Sentiment analysis of clinical narratives: A scoping review

A clinical sentiment is a judgment, thought or attitude promoted by an observation with respect to the health of an individual. Sentiment analysis has drawn attention in the healthcare domain for secondary use of data from clinical narratives, with a variety of applications including predicting the likelihood of emerging mental illnesses or clinical outcomes. The current state of research has not yet been summarized. This study presents results from a scoping review aiming at providing an overview of sentiment analysis of clinical narratives in order to summarize existing research and identify open research gaps. The scoping review was carried out in line with the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guideline. Studies were identified by searching 4 electronic databases (e.g., PubMed, IEEE Xplore) in addition to conducting backward and forward reference list checking of the included studies. We extracted information on use cases, methods and tools applied, used datasets and performance of the sentiment analysis approach. Of 1,200 citations retrieved, 29 unique studies were included in the review covering a period of 8 years. Most studies apply general domain tools (e.g. TextBlob) and sentiment lexicons (e.g. SentiWordNet) for realizing use cases such as prediction of clinical outcomes; others proposed new domain-specific sentiment analysis approaches based on machine learning. Accuracy values between 71.5-88.2% are reported. Data used for evaluation and test are often retrieved from MIMIC databases or i2b2 challenges. Latest developments related to artificial neural networks are not yet fully considered in this domain. We conclude that future research should focus on developing a gold standard sentiment lexicon, adapted to the specific characteristics of clinical narratives. Efforts have to be made to either augment existing or create new high-quality labeled data sets of clinical narratives. Last, the suitability of state-of-the-art machine learning methods for natural language processing and in particular transformer-based models should be investigated for their application for sentiment analysis of clinical narratives

A safer surgical ward: real-time patient safety risk assessment for the post-operative care environment

The inpatient ward environment is the basic unit of a healthcare facility. Both intrinsic and extrinsic influences on this unit often dictate the quality and safety of care. For surgical patients, although significant focus has been given to care quality in the peri-operative phase, it has become increasingly evident that the overall outcome is determined during the post-operative period of care on the surgical ward. This is demonstrated through the concept of failure to rescue, where stark differences in mortality rates between institutions are seen despite similar complication rates. Research to identify the drivers of these variations often focus on specific themes, rather than evaluating the surgical ward as a system. Furthermore, much of the research examines large administrative datasets with analysis conducted at the institutional, rather than unit level. This thesis assesses the degree of variation that exists on surgical wards and identifies contributors to error that span the Donabedian model; this considers how processes are performed and how structural factors may influence outcomes. A close examination at the grassroots level has facilitated the identification of granular new metrics with direct relevance to day-to-day care at the ward level. With this approach, the potential for real-time risk assessment of this environment has been proposed, along with future directions to realise this objective. This has been achieved via a sequence of studies that utilise a range of methods. Following a review of the current literature, a semi-structured interview study was conducted across multiple sites. The experiences of surgical patients, nurses, doctors and managers was explored through 51 interviews. Stakeholders were acutely aware that some surgical wards were safer than others and were able to identify errors within a number of processes, such as the conduction of ward rounds, communication among healthcare staff and medication administration. Furthermore, the development of potential errors was seen as embedded in complex structural influences; the effective performance of processes was impacted by factors such as staffing shortages, organisational bed pressures (i.e., leading to outlier patients) and a potentially challenging physical environment, with layout and lack of space presented as a potential obstacle to safe care. Participants were also able to propose a range of quality markers that reflected the range of influences at play on the ward. This was followed with a Delphi Consensus study which organised the wide range of factors identified in the previous study and prioritised those deemed to have the most influence on the delivery of safe care on the surgical ward. An international panel of experts in patient safety and patient advocates considered multiple facets of this environment. Sixty-four of the 85 statements in the final questionnaire achieved consensus, highlighting the inherent complexity of the surgical ward. This led to an ethnographic observational study of surgical wards, with the aim to assess the degree of variability and measurability of these prioritised factors. Three broad domains were observed – processes of care, the care environment and organisational health. Alongside this observation, patients and nurses also completed validated questionnaires that measure safety culture. There was a high degree of disparity with respect to how a ward behaves as a system from day-to-day. Variation in timings and features of the ward round as well as timeliness of clinical and nursing task completion was demonstrated. Organisational influences (e.g., staffing levels, skill mix, use of temporary staffing, ward occupancy, outlier patients etc) were highly dynamic. The final study establishes an association between measurable factors identified in the observational study and patient outcomes and presents the feasibility of using these as real-time measures of safe care on the surgical ward. Many of these risk factors are retrievable from routinely collected data and were extracted from electronic health records and duty rostering programmes. The patient outcomes identified were also available from the same data sources, namely wrong time medication errors and clinical deterioration. Preliminary statistical models of harm are presented in this study, thus demonstrating that local routinely collected data may have a role in predictive modelling of the risk of harm within a specific setting. Local teams may be able to harness their own data to predict their own risk. This could help guide future policies and improvement strategies. In conclusion, this thesis has comprehensively explored the entirety of the surgical ward as a system of care delivery, examined the complex array of factors at play as well as their potential interactions with one another and proposed new granular safety metrics that have a role for predictive modelling of the risk of harm at the local level. Further work is needed to develop these predictive models further, such as establishing methods to measure those factors that are not currently available through routinely collated data. This will allow future iterations of the predictive model to incorporate a wider range of factors that are potentially influencing care quality on the surgical ward, with the aim of enhancing sensitivity and applicability of the final model.Open Acces

NEEDS OF PATIENT’S FAMILIES IN THE HOSPITAL TELE-INTENSIVE CARE UNIT

Purpose: To explore, identify and describe the perceptions of family members of a patient admitted to a telemedicine intensive care unit (tele-ICU); and to determine if these needs differ from those established by the Critical Care Family Needs Inventory (CCFNI) in the traditional ICU setting. Background: The tele-ICU is a new care modality in which offsite nurses provide consultation to bedside clinical staff at geographically-dispersed ICUs. The last decade demonstrates a growing existence of tele-ICU’s in our healthcare culture. ’Information’, ‘close proximity’, ‘assurance’, ‘support’ and ‘comfort’ have been identified as the top five needs of family members in the traditional ICU setting. Yet, we do not know what the family needs are within the tele-ICU context. Significance: The complexity of the tele-ICU adds another dimension to patient-family care, requiring nurses to have appropriate knowledge of family member experiences in order to meet these needs. This study was the first of its kind using face-to-face interviews to focus on the unique perceptions and needs of family members in this new care modality; and a follow-up to the published pilot study by this author. Methods: This was a descriptive study using exploratory inquiry; semi-structured recorded interview method was used with a convenience sample of family-members to assess their experiences, needs, and perceptions while patients received care in a tele-ICU. Conclusion: This study demonstrated significant gaps in communication about the tele-ICU between staff and patients’ family. This finding is consistent with the pilot study. Although once informed about the tele-ICU existence and purpose by the investigator, perceptions of the tele-ICU model of care were generally favorable. The fact that 11 of the 16 family-participants interviewed (68.75%) indicated that they had not been informed that the patient was receiving care in a tele-ICU, as well as all 16 (100%) of the respondents never having been introduced to the remote staff, suggests the need for more timely, organized, and proactive communication strategies to inform patients’ family members about this novel technology. Improved comprehension of the families’ understanding of the role of the tele-ICU in the care of critically ill patient may support their informational needs