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Application of AI in the creation of discharge summaries in psychiatric clinics 人工智能在精神病诊所出院摘要制作中的应用
Pub Date : 2024-09-17 DOI: 10.1177/00912174241284730
Bertrand Janota, Krzysztof Janota
BackgroundThe integration of artificial intelligence (AI; ChatGPT 4.0) into medical workflows presents a great potential to enhance efficiency and quality. The use of artificial intelligence in the creation of discharge summaries seems particularly interesting and valid. The course of each hospitalization is described in the discharge summary, which is given to each patient and then to his general practitioner at the end of hospital treatment. An exploratory analysis of discharge summaries in psychiatric clinics underscores that these documents must fulfill diverse and specific requirements. Nevertheless, AI-generated discharge summaries offer the opportunity to optimize information transfer and alleviate the workload on physicians.MethodThe study evaluates the quality of discharge summaries produced by clinical staff and by an AI model (ChatGPT 4.0). The clinicians involved in writing of the discharge summaries were not informed about the study’s purpose or methodology. The completed summaries were subsequently assessed by four attending physicians using predefined criteria. These physicians were also blinded to the study’s objectives and were unaware of the individual authors of the summaries. The evaluation criteria included consistency, completeness, and comprehensibility. Additionally, the time required to prepare these summaries and its impact on overall quality were analyzed.ResultsThe results of the study indicate that discharge summaries generated by AI are more efficient than discharge summaries prepared by clinic staff. The AI was particularly effective in terms of coherence and information structure.ConclusionFurther research, training and development is needed to improve the accuracy and reliability of AI-generated discharge summaries.
背景将人工智能(AI;ChatGPT 4.0)融入医疗工作流程,在提高效率和质量方面具有巨大潜力。将人工智能应用于出院小结的制作似乎特别有趣和有效。每次住院治疗的过程都会在出院小结中进行描述,出院小结会交给每位病人,然后在医院治疗结束后交给全科医生。对精神病诊所出院摘要的探索性分析表明,这些文件必须满足不同的特定要求。然而,人工智能生成的出院小结为优化信息传递和减轻医生的工作量提供了机会。方法本研究评估了临床工作人员和人工智能模型(ChatGPT 4.0)生成的出院小结的质量。参与撰写出院摘要的临床医生未被告知本研究的目的或方法。随后,由四位主治医师根据预先设定的标准对完成的摘要进行评估。这些医生对研究目的也是盲人,不知道摘要的作者是谁。评估标准包括一致性、完整性和可理解性。研究结果表明,人工智能生成的出院摘要比诊所员工编写的出院摘要更有效。结论要提高人工智能生成的出院摘要的准确性和可靠性,还需要进一步的研究、培训和开发。
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引用次数: 0
Clinical correlates of medication adherence in individuals with bipolar disorder and comorbid hypertension 双相情感障碍和合并高血压患者坚持用药的临床相关性
Pub Date : 2024-09-14 DOI: 10.1177/00912174241281984
Jennifer B. Levin, David J. Moore, Farren Briggs, Mahboob Rahman, Jessica Montoya, Colin Depp, Douglas Einstadter, Kurt C. Stange, Celeste Weise, Taylor Maniglia, Richard Barigye, Gracie Howard Griggs, Clara Adeniyi, Joy Yala, Martha Sajatovic
ObjectiveIndividuals with bipolar disorder (BD) have high rates of suboptimal medication adherence, medical illness, and premature mortality, largely from cardiovascular causes. This analysis examined the association between adherence to antihypertensive and BD medications and clinical symptoms in patients with BD and comorbid hypertension (HTN) from an ongoing trial to optimize adherence.MethodInclusion criteria were a BD diagnosis, treatment with antihypertensives, adherence challenges, and poorly controlled HTN. Adherence was measured via self-report using the Tablets Routine Questionnaire and using eCAP, an electronic pillcap which captures openings. Average systolic blood pressure (SBP) was calculated from 12 readings over 1 week. The Montgomery-Asberg Depression Rating Scale (MADRS) and the Brief Psychiatric Rating Scale (BPRS) assessed BD symptoms.ResultsA total of 83 participants with BD and HTN were included. Adherence to BD and antihypertensive medications were positively correlated. eCAP openings showed more missed doses than self-reported antihypertensive adherence. BD medication adherence was positively correlated with BPRS at baseline; antihypertensive adherence was negatively correlated with SBP at screening. Antihypertensive adherence improved and SBP decreased between screening and baseline.ConclusionsAdherence levels fluctuated over time and differed based on measurement method in people with comorbid BD and HTN. Self-reported BD adherence was positively related to global psychiatric symptoms and antihypertensive adherence was related to better SBP control. Monitoring both medication and blood pressure led to change in self-reported adherence. BD symptom severity may indicate poor adherence in patients with BD and should be considered in treatment planning.
目的双相情感障碍(BD)患者的服药依从性、医疗疾病和过早死亡的发生率很高,其中大部分是心血管疾病引起的。这项分析研究了双相情感障碍和合并高血压(HTN)患者的降压药和双相情感障碍药物依从性与临床症状之间的关系,这些临床症状来自一项正在进行的优化依从性试验。方法:纳入标准为双相情感障碍诊断、降压药治疗、依从性挑战和高血压控制不佳。依从性的测量是通过使用片剂常规问卷的自我报告和使用电子药帽(eCAP)进行的,电子药帽可捕捉开药情况。平均收缩压 (SBP) 根据一周内的 12 次读数计算得出。蒙哥马利-阿斯伯格抑郁评定量表(MADRS)和简明精神病评定量表(BPRS)评估 BD 症状。BD 和降压药物的依从性呈正相关,而 eCAP 公开资料显示的漏服剂量多于自我报告的降压依从性。BD 服药依从性与基线时的 BPRS 呈正相关;降压药依从性与筛查时的 SBP 呈负相关。结论对于合并有 BD 和 HTN 的患者,其依从性水平会随着时间的推移而波动,并因测量方法的不同而不同。自我报告的 BD 依从性与总体精神症状呈正相关,而降压依从性与更好的 SBP 控制有关。同时监测药物和血压会导致自我报告的依从性发生变化。BD 症状的严重程度可能表明 BD 患者的依从性较差,在制定治疗计划时应加以考虑。
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引用次数: 0
All medical workers together: For better mental health and primary health care- Posters 所有医务工作者齐心协力:为了更好地开展心理健康和初级保健工作--海报
Pub Date : 2024-04-29 DOI: 10.1177/00912174241248903
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引用次数: 0
Duration of untreated psychosis and its associated sociodemographic and clinical factors in first-episode psychosis: A study from Eastern Nepal 首次发病的精神病患者未经治疗的持续时间及其相关的社会人口和临床因素:尼泊尔东部的一项研究
Pub Date : 2024-04-15 DOI: 10.1177/00912174241247611
Suren Limbu, Suraj Nepal, Sanjeev Kumar Mishra
ObjectiveDuration of untreated psychosis (DUP) is considered an important factor in outcome. Individual, familial and illness factors may prolong DUP. Little data on this issue is available from the country of Nepal. The purpose of the present study was to assess DUP in patients with first-episode psychosis and identify associations with patients’ socio-demographic and clinical factors.MethodsA cross-sectional, descriptive study was conducted in the department of psychiatry, of Tertiary Hospital in the Eastern part of Nepal. Eighty-six patients were enrolled. ICD-10 was used to make the diagnosis. Nottingham Onset Schedule-DUP version (NOS-DUP) was used to assess DUP. Positive and Negative Syndrome Scale (PANSS) was used to assess patients’ clinical symptoms.ResultsThe mean (SD) DUP was 21.4 (42.1) months and median DUP was 3.0 months (IQR = 23.5). Participants from mountainous region, the unemployed, having an insidious onset of illness, and patients with a diagnosis of schizophrenia had significantly longer DUP ( P < .005). Duration of untreated psychosis was also positively correlated with negative symptoms (r = .42, ( P < .001) and total PANSS score (r = .42, P < .001).ConclusionDuration of untreated psychosis in first-episode psychotic patients was relatively long (compared to studies in other countries), and was found to be positively associated with mountainous regions of Nepal, being unemployed, having an insidious onset of illness, and having a diagnosis of schizophrenia. Programs and educational efforts are needed to ensure early treatment of patients with first-episode psychosis, especially in the mountainous rural areas of Nepal.
目标未经治疗的精神病持续时间(DUP)被认为是影响预后的一个重要因素。个人、家庭和疾病因素都可能延长未治疗精神病的持续时间。尼泊尔在这方面的数据很少。本研究的目的是评估首发精神病患者的 DUP,并确定其与患者的社会人口学和临床因素之间的关联。方法 在尼泊尔东部地区的三级医院精神病科进行了一项横断面描述性研究。共招募了 86 名患者。采用 ICD-10 进行诊断。诺丁汉发病时间表-DUP 版本(NOS-DUP)用于评估 DUP。结果 平均(标清)DUP为21.4(42.1)个月,中位DUP为3.0个月(IQR = 23.5)。来自山区、失业者、起病隐匿者和被诊断为精神分裂症患者的 DUP 明显更长(P < .005)。未经治疗的精神病持续时间还与阴性症状(r = .42,( P <.001)和 PANSS 总分(r = .42,P <.001)呈正相关。结论 首次发病的精神病患者未经治疗的精神病持续时间相对较长(与其他国家的研究相比),并且与尼泊尔山区、失业、起病隐匿和精神分裂症诊断呈正相关。有必要制定计划并开展教育工作,以确保初发精神病患者得到早期治疗,尤其是在尼泊尔的山区农村地区。
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引用次数: 0
Depression, anxiety, hopelessness, and suicide in first-degree relatives of patients hospitalised in intensive care units in Türkiye 土耳其重症监护病房住院患者一级亲属的抑郁、焦虑、绝望和自杀情况
Pub Date : 2024-04-04 DOI: 10.1177/00912174241244812
Başak Merve Yanmaz, Melike Yüce Aktepe, Ali Erdoğan, Özlem Çakin
ObjectiveThe purpose of this study was to investigate the prevalence of depression, anxiety disorder, hopelessness, and suicide among first-degree relatives of patients hospitalised in medical and anaesthesia intensive care units at an academic medical centre.MethodsIn this case–control study conducted in Türkiye, 32 first-degree relatives of 32 patients hospitalised for 14 days or more in intensive care units and 32 healthy volunteers were included for assessment. The Beck Depression Scale (BDS), Beck Anxiety Scale (BAS), Beck Hopelessness Scale (BHS), and Suicide Probability Scale (SPS) were administered to participants. Results: The mean age of patients’ relatives was 42.1 ± 11.6 years and that of the controls was 43.0 ± 11.3 years. The median scores for the BDS, BHS, and SPS were significantly higher among the relatives of the patients than among controls ( P = .008, P = .013, and P = .001, respectively). Based on cutoff scores for the BDS and BAS, depression was observed in 56.3% of the relatives of the patients and anxiety disorder was observed in 46.9%. In the group comprising patients’ relatives, the median score for the BDS was significantly higher among female participants than among male participants ( P = .038).ConclusionsFirst-degree relatives of patients hospitalised in intensive care units have a higher prevalence of depression, hopelessness, and suicidality. Female relatives are more depressed than male. Ensuring psychiatric evaluation of the relatives of patients hospitalised in intensive care units in Türkiye is important.
本研究旨在调查一家学术医疗中心内科和麻醉科重症监护病房住院患者的一级亲属中抑郁症、焦虑症、绝望症和自杀的患病率。方法 在土耳其进行的这项病例对照研究中,纳入了 32 名在重症监护病房住院 14 天或以上的患者的 32 名一级亲属和 32 名健康志愿者进行评估。对参与者进行了贝克抑郁量表(BDS)、贝克焦虑量表(BAS)、贝克无望量表(BHS)和自杀可能性量表(SPS)的测试。结果显示患者亲属的平均年龄为(42.1 ± 11.6)岁,对照组的平均年龄为(43.0 ± 11.3)岁。患者亲属的 BDS、BHS 和 SPS 中位数得分明显高于对照组(分别为 P = .008、P = .013 和 P = .001)。根据 BDS 和 BAS 的临界值,56.3% 的患者亲属患有抑郁症,46.9% 的患者亲属患有焦虑症。在由患者亲属组成的小组中,女性参与者的 BDS 中位数得分明显高于男性参与者 ( P = .038)。女性亲属比男性亲属更容易患抑郁症。确保对土耳其重症监护病房住院患者的亲属进行精神评估非常重要。
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引用次数: 0
Abstract 摘要
Pub Date : 2024-03-07 DOI: 10.1177/00912174241234416
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引用次数: 0
Book Review: Insights from a sixty-four-year case of anorexia nervosa: Constancy and change in symptoms and treatment 书评:来自64年神经性厌食症病例的见解:症状和治疗的恒常性和变化
Pub Date : 2023-09-07 DOI: 10.1177/00912174231201010
J. Yager
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引用次数: 0
First experiences of the dying patient: student essays from Australia 临终病人的第一次经历:来自澳大利亚的学生论文
Pub Date : 2022-05-29 DOI: 10.1177/00912174221105841
Alexa Gilbert-Obrart, H. Wilson
Two articles in this issue of the Journal are from the Balint Society of Australia and New Zealand (BSANZ), which has been supporting an essay competition for medical students since 2015. These essays are two of 45 student entries in 2021, based on reflections about a significant patient. This biannual competition uses similar criteria to the International Ascona Prize. Students are encouraged to describe a student-patient relationship from their medical studies and to include critical reflection on the implications of their learning in relation to becoming a doctor. Since its inception, there have been 60 to 75 entries in each competition from Australian and New Zealand medical students. Despite the distractions and uncertainty of Covid-19 over the last two years, it was particularly rewarding in 2021 to receive 45 essays of a high standard. Many of the students’more poignant essays focussed on their first experiences of end-of-life care. Australasian medical schools are largely postgraduate entry. These essays are from junior students as they first enter the clinical phase of training. At this stage, it can be profoundly shocking for students to get to know a patient, who then dies from a terminal illness. These essays may represent opportunities to work through their affective responses to those patients, as while there are some reflective groups in these
本期《华尔街日报》的两篇文章来自澳大利亚和新西兰巴林特协会(BSANZ),该协会自2015年以来一直支持医学生征文比赛。这些文章是2021年45篇学生作品中的两篇,基于对一位重要病人的反思。这个两年一度的比赛使用与国际阿斯科纳奖相似的标准。鼓励学生从他们的医学学习中描述学生与病人的关系,并对他们的学习对成为一名医生的影响进行批判性反思。自举办以来,每次比赛都有来自澳大利亚和新西兰医科学生的60至75个参赛作品。尽管在过去的两年里,Covid-19让人分心,充满了不确定性,但在2021年,收到45篇高水平的论文是特别有意义的。许多学生比较尖锐的文章集中在他们第一次接受临终关怀的经历上。澳大利亚的医学院主要招收研究生入学。这些文章来自初中生,因为他们第一次进入临床训练阶段。在这个阶段,对于学生来说,了解一个死于绝症的病人可能会非常震惊。这些文章可能代表了通过他们对这些病人的情感反应来工作的机会,因为在这些文章中有一些反思小组
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引用次数: 1
Too momentous for words 重大得难以言表
Pub Date : 2022-05-27 DOI: 10.1177/00912174221105845
Madison Booth
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引用次数: 1
Beyond the Medical 超越医学
Pub Date : 2022-05-27 DOI: 10.1177/00912174221105846
Stephanie Lee
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引用次数: 2
期刊
The International Journal of Psychiatry in Medicine
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