Designing Clinical Data Presentation Using Cognitive Task Analysis Methods

Despite the many decades of research on effective use of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practicing dentists in the United States. One critical reason is the poor usability of clinical systems, which makes it difficult for providers to navigate through the system and obtain an integrated view of patient data during patient care. Cognitive science methods have shown significant promise to meaningfully inform and formulate the design, development and assessment of clinical information systems. Most of these methods were applied to evaluate the design of systems after they have been developed. Very few studies, on the other hand, have used cognitive engineering methods to inform the design process for a system itself. It is this gap in knowledge – how cognitive engineering methods can be optimally applied to inform the system design process – that this research seeks to address through this project proposal. This project examined the cognitive processes and information management strategies used by dentists during a typical patient exam and used the results to inform the design of an electronic dental record interface. The resulting 'proof of concept' was evaluated to determine the effectiveness and efficiency of such a cognitively engineered and application flow design. The results of this study contribute to designing clinical systems that provide clinicians with better cognitive support during patient care. Such a system will contribute to enhancing the quality and safety of patient care, and potentially to reducing healthcare costs

Recurrent non immune hydrops fetalis: a case report

Recurrent non-immune fetal hydrops (NIHF) is a known but rare disease. We report a case of recurrent fetal hydrops in a multipara with no significant surgical or medical history. She presented for a preconceptional counselling with a background history of having two previous pregnancies affected by hydrops. Both the affected pregnancies resulted in mid trimester pregnancy termination. Detailed evaluation of the couple was done in our hospital before planning the third pregnancy. No obvious cause of recurrent hydrops was found. She conceived spontaneously and finally delivered a healthy baby. This case highlights the fact that thorough investigation is essential in case of hydrops fetalis so that further pregnancies are not affected

Heterotopic triplet gestation in natural conception following an IVF cycle: a rare case report

Heterotopic gestation although common with assisted conception techniques is very rare with natural conception. High index of suspicion is required for timely intervention and prevention of morbidity and mortality. We report a rare case of heterotopic pregnancy in a 34 year of G2 P1 L2 women with previous conception following ART (IVF) for unexplained infertility. She presented with 7 ½ weeks of amenorrhoea with no other signs or symptoms and diagnosis picked up on ultrasound examination as triplet gestation at 7 weeks with twin intrauterine gestation with sac 1 - 19 × 5 mm with intrauterine live fetus, sac 2 - 17 × 7 mm gestational sac, no yolk sac or fetal pole imaged -anembryonic intrauterine pregnancy and sac -3 as right adnexal sac 5 × 6 mm - anembryonic right ectopic pregnancy. She was managed successfully with suction & evacuation & methotrexate

Identifying Patients' Smoking Status from Electronic Dental Records Data

Smoking is a significant risk factor for initiation and progression of oral diseases. A patient's current smoking status and tobacco dependency can aid clinical decision making and treatment planning. The free-text nature of this data limits accessibility causing obstacles during the time of care and research utility. No studies exist on extracting patient's smoking status automatically from the Electronic Dental Record. This study reports the development and evaluation of an NLP system for this purpose

Leveraging Electronic Dental Record Data to Classify Patients Based on Their Smoking Intensity

Background Smoking is an established risk factor for oral diseases and, therefore, dental clinicians routinely assess and record their patients' detailed smoking status. Researchers have successfully extracted smoking history from electronic health records (EHRs) using text mining methods. However, they could not retrieve patients' smoking intensity due to its limited availability in the EHR. The presence of detailed smoking information in the electronic dental record (EDR) often under a separate section allows retrieving this information with less preprocessing. Objective To determine patients' detailed smoking status based on smoking intensity from the EDR. Methods First, the authors created a reference standard of 3,296 unique patients’ smoking histories from the EDR that classified patients based on their smoking intensity. Next, they trained three machine learning classifiers (support vector machine, random forest, and naïve Bayes) using the training set (2,176) and evaluated performances on test set (1,120) using precision (P), recall (R), and F-measure (F). Finally, they applied the best classifier to classify smoking status from an additional 3,114 patients’ smoking histories. Results Support vector machine performed best to classify patients into smokers, nonsmokers, and unknowns (P, R, F: 98%); intermittent smoker (P: 95%, R: 98%, F: 96%); past smoker (P, R, F: 89%); light smoker (P, R, F: 87%); smokers with unknown intensity (P: 76%, R: 86%, F: 81%), and intermediate smoker (P: 90%, R: 88%, F: 89%). It performed moderately to differentiate heavy smokers (P: 90%, R: 44%, F: 60%). EDR could be a valuable source for obtaining patients’ detailed smoking information. Conclusion EDR data could serve as a valuable source for obtaining patients' detailed smoking information based on their smoking intensity that may not be readily available in the EHR

Assessing Information Congruence of Documented Cardiovascular Disease between Electronic Dental and Medical Records

Dentists are more often treating patients with Cardiovascular Diseases (CVD) in their clinics; therefore, dentists may need to alter treatment plans in the presence of CVD. However, it’s unclear to what extent patient-reported CVD information is accurately captured in Electronic Dental Records (EDRs). In this pilot study, we aimed to measure the reliability of patient-reported CVD conditions in EDRs. We assessed information congruence by comparing patients’ self-reported dental histories to their original diagnosis assigned by their medical providers in the Electronic Medical Record (EMR). To enable this comparison, we encoded patients CVD information from the free-text data of EDRs into a structured format using natural language processing (NLP). Overall, our NLP approach achieved promising performance extracting patients’ CVD-related information. We observed disagreement between self-reported EDR data and physician-diagnosed EMR data

Empty follicle syndrome after GnRH agonist trigger, rescued with HCG in a donor oocyte with successful pregnancy outcome: a case report

Empty follicle syndrome (EFS) is a rare condition characterized by failure to obtain oocytes despite repeated meticulous aspiration from normally growing ovarian follicles during in vitro fertilization (IVF) cycles. Here we report a case of empty follicle syndrome in donor oocyte cycle after gonadotropin releasing hormone agonist (GnRHa) triggering for final oocyte maturation. Her estradiol on the day of trigger was 4564.3 IU/L. No oocytes were collected from the right ovary and the procedure was abandoned. The patient was successfully rescued by retriggering with 10,000 units of Inj. hCG and 5 oocytes were collected after 35 hours of retriggering. All oocytes were mature (MII) and fertilized by recipient’s husband sperm. Recipient cycle was prepared by hormone therapy, and underwent day 3 fresh embryo transfer. Successful pregnancy was achieved and a term female child was delivered at 37 weeks by lower segment caesarean section. Management options of EFS in hyper responder patients triggered with GnRH agonist may be a risk factor for empty follicle syndrome & retriggering with Rescue hCG might help in oocyte retrieval in a donor.

Recurrent genuine empty follicle syndrome: a rare case report

Failure to aspirate oocytes from follicles after Controlled ovarian stimulation with apparently normal growing follicles with normal steroidgenesis after meticulous follicular aspiration is called Empty follicular syndrome (EFS). EFS are mainly two types, Genuine EFS & False EFS. Here we report a case of 24 yrs female presenting with primary subfertility with normal ovarian reserve, husband having normal semen analysis, planned for In vitro fertilization for failed Intra uterine insemination (IUI) & underwent two cycles of oocytes retrieval after controlled ovarian stimulation. We couldn’t retrieve any oocytes in spite of adequate serum βhCG level in both the cycles. Karyotyping of the patient was normal (46 XX). In this patient we were not able to find out any cause for recurrent genuine empty follicle syndrome. So we advised the couple to opt for oocyte donation program

Ureteral endometriosis: a rare and underdiagnosed cause of renal dysfunction

Ureteral endometriosis is a serious localization of disease that can lead to urinary tract obstruction, hydroureteronephrosis and potential kidney loss. We describe three cases of ureteral endometriosis where there was documented renal function loss with subsequent workup and surgical intervention. Clinical suspicion and preoperative assessment may help with diagnosis and allows for a multidisciplinary pre-consultation. Surgical technique to treatment varies, but the goal is to salvage renal function and decrease disease burden. Laparoscopic surgical approach can be carried out successfully in the hands of an experienced laparoscopic surgeon. These cases illustrate varying surgical approaches tailored to management of ureteral endometriosis. Women in reproductive age presenting with pelvic pain diagnosed to have hydronephrosis must be adequately evaluated for ureteral endometriosis

Characterizing Restorative Dental Treatments of Sjögren's Syndrome Patients Using Electronic Dental Records Data

Scant knowledge exists on the type of restorative treatments Sjögren's syndrome patients (SSP) receive in spite of their high dental disease burden due to hyposalivation. Increased adoption of electronic dental records (EDR) could help in leveraging information from these records to assess dental treatment outcomes in SSP. In this study, we evaluated the feasibility of using EDR to characterize the dental treatments SSP received and assess the longevity of implants in these patients. We identified 180 SSP in ten years of patients' data at the Indiana University School of Dentistry clinics. A total of 104 (57.77%) patients received restorative or endodontic treatments. Eleven patients received 23 implants with a survival rate of 87% at 40 months follow-up. We conclude that EDR data could be used for characterizing the treatments received by SSP and for assessing treatment outcomes