falan42/nurse_detection huggingface dataset:
CPAP Titration Study 

PROCEDURE: , The test was performed in an observed hospital laboratory due to the evidence of obstructive sleep apnea.  The patient was monitored for EEG, EOG, jaw and leg EMG, thoracoabdominal impedance, oral/nasal thermistors, EKG, and oximetry.,CPAP TITRATION STUDY:,  Total sleep time 425 minutes, sleep onset 7.8 minutes, and sleep efficiency 95%.  Stage I 6%, stage II 53%, stage III 20%, and REM stage 15%, and awake 5%.  Number of awakenings 6.  Total arousals 36 with index 5.4, mild leg jerk movement with index 10.1.  There was one apnea and 17 hypopneas with apnea/hypopnea index 2.7.  The pressures required to prevent apnea/hypopnea varied between 5 and 11 cm H2O.  The optimal pressure was 11 cm H2O, which prevented all of the apneas/hypopneas.  The patient spent all his sleeping time in supine position.  Average oxygen saturation 94% with lowest oxygen saturation 89%.  Only less than 0.2 minutes was spent with oxygen saturation less than 90%.,SUMMARY: , Weight loss, PFTs if not done and CPAP with nasal mask at 11 cm H2O.sleep medicine, obstructive sleep apnea, cpap titration study, cpap titration, oral/nasal thermistors, thermistors ekg, oxygen saturation, eeg, eog, emg, thoracoabdominal, thermistors, ekg, oximetry, apnea, cpap, oral/nasalNOTE
Rheumatoid Arthritis 

RHEUMATOID ARTHRITIS, (or RA) is a chronic, systemic condition with primary involvement of the joints.  Joint inflammation is present due to an abnormal immune response in which the body attacks its own tissue.  Specifically, the tissues lining the joint are involved as well as cartilage and muscle and sometimes the eyes and blood vessels.  The cause of rheumatoid arthritis is obscure but it is associated with a family history, genetic and autoimmune problems, people ages 20-60, female gender 3:1 or a Native American background.,SIGNS AND SYMPTOMS:,*  Joint pain, swelling, redness, warmth.  Commonly involved joints are the small joints of the hands and feet and the ankles, wrists, knees, shoulders and elbows.,*  Multiple swollen joints (more than 3) with simultaneous involvement of same joints on opposite side of the body.,*  Morning stiffness that lasts longer than 30 minutes.,*  Difficulty making a fist; poor grip strength.,*  Night pain.,*  Feeling "sick" - low fever, loss of appetite, tiredness, generalized aching and stiffness, weakness.,*  Rheumatoid nodules under the skin, usually along the surface of tendons or over bony prominences.,*  Disease may lead to deformed joints, decreased vision, anemia, muscle weakness, peripheral nerve problems, pericarditis, enlarged spleen, increased frequency of infections.,*  Blood tests will reveal a positive rheumatoid factor (RF) to be present the majority of the time.,TREATMENT:,*  To diagnose RA, blood studies are done to detect a substance known as rheumatoid factor and x-rays may show typical findings.,*  Night splints for involved joints.  Avoid putting a pillow under the knees as this will contribute to joint contracture.,*  Heat helps relieve the pain; hot water soaks, whirlpool baths, heat lamps, heating pads, etc. applied to affected joints 15-20 minutes 3 times per day is helpful.,*  Sleep on a firm mattress and sleep at least 10-12 hours per night.  Get rest during the day; take naps.,*  Get bed rest during an active flare-up until symptoms subside.,*  Avoid humid weather if possible.,*  NSAIDs (non-steroidal anti-inflammatory drugs).,*  DMARDs (disease-modifying anti-rheumatic drugs) - gold compounds, D-penicillamine, sulfasalazine, methotrexate, antimalarials.,*  Immunosuppressive drugs.,*  Acetaminophen (Tylenol) for pain relief only when necessary.,*  Oral corticosteroids short term; corticosteroid injection into joint can temporarily relieve pain and inflammation.,*  Exercise as recommended by your physician.  Exercise helps keep the joints limber and increases strength.  Swimming and water activities are a good way to workout.  Put all your joints through their full ranges of motion every day to prevent contractures. *  Physical therapy may be recommended.,*  Surgical intervention.,*  Lose excess weight as being overweight will only stress the joints further.,*  Eat a normal, well-balanced diet.rheumatology, ra, rheumatoid arthritis, joint inflammation, swollen joints, arthritis, joints, inflammation, corticosteroids, rheumatoid,
Electroencephalogram 

DESCRIPTION OF RECORD:  ,This tracing was obtained utilizing 27 paste-on gold-plated surface disc electrodes placed according to the International 10-20 system.  Electrode impedances were measured and reported at less than 5 kilo-ohms each.,FINDINGS: , In general, the background rhythms are bilaterally symmetrical.  During the resting awake state they are composed of moderate amounts of low amplitude fast activity intermixed with moderate amounts of well-modulated 9-10 Hz alpha activity best seen posteriorly.  The alpha activity attenuates with eye opening.,During some portions of the tracing the patient enters a drowsy state in which the background rhythms are composed predominantly of moderate amounts of low amplitude fast activity intermixed with moderate amounts of low to medium amplitude polymorphic theta activity.,There is no evidence of focal slowing or paroxysmal activity.,IMPRESSION: , Normal awake and drowsy (stage I sleep) EEG for patient's age.sleep medicine, gold-plated surface disc electrodes, paroxysmal activity, eeg, drowsy stage, sleep eeg, stage, sleep, electrodes, awake, moderate, activity
Rheumatology Progress Note 

SUBJECTIVE:,  The patient is here for a follow-up.  The patient has a history of lupus, currently on Plaquenil 200-mg b.i.d.  Eye report was noted and appreciated.  The patient states that she is having some aches and pains of the hands and elbows that started recently a few weeks ago.  She denied having any trauma.  She states that the pain is bothering her.  She denies having any fevers, chills, or any joint effusion or swelling at this point.  She noted also that there is some increase in her hair loss in the recent times.,OBJECTIVE:,  The patient is alert and oriented.  General physical exam is unremarkable.  Musculoskeletal exam reveals positive tenderness in both lateral epicondyles of both elbows, no effusion.  Hand examination is unremarkable today.  The rest of the musculoskeletal exam is unremarkable.,ASSESSMENT:,  Epicondylitis, both elbows, possibly secondary to lupus flare-up.,PLAN:,  We will inject both elbows with 40-mg of Kenalog mixed with 1 cc of lidocaine.  The posterior approach was chosen under sterile conditions.  The patient tolerated both procedures well.  I will obtain CBC and urinalysis today.  If the patient's pain does not improve, I will consider adding methotrexate to her therapy.,Sample Doctor M.D.rheumatology, 1 cc of lidocaine, epicondylitis, kenalog, kenalog mixed with 1 cc of lidocaine, progress note, aches and pains, history of lupus, lidocaine, lupus, methotrexate, kenalog mixed, injected,
Rheumatoid Arthritis - Consult 

HISTORY OF PRESENT ILLNESS: , A 71-year-old female who I am seeing for the first time.  She has a history of rheumatoid arthritis for the last 6 years.  She was followed by another rheumatologist.  She says she has been off and on, on prednisone and Arava.  The rheumatologist, as per the patient, would not want her to be on a long-term medicine, so he would give her prednisone and then switch to Arava and then switch her back to prednisone.  She says she had been on prednisone for the last 6 to 9 months.  She is on 5 mg a day.  She recently had a left BKA and there was a question of infection, so it had to be debrided.  I was consulted to see if her prednisone is to be continued.  The patient denies any joint pains at the present time.  She says when this started she had significant joint pains and was unable to walk.  She had pain in the hands and feet.  Currently, she has no pain in any of her joints.,REVIEW OF SYSTEMS: , Denies photosensitivity, oral or nasal ulcer, seizure, psychosis, and skin rashes.,PAST MEDICAL HISTORY: , Significant for hypertension, peripheral vascular disease, and left BKA.,FAMILY HISTORY:  ,Noncontributory.,SOCIAL HISTORY: , Denies tobacco, alcohol or illicit drugs.,PHYSICAL EXAMINATION:,VITAL SIGNS:  BP 130/70, heart rate 80, and respiratory rate 14.,HEENT:  EOMI.  PERRLA.,NECK:  Supple.  No JVD.  No lymphadenopathy.,CHEST:  Clear to auscultation.,HEART:  S1 and S2.  No S3, no murmurs.,ABDOMEN:  Soft and nontender.  No organomegaly.,EXTREMITIES:  No edema.,NEUROLOGIC:  Deferred.,ARTICULAR:  She has swelling of bilateral wrists, but no significant tenderness.,LABORATORY DATA:,  Labs in chart was reviewed.,ASSESSMENT AND PLAN:,  A 71-year-old female with a history of rheumatoid arthritis, on longstanding prednisone.  She is not on DMARD, but as she recently had a surgery followed by a probable infection, I will hold off on that.  As she has no pain, I have decreased the prednisone to 2.5 mg a day starting tomorrow if she is to go back to her nursing home tomorrow.  If in a couple of weeks her symptoms stay the same, then I would discontinue the prednisone.  I would defer that to Dr. X.  If she flares up at that point, prednisone may have to be restarted with a DMARD, so that eventually she could stay off the prednisone.  I discussed this at length with the patient and she is in full agreement with the plan.  I explained to her that if she is to be discharged, if she wishes, she could follow up with me in clinic or if she goes back to Victoria, then see her rheumatologist over there.rheumatology, prednisone, joint pains, rheumatoid arthritis, arthritis, dmard, rheumatologist, rheumatoid, pains,
Discoid Lupus 

HISTORY:  ,A is 12-year-old female who comes today for follow-up appointment and a CCS visit.  She has the diagnosis of discoid lupus and we have been following her for her conditions, her treatments, and also to watch her for any development of her systemic lupus.  A has been doing well with just Plaquenil alone and mother said that during the summer, the rash gets brighter, but now that it is getting darker and she is at school, the rash is starting to become lighter again.  She has been using her cream, which is hydrocortisone at night and applying it with no problems.  She denies any hair losses, denies any decrease in appetite, actually, she has been gaining some weight.  She denies any ulcerations in her mouth, eye problems, or any lumps in her body.  She denies any fevers or any problems with the urine.,PHYSICAL EXAMINATION: ,VITAL SIGNS:  Today temperature is 100.1, weight is 73.5 kg, blood pressure is 121/61, height is 158, and pulse is 84.,GENERAL:  She is alert, active, and oriented in no distress.,HEENT:  She had a head full of hair with no bald spots.  She has a macular rash on her cheeks bilaterally with hyperpigmented circles.  No scales, no excoriations, and no palpable erythema.  Oral mucosa is clear with no ulcerations.,NECK:  Soft with no masses.  She does have acanthosis nigricans on the base of the neck.,CHEST:  Clear to auscultation.,HEART:  Regular rhythm with no murmur.,ABDOMEN:  Soft and nontender with no visceromegaly.,MUSCULOSKELETAL:  Shows no limitation, swelling, or tenderness in any of her joints.,SKIN:  Shows a discoid rash with macules approximately 1 cm in diameter in different shapes and size, but most of them are about 1 cm in diameter, which are hyperpigmented.  No erythema, no purpura, no petechiae, and no raised borders.  They look more like cigarette points.  She has this in her upper extremities especially in the forearms and also on her lower extremities, on the legs, but just very few lesions and very light.  She has some periungual erythema, as well as some palmar erythema, but this is minimal.,LABORATORY DATA:,  Laboratories today done, we have a CBC with a white blood cell count of 7.9, hemoglobin is 14.3, platelet count is 321,000, sed rate is only 11, and CMP shows no abnormalities.  Pending is antinuclear antibody complement level.,ASSESSMENT: , She is 12-year-old with discoid lupus on the control with optimal regimen.  We are going to switch her to Protopic at night, especially in the face.  Continue on Plaquenil, get some laboratories and wait for the results.  Diet evaluation today because of the gaining weight and acanthosis nigricans, and will see her back in about 3 months for follow-up.  Future plans will be depending on whether or not she evolves into a full-blown lupus.  I discussed the plan with her mother and they had no further questions.rheumatology, lupus, systemic lupus, acanthosis nigricans, discoid lupus, extremities, rash, erythema, discoid,
Oligoarticular Arthritis - 2 

HISTORY: , A is a young lady, who came here with a diagnosis of seizure disorder and history of Henoch-Schonlein purpura with persistent proteinuria.  A was worked up for collagen vascular diseases and is here to find out the results.  Also was recommended to take 7.5 mg of Mobic every day for her joint pains.  She states that she continues with some joint pain and feeling tired all the time.  Mother states that also her seizure has continued without any control so far.  She is having some studies in the next few days.  She is mostly stiff on her legs, neck, and also on her hands.  The rest of the review of systems is in the chart.,PHYSICAL EXAMINATION: , ,VITAL SIGNS:  Temperature today is 99.2 degrees Fahrenheit, weight is 45.9 kg, blood pressure is 123/59, height is 149.5 cm, and pulse is 94.,HEENT:  She has no facial rashes, no lymphadenopathy, no alopecia, no oral ulcerations.  Pupils are reactive to accommodation.  Funduscopic examination is within normal limits.,NECK:  No neck masses.,CHEST:  Clear to auscultation.,HEART:  Regular rhythm with no murmur.,ABDOMEN:  Soft, nontender with no visceromegaly.,SKIN:  No rashes today.,MUSCULOSKELETAL:  Examination shows good range of motion with no swelling or tenderness in any of her joints of the upper extremities, but she does have minus/plus swelling of her knees with flexion contracture bilaterally on both.,LABORATORY DATA: , Laboratories were not done recently, but we have some lab results from the previous evaluation that basically is negative for any collagen vascular disease, but shows some evidence of decreased calcium and vitamin D levels.,ASSESSMENT: , This is a patient, who today presents with symptoms consistent with possible oligoarticular arthritis of her knees with also arthralgias and deficiency in vitamin D.  She also has chronic proteinuria and seizure disorder.  My recommendation is to start her on vitamin D and calcium supplements, and also increase the Mobic to 50 mg, which is one of the few things she can tolerate with all the medication she is taking.  We are going to refer her to physical therapy and see her back in 2 months for followup.  The plan was discussed with A and her parents and they have no further questions.rheumatology, arthralgias, deficiency, vitamin d, collagen vascular diseases, seizure disorder, vascular diseases, joint pains, oligoarticular arthritis, arthritis, oligoarticular,
Ultrasound Scrotum 

EXAM: , Ultrasound examination of the scrotum.,REASON FOR EXAM: , Scrotal pain.,FINDINGS:  ,Duplex and color flow imaging as well as real time gray-scale imaging of the scrotum and testicles was performed.  The left testicle measures 5.1 x 2.8 x 3.0 cm.  There is no evidence of intratesticular masses.  There is normal Doppler blood flow.  The left epididymis has an unremarkable appearance.  There is a trace hydrocele.,The right testicle measures 5.3 x 2.4 x 3.2 cm.  The epididymis has normal appearance.  There is a trace hydrocele.  No intratesticular masses or torsion is identified.  There is no significant scrotal wall thickening.,IMPRESSION:  ,Trace bilateral hydroceles, which are nonspecific, otherwise unremarkable examination.radiology, scrotal pain, epididymis, torsion, ultrasound examination, intratesticular masses, ultrasound, scrotal, testicles, scrotum,
X-RAY - Neck Soft Tissues 

EXAM: , Two views of the soft tissues of the neck.,HISTORY:,  Patient has swelling of the left side of his neck.,TECHNIQUE:,  Frontal and lateral views of the soft tissues of the neck were evaluated. There were no soft tissues of the neck radiographs for comparison. However, there was an ultrasound of the neck performed on the same day.,FINDINGS: , Frontal and lateral views of the soft tissues of the neck were evaluated and reveal there is an asymmetry seen to the left-sided soft tissues of the patient's neck which appear somewhat enlarged when compared to patient's right side. However the trachea appears to be normal caliber and contour.  Lateral views show a patent airway. The adenoids and tonsils appear normal caliber without evidence of hypertrophy. Airway appears patent. Osseous structures appear grossly normal.,IMPRESSION:,1. Patent airway. No evidence of any soft tissue swelling involving the patient's adenoids/tonsils, epiglottis or aryepiglottic folds. No evidence of any prevertebral soft tissue swelling.,2. Slight asymmetry seen to the soft tissues of the left side of the patient's neck which appears somewhat larger when compared to the right side.radiology, swelling, soft tissues, ultrasound, tonsils, adenoids, osseous structures, epiglottis, aryepiglottic folds, frontal and lateral, normal caliber, frontal, asymmetry,
Oligoarticular Arthritis - 1 

HISTORY:,  A is here for a follow up appointment at our Pediatric Rheumatology Clinic as well as the CCS Clinic.  A is a 17-year-old male with oligoarticular arthritis of his right knee.  He had a joint injection back in 03/2007 and since then he has been doing relatively well.  He is taking Indocin only as needed even though he said he has pain regularly, and he said that his knee has not changed since the beginning, but he said he only takes the medicine when he has pain, which is not every day, but almost every day.  He denies any swelling more than what it was before, and he denies any other joints are affected at this moment.  Denies any fevers or any rashes.,PHYSICAL EXAMINATION:,  On physical examination, his temperature is 98.6, weight is 104.6 kg; which is 4.4 kg less than before, 108/70 is his blood pressure, weight is 91.0 kg, and his pulse is 80.  He is alert, active, and oriented in no distress.  He has no facial rashes, no lymphadenopathy, no alopecia.  Funduscopic examination is within normal limit.  He has no cataracts and symmetric pupils to light and accommodation.  His chest is clear to auscultation.  The heart has a regular rhythm with no murmur.  The abdomen is soft and nontender with no :  visceromegaly.  Musculoskeletal examination showed good range of motion of all his upper extremities with no swelling or tenderness.  Lower extremities:  He still has some weakness of the knees, hip areas, and the calf muscles.  He does have minus/plus swelling of the right knee with a very hypermobile patella.  There is no limitation in his range of motion, and the swelling is very minimal with some mild tenderness.,In terms of his laboratories, they were not done today.,ASSESSMENT: , This is a 17-year-old male with oligoarticular arthritis.  He is HLA-B27 negative.,PLAN:,  In terms of the plan, I discussed with him what things he should be taking and the fact that since he has persistent symptoms, he should be on medication every day.  I am going to switch him to Indocin 75 mg SR just to give more sustained effect to his joints, and if he does not respond to this or continue with the symptoms, we may need to get an MRI.  We will see him back in three months.  He was evaluated by our physical therapist, who gave him some recommendations in terms of exercise for his lower extremities.  Future plans for A may include physical therapy and more stronger medications as well as imaging studies with an MRI.  Today he received his flu shot.  Discussed this with A and his aunt and they had no further questions.rheumatology, rheumatology clinic, lower extremities, oligoarticular arthritis, arthritis, oligoarticular, knee, swelling,
Ultrasound OB - 5 

GENERAL EVALUATION:,Fetal Cardiac Activity: Normal with a heart rate of 135BPM,Fetal Presentation: Cephalic.,Placenta: Anterior,Placentral grade: II,Previa: ? None.,Amniotic Fluid: 1.5 + 2.5 + 0.0 + 0.0 = 4cm compatible with oligohydramnios.,BIOMETRY:,BPD: 9.0cm consistent with 36weeks, 4days gestation,HC: 34.6cm which equals 40weeks and 1day gestational age.,FL: 6.9cm which equals 35weeks and 3days gestational age.,AC: 34.6cm which equals 38weeks and 4days gestational age.,CI (BPD/OFD):  (70-86) 73,FL/BPD: (71-87) 77,FL/HC: (20.8-22.6) 19.9,FL/AC (20-24) 20,HC/AC: (0.92-1.05) 1.00,GESTATIONAL AGE BY CURRENT ULTRASOUND: 37weeks 4days.,FETAL WEIGHT BY CURRENT ULTRASOUND: 3289grams (7pounds 4ounces).,ESTIMATED FETAL WEIGHT PERCENTILE: 24%.,EDD BY CURRENT ULTRASOUND: 06/04/07.,GESTATIONAL AGE BY DATES: 40weeks 0days.,L M P: Unknown.,EDD BY DATES: 05/18/07.,DATE OF PREVIOUS ULTRASOUND: 03/05/07.,EDD BY PREVIOUS ULTRASOUND: 05/24/07.,FETAL ANATOMY:,Fetal Ventricles: Normal,Fetal Cerebellum: Normal,Fetal Cranium: Normal,Fetal Face: Normal Nose and Mouth,Fetal Heart (4 Chamber View): Normal,Fetal Diaphragm: Normal,Fetal Stomach: Normal,Fetal Cord: Normal three-vessel cord,Fetal Abdominal Wall: Normal,Fetal Spine: Normal,Fetal Kidneys: Normal,Fetal Bladder: Normal,Fetal Limbs: Normal,IMPRESSION:,Active intrauterine pregnancy with a sonographic gestational age of 37weeks and 4days.,AFI=4cm compatible with mild oligohydramnios.,Fetal weight equals 3289grams (7pounds 4ounces). EFW percentile is 24%.,Placental grade is II.,No evidence of gross anatomical abnormality, with a biophysical profile total equal to 8 out of 8.,nan
Whole Body Radionuclide Bone Scan 

INDICATION:,  Prostate Cancer.,TECHNIQUE:,  3.5 hours following the intravenous administration of 26.5 mCi of Technetium 99m MDP, the skeleton was imaged in the anterior and posterior projections.,FINDINGS:,  There is a focus of abnormal increased tracer activity overlying the right parietal region of the skull.  The uptake in the remainder of the skeleton is within normal limits.  The kidneys image normally.  There is increased activity in the urinary bladder suggesting possible urinary retention.,CONCLUSION:,1.  Focus of abnormal increased tracer activity overlying the right parietal region of the skull.  CT scanning of magnetic resonance imaging of the skull and brain could be done for further assessment if it is clinically indicated.,2.  There is probably some degree of urinary retention.,radiology, prostate cancer, technetium, whole body, urinary retention, bone scan, radionuclide,
Ultrasound OB - 7 

GENERAL EVALUATION:,Fetal Cardiac Activity: Normal at 150BPM.  Fetal Lie: Longitudinal.  Fetal Presentation: Cephalic.  Placenta: Anterior Grade I.  Uterus: Normal.  Cervix: Closed.  Adnexa: Not seen.  Amniotic Fluid: Normal.,BIOMETRY:,BPD: 8.4 cm consistent with 33 weeks, 6 days gestation,HC: 29.8 cm consistent with 33 weeks, 0 days gestation,AC: 29.7 cm consistent with 33 weeks, 5 days gestation,FL:nan
Ultrasound OB - 8 

REASON FOR EXAM: , Pregnant female with nausea, vomiting, and diarrhea.,FINDINGS: , The uterus measures 8.6 x 4.4 x 5.4 cm and contains a gestational sac with double decidual sac sign.  A yolk sac is visualized.  What appears to represent a crown-rump length measures 3.3 mm for an estimated sonographic age of 6 weeks 0 days and estimated date of delivery of 09/28/09.,Please note however that no fetal heart tones are seen.  However, fetal heart tones would be expected at this age.,The right ovary measures 3.1 x 1.6 x 2.3 cm.  The left ovary measures 3.3 x 1.9 x 3.5 cm.  No free fluid is detected.,IMPRESSION: , Single intrauterine pregnancy at 6 weeks 0 days with an estimated date of delivery of 09/28/09.  A live intrauterine pregnancy, however, could not be confirmed, as a sonographic fetal heart rate would be expected at this time.  A close interval followup in correlation with beta-hCG is necessary as findings may represent an inevitable abortion.radiology, intrauterine pregnancy, estimated date of delivery, nausea, vomiting, fetal heart tones, ovary measures, fetal heart, ultrasound, ob, ovary, pregnancy, sac, fetal, intrauterine