train_data-text_and_labels.csv

row_id,text,label
0,"LV gram
revealed LVEF of 20%.  On HD3 patient was taken to the cath lab
and had successful stenting of his left circumflex.  He was
continued on plavix and aspirin throughout admission.

# ESRD on HD: Patient receives chronic HD on MWF schedule.
Patient's electrolytes were monitored closely throughout
admission.  Patient was dialyzed on his normal schedule and
pressures tolerated this without issue.  He refused many of his
medications throughout admission.

#Bacteremia: Patient had one blood culture positive for gram
positive cocci, MSSA.  He was treated with IV vancomycin given
penicillin allergy.  Patient will be treated for 10 day course,
last day [**2158-8-15**].",1
1,"CARDIAC HISTORY:
- PERCUTANEOUS CORONARY INTERVENTIONS:  [**2158-8-1**] BMS to RCA x 3
3. OTHER PAST MEDICAL HISTORY:
- ESRD [**2-1**] to diabetic nephropathy on HD x7yrs MWF
- Osteomyelitis of the spine with resultant paraplegia
- Hyperparathyroidism
- Left BKA [**2-1**] to gangrene
- Right arm fistula


Social History:
Single Male. Has been on disability in his left BKA. Lives in a
nursing home.
- Tobacco history:  Denies
- ETOH:  Denies
- Illicit drugs:  Denies

Family History:
- No family history of early MI, arrhythmia, cardiomyopathies,
or sudden cardiac death; otherwise non-contributory.
- Significant for diabetes

Physical Exam:
Admission Exam:
GENERAL: Profoundly hard of hearing. NAD.",1
2,"14. Actos 30 mg Tablet Sig: One (1) Tablet PO once a day.


Discharge Disposition:
Extended Care

Facility:
Colonial Heights Care and Rehabilitation Center - [**Hospital1 487**]

Discharge Diagnosis:
Primary Diagnosis:
1.  Cardiogenic shock
2.  Left circumflex stenosis

Secondary Diagnosis:
1.  Coronary artery disease
2.  End stage renal disease
3.  Diabetes mellitus type II
4.  Peripheral vascular disease
5.  Chronic right heel ulcer


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Out of Bed with assistance to chair or
wheelchair.


Discharge Instructions:
Dear Mr. [**Last Name (Titles) 90824**],
It was a pleasure taking care of you during your recent
admission to [**Hospital1 18**].",1
3,"Admission Date:  [**2181-5-4**]              Discharge Date:   [**2181-5-9**]

Date of Birth:  [**2132-1-15**]             Sex:   M

Service: SURGERY

Allergies:
Patient recorded as having No Known Allergies to Drugs

Attending:[**First Name3 (LF) 371**]
Chief Complaint:
s/p Motor vehicle crash

Major Surgical or Invasive Procedure:
ORIF left femur fracture

History of Present Illness:
49M with + EtOH s/p motor vehicle crash; restrained driver vs.
tree. He was transported to [**Hospital1 18**] for further care.

Past Medical History:
Hypothyroidism

Family History:
Noncontributory

Pertinent Results:
[**2181-5-4**] 08:16PM   GLUCOSE-151* LACTATE-5.9*
[**2181-5-4**] 03:09PM   WBC-13.",1
4,"Disp:*16 Capsule(s)* Refills:*0*


Discharge Disposition:
Home

Discharge Diagnosis:
SAH
hydrocephalus
intracranial hypertension
Pyrexia


Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.


Discharge Instructions:
General Instructions
??????	Take your pain medicine as prescribed.
??????	Exercise should be limited to walking; no lifting, straining,
or excessive bending.
??????	Increase your intake of fluids and fiber, as narcotic pain
medicine can cause constipation. We generally recommend taking
an over the counter stool softener, such as Docusate (Colace)
while taking narcotic pain medication.

**** Continue Nimodipine as prescribed, if there is an high
co-pay please call our office prior to purchasing.",1
5,"Discharge Diagnosis:
s/p Motor vehicle crash
Comminuted left femur fracture
Acute blood loss anemia

Discharge Condition:
Mental Status: Clear and coherent.
Activity Status: Out of Bed with assistance to chair or
wheelchair.
Level of Consciousness: Alert and interactive.

Discharge Instructions:
You may touch down weight bear only on your left leg.

You should AVOID drinking alcohol or taking illicit drugs as
these behaviors put you at risk for further injuries.

Followup Instructions:
Follow up in 2 weeks Dr. [**Last Name (STitle) 7376**], Orthopedics Trauma; call
[**Telephone/Fax (1) 1228**] for an appointment.

Follow up after discharge from rehab with your PCP.



Completed by:[**2181-5-8**]",1
6,"Active Issues:
# Cardiogenic Shock: Patient required pressor support with
dopamine following PCI at OSH and was transferred to [**Hospital1 18**] at a
dose of 8mg/kg/min.  On HD6 patient was successfully weaned from
dopamine and was maintaining a stable blood pressure.  He
maintained pressures through dialysis as well.  He was restarted
on his home anti-hypertensives prior to discharge.

# CAD:  Patient did not have prior history of known CAD, but
recent TTE from [**5-/2158**] revealed anterolateral and apical defects
consistent with CAD. Patient presented on [**8-1**] with RCA infarct
that required BMS x3. Cardiac cath also revealed 90% LCx disease
and completely occluded LAD that was presumed chronic.",1
7,"[**2181-5-4**] 3:29 PM
 CHEST (PORTABLE AP); -77 BY DIFFERENT PHYSICIAN                 [**Name Initial (PRE) 7**] # [**Clip Number (Radiology) 82593**]
 Reason: 49 year old man s/p MVC w/ hip fracture postop intubated wit
 Admitting Diagnosis: S/P MOTOR VEHICLE ACCIDENT
 ______________________________________________________________________________
 [**Hospital 2**] MEDICAL CONDITION:
  49 year old man s/p MVC w/ hip fracture postop intubated with massive blood
  loss and metabolic acidosis. Eval for acute lung pathology or trauma.
 REASON FOR THIS EXAMINATION:
  49 year old man s/p MVC w/ hip fracture postop intubated with massive blood
  loss and metabolic acidosis. Eval for acute lung pathology or trauma.
 ______________________________________________________________________________
                                 FINAL REPORT
 PORTABLE CHEST [**2181-5-4**]

 COMPARISON:  Study of earlier the same date.

 INDICATION:  Intubated.

 FINDINGS:  Interval placement of endotracheal tube, with tip terminating 5.8
 cm above carina.  Cardiomediastinal contours are similar in appearance to the
 prior study, and lungs are remarkable for multifocal areas of atelectasis,
 most pronounced at the left lung base and right retrocardiac region.
 Coexisting aspiration is possible.",1
8,"HCTZ was held in the
setting of hypercalcemia. The home dose of hydralazine was
increased to 75 mg QID and imdur was started at a dose of 30 mg
daily with subsequent improvement in blood pressure control.
Renal ultrasound did not reveal evidence of renal artery
stenosis, consistent with the results of an MRA in [**2195-4-18**].
.
# Hypercalcemia: [**Year (4 digits) 32883**] calcium peaked at 12.7 with a peak
ionized calcium of 1.51. The level improved modestly with
aggressive IVF. [**Name (NI) 32883**] PTH was low. Workup for an underlying
cause was unremarkable, including [**Name (NI) **] cortisol, SPEP/UPEP,
chest x-ray, non-contrast CT of the chest/abdomen/pelvis, and
bone scan.",1
9,"Per
vascular surgery, the patient should have an ABI checked as an
outpatient.

# Bilateral hearing loss: Patient reported acute hearing deficit
coinciding with his myocardial infarction. No obstructive cause
was apparent on otoscopic examination. Hearing loss appeared to
be symmetric. He was not given otoxic drugs. Ischemia in the
setting of cardiogenic shock is also a possiblity. Symptoms were
not consistent with CVA causing hearing loss, as he had no
associated symptoms of nystagmus, nausea or dizziness as would
be expected.  Patient's hearing improved spontaneously.  He
should have ENT follow-up as an outpatient if he continues to
have further issues.",1
10,"There is no
evidence of caliber change in the anterior or posterior
circulation to suggest vasospasm. Evaluation for residual
filling of the previously coiled distal left anterior cerebral
artery aneurysm is limited by streak artifact. No additional
aneurysms are identified.

IMPRESSION:
1. Decreased subarachnoid hemorrhage.
2. Redistribution of intraventricular hemorrhage without
evidence of new
hemorrhage. Stable ventricular size without hydrocephalus.
3. No evidence of vasospasm.

CTA Head [**2161-8-27**]:
IMPRESSION:
1. Decrease in extent and density of subarachnoid hemorrhage.
2. No new hemorrhage. Stable ventricular size without
hydrocephalus.
3. The A1 and A2 segments of the left anterior cerebral artery
are minimally decreased in caliber compared to study on [**8-20**], [**2161**].",0
11,"Left vertebral artery arteriogram shows filling of the left vertebral artery
 with reflux into the right vertebral artery.  Both posterior cerebral arteries
 are seen well.  Both AICA and superior cerebellar artery are seen well.  The
 AICA on the left is an AICA-PICA configuration.  The right PICA is seen
 normally.

 Left internal carotid artery arteriogram status post coil embolization shows
 that the aneurysm is now obliterated.

 Right common femoral artery arteriogram shows widely patent right common
 femoral artery.

 IMPRESSION:  [**Known firstname 12138**] [**Known lastname 39239**] underwent cerebral angiography and coil embolization
 of a 2.2 mm distal anterior cerebral artery aneurysm.  There were no
 complications.",0
12,"At the time of
discharge, his dose was 300mg po BID.  He will continue this for
11 days, ending [**2158-8-21**].  At that time, he should be
transitioned to amiodarone 200mg po daily.  Despite CHADS2 score
of 3, patient was felt to be a poor candidate for
anticoagulation given poor medication compliance and fall risk.
Patient was in sinus rhythm and hemodynamically stable at the
time of discharge.

# HTN: Patient was in cardiogenic shock at the time of
admission, therefore his home anti-hypertensives were held.
Since BPs were still lowish at discharge norvasc was
discontinued and valsartan was continued but at a much lower
dose (40mg [**Hospital1 **]).",0
13,"We now catheterized the above-mentioned vessels and AP,
 lateral filming was done.  This revealed a 2 mm aneurysm at the distal
 anterior cerebral artery at the branch point of a frontopolar branch.  The
 aneurysm measured about 2.5 mm in size.

 Therefore we exchanged out the [**Doctor Last Name 586**] 2 catheter in the left internal carotid
 artery for a Neuron 6 French catheter.  The aneurysm itself was catheterized
 with an SL-10 microcatheter and Synchro wire.  The aneurysm was coiled with a
 single coil of 2.2 mm into 3 mm 360 UltraSoft Target coil.  Following this,
 there was very minimal filling at the base of the aneurysm.",0
14,"The cause of this problem remains unclear despite many tests.
Please stop taking TRIAMTERENE-HYDROCHLOROTHIAZIDE because it
can raise calcium levels. It is imperative that you stay
well-hydrated by drinking plenty of fluids to help keep the
calcium level down.

You had a urinary tract infection which was partially treated
with the antibiotic ciprofloxacin. Please continue taking this
medication through Monday [**1-27**].

The following changes to your blood pressure medications were
recommended:
1) Start taking ISOSORBIDE MONONITRATE (IMDUR) 30 mg daily.
2) Increase HYDRALAZINE to 75 every 6 hours.
3) Discontinue TRIAMTERENE-HYDROCHLOROTHIAZIDE.

Please have repeat blood work done on Monday, [**1-27**].",0
15,"Pt received some juice prior to
transfer to the ED.
.
VS on arrival to ED: T 97.8 BP 194/90 HR 56 RR 18 Sat 100% on
RA. BS on arrival was noted to be 35, she received a total of
2.5 amps of dextrose, Glucagon, Octreotide 50mcg, 1L of NS and
started on D5 1/2 NS for BS that would transiently come up above
100 and then fall back to 40s. EKGs were essentially unchanged
and CXR was clear. Pt was given Hydralazine 50mg X 1 po for sbp
in 200s, followed by Hydralazine 10mg IV.",0
16,"_________________________________________________________
                             STAPH AUREUS COAG +
                             |
OXACILLIN-------------       S

   Aerobic Bottle Gram Stain (Final [**2158-8-5**]):
      Reported to and read back by [**First Name4 (NamePattern1) **] [**Last Name (NamePattern1) 90823**] @ 2232 ON [**8-5**]
-[**Numeric Identifier 28124**].
      GRAM POSITIVE COCCI.
      IN PAIRS AND CLUSTERS.

   Anaerobic Bottle Gram Stain (Final [**2158-8-5**]):
      GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS.

Imaging:
CXR AP [**2158-8-4**]: Central catheter projects over the lower superior
vena cava. Lung volumes are quite low, making evaluation of the
lungs difficult. There are multiple bilateral rib fractures. I
see no pneumothorax.

TTE [**2158-8-5**]: The left atrium is mildly dilated.",0
17,"Disp:*44 Tablet(s)* Refills:*2*
9. vancomycin in D5W 1 gram/200 mL Piggyback Sig: One (1)
Intravenous HD PROTOCOL (HD Protochol) for 4 days: ending
[**2158-8-15**].
Disp:*4 units* Refills:*0*
10. Norvasc 10 mg Tablet Sig: One (1) Tablet PO on non-HD days:
hold for SBP<90, HR<60.
11. Sensipar 60 mg Tablet Sig: Two (2) Tablet PO once a day.
12. Diovan 40 mg Tablet Sig: One (1) Tablet PO twice a day: hold
for SBP<90, HR<60.
13. glipizide 5 mg Tablet Sig: One (1) Tablet PO once a day.",0
18,"No evidence of new hemorrhage or
infarction.
2. Interval placement of a right frontal approach ventricular
catheter
terminating in the frontal [**Doctor Last Name 534**] of the right lateral ventricle,
with no change in ventricular size. Small amount of
intraventricular hemorrhage in the occipital horns and fourth
ventricle, unchanged from prior study.
3. Coil pack in the interhemispheric fissure with associated
artifact at that level.

[**2161-8-21**] Femoral (right) Ultrasound:
IMPRESSION: Normal appearance of right common femoral artery and
common
femoral vein with no evidence of pseudoaneurysm.

[**2161-8-23**] CTA Head:
HEAD CTA: The intracranial internal carotid and vertebral
arteries, and their major branches, appear patent.",0
19,"Compared with the report of the prior study (images unavailable
for review) of [**2193-1-18**], the left ventricle is more
hypertrophied with increased severity of mitral regurgitation.

[**1-15**] Head CT
No evidence of acute intracranial hemorrhage, edema or mass.

[**1-15**] Renal US with dopplers
IMPRESSION: Limited examination. Bilateral brisk systolic
upstrokes in the
main renal arteries at the hilum are present and therefore no
evidence of renal artery stenosis is present. Blunted systolic
upstrokes of intrarenal waveforms could reflect parenchymal
abnormality but cannot be reliably assessed due to limitations
of the examination. If further evaluation is required then non-
gadolinium- enhanced MRA may be attempted.",0