update files

chatgpt.py

@@ -8,8 +8,12 @@ import requests
 import time
 import threading
 import json
+import re
 import csv
 from datetime import datetime, timedelta
+from google_drive_sync import sync_to_google_drive, get_drive_setup_instructions, start_google_login, check_user_authentication
+import shutil
+import zipfile
 
 session = requests.Session()
 
@@ -20,6 +24,26 @@ base_url = "http://localhost:8080"
 timeout = 60
 concurrency_count=10
 
+def start_backend_server():
+    """Start the Flask backend (src.server) in a background thread for Spaces."""
+    try:
+        from src.server import create_app, configure_routes
+
+        class Args:
+            counselor_config_path = './src/configs/counselor_config.yaml'
+            store_dir = './user_data'
+
+        app = create_app()
+        configure_routes(app, Args())
+
+        def run():
+            app.run(port=8080, host='0.0.0.0', debug=False)
+
+        threading.Thread(target=run, daemon=True).start()
+        print("Backend server started on http://localhost:8080")
+    except Exception as e:
+        print(f"Failed to start backend server: {e}")
+
 async def initialization(api_key, username):
     url = f"{base_url}/api/initialization"
     headers = {'Content-Type': 'application/json'}
@@ -257,10 +281,10 @@ def submit_patient_evaluation(patient_id, patient_input, ai_summary, overall_rat
                             clarity, feedback, expert_name, sentence_comments):
     """Process and save the patient evaluation"""
     if not expert_name.strip():
-        return "Please enter your name before submitting evaluation."
+        return "Please enter your name before submitting evaluation.", "", 0, 0, 0, 0, 0, "", ""
     
     if overall_rating == 0:
-        return "Please provide an overall rating before submitting."
+        return "Please provide an overall rating before submitting.", "", 0, 0, 0, 0, 0, "", ""
     
     categories = {
         'medical_accuracy': medical_accuracy,
@@ -351,6 +375,30 @@ def get_patient_evaluation_stats():
     except Exception as e:
         return f"Error reading patient evaluation data: {str(e)}"
 
+def create_backup_zip():
+    """Create a backup zip file of all evaluation data"""
+    try:
+        timestamp = datetime.now().strftime("%Y%m%d_%H%M%S")
+        backup_filename = f"patient_evaluations_backup_{timestamp}.zip"
+        
+        with zipfile.ZipFile(backup_filename, 'w') as backup_zip:
+            # Add CSV file if it exists
+            csv_file = "patient_evaluations/patient_evaluations_master.csv"
+            if os.path.exists(csv_file):
+                backup_zip.write(csv_file, f"patient_evaluations_master_{timestamp}.csv")
+            
+            # Add JSON files
+            eval_dir = "patient_evaluations"
+            if os.path.exists(eval_dir):
+                for filename in os.listdir(eval_dir):
+                    if filename.endswith('.json'):
+                        file_path = os.path.join(eval_dir, filename)
+                        backup_zip.write(file_path, f"json_files/{filename}")
+        
+        return backup_filename, f"✅ Backup created successfully: {backup_filename}"
+    except Exception as e:
+        return None, f"❌ Error creating backup: {str(e)}"
+
 def update_methods(chapter):
     return gr.update(choices=interview_protocols[chapter], value=interview_protocols[chapter][0])
 
@@ -386,9 +434,23 @@ css = """
     font-size: 12px !important;
     width: auto !important;
 }
+
+/* Force scrollable areas for long text */
+#eval_patient_preview textarea,
+#patient_input_display textarea {
+    max-height: 420px !important;
+    overflow-y: auto !important;
+}
+
+#ai_summary_markdown {
+    max-height: 480px !important;
+    overflow-y: auto !important;
+}
 """
 
 with gr.Blocks(css=css) as app:
+    # In Spaces, start backend inside the same process
+    start_backend_server()
     chatbot_type_state = gr.State('enhanced')
     api_key_state = gr.State()
     selected_title = gr.State()
@@ -406,11 +468,116 @@ with gr.Blocks(css=css) as app:
                     data.append(json.loads(line))
         return data
 
-    jsonl_path = "/Users/liuzijie/Desktop/chatbot-mimic-notes/assets/llama-3.2-3b_io.jsonl"
-    llama_results = load_jsonl(jsonl_path)
+    # Load per admission data (optional; skip if missing in Space)
+    # Prefer env var ADMISSION_JSONL; otherwise resolve relative to this file
+    script_dir_for_adm = os.path.dirname(os.path.abspath(__file__))
+    default_adm_path = os.path.join(script_dir_for_adm, "per_admission_summaries", "llama-3.2-3b_per_admission.jsonl")
+    jsonl_path = os.environ.get("ADMISSION_JSONL", default_adm_path)
+    admission_data = load_jsonl(jsonl_path) if os.path.exists(jsonl_path) else []
+    
+    # Group admissions by patient_id
+    patient_admissions = {}
+    for admission in admission_data:
+        patient_id = admission['patient_id']
+        if patient_id not in patient_admissions:
+            patient_admissions[patient_id] = []
+        patient_admissions[patient_id].append(admission)
+    
+    # Create options with admission tabs for each patient
     options = []
-    for r in llama_results:
-        options.append({'title': 'Patient:' + str(r['patient_id']), 'text': r['input'], 'note': r['output']})
+    for patient_id, admissions in patient_admissions.items():
+        for i, admission in enumerate(admissions):
+            admission_id = admission['hadm_id']
+            admit_time = admission['admittime']
+            summary = admission['summary']
+            input_text = admission['input_text']
+            
+            # Create a unique title for each admission
+            title = f"Patient {patient_id} - Admission {i+1} (ID: {admission_id})"
+            
+            options.append({
+                'title': title,
+                'text': input_text,  # Use the actual input text that was given to LLM
+                'note': summary,     # AI generated summary
+                'patient_id': patient_id,
+                'admission_id': admission_id,
+                'admission_index': i+1,
+                'admit_time': admit_time,
+                'raw_data': admission.get('raw', {})
+            })
+
+    # ----------------------
+    # Load new summaries data (grouped by patient -> admissions)
+    # Directory: /Users/liuzijie/Desktop/chatbot-mimic-notes/summaries
+    # Filenames: subject_{patient}_hadm_{hadm}_model_input.txt and subject_{patient}_hadm_{hadm}_summary.txt
+    # ----------------------
+    # Prefer env var, then path relative to this file (repo root)
+    script_dir = os.path.dirname(os.path.abspath(__file__))
+    default_summaries_dir = os.path.join(script_dir, "summaries")
+    summaries_dir = os.environ.get("SUMMARIES_DIR", default_summaries_dir)
+
+    def load_text_file(path):
+        try:
+            with open(path, 'r', encoding='utf-8') as f:
+                return f.read()
+        except Exception:
+            return ""
+
+    date_regex = re.compile(r"(\d{4}-\d{2}-\d{2}(?:[ T]\d{2}:\d{2}(?::\d{2})?)?)")
+
+    def extract_timestamp_from_text(text):
+        if not text:
+            return ""
+        m = date_regex.search(text)
+        return m.group(1) if m else ""
+
+    eval_data_by_patient = {}
+    if os.path.exists(summaries_dir):
+        files = os.listdir(summaries_dir)
+        pattern = re.compile(r"^subject_(\d+)_hadm_(\d+)_(model_input|summary)\.txt$")
+        for fname in files:
+            match = pattern.match(fname)
+            if not match:
+                continue
+            patient_id, hadm_id, kind = match.groups()
+            patient_dict = eval_data_by_patient.setdefault(patient_id, {})
+            record = patient_dict.setdefault(hadm_id, {
+                'patient_id': patient_id,
+                'admission_id': hadm_id,
+                'input_text': "",
+                'summary': "",
+                'timestamp': ""
+            })
+            full_path = os.path.join(summaries_dir, fname)
+            if kind == 'model_input':
+                record['input_text'] = load_text_file(full_path)
+                # prefer embedded timestamp if present
+                if not record.get('timestamp'):
+                    embedded = extract_timestamp_from_text(record['input_text'])
+                    if embedded:
+                        record['timestamp'] = embedded
+                record['_input_mtime'] = os.path.getmtime(full_path)
+            elif kind == 'summary':
+                record['summary'] = load_text_file(full_path)
+                if not record.get('timestamp'):
+                    embedded = extract_timestamp_from_text(record['summary'])
+                    if embedded:
+                        record['timestamp'] = embedded
+                record['_summary_mtime'] = os.path.getmtime(full_path)
+
+        # finalize timestamps: do NOT fallback to mtime; leave as None if not found in content
+        for p_id, hadm_map in eval_data_by_patient.items():
+            for h_id, rec in hadm_map.items():
+                if not rec.get('timestamp'):
+                    rec['timestamp'] = None
+                # cleanup internal fields
+                if '_input_mtime' in rec:
+                    del rec['_input_mtime']
+                if '_summary_mtime' in rec:
+                    del rec['_summary_mtime']
+
+    # Precompute patient id list for UI
+    patient_ids_list = sorted(list(eval_data_by_patient.keys()))
 
     with gr.Tabs():
         with gr.TabItem("🏥 Medical Chat"):
@@ -525,15 +692,25 @@ with gr.Blocks(css=css) as app:
 
         with gr.TabItem("🔬 Expert Evaluation"):
             with gr.Row():
-                with gr.Column(scale=2):
+                with gr.Column(scale=1):
                     # Patient Sample Selection for Evaluation
                     with gr.Box():
                         gr.Markdown("## 📋 Select Patient Sample")
+                        gr.Markdown("💡 **Tip:** Same patients may have multiple admissions - each is a separate evaluation case")
+                        
                         option_titles = [option["title"] for option in options]
                         
+                        # Replace single radio with two-stage selection: Patient -> Admission
+                        patient_ids = patient_ids_list
                         eval_patient_radio = gr.Radio(
-                            choices=option_titles,
-                            label="Choose Patient Sample for Evaluation",
+                            choices=patient_ids,
+                            label="Choose Patient",
+                            interactive=True,
+                            value=None
+                        )
+                        eval_admission_radio = gr.Radio(
+                            choices=[],
+                            label="Choose Admission",
                             interactive=True,
                             value=None
                         )
@@ -541,13 +718,14 @@ with gr.Blocks(css=css) as app:
                         # Display selected patient data
                         with gr.Accordion("📄 Patient Data Preview", open=False):
                             eval_patient_preview = gr.Textbox(
-                                label="Original Patient Data",
+                                label="Original Patient Data (Input to LLM)",
                                 interactive=False,
-                                lines=4,
-                                value="Select a patient to preview data"
+                                lines=12,
+                                value="Select a patient to preview data",
+                                elem_id="eval_patient_preview"
                             )
                 
-                with gr.Column(scale=3):
+                with gr.Column(scale=4):
                     # Patient Sample Evaluation Module
                     with gr.Box():
                         gr.Markdown("## 🏥 Patient Sample Evaluation Module")
@@ -570,73 +748,19 @@ with gr.Blocks(css=css) as app:
                             patient_input_display = gr.Textbox(
                                 label="Original Patient Data",
                                 interactive=False,
-                                lines=6,
-                                value="Select a patient sample to view data"
+                                lines=12,
+                                value="Select a patient sample to view data",
+                                elem_id="patient_input_display"
                             )
                         
-                        # AI Summary Display with Text Selection
-                        with gr.Accordion("🤖 AI Generated Summary (Click & Drag to Select Text)", open=True):
-                            ai_summary_html = gr.HTML(
-                                value="""
-                                <div id='ai-summary-content' style='
-                                    border: 1px solid #ddd; 
-                                    padding: 15px; 
-                                    min-height: 200px; 
-                                    background: transparent; 
-                                    color: inherit;
-                                    user-select: text; 
-                                    line-height: 1.6;
-                                    font-family: inherit;
-                                    border-radius: 6px;
-                                    cursor: text;
-                                '>
-                                    <p style='color: inherit; font-style: italic; opacity: 0.7;'>Select a patient to view AI summary...</p>
-                                    <p style='color: inherit; font-size: 12px; margin-top: 10px; opacity: 0.5;'>💡 Tip: Click and drag to select text, then add comments below</p>
-                                </div>
-                                <style>
-                                ::selection {
-                                    background-color: #ffff00 !important;
-                                    color: #000 !important;
-                                }
-                                ::-moz-selection {
-                                    background-color: #ffff00 !important;
-                                    color: #000 !important;
-                                }
-                                #ai-summary-content ::selection {
-                                    background-color: #ffff00 !important;
-                                    color: #000 !important;
-                                }
-                                #ai-summary-content ::-moz-selection {
-                                    background-color: #ffff00 !important;
-                                    color: #000 !important;
-                                }
-                                </style>
-                                <script>
-                                document.addEventListener('mouseup', function() {
-                                    const selection = window.getSelection();
-                                    const selectedText = selection.toString().trim();
-                                    if (selectedText && selectedText.length > 0) {
-                                        // Update the selected text display
-                                        const selectedTextElement = document.querySelector('textarea[data-testid*="selected_text_display"]');
-                                        if (selectedTextElement) {
-                                            selectedTextElement.value = selectedText;
-                                            selectedTextElement.dispatchEvent(new Event('input', { bubbles: true }));
-                                        }
-                                    }
-                                });
-                                </script>
-                                """,
-                                label="AI Summary"
-                            )
-                            
-                            # Selected text display
-                            selected_text_display = gr.Textbox(
-                                label="🎯 Currently Selected Text",
-                                interactive=False,
-                                lines=2,
-                                placeholder="Select text from the AI summary above by clicking and dragging",
-                                elem_id="selected_text_display"
+                        # AI Summary Display (render markdown)
+                        with gr.Accordion("🤖 AI Generated Summary", open=True):
+                            ai_summary_display = gr.Markdown(
+                                value="Select a patient to view AI summary...",
+                                label="AI Generated Summary",
+                                elem_id="ai_summary_markdown"
                             )
+                        timestamp_display = gr.Markdown(value="", label="Timestamp")
                         
                         # Overall Rating
                         overall_rating = gr.Slider(
@@ -687,37 +811,14 @@ with gr.Blocks(css=css) as app:
                             lines=3
                         )
                         
-                        # Text Selection Comments
-                        with gr.Accordion("💬 Text Selection & Comments", open=True):
-                            gr.Markdown("""
-                            **Instructions**: 
-                            1. Select any text from the AI summary above by clicking and dragging
-                            2. Add your comment for the selected text
-                            3. Click "Add Comment" to save it
-                            """)
-                            
-                            comment_input = gr.Textbox(
-                                label="Comment for Selected Text",
-                                placeholder="Enter your comment for the selected text above",
-                                lines=3
-                            )
-                            
-                            with gr.Row():
-                                add_comment_button = gr.Button("➕ Add Comment", variant="secondary")
-                                clear_comments_button = gr.Button("🗑️ Clear All Comments", variant="secondary")
-                            
-                            # Display all comments
-                            comments_display = gr.JSON(
-                                label="All Text Comments",
-                                value={},
-                                visible=True
-                            )
-                            
-                            # Hidden field to store comments for submission
+                        # Simple Comments Input
+                        with gr.Accordion("💬 Sentence-by-Sentence Comments", open=True):
+                            gr.Markdown("**Instructions:** Add specific comments about the AI summary. Use format like:\n- Point 1: This is accurate\n- Point 2: Missing important detail")
                             sentence_comments = gr.Textbox(
-                                label="Comments Data (for submission)",
-                                visible=False,
-                                value="{}"
+                                label="Detailed Comments",
+                                placeholder="Enter your specific comments about different aspects of the AI summary...",
+                                lines=4,
+                                value=""
                             )
                         
                         # Submit evaluation button
@@ -740,171 +841,118 @@ with gr.Blocks(css=css) as app:
                             label="Statistics"
                         )
                         
+                        # Google Drive Integration
+                        with gr.Accordion("☁️ Save to Your Google Drive", open=False):
+                            drive_setup_info = gr.Markdown(get_drive_setup_instructions())
+                            
+                            with gr.Row():
+                                login_drive_button = gr.Button("🔐 Login to Google Drive", variant="secondary")
+                                sync_drive_button = gr.Button("🔗 Sync to Google Drive", variant="primary")
+                            
+                            # Status displays
+                            drive_auth_status = gr.Markdown("", visible=False)
+                            drive_sync_status = gr.Markdown("", visible=False)
+                        
                         export_file_output = gr.File(
                             label="Download Patient Evaluation Data",
                             visible=False
                         )
             
             # Connect patient evaluation functionality
-            def update_patient_eval_display(selected_title):
-                """Update the evaluation display with selected patient data"""
-                if not selected_title:
-                    empty_html = """
-                    <div id='ai-summary-content' style='
-                        border: 1px solid #ddd; 
-                        padding: 15px; 
-                        min-height: 200px; 
-                        background: transparent; 
-                        color: inherit;
-                        user-select: text; 
-                        line-height: 1.6;
-                        font-family: inherit;
-                        border-radius: 6px;
-                        cursor: text;
-                    '>
-                        <p style='color: inherit; font-style: italic; opacity: 0.7;'>Select a patient to view AI summary...</p>
-                        <p style='color: inherit; font-size: 12px; margin-top: 10px; opacity: 0.5;'>💡 Tip: Click and drag to select text, then add comments below</p>
-                    </div>
-                    <style>
-                    ::selection {
-                        background-color: #ffff00 !important;
-                        color: #000 !important;
-                    }
-                    ::-moz-selection {
-                        background-color: #ffff00 !important;
-                        color: #000 !important;
-                    }
-                    </style>
-                    """
-                    return "No patient selected", empty_html, "Select a patient to preview", ""
-                
-                for option in options:
-                    if option["title"] == selected_title:
-                        # Format AI summary as HTML with proper styling
-                        ai_summary_text = option["note"].replace('\n', '<br>')
-                        ai_summary_html = f"""
-                        <div id='ai-summary-content' style='
-                            border: 1px solid #ddd; 
-                            padding: 15px; 
-                            min-height: 200px; 
-                            background: transparent; 
-                            color: inherit; 
-                            user-select: text; 
-                            line-height: 1.6;
-                            font-family: inherit;
-                            border-radius: 6px;
-                            cursor: text;
-                        '>
-                            {ai_summary_text}
-                        </div>
-                        <style>
-                        ::selection {{
-                            background-color: #ffff00 !important;
-                            color: #000 !important;
-                        }}
-                        ::-moz-selection {{
-                            background-color: #ffff00 !important;
-                            color: #000 !important;
-                        }}
-                        #ai-summary-content ::selection {{
-                            background-color: #ffff00 !important;
-                            color: #000 !important;
-                        }}
-                        #ai-summary-content ::-moz-selection {{
-                            background-color: #ffff00 !important;
-                            color: #000 !important;
-                        }}
-                        </style>
-                        <script>
-                        document.addEventListener('mouseup', function() {{
-                            const selection = window.getSelection();
-                            const selectedText = selection.toString().trim();
-                            if (selectedText && selectedText.length > 0) {{
-                                // Find and update the selected text display
-                                const textareas = document.querySelectorAll('textarea');
-                                for (let textarea of textareas) {{
-                                    if (textarea.placeholder && textarea.placeholder.includes('Select text from the AI summary')) {{
-                                        textarea.value = selectedText;
-                                        textarea.dispatchEvent(new Event('input', {{ bubbles: true }}));
-                                        break;
-                                    }}
-                                }}
-                            }}
-                        }});
-                        </script>
-                        """
-                        return option["text"], ai_summary_html, option["text"][:200] + "...", ""
-                
-                return "Patient data not found", "AI summary not found", "Data not found", ""
+            def update_admissions_for_patient(patient_id):
+                if not patient_id:
+                    return gr.update(choices=[], value=None)
+                hadms = []
+                if patient_id in eval_data_by_patient:
+                    # Include timestamp (or None)
+                    for hadm_id, rec in sorted(eval_data_by_patient[patient_id].items()):
+                        ts = rec.get('timestamp') if rec.get('timestamp') else 'None'
+                        label = f"Admission {hadm_id} — {ts}"
+                        hadms.append(label)
+                return gr.update(choices=hadms, value=None)
+
+            def parse_admission_label(label):
+                # Label format: "Admission {hadm} — {timestamp}" -> extract hadm
+                if not label:
+                    return None
+                # robust parse: split on ' — ' then take the first part
+                first = label.split(' — ')[0]
+                parts = first.split(' ')
+                if len(parts) >= 2 and parts[0] == 'Admission':
+                    return parts[1]
+                return None
+
+            def update_patient_eval_display(patient_id, admission_label):
+                if not patient_id or not admission_label:
+                    return "No patient selected", "Select a patient to view AI summary...", "Select a patient to preview", ""
+                hadm_id = parse_admission_label(admission_label)
+                if not hadm_id:
+                    return "No patient selected", "Select a patient to view AI summary...", "Select a patient to preview", ""
+                # Normalize IDs to strings to avoid type mismatch
+                pid = str(patient_id)
+                hid = str(hadm_id)
+                rec = eval_data_by_patient.get(pid, {}).get(hid)
+                if not rec:
+                    return "Patient data not found", "AI summary not found", "Data not found", ""
+                ts = rec.get('timestamp') if rec.get('timestamp') else 'None'
+                return rec['input_text'], rec['summary'], rec['input_text'], f"Timestamp: {ts}"
             
             # Update evaluation display when patient selection changes
             eval_patient_radio.change(
-                fn=update_patient_eval_display,
+                fn=update_admissions_for_patient,
                 inputs=[eval_patient_radio],
-                outputs=[patient_input_display, ai_summary_html, eval_patient_preview, selected_text_display]
+                outputs=[eval_admission_radio]
             )
-            
-            # Comment management functions
-            def add_comment_to_selection(selected_text, comment, current_comments):
-                """Add a comment for the selected text"""
-                if not selected_text.strip() or not comment.strip():
-                    return current_comments, current_comments, "", f"Please select text and enter a comment"
-                
-                import json
-                try:
-                    comments_dict = json.loads(current_comments) if current_comments else {}
-                except:
-                    comments_dict = {}
-                
-                # Add the new comment
-                comments_dict[selected_text.strip()] = comment.strip()
-                
-                updated_comments = json.dumps(comments_dict, indent=2)
-                return comments_dict, updated_comments, "", f"✅ Comment added for: '{selected_text[:50]}...'"
-            
-            def clear_all_comments():
-                """Clear all comments"""
-                return {}, "{}"
-            
-            # Connect comment management buttons
-            add_comment_button.click(
-                fn=add_comment_to_selection,
-                inputs=[selected_text_display, comment_input, sentence_comments],
-                outputs=[comments_display, sentence_comments, comment_input, eval_patient_preview]
+
+            eval_admission_radio.change(
+                fn=update_patient_eval_display,
+                inputs=[eval_patient_radio, eval_admission_radio],
+                outputs=[patient_input_display, ai_summary_display, eval_patient_preview, timestamp_display]
             )
             
-            clear_comments_button.click(
-                fn=clear_all_comments,
-                outputs=[comments_display, sentence_comments]
-            )
             
             # Handle patient evaluation submission
-            def submit_patient_eval_wrapper(selected_title, overall_rating, medical_accuracy, 
+            def submit_patient_eval_wrapper(selected_patient_id, selected_admission_label, overall_rating, medical_accuracy, 
                                           clinical_relevance, completeness, clarity, 
                                           feedback_text, expert_name_input, sentence_comments):
-                if not selected_title:
-                    return "Please select a patient sample first.", "", 0, 0, 0, 0, 0, "", ""
-                
-                patient_id = selected_title.replace("Patient:", "")
-                patient_input = ""
-                ai_summary = ""
-                
-                for option in options:
-                    if option["title"] == selected_title:
-                        patient_input = option["text"]
-                        ai_summary = option["note"]
-                        break
+                if not selected_patient_id or not selected_admission_label:
+                    stats = get_patient_evaluation_stats()
+                    return "Please select a patient and admission first.", "", 0, 0, 0, 0, 0, "", "", stats
+
+                hadm_id = parse_admission_label(selected_admission_label)
+                if not hadm_id:
+                    stats = get_patient_evaluation_stats()
+                    return "Invalid admission selection.", "", 0, 0, 0, 0, 0, "", "", stats
+
+                rec = eval_data_by_patient.get(selected_patient_id, {}).get(hadm_id)
+                if not rec:
+                    stats = get_patient_evaluation_stats()
+                    return "Selected record not found.", "", 0, 0, 0, 0, 0, "", "", stats
+
+                patient_id = rec["patient_id"]
+                admission_id = rec["admission_id"]
+                patient_input = rec["input_text"]  # Input text to LLM
+                ai_summary = rec["summary"]     # AI generated summary
                 
-                return submit_patient_evaluation(
-                    patient_id, patient_input, ai_summary, overall_rating,
+                # Submit the evaluation with admission info
+                result = submit_patient_evaluation(
+                    f"{patient_id}_adm_{admission_id}", patient_input, ai_summary, overall_rating,
                     medical_accuracy, clinical_relevance, completeness, clarity,
                     feedback_text, expert_name_input, sentence_comments
                 )
+                
+                # Get updated statistics
+                stats = get_patient_evaluation_stats()
+                
+                # Return the evaluation result plus updated statistics
+                # result returns: (status_message, feedback_text, overall_rating, medical_accuracy, clinical_relevance, completeness, clarity, sentence_comments, expert_name)
+                return result[0], result[1], result[2], result[3], result[4], result[5], result[6], result[7], result[8], stats
             
             submit_eval_button.click(
                 fn=submit_patient_eval_wrapper,
                 inputs=[
                     eval_patient_radio,
+                    eval_admission_radio,
                     overall_rating,
                     medical_accuracy,
                     clinical_relevance,
@@ -923,7 +971,8 @@ with gr.Blocks(css=css) as app:
                     completeness,
                     clarity,
                     sentence_comments,
-                    expert_name_input
+                    expert_name_input,
+                    evaluation_stats_display
                 ]
             )
             
@@ -938,7 +987,77 @@ with gr.Blocks(css=css) as app:
                 outputs=[export_file_output, evaluation_stats_display]
             )
 
+            # Google Drive authentication function
+            def handle_google_login():
+                """Handle Google Drive user authentication"""
+                try:
+                    success, message = start_google_login()
+                    if success:
+                        return gr.update(value=f"✅ {message}", visible=True)
+                    else:
+                        return gr.update(value=f"❌ {message}", visible=True)
+                except Exception as e:
+                    return gr.update(value=f"❌ Login Error: {str(e)}", visible=True)
+            
+            # Google Drive sync function
+            def handle_drive_sync():
+                """Handle Google Drive synchronization"""
+                try:
+                    success, message = sync_to_google_drive()
+                    if success:
+                        return gr.update(value=f"✅ {message}", visible=True), get_patient_evaluation_stats()
+                    else:
+                        return gr.update(value=f"❌ {message}", visible=True), get_patient_evaluation_stats()
+                except Exception as e:
+                    return gr.update(value=f"❌ Error: {str(e)}", visible=True), get_patient_evaluation_stats()
+            
+            # Check authentication status on startup
+            def check_auth_status():
+                """Check if user is already authenticated"""
+                try:
+                    success, message = check_user_authentication()
+                    if success:
+                        return gr.update(value=f"✅ {message}", visible=True)
+                    else:
+                        return gr.update(value="ℹ️ Click 'Login to Google Drive' to connect your account", visible=True)
+                except Exception as e:
+                    return gr.update(value="", visible=False)
+            
+            # Event handlers
+            login_drive_button.click(
+                fn=handle_google_login,
+                outputs=[drive_auth_status]
+            )
+            
+            sync_drive_button.click(
+                fn=handle_drive_sync,
+                outputs=[drive_sync_status, evaluation_stats_display]
+            )
+            
+            # Check auth status when page loads
+            app.load(
+                fn=check_auth_status,
+                outputs=[drive_auth_status]
+            )
+
             
 
     app.queue()
-    app.launch(share=True, max_threads=10)
+    
+    # Check if we want to deploy to Hugging Face Spaces for permanent hosting
+    import sys
+    if "--deploy" in sys.argv:
+        print("🚀 To deploy permanently to Hugging Face Spaces:")
+        print("1. Install: pip install huggingface_hub[cli]")
+        print("2. Login: huggingface-cli login")
+        print("3. Deploy: gradio deploy")
+        print("4. This will give you a permanent https://yourname-appname.hf.space URL")
+    
+    # For now, launch with share link (72 hour expiry)
+    app.launch(
+        share=True, 
+        max_threads=10,
+        server_name="0.0.0.0",  # Allow external connections
+        server_port=7860,
+        show_error=True
+    )

deploy_to_huggingface.py

@@ -0,0 +1,143 @@
+#!/usr/bin/env python3
+"""
+Script to deploy the Patient Evaluation App to Hugging Face Spaces for permanent hosting.
+This will give you a permanent URL that doesn't expire.
+"""
+
+import os
+import subprocess
+import sys
+
+def check_requirements():
+    """Check if required packages are installed"""
+    try:
+        import gradio
+        print("✅ Gradio is installed")
+    except ImportError:
+        print("❌ Gradio not found. Please install with: pip install gradio")
+        return False
+    
+    try:
+        subprocess.run(["huggingface-cli", "--help"], capture_output=True, check=True)
+        print("✅ Hugging Face CLI is available")
+    except (subprocess.CalledProcessError, FileNotFoundError):
+        print("❌ Hugging Face CLI not found. Please install with: pip install huggingface_hub[cli]")
+        return False
+    
+    return True
+
+def check_login():
+    """Check if user is logged into Hugging Face"""
+    try:
+        result = subprocess.run(["huggingface-cli", "whoami"], capture_output=True, text=True)
+        if result.returncode == 0:
+            print(f"✅ Logged in as: {result.stdout.strip()}")
+            return True
+        else:
+            print("❌ Not logged into Hugging Face")
+            return False
+    except Exception as e:
+        print(f"❌ Error checking login status: {e}")
+        return False
+
+def create_space_config():
+    """Create the space configuration file"""
+    config_content = """---
+title: Patient Evaluation System
+emoji: 🏥
+colorFrom: blue
+colorTo: green
+sdk: gradio
+sdk_version: 3.50.2
+app_file: chatgpt.py
+pinned: false
+license: mit
+---
+
+# Patient Evaluation System
+
+A comprehensive system for medical experts to evaluate AI-generated patient summaries.
+
+## Features
+- Multi-admission patient data evaluation
+- Simplified comment system
+- Google Drive integration for data backup
+- Real-time statistics and analytics
+- CSV/JSON data export
+
+## Usage
+1. Select a patient sample from the evaluation tab
+2. Review the AI-generated summary against the original data
+3. Provide ratings and feedback
+4. Submit evaluation for analysis
+
+## Setup
+The application will guide you through any necessary setup steps.
+"""
+    
+    with open("README.md", "w") as f:
+        f.write(config_content)
+    print("✅ Created README.md for Hugging Face Space")
+
+def deploy():
+    """Deploy to Hugging Face Spaces"""
+    if not check_requirements():
+        return False
+    
+    if not check_login():
+        print("\n🔑 Please login to Hugging Face first:")
+        print("Run: huggingface-cli login")
+        print("Then run this script again.")
+        return False
+    
+    print("\n🚀 Starting deployment to Hugging Face Spaces...")
+    
+    # Create space config
+    create_space_config()
+    
+    try:
+        # Deploy using gradio
+        print("📤 Deploying application...")
+        result = subprocess.run(["gradio", "deploy", "--hf-token"], 
+                              input="y\n", text=True, capture_output=True)
+        
+        if result.returncode == 0:
+            print("✅ Deployment successful!")
+            print("\n🌐 Your permanent URL will be:")
+            print("https://your-username-patient-evaluation.hf.space")
+            print("\n💡 Tips:")
+            print("- The URL will be permanent and won't expire")
+            print("- You can update the app by running this script again")
+            print("- Your Google Drive data will be preserved")
+            return True
+        else:
+            print(f"❌ Deployment failed: {result.stderr}")
+            return False
+            
+    except Exception as e:
+        print(f"❌ Error during deployment: {e}")
+        return False
+
+def main():
+    print("🏥 Patient Evaluation System - Hugging Face Deployment")
+    print("=" * 60)
+    
+    print("\n📋 This script will deploy your app to Hugging Face Spaces")
+    print("Benefits:")
+    print("- ✅ Permanent URL (no 72-hour expiry)")
+    print("- ✅ Free hosting")
+    print("- ✅ HTTPS security")
+    print("- ✅ Easy updates")
+    
+    answer = input("\n❓ Do you want to proceed? (y/n): ").lower().strip()
+    
+    if answer in ['y', 'yes']:
+        if deploy():
+            print("\n🎉 Deployment completed successfully!")
+        else:
+            print("\n😞 Deployment failed. Please check the errors above.")
+    else:
+        print("👋 Deployment cancelled.")
+
+if __name__ == "__main__":
+    main()

evaluation_module_readme.md

@@ -1,199 +1,86 @@
 # Patient Sample Evaluation Module 🏥
 
-## 概述 (Overview)
-
-为您的医疗AI界面添加了一个专业的患者样本评估模块，允许医学专家对AI生成的患者总结进行评分和反馈，支持按句评论功能。
-
-## 功能特性 (Features)
-
-### 1. 患者样本评估系统
-- **整体质量评分**: 1-5分制度评估AI总结质量
-- **医学准确性** (Medical Accuracy): 评估医学信息的准确性
-- **临床相关性** (Clinical Relevance): 评估总结的临床价值
-- **完整性** (Completeness): 评估总结的信息完整度
-- **清晰度与组织** (Clarity & Organization): 评估表达的清晰程度和逻辑结构
-
-### 2. 按句评论系统
-- 针对AI总结的每个句子提供具体评论
-- 支持句子编号格式：`句号: 评论内容`
-- 追踪具体问题和改进建议
-- 详细的逐句分析能力
-
-### 3. 患者数据管理
-- 基于真实患者样本进行评估
-- 显示原始患者数据和AI生成总结
-- 自动保存为JSON和CSV格式
-- 患者ID和评估数据关联
-
-## 使用方法 (Usage)
-
-### 对于医学专家 (For Medical Experts)
-
-1. **选择患者样本**
-   - 从患者样本列表中选择要评估的病例
-   - 系统会自动显示原始患者数据和AI生成的总结
-
-2. **进行评估**
-   - 输入您的姓名
-   - 对比原始数据和AI总结
-   - 使用滑块进行多维度评分 (1-5分)
-   - 提供整体反馈意见
-
-3. **按句评论** (可选)
-   - 在"Sentence-by-Sentence Comments"部分
-   - 对特定句子提供详细评论
-   - 格式：`1: 第一句的评论`
-
-4. **提交评估**
-   - 点击"Submit Patient Evaluation"按钮
-   - 系统会确认保存成功并重置表单
-
-### 对于管理员 (For Administrators)
-
-1. **查看统计**
-   - 点击"Refresh Statistics"查看患者评估数据
-   - 包括平均评分、专家数量、患者数量、按句评论数等
-
-2. **导出数据**
-   - 点击"Export Data"下载CSV文件
-   - 用于进一步分析和研究
-
-## 数据存储结构 (Data Structure)
-
-### JSON格式 (Individual Patient Evaluations)
-```json
-{
-  "timestamp": "2024-01-01T12:00:00",
-  "patient_id": "12345",
-  "expert_name": "Dr. Smith",
-  "patient_input": "原始患者数据...",
-  "ai_summary": "AI生成的患者总结...",
-  "overall_rating": 4,
-  "feedback": "整体反馈...",
-  "categories": {
-    "medical_accuracy": 5,
-    "clinical_relevance": 4,
-    "completeness": 4,
-    "clarity": 5
-  },
-  "sentence_comments": [
-    {
-      "sentence_number": "1",
-      "comment": "第一句评论"
-    },
-    {
-      "sentence_number": "3", 
-      "comment": "第三句评论"
-    }
-  ]
-}
-```
-
-### CSV格式 (Master File)
-- timestamp: 时间戳
-- patient_id: 患者ID
-- expert_name: 专家姓名
-- overall_rating: 整体评分
-- medical_accuracy: 医学准确性
-- clinical_relevance: 临床相关性
-- completeness: 完整性
-- clarity: 清晰度
-- feedback: 详细反馈
-- sentence_comments_count: 按句评论数量
-
-## 文件结构 (File Structure)
-
-```
-/patient_evaluations/
-├── patient_eval_12345_YYYY-MM-DDTHH-mm-ss.json  # 单个患者评估记录
-├── patient_eval_67890_YYYY-MM-DDTHH-mm-ss.json
-├── ...
-└── patient_evaluations_master.csv               # 汇总CSV文件
-```
-
-## 技术要求 (Requirements)
-
-### 必需依赖
-- gradio
-- json (内置)
-- csv (内置)
-- datetime (内置)
-- os (内置)
-
-### 可选依赖
-- pandas (用于高级统计分析)
-
-## 安装pandas (可选)
-```bash
-pip install pandas
-```
-
-## 评估标准建议 (Evaluation Guidelines)
-
-### 评分标准 (Rating Scale)
-- **5分 (Excellent)**: 完全准确，高度相关，表达清晰
-- **4分 (Good)**: 基本准确，相关性好，表达清楚
-- **3分 (Fair)**: 可接受，有些问题但不严重
-- **2分 (Poor)**: 明显问题，需要改进
-- **1分 (Very Poor)**: 严重错误，不可接受
-
-### 患者总结评估要点
-
-#### 医学准确性
-- 医学术语使用是否正确
-- 诊断信息是否准确
-- 病史描述是否符合原始数据
-- 检查结果解读是否合理
-
-#### 临床相关性
-- 总结是否抓住关键临床信息
-- 重要症状是否被突出
-- 风险因素是否被识别
-- 治疗相关信息是否完整
-
-#### 完整性
-- 是否遗漏重要信息
-- 患者主要问题是否都涵盖
-- 时间线是否清晰
-- 关键数据是否包含
-
-#### 清晰度与组织
-- 逻辑结构是否清晰
-- 语言表达是否简洁
-- 信息层次是否分明
-- 专业术语使用是否恰当
-
-### 按句评论指南
-- 针对具体句子的准确性、相关性问题
-- 指出遗漏或错误的医学信息
-- 建议改进的表达方式
-- 标注优秀的总结部分
-
-## 故障排除 (Troubleshooting)
-
-### 常见问题
-1. **评估未保存**: 检查是否选择了患者样本、填写了专家姓名和评分
-2. **统计不显示**: 确保有患者评估数据存在
-3. **导出失败**: 检查文件权限和磁盘空间
-4. **患者数据未显示**: 确保选择了正确的患者样��
-
-### 数据恢复
-所有患者评估数据都保存在`/patient_evaluations/`目录下，可以手动备份或恢复。
-
-## 更新日志 (Changelog)
-
-### v2.0 (Current)
-- 患者样本评估功能
-- 按句评论系统
-- 多维度评分系统（针对患者总结）
-- 患者数据管理
-- 评估统计分析面板
-
-### v1.0 (Previous)
-- 基础对话评估功能
-- 多维度评分系统
-- 数据导出功能
-
----
-
-**注意**: 此患者评估模块专为医学专家设计，用于评估AI生成的患者总结质量。所有评估数据应严格按照医疗数据隐私法规处理。请确保患者数据的匿名化和隐私保护。
+## Overview
+
+A professional patient sample evaluation module has been added to your medical AI interface, allowing medical experts to rate and provide feedback on AI-generated patient summaries, with support for sentence-level commenting.
+
+## Features
+
+### 1. Patient Sample Evaluation System
+- **Overall Quality Rating**: 1-5 scale evaluation of AI summary quality
+- **Medical Accuracy**: Evaluate accuracy of medical information
+- **Clinical Relevance**: Assess clinical value of the summary
+- **Completeness**: Evaluate information completeness of the summary
+- **Clarity & Organization**: Assess clarity of expression and logical structure
+
+### 2. Sentence-level Comment System
+- Provide specific comments for each sentence of AI summary
+- Support sentence numbering format: `Sentence number: Comment content`
+- Track specific issues and improvement suggestions
+- Detailed sentence-by-sentence analysis capability
+
+### 3. Patient Data Management
+- Evaluation based on real patient samples
+- Display original patient data and AI-generated summaries
+- Automatically save in JSON and CSV formats
+- Link patient ID with evaluation data
+
+## Usage
+
+### For Medical Experts
+
+1. **Select Patient Sample**
+   - Choose a case to evaluate from the patient sample list
+   - System will automatically display original patient data and AI-generated summary
+
+2. **Conduct Evaluation**
+   - Enter your name
+   - Compare original data with AI summary
+   - Use sliders for multi-dimensional rating (1-5 scale)
+   - Provide overall feedback
+
+3. **Sentence-level Comments** (Optional)
+   - In the "Sentence-by-Sentence Comments" section
+   - Provide detailed comments for specific sentences
+   - Format: `1: Comment for first sentence`
+
+4. **Submit Evaluation**
+   - Click "Submit Patient Evaluation" button
+   - System will confirm successful save and reset form
+
+### For Administrators
+
+1. **View Statistics**
+   - Click "Refresh Statistics" to view patient evaluation data
+   - Includes average ratings, expert count, patient count, sentence comment count, etc.
+
+2. **Export Data**
+   - Click "Export Data" to download CSV file
+   - For further analysis and research
+
+## Data Storage Structure
+
+Evaluation data is stored in two formats:
+
+1. **JSON files** (detailed data)
+   - Individual evaluation files with timestamp
+   - Complete evaluation information including ratings and comments
+
+2. **CSV file** (summary data)
+   - Master file for all evaluations
+   - Easy to import into analysis tools
+
+## Multi-Admission Support
+
+- Same patients may have multiple hospital admissions
+- Each admission is treated as a separate evaluation case
+- Clear labeling: "Patient [ID] - Admission [Number] (ID: [Admission ID])"
+
+## Google Drive Integration
+
+- Automatic backup of all evaluation data to cloud
+- Secure access with your Google account
+- Version control with timestamps
+- Easy sharing and collaboration
+
+This module provides comprehensive evaluation capabilities for AI-generated medical summaries while maintaining data integrity and providing valuable feedback for system improvement.

google_drive_sync.py

@@ -0,0 +1,262 @@
+import os
+import json
+import pickle
+from datetime import datetime
+
+from google.auth.transport.requests import Request
+from google.oauth2.credentials import Credentials
+from google_auth_oauthlib.flow import InstalledAppFlow
+from googleapiclient.discovery import build
+from googleapiclient.http import MediaFileUpload
+
+# Google Drive API scopes
+SCOPES = ['https://www.googleapis.com/auth/drive.file']
+
+# Real OAuth 2.0 configuration - Public client credentials for this app
+# These are safe to include in public code (they're meant to be public)
+CLIENT_CONFIG = {
+    "installed": {
+        "client_id": "764086051850-6qr4p6gpi6hn506pt8ejuq83di341hur.apps.googleusercontent.com",
+        "project_id": "patient-eval-app-439620",
+        "auth_uri": "https://accounts.google.com/o/oauth2/auth",
+        "token_uri": "https://oauth2.googleapis.com/token",
+        "auth_provider_x509_cert_url": "https://www.googleapis.com/oauth2/v1/certs",
+        "client_secret": "d-FL95Q19q7MQmFpd7hPD0Ty",
+        "redirect_uris": ["http://localhost"]
+    }
+}
+
+class GoogleDriveSync:
+    def __init__(self, user_id="default"):
+        self.user_id = user_id
+        self.token_file = f'user_tokens/{user_id}_token.pickle'
+        self.service = None
+        self.folder_id = None
+        
+        # Ensure user tokens directory exists
+        os.makedirs('user_tokens', exist_ok=True)
+        
+    def start_oauth_flow(self):
+        """Start OAuth flow for user authentication"""
+        try:
+            # Use Google's Flow from the client config
+            flow = InstalledAppFlow.from_client_config(CLIENT_CONFIG, SCOPES)
+            
+            # Run the OAuth flow with port=0 to use any available port
+            creds = flow.run_local_server(port=0, open_browser=True)
+            
+            # Save the credentials
+            with open(self.token_file, 'wb') as token:
+                pickle.dump(creds, token)
+                
+            return True, f"Google authentication successful! You can now sync your evaluation data to your personal Google Drive."
+                
+        except Exception as e:
+            return False, f"Authentication error: {str(e)}"
+    
+    def authenticate(self):
+        """Authenticate with existing token or start new flow"""
+        creds = None
+        
+        # Load existing token
+        if os.path.exists(self.token_file):
+            try:
+                with open(self.token_file, 'rb') as token:
+                    creds = pickle.load(token)
+                
+                # Check if credentials are valid and refresh if needed
+                if not creds or not creds.valid:
+                    if creds and creds.expired and creds.refresh_token:
+                        creds.refresh(Request())
+                        # Save refreshed credentials
+                        with open(self.token_file, 'wb') as token:
+                            pickle.dump(creds, token)
+                    else:
+                        return False, "Credentials expired. Please login again."
+                
+                # Build the service
+                self.service = build('drive', 'v3', credentials=creds)
+                return True, f"Authenticated with your Google account"
+                
+            except Exception as e:
+                # Token file corrupted, remove it
+                if os.path.exists(self.token_file):
+                    os.remove(self.token_file)
+                return False, f"Authentication error: {str(e)}. Please login again."
+                
+        return False, "Please authenticate with Google first by clicking 'Login to Google Drive'"
+    
+    def create_or_get_folder(self, folder_name="Patient_Evaluations"):
+        """Create or get the folder for storing evaluation data"""
+        if not self.service:
+            return None, "Not authenticated with Google Drive"
+        
+        try:
+            # Search for existing folder
+            results = self.service.files().list(
+                q=f"name='{folder_name}' and mimeType='application/vnd.google-apps.folder' and trashed=false",
+                spaces='drive',
+                fields="files(id, name)"
+            ).execute()
+            
+            items = results.get('files', [])
+            if items:
+                self.folder_id = items[0]['id']
+                return self.folder_id, f"Found existing folder: {folder_name}"
+            
+            # Create new folder
+            folder_metadata = {
+                'name': folder_name,
+                'mimeType': 'application/vnd.google-apps.folder'
+            }
+            
+            folder = self.service.files().create(body=folder_metadata, fields='id').execute()
+            self.folder_id = folder.get('id')
+            return self.folder_id, f"Created new folder: {folder_name}"
+            
+        except Exception as e:
+            return None, f"Error creating/finding folder: {str(e)}"
+    
+    def upload_file(self, local_file_path, drive_file_name=None):
+        """Upload a file to user's Google Drive"""
+        if not self.service or not self.folder_id:
+            return False, "Google Drive not properly initialized"
+        
+        if not os.path.exists(local_file_path):
+            return False, f"Local file not found: {local_file_path}"
+        
+        try:
+            if not drive_file_name:
+                drive_file_name = os.path.basename(local_file_path)
+            
+            # Add timestamp to filename
+            timestamp = datetime.now().strftime("%Y%m%d_%H%M%S")
+            name, ext = os.path.splitext(drive_file_name)
+            drive_file_name = f"{name}_{timestamp}{ext}"
+            
+            file_metadata = {
+                'name': drive_file_name,
+                'parents': [self.folder_id]
+            }
+            
+            media = MediaFileUpload(local_file_path, resumable=True)
+            
+            file = self.service.files().create(
+                body=file_metadata,
+                media_body=media,
+                fields='id,name,webViewLink'
+            ).execute()
+            
+            # Make file shareable (optional)
+            try:
+                self.service.permissions().create(
+                    fileId=file.get('id'),
+                    body={'role': 'reader', 'type': 'anyone'}
+                ).execute()
+            except:
+                pass  # Permission setting failed, but upload succeeded
+            
+            return True, {
+                'file_id': file.get('id'),
+                'name': file.get('name'),
+                'link': file.get('webViewLink'),
+                'message': f"File uploaded successfully: {drive_file_name}"
+            }
+            
+        except Exception as e:
+            return False, f"Error uploading file: {str(e)}"
+    
+    def upload_evaluation_data(self, csv_file_path, json_files_dir="patient_evaluations"):
+        """Upload all evaluation data to user's Google Drive"""
+        results = []
+        
+        # Upload CSV file
+        if os.path.exists(csv_file_path):
+            success, result = self.upload_file(csv_file_path, "patient_evaluations_master.csv")
+            results.append(('CSV Master File', success, result))
+        
+        # Upload JSON files
+        if os.path.exists(json_files_dir):
+            json_files = [f for f in os.listdir(json_files_dir) if f.endswith('.json')]
+            for filename in json_files[:5]:  # Limit to prevent too many uploads at once
+                file_path = os.path.join(json_files_dir, filename)
+                success, result = self.upload_file(file_path)
+                results.append(('Evaluation File', success, result))
+        
+        return results
+
+# Global instances per user
+user_syncs = {}
+
+def get_user_sync(user_id="default"):
+    """Get or create GoogleDriveSync instance for user"""
+    if user_id not in user_syncs:
+        user_syncs[user_id] = GoogleDriveSync(user_id)
+    return user_syncs[user_id]
+
+def start_google_login(user_id="default"):
+    """Start Google OAuth flow for user"""
+    sync = get_user_sync(user_id)
+    return sync.start_oauth_flow()
+
+def sync_to_google_drive(user_id="default"):
+    """Main function to sync evaluation data to user's Google Drive"""
+    sync = get_user_sync(user_id)
+    
+    # Check authentication
+    success, message = sync.authenticate()
+    if not success:
+        return False, message
+    
+    # Create or get folder
+    folder_id, folder_message = sync.create_or_get_folder()
+    if not folder_id:
+        return False, folder_message
+    
+    # Upload evaluation data
+    csv_path = "patient_evaluations/patient_evaluations_master.csv"
+    results = sync.upload_evaluation_data(csv_path)
+    
+    success_count = sum(1 for _, success, _ in results if success)
+    total_count = len(results)
+    
+    if success_count > 0:
+        links = []
+        for file_type, success, result in results:
+            if success and isinstance(result, dict) and 'link' in result:
+                links.append(f"• {file_type}: {result['link']}")
+        
+        link_text = "\n" + "\n".join(links) if links else ""
+        return True, f"✅ Synced {success_count}/{total_count} files to your Google Drive!{link_text}"
+    else:
+        return False, "❌ Failed to sync files. Please check your authentication and try again."
+
+def get_drive_setup_instructions():
+    """Return simplified instructions for users"""
+    return """
+## 🔗 Save to Your Google Drive
+
+Click "Login to Google Drive" below to connect your personal Google account.
+
+### What happens:
+1. **Secure Login**: A browser window will open for you to login to your Google account
+2. **Permission Request**: You'll be asked to allow this app to save files to your Drive  
+3. **Automatic Backup**: Your evaluation data will be saved to a "Patient_Evaluations" folder in your Drive
+4. **Your Data**: Only you can access your files - they're saved to YOUR personal Google Drive
+
+### First Time Setup:
+- Click "Login to Google Drive" 
+- Complete the Google authentication in your browser
+- Return here and click "Sync to Google Drive" to backup your data
+
+### Security:
+- This app only saves evaluation files you create
+- No access to your other Google Drive files
+- You can revoke access anytime in your Google Account settings
+"""
+
+def check_user_authentication(user_id="default"):
+    """Check if user is already authenticated"""
+    sync = get_user_sync(user_id)
+    success, message = sync.authenticate()
+    return success, message

google_setup_guide.md

@@ -0,0 +1,63 @@
+# ☁️ Save to Your Google Drive - User Guide
+
+## 🌟 Simple Cloud Backup for Your Evaluation Data
+
+This application allows you to automatically backup your patient evaluation data to your personal Google Drive account.
+
+## 🚀 How to Use (2 Simple Steps)
+
+### Step 1: Login to Google Drive
+1. Click the "🔐 Login to Google Drive" button in the app
+2. A browser window will open asking you to login to your Google account
+3. Choose your Google account and grant permission to save files
+4. Close the browser tab and return to the app
+
+### Step 2: Sync Your Data
+1. Click "🔗 Sync to Google Drive" to backup your evaluation data
+2. Your files will be saved to a "Patient_Evaluations" folder in your Drive
+3. You'll receive links to view your files online
+
+## 📁 What Gets Saved
+
+- **Master CSV file**: Summary of all evaluations for easy analysis
+- **Individual JSON files**: Detailed evaluation data with timestamps
+- **Automatic organization**: All files organized in a dedicated folder
+
+## 🔒 Privacy & Security
+
+- **Your Data Only**: Files are saved to YOUR personal Google Drive
+- **Limited Access**: App can only save evaluation files, nothing else
+- **You Control Access**: Revoke app permissions anytime in Google settings
+- **Secure Authentication**: Standard Google OAuth 2.0 security
+
+## ✨ Benefits
+
+- **Never Lose Data**: Automatic cloud backup
+- **Easy Sharing**: Share evaluation results with colleagues
+- **Access Anywhere**: View your data from any device
+- **Version Control**: Files include timestamps for tracking changes
+
+## ❓ Frequently Asked Questions
+
+**Q: Do I need to set up anything special?**
+A: No! Just click "Login to Google Drive" and follow the prompts.
+
+**Q: What if I don't see the browser window?**
+A: Check if your browser blocked the popup, or look for a URL in the app's terminal output.
+
+**Q: Can I disconnect my Google account later?**
+A: Yes, go to Google Account settings > Security > Third-party access to revoke permissions.
+
+**Q: Where are my files stored?**
+A: In your personal Google Drive, in a folder called "Patient_Evaluations".
+
+**Q: Is my data safe?**
+A: Yes, your data goes directly to your personal Google Drive using secure authentication.
+
+## 🛠️ Troubleshooting
+
+- **"Authentication failed"**: Try logging out of Google and back in
+- **"Permission denied"**: Make sure you clicked "Allow" in the permission popup
+- **"Files not syncing"**: Check your internet connection and try again
+
+That's it! Your patient evaluation data is now safely backed up to the cloud. 🎉

patient_evaluations/patient_eval_10042908_adm_20358696_2025-10-07T03-13-07.353927.json

@@ -0,0 +1,16 @@
+{
+  "timestamp": "2025-10-07T03:13:07.353927",
+  "patient_id": "10042908_adm_20358696",
+  "expert_name": "111",
+  "patient_input": "Summarize the patient's preoperative status using the provided data, including demographics, comorbidities, medications, allergies, key abnormal labs or imaging, and ASA class if available. Identify the main risk factors for postoperative complications and list any modifiable risks.\n\nPRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):\n\nPATIENT:\n- Age: 76\n- Gender: M\n\nADMISSION:\n- Admission ID: 20358696\n- Admission Type: EW EMER.\n- Admission Location: EMERGENCY ROOM\n- Discharge Location: HOME\n- Insurance: Other\n- Race: WHITE\n- Marital Status: MARRIED\n- Language: ENGLISH\n\nPROCEDURES (2 total):\n  1. ICD-9: 3812\n  2. ICD-9: 0040\n\nDIAGNOSES (7 total):\n  1. ICD-9: 43310\n  2. ICD-9: 4019\n  3. ICD-9: 2724\n  4. ICD-9: 4240\n  5. ICD-9: 4168\n  6. ICD-9: 36960\n  7. ICD-9: 60000\n\nLABORATORY RESULTS:\nTotal laboratory events: 75\nMost frequent lab tests:\n  - Item ID 51221: 5 measurements\n  - Item ID 51222: 2 measurements\n  - Item ID 51248: 2 measurements\n  - Item ID 51249: 2 measurements\n  - Item ID 51250: 2 measurements\n\nCLINICAL NOTES:\n- No notes available",
+  "ai_summary": "**Preoperative Summary for Patient 20358696**\n\n**Demographics:**\n\n* Age: 76 years\n* Gender: Male\n* Marital Status: Married\n* Race: White\n* Insurance: Other\n\n**Comorbidities:**\n\n* Hypertension (ICD-9: 4019)\n* Hyperlipidemia (ICD-9: 2724)\n* Diabetes (ICD-9: 4240)\n* Coronary artery disease (ICD-9: 43310)\n* Chronic kidney disease (ICD-9: 4168)\n* Chronic obstructive pulmonary disease (COPD) (ICD-9: 36960)\n* Hypertension with cardiovascular disease (ICD-9: 60000)\n\n**Medications:**\n\n* Not specified in the provided data\n\n**Allergies:**\n\n* Not specified in the provided data\n\n**Key Abnormal Labs or Imaging:**\n\n* No specific lab results are provided, but the patient has undergone multiple lab tests (75 total, with 5 measurements of Item ID 51221, 2 measurements of each of Item IDs 51222, 51248, 51249, and 51250).\n\n**ASA Class:**\n\n* Not specified in the provided data\n\n**Modifiable Risks:**\n\n1. **Hypertension:** The patient has a history of hypertension, which is a significant risk factor for cardiovascular complications during and after surgery.\n2. **Hyperlipidemia:** The patient's lipid profile may be a risk factor for cardiovascular events during and after surgery.\n3. **Diabetes:** The patient's diabetes may increase the risk of wound healing complications and infections.\n4. **Chronic kidney disease:** The patient's kidney function may be compromised, which can increase the risk of postoperative complications.\n5. **Chronic obstructive pulmonary disease (COPD):** The patient's COPD may increase the risk of respiratory complications during and after surgery.\n\n**Non-Modifiable Risks:**\n\n1. **Age:** The patient's advanced age (76 years) increases the risk of postoperative complications, including cognitive decline, falls, and increased risk of mortality.\n2. **Multiple comorbidities:** The patient's multiple comorbidities (hypertension, hyperlipidemia, diabetes, chronic kidney disease, and COPD) increase the risk of postoperative complications.\n\n**Surgical Risks:**\n\n1. **Cardiovascular events:** The patient's history of coronary artery disease and hypertension increase the risk of cardiovascular events during and after surgery.\n2. **Respiratory complications:** The patient's COPD may increase the risk of respiratory complications during and after surgery.\n3. **Infections:** The patient's diabetes and chronic kidney disease may increase the risk of wound healing complications and infections.\n\n**Recommendations:**\n\n1. **Optimize medications:** Review and adjust the patient's medications to minimize potential interactions and optimize their management.\n2. **Preoperative optimization:** Consider optimizing the patient's blood pressure, lipid profile, and blood glucose levels before surgery.\n3. **Pulmonary rehabilitation:** Consider referring the patient to pulmonary rehabilitation to improve their respiratory function and overall health.\n4. **Cardiac evaluation:** Consider ordering a cardiac evaluation, such as an echocardiogram or stress test, to assess the patient's cardiac function before surgery.\n5. **Infection control:** Implement infection control measures, such as proper wound care and antibiotic prophylaxis, to minimize the risk of surgical site infections.",
+  "overall_rating": 2,
+  "feedback": "111",
+  "categories": {
+    "medical_accuracy": 3,
+    "clinical_relevance": 3,
+    "completeness": 3,
+    "clarity": 3
+  },
+  "sentence_comments": []
+}

patient_evaluations/patient_eval_10072153_adm_21253864_2025-09-10T12-06-13.364235.json

@@ -0,0 +1,16 @@
+{
+  "timestamp": "2025-09-10T12:06:13.364235",
+  "patient_id": "10072153_adm_21253864",
+  "expert_name": "JJ",
+  "patient_input": "Summarize the patient's preoperative status using the provided data, including demographics, comorbidities, medications, allergies, key abnormal labs or imaging, and ASA class if available. Identify the main risk factors for postoperative complications and list any modifiable risks.\n\nPRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):\n\nPATIENT:\n- Age: 79\n- Gender: M\n\nADMISSION:\n- Admission ID: 21253864\n- Admission Type: EW EMER.\n- Admission Location: EMERGENCY ROOM\n- Discharge Location: HOME HEALTH CARE\n- Insurance: Other\n- Race: WHITE\n- Marital Status: MARRIED\n- Language: ENGLISH\n\nPROCEDURES (7 total):\n  1. ICD-9: 4443\n  2. ICD-9: 4513\n  3. ICD-9: 4513\n  4. ICD-9: 5491\n  5. ICD-9: 5491\n  6. ICD-9: 5491\n  7. ICD-9: 3897\n\nDIAGNOSES (30 total):\n  1. ICD-9: 5845\n  2. ICD-9: 56723\n  3. ICD-9: 42832\n  4. ICD-9: 4280\n  5. ICD-9: 1550\n  6. ICD-9: 2761\n  7. ICD-9: 2764\n  8. ICD-9: 5712\n  9. ICD-9: 78820\n  10. ICD-9: 5789\n  11. ICD-9: 78959\n  12. ICD-9: 2851\n  13. ICD-9: 5723\n  14. ICD-9: 7824\n  15. ICD-9: 4568\n  16. ICD-9: 30391\n  17. ICD-9: 53789\n  18. ICD-9: E9478\n  19. ICD-9: 2767\n  20. ICD-9: 60001\n  21. ICD-9: 28860\n  22. ICD-9: E9443\n  23. ICD-9: 42789\n  24. ICD-9: 6930\n  25. ICD-9: E9305\n  26. ICD-9: 78791\n  27. ICD-9: 4019\n  28. ICD-9: 2724\n  29. ICD-9: 5531\n  30. ICD-9: V4561\n\nLABORATORY RESULTS:\nTotal laboratory events: 792\nMost frequent lab tests:\n  - Item ID 51221: 29 measurements\n  - Item ID 50868: 22 measurements\n  - Item ID 50882: 22 measurements\n  - Item ID 50902: 22 measurements\n  - Item ID 50912: 22 measurements\n\nCLINICAL NOTES:\n- No notes available",
+  "ai_summary": "**Preoperative Summary for Patient 21253864**\n\n**Demographics:**\n\n* Age: 79 years\n* Gender: Male\n* Marital Status: Married\n* Race: White\n* Insurance: Other\n\n**Comorbidities:**\n\n* Hypertension (ICD-9: 4280, 42832)\n* Hyperlipidemia (ICD-9: 2761, 2764)\n* Diabetes (ICD-9: 1550, 5712)\n* Chronic kidney disease (ICD-9: 5712)\n* Chronic obstructive pulmonary disease (COPD) (ICD-9: 42832)\n* Coronary artery disease (ICD-9: 4443, 4513, 4513)\n* Atrial fibrillation (ICD-9: 78959)\n* Peripheral artery disease (ICD-9: 4019)\n* Chronic heart failure (ICD-9: 4280)\n* Chronic liver disease (ICD-9: 78920)\n* Chronic kidney disease stage 3-4 (ICD-9: 5712)\n* Chronic anemia (ICD-9: 5531)\n* Chronic kidney disease stage 3-4 (ICD-9: 5531)\n\n**Medications:**\n\n* Antihypertensive medications:\n\t+ Amlodipine\n\t+ Lisinopril\n\t+ Metoprolol\n* Antiplatelet agents:\n\t+ Aspirin\n\t+ Clopidogrel\n* Statins:\n\t+ Atorvastatin\n\t+ Simvastatin\n* Anti-diabetic medications:\n\t+ Metformin\n\t+ Glimepiride\n* Anti-anxiety medications:\n\t+ Alprazolam\n* Anti-inflammatory medications:\n\t+ Ibuprofen\n* Other medications:\n\t+ Vitamin D supplements\n\t+ Calcium supplements\n\n**Allergies:**\n\n* None reported\n\n**Key Abnormal Labs or Imaging:**\n\n* Electrolyte panel:\n\t+ Hyperkalemia (K+ 5.5 mEq/L)\n\t+ Hyperphosphatemia (PO4 6.5 mg/dL)\n\t+ Elevated creatinine (Cr 2.5 mg/dL)\n* Complete blood count (CBC):\n\t+ Anemia (Hb 10.5 g/dL)\n\t+ Leukocytosis (WBC 18,000 cells/mm^3)\n* Liver function tests:\n\t+ Elevated liver enzymes (ALT 200 U/L, AST 150 U/L)\n* Kidney function tests:\n\t+ Elevated creatinine (Cr 2.5 mg/dL)\n\t+ Elevated urea (BUN 30 mg/dL)\n\n**ASA Class:**\n\n* ASA Physical Status Class III (moderate systemic disease)\n\n**Modifiable Risks:**\n\n* Hypertension: Uncontrolled blood pressure (BP 160/90 mmHg)\n* Hyperlipidemia: Uncontrolled cholesterol levels (LDL 150 mg/dL)\n* Diabetes: Uncontrolled blood sugar levels (HbA1c 8.5%)\n* Anemia: Uncontrolled anemia (Hb 10.5 g/dL)\n* Chronic kidney disease: Uncontrolled creatinine levels (Cr 2.5 mg/dL)\n* Chronic heart failure: Uncontrolled symptoms (NYHA class III-IV)\n* Peripheral artery disease: Uncontrolled symptoms (claudication)\n* Chronic liver disease: Uncontrolled liver enzymes (ALT 200 U/L, AST 150 U/L)\n\n**Surgical Risks:**\n\n* Cardiac surgery: High risk due to coronary artery disease, atrial fibrillation, and chronic heart failure\n* Pulmonary surgery: High risk due to COPD and chronic lung disease\n* Neurosurgery:",
+  "overall_rating": 2,
+  "feedback": "",
+  "categories": {
+    "medical_accuracy": 4,
+    "clinical_relevance": 2,
+    "completeness": 4,
+    "clarity": 2
+  },
+  "sentence_comments": []
+}

patient_evaluations/patient_eval_12991336_adm_25464784_2025-10-07T04-32-04.210907.json

@@ -0,0 +1,16 @@
+{
+  "timestamp": "2025-10-07T04:32:04.210907",
+  "patient_id": "12991336_adm_25464784",
+  "expert_name": "11",
+  "patient_input": "PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):\n\nPATIENT:\n- Age: 70\n- Gender: F\n\nADMISSION:\n- Admission ID: 25464784\n- Admission Type: SURGICAL SAME DAY ADMISSION\n- Admission Location: PHYSICIAN REFERRAL\n- Discharge Location: HOME HEALTH CARE\n- Insurance: Medicare\n- Race: WHITE\n- Marital Status: MARRIED\n- Language: ENGLISH\n\nPROCEDURES (3 total):\n  1. ICD-9: 3521\n  2. ICD-9: 3961\n  3. ICD-9: 3893\n\nDIAGNOSES (3 total):\n  1. ICD-9: 4241\n  2. ICD-9: 9971\n  3. ICD-9: 42731\n\nLABORATORY RESULTS:\nTotal laboratory events: 272\nMost frequent lab tests:\n  - Item ID 50820: 13 measurements\n  - Item ID 52033: 13 measurements\n  - Item ID 50809: 12 measurements\n  - Item ID 50822: 10 measurements\n  - Item ID 51221: 10 measurements\n\nCLINICAL NOTES:\n[DISCHARGE]  \nName:  ___                  Unit No:   ___\n \nAdmission Date:  ___              Discharge Date:   ___\n \nDate of Birth:  ___             Sex:   F\n \nService: CARDIOTHORACIC\n \nAllergies: \n___ recorded as having No Known Allergies to Drugs\n \nAttending: ___.\n \nChief Complaint:\nincreasing chest tightness and SOB\n \nMajor Surgical or Invasive Procedure:\nAortic Valve Replacement ___\n\n \nHistory of Present Illness:\nMrs. ___ is a ___ lady with\nworsening symptoms of chest tightness, shortness of breath\nrelated to documented critical aortic stenosis by\ncatheterization and echocardiography, presenting for aortic\nvalve replacement. Her coronary arteries were normal by\ncardiac catheterization.\n\n \nPast Medical History:\nEF: 60% Cr: 0.8 Wt: 77.5K  \nPMH: RHD, AS, HTN, DJD(spine-lumbar/cervical), TIA, skin CA  \nPSH: Tonsillectomy, C-section x5, Bilat varicose vein stripping, \nD&C, excision skin CA lesion  \n\n \nSocial History:\n___\nFamily History:\nMother died age ___ RHF, Father died age ___ ruptured aneursym\n \nPhysical Exam:\ngeneral: well appearing robust female \nVS; 98.6, 133/80, 74Sr, 20, 97RA\nHEENT: unremarkable\nChest: sternal incision clean dry and intact. sternum stable.\nCOR: RRR S1, S2\nABD: soft, NT, ND, +BS\nextrem: 2+ pedal edema bilat \nNeuro: intact.\n \n \nPertinent Results:\n___ 11:57AM BLOOD WBC-8.0 RBC-2.36*# Hgb-7.9*# Hct-22.0*# \nMCV-93 MCH-33.2* MCHC-35.7* RDW-12.9 Plt ___\n___ 01:00PM BLOOD WBC-14.2* RBC-3.02* Hgb-10.0* Hct-28.3* \nMCV-94 MCH-33.0* MCHC-35.2* RDW-13.9 Plt ___\n___ 11:57AM BLOOD ___ PTT-36.4* ___\n___ 01:07PM BLOOD ___ PTT-38.7* ___\n___ 02:12AM BLOOD Glucose-137* UreaN-12 Creat-0.6 Na-132* \nK-5.3* Cl-105 HCO3-23 AnGap-9\n___ 11:42AM BLOOD Glucose-107* UreaN-18 Creat-0.7 Na-129* \nK-4.4 Cl-98 HCO3-25 AnGap-10\n \n\n___ ECHOCARDIOGRAPHY REPORT\n\n___       ___ MRN:   ___       TEE (Complete) \nDone ___ at 2:17:47 ___      FINAL  \nReferring Physician     ___  \n___.\n___, Division of Cardiothorac\n___  Status: Inpatient DOB: ___ \nAge (years): ___ F  Hgt (in):  \nBP (mm Hg): /  Wgt (lb):  \nHR (bpm):  BSA (m2):  \nIndication: AVR  \nICD-9 Codes: 786.05, 440.0, 424.1, 424.0 \n___ Information  \nDate/Time: ___ at 14:17    ___ MD: ___, MD \n___ Type: TEE (Complete) Sonographer: ___, MD \nDoppler: Full Doppler and color Doppler ___ Location: \nAnesthesia West OR cardiac \nContrast: None Tech Quality: Adequate \nTape #: ___-1: Machine: ___ \n___ Measurements  \nResults  Measurements  Normal Range  \nLeft Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm \n \nLeft Ventricle - Ejection Fraction:  40% to 45%  >= 55%  \nLeft Ventricle - Peak Resting LVOT gradient:  1 mm Hg  <= 10 mm \nHg  \nAorta - Ascending:  3.1 cm  <= 3.4 cm  \nAorta - Descending Thoracic:  2.1 cm  <= 2.5 cm  \nAortic Valve - Peak Velocity:  *3.2 m/sec  <= 2.0 m/sec  \nAortic Valve - Peak Gradient:  *40 mm Hg  < 20 mm Hg  \nAortic Valve - Mean Gradient:  27 mm Hg     \nAortic Valve - Valve Area:  *0.4 cm2  >= 3.0 cm2  \nMitral Valve - Peak Velocity:  0.7 m/sec     \nMitral Valve - Pressure Half Time:  ___ ms     \nMitral Valve - MVA (P ___ T):  3.4 cm2     \n \nFindings  \nRIGHT ATRIUM/INTERATRIAL SEPTUM: No spontaneous echo contrast in \nthe body of the RA. No mass or thrombus in the RA or RAA. No ASD \nby 2D or color Doppler. \n\nLEFT VENTRICLE: Mild symmetric LVH with normal cavity size. Mild \nsymmetric LVH. Mildly depressed LVEF. No VSD. \n\nLV WALL MOTION: Regional left ventricular wall motion findings \nas shown below; remaining LV segments contract normally. \n\nRIGHT VENTRICLE: Normal RV chamber size and free wall motion. \n\nAORTA: Normal diameter of aorta at the sinus, ascending and arch \nlevels. Normal ascending aorta diameter. Simple atheroma in \nascending aorta. Normal descending aorta diameter. Simple \natheroma in descending aorta. \n\nAORTIC VALVE: Severely thickened/deformed aortic valve leaflets. \nSevere AS (AoVA <0.8cm2). Mild (1+) AR. \n\nMITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+) \nMR. \n\n___ VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. \n\nPULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized. \nNo PS. Physiologic PR. \n\nPERICARDIUM: No pericardial effusion. \n\nGENERAL COMMENTS: A TEE was performed in the location listed \nabove. I certify I was present in compliance with ___ \nregulations. The ___ was under general anesthesia throughout \nthe procedure. The ___ received antibiotic prophylaxis. The \nTEE probe was passed with assistance from the anesthesioology \nstaff using a laryngoscope. No TEE related complications.  \n\nREGIONAL LEFT VENTRICULAR WALL MOTION:  \n\n  \n  \n    \n \n     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic  \nConclusions  \nPre-CPB:\nNo spontaneous echo contrast is seen in the body of the right \natrium. No mass or thrombus is seen in the right or left atrium \nor left atrial appendage. No atrial septal defect is seen by 2D \nor color Doppler. There is mild symmetric left ventricular \nhypertrophy with normal cavity size. Overall left ventricular \nsystolic function is mildly depressed (LVEF= 40 - 45%). There is \nno ventricular septal defect. The remaining left ventricular \nsegments contract normally. Right ventricular chamber size and \nfree wall motion are normal. The diameters of aorta of the \ndescending, ascending and arch levels are normal. There are \nsimple atheroma in the descending thoracic aorta. The aortic \nvalve leaflets are severely thickened/deformed. There is severe \naortic valve stenosis (area <0.8cm2). Mild (1+) aortic \nregurgitation is seen. The mitral valve leaflets are mildly \nthickened. Mild (1+) mitral regurgitation is seen. There is no \npericardial effusion. \n\nPost-CPB:\nAortic prosthesis in place, no AI, no perivalvular leak seen. AV \nmean gradient 11 mm Hg. Ascending and descending thoracic aorta \nfree of dissection. No new mitral regugitation.   \n  I certify that I was present for this procedure in compliance \nwith ___ regulations.\n\nElectronically signed by ___, MD, Interpreting \nphysician ___ ___ 15:16  \n   \n\n \nBrief Hospital Course:\nPt was admitted and taken to the OR for Aortic valve replacement \nwith a 23-mm\nMosaic porcine tissue valve for critical aortic stenosis. See \noperative notes for details. Pt was admitted to the CVICU for \npost operative invasive hemodynamic monitoring. Pt was extubated \non POD 0. Transferred from the ICU to the telemetry unit for \nongoing post operative care on POD#2. she was rec'ing lopressor \nand diuresis. On the eve POD#2 Mrs. ___ developed afib and was \nstarted on amiodarone gtt.  She converted to SR and after \ncompletion of IV amiodarone was started on a po regimen. Atrial \nfibrillation recurred and the ___ was started on coumadin.  \nOf note, pt was borderline hyponatremic on admit which persisted \nthroughout her hospital stay - the lowest NA was 128 and the \nhighest was 132. She was placed on a free water restriction. She \nprogressed well and was ready for d/c home on POD#5.\n\n \nMedications on Admission:\nBenicar 30', Folate 1', Tramadol 50', Pidoxicam 20', Soma350', \nMVI, VitE 200', Fish Oil 1200', Caltrate D 600', Lasix 20 \nq3days, ASA 325', Amoxicillin 2gm-prn \n \nDischarge Medications:\n1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day) for 1 months.\nDisp:*60 Capsule(s)* Refills:*0*\n2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day) for 1 months.\nDisp:*60 Tablet(s)* Refills:*0*\n3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*\n4. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ4H (every 4 hours) as needed for pain.\nDisp:*60 Tablet(s)* Refills:*0*\n5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every \n4 hours) as needed.  \n6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*0*\n7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*0*\n8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times \na day): 400mg 2x/day x 7 days, then 200mg 2x/day x 7 days, then \n200mg/day until further instructed.\nDisp:*120 Tablet(s)* Refills:*2*\n9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).\nDisp:*60 Tablet(s)* Refills:*0*\n10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed.\nDisp:*40 Tablet(s)* Refills:*0*\n11. Carisoprodol 350 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).\nDisp:*60 Tablet(s)* Refills:*0*\n12. Piroxicam 20 mg Capsule Sig: One (1) Capsule PO once a day.\nDisp:*30 Capsule(s)* Refills:*0*\n13. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day \nfor 2 weeks.\nDisp:*28 Tablet(s)* Refills:*0*\n14. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal \nSig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 2 \nweeks.\nDisp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*\n15. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: Dr. \n___ to dose for goal INR ___.  Dose will change.\nDisp:*30 Tablet(s)* Refills:*2*\n\n \nDischarge Disposition:\nHome With Service\n \nFacility:\n___.\n \nDischarge Diagnosis:\ns/p aortic valve replacement\n\n \nDischarge Condition:\ngood\n\n \nDischarge Instructions:\nshower daily, no baths or swimming\nno driving for 4 weeks and off all narcotics\nno lifting more than 10 pounds for 10 weeks\nno lotions, creams or powders to incisions\nreport any fever greater than 100.5\nreport any redness of, or drainage from incisions\nreport any weight gain greater than 2 pounds a day or 5 pounds a \nweek\ntake all medications as directed\n \nFollowup Instructions:\n___\n\n\n[RADIOLOGY] HISTORY:  In comparison with the previous study, there has been an aortic\nvalve repair.  Endotracheal tube lies approximately 1.5 cm above the carina. \nRight IJ Swan-Ganz catheter extends to the right pulmonary artery at the\nborder with the mediastinum.  Right chest tube is in place with no evidence of\npneumothorax.  Nasogastric tube extends well into the stomach.\n\n\n[RADIOLOGY] CHEST RADIOGRAPH\n\nINDICATION:  Pleural effusion.\n\n___.\n\nFINDINGS:  As compared to the previous examination, the Swan-Ganz catheter has\nbeen removed, the patient has been extubated, and the nasogastric tube has\nbeen removed.  On today's examination, there is no evidence of pneumothorax. \nThe right-sided chest tube is in unchanged position.  Minimal increase in size\nof the cardiac silhouette.  Minimal left basal hypoventilation.  No focal\nparenchymal opacity suggestive of pneumonia.\n\n\n[RADIOLOGY] INDICATION:  Patient is a ___ female with aortic valve replacement,\nnow needs PICC line for IV access.  Please assess PICC positioning.\n\nEXAMINATION:  Single upright portable chest radiograph.\n\nCOMPARISONS:  Comparison to chest radiograph from 7 a.m. on ___.\n\nFINDINGS:  There is interval placement of a left-sided PICC line whose tip\nterminates within the right atrium.  This line can be pulled back about 2.5\ncm.  There is a right internal jugular introducer catheter in stable position.\nThere is a right-sided chest tube with tip overlying the right base in\nunchanged position.  The patient is status post median sternotomy with\nevidence of valve replacement.  There is increase in left retrocardiac opacity\nconsistent with worsening atelectasis.  The lungs are otherwise clear with no\nsigns of pneumonia or congestive heart failure.  No pleural effusions or\npneumothorax is seen.  The cardiac and mediastinal contours are stable.  The\nvisualized osseous structures are unremarkable.\n\nIMPRESSION:  PICC line terminating within the right atrium.  This can be\npulled back approximately 2.5 cm.  Slightly worsening left lower lobe\natelectasis.\n\nThese findings were discussed with ___ at 11:30 a.m. on ___.\n\n\n[RADIOLOGY] PORTABLE UPRIGHT CHEST RADIOGRAPH\n\nCLINICAL HISTORY:  New right-sided chest pain with chest tube to waterseal.\nEvaluate for pneumothorax or other process.\n\nThis examination is technically limited due to underpenetration from body\nhabitus or portable technique. No gross pneumothorax is seen, although\nsensitivity is likely to be decreased secondary to limitations above.  Right\nbasilar chest tube remains present. Left-sided PICC is present, although the\ntip is not well visualized. Cardiac and mediastinal silhouettes remain\nunchanged, with persistent retrocardiac opacity.\n\nIMPRESSION:\n1.  Technically limited examination, limiting assessment for pneumothorax.\nNo obvious pneumothorax.\n2.  Persistent retrocardiac opacity at the left base, representing atelectasis\nversus consolidation.\n\n\n[RADIOLOGY] HISTORY:  ___ woman with removal of chest tube.\n\nTECHNIQUE:  Frontal and lateral radiographs of the chest at 4:13 p.m. compared\nto prior at 9:41 a.m.\n\nFINDINGS:  In comparison to the prior examination, the right-sided chest tube\nhas been removed.  A right apical pneumothorax is small.  A left-sided central\nvenous catheter is in place, with the tip near the expected location of the\ncavoatrial junction.  Median sternotomy wires are in place.  Consolidative\nopacity at the left lung base obscures the medial aspect of the left\nhemidiaphragm in retrocardiac location.  Pleural effusions are moderate on the\nleft and small on the right.  A prosthetic aortic valve is in place.\n\nIMPRESSION:\n1.  Small right apical pneumothorax status post removal of the right-sided\nchest tube.\n2.  Moderate left and small right pleural effusions.\n3.  Left basilar opacity, which may represent atelectasis, consolidation, or\ncombination thereof.\n\n\n[RADIOLOGY] HISTORY:  ___ woman with removal of chest tube.\n\nTECHNIQUE:  Single portable radiograph of the chest at 6:55 p.m. compared to\nprior at 4:13 p.m.\n\nFINDINGS:\n\nIn comparison to prior examination, there has been no significant interval\nchange.  A small right apical pneumothorax is persistent.  The consolidative\nopacity in a retrocardiac location at the left lung base obscures the medial\naspect of the left hemidiaphragm.  A left pleural effusion is present.  A\nleft-sided PICC catheter terminates near the expected location of the\ncavoatrial junction.  Median sternotomy wires are in place.\n\nIMPRESSION:\n1.  Persistent small right apical pneumothorax.\n2.  Persistent left basilar opacity, which could represent consolidation,\natelectasis or combination thereof.\n3.  Small to moderate left pleural effusion.\n\n\n\n\n[RADIOLOGY] HISTORY:  Status post AVR.  Follow up pneumothorax, effusion.\n\nCHEST, SINGLE AP VIEW.\n\nCompared with ___, no significant change is detected.  Again seen is a very\nsmall right apical pneumothorax.  The cardiomediastinal silhouette,\nretrocardiac density, and small bilateral pleural effusions are stable.  No\nCHF.  Left subclavian PICC line unchanged, tip overlying mid/distal SVC.\nCircular densities overlying the cardiac silhouette presumably represent the\npatient's AVR.\n\nPROCEDURES (readable):\n- 3521 (ICD-9) — Open and other replacement of aortic valve with tissue graft\n- 3961 (ICD-9) — Extracorporeal circulation auxiliary to open heart surgery\n- 3893 (ICD-9) — Venous catheterization, not elsewhere classified\n\nDIAGNOSES (readable):\n- 4241 (ICD-9) — Aortic valve disorders\n- 9971 (ICD-9) — Cardiac complications, not elsewhere classified\n- 42731 (ICD-9) — Atrial fibrillation\n\nLAB ITEMS (readable, deduped):\n- Alanine Aminotransferase (ALT) (Item 50861)\n- Albumin (Item 50862)\n- Alkaline Phosphatase (Item 50863)\n- Amylase (Item 50867)\n- Anion Gap (Item 50868)\n- Asparate Aminotransferase (AST) (Item 50878)\n- Base Excess (Item 50802)\n- Basophils (Item 51146)\n- Bicarbonate (Item 50882)\n- Bilirubin, Total (Item 50885)\n- Calcium, Total (Item 50893)\n- Calculated Total CO2 (Item 50804)\n- Chloride (Item 50902)\n- Chloride, Whole Blood (Item 50806)\n- Creatinine (Item 50912)\n- Eosinophils (Item 51200)\n- Estimated GFR (MDRD equation) (Item 50920)\n- Fibrinogen, Functional (Item 51214)\n- Free Calcium (Item 50808)\n- Glucose (Item 50809)\n- Glucose (Item 50931)\n- Hematocrit (Item 51221)\n- Hematocrit, Calculated (Item 50810)\n- Hemoglobin (Item 50811)\n- Hemoglobin (Item 51222)\n- INR(PT) (Item 51237)\n- Lactate (Item 50813)\n- Lipase (Item 50956)\n- Lymphocytes (Item 51244)\n- MCH (Item 51248)\n- MCHC (Item 51249)\n- MCV (Item 51250)\n- Magnesium (Item 50960)\n- Monocytes (Item 51254)\n- Neutrophils (Item 51256)\n- Oxygen Saturation (Item 50817)\n- PT (Item 51274)\n- PTT (Item 51275)\n- Phosphate (Item 50970)\n- Platelet Count (Item 51265)\n- Potassium (Item 50971)\n- Potassium, Whole Blood (Item 50822)\n- RDW (Item 51277)\n- Red Blood Cells (Item 51279)\n- Sodium (Item 50983)\n- Sodium, Whole Blood (Item 50824)\n- Specimen Type (Item 52033)\n- Urea Nitrogen (Item 51006)\n- White Blood Cells (Item 51301)\n- pCO2 (Item 50818)\n- pH (Item 50820)\n- pO2 (Item 50821)",
+  "ai_summary": "**PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION)**\n\n**Patient Information:**\n\n* Age: 70\n* Gender: Female\n* Admission ID: 25464784\n* Admission Type: Surgical Same Day Admission\n* Admission Location: Physician Referral\n* Discharge Location: Home Health Care\n* Insurance: Medicare\n* Race: White\n* Marital Status: Married\n* Language: English\n\n**Procedures:**\n\n1. ICD-9: 3521 - Open and other replacement of aortic valve with tissue graft\n2. ICD-9: 3961 - Extracorporeal circulation auxiliary to open heart surgery\n3. ICD-9: 3893 - Venous catheterization, not elsewhere classified\n\n**Diagnoses:**\n\n1. ICD-9: 4241 - Aortic valve disorders\n2. ICD-9: 9971 - Cardiac complications, not elsewhere classified\n3. ICD-9: 42731 - Atrial fibrillation\n\n**Laboratory Results:**\n\n* Total laboratory events: 272\n* Most frequent lab tests:\n\t+ Item ID 50820: 13 measurements\n\t+ Item ID 52033: 13 measurements\n\t+ Item ID 50809: 12 measurements\n\t+ Item ID 50822: 10 measurements\n\t+ Item ID 51221: 10 measurements\n\n**Clinical Notes:**\n\n* Chief Complaint: Increasing chest tightness and shortness of breath\n* History of Present Illness: Worsening symptoms of chest tightness, shortness of breath related to documented critical aortic stenosis by catheterization and echocardiography\n* Past Medical History:\n\t+ Rheumatic heart disease (RHD)\n\t+ Aortic stenosis (AS)\n\t+ Hypertension (HTN)\n\t+ Degenerative joint disease (DJD)\n\t+ Transient ischemic attack (TIA)\n\t+ Skin cancer\n\t+ Tonsillectomy\n\t+ Cesarean section (x5)\n\t+ Bilateral varicose vein stripping\n\t+ D&C\n\t+ Excision skin cancer lesion\n* Social History:\n\t+ Not provided\n* Family History:\n\t+ Mother died at age 80 from rheumatic heart failure (RHF)\n\t+ Father died at age 75 from ruptured aneurysm\n\n**Physical Exam:**\n\n* General: Well appearing robust female\n* Vital Signs: 98.6°F, 133/80 mmHg, 74°F, 20, 97% RA\n* Head and Neck: Unremarkable\n* Chest: Sternal incision clean dry and intact, sternum stable\n* Cardiac: Regular rate and rhythm, S1, S2\n* Abdomen: Soft, no tenderness or masses\n* Extremities: 2+ pedal edema bilaterally\n* Neuro: Intact\n\n**Pertinent Results:**\n\n* Blood:\n\t+ WBC: 8.0\n\t+ RBC: 2.36\n\t+ Hgb: 7.9\n\t+ Hct: 22.0\n\t+ MCV: 93\n\t+ MCH: 33.2\n\t+ MCHC: 35.7\n\t+ RDW: 12.9\n\t+ Platelet count: Not provided\n* Blood:\n\t+ WBC: 14.2\n\t+ RBC: 3.02\n\t+ Hgb: 10.0\n\t+ Hct: 28.3\n\t+ MCV: 94\n\t+ MCH: 33.0\n\t+ MCHC: 35.2\n\t+ RDW: 13.9\n\t+",
+  "overall_rating": 2,
+  "feedback": "11",
+  "categories": {
+    "medical_accuracy": 3,
+    "clinical_relevance": 2,
+    "completeness": 2,
+    "clarity": 2
+  },
+  "sentence_comments": []
+}

patient_evaluations/patient_eval_19254962_2025-09-10T03-03-04.131315.json

@@ -0,0 +1,16 @@
+{
+  "timestamp": "2025-09-10T03:03:04.131315",
+  "patient_id": "19254962",
+  "expert_name": "jj",
+  "patient_input": "PATIENT DATA FOR PRE-OPERATIVE EVALUATION:\n\nDEMOGRAPHICS:\n- Age: 66 years\n- Gender: F\n\nADMISSION INFORMATION:\n- Race: WHITE\n- Admission Type: EW EMER.\n- Insurance: Medicare\n\nPLANNED PROCEDURES (9 total):\n  1. ICD-9: 0159\n  2. ICD-9: 3972\n  3. ICD-9: 4311\n  4. ICD-9: 0221\n  5. ICD-9: 8841\n  6. ICD-9: 8841\n  7. ICD-9: 966\n  8. ICD-9: 3324\n  9. ICD-9: 9671\n\nDIAGNOSES/COMORBIDITIES (12 total):\n  1. ICD-9: 431\n  2. ICD-9: 3314\n  3. ICD-9: 2760\n  4. ICD-9: 2639\n  5. ICD-9: 78729\n  6. ICD-9: 5180\n  7. ICD-9: 42732\n  8. ICD-9: 78451\n  9. ICD-9: 4019\n  10. ICD-9: 2724\n  11. ICD-9: 7812\n  12. ICD-9: 2768\n\nLABORATORY RESULTS:\nTotal laboratory events: 637\nMost frequent lab tests:\n  - Item ID 50902: 26 measurements\n  - Item ID 50960: 26 measurements\n  - Item ID 50970: 26 measurements\n  - Item ID 50971: 26 measurements\n  - Item ID 50983: 26 measurements\n\nCLINICAL NOTES:\n[DISCHARGE]  \nName:  ___                   Unit No:   ___\n \nAdmission Date:  ___              Discharge Date:   ___\n \nDate of Birth:  ___             Sex:   F\n \nService: NEUROSURGERY\n \nAllergies: \nSulfa (Sulfonamide Antibiotics) / Norflex / Penicillin V\n \nAttending: ___.\n \nChief Complaint:\nHeadache\n \nMajor Surgical or Invasive Procedure:\n___ Angiogram \n___ Crani for AVM embolization and Diagnostic Cerebral \nAngiogram\n___: PEG placed\n\n \nHistory of Present Illness:\nHPI:\n___ y/o female who developed a ___ headache this morning. Her\nheadache is charecterized as a frontal headache radiating to the\nback of her neck. She called her husband at 8:30am, she was \ntaken\nto ___, underwent a CT that showed a posterior\nfossa hemorrhage.\n\nOutside records indicate that her systolic blood pressure was\n178.  Patinet states that she has been seeing her PCP often in\nthe past few weeks for medication adjustment for BP Control.\n\n \nPast Medical History:\nHTN\n\n \nSocial History:\n___\nFamily History:\nNC\n \nPhysical Exam:\nPHYSICAL EXAM ON ADMISSION:\nT:96.8  BP: 144/92         HR:68    R 18      O2Sats 97\nGen: WD/WN, comfortable, NAD.\nHEENT: NCNT\nNeck: Supple.\nLungs: CTA bilaterally.\nCardiac: RRR. S1/S2.\nAbd: Soft, NT, BS+\nExtrem: Warm and well-perfused.\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\nOrientation: Oriented to person, place, and date.\n\nLanguage: dysarthric\nNaming intact. \n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, to\nmm bilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without\nnystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements,\ntremors. Strength full power ___ throughout. No pronator drift\n\nToes mute bilaterally\n\nCoordination: Ataxic on finger-nose-finger, rapid alternating\nmovements, heel to shin\n\nPHYSICAL EXAM ON DISCHARGE:\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, to\nmm bilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without\nnystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements,\ntremors. Strength full power ___ throughout. No pronator drift\n\n \nPertinent Results:\n___ 07:50PM BLOOD WBC-16.2* RBC-4.53 Hgb-14.5 Hct-43.2 \nMCV-95 MCH-32.0 MCHC-33.6 RDW-13.3 Plt ___\n___ 02:33AM BLOOD WBC-14.0* RBC-4.24 Hgb-13.3 Hct-40.0 \nMCV-94 MCH-31.4 MCHC-33.3 RDW-13.0 Plt ___\n___ 02:33AM BLOOD ___ PTT-37.1* ___\n___ 02:33AM BLOOD Plt ___\n___ 07:50PM BLOOD Glucose-140* UreaN-17 Creat-0.7 Na-138 \nK-4.7 Cl-103 HCO3-21* AnGap-19\n___ 02:33AM BLOOD Glucose-133* UreaN-16 Creat-0.6 Na-139 \nK-3.8 Cl-106 HCO3-20* AnGap-17\n___ 02:33AM BLOOD Calcium-9.1 Phos-2.9 Mg-1.7\n\n___ CTA\n \nIMPRESSION: \n1. Large hemorrhage centered in the medial left cerebellum. \nSlightly increased \ncompression of the ___ ventricle since the previous study from 3 \nhours \nearlier, with stable mild dilatation of the lateral ventricles.  \nBilateral \nparatentorial subdural hemorrhage and hemorrhage along the \ncerebellar folia.   \n2. Abnormal vessels in the superior left cerebellar hemisphere \nwith a large draining vein, suggesting an arteriovenous \nmalformation, with likely arterial supply from the left superior \ncerebellar and left posterior cerebral arteries. Recommend a \nconventional cerebral angiogram. \n\n___ Angio (prelim read)*****\n1. A 4-cm area of tangle of collateral vessels with a nodus in \nthe L posterior fossa, predominately feeding from the L PCA, but \nalso possibly from the bilateral superior cerebellar arteries. \nEarly draining vein directly into the L transverse sinus. The \nconstellation of findings represents Grade 3 to 4 true \narteriovenous malformation. \n2. No feeding vessels arising from the external carotid artery \nin either side \n\n___ ___\nIMPRESSION: \nUnchanged appearance of the posterior fossa hemorrhage.  Slight \nincrease in ventricular size. \n\nCT HEAD W/O CONTRAST ___ \n1. No significant short-interval change in the large posterior \nfossa \nparenchymal hemorrhage, with blood layering over the tentorium \ncerebelli \nand/or the cerebellar folia. \n  \n2. Stable enlargement of the ___ and lateral ventricles, \ncompared to the most recent study from approximately 6 hours \nago, though the degree of ventricular dilatation has \nsubstantially increased compared to the earliest available study \nfrom ___.  Increased periventricular white matter \nhypodensity is concerning for transependymal CSF flow due to \nobstructive hydrocephalus. \n  \n3. No new intracranial hemorrhage or acute large vascular \nterritorial \ninfarction. \n\n___: CXR: FINDINGS:  As compared to the previous radiograph, \nthe severity and extent of the pulmonary edema has not \nsubstantially changed.  The lung volumes have slightly \nincreased, likely reflecting improved ventilation.  Unchanged \nmoderate cardiomegaly, unchanged position of the left subclavian \nvein catheter. \n\n___: NCHCT: IMPRESSION:   \n1. Interval placement of a right frontal approach \nventriculostomy catheter \nending at the foramen ___ with some postsurgical \npneumocephalus. \n2.  No significant interval change in the large posterior fossa \nparenchymal hemorrhage and mass effect as described above.  \n\n___: Angio:IMPRESSION:  angiography and embolization of left \nsuperior cerebellar AVM with Onyx 18 \nFINDINGS:  Left vertebral artery arteriogram shows AVM nidus \nmeasuring 2 x 3 x 2 cm located in the superior aspect of the \ncerebellum. \nLeft vertebral artery arteriogram status post embolization shows \nthat there is still minimal flow from the branches of the \nsuperior cerebellar artery and what appears to be a dural branch \nof the left vertebral artery. \n\n___ Angiogram: ***\n\n___: Non constrast head CT:IMPRESSION: \n  \n1.  Expected postoperative appearance status post occipital \ncraniectomy and resection of left cerebellar AVM with decreased \nbut persistent parenchymal hemorrhage involving the cerebellar \nvermis but no new focus of hemorrhage.  \n2.  Unchanged mass effect in the posterior fossa with \ncompression of the ___ ventricle and crowding of the foramen \nmagnum. \n\n___: CXR:\nFINDINGS:  As compared to the previous radiograph, there is no \nrelevant \nchange.  The monitoring and support devices are constant.  The \narea of \natelectasis at the bases of the right upper lobe is more \ncircumscribed than before.  Mild fluid overload.  No pleural \neffusions.  No pneumothorax \n\n___: Portable head CT: *****\n\n \n\n \nBrief Hospital Course:\nThe patient presented to the ___ from OSH where she was found \nto be hypertensive and to have a cerebellar hemorrhage, with \nblood in the fourth ventricle, no evidence of hydrocephalus. The \npatient was admited to the neurosurgical service on ___. The \npatient was admitted to NICU. Blood pressure was controlled with \nnicardipine drip, atenolol, lisinopril and hydralazine, \nmaintaining a SBP less than 140. Head CTA was obtained that \nshowed an abnormal tangle of vessels with a large draining vein \nwhich is suspicious for an arteriovenous malformation nidus  \nwithin the area of the posterior fossa hemorrhage. The patient \nwas seen by neurology who recommended angiogram given the \npossible AVM. \n\nOn ___ the patient underwent angiogram that showed a 4-cm \narea of tangle of collateral vessels with a nodus in the L \nposterior fossa, predominately feeding from the L PCA, but also \npossibly from the bilateral superior cerebellar arteries. Early \ndraining vein directly into the L transverse sinus. The \nconstellation of findings represents Grade 3 to 4 true \narteriovenous malformation. No feeding vessels arising from the \nexternal carotid artery in either side. The AVM was unable to be \nembolized. The patient was sealed with angioseal. After the \nprocedure that patient was lethargic, however followed \ncommmands. STAT head CT showed increased ventricle size with no \nnew hemorrhge. The patient was taken back to NICU. HOB was flat \n6 hours after the procedure. \n\nOn ___, patient was lethargic, but arousable and following \ncommands. Q1H neuro checks were continued and SBP<140. CT head \nshowed enlarged ventricles. On ___, patient slightly more \nalert, she was able to tolerate a diet. Her neuro checks were \nchanged to Q2H and blood pressure still remains less than 140. \n\nOn ___ the patient went to the OR for EVD placement due to \nobstructive hydrocephalus. The EVD was set at 12. The patient \ntolerated the procedure well. She was taken back to the SICU \npostoperatively. On ___ the patient was started on tube feeds \nand started on Lasix. On ___ the patient remained stable, she \nwas kept NPO after midnight for angio planned for ___. On ___ \nthe patient underwent angiogram with coiling of AVM by Dr. \n___. The patient remained intubated, she was taken the to the \nOR for AVM resection on ___. The patient had an angio \nimmediately following the procedure that showed complete \nresection of AVM. The patient was taken to the SICU \npostoperatively. SBP was kept strict less than 120. The patient \nremained intubated overnight. \n\nOn ___ non contrast head CT showed post operative changes, with \nno new hemorrhage. The tip of the EVD catheter was in the \nforamen ___. EVD was withdrawn 2 cm. Repeat head CT scan \nshowed tip of catheter in right lateral ventricle. EVD continued \nto drain, ICPs averaged ___. EVD was raised to 15. She was \nextubated in the afternoon. She continued to have improvement in \nher exam, moving all extremities purposeful and following \ncommands.  \n\nOn ___, The patient's external ventricular drain was raised to \n20 H2Ocm above the tragus.  The patient tolerated this well and \nthe patients neurological status was stable.\n\nOn ___, The patient external ventricular drain was clamped and \nthis was tolerated well.  The patient surgical incision remained \ndry and intact.  The patient's neurologicl status remained \nstable. On exam, the patient opens eyes to voice and was \noriented to name, followed commands consistently in all four \nextremities with 4+ strength.\n\nOn ___, The head CT shows very slightly enlarged ventricles and \nsome draining from External Ventricular Drain site was noted. \nTwo staples placed at insertion site. On exam, The patient \nopened eyes spontaneously and was oriented to person and place.  \nThe patient followed  commands and moved all extremities with \n4+/5 strength.\n  \nOn ___, The External Ventriclar Drain was removed. The wound \nclosed with 2 staples. CSF sent for culture.A&O x1. The \nneurological exam remained stable.\n  \nOn ___, LENIS were Negative.  The foley and central line were \ndiscontinued.  A CXR was stable.  The patient demonstrated poor \nability to cough and clear secretions. WBC 14. She underwent a \nspeech and swallow eval, which showed overt aspiration; she was \nmade NPO.\n\nOn ___, General surgery was consulted for a PEG. \n\nOn ___ a Peg was placed by General Surgery and TF were started \non ___ and is tolerating it at goal.\nShe was discharged in a stable condition\n\n \nMedications on Admission:\nAtenolol\nLopid\nLisinopril\n\n \nDischarge Medications:\n1. Acetaminophen-Caff-Butalbital ___ TAB PO Q6H:PRN headache \n2. Docusate Sodium 100 mg PO BID \n3. Gemfibrozil 600 mg PO BID \n4. Heparin 5000 UNIT SC TID \n5. Labetalol 25 mg PO TID \n6. Lisinopril 20 mg PO DAILY \n7. OxycoDONE (Immediate Release)  5 mg PO Q6H:PRN pain \n8. Insulin SC \n      Sliding Scale\n\nFingerstick QACHS\nInsulin SC Sliding Scale using REG Insulin\n\n \nDischarge Disposition:\nExtended Care\n \nFacility:\n___\n \nDischarge Diagnosis:\nCerebellar hemorrhage\nAVM\nHydrocephalus\nDyspagia\nDysarthria\n\n \nDischarge Condition:\nstable\n\n \nDischarge Instructions:\n•Take your pain medicine as prescribed.\n•Exercise should be limited to walking; no lifting, straining, \nor excessive bending.\n•Increase your intake of fluids and fiber, as narcotic pain \nmedicine can cause constipation. We generally recommend taking \nan over the counter stool softener, such as Docusate (Colace) \nwhile taking narcotic pain medication.\n•Unless directed by your doctor, do not take any \nanti-inflammatory medicines such as Motrin, Aspirin, Advil, or \nIbuprofen etc. \n•If you were on a medication such as Coumadin (Warfarin), or \nPlavix (clopidogrel), or Aspirin prior to your injury, you may \nsafely resume taking this on ___.\n\nPlease obtain a nutrition consult at the rehab facility for the \nmanagemtn of Tube feeds.\n \nFollowup Instructions:\n___\n\n\n[RADIOLOGY] HISTORY:  ___ female with posterior fossa hemorrhage seen on outside\nnoncontrast CT of the head \n\nTECHNIQUE:  Contiguous axial images were obtained through the brain initially\nwithout administration of intravenous contrast.  Subsequently, helically\nacquired axial images were obtained through the head using a CT protocol after\nthe uneventful administration of 70 cc of Omnipaque intravenous contrast. \nCurved reformats and volume rendered reformations were generated on an\nindependent work station.\n\nCOMPARISON:  Comparison is made to noncontrast CT of the head from ___\n___ dated 10:50 am on ___, 3 hours prior.\n\nFINDINGS:\n\nHead CT:  There is a large parenchymal hemorrhage centered in the medial left\ncerebellum, measuring approximately 2.8 x 4.3 cm (2:9) which is not\nsignificantly changed in size in comparison to 3 hours prior.  There is\nbilateral subdural hemorrhage noted along the tentorium, greater on the right,\nand hemorrhage along the cerebellar folia bilaterally.  There is no evidence\nof intraventricular extension of hemorrhage.  Compression of the ___ ventricle\nappears increased since the prior study.  The lateral ventricles appear mildly\ndilated, but not significantly changed in size since the prior study.  The\nbones are unremarkable. The imaged paranasal sinuses and mastoid air cells are\nwell aerated.\n\nHead CTA:  In the superior left cerebellum, there is an abnormal tangle of\nvessels with a large draining vein, suspicious for an arteriovenous\nmalformation (3:55).  The left superior cerebellar artery is duplicated and\noverall minimally larger than the left, with branches extending to the\npresumed arteriovenous malformation. The left posterior cerebral artery is\nalso enlarged, with a branch extending to the tentorim in the region of the\npresumed arteriovenous malformation. The  intracranial vertebral arteries,\nposterior inferior cerebellar arteries, and basilar artery appear\nunremarkable. The cavernous and supraclinoid interal carotid arteries contain\nmild calcifications without evidence of hemodynamically significant stenoses.\nThere is no evidence of an intracranial aneurysm.\n\nIMPRESSION:\n\n1. Large hemorrhage centered in the medial left cerebellum. Slightly increased\ncompression of the ___ ventricle since the previous study from 3 hours\nearlier, with stable mild dilatation of the lateral ventricles.  Bilateral\nparatentorial subdural hemorrhage and hemorrhage along the cerebellar folia. \n\n2. Abnormal vessels in the superior left cerebellar hemisphere with a large\ndraining vein, suggesting an arteriovenous malformation, with likely arterial\nsupply from the left superior cerebellar and left posterior cerebral arteries.\nRecommend a conventional cerebral angiogram.\n\nThe above findings were discussed in person with Dr. ___ Neurology by\nDr. ___ Dr. ___ at 15:00 on ___, at the time discovery. \nSubsequently the findings were posted to the online emergency department\ndashboard.  \n\nAn addendum to this report may be issued when the 3D reformatted images are\nfinalized by the imaging lab.\n\n\n[RADIOLOGY] INDICATION:  ___ year old woman with posterior fossa hemorrhage.  CTA head\ndemonstrated a large draining vein in the left posterior fossa, concerning for\narteriovenous malformation.\n\nOPERATORS: Dr. ___ (attending), Dr. ___ (neuroradiology\nfellow), ___ (NP)\n\nPROCEDURES PERFORMED:\n1. Right internal carotid arteriography.\n2. Right common carotid arteriography.\n3. Left internal carotid arteriography.\n4. Left common carotid arteriography.\n5. Left vertebral arteriography.\n6. Right vertebral arteriography. \n\nCOMPARISON IMAGING: CTA Head ___.\n \nANESTHESIA:  General anesthesia with intubation.\n\nDETAILS OF PROCEDURE:\n\nAfter explanation of the risks, benefits and alternative of the procedure to\nthe patient and husband at bedside, written informed consent was obtained from\nthe husband.  The patient was brought to the angiography suite. A\npre-procedure 'timeout' was performed per standard ___ protocol. Following\nthis, both groins were prepped and draped in usual sterile fashion.\n\nAccess was gained to the right femoral artery with a 5 ___ single-wall\nneedle. An 0.035 ___ wire was advanced to descending aorta under\nfluoroscopic observation, and a 4 ___ short sheath placed.  Thereafter,\naccess to the right common and internal carotid arteries, left common and\ninternal carotid arteres, left and right vertebral arteries, was obtained. \nDynamic angiographic images were acquired.  Dedicated volumetric CT images\nwere obtained centered at the left posterior fossa \n\nThereafter, the wires and catheters were removed.  The sheath was then removed\nand manual pressure held at the arteriotomy site for 15 minutes.  Excellent\nhemostasis was achieved and a sterile dressing was applied.  The patient left\nthe angiography suite in stable condition.\n\nFINDINGS:\n\nRIGHT INTERNAL CAROTID ARTERY:  The right ICA is normal in caliber and\nbranching pattern.  There is no aneurysm or significant stenosis.  There is a\nrobust right posterior communicating artery. \n\nRIGHT COMMON AND EXTERNAL CAROTID ARTERY:  The right CCA and ECA are normal in\ncaliber and branching pattern.  There is no aneurysm or significant stenosis. \nThere is no evidence of abnormal feeding vessel arising directly from the\nright CCA/ECA  to the left posterior fossa AVM. \n\nLEFT INTERNAL CAROTID ARTERY:  The left ICA is normal in caliber and branching\npattern.  There is no aneurysm or significant stenosis.  The left posterior\ncommunicating artery is hypoplastic. \n\nLEFT COMMON AND EXTERNAL CAROTID ARTERY:  The left CCA and ECA are normal in\ncaliber and branching pattern.  There is no aneurysm or significant stenosis. \nThere is no evidence of abnormal feeding vessel arising directly from the left\nCCA/ECA to the left posterior fossa AVM. \n\nLEFT VERTEBRAL ARTERY:  The left vertebral artery and the basilar artery are\nnormal in caliber.  Sequential angiographic images demonstrate filling of a\n4-cm area of tangled collateral vessels in the left posterior fossa.  The\nfeeding vessels are predominately from the left posterior cerebral artery,\nwith possibly smaller feeding vessels from the superior cerebellar arteries\nbilaterally.  There is early venous drainage directly into the adjacent left\ntransverse sinus.\n\nRIGHT VERTEBRAL ARTERY:  The right vertebral artery and the basilar artery are\nnormal in caliber.  Angiographic images demonstrate identical filling and\ndraining pattern of the left posterior fossa arteriovenous malformation, as\nalready described the LEFT VERTEBRAL ARTERY section.  No additional feeding\nvessel is identified arising directly from the right vertebral artery.\n\nIMPRESSION:  ___ underwent cerebral angiography revealing:\n\n1.  A 4-cm area of tangled collateral vessels with a nidus in the left\nposterior fossa, predominately feeding from the left posterior cerebral\nartery, but also possibly from the bilateral superior cerebellar arteries. \nEarly draining vein directly into the left transverse sinus.  The\nconstellation of findings represents arteriovenous malformation.The\nmalformation measures aaproximately 4 cms in diameter. \n\n2.  No feeding vessels arising from the external carotid artery in either\nside.\n\n\n\n[RADIOLOGY] HISTORY:  Patient with posterior fossa hemorrhage likely secondary to\narteriovenous malformation status post diagnostic angiography.\n\nTECHNIQUE:  Axial images of the head were obtained without contrast.\n\nCOMPARISON:  Comparison was made with the CTA examination of ___ and\ncerebral angiography of ___.\n\nFINDINGS:\n\nAgain identified is a cerebellar hemorrhage in the region of vermis which\nextends to the adjacent subdural space.  There is mass effect on the ___\nventricle.  There is ventricular dilatation which appears to have slightly\nincreased from the prior study.  There is contrast visualized within the\nvascular structures from recent angiography.  There is no area of loss of\ngray-white matter differentiation seen.  Artifacts limit evaluation in the\noccipital region.\n\nIMPRESSION:\n\nUnchanged appearance of the posterior fossa hemorrhage.  Slight increase in\nventricular size.\n\n\n\n[RADIOLOGY] INDICATION:  Patient with posterior fossa hemorrhage.  Assess for interval\nchange.\n\nCOMPARISONS:  NECTs of ___ (6.5 hours earlier), ___.\n\nTECHNIQUE:  MDCT-acquired contiguous images through the head were obtained\nwithout intravenous contrast at 5-mm section thickness.  Coronally and\nsagittally reformatted images are provided.  The initial attempts were\nsubstantially motion-degraded; the third effort is of diagnostic quality.\n\nFINDINGS:  There is a large parenchymal hemorrhage, centered at the level of\nthe cerebellar vermis, which has not significantly changed in extent since\nstudy obtained 6.5 hours prior.  There is persistent adjacent edema and mass\neffect on the fourth ventricle., which appears compressed, unchanged since\nprior.  Blood products are also seen layering along the tentorium cerebelli\nand cerebellar folia.  The lateral and third ventricles are minimally\nincreased in size since prior.  The temporal horns appear dilated, as before. \nThe perimesencephalic cisterns are effaced.  The suprasellar cisterns remain\npatent.  No vascular territorial infarction is noted.  There is no shift of\nnormally midline structures.  Imaged paranasal sinuses and mastoid air cells\nare well aerated.  The orbits are unremarkable.  No acute fracture is\ndetected.\n\nIMPRESSION:  In comparison to study obtained 6.5 hours prior, there is no\nsignificant change in the extenisve posterior fossa hemorrhage as described\nabove.  There is persistent adjacent edema and mass effect on the fourth\nventricle.  There is minimal increase in size of the lateral and third\nventricles since prior exam.  No new focus of acute intracranial hemorrhage.\n\nNOTE ADDED IN ATTENDING REVIEW: There is both an intra- and an extra-axial\ncomponent to the posterior fossa hemorrhage; as above, the blood and\nsurrounding edema exert significant mass effect, with both upward\ntranstentorial and cerebellar tonsillar herniation. There is effacement of the\n___ ventricle with obstructive hydrocephalus and early transependymal\nmigration of CSF.  These findings have progressed significantly since the\noriginal (___) NECT of 10:50, ___.\n\n\n[RADIOLOGY] HISTORY:  Posterior fossa arterial venous malformation with hemorrhage. \nEvaluate for interval change.\n\nTECHNIQUE:  Sequential axial images were acquired through the head without\nadministration of intravenous contrast material.  Multiplanar reformats were\nperformed.\n\nCOMPARISON:  Multiple prior CT studies dating back through ___,\nincluding the most recent study from ___.\n\nFINDINGS:\n\nThere is redemonstration of a large parenchymal hemorrhage centered in the\ncerebellar vermis, causing compression of the ___ ventricle, similar in\nappearance compared to the prior study from approximately 6 hours ago. \nHemorrhagic material is also seen layering over the tentorium cerebelli and\ncerebellar folia, not significantly changed.  Dilatation of the ___ ventricle\nand lateral ventricles is not significantly changed compared to the most\nrecent CT from ___, although has increased compared to the earliest\navailable CT from ___.  The cerebellar tonsils protrude inferiorly\ninto the foramen magnum (9:1), similar in appearance to the CTs of ___.  The perimesencephalic cisterns remain effaced, while the suprasellar\ncistern is preserved.  There is no new intracranial hemorrhage or evidence of\nacute large vascular territorial infarction.  Periventricular white matter\nhypodensities have progressed since the earliest available CT from ___, although are similar in appearance compared to the most recent study\nfrom ___, concerning for transependymal flow of CSF relating to\nobstructive hydrocephalus.  The orbits are unremarkable.  The imaged portions\nof the paranasal sinuses and mastoid air cells are well aerated.\n\nIMPRESSION:\n\n1. No significant short-interval change in the large posterior fossa\nparenchymal hemorrhage, with blood layering over the tentorium cerebelli\nand/or the cerebellar folia.\n\n2. Stable enlargement of the ___ and lateral ventricles, compared to the most\nrecent study from approximately 6 hours ago, though the degree of ventricular\ndilatation has substantially increased compared to the earliest available\nstudy from ___.  Increased periventricular white matter hypodensity\nis concerning for transependymal CSF flow due to obstructive hydrocephalus.\n\n3. No new intracranial hemorrhage or acute large vascular territorial\ninfarction.\n\nCOMMENT: Pertinent findings were discussed with Dr. ___ (Neurosurgery\nservice), by Dr. ___ telephone, at 05:25 AM on ___.  \n\n\n\n[RADIOLOGY] HISTORY:  ___ female with posterior fossa hemorrhage here for\nassessment of line placement.\n\nCOMPARISON:  ___.\n\nFINDINGS:  Single frontal view of the chest demonstrates a new left subclavian\napproach central venous catheter with tip projecting over the upper SVC. \nThere is no appreciable pneumothorax.  Lung volumes are decreased as compared\nto 2 days prior, with increased perihilar vascular congestion and mild\npulmonary edema.   There is mild cardiomegaly.  There may be a small left\npleural effusion.\n \n\nIMPRESSION:  \n\n1. Left subclavian central venous catheter appropriate in position, without\npneumothorax. \n\n2. Mild pulmonary edema.\n\n\n\n[RADIOLOGY] CHEST RADIOGRAPH\n\nINDICATION:  Posterior fossa hemorrhage, pulmonary edema, evaluation for\ninterval change.\n\nCOMPARISON:  ___.\n\nFINDINGS:  As compared to the previous radiograph, the severity and extent of\nthe pulmonary edema has not substantially changed.  The lung volumes have\nslightly increased, likely reflecting improved ventilation.  Unchanged\nmoderate cardiomegaly, unchanged position of the left subclavian vein\ncatheter.\n\n\n[RADIOLOGY] HISTORY:   ___ y/o F with posterior fossa hemorrhage, likely secondary to\nruptured AVM. Evaluate for interval change, as patient has increased\nsomnolence and is disoriented.\n\nTECHNIQUE:  Sequential axial images were acquired through the head without\nadministration of intravenous contrast material.  \n\nCOMPARISON:  Multiple prior CT studies, most recent on ___.\n\nDLP: 1410.36 mGy-cm\nCTDI: 58.56 mGy\n\nFINDINGS:\n\nThere is no significant interval change in large parenchymal hemorrhage\ncentered in the cerebellar vermis, causing compression of the ___ ventricle.\nPeripheral edema is slightly more conspicuous than in prior.  Hemorrhagic\nmaterial is also seen layering over the tentorium cerebelli and cerebellar\nfolia, not significantly changed.  Dilatation of the ___ ventricle and lateral\nventricles as well as protrusion of the cerebellar tonsils into the foramen\nmagnum have increased compared with prior.  The perimesencephalic cisterns\nremain effaced, while the suprasellar cistern is preserved.  \n\nThere is no new hemorrhage and no evidence of infarction.  Periventricular\nwhite matter hypodensities are similar in appearance to prior exam.  The\norbits are unremarkable.  The imaged portions of the paranasal sinuses and\nmastoid air cells are well aerated.\n\nIMPRESSION:\n\n1. No significant interval change in the large posterior fossa parenchymal\nhemorrhage, with blood layering over the tentorium cerebelli and cerebellar\nfolia.\n\n2. Stable enlargement of the ___ and lateral ventricles, effacement of the\nperimesencephalic cisterns and cerebellar tonsils protrusion into the foramen\nmagnum. \n\n\n\n\n[RADIOLOGY] CHEST RADIOGRAPH\n\nINDICATION:  Nasogastric tube placement.\n\nCOMPARISON:  ___, 4:41 a.m.\n\nFINDINGS:  As compared to the previous radiograph, the patient has received a\nnasogastric tube.  The course of the tube is unremarkable, the tip of the tube\nprojects over the middle parts of the stomach.  There is no evidence of\ncomplications.  Otherwise, unchanged radiograph with moderate pulmonary edema,\nlarge right hilus and moderate cardiomegaly as well as an unchanged position\nof the left subclavian vein catheter.\n\n\n[RADIOLOGY] HISTORY:   ___ y/o F with posterior fossa hemmorhage, likely secondary to\nruptured AVM s/p ventriculostomy catheter placement.\n\nTECHNIQUE:  Sequential axial images were acquired through the head without\nadministration of intravenous contrast material.  \n\nCOMPARISON:  Multiple prior CT studies, most recent performed today prior to\nprocedure.\n\nDLP: 1048.01 mGy-cm\nCTDI: 65.98 mGy\n\nFINDINGS:\n\nThere has been interval placement of a right frontal approach ventriculostomy\ncatheter with some pneumocephalus but no blood product noted in the\ncraniostomy site or along the course of the cathter, which ends at the foramen\nof ___.\n\nOtherwise, there is no significant interval change in large parenchymal\nhemorrhage centered in the cerebellar vermis with surrounding edema with\nassociated hemorrhagic material layering over the tentorium cerebelli and\ncerebellar folia.  Mass effect in the form of compression of the ___\nventricle, dilatation of the ___ ventricle and lateral ventricles, protrusion\nof the cerebellar tonsils into the foramen magnum and effacement of the\nperimesencephalic cisterns are unchanged.  \n\nThere is no evidence of new hemorrhage.  The imaged portions of the paranasal\nsinuses and mastoid air cells are well aerated.\n\nIMPRESSION:\n\n1. Interval placement of a right frontal approach ventriculostomy catheter\nending at the foramen ___ with some postsurgical pneumocephalus.\n\n2.  No significant interval change in the large posterior fossa parenchymal\nhemorrhage and mass effect as described above. \n\n\n[RADIOLOGY] CHEST RADIOGRAPH\n\nINDICATION:  Cerebral hemorrhage, evaluation.\n\nCOMPARISON:  ___, 4:05 p.m.\n\nFINDINGS:  As compared to the previous radiograph, there is no relevant\nchange.  Moderate pulmonary edema.  Left lower lobe atelectasis, mild\ncardiomegaly.  No abnormalities with regard to the positions of the left\nsubclavian vein catheter and the nasogastric tube.\n\n\n[RADIOLOGY] ANGIO REPORT\n\nDATE OF SERVICE:  ___.\n\nPROCEDURES PERFORMED:\n1.  Left vertebral artery arteriogram.\n2.  Embolization of left superior cerebellar AVM with Onyx 18.\n\nANESTHESIA:  General.\n\nINDICATION:  The patient had presented with a cerebellar hemorrhage from a\nruptured arteriovenous malformation primarily fed by branches of the superior\ncerebellar artery.  Therefore, after discussing the risks and benefits with\nhusband, we decided to proceed with an angiogram and possible embolization.\n\nDETAILS OF PROCEDURE:  Patient was brought to the angiography suite.  IV\nanesthesia was induced in the supine position.  Following this both groins\nwere prepped and draped in a sterile fashion.  Access was gained to the right\ncommon femoral artery using a Seldinger technique and a 6 ___ vascular\nsheath was placed in the right common femoral artery.  We now catheterized the\nleft vertebral artery and AP lateral filming was done.  We now exchanged out\nthe ___ 2 catheter in the left vertebral artery for a Neuron 6 ___ 070\ncatheter.  This was continued to connect to a continuous saline flush. \nFollowing this, 036 DAC catheter was placed in the distal left vertebral\nartery and through this the superior cerebellar artery branches were\ncatheterized with a Synchro wire and SL-10 microcatheter.  We injected two\npedicles with Onyx 18 to obtain a fairly good cast of the AVM with very\nminimal residual AVM; however the draining vein was still apparent at the end\nof the procedure.\n\nThe vascular sheath was left in place and during the procedure patient was\nanticoagulated with an ACD of 206.\n\nFINDINGS:  Left vertebral artery arteriogram shows AVM nidus measuring 2 x 3 x\n2 cm located in the superior aspect of the cerebellum.\n\nLeft vertebral artery arteriogram status post embolization shows that there is\nstill minimal flow from the branches of the superior cerebellar artery and\nwhat appears to be a dural branch of the left vertebral artery.\n\nIMPRESSION:  ___ underwent cerebellar angiography and embolization\nof left superior cerebellar AVM with Onyx 18.\n\n\n[RADIOLOGY] REASON FOR EXAMINATION:  Evaluation of the patient with posterior fossa\nhemorrhage and recently intubated.\n\nPortable AP radiograph of the chest was reviewed on ___.\n\nThe ET tube tip is 2.3 cm above the carina.  The left subclavian line tip is\nat the junction of brachiocephalic vein and SVC.  Heart size and mediastinum\nare unchanged.  There is interval improvement of pulmonary edema.\n\n\n[RADIOLOGY] HISTORY:\n\nPatient is status post embolization and surgery, removal of AV malformation in\nthe posterior fossa on the left.  The patient is here for a followup\nangiogram.\n\nTechnique:\nThe patient was brought to the fluoroscopic suite and placed on the table in\nthe supine position. \nThe right groin was prepped and draped in the usual sterile fashion. Access to\nthe right common femoral artery was obtained using a 19 gauge needle using\nseldinger technique. A ___ Fr sheath and ___ Fr Berenstein 2 catheter was used to\nselect the left vertebral artery.\n\nLEFT VERTEBRAL ARTERY:\n\nEvaluation of the left vertebral artery demonstrates good flow in the proximal\nand distal left vertebral artery, posterior cerebral arteries and superior\ncerebellar arteries bilaterally.  No definite residual arteriovenous\nmalformation noted.\n\nIMPRESSION:\nSuccessful resection of the previously known arteriovenous malformation in the\nposterior fossa on the left.  No definite residual arteriovenous malformation\nnoted.\n\n\n[RADIOLOGY] CHEST RADIOGRAPH\n\nINDICATION:  Posterior fossa hemorrhage, evaluation for interval change.\n\nCOMPARISON:  ___.\n\nFINDINGS:  As compared to the previous radiograph, there is no relevant\nchange.  The monitoring and support devices are constant.  The area of\natelectasis at the bases of the right upper lobe is more circumscribed than\nbefore.  Mild fluid overload.  No pleural effusions.  No pneumothorax.\n\n\n[RADIOLOGY] HISTORY:  Posterior fossa AVM complicated by acute hemorrhage status post onyx\nembolization and recent resection, here to evaluate for interval changes.  \n\nCOMPARISON:  None contrast head CT dated ___.  Cerebral angiogram\ndated ___ and ___. \n\nTechnique:  Multi detector CT imaging of the head was performed without\nintravenous contrast.  Coronal and sagittal reformatted images as well as thin\nsection images in bone window algorithm were generated and reviewed.  \n\nFINDINGS:\n\nThe patient is status post occipital craniectomy with overlying metallic mesh\nand expected postoperative changes including left posterior fossa\npneumocephalus.  Onyx embolization material is noted in the left superior\ncerebellar hemisphere compatible with recent embolization of bleeding AVM. \nResidual hyperdense blood products are again seen centered in the cerebellar\nvermis compatible with parenchymal hemorrhage, decreased in extent compared to\nthe prior CT of ___.  No new focus of hemorrhage is detected.  There\nis unchanged associated mass effect with compression of the ___ ventricle and\ncrowding of the foramen magnum effacing the perimesencephalic cisterns, which\nis unchanged. \n\nA right frontal approach ventriculostomy catheter is unchanged in position\nwith the tip terminating at the foramen of ___.  The gray-white matter\ninterface is relatively preserved without evidence of acute major vascular\nterritorial infarct.  Mild mucosal thickening is noted in the bilateral\nmaxillary sinuses.  There is near complete opacification of the right ethmoid\nair cells greater than the left.  Mucosal thickening in the bilateral sphenoid\nsinuses is also noted with an air-fluid level in the right sphenoid sinus. \nThe mastoid air cells and middle ear cavities are clear bilaterally.  Vascular\ncalcification in the carotid siphons is noted.  \n\nIMPRESSION:\n\n1.  Expected postoperative appearance status post occipital craniectomy and\nresection of left cerebellar AVM with decreased but persistent parenchymal\nhemorrhage involving the cerebellar vermis but no new focus of hemorrhage. \n\n2.  Unchanged mass effect in the posterior fossa with compression of the ___\nventricle and crowding of the foramen magnum.  \n\n\n\n[RADIOLOGY] HISTORY:  Status post left cerebellar AVM resection with EVD pulled back. \nEvaluate for interval change.\n\nTECHNIQUE:  Contiguous axial helical MDCT images were obtained of the brain\nwithout contrast.\n\nDLP: 113___.65 mGy-cm.\n\nCOMPARISON:  Noncontrast head CT ___.\n\nFINDINGS:\n\nThe patient is status post occipital craniectomy with resection of left\ncerebellar AVM with mesh placement.  Unchanged postoperative changes are noted\nincluding mild posterior fossa pneumocephalus, residual Onyx embolization\nmaterial, and residual hyperdense blood products in the cerebellar vermis\nwithout new hemorrhage identified.  There has been interval partial withdrawal\nof the right frontal approach ventriculostomy catheter which now terminates in\nthe anterior horn of the right lateral ventricle.  Overall ventricular size is\nmildly decreased compared to prior study when taking into account the plane of\nthe scan.  Local mass-effect obliterating the ___ ventricle and effacing the\nperimesencephalic cisterns is unchanged from prior study.  Mucosal wall\nthickening is again noted in the right maxillary sinus and ethmoid air cells\nalong with air-fluid level in the right sphenoid sinus.  The mastoid air cells\nand middle ear cavities are well aerated.  Atherosclerotic mural\ncalcifications are noted in the carotid siphons.\n\nIMPRESSION:\n\nPartial withdrawal of the right frontal approach ventriculostomy catheter with\nthe tip terminating in the anterior horn of the right lateral ventricle with\nminimal decrease in size of ventricles.  Otherwise no significant change\ncompared to exam from 9 hours prior.\n\n\n\n[RADIOLOGY] CHEST RADIOGRAPH\n\nINDICATION:  Posterior fossa hemorrhage, evaluation for nasogastric tube\nposition.\n\nFINDINGS:  As compared to the previous radiograph, the nasogastric tube has\nbeen advanced.  The tip is difficult to visualize but appears to project over\nthe distal parts of the stomach.  The other monitoring and support devices are\nin constant position.  Moderate cardiomegaly, endotracheal tube in situ. \nUnchanged position of the left subclavian catheter.  The pre-existing disease\nat the bases of the right upper lobe has resolved in the interval.\n\n\n[RADIOLOGY] PORTABLE AP CHEST X-RAY\n\nINDICATION:  Patient with posterior fossa hemorrhage, AVN coil, rule out acute\nchange.\n\nCOMPARISON:  ___.\n\nFINDINGS:\n\nPatient has been extubated.  Left lung increased opacification is accompanied\nwith shift of the mediastinum.  NG tube is in adequate position and left\nsubclavian line ends at the junction of the brachiocephalic vein and superior\nvena cava.  There is no pneumothorax.\n\nCONCLUSION:\n\n1.  Patient has been extubated.\n2.  New left lung opacification and mediastinal shift is probably explained by\npartial lung collapse due to mucus plugging.\n\n\n[RADIOLOGY] PORTABLE AP CHEST X-RAY\n\nINDICATION:  Patient with posterior fossa hemorrhage.\n\nCOMPARISON:  ___, at 20:22.\n\nFINDINGS:\n\nLeft lung atelectasis has significantly improved with only minimal residual\nvolume loss at the lung base.  Mild pulmonary congestion is unchanged.  Left\nsubclavian line ends at the junction of superior vena cava and brachiocephalic\nvein.  There is no pneumothorax.  Bilateral pleural effusions are small.\n\nCONCLUSION:\n\n1.  Significant improvement of left lung atelectasis.\n2.  Unchanged mild pulmonary edema.\n\n\n[RADIOLOGY] HISTORY:  NG tube placement.\n\nFINDINGS:  In comparison with the study of ___, the nasogastric tube extends\nto the lower stomach, where it crosses the lower margin of the image.  The\ndegree of pulmonary vascular congestion has decreased.  Mild residual\natelectasis at the left base.\n\n\n[RADIOLOGY] PORTABLE CHEST, ___\n\nCOMPARISON:  ___ radiograph.\n\nFINDINGS:  Cardiomediastinal contours are stable in appearance.  Persistent\npatchy and linear atelectasis at left lung base with otherwise clear lungs.\n\n\n[RADIOLOGY] CHEST RADIOGRAPH\n\nINDICATION:  Foci of hemorrhage, evaluation for interval change.\n\nCOMPARISON:  ___.\n\nFINDINGS:  As compared to the previous radiograph, there is no relevant\nchange.  Mild cardiomegaly with mild fluid overload but no evidence of\npneumonia or overt pulmonary edema.  No pleural effusions.  No evidence of\npneumonia.  The monitoring and support devices are in constant position.\n\n\n[RADIOLOGY] EXAM:  CT of the head.\n\nCLINICAL INFORMATION:  Patient with posterior fossa hemorrhage, for further\nevaluation.\n\nTECHNIQUE:  Axial images of the head were obtained without contrast and\ncompared with prior CT of ___.\n\nFINDINGS:  There has been interval change in the position of the frontal\ndrain.  It now ends in the anterior horn of the right lateral ventricle. \nThere is mild prominence of ventricles which is unchanged.  Extensive\nposterior fossa clips and embolization material is identified as well as\ncranioplasty is seen.  The previously seen hemorrhage has decreased in size\nbut a small area of hyperdensity is seen in the midline.  There remains some\ncompression of the fourth ventricle.  There is no definite new hemorrhage\nseen.  The basal cisterns remain patent, but the quadrigeminal cistern is\nstill not clearly visualized.  Extensive soft tissue changes are seen\npredominantly in the right sphenoid sinus as before.\n\nIMPRESSION:  Mild ventriculomegaly, unchanged from prior study, but the\nventricular catheter tip has now changed into the anterior horn of the right\nlateral ventricle.  Further evaluation of posterior fossa blood products with\nstill a small area of high density is seen in the midline, but no new\nhemorrhage.  Post-embolization and surgical changes are seen in the posterior\nfossa as before.\n\n\n[RADIOLOGY] HISTORY:  Posterior fossa hemorrhage secondary to arteriovenous malformation\nstatus post coiling.\n\nTECHNIQUE:  Contiguous axial MDCT images of the head were obtained without\ncontrast.\n\nDLP: ___.\n\nCOMPARISON:  Multiple noncontrast head CTs ranging from ___.\n\nFINDINGS:\n\nThere has been no significant interval change compared to ___ with re-\ndemonstration of a postprocedural change from posterior cranioplasty and the\nmultiple posterior fossa surgical clips and embolization material.  A small\narea of hyperattenuating material is again noted in the midline adjacent to\nthe embolization site.  The ventriculostomy catheter remains in the frontal\nhorn of the right lateral ventricle where unchanged size and configuration of\nthe ventricles.  Effacement of the ___ ventricle from edema is unchanged. \nSurrounding edema is causing unchanged upward herniation of the cerebellum\nwith effacement of the quadrigeminal cistern.  Fluid levels in the right\nsphenoid air cell is unchanged.  Mucosal wall thickening is noted in bilateral\nmaxillary sinuses.  The mastoid air cells and middle ear cavities are clear.\n\nIMPRESSION:\n\nNo significant change compared to ___ with stable post embolization and\nsurgical changes of posterior fossa with surrounding unchanged blood products\nand stable configuration of the ventricles.\n\n\n\n[RADIOLOGY] INDICATION:  ___ female patient with posterior fossa hemorrhage. \nStudy requested for evaluation of interval change.\n\nCOMPARISON:  Prior chest radiograph from ___.\n\nTECHNIQUE:  Portable erect AP chest radiograph.\n\nFINDINGS:  A left subclavian catheter line is seen projecting within the SVC.\nA nasogastric tube projects over the gastric fundus.  As compared to most\nrecent prior exam, there has been no significant change.  There is stable mild\ncardiomegaly.  There is no evidence of pneumonia.  There are no pleural\neffusions or pneumothorax.\n\nIMPRESSION:  Stable chest examination with no evidence of pneumonia.\n\n\n[RADIOLOGY] HISTORY:  ___ female status post arm embolization with prolonged bed\nrest.  Evaluate for DVT in either leg.\n\nCOMPARISON:  No previous exam for comparison.\n\nFINDINGS:\n\nGrayscale, color and Doppler images were obtained of bilateral common femoral,\nfemoral, popliteal and tibial veins.  Normal flow, compression and\naugmentation is seen in all of the vessels.\n\nIMPRESSION:\n\nNo evidence of deep vein thrombosis in either leg.\n\n\n\n[RADIOLOGY] SINGLE FRONTAL VIEW OF THE CHEST\n\nREASON FOR EXAM:  posterior fossa hemorrhage secondary to AVM.\n\nComparison is made with prior study ___.\n\nCardiomegaly is stable.  NG tube tip is in the stomach and the tip is coiled\nin the stomach.  The lungs are clear.  There is no evidence of pulmonary\nedema, pneumothorax or pleural effusion.\n\n\n[RADIOLOGY] HISTORY:  Posterior fossa hemorrhage secondary to AVM status post surgery and\nembolization.\n\nTECHNIQUE:  Portable CT images were obtained of the head without contrast.\n\nDLP 1131.65 mGy-cm.\n\nCOMPARISON:  Multiple noncontrast head CTs dating back to ___.\n\nFINDINGS:\n\nWhen serial exams are compared dating back to ___, there appears to be\nslight, progressive inward bending of the cranial mesh presenting a degree of\nlocal mass effect.  There has been interval withdrawal of a right frontal\napproach ventriculostomy catheter and the ventricular size and configuration\nremains unchanged. There is otherwise no significant change compared to ___ with redemonstrations of postprocedural changes in the posterior fossa as\nwell as an unchanged amount of blood products Degree of posterior fossa edema\nis unchanged causing upward herniation of the cerebellum with effacement of\nthe quadrigeminal cistern and ___ ventricle.  No new bleed or vascular\nterritory infarct is identified.  Fluid levels in the right sphenoid air cell\nis unchanged.  Mucosal wall thickening is noted in bilateral maxillary\nsinuses.\n\nIMPRESSION:\n\nSerial comparison of studies from ___ shows progressive inward bending of\nthe cranial mesh into the posterior fossa presenting some degree of mass\neffect.  Interval withdrawal of ventriculostomy catheter.  Otherwise no\nsignificant change compared to ___.\n\n\n\n[RADIOLOGY] INDICATION:  ___ female patient with posterior fossa hemorrhage, AVM,\nstatus post coil.  Study requested for evaluation of edema, consolidation\nand/or interval change.\n\nCOMPARISON:  Prior chest radiograph from ___.\n\nTECHNIQUE:  Portable semi-erect AP chest radiograph.\n\nFINDINGS:  As compared to prior chest radiograph from ___, lung\nvolumes have decreased accentuating the cardiac silhouette and bronchovascular\nstructures. No focal consolidations concerning for pnuemonia are identified.\nThere is no pulmonary edema, pleural effusions or pneumothorax.    \n\nIMPRESSION:  No radiographic evidence of an acute cardiopulmonary process.\n\n\n[RADIOLOGY] HISTORY:  Status post left suboccipital craniotomy and resection of\narteriovenous malformation.\n\nTECHNIQUE:  Contiguous axial MDCT images were obtained of the head without\ncontrast.\n\nDLP:  780.44 mGy-cm.\n\nCOMPARISON:  Noncontrast head CT ___.\n\nFINDINGS:\n\nAgain appreciated ia hyperdense Onyx embolization products in the left\noccipital lobe from prior arteriovenous malformation embolization.  The\npatient is status post left suboccipital craniectomy with a resection of the\nAVM and placement of a cranial mesh.  Compared to prior study the cranial mesh\nappears more straight and is no longer bowing into the surrounding brain\nparenchyma.  There has been interval resolution of surrounding cerebellar and\noccipital parenchymal edema surrounding the resection bed.  There has been\nresolution of postsurgical blood products as well.  There is no edema, mass\neffect, hemorrhage or major territorial infarct.  Prominent ventricles and\nsulci are suggestive of age-related involutional change.  The overall size and\nconfiguration of the ventricles is unchanged.  Areas of periventricular,\nsubcortical and deep white matter hypodensity is compatible with chronic small\nvessel ischemic disease.  And the basal cisterns are patent and there is\npreservation of gray-white matter differentiation.  No fracture is identified.\nThere is redemonstration of mucosal wall thickening in the right sphenoid air\ncell however the fluid opacification of the ethmoid air cells has improved. \nThe middle ear cavities and mastoid air cells are clear.  The globes are\nunremarkable.\n\nIMPRESSION:\n\nStatus post resection of left occipital arteriovenous malformation with\nassociated postoperative change and residual Onyx embolization material. \nThere has been interval resolution of blood products in the resection bed as\nwell as the surrounding edema.  The overlying cranial mesh appears in adequate\nposition and it no longer bows into the parenchyma.\n\n\n\n[RADIOLOGY] HISTORY:  ___ woman status post left suboccipital craniotomy for\nresection of cerebral arteriovenous malformation.  Assess for change.\n\nTECHNIQUE:  Contiguous axial MDCT images were obtained through the brain\nwithout administration of IV contrast.\n\nCOMPARISON:  Multiple nonenhanced CT scans of the head dated ___ and\n___.\n\nTotal DLP:  780.44 mGy/cm\n\nCTDIvol:  52.22 mGy\n\nFINDINGS:\n\nThe again appreciated are hyperdense embolization products in the left\noccipital lobe from prior AV malformation embolization.  There is a large\namount of streak artifact present within this region.  Assessment of evolution\nof AVM is limited based on both the degree of streak artifact present, as well\nas the lack of IV contrast. The patient is status post left suboccipital\ncraniectomy with resection of the AVM and placement of cranial mesh, which\nappears unchanged from prior study.  A right-sided fronto-temporal burr hole\nis again noted. \n\nThere is no edema, mass effect, hemorrhage, or large vascular territory\ninfarction.  Again noted are slightly prominent ventricles and sulci,\nsuggestive of age-related involutional change.  There are stable areas of\nperiventricular white matter hypodensities, consistent with chronic small\nvessel ischemic disease.  The basal cisterns appear patent and there is\npreservation of gray-white matter differentiation.  The visualized paranasal\nsinuses, and mastoid air cells, and middle ear cavities are clear.  The globes\nare unremarkable.\n\nIMPRESSION:\n\nNo acute intracranial process.",
+  "ai_summary": "**Patient's Preoperative Status Summary**\n\n**Demographics:**\n\n* Age: 66 years\n* Gender: Female\n* Race: White\n* Admission Type: Emergency\n* Insurance: Medicare\n\n**Comorbidities:**\n\n1. Hypertension (HTN)\n2. Coronary artery disease (not explicitly stated, but implied by the presence of multiple medications)\n3. Diabetes (not explicitly stated, but implied by the presence of medications)\n4. Chronic kidney disease (CKD) (not explicitly stated, but implied by the presence of medications)\n5. Hyperlipidemia (not explicitly stated, but implied by the presence of medications)\n6. Chronic obstructive pulmonary disease (COPD) (not explicitly stated, but implied by the presence of medications)\n7. Atrial fibrillation (not explicitly stated, but implied by the presence of medications)\n8. Chronic obstructive pulmonary disease (COPD) (not explicitly stated, but implied by the presence of medications)\n9. Chronic kidney disease (CKD) (not explicitly stated, but implied by the presence of medications)\n10. Hyperlipidemia (not explicitly stated, but implied by the presence of medications)\n11. Atrial fibrillation (not explicitly stated, but implied by the presence of medications)\n12. Chronic obstructive pulmonary disease (COPD) (not explicitly stated, but implied by the presence of medications)\n\n**Medications:**\n\n1. Atenolol (beta-blocker)\n2. Lisinopril (ACE inhibitor)\n3. Lisinopril (ACE inhibitor)\n4. Hydralazine (antihypertensive)\n5. Nicardipine (antihypertensive)\n6. OxyContin (opioid analgesic)\n7. Insulin (glucose-lowering)\n8. Gemfibrozil (lipid-lowering)\n9. Docusate (stool softener)\n10. Lasix (diuretic)\n\n**Lab Results:**\n\n1. WBC: 16.2 (elevated)\n2. RBC: 4.53 (mildly decreased)\n3. Hgb: 14.5 (mildly decreased)\n4. Hct: 43.2 (mildly decreased)\n5. MCV: 95 (normal)\n6. MCH: 32.0 (normal)\n7. MCHC: 33.6 (normal)\n8. RDW: 13.3 (normal)\n9. Plt: Not provided (not available)\n\n**Imaging Results:**\n\n1. CTA head:\n\t* Large hemorrhage centered in the medial left cerebellum\n\t* Slightly increased compression of the third ventricle\n\t* Bilateral paratentorial subdural hemorrhage and hemorrhage along the cerebellar folia\n\t* Abnormal vessels in the superior left cerebellar hemisphere with a large draining vein, suggesting an arteriovenous malformation (AVM)\n2. Angiogram:\n\t* A 4-cm area of tangled collateral vessels with a nodus in the left posterior fossa, predominately feeding from the left posterior cerebral artery, but also possibly from the bilateral superior cerebellar arteries\n\t* Early draining vein directly into the left transverse sinus\n3. CT head without contrast:\n\t* Unchanged appearance of the posterior fossa hemorrhage\n\t* Slight increase in ventricular size\n\t* Increased periventricular white matter hypodensity is concerning for transependymal CSF flow due to obstructive hydrocephalus\n4. CTA head:\n\t* Large hemorrhage centered in the medial left cerebellum\n\t* Slightly increased compression of the third ventricle\n\t* Bilateral paratentorial subdural hemorrhage and hemorrhage along the cerebellar fol",
+  "overall_rating": 2,
+  "feedback": "1",
+  "categories": {
+    "medical_accuracy": 3,
+    "clinical_relevance": 3,
+    "completeness": 3,
+    "clarity": 3
+  },
+  "sentence_comments": []
+}

patient_evaluations/patient_evaluations_master.csv

@@ -1,2 +1,6 @@
 timestamp,patient_id,expert_name,overall_rating,medical_accuracy,clinical_relevance,completeness,clarity,feedback,sentence_comments_count
 2025-09-03T01:08:09.956832,15110470,Jesse,2,2,2,4,2,Good,0
+2025-09-10T03:03:04.131315,19254962,jj,2,3,3,3,3,1,0
+2025-09-10T12:06:13.364235,10072153_adm_21253864,JJ,2,4,2,4,2,,0
+2025-10-07T03:13:07.353927,10042908_adm_20358696,111,2,3,3,3,3,111,0
+2025-10-07T04:32:04.210907,12991336_adm_25464784,11,2,3,2,2,2,11,0

requirements.txt

@@ -65,3 +65,8 @@ tzdata==2024.1
 urllib3==2.2.3
 uvicorn==0.30.6
 websockets==11.0.3
+google-api-python-client==2.143.0
+google-auth-httplib2==0.2.0
+google-auth-oauthlib==1.2.1
+Flask==2.3.3
+flask-cors==4.0.0

src/conversation.py

@@ -96,6 +96,6 @@ class Conversation:
 
 
 if __name__ == '__main__':
-    os.environ["OPENAI_API_KEY"] = "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"
+    os.environ["OPENAI_API_KEY"] = OPENAI_API_KEY
     c = Conversation()
     c.start_session()

src/server.py

@@ -141,8 +141,9 @@ def configure_routes(app, args):
         '''
         data = request.get_json()
         username = data.get('username')
-
-        os.environ["OPENAI_API_KEY"] = "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"
+        api_key = data.get('api_key')
+        if api_key and isinstance(api_key, str) and api_key.strip():
+            os.environ["OPENAI_API_KEY"] = api_key.strip()
 
         # initialize
         # server.patient.patient_id = username

summaries/subject_11402775_hadm_25285222_input.txt

@@ -0,0 +1,724 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 55
+- Gender: M
+
+ADMISSION:
+- Admission ID: 25285222
+- Admission Type: EW EMER.
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: HOME
+- Insurance: Other
+- Race: BLACK/AFRICAN AMERICAN
+- Marital Status: SINGLE
+- Language: ENGLISH
+
+PROCEDURES (0 total):
+- None
+
+DIAGNOSES (13 total):
+- A481 (ICD-10)
+- N179 (ICD-10)
+- E871 (ICD-10)
+- E440 (ICD-10)
+- E860 (ICD-10)
+- E8339 (ICD-10)
+- I480 (ICD-10)
+- R197 (ICD-10)
+- D649 (ICD-10)
+- E041 (ICD-10)
+- F1011 (ICD-10)
+- Z87891 (ICD-10)
+- Z6820 (ICD-10)
+
+LABORATORY RESULTS:
+- Item ID 50802: 1 measurements, 2197-09-13 16:38:00 to 2197-09-13 16:38:00
+- Item ID 50804: 1 measurements, 2197-09-13 16:38:00 to 2197-09-13 16:38:00
+- Item ID 50813: 3 measurements, 2197-09-13 16:38:00 to 2197-09-14 13:16:00
+- Item ID 50818: 1 measurements, 2197-09-13 16:38:00 to 2197-09-13 16:38:00
+- Item ID 50820: 1 measurements, 2197-09-13 16:38:00 to 2197-09-13 16:38:00
+- Item ID 50821: 1 measurements, 2197-09-13 16:38:00 to 2197-09-13 16:38:00
+- Item ID 50861: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50862: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 50863: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50868: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50878: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50882: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50883: 1 measurements, 2197-09-13 16:03:00 to 2197-09-13 16:03:00
+- Item ID 50884: 1 measurements, 2197-09-13 16:03:00 to 2197-09-13 16:03:00
+- Item ID 50885: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50889: 2 measurements, 2197-09-14 07:10:00 to 2197-09-15 06:33:00
+- Item ID 50893: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50902: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50909: 2 measurements, 2197-09-13 16:03:00 to 2197-09-14 09:32:00
+- Item ID 50912: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50920: 1 measurements, 2197-09-14 07:10:00 to 2197-09-14 07:10:00
+- Item ID 50924: 7 measurements, 2197-09-07 16:03:00 to 2197-09-15 06:33:00
+- Item ID 50931: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50934: 14 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50935: 1 measurements, 2197-09-13 16:03:00 to 2197-09-13 16:03:00
+- Item ID 50938: 1 measurements, 2197-09-08 06:42:00 to 2197-09-08 06:42:00
+- Item ID 50940: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 50941: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 50942: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 50943: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 50947: 14 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50952: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 50953: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 50954: 6 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50960: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50963: 1 measurements, 2197-09-13 16:03:00 to 2197-09-13 16:03:00
+- Item ID 50964: 1 measurements, 2197-09-12 06:50:00 to 2197-09-12 06:50:00
+- Item ID 50970: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50971: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50979: 3 measurements, 2197-09-12 00:00:00 to 2197-09-12 00:00:00
+- Item ID 50983: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 50993: 1 measurements, 2197-09-13 06:42:00 to 2197-09-13 06:42:00
+- Item ID 50998: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 51006: 11 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51082: 3 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51087: 5 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51093: 3 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51099: 1 measurements, 2197-09-13 13:30:00 to 2197-09-13 13:30:00
+- Item ID 51100: 3 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51102: 1 measurements, 2197-09-13 13:30:00 to 2197-09-13 13:30:00
+- Item ID 51103: 2 measurements, 2197-09-11 15:38:00 to 2197-09-12 00:00:00
+- Item ID 51133: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 51146: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 51200: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 51221: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51222: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51237: 4 measurements, 2197-09-07 07:43:00 to 2197-09-15 06:33:00
+- Item ID 51244: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 51248: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51249: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51250: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51254: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 51256: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 51265: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51274: 4 measurements, 2197-09-07 07:43:00 to 2197-09-15 06:33:00
+- Item ID 51275: 3 measurements, 2197-09-07 07:43:00 to 2197-09-15 06:33:00
+- Item ID 51277: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51279: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51282: 1 measurements, 2197-09-13 16:03:00 to 2197-09-13 16:03:00
+- Item ID 51283: 1 measurements, 2197-09-13 16:03:00 to 2197-09-13 16:03:00
+- Item ID 51301: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51463: 1 measurements, 2197-09-08 13:15:00 to 2197-09-08 13:15:00
+- Item ID 51464: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51466: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51476: 1 measurements, 2197-09-08 13:15:00 to 2197-09-08 13:15:00
+- Item ID 51478: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51479: 1 measurements, 2197-09-08 13:15:00 to 2197-09-08 13:15:00
+- Item ID 51482: 1 measurements, 2197-09-08 13:15:00 to 2197-09-08 13:15:00
+- Item ID 51484: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51486: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51487: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51491: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51492: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51493: 1 measurements, 2197-09-08 13:15:00 to 2197-09-08 13:15:00
+- Item ID 51498: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51506: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51508: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51512: 1 measurements, 2197-09-08 13:15:00 to 2197-09-08 13:15:00
+- Item ID 51514: 2 measurements, 2197-09-08 13:15:00 to 2197-09-13 13:30:00
+- Item ID 51516: 1 measurements, 2197-09-08 13:15:00 to 2197-09-08 13:15:00
+- Item ID 51519: 1 measurements, 2197-09-08 13:15:00 to 2197-09-08 13:15:00
+- Item ID 51564: 1 measurements, 2197-09-09 07:17:00 to 2197-09-09 07:17:00
+- Item ID 51657: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 51658: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 51659: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 51662: 1 measurements, 2197-09-08 06:42:00 to 2197-09-08 06:42:00
+- Item ID 51663: 1 measurements, 2197-09-07 16:03:00 to 2197-09-07 16:03:00
+- Item ID 51678: 14 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 51706: 1 measurements, 2197-09-11 18:21:00 to 2197-09-11 18:21:00
+- Item ID 52033: 1 measurements, 2197-09-13 16:38:00 to 2197-09-13 16:38:00
+- Item ID 52069: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 52073: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 52074: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 52075: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 52135: 5 measurements, 2197-09-08 06:42:00 to 2197-09-16 06:52:00
+- Item ID 52171: 1 measurements, 2197-09-13 16:03:00 to 2197-09-13 16:03:00
+- Item ID 52172: 10 measurements, 2197-09-07 07:43:00 to 2197-09-16 06:52:00
+- Item ID 53153: 1 measurements, 2197-09-09 07:17:00 to 2197-09-09 07:17:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                     Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: MEDICINE
+ 
+Allergies: 
+Penicillins
+ 
+Attending: ___.
+ 
+Chief Complaint:
+Abd Pain, Diarrhea, Fever
+
+ 
+Major Surgical or Invasive Procedure:
+None
+
+ 
+History of Present Illness:
+___ PMHx EtOH use disorder who presents with fever, diarrhea. He 
+reports 2 weeks of large volume diarrhea with one to two 
+episodes per day. The diarrhea is watery and non-bloody. 
+Additionally, he reports that he has 'felt like he had the flu' 
+for a week and has had generalized malaise, decreased appetite, 
+and nausea with no emesis. He reported fevers at home up to 
+103.4.
+ 
+Past Medical History:
+Alcohol use disorder
+ 
+Social History:
+___
+Family History:
+No family history of HTN, DM, or cancer
+ 
+Physical Exam:
+ADMISSION PHYSICAL EXAM
+=======================
+GENERAL: Alert and interactive. In no acute distress.
+HEENT: PERRL, EOMI. 
+NECK: No cervical lymphadenopathy. No JVD.
+CARDIAC: regular rate and rhythm , no m/r/g
+LUNGS: Crackles in LLL
+BACK: No CVA tenderness.
+ABDOMEN: Soft, NT, ND, +BS
+EXTREMITIES: No clubbing, cyanosis, or edema. 
+SKIN: Warm. No rashes.
+NEUROLOGIC: AOx3. CN2-12 intact. Grossly intact.  
+
+DISCHARGE PHYSICAL EXAM
+=======================
+GENERAL: Alert and interactive. In no acute distress.
+HEENT: PERRL, EOMI. 
+NECK: No cervical lymphadenopathy. No JVD.
+CARDIAC: Tachycardic, regular rhythm , no m/r/g
+LUNGS: Crackles in LLL 
+BACK: No CVA tenderness.
+ABDOMEN: Soft, NT, ND, +BS
+EXTREMITIES: No clubbing, cyanosis, or edema. 
+SKIN: Warm. No rashes.
+NEUROLOGIC: AOx3. CN2-12 intact. Grossly intact. 
+ 
+Pertinent Results:
+ADMISSION LABS
+==============
+___ 04:37PM BLOOD WBC-6.9 RBC-4.67 Hgb-14.0 Hct-39.9* 
+MCV-85 MCH-30.0 MCHC-35.1 RDW-13.4 RDWSD-42.3 Plt ___
+___ 04:37PM BLOOD Glucose-124* UreaN-34* Creat-1.9*# 
+Na-128* K-4.6 Cl-89* HCO3-25 AnGap-14
+___ 04:37PM BLOOD ALT-274* AST-538* AlkPhos-71 TotBili-1.6* 
+DirBili-0.6* IndBili-1.0
+___ 04:03PM BLOOD calTIBC-157* Ferritn-4264* TRF-121*
+
+DISCHARGE LABS
+==============
+___ 06:52AM BLOOD WBC-7.4 RBC-3.31* Hgb-9.9* Hct-30.3* 
+MCV-92 MCH-29.9 MCHC-32.7 RDW-14.6 RDWSD-48.6* Plt ___
+___ 06:52AM BLOOD Glucose-110* UreaN-9 Creat-0.7 Na-139 
+K-4.2 Cl-105 HCO3-23 AnGap-11
+___ 06:52AM BLOOD ALT-98* AST-95* LD(LDH)-310* AlkPhos-74 
+TotBili-0.5
+___ 06:52AM BLOOD Albumin-2.6* Calcium-8.2* Phos-3.0 Mg-1.7
+___ 06:33AM BLOOD Ferritn-876*
+
+RELEVANT IMAGING
+================
+IMPRESSION:  
+Pre-existing pneumonia in the left upper and lower lobes, 
+attributed to 
+Legionella, as per OMR notes.  No evidence of parenchymal 
+abscesses or 
+empyemas.  Small mediastinal lymph nodes are likely reactive. 
+
+RELEVANT MICRO
+==============
+___ 5:00 pm URINE      TAKEN FROM ___. 
+
+                            **FINAL REPORT ___
+
+   Legionella Urinary Antigen  (Final ___: 
+      PRESUMPTIVE POSITIVE FOR LEGIONELLA SEROGROUP 1 ANTIGEN. 
+             (Reference Range-Negative). 
+
+ 
+Brief Hospital Course:
+SUMMARY
+=======
+Mr. ___ is a ___ y/o M w/ no significant past medical 
+history presented with Legionnaires disease c/b hyponatremia, 
+transaminitis, and an episode of tachyarrythmia. He was treated 
+with IV Levofloxacin and transitioned to PO with resolution of 
+fevers. 
+
+ACUTE/ACTIVE ISSUES
+===================
+# Legionnaires Disease
+Presented with 2 weeks diarrhea, found to have pneumonia on CT, 
+diagnosis of legionella confirmed by urine antigen (99% 
+specific). Also found to have hyponatremia, hypophosphatemia, 
+transaminitis, and hyperferritinemia, all classically associated 
+with legionella. The source of infection is unclear based on 
+housing/occupational history, but health dept was alerted for 
+further investigation into water source. ID was consulted and IV 
+levofloxacin was initiated. Imaging of his chest was obtained on 
+day 5 due to ongoing fevers over 103. CT ruled out empyema. Skin 
+exam was negative for extrapulmonary lesions. Echo was 
+reassuring against endocarditis. He was switched to PO 
+levofloxacin once fevers defervesced and he clinically imrpoved 
+on day 7. EKGs were obtained daily which showed mild QTc 
+prolongation likely due to levofloxacin and inflammation, but 
+never >500. He was discharged home with PO levofloxacin in order 
+to complete total 2 week course (final dose on ___.
+[] Patient will need to complete a total of 2 weeks of 
+antibiotics with levofloxacin. His last dose of medication will 
+be on ___. 
+[] Patient should have repeat lung imaging in ___ weeks after 
+completion of antibiotics in order to ensure resolution of his 
+pneumonia. 
+
+# Tachyarrhythmia 
+Mr ___ had one sustained episode of narrow complex SVT to 
+140s, throughout which he was asymptomatic. The arrythmia 
+resolved without intervention. EKG was obtained which was 
+concerining for A Fib vs AVNRT. Chads vasc score is 0, so no 
+anticoagulation indicated. He was also found to have orthostatic 
+hypotension to 77/53 suggesting hypovolemia as etiology, but 
+given his ample urine output with low urine osms, and his 
+persistent tachycardia despite IV fluid repletion, dehydration 
+was felt to be unlikely cause. No sign of hypovolemia from blood 
+or other fluid losses. Echo reassuring against 
+structural/functional cardiac abnormalities. CTA was negative 
+for PE. TSH was not consistent with thyrotoxicosis. Cortisol was 
+15.1. Cardiology was consulted, and also had difficulty 
+differentiating his tachyarrhythmia. He was discharged with a 
+Ziopatch for 1 month monitoring as an outpatient.
+[] Patient is being discharge with a Ziopatch for 1 month of 
+monitoring. This should be followed up by his PCP. 
+
+# Anemia
+Hgb downtrended throughout admission, most likely acute phase 
+reaction from inflammation. Hemolysis labs were negative, making 
+AIHA triggered by legionella or levofloxacin unlikely. Guiac was 
+obtained to assess for occult GI bleeding, but was negative. 
+Improved prior to discharge. 
+
+# Transaminitis
+Consistent with legionella infection as above. Not thought to be 
+related to previous history of alcohol use. Tested negative for 
+leptospirosis, Hepatitis A/B/C, and HIV. ALT and AST downtrended 
+with treatment of legionella infection. Continue to follow in an 
+outpatient setting. 
+[] Patient will require repeat LFTs prior to his appointment on 
+___. 
+
+# Hyponatremia
+Consistent with legionella, and likely some component of 
+hypovolemia based on urine lytes on admission. Improved with 
+increased PO intake.
+
+# Diarrhea
+Patient presented with 2 weeks of diarrhea likely related to 
+Legionella infection which quickly resolved with initiation of 
+levofloxacin. Negative for C Diff, HIV, and Hep A. He was 
+treated with IV fluids and phospate repletion. 
+
+# ___
+Pre-renal, with urine lytes demonstrating high osm and low 
+sodium. Likely due to dehydration from diarrhea and low PO 
+intake in setting of legionella. Resolved with IVF.
+
+TRANSITIONAL ISSUES
+===================
+[] Patient has an appointment to establish care with a new PCP 
+on discharge. He would benefit from more regular screening of 
+his healthcare maintenance. 
+[] Patient will need to complete a total of 2 weeks of 
+antibiotics with levofloxacin. His last dose of medication will 
+be on ___. 
+[] Patient should have repeat lung imaging in ___ weeks after 
+completion of antibiotics in order to ensure resolution of his 
+pneumonia. 
+[] Patient was incidentally noted to have a Right Thyroid Nodule 
+of 17mm. It should be further evaluated with ultrasound of the 
+thyroid. 
+[] Patient will require repeat LFTs prior to his appointment on 
+___. 
+[] Patient is being discharge with a Ziopatch for 1 month of 
+monitoring. This should be followed up by his PCP. 
+ 
+Medications on Admission:
+The Preadmission Medication list is accurate and complete.
+1. This patient is not taking any preadmission medications
+
+ 
+Discharge Medications:
+1.  LevoFLOXacin 750 mg PO DAILY 
+RX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*2 
+Tablet Refills:*0 
+2.Outpatient Lab Work
+ICD-9 Code: ___
+Contact: ___ phone: ___ fax: ___ 
+Labs: Basic Metabolic Panel, Liver Function Tests
+
+ 
+Discharge Disposition:
+Home
+ 
+Discharge Diagnosis:
+PRIMARY
+=======
+Legionella Pneumonia 
+
+SECONDARY
+=========
+Hyponatremia
+Transaminits 
+Tachyarrhythmia 
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - Independent.
+
+ 
+Discharge Instructions:
+======================  
+DISCHARGE INSTRUCTIONS  
+======================  
+Dear Mr. ___,  
+
+It was a pleasure caring for you at ___ 
+___.  
+
+WHY WAS I IN THE HOSPITAL?  
+- You came to the hospital with fatigue and diarrhea. You were 
+found to have an infection called legionella. 
+
+WHAT HAPPENED TO ME IN THE HOSPITAL?  
+- We performed lab tests and imaging to diagnose the infection.
+- You were treated with an antibiotic called levofloxacin 
+through an IV and transitioned to the oral version. You were 
+given IV fluids because you were dehydrated.  
+- Your heart was found to be beating quickly. In order to better 
+evaluate this, we gave you a monitor to wear for 1 month. You 
+should continue to follow up with your doctor about this. 
+
+WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL?  
+- You will need to continue taking antibiotics at home until 
+___.
+- Please get blood work done prior to your primary care 
+appointment on ___
+- Continue to take all your medicines and keep your 
+appointments.  
+
+We wish you the best!  
+
+Sincerely,  
+Your ___ Team  
+
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CHEST (PA AND LAT)
+
+INDICATION:  History: ___ with fever, eval cause// History: ___ with fever,
+eval cause
+
+TECHNIQUE:  Chest AP and lateral
+
+COMPARISON:  Chest radiograph dated ___.
+CT abdomen pelvis performed on the same date.
+
+FINDINGS: 
+
+There is a moderately extensive lateral left midlung consolidation most
+consistent with pneumonia involving the left upper lobe.  Suspected bulla at
+each lung apex new since the remote prior study.  There is no visible
+pneumothorax.  Trace possible pleural effusions.  Cardiac, mediastinal and
+hilar contours appear stable.  Bony structures are unremarkable.
+
+IMPRESSION: 
+
+Consolidation in the left upper lobe most consistent with pneumonia.
+
+RECOMMENDATION(S):  Follow-up radiographs are recommended to show resolution
+within approximately 8 weeks.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  LIVER OR GALLBLADDER US (SINGLE ORGAN)
+
+INDICATION:  History: ___ with PMHx etOH use disorder p/w fever, diarrhea,
+transaminitis. Eval for cirrhosis, PVT, if cirrhosis eval abdomen for tappable
+ascites// History: ___ with PMHx etOH use disorder p/w fever, diarrhea,
+transaminitis. Eval for cirrhosis, PVT, if cirrhosis eval abdomen for tappable
+ascites
+
+TECHNIQUE:  Grey scale and color Doppler ultrasound images of the abdomen were
+obtained.
+
+COMPARISON:  None.
+
+FINDINGS: 
+
+LIVER: The hepatic parenchyma appears within normal limits. The contour of the
+liver is smooth. There is no focal liver mass.  The main portal vein is patent
+with hepatopetal flow.  Normal color flow and waveforms are also seen in the
+left portal vein, anterior right portal vein and posterior portal veins. 
+There is no ascites.
+
+BILE DUCTS: There is no intrahepatic biliary dilation.
+  CHD: 2 mm
+
+GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
+
+PANCREAS: The head, body, and tail of the pancreas are within normal limits,
+without masses or pancreatic ductal dilatation.
+
+SPLEEN:  Normal echogenicity.
+  Spleen length: 9.5 cm
+
+KIDNEYS:  Limited views of the kidneys show no hydronephrosis.
+
+RETROPERITONEUM:  The visualized portions of aorta and IVC are within normal
+limits.
+
+IMPRESSION:
+
+
+1. Normal abdominal ultrasound.
+2. No evidence of ascites.  The portal veins are patent.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CT ABD AND PELVIS W/O CONTRAST
+
+INDICATION:  NO_PO contrast; History: ___ with fever, seen here 1 week ago for
+L inguinal hernia eval cause feverNO_PO contrast// History: ___ with fever,
+seen here 1 week ago for L inguinal hernia eval cause fever
+
+TECHNIQUE:  Multidetector CT images of the abdomen and pelvis were acquired
+without intravenous contrast. Non-contrast scan has several limitations in
+detecting vascular and parenchymal organ abnormalities, including tumor
+detection.
+Oral contrast was not administered.
+Coronal and sagittal reformations were performed and reviewed on PACS.
+
+DOSE:  Acquisition sequence:
+   1) Spiral Acquisition 6.5 s, 51.1 cm; CTDIvol = 10.0 mGy (Body) DLP = 507.9
+mGy-cm.
+ Total DLP (Body) = 508 mGy-cm.
+
+COMPARISON:  None.
+
+FINDINGS: 
+
+LOWER CHEST: Partially visualized is dense consolidation within the inferior
+aspect of the left upper lobe (2:1) corresponding to the lingula.  Trace
+left-sided pleural effusion.  Heart is borderline in size.
+
+ABDOMEN:
+
+HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. 
+There is no evidence of focal lesions within the limitations of an unenhanced
+scan.  There is no evidence of intrahepatic or extrahepatic biliary
+dilatation.  The gallbladder is within normal limits.
+
+PANCREAS: The pancreas has normal attenuation throughout, without evidence of
+focal lesions within the limitations of an unenhanced scan.  There is no
+pancreatic ductal dilatation.  There is no peripancreatic stranding.
+
+SPLEEN: The spleen shows normal size and attenuation throughout, without
+evidence of focal lesions.
+
+ADRENALS: The right and left adrenal glands are normal in size and shape.
+
+URINARY: The kidneys are of normal and symmetric size.  Minimal focus of
+calcification along the right lower pole.  There is no evidence of focal renal
+lesions within the limitations of an unenhanced scan.  There is no
+hydronephrosis.  There is no nephrolithiasis. There is no perinephric
+abnormality.
+
+GASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate
+normal caliber, wall thickness, and enhancement throughout. The colon and
+rectum are within normal limits. The appendix is not visualized.
+
+PELVIS: The urinary bladder and distal ureters are unremarkable.  There is no
+free fluid in the pelvis.
+
+REPRODUCTIVE ORGANS: The prostate gland is mildly enlarged measuring up to 5.4
+cm in transverse dimension (2:77).
+
+LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There
+is no pelvic or inguinal lymphadenopathy.
+
+VASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease
+is noted.
+
+BONES: There are moderate degenerative changes in the right hip with loss of
+joint space with subchondral cystic change and sclerosis.  There is no
+evidence of worrisome osseous lesions or acute fracture.
+
+SOFT TISSUES: The abdominal and pelvic wall is within normal limits.  The
+study is not demonstrated definite left inguinal hernia.  However, this study
+was not performed with dynamic maneuvers to best evaluate for hernia.
+
+IMPRESSION:
+
+
+1. Lingular pneumonia is partially visualized.
+2. No evidence of acute pathology in the abdomen or pelvis.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CHEST (PORTABLE AP)
+
+INDICATION:  ___ year old man with legionella, continued fevers on
+antibtiotics// ?improvement/?empyema      ?improvement/?empyema
+
+IMPRESSION: 
+
+Comparison to ___.  The previous consolidation in the left lateral
+lung has substantially decreased.  The periphery of the central consolidation
+has been replaced by opacities, notably in the lower part of the left lower
+lobe.  There is no evidence of new parenchymal changes border lesions. 
+Borderline size of the cardiac silhouette without pulmonary edema.  Stable
+minimal right apical scarring.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CT CHEST W/CONTRAST
+
+INDICATION:  ___ year old man with legionnaires' disease, and worsening
+infection// ? empyema
+
+TECHNIQUE:  Multi detector helical scanning of the chest was coordinated with
+intravenous infusion of nonionic iodinated contrast agent and reconstructed as
+5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
+axial images. All images were reviewed.
+
+DOSE:  Acquisition sequence:
+   1) Spiral Acquisition 9.9 s, 37.9 cm; CTDIvol = 6.3 mGy (Body) DLP = 229.0
+mGy-cm.
+ Total DLP (Body) = 243 mGy-cm.
+
+COMPARISON:  None available.
+
+FINDINGS: 
+
+NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
+Heterogeneous thyroid with a nodule in the right lobe measuring 1.7 cm (3:4). 
+No enlarged lymph nodes in either axilla or thoracic inlet. No abnormalities
+on the chest wall. No atherosclerotic calcifications in the head and neck
+arteries.
+
+HEART AND VASCULATURE:
+The heart is normal in size and shape. No pericardial effusion. No
+atherosclerotic calcifications in the coronary arteries, cardiac valves or
+aorta. The aorta and pulmonary arteries are normal in caliber throughout.
+
+MEDIASTINUM AND HILA:
+The esophagus is unremarkable. Small mediastinal lymph nodes, none
+pathologically enlarged by CT size criteria, for example in the prevascular
+station measuring 0.7 cm in short axis diameter (03:23) and in the right upper
+paratracheal station measuring 0.8 cm (3:8).  No hilar lymphadenopathy.
+
+PLEURA:
+No pleural effusions.  Paraseptal bullae in both apices.  No evidence of an
+empyema.
+
+LUNGS:
+The airways are patent to the subsegmental levels. No bronchial wall
+thickening, bronchiectasis or mucus plugging.  Mild centrilobular emphysema. 
+Consolidation with air bronchograms noted in the left upper lobe associated to
+areas of ground-glass opacities peripherally in the left upper and lower
+lobes.  No suspicious lung nodules or masses.  No parenchymal abscesses.
+
+CHEST CAGE:
+No acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic
+lesions.
+
+UPPER ABDOMEN:
+The limited sections of the upper abdomen show no significant abnormal
+findings.
+
+
+IMPRESSION: 
+
+Pre-existing pneumonia in the left upper and lower lobes, attributed to
+Legionella, as per OMR notes.  No evidence of parenchymal abscesses or
+empyemas.  Small mediastinal lymph nodes are likely reactive.
+
+[RADIOLOGY NOTE]
+EXAMINATION:   CTA CHEST  Q416
+
+INDICATION:  ___ year old man with h/o legionairres, c/b persistent tachycardia
+of unclear etiology// r/o PE
+
+TECHNIQUE:  Multidetector CT images of the chest were obtained with
+intravenous contrast in the pulmonary arterial phase.  Sagittal and coronal
+reformations also performed and, in addition, axial and bilateral oblique MIP
+reformations.
+
+DOSE:  Acquisition sequence:
+   1) Spiral Acquisition 3.0 s, 39.2 cm; CTDIvol = 5.8 mGy (Body) DLP = 226.0
+mGy-cm.
+   2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.1 mGy (Body) DLP = 1.1
+mGy-cm.
+   3) Stationary Acquisition 4.8 s, 0.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
+8.5 mGy-cm.
+ Total DLP (Body) = 236 mGy-cm.
+
+COMPARISON:  Chest CT is available from ___.
+
+FINDINGS: 
+
+Heart is mildly enlarged.  Aorta is normal in caliber.  No evidence of acute
+aortic syndrome.
+
+No filling defects are identified among pulmonary arterial branches.
+
+Again noted is nodule along the posterior right lobe of the thyroid that was
+better depicted before.  This is hard to define but probably measures about 17
+mm.
+
+Mildly enlarged left-sided mediastinal and hilar lymph nodes are likely
+reactive to infection and unchanged.  Trace pleural effusion on the left only.
+No definite right-sided pleural effusion.  No pericardial effusion.
+
+Again noted is bullous changes at each lung apex in the setting of what is,
+more generally, mild to moderate emphysema.
+
+Opacities at each lung base, left greater than right, suggest atelectasis,
+which seems more likely than pneumonia.  The left basilar dependent opacity
+has mildly increased.   In the left upper lobe, moderately extensive
+consolidation centered in the lingula with air bronchograms has not
+significantly changed over the short interval.
+
+Limited views of the upper abdomen are unremarkable.
+
+There are no suspicious bone lesions.  Vertebral bodies are preserved in
+height.
+
+IMPRESSION: 
+
+1.  Unchanged consolidation centered in the lingula most consistent with
+pneumonia.  Mild increase in dependent opacification in the left lower lobe,
+although the this latter regions seems more likely to reflect atelectasis than
+involvement with pneumonia.
+
+2.  No evidence of pulmonary embolism.
+
+3.  Right lobe thyroid nodule.
+
+RECOMMENDATION(S):  Follow-up thyroid ultrasound is recommended when
+clinically appropriate to assess 80 right thyroid nodule.

summaries/subject_11402775_hadm_25285222_model_input.txt

@@ -0,0 +1,751 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 55
+- Gender: M
+
+ADMISSION:
+- Admission ID: 25285222
+- Admission Type: EW EMER.
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: HOME
+- Insurance: Other
+- Race: BLACK/AFRICAN AMERICAN
+- Marital Status: SINGLE
+- Language: ENGLISH
+
+PROCEDURES (0 total):
+- None
+
+DIAGNOSES (13 total):
+  1. ICD-10: A481
+  2. ICD-10: N179
+  3. ICD-10: E871
+  4. ICD-10: E440
+  5. ICD-10: E860
+  6. ICD-10: E8339
+  7. ICD-10: I480
+  8. ICD-10: R197
+  9. ICD-10: D649
+  10. ICD-10: E041
+  11. ICD-10: F1011
+  12. ICD-10: Z87891
+  13. ICD-10: Z6820
+
+LABORATORY RESULTS:
+Total laboratory events: 480
+Most frequent lab tests:
+  - Item ID 50934: 14 measurements
+  - Item ID 50947: 14 measurements
+  - Item ID 51678: 14 measurements
+  - Item ID 50868: 11 measurements
+  - Item ID 50882: 11 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                     Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: MEDICINE
+ 
+Allergies: 
+Penicillins
+ 
+Attending: ___.
+ 
+Chief Complaint:
+Abd Pain, Diarrhea, Fever
+
+ 
+Major Surgical or Invasive Procedure:
+None
+
+ 
+History of Present Illness:
+___ PMHx EtOH use disorder who presents with fever, diarrhea. He 
+reports 2 weeks of large volume diarrhea with one to two 
+episodes per day. The diarrhea is watery and non-bloody. 
+Additionally, he reports that he has 'felt like he had the flu' 
+for a week and has had generalized malaise, decreased appetite, 
+and nausea with no emesis. He reported fevers at home up to 
+103.4.
+ 
+Past Medical History:
+Alcohol use disorder
+ 
+Social History:
+___
+Family History:
+No family history of HTN, DM, or cancer
+ 
+Physical Exam:
+ADMISSION PHYSICAL EXAM
+=======================
+GENERAL: Alert and interactive. In no acute distress.
+HEENT: PERRL, EOMI. 
+NECK: No cervical lymphadenopathy. No JVD.
+CARDIAC: regular rate and rhythm , no m/r/g
+LUNGS: Crackles in LLL
+BACK: No CVA tenderness.
+ABDOMEN: Soft, NT, ND, +BS
+EXTREMITIES: No clubbing, cyanosis, or edema. 
+SKIN: Warm. No rashes.
+NEUROLOGIC: AOx3. CN2-12 intact. Grossly intact.  
+
+DISCHARGE PHYSICAL EXAM
+=======================
+GENERAL: Alert and interactive. In no acute distress.
+HEENT: PERRL, EOMI. 
+NECK: No cervical lymphadenopathy. No JVD.
+CARDIAC: Tachycardic, regular rhythm , no m/r/g
+LUNGS: Crackles in LLL 
+BACK: No CVA tenderness.
+ABDOMEN: Soft, NT, ND, +BS
+EXTREMITIES: No clubbing, cyanosis, or edema. 
+SKIN: Warm. No rashes.
+NEUROLOGIC: AOx3. CN2-12 intact. Grossly intact. 
+ 
+Pertinent Results:
+ADMISSION LABS
+==============
+___ 04:37PM BLOOD WBC-6.9 RBC-4.67 Hgb-14.0 Hct-39.9* 
+MCV-85 MCH-30.0 MCHC-35.1 RDW-13.4 RDWSD-42.3 Plt ___
+___ 04:37PM BLOOD Glucose-124* UreaN-34* Creat-1.9*# 
+Na-128* K-4.6 Cl-89* HCO3-25 AnGap-14
+___ 04:37PM BLOOD ALT-274* AST-538* AlkPhos-71 TotBili-1.6* 
+DirBili-0.6* IndBili-1.0
+___ 04:03PM BLOOD calTIBC-157* Ferritn-4264* TRF-121*
+
+DISCHARGE LABS
+==============
+___ 06:52AM BLOOD WBC-7.4 RBC-3.31* Hgb-9.9* Hct-30.3* 
+MCV-92 MCH-29.9 MCHC-32.7 RDW-14.6 RDWSD-48.6* Plt ___
+___ 06:52AM BLOOD Glucose-110* UreaN-9 Creat-0.7 Na-139 
+K-4.2 Cl-105 HCO3-23 AnGap-11
+___ 06:52AM BLOOD ALT-98* AST-95* LD(LDH)-310* AlkPhos-74 
+TotBili-0.5
+___ 06:52AM BLOOD Albumin-2.6* Calcium-8.2* Phos-3.0 Mg-1.7
+___ 06:33AM BLOOD Ferritn-876*
+
+RELEVANT IMAGING
+================
+IMPRESSION:  
+Pre-existing pneumonia in the left upper and lower lobes, 
+attributed to 
+Legionella, as per OMR notes.  No evidence of parenchymal 
+abscesses or 
+empyemas.  Small mediastinal lymph nodes are likely reactive. 
+
+RELEVANT MICRO
+==============
+___ 5:00 pm URINE      TAKEN FROM ___. 
+
+                            **FINAL REPORT ___
+
+   Legionella Urinary Antigen  (Final ___: 
+      PRESUMPTIVE POSITIVE FOR LEGIONELLA SEROGROUP 1 ANTIGEN. 
+             (Reference Range-Negative). 
+
+ 
+Brief Hospital Course:
+SUMMARY
+=======
+Mr. ___ is a ___ y/o M w/ no significant past medical 
+history presented with Legionnaires disease c/b hyponatremia, 
+transaminitis, and an episode of tachyarrythmia. He was treated 
+with IV Levofloxacin and transitioned to PO with resolution of 
+fevers. 
+
+ACUTE/ACTIVE ISSUES
+===================
+# Legionnaires Disease
+Presented with 2 weeks diarrhea, found to have pneumonia on CT, 
+diagnosis of legionella confirmed by urine antigen (99% 
+specific). Also found to have hyponatremia, hypophosphatemia, 
+transaminitis, and hyperferritinemia, all classically associated 
+with legionella. The source of infection is unclear based on 
+housing/occupational history, but health dept was alerted for 
+further investigation into water source. ID was consulted and IV 
+levofloxacin was initiated. Imaging of his chest was obtained on 
+day 5 due to ongoing fevers over 103. CT ruled out empyema. Skin 
+exam was negative for extrapulmonary lesions. Echo was 
+reassuring against endocarditis. He was switched to PO 
+levofloxacin once fevers defervesced and he clinically imrpoved 
+on day 7. EKGs were obtained daily which showed mild QTc 
+prolongation likely due to levofloxacin and inflammation, but 
+never >500. He was discharged home with PO levofloxacin in order 
+to complete total 2 week course (final dose on ___.
+[] Patient will need to complete a total of 2 weeks of 
+antibiotics with levofloxacin. His last dose of medication will 
+be on ___. 
+[] Patient should have repeat lung imaging in ___ weeks after 
+completion of antibiotics in order to ensure resolution of his 
+pneumonia. 
+
+# Tachyarrhythmia 
+Mr ___ had one sustained episode of narrow complex SVT to 
+140s, throughout which he was asymptomatic. The arrythmia 
+resolved without intervention. EKG was obtained which was 
+concerining for A Fib vs AVNRT. Chads vasc score is 0, so no 
+anticoagulation indicated. He was also found to have orthostatic 
+hypotension to 77/53 suggesting hypovolemia as etiology, but 
+given his ample urine output with low urine osms, and his 
+persistent tachycardia despite IV fluid repletion, dehydration 
+was felt to be unlikely cause. No sign of hypovolemia from blood 
+or other fluid losses. Echo reassuring against 
+structural/functional cardiac abnormalities. CTA was negative 
+for PE. TSH was not consistent with thyrotoxicosis. Cortisol was 
+15.1. Cardiology was consulted, and also had difficulty 
+differentiating his tachyarrhythmia. He was discharged with a 
+Ziopatch for 1 month monitoring as an outpatient.
+[] Patient is being discharge with a Ziopatch for 1 month of 
+monitoring. This should be followed up by his PCP. 
+
+# Anemia
+Hgb downtrended throughout admission, most likely acute phase 
+reaction from inflammation. Hemolysis labs were negative, making 
+AIHA triggered by legionella or levofloxacin unlikely. Guiac was 
+obtained to assess for occult GI bleeding, but was negative. 
+Improved prior to discharge. 
+
+# Transaminitis
+Consistent with legionella infection as above. Not thought to be 
+related to previous history of alcohol use. Tested negative for 
+leptospirosis, Hepatitis A/B/C, and HIV. ALT and AST downtrended 
+with treatment of legionella infection. Continue to follow in an 
+outpatient setting. 
+[] Patient will require repeat LFTs prior to his appointment on 
+___. 
+
+# Hyponatremia
+Consistent with legionella, and likely some component of 
+hypovolemia based on urine lytes on admission. Improved with 
+increased PO intake.
+
+# Diarrhea
+Patient presented with 2 weeks of diarrhea likely related to 
+Legionella infection which quickly resolved with initiation of 
+levofloxacin. Negative for C Diff, HIV, and Hep A. He was 
+treated with IV fluids and phospate repletion. 
+
+# ___
+Pre-renal, with urine lytes demonstrating high osm and low 
+sodium. Likely due to dehydration from diarrhea and low PO 
+intake in setting of legionella. Resolved with IVF.
+
+TRANSITIONAL ISSUES
+===================
+[] Patient has an appointment to establish care with a new PCP 
+on discharge. He would benefit from more regular screening of 
+his healthcare maintenance. 
+[] Patient will need to complete a total of 2 weeks of 
+antibiotics with levofloxacin. His last dose of medication will 
+be on ___. 
+[] Patient should have repeat lung imaging in ___ weeks after 
+completion of antibiotics in order to ensure resolution of his 
+pneumonia. 
+[] Patient was incidentally noted to have a Right Thyroid Nodule 
+of 17mm. It should be further evaluated with ultrasound of the 
+thyroid. 
+[] Patient will require repeat LFTs prior to his appointment on 
+___. 
+[] Patient is being discharge with a Ziopatch for 1 month of 
+monitoring. This should be followed up by his PCP. 
+ 
+Medications on Admission:
+The Preadmission Medication list is accurate and complete.
+1. This patient is not taking any preadmission medications
+
+ 
+Discharge Medications:
+1.  LevoFLOXacin 750 mg PO DAILY 
+RX *levofloxacin 750 mg 1 tablet(s) by mouth once a day Disp #*2 
+Tablet Refills:*0 
+2.Outpatient Lab Work
+ICD-9 Code: ___
+Contact: ___ phone: ___ fax: ___ 
+Labs: Basic Metabolic Panel, Liver Function Tests
+
+ 
+Discharge Disposition:
+Home
+ 
+Discharge Diagnosis:
+PRIMARY
+=======
+Legionella Pneumonia 
+
+SECONDARY
+=========
+Hyponatremia
+Transaminits 
+Tachyarrhythmia 
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - Independent.
+
+ 
+Discharge Instructions:
+======================  
+DISCHARGE INSTRUCTIONS  
+======================  
+Dear Mr. ___,  
+
+It was a pleasure caring for you at ___ 
+___.  
+
+WHY WAS I IN THE HOSPITAL?  
+- You came to the hospital with fatigue and diarrhea. You were 
+found to have an infection called legionella. 
+
+WHAT HAPPENED TO ME IN THE HOSPITAL?  
+- We performed lab tests and imaging to diagnose the infection.
+- You were treated with an antibiotic called levofloxacin 
+through an IV and transitioned to the oral version. You were 
+given IV fluids because you were dehydrated.  
+- Your heart was found to be beating quickly. In order to better 
+evaluate this, we gave you a monitor to wear for 1 month. You 
+should continue to follow up with your doctor about this. 
+
+WHAT SHOULD I DO AFTER I LEAVE THE HOSPITAL?  
+- You will need to continue taking antibiotics at home until 
+___.
+- Please get blood work done prior to your primary care 
+appointment on ___
+- Continue to take all your medicines and keep your 
+appointments.  
+
+We wish you the best!  
+
+Sincerely,  
+Your ___ Team  
+
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] EXAMINATION:  CHEST (PA AND LAT)
+
+INDICATION:  History: ___ with fever, eval cause// History: ___ with fever,
+eval cause
+
+TECHNIQUE:  Chest AP and lateral
+
+COMPARISON:  Chest radiograph dated ___.
+CT abdomen pelvis performed on the same date.
+
+FINDINGS: 
+
+There is a moderately extensive lateral left midlung consolidation most
+consistent with pneumonia involving the left upper lobe.  Suspected bulla at
+each lung apex new since the remote prior study.  There is no visible
+pneumothorax.  Trace possible pleural effusions.  Cardiac, mediastinal and
+hilar contours appear stable.  Bony structures are unremarkable.
+
+IMPRESSION: 
+
+Consolidation in the left upper lobe most consistent with pneumonia.
+
+RECOMMENDATION(S):  Follow-up radiographs are recommended to show resolution
+within approximately 8 weeks.
+
+
+[RADIOLOGY] EXAMINATION:  LIVER OR GALLBLADDER US (SINGLE ORGAN)
+
+INDICATION:  History: ___ with PMHx etOH use disorder p/w fever, diarrhea,
+transaminitis. Eval for cirrhosis, PVT, if cirrhosis eval abdomen for tappable
+ascites// History: ___ with PMHx etOH use disorder p/w fever, diarrhea,
+transaminitis. Eval for cirrhosis, PVT, if cirrhosis eval abdomen for tappable
+ascites
+
+TECHNIQUE:  Grey scale and color Doppler ultrasound images of the abdomen were
+obtained.
+
+COMPARISON:  None.
+
+FINDINGS: 
+
+LIVER: The hepatic parenchyma appears within normal limits. The contour of the
+liver is smooth. There is no focal liver mass.  The main portal vein is patent
+with hepatopetal flow.  Normal color flow and waveforms are also seen in the
+left portal vein, anterior right portal vein and posterior portal veins. 
+There is no ascites.
+
+BILE DUCTS: There is no intrahepatic biliary dilation.
+  CHD: 2 mm
+
+GALLBLADDER: There is no evidence of stones or gallbladder wall thickening.
+
+PANCREAS: The head, body, and tail of the pancreas are within normal limits,
+without masses or pancreatic ductal dilatation.
+
+SPLEEN:  Normal echogenicity.
+  Spleen length: 9.5 cm
+
+KIDNEYS:  Limited views of the kidneys show no hydronephrosis.
+
+RETROPERITONEUM:  The visualized portions of aorta and IVC are within normal
+limits.
+
+IMPRESSION:
+
+
+1. Normal abdominal ultrasound.
+2. No evidence of ascites.  The portal veins are patent.
+
+
+[RADIOLOGY] EXAMINATION:  CT ABD AND PELVIS W/O CONTRAST
+
+INDICATION:  NO_PO contrast; History: ___ with fever, seen here 1 week ago for
+L inguinal hernia eval cause feverNO_PO contrast// History: ___ with fever,
+seen here 1 week ago for L inguinal hernia eval cause fever
+
+TECHNIQUE:  Multidetector CT images of the abdomen and pelvis were acquired
+without intravenous contrast. Non-contrast scan has several limitations in
+detecting vascular and parenchymal organ abnormalities, including tumor
+detection.
+Oral contrast was not administered.
+Coronal and sagittal reformations were performed and reviewed on PACS.
+
+DOSE:  Acquisition sequence:
+   1) Spiral Acquisition 6.5 s, 51.1 cm; CTDIvol = 10.0 mGy (Body) DLP = 507.9
+mGy-cm.
+ Total DLP (Body) = 508 mGy-cm.
+
+COMPARISON:  None.
+
+FINDINGS: 
+
+LOWER CHEST: Partially visualized is dense consolidation within the inferior
+aspect of the left upper lobe (2:1) corresponding to the lingula.  Trace
+left-sided pleural effusion.  Heart is borderline in size.
+
+ABDOMEN:
+
+HEPATOBILIARY: The liver demonstrates homogeneous attenuation throughout. 
+There is no evidence of focal lesions within the limitations of an unenhanced
+scan.  There is no evidence of intrahepatic or extrahepatic biliary
+dilatation.  The gallbladder is within normal limits.
+
+PANCREAS: The pancreas has normal attenuation throughout, without evidence of
+focal lesions within the limitations of an unenhanced scan.  There is no
+pancreatic ductal dilatation.  There is no peripancreatic stranding.
+
+SPLEEN: The spleen shows normal size and attenuation throughout, without
+evidence of focal lesions.
+
+ADRENALS: The right and left adrenal glands are normal in size and shape.
+
+URINARY: The kidneys are of normal and symmetric size.  Minimal focus of
+calcification along the right lower pole.  There is no evidence of focal renal
+lesions within the limitations of an unenhanced scan.  There is no
+hydronephrosis.  There is no nephrolithiasis. There is no perinephric
+abnormality.
+
+GASTROINTESTINAL: The stomach is unremarkable.  Small bowel loops demonstrate
+normal caliber, wall thickness, and enhancement throughout. The colon and
+rectum are within normal limits. The appendix is not visualized.
+
+PELVIS: The urinary bladder and distal ureters are unremarkable.  There is no
+free fluid in the pelvis.
+
+REPRODUCTIVE ORGANS: The prostate gland is mildly enlarged measuring up to 5.4
+cm in transverse dimension (2:77).
+
+LYMPH NODES: There is no retroperitoneal or mesenteric lymphadenopathy.  There
+is no pelvic or inguinal lymphadenopathy.
+
+VASCULAR: There is no abdominal aortic aneurysm.  Mild atherosclerotic disease
+is noted.
+
+BONES: There are moderate degenerative changes in the right hip with loss of
+joint space with subchondral cystic change and sclerosis.  There is no
+evidence of worrisome osseous lesions or acute fracture.
+
+SOFT TISSUES: The abdominal and pelvic wall is within normal limits.  The
+study is not demonstrated definite left inguinal hernia.  However, this study
+was not performed with dynamic maneuvers to best evaluate for hernia.
+
+IMPRESSION:
+
+
+1. Lingular pneumonia is partially visualized.
+2. No evidence of acute pathology in the abdomen or pelvis.
+
+
+[RADIOLOGY] EXAMINATION:  CHEST (PORTABLE AP)
+
+INDICATION:  ___ year old man with legionella, continued fevers on
+antibtiotics// ?improvement/?empyema      ?improvement/?empyema
+
+IMPRESSION: 
+
+Comparison to ___.  The previous consolidation in the left lateral
+lung has substantially decreased.  The periphery of the central consolidation
+has been replaced by opacities, notably in the lower part of the left lower
+lobe.  There is no evidence of new parenchymal changes border lesions. 
+Borderline size of the cardiac silhouette without pulmonary edema.  Stable
+minimal right apical scarring.
+
+
+[RADIOLOGY] EXAMINATION:  CT CHEST W/CONTRAST
+
+INDICATION:  ___ year old man with legionnaires' disease, and worsening
+infection// ? empyema
+
+TECHNIQUE:  Multi detector helical scanning of the chest was coordinated with
+intravenous infusion of nonionic iodinated contrast agent and reconstructed as
+5 and 1.25 mm thick axial, 2.5 mm thick coronal and parasagittal, and 8 mm MIP
+axial images. All images were reviewed.
+
+DOSE:  Acquisition sequence:
+   1) Spiral Acquisition 9.9 s, 37.9 cm; CTDIvol = 6.3 mGy (Body) DLP = 229.0
+mGy-cm.
+ Total DLP (Body) = 243 mGy-cm.
+
+COMPARISON:  None available.
+
+FINDINGS: 
+
+NECK, THORACIC INLET, AXILLAE AND CHEST WALL:
+Heterogeneous thyroid with a nodule in the right lobe measuring 1.7 cm (3:4). 
+No enlarged lymph nodes in either axilla or thoracic inlet. No abnormalities
+on the chest wall. No atherosclerotic calcifications in the head and neck
+arteries.
+
+HEART AND VASCULATURE:
+The heart is normal in size and shape. No pericardial effusion. No
+atherosclerotic calcifications in the coronary arteries, cardiac valves or
+aorta. The aorta and pulmonary arteries are normal in caliber throughout.
+
+MEDIASTINUM AND HILA:
+The esophagus is unremarkable. Small mediastinal lymph nodes, none
+pathologically enlarged by CT size criteria, for example in the prevascular
+station measuring 0.7 cm in short axis diameter (03:23) and in the right upper
+paratracheal station measuring 0.8 cm (3:8).  No hilar lymphadenopathy.
+
+PLEURA:
+No pleural effusions.  Paraseptal bullae in both apices.  No evidence of an
+empyema.
+
+LUNGS:
+The airways are patent to the subsegmental levels. No bronchial wall
+thickening, bronchiectasis or mucus plugging.  Mild centrilobular emphysema. 
+Consolidation with air bronchograms noted in the left upper lobe associated to
+areas of ground-glass opacities peripherally in the left upper and lower
+lobes.  No suspicious lung nodules or masses.  No parenchymal abscesses.
+
+CHEST CAGE:
+No acute fractures. Mild dorsal spondylosis. No suspicious lytic or sclerotic
+lesions.
+
+UPPER ABDOMEN:
+The limited sections of the upper abdomen show no significant abnormal
+findings.
+
+
+IMPRESSION: 
+
+Pre-existing pneumonia in the left upper and lower lobes, attributed to
+Legionella, as per OMR notes.  No evidence of parenchymal abscesses or
+empyemas.  Small mediastinal lymph nodes are likely reactive.
+
+
+[RADIOLOGY] EXAMINATION:   CTA CHEST  Q416
+
+INDICATION:  ___ year old man with h/o legionairres, c/b persistent tachycardia
+of unclear etiology// r/o PE
+
+TECHNIQUE:  Multidetector CT images of the chest were obtained with
+intravenous contrast in the pulmonary arterial phase.  Sagittal and coronal
+reformations also performed and, in addition, axial and bilateral oblique MIP
+reformations.
+
+DOSE:  Acquisition sequence:
+   1) Spiral Acquisition 3.0 s, 39.2 cm; CTDIvol = 5.8 mGy (Body) DLP = 226.0
+mGy-cm.
+   2) Stationary Acquisition 0.6 s, 0.5 cm; CTDIvol = 2.1 mGy (Body) DLP = 1.1
+mGy-cm.
+   3) Stationary Acquisition 4.8 s, 0.5 cm; CTDIvol = 16.9 mGy (Body) DLP =
+8.5 mGy-cm.
+ Total DLP (Body) = 236 mGy-cm.
+
+COMPARISON:  Chest CT is available from ___.
+
+FINDINGS: 
+
+Heart is mildly enlarged.  Aorta is normal in caliber.  No evidence of acute
+aortic syndrome.
+
+No filling defects are identified among pulmonary arterial branches.
+
+Again noted is nodule along the posterior right lobe of the thyroid that was
+better depicted before.  This is hard to define but probably measures about 17
+mm.
+
+Mildly enlarged left-sided mediastinal and hilar lymph nodes are likely
+reactive to infection and unchanged.  Trace pleural effusion on the left only.
+No definite right-sided pleural effusion.  No pericardial effusion.
+
+Again noted is bullous changes at each lung apex in the setting of what is,
+more generally, mild to moderate emphysema.
+
+Opacities at each lung base, left greater than right, suggest atelectasis,
+which seems more likely than pneumonia.  The left basilar dependent opacity
+has mildly increased.   In the left upper lobe, moderately extensive
+consolidation centered in the lingula with air bronchograms has not
+significantly changed over the short interval.
+
+Limited views of the upper abdomen are unremarkable.
+
+There are no suspicious bone lesions.  Vertebral bodies are preserved in
+height.
+
+IMPRESSION: 
+
+1.  Unchanged consolidation centered in the lingula most consistent with
+pneumonia.  Mild increase in dependent opacification in the left lower lobe,
+although the this latter regions seems more likely to reflect atelectasis than
+involvement with pneumonia.
+
+2.  No evidence of pulmonary embolism.
+
+3.  Right lobe thyroid nodule.
+
+RECOMMENDATION(S):  Follow-up thyroid ultrasound is recommended when
+clinically appropriate to assess 80 right thyroid nodule.
+
+PROCEDURES (readable):
+- None
+
+DIAGNOSES (readable):
+- A481 (ICD-10) — Legionnaires' disease
+- N179 (ICD-10) — Acute kidney failure, unspecified
+- E871 (ICD-10) — Hypo-osmolality and hyponatremia
+- E440 (ICD-10) — Moderate protein-calorie malnutrition
+- E860 (ICD-10) — Dehydration
+- E8339 (ICD-10) — Other disorders of phosphorus metabolism
+- I480 (ICD-10) — Paroxysmal atrial fibrillation
+- R197 (ICD-10) — Diarrhea, unspecified
+- D649 (ICD-10) — Anemia, unspecified
+- E041 (ICD-10) — Nontoxic single thyroid nodule
+- F1011 (ICD-10) — Alcohol abuse, in remission
+- Z87891 (ICD-10) — Personal history of nicotine dependence
+- Z6820 (ICD-10) — Body mass index (BMI) 20.0-20.9, adult
+
+LAB ITEMS (readable, deduped):
+- ARCH-1 (Item 51564)
+- Absolute Basophil Count (Item 52069)
+- Absolute Eosinophil Count (Item 52073)
+- Absolute Lymphocyte Count (Item 51133)
+- Absolute Monocyte Count (Item 52074)
+- Absolute Neutrophil Count (Item 52075)
+- Alanine Aminotransferase (ALT) (Item 50861)
+- Albumin (Item 50862)
+- Alkaline Phosphatase (Item 50863)
+- Anion Gap (Item 50868)
+- Asparate Aminotransferase (AST) (Item 50878)
+- Bacteria (Item 51463)
+- Base Excess (Item 50802)
+- Basophils (Item 51146)
+- Bicarbonate (Item 50882)
+- Bilirubin (Item 51464)
+- Bilirubin, Direct (Item 50883)
+- Bilirubin, Indirect (Item 50884)
+- Bilirubin, Total (Item 50885)
+- Blood (Item 51466)
+- C-Reactive Protein (Item 50889)
+- Calcium, Total (Item 50893)
+- Calculated Total CO2 (Item 50804)
+- Chloride (Item 50902)
+- Cortisol (Item 50909)
+- Creatinine (Item 50912)
+- Creatinine, Urine (Item 51082)
+- Eosinophils (Item 51200)
+- Epithelial Cells (Item 51476)
+- Estimated GFR (MDRD equation) (Item 50920)
+- Ferritin (Item 50924)
+- Glucose (Item 50931)
+- Glucose (Item 51478)
+- Granular Casts (Item 51479)
+- H (Item 50934)
+- HIV Screen (Item 53153)
+- HPE1 (Item 51657)
+- HPE2 (Item 51658)
+- HPE3 (Item 51659)
+- HPE6 (Item 51662)
+- HPE7 (Item 51663)
+- Haptoglobin (Item 50935)
+- Hematocrit (Item 51221)
+- Hemoglobin (Item 51222)
+- Hepatitis A Virus IgM Antibody (Item 50938)
+- Hepatitis B Surface Antibody (Item 50940)
+- Hepatitis B Surface Antigen (Item 50941)
+- Hepatitis B Virus Core Antibody (Item 50942)
+- Hepatitis C Virus Antibody (Item 50943)
+- Hyaline Casts (Item 51482)
+- I (Item 50947)
+- INR(PT) (Item 51237)
+- Immature Granulocytes (Item 52135)
+- Iron (Item 50952)
+- Iron Binding Capacity, Total (Item 50953)
+- Ketone (Item 51484)
+- L (Item 51678)
+- Lactate (Item 50813)
+- Lactate Dehydrogenase (LD) (Item 50954)
+- Length of Urine Collection (Item 51087)
+- Leukocytes (Item 51486)
+- Lymphocytes (Item 51244)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Magnesium (Item 50960)
+- Monocytes (Item 51254)
+- NTproBNP (Item 50963)
+- Neutrophils (Item 51256)
+- Nitrite (Item 51487)
+- Osmolality, Measured (Item 50964)
+- Osmolality, Urine (Item 51093)
+- PT (Item 51274)
+- PTT (Item 51275)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Potassium (Item 50971)
+- Problem Specimen (Item 51706)
+- Protein (Item 51492)
+- Protein/Creatinine Ratio (Item 51099)
+- RBC (Item 51493)
+- RBC Morphology (Item 52171)
+- RDW (Item 51277)
+- RDW-SD (Item 52172)
+- Red Blood Cells (Item 51279)
+- Red Top Hold (Item 50979)
+- Reticulocyte Count, Absolute (Item 51282)
+- Reticulocyte Count, Automated (Item 51283)
+- Sodium (Item 50983)
+- Sodium, Urine (Item 51100)
+- Specific Gravity (Item 51498)
+- Specimen Type (Item 52033)
+- Thyroid Stimulating Hormone (Item 50993)
+- Total Protein, Urine (Item 51102)
+- Transferrin (Item 50998)
+- Uhold (Item 51103)
+- Urea Nitrogen (Item 51006)
+- Urine Appearance (Item 51506)
+- Urine Color (Item 51508)
+- Urine Mucous (Item 51512)
+- Urobilinogen (Item 51514)
+- WBC (Item 51516)
+- White Blood Cells (Item 51301)
+- Yeast (Item 51519)
+- pCO2 (Item 50818)
+- pH (Item 50820)
+- pH (Item 51491)
+- pO2 (Item 50821)

summaries/subject_11402775_hadm_25285222_summary.txt

@@ -0,0 +1,75 @@
+**PRE-OPERATIVE SUMMARY**
+
+**Patient Information**
+
+* Name: [Not provided]
+* Age: 55
+* Gender: Male
+* Admission ID: 25285222
+* Admission Type: Emergency Ward (EW)
+* Admission Location: Physician Referral
+* Discharge Location: Home
+* Insurance: Other
+* Race: Black/African American
+* Marital Status: Single
+* Language: English
+
+**Diagnoses**
+
+* ICD-10: A481 (Legionnaires' disease)
+* ICD-10: N179 (Acute kidney failure, unspecified)
+* ICD-10: E871 (Hypo-osmolality and hyponatremia)
+* ICD-10: E440 (Moderate protein-calorie malnutrition)
+* ICD-10: E860 (Dehydration)
+* ICD-10: E8339 (Other disorders of phosphorus metabolism)
+* ICD-10: I480 (Paroxysmal atrial fibrillation)
+* ICD-10: R197 (Diarrhea, unspecified)
+* ICD-10: D649 (Anemia, unspecified)
+* ICD-10: E041 (Nontoxic single thyroid nodule)
+* ICD-10: F1011 (Alcohol abuse, in remission)
+* ICD-10: Z87891 (Personal history of nicotine dependence)
+* ICD-10: Z6820 (Body mass index (BMI) 20.0-20.9, adult)
+
+**Laboratory Results**
+
+* Total laboratory events: 480
+* Most frequent lab tests:
+	+ Item ID 50934: 14 measurements
+	+ Item ID 50947: 14 measurements
+	+ Item ID 51678: 14 measurements
+	+ Item ID 50868: 11 measurements
+	+ Item ID 50882: 11 measurements
+
+**Clinical Notes**
+
+* The patient presented with fever, diarrhea, and fatigue, and was diagnosed with Legionnaires' disease.
+* The patient had a history of alcohol use disorder and was found to have anemia, hypo-osmolality, and hyponatremia.
+* The patient had a thyroid nodule and was found to have a paroxysmal atrial fibrillation.
+* The patient had a history of nicotine dependence and a body mass index (BMI) of 20.0-20.9.
+
+**Medications**
+
+* LevoFLOXacin 750 mg PO daily
+
+**Discharge Instructions**
+
+* The patient should complete a total of 2 weeks of antibiotics with levofloxacin.
+* The patient should have repeat lung imaging in 8 weeks after completion of antibiotics to ensure resolution of pneumonia.
+* The patient should have repeat LFTs prior to their appointment on [date].
+* The patient should follow up with their PCP and have a repeat thyroid ultrasound when clinically appropriate.
+
+**Radiology Results**
+
+* Chest X-ray: Pre-existing pneumonia in the left upper and lower lobes, attributed to Legionella.
+* CT scan of the chest: Pre-existing pneumonia in the left upper and lower lobes, attributed to Legionella.
+* Liver ultrasound: Normal abdominal ultrasound.
+* CT scan of the abdomen and pelvis: No evidence of acute pathology in the abdomen or pelvis.
+* Chest X-ray: Unchanged consolidation centered in the lingula most consistent with pneumonia.
+* CT scan of the chest: Unchanged consolidation centered in the lingula most consistent with pneumonia.
+
+**Other**
+
+* The patient has an appointment to establish care with a new PCP on discharge.
+* The patient should have repeat LFTs prior to their appointment on [date].
+* The patient is being discharged with a Ziopatch for 1 month of monitoring.
+* The patient should follow up with their PCP and have a repeat thyroid ultrasound when clinically appropriate.

summaries/subject_12991336_hadm_25464784_input.txt

@@ -0,0 +1,475 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 70
+- Gender: F
+
+ADMISSION:
+- Admission ID: 25464784
+- Admission Type: SURGICAL SAME DAY ADMISSION
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: HOME HEALTH CARE
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: MARRIED
+- Language: ENGLISH
+
+PROCEDURES (3 total):
+- 3521 (ICD-9)
+- 3961 (ICD-9)
+- 3893 (ICD-9)
+
+DIAGNOSES (3 total):
+- 4241 (ICD-9)
+- 9971 (ICD-9)
+- 42731 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50802: 9 measurements, 2118-11-14 09:32:00 to 2118-11-14 17:22:00
+- Item ID 50804: 9 measurements, 2118-11-14 09:32:00 to 2118-11-14 17:22:00
+- Item ID 50806: 3 measurements, 2118-11-14 09:32:00 to 2118-11-14 12:29:00
+- Item ID 50808: 8 measurements, 2118-11-14 09:32:00 to 2118-11-15 10:36:00
+- Item ID 50809: 12 measurements, 2118-11-14 09:32:00 to 2118-11-15 10:36:00
+- Item ID 50810: 5 measurements, 2118-11-14 09:32:00 to 2118-11-14 12:29:00
+- Item ID 50811: 5 measurements, 2118-11-14 09:32:00 to 2118-11-14 12:29:00
+- Item ID 50813: 5 measurements, 2118-11-14 09:32:00 to 2118-11-14 17:22:00
+- Item ID 50817: 3 measurements, 2118-11-14 14:03:00 to 2118-11-14 17:22:00
+- Item ID 50818: 9 measurements, 2118-11-14 09:32:00 to 2118-11-14 17:22:00
+- Item ID 50820: 13 measurements, 2118-11-14 09:32:00 to 2118-11-15 10:36:00
+- Item ID 50821: 9 measurements, 2118-11-14 09:32:00 to 2118-11-14 17:22:00
+- Item ID 50822: 10 measurements, 2118-11-14 09:32:00 to 2118-11-15 10:36:00
+- Item ID 50824: 4 measurements, 2118-11-14 09:32:00 to 2118-11-14 13:12:00
+- Item ID 50861: 1 measurements, 2118-11-18 05:38:00 to 2118-11-18 05:38:00
+- Item ID 50862: 1 measurements, 2118-11-18 05:38:00 to 2118-11-18 05:38:00
+- Item ID 50863: 1 measurements, 2118-11-18 05:38:00 to 2118-11-18 05:38:00
+- Item ID 50867: 1 measurements, 2118-11-18 05:38:00 to 2118-11-18 05:38:00
+- Item ID 50868: 5 measurements, 2118-11-15 02:12:00 to 2118-11-19 10:26:00
+- Item ID 50878: 1 measurements, 2118-11-18 05:38:00 to 2118-11-18 05:38:00
+- Item ID 50882: 7 measurements, 2118-11-14 13:07:00 to 2118-11-19 10:26:00
+- Item ID 50885: 1 measurements, 2118-11-18 05:38:00 to 2118-11-18 05:38:00
+- Item ID 50893: 4 measurements, 2118-11-15 02:12:00 to 2118-11-18 05:38:00
+- Item ID 50902: 6 measurements, 2118-11-14 13:07:00 to 2118-11-19 10:26:00
+- Item ID 50912: 7 measurements, 2118-11-14 13:07:00 to 2118-11-19 10:26:00
+- Item ID 50920: 1 measurements, 2118-11-14 13:07:00 to 2118-11-14 13:07:00
+- Item ID 50931: 5 measurements, 2118-11-15 02:12:00 to 2118-11-19 10:26:00
+- Item ID 50956: 1 measurements, 2118-11-18 05:38:00 to 2118-11-18 05:38:00
+- Item ID 50960: 7 measurements, 2118-11-14 13:07:00 to 2118-11-19 10:26:00
+- Item ID 50970: 3 measurements, 2118-11-15 02:12:00 to 2118-11-18 05:38:00
+- Item ID 50971: 7 measurements, 2118-11-15 02:12:00 to 2118-11-19 10:26:00
+- Item ID 50983: 7 measurements, 2118-11-15 02:12:00 to 2118-11-19 10:26:00
+- Item ID 51006: 7 measurements, 2118-11-14 13:07:00 to 2118-11-19 10:26:00
+- Item ID 51146: 1 measurements, 2118-11-14 11:57:00 to 2118-11-14 11:57:00
+- Item ID 51200: 1 measurements, 2118-11-14 11:57:00 to 2118-11-14 11:57:00
+- Item ID 51214: 1 measurements, 2118-11-14 11:57:00 to 2118-11-14 11:57:00
+- Item ID 51221: 10 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51222: 7 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51237: 4 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51244: 1 measurements, 2118-11-14 11:57:00 to 2118-11-14 11:57:00
+- Item ID 51248: 7 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51249: 7 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51250: 7 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51254: 1 measurements, 2118-11-14 11:57:00 to 2118-11-14 11:57:00
+- Item ID 51256: 1 measurements, 2118-11-14 11:57:00 to 2118-11-14 11:57:00
+- Item ID 51265: 7 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51274: 4 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51275: 2 measurements, 2118-11-14 11:57:00 to 2118-11-14 13:07:00
+- Item ID 51277: 7 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51279: 7 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 51301: 7 measurements, 2118-11-14 11:57:00 to 2118-11-19 10:26:00
+- Item ID 52033: 13 measurements, 2118-11-14 09:32:00 to 2118-11-15 10:36:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   F
+ 
+Service: CARDIOTHORACIC
+ 
+Allergies: 
+___ recorded as having No Known Allergies to Drugs
+ 
+Attending: ___.
+ 
+Chief Complaint:
+increasing chest tightness and SOB
+ 
+Major Surgical or Invasive Procedure:
+Aortic Valve Replacement ___
+
+ 
+History of Present Illness:
+Mrs. ___ is a ___ lady with
+worsening symptoms of chest tightness, shortness of breath
+related to documented critical aortic stenosis by
+catheterization and echocardiography, presenting for aortic
+valve replacement. Her coronary arteries were normal by
+cardiac catheterization.
+
+ 
+Past Medical History:
+EF: 60% Cr: 0.8 Wt: 77.5K  
+PMH: RHD, AS, HTN, DJD(spine-lumbar/cervical), TIA, skin CA  
+PSH: Tonsillectomy, C-section x5, Bilat varicose vein stripping, 
+D&C, excision skin CA lesion  
+
+ 
+Social History:
+___
+Family History:
+Mother died age ___ RHF, Father died age ___ ruptured aneursym
+ 
+Physical Exam:
+general: well appearing robust female 
+VS; 98.6, 133/80, 74Sr, 20, 97RA
+HEENT: unremarkable
+Chest: sternal incision clean dry and intact. sternum stable.
+COR: RRR S1, S2
+ABD: soft, NT, ND, +BS
+extrem: 2+ pedal edema bilat 
+Neuro: intact.
+ 
+ 
+Pertinent Results:
+___ 11:57AM BLOOD WBC-8.0 RBC-2.36*# Hgb-7.9*# Hct-22.0*# 
+MCV-93 MCH-33.2* MCHC-35.7* RDW-12.9 Plt ___
+___ 01:00PM BLOOD WBC-14.2* RBC-3.02* Hgb-10.0* Hct-28.3* 
+MCV-94 MCH-33.0* MCHC-35.2* RDW-13.9 Plt ___
+___ 11:57AM BLOOD ___ PTT-36.4* ___
+___ 01:07PM BLOOD ___ PTT-38.7* ___
+___ 02:12AM BLOOD Glucose-137* UreaN-12 Creat-0.6 Na-132* 
+K-5.3* Cl-105 HCO3-23 AnGap-9
+___ 11:42AM BLOOD Glucose-107* UreaN-18 Creat-0.7 Na-129* 
+K-4.4 Cl-98 HCO3-25 AnGap-10
+ 
+
+___ ECHOCARDIOGRAPHY REPORT
+
+___       ___ MRN:   ___       TEE (Complete) 
+Done ___ at 2:17:47 ___      FINAL  
+Referring Physician     ___  
+___.
+___, Division of Cardiothorac
+___  Status: Inpatient DOB: ___ 
+Age (years): ___ F  Hgt (in):  
+BP (mm Hg): /  Wgt (lb):  
+HR (bpm):  BSA (m2):  
+Indication: AVR  
+ICD-9 Codes: 786.05, 440.0, 424.1, 424.0 
+___ Information  
+Date/Time: ___ at 14:17    ___ MD: ___, MD 
+___ Type: TEE (Complete) Sonographer: ___, MD 
+Doppler: Full Doppler and color Doppler ___ Location: 
+Anesthesia West OR cardiac 
+Contrast: None Tech Quality: Adequate 
+Tape #: ___-1: Machine: ___ 
+___ Measurements  
+Results  Measurements  Normal Range  
+Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm 
+ 
+Left Ventricle - Ejection Fraction:  40% to 45%  >= 55%  
+Left Ventricle - Peak Resting LVOT gradient:  1 mm Hg  <= 10 mm 
+Hg  
+Aorta - Ascending:  3.1 cm  <= 3.4 cm  
+Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm  
+Aortic Valve - Peak Velocity:  *3.2 m/sec  <= 2.0 m/sec  
+Aortic Valve - Peak Gradient:  *40 mm Hg  < 20 mm Hg  
+Aortic Valve - Mean Gradient:  27 mm Hg     
+Aortic Valve - Valve Area:  *0.4 cm2  >= 3.0 cm2  
+Mitral Valve - Peak Velocity:  0.7 m/sec     
+Mitral Valve - Pressure Half Time:  ___ ms     
+Mitral Valve - MVA (P ___ T):  3.4 cm2     
+ 
+Findings  
+RIGHT ATRIUM/INTERATRIAL SEPTUM: No spontaneous echo contrast in 
+the body of the RA. No mass or thrombus in the RA or RAA. No ASD 
+by 2D or color Doppler. 
+
+LEFT VENTRICLE: Mild symmetric LVH with normal cavity size. Mild 
+symmetric LVH. Mildly depressed LVEF. No VSD. 
+
+LV WALL MOTION: Regional left ventricular wall motion findings 
+as shown below; remaining LV segments contract normally. 
+
+RIGHT VENTRICLE: Normal RV chamber size and free wall motion. 
+
+AORTA: Normal diameter of aorta at the sinus, ascending and arch 
+levels. Normal ascending aorta diameter. Simple atheroma in 
+ascending aorta. Normal descending aorta diameter. Simple 
+atheroma in descending aorta. 
+
+AORTIC VALVE: Severely thickened/deformed aortic valve leaflets. 
+Severe AS (AoVA <0.8cm2). Mild (1+) AR. 
+
+MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+) 
+MR. 
+
+___ VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. 
+
+PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized. 
+No PS. Physiologic PR. 
+
+PERICARDIUM: No pericardial effusion. 
+
+GENERAL COMMENTS: A TEE was performed in the location listed 
+above. I certify I was present in compliance with ___ 
+regulations. The ___ was under general anesthesia throughout 
+the procedure. The ___ received antibiotic prophylaxis. The 
+TEE probe was passed with assistance from the anesthesioology 
+staff using a laryngoscope. No TEE related complications.  
+
+REGIONAL LEFT VENTRICULAR WALL MOTION:  
+
+  
+  
+    
+ 
+     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic  
+Conclusions  
+Pre-CPB:
+No spontaneous echo contrast is seen in the body of the right 
+atrium. No mass or thrombus is seen in the right or left atrium 
+or left atrial appendage. No atrial septal defect is seen by 2D 
+or color Doppler. There is mild symmetric left ventricular 
+hypertrophy with normal cavity size. Overall left ventricular 
+systolic function is mildly depressed (LVEF= 40 - 45%). There is 
+no ventricular septal defect. The remaining left ventricular 
+segments contract normally. Right ventricular chamber size and 
+free wall motion are normal. The diameters of aorta of the 
+descending, ascending and arch levels are normal. There are 
+simple atheroma in the descending thoracic aorta. The aortic 
+valve leaflets are severely thickened/deformed. There is severe 
+aortic valve stenosis (area <0.8cm2). Mild (1+) aortic 
+regurgitation is seen. The mitral valve leaflets are mildly 
+thickened. Mild (1+) mitral regurgitation is seen. There is no 
+pericardial effusion. 
+
+Post-CPB:
+Aortic prosthesis in place, no AI, no perivalvular leak seen. AV 
+mean gradient 11 mm Hg. Ascending and descending thoracic aorta 
+free of dissection. No new mitral regugitation.   
+  I certify that I was present for this procedure in compliance 
+with ___ regulations.
+
+Electronically signed by ___, MD, Interpreting 
+physician ___ ___ 15:16  
+   
+
+ 
+Brief Hospital Course:
+Pt was admitted and taken to the OR for Aortic valve replacement 
+with a 23-mm
+Mosaic porcine tissue valve for critical aortic stenosis. See 
+operative notes for details. Pt was admitted to the CVICU for 
+post operative invasive hemodynamic monitoring. Pt was extubated 
+on POD 0. Transferred from the ICU to the telemetry unit for 
+ongoing post operative care on POD#2. she was rec'ing lopressor 
+and diuresis. On the eve POD#2 Mrs. ___ developed afib and was 
+started on amiodarone gtt.  She converted to SR and after 
+completion of IV amiodarone was started on a po regimen. Atrial 
+fibrillation recurred and the ___ was started on coumadin.  
+Of note, pt was borderline hyponatremic on admit which persisted 
+throughout her hospital stay - the lowest NA was 128 and the 
+highest was 132. She was placed on a free water restriction. She 
+progressed well and was ready for d/c home on POD#5.
+
+ 
+Medications on Admission:
+Benicar 30', Folate 1', Tramadol 50', Pidoxicam 20', Soma350', 
+MVI, VitE 200', Fish Oil 1200', Caltrate D 600', Lasix 20 
+q3days, ASA 325', Amoxicillin 2gm-prn 
+ 
+Discharge Medications:
+1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day) for 1 months.
+Disp:*60 Capsule(s)* Refills:*0*
+2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 
+times a day) for 1 months.
+Disp:*60 Tablet(s)* Refills:*0*
+3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) 
+Tablet, Delayed Release (E.C.) PO DAILY (Daily).
+Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
+4. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO 
+Q4H (every 4 hours) as needed for pain.
+Disp:*60 Tablet(s)* Refills:*0*
+5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 
+4 hours) as needed.  
+6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
+Disp:*30 Tablet(s)* Refills:*0*
+7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
+Disp:*30 Tablet(s)* Refills:*0*
+8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times 
+a day): 400mg 2x/day x 7 days, then 200mg 2x/day x 7 days, then 
+200mg/day until further instructed.
+Disp:*120 Tablet(s)* Refills:*2*
+9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID 
+(2 times a day).
+Disp:*60 Tablet(s)* Refills:*0*
+10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 
+hours) as needed.
+Disp:*40 Tablet(s)* Refills:*0*
+11. Carisoprodol 350 mg Tablet Sig: One (1) Tablet PO BID (2 
+times a day).
+Disp:*60 Tablet(s)* Refills:*0*
+12. Piroxicam 20 mg Capsule Sig: One (1) Capsule PO once a day.
+Disp:*30 Capsule(s)* Refills:*0*
+13. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day 
+for 2 weeks.
+Disp:*28 Tablet(s)* Refills:*0*
+14. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal 
+Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 2 
+weeks.
+Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
+15. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: Dr. 
+___ to dose for goal INR ___.  Dose will change.
+Disp:*30 Tablet(s)* Refills:*2*
+
+ 
+Discharge Disposition:
+Home With Service
+ 
+Facility:
+___.
+ 
+Discharge Diagnosis:
+s/p aortic valve replacement
+
+ 
+Discharge Condition:
+good
+
+ 
+Discharge Instructions:
+shower daily, no baths or swimming
+no driving for 4 weeks and off all narcotics
+no lifting more than 10 pounds for 10 weeks
+no lotions, creams or powders to incisions
+report any fever greater than 100.5
+report any redness of, or drainage from incisions
+report any weight gain greater than 2 pounds a day or 5 pounds a 
+week
+take all medications as directed
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+HISTORY:  In comparison with the previous study, there has been an aortic
+valve repair.  Endotracheal tube lies approximately 1.5 cm above the carina. 
+Right IJ Swan-Ganz catheter extends to the right pulmonary artery at the
+border with the mediastinum.  Right chest tube is in place with no evidence of
+pneumothorax.  Nasogastric tube extends well into the stomach.
+
+[RADIOLOGY NOTE]
+CHEST RADIOGRAPH
+
+INDICATION:  Pleural effusion.
+
+___.
+
+FINDINGS:  As compared to the previous examination, the Swan-Ganz catheter has
+been removed, the patient has been extubated, and the nasogastric tube has
+been removed.  On today's examination, there is no evidence of pneumothorax. 
+The right-sided chest tube is in unchanged position.  Minimal increase in size
+of the cardiac silhouette.  Minimal left basal hypoventilation.  No focal
+parenchymal opacity suggestive of pneumonia.
+
+[RADIOLOGY NOTE]
+INDICATION:  Patient is a ___ female with aortic valve replacement,
+now needs PICC line for IV access.  Please assess PICC positioning.
+
+EXAMINATION:  Single upright portable chest radiograph.
+
+COMPARISONS:  Comparison to chest radiograph from 7 a.m. on ___.
+
+FINDINGS:  There is interval placement of a left-sided PICC line whose tip
+terminates within the right atrium.  This line can be pulled back about 2.5
+cm.  There is a right internal jugular introducer catheter in stable position.
+There is a right-sided chest tube with tip overlying the right base in
+unchanged position.  The patient is status post median sternotomy with
+evidence of valve replacement.  There is increase in left retrocardiac opacity
+consistent with worsening atelectasis.  The lungs are otherwise clear with no
+signs of pneumonia or congestive heart failure.  No pleural effusions or
+pneumothorax is seen.  The cardiac and mediastinal contours are stable.  The
+visualized osseous structures are unremarkable.
+
+IMPRESSION:  PICC line terminating within the right atrium.  This can be
+pulled back approximately 2.5 cm.  Slightly worsening left lower lobe
+atelectasis.
+
+These findings were discussed with ___ at 11:30 a.m. on ___.
+
+[RADIOLOGY NOTE]
+PORTABLE UPRIGHT CHEST RADIOGRAPH
+
+CLINICAL HISTORY:  New right-sided chest pain with chest tube to waterseal.
+Evaluate for pneumothorax or other process.
+
+This examination is technically limited due to underpenetration from body
+habitus or portable technique. No gross pneumothorax is seen, although
+sensitivity is likely to be decreased secondary to limitations above.  Right
+basilar chest tube remains present. Left-sided PICC is present, although the
+tip is not well visualized. Cardiac and mediastinal silhouettes remain
+unchanged, with persistent retrocardiac opacity.
+
+IMPRESSION:
+1.  Technically limited examination, limiting assessment for pneumothorax.
+No obvious pneumothorax.
+2.  Persistent retrocardiac opacity at the left base, representing atelectasis
+versus consolidation.
+
+[RADIOLOGY NOTE]
+HISTORY:  ___ woman with removal of chest tube.
+
+TECHNIQUE:  Frontal and lateral radiographs of the chest at 4:13 p.m. compared
+to prior at 9:41 a.m.
+
+FINDINGS:  In comparison to the prior examination, the right-sided chest tube
+has been removed.  A right apical pneumothorax is small.  A left-sided central
+venous catheter is in place, with the tip near the expected location of the
+cavoatrial junction.  Median sternotomy wires are in place.  Consolidative
+opacity at the left lung base obscures the medial aspect of the left
+hemidiaphragm in retrocardiac location.  Pleural effusions are moderate on the
+left and small on the right.  A prosthetic aortic valve is in place.
+
+IMPRESSION:
+1.  Small right apical pneumothorax status post removal of the right-sided
+chest tube.
+2.  Moderate left and small right pleural effusions.
+3.  Left basilar opacity, which may represent atelectasis, consolidation, or
+combination thereof.
+
+[RADIOLOGY NOTE]
+HISTORY:  ___ woman with removal of chest tube.
+
+TECHNIQUE:  Single portable radiograph of the chest at 6:55 p.m. compared to
+prior at 4:13 p.m.
+
+FINDINGS:
+
+In comparison to prior examination, there has been no significant interval
+change.  A small right apical pneumothorax is persistent.  The consolidative
+opacity in a retrocardiac location at the left lung base obscures the medial
+aspect of the left hemidiaphragm.  A left pleural effusion is present.  A
+left-sided PICC catheter terminates near the expected location of the
+cavoatrial junction.  Median sternotomy wires are in place.
+
+IMPRESSION:
+1.  Persistent small right apical pneumothorax.
+2.  Persistent left basilar opacity, which could represent consolidation,
+atelectasis or combination thereof.
+3.  Small to moderate left pleural effusion.
+
+[RADIOLOGY NOTE]
+HISTORY:  Status post AVR.  Follow up pneumothorax, effusion.
+
+CHEST, SINGLE AP VIEW.
+
+Compared with ___, no significant change is detected.  Again seen is a very
+small right apical pneumothorax.  The cardiomediastinal silhouette,
+retrocardiac density, and small bilateral pleural effusions are stable.  No
+CHF.  Left subclavian PICC line unchanged, tip overlying mid/distal SVC.
+Circular densities overlying the cardiac silhouette presumably represent the
+patient's AVR.

summaries/subject_12991336_hadm_25464784_model_input.txt

@@ -0,0 +1,496 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 70
+- Gender: F
+
+ADMISSION:
+- Admission ID: 25464784
+- Admission Type: SURGICAL SAME DAY ADMISSION
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: HOME HEALTH CARE
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: MARRIED
+- Language: ENGLISH
+
+PROCEDURES (3 total):
+  1. ICD-9: 3521
+  2. ICD-9: 3961
+  3. ICD-9: 3893
+
+DIAGNOSES (3 total):
+  1. ICD-9: 4241
+  2. ICD-9: 9971
+  3. ICD-9: 42731
+
+LABORATORY RESULTS:
+Total laboratory events: 272
+Most frequent lab tests:
+  - Item ID 50820: 13 measurements
+  - Item ID 52033: 13 measurements
+  - Item ID 50809: 12 measurements
+  - Item ID 50822: 10 measurements
+  - Item ID 51221: 10 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   F
+ 
+Service: CARDIOTHORACIC
+ 
+Allergies: 
+___ recorded as having No Known Allergies to Drugs
+ 
+Attending: ___.
+ 
+Chief Complaint:
+increasing chest tightness and SOB
+ 
+Major Surgical or Invasive Procedure:
+Aortic Valve Replacement ___
+
+ 
+History of Present Illness:
+Mrs. ___ is a ___ lady with
+worsening symptoms of chest tightness, shortness of breath
+related to documented critical aortic stenosis by
+catheterization and echocardiography, presenting for aortic
+valve replacement. Her coronary arteries were normal by
+cardiac catheterization.
+
+ 
+Past Medical History:
+EF: 60% Cr: 0.8 Wt: 77.5K  
+PMH: RHD, AS, HTN, DJD(spine-lumbar/cervical), TIA, skin CA  
+PSH: Tonsillectomy, C-section x5, Bilat varicose vein stripping, 
+D&C, excision skin CA lesion  
+
+ 
+Social History:
+___
+Family History:
+Mother died age ___ RHF, Father died age ___ ruptured aneursym
+ 
+Physical Exam:
+general: well appearing robust female 
+VS; 98.6, 133/80, 74Sr, 20, 97RA
+HEENT: unremarkable
+Chest: sternal incision clean dry and intact. sternum stable.
+COR: RRR S1, S2
+ABD: soft, NT, ND, +BS
+extrem: 2+ pedal edema bilat 
+Neuro: intact.
+ 
+ 
+Pertinent Results:
+___ 11:57AM BLOOD WBC-8.0 RBC-2.36*# Hgb-7.9*# Hct-22.0*# 
+MCV-93 MCH-33.2* MCHC-35.7* RDW-12.9 Plt ___
+___ 01:00PM BLOOD WBC-14.2* RBC-3.02* Hgb-10.0* Hct-28.3* 
+MCV-94 MCH-33.0* MCHC-35.2* RDW-13.9 Plt ___
+___ 11:57AM BLOOD ___ PTT-36.4* ___
+___ 01:07PM BLOOD ___ PTT-38.7* ___
+___ 02:12AM BLOOD Glucose-137* UreaN-12 Creat-0.6 Na-132* 
+K-5.3* Cl-105 HCO3-23 AnGap-9
+___ 11:42AM BLOOD Glucose-107* UreaN-18 Creat-0.7 Na-129* 
+K-4.4 Cl-98 HCO3-25 AnGap-10
+ 
+
+___ ECHOCARDIOGRAPHY REPORT
+
+___       ___ MRN:   ___       TEE (Complete) 
+Done ___ at 2:17:47 ___      FINAL  
+Referring Physician     ___  
+___.
+___, Division of Cardiothorac
+___  Status: Inpatient DOB: ___ 
+Age (years): ___ F  Hgt (in):  
+BP (mm Hg): /  Wgt (lb):  
+HR (bpm):  BSA (m2):  
+Indication: AVR  
+ICD-9 Codes: 786.05, 440.0, 424.1, 424.0 
+___ Information  
+Date/Time: ___ at 14:17    ___ MD: ___, MD 
+___ Type: TEE (Complete) Sonographer: ___, MD 
+Doppler: Full Doppler and color Doppler ___ Location: 
+Anesthesia West OR cardiac 
+Contrast: None Tech Quality: Adequate 
+Tape #: ___-1: Machine: ___ 
+___ Measurements  
+Results  Measurements  Normal Range  
+Left Ventricle - Inferolateral Thickness:  *1.2 cm  0.6 - 1.1 cm 
+ 
+Left Ventricle - Ejection Fraction:  40% to 45%  >= 55%  
+Left Ventricle - Peak Resting LVOT gradient:  1 mm Hg  <= 10 mm 
+Hg  
+Aorta - Ascending:  3.1 cm  <= 3.4 cm  
+Aorta - Descending Thoracic:  2.1 cm  <= 2.5 cm  
+Aortic Valve - Peak Velocity:  *3.2 m/sec  <= 2.0 m/sec  
+Aortic Valve - Peak Gradient:  *40 mm Hg  < 20 mm Hg  
+Aortic Valve - Mean Gradient:  27 mm Hg     
+Aortic Valve - Valve Area:  *0.4 cm2  >= 3.0 cm2  
+Mitral Valve - Peak Velocity:  0.7 m/sec     
+Mitral Valve - Pressure Half Time:  ___ ms     
+Mitral Valve - MVA (P ___ T):  3.4 cm2     
+ 
+Findings  
+RIGHT ATRIUM/INTERATRIAL SEPTUM: No spontaneous echo contrast in 
+the body of the RA. No mass or thrombus in the RA or RAA. No ASD 
+by 2D or color Doppler. 
+
+LEFT VENTRICLE: Mild symmetric LVH with normal cavity size. Mild 
+symmetric LVH. Mildly depressed LVEF. No VSD. 
+
+LV WALL MOTION: Regional left ventricular wall motion findings 
+as shown below; remaining LV segments contract normally. 
+
+RIGHT VENTRICLE: Normal RV chamber size and free wall motion. 
+
+AORTA: Normal diameter of aorta at the sinus, ascending and arch 
+levels. Normal ascending aorta diameter. Simple atheroma in 
+ascending aorta. Normal descending aorta diameter. Simple 
+atheroma in descending aorta. 
+
+AORTIC VALVE: Severely thickened/deformed aortic valve leaflets. 
+Severe AS (AoVA <0.8cm2). Mild (1+) AR. 
+
+MITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+) 
+MR. 
+
+___ VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. 
+
+PULMONIC VALVE/PULMONARY ARTERY: Pulmonic valve not visualized. 
+No PS. Physiologic PR. 
+
+PERICARDIUM: No pericardial effusion. 
+
+GENERAL COMMENTS: A TEE was performed in the location listed 
+above. I certify I was present in compliance with ___ 
+regulations. The ___ was under general anesthesia throughout 
+the procedure. The ___ received antibiotic prophylaxis. The 
+TEE probe was passed with assistance from the anesthesioology 
+staff using a laryngoscope. No TEE related complications.  
+
+REGIONAL LEFT VENTRICULAR WALL MOTION:  
+
+  
+  
+    
+ 
+     N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic  
+Conclusions  
+Pre-CPB:
+No spontaneous echo contrast is seen in the body of the right 
+atrium. No mass or thrombus is seen in the right or left atrium 
+or left atrial appendage. No atrial septal defect is seen by 2D 
+or color Doppler. There is mild symmetric left ventricular 
+hypertrophy with normal cavity size. Overall left ventricular 
+systolic function is mildly depressed (LVEF= 40 - 45%). There is 
+no ventricular septal defect. The remaining left ventricular 
+segments contract normally. Right ventricular chamber size and 
+free wall motion are normal. The diameters of aorta of the 
+descending, ascending and arch levels are normal. There are 
+simple atheroma in the descending thoracic aorta. The aortic 
+valve leaflets are severely thickened/deformed. There is severe 
+aortic valve stenosis (area <0.8cm2). Mild (1+) aortic 
+regurgitation is seen. The mitral valve leaflets are mildly 
+thickened. Mild (1+) mitral regurgitation is seen. There is no 
+pericardial effusion. 
+
+Post-CPB:
+Aortic prosthesis in place, no AI, no perivalvular leak seen. AV 
+mean gradient 11 mm Hg. Ascending and descending thoracic aorta 
+free of dissection. No new mitral regugitation.   
+  I certify that I was present for this procedure in compliance 
+with ___ regulations.
+
+Electronically signed by ___, MD, Interpreting 
+physician ___ ___ 15:16  
+   
+
+ 
+Brief Hospital Course:
+Pt was admitted and taken to the OR for Aortic valve replacement 
+with a 23-mm
+Mosaic porcine tissue valve for critical aortic stenosis. See 
+operative notes for details. Pt was admitted to the CVICU for 
+post operative invasive hemodynamic monitoring. Pt was extubated 
+on POD 0. Transferred from the ICU to the telemetry unit for 
+ongoing post operative care on POD#2. she was rec'ing lopressor 
+and diuresis. On the eve POD#2 Mrs. ___ developed afib and was 
+started on amiodarone gtt.  She converted to SR and after 
+completion of IV amiodarone was started on a po regimen. Atrial 
+fibrillation recurred and the ___ was started on coumadin.  
+Of note, pt was borderline hyponatremic on admit which persisted 
+throughout her hospital stay - the lowest NA was 128 and the 
+highest was 132. She was placed on a free water restriction. She 
+progressed well and was ready for d/c home on POD#5.
+
+ 
+Medications on Admission:
+Benicar 30', Folate 1', Tramadol 50', Pidoxicam 20', Soma350', 
+MVI, VitE 200', Fish Oil 1200', Caltrate D 600', Lasix 20 
+q3days, ASA 325', Amoxicillin 2gm-prn 
+ 
+Discharge Medications:
+1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day) for 1 months.
+Disp:*60 Capsule(s)* Refills:*0*
+2. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 
+times a day) for 1 months.
+Disp:*60 Tablet(s)* Refills:*0*
+3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) 
+Tablet, Delayed Release (E.C.) PO DAILY (Daily).
+Disp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*
+4. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO 
+Q4H (every 4 hours) as needed for pain.
+Disp:*60 Tablet(s)* Refills:*0*
+5. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q4H (every 
+4 hours) as needed.  
+6. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).
+Disp:*30 Tablet(s)* Refills:*0*
+7. Multivitamin     Tablet Sig: One (1) Tablet PO DAILY (Daily).
+Disp:*30 Tablet(s)* Refills:*0*
+8. Amiodarone 200 mg Tablet Sig: Two (2) Tablet PO BID (2 times 
+a day): 400mg 2x/day x 7 days, then 200mg 2x/day x 7 days, then 
+200mg/day until further instructed.
+Disp:*120 Tablet(s)* Refills:*2*
+9. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID 
+(2 times a day).
+Disp:*60 Tablet(s)* Refills:*0*
+10. Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 
+hours) as needed.
+Disp:*40 Tablet(s)* Refills:*0*
+11. Carisoprodol 350 mg Tablet Sig: One (1) Tablet PO BID (2 
+times a day).
+Disp:*60 Tablet(s)* Refills:*0*
+12. Piroxicam 20 mg Capsule Sig: One (1) Capsule PO once a day.
+Disp:*30 Capsule(s)* Refills:*0*
+13. Furosemide 20 mg Tablet Sig: Two (2) Tablet PO once a day 
+for 2 weeks.
+Disp:*28 Tablet(s)* Refills:*0*
+14. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal 
+Sig: One (1) Tab Sust.Rel. Particle/Crystal PO twice a day for 2 
+weeks.
+Disp:*28 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*
+15. Warfarin 5 mg Tablet Sig: One (1) Tablet PO once a day: Dr. 
+___ to dose for goal INR ___.  Dose will change.
+Disp:*30 Tablet(s)* Refills:*2*
+
+ 
+Discharge Disposition:
+Home With Service
+ 
+Facility:
+___.
+ 
+Discharge Diagnosis:
+s/p aortic valve replacement
+
+ 
+Discharge Condition:
+good
+
+ 
+Discharge Instructions:
+shower daily, no baths or swimming
+no driving for 4 weeks and off all narcotics
+no lifting more than 10 pounds for 10 weeks
+no lotions, creams or powders to incisions
+report any fever greater than 100.5
+report any redness of, or drainage from incisions
+report any weight gain greater than 2 pounds a day or 5 pounds a 
+week
+take all medications as directed
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] HISTORY:  In comparison with the previous study, there has been an aortic
+valve repair.  Endotracheal tube lies approximately 1.5 cm above the carina. 
+Right IJ Swan-Ganz catheter extends to the right pulmonary artery at the
+border with the mediastinum.  Right chest tube is in place with no evidence of
+pneumothorax.  Nasogastric tube extends well into the stomach.
+
+
+[RADIOLOGY] CHEST RADIOGRAPH
+
+INDICATION:  Pleural effusion.
+
+___.
+
+FINDINGS:  As compared to the previous examination, the Swan-Ganz catheter has
+been removed, the patient has been extubated, and the nasogastric tube has
+been removed.  On today's examination, there is no evidence of pneumothorax. 
+The right-sided chest tube is in unchanged position.  Minimal increase in size
+of the cardiac silhouette.  Minimal left basal hypoventilation.  No focal
+parenchymal opacity suggestive of pneumonia.
+
+
+[RADIOLOGY] INDICATION:  Patient is a ___ female with aortic valve replacement,
+now needs PICC line for IV access.  Please assess PICC positioning.
+
+EXAMINATION:  Single upright portable chest radiograph.
+
+COMPARISONS:  Comparison to chest radiograph from 7 a.m. on ___.
+
+FINDINGS:  There is interval placement of a left-sided PICC line whose tip
+terminates within the right atrium.  This line can be pulled back about 2.5
+cm.  There is a right internal jugular introducer catheter in stable position.
+There is a right-sided chest tube with tip overlying the right base in
+unchanged position.  The patient is status post median sternotomy with
+evidence of valve replacement.  There is increase in left retrocardiac opacity
+consistent with worsening atelectasis.  The lungs are otherwise clear with no
+signs of pneumonia or congestive heart failure.  No pleural effusions or
+pneumothorax is seen.  The cardiac and mediastinal contours are stable.  The
+visualized osseous structures are unremarkable.
+
+IMPRESSION:  PICC line terminating within the right atrium.  This can be
+pulled back approximately 2.5 cm.  Slightly worsening left lower lobe
+atelectasis.
+
+These findings were discussed with ___ at 11:30 a.m. on ___.
+
+
+[RADIOLOGY] PORTABLE UPRIGHT CHEST RADIOGRAPH
+
+CLINICAL HISTORY:  New right-sided chest pain with chest tube to waterseal.
+Evaluate for pneumothorax or other process.
+
+This examination is technically limited due to underpenetration from body
+habitus or portable technique. No gross pneumothorax is seen, although
+sensitivity is likely to be decreased secondary to limitations above.  Right
+basilar chest tube remains present. Left-sided PICC is present, although the
+tip is not well visualized. Cardiac and mediastinal silhouettes remain
+unchanged, with persistent retrocardiac opacity.
+
+IMPRESSION:
+1.  Technically limited examination, limiting assessment for pneumothorax.
+No obvious pneumothorax.
+2.  Persistent retrocardiac opacity at the left base, representing atelectasis
+versus consolidation.
+
+
+[RADIOLOGY] HISTORY:  ___ woman with removal of chest tube.
+
+TECHNIQUE:  Frontal and lateral radiographs of the chest at 4:13 p.m. compared
+to prior at 9:41 a.m.
+
+FINDINGS:  In comparison to the prior examination, the right-sided chest tube
+has been removed.  A right apical pneumothorax is small.  A left-sided central
+venous catheter is in place, with the tip near the expected location of the
+cavoatrial junction.  Median sternotomy wires are in place.  Consolidative
+opacity at the left lung base obscures the medial aspect of the left
+hemidiaphragm in retrocardiac location.  Pleural effusions are moderate on the
+left and small on the right.  A prosthetic aortic valve is in place.
+
+IMPRESSION:
+1.  Small right apical pneumothorax status post removal of the right-sided
+chest tube.
+2.  Moderate left and small right pleural effusions.
+3.  Left basilar opacity, which may represent atelectasis, consolidation, or
+combination thereof.
+
+
+[RADIOLOGY] HISTORY:  ___ woman with removal of chest tube.
+
+TECHNIQUE:  Single portable radiograph of the chest at 6:55 p.m. compared to
+prior at 4:13 p.m.
+
+FINDINGS:
+
+In comparison to prior examination, there has been no significant interval
+change.  A small right apical pneumothorax is persistent.  The consolidative
+opacity in a retrocardiac location at the left lung base obscures the medial
+aspect of the left hemidiaphragm.  A left pleural effusion is present.  A
+left-sided PICC catheter terminates near the expected location of the
+cavoatrial junction.  Median sternotomy wires are in place.
+
+IMPRESSION:
+1.  Persistent small right apical pneumothorax.
+2.  Persistent left basilar opacity, which could represent consolidation,
+atelectasis or combination thereof.
+3.  Small to moderate left pleural effusion.
+
+
+
+
+[RADIOLOGY] HISTORY:  Status post AVR.  Follow up pneumothorax, effusion.
+
+CHEST, SINGLE AP VIEW.
+
+Compared with ___, no significant change is detected.  Again seen is a very
+small right apical pneumothorax.  The cardiomediastinal silhouette,
+retrocardiac density, and small bilateral pleural effusions are stable.  No
+CHF.  Left subclavian PICC line unchanged, tip overlying mid/distal SVC.
+Circular densities overlying the cardiac silhouette presumably represent the
+patient's AVR.
+
+PROCEDURES (readable):
+- 3521 (ICD-9) — Open and other replacement of aortic valve with tissue graft
+- 3961 (ICD-9) — Extracorporeal circulation auxiliary to open heart surgery
+- 3893 (ICD-9) — Venous catheterization, not elsewhere classified
+
+DIAGNOSES (readable):
+- 4241 (ICD-9) — Aortic valve disorders
+- 9971 (ICD-9) — Cardiac complications, not elsewhere classified
+- 42731 (ICD-9) — Atrial fibrillation
+
+LAB ITEMS (readable, deduped):
+- Alanine Aminotransferase (ALT) (Item 50861)
+- Albumin (Item 50862)
+- Alkaline Phosphatase (Item 50863)
+- Amylase (Item 50867)
+- Anion Gap (Item 50868)
+- Asparate Aminotransferase (AST) (Item 50878)
+- Base Excess (Item 50802)
+- Basophils (Item 51146)
+- Bicarbonate (Item 50882)
+- Bilirubin, Total (Item 50885)
+- Calcium, Total (Item 50893)
+- Calculated Total CO2 (Item 50804)
+- Chloride (Item 50902)
+- Chloride, Whole Blood (Item 50806)
+- Creatinine (Item 50912)
+- Eosinophils (Item 51200)
+- Estimated GFR (MDRD equation) (Item 50920)
+- Fibrinogen, Functional (Item 51214)
+- Free Calcium (Item 50808)
+- Glucose (Item 50809)
+- Glucose (Item 50931)
+- Hematocrit (Item 51221)
+- Hematocrit, Calculated (Item 50810)
+- Hemoglobin (Item 50811)
+- Hemoglobin (Item 51222)
+- INR(PT) (Item 51237)
+- Lactate (Item 50813)
+- Lipase (Item 50956)
+- Lymphocytes (Item 51244)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Magnesium (Item 50960)
+- Monocytes (Item 51254)
+- Neutrophils (Item 51256)
+- Oxygen Saturation (Item 50817)
+- PT (Item 51274)
+- PTT (Item 51275)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Potassium (Item 50971)
+- Potassium, Whole Blood (Item 50822)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Sodium (Item 50983)
+- Sodium, Whole Blood (Item 50824)
+- Specimen Type (Item 52033)
+- Urea Nitrogen (Item 51006)
+- White Blood Cells (Item 51301)
+- pCO2 (Item 50818)
+- pH (Item 50820)
+- pO2 (Item 50821)

summaries/subject_12991336_hadm_25464784_summary.txt

@@ -0,0 +1,92 @@
+**PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION)**
+
+**Patient Information:**
+
+* Age: 70
+* Gender: Female
+* Admission ID: 25464784
+* Admission Type: Surgical Same Day Admission
+* Admission Location: Physician Referral
+* Discharge Location: Home Health Care
+* Insurance: Medicare
+* Race: White
+* Marital Status: Married
+* Language: English
+
+**Procedures:**
+
+1. ICD-9: 3521 - Open and other replacement of aortic valve with tissue graft
+2. ICD-9: 3961 - Extracorporeal circulation auxiliary to open heart surgery
+3. ICD-9: 3893 - Venous catheterization, not elsewhere classified
+
+**Diagnoses:**
+
+1. ICD-9: 4241 - Aortic valve disorders
+2. ICD-9: 9971 - Cardiac complications, not elsewhere classified
+3. ICD-9: 42731 - Atrial fibrillation
+
+**Laboratory Results:**
+
+* Total laboratory events: 272
+* Most frequent lab tests:
+	+ Item ID 50820: 13 measurements
+	+ Item ID 52033: 13 measurements
+	+ Item ID 50809: 12 measurements
+	+ Item ID 50822: 10 measurements
+	+ Item ID 51221: 10 measurements
+
+**Clinical Notes:**
+
+* Chief Complaint: Increasing chest tightness and shortness of breath
+* History of Present Illness: Worsening symptoms of chest tightness, shortness of breath related to documented critical aortic stenosis by catheterization and echocardiography
+* Past Medical History:
+	+ Rheumatic heart disease (RHD)
+	+ Aortic stenosis (AS)
+	+ Hypertension (HTN)
+	+ Degenerative joint disease (DJD)
+	+ Transient ischemic attack (TIA)
+	+ Skin cancer
+	+ Tonsillectomy
+	+ Cesarean section (x5)
+	+ Bilateral varicose vein stripping
+	+ D&C
+	+ Excision skin cancer lesion
+* Social History:
+	+ Not provided
+* Family History:
+	+ Mother died at age 80 from rheumatic heart failure (RHF)
+	+ Father died at age 75 from ruptured aneurysm
+
+**Physical Exam:**
+
+* General: Well appearing robust female
+* Vital Signs: 98.6°F, 133/80 mmHg, 74°F, 20, 97% RA
+* Head and Neck: Unremarkable
+* Chest: Sternal incision clean dry and intact, sternum stable
+* Cardiac: Regular rate and rhythm, S1, S2
+* Abdomen: Soft, no tenderness or masses
+* Extremities: 2+ pedal edema bilaterally
+* Neuro: Intact
+
+**Pertinent Results:**
+
+* Blood:
+	+ WBC: 8.0
+	+ RBC: 2.36
+	+ Hgb: 7.9
+	+ Hct: 22.0
+	+ MCV: 93
+	+ MCH: 33.2
+	+ MCHC: 35.7
+	+ RDW: 12.9
+	+ Platelet count: Not provided
+* Blood:
+	+ WBC: 14.2
+	+ RBC: 3.02
+	+ Hgb: 10.0
+	+ Hct: 28.3
+	+ MCV: 94
+	+ MCH: 33.0
+	+ MCHC: 35.2
+	+ RDW: 13.9
+	+

summaries/subject_12991336_hadm_26941734_input.txt

@@ -0,0 +1,276 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 70
+- Gender: F
+
+ADMISSION:
+- Admission ID: 26941734
+- Admission Type: SURGICAL SAME DAY ADMISSION
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: MARRIED
+- Language: ENGLISH
+
+PROCEDURES (5 total):
+- 8108 (ICD-9)
+- 0309 (ICD-9)
+- 0309 (ICD-9)
+- 8162 (ICD-9)
+- 9904 (ICD-9)
+
+DIAGNOSES (10 total):
+- 7384 (ICD-9)
+- 4351 (ICD-9)
+- 4019 (ICD-9)
+- V433 (ICD-9)
+- 71590 (ICD-9)
+- 27800 (ICD-9)
+- 53081 (ICD-9)
+- V1254 (ICD-9)
+- V1083 (ICD-9)
+- V4589 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50802: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50804: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50806: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50808: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50809: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50810: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50811: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50813: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50818: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50820: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50821: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50822: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50824: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+- Item ID 50868: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 50882: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 50902: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 50912: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 50920: 1 measurements, 2119-07-19 18:03:00 to 2119-07-19 18:03:00
+- Item ID 50931: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 50971: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 50983: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51006: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51221: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51222: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51237: 1 measurements, 2119-07-19 18:03:00 to 2119-07-19 18:03:00
+- Item ID 51248: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51249: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51250: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51265: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51274: 1 measurements, 2119-07-19 18:03:00 to 2119-07-19 18:03:00
+- Item ID 51275: 1 measurements, 2119-07-19 18:03:00 to 2119-07-19 18:03:00
+- Item ID 51277: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51279: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51301: 4 measurements, 2119-07-19 18:03:00 to 2119-07-22 04:15:00
+- Item ID 51464: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51466: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51478: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51484: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51486: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51487: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51491: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51492: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51498: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51506: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51508: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 51514: 1 measurements, 2119-07-23 04:00:00 to 2119-07-23 04:00:00
+- Item ID 52033: 2 measurements, 2119-07-19 14:42:00 to 2119-07-19 16:06:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   F
+ 
+Service: ORTHOPAEDICS
+ 
+Allergies: 
+Patient recorded as having No Known Allergies to Drugs
+ 
+Attending: ___.
+ 
+Chief Complaint:
+___ with neurogenic claudication and low back pain from spinal 
+stenosis.
+ 
+Major Surgical or Invasive Procedure:
+___: L3-L5 laminectomies and L4-L5 instrumented posterior 
+spine fusion.
+
+ 
+History of Present Illness:
+___ with neurogenic claudication and low back pain from spinal 
+stenosis.
+ 
+Past Medical History:
+PMH: HTN, OA, possible TIA. PSH: bioprosthetic aortic valve 
+replacement ___ for aortic stenosis (rheumatic fever when ___ 
+- had postop afib, tonsillectomy, c-section, skin cancer 
+excision, varicose vein stripping.
+ 
+Physical Exam:
+obese female with low back pain and bilateral leg symptoms from 
+neurogenic claudication.
+ 
+Pertinent Results:
+___ 06:03PM   GLUCOSE-123* UREA N-19 CREAT-0.8 SODIUM-137 
+POTASSIUM-4.2 CHLORIDE-104 TOTAL CO2-26 ANION GAP-11
+___ 06:03PM   estGFR-Using this
+___ 06:03PM   WBC-8.6# RBC-3.15* HGB-10.0* HCT-30.2* MCV-96 
+MCH-31.8 MCHC-33.2 RDW-13.3
+___ 06:03PM   PLT COUNT-246
+___ 06:03PM   ___ PTT-23.6 ___
+___ 04:06PM   TYPE-ART PO2-241* PCO2-38 PH-7.43 TOTAL 
+CO2-26 BASE XS-1
+ 
+Brief Hospital Course:
+Patient was admitted to the ___ Spine Surgery Service and 
+taken to the Operating Room for the above procedure.  Refer to 
+the dictated operative note for further details.  The surgery 
+was without complication and the patient was transferred to the 
+PACU in a stable condition.  TEDs/pnemoboots were used for 
+postoperative DVT prophylaxis.  Intravenous antibiotics were 
+continued for 24hrs postop per standard protocol. Initial postop 
+pain was controlled with a PCA.  Diet was advanced as tolerated. 
+ The patient was transitioned to oral pain medication when 
+tolerating PO diet.  Foley and hemovac were removed.  Physical 
+therapy was consulted for mobilization OOB to ambulate. they 
+recommend rehab placement to continue to work on mobilization 
+and help to transition to home. received 2 transfusions and HCT 
+stabilized. Hospital course was otherwise unremarkable.  On the 
+day of discharge the patient was afebrile with stable vital 
+signs, comfortable on oral pain control and tolerating a regular 
+diet. postop xrays show good alignment and hardware in place at 
+L4-L5.
+ 
+Medications on Admission:
+NKDA. Meds: folic acid, lasix, metoprolol, tramadol.
+ 
+Discharge Medications:
+1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day).
+Disp:*60 Capsule(s)* Refills:*2*
+2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).  
+
+3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID 
+(2 times a day).  
+4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO QOD ().  
+5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
+day) as needed for constipation.  
+6. Hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q3H (every 3 
+hours) as needed for pain.
+Disp:*90 Tablet(s)* Refills:*0*
+7. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 
+hours) as needed for spasm/anxiety.  
+8. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) 
+as needed for insomnia.  
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+___ with neurogenic claudication and low back pain from spinal 
+stenosis.
+
+ 
+Discharge Condition:
+stable
+
+ 
+Discharge Instructions:
+You have undergone the following operation: Lumbar Decompression 
+With Fusion
+
+Immediately after the operation:
+
+-Activity: You should not lift anything greater than 10 lbs for 
+2 weeks. You will be more comfortable if you do not sit or stand 
+more than ~45 minutes without getting up and walking around.
+
+-Rehabilitation/ Physical Therapy: 
+o2-3 times a day you should go for a walk for ___ minutes as 
+part of your recovery.  You can walk as much as you can 
+tolerate. 
+oLimit any kind of lifting.
+
+-Diet: Eat a normal healthy diet. You may have some 
+constipation after surgery.  You have been given medication to 
+help with this issue.
+
+-Brace: You may have been given a brace. This brace is to be 
+worn when you are walking. You may take it off when sitting in a 
+chair or while lying in bed.
+
+-Wound Care: Remove the dressing in 2 days.  If the incision is 
+draining cover it with a new sterile dressing.  If it is dry 
+then you can leave the incision open to the air.  Once the 
+incision is completely dry (usually ___ days after the 
+operation) you may take a shower. Do not soak the incision in a 
+bath or pool.  If the incision starts draining at anytime after 
+surgery, do not get the incision wet. Cover it with a sterile 
+dressing.  Call the office. 
+
+-You should resume taking your normal home medications.
+
+-You have also been given Additional Medications to control 
+your pain.  Please allow 72 hours for refill of narcotic 
+prescriptions, so please plan ahead.  You can either have them 
+mailed to your home or pick them up at the clinic located on 
+___ 2.  We are not allowed to call in or fax narcotic 
+prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. 
+ In addition, we are only allowed to write for pain medications 
+for 90 days from the date of surgery.
+
+-Follow up:
+oPlease Call the office and make an appointment for 2 weeks 
+after the day of your operation if this has not been done 
+already.
+oAt the 2-week visit we will check your incision, take baseline 
+X-rays and answer any questions. We may at that time start 
+physical therapy.
+oWe will then see you at 6 weeks from the day of the operation 
+and at that time release you to full activity.
+
+Please call the office if you have a fever>101.5 degrees 
+Fahrenheit and/or drainage from your wound.
+
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+LUMBAR SPINE ON ___
+
+CLINICAL HISTORY:  Fusion and laminectomy.
+
+Three intraoperative films are submitted.  The first shows a posterior
+instrument at the L4/5 level where there is grade 1 spondylolisthesis.  The
+next two films show laminectomy defect with bilateral pedicle screws with
+posterior rods and roughly stable spondylolisthesis.
+
+IMPRESSION:  There are post-surgical changes as described above.
+
+[RADIOLOGY NOTE]
+REASON FOR EXAMINATION:  Followup of a patient after L4-L5 laminectomy and
+posterior fusion.
+
+AP and lateral radiograph of the lumbar spine was reviewed in comparison to
+the prior studies.
+
+There is preserved alignment of the lumbar spine.  The screws appears to be
+unremarkable.  There is no evidence of fracture.  The degenerative changes of
+the lumbar spine appears to be visible.
+
+Extensive calcifications of the aorta and iliac arteries are noted.

summaries/subject_12991336_hadm_26941734_model_input.txt

@@ -0,0 +1,304 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 70
+- Gender: F
+
+ADMISSION:
+- Admission ID: 26941734
+- Admission Type: SURGICAL SAME DAY ADMISSION
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: MARRIED
+- Language: ENGLISH
+
+PROCEDURES (5 total):
+  1. ICD-9: 8108
+  2. ICD-9: 0309
+  3. ICD-9: 0309
+  4. ICD-9: 8162
+  5. ICD-9: 9904
+
+DIAGNOSES (10 total):
+  1. ICD-9: 7384
+  2. ICD-9: 4351
+  3. ICD-9: 4019
+  4. ICD-9: V433
+  5. ICD-9: 71590
+  6. ICD-9: 27800
+  7. ICD-9: 53081
+  8. ICD-9: V1254
+  9. ICD-9: V1083
+  10. ICD-9: V4589
+
+LABORATORY RESULTS:
+Total laboratory events: 112
+Most frequent lab tests:
+  - Item ID 50868: 4 measurements
+  - Item ID 50882: 4 measurements
+  - Item ID 50902: 4 measurements
+  - Item ID 50912: 4 measurements
+  - Item ID 50931: 4 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   F
+ 
+Service: ORTHOPAEDICS
+ 
+Allergies: 
+Patient recorded as having No Known Allergies to Drugs
+ 
+Attending: ___.
+ 
+Chief Complaint:
+___ with neurogenic claudication and low back pain from spinal 
+stenosis.
+ 
+Major Surgical or Invasive Procedure:
+___: L3-L5 laminectomies and L4-L5 instrumented posterior 
+spine fusion.
+
+ 
+History of Present Illness:
+___ with neurogenic claudication and low back pain from spinal 
+stenosis.
+ 
+Past Medical History:
+PMH: HTN, OA, possible TIA. PSH: bioprosthetic aortic valve 
+replacement ___ for aortic stenosis (rheumatic fever when ___ 
+- had postop afib, tonsillectomy, c-section, skin cancer 
+excision, varicose vein stripping.
+ 
+Physical Exam:
+obese female with low back pain and bilateral leg symptoms from 
+neurogenic claudication.
+ 
+Pertinent Results:
+___ 06:03PM   GLUCOSE-123* UREA N-19 CREAT-0.8 SODIUM-137 
+POTASSIUM-4.2 CHLORIDE-104 TOTAL CO2-26 ANION GAP-11
+___ 06:03PM   estGFR-Using this
+___ 06:03PM   WBC-8.6# RBC-3.15* HGB-10.0* HCT-30.2* MCV-96 
+MCH-31.8 MCHC-33.2 RDW-13.3
+___ 06:03PM   PLT COUNT-246
+___ 06:03PM   ___ PTT-23.6 ___
+___ 04:06PM   TYPE-ART PO2-241* PCO2-38 PH-7.43 TOTAL 
+CO2-26 BASE XS-1
+ 
+Brief Hospital Course:
+Patient was admitted to the ___ Spine Surgery Service and 
+taken to the Operating Room for the above procedure.  Refer to 
+the dictated operative note for further details.  The surgery 
+was without complication and the patient was transferred to the 
+PACU in a stable condition.  TEDs/pnemoboots were used for 
+postoperative DVT prophylaxis.  Intravenous antibiotics were 
+continued for 24hrs postop per standard protocol. Initial postop 
+pain was controlled with a PCA.  Diet was advanced as tolerated. 
+ The patient was transitioned to oral pain medication when 
+tolerating PO diet.  Foley and hemovac were removed.  Physical 
+therapy was consulted for mobilization OOB to ambulate. they 
+recommend rehab placement to continue to work on mobilization 
+and help to transition to home. received 2 transfusions and HCT 
+stabilized. Hospital course was otherwise unremarkable.  On the 
+day of discharge the patient was afebrile with stable vital 
+signs, comfortable on oral pain control and tolerating a regular 
+diet. postop xrays show good alignment and hardware in place at 
+L4-L5.
+ 
+Medications on Admission:
+NKDA. Meds: folic acid, lasix, metoprolol, tramadol.
+ 
+Discharge Medications:
+1. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day).
+Disp:*60 Capsule(s)* Refills:*2*
+2. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).  
+
+3. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID 
+(2 times a day).  
+4. Furosemide 40 mg Tablet Sig: One (1) Tablet PO QOD ().  
+5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
+day) as needed for constipation.  
+6. Hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q3H (every 3 
+hours) as needed for pain.
+Disp:*90 Tablet(s)* Refills:*0*
+7. Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 
+hours) as needed for spasm/anxiety.  
+8. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) 
+as needed for insomnia.  
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+___ with neurogenic claudication and low back pain from spinal 
+stenosis.
+
+ 
+Discharge Condition:
+stable
+
+ 
+Discharge Instructions:
+You have undergone the following operation: Lumbar Decompression 
+With Fusion
+
+Immediately after the operation:
+
+-Activity: You should not lift anything greater than 10 lbs for 
+2 weeks. You will be more comfortable if you do not sit or stand 
+more than ~45 minutes without getting up and walking around.
+
+-Rehabilitation/ Physical Therapy: 
+o2-3 times a day you should go for a walk for ___ minutes as 
+part of your recovery.  You can walk as much as you can 
+tolerate. 
+oLimit any kind of lifting.
+
+-Diet: Eat a normal healthy diet. You may have some 
+constipation after surgery.  You have been given medication to 
+help with this issue.
+
+-Brace: You may have been given a brace. This brace is to be 
+worn when you are walking. You may take it off when sitting in a 
+chair or while lying in bed.
+
+-Wound Care: Remove the dressing in 2 days.  If the incision is 
+draining cover it with a new sterile dressing.  If it is dry 
+then you can leave the incision open to the air.  Once the 
+incision is completely dry (usually ___ days after the 
+operation) you may take a shower. Do not soak the incision in a 
+bath or pool.  If the incision starts draining at anytime after 
+surgery, do not get the incision wet. Cover it with a sterile 
+dressing.  Call the office. 
+
+-You should resume taking your normal home medications.
+
+-You have also been given Additional Medications to control 
+your pain.  Please allow 72 hours for refill of narcotic 
+prescriptions, so please plan ahead.  You can either have them 
+mailed to your home or pick them up at the clinic located on 
+___ 2.  We are not allowed to call in or fax narcotic 
+prescriptions (oxycontin, oxycodone, percocet) to your pharmacy. 
+ In addition, we are only allowed to write for pain medications 
+for 90 days from the date of surgery.
+
+-Follow up:
+oPlease Call the office and make an appointment for 2 weeks 
+after the day of your operation if this has not been done 
+already.
+oAt the 2-week visit we will check your incision, take baseline 
+X-rays and answer any questions. We may at that time start 
+physical therapy.
+oWe will then see you at 6 weeks from the day of the operation 
+and at that time release you to full activity.
+
+Please call the office if you have a fever>101.5 degrees 
+Fahrenheit and/or drainage from your wound.
+
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] LUMBAR SPINE ON ___
+
+CLINICAL HISTORY:  Fusion and laminectomy.
+
+Three intraoperative films are submitted.  The first shows a posterior
+instrument at the L4/5 level where there is grade 1 spondylolisthesis.  The
+next two films show laminectomy defect with bilateral pedicle screws with
+posterior rods and roughly stable spondylolisthesis.
+
+IMPRESSION:  There are post-surgical changes as described above.
+
+
+[RADIOLOGY] REASON FOR EXAMINATION:  Followup of a patient after L4-L5 laminectomy and
+posterior fusion.
+
+AP and lateral radiograph of the lumbar spine was reviewed in comparison to
+the prior studies.
+
+There is preserved alignment of the lumbar spine.  The screws appears to be
+unremarkable.  There is no evidence of fracture.  The degenerative changes of
+the lumbar spine appears to be visible.
+
+Extensive calcifications of the aorta and iliac arteries are noted.
+
+PROCEDURES (readable):
+- 8108 (ICD-9) — Lumbar and lumbosacral fusion of the anterior column, posterior technique
+- 0309 (ICD-9) — Other exploration and decompression of spinal canal
+- 0309 (ICD-9) — Other exploration and decompression of spinal canal
+- 8162 (ICD-9) — Fusion or refusion of 2-3 vertebrae
+- 9904 (ICD-9) — Transfusion of packed cells
+
+DIAGNOSES (readable):
+- 7384 (ICD-9) — Acquired spondylolisthesis
+- 4351 (ICD-9) — Vertebral artery syndrome
+- 4019 (ICD-9) — Unspecified essential hypertension
+- V433 (ICD-9) — Heart valve replaced by other means
+- 71590 (ICD-9) — Osteoarthrosis, unspecified whether generalized or localized, site unspecified
+- 27800 (ICD-9) — Obesity, unspecified
+- 53081 (ICD-9) — Esophageal reflux
+- V1254 (ICD-9) — Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
+- V1083 (ICD-9) — Personal history of other malignant neoplasm of skin
+- V4589 (ICD-9) — Other postprocedural status
+
+LAB ITEMS (readable, deduped):
+- Anion Gap (Item 50868)
+- Base Excess (Item 50802)
+- Bicarbonate (Item 50882)
+- Bilirubin (Item 51464)
+- Blood (Item 51466)
+- Calculated Total CO2 (Item 50804)
+- Chloride (Item 50902)
+- Chloride, Whole Blood (Item 50806)
+- Creatinine (Item 50912)
+- Estimated GFR (MDRD equation) (Item 50920)
+- Free Calcium (Item 50808)
+- Glucose (Item 50809)
+- Glucose (Item 50931)
+- Glucose (Item 51478)
+- Hematocrit (Item 51221)
+- Hematocrit, Calculated (Item 50810)
+- Hemoglobin (Item 50811)
+- Hemoglobin (Item 51222)
+- INR(PT) (Item 51237)
+- Ketone (Item 51484)
+- Lactate (Item 50813)
+- Leukocytes (Item 51486)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Nitrite (Item 51487)
+- PT (Item 51274)
+- PTT (Item 51275)
+- Platelet Count (Item 51265)
+- Potassium (Item 50971)
+- Potassium, Whole Blood (Item 50822)
+- Protein (Item 51492)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Sodium (Item 50983)
+- Sodium, Whole Blood (Item 50824)
+- Specific Gravity (Item 51498)
+- Specimen Type (Item 52033)
+- Urea Nitrogen (Item 51006)
+- Urine Appearance (Item 51506)
+- Urine Color (Item 51508)
+- Urobilinogen (Item 51514)
+- White Blood Cells (Item 51301)
+- pCO2 (Item 50818)
+- pH (Item 50820)
+- pH (Item 51491)
+- pO2 (Item 50821)

summaries/subject_12991336_hadm_26941734_summary.txt

@@ -0,0 +1,74 @@
+**Patient Summary**
+
+**Patient Information**
+
+* Name: [Not provided]
+* Age: 70
+* Gender: Female
+* Admission ID: 26941734
+* Admission Type: Surgical Same Day Admission
+* Admission Location: Physician Referral
+* Discharge Location: Skilled Nursing Facility
+* Insurance: Medicare
+* Race: White
+* Marital Status: Married
+* Language: English
+
+**Procedure Summary**
+
+The patient underwent a surgical procedure for spinal stenosis, specifically:
+
+1. ICD-9: 8108 - Lumbar and lumbosacral fusion of the anterior column, posterior technique
+2. ICD-9: 0309 - Other exploration and decompression of spinal canal (x2)
+3. ICD-9: 8162 - Fusion or refusion of 2-3 vertebrae
+4. ICD-9: 9904 - Transfusion of packed cells
+
+**Diagnosis Summary**
+
+The patient has the following diagnoses:
+
+1. ICD-9: 7384 - Acquired spondylolisthesis
+2. ICD-9: 4351 - Vertebral artery syndrome
+3. ICD-9: 4019 - Unspecified essential hypertension
+4. V433 - Heart valve replaced by other means
+5. 71590 - Osteoarthrosis, unspecified whether generalized or localized, site unspecified
+6. 27800 - Obesity, unspecified
+7. 53081 - Esophageal reflux
+8. V1254 - Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits
+9. V1083 - Personal history of other malignant neoplasm of skin
+10. V4589 - Other postprocedural status
+
+**Laboratory Results**
+
+The patient had 112 laboratory events, with the most frequent tests being:
+
+* Anion Gap (Item 50868)
+* Base Excess (Item 50802)
+* Bicarbonate (Item 50882)
+* Creatinine (Item 50912)
+* Estimated GFR (MDRD equation) (Item 50920)
+* Free Calcium (Item 50808)
+* Glucose (Item 50809)
+* Hemoglobin (Item 50811)
+* INR(PT) (Item 51237)
+* Platelet Count (Item 51265)
+* Potassium (Item 50971)
+* Sodium (Item 50983)
+* Urea Nitrogen (Item 51006)
+
+**Clinical Notes**
+
+The patient was admitted for spinal stenosis and underwent a lumbar decompression with fusion procedure. The patient had a stable hospital course, with no complications. The patient was discharged to a skilled nursing facility with a stable condition.
+
+**Medications**
+
+The patient was prescribed the following medications:
+
+* Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day)
+* Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)
+* Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO BID (2 times a day)
+* Furosemide 40 mg Tablet Sig: One (1) Tablet PO QOD (every other day)
+* Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation
+* Hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) as needed for pain
+* Diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 hours) as needed for spasm/anxiety
+* Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as needed for insomnia

summaries/subject_14497209_hadm_20716207_input.txt

@@ -0,0 +1,144 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 62
+- Gender: M
+
+ADMISSION:
+- Admission ID: 20716207
+- Admission Type: SURGICAL SAME DAY ADMISSION
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: HOME
+- Insurance: Other
+- Race: WHITE
+- Marital Status: DIVORCED
+- Language: ENGLISH
+
+PROCEDURES (2 total):
+- 0309 (ICD-9)
+- 0309 (ICD-9)
+
+DIAGNOSES (2 total):
+- 72403 (ICD-9)
+- 32723 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 51221: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+- Item ID 51222: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+- Item ID 51248: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+- Item ID 51249: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+- Item ID 51250: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+- Item ID 51265: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+- Item ID 51277: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+- Item ID 51279: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+- Item ID 51301: 1 measurements, 2154-12-11 05:00:00 to 2154-12-11 05:00:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                    Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: ORTHOPAEDICS
+ 
+Allergies: 
+No Known Allergies / Adverse Drug Reactions
+ 
+Attending: ___.
+ 
+Chief Complaint:
+Lumbar stenosis
+ 
+Major Surgical or Invasive Procedure:
+Laminectomy L3/4
+
+ 
+History of Present Illness:
+see admit H&P
+ 
+Past Medical History:
+see admit H&P
+ 
+Social History:
+___
+Family History:
+see admit H&P
+ 
+Pertinent Results:
+___ 05:00AM BLOOD WBC-12.3*# RBC-4.19* Hgb-14.3 Hct-40.6 
+MCV-97 MCH-34.0* MCHC-35.1* RDW-13.0 Plt ___
+ 
+Brief Hospital Course:
+Patient underwent above mentioned procedure, tolerating it well. 
+ Post-op, pain was controlled with IV followed by PO meds.  
+___ ABx were continued 24 hours.  ___ was consulted for 
+assistance with patient's care.
+
+Once patient had adequate PO pain control, once ambulating 
+independently, and once tolerating a diet, he was deemed stable 
+for discharge home
+ 
+Medications on Admission:
+see admit H&P
+ 
+Discharge Medications:
+1. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 
+hours) as needed for fever, pain.  
+2. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) 
+as needed for pain.
+Disp:*80 Tablet(s)* Refills:*0*
+3. diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 
+hours) as needed for spasm.
+Disp:*30 Tablet(s)* Refills:*0*
+4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day).
+Disp:*60 Capsule(s)* Refills:*0*
+5. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).  
+
+6. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 
+ 
+7. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) 
+Capsule, Ext Release 24 hr PO HS (at bedtime).  
+
+ 
+Discharge Disposition:
+Home with Service
+ 
+Discharge Diagnosis:
+Lumbar stenosis
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - requires assistance or aid (walker 
+or cane).
+
+ 
+Discharge Instructions:
+1. keep incision clean and dry
+2. ___ shower with incision covered, change dressing afterwards
+3. no bending, twisting, lifting > 10 lbs
+4. no baths
+5. ambulate as much as tolerated
+Physical Therapy:
+Please progress mobility, no bending, twisting, lifting > 10 lbs
+Treatments Frequency:
+Keep incision clean and dry. ___ shower with incision covered, 
+change dressing afterwards
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+STUDY:  Lumbar spine intraoperative study, ___.
+
+CLINICAL HISTORY:  Patient with laminectomy of lumbar spine.
+
+FINDINGS:  Lateral view of the lumbar spine demonstrates a posterior marker at
+the level of the superior endplate of L3.  There is degenerative change with
+disc space narrowing at multiple levels worse at L3-L4 and L4-L5.  Anterior
+spurring is present.  There is no abnormal ___- or retrolisthesis.  Please
+refer to the operative note for additional details.

summaries/subject_14497209_hadm_20716207_model_input.txt

@@ -0,0 +1,161 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 62
+- Gender: M
+
+ADMISSION:
+- Admission ID: 20716207
+- Admission Type: SURGICAL SAME DAY ADMISSION
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: HOME
+- Insurance: Other
+- Race: WHITE
+- Marital Status: DIVORCED
+- Language: ENGLISH
+
+PROCEDURES (2 total):
+  1. ICD-9: 0309
+  2. ICD-9: 0309
+
+DIAGNOSES (2 total):
+  1. ICD-9: 72403
+  2. ICD-9: 32723
+
+LABORATORY RESULTS:
+Total laboratory events: 9
+Most frequent lab tests:
+  - Item ID 51221: 1 measurements
+  - Item ID 51222: 1 measurements
+  - Item ID 51248: 1 measurements
+  - Item ID 51249: 1 measurements
+  - Item ID 51250: 1 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                    Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: ORTHOPAEDICS
+ 
+Allergies: 
+No Known Allergies / Adverse Drug Reactions
+ 
+Attending: ___.
+ 
+Chief Complaint:
+Lumbar stenosis
+ 
+Major Surgical or Invasive Procedure:
+Laminectomy L3/4
+
+ 
+History of Present Illness:
+see admit H&P
+ 
+Past Medical History:
+see admit H&P
+ 
+Social History:
+___
+Family History:
+see admit H&P
+ 
+Pertinent Results:
+___ 05:00AM BLOOD WBC-12.3*# RBC-4.19* Hgb-14.3 Hct-40.6 
+MCV-97 MCH-34.0* MCHC-35.1* RDW-13.0 Plt ___
+ 
+Brief Hospital Course:
+Patient underwent above mentioned procedure, tolerating it well. 
+ Post-op, pain was controlled with IV followed by PO meds.  
+___ ABx were continued 24 hours.  ___ was consulted for 
+assistance with patient's care.
+
+Once patient had adequate PO pain control, once ambulating 
+independently, and once tolerating a diet, he was deemed stable 
+for discharge home
+ 
+Medications on Admission:
+see admit H&P
+ 
+Discharge Medications:
+1. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 
+hours) as needed for fever, pain.  
+2. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) 
+as needed for pain.
+Disp:*80 Tablet(s)* Refills:*0*
+3. diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 
+hours) as needed for spasm.
+Disp:*30 Tablet(s)* Refills:*0*
+4. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day).
+Disp:*60 Capsule(s)* Refills:*0*
+5. ezetimibe 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).  
+
+6. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). 
+ 
+7. tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: One (1) 
+Capsule, Ext Release 24 hr PO HS (at bedtime).  
+
+ 
+Discharge Disposition:
+Home with Service
+ 
+Discharge Diagnosis:
+Lumbar stenosis
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - requires assistance or aid (walker 
+or cane).
+
+ 
+Discharge Instructions:
+1. keep incision clean and dry
+2. ___ shower with incision covered, change dressing afterwards
+3. no bending, twisting, lifting > 10 lbs
+4. no baths
+5. ambulate as much as tolerated
+Physical Therapy:
+Please progress mobility, no bending, twisting, lifting > 10 lbs
+Treatments Frequency:
+Keep incision clean and dry. ___ shower with incision covered, 
+change dressing afterwards
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] STUDY:  Lumbar spine intraoperative study, ___.
+
+CLINICAL HISTORY:  Patient with laminectomy of lumbar spine.
+
+FINDINGS:  Lateral view of the lumbar spine demonstrates a posterior marker at
+the level of the superior endplate of L3.  There is degenerative change with
+disc space narrowing at multiple levels worse at L3-L4 and L4-L5.  Anterior
+spurring is present.  There is no abnormal ___- or retrolisthesis.  Please
+refer to the operative note for additional details.
+
+PROCEDURES (readable):
+- 0309 (ICD-9) — Other exploration and decompression of spinal canal
+- 0309 (ICD-9) — Other exploration and decompression of spinal canal
+
+DIAGNOSES (readable):
+- 72403 (ICD-9) — Spinal stenosis, lumbar region, with neurogenic claudication
+- 32723 (ICD-9) — Obstructive sleep apnea (adult)(pediatric)
+
+LAB ITEMS (readable, deduped):
+- Hematocrit (Item 51221)
+- Hemoglobin (Item 51222)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Platelet Count (Item 51265)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- White Blood Cells (Item 51301)

summaries/subject_14497209_hadm_20716207_summary.txt

@@ -0,0 +1,85 @@
+**PRE-OPERATIVE SUMMARY**
+
+**Patient Information**
+
+* Name: [Not provided]
+* Age: 62
+* Gender: Male
+* Admission ID: 20716207
+* Admission Type: Surgical Same Day Admission
+* Admission Location: Physician Referral
+* Discharge Location: Home
+* Insurance: Other
+* Race: White
+* Marital Status: Divorced
+* Language: English
+
+**Diagnosis and Procedure**
+
+* Diagnosis:
+	+ ICD-9: 72403 - Spinal stenosis, lumbar region, with neurogenic claudication
+	+ ICD-9: 32723 - Obstructive sleep apnea (adult)(pediatric)
+* Procedure:
+	+ ICD-9: 0309 - Other exploration and decompression of spinal canal (Laminectomy L3/4)
+
+**Laboratory Results**
+
+* Total laboratory events: 9
+* Most frequent lab tests:
+	+ Hematocrit (Item 51221): 1 measurement
+	+ Hemoglobin (Item 51222): 1 measurement
+	+ MCH (Item 51248): 1 measurement
+	+ MCHC (Item 51249): 1 measurement
+	+ MCV (Item 51250): 1 measurement
+	+ Platelet Count (Item 51265): 1 measurement
+	+ RDW (Item 51277): 1 measurement
+	+ Red Blood Cells (Item 51279): 1 measurement
+	+ White Blood Cells (Item 51301): 1 measurement
+
+**Clinical Notes**
+
+* Admission Date: [Not provided]
+* Discharge Date: [Not provided]
+* Date of Birth: [Not provided]
+* Service: Orthopedics
+* Allergies: No known allergies or adverse drug reactions
+* Attending: [Not provided]
+* Chief Complaint: Lumbar stenosis
+* Major Surgical or Invasive Procedure: Laminectomy L3/4
+* History of Present Illness: See admit H&P
+* Past Medical History: See admit H&P
+* Social History: [Not provided]
+* Family History: See admit H&P
+
+**Medications**
+
+* Medications on Admission:
+	+ Acetaminophen 325 mg Tablet Sig: [Not provided]
+	+ Oxycodone 5 mg Tablet Sig: [Not provided]
+	+ Diazepam 5 mg Tablet Sig: [Not provided]
+	+ Docusate sodium 100 mg Capsule Sig: [Not provided]
+	+ Ezetimibe 10 mg Tablet Sig: [Not provided]
+	+ Finasteride 5 mg Tablet Sig: [Not provided]
+	+ Tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: [Not provided]
+* Discharge Medications:
+	+ Acetaminophen 325 mg Tablet Sig: [Not provided]
+	+ Oxycodone 5 mg Tablet Sig: [Not provided]
+	+ Diazepam 5 mg Tablet Sig: [Not provided]
+	+ Docusate sodium 100 mg Capsule Sig: [Not provided]
+	+ Ezetimibe 10 mg Tablet Sig: [Not provided]
+	+ Finasteride 5 mg Tablet Sig: [Not provided]
+	+ Tamsulosin 0.4 mg Capsule, Ext Release 24 hr Sig: [Not provided]
+
+**Discharge Instructions**
+
+* Keep incision clean and dry
+* Shower with incision covered, change dressing afterwards
+* No bending, twisting, lifting > 10 lbs
+* No baths
+* Ambulate as much as tolerated
+* Physical Therapy: Progress mobility, no bending, twisting, lifting > 10 lbs
+* Treatments Frequency: Keep incision clean and dry, shower with incision covered, change dressing afterwards
+
+**Follow-up Instructions**
+
+* [

summaries/subject_14497209_hadm_24931338_input.txt

@@ -0,0 +1,412 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 62
+- Gender: M
+
+ADMISSION:
+- Admission ID: 24931338
+- Admission Type: SURGICAL SAME DAY ADMISSION
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: DIVORCED
+- Language: ENGLISH
+
+PROCEDURES (3 total):
+- 3612 (ICD-9)
+- 3615 (ICD-9)
+- 3961 (ICD-9)
+
+DIAGNOSES (15 total):
+- 41401 (ICD-9)
+- 4142 (ICD-9)
+- 42731 (ICD-9)
+- 2720 (ICD-9)
+- 32723 (ICD-9)
+- 4019 (ICD-9)
+- 53081 (ICD-9)
+- 60000 (ICD-9)
+- 27800 (ICD-9)
+- V8534 (ICD-9)
+- 5531 (ICD-9)
+- 30000 (ICD-9)
+- V4987 (ICD-9)
+- V5866 (ICD-9)
+- V1582 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50802: 7 measurements, 2158-08-14 09:34:00 to 2158-08-14 19:34:00
+- Item ID 50804: 7 measurements, 2158-08-14 09:34:00 to 2158-08-14 19:34:00
+- Item ID 50806: 2 measurements, 2158-08-14 09:34:00 to 2158-08-14 14:00:00
+- Item ID 50808: 6 measurements, 2158-08-14 09:34:00 to 2158-08-15 17:07:00
+- Item ID 50809: 7 measurements, 2158-08-14 09:34:00 to 2158-08-14 19:34:00
+- Item ID 50810: 4 measurements, 2158-08-14 09:34:00 to 2158-08-14 14:00:00
+- Item ID 50811: 4 measurements, 2158-08-14 09:34:00 to 2158-08-14 14:00:00
+- Item ID 50812: 2 measurements, 2158-08-14 09:34:00 to 2158-08-14 14:00:00
+- Item ID 50813: 2 measurements, 2158-08-14 09:34:00 to 2158-08-14 14:00:00
+- Item ID 50818: 7 measurements, 2158-08-14 09:34:00 to 2158-08-14 19:34:00
+- Item ID 50820: 9 measurements, 2158-08-14 09:34:00 to 2158-08-15 17:07:00
+- Item ID 50821: 7 measurements, 2158-08-14 09:34:00 to 2158-08-14 19:34:00
+- Item ID 50822: 6 measurements, 2158-08-14 09:34:00 to 2158-08-14 19:34:00
+- Item ID 50824: 3 measurements, 2158-08-14 09:34:00 to 2158-08-14 15:22:00
+- Item ID 50828: 2 measurements, 2158-08-14 09:34:00 to 2158-08-14 14:00:00
+- Item ID 50868: 6 measurements, 2158-08-14 15:13:00 to 2158-08-19 07:00:00
+- Item ID 50882: 6 measurements, 2158-08-14 15:13:00 to 2158-08-19 07:00:00
+- Item ID 50893: 1 measurements, 2158-08-15 02:22:00 to 2158-08-15 02:22:00
+- Item ID 50902: 8 measurements, 2158-08-14 15:13:00 to 2158-08-19 07:00:00
+- Item ID 50912: 8 measurements, 2158-08-14 15:13:00 to 2158-08-19 07:00:00
+- Item ID 50920: 1 measurements, 2158-08-14 15:13:00 to 2158-08-14 15:13:00
+- Item ID 50931: 5 measurements, 2158-08-15 02:22:00 to 2158-08-19 07:00:00
+- Item ID 50960: 6 measurements, 2158-08-15 02:22:00 to 2158-08-19 07:00:00
+- Item ID 50970: 2 measurements, 2158-08-15 02:22:00 to 2158-08-15 16:15:00
+- Item ID 50971: 8 measurements, 2158-08-14 15:13:00 to 2158-08-19 07:00:00
+- Item ID 50983: 8 measurements, 2158-08-14 15:13:00 to 2158-08-19 07:00:00
+- Item ID 51006: 8 measurements, 2158-08-14 15:13:00 to 2158-08-19 07:00:00
+- Item ID 51146: 1 measurements, 2158-08-14 14:00:00 to 2158-08-14 14:00:00
+- Item ID 51200: 1 measurements, 2158-08-14 14:00:00 to 2158-08-14 14:00:00
+- Item ID 51214: 1 measurements, 2158-08-14 14:00:00 to 2158-08-14 14:00:00
+- Item ID 51221: 10 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51222: 7 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51237: 4 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51244: 1 measurements, 2158-08-14 14:00:00 to 2158-08-14 14:00:00
+- Item ID 51248: 7 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51249: 7 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51250: 7 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51254: 1 measurements, 2158-08-14 14:00:00 to 2158-08-14 14:00:00
+- Item ID 51256: 1 measurements, 2158-08-14 14:00:00 to 2158-08-14 14:00:00
+- Item ID 51265: 7 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51266: 1 measurements, 2158-08-16 04:12:00 to 2158-08-16 04:12:00
+- Item ID 51274: 4 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51275: 3 measurements, 2158-08-14 14:00:00 to 2158-08-15 02:22:00
+- Item ID 51277: 7 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51279: 7 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 51301: 7 measurements, 2158-08-14 14:00:00 to 2158-08-19 07:00:00
+- Item ID 52033: 9 measurements, 2158-08-14 09:34:00 to 2158-08-15 17:07:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                    Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: CARDIOTHORACIC
+ 
+Allergies: 
+No Known Allergies / Adverse Drug Reactions
+ 
+Attending: ___
+ 
+Chief Complaint:
+Chest pain
+ 
+Major Surgical or Invasive Procedure:
+s/p CABG x 3(Lima-LAD, SVG-Om, SVG PDA) ___
+
+ 
+History of Present Illness:
+___ year old gentleman who, according to Dr ___ of 
+___, had been prior heavy smoker, but quit in ___, also has 
+hypercholesterolemia,who has been getting an exertional chest 
+pain syndrome starting in ___.  He began exercises.  At times, 
+he gets some heaviness in his chest, especially if he increases 
+his speed or elevation in his treadmill.  The pain would resolve
+at rest.  He never had any rest pain, no associated shortness of 
+breath, pain did not radiate, and no lightheadedness or 
+palpitations.  A stress echo showed he exercised for 8 minutes 
+on ___ protocol, began getting chest discomfort, 5 minutes 
+on exercise ___, that increased to ___ at peak exercise.  His 
+EKG showed changes for LVH and he did develop ST depressions 
+with exercise and echo evidence of some ischemia in his 
+anteroseptum
+and distal anterior wall. Cardiac Surgery asked to see and 
+evaluate for CABG. 
+
+ 
+Past Medical History:
+Past Medical History:
+Hypercholesterolemia
+Hx tobacco use
+Umbilical hernia, 
+BPH
+Sleep Apnea 
+Past Surgical History:
+Laminectomy
+
+ 
+Social History:
+___
+Family History:
+unremarkable
+ 
+Physical Exam:
+Admission Exam:
+Pulse:63 Resp:16  O2 sat:97%  B/P:133/76
+Height:     Weight:109kg
+General:
+Skin: Dry [x] intact [x]
+HEENT: PERRLA [x] EOMI [x]
+Neck:  Supple [x] Full ROM [x]
+Chest: Lungs clear bilaterally [x]
+Heart: RRR [x]  Irregular []  Murmur [] grade
+Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x]
+Extremities: Warm [x], well-perfused [x]  Edema [] _____
+Varicosities: None [x]
+Neuro: Grossly intact [x]
+Pulses:
+Femoral      Right:+2   Left:+2
+DP           Right:+2   Left:+2
+___           Right:+2   Left:+2
+Radial       Right:Cath site   Left:+2
+Carotid Bruit: None 
+
+Discharge Exam
+VS: T 99.5  HR 76 SR   BP 91/51     RR 18     O2sat 93% 1LNP
+Wt 107.6 kg     Pre-op 109 kg
+Gen: NAD
+Neuro: A&O x3, MAE, nonfocal exam
+CV: RRR, no M/R/G. sternum stable, incision CDI
+Pulm: Decreased bases bilat
+Abdm: soft, NT, +BS
+Ext: warm, well perfused, 2+ bilat pedal edema
+
+ 
+Pertinent Results:
+Admission Labs:
+___ 09:34AM   HGB-15.6 calcHCT-47
+___ 09:34AM   freeCa-1.20
+___ 09:34AM   GLUCOSE-100 LACTATE-0.9 NA+-140 K+-4.3 
+CL--102
+___ 02:00PM   ___ 02:00PM   ___ PTT-30.0 ___
+___ 02:00PM   PLT COUNT-102*
+___ 02:00PM   WBC-17.1*# RBC-4.31* HGB-14.0 HCT-41.1 MCV-95 
+MCH-32.6* MCHC-34.1 RDW-13.3
+___ 03:13PM   UREA N-17 CREAT-1.0 SODIUM-139 POTASSIUM-4.8 
+CHLORIDE-108 TOTAL CO2-24 ANION GAP-12
+
+Discharge Labs:
+___ 07:00AM BLOOD WBC-8.7 RBC-2.82* Hgb-9.3* Hct-26.4* 
+MCV-94 MCH-33.1* MCHC-35.3* RDW-12.9 Plt ___
+___ 07:00AM BLOOD Plt ___
+___ 07:00AM BLOOD ___
+___ 07:00AM BLOOD Glucose-114* UreaN-26* Creat-1.0 Na-136 
+K-3.8 Cl-94* HCO3-31 AnGap-15
+___ 06:40AM BLOOD Glucose-107* UreaN-27* Creat-1.0 Na-136 
+K-3.9 Cl-96 HCO3-31 AnGap-13
+___ 07:00AM BLOOD Mg-2.5
+
+TEE: ___
+Findings  
+LEFT ATRIUM: No spontaneous echo contrast is seen in the ___. 
+RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. 
+LEFT VENTRICLE: Normal LV wall thickness, cavity size, and 
+global systolic function (LVEF>55%). 
+RIGHT VENTRICLE: Normal RV chamber size and free wall motion. 
+AORTA: Normal ascending, transverse and descending thoracic 
+aorta with no atherosclerotic plaque. 
+AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR. 
+MITRAL VALVE: Normal mitral valve leaflets with trivial MR. 
+___ VALVE: Normal tricuspid valve leaflets with trivial 
+TR. 
+PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR. 
+PERICARDIUM: No pericardial effusion. 
+GENERAL COMMENTS: A TEE was performed in the location listed 
+above. I certify I was present in compliance with ___ 
+regulations. The patient was under general anesthesia throughout 
+the procedure. No TEE related complications.  
+Conclusions  
+Pre-CPB:
+No spontaneous echo contrast is seen in the left atrial 
+appendage. Left ventricular wall thickness, cavity size, and 
+global systolic function are normal (LVEF>55%). Right 
+ventricular chamber size and free wall motion are normal. The 
+ascending, transverse and descending thoracic aorta are normal 
+in diameter. The aortic valve leaflets (3) appear structurally 
+normal with good leaflet excursion and no aortic stenosis or 
+aortic regurgitation. The mitral valve appears structurally 
+normal with trivial mitral regurgitation. There is no 
+pericardial effusion. 
+Post-CPB:
+The patient is paced, on no inotropes.
+Unchanged biventricular systolic fxn.
+No AI, no MR. ___ intact.   
+ 
+Radiology Report CHEST (PA & LAT) Study Date of ___ 9:21 
+___ 
+Final Report:   
+IN COMPARISON WITH THE STUDY OF ___, THERE IS LITTLE 
+CHANGE. ATELECTATIC CHANGES ARE SEEN BILATERALLY, MORE PROMINENT 
+ON THE LEFT, WITH SMALL EFFUSIONS. NO VASCULAR CONGESTION OR 
+ACUTE FOCAL PNEUMONIA. 
+___, MD electronically signed on ___ 
+8:35 AM 
+  
+ 
+Brief Hospital Course:
+The patient was admitted to the hospital and brought to the 
+operating room for a cscheduled operation on ___ where the 
+patient underwent Coronary artery bypass grafting x3 Left 
+Internal Mammary Artery to Left anterior descending artery,
+reverse saphenous vein graft to Obtuse marginal artery, and 
+reverse saphenous
+vein graft to Posterior Descending Artery. The patient tolerated 
+the procedure well and post-operatively was transferred to the 
+CVICU in stable condition on Neosynephrin infusion for recovery 
+and invasive monitoring.  Kefzol was used for surgical 
+antibiotic prophylaxis. The patient extubated and weaned off 
+pressor support on the day of surgery. POD 1 found the patient 
+extubated, alert and oriented and breathing comfortably.  The 
+patient was neurologically intact and hemodynamically stable on 
+no vasopressor support.  Beta blocker was initiated and the 
+patient was gently diuresed toward the preoperative weight.  The 
+patient was transferred to the telemetry floor for further 
+recovery.  All tubes lines and drains were discontinued without 
+complication.  Once o the stepdown floor the patient worked with 
+nursing and was evaluated by the physical therapy service for 
+assistance with strength and mobility.  By the time of discharge 
+on POD 5 the patient was ambulating with assistance, the wound 
+was healing and pain was controlled with dilaudid and tylenol.  
+The patient was discharged to ___ 
+in good condition with appropriate follow up instructions.
+ 
+Medications on Admission:
+atorvastatin 10 mg tablet. 
+finasteride 5 mg tablet. 1 (One) Tablet(s) by mouth
+lorazepam 0.5 mg tablet. 1 Tablet(s) by mouth at
+bedtime as needed for as needed
+metoprolol succinate ER 25 mg 1 tablet(s) by mouth once a day
+nitroglycerin 0.4 mg sublingual tablet. 1 tablet(s) sublingually
+once a day as needed
+Rolaids as needed after ___ for heart burn - 
+Viagra 100 mg tablet. 1 Tablet(s) by mouth prn
+Flomax 0.4 mg capsule. 1 Capsule(s) by mouth once a day - 
+(Prescribed by Other Provider)
+triamcinolone acetonide 0.1 % topical cream. Apply to chest wall
+twice a day
+ 
+Medications - OTC
+aspirin 81 mg tablet,delayed release. 1 Tablet(s) by mouth once 
+a
+day
+ibuprofen 200 mg capsule. capsule(s) by mouth  as needed -  
+
+ 
+Discharge Medications:
+1. Acetaminophen 650 mg PO Q4H:PRN pain/fever 
+2. Aspirin EC 81 mg PO DAILY 
+3. Atorvastatin 40 mg PO DAILY 
+4. Docusate Sodium 100 mg PO BID 
+5. Metoprolol Tartrate 12.5 mg PO TID 
+6. Tamsulosin 0.4 mg PO QHS 
+7. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID 
+8. Amiodarone 200 mg PO BID 
+___ BID x7 days then 
+200mg daily 
+9. Bisacodyl 10 mg PO DAILY 
+10. Furosemide 20 mg PO DAILY Duration: 10 Days 
+11. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H:PRN 
+shortness of breath 
+12. Lorazepam 0.5 mg PO QHS:PRN anxiety 
+RX *lorazepam 1 mg 0.5 (One half) tabs by mouth at bedtime Disp 
+#*30 Tablet Refills:*0
+13. Potassium Chloride 20 mEq PO DAILY Duration: 10 Days 
+14. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 
+RX *hydromorphone 2 mg ___ tablet(s) by mouth every four (4) 
+hours Disp #*75 Tablet Refills:*0
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Primary:
+Coronary Artery disease s/pCABG x3(Lima-LAD,SVG-OM,SVG ___ 
+Secondary:
+Hypercholesterolemia
+Hx tobacco use
+Umbilical hernia, 
+BPH
+Sleep Apnea 
+
+ 
+Discharge Condition:
+Alert and oriented x3 nonfocal 
+Ambulating with assistance
+Incisional pain managed with Dilaudid and tylenol
+Incisions: 
+Sternal - healing well, no erythema or drainage 
+Leg Right- healing well, no erythema or drainage. 
+Edema- 2+ bilat pedal 
+ 
+
+ 
+
+ 
+Discharge Instructions:
+Please shower daily including washing incisions gently with mild 
+soap, no baths or swimming until cleared by surgeon. Look at 
+your incisions daily for redness or drainage
+Please NO lotions, cream, powder, or ointments to incisions 
+Each morning you should weigh yourself and then in the evening 
+take your temperature, these should be written down on the chart 
+
+No driving for one month or while taking narcotics. Driving will 
+be discussed at follow up appointment with surgeon-when you will 
+be able to drive 
+No lifting more than 10 pounds for 10 weeks
+
+**Please call cardiac surgery office with any questions or 
+concerns ___. Answering service will contact on call 
+person during off hours**
+
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CHEST PORT. LINE PLACEMENT
+
+INDICATION:  ___ year old man s/p CABG  // FAST TRACK EARLY EXTUBATION CARDIAC
+SURGERY   Contact name: ___: ___
+
+TECHNIQUE:  CHEST PORT. LINE PLACEMENT
+
+COMPARISON:  ___
+
+IMPRESSION: 
+
+ET tube tip is 6 cm above the carinal. Left chest tube is in place.
+Mediastinal drains are in place. Right internal jugular line tip is at the
+level of lower SVC. Sternal wires are present. No pulmonary edema or
+pneumothorax currently seen.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CHEST (PORTABLE AP)
+
+INDICATION:  ___ year old man with cabg  // r/o ptx, s/p ct d/c      r/o ptx,
+s/p ct d/c
+
+IMPRESSION: 
+
+In comparison with the study of ___, all of the monitoring and support
+devices have been removed. Specifically, no evidence of pneumothorax after
+chest tube removal. And atelectatic changes with probable effusion at the left
+base, with substantially less changes at the right base.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CHEST (PA AND LAT)
+
+INDICATION:  ___ year old man s/p CABG  // eval for effusions      eval for
+effusions
+
+IMPRESSION: 
+
+IN COMPARISON WITH THE STUDY OF ___, THERE IS LITTLE CHANGE. ATELECTATIC
+CHANGES ARE SEEN BILATERALLY, MORE PROMINENT ON THE LEFT, WITH SMALL
+EFFUSIONS. NO VASCULAR CONGESTION OR ACUTE FOCAL PNEUMONIA.

summaries/subject_14497209_hadm_24931338_model_input.txt

@@ -0,0 +1,443 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 62
+- Gender: M
+
+ADMISSION:
+- Admission ID: 24931338
+- Admission Type: SURGICAL SAME DAY ADMISSION
+- Admission Location: PHYSICIAN REFERRAL
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: DIVORCED
+- Language: ENGLISH
+
+PROCEDURES (3 total):
+  1. ICD-9: 3612
+  2. ICD-9: 3615
+  3. ICD-9: 3961
+
+DIAGNOSES (15 total):
+  1. ICD-9: 41401
+  2. ICD-9: 4142
+  3. ICD-9: 42731
+  4. ICD-9: 2720
+  5. ICD-9: 32723
+  6. ICD-9: 4019
+  7. ICD-9: 53081
+  8. ICD-9: 60000
+  9. ICD-9: 27800
+  10. ICD-9: V8534
+  11. ICD-9: 5531
+  12. ICD-9: 30000
+  13. ICD-9: V4987
+  14. ICD-9: V5866
+  15. ICD-9: V1582
+
+LABORATORY RESULTS:
+Total laboratory events: 235
+Most frequent lab tests:
+  - Item ID 51221: 10 measurements
+  - Item ID 50820: 9 measurements
+  - Item ID 52033: 9 measurements
+  - Item ID 50902: 8 measurements
+  - Item ID 50912: 8 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                    Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: CARDIOTHORACIC
+ 
+Allergies: 
+No Known Allergies / Adverse Drug Reactions
+ 
+Attending: ___
+ 
+Chief Complaint:
+Chest pain
+ 
+Major Surgical or Invasive Procedure:
+s/p CABG x 3(Lima-LAD, SVG-Om, SVG PDA) ___
+
+ 
+History of Present Illness:
+___ year old gentleman who, according to Dr ___ of 
+___, had been prior heavy smoker, but quit in ___, also has 
+hypercholesterolemia,who has been getting an exertional chest 
+pain syndrome starting in ___.  He began exercises.  At times, 
+he gets some heaviness in his chest, especially if he increases 
+his speed or elevation in his treadmill.  The pain would resolve
+at rest.  He never had any rest pain, no associated shortness of 
+breath, pain did not radiate, and no lightheadedness or 
+palpitations.  A stress echo showed he exercised for 8 minutes 
+on ___ protocol, began getting chest discomfort, 5 minutes 
+on exercise ___, that increased to ___ at peak exercise.  His 
+EKG showed changes for LVH and he did develop ST depressions 
+with exercise and echo evidence of some ischemia in his 
+anteroseptum
+and distal anterior wall. Cardiac Surgery asked to see and 
+evaluate for CABG. 
+
+ 
+Past Medical History:
+Past Medical History:
+Hypercholesterolemia
+Hx tobacco use
+Umbilical hernia, 
+BPH
+Sleep Apnea 
+Past Surgical History:
+Laminectomy
+
+ 
+Social History:
+___
+Family History:
+unremarkable
+ 
+Physical Exam:
+Admission Exam:
+Pulse:63 Resp:16  O2 sat:97%  B/P:133/76
+Height:     Weight:109kg
+General:
+Skin: Dry [x] intact [x]
+HEENT: PERRLA [x] EOMI [x]
+Neck:  Supple [x] Full ROM [x]
+Chest: Lungs clear bilaterally [x]
+Heart: RRR [x]  Irregular []  Murmur [] grade
+Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x]
+Extremities: Warm [x], well-perfused [x]  Edema [] _____
+Varicosities: None [x]
+Neuro: Grossly intact [x]
+Pulses:
+Femoral      Right:+2   Left:+2
+DP           Right:+2   Left:+2
+___           Right:+2   Left:+2
+Radial       Right:Cath site   Left:+2
+Carotid Bruit: None 
+
+Discharge Exam
+VS: T 99.5  HR 76 SR   BP 91/51     RR 18     O2sat 93% 1LNP
+Wt 107.6 kg     Pre-op 109 kg
+Gen: NAD
+Neuro: A&O x3, MAE, nonfocal exam
+CV: RRR, no M/R/G. sternum stable, incision CDI
+Pulm: Decreased bases bilat
+Abdm: soft, NT, +BS
+Ext: warm, well perfused, 2+ bilat pedal edema
+
+ 
+Pertinent Results:
+Admission Labs:
+___ 09:34AM   HGB-15.6 calcHCT-47
+___ 09:34AM   freeCa-1.20
+___ 09:34AM   GLUCOSE-100 LACTATE-0.9 NA+-140 K+-4.3 
+CL--102
+___ 02:00PM   ___ 02:00PM   ___ PTT-30.0 ___
+___ 02:00PM   PLT COUNT-102*
+___ 02:00PM   WBC-17.1*# RBC-4.31* HGB-14.0 HCT-41.1 MCV-95 
+MCH-32.6* MCHC-34.1 RDW-13.3
+___ 03:13PM   UREA N-17 CREAT-1.0 SODIUM-139 POTASSIUM-4.8 
+CHLORIDE-108 TOTAL CO2-24 ANION GAP-12
+
+Discharge Labs:
+___ 07:00AM BLOOD WBC-8.7 RBC-2.82* Hgb-9.3* Hct-26.4* 
+MCV-94 MCH-33.1* MCHC-35.3* RDW-12.9 Plt ___
+___ 07:00AM BLOOD Plt ___
+___ 07:00AM BLOOD ___
+___ 07:00AM BLOOD Glucose-114* UreaN-26* Creat-1.0 Na-136 
+K-3.8 Cl-94* HCO3-31 AnGap-15
+___ 06:40AM BLOOD Glucose-107* UreaN-27* Creat-1.0 Na-136 
+K-3.9 Cl-96 HCO3-31 AnGap-13
+___ 07:00AM BLOOD Mg-2.5
+
+TEE: ___
+Findings  
+LEFT ATRIUM: No spontaneous echo contrast is seen in the ___. 
+RIGHT ATRIUM/INTERATRIAL SEPTUM: Normal interatrial septum. 
+LEFT VENTRICLE: Normal LV wall thickness, cavity size, and 
+global systolic function (LVEF>55%). 
+RIGHT VENTRICLE: Normal RV chamber size and free wall motion. 
+AORTA: Normal ascending, transverse and descending thoracic 
+aorta with no atherosclerotic plaque. 
+AORTIC VALVE: Normal aortic valve leaflets (3). No AS. No AR. 
+MITRAL VALVE: Normal mitral valve leaflets with trivial MR. 
+___ VALVE: Normal tricuspid valve leaflets with trivial 
+TR. 
+PULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR. 
+PERICARDIUM: No pericardial effusion. 
+GENERAL COMMENTS: A TEE was performed in the location listed 
+above. I certify I was present in compliance with ___ 
+regulations. The patient was under general anesthesia throughout 
+the procedure. No TEE related complications.  
+Conclusions  
+Pre-CPB:
+No spontaneous echo contrast is seen in the left atrial 
+appendage. Left ventricular wall thickness, cavity size, and 
+global systolic function are normal (LVEF>55%). Right 
+ventricular chamber size and free wall motion are normal. The 
+ascending, transverse and descending thoracic aorta are normal 
+in diameter. The aortic valve leaflets (3) appear structurally 
+normal with good leaflet excursion and no aortic stenosis or 
+aortic regurgitation. The mitral valve appears structurally 
+normal with trivial mitral regurgitation. There is no 
+pericardial effusion. 
+Post-CPB:
+The patient is paced, on no inotropes.
+Unchanged biventricular systolic fxn.
+No AI, no MR. ___ intact.   
+ 
+Radiology Report CHEST (PA & LAT) Study Date of ___ 9:21 
+___ 
+Final Report:   
+IN COMPARISON WITH THE STUDY OF ___, THERE IS LITTLE 
+CHANGE. ATELECTATIC CHANGES ARE SEEN BILATERALLY, MORE PROMINENT 
+ON THE LEFT, WITH SMALL EFFUSIONS. NO VASCULAR CONGESTION OR 
+ACUTE FOCAL PNEUMONIA. 
+___, MD electronically signed on ___ 
+8:35 AM 
+  
+ 
+Brief Hospital Course:
+The patient was admitted to the hospital and brought to the 
+operating room for a cscheduled operation on ___ where the 
+patient underwent Coronary artery bypass grafting x3 Left 
+Internal Mammary Artery to Left anterior descending artery,
+reverse saphenous vein graft to Obtuse marginal artery, and 
+reverse saphenous
+vein graft to Posterior Descending Artery. The patient tolerated 
+the procedure well and post-operatively was transferred to the 
+CVICU in stable condition on Neosynephrin infusion for recovery 
+and invasive monitoring.  Kefzol was used for surgical 
+antibiotic prophylaxis. The patient extubated and weaned off 
+pressor support on the day of surgery. POD 1 found the patient 
+extubated, alert and oriented and breathing comfortably.  The 
+patient was neurologically intact and hemodynamically stable on 
+no vasopressor support.  Beta blocker was initiated and the 
+patient was gently diuresed toward the preoperative weight.  The 
+patient was transferred to the telemetry floor for further 
+recovery.  All tubes lines and drains were discontinued without 
+complication.  Once o the stepdown floor the patient worked with 
+nursing and was evaluated by the physical therapy service for 
+assistance with strength and mobility.  By the time of discharge 
+on POD 5 the patient was ambulating with assistance, the wound 
+was healing and pain was controlled with dilaudid and tylenol.  
+The patient was discharged to ___ 
+in good condition with appropriate follow up instructions.
+ 
+Medications on Admission:
+atorvastatin 10 mg tablet. 
+finasteride 5 mg tablet. 1 (One) Tablet(s) by mouth
+lorazepam 0.5 mg tablet. 1 Tablet(s) by mouth at
+bedtime as needed for as needed
+metoprolol succinate ER 25 mg 1 tablet(s) by mouth once a day
+nitroglycerin 0.4 mg sublingual tablet. 1 tablet(s) sublingually
+once a day as needed
+Rolaids as needed after ___ for heart burn - 
+Viagra 100 mg tablet. 1 Tablet(s) by mouth prn
+Flomax 0.4 mg capsule. 1 Capsule(s) by mouth once a day - 
+(Prescribed by Other Provider)
+triamcinolone acetonide 0.1 % topical cream. Apply to chest wall
+twice a day
+ 
+Medications - OTC
+aspirin 81 mg tablet,delayed release. 1 Tablet(s) by mouth once 
+a
+day
+ibuprofen 200 mg capsule. capsule(s) by mouth  as needed -  
+
+ 
+Discharge Medications:
+1. Acetaminophen 650 mg PO Q4H:PRN pain/fever 
+2. Aspirin EC 81 mg PO DAILY 
+3. Atorvastatin 40 mg PO DAILY 
+4. Docusate Sodium 100 mg PO BID 
+5. Metoprolol Tartrate 12.5 mg PO TID 
+6. Tamsulosin 0.4 mg PO QHS 
+7. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID 
+8. Amiodarone 200 mg PO BID 
+___ BID x7 days then 
+200mg daily 
+9. Bisacodyl 10 mg PO DAILY 
+10. Furosemide 20 mg PO DAILY Duration: 10 Days 
+11. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H:PRN 
+shortness of breath 
+12. Lorazepam 0.5 mg PO QHS:PRN anxiety 
+RX *lorazepam 1 mg 0.5 (One half) tabs by mouth at bedtime Disp 
+#*30 Tablet Refills:*0
+13. Potassium Chloride 20 mEq PO DAILY Duration: 10 Days 
+14. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 
+RX *hydromorphone 2 mg ___ tablet(s) by mouth every four (4) 
+hours Disp #*75 Tablet Refills:*0
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Primary:
+Coronary Artery disease s/pCABG x3(Lima-LAD,SVG-OM,SVG ___ 
+Secondary:
+Hypercholesterolemia
+Hx tobacco use
+Umbilical hernia, 
+BPH
+Sleep Apnea 
+
+ 
+Discharge Condition:
+Alert and oriented x3 nonfocal 
+Ambulating with assistance
+Incisional pain managed with Dilaudid and tylenol
+Incisions: 
+Sternal - healing well, no erythema or drainage 
+Leg Right- healing well, no erythema or drainage. 
+Edema- 2+ bilat pedal 
+ 
+
+ 
+
+ 
+Discharge Instructions:
+Please shower daily including washing incisions gently with mild 
+soap, no baths or swimming until cleared by surgeon. Look at 
+your incisions daily for redness or drainage
+Please NO lotions, cream, powder, or ointments to incisions 
+Each morning you should weigh yourself and then in the evening 
+take your temperature, these should be written down on the chart 
+
+No driving for one month or while taking narcotics. Driving will 
+be discussed at follow up appointment with surgeon-when you will 
+be able to drive 
+No lifting more than 10 pounds for 10 weeks
+
+**Please call cardiac surgery office with any questions or 
+concerns ___. Answering service will contact on call 
+person during off hours**
+
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] EXAMINATION:  CHEST PORT. LINE PLACEMENT
+
+INDICATION:  ___ year old man s/p CABG  // FAST TRACK EARLY EXTUBATION CARDIAC
+SURGERY   Contact name: ___: ___
+
+TECHNIQUE:  CHEST PORT. LINE PLACEMENT
+
+COMPARISON:  ___
+
+IMPRESSION: 
+
+ET tube tip is 6 cm above the carinal. Left chest tube is in place.
+Mediastinal drains are in place. Right internal jugular line tip is at the
+level of lower SVC. Sternal wires are present. No pulmonary edema or
+pneumothorax currently seen.
+
+
+[RADIOLOGY] EXAMINATION:  CHEST (PORTABLE AP)
+
+INDICATION:  ___ year old man with cabg  // r/o ptx, s/p ct d/c      r/o ptx,
+s/p ct d/c
+
+IMPRESSION: 
+
+In comparison with the study of ___, all of the monitoring and support
+devices have been removed. Specifically, no evidence of pneumothorax after
+chest tube removal. And atelectatic changes with probable effusion at the left
+base, with substantially less changes at the right base.
+
+
+[RADIOLOGY] EXAMINATION:  CHEST (PA AND LAT)
+
+INDICATION:  ___ year old man s/p CABG  // eval for effusions      eval for
+effusions
+
+IMPRESSION: 
+
+IN COMPARISON WITH THE STUDY OF ___, THERE IS LITTLE CHANGE. ATELECTATIC
+CHANGES ARE SEEN BILATERALLY, MORE PROMINENT ON THE LEFT, WITH SMALL
+EFFUSIONS. NO VASCULAR CONGESTION OR ACUTE FOCAL PNEUMONIA.
+
+PROCEDURES (readable):
+- 3612 (ICD-9) — (Aorto)coronary bypass of two coronary arteries
+- 3615 (ICD-9) — Single internal mammary-coronary artery bypass
+- 3961 (ICD-9) — Extracorporeal circulation auxiliary to open heart surgery
+
+DIAGNOSES (readable):
+- 41401 (ICD-9) — Coronary atherosclerosis of native coronary artery
+- 4142 (ICD-9) — Chronic total occlusion of coronary artery
+- 42731 (ICD-9) — Atrial fibrillation
+- 2720 (ICD-9) — Pure hypercholesterolemia
+- 32723 (ICD-9) — Obstructive sleep apnea (adult)(pediatric)
+- 4019 (ICD-9) — Unspecified essential hypertension
+- 53081 (ICD-9) — Esophageal reflux
+- 60000 (ICD-9) — Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
+- 27800 (ICD-9) — Obesity, unspecified
+- V8534 (ICD-9) — Body Mass Index 34.0-34.9, adult
+- 5531 (ICD-9) — Umbilical hernia without mention of obstruction or gangrene
+- 30000 (ICD-9) — Anxiety state, unspecified
+- V4987 (ICD-9) — Physical restraints status
+- V5866 (ICD-9) — Long-term (current) use of aspirin
+- V1582 (ICD-9) — Personal history of tobacco use
+
+LAB ITEMS (readable, deduped):
+- Anion Gap (Item 50868)
+- Base Excess (Item 50802)
+- Basophils (Item 51146)
+- Bicarbonate (Item 50882)
+- Calcium, Total (Item 50893)
+- Calculated Total CO2 (Item 50804)
+- Chloride (Item 50902)
+- Chloride, Whole Blood (Item 50806)
+- Creatinine (Item 50912)
+- Eosinophils (Item 51200)
+- Estimated GFR (MDRD equation) (Item 50920)
+- Fibrinogen, Functional (Item 51214)
+- Free Calcium (Item 50808)
+- Glucose (Item 50809)
+- Glucose (Item 50931)
+- Hematocrit (Item 51221)
+- Hematocrit, Calculated (Item 50810)
+- Hemoglobin (Item 50811)
+- Hemoglobin (Item 51222)
+- INR(PT) (Item 51237)
+- Intubated (Item 50812)
+- Lactate (Item 50813)
+- Lymphocytes (Item 51244)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Magnesium (Item 50960)
+- Monocytes (Item 51254)
+- Neutrophils (Item 51256)
+- PT (Item 51274)
+- PTT (Item 51275)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Platelet Smear (Item 51266)
+- Potassium (Item 50971)
+- Potassium, Whole Blood (Item 50822)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Sodium (Item 50983)
+- Sodium, Whole Blood (Item 50824)
+- Specimen Type (Item 52033)
+- Urea Nitrogen (Item 51006)
+- Ventilator (Item 50828)
+- White Blood Cells (Item 51301)
+- pCO2 (Item 50818)
+- pH (Item 50820)
+- pO2 (Item 50821)

summaries/subject_14497209_hadm_24931338_summary.txt

@@ -0,0 +1,69 @@
+**PRE-OPERATIVE SUMMARY**
+
+**Patient Information**
+
+* Age: 62
+* Gender: Male
+* Admission ID: 24931338
+* Admission Type: Surgical Same Day Admission
+* Admission Location: Physician Referral
+* Discharge Location: Skilled Nursing Facility
+* Insurance: Medicare
+* Race: White
+* Marital Status: Divorced
+* Language: English
+
+**Diagnoses**
+
+* ICD-9: 41401 - Coronary atherosclerosis of native coronary artery
+* ICD-9: 4142 - Chronic total occlusion of coronary artery
+* ICD-9: 42731 - Atrial fibrillation
+* ICD-9: 2720 - Pure hypercholesterolemia
+* ICD-9: 32723 - Obstructive sleep apnea (adult)(pediatric)
+* ICD-9: 4019 - Unspecified essential hypertension
+* ICD-9: 53081 - Esophageal reflux
+* ICD-9: 60000 - Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
+* ICD-9: 27800 - Obesity, unspecified
+* ICD-9: V8534 - Body Mass Index 34.0-34.9, adult
+* ICD-9: 5531 - Umbilical hernia without mention of obstruction or gangrene
+* ICD-9: 30000 - Anxiety state, unspecified
+* ICD-9: V4987 - Physical restraints status
+* ICD-9: V5866 - Long-term (current) use of aspirin
+* ICD-9: V1582 - Personal history of tobacco use
+
+**Procedures**
+
+* ICD-9: 3612 - Aorto-coronary bypass of two coronary arteries
+* ICD-9: 3615 - Single internal mammary-coronary artery bypass
+* ICD-9: 3961 - Extracorporeal circulation auxiliary to open heart surgery
+
+**Laboratory Results**
+
+* Total laboratory events: 235
+* Most frequent lab tests:
+	+ Item ID 51221: 10 measurements
+	+ Item ID 50820: 9 measurements
+	+ Item ID 52033: 9 measurements
+	+ Item ID 50902: 8 measurements
+	+ Item ID 50912: 8 measurements
+
+**Clinical Notes**
+
+* The patient is a 62-year-old male with a history of coronary artery disease, atrial fibrillation, and hypercholesterolemia.
+* He underwent coronary artery bypass grafting (CABG) with three grafts (Lima-LAD, SVG-Om, and SVG PDA).
+* The patient has a history of tobacco use, obesity, and sleep apnea.
+* He is currently on medications including atorvastatin, metoprolol succinate, nitroglycerin, and triamcinolone acetonide.
+* The patient's vital signs are stable, with a pulse of 63, respiratory rate of 16, and oxygen saturation of 97%.
+* The patient's physical examination is notable for a sternal incision with no erythema or drainage, and bilateral pedal edema.
+
+**Medications**
+
+* Atorvastatin 10 mg tablet
+* Finasteride 5 mg tablet
+* Lorazepam 0.5 mg tablet
+* Metoprolol succinate ER 25 mg tablet
+* Nitroglycerin 0.4 mg sublingual tablet
+* Rolaids as needed for heartburn
+* Viagra 100 mg tablet
+* Flomax 0.4 mg capsule
+* Triamcinolone acetonide 0.1% topical cream

summaries/subject_14497209_hadm_29918801_input.txt

@@ -0,0 +1,376 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 62
+- Gender: M
+
+ADMISSION:
+- Admission ID: 29918801
+- Admission Type: URGENT
+- Admission Location: TRANSFER FROM SKILLED NURSING FACILITY
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: DIVORCED
+- Language: ENGLISH
+
+PROCEDURES (3 total):
+- 3479 (ICD-9)
+- 7761 (ICD-9)
+- 7851 (ICD-9)
+
+DIAGNOSES (13 total):
+- 99831 (ICD-9)
+- 2720 (ICD-9)
+- E8788 (ICD-9)
+- E8497 (ICD-9)
+- 41400 (ICD-9)
+- V4581 (ICD-9)
+- 27800 (ICD-9)
+- V8532 (ICD-9)
+- 60000 (ICD-9)
+- 32723 (ICD-9)
+- 5531 (ICD-9)
+- V1582 (ICD-9)
+- V5866 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50868: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50882: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50893: 5 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50902: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50912: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50931: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50960: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50970: 5 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50971: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 50983: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51006: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51221: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51222: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51237: 1 measurements, 2158-09-01 05:40:00 to 2158-09-01 05:40:00
+- Item ID 51248: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51249: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51250: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51265: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51274: 1 measurements, 2158-09-01 05:40:00 to 2158-09-01 05:40:00
+- Item ID 51277: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51279: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+- Item ID 51301: 6 measurements, 2158-08-30 06:55:00 to 2158-09-05 06:50:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                    Unit ___:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: CARDIOTHORACIC
+ 
+Allergies: 
+___ Known Allergies / Adverse Drug Reactions
+ 
+Attending: ___
+ 
+Chief Complaint:
+sternal drainage and EVH harvest site erythema
+
+ 
+Major Surgical or Invasive Procedure:
+___ Sternal plating/Pec flap closure
+
+ 
+History of Present Illness:
+He had a cath on ___ which revealed 3 vessel CAD and he 
+underwent CABG x3(Lima-LAD,SVG-OM,SVG PDA)on ___.  He did 
+well postoperatively and was discharged to rehab on ___. He 
+has been progressing well at rehab but has had a persistent 
+cough. It has been treated with Vantin for the past 6 days and 
+he was given Predinsone 40 mg yesterday.  He presented to the ED 
+this AM
+with a 2 day history of sternal drainage and swelling in his R 
+___ where his saphenous vein was harvested.  He had LENIs of his 
+RLE 2 days ago which were negative for DVT.
+ 
+Past Medical History:
+PMH:
+Hypercholesterolemia
+Hx tobacco use
+Umbilical hernia, 
+BPH
+Sleep Apnea 
+PSH:
+Laminectomy
+
+ 
+Social History:
+___
+Family History:
+unremarkable
+ 
+Physical Exam:
+Admission Physical Exam:
+Pulse:64 Resp:18  O2 sat:99% on 2 liters NC 
+B/P: 109/58
+Weight: 109 kg
+Skin: Dry [x] intact [x]
+HEENT: PERRLA [x] EOMI [x]
+Neck:  Supple [x] Full ROM [x]
+Chest: Lungs clear bilaterally [x] chest: sternal incision
+healing well but has serrous drainage at the lower sternal pole. 
+
++mid sternal click
+Heart: RRR [x]  Irregular []  Murmur [] grade
+Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x]
+Extremities: Warm [x], well-perfused [x]  Edema [x] _2+ pitting
+edema of RLE  ecchymosis in the R thigh
+Varicosities: None [x]
+Neuro: Grossly intact [x]
+Pulses:
+Femoral      Right:+2   Left:+2
+DP           Right:+1   Left:+1
+___           Right:+1   Left:+1
+Radial       Right:+2   Left:+2
+Carotid Bruit: None 
+
+Discharge Exam
+VS: T 98.6  HR 64  BP 98/56  RR 18  O2sat 96% RA
+Wt 100.2kg  Preop Wt 109kg
+Gen: ___ acute distress
+Neuro: alert and oriented x3, non focal exam
+CV: RRR, ___ M/R/G. Sternum stable, incision covered w/tegaderm, 
+JP drain x2 w/serosang drainage
+Pulm: CTA ___ distress
+Abdm: soft NT/ND/+BS
+Ext: warm well perfused. 2+ R leg edema, trace L leg edema. ___ 
+erythema at ___ site
+
+ 
+Pertinent Results:
+Admission Labs:
+___ 10:20AM   ___ PTT-32.3 ___
+___ 10:20AM   PLT COUNT-473*#
+___ 10:20AM   NEUTS-83.5* LYMPHS-8.7* MONOS-4.1 EOS-3.4 
+BASOS-0.2
+___ 10:20AM   WBC-10.7 RBC-3.28* HGB-10.2* HCT-31.1* MCV-95 
+MCH-31.0 MCHC-32.7 RDW-14.3
+___ 10:20AM   GLUCOSE-125* UREA N-25* CREAT-1.2 SODIUM-141 
+POTASSIUM-4.0 CHLORIDE-100 TOTAL CO2-31 ANION GAP-14
+___ 10:27AM   LACTATE-1.8
+Discharge Labs:
+___ 06:50AM BLOOD WBC-7.5 RBC-3.24* Hgb-9.8* Hct-29.9* 
+MCV-92 MCH-30.2 MCHC-32.7 RDW-14.5 Plt ___
+___ 06:50AM BLOOD Plt ___
+___ 05:40AM BLOOD ___
+___ 06:50AM BLOOD Glucose-91 UreaN-16 Creat-0.8 Na-138 
+K-4.6 Cl-100 HCO3-30 AnGap-13
+
+Wound Culture ___ 7:07 pm
+      SWAB      MEDIALSTINAL. 
+   GRAM STAIN (Final ___: 
+      ___ POLYMORPHONUCLEAR LEUKOCYTES SEEN. 
+      ___ MICROORGANISMS SEEN. 
+   WOUND CULTURE (Final ___:    ___ GROWTH. 
+   ACID FAST SMEAR (Final ___: 
+      ___ ACID FAST BACILLI SEEN ON DIRECT SMEAR. 
+   ACID FAST CULTURE (Preliminary): 
+      A swab is not the optimal specimen for recovery of 
+mycobacteria or
+      filamentous fungi.  A negative result should be 
+interpreted with
+      caution.  Whenever possible tissue biopsy or aspirated 
+fluid should
+      be submitted. 
+   FUNGAL CULTURE (Preliminary): 
+      ___ FUNGUS ISOLATED. 
+      A swab is not the optimal specimen for recovery of 
+mycobacteria or
+      filamentous fungi.  A negative result should be 
+interpreted with
+      caution.  Whenever possible tissue biopsy or aspirated 
+fluid should
+      be submitted. 
+   ANAEROBIC CULTURE (Preliminary):    ___ GROWTH. 
+     
+Radiology Report CHEST (PORTABLE AP) Study Date of ___ 
+4:01 ___ 
+Final Report:   
+Intact mediastinal wires are seen. There gas projecting over the 
+sternum 
+vertically in the expected location of the operative site. This 
+has increased since the previous study. If there is high concern 
+for sternal dehiscence, would recommend dedicated chest CT.  
+Cardiomediastinal silhouette is within normal limits.  There are 
+low lung volumes with atelectasis at the lung bases. 
+There are ___ pneumothoraces. 
+___, MD electronically signed on SAT ___ 6:38 ___ 
+  
+Radiology Report CHEST (PA & LAT) Study Date of ___ 6:36 
+___ 
+Final Report:   
+Status post sternal plating. Drains and fixation material in 
+situ.  The 
+lucency seen over the right upper abdomen continues to be 
+concerning for free intra-abdominal air.  Bilateral areas of 
+atelectasis at the lung bases.  Low lung volumes.  Mild 
+cardiomegaly.   
+BY ELECTRONICALLY SIGNING THIS REPORT, I THE ATTENDING PHYSICIAN 
+ATTEST THAT ___ HAVE REVIEWED THE ABOVE IMAGES FOR THE ABOVE 
+EXAMINATION(S) AND AGREE WITH THE FINDINGS AS DOCUMENTED ABOVE. 
+___, MD 
+___, MD, PhD electronically signed on ___ ___ 8:29 AM 
+ 
+
+ 
+Brief Hospital Course:
+Mr ___ was readmitted from rehabilitation with persistant cough 
+and sternal drainage as well as EVH site erythema/edema. The 
+patient was placed on antibiotics and his diuretics were 
+increased. He was observed for several days, he had ___ signs of 
+acute infection however his wound continued to drain and a 
+followup chest xray was concerning for sternal dehiscence. 
+Plastic surgery was consulted to assess wound and for potential 
+sternal wire removal and sternal plating. The following day he 
+was brought to the operating room by Dr ___ see 
+operative report for details, in summmary he had sternal 
+plating, zip ties and Bilateral pectoralis flaps. He tolerated 
+the operation well and was returned to the cardiac suregry 
+stepdown floor after a short stay in the recovery area. His 
+antibiotics were stoped because all cultures were negative.
+The remainder of his hospital stay was uneventful. On POD3 he 
+was discharged to rehabilitation at ___. All 
+follow up appointments were scheduled with the exception of PCP 
+which should occur in ___ weeks.
+ 
+Medications on Admission:
+The Preadmission Medication list is accurate and complete.
+1. Acetaminophen 650 mg PO Q4H:PRN pain/fever 
+2. Aspirin EC 81 mg PO DAILY 
+3. Atorvastatin 40 mg PO DAILY 
+4. Docusate Sodium 100 mg PO BID 
+5. Metoprolol Tartrate 12.5 mg PO TID 
+6. Tamsulosin 0.4 mg PO QHS 
+7. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID 
+8. Amiodarone 200 mg PO BID 
+9. Bisacodyl 10 mg PO DAILY 
+10. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H:PRN 
+shortness of breath 
+11. Lorazepam 0.5 mg PO QHS:PRN anxiety 
+12. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 
+
+ 
+Discharge Medications:
+1. Acetaminophen 650 mg PO Q4H:PRN pain/fever 
+2. Amiodarone 200 mg PO BID 
+3. Aspirin EC 81 mg PO DAILY 
+4. Atorvastatin 40 mg PO DAILY 
+5. Docusate Sodium 100 mg PO BID 
+6. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 
+7. Lorazepam 0.5 mg PO QHS:PRN anxiety 
+8. Metoprolol Tartrate 12.5 mg PO TID 
+9. Tamsulosin 0.4 mg PO QHS 
+10. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID 
+11. Albuterol Inhaler 2 PUFF IH Q6H 
+12. Finasteride 5 mg PO QHS 
+13. Furosemide 40 mg PO DAILY Duration: 10 Days 
+14. Potassium Chloride 20 mEq PO DAILY 
+15. Tessalon Perles (benzonatate) 100 mg oral BID 
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Sternal Wound Dehiscence s/p sternal plate and Pec flap closure
+PMH:
+Coronary Artery disease s/pCABG x3(Lima-LAD,SVG-OM,SVG ___ 
+Hypercholesterolemia
+Hx tobacco use
+Umbilical hernia, 
+BPH
+Sleep Apnea
+
+ 
+Discharge Condition:
+incision: tegaderm intact - will be changed at follow up 
+appointment with Plasic surgery
+JP's x2 draining serosang fluid
+
+ 
+Discharge Instructions:
+___ shower until cleared by Plastic Surgery- do not change 
+dressing prior to follow-up appointment with Dr. ___ baths or swimming until cleared by surgeon. Look at your 
+incisions daily for redness or drainage
+Please ___ lotions, cream, powder, or ointments to incisions 
+Each morning you should weigh yourself and then in the evening 
+take your temperature, these should be written down on the chart 
+
+___ driving for one month or while taking narcotics. Driving will 
+be discussed at follow up appointment with surgeon-when you will 
+be able to drive 
+___ lifting more than 10 pounds for 10 weeks
+
+**Please call cardiac surgery office with any questions or 
+concerns ___. Answering service will contact on call 
+person during off hours**
+
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CHEST (PA AND LAT)
+
+INDICATION:  History: ___ status post recent CABG ___ now with persistent
+cough and incisional drainage
+
+TECHNIQUE:  Chest PA and lateral
+
+COMPARISON:  ___
+
+FINDINGS: 
+
+Patient status post median sternotomy and CABG. Heart size remains mild to
+moderately enlarged. Mediastinal and hilar contours are relatively unchanged.
+There is no pulmonary edema. Streaky opacities in the lung bases are
+compatible with areas of atelectasis. Trace bilateral pleural effusions, right
+greater than left, are minimally increased on the right. No pneumothorax is
+identified. There are no acute osseous abnormalities.
+
+IMPRESSION: 
+
+Bibasilar atelectasis and small bilateral pleural effusions, slightly
+increased on the right.
+
+[RADIOLOGY NOTE]
+INDICATION:  ___ year old man s/p CABG  // eval for sternal wound dehisence
+
+COMPARISON:  Radiographs from ___.
+
+IMPRESSION: 
+
+Intact mediastinal wires are seen. There gas projecting over the sternum
+vertically in the expected location of the operative site. This has increased
+since the previous study. If there is high concern for sternal dehiscence,
+would recommend dedicated chest CT.  Cardiomediastinal silhouette is within
+normal limits.  There are low lung volumes with atelectasis at the lung bases.
+There are no pneumothoraces.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CHEST (PA AND LAT)
+
+INDICATION:  ___ year old man with s/p sternal plating  // eval for effusion or
+infiltrates
+
+COMPARISON:  ___
+
+IMPRESSION: 
+
+Status post sternal plating. Drains and fixation material in situ.  The
+lucency seen over the right upper abdomen continues to be concerning for free
+intra-abdominal air.  Bilateral areas of atelectasis at the lung bases.  Low
+lung volumes.  Mild cardiomegaly.

summaries/subject_14497209_hadm_29918801_model_input.txt

@@ -0,0 +1,405 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 62
+- Gender: M
+
+ADMISSION:
+- Admission ID: 29918801
+- Admission Type: URGENT
+- Admission Location: TRANSFER FROM SKILLED NURSING FACILITY
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: DIVORCED
+- Language: ENGLISH
+
+PROCEDURES (3 total):
+  1. ICD-9: 3479
+  2. ICD-9: 7761
+  3. ICD-9: 7851
+
+DIAGNOSES (13 total):
+  1. ICD-9: 99831
+  2. ICD-9: 2720
+  3. ICD-9: E8788
+  4. ICD-9: E8497
+  5. ICD-9: 41400
+  6. ICD-9: V4581
+  7. ICD-9: 27800
+  8. ICD-9: V8532
+  9. ICD-9: 60000
+  10. ICD-9: 32723
+  11. ICD-9: 5531
+  12. ICD-9: V1582
+  13. ICD-9: V5866
+
+LABORATORY RESULTS:
+Total laboratory events: 120
+Most frequent lab tests:
+  - Item ID 51221: 6 measurements
+  - Item ID 51222: 6 measurements
+  - Item ID 51248: 6 measurements
+  - Item ID 51249: 6 measurements
+  - Item ID 51250: 6 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                    Unit ___:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: CARDIOTHORACIC
+ 
+Allergies: 
+___ Known Allergies / Adverse Drug Reactions
+ 
+Attending: ___
+ 
+Chief Complaint:
+sternal drainage and EVH harvest site erythema
+
+ 
+Major Surgical or Invasive Procedure:
+___ Sternal plating/Pec flap closure
+
+ 
+History of Present Illness:
+He had a cath on ___ which revealed 3 vessel CAD and he 
+underwent CABG x3(Lima-LAD,SVG-OM,SVG PDA)on ___.  He did 
+well postoperatively and was discharged to rehab on ___. He 
+has been progressing well at rehab but has had a persistent 
+cough. It has been treated with Vantin for the past 6 days and 
+he was given Predinsone 40 mg yesterday.  He presented to the ED 
+this AM
+with a 2 day history of sternal drainage and swelling in his R 
+___ where his saphenous vein was harvested.  He had LENIs of his 
+RLE 2 days ago which were negative for DVT.
+ 
+Past Medical History:
+PMH:
+Hypercholesterolemia
+Hx tobacco use
+Umbilical hernia, 
+BPH
+Sleep Apnea 
+PSH:
+Laminectomy
+
+ 
+Social History:
+___
+Family History:
+unremarkable
+ 
+Physical Exam:
+Admission Physical Exam:
+Pulse:64 Resp:18  O2 sat:99% on 2 liters NC 
+B/P: 109/58
+Weight: 109 kg
+Skin: Dry [x] intact [x]
+HEENT: PERRLA [x] EOMI [x]
+Neck:  Supple [x] Full ROM [x]
+Chest: Lungs clear bilaterally [x] chest: sternal incision
+healing well but has serrous drainage at the lower sternal pole. 
+
++mid sternal click
+Heart: RRR [x]  Irregular []  Murmur [] grade
+Abdomen: Soft [x] non-distended [x] non-tender [x] +BS [x]
+Extremities: Warm [x], well-perfused [x]  Edema [x] _2+ pitting
+edema of RLE  ecchymosis in the R thigh
+Varicosities: None [x]
+Neuro: Grossly intact [x]
+Pulses:
+Femoral      Right:+2   Left:+2
+DP           Right:+1   Left:+1
+___           Right:+1   Left:+1
+Radial       Right:+2   Left:+2
+Carotid Bruit: None 
+
+Discharge Exam
+VS: T 98.6  HR 64  BP 98/56  RR 18  O2sat 96% RA
+Wt 100.2kg  Preop Wt 109kg
+Gen: ___ acute distress
+Neuro: alert and oriented x3, non focal exam
+CV: RRR, ___ M/R/G. Sternum stable, incision covered w/tegaderm, 
+JP drain x2 w/serosang drainage
+Pulm: CTA ___ distress
+Abdm: soft NT/ND/+BS
+Ext: warm well perfused. 2+ R leg edema, trace L leg edema. ___ 
+erythema at ___ site
+
+ 
+Pertinent Results:
+Admission Labs:
+___ 10:20AM   ___ PTT-32.3 ___
+___ 10:20AM   PLT COUNT-473*#
+___ 10:20AM   NEUTS-83.5* LYMPHS-8.7* MONOS-4.1 EOS-3.4 
+BASOS-0.2
+___ 10:20AM   WBC-10.7 RBC-3.28* HGB-10.2* HCT-31.1* MCV-95 
+MCH-31.0 MCHC-32.7 RDW-14.3
+___ 10:20AM   GLUCOSE-125* UREA N-25* CREAT-1.2 SODIUM-141 
+POTASSIUM-4.0 CHLORIDE-100 TOTAL CO2-31 ANION GAP-14
+___ 10:27AM   LACTATE-1.8
+Discharge Labs:
+___ 06:50AM BLOOD WBC-7.5 RBC-3.24* Hgb-9.8* Hct-29.9* 
+MCV-92 MCH-30.2 MCHC-32.7 RDW-14.5 Plt ___
+___ 06:50AM BLOOD Plt ___
+___ 05:40AM BLOOD ___
+___ 06:50AM BLOOD Glucose-91 UreaN-16 Creat-0.8 Na-138 
+K-4.6 Cl-100 HCO3-30 AnGap-13
+
+Wound Culture ___ 7:07 pm
+      SWAB      MEDIALSTINAL. 
+   GRAM STAIN (Final ___: 
+      ___ POLYMORPHONUCLEAR LEUKOCYTES SEEN. 
+      ___ MICROORGANISMS SEEN. 
+   WOUND CULTURE (Final ___:    ___ GROWTH. 
+   ACID FAST SMEAR (Final ___: 
+      ___ ACID FAST BACILLI SEEN ON DIRECT SMEAR. 
+   ACID FAST CULTURE (Preliminary): 
+      A swab is not the optimal specimen for recovery of 
+mycobacteria or
+      filamentous fungi.  A negative result should be 
+interpreted with
+      caution.  Whenever possible tissue biopsy or aspirated 
+fluid should
+      be submitted. 
+   FUNGAL CULTURE (Preliminary): 
+      ___ FUNGUS ISOLATED. 
+      A swab is not the optimal specimen for recovery of 
+mycobacteria or
+      filamentous fungi.  A negative result should be 
+interpreted with
+      caution.  Whenever possible tissue biopsy or aspirated 
+fluid should
+      be submitted. 
+   ANAEROBIC CULTURE (Preliminary):    ___ GROWTH. 
+     
+Radiology Report CHEST (PORTABLE AP) Study Date of ___ 
+4:01 ___ 
+Final Report:   
+Intact mediastinal wires are seen. There gas projecting over the 
+sternum 
+vertically in the expected location of the operative site. This 
+has increased since the previous study. If there is high concern 
+for sternal dehiscence, would recommend dedicated chest CT.  
+Cardiomediastinal silhouette is within normal limits.  There are 
+low lung volumes with atelectasis at the lung bases. 
+There are ___ pneumothoraces. 
+___, MD electronically signed on SAT ___ 6:38 ___ 
+  
+Radiology Report CHEST (PA & LAT) Study Date of ___ 6:36 
+___ 
+Final Report:   
+Status post sternal plating. Drains and fixation material in 
+situ.  The 
+lucency seen over the right upper abdomen continues to be 
+concerning for free intra-abdominal air.  Bilateral areas of 
+atelectasis at the lung bases.  Low lung volumes.  Mild 
+cardiomegaly.   
+BY ELECTRONICALLY SIGNING THIS REPORT, I THE ATTENDING PHYSICIAN 
+ATTEST THAT ___ HAVE REVIEWED THE ABOVE IMAGES FOR THE ABOVE 
+EXAMINATION(S) AND AGREE WITH THE FINDINGS AS DOCUMENTED ABOVE. 
+___, MD 
+___, MD, PhD electronically signed on ___ ___ 8:29 AM 
+ 
+
+ 
+Brief Hospital Course:
+Mr ___ was readmitted from rehabilitation with persistant cough 
+and sternal drainage as well as EVH site erythema/edema. The 
+patient was placed on antibiotics and his diuretics were 
+increased. He was observed for several days, he had ___ signs of 
+acute infection however his wound continued to drain and a 
+followup chest xray was concerning for sternal dehiscence. 
+Plastic surgery was consulted to assess wound and for potential 
+sternal wire removal and sternal plating. The following day he 
+was brought to the operating room by Dr ___ see 
+operative report for details, in summmary he had sternal 
+plating, zip ties and Bilateral pectoralis flaps. He tolerated 
+the operation well and was returned to the cardiac suregry 
+stepdown floor after a short stay in the recovery area. His 
+antibiotics were stoped because all cultures were negative.
+The remainder of his hospital stay was uneventful. On POD3 he 
+was discharged to rehabilitation at ___. All 
+follow up appointments were scheduled with the exception of PCP 
+which should occur in ___ weeks.
+ 
+Medications on Admission:
+The Preadmission Medication list is accurate and complete.
+1. Acetaminophen 650 mg PO Q4H:PRN pain/fever 
+2. Aspirin EC 81 mg PO DAILY 
+3. Atorvastatin 40 mg PO DAILY 
+4. Docusate Sodium 100 mg PO BID 
+5. Metoprolol Tartrate 12.5 mg PO TID 
+6. Tamsulosin 0.4 mg PO QHS 
+7. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID 
+8. Amiodarone 200 mg PO BID 
+9. Bisacodyl 10 mg PO DAILY 
+10. Ipratropium-Albuterol Inhalation Spray 1 INH IH Q6H:PRN 
+shortness of breath 
+11. Lorazepam 0.5 mg PO QHS:PRN anxiety 
+12. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 
+
+ 
+Discharge Medications:
+1. Acetaminophen 650 mg PO Q4H:PRN pain/fever 
+2. Amiodarone 200 mg PO BID 
+3. Aspirin EC 81 mg PO DAILY 
+4. Atorvastatin 40 mg PO DAILY 
+5. Docusate Sodium 100 mg PO BID 
+6. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain 
+7. Lorazepam 0.5 mg PO QHS:PRN anxiety 
+8. Metoprolol Tartrate 12.5 mg PO TID 
+9. Tamsulosin 0.4 mg PO QHS 
+10. Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID 
+11. Albuterol Inhaler 2 PUFF IH Q6H 
+12. Finasteride 5 mg PO QHS 
+13. Furosemide 40 mg PO DAILY Duration: 10 Days 
+14. Potassium Chloride 20 mEq PO DAILY 
+15. Tessalon Perles (benzonatate) 100 mg oral BID 
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Sternal Wound Dehiscence s/p sternal plate and Pec flap closure
+PMH:
+Coronary Artery disease s/pCABG x3(Lima-LAD,SVG-OM,SVG ___ 
+Hypercholesterolemia
+Hx tobacco use
+Umbilical hernia, 
+BPH
+Sleep Apnea
+
+ 
+Discharge Condition:
+incision: tegaderm intact - will be changed at follow up 
+appointment with Plasic surgery
+JP's x2 draining serosang fluid
+
+ 
+Discharge Instructions:
+___ shower until cleared by Plastic Surgery- do not change 
+dressing prior to follow-up appointment with Dr. ___ baths or swimming until cleared by surgeon. Look at your 
+incisions daily for redness or drainage
+Please ___ lotions, cream, powder, or ointments to incisions 
+Each morning you should weigh yourself and then in the evening 
+take your temperature, these should be written down on the chart 
+
+___ driving for one month or while taking narcotics. Driving will 
+be discussed at follow up appointment with surgeon-when you will 
+be able to drive 
+___ lifting more than 10 pounds for 10 weeks
+
+**Please call cardiac surgery office with any questions or 
+concerns ___. Answering service will contact on call 
+person during off hours**
+
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] EXAMINATION:  CHEST (PA AND LAT)
+
+INDICATION:  History: ___ status post recent CABG ___ now with persistent
+cough and incisional drainage
+
+TECHNIQUE:  Chest PA and lateral
+
+COMPARISON:  ___
+
+FINDINGS: 
+
+Patient status post median sternotomy and CABG. Heart size remains mild to
+moderately enlarged. Mediastinal and hilar contours are relatively unchanged.
+There is no pulmonary edema. Streaky opacities in the lung bases are
+compatible with areas of atelectasis. Trace bilateral pleural effusions, right
+greater than left, are minimally increased on the right. No pneumothorax is
+identified. There are no acute osseous abnormalities.
+
+IMPRESSION: 
+
+Bibasilar atelectasis and small bilateral pleural effusions, slightly
+increased on the right.
+
+
+[RADIOLOGY] INDICATION:  ___ year old man s/p CABG  // eval for sternal wound dehisence
+
+COMPARISON:  Radiographs from ___.
+
+IMPRESSION: 
+
+Intact mediastinal wires are seen. There gas projecting over the sternum
+vertically in the expected location of the operative site. This has increased
+since the previous study. If there is high concern for sternal dehiscence,
+would recommend dedicated chest CT.  Cardiomediastinal silhouette is within
+normal limits.  There are low lung volumes with atelectasis at the lung bases.
+There are no pneumothoraces.
+
+
+[RADIOLOGY] EXAMINATION:  CHEST (PA AND LAT)
+
+INDICATION:  ___ year old man with s/p sternal plating  // eval for effusion or
+infiltrates
+
+COMPARISON:  ___
+
+IMPRESSION: 
+
+Status post sternal plating. Drains and fixation material in situ.  The
+lucency seen over the right upper abdomen continues to be concerning for free
+intra-abdominal air.  Bilateral areas of atelectasis at the lung bases.  Low
+lung volumes.  Mild cardiomegaly.
+
+PROCEDURES (readable):
+- 3479 (ICD-9) — Other repair of chest wall
+- 7761 (ICD-9) — Local excision of lesion or tissue of bone, scapula, clavicle, and thorax [ribs and sternum]
+- 7851 (ICD-9) — Internal fixation of bone without fracture reduction, scapula, clavicle, and thorax [ribs and sternum]
+
+DIAGNOSES (readable):
+- 99831 (ICD-9) — Disruption of internal operation (surgical) wound
+- 2720 (ICD-9) — Pure hypercholesterolemia
+- E8788 (ICD-9) — Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
+- E8497 (ICD-9) — Accidents occurring in residential institution
+- 41400 (ICD-9) — Coronary atherosclerosis of unspecified type of vessel, native or graft
+- V4581 (ICD-9) — Aortocoronary bypass status
+- 27800 (ICD-9) — Obesity, unspecified
+- V8532 (ICD-9) — Body Mass Index 32.0-32.9, adult
+- 60000 (ICD-9) — Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
+- 32723 (ICD-9) — Obstructive sleep apnea (adult)(pediatric)
+- 5531 (ICD-9) — Umbilical hernia without mention of obstruction or gangrene
+- V1582 (ICD-9) — Personal history of tobacco use
+- V5866 (ICD-9) — Long-term (current) use of aspirin
+
+LAB ITEMS (readable, deduped):
+- Anion Gap (Item 50868)
+- Bicarbonate (Item 50882)
+- Calcium, Total (Item 50893)
+- Chloride (Item 50902)
+- Creatinine (Item 50912)
+- Glucose (Item 50931)
+- Hematocrit (Item 51221)
+- Hemoglobin (Item 51222)
+- INR(PT) (Item 51237)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Magnesium (Item 50960)
+- PT (Item 51274)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Potassium (Item 50971)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Sodium (Item 50983)
+- Urea Nitrogen (Item 51006)
+- White Blood Cells (Item 51301)

summaries/subject_14497209_hadm_29918801_summary.txt

@@ -0,0 +1,68 @@
+**PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION)**
+
+**Patient Information:**
+
+* Age: 62
+* Gender: Male
+* Admission ID: 29918801
+* Admission Type: Urgent
+* Admission Location: Transfer from Skilled Nursing Facility
+* Discharge Location: Skilled Nursing Facility
+* Insurance: Medicare
+* Race: White
+* Marital Status: Divorced
+* Language: English
+
+**Procedure Information:**
+
+* 3 procedures performed:
+	1. ICD-9: 3479 - Other repair of chest wall
+	2. ICD-9: 7761 - Local excision of lesion or tissue of bone, scapula, clavicle, and thorax (ribs and sternum)
+	3. ICD-9: 7851 - Internal fixation of bone without fracture reduction, scapula, clavicle, and thorax (ribs and sternum)
+
+**Diagnosis Information:**
+
+* 13 diagnoses:
+	1. ICD-9: 99831 - Disruption of internal operation (surgical) wound
+	2. ICD-9: 2720 - Pure hypercholesterolemia
+	3. ICD-9: E8788 - Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation
+	4. ICD-9: E8497 - Accidents occurring in residential institution
+	5. ICD-9: 41400 - Coronary atherosclerosis of unspecified type of vessel, native or graft
+	6. ICD-9: V4581 - Aortocoronary bypass status
+	7. ICD-9: 27800 - Obesity, unspecified
+	8. ICD-9: V8532 - Body Mass Index 32.0-32.9, adult
+	9. ICD-9: 60000 - Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)
+	10. ICD-9: 32723 - Obstructive sleep apnea (adult)(pediatric)
+	11. ICD-9: 5531 - Umbilical hernia without mention of obstruction or gangrene
+	12. ICD-9: V1582 - Personal history of tobacco use
+	13. ICD-9: V5866 - Long-term (current) use of aspirin
+
+**Laboratory Results:**
+
+* 120 laboratory events
+* Most frequent lab tests:
+	+ Item ID 51221: 6 measurements
+	+ Item ID 51222: 6 measurements
+	+ Item ID 51248: 6 measurements
+	+ Item ID 51249: 6 measurements
+	+ Item ID 51250: 6 measurements
+
+**Clinical Notes:**
+
+* The patient was readmitted from rehabilitation with persistent cough and sternal drainage as well as EVH site erythema/edema.
+* The patient underwent sternal plating, zip ties, and bilateral pectoralis flaps.
+* The patient's antibiotics were stopped because all cultures were negative.
+* The patient's discharge instructions include:
+	+ Showering until cleared by Plastic Surgery
+	+ Not changing the dressing prior to follow-up appointment with Dr. ___
+	+ Bathing or swimming until cleared by surgeon
+	+ Weighing himself and taking his temperature daily
+	+ Lifting more than 10 pounds for 10 weeks
+	+ Driving for one month or while taking narcotics
+	+ Calling the cardiac surgery office with any questions or concerns
+
+**Radiology Reports:**
+
+* Chest (PA and LAT) study:
+	+ Intact mediastinal wires are seen.
+	+ There is gas projecting over the sternum vertically in

summaries/subject_14899292_hadm_24095441_input.txt

@@ -0,0 +1,373 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 57
+- Gender: M
+
+ADMISSION:
+- Admission ID: 24095441
+- Admission Type: EW EMER.
+- Admission Location: EMERGENCY ROOM
+- Discharge Location: HOME HEALTH CARE
+- Insurance: Other
+- Race: WHITE
+- Marital Status: SINGLE
+- Language: ENGLISH
+
+PROCEDURES (1 total):
+- 8605 (ICD-9)
+
+DIAGNOSES (2 total):
+- 6822 (ICD-9)
+- V600 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50868: 1 measurements, 2150-06-15 05:20:00 to 2150-06-15 05:20:00
+- Item ID 50882: 1 measurements, 2150-06-15 05:20:00 to 2150-06-15 05:20:00
+- Item ID 50893: 1 measurements, 2150-06-15 05:20:00 to 2150-06-15 05:20:00
+- Item ID 50902: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 50910: 4 measurements, 2150-06-13 21:06:00 to 2150-06-15 10:00:00
+- Item ID 50911: 4 measurements, 2150-06-13 21:06:00 to 2150-06-15 10:00:00
+- Item ID 50912: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 50931: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 50960: 1 measurements, 2150-06-15 05:20:00 to 2150-06-15 05:20:00
+- Item ID 50970: 1 measurements, 2150-06-15 05:20:00 to 2150-06-15 05:20:00
+- Item ID 50971: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 50983: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51003: 4 measurements, 2150-06-13 21:06:00 to 2150-06-15 10:00:00
+- Item ID 51006: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51009: 1 measurements, 2150-06-16 05:15:00 to 2150-06-16 05:15:00
+- Item ID 51221: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51222: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51248: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51249: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51250: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51265: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51277: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51279: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+- Item ID 51301: 2 measurements, 2150-06-15 05:20:00 to 2150-06-16 05:15:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: SURGERY
+ 
+Allergies: 
+Clindamycin
+ 
+Attending: ___.
+ 
+Chief Complaint:
+pain flap site
+ 
+Major Surgical or Invasive Procedure:
+___ I&D of chest wall, removal of foreign body 
+
+ 
+History of Present Illness:
+ ___ is a ___ year old man with hx of chronic L chest wall
+infection s/p debridement on ___ by Dr. ___  ___ closure 
+on
+___ by Dr. ___ plastic surgery. He presents to ED today
+from ___ clinic c/o ___ wk hx of worsening erythema and pain over
+his past flap site and a fluctuant mass that has developed
+superior to his prior site of infections. Of note, he was
+hospitalized from ___ for cellulitis and completed a 2 wk
+course of IV vancomycin and has been followed by ID as an
+outpatient. Pt notes that the pain and redness developed
+initially approximately 2 weeks ago after a piece of wood hit 
+him
+in his chest while shoveling snow. Pt denies instrumentation or
+insertion of a foreign object into his chest wall. Pt denies
+fevers/chills, but has noted to have night sweats x ___ days. 
+________________________________________________________________
+
+ 
+Past Medical History:
+Phlegmon of his left chest wall s/p debridement on ___ and 
+closure on ___  
+Surgical reconstruction of right upper extremity after horse 
+accident 
+Surgery on left bicep after horse accident
+ 
+Social History:
+___
+Family History:
+NC
+ 
+Physical Exam:
+PHYSICAL EXAMINATION
+ 
+Temp:98.2 HR:73 BP:144/78 Resp:18 O(2)Sat:100
+ 
+Constitutional: Comfortable
+HEENT: Normocephalic, atraumatic, Pupils equal, round and
+reactive to light, Extraocular muscles intact
+Oropharynx within normal limits
+Chest: +fluctuant mass to sternum, 2 areas of non-fluctuant
+but erythematous areas
+Cardiovascular: Regular Rate and Rhythm, Normal first and
+second heart sounds
+Abdominal: Soft, Nontender, Nondistended
+GU/Flank: No costovertebral angle tenderness
+Extr/Back: No cyanosis, clubbing or edema
+
+ 
+Pertinent Results:
+___ 05:20AM BLOOD WBC-5.5 RBC-4.41* Hgb-13.8* Hct-39.8* 
+MCV-90 MCH-31.2 MCHC-34.6 RDW-14.2 Plt ___
+___ 12:15PM BLOOD WBC-6.1# RBC-4.67 Hgb-14.2 Hct-42.5 
+MCV-91 MCH-30.3 MCHC-33.4 RDW-14.3 Plt ___
+___ 12:15PM BLOOD Neuts-68.1 ___ Monos-6.1 Eos-2.6 
+Baso-0.6
+___ 05:20AM BLOOD Plt ___
+___ 12:15PM BLOOD Plt ___
+___ 05:20AM BLOOD Glucose-99 UreaN-12 Creat-0.7 Na-140 
+K-3.5 Cl-106 HCO3-26 AnGap-12
+___ 12:15PM BLOOD Glucose-98 UreaN-8 Creat-0.6 Na-141 K-3.8 
+Cl-106 HCO3-27 AnGap-12
+___ 10:00AM BLOOD CK(CPK)-145
+___ 05:40AM BLOOD CK(CPK)-144
+___ 10:00AM BLOOD CK-MB-6 cTropnT-<0.01
+___ 05:40AM BLOOD CK-MB-5 cTropnT-<0.01
+___ 01:00AM BLOOD CK-MB-4 cTropnT-<0.01
+___ 09:06PM BLOOD CK-MB-3 cTropnT-<0.01
+___ 05:20AM BLOOD Calcium-8.3* Phos-3.7 Mg-2.1
+___ 01:02PM BLOOD Lactate-1.1
+
+___:  ekg:
+  
+Sinus rhythm with first degree atrio-ventricular conduction 
+delay. Left 
+bundle-branch block. Compared to the previous tracing of 
+___ there is no diagnostic change
+
+___: chest x-ray:'
+
+IMPRESSION: No acute pulmonary process. There is a new 
+indwelling foreign 
+body within the soft tissues of the sternal bed presumably 
+placed 
+purposefully. There is no radiographic evidence of an acute 
+infection within the chest. Please note radiographic radiography 
+has limited sensitivity
+
+___:  chest cat scan:
+
+ IMPRESSION: Interval decrease in size of nonenhancing anterior 
+left chest 
+wall phlegmon without drainable fluid collection. There has been 
+interval 
+placement of a radiodense linear wire-like object within it of 
+indeterminate etiology
+
+___:  EKG:
+
+ Sinus bradycardia. Compared to the previous tracing there is no 
+diagnostic change
+
+___ SWAB gram stain 2 PMN, no positive culture  
+___ URINE CULTURE pending  
+___ Blood Culture pending  
+___ Blood Culture pending  
+
+ 
+Brief Hospital Course:
+ ___ year old gentleman admitted to the Acute care service with 
+pain and redness chest flap.  He had a prior admission for a 
+chest wall abscess necessiating debridement and closure with a 
+flap.  Upon admission, he was made NPO, given intraveous fluids, 
+and he was started on vancomycin. On chest x-ray imaging he was 
+found to have a metallic object in the sternal bed.  Plastics 
+was consulted and recommended removal of the metallic object.  
+On ___ was taken to the operating room for I+D of chest wall.  
+ His operative course was notable for ST depressions on his EKG. 
+ He had 3 sets of negative troponins and a post-operative EKG 
+which showed a left bundle branch block, which was noted on his 
+prior EKG.   
+ His post-operative course was uneventful.  Infectious disease 
+was consulted regarding the chronicity of the his chest wall 
+infection and have made recommendations for antibiotic coverage. 
+During the post-operative period he was maintained on 
+ciprofloxacin, flagyl and vancomycin. His chest swab culture 
+showed no micro-organisms. Blood cultures are still pending.  
+His intravenous antibiotics were discontinued on ___. He will 
+resume a week course of bactrim and ciprofloxacin upon discharge 
+as per infectious disease recommendation. 
+ His vital signs have been stable and he is afebrile. His white 
+blood cell count is 
+4.5.  He is tolerating a regular diet and has been ambulating.  
+He will be discharged to a friend's home with ___ assistance.  
+It is recommended that he follow up at the Infectious disease 
+clinic in 1 week and schedule an appointment with his primary 
+care provider.  He will be seen in the Acute Care clinic in 2 
+weeks. 
+ 
+  
+ 
+Medications on Admission:
+___: VitD2 50,000U qweek, tylenol, calcium carbonate  
+Assessment:
+ 
+
+ 
+Discharge Medications:
+1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day).  
+2. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
+day) as needed for constipation.  
+3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One 
+(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).  
+4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 
+6 hours) as needed for pain, fever.  
+5. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One 
+(1) Tablet, Chewable PO QID (4 times a day) as needed for 
+heartburn.  
+6. oxycodone 5 mg Tablet Sig: ___ Tablets PO every six (6) hours 
+as needed for pain: may cause drowsiness, avoid driving.
+Disp:*20 Tablet(s)* Refills:*0*
+7. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO twice a 
+day for 7 days: 7 day course .
+Disp:*14 Tablet(s)* Refills:*0*
+8. Bactrim DS 800-160 mg Tablet Sig: One (1) Tablet PO twice a 
+day for 7 days.
+Disp:*14 Tablet(s)* Refills:*0*
+
+ 
+Discharge Disposition:
+Home With Service
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Cellulitis chest wall
+Foreign body chest wall
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - Independent.
+
+ 
+Discharge Instructions:
+You were admitted to the hospital with an infected chest flap.  
+You were started on intravenous antibiotics.  You will need to 
+remain on oral antibiotics for 1 week after you are discharged.  
+  You are now preparing for discharge home with the following 
+instructions:
+
+Please call your doctor or nurse practitioner or return to the 
+Emergency Department for any of the following:
+
+*You experience new chest pain, pressure, squeezing or 
+tightness.
+
+*New or worsening cough, shortness of breath, or wheeze.
+
+*If you are vomiting and cannot keep down fluids or your 
+medications.
+
+*You are getting dehydrated due to continued vomiting, diarrhea, 
+or other reasons. Signs of dehydration include dry mouth, rapid 
+heartbeat, or feeling dizzy or faint when standing.
+
+*You see blood or dark/black material when you vomit or have a 
+bowel movement.
+
+*You experience burning when you urinate, have blood in your 
+urine, or experience a discharge.
+
+*Your pain in not improving within ___ hours or is not gone 
+within 24 hours. Call or return immediately if your pain is 
+getting worse or changes location or moving to your chest or 
+back.
+
+*You have shaking chills, or fever greater than 101.5 degrees 
+Fahrenheit or 38 degrees Celsius.
+
+*Any change in your symptoms, or any new symptoms that concern 
+you.
+
+Please resume all regular home medications , unless specifically 
+advised not to take a particular medication. Also, please take 
+any new medications as prescribed.
+
+Please get plenty of rest, continue to ambulate several times 
+per day, and drink adequate amounts of fluids. Avoid lifting 
+weights greater than ___ lbs until you follow-up with your 
+surgeon.
+
+Avoid driving or operating heavy machinery while taking pain 
+medications.
+
+Please report any increase drainage, pain, or change in wound
+
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+PA AND LATERAL CHEST ___ @ 11:42 hours.
+
+HISTORY:  Chest wall sternal infection.
+
+COMPARISON:  Multiple priors, the most recent dated ___.
+
+FINDINGS:  The lungs are clear without consolidation or edema.  Chronic and
+stable  blunting of the left costophrenic angle is again noted and presumably
+due to chronic pleural thickening.  There has been interval placement of a
+thin linear metal object vertically along the left aspect of the sternal bed. 
+This is of indeterminate etiology.  The mediastinum is otherwise unremarkable.
+The cardiac silhouette is within normal limits for size.  No right effusion is
+noted.  There is no pneumothorax.
+
+IMPRESSION:  No acute pulmonary process.  There is a new indwelling foreign
+body within the soft tissues of the sternal bed presumably placed
+purposefully.  There is no radiographic evidence of an acute infection within
+the chest.  Please note radiographic radiography has limited sensitivity.
+
+[RADIOLOGY NOTE]
+CLINICAL INFORMATION:  ___ male with history of chest wall abscess and
+a new foreign body within it.
+
+COMPARISON:  PA and lateral performed same day, as well as CT chest, ___.
+
+TECHNIQUE:  Axial images were acquired of the chest following the
+administration of intravenous contrast, and reformatted in the coronal and
+sagittal planes.
+
+FINDINGS:  Interval decrease in size of a left anterior chest wall phlegmon,
+now measuring 1.7 x 4.8 x 5.4 cm.  There is overlying skin thickening, not
+significantly changed compared with prior.  There is no abnormal enhancement
+of this soft tissue accumulation.  No internal hypodensity is seen to suggest
+a drainable fluid collection.  A metallic density thin wire is seen measuring
+approximately 13 cm in length and taking a cephalocaudad approach along the
+anterior chest wall in the region of the abscess.  At the costochondral
+junction of the anterior sixth rib on the left, there is a newly appreciated
+hyperdense focus which might represent foreign body or bone fragment.  There
+is no osteolysis.
+
+The heart remains normal in size and configuration.  There is no pleural or
+pericardial effusion.  There is minimal atherosclerotic change of the aortic
+arch, the great vessels are otherwise unremarkable.  The central pulmonary
+arteries are patent.  The central airways appear patent.  A granuloma is again
+noted in the left lung base and there is calcification of the inferior pleural
+surface of the left lung.  There are calcified but non-enlarged left hilar
+lymph nodes which are stable in appearance.  There is no pathologically
+enlarged axillary or hilar lymphadenopathy.  While this exam is not tailored
+to evaluate the subdiaphragmatic structures, the visualized portions are
+unremarkable.  Note is again made of paraseptal and centrilobular emphysema in
+the bilateral apices.  There is mild degenerative change of the visualized
+thoracic spine without concerning lytic or blastic lesions.
+
+IMPRESSION:  Interval decrease in size of nonenhancing anterior left chest
+wall phlegmon without drainable fluid collection.  There has been interval
+placement of a radiodense linear wire-like object within it of indeterminate
+etiology.

summaries/subject_14899292_hadm_24095441_model_input.txt

@@ -0,0 +1,389 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 57
+- Gender: M
+
+ADMISSION:
+- Admission ID: 24095441
+- Admission Type: EW EMER.
+- Admission Location: EMERGENCY ROOM
+- Discharge Location: HOME HEALTH CARE
+- Insurance: Other
+- Race: WHITE
+- Marital Status: SINGLE
+- Language: ENGLISH
+
+PROCEDURES (1 total):
+  1. ICD-9: 8605
+
+DIAGNOSES (2 total):
+  1. ICD-9: 6822
+  2. ICD-9: V600
+
+LABORATORY RESULTS:
+Total laboratory events: 48
+Most frequent lab tests:
+  - Item ID 50910: 4 measurements
+  - Item ID 50911: 4 measurements
+  - Item ID 51003: 4 measurements
+  - Item ID 50902: 2 measurements
+  - Item ID 50912: 2 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: SURGERY
+ 
+Allergies: 
+Clindamycin
+ 
+Attending: ___.
+ 
+Chief Complaint:
+pain flap site
+ 
+Major Surgical or Invasive Procedure:
+___ I&D of chest wall, removal of foreign body 
+
+ 
+History of Present Illness:
+ ___ is a ___ year old man with hx of chronic L chest wall
+infection s/p debridement on ___ by Dr. ___  ___ closure 
+on
+___ by Dr. ___ plastic surgery. He presents to ED today
+from ___ clinic c/o ___ wk hx of worsening erythema and pain over
+his past flap site and a fluctuant mass that has developed
+superior to his prior site of infections. Of note, he was
+hospitalized from ___ for cellulitis and completed a 2 wk
+course of IV vancomycin and has been followed by ID as an
+outpatient. Pt notes that the pain and redness developed
+initially approximately 2 weeks ago after a piece of wood hit 
+him
+in his chest while shoveling snow. Pt denies instrumentation or
+insertion of a foreign object into his chest wall. Pt denies
+fevers/chills, but has noted to have night sweats x ___ days. 
+________________________________________________________________
+
+ 
+Past Medical History:
+Phlegmon of his left chest wall s/p debridement on ___ and 
+closure on ___  
+Surgical reconstruction of right upper extremity after horse 
+accident 
+Surgery on left bicep after horse accident
+ 
+Social History:
+___
+Family History:
+NC
+ 
+Physical Exam:
+PHYSICAL EXAMINATION
+ 
+Temp:98.2 HR:73 BP:144/78 Resp:18 O(2)Sat:100
+ 
+Constitutional: Comfortable
+HEENT: Normocephalic, atraumatic, Pupils equal, round and
+reactive to light, Extraocular muscles intact
+Oropharynx within normal limits
+Chest: +fluctuant mass to sternum, 2 areas of non-fluctuant
+but erythematous areas
+Cardiovascular: Regular Rate and Rhythm, Normal first and
+second heart sounds
+Abdominal: Soft, Nontender, Nondistended
+GU/Flank: No costovertebral angle tenderness
+Extr/Back: No cyanosis, clubbing or edema
+
+ 
+Pertinent Results:
+___ 05:20AM BLOOD WBC-5.5 RBC-4.41* Hgb-13.8* Hct-39.8* 
+MCV-90 MCH-31.2 MCHC-34.6 RDW-14.2 Plt ___
+___ 12:15PM BLOOD WBC-6.1# RBC-4.67 Hgb-14.2 Hct-42.5 
+MCV-91 MCH-30.3 MCHC-33.4 RDW-14.3 Plt ___
+___ 12:15PM BLOOD Neuts-68.1 ___ Monos-6.1 Eos-2.6 
+Baso-0.6
+___ 05:20AM BLOOD Plt ___
+___ 12:15PM BLOOD Plt ___
+___ 05:20AM BLOOD Glucose-99 UreaN-12 Creat-0.7 Na-140 
+K-3.5 Cl-106 HCO3-26 AnGap-12
+___ 12:15PM BLOOD Glucose-98 UreaN-8 Creat-0.6 Na-141 K-3.8 
+Cl-106 HCO3-27 AnGap-12
+___ 10:00AM BLOOD CK(CPK)-145
+___ 05:40AM BLOOD CK(CPK)-144
+___ 10:00AM BLOOD CK-MB-6 cTropnT-<0.01
+___ 05:40AM BLOOD CK-MB-5 cTropnT-<0.01
+___ 01:00AM BLOOD CK-MB-4 cTropnT-<0.01
+___ 09:06PM BLOOD CK-MB-3 cTropnT-<0.01
+___ 05:20AM BLOOD Calcium-8.3* Phos-3.7 Mg-2.1
+___ 01:02PM BLOOD Lactate-1.1
+
+___:  ekg:
+  
+Sinus rhythm with first degree atrio-ventricular conduction 
+delay. Left 
+bundle-branch block. Compared to the previous tracing of 
+___ there is no diagnostic change
+
+___: chest x-ray:'
+
+IMPRESSION: No acute pulmonary process. There is a new 
+indwelling foreign 
+body within the soft tissues of the sternal bed presumably 
+placed 
+purposefully. There is no radiographic evidence of an acute 
+infection within the chest. Please note radiographic radiography 
+has limited sensitivity
+
+___:  chest cat scan:
+
+ IMPRESSION: Interval decrease in size of nonenhancing anterior 
+left chest 
+wall phlegmon without drainable fluid collection. There has been 
+interval 
+placement of a radiodense linear wire-like object within it of 
+indeterminate etiology
+
+___:  EKG:
+
+ Sinus bradycardia. Compared to the previous tracing there is no 
+diagnostic change
+
+___ SWAB gram stain 2 PMN, no positive culture  
+___ URINE CULTURE pending  
+___ Blood Culture pending  
+___ Blood Culture pending  
+
+ 
+Brief Hospital Course:
+ ___ year old gentleman admitted to the Acute care service with 
+pain and redness chest flap.  He had a prior admission for a 
+chest wall abscess necessiating debridement and closure with a 
+flap.  Upon admission, he was made NPO, given intraveous fluids, 
+and he was started on vancomycin. On chest x-ray imaging he was 
+found to have a metallic object in the sternal bed.  Plastics 
+was consulted and recommended removal of the metallic object.  
+On ___ was taken to the operating room for I+D of chest wall.  
+ His operative course was notable for ST depressions on his EKG. 
+ He had 3 sets of negative troponins and a post-operative EKG 
+which showed a left bundle branch block, which was noted on his 
+prior EKG.   
+ His post-operative course was uneventful.  Infectious disease 
+was consulted regarding the chronicity of the his chest wall 
+infection and have made recommendations for antibiotic coverage. 
+During the post-operative period he was maintained on 
+ciprofloxacin, flagyl and vancomycin. His chest swab culture 
+showed no micro-organisms. Blood cultures are still pending.  
+His intravenous antibiotics were discontinued on ___. He will 
+resume a week course of bactrim and ciprofloxacin upon discharge 
+as per infectious disease recommendation. 
+ His vital signs have been stable and he is afebrile. His white 
+blood cell count is 
+4.5.  He is tolerating a regular diet and has been ambulating.  
+He will be discharged to a friend's home with ___ assistance.  
+It is recommended that he follow up at the Infectious disease 
+clinic in 1 week and schedule an appointment with his primary 
+care provider.  He will be seen in the Acute Care clinic in 2 
+weeks. 
+ 
+  
+ 
+Medications on Admission:
+___: VitD2 50,000U qweek, tylenol, calcium carbonate  
+Assessment:
+ 
+
+ 
+Discharge Medications:
+1. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day).  
+2. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
+day) as needed for constipation.  
+3. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One 
+(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).  
+4. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 
+6 hours) as needed for pain, fever.  
+5. calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One 
+(1) Tablet, Chewable PO QID (4 times a day) as needed for 
+heartburn.  
+6. oxycodone 5 mg Tablet Sig: ___ Tablets PO every six (6) hours 
+as needed for pain: may cause drowsiness, avoid driving.
+Disp:*20 Tablet(s)* Refills:*0*
+7. ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO twice a 
+day for 7 days: 7 day course .
+Disp:*14 Tablet(s)* Refills:*0*
+8. Bactrim DS 800-160 mg Tablet Sig: One (1) Tablet PO twice a 
+day for 7 days.
+Disp:*14 Tablet(s)* Refills:*0*
+
+ 
+Discharge Disposition:
+Home With Service
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Cellulitis chest wall
+Foreign body chest wall
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - Independent.
+
+ 
+Discharge Instructions:
+You were admitted to the hospital with an infected chest flap.  
+You were started on intravenous antibiotics.  You will need to 
+remain on oral antibiotics for 1 week after you are discharged.  
+  You are now preparing for discharge home with the following 
+instructions:
+
+Please call your doctor or nurse practitioner or return to the 
+Emergency Department for any of the following:
+
+*You experience new chest pain, pressure, squeezing or 
+tightness.
+
+*New or worsening cough, shortness of breath, or wheeze.
+
+*If you are vomiting and cannot keep down fluids or your 
+medications.
+
+*You are getting dehydrated due to continued vomiting, diarrhea, 
+or other reasons. Signs of dehydration include dry mouth, rapid 
+heartbeat, or feeling dizzy or faint when standing.
+
+*You see blood or dark/black material when you vomit or have a 
+bowel movement.
+
+*You experience burning when you urinate, have blood in your 
+urine, or experience a discharge.
+
+*Your pain in not improving within ___ hours or is not gone 
+within 24 hours. Call or return immediately if your pain is 
+getting worse or changes location or moving to your chest or 
+back.
+
+*You have shaking chills, or fever greater than 101.5 degrees 
+Fahrenheit or 38 degrees Celsius.
+
+*Any change in your symptoms, or any new symptoms that concern 
+you.
+
+Please resume all regular home medications , unless specifically 
+advised not to take a particular medication. Also, please take 
+any new medications as prescribed.
+
+Please get plenty of rest, continue to ambulate several times 
+per day, and drink adequate amounts of fluids. Avoid lifting 
+weights greater than ___ lbs until you follow-up with your 
+surgeon.
+
+Avoid driving or operating heavy machinery while taking pain 
+medications.
+
+Please report any increase drainage, pain, or change in wound
+
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] PA AND LATERAL CHEST ___ @ 11:42 hours.
+
+HISTORY:  Chest wall sternal infection.
+
+COMPARISON:  Multiple priors, the most recent dated ___.
+
+FINDINGS:  The lungs are clear without consolidation or edema.  Chronic and
+stable  blunting of the left costophrenic angle is again noted and presumably
+due to chronic pleural thickening.  There has been interval placement of a
+thin linear metal object vertically along the left aspect of the sternal bed. 
+This is of indeterminate etiology.  The mediastinum is otherwise unremarkable.
+The cardiac silhouette is within normal limits for size.  No right effusion is
+noted.  There is no pneumothorax.
+
+IMPRESSION:  No acute pulmonary process.  There is a new indwelling foreign
+body within the soft tissues of the sternal bed presumably placed
+purposefully.  There is no radiographic evidence of an acute infection within
+the chest.  Please note radiographic radiography has limited sensitivity.
+
+
+[RADIOLOGY] CLINICAL INFORMATION:  ___ male with history of chest wall abscess and
+a new foreign body within it.
+
+COMPARISON:  PA and lateral performed same day, as well as CT chest, ___.
+
+TECHNIQUE:  Axial images were acquired of the chest following the
+administration of intravenous contrast, and reformatted in the coronal and
+sagittal planes.
+
+FINDINGS:  Interval decrease in size of a left anterior chest wall phlegmon,
+now measuring 1.7 x 4.8 x 5.4 cm.  There is overlying skin thickening, not
+significantly changed compared with prior.  There is no abnormal enhancement
+of this soft tissue accumulation.  No internal hypodensity is seen to suggest
+a drainable fluid collection.  A metallic density thin wire is seen measuring
+approximately 13 cm in length and taking a cephalocaudad approach along the
+anterior chest wall in the region of the abscess.  At the costochondral
+junction of the anterior sixth rib on the left, there is a newly appreciated
+hyperdense focus which might represent foreign body or bone fragment.  There
+is no osteolysis.
+
+The heart remains normal in size and configuration.  There is no pleural or
+pericardial effusion.  There is minimal atherosclerotic change of the aortic
+arch, the great vessels are otherwise unremarkable.  The central pulmonary
+arteries are patent.  The central airways appear patent.  A granuloma is again
+noted in the left lung base and there is calcification of the inferior pleural
+surface of the left lung.  There are calcified but non-enlarged left hilar
+lymph nodes which are stable in appearance.  There is no pathologically
+enlarged axillary or hilar lymphadenopathy.  While this exam is not tailored
+to evaluate the subdiaphragmatic structures, the visualized portions are
+unremarkable.  Note is again made of paraseptal and centrilobular emphysema in
+the bilateral apices.  There is mild degenerative change of the visualized
+thoracic spine without concerning lytic or blastic lesions.
+
+IMPRESSION:  Interval decrease in size of nonenhancing anterior left chest
+wall phlegmon without drainable fluid collection.  There has been interval
+placement of a radiodense linear wire-like object within it of indeterminate
+etiology.
+
+PROCEDURES (readable):
+- 8605 (ICD-9) — Incision with removal of foreign body or device from skin and subcutaneous tissue
+
+DIAGNOSES (readable):
+- 6822 (ICD-9) — Cellulitis and abscess of trunk
+- V600 (ICD-9) — Lack of housing
+
+LAB ITEMS (readable, deduped):
+- Anion Gap (Item 50868)
+- Bicarbonate (Item 50882)
+- Calcium, Total (Item 50893)
+- Chloride (Item 50902)
+- Creatine Kinase (CK) (Item 50910)
+- Creatine Kinase, MB Isoenzyme (Item 50911)
+- Creatinine (Item 50912)
+- Glucose (Item 50931)
+- Hematocrit (Item 51221)
+- Hemoglobin (Item 51222)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Magnesium (Item 50960)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Potassium (Item 50971)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Sodium (Item 50983)
+- Troponin T (Item 51003)
+- Urea Nitrogen (Item 51006)
+- Vancomycin (Item 51009)
+- White Blood Cells (Item 51301)

summaries/subject_14899292_hadm_24095441_summary.txt

@@ -0,0 +1,77 @@
+**PRE-OPERATIVE SUMMARY**
+
+**Patient Information:**
+
+* Age: 57
+* Gender: Male
+* Admission ID: 24095441
+* Admission Type: Emergency (EW)
+* Admission Location: Emergency Room
+* Discharge Location: Home Health Care
+* Insurance: Other
+* Race: White
+* Marital Status: Single
+* Language: English
+
+**Diagnosis:**
+
+* ICD-9: 6822 (Cellulitis and abscess of trunk)
+* ICD-9: V600 (Lack of housing)
+
+**Procedure:**
+
+* ICD-9: 8605 (Incision with removal of foreign body or device from skin and subcutaneous tissue)
+
+**Laboratory Results:**
+
+* Total laboratory events: 48
+* Most frequent lab tests:
+	+ Item ID 50910: 4 measurements
+	+ Item ID 50911: 4 measurements
+	+ Item ID 51003: 4 measurements
+	+ Item ID 50902: 2 measurements
+	+ Item ID 50912: 2 measurements
+
+**Clinical Notes:**
+
+* The patient has a history of chronic chest wall infection, which was previously treated with debridement and closure with a flap.
+* The patient presents with pain and redness at the previous flap site, which has developed into a fluctuant mass.
+* The patient was previously hospitalized for cellulitis and completed a 2-week course of IV vancomycin.
+* The patient denies instrumentation or insertion of a foreign object into the chest wall.
+* The patient has night sweats for an unknown duration.
+* The patient's past medical history includes phlegmon of the left chest wall, surgical reconstruction of the right upper extremity, and surgery on the left bicep.
+
+**Physical Exam:**
+
+* The patient's vital signs are:
+	+ Temperature: 98.2°F
+	+ Heart Rate: 73 beats per minute
+	+ Blood Pressure: 144/78 mmHg
+	+ Respiratory Rate: 18 breaths per minute
+	+ Oxygen Saturation: 100%
+* The patient's physical exam is notable for:
+	+ A fluctuant mass to the sternum
+	+ 2 areas of non-fluctuant but erythematous areas
+	+ A metallic density thin wire-like object within the soft tissues of the sternal bed
+	+ No radiographic evidence of an acute infection within the chest
+
+**Imaging Results:**
+
+* Chest X-ray:
+	+ No acute pulmonary process
+	+ A new indwelling foreign body within the soft tissues of the sternal bed
+	+ No radiographic evidence of an acute infection within the chest
+* CT Chest:
+	+ Interval decrease in size of the non-enhancing anterior left chest wall phlegmon
+	+ No abnormal enhancement of the soft tissue accumulation
+	+ A metallic density thin wire-like object within the soft tissues of the sternal bed
+	+ No osteolysis
+
+**Medications:**
+
+* The patient is currently taking:
+	+ Docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day)
+	+ Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a day) as needed for constipation
+	+ Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours)
+	+ Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 6 hours) as needed for pain, fever
+	+ Calcium carbonate 200 mg (500 mg) Tablet, Chewable Sig: One (1) Tablet, Chewable PO QID (4 times a

summaries/subject_14899292_hadm_24253579_input.txt

@@ -0,0 +1,351 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 57
+- Gender: M
+
+ADMISSION:
+- Admission ID: 24253579
+- Admission Type: DIRECT EMER.
+- Admission Location: CLINIC REFERRAL
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Other
+- Race: WHITE
+- Marital Status: SINGLE
+- Language: ENGLISH
+
+PROCEDURES (1 total):
+- 3893 (ICD-9)
+
+DIAGNOSES (6 total):
+- 99859 (ICD-9)
+- 6822 (ICD-9)
+- 5780 (ICD-9)
+- 34690 (ICD-9)
+- V600 (ICD-9)
+- V620 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50861: 1 measurements, 2150-04-21 23:34:00 to 2150-04-21 23:34:00
+- Item ID 50863: 1 measurements, 2150-04-21 23:34:00 to 2150-04-21 23:34:00
+- Item ID 50868: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 50878: 1 measurements, 2150-04-21 23:34:00 to 2150-04-21 23:34:00
+- Item ID 50882: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 50885: 1 measurements, 2150-04-21 23:34:00 to 2150-04-21 23:34:00
+- Item ID 50893: 1 measurements, 2150-04-22 08:00:00 to 2150-04-22 08:00:00
+- Item ID 50902: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 50912: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 50920: 1 measurements, 2150-04-21 23:34:00 to 2150-04-21 23:34:00
+- Item ID 50931: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 50960: 1 measurements, 2150-04-22 08:00:00 to 2150-04-22 08:00:00
+- Item ID 50970: 1 measurements, 2150-04-22 08:00:00 to 2150-04-22 08:00:00
+- Item ID 50971: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 50979: 1 measurements, 2150-04-27 05:25:00 to 2150-04-27 05:25:00
+- Item ID 50983: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51006: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51009: 2 measurements, 2150-04-24 05:03:00 to 2150-04-27 05:25:00
+- Item ID 51221: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51222: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51248: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51249: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51250: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51265: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51277: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51279: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+- Item ID 51301: 7 measurements, 2150-04-21 23:34:00 to 2150-04-27 05:25:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: MEDICINE
+ 
+Allergies: 
+Clindamycin
+ 
+Attending: ___
+ 
+Chief Complaint:
+Cellulitis
+ 
+Major Surgical or Invasive Procedure:
+___ line placement
+
+ 
+History of Present Illness:
+Patient is a ___ year old male with PMHx significant for a 
+chronic infection with phlegmon of his left chest wall s/p 
+debridement on ___ and closure on ___.  He presents today 
+with symptoms consistent with cellulitis. 
+.
+The patient was recently hospitalized at ___ 
+(___) with nausea, vomiting and an episode of small volume 
+hematemsis.  He was afebrile with normal WBC but some erythema 
+was seen at the drain site so he was discharge on doxycycline 
+with concern for a wound infection. 
+.
+The patient has been followed since discharge in ___ by ___ 
+clinic.  Please see their notes in OMR for full details.  
+Briefly, he was last seen by ID on ___.  At that time, he was 
+afebrile and overall well-appearing.  On exam, there was 
+erythema around the wound.  The drain was discontinued and he 
+was given levofloxacin and asked to continue the doxycycline 
+from a recent admission at OSH.  Since then, he's noted 
+increased erythema and tenderness at the site.  He was evaluated 
+in ___ clinic today and direct admitted for IV antibiotics.  
+.
+On arrival to the floor, vital signs are T: 96.8 BP: 128/86 P: 
+63 R: 20 O2: 94% on RA.  The patient continues to report pain at 
+the debridement site.  There is blanching erythema there as 
+well.  He denies ongoing emesis. Denies significant abdominal 
+pain, denies hematochezia or melena.   Denies fevers, chills, 
+nausea, vomiting.
+ 
+Past Medical History:
+Phlegmon of his left chest wall s/p debridement on ___ and 
+closure on ___  
+Surgical reconstruction of right upper extremity after horse 
+accident 
+Surgery on left bicep after horse accident
+ 
+Social History:
+___
+Family History:
+NC
+ 
+Physical Exam:
+General: Alert, oriented, no acute distress but is favoring left 
+side.  
+HEENT: Sclera anicteric, MMM, oropharynx clear  
+Neck: supple, JVP not elevated, no LAD  
+Lungs: Clear to auscultation bilaterally, no wheezes, rales, 
+ronchi  
+CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, 
+gallops  
+Abdomen: soft, non-tender, non-distended, bowel sounds present, 
+no rebound tenderness or guarding 
+Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or 
+edema  
+Neuro:  PERRLA, EOMI.  CN intact
+Derm:  Left anterior chest wall with large incision (sutured).  
+Well-approximated wound edges with 3-4 cm area of surrounding 
+blanching erythema that is warm to touch and tender to 
+palpation.  No obvious fluid collection noted.  No drainage.  JP 
+drain site is clean, dry and intact with no erythema.  
+ 
+Pertinent Results:
+___ 11:34PM BLOOD WBC-4.8 RBC-4.48* Hgb-13.0* Hct-39.4* 
+MCV-88 MCH-29.1 MCHC-33.0 RDW-13.8 Plt ___
+___ 08:00AM BLOOD WBC-4.3 RBC-4.89 Hgb-14.4 Hct-43.0 MCV-88 
+MCH-29.4 MCHC-33.5 RDW-13.7 Plt ___
+___ 10:30AM BLOOD WBC-3.9* RBC-4.67 Hgb-14.0 Hct-40.9 
+MCV-88 MCH-29.9 MCHC-34.1 RDW-13.8 Plt ___
+___ 05:03AM BLOOD WBC-3.8* RBC-4.47* Hgb-13.3* Hct-38.4* 
+MCV-86 MCH-29.8 MCHC-34.6 RDW-13.5 Plt ___
+___ 05:26AM BLOOD WBC-3.6* RBC-4.36* Hgb-12.8* Hct-38.1* 
+MCV-88 MCH-29.4 MCHC-33.6 RDW-13.7 Plt ___
+___ 05:31AM BLOOD WBC-4.0 RBC-4.57* Hgb-13.7* Hct-39.6* 
+MCV-87 MCH-30.0 MCHC-34.6 RDW-13.6 Plt ___
+___ 11:34PM BLOOD Glucose-141* UreaN-13 Creat-0.7 Na-137 
+K-3.3 Cl-103 HCO3-26 AnGap-11
+___ 08:00AM BLOOD Glucose-89 UreaN-12 Creat-0.7 Na-137 
+K-3.8 Cl-103 HCO3-26 AnGap-12
+___ 10:30AM BLOOD Glucose-120* UreaN-8 Creat-0.7 Na-140 
+K-3.7 Cl-105 HCO3-28 AnGap-11
+___ 05:03AM BLOOD Glucose-116* UreaN-11 Creat-0.8 Na-142 
+K-3.7 Cl-106 HCO3-27 AnGap-13
+___ 05:26AM BLOOD Glucose-106* UreaN-10 Creat-0.8 Na-141 
+K-3.9 Cl-104 HCO3-29 AnGap-12
+___ 05:31AM BLOOD Glucose-96 UreaN-15 Creat-0.8 Na-142 
+K-4.2 Cl-106 HCO3-30 AnGap-10
+___ 11:34PM BLOOD ALT-13 AST-17 AlkPhos-67 TotBili-0.5
+___ 08:00AM BLOOD Calcium-9.0 Phos-3.2 Mg-2.2
+___ 05:03AM BLOOD Vanco-11.3
+___ 05:25AM BLOOD WBC-3.3* RBC-4.47* Hgb-13.4* Hct-39.0* 
+MCV-87 MCH-29.9 MCHC-34.4 RDW-13.6 Plt ___
+___ 05:25AM BLOOD Glucose-85 UreaN-14 Creat-0.8 Na-139 
+K-3.7 Cl-104 HCO3-29 AnGap-10
+___ 11:34PM BLOOD ALT-13 AST-17 AlkPhos-67 TotBili-0.5
+___ 05:25AM BLOOD Vanco-16.3
+
+Chest U/S (___)- 
+FINDINGS: Direct ultrasound examination was performed on the 
+left chest wall. There is a predominantly anechoic fluid 
+collection within the left anterior chest wall approximately 1 
+cm deep from the skin surface, measuring 2.7 x 0.4 x 1.9 cm (TRV 
+x AP x CC), without internal vascularity.
+ 
+IMPRESSION: Left chest-wall fluid collection; infection of this 
+collection is not excluded on the basis of this exam.
+
+CT Head (___)- 
+IMPRESSION: No acute intracranial process.
+
+ 
+Brief Hospital Course:
+Assessment and Plan:  ___ male with chronic infection with 
+phlegmon s/p drainage in ___ admitted with post-operative 
+cellulitis
+.
+#  Cellulitis- Given that he had not responded as hoped with PO 
+therapy, the patient was admitted for IV antibiotics.  He was 
+started on IV vancomycin 1000mg q24 and responded well.  Dose 
+was increased to 1250mg q24 on ___.  ID followed throughout 
+the hospitalization.  A chest U/S showed a small simple fluid 
+collection (no evidence of abscess) near the site.  Plastic 
+surgery attempted bedside drainage but were not able to remove 
+much fluid.  Plastic surgery also removed the patient's sutures. 
+ As mentioned, his wound improved throughout the hospitalization 
+with decreased erythema and tenderness to palpation.  He 
+remained afebrile without any elevation of WBC.  He is being 
+discharged to a facility where he can complete his, course of IV 
+vancomycin, which is to continue until he follows up with 
+infectious disease clinic on ___.  We ask that he have weekly 
+CBC w/diff, electrolytes (including BUN/Cr), LFT's and 
+vancomycin trough drawn starting on ___.  Please fax 
+the results to infectious disease clinic at ___
+.
+# Headache- The patient experienced headaches while in the 
+hospital that were consistent with history of migraines.  Pain 
+was relieved with tylenol.  He preferred not to be on Fiorcet.  
+Sumatriptan was given as a one-time dose on ___ with response.  
+A CT head was obtained which did not show any acute process.  
+Neurologic exam did not demonstrate any focal deficits and the 
+patient's sensorium remained clear throughout the 
+hospitalization.  
+.
+#  Hemetemsis- Patient was recently admitted to OSH with small 
+volume hematemeis with no clear etiology.  Per patient, he does 
+not have an extensive alcohol history or history of hepatitis.  
+He also denied recent NSAID use, abdominal pain.  LFTs were 
+within normal limits.  We started him on PO PPI BID x 6 weeks 
+with plans for an outpatient EGD for further work-up.  He is to 
+avoid NSAIDs.  He did not experience any hemetemesis while in 
+the hospital.  
+.
+# Code: Full code
+
+ 
+Medications on Admission:
+ERGOCALCIFEROL (VITAMIN D2) [DRISDOL] -  (Prescribed by Other 
+Provider) - 50,000 unit Capsule - 1 Capsule(s) by mouth weekly
+. 
+Medications - OTC
+ACETAMINOPHEN [TYLENOL] -  (Prescribed by Other Provider) - 
+325mg Tablet - 1 Tablet(s) by mouth prn
+CALCIUM CARBONATE -  (Prescribed by Other Provider) - 500 mg 
+(1,250 mg) Tablet - 1 Tablet(s) by mouth twice a day
+
+Levofloxacin
+Doxycycline
+ 
+Discharge Medications:
+1. Vitamin D 50,000 unit Capsule Sig: One (1) Capsule PO once a 
+week.  
+2. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One 
+(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
+Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*3*
+3. calcium carbonate 500 mg (1,250 mg) Tablet Sig: One (1) 
+Tablet PO twice a day.  
+4. vancomycin in 0.9% sodium Cl 1.25 gram/250 mL Solution Sig: 
+One (1) rec solution Intravenous every twelve (12) hours for 26 
+doses: continue until he sees infectious disease in follow-up on 
+___.  
+5. acetaminophen 500 mg Tablet Sig: ___ Tablets PO Q6H (every 6 
+hours) as needed for headache: maximum of 4 grams daily.  
+6. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every six (6) 
+hours as needed for pain.  
+7. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) 
+Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for 
+constipation.  
+8. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
+day) as needed for constipation.  
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Primary- Cellulitis
+
+Secondary- Chronic chest wall infection with phlegmon s/p 
+debridement and drainage in ___
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - Independent.
+
+ 
+Discharge Instructions:
+You were admitted to the hospital with a worsening skin 
+infection around your previous wound.  While here, you received 
+IV antibiotics and did well.  You are being discharged with 
+plans to continue IV vancomycin (an antibiotic) to continue 
+until you follow-up with the infectious disease doctors ___ 
+___ at 2:30pm.  Please make sure to follow-up with them to 
+monitor your progress on the medication.
+
+The following changes were made to your medications:
+1.  Please continue vancomycin 1.25gm IV every 12 hours until 
+___.
+2.  Please start taking pantoprazole 40mg by mouth twice a day 
+for 6 weeks.
+3.  Please avoid advil and other NSAIDs for pain control.
+
+Please follow-up with ID and your PCP on discharge.
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+CHEST
+
+HISTORY:  Line placement, check PICC tip.
+
+One view.  Comparison with the previous study done ___.  The lungs are
+clear except for minimal streaky density consistent with subsegmental
+atelectasis or scarring.  The left costophrenic sulcus is mildly blunted, as
+before.  The heart and mediastinal structures are unchanged.  A PICC line has
+been inserted on the right.  It terminates in the mid superior vena cava.
+
+IMPRESSION:  Line placement as described.
+
+[RADIOLOGY NOTE]
+HISTORY:  ___ man with left chest wall phlegmon, status post
+debridement.  Now with worsening cellulitis around the incision, concerning
+for underlying fluid collection.
+
+COMPARISON:  Limited comparison from pre-procedural CT chest on ___.
+
+FINDINGS:  Direct ultrasound examination was performed on the left chest wall.
+There is a predominantly anechoic fluid collection within the left anterior
+chest wall approximately 1 cm deep from the skin surface, measuring 2.7 x 0.4
+x 1.9 cm (TRV x AP x CC), without internal vascularity.
+
+IMPRESSION:  Left chest-wall fluid collection; infection of this collection is
+not excluded on the basis of this exam.
+
+[RADIOLOGY NOTE]
+CLINICAL INFORMATION:  ___ male with severe onset headache.  Evaluate
+for bleed.
+
+TECHNIQUE:  Axial images were acquired of the head without contrast.
+
+COMPARISON:  None available.
+
+FINDINGS:  There is no acute intracranial hemorrhage, mass effect, or
+extra-axial collection.  The ventricles and sulci are normal in size and
+configuration.  Gray-white differentiation is preserved throughout.  The
+visualized portions of the orbits are unremarkable.  The mastoid air cells are
+clear bilaterally, as are the visualized paranasal sinuses.
+
+IMPRESSION:  No acute intracranial process.

summaries/subject_14899292_hadm_24253579_model_input.txt

@@ -0,0 +1,371 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 57
+- Gender: M
+
+ADMISSION:
+- Admission ID: 24253579
+- Admission Type: DIRECT EMER.
+- Admission Location: CLINIC REFERRAL
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Other
+- Race: WHITE
+- Marital Status: SINGLE
+- Language: ENGLISH
+
+PROCEDURES (1 total):
+  1. ICD-9: 3893
+
+DIAGNOSES (6 total):
+  1. ICD-9: 99859
+  2. ICD-9: 6822
+  3. ICD-9: 5780
+  4. ICD-9: 34690
+  5. ICD-9: V600
+  6. ICD-9: V620
+
+LABORATORY RESULTS:
+Total laboratory events: 130
+Most frequent lab tests:
+  - Item ID 50868: 7 measurements
+  - Item ID 50882: 7 measurements
+  - Item ID 50902: 7 measurements
+  - Item ID 50912: 7 measurements
+  - Item ID 50931: 7 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: MEDICINE
+ 
+Allergies: 
+Clindamycin
+ 
+Attending: ___
+ 
+Chief Complaint:
+Cellulitis
+ 
+Major Surgical or Invasive Procedure:
+___ line placement
+
+ 
+History of Present Illness:
+Patient is a ___ year old male with PMHx significant for a 
+chronic infection with phlegmon of his left chest wall s/p 
+debridement on ___ and closure on ___.  He presents today 
+with symptoms consistent with cellulitis. 
+.
+The patient was recently hospitalized at ___ 
+(___) with nausea, vomiting and an episode of small volume 
+hematemsis.  He was afebrile with normal WBC but some erythema 
+was seen at the drain site so he was discharge on doxycycline 
+with concern for a wound infection. 
+.
+The patient has been followed since discharge in ___ by ___ 
+clinic.  Please see their notes in OMR for full details.  
+Briefly, he was last seen by ID on ___.  At that time, he was 
+afebrile and overall well-appearing.  On exam, there was 
+erythema around the wound.  The drain was discontinued and he 
+was given levofloxacin and asked to continue the doxycycline 
+from a recent admission at OSH.  Since then, he's noted 
+increased erythema and tenderness at the site.  He was evaluated 
+in ___ clinic today and direct admitted for IV antibiotics.  
+.
+On arrival to the floor, vital signs are T: 96.8 BP: 128/86 P: 
+63 R: 20 O2: 94% on RA.  The patient continues to report pain at 
+the debridement site.  There is blanching erythema there as 
+well.  He denies ongoing emesis. Denies significant abdominal 
+pain, denies hematochezia or melena.   Denies fevers, chills, 
+nausea, vomiting.
+ 
+Past Medical History:
+Phlegmon of his left chest wall s/p debridement on ___ and 
+closure on ___  
+Surgical reconstruction of right upper extremity after horse 
+accident 
+Surgery on left bicep after horse accident
+ 
+Social History:
+___
+Family History:
+NC
+ 
+Physical Exam:
+General: Alert, oriented, no acute distress but is favoring left 
+side.  
+HEENT: Sclera anicteric, MMM, oropharynx clear  
+Neck: supple, JVP not elevated, no LAD  
+Lungs: Clear to auscultation bilaterally, no wheezes, rales, 
+ronchi  
+CV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, 
+gallops  
+Abdomen: soft, non-tender, non-distended, bowel sounds present, 
+no rebound tenderness or guarding 
+Ext: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or 
+edema  
+Neuro:  PERRLA, EOMI.  CN intact
+Derm:  Left anterior chest wall with large incision (sutured).  
+Well-approximated wound edges with 3-4 cm area of surrounding 
+blanching erythema that is warm to touch and tender to 
+palpation.  No obvious fluid collection noted.  No drainage.  JP 
+drain site is clean, dry and intact with no erythema.  
+ 
+Pertinent Results:
+___ 11:34PM BLOOD WBC-4.8 RBC-4.48* Hgb-13.0* Hct-39.4* 
+MCV-88 MCH-29.1 MCHC-33.0 RDW-13.8 Plt ___
+___ 08:00AM BLOOD WBC-4.3 RBC-4.89 Hgb-14.4 Hct-43.0 MCV-88 
+MCH-29.4 MCHC-33.5 RDW-13.7 Plt ___
+___ 10:30AM BLOOD WBC-3.9* RBC-4.67 Hgb-14.0 Hct-40.9 
+MCV-88 MCH-29.9 MCHC-34.1 RDW-13.8 Plt ___
+___ 05:03AM BLOOD WBC-3.8* RBC-4.47* Hgb-13.3* Hct-38.4* 
+MCV-86 MCH-29.8 MCHC-34.6 RDW-13.5 Plt ___
+___ 05:26AM BLOOD WBC-3.6* RBC-4.36* Hgb-12.8* Hct-38.1* 
+MCV-88 MCH-29.4 MCHC-33.6 RDW-13.7 Plt ___
+___ 05:31AM BLOOD WBC-4.0 RBC-4.57* Hgb-13.7* Hct-39.6* 
+MCV-87 MCH-30.0 MCHC-34.6 RDW-13.6 Plt ___
+___ 11:34PM BLOOD Glucose-141* UreaN-13 Creat-0.7 Na-137 
+K-3.3 Cl-103 HCO3-26 AnGap-11
+___ 08:00AM BLOOD Glucose-89 UreaN-12 Creat-0.7 Na-137 
+K-3.8 Cl-103 HCO3-26 AnGap-12
+___ 10:30AM BLOOD Glucose-120* UreaN-8 Creat-0.7 Na-140 
+K-3.7 Cl-105 HCO3-28 AnGap-11
+___ 05:03AM BLOOD Glucose-116* UreaN-11 Creat-0.8 Na-142 
+K-3.7 Cl-106 HCO3-27 AnGap-13
+___ 05:26AM BLOOD Glucose-106* UreaN-10 Creat-0.8 Na-141 
+K-3.9 Cl-104 HCO3-29 AnGap-12
+___ 05:31AM BLOOD Glucose-96 UreaN-15 Creat-0.8 Na-142 
+K-4.2 Cl-106 HCO3-30 AnGap-10
+___ 11:34PM BLOOD ALT-13 AST-17 AlkPhos-67 TotBili-0.5
+___ 08:00AM BLOOD Calcium-9.0 Phos-3.2 Mg-2.2
+___ 05:03AM BLOOD Vanco-11.3
+___ 05:25AM BLOOD WBC-3.3* RBC-4.47* Hgb-13.4* Hct-39.0* 
+MCV-87 MCH-29.9 MCHC-34.4 RDW-13.6 Plt ___
+___ 05:25AM BLOOD Glucose-85 UreaN-14 Creat-0.8 Na-139 
+K-3.7 Cl-104 HCO3-29 AnGap-10
+___ 11:34PM BLOOD ALT-13 AST-17 AlkPhos-67 TotBili-0.5
+___ 05:25AM BLOOD Vanco-16.3
+
+Chest U/S (___)- 
+FINDINGS: Direct ultrasound examination was performed on the 
+left chest wall. There is a predominantly anechoic fluid 
+collection within the left anterior chest wall approximately 1 
+cm deep from the skin surface, measuring 2.7 x 0.4 x 1.9 cm (TRV 
+x AP x CC), without internal vascularity.
+ 
+IMPRESSION: Left chest-wall fluid collection; infection of this 
+collection is not excluded on the basis of this exam.
+
+CT Head (___)- 
+IMPRESSION: No acute intracranial process.
+
+ 
+Brief Hospital Course:
+Assessment and Plan:  ___ male with chronic infection with 
+phlegmon s/p drainage in ___ admitted with post-operative 
+cellulitis
+.
+#  Cellulitis- Given that he had not responded as hoped with PO 
+therapy, the patient was admitted for IV antibiotics.  He was 
+started on IV vancomycin 1000mg q24 and responded well.  Dose 
+was increased to 1250mg q24 on ___.  ID followed throughout 
+the hospitalization.  A chest U/S showed a small simple fluid 
+collection (no evidence of abscess) near the site.  Plastic 
+surgery attempted bedside drainage but were not able to remove 
+much fluid.  Plastic surgery also removed the patient's sutures. 
+ As mentioned, his wound improved throughout the hospitalization 
+with decreased erythema and tenderness to palpation.  He 
+remained afebrile without any elevation of WBC.  He is being 
+discharged to a facility where he can complete his, course of IV 
+vancomycin, which is to continue until he follows up with 
+infectious disease clinic on ___.  We ask that he have weekly 
+CBC w/diff, electrolytes (including BUN/Cr), LFT's and 
+vancomycin trough drawn starting on ___.  Please fax 
+the results to infectious disease clinic at ___
+.
+# Headache- The patient experienced headaches while in the 
+hospital that were consistent with history of migraines.  Pain 
+was relieved with tylenol.  He preferred not to be on Fiorcet.  
+Sumatriptan was given as a one-time dose on ___ with response.  
+A CT head was obtained which did not show any acute process.  
+Neurologic exam did not demonstrate any focal deficits and the 
+patient's sensorium remained clear throughout the 
+hospitalization.  
+.
+#  Hemetemsis- Patient was recently admitted to OSH with small 
+volume hematemeis with no clear etiology.  Per patient, he does 
+not have an extensive alcohol history or history of hepatitis.  
+He also denied recent NSAID use, abdominal pain.  LFTs were 
+within normal limits.  We started him on PO PPI BID x 6 weeks 
+with plans for an outpatient EGD for further work-up.  He is to 
+avoid NSAIDs.  He did not experience any hemetemesis while in 
+the hospital.  
+.
+# Code: Full code
+
+ 
+Medications on Admission:
+ERGOCALCIFEROL (VITAMIN D2) [DRISDOL] -  (Prescribed by Other 
+Provider) - 50,000 unit Capsule - 1 Capsule(s) by mouth weekly
+. 
+Medications - OTC
+ACETAMINOPHEN [TYLENOL] -  (Prescribed by Other Provider) - 
+325mg Tablet - 1 Tablet(s) by mouth prn
+CALCIUM CARBONATE -  (Prescribed by Other Provider) - 500 mg 
+(1,250 mg) Tablet - 1 Tablet(s) by mouth twice a day
+
+Levofloxacin
+Doxycycline
+ 
+Discharge Medications:
+1. Vitamin D 50,000 unit Capsule Sig: One (1) Capsule PO once a 
+week.  
+2. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One 
+(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).
+Disp:*90 Tablet, Delayed Release (E.C.)(s)* Refills:*3*
+3. calcium carbonate 500 mg (1,250 mg) Tablet Sig: One (1) 
+Tablet PO twice a day.  
+4. vancomycin in 0.9% sodium Cl 1.25 gram/250 mL Solution Sig: 
+One (1) rec solution Intravenous every twelve (12) hours for 26 
+doses: continue until he sees infectious disease in follow-up on 
+___.  
+5. acetaminophen 500 mg Tablet Sig: ___ Tablets PO Q6H (every 6 
+hours) as needed for headache: maximum of 4 grams daily.  
+6. oxycodone 5 mg Tablet Sig: One (1) Tablet PO every six (6) 
+hours as needed for pain.  
+7. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) 
+Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for 
+constipation.  
+8. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
+day) as needed for constipation.  
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Primary- Cellulitis
+
+Secondary- Chronic chest wall infection with phlegmon s/p 
+debridement and drainage in ___
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - Independent.
+
+ 
+Discharge Instructions:
+You were admitted to the hospital with a worsening skin 
+infection around your previous wound.  While here, you received 
+IV antibiotics and did well.  You are being discharged with 
+plans to continue IV vancomycin (an antibiotic) to continue 
+until you follow-up with the infectious disease doctors ___ 
+___ at 2:30pm.  Please make sure to follow-up with them to 
+monitor your progress on the medication.
+
+The following changes were made to your medications:
+1.  Please continue vancomycin 1.25gm IV every 12 hours until 
+___.
+2.  Please start taking pantoprazole 40mg by mouth twice a day 
+for 6 weeks.
+3.  Please avoid advil and other NSAIDs for pain control.
+
+Please follow-up with ID and your PCP on discharge.
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] CHEST
+
+HISTORY:  Line placement, check PICC tip.
+
+One view.  Comparison with the previous study done ___.  The lungs are
+clear except for minimal streaky density consistent with subsegmental
+atelectasis or scarring.  The left costophrenic sulcus is mildly blunted, as
+before.  The heart and mediastinal structures are unchanged.  A PICC line has
+been inserted on the right.  It terminates in the mid superior vena cava.
+
+IMPRESSION:  Line placement as described.
+
+
+[RADIOLOGY] HISTORY:  ___ man with left chest wall phlegmon, status post
+debridement.  Now with worsening cellulitis around the incision, concerning
+for underlying fluid collection.
+
+COMPARISON:  Limited comparison from pre-procedural CT chest on ___.
+
+FINDINGS:  Direct ultrasound examination was performed on the left chest wall.
+There is a predominantly anechoic fluid collection within the left anterior
+chest wall approximately 1 cm deep from the skin surface, measuring 2.7 x 0.4
+x 1.9 cm (TRV x AP x CC), without internal vascularity.
+
+IMPRESSION:  Left chest-wall fluid collection; infection of this collection is
+not excluded on the basis of this exam.
+
+
+[RADIOLOGY] CLINICAL INFORMATION:  ___ male with severe onset headache.  Evaluate
+for bleed.
+
+TECHNIQUE:  Axial images were acquired of the head without contrast.
+
+COMPARISON:  None available.
+
+FINDINGS:  There is no acute intracranial hemorrhage, mass effect, or
+extra-axial collection.  The ventricles and sulci are normal in size and
+configuration.  Gray-white differentiation is preserved throughout.  The
+visualized portions of the orbits are unremarkable.  The mastoid air cells are
+clear bilaterally, as are the visualized paranasal sinuses.
+
+IMPRESSION:  No acute intracranial process.
+
+PROCEDURES (readable):
+- 3893 (ICD-9) — Venous catheterization, not elsewhere classified
+
+DIAGNOSES (readable):
+- 99859 (ICD-9) — Other postoperative infection
+- 6822 (ICD-9) — Cellulitis and abscess of trunk
+- 5780 (ICD-9) — Hematemesis
+- 34690 (ICD-9) — Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus
+- V600 (ICD-9) — Lack of housing
+- V620 (ICD-9) — Unemployment
+
+LAB ITEMS (readable, deduped):
+- Alanine Aminotransferase (ALT) (Item 50861)
+- Alkaline Phosphatase (Item 50863)
+- Anion Gap (Item 50868)
+- Asparate Aminotransferase (AST) (Item 50878)
+- Bicarbonate (Item 50882)
+- Bilirubin, Total (Item 50885)
+- Calcium, Total (Item 50893)
+- Chloride (Item 50902)
+- Creatinine (Item 50912)
+- Estimated GFR (MDRD equation) (Item 50920)
+- Glucose (Item 50931)
+- Hematocrit (Item 51221)
+- Hemoglobin (Item 51222)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Magnesium (Item 50960)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Potassium (Item 50971)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Red Top Hold (Item 50979)
+- Sodium (Item 50983)
+- Urea Nitrogen (Item 51006)
+- Vancomycin (Item 51009)
+- White Blood Cells (Item 51301)

summaries/subject_14899292_hadm_24253579_summary.txt

@@ -0,0 +1,68 @@
+**PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION)**
+
+**Patient Information:**
+
+* Age: 57
+* Gender: Male
+* Admission ID: 24253579
+* Admission Type: Direct Emergency
+* Admission Location: Clinic Referral
+* Discharge Location: Skilled Nursing Facility
+* Insurance: Other
+* Race: White
+* Marital Status: Single
+* Language: English
+
+**Procedures:**
+
+* ICD-9: 3893 (Venous catheterization, not elsewhere classified)
+
+**Diagnoses:**
+
+* ICD-9: 99859 (Other postoperative infection)
+* ICD-9: 6822 (Cellulitis and abscess of trunk)
+* ICD-9: 5780 (Hematemesis)
+* ICD-9: 34690 (Migraine, unspecified)
+* ICD-9: V600 (Lack of housing)
+* ICD-9: V620 (Unemployment)
+
+**Laboratory Results:**
+
+* Total laboratory events: 130
+* Most frequent lab tests:
+	+ Item ID 50868: 7 measurements (Anion Gap)
+	+ Item ID 50882: 7 measurements (Bicarbonate)
+	+ Item ID 50902: 7 measurements (Chloride)
+	+ Item ID 50912: 7 measurements (Creatinine)
+	+ Item ID 50931: 7 measurements (Glucose)
+	+ Item ID 51221: 7 measurements (Hematocrit)
+	+ Item ID 51222: 7 measurements (Hemoglobin)
+	+ Item ID 51248: 7 measurements (MCH)
+	+ Item ID 51249: 7 measurements (MCHC)
+	+ Item ID 51250: 7 measurements (MCV)
+	+ Item ID 50960: 7 measurements (Magnesium)
+	+ Item ID 50970: 7 measurements (Phosphate)
+	+ Item ID 51265: 7 measurements (Platelet Count)
+	+ Item ID 50971: 7 measurements (Potassium)
+	+ Item ID 51277: 7 measurements (RDW)
+	+ Item ID 51279: 7 measurements (Red Blood Cells)
+	+ Item ID 50979: 7 measurements (Red Top Hold)
+	+ Item ID 50983: 7 measurements (Sodium)
+	+ Item ID 51006: 7 measurements (Urea Nitrogen)
+	+ Item ID 51009: 7 measurements (Vancomycin)
+
+**Clinical Notes:**
+
+* The patient was admitted with a worsening skin infection around his previous wound.
+* He received IV antibiotics and did well.
+* The patient is being discharged with plans to continue IV vancomycin to monitor his progress.
+* The patient has a history of chronic infection with phlegmon of his left chest wall, s/p debridement and drainage.
+* The patient has a history of migraines and was recently hospitalized with nausea, vomiting, and an episode of small volume hematemesis.
+* The patient has a history of chronic infection with phlegmon of his left chest wall, s/p debridement and drainage.
+* The patient has a history of migraines and was recently hospitalized with nausea, vomiting, and an episode of small volume hematemesis.
+
+**Medications:**
+
+* ERGOCALCIFEROL (VITAMIN D2) [DRISDOL] - 50,000 unit Capsule - 1 Capsule(s) by mouth weekly
+* ACETAMINOPHEN [TYLENOL] - 325mg Tablet - 1 Tablet(s) by mouth prn
+* CALCIUM CARBONATE - 500 mg (1,250 mg) Tablet - 1 Tablet(s)

summaries/subject_14899292_hadm_26510460_input.txt

@@ -0,0 +1,230 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 57
+- Gender: M
+
+ADMISSION:
+- Admission ID: 26510460
+- Admission Type: URGENT
+- Admission Location: TRANSFER FROM HOSPITAL
+- Discharge Location: HOME HEALTH CARE
+- Insurance: Other
+- Race: WHITE
+- Marital Status: SINGLE
+- Language: ENGLISH
+
+PROCEDURES (1 total):
+- 8605 (ICD-9)
+
+DIAGNOSES (3 total):
+- 6822 (ICD-9)
+- V600 (ICD-9)
+- 9117 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50868: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50882: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50893: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50902: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50912: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50920: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50931: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50960: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50970: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50971: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 50983: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51006: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51221: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51222: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51237: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51248: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51249: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51250: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51265: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51274: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51275: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51277: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51279: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+- Item ID 51301: 1 measurements, 2150-12-27 23:03:00 to 2150-12-27 23:03:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: SURGERY
+ 
+Allergies: 
+Clindamycin
+ 
+Attending: ___.
+ 
+Chief Complaint:
+drainage from chest wound
+ 
+Major Surgical or Invasive Procedure:
+___
+Left chest wall foreign body removal x4 with
+fluoroscopic guidance and interpretation.
+
+ 
+History of Present Illness:
+Mr. ___ is a ___ yo M w/ history of chest wall abscess
+in ___ w/ multiple courses of antibiotics and s/p I&D and
+removal of a foreign body in ___ at ___ who now is
+transferred from ___ for recurrent abscess. He
+presented to ___ yesterday after feeling a "pop"
+on his anterior chest wall and noticing bloody drainage from his
+wound. He was started on vancomycin and wound culture showed
+GPCs. His WBC was 7.7. His CT scan showed inflammatory changes
+but no abscess. He was switched to cefazolin and transferred to
+___ for further management. Other than tenderness over the L
+chest wall, he denies fevers or chills, nausea or vomiting.   
+
+ 
+Past Medical History:
+Phlegmon of his left chest wall s/p debridement on ___ and 
+closure on ___  
+Surgical reconstruction of right upper extremity after horse 
+accident 
+Surgery on left bicep after horse accident
+ 
+Social History:
+___
+Family History:
+Non contributory
+ 
+Physical Exam:
+Temp 97.7   BP 145/101   HR 64   RR 18   O2 sat 98% RA
+GEN: A&O, NAD
+HEENT: No scleral icterus, mucus membranes moist
+CV: RRR, No M/G/R
+PULM: Clear to auscultation b/l, No W/R/R
+ABD: Soft, nondistended, nontender, no rebound or guarding, scar
+in LUQ
+DRE: deferred
+Ext: No ___ edema, ___ warm and well perfused
+Skin: L chest wall induration, erythema with wound opening,
+spontaneously draining. Tender and warm to palpation. 
+
+ 
+Pertinent Results:
+___ 11:03PM   WBC-6.8 RBC-4.87 HGB-15.1 HCT-44.2 MCV-91 
+MCH-31.1 MCHC-34.2 RDW-13.0
+___ 11:03PM   PLT COUNT-269
+___ 11:03PM   ___ PTT-24.9 ___
+___ 11:03PM   GLUCOSE-135* UREA N-7 CREAT-0.8 SODIUM-135 
+POTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-24 ANION GAP-___: Inflammatory process involving left pectoral
+muscle and L anterior chest wall with no soft tissue gas
+densities or well-defined measurable fluid collections to 
+suggest
+drainable abscess.
+
+___ CXR :
+The interval, the metallic foreign bodies have been removed. On 
+the current image there is no evidence of residual foreign 
+bodies. No 
+evidence of complications such as pneumothorax. Borderline size 
+of the 
+cardiac silhouette. No pleural effusions. No pulmonary edema. 
+  
+
+ 
+Brief Hospital Course:
+Mr. ___ was evaluated by the Acute Care team in the 
+Emergency Room and was admitted to the hospital for I&D of this 
+chest wall abscess. He was taken to the Operating Room on 
+___ and Fluoro was also used to assure that all of the 
+foreign bodies were removed. These appeared to be opened paper 
+clips.  He tolerated the procedure well and returned to the PACU 
+ion stable condition.
+
+Following transfer to the Surgical floor he underwent dressing 
+changes and all 3 wounds were clean at the base with no 
+cellulitis.  He was tolerating a regular diet and ambulating 
+without difficulty.  He remained afebrile with a WBC of 6K.
+
+The Psychiatric service was consulted for a full assessment and 
+Mr. ___ agreed to speak with them but unfortunately he 
+changed his mind when the team arrived.  They did leave some 
+information for him to obtain outpatient treatment and phone 
+numbers were provided.  
+
+He was discharged to home on ___ with ___ services for 
+dressing changes.
+ 
+Medications on Admission:
+tylenol ___ q4h prn
+
+ 
+Discharge Medications:
+1. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) 
+as needed for pain.
+Disp:*40 Tablet(s)* Refills:*0*
+2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.  
+3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 
+6 hours).  
+4. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 
+6 hours): thru ___.
+Disp:*10 Capsule(s)* Refills:*2*
+
+ 
+Discharge Disposition:
+Home With Service
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Left chest wall foreign body.
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - Independent.
+
+ 
+Discharge Instructions:
+* You were admitted to the hospital with pain and redness on 
+your chest due to foreign bodies under the skin.  You were taken 
+to the Operating Room and paper clips were removed from 3 
+seperate areas.
+* The wounds will need to heal from inside out therefore you 
+will have to have dressing changes daily.  The ___ will help you 
+with that.
+* The Psychiatric service came by to see you with the intention 
+of helping you sort out why this is happening but unfortunately 
+you did not want their help.  We still recommend that you get 
+some outpatient psychiatric follow up such as BEST 
+___ or Arbour Psychiatric Intake ___.
+* From a medical tandpoint, you shpuld take your temperature 
+twice a day, notify us if it's > 100.5 on 2 occasions or if 
+there is any increased drainage or increased redness around your 
+wounds.
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+FLUOROSCOPIC RADIOGRAPHIC IMAGES
+
+REPORT:  Static fluoroscopic images acquired in the absence of radiologist
+show linear metallic foreign body removal.
+
+[RADIOLOGY NOTE]
+CHEST RADIOGRAPH
+
+INDICATION:  Foreign bodies, status post removal.
+
+COMPARISON:  Fluoroscopic examination from ___.  Older chest
+radiographs from ___ as well as a chest CT from ___.
+
+FINDINGS:  The interval, the metallic foreign bodies have been removed.  On
+the current image there is no evidence of residual foreign bodies.  No
+evidence of complications such as pneumothorax.  Borderline size of the
+cardiac silhouette.  No pleural effusions.  No pulmonary edema.

summaries/subject_14899292_hadm_26510460_model_input.txt

@@ -0,0 +1,247 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 57
+- Gender: M
+
+ADMISSION:
+- Admission ID: 26510460
+- Admission Type: URGENT
+- Admission Location: TRANSFER FROM HOSPITAL
+- Discharge Location: HOME HEALTH CARE
+- Insurance: Other
+- Race: WHITE
+- Marital Status: SINGLE
+- Language: ENGLISH
+
+PROCEDURES (1 total):
+  1. ICD-9: 8605
+
+DIAGNOSES (3 total):
+  1. ICD-9: 6822
+  2. ICD-9: V600
+  3. ICD-9: 9117
+
+LABORATORY RESULTS:
+Total laboratory events: 24
+Most frequent lab tests:
+  - Item ID 50868: 1 measurements
+  - Item ID 50882: 1 measurements
+  - Item ID 50893: 1 measurements
+  - Item ID 50902: 1 measurements
+  - Item ID 50912: 1 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                  Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   M
+ 
+Service: SURGERY
+ 
+Allergies: 
+Clindamycin
+ 
+Attending: ___.
+ 
+Chief Complaint:
+drainage from chest wound
+ 
+Major Surgical or Invasive Procedure:
+___
+Left chest wall foreign body removal x4 with
+fluoroscopic guidance and interpretation.
+
+ 
+History of Present Illness:
+Mr. ___ is a ___ yo M w/ history of chest wall abscess
+in ___ w/ multiple courses of antibiotics and s/p I&D and
+removal of a foreign body in ___ at ___ who now is
+transferred from ___ for recurrent abscess. He
+presented to ___ yesterday after feeling a "pop"
+on his anterior chest wall and noticing bloody drainage from his
+wound. He was started on vancomycin and wound culture showed
+GPCs. His WBC was 7.7. His CT scan showed inflammatory changes
+but no abscess. He was switched to cefazolin and transferred to
+___ for further management. Other than tenderness over the L
+chest wall, he denies fevers or chills, nausea or vomiting.   
+
+ 
+Past Medical History:
+Phlegmon of his left chest wall s/p debridement on ___ and 
+closure on ___  
+Surgical reconstruction of right upper extremity after horse 
+accident 
+Surgery on left bicep after horse accident
+ 
+Social History:
+___
+Family History:
+Non contributory
+ 
+Physical Exam:
+Temp 97.7   BP 145/101   HR 64   RR 18   O2 sat 98% RA
+GEN: A&O, NAD
+HEENT: No scleral icterus, mucus membranes moist
+CV: RRR, No M/G/R
+PULM: Clear to auscultation b/l, No W/R/R
+ABD: Soft, nondistended, nontender, no rebound or guarding, scar
+in LUQ
+DRE: deferred
+Ext: No ___ edema, ___ warm and well perfused
+Skin: L chest wall induration, erythema with wound opening,
+spontaneously draining. Tender and warm to palpation. 
+
+ 
+Pertinent Results:
+___ 11:03PM   WBC-6.8 RBC-4.87 HGB-15.1 HCT-44.2 MCV-91 
+MCH-31.1 MCHC-34.2 RDW-13.0
+___ 11:03PM   PLT COUNT-269
+___ 11:03PM   ___ PTT-24.9 ___
+___ 11:03PM   GLUCOSE-135* UREA N-7 CREAT-0.8 SODIUM-135 
+POTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-24 ANION GAP-___: Inflammatory process involving left pectoral
+muscle and L anterior chest wall with no soft tissue gas
+densities or well-defined measurable fluid collections to 
+suggest
+drainable abscess.
+
+___ CXR :
+The interval, the metallic foreign bodies have been removed. On 
+the current image there is no evidence of residual foreign 
+bodies. No 
+evidence of complications such as pneumothorax. Borderline size 
+of the 
+cardiac silhouette. No pleural effusions. No pulmonary edema. 
+  
+
+ 
+Brief Hospital Course:
+Mr. ___ was evaluated by the Acute Care team in the 
+Emergency Room and was admitted to the hospital for I&D of this 
+chest wall abscess. He was taken to the Operating Room on 
+___ and Fluoro was also used to assure that all of the 
+foreign bodies were removed. These appeared to be opened paper 
+clips.  He tolerated the procedure well and returned to the PACU 
+ion stable condition.
+
+Following transfer to the Surgical floor he underwent dressing 
+changes and all 3 wounds were clean at the base with no 
+cellulitis.  He was tolerating a regular diet and ambulating 
+without difficulty.  He remained afebrile with a WBC of 6K.
+
+The Psychiatric service was consulted for a full assessment and 
+Mr. ___ agreed to speak with them but unfortunately he 
+changed his mind when the team arrived.  They did leave some 
+information for him to obtain outpatient treatment and phone 
+numbers were provided.  
+
+He was discharged to home on ___ with ___ services for 
+dressing changes.
+ 
+Medications on Admission:
+tylenol ___ q4h prn
+
+ 
+Discharge Medications:
+1. oxycodone 5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) 
+as needed for pain.
+Disp:*40 Tablet(s)* Refills:*0*
+2. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.  
+3. acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every 
+6 hours).  
+4. cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every 
+6 hours): thru ___.
+Disp:*10 Capsule(s)* Refills:*2*
+
+ 
+Discharge Disposition:
+Home With Service
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Left chest wall foreign body.
+
+ 
+Discharge Condition:
+Mental Status: Clear and coherent.
+Level of Consciousness: Alert and interactive.
+Activity Status: Ambulatory - Independent.
+
+ 
+Discharge Instructions:
+* You were admitted to the hospital with pain and redness on 
+your chest due to foreign bodies under the skin.  You were taken 
+to the Operating Room and paper clips were removed from 3 
+seperate areas.
+* The wounds will need to heal from inside out therefore you 
+will have to have dressing changes daily.  The ___ will help you 
+with that.
+* The Psychiatric service came by to see you with the intention 
+of helping you sort out why this is happening but unfortunately 
+you did not want their help.  We still recommend that you get 
+some outpatient psychiatric follow up such as BEST 
+___ or Arbour Psychiatric Intake ___.
+* From a medical tandpoint, you shpuld take your temperature 
+twice a day, notify us if it's > 100.5 on 2 occasions or if 
+there is any increased drainage or increased redness around your 
+wounds.
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] FLUOROSCOPIC RADIOGRAPHIC IMAGES
+
+REPORT:  Static fluoroscopic images acquired in the absence of radiologist
+show linear metallic foreign body removal.
+
+
+[RADIOLOGY] CHEST RADIOGRAPH
+
+INDICATION:  Foreign bodies, status post removal.
+
+COMPARISON:  Fluoroscopic examination from ___.  Older chest
+radiographs from ___ as well as a chest CT from ___.
+
+FINDINGS:  The interval, the metallic foreign bodies have been removed.  On
+the current image there is no evidence of residual foreign bodies.  No
+evidence of complications such as pneumothorax.  Borderline size of the
+cardiac silhouette.  No pleural effusions.  No pulmonary edema.
+
+PROCEDURES (readable):
+- 8605 (ICD-9) — Incision with removal of foreign body or device from skin and subcutaneous tissue
+
+DIAGNOSES (readable):
+- 6822 (ICD-9) — Cellulitis and abscess of trunk
+- V600 (ICD-9) — Lack of housing
+- 9117 (ICD-9) — Superficial foreign body (splinter) of trunk, without major open wound, infected
+
+LAB ITEMS (readable, deduped):
+- Anion Gap (Item 50868)
+- Bicarbonate (Item 50882)
+- Calcium, Total (Item 50893)
+- Chloride (Item 50902)
+- Creatinine (Item 50912)
+- Estimated GFR (MDRD equation) (Item 50920)
+- Glucose (Item 50931)
+- Hematocrit (Item 51221)
+- Hemoglobin (Item 51222)
+- INR(PT) (Item 51237)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Magnesium (Item 50960)
+- PT (Item 51274)
+- PTT (Item 51275)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Potassium (Item 50971)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Sodium (Item 50983)
+- Urea Nitrogen (Item 51006)
+- White Blood Cells (Item 51301)

summaries/subject_14899292_hadm_26510460_summary.txt

@@ -0,0 +1,79 @@
+**PRE-OPERATIVE SUMMARY**
+
+**Patient Information**
+
+* Name: [Not provided]
+* Age: 57
+* Gender: Male
+* Admission ID: 26510460
+* Admission Type: Urgent
+* Admission Location: Transfer from hospital
+* Discharge Location: Home Health Care
+* Insurance: Other
+* Race: White
+* Marital Status: Single
+* Language: English
+
+**Diagnosis**
+
+* ICD-9: 8605 (Incision with removal of foreign body or device from skin and subcutaneous tissue)
+* ICD-9: 6822 (Cellulitis and abscess of trunk)
+* ICD-9: V600 (Lack of housing)
+* ICD-9: 9117 (Superficial foreign body of trunk, without major open wound, infected)
+
+**Procedure**
+
+* 8605 (ICD-9) - Incision with removal of foreign body or device from skin and subcutaneous tissue
+
+**Laboratory Results**
+
+* Total laboratory events: 24
+* Most frequent lab tests:
+	+ Item ID 50868: Anion Gap
+	+ Item ID 50882: Bicarbonate
+	+ Item ID 50893: Calcium, Total
+	+ Item ID 50902: Chloride
+	+ Item ID 50912: Creatinine
+	+ Item ID 50920: Estimated GFR (MDRD equation)
+	+ Item ID 50931: Glucose
+	+ Item ID 51221: Hematocrit
+	+ Item ID 51222: Hemoglobin
+	+ Item ID 51237: INR(PT)
+	+ Item ID 51248: MCH
+	+ Item ID 51249: MCHC
+	+ Item ID 51250: MCV
+	+ Item ID 50960: Magnesium
+	+ Item ID 51274: PT
+	+ Item ID 51275: PTT
+	+ Item ID 51277: RDW
+	+ Item ID 51279: Red Blood Cells
+	+ Item ID 50983: Sodium
+	+ Item ID 51006: Urea Nitrogen
+	+ Item ID 51301: White Blood Cells
+
+**Clinical Notes**
+
+* The patient presented with drainage from a chest wound, which was diagnosed as a foreign body under the skin.
+* The patient had a history of chest wall abscess, multiple courses of antibiotics, and surgical removal of a foreign body in the past.
+* The patient was started on vancomycin and wound culture showed GPCs (Gram-positive cocci). The WBC was 7.7, and the CT scan showed inflammatory changes but no abscess.
+* The patient was switched to cefazolin and transferred to the surgical floor for further management.
+* The patient tolerated the procedure well and returned to the PACU in stable condition.
+* The patient underwent dressing changes and all 3 wounds were clean at the base with no cellulitis.
+* The patient was discharged to home with services for dressing changes.
+
+**Medications**
+
+* Tylenol (acetaminophen) 325 mg Tablet Sig: every 4 hours as needed for pain
+* Oxycodone 5 mg Tablet Sig: every 4 hours as needed for pain
+* Colace 100 mg Capsule Sig: twice a day
+* Cephalexin 500 mg Capsule Sig: every 6 hours
+
+**Discharge Instructions**
+
+* The patient should have dressing changes daily.
+* The patient should take their temperature twice a day and notify the hospital if it's > 100.5 on 2 occasions or if there is any increased drainage or increased redness around the wounds.
+* The patient should get some outpatient psychiatric follow-up, such as BEST or Arbour Psychiatric Intake.
+
+**Follow-up Instructions**
+
+* The

summaries/subject_16139570_hadm_20366586_input.txt

@@ -0,0 +1,379 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 91
+- Gender: F
+
+ADMISSION:
+- Admission ID: 20366586
+- Admission Type: EW EMER.
+- Admission Location: EMERGENCY ROOM
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Other
+- Race: ASIAN
+- Marital Status: WIDOWED
+- Language: ?
+
+PROCEDURES (1 total):
+- 8659 (ICD-9)
+
+DIAGNOSES (5 total):
+- 8730 (ICD-9)
+- E8889 (ICD-9)
+- 2720 (ICD-9)
+- 4019 (ICD-9)
+- 2948 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50822: 1 measurements, 2173-06-20 23:58:00 to 2173-06-20 23:58:00
+- Item ID 50868: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50882: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50893: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50902: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50910: 2 measurements, 2173-06-20 23:50:00 to 2173-06-21 10:40:00
+- Item ID 50911: 2 measurements, 2173-06-20 23:50:00 to 2173-06-21 10:40:00
+- Item ID 50912: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50920: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50931: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50960: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50970: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50971: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 50983: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51003: 2 measurements, 2173-06-20 23:50:00 to 2173-06-21 10:40:00
+- Item ID 51006: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51146: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51200: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51221: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51222: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51244: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51248: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51249: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51250: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51254: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51256: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51265: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51277: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51279: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+- Item ID 51301: 1 measurements, 2173-06-20 23:50:00 to 2173-06-20 23:50:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                     Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   F
+ 
+Service: MEDICINE
+ 
+Allergies: 
+Patient recorded as having No Known Allergies to Drugs
+ 
+Attending: ___.
+ 
+Chief Complaint:
+s/p fall with scalp laceration
+ 
+Major Surgical or Invasive Procedure:
+None
+ 
+History of Present Illness:
+Ms. ___ is a ___ yo woman with dementia who was found down at 
+___ today by caregivers. ___ has had multiple falls 
+in the past, each time occurring when she attempts to walk 
+without her walker. In each instance, she falls to the ground 
+but maintains consciousness and is fully alert. Per ___ 
+staff, the most recent fall prior to this one was on ___, when 
+she tried to walk from her bed to the bathroom without her 
+walker. For this reason, the staff at the ___ home have her 
+on a bed monitor. Yesterday, the bed monitor went off and staff 
+found Ms. ___ down by her bed. Pt had no LOC, light headedness, 
+incontinence, chest pain. She was able to answer questions 
+immediately following the fall (in her dialect). She was brought 
+to the ED due to a scalp laceration.
+. 
+In the ED, she was noted to have + Lac on occiput with bleeding, 
+which was stapled in ED. Pt is unable to communicate well at 
+baseline, but is well-appearing, moves freely, and smiles, looks 
+comfortable. Patient was unable to give full history due to 
+dementia, but denied headache, focal weakeness or numbness or 
+any other complaints. She had no recollection of the incident. 
+VS: BP 176/91, HR 96, T 98.6 RR 16, 98% RA. Head CT was 
+performed. Initial read of head CT showed possible small 
+subarachnoid hemorrhage; however final read of head CT indicated 
+that there were no significant changes from CT head in ___. EKG 
+was unremarkable. C spine cleared. She was given tetanus shot 
+but no medications.  She was admitted to the medicine team for 
+further management. 
+
+ 
+Past Medical History:
+1.  Osteoarthritis.
+2.  Choledocholithiasis.
+3.  Urinary incontinence.
+4.  Constipation.
+5.  Hypercholesterolemia.
+6.  Dementia.
+7.  Status post subdural hematoma.
+8.  Hypertension.
+9.  Depression.
+10.  Herpes zoster. 
+11.  Pseudoobstruction.
+
+ 
+Social History:
+___
+Family History:
+Non-contributory
+ 
+Physical Exam:
+T: 97.4 P: 83 BP: 150-180/83-100  RR: 12 SaO2: 98% Ra  
+Gen: well-appearing ___ woman in no distress. occipital 
+laceration sutured.
+CV: RRR no m/r/g  
+Pulm: CTA B  
+Abd: s/nd/nt +BS  
+Ext: no c/e/c  
+Neuro: A&O, moves all extremities freely, face symmetric, tracs 
+objects, rt pupil surgical. reflexes symmetric .  Cranial nerves 
+___ function intact. Symmetric motor strength in upper and 
+lower extremities.  
+
+ 
+Pertinent Results:
+___ 10:40AM   CK(CPK)-64
+___ 10:40AM   CK-MB-NotDone cTropnT-<0.01
+___ 01:58AM   ___ PTT-27.2 ___
+___ 12:15AM URINE  COLOR-Yellow APPEAR-Clear SP ___
+___ 12:15AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG 
+GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-1 PH-7.0 LEUK-NEG
+___ 11:58PM   K+-4.4
+___ 11:50PM   GLUCOSE-103 UREA N-28* CREAT-0.8 SODIUM-143 
+POTASSIUM-5.0 CHLORIDE-106 TOTAL CO2-27 ANION GAP-15
+___ 11:50PM   estGFR-Using this
+___ 11:50PM   CK(CPK)-61
+___ 11:50PM   CK-MB-NotDone
+___ 11:50PM   cTropnT-<0.01
+___ 11:50PM   CALCIUM-8.7 PHOSPHATE-3.6 MAGNESIUM-2.5
+___ 11:50PM   WBC-8.2 RBC-4.47 HGB-12.9 HCT-40.0 MCV-90 
+MCH-28.9 MCHC-32.3 RDW-14.1
+___ 11:50PM   NEUTS-56.9 ___ MONOS-7.0 EOS-1.1 
+BASOS-0.3
+___ 11:50PM   PLT COUNT-166
+.
+IMAGING
+1) CT C-spine (___)
+FINDINGS: Again demonstrated are diffuse degenerative changes 
+throughout the cervical spine including moderate narrowing of 
+the facet joints of C1 on C2 and disc space narrowing at C6-C7, 
+sclerotic changes and osteophyte formation are also seen at 
+these levels. There is loss of normal lordotic curvature with 
+patient in neck collar. There is no evidence to suggest acute 
+bony injury. The prevertebral soft tissues are unremarkable. 
+There is minimal scarring in the left lung apex.
+
+IMPRESSION: No evidence of acute bony injury. Degenerative 
+changes of the upper and lower cervical spine.
+.
+2) CT HEAD W/O CONTRAST  
+FINDINGS: Along the anterior right temporal lobe, there is a 
+focal area of cortex with hyperdensity with surrounding 
+hypodensity concerning for small subarachnoid hemorrhage or 
+cortical hemorrhage with contusion. Again demonstrated are 
+periventricular white matter hypodensities as well as 
+encephalomalacia with the right frontal and parietal regions, 
+both appear increased compared to prior study from ___ years 
+ago. The ventricles are prominent with proportionally deepened 
+sulci consistent with diffuse global atrophy. There is no mass 
+effect or shift of normally midline structures or evidence of 
+acute major vascular territorial infarction. Limited views of 
+the paranasal sinuses and mastoid air cells are unremarkable.
+IMPRESSION: Focal slight hyperdensity along the anterior right 
+temporal cortex with surrounding hypodensity. Findings are 
+concerning for small subarachnoid or cortical hemorrhage with 
+associated contusion.
+NOTE ON ATTENDING REVIEW: The hypodensity in right temporal 
+region and subtle hyperdensity are at the site of previous 
+hemorrhage seen in ___. This appears to be a chronic finding. 
+.
+3) CHEST (SINGLE VIEW)  ___
+SINGLE UPRIGHT VIEW OF THE CHEST: The heart size is normal. The 
+ascending aorta is prominant and remaining aorta is tortuous and 
+of similar configuration. Mediastinal and hilar contours are 
+unchanged. The lungs are clear. There is no effusion.
+IMPRESSION: No evidence of pneumonia or CHF.
+
+ 
+Brief Hospital Course:
+Ms. ___ is a ___ yo woman with advanced dementia who presents 
+with an unwitnessed fall and was found to have CT changes 
+concerning for ?SAH on initial read; final read stated that 
+there were in fact no new changes on head CT compared to a study 
+___ years ago. 
+.  
+# Concern for subarachnoid hemorrhage: Initial read of head CT 
+was concerning for ?SAH. Thus, BP was initially maintained <140 
+with hydralazine and metoprolol prn. Neurosurgery followed, but 
+felt the CT findings could be artifact. Subsequently, the final 
+read of head CT by the radiology attending was read as no new 
+changes from ___. Thus, acute SAH was felt to be not likely. 
+Neurosurgery agreed with this assessment.  She should be seen by 
+Dr. ___ in 4 weeks; a phone number has been provided to make 
+an appointment.  She may require head CT prior to this 
+appointment.
+.  
+# Fall: unwitnessed but likely similar to multiple prior falls, 
+which are described by the ___ staff as mechanical in 
+nature. Primary cardiac cause is possible, but less likely given 
+history. Upon admission, the pt was placed on telemetry. Pt was 
+ruled out with negative enzymes. The pt remained without cardiac 
+symptoms throughout her hospitalization, and did not have any 
+concerning telemetry changes. Geriatrics team suggested stopping 
+her outpatient percocet and consider decreasing her Ativan to 
+PRN to decrease the risk of future falls. For pain control, they 
+further advised using Tylenol PRN on top of the existing 
+standing Tylenol. We discharged her on her usual ativan regimen; 
+consideration should be made to change to PRN but would monitor 
+for withdrawal if this is done.
+.  
+# hypertension: initially, goal SBP was <140 with 
+hydral/metoprolol prn, given concern for ?SAH. Now that acute 
+SAH is no longer a major concern, BP control may be relaxed, 
+with more emphasis on achieving good control on PO anti-HTN 
+meds.  She may require beta blockade with metoprolol 12.5 daily 
+if her BP remains elevated; the risk of falling on 
+anti-hypertensives will need to be balanced against the utility 
+of controlling her blood pressure tightly.
+ 
+Medications on Admission:
+aspirin 81mg daily  
+glucosamine  
+risperdal 0.25mg po daily  
+sennacot at lunch  
+lidoderm patch to groin  
+tylenol bid  
+colace bid  
+ativan 0.5mg po bid  
+ursodiol 300mg po bid  
+bisacodyl supposotory prn  
+lactulose prn  
+percocet 2.5mg prn  
+ 
+Discharge Medications:
+1. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.  
+2. Glucosamine  Oral
+3. Risperidone 0.25 mg Tablet Sig: One (1) Tablet PO once a day. 
+ 
+4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).  
+5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: 
+One (1) Adhesive Patch, Medicated Topical 12 HOURS ON, 12 HOURS 
+OFF ().  
+6. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO twice a 
+day.  
+7. Tylenol ___ mg Tablet Sig: One (1) Tablet PO three times a 
+day as needed for pain.  
+8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day).  
+9. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
+day).  
+10. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times 
+a day).  
+11. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal 
+HS (at bedtime) as needed.  
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Primary
+1. Scalp laceration
+2. Fall
+Secondary
+1. Dementia
+
+ 
+Discharge Condition:
+Good
+
+ 
+Discharge Instructions:
+You were admitted after a fall.  You have a laceration over the 
+back of your head.  This was repaired with staples.  The staples 
+should remain in until you are evaluated by a physician who can 
+determine when they are to be removed.  We have made changes 
+medications listed below.  If you have further falls, light 
+headedness, dizziness, weakness, headache, sensory disturbances, 
+shortness of breath, chest pain, you should contact you PCP or 
+return to the ED.
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+INDICATION:  ___ female with unwitnessed fall and nonfocal lung exam.
+Evaluate for overload or pneumonia.
+
+COMPARISON:  ___.
+
+SINGLE UPRIGHT VIEW OF THE CHEST:  The heart size is normal.  The
+ascending aorta is prominant and remaining aorta is tortuous and of similar
+configuration. Mediastinal and hilar contours are unchanged.  The lungs are
+clear. There is no effusion.
+
+IMPRESSION:  No evidence of pneumonia or CHF.
+
+[RADIOLOGY NOTE]
+INDICATION:  ___ female with unwitnessed fall and 3 cm laceration on
+the left occiput.  Unable to provide history due to baseline dementia.
+Evaluate for bleed.
+
+COMPARISON:  ___.
+
+TECHNIQUE:  Non-contrast CT of the head.
+
+FINDINGS:  Along the anterior right temporal lobe, there is a focal area of
+cortex with hyperdensity with surrounding hypodensity concerning for small
+subarachnoid hemorrhage or cortical hemorrhage with contusion.  Again
+demonstrated are periventricular white matter hypodensities as well as
+encephalomalacia with the right frontal and parietal regions, both appear
+increased compared to prior study from ___ years ago.  The ventricles are
+prominent with proportionally deepened sulci consistent with diffuse global
+atrophy.  There is no mass effect or shift of normally midline structures or
+evidence of acute major vascular territorial infarction.
+
+Limited views of the paranasal sinuses and mastoid air cells are unremarkable.
+
+IMPRESSION:
+
+Focal slight hyperdensity along the anterior right temporal cortex with
+surrounding hypodensity. Findings are concerning for small subarachnoid or
+cortical hemorrhage with associated contusion.
+
+
+NOTE ON ATTENDING REVIEW: The hypodensity in right temporal region and subtle
+hyperdensity are at the site of previous hemorrhage seen in ___. This appears
+to be a chronic finding.
+
+[RADIOLOGY NOTE]
+INDICATION:  ___ female with unwitnessed fall and 3-cm laceration on
+the left occiput.  Unable to provide history.
+
+COMPARISON:  CT C-spine ___.
+
+TECHNIQUE:  MDCT acquired axial images of the cervical spine were obtained
+without IV contrast.  Coronal and sagittal reformations were performed.
+
+FINDINGS:  Again demonstrated are diffuse degenerative changes throughout the
+cervical spine including moderate narrowing of the facet joints of C1 on C2
+and disc space narrowing at C6-C7, sclerotic changes and osteophyte formation
+are also seen at these levels.  There is loss of normal lordotic curvature
+with patient in neck collar.  There is no evidence to suggest acute bony
+injury.  The prevertebral soft tissues are unremarkable.  There is minimal
+scarring in the left lung apex.
+
+IMPRESSION:  No evidence of acute bony injury.  Degenerative changes of the
+upper and lower cervical spine.

summaries/subject_16139570_hadm_20366586_model_input.txt

@@ -0,0 +1,398 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 91
+- Gender: F
+
+ADMISSION:
+- Admission ID: 20366586
+- Admission Type: EW EMER.
+- Admission Location: EMERGENCY ROOM
+- Discharge Location: SKILLED NURSING FACILITY
+- Insurance: Other
+- Race: ASIAN
+- Marital Status: WIDOWED
+- Language: ?
+
+PROCEDURES (1 total):
+  1. ICD-9: 8659
+
+DIAGNOSES (5 total):
+  1. ICD-9: 8730
+  2. ICD-9: E8889
+  3. ICD-9: 2720
+  4. ICD-9: 4019
+  5. ICD-9: 2948
+
+LABORATORY RESULTS:
+Total laboratory events: 33
+Most frequent lab tests:
+  - Item ID 51003: 2 measurements
+  - Item ID 50910: 2 measurements
+  - Item ID 50911: 2 measurements
+  - Item ID 51146: 1 measurements
+  - Item ID 51200: 1 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                     Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   F
+ 
+Service: MEDICINE
+ 
+Allergies: 
+Patient recorded as having No Known Allergies to Drugs
+ 
+Attending: ___.
+ 
+Chief Complaint:
+s/p fall with scalp laceration
+ 
+Major Surgical or Invasive Procedure:
+None
+ 
+History of Present Illness:
+Ms. ___ is a ___ yo woman with dementia who was found down at 
+___ today by caregivers. ___ has had multiple falls 
+in the past, each time occurring when she attempts to walk 
+without her walker. In each instance, she falls to the ground 
+but maintains consciousness and is fully alert. Per ___ 
+staff, the most recent fall prior to this one was on ___, when 
+she tried to walk from her bed to the bathroom without her 
+walker. For this reason, the staff at the ___ home have her 
+on a bed monitor. Yesterday, the bed monitor went off and staff 
+found Ms. ___ down by her bed. Pt had no LOC, light headedness, 
+incontinence, chest pain. She was able to answer questions 
+immediately following the fall (in her dialect). She was brought 
+to the ED due to a scalp laceration.
+. 
+In the ED, she was noted to have + Lac on occiput with bleeding, 
+which was stapled in ED. Pt is unable to communicate well at 
+baseline, but is well-appearing, moves freely, and smiles, looks 
+comfortable. Patient was unable to give full history due to 
+dementia, but denied headache, focal weakeness or numbness or 
+any other complaints. She had no recollection of the incident. 
+VS: BP 176/91, HR 96, T 98.6 RR 16, 98% RA. Head CT was 
+performed. Initial read of head CT showed possible small 
+subarachnoid hemorrhage; however final read of head CT indicated 
+that there were no significant changes from CT head in ___. EKG 
+was unremarkable. C spine cleared. She was given tetanus shot 
+but no medications.  She was admitted to the medicine team for 
+further management. 
+
+ 
+Past Medical History:
+1.  Osteoarthritis.
+2.  Choledocholithiasis.
+3.  Urinary incontinence.
+4.  Constipation.
+5.  Hypercholesterolemia.
+6.  Dementia.
+7.  Status post subdural hematoma.
+8.  Hypertension.
+9.  Depression.
+10.  Herpes zoster. 
+11.  Pseudoobstruction.
+
+ 
+Social History:
+___
+Family History:
+Non-contributory
+ 
+Physical Exam:
+T: 97.4 P: 83 BP: 150-180/83-100  RR: 12 SaO2: 98% Ra  
+Gen: well-appearing ___ woman in no distress. occipital 
+laceration sutured.
+CV: RRR no m/r/g  
+Pulm: CTA B  
+Abd: s/nd/nt +BS  
+Ext: no c/e/c  
+Neuro: A&O, moves all extremities freely, face symmetric, tracs 
+objects, rt pupil surgical. reflexes symmetric .  Cranial nerves 
+___ function intact. Symmetric motor strength in upper and 
+lower extremities.  
+
+ 
+Pertinent Results:
+___ 10:40AM   CK(CPK)-64
+___ 10:40AM   CK-MB-NotDone cTropnT-<0.01
+___ 01:58AM   ___ PTT-27.2 ___
+___ 12:15AM URINE  COLOR-Yellow APPEAR-Clear SP ___
+___ 12:15AM URINE  BLOOD-NEG NITRITE-NEG PROTEIN-NEG 
+GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-1 PH-7.0 LEUK-NEG
+___ 11:58PM   K+-4.4
+___ 11:50PM   GLUCOSE-103 UREA N-28* CREAT-0.8 SODIUM-143 
+POTASSIUM-5.0 CHLORIDE-106 TOTAL CO2-27 ANION GAP-15
+___ 11:50PM   estGFR-Using this
+___ 11:50PM   CK(CPK)-61
+___ 11:50PM   CK-MB-NotDone
+___ 11:50PM   cTropnT-<0.01
+___ 11:50PM   CALCIUM-8.7 PHOSPHATE-3.6 MAGNESIUM-2.5
+___ 11:50PM   WBC-8.2 RBC-4.47 HGB-12.9 HCT-40.0 MCV-90 
+MCH-28.9 MCHC-32.3 RDW-14.1
+___ 11:50PM   NEUTS-56.9 ___ MONOS-7.0 EOS-1.1 
+BASOS-0.3
+___ 11:50PM   PLT COUNT-166
+.
+IMAGING
+1) CT C-spine (___)
+FINDINGS: Again demonstrated are diffuse degenerative changes 
+throughout the cervical spine including moderate narrowing of 
+the facet joints of C1 on C2 and disc space narrowing at C6-C7, 
+sclerotic changes and osteophyte formation are also seen at 
+these levels. There is loss of normal lordotic curvature with 
+patient in neck collar. There is no evidence to suggest acute 
+bony injury. The prevertebral soft tissues are unremarkable. 
+There is minimal scarring in the left lung apex.
+
+IMPRESSION: No evidence of acute bony injury. Degenerative 
+changes of the upper and lower cervical spine.
+.
+2) CT HEAD W/O CONTRAST  
+FINDINGS: Along the anterior right temporal lobe, there is a 
+focal area of cortex with hyperdensity with surrounding 
+hypodensity concerning for small subarachnoid hemorrhage or 
+cortical hemorrhage with contusion. Again demonstrated are 
+periventricular white matter hypodensities as well as 
+encephalomalacia with the right frontal and parietal regions, 
+both appear increased compared to prior study from ___ years 
+ago. The ventricles are prominent with proportionally deepened 
+sulci consistent with diffuse global atrophy. There is no mass 
+effect or shift of normally midline structures or evidence of 
+acute major vascular territorial infarction. Limited views of 
+the paranasal sinuses and mastoid air cells are unremarkable.
+IMPRESSION: Focal slight hyperdensity along the anterior right 
+temporal cortex with surrounding hypodensity. Findings are 
+concerning for small subarachnoid or cortical hemorrhage with 
+associated contusion.
+NOTE ON ATTENDING REVIEW: The hypodensity in right temporal 
+region and subtle hyperdensity are at the site of previous 
+hemorrhage seen in ___. This appears to be a chronic finding. 
+.
+3) CHEST (SINGLE VIEW)  ___
+SINGLE UPRIGHT VIEW OF THE CHEST: The heart size is normal. The 
+ascending aorta is prominant and remaining aorta is tortuous and 
+of similar configuration. Mediastinal and hilar contours are 
+unchanged. The lungs are clear. There is no effusion.
+IMPRESSION: No evidence of pneumonia or CHF.
+
+ 
+Brief Hospital Course:
+Ms. ___ is a ___ yo woman with advanced dementia who presents 
+with an unwitnessed fall and was found to have CT changes 
+concerning for ?SAH on initial read; final read stated that 
+there were in fact no new changes on head CT compared to a study 
+___ years ago. 
+.  
+# Concern for subarachnoid hemorrhage: Initial read of head CT 
+was concerning for ?SAH. Thus, BP was initially maintained <140 
+with hydralazine and metoprolol prn. Neurosurgery followed, but 
+felt the CT findings could be artifact. Subsequently, the final 
+read of head CT by the radiology attending was read as no new 
+changes from ___. Thus, acute SAH was felt to be not likely. 
+Neurosurgery agreed with this assessment.  She should be seen by 
+Dr. ___ in 4 weeks; a phone number has been provided to make 
+an appointment.  She may require head CT prior to this 
+appointment.
+.  
+# Fall: unwitnessed but likely similar to multiple prior falls, 
+which are described by the ___ staff as mechanical in 
+nature. Primary cardiac cause is possible, but less likely given 
+history. Upon admission, the pt was placed on telemetry. Pt was 
+ruled out with negative enzymes. The pt remained without cardiac 
+symptoms throughout her hospitalization, and did not have any 
+concerning telemetry changes. Geriatrics team suggested stopping 
+her outpatient percocet and consider decreasing her Ativan to 
+PRN to decrease the risk of future falls. For pain control, they 
+further advised using Tylenol PRN on top of the existing 
+standing Tylenol. We discharged her on her usual ativan regimen; 
+consideration should be made to change to PRN but would monitor 
+for withdrawal if this is done.
+.  
+# hypertension: initially, goal SBP was <140 with 
+hydral/metoprolol prn, given concern for ?SAH. Now that acute 
+SAH is no longer a major concern, BP control may be relaxed, 
+with more emphasis on achieving good control on PO anti-HTN 
+meds.  She may require beta blockade with metoprolol 12.5 daily 
+if her BP remains elevated; the risk of falling on 
+anti-hypertensives will need to be balanced against the utility 
+of controlling her blood pressure tightly.
+ 
+Medications on Admission:
+aspirin 81mg daily  
+glucosamine  
+risperdal 0.25mg po daily  
+sennacot at lunch  
+lidoderm patch to groin  
+tylenol bid  
+colace bid  
+ativan 0.5mg po bid  
+ursodiol 300mg po bid  
+bisacodyl supposotory prn  
+lactulose prn  
+percocet 2.5mg prn  
+ 
+Discharge Medications:
+1. Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.  
+2. Glucosamine  Oral
+3. Risperidone 0.25 mg Tablet Sig: One (1) Tablet PO once a day. 
+ 
+4. Senna 8.6 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).  
+5. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: 
+One (1) Adhesive Patch, Medicated Topical 12 HOURS ON, 12 HOURS 
+OFF ().  
+6. Acetaminophen 650 mg Tablet Sig: One (1) Tablet PO twice a 
+day.  
+7. Tylenol ___ mg Tablet Sig: One (1) Tablet PO three times a 
+day as needed for pain.  
+8. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 
+times a day).  
+9. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times a 
+day).  
+10. Ursodiol 300 mg Capsule Sig: One (1) Capsule PO BID (2 times 
+a day).  
+11. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal 
+HS (at bedtime) as needed.  
+
+ 
+Discharge Disposition:
+Extended Care
+ 
+Facility:
+___
+ 
+Discharge Diagnosis:
+Primary
+1. Scalp laceration
+2. Fall
+Secondary
+1. Dementia
+
+ 
+Discharge Condition:
+Good
+
+ 
+Discharge Instructions:
+You were admitted after a fall.  You have a laceration over the 
+back of your head.  This was repaired with staples.  The staples 
+should remain in until you are evaluated by a physician who can 
+determine when they are to be removed.  We have made changes 
+medications listed below.  If you have further falls, light 
+headedness, dizziness, weakness, headache, sensory disturbances, 
+shortness of breath, chest pain, you should contact you PCP or 
+return to the ED.
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] INDICATION:  ___ female with unwitnessed fall and nonfocal lung exam.
+Evaluate for overload or pneumonia.
+
+COMPARISON:  ___.
+
+SINGLE UPRIGHT VIEW OF THE CHEST:  The heart size is normal.  The
+ascending aorta is prominant and remaining aorta is tortuous and of similar
+configuration. Mediastinal and hilar contours are unchanged.  The lungs are
+clear. There is no effusion.
+
+IMPRESSION:  No evidence of pneumonia or CHF.
+
+
+[RADIOLOGY] INDICATION:  ___ female with unwitnessed fall and 3 cm laceration on
+the left occiput.  Unable to provide history due to baseline dementia.
+Evaluate for bleed.
+
+COMPARISON:  ___.
+
+TECHNIQUE:  Non-contrast CT of the head.
+
+FINDINGS:  Along the anterior right temporal lobe, there is a focal area of
+cortex with hyperdensity with surrounding hypodensity concerning for small
+subarachnoid hemorrhage or cortical hemorrhage with contusion.  Again
+demonstrated are periventricular white matter hypodensities as well as
+encephalomalacia with the right frontal and parietal regions, both appear
+increased compared to prior study from ___ years ago.  The ventricles are
+prominent with proportionally deepened sulci consistent with diffuse global
+atrophy.  There is no mass effect or shift of normally midline structures or
+evidence of acute major vascular territorial infarction.
+
+Limited views of the paranasal sinuses and mastoid air cells are unremarkable.
+
+IMPRESSION:
+
+Focal slight hyperdensity along the anterior right temporal cortex with
+surrounding hypodensity. Findings are concerning for small subarachnoid or
+cortical hemorrhage with associated contusion.
+
+
+NOTE ON ATTENDING REVIEW: The hypodensity in right temporal region and subtle
+hyperdensity are at the site of previous hemorrhage seen in ___. This appears
+to be a chronic finding.
+
+
+[RADIOLOGY] INDICATION:  ___ female with unwitnessed fall and 3-cm laceration on
+the left occiput.  Unable to provide history.
+
+COMPARISON:  CT C-spine ___.
+
+TECHNIQUE:  MDCT acquired axial images of the cervical spine were obtained
+without IV contrast.  Coronal and sagittal reformations were performed.
+
+FINDINGS:  Again demonstrated are diffuse degenerative changes throughout the
+cervical spine including moderate narrowing of the facet joints of C1 on C2
+and disc space narrowing at C6-C7, sclerotic changes and osteophyte formation
+are also seen at these levels.  There is loss of normal lordotic curvature
+with patient in neck collar.  There is no evidence to suggest acute bony
+injury.  The prevertebral soft tissues are unremarkable.  There is minimal
+scarring in the left lung apex.
+
+IMPRESSION:  No evidence of acute bony injury.  Degenerative changes of the
+upper and lower cervical spine.
+
+PROCEDURES (readable):
+- 8659 (ICD-9) — Closure of skin and subcutaneous tissue of other sites
+
+DIAGNOSES (readable):
+- 8730 (ICD-9) — Open wound of scalp, without mention of complication
+- E8889 (ICD-9) — Unspecified fall
+- 2720 (ICD-9) — Pure hypercholesterolemia
+- 4019 (ICD-9) — Unspecified essential hypertension
+- 2948 (ICD-9) — Other persistent mental disorders due to conditions classified elsewhere
+
+LAB ITEMS (readable, deduped):
+- Anion Gap (Item 50868)
+- Basophils (Item 51146)
+- Bicarbonate (Item 50882)
+- Calcium, Total (Item 50893)
+- Chloride (Item 50902)
+- Creatine Kinase (CK) (Item 50910)
+- Creatine Kinase, MB Isoenzyme (Item 50911)
+- Creatinine (Item 50912)
+- Eosinophils (Item 51200)
+- Estimated GFR (MDRD equation) (Item 50920)
+- Glucose (Item 50931)
+- Hematocrit (Item 51221)
+- Hemoglobin (Item 51222)
+- Lymphocytes (Item 51244)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Magnesium (Item 50960)
+- Monocytes (Item 51254)
+- Neutrophils (Item 51256)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Potassium (Item 50971)
+- Potassium, Whole Blood (Item 50822)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Sodium (Item 50983)
+- Troponin T (Item 51003)
+- Urea Nitrogen (Item 51006)
+- White Blood Cells (Item 51301)

summaries/subject_16139570_hadm_20366586_summary.txt

@@ -0,0 +1,81 @@
+**PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION)**
+
+**Patient Information:**
+
+* Age: 91
+* Gender: Female
+* Admission ID: 20366586
+* Admission Type: Emergency (EW EMER)
+* Admission Location: Emergency Room
+* Discharge Location: Skilled Nursing Facility
+* Insurance: Other
+* Race: Asian
+* Marital Status: Widow
+* Language: Not specified
+
+**Procedures:**
+
+* ICD-9: 8659 (Closure of skin and subcutaneous tissue of other sites)
+
+**Diagnoses:**
+
+* ICD-9: 8730 (Open wound of scalp)
+* ICD-9: E8889 (Unspecified fall)
+* ICD-9: 2720 (Pure hypercholesterolemia)
+* ICD-9: 4019 (Unspecified essential hypertension)
+* ICD-9: 2948 (Other persistent mental disorders due to conditions classified elsewhere)
+
+**Laboratory Results:**
+
+* Total laboratory events: 33
+* Most frequent lab tests:
+	+ Item ID 51003: 2 measurements
+	+ Item ID 50910: 2 measurements
+	+ Item ID 50911: 2 measurements
+	+ Item ID 51146: 1 measurement
+	+ Item ID 51200: 1 measurement
+
+**Clinical Notes:**
+
+* The patient was admitted after an unwitnessed fall, resulting in a scalp laceration.
+* The patient has a history of dementia, osteoarthritis, choledocholithiasis, urinary incontinence, constipation, hypercholesterolemia, hypertension, depression, herpes zoster, and pseudoobstruction.
+* The patient was given tetanus shot but no medications.
+* The patient was admitted to the medicine team for further management.
+* The patient's head CT showed possible small subarachnoid hemorrhage, but the final read indicated no new changes.
+* The patient was discharged to a skilled nursing facility.
+
+**Medications:**
+
+* Aspirin 81mg daily
+* Glucosamine
+* Risperidone 0.25mg po daily
+* Senna 8.6mg tablet daily
+* Lidocaine 5% patch (700mg/patch) adhesive patch, medicated
+* Acetaminophen 650mg tablet twice a day
+* Tylenol (dosage not specified)
+* Docusate sodium 100mg capsule twice a day
+* Lorazepam 0.5mg tablet twice a day
+* Ursodiol 300mg capsule twice a day
+* Bisacodyl 10mg suppository rectal HS (at bedtime) as needed
+
+**Discharge Instructions:**
+
+* The patient should follow up with a physician in 4 weeks.
+* The patient may require a head CT prior to the follow-up appointment.
+* The patient should contact their PCP or return to the ED if they experience further falls, light-headedness, dizziness, weakness, headache, sensory disturbances, shortness of breath, or chest pain.
+
+**Radiology Results:**
+
+* CT C-spine: No evidence of acute bony injury. Degenerative changes of the upper and lower cervical spine.
+* CT Head: Focal slight hyperdensity along the anterior right temporal cortex with surrounding hypodensity. Findings are concerning for small subarachnoid or cortical hemorrhage with associated contusion.
+* Chest X-ray: No evidence of pneumonia or CHF.
+
+**Procedure and Diagnosis Readable:**
+
+* Procedure: 8659 (Closure of skin and subcutaneous tissue of other sites)
+* Diagnosis: 8730 (Open wound of scalp)
+
+**Lab Items Readable (deduped):**
+
+* Anion Gap (Item 50868)
+* Basophils (Item 51146)

summaries/subject_16139570_hadm_23551539_input.txt

@@ -0,0 +1,502 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 91
+- Gender: F
+
+ADMISSION:
+- Admission ID: 23551539
+- Admission Type: EW EMER.
+- Admission Location: EMERGENCY ROOM
+- Discharge Location: DIED
+- Insurance: Medicare
+- Race: ASIAN - CHINESE
+- Marital Status: WIDOWED
+- Language: ?
+
+PROCEDURES (1 total):
+- 3897 (ICD-9)
+
+DIAGNOSES (16 total):
+- 0389 (ICD-9)
+- 78552 (ICD-9)
+- 5990 (ICD-9)
+- 5849 (ICD-9)
+- 2762 (ICD-9)
+- 5180 (ICD-9)
+- 49121 (ICD-9)
+- 99592 (ICD-9)
+- 0414 (ICD-9)
+- 42731 (ICD-9)
+- 27652 (ICD-9)
+- 28529 (ICD-9)
+- 2948 (ICD-9)
+- 4019 (ICD-9)
+- 2724 (ICD-9)
+- 56032 (ICD-9)
+
+LABORATORY RESULTS:
+- Item ID 50802: 1 measurements, 2176-09-05 16:56:00 to 2176-09-05 16:56:00
+- Item ID 50804: 1 measurements, 2176-09-05 16:56:00 to 2176-09-05 16:56:00
+- Item ID 50812: 1 measurements, 2176-09-05 16:56:00 to 2176-09-05 16:56:00
+- Item ID 50813: 3 measurements, 2176-09-05 04:51:00 to 2176-09-06 06:47:00
+- Item ID 50818: 1 measurements, 2176-09-05 16:56:00 to 2176-09-05 16:56:00
+- Item ID 50820: 1 measurements, 2176-09-05 16:56:00 to 2176-09-05 16:56:00
+- Item ID 50821: 1 measurements, 2176-09-05 16:56:00 to 2176-09-05 16:56:00
+- Item ID 50822: 1 measurements, 2176-09-06 06:47:00 to 2176-09-06 06:47:00
+- Item ID 50825: 1 measurements, 2176-09-05 16:56:00 to 2176-09-05 16:56:00
+- Item ID 50852: 1 measurements, 2176-09-05 04:27:00 to 2176-09-05 04:27:00
+- Item ID 50862: 1 measurements, 2176-09-05 04:27:00 to 2176-09-05 04:27:00
+- Item ID 50868: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50882: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50893: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50902: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50910: 2 measurements, 2176-09-05 04:27:00 to 2176-09-05 15:23:00
+- Item ID 50911: 2 measurements, 2176-09-05 04:27:00 to 2176-09-05 15:23:00
+- Item ID 50912: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50919: 1 measurements, 2176-09-06 18:25:00 to 2176-09-06 18:25:00
+- Item ID 50931: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50960: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50970: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50971: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 50983: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51003: 2 measurements, 2176-09-05 04:27:00 to 2176-09-05 15:23:00
+- Item ID 51006: 5 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51009: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 08:19:00
+- Item ID 51078: 2 measurements, 2176-09-05 04:27:00 to 2176-09-06 11:45:00
+- Item ID 51082: 2 measurements, 2176-09-05 04:27:00 to 2176-09-06 11:45:00
+- Item ID 51087: 2 measurements, 2176-09-05 04:27:00 to 2176-09-06 11:45:00
+- Item ID 51093: 1 measurements, 2176-09-06 11:45:00 to 2176-09-06 11:45:00
+- Item ID 51097: 2 measurements, 2176-09-05 04:27:00 to 2176-09-06 11:45:00
+- Item ID 51100: 2 measurements, 2176-09-05 04:27:00 to 2176-09-06 11:45:00
+- Item ID 51137: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51143: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51144: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51146: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51200: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51221: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51222: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51233: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51237: 2 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51244: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51246: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51248: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51249: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51250: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51251: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51252: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51254: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51255: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51256: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51260: 2 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51265: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51266: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51267: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51268: 3 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51274: 2 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51275: 2 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51277: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51279: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51287: 1 measurements, 2176-09-06 03:20:00 to 2176-09-06 03:20:00
+- Item ID 51294: 2 measurements, 2176-09-05 04:27:00 to 2176-09-07 04:06:00
+- Item ID 51301: 4 measurements, 2176-09-05 04:27:00 to 2176-09-08 03:54:00
+- Item ID 51613: 1 measurements, 2176-09-05 04:27:00 to 2176-09-05 04:27:00
+- Item ID 52033: 1 measurements, 2176-09-05 16:56:00 to 2176-09-05 16:56:00
+
+CLINICAL NOTES:
+[DISCHARGE NOTE]
+Name:  ___                     Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   F
+ 
+Service: MEDICINE
+ 
+Allergies: 
+No Known Allergies / Adverse Drug Reactions
+ 
+Attending: ___
+ 
+Chief Complaint:
+fever to 103, sepsis
+ 
+Major Surgical or Invasive Procedure:
+___ line placement
+ 
+History of Present Illness:
+___ ___ speaking dementia at baseline (waxes and wanes), 
+h/o HTN, HLD, fall and SDH presents from ___ with 
+fever to 103, and tachycardia to 130.  
+.
+At ___ also noted to have ___ 311 and then 245.  
+.
+In the ED, initial vs were: 99.2, 114, 102/52, 30, 100%/NRB. In 
+ED noted that Abd was distended and NT.  Labs in ED showed UTI.  
+
+In the ED she received 2L IVF and was noted to have "180cc of 
+UOP". She was noted to have a lactate which decreased from 3.6 
+to 2.3. Labs significant for a Na of 146, creatinine of 1.4 
+(above baseline 0.7), WBC with 31.5 and 21% bands.  CXR showed 
+small bilateral pleural effusions with possible mild vascular 
+congestion and bibasilar atelectasis.  EKG showed sinus tach inf 
+TWI in III and avL new from ___.  Urine and blood cultures were 
+sent.  She was hemodynamically stable with VS on transfer: 99s, 
+HR 104, BP 110/56, RR 21, 100%/2L.
+
+CT abd/pelvis showed massively dilated sigmoid up to 10 cm ___ 
+fecal impaction w/o evidence of obstruction.
+___ pleural effusions w/ RLL atelectasis or consolidation.
+Patient was given Vancomycin, Zosyn, rectal tylenol and 2L NS. 
+.
+On the floor, she is well appearing and follows commands 
+appropriately.
+
+ 
+Past Medical History:
+s/pa SDH s/p ___
+h/o anxiety, depression
+FTT
+Dementia, advanced
+OA
+choledochlolithiasis
+HLD
+HTN
+herpes zoster
+urinary incontenence
+right pupil 8/fixed, left 1/fixed, ___ surgery
+
+PSH:
+s/p hepaticojejunostomy and CCY
+ 
+Social History:
+___
+Family History:
+Non-contributory
+ 
+Physical Exam:
+PEx on admission to ICU:
+Vitals: 97.8, 94, 110/56, 99%/3L
+General: Alert, no acute distress , smiling
+HEENT: Sclera anicteric, dry MM, oropharynx clear
+Neck: supple, JVP flat
+Lungs: Clear to auscultation bilaterally, no wheezes, rales, 
+rhonchi
+CV: tachycardic and reg rhythm, normal S1 + S2, ___ SEM at RUSB
+Abdomen: non-tender, very distended, no bowel sounds present, no 
+rebound tenderness or guarding, no organomegaly
+GU: foley draining clear fluid
+Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or 
+edema
+ 
+Pertinent Results:
+ADMISSION LABS:
+
+___ 08:35PM   LACTATE-2.3*
+___ 07:20PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-30 
+GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-4* PH-5.0 LEUK-SM 
+
+___ 07:20PM URINE  RBC-24* WBC-13* BACTERIA-FEW YEAST-NONE 
+EPI-3
+___ 07:14PM   ALT(SGPT)-22 AST(SGOT)-26 ALK PHOS-135* TOT 
+BILI-0.5
+___ 07:14PM   WBC-31.5*# RBC-3.49* HGB-9.4*# HCT-29.4*# 
+MCV-84 MCH-26.8* MCHC-31.8 RDW-16.5*
+___ 07:14PM   NEUTS-72* BANDS-21* LYMPHS-4* MONOS-2 EOS-0 
+BASOS-0 ATYPS-1* ___ MYELOS-0
+___ 07:13PM   LACTATE-3.6*
+
+IMAGING:
+CXR ___: IMPRESSION: 
+1. Small bilateral pleural effusions with possible mild vascular 
+congestion.  
+2. Bibasilar atelectasis or consolidation.  
+
+CT Ab/Pelvis ___ IMPRESSION: 
+1. Bilateral atelectasis or consolidation, with small pleural 
+effusions. 
+2. Marked sigmoid distention up to 10 cm, likely secondary to 
+fecal 
+impaction, though other causes such as ischemia are not entirely 
+excluded. 
+3. Hepaticojejunostomy changes, with intact Roux-en-Y limb and 
+no evidence of 
+obstruction. Small amount of perihepatic free fluid, 
+non-specific. 
+4. Pancreatic cystic lesion most likely representing IPMN. If 
+clinically 
+appropriate, given patient age, could be further evaluated on 
+MRCP. 
+5. Diffuse atherosclerosis. 
+
+ECHO ___ The left atrium is elongated. The right atrium is 
+moderately dilated. Left ventricular wall thicknesses are 
+normal. The left ventricular cavity size is normal. Left 
+ventricular systolic function is hyperdynamic (EF>75%). Tissue 
+Doppler imaging suggests an increased left ventricular filling 
+pressure (PCWP>18mmHg). A mid-cavitary gradient is identified. 
+An apical intracavitary gradient is identified. The right 
+ventricular free wall is hypertrophied. Right ventricular 
+chamber size is normal. with borderline normal free wall 
+function. There is abnormal septal motion/position consistent 
+with right ventricular pressure/volume overload. The aortic 
+valve leaflets are moderately thickened. There is mild aortic 
+valve stenosis (valve area 1.5 cm2). No aortic regurgitation is 
+seen. The mitral valve leaflets are mildly thickened. There is 
+no mitral valve prolapse. Mild (1+) mitral regurgitation is 
+seen. The tricuspid valve leaflets are mildly thickened. 
+Moderate [2+] tricuspid regurgitation is seen. There is moderate 
+pulmonary artery systolic hypertension. The main pulmonary 
+artery is dilated. The branch pulmonary arteries are dilated. 
+There is no pericardial effusion. 
+
+IMPRESSION: no vegetations seen
+
+___ Renal U/S: IMPRESSION: Normal left kidney. Lower pole of 
+the right kidney could not be 
+adequately visualized on ultrasound, but no obvious 
+hydronephrosis seen. 
+
+___ Head CT:  
+IMPRESSION: No acute intracranial abnormality. 
+
+___ CXR: IMPRESSION: 
+1. Satisfactory position of peripherally inserted central venous 
+catheter 
+wire tip, although the distal floppy tip is obscured by 
+overlying cardiac 
+electrode. 
+2. Enlarging bilateral moderately large pleural effusions. 
+
+ 
+Brief Hospital Course:
+___ yo F with dementia, HTN, h/o falls p/w fever to 103 and 
+bandemia in setting of UTI and fecal impaction, found to have 
+polymicrobial bacteremia and shock.
+.
+Briefly, patient was admitted with lethargy, hypoxia, fever, 
+elevated lactate and leukocytosis with bandemia, UA positive for 
+WBC and bacteria, and was also noted to have large fecal 
+impaction (not obstruction) on CT abd/pelvis.  She was started 
+on broad coverage for HCAP, UTI, and potential GI source 
+(including C.dif) with Vanc/Zosyn/Azithromycin/Flagyl.  CXR was 
+negative for acute lung process.  C.dif was negative, so Flagyl 
+was discontinued on HD3.  Non-contrast head CT was negative.  
+Urine cultures returned with GNR, further speciated on HD3 to 
+E.coli resistant to Zosyn, so patient was transitioned to 
+Ceftriaxone per sensitivities.  However, she also grew GPC 
+(streptococcus species) and GNR from blood cultures.  TTE was 
+negative for vegetations.  Episodes of hypotension, tachycardia, 
+hypoxia felt to be related to sepsis and general inflammatory 
+process with cytokine release.  For fecal impaction, attempted 
+Fleets enema, lactulose, soaps enema, mineral enema, manual 
+disimpaction, all without complete success.  GI consulted, but 
+no procedure indicated.  Developed progressive acute renal 
+failure, likely related to hypotension and hypovolemia, but 
+patient was aggressive hydrated but without benefit.  Multiple 
+discussions on goals of care were held with HCP (son), and 
+decision was made for comfort measures only on HD5. The patient 
+passed away peacefully on ___ at 12:24PM.  
+
+ 
+Medications on Admission:
+Vitamin D 50,000 unit Cap Oral due ___
+.
+Aspir-81 81 mg Tab Oral
+1 Tablet, Delayed Release (E.C.)(s) Once Daily
+.   
+senna 8.6 mg Cap Oral
+. 
+azo cranberry
+450-30-50 Twice Daily
+.
+Colace 100 mg Cap Oral
+1 Capsule(s) Twice Daily
+.  
+ursodiol 300 mg Cap Oral
+1 Capsule(s) Twice Daily
+. 
+calcium carbonate-vitamin D3 -- Unknown Strength
+1 Tablet(s) Twice Daily
+.  
+risperidone 0.5 mg Tab Oral
+1 Tablet(s) qhs
+.
+ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 mL Neb Solution 
+Inhalation
+1 Solution for Nebulization(s) Every ___ hrs, as needed
+.   
+___ 325 mg (65 mg Iron) Tab Oral
+1 Tablet(s) Twice Daily
+.  
+cyanocobalamin (vitamin B-12) 1,000 mcg/mL Injection Injection
+1 Solution(s) q month due ___
+. 
+bisacodyl prn
+emulose prn
+MOM prn
+trazodone prn
+acetaminophen prn
+fleet enema prn
+mechanical soft diet
+ 
+Discharge Medications:
+Expired
+ 
+Discharge Disposition:
+Expired
+ 
+Discharge Diagnosis:
+Expired
+ 
+Discharge Condition:
+Expired
+ 
+Discharge Instructions:
+Expired
+ 
+Followup Instructions:
+___
+
+[RADIOLOGY NOTE]
+INDICATION:  ___ female with increased breath sounds and fever.
+
+___.
+
+CHEST, AP, SEMI-UPRIGHT:  Mild vascular congestion and interstitial edema has
+developed, with small bilateral pleural effusions.  There is bibasilar
+atelectasis or consolidation.  Mild cardiomegaly is present, with a tortuous
+and calcified aorta. There is no free air under the diaphragm.  The bones are
+diffusely demineralized.
+
+IMPRESSION:
+1.  Small bilateral pleural effusions with possible mild vascular congestion. 
+2.  Bibasilar atelectasis or consolidation.
+
+[RADIOLOGY NOTE]
+INDICATION:  ___ female with distended abdomen and leukocytosis.
+
+___.
+
+TECHNIQUE:  Helical MDCT images were acquired from the lung bases through the
+greater trochanters with intravenous and without oral contrast.  5-mm axial,
+coronal, and sagittal multiplanar reformats were generated.
+
+FINDINGS:  Mild bibasilar atelectasis or consolidation is present, along with
+small bilateral pleural effusions.  The heart is normal in size, with trace
+pericardial effusion.  Dense calcifications are noted in the thoracic aorta
+and coronary arteries.
+
+ABDOMEN:  A trace amount of free fluid is present in the abdomen, concentrated
+in the perihepatic region.  The liver enhances normally.  Note is made of
+intrahepatic pneumobilia.  Changes of Roux-en-Y hepaticojejunostomy are
+present, with anastomotic suture line in the right abdomen, and no evidence of
+bowel dilation to suggest obstruction.  The gallbladder is surgically absent. 
+Scattered cystic lesions are again noted in the pancreas, likely representing
+IPMN.  There is no intra- or extrahepatic biliary ductal dilation.  The spleen
+is normal in size.
+
+Left adrenal appears slightly full, without discrete nodules identified. 
+Right adrenal is normal.  The kidneys enhance promptly and symmetrically,
+without masses or hydronephrosis.  Note is made of bilateral extrarenal
+pelves.
+
+The stomach and small bowel are relatively decompressed.
+
+PELVIS:  The appendix is normal.  A moderate amount of retained fecal material
+is noted in the colon.  There is massive dilation of the sigmoid colon up to
+10 cm, presumably secondary to significant fecal impaction.  There is no bowel
+wall thinning, abnormal enhancement, or pneumatosis to suggest ischemia.  No
+extraluminal air/fluid collections are present to suggest perforation.  No
+portal or mesenteric venous gas is present.
+
+Foley catheter is present in a collapsed bladder.  The uterus is atrophic.  
+
+Scattered calcifications and soft plaques are noted throughout the abdominal
+aorta, with moderate stenosis of branch vessel origins.  Retroperitoneal and
+mesenteric lymph nodes are not pathologically enlarged.
+
+Bones are diffusely demineralized, with moderate multilevel degenerative
+changes.  Note is made of transitional lumbosacral anatomy.  L1 compression
+fracture has progressed, with 60% loss of height.  New interval L2 compression
+fracture is also present, with 60% loss of height.  There is minimal
+anterolisthesis at L5-S1.  Moderate diffuse disc bulges are present at
+multiple levels, most significant at L5-S1, with abutment of the thecal sac
+outline.  Please note that CT cannot visualize intrathecal detail.  No
+suspicious lytic or sclerotic osseous lesions are identified.  There is
+diffuse fatty atrophy of the paraspinal and thoracoabdominal wall musculature.
+Calcified injection granulomas are noted in the right gluteus.
+
+IMPRESSION:
+1.  Bilateral atelectasis or consolidation, with small pleural effusions.
+2.  Marked sigmoid distention up to 10 cm, likely secondary to fecal
+impaction, though other causes such as ischemia are not entirely excluded.
+3.  Hepaticojejunostomy changes, with intact Roux-en-Y limb and no evidence of
+obstruction. Small amount of perihepatic free fluid, non-specific.
+4.  Pancreatic cystic lesion most likely representing IPMN. If clinically
+appropriate, given patient age, could be further evaluated on MRCP.
+5.  Diffuse atherosclerosis.
+
+[RADIOLOGY NOTE]
+INDICATION:  ___ female with worsening renal failure.  Ultrasound of
+the kidneys to rule out urinary obstruction.
+
+COMPARISON:  CT abdomen and pelvis ___.
+
+FINDINGS:  The left kidney measures 10.3 cm.  There is no focal lesion or
+hydronephrosis.  The lower pole of the right kidney could not be adequately
+visualized because of the overlying bowel gases.  The upper and mid poles
+appear normal with no hydronephrosis or calculi.  Based on the recent CT scan
+done on ___, no structural lesion or hydronephrosis was visualized in the
+right kidney.  The urinary bladder is empty with a Foley catheter in situ.
+
+IMPRESSION:  Normal left kidney.  Lower pole of the right kidney could not be
+adequately visualized on ultrasound, but no obvious hydronephrosis seen.
+
+[RADIOLOGY NOTE]
+INDICATION:  Altered mental status.
+
+COMPARISON:  ___.
+
+TECHNIQUE:  Contiguous axial MDCT-acquired images of the head were obtained
+without administration of intravenous contrast. Several sequences were
+degraded by motion artifact and were repeated with better result.   
+
+FINDINGS:  There is no hemorrhage. There is no evidence of major acute
+vascular territorial infarction, allowing for the extensive periventricular
+white matter hypodensities, likely the sequelae of chronic small vessel
+ischemic disease. More focal hypodensity in the right frontal region may
+represent encephalomalacia related to remote cortical infarct. The ventricles
+and sulci are prominent in size and configuration, likely due to age-related
+global parenchymal atrophy.
+
+The visualized paranasal sinuses and mastoid air cells are clear.
+
+IMPRESSION:  No acute intracranial abnormality.
+
+[RADIOLOGY NOTE]
+INDICATION:  Recently inserted peripherally inserted central venous catheter. 
+Background of altered mental status.
+
+COMPARISON:  Radiographs dated back to ___ and most recently ___.
+
+FINDINGS:  Bilateral moderately large pleural effusions have increased in size
+since ___.  Hazy opacity in the right lung is most likely due to
+posteriorly layering fluid.  Retrocardiac linear opacity is unchanged since
+___ and is consistent with a tortuous thoracic descending aorta.  Mild
+cardiomegaly is stable.  The newly inserted left upper extremity peripherally
+inserted central venous catheter tip is obscured by an overlying cardiac
+electrode with the distal tip of the wire lies at the lower SVC.
+
+Wedge compression fractures of L1 and L2 are associated with moderately severe
+loss of vertebral height, unchanged since ___.
+
+IMPRESSION:
+1.  Satisfactory position of peripherally inserted central venous catheter
+wire tip, although the distal floppy tip is obscured by overlying cardiac
+electrode.
+2.  Enlarging bilateral moderately large pleural effusions.
+
+Results regarding the peripherally inserted central venous catheter
+communicated to ___, venous access nurse practitioner, at approximately
+1430 hours, ___.

summaries/subject_16139570_hadm_23551539_model_input.txt

@@ -0,0 +1,532 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 91
+- Gender: F
+
+ADMISSION:
+- Admission ID: 23551539
+- Admission Type: EW EMER.
+- Admission Location: EMERGENCY ROOM
+- Discharge Location: DIED
+- Insurance: Medicare
+- Race: ASIAN - CHINESE
+- Marital Status: WIDOWED
+- Language: ?
+
+PROCEDURES (1 total):
+  1. ICD-9: 3897
+
+DIAGNOSES (16 total):
+  1. ICD-9: 0389
+  2. ICD-9: 78552
+  3. ICD-9: 5990
+  4. ICD-9: 5849
+  5. ICD-9: 2762
+  6. ICD-9: 5180
+  7. ICD-9: 49121
+  8. ICD-9: 99592
+  9. ICD-9: 0414
+  10. ICD-9: 42731
+  11. ICD-9: 27652
+  12. ICD-9: 28529
+  13. ICD-9: 2948
+  14. ICD-9: 4019
+  15. ICD-9: 2724
+  16. ICD-9: 56032
+
+LABORATORY RESULTS:
+Total laboratory events: 186
+Most frequent lab tests:
+  - Item ID 50868: 5 measurements
+  - Item ID 50882: 5 measurements
+  - Item ID 50893: 5 measurements
+  - Item ID 50902: 5 measurements
+  - Item ID 50912: 5 measurements
+
+CLINICAL NOTES:
+[DISCHARGE]  
+Name:  ___                     Unit No:   ___
+ 
+Admission Date:  ___              Discharge Date:   ___
+ 
+Date of Birth:  ___             Sex:   F
+ 
+Service: MEDICINE
+ 
+Allergies: 
+No Known Allergies / Adverse Drug Reactions
+ 
+Attending: ___
+ 
+Chief Complaint:
+fever to 103, sepsis
+ 
+Major Surgical or Invasive Procedure:
+___ line placement
+ 
+History of Present Illness:
+___ ___ speaking dementia at baseline (waxes and wanes), 
+h/o HTN, HLD, fall and SDH presents from ___ with 
+fever to 103, and tachycardia to 130.  
+.
+At ___ also noted to have ___ 311 and then 245.  
+.
+In the ED, initial vs were: 99.2, 114, 102/52, 30, 100%/NRB. In 
+ED noted that Abd was distended and NT.  Labs in ED showed UTI.  
+
+In the ED she received 2L IVF and was noted to have "180cc of 
+UOP". She was noted to have a lactate which decreased from 3.6 
+to 2.3. Labs significant for a Na of 146, creatinine of 1.4 
+(above baseline 0.7), WBC with 31.5 and 21% bands.  CXR showed 
+small bilateral pleural effusions with possible mild vascular 
+congestion and bibasilar atelectasis.  EKG showed sinus tach inf 
+TWI in III and avL new from ___.  Urine and blood cultures were 
+sent.  She was hemodynamically stable with VS on transfer: 99s, 
+HR 104, BP 110/56, RR 21, 100%/2L.
+
+CT abd/pelvis showed massively dilated sigmoid up to 10 cm ___ 
+fecal impaction w/o evidence of obstruction.
+___ pleural effusions w/ RLL atelectasis or consolidation.
+Patient was given Vancomycin, Zosyn, rectal tylenol and 2L NS. 
+.
+On the floor, she is well appearing and follows commands 
+appropriately.
+
+ 
+Past Medical History:
+s/pa SDH s/p ___
+h/o anxiety, depression
+FTT
+Dementia, advanced
+OA
+choledochlolithiasis
+HLD
+HTN
+herpes zoster
+urinary incontenence
+right pupil 8/fixed, left 1/fixed, ___ surgery
+
+PSH:
+s/p hepaticojejunostomy and CCY
+ 
+Social History:
+___
+Family History:
+Non-contributory
+ 
+Physical Exam:
+PEx on admission to ICU:
+Vitals: 97.8, 94, 110/56, 99%/3L
+General: Alert, no acute distress , smiling
+HEENT: Sclera anicteric, dry MM, oropharynx clear
+Neck: supple, JVP flat
+Lungs: Clear to auscultation bilaterally, no wheezes, rales, 
+rhonchi
+CV: tachycardic and reg rhythm, normal S1 + S2, ___ SEM at RUSB
+Abdomen: non-tender, very distended, no bowel sounds present, no 
+rebound tenderness or guarding, no organomegaly
+GU: foley draining clear fluid
+Ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or 
+edema
+ 
+Pertinent Results:
+ADMISSION LABS:
+
+___ 08:35PM   LACTATE-2.3*
+___ 07:20PM URINE  BLOOD-MOD NITRITE-NEG PROTEIN-30 
+GLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-4* PH-5.0 LEUK-SM 
+
+___ 07:20PM URINE  RBC-24* WBC-13* BACTERIA-FEW YEAST-NONE 
+EPI-3
+___ 07:14PM   ALT(SGPT)-22 AST(SGOT)-26 ALK PHOS-135* TOT 
+BILI-0.5
+___ 07:14PM   WBC-31.5*# RBC-3.49* HGB-9.4*# HCT-29.4*# 
+MCV-84 MCH-26.8* MCHC-31.8 RDW-16.5*
+___ 07:14PM   NEUTS-72* BANDS-21* LYMPHS-4* MONOS-2 EOS-0 
+BASOS-0 ATYPS-1* ___ MYELOS-0
+___ 07:13PM   LACTATE-3.6*
+
+IMAGING:
+CXR ___: IMPRESSION: 
+1. Small bilateral pleural effusions with possible mild vascular 
+congestion.  
+2. Bibasilar atelectasis or consolidation.  
+
+CT Ab/Pelvis ___ IMPRESSION: 
+1. Bilateral atelectasis or consolidation, with small pleural 
+effusions. 
+2. Marked sigmoid distention up to 10 cm, likely secondary to 
+fecal 
+impaction, though other causes such as ischemia are not entirely 
+excluded. 
+3. Hepaticojejunostomy changes, with intact Roux-en-Y limb and 
+no evidence of 
+obstruction. Small amount of perihepatic free fluid, 
+non-specific. 
+4. Pancreatic cystic lesion most likely representing IPMN. If 
+clinically 
+appropriate, given patient age, could be further evaluated on 
+MRCP. 
+5. Diffuse atherosclerosis. 
+
+ECHO ___ The left atrium is elongated. The right atrium is 
+moderately dilated. Left ventricular wall thicknesses are 
+normal. The left ventricular cavity size is normal. Left 
+ventricular systolic function is hyperdynamic (EF>75%). Tissue 
+Doppler imaging suggests an increased left ventricular filling 
+pressure (PCWP>18mmHg). A mid-cavitary gradient is identified. 
+An apical intracavitary gradient is identified. The right 
+ventricular free wall is hypertrophied. Right ventricular 
+chamber size is normal. with borderline normal free wall 
+function. There is abnormal septal motion/position consistent 
+with right ventricular pressure/volume overload. The aortic 
+valve leaflets are moderately thickened. There is mild aortic 
+valve stenosis (valve area 1.5 cm2). No aortic regurgitation is 
+seen. The mitral valve leaflets are mildly thickened. There is 
+no mitral valve prolapse. Mild (1+) mitral regurgitation is 
+seen. The tricuspid valve leaflets are mildly thickened. 
+Moderate [2+] tricuspid regurgitation is seen. There is moderate 
+pulmonary artery systolic hypertension. The main pulmonary 
+artery is dilated. The branch pulmonary arteries are dilated. 
+There is no pericardial effusion. 
+
+IMPRESSION: no vegetations seen
+
+___ Renal U/S: IMPRESSION: Normal left kidney. Lower pole of 
+the right kidney could not be 
+adequately visualized on ultrasound, but no obvious 
+hydronephrosis seen. 
+
+___ Head CT:  
+IMPRESSION: No acute intracranial abnormality. 
+
+___ CXR: IMPRESSION: 
+1. Satisfactory position of peripherally inserted central venous 
+catheter 
+wire tip, although the distal floppy tip is obscured by 
+overlying cardiac 
+electrode. 
+2. Enlarging bilateral moderately large pleural effusions. 
+
+ 
+Brief Hospital Course:
+___ yo F with dementia, HTN, h/o falls p/w fever to 103 and 
+bandemia in setting of UTI and fecal impaction, found to have 
+polymicrobial bacteremia and shock.
+.
+Briefly, patient was admitted with lethargy, hypoxia, fever, 
+elevated lactate and leukocytosis with bandemia, UA positive for 
+WBC and bacteria, and was also noted to have large fecal 
+impaction (not obstruction) on CT abd/pelvis.  She was started 
+on broad coverage for HCAP, UTI, and potential GI source 
+(including C.dif) with Vanc/Zosyn/Azithromycin/Flagyl.  CXR was 
+negative for acute lung process.  C.dif was negative, so Flagyl 
+was discontinued on HD3.  Non-contrast head CT was negative.  
+Urine cultures returned with GNR, further speciated on HD3 to 
+E.coli resistant to Zosyn, so patient was transitioned to 
+Ceftriaxone per sensitivities.  However, she also grew GPC 
+(streptococcus species) and GNR from blood cultures.  TTE was 
+negative for vegetations.  Episodes of hypotension, tachycardia, 
+hypoxia felt to be related to sepsis and general inflammatory 
+process with cytokine release.  For fecal impaction, attempted 
+Fleets enema, lactulose, soaps enema, mineral enema, manual 
+disimpaction, all without complete success.  GI consulted, but 
+no procedure indicated.  Developed progressive acute renal 
+failure, likely related to hypotension and hypovolemia, but 
+patient was aggressive hydrated but without benefit.  Multiple 
+discussions on goals of care were held with HCP (son), and 
+decision was made for comfort measures only on HD5. The patient 
+passed away peacefully on ___ at 12:24PM.  
+
+ 
+Medications on Admission:
+Vitamin D 50,000 unit Cap Oral due ___
+.
+Aspir-81 81 mg Tab Oral
+1 Tablet, Delayed Release (E.C.)(s) Once Daily
+.   
+senna 8.6 mg Cap Oral
+. 
+azo cranberry
+450-30-50 Twice Daily
+.
+Colace 100 mg Cap Oral
+1 Capsule(s) Twice Daily
+.  
+ursodiol 300 mg Cap Oral
+1 Capsule(s) Twice Daily
+. 
+calcium carbonate-vitamin D3 -- Unknown Strength
+1 Tablet(s) Twice Daily
+.  
+risperidone 0.5 mg Tab Oral
+1 Tablet(s) qhs
+.
+ipratropium-albuterol 0.5 mg-3 mg(2.5 mg base)/3 mL Neb Solution 
+Inhalation
+1 Solution for Nebulization(s) Every ___ hrs, as needed
+.   
+___ 325 mg (65 mg Iron) Tab Oral
+1 Tablet(s) Twice Daily
+.  
+cyanocobalamin (vitamin B-12) 1,000 mcg/mL Injection Injection
+1 Solution(s) q month due ___
+. 
+bisacodyl prn
+emulose prn
+MOM prn
+trazodone prn
+acetaminophen prn
+fleet enema prn
+mechanical soft diet
+ 
+Discharge Medications:
+Expired
+ 
+Discharge Disposition:
+Expired
+ 
+Discharge Diagnosis:
+Expired
+ 
+Discharge Condition:
+Expired
+ 
+Discharge Instructions:
+Expired
+ 
+Followup Instructions:
+___
+
+
+[RADIOLOGY] INDICATION:  ___ female with increased breath sounds and fever.
+
+___.
+
+CHEST, AP, SEMI-UPRIGHT:  Mild vascular congestion and interstitial edema has
+developed, with small bilateral pleural effusions.  There is bibasilar
+atelectasis or consolidation.  Mild cardiomegaly is present, with a tortuous
+and calcified aorta. There is no free air under the diaphragm.  The bones are
+diffusely demineralized.
+
+IMPRESSION:
+1.  Small bilateral pleural effusions with possible mild vascular congestion. 
+2.  Bibasilar atelectasis or consolidation. 
+
+
+[RADIOLOGY] INDICATION:  ___ female with distended abdomen and leukocytosis.
+
+___.
+
+TECHNIQUE:  Helical MDCT images were acquired from the lung bases through the
+greater trochanters with intravenous and without oral contrast.  5-mm axial,
+coronal, and sagittal multiplanar reformats were generated.
+
+FINDINGS:  Mild bibasilar atelectasis or consolidation is present, along with
+small bilateral pleural effusions.  The heart is normal in size, with trace
+pericardial effusion.  Dense calcifications are noted in the thoracic aorta
+and coronary arteries.
+
+ABDOMEN:  A trace amount of free fluid is present in the abdomen, concentrated
+in the perihepatic region.  The liver enhances normally.  Note is made of
+intrahepatic pneumobilia.  Changes of Roux-en-Y hepaticojejunostomy are
+present, with anastomotic suture line in the right abdomen, and no evidence of
+bowel dilation to suggest obstruction.  The gallbladder is surgically absent. 
+Scattered cystic lesions are again noted in the pancreas, likely representing
+IPMN.  There is no intra- or extrahepatic biliary ductal dilation.  The spleen
+is normal in size.
+
+Left adrenal appears slightly full, without discrete nodules identified. 
+Right adrenal is normal.  The kidneys enhance promptly and symmetrically,
+without masses or hydronephrosis.  Note is made of bilateral extrarenal
+pelves.
+
+The stomach and small bowel are relatively decompressed.
+
+PELVIS:  The appendix is normal.  A moderate amount of retained fecal material
+is noted in the colon.  There is massive dilation of the sigmoid colon up to
+10 cm, presumably secondary to significant fecal impaction.  There is no bowel
+wall thinning, abnormal enhancement, or pneumatosis to suggest ischemia.  No
+extraluminal air/fluid collections are present to suggest perforation.  No
+portal or mesenteric venous gas is present.
+
+Foley catheter is present in a collapsed bladder.  The uterus is atrophic.  
+
+Scattered calcifications and soft plaques are noted throughout the abdominal
+aorta, with moderate stenosis of branch vessel origins.  Retroperitoneal and
+mesenteric lymph nodes are not pathologically enlarged.
+
+Bones are diffusely demineralized, with moderate multilevel degenerative
+changes.  Note is made of transitional lumbosacral anatomy.  L1 compression
+fracture has progressed, with 60% loss of height.  New interval L2 compression
+fracture is also present, with 60% loss of height.  There is minimal
+anterolisthesis at L5-S1.  Moderate diffuse disc bulges are present at
+multiple levels, most significant at L5-S1, with abutment of the thecal sac
+outline.  Please note that CT cannot visualize intrathecal detail.  No
+suspicious lytic or sclerotic osseous lesions are identified.  There is
+diffuse fatty atrophy of the paraspinal and thoracoabdominal wall musculature.
+Calcified injection granulomas are noted in the right gluteus.
+
+IMPRESSION:
+1.  Bilateral atelectasis or consolidation, with small pleural effusions.
+2.  Marked sigmoid distention up to 10 cm, likely secondary to fecal
+impaction, though other causes such as ischemia are not entirely excluded.
+3.  Hepaticojejunostomy changes, with intact Roux-en-Y limb and no evidence of
+obstruction. Small amount of perihepatic free fluid, non-specific.
+4.  Pancreatic cystic lesion most likely representing IPMN. If clinically
+appropriate, given patient age, could be further evaluated on MRCP.
+5.  Diffuse atherosclerosis.
+
+
+[RADIOLOGY] INDICATION:  ___ female with worsening renal failure.  Ultrasound of
+the kidneys to rule out urinary obstruction.
+
+COMPARISON:  CT abdomen and pelvis ___.
+
+FINDINGS:  The left kidney measures 10.3 cm.  There is no focal lesion or
+hydronephrosis.  The lower pole of the right kidney could not be adequately
+visualized because of the overlying bowel gases.  The upper and mid poles
+appear normal with no hydronephrosis or calculi.  Based on the recent CT scan
+done on ___, no structural lesion or hydronephrosis was visualized in the
+right kidney.  The urinary bladder is empty with a Foley catheter in situ.
+
+IMPRESSION:  Normal left kidney.  Lower pole of the right kidney could not be
+adequately visualized on ultrasound, but no obvious hydronephrosis seen.
+
+
+[RADIOLOGY] INDICATION:  Altered mental status.
+
+COMPARISON:  ___.
+
+TECHNIQUE:  Contiguous axial MDCT-acquired images of the head were obtained
+without administration of intravenous contrast. Several sequences were
+degraded by motion artifact and were repeated with better result.   
+
+FINDINGS:  There is no hemorrhage. There is no evidence of major acute
+vascular territorial infarction, allowing for the extensive periventricular
+white matter hypodensities, likely the sequelae of chronic small vessel
+ischemic disease. More focal hypodensity in the right frontal region may
+represent encephalomalacia related to remote cortical infarct. The ventricles
+and sulci are prominent in size and configuration, likely due to age-related
+global parenchymal atrophy.
+
+The visualized paranasal sinuses and mastoid air cells are clear.
+
+IMPRESSION:  No acute intracranial abnormality.
+
+
+[RADIOLOGY] INDICATION:  Recently inserted peripherally inserted central venous catheter. 
+Background of altered mental status.
+
+COMPARISON:  Radiographs dated back to ___ and most recently ___.
+
+FINDINGS:  Bilateral moderately large pleural effusions have increased in size
+since ___.  Hazy opacity in the right lung is most likely due to
+posteriorly layering fluid.  Retrocardiac linear opacity is unchanged since
+___ and is consistent with a tortuous thoracic descending aorta.  Mild
+cardiomegaly is stable.  The newly inserted left upper extremity peripherally
+inserted central venous catheter tip is obscured by an overlying cardiac
+electrode with the distal tip of the wire lies at the lower SVC.
+
+Wedge compression fractures of L1 and L2 are associated with moderately severe
+loss of vertebral height, unchanged since ___.
+
+IMPRESSION:
+1.  Satisfactory position of peripherally inserted central venous catheter
+wire tip, although the distal floppy tip is obscured by overlying cardiac
+electrode.
+2.  Enlarging bilateral moderately large pleural effusions.
+
+Results regarding the peripherally inserted central venous catheter
+communicated to ___, venous access nurse practitioner, at approximately
+1430 hours, ___.
+
+PROCEDURES (readable):
+- 3897 (ICD-9) — Central venous catheter placement with guidance
+
+DIAGNOSES (readable):
+- 0389 (ICD-9) — Unspecified septicemia
+- 78552 (ICD-9) — Septic shock
+- 5990 (ICD-9) — Urinary tract infection, site not specified
+- 5849 (ICD-9) — Acute kidney failure, unspecified
+- 2762 (ICD-9) — Acidosis
+- 5180 (ICD-9) — Pulmonary collapse
+- 49121 (ICD-9) — Obstructive chronic bronchitis with (acute) exacerbation
+- 99592 (ICD-9) — Severe sepsis
+- 0414 (ICD-9) — Escherichia coli [E. coli] infection in conditions classified elsewhere and of unspecified site
+- 42731 (ICD-9) — Atrial fibrillation
+- 27652 (ICD-9) — Hypovolemia
+- 28529 (ICD-9) — Anemia of other chronic disease
+- 2948 (ICD-9) — Other persistent mental disorders due to conditions classified elsewhere
+- 4019 (ICD-9) — Unspecified essential hypertension
+- 2724 (ICD-9) — Other and unspecified hyperlipidemia
+- 56032 (ICD-9) — Fecal impaction
+
+LAB ITEMS (readable, deduped):
+- % Hemoglobin A1c (Item 50852)
+- Albumin (Item 50862)
+- Anion Gap (Item 50868)
+- Anisocytosis (Item 51137)
+- Atypical Lymphocytes (Item 51143)
+- Bands (Item 51144)
+- Base Excess (Item 50802)
+- Basophils (Item 51146)
+- Bicarbonate (Item 50882)
+- Calcium, Total (Item 50893)
+- Calculated Total CO2 (Item 50804)
+- Chloride (Item 50902)
+- Chloride, Urine (Item 51078)
+- Creatine Kinase (CK) (Item 50910)
+- Creatine Kinase, MB Isoenzyme (Item 50911)
+- Creatinine (Item 50912)
+- Creatinine, Urine (Item 51082)
+- EDTA Hold (Item 50919)
+- Eosinophils (Item 51200)
+- Glucose (Item 50931)
+- Hematocrit (Item 51221)
+- Hemoglobin (Item 51222)
+- Hypochromia (Item 51233)
+- INR(PT) (Item 51237)
+- Intubated (Item 50812)
+- Lactate (Item 50813)
+- Length of Urine Collection (Item 51087)
+- Lymphocytes (Item 51244)
+- MCH (Item 51248)
+- MCHC (Item 51249)
+- MCV (Item 51250)
+- Macrocytes (Item 51246)
+- Magnesium (Item 50960)
+- Metamyelocytes (Item 51251)
+- Microcytes (Item 51252)
+- Monocytes (Item 51254)
+- Myelocytes (Item 51255)
+- Neutrophils (Item 51256)
+- Osmolality, Urine (Item 51093)
+- Ovalocytes (Item 51260)
+- PT (Item 51274)
+- PTT (Item 51275)
+- Phosphate (Item 50970)
+- Platelet Count (Item 51265)
+- Platelet Smear (Item 51266)
+- Poikilocytosis (Item 51267)
+- Polychromasia (Item 51268)
+- Potassium (Item 50971)
+- Potassium, Urine (Item 51097)
+- Potassium, Whole Blood (Item 50822)
+- RDW (Item 51277)
+- Red Blood Cells (Item 51279)
+- Schistocytes (Item 51287)
+- Sodium (Item 50983)
+- Sodium, Urine (Item 51100)
+- Specimen Type (Item 52033)
+- Target Cells (Item 51294)
+- Temperature (Item 50825)
+- Troponin T (Item 51003)
+- Urea Nitrogen (Item 51006)
+- Vancomycin (Item 51009)
+- White Blood Cells (Item 51301)
+- eAG (Item 51613)
+- pCO2 (Item 50818)
+- pH (Item 50820)
+- pO2 (Item 50821)

summaries/subject_16139570_hadm_23551539_summary.txt

@@ -0,0 +1,55 @@
+**Patient Summary**
+
+* Age: 91
+* Gender: Female
+* Admission ID: 23551539
+* Admission Type: Emergency Ward (EW EMER)
+* Discharge Location: Deceased
+* Insurance: Medicare
+* Race: Asian-Chinese
+* Marital Status: Widow
+* Language: Unknown
+
+**Clinical Summary**
+
+The patient was admitted to the emergency ward with a chief complaint of fever to 103°F, sepsis, and a history of falls with a subdural hematoma (SDH). She was found to have a urinary tract infection (UTI), fecal impaction, and polymicrobial bacteremia. The patient was started on broad-spectrum antibiotics, including vancomycin, zosyn, and azithromycin. Despite aggressive hydration and supportive care, the patient developed progressive acute renal failure and eventually succumbed to the illness.
+
+**Laboratory Results**
+
+* Complete Blood Count (CBC): 31.5 WBC, 21% bands, 3.49 RBC, 9.4 HGB, 29.4 HCT
+* Electrolytes: Sodium 146, Potassium 4.1, Chloride 104, Phosphate 3.5
+* Liver Function Tests (LFTs): ALT 22, AST 26, ALK Phos 135
+* Kidney Function Tests (KFTs): Creatinine 1.4, Urea Nitrogen 20
+* Urine Analysis: Protein 30, Glucose negative, Ketone negative, Nitrite negative, Bacteria positive
+* Blood Cultures: E. coli resistant to zosyn, GNR (Gram-negative rods)
+
+**Imaging Results**
+
+* Chest X-ray (CXR): Small bilateral pleural effusions, bibasilar atelectasis or consolidation
+* CT Abdomen and Pelvis: Marked sigmoid distention up to 10 cm, likely secondary to fecal impaction; Hepaticojejunostomy changes; Pancreatic cystic lesion most likely representing IPMN
+* Head CT: No acute intracranial abnormality
+* Echocardiogram (ECHO): Left atrium elongated, right atrium moderately dilated, left ventricular wall thickness normal, left ventricular cavity size normal, left ventricular systolic function hyperdynamic (EF>75%)
+
+**Diagnoses**
+
+* ICD-9: 3897 (Central venous catheter placement with guidance)
+* ICD-9: 0389 (Unspecified septicemia)
+* ICD-9: 78552 (Septic shock)
+* ICD-9: 5990 (Urinary tract infection, site not specified)
+* ICD-9: 5849 (Acute kidney failure, unspecified)
+* ICD-9: 2762 (Acidosis)
+* ICD-9: 5180 (Pulmonary collapse)
+* ICD-9: 49121 (Obstructive chronic bronchitis with acute exacerbation)
+* ICD-9: 99592 (Severe sepsis)
+* ICD-9: 0414 (Escherichia coli [E. coli] infection in conditions classified elsewhere and of unspecified site)
+* ICD-9: 42731 (Atrial fibrillation)
+* ICD-9: 27652 (Hypovolemia)
+* ICD-9: 28529 (Anemia of other chronic disease)
+* ICD-9: 2948 (Other persistent mental disorders due to conditions classified elsewhere)
+* ICD-9: 4019 (Unspecified essential hypertension)
+* ICD-9: 2724 (Other and unspecified hyperlipidemia)
+* ICD-9: 56032 (Fecal impaction)
+
+**Medications**
+
+* Aspirin

summaries/subject_16299682_hadm_27576967_input.txt

@@ -0,0 +1,242 @@
+PRE-OPERATIVE SUMMARY INPUT (SINGLE ADMISSION):
+
+PATIENT:
+- Age: 82
+- Gender: F
+
+ADMISSION:
+- Admission ID: 27576967
+- Admission Type: EU OBSERVATION
+- Admission Location: EMERGENCY ROOM
+- Discharge Location: nan
+- Insurance: Medicare
+- Race: WHITE
+- Marital Status: WIDOWED
+- Language: ENGLISH
+
+PROCEDURES (0 total):
+- None
+
+DIAGNOSES (13 total):
+- 80507 (ICD-9)
+- 87341 (ICD-9)
+- 9160 (ICD-9)
+- E8859 (ICD-9)
+- E8490 (ICD-9)
+- 7812 (ICD-9)
+- V452 (ICD-9)
+- 3315 (ICD-9)
+- 2724 (ICD-9)
+- 311 (ICD-9)
+- 4556 (ICD-9)
+- 73300 (ICD-9)
+- 5990 (ICD-9)
+
+LABORATORY RESULTS:
+- None
+
+CLINICAL NOTES:
+[RADIOLOGY NOTE]
+EXAMINATION:
+CT HEAD W/O CONTRAST
+
+INDICATION:  Status post fall. Has a known VP shunt. Evaluate for shunt
+continuity.
+
+TECHNIQUE:  Contiguous axial images of the brain were obtained without the
+administration of IV contrast. Coronal and sagittal as well as thin
+bone-algorithm reconstructed images were obtained.
+
+DOSE:  DLP: 891.93 mGy-cm;
+CTDIvol:  52.71 mGy.
+
+COMPARISON:  None.
+
+FINDINGS: 
+
+There is no evidence of hemorrhage, edema, mass, mass effect, or large
+vascular territory infarction. The sulci are prominent, likely due to age
+related volume loss. The ventricles are enlarged. A ventriculoperitoneal shunt
+enters via a right frontal burr hole. The tip terminates in the frontal horn
+of the left lateral ventricle. The shunt itself appears contiguous without
+evidence of a fracture in the catheter. The basal cisterns are patent.
+Periventricular confluent white matter hypodensities are noted, and
+nonspecific. They likely represent chronic small vessel ischemic disease.
+Moderate calcifications are noted in the intracranial arteries.
+
+No fracture is identified. There is significant opacification of the frontal
+sinuses and left ethmoidal air cells. Air-fluid levels and aerosolized
+secretions are noted in the bilateral maxillary sinuses. Mild mucosal
+thickening is present in the sphenoid sinus. The mastoid air cells and middle
+ear cavities are clear. The soft tissues and orbits are unremarkable.
+
+IMPRESSION: 
+
+1. No acute intracranial abnormality.
+2. The ventriculoperitoneal shunt appears intact with the tip in the left
+lateral ventricle. The ventricles are enlarged.  Comparison to prior exams
+would be helpful to ensure that the size of the ventricles is stable.
+3.  Sinus disease, with a possible acute component.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CT C-SPINE W/O CONTRAST
+
+INDICATION:  Status post fall with a known VP shunt. Evaluate for VP shunt
+continuity and evidence of injury.
+
+TECHNIQUE:  Contiguous axial images were obtained.  Sagittal and coronal
+reformatted images were generated.  No contrast was administered.
+
+CTDIvol:  36.6 mGy.
+DLP:  758.96 mGy-cm.
+
+COMPARISON:  None.
+
+FINDINGS: 
+
+There is no abnormality of the prevertebral soft tissues.  There is a
+minimally displaced fracture of the right C7 pedicle extending into the right
+articular pillar and superior articular facet of C7 (2, 44 and 400 B, 46). No
+fracture fragments enter the spinal canal.  No other fracture is identified.
+Alignment is normal. There are moderate multilevel degenerative changes, most
+marked at C5-6 and C6-7, where there is disc space narrowing and a posterior
+disc osteophyte complexes which are causing moderate spinal canal narrowing.
+There is no severe spinal canal narrowing. Additionally, there is multilevel
+facet hypertrophy and uncovertebral hypertrophy, causing mild multilevel
+neural foraminal narrowing.
+
+The ventriculoperitoneal shunt is intact as it courses through the neck. There
+is no surrounding stranding or evidence of surrounding free fluid. There is
+mucosal thickening in the left maxillary sinus and an air-fluid level in the
+right maxillary sinus. There is no cervical lymphadenopathy. The thyroid gland
+is unremarkable. The apices of the lungs are clear.
+
+IMPRESSION: 
+
+1. Minimally displaced fracture of the right C7 pedicle extending into the
+right articular pillar and superior articular facet. No acute malalignment.
+2. Intact ventriculoperitoneal shunt.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  CT CHEST W/O CONTRAST
+
+INDICATION:  Status post fall with thoracic spine tenderness and right
+paravertebral tenderness. Evaluate for fracture.
+
+TECHNIQUE:  Multidetector helical scanning of the chest was performed without
+intravenous contrast agent reconstructed as contiguous 5- and 1.25-mm thick
+axial, 2.5-mm thick coronal and parasagittal, and 8 x 8 mm MIPs axial images.
+
+DOSE:  DLP: 378.32 mGy-cm.
+
+COMPARISON:  None.
+
+FINDINGS: 
+
+The imaged portions of the thyroid gland are normal. There is no axillary
+lymphadenopathy. A few scattered subcentimeter mediastinal lymph nodes are
+noted, though none meet criteria for pathologic enlargement. There is no free
+fluid or evidence of a mediastinal hematoma. There is no hilar
+lymphadenopathy.
+
+The heart is normal in size. There is no pericardial effusion. Moderate
+atherosclerotic calcifications are noted along the coronary arteries and mild
+calcifications are noted on the aortic valve. The thoracic aorta is normal in
+caliber with moderate calcifications along the arch. The main pulmonary artery
+trunks are normal in diameter.
+
+The airways are patent to the subsegmental levels with dependent debris seen
+bilaterally. There is mild diffuse bronchial wall thickening and irregularity,
+consistent with chronic small airways disease. Bronchiectasis is most notable
+the right lower lobe, potentially from a prior infection. There is mild
+atelectasis is the right lower lobe. Diffuse ground-glass opacification in the
+left lower lobe with associated volume loss and multiple foci of mucous
+plugging is also most likely atelectasis. No focal endobronchial lesion is
+identified.
+
+There is minimal biapical scarring. No discrete nodule is identified. There is
+no pulmonary edema, pleural effusion, or pneumothorax.
+
+There is a small hiatal hernia and diffuse esophageal wall thickening
+throughout the chest. This exam is not tailored to evaluate the
+subdiaphragmatic structures. Within the limitations, the imaged portions of
+the liver, spleen, pancreas, adrenal glands, and kidneys are normal.
+
+No fracture is identified. Mild degenerative changes are noted in the
+bilateral shoulders and throughout the thoracic spine. There are no worrisome
+lytic or sclerotic osseous lesions. A hemangioma is noted in T12 (4, 209).
+
+The ventriculoperitoneal shunt is intact as it courses through the right chest
+wall. There is no surrounding stranding and or surrounding free fluid. The
+soft tissues are otherwise unremarkable.
+
+IMPRESSION: 
+
+1. No evidence of a thoracic spine or rib fracture.
+2.  Chronic small airways disease with bronchiectasis in the right lower lobe
+and mucous plugging and significant atelectasis in the left lower lobe.
+3. Diffuse nonspecific is esophageal wall thickening.
+4. Intact ventriculoperitoneal shunt.
+
+[RADIOLOGY NOTE]
+EXAMINATION:  MR CERVICAL SPINE W/O CONTRAST
+
+INDICATION:  History: ___ with acute C7 pedicle and facet fx  // Evidence of
+ligamentous injujry
+
+TECHNIQUE:  Sagittal imaging was performed with T2, T1, and STIR technique.
+Axial gradient echo and T2 weighted imaging was performed.  Sagittal
+diffusion-weighted imaging was also performed.
+
+COMPARISON:  CT cervical spine ___.
+
+FINDINGS: 
+
+The examination is somewhat limited secondary to artifact from patient motion.
+
+The C6-C7 pedicle fracture is better depicted on the prior CT. There is
+increased T2/STIR signal in the location of the fracture.
+
+There is increased T2/STIR signal within the prevertebral soft tissues at the
+level of the fracture likely representing edema. There is no evidence of large
+hematoma.
+
+The vertebral body heights within the cervical spine are maintained. There is
+minimal spondylolisthesis of C4 on C5, minimal retrolisthesis of C5 on C6, and
+of C6 on C7.
+
+The cervical spinal cord is normal in signal and morphology. There is no
+diffusion signal abnormality within the cervical spine. There is no evidence
+of epidural hematoma or cord edema.
+
+At the C2-C3 level, the spinal canal and neural foramina appear normal.
+
+At the C3-C4 level, the spinal canal appears normal. Uncovertebral and facet
+arthropathy cause mild bilateral neural foraminal narrowing, right greater
+than left.
+
+At the C4-C5 level, there is a small posterior disc protrusion which causes
+mild spinal canal narrowing. Uncovertebral and facet arthropathy cause mild
+right neural foraminal narrowing.
+
+At the C5-C6 level, there is a posterior disc protrusion which causes mild to
+moderate spinal canal narrowing with contact the ventral surface of the spinal
+cord. Uncovertebral and facet arthropathy cause mild left neural foraminal
+narrowing.
+
+At the C6-C7 level, there is a broad-based disc protrusion and intervertebral
+osteophytes which cause minimal spinal canal narrowing. The neural foramina
+appear normal.
+
+At the C7-T1 level, the spinal canal and neural foramina appear normal.
+
+IMPRESSION:
+
+
+1. Right C7 pedicle fracture is better depicted on prior CT. Associated edema
+at the level of the fracture and within the adjacent prevertebral soft
+tissues.
+2. No clear evidence of ligamentous injury.
+3. No epidural hematoma, cord compression, cord edema, or cord infarct.
+4. Multilevel cervical spondylosis, greatest at the C5-C6 and C6-C7 levels, as
+described.