{ "file": "DC 1 (2).pdf", "path": "\/home\/fintrixorcouk\/public_html\/staging\/storage\/app\/public\/test-evidence\/DC 1 (2).pdf", "mime": "application\/pdf", "size": 4613107, "page_count": 500, "is_large": true, "skipped": false, "skip_reason": null, "verify": null, "filter": { "method": "heuristic", "total_pages": 500, "relevant": 500, "excluded": 0 }, "items": [ { "page": 30, "quote": "Problem title: Benzodiazepine dependence", "category": "addiction", "severity": "medium", "comment": "Documented benzodiazepine dependence, may represent a long-term consequence of childhood abuse." }, { "page": 30, "quote": "History: accidentally took 20 DHC tabs last night - woke un a daze and took them thinking it was diazepam", "category": "drug_alcohol", "severity": "medium", "comment": "Incident of accidental overdose, potential long-term consequence of childhood abuse." }, { "page": 36, "quote": "Comment: prescription given to last over xmas, next rx due 2\/1\/07", "category": "addiction", "severity": "medium", "comment": "Ongoing issue with benzodiazepine dependence, potential long-term consequence of childhood abuse." }, { "page": 76, "quote": "Problem title: Benzodiazepine dependence", "category": "addiction", "severity": "medium", "comment": "Documented benzodiazepine dependence \u2014 potential long-term consequence of childhood abuse." }, { "page": 77, "quote": "Comment: Possible alcohol prob-gastritis and ?hepatitis.", "category": "drug_alcohol", "severity": "medium", "comment": "Alcohol misuse \u2014 potential long-term consequence of childhood abuse." }, { "page": 81, "quote": "Problem title: Benzodiazepine dependence", "category": "addiction", "severity": "medium", "comment": "Ongoing benzodiazepine dependence \u2014 potential long-term consequence of childhood abuse." }, { "page": 83, "quote": "History: LONG TERM DEPENDENCE.", "category": "addiction", "severity": "medium", "comment": "Long-term drug dependence noted \u2014 potential long-term consequence of childhood abuse." }, { "page": 96, "quote": "Comment: rx given", "category": "addiction", "severity": "medium", "comment": "Prescription issued for benzodiazepine dependence \u2014 potential long-term consequence of childhood abuse." }, { "page": 101, "quote": "Problem title: Benzodiazepine dependence History: 2 weeks given last week post dated Comment: he says unable to go to mental health team appt so rearrange", "category": "addiction", "severity": "medium", "comment": "Benzodiazepine dependence - potential long-term consequence of childhood abuse." }, { "page": 101, "quote": "Benzodiazepine dependence (X00Rv) (Ongoing Episode)", "category": "addiction", "severity": "medium", "comment": "Ongoing episode of benzodiazepine dependence - potential long-term consequence of childhood abuse." }, { "page": 105, "quote": "Benzodiazepine dependence (X00Rv) (Ongoing Episode)", "category": "addiction", "severity": "medium", "comment": "Continuation of benzodiazepine dependence issue noted on previous pages - potential long-term consequence of childhood abuse." }, { "page": 119, "quote": "Problem: Benzodiazepine dependence (X00Rv) History: still on diazepam no self harm thoughts - asking for ativan which he says helped in past - advised already on diazepam. Said antidepressants did not help.", "category": "addiction", "severity": "medium", "comment": "Persistent benzodiazepine dependence with ongoing treatment noted - potential long-term consequence of childhood abuse." }, { "page": 121, "quote": "Problem: O\/E - depressed (2257.) History: see letter from neurologist ok for antidepreessant Plan: 1 He says no time for flu vaccine today but will mkake an appt to see nurse.", "category": "mental_health", "severity": "medium", "comment": "Patient continues to experience depression, requiring antidepressant therapy - potential long-term consequence of childhood abuse." }, { "page": 156, "quote": "Problem: Benzodiazepine dependence (X00Rv) History: discussed withdrawal of diazepam, he has appt tomorrow with Mental health team so review 1 week", "category": "addiction", "severity": "medium", "comment": "Benzodiazepine dependence noted, potential long-term consequence of childhood abuse." }, { "page": 156, "quote": "Referral to community mental health team (XaIkd) Hospital Referral to community mental health team", "category": "mental_health", "severity": "medium", "comment": "Referral to mental health team suggests ongoing mental health issues possibly linked to childhood abuse." }, { "page": 163, "quote": "Opioid type drug dependence (XE1YR) (New Episode) Opioid type drug dependence (XE1YR)", "category": "addiction", "severity": "medium", "comment": "Opioid dependence documented, potential long-term consequence of childhood abuse." }, { "page": 170, "quote": "History: C\/O central chest pain since waking up at 10am today.... Known COPD.", "category": "drug_alcohol", "severity": "low", "comment": "Chest pain and COPD possibly exacerbated by medication use, but low severity mention." }, { "page": 211, "quote": "Discharged from hospital (8HE..) Alcohol detoxification (8BA8.)", "category": "addiction", "severity": "high", "comment": "Hospital discharge includes alcohol detoxification, indicating a history of substance misuse possibly linked to childhood abuse." }, { "page": 213, "quote": "Seen in substance misuse clinic (XaQE7) (New Episode)", "category": "addiction", "severity": "medium", "comment": "Ongoing substance misuse treatment \u2014 potential long-term impact of childhood abuse." }, { "page": 214, "quote": "S2S have advising increasing sertraline to 100mg, pt happy to increase, asking regarding analgesia, saw KS, amitriptyline made him too tired would like alternative, ortho wont operate, seen pain team, did not get on with gabapentin in the past either agreed pregabalin trial in meantime", "category": "mental_health", "severity": "medium", "comment": "Change of medication for mental health issues \u2014 potential long-term consequence of childhood abuse." }, { "page": 213, "quote": "admits depression, not wanting to inc ads currently.", "category": "mental_health", "severity": "medium", "comment": "Admission of depression \u2014 potential long-term impact of childhood abuse." }, { "page": 214, "quote": "lost his temper with me at one point, firend persauded to come back in and he apologised.", "category": "mental_health", "severity": "low", "comment": "Potential emotional regulation issues linked to mental health; possible impact of childhood experiences." }, { "page": 257, "quote": "Diagnosis: sudden deterioration of long standing back pain, SOB related to pain on walking, increased frequency of micturition- every 20 mins, H\/O self abuse and says long standing use of steroids for chest issues.", "category": "drug_alcohol", "severity": "medium", "comment": "History of self-abuse and long-standing steroid use potentially linked to childhood vulnerabilities." }, { "page": 259, "quote": "Alcoholic fatty liver (J610.)", "category": "addiction", "severity": "medium", "comment": "Documented alcohol misuse \u2014 potential long-term consequence of childhood abuse." }, { "page": 266, "quote": "Drug overdose (Xa4eX) - Aminophylline 10 x 200mg", "category": "drug_alcohol", "severity": "medium", "comment": "Drug overdose \u2014 potential long-term consequence of childhood abuse." }, { "page": 266, "quote": "Liver function tests (X77WP) - Serum alanine aminotransferase level (XaLJx) 33 iu\/L [< 41] Serum C reactive protein level;Urea and electrolytes;Liver function tests Report, Abnormal, but expected, No Further Action: done by KGH A&E and actioned.", "category": "drug_alcohol", "severity": "low", "comment": "Documented liver function issues likely related to alcohol history, with no further action needed." }, { "page": 269, "quote": "hx of substance abuse,", "category": "addiction", "severity": "medium", "comment": "History of substance abuse \u2014 potential long-term consequence of childhood abuse." }, { "page": 287, "quote": "in treatment for opiate abuse. On buprenoprhine.", "category": "addiction", "severity": "medium", "comment": "Potential long-term consequence of childhood abuse; ongoing treatment for substance misuse." }, { "page": 287, "quote": "Memory impairment (X75xU) (New Episode)", "category": "mental_health", "severity": "medium", "comment": "Potential long-term consequence of childhood abuse; new episode of memory impairment noted." }, { "page": 299, "quote": "Referral to NHS stop smoking service (XaQT5)", "category": "other", "severity": "medium", "comment": "Referral to smoking cessation service; indicates ongoing effort to address health issues possibly linked to long-term consequences of childhood trauma." }, { "page": 315, "quote": "Substance Misuse to Lakeside Healthcare", "category": "addiction", "severity": "medium", "comment": "Substance misuse reference \u2014 potential long-term consequence of childhood abuse." }, { "page": 327, "quote": "no alcohol for 7 years referred to first fit clinic", "category": "addiction", "severity": "medium", "comment": "Referral to first fit clinic; potential alcohol misuse history." }, { "page": 327, "quote": "hx buprenorphine usage for back pain", "category": "addiction", "severity": "medium", "comment": "Buprenorphine usage suggests history of opioid use; potential long-term consequence of childhood abuse." }, { "page": 369, "quote": "smoking cessation advice (Ua1Nz)\nadvised to get bloods on the system\nadvised chest xray\nAsthma annual review (XaIeq)\nAsthma control test (XaQHq) 8\nChronic obstructive pulmonary disease annual review (XaIet)\nSmoker (137R.)", "category": "mental_health", "severity": "medium", "comment": "Smoking cessation advice and COPD review indicate potential impact from prior childhood issues; relevant in the context of long-term health impacts." }, { "page": 374, "quote": "Duncan said he is mainly struggling with back and leg pain which is making it difficult for him to walk. Duncan said he would like to see a GP about his back and leg pain. Duncan said he would like to try pain patches but the surgery has things on his record that shouldn't be on his record. Duncan said the surgery has him down as an alcoholic and a drug user but he doesn't use drugs and he hasn't drank in 7 years.", "category": "addiction", "severity": "medium", "comment": "Reports of past alcohol issues and current denial may represent long-term consequences of childhood abuse." }, { "page": 375, "quote": "Denies drug dependence, but is on buprenorphine from S2S, which he says is for pain.", "category": "addiction", "severity": "medium", "comment": "Use of buprenorphine suggests managed substance use, potentially indicating long-term consequences of childhood abuse." }, { "page": 389, "quote": "Alcohol abuse (Xa1yZ)", "category": "addiction", "severity": "medium", "comment": "Documented alcohol abuse disorder \u2014 potential long-term consequence of childhood abuse." }, { "page": 389, "quote": "Clinical Information: Alcohol Withdrawal", "category": "addiction", "severity": "medium", "comment": "Alcohol withdrawal indication \u2014 reinforces potential long-term consequence of childhood abuse." } ], "item_count": 38, "severity_counts": { "high": 1, "medium": 34, "low": 3 }, "error": null, "elapsed_ms": 173898.26202392578125 }