Thirty-three patients with AVMs involving language areas were prospectively enrolled. Patients were categorized into 3 groups according to the lesion locations: the frontal (14 patients), temporal (15 patients), and parietal groups (4 patients). Thirty age- and sex-matched healthy controls were enrolled as comparison. All participants underwent diffusion tensor imaging scans, and automated fiber quantification method was applied to quantitatively study the difference of segmented language-related white matter connectivity between 3 AVM groups and control group. Results: Language functions were normal in all subjects according to Western Aphasia Battery test. In the frontal group, fractional anisotropy (FA) value decreased in the left arcuate fascicle and increased in left superior longitudinal fasciculus and uncinate fascicle; in the temporal group, FA values decreased in left inferior fronto-occipital fascicle and inferior longitudinal fascicle and increased in right anterior thalamic radiation and uncinate fascicle; in the parietal group, FA values decreased in left arcuate fascicle and inferior longitudinal fascicle and increased in bilateral anterior thalamic radiations and uncinate fascicles and right inferior fronto-occipital fascicle. In fascicles with decreased FA values, the increase of radial diffusivity was common, and fascicles with increased FA values usually presented along with increased axial diffusivity values. Conclusions: Remodeling of language-related white matter occurs when traditional language areas are involved by AVM nidus, and its reorganization patterns vary with locations of AVM nidus. Fascicle impairment is mainly caused by the myelin deficits, and its plasticity may be dominated by the axon remodeling procedure.

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Dedhia, Priya H., Kallie Chen, Yiqiang Song, Eric LaRose, Joseph R. Imbus, Peggy L. Peissig, Eneida A. Mendonca, and David F. Schneider. "Ambiguous and Incomplete: Natural Language Processing Reveals Problematic Reporting Styles in Thyroid Ultrasound Reports." Methods of Information in Medicine, January 6, 2022. http://dx.doi.org/10.1055/s-0041-1740493.

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Abstract Objective Natural language processing (NLP) systems convert unstructured text into analyzable data. Here, we describe the performance measures of NLP to capture granular details on nodules from thyroid ultrasound (US) reports and reveal critical issues with reporting language. Methods We iteratively developed NLP tools using clinical Text Analysis and Knowledge Extraction System (cTAKES) and thyroid US reports from 2007 to 2013. We incorporated nine nodule features for NLP extraction. Next, we evaluated the precision, recall, and accuracy of our NLP tools using a separate set of US reports from an academic medical center (A) and a regional health care system (B) during the same period. Two physicians manually annotated each test-set report. A third physician then adjudicated discrepancies. The adjudicated “gold standard” was then used to evaluate NLP performance on the test-set. Results A total of 243 thyroid US reports contained 6,405 data elements. Inter-annotator agreement for all elements was 91.3%. Compared with the gold standard, overall recall of the NLP tool was 90%. NLP recall for thyroid lobe or isthmus characteristics was: laterality 96% and size 95%. NLP accuracy for nodule characteristics was: laterality 92%, size 92%, calcifications 76%, vascularity 65%, echogenicity 62%, contents 76%, and borders 40%. NLP recall for presence or absence of lymphadenopathy was 61%. Reporting style accounted for 18% errors. For example, the word “heterogeneous” interchangeably referred to nodule contents or echogenicity. While nodule dimensions and laterality were often described, US reports only described contents, echogenicity, vascularity, calcifications, borders, and lymphadenopathy, 46, 41, 17, 15, 9, and 41% of the time, respectively. Most nodule characteristics were equally likely to be described at hospital A compared with hospital B. Conclusions NLP can automate extraction of critical information from thyroid US reports. However, ambiguous and incomplete reporting language hinders performance of NLP systems regardless of institutional setting. Standardized or synoptic thyroid US reports could improve NLP performance.

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Karim, Nurose, Suzanne Stone, Amber Salter, Mark Johnson, and Erica Jones. "Abstract TP154: Impact Of Non-English Primary Language On Mechanical Thrombectomy Outcomes." Stroke 53, Suppl_1 (February 2022). http://dx.doi.org/10.1161/str.53.suppl_1.tp154.

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Background: Delays in acute treatment of ischemic stroke have been associated with worse outcomes. Ischemic stroke patients with non-English primary language have not been shown to have delay in receiving thrombolytic therapy. We assessed whether non-English primary language was associated with functional outcomes in patients receiving mechanical thrombectomy (MT). Method: This is a retrospective study of our MT database from two comprehensive stroke centers from January 2016 to May 2021. Primary endpoints were discharge and 90-day modified Rankin Scale (mRS) 0-2. Descriptive statistics were used to summarize the demographic and clinical characteristics, means and standard deviation or median and the 25th and 75th percentiles for continuous variables and frequency and percentages for categorical variables. Differences between primary English speaking (ES) and primary non-English speaking (nES) patients were evaluated using an analysis of variance (ANOVA), Kruskal-Wallis and chi square test. Multivariable logistic regression was used to evaluate ES vs nES patients adjusted for age, hemoglobin A1c, tPA treatment, and TICI 2B/3 reperfusion which were selected a priori. The significance level was set at 0.05. Result: We identified 276 patients receiving MT with 83% ES and 17% nES patients. nES patients had higher mean hemoglobin A1c, were less likely to have insurance, and more likely to have symptomatic intracranial hemorrhage compared to ES patients (Table). No differences were observed in discharge or 90-day mRS in the univariate and multivariable logistic regression. We observed a nominally longer median ED arrival to groin puncture time in the nES group. Conclusion: There was no difference between nES and ES in good functional outcome rates in patients treated with MT. The trend toward longer ED length of stay in non-English language patients warrants additional study to identify specific causes of delay that may be targeted for intervention.

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Dippel, Diederik W., Yvette Crijnen, Femke Nouwens, Hester F. Lingsma, Lonneke de Lau, Evy Visch, Mieke van de Sandt-Koenderman, et al. "Abstract WP22: Differential Effect of Intra-arterial Treatment for Acute Ischemic Stroke on Motor versus Language Deficit. A Post-hoc Mr Clean Subgroup Analysis." Stroke 47, suppl_1 (February 2016). http://dx.doi.org/10.1161/str.47.suppl_1.wp22.

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Introduction: Clinical observations suggest that language deficits in acute ischemic stroke do not respond as rapidly to reperfusion therapy as motor deficits. We tested for a differential effect of intra-arterial treatment with retrievable stents on recovery from aphasia and upper limb paresis in MR CLEAN. Hypothesis: The early effect of IAT on recovery from language and motor deficits is similar in size. Methods: All patients with aphasia who were randomized in MR CLEAN were included. Primary outcomes were the score on the NIH stroke scale item for upper extremity paresis contralateral to the affected hemisphere, and the score for language, at 24 hours and 5-7 days after treatment. We estimated the effect of IAT on the shift on these item scores and tested for a differential effect of IAT on language versus motor recovery, by introducing a multiplicative term in a multilevel multivariable ordinal logistic regression model. Results: In total, 288 patients had an aphasia score of 1 or more. Of these 126 (44%) were assigned to IAT and 162 (56%) to no IAT. The common odds ratio (cOR) for improvement in language and motor score at 24 hours was 1.68 (1.06 to 2.67) and 2.51 (1.57 to 4.03) (p=0.006). At 5-7 days the cOR was 1.87 (1.18 to 2.98) for aphasia score and 2.41 (1.47 to 3.95) for motor deficit (p=0.011). The proportion of patients with good recovery at 5-7 days was similar (Figure). Conclusion: The early effect of IAT on language deficit is smaller than the effect on motor deficit, but final recovery after 1 week is similar.

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Leung, Kai, Nomazulu Dlamini, Robyn Westmacott, and Monika Molnar. "Abstract WP173: Children’s Post-Stroke Expressive Language Outcomes Are Affected By Bilingual Exposure." Stroke 53, Suppl_1 (February 2022). http://dx.doi.org/10.1161/str.53.suppl_1.wp173.

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Introduction: Approximately 2/3 of children face neurological deficits following arterial ischemic stroke (AIS). In neurotypical development, bilingualism is thought to confer certain linguistic and cognitive advantages. However, research on whether this may affect development in bilingual pediatric stroke patients is scarce. Objectives: To evaluate the effects of bilingual vs. monolingual exposure on language and cognitive outcomes in children following arterial ischemic stroke across two studies: (1) large-scale group analysis using the Pediatric Stroke Outcome Measure (PSOM); (2) exploratory case studies using neuropsychological measures. Methods: An institutional stroke registry and chart review were used to gather patient and stroke data, including the Pediatric Stroke Outcome Measure (PSOM) and standardized neuropsychological measures performed at several timepoints post-stroke in children with AIS. In Study 1, growth curve modeling based on PSOM subscales, predicted by age at stroke groups, language groups and their interactions was used. In Study 2, comparative case studies were conducted with a monolingual-bilingual pair, aged 7 and 8 at stroke onset. Results: In Study 1, 237 patients were identified (44%, bilingual patients). Patients were stratified based on age at stroke onset i.e. neonatal (<28 days of life), first-year (28 days-12 months) and childhood (13 months - 18 years). On the PSOM’s language expression subscale, an interaction revealed better post-stroke outcomes among bilingual children aged 1-12 months at stroke (beta = -0.32, t =-2.33, p = 0.02). In Study 2, the bilingual’s performance on neuropsychological assessments corroborated findings of Study 1, favoring a recovery of expressive language. Conclusion: Overall, we found no negative consequences of a bilingual environment on post-stroke outcomes. Additionally, it is possible that bilingualism has a faciliatory effect on expressive language development post-stroke. Further research should evaluate linguistic advantage effects prospectively in bilingual children with stroke and a control group.

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Panny, Aloksagar, Harshad Hegde, Ingrid Glurich, Frank A. Scannapieco, Jayanth G. Vedre, Jeffrey J. VanWormer, Jeffrey Miecznikowski, and Amit Acharya. "A methodological approach to validate pneumonia encounters from radiology reports using Natural Language Processing (NLP)." Methods of Information in Medicine, April 5, 2022. http://dx.doi.org/10.1055/a-1817-7008.

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Introduction: Pneumonia is caused by microbes that establish an infectious process in the lungs. The gold standard for pneumonia diagnosis is radiologist-documented pneumonia-related features in radiology notes that are captured in electronic health records in an unstructured format. Objective: The study objective was to develop a methodological approach for assessing validity of a pneumonia diagnosis based on identifying presence or absence of key radiographic features in radiology reports with subsequent rendering of diagnostic decisions into a structured format. Methods: A pneumonia-specific Natural Language Processing (NLP) pipeline was strategically developed applying cTAKES to validate pneumonia diagnoses following development of a pneumonia feature-specific lexicon. Radiographic reports of study-eligible subjects identified by International Classification of Diseases (ICD) codes were parsed through the NLP pipeline. Classification rules were developed to assign each pneumonia episode into one of three categories: “positive”, “negative” or “not classified: requires manual review” based on tagged concepts that support or refute diagnostic codes. Results: A total of 91,998 pneumonia episodes diagnosed in 65,904 patients were retrieved retrospectively. Approximately 89% (81,707/91,998) of the total pneumonia episodes were documented by 225,893 chest x-ray reports. NLP classified and validated 33% (26,800/81,707) of pneumonia episodes classified as ‘Pneumonia-positive’, 19% as (15401/81,707) as ‘Pneumonia-negative’ and 48% (39,209/81,707) as ‘‘episode classification pending further manual review’. NLP pipeline performance metrics included accuracy (76.3%), sensitivity (88%), and specificity (75%). Conclusion: The pneumonia-specific NLP pipeline exhibited good performance comparable to other pneumonia-specific NLP systems developed to date.

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Scharf, Anne-Carina, Janine Gronewold, Olga Todica, Christoph Moenninghoff, Thorsten R. Doeppner, Bianca de Haan, Claudio L. A. Bassetti, and Dirk M. Hermann. "Evolution of Neuropsychological Deficits in First-Ever Isolated Ischemic Thalamic Stroke and Their Association With Stroke Topography: A Case-Control Study." Stroke, March 9, 2022. http://dx.doi.org/10.1161/strokeaha.121.037750.

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Background: The thalamus plays an essential role in cognition. Cognitive deficits have to date mostly been studied retrospectively in chronic thalamic stroke in small cohorts. Studies prospectively evaluating the evolution of cognitive deficits and their association with thalamic stroke topography are lacking. This knowledge is relevant for targeted patient diagnostics and rehabilitation. Methods: Thirty-seven patients (57.5±17.5 [mean±SD] years, 57% men) with first-ever acute isolated ischemic stroke covering the anterior (n=5), paramedian (n=12), or inferolateral (n=20) thalamus and 37 in-patient controls without stroke with similar vascular risk factors matched for age and sex were prospectively studied. Cognition was evaluated using predefined tests at 1, 6, 12, and 24 months. Voxel-based lesion-symptom mapping was used to determine associations between neuropsychological deficits and stroke topography. Results: Patients with anterior thalamic stroke revealed severe deficits in verbal memory (median T score [Q1–Q3]: 39.1 [36.1–44.1]), language (31.8 [31.0–43.8]), and executive functions (43.8 [35.5–48.1]) at 1 month compared with controls (verbal memory: 48.5 [43.6–61.0], language: 55.7 [42.3–61.1], executive functions: 51.3 [50.1–56.8]). Patients with paramedian thalamic stroke showed moderate language (44.7 [42.8–55.9]) and executive (49.5 [44.3–55.1]) deficits and no verbal memory deficits (48.1 [42.5–54.7]) at 1 month compared with controls (59.0 [47.0–64.5]; 59.6 [51.1–61.3]; 52.5 [44.2–55.3]). The language and executive deficits in paramedian thalamic stroke patients almost completely recovered during follow-up. Intriguingly, significant deficits in verbal memory (44.7 [41.5–51.9]), language (47.5 [41.8–54.1]), and executive functions (48.2 [46.2–59.7]) were found in inferolateral thalamic stroke patients at 1 month compared with controls (50.5 [46.7–59.9]; 57.0 [51.2–62.9]; 57.4 [51.2–60.7]). Language, but not executive deficits persisted during follow-up. Voxel-based lesion-symptom mapping revealed an association of verbal memory deficits with anterior thalamus lesions and an association of non-verbal memory, language, and executive deficits with lesions at the anterior/paramedian/inferolateral border. Conclusions: All 3 stroke topographies exhibited significant deficits in diverse cognitive domains, which recovered to a different degree depending on the stroke localization. Our study emphasizes the need for comprehensive neuropsychological diagnostics to secure adequate patient rehabilitation.

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