Combining supervised and unsupervised named entity recognition to detect psychosocial risk factors in occupational health checks.

INTRODUCTION: In occupational health checks the information about psychosocial risk factors, which influence work ability, is documented in free text. Early detection of psychosocial risk factors helps occupational health care to choose the right and targeted interventions to maintain work capacity. In this study the aim was to evaluate if we can automate the recognition of these psychosocial risk factors in occupational health check electronic records with natural language processing (NLP). MATERIALS AND METHODS: We compared supervised and unsupervised named entity recognition (NER) to detect psychosocial risk factors from health checks' documentation. Occupational health nurses have done these records. RESULTS: Both methods found over 60% of psychosocial risk factors from the records. However, the combination of BERT-NER (supervised NER) and QExp (query expansion/paraphrasing) seems to be more suitable. In both methods the most (correct) risk factors were found in the work environment and equipment category. CONCLUSION: This study showed that it was possible to detect risk factors automatically from free-text documentation of health checks. It is possible to develop a text mining tool to automate the detection of psychosocial risk factors at an early stage.

Towards automated detection of psychosocial risk factors with text mining.

BACKGROUND: Psychosocial risk factors influence early retirement and absence from work. Health checks by occupational health nurses (OHNs) may prevent deterioration of work ability. Health checks are documented electronically mostly as free text, and therefore the effect of psychological risk factors on working capacity is difficult to detect. AIMS: To evaluate the potential of text mining for automated early detection of psychosocial risk factors by examining health check free-text documentation, which may indicate medical statements recommending early retirement, prolonged sick leave or rehabilitation. Psychosocial risk factors were extracted from OHN documentation in a nationwide occupational health care registry. METHODS: Analysis of health check documentation and medical statements regarding pension, sick leave and rehabilitation. Annotations of 13 psychosocial factors based on the Prima-EF standard (PAS 1010) were used with a combination of unsupervised machine learning, a document search engine and manual filtering. RESULTS: Health check documentation was analysed for 7078 employees. In 83% of their health checks, psychosocial risk factors were mentioned. All of these occurred more frequently in the group that received medical statements for pension, rehabilitation or sick leave than the group that did not receive medical statement. Documentation of career development and work control indicated future loss of work ability. CONCLUSIONS: This study showed that it was possible to detect risk factors for sick leave, rehabilitation and pension from free-text documentation of health checks. It is suggested to develop a text mining tool to automate the detection of psychosocial risk factors at an early stage.

Acute kidney injury with renal replacement therapy in trauma patients.

BACKGROUND: Acute kidney injury (AKI) with renal replacement therapy (RRT) is rare in trauma patients. The primary aim of the study was to assess incidence, mortality and chronic RRT dependency in this patient group. METHODS: Adult trauma patients with AKI receiving RRT at a regional trauma referral center over a 12-year period were retrospectively reviewed. RESULTS: Population-based incidence of post-traumatic AKI with RRT was 1.8 persons per million inhabitants per year (p.p.m./year) [95% confidence the interval (CI) 1.5-2.1 p.p.m./year]. In trauma patients admitted to hospital, incidence was 0.5 per thousand (95% CI 0.3-0.7 per thousand) of those treated in intensive care unit (ICU), it was 8.3% (95% CI 5.9-10.8%). The median age was 46 years. Odds ratio (OR) for post-traumatic AKI requiring RRT was higher in males than in females in general population (OR 5.6, 95% CI 2.2-14.0), and in trauma patients admitted to hospital (OR 4.4, 95% CI 1.9-10.3) and ICU (OR 4.5, 95% CI 1.9-10.7). The in-hospital mortality rate was 24% (95% CI 11-37%), 3-month mortality 36% (95% CI 21-51%) and 1-year mortality 40% (95% CI 25-55%). Age was a risk factor for death after 1 year, with 57% (95% CI 7-109%) increased risk for each 10 years added. None of the survivors was dialysis-dependent 3 months or 1 year after trauma. CONCLUSION: AKI in trauma patients requiring RRT was rare in this single-center study. More males than females were affected. Mortality was modest, and renal recovery was excellent as none of the survivors became dependent on chronic RRT.

[Activity registration in intensive care units]. / Virksomhetsregistrering ved intensivavdelinger.

Intensive care treatment is expensive and its capacity is limited. The population of elderly patients with greater need for intensive care increases. It has become more important to evaluate the use of intensive care resources and to compare it with the results of treatment. Diagnoses do not provide a satisfactory description of the stay in the intensive care unit. Scoring systems for severity of illness and for resource needs are therefore of great value. The Norwegian Board of Health has requested all intensive care units in Norway to describe their activities by scoring systems for severity of illness, SAPS II (Simplified Acute Physiology Score II) and for use of resources NEMS (Nine Equivalents of Nursing Manpower Use Score). The systems are generally well recognised, easy to learn and not time-consuming. Through SAPS II and NEMS it is possible to compare results of treatment and use of resources across intensive care units or against a standard.

[Experiences with scoring systems SAPS II and NEMS for registration of activities in an intensive care unit]. / Erfaringer med bruk av skåringssystemene SAPS II og NEMS i virksomhetsregistrering i en intensivavdeling.

BACKGROUND: Intensive care is highly expensive, hence the requirement of efficient use of resources calls for evaluation of the severity of disease or injury for each individual patient, so that management may be optimised. MATERIAL AND METHODS: At Ullevaal University Hospital, two different scoring systems have been used since 1996: SAPS II (Simplified Acute Physiology Score) for severity of illness and NEMS (Nine Equivalents of Nursing Manpower Use Score) for assessment of resource utilisation. RESULTS: A significant relationship between severity of illness and mortality was found. Length of stay in ICU correlated with increasing SAPS II score in the range 0 to 50, but at higher scores no relationship was found. Patients with trauma and cardiovascular surgical patients used most of the resources. 79% of total NEMS score consisted of vital signs monitoring, intravenous drug medication and mechanical ventilation of the patients. INTERPRETATION: SAPS II and NEMS scoring systems provide useful information needed in the assessment of patient care in the ICU and are helpful in the documentation of financial and medical resource needs.

Patient satisfaction and ward atmosphere during a crisis in an open psychiatric ward.

BACKGROUND: There is great need for useful indicators of quality of care for inpatient psychiatric treatment. The study examines whether patient satisfaction and ward atmosphere can be used as a means of evaluating an assumed decline in quality of care during a crisis in an open psychiatric ward. METHODS: Twice a year for 2 years ten patients filled out a standardized patient satisfaction questionnaire developed by the Swedish Institute for Health Services Development (SPRI) on their day of departure. At the same time all the patients in the ward evaluated the ward atmosphere using the Ward Atmosphere Scale (WAS). In the third study period the ward went through a crisis where quality of care was expected to be lower. RESULTS: The SPRI questionnaire confirmed the decline in patients' perceived quality of care on six of 41 questions, WAS was markedly lower on five of ten subscales. CONCLUSIONS: Both WAS and the SPRI questionnaire gave useful information on how the ward was affected by the crisis. WAS seemed to be a more sensitive way of measuring quality of care, while the SPRI questionnaire indicated more clearly the practical consequences.

[Urosepsis]. / Urosepsis.

Septicemia as a result of urinary infection is a serious condition, almost always caused by gram-negative bacteria. The bacterial toxins have a profound influence on haemostasis, microcirculation, and cardiac anf respiratory function. This article contains a brief review of aetiology, pathogenesis, pathophysiology, diagnostic work-up and treatment of this life-threatening condition. As soon as specimens from urine and blood are sent for bacteriological examination, intravenous antibiotics are given. It is essential that free drainage of urine from both kidneys is established by means of a bladder catheter, retrograde catheterization or percutaneous nephrostomy. The development of septic shock is a life-threatening condition which should be treated in an intensive care unit with continuous monitoring of vital parameters.

Clinical significance of condylar chondromalacia after arthroscopic resection of flap-tears of the medial meniscus. A prospective study of 93 cases.

We describe the results after arthroscopic resection of flap-tears of the medial meniscus posterior horn in 93 patients with (40) or without (53) chondromalacia of the adjacent condylar cartilage at the time of operation. These were 93 consecutive patients presenting with medial flap-tears during the period 1988-1990 in our departments. The follow-up averaged 42 (range 26-50) months. There was a significant difference in the functional results at review depending on the presence or absence of condylar chondromalacia at arthroscopy. Among the 40 patients with chondromalacia, the Lysholm score was significantly lower (P < 0.004), and only about half the patients reported a satisfactory result. There was a significant increase in the presence of chondromalacia with age (P < 0.001). In conclusion, the presence of minor degenerative changes in the articular cartilage adjacent to meniscal flap-tears correlated with a less favourable outcome.

Interpleural or thoracic epidural analgesia for pain after thoracotomy. A double blind study.

The analgetic effect of bupivacaine given epidurally or interpleurally after thoracotomy was investigated in a randomized, double blind, placebo controlled study. 32 patients with both an epidural and an interpleural catheter, were randomized to receive either interpleural or epidural analgesia. The interpleural group was given bupivacaine 5 mg.ml-1 with 5 microgram epinephrine as a 30 ml interpleural bolus, followed by a continuous infusion starting at a rate of 7 ml per hour and epidurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. The epidural group was given bupivacaine 3.75 mg.ml-1 with 5 microgram epinephrine as a 5 ml epidural bolus, followed by a continuous infusion starting at a rate of 5 ml per hour and interpleurally a bolus of 0.9% NaCl followed by a continuous infusion of 0.9% NaCl. The draining tubes were clamped during the injection of the interpleural bolus and 15 min afterwards. Adequacy of pain relief was evaluated with the Prins-Henry pain scale. Morphine requirement was registered, there was no difference between the groups in pain scores or need for additional morphine.

[Treatment of relatives]. / Behandling av pårørende.

The article addresses the physician's relationship to the next of kin of multi-traumatized patients. The various phases of grief are discussed:phase of shock, lack of emotion, disturbance of the imagination, sense of guilt, as well as aspects connected to donation of organs. Finally three case reports are presented to further illustrate the points made in the article.

[Volume therapy in traumatology]. / Volumbehandling i traumatologien.

Circulatory failure is the most dominating problem in the multitraumatized patient in hospital. This article describes the most important pathophysiological events from a compensated stage to the final irreversible stage. The practical consequences for both the doctor and the patient are the amount of bleeding and the duration of the stage of shock. When there are technical problems with venous access we recommend surgical cut-down of peripheral veins. The article also describes the principal quality of the most commonly used volume substitutes. Finally, the author discusses the use of sodium bicarbonate in the event of lactacidosis.

[Acute pulmonary dysfunction in adults. Adult respiratory distress syndrome--ARDS]. / Akutt lungesvikt hos voksne. Adult respiratory distress syndrome--ARDS.

During a 3-year period 0.1% of all patients undergoing surgery and 0.3% of the patients submitted for trauma developed ARDS. The diagnosis was based on strict criteria. Mortality among the 42 patients was 45.2%. Abdominal sepsis was associated with high mortality, trauma with a much better prognosis. Swan-Ganz catheters were used in 81% of the patients. The measurements were characterized by high pulmonary vascular resistance and increased intrapulmonary shunting. However, the initial recordings showed only small differences between survivors and fatal cases as regards haemodynamics and blood gas parameters. Mortality was associated with low diuresis, heart failure, need of inotropic support and on age of over 50 years. The significance of invasive central monitoring is discussed.

Motor responses to serotonin in isolated guinea pig fundus and antrum.

The effects of serotonin on gut motility have been both excitatory and inhibitory. The purpose of the present study was to elucidate how serotonin influences motor activity in two functionally different parts of the stomach. Pressure recordings were made from fundic and antral pouches of isolated guinea pig whole stomach preparations. In the fundus serotonin induced relaxation, which developed gradually within 3 min. In the antrum serotonin initiated phasic contractions, which culminated within 3 min and then returned to near or below prestimulatory values. Whereas tetrodotoxin did not significantly reduce the fundic relaxation, the antral excitation was strongly inhibited by both atropine and tetrodotoxin, indicating different effect mechanisms in fundus and antrum.