4,339 research outputs found
A Framework (SOCRATex) for Hierarchical Annotation of Unstructured Electronic Health Records and Integration Into a Standardized Medical Database: Development and Usability Study
Background: Although electronic health records (EHRs) have been widely used in secondary assessments, clinical documents are relatively less utilized owing to the lack of standardized clinical text frameworks across different institutions.
Objective: This study aimed to develop a framework for processing unstructured clinical documents of EHRs and integration with standardized structured data.
Methods: We developed a framework known as Staged Optimization of Curation, Regularization, and Annotation of clinical text (SOCRATex). SOCRATex has the following four aspects: (1) extracting clinical notes for the target population and preprocessing the data, (2) defining the annotation schema with a hierarchical structure, (3) performing document-level hierarchical annotation using the annotation schema, and (4) indexing annotations for a search engine system. To test the usability of the proposed framework, proof-of-concept studies were performed on EHRs. We defined three distinctive patient groups and extracted their clinical documents (ie, pathology reports, radiology reports, and admission notes). The documents were annotated and integrated into the Observational Medical Outcomes Partnership (OMOP)-common data model (CDM) database. The annotations were used for creating Cox proportional hazard models with different settings of clinical analyses to measure (1) all-cause mortality, (2) thyroid cancer recurrence, and (3) 30-day hospital readmission.
Results: Overall, 1055 clinical documents of 953 patients were extracted and annotated using the defined annotation schemas. The generated annotations were indexed into an unstructured textual data repository. Using the annotations of pathology reports, we identified that node metastasis and lymphovascular tumor invasion were associated with all-cause mortality among colon and rectum cancer patients (both P=.02). The other analyses involving measuring thyroid cancer recurrence using radiology reports and 30-day hospital readmission using admission notes in depressive disorder patients also showed results consistent with previous findings.
Conclusions: We propose a framework for hierarchical annotation of textual data and integration into a standardized OMOP-CDM medical database. The proof-of-concept studies demonstrated that our framework can effectively process and integrate diverse clinical documents with standardized structured data for clinical research.ope
Literary Advice or Literally Advice? A comparative analysis of memoirs and self-help manuals as therapeutic devices for mental illnesses
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bruke litteratur som verktĂžy for Ă„ forbedre seg selv har Ăžkt betraktelig i lĂžpet av det siste Ă„rhundre. Overalt hvor man ser, finner man litterĂŠre verk med Ăžnske om Ă„ forbedre aspekter med livet. En sjanger som har bemerket seg spesielt pĂ„ dette omrĂ„det er selvhjelpssjangeren, som angivelig har et steg-for-steg-svar pĂ„ nĂŠrmest alt. Samtidig som denne sjangeren har utviklet seg, har ogsĂ„ sĂžkelyset pĂ„ mental helse Ăžkt betraktelig. Et utfall av dette er at selvhjelpssangeren tilbyr lesere raske kurer pĂ„ ulike mentale sykdommer. Til tross for gode tilbud, stiller jeg spĂžrsmĂ„l til at en slik monologisk guide kan ha enkle lĂžsninger pĂ„ kompliserte mentale sykdommer, og foreslĂ„r at man heller kan utforske memoarer som et godt alternativ til selvhjelpsbĂžker. Gjennom teorier hovedsakelig av Mikhail M. Bakthin, Marielle MacĂ©, Wolfgang Iser og J. Hillis Miller, finner jeg at forstĂ„else av litteratur, diskurs og tilnĂŠrminger til litterĂŠre verk er avgjĂžrende for leserens utfall. Memoarer kan fremme et dialogisk samspill mellom tekst og leser, og forfattere av memoarer inviterer leseren til Ă„ ta del i leseprosessen og finne ut selv hva de Ăžnsker Ă„ fĂ„ ut av teksten. Denne avhandlingen gjennomfĂžrer en analyse av selvhjelpsboken The Depression Cure av Stephen L. Ilardi og memoarene Prozac Nation av Elizabeth Wurtzel og Girl, Interrupted av Susanna Kaysen. Ved Ă„ lese disse litterĂŠre verkene som terapeutisk litteratur, Ăžnsker jeg Ă„ fremme leserens rolle i lesningen og se pĂ„ hvilke muligheter forfatteren og teksten legger til rette for.Engelsk mastergradsoppgaveENG350MAHF-ENGMAHF-LĂF
Examining Depressive Symptoms Over Time in Women with Coronary Heart Disease
Coronary heart disease (CHD) is the number one killer of women in the US. Women also experience roughly twice as much depression as men, and depression in CHD is associated with increased morbidity and mortality. Despite these facts, women continue to be under-represented in CHD research, and results by gender are not routinely reported.
Screening for depression in this population is problematic due to inconsistent inclusion of somatic symptoms on screening instruments and disagreement about appropriate cutoff scores.
This body of work clarifies the concept of depression in women with CHD, presents a systematic review of the longitudinal literature on depressive symptoms in women with CHD examined by instrument, and presents results of a 3-month feasibility study examining womenâs depressive symptoms. The purpose of the study was to evaluate participant enrollment, data collection, preliminary quantitative trends, and qualitative surveys for qualitative data collection.
Participant recruitment by individuals other than the P.I. was generally poor and attrition was problematic (16.7 â 28%). Prevalence of mean depression screening scores â„ cutoff values averaged 30% at baseline, 26% at month 2, and 25% at month 3. Trends in symptom severity over the course of the study reflected trends in somatic symptoms and distress but not cognitive symptoms. Current depression was strongly correlated with fatigue and sleep as well as younger age, comorbid diabetes, a history of anxiety, and acute coronary syndrome symptoms. It was less strongly correlated with a history of depression and cardiac rehabilitation attendance. No correlation was found between current depression and employment status. Qualitative survey uptake was poor and the original survey was too restrictive, requiring modification.
This dissertation clarifies our understanding of the concept of depression in women with CHD and summarizes the longitudinal descriptive literature on depression in women with CHD. The dissertation study enhances our understanding of depressive symptoms experienced in this population, gives some important preliminary data on use of the PROMIS Depression 8b instrument in this population, highlights the importance of screening for depressive symptoms in this population, and emphasizes the ongoing need for CHD studies which examine and report data by gender
ìŁŒì ì°ìž ì„ì ì ìì± êž°ë° ë¶ì: ì°ìì ìž ë°íì ìí„ì ëłíë„Œ ì€ìŹìŒëĄ
íìë
ŒëŹž(ë°ìŹ) -- ììžëíê”ëíì : ì”í©êłŒíêž°ì ëíì ì”í©êłŒíë¶(ëì§ížì 볎ì”í©ì êł”), 2023. 2. ìŽê”ê”Ź.Major depressive disorder (commonly referred to as depression) is a common disorder that affects 3.8% of the world's population. Depression stems from various causes, such as genetics, aging, social factors, and abnormalities in the neurotransmitter system; thus, early detection and monitoring are essential. The human voice is considered a representative biomarker for observing depression; accordingly, several studies have developed an automatic depression diagnosis system based on speech.
However, constructing a speech corpus is a challenge, studies focus on adults under 60 years of age, and there are insufficient medical hypotheses based on the clinical findings of psychiatrists, limiting the evolution of the medical diagnostic tool. Moreover, the effect of taking antipsychotic drugs on speech characteristics during the treatment phase is overlooked.
Thus, this thesis studies a speech-based automatic depression diagnosis system at the semantic level (sentence). First, to analyze depression among the elderly whose emotional changes do not adequately reflect speech characteristics, it developed the mood-induced sentence to build the elderly depression speech corpus and designed an automatic depression diagnosis system for the elderly.
Second, it constructed an extrapyramidal symptom speech corpus to investigate the extrapyramidal symptoms, a typical side effect that can appear from an antipsychotic drug overdose. Accordingly, there is a strong correlation between the antipsychotic dose and speech characteristics. The study paved the way for a comprehensive examination of the automatic diagnosis system for depression.ìŁŒì ì°ìž ì„ì ìŠ íí ì°ìžìŠìŽëŒêł ìŒì»ŹìŽì§ë êž°ë¶ ì„ì ë ì ìžêłìž ì€ 3.8%ì ëŹíë ìŹëë€ìŽ êČȘìë° ìë ë§€ì° íí ì§ëłìŽë€. ì ì , ë
ží, ìŹíì ììž, ì êČœì ëŹëŹŒì§ ìČŽêłì ìŽìë± ë€ìí ììžìŒëĄ ë°ìíë ì°ìžìŠì ìĄ°êž° ë°êČŹ ë° ìŒì ìíììì êŽëŠŹê° ë§€ì° ì€ìíë€êł í ì ìë€. ìžê°ì ìì±ì ì°ìžìŠì êŽì°°íêž°ì ëíì ìž ë°ìŽì€ë§ì»€ëĄ ìŹêČšì ž ììŒë©°, ìì± ë°ìŽí°ë„Œ êž°ë°ìŒëĄí ìë ì°ìžìŠ ì§ëš ìì€í
ê°ë°ì ìí ìŹëŹ ì°ê”Źë€ìŽ ì§íëìŽ ìë€. ê·žëŹë ìì± ë§ëìč ê”Źì¶ì ìŽë €ìêłŒ 60ìž ìŽíì ì±ìžë€ìêČ ìŽì ìŽ ë§ì¶ìŽì§ ì°ê”Ź, ì ì êłŒ ììŹë€ì ìì ìêČŹì ë°íìŒëĄí ìíì ê°ì€ ì€ì ì 믞íĄë±ì íêłì ì ê°ì§êł ììŒë©°, ìŽë ìëŁ ì§ëš êž°ê”ŹëĄ ë°ì íëë° íêłì ìŽëŒêł í ì ìë€. ëí, íì ì ì± ìœëŹŒì ëł”ì©ìŽ ìì± íčì§ì 믞ìč ì ìë ìí„ ëí ê°êłŒëêł ìë€.
ëłž ë
ŒëŹžììë ìì íêłì ë€ì 볎ìíêž° ìí ìëŻžëĄ ì ìì€ (ëŹžì„ ëšì)ììì ìì± êž°ë° ìë ì°ìžìŠ ì§ëšì ëí ì°ê”Źë„Œ ìííêł ì íë€. ì°ì ì ìŒëĄ ê°ì ì ëłíê° ìì± íčì§ì ì ë°ìëì§ ìë ë
žìžìž”ì ì°ìžìŠ ë¶ìì ìíŽ ê°ì ë°í 돞ì„ì ê°ë°íìŹ ë
žìž ì°ìžìŠ ìì± ë§ëìčë„Œ ê”Źì¶íêł , ëŹžì„ ëšìììì êŽì°°ì í”íŽ ë
žìž ì°ìžìŠ ê”°ìì ê°ì ëŹžì„ ë°íê° ëŻžìčë ìí„êłŒ ê°ì ì ìŽë„Œ íìží ì ìììŒë©°, ë
žìžìž”ì ìë ì°ìžìŠ ì§ëš ìì€í
ì ì€êłíìë€. ì”ìą
ì ìŒëĄ íì ì ëł ìœëŹŒì êłŒëł”ì©ìŒëĄ ëíë ì ìë ëíì ìž ë¶ìì©ìž ì¶ìČŽìžëĄ ìŠìì ìĄ°ìŹíêž° ìíŽ ì¶ìČŽìžëĄ ìŠì ìì± ë§ëìčë„Œ ê”Źì¶íìêł , íì ì ëł ìœëŹŒì ëł”ì©ëêłŒ ìì± íčì§ê°ì ìêŽêŽêłë„Œ ë¶ìíìŹ ì°ìžìŠì ìčëŁ êłŒì ìì íì ì ëł ìœëŹŒìŽ ìì±ì 믞ìč ì ìë ìí„ì ëíŽì ìĄ°ìŹíìë€. ìŽë„Œ í”íŽ ìŁŒì ì°ìž ì„ì ì ììì ëí íŹêŽì ìž ì°ê”Źë„Œ ì§ííìë€.Chapter 1 Introduction 1
1.1 Research Motivations 3
1.1.1 Bridging the Gap Between Clinical View and Engineering 3
1.1.2 Limitations of Conventional Depressed Speech Corpora 4
1.1.3 Lack of Studies on Depression Among the Elderly 4
1.1.4 Depression Analysis on Semantic Level 6
1.1.5 How Antipsychotic Drug Affects the Human Voice? 7
1.2 Thesis objectives 9
1.3 Outline of the thesis 10
Chapter 2 Theoretical Background 13
2.1 Clinical View of Major Depressive Disorder 13
2.1.1 Types of Depression 14
2.1.2 Major Causes of Depression 15
2.1.3 Symptoms of Depression 17
2.1.4 Diagnosis of Depression 17
2.2 Objective Diagnostic Markers of Depression 19
2.3 Speech in Mental Disorder 19
2.4 Speech Production and Depression 21
2.5 Automatic Depression Diagnostic System 23
2.5.1 Acoustic Feature Representation 24
2.5.2 Classification / Prediction 27
Chapter 3 Developing Sentences for New Depressed Speech Corpus 31
3.1 Introduction 31
3.2 Building Depressed Speech Corpus 32
3.2.1 Elements of Speech Corpus Production 32
3.2.2 Conventional Depressed Speech Corpora 35
3.2.3 Factors Affecting Depressed Speech Characteristics 39
3.3 Motivations 40
3.3.1 Limitations of Conventional Depressed Speech Corpora 40
3.3.2 Attitude of Subjects to Depression: Masked Depression 43
3.3.3 Emotions in Reading 45
3.3.4 Objectives of this Chapter 45
3.4 Proposed Methods 46
3.4.1 Selection of Words 46
3.4.2 Structure of Sentence 47
3.5 Results 49
3.5.1 Mood-Inducing Sentences (MIS) 49
3.5.2 Neutral Sentences for Extrapyramidal Symptom Analysis 49
3.6 Summary 51
Chapter 4 Screening Depression in The Elderly 52
4.1 Introduction 52
4.2 Korean Elderly Depressive Speech Corpus 55
4.2.1 Participants 55
4.2.2 Recording Procedure 57
4.2.3 Recording Specification 58
4.3 Proposed Methods 59
4.3.1 Voice-based Screening Algorithm for Depression 59
4.3.2 Extraction of Acoustic Features 59
4.3.3 Feature Selection System and Distance Computation 62
4.3.4 Classification and Statistical Analyses 63
4.4 Results 65
4.5 Discussion 69
4.6 Summary 74
Chapter 5 Correlation Analysis of Antipsychotic Dose and Speech Characteristics 75
5.1 Introduction 75
5.2 Korean Extrapyramidal Symptoms Speech Corpus 78
5.2.1 Participants 78
5.2.2 Recording Process 79
5.2.3 Extrapyramidal Symptoms Annotation and Equivalent Dose Calculations 80
5.3 Proposed Methods 81
5.3.1 Acoustic Feature Extraction 81
5.3.2 Speech Characteristics Analysis recording to Eq.dose 83
5.4 Results 83
5.5 Discussion 87
5.6 Summary 90
Chapter 6 Conclusions and Future Work 91
6.1 Conclusions 91
6.2 Future work 95
Bibliography 97
ìŽ ëĄ 121ë°
Autonomy and autonomy disturbances in self-development and psychopathology: research on motivation, attachment, and clinical process
Self-determination theory (SDT) maintains that the adequate support and satisfaction of individuals' psychological needs for autonomy, competence, and relatedness promotes the gradual unfolding of individuals' integrative tendencies, as manifested through intrinsic motivation, internalization, identity development, and integrative emotion regulation. At the same time, the thwarting of these same psychological needs and the resultant need frustration is presumed to evoke or amplify a variety of psychopathologies, many of which involve autonomy disturbances. We begin by defining what autonomy involves and how socializing agents, particularly parents, can provide a nurturing (i.e., need-supportive) environment, and we review research within the SDT literature that has shed light on various integrative tendencies and how caregivers facilitate them. In the second part of this chapter, we detail how many forms of psychopathology involve autonomy disturbances and are associated with a history of psychological need thwarting. We especially focus on internally controlling regulation in internalizing disorders; impairments of internalization in conduct disorders and antisocial behavior; and fragmented self-functioning in borderline and dissociative disorders. The role of autonomy support as an ameliorative factor in treatment settings is then discussed among other translational issues. Finally we highlight some implications of recognizing the important role of basic psychological needs for both growth-related and pathology-related processes
The biopsychosocial model and hypothyroidism
This paper comments on the role and emergence of the biopsychosocial model in modern medical literature and health care settings. The evolution of the biopsychosocial model and its close association with modern pain theory is also examined. This paper seeks to discuss the place of this model with respect to the management of hypothyroidism. This discussion represents a forerunner to a randomised control trial that will seek to investigate the effect of a biopsychosocial-based treatment regime on hypothyroidism
Fatherhood and mental illness: a review of key issues
Researchers have traditionally paid little attention to the intersections between menâs mental illness and family life. Recently, however, this has been changing. This paper provides practitioners and policy-makers with a broad overview of some of the key issues identified in the growing literature on paternal mental illness.
Key messages
Compared to many other life stages, the transition to fatherhood and the early years of childrearing are periods in which men are at a substantially increased risk of experiencing psychological distress.
The children of men with a mental illness are more likely than other children to experience internalising (i.e., emotional) and externalising (i.e., behavioural) problems, as well as to be diagnosed with a mental illness themselves.
Parenting behaviour is one of the mechanisms by which parental mental illness may translate into problem outcomes in children. Fathers with a mental illness are more likely than other fathers to show low levels of parental engagement, warmth and appropriate monitoring.
The scarce qualitative literature exploring fathers\u27 experiences of mental illness suggests that fatherhood is central to the image many men have of themselves - their experience of mental illness and their paternal identity are inextricably linked.
Stigma is a significant source of suffering for many people with mental health concerns. Fathers with a mental illness can be subject to unique forms of stigma, which can influence their perceptions and experiences in a number of ways.
Psychiatric and welfare service providers in Australia and internationally have often struggled to effectively engage fathers, either failing to see men as members of a family unit, or failing to offer services tailored to their specific needs
Multimodal Machine Learning for Automated ICD Coding
This study presents a multimodal machine learning model to predict ICD-10
diagnostic codes. We developed separate machine learning models that can handle
data from different modalities, including unstructured text, semi-structured
text and structured tabular data. We further employed an ensemble method to
integrate all modality-specific models to generate ICD-10 codes. Key evidence
was also extracted to make our prediction more convincing and explainable. We
used the Medical Information Mart for Intensive Care III (MIMIC -III) dataset
to validate our approach. For ICD code prediction, our best-performing model
(micro-F1 = 0.7633, micro-AUC = 0.9541) significantly outperforms other
baseline models including TF-IDF (micro-F1 = 0.6721, micro-AUC = 0.7879) and
Text-CNN model (micro-F1 = 0.6569, micro-AUC = 0.9235). For interpretability,
our approach achieves a Jaccard Similarity Coefficient (JSC) of 0.1806 on text
data and 0.3105 on tabular data, where well-trained physicians achieve 0.2780
and 0.5002 respectively.Comment: Machine Learning for Healthcare 201
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