Abstract：
Rationale The American Academy of Neurology (AAN) recommends annual sexual and reproductive health (SRH) counseling for all people with epilepsy of gestational capacity (PWEGC). Child neurologists report discussing SRH concerns infrequently with adolescents. Limited research exists regarding documentation of such counseling.
We retrospectively studied clinical notes using natural language processing to investigate child neurologists\' documentation of SRH counseling for adolescent and young adult PWEGC. We segmented notes into sentences and evaluated for references to menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in a labeling application and used machine learning to identify additional counseling instances. We repeated this iteratively until we identified no new relevant sentences. We validated results using external reviewers; after removing sentences reviewers disagreed on (n = 13/400), we calculated Cohen\'s kappa values between the model and reviewers (>0.98 for all categories). We evaluated labeled texts for each patient per calendar year with descriptive statistics and logistic regression, adjusting for race/ethnicity, age, and teratogen use.
Data comprised 971 PWEGC age 13-21 years with 2277 patient-years and 3663 outpatient child neurology notes. Nearly half of patient-years lacked SRH counseling documentation (49.1%). Among all patients, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of antiseizure medications that have a higher risk of teratogenic effects (OR = 1.27, p = 0.020, 95% CI = [1.04,1.54]; OR = 1.27, p = 0.027, 95% CI = [1.03,1.58]). Documentation regarding contraception, folic acid, and sexual activity was increased among older patients (OR = 1.28, p < 0.001, 95% CI = [1.21,1.35]; OR = 1.26, p < 0.001, 95% CI = [1.19,1.32]; OR = 1.26, p = 0.004, 95% CI = [1.08,1.47]). Documentation regarding sexual activity was decreased among patients identifying as White/Non-Hispanic (OR = 0.39, p = 0.007, 95% CI = [0.20,0.78]).
Child neurologists counsel PWEGC on SRH less frequently than recommended by the AAN based on documentation.
We retrospectively studied clinical notes using natural language processing to investigate child neurologists\' documentation of SRH counseling for adolescent and young adult PWEGC. We segmented notes into sentences and evaluated for references to menstruation, sexual activity, contraception, folic acid, teratogens, and pregnancy. We developed training sets in a labeling application and used machine learning to identify additional counseling instances. We repeated this iteratively until we identified no new relevant sentences. We validated results using external reviewers; after removing sentences reviewers disagreed on (n = 13/400), we calculated Cohen\'s kappa values between the model and reviewers (>0.98 for all categories). We evaluated labeled texts for each patient per calendar year with descriptive statistics and logistic regression, adjusting for race/ethnicity, age, and teratogen use.
Data comprised 971 PWEGC age 13-21 years with 2277 patient-years and 3663 outpatient child neurology notes. Nearly half of patient-years lacked SRH counseling documentation (49.1%). Among all patients, 38.0% never had SRH counseling documented. Documentation was present regarding menstruation in 26.7% of patient-years, folic acid in 25.0%, contraception in 21.9%, pregnancy in 3.5%, teratogens in 3.0%, and sexual activity in 1.8%. Documentation regarding menstruation and contraception was associated with prescription of antiseizure medications that have a higher risk of teratogenic effects (OR = 1.27, p = 0.020, 95% CI = [1.04,1.54]; OR = 1.27, p = 0.027, 95% CI = [1.03,1.58]). Documentation regarding contraception, folic acid, and sexual activity was increased among older patients (OR = 1.28, p < 0.001, 95% CI = [1.21,1.35]; OR = 1.26, p < 0.001, 95% CI = [1.19,1.32]; OR = 1.26, p = 0.004, 95% CI = [1.08,1.47]). Documentation regarding sexual activity was decreased among patients identifying as White/Non-Hispanic (OR = 0.39, p = 0.007, 95% CI = [0.20,0.78]).
Child neurologists counsel PWEGC on SRH less frequently than recommended by the AAN based on documentation.
摘要：
美国神经病学会（AAN）建议为所有妊娠能力癫痫患者（PWEGC）提供年度性和生殖健康（SRH）咨询。儿童神经学家报告说，青少年很少讨论SRH问题。关于此类咨询文件的研究有限。
我们回顾性研究了使用自然语言处理的临床记录，以调查儿童神经科医生为青少年和年轻成人PWEGC提供SRH咨询的文档。我们将笔记分割成句子，并评估月经的参考，性活动,避孕,叶酸,致畸剂,和怀孕。我们在标签应用程序中开发了训练集，并使用机器学习来识别其他咨询实例。我们反复重复这个，直到我们确定没有新的相关句子。我们使用外部审稿人验证了结果；在删除审稿人不同意的句子后(n=13/400)，我们计算了模型和审阅者之间的Cohen\的kappa值(所有类别>0.98)。我们通过描述性统计和逻辑回归评估了每个日历年每位患者的标记文本，适应种族/民族，年龄,和致畸剂的使用。
数据包括971名13-21岁的PWEGC，2277名患者年和3663名门诊儿童神经病学笔记。近一半的患者年缺乏SRH咨询文件（49.1%）。在所有患者中，38.0%从未记录过SRH咨询。在26.7%的患者年中，有关于月经的文献，叶酸含量为25.0%，避孕占21.9%，怀孕3.5％，致畸剂在3.0%，性活动占1.8%。关于月经和避孕的文献与具有较高致畸作用风险的抗癫痫药物的处方相关(OR=1.27,p=0.020,95%CI=[1.04,1.54];OR=1.27,p=0.027,95%CI=[1.03,1.58])。关于避孕的文件，叶酸,老年患者的性活动增加(OR=1.28,p<0.001,95%CI=[1.21,1.35];OR=1.26,p<0.001,95%CI=[1.19,1.32];OR=1.26,p=0.004,95%CI=[1.08,1.47])。在确定为白人/非西班牙裔的患者中，有关性活动的文献减少（OR=0.39，p=0.007，95％CI=[0.20，0.78]）。
儿童神经学家为PWEGC提供关于SRH的咨询频率低于AAN根据文档推荐的频率。
我们回顾性研究了使用自然语言处理的临床记录，以调查儿童神经科医生为青少年和年轻成人PWEGC提供SRH咨询的文档。我们将笔记分割成句子，并评估月经的参考，性活动,避孕,叶酸,致畸剂,和怀孕。我们在标签应用程序中开发了训练集，并使用机器学习来识别其他咨询实例。我们反复重复这个，直到我们确定没有新的相关句子。我们使用外部审稿人验证了结果；在删除审稿人不同意的句子后(n=13/400)，我们计算了模型和审阅者之间的Cohen\的kappa值(所有类别>0.98)。我们通过描述性统计和逻辑回归评估了每个日历年每位患者的标记文本，适应种族/民族，年龄,和致畸剂的使用。
数据包括971名13-21岁的PWEGC，2277名患者年和3663名门诊儿童神经病学笔记。近一半的患者年缺乏SRH咨询文件（49.1%）。在所有患者中，38.0%从未记录过SRH咨询。在26.7%的患者年中，有关于月经的文献，叶酸含量为25.0%，避孕占21.9%，怀孕3.5％，致畸剂在3.0%，性活动占1.8%。关于月经和避孕的文献与具有较高致畸作用风险的抗癫痫药物的处方相关(OR=1.27,p=0.020,95%CI=[1.04,1.54];OR=1.27,p=0.027,95%CI=[1.03,1.58])。关于避孕的文件，叶酸,老年患者的性活动增加(OR=1.28,p<0.001,95%CI=[1.21,1.35];OR=1.26,p<0.001,95%CI=[1.19,1.32];OR=1.26,p=0.004,95%CI=[1.08,1.47])。在确定为白人/非西班牙裔的患者中，有关性活动的文献减少（OR=0.39，p=0.007，95％CI=[0.20，0.78]）。
儿童神经学家为PWEGC提供关于SRH的咨询频率低于AAN根据文档推荐的频率。
